Regularity of lymph node metastasis in distal gastric cancer and its clinical significance / 中国肿瘤临床

Objective:The characteristics of lymph node metastasis were investigated to guide the range of lymph node dissection during the radical operation of distal gastric cancer. Methods:The clinical data of 773 patients with distal gastric cancer who under-went radical distal subtotal gastrectomy at the Tianjin Medical University Cancer Institute and Hospital between February 2010 and September 2014 were reviewed and analyzed to infer the potential clinical mechanisms of lymph node metastasis. Results:Among the included patients, 423 (54.72%) had lymph node metastasis. The proportion of metastasis in the patients from the highest to the lowest rate was observed in group NO. 6, 3, 4sb, and 5 lymph nodes. The metastasis rates of the N1 lymph nodes from the highest to the low-est were observed in group NO. 3, 6, 5, and 4d lymph nodes, whereas those of the N2 lymph nodes occurred in group NO. 8a, 7, and 1 lymph nodes. Group NO. 8a lymph node with skipped metastasis was observed in 50.68%of the patients. Conclusion:During radical distal gastric cancer surgery, attention should be given to the possibility of metastasis in group NO. 8a lymph node. Appropriate exten-sion of the lymph node dissection should be conducted when necessary.

Effect of perioperative blood transfusion on the prognosis of gastric cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the association of perioperative blood transfusion (PBT) with survival of gastric cancer after surgery.</p><p><b>METHODS</b>We retrospectively reviewed the medical records of 1 000 gastric cancer patients, including 738 non-transfused (73.8%) and 262 transfused (26.2%) cases. A one to one match was created using propensity score analysis, except preoperative hemoglobin level and operative blood loss. The survival was analyzed by Kaplan-Meier survival model.</p><p><b>RESULTS</b>The 5-year survival rate of the 1 000 cases of gastric cancer patients was 39.9%. Before matching, there was a significant difference between transfused group (33.6%) and non-transfused group (49.1%, P<0.005). Univariate analysis showed that age, tumor size, hemoglobin level, albumin level, depth of invasion, lymph node metastasis, lymph node dissection, surgery mode, adjuvant chemotherapy, blood loss and blood transfusion during perioperative period were associated with prognosis in the gastric cancer patients (all P<0.05). Multivariate analysis showed that tumor invasion, lymph node metastasis, lymph node dissection, chemotherapy and perioperative blood transfusion were independent prognostic factors in gastric cancer (all P<0.05). After matching, the 5-year survival rate of the 262 non-transfused patients was 37.7%, while that of the 262 transfused patients was 33.6% (P>0.05).</p><p><b>CONCLUSIONS</b>Perioperative blood transfusion has no significant effect on the prognosis of gastric cancer patients.</p>

Clinicopathological features and prognostic analysis of patients with signet ring cell gastric carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To compare the clinicopathological features of signet ring cell gastric carcinoma (SRCC) with those of non-signet ring cell cancers and explore the prognostic factors of signet ring cell gastric carcinoma.</p><p><b>METHODS</b>We retrospectively reviewed the medical records of 1447 gastric cancer patients, including gastric signet ring cell and non-signet ring cell cancers. Their clinicopathological characteristics and overall survival data were analyzed.</p><p><b>RESULTS</b>The differences in the age, sex, tumor location, depth of invasion, lymph node metastasis, distant metastasis, TNM classification and surgical type were significant between gastric signet ring cell and non-signet ring cell gastric carcinomas. The 5-year survival rate of the patients with gastric signet ring cell carcinoma was 29.6%, while that of the non-signet ring cell cancers was 42.9% (P < 0.05). The 5-year survival rate for each stage of gastric signet ring cell carcinoma and non-signet ring cell cancers was 71.0% and 79.3% for stage I, 45.6% and 58.3% for stage II, 16.9% and 29.2% for stage III, and 6.0% and 11.9% for stage IV cases, respectively, with a significant difference only between stages III and IV cancers (P < 0.05). Multivariate analysis showed that tumor diameter, T stage and N stage were independent prognostic factors for signet ring cell gastric carcinoma.</p><p><b>CONCLUSIONS</b>The signet ring cell gastric carcinoma has unique clinicopathological features compared with non-signet ring cell carcinoma. Early detection and treatment can improve the prognosis for patients with gastric signet ring cell carcinoma.</p>

Clinicopathological features and prognosis of patients with Borrmann type Ⅳ gastric cancer / 中华普通外科杂志

Objective To compare the clinicopathological features of Borrmann type Ⅳ gastric cancer with other gastric cancer and explore prognostic factors of the patients with Borrmann type Ⅳ cancer.Methods We retrospectively reviewed the clinical data of 671 advanced gastric cancer patients.They were divided into 2 groups:Borrmann type Ⅳ (64 cases) and other macroscopic Borrmann types of cancer (607 cases).Their clinicopathologic characteristics and overall survival data were analyzed.Results Age,sex,tumor size,tumor location,lymph node metastasis,distant metastasis,TNM classification were discrepant between Borrmann type Ⅳ and other macroscopic Borrmann types of cancer.The 5-year survival rate of Borrmann type Ⅳ cancer patients was 20.1％,while it was 40.3％ for other types of cancer (P ＜ 0.05).The 5-year survival rate for Borrmann type Ⅳ gastric cancer and the other type gastric cancer was 50.0％ and 72.0％ at stage Ⅰ,30.0％ and 57.9％ at stage Ⅱ,18.0％ and 28.4％ at stage Ⅲ,and 16.4％ and 20.0％ at stage Ⅳ (all P ＜ 0.05),respectively.Multivariate analyses revealed age,histology differentiation type,tumor size,the Borrmann type carcinoma and tumor stage to be independent prognostic factors for survival.Conclusions Borrmann type carcinoma has unique clinicopathological features compared with other types of gastric carcinoma and is an important independent prognostic factor.

The impact of preoperative weight loss for gastric cancer patients after gastrectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To elucidate the prognostic influence of preoperative weight loss for gastric cancer.</p><p><b>METHODS</b>A total of 672 gastric cancer patients who underwent gastrectomy between January 2003 and December 2007 were enrolled. The patients were categorized into three groups according to the percentage of weight loss before surgery: no weight loss group (0%), limited group ( < 10%), and severe group ( ≥ 10%). Compared the clinicopathologic characteristics and analyzed the prognostic influence of preoperative weight loss. The survival was analyzed by Kaplan-Meier survival cure and the prognostic factors were analyzed univariately and multivariately by Cox comparative hazard modal.</p><p><b>RESULTS</b>Among the 672 cases gastric cancer, no weight loss group had 275 cases, limited group 294 cases, severe group 103 cases. Tumor size (F = 4.386) , tumor location (χ² = 15.864), depth of invasion (χ² = 22.245) , the number of lymph node metastasis (χ² = 23.803), Surgical approach (χ² = 18.423) , extent of lymphadenectomy (χ² = 8.172) , curability (χ² = 15.650) were discrepant among the three groups (all P < 0.05) . The 5-year survival rate of the patients with severe group was 28.0%, limited group was 37.7%, while the no weight loss group was 40.3% (χ² = 20.148, P < 0.05). Age (95% CI: 0.480 - 0.744, P = 0.000), weight loss before surgery (95% CI: 0.371 - 0.687, P = 0.000), depth invasion (95% CI: 0.289 - 0.564, P = 0.000), lymph node metastasis (95% CI: 0.451 - 0.783, P = 0.000), extent of lymphadenectomy (95% CI: 0.647 - 0.990, P = 0.000), curability (95% CI: 0.291 - 0.486, P = 0.000), postoperative adjuvant chemotherapy (95% CI: 0.511 - 0.846, P = 0.000) were associated with survival of this group. In multivariate analysis, age (HR = 1.618, 95% CI: 1.298 - 2.016, P = 0.000), weight loss before surgery (HR = 1.258, 95%CI: 1.077 - 1.469, P = 0.004), depth of invasion (HR = 1.810, 95% CI: 1.287 - 2.545, P = 0.000), N stage (HR = 1.555, 95% CI: 1.413 - 1.172, P = 0.000) were independent prognostic factors for survival.</p><p><b>CONCLUSIONS</b>Patients with weight loss above 10% have poor prognosis. Weight loss before surgery may be an important independent prognostic factor for gastric cancer.</p>

The value of negative lymph node count in T3 gastric cancer / 中华普通外科杂志

Objective To evaluate negative lymph node count (NLNC) in prediction of prognosis of T3 gastric cancer after radical resection.Method 214 T3 patients of radical gastrectomy with complete clinical and follow-up data between Jan 2003 to Dec 2007 were enrolled.Survival was determined by the Kaplan-Metier method and univariate analysis was done by Log-rank test,Multivariate analysis was performed using the COX proportional hazard regression model.-2loglikelihood value and the hazard ratio (HR) value were used to compared the value of number of lymph node-negative (NLNC) staging and pN staging and lymph node metastasis rate (MLR) in gastric cancer prognosis evaluation.Results Univariate analysis showed that,pN stage (x2 =31.664),MLR stage (x2 =34.123),tumor size (x2 =5.025),type of differentiation (x2 =5.993),Borrmann classification (x2 =5.401),NLNC stage (x2 =37.256) were related to survival (P ＜ 0.05).COX multivariate analysis showed that-2loglikelihood of pN staging is 1 336.761,HR value is 1.464,-2loglikelihood value of MRL staging is 1 335.821,HR value is 1.441.-2loglikelihood value of NLNC staging is 1 326.902,HR value is 1.725.The N0 and N1 staging prognosis in different NLNC staging was significant (P =0.008,P =0.014).Conclusions Sufficient number of negative lymph node prolongs survival and reduces the risk of early recurrence in advanced gastric cancer.

Clinical observation of abdominal regional fluorouracil implants in advanced gastric cancer patients during operation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the postoperative adverse events and survival of patients with sustained-released fluorouracil implanted during operation.</p><p><b>METHODS</b>Data of 124 patients with advanced gastric cancer undergoing radical operation in Tianjin Medical University Cancer Institute and Hospital from January 2007 to January 2009 were analyzed retrospectively. All the patients were divided into two groups according to whether intra-operative fluorouracil was implanted or not. The treatment group(n=64) was implanted with fluorouracil in abdominal cavity after radical resection. The control group(n=60) did not receive fluorouracil implant in abdominal cavity after radical resection. Abdominal drainage fluid, temperature and adverse events within 15 postoperative days and 3-year survival were observed and compared between the two groups.</p><p><b>RESULTS</b>Pathological findings of the two groups were similar. No statistical significances existed in abdominal drainage fluid, temperature and adverse events within 15 postoperative days(P>0.05). The 3-year survival rate was higher in treatment group(64.3% vs. 42.4%, P=0.018).</p><p><b>CONCLUSION</b>Intra-operative sustained-released fluorouracil implants are safe and tolerable, and can improve the survival rate of patients with advanced gastric cancer.</p>

Analysis of clinicopathological characteristics and prognosis of 91 patients with familial gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the clinicopathological characteristics and prognosis of familial gastric cancer(FGC) and to provide clinical evidence for rational treatment program.</p><p><b>METHODS</b>Clinicopathological data of 91 patients with FGC and 293 patients with sporadic gastric cancer(SGC) in our department from March 2003 to October 2007 were retrospectively analyzed and compared between the two groups.</p><p><b>RESULTS</b>Tumors with a diameter of less than or equal to 5 cm were more common in FGC patients than SGC patients [65.9%(60/91) vs. 52.6%(154/293), P=0.025]. Proportion of FGC patients with poor differentiation was significantly higher as compared to SGC patients [68.1%(62/91) vs. 55.6%(163/293), P=0.034]. The 5-year overall survival rate in FGC patients was significantly lower than that in SGC patients(25.6% vs. 38.9%, P=0.001). Further stratified analysis revealed that the 5-year survival rates of T4 FGC and T4 SGC patients were 14.5% and 30.5% respectively, the 5-year survival rates of N3 FGC and N3 SGC patients were 10.4% and 17.3% respectively, and the differences were statistically significant(all P<0.05), while other T stage and N stage between the two groups were not significantly different(all P>0.05). Univarite analysis showed that tumor size, tumor location, pathological type, operation method, infiltration depth and lymph node metastasis were influencing factors of prognosis of FGC. Multivariate analysis showed that tumor size(HR=2.271), pathology types(HR=1.449), lymph node metastasis(HR=1.748) and the infiltration depth(HR=1.487) were independent risk factors affecting the prognosis of patients with FGC.</p><p><b>CONCLUSION</b>Compared with SGC, FGC is associated with poor differentiation and poor prognosis.</p>