[Prognostic factors in gastric cancer. Our experience and review of the literature]. / Fattori prognostici nel cancro gastrico. Nostra esperienza e revisione della letteratura.

BACKGROUND: This review of the latest literature and retrospective analysis of the authors' series aimed to identify the most relevant prognostic factors for gastric cancer. METHODS: A total of 81 patients were operated in our series from 1980 onwards. Eighteen patients underwent minor surgery and 5 were not treated. All resected patients underwent R2 lymphadenectomy. RESULTS: In the majority of cases the histiotype was found to be adenocarcinoma. Undifferentiated forms were only found in 8 cases. The prognostic factors identified in our series and in the most recent literature were age, lesion sites, histiotype, the number of metastatic lymph nodes and T3. The poor prognosis in younger patients may be explained by late diagnosis and more aggressive tumours. Neoplasms in the upper third of the stomach have a worse prognosis owing to a faster metastasis rate, lymphatic drainage directly into the left para-aortic lymph nodes and lack of serosa in the gastric fundus, meaning that in practice T2 becomes T3. Lymphatic diffusion represents one of the most important factors, in particular the number of lymph nodes affected by the tumour is decisive for prognosis: from the literature, in both T1-T2 and T3-T4, if > or = 5 lymph nodes are positive then survival rates decrease significantly. CONCLUSIONS: From our personal experience, N2 determines the prognosis in both T2 and T3. N2 is important, but survival diminishes in T3, thus demonstrating the importance of serous infiltration. The majority of Western and Japanese authors deem that T3 represents one of the decisive factors.

[Efficacy of immunomodulating treatment in patients with different degrees of immunosuppression]. / Efficacia del trattamento immuno-modulante nei soggetti con diverso grado di immunodepressione.

Immunodepression is a common condition in patients undergoing elective operations and it constitutes a high risk for the onset of postoperative infective complications. The use of immunomodulatory drugs has proved useful in the prophylaxis of these complications, although the precise indications for each drug have not yet been clearly codified. The present study aimed to assess the effects of thymostimulin in patients with different degrees of immunodepression, by evaluating both the incidence of postoperative infections and the changes induced in various immunological parameters. The results obtained indicated that those subjects with the highest degree of immunodepression (hypo-anergic) benefited most from drug therapy in comparison to those with a lesser degree of immunodepression (relatively hypo-ergic). The advantages were evident in hypo-anergic subjects both with regard to the frequency of early postoperative infections, and with regard to immunological parameters. On the other hand, in relatively hypo-ergic subjects, benefits were limited to the improvement of some immunological parameters. In our opinion, the use of thymostimulin is of particular use only in those subjects with marked immunodepression since the incidence of post-operative sepsis is highest in this group.

[Primary lymphoma of the stomach. Clinical and prognostic analysis of our experience and 20 years' literature]. / Linfoma gastrico primitivo. Analisi clinica e prognostica della nostra esperienza e di 20 anni di letteratura.

Primary gastric lymphoma (PGL) is a comparatively rare cancer. A large series from the literature forms the basis for a review of the clinical aspects, the diagnostic and therapeutic procedures most recently adopted and the long-term results. 1837 cases of PGL have been analysed: in 1196 of them symptomatology was painful, ulcer-like; the diagnosis of a malignant lesion was obtained in 72% of cases by radiography, while oesophagogastroduodenoscopy with biopsy produced a diagnosis of gastric lymphoma in 47.6% of cases. 1634 patients were subjected to surgical therapy with a resection index of 66.5% and postoperative mortality between 0 and 22.25%. Back-up treatment for the various stages of the disease is not well codified but is indicated by most authors. The prognosis of PGL is comparatively good compared to that of other intestinal lymphomas with total survival, independently of the stage, of 44.3% at 5 years. Surgical therapy is the intervention of choice in cases in which there is a possibility of resection in advanced stages also. Overviews are required so as to quantify the role of radiotherapy and chemotherapy in both initial and advanced stages.