Objective To investigate the expression of cell division regulators p16, Rb and cyclin D1 in human early gasric carcinoma tissues and their role in tumor transformation and the correlation among p16, Rb and cyclin D1. MethodsA comparative study was carried out by using immuno-histochemical techniques between the paracarcinomatous intestinal metaplasia of 39 cases of early gatric carcinoma and the non-carcinomatous gastric mucosal intestinal metaplasia tissues of 34 cases.ResultsOver expression of cyclin D1 was determined in 33/39 carcinomatous samples(84.6%) and also in para-carcinomatous intestinal metaplasia tissues. p16 was undetectable in 12 of 39 samples. Interestingly, 15 of 26 Rb positive cancers had no or low p16,while 9 Rb negative cancers showed high levels of p16.Conclusion The over expression of cyclin D1 may be a common molecular abnormality and an early molecular event in early gastric carcinoma. Cyclin D1 over expression and Rb inactivation can co-exist in early gastric carcinoma. However, there is a reciprocity between Rb inactivation and p16 expression in early gastric carcinoma. Thus, abnormality in the negative feedback regulatory pathway of cyclin D1,Rb and p16 may be related to the tumorigenesis in early gastric carcinoma.
Objective To study the relationship between early gastric cancer and MiB-1 expression. Methods Resected early gastric cancer from 99 cases were studied by immunohistochemical method. Results MiB-1 proliferation index (MiB-1 PI) was related to patient ’s age, tumor size, location and depth of invasion. MiB-1 PI was higher in differentiated adenocarcinomas than in undifferentiated adenocarcinomas(P＜0.01). Cancers with lymphatic vessel invasion or lymph node metastasis had higher MiB-1 PI (P＜0.05). The postoperative survival was related to MiB-1 proliferation grade (MiB-1 PG), being higher in MiB-1 PG 1,2 grade than that in MiB-1 PG 3,4 grade. Conclusion Even in the early stage of gastric cancer, tumor proliferation activity was related to patients’ prognosis.
ObjectiveTo investigate the relationship between clinicopathological characteristics and invasion depth of early gastric cancer (EGC), in order to put forward suitable regimens for EGC with different clinicopathological characteristics. MethodsThe clinicopathological data of 18 patients with EGC diagnosed from January 2008 to January 2013 were retrospectively analyzed. Clinicopathologic variables such as age, gender, tumor size and location, Helicobacter pylori infection, melaena, macroscopic type, and histopathological type were investigated by using chi-square test for their possible relationship with the depth of invasion. ResultsLymph node metastasis was more common in patients with submucous cancer (3/9, 33.3%) than in those with mucous cancer (0/9, 0%). Submucosal invasion was found in 77.8% (7/9) of undifferentiated adenocarcinoma cases, whereas only 22.2% (2/9) of differentiated adenocarcinoma had submucosal invasion. TypeⅢ EGC had a significant association with submucosal invasion (P<0.05). ConclusionEndoscopic treatment is unsuitable for patients with Type Ⅲ EGC.
ObjectiveTo summary the standard treatment for early gastric cancer. MethodsThe current early gastric cancer treatment guidelines around the world were analyzed and the standardized treatment patterns for early gastric cancer were concluded. ResultsThe accurate preoperative evaluation for early gastric cancer is the basis of standardized treatment which can be divided into staging evaluation and histological evaluation.The staging evaluation is focused on the gastric wall invasion and lymph node involvement of the tumor while the histologic evaluation emphasize the histological type and grading of the tumor.According to the precise evaluation for early gastric cancer, endoscopic surgery, laparoscopic surgery, open surgery, and multimodal therapy can be applied individually to the patients.Different treatment methods have their indications, but the indications of the therapies in different guidelines are suggested with slight differences. ConclusionIn clinical practice, the choice of treatment should be made with comprehensive consideration of diagnosis and individual characteristics of patients to achieve the most benefit on prognosis.
ObjectiveTo explore the feasibility and clinical efficacy of laparoscopic sentinel lymph node biopsy combined with endoscopic submucosal dissection(ESD) for patients with early gastric cancer(EGC). MethodsThe clinical data of 26 cases who received ESD combined with laparoscopic sentinel lymph node biopsy for EGC between March 2009 to August 2013 in Affiliated Hospital of Jiangnan University were analyzed retrospectively. These patients first underwent laparoscopic sentinel lymph node(SLN) biopsy. If frozen sectioning examination suggested there was lymph node metastasis, laparoscopic D2 radical gastrectomy would be operated. However, the ESD would be operated if the frozen sectioning examination was negative. ResultsThe total numbers of SLN were 95, and mean numbers of SLN were 3.7±1.4(range from 1 to 6). Two patients with positive SLN underwent laparoscopic-assisted distal gastrectomy and 24 patients with negative SLN underwent ESD. The disease free survival(DFS) and local recurrence rate after ESD for EGC was 91.7%(22/24) and 4.2%(1/24), respectively. And the total DFS for all patients was 96.2% (25/26). ConclusionESD for EGC is a safe and feasible procedure, combined with laparoscopic sentinel lymph node biopsy conforms more to the concept of principle of radical operation.
Objective To explore the clinicopathological characteristics which were associated with lymph node metastases in early gastric cancer patients. Methods Clinical data of 187 early gastric cancer patients who received surgical treatment in The Second People’s Hospital of Jiaozuo between January 2009 and January 2016, were retrospectively analyzed, and then exploring the clinicopathological characteristics which were associated with lymph node metastases in early gastric cancer, including age, gender, tumor location, diameter of tumor, number of tumor, depth of invasion, macroscopic type, histological type, venous invasion, and local ulcer. Results In this study, 187 patients with early gastric cancer were included, and lymph node metastasis was detected in 32 patients (17.1%). Results of multivariate logistic regression analysis showed that, lymph node metastasis was significantly closely related with diameter of tumor (OR=2.080,P=0.022), depth of invasion (OR=21.048,P=0.001), histological type (OR=3.507,P=0.018), venous invasion (OR=2.406,P=0.009), and local ulcer (OR=2.738,P=0.001), patients with diameter of tumor larger than 2 cm, infiltration depth of submucosa, histological types of undifferentiated type, vascular infiltration, and local ulcer had higher lymph node metastasis rate. Conclusion The clinicopathological characteristics, including diameter of tumor, depth of invasion, histological type, venous invasion, and local ulcer are risk factors for lymph node metastasis of early gastric cancer patients, which should be paid high attention.
Objective To investigate pattern of lymph node metastasis (LNM) in patient with early gastric cancer (EGC) and it’s relation to clinicopathologic features so as to providing evidence for proper clinical management for EGC. Method The clinical and pathologic data of 101 EGC patients who were diagnosed and treated in the West China Hospital of Sichuan University from January 2011 to December 2012 were retrospectively analyzed. Results The LNM was found in the 28 patients, the rate of the LNM was 27.7% (28/101). In the univariate analysis, the LNM was associated with the macroscopic type (P=0.013), depth of invasion (P<0.001), differentiation type (P=0.044), and lymphovascular invasion (P=0.020); In the multivariate logistic regression analysis, the factors including of the macroscopic type (RR=4.742, P=0.009), differentiation type (RR=6.369, P=0.011), and depth of invasion (RR=15.218, P<0.001) were the independent risk factors for the LNM. Twenty-eight patients with LNM had only 1 positive lymph node, 4 patients had more than 7 positive lymph nodes. The No.6 lymph node was the most frequently involved station (35.7%, 10/28). The LNMs in the 69.7% (19/28) patients were restricted in the extent of the D1 lymphadenectomy, 3 (10.7%) patients without the perigastric lymph node involvement had the No.8a or No.9 LNM. Conclusion LNM in patient with EGC is correlated with clinicopathologic features such as macroscopic type, depth of invasion, differentiation type, and lymphovascular, further investigation is warranted to clarify risk factors of LNM in patient with EGC.
Objective To analyze risk factors of lymphatic metastasis in early gastric cancer in order to discuss reasonable therapeutic regimen. Methods The clinical data of 148 patients with early gastric cancer surgically treated in the Anhui Tumor Hospital from February 2013 to November 2017 were retrospectively analyzed. The relationship between the lymphatic metastasis with the clinicopathologic characteristics of the patient with the early gastric cancer was analyzed by the univariate and multiple regression analyses. Results The lymphatic metastasis were observed in 15 of 148 patients (10.14%), 1 in the 70 (1.43%) mucosal lesions and 14 in the 78 (17.95%) submucosal lesions. The results of the univariate analysis showed that the patients’ age, size of tumor, macroscopic type, invasion depth, and vascular invasion were related to the lymphatic metastasis in the early gastric cancer (P<0.050), the results of the multiple regression analysis showed that the invasion depth and vascular invasion were the independent risk factors of the lymphatic metastasis in the early gastric cancer (P<0.050). Conclusions Invasion depth and vascular invasion are closely related to lymphatic metastasis in early gastric cancer. Precise evaluation of lymphatic metastasis before treatment is very important to patient with early gastric cancer.