Objective To summarize the current value of neoadjuvant chemotherapy (NAC) for potentially resectable gastric cancer. Methods The recent 5-year literatures searched through the PubMed with the key words: stomach neoplasm, gastric cancer/carcinoma, neoadjuvant therapy/chemotherapy and preoperative therapy/chemotherapy as well as the relevant reports presented in the ASCO Annual Meeting in 2007 and 2008 were analyzed. The present status of NAC for advanced gastric cancer was summarized, the necessity and feasibility were evaluated, and the patients features for selecting, the predictors for response, the mainly existing problems and development trend of NAC were analyzed. Results At present, there were 7 randomized control trails (RCT) published, and among them 3 were phase Ⅲ. It was safe, effective and feasible to most of trails in NAC for gastric cancer. However, it was still little to obtain survival benefit for NAC RCT, and short of randomized trial comparing strict preoperative chemotherapy to surgery alone or perioperative chemotherapy to surgery plus adjuvant chemotherapy. It remained lots of problems such as how to select the appropriate patients, the effective induced regimes and the predicted factors, the evaluated indices for response. Conclusion NAC is a safe, feasible and efficient method to potentially resectable gastric cancer, but strict phase Ⅲ randomized trials are needed. In the future, substantial improvements of treatment outcome will likely depend on the novel drugs and molecular biological targeted therapies.
ObjectiveTo explore the expression of alpha B-crystallin (CRYAB) in human gastric cancer tissue and the influence of chemotherapeutics on expression of CRYAB mRNA.Methods① The gastric cancer tissues and corresponding adjacent tissues of 76 patients underwent radical resection from April 2018 to March 2020 in The First Affiliated Hospital of Southwest Medical University and the Sichuan Mianyang 404 Hospital were collected, the expression of CRYAB protein in the gastric cancer tissues and corresponding adjacent tissues of 76 patients with gastric cancer were detected by immunohistochemistry SP technique. The relation between the expression of CRYAB protein and clinicopathologic features was analyzed. ② Twenty-one gastric tissues of patients accepted neoadjuvant chemotherapy and 26 gastric tissues of patients with no neoadjuvant chemotherapy in the The First Affiliated Hospital of Southwest Medical University were collected from November 2018 to March 2020, the expression of CRYAB mRNA was detected by real time-PCR.ResultsThe expression of CRYAB protein in gastric cancer tissues was positive in 51 cases (67.1%) and in the corresponding adjacent tissues was positive in 32 cases (42.1%), the positive rate was higher in gastric cancer tissues (χ2=9.581, P=0.002). The over-expression of CRYAB protein in the gastric cancer tissues was correlated with the TNM stage, Borrmann typing, degree of differentiation, lymph node metastasis, depth of invasion of the patients, and Lauren classification (P<0.05), but not correlated with the age, gender, tumor sitation, and diameter (P>0.05). The expression of CRYAB mRNA in the gastric cancer tissues with neoadjuvant chemotherapy was significantly higher than that in the gastric cancer tissues without neoadjuvant chemotherapy (t=8.37, P<0.001).ConclusionsThe over-expression of CRYAB protein is closely related to the invasion and progression of gastric cancer, they may be involved in the progression of gastric cancer and play a crucial role. Moreover, the expression of CRYAB mRNA increases after chemotherapy, it suggests that chemotherapy drugs can activate the self-protection mechanism of tumor cells to some extent, and influence the effect of chemotherapy by increasing expression of CRYAB protein.
ObjectiveTo investigate the correlation between expression of stromal interaction molecule 1 (STIM1) and tumor malignant degree or lymph node metastasis in patients with gastric cancer. MethodsA total of 83 patients with gastric cancer treated in the Affiliated Hospital of Southwest Medical University and Sichuan Mianyang 404 Hospital from October 2018 to April 2021 were collected. The expression of STIM1 protein in the gastric cancer tissues and the corresponding adjacent normal gastric tissues was detected by immunohistochemistry method. Meanwhile the correlation between the expression of STIM1 protein and clinicopathologic features or postoperative lymph node status of the patients with gastric cancer was analyzed. ResultsThe positive rate of STIM1 protein expression in the gastric cancer tissues was 95.2% (79/83), including 62 (74.7%) patients with high expression (STIM1 scoring 5–7) and 21 (25.3%) patients with low expression (STIM1 scoring 2–4), which in the corresponding adjacent normal gastric tissues was 41.0% (34/83), the difference was statistically significant (χ2=58.078, P<0.001). The expression of STIM1 protein was not related to gender, age, and tumor size of the patients with gastric cancer (P>0.05), while the proportions of the patients with high expression of STIM1 protein in the gastric cancer patients with low/undifferentiated tumor, T3+T4 of infiltration depth, TNM stage Ⅲ, and lymph node metastasis were higher than those with high/medium differentiation (χ2=11.052, P=0.001), T1+T2 of infiltration depth (χ2=24.720, P<0.001), TNM stage Ⅰ+Ⅱ (χ2=9.980, P=0.002), and non-lymph node metastasis (χ2=6.097, P=0.014). The expression intensity of STIM1 protein was positively correlated with the number of lymph node metastasis (r=0.552, Z=–3.098, P=0.002) and the rate of lymph node metastasis (r=0.561, Z=–6.387, P<0.001). ConclusionsPositive rate of STIM1 protein expression in gastric cancer tissues is relatively high. STIM1 protein expression in gastric cancer tissue is closely related to tumor malignancy and lymph node metastasis, so it might play an important role in progression of gastric cancer.
Objective To describe a new technique for digestive tract reconst ruction of total gast rectomy.Methods The modified functional jejunal interposition ( FJ I) was performed in 38 patient s who underwent total gastrectomy between June 2004 and March 2006. At digestive tract reconst ruction, the jejunum with suitable suture ligated at 2 cm distal to side-to-end jejunoduodenostomy was changed to sew up 2－3 needles and to narrow it . End-to-side esophagojejunostomy to Treitz ligament was shortened to 20－25 cm befittingly. Side2to2side jejunojejunostomy to Treitz ligament was 10 cm. Both esophagojejunostomy and jejunojejunostomy must not be tensioned. Results No patients died or had anastomotic leakage in perioperative period. Roux-en-Y stasis syndrome (RSS) was in 2 patients. The Visick grade: 35 patient s were grade Ⅰ, 3 patient s were grade Ⅱ. Serum nut ritional parameters in 2 patients hemoglobin was only lower than normal. At 6 months after operation , food intake per meal and body weight were recovered to the preoperative level in 36 patients, and only 2 patients appeared weight worse. One patient had reflux esophagitis and no dumping syndrome occurred. Through the upper gast rointestinal radiograph , the bariums entered into duodenal channels mostly , and a little into the narrow channels. Conclusion The modified FJ I not only reserved all advantages of the primary procedure , but also could further lower the complications and improve of the quantity life of the patients who were underwent total gast rectomy. It would be necessary for further prospective randomized controlled trial in tlhe largescale cases.
Objective To explore the optimal technique for digestive tract reconstruction of proximal gastrectomy. Methods Fifty-nine patients who underwent proximal subtotal gastrectomy during June 2004 and January 2007 were analyzed retrospectively. All patients were divided into 2 groups according to the styles of reconstruction: one group with gastroesophagostomy (GE group) and the other with accommodation double tract digestive reconstruction of jejunal interposition (GIE group). The reconstruction of GIE group was to interposite a continuous 35 cm jejunum between the gastric stump and the oesophagus, which detail had been reported in our previous literature. The quality of life in 2 groups were evaluated and compared. Results No patient died and there was no anastomotic leakage, dumping syndrome and moderate or severe anemia occurred during perioperative period. There was no significant difference of the following indexes of nutrition between 2 groups 1 month and 6 months after operation: the value of weight, RBC, Hb, Alb, PNI and the indexes versus the preoperative ones (Pgt;0.05), for the exception of the indexes of RBC (P=0.006), Hb (P=0.001) in 1 month after operation versus the preoperative ones. The abdominal and the reflux esophagitis symptoms in GIE group were milder than those in GE group (Plt;0.001). The Visick scoring: most of the GIE group were gradeⅡ (74.2%), and grade Ⅲ (64.3%) in the GE group. There was no delay of the first time of adjuvant chemotherapy in GIE group (Pgt;0.05), and the surgical time was (0.35±0.13) h more than that of GE group (P=0.01). Conclusion The accommodation double tract digestive reconstruction of jejunal interposition for proximal subtotal gastrectomy may be safe and feasible by decreasing residual cancer cells and improving the quality of life of patients with proximal gastric carcinoma who underwent such surgical procedure.
Objective To summarize and analyze the treatment options and prognostic factors of gastric stump carcinoma （GSC）. Methods The clinical data of 114 patients with GSC treated in The Second Affiliated Hospital of Northern Sichuan Medical College and The General Hospital of Chinese People’s Liberation Army from Mar. 2000 to May.2008 were reviewed， and influencing factors of surgical resection and prognosis were analyzed. Results For all patients，the ratios of surgical resection and curative resection（R0 resection） were 57.0%（65/114） and 54.4% （62/114）， respec-tively. The ratios of total gastrectomy， distal gastrectomy， proximal gastrectomy， endoscopic mucosal resection （EMR），and endoscopic submucosal dissection （ESD） were 73.8%（48/65）， 16.9%（11/65）， 3.1%（2/65）， 4.6%（3/65）， and 1.5%（1/65）in resection cases， and were 75.8%（47/62）， 16.1%（10/62）， 3.2%（2/62）， 4.8%（3/62）， and 0 in R0 resection cases， respectively. Seventy-five patients were followed-up for 0.3-79 months （median 12 months）， the mediansurvival time was 19.5 months， and 1-， 3-， and 5-year overall survival rates were 61.8%， 42.3%， and 30.1%， respectively. The results of multivariate analysis showed that resection rate was higher in patients with initial distalgastrectomy （P=0.002）， kps score≥80 （P=0.016）,lower macroscopic type （P=0.013）， and cM0 （P=0.000）. R0 resection （P=0.000）， macroscopic type （P=0.005）， and cT stage （P=0.006） were the independent prognostic factors. There were both no significant difference on survival between the patients with previous benign disease and those with original malignant disease when analyzed with univariate or multivariate method （P＞0.05）. There were no significant difference on overall survival curve among patients treated with palliative resection， palliative chemotherapy， simple laparotomy， and best supportive care （P＞0.05）. Conclusions The treatment options and prognosis of GSC were not influenced by the primary benign diseases or malignant diseases， and R0 resection is the most important prognostic factor. Removal of total remnant stomach is the best surgical procedure for GSC， and palliative laparotomy should be avoided.
Objective To analyze the clinicopathologic characteristics of remnant gastric cancer （RGC）. Methods The clinical data of 114 patients with RGC treated in The Second Affiliated Hospital of Northern Sichuan MedicalCollege and The General Hospital of Chinese People’s Liberation Army from March 2000 to May 2008 were reviewed and analyzed retrospectively. The clinicopathologic characteristics between the patients with primary benign diseases and those with malignant diseases were evaluated. Results A total of 114 cases，the age was （62.6±11.3） years，and the males versus females was 4.7∶1.0. Most patients （76.2%，64/84） were diagnosed at advanced stages （consistent with pT），and the proportion of pT1 stage cases was only 23.8% （20/84），tumor invasion pT4 was 60.7% （51/84）. It was more common that tumor directly invaded adjacent organs or structures （27.4%，23/84），lymph nodes positive （42.9%，36/84），and distant metastasis （27.2%，31/114）. The location of distant metastasis was usually confined in the abdominal cavity （93.5%，29/31），and the peritoneum disseminated was the most commonly structures （67.7%，21/31）. Histologically，the incidence of poorly differentiated adenocarcinoma （76.7%，79/103） was the mostly histologic grade as well as the diffuse type （78.6%，81/103） was the mostly Laurén classification. Between the patients with primary benign diseases and those with initial malignant disease，the initial gastrectomy or the methods of reconstruction had significantly differences （both P=0.000）. The median time from initial resection to development of RGC was 30.0 years in the patients with original benign disease，contrary to 3.3 years in those with previous malignant disease （P=0.000）. Both primary diseases （benign or malignant） and the age at initial gastrectomy were the major influencing factors for the time of RGC developed （P＜0.05）. For pathohistology characters，except signet-ring cell carcinoma （P=0.045）， pT4b （P=0.049），pN stage （P=0.025），and Borrmann classification （P=0.005），there were no significant differences between the patients with previous benign diseases and those with original malignant disease，as well as the resectability rate，curative resection （R0） rate，and overall survival rate （P＞0.05）. Conclusions It is almost unaffected by originalbenign diseases or malignant diseases for clinicopathologic characteristics including the treatment option and prognostic factors.It is necessary and feasibility to form a pattern of endoscopic follow-up for RGC.