The predictive factors of gastric cancer recurrence after the completion of adjuvant chemotherapy in advanced gastric cancer

Objective: the administration of adjuvant chemotherapy after a curative resection is accepted as the standard treatment to improve the prognosis of advanced gastric cancer. Nevertheless, the prognosis of recurrence-related gastric cancer is still not clinically satisfactory. We aimed to assess the therapeutic yield of a radical gastrectomy with D2 lymphadenectomy (R0 resection) and the completion of adjuvant chemotherapy. The predictive risk factors for recurrence were also assessed. Methods: a retrospective cohort study was designed with patients diagnosed with advanced gastric cancer. Patients with an R0 resection who had completed adjuvant chemotherapy were included in the study. Results: data from 130 patients who had undergone an R0 resection and had completed six cycles of adjuvant chemotherapy were analyzed. The chemotherapy compliance rate was 63.11% and the overall recurrence rate was 36.9%. The lymph node ratio (LNR), which was defined as the number of metastatic lymph nodes divided by the retrieved lymph nodes, was a significant risk factor in the lymph node-positive group (p < 0.01). This parameter had a relatively high sensitivity to predict recurrence compared with the 7th and 8th edition of the AJCC staging system, with an area under the curve of 0.735 (95% confidence interval: 0.639-0.832). Baseline CA19-9 level was a risk factor in the lymph node-negative group (p = 0.01). Conclusions: LNR and baseline CA19-9 levels, as simple markers, had strong predictive values for the recurrence of advanced gastric cancer. With regard to recurrence, more potent adjuvant therapy should be considered in high-risk patients

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The predictive factors of gastric cancer recurrence after the completion of adjuvant chemotherapy in advanced gastric cancer.

OBJECTIVE: the administration of adjuvant chemotherapy after a curative resection is accepted as the standard treatment to improve the prognosis of advanced gastric cancer. Nevertheless, the prognosis of recurrence-related gastric cancer is still not clinically satisfactory. We aimed to assess the therapeutic yield of a radical gastrectomy with D2 lymphadenectomy (R0 resection) and the completion of adjuvant chemotherapy. The predictive risk factors for recurrence were also assessed. METHODS: a retrospective cohort study was designed with patients diagnosed with advanced gastric cancer. Patients with an R0 resection who had completed adjuvant chemotherapy were included in the study. RESULTS: data from 130 patients who had undergone an R0 resection and had completed six cycles of adjuvant chemotherapy were analyzed. The chemotherapy compliance rate was 63.11% and the overall recurrence rate was 36.9%. The lymph node ratio (LNR), which was defined as the number of metastatic lymph nodes divided by the retrieved lymph nodes, was a significant risk factor in the lymph node-positive group (p < 0.01). This parameter had a relatively high sensitivity to predict recurrence compared with the 7th and 8th edition of the AJCC staging system, with an area under the curve of 0.735 (95% confidence interval: 0.639-0.832). Baseline CA19-9 level was a risk factor in the lymph node-negative group (p = 0.01). CONCLUSIONS: LNR and baseline CA19-9 levels, as simple markers, had strong predictive values for the recurrence of advanced gastric cancer. With regard to recurrence, more potent adjuvant therapy should be considered in high-risk patients.

The Etiologic Evaluation of Acute Pancreatitis in a General Hospital of Seoul-Gyeonggi Province in Korea.

BACKGROUND/AIMS: In recent years, the incidence of acute pancreatitis (AP) has been increasing. A better understanding of the etiology is directly linked to more favorable outcomes. Unfortunately, there have been reports suggesting the variation of etiologies of AP across countries. The objective of this study was to determine the etiology of AP in a general hospital of Seoul-Gyeonggi province in Korea during the past decade. METHODS: We retrospectively reviewed the medical records of consecutive patients with AP who were admitted to St. Paul's Hospital (Seoul, Korea) with an affiliation to the Catholic University of Korea between January 2003 and January 2013. RESULTS: A total of 1,110 patients were enrolled, totaling 1,833 attacks, and the most frequent cause of AP was alcohol consumption. The recurrence rate of AP was 24.5% (272/1,110), and habitual recurrence rate (more than three times) was 12.6% (140/1,110). The rate of severe AP was 4.9% (90/1,833 attacks). The mortality rate of AP was 2.6% (29/1,110 patients). The frequency of an idiopathic cause of AP was 13.3%. The recurrence rate and mortality rate of idiopathic AP were 16.2% and 5.4%, respectively. In 41.7% (10/24) of cases of idiopathic AP, microlithiasis was suspected. CONCLUSIONS: Between 2003 and 2013 in Korea, alcohol was the most frequent cause of AP in the general hospital of Seoul-Gyeonggi province of Korea. It appears that alcohol abstinence program may be necessary. Further nationwide studies would be needed to evaluate the etiologies of AP.

[Micrometastasis in Gastric Cancer].

Although the incidence and mortality rate of gastric cancer have been steadily declining, gastric cancer is still the fourth most common cancer in the world and more than 50% of cases occur in Eastern Asia. In Korea, gastric cancer is the second most common cancer and third cause of cancer related death. The standard surgical procedure for resectable advanced gastric cancer is D2 lymphadenectomy with radical gastrectomy. Even though R0 resection was completed, recurrence is relatively common, and contributes to the limited survival of the patients in gastric cancer. As a clinically relevant factor for detection of the recurrence, the presence of isolating tumor cells has been introduced and it is so called as 'micrometastasis'. Numerous immunohistochemistry and molecular studies have shown that micrometastasis can be demonstrated not only in lymph nodes but also in such body compartments as the bone marrow, peritoneal cavity and blood. Herein, we review the current knowledge and evidence of the prognostic significance of micrometastasis in peritoneal, lymph node, bone marrow. Also, we discuss the current state of research on the circulating tumor cell in peripheral blood.

Analysis of factors influencing survival in patients with severe acute pancreatitis.

OBJECTIVE: Acute pancreatitis (AP) ranges from a mild and self-limiting disease to a fulminant illness with significant morbidity and mortality. Severe acute pancreatitis (SAP) is defined as persistent organ failure lasting for 48 h. We aimed to determine the factors that predict survival and mortality in patients with SAP. METHODS: We reviewed a consecutive series of patients who were admitted with acute pancreatitis between January 2003 and January 2013. A total of 1213 cases involving 660 patients were evaluated, and 68 cases with SAP were selected for the study. Patients were graded based on the Computer Tomography Severity Index (CTSI), the bedside index for severity (BISAP), and Ranson's criteria. RESULTS: The frequency of SAP was 5.6% (68/1213 cases). Among these patients, 17 died due to pancreatitis-induced causes. We compared several factors between the survivor (n = 51) and non-survivor (n = 17) groups. On multivariate analysis, there were significant differences in the incidence of diabetes mellitus (p = .04), Ranson score (p = .03), bacteremia (p = .05) and body mass index (BMI) (p = .02) between the survivor and non-survivor groups. CONCLUSIONS: Bacteremia, high Ranson score, DM, and lower BMI were closely associated with mortality in patients with SAP. When patients with SAP show evidence of bacteremia or diabetes, aggressive treatment is necessary. For the prediction of disease mortality, the Ranson score might be a useful tool in SAP.

Factor analysis of recurrent biliary events in long-term follow up of gallstone pancreatitis.

OBJECTIVE: Recurrent attacks after acute gallstone pancreatitis (GSP) are substantial problems, together with associated morbidity and mortality. The recommended therapies for recurrent attacks are cholecystectomy and endoscopic sphincterotomy (EST). This study aimed to evaluate the long-term results of cholecystectomy and EST after clinical improvement of GSP. METHODS: A consecutive series of patients who were admitted with GSP from January 2003 to December 2014 were analyzed. Patients were categorized into three treatment subgroups: cholecystectomy (n = 53), EST (n = 51) and conservative care (n = 67). RESULTS: A total of 171 patients were enrolled. The mean follow-up period was 58 months (range 6-125 months). The pancreatitis-induced in-hospital mortality rate was 1.5%. The cholecystectomy and EST groups had a significantly lower frequency of recurrent pancreatitis than the conservative care group (P < 0.01). For recurrent pancreatitis, there was no significant difference between the cholecystectomy with and without EST subgroups. With respect to total recurrent biliary events, the cholecystectomy group was superior to the EST only group (P < 0.01). In patients receiving definitive treatment (cholecystectomy with or without EST), the presence of common bile duct (CBD) stone was an independent risk factor for recurrent biliary events (P < 0.01). CONCLUSIONS: In the long-term follow up of GSP, cholecystectomy can offer better protection against recurrent biliary events than EST only. The presence of CBD stones at time of definitive therapy might be a risk factor for recurrent biliary events.

An inverse relationship between the expression of the gastric tumor suppressor RUNX3 and infection with Helicobacter pylori in gastric epithelial dysplasia.

BACKGROUND/AIMS: This study was performed to determine the association between RUNX3 expression and Helicobacter pylori infection in premalignant gastric lesions. METHODS: We examined 107 patients with gastric epithelial dysplasia who had undergone endoscopic mucosal resection or submucosal dissection. All tissue samples were evaluated by RUNX3 staining and subclassified by immunophenotype. H. pylori infection in dysplastic lesions and the normal surrounding tissue was examined by silver staining, and cagA status was assessed by polymerase chain reaction. RESULTS: The loss of RUNX3 expression was observed in 62 cases (57.9%), and an association with H. pylori infection was found in 54 cases (50.5%). The infection rate with the cagA-positive H. pylori strain was 63.0%. In RUNX3-negative lesions, the rate of H. pylori infection (p=0.03) and the frequency of category 4 lesions (according to the revised Vienna classification) were high (p=0.02). In addition, the gastric mucin phenotype was predominant. In RUNX3-negative category 4 lesions, the rate of cagA-positive H. pylori infection rate was high but not significantly increased (p=0.08). CONCLUSIONS: Infection with H. pylori is associated with inactivation of RUNX3 in early gastric carcinogenesis. This mechanism was prominent in gastric cancer with a gastric mucin phenotype.