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Stomach Cancer

Gastric cancer (cancer of the stomach) is a disease in which malignant cells arise in the tissues of the stomach. Early symptoms can include indigestion, feeling bloated after eating, mild nausea, loss of appetite, or heartburn. In more advanced stages symptoms may include blood in the stool, vomiting, weight loss, or pain in the stomach. Known risk factors include prior stomach infection by Helicobacter pylori, smoking, frequent diet of dry salted foods, Menetrier's disease, and familial polyposis. Most cancers of the stomach are adenocarcinomas of which there are many sub-types.

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Latest Research Publications

This list of publications is regularly updated (Source: PubMed).

Jung JH, Choi KD, Koh YW, et al.
Risk factors of lymph node metastasis in patients with gastric neuroendocrine tumor with normal serum gastrin level.
Hepatogastroenterology. 2015 Jan-Feb; 62(137):207-13 [PubMed] Related Publications
BACKGROUND/AIMS: Locoregional gastric carcinoids with normal serum gastrin level have been recommended radical resection regardless of tumor size or depth of invasion. However, there have been some reports which showed small sporadic gastric carcinoids could be treated with local resection. The aim of this study was to elucidate risk factors of lymph node metastasis in patients with gastric carcinoids with normal serum gastrin level and determine the indications for limited resection such as endoscopic treatment.
METHODOLOGY: We performed clinicopathologic reviews of thirty gastric carcinoids with normal serum gastrin level from January 1996 to December 2010.
RESULTS: One case show distant metastasis and two cases showed lymph node metastasis at the time of diagnosis. For twenty seven cases which showed no regional lymph node or distant metastasis initially no additional lymph node or distant metastasis were diagnosed throughout the follow up period. Large tumor size (>10 mm), proper muscle infiltration, WHO classification grade 2 and lymphovascular invasion was noted risk factor of lymph node metastasis by univariate logistic regression analysis.
CONCLUSIONS: Small (≤10 mm) gastric carcinoids with normal serum gastrin level confined to submucosa can be treated with endoscopic or local resection unless lymphovascular invasion.

Kong W, Wang J, Ping X, et al.
Biomarkers for assessing mucosal barrier dysfunction induced by chemotherapy: Identifying a rapid and simple biomarker.
Clin Lab. 2015; 61(3-4):371-8 [PubMed] Related Publications
BACKGROUND: Chemotherapy-induced mucosal barrier dysfunction is of clinical interest. However, the assessment of mucosal barrier dysfunction still poses challenges. In this study, we compared several biomarkers with the dual sugar gut permeability test for assessing mucosal barrier dysfunction during chemotherapy.
METHODS: Forty-two patients with gastric or colorectal cancer underwent chemotherapy, including FAM or FOLFOX4 regimens. Patients were asked to grade and record their symptoms of gastrointestinal toxicity daily. The urinary lactulose-mannitol ratio was measured to assess the intestinal permeability. Plasma levels of citrulline, diamine oxidase (DAO), D-lactic acid, and endotoxin were also measured. Intestinal permeability was observed in the subgroup of patients with diarrhea or constipation.
RESULTS: The urinary lactulose-mannitol ratio and plasma citrulline levels increased on the third and sixth post-chemotherapy days, respectively. There were no significant differences in the plasma levels of D-lactic acid, endotoxin or DAO activity compared to their levels before chemotherapy. The urinary lactulose-mannitol ratio in diarrhea patients was significantly higher than in constipation patients.
CONCLUSIONS: These results indicate that the urinary lactulose-mannitol ratio and plasma citrulline level are appropriate biomarkers for assessing mucosal barrier dysfunction in patients receiving chemotherapy. Mucosal barrier dysfunction in diarrhea patients was greater than in constipation patients.

Tokuhara T, Nakata E, Tenjo T, et al.
A new option for intracorporeal circular-stapled esophagojejunostomy in laparoscopic total gastrectomy: Roux-en-Y reconstruction with its efferent loop located at the left side of the patient to prevent twisting of the esophagojejunostomy.
Hepatogastroenterology. 2015 Mar-Apr; 62(138):551-4 [PubMed] Related Publications
BACKGROUND/AIMS: Laparoscopic total gastrectomy (LTG) has not gained widespread acceptance because of the difficult reconstruction technique, especially for esophagojejunostomy. Although various modified procedures using a circular stapler for esophagojejunostomy have been reported, an optimal technique has not yet been established. In addition, in intracorporeal techniques, twisting of the esophagojejunostomy, which might be the cause of stenosis, is often encountered because application of the shaft is restricted. To prevent twisting of the esophagoejunostomy, we underwent LTG with Roux-en-Y reconstruction with its efferent loop located at the left side of the patient.
METHODOLOGY: From November 2013 to November 2014, a series of 9 patients underwent LTG with Roux-en-Y reconstruction using the transorally inserted anvil (OrVil™, Covidien, Mansfield, MA, USA), whose efferent loop was located at the left side of the patient.
RESULTS: No twisting of the esophagojejunostomy was encountered in all cases. In addition, no stenosis or leakage of the esophagojejunostomy occurred.
CONCLUSIONS: This reconstruction system may be a feasible surgical procedure in LTG.

Yoshii M, Tanaka H, Ohira M, et al.
Regulation of neutrophil infiltration into peritoneal cavity by laparoscopic gastrectomy.
Hepatogastroenterology. 2015 Mar-Apr; 62(138):546-50 [PubMed] Related Publications
BACKGROUND/AIMS: Laparoscopic surgery is a minimally invasive operation developed for treating gastrointestinal malignancies. We aimed to characterize the differences in the intra-abdominal environment following open and laparoscopic surgeries.
METHODOLOGY: We investigated data of 48 patients who underwent gastrectomy between 2010 and 2012. We analyzed the mRNA expression of chemokines, indoleamine 2, 3-dioxygenase (IDO), and so on in peritoneal lavage fluid with real-time RT-PCR. We also determined the leukocyte population and calculated the granulocyte/lymphocyte (G/L) ratio in peritoneal lavage fluid using flow cytometry.
RESULTS: CCL3 mRNA was significantly upregulated, whereas IDO mRNA was significantly downregulated, in the open group compared to the laparoscopic surgery group. Flow cytometry revealed that the G/L ratio was significantly higher in the open group.
CONCLUSIONS: We suggest that the production of chemokines and neutrophil infiltration into the abdominal cavity may be suppressed in the laparoscopic surgery. Thus, laparoscopic surgery may be beneficial in preserving local immunity.

Ikeo K, Oshima T, Shan J, et al.
Junctional adhesion molecule-A promotes proliferation and inhibits apoptosis of gastric cancer.
Hepatogastroenterology. 2015 Mar-Apr; 62(138):540-5 [PubMed] Related Publications
BACKGROUND/AIMS: Junctional adhesion molecules (JAMs) are known as integral constituents of cellular tight junctions. However, the functions of JAMs in cancer tissues are controversial and the function of JAM-A in gastric cancer is unclear. Acordingly, we investigated the function of JAM-A in gastric epithelial and gastric cancer cell proliferation, invasion and apoptosis.
METHODOLOGY: A normal rat gastric mucosa-derived cell line (RGM1), a rat gastric cancer-like cell line established from RGM1 (RGK1), and a human gastric cancer cell line (NCI-N87) were used in this study. To examine the expression of junctional proteins, immunoblotting and immunofluorescent staining were performed with specific antibodies (JAM-A, claudins, occludin and ZO-1). JAM-A was knocked down by small interfering RNA.
RESULTS: RGM1 and RGK1 expressed JAM-A, occludin and ZO-1 but not claudins. RGK1 were significantly more invasive than RGM1. JAM-A knock-down significantly decreased the proliferation and the invasion of RGK1 but not of RGM1. JAM-A knock-down significantly decreased the proliferation of NCI-N87 cells and significantly decreased expression of the anti-apoptotic protein Bcl-xL but not the expression of AKT or Mcl-1.
CONCLUSIONS: JAM-A promotes proliferation and inhibits apoptosis of gastric cancer, suggesting that it has a pivotal role in gastric cancer progression.

Nomura E, Lee SW, Kawai M, et al.
Comparison between early enteral feeding with a transnasal tube and parenteral nutrition after total gastrectomy for gastric cancer.
Hepatogastroenterology. 2015 Mar-Apr; 62(138):536-9 [PubMed] Related Publications
BACKGROUND/AIMS: This retrospective study evaluated 21 patients with early enteral feeding (EEF group) and 22 patients without early enteral feeding (non-EEF group) who underwent open total gastrectomy followed by Roux en Y reconstruction and were RO resectable cases. METHDOLOGY: Postoperative complications and course, postoperative/preoperative body weight, whole meal intake, and nutritional, inflammatory, and immunological parameters were recorded and evaluated in both groups.
RESULTS: Postoperative meal intake was significantly higher and the first day of defecation was significantly earlier in the EEF group than in the non-EEF group. There were no significant differences between the 2 groups in the blood laboratory data and the rate of complications. In patients with complications, lymphocyte counts and postoperative body weights were compared as indicators of immunostimulation. The lymphocyte counts 7 days after operation and postoperative/preoperative body weight were significantly higher in the EEF group than in the non-EEF group.
CONCLUSIONS: Although immunostimulation-like findings were observed in the patients with complications after surgery in the present study, the significance of EEF was not clarified because of the lack of cases whose conditions were severe. EEF should be used especially for patients in whom severe disease is possible and avoidance of TPN is desirable.

Jian T, Chen Y
Regulatory mechanisms of transcription factors and target genes on gastric cancer by bioinformatics method.
Hepatogastroenterology. 2015 Mar-Apr; 62(138):524-8 [PubMed] Related Publications
BACKGROUND/AIMS: Gastric cancer is one of the most lethal diseases and has caused a global health problem. We aimed to elucidate the major mechanisms involved in the gastric cancer progression.
METHODOLOGY: The expression profile GSE13911 was downloaded from GEO database, composing of 31 normal and 38 tumor samples. The transcription factor (TF)--target gene regulatory network and protein-protein interaction (PPI) network related to gastric cancer were obtained from TRED and TRANSFAC databases. After combining the two networks, we constructed an integrated network.
RESULTS: In total, 5255 DEGs in tumor samples were identified, which were mainly enriched in 12 pathways including cell cycle. The integrated network of TF--target gene--protein interaction included 7 genes related to cell cycle, in which E2F1 was predicted to mediate the expression of MCM4, MCM5 and CDC6 through regulating the expression of its target gene MCM3.
CONCLUSION: In gastric cancer progression, E2F1 may play vital roles in the involvement of cell cycle pathway through regulating its target gene MCM3, which might interact with MCM4, MCM5 and MCM7. Besides, STAT1 was another potentially critical transcription factor which could regulate multiple target genes.

Jiang ZW, Zhang S, Wang G, et al.
Single-incision laparoscopic distal gastrectomy for early gastric cancer through a homemade single port access device.
Hepatogastroenterology. 2015 Mar-Apr; 62(138):518-23 [PubMed] Related Publications
BACKGROUND/AIMS: We presented a series of single-incision laparoscopic distal gastrectomies for early gastric cancer patients through a type of homemade single port access device and some other conventional laparoscopic instruments.
METHODOLOGY: A single-incision laparoscopic distal gastrectomy with D1 + α lymph node dissection was performed on a 46 years old male patient who had an early gastric cancer.
RESULTS: This single port access device has facilitated the conventional laparoscopic instruments to accomplish the surgery and we made in only 6 minutes. Total operating time for this surgery was 240 minutes. During the operation, there were about 100 milliliters of blood loss, and 17 lymph-nodes were retrieved.
CONCLUSION: This homemade single port access device shows its superiority in economy and convenience for complex single-incision surgeries. Single-incision laparoscopic distal gastrectomy for early gastric cancer can be conducted by experienced laparoscopic surgeons. Fully take advantage of both SILS and fast track surgery plan can bring to successful surgeries with minimal postoperative pain, quicker mobilization, early recovery of intestinal function, and better cosmesis effect for the patients.

Han JS, Jang JS, Ryu HC, et al.
Risk factors associated with multiple and missed gastric neoplastic lesions after endoscopic resection: prospective study at a single institution in south Korea.
Hepatogastroenterology. 2015 Mar-Apr; 62(138):512-7 [PubMed] Related Publications
BACKGROUND/AIMS: Only a small part of visible gas tric mucosal lesion can be removed by endoscopic resection. This study is aimed to identify incidence rate and associated risk factors of multiple and missed gastric lesions, and proper timing of follow-up en doscopy.
METHODOLOGY: Endoscopic surveillance was performed on 1 week, and 1, 6, 12 months af ter endoscopic resection. All multiple gastric lesions were divided into main and accessory lesions. The accessory lesions were subdivided into detected and missed lesions.
RESULTS: Totally, 250 lesions of 215 patients were analyzed. There were 81 early gastric cancers, 50 high grade dysplasias and 119 low grade dysplasias. Thirty patients (14%) had multiple gastric neoplastic lesions, either adenoma or cancer, within 1 year follow-up after endoscopic resection. Old age, male gender and severe intestinal metaplasia were independent risk factors of multiple gastric lesions. Small size (≤ 1 cm) and flat morphology were major risk factors of missed lesion. Among 10 missed lesions, 9 (90%) could be detected within 6 month after resection.
CONCLUSIONS: Old age, male gender, severe intestinal metaplasia were risk factors for multiple gastric lesions after endoscopic resection. Follow-up endoscopy is needed at least one time within six months after resection, with careful inspection of entire stomach.

Li X, Liu Y, Cao B, et al.
Metastatic lymph node ratio and prognosis of gastric cancer at different pT stages.
Hepatogastroenterology. 2015 Mar-Apr; 62(138):507-11 [PubMed] Related Publications
BACKGROUND/AIMS: This study aimed to investigate the role of metastatic lymph node ratio (MLR) in the evaluation of prognosis of patients with gastric cancer at different T stages.
METHODOLOGY: Clinical information was reviewed retrospectively in a total 535 patients who underwent surgery for gastric cancer. The prognostic value of MLR was compared with that of pN determined according to the UICC/AJCC guidelines (7th Edition), and the characteristics and advantages of MLR were analyzed. Moreover, the role of MLR in the evaluation of prognosis of patients with gastric cancer at different pT stages was investigated.
RESULTS: Univariate Kaplan-Meier method was used for the analysis of survival, and the results showed that MLR was closely associated with the prognosis of these patients. Multivariate analysis with Cox proportional hazards regression model showed that MLR was a major independent risk factor in the prognosis of gastric cancer patients. The area under the ROC curve of MLR in predicting the death of gastric cancer patients within 5 years after surgery was not associated with pN stage. MLR was effective in predicting the prognosis of patients with stage pT2 or pT3 gastric cancer (P < 0.05).
CONCLUSIONS: MLR is an independent risk factor in the prognosis of gastric cancer. MLR has a prognostic ability comparable to that of pN stage in gastric cancer. Thus, it is more reliable than pN in the evaluation of prognosis of gastric cancer patients, especially those with stage pT2-pT3 gastric cancer.

Zhu H, Zheng Z, Zhang J, et al.
Effects of AGBL2 on cell proliferation and chemotherapy resistance of gastric cancer.
Hepatogastroenterology. 2015 Mar-Apr; 62(138):497-502 [PubMed] Related Publications
BACKGROUND/AIMS: The present study aimed to investigate the expression status of AGBL2 and its inhibitor latexin, and elucidate their clinical implications in gastric cancer.
METHODOLOGY: AGBL2 expression status was examined in gastric cancer cells and 256 gastric cancer specimens by immunohistochemistry staining. The relationship between AGBL2 protein expression and clinicopathological parameters and prognosis was subsequently determined.
RESULTS: AGBL2 expression was determined to be related to pathological tumor and nodal stages by Spearman's regression correlation analysis. The Cox regression test identified AGBL2 protein expression as an independent prognostic factor. AGBL2 and latexin were- found to be related to proliferation and chemotherapy resistance. The 2 proteins also formed immune com- plexes in immunoprecipitation experiments.
CONCLUSIONS: Our results demonstrate that AGBL2 interacts with latexin, regulating the tubulin tyrosination cycle. It is therefore a potential target for intervention.

Jiang ZW, Liu J, Wang G, et al.
Esophagojejunostomy reconstruction using a robot-sewing technique during totally robotic total gastrectomy for gastric cancer.
Hepatogastroenterology. 2015 Mar-Apr; 62(138):323-6 [PubMed] Related Publications
BACKGROUND/AIMS: The aim of this study was to report on the feasibility of esophagojejunostomy reconstruction using a robot-sewing technique during a completely robotic total gastrectomy for gastric cancer.
METHODOLOGY: Between May 2011 and July 2012, 65 patients in whom gastric adenocarcinoma was diagnosed underwent a completely robotic total gastrectomy, including a robot-sewing esophagojejunal anastomosis. We demonstrated the surgical techniques with analysis of clinicopathologic data and short-term surgical outcomes.
RESULTS: All robotic surgeries were successfully performed without conversion. Among the 65 patients, 46 were men and 19 were women. The mean age (± SD) was 57.8 ± 6.5 y. The mean total operative time (± SD), EJ anastomosis time (± SD), and blood loss (± SD) were 245 ± 53 min, 45 ± 26 min, and 75 ± 50 ml, respectively. The mean (± SD) post-operative hospital stay was 5.4 ± 2.5 d. One patient was readmitted for an intestinal obstruction and underwent re-operation 14 d post-operatively; he recovered uneventfully and was discharged 10 d post- operatively. During the follow-up, no patients developed an esophgojejunostomy stricture.
CONCLUSIONS: A robot-sewing anastomosis for esophagojejunostomy reconstruction during robotic total gastrectomy for gastric cancer is feasible. Indeed, a robot-sewing anastomosis for esophagojejunostomy reconstruction may become a standard surgical technique during completely robotic total gastrectomy for gastric cancer.

Mocellin S, Pasquali S
Diagnostic accuracy of endoscopic ultrasonography (EUS) for the preoperative locoregional staging of primary gastric cancer.
Cochrane Database Syst Rev. 2015; 2:CD009944 [PubMed] Related Publications
BACKGROUND: Endoscopic ultrasound (EUS) is proposed as an accurate diagnostic device for the locoregional staging of gastric cancer, which is crucial to developing a correct therapeutic strategy and ultimately to providing patients with the best chance of cure. However, despite a number of studies addressing this issue, there is no consensus on the role of EUS in routine clinical practice.
OBJECTIVES: To provide both a comprehensive overview and a quantitative analysis of the published data regarding the ability of EUS to preoperatively define the locoregional disease spread (i.e., primary tumor depth (T-stage) and regional lymph node status (N-stage)) in people with primary gastric carcinoma.
SEARCH METHODS: We performed a systematic search to identify articles that examined the diagnostic accuracy of EUS (the index test) in the evaluation of primary gastric cancer depth of invasion (T-stage, according to the AJCC/UICC TNM staging system categories T1, T2, T3 and T4) and regional lymph node status (N-stage, disease-free (N0) versus metastatic (N+)) using histopathology as the reference standard. To this end, we searched the following databases: the Cochrane Library (the Cochrane Central Register of Controlled Trials (CENTRAL)), MEDLINE, EMBASE, NIHR Prospero Register, MEDION, Aggressive Research Intelligence Facility (ARIF), ClinicalTrials.gov, Current Controlled Trials MetaRegister, and World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), from 1988 to January 2015.
SELECTION CRITERIA: We included studies that met the following main inclusion criteria: 1) a minimum sample size of 10 patients with histologically-proven primary carcinoma of the stomach (target condition); 2) comparison of EUS (index test) with pathology evaluation (reference standard) in terms of primary tumor (T-stage) and regional lymph nodes (N-stage). We excluded reports with possible overlap with the selected studies.
DATA COLLECTION AND ANALYSIS: For each study, two review authors extracted a standard set of data, using a dedicated data extraction form. We assessed data quality using a standard procedure according to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria. We performed diagnostic accuracy meta-analysis using the hierarchical bivariate method.
MAIN RESULTS: We identified 66 articles (published between 1988 and 2012) that were eligible according to the inclusion criteria. We collected the data on 7747 patients with gastric cancer who were staged with EUS. Overall the quality of the included studies was good: in particular, only five studies presented a high risk of index test interpretation bias and two studies presented a high risk of selection bias.For primary tumor (T) stage, results were stratified according to the depth of invasion of the gastric wall. The meta-analysis of 50 studies (n = 4397) showed that the summary sensitivity and specificity of EUS in discriminating T1 to T2 (superficial) versus T3 to T4 (advanced) gastric carcinomas were 0.86 (95% confidence interval (CI) 0.81 to 0.90) and 0.90 (95% CI 0.87 to 0.93) respectively. For the diagnostic capacity of EUS to distinguish T1 (early gastric cancer, EGC) versus T2 (muscle-infiltrating) tumors, the meta-analysis of 46 studies (n = 2742) showed that the summary sensitivity and specificity were 0.85 (95% CI 0.78 to 0.91) and 0.90 (95% CI 0.85 to 0.93) respectively. When we addressed the capacity of EUS to distinguish between T1a (mucosal) versus T1b (submucosal) cancers the meta-analysis of 20 studies (n = 3321) showed that the summary sensitivity and specificity were 0.87 (95% CI 0.81 to 0.92) and 0.75 (95% CI 0.62 to 0.84) respectively. Finally, for the metastatic involvement of lymph nodes (N-stage), the meta-analysis of 44 studies (n = 3573) showed that the summary sensitivity and specificity were 0.83 (95% CI 0.79 to 0.87) and 0.67 (95% CI 0.61 to 0.72), respectively.Overall, as demonstrated also by the Bayesian nomograms, which enable readers to calculate post-test probabilities for any target condition prevalence, the EUS accuracy can be considered clinically useful to guide physicians in the locoregional staging of people with gastric cancer. However, it should be noted that between-study heterogeneity was not negligible: unfortunately, we could not identify any consistent source of the observed heterogeneity. Therefore, all accuracy measures reported in the present work and summarizing the available evidence should be interpreted cautiously. Moreover, we must emphasize that the analysis of positive and negative likelihood values revealed that EUS diagnostic performance cannot be considered optimal either for disease confirmation or for exclusion, especially for the ability of EUS to distinguish T1a (mucosal) versus T1b (submucosal) cancers and positive versus negative lymph node status.
AUTHORS' CONCLUSIONS: By analyzing the data from the largest series ever considered, we found that the diagnostic accuracy of EUS might be considered clinically useful to guide physicians in the locoregional staging of people with gastric carcinoma. However, the heterogeneity of the results warrants special caution, as well as further investigation for the identification of factors influencing the outcome of this diagnostic tool. Moreover, physicians should be warned that EUS performance is lower in diagnosing superficial tumors (T1a versus T1b) and lymph node status (positive versus negative). Overall, we observed large heterogeneity and its source needs to be understood before any definitive conclusion can be drawn about the use of EUS can be proposed in routine clinical settings.

Shen Z, Yu J, Lei S, et al.
Glycemic changes after gastrectomy in non-morbidly obese patients with gastric cancer and diabetes.
Hepatogastroenterology. 2015 Jan-Feb; 62(137):245-50 [PubMed] Related Publications
BACKGROUND/AIMS: To evaluate the glycemic changes after gastrectomy in non-morbidly obese patients with gastric cancer (GC) and type 2 diabetes mellitus (T2DM).
METHODOLOGY: Between December 2011 and June 2014, we included 46 patients with gastric cancer and T2DM of a body mass index (BMI) < 30 kg/m2, who underwent gastrectomy in our center. The comparisons of FPGs in specific periods were performed according to age, extent of gastrectomy, reconstruction type, preoperative triglyceride (TG) level and so on.
RESULTS: The non-morbidly obese patients experienced an improvement of glycemic control. T2DM resolution happened 3 weeks after surgery. FPG decreased significantly after postoperative day 21 compared to preoperative FPG. 32 patients experienced DM improvement after postoperative day 21. The age and relatively lower preoperative TG patients, who underwent total gastrectomy (P<0.001) or duodenal bypass reconstruction (Billroth II, Roux-en-Y gastrojejunostomy, or Roux-en-Y esophagojejunostomy, P=0.009) appeared to have a better glycemic control.
CONCLUSIONS: Our finding observed through this simulation model suggested that non-morbidly obese patients may also benefit from metabolic surgery for glycemic control, associated with age, extent of gastrectomy, reconstruction type, and preoperative triglyceride level.

Lan H, Zhu N, Lan Y, et al.
Laparoscopic gastrectomy for gastric cancer in China: an overview.
Hepatogastroenterology. 2015 Jan-Feb; 62(137):234-9 [PubMed] Related Publications
Since its introduction in China in 2000, laparoscopic gastrectomy has shown classical advantages of minimally invasive surgery over open counterpart. Like all the pioneers of the technique, Chinese gastrointestinal surgeons claim that laparoscopic gastrectomy led to faster recovery, shorter hospital stay and more rapid return to daily activities respect to open gastrectomy while offering the same functional and oncological results. There has been booming interest in laparoscopic gastrectomy since 2006 in China. The last decade has witnessed national growth in the application of laparoscopic gastrectomy and yielded a significant amount of scientific data to support its clinical merits and advantages. However, few prospective randomized controlled trials have investigated the benefits of laparoscopic gastrectomy in China. In this article, we make an overview of the current data and state of the art of laparoscopic gastrectomy for gastric cancer in China.

Qiu Z, Sun W, Zhou C, Zhang J
HER2 expression variability between primary gastric cancers and corresponding lymph node metastases.
Hepatogastroenterology. 2015 Jan-Feb; 62(137):231-3 [PubMed] Related Publications
BACKGROUND/AIMS: The efficacy of anti-HER2 therapy is mainly dependent on HER2 overexpression in the metastatic lesions. It is essential to decipher the heterogeneity of gene profiles between primary tumor and matched metastases in gastric cancer.
METHODOLOGY: The frequency of HER2 expression in 100 gastric cancers of both primary tumors and corresponding multiple lymph node metastases were determined immunohistochemically. A modified HER2-scoring criteria by Hofmann et al recommended for gastric cancer were followed in our study, which considers basolateral, so-called "U-shape", HER2-expression as positive.
RESULTS: HER2 overexpression (2+, 3+) was seen in 33.0% of primary gastric cancers and 39.4% of the corresponding metastatic lymph nodes. For the first time, we compare HER2 expression heterogeneity among different lymph node metastases in the same patient, for the cases with 2 or more metastatic lymph nodes, HER2 expression discordance among the nodes was observed in 25.3% of the cases.
CONCLUSIONS: HER2 overexpression was seen in one-third of primary gastric cancers with lymph node metastases. As the receptor expression may lose or gain in the metastases at a probability of approximately 30%, assessment of the receptor status in metastatic lesions is encouraged.

Zu H, Wang H, Li C, et al.
Clinico-pathological features and prognostic analysis of gastric cancer patients in different age groups.
Hepatogastroenterology. 2015 Jan-Feb; 62(137):225-30 [PubMed] Related Publications
BACKGROUND/AIMS: The prognostic value of age on patients with gastric cancer is not well defined. The aim of this retrospective study is to analyze the impact of age on survival in patients with gastric cancer.
METHODOLOGY: A total of 1800 patients with gastric carcinoma, who had undergone gastrectomy between 1997-2007 years were included. They were divided into six different age groups (21-30, 31-40, 41-50, 51- 60, 61-70 and 71-80 years). We reviewed patient's clinico-pathological characteristics and the prognosis with special reference to their ages.
RESULTS: Among the six age groups, the younger patients have more female-dominated patients and poorly differentiated carcinoma, whereas the older patients have a higher incidence of large tumors (≥5 cm) and more patients with stage T3. Moreover, there were more liver metastases in the older age groups. Univariate analysis showed that there were significant differences in 5-year survival rates among the six age groups. Multivariate analysis confirmed age, tumor size, pT stage, pN stage and curability were independent prognostic factors.
CONCLUSION: There are several distinctive properties related to age of patients with gastric cancer, the older patients have more aggressive features and poorer prognosis than the younger patients.

Nakamura M, Tahara T, Shiroeda H, et al.
The effect of short-term proton pump inhibitor plus anti-ulcer drug on the healing of endoscopic submucosal dissection-derived artificial ulcer: a randomized controlled trial.
Hepatogastroenterology. 2015 Jan-Feb; 62(137):219-24 [PubMed] Related Publications
BACKGROUND/AIMS: Artificial ulcers remain a major complication after Endoscopic submucosal dissection (ESD). The development of more effective treatment regimen for this ulcer is required than the use of proton pump inhibitor (PPI) alone.
METHODOLOGY: Patients with ESD-derived artificial ulcers were randomly assigned to two groups: a group of patients who received rabeprazole 20 mg daily for 8 weeks (PPI group) and a group of patients who received a combination of rebamipide 300 mg daily for 8 weeks and rabeprazole 20 mg dairy for the first 4 weeks (reb+PPI group). The area reduction ratio and healing status of ulcers were evaluated endoscopically on postoperative 7, 28 and 56 days.
RESULTS: The overall ulcer area reduction ratio was higher in the reb+PPI group than in the PPI group, especially at an early stage. The ratio of progression to the H1 stage in the reb+PPI group was significantly higher than that in the PPI group, especially at an early stage.
CONCLUSIONS: Treatment with 8 weeks of rebamipide plus the first 4 weeks of PPI demonstrated a reduction ratio of artificial ulcers superior to that with 8 weeks of PPI mono-therapy. This combination treatment is, therefore, one of the candidate treatment strategies against ESD-derived artificial ulcers.

Kikuchi S, Mieno H, Moriya H, et al.
A preliminary study on pre-operative tumor volumetry measured by three-dimensional computer tomography in gastric cancer.
Hepatogastroenterology. 2015 Jan-Feb; 62(137):214-8 [PubMed] Related Publications
BACKGROUND/AIMS: The aim of the present study was to evaluate the clinical significance of tumor volumetry measured by three-dimensional (3-D) multidetector row computed tomography (MD-CT).
METHODOLOGY: A total of 50 patients with gastric cancer who had undergone pre-operative tumor volumetry using 3D-MD-CT followed by subsequent laparotomy (11 women, 39 men; mean age 63.9 years) were examined. Tumor volume and conventional clinicopathological factors were studied and then analyzed with respect to survival.
RESULTS: Tumor volume was distributed widely and ranged from 0.16 cm3 to 363.5 cm3 with a mean of 43.6 cm3 (<10 cm3, 21 tumors; ≥10 cm3, 29 tu- mors). Significant differences in survival were found for volume (<10.0 cm3 vs. ≥10.0 cm3; p=0.0414), and depth of invasion (T1-2 vs. T3-4; p=0.0475), but not for diameter (<50 mm vs. ≥50 mm; p=0.2142), location (proximal third vs. middle or distal third; p=0.3254), macroscopic type (localized vs. invasive; p=0.3619), or microscopic type (differentiated vs. undifferentiated; p=0.1230).
CONCLUSIONS: The present findings suggest that tumor volume measured by pre-operative 3D-MD-CT offers an alternative indicator for determining the prognosis in gastric cancer.

Hu HK, Ke NW, Li A, et al.
Clinical characteristics and prognostic factors of gastroenteropancreatic neuroendocrine tumors: a single center experience in China.
Hepatogastroenterology. 2015 Jan-Feb; 62(137):178-83 [PubMed] Related Publications
BACKGROUND/AIMS: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are a unique subgroup of tumors in the digestive system but with great clinical heterogeneity. The information on clinical characteristics and prognostic factors of Chinese patients is rather limited.
METHODOLOGY: We retrospectively analyzed the clinical features, prognostic factors of this disease in a consecutive cohort (N=294) between January 2007 and December 2012.
RESULTS: Functioning tumors accounted for 9.2%. Rectum was the most predominant GEP-NETs locations. Abdominal pain occurred in 46.5% patients which was the most common initial symptom. G1, G2 and G3 tumors accounted for 41.5%, 34.7% and 23.8%, respectively. Endoscopy provided the highest detection rate of 95.7%. Consistence between endoscopic ultrasound guided fine needle aspiration biopsy (EUS-FNAB) and surgically obtained histological Ki-67 index was 36.4%. Serum CgA test showed a 80.0% consistence with the tissue biopsy. The median follow up duration was 2.8 years (0.02-5.90 years), the median survival was 4.8 years, overall 5-year survival rate was 69.6%. We found colonic localization, tumor size larger than 20 mm, G3 tumor and metastasis were associated with worse outcome (p<0.05).
CONCLUSION: We found both consistence and differences in GEP-NETs characteristics between our study and previous reports.

Kasetsermwiriya W, Nagai E, Nakata K, et al.
Surgery of upper GI gastrointestinal stromal tumors: our experience, prognostic analysis.
Hepatogastroenterology. 2015 Jan-Feb; 62(137):87-92 [PubMed] Related Publications
BACKGROUND/AIMS: To review our treatment experience of gastrointestinal stromal tumors (GISTs) of the upper gastrointestinal tract and identify the prognostic factors that influence tumor recurrence.
METHODOLOGY: Data of 46 consecutive patients with upper GI GISTs who underwent surgery from 1988 to 2011 were reviewed. The overall and disease-free survival rates and influence of clinicopathologic variables on disease-free survival rate were evaluated.
RESULTS: The median age was 64 years (range, 20-86 years). R0 resections were performed in 43 (93.5%) patients. With a median follow-up time of 33 months (1-275 months), there were 5 (10.9%) recurrences and 2 mortalities in the high-risk group. The overall survival and recurrence-free survival rates at 5 years were 92.1% and 84.6%, respectively. Male gender, tumor size of >10 cm, high numbers of mitotic figures, R1 resection, high risk according to the Joensuu criteria, and a Ki-67 index of >10% were associated with a poor prognosis.
CONCLUSIONS: Surgical resection of low- and intermediate-risk GISTs has excellent results. High counts of mitotic figures, male gender, incomplete resection, large tumor size, and a high Ki-67 index are associated with a poor prognosis.

Ren X, Zhao Z, Huang W, et al.
Analysis of the characteristics and factors influencing lymph node metastasis in thoracic esophageal carcinoma and cancer of the gastric cardia.
Hepatogastroenterology. 2015 Jan-Feb; 62(137):73-6 [PubMed] Related Publications
BACKGROUND/AIMS: To analyze the metastatic characteristics of lymph nodes in thoracic esophageal carcinoma and cancer of the gastric cardia, and to explore the factors influencing lymph node metastasis.
METHODOLOGY: A retrospective analysis of the treatment of 37 patients who received surgical treatment for thoracic esophageal and gastric cardia cancers from January 2010 to January 2012 was carried out,
RESULTS: Lymph node metastasis in patients with thoracic esophageal carcinoma was frequently found on the superior mediastinum, hilum of the lung, and inferior extremity of the carina. Metastasis in patients with cancer of the gastric cardia occurred mainly in the abdominal cavity and peripheral gastric cardia. A single factor analysis showed that a tumor infiltrating full-thickness, > 5 cm in length, and with a low degree of cell differentiation affected lymph node metastasis (P < 0.05). The degree of differentiation, length, and infiltrating depth of the tumor were independent factors affecting lymph node metastasis (P < 0.05).
CONCLUSIONS: Lymph node metastasis in patients with cancers of the esophagus and gastric cardia exhibits special characteristics. The cleaning scope should be assessed according to the actual situation, including the degree of tumor differentiation, lesion length, and infiltration depth.

Wu FL, Lu DC, Ying YP, et al.
A Meta-analysis Reveals S-1-based Chemotherapy Improves the Survival of Patients With Advanced Gastric Cancer.
Medicine (Baltimore). 2015; 94(16):e652 [PubMed] Related Publications
The aim of this study was to compare the efficacy and safety of S-1-based therapy versus non-S-1-based therapy in advanced gastric cancer (AGC) patients.Eligible studies stratifying objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and adverse events (AEs) in AGC patients were identified from Embase, Pubmed, Cochrane Library, and China National Knowledge Infrastructure databases. The STATA package (version 11.0) was used to pool the data from the eligible studies.Fifteen studies with 2973 AGC cases, of which 1497 (50.4%) received S-1-based therapy and 1476 (49.6%) received non-S-1-based therapy, were identified in the meta-analysis. AGC patients who had received S-1-based therapy had a higher median OS, median PFS, and ORR than those who had received 5-fluorouracil (FU)-based therapy (OS: hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.80-0.98, P = 0.015; PFS: HR 0.88, 95% CI 0.80-0.98, P = 0.016; ORR: OR 1.25, 95% CI 1.08-1.45, P = 0.003, respectively). S-1-based therapy had similar efficacy to capecitabine-based therapy in terms of median OS (HR 1.14, 95% CI 0.91-1.41, P = 0.253), median PFS (HR 1.01, 95% CI 0.82-1.25, P = 0.927), and ORR (OR 0.84, 95% CI 0.63-1.12, P = 0.226). Subgroup analysis for grade 3 to 4 toxicity showed higher incidence of neutropenia (relative risk [RR] = 0.827, P = 0.006), nausea (RR = 0.808, P = 0.040), and lower diarrhea (RR = 1.716, P = 0.012) in 5-FU-based arm, and higher diarrhea (RR = 0.386, P = 0.007) in capecitabine-based arm.S-1-based chemotherapy is favorable to AGC patients with better clinical benefit than 5-FU-based chemotherapy and with equivalent antitumor compare with capecitabine-based therapy.

Wang F, Li XW, Lu WB, Jin JH
J Biol Regul Homeost Agents. 2015 Jan-Mar; 29(1):181-6 [PubMed] Related Publications
βig-h3 is an extracellular matrix protein induced by transforming growth factor-β1 (TGF-β1) and involved in adhesion between cell and cell, cell and matrix. It has been proved that βig-h3 is highly expressed in human lung cancer and colorectal cancer cells, and thus it is considered to have the same effect on gastric cancer cells. This research applied histochemical staining and RT-PCR to detect the content of βig-h3 in peritoneal mesothelial cells and the content of carcino embryonic antigen (CEA) mRNA in abdominal dropsy or peritoneal washing liquid, in order to explore the relationship between the factors of peritoneal metastasis of gastric cancer and βig-h3. It was found that the positive ratio of βig-h3 in the gastric cancer group was higher than that in the benign disease group, and the positive rate of immunohistochemistry was closely related to the relative factors of peritoneal metastasis such as tumor infiltration depth, serosal types, macroscopic peritoneal metastasis, CEA mRNA, results of pleural lavage cytology (PLC) examination, etc. Research found that βig-h3 expressed distinctly in gastric cancer peritoneal metastasis, therefore, it is useful for monitoring biological behavior of gastric cancer.

Wang EY, Wang Y, Qian ZH, et al.
Probing head-to-toe deformation law assessment for abdominal tumor through respiratory movement simulation and CTVision radiation research.
J Biol Regul Homeost Agents. 2015 Jan-Mar; 29(1):19-25 [PubMed] Related Publications
This paper aims to explore head-to-toe deformation law for abdominal tumor with CTVision and selfdesigned respiratory movement simulation mold and meanwhile verify the accuracy and correctness of the treatment. In experimental group, a self-designed respiratory movement mold was used. The image was scanned out by CT scanning based on the movement state and then sent to the planning system to compare the location variation of tumor and formulating the treatment plan accordingly, followed by verification and verified derivation values observation. A total of 21 cases of abdominal tumor were included in the case group. Their breathing movement was detected under a simulated locator and then the data was recorded. The image was scanned and sent to the planning system to compare the location variation of the tumor, the patients then underwent 3D conformal therapy (3D-CRT) and we performed verification and observed verified derivation values. Finally, the results of the case group and the experimental group were compared. The mean of the verified derivation values was smaller than respiratory motion values in experimental group (t=-10.78, P=0, P < 0.05); the mean of verified derivation values of the patients was smaller than respiratory motion values in group f, g, h, i, j, l, n, o, p, q, r, s t, u in the case group (P < 0.05); no remarkable difference was found between the two values in group a, b, c, k and m (P < 0.05); group e was unable to undergo the statistical test since its standard deviation was 0; the mean of the verified derivation values was higher than respiratory motion values in group d (P < 0.05). In conclusion, radiation therapy applied with CTVision proved to be accurate and convincing in the treatment of abdominal tumor.

Zhang S, Lee DS, Morrissey R, et al.
Early or late antibiotic intervention prevents Helicobacter pylori-induced gastric cancer in a mouse model.
Cancer Lett. 2015; 359(2):345-51 [PubMed] Related Publications
H. pylori infection causes gastritis, peptic ulcers and gastric cancer. Eradicating H. pylori prevents ulcers, but to what extent this prevents cancer remains unknown, especially if given after intestinal metaplasia has developed. H. pylori infected wild-type (WT) mice do not develop cancer, but mice lacking the tumor suppressor p27 do so, thus providing an experimental model of H. pylori-induced cancer. We infected p27-deficient mice with H. pylori strain SS1 at 6-8 weeks of age. Persistently H. pylori-infected WT C57BL/6 mice served as controls. Mice in the eradication arms received antimicrobial therapy (omeprazole, metronidazole and clarithromycin) either "early" (at 15 weeks post infection, WPI) or "late" at 45 WPI. At 70 WPI, mice were euthanized for H. pylori determination, histopathology and cytokine/chemokine expression. Persistently infected mice developed premalignant lesions including high-grade dysplasia, whereas those given antibiotics did not. Histologic activity scores in the eradication groups were similar to each other, and were significantly decreased compared with controls for inflammation, epithelial defects, hyperplasia, metaplasia, atrophy and dysplasia. IP-10 and MIG levels in groups that received antibiotics were significantly lower than controls. There were no significant differences in expression of IFN-γ, TNF-α, IL-1β, RANTES, MCP-1, MIP-1α or MIP-1β among the three groups. Thus, H. pylori eradication given either early or late after infection significantly attenuated gastric inflammation, gastric atrophy, hyperplasia, and dysplasia in the p27-deficient mice model of H. pylori-induced gastric cancer, irrespective of the timing of antibiotic administration. This was associated with reduced expression of IP-10 and MIG.

Alkan A, Mızrak D, Utkan G
Lower folate levels in gastric cancer: is it a cause or a result?
World J Gastroenterol. 2015; 21(13):4101-2 [PubMed] Free Access to Full Article Related Publications
Folate deficiency and its association with cancer have been studied in the literature, but its clinical impact is still unknown. Folate deficiency and its result on gastric cancer is a mysterious part of oncology, with ongoing studies hopefully clarifying its impact on gastric cancer management. Lee et al studied folate deficiency and its impact on staging and clinical results. Here we try to contribute to the field by expressing our own thoughts about the paper.

Giorlandino A, Caltabiano R, Gurrera A, Lanzafame S
Gastrointestinal stromal tumour of the stomach with osseous differentiation: a case report.
Pathologica. 2014; 106(4):345-7 [PubMed] Related Publications
Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal neoplasm of the gastrointestinal tract, while osseous metaplasia of this tumour is an unexpected event. To date, no cases have been reported in the literature. Herein, we report a case of a 60-year-old man affected by a GIST with benign osseous metaplasia and mature bone formation. We also discuss the pathogenesis of intratumoural ossification and review the relevant literature. The prognostic significance of ossification in GIST remains unclear because of the limited cases reported.

Selby LV, Vertosick EA, Sjoberg DD, et al.
Morbidity after Total Gastrectomy: Analysis of 238 Patients.
J Am Coll Surg. 2015; 220(5):863-871.e2 [PubMed] Related Publications
BACKGROUND: Surgical quality improvement requires well-defined benchmarks and accurate reporting of postoperative adverse events, which have not been well defined for total gastrectomy.
STUDY DESIGN: Detailed postoperative outcomes on 238 patients who underwent total gastrectomy with curative intent, from 2003 to 2012, were reviewed by a dedicated surgeon chart reviewer to establish 90-day patterns of adverse events.
RESULTS: Of the 238 patients with stage I to III gastric adenocarcinoma who underwent curative-intent total gastrectomy, the median age was 66 years, and 68% were male. Median body mass index was 28 kg/m(2), and 68% of patients had at least 1 medical comorbidity. Forty-three percent of our patients received neoadjuvant chemotherapy, and 34% received postoperative adjuvant chemotherapy. Over the 90-day study period, 30-day mortality was 2.5% (6 of 238), and 90-day mortality was 2.9% (7 of 238). At least 1 postoperative adverse event was documented in 62% of patients, with 28% of patients experiencing a major adverse event requiring invasive intervention. The readmission rate was 20%. Anemia was the most common adverse event (20%), followed by wound complications (18%). The most common major adverse event was esophageal anastomotic leak, which required invasive intervention in 10% of patients.
CONCLUSIONS: This analysis has defined comprehensive 90-day patterns in postoperative adverse events after total gastrectomy with curative intent in a Western population. This benchmark allows surgeons to measure, compare, and improve outcomes and informed consent for this surgical procedure.

Zhang Y, Li B, Cai L, et al.
Gastric Schwannoma mimicking malignant gastrointestinal stromal tumor and misdiagnosed by (18)F-FDG PET/CT.
Hell J Nucl Med. 2015 Jan-Apr; 18(1):74-6 [PubMed] Related Publications
Gastric Schwannoma is a rare benign mesenchymal tumor that accounts for only 0.2% of all gastric tumors. The current study presents a case of gastric Schwannoma misdiagnosed as malignant gastrointestinal stromal tumor (GIST) by esophagogastroduodenoscopy, endoscopic ultrasonography, and contrast-enhanced or not enhanced and (18)F-FDG PET/CT imaging.

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