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Prognostic Value of Esophageal Resection- line Involvement in a Total Gastrectomy for Gastric Cancer.

Journal of the Korean Gastric Cancer Association.2001;1(3):168-173. doi:10.5230/jkgca.2001.1.3.168

PURPOSE: A positive esophageal margin is encountered in a total gastrectomy not infrequently. The aim of this retrospective review was to evaluate whether a positive esophageal margin predisposes a patient to loco-regional recurrence and whether it has an independent impact on long-term survival. MATENRIALS AND METHODS: A retrospective review of 224 total gastrectomies for adenocarcinomas was undertaken. 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 independent prognostic significance was evaluated using the Cox regression method. RESULTS: The prevalence of esophageal margin involvement was 3.6% (8/224). Univariate analysis showed that advanced stage (stage III/IV), tumor size (> or =5 cm), tumor site (whole or upper one-third of the stomach), macroscopic type (Borrmann type 4), esophageal invasion, esophageal margin involvement, lymphatic invasion, and venous invasion affected survival. Multivariate analysis demonstrated that TNM stage, venous invasion, and esophageal margin involvement were the only significant factors influencing the prognosis. All patients with a positive esophageal margin died with metastasis before local recurrence became a problem. A macroscopic proximal distance of more than 6 cm of esophagus was needed to be free of tumors, excluding one exceptional case which involved 15 cm of esophagus. CONCLUSION: All of the patients with a positive proximal resection margin after a total gastrectomy had advanced disease with a poor prognosis, but they were not predisposed to anastomotic recurrence. Early detection and extended, but reasonable, surgical resection of curable lesions are mandatory to improve the prognosis.
Adenocarcinoma ; Esophagus ; Gastrectomy* ; Humans ; Multivariate Analysis ; Neoplasm Metastasis ; Prevalence ; Prognosis ; Recurrence ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate

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Chronological Changes in the Clinical Features of Gastric Cancer.

Chun Hwan LEE ; Sun Il LEE ; Keun Won RYU ; Young Jae MOK

Journal of the Korean Gastric Cancer Association.2001;1(3):161-167. doi:10.5230/jkgca.2001.1.3.161

PURPOSE: Although gastric carcinomas occur throughout the world and the incidence is on the decrease, they remain the most common type of carcinoma in Korea. Significant advancements in the diagnostics and the surgical treatment of gastric carcinomas have been achieved during the last three decades. The present retrospective study was undertaken to investigate the chronological changes in the clinical features, including clinicopathological findings, operative treatment, and prognosis of gastric carcinomas. MATENRIALS AND METHODS: A total of 1973 patients with a primary gastric adenocarcinoma who had been treated surgically during the period from 1983 to 1998 at the Department of Surgery, Korea University College of Medicine, were divided into two groups to evaluate chronological changes: 1007 patients had been treated during the period from 1983 to 1992 (early period) and 966 patients during the period from 1993 to 1998 (late period). Chronological changes in age, sex, ratio of early gastric cancer (EGC), and resectability were analyzed in all 1973 cases. For the 1755 resected cases, we also studied the chronological changes in the clinicopathological and treatment factors between the early-period (n=894) and the late-period (n=867) groups. RESULTS: There were significant differences between the two periods with regard to age and ratio of EGC: EGC was more frequent in the late period. Univariate analysis of resected cases showed that gross type, tumor size, depth of invasion, UICC stage, and histological type were statistically significant. The analysis of the treatment factors revealed that total gastrectomies and extended lymphadenectomies were more frequent during the late period. The number of lymph nodes dissected was 26.0+/-12.7 in the early period and 33.4+/-14.1 in the late period (p<0.01). The 5-year survival rate in all cases was 51.4% in the early period and 55.9% in the late period. The stage-related survival rates (UICC 4th Ed., 1987) in the early vs. the late periods were 92.9% vs. 95.5% in stage IA, 82.1% vs. 91.1% in stage IB, 76.5% vs. 73.1% in stage II, 46.5% vs. 52.1% in stage IIIA, 14.5% vs. 33.6% in stage IIIB, and 2.8% vs. 8.8% in stage IV. There was a statistically significant difference in survival between stage IIIB and IV. CONCLUSION: These results suggest that the differences in the clinicopathological findings are related primarily to the increased number of early gastric cancer cases in the late period and that the improved survival noted during the late period for in stage IIIB and IV cancers might be related to extended surgery.
Adenocarcinoma ; Gastrectomy ; Humans ; Incidence ; Korea ; Lymph Node Excision ; Lymph Nodes ; Prognosis ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate

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Predictors of Lymph Node Metastasis in Submucosal Gastric Carcinomas.

Seong Ju KO ; Jae Hwan SUH ; Heung Kyu PARK ; Hoon Gyu LEE ; Seung Yeon CHO ; Woon Gi LEE ; Jeong Nam LEE ; Young Don LEE ; Hyun Yee CHO

Journal of the Korean Gastric Cancer Association.2001;1(3):155-160. doi:10.5230/jkgca.2001.1.3.155

PURPOSE: Submucosal gastric carcinomas metastasize to lymph nodes more often than the intramucosal gastric carcinomas. The objectives of this study are to clarify the characteristics of submucosal gastric carcinomas, especially in reference to the status of lymph node metastasis, and to explore the possibility of a minimally invasive operation. MATENRIALS AND METHODS: The clinicopathologic features of 88 patients with submucosal gastric carcinoma, all of whom were treated with a D2+alpha gastrectomy between January 1994 and December 1999, were examined retrospectively with respect to the status of lymph nodes. The size, depth of submucosal invasion, histologic differentiation, location, and macroscopic finding of the tumor were investigated in association with the presence or the absence of lymph node metastasis. RESULTS: Among the 88 patients, 15 (17.05%) had lymph node metastasis, and the status of metastasis was significantly correlated with tumor size and depth of submucosal invasion. The frequency of metastasis was 0% (0/7) of up to 1.0 cm and 18.5% (15/81) over 1.0 cm in size (p=0.034) and 6.1% (2/33) of up to 1.0mm and 23.6% (13/55) over 1.0 mm in depth of submucosal invasion (p=0.042). CONCLUSION: The tumor size and depth of submucosal invasion are useful indicators of lymph node metastasis in submucosal gastric carcinoma. A minimally invasive op-eration can be applied for submucosal gastric carcinoma up to 1.0 cm in size Further studies are needed to limited surgery for depth of submucosal invasion.
Gastrectomy ; Humans ; Lymph Nodes* ; Neoplasm Metastasis* ; Retrospective Studies

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Multiple Early Gastric Cancer.

Sung Soo PARK ; Keun Won RYU ; Tae Jin SONG ; Young Jae MOK ; Chong Suk KIM ; Seung Joo KIM

Journal of the Korean Gastric Cancer Association.2001;1(3):150-154. doi:10.5230/jkgca.2001.1.3.150

PURPOSE: Multiple early gastric cancers were found in 6.9~11.7% of patients with early gastric cancer. The goal of this study was to clarify the clinicopathologic features of and to investigate treatment strategy for multiple early gastric cancer. MATENRIALS AND METHODS: Of 967 patients with an gastric adenocarcinoma who were treated by surgical resection during the period of 1993~1998 at the Department of Surgery, Korea University College of Medicine, 267 patients had early gastric cancer. A retrospective analysis of the clinicopathologic differences between the main and the accessory lesions in multiple early gastric cancer was carried out. A comparative analysis was also conducted between solitary early gastric cancer and multiple early gastric cancer. RESULTS: Of 267 patients with early gastric cancer, multiple early gastric cancers were found in 12 patients (4.5%), including 10 men and 2 women. Eleven patients with multiple early gastric cancer had one accessory lesion and 1 patient had 2 accessory lesions. Of the 13 accessory lesions, 7 (53.8%) were located in the same region as the main lesion. The most frequent combination of macroscopic types for the main lesion and the accessory lesion were depressed and depressed types (6 cases, 46.1%). The most frequent histologic type of main lesion was a well differentiated adenocarcinoma in 7 (58.3%) of the 12 cases; the accessory lesion was also well differentiated in 4 of those 7 cases. Of the 13 accessory lesions, 4 (30.8%) had been overlooked preoperatively; most of them were located in the lower third of the stomach and were IIb or IIc type and measured less than 1 cm in diameter. Lymph node metastasis was detected in 1 patient (8.3%). The clinicopathologic features of multiple early gastric cancer were not different from those of solitary early gastric cancer. CONCLUSION: In multiple early gastric cancer, the main and the accessory lesions showed similar differentiation, and lymph node metastasis was less frequent than in solitary early gastric cancer. Therefore, limited procedures, including endoscopic mucosal resection, may be indicated if each lesion of the multiple early gastric cancer fits the criteria for treatment strategy.
Adenocarcinoma ; Female ; Humans ; Korea ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Retrospective Studies ; Stomach ; Stomach Neoplasms*

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Gastric Stump Cancer.

Young Seok OH ; Young Sik KIM ; Yeon Myung SIN ; Sang Ho LEE ; Yeon Chang MOON ; Kyung Hyun CHOI ; Bong Churl CHUNG

Journal of the Korean Gastric Cancer Association.2001;1(3):144-149. doi:10.5230/jkgca.2001.1.3.144

PURPOSE: Gastric stump cancer is defined as a cancer that develops in the stomach after a resection in cases of non-malignant or malignant gastric disease. The interval between the gastrectomy and the detection of gastric stump cancer must be over 5 years. Since duodenogastric reflux gastritis is a precancerous condition and one of the most important factors inducing gastric stump cancer, we compared the bile-acid content of gastric juice between gastric stump cancer patients and controls. MATENRIALS AND METHODS: To evaluate retrospectively the surgical treatment of patients with gastric stump cancer, we reviewed the cases histories of 1016 stomach cancer patients who had been operated on at the Department of General Surgery, Kosin University Gospel Hospital, between 1995 and 1998. The gastric juice was collected during the operations on the gastric stump cancer patients by using a needle puncture of the fundus of the stomach and during the endoscopic examinations of the control subjects. The samples were analyzed for various bile acids (gas chromatography/mass spectrometry). RESULTS: The 6 gastric stump cancer cases accounted for 0.6% of all gastric cancer patients; 5 patients were first operated on for a peptic ulcer and the remaining one for an adenocarcinoma of the stomach. All of the cases were men. The reconstruction method after the initial gastrectomy was a Billroth II in all cases. The sites of the gastric stump cancer were the anastomotic sitein 2 patients, the upper body in 2, the fundus in 1 and the cardia in 1. The operative methods were 3 total gastrectomies, 2 subtotal gastrectomies with Roux en Y anastomosis, and 1 partial gastrectomy with lymph node dissection and had a curative intention in all patients. All of the patients were still surviving at the time of this report. The gastric juices of 4 gastric stump patients showed significantly higher contents of cholic acid (36.42microgram/ ml) compared to the gastric juices of 35 control subjects (12.82microgram/ml)(p< or =0.0001). Chenodeoxycholic acid and lithocholic acid were not significantly different. CONCLUSION: The gastric juice of gastric stump cancer patients contained a significantly higher cholic acid content. At the time of the initial gastrectomy, an operative method that prevents duodenogastric reflux may prevent or minimize the development of gastric stump cancer, and more aggressive surgical treatment may improve survival.
Adenocarcinoma ; Anastomosis, Roux-en-Y ; Bile Acids and Salts ; Cardia ; Chenodeoxycholic Acid ; Cholic Acid ; Duodenogastric Reflux ; Gastrectomy ; Gastric Juice ; Gastric Stump* ; Gastritis ; Gastroenterostomy ; Humans ; Intention ; Lithocholic Acid ; Lymph Node Excision ; Male ; Needles ; Peptic Ulcer ; Precancerous Conditions ; Punctures ; Retrospective Studies ; Stomach ; Stomach Diseases ; Stomach Neoplasms

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Effect of Radical Removal of Primary and Metastatic Lesions in Gastric Cancer with Peritoneal Seeding.

Young Sik KIM ; Sang Ho LEE ; Kyung Hyun CHOI

Journal of the Korean Gastric Cancer Association.2001;1(3):136-143. doi:10.5230/jkgca.2001.1.3.136

PURPOSE: The prognosis for gastric cancer with peritoneal seeding is very poor, and the role of surgical intervention is limited. We evaluated the effect of radical removal of primary and metastatic lesions on survival in gastric cancer with peritoneal seeding. MATENRIALS AND METHODS: From May 1989 to March 1999 at Kosin University Gospel Hospital, 115 patients revealed gastric cancer with peritoneal seeding but without liver or lung metastasis and without follow-up loss. The study group included 86 patients who underwent surgery for radical removal of primary gastric and metastatic peritoneal lesions. The control group included 29 patients who experienced incomplete removal of primary or metastatic lesions. Both groups received intraoperative intraperitoneal chemotherapy using mytomycin or cisplatin, and 25 patients underwent postoperative intravenous chemotherapy. RESULTS: The median survival times in the study and the control groups were 13 months and 4 months, respectively (p<0.0001). The 1-year, 2-year, and 5-year survival rates were, respectively, 50.6%, 18.1%, and 11.3% in the study group and 14.8%, 3.7%, and 0% in the control group (p<0.0001). In the study group, neither postoperative intravenous chemotherapy nor microscopic invasion of the resection margin had any effect on survival, but intraoperative intraperitoneal chemotherapy and degree of peri-toneal seeding, especially the amount of peritoneal seeding, had an effect on survival. In the control group, neither intraperitoneal nor intravenous chemotherapy had any effect on survival, but resection of the primary gastric lesion improved survival. CONCLUSION: Radical removal of primary gastric and metastatic peritoneal lesions improved the survival rate for gastric cancer with peritoneal seeding. However, a randomized prospective study is needed to correctly evaluate the effect of intraperitoneal or intravenous chemotherapy.
Cisplatin ; Drug Therapy ; Follow-Up Studies ; Humans ; Liver ; Lung ; Neoplasm Metastasis ; Prognosis ; Stomach Neoplasms* ; Survival Rate

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Clonality Assay of Dysplastic Epithelial Lesions of the Stomach.

Ho Soo CHOI ; Mi Sook KIM ; Jae Woo PARK ; Chang Soo PARK ; Young Jin KIM ; Sang Woo JUHNG

Journal of the Korean Gastric Cancer Association.2001;1(3):129-135. doi:10.5230/jkgca.2001.1.3.129

PURPOSE: Dysplasia or flat adenoma of the stomach is regarded as a precancerous lesion. However, the frequency and the evolutionary process of malignant transformation of gastric dysplasia are still debated. In order to see whether the lesion was a monoclonal or a polyclonal proliferation, clonality was assayed by X-linked HUMARA polymorphism. MATENRIALS AND METHODS: DNA was extracted from the paraffin-embedded tissue of 16 consecutive cases of endoscopic biopsy, eight of which supplied both dysplastic and nondysplastic tissue for comparison. HUMARA was amplified by PCR with or without pretreatment with methylation- sensitive restriction enzyme, HpaII. The amplification products were electrophoresed on polyacrylamide gel and silver-stained. RESULTS: Among the 16 cases, 13 cases were informative and 3 cases noninformative. Of the 13 cases, one case showed skewed lyonization, rendering 12 cases to be analyzed further. A monoclonal band pattern was noted in 2 cases, and a polyclonal band pattern in 10 cases. A review of the histopathologies of the monoclonal and the polyclonal cases did not reveal features discriminating the two groups. CONCLUSION: These results suggest that gastric dysplasia is a disease entity heterogeneous in the genetic level, and many cases may be non-neoplastic.
Adenoma ; Biopsy ; DNA ; Polymerase Chain Reaction ; Stomach* ; X Chromosome Inactivation

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Correlation between Infiltrations of Tumor-associated Macrophages, Mast Cells, and Dendritic Cells with Clinicopathologic Factors in Advanced Gastric Cancer.

Seung Bum LEE ; Kyong Chon CHI

Journal of the Korean Gastric Cancer Association.2005;5(3):206-212. doi:10.5230/jkgca.2005.5.3.206

PURPOSE: Angiogenesis has a critical role in tumor proliferation, invasion, and metastasis. In gastric cancer, tumor- associated macrophages and mast cells produce angiogenic factors such as VEGF, that inhibit the functional maturation of dendritic cells. The aim of this study is to identify tumor-associated macrophages, mast cells, dendritic cell infiltrations, and microvessel densities (MVD) to investigate the relationship between them and the prognosis for gastric-cancer patients. MATERIALS AND METHODS: The subjects were 79 patients selected from those who had undergone a curative gastric resection for stomach cancer. With them, Immuno-histochemical staining was done using CD34 for the MVD, CD68 antigen for macrophages, and S-100 protein for dendritic cells, and toluidine blue staining was done for mast cells. RESULTS: Macrophage infiltration showed a statistically significant positive correlation with histologic differentiation and a negative correlation with invasion depth, nodal metastasis, and stage. S-100 (+) dendritic cells and mast cells had no significant correlations with histologic differentiation, invasion depth, nodal metastasis, distant metastasis, stage, and MVD. As survival, no statistically significant differences were seen between the variables. CONCLUSION: Tumor-associated macrophages should be evaluated as possible prognostic markers in gastric-cancer patients.
Angiogenesis Inducing Agents ; Dendritic Cells* ; Humans ; Macrophages* ; Mast Cells* ; Microvessels ; Neoplasm Metastasis ; Prognosis ; S100 Proteins ; Stomach Neoplasms* ; Tolonium Chloride ; Vascular Endothelial Growth Factor A

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Expression Pattern of KLF4 in Korean Gastric Cancers.

Jae Hwi SONG ; Yong Gu CHO ; Chang Jae KIM ; Cho Hyun PARK ; 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.2005;5(3):200-205. doi:10.5230/jkgca.2005.5.3.200

PURPOSE: KLF4, a member of the KLF family, is a zinc finger tumor suppressor protein that is critical for gastric epithelial homeostasis. Our aim was to determine whether the altered expression of KLF4 might be associated with gastric cancer development and, if so, to determine to which pathologic parameter it is linked. MATERIALS AND METHODS: For the construction of the gastric cancer tissue microarray, 84 paraffin-embedded tissues containing gastric cancer areas were cored 3 times and transferred to the recipient master block. The expression pattern of KLF4 was examined on tissue microarray slides by using immunohistochemistry and was compared with pathologic parameters, including histologic type, depth of invasion, lymph node metastasis, and peritoneal dissemination. RESULTS: The KLF4 protein was expressed in cytoplasm and nucleus of superficial and foveolar epithelial cells in the normal gastric mucosa. We found markedly reduced or loss of KLF4 expression in 43 (51.2%) of the 84 gastric cancer tissues. There was no significant correlation between KLF4 expression and pathologic parameters, including histologic type, depth of invasion, lymph node metastasis and peritoneal dissemination. CONCLUSION: Our findings suggest that altered expression of KLF4 may contribute to abnormal regulation of gastrointestinal epithelial cell growth and differentiation and to the development of Korean gastric cancer, as an early event.
Apoptosis ; Cytoplasm ; Epithelial Cells ; Gastric Mucosa ; Homeostasis ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Stomach Neoplasms* ; Zinc Fingers

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Suppression of Helicobacter pylori-induced Angiogenesis by a Gastric Proton Pump Inhibitor.

Sung Ho JIN ; Hwa Young LEE ; Dong Kyu KIM ; Yong Kwan CHO ; Ki Baik HAHM ; Sang Uk HAN

Journal of the Korean Gastric Cancer Association.2005;5(3):191-199. doi:10.5230/jkgca.2005.5.3.191

BACKGROUND: Though infections of Helicobacter pylori (H. pylori) are closely associated with activation of host angiogenesis, the underlying mechanisms, as well as the strategy for its prevention, have not been identified. Here, we investigated a causal role of H. pylori infection in angiogenesis of gastric mucosa and a potent inhibitory effect of a gastric proton pump inhibitor (PPI) on the gastropathy. MATERIALS AND METHODS: A comparative analysis of CD 34 expression in tissues obtained from 20 H. pylori-associated gastritis and 18 H. pylori-negative gastritis patients was performed. Expression of HIF-1alpha and VEGF were tested by using RT-PCR. To evaluate the direct effect of H. pylori infection on differentiation of endothelial HUVEC cells, we carried out an in vitro angiogenesis assay. RESULTS: H. pylori-associated gastritis tissues showed significantly higher density of CD34+ blood vessels than did H. pylori-negative gastritis tissues, and the levels were well correlated with expressions of HIF-1alpha. Conditioned media from H. pylori-infected gastric mucosal cells stimulated a tubular formation of HUVEC cells. We also found a significant inhibitory effect of PPI, an agent frequently used for H. pylori eradication, on H. pylori-induced angiogenesis. This drug effectively inhibited the phosphorylation of MAP kinase ERK1/2, which is a principal signal for H. pylori-induced angiogenesis. CONCLUSION: The fact that PPIs can down-regulate H. pylori-induced angiogenesis suggest that anti-angiogenic treatment using PPI may be a preventive approach for H. pylori-associated carcinogenesis.
Blood Vessels ; Carcinogenesis ; Culture Media, Conditioned ; Gastric Mucosa ; Gastritis ; Helicobacter pylori ; Helicobacter* ; Human Umbilical Vein Endothelial Cells ; Humans ; Phosphorylation ; Phosphotransferases ; Proton Pumps* ; Protons* ; Stomach Neoplasms ; Vascular Endothelial Growth Factor A

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