Kim Chi-Ho;Jang Seok-Won;Kang Su-Hwan;Kim Sang-Woon;Song Sun-Kyo
Journal of Gastric Cancer
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v.5
no.2
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pp.113-119
/
2005
Purpose: Some controversies exist over the prognostic values of lymphatic, venous, and neural invasion in patients with gastric cancer. This study was conducted to confirm the prognostic values of these histopathologic factors in gastric cancer patients who received a gastrectomy. Materials and Methods: Data for clinicopathologic factors and clinical outcomes were collected retrospectively from the medical records of 1,018 gastric cancer patients who received a gastrectomy at Yeungnam University Medical Center between January 1995 and December 1999. A statistical analysis was done using the SPSS program for Windows (Version 10.0, SPSS Inc., USA). The Kaplan-Meier method was used for the survival analysis. Prognostic factors were analyzed by using a multivariate analysis with Cox proportional hazard regression model. Results: Ages ranged from 21 to 79 (median age, 56). A univariate analysis revealed that age, tumor size, location, gross type, depth of invasion, extent of gastrectomy or lymph node dissection, lymph node metastasis, distant metastasis, lymphatic invasion, venous invasion, neural invasion, pathologic stage, histologic type, and curability of surgery had statistical significance. Among these factors, lymph node metastasis, curability of surgery, neural invasion, lymphatic invasion, and depth of invasion were found to be independent prognostic factors by using a multivariate analysis. Venous invasion showed no prognostic value in the multivariate analysis. Conclusion: Neural invasion and lymphatic invasion are useful parameters in determining a prognosis for gastric cancer patients.
Purpose: The prognostic significance of peri-operative serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA)19-9 determination in patients with gastric cancer has been controversial. This study was performed to evaluate the significance of CEA and CA19-9 as clinical predictors of prognosis. Materials and Methods: The correlations between peri-operative serum CEA/CA19-9 levels and clinicopathologic factors were evaluated retrospectively in gastric cancer patients who had undergone curative surgery during the period from January 1995 to December 1998 at the Department of Surgery, Yonsei University College of Medicine. Results: The positive rates for CEA and CA19-9 were $17.9\%$ and $18.4\%$, respectively. The CEA positivity was related to the depth of invasion (P=0.040), lymph-node metastasis (P=0.000), and stage (P=0.001). The CA19-9 positivity was significantly related to the depth of invasion (P=0.000), lymph-node status (P=0.000), and stage (P=0.000). The positive rate of combined assay of pre-operative CEA and CA19-9 was $30.0\%$ There were statistically significant correlations with stage, depth of invasion, or degree of lymphnode metastasis in the combined assay. The survival rates according to the positivity of CEA and to the positivity of CA19-9 were clearly different (P=0.000). Conclusion: It should be stressed that even a simple blood test prior to surgery could be useful in establishing the depth of invasion, the status of lymph-node involvement, and the prognosis. For improved survival, an aggressive lymphadenectomy and adjuvant chemotherapy should be considered for patients with positive levels of pre-operative CA19- 9.
Jang, Seong Uk;Oh, Jung Ho;Kim, Seo Bin;Kim, Sung Won;Lee, Hyoung Shin;Noh, Woong Jae;Lee, Kang Dae
Korean Journal of Head & Neck Oncology
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v.31
no.2
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pp.6-10
/
2015
Background and Objective : Papillary thyroid microcarcinoma(PTMC) is known as slow growing cancer with good prognosis. However, extrathyroidal extension may increase the risk of cervical lymph node metastasis and local invasion to surrounding structures. The aim of this study was to assess the characteristic features of the tumor invading the posterior thyroid capsule. Material and Methods : We made a retrospective review of 123 PTMC patients with thyroid capsule invasion, pathologically staged as T3 or T4. 74 patients (60.2%) had invasion to posterior thyroid capsule (group A) while 49 patients (39.8%) had invasion to-anterior thyroid capsule or anterior wall of trachea (group B). We assessed the clinicopathologic factors of the patients according to the location of capsular invasion of PTMC. Results : There was no difference regarding age, gender, T and N classification and incidence of lymph node metastasis between two groups. Local invasion rate to recurrent laryngeal nerve was 6.8% in patients with posterior thyroid capsule invasion, while the incidence was zero in those with capsular invasion to other locations Conclusion : Increased risk of local invasion to the recurrent laryngeal nerve should be considered in patients with PTMC presenting invasion of the posterior capsule.
The authors present 15 cases in which the diagnosis of thyroid cancer was established pathologically among 300 cases of Graves' disease diagnosed clinically at Chosun University Hospital, from January 1982 to December 1994. These cases were analyzed in order to establish guidelines for prophylactic node dissection as part of the initial management of thyroid cancer in patients with Graves' disease. The analysis revealed the following: 1) The average age of the 15 patients was 34.5 years and the male: female ratio was 1 : 4.0. 2) In 8 of the 15 cases(53.5 %) the occult thyroid carcinoma measured less than 1.5cm. 3) The degree of invasivensess manifested in these fifteen cases may be summarized as follows: In Group 1(6 cases) there was absence of microscopic capsular invasion and of lymphnode metastasis. In Group 11(4 cases) threre was microscopic capsular invasion but absence of lymphnode metastasis: In Group III(4 cases) there was either extrathyrodal soft tissue invasion or regional lymph node metastasis: and in Group IV(1 case) there was lymphnode invasion and distant metastasis. 4) Thirteen patients underwent either subtotal or near total thyroidectomy, and 2 patients underwent total thyroidectomy. Seven patients underwent some type of neck dissection, as follows: anterior compartment dissection in one of the cases in Group I; functional neck dissection in two cases and jugular node dissection in one case in Group II; and anterior compartment dissection in one case and modified radical neck dissection in two cases in Group III. 5) The author propose the following guidelines for prophylactic initial node dissection when a unexpected coexisting thyroid carcinoma in encountered on the frozen section during the surgical management of Graves' disease; Group I cases do not require initial neck dissection in group II, anterior compartment dissection in sufficient. In Group III, either jugular node dissection or functional neck dissection should be performed, and followed by postoperative Ra$^{131}$I therapy, Group IV requires Ra$^{131}$I therapy with or without modified radical neck dissection depending in the patient's condition.
Purpose: To evaluate the status of number 3b lymph node (LN) station in patients with adenocarcinoma of the esophagogastric junction (AEG) and to investigate the optimal indications for radical proximal gastrectomy (PG) for AEG. Materials and Methods: Data of 51 patients with clinically advanced Siewert types II and III AEG who underwent total gastrectomy (TG) between April 2010 and July 2017 were reviewed. The proportion of metastatic LNs at each LN station was examined. Number 3 LN station was separately classified into number 3a and number 3b. The risk factors for number 3b LN metastasis and the clinicopathological features of number 3b-positive AEG patients were investigated. Results: The incidences of LN metastasis were the highest in number 1 (47.1%), followed by number 2 (23.5%), number 3a (39.2%), and number 7 (23.5%) LN stations. LN metastasis in number 3b LN station was detected in 4 patients (7.8%). A gastric invasion length of more than 40 mm was a significant risk factor for number 3b LN metastasis. All 4 patients with number 3b-positive AEG had advanced cancer with a gastric invasion length of more than 40 mm. The 5-year survival rate of patients with a gastric invasion length of more than 40 mm was 50.0%. Conclusions: Radical PG may be indicated for patients with AEG with gastric invasion length of less than 40 mm.
Kim, Ji Yeon;Kim, Yi Young;Kim, Se Jin;Park, Jung Chul;Kwon, Yong Hwan;Jung, Min Kyu;Kwon, Oh Kyoung;Chung, Ho Young;Yu, Wansik;Park, Ji Young;Lee, Yong Kook;Park, Sung Sik;Jeon, Seong Woo
Journal of Gastric Cancer
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v.13
no.2
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pp.93-97
/
2013
Purpose: Endoscopic submucosal dissection has recently been practiced on a differentiated type of early gastric cancer. However, there is no clear evidence for endoscopic treatments of signet ring cell carcinoma. The aim of this study is to identify the predictive clinicopathological factors for lymph node metastasis in signet ring cell carcinoma for assisting endoscopic submucosal dissection trials. Materials and Methods: A total of 186 patients with early signet ring cell carcinoma who underwent radical curative gastrectomy between January 2001 and September 2009 were enrolled in this study. Retrospective reviews of their medical records are being conducted. Several clinicopathologic factors were being investigated in order to identify predictive factors for lymph nodes metastasis: age, gender, tumor size, type of operation, tumor location, gross type, ulceration, Lauren's classification, depth of invasion, and lymphatic invasion. Results: The lymph node metastasis rate for signet ring cell carcinoma was 4.3% (n=8). Of the 186 lesions with early signet ring cell carcinoma, 91 (48.9%) tumors were larger than 15 mm in size and 40 (21.5%) showed submucosal invasions in the resection specimens. In multivariate analysis, only the lymphatic invasion (P<0.0001) showed an association with lymph node metastasis. To evaluate cutoff values for tumor sizes in the presence of lymph node metastasis, early signet ring cell carcinomas with lymphatic invasions were excluded. In the absence of lymphatic invasion, mucosal cancer with tumor sizes <15 mm had no lymph node metastasis. Conclusions: Endoscopic submucosal dissection can be performed on patients with early signet ring cell carcinoma limited to the mucosa and less than 15 mm.
Objective: The aim of this study was to investigate the clinical significance of annexin a1 (ANXA1) and provide molecular evidence to support that decreased ANXA1 expression could enhance cancer migration and invasion in pancreatic ductal adenocarcinoma (PDAC). Materials and Methods: Immunohistochemistry of a tissue microarray with 162 surgically resected PDAC specimens was performed to examine the expression of ANXA1. We also investigated the relationship between ANXA1 expression and clinicopathological factors and prognosis of PDAC patients. We further studied the role of ANXA1 in PDAC cell proliferation, migration and invasion by cell proliferation assay, migration assay and matrigel invasion assay with reduced ANXA1 expression by RNAi. Western blotting was used to detect matrix metalloproteinase-9 (MMP-9), and tissue inhibitor of metalloproteinase-1 (TIMP-1) expression. We also detected MMP-9 enzyme activity by gelatin zymography. Results: Decreased expression of ANXA1 was significantly associated with poor differentiation, lymph node metastasis and advanced TNM stage of PDAC patients (p<0.05). Moreover, decreased expression of ANXA1 was correlated with poor survival (p<0.05). Furthermore, we found that ANXA1 knockdown inhibited cell proliferation, induced G1 phase cell cycle arrest, increased PDAC cell migration and invasion capacity compared with controls. In addition, Western blotting showed that ANXA1 knockdown increased the MMP-9 protein level and decreased TIMP-1 expression. Gelatin zymography showed that MMP-9 enzyme activity was also elevated. Conclusions: Negative ANXA1 expression is a most unfavorable prognostic factor for PDAC patients. ANXA1 knockdown inhibits cell proliferation by inducing G1 phase cell cycle arrest and increases migration and invasion of PDAC cells through up-regulating MMP-9 expression and activity, implying that ANXA1 may serve as a promising prognostic biomarker and therapeutic target for PDAC.
Kim, Yu Li;Lee, Sun Kyoung;Park, Kwang-Kyun;Chung, Won-Yoon
Journal of Cancer Prevention
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v.21
no.2
/
pp.88-94
/
2016
Background: Breast cancer is the most common malignant disease in women. The patients with advanced breast cancer develop metastasis to bone. Bone metastasis and skeletal-related events by breast cancer are frequently associated with the invasiveness of breast cancer cells and osteoclasts-mediated bone resorption. Forsythia koreana is used in oriental traditional medicine to treat asthma, atopy, and allergic diseases. The aim of this study was to evaluate the inhibitory effects of F. koreana extracts on the invasion of breast cancer cells and bone resorption by osteoclasts. Methods: Cell viability was measured by an MTT assay and the migration and invasion of MDA-MB-231 cells were detected by a Boyden chamber assay. The formation of osteoclasts and pit was detected using tartrate-resistant acid phosphatase staining and calcium phosphate-coated plates, respectively. The activities of matrix metalloproteinases (MMPs) and cathepsin K were evaluated by gelatin zymography and a cathepsin K detection kit. Results: The fruit and leaf extracts of F. koreana significantly inhibited the invasion of MDA-MB-231 cells at noncytotoxic concentrations. The fruit extract of F. koreana reduced the transforming growth factor ${\beta}1-induced$ migration, invasion and MMPs activities of MDA-MB-231 cells. In addition, the fruit, branch, and leaf extracts of F. koreana also inhibited the receptor activator of nuclear factor kappa-B ligand-induced osteoclast formation and osteoclast-mediated bone-resorbing activity by reducing the activities of MMPs and cathepsin K. Conclusions: The extracts of F. koreana may possess the potential to inhibit the breast cancer-induced bone destruction through blocking invasion of breast cancer cells, osteoclastogenesis, and the activity of mature osteoclasts.
Objective: To study the expression of the mismatch repair proteins hMSH2 and nm23 in sporadic colorectal cancer, determine any inter-relationship, and further investigate any clinical significance. Methods: Expression of hMSH2 and nm23 proteins was assessed in 87 colorectal cancer tissues by SP immunohistochemistry, with analysis of survival using follow-up data. Results: In the sporadic colorectal cancer tissues, nm23 protein expression appeared independent of the histological type (P>0.05), but correlated with the invasion depth and lymphatic metastasis (P<0.05). In contrast, hMSH2 protein expression was not significantly correlated with these clinicopathologic features (P>0.05), although it positively correlated with that of nm23 protein in the sporadic colorectal cancers (rs=0.635, P<0.05). Combined expression of the two was found to be related with invasion depth, lymphatic metastasis and prognosis of sporadic colorectal cancer (P<0.05). Conclusion: nm23 protein level was related with the degree of malignancy, and could be used as an index to predict the invasion and metastasis potential. The expression of hMSH2 protein is positively correlated that of nm23 protein, and the combined expression of the two has certain guiding significance for the prognosis of sporadic colorectal cancer.
Background: We aimed to establish robust histoprognostic predictors on residual rectal cancer after preoperative chemoradiotherapy (CRT). Methods: Analyzing known histoprognostic factors in 146 patients with residual disease allows associations with patient outcome to be evaluated. Results: The median follow-up time was 77.8 months, during which 59 patients (40.4%) experienced recurrence and 41 (28.1%) died of rectal cancer. On univariate analysis, residual tumor size, ypT category, ypN category, ypTNM stage, downstage, tumor regression grade, lymphatic invasion, perineural invasion, venous invasion, and circumferential resection margin (CRM) were significantly associated with recurrence free survival (RFS) or/and cancer-specific survival (CSS) (all p<0.005). On multivariate analysis, higher ypTNM stage and CRM positivity were identified as independent prognostic factors for RFS (ypTNM stage, p=0.024; CRM positivity, p<0.001) and CSS (p=0.022, p=0.017, respectively). Furthermore, CRM positivity was an independent predictor of reduced RFS and CSS, irrespective of subgrouping according to downstage (non-downstage, p<0.001 and p<0.001; downstage, p=0.002 and p=0.002) or lymph node metastasis (non-metastasis, p<0.001 and p=0.001; metastasis, p<0.001 and p<0.001). Conclusion: CRM status may be as powerful as ypTNM stage as a prognostic indicator for patient outcome in patients with residual rectal cancer after preoperative CRT.
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