• Journal of Gastric Cancer
• /
• 제23권4호
• /
• pp.598-608
• /
• 2023

Purpose: Lymph node (LN) metastasis is a crucial factor in the prognosis of patients with gastric cancer (GC) and is known to occur more frequently in cases with an advanced T stage. This study aimed to analyze the survival data of patients with advanced LN metastasis in T1 GC. Materials and Methods: From January 2008 to June 2018, 677 patients with pathological stage II GC who underwent radical gastrectomy were divided into an early GC group (EG: T1N2 and T1N3a, n=103) and an advanced GC (AGC) group (AG: T2N1, T2N2, T3N0, T3N1, and T4aN0, n=574). Short- and long-term survival rates were compared between the 2 groups. Results: A total of 80.6% (n=83) of the patients in the EG group and 52.8% (n=303) in the AG group had stage IIA AGC. The extent of LN dissection, number of retrieved LNs, and short-term morbidity and mortality rates did not differ between the 2 groups. The 5-year relapse-free survival (RFS) of all patients was 87.8% and the overall survival was 84.0%. RFS was lower in the EG group than in the AG group (82.2% vs. 88.7%, P=0.047). This difference was more pronounced among patients with stage IIA (82.4% vs. 92.9%, P=0.003). Conclusions: T1 GC with multiple LN metastases seems to have a worse prognosis compared to tumors with higher T-stages at the same level. Adjuvant chemotherapy is highly recommended for these patients, and future staging systems may require upstaging T1N2-stage tumors.

• Asian Pacific Journal of Cancer Prevention
• /
• 제13권9호
• /
• pp.4445-4452
• /
• 2012

Background: Prognosis of breast cancer depends on classic pathological factors and also tumor angiogenesis. This study aimed to evaluate the clinicopathological factors of breast cancer in a tertiary centre with a focus on the relationship between tumor angiogenesis and clinicopathological factors. Methods: Clinicopathological data were retrieved from the archived formal pathology reports for surgical specimens diagnosed as invasive ductal carcinoma, NOS. Microvessels were immunohistochemically stained with anti-CD34 antibody and quantified as microvessel density. Results: At least 50% of 94 cases of invasive breast ductal carcinoma in the study were advanced stage. The majority had poor prognosis factors such as tumor size larger than 50mm (48.9%), positive lymph node metastasis (60.6%), and tumor grade III (52.1%). Higher percentages of estrogen and progesterone receptor negative cases were recorded (46.8% and 46.8% respectively). Her-2 overexpression cases and triple negative breast cancers constituted 24.5% and 22.3% respectively. Significantly higher microvessel density was observed in the younger patient age group (p=0.012). There were no significant associations between microvessel density and other clinicopathological factors (p>0.05). Conclusions: Majority of the breast cancer patients of this institution had advanced stage disease with poorer prognostic factors as compared to other local and western studies. Breast cancer in younger patients might be more proangiogenic.

• Asian Pacific Journal of Cancer Prevention
• /
• 제14권6호
• /
• pp.3815-3817
• /
• 2013

Background: Breast cancer is a common cancer worldwide. With the establishment of Thailand's population-based cancer registry and availability of complete data from 2002-2011, it is of interest to investigate the epidemiologic and clinic-pathological profiles of breast cancer based on the population-based registry data. Methods: The data of all breast cancer patients in the registry for the period of 2002-2011 were included. All medical records of the patients diagnosed from documents of National Cancer Registry of Thailand were retrieved and the following information abstracted: age, clinical characteristics, and histological variables. Thailand census data for the period of 2002-2011 were used to provide the general population's statistics on age, gender, and other related demographic factors. Results: Over the 10 year-period, 7,711 breast cancer cases were included. The disease incidence under age 40 years was relatively low (4.13/$10^5$) while the incidence in the age groups 40 and older was very high (39.2/$10^5$). The vast majority of breast cancer cases (88.8%) were diagnosed by histology as primary lesions in the breast. The most common of patients with breast cancer (36.4%) had regional lymph node involvement and the most common of histopathology diagnosed in patients (84.2%) was an infiltrating duct carcinoma. Conclusions: This study showed a high incidence of breast cancer in older subjects, and high rate of breast cancer in Thailand. Future studies should explore clinical and molecular disease patterns.

• Journal of Gastric Cancer
• /
• 제16권4호
• /
• pp.207-214
• /
• 2016

Purpose: The utility of N classification has been questioned after the 7th edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) was published. We evaluated the correlation between ratio-based N (rN) classification with the overall survival of pathological T4 gastric cancer patients who underwent D2 lymphadenectomy. Materials and Methods: We reviewed 222 cases of advanced gastric cancer patients who underwent curative gastrectomy between January 2006 and December 2015. The T4 gastric cancer patents were classified into four groups according to the lymph node ratio (the number of metastatic lymph nodes divided by the retrieved lymph nodes): rN0, 0%; rN1, ${\leq}13.3%$; rN2, ${\leq}40.0%$; and rN3, >40.0%. Results: The rN stage showed a large down stage migration compared with pathological T4N3 (AJCC/UICC). There was a significant difference in overall survival between rN2 and rN3 groups in patients with pT4N3 (P=0.013). In contrast, the difference in metastatic lymph nodes was not significant in these patients (${\geq}16$ vs. <15; P=0.177). In addition, the rN staging system showed a more distinct difference in overall survival than the pN staging system for pathological T4 gastric cancer patients. Conclusions: Our results confirm that rN staging could be a good alternative for pathological T4 gastric cancer patients who undergo D2 lymphadenectomy. However, before applying this system to gastric cancer patients who undergo D2 lymphadenectomy, a larger sample size is required to further evaluate the usefulness of the rN staging system for all stages, including less advanced stages.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권20호
• /
• pp.8871-8876
• /
• 2014

Background: Postoperative chemoradiotherapy (CRT) of gastric carcinoma improves survival among high-risk patients. This study was undertaken to analyse long-term survival probability and the impact of certain covariates on the survival outcome in affected individuals. Materials and Methods: Between January 2000 and December 2005, 244 patients with gastric cancer underwent adjuvant radiotherapy (RT) in our institution. Data were retrieved retrospectively from patient files and analysed with SPSS version 21.0. Results: A total of 244 cases, with a male to female ratio of 2.2:1, were enrolled in the study. The median age of the patients was 52 years (range, 20-78 years). Surgical margin status was positive or close in 72 (33%) out of 220 patients. Postoperative adjuvant RT dose was 46 Gy. Median follow-up was 99 months (range, 79-132 months) and 23 months (range, 2-155 months) for surviving patients and all patients, respectively. Actuarial overall survival (OS) probability for 1-, 3-, 5- and 10-year was 79%, 37%, 24% and 16%, respectively. Actuarial progression free survival (PFS) probability was 69%, 34%, 23% and 16% in the same consecutive order. AJCC Stage I-II disease, subtotal gastrectomy and adjuvant CRT were significantly associated with improved OS and PFS in multivariate analyses. Surgical margin status or lymph node dissection type were not prognostic for survival. Conclusions: Postoperative CRT should be considered for all patients with high risk of recurrence after gastrectomy. Beside well-known prognostic factors such as stage, lymph node status and concurrent chemotherapy, the type of gastrectomy was an important prognostic factor in our series. With our findings we add to the discussion on the definition of required surgical margin for subtotal gastrectomy. We consider that our observations in gastric cancer patients in our clinic can be useful in the future randomised trials to point the way to improved outcomes.

• Journal of Gastric Cancer
• /
• 제11권2호
• /
• pp.69-77
• /
• 2011

Purpose: In an effort to examine the clinicopathological characteristics of GC and the status of its surgical treatment, the Korean Gastric Cancer Association (KGCA) conducted a nationwide survey targeting surgically-treated gastric cancer patients in 2009. Materials and Methods: A standardized electrical case report was sent to every member institution of the KGCA via E-mail with detailed instructions regarding the survey data. Completed data forms were retrieved from each institution and analyzed by the KGCA information committee. Results: Data on 14,658 patients was collected from 59 institutions. The mean patient age was $59.2{\pm}11.9$ years with a male to female ratio of 2.05 : 1. Lower third cancer (56.0%) was the most common among all gastric cancers. The histological type revealed poorly differentiated adenocarcinoma (34.1%) to be the most common, and the Lauren classification revealed the intestinal type (50.0%) to be the most prevalent. Curative surgery was performed in 92.4% of patients with laparoscopic surgery in 25.8% of patients. A Billroth I reconstruction was performed most frequently after a distal gastrectomy (63.4% of distal gastrectomy). T1 cancers accounted for 57.6% of all cases, and 62.6% of patients showed no lymph node metastasis. Compared to previous reports, it was found that patients are becoming older, laparoscopic surgery is being performed increasingly, and the proportion of T1 cancer is increasing with time. Conclusions: This survey presented the clinicopathological characteristics and current status of the surgical treatment of gastric cancer in Korea. This survey is expected aid research studies as well as planning and evaluation programs targeting cancer control.

• Asian Pacific Journal of Cancer Prevention
• /
• 제16권15호
• /
• pp.6591-6594
• /
• 2015

Background: Mantle-cell lymphoma (MCL) is a unique entity of peripheral B-cell lymphoma that has a discrete morphologic, immunologic, and genetic phenotype, with more common 'classic' and less frequent 'blastoid' and 'pleomorphic' variants, associated with an aggressive clinical course. The aim of this study was to analyze proliferation (Ki-67) indices of 'classic' (c-MCL) and 'blastoid' (b-MCL) variants of a cohort of MCL and to suggest cut off values for the Ki-67 proliferation index in these two subsets. Materials and Methods: MCL cases diagnosed over $4{\frac{1}{2}}$ years at Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi were retrieved and reviewed. Ki-67 labelling was scored and analysed. Results: A total of 90 of cases of MCL were scrutinized. Mean age ${\pm}SD$ was $60.2{\pm}12.5$ years and the male to female ratio was 4:1, with 67 (75%) cases of c-MCL and 23 (25%) cases of b-MCL. Most samples were lymph node biopsies (n=68), whereas the remainder were from various extranodal sites The mean Ki-67 proliferation index was $29.5%{\pm}14.4%$ in classic variants and $64.4{\pm}15.2%$ for the blastoid variant, the difference being statistically significant (p = 0.029). Conclusions: It was concluded that differential cut-off values of Ki-67 labeling may be used in more objective way to reliably classify MCL into classic or blastoid variants by diagnostic pathologists. We propose a < 40 proliferative index to be suggestive of c-MCL and one of > 50 for the blastoid variant.

• Journal of Gastric Cancer
• /
• 제21권3호
• /
• pp.308-318
• /
• 2021

Purpose: The benefits of robotic gastrectomy remain controversial. We designed this study to elucidate the advantages of a hybrid robot and laparoscopic gastrectomy over conventional laparoscopic surgery. Materials and Methods: A total of 176 patients who underwent gastrectomy for gastric cancer were included in this study. We compared 88 patients treated with hybrid robotic and laparoscopic gastrectomy (HRLG) and 88 patients who underwent conventional laparoscopic gastrectomy (CLG). In HRLG, suprapancreatic lymph node (LN) dissection was performed in a robotic setting. Clinicopathological characteristics, operative details, and short-term outcomes were analyzed for the patients. Results: The number of LNs retrieved from the suprapancreatic area was significantly greater in the HRLG group (11.27±5.46 vs. 9.17±5.19, P=0.010). C-reactive protein levels were greater in the CLG group on both postoperative day (POD) 1 (5.11±2.64 vs. 4.29±2.38, P=0.030) and POD 5 (9.86±6.51 vs. 7.75±5.17, P=0.019). In addition, the neutrophil-to-lymphocyte ratio was significantly greater in the CLG group on both POD 1 (7.44±4.72 vs. 6.16±2.91, P=0.031) and POD 5 (4.87±3.75 vs. 3.81±1.87, P=0.020). Pulmonary complications occurred only in the CLG group (4/88 [4.5%] vs. 0/88 [0%], P=0.043). Conclusions: HRLG is superior to CLG in terms of suprapancreatic LN dissection and postoperative inflammatory response.

• Journal of Gastric Cancer
• /
• 제6권3호
• /
• pp.167-172
• /
• 2006

목적: 조기위암 치료에 있어서 복강경 위암 수술이 새로운 패러다임으로 정착하고 있다. 기존에 시행하고 있던 개복에 의한 위절제술에 익숙한 경험 많은 외과의사들은 복강경 위암 수술은 시간이 많이 소요되며 기술적으로 습득하는데 많은 제약이 있음을 느끼며 복강경 수술에 소극적 자세를 취하는 경향이 있다. 이에 저자 등은 개복 위절제술에 경험이 풍부한 외과의사에 의한 복강경 위절제술의 learning curve를 결정하고, 이에 영향을 미치는 요인들을 분석하였다. 대상 및 방법: 2005년 4월부터 2006년 3월까지 한 명의 술자에 의하여 수술전 조기 위암(cT1N0)으로 진단 받고 복강경 보조하 원위부 위절제술(LADG) 및 $D1+{\beta}$ 림프절 곽청을 시행 받은 62명을 대상으로 하였으며 복강경 위절제술 시행을 위하여 전문팀을 구성하였다. 대상 환자를 6명씩 한 그룹으로 총 10그룹(마지막 그룹은 8명으로 구성함)으로 나누어 각 그룹의 평균 수술시간을 비교하여 learning curve 극복 전후의 나이, 성별, 수술 후 합병증, 절개창의 길이, 수혈유무, 적출된 림프절 개수, 수술 전 후 혈색소 변화 등을 분석하였다. 결과: 평균 수술 시간을 분석한 결과 여섯 번째 그룹 (31st case)부터 수술 시간의 Plateau를 보였다. 이에 저자들은 learning curve 극복시점을 30th case (7개월)로 간주하였으며 극복 전후 집단 간의 평균 수술시간을 분석하였을 때 각각 $239.0{\pm}69.7$분과 $170.0{\pm}32.6$분으로 유의하게 나타났다(P<0.05), 양 군 간 평균나이, 성별, BMI, 수술 전후의 혈색소 수치변화, 적출된 림프절 개수 등은 유의한 차이를 보이지 않았다. 또한 절개창의 길이, 수혈유무, 수술 후 합병증 유무도 양 군 간에 통계적으로 유의하지 않았다. 결론: 저자들의 LADG learning curve 극복은 30예(7개월)로 다른 보고보다 일찍 도달할 수 있었다. 이는 개복 수술의 풍부한 경험, 전문 수술팀 구성, 그리고 단기간 집중적인 시술에 의한 것으로 생각된다.

• Journal of Gastric Cancer
• /
• 제8권2호
• /
• pp.79-84
• /
• 2008

목적: 복강경 기구의 발달과 시술자의 숙련도가 증가함에 따라 점차로 조기위암 이상으로 복강경 위절제술을 확대 적용하려는 노력들이 이루어지고 있다. 본 연구는 복강경 D2 림프절 절제술의 적절성 및 유용성을 평가하고자 하였다. 대상 및 방법: 2007년 2월부터 2007년 8월까지 복강경 D2 림프절 절제술을 시행 받은 22명의 원위부위암 환자들을 대상으로 임상병리학적 특성, 수술 성적 및 수술 후 경과 등에 대하여 같은 시기에 시행된 38명의 개복 D2 림프절 절제술 환자와 비교하였다. 결과: 복강경 D2 림프절 절제술은 평균 수술시간이 오래 소요되었으나($160{\pm}25min$. vs. $135{\pm}21min$., P<0.001), 평균 근위부 절제연 거리($6.1{\pm}2.8cm$ vs. $5.8{\pm}2.5$, P=ns), 평균 림프절 절재 개수($25{\pm}11$ vs. $26{\pm}9$, P=ns)에서 개복 수술과 유의한 차이가 없었다. 수술 후 경과는 복강경 수술군에서 식이개시, 재원일수 등이 유의하게 빨랐다. 복강경 D2 림프절 절제술을 시행 받은 환자 중 개복으로의 전환은 없었으며, 양군에서 유사한 수술 후 합병증 발생빈도를 보여주었다. 결론: 복강경 D2 림프절 절제술은 개복수술과 유사한 수술성적을 가지며, 양호한 수술 후 경과를 보인다. 향후 전향적 연구를 통해 복강경 D2 림프절 절제술의 유용성에 대한 연구가 필요하리라 생각된다.