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H Katai

Publications and source records attributed to H Katai.

At least 19 recordsLinked to original sources
PubMed2007

Cancer of the gastric stump following distal gastrectomy for cancer.

BACKGROUND: Cancer of the gastric stump (CGS) after distal gastrectomy for cancer has not been characterized in a large study. The aim of this study was to investigate the clinicopathological features and outcome of CGS following distal gastrectomy for cancer. METHODS: Patients with CGS following distal gastrectomy for gastric cancer diagnosed between 1970 and 2002 were reviewed retrospectively. RESULTS: A total of 108 patients was identified. The median interval between the initial gastrectomy and resection for CGS was 7.5 (range 1-41) years. The depth of tumour invasion was T1 in 67 patients, T2 in 16, T3 in eight and T4 in 17 patients. Endoscopic mucosal resection was performed in 25 patients with T1 tumours. R0 resection was achieved in 103 patients. The overall 5-year survival rate was 53.1 per cent. The 5-year survival rates for patients with T1, T2, T3 and T4 disease were 76, 40, 13 and 9 per cent respectively. CONCLUSION: The outcome for patients with non-early CGS was poor. Early detection of CGS is important following distal gastrectomy for gastric cancer and strict surveillance is recommended for at least 10 years after the initial gastrectomy.

Adult↗
PubMed2006

Extranodal metastasis is an indicator of poor prognosis in patients with gastric carcinoma.

BACKGROUND: The aim of this study was to determine the clinical significance and prognostic impact of extranodal metastasis (EM) in gastric carcinoma. METHODS: The study included 1023 patients who underwent gastrectomy with lymphadenectomy for primary gastric carcinoma between January 1993 and December 1996. EM was defined as the presence of tumour cells in extramural soft tissue that was discontinuous with either the primary lesion or locoregional lymph nodes. RESULTS: EM was detected in 146 (14.3 per cent) of the 1023 patients and in 1060 (3.0 per cent) of the 35 811 nodules that were retrieved as 'lymph nodes' from adipose connective tissues. The incidence of EM was significantly higher in patients with tumours that were large (diameter 10 cm or more), infiltrative, deeply invading or undifferentiated and in those with lymph node, peritoneal or liver metastases, or lymphatic or vascular involvement. After curative operation overall survival was significantly worse for patients with EM than those without (P < 0.001). Multivariate analysis identified EM as an independent prognostic factor (hazard ratio 1.82 (95 per cent confidence interval 1.23 to 2.71); P = 0.003). CONCLUSION: EM is an independent prognostic factor and should therefore be included in the tumour node metastasis (TNM) staging system.

Aged↗
PubMed2003

Prospective study of proximal gastrectomy for early gastric cancer in the upper third of the stomach.

BACKGROUND: Total gastrectomy with D2 dissection is the standard treatment in Japan for early upper-third gastric cancer. The purpose of this study was to confirm the safety and radicality of proximal gastrectomy as an alternative operation. METHODS: Between 1993 and 1999, 45 patients with an apparent primary early gastric cancer in the upper third of the stomach were treated by proximal gastrectomy with jejunal interposition. The spleen was preserved, but the suprapancreatic nodes were cleared. RESULTS: Histology confirmed early gastric cancer in 37 patients while eight had advanced disease. Nodal metastasis was observed in six patients. There was no hospital death and no early postoperative complications. One patient died from nodal recurrence and two from unrelated causes. Two patients had reflux symptoms without endoscopic oesophagitis. Mean weight loss was 11.5 per cent of initial bodyweight. CONCLUSION: Proximal gastrectomy for early upper-third gastric cancer can be performed safely with an excellent cure rate. This procedure deserves further clinical evaluation to assess patients' quality of life.

Adult↗
PubMed2001

Immunohistochemically detected micrometastases of the lymph nodes in patients with gastric carcinoma.

BACKGROUND: Lymph node status is a major determinant of disease recurrence after patients undergo curative resection for gastric carcinoma. A proportion of patients without lymph node metastasis develop systemic recurrences. Recent studies in a range of solid tumors have found a high incidence of micrometastases in the regional lymph nodes of patients with apparently negative lymph nodes. In patients with breast and colorectal carcinoma, the presence of micrometastases has been associated with a poorer prognosis. In patients with gastric carcinoma, the significance of micrometastases in lymph nodes remains controversial. Most published reports on this subject suffer from the problems of small sample size and selection bias. METHODS: One hundred seven patients with pathologic T2N0M0 (tumor invades muscularis propria or subserosa [T2], no regional lymph node metastasis [N0], and no distant metastasis [M0]; pT2N0M0) gastric carcinoma who underwent gastric resection between 1984 and 1990 at the National Cancer Center Hospital were studied. Two consecutive sections were newly prepared from each lymph node for hematoxylin and eosin staining and immunohistochemical staining (IHC) with antibody against cytokeratin. Associations between clinicopathologic factors and the presence of micrometastases as well as micrometastases and survival were sought. RESULTS: Micrometastases were identified in 38 of 107 patients (35.5%) and in 87 of 4484 lymph nodes (1.94%) by IHC. The incidence of micrometastases was significantly higher in patients with infiltrative tumors than in patients with expansive, growing tumors (P = 0.02). Other clinicopathologic findings had no statistically significant correlation with the incidence of micrometastases. The 5-year survival rates of patients with and without micrometastases were 94% and 89%, respectively. Similarly, the 10-year survival rates were 79% and 74%, respectively. The survival curves of patients with or without micrometastasis were nearly superimposed (P = 0.86). CONCLUSIONS: The presence of immunohistochemically detected micrometastases in the regional lymph nodes did not affect the survival of Japanese patients with pT2N0M0 gastric carcinoma who had undergone gastrectomy with D2 lymph node dissection.

Adult↗
PubMed2001

Evaluation of the necessity for gastrectomy with lymph node dissection for patients with submucosal invasive gastric cancer.

BACKGROUND: When cancer cells are found in the submucosal layer of an endoscopically resected specimen, patients are recommended to undergo gastrectomy with lymph node dissection. If it were possible to identify those patients in whom the risk of lymph node metastasis was negligible, it might be possible to avoid surgery. METHODS: Among those who underwent gastrectomy for gastric cancer from 1980 to 1999, 1091 patients with a cancer invading the submucosa were studied. Clinicopathological factors (sex, age, tumour location, macroscopic type, size, ulceration, histological type, lymphatic-vascular involvement and degree of submucosal penetration) were investigated for their possible association with lymph node metastasis. RESULTS: Lymph node metastases were found in 222 patients (20.3 per cent). Univariate analysis showed that larger tumour size (more than 30 mm), undifferentiated histological type, lymphatic-vascular involvement and massive submucosal penetration had a significant association with lymph node metastasis. Tumour size, histological type and lymphatic-vascular involvement were independent risk factors for lymph node metastasis. By combining these three factors with submucosal penetration of less than 500 microm, 117 patients could be selected as having a minimal risk of lymph node metastasis (95 per cent confidence interval 0-3.1 per cent). CONCLUSION: Lymphadenectomy may not be necessary for patients with gastric cancer invading the submucosa who fulfil the above conditions

Female↗
PubMed2001

Node-positive mucosal gastric cancer: a follow-up study.

BACKGROUND: Lymph node metastasis from mucosal gastric carcinoma is rare and the prognosis of the patients has seldom been reported. METHODS: Forty-five patients with node-positive mucosal gastric cancer were studied. They accounted for 2.5% of 1770 patients with mucosal gastric cancer who underwent gastrectomy with lymphadenectomy at the National Cancer Center Hospital, Tokyo. The clinicopathological features were studied and the current clinical status was sought. RESULTS: The majority of patients (87%) were treated with D2 lymphadenectomy. The metastasis was confined to the perigastric nodes (pN1 by Japanese classification) in 30 patients (67%). The number of positive nodes was less than seven (pN1 by TNM) in 42 patients (93%). Two patients had para-aortic nodal metastasis. The median follow-up period was 11 years. Four patients died of definite or possible recurrent disease and the disease-specific 5- and 10-year survival rates were 95 and 89%, respectively. CONCLUSIONS: Although nodal metastasis is an important prognostic factor for gastric cancer, the prognosis was excellent as long as the primary tumor was confined to the mucosa and was treated with gastrectomy and lymphadenectomy.

Adenocarcinoma↗
PubMed2001

[Problems of international standardization of gastric cancer surgery].

Treatment results of gastric cancer patients differ considerably between Japan and the West, even at the same stage of disease. This may be partly explained by the varying extent of local control and the "stage-migration" theory. There is an important conceptual difference concerning lymphadenopathy and lymphadenectomy: Japanese surgeons believe that lymph nodes are the governors of metastatic disease and thus that lymphadenectomy will result in cure, while in the West lymph nodes are seen merely as the indicators of systemic metastasis and thus lymphadenectomy serves only for staging. The UICC TNM system has recently abandoned the anatomical N-classification and adopted the numeric N-classification. Although this is a good prognostic indicator, it does not provide surgeons with any information for surgical decision-making. Japanese surgeons will continue to use the Japanese classification that has served as a guideline for standard D2 lymphadenectomy. To establish an international standard for gastric cancer treatment, both sides should make efforts to understand each other and discuss most practical and beneficial treatment modalities for patients in the respective medical environments.

Gastrectomy↗
PubMed2000

Evaluation of the New International Union Against Cancer TNM staging for gastric carcinoma.

BACKGROUND: The lymph node (N) classification in the International Union Against Cancer (UICC) TNM staging system for gastric adenocarcinoma has been revised. The new classification is based on the number of positive regional lymph nodes instead of the anatomic location of the regional lymph node metastasis. Both classification systems were compared for prognostic significance. METHODS: A total of 4362 gastric carcinoma patients who underwent resection between 1969 and 1990 were analyzed. RESULTS: Thirteen percent of patients could not be staged according to the new system. Based on the previous classification, 647 patients were classified as pN1 and 711 patients as pN2. When reclassified, 587 patients remained pN1, 54 patients became pN2, and 6 patients became pN3. Of the 711 pN2 patients, 333 became pN1, 267 remained pN2, and 111 patients became pN3. Both lymph node classification methods defined groups with widely differing prognoses. The prognoses of patients classified as new pN2 were more homogeneous than those of the group classified as old pN2. Survival of new pT4/pN1 patients was significantly better than that of other subgroups in Stage IV. Nine potential prognostic factors, including lymph node metastasis, were studied in multivariate analysis. The hazard ratios were 1.38 (1.16-1.64) for pN1 and 2.55 (2.16-3.01) for pN2, based on the old classification. They were 1.51 (1.29-78) for pN1, 3.11 (2.56-3.78) for pN2, and 3.88 (2.98-5.05) for pN3, based on the new classification. CONCLUSIONS: The new N classification is superior as a prognostic factor to the old N classification, although there is inadequacy in stage grouping. [See editorial on pages 1763-5, this issue.]

Humans↗
PubMed2000

Gastric lymphography and detection of sentinel nodes.

The lymphatic drainage system of the stomach was studied using lymphography with various dyes, and several major routes have been shown. Gastric lymph channels are multidirectional and form complex networks. We conducted a retrospective study to know the first site of metastasis from small gastric cancers by examining 89 cases with only one lymph node metastasis. The perigastric nodal area close to the primary tumor was the first site of metastasis in only 62% of the cases. N2 metastasis without N1 involvement was seen in 13%. In order to identify sentinel nodes for local resection of gastric cancer, a novel method needs to be developed.

Carbon↗
PubMed2000

Expression of SART3 tumor-rejection antigen in gastric cancers.

We previously reported SART3 as a tumor-rejection antigen recognized by histocompatibility leukocyte antigen (HLA)-A24-restricted cytotoxic T lymphocytes (CTLs). In this study, we investigated the expression of the SART3 antigen in gastric cancers, as a candidate for use in specific immunotherapy. The SART3 antigen was detected in 9 of 10 (90%) gastric cancer cell lines, 35 of 52 (67.3%) gastric cancer tissues, and 0 of 20 non-tumorous gastric tissues. SART3-derived peptides corresponding to positions 109- 118 and 315-323 induced HLA-A24-restricted and tumor-specific CTLs from peripheral blood mononuclear cells (PBMCs) of gastric cancer patients. These peptide-induced CTLs recognized HLA-A24(+) SART3(+) gastric cancer cells, but not HLA-A24(+) SART3(-) or HLA-A24(-) SART3(+) gastric cancer cells. Therefore, the SART3 peptides could be useful in specific immunotherapy of gastric cancer patients.

Adenocarcinoma↗