Peritoneal metastasis of gastric cancer is the main cause of death in gastric cancer patients. Peritoneal metastasis of gastric cancer is difficult to diagnose in its early stage due to lack of obvious clinical signs and symptoms, and poor treatment outcomes and prognosis are often associated with late stage peritoneal metastasis. Therefore, it is crucial to utilize effective early diagnostic tools and to improve the long-term outcomes and the prognosis of patients with advanced gastric cancer. Recently, systemic chemotherapy and intraperitoneal chemotherapy are the first line therapy, and cytoreductive operation plus abdominal cavity thermochemotherapy may be the best method in the treatment of peritoneal metastasis. However, conversion therapy has been gradually incorporated into the treatment of peritoneal metastasis of gastric cancer because of the better efficacy and the higher survival.
Antineoplastic Agents ; therapeutic use ; Antineoplastic Protocols ; Combined Modality Therapy ; methods ; Cytoreduction Surgical Procedures ; Early Detection of Cancer ; methods ; Humans ; Hyperthermia, Induced ; Peritoneal Neoplasms ; diagnosis ; secondary ; Prognosis ; Stomach Neoplasms ; mortality ; pathology ; Treatment Outcome

OBJECTIVETo establish an evaluation model of peritoneal metastasis in gastric cancer, and to assess its clinical significance.

METHODSClinical and pathologic data of the consecutive cases of gastric cancer admitted between April 2015 and December 2015 in Department of General Surgery, Zhongshan Hospital of Fudan University were analyzed retrospectively. A total of 710 patients were enrolled in the study after 18 patients with other distant metastasis were excluded. The correlations between peritoneal metastasis and different factors were studied through univariate (Pearson's test or Fisher's exact test) and multivariate analyses (Binary Logistic regression). Independent predictable factors for peritoneal metastasis were combined to establish a risk evaluation model (nomogram). The nomogram was created with R software using the 'rms' package. In the nomogram, each factor had different scores, and every patient could have a total score by adding all the scores of each factor. A higher total score represented higher risk of peritoneal metastasis. Receiver operating characteristic (ROC) curve analysis was used to compare the sensitivity and specificity of the established nomogram. Delong. Delong. Clarke-Pearson test was used to compare the difference of the area under the curve (AUC). The cut-off value was determined by the AUC, when the ROC curve had the biggest AUC, the model had the best sensitivity and specificity.

RESULTSAmong 710 patients, 47 patients had peritoneal metastasis (6.6%), including 30 male (30/506, 5.9%) and 17 female (17/204, 8.3%); 31 were ≥ 60 years old (31/429, 7.2%); 38 had tumor ≥ 3 cm(38/461, 8.2%). Lauren classification indicated that 2 patients were intestinal type(2/245, 0.8%), 8 patients were mixed type(8/208, 3.8%), 11 patients were diffuse type(11/142, 7.7%), and others had no associated data. CA19-9 of 13 patients was ≥ 37 kU/L(13/61, 21.3%); CA125 of 11 patients was ≥ 35 kU/L(11/36, 30.6%); CA72-4 of 11 patients was ≥ 10 kU/L(11/39, 28.2%). Neutrophil/lymphocyte ratio (NLR) of 26 patients was ≥ 2.37(26/231, 11.3%). Multivariate analysis showed that Lauren classification (HR=8.95, 95%CI:1.32-60.59, P=0.025), CA125(HR=17.45, 95%CI:5.54-54.89, P=0.001), CA72-4(HR=20.06, 95%CI:5.05-79.68, P=0.001), and NLR (HR=4.16, 95%CI:1.17-14.75, P=0.032) were independent risk factors of peritoneal metastasis in gastric cancer. In the nomogram, the highest score was 241, including diffuse or mixed Lauren classification (54 score), CA125 ≥ 35 kU/L (66 score), CA72-4 ≥ 10 kU/L (100 score), and NLR ≥ 2.37 (21 score), which represented a highest risk of peritoneal metastasis (more than 90%). The AUC of nomogram was 0.912, which was superior than any single variable (AUC of Lauren classification: 0.678; AUC of CA125: 0.720; AUC of CA72-4: 0.792; AUC of NLR: 0.613, all P=0.000). The total score of nomogram increased according to the TNM stage, and was highest in the peritoneal metastasis group (F=49.1, P=0.000). When the cut-off value calculated by ROC analysis was set at 140, the model could best balanced the sensitivity (0.79) and the specificity (0.87). Only 5% of patients had peritoneal metastasis when their nomogram scores were lower than 140, while 58% of patients had peritoneal metastasis when their scores were ≥ 140(χ=69.1, P=0.000).

CONCLUSIONThe risk evaluation model established with Lauren classification, CA125, CA72-4 and NLR can effectively predict the risk of peritoneal metastasis in gastric cancer, and provide the reference to preoperative staging and choice of therapeutic strategy.

Antigens, Tumor-Associated, Carbohydrate ; blood ; Area Under Curve ; CA-125 Antigen ; blood ; CA-19-9 Antigen ; blood ; Female ; Humans ; Leukocyte Count ; statistics & numerical data ; Logistic Models ; Lymphocytes ; pathology ; Male ; Middle Aged ; Neoplasm Metastasis ; diagnosis ; Neutrophils ; pathology ; Nomograms ; Peritoneal Neoplasms ; secondary ; Prognosis ; ROC Curve ; Retrospective Studies ; Risk Assessment ; methods ; Risk Factors ; Sensitivity and Specificity ; Stomach Neoplasms ; blood ; classification ; diagnosis ; pathology

The death of patients with gastric cancer is mainly due to its recurrence and metastasis, and circulating tumor cell (CTC) is the necessary condition of metastasis. As liquid biopsy, CTC detection has its certain clinical significance. The detection is required after enrichment because circulating tumor cells are rare. Many enrichment methods have been developed: methods based on physical characteristics of TCT, like density, size and dielectric properties and so on; immunogenicity, like Cell Search System; and microfluidic chip technology. The immunofluorescence is commonly used to identify CTC in gastric cancer and the isolated CTC can also be used for the following analysis on the level of nucleic acid, protein and gene regulation. Detection of CTC in gastric cancer is helpful to judge the prognosis, assess staging, monitor the curative effect and guide the development of drug. There are many challenges for clinical transformation of CTC: the lower enrichment efficiency, the less specific surface markers, the uncertain diagnostic efficiency and so on, but it also has the good research prospect because it is non-invasive, repeatable and can real-time monitor the condition and guide the clinical treatment compared with pathological biopsy. In this paper, the detection and identification methods, and clinical value of CTC in gastric cancer patients are reviewed.
Biomarkers, Tumor ; Biopsy ; Cell Separation ; methods ; Cytodiagnosis ; methods ; Flow Cytometry ; methods ; Fluorescent Antibody Technique ; methods ; Humans ; Microchip Analytical Procedures ; methods ; Neoplasm Recurrence, Local ; prevention & control ; Neoplasm Staging ; methods ; Neoplastic Cells, Circulating ; metabolism ; pathology ; Prognosis ; Secondary Prevention ; Stomach Neoplasms ; blood ; diagnosis ; genetics ; therapy ; Treatment Outcome

OBJECTIVETo explore the clinicopathalogical features, treatment methods and prognostic factors of metastatic ovarian tumors from gastric cancer.

METHODClinical data of 110 gastric cancer patients with metastatic ovarian tumor between January 2001 and August 2015 of Tianjin Medical University Cancer Institute and Hospital were reviewed retrospectively. Univariate and Cox regression model multivariate analyses were performed to investigate the risk factors of metastatic ovarian tumor from gastric cancer.

RESULTThe follow-up duration ranged from 3 to 60 months (mean 12 months). The follow-up rate was 94.5%(104/110). 104 cases underwent surgical treatment, including satisfactory cytoreductive surgery (57 cases) and unsatisfactory cytoreductive surgery (47 cases). The median overall survival was 12 months and median progression-free survival was 8 months. The survival rates of 1-, 3- and 5-year were 48.1%, 7.7% and 0, respectively. Univariate analysis revealed that pattern of metastasectomy, number of metastatic lymph node, cytoreductive surgery level, presence of peritoneal metastasis or not when ovarian metastasis was diagnosed, ovariectomy prior to primary gastric cancer and extent of ovarian metastatic lesion were associated with prognosis(P<0.05). Multivariate analysis revealed that extent of ovarian metastatic lesion(RR=2.76, 95% CI: 1.68 to 4.54, P=0.005), presence of peritoneal metastasis when ovarian metastasis was diagnosed (RR=0.21, 95% CI: 0.11 to 0.41, P=0.003) and cytoreductive surgery level(RR=3.67, 95% CI: 2.13 to 6.33, P=0.011) were independent prognostic factors.

CONCLUSIONSPrognosis of patients with metastatic ovarian carcinoma from gastric cancer is quite poor. Extent of ovarian metastatic lesion and peritoneal metastasis were independent prognostic factors. Optimal cytoreduction is associated with better survival.

Disease-Free Survival ; Female ; Humans ; Multivariate Analysis ; Neoplasms, Glandular and Epithelial ; diagnosis ; secondary ; Ovarian Neoplasms ; diagnosis ; secondary ; Prognosis ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; pathology ; Survival Rate

The aim of the present study was to accurately evaluate the association of Sox2 expression with the survival of patients with digestive tract cancers. Relevant literatures were identified by comprehensively searching databases including the Pubmed, Embase, CBMdisc, and Wanfang (up to October 2014). A meta-analysis was performed to clarify the association between Sox2 expression and overall survival or clinicopathological parameters of patients with digestive tract cancers (esophageal, gastric, and colorectal cancers). The results showed a significant association between high Sox2 expression and poor overall survival in patients with digestive tract carcinomas (HR=1.55, 95% CI=1.04-2.31), especially for patients with esophageal cancer (HR=2.04, 95%CI=1.30-3.22), colorectal cancer (HR=1.40, 95% CI=1.04-1.89), and digestive tract adenocarcinoma (HR=1.80, 95% CI=1.12-2.89), for Europeans (HR=1.98, 95% CI=1.44-2.71) or patients who did not receive neoadjuvant treatment (HR=1.73, 95% CI=1.10-2.72). Furthermore, Sox2 over-expression was highly correlated with vascular invasion (OR=1.86, 95% CI=1.25-2.77) and poor differentiation (OR=1.88, 95% CI=1.14-3.08), especially in esophageal and colorectal cancers. In conclusion, Sox2 expression may serve as a novel prognostic factor for patients with digestive tract cancers. Over-expression of Sox2 that is correlated with vascular invasion and poor differentiation suggests poor outcomes of patients with digestive tract cancers.
Antineoplastic Agents ; therapeutic use ; Biomarkers, Tumor ; genetics ; metabolism ; Colorectal Neoplasms ; diagnosis ; drug therapy ; mortality ; pathology ; Esophageal Neoplasms ; diagnosis ; drug therapy ; mortality ; pathology ; Gastrointestinal Tract ; metabolism ; pathology ; Gene Expression ; Humans ; Neoadjuvant Therapy ; methods ; Neoplasm Grading ; Neoplasms, Vascular Tissue ; diagnosis ; drug therapy ; mortality ; secondary ; Prognosis ; SOXB1 Transcription Factors ; genetics ; metabolism ; Stomach Neoplasms ; diagnosis ; drug therapy ; mortality ; pathology ; Survival Analysis

Leiomyosarcoma is an uncommon tumor that originates from various organs, including uterus, kidney, retroperitoneum, and soft tissues. In particular, leiomyosarcoma of the stomach is extremely rare. Only 9 cases have been reported worldwide since the discovery of KIT-activating mutation. A 48-year-old woman was admitted to our hospital with abdominal discomfort and generalized weakness. Upon detection of multiple nodules in both lung on chest posterior-anterior radiograph taken at the time of admission, chest CT was performed and it revealed multiple mass lesions in the lung, liver, and pancreas along with multiple lymph node metastases. On endoscopic examination, a 2.0 cm sized ulcerofungating mass lesion was found on the stomach body. Biopsy was performed and the mass lesion proved to be leiomyosarcoma confirmed by immunohistochemical staining. Chemotherapy was thus initiated, but the patient died after one year due to tumor progression. Our experience suggests that leiomyosarcoma can manifest aggressive behavior in its early stage. Herein, we report a case of gastric leiomyosarcoma with multiple metastases along with review of relevant literature.
Female ; Gastroscopy ; Humans ; Leiomyosarcoma/*diagnosis/pathology ; Liver Neoplasms/pathology/secondary ; Lung Neoplasms/pathology/secondary ; Lymphatic Metastasis ; Middle Aged ; Pancreatic Neoplasms/pathology/secondary ; Stomach Neoplasms/*diagnosis/pathology ; Tomography, X-Ray Computed

Vaginal cancer is rare worldwide and represents 2% of all gynaecological cancers in Singapore. Primary vaginal malignancies are rare and vaginal metastases constitute the majority of vaginal malignancies. Most of these metastases arise from the cervix, endometrium or ovary, although they can also metastasise from distant sites such as the colon, breast and pancreas. We report a rare case of vaginal metastasis in a patient with previous gastric and rectal adenocarcinomas. An 89-year-old woman with a history of gastric and rectal malignancy presented with postmenopausal bleeding. A 2-cm vaginal tumour at the introitus was discovered upon examination. This case demonstrates the importance of performing a gynaecological examination during follow-up for patients with a history of malignancy. The prognosis for vaginal metastasis is poor, as it is often associated with disseminated disease. Depending on the extent of the lesions, radiotherapy or surgery can be considered.
Adenocarcinoma ; diagnosis ; pathology ; secondary ; Aged, 80 and over ; Biopsy ; Female ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Postmenopause ; Rectal Neoplasms ; pathology ; Stomach Neoplasms ; pathology ; Uterine Hemorrhage ; diagnosis ; Vaginal Neoplasms ; diagnosis ; pathology ; secondary

Low-grade fibromyxoid sarcoma is a slowly growing soft tissue neoplasm that shows benign histologic features but may have clinical course of malignant disease. It has been reported to occur in the thigh, inguinal area, axilla, shoulder, neck, perineum or buttock. However, there have been few cases of abdominal organ involvement. A 21-year-old woman presented with a large palpable abdominal mass. A 7x4 cm sized round soft tissue tumor at right upper quadrant area was identified by abdominopelvic CT scan. Percutaneous ultrasound-guided biopsy revealed features of spindle cell tumor. On exploration, the tumor originated from transvers colon and was attached to gastrocolic ligament, transverse mesocolon and stomach. The tumor could be dissected with transverse colectomy and partial gastrectomy. The excised tumor, measuring 7x5x5 cm, was well demarcated and appeared as an ovoid mass with firm and myxoid cut surface. She was diagnosed with low-grade fibromyxoid sarcoma arising from transverse colon, and is currently being followed-up without recurrence or metastasis.
Colon, Transverse ; Female ; Humans ; S100 Proteins/metabolism ; Sarcoma/*diagnosis/pathology/surgery ; Soft Tissue Neoplasms/*diagnosis/pathology/surgery ; Stomach Neoplasms/pathology/secondary ; Tomography, X-Ray Computed ; Young Adult

BACKGROUND/AIMS: Accurate preoperative detection of regional lymph nodes and evaluation of tumor resectability is critical to determining the most adequate therapy for gastric cancer. The aim of this study is to identify a possible link between 18F-fluorodeoxyglucose (18F-FDG) uptake on PET scan combined with CT scan (PET/CT) and predictions of lymph node metastasis and non-curative surgery. METHODS: This study included 156 gastric cancer patients who underwent preoperative 18F-FDG PET/CT and surgery. In cases with perceptible FDG uptake in the primary tumor or lymph nodes, the maximum standardized uptake value (SUVmax) was calculated. RESULTS: In multivariate analysis, non-curative surgery (OR, 11.05; 95% CI, 1.10-111.08; p=0.041), tumor size (> or =3 cm) (OR, 7.39; 95% CI, 2.41-22.70; p<0.001), and lymph node metastasis (OR, 5.47; 95% CI, 2.05-14.64; p=0.001) were significant independent predictors for 18F-FDG uptake in the primary tumors. Tumor size (tumor size > or =3 cm) (OR, 3.15; 95% CI, 1.16-8.58; p=0.025) and lymph node metastasis (OR, 3.36; 95% CI, 1.23-9.14; p=0.018) showed significant association with 18F-FDG uptake in lymph node. When the SUVmax of the primary gastric tumor was greater than 3.75, the sensitivity and specificity of PET/CT with regard to the diagnosis of metastatic lymph node were 73.5% and 74.5%. When the SUVmax of the primary gastric tumor was greater than 4.35 and the FDG uptake of lymph nodes was positive, non-curative surgery was predicted with a sensitivity of 58.8% and specificity of 91.6%. CONCLUSIONS: A high FDG uptake of the gastric tumor was related to histologic positive lymph nodes and non-curative surgery.
Adult ; Aged ; Aged, 80 and over ; Area Under Curve ; Carcinoma/*diagnosis/pathology/surgery ; Female ; Fluorodeoxyglucose F18 ; Humans ; Lymph Nodes/surgery ; Lymphatic Metastasis/radionuclide imaging ; Male ; Middle Aged ; Neoplasm Staging ; Odds Ratio ; Peritoneal Neoplasms/diagnosis/secondary ; Positron-Emission Tomography ; ROC Curve ; Regression Analysis ; Stomach Neoplasms/*diagnosis/pathology/surgery ; Tomography, X-Ray Computed

Although hematogenous metastasis of cancer to the gastrointestinal track is rare, it sometime has been reported in patients with malignant melanoma and breast cancer. However, it is extremely rare for lung cancer to metastasize to the stomach, not to mention solitary gastric metastasis. Herein, the authors report a case of a 69-year-old man who was initially diagnosed with lung cancer with synchronous primary gastric cancer which proved to be lung cancer with solitary gastric metastasis after the operation.
Adenocarcinoma/*diagnosis/pathology ; Aged ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Diagnosis, Differential ; Endoscopy, Digestive System ; Humans ; Lung Neoplasms/*diagnosis/drug therapy/pathology ; Male ; Stomach Neoplasms/*diagnosis/secondary/surgery ; Tomography, X-Ray Computed