Prognostic significance of subclassification of stage IV gastric cancer according to pTNM categories.

BACKGROUND/AIMS: The aim was to evaluate the surgical outcome and prognosis of patients with stage IV gastric cancer, and to investigate whether stage IV gastric cancer should be further subclassified for more accurate prediction of outcome. METHODOLOGY: We analyzed 401 patients with stage IV gastric cancer who underwent gastric resection from 1998 to 2004. According to TNM categories, we separated them into T1-3N3M0, T4N1-2M0, T4N3M0, And TanyNanyM1 groups. RESULTS: The survival rate of patients with subclassification IVa (T1-3N3M0 and T4N1-2M0) gastric cancers was significant higher than that of patients with sub-classification IVb (T4N3M0 and TanyNanyM1) ones (p < 0.001). Multivariate analysis showed that sub-classification, distant metastasis, and curability of operation were significant factors affecting survival. CONCLUSIONS: Sub-classification of stage IV gastric cancer into a relatively favorable group (T4N1-2M0 and T1-3N3M0; stage IVa) and an unfavorable group (T4N3M0 and TanyNanyM1; stage IVb) may predict patients' prognosis more accurately.

Regulating effects of arsenic trioxide on cell death pathways and inflammatory reactions of pancreatic acinar cells in rats.

BACKGROUND: It is accepted that inflammatory cytokines play a key role in the development of acute pancreatitis, so blocking the initiation of inflammatory reactions may alleviate pathological changes of acute pancreatitis. We studied the regulatory effect of arsenic trioxide (As(2)O(3)) on apoptosis and oncosis of pancreatic acinar cells in vitro and in vivo and its therapeutic effect on acute pancreatitis. METHODS: Pancreatic acinar cells were isolated by collagenase digestion method. Apoptosis and oncosis of isolated pancreatic acinar cells were detected with Hoechst 33258 + PI or Annexin V + PI double fluorescent staining. Amylase and lactate dehydrogenase release were measured. Acute pancreatitis was induced in Wistar rats by intraperitoneal injections of caerulein, and apoptosis was detected with terminal dUTP nick-end labeling method. Tumor necorsis factor alpha (TNF-alpha) mRNA, myeloperoxidase, nuclear factor-kappaB and histological grading of pancreatic damage were measured. RESULTS: There was an increased apoptosis but a decreased oncosis of pancreatic acinar cell after the treatment with As(2)O(3). The levels of lactate dehydrogenase and amylase release were markedly decreased in As(2)O(3) treated group. Myeloperoxidase content, TNF-alpha mRNA level, nuclear factor-kappaB activation and pathological score in As(2)O(3) treated group were significantly lower than in the untreated group. CONCLUSIONS: As(2)O(3) can induce apoptosis and reduce oncosis of pancreatic acinar cell, thus resulting in reduced release of endocellular enzyme of acinar cells, reduced inflammatory cell infiltration and decreased the production of inflammatory cytokines, so that the outcome of alleviated pathological changes was finally achieved.