Objective To investigate the expression of suppressor gene Runt-related transcription factor 3 (Runx3) in gastric carcinoma and its relationship with clinicopathologic parameters. Methods RT-PCR and Western blot were used to determine the mRNA expression and protein expression of Runx3 gene in primary tumor and corresponding normal tissues respectively in 52 patients with gastric carcinoma. The relationship between Runx3 expression and clinicopathologic parameters was analyzed. Results RT-PCR and Western blot analysis in 52 patients with gastric carcinoma showed down-regulation of Runx3 mRNA and Runx3 protein in 59.6% (31/52) and 48.1% （25/52） of the primary tumors tested, and in none of the normal tissues (P＜0.05) respectively. There was a significant negative correlation between the expression level of Runx3 gene and the clinicopathologic parameters such as tumor size, differentiation, infiltrative depth, lymph node metastasis and TNM stage (P＜0.05， P＜0.01). Runx3 gene transcription was coincident with its protein expression (r=0.840, P＜0.01）. Conclusion The expression of Runx3 gene is down-regulated in gastric carcinoma, which suggests that Runx3 gene plays an important role in carcinogenesis and the progression of gastric carcinoma. It may be a new target of diagnosis and treatment of gastric carcinoma.
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.
Objective To evaluate the effect of ultrasound guided percutaneous drainage on acute perforation of gastroduodenal ulcer in elderly patients. Methods The clinical features, treatments, and the curative effects of 86 elderly cases (≥65 years) of acute perforation of gastroduodenal ulcer in our hospital between January 2004 and October 2009 were retrospectively analyzed. Twenty-one cases were treated by ultrasound guided percutaneous drainage (drainage group), and 65 cases were treated by exploring operation (operation group). Results Drainage group was cured and had no complications. In 15 patients which accepted recheck one month after drainage, gastroscope showed the ulcer healed in 12 cases， and improved in 3 cases. In operation group, 63 cases were cured and 2 cases died. Compared with the drainage group, there was no significant difference in cure rate (Pgt;0.05). However, 11 patients had operative complications in operation group, which was significantly more than that in the drainage group （Plt;0.05）. In 45 patients which accepted recheck one month after operation, gastroscope showed the ulcer healed in 38 cases， and improved in 7 cases. Conclusion For elderly patients with acute perforation of gastroduodenal ulcer， if the patients do not fit for exploring operation， ultrasound guided percutaneous drainage is proved to be a simple, safe, and effective means.
Objective To investigate the clinicopathological characteristics of proximal gastric cancer (PGC). MethodsThe clinical course and pathologic feature of 118 PGC patients were analyzed, and compared with those of 310 distal gastric cancer (DGC) patients. ResultsThe incidence of PGC was lower than DGC, the percentage of Ⅲ,Ⅳ stages and undifferentiated type in the PGC group were significantly higher than in DGC. For the surgical procedure, patients in the PGC had significantly higher percentages of total gastrectomy and other organ resection than in DGC. The percentage of patients with positive margin and lymph node metastasis in PGC was also significantly higher than in DGC. Esophageal invasion and lymph node metastasis were much more in PGC. The 5year survival of patients with PGC was significantly lower than that with DGC. No significant differences were found between the two groups with respect to the mortality rates and complications. Conclusion The relatively poor prognosis associated with PGC is mainly from advanced cases and esophageal invasion. Early detection and treatment is the most important strategy to improve the survival of patients with PGC.
Objective To investigate the expression of transcription factor e2f-1 in the different development stages of gastric cancer, the relationships between clinicopathologic characteristics and e2f-1 expression status, as well as its influences on the prognosis. Methods The operative samples from primary lesion of 121 patients who underwent radical resection for gastric cancer were detected by SABC immunohistochemical staining. The relationships of e2f-1 expression with clinicopathologic characteristics and with the prognosis were observed by univariate, multivariate and relative analyses. Results The total positive expression rate of e2f-1 in all patients was 38.8% （47/121）. With the advancement of gastric cancer, the level of e2f-1 expression in TNMⅠ-Ⅳ stage was gradually decreased (r=－0.320， Plt;0.05)： Ⅰa stage with 62.5% （10/16）， Ⅰb with 47.1% （8/17）， Ⅱwith 55.0% （11/20）， Ⅲa with 40.0% （8/20）， Ⅲb with 27.3% （6/22）， Ⅳ with 15.4% （4/26）. The expression of e2f-1 was significantly negative correlated with tumor diameter, depth of infiltration, lymph node metastasis ratio, and N stage （Plt;0.05）. The multivariate analysis revealed that either histology type, or survival time was respectively an independent factor for e2f-1 expression （Plt;0.05）. Log-Rank test showed the relative factors to survival included N stage, tumor diameter, tumor position, lymph node metastasis ratio, depth of infiltration, and TNM stage （Plt;0.05）. Cox survival analysis found that both of later N stage and e2f-1 higher expression were independent prognostic factors （Plt;0.05）. The higher e2f-1 expression was related to a poor survival in TNM stageⅠand Ⅱ patients （r=－0.304, Plt;0.05）, the prognosis of patients with e2f-1 positive expression was worse than that of patients with negative expression （χ2=13.437， Plt;0.05）, and there was no statistic relationship between the expression of e2f-1 and prognosis in stage Ⅲ and Ⅳ patients （Pgt;0.05）. Conclusions e2f-1, as a useful marker, seems to be an indication for the malignant behavior in relatively earlier gastric cancer, in which the e2f-1 positive expression shares a significantly poor survival. And the lower expression of e2f-1 has been identified in later advanced gastric cancer, the more malignances in advanced gastric cancer might associate with a lower expression of e2f-1.
ObjectiveTo investigate the rule of lymph node metastasis in early gastric cancer (EGC) so as to provide a reasonable treatment. MethodsWe retrospectively analyzed the clinical data of 118 EGC patients who had been treated from January 2006 to December 2012,and a total of 8 potential factors associated with occurrence of EGC were evaluated by univariate analysis and multivariate logistic regression analysis. ResultsThe univariate analysis showed that ulcer,tumor size,depth of invasion and lymphatic involvement were correlated with lymph node metastasis (P<0.05).Multivariate logistic regression analysis showed that presence of an ulcer (OR=2.872),tumor of 3.0 cm or larger than that (OR=2.351),tumor invasion into the submucous layer (OR=3.461) and invasion into the lymphatic tubes (OR=1.784) were found to be independent risk factors. ConclusionLymph node metastasis of EGC is correlated with many factors,so EGC treatment choice should be made reasonably based on strict screening to exclude various risk factors before taking surgery.
Objective To explore the association of macrophages with carcinogenesis and development of gastric cancer. Method The related literatures at home and abroad were consulted and reviewed. Results The microenvironment of gastric cancer could induce the polarization of macrophages，and then the activated macrophages，especially the tumor associated macrophages，could in turn motivate the growth，invasion，and metastasis of tumor cells by secreting a series of active substances. Conclusions Macrophages，especially the tumor associated macrophages play an importantrole in the carcinogenesis and development of gastric cancer. Investigating the macrophages and their interaction with gastric cancer may lead to a profound understanding of carcinogenesis of gastric cancer as well as opening up a new prospectfor treatment.
Objective To investigate the clinical meanings of lymphangiogenesis, lymph vessel invasion (LVI) and lymph node (LN) micrometastasis in gastric cancer. Methods The expression of D2-40 in 68 patients with gastric cancer of primary lesion and the expressions of CK20 and (or) CKpan in 791 lymph nodes from 51 cases which were detected by immunohistochemical staining were analyzed, as well as their clinicopathologic profiles. The relationship of lymph vessel density (LVD), LVI and LN micrometastasis with LN metastasis and other clinicopathologic parameters was analyzed respectively. Results Positive rate of LVI with HE (LVI-HE) and D2-40 (LVI-IM) staining was respectively 66.2%(45/68) and 76.5%(52/68), P=0.118. The positive rate of LVI-IM was related to deeper tumor invasion (P=0.044), later stage of TNM (P=0.003) and LN metastasis (P=0.000). Average LVD of 68 cases was (18.19±7.44)/HP. The increment of LVD was significantly associated with LVI-HE positive status （P=0.040）, LVI-IM positive status （P=0.001）, venous invasion （P=0.037）, later stage of TNM （P=0.020） and LN metastasis （P=0.001）. The survival rate of the group sharing ≥15/HP of LVD was significantly lower than that in the group sharing ≤14/HP of LVD in early period of follow-up （P=0.032）. The incidence of nodal involvement in 51 patients was increased from 74.5%(38/51) by HE staining to 88.2%(45/51) by CK (CK20 or CKpan) immunostaining. The detection rate of metastasized LN was increased from 32.0%（253/791） by HE staining to 41.5%（328/791） by CK immunostaining (Plt;0.001). The significant difference of LN micrometastasis detection rate between CK20 (8.7%) and CKpan (12.3%) was also identified (P=0.003). The increased number of LN micrometastasis was related to larger diameter of tumor (P=0.001), higher LVI-HE positive rate (P=0.040), deeper invasion of tumor (P=0.018) and later stage of TNM (P=0.012). Both LN stage and TNM stage were changed according to the detection of LN micrometastasis: Seven patients of N0 should be recognized as N1 (N0→N1)， 6 as N1→N2, 1 as N2→N3. Four patients of stage Ⅰb should be recognized as stage Ⅱ (Ⅰb→Ⅱ)， 4 as Ⅱ→Ⅲa， 3 as Ⅲa→Ⅲb， 1 as Ⅲb→Ⅳ. Conclusion Detection of D2-40 and CK in diagnosis of LVI and LN micrometastasis is better than HE staining. The combined detection of CK20 and CKpan may be much easier to find out the LN with micrometastasis. Later stage of TNM the tumor is, more frequently the LN micrometastasis happens. The relationships of LVI-IM, LVD and LN micrometastasis with LN metastasis in gastric cancer has been demonstrated. Patients with higher LVD share a lower survival rate in early period of follow-up.
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 investigate perfusion features of gastric antrum cancer by 64-multidetector CT and to assess the correlation between perfusion CT parameters and immunohistochemical markers of angiogenesis in gastric cancer. Methods Perfusion CT was performed in 30 patients with gastric antrum cancer （gastric antrum cancer group） and 24 patients with normal stomach (control group), and postoperative specimens were stained using a polyclonal antibody to VEGF and CD34. The correlation between perfusion parameters and microvessel density (MVD), and VEGF were analyzed. Results Blood volume (BV) increased in the gastric antrum cancer group (Plt;0.01). There was no significant difference in perfusion (PF), peak enhancement (PE), or time to peak (TTP) between the gastric antrum cancer and the normal groups (Pgt;0.05). BV was positively significantly correlated with MVD （r=0.522, P=0.02), but no significant correlation was found between PF （r=0.072, P=0.78), PE （r=0.253, P=0.31), or TTP （r=0.235, P=0.35) and MVD. No correlation was found between PF （r=-0.208, P=0.45), PE （r=-0.251, P=0.37), TTP（r=-0.284, P=0.31), or BV（r=-0.472, P=0.09) and VEGF.Conclusion Blood volume can evaluate the angiogenesis of tumor and perfusion CT can be a tool to assess microvessel status in gastric antrum cancer.