Objective: Advanced ovarian clear cell carcinoma (OCCC) is associated with poor outcomes owing to chemoresistance. Bevacizumab (Bev) is increasingly being used to treat advanced ovarian cancer; however, its efficacy in OCCC remains unclear. This study evaluated the treatment outcomes of frontline bevacizumab chemotherapy in patients with OCCC. Methods: This retrospective multi-institutional study included patients diagnosed with advanced OCCC at eight institutions in Japan between 2008 and 2018. Patients were categorized into pre and post-market groups based on the Bev approval dates. Progressionfree survival (PFS) and overall survival (OS) were analyzed using univariate and multivariate methods. Additionally, patients were classified into Bev-treated (Bev+) and non-Bev-treated (Bev−) groups, and their prognoses were compared. Results: A total of 96 patients were in the pre-market group and 82 in the post-market group. The post-market group had a significantly higher proportion of patients with poor performance status and patients who underwent interval debulking surgery (p<0.01 and p<0.01, respectively). Univariate analysis demonstrated a better PFS in the post-market group (p=0.041). In multivariate analysis, better PFS (hazard ratio [HR]=0.52; p=0.002) and OS (HR=0.47; p=0.002) were observed in the post-market group than in the pre-market group.Bev+ patients had significantly better PFS and OS than Bev− patients in univariate (p<0.001 and p<0.001, respectively) and multivariate analyses (PFS: HR=0.36; p<0.001 and OS:HR=0.21; p=0.001, respectively). Conclusion Incorporating Bev into frontline chemotherapy may improve outcomes in patients with advanced OCCC.

OBJECTIVEParaaortic lymph nodes dissection in advanced gastric carcinoma is controversial. Investigation of micrometastasis in these critical lymph nodes is important in the evaluation of prophylactic lymphadenectomy.

METHODSA total of 2 339 lymph nodes, including 390 paraaortic nodes, obtained from 47 patients with advanced gastric carcinoma were examined immunohistochemically using cytokeratin antibody.

RESULTSParaaortic lymph node metastasis was found in 95 of 390 nodes of 14 patients by routine histological examination. Micrometastasis in the paraaortic lymph nodes was immunohistochemically detected in 45 of 295 negative nodes from 15 of 33 patients. The 5-year-survival rate in patients with paraaortic lymph node metastasis was 56.0% in the node negative group, 25.2% in the cytokeratin positive group and 9.0% in the hematoxilin and eosin positive group.

CONCLUSIONSWe have demonstrated a high rate of micrometastasis in the paraaortic lymph nodes of patients with advanced gastric carcinoma and have confirmed that prophylactic lymphadenectomy of these nodes is effective for such patients.

Adult ; Aged ; Female ; Humans ; Immunohistochemistry ; Keratins ; analysis ; Lymph Nodes ; chemistry ; pathology ; Lymphatic Metastasis ; pathology ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Stomach Neoplasms ; mortality ; pathology ; Survival Rate

PURPOSE: Tumor spread is mainly dependent on both hematogenous and lymphogeneous systems, and recently, several angiogenic factors have been identified. In the present study, we investigated whether the expressions of VEGF-A and -C are related with angiogenesis and lymph node metastasis in early gastric cancer. MATERIALS AND METHODS: A total of 97 specimens btained from patients with early gastric cancer were studied by immunohistochemical methods using anti- VEGF-A and -C polyclonal antibodies, anti-Factor VIII- related antigen antibody, and anti-p53 antibody. RESULTS: The percentage of the positive expressions of VEGF-A and -C were 24.7% (24/97) and 25.7% (25/97), respectively. Significant differences were found between the expression of VEGF-A and lymphatic invasion and lymph node metastasis, and between expression of VEGF-C and gross type, lymphatic invasion, and lymph node metastasis (p<0.05). The mean microvessel counts in VEGF-A and -C positive tumors were significantly higher than those in VEGF-A and -C negative tumors (p<0.05). In multivariate analysis, tumor size, lymphatic invasion and VEGF-C were identified as independent factors related to lymph node metastasis (p<0.05). CONCLUSION: The expressions of VEGF-A and -C were found to be related to angiogenic activity and VEGF-C expression correlated significantly with lymph node metastasis. The determination of VEGF-C expression may be helpful for predicting lymph node metastases in early gastric cancer, and further studies involving many specimens are warranted.
Angiogenesis Inducing Agents ; Antibodies ; Humans ; Lymph Nodes ; Microvessels ; Multivariate Analysis ; Neoplasm Metastasis ; Stomach Neoplasms* ; Vascular Endothelial Growth Factor A* ; Vascular Endothelial Growth Factor C*

ObjectiveTo study the clinicopathology and postoperative survival of patients with signet cell carcinoma of the stomach. MethodsThe clinicopathology and survival of 815 cases of gastric cancer were analyzed in this article. Results Most patients with signet ring cell carcinoma of the stomach were young female, and this cancer took up 9 9% of the total gastric cancers. In the early gastric cancer, the rate of lymph node metastasis caused by signet ring cell carcinoma was not different from that of other gastric cancer. The 5 year survival of patients with signet ring cell carcinoma was 100%, better than that of other types of gastric cancer 82 6% ( P

Objective Tumors with accelerated growth or high malignancy are thought to undergo active angiogenesis. Whereas by far, there is few study concerning the combination of MIB-1 proliferation index (MIB-1 PI) and tumor angiogenesis in carcinomas to show their significance in relate to clinicopathological parameters. In the present study, we evaluated the significance of MIB-1 PI and angiogenesis in early stage of gastric cancer. Our focus was especially on the combination of MIB-1 PI and angiogenesis in relate to lymph node metastasis. Methods Specimens from 95 patients with early gastric cancer were studied by means of immunohistochemistry using monocional MIB-1 and factor Ⅷ related antigen antibodies. Results The mean MIB-1 PI and microvessel count were 22.9％ and 34.7,respectively. The MIB-1 PI did not correlate with microvessei count. Both correlated with depth of tumor invasion,lymphatic vessel invasion and lymph node metastasis. Multivariate analysis showed that combined high MIB-1 PI/hypervascularity, as well as lymphatic vessel invasion and tumor size were independent factors that impact on lymph node metastasis. Conclusion A combination of the high MIB-1 PI/hypervascularity is a factor that related to lymph node metastasis in early gastric cancer.

Objective To investigate the correlation between angiogenesis and tumor growth pattern as well as the lymph node metastasis to reveal the significance of vascularity in the early stage of gastric cancer.Methods 97 specimens from patients with early gastric cancer were studied by immunohistochemical method using anti-factor Ⅷ related antigen antibody.Results Microvessel count was related to tumor growth pattern. The mean vessel count was higher in superficially spreading and penetrating types of tumors. Lymph node metastasis was correlated to microvessel count. Tumors with lymph node metastasis had higher microvessel counts than those without lymph node metastasis.Conclusions In the early stage of gastric carcinoma, angiogenesis is correlated with tumor growth pattern and lymph node metastasis. Identification of tumors with high density of vascularization is beneficial for closer follow-up and adjuvant therapy.