An Alternative Method for Screening Gastric Cancer Based on Serum Levels of CEA, CA19-9, and CA72-4.

PURPOSE: The goal of this study was to create a novel method for screening gastric cancer (GC) based on serum levels of carcinoembryonic antigen (CEA), cancer antigen 19-9 (CA19-9), and cancer antigen 72-4 (CA72-4) tumor markers. METHODS: Retrospectively, the predictive value for GC was calculated using a logistic analysis on serum levels of CEA, CA19-9, and CA72-4 from 216 GC and 49 benign patients. The predictive value was used to make a recommendation system on whether further GC screening was necessary. Prospectively, 80 GC and 33 benign patients were used to assess the value of this method. RESULTS: The recommendation system to determine whether additional GC screening was necessary consisted of three grades: grade I, no proposals; grade II, proposals; grade III, strong proposals. Additional screening was suggested when the predictive value was ≤0.700 (grade I), 0.700-0.850 (grade II), and >0.850 (grade III). Of the total 216 GC patients, 20.4, 27.8, and 51.9% were classified as grades I, II, and III, respectively. Of the 49 benign cases, 57.1, 32.7, and 10.2% were classified as grades I, II, and III, respectively. Of the 80 prospective GC patients, 17.3, 28.4, and 54.3% were classified as grades I, II, and III, respectively. Of the 33 prospective benign cases, 54.6, 33.3, and 12.1% were classified as grades I, II, and III, respectively. CONCLUSION: The new screening recommendation system based on serum levels of CEA, CA19-9, and CA72-4 is an effective approach for detecting GC.

Differences and correlation of serum CEA, CA19-9 and CA72-4 in gastric cancer.

The sensitivity of three biomarkers, carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9 and CA72-4, in combination has been identified to be greater than that of any of the biomarkers considered in isolation in cases of gastric cancer (GC). However, the fundamental cause underlying this phenomenon remains to be fully elucidated. In the present study, the differences and correlation of these three biomarkers were investigated in patients with GC in order to determine how the three biomarkers in combination work more effectively compared with any of the biomarkers considered alone. The serum levels of CEA, CA19-9 and CA72-4 of 216 patients with gastric adenocarcinoma were analyzed on admission to hospital. The differences in positive rates and the serum levels of CEA, CA19-9 and CA72-4 were analyzed using the χ2 test and the non-parametric Wilcoxon two-sample test. Phi (f) correlation analysis was used to study the correlation among the expression (positive or not) levels of CEA, CA19-9 and CA72-4. The correlation among the serum levels of biomarkers was analyzed using Spearman's test. The results demonstrated that the combined positive rate of CEA, CA19-9 and CA72-4 was significantly higher compared with the individual CEA, CA19-9 and CA72-4 positive rates (44.91% vs. 22.69, 18.98 and 22.69%, respectively; all P<0.05). The positive rate of CA19-9 and CA72-4 in the extent of the primary tumor/involvement of regional lymph node/distant metastases (TNM)-III/IV stage subgroup was higher compared with that in the TNM-I/II subgroup (χ2=5.902, P=0.015; χ2=8.009, P=0.005), although not the positive rate of CEA (χ2=0.302, P=0.583). A significant correlation was identified between the expression level of CEA and CA72-4 (f correlation coefficient=0.182; P=0.008) and between that of CA19-9 and CA72-4 (f correlation coefficient=0.189; P=0.006), although not between that of CEA and CA19-9 (f correlation coefficient=0.048; P=0.482) in the total number of patients with GC. A significant correlation was also identified between the serum levels of CEA and CA19-9, of CEA and CA72-4 and of CA19-9 and CA72-4 (Spearman's correlation coefficient=0.231, -0.271 and 0.167; P=0.001, P<0.0001 and P=0.014, respectively). The present study indicated that there was only a weak correlation between the positive rate of CEA and CA72-4 and between that of CA19-9 and CA72-4, and no correlation was identified between the positive rate of CEA and CA19-9, even if a correlation was identified between the serum levels of the biomarkers. The present study suggested that the evidence that the sensitivity of the three biomarkers in combination is greater than that of any of the biomarkers taken in isolation is due to less co-presentation of CEA, CA19-9 and CA72-4 in patients with GC.

Age trend of the male to female sex ratio in surgical gastric cancer patients at a single institution.

BACKGROUND: In previous reports concerning the association between sex disparity and age, gastric cancer (GC) patients were simply divided into younger and older groups by age. We analyzed the age trend of the male to female sex ratio (MFSR) in GC based on patient sequential age in order to observe the changing process of MFSR with age. METHODS: One thousand seven hundred fifty-one surgical gastric adenocarcinoma patients aged 26 to 85 years were investigated between January 1996 and December 2010. The patients were grouped by age intervals of 5 years. The Cochran-Armitage trend test was used to determine how the MFSR changed with age. RESULTS: The median age of the 1,751 patients with GC was 60 years (26 to 85 years). There were 1,334 male and 417 female patients (MFSR was 3.20). Cochran-Armitage trend test analysis showed that total MFSR increased significantly with age (Z = 5.964, P < 0.0001). Further studies on age groups of 26 to 60 years and 61 to 85 years were conducted. The trend test showed that MFSR increased significantly with age from 26 to 60 years (Z = 7.433, P < 0.0001). However, MFSR did not increase in ages 61 to 85 years (Z = -0.607, P = 0.544). CONCLUSIONS: MFSR in GC presented an increasing trend until 60 years of age. The male GC patients showed an increasing tendency, and female GC patients showed a decreasing tendency with age. This trend reached a plateau phase after 60 years of age.

The impact of microbial immune enteral nutrition on the patients with acute radiation enteritis in bowel function and immune status.

The aim of the study was to investigate the effect of microbial immune enteral nutrition by microecopharmaceutics and deep sea fish oil and glutamine and Peptisorb on the patients with acute radiation enteritis in bowel function and immune status. From June 2010 to January 2013, 46 acute radiation enteritis patients in Liaocheng People's Hospital were randomized into the microbial immune enteral nutrition group and the control group: 24 patients in treatment group and 22 patients in control group. The immune microbial nutrition was given to the study group, but not to the control group. The concentration of serum albumin and prealbumin and the number of CD3 (+) T cell, CD4 (+) T cell, CD8 (+) T cell, CD4 (+)/CD8 (+) and natural killer cell of the two groups were detected on the 1, 7 and 14 days after treatment. The arm muscle circumference and triceps skinfold thickness (TSF) were recorded, and the tolerance of the two groups for enteral nutrition and intestinal symptoms was collected and then comparing the two indicators and get results. The tolerance of microbial immune enteral nutrition group about abdominal pain, bloating and diarrhea was better than the control group (P values were 0.018, 0.04 and 0.008 after 7 days; P values were 0.018, 0.015 and 0.002 after 14 days); and the cellular immune parameters were better than the control group((△) P = 0.008,([Symbol: see text]) P = 0.039, (☆) P = 0.032); No difference was found in nutrition indicators. To the patients with acute radiation enteritis, microbial immune enteral nutrition could improve the patient's immune status, and the tolerance of enteral nutrition could be better for the bowel function and the patients' rehabilitation.

Family history of malignant neoplasm and its relation with clinicopathologic features of gastric cancer patients.

BACKGROUND: Few studies to date have evaluated gastric cancer(GC)-related malignant neoplasm family history (MN-FH), and their findings have been largely inconsistent. The aim of this study is to evaluate the prevalence of MN-FH and its relation to the clinicopathologic features of GC. METHODS: A total of 104 hospitalized patients with primary gastric adenocarcinoma was prospectively analyzed from 2008 to 2009. Positive MN-FH was defined as MN-affected first- and second-degree relatives of the current GC cases. The relation between prevalence of positive MN-FH and clinicopathologic features in the current GC patients was assessed using the Chi-square test with Cramer's V coefficient. RESULTS: Thirty-seven (35.6%) of the GC patients had positive MN-FH, with 42 associated tumors in first- and second-degree relatives. Twenty-six (61.9%) of the associated tumors were located in the digestive system, including the esophagus (26.2%), stomach (23.8%), liver (9.5%) and colon (2.4%). Lung cancers were the most prevalent non-digestive system-associated tumors (9.5%). Correlation analysis revealed no significant relations with prevalence of MN-FH and any of the clinicopathologic features (all, P > 0.05), including sex (V = 0.044), age (V = 0.060) and histological subtypes (V = 0.109). CONCLUSIONS: More than one-third of the GC patients in our hospital had positive MN-FH. The most frequent forms of MN-FH were esophageal cancer and GC. The prevalence of positive MN-FH was not correlated to any of the clinicopathologic features, including sex, age and histological subtypes in the study population of GC patients.

The sex ratio and age of onset features of gastric cancer patients in hereditary diffuse gastric cancer families.

An understanding of the clinical features of gastric cancer (GC) in hereditary diffuse gastric cancer (HDGC) families may be helpful in deciding who should receive prophylactic total gastrectomy and when. This study evaluates the sex ratio and age of onset features of these patients. Forty-seven HDGC families were screened from the English (40 families), Chinese (7 families) literature. One family was ascertained in our hospital. A total of 48 HDGC families with 192 GC cases were analyzed. The patients were grouped as Asian and non-Asian cases according the first author corresponding address. The male to female ratio of GC patients in our study was less than general GC population (0.769 vs. 1.826, P < 0.0001). The mean age of male cases was higher than that for females (48.9 vs. 43.1 years; P = 0.012). The mean age for parents of cases was higher than that for the offspring of cases (52.5 vs. 37.4 years; P = 0.0001). There was a significant age correlation between sib-sib GC pairs (P < 0.0001). The male to female ratio of Asian GC patients was higher than that of non-Asian GC cases (1.450 vs. 0.614, P = 0.01). The age for Asian GC patients was higher than that of non-Asian GC patients (52.1 vs. 43.5 years, P = 0.001). The results showed that female GC patients were more frequent and younger than male patients in HDGC families. The parents of cases were older than offspring cases. There was a significant age correlation between sib-sib cases. There was regional disparity in the sex ratio and age features.

[Changing trends in the clinicopathological characteristics of patients with gastric carcinoma undergoing surgery between 1979 and 2008 in Liaocheng Shandong province].

OBJECTIVE: To evaluate the changing trends in clinicopathological characteristics of patients with gastric carcinoma undergoing surgery between 1979 and 2008. METHODS: Two thousand seven hundred and fifteen patients with gastric cancer who received operation in Liaocheng People's hospital between 1979 and 2008 were analyzed retrospectively, and were compared to 168 patients between 1974 and 1978. Categorical data were evaluated with Chi-squared or Fisher's exact test. Quantitative data were analyzed with nonparametric test. Time series analysis was used to evaluate the changing trend of data. RESULTS: The male to female ratio during 1979-2008 was 3.393, which was higher than that (1.897) during 1974-1978 (χ2=12.193, P<0.01). The median age (59 years) during 1979-2008 was higher than that (53.5 years) during 1974-1978 (z=-6.294 P<0.01). Comparing the tumor distribution of gastric cancer during 1979-2008 with that during 1974-1978, proportion of gastric cardia and fundus cancer was higher (45.7% vs. 13.0%, χ2=56.596, P<0.01), while the proportion of gastric antrum cancer was lower (44.9% vs. 73.2%, χ2=53.980, P<0.01). There was no significant difference in gastric body cancer (13.8% vs. 9.4%, χ2=2.026, P=0.155). Compared to 1994-1998, there were more poorly differentiated adenocarcinomas during 2004-2008 (62.1% vs. 51.7%, χ2=12.267, P<0.01), and there were less tubular adenocarcinomas during 2004-2008 (23.9% vs. 31.8%, χ2=8.78, P<0.01). Time series analysis showed the patient age during 1979 to 2008 increased (Root mean square error=1.275, R-square=0.702), gastric cardia and fundus cancer was increasing and antrum cancer was decreasing (Root mean square error=0.055, R-square=0.798). CONCLUSIONS: In the past 30 years from 1979 to 2008, the male to female ratio and the median age of surgical patients with gastric cancer increased with time. The gastric cardia and fundus cancer increased over time, however antrum cancer decreased with time. In the past 15 years from 1994 to 2008, the proportion of poorly differentiated adenocarcinoma increased, and that of tubular adenocarcinoma declined.

The demographic characteristics of histological types of gastric cancer with gender, age, and tumor location.

OBJECTIVE: The objective of this paper is to study demographic characteristics of different histological types with patient's gender, age, and tumor location in gastric cancer. METHODS: Three hundred and fifty-one patients who had gastric cancer and undergone a D2 or greater gastrectomy were analyzed retrospectively. The association between gender and age, tumor location and histological types, including tubular adenocarcinoma (TUB), poorly differentiated adenocarcinoma (POR), signet-ring cell carcinoma (SIG), mucinous adenocarcinoma, and undifferentiated carcinoma (UND), were analyzed by chi-square test or Fisher exact test. RESULTS: The proportion of TUB in males was higher than that in females (52.4% vs 30.1%, p value of 0.000), and the proportion of SIG in females was higher than that in males (26.2% vs 12.9%, p = 0.002). The prevalence of TUB in patients aged >60 years (54.9%) was significantly higher than that in patients aged 40-60 years (42.2%) and <40 years (24.1%). The prevalence of SIG in the group aged <40 years was significantly higher than that in the other two age groups (44.8% vs 15.6%, 12.7%, p = 0.000). Among the three age groups, the proportion of UND was highest in patients aged 40-60 years (7.8% vs 0%, 1.4%, p = 0.012). The proportion of TUB was highest in the upper part of the stomach as compared to the middle and lower parts of the stomach (56.1% vs 30.8%, 48.2%, p = 0.016). POR was commonly found in the middle part of the stomach as compared to the upper and lower parts (44.6% vs 26.1%, 14.6%, p = 0.002). CONCLUSION: TUB was commonly found in the upper part of the stomach in old, male patients, and SIG was the most common histological type in young, female patients. UND was common in middle-aged patients, and POR was mainly found in the middle part of the stomach.

A study on the association of histological types and TNM stages.

BACKGROUND/AIMS: To study the association between different histological types and staging of the gastric cancer. METHODOLOGY: Three hundred and fifty-one patients with gastric cancer and undergone D2 or greater gastrectomy were analyzed retrospectively. The association between TNM stages and histological types, including tubular adenocarcinoma (TUB), poorly differentiated adenocarcinoma (POR), signet-ring cell carcinoma (SIG), mucinous adenocarcinoma (MUC), and undifferentiated carcinoma (UND), were analyzed by univariate and multivariate analysis. RESULTS: Univariate analysis showed that the prevalence rates of T,M stages of POR, MUC, SIG, UND were not significantly different from that of TUB (all p values > 0.05). The prevalence rates of the N stage of POR, MUC, UND were significantly different from TUB p = 0.002, 0.011, 0.032). The prevalence rates of the N stage of SIG were not significantly different from TUB (p = 0.070). Multivariate analysis indicated that there was no histological type that was influencing factors on the T, M stages of gastric cancer. MUC, SIG, UND were not influencing factors on N stage, but, POR was influencing factor on the N stage (p = 0.011). CONCLUSIONS: There was no association between histological type and TNM stages, except the POR, which has a significant association with the N stage of gastric cancer.

[Familiar gastric cancer: case report and systematic review of the Chinese literature].

OBJECTIVE: To investigate the clinicopathologic characteristics of familiar gastric cancer (FGC) in Chinese. METHODS: A family with FGC was screened. China National Knowledge Infrastructure was retrieved, and fifteen families with FGC were collected. Systematic literature review was carried out on these sixteen families. RESULTS: There were 63 cases of FGC in these 16 families, 38 males and 25 females, aged 54 (30 - 72). The mean age of the parental patients was 61, older than that of the filial patients (43 years, Z = 3.494, P < 0.01). There was a correlation between the ages of sibling patients (r(s) = 0.664, P < 0.01). Among the 44 cases with clearly described tumor location, the tumor was located in the gastric antrum in 21 patients (47.7%). Among the 8 families with complete records of tumor location, 4 families showed consistent tumor location. Accompanying other malignant tumors were seen in 7 families, 5 being tumors in the alimentary canal. CONCLUSION: The onset age of filial patients with FGC is younger than that of the parental patients in Chinese. The onset ages of the sibling cases are significantly correlated. In a specific family the tumor is nearly located at the same places. And most of tumors are located in gastric antrum.Most of the accompanying tumors are alimentary canal tumors.

High DcR3 expression predicts stage pN2-3 in gastric cancer.

BACKGROUND: A soluble decoy receptor 3 (DcR3), also known as TR6 or M68, is a member of the TNF receptor family. It has been reported that high DcR3 expression occurs in many tumors. METHODS: This prospective study evaluated the DcR3 tissue status by RT-PCR and its correlation with the lymph node (N) stages in 62 primary gastric cancers. RESULTS: DcR3 expression levels in patients with pN2-3 disease were much higher than those in patients with pN0-1 disease (median values 1.31 vs. 0, P < 0.01). Using ROC analysis, a cutoff level of DcR3 expression at 1.20 was found to be associated with optimal sensitivity and specificity of 62.5% (15 of 24) and 92.1% (35 of 38) respectively, in the prediction of stage pN2-3. According to the cutoff value, patients were divided into 2 groups with relatively high and low levels of DcR3 expression. Among the 18 patients with high DcR3 expression, 83.3% (15 of 18) were staged as pN2-3. In the other 44 patients with low DcR3 expression, only 20.5% (9 of 44) were identified as pN2-3. Logistic regression analysis for stage pN2-3 revealed that high DcR3 expression was an independent risk factor. CONCLUSION: Gastric cancer patients with high DcR3 expression presented more advanced pN2-3 disease than those with low DcR3 expression. Preoperative checking DcR3 expression might be an additional approach to imaging modalities for evaluating N stages in gastric cancer to guide the operative procedures.

The staging system of metastatic lymph node ratio in gastric cancer.

BACKGROUND/AIMS: The metastatic lymph node ratio (MLR) was proposed as an indicator of prognosis. But, there is disagreement over the use of staging standards based on the MLR. The aim of this study was to define a staging system of metastatic lymph node ratio (MLR) in gastric cancer that could be used to predict the postoperative survival time. METHODOLOGY: A total of 217 patients with gastric cancer were studied retrospectively. MLR was defined as the ratio of the number of metastatic lymph nodes to the total number of lymph nodes found in pathological examination. The patients were stratified into ten subgroups based on 10% MLR intervals. The 2-year cumulative survival rates of each subgroup were calculated using the Kaplan-Meier method and compared using the log rank test. Four MLR stages were determined based on survival rates, and a staging system of MLR was established. The 2-year survival rates of patients classified by a staging system of MLR were calculated and compared to evaluate the effectiveness of the staging system developed. RESULTS: Four stages of MLR were defined: 0, 0-0.3, 0.3-0.6, >0.6. The 2-year survival rate decreased as MLR increased: 98.1% for MLR 0; 79.1% for MLR 0-0.3; 52.2% for MLR 0.3-0.6; and 30.1% for MLR >0.6. Significant differences in survival rates were found among the four subgroups of patients. CONCLUSIONS: The staging system of MLR in our study is a reasonable categorization that can be used to objectively predict prognosis of gastric cancer.

High DcR3 expression predicts stage pN2 in gastric cancer.

BACKGROUND/AIMS: A soluble decoy receptor 3 (DcR3), also known as TR6 or M68, is a member of the TNF receptor family. It has been reported that high DcR3 expression occurs in many tumors. METHODOLOGY: This prospective study evaluated the DcR3 tissue status by RT-PCR and its correlation with the lymph node (N) stages in 62 primary gastric cancers. RESULTS: DcR3 expression levels in patients with pN2 disease were much higher than those in patients with pN0-1 disease (Median values 1.31 vs. 0, P< 0.01). Using ROC analysis, a cut-off level of DcR3 expression at 1.20 was found to be associated with optimal sensitivity and specificity of 62.5% (15/24) and 92.1% (35/38) respectively, in the prediction of stage pN2. According to the cut-off value, patients were divided into two groups with relatively high and low levels of DcR3 expression. Among the 18 patients with high DcR3 expression, 83.3% (15/18) showed metastases to the second level lymph nodes. In the other 44 patients with low DcR3 expression, only 20.5% (9/44) had secondary nodal involvement. Logistic regression analysis for stage pN2 revealed that high DcR3 expression was an independent risk factor. CONCLUSIONS: Gastric cancer patients with high DcR3 expression presented more advanced pN2 disease than those with low DcR3 expression. Preoperative checking DcR3 expression might be an additional approach to imaging modalities for evaluating N stages in gastric cancer to guide the operative procedures.

A practical scoring system based upon ROC analysis for evaluating potential lymph nodes metastasis during gastric surgery.

BACKGROUND AND OBJECTIVES: Current preoperative N staging does not offer an accurate estimation of lymph node involvement. We establish a new scoring system for predicting N stages to guide a rational lymphadenectomy for gastric cancer. METHODS: Variables correlated with N stages were selected by multivariate stepwise logistic regression analysis. Variables granted the different scores according to the odds ratio (OR). Receiver operating characteristic (ROC) analysis was used to generate scoring ranges from N0 to N3. The agreement between predicted N staging and actual pN classification was analyzed using kappa statistics. RESULTS: Tumor size, depth of invasion, and histological types were selected to establish the scoring system. Scores 0-4, 5-7, 8-9, and 10-13 were postulated to predict N0-3, respectively. The predicted N stage has good agreement with the actual pN classifications. The negative predictive values for N0-3 were 87.0, 86.4, 90.4, and 90.2%; the positive predictive values were 74.7, 62.8, 57.3, and 69.6%, respectively. The accuracy is 82% for N0-1, and 83.7% for N2-3. CONCLUSIONS: The new scoring system can predict the N stage of gastric cancer. With its good negative predictive value, it is possible to minimize the potential hazards of applying a more extensive lymph node dissection than necessary.

[The value of metastatic lymph nodes ratio in predicting the prognosis of patients with T3 gastric carcinoma].

OBJECTIVE: To evaluate the value of the metastatic lymph node ratio (MLR) in predicting the postoperatively survival time of patients with T(3) gastric carcinoma. METHODS: Eighty-nine patients with T(3) gastric carcinoma who underwent curative gastrectomy were analyzed retrospectively. The correlations between MLR, positive nodes and the total lymph nodes (15 or more) in histologic examination were analyzed using Spearman's correlation analysis. The influence of MLR and positive nodes on survival time of patients was identified with univariate Kaplan-Meier survival analysis and multivariate Cox proportional hazard model analysis. The predicting accuracy of MLR to death of patients within 2 years postoperatively was determined by receiver working characteristic curve and was compared with that of positive nodes. RESULTS: (1) The MLR did not correlate with the total lymph nodes in histologic examination (Spearman's correlation coefficient was -0.0022, P > 0.05), whereas positive lymph nodes did (correlation coefficient was 0.2504, P < 0.05). (2) Kaplan-Meier survival analysis identified that the MLR influenced significantly the survival time postoperatively (Log-rank chi(2) = 35.7470, P < 0.01). Cox proportional hazard model showed the high MLR was an independent poor prognostic factor (chi(2) = 7.9708, P < 0.01). (3) There was not difference between the area under the receiver working curve of MLR and positive nodes to predict the death of patients within 2 years postoperatively (P > 0.05). CONCLUSION: The MLR in T(3) gastric carcinoma is not correlated with the number of total lymph nodes examined on the condition that 15 or more lymph nodes were assessed in pathology. The predicting accuracy of MLR to death of patients with T(3) gastric carcinoma within 2 years postoperatively is same as, but not better than that of positive nodes if the extent of lymphadenectomy is optimal.

[A prognostic scoring system for preoperative prediction of lymph node metastases in gastric cancers].

OBJECTIVE: To establish a preoperative scoring system to predict the lymph node metastases (N) in gastric cancers. METHODS: The clinicopathologic data of 291 cases with gastric cancer were analyzed retrospectively. The factors influencing significantly actual lymph node status (pN) were selected through the univariate and the multivariate analysis, and the score of each factor was identified. Scores predicting different N stages were identified using receiver operating characteristic curves. The N stages defined by the score system were compared with the actual pN status using kappa statistics and diagnostic test. RESULTS: Tumor size, depth of invasion and histopathological types were selected to establish the scoring system. According to this score system, scores 0-4 predict N0, scores 5-7 predict N1, scores 8-9 predict N2 and scores 10-13 predict N3. There was a good agreement between N stages predicted by the scoring system and the actual pN status (weighted kappa = 0.605, u = 14.548, P < 0.0001). The crude agreement, positive predictive value and negative predictive value of the scoring system were 82.8%, 65.6% and 88.5%, respectively. CONCLUSION: The scoring system can provide accurate and reliable information to predict the lymph node metastases of gastric cancers preoperatively. It is simple and practical to use in clinical work and can help surgeons to choose an optimal extent of lymph node dissection for gastric cancer.

[Distribution of sentinel lymph nodes in gastric cancer and factors correlated with its metastasis].

OBJECTIVE: To investigate the distribution of sentinel lymph nodes in gastric cancer, and evaluate clinicopathologic characteristics leading its metastasis. METHODS: The location of metastatic lymph nodes was analyzed retrospectively in 27 patients of gastric carcinoma with solitary lymph node metastases, and in 80 cases metastasis was limited to only 1 station in Japanese nodal classification. The clinicopathologic characteristics of the patients with solitary lymph node metastases and 111 cases without lymph node metastases were compared. RESULTS: Twenty-five in 27 cases with solitary lymph node metastases were limited in level I. Skip metastasis occurred in 2 cases. Sentinel lymph nodes of 16 cases in 21 patients with the tumors in the lower and middle third stomach were located in less curvature (No. 3) and in greater curvature (No. 4). Sentinel lymph nodes of 3 cases in 6 patients in the upper third stomach were located in right cardia (No. 1). Multivariate analysis showed that the frequency of sentinel lymph node metastasis of pT(3) lesion was significantly higher than that of pT(1) lesion with an odds ratio of 4.926 (P < 0.01). The frequency of sentinel lymph node metastasis in the tumor located in the upper third stomach was significantly higher than that in lower third stomach, with an odds ratio of 4.381 (P < 0.05). Early gastric cancer had lower risk for sentinel lymph node metastasis than that in Borrmann type I cancer, with an odds ratio of 0.082 (P < 0.05). CONCLUSIONS: Majority of sentinel lymph nodes are located in the regional perigastric lymph node groups close to the tumor. Skip metastasis is rare. Depth of invasion and location of tumor are correlated with sentinel lymph node metastasis. Sentinel lymph node assessment can instruct to determine extent of lymph node dissection for gastric cancer.

Safe major abdominal operations: hepatectomy, gastrectomy and pancreatoduodenectomy in elder patients.

AIM: To evaluate the impact of advanced age on outcome after hepatectomy, gastrectomy and pancreatoduodenectomy. METHODS: Two hundreds and eleven patients undergone hepatectomy, gastrectomy and pancreatoduodenectomy from January 1998 to September 2002 were analyzed retrospectively. Clinicopathologic features and operative outcome of 83 patients aged 65 years or more were compared with that in 128 younger patients aged less than 65 years. RESULTS: The nutritional state, such as pre-operation level of serum albumin and hemoglobin in the older patients was poorer than that in the younger patients. The older patients had higher comorbidities than the younger patients (48.2% vs 15.6%). No significant difference was observed in perioperative mortality, and complication rate between the older and younger patients (2.4% vs 1.6% and 22.9% vs 20.3%, respectively). Multivariate analysis demonstrated that pancreatoduodenectomy, hepatectomy with resection of more than 2 segments and comorbidities were independent predictors of postoperative complication, whereas age was not (P=0.3172). CONCLUSION: It is safe for patients aged 65 years or more to undergo hepatic, pancreatic and gastric resection if great care is taken during perioperative period.