ABSTRACT
Background & objective: Gastric cancer is the fourth most common cancer and the second leading cause of cancer-related deaths after lung carcinoma. The aim of this study was to understand the difference in clinicopathological behaviours and prognosis of gastric cancer in patients from China and Japan. Methods: Paraffin-fixed tissue samples of gastric cancer were collected retrospectively from two hospitals between 1993 to 2006 in Japan (n=2063) and during 1980-2003 in China (n=2496) respectively, and staging was done by TNM system and typing by Japanese Endoscopy Society criteria or Borrmann’s classification. The histological architecture of the tumours was expressed according to Lauren’s classification. Results: Compared to Japan, the occurrence of gastric cancer was more common in younger Chinese population and prone to invasion and metastasis in muscularis propia, lymphatic, lymph node, liver, peritoneal parts, and exhibited large tumour size and high TNM staging in both the sexes and in different age groups (P<0.05). Intestinal and mixed types of carcinomas were more frequently observed in Japanese patients compared to Chinese and the difference was significant (P<0.05). It was observed that the commonly reported types in early gastric cancers (EGC) in Japanese patients were IIc, IIa+IIc or IIa while those of Chinese patients were IIc, III or IIb. In the case of advanced gastric cancers (AGC), type II and III were most common in both the countries. The cumulative survival rate of Chinese patients was significantly (P<0.05) higher compared to Japanese in different stratified groups via depth of invasion, TNM staging or Lauren’s classification. Interpretation & conclusion: Gastric cancers in Chinese patients had more aggressive pathological characteristics and poorer prognosis than those from Japan. To reduce incidence and to improve treatment facilities, it is necessary to have a systematic screening system.
Subject(s)
Age Factors , China/epidemiology , Female , Histological Techniques , Humans , Incidence , Japan/epidemiology , Male , Neoplasm Staging/statistics & numerical data , Prognosis , Retrospective Studies , Statistics, Nonparametric , Stomach Neoplasms/classification , Stomach Neoplasms/epidemiology , Stomach Neoplasms/mortality , Stomach Neoplasms/pathologyABSTRACT
The factors influencing the long-term survival of patients with proximal gastric cancer(PGC)after curative resection were investigated.Data from 171 patients who underwent curative resection for PGC were retrospectively analyzed.The patients were grouped according to the clinicopathological factors and operative procedures.The tumor depth(T stage)and lymph node metastasis(pN stage)were graded according to the fifth edition of TNM Staging System published by UICC in1997.The metastatic lymph node ratio(MLR)was divided into four levels: 0%,<10%,10%-30%and >30%.The data of survival rate were analyzed by Kaplan-Meier method(log-rank test)and Cox regression model.The 5-year overall survival rate of 171 patients was 37.32%.The univariate analysis demonstrated that the survival time of the postoperative patients with PGC was related to tumor size(;(2=4.57,P=-0.0325),gross type(χ2=21.38,P<0.001),T stage(χ2=27.91,P<0.001),pN stage(χ2=44.72,P<0.001),MLR(χ2=61.12,P<0.001),TNM stage(χ2=44.91,P<0.001),and range of gastrectomy (χ2=4.36,P=0.0368).Multivariate analysis showed that MLR(χ2=10.972,P=0.001),pN stage(χ2=6.640,P=0.010),TNM stage(χ2=7.081,P=0.007),T stage(χ2=7.687,P=0.006)and gross type(χ2=6.252,P=0.012)were the independent prognostic factors.In addition,the prognosis of patients who underwent total gastrectomy(TG)was superior to that of patients who underwent proximal gastrectomy(PG)for the cases of tumor ≥5 cm(χ2=6.31,P=0.0120),Borrmann Ⅲ/Ⅳ(χ2=7.96,P=0.0050),T4(χ2=4.57,P=0.0325),pN2(χ2=5.52,P=0.0188),MLR 10%-30%(χ2=4.46,P=0.0347),MLR >30%(χ2=13.34,P=0.0003),TNM Ⅲ(χ2=14.05,P=0.0002)or TNM Ⅳ stage(χ2=4.37,P=0.0366);and combining splenectomy was beneficial to the cases of T3(χ2=5.68,P=0.0171)or MLR >30%(χ2=6.11,P=0.0134).It was concluded that MLR,pN stage,TNM stage,T stage,and gross type had advantages in providing a precise prognostic evaluation for patients undergoing curative resection for PGC,in which MLR was the most valuable index.TG and combining splenectomy were useful to improve the prognosis to patients with PGC of TNM Ⅲ/Ⅳ stage,serosa invasion,or extensive regional lymph node metastasis.
ABSTRACT
Paget's disease of the breast is an uncommon disorder that accounts for 1% to 3% of all mammary tumors. The incidence of underlying carcinoma associated with Paget's disease has been re-ported in 82% to 100% of cases. The finding of underlying carcinoma reaches almost 100% when a palpable lump is also present. In this rare case, we described a patient presenting with Paget's disease but no palpable lump. However, we found 11 independent regions which were all invasive ductal carci-noma after the operation. Considering this patient, we should pay more attention to a multifocal and multicentric breast carcinoma associated with Paget's disease. Furthermore, we believe the mammog-raphy examination and a modified radical mastectomy are the most appropriate treatments for this population in clinical practice.
ABSTRACT
This study examined the mechanism by which the gastric cancer cells lead to early peritoneal metastasis.HMrSV5 cells,a human peritoneal mesothelial cell line,were co-incubated with the supernatants of gastric cancer cells.Morphological changes of HMrSV5 cells were observed.The cell damage was quantitatively determined by MTT assay.The apoptosis of HMrSV5 cells was observed under transmission electron microscope.Acridine orange/ethidium bromidestained condensed nuclei was detected by fluorescent microscopy and flow cytometry.The expressions of Bcl-2 and Bax was immunochemically evaluated.The results showed that conspicuous morphological changes of apoptosis were observed in HMrSV5 cells 24 h after treatment with the supematants of gastric cancer cells.The supernatants could induce apoptosis of HMrSV5 cells in a time-dependent manner.Th esupematants could up-regulate the expression of Bax and suppress that of Bcl-2 in HMrSV5 cells.These findings demonstrated that gastric cancer cells can induce the apoptosis of HPMCs through supernatants in the early peritoneal metastasis.The abnormal expressions of Bcl-2 and Bax may contribute to the apoptosis.Anti-apoptosis drugs promise to be adjuvant chemotherapeutic agents in the treatment of peritoneal metastasis of gastric cancer.