Synchronous Multiple Gastric Carcinoma Research Articles

A Case of Synchronous Multiple Gastric Carcinoma Composed of Small Cell Carcinoma and Adenocarcinoma

A Case of Synchronous Multiple Gastric Carcinoma Composed of Small Cell Carcinoma and Adenocarcinoma

Analysis of clinicopathological features and prognosis of 142 cases with synchronous multiple gastric carcinoma

To investigate the correlation between clinicopathological features and prognosis in patients with synchronous multiple gastric carcinoma (SMGC). The clinicopathological data of 142 patients who underwent gastrectomy for SMGC from January 2000 to May 2014 at the Department of Abdominal Surgery, Cancer Institute & Hospital, Chinese Academy of Medical Sciences were retrospectively analyzed, mainly including epidemiological statistics (age, gender), surgery-related information (surgical mode, operation time, intraoperative blood loss), carcinoma-related data (quantity, location, degree of differentiation, T stage, maximum tumor diameter, vascular tumor thrombus, cutting edge, postoperative adjuvant chemotherapy), and lymph node status (number of lymph nodes dissected, lymph node metastasis). The survival analysis was performed using the Kaplan-Meier and log-rank test and multi-factor analysis with the Cox proportional hazard regression model. A total of 142 SMGC patients were included in the study, 118 men and 24 women, with an average age of 66.9 (range 32-90) years old at the time of diagnosis. There were a total of 294 lesions in 142 patients, including 136 with 2 primary gastric tumors and other 6 with 3 or more. Among these lesions, 104, 83, and 107 carcinomas were located in the proximal stomach, gastric body and distal stomach, respectively. The average diameter of the main tumors was 3.65 (0.8-15) cm, while that of the accessory ones was 3.31 (0.5-12) cm. The postoperative pathology showed that there were 97 T1, 51 T2, 62 T3, and 84 T4 lesions. Among the 142 patients, 90 (63.4%) had lymph node metastasis, and the average number of dissected lymph nodes was 25.5 (13-66). The postoperative 3-year and 5-year survival rates of the 142 patients were 73.5% and 52.2%, respectively. The univariate analysis revealed that both the main tumor T stage and TNM stage are related to the postoperative survival of SMGC patients (P<0.05 for both). The multivariate analysis showed that main tumor T stage and TNM stage are independent factors affecting prognosis of SMGC patients (average P<0.05 for both). SMGC is a special type of gastric cancer. The main treatment is radical gastrectomy. The Main tumor T stage and TNM stage are associated with the prognosis of SMGC patients.

The 7th AJCC/UICC TNM staging system may be not suitable in predicting prognosis of synchronous multiple gastric carcinoma patients with D2 gastrectomy.

To assess the suitability of the 7th AJCC/UICC TNM staging system in predicting the prognosis of synchronous multiple gastric carcinomas (SMGCs). A total of 129 SMGC patients who underwent gastrectomy with D2 lymphadenectomy from January 1999 to January 2009 were enrolled in this study. The location, diameter, and depth of invasion of the main tumor were all related to prognosis (P < 0.05). Multivariate analysis revealed depth of invasion as an independent predictive factor for survival (P < 0.05). Interestingly, logistic regression analysis showed that the 7th AJCC/UICC N staging system was unable to significantly predict survival in SMGCS patients (P > 0.05). Cut-point survival analysis identified the most appropriate cut-offs for metastatic lymph nodes (MLNs) as 0, 1, 6, 10, and 19: patients with 0, 1-6, 7-10, and 11-19, and ≥ 20 MLNs had median survival times of 70, 56, 35, 52, and 32 months, respectively. Multivariate analysis suggested this new categorization of MLNs to be a significant predictor of survival (P < 0.05). Preoperative assessment of depth of invasion can help in the prognosis of SMGCs patients. The 7th UICC TNM staging system may be not suitable for SMGC patients and needs improvement for rational grading of SMGCs.

Clinicopathologic Features and Prognosis of Synchronous Multiple Gastric Carcinomas

Objective : The study of synchronous multiple gastric carcinoma is of the utmost importance in the management of carcinoma of the gastric remnant and in the epidemiology and histogenesis of gastric carcinoma. We compared the clinicopathologic features and outcome of patients with synchronous multiple gastric carcinoma (SMGC) to those of patients with single gastric carcinoma.Methods : Of the 3,320 patients diagnosed with gastric carcinoma who underwent surgery in our hospital, 188 patients (5.7%) were diagnosed with SMGCs.Results : Early carcinomas were more frequently observed in patients with SMGCs than in patients with single gastric carcinoma (p < 0.001). In addition, lymph node metastasis was less common in patients with SMGCs than in patients with single gastric carcinomas (p < 0.05). Regarding the operative procedures, total gastrectomy was more frequently performed in patients with SMGC (32.5 vs. 20.2%; p < 0.001). The 5-year survival rate of patients with SMGCs was higher than that of patients with single gastric carcinoma (69.3% vs. 54.1%, p < 0.001). Multivariate analysis showed that lymph node metastasis, serosal invasion, and curative resection were significant prognostic factors for the survival of patients with SMGCs.Conclusion : More recently, endoscopic or laparoscopic resection for early gastric carcinoma has frequently been performed. Careful preoperative and intraoperative evaluation and postoperative follow-ups are essential to detect any missed lesions in the remnant stomach, particularly in elderly patients with early gastric carcinoma.

Study of clinicopathological factors associated with the occurrence of synchronous multiple gastric carcinomas

Multiple gastric carcinomas often arise in gastric mucosa with chronic gastritis, particularly severe intestinal metaplasia. In regard to such characteristics, several clinicopathological risk factors for multiple carcinomas have been reported, but no clinically useful criteria are available at present for assessing the onset of multiple gastric carcinomas. If the risk for multiple gastric carcinomas could be accurately assessed, efficient and accurate surveillance could be performed following minimally invasive therapies. In the present study, we investigated clinicopathological differences between 94 cases of multiple early gastric carcinomas and 285 cases of solitary early gastric carcinoma. We tested 379 specimens of gastric carcinomas that had been surgically resected at the Department of General and Gastroenterological Surgery of Osaka Medical College, Japan, from April 1999 to December 2006. Univariate analysis of clinicopathological factors in the present study showed that multiple gastric carcinomas were significantly correlated to old age (> or =65 years), well- and moderately differentiated histological type, mucin phenotype (intestinal type), distribution of atrophic mucosa in the stomach (severe), degree of intestinal metaplasia in the surrounding mucosa (severe), and heterotopic glandular cysts. Multivariate analysis using the stepwise method identified age (> or =65 years) and degree of intestinal metaplasia in the surrounding mucosa (severe) as significant independent risk factors for multiple gastric carcinomas. While other studies have shown risk factors for multiple gastric carcinomas, the present study is unique in showing risk assessment criteria based on a combination of risk factors for multiple gastric carcinomas.

Epstein-Barr virus and microsatellite instability in gastric carcinogenesis.

Little information is available concerning the relationship between transforming viruses and microsatellite instability (MSI). We evaluated Epstein-Barr virus (EBV) using in situ hybridization for EBV-encoded small RNAs and MSI using the polymerase chain reaction in surgically resected gastric cancer. The study subjects included 298 consecutive cases of solitary gastric carcinoma, 63 gastric carcinomas in young patients (</=30 years old), 64 cases of gastric cancer coexisting with gastric adenoma in a single lesion, 26 cases of gastric remnant cancer, and 98 carcinomas from 47 patients with synchronous multiple gastric carcinomas. There was no overlapping case among these subsets of gastric cancer. None of these 549 gastric carcinomas demonstrated both EBV positivity and MSI positivity. Furthermore, the EBV-positive and the MSI-positive cases showed a mutually negative association in all subsets of gastric cancer. 5.7% of consecutive solitary gastric carcinomas were EBV positive, and 9.7% were MSI positive. EBV was positive in 1.6% of gastric cancers coexisting with gastric adenoma, 12.7% of younger patients, 28.6% of gastric remnant cancer with previous gastrectomy for benign disease, and 14.5% of synchronous cancers without adenoma. MSI was found in 1.6% of younger patients, 18.8% of gastric cancers coexisting with gastric adenoma, 25% of gastric remnant cancer with previous gastrectomy for gastric cancer, and in 53.3% of synchronous gastric carcinomas having gastric adenoma remote from the cancer. In conclusion, the carcinogenic roles of EBV and MSI may be different in terms of each subset of gastric cancer. EBV and MSI may contribute to functionally equivalent pathways in gastric carcinogenesis.

A CASE OF SYNCHRONOUS MULTICENTRIC RESECTED GASTRIC CARCINOMA WITH SIX LESIONS

An 80-year-old woman who was admitted to the hospital for anemia was found to have multicentric mucosal lesions (5 lesions) of the stomach on an upper gastrointestinal series. Biopsies for all five lesions resulted in Group V. Pylorogastrectomy with D1+α lymphnodes dissection was performed. Pathological evaluation after the operation revealed, one advanced Borrmann type 2 carcinoma and five other early carcinomas. Then we diagnosed them as synchronous multiple gastric carcinoma with six lesions. With the aging of the Japanese population, multiple gastric carcinomas have been increasingly reported recently, but synchronous gastric carcinoma in six lesions like in this case is very rare.

Multifocal occurrence of gastric carcinoma in patients with a family history of gastric carcinoma

Smoking and alcoholic beverage drinking habits as well as a family history of cancer are well known risk factors for the multifocal occurrence of squamous cell carcinoma of the esophagus and the head and neck region. However, the role of these risk factors in multiple gastric carcinoma remains to be clarified. The purpose of this study was to examine the risk factors for multiple gastric carcinoma. The smoking and drinking habits as well as the family history of 157 patients with synchronous multiple gastric carcinoma and 157 patients with solitary gastric carcinoma who were similar with regard to gender, age, stage of the tumor, and year of admission were investigated. The risk of a multiple occurrence of gastric carcinoma also was elevated using the odds ratio (OR). The ORs of a multifocal occurrence of gastric carcinoma in patients who currently smoked and drank alcoholic beverages were 1.1 and 0.8, respectively, although the ORs were not related to the quantity of smoking or drinking. In patients with a close relative with gastric carcinoma the OR was 2.1 (95% confidence interval [CI], 1.3-3.7). In those patients with > or =2 close relatives with gastric carcinoma, the OR increased to 5.1 (95% CI, 1.2-21.1). Conversely, no significant elevation in the ORs was recognized regarding a family history of other cancers. In this study, a family history of gastric carcinoma was found to be clearly associated with the multifocal occurrence of gastric carcinoma; however, no significant correlation between the multifocal occurrence of gastric carcinoma in these patients and their smoking and drinking habits was recognized.

Synchronous multiple early gastric carcinoma: a study of 178 cases.

AbstractOver the past 3 decades, ending in 1979, resection has been performed in 7,220 patients with gastric carcinoma. Synchronous multiple gastric carcinoma, according to the diagnostic criteria of Moertel, was found in 468, of which 178 (38%) were “early.” There were 135 double, 33 triple, and 10 quadruple early carcinomas. Fewer than one‐third of the smaller tumors were diagnosed preoperatively, and 61.5% of the smaller lesions were less than 10 mm in diameter. In 53% of the patients, the smaller lesions were in the lower one‐third of the stomach with the main lesion in the upper one‐third, whereas in 13% the smaller neoplasms were located in the upper one‐third of the stomach with the main lesion in the lower one‐third. The clinical significance of the smaller lesions was their location relative to the resection line. When planning treatment of gastric carcinoma, it is important to evaluate the whole stomach before and during the operation and after examining the resected specimen. The 5‐year survival rate for patients with multiple early gastric carcinoma was 85.8%.