Impact of gender and body mass index on surgical outcomes following gastrectomy: an Asia-Pacific perspective / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Although surgeons may expect difficulties in performing gastrectomy on patients with high body mass index (BMI), it is not always the case, especially regarding patient gender. The aim of this study was to evaluate gender as a predictive factor of surgical outcomes related to obesity, as defined by the World Health Organization for the Asia-Pacific region.</p><p><b>METHODS</b>Data of short-term surgical outcomes were obtained from 243 patients following open curative distal subtotal gastrectomy for gastric adenocarcinoma. Patients were classified into two groups by gender, and were further classified by BMI into group A (BMI ≥ 25 kg/m(2)) and group B (BMI < 25 kg/m(2)). The operation time, extent of surgical bleeding, the number of resected lymph nodes, postoperative hospital stay, serum amylase levels, white blood cell count and postoperative complications were accessed for each group.</p><p><b>RESULTS</b>Within male patients, the operation time tended to be longer in group A, albeit without statistical significance (P = 0.075). However, the extent of surgical bleeding was significantly larger in group A (P = 0.002). Within female patients, there were no such differences. When comparisons were made between male and female patients in group A, the operation time was significantly longer in male patients (P = 0.019). The extent of bleeding tended to be larger in males, albeit without statistical significance (P = 0.065). No such differences were seen when comparisons were made between male and female patients in group B.</p><p><b>CONCLUSIONS</b>Disparity in surgical outcomes between male and female patients does exist, particularly in patients with high BMI. Gender adjustment of BMI must be performed when predicting surgical outcomes.</p>

Early Gastric Cancer with Signet Ring Cell Histology Remained Unresected for 53 Months

The natural course of untreated patients with signet ring cell carcinoma of the stomach remains poorly understood while assumptions have been made to distinguish it from other types of gastric cancer. A 74-year-old Korean woman was diagnosed with early gastric cancer with signet ring cell histology and refused surgery. A satellite lesion was identified 46 months after the initial diagnosis. The patient finally agreed to undergo distal subtotal gastrectomy 53 months following the initial diagnosis. Postoperative histological examination of both lesions confirmed signet ring cell carcinoma associated with submucosal invasion. There was no evidence of lymph node metastasis.

Predictive Factors for Lymph Node Metastasis in Submucosal Gastric Cancer

PURPOSE: Lymph node metastasis is an important prognostic factor in patients with early gastric cancer. Therefore, we analyzed the predictive factors for lymph node metastasis in submucosal gastric cancer and explored the feasibility of minimally invasive surgery. METHODS: The clinicopathological features of 317 patients with submucosal gastric cancer, who underwent radical gastrectomy with lymph node dissection at Department of Surgery, Keimyung University School of Medicine from January 2003 to December 2007, were examined retrospectively. The lesions were divided into 3 layers according to the depth of submucosal invasion of the cancer cell (SM1, SM2, and SM3). We analyzed the clinicopathological variables regarding lymph node metastasis. RESULTS: Of the 317 patients, 74 patients (23.3%) had lymph node metastasis. Tumor size, histological type, Lauren classification, depth of invasion, lymphatic invasion, vascular invasion, and perineural invasion showed a positive correlation with lymph node metastasis by univariate analysis. In multivariate analysis, tumor size (> or =4 cm vs <2 cm, P=0.034 and 2~4 cm vs <2 cm, P=0.043), histological type (P=0.013), and lymphatic invasion (P=0.000) were significantly correlated with lymph node metastasis. CONCLUSION: Tumor size, histological type, and lymphatic invasion were independent risk factors for lymph node metastasis in submucosal gastric cancer. Minimally invasive surgery, such as endoscopic submucosal dissection may be applied to submucosal gastric cancer with a tumor size less than 2 cm, differentiated histological type, and no lymphatic invasion.

Comparative Analysis of before and after the Learning Curve and according to Obesity for Performing Laparoscopic Distal Gastrectomy in Gastric Cancer Patients

PURPOSE: Laparoscopy-assisted distal gastrectomy (LADG) has become a viable alternative treatment for patients suffering with early gastric cancer. Surgeons have long thought that obesity might increase the rate of intraoperative or postoperative complications. This study was performed to evaluate the impact of obesity, according to the learning curve, in patients who underwent laparoscopy assisted distal gastrectomy for gastric cancer. METHODS: We retrospectively reviewed 100 patients who had undergone LADG for gastric cancer between September 2004 and May 2007 at Keimyung University Dongsan Medical Center. We measured the degree of obesity by using the body mass index (BMI: kg/m(2)), and we compared the surgical outcomes between the low BMI group (BMI 25 kg/m(2), n=28). We further subdivided the patients into the surgeons' number of cumulative LADG cases, the early learning curve group (from the first patient to the 50th patient) and the late learning curve group (from the 51th patient to the 100th patient). We analyzed them in terms of the operation time, the amount of intraoperative bleeding, the number of retrieved lymph nodes, the rate of operative morbidity and the length of the postoperative hospital stay. RESULTS: There no significant differences between the high and low BMI groups in terms of the patients' clinicopathologic characteristics and surgical outcomes, but there was a statistically significant difference in the operation times between the high BMI (303.3 min) and low BMI groups (269.3 min, P=0.029). The postoperative morbidity was not different between the high BMI (25%) and low BMI groups (12.5%, P=0.12). However, when we subdivided the patients by the learning curve, there was a statistically significant difference for the operation time (360 vs 297 minutes, respectively), postoperative morbidity (41.7 vs 10.5%, respectively) and the postoperative hospital stay (15.5 vs 8.6 day, respectively) between the high BMI and low BMI groups at the early learning curve period. Especially for male patients, the early learning curve period showed significant differences in the operation time, the postoperative morbidity and the postoperative hospital stay between the high BMI and low BMI groups, but in case of the female patients, there was no difference in postoperative morbidity and the length of the postoperative hospital stay. At the late learning curve period, there was no difference according to gender and obesity. CONCLUSION: Obesity itself does not increase operative morbidity when performing LADG in patients with gastric cancer. However, at a surgeon's initial period of performing LADG, a careful approach seems to be required for male obese patients.

Comparison of Laparoscopy-assisted Distal Gastrectomy with Open Distal Gastrectomy for Early Gastric Cancer

PURPOSE: Laparoscopy-assisted distal gastrectomy (LADG) is gaining wider acceptance as a minimally invasive treatment for early gastric cancer. Generally; LADG, with extraperigastric lymph node dissection, is considered a technically more complicated procedure for gastric cancer than a conventional open distal gastrectomy (CODG). LADG, with extraperigastric lymph node dissection, for gastric cancers has previously been described, but the safety, efficacy and clinical benefits of these types of surgery are still unclear. To evaluate the short-term surgical validity, surgical outcome of a LADG, with extraperigastric lymph node dissection, was compared with that of a CODG in early gastric cancer patients. METHODS: A retrospective study of 80 patients with early gastric cancer (EGC), who underwent a LADG, with extraperigastric lymph node dissection, between September 2004 and August 2006, at Keimyung University Dongsan Medical Center, was performed. Over the same period, conventional open gastrectomies were performed in 97 patients, confirmed to have EGC from their pathology. Various clinicopathological parameters were evaluated from the medical records. RESULTS: The baseline characteristics, including gender, age, body mass index (BMI) and tumor size, were similar between the two groups. In the LADG group, the operation time was longer (P=0.000), but the blood loss was less (P=0.000) than in the CODG group. The postoperative recovery in the LADG group was faster, as reflected by the shorter time to pass gas and the shorter hospital stay, which resulted in significantly lower serum white blood cell count amylase and C-reactive protein levels on day 1. Pathological examinations showed the surgery to be equally radical in the two groups. CONCLUSION: According to this study; LADG, with extraperigastric lymph node dissection, is a safe and technically feasible procedure for the treatment of early gastric cancer. The LADG procedure provides several advantages to that of a conventional open distal gastrectomy; less inflammatory reactions, a rapid return of gastrointestinal function and a shorter hospital stay, with no decrease in the operative curability.

Splenosis Mimicking Carcinomatosis Peritonei in Advanced Gastric Cancer

Splenosis is the autotransplantation of fragmented splenic tissue that occurs as a result of traumatic splenic rupture or a routine splenectomy. Generally, splenic implants are numerous and located within the peritoneal cavity; peritoneum, omentum and abdominal viscera, and occasionally on extra-abdominal surfaces. Splenic implants are rarely clinically significant and are incidental found during an abdominal operation, but occasionally mimics primary or metastatic tumors, as seen on radiological studies. Herein, the case of a patient in whom multiple abdominal masses were identified as splenosis, but the initial radiographic finding was that of carcinomatosis peritonei.

Prognostic significance of age in curatively resected gastric cancer / 대한내과학회지

BACKGROUND: The purpose of this study was to clarify whether the patients' age is an independent prognostic factor in curatively resected gastric adenocarcinoma. METHODS: Clinicopathologic information was reviewed for consecutive patients undergoing curative gastrectomy for gastric cancer during 6-year period (Jan. 1996-Dec. 2001) at the Keimyung University School of Medicine at Daegu. Overall survival was examined by the Kaplan-Meier method, and multivariate analysis by Cox proportional hazards was used to identify whether age had independent prognostic significance for survival. RESULTS: The patients were divided into two groups: 838 patients (72.4%) with age of less than 65 years old, and 320 patients (27.6%) with age more than 65 years old. In these two groups, there were statistically differences in WHO classification, Lauren classification, vascular invasion, T stage, total stage, operational morbidity and mortality, and overall survival rate. The 5-year overall survival rate of age less than 65 years old was 87.8%, and 83.0% of age more than 65 years old (p=0.019). Multivariate Cox regression analysis revealed that age was an independent prognostic factor to predict overall survival in curatively resected gastric cancer (p=0.038). However, after excluding cases who died within 1 month after gastric resection, overall survival rate was significantly different between two groups (p=0.050), but Cox regression analysis showed that age was not an independent prognostic factor (p=0.054). CONCLUSION: The age is not an independent prognostic factor in curatively resected gastric cancer patients, and survival differences are due to an increased operative mortality in elderly patients.

Mutation Analysis of Genes Related to Gastrointestinal Stromal Tumors

PURPOSE: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor of the gastrointestinal tract. Recent studies have revealed much of the biological and genetics underpinning GISTs. METHODS: KIT, PDGFRA, NF2 and GPHN mutations were examined by PCR-SSCP and DNA sequencing. Immunohistochemical analyses of CD117, CD34, SMA, S-100 and desmin were performed in 11 GISTs cases, and each tumor classified as being either very low, low, intermediate or high risk. RESULTS: Mutation in exon 11 of KIT was identified in 6 of the 11 GISTs, but mutations in exon 9, 13 and 17 of KIT were not detected. Three cases lacking KIT mutations showed PDGFRA mutations. No NF2 mutations were detected. GPHN gene mutation in exon 1 was identified in one case, which showed a simple point mutation in exon 11 of KIT. In a correlation between the mutation types and risk of aggressive behavior, four tumors involved multiple ( >2 codons) KIT mutations and one showed a point mutation of KIT plus a GPHN mutation were high risk, but one tumor with a point mutation of KIT showed a low risk. Three tumors having a PDGFRA mutation were of intermediate or very low risk. CONCLUSION: Mutations at exon 9, 13 or 17 of KIT and a NF2 mutation are considered rare in sporadic GIST. KIT and PDGFRA mutations appeared to be alternatives. A GPHN mutation occurring with a KIT mutation may be a secondary change in the pathogenesis of GIST, as the KIT mutation is a major event in GIST. KIT mutant GIST may have a poorer prognosis than PDGFRA mutant GIST.

Preoperative Predictive Factors of Lymph Node Metastasis in Early Gastric Cancer

PURPOSE: Early gastric cancer (EGC) is defined as gastric cancer confined to the mucosa or submucosa, regardless of lymph node (LN) metastasis. LN metastasis is the most important factor in the treatment of EGC. If LN metastasis is predicted before or during surgery, function preserving surgery, such as endoscopic mucosal resection, laparoscopic partial gastrectomy, and pylorus preserving gastrectomy, without radical LN dissection, can be applied. This study was undertaken to determine the factors affecting LN metastasis and to aid in planning therapeutic approaches for such patients. METHODS: A retrospective study was performed on 1, 203 patients with EGC, who had undergoing a gastrectomy, with lymphadectomy, between 1990 and 2003 at the Keimyung University, Dongsan Medical Center. We analyzed tumor size, depth of invasion, macroscopic, and histologic types and lymph node metastasis using preoperative endoscopy and radiological findings. RESULTS: The incidence of EGC of all gastric cancer has increased annually. Of the 1, 203 patients, 54.2% and 45.8% had mucosal and submucosal cancers, respectively. The incidences of LN metastasis were 4.0% and 23.0% in mucosal and submucosal cancers, respectively. There was no LN metastasis in mucosal cancer, with a tumor size of less than 1 cm (0/169). In the elevated and flat types, the size of the tumors were between 1 and 2 cm, and there was no LN metastasis (0/40), (0/28), but with the depressed type there was an LN metastasis rate of 6.1%. In the well differentiated type, there were 0.5 (1/193) and 12.9% (11/85) LN metastasis in the mucosal and submucosal cancers, respectively. CONCLUSION: A gastrectomy without LN dissection can be applied for EGC less than 1 cm in size and to all well differentiated types of mucosal cancer. Also, it can be applied to elevated and flat EGC types less than 2 and 1 cm in size in mucosal cancer and less than 1 cm sized in submucosal cancers, respectively. A conventional gastrectomy, with LN dissection, is recommended in other EGC types.

Prognostic Significance of Immunohistochemical Expression of p53 and Retinoblastoma Gene Protein (pRB) in Curatively Resected Gastric Cancer

BACKGROUND: The aim of this study was to determine the prognostic significance of the expression of p53 and retinoblastoma (Rb) gene products in cases of curatively resected gastric adenocarcinoma, by immunohistochemical analysis. METHODS: Between January 1996 and December 2001, 736 curatively resected gastric cancer patients underwent immunohistochemical staining for p53 or Rb proteins (pRb), and we retrospectively analyzed the correlation of our results with the clinical outcomes of these cases. RESULTS: High levels of expression of p53 (> 25% p53-positive cells) and Rb (> 50% Rb-positive cells) proteins were detected in 40.1% and 43.7% of cases, respectively. Tubular type was found to frequently exhibit higher levels of p53 expression (high expression in 44.2%) than signet ring cell type (high expression in 26.0%) (p=0.042). The incidence of vascular invasion was lower in the high pRb expressors (43.2%) than in the pRb low expressors (56.8%), but this was not a statistically significant discrepancy (p=0.063). Preoperative CEA levels were found to be low in high pRb expressors: initial CEA level in the high pRb expressors was 2.31 +/- 3.30 ng/mL, and was 5.18 +/- 24.80 ng/mL in the low pRb expressors (p=0.033). Tumor depth and node metastasis were both independent of the levels of expression of p53 and Rb proteins. The seven-year overall survival rate and relapse-free survival rates of patients were 87.2% and 75.7%, respectively. Multivariate Cox regression analysis indicated that tumor stage, tumor size, patient age and pRb expression were the significant prognostic factors with regard to overall survival, and tumor stage and age were both significant factors with regard to relapse-free survival. CONCLUSION: Immunohistochemical staining of retinoblastoma gene products was an independent prognostic factor for the prediction of overall survival in curatively resected gastric cancer patients.

Prognostic Significance of Immunohistochemical Expression of EGFR and C-erbB-2 Oncoprotein in Curatively Resected Gastric Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to investigate the prognostic significance of the expression of EGFR and C-erbB-2 gene products by immunohistochemical analysis for curatively resected gastric adenocarcinoma. MATERIALS AND METHODS: Between January 1996 and December 2001, 739 patients with curatively resected gastric cancer patients underwent Immunohistochemical staining for EGFR and C-erbB-2 proteins, and we retro spectively analyzed their correlation with the clinical outcome. RESULTS: The overexpressions of EGFR and C-erbB-2 were 25.4% and 26.2%, respectively. The overexpressions of EGFR was associated with the more poorly differentiated tumor (p=0.000) and with neuronal invasion (p=0.03). Overexpression of C-erbB-2 was associated with less vascular invasion (p=0.001). Tumor depth or node metastasis was not related to the overexpression of EGFR or C-erbB-2. The seven-year overall survival and relapse-free survival rates were 87.2% and 75.8%, respectively. Upon multivariate Cox regression analysis, the tumor stage, tumor size and patient age were important prognostic factors for overall survival, and tumor stage was the important factor for relapse-free survival. Overexpressions of EGFR or c-erbB-2 were not significant prognostic factors. CONCLUSION: Immunohistochemical staining of EGFR and C-erbB-2 gene products were not independent prognostic factors for predicting the overall survival and the relapse-free survival in curatively resected gastric cancer.

Posttraumatic Intestinal Stenosis

We report a case of posttraumatic intestinal stenosis (PIS), an uncommon sequela of blunt abdominal trauma, in which injury to the mesentery and bowel wall results in later focal ischemic stricture of that segment. We present CT images at the time of trauma and 3 weeks later when clinical signs of intestinal obstruction occurred. At surgery, a stenotic small bowel loop was found adjacent to a healed defect in the mesentery. Histologic examination of the resected segment showed mucosal and submucosal ischemia with mucosal ulceration, mural inflammation, and fibrosis. PIS subsequent to a mesenteric tear should be included in the differential diagnosis for a patient with a history of blunt abdominal trauma and signs of intestinal obstruction.

Classification and Clinical Evaluation of Gastrointestinal Stromal Tumor: Immunohistochemical Expression of CD117, CD34, alpha- Smooth Muscle Actin, S-100

PURPOSE: Gastrointestinal stromal tumors (GISTs) represent a distinct and the most important subset of, mesenchymal tumors of the GI tract. Stromal tumors of the gastrointestinal tract have long been a source of confusion and controversy, with regard to their classification, differentiation, criteria of malignancy and prognostic features. METHODS: The 26 case studies of patients treated for a Gastrointestinal mesenchymal tumor, including leiomyomas, leiomyosarcomas and GISTs, between 1994 and 2002 at Keimyung University Hospital, were evaluated retrospectively. The cases were confirmed as leiomyomas, schwannomas, or GISTs by pathological re-examination. 20 of the cases were diagnosed as GISTs, from the pathological examination, and were chosen for the evaluation of their clinicopathological and immunohistochemical characteristics, using CD34, CD117, alpha-SMA and S-100 done. RESULTS: The new diagnoses of the mesenchymal tumors were a leiomyoma in 3 cases, a schwannoma in 3 and gastric stromal tumors in all 20. The immunohistochemical studies were positive for CD117 and CD34 in 95 and 75% of the gastric stromal tumors, respectively. The histopathological findings showed 5 benign tumors, 3 borderline tumors, and 12 malignant tumors in the 20 patients. CONCLUSION: The immunohistochemical marker (CD117) for KIT is a specific marker for GISTs among the tumors occurring in the stomach, and can be used to distinguish GISTs from true leiomyomas and gastric schwannomas. We also found that severe cellularity, atypism, intratumoral hemorrhage and necrosis, large size and a high mitotic count correlate with malignant behaviour and a poor prognosis.

Primary Gastric Choriocarcinoma

A choriocarcinoma is a rapidly invasive, widely metastatic, human chorionic gonadotropin (HCG)-producing neoplasm, which are usually intrauterine and gestational. A primary gastric choriocarcinoma is very rare, and its pathogenesis is still uncertain. A 56-year old man presented with gastrointestinal bleeding and a gastric mass, clinically suspicious of a gastric adenocarcinoma. Thus, a radical subtotal gastrectomy and lymph node dissection, with a reconstruction, was performed. The resected specimen was found to be a Borrmann type I tumor, and a histological examination showed it to be a primary gastric choriocarcinoma, with an associated adenocarcinoma and a syncytiotrophoblast, which was immunostained by human chorionic gonadotropin (HCG). The serum HCG level, on the 7th postoperative day, was found to be 2, 775 mIU/ml. Chemotherapy was administered two months after surgery, as the patient refused chemotherapy during the immediate post operative period. At that time, the tumor rapidly recurred and disseminated to the liver. The patient died three months after the initial diagnosis.

Primary Gastric Choriocarcinoma

A choriocarcinoma is a rapidly invasive, widely metastatic, human chorionic gonadotropin (HCG)-producing neoplasm, which are usually intrauterine and gestational. A primary gastric choriocarcinoma is very rare, and its pathogenesis is still uncertain. A 56-year old man presented with gastrointestinal bleeding and a gastric mass, clinically suspicious of a gastric adenocarcinoma. Thus, a radical subtotal gastrectomy and lymph node dissection, with a reconstruction, was performed. The resected specimen was found to be a Borrmann type I tumor, and a histological examination showed it to be a primary gastric choriocarcinoma, with an associated adenocarcinoma and a syncytiotrophoblast, which was immunostained by human chorionic gonadotropin (HCG). The serum HCG level, on the 7th postoperative day, was found to be 2, 775 mIU/ml. Chemotherapy was administered two months after surgery, as the patient refused chemotherapy during the immediate post operative period. At that time, the tumor rapidly recurred and disseminated to the liver. The patient died three months after the initial diagnosis.

Clinicopathological Analysis of Recurrent Gastric Cancer after Curative Resection

PURPOSE: Despite radical lymph node dissections and combined resections, experiences of recurrent gastric carcinomas are not infrequent. The prognosis of a recurrent gastric carcinoma has not improved despite the considerable recent progress in their treatment. This study was designed to investigate the correlation between the clinicopathological characteristics and recurrence patterns in gastric cancer following a curative resection. METHODS: The medical records of 1, 163 patients, who had undergone curative resection for primary gastric cancer, in Department of Surgery, Keimyung University School of Medicine, between January 1990 and December 1996, were retrospectively reviewed. The clinicopathological characteristics, relationship of each factor with the pattern of recurrence and the rate of recurrence were analyzed. RESULTS: Recurrent gastric cancer was confirmed in 350 patients (30.09%). The mean time interval to recurrence was 20.41+/-15.94 months. Of the patients with a recurrence, 231 (66.0%), 109 (31.1%) and 10 (2.9%) were early (0~2 years), intermediate (2~5 years) and late (more than 5 years) recurrences, respectively. 180 (51.4%), 90 (25.7%), 51 (14.6%) and 29 (8.3%) were peritoneal, loco-regional, distant and mixed recurrences, respectively. The recurrence patterns after a curative resection for a gastric carcinoma were related to the tumor location, differentiation, N-category and TNM stage. In a multivariate analysis, the size of tumor, Borrmann's classification, T-category, N-category, vascular invasion and Stage were found to be independent prognostic factors for a recurrence. CONCLUSION: Most recurrences of gastric carcinomas, following a curative resection, were found within 24 months. Therefore, the close follow up, with clinicopathological factors, is very important during this period, and might facilitate the early detection of a recurrence.

Expression of Survivin and HIAP-1 in Korean Gastric Cancers

PURPOSE: Dysregulation of apoptosis may attribute to development of cancer by abnormally prolonging cell viability with accumulation of transforming mutations. Survivin and HIAP (Human Inhibitors of Apoptosis)-1 were recently described as apoptosis inhibitors. Their pathogenic roles in gastric cancer are largely unknown. In the present study, we examined the expression of survivin and HIAP-1 in gastric cancer tissues and cell lines in order to elucidate the roles of survivin and HIAP-1 in the process of gastric carcinogenesis. MATENRIALS AND METHODS: Eight gastric cancer cell lines and five gastric cancer tissues were studied. The expression of survivin and HIAP-1 were evaluated by reverse transcription -polymerase chain reaction (RT-PCR), immunohistochemistry, and Western blot. RESULTS: Western blot and RT-PCR analysis revealed survivin and HIAP-1 expression in all gastric cancer cell lines. Increased expression of survivin and HIAP-1 were found in all cases of gastric cancer tissues compared to normal tissues by Western blot analysis. In immunohistochemical analysis tumor cells were stained with anti-survivin and anti-HIAP-1 antibodies. Cell cycle dependence of survivin expression was preserved in gastric cancer cell lines. CONCLUSION: The results indicate that increased expression of survivin and HIAP-1 genes may play an important role in gastric cancer.

Analysis of Prognostic Factors and Outcome of Early Gastric Cancer with and without Lymph Node Metastasis

PURPOSE: Lymph node (LN) metastasis and depth of invasion are known to be prognostic factors in early gastric cancer (EGC). This study was designed to determine the clinicopathological features of EGC with and without LN metastasis and an appropriate procedure for EGC. METHODS: The authors retrospectively reviewed 489 patients with EGC who underwent curative resection with LN dissection between January 1990 and December 1997 at the Department of Surgery, Keimyung University Dong San Medical Center. The authors divided the 489 patients into two groups. Group 1: EGC with LN metastasis, Group 2: EGC without LN metastasis. We analyzed and compared the clinicopathologic features (age, sex, tumor location and size, gastric resection and LN dissection, macroscopic type, depth of invasion, histological type, Lauren classification and lymphatic and vascular invasion) of the two groups. RESULTS: The incidence of EGC among all gastric cancer was 29.1% and increased annually (19.1% in 1990, 31.5% in 1994 and 40.2% in 1997). The incidence of LN metastasis was 16.2% (79/489) with 7.2% in mucosal cancer and 26.7% in submucosal cancer. Univariate analysis of 12 prognostic factors revealed only 4 factors, that were statistically significant: depth of invasion, tumor size, histologic type and lymphatic invasion. Multivariate analysis of these 4 significant prognostic factors did not yield significant results but the risk ratio revealed depth of invasion, tumor size, histological type and lymphatic invasion occurred in order of decreasing frequency. The five-year survival rate of EGC was90.83% (91.82% in EGC with LN metastasis and 85.80% in EGC without LN metastasis, p=0.0242). The relationship between the depth of invasion, macroscopic type, tumor size and LN metastasis revealed there was no LN metastasis in tumors of less than 2.0 cm in size in the elevated type (both in mucosal and submucosal cancer) and less than 1.0 cm in the size in the depressed type (only in mucosal cancer). CONCLUSION: Gastrectomy without LN dissection can be applied for EGC less than 2.0 cm in size in elevated types (both in mucosal and submucosal cancer) and less than 1.0 cm in size in depressed types (only in mucosal cancer). Conventional gastrectomy with LN dissection is recommended in other early gastric cancer.

Cancer Incidence in Daegu in 1997~98: The First Results of the Daegu Cancer Registry / 대한암학회지

PURPOSE: A population-based cancer registry was set up in January 1, 1997 to estimate the incidence of cancer in Daegu, South Korea. MATERIALS AND METHODS: Data sources for case-finding and abstracting were hospital inpatients, other sources in hospitals other than inpatients, and private pathology laboratories. The registered cases were matched against two external databases, the death certificate and medical insurance claims. RESULTS: A total of 7,837 cases (4,203 males, 3,634 females) were registered in 1997~98 excluding 2,718 cases of DCN. The crude incidence rates of all cancers combined were 170.7/100,000 (ASR 255.0) in males and 149.8 (ASR 154.4) in females. In males, the most common cancer was stomach (47.3, ASR 69.0), followed by liver (28.0, ASR 37.6), lung (26.0, ASR 44.1), colorectum (14.9, ASR 23.3),urinary bladder (4.5, ASR 7.0) and prostate (3.5, ASR 7.0). The most common cancer in females was stomach (25.8, ASR 26.9), followed by breast (21.7, ASR 20.4), cervix uteri (21.1, ASR 20.4), colorectum (14.9, ASR 16.0), lung (9.9, ASR 11.0), liver (9.3, ASR 10.1), and thyroid (6.1, ASR 5.7). The overall percentage of microscopically verified and the DCN% were 80.3%, 27.7% in males and 88.7%, 20.7% in females, respectively. CONCLUSION: These results show that the incidence level of all cancers combined in both sexes in Daegu is approaching that of other industrialized regions in Asia as well as in the world.

Expression of bcl-2 and p53 Protein in Primary Gastric Lymphomas

The bcl-2 gene is a proto-oncogene which extends cell survival by blocking apoptosis. Bcl-2 expression has been detected in many types of nodal and MALT lymphoma. The p53 gene is a tumor suppressor gene and p53 mutation is the most common genetic alteration in human malignancies. The relationship between the expression of bcl-2 and p53 protein in primary gastric lymphoma has been rarely reported. The authors investigated the expression of bcl-2 and p53 protein in 37 cases of primary gastric lymphoma by immunohistochemical method using bcl-2 and p53 monoclonal antibodies. There were five cases of low grade B-cell MALT lymphomas and thirty two cases of high grade B-cell lymphomas. Fifteen of 37 cases (41%) showed bcl-2 protein expression in the cytoplasm of tumor cells and 26 cases (70%) showed p53 protein expression in the nucleus of tumor cells. Bcl-2 protein was detected in 4 of 5 (80%) low grade MALT lymphomas, and in 11 of 32 (34%) high grade lymphomas. There was no significant correlation between bcl-2 expression and histologic grade of primary gastric lymphomas (p>0.05). p53 protein was positive in 25 of 32 (78%) high grade lymphomas, and in 1 of 5 (20%) low grade MALT lymphomas. The expression of p53 protein is significantly higher in high grade lymphoma than in low grade MALT lymphoma (p<0.05). The p53 expression in the bcl-2 negative cases (86%) was significantly higher than in the bcl-2 positive cases (47%). There was an inverse relationship between bcl-2 and p53 expression in primary gastric lymphoma. These results suggest that bcl-2 and p53 expression in primary gastric lymphoma may be involved in the transition from low grade MALT lymphoma to high grade lymphoma.