Increased ANXA5 expression in stomach adenocarcinoma infers a poor prognosis and high level of immune infiltration.

BACKGROUND: The prognostic role of annexin A5 (ANXA5) in stomach adenocarcinoma (STAD) has not been studied, and its relationship with immune infiltration is still unclear. OBJECTIVE: This investigation aimed at exploring the role of ANXA5 in STAD using an integrated bioinformatics analysis. METHODS: The expression of ANXA5 in STAD and the correlations between the effect of ANXA5 and survival of STAD patients were investigated using database. The clusterProfiler package in R software was used to perform enrichment analysis on the top 100 co-expressed genes of ANXA5 from the COXPRESdb online database. Correlations between ANXA5 and immune cell infiltrates were analyzed using the TIMER database. RESULTS: In STAD, ANXA5 expression was significantly upregulated and increased ANXA5 expression was significantly correlated with poor overall survival (P< 0.05). In multivariate analysis, upregulated ANXA5 expression was an independent predictive factors of poor prognosis (P< 0.05). The co-expressed genes were involved in extracellular matrix (ECM)-related processes. In STAD, ANXA5 expression was significantly correlated with various infiltrating immune cells (P< 0.05). CONCLUSIONS: Together with our findings, ANXA5 could serve as a potential biomarker to assess prognosis and immune infiltration level in STAD.

Pathological complete response from oral chemotherapy combined with trans-arterial chemotherapy and embolization in an unresectable gastric cancer patient: A case report.

RATIONALE: Gastric cancer is still one of the most common cancer in East Asia. More than 70% gastric cancer patients are diagnosed at an advanced stage in China. Moreover, about 10% cases are unresectable which usually suffer a poor prognosis with a median survival time of 5 to 12 months. In recent years, some clinical studies found that many unresectable gastric cancer cases could get opportunity for surgery after treatment that improve prognosis significantly PATIENT CONCERNS:: 64-year-old male patient was admitted with upper abdominal pain. Upper gastrointestinal endoscopy showed a large ulcerated tumor located from the cardia to the anterior wall of the upper gastric body. Histopathological examination showed it was moderately differentiated adenocarcinoma. Computed tomography (CT) scan image showed a large bulging mass with internal ulcer at the lesser curvature wall, left gastric artery and coeliac trunk were surrounded by fused lymph nodes. DIAGNOSES: Based on the histopathological examination and imaging findings, patient was diagnosed advanced gastric cancer and hardly to resect radically. INTERVENTION: Oral chemotherapy combined with trans-arterial chemotherapy and embolization (TACE) was initiated. Eight weeks after initial therapy, radical laparoscopy-assisted total gastrectomy with D2 lymph node dissection and Roux-en-Y anastomosis were performed successfully. OUTCOMES: Patient was discharged on postoperative day 11 without complications. Histological analysis of the specimen and resected 31 lymph nodes revealed no malignancy. The patient experienced a pathological complete response (pCR). LESSONS: In this case, oral chemotherapy combined with TACE which was rarely reported in the treatment of unresectable gastric cancer achieves a great therapeutic benefit. Although further clinical studies will be needed to establish, it may be a potent strategy for degrading stage and supplying a new chance for surgery.

Laparoscopy-Assisted D2 Radical Gastrectomy for Advanced Gastric Cancer.

BACKGROUND/AIMS: The aim of this study was to investigate the efficacy and advantages of laparoscopy-assisted gastrectomy (LAG) with D2 lymphadenectomy versus conventional open D2 gastrectomy (ODG) in advanced gastric cancer (AGC) patients. METHODOLOGY: From June 2009 to June 2014, 233 patients who were treated by conventional radical ODG and 188 cases who underwent radical LAG for AGC at our department were enrolled in this study. Clinical data recorded in hospital database was retrospectively reviewed and analyzed. RESULTS: There were no significant differences in age, gender or preoperative laboratory tests distribution between the LAG group and the ODG group. Two (1%) of the patients who underwent LAG required conversion to ODG. The advantages of minimally invasive surgery including earlier recovery of bowel movements and shorter postoperative hospitalization time were observed in LAG group. The number of harvested lymph nodes was 24.3 ± 3.3 in the LAG group and 25.0 ± 2.8 in ODG (p = 0.110). CONCLUSIONS: Although prospective randomized trials with long follow-up period are needed to identify the feasibility, we have shown the safety and advantages of LAG with D2 lymphadenectomy for treating AGC patients in this study.

Sentinel lymph node and skip metastases in gastric cancer: a prospective study.

BACKGROUND/AIMS: The aim of the present study was to investigate localization and distribution of sentinel lymph node (SLN) in gastric cancer and influenced factors of skip metastasis. METHODOLOGY: Eighty-nine cases with solitary or single station metastatic lymph nodes (LNs) among 779 gastric cancer patients were included in this study. D2 or D2+ lymph node dissection with total or distal gastrectomy had been performed. The location of SLNs and characteristics were analyzed retrospectively. RESULTS: Seventy-one patients (79.8%) had SLNs at the first level of the regional LN group and 18 cases (20.2%) had skip metastases SLNs. NO.7 (44.4%) and NO.8a (27.8%) were the most common sites of skip metastases. Multivariate analysis identified the differentiated degree of tumor as the only significant influenced factor of skip metastases (p=0.031). The number of metastatic SLNS was significantly greater in advanced gastric cancer patients (2.4 ± 1.4) than early gastric cancer patients (1.5 ± 0.9) (pT4 vs. pT1, p=0.002; pT4 vs. pT2, p=0.014; pT3 vs. pT1, p=0.018). CONCLUSIONS: The differentiated degree of gastric cancer is the most important influenced factor of skip metastases and NO.7 and NO.8a are the most important N2 LN stations that should be observed when lymphadenectomy is performed.