Pathological Characteristics Of Gastric Cancer Research Articles

Gastric cancer in patients aged younger and older than 50 years: characteristics of gastric cancer and survival analysis

Objective. To study clinical and pathological characteristics of gastric cancer in patients aged younger and older than 50 years, who received anticancer treatment including surgery, as well as to identify prognostic factors for overall survival of these patients.Material and methods. A retrospective study of surgical treatment outcomes was conducted in 350 gastric cancer patients, who were divided into 2 groups. The study group included 34 (9.71 %) patients aged 50 years and younger and the control group consisted of 316 (90.29 %) patients aged 51 years and older.Results. The analysis of treatment outcomes and survival rates was carried out. The diffuse-type gastric cancer was more frequently diagnosed in younger than in older patients (p<0.001), and asymptomatic disease often present in younger patients (p<0.001). There were no differences in the extent of surgery between the groups (p=0.613). The overall survival rate was lower in the control group than in the study group (p=0.002). The multivariate analysis revealed that a worse prognosis was observed in patients of the control group (hr=12.71), with regional lymph node metastases (hr=2.64), distant metastases (hr=1.83), iii/iv stage of the disease (hr=2.01), lymphovascular (hr=3.15) and perineural invasion (hr=2.46), as well as with postoperative complications (hr=2.12). Adjuvant chemotherapy improved the disease prognosis (hr=0.35).Conclusion. Specific clinical and pathological features predicted survival of gastric cancer patients aged younger and older 50 years.

Changes in the Clinical and Pathological Characteristics of Gastric Cancer during the Last 16 Years: A Study of a Single Institution in Korea

Background/Aims The incidence of gastric cancer (GC) in Korea is very high compared to that in other countries. The aim of this study was to investigate the trends of GC in patients for over 16 years. Materials and Methods A total of 1,227 patients with GC were prospectively enrolled at Seoul National University Bundang Hospital between 2003 and 2018. Age, sex, histologic type (Lauren classification), and Helicobacter pylori (H. pylori) infection status were compared between three periods (2003~2007, 2008~2012, and 2013~2018). H. pylori infection status was evaluated based on histology, rapid urease test, culture, serology, and history of H. pylori eradication. Patients with severe atrophy or intestinal metaplasia based on histology were assumed to have previous H. pylori infection. Results Most patients with GC underwent endoscopic mucosal resection/endoscopic submucosal dissection or another type of surgery. Early GC (EGC) and advanced GC (AGC) were detected in 769 (62.7%) and 458 (37.3%) patients, respectively, and intestinal and diffuse types were detected in 714 (58.2%) and 485 (39.5%) patients, respectively. The prevalence of EGC increased from 54.0% (252/467) to 63.5% (359/565) to 81.0% (158/195) in 2003~2007, 2008~2012, and 2013~2018, respectively. The prevalence of H. pylori-positive GC decreased from 93.4% (436/467) to 88.5% (500/565) to 82.1% (160/195) during these three periods, respectively (P<0.001). Multivariate logistic analysis showed that diffuse-type GC was continuously more prevalent in those who were younger than 50 years, who were female, and who harbored the predominant AGC type. Conclusions Over 16 years, the prevalence of EGC increased with a decrease in H. pylori infection rate. Diffuse-type GC was continuously more common in young and female patients. Key words: Diffuse type; Gastric cancer; Helicobacter pylori; Trend

Sa1272 - Clinical and Pathological Characteristics of Gastric Cancer without Helicobacter Pylori Infection and its Background Gastric Mucosa

Sa1272 - Clinical and Pathological Characteristics of Gastric Cancer without Helicobacter Pylori Infection and its Background Gastric Mucosa

Silence of long noncoding RNA UCA1 inhibits malignant proliferation and chemotherapy resistance to adriamycin in gastric cancer.

Urothelial carcinoma associated 1 (UCA1) gene is a long noncoding RNA (lncRNA), which shows expression and function abnormality in some kinds of malignant cancers. This study aimed to investigate its clinical significance and to examine its regulative effects of malignant proliferation and chemosensitivity to doxorubicin in gastric cancer cells. The expression of UCA1 was detected by quantitative real-time PCR. Statistical analysis was used to determine the relationship between UCA1 expression and clinical features and the prognostic value of UCA1 for disease-free survival. MTT assay was used to detect cell proliferation ability and chemosensitivity. Dual-color flow cytometric method was used to detect cell apoptosis. The expression of cleaved PARP and Bcl-2 protein was examined by Western blot. UCA1 was highly expressed in gastric cancer tissues and cells, and its high expression level had a positive correlation with some malignant pathological characteristics of gastric cancer, such as higher grade and poor differentiation. Moreover, UCA1 was an independent prognostic biomarker of disease-free survival for gastric cancer patients. Silence of UCA1 could significantly inhibit the cell proliferation of gastric cancer BGC-823 and SGC7901 cells. The chemotherapy resistance to adriamycin of SGC7901/ADR cells was depressed by UCA1 silence, and IC50 for adriamycin presented a conspicuous depression. UCA1 silence advanced apoptosis induced by adriamycin in SGC7901/ADR cells, up-regulated cleaved PARP protein expression and depressed the expression of anti-apoptosis protein Bcl-2. These results demonstrated that chemotherapy resistance changes induced by UCA1 silence might be mediated by the cell apoptosis pathway. In summary, lncRNA UCA1 was an independent prognostic biomarker of disease-free survival in gastric cancer patients and acted as an oncogene to regulate the malignant proliferation and resistance to adriamycin in gastric cancer cells. UCA1 might provide a new potential therapeutic target and stratagem for gastric cancer.

Integration and analysis of associated data in surgical treatment of gastric cancer based on multicenter, high volume databases

To elucidate the current diagnosis and treatment status of gastric cancer in the Chinese population based on three high volume databases. Clinical and pathological data of patients who underwent gastric cancer resection with complete follow-up information between January 2000 and December 2012 from Sun Yat-sen University Cancer Center, The First Affiliated Hospital of China Medical University and Tianjin Medical University Cancer Hospital were retrospectively analyzed. The overall survival rate was calculated by Kaplan-Meier method. The prognostic risk factors were analyzed by using Cox proportional hazards model. A total of 8 338 cases were enrolled into the study, including 2 977 cases (35.7%) from Sun Yat-sen University Cancer Center, 3 043 cases (36.5%) from The First Affiliated Hospital of China Medical University and 2 318 cases (27.8%) from Tianjin Medical University Cancer Hospital. There were 5 852 male cases and 2 486 female cases with a ratio of 2.4 to 1.0. The age of patients was from 15 to 89 years old (median 59 years old). The ratio of early gastric cancer (T1NanyM0) was 11.5% (956/8 338). There were 2 226 gastric cancer cases (26.7%) originating from the fundus and cardiac region, 1 637 cases (19.6%) from the body, 3739 (44.9%) cases from the antrum, and 736 cases (8.8%) from the whole stomach. The median maximal tumor diameter was (4.5 ± 2.8) cm. Based on the Lauren classification, 3 448 cases (41.4%) were intestinal type and 4 890 cases (58.6%) diffuse type. A total of 1 975 cases (23.7%) and 6 363 cases (76.3%) underwent complete and subtotal gastrectomy respectively. The majority of patients (7 707 cases, 92.4%) underwent radical gastric resection, while 631 cases (7.6%) palliative resection. According to AJCC/UICC seventh edition of gastric cancer TNM staging system, 802 patients (9.6%) were stage I(A, 735 patients (8.8%) stage I(B, 695 patients (8.3%) stage II(A, 1 507 patients (18.1%) stage II(B, 1 247 patients (15.0%) stage III(A, 1 342 patients (16.1%) stage III(B, 1 583 patients (19.0%) stage III (C and 427 patients (5.1%) stage IIII(. The average number of retrieved lymph node was 21.0 ± 13.1, in which 5 761 patients (69.1%) had more than 15 retrieved lymph nodes. The overall 1-, 3-, 5- and 10-year survival rates were 83.0%, 56.8%, 49.1% and 43.0% respectively. For patients receiving radical resection, the 1-, 3-, 5- and 10-year survival rates were 84.9%, 59.5%, 51.7% and 45.3% respectively. The overall 5-year survival rates for different stages were as follows: stage I(A 93.8%, stage I(B 80.8%, stage II(A 70.8%, stage II(B 59.6%, stage III(A 44.4%, stage III(B 32.9%, stage III(C 18.9% and stage IIII( 10.2%. Cox regression model showed that age, tumor site, tumor size, Lauren type, T staging, N staging, M staging and number of retrieved lymph nodes were independent factors affecting the prognosis of gastric cancer patients (P=0.000). Retrospective study on these domestic three high volume databases demonstrates the clinical and pathological characteristics of gastric cancer based on Chinese population, which is expected to stand as a ground of basic data for future clinical research.

Association between cadherin-17 expression and pathological characteristics of gastric cancer: a meta-analysis.

To construct a meta-analysis in order to examine the relationship between cadherin-17 (CDH17) and gastric cancer (GC). Related articles were selected by searching the following English or Chinese electronic databases: CINAHL, MEDLINE, Science Citation Index, the Chinese Journal Full-Text, and the Weipu Journal. Newcastle-Ottawa Scale (NOS) criteria were used to ensure consistency in reviewing and reporting results. Statistical analyses were conducted with Version 12.0 STATA statistical software. Ultimately, 11 articles, with a total of 2,120 GC patients, were found to be eligible for study inclusion. In comparisons of GC patients by TNM stage (III-IV vs I-II: OR = 2.35, 95%CI: 1.15-4.825, P = 0.019), histologic grade (3-4 vs 1-2: OR = 3.48, 95%CI: 1.36-8.92, P = 0.009), invasion grade (T3-4 vs T1-2: OR = 2.86; 95%CI: 1.69-4.83; P = 0.000), and lymph node metastasis (positive vs negative: OR = 2.64; 95%CI: 1.33-5.27; P = 0.006), it was found that CDH17 showed more positive expressions in each of the more severe cases. Country-stratified analyses from all four experimental subgroups showed that high CDH17 expression levels may be related to GC among Chinese and Korean populations (all P < 0.05), with the exception of the invasion grade T3-4 vs T1-2 comparison, where the relation only held among the Chinese population (OR = 2.86, 95%CI: 1.69-4.83, P = 0.000). Collectively, the data reflects the capacity of CDH17 in tumor proliferation and metastasis among GC patients.

Expression of Rab25 correlates with the invasion and metastasis of gastric cancer.

The objective of this study was to determine the expression of the important vesicle trafficking-regulating factor Rab25 in human gastric cancer tissues, to analyze the correlation between Rab25 protein expression with gastric cancer occurrence and development, and to discuss the correlation of Rab25 protein expression with gastric cancer cell metastasis. The overall aim was to provide experimental evidence that can be used to design future biological treatments of human gastric cancer. Human gastric cancer tissue and the adjacent normal gastric tissue were surgically removed, and immunohistochemistry and Western blotting were used to detect Rab25 protein expression. The correlation between Rab25 protein expression with the development and pathological characteristics of gastric cancer was analyzed. Using RNAi, Rab25 expression was reduced in the gastric cancer cell line MGC80-3, and the changes in MGC80-3 cell invasiveness were then monitored. Immunohistochemistry showed that the Rab25 protein expression rates were 78.21% and 23.08% in gastric carcinoma and the adjacent normal gastric tissue, respectively. Immunohistochemistry and Western blot results showed that Rab25 protein expression in gastric cancer was significantly higher than in adjacent normal gastric tissues (P<0.01). Less differentiated gastric cancer cells had higher expression of Rab25 protein (P<0.01). Gastric carcinomas from patients with a late pathological stage (III-IV) had significantly higher Rab25 protein expression than early stage (I-II) patients (P<0.01). Gastric carcinomas from patients with lymph node metastasis had significantly higher Rab25 protein expression than lymph node metastasis-free patients (P<0.01). Gastric carcinomas from patients with distant metastases had significantly higher Rab25 protein expression than the distant metastasis-negative patients (P<0.01). Rab25 protein expression in gastric cancer was not affected by the patients(,) sex, age, or tumor size (P>0.05). MGC80-3 cells transfected with Rab25 siRNA had significantly lower Rab25 protein expression (P<0.01) and a significantly lower number of cells that passed through a Transwell chamber compared with non-transfected controls and the transfected control group (P<0.01). Rab25 protein expression is associated with the development of gastric cancer. siRNA knockdown of Rab25 protein expression in MGC80-3 gastric cancer cells reduced MGC80-3 cell invasiveness and provided experimental evidence for potential future biological treatment strategies of human gastric cancer.

Agressivité du cancer gastrique chez le sujet jeune : mythe ou réalité ?

IntroductionAlthough gastric cancer (GC) is considered as a disease of middle-aged and elderly, 2%–15% of patients with CG are younger than 45 years and especially among women. Until now, many epidemiological and clinicopathological characteristics of gastric cancer, including risk factors, were conducted in the elderly. However, in young, only a few studies with small samples have been conducted. Within each study the results of these studies were highly variable, which may be due to low statistical power.Study purposeWe propose through this study a review of epidemiological, clinical and pathological characteristics of gastric cancer in young adults.Materials and methodsIt is a retrospective study including all patients sent to the hepato gastroenterology department of the University Hospital Hassan II for management of gastric adenocarcinoma gastric tumor between April 2001 and June 2010.We first described the demographic, clinical, endoscopic, histopathological, radiological treatments and also the outcome of gastric cancer in young patients and secondary we make a comparison with the characteristics of those over 45 years.ResultsTwo hundred and three patients were included during this period. Patients aged under 45 accounted for 25% (n=50). There was a female predominance in this group of patients (p=0.05), familial forms were not more frequent (p=0.1). The location of the tumor does not differ between the 2 age groups (p=0.07). On the histological side Linitic form was more frequent in young adult (40%, p=0.01), they had more metastatasis at diagnosis (p=0.0001), mostly of peritoneal carcinomatosis (p=0.04).ConclusionIn our study, gastric cancer remains uncommon in younger patients (25% of all gastric cancers). This frequency is certainly not explained by familial forms (only 1.5%). Linitic forms seem to be more frequent in younger patients, and carcinomatosis is much more common at diagnosis.

Gastric cancer: Biology and clinical manifestations in Israel

Gastric cancer (GC) in Israel remains incompletely characterized. The aim of this study was to define the clinical and pathological characteristics of GC in Israel and to compare them to the general Western population. This is a retrospective analysis of 461 consecutive GC patients treated at a single institution between 1995 and 2007. Epidemiological and clinical-pathological data were retrieved from the patients' medical files and the institutional electronic database and analyzed using standard statistical methods. Epidemiology, clinical manifestations, histopathological findings, clinical course, and prognostic factors for disease outcome were all similar to those reported in the Western literature. Findings unique to the Israeli population included: (1) rarity of GC-associated risk factors; (2) increased GC incidence in Ashkenazi Jews; (3) high incidence of second primary malignancy and family history of cancer; and (4) no dominancy of proximal GCs. There do not appear to be any major differences in the biology or clinical manifestations of GC in Israel. Western recommendations for diagnosis and treatment of GC may therefore be applied to the Israeli patient population.

Correlation between p53 expression and clinical-pathological characteristics of gastric cancer

BACKGRAUND/AIM: Gene p53, or "cell genome keeper", has a preventive effect on the occurrence of genetic aberrations and prevents abnormal expansion of (tumor) cells. In gastric cancer cells in most cases we register high expression of mutated p53 gene, which correlates with prognosis and specific clinical-pathological characteristics of gastric cancer. Using the imunohistochemical method we determined the level of expression of p53 protein in 62 gastric cancers and 30 precancerous conditions (intestinal metaplasia of the stomach). We analyzed the relationship of the level of p53 expression and clinical pathological characteristics of gastric cancer. Expression of p53 was positive in 42 (67.7%) tumor cases and in 7 (14.3%) cases of intestinal metaplasia. Expression of P53 and stomach cancer were in direct correlation (p = 0.000). Sensitivity for p53 in stomach cancer cases was 67.7% (42/62), and specifility was 76.7% (23/30). Expression of mutated p53 protein was in direct correlation with the invasion of lymph nodes (p = 0.034) and with invasion of blood vessels by carcinoma cells (p = 0.042). There is a direct correlation between p53 expression and gastric cancer and it indicates the ability of carcinoma cells to invade blood vessels.

Expression of synuclein g in gastric carcinoma and its relationship with MMP-2 and MMP-9

0AIM: To study the expression and significance of synuclein γ (SNCG) in gastric cancer, and to explore the relationship between SNCG and MMP-2, and MMP-9 in gastric carcinoma. METHODS: Expression levels of SNCG protein, MMP-2, MMP-9 in sixty gastric cancer samples were detected using immuno-histochemical analysis and 20 paraffin wax samples of normal gastric mucosa were also detected and compared. RESULTS: The positive rates of SNCG, MMP-2 and MMP-9 were higher in gastric carcinoma than in neighboring normal tissues (65%, 75%, 68.3% vs 0%, 25%, 20%, all P＜0.05). Their expression was positively correlated with depth of tumor infiltration, lymphatic metastasis, as well as the clinical staging of tumor (all P＜0.05). Expression of SNCG was also positively correlated with that of MMP-2 and MMP-9 (r=0.383, 0.552, both P＜0.01). In addition, expression of MMP-2 was positively correlated with MMP-9 (r=0.352, P＜0.01). CONCLUSION: The aberrant expression of SNCG, MMP-2 and MMP-9 are likely to jointly participate in the process of genesis and development of gastric carcinoma, therefore the detection of SNCG, MMP-2 and MMP-9, which reflect the pathological characteristics of gastric cancer, could be regarded as a reference index.

Laparoscopy-assisted distal gastrectomy with D1+β compared with D1+α lymph node dissection

Laparoscopy-assisted distal gastrectomy (LADG) with D1+beta lymph node dissection has become the most popular treatment for early gastric cancer in Asian countries. However, the same clinical advantages with this procedure as with LADG with D1+alpha lymph node dissection has not been shown. The aim of this study was to compare the outcome of LADG with D1+beta to that of LADG with D1+alpha lymph node dissection. During the period June 2002 through June 2006, LADG with D1+alpha lymph node dissection was performed in 54 patients, and LADG with D1+beta lymph node dissection was performed in 42 patients. Surgical findings, clinicopathological data, postoperative course, complications, nutritional status, and blood analysis findings were compared between the two groups. Differences were analyzed with Mann-Whitney U test and chi-square test. Patients in the two groups were comparable with respect to age, sex, body mass index, and stage and pathological characteristics of gastric cancer. A significantly greater number of N2 lymph nodes were harvested by D1+beta lymph node dissection than by D1+alpha dissection (5.9 vs. 2.7, P < 0.01). However, no significances in the total number of retrieved lymph nodes (24.7 vs. 22.2) or perigastric lymph nodes dissected (18.9 vs. 19.4) were identified between the D1+beta and D1+alpha groups. There was also no significant difference between the D1+alpha and D1+beta groups with respect to operation time, blood loss, complication rate, time to first walking, first flatus, first eating, and first defecation, frequency of analgesics given, volume of food intake on postoperative day 7, weight loss, and postoperative hospital stay. Blood analysis showed there were no significant differences in white blood cell count, granulocyte count, lymphocyte count, levels of C-reactive protein, and serum albumin. The short-term outcome of LADG with D1+beta lymph node dissection is comparable to that of LADG with D1+alpha lymph node dissection. According to the oncological requirements, we can apply this operation as a minimally invasive surgery.

Relationship of Helicobacter pylori to Bcl-2 Family Expression, DNA Content, and Pathological Characteristics of Gastric Cancer

Despite the fact that the association of Helicobacter pylori with an increased risk of gastric cancer has been well documented, the exact mechanisms of this association have not been fully elucidated. Scarce data on H. pylori infection and its relationship with the different pathological characteristics are available in Egypt. The rationale of the present study was to determine the prevalence of H. pylori in a group of gastric cancer patients and to analyze the relationship between H. pylori infection with the different pathological characteristics including the types of gastric cancer and tumor location within the stomach, in addition, to investigate the Bcl-2 and Bax expressions along with DNA flow cytometric analysis in the gastric cancer patients with and without H. pylori infection. Samples were obtained from 66 consecutive patients with gastric cancer (46 males and 20 females). The youngest patient was 20 yr old, the oldest 76 yr with mean age of 52.8 yr. The samples were subjected for histopathological characterization, H. pylori detection, DNA flow cytometric analysis, and Bcl-2 and Bax expressions detection, in addition to apoptosis analysis. The obtained results showed that the H. pylori infection was found in 38/66 (57.6%) [Odds ratio=1.357 with 95% confidence interval (CI) 0.84-2.2]. There was a statistical significance for Bcl-2, Bax, and apoptosis with H. pylori status (p = 0.009, 0.008, 0.032, respectively). On the other hand, There was a statistical significance for H. pylori infection with the disease grade (p = 0.015) and lymph node metastasis (p = 0.05). No statistical significance was found between H. pylori status with the patients' age, gender, tumor site, tumor type, depth of invasion, and stromal reaction. These data may indicate that the H. pylori infection not only contributes in the disease formation through the apoptosis dysregulation but also takes a part in the disease dissemination and progression. In addition, it may reflect a biologic, pathogenic, and ethnic background affecting the relationship of H. pylori infection to gastric cancer in the Egyptian patients. A high rate of smoking in Egypt and the diet are important factors that may affect such background. Further studies are warranted.

Microsatellite instability in solitary and sporadic gastric cancer

Recently, the presence of microsatellite instability (MSI) has been reported in gastric cancer and associated with older age of presentation, distal tumor location, early disease staging, and better overall prognosis. Different characteristics in presentation and in tumor behavior may be explained by different genetic alterations during carcinogenesis of gastric cancer. Identification of specific genetic pathways in gastric cancer may have direct impact on prognosis and selection of treatment strategies. All 24 patients were treated by radical surgery. Fragments of normal and tumor tissues were extracted from the specimen and stored at -80 degrees C before DNA purification and extraction. PCR amplification utilizing microsatellite markers was performed. Tumors presenting PCR products of abnormal sizes were considered positive for microsatellite instability (MSI+). Five patients (21%) had tumors that were MSI+ in at least 1 marker. In the group of patients with Lauren's intestinal-type gastric carcinoma, 3 had tumors that were MSI+ (23%), while in the group of diffuse-type gastric cancer, 2 patients had tumors that were MSI+ (19%). The mean age of presentation and the male:female ratio was similar in both groups. Tumors that were MSI+ were more frequently located in proximal portion of the stomach compared to microsatellite-stable (MSS) tumors (40% vs. 16%). Although there was a trend of patients with MSI+ tumors towards a proximal gastric tumor location, early staging, and negative lymph node metastasis, there was no statistical significance compared to those with MSS tumors (P >.1). Comparison of overall and disease-free survival between gastric tumors that were MSI+ and those that were MSS found no statistically significant differences (P >.1). Microsatellite instability is a frequent event in gastric carcinogenesis and shows a trend towards distinct clinical and pathological characteristics of gastric cancer.

Effect of survivin on cell proliferation and apoptosis in gastric cancer

We investigated the effect of expression of survivin, an apoptosis inhibiting protein, on cellular proliferation and apoptosis in gastric cancer and assessed its relation to the pathological characteristics of gastric cancer. Resected gastric cancer specimens from 42 patients (intestinal type; 21 cases and diffuse type; 21 cases) were evaluated. There were no significant differences in the clinicopathologic factors between the two groups. Survivin mRNA expression was measured using real-time reverse transcription-polymerase chain reaction, and survivin protein expression was evaluated by immunohistochemical staining. The Ki-67 index was adopted for cell proliferation scoring, and the ss-DNA positive rate as an apoptotic index. The survivin mRNA expression inversely correlated with the apoptotic index (p<0.05). Survivin mRNA expression (p<0.001) and survivin protein expression (p<0.001) were significantly higher in the diffuse type than the intestinal type. In conclusion, gastric cancer avoids cellular death by survivin expression and this tendency was more conspicuous in diffuse type gastric cancer.

Clinical and pathological study of gastric cancer treated without surgery in elderly patients

To clarify the clinical and pathological characteristics of gastric cancer in the elderly. Clinical and pathological characteristics of patients who died during 1986-94 with gastric cancer which did not undergo surgery were studied retrospectively. The patients were divided into three groups according to age: A (65-74 years, n = 38), B (75-84 years, n = 77), and C (85 years and over, n = 43). Borrman type-1 was more frequent in group C and Borrman type-4 was frequent in group B. "Early cancer", protruded type (type I or type IIa) was more frequent in group C. In cases of advanced cancer some patients did not undergo surgery because the cancer was to advanced, and others had concomitant diseases that made surgery risky. In all groups, a few patients refused surgery. In cases of "early cancer", the most reason for not undergoing surgery was a concomitant disease in all groups. Other reasons were general weakness and dementia in group C, second malignancy and dementia in group B, and second malignancy in group A. After advanced cancer was diagnosed, 9.6% survived for 1 year, and 1.7% for 2 years. After early cancer was diagnosed, 50.7% survived for 1 year, 15.2% for 3 years and 7.8% for 4 years. The survival rates did not differ by age. In all age groups, gastric cancer was frequently the main cause of death in patients with advanced cancer, but many patients with "early cancer" died of other causes.

The relationship between serosal types, pathological characteristics and free cancer cells in the peritoneal cavity of gastric cancer patients

The relationship between free cancer cells and the pathological characteristics of gastric cancer were studied. Of 100 cases of gastric cancer, free cancer cells in the peritoneal cavity were detected in 32 cases (32%). Free cancer cells were most often found in tendonoid (62.2%) and colour diffused (60.0%) serosal types. When the area of serosal invasion was over 20 cm, the positive free cancer cell rate was 56.6% and only 2.5% if below 20 cm. Free cancer cells were related to the depth of cancer infiltration, often found in the S2 and S3 invasion layers, as well as to the pathological characteristics of gastric cancer. Free cancer cells were often seen in infiltrated type cancer, histologically poorly differentiated or undifferentiated adenocarcinoma, and nest or diffused growth types. In patients without peritoneal metastasis (P0), the positive rate was 26.1%. This study proved that Chen’s serosal classification is correct and useful in assessing whether the cancer cells have penetrated through the serosa or not during surgery. Different treatments should be used in the cases with different serosal types. In addition to surgery, destruction of free cancer cells should be considered in tendonoid and colour diffused serosal types, so as to prevent peritoneal metastasis.

Chronological Trends in the Pathological Characteristics of Gastric Cancer

1,780 patients have undergone gastrectomy for gastric cancer in our clinic, and the chronological trends in the pathological findings of this cancer have been evaluated. Recently, the proportion of patients with early cancer was markedly increased: from 22.4% in the 1960s to 29.6% in the 1970s and 39.2% in the 1980s. In terms of age distribution, a decrease in the proportion of patients under 50 years of age (27.6,26.4 and 18.4% in the 1960s, 1970s, and 1980s, respectively) and an increase in the proportion of patients over 70 years of age (9.4,16.5 and 22.8% in the 1960s, 1970s and 1980s, respectively) were noticed. The decrease may be related to westernization of dietary habits in Japan after World War II. In terms of pathological findings, macroscopically there was a decrease in the elevated type of early cancer (23.9% in the 1960s, 18.9% in the 1970s and 10.5% in the 1980s) and in the localized type of advanced cancer (36.6, 23.5 and 27.9% in the 1960s, 1970s and 1980s, respectively). Microscopically, there was a decrease in the proportion of the intestinal type, such as papillary adenocarcinoma (from 37.7% in the 1960s to 22.2% in the 1980s in early cancers; and from 18.5% in the 1960s to 13.2% in the 1980s in advanced cancer). Thus, a westernization of the characteristics of gastric cancer was observed, and consequently, in Japan, a reduction in the incidence of gastric cancer is expected. As the rates of resectability and curative resectability have improved, the 5-year survival rate has improved chronologically, with rates of 60.7, 67.6 and 76.7% in the 1960s, 1970s and 1980s, respectively.

Pathological characteristics of gastric cancer that develop hematogenous recurrence, with special reference to the site of recurrence.

The pathologic characteristics of gastric cancer in 57 patients with hematogenous recurrence were pathologically analyzed by the site of recurrence. In recurrence of gastric cancer that developed in the liver, macroscopic observation revealed that cancers of Borrmann type 2 and 3 were most frequent. Microscopic examination revealed that the rate of occurrence of the medullary type of differentiated or poorly differentiated adenocarcinoma were high and that there were relatively frequent invasion by cancerous cells of the blood vessel that were closely related to the hematogenous metastasis. On the other hand, with respect to recurrence of gastric cancer that had developed in the lung or bone, Borrmann type 3 and 4, respectively, were more frequently observed. In these cases, microscopic analysis revealed that these cancers were poorly differentiated adenocarcinomas. In gastric cancer with bone recurrence, the rate of recurrence of the scirrhous type of tumor were higher than that of other types. It is important, for the management of patients after gastric cancer surgery, to predict possible hematogenous recurrence and its site by evaluation of the pathologic characteristics of the gastric cancer.