Lymphatic Vessel Involvement Research Articles

Prognostic value of clinicopathological parameters and outcome in 484 patients with oral squamous cell carcinoma: microvascular invasion (V+) is an independent prognostic factor for OSCC

Several clinicopathological parameters have been implicated in prognosis, recurrence and survival, following oral squamous cell carcinoma (OSCC). The purpose of this retrospective study was to review the outcome of patients with oral cavity squamous cell carcinoma treated at a single institution by primary surgical resection with or without adjuvant radiotherapy or radiochemotherapy, or brachytherapy and to identify the factors affecting survival and locoregional control. We retrospectively reviewed the records of 429 consecutive patients after primary radical R0 tumor resection and 55 patients after brachytherapy in our department between 1997 and 2010. OSCC pathological parameters were analyzed including age, gender, site distribution, tumor size, lymph node involvement, grading, microvascular invasion, lymphatic vessel involvement, and distant metastasis. Descriptive statistics were calculated for each variable and survival was calculated using the univariate Kaplan-Meier method. Prognostic factors were analyzed using the multivariate Cox proportional hazard model. Average tumor size was 10.9 mm (95 % CI for the mean 9.6-12.3). Disease-free survival at 5 years was 65 % and overall 5-year survival was 62 %. On univariate analysis, patients with increased tumor size, lymph node involvement, microvascular invasion, and lymphatic vessel involvement had a significant poor prognosis. Multivariate analysis showed that independent prognostic factors were increased tumor size and microvascular invasion. This hospital-based retrospective cohort study points out different clinicopathological prognostic factors of survival in a large patient cohort treated for OSCC. It highlights increased tumor size and microvascular invasion as the most independent prognostic factors in predicting survival in patients with OSCC.

Identification of clinicopathological factors predicting lymph node metastasis in differentiated submucosal gastric cancer: Impact on surgical strategy

The aim of this study was to identify the clinicopathological factors predictive of lymph node metastasis (LNM) in differentiated submucosal gastric cancer (SGC), and to establish a simple criterion which may be useful in selecting the optimal treatment for cases with SGC. A total of 70 patients with differentiated and surgically treated SGC were retrospectively examined, and the association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses. Odds ratios (OR) with 95% confidence intervals (95% CI) were calculated. In the univariate analysis, tumor size, lymphatic vessel involvement and the presence of intermingled components of undifferentiated cancer cells were significantly associated with a higher rate of LNM (all P<0.05). In the multivariate analysis, lymphatic vessel involvement (OR=392.269; 95% CI 1.380-1115.032; P=0.038) and presence of intermingled components of undifferentiated cancer cells (OR=98.515; 95% CI 2.687-3612.400; P=0.012) were found to be independent pathological risk factors for LNM. LNM was observed in 75.0% (3/4) of patients with the two risk factors, but in none of the 45 patients without the two risk factors. Lymphatic vessel involvement and presence of intermingled components of undifferentiated cancer cells are independently associated with the presence of LNM in differentiated SGC. Thus, these two risk factors may be used to establish a simple criterion to guide further surgical procedures in cases with SGC revealed after endoscopic mucosal resection (EMR).

Defining a subgroup treatable for laparoscopic surgery in poorly differentiated early gastric cancer: the role of lymph node metastasis.

ObjectiveThe present study aims to identify the clinicopathologic factors predictive of lymph node metastasis (LNM) in poorly differentiated early gastric cancer (EGC) and to expand the possibility of using laparoscopic surgery for the treatment of poorly differentiated EGC.MethodsData from 70 cases of poorly differentiated EGC treated with surgery were collected. The association between clinicopathologic factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses.ResultsUnivariate analysis showed that tumor size, depth of invasion, and lymphatic vessel involvement (LVI) were the significant and independent risk factors for LNM (all P<0.05). The LNM rates were 6.9%, 45.5%, and 60.0%, respectively. There was no LNM in 25 patients without the above three risk factors.ConclusionsLaparoscopic surgery is a sufficient treatment for intramucosal poorly differentiated EGC if the tumor is less than or equal to 2.0 cm in size and when LVI is absent upon postoperative histological examination.

Risk clinicopathological factors for lymph node metastasis in poorly differentiated early gastric cancer and their impact on laparoscopic wedge resection

To investigate the predictive factors of lymph node metastasis (LNM) in poorly differentiated early gastric cancer (EGC), and enlarge the possibility of using laparoscopic wedge resection (LWR). We retrospectively analyzed 85 patients with poorly differentiated EGC who underwent surgical resection between January 1992 and December 2010. The association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses. Odds ratios (OR) with 95%CI were calculated. We further examined the relationship between the positive number of the three significant predictive factors and the LNM rate. In the univariate analysis, tumor size (P = 0.011), depth of invasion (P = 0.007) and lymphatic vessel involvement (P < 0.001) were significantly associated with a higher rate of LNM. In the multivariate model, tumor size (OR = 7.125, 95%CI: 1.251-38.218, P = 0.041), depth of invasion (OR = 16.624, 95%CI: 1.571-82.134, P = 0.036) and lymphatic vessel involvement (OR = 39.112, 95%CI: 1.745-123.671, P = 0.011) were found to be independently risk clinicopathological factors for LNM. Of the 85 patients diagnosed with poorly differentiated EGC, 12 (14.1%) had LNM. The LNM rates were 5.7%, 42.9% and 57.1%, respectively in cases with one, two and three of the risk factors respectively in poorly differentiated EGC. There was no LNM in 29 patients without the three risk clinicopathological factors. LWR alone may be sufficient treatment for intramucosal poorly differentiated EGC if the tumor is less than or equal to 2.0 cm in size, and when lymphatic vessel involvement is absent at postoperative histological examination.

Systematic review of the predictors of positive margins in gastric cancer surgery and the effect on survival

Complete resection is the only definitive treatment available for gastric cancer. Factors associated with positive margins and their survival effects have been the subject of many studies, but the appropriate management for these patients is still debated. The objective of this review is to examine positive margins after gastric cancer resections by exploring predictive factors, impact on survival, and optimal strategies for re-resection. A systematic electronic literature search was conducted using Medline and EMBASE from January 1, 1998, to December 31, 2009. Studies on gastric or gastroesophageal junction adenocarcinoma that either investigated the predictors for positive margin or employed multivariate methods to analyze the survival effects of positive margins were selected. Twenty-two studies incorporating 19355 patients were included in this review. Positive margins were associated with larger tumor size, deeper wall penetration, more extensive gastric involvement, greater nodal involvement, higher stage, diffuse histology, higher Borrmann type, lymphatic vessel involvement, and total gastrectomy. Patient survival was independently associated with margin status, and this survival effect was more prominent in early cancers in most studies that performed subgroup analyses. The probability of acquiring positive margins is highly dependent on the biology and the extent of the tumor. There is a significant negative effect on survival, which is more prominent in cancers at early stages, making re-resection or a second operation important. Patients with more advanced disease can be offered more extensive surgery to remove disease, but this should be balanced against the risks of more extensive resections.

Erysipelas after breast cancer treatment

Erysipelas is a distinct type of superficial cutaneous cellulitis with marked dermal lymphatic vessel involvement caused by group A beta hemolytic streptococcus (very uncommonly group C or C streptococcus) and rarely caused by S. aureus. Lymphedema, venous stasis, web intertrigo, and obesity are risk factors in the adult patient.1 Erysipelas of the upper extremity following breast cancer treatment was vaguely described as a complication in a German-language journal2 and as a case report in a Dutch-language journal.

Diagnosis and treatment of 166 patients with early gastric cancer

To summarize our experiences in the diagnosis and treatment of early gastric cancer (EGC). The clinicopathological data of the 166 EGC inpatients who were treated in our hospital from January 1999 to January 2009 were retrospectively analyzed and their treatment outcomes were followed up. Surgical treatment for ECG accounted for 9.04% (176/1946) among all the surgeries performed for gastric cancers. Among the analyzed 166 cases, 9 asymptomatic patients were diagnosed by routine examination, 29 (17.47%) had a history of gastric ulcer or chronic gastritis, and 20 (12.05%) had a family history of esophageal or gastric cancer. Of 64 patients who received double-contrast gastric X-ray examination, 57 patients (89.06%) were found to be with abnormalities. Endoscopy revealed lesions in lower third, middle third, and upper third of the stomach in 115 patients (69.28%), 26 patients (15.66%), and 25 patients (15.06%), respectively. A total of 126 patients received D(0) or D1 operations and 40 patients received operations more than D+1 operation. As shown by post-operative pathological examinations, the mean diameter of the lesions was (2.52±1.62) cm; 75 patients (45.18%) had mucosal gastric cancer, 91 (54.82%) had submucosal gastric cancer, 20 patients with submucosal gastric cancer had lymph node metastasis, and 8 patients had lymphatic vessel involvement. The overall 5-year survival rate was 70.0% and 89.7% among patients with or without lymph node metastasis (P=0.002). Univariate analysis revealed that depth of tumor invasion (submucosa) and lymphatic vessel involvement were significantly correlated with lymph node metastasis (P=0.000, P=0.001). Multivariate analysis showed that lymphatic vessel involvement was significantly correlated with lymph node metastasis (odds ratio: 15.67; 95% confidence interval, 3.40-72.14). The proportion of EGC patients undergoing gastrectomy is relatively low among all gastric cancer patients. Lymph node metastasis is a key prognostic factor for EGC. A proper staging of gastric cancer, a precise evaluation of the depth of infiltration, and appropriate and standardized treatment are important to improve the outcomes.

Intratumoral Lymphatic Vessel Involvement is an Invasive Indicator of Completely Resected Pathologic Stage I Non-small Cell Lung Cancer

Therapeutic strategies remain controversial for the completely resected stage I non-small cell lung cancer patients with worse long-term survival. Comprehensive patient selection for adjuvant chemotherapy should be based on proven risk factors. The records of 610 patients with pathologic stage I complete pulmonary resection were retrospectively reviewed. Survival was analyzed by the Kaplan-Meier method, log-rank test, and Cox proportional hazards analysis. Overall 5-year survival rate was 75.1%. Univariate analysis for all patients revealed eight significant prognostic factors: age (p < 0.0001); gender (p = 0.0001); histopathology (p < 0.0001); differentiation (p < 0.0001); tumor size (T factor) (p < 0.0001); pleural involvement (p = 0.0007); blood vessel involvement (p < 0.0001); and lymphatic vessel involvement (p < 0.0001). Multivariate analysis revealed age, tumor size, and lymphatic vessel involvement as significant factors. Hazard ratios for death were 0.563 for age younger than 70 years (p = 0.0004), 0.629 for T1 tumor (p = 0.0126), and 0.514 for ly(-) (p = 0.0002). Five-year survival rates in patients with T1 without lymphatic vessel involvement, T1 with lymphatic vessel involvement, T2 without lymphatic vessel involvement, and T2 with lymphatic vessel involvement were 88.7, 69.8, 73.5, and 56.1%, respectively. Overlapping prognoses were seen between T1 with lymphatic vessel involvement classed as stage IA and T2 without lymphatic vessel involvement classed as stage IB disease. Our analyses indicate lymphatic vessel involvement as an independent indicator of cancer invasiveness, surpassing the size-dependent tumor, node, metastasis staging system in pathologic stage I non-small cell lung cancer. Patients who would show survival benefits from adjuvant chemotherapy might be found by stratifying prognostic factors.

Predictive factors of lymph node metastasis in early mucinous adenocarcinoma

OBJECTIVE To identify clinicopathologic factors which predict lymph node metastases (LNM) in early mucinous adenocarcinoma patients, and to further explore the possibility of using minimally invasive treatment for patients with the disease. METHODS Data was collected from 38 patients with early mucinous adenocarcinoma who were surgically treated, and the association between clinicopathologic factors and the presence of LNM was retrospectively analyzed using univariate and multivariate logistic regression analysis. RESULTS Tumor size greater than 2.0 cm, the development of submucosal invasion, and the presence of lymphatic vessel involvement (LVI) were con fi rmed through univariate analysis as having a significant association with LNM and were considered to be significant and independent risk factors for LNM through multivariate analysis. CONCLUSION Tumor size > 2.0 cm, the development of submucosal invasion, and the presence of LVI are independent predictive factors for LNM in early mucinous adenocarcinoma. Minimally invasive treatment may be an effective treatment for intramucosal early mucinous adenocarcinoma when the tumor size is 2.0 cm or less, and if LVI has not occurred, as confi rmed by postoperative histologic examination.

Recent Developments on the Significance and Pathogenesis of Lymph Node Involvement in Ovarian Serous Tumors of Low Malignant Potential (Borderline Tumors)

In approximately 27% of patients that were surgically staged for ovarian serous borderline tumors (ovarian serous tumors of low malignant potential), regional lymph nodes, most commonly the pelvic and paraaortic groups, display morphologically similar epithelial clusters. Lymph nodes above the diaphragm may also be involved. Lymph node involvement does not adversely impact the overall survival of patients with ovarian serous borderline tumors, but there is controversy as to whether this finding is associated with a decrease in recurrence-free survival. Nodular aggregates of epithelium greater than 1 mm in maximum dimension, as compared with all other patterns of nodal involvement, have been associated with reduced recurrence-free survival. The lymph nodes may also be the site of recurrence and/or progression to carcinoma of an ovarian serous borderline tumor. Recent molecular and morphologic data suggest that although most nodal implants are indeed metastatic from their synchronous ovarian neoplasms, a small subset arise de novo from nodal endosalpingiosis. The precise mechanistic basis for how these noninvasive neoplasms achieve nodal metastases is unclear. However, because most patients with nodal metastases also have peritoneal implants, tumors that are ovary-confined and without ovarian surface involvement are rarely associated with nodal involvement, microinvasive borderline tumors frequently display lymphatic vessel involvement yet show a remarkably low frequency of nodal involvement, in conjunction with the recent finding that node-positive and node-negative tumors display no significant differences in lymphatic vessel density, suggest that the route of spread to lymph nodes in most cases is via the peritoneal and not tumoral lymphatics.

Predictive factors for lymph node metastasis in poorly differentiated early gastric cancer and their impact on the surgical strategy

To identify the predictive clinicopathological factors for lymph node metastasis (LNM) in poorly differentiated early gastric cancer (EGC) and to further expand the possibility of using endoscopic mucosal resection (EMR) for the treatment of poorly differentiated EGC. Data were collected from 85 poorly-differentiated EGC patients who were surgically treated. Association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses. Univariate analysis showed that tumor size (OR= 5.814, 95% CI = 1.050 - 32.172, P = 0.044), depth of invasion (OR=10.763, 95% CI=1.259 - 92.026, P = 0.030) and lymphatic vessel involvement (OR= 61.697, 95% CI= 2.144 - 175.485, P = 0.007) were the significant and independent risk factors for LNM. The LNM rate was 5.4%, 42.9% and 50%, respectively, in poorly differentiated EGC patients with one, two and three of the risk factors, respectively. No LNM was found in 25 patients without the three risk factors. Forty-four lymph nodes were found to have metastasis, 29 (65.9%) and 15 (34.1%) of the lymph nodes involved were within N1 and beyond N1, respectively, in 12 patients with LNM. Endoscopic mucosal resection alone may be sufficient to treat poorly differentiated intramucosal EGC (< or = 2.0 cm in diameter) with no histologically-confirmed lymphatic vessel involvement. When lymphatic vessels are involved, lymph node dissection beyond limited (D1) dissection or D1+ lymph node dissection should be performed depending on the tumor location.

Predictors of lymph node metastasis in early gastric cancer.

Data were analysed on 396 patients with early gastric cancer who underwent resection in this department; special reference was made to lymph node metastasis. Metastases were present in the dissected lymph nodes of 47 patients (11.9 per cent). The survival rate for patients with metastasis to lymph nodes was lower than for those without such metastasis (P less than 0.05). Lymph node metastasis was associated with larger tumour, a higher incidence of submucosal invasion, a higher rate of lymphatic vessel involvement, an advanced stage of disease and a non-curative resection rate of 6.4 per cent. Multivariate analysis showed that the independent risk factors for lymph node metastasis in patients with early gastric cancer were large tumour size, lymphatic vessel involvement and invasion into the submucosal layer. In patients with these risk factors, lymph node dissection and postoperative adjuvant therapy should be performed in an attempt to prevent recurrence in the form of lymph node metastasis.

Pathological approach to evolving prognostic and predictive factors of breast cancer

Among the evolving concepts of prognostic and predictive factors in breast carcinoma pathology are those relating to lymph node status, tumor size, histological type, histological grade, bone marrow micrometastasis, and lymphatic and blood vessel involvement. Correct identification based on a uniform and complete pathological evaluation of tumor specimens is vital to correctly decide treatment. In addition we describe inflammatory cell infiltrates in breast carcinoma as not only prognostic and predictive factors but also pleiotropic regulators and/or effectors.

Association of lymphatic vessel invasion and progression of cervical cancer with focused expression of CD9

5036 Background: Lymphovascular space invasion plays a critical role in the progression of cervical cancer. It is responsible for an unfavorable prognosis even in patients with early stage disease. The identification and functional characterization of molecules that are differently expressed in tumors with lymphatic vessel involvement in comparison to those without are of particular interest. For a number of malignant diseases, the level of CD9 expression a transmembrane protein involved in various fundamental cellular processes was found to be inversely correlated with tumor invasiveness, ability to form metastases, and poor clinical outcome. We demonstrate that carcinomas of the cervix locally re-express CD9 at sites of lymphatic space invasion. This suggests its functional involvement in transendothelial migration as a crucial step in the formation of lymph node metastases. Methods: Formalin-fixed, paraffin-embedded surgical specimens of 44 consecutive patients with invasive cervical cancer were examin...

Prospektive Studie zur endoskopischen Therapie des kolorektalen pT1-Karzinoms

INTRODUCTION In a prospective study initiated in 1982, we have been investigating the question as to whether - and if so, which - pT1 carcinomas of the colorectum can be treated exclusively via the endoscope. METHOD In the period between February 1, 1982 and April 30, 2001, a total of 5,470 polyps were removed endoscopically at the Medical Department I of the Klinikum Ludwigsburg. Among these lesions, a total of 144 (2.6 %) pT1 carcinomas were found in 141 patients. We were able to follow 120 patients with 123 pT1 carcinomas over a mean follow-up period of 46 months (range: 1-60). In low-risk situations (definitive removal in healthy tissue, G1-G2, no lymphatic involvement), endoscopic treatment alone usually represented sufficient treatment. In high-risk cases (removal in healthy tissue uncertain or negative, and/or lymphatic vessel involvement, and/or G3/G4), subsequent surgical resection was carried out. RESULTS 64 cases were classified as high-risk, 59 as low-risk. Nevertheless, 9 patients with 10 low-risk carcinomas were submitted to surgery (young age, patient's own request). In none of these 10 cases was residual tumour or lymph node metastasis detected in the surgical specimen. 47 patients with 49 low-risk carcinomas were treated solely by endoscopic polypectomy using the diathermy snare, and 45 patients with 47 carcinomas remained recurrence-free during the follow-up period. In a single case, a local recurrence was detected 2 months after polypectomy and underwent curative resection. In another case, peritoneal carcinosis with tumour infiltrating into the colon developed 8 months after initial treatment; this, however, was most probably a recurrence of a previously operated carcinoma of the uterus. Among the high-risk cases, 10 were not submitted to surgery on account of advanced age and/or rejection of an operation by the patient; all remained recurrence-free. Among the surgically treated high-risk carcinomas, 3 surgical specimens contained residual tumour, while 2 revealed a lymph node metastasis. In our group of patients, no tumour-related mortality was seen among endoscopically treated patients. DISCUSSION In the light of the fact that the reported mortality rate associated with open surgery for colorectal carcinoma is 3 % as compared with about 1 % risk of lymph node metastasis and 0,1 % mortality rate for the endoscopic modality, endoscopic removal of a pT1 tumour in a low-risk situation followed by appropriate surveillance can be considered as adequate treatment.

Clinicopathologic characteristics of peripheral squamous cell carcinoma of the lung.

Squamous cell carcinoma of the lung can be divided into two types according to the location of the primary site: the central type and the peripheral type. The clinicopathologic factors in the peripheral type of lung squamous cell carcinoma have not yet been fully evaluated. A total of 204 surgically resected lung squamous cell carcinomas were reviewed with special reference to their location, histologic characteristics based on tumor growth patterns, and clinicopathologic factors. The central type and the peripheral type accounted for 95 and 109 cases, respectively. Although the patient population of the peripheral type was older, with a lower pathologic stage, lower lymphatic vessel involvement, and lymph node metastasis, the Kaplan-Meier survival proportions did not differ significantly between these two groups. Based on the histologic growth pattern, the peripheral type was classified under three subgroups as follows: 1). the alveolar space-filling type, 2). the expanding type, and 3). the combined type. Among these three types, the alveolar space-filling type showed neither lymphatic vessel invasion nor lymph node metastasis and had the most favorable prognosis. The central and peripheral types of lung squamous cell carcinoma have different clinicopathologic characteristics and should be classified under respectively different categories.

Vascular endothelial growth factor-C expression in human gallbladder cancer and its relationship to lymph node metastasis

Lymph node metastasis is a major prognostic factor in human cancer. Vascular endothelial growth factor C (VEGF-C) is a lymphangiogenic polypeptide that has been implicated in several human solid tumors. However, the clinical significance of VEGF-C has remained unknown in gallbladder carcinoma. Paraffin-embedded tumor specimens of 52 surgically resected gallbladder cancers were immunohistochemically stained for VEGF-C, VEGF, and CD34. The correlations among VEGF-C expression, VEGF expression, microvessel density (MVD), clinicopathologic features, and clinical outcomes were statistically analyzed. Thirty-three (63%) of the 52 gallbladder cancers were highly positive for VEGF-C protein by immunohistochemistry. VEGF-C expression was significantly correlated with lymphatic vessel involvement, lymph node metastasis, and worse outcomes after operation (p<0.001, p<0.001, p<0.001, respectively), but not with MVD. By the Cox regression model, lymphatic vessel involvement emerged as an independent prognostic parameter. These results suggest that VEGF-C may play a role in tumor progression via lymphangiogenesis and lymph node metastasis in human gallbladder cancer.

Risk factors predictive of lymph node metastasis in depressed early gastric cancer

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.

Comparative Analysis of Three Subgroups in Stage II Stomach Cancer

Purpose: Three subgroups of stage II stomach cancer (T1N2M0, T2N1M0, T3N0M0) by UICC-TNM staging system show obvious survival difference to each other, which becomes the pitfall of the current staging system. We analyzed the survival and relapse pattern of stage II stomach cancer patients in three subgroups retrospectively to prove the need for change in staging system. Materials and Methods: From July 1989 to December 1995, curative gastric resection was performed in 1,037 patients with gastric adenocarcinoma, and among them 268 patients () were in stage II. The number in each of subgroups (T1N2M0, T2N1M0, and T3N0M0) were 17, 139 and 112 respectively. Survival and relapse pattern were analyzed and median follow up period was 46 months. Results: The 3-year cumulative survival rates of T1N2M0, T2N1M0, and T3N0M0 were respectively (p=0.001). And the 3-year cumulative survival rates of T1N2M0 was comparable to those of 2 subgroups of stage IIIa (T2N2M0, T3N1M0), (p>0.05). Peritoneal recurrence was the most frequent in T3N0M0. And hematogenous spread was more frequent in T2N1M0 while nodal spread was more frequent in T1N2M0. Ten out of 17 cases of T1N2M0 died of recurrence. Most of them showed submucosal tumor with depressed lesion and mean tumor size was 3.3 cm. Conclusions: Up-staging of T1N2M0 should be considered because it has the lowest survival rate and the worst prognosis among the three subgroups of Stage II stomach cancer patients. In early gastric cancer patients with high-risk factors (large tumor size, invasion into the submucosal layer, and lymphatic vessel involvement), lymph node dissection and postoperative adjuvant therapy is recommended in an attempt to prevent recurrence in the form of lymph node metastasis.

Tissue Concentration of Platelet-Derived Endothelial Cell Growth Factor in Colorectal Cancer

Background: Angiogenesis is essential for the continuous growth of tumour cells under unfavourable conditions in patients. Experimentally, platelet-derived endothelial cell growth factor (PD-ECGF) promotes tumour proliferation by stimulating angiogenesis. However, the clinical significance and regulating mechanism of its production in colorectal cancer are not well understood. Methods: The tissue concentration of PD-ECGF in colorectal neoplasm and normal mucosa was determined. The systemic oxygenation and nutritional status of the patients were also evaluated. Results: The mean concentration of PD-ECGF in the cancer was significantly higher than that in the normal mucosa or adenoma. The tissue concentration of PD-ECGF in the cancer was associated with the clinicopathologic findings, including the tumour size, serosal invasion, lymphatic vessel involvement, and lymph node metastasis. It was also correlated with the patient's age, levels of PO2 and O2 saturation in arterial blood, and the variables reflecting nutritional status. The multivariate regression model showed that the serum concentration of cholinesterase, the arterial level of PO22, lymph node metastasis, and the tumour size were the independent factors that influenced the tissue concentration of PD-ECGF in colorectal cancer. In contrast, these factors were not associated with the PD-ECGF concentration in normal mucosa. Conclusions: PD-ECGF may play an important role in the progression of colorectal cancer. Systemic deterioration of oxygenation and nutritional condition in wasted patients may also lead to local activation of PD-ECGF specifically in the cancer tissue. PD-ECGF may be indispensable for maintaining relentless growth of colorectal cancer, and the control of its expression may be of therapeutic importance.