Changing trends in the clinicopathological characteristics of patients with gastric carcinoma undergoing surgery between 1979 and 2008 in Liaocheng Shandong province / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the changing trends in clinicopathological characteristics of patients with gastric carcinoma undergoing surgery between 1979 and 2008.</p><p><b>METHODS</b>Two thousand seven hundred and fifteen patients with gastric cancer who received operation in Liaocheng People's hospital between 1979 and 2008 were analyzed retrospectively, and were compared to 168 patients between 1974 and 1978. Categorical data were evaluated with Chi-squared or Fisher's exact test. Quantitative data were analyzed with nonparametric test. Time series analysis was used to evaluate the changing trend of data.</p><p><b>RESULTS</b>The male to female ratio during 1979-2008 was 3.393, which was higher than that (1.897) during 1974-1978 (χ2=12.193, P<0.01). The median age (59 years) during 1979-2008 was higher than that (53.5 years) during 1974-1978 (z=-6.294 P<0.01). Comparing the tumor distribution of gastric cancer during 1979-2008 with that during 1974-1978, proportion of gastric cardia and fundus cancer was higher (45.7% vs. 13.0%, χ2=56.596, P<0.01), while the proportion of gastric antrum cancer was lower (44.9% vs. 73.2%, χ2=53.980, P<0.01). There was no significant difference in gastric body cancer (13.8% vs. 9.4%, χ2=2.026, P=0.155). Compared to 1994-1998, there were more poorly differentiated adenocarcinomas during 2004-2008 (62.1% vs. 51.7%, χ2=12.267, P<0.01), and there were less tubular adenocarcinomas during 2004-2008 (23.9% vs. 31.8%, χ2=8.78, P<0.01). Time series analysis showed the patient age during 1979 to 2008 increased (Root mean square error=1.275, R-square=0.702), gastric cardia and fundus cancer was increasing and antrum cancer was decreasing (Root mean square error=0.055, R-square=0.798).</p><p><b>CONCLUSIONS</b>In the past 30 years from 1979 to 2008, the male to female ratio and the median age of surgical patients with gastric cancer increased with time. The gastric cardia and fundus cancer increased over time, however antrum cancer decreased with time. In the past 15 years from 1994 to 2008, the proportion of poorly differentiated adenocarcinoma increased, and that of tubular adenocarcinoma declined.</p>

Preoperative evaluation on lymphatic metastasis of gastric cancer / 国外医学(肿瘤学分册)

Evaluating lymph node metastasis of gastric cancer preoperatively can help surgeons to choose the optimal extent of surgical lymph node resection. The diagnostic accuracy of computed tomography for lymph node metastasis of gastric cancer is about 70% , which is less accurate than endoscopic ultrasonography,and more accurate than magnetic resonance and positron emission tomography. Many molecular markers can predict the lymph node metastasis. The prognostic role of gene expression profiles is better than that of a marker. Sentinel lymph node and mathematical methods (Maruyama software, artificial neural network) may be useful in predicting the lymph node metastasis. Laparoscopy and quantum dots technique are potential methods in predicting lymph node metastasis.

A prognostic scoring system for preoperative prediction of lymph node metastases in gastric cancers / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To establish a preoperative scoring system to predict the lymph node metastases (N) in gastric cancers.</p><p><b>METHODS</b>The clinicopathologic data of 291 cases with gastric cancer were analyzed retrospectively. The factors influencing significantly actual lymph node status (pN) were selected through the univariate and the multivariate analysis, and the score of each factor was identified. Scores predicting different N stages were identified using receiver operating characteristic curves. The N stages defined by the score system were compared with the actual pN status using kappa statistics and diagnostic test.</p><p><b>RESULTS</b>Tumor size, depth of invasion and histopathological types were selected to establish the scoring system. According to this score system, scores 0-4 predict N0, scores 5-7 predict N1, scores 8-9 predict N2 and scores 10-13 predict N3. There was a good agreement between N stages predicted by the scoring system and the actual pN status (weighted kappa = 0.605, u = 14.548, P < 0.0001). The crude agreement, positive predictive value and negative predictive value of the scoring system were 82.8%, 65.6% and 88.5%, respectively.</p><p><b>CONCLUSION</b>The scoring system can provide accurate and reliable information to predict the lymph node metastases of gastric cancers preoperatively. It is simple and practical to use in clinical work and can help surgeons to choose an optimal extent of lymph node dissection for gastric cancer.</p>

Distribution of sentinel lymph nodes in gastric cancer and factors correlated with its metastasis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the distribution of sentinel lymph nodes in gastric cancer, and evaluate clinicopathologic characteristics leading its metastasis.</p><p><b>METHODS</b>The location of metastatic lymph nodes was analyzed retrospectively in 27 patients of gastric carcinoma with solitary lymph node metastases, and in 80 cases metastasis was limited to only 1 station in Japanese nodal classification. The clinicopathologic characteristics of the patients with solitary lymph node metastases and 111 cases without lymph node metastases were compared.</p><p><b>RESULTS</b>Twenty-five in 27 cases with solitary lymph node metastases were limited in level I. Skip metastasis occurred in 2 cases. Sentinel lymph nodes of 16 cases in 21 patients with the tumors in the lower and middle third stomach were located in less curvature (No. 3) and in greater curvature (No. 4). Sentinel lymph nodes of 3 cases in 6 patients in the upper third stomach were located in right cardia (No. 1). Multivariate analysis showed that the frequency of sentinel lymph node metastasis of pT(3) lesion was significantly higher than that of pT(1) lesion with an odds ratio of 4.926 (P < 0.01). The frequency of sentinel lymph node metastasis in the tumor located in the upper third stomach was significantly higher than that in lower third stomach, with an odds ratio of 4.381 (P < 0.05). Early gastric cancer had lower risk for sentinel lymph node metastasis than that in Borrmann type I cancer, with an odds ratio of 0.082 (P < 0.05).</p><p><b>CONCLUSIONS</b>Majority of sentinel lymph nodes are located in the regional perigastric lymph node groups close to the tumor. Skip metastasis is rare. Depth of invasion and location of tumor are correlated with sentinel lymph node metastasis. Sentinel lymph node assessment can instruct to determine extent of lymph node dissection for gastric cancer.</p>

Clinical significance and correlation between elevated serum TR6 and lympho-metastasis in gastric cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the value of serum TR(6) for the diagnosis and TNM classification in patients with gastric carcinoma.</p><p><b>METHODS</b>Serum TR(6) levels were measured using ELISA method in 31 gastric cancer patients, 19 patients with nonmalignant conditions and 29 healthy individuals. TR(6) expression in tumor mass was studied with immunohistochemistry. TR(6) gene copy number in tumor tissues was evaluated by real time PCR.</p><p><b>RESULTS</b>Ninety-seven point nine percent (47 of 48 cases) of healthy individuals and patients with nonmalignant conditions were serum TR(6)-negative. In contrast, 71% (22 of 31 cases) of gastric cancer patients were serum TR(6)-positive. Serum TR(6) positiveness was closely correlated with tumor differentiation status and TNM classification. TR(6) gene amplification did not occur in gastric carcinoma.</p><p><b>CONCLUSIONS</b>Serum TR(6) levels were correlated significantly with TNM stage and histopathological type of tumor. This can help to determine the pre-operative TNM classification and to choose the optimal extent of lymph node dissection for gastric cancer.</p>