Coexistence of gastrointestinal stromal tumor, esophageal and gastric cardia carcinomas

Gastric gastrointestinal stromal tumor (GIST), esophageal squamous cell carcinoma and gastric cardia adenocarcinoma are distinct neoplasms originating from different cell layers; therefore, simultaneous development of such carcinomas is relatively rare. Auxiliary examinations revealed coexistence of esophageal and gastric cardia carcinoma with lymph node metastasis in a 77-year-old man. Intraoperatively, an extraluminal tumor (about 6.0 cm × 5.0 cm × 6.0 cm) at the posterior wall of the gastric body, a tumor (about 2.5 cm × 2.0 cm) in the lower esophagus, and an infiltrative and stenosing tumor (about 1.0 cm × 2.0 cm) in the gastric cardia were detected. Wedge resection for extraluminal gastric tumor, radical esophagectomy for lower esophageal tumor, and cardiac resection with gastroesophageal (supra-aortic arch anastomoses) were performed. Postoperative histological examination showed synchronous occurrence of gastric GIST, esophageal squamous cell carcinoma, and gastric cardia adenocarcinoma. Furthermore, immunohistochemistry indicated strong staining for c-Kit/CD117, Dog-1, Ki-67 and smooth muscle, while expression of S-100 and CD34 was negative.

Adenocarcinoma of gastric cardia in the elderly: Surgical problems and prognostic factors

AIM: To analyze retrospectively, our results about patients who underwent surgical treatment for adenocarcinoma of the cardia in relation to age, in order to evaluate surgical problems and prognostic factors.METHODS: From January 1987 to March 2003, 140 patients with adenocarcinoma of the cardia underwent resection in the authors' institution. They were divided into three groups with regard to age. Patients <70 and >60 year old (31) were excluded; we also excluded 18 out of 109 patients with poor general status or systemic metastases. So, we compared 51 elderly (≥ 70 year old)and 58 younger patients (≤ 60 year old). The treatment was esophagectomy for type Ⅰ tumors, and extended gastrectomy and distal esophagectomy for type Ⅱ and Ⅲ lesions.RESULTS: Laparotomy was carried out in 91 patients (83.4%), 38 in the elderly (74.5%) and 53 in younger patients (91.3%, P＜0.05). Primary resection was performed in 811 cases (89%) without significant differences between the two groups. Postoperative death was higher in the elderly (12.1%) than the other group (4.1%, P＜0.05), while morbidity was similar in both groups. A curative resection (R0) was performed in 59 patients (72.8%), 69.6% in the elderly and 75% in the younger group (P＞0.05). The overall 3- and 5-year survival rates were 26.7% and 117.8% respectively for the elderly and 40.7% and 35.1% respectively for younger patients (P = 0.1544). Survival rates were significantly associated with R0 resection,pathological node-positive category and tumor differentiation in both groups.CONCLUSION: As the age of the general population increases, more elderly patients with gastric cardia cancer will be candidates for surgical resection. Age alone should not preclude surgical treatment in elderly patients with gastric cardia cancer and a tumor resection can be carried out safely. Certainly, we should take care in defining the surgical treatment in elderly patients, particularly as regarding the surgical approach; although the surgical approach does not influence the survival rate, the transhiatal way still remains the best one due, to the lower incidence of respiratory morbidity and thoracic pain.

The clinical trial research of preoperative induced hypertension chemotherapy on the III staging cardia or fundus of stomach carcinoma

Objective: To observation the therapeutic effect and the adverse reaction of preoperative induced hypertension chemotherapy (IHC) on the III staging cardia or fundus of stomach carcinoma. Methods: 49 cases of the III staging cardia or fundus of stomach carcinoma were divided into two groups at random. The observation group included 19 cases and the control group included 30 cases. Every case used one cycle chemotherapy. The observation group (IHC group) used chemotherapy and AT II. The control group (simple chemotherapy group) used simple chemotherapy. All cases of the two groups operated after 3 weeks rest. The specimen’s DNA was analyzed by flow cytometry. Results: The effective power of observation group was 63.2% (12/19), exairesis ratio was 84.2% (16/19). The effective power of control group was 30% (9/30), exairesis ratio was 63.3% (19/30). DNA ploid determination: 13 cases were diploid and 5 cases were heteroploid in the observation group, 9 cases were diploid and 16 cases were heteroploid in the control group. The operative complications and risks of the two groups did not increase. Conclusion: IHC can increase the therapeutic effect of III staging cardia or fundus of stomach carcinoma obviously. IHC is one of the chemotherapy methods that have good future. It has good value of clinic enlarge trial.

Neuroendocrine carcinoma of cardia:one case report

Neuroendocrine carcinomas（NECs）are exceedingly uncommon,and its incidence rate is about 1/100 000,about 10% of them is originated from the gastrointestinal tract[1].Here wereport a case of neuroendocrine carcinoma of cardia.

Study of the Value of Combined Multiorgan Resection in Surgical Treatment of Carcinoma of the Gastric Cardia

OBJECTIVE:To determine the value of resection of combined visceral organs in surgical treatment of gastric cardiac carcinoma. METHODS:We retrospectively analyzed 217 random patients with car- cinoma of the gastric cardia who underwent a gastric cardiac resection.The patients had been treated as fol ows:186 with partial gastrectomy,31 with total gastrectomy,97 with a combined-visceral resection,of which 82 under- went a splenectomy plus partial pancreatectomy,10 with splenectomy alone and 5 with partial hepatectomy and diaphragmatectomy. RESULTS:The total patients were divided into 3 groups:128 with a gas- trectomy alone,10 with gastrectomy and splenectomy,and 82 with gastrec- tomy and splenectomy plus pancreatectomy.The operating times for these 3 groups were respectively 3.0 h,3.1 h and 3.8 h.The hospitalization times were respectively 23.8 d,31.2 d and 25.9 d.No differences in post-operative complications were found between these 3 groups.There were 92 patients who underwent a gastrectomy combined with a splenectomy and(or)the pancreatectomy,in which 92 No.10 lymph nodes were eliminated,with an average of one in each patient.Among the 125 patients not receiving a sple- nectomy but with elimination of lymph nodes,82 underwent a gastrectomy combined with partial pancreatectomy,of which 107 lymph nodes were elimi- nated for the No.11 group,with an average of 1.3 in each patient.There was a statisticaly significant difference between the 2 groups.The overal survival rates were similar in the 3 groups showing no statistical differences, but was higher in the Stage III patients with a combined resection of multi- organs.For patients in the Stage IV without resection of multi-organs,the survival rate was higher,but there was no significant difference between the 2 groups. CONCLUSION:It is difficult to determine precisely the involvement of para-tumorous organs with the eye during an operation.Combining a sple- nectomy with a pancreatectomy does not increase the post-operative compli- cations following surgical treatment for carcinoma of the gastric cardia.The combination of a splenectomy and partial pancreatectomy results in a higher survival rate and has an important significance for eliminating the lymph nodes of group 10 and 11,especially for patients in Stage III.In the applica- tion of a resection combining multi-organs,the doctor should make every effort to decrease the trauma and the complications based on the condition that the cancerous tissue is totally resected.

激光光动力疗法联合靶向治疗在晚期贲门-胃底癌中的应用效果

目的:观察激光光动力疗法(LPDT)联合靶向治疗在晚期贲门-胃底癌(CFGC)中的应用效果。方法:选取2020年4月—2022年5月安阳市中医院收治的62例晚期CFGC患者作为研究对象。根据随机数表法将其分为对照组和观察组,各31例。观察组给予靶向治疗联合LPDT,对照组给予靶向治疗。比较两组治疗后食管梗阻程度、近期疗效、不良反应、生存质量,随访3个月、6个月、9个月、12个月生存率。结果:治疗后,观察组食管梗阻程度显著优于对照组,差异有统计学意义(P<0.05)。观察组总有效率为93.55%,明显高于对照组的74.19%,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。观察组生存质量改善率为61.29%,明显高于对照组的35.48%,差异有统计学意义(P<0.05)。观察组治疗后12个月生存率为58.06%,显著高于对照组的32.26%,差异有统计学意义(P<0.05)。结论:LPDT联合靶向治疗可改善晚期CFGC梗阻症状,提高近期疗效,并有助于延长生存期,改善患者生存质量。

Human papillomavirus DNA and P16～(INK4A) expression in concurrent esophageal and gastric cardia cancers

AIM:To investigate the relationship between human papillomavirus (HPV) infection and concurrent esophagus and gastric cardia cancer from the same patient (CC) and examine the significance of P16 INK4A protein expression.METHODS:Polymerase chain reaction was used to detect the presence of HPV type16 (HPV16).The expression of P16 INK4A protein was detected using immunohistochemistry.RESULTS:Among the CC specimens,HPV16-DNA was found in eight cases of esophageal squamous cell carcinoma (ESCC) and five cases of gastric cardia adenocarcinoma (GCA),respectively (47% vs 29%),and two of both ESCC and GCA.P16 INK4A was highly expressed in both ESCC and GCA.In the HPV-associated positive CC,higher P16 INK4A expression was observed in the GCA than in the ESCC (75% vs 25%,P < 0.05).CONCLUSION:HPV16 as a correlated risk factor may play an important role in the development of ESCC and GCA.P16 INK4A may be a screening index in the HPVassociated carcinoma of gastric cardia.

Vagus-preserving Merendino-Procedure for Early Carcinoma ofthe Gastroesophageal Junction

Optimal therapy for early carcinoma of the gastroesophageal junction remains uncertain. Treat- ment alternatives discussed today reach from endoluminal techniques to radical esophagectomy with 2- or 3-?eld lymphadenectomy. In this context, the Merendino procedure with preservation of the vagal innerva- tion to the stomach appears as an interesting therapeutic alternative. This paper summarizes indications, operative technique, and functional results with respect to postoperative quality of life, based upon 2 cases operated in our department.

1526例胸段食管癌及贲门癌淋巴结转移状况分析(附1996～2004年河北医科大学第四医院随机抽样报告)

目的:本研究拟通过分析胸段食管癌及贲门癌淋巴结转移状况及规律,探究影响淋巴结转移的因素。方法:随机抽取1996年1月～2004年12月河北医科大学第四医院收治的胸段食管癌及贲门癌手术病例1526例,建立患者临床资料Access数据库。选取年龄、肿瘤部位、肿瘤长度、病理类型、浸润深度、脉管瘤栓、周围器官受侵和标本残端8个临床特征因素,对每一因素进行分层,分析其与淋巴结转移之间的相关性。统计分析采用SPSS13.0软件包进行分析。结果:胸段食管癌淋巴结转移部位包括胸腔和腹腔;胸上段食管癌主要向颈部和胸腔淋巴结转移;胸中段食管癌淋巴结转移呈上下双向;胸下段食管癌主要向食管旁淋巴结、贲门旁淋巴结和胃左动脉淋巴结转移,其转移率和转移度均显著高于胸上段和胸中段食管癌(P<0.0125)。贲门癌腹腔淋巴结转移程度显著高于胸段食管癌。贲门癌组贲门旁和胃左动脉淋巴结的转移率和转移度显著高于食管癌组(P<0.05);贲门癌胸腔食管旁淋巴结也易发生转移,转移程度与胸段食管癌相似。食管旁淋巴结的转移率和转移度在贲门癌和胸段食管癌两组之间无显著性差异(P>0.05)。多因素Logistic回归分析:肿瘤长度、浸润深度、脉管瘤栓、标本残端情况对淋巴结转移均有显著性影响(P<0.05)。结论:胸上段食管癌主要向颈部及胸腔淋巴结转移,胸中段食管癌淋巴结转移呈上下双向转移,胸下段食管癌主要向胸腔、腹腔淋巴结转移,贲门癌淋巴结转移主要在腹腔,食管旁淋巴结也易出现转移。胸段食管癌颈部淋巴结清扫应引起重视,胃左动脉淋巴结同样是清扫中最需要关注的,贲门癌食管旁淋巴结的清扫不容忽视。随着肿瘤长度、浸润深度的增加以及脉管瘤栓和残端癌细胞的出现,发生淋巴结转移的危险性显著增加。

食管癌贲门癌患者T淋巴细胞、NK细胞免疫功能检测及意义

目的本研究检测食管癌、贲门癌患者的免疫功能,寻找肿瘤患者的病情量化指标,用来预测和判定临床治疗效果。方法采集本院胸外科手术前的食管癌贲门癌患者115例及359例正常体检者的血液标本,应用流式细胞术检测外周血T淋巴细胞表面CD3、CD4、CD8及NK细胞(CD56)的表达。结果食管癌、贲门癌组与健康对照组相比较CD3、CD4有明显下降(P<0.05),而CD8、CD56有明显的增高(P<0.05)。将癌症组分为淋巴结转移组和无淋巴转移组,两组间CD3、CD4、CD8、CD56的差异均无统计学意义(P>0.05)。结论食管癌外周血T细胞免疫检测有助于了解疾病的发展进程。

贲门癌手术切缘癌残留相关因素分析

目的:分析贲门癌切除手术后切缘镜下癌残留相关原因,为提高贲门癌外科治疗效果总结经验。方法:回顾性分析我院1995～2005年间收治的123例贲门癌临床资料,应用单因素分析方法探讨贲门癌切除手术上下切缘癌残留的相关因素。结果:123例贲门癌术后病理诊断切缘镜下癌残留11例,上切缘残留5例,下切缘残留6例,上下切缘均残留1例,残留率8.9%,切缘癌残留者与切缘无癌残留肿瘤最长径分别为9.5±3.8cm和6.5±3.1cm,P<0.05;不同肿瘤大小、不同TNM分期的切缘癌残留发生率有明显统计学差异(P<0.05),贲门癌肿瘤最长径>7cm以及TNM分期为Ⅳ期是切缘癌残留的危险因素。结论:在贲门癌外科治疗中,根据肿瘤最长径来决定贲门癌手术切除范围及术式以减少切缘癌残留有重要临床价值:肿瘤最长径超过7cm,肿瘤TNM分期至Ⅳ期患者应行全胃切除术,并保证足够长度的上切缘以减少切缘癌残留发生。

贲门癌瘤体最长直径与临床病理特征的关系及其对患者生存期的影响

目的探讨贲门癌瘤体最长直径(maximum tumor diameter,MTD)与浸润程度、淋巴结转移和分化程度的关系及其对患者生存期的影响,为贲门癌临床病理TNM分期提供依据。方法测量4826例手术治疗的贲门癌患者MTD,分析MTD与肿瘤浸润程度、淋巴结转移和分化程度的关系;对其中1 756例患者进行入户问卷调查、和(或)电话随访,采用Kaplan-Meier法计算其生存期并绘制生存曲线,Log rank检验分析组间生存期的差异,Cox比例风险回归模型分析MTD对患者生存期的影响。结果 4 826例贲门癌患者平均MTD为(5.6±2.3)cm,MTD中位数为5.0 cm(0.5~18.0 cm)。依MTD长度,将贲门癌患者分为四组(MTD【3 cm、3~6 cm、≥6~9 cm、≥9 cm)。随MTD增长,患者淋巴结转移阳性率明显升高(r=0.254,P【0.05),浸润程度逐渐加深(r=0.102,P【0.05),癌细胞分化程度变差(r=0.069,P【0.05);5年生存率明显降低(P【0.05)。特别需要指出的是,随MTD增长,淋巴结转移阴性组患者5年生存率也明显降低。Cox多因素生存分析发现,MTD、淋巴结转移、浸润程度和分化程度是影响贲门癌患者预后的独立因素。结论贲门癌MTD与淋巴结转移、肿瘤细胞浸润程度和分化程度密切相关;是影响贲门癌患者预后的独立因素。

63例贲门癌胸腔纵隔淋巴结转移特点分析

目的研究贲门癌胸腔内纵隔淋巴结转移特点。方法采用前瞻性分析2008年6月—2009年10月随机选择63例贲门癌患者进行胸腔内纵隔淋巴结清扫并分析其转移特点。结果 63例贲门癌患者腹腔淋巴结转移度、转移率分别为38.39%、66.67%。胸腔淋巴结转移度、转移率分别为10.60%、20.63%。胸腔纵隔淋巴结转移与肿瘤长度、病理分级、浸润深度、肿瘤是否累及食管下段、腹腔淋巴结有关,Logistic回归多因素分析则显示肿瘤是否累及食管下段是主要影响因素。结论贲门癌主要向腹腔、胸腔淋巴结转移,贲门癌淋巴结清扫范围应包括胸腔内纵隔淋巴结与腹腔淋巴结。

136例高龄食管癌、贲门癌患者的外科手术治疗体会

目的总结>70岁高龄食管癌、贲门癌患者的外科治疗经验。方法回顾性分析2008年1月～2011年4月在我科手术治疗的136例>70岁高龄食管癌、贲门癌患者的临床资料(≥80岁24例)。结果全组均行肿瘤根治术。手术时间(141.5±48.7)min。术后发生吻合口瘘3例,肺不张4例,肺部感染12例,呼吸衰竭9例,急性肾功能衰竭2例,心律失常15例,伤口感染2例,乳糜胸1例;死亡3例,其余均经治疗后痊愈出院。术后平均住院时间(12.3±3.4)d。随访78例,随访1～39个月,10例死亡,其中4例死于肿瘤复发或者远处转移,6例死于心脑血管意外,其余患者生活质量良好。结论在合理掌握适应证的前提下,对>70岁高龄食管癌、贲门癌患者进行积极的手术治疗是安全有效的,但对各种并发症应有充分的认识,同时需要加强围术期管理。

环氧合酶-2在食管癌、胃癌、贲门癌的表达比较

目的 研究环氧合酶2(Cox 2)蛋白及其mRNA在食管癌、胃癌、贲门癌中的表达量和细胞内定位的异同,探讨Cox 2抑制剂对贲门癌的预防作用。方法 免疫组化法定量检测了3 种肿瘤共48 例标本的Cox 2 蛋白,RT PCR法和原位PCR法检测了其中29 例标本的Cox 2mRNA及其在组织细胞内的定位。结果 食管癌、胃癌、贲门癌的Cox 2染色分数分别为4.15±1.39, 3.66±1.16, 2.93±1.03,均高于正常组织。贲门癌的染色分数与胃癌的无显著性差异。Cox 2mRNA在贲门癌的检出率为87.5%(ISPCR),75%(RT PCR),在胃癌、食管癌的检出率为100%,无显著性差异。Cox 2mRNA位于癌细胞胞浆,胞核中也有少量存在,其在3 种肿瘤中相同。结论 Cox 2 在贲门癌中显著升高,其表达特点与胃癌、食管癌中基本相同。Cox 2抑制剂对贲门癌可能有预防作用。

全胃切除术与近端胃大部切除术治疗胃底贲门癌的远期疗效对比

目的探讨不同术式治疗胃底贲门癌的远期疗效。方法对58例胃底贲门癌患者采用手术治疗,其中全胃切除术29例,近端胃大部切除术29例。分析比较2组患者术后并发症和5年生存率。结果全胃切除术和近端胃大部切除术患者3年生存率分别为62.07%和44.83%(P>0.05),5年生存率为48.28%和20.69%(P<0.05)。近端大部切除组的反流性食管炎发生率为75.86%,高于全胃切除组的34.48%(P<0.05);2组患者的其他并发症发生率无统计学差异。肿瘤>3.0 cm和淋巴结转移患者全胃切除后5年生存率高于近端大部切除组(P<0.05),其他情况2组的生存率比较无差异。结论对胃底贲门癌患者实施全胃切除术治疗能够有效提高患者的长期生存率,尤其是对于肿瘤>3.0 cm和出现淋巴结转移的患者。

紫杉醇联合奥沙利铂及低剂量替吉奥治疗老年晚期贲门癌的近期疗效及安全性分析

目的分析观察紫杉醇联合奥沙利铂及低剂量替吉奥治疗老年晚期贲门癌的临床疗效和安全性。方法选取78例经病理学确诊的老年晚期贲门癌患者,按治疗方法不同分为A、B、C 3组,每组各26例,A组为紫杉醇联合奥沙利铂及低剂量替吉奥治疗,B组为低剂量替吉奥联合奥沙利铂治疗,C组为高剂量替吉奥联合奥沙利铂治疗,每组均21 d为1个周期,药物治疗2个周期后观察每组的临床疗效及不良反应发生情况。结果 A、B、C 3组的近期化疗有效率分别为19.2%、19.2%、11.5%,疾病控制率分别为92.3%、84.6%、84.6%,差异均无统计学意义(P﹥0.05);A组的整体疗效高于B、C两组(P﹤0.05)。A、B、C 3组的化疗不良反应主要表现为血液系统和消化道系统不良反应,如贫血、血小板减少、便秘、腹泻等,其中A组的贫血、血小板减少、中性粒细胞缺乏、恶心呕吐、便秘、腹泻的发生率低于B、C组,差异有统计学意义(P﹤0.05)。结论紫杉醇联合奥沙利铂及低剂量替吉奥治疗老年晚期贲门癌的总体临床有效率高,不良反应小,在老年晚期贲门癌患者中应予以推广。

贲门癌淋巴结转移的临床病理特点及意义

背景:贲门癌是位于食管胃结合部的消化道肿瘤,淋巴结转移有向胸腹腔两个途径转移,淋巴结转移是制约贲门癌长期生存的最重要因素。患者与方法:总计100例患者,其中男性80例,女性20例,年龄29~75岁,平均年龄57.8岁,均经病理确诊为贲门腺癌,所有病例均完成手术治疗。其中经左胸76例、经腹22例,胸腹联合切口2例。手术发现肿瘤<3.0 cm 8例,3.0 cm^7.0 cm 68例,>7 cm 24例。结果:淋巴结转移与肿瘤大小的关系不大,但与肿瘤侵及深度关系密切。手术方式对淋巴结转移的贲门癌是一种有效方式,可以给患者带来长期生存获益。统计学处理采用卡方检验进行统计学处理来研究淋巴结转移与临床预后的关系。结论:手术方式对淋巴结转移的贲门癌是一种有效治疗方式,可以给患者带来长期生存获益。探索一种创伤小,安全性高的贲门癌外科手术治疗标准术式势在必行,经上腹左胸二切口贲门癌切除二野淋巴结清扫术是理想术式。

SIRT1在贲门癌中的表达及临床病理学意义研究

目的研究SIRT1表达与贲门癌临床病理学间的关系及对预后的影响。方法应用组织芯片技术和免疫组化方法检测176例贲门癌组织和32例正常贲门组织中SIRT1、p53、Ki67蛋白的表达情况。结果 SIRT1在贲门癌中的阳性表达率高于正常贲门中的阳性表达率(P<0.01);176例贲门癌中,SIRT1在淋巴结有转移组中的表达高于淋巴结无转移组(P<0.01);且SIRT1表达与贲门癌TNM分期呈正相关(P<0.05)。SIRT1阳性组的Ki67蛋白水平高于SIRT1阴性组(P<0.05)。其中90例有随访资料的贲门癌病例中,SIRT1阳性患者的3年生存率及平均生存时间,低于SIRT1阴性表达患者(P<0.05)。结论 SIRT1在贲门癌组织中存在过表达,与淋巴结转移、TNM分期、肿瘤增殖状态以及预后相关,可能成为判定贲门癌恶性程度及评估预后的生物学指标。

食管胃连接部腺癌新的分型标准在中国的应用

目的:了解食管胃连接部腺癌新的分型标准的临床应用情况。方法:回顾分析食管远端癌、贲门癌、近端胃癌病人资料,采用新的分型标准对其临床病理特征、手术方式及生存率进行分析。结果:符合条件的203例病人中,食管远端腺癌29例(I型),真性贲门癌80例(Ⅱ型),贲门下胃癌94例(III型)。3型肿瘤术后5年总的生存率分别为Ⅰ型34%,Ⅱ型27.5%,III型24.5%(P<0.05)。根治术后5年生存率分别为37.5%,34.5%和33.3%,3型之间无明显差别(P>0.05)。结论:3型食管胃连接部腺癌其临床病理特征具有不同程度的差异,目前对它们的确切关系仍不清楚。TNM分期、手术切除的完整性以及淋巴结转移情况是预后的决定因素。