TK1、CEA、CA19-9检测在胃癌诊断中的应用

观察检测血清胸苷激酶1(TK1)、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)于胃癌诊断中及与病理特征相关性。方法 将在我(2021年01月-2022年01月)手术病理为胃癌30例设胃癌组,另30例胃部良性肿物设良性组,30例健康体检为健康组。分析三组血清TK1、CEA、CA19-9水平,诊断价值与病理特征相关性。结果 恶性组血清TK1、CEA、CA19-9指标最高,(P<0.05)。联合检测诊断价值更高(P<0.05)。胃癌血清TK1、CEA及 CA19-9 与肿瘤直径大、胃上部、低分化以及有淋巴结转移中较高,TK1随肿瘤TNM分期递增,水平也逐渐升高,(P<0.05)。结论 在胃癌诊断中,以血清TK1、CEA、CA19-9联合检测,具有较高诊断价值,肿瘤直径大小、部位、分化、转移情况及肿瘤TNM分期中,有显著相关性。

胃癌组织中B7-H1的表达及临床意义研究

目的检测人体胃癌组织中B7-H1的表达,探讨其与患者临床病理特征的关系及对预后的影响。方法采用免疫组化染色法检测胃癌组织中B7-H1的表达,分析其在胃癌组织中的阳性表达率与患者临床病理特征之间的关系,并绘制患者术后生存曲线,评价B7-H1表达对预后的影响。结果 65例胃癌组织中癌细胞的细胞膜、细胞质以及部分肿瘤组织浸润的淋巴管及淋巴细胞中均有检测到B7-H1的阳性表达,阳性率为36.9%。有淋巴结转移或脉管内有癌栓的患者B7-H1阳性率较高(均P<0.05)。B7-H1阳性表达的胃癌患者术后5年生存率(25.0%)低于阴性表达的患者(56.1%)(P<0.05)。结论 B7-H1阳性表达的胃癌患者易发生淋巴结转移,预后较差,B7-H1可作为评价胃癌患者预后的指标之一。

Meta-analysis of short-term outcomes after laparoscopy-assisted distal gastrectomy

AIM： To elucidate the current status of laparoscopyassisted distal gastrectomy （LADG） with regard to its short-term outcomes by comparing it with conventional open distal gastrectomy （CODG）.METHODS： Original articles published from 3anuary 1991 to August 2006 were searched in the MEDLINE, EMBASE, and Cochrane Controlled Trials Register. Clinical appraisal and data extraction were conducted independently by 2 reviewers. A meta-analysis was performed using a random effects model.RESULTS： Outcomes of 1611 procedures from 4 randomized controlled trials and 12 retrospective studies were analyzed. Compared to CODG, LADG was a longer procedure （weighted mean difference [WMD] 54.3; 95% confidence interval [CI] 38.8 to 69.8; P 〈 0.001）, but was associated with a lower associated morbidity （odds ratio [OR] 0.54; 95% CI 0.37 to 0.77; P 〈 0.001）; this was most significant for postoperative ileus （OR 0.27; 95% CI 0.09 to 0.84; P = 0.02）. There was no significant difference between the two groups in anastomotic, pulmonary, and wound complications and mortality. Duration from surgery to first passage of flatus was faster （WMD -0.68; 95% CI -0.85 to -0.50; P 〈 0.001） and the frequency of additional analgesic requirement （WMD -1.36; 95% CI -2.44 to -0.28; P = 0.01）, and duration of hospital stay （WMD -5.51; 95% CI -7.61 to -3,42; P 〈 0,001） were significantly lower after LADG, However, a significantly higher number of lymph nodes were dissected by CODG （WMD -4.35; 95% CI -5.73 to -2.98; P 〈 0.001）. CONCLUSION： LADG for early gastric cancer is associated with a lower morbidity, less pain, faster bowel function recovery, and shorter hospital stay.

Microvessel density is a prognostic marker of human gastric cancer

AIM: To investigate whether microvessel density (MVD) is related with prognosis in gastric cancer patients, and the expression of cyclooxygenase-2 (COX-2) and vessel endothelial growth factor (VEGF) so as to determine the possible role of COX-2 and VEGF in gastric cancer angiogenesis.METHODS: Forty-seven formalin-fixed paraffin-embedded tissue samples of gastric cancer were evaluated for COX-2, VEGF by immunohitochemical staining. To assess tumor angiogenesis, MVD was determined by immunohitochemical staining of endothelial protein factor Ⅷ-related antigen. The relationship among COX-2 and VEGF expression, MVD, and clinicopathologic parameters was analyzed. RESULTS: Among the 67 samples, high MVD was significantly associated with lymph node metastasis and poor survival. Multivariate survival analysis showed that MVD value and lymph node metastasis were independent prognostic factors. The expression rate of COX-2 and VEGF was significantly higher than that of the adjacent tissues. COX-2 and VEGF expression in gastric cancer was significantly correlated with tumor differentiation and depth of invasion, but not with survival. The mean MVD value of COX-2 or VEGF positive tumors was higher than that of COX-2 or VEGF negative tumors. A significant correlation was found between the expressions of COX-2and VEGF. CONCLUSION: MVD may be one of the important prognostic factors for gastric cancer patients. COX-2 and VEGF may play an important role in tumor progression by stimulating angiogenesis. VEGF might play a main role in the COX-2 angiogenic pathway. The inhibition of angiogenesis or COX-2, VEGF activity may have an important therapeutic benefit in the control of gastric cancer.

Changes in the clinicopathological characteristics of gastric cancer in Hehuang Valley of China–2379 cases of gastric cancer in recent 10 years

Objective： The aim of our studywas to discuss changes in the clinicopathological characteristics of gastric cancer in Hehuang Valley of China in recent 10 years. Methods： A retrospective case-control study was performed on 2379 newly-diagnosed gastric cancer patients. All of them came from Hehuang Valley. The patients were divided into two groups [recent 5 years （R5Y） and late 5 years （L5Y）] from February 2003 to February 2013, and the clinicopathological data were surveyed retrospectively. Results： The constituent ratio of upper 1/3 gastric cancer in R5Y and L5Y was 33.5% and 20.7%, respectively, and it showed a significant difference between the two groups （X2 = 21.28, P = 0.00）, The constituent ratio of squamous carcinoma/adenosquamous carcinoma was 2.7% and 1.6%, respectively, and it also showed a significant differ- ence between two groups （X2 = 50.91, P = 0.00）. The constituent ratio of moderately-poorly differentiated/poorly differentiated gastric carcinoma was 84.2% and 50.2%, respectively, and it showed statistically significant difference （X2 = 30.28, P = 0.00）. The detection rate of early gastric cancer （EGC） was 1.47% （35/2379）. The constituent ratio of the types of Borrmann II and Borrmann IV of advanced gastric cancer （AGC） among 2379 cases was 47.6% and 40.8%, respectively, and that still showed statistically significant difference （X2 = 18,80, P = 0.00）. The constituent ratio of diffuse-type of gastric cancer in R5Y and L5Y was 36.2% and 30.8%, respectively, even there was a significant difference （X2 = 7.49, P = 0.01）. Furthermore, there were also significant differences in regional lymph nodes metastasis, perineural infiltration and vascular invasion （P 〈 0.05）. The positive detection rate of HER2, ER and PR was 14.88%, 17.23% and 15.93%, respectively. The constituent ratio of HP in two groups was 43.8% and 36.2% respectively, and it also showed a significant difference （~2 = 13.51, P = 0.00）. Conclusion： The pathogenic sites in gastric cancer change to the upper stomach in Hehuang Valley in recent 10 years, and the detection rate of squamous carcinoma/adenosquamous carcinoma reveals a sharp rise. Borrmann III is still one of the main types of advanced gastric cancer, but the detection rates of Borrmann II and IV are increasing. The main type of gastric cancer is the intestinal- type, but the ratio of diffuse-type is also increasing in recent 10 years. The HP detection rate is 40.65% （967/2379）, and it has a slight rise in recent 10 years. The detection rate of poorly differentiated adenocarcinoma is increasing despite the fact that the moderately/moderately-poorly differentiated adenocarcinoma is the main histologic types. High detection rates of lymph nodes metastasis, perineural infiltration and vascular invasion indicate poor prognosis in patients with gastric cancer. There is no change in HER2 positive rate, on the contrary, there are a little increase in ER and PR expression in Hehuang Valley.

Family history of cancer in Chinese gastric cancer patients

Objective:The aim of the study was to investigate the influence of gastric cancer family history in the gastric cancer (GC) patients. Methods: Gastric cancer family histories within second degree relatives and clinicopathological features were obtained for 497 patients. Results:Of the 497 probands,235 probands were incorporated into familial gastric cancer (FGC) group (there were at least two GC members in the family); 262 probands were included in the non-FGC group (relatives only affected with non-GCs). Of 614 tumors in relatives,GC was the most frequent,followed by lung cancer,esophageal cancer,hepatocellular cancer,colorectal cancer,urogenital cancer,breast cancer,and pancreatic cancer. Most affected members aggregated within first-degree relatives. The ratio of males to females in affected first-degree relatives was usually higher in male probands. Paternal history of GC was a strong risk for GC in males,while risk of GC by maternal history of GCs was increased in females. Difference in tumor histological types between the two groups was derived from an excess of diffuse GC in non-FGC male probands. The lower site was the most frequent tumor location in all subgroups. Conclusion:Distribution of associated non-GCs in a family history of GC may vary with geographic areas. GC may have different genetic and/or environmental etiology in different families,and a certain subtype may be inherited in a male-influenced fashion.

Clinicopathologic Characteristics and Surgical Outcome of Gastric Cancer in Patients Younger than 36 Years of Age

OBJECTIVE This study was designed to determine theclinicopathologic features of young patients who underwentgastrectomy for gastric cancer and to improve the clinicalmanagement of this disease.METHODS From 1981 to 2000,among 1,830 gastric cancerpatients were admitted in our hospital for surgical treatment,66of them were<36 years of age.The clinicopathologic data of theseyoung patients were collected and reviewed.RESULTS The male:female ratio was 1.2:1.Most tumors werelocated in the lower third of the stomach(63.1%).The overall5-year survival rate of 66 cases was 28.7%.The 5-year survivalrates in the patients with early stages and with advanced stages ofgastric carcinoma were 77.8%(7/9)and 21.1%(12/57),respectively.Unfavorable prognostic factors associated with poor 5-yearsurvival included the degree of the invasion in the gastric wall(P<0.05),and curability of resection(non-curative vs.curative;P<0.05).CONCLUSION Gastric cancer in young adults tends to be moreadvanced presentation when diagnosed.However,young patientswith early gastric cancer can tolerate radical treatments well.Itis important to promptly make a precise diagnosis for gastriccarcinoma in young patients and to treat it in early stage.

Factors predicting survival in patients with proximal gastric carcinoma involving the esophagus

AIM： To investigate the clinicopathologic features which predict surgical overall survival in patients with proxima gastric carcinoma involving the esophagus （PGCE）. METHODS： Electronic pathology database established in the Department of Pathology of the Nanjing Drum Tower Hospital was searched for consecutive resection cases of proximal gastric carcinoma over the period from May 2004 through July 2009. Each retrieved pa- thology report was reviewed and the cases with tumors crossing the gastroesophageal junction line were se- lected as PGCE. Each tumor was re-staged, following the guidelines on esophageal adenocarcinoma, accord- ing to the 7th edition of the American Joint Commission on Cancer Staging Manual. All histology slides were studied along with the pathology report for a retrospec- tive analysis of 13 clinicopathologic features, i.e., age, gender, Helicobacter pylori （H. pylon} infection, surgical modality, Siewert type, tumor Bormann＇s type, size, dif- ferentiation, histology type, surgical margin, lympho- vascular and perineural invasion, and pathologic stage in relation to survival after surgical resection. Prognos- tic factors for overall survival were assessed with uni- and multi-variate analyses. RESULTS： Patients＇ mean age was 65 years （range： 47-90 years）. The male： female ratio was 3.3. The 1-, 3- and 5-year overall survival rates were 87%, 61% and 32%, respectively. By univariate analysis, age, male gender, H. pylori, tumor Bormann＇s type, size, histology type, surgical modality, positive surgical margin, lym- phovascular invasion, and pT stage were not predictive for overall survival; in contrast, perineural invasion （P = 0.003）, poor differentiation （P = 0.0003）, 〉 15 to- tal lymph nodes retrieved （P = 0.008）, positive lymph nodes （P = 0.001）, and distant metastasis （P = 0.005） predicted poor post-operative overall survival. Celiac axis nodal metastasis was associated with significantly worse overall survival （P = 0.007）. By multivariate analysis, ≥ 16 positive nodes （P = 0.018）, lymph node ratio 〉 0.2 （P = 0.003）, and overall pathologic stage （P= 0.002） were independent predictors for poor overa survival after resection. CONCLUSION： Patients with PGCE showed worse over- all survival in elderly, high nodal burden and advanced pathologic stage. This cancer may be more accurately staged as gastric, than esophageal, cancer.

Methylation of the PCDH8 (Protocadherin-8) gene in gastric cancer

Objective: To investigate the methylation status of the PCDH8 (Protocadherin-8) gene in gastric cancer tissues and find out the relationship between methylation status of the PCDH8 and clinicopathological features in gastric cancer patients. Methods: We first investigated the methylation status of the PCDH8 (Protocadherin-8) gene in 65 gastric cancer and detected aberrant promoter methylation in gastric cancers; and then analyzed he relationship between methylation status of the PCDH8 and clinicopathological status with SPSS 13.0 software. Results: We first investigated the methylation status of the PCDH8 (Protocadherin-8) gene in 65 gastric cancer and detected aberrant promoter methylation in 36 of 65 (55.4%) gastric cancers. There was no significant difference in the distribution of patients with methylation or unmethylation of PCDH8 in terms of age, sex, tumor size, distant metastasis, or TNM stage. Methylation of PCDH8 was significantly correlated to negative pathological lymph node metastasis (P=0.038) and tumor differentiation (P=0.01). These two factors were proved to be of prognostic importance. Conclusion: Methylated PCDH8 seems to have a trend for worse prognosis in gastric cancer. However, a further large series of tumor samples and a longer follow-up period are required to elucidate its potential role.

Endoscopic and clinicopathologic characteristics of early gastric cancer with high microsatellite instability

AIM： To investigate endoscopic and clinicopathologic characteristics of early gastric cancer （EGC） according to microsatellite instability phenotype. METHODS： Data were retrospectively collected from a single tertiary referral center. Of 981 EGC patients surgically treated between December 2003 and October 2007, 73 consecutive EGC patients with two or more microsatellite instability （MSI） mutation [high MSI （MSI-H）] and 146 consecutive EGC patients with one or no MSI mutation （non-MSI-H） were selected. The endoscopic and clinicopathologic features were compared between the MSI-H and non-MSI-H EGC groups.RESULTS： In terms of endoscopic characteristics, MSI-H EGCs more frequently presented with elevated pattern （OR 4.38, 95% Cl： 2.40-8.01, P 〈 0.001）, moderate- to-severe atrophy in the surrounding mucosa （OR 1.91, 95% CI： 1.05-3.47, P = 0.033）, antral location （OR 3.99, 95% CI： 2.12-7.52, P 〈 0.001） and synchronous le- sions, compared to non-MSI-H EGCs （OR 2.65, 95% CI： 1.16-6.07, P = 0.021）. Other significant clinicopatholog- ic characteristics of MSI-H EGC included predominance of female sex （OR 2.77, 95% CI： 1.53-4.99, P 〈 0.001）, older age （〉 70 years） （OR 3.30, 95% CI： 1.57-6.92, P = 0.002）, better histologic differentiation （OR 2.35, 95% Cl： 1.27-4.34, P = 0.007）, intestinal type by Lau- ren classification （OR 2.34, 95% CI： 1.15-4.76, P = 0.019）, absence of a signet ring cell component （OR 2.44, 95% CI： 1.02-5.86, P = 0.046）, presence of mu- cinous component （OR 5.06, 95% Cl： 1.27-20.17, P = 0.022）, moderate-to-severe lymphoid stromal reaction （OR 3.95, 95% CI： 1.59-9.80, P = 0.003）, and co-exist- ing underlying adenoma （OR 2.66, 95% CI： 1.43-4.95, P = 0.002）. CONCLUSION： MSI-H EGC is associated with unique endoscopic and clinicopathologic characteristics includ- ing frequent presentation in protruded type, co-exist- ing underlying adenoma, and synchronous lesions.

Clinicopathological significance of B-cell-specific Moloney murine leukemia virus insertion site 1 expression in gastric carcinoma and its precancerous lesion

AIM： To explore the relation between B-cell-specific Moloney murine leukemia virus insertion site 1 （Bmi-1） expression and the clinicopathological features of gastric carcinoma （GC）.METHODS： Immunohistochemistry was used to detect the expression of Bmi-1 and ki-67. Doublelabeling staining was used to display the distribution of Bcl-2^＋/ki-67 cells in 162 cases of GC and its matched normal mucosa and precancerous lesion.RESULTS： The positive rate of Bmi-1 expression in GC（52.5%） was significantly higher than that in normal gastric mucosa （21.6%, X^2 = 33.088, P 〈 0.05）. The Bmi-1 expression in GC was closely related with the Lauren＇s and Borrmann＇s classification and clinicalstage （X^2 = 4.400, 6.122 and 11.190, respectively, P〈 0.05）. The expression of ki-67 was related to the Borrmann＇s classification （X^2 = 13.380, P 〈 0.05）.Bcl-2 expression was correlated with the Lauren＇s classification （Z2 = 4.725, P 〈 0.05）, and the Bmi-1 expression both in GC （rk = 0.157, P 〈 0.05） and inintestinal metaplasia （rk = 0.270, P 〈 0.05）.CONCLUSION： Abnormal Bmi-1 expression in GCmay be involved in cell proliferation, apoptosis andcancerization. This marker can objectively indicate theclinicopathological characteristics of GC.

Clinicopathological features of early gastric cancer with duodenal invasion

The incidence of early gastric cancer （EGC） with duodenal invasion is extremely low, although advanced gastric cancer that arises in the antrum occasionally invades the duodenum. We investigated the clinicopathological features of EGC with duodenal invasion and provided strategies for clinical management.A Medline search was performed using the keyword early gastric cancer＂ and ＂duodenal invasion＇： Additional articles were obtained from references within the papers identified by the Medline search. We revealed that EGC with duodenal invasion was of the superficial spreading type of tumor. Tumors 〉 60 mm in size invaded the duodenum more extensively, and the distance of duodenal invasion from the pyloric ring was further in the elevated type than in the depressed type of tumor.There was no significant difference between the length of duodenal invasion and the histological type of the tumor. Gastric cancer located adjacent to the pyloric ring, even if cancer invasion was confined to the mucosa or submucosa, was more likely to invade the duodenum.The present study reveals that the elevated type of EGC is associated with more extensive duodenal invasion when the tumor size is 〉 60 ram, thus highlighting the importance of identification of duodenal invasion in these cases. We also reveal that sufficient duodenal resection with a cancer-free distal surgical margin should be performed in cases of duodenal invasion.

Comparative Analysis between Clinicopathologic Characteristics and Prognosis in Patients with Local and Infiltrative Gastric Cancer

OBJECTIVE To investigate the differences between theclinicopathologic characteristics and prognostic factors in patientswith localized and infiltrative gastric cancer (GC).METHODS Patients with advanced GC, who were admittedto the Department of Surgical Oncology of the First AffiliatedHospital of China Medical University, Shenyang, during a periodof January 1980-January 2000, were divided into the localizedand infiltrative GC groups. A comparative analysis of theclinicopathologic data and prognosis in the patients enrolled in thestudy was carried out based on the different macroscopic types.RESULTS There were significant differences in the sex ratio,tumor location, histologic type, depth of invasion, lymph nodemetastasis, lymphovascular cancer embolus (LVCE), growthpattern, and degree of radical surgery between the 2 groups.However, there were no significant differences in age, tumorsize, and intravenous cancer embolus between the 2 groups.The prognosis of the infiltrative GC group was poor. There weresignificant differences in the prognosis of the patients betweenthe 2 groups when tumor infiltration was within the muscularlayer or subserosa, yet the differences disappeared once the tumorinfiltration was beyond the serosal layer. The prognosis of thepatients with localized GC was closely related to tumor locationand lymph node metastasis. The prognostic factors of the patientsin the infiltrative GC group included lymph node metastasis,depth of invasion, and tumor size.CONCLUSION There are significant differences in theclinicopathologic characteristics and prognosis between the 2groups. Based on the biological characteristics of the tumors,individualized therapeutic plans will help to improve thetreatment outcome.

The relationship between Bag-1 and gastric cancer clinicopathologic characteristic

Objective： The aim of our study was to investigate Bcl-2 antanogene-1 （Bag-l） expressions in gastric cancer and evaluate their clinical significance. Methods： Bag-1 expressions were studied by the immunohistochemical streptavidin- perosidase （S-P） method in 62 samples of gastric cancer tissues, 11 normal gastric tissues, and their clinical significance was analyzed. Results： The positive rate of Bag-1 expression in the gastric carcinoma tissues was 41.94% （26/62）, while it was 9.09% （1/11） in the normal gastric tissues （P = 0.046）. Though Bag-1 was positively related to the tumour pathological grade, lymph node metastasis and prognosis （P 〈 0.05）, it was not related to the sex, age, location, tumour diameter, depth of invasion （P 〉 0.05）. Conclusion： There are over expression of Bag-1 gene protein in gastric cancer, it is significance in prognosis of gastric cancer.