Carcinoma Of Gastric Cardia Research Articles

The evil lies below the surface: Subsquamous tumor extension in Barrett's adenocarcinoma.

The presence of intestinal metaplasia underneath the surrounding squamous epithelium is a well known phenomenon in Barrett’s esophagus (BE) 1. Mostly caused by re-epithelialization with neosquamous epithelium in the context of mucosal healing (due to acid suppressive therapy or after biopsy sampling, for example), this issue has recently attracted new attention in the context of an increasing application of ablative therapies for Barrett’s esophagus, above all radiofrequency ablation (RFA). Although follow-up studies after RFA treatment have shown that the frequency of so called “buried glands” after re-epithelialization with neosquamous epithelium is much lower than previously feared, the limited diagnostic accessibility of these structures below the surface is still worrisome due to their potential risk of malignant transformation 2 Retrospective studies on resection specimens of Barrett’s adenocarcinoma have revealed subsquamous extension of intestinal metaplasia and even neoplasia in a huge number of cases 3. Although the clinical impact of this “subsquamous tumor extension” (SSTE) is still controversial, it needs consideration in the context of assessing the lateral borders of neoplastic lesions prior to endoscopic resection, especially for carcinomas arising near the squamocolumnar junction. As for buried glands, the prediction of SSTE relying on superficial features is very difficult. Slight elevation and irregular vascular architecture might be some of the subtle changes that can be seen in areas of the squamous epithelium that have been undermined by an adjacent adenocarcinoma. Attempts to improve visualization of SSTE included the use of chromoendoscopy with acetic acid, magnifying endoscopy with narrow band imaging, and optical coherence tomography 4 5 6. However, controlled studies on the additional diagnostic yield of these techniques for the detection of SSTE are still lacking. Given that SSTE is mostly limited to a few millimeters, this raises the question whether it is really necessary to assess its precise extent in order to achieve complete resection of neoplasia. In the present study of Nagamy et al. which represents a retrospective analysis of prospectively gained clinical data, the authors investigated the efficacy of endoscopic submucosal dissection (ESD) on tumors of the esophagogastric junction (EGJ). Applying a proximal safety margin of 1 cm outside of the squamocolumnar junction or the slight elevation interpreted as SSTE, they were able to achieve an en bloc resection rate of 100 % for both gastric cardia carcinoma and Barrett’s adenocarcinoma. For the latter, the histological evaluation revealed SSTE in 12/14 cases, half of them undetected prior to endoscopic resection, but at worst 7 mm at maximum extent, wherefore the authors concluded quite rightly that a safety margin of 1 cm may be acceptable for ESD in these tumors. Although exact delineation of SSTE by advanced endoscopic imaging techniques may be fancy, the study by Nagamy et al. nicely demonstrates that a simple and clear algorithm for resection margins based on former clinical experience may lead to excellent results for endoscopic resection. Even if SSTE might be frequent and sometimes indiscernible, it seems to be a soluble problem in the endoscopic management of Barrett’s adenocarcinoma.

Esophageal/Gastric Cancer Screening in High-risk Populations in Henan Province, China

To summarize the endoscopic screening findings in high-risk population of esophageal and gastric carcinoma and analyze influential factors related to screening. In seven selected cities and counties with high incidences of esophageal carcinoma, people at age of 40-69 were set as the target population. Those with gastroscopy contradictions were excluded, and all who were voluntary and willing to comply with the medical requirements were subjected to endoscopic screening and histological examination for esophageal, gastric cardia and gastric carcinoma in accordance with national technical manual for early detection and treatment of cancer. In three years, 36,154 people were screened, and 16,847 (46.60%) cases were found to have precancerous lesions. A total of 875 cases were found to have cancers (2.42%), and among them 739 cases had early stage with an early diagnosis rate is 84.5%. Some 715 patients underwent prompt treatment and the success rate was 81.8%. In a high-risk population of esophageal and gastric carcinoma, it is feasible to implement early detection and treatment by endoscopic screening. Screening can identify potential invasive carcinoma, early stage carcinoma and precancerous lesions, improving efficacy through early detection and treatment. The exploratory analysis of related influential factors will help broad implementation of early detection and treatment for esophageal and gastric carcinoma.

Modified thoracoabdominal incision combined with instrumental anastomosis for gastric cardia cancer

Objective To investigate the advantage and disadvantage and the feasibility of modified thoracoabdomianl incision with instrumental anastomosis for gastric cardia carcinoma.Methods 62 patients who scheduled for modified procedure were assigned to a study group; and 62 patients who randomly scheduled for conventional thoracoabdominal,transabdominal,or transthoracic incision in the same period were allocated to control group Ⅰ,Ⅱ,or Ⅲ.Average surgical duration,average length of hospital stay,intraoperative blood volume,postoperative cardiopulmonary complications,positive rate incision margins and clearance of lymph nodes were compared among the groups.Results The average surgical duration and length of hospital stay were longer in group Ⅰ than in groups Ⅱ and Ⅲ.The extents of tumor excision and lymph node clearance were significantly greater in group Ⅰ than in group Ⅱ.The average surgical duration and length of hospital stay were markedly longer and the intraoperative blood valume was obviously smaller in the study group than in group Ⅰ,while the extents of tumor excision and lymph node clearance were similar.The rate of complications did not differ significantly among the groups.Conclusions Modified thoracoabdominal incision has a markedly lower rate of complications than traditional methods,is less invasive,and a shorter convalescence period.It is worth further being studied. Key words: Gastric cardia carcinoma; Modified surgical incision; Thoracoabdominal incision

Coexistence of gastrointestinal stromal tumor, esophageal and gastric cardia carcinomas

Gastric gastrointestinal stromal tumor (GIST), esophageal squamous cell carcinoma and gastric cardia adenocarcinoma are distinct neoplasms originating from different cell layers; therefore, simultaneous development of such carcinomas is relatively rare. Auxiliary examinations revealed coexistence of esophageal and gastric cardia carcinoma with lymph node metastasis in a 77-year-old man. Intraoperatively, an extraluminal tumor (about 6.0 cm × 5.0 cm × 6.0 cm) at the posterior wall of the gastric body, a tumor (about 2.5 cm × 2.0 cm) in the lower esophagus, and an infiltrative and stenosing tumor (about 1.0 cm × 2.0 cm) in the gastric cardia were detected. Wedge resection for extraluminal gastric tumor, radical esophagectomy for lower esophageal tumor, and cardiac resection with gastroesophageal (supra-aortic arch anastomoses) were performed. Postoperative histological examination showed synchronous occurrence of gastric GIST, esophageal squamous cell carcinoma, and gastric cardia adenocarcinoma. Furthermore, immunohistochemistry indicated strong staining for c-Kit/CD117, Dog-1, Ki-67 and smooth muscle, while expression of S-100 and CD34 was negative.

Situs inversus totalis with carcinoma of gastric cardia: a case report

Situs inversus is an uncommon anomaly with rare incidence. Some cases of situs inversus totalis have been described with different types of associations. Here we report a case of situs inversus with carcinoma of the gastric cardia.

Increased incidence and survival for oesophageal cancer but not for gastric cardia cancer in the Netherlands

IntroductionA worldwide increasing incidence is seen for oesophageal adenocarcinoma, but not for oesophageal squamous cell carcinoma (SCC) and gastric cardia adenocarcinoma. Purposes of the current study were to evaluate the changing incidence rates of oesophageal and gastric cardia cancer, and to assess survival trends. Patients and methodsPatients diagnosed with oesophageal adenocarcinoma (N=12,195) or SCC (N=9046), or gastric cardia adenocarcinoma (N=9900) between 1989 and 2008 in the Netherlands were included. Changes in European Standard Population (ESP) and relative survival over time were evaluated. ResultsIncidence rates for oesophageal adenocarcinoma increased in males (+7.5%, P<0.001) and females (+5.2%, P<0.001), while the incidence for oesophageal SCC remained stable in males (−0.2%, P=0.6) and slightly increased in females (+1.7%, P=0.001). The incidence for gastric cardia cancer decreased in males (−1.2%, P<0.006), and remained stable in females (−0.2%, P=0.7).Five-year survival for both M0 and M1 oesophageal carcinoma doubled over the last 20years. No significant changes in survival were found for M0 and M1 gastric cardia carcinoma. DiscussionIn the Netherlands, a rising incidence is seen for oesophageal adenocarcinoma, but not for gastric cardia adenocarcinoma. This finding most likely reflects true changes in disease burden, rather than being the result of changes in diagnosis or classification. The increased survival for oesophageal carcinoma can be attributed to centralisation of surgery, and an increased use of multimodality therapy, factors hardly acknowledged for gastric cancer.

Double contrast-enhanced two-dimensional and three-dimensional ultrasonography for evaluation of gastric lesions

To investigate the value of two-dimensional (2D) and three-dimensional (3D) double contrast-enhanced ultrasonography (DCUS) imaging for evaluation of gastric lesions. 2D and 3D DCUS imaging with both oral and intravenous administrations of contrast agents was used to assess gastroscopiclly-confirmed gastric lesions in 46 patients with benign and malignant diseases. Initially, liquid-based ultrasound contrast agent (Xinzhang®) was given orally at dose of 500-600 mL for conventional ultrasound examination of the gastric lesions, and then a microbubble-based contrast agent (SonoVue) was injected intravenously at dose of 1.2-2.4 mL in bolus fashion to assess the perfusion pattern of the lesions using contrast imaging modes. The parameters derived from time-intensity curves including the arrival time (AT), time to peak (TTP), peak intensity (PI) and enhanced intensity (EI) were measured on the 2D DCUS imaging. 3D DCUS of the lesions was acquired to demonstrate the value of this imaging mode. There were 22 cases with benign lesions including chronic gastritis (n = 5), gastric ulcer (n = 9), gastric polyps (n = 3), gastric stromal tumors (n = 5), and 24 cases with malignant lesions including gastric cancer (n = 20), gastric cardia carcinoma (n = 3) and post-operative recurrent gastric cancer (n = 1) in the study. The oral contrast-enhanced ultrasonography (CEUS) imaging of the stomach clearly demonstrated the anatomy of the stomach and morphologic features of gastric lesions. With optimal scanning window and imaging display under oral CEUS, intravenous CEUS clearly showed the perfusion of gastric lesions with various characteristic manifestations. Both 2D and 3D DCUS images clearly demonstrated normal gastric wall as a three-layer structure, from the inside out, hyperechoic mucosa, hypoechoic muscularis and hyperechoic serosa, respectively. There were statistical significant differences of AT (8.68 ± 2.06 vs 10.43 ± 2.75, P = 0.017), PI (34.64 ± 6.63 vs 29.58 ± 8.22, P = 0.023) and EI (29.72 ± 6.69 vs 22.66 ± 7.01, P = 0.001) between malignant lesions and normal gastric wall. However, no differences of AT, PI and EI between benign lesions and normal gastric wall tissue were found. 3D DCUS could intuitively display morphological features and vascularities of the lesions with multiplanar and volume views. 3D DCUS imaging provided comprehensive information complementary to 2D imaging. The crater or wellhead appearances and feeding vessels as well as distorted nourishing vasculature of gastric carcinoma were better seen with 3D imaging than 2D imaging. DCUS imaging can simultaneously display the anatomic and perfusion features of gastric lesions. 3D DCUS can provide additional information to 2D DCUS for evaluation of gastric lesions.

Focus on small lesion of alpha-fetoprotein producing gastric cancer

Dear Editor: Alpha-fetoprotein (AFP) remains a clinically meaningful instrument for diagnosis of hepatocellular carcinoma (HCC). We meet a female patient with AFP-producing gastric cancer (AFP-GC) accompanied with gallbladder adenomyosis; she was misdiagnosed with gallbladder cancer in the beginning. A 50-year-old woman complained of abdominal distension and fatigue for 3 months. She underwent an ultrasonographic examination and was diagnosed with adenomyomatosis of the gallbladder. Also, she underwent a gastroscopy with biopsies and was diagnosed with ulcer of gastric cardia (0.7×0.5 cm) accompanied with Helicobacter pylori infection; so she accepted quadruple therapy. Her serum AFP level (43.8 ng/ml) was slightly higher than the reference value. As the AFP was positive, associated with adenomyomatosis of gallbladder, she came to our hospital for further diagnosis. Abdominal computerized tomography showed adenomyomatosis of the gallbladder. However, AFP level (74.3 ng/ml) was higher than the previous level. Based on the above results, she decided to accept laparoscopic cholecystectomy, and pathology confirmed adenomyomatosis of gallbladder. Unfortunately, after quadruple therapy and cholecystectomy, she still felt abdominal distension and fatigue. Gastroscopy was performed and showed that gastric angle ulcer did not heal, and pathology confirmed carcinoma of gastric cardia. Simultaneously, AFP level (96.4 ng/ml) was obviously higher than the previous two tests. She accepted gastrectomy surgery, and fortunately, there was no peripheral lymphnode malignant metastasis. After six courses of chemotherapy, AFP level (4.5 ng/ml) returned to normal. Alpha-fetoprotein (AFP) is a serum protein, which is synthesized by fetal liver, yolk sac cells, and fetal gastrointestinal cells. Actually, AFP is evaluated as it is one of most important serum marker for early stage HCC, clinically. AFP-GC has an aggressive behavior with the lymphatic system, is hematogenous, and metastasizes into the liver at an early stage. After cholecystectomy, if we did not follow up the AFP levels of the patient, she could be misdiagnosed or liver metastasis could have occurred when she came to hospital again. Due to poor prognosis of AFP-GC, clinicians need to pay more attention to the diagnosis. When we encountered patients with elevated AFP, we need to focus on AFP-GC except HCC.

Association of DNA repair gene XRCC1 and XPD polymorphisms with genetic susceptibility to gastric cancer in a Chinese population

Background: DNA repair gene polymorphisms can contribute to susceptibility of human cancer, including gastric cancer. Three single nucleotide polymorphisms (SNPs) of xeroderma pigmentosum group D ( XPD) and X-ray repair cross complement 1 ( XRCC1) genes were genotyped in gastric cancer and control subjects in a population from Southwestern China for their association with susceptibility of gastric cancer risk. Methods: 190 hospital-based cases and 180 matched controls were recruited and blood samples were collected from each of them and amplified with a PCR and DNA sequenced for XPD Asp312Asn, XRCC1 Arg194Trp, and XRCC1 Arg280Gln genotyping. Results: Allelic association analysis of these three SNPs showed that the frequency of XRCC1 194Trp in gastric cancer case and the control was 17.2% and 7.3%, respectively, which was significantly associated with gastric cancer risk (OR = 2.72, 95% CI: 1.04–7.24, p = 0.027). Furthermore, XRCC1 194Trp allele increased gastric carcinoma risk in male patients with older age and distant metastasis of gastric cancer. In addition, XRCC1 Trp allele but not XRCC1 Arg allele was closely associated to development of gastric cardia carcinoma. However, other SNPs did not show an association with gastric cancer risk or other clinicopathologic data of the patients. Conclusion: XRCC1 194Trp allele significantly increased the risk of gastric cancer and also associated with risk of gastric cardia carcinoma and promoted distant metastasis of gastric cancer. Future study will verify these findings for use of this SNP as biomarker in gastric cancer.

Clinical relationship between expression of MMP-2 and TIM-3 in cardia carcinoma

Objective The aim of this study was to explore MMP-2 and TIMP-3 expression in the gastric cardia carcinoma and with the relationship between the pathological stages.Methods Gastric cardia carcinoma surgical resection speciments of 115 cases were for the trial group.paraneoplastic gastric noncancerous tissues of 40 cases (the distance to cancer border>5 cm) as normal controls.The expression of MMP-2 and TIMP-3 was detected by two-step immunohistochemical method.The relationship of MMP-2 and TIMP-3 between clinicopathological stages was analyze. Results MMP-2 in carcinoma of the gastric cardia and the paraneoplastic tissues of organizations positive expression rates were 57.4%(66/115) and 40.0%(16/40) (P<0.05).MMP-2 expression was positively correlated with tumor size,tumor invasion depth,lymphatic metastasis and stage of tumor, which was negatively correlated with the prognosis of gastric cardia carcinoma (P<0.05).TIMP-3 in carcinoma of the gastric cardia and the paraneoplastic tissues of organizations positive expression rates were 48.7%(56/115) and 95.0%(38/40) (P<0.05).TIMP-3 expression was negatively correlated with tumor size,tumor invasion depth,lymphatic metastasis and stage of tumor, which was positively correlated with the prognosis of gastric cardia carcinoma. Conclusion The over expression of MMP-2 and the lost of TIMP-3 may play an important role in the invasion and metastasis of gastric cardia carcinoma.Combined MMP-2 and TIMP-3 detection may help to judge gastric cardia carcinoma development and to assess the prognosis of patients. Key words: Stomach neoplasms; Immunohistochemistry; Matrix metalloproteinase 2; Tissue inhibitor of metalloproteinase 3

The clinical analysis about the dilatation for the stoma narrow after operation of carcinoma of esophago cardia

Objective The author summarizes the clinical curative effect about the dilatation for the stoma narrow after operation of carcinoma of esophago cardia. Methods 242 patients included were expanded with Savary-Gilliard dilator. Results 647 expanding therapies were made, average 2.67 times per patient. The effective rate is 99.1%,the recovery rate is 87.6%. Conclusion The dilatation using Savary-Gilliard dilator is one of the safe, convenient, effective methods in the treatment of stoma narrow after operation of carcinoma of esophago cardia. Key words: Esophageal carcinoma; Carcinoma of gastric cardia; Stoma narrow; Dilatation

The curative effect of inner stents on the treatment of malignant esophageal stenosis

Objective To observe the effect and safety of home-made metallic stent implantation in the treatment of malignant esophageal stricture. Methods Among 47 cases with malignant esophageal stricture, there were 8 cases in superior esophagus, 12 cases in middle esophagus,27 cases in inferior esophagus, and 12 cases with gastric cardia carcinoma. Those cases were not suitable or willing to accept surgical operation. Before stenting, radiotherapies were not done in all cases. Different shape home-made metallic stents were used to place the segment of structure via mouth according to the positions and diameters of esophageal stricture. The follow-up periods was 5 ～ 16 months. Results 48 stents were implanted successfully in 47 patients. After operation,swallow was improved in all patients. No major complications occurred in these groups. Restenosis occurred in the third month post-operation in 1 case owing to tumor relapsed and grew at proximal stent, and another stent was implanted successfully. Conclusions Stents implantation for malignant stricture can effectively and safely relieve the dysphasia. Key words: Esophageal stenosis; Stents; Radiology, Interventional

A genetic epidemiological study on esophageal cancer and carcinoma of the gastric cardia in Cixian county of Hebei Province

Objective To investigate the role of family aggregation and genetic factors of esophageal cancer (EC), including carcinoma of gastric cardia (CGC), in Cixian county, and to calculate the segregation ratio and heritability of first-degree relatives (FDR) in EC cases.

Comparison of Anastomotic Leakage and Stricture Formation following Layered and Stapler Oesophagogastric Anastomosis for Cancer: A Prospective Randomized Controlled Trial

The objective of this prospective, randomized, controlled trial, conducted from May 2002 to December 2007, was to compare post-operative anastomotic leakage and stricture formation following layered manual versus stapler oesophagogastric anastomosis in patients who underwent resection of oesophageal or gastric cardia carcinoma. Patients (n = 516) were randomized to receive either layered manual or circular stapled oesophagogastric anastomosis. Mean follow-up time was > 12 months. Anastomotic leakage occurred in one (0.4%) patient in the layered group and six (2.2%) in the stapler group; no statistically significant between-group difference. After operation, two (0.8%) patients in the layered group and 13 (5.0%) in the stapler group developed a benign oesophageal stricture; the difference between the groups was statistically significant. Compared with stapler anastomosis, layered manual anastomosis may significantly reduce the incidence of anastomotic strictures. This method is easy to apply and could be used as an alternative procedure for oesophagogastric anastomosis after resection for oesophageal or cardia carcinoma.

Human papillomavirus DNA and P16INK4Aexpression in concurrent esophageal and gastric cardia cancers

To investigate the relationship between human papillomavirus (HPV) infection and concurrent esophagus and gastric cardia cancer from the same patient (CC) and examine the significance of P16(INK4A) protein expression. Polymerase chain reaction was used to detect the presence of HPV type16 (HPV16). The expression of P16(INK4A) protein was detected using immunohistochemistry. Among the CC specimens, HPV16-DNA was found in eight cases of esophageal squamous cell carcinoma (ESCC) and five cases of gastric cardia adenocarcinoma (GCA), respectively (47% vs 29%), and two of both ESCC and GCA. P16(INK4A) was highly expressed in both ESCC and GCA. In the HPV-associated positive CC, higher P16(INK4A) expression was observed in the GCA than in the ESCC (75% vs 25%, P < 0.05). HPV16 as a correlated risk factor may play an important role in the development of ESCC and GCA. P16(INK4A) may be a screening index in the HPV-associated carcinoma of gastric cardia.

Clinical Observation of Gastrostomize with Double Vessel for Postoperative Fistula in the Anastomotic Stoma of Esophagogastrostomy

Objective To investigate the improvement in therapies of postoperative fistula in the anastomotic stoma of carcinoma of esophagus or gastric cardia.Methods 27cases of carcinoma of esophagus or gastric cardia,which were found postoperative fistula in the anastomotic stoma,received gastrostomize with double vessel by which gastrointestinal decompression and intestinal tract nutritional support were taken.Results 25 patients fully recovered to leave hospital.while 2 cases died of severe septic shock and multiple organ failure.Conclusion Therapies of gastrointestinal decompression and intestinal tract nutritional support by gastrostomize with double vessel could efficiently promote healing of fistula in the anastomotic stoma,degrade the death rate notably. Key words: Esophageal carcinoma; Carcinoma of gastric cardia; Fistula in the anastomotic stoma

Gastric Cardia Carcinoma is Associated with the Promoter -77T>C Gene Polymorphism of X-Ray Cross-Complementing Group 1 (XRCC1)

PurposeX-ray repair cross complementing group 1 (XRCC1) is one of the major DNA repair proteins involved in the bas-excision repair pathway. Several single-nucleotide polymorphisms in the XRCC1 gene are identified and related with increased cancer risk development. In particular, the -77T>C polymorphism located on the promoter region relates with lung cancer risk development. The aim of this study is to analyze the -77T>C allelic frequencies in a population composed of 456 primary gastric cancer patients (GC) and 507 blood donor controls. MethodsGC patients were observed at the University of Siena, Italy; clinicopathological data and family history were available for the cancer group. The control group is composed of blood donors. Constitutional genomic DNA was PCR amplified, and XRCC1 -77T>C was detected using restriction enzyme BsrB I and analyzed in a 3% agarose gel. ResultsThe -77C>C homozygous genotype was significantly associated with increased risk of gastric cardia carcinoma (p = 0.023) with an odds ratio of 1.65 (95% confidence interval 1.14 to 2.4). In the family history stratification, we report a significant association (p = 0.043) between the -77T>C polymorphism and GC cases with familial lung cancer aggregation. ConclusionsOur results suggest that the XRCC1 -77T>C polymorphism is a relevant host susceptibility factor for gastric cardia cancer development and specific subsets of familial clustering of GC.

HER2 status in 146 gastroesophageal carcinomas assessed by two rabbit monoclonal antibodies (SP3 and 4B5) and two in situ hybridisation methods (FISH and SISH)

e15555 Background: In the industrialized world, the incidence of adenocarcinomas of the distal esophagus/gastric cardia is increasing rapidly and though the incidence of carcinomas of the gastric body / antrum are decreasing they still represent a significant health problem. Several reports claim a significant HER2-positivity in gastro-esophageal adenocarcinomas. A large phase III trial in which HER2-positive gastric cancer patients are treated with trastuzumab is ongoing. New HER2 assessment methods are gaining popularity in breast cancer. Methods: HER2 status was examined in gastro-esophageal carcinomas, comparing SP3 (Labvision) and 4B5 (Ventana) immunohistochemistry (IHC), conventional dual probe HER2 FISH (DAKO), and SISH (Ventana) in a single Dutch institution. Results: IHC was carried out on biopsies of 146 patients with adenocarcinomas of the esophagus (n=44), gastric cardia (n=28), body (n=24) and antrum (n=50). IHC positivity, as defined by an immunoscore 2+ or 3+ using a modified scoring system, was present in 17 cases with the SP3 antibody, and in 24 cases with 4B5. FISH/SISH showed identical results in 40 cases carried out when any immunoreactivity in either antibody was detected. 100% of SP3-IHC-positive cases, and 92% of 4B5-IHC-positive were amplified. The negative predictive value of SP3 and 4B5 (immunoscores 0/1+) was 77% and 95%, respectively. Heterogenous HER2- positivity with partial staining/amplification was present in 73% of the adenocarcinomas, occasionally with only a tumor area of 10–20% showing positivity. HER2-amplification was present in 27% of esophageal and 18% in gastric cardia carcinomas (resulting in 24% amplification of tumors of the esophago-gastric region). In the distal stomach, 7% HER2-amplification was seen. Conclusions: HER2 amplification is present in a significant proportion of esophago-gastric region adenocarcinomas (24%) but at a much lower rate in the distal stomach (7%). Both antibodies can be used for initial screening for possible amplification though the 4B5 antibody has the highest negative predictive value. FISH and SISH yield identical results but the SISH assay offers rapid assessment. [Table: see text]

Analysis of lymph node metastases of 1,526 cases with thoracic esophageal and cardiac carcinomas: A random sampling report from the Fourth Hospital of Hebei Medical University from 1996 to 2004

To summarize the regular pattern and state of lymph node metastasis of patients with esophageal and cardiac carcinomas, so as to analyze factors influencing lymph node metastasis. Clinical data collected from 1,526 thoracic esophageal and cardiac carcinoma patients who were admied in the Fourth Hospital of Hebei Medical University during a period from January 1996 to December 2004, were randomly selected and an Access Database of the patient’s information was set up. Eight clinico-pathologic factors, including the patient’s age, tumor location and size, pathological classification, the depth of tumor invasion, vascular tumor embolus (VTE), the state of surrounding organ encroachment and the status of tumor residues, were identified. A correlation between these factors and metastases was statistically analyzed using SPSS13.0 so ware. Lymph node metastatic sites from esophageal carcinomas included the thoracic and abdominal cavity. Lymph node metastasis from the superior esophageal carcinomas mainly occurred in the neck and thoracic cavity. There was a two-way lymph node metastasis in the patients with the middle esophageal carcinoma. The inferior esophageal carcinomas mainly metastasized to the paraesophageal, paragastric cardia, and left gastric artery lymph nodes. The rate and degree of the metastasis from the inferior esophageal carcinomas were significantly higher compared to those of the superior and the middle esophageal carcinomas (P 0.05). Multifactorial logistic regression analysis showed that the tumor size, depth of tumor encroachment, VTE, and tumor residues could all bring about obvious impact on lymph-node metastases (P < 0.05). Lymph node metastasis from superior esophageal carcinomas mainly occurs in the neck and thoracic cavity. The middle esophageal carcinomas presented a two-way lymph-node metastasis (both the upwards and the downwards), and the lymph node metastasis from inferior esophageal carcinomas mainly occurred in the thoracic and abdominal cardia were most commonly found in the abdominal cavity, with frequent paraesophageal lymph-node metastasis. The sufficient attention should be paid to neck lymph node clearance in cases of esophageal carcinoma. What is of the greatest concern is the clearance of the le gastric artery lymph nodes, and also in cases of gastric cardia carcinoma, clearance, the paraesophageal lymph nodes. With an increase in the tumor size and depth of tumor encroachment, and occurrence of VTE and tumor residual cells, the risk of lymph node metastasis is significantly raised (P < 0.05).

Detection of serum autoantlbodies for cyclinB1,p62,Koc,IMP1 and Survivin in the subjects with esophageal and gastric cardia carcinoma and precancerous lesions and their expressions in the esophageal and gastric cardia Cancer tissue

Objective To characterise the alterations of serum autoantibodies for cyclinB1,p62,Koc-IMP1 and survivin in the subjects with esophgeal and gastric cardia carcinoma and precancerous lesion and their expres-sions in the esophageal and gastric cardia cancer tissue.Methods Enzyme-linked immunoassay and tumor-associated antigen mini-array (consisting of five full-length recombinant proteins,including eyefinB1-p62-Koc,IMP1 and Survivin)were applied to determine the serum level of the autoantibodies of these antigens on 376 subjects with e-sephageal and gastric cardia carcinoma and precancerous lesions.At the same time,the expression of these antigens was detected by immunohistochemical method(ABC)on 13 patients with esophageal cancer and 16 with gastric car-dia cancer.Results All of the 5 antigens determined,the linear correlation Was observed for the detection frequency of cyclinB1,IMPI and p62 in esophageal carcinogenesis,and for p62 in gastric cardia multi-stage progression from normal to precancerous and cancerous lesions(P<0.05).The detection rale with single positive antoantibody im-munoreactivity for both esophageal and gastric cardia cancers were low.However.the positive detection mte for both esophageal and gastric cardia cancer increased apparently when the multiple positive markers were combined together for analysis,which increased tO 3～5 and 3～4 folds respectively.Furthermore,the difference in autoantibody immu-noreactive rate was significant with the lesion progressed from mild tO severe precancerous lesions and to cancer both in esophageal and gastric cardia cancers(P<0.05).The positive immunoreactions of the 5 antigens were detected in cancer tissues.The positive immunostaining rates for cyclinB1,Koc,IMP1 and Survivin both in esophageal and gastric cardia cancers were higher compared to their serllin positive rate of autoantibodies I P<0.05).Of the pa-tients with positive immunostaining in the two cancer tissues,the autoantibodies in the serum for the corresponding antigens could be detected in the same patient.Conclusion The production of the tumor-associated autoantibodies is related tO antigens.The screening rate through serum tumor-associated antigen mini-array for the patients with e-sophageal and gastric cardia carcinoma and precancerous lesions has been increased apparently with combined analy-sis of multiple autoantibodies than with single one. Key words: Esophageal carcinoma; Carcinonla of gastric cardia; Tumor-associated antigens; Au-toantibody