To evaluate the clinical impact of surveillance for head and neck (HN) region with narrow band imaging (NBI) in patients with esophageal squamous cell carcinoma (ESCC).METHODSSince 2006, we introduced the surveillance...To evaluate the clinical impact of surveillance for head and neck (HN) region with narrow band imaging (NBI) in patients with esophageal squamous cell carcinoma (ESCC).METHODSSince 2006, we introduced the surveillance for HN region using NBI for all patients with ESCC before treatment, and each follow-up. The patients with newly diagnosed stage I to III ESCC were enrolled and classified into two groups as follows: Group A (no surveillance for HN region); between 1992 and 2000), and Group B (surveillance for HN region with NBI; between 2006 and 2008). We comparatively evaluated the detection rate of superficial head and neck squamous cell carcinoma (HNSCC), and the serious events due to metachronous advanced HNSCC during the follow-up.RESULTSA total 561 patients (group A: 254, group B: 307) were enrolled. Synchronous superficial HNSCC was detected in 1 patient (0.3%) in group A, and in 12 (3.9%) in group B (P = 0.008). During the follow up period, metachronous HNSCC were detected in 10 patients (3.9%) in group A and in 30 patients (9.8%) in group B (P = 0.008). All metachronous lesions in group B were early stage, and 26 patients underwent local resection, however, 6 of 10 patients (60%) in group A lost their laryngeal function and died with metachronous HNSCC.CONCLUSIONSurveillance for the HN region by using NBI endoscopy increase the detection rate of early HNSCC in patients with ESCC, and led to decrease serious events related to advanced metachronous HNSCC.展开更多
Helicobacter pylori(H.pylori)plays an important role in gastric carcinogenesis,as the majority of gastric cancers develop from H.pylori-infected gastric mucosa.The rate of early gastric cancer diagnosis has increased ...Helicobacter pylori(H.pylori)plays an important role in gastric carcinogenesis,as the majority of gastric cancers develop from H.pylori-infected gastric mucosa.The rate of early gastric cancer diagnosis has increased in Japan and Korea,where H.pylori infection and gastric cancer are highly prevalent.Early intestinal-type gastric cancer without concomitant lymph node metastasis is usually treated by endoscopic resection.Secondary metachronous gastric cancers often develop because atrophic mucosa left untreated after endoscopic treatment confers a high risk of gastric cancer.The efficacy of H.pylori eradication for the prevention of metachronous gastric cancer remains controversial.However,in patients who undergo endoscopic resection of early gastric cancer,H.pylori eradication is recommended to suppress or delay metachronous gastric cancer.Careful and regularly scheduled endoscopy should be performed to detect minute metachronous gastric cancer after endoscopic resection.展开更多
AIM To investigate the effect of Helicobacter pylori(H. pylori) status test and H. pylori eradication on the occurrence of metachronous gastric cancer(MGC) after endoscopic submucosal dissection(ESD) of early gastric ...AIM To investigate the effect of Helicobacter pylori(H. pylori) status test and H. pylori eradication on the occurrence of metachronous gastric cancer(MGC) after endoscopic submucosal dissection(ESD) of early gastric cancer(EGC) and risk factors of MGC. METHODS The authors retrospectively reviewed the medical records of 433 patients(441 lesions) who underwent ESD for EGC from January 2005 to January 2015 in Yeungnam University Hospital. Patients were categorized into two groups; the H. pylori tested group(n = 257) and the H. pylori non-tested group(n = 176) based on performance of H. pylori status test after ESD of EGC. The H. pylori tested group was further categorized into three subgroups based on H. pylori status; the H. pylori-eradicated subgroup(n = 120), the H. pylori-persistent subgroup(n = 42), and the H. pylori-negative subgroup(n = 95). Incidences of MGC and risk factors of MGC were identified.RESULTS Median follow-up duration after ESD was 30.00 mo(range, 6-107 mo). Total 15 patients developed MGC during follow-up. MGC developed in 11 patients of the H. pylori tested group(7 in the H. pylori-negative subgroup, 3 in the H. pylori-eradicated subgroup, and 1 in the H. pylori-persistent subgroup) and 4 patients of the H. pylori non-tested group(P > 0.05). The risk factors of MGC were endoscopic mucosal atrophy in the H. pylori tested group and intestinal metaplasia in all patients. CONCLUSION H. pylori eradication and H. pylori status test seems to have no preventive effect on the development of MGC after ESD for EGC. The risk factors of MGC development were endoscopic mucosal atrophy in the H. pylori tested group alone and intestinal metaplasia in all patients.展开更多
BACKGROUND Helicobacter pylori(H.pylori)infection is a risk factor for gastric cancer(GC),especially in East Asian populations.Most East Asian populations infected with H.pylori are at higher risk for GC than H.pylori...BACKGROUND Helicobacter pylori(H.pylori)infection is a risk factor for gastric cancer(GC),especially in East Asian populations.Most East Asian populations infected with H.pylori are at higher risk for GC than H.pylori-positive European and United States populations.H.pylori eradication therapy reduces gastric cancer risk in patients after endoscopic and operative resection for GC,as well as in non-GC patients with atrophic gastritis.AIM To clarify the chemopreventive effects of H.pylori eradication therapy in an East Asian population with a high incidence of GC.METHODS PubMed and the Cochrane library were searched for randomized control trials(RCTs)and cohort studies published in English up to March 2019.Subgroup analyses were conducted with regard to study designs(i.e.,RCTs or cohort studies),country where the study was conducted(i.e.,Japan,China,and South Korea),and observation periods(i.e.,≤5 years and>5 years).The heterogeneity and publication bias were also measured.RESULTS For non-GC patients with atrophic gastritis and patients after resection for GC,4 and 4 RCTs and 12 and 18 cohort studies were included,respectively.In RCTs,the median incidence of GC for the untreated control groups and the treatment groups was 272.7(180.4–322.4)and 162.3(72.5–588.2)per 100000 person-years in non-GC cases with atrophic gastritis and 1790.7(406.5–2941.2)and 1126.2(678.7–1223.1)per 100000 person-years in cases of after resection for GC.Compared with non-treated H.pylori-positive controls,the eradication groups had a significantly reduced risk of GC,with a relative risk of 0.67[95%confidence interval(CI):0.47–0.96]for non-GC patients with atrophic gastritis and 0.51(0.36–0.73)for patients after resection for GC in the RCTs,and 0.39(0.30–0.51)for patients with gastritis and 0.54(0.44–0.67)for patients after resection in cohort studies.CONCLUSION In the East Asian population with a high risk of GC,H.pylori eradication effectively reduced the risk of GC,irrespective of past history of previous cancer.展开更多
Colorectal carcinoma(CRC) is one of the most frequent cancers. Along the surface of the large bowel, several foci of CRC may appear simultaneously or over the time. The development of at least two different tumours ha...Colorectal carcinoma(CRC) is one of the most frequent cancers. Along the surface of the large bowel, several foci of CRC may appear simultaneously or over the time. The development of at least two different tumours has been defined as multiple primary CRC(MPCRC):When more than one tumour is diagnosed at the same time, it is known as synchronous CRC(SCRC), while when a second neoplasm is diagnosed some time after the resection and/or diagnosis of the first lesion, it is called metachronous CRC(MCRC). Multiple issues can promote the development of MPCRC, ranging from different personal factors, such as environmental exposure, to familial predisposition due to hereditary factors. However, most studies do not distinguish this dichotomy. High- and low-pentrance genetic variants are involved in MPCRC. An increased risk for MPCRC has been described in Lynch syndrome, familial adenomatous polyposis, and serrated polyposis. Non-syndromic familial CRCs should also be considered as risk factors for MPCRC. Environmental factors can promote damage to colon mucosae that enable the concurrence of MPCRC. Epigenetics are thought to play a major role in the carcinogenesis of sporadic MPCRC. The methylation state of the DNA depends on multiple environmental factors(e.g., smoking and eating foods cooked at high temperatures), and this can contribute to increasing the MPCRC rate. Certain clinical features may also suggest individual predisposition for MPCRC. Different etiopathogenic factors are suspected to be involved in SCRC and MCRC, and different familial vs individual factors may be implicated. MCRC seems to follow a familial pattern, whereas individual factors are more important in SCRC. Further studies must be carried out to know the molecular basis of risks for MPCRC in order to modify, if necessary, its clinical management, especially from a preventive point of view.展开更多
To investigate predictive markers for metachronous and synchronous gastric cancer (GC), which can develop after endoscopic submucosal dissection (ESD). METHODSA total of 352 patients underwent ESD for early GC at NTT ...To investigate predictive markers for metachronous and synchronous gastric cancer (GC), which can develop after endoscopic submucosal dissection (ESD). METHODSA total of 352 patients underwent ESD for early GC at NTT West Osaka Hospital between June 2006 and February 2016. Exclusion criteria were as follows: Remnant stomach, unknown Helicobacter pylori status, and endoscopic observation of the whole stomach outside our hospital. We analyzed data from 192 patients comprising 109 patients with solitary GC (Group A) and 83 with metachronous and synchronous GC (Group B). We retrospectively investigated the clinicopathological and endoscopic characteristics, and endoscopic risk score as predictive markers for GC. RESULTSThe median age of Group B [72 years (interquartile range 63-78)] was significantly higher than that of Group A [66 years (interquartile range 61-74), respectively, P = 0.0009]. The prevalence of intestinal metaplasia in Group B tended to be higher than that in Group A (57.8% vs 45.0%, P = 0.08). The prevalence of gastric xanthoma (GX) in Group B was significantly higher than that in Group A (54.2% vs 32.1%, P = 0.003). The atrophy score in Group B was significantly higher than that in Group A (P = 0.005). Multivariate analysis revealed that higher age and the presence of GX were independently related to metachronous and synchronous GC [OR = 1.04 (1.01-1.08), P = 0.02; and OR = 2.11 (1.14-3.99), P = 0.02, respectively]. CONCLUSIONThe presence of GX is a useful predictive marker for metachronous and synchronous GC.展开更多
AIM To evaluate prognostic pathological factors associated with early metachronous disease and adverse longterm survival in these patients.METHODS Clinical and histological features were analysed retrospectively over ...AIM To evaluate prognostic pathological factors associated with early metachronous disease and adverse longterm survival in these patients.METHODS Clinical and histological features were analysed retrospectively over an eight-year period for prognostic impact on recurrent disease and overall survival in patients undergoing curative resection of a primary colorectal cancer. RESULTS A total of 266 patients underwent curative surgery during the study period. The median age of the study cohort was 68 year(range 26 to 91) with a followup of 7.9 years(range 4.6 to 12.6). Resection was undertaken electively in 225(84.6%) patients and emergency resection in 35(13.2%). Data on timing of surgery was missing in 6 patients. Recurrence was noted in 67(25.2%) during the study period and was predominantly early within 3 years(82.1%) and involved hepatic metastasis in 73.1%. Emergency resection(OR = 3.60, P = 0.001), T4 stage(OR = 4.33, P < 0.001) and lymphovascular invasion(LVI) (OR = 2.37, P = 0.032) were associated with higher risk of recurrent disease. Emergency resection, T4 disease and a high lymph node ratio(LNR) were strong independent predictors of adverse long-term survival. CONCLUSION Emergency surgery is associated with adverse disease free and long-term survival. T4 disease, LVI and LNR provide strong independent predictive value of longterm outcome and can inform surveillance strategies to improve outcomes.展开更多
Helicobacter pylori(H.pylori) infection was thought to be the main cause of gastric cancer,and its eradication showed improvement in gastric inflammation and dec-reased the risk of gastric cancer.Recently,a number of ...Helicobacter pylori(H.pylori) infection was thought to be the main cause of gastric cancer,and its eradication showed improvement in gastric inflammation and dec-reased the risk of gastric cancer.Recently,a number of studies reported the occurrence of gastric cancer after successful eradication.Patients infected with H.pylori,even after eradication,have a higher risk for the occurrence of gastric cancer when compared with uninfected patients.Metachronous gastric cancer occurs frequently following the endoscopic removal of early gastric cancer.These data indicate that metachronous cancer leads to the occurrence of gastric cancer even after successful eradication of H.pylori.The pathogenesis of this metachronous cancer remains unclear.Further research is needed to identify biomarkers to predict the development of metachronous gastric cancer and methods for gastric cancer screening.In this article,we review the role of the H.pylori in carcinogenesis and the histological and endoscopic characteristics and risk factors for metachronous gastric cancer after eradication.Additionally,we discuss recent risk predictions and possible approaches for reducing the risk of metachro-nous gastric cancer after eradication.展开更多
BACKGROUND Studies evaluating the characteristics of dual primary gastric and colorectal cancer(CRC)(DPGCC)are limited.AIM To analyze the clinicopathologic characteristics and prognosis of synchronous and metachronous...BACKGROUND Studies evaluating the characteristics of dual primary gastric and colorectal cancer(CRC)(DPGCC)are limited.AIM To analyze the clinicopathologic characteristics and prognosis of synchronous and metachronous cancers in patients with DPGCC.METHODS From October 2010 to August 2021,patients with DPGCC were retrospectively reviewed.The patients with DPGCC were divided into two groups(synchronous and metachronous).We compared the overall survival(OS)between the groups using Kaplan-Meier survival methods.Univariate and multivariate analyses were performed using Cox’s proportional hazards model to identify the independent prognostic factors for OS.RESULTS Of the 76 patients with DPGCC,46 and 30 had synchronous and metachronous cancers,respectively.The proportion of unresectable CRC in patients with synchronous cancers was higher than that in patients with metachronous cancers(28.3%vs 3.3%,P=0.015).The majority of the second primary cancers had occurred within 5 years.Kaplan-Meier survival analysis showed that the patients with metachronous cancers had a better prognosis than patients with synchronous cancers(P=0.010).The patients who had undergone gastrectomy(P<0.001)or CRC resection(P<0.001)had a better prognosis than those who had not.In the multivariate analysis,synchronous cancer[hazard ratio(HR)=6.8,95%confidence interval(95%CI):2.0-22.7,(P=0.002)]and stage III-IV gastric cancer(GC)[HR=10.0,95%CI:3.4-29.5,(P<0.001)]were risk prognostic factor for OS,while patients who underwent gastrectomy was a protective prognostic factor for OS[HR=0.2,95%CI:0.1-0.6,P=0.002].CONCLUSION Regular surveillance for metachronous cancer is necessary during postoperative follow-up.Surgical resection is the mainstay of therapy to improve the prognosis of DPGCC.The prognosis appears to be influenced by the stage of GC rather than the stage of CRC.Patients with synchronous cancer have a worse prognosis,and its treatment strategy is worth further exploration.展开更多
The occurrence of both primary gastric lymphoma and gastric adenocarcinoma in the same patient is a rare entity. The possible causative factors of synchronous or metachronous occurrence of both malignancies and variet...The occurrence of both primary gastric lymphoma and gastric adenocarcinoma in the same patient is a rare entity. The possible causative factors of synchronous or metachronous occurrence of both malignancies and varieties in the treatment modalities are reviewed according to published cases in English language medical literature.展开更多
Glycogen storage disease type Ia (GSD-Ia; also called von Gierke disease) is an autosomal recessive disorder of carbohydrate metabolism caused by glucose-6-phosphatase deficiency. There have been many reports describ... Glycogen storage disease type Ia (GSD-Ia; also called von Gierke disease) is an autosomal recessive disorder of carbohydrate metabolism caused by glucose-6-phosphatase deficiency. There have been many reports describing hepatic tumors in GSD patients; however, most of these reports were of hepatocellular adenomas, whereas there are only few reports describing focal nodular hyperplasia (FNH) or hepatocellular carcinoma (HCC). We report a case with GSD-Ia who had undergone a partial resection of the liver for FNH at 18 years of age and in whom moderately differentiated HCC had developed. Preoperative imaging studies, including ultrasonography, dynamic computer tomography (CT) and magnetic resonance imaging, revealed benign and malignant features. In particular, fluorodeoxyglucose-positron emission tomography (FDG-PET)/CT revealed the atypical findings that FDG accumulated at high levels in the non-tumorous hepatic parenchyma and low levels in the tumor. Right hemihepatectomy was performed. During the perioperative period, high-dose glucose and sodium bicarbonate were administered to control metabolic acidosis. He had multiple recurrences of HCC at 10 mo after surgery and was followed-up with transcatheter arterial chemoembolization. The tumor was already highly advanced when it was found by chance; therefore, a careful follow-up should be mandatory for GSD-I patients as they are at a high risk for HCC, similar to hepatitis patients.展开更多
Early detection of early gastric cancer(EGC)is important to improve the prognosis of patients with gastric cancer.Recent advances in endoscopic modalities and treatment devices,such as image-enhanced endoscopy and hig...Early detection of early gastric cancer(EGC)is important to improve the prognosis of patients with gastric cancer.Recent advances in endoscopic modalities and treatment devices,such as image-enhanced endoscopy and high-frequency generators,may make endoscopic treatment,such as endoscopic submucosal dissection,a therapeutic option for gastric intraepithelial neoplasia.Consequently,short-term outcomes of endoscopic resection(ER)for EGC have improved.Therefore,surveillance with endoscopy after ER for EGC is becoming more important,but how to perform endoscopic surveillance after ER has not been established,even though the follow-up strategy for more advanced gastric cancer has been outlined.Therefore,a surveillance strategy for patients with EGC after ER is needed.展开更多
文摘To evaluate the clinical impact of surveillance for head and neck (HN) region with narrow band imaging (NBI) in patients with esophageal squamous cell carcinoma (ESCC).METHODSSince 2006, we introduced the surveillance for HN region using NBI for all patients with ESCC before treatment, and each follow-up. The patients with newly diagnosed stage I to III ESCC were enrolled and classified into two groups as follows: Group A (no surveillance for HN region); between 1992 and 2000), and Group B (surveillance for HN region with NBI; between 2006 and 2008). We comparatively evaluated the detection rate of superficial head and neck squamous cell carcinoma (HNSCC), and the serious events due to metachronous advanced HNSCC during the follow-up.RESULTSA total 561 patients (group A: 254, group B: 307) were enrolled. Synchronous superficial HNSCC was detected in 1 patient (0.3%) in group A, and in 12 (3.9%) in group B (P = 0.008). During the follow up period, metachronous HNSCC were detected in 10 patients (3.9%) in group A and in 30 patients (9.8%) in group B (P = 0.008). All metachronous lesions in group B were early stage, and 26 patients underwent local resection, however, 6 of 10 patients (60%) in group A lost their laryngeal function and died with metachronous HNSCC.CONCLUSIONSurveillance for the HN region by using NBI endoscopy increase the detection rate of early HNSCC in patients with ESCC, and led to decrease serious events related to advanced metachronous HNSCC.
文摘Helicobacter pylori(H.pylori)plays an important role in gastric carcinogenesis,as the majority of gastric cancers develop from H.pylori-infected gastric mucosa.The rate of early gastric cancer diagnosis has increased in Japan and Korea,where H.pylori infection and gastric cancer are highly prevalent.Early intestinal-type gastric cancer without concomitant lymph node metastasis is usually treated by endoscopic resection.Secondary metachronous gastric cancers often develop because atrophic mucosa left untreated after endoscopic treatment confers a high risk of gastric cancer.The efficacy of H.pylori eradication for the prevention of metachronous gastric cancer remains controversial.However,in patients who undergo endoscopic resection of early gastric cancer,H.pylori eradication is recommended to suppress or delay metachronous gastric cancer.Careful and regularly scheduled endoscopy should be performed to detect minute metachronous gastric cancer after endoscopic resection.
基金Supported by the 2015 Yeungnam University Research Grant
文摘AIM To investigate the effect of Helicobacter pylori(H. pylori) status test and H. pylori eradication on the occurrence of metachronous gastric cancer(MGC) after endoscopic submucosal dissection(ESD) of early gastric cancer(EGC) and risk factors of MGC. METHODS The authors retrospectively reviewed the medical records of 433 patients(441 lesions) who underwent ESD for EGC from January 2005 to January 2015 in Yeungnam University Hospital. Patients were categorized into two groups; the H. pylori tested group(n = 257) and the H. pylori non-tested group(n = 176) based on performance of H. pylori status test after ESD of EGC. The H. pylori tested group was further categorized into three subgroups based on H. pylori status; the H. pylori-eradicated subgroup(n = 120), the H. pylori-persistent subgroup(n = 42), and the H. pylori-negative subgroup(n = 95). Incidences of MGC and risk factors of MGC were identified.RESULTS Median follow-up duration after ESD was 30.00 mo(range, 6-107 mo). Total 15 patients developed MGC during follow-up. MGC developed in 11 patients of the H. pylori tested group(7 in the H. pylori-negative subgroup, 3 in the H. pylori-eradicated subgroup, and 1 in the H. pylori-persistent subgroup) and 4 patients of the H. pylori non-tested group(P > 0.05). The risk factors of MGC were endoscopic mucosal atrophy in the H. pylori tested group and intestinal metaplasia in all patients. CONCLUSION H. pylori eradication and H. pylori status test seems to have no preventive effect on the development of MGC after ESD for EGC. The risk factors of MGC development were endoscopic mucosal atrophy in the H. pylori tested group alone and intestinal metaplasia in all patients.
文摘BACKGROUND Helicobacter pylori(H.pylori)infection is a risk factor for gastric cancer(GC),especially in East Asian populations.Most East Asian populations infected with H.pylori are at higher risk for GC than H.pylori-positive European and United States populations.H.pylori eradication therapy reduces gastric cancer risk in patients after endoscopic and operative resection for GC,as well as in non-GC patients with atrophic gastritis.AIM To clarify the chemopreventive effects of H.pylori eradication therapy in an East Asian population with a high incidence of GC.METHODS PubMed and the Cochrane library were searched for randomized control trials(RCTs)and cohort studies published in English up to March 2019.Subgroup analyses were conducted with regard to study designs(i.e.,RCTs or cohort studies),country where the study was conducted(i.e.,Japan,China,and South Korea),and observation periods(i.e.,≤5 years and>5 years).The heterogeneity and publication bias were also measured.RESULTS For non-GC patients with atrophic gastritis and patients after resection for GC,4 and 4 RCTs and 12 and 18 cohort studies were included,respectively.In RCTs,the median incidence of GC for the untreated control groups and the treatment groups was 272.7(180.4–322.4)and 162.3(72.5–588.2)per 100000 person-years in non-GC cases with atrophic gastritis and 1790.7(406.5–2941.2)and 1126.2(678.7–1223.1)per 100000 person-years in cases of after resection for GC.Compared with non-treated H.pylori-positive controls,the eradication groups had a significantly reduced risk of GC,with a relative risk of 0.67[95%confidence interval(CI):0.47–0.96]for non-GC patients with atrophic gastritis and 0.51(0.36–0.73)for patients after resection for GC in the RCTs,and 0.39(0.30–0.51)for patients with gastritis and 0.54(0.44–0.67)for patients after resection in cohort studies.CONCLUSION In the East Asian population with a high risk of GC,H.pylori eradication effectively reduced the risk of GC,irrespective of past history of previous cancer.
文摘Colorectal carcinoma(CRC) is one of the most frequent cancers. Along the surface of the large bowel, several foci of CRC may appear simultaneously or over the time. The development of at least two different tumours has been defined as multiple primary CRC(MPCRC):When more than one tumour is diagnosed at the same time, it is known as synchronous CRC(SCRC), while when a second neoplasm is diagnosed some time after the resection and/or diagnosis of the first lesion, it is called metachronous CRC(MCRC). Multiple issues can promote the development of MPCRC, ranging from different personal factors, such as environmental exposure, to familial predisposition due to hereditary factors. However, most studies do not distinguish this dichotomy. High- and low-pentrance genetic variants are involved in MPCRC. An increased risk for MPCRC has been described in Lynch syndrome, familial adenomatous polyposis, and serrated polyposis. Non-syndromic familial CRCs should also be considered as risk factors for MPCRC. Environmental factors can promote damage to colon mucosae that enable the concurrence of MPCRC. Epigenetics are thought to play a major role in the carcinogenesis of sporadic MPCRC. The methylation state of the DNA depends on multiple environmental factors(e.g., smoking and eating foods cooked at high temperatures), and this can contribute to increasing the MPCRC rate. Certain clinical features may also suggest individual predisposition for MPCRC. Different etiopathogenic factors are suspected to be involved in SCRC and MCRC, and different familial vs individual factors may be implicated. MCRC seems to follow a familial pattern, whereas individual factors are more important in SCRC. Further studies must be carried out to know the molecular basis of risks for MPCRC in order to modify, if necessary, its clinical management, especially from a preventive point of view.
文摘To investigate predictive markers for metachronous and synchronous gastric cancer (GC), which can develop after endoscopic submucosal dissection (ESD). METHODSA total of 352 patients underwent ESD for early GC at NTT West Osaka Hospital between June 2006 and February 2016. Exclusion criteria were as follows: Remnant stomach, unknown Helicobacter pylori status, and endoscopic observation of the whole stomach outside our hospital. We analyzed data from 192 patients comprising 109 patients with solitary GC (Group A) and 83 with metachronous and synchronous GC (Group B). We retrospectively investigated the clinicopathological and endoscopic characteristics, and endoscopic risk score as predictive markers for GC. RESULTSThe median age of Group B [72 years (interquartile range 63-78)] was significantly higher than that of Group A [66 years (interquartile range 61-74), respectively, P = 0.0009]. The prevalence of intestinal metaplasia in Group B tended to be higher than that in Group A (57.8% vs 45.0%, P = 0.08). The prevalence of gastric xanthoma (GX) in Group B was significantly higher than that in Group A (54.2% vs 32.1%, P = 0.003). The atrophy score in Group B was significantly higher than that in Group A (P = 0.005). Multivariate analysis revealed that higher age and the presence of GX were independently related to metachronous and synchronous GC [OR = 1.04 (1.01-1.08), P = 0.02; and OR = 2.11 (1.14-3.99), P = 0.02, respectively]. CONCLUSIONThe presence of GX is a useful predictive marker for metachronous and synchronous GC.
文摘AIM To evaluate prognostic pathological factors associated with early metachronous disease and adverse longterm survival in these patients.METHODS Clinical and histological features were analysed retrospectively over an eight-year period for prognostic impact on recurrent disease and overall survival in patients undergoing curative resection of a primary colorectal cancer. RESULTS A total of 266 patients underwent curative surgery during the study period. The median age of the study cohort was 68 year(range 26 to 91) with a followup of 7.9 years(range 4.6 to 12.6). Resection was undertaken electively in 225(84.6%) patients and emergency resection in 35(13.2%). Data on timing of surgery was missing in 6 patients. Recurrence was noted in 67(25.2%) during the study period and was predominantly early within 3 years(82.1%) and involved hepatic metastasis in 73.1%. Emergency resection(OR = 3.60, P = 0.001), T4 stage(OR = 4.33, P < 0.001) and lymphovascular invasion(LVI) (OR = 2.37, P = 0.032) were associated with higher risk of recurrent disease. Emergency resection, T4 disease and a high lymph node ratio(LNR) were strong independent predictors of adverse long-term survival. CONCLUSION Emergency surgery is associated with adverse disease free and long-term survival. T4 disease, LVI and LNR provide strong independent predictive value of longterm outcome and can inform surveillance strategies to improve outcomes.
文摘Helicobacter pylori(H.pylori) infection was thought to be the main cause of gastric cancer,and its eradication showed improvement in gastric inflammation and dec-reased the risk of gastric cancer.Recently,a number of studies reported the occurrence of gastric cancer after successful eradication.Patients infected with H.pylori,even after eradication,have a higher risk for the occurrence of gastric cancer when compared with uninfected patients.Metachronous gastric cancer occurs frequently following the endoscopic removal of early gastric cancer.These data indicate that metachronous cancer leads to the occurrence of gastric cancer even after successful eradication of H.pylori.The pathogenesis of this metachronous cancer remains unclear.Further research is needed to identify biomarkers to predict the development of metachronous gastric cancer and methods for gastric cancer screening.In this article,we review the role of the H.pylori in carcinogenesis and the histological and endoscopic characteristics and risk factors for metachronous gastric cancer after eradication.Additionally,we discuss recent risk predictions and possible approaches for reducing the risk of metachro-nous gastric cancer after eradication.
基金Supported by National Natural Science Foundation of China,No.82070684the Fundamental and Applied Basic Research Program of Guangdong Province,No.2020B151502005+3 种基金the Bethune Aixikang Distinguished Surgical Fund project,No.HZB-20190528-5China international medical foundation,No.Z-2017-24-2110the Program of Guangdong Provincial Clinical Research Center for Digestive Diseases,No.2020B1111170004the National Key Clinical Discipline.
文摘BACKGROUND Studies evaluating the characteristics of dual primary gastric and colorectal cancer(CRC)(DPGCC)are limited.AIM To analyze the clinicopathologic characteristics and prognosis of synchronous and metachronous cancers in patients with DPGCC.METHODS From October 2010 to August 2021,patients with DPGCC were retrospectively reviewed.The patients with DPGCC were divided into two groups(synchronous and metachronous).We compared the overall survival(OS)between the groups using Kaplan-Meier survival methods.Univariate and multivariate analyses were performed using Cox’s proportional hazards model to identify the independent prognostic factors for OS.RESULTS Of the 76 patients with DPGCC,46 and 30 had synchronous and metachronous cancers,respectively.The proportion of unresectable CRC in patients with synchronous cancers was higher than that in patients with metachronous cancers(28.3%vs 3.3%,P=0.015).The majority of the second primary cancers had occurred within 5 years.Kaplan-Meier survival analysis showed that the patients with metachronous cancers had a better prognosis than patients with synchronous cancers(P=0.010).The patients who had undergone gastrectomy(P<0.001)or CRC resection(P<0.001)had a better prognosis than those who had not.In the multivariate analysis,synchronous cancer[hazard ratio(HR)=6.8,95%confidence interval(95%CI):2.0-22.7,(P=0.002)]and stage III-IV gastric cancer(GC)[HR=10.0,95%CI:3.4-29.5,(P<0.001)]were risk prognostic factor for OS,while patients who underwent gastrectomy was a protective prognostic factor for OS[HR=0.2,95%CI:0.1-0.6,P=0.002].CONCLUSION Regular surveillance for metachronous cancer is necessary during postoperative follow-up.Surgical resection is the mainstay of therapy to improve the prognosis of DPGCC.The prognosis appears to be influenced by the stage of GC rather than the stage of CRC.Patients with synchronous cancer have a worse prognosis,and its treatment strategy is worth further exploration.
文摘The occurrence of both primary gastric lymphoma and gastric adenocarcinoma in the same patient is a rare entity. The possible causative factors of synchronous or metachronous occurrence of both malignancies and varieties in the treatment modalities are reviewed according to published cases in English language medical literature.
文摘 Glycogen storage disease type Ia (GSD-Ia; also called von Gierke disease) is an autosomal recessive disorder of carbohydrate metabolism caused by glucose-6-phosphatase deficiency. There have been many reports describing hepatic tumors in GSD patients; however, most of these reports were of hepatocellular adenomas, whereas there are only few reports describing focal nodular hyperplasia (FNH) or hepatocellular carcinoma (HCC). We report a case with GSD-Ia who had undergone a partial resection of the liver for FNH at 18 years of age and in whom moderately differentiated HCC had developed. Preoperative imaging studies, including ultrasonography, dynamic computer tomography (CT) and magnetic resonance imaging, revealed benign and malignant features. In particular, fluorodeoxyglucose-positron emission tomography (FDG-PET)/CT revealed the atypical findings that FDG accumulated at high levels in the non-tumorous hepatic parenchyma and low levels in the tumor. Right hemihepatectomy was performed. During the perioperative period, high-dose glucose and sodium bicarbonate were administered to control metabolic acidosis. He had multiple recurrences of HCC at 10 mo after surgery and was followed-up with transcatheter arterial chemoembolization. The tumor was already highly advanced when it was found by chance; therefore, a careful follow-up should be mandatory for GSD-I patients as they are at a high risk for HCC, similar to hepatitis patients.
文摘Early detection of early gastric cancer(EGC)is important to improve the prognosis of patients with gastric cancer.Recent advances in endoscopic modalities and treatment devices,such as image-enhanced endoscopy and high-frequency generators,may make endoscopic treatment,such as endoscopic submucosal dissection,a therapeutic option for gastric intraepithelial neoplasia.Consequently,short-term outcomes of endoscopic resection(ER)for EGC have improved.Therefore,surveillance with endoscopy after ER for EGC is becoming more important,but how to perform endoscopic surveillance after ER has not been established,even though the follow-up strategy for more advanced gastric cancer has been outlined.Therefore,a surveillance strategy for patients with EGC after ER is needed.
