Management Of Gastric Cancer Patients Research Articles

Histopathological regression of gastric adenocarcinoma after neoadjuvant therapy: a critical review.

As the perioperative chemotherapy has been widely implemented on the management of gastric cancer patients, heterogeneity of clinical outcomes has been evidenced in parallel to different histopathological regression pattern of gastric cancer cells. Tumor histological response to preoperative therapy has been graded by various systems in order to categorize the amount of regressive changes induced by chemotherapy in relation to residual tumor. In this context, tumor regression grading (TRG) systems might provide important prognostic information as the variety of tumor response may imply on different clinical outcomes with impact in survival rates. Moreover, gastric cancer behavior varies enormously upon individual factors such as histological classification and tumor anatomic site of involvement that have been shown to affect the TRG interpretation. On the other hand, some studies have assessed the role of molecular markers as a predictor of tumor response to neoadjuvant chemotherapy in terms of TRG. Thus, the aim of this review is to evaluate how TRG has been interpreted in gastric cancer, discuss their clinical and prognostic relevance and also address the molecular markers involved in this process.

Relationship Between 18F-FDG PET/CT Findings and HER2 Expression in Gastric Cancer.

(18)F-FDG PET has been widely used in the management of malignant tumors. In gastric cancer, the status of human epidermal growth factor receptor 2 (HER2) predicts the response to anti-HER2 antibody therapy, and testing of HER2 expression is now routine in the management of gastric cancer patients. However, to date, the relationship between (18)F-FDG uptake and HER2 expression has not, to our knowledge, been investigated. In this study, we aimed to investigate whether HER2 expression is associated with (18)F-FDG uptake and whether (18)F-FDG PET/CT can be used to predict the HER2 status of gastric cancer. A retrospective analysis was performed on 64 gastric cancer patients who had undergone (18)F-FDG PET/CT before surgical resection. Tumor SUVmax was calculated from the level of (18)F-FDG uptake. No significant correlation was found between SUVmax and HER2 expression in gastric cancer. However, when signet-ring cell carcinoma was excluded, SUVmax was significantly higher in the HER2-negative group than in the HER2-positive group (8.619 ± 5.878 vs. 3.789 ± 2.613, respectively; P = 0.021). Multivariate analysis indicated that SUVmax and tumor differentiation remained significantly associated with HER2 expression (P = 0.048 and P = 0.028, respectively). HER2 expression was predicted with an accuracy of 64.4% when an SUVmax cutoff of 6.2 was used. (18)F-FDG uptake by gastric cancer is associated with HER2 expression. (18)F-FDG PET/CT may be useful for predicting the HER2 status of gastric cancer and for determining the therapeutic strategy.

Prognostic Importance of Cell Cycle Regulators Cyclin D1 (CCND1) and Cyclin-Dependent Kinase Inhibitor 1B (CDKN1B/p27) in Sporadic Gastric Cancers

Background. Gastric cancer is known for a notable variety in the course of the disease. Clinical factors, such as tumor stage, grade, and localization, are key in patient survival. It is expected that molecular factors such as somatic mutations and gene amplifications are also underlying tumor biological behavior and may serve as factors for prognosis estimation. Aim. The purpose of this study was to examine gene amplifications from a panel of genes to uncover potential prognostic marker candidates. Methods. A panel of gene amplifications including 71 genes was tested by multiplex ligation-dependent probe amplification (MLPA) technique in 76 gastric cancer samples from a Caucasian population. The correlation of gene amplification status with patient survival was determined by the Kaplan-Meier method. Results. The amplification of two cell cycle regulators, CCND1 and CDKN1B, was identified to have a negative prognostic role. The medial survival of patients with gastric cancer displaying amplification compared to patients without amplification was 192 versus 725 days for CCND1 (P = 0.0012) and 165 versus 611 days for CDKN1B (P = 0.0098). Conclusion. Gene amplifications of CCND1 and CDKN1B are potential candidates to serve as prognostic markers for the stratification of patients based on the estimate of survival in the management of gastric cancer patients.

GTSE1 expression represses apoptotic signaling and confers cisplatin resistance in gastric cancer cells

BackgroundPlatinum based therapy is commonly used in the treatment of advanced gastric cancer. However, resistance to chemotherapy is a major challenge that causes marked variation in individual response rate and survival rate. In this study, we aimed to identify the expression of GTSE1 and its correlation with cisplatin resistance in gastric cancer cells.MethodsMethylation profiling was carried out in tissue samples from gastric cancer patients before undergoing neoadjuvent therapy using docetaxel, cisplatin and 5FU (DCX) and in gastric cancer cell lines. The correlation between GTSE1 expression and methylation in gastric cancer cells was determined by RT-PCR and MSP respectively. GTSE1 expression was knocked-down using shRNA’s and its effects on cisplatin cytotoxicity and cell survival were detected by MTS, proliferation and clonogenic survival assays. Additionally, the effect of GTSE1 knock down in drug induced apoptosis was determined by western blotting and apoptosis assays.ResultsGTSE1 exhibited a differential methylation index in gastric cancer patients and in cell lines that correlated with DCX treatment response and cisplatin sensitivity, respectively. In-vitro, GTSE1 expression showed a direct correlation with hypomethylation. Interestingly, Cisplatin treatment induced a dose dependent up regulation as well as nuclear translocation of GTSE1 expression in gastric cancer cells. Knock down of GTSE1 enhanced cisplatin cytotoxity and led to a significant reduction in cell proliferation and clonogenic survival. Also, loss of GTSE1 expression caused a significant increase in P53 mediated apoptosis in cisplatin treated cells.ConclusionOur study identifies GTSE1 as a biomarker for cisplatin resistance in gastric cancer cells. This study also suggests the repressive role of GTSE1 in cisplatin induced apoptosis and signifies its potential utility as a therapeutic target for better clinical management of gastric cancer patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1550-0) contains supplementary material, which is available to authorized users.

A Potential Role of H. Pylori PPIase in the Transformation of Gastric Epithelial Cell and the Development of Gastric Cancer

Helicobacter pylori (H. pylori) is the causative agent of chronic gastritis and gastric cancer, the second leading cause of cancer mortality worldwide. H. pylori colonizes the stomach in more than half of the world's population and has been classified as a class I carcinogen. H. pylori produces several virulence factors, including CagA, VacA and urease. Because the clinical outcomes of H. pylori infection do not necessarily correlate with the presence of these proteins, there is a need to identify new H. pylori factors that may modulate the clinical course of H. pylori‐associated diseases. Recently, we identified several gastric cancer‐associated H. pylori genes, including FKBP‐type peptidyl‐prolyl cis‐trans isomerase (PPIase‐FKBP). In this study, we show that co‐culture of gastric epithelial cells (AGS) with PPIase‐FKBP deletion H. pylori strain prevented H. pylori‐induced proliferation of AGS cells. Consistent with this observation, ectopic expression of H. pylori PPIase‐FKBP promoted AGS cell proliferation and anchorage‐independent growth. To gain insight into the biochemical mechanism of PPIase‐FKBP‐induced effect, early signal events involved in mitogenic signal pathways were evaluated. Expression of PPIase‐FKBP induced increases in basal as well as EGF‐stimulated phosphorylation of ERK and EGF receptor at Tyr1086. Pretreatment with MEK inhibitor completely blocked PPIase‐FKBP‐induced cell proliferation, suggesting that the action of PPIase‐FKBP is mediated by activation of ERK1/2 mitogenic signal pathway. H. pylori PPIase‐FKBP may represent a novel target for therapeutic management of gastric cancer patients.

Helicobacter pylori FKBP-type PPIase promotes gastric epithelial cell proliferation and anchorage-independent growth through activation of ERK-mediated mitogenic signaling pathway.

Though Helicobacter pylori (H. pylori) has been classified as class I carcinogen, key virulence factor(s) generated by H. pylori that causes gastric cancer remains to be fully determined. Here, we show that deletion of peptidyl-prolyl cis-trans isomerase (PPIase) prevented H. pylori from stimulating human gastric epithelial cell (AGS) proliferation. Consistent with this observation, ectopic expression of H. pylori PPIase promoted AGS cell proliferation and anchorage-independent growth. To gain insight into the biochemical mechanism of PPIase-induced effect, early signal events involved in mitogenic signaling pathways were evaluated. Expression of H. pylori PPIase caused an increase in basal as well as EGF-stimulated phosphorylation of ERK and EGF receptor at Tyr1086. Treatment with MEK inhibitor completely blocked PPIase-induced cell proliferation. Our results suggest that H. pylori PPIase has the potential to activate mitogenic signaling pathway and to promote transformation of gastric epithelial cells. H. pylori PPIase may represent a novel target for therapeutic management of gastric cancer patients.

MOR1 expression in gastric cancer: a biomarker associated with poor outcome.

At present, the expression of MOR1 and its function in gastric cancer remains unclear with evidence suggesting that it is to be involved in tumor progression and metastasis. The study was to assess the clinicopathologic relevance and prognostic value of MOR1 expression in gastric cancer. Real-time quantitative RT-PCR and immunohistochemical staining were used to detect MOR1 expression in primary gastric cancerous surgical specimens and adjacent nontumorous tissues. High MOR1 expression was detected in cancerous tumor compared with their adjacent nontumorous tissues. In addition, the chi-square test revealed that high MOR1 expression was significantly correlated with depth of invasion (p = 0.006), lymph node metastasis (p = 0.001), distant metastasis (p = 0.017), and TNM staging (p = 0.027). Moreover, Kaplan-Meier analysis revealed a significant association between MOR1 expression and overall survival. High expression of MOR1 was identified as an independent and significant predictor gene of reduced postoperative survival. We conclude that MOR1 expression may be a useful biomarker for better prediction of the clinical outcome and management of gastric cancer patients.

Molecular profiles of gastric cancer: The UCSD experience.

29 Background: Gastric cancer is the 2nd leading cause of cancer mortality globally. A small number of studies reported that low TS and ERCC1 mRNA levels are associated with improved survival, and may be important as prognostic factors. Methods: Intratumoral gene expression levels were assessed using laser-captured micro-dissection and quantitative Real-Time PCR on formalin fixed paraffin embedded tumor samples from 22 gastric adenocarcinomas. A retrospective chart review was performed to measure clinical parameters. Primary objectives were to determine the range of expression of TS, ERCC1, and HER2, and to investigate if these biomarkers are predictive of survival. Results: TS, ERCC1, and HER2 median expression levels using RT-PCR were 3.56, 1.54, and 0.085, respectively. Median OS was 62 months. Subjects with low TS trended towards improved survival (92 months vs. 34 months, p: 0.17), as did subjects with low ERCC1 (92 months vs. 55 months, p: 0.44). There was no association between HER2 expression and OS. All subjects had HER2 levels below 0.55. With regard to treatment, 90.9% of patients received platinum-based chemotherapy and 4.5% received HER2-guided therapy. Conclusions: Our results are consistent with prior reports that associate low TS and low ERCC1 with improved OS, and may imply prognostic significance. Although these trends did not reach statistical significance, they are consistent with prior studies. Further molecular studies are needed to better assess the utility of these markers as prognostic indicators. There was no clear trend between HER2 levels and OS, most likely because all subjects had low HER2 levels. However, as accurate determination of HER2 expression is becoming increasingly important in the management of gastric cancer patients, further research into the degree of concordance between RT-PCR assessment and FISH assessment of HER2 gene amplication is warranted. Overall, more molecular studies are needed to better stratify this disease into subtypes, and identify new drug targets for chemo-resistant subtypes.

Perioperative management of gastric cancer patients

Gastric cancer is one of the most serious health problems in China. The overall survival rate after surgical treatment has increased and the rate of postoperative complication has decreased. These improvements are due to the introduction of more radical surgical techniques, early detection, and the improvement of anesthesia, perioperative care, and nutritional support. The aim of this article is to introduce the general perioperative management of patients with gastric cancer. Good perioperative management of gastric cancer contributes to the improvement of surgical outcomes. There are several controversial issues in the general perioperative management of gastric cancer, such as gastric tube decompression and nutritional support.

Quantitative analysis of cell-free DNA in the plasma of gastric cancer patients

In the present study, an accurate and reproducible method for quantifying cell-free DNA (cfDNA) in human blood was established and tested for its ability to predict gastric cancer in patients. Using 'Alu81-qPCR' to amplify 81-bp Alu DNA sequences, we first estimated the amount of cfDNA in the serum or plasma of 130 patients with gastric cancer to identify which source of cfDNA is more suitable for the biomarker screening of these patients. The results of Alu81-qPCR revealed that the amount of cfDNA in the plasma was low compared with that in the serum, but was found at similar levels among the samples, indicating that the plasma may be a more suitable source of cfDNA for biomarker screening. For the 54 patients with gastric cancer and the 59 age-matched healthy controls, the mean levels of plasma cfDNA were 2.4-fold higher in the patient group compared with the control group, indicating that plasma cfDNA levels may be useful for predicting patients with gastric cancer. The results of our study suggest that Alu81-qPCR is a more reliable method than other techniques, such as the PicoGreen assay, for quantifying cfDNA in human blood, demonstrating the potential to complement current diagnostic procedures for the management of gastric cancer patients.

General perioperative management of gastric cancer patients at high-volume centers

Gastric cancer is very common in Korea and Japan, where many hospitals annually perform high numbers of gastrectomies for gastric cancer. The aim of this study was to compare the general management of gastric cancer in high-volume centers in Korea and Japan. We undertook a survey of the general management of gastric cancer at high-volume centers (over 200 cases/year) and analyzed the answers. In six of 14 hospitals surveyed, antimicrobial prophylaxis for elective gastrectomy was administered until postoperative day 3. A Levin tube and an abdominal drain were routinely inserted in seven and ten hospitals, respectively. Laboratory tests, such as complete blood cell count, liver function test, electrolytes, and blood urea nitrogen/creatinine were performed frequently on postoperative days 1, 2, 3, and 5. Sips of water after open distal gastrectomy were restarted up to postoperative day 3 in twelve hospitals. The surgical pathology was reported up to postoperative day 10 in thirteen hospitals. Twelve hospitals provided a regular patient education program and only one hospital provided an integrated education program which included the participation of a surgeon, an oncologist, a nurse, and a nutritionist. The general management of gastric cancer in 14 high-volume centers was not so different among the centers. The general management protocols noted here are expected to provide useful information for perioperative care.

Epidemiology, Surgical Management and Early Postoperative Outcome in a Cohort of Gastric Cancer Patients of a Tertiary Referral Center in Relation to Multi-Center Quality Assurance Studies

The aim of the study was to analyze epidemiologic parameters, treatment-related data and prognostic factors in the management of gastric cancer patients of a university surgical center under conditions of routine clinical care before the onset of the era of multimodal therapies. By analyzing our data in relation with multi-center quality assurance trials [German Gastric Cancer Study - GGCS (1992) and East German Gastric Cancer Study - EGGCS (2004)] we aimed at providing an instrument of internal quality control at our institution as well as a base for comparison with future analyses taking into account the implementation of evolving (multimodal) therapies and their influence on treatment results. Retrospective analysis of prospectively gathered data of gastric cancer patients treated at a single institution during a defined 10-year time period with multivariate analysis of risk factors for early postoperative outcome. From 04/01/1993 through 03/31/2003, a total of 328 gastric cancer patients were treated. In comparison with the EGGCS cohort there was a larger proportion of patients with locally advanced and proximally located tumors. 272 patients (82.9%) underwent surgery with curative intent; in 88.4% of these an R0 resection was achieved (EGGCS/GGCS: 82.5%/71.5%). 68.2% of patients underwent preoperative endoluminal ultrasound (EUS) (EGGCS: 27.4%); the proportion of patients undergoing EUS increased over the study period. Diagnostic accuracy of EUS for T stage was 50.6% (EGGCS: 42.6%). 77.2% of operated patients with curative intent underwent gastrectomy (EGGCS/GGCS: 79.8%/71.1%). Anastomotic leaks at the esophagojejunostomy occurred slightly more frequently (8.8%) than in the EGGCS (5.9%) and GGCS (7.2%); however, postoperative morbidity (36.1%) and early postoperative mortality (5.3%) were not increased compared to the multi-center quality assurance study results (EGGCS morbidity, 45%); EGGCS/GGCS mortality, 8%/8.9%). D2 lymphadenectomy was performed in 72.6% of cases (EGGCS: 70.9%). Multivariate analysis revealed splenectomy as an independent risk factor for postoperative morbidity and ASA status 3 or 4 as an independent risk factor for early postoperative mortality. The rate of splenectomies performed during gastric cancer surgery decreased substantially during the study period. Preoperative diagnostics were able to accurately predict resectability in almost 90% of patients which is substantially more than the corresponding results of both the EGGCS and the GGCS. In the future, more wide-spread use of EUS will play an increasing role as stage-dependent differentiation of therapeutic concepts gains acceptance. However, diagnostic accuracy of EUS needs to be improved. Our early postoperative outcome data demonstrate that the quality standard of gastric cancer care established by the EGGCS is being fulfilled at our institution in spite of distinct characteristics placing our patients at higher surgical risk. Besides being a valuable instrument of internal quality control, our study provides a good base for comparison with ongoing analyses on future developments in gastric cancer therapy.

Feasibility of Gastric Cancer Surgery at Low Volume Hospitals

PurposeMost gastric cancer patients undergo operations at large tertiary hospitals in Korea. However, some patients are treated at low volume hospitals. We investigated patient outcomes after gastric surgery at a secondary hospital and compared with outcomes of large volume centers.Materials and MethodsWe included 184 patients who underwent gastric surgery for gastric cancer at our hospital from January 2003 to December 2008. We conducted a retrospective study and evaluated the clinicopathological characteristics, clinical outcomes and survival rate of patients.ResultsMean age was 61.7 years old. Male to female ratio was 2.2 : 1. Proportion of early gastric cancer was 38.6% and that of advanced gastric cancer was 61.4%. The 5 year overall survival rate of 184 patients was 66.3%. The overall survival rate was significantly lower for people over 62 years old. The morbidity rate and mortality at our hospital were 10.3% and 0.5%, respectively.ConclusionsThe overall survival rate, morbidity and mortality were similar to those of the previous reports from Korea. Treatment of gastric cancer at a secondary hospital is feasible and safe. Standardization of operations and management of gastric cancer patients of the Korean Gastric Cancer Association is the most important factor to achieve these outcomes.

Cytogenetic and molecular aspects of gastric cancer: Clinical implications

Gastric cancer is of major importance world-wide being the second most common cause of cancer-related death in the world. According to Lauren’s histological classification gastric cancer is divided in two groups, the better differentiated intestinal carcinomas and the poorly differentiated diffuse-type cancers. The genetic changes underlying the initiation and progression of gastric cancer are not well defined. Gastric carcinogenesis is a multistep process involving a number of genetic and epigenetic factors. Although it has been proposed that different genetic pathways exist for differentiated and undifferentiated carcinomas, the two histological subtypes of gastric cancer share some common genetic alterations. Currently, tumor histology and pathologic stage are the major prognostic variables used in the clinical practice for gastric cancer patients. However, it is known that tumors with similar morphology may differ in biological aggressiveness, prognosis and response to treatment. Molecular genetic analysis of gastric cancer revealed a number of associations of certain genetic changes with pathological features, tumor biological behavior and prognosis of gastric cancer patients, suggesting that these genetic abnormalities might play an important role in gastric tumorigenesis. Increasing evidence suggests that the molecular genetic changes could be helpful in the clinical setting, contributing to prognosis and management of patients. Regarding epigenetic events in gastric tumorigenesis, a number of methylating markers have been proposed for risk assessment, prognostic evaluation and as therapeutic targets. However, further research is required in order to systematically investigate the genetic changes in gastric cancer estimating also their usefulness in the clinical practice. A good understanding of the genetic changes underlying gastric carcinogenesis may provide new perspectives for prognosis and screening of high risk individuals. Some of the genetic alterations could definitely improve tumor classification and management of gastric cancer patients. Also, based on molecular data identified in gastric cancer novel therapeutics might help to improve the treatment of this disease.

Expression of p27Kip1 and cyclin D1 proteins is inversely correlated and is associated with poor clinical outcome in human gastric cancer.

p27Kip1 is an inhibitor of cyclin-dependent kinases and is speculated to be a potential prognostic indicator in numerous human cancers. We investigated expression of p27Kip1 along with cyclin D1 in gastric cancer to estimate the clinical utility of p27Kip1. Immunohistochemical assay for p27Kip1 and cyclin D1 proteins was performed in 64 patients with primary gastric cancer. Correlation between p27Kip1 expression and clinical-biological parameters including patient survival was analyzed. p27Kip1 expression was suppressed in 40 (62.5%) of 64 gastric cancer patients and cyclin D1 was overexpressed in 22 (34.4%) out of 64. Expression of p27Kip1 was significantly reduced in poorly differentiated cancers (82.1%, 23/28; P = 0.015) and was also reduced in the tumors with high S-phase fraction (86.7%, 26/30) compared with tumors showing low S-phase fraction (41.2%, 14/34; P = 0.0002). Expression of p27Kip1 and cyclin D1 was inversely correlated (P = 0.021). In univariate analysis, extent of the disease (P < 0.001), expression of cyclin D1 (P = 0.0001), and reduced expression of p27Kip1 (P = 0. 0006), were statistically significant to predict patient's outcome, but depth of invasion (P = 0.008) and pathologic stage (P = 0.009) emerged as significant prognostic indicators in multivariate analysis. Expression of p27Kip1 is closely linked with cell proliferation and differentiation of human gastric cancer. p27Kip1 seems to have potential as a prognostic marker in the management of gastric cancer patients.

Minimally invasive surgery for gastric cancer.

The use of laparoscopic surgery in the treatment of gastric cancer has not yet met with widespread acceptance; thus, it should be regarded as still in the developmental phase. Nevertheless, the laparoscopic approach appears to have some valuable advantages for the management of gastric cancer patients, and it can be expected to have a dramatic impact on public health expenditures. Herein we present the results of our experience with laparoscopic and laparoscopy-assisted gastrectomies for cancer, and we discuss the role of these procedures in current surgical practice. Between June 1993 and November 1997, we performed a total of 13 laparoscopic procedures on 13 patients affected with gastric carcinoma. There were eight male and five female patients with a mean age of 65.4 years (range, 42-78). All patients were staged preoperatively with US and CT scan and required to sign a formal consent. Altogether we performed nine D1 laparoscopic total gastrectomies, seven of which were done with a laparoscopy-assisted approach; three D2 laparoscopy-assisted total gastrectomies, associated in one case with a distal pancreasectomy; and one laparoscopy-assisted distal gastrectomy performed on a morbid obese patient. The preliminary laparoscopic staging allowed for a better definition of tumor extension and identification of undetected hepatic metastases in two patients. The mean duration of the intervention was 240 min. Blood losses were as high as 300 cc on average. We recorded one major intraoperative complication, consisting of an inadvertent injury to the proper hepatic artery, which was successfully repaired by the same laparoscopic route. The postoperative course was uneventful in all patients but one, who died of acute hepatic failure on day 6. At a mean follow-up of 27.5 months, 11 patients are still alive. Two of them have hepatic metastases and nine are disease-free. Although they remain challenging procedures, laparoscopic gastrectomies appear to be oncologically adequate. We believe that a pure laparoscopic approach should be reserved for low-stage lesions (N0, up to T2), while a combined approach is preferable for locally advanced cancer (N1 or higher, T3 or higher). Much work still needs to be done to establish the optimal strategy in both open and laparoscopic surgery, but laparoscopy can be a valuable tool in the decision-making process for patients affected with gastric malignancies.

Diagnostic, prognostic and monitoring value of CA 72.4 in gastric cancer. A prospective study including CA 19.9 and CEA

The diagnostic, prognostic and monitoring value of CA 72.4 in gastric cancer was prospectively studied, in parallel with CA 19.9 and CEA. Thirty-eight patients with primary gastric carcinoma were included in a prospective two-year study. The mean values of CA 72.4 and CA 19.9 before surgery were statistically different from those of a control group (n = 38) with benign gastro-intestinal (GI) diseases. CA 72.4 adds independent complementary sensitivity to CEA and CA 19.9. According to the ROC analysis, the highest area under the ROC curve was that of CA 72.4 (0.75 ± 0.06), followed by CA 19.9 (0.64 ± 0.07) and CEA (0.53 ± 0.07). Using the “kinetic profile” index, prognostic studies revealed significant correlations between CEA (at days 0, 7 and 14) and overall survival. In the patients with no evidence of disease nor progression, the true negative rate of CA 72.4 was higher (100 %) than that of CEA (86.7 %) and CA 19.9 (73.3 %) ; the false positive rate was 0 %, 13.3 % and 26.7 % for CA 72.4, CEA and CA 19.9, respectively, and highlighting the absolute specificity of CA 72.4. A higher true positive rate for detecting progressive disease or recurrence was noted for CA 72.4 (81.6 %) than for CEA (54.5 %) and CA 19.9 (45.5 %). CA 72.4 may constitute a useful test assisting in the clinical management of gastric cancer patients. Les valeurs diagnostique, pronostique et dans le suivi du CA 72.4 dans le cancer de l'estomac ont été étudiées parallèlement avec le CA 19.9 et l'ACE. Trente-huit patients présentant un cancer gastrique ont été inclus dans cette étude prospective de deux ans. Les taux moyens de CA 72.4 et de CA 19.9 avant chirurgie sont statistiquement différents de ceux du groupe contrôle (n = 38), constitué de pathologies gastro-intestinales bénignes. Le CA 72.4 ajoute une sensibilité indépendante complémentaire à l'ACE et au CA 19.9. Conformément à l'analyse ROC, l'aire sous la courbe ROC la plus élevée était celle du CA 72.4 (0,75 ± 0,06), suivie de celle du CA 19.9 (0,64 ± 0,07) et de l'ACE (0,53 ± 0,07). Utilisant l'index de ≪ profil cinétique≫, les études pronostiques ont révélé des corrélations significatives entre l'ACE (aux jours 0,7 et 14) et la survie globale. Chez les malades sans progression, le taux de vrais négatifs de l'ACE était supérieur (100 %) à celui de l'ACE (86,7 %) et du CA 19.9 (73,3 %) ; le taux de faux positifs était respectivement de 0 %, 13,3 % et 26,7 % pour le CA 72.4, l'ACE et le CA 19.9, mettant en valeur la spécificité absolue du CA 72.4. Un taux de vrais positifs plus élevé pour la détection des récidives a été noté pour le CA 72.4 (81,6 %), comparativement à l'ACE (54,5 %) et au CA 19.9 (45,4 %).Le CA 72.4 peut constituer un test utile dans la prise en charge du cancer gastrique.

Surgical Management of Gastric Cancer Patients with Liver Cirrhosis.

From 1966 to 1992, a total of 3,118 gastric cancer (GC) patients were referred to the First Department of Surgery, Kurume University Hospital. Fifty-six (0.02%) of these patients also had liver cirrhosis (LC). Forty-nine (87.5%) of these patients with LC underwent GC resection. Postoperative complications occurred in 32.7%, but the operative mortality rate was zero using our preoperative assessment of liver function to decide the operation. The 5-year survival rate following curative resection was 69% in early cancer and 17% in advanced cancer. Deaths were mainly cirrhosis-related in the early cancer cases, while cancer recurrence and hepatic failure were the main causes of mortality in the advanced cancer cases.