Résumé
Gastric cancer is not only one of the most common cancers in the world but also one of the most important malignant tumors in terms of incidence in Korea. In spite of it's clinical significance, the mechanism of malignant transformation in the stomach has not yet been well characterized. Recent studies disclosed enormous data suggesting that the p53 protein and the c-erbB-2 proto-oncogene have a critical role in the tumorogenesis of gastric cancer. More recently, the expression of the p53 protein has been associated with increased proliferative activity, but serves as a poor prognostic indicator in the case of patients for whom aggressive adjuvant therapy is required. Amplification of the c-erbB-2 oncogene has also been reported in gastric cancer. In the case of breast cancer, it has been demonstrated that no close correlation exists between the c-erbB-2 expression and the prognosis. However, no reports describe the relation between c-erbB-2 expression, p53 expression, PCNA expression and the prognosis for patients with gastric cancer. So this study was done to evaluate the expression of the p53 and c-erbB-2 and to assess the prognostic value in patients eith gastric cancer. The results are as follows: 1) The overall expression rates for p53 and c-erbB-2 were 38% and 20%, respectively. 2) There was no close relation between the expression rate of p53 and the tumor size, the Borrmann type, the nodal involvement, distant metastasis, Ming's classification, or Lauren's classification. The expression rate of p53 was closely related the tumor stage. 3) The expression rate of p53 in tumors which expressed PCNA was higher than that in tumors which did not express PCNA (p5 cm) was higher than that in small tumors(0.05). 6) The overall cumulative 5-year survival rate in the positive expression group for c-erbB-2 was lower than that in the negative group and the difference was statistically significant(p<0.05). In conclusion, it is suggested that p53 expression can not used as a prognostic factor for gastric cancer, but c-erbB-2 may be such a prognostic factor.
Sujets)
Humains , Tumeurs du sein , Classification , Gènes erbB-2 , Incidence , Corée , Métastase tumorale , Oncogènes , Pronostic , Antigène nucléaire de prolifération cellulaire , Récepteur ErbB-2 , Estomac , Tumeurs de l'estomac , Taux de survieRésumé
PURPOSE: The gastric cancer is most frequent malignant disease in Korea. With increase of GNP and social welfare, lot of people pay attention to that. But many of gastric cancer patients who were diagnosed, are advanced -stage III or more- case and produces poor result of treatment. Nowadays many surgeons report that the resection of cancer mass and radical lymph node dissection, which called systematic lymph node dissection, can increase the longterm survival rate and curability of patients. For this purpose Maruyama and his colleagues made a program to predict the 5 year survival rate, cause of death, and the status of lymph node metastases. We put the basic datas of pateints in AGC into Maruyama's program and compare its result to final histologic reports. We would check sesitivity, specificity, positive predictive value, negative predictive values between Maruyamas program and hitologic reports. MATERIALS AND METHODS: From Sep. 1995 to Sep. 1996, We operated 55 patients with gastric cancer with this program in GNUH. We checked the histopathologic reports and put the data into the prediction program. The datas were sex, age, maximal size of tumor, differentiation, gross type and location. We compared status of lymph node metastases, TNM stages between the reports of histopathology and that of predictive program. RESULTS: In early stages the sensitivity and specificity of the program showed poor result but in advanced stages did not. The distribution of lymph node metastasis showed a same pattern. The patterns of perigastric lymph node metastasis were somewhat different according to the location of tumor. But its significance was not confirmed. We analysed the metastaic rate between lymph node groups and compared with the results between two reports. The sensitivity, and negative predictive value were 100% in each groups, and positive predictive value was also high. CONCLUSION: The systematic lymph node dissection is an effective and safe procedure in the surgical treatment of gastric cancer. We suggest that the techniques should be standardized and popularized in Korea. This procedure will improve the survival rate of gastric cancer patients and decrease the local recurrence of gastric cancer.