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<p><b>OBJECTIVE</b>To explore the value of superior mesenteric vein (No.14v) lymph node dissection in D2 gastrectomy for locally advanced distal gastric cancer.</p><p><b>METHODS</b>A retrospective cohort study was carried out. A total of 796 patients with locally advanced distal gastric cancer undergoing D2 gastrectomy at the Cancer Center of Guangzhou Medical University between 2002 and 2016 were enrolled.</p><p><b>INCLUSION CRITERIA</b>locally advanced distal gastric adenocarcinoma confirmed by postoperative pathology; adenocarcinoma located at or invaded into lower 1/3 stomach; lymphadenectomy was D2 or D2+; negative resection margin confirmed by pathology; no distal metastasis was found; preoperative neoadjuvant chemotherapy was not administrated. Patients with undefined group of lymph nodes by postoperative pathology and those who were died perioperatively were excluded. Among 796 patients, 293 underwent No.14v dissection (No.14vD+ group) and the other 503 patients did not undergo No.14v dissection (No.14vD- group). The 5-year overall survival was compared between the two groups. Therapeutic index of No.14v lymph nodes was calculated according to the following formula: therapeutic index=metastatic rate of No.14 lymph nodes (%) × 5-year survival rate of patients with No.14 lymph node metastasis(%) × 100. Meanwhile, stratified analyses based on pathological TNM staging were performed.</p><p><b>RESULTS</b>There were no significant differences in age, gender, tumor size, Borrmann type, Lauren classification, histological type, surgical procedure, and number of harvested lymph node between two groups (all P>0.05). However, compared to No.14vD- group, No.14vD+ group had more advanced T staging (χ² =14.771, P=0.005) and TNM staging (χ² =18.339, P=0.003), and higher ratio of receiving adjuvant chemotherapy (χ² =4.205, P=0.040). The median follow-up period was 47 months. The 5-year survival rate in No.14vD+ and No.14vD- groups was 57.4% and 46.8% respectively without statistically significant difference (P=0.313). After adjusting for confounding factors, Cox proportional hazards model showed that No.14v lymphadenectomy was not an independent prognostic factor(HR=0.802, 95%CI: 0.545-1.186, P=0.124). Stratified analyses revealed that in all TNM stages, 5-year survival rates were not significantly different between two groups (all P>0.05). However, No.14v lymphadenectomy showed a tendency of survival benefit when the tumor staging after advancing to III A stage(III A: P=0.103; III B: P=0.085; III C: P=0.060). Five-year survival rates of No.14vD+ and No.14vD- groups in stage III A were 54.9% and 45.2%, in III B stage were 39.8% and 29.5%, in III C stage were 27.5% and 16.2%, respectively. After combining III A, III B and III C, the No.14vD+ group had a higher 5-year survival rate than No.14vD- group (39.2% vs. 27.7%, P=0.006). The No.14v metastasis rate in No14v+ group was 12.6%(37/293), including 0%(0/46), 2.5%(1/40), 4.9%(2/41), 15.7%(8/51), 20.8%(11/53) and 24.2%(15/62) in stages I B, II A, II B, III A, III B and III C respectively. The metastasis rate of No.14v lymph node in stage III patients was 20.5%(34/166). The 5-year survival rate of these 34 stage III patients with No.14v metastasis was 21.1%. The therapeutic index of No.14v lymph node in stage III patients was 4.3, which was comparable with 3.9 of No.9 and 4.9 of No.11p, even higher than 2.6 of No.1.</p><p><b>CONCLUSIONS</b>Although No.14v lymphadenectomy can not improve the overall survival of patients with locally advanced distal gastric cancer, but it may significantly improve survival in those with stage III cancer. The therapeutic index of No.14v lymph node is similar to No.2 station lymph node in patients with stage III distal gastric cancer. Therefore No.14v lymph node should be included in D2 dissection.</p>
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Objective To study the effect of age on the recurrence-free survival rate after hepatic resection for hepatocellular carcinoma(HCC)and the relationship between microvessel density (MVD)and recurrence of HCC in the elderly. Methods Severty one cases of elderly patients with HCC were analyzed retrospectively with 352 cases of non-elderly HCC patients as control,and the effect of age on the recurrence-free survival rate was studied.The expressions of CD34 and endocan in HCC tissues were detected by immunohistochemistry in 30 elderly and 30 non-elderly patients.Results The 1-,3- and 5-year recurrence free survival rates were 75.7%,43.0% and 43.0% in the elderly group respectively,which were higher than those in the non-elderly group(53.6%,38.5% and 33.4%,respectively,Log Rank value=10.25,P＜0.05).The positive rate of alpha fetoprotein (AFP)in the elderly group was 47.9%,which was lower than that in the non-elderly group(62.2%)(X2=23.68,P＜0.05).The median survival times in the high CD34-MVD group and high endocan MVD group were shorter than those in the low CD34-MVD group and low endocan-MVD group(260 d vs.850 d,360 d vs.800 d,Log Rank value was 22.18 and 20.56 respectively,both P＜0.05).Conclusions The long-term prognosis of hepatic resection for HCC is better in elderly patients than in non-elderly patients.The recurrence of HCC in the elderly is closely related with angiogenesis.
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ObjectiveTo study the effect of age on the perioperative and long-term outcome of hepatic resection for hepatocellular carcinoma. MethodsFifty two cases of elderly patients with hepatic resection for hepatocellular carcinoma were analysised retrospectively. ResultsThe morbidity rate and in-hospital duration in elderly group were 32.7% and (29.94.3)d respectively, higher than 18.6% and (24.76.1)d in non-elderly group (P
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ObjectiveTo investigate the expression of RhoC gene in primary hepatocellular carcinoma and to evaluate the relationship between RhoC gene expression and invasion and metastasis of primary hepatocellular carcinoma.MethodsThe mRNA expression of RhoC gene was examined by polymerase chain reation after reverse transcription (RT-PCR) in 25 cases of primary hepatocellular carcinoma (HCC) and adjacent non-cancerous tissuse. In addition, the mutation of RhoC gene was examined by polymerase chain reaction-single strand conformational polymorphism(PCR-SSCP)ResultsThe mRNA expression of RhoC in tumor tissue were higher than that in adjacent liver tissue,1.8?1.1 vs. 1.0?0.7( P
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Objective To investigate the expressions of vascular endothelial growth factor (VEGF) , hypoxia inducible factor 1 alpha (HIF 1?) and epidermal growth factor (EGF) in hepatocellular carcinoma (HCC) and their clinical significance. Methods The expressions of VEGF, HIF 1? and EGF in 36 cases of HCC and corresponding paraneoplastic tissues and normal liver tissues (6 cases) were studied by immunohistochemistry assay. ResultsThe expression rate of VEGF, HIF 1? and EGF in HCC tissue was 89%, 67% and 75% respectively, higher than those in paraneoplastic tissues and normal liver tissues ( P