胃癌合并萎缩性胃炎110例的回顾性调查

随着纤维胃镜在临床的广泛应用,对胃部等器官疾病认识更加深入。目前已认识到慢性萎缩性胃炎(CAG)与胃癌有密切关系。为了研究胃癌与CAG的关系,笔者对1982年6月～1986年12月间经本院胃镜及病理活检确诊的胃癌,进行了回顾性调查,结果如下:

Nutritional factors and gastric cancer in Zhoushan Islands, China

AIM: To investigate the association between nutrient intakes and high incidence rate of gastric cancer among residents in Zhoushan Islands.METHODS: A frequency-matched design of case-control study was used during the survey on dietary factors and gastric cancer in Zhoushan Islands, China. A total of 103 cases of gastric cancer diagnosed in 2001 were included in the study and 133 controls were randomly selected from the residents in Zhoushan Islands. A food frequency questionnaire was specifically designed for the Chinese dietary pattern to collect information on dietary intake. A computerized database of the dietary and other relative information of each participant was completed. Total calories and 15 nutrients were calculated according to the food composition table and their adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by gender using unconditional logistic regression models.RESULTS: High intakes of protein, saturated fat, and cholesterol were observed with the increased risk of gastric cancer particularly among males (ORQ4 vsQ1 were 10.3, 3.24, 2.76 respectively). While carbohydrate was a significant high-risk nutrient (ORQ4 vsQ1 = 14.8; Pfor linear trend = 0.024) among females. Regardless of their gender, the cases reported significantly higher daily intake of sodium mainly from salts. As to the nutrients of vitamins A and C, an inversed association with the risk of GC was found. Baseline characteristics of participants were briefly described.CONCLUSION: The findings from this study confirm the role of diet-related exposure in the etiology of gastric cancer from the point of view of epidemiology. An increased risk of gastric cancer is associated with high intakes of protein, saturated fat, cholesterol and sodium,while consumption of polyunsaturated fat, vitamin A and ascorbic acid may have a protective effect against gastric cancer.

Surgical Treatment of Carcinoma of Esophagus and Gastric Cardia—A 34—year Investigation

Objective To understand the progress in surgical treatment of 12 970 patients with carcinoma of esophagus and gastric cardiac during 1965-1998.Methods The patients were divided into A, B and C groups: 3 155 patients (group A) were treated surgically in the first 14 years, 5952 patients (group B) in the next 10 years, and 3 863 patients (group C) in the last 10 years. The early stage lesions (Tis, Tl) were assigned as a separate group. The results of these groups were compared.Results The resectability for esophageal and gastric cardiac carcinoma was 94.0% and 84.4% respectively, and the overall resectability was 91.3% . The resectabih'ty for groups A, B, C and the early stage group was 82.1% , 85.1% , 90.2% and 100% , respectively. The overall operative mortality was 1.8%, it was 4.4% for group A, 1.6% for group B, and 0.5% for group C. The overall 5-year survival was 31.6% . The 5-year survival for groups A, B, C and the early stage group was 27.0% , 29.1%, 32.0% and 92.6%, respectively . Among the 3 temporal groups, differences were observed in terms of lesion stage, location and size, surgery with or without combined therapy and postoperative complications.Conclusion Best results were achieved in the early cases, with a resectability of 100% and a 5-year survival of 92.6% . The indications for surgical treatment were extended with increased resectability and decreased mortality. Subtotal esophagectomy combined with cervical esophagogastrostomy was advocated as the procedure of first choice for esophageal carcinoma in attempt to diminish the chance of recurrence, and to achieve better outcomes by using combined therapy for patients with e" stage b! lesion.

Clinical profile of gastric cancer in Khuzestan, southwest of Iran

AIM： To analyze the characteristics of epidemiological, clinical and survival patterns among patients with carcinoma of the stomach. METHODS： We retrospectively studied the characteristics of 186 gastric adenocarcinoma patients at Ahwaz Jundishapur University Hospitals （AJSUH） from September 1, 1996 to September 1, 2002. All the patients had histopathologically-confirmed malignancy. Demographic variables, family history of gastric cancer （GC）, clinicopathologic characteristics and treatment-related variables were analyzed. Univariate analysis was performed with the log-rank test and multivariate analysis with Cox regression. P 〈 0.05 was considered statistically significant. RESULTS： Male to female ratio was 2.6：1. The mean age was 60.6 years and 14% of the patients were younger than 40 years. Adenocarcinoma, gastric lymphoma, and gastric metastasis were found in 94.5%, 2.3%, and 3% patients, respectively. There was an average of 6-mo delay between the initial symptoms and the diagnosis. Among adenocarcinoma groups, intestinal type was the commonest （55.9%） and the distal third was the most common localization （88.4%）. One hundred and thirty-four patients （72.1%） were males. Thirty-one patients （17%） had a family history of GC. Surgery was performed in 90% of patients （non-curative）. CONCLUSION： The epidemiological features of GC in south Iran mimic those in high-risk areas. There is a higher frequency of GC in young patients at our institution. Patients are detected and treated after a relatively long delay. Most patients present in advanced stages, which favors a poor overall survival, Family history of GC has a significant problem in our area, Studying the etiology of this cancer in south Iran and earlier diagnosis and subsequent better cares are recommended.

Correlation between Thymidylate Synthase Genotype and Susceptibility to Gastric Carcinoma

OBJECTIVE To investigate the correlation between polymorphism of the 5′-untranslated region （5′-UTR） of thymidylate synthase genes, as well as the lifestyle, and the susceptibility of gastric carcinoma. METHODS A case-control study, with 60 cases of gastric carcinoma and 170 cases of general risk population-based controls from Nantong, Jiangsu province, China, was conducted. The epidemiological data, such as living habits of the cancer patients, were collected. DNA of peripheral blood leukocytes was obtained from all of the subjects. The TS 5′-UTR tandem repeat genotype was detected using polymerase chain reaction （PCR）. RESULTS There were three TS 5′-UTR genotypes in the group of gastric cancer cases （2R/2R, 2R/3R and 3R/3R） and six TS 5′-UTR genotypes in the group of the controls （2R/2R, 2R/3R, 3W3R, 2R/4R, 2R/5R and 3R/4R）. The genotypic frequencies were respectively 5.0%, 43.3% and 51.7% in the gastric cancer group. Compared with the parameters in the control group, i.e., 4.7%, 31.7%, 60.6%, 1.2%, 1.2% and 0.6%. There were no significant differences between the two groups. Compared with the 3R/3R- genotype individuals who where non-smokers, drank alcohol twice or less each week, drank tea and did not intake pickled food （PF）, the risk of gastric cancer significantly went up in the 2R/2R or 2R/3R-genotype people who had habits of smoking, drinking alcohol more than twice each week, no tea drinking but with frequent intake of PF. The adjusted ORs were as follows, 3.79 （95% CI： 2.45-8.64）, 3.41 （95% CI and 3.61 （95% CI： 1.81-8.78）. CONCLUSION There is 1.21-8.47）, 5.99 （95% Ch 3.01-14.7）, an obvious correlation between the polymorphisms of TS 5′-UTR genotypes and the lifestyle of individuals in the development of gastric carcinoma.

Carcinoma of the gastroesophageal junction in Chinese patients

Carcinoma of the gastroesophageal junction(GEJ) is defined as carcinoma that crosses the GEJ line,irrespective of where the tumor epicenter is located.This group of cancer is rare but controversial.Based on study results from the majority of epidemiologic and clinicopathologic investigations carried out in Western countries,this cancer is believed to arise from Barrett's esophagus(BE) and includes both distal esophageal and proximal gastric carcinomas because of similar characteristics in epidemiology,clinicopathology,and molecular pathobiology in relation to BE.As such,the most recent American Joint Committee on Cancer staging manual requires staging all GEJ carcinomas with the rule for esophageal adenocarcinoma(EA).This mandate has been challenged recently by the data from several studies carried out mainly in Chinese patients.The emerging evidence derivedfrom those studies suggests:(1) both BE and EA are uncommon in the Chinese population;(2) almost all GEJ cancers in Chinese arise in the proximal stomach and show the features of proximal gastric cancer,not those of EA;(3) application of the new cancer staging rule to GEJ cancer of Chinese patients cannot stratify patients' prognosis effectively;and(4) prognostic factors of GEJ cancer in Chinese are similar,but not identical,to those of EA.In conclusion,the recent evidence suggests that GEJ cancer in Chinese shows distinct clinicopathologic characteristics that are different from EA.Further investigations in molecular pathology may help illustrate the underlying pathogenesis mechanisms of this cancer in Chinese patients and better manage patients with this fatal disease.