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2.
BMC Surg ; 20(1): 42, 2020 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-32122361

RESUMO

BACKGROUND: We herein report a rare case of an ectopic bronchogenic cyst of the gastric cardia. The initial diagnosis was a gastrointestinal stromal tumor (GIST); however, postoperative pathologic examination confirmed that it was a bronchogenic cyst. CASE PRESENTATION: A 62-year-old woman visited our hospital for abdominal pain. The diagnosis prior to surgery was a GIST. Computed tomography imaging showed that the mass was located in the gastric cardia on the side of the lesser curvature. During the surgical exploration, it was noted that the tactility of the mass was not consistent with a GIST. Thus, we decided to perform local resection of the mass and part of the gastric wall without wedge resection. The pathological examination revealed a bronchogenic cyst. CONCLUSIONS: This case suggests that a bronchogenic cyst should be considered as a differential diagnosis of a GIST. It is also a unusual but necessary situation should be considered when explaining the etiology of a bronchogenic cyst.


Assuntos
Cisto Broncogênico/diagnóstico , Tumores do Estroma Gastrointestinal/diagnóstico , Neoplasias Gástricas/diagnóstico , Dor Abdominal/etiologia , Cárdia/patologia , Diagnóstico Diferencial , Feminino , Tumores do Estroma Gastrointestinal/patologia , Humanos , Pessoa de Meia-Idade , Neoplasias Gástricas/cirurgia , Tomografia Computadorizada por Raios X
3.
Khirurgiia (Mosk) ; (2): 79-83, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32105260

RESUMO

Esophagocardiomyotomy followed by anterior fundoplication is a standard treatment of achalasia cardia, whereas cruroraphy with complete or partial posterior fundoplication is carried out for hiatal hernia and gastroesophageal reflux disease. The most common postoperative complications of hiatal hernia repair are dysphagia due to malformed cuff, phenomenon of 'telescope' and slow gastric emptying syndrome. Recurrent hiatal hernia is observed in 3-15% of cases. Currently, there are a lot of reports devoted to redo antireflux procedures in patients with hiatal hernia. The goal of the study is to demonstrate difficulties of diagnosis and treatment in a patient with achalasia cardia after previous hiatal hernia repair.


Assuntos
Acalasia Esofágica , Hérnia Hiatal , Herniorrafia , Laparoscopia , Cárdia , Diagnóstico Diferencial , Acalasia Esofágica/diagnóstico , Acalasia Esofágica/etiologia , Fundoplicatura , Hérnia Hiatal/cirurgia , Herniorrafia/efeitos adversos , Humanos , Resultado do Tratamento
4.
World J Gastroenterol ; 25(44): 6571-6578, 2019 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-31802836

RESUMO

BACKGROUND: Most melanomas identified in the stomach are metastatic; primary gastric melanoma (PGM) is extremely rare, and the relevant studies are relatively scarce. PGM may be incorrectly diagnosed as other gastric malignant tumor types. CASE SUMMARY: We describe a rare case of PGM confirmed through long-term clinical observation and pathological diagnosis. A 67-year-old woman presented to our hospital with recurrent chest tightness and chest pain. Digital gastrointestinal radiography revealed a circular shadow in the gastric cardia. Computed tomography (CT) revealed a heterogeneous tumor with uneven enhancement. Enlarged lymph nodes were noted in the lesser curvature of the stomach. On magnetic resonance imaging (MRI), T1- and T2-weighted imaging revealed hyperintensity in and hypointensity in the tumor, respectively, both of which increased substantially after uneven enhancement. Near total gastrectomy was performed, and the tumor was pathologically confirmed to be a gastric melanoma. Because no other possible primary site of malignant melanoma was suspected, a clinical diagnosis of PGM was made. The patient was followed for nearly 5 years, during which she received CT reexamination, but no recurrence or metastasis was observed. CONCLUSION: Certain imaging characteristics could be revealed in PGM. Imaging examination can be of great value in preoperative diagnosis, differential diagnosis, and follow-up of patients with PGM.


Assuntos
Cárdia/diagnóstico por imagem , Melanoma/diagnóstico , Neoplasias Gástricas/diagnóstico , Idoso , Cárdia/patologia , Cárdia/cirurgia , Diagnóstico Diferencial , Feminino , Seguimentos , Gastrectomia , Humanos , Imagem por Ressonância Magnética , Melanoma/patologia , Melanoma/cirurgia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
5.
Zhonghua Yi Xue Za Zhi ; 99(47): 3687-3693, 2019 Dec 17.
Artigo em Chinês | MEDLINE | ID: mdl-31874491

RESUMO

Objective: To assess the feasibility, safety, and efficacy of a novel fully covered radioactive stent for the treatment of advanced esophageal and gastric cardia cancer. Methods: Data of 122 patients, who underwent esophageal radioactive stent placement for advanced esophageal or gastric cardia cancer between January 2012 and September 2017 in Zhongda Hospital, were retrospectively analyzed. Patients were divided into the novel stent group (n=59; 45 males, 14 females; mean age 73±10 years old) and the conventional stent group (n=63; 51 males, 12 females; mean age 72±9 years old), according to the types of radioactive stents. No significant difference was found between the two groups in baseline characteristics (all P>0.05). Outcomes were measured in terms of technical success, dysphagia score, stent restenosis, stent migration, major complications, and overall survival. Results: The technical success rate was 98.3% in the novel stent group, and 100.0% in the conventional stent group (P=0.484) . The dysphagia scores 3 days after surgery decreased from 3.27±0.45 and 3.37±0.49 to 1.25±0.66 and 1.32±0.50, respectively (all P<0.01), and the variances were comparable (P=0.709). Compared with conventional stents, novel stents were significantly associated with a decreased in the rate of stent restenosis, 11.9% vs 27.0%; cause-specific hazard ratio 0.387, 95%CI 0.160-0.934 (P=0.035); sub-distributional hazard ratio 0.401, 95%CI 0.167-0.963 (P=0.041), while the stent migration rate was statistically comparable (13.6% vs 6.3%, P=0.181). There was no significant difference between the novel stent group and the conventional stent group in major complications (all P>0.05), including moderate-severe chest pain (22.0% vs 25.4%), hemorrhage (11.9% vs 11.1%), fistula formation (1.7% vs 4.8%), and aspiration pneumonia (5.1% vs 6.3%). The median overall survival was 146(95%CI 115-177) days in the novel stent group, and 147(95%CI 98-196) days in the conventional stent group, and no significant difference was found (P=0.967). Conclusions: In patients with advanced esophageal or gastric cardia cancer,placement of a novel fully covered radioactive stent is safe and effective. This novel stent can relieve dysphagia rapidly and prevent stent restenosis effectively.


Assuntos
Transtornos de Deglutição , Neoplasias Esofágicas , Neoplasias Gástricas , Idoso , Idoso de 80 Anos ou mais , Cárdia , Neoplasias Esofágicas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Estudos Retrospectivos , Stents , Neoplasias Gástricas/cirurgia , Resultado do Tratamento
6.
Medicine (Baltimore) ; 98(50): e18397, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852158

RESUMO

There are still many controversies about the characteristics and prognosis of gastric cardia cancer. We aimed to evaluate the clinical characteristics and outcome between cardia and noncardia cancer. Also, we evaluated the clinical outcome according to etiologic factors.We performed a retrospective cohort study of 92 patients with gastric cardia cancer from January 2003 to December 2013. The patients with noncardia cancer were selected as age- and sex-matched control.The frequencies of gastroesophageal reflux disease (GERD) and negative Helicobacter pylori infection without atrophy were significantly higher in gastric cardia cancers, but there was no difference in the frequency of obesity. The frequency of early gastric cancers was 40.0%, which was significantly lower than that of noncardia cancer. The rate of recurrence, disease-free survival, and overall survival duration were significantly lower in gastric cardia cancers (P < .01), even though there was no significant difference in the rate of curative resection (R0). In terms of the etiologic factors, there were no differences of disease prognosis, regardless of the presence of GERD, obesity, and H pylori infection with associated gastritis.Gastric cardia cancer showed distinct clinical characteristics and a negative prognostic impact compared with gastric noncardia cancer.


Assuntos
Adenocarcinoma/etiologia , Cárdia , Neoplasias Gástricas/etiologia , Adenocarcinoma/diagnóstico , Adenocarcinoma/epidemiologia , Estudos de Casos e Controles , Intervalo Livre de Doença , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/epidemiologia , Refluxo Gastroesofágico/etiologia , Infecções por Helicobacter/epidemiologia , Humanos , Recidiva Local de Neoplasia/epidemiologia , Obesidade/epidemiologia , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/epidemiologia
7.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(11): 1115-1118, 2019 Nov 06.
Artigo em Chinês | MEDLINE | ID: mdl-31683397

RESUMO

Objective: To evaluate the effectiveness and benefit of the upper gastrointestinal cancer screening in Yangzhong city, Jiangsu province, from 2009 to 2015. Methods: From 2009 to 2015, 31 natural villages with high-incidence of upper gastrointestinal cancer were selected from Baqiao town, Youfang town and Xinglong sub-district in Yangzhong city. 13 776 residents aged 40 to 69 years old were recruited and screened for upper gastrointestinal cancer by using endoscopic examination and pathological diagnosis. Two economic evaluation methods, cost-effectiveness analysis and cost-benefit analysis, were performed to evaluate the current screening schemes. Results: The mean age of all respondents were (53.60±8.14) years old and the males accounted for 43.64% (6 012). A total of 502 cases of upper gastrointestinal tract lesions were detected, including 100 cases of cancer (62 cases of esophagus, gastric/cardiac early stage cancer, 38 cases of advanced stage cancer), 38 cases of severe esophageal hyperplasia/carcinoma in situ, and 15 cases of high-grade intraepithelial neoplasia in stomach/cardia, the detection rate was 0.73%, 0.28% and 0.11%, respectively; the early diagnosis rate was 75.16% (115/153). The cost of a precancerous lesion, a case diagnosed at the early stage and a positive case identified through the upper gastrointestinal cancer screening in Yangzhong City was 10 037.17, 30 460.64 and 22 895.25 RMB, respectively. The early detection cost index from 2009 to 2015 was 0.52, 0.56, 0.48, 0.48, 0.21, 0.30, and 0.26, respectively. The effectiveness-cost ratio from 2009 to 2015 was 3.41, 2.77, 2.66, 2.58, 4.99, 3.12, and 3.48, respectively. Conclusions: The project of early diagnosis and treatment of upper gastrointestinal tract cancer in Yangzhong city has achieved good results and benefits.


Assuntos
Cárdia/patologia , Detecção Precoce de Câncer/economia , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/economia , Programas de Rastreamento/economia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/economia , Adulto , Idoso , China/epidemiologia , Análise Custo-Benefício , Neoplasias Esofágicas/etnologia , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Neoplasias Gástricas/etnologia
8.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(11): 1119-1123, 2019 Nov 06.
Artigo em Chinês | MEDLINE | ID: mdl-31683398

RESUMO

Objective: To investigate the association between the promoter region-938 polymorphism of B-cell lymphoma/leukemia-2 (Bcl-2) gene and the esophageal cancer (EC) and gastric cardia adenocarcinoma (GCA) in Hebei Province. Methods: From 2007 to 2010, 145 esophageal cancer patients and 169 cardiaccancer patientsfrom the outpatient department of the Fourth Hospital of Hebei Medical Universitywereselected in a case group, and 195 non-tumor patients were selected in a control group during the same period. A questionnaire survey was used to collect information of research subjects. Pathological tissues were collected to extract genomic DNA and detect the genotype of bcl-2 gene -938. A multivariate logistic regression model was used to analyze the association between the bcl-2 gene locus 938 CC genotype and the EC and GCA. The interaction between age, gender, smoking, drinking, upper gastrointestinal family history and the bcl-2 gene locus 938 CC genotype was analyzed by likelihood ratio test. Results: The age of the esophageal and cardiac cancer groups was (56.3±8.3) and (57.1±8.4) years old, and that of the control group was (54.7±7.1) years old. The proportion of the bcl-2 gene locus 938 CC genotype in the esophageal group [48.3% (70/145)] and the cardiac cancer group [48.5% (82/169)] was higher than that in the control group [33.8% (66/195)] (both P values<0.05).Compared with the AA genotype, the risk of esophageal cancer and cardiac cancerin people with the CC genotype was 2.386 (1.20-4.76) and 2.564 (1.27-5.18) respectively. In the population with CC genotype, compared with the positive family history, drinking, and male, the negative family history, non-drinking, and female had a higher risk of esophageal cancer; compared with the non-smoking, negative family history, non-drinking and male, the smoking, positive family history, drinking, and female had a higher risk of cardiac cancer (all the P interaction values were <0.05). Conclusion: People with bcl-2 gene locus 938 CC genotype in Hebei Provincewere more likely to suffer from the esophageal and gastric cardia adenocarcinoma.


Assuntos
Adenocarcinoma/genética , Cárdia/patologia , Neoplasias Esofágicas/genética , Genes bcl-2/genética , Predisposição Genética para Doença , Polimorfismo de Nucleotídeo Único/genética , Neoplasias Gástricas/genética , Adenocarcinoma/epidemiologia , Adenocarcinoma/patologia , Idoso , Estudos de Casos e Controles , China/epidemiologia , Neoplasias Esofágicas/epidemiologia , Neoplasias Esofágicas/patologia , Feminino , Genótipo , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/patologia
9.
Future Oncol ; 15(31): 3579-3585, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31650851

RESUMO

Aim: To determine the prevalence of Helicobacter pylori infection and correlation between H. pylori infection and single nucleotide polymorphism (SNPs) identified in gastric cardia adenocarcinoma (GCA) patients. Methods: A case control study was performed. 22 risks of GCA-related SNPs were identified by genotyping assay and the relationship between susceptibility loci for GCA and H. pylori infection was further analyzed. Results: Helicobacter pylori infection was associated with GCA significantly (odds ratio: 1.40; 95% CI: 1.29-1.53 p < 0.01). Five GCA risk SNPs had their genotypes significantly different between H. pylori positive patients and H. pylori negative patients. Conclusion: The interaction between SNPs susceptibility loci and H. pylori infection is associated with an increased risk of GCA.


Assuntos
Adenocarcinoma/etiologia , Cárdia/patologia , Infecções por Helicobacter/complicações , Infecções por Helicobacter/microbiologia , Helicobacter pylori , Polimorfismo de Nucleotídeo Único , Neoplasias Gástricas/etiologia , Adenocarcinoma/diagnóstico , Alelos , Suscetibilidade a Doenças , Estudo de Associação Genômica Ampla , Genótipo , Interações Hospedeiro-Patógeno , Humanos , Estadiamento de Neoplasias , Razão de Chances , Medição de Risco , Fatores de Risco , Neoplasias Gástricas/diagnóstico
10.
Obesity (Silver Spring) ; 27(9): 1520-1526, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31380608

RESUMO

OBJECTIVE: Esophageal adenocarcinoma (EA) and gastric cardia adenocarcinoma (GCA) are among the most rapidly increasing cancers in Western countries. Elevated BMI in adulthood is a known risk factor, but associations in early life are unclear. METHODS: This study assessed weight change between childhood and early adulthood in relation to EA/GCA. Measured weights and heights during childhood (7-13 years) and early adulthood (17-26 years) were available for 64,695 young men from the Copenhagen School Health Records Register and the Danish Conscription Database. Individuals were categorized as having normal weight or overweight. Linkage with the Danish Cancer Registry identified 275 EA/GCA cases. Hazard ratios (HR) and 95% CI were estimated using Cox proportional hazards regression. RESULTS: The risk of EA/GCA was 2.5 times higher in men who were first classified as having overweight at age 7 (HR = 2.49; 95% CI: 1.50-4.14) compared with men who were never classified as having overweight. Men who had persistent overweight at ages 7 and 13 and in early adulthood had an EA/GCA risk that was 3.2 times higher (HR = 3.18; 95% CI: 1.57-6.44). However, there was little evidence of increased EA/GCA risk for men with overweight during childhood and subsequent remittance by early adulthood. CONCLUSIONS: Persistent overweight in early life is associated with increased EA/GCA risk, which declines if body weight is reduced.


Assuntos
Adenocarcinoma/etiologia , Cárdia/fisiopatologia , Neoplasias Esofágicas/etiologia , Sobrepeso/complicações , Neoplasias Gástricas/etiologia , Adenocarcinoma/fisiopatologia , Adolescente , Adulto , Criança , Neoplasias Esofágicas/fisiopatologia , Feminino , Humanos , Masculino , Estudos Prospectivos , Fatores de Risco , Neoplasias Gástricas/fisiopatologia , Adulto Jovem
11.
Z Gastroenterol ; 57(8): 952-959, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31398766

RESUMO

AIMS: The aim of this study was to evaluate the short-term complications of submucosal tunneling endoscopic resection (STER) for large submucosal tumors (SMTs) originating from the muscularis propria (MP) layer in the esophagus and gastric cardia. METHODS: We performed 286 cases of STER from September 2012 to December 2017. The clinical data of patients with SMTs originating from the MP layer of 3.0-7.0 cm, who underwent STER procedure at the endoscopy center of Tianjin Medical University General Hospital, were collected retrospectively. Epidemiological data, tumor location, tumor size, procedure-related parameters, complications, and follow-up were included. RESULTS: A total of 27 (9.4 % [27/286]) patients were large-size SMTs, with a mean age of 51.9 ±â€Š9.4 years. The male/female ratio was 19:8. Of the 27 SMTs, 23 were located in the esophagus and 4 in the gastric cardia. The mean tumor size was 4.0 ± 1.1 cm. The en bloc resection rate was 85.2 % (23/27), and the complete resection rate was 100 % (27/27). Intra-operative perforation occurred in 2 patients (7.4 %) and post-operative perforation occurred in 2 patients (7.4 %). No other complications were observed. The average cost of the procedure was $3357.99 ± $1171.60 per inpatient stay (including both the procedure and an additional inpatient stay). The mean follow-up time was 15 ±â€Š10.1 months. No recurrence and metastasis occurred during the follow-up period. CONCLUSIONS: There is low risk of STER for the large-sized SMTs in the esophagus and gastric cardia, and the most common complication occurred during or after the procedure is perforation.


Assuntos
Cárdia/patologia , Ressecção Endoscópica de Mucosa/métodos , Neoplasias Esofágicas/cirurgia , Junção Esofagogástrica/cirurgia , Gastrectomia/métodos , Mucosa Gástrica/patologia , Mucosa Gástrica/cirurgia , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Neoplasias Esofágicas/patologia , Esôfago , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Resultado do Tratamento
12.
Am J Clin Oncol ; 42(7): 581-587, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31157623

RESUMO

BACKGROUND: The incidence of gastric cardia cancer (GCC) patients has been increasing, while the survival trends of GCC patients over time remains unclear. Thus, the aim of our study was to determine the survival trends of GCC patients over time using a population-based data in the United States. METHODS: A total of 9044 surgically resected GCC patients during 1988 to 2015 from the Surveillance, Epidemiology, and End Results (SEER) database were identified. The survival probabilities were calculated by Kaplan-Meier method and the different survival probabilities between groups were examined by log-rank test. RESULTS: The median overall survival time was 27 (interquartile range, 12 to 99) months, and the median disease-specific survival time was 32 (interquartile range, 13 to 320) months for GCC patients. There was a statistically significant increase in median overall survival time (17 to 46 mo; P<0.001) and disease-specific survival time (19 to 67 mo; P<0.001) from 1988 to 1997 to 2008 to 2015. More GCC patients were diagnosed at an early stage in recent years. Meanwhile, adequate lymph nodes examined (eLNs) were obtained in more GCC patients during surgery. Also, the proportion of GCC patients who received chemoradiotherapy increased significantly. Moreover, early diagnosis, adequate eLNs, and chemoradiotherapy were associated with mortality. CONCLUSIONS: The survival rates of surgically resected GCC patients had a significant improvement from 1988 to 1997 to 2008 to 2015 in the United States, which might relate to the early discovery of GCC, greater utilization of adequate eLNs, and chemoradiotherapy.


Assuntos
Gastrectomia/estatística & dados numéricos , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cárdia , Quimiorradioterapia Adjuvante , Feminino , Humanos , Estimativa de Kaplan-Meier , Excisão de Linfonodo , Linfonodos/patologia , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Programa de SEER , Neoplasias Gástricas/patologia , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia , Adulto Jovem
13.
Cir Esp ; 97(8): 465-469, 2019 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31060735

RESUMO

Five-year survival of tumors of the esophagogastric junction is 50%, in the most favourable stages and with the most effective adjuvant treatments. More than 40% of patients will have recurrences within a short period, usually the first year after potentially curative surgery. Survival after this recurrence is usually less than 6 months because treatment is not very effective, be it palliative chemotherapy, radiotherapy or surgical excision of single recurrences. As the detection of asymptomatic recurrences allows for earlier and more effective treatments to be used, the type and frequency of follow-up has an influence on survival.


Assuntos
Adenocarcinoma/mortalidade , Neoplasias Esofágicas/mortalidade , Junção Esofagogástrica , Recidiva Local de Neoplasia/mortalidade , Neoplasias Gástricas/mortalidade , Esôfago de Barrett/complicações , Cárdia , Neoplasias Esofágicas/terapia , Seguimentos , Humanos , Recidiva Local de Neoplasia/terapia , Prognóstico , Neoplasias Gástricas/terapia , Fatores de Tempo
15.
Gastroenterology ; 157(2): 349-364.e1, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31082367

RESUMO

In patients with Barrett's esophagus (BE), metaplastic columnar mucosa containing epithelial cells with gastric and intestinal features replaces esophageal squamous mucosa damaged by gastroesophageal reflux disease. This condition is estimated to affect 5.6% of adults in the United States, and is a major risk factor for esophageal adenocarcinoma. Despite the prevalence and importance of BE, its pathogenesis is incompletely understood and there are disagreements over the cells of origin. We review mechanisms of BE pathogenesis, including transdifferentiation and transcommitment, and discuss potential cells of origin, including basal cells of the squamous epithelium, cells of esophageal submucosal glands and their ducts, cells of the proximal stomach, and specialized populations of cells at the esophagogastric junction (residual embryonic cells and transitional basal cells). We discuss the concept of metaplasia as a wound-healing response, and how cardiac mucosa might be the precursor of the intestinal metaplasia of BE. Finally, we discuss shortcomings in current diagnostic criteria for BE that have important clinical implications.


Assuntos
Esôfago de Barrett/patologia , Células Epiteliais/patologia , Mucosa Esofágica/patologia , Adenocarcinoma/patologia , Adenocarcinoma/prevenção & controle , Esôfago de Barrett/diagnóstico , Esôfago de Barrett/epidemiologia , Cárdia/citologia , Cárdia/patologia , Transdiferenciação Celular , Progressão da Doença , Mucosa Esofágica/citologia , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/prevenção & controle , Junção Esofagogástrica/citologia , Junção Esofagogástrica/patologia , Mucosa Gástrica/citologia , Mucosa Gástrica/patologia , Humanos , Metaplasia/patologia , Estados Unidos , Cicatrização/fisiologia
17.
Gastric Cancer ; 22(6): 1121-1129, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-30989434

RESUMO

BACKGROUND: Defective mismatch repair (dMMR) and microsatellite instability (MSI) correlate with gastric cancer (GC) outcome. We hypothesized that MMR genetic polymorphisms that have low-penetrant effects but may cause heterogeneous MMR capability among individuals also affect GC outcome. METHODS: The polymorphisms rs1800734 in MLH1, rs2303428 and rs3732183 in MSH2, rs735943 in EXO1, and rs11797 in TREX1 were selected and analyzed in independent discovery and validation sets that included 167 and 593 patients, respectively. MSI was determined. RESULTS: In both the discovery and validation sets, the rs2303428 TC + CC genotype correlated with poor overall survival (OS) in non-cardia (P < 0.05) but not in cardia GC. Multivariate models showed that for OS of patients with non-cardia GC, the rs2303428 TC + CC genotype was an independent predictor in the validation set (HR 1.54; 95% CI 1.02-2.32; P = 0.040) and had a trend to be an independent predictor in the discovery set (HR 1.70; 95% CI 0.96-3.01; P = 0.067). Furthermore, in both patient sets, fluoropyrimidines-based adjuvant chemotherapy improved OS for non-cardia patients with the rs2303428 TC + CC genotype (HR 0.14; 95% CI 0.04-0.57; P = 0.006; and HR 0.29; 95% CI 0.15-0.58; P < 0.001, respectively) but not for those with the TT genotype. The rs2303428 genotypes were not associated with MSI frequency. The rs2303428 TC + CC genotype correlated with reduced expressions for thymidylate synthetase, P-glycoprotein and ERCC1 (P < 0.05) in non-cardia GC. CONCLUSIONS: The rs2303428 genotypes may predict prognosis and adjuvant chemotherapy benefit in non-cardia GC patients.


Assuntos
Reparo de Erro de Pareamento de DNA , Instabilidade de Microssatélites , Neoplasias Gástricas/terapia , Idoso , Cárdia/patologia , Quimioterapia Adjuvante , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo Genético , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Neoplasias Gástricas/genética , Neoplasias Gástricas/patologia , Taxa de Sobrevida
18.
World J Gastroenterol ; 25(14): 1640-1652, 2019 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-31011251

RESUMO

The gravest prognostic factor in early gastric cancer is lymph-node metastasis, with an incidence of about 10% overall. About two-thirds of early gastric cancer patients can be diagnosed as node-negative prior to treatment based on clinic-pathological data. Thus, the tumor can be resected by endoscopic submucosal dissection. In the remaining third, surgical resection is necessary because of the possibility of nodal metastasis. Nevertheless, almost all patients can be cured by gastrectomy with D1+ lymph-node dissection. Laparoscopic or robotic gastrectomy has become widespread in East Asia because perioperative and oncological safety are similar to open surgery. However, after D1+ gastrectomy, functional symptoms may still result. Physicians must strive to minimize post-gastrectomy symptoms and optimize long-term quality of life after this operation. Depending on the location and size of the primary lesion, preservation of the pylorus or cardia should be considered. In addition, the extent of lymph-node dissection can be individualized, and significant gastric-volume preservation can be achieved if sentinel node biopsy is used to distinguish node-negative patients. Though the surgical treatment for early gastric cancer may be less radical than in the past, the operative method itself seems to be still in transition.


Assuntos
Ressecção Endoscópica de Mucosa/métodos , Gastrectomia/métodos , Excisão de Linfonodo/métodos , Tratamentos com Preservação do Órgão/métodos , Neoplasias Gástricas/cirurgia , Cárdia/patologia , Cárdia/cirurgia , Ressecção Endoscópica de Mucosa/efeitos adversos , Gastrectomia/efeitos adversos , Humanos , Excisão de Linfonodo/efeitos adversos , Metástase Linfática/patologia , Estadiamento de Neoplasias , Tratamentos com Preservação do Órgão/efeitos adversos , Prognóstico , Piloro/patologia , Piloro/cirurgia , Qualidade de Vida , Biópsia de Linfonodo Sentinela , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Resultado do Tratamento
20.
Cir Esp ; 97(8): 445-450, 2019 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31027834

RESUMO

There is significant controversy in the management of cardiac cancer. It seems unanimous that Siewert type I tumors be operated on as cancer of the esophagus and Siewert type III as gastric cancer. However, for "true" cancer of the gastric cardia or Siewert II, the authors do not agree. There is the obvious need for free proximal and distal margins, as well as correct lymphadenectomy. For some, esophagectomy is necessary to perform correct radical oncological surgery, but other authors defend that an abdominal approach is sufficient to perform total gastrectomy and distal esophagectomy. Recent and older papers published do not clarify this issue, and their results are contradictory. Chemotherapy prior to surgery can reduce the size of the tumor and the presence of lymphadenopathies.


Assuntos
Cárdia/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Junção Esofagogástrica/cirurgia , Gastrectomia/métodos , Neoplasias Gástricas/cirurgia , Cárdia/patologia , Neoplasias Esofágicas/classificação , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/patologia , Junção Esofagogástrica/patologia , Humanos , Excisão de Linfonodo/métodos , Margens de Excisão , Qualidade de Vida , Neoplasias Gástricas/classificação , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologia , Resultado do Tratamento , Carga Tumoral/efeitos dos fármacos
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