Radical Resection Of Gastric Carcinoma Research Articles

High expression of ATP5A1 in gastric carcinoma is correlated with a poor prognosis and enhanced glucose metabolism in tumor cells

To analyze the expression level of ATP5A1 in gastric carcinoma and its influence on the prognosis of the patients and glucose metabolism in the tumor cells. We retrospectively analyzed the data of 115 patients undergoing radical resection of gastric carcinoma in our hospital from February, 2013 to November, 2016. ATP5A1 expression in the surgical specimens were detected using immunohistochemistry, and the long-term prognosis of the patients with high (n=58) and low ATP5A1 expression (n=57) were analyzed. In gastric carcinoma MGC803 cells, the effects of lentivirus-mediated ATP5A1 knockdown or overexpression on glucose metabolism were investigated. We also observed the growth and glucose metabolism of xenografts derived from MGC803 cells with ATP5A1 knockdown or overexpression in nude mice. ATP5A1 was significantly overexpressed in gastric carcinoma tissues in close correlation with blood CEA and CA19-9 levels, pathological grade, T stage and N stage (P < 0.05). ATP5A1 overexpression was an independent risk factor for a significantly lowered 5-year survival rate of patients with gastric carcinoma (P < 0.05). ROC curve analysis demonstrated the predictive value of high ATP5A1 expression for the patients'prognosis (P < 0.001). In MGC803 cells, ATP5A1 overexpression significantly upregulated cellular glucose uptake and lactate production and increased the protein levels of HK2, PFK1, and LDHA (P < 0.05), while ATP5A1 knockdown produced the opposite changes (P < 0.05). In the tumor-bearing mice, overexpression of ATP5A1 increased glucose metabolism of the tumor cells and promoted tumor growth (P < 0.05). Overexpression of ATP5A1 promoted the expressions of p-JNK and p-JUN in MGC803 cells (P < 0.05), and the JNK inhibitor SP600125 significantly inhibited the enhancement of cellular glucose metabolism induced by ATP5A1 overexpression (P < 0.05). High ATP5A1 expression in gastric cancer is associated a poor long-term prognosis of the patients, and its effect is mediated at least partly by promoting glucose metabolism of the cells through the JNK/JUN pathway.

Prognostic role of tumor stroma ratio, tumor-infiltrating lymphocytes, and tumor budding in patients with intestinal-type gastric cancer after radical resection.

4055 Background: Tumor microenvironmental (TME) features including tumor stroma ratio (TSR), tumor infiltrating lymphocytes (TILs) and tumor budding (TB), may be associated with tumor metastatic potential. We sought to identify the association of these features with prognosis of patients with resectable intestinal-type gastric cancer. Methods: Radical resection of gastric carcinoma (&gt; 15 LNs removed) was performed in 493 patients (stage I, n=225; stage II, n=119; stage III, n=149) at two university hospitals between 2010 and 2016. Cutpoints were as follows: TSR (50%), TILs (median), and TB (Bd0-Bd3). TME features and their association with clinicopathological characteristics, time-to-recurrence (TTR) and overall survival (OS) were analyzed by univariate and multivariate Cox methods.. Results: Among 493 patients, high TSR, low TILs and high TB (Bd1-Bd3) were significantly associated with higher histological grade, larger tumor size, and increased T and N stages. Each of these features was significantly associated with poorer TTR and OS at 5 years. In Cox multivariable analysis, N stage and TSR were the only variables that were significantly associated with TTR and OS (Table). The relative contribution (%) of TSR to TTR ranked second (17.5%) behind N stage (49.2%) and ahead of TILs (7.2%) and TB (0.1%). Conclusions: Among TME features, TSR was the most robust and was significantly and independently associated with TTR and OS. The relative contribution of TSR to TTR was second only to nodal status. [Table: see text]

Structure and function of proximal segment of the dorsal mesogastrium: from the perspective of radical resection of gastric carcinoma

The bursa sac and greater omentum were considered as the dorsal mesogastrium more than 100 years. Bursectomy and omentectomy has been used as an essential part of radical gastrectomy with extended lymphadenectomy. However, structure of the bursa sac and omentum were difficult to be consistent with the definition and deduction of the mesentery. Also, it was hard to be proved that bursectomy and omentectomy could get oncological benefit from clinical randomized control trials recent years. We proposed a model of the proximal segment of dorsal mesogastrium (PSDM) here to compared with bursa model. It was demonstrated that the PSDM was consisted by the right gastric mesentery, right gastroepiploic mesentery, left gastric mesentery, left gastroepiploic mesentery, posterior gastric mesentery, and short gastric mesentery. The complete PSDM excision have been proved efficient in decreasing bleeding during operation and preventing cancer leak from PSDM during lymphadenectomy, as well as limiting the surgical hazard and developing oncological benefit. So that, PSDM model was presented as an alternative model for surgeons to practice and prove, even more evidences are still on the way.

Myosteatosis predicts prognosis after radical gastrectomy for gastric cancer: A propensity score–matched analysis from a large-scale cohort

BackgroundIncreasing evidence has suggested that sarcopenia is linked with cancer prognosis, but only limited data have focused on the impact of myosteatosis on cancer outcomes. This study evaluates the influence of myosteatosis on postoperative complications and survival in those patients who underwent radical resection of gastric carcinoma. MethodsPatients who underwent elective radical gastrectomy for gastric cancer and had computed tomographic images available were identified from a prospectively collected database between 2008 and 2013. Myosteatosis was diagnosed by the cutoff values obtained from the method of optimum stratification. To obtain 2 well-balanced cohorts for available variables influencing clinical outcomes, the myosteatosis group was matched 1:1 with nonmyosteatosis group by using a propensity score match. ResultsOf 973 patients, 584 were matched for analyses. Compared with the nonmyosteatosis group, the myosteatosis group manifested significantly higher severe postoperative complications rates, shorter overall survival, and disease-free survival. Before matching, multivariate analyses identified that myosteatosis was an independent risk factor for severe postoperative complications, and Cox proportions hazards model showed that myosteatosis was an independent predictor for shorter overall survival and disease-free survival. In addition, subgroup analyses of each muscle phenotype showed that patients with both sarcopenia and myosteatosis had a poorer overall survival and disease-free survival than other patients. ConclusionMyosteatosis in gastric cancer is associated with poor prognosis. Classifying the skeletal muscle into subranges of radio density is a promising strategy to understand the impact of skeletal muscle on unfavorable surgical outcomes in gastric cancer patients.

Guiding values of multislice spiral computed tomography angiography in laparoscopic D2 radical gastrectomy of local advanced gastric carcinoma.

This study aims to investigate the application values of preoperative multislice spiral computed tomography angiography (MSCTA) in laparoscopic radical resection of gastric carcinoma (GC). A total of 108 GC patients were divided into Groups I (i.e., where preoperative MSCTA was performed; n = 60) and II (i.e., where preoperative MSCTA was not performed; n = 48). Surgery was performed by the same group of surgeons. Seven cases of blood vascular variation were detected in Group I during surgery, whereas four cases were detected in Group II. The operation time for Group I ([207 ± 24] min) was shorter than that for Group II ([260 ± 31] min) (95% confidence interval [95% CI]: -21.543--0.920, P = 0.044). The operation time of patients with gastric vascular anatomic variation in Group I ([189 ± 49] min) was shorter than that of patients in Group II ([257 ± 61] min) (95% CI: -99.68--3.201, P = 0.048). The differences in the number of lymph node dissection, average blood loss, eating time, complication rate, and postoperative hospital stay between the two groups was not statistically significant (P > 0.05). MSCTA before endoscopic radical resection exhibits guiding values in assessing blood vascular variations and shortening operation times.

Long-term efficacy and prognostic factors of surgical treatment for gastric carcinoma with liver metastases: a Meta analysis

Objective To evaluate systematically the long-term efficacy and prognostic of surgical treatment for gastric carcinoma with liver metastases(GCLM). Methods Database including Chinese Journal Full Text Database, Wan Fang Database, VIP database, Chinese Database of Literature on Biomedicine, Pubmed, EMBASE, Cochrane Library, Medline, Springerlink and Wiley Online Library were searched with 胃癌, 胃肿瘤, 肝转移, 手术治疗, 外科手术, 肝切除术, 生存率, 预后因素, gastric cancer, gastric carcinoma, hepatic, resection, hepatic resection, hepatectomy, liver metastases, hepatic metastases, surgery, surgical, survival, prognostic factors . The time for retrieving was from January 1995 to August 2015. Literatures on long-term efficacy and prognostic of radical resection of gastric carcinoma combined with hepatectomy for GCLM were retrieved, and data were analyzed and evaluated by 2 independent researchers. The count data were presented by the relative risk (RR) and 95% confidence interval (95%CI). The group rate was merged by the formula RR/(1+ RR), corresponding 95%CI upper limit values were transferred by the formula RR/(1+ upper limit value RR), and the lower limit values were transferred by the formula RR/(1+ lower limit value RR). The comparison of group rates was done by indirect comparison, Z=difference between group rate/. The heterogeneity was analyzed by I2. Results Eighteen literatures of cross-sectional studies were retrieved and the total sample size was 410 patients. The results of Meta analysis: (1) the summary RR of 3-year overall survival of surgical patients with GCLM was 0.47 (95%CI: 0.37-0.60) while the summary 3-year overall survival rate was 32.0% (95%CI: 0.27-0.38). (2)The summary RR of 5-year overall survival of surgical patients with GCLM was 0.35 (95%CI: 0.27-0.45), summary RR of 5-year overall survival rate was 25.9% (95%CI: 0.21-0.31). (3)The summary RR of overall recurrence of surgical patients with GCLM was 2.95 (95%CI: 2.23-3.88) while the summary overall recurrence rate was 74.7% (95%CI: 0.69-0.80). (4)The summary RR of remnant liver recurrence of surgical patients with GCLM was 1.39 (95%CI: 0.91-2.15) while the summary RR of remnant liver recurrence rate was 58.2%(95%CI: 0.48-0.68). (5)The summary 3-year survival rate of surgical patients with GCLM and primary carcinoma serosal invasion was 32.9%(95%CI: 0.23-0.44), and summary 5-year survival rate was 25.9%(95%CI: 0.16-0.40). The summary 3-year survival rate of surgical patients with GCLM and without primary carcinoma serosal invasion was 47.9%(95%CI: 0.38-0.58), and summary 5-year survival rate was 38.3%(95%CI: 0.29-0.49). The summary 3-year survival rate of surgical patients with synchronous hepatic metastases was 30.6%(95%CI: 0.24-0.38), and summary 5-year survival rate was 24.2%(95%CI: 0.18-0.32). The summary 3-year survival rate of surgical patients with metachronous hepatic metastases was 40.1%(95%CI: 0.32-0.48), and summary 5-year survival rate was 32.9%(95%CI: 0.25-0.41). The summary 3-year survival rate of surgical patients with solitary metastatic hepatic carcinoma was 47.6%(95%CI: 0.40-0.56), and summary 5-year survival rate was 37.1%(95%CI: 0.26-0.48). The summary 3-year survival rate of surgical patients with multiple metastatic hepatic carcinoma was 28.6%(95%CI: 0.18-0.42), and summary 5-year survival rate was 15.3%(95%CI: 0.07-0.30). The summary 3-year survival rate of surgical patients with GCLM and R0 resection was 28.6%(95%CI: 0.19-0.40), and summary 5-year survival rate was 20.0%(95%CI: 0.12-0.32). The summary 3-year survival rate of surgical patients with GCLM and without R0 resection was 0.0, and summary 5-year survival rate was 9.1%(95%CI: 0.03-0.25). The summary 3-year survival rate of surgical patients with GCLM and resection margin<10 mm was 13.0%(95%CI: 0.05-0.30), and summary 5-year survival rate was 8.3%(95%CI: 0.02-0.28). The summary 3-year survival rate of surgical patients with GCLM and resection margin≥10 mm was 34.6%(95%CI: 0.21-0.52), and summary 5-year survival rate was 34.6%(95%CI: 0.21-0.52). The summary 3-year survival rate of surgical patients with GCLM and chemotherapy was 45.9%(95%CI: 0.29-0.64), and summary 5-year survival rate was 29.1%(95%CI: 0.19-0.42). The summary 3-year survival rate of surgical patients with GCLM and without chemotherapy was 38.7%(95%CI: 0.26-0.53), and the summary 5-year survival rate was 25.4%(95%CI: 0.18-0.35). The 3-year survival rate of surgical patients without primary carcinoma serosal invasion and with metachronous hepatic metastases, solitary metastatic hepatic carcinoma, R0 resection and resection margin≥10 mm was statistically significantly higher than that of surgical patients with primary carcinoma serosal invasion, synchronous hepatic metastases, multiple metastatic hepatic carcinoma and resection margin<10 mm and without R0 resection (Z=2.118, 1.999, 3.018, 5.295, 2.183, P<0.05). The 5-year survival rate of surgical patients with solitary metastatic hepatic carcinoma and resection margin≥10 mm was statistically significantly higher than that of surgical patients with multiple metastatic hepatic carcinoma and resection margin<10 mm (Z=4.528, 2.819, P<0.05). Conclusion Overall long-term efficacy of surgical patients with GCLM is not good enough, and there is the better prognosis in the surgical patients without primary carcinoma serosal invasion and with metachronous hepatic metastases, solitary metastatic hepatic carcinoma, R0 resection and resection margin≥10 mm. Key words: Gastric neoplasms; Liver metastases; Surgical procedures, operative; Prognosis; Meta analysis

Treatment of Afferent Loop Obstruction by Percutaneous Trans-Hepatic Biliary and Intestinal Drainage

We presented a rare case of chronic afferent loop obstruction after radical resection of gastric carcinoma. A 44- year-old man was admitted because of “upper abdominal distension and abdominal pain for 3 months, skin and sclera jaundice for 2 weeks”. Abdominal CT revealed dilatation of the intrahepatic bile duct and common bile duct, a large, abdominal cystic lesion, as well as left adrenal gland metastasis. MRCP revealed that the cystic lesion was an expansion of loops. Thus, the diagnosis of afferent loop (A-loop) obstruction was made. Subsequently, the patient underwent percutaneous transhepatic cholangial drainage (PTCD). The patient’s abdominal pain was significantly reduced, and the jaundice subsided. We should consider the possibility of the occurrence of the left adrenal metastasis and abdominal lymph node metastasis led to a chronic obstruction of A-loop. The chronic obstruction gradually developed into a complete blockage, further causing biliary obstruction and resulting in the occurrence of severe jaundice and abdominal pain. Here we not only reported a case of chronic afferent loop obstruction following radical resection of gastric carcinoma, but also analyzed the characteristic features of CT imaging and treatment. This case report is a good reference to similar gastrointestinal malignancy.

Validation of the new AJCC TNM staging system for gastric cancer in a large cohort of patients ( n = 2,155): Focus on the T category

Background The prognostic value of T subclassification in patients with gastric carcinoma has been just implemented in the new AJCC TNM staging system, which has reclassified T2a and T2b into T2 and T3 tumors, respectively. The aim of the present study was to validate the prognostic significance of the new T categorization within the frame of the latest TNM staging system. Methods We retrospectively reviewed the records of 686 T2/T3 patients among 2155 subjects who underwent radical resection for gastric carcinoma at six Italian centers from 1988 through 2006. Results Upon multivariate analysis, the new T categories, extent of lymph node dissection (D) and patient’s age were retained by the survival model as independent prognostic factors. In particular, the death risk for patients with T3 tumors was higher than that of patients with T2 tumors (HR: 1.42, P = 0.005). Among the 686 patients previously classified as having T2 tumors, patients with T2 and T3 disease were 270 (39.4%) and 416 (60.6%), respectively. After a median follow-up of 55 months, the 5-year overall survival rates were 67.3% and 52.3% for patients with T2 and T3 tumors, respectively ( P < 0.001). The survival advantage for the T2 as compared to T3 category was maintained even when N0 and N+ patients were separately considered ( P = 0.0154 and P < 0.001, respectively). Conclusions Our data confirm the prognostic difference between the newly proposed T2 and T3 categories, which should be implemented in the routine clinical practice to improve risk stratification of patients with gastric cancer.

Expression and significance of RhoA and NF-ΚB in human gastric carcinoma

To investigate the expression of RhoA and NF-κB in gastric carcinoma and their correlation with clinicopathological fearures. To determine the effective prognostic factors of long-term suivival of gastric carcinoma patients. The role of RhoA and NF-κB in gastric carcinoma was assessed by tissue array technology and the levels of RhoA and NF-κB expression in paraffin-embedded tissues was quantified by immunohistochemistry from 189 cases of gastric carcinoma, 54 cases of their adjacent tissues, and 32 cases of normal gastric mucosa. The prognosis of gastric carcinoma was evaluated by Kaplan-Meier survival analysis and Cox multivariate regression analysis. The positive rates of RhoA expression were 84.7%, 68.5% and 65.6% in gastric carcinoma, adjacent tissues and normal mucosa, respectively. The expression of RhoA in gasric carcinoma was significantly higher than that in adjacent tissues and normal mucosa (P < 0.05). The positive rates of NF-κB expression were 75.1%, 42.6% and 15.6%% in gastric carcinoma, adjacent tissues and normal mucosa, respectively. The expression of NF-κB in gasric carcinoma was significantly higher than that in adjacent tissues and normal mucosa (P < 0.05). RhoA was positively linked with NF-κB (r = 0.203, P = 0.005). In gastric carcinoma, the expression of RhoA was related with depth of invasion (P < 0.05), and the expression of NF-κB was related with depth of invasion and lymph node metastasis (P < 0.05). The Kaplan-Meier survival analysis showed that the tumor size, lymph node metastasis, depth of invasion, expression of RhoA and NF-κB can shorten the cumulative survival rate. With these paramaters entering the Cox multivariate regression analysis mode, it was revealed that expression of NF-κB, lymph node metastasis and depth of invasion are independent prognostic factors. The overexpression of RhoA and NF-κB is involved in the occurrence and development of gastric carcinoma. RhoA is positively linked with NF-κB. They are correlated with the invasion and metastasis of gastric carcinoma. The expression of NF-κB, lymph node metastasis, depth of invasion are independent prognostic factors playing an important role in prediction of the clinical outcome after radical resection of gastric carcinoma.

The prognostic value of N-ratio in patients with gastric cancer: Validation in a large, multicenter series

Aims The proportion between metastatic and examined lymph nodes (N-ratio) has been proposed as an independent prognostic factor in patients with gastric cancer. In the present work we validated the reliability of N-ratio in a large, multicenter series. Patients and methods We retrospectively reviewed the data of 1853 patients who underwent radical resection for gastric carcinoma. Survival of patients with >15 (Group-1, n = 1421) and those with ≤15 (Group-2, n = 432) lymph nodes examined was separately analyzed in order to evaluate the influence of lymph node dissection on disease staging. N-ratio categories (N-ratio 0, 0%; N-ratio 1, 1–9%; N-ratio 2, 10–25%; N-ratio 3, >25%) were determined by the best cut-off approach. Results At multivariate analysis, N-ratio (but not TNM N-category) was retained as an independent prognostic factor both in Group-1 and Group-2 (HR for N-ratio 1, N-ratio 2 and N-ratio 3 = 1.67, 2.96 and 6.59, and 1.56, 2.68 and 4.28, respectively). After a median follow-up of 45.5 months, the 5-year overall survival rates of TNM N0, N1 and N2 patients were significantly different in Group-1 vs Group-2. This was not the case when adopting the N-ratio classification, suggesting that a low number of excised lymph nodes can lead to patients being understaged using the N-category, but not N-ratio. Moreover, N-ratio identified subsets of patients with significantly different survival rates within TNM N1 and N2 categories in both groups. Conclusions N-ratio is a simple and reproducible prognostic tool that can stratify patients with gastric cancer, including those cases with limited lymph node dissection. These data support the rationale to propose the implementation of N-ratio into the current TNM staging system.

The Ratio Between Metastatic and Examined Lymph Nodes (N Ratio) Is an Independent Prognostic Factor in Gastric Cancer Regardless of the Type of Lymphadenectomy

To investigate whether the ratio between metastatic and examined lymph nodes (N ratio) is a better prognostic factor as compared with traditional staging systems in patients with gastric cancer regardless of the extension of lymph node dissection. We retrospectively reviewed the data of 1853 patients who underwent radical resection for gastric carcinoma at 6 Italian centers. Patients with >15 (group 1, n = 1421) and those with <or=15 (group 2, n = 432) lymph nodes examined were separately analyzed. N ratio categories (N ratio 0, 0%; N ratio 1, 1%-9%; N ratio 2, 10%-25%; N ratio 3, >25%) were determined by the best cut-off approach. After a median follow-up of 45.5 months (range, 4-182 months), the 5-year overall survival of N0, N1, and N2 patients of group 1 versus group 2 was 83.4% versus 74.2% (P = 0.0026), 54.3% versus 44.3% (P = 0.018), and 32.7% versus 14.7% (P = 0.004), respectively, suggesting that a low number of excised lymph nodes can lead to the understaging of patients. N ratio identified subsets of patients with significantly different survival rates within N1 and N2 stages in both groups. At multivariate analysis, the N ratio (but not N stage) was retained as an independent prognostic factor both in group 1 and group 2 (HR for N ratio 1, N ratio 2, and N ratio 3 = 1.67, 2.96, and 6.59, and 1.56, 2.68, and 4.28, respectively). In our series, the implementation of N ratio led to the identification of subgroups of patients prognostically more homogeneous than those classified by the TNM system. N ratio is a simple and reproducible prognostic tool that can stratify patients with gastric cancer also in case of limited lymph node dissection. These data may represent the rational for improving the prognostic power of current UICC TNM staging system and ultimately the selection of patients who may most benefit from adjuvant treatments.

Survival following microscopically confirmed radical resection of N0 gastric cancer.

In a series of 128 patients operated on for gastric cancer, 27 satisfied microscopic criteria for radical resection. The median age of these patients was 72.3 (range 36-84) years at operation; the median hospital stay after surgery was 12.9 days. The median observation time was 3.8 years and the crude 5-year survival rate 48 per cent. Older patients did remarkably well. No significant difference was found in the number of survivors, survival-observation time or hospital stay in the age groups 55-64, 65-74 or 75-84 years. Thus, age alone should not be considered a barrier to curative surgical treatment. When the study was ended, 12 of the 27 patients who underwent microscopically confirmed radical resection were still alive; six had died from recurrent gastric cancer and nine from other causes. At 5 years after microscopically confirmed radical resection for gastric carcinoma, the gastric cancer-specific mortality rate was 23 per cent.

Gastric carcinoma treated by chemotherapy after resection: A controlled study

A prospective controlled study of combined chemotherapy with 5-fluorouracil, vinblastine and cyclophosphamide was conducted in 53 patients with radical resection for gastric carcinoma. The patients were divided into two groups, a control group of 26 patients and a chemotherapy group of 27 patients, that were similar in regard to age, sex, location of carcinoma, type of resection and pathologic findings. No significant differences in survival rate were observed between the control group and the chemotherapy groups.