[Relationship between sphingosine kinase 1 expression and tumor invasion, metastasis and prognosis in gastric cancer].

OBJECTIVE: To explore the clinical significance of sphingosine kinase 1 (SPHK1) in the invasion, metastasis and prognosis of gastric cancer. METHODS: Immunohistochemistry was employed to analyze the expression of SPHK1 in 206 clinicopathologically characterized gastric cancer cases from January 2001 to December 2005 at Zhejiang Provincial People's Hospital. RESULTS: SPHK1 protein was detected in 3 (7.5%) of 40 human non-tumor mucosa. All samples expressed the protein at a low level. SPHK1 protein was detected in 181 (87.9%) of 206 human gastric cancer cases. An elevated expression of SPHK1 protein was detected in 126 (61.2%) tumors. And SPHK1 protein was up-regulated in gastric cancer lesions compared with adjacent noncancerous tissues (P = 0.001). The expression of SPHK1 was correlated with the depth of invasion, lymph node metastasis, distant metastasis and TNM stage (P = 0.039, 0.003, 0.020, 0.003). In stages I-II and III, the 5-year survival rate of the patients with a high expression of SPHK1 was significantly lower than those with a low expression (53.6% (15/28) vs 68.6% (24/35), 7.8% (6/77) vs 30.8% (12/39), P = 0.009, 0.006). In stage IV, the expression of SPHK1 was not correlated with the 5-year survival rate (P > 0.05). Further multivariate analysis suggested that lymph node metastasis, distant metastasis, TNM stage and the up-regulation of SPHK1 were independent prognostic indicators for gastric cancer. CONCLUSION: The expression of SPHK1 in gastric cancer is significantly associated with lymph node metastasis, distant metastasis and a poor prognosis. SPHK1 may become a useful marker of predicting tumor progression and prognosis.

[Value of reoperation in the treatment of recurrent gastric cancer].

OBJECTIVE: To determine the value of reoperation in the treatment of recurrent gastric cancer. METHODS: Clinical and survival data of 85 patients undergoing reoperation for recurrent gastric cancer from January 1986 to December 2003 were studied retrospectively. RESULTS: Among 85 cases, there were 46 cases with recurrence within the stump stomach and 58 cases recurred within 2 years post-operation. Resection was performed in 45 patients including 34 cases treated by radical resection and 11 cases by palliative residual stomach resection. The 1, 3, 5-year survival rate of 34 cases after radical resection was 86%, 57% and 21% respectively. The mean survival time of palliative and comprehensive treatment cases was 16 months (range: 6 - 26) while all patients undergoing reoperation without resection died within 6 months post-operation. CONCLUSION: An early diagnosis of recurrent gastric cancer depends on frequent re-examinations. Most postoperative recurrent gastric cancers, within the residual stomach, may be treated by re-operation.