ABSTRACT
BACKGROUND/AIMS: This study was conducted to define the clinical significance of intraoperative determination of carcinoembryonic antigen levels in peritoneal washes from patients undergoing surgery for colorectal cancer. METHODOLOGY: The correlation of carcinoembryonic antigen levels in peritoneal washes (pCEA) with several clinicopathological factors and the long-term surgical outcome in 54 patients with resectable colorectal cancer was determined retrospectively. RESULTS: Among several clinicopathological factors, the depth of tumor invasion significantly and independently correlated with pCEA levels as revealed by multivariate stepwise logistic regression analysis. A significant difference in overall survival rates was observed between pCEA-positive and pCEA-negative groups: five-year survival rates were 97.1% in pCEA-negative patients and 78.9% in pCEA-positive patients (p = 0.0274). CONCLUSIONS: Intraoperative determination of carcinoembryonic antigen levels in peritoneal washes could be a potentially predictive factor of a poor prognosis in patients with colorectal cancer.
Subject(s)
Carcinoembryonic Antigen/analysis , Colorectal Neoplasms/pathology , Adult , Aged , Aged, 80 and over , Body Fluids/chemistry , Colorectal Neoplasms/mortality , Colorectal Neoplasms/surgery , Female , Humans , Intraoperative Period , Logistic Models , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Invasiveness , Prognosis , Retrospective Studies , Therapeutic IrrigationABSTRACT
BACKGROUND: This study was conducted to identify risk factors predictive of regional lymph node metastasis in depressed early gastric cancer and further to establish an objective criterion useful to indicate additional surgical treatment in cases in which submucosal tumor extension becomes evident by endoscopic mucosal resection (EMR). METHODS: Data from 276 patients surgically treated for depressed early gastric cancer were collected, and the relationship between the patient and tumor characteristics, and the lymph node metastasis was retrospectively evaluated by multivariate analysis. RESULTS: In the multivariate logistic regression model, female sex, a larger tumor size (20 mm or more), submucosal invasion, and presence of lymphatic vessel involvement were found to be independent risk factors for lymph node metastasis. Among 145 patients with submucosally invasive carcinoma, no lymph node metastasis was observed in patients who showed none of the other three risk factors, whereas 14.3% and 23.3% of patients with one and two of these factors had lymph node metastasis, respectively. The lymph node metastasis rate was calculated to be 86.7% in patients who had all three factors. CONCLUSIONS: Submucosal invasion, female sex, tumor size of 20 mm or more, and lymphatic vessel involvement were significantly and independently related to the presence of lymph node metastasis in depressed early gastric cancer. The positive number of the latter three risk factors is a simple criterion to indicate additional surgical treatment in cases with submucosal invasion revealed first by EMR.
Subject(s)
Lymphatic Metastasis/pathology , Stomach Neoplasms/pathology , Adult , Aged , Female , Gastrectomy , Gastroscopy , Humans , Lymph Node Excision , Male , Middle Aged , Multivariate Analysis , Neoplasm Invasiveness , Retrospective Studies , Risk Factors , Sex Factors , Stomach Neoplasms/surgeryABSTRACT
A causal relationship has been suggested between Helicobacter pylori infection and gastric malignancy, including both gastric cancer and low grade lymphoma of mucosa-associated lymphoid tissue (MALToma). We describe a rare case of simultaneous occurrence of low grade MALToma and early cancer of the stomach in a 72-year-old woman. In this patient, low grade MALToma not only had preceded gastric cancer by 5 years, but had also disappeared, and subsequently reappeared coexisting with early cancer of the stomach and Helicobacter pylori infection. Eradication therapy for Helicobacter pylori was performed immediately prior to subtotal gastrectomy for early gastric cancer of the pyloric area. Thereafter, regression of MALToma was observed. These results, taken together with a previously reported case of low grade MALToma, suggest that low grade MALToma of the stomach may fluctuate, at least in the initial stages, even in the presence of constant Helicobacter pylori infection.
