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A Case Report of Floxuridine Hepatic Arterial Infusion Therapy for a Metastatic Liver Tumor from Advanced Gastric Cancer.

Cheol Jong LEE ; Seok Reyol CHOI ; Wan Su KIM ; Jong Hun LEE ; Sung Wook PARK ; Sang Young HAN

Journal of the Korean Gastric Cancer Association.2001;1(2):124-127. doi:10.5230/jkgca.2001.1.2.124

A 45-year-old man was found to have advanced cancer of the gastric antrum and lower body with multiple liver metastases. A palliative subtotal gastrectomy was performed, and multiple hepatic lesions were treated by hepatic arterial infusion therapy with floxuridine (FUdR) 3 weeks after the operation. This therapy was given for 14 days every 3 weeks. He received 4 cycles of the therapy. A systemic combination of chemotherapy with 5-FU and cisplatin was also perfomed. These two courses of intraarterial infusion therapy produced marked regression of liver metastases and necrosis. The effect was, thus, rated as a partial response. However, after the 4th course of the therapy, the patient dropped out for personal reasons. A brain metastasis was found 4 months later, and this intraarterial infusion therapy could no longer be performed. This case indicates that intraarterial infusion chemotherapy with FUdR may be useful in treating multiple liver metastases from gastric cancer.
Brain ; Cisplatin ; Drug Therapy ; Floxuridine* ; Fluorouracil ; Gastrectomy ; Humans ; Infusions, Intra-Arterial ; Liver* ; Middle Aged ; Necrosis ; Neoplasm Metastasis ; Pyloric Antrum ; Stomach Neoplasms*

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Risk Factors Affecting Lymph Node Metastasis and Recurrence in Early Gastric Cancer.

Jong Keun SHIN ; Young Do SHIN ; Choong YOON ; Hoong Zae JOO

Journal of the Korean Gastric Cancer Association.2001;1(2):119-123. doi:10.5230/jkgca.2001.1.2.119

PURPOSE: The prognosis of operated early gastric cancer is quite excellent and the 5-year survival rate shows to be over 90%. The less extensive treatment has been considered to be attractive. However, lymph node metastasis remains a main risk factor for recurrence of early gastric cancer. The author performed this study in order to determine which clinicopathologic factors of early gastric cancer influence lymph node metastasis and recurrence. MATENRIALS AND METHODS: A retrospective study was conducted on 222 patients with early gastric cancer who had been treated by gastrectomy combined with D2 or more extended lymph node dissection between January 1991 and December 1997 at the Department of Surgery, Kyunghee University Hospital. RESULTS: Lymph node metastasis was observed in 26 patients (11.7%), and the depth of tumor invasion and tumor size among clinicopathologic factors affected lymph node metastasis. The 5-year recurrence rate was 4.4%, and it was revealed that lymph node metastasis and depth of tumor invasion had a greater effect on recurrence than other clinicopathologic factors. CONCLUSION: The high risk factors of early gastric cancer in recurrence were submucosal tumor invasion, tumor size more than 2 cm, and lymph node metastasis. Patients of early gastric cancer with such high risk factors should undergo radical gastric resection than limited surgery.
Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Neoplasm Metastasis* ; Prognosis ; Recurrence* ; Retrospective Studies ; Risk Factors* ; Stomach Neoplasms* ; Survival Rate

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Brain Metastasis after a Gastrectomy for Gastric Cancer.

Yong Il KIM ; Jun Ho LEE ; Seong Hyeon YUN ; Sung Hoon NOH ; Jin Sik MIN

Journal of the Korean Gastric Cancer Association.2001;1(2):113-128. doi:10.5230/jkgca.2001.1.2.113

PURPOSE: The common features of brain metastases from gastric cancer are unknown because brain metastasis is an uncommon pattern of metastasis. The purpose of this study was to investigate the clinical features of and the prognosis for patients with brain metastases after a curative resection for gastric cancer. MATERIALS AND METHODS: Twenty-one (21) cases of patients with brain metastases of gastric cancer, who had been treated at the Department of Surgery, Yonsei University College of Medicine, were assessed retrospectively. RESULTS: The mean age was 55.8+/-9.6 years (range: 34~70 years), and the male-to-female ratio was 2.5:1. The most common neurologic symptom was headache (38.5%), and no patient was free from the neurologic symptoms. The incidence of parenchymal metastasis (PM: 76.2%) was higher than that of leptomeningeal metastasis (LM: 19.0%). Patients with gastric cancer and brain metastasis showed high rates of blood and lymphatic vessel invasion (lymphatic vessel invasion: 85.7%; blood vessel invasion: 80.9%). According to Lauren's classification, the incidence of intestinal types was 14/21 (66.7%), that of diffuse types was 3/21 (14.3%) and that of mixed types was 4/21 (19.0%). The mean interval between the gastrectomy and the diagnosis of brain metastasis was 24.7+/-4.0 months (PM: 26.8 months; LM: 20.3 months). The median period of survival after diagnosis of brain metastasis was 2 months for paren chymal metastasis and 0 months for leptomeningeal metastasis. CONCLUSION: During a follow-up period, patients with neurologic symptoms should be suspected of having brain metastasis. Early diagnosis and treatment is the only hope to prolong survival in such patients.
Blood Vessels ; Brain* ; Classification ; Diagnosis ; Early Diagnosis ; Follow-Up Studies ; Gastrectomy* ; Headache ; Hope ; Humans ; Incidence ; Lymphatic Vessels ; Neoplasm Metastasis* ; Neurologic Manifestations ; Prognosis ; Retrospective Studies ; Stomach Neoplasms*

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Risk Factors for Recurrence after Curative Surgery for Early Gastric Cancer.

Dong Woo SHIN ; Woo Jin HYUNG ; Sung Hoon NOH ; Jin Sik MIN

Journal of the Korean Gastric Cancer Association.2001;1(2):106-112. doi:10.5230/jkgca.2001.1.2.106

PURPOSE: Even with excellent surgical outcome, recurrence of early gastric cancer (EGC) after a curative resection is not declining because the incidence of EGC is increasing. The aim of this study was to propose an appropriate treatment strategy by assessing the risk factors for recurrence of curatively resected early gastric cancer. MATENRIALS AND METHODS: Of 3662 patients who had undergone gastric resections for gastric cancer from 1987 to 1996, the cases of 1050 curatively resected EGC patients were reviewed retrospectively. Among those 1050 patients, 50 patients (4.8%) were diagnosed as having recurrent cancer, which was confirmed by clinico-radiological examination or re-operation. The risk factors that determined the recurrence patterns were investigated by using univariate and multivariate analyses. RESULTS: The mean time to recurrence was 30.9 months, and hematogenous recurrence was the most frequent type (32.0%). Among the 50 recurred patients, peritoneal recurrence showed the shortest mean time to recurrence (18.5+/-17.7 months). Between the recurred and the non-recurred patients, there was no statistically significant difference with respect to age, sex, operation type, tumor size, tumor location, gross appearance, or histological differentiation. However, depth of invasion (submucosal invasion) and nodal involvement were significantly different (P<0.001) between the two groups. Using logistic regression analyses, nodal involvement was the only significant risk factor for recurrence in early gastric cancer (P<0.001). The median survival after the recurrence had been diagnosed was 4 months. CONCLUSION: Although the prognosis for EGC patients is excellent and recurrence of EGC after a curative resection is rare, the time to recurrence and the patterns of recurrence in EGC patients were diverse and unpredictable, and the result after recurrence is dismal. Considering the impact of lymph node metastasis on recurrence of EGC, a systematic lymphadenectomy, rather than limited surgery, should be performed if lymph node involvement is confirmed pre- or intraoperatively. Also if the postoperative pathologic findings reveal lymph node involvement, adjuvant chemotherapy is recommended.
Chemotherapy, Adjuvant ; Humans ; Incidence ; Logistic Models ; Lymph Node Excision ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Recurrence* ; Retrospective Studies ; Risk Factors* ; Stomach Neoplasms*

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The Prognosis of Patients with Stage IV Gastric Carcinoma without Distant Metastasis.

Jun Ho LEE ; Sung Hoon NOH ; Seung Ho CHOI ; Jin Sik MIN

Journal of the Korean Gastric Cancer Association.2001;1(2):100-105. doi:10.5230/jkgca.2001.1.2.100

PURPOSE: In the UICC staging system, stage IV contains not only those patients with distant metastasis but also patients with far advanced T and N status but without distant metastasis. We investigated the prognostic factors of stage IV gastric carcinoma patients without distant metastasis after curative resection. MATENRIALS AND METHODS: 190 stage IV gastric carcinoma patients without distant metastasis were reviewed after curative resection. RESULTS: Male sex, distal third location, Borrmann type III, IV and histologically undifferentiated type were common. 5 year survival rate of the 190 patients was 22.2%. Depth of invasion and lymph node metastasis did not influence survival. The lymph node ratio (positive lymph node / retrieved lymph node) and combined resection affected survival by univariate and multivariate analysis. CONCLUSION: Combined resection and positive lymph node ratio were the independent prognostic factors in the patients with stage IV gastric carcinoma who underwent curative resection.
Humans ; Lymph Nodes ; Male ; Multivariate Analysis ; Neoplasm Metastasis* ; Prognosis* ; Survival Rate

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Study of the Expression of E-cadherin, beta-catenin, and c-Met in Gastric Adenocarcinomas.

Seong Jin CHO ; Min Kyung KIM ; Bong Kyung SHIN ; Youn Ki MIN ; Min Young CHO ; Sung Ock SUH ; Nam Hee WON ; Yang Seok CHAE

Journal of the Korean Gastric Cancer Association.2001;1(2):92-99. doi:10.5230/jkgca.2001.1.2.92

PURPOSE: E-cadherin is an adhesion molecule essential for tight connection between cells, forming the cadherin/catenin complex. Truncated beta-catenin disrupts the interaction between E-cadherin and alpha-catenin, leading to the loss of intercellular adhesion. Met protein, the hepatocyte growth factor receptor, plays important roles in signal transduction. We investigated the relationships between the expressions of E-cadherin, beta-catenin, and c-met protein and the clinicopathological and prognostic parameters in gastric adenocarcinomas. MATENRIALS AND METHODS: The patterns of E-cadherin, beta- catenin, and c-met protein expression were studied using immunohistochemistry in formalin-fixed, paraffin-embedded archival tissues from 76 surgically resected gastric adenocarcinomas. RESULTS: Increased expressions of E-cadherin, beta-catenin, and c-met were more significantly correlated in early gastric cancers (EGC) than in advanced gastric cancers (AGC) (P=0.002, P=0.003 and P=0.026). The positive immunoreactivities of all three markers were markedly lower in signet ring-cell type and poorly differentiated type lesions than in intestinal-type lesions. Decreased expression of the beta-catenin protein correlated well with increased tumor invasion depth (P=0.039), and increased lymph node metastasis correlated well with reduced expression of c-met (P=0.046). CONCLUSION: In gastric cancers, reduced expressions of the E-cadherin, beta-catenin, and c-met proteins may play some role in poorer tumor differentiation, deeper tumor invasion, and increased lymph node metastasis. Also, the c-met gene is thought to play a specific role in the mechanism of the yet unknown catenin action.
Adenocarcinoma* ; alpha Catenin ; beta Catenin* ; Cadherins* ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Proto-Oncogene Proteins c-met ; Signal Transduction ; Stomach Neoplasms

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Study of the Expression of FasL and of Apoptosis in Gastric Epithelial Dysplasia and Gastric Adenocarcinomas.

Gun Uk PARK ; Sang Young HAN ; Jong Hun LEE ; Dong Joo KEUM ; Myung Hwan ROH ; Seok Ryeol CHOI ; Jong Seong KIM ; Mee Sook ROH

Journal of the Korean Gastric Cancer Association.2001;1(2):83-91. doi:10.5230/jkgca.2001.1.2.83

PURPOSE: This study was to observe whether the apoptotic function of tumor-infiltrating lymphocytes (TIL) is induced in human gastric epithelial dysplasia and gastric adenocarcinoma according to the role of FasL expression. MATENRIALS AND METHODS: A total of 56 gastric epithelial dysplasia and gastric adenocarcinoma patients were enrolled in this study: 9 cases of gastric epithelial dysplasia, 18 cases of early gastric carcinomas (EGC) and 29 cases of advanced gastric carcinomas (AGC). Immunohistochemical staining was performed for FasL and CD45, and the terminal deoxynucleotidyl transferase mediated dUTP nick end labelling (TUNEL) method was used to detect cell death in tumor-infiltrating lymphocytes. RESULTS: 1) Positive reactions of FasL to neoplastic cells were 88.9% (8/9) in gastric epithelial dysplasia, 83.3% (15/18) in EGC, and 75.9% (22/29) in AGC. 2) Expression of TIL was decreased in the FasL positive region and was increased in the FasL negative region, and significant expression of TIL was observed in the AGC group (P=0.001). 3) Expression of apoptotic TIL was very similar to the FasL expression, and 100% expression was observed in gastric epithelial dysplasia group. 4) Expression of apoptotic TIL was increased in the FasL positive region and decreased in the FasL negative region, and significant apoptotic expression was observed in the gastric epithelial dysplasia and EGC groups (P=0.0420, P=0.0263, respectively). CONCLUSION: These results suggest that FasL is a prevalent mediator of immune privilege in epithelial dysplasia and cancer of the stomach.
Adenocarcinoma* ; Apoptosis* ; Cell Death ; DNA Nucleotidylexotransferase ; Humans ; Lymphocytes, Tumor-Infiltrating ; Stomach Neoplasms

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Prognostic Significance of Lymphatic and Perineural Invasions in Patients with Gastric Cancer Who Have No Lymph Node and Serosal Involvement.

Wook KIM ; Cho Hyun PARK ; Seung Man PARK ; Woo Bai PARK ; Keun Woo LIM ; Seung Nam KIM

Journal of the Korean Gastric Cancer Association.2001;1(2):77-82. doi:10.5230/jkgca.2001.1.2.77

PURPOSE: The most important prognostic factors in gastric cancer are depth of invasion and lymph node metastasis. Therefore, the prognosis for serosa and lymph node negative gastric cancer is favorable. However, there is no general agreement on the prognostic factors in this subset of patients. This study was undertaken to evaluate the prognostic significances of venous invasion (VI), lymphatic invasion (LI), and perineural invasion (NI) in T1 and T2 gastric cancer without lymph node involvement. MATENRIALS AND METHODS: We retrospectively evaluated 206 patients with T1 and T2, lymph node negative gastric cancer who underwent a curative resection from 1989 to 1993 at Kangnam St. Mary's Hospital, Seoul, Korea. The Chi-square test was used to determine the statistical significance of differences, and the Kaplan-Meier method was used to calculate survival rates. Significant differences in the survival rates were assessed using the log-rank test, and the Cox regression method was used to evaluate independent prognostic significance. RESULTS: The rate of VI, LI and NI correlated well with the depth of tumor invasion. The rates of VI (+) for T1 vs T2 was 0% vs 5.1%, of LI (+) was 5.6% vs 26.8%, and of NI (+) was 1.6% vs 26.8% in NI (+). There were 13 recurrent cases, 10 cases out of the 13 were T2 gastric cancers, and the recurrence rate was higher in LI (+) andNI (+) cases than in LI (-) and NI (-) cases. The 5-year survival rates were 93.4% in LI (-) cases, 77.4% in LI (+) cases, 92.5% in NI (-) cases, 74% in NI(+) cases, 95.9% in LI (-) NI (-) cases, and 73.9% in LI (+) NI (+) cases. Multivariate analysis demonstrated that simultaneous LI and NI was the only significant factor influencing the prognosis. CONCLUSION: These results suggest that simultaneous lymphatic and perineural invasion may be an independent prognostic factor in patients with T1 and T2 gastric cancer without lymph node metastasis.
Humans ; Korea ; Lymph Nodes* ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Seoul ; Serous Membrane ; Stomach Neoplasms* ; Survival Rate

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Outcome of Surgical Treatment for Borrmann Type 4 Gastric Cancer.

Sung Soo PARK ; Sung Hoon KIM ; Seung Joo KIM ; Chong Suk KIM ; Young Jae MOK

Journal of the Korean Gastric Cancer Association.2003;3(4):221-225. doi:10.5230/jkgca.2003.3.4.221

PURPOSE: The prognosis for Borrmann type 4 gastric cancer is dismal although therapies for gastric cancer have been developed. We investigated the outcomes for Borrmann type 4 gastric cancers compared to those for other types of cancer. MATENRIALS AND METHODS: Between 1993 and 2000, 777 patients with advanced gastric cancer underwent surgical resection at the Department of Surgery, Korea University Hospital. The clinicopathologic features of 138 patients with Borrmann type 4 carcinomas of the stomach were retrospectively reviewed from the database of gastric cancer. The results were compared with those of 639 patients with other types of gastric carcinomas. RESULTS: Patients with Borrmann type 4 carcinomas tended to be younger and to have larger tumors. The location, the depth of invasion, lymph node metastasis, and distant metastasis were significantly different between the two groups. Patients with Borrmann type 4 carcinomas had a more advanced stage than patients with other types of carcinomas. The analysis of the treatment factors revealed that total gastrectomies were more frequent in the group with Borrmann type 4 carcinomas and that the curative resection rate of patients with Borrmann type 4 gastric carcinomas was lower than that of patients with other types of gastric carcinomas (P<0.001). The 5-year survival rate for Borrmann type 4 gastric cancer was 19.4% and that for other types was 52.9% (P=0.001). In curative cases, the 5-year survival rates were 32.8% for patients with Borrmann type 4 gastric carcinomas and 63.4% for other types of carcinomas (P=0.001). CONCLUSION: Borrmann type IV gastric cancer has more advanced features and a poorer prognosis than other types of gastric cancer. Improving the prognosis for patients with Borrmann type 4 gastric cancer requires early detection and a curative resection.
Gastrectomy ; Humans ; Korea ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Stomach ; Stomach Neoplasms* ; Survival Rate

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Loss of Heterozygosity and Microsatellite Instability at Multiple Tumor Suppressor Genes in Gastric Carcinomas.

Young Gu CHO ; Chang Jae KIM ; Cho Hyun PARK ; Young Sil KIM ; Su Young KIM ; Suk Woo NAM ; Sug Hyung LEE ; Nam Jin YOO ; Jung Young LEE ; Won Sang PARK

Journal of the Korean Gastric Cancer Association.2003;3(4):214-220. doi:10.5230/jkgca.2003.3.4.214

PURPOSE: The aim of this study was to investigate the frequency of loss of heterozygosity and the microsatellite instability at multiple tumor suppressor gene loci in gastric adenocarcinomas. MATENRIALS AND METHODS: Loss of heterozygosity and the microsatellite instability at several tumor suppressor gene loci were analyzed in 29 primary gastric carcinomas by using microdissection and the polymerase chain reaction. RESULTS: Twenty-three (79%) of the 29 cases demonstrated loss of heterozygosity at one or more loci. The frequency of loss of heterozygosity at the p53 locus was the highest (63%) and those at the VHL, APC, p16, Rb, MEN1, BRCA1, DPC4, 3p21, and 16p13 region were 41%, 36%, 19%, 29%, 33%, 26%, 21%, 32%, and 11%, respectively. Compared with histological type, loss of heterozygosity was more common in diffuse-type gastric cancer (P<0.01). Interestingly, 9 of 10 tumors with allelic deletion at the p53 locus showed loss of heterozygosity at other tumor suppressor gene loci. The microsatellite instability was also detected in 6 (20%) of the 29 cases at one or more loci. CONCLUSION: These data suggest that frequent loss of heterozygosity and the microsatellite instability at multiple tumor suppressor genes might be required for the development and the progression of gastric carcinomas and that p53 allelic loss may be the most frequent event in the development of gastric carcinomas.
Adenocarcinoma ; Genes, Tumor Suppressor* ; Loss of Heterozygosity* ; Microdissection ; Microsatellite Instability* ; Microsatellite Repeats* ; Multiple Endocrine Neoplasia Type 1 ; Polymerase Chain Reaction ; Stomach Neoplasms

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