Biomedical subjects

M Maeta

Publications and source records attributed to M Maeta.

At least 163 records · Page 9Linked to original sources

PubMedDate not supplied

A case-matched control study of intrahepatoarterial chemotherapy in combination with or without regional hyperthermia for treatment of primary and metastatic hepatic tumours.

The efficacy of the combined application of intrahepatoarterial (IHA) chemotherapy and regional hyperthermia for the treatment of unresectable hepatic tumours was studied in a case-matched, retrospective control study. Well-matched pairs of patients with the same or similar background factors, who had been treated with IHA chemotherapy plus hyperthermia (group A; n = 32) and with IHA chemotherapy alone (group B; n = 32) were included in this study. In group A, partial responses (PRs) were found in 2 of 8, 4 of 8, and 5 of 16 patients with hepatocellular carcinoma, metastatic gastric cancer, and metastatic colorectal cancer, respectively. In group B, PRs were found in 1 of 8, 3 of 8, and 5 of 16 patients with those diseases, respectively. Overall, PRs were found in 12 (37%) and 9 (28%) of 32 patients in groups A and B, respectively; progressive disease was found in 6 (19%) in group A and in 12 (38%) in group B. These results indicate that this combination therapy is of therapeutic benefit in the treatment of unresectable hepatic tumours.

Antineoplastic Agents↗

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Cell-proliferative activity and its relationship to the histologic type of early gastric cancer.

To evaluate the biological characteristics of gastric carcinoma and of the normal gastric mucosa from which carcinoma seems to develop, we analyzed the DNA content and proliferative activity of cells in 154 patients with primary mucosal gastric cancer and 40 patients with gastric ulcer by flow cytometric analysis. A total of 154 samples from mucosal gastric carcinomas, 154 samples from normal gastric mucosa adjacent to carcinomas and 40 samples from normal gastric mucosa adjacent to gastric ulcers were subjected to analysis. The incidence of DNA aneuploidy of differentiated carcinoma cells (34.3%) was significantly higher than that of undifferentiated carcinoma cells (14.5%, P=0.014). Among the cancers with diploid DNA, the mean value of the proportion of cells in the S phase of the cell cycle in differentiated carcinomas was 6.64% and it was significantly higher than that in undifferentiated carcinomas (5.53%, P=0.01). The mean values for the S and G2 + M phases for cells in the normal gastric mucosa from sites adjacent to the differentiated carcinomas were 5.29% and 1.81%. These values were higher than those for cells in normal gastric mucosa from sites adjacent to undifferentiated carcinomas (4.89% and 1.40%, respectively) and than those for cells in normal mucosa from sites adjacent to gastric ulcers (4.48% and 1.68%, respectively). During the early phase of gastric cancer, differentiated carcinoma seems to develop from gastric mucosa where cells have high proliferative activity. Reflecting this biological characteristic, the cells of differentiated carcinomas also have high proliferative activity.

Aneuploidy↗

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Clinical significance of dendritic cell infiltration in esophageal squamous cell carcinoma.

We investigated the clinicopathological significance of dendritic cell infiltration (DCsI) in esophageal squamous cell carcinoma and in regional lymph nodes of 88 patients. The expression of mutated p53 protein and the degree of positive cancer cells of proliferating cell nuclear antigen (PCNA labeling index) in tumors were analyzed as biological markers. These factors were compared with the degree of DCsI in tumors and in lymph nodes. The number of dendritic cells (DCs) were counted and scored as per mm2 in each case. The degree of DCsI of tumors with expression of p53 (19/mm2, n=50) was significantly lower than that of DCsI in 38 tumors without expression of p53 (27/mm2, P=0.0411). However, no significant correlation was detected between the PCNA labeling index and the degree of DCsI in 88 primary tumors (P=0.1273). The degree of DCsI in 53 metastatic lymph nodes (30/mm2) was significantly lower than that of DCsI in 264 cancer-free regional lymph nodes (48/mm2, P=0. 02). Although the degree of DCsI in tumors was not an independent prognostic factor for the 78 surviving patients (P=0.2647), the 3-year survival rate of patients in stage III and IV who underwent curative operation and who had tumors with high DCsI (>9/mm2, n=16, 72%) was significantly higher than that of the 24 patients who had tumors with low DCsI (< or = 9/mm2, 21%, P=0.008). These findings indicate that DCs infiltrated in and around the esophageal cancer may play a defensive role of the hosts against the tumors. This immune defense of the hosts might be an important prognostic factor for patients with advanced esophageal cancer. However, cancer cells which express a mutated p53 protein might regulate the function or activity of DCs.

Aged↗

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Immunohistochemical detection of occult metastases in paraaortic lymph nodes in advanced gastric cancer.

Some Japanese surgeons have examined the utility of super-extended paraaortic lymphadenectomy (PAL) as part of the surgical treatment for advanced gastric cancer. However, therapeutic value of this PAL remains controvertial. The purpose of this study was to evaluate appropriate candidates who might benefit from PAL by the immunostaining with cytokeratin (CK) of the macroscopically intact paraaortic nodes. A total of 525 paraaortic nodes from 35 patients was serially sectioned and stained with hematoxylin-eosin (H&E) and CK staining. A total of 17 nodes (3.2%) from 7 patients (20.0%), among 525 macroscopically intact paraaortic nodes, was determined to be immunopositive for CK. In 4 patients, 8 H&E-positive nodes with metastases were all immunopositive and, in addition, 4 H&E-negative nodes were also immunopositive. Furthermore, 3 patients with H&E-negative nodes had five immunopositive nodes. Immunostaining with CK was useful for detection of occult metastases. Survival was prolonged in 3 of these 7 patients. The incidence of CK-positive nodes was significantly higher in patients with gross type of 3 or 4 gastric cancer and in patients with H&E-detected nodal metastasis within group 3 (N3) nodes. It seems that such patients would benefit from prophylactic PAL.

Aged↗

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Nuclear accumulation of p53 protein in gastric cancer strongly correlates with enlargement of nuclear area of cancer cells.

The nuclear area (NA) of cancer cells have been reported to be a useful prognostic indicator in various tumors. However, this image analysis of cancer nucleus has only rarely been applied to gastric adenocarcinoma. Moreover, it remains to be shown what types of biological factors influence this nuclear feature. In this study, we analyzed the area of cancer nuclei in tumors from 97 patients with advanced gastric cancer (t3, n0, stage II) by using hematoxylin and eosin stained slides with a computer-assisted image-analysis system. The morphometric data were compared with clinicopathological and biological status of the tumors. The mean NA of 50 tumors with venous invasion (50 microm2) was significantly larger than that of 47 tumors without venous invasion (38 microm2, p<0.0001). There was a significant correlation between the NAs of cancer cells and the p53 labeling indices of tumors (p=0.0012) and Ki-67 labeling indices of tumors (p=0.0324). However, no significant correlation was detected between the NAs of cancer cells and other factors, such as, tumor size, DNA ploidy pattern, expression of vascular endothelial growth factor (VEGF), or microvessel density of tumors. The five-year survival rate of 49 patients with large nuclear area (NA > or =41 microm2, 63%) was significantly lower than that of 48 patients with small nuclear area (NA <41 microm2, 78%, p=0.043). Data from computerized morphometry are objective and can be obtained rapidly by conventional microscopic analysis. The NA of cancer cells in advanced gastric cancer appears to predict the ability to invade the microvessels in the gastric wall. This nuclear morphological feature strongly correlated with p53 accumulation in the nuclei of gastric adenocarcinoma.

Cell Nucleus↗

PubMedDate not supplied

Combined analysis of tumour neoangiogenesis and local immune response in advanced gastric carcinoma.

Neovascularization and host immune response are important in the growth and metastasis of solid tumours. Thus, microvessel density, and dendritic cell (DC) infiltration, which was thought to be an indicator of local immune function, were examined by immunohistochemistry and their prognostic significance was determined in patients with advanced gastric carcinoma. The 5-year survival rates in patients with both low microvessel counts and marked DC infiltration, in patients with either low microvessel counts or marked DC infiltration, and in patients with both high microvessel counts and slight DC infiltration were 82.6%, 68.6%, and 30.2%, respectively, the differences were statistically significant. Moreover, the multivariate analysis showed that combined analysis of microvessel counts and DC density was an independent prognostic indicator. Our findings indicate that combined analysis of tumour neoangiogenesis and local immune response might be useful for predicting prognoses of patients with advanced gastric carcinoma.

Adenocarcinoma↗

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Mutated p53 protein expression and proliferative activity in advanced gastric cancer.

BACKGROUND/AIMS: When the DNA of cells is damaged, wild-type p53 protein induces the expression of p21 (Waf1/Cip1/Sdi1), and regulates the progression of the cell cycle by inducing G1 arrest. Thus, wild type p53 or p21 protein negatively regulates cancer cell proliferation. However, in tumor with loss of expression of functional wild-type p53 protein by mutation or allelic deletion of the gene for p53, whether the proliferative activity of cancer cells might be accelerated or not is unclear. In this study, we investigated the correlation between the level of expression of mutated p53 protein and the proliferative activity of cancer cells in advanced gastric cancer. METHODOLOGY: Ninety-seven samples from patients with gastric cancer that had invaded the serosa without lymph node metastasis (t3, n0, stage II) were investigated by immunohistochemical staining with a monoclonal antibody against p53 and against p21, and with the monoclonal antibody Ki-67. DNA ploidy patterns were analyzed by flow cytometry. The immunoreactivity against p53 and the proliferative activity of cancer cells were scored in terms of a labeling index (LI; percentage of immunostained cells) in each case. Moreover, the prognostic values for 93 surviving patients were evaluated by univariate and multivariate analysis. RESULTS: The mean p53 LI was 24% (range: 0-82.4%) and the mean Ki-67 LI was 23.1% (range: 0-70.7%) in 97 tumors. The expression of p21 protein was detected in 30 of 97 tumors (30.9%) and DNA aneuploidy was detected in 36 of 97 tumors (37.1%). There was significant correlation between the p53 LI and the Ki-67 LI (r = 0.61, t = 7.456, p < 0.001) in 97 tumors. Although, no significant difference was detected, the mean p53 LI (18.3%) of 30 tumors with expression of p21 protein was lower than that of 67 tumors without expression of p21 protein (26.6%, p = 0.096). However, no significant correlation between expression of p21 protein and Ki-67 LI was observed. The p53 LI was not an independent prognostic factor in 93 surviving patients by multivariate survival analysis (p = 0.069). However, the 5-year survival rate of 50 patients with a low level of p53 LI (p53 LI (< or = 10%, 78.3%) was significantly better than that of 43 patients with a high level of p53 LI (p53 LI > 10%, 62.1%, p = 0.045). CONCLUSIONS: Accumulation of mutated p53 protein might suppress the expression of p21 protein in gastric adenocarcinoma, and cancer cells with overexpression of mutated p53 protein might have a high proliferative activity.

Adenocarcinoma↗

PubMedDate not supplied

The expression of thymidine phosphorylase and its correlation with angiogenesis in gastric adenocarcinoma.

BACKGROUND: It has been recently reported that thymidine phosphorylase (dThdPase) is identical to platelet-derived endothelial cell growth factor (PD-ECGF). dThdPase is known to be one of the angiogenic factors. Expression of dThdPase has been detected both in cancer cells and in stroma cells. However, the role of dThdPase, in cancer cells and in stroma cells regarding, neovascularization in gastric adenocarcinoma is still unclear. In this study, we analyzed the correlation between dThdPase activity and neovascularization in gastric cancer. MATERIALS AND METHODS: We obtained fresh samples (tumors and adjacent normal mucosas) from 67 patients with gastric cancer who underwent gastrectomy between 1993 and 1994. The dThdPase activity was analyzed by the ELISA (enzyme-linked immunosorbent assay) method and by the immunohistochemical staining. Microvessel density (MVD) and vascular endothelial growth factor expression of tumors were analyzed by immunohistochemical staining. RESULTS: The dThdPase activity of tumors (117 +/- 98 U/mg protein) was significantly higher than that of normal mucosas (46 +/- 36 U/mg protein, P < 0.0001). The expression of dThdPase was detected by immunostaining in stroma cells but not in mucosal cells in normal tissues. Based on the immunostaining results, 16 tumors expressed dThdPase both in cancer cells and stroma cells. The mean dThdPase activity and the mean MVD of these 16 tumors were significantly higher than those of 15 tumors with expression of dThdPase only in the stroma cells, and than those of 36 tumors with expression of dThdPase in neither the cancer cells or the stroma cells. The MVD of tumors strongly correlated with the dThdPase activity of tumors detected by the ELISA method (P < 0.0001). CONCLUSIONS: The total amount of dThdPase produced by cancer cells and stroma cells may influence tumor angiogenesis in gastric cancer.

Adenocarcinoma↗

PubMedDate not supplied

Prognostic benefit of extended radical lymphadenectomy for patients with gastric cancer.

BACKGROUND: The therapeutic value of extensive gastric lymphadenectomy in gastric cancer is controversial. We retrospectively investigated the effect of extended lymphadenectomy on survival in 882 patients with gastric cancer. MATERIALS AND METHODS: From 882 patients who underwent gastrectomy, D0 or D1 lymphadenectomy was performed on 137 patients, D2 lymphadenectomy on 524 and D3 lymphadenectomy on 221. Curative gastrectomy was performed on 771 patients and the 5-year survival rate of patients had undergone D0 or D1 lymphadenectomy (D1 group) and that of patients who had undergone D2 lymphadenectomy (D2 group) was compared with that of patients had undergone D3 lymphadenectomy (D3 group). RESULTS: In each stage, the 5-year survival rates of patients who had undergone curative operations (n = 771) were compared among the D1, D2 and D3 groups. The 5-year survival rates were as follows: Stage I: n = 510, 89.3% (D1 group: n = 91, 85.8%; D2 group: n = 384, 90.3%; D3 group: n = 35, 88.1%; p = 0.539), Stage II: n = 83, 77.8% (D2 group: n = 35, 82.7%; D3 group: n = 48, 74.3%; p = 0.601), Stage III: n = 133, 50.2% (D2 group: n = 46, 39%; D3 group: n = 87, 56.1%; p = 0.027), Stage IV: n = 45, 8.9% (D2 group: n = 10, 0%; D3 group: n = 35, 11.4%; p = 0.588). Postoperative complications were detected in 10.4% of the cases and the in-hospital mortality rate was 2.4%. The postoperative morbidity rate of the D3 group (15.8%) was significantly higher than that of the other groups (D1 group: 7.3% and D2 group: 9%; p = 0.008). However, the in-hospital mortality rate of the D3 group (1.4%) was not different from that of the other groups (D1 group: 3.7% and D2 group: 2.5%; p = 0.374). CONCLUSION: These results indicate that D3 lymphadenectomy might be performed as safely as D1 or D2 lymphadenectomy on patients with gastric cancer. In addition, D3 lymphadenectomy might provide a survival benefit for patients with Stage III or Stage IV gastric cancer.

Adult↗

PubMedDate not supplied

Pharmacokinetics of hypotonic cisplatin chemotherapy administered into the peritoneal and the pleural cavities in experimental model.

The pharmacokinetics of intraperitoneal (i.p.) and intrapleural (i.pl.) hypotonic cisplatin (CDDP) were compared under the same experimental conditions. The same dose of CDDP was administered in hypotonic (62 mOsm/L) and isotonic (308 mOsm/L) solutions to the peritoneal and pleural cavities of Ehrlich carcinoma cell bearing mice. The intracellular amount of platinum increased for more than 60 minutes after an i.pl. injection of the hypotonic solution of CDDP, whereas it increased for up to 30 minutes after an i.p. injection. Although hypotonic conditions augmented the amount of platinum taken-up by Ehrlich cells, the amount was significantly greater in the pleural cavity than in the peritoneal cavity. In Donryu rats, the levels of platinum in the i.p. and i.pl. fluids decreased rapidly after injection of hypotonic solution as compared with isotonic solution. The extent of this decrease was greater in the peritoneal cavity than in the pleural cavity. In the hypotonic condition, the area under the curve of concentration versus time (AUC) for platinum of i.pl. fluid was greater than that of i.p. fluid. When i.p. and i.pl. hypotonic CDDP were administered, the osmolarity of the fluid returned rapidly to the isotonic level, with equilibration in 30 or 180 minutes respectively. The lower osmolarity continued for a longer duration in the pleural cavity than in the peritoneal cavity. These results indicate that the pleural cavity may require a smaller amount of CDDP to achieve the same effect on intracellular uptake of platinum than the peritoneal cavity.

Animals↗

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An elevated serum level of transforming growth factor-beta 1 (TGF-beta 1) significantly correlated with lymph node metastasis and poor prognosis in patients with gastric carcinoma.

BACKGROUND: Overexpression of transforming growth factor beta s (TGF-beta s), multifunctional polypeptides, have been reported in the tissue of various types of carcinomas, including gastric carcinoma. To our knowledge, serum levels of TGF-beta 1 have not previously been examined in patients with gastric carcinoma as a possible indicator of prognosis. METHODS: Preoperative serum levels of TGF-beta 1 were measured in 111 patients with gastric carcinoma by an enzyme-linked immunosorbent assay. RESULTS: An elevated level of TGF-beta 1 was significantly correlated with lymph node metastasis and poor prognosis. Moreover, the preoperative serum levels of TGF-beta 1 in patients with peritoneal recurrence were significantly higher than those in patients both with lymph node recurrence and without recurrence. CONCLUSION: The serum level of TGF-beta 1 might be useful for predicting recurrence patterns and prognosis in patients with gastric carcinoma.

Analysis of Variance↗

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Prediction of survival period for patients with postoperative recurrence after curative resection for advanced gastric carcinoma.

BACKGROUND/AIMS: Although many studies have attempted to clarify the prognostic indicators for gastric carcinoma, there have been few studies regarding the factors that correlate with the survival period of patients with postoperative recurrence. METHODOLOGY: Among 504 advanced gastric adenocarcinoma patients who had undergone curative gastrectomy, 188 patients who had died of recurrence were used in this study. RESULTS: Univariate analysis indicated that age, the presence of lymph node metastasis and blood vessel invasion, the number of positive lymph nodes, and gastrectomy significantly correlated with the survival period. Multivariate analysis indicated that the length of the survival period was independently influenced by the number of positive lymph nodes and blood vessel invasion. The survival time of patients with less than 3 positive lymph nodes and no accompanying blood vessel invasion was significantly longer than that of other patients. CONCLUSIONS: The number of positive lymph nodes and the presence of blood vessel invasion are the most important factors predicting the survival period of patients with postoperative recurrence after curative resection for advanced gastric carcinoma.

Adenocarcinoma↗

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Pharmacokinetics of intraoperative intrapleural cisplatin chemotherapy of various osmolarities in cases of esophageal cancer.

Intraoperative intrapleural (i.pl.) cisplatin (CDDP) treatment during thoracotomy was performed for esophageal cancers. Three patients underwent isotonic (308 mOsm/l) CDDP treatment. Hypotonic CDDP treatments with a 154 mOsm/l solution and a 62 mOsm/l solution were administered to 4 and 9 patients, respectively. The maximum concentrations (Cmax) of both total and filterable platinum in the plasma after injection of the hypotonic solution were significantly higher than those after injection of the isotonic solution. The area under the curve of concentration versus time (AUC) of the plasma of the 62 mOsm/l solution was significantly higher than that of the 154 mOsm/l and isotonic solution. Although higher levels of the Cmax may increase side-effects, the hypotonic condition of the i.pl. fluid and increased AUC in the plasma may escalate the accumulation of platinum in i.pl. cancer cells. These results suggest that hypotonic i.pl. CDDP is tolerable and may be useful for treatment of the incipient phase of pleural carcinomatosis and for prophylaxis of postoperative recurrence.

Aged↗

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Prognostic factors in patients with advanced gastric cancer treated by noncurative resection: a multivariate analysis.

BACKGROUND/AIMS: The relationship between prognostic factors and survival time after noncurative gastric resection in patients with advanced gastric cancer was examined by a retrospective review of data on 364 patients. METHODOLOGY: There were 168 patients without metastasis to the liver or peritoneum (group A), 127 with peritoneal metastasis and no liver metastasis (group B), 50 with liver metastasis and no peritoneal metastasis (group C) and 19 with synchronous liver and peritoneal metastases (group D). Patients were primarily treated with the following 3 drugs: the fluorinated pyrimidines, cisplatin, and mitomycin C. RESULTS: Patients in group D had a very poor prognosis as compared with the other groups. Multivariate analysis using the Cox's proportional hazard model adjusted for sex, age, and other covariants indicated that lymph node metastasis, lymph node dissection, and fluorinated pyrimidines for group A, cisplatin for group B, and lymph node dissection for group C were independent prognostic factors. An analysis of patients excluding cases who died within 30 days after surgery revealed that lymph node dissection for group A, lymph node dissection and cisplatin for group B, and lymph node dissection for group C were independent prognostic factors. CONCLUSIONS: Treatment protocol specific for the residual disease may improve the survival of patients with advanced gastric cancer treated by noncurative resection.

Aged↗

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Postoperative morbidity and mortality after gastrectomy for gastric carcinoma.

BACKGROUND/AIMS: Surgical technique and postoperative care for gastric cancer have significantly improved in recent years. However, whether postoperative morbidity or mortality rates after gastrectomy for gastric cancer were reduced or not in recent years was unclear. In this study, we analyzed the chronological changes of postoperative morbidity and mortality rates, and we analyzed risk factors for postoperative morbidity and mortality in patients undergoing gastrectomy for carcinomas of the stomach. METHODOLOGY: A total of 887 patients with gastric cancer were gastrectomized in our hospital between January 1985 and December 1996. The patients were divided into three groups on the basis of chronology. The first group included patients treated over the period 1985 to 1988 (n = 324); the second group, 1989 to 1992 (n = 300); and the third group, 1993 to 1996 (n = 263). Postoperative morbidity rates and mortality rates were compared among the three groups. Also, significant risk factors affecting postoperative morbidity and in-hospital mortality were analyzed by the multiple logistic regression analysis. RESULTS: Postoperative complications were detected in 95 patients (10.7%) and in-hospital mortality rate was 2.4% (21/887). Postoperative morbidity rates were 10.5%, 11%, and 10.6% in the first, second, and third groups, respectively and postoperative mortality rates were 2.5%, 2%, and 2.7%, respectively. These postoperative morbidity and mortality rates were not different between the groups (P = 0.979 and P = 0.866). The most common postoperative complication was anastomotic leakage (56/95, 58.9%). Significant risk factors affecting in-hospital mortality were Stage IV (P = 0.006) and noncurative gastric resection (P = 0.004). However, the extent of lymph node dissection, combined resection, or the existence of preoperative complications were not significant risk factors of in-hospital mortality by multiple logistic regression analysis. CONCLUSIONS: These results indicate that patients with far-advanced gastric cancer might have a high risk of postoperative mortality. In noncurative operations for patients with advanced gastric cancer, unnecessary lymph node dissection or combined resection should be avoided.

Adult↗

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Relationship between the cell-proliferative activity of gastric cancers and that of the normal epithelium.

Samples of gastric carcinomas and of normal gastric mucosa adjacent to tumors from 104 patients with primary mucosal gastric cancer were analysed by flow-cytometry. These patients were divided into two groups according to the histologic type of their tumors (differentiated group and undifferentiated group). The pattern of DNA ploidy and the sizes of the S- and G2M-phase fractions (percentages of cells at each respective phase) were compared between these two groups. DNA aneuploidy was encountered in 25.4% of the cases in the differentiated group and in 21.2% of the cases in the undifferentiated group. The mean sizes of S- and G2M-phase fractions of carcinomas in the differentiated group were 8.85% and 3.75% and they were significantly higher than the mean sizes of S- and G2M-phase fractions of carcinomas in the undifferentiated group (6.97% and 2.92%). Moreover, the S-phase fraction of normal gastric mucosa adjacent to the differentiated adenocarcinoma was 5.75% and this value was significantly higher than that of normal gastric mucosa adjacent to undifferentiated adenocarcinoma (4.80%). These results suggest that the proliferative activity of mucosal gastric cancer cells, as described by flow-cytometry, is higher in cases of differentiated adenocarcinoma than in cases of undifferentiated adenocarcinoma, and that the proliferative activity of normal cells in the gastric mucosa close to where adenocarcinoma develops is higher in cases of differentiated adenocarcinoma than in cases of undifferentiated adenocarcinoma. Thus, differentiated adenocarcinoma seems to develop from gastric mucosa with high proliferative activity.

Adenocarcinoma↗

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Relationship between area of serosal invasion and intraperitoneal free cancer cells in patients with gastric cancer.

This study, we evaluated the relationship between the macroscopic area of serosal invasion by gastric carcinoma and the incidence of intraperitoneal free cancer cells which were detected by lavage of the Douglas cavity. Between 1976 and 1989, 362 patients with advanced gastric cancer (t3, t4) were gastrectomized and intraperitoneal free cancer cells were recognized in 119 patients (32.9%). Only 17.3% of patients with an area of serosal invasion of less than 10 cm2 had free cancer cells in their peritoneal cavities, however, 68.5% of patients with an area of serosal invasion greater than 20 cm2 had free cancer cells. Even, if curative surgery was performed for patients with free cancer cells, their five-year survival rate was very poor. The five-year survival rate of patients with curatively operated gastric cancer without free cancer cells was 49.3%, however that of patients with free cancer cells was significantly lower (15.4%, P < 0.01). Even when we are not able to receive the cytologic diagnosis for intraperitoneal free cancer cells during the operation, patients with macroscopic areas of serosal invasion greater than 20 cm2 may have free cancer cells in a very high percentage. They should be treated with effective adjuvant chemotherapy the soon after the operation to prevent peritoneal metastatic recurrence and to prolong survival.

Aged↗

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Relationship between hematogenic metastasis of gastric cancer and the maximum extent of venous invasion by cancer cells in the gastric wall.

BACKGROUND/AIMS: The prognosis or the incidence of hematogenic metastasis after operation in patients with gastric cancer with venous invasion by cancer cells is still unclear. MATERIALS AND METHODS: The correlation was examined between venous invasion by gastric cancer and the occurrence of hematogenic metastasis in patients with gastric cancer at stage t2 (tumor had invaded muscularis propria or subserosa). RESULTS: The incidence of venous invasion by cancer cells in 228 patients with t2 gastric cancer was 53.5%, as determined histologically. Between 1977 and 1993, 32 of these 22 patients died from hematogenic metastasis. Thirty of the 32 patients (93.8%) with hematogenic metastasis had evidence of venous invasion by cancer cells of the gastric wall. Furthermore, 17 of the 30 patients (56.7%) had venous invasion at the subserosal layer of the stomach (ssv). However, of 196 patients without hematogenic metastasis, 92 patients had venous invasion and only 8 of 92 patients (8.7%) had ssv. The mean maximum extent of ssv in 8 patients without hematogenic metastasis was 2.28 mm but it was 4.76 mm in 17 patients with hematogenic metastasis (P = 0.028). CONCLUSION: Thus, the hematogenic metastasis of gastric cancer was very closely related to the presence of extensive venous invasion by cancer cells of the subserosal layer in the gastric wall.

Adenocarcinoma↗