Cases Of Resected Gastric Cancer Research Articles

Mucinous Adenocarcinoma of the Stomach. Clinicopathological Studies.

The clinical and morphological features of 58 cases of the rare mucinous adenocarcinoma of the stomach (MUC) were investigated and compared to those of other pathological types. The incidence of MUC was only 2.9% of all cases of resected gastric cancer. Among the 58 cases of MUC, the incidence of early cases was only 19% (Group 1), while among other pathological types of cancer, it was 42% (Group 2) (p < 0.001). The incidence of early mucosal cancer was 0% in Group 1, and 54% in Group 2 of the resected early gastric cancer. The incidence of lymph node metastasis rate was 81% in Group 1, and was 46% in Group 2 (p < 0.001). The presence of peritoneal dissemination was 21% in Group 1, and was 8% in Group 2 (p < 0.001). The incidence of liver metastasis pre- and intraoperatively was 0% in Group 1, and was 3.5% in Group 2. The overall 5-year-survival rate was 45% in Group 1, and was 61% in Group 2 (p < 0.05). In stage III, the 5-year-survival rate was 30% in Group 1, and was 49% in Group 2 (p < 0.05). There was no statistical prognostic difference between the two groups in stage I, II and stage IV. Therefore, to improve the outcome for MUC, more effective radical gastrectomy and aggressive immunochemotherapy should be selected especially for stage III mucinous adenocarcinoma of the stomach.

Lymph node metastasis as a significant prognostic factor in early gastric cancer: Analysis of 1,136 early gastric cancers

Gastric cancer is the most frequent cancer and the leading cause of death from cancer in Korea. Early gastric cancer has been defined as a gastric carcinoma confined to mucosa or submucosa, regardless of lymph node status, and has an excellent prognosis with a > 90% 5-year survival rate. From 1974 to 1992, we encountered 7,606 cases of gastric cancer and performed 6,928 gastric resections. Among them, 1,136 cases were early gastric cancer (14.9% of all gastric cancer cases and 16.4% of resected gastric cancer cases). A retrospective analysis of 1,136 cases of early gastric cancer was performed to evaluate the prognostic significance of clinicopathologic features (sex, age, tumor location, gross type, histologic type, depth of invasion, status of lymph node metastasis, resection type). Lymph node metastasis was classified into three groups: N(n = 0) for no lymph node metastasis; N(n = 1-3) for one to three lymph node metastases; and N(n > 3) for more than three lymph node metastases. All patients received radical total or subtotal gastrectomy with lymph node dissection. In univariate and multivariate analysis of these nine factors, the only statistically significant prognostic factor was regional lymph node metastasis (p < 0.001). The others had no statistically significant association with prognosis. Lymph node metastasis was present in 178 cases (15.7%). The factors associated with the lymph node metastasis were depth of invasion and gross type [protruding type (e.g., types I, IIa)]. One hundred twenty-five of these patients had one to three lymph node metastases, and 53 cases had more than three lymph node metastases. The difference in 5-year survival rates among these groups was statistically significant: 94.5% for N(n = 0), 88.3% for N(n = 1-3), and 77.3% for N(n > 3). We propose that for early gastric cancer, lymph node dissection is necessary in addition to gastric resection, at least in patients with a high risk of lymph node metastasis.

PREOPERATIVE DIAGNOSIS OF LYMPH NODE METASTASIS OF GASTRIC CANCER

We studied the usefullness of dynamic computed tomography (CT), abdominal ultrasonography (US) and endoscopic ultrasonography (EUS) for the diagnosis of lymph node metastasis of gastric cancer. Seventy eight resected cases of gastric cancer were subjected to the study. The results of diagnosis of lymph node metastasis obtained by CT in 30 cases, US in 78 cases and EUS in 44 cases were compared with the histological results. The regional lymph nodes were classified into three groups, that is, the lesser curvature group consisting of lymph nodes 1, 3 and 5, the greater curvature group consisting of lymph nodes 2, 4 and 6, and the celiac artery group consisting of lymph nodes 7, 8, 9 and 11. The sensitivity of the diagnosis by EUS for the metastasis of the lesser curvature group was 69% and the accuracy was 80%, these percentages being better than those by US and CT. The sensitivity of the diagnosis by CT for metastasis of the greater curvature group was 50% and the accuracy was 87%, these percentages being better than those by US and EUS. Moreover the sensitivity by US was only 8%. Therefore it seemed to be difficult to diagnose lymph node metastasis of greater curvature group by diagnostic imagings. The sensitivity by CT for the metastasis of the celiac artery gruop was 67% which was the best result. In conclusion the combinatiuon diagnosis of CT, US and EUS is essential for the evaluation of lymph node metastasis, and the grading of lymph node dissection at operation should be determined carefully, because there is a limitation of the ability of diagnostic imagings.

A CLINICAL STUDY ON 6 CASES OF GASTRIC ADENOSQUAMOUS CELL CARCINOMA

A clinicopathological study was conducted on the cases of adenosquamous cell carcinoma of the stomach. Adenosquamous cell carcinoma of the stomach represented 0.4% (6 cases) of 1463 resected cases of gastric cancer experienced at the institution during the same period. All 6 carcinomas were in an advanced stage and the patients had a poor prognosis. Histologicaloy, both components of adenocarcinoma and squamous cell carcinoma were undifferentiated type. Tumors showed mixed histologic types of adenocarcinoma and squamous cell carcinoma. Since a transition from adenocarcinoma to squamous cell carcinoma can be seen, the majority of adenosquamous cell carcinoma probably arises from the squamous metaplasia of adenocarcinoma.

A CLINICAL STUDY OF PREOPERATIVE SERUM IMMUNOSUPPRESSIVE ACIDIC PROTEIN IN GASTRIC CANCER

This study was designed to apply immunosuppressive acidic protein (IAP), which increases in serum of cancer-bearing patients, to the treatment of patients with gastric cancer. Preoperative IAP level was measured in 143 resected cases of gastric cancer and the relationship with histopathological findings or prognosis was studied. The high IAP levels were observed in the advanced cases. Significantly increased IAP level was noted in the patients in stage N, with lymphnode metastasis, vascural invasion, and subserosal invasion. In curative resection cases, the 5-year survival rate in the high LAP group (more than 580 μg/dl) was significantly poorer than that of low IAP group. Non-curative resection cases had remarkably poor prognosis compared with curative cases, and there was no significant difference in the 5-year survival rate between high and low IAP groups. Further analysis of curative resection cases by considering background factors revealed that in even early cases such as Stage I+II, ps (-), n (-), v (-), and ly (-), high IAP group had poor prognosis compared with low IAP group, with a significant difference. These findings suggest that preoperative lAP level can offer important information for determining the operative method in the cases of early gastric cancer.

LONG TERM PROGNOSIS ACCORDING TO HISTOLOGICAL TYPE OF GASTRIC CANCER

Four hundred and ninety-three resected cases of gastric cancer at the department from January 1975 to December 1987 were analyzed for clinicopathological features and prognosis by histological types of the cancers. In this study histological types of gastric cancers were classified into differentiated and undifferentiated types according to “The General Rules for the Gastric Cancer Study”. There were 246 differentiated and 247 undifferentiated cancers. In differentiated cancer group, male-to-female ratio was 2.2:1 with an average age of 63.6±10.6 years old, versus 1.3:1 with an average age of 56.5±13.5 years old in undifferentiated cancer group. Differentiated type was predominant in older (p<0.001) males (p<0.005) compared with undifferentiated type. Differentiated type carcinomas were more frequent in the distal portion of the stomach, while most undifferentiated types were seen in the middle and upper portion of the stomach (p<0.05). Severe lymphatic and venous involvement by the tumor and tumor cells penetration were noted in undifferentiated types. In each histological stage, there was no significant difference in cumulative survival curves between two histological types. However, 5-and 10-year survival rates achieved in patients with differentiated type were superior to those in patients with undifferentiated type (p<0.01). This difference in prognosis might be caused by a fact that almost half of the differentiated cancers were in stage I and most undifferentiated cancers were in an advanced stage with severe penetration.

A CLINICOPATHOLOGICAL STUDY ON MULTIPLE PRIMARY TUMOR IN THE STOMACH AND OTHER ORGANS

In Kobe Rosai Hospital, 720 cases of resected gastric cancer managed in a past 15-year period. Multiple primary cancer in the stomach and other organs was encountered in forty-four patients, amounting to 6.1%. Twenty-eitht patients were men, and sixteen were women.The average age of multiple primary cancers was higher than that of single stomach cancers and women patients of multiple primary cancers were comparatively younger than men.Seventeen synchronous cancers -cancers of another organs appeared within a year- came to 38.6% and 27 metachronous cancers -cancers of another organs appeared after over a year- was 61.4%. It was also found that the average interval between stomach cancers and those of another organs was longer in women.Among multiple primary cancers with stomach cancers, the colon cancers ranked first in men: 11 patients, 39.0% and breast cancers came first in women, 43.8%. On the whole, colon cancers ranked first, 14 cases, 31.8%, fallowed by breast cancers and rectum cancers.When compared with single gastric cancers, a 5-year survival rate of the multiple primary cancers was lower: this was 25.0% and that was 40.8%.Death occurred in 34 patients. The causes were due to cancers of other organs rather than single stomach cancers. Direct causes of death were chiefly by peritonitis carcinomatosa and metastasis of major organs. Fourteen deaths by another diseases were also reported.

A CLINICOPATHOLOGICAL STUDY OF 205 CASES OF EARLY GASTRIC CANCER

Early gastric cancer was statistically examined in 205 cases consisting of 93 cases of m cancer and 112 cases of sm cancer treated in our hospital over the last 9 years. Early gastric cancer accounted for 33.2% of all resected cases of gastric cancer, showing a tendency to increase in number annually. The mean age of the patients was 59.1 years, and the male-female ratio was 2.25:1. Average maximum tumor diameter was 3.28 cm, and approximately 70% of them were differentiated carcinoma. The tumors, which were mostly of depressed type, were found to develop frequently in the M and A regions as well as in the lesser curvature. Rates of lymph node metastasis, lymphatic vessel invasion and venous invasion were 7.8%, 13.7% and 2.4%, respectively. Cases of sm cancer showed a significantly larger maximum tumor diameter, a smaller proportion of sig type and a larger proportion of por type than m cancer. It also presented higher rates of lymph node metastasis and lymphatic vessel invasion in comparison with m cancer. Patients with sm cancer of the lesser curvature, intermediate type, ly (+) type or v (+) type tended to show a significantly high rate of lymph node metastasis. However, no positive conditions indicating reduced lymph node dissection were found. It can be said that, at present, dissection of the group 2 lymph nodes is necessary in the treatment of early gastric cancer, so that further studies on clinical cases should be done to resolve the above question.

POSTOPERATIVE RESULTS IN SCIRRHOUS CARCINOMA OF THE STOMACH

In 530 resected cases of gastric cancer, scirrhous carcinoma occurred in 51 (21 males, 30 females). Operative methods were total gastrectomy in 36 cases and subtotal gastrectomy in 15 cases. Combined resection of adjacent organs was done in 34 cases (66.7%). Most of the cases were classified histologically as poorly differentiated adenocarcinoma. Most of the cases were exposed to the serosa, and most of the cancers were in stage IV. The 4-year-survival rate (y.s.r.) was 9.5%, which is worse than other macroscopic types. The 3-y.s.r. for curative resection cases was 34.4% (n=27) and 5.8% (n=24) for non-curative resection cases, a significant difference (p<0.02). The 3-y.s.r. for tumors 8.0 cm or less was 45.2% (n=15) and 12.8% (n=36) for tumors more than 8.0cm, also a significant difference (p<0.05). The 3-y.s.r. under the classification by Iwanaga was: linitis plastica type, 5.6% (n=18); superficial IIc type, 68.6% (n=8); erosive type, 21.2% (n=18), and stenotic type, 33.3% (n=7, 2-y.s.r.). The survival in the superficial IIc type was significantly better than the linitis plastica type (p<0.02). The methods of adjuvant chemotherapy had no influence on the prognosis. From the above, extended radical operaton of total gastrectomy or combined resection is necessary to improve the prognosis in scirrhous carcinoma.

Evaluation of Chemotherapy for Palliatively Resected Cases of Gastric Cancer

The effect of chemotherapy on palliatively resected cases of gastric cancer was evaluated on the basis of survival. The results showed a significant effect of chemotherapy only in the one-year survival rate. Drug treatment prolonged survival by at most three months. Among various regimens, the results favored significantly both the FAMT (5-FU+CPA+MMC+Chromomycin A3) combination and ftorafur alone as compared with the controls. However, there was no significant difference in survival between the group treated with the FAMT combination and that treated with ftorafur alone. In respect to each factor for which surgery became palliative, the effect of chemotherapy was high in the cases in which the P factor (peritoneal dissemination) was dominant, i.e., those which showed clinically carcino-matous peritonitis, but there was little effect in the cases of S factor alone (serosal involvement), i.e., those which showed the status of direct extension to adjacent structures, even if only the primary lesion was removed. In terms of macroscopic or histological classification, the effect of chemotherapy was high in Borrmann's type 3 or undifferentiated type.