Hong Fu

Prognostic factors for extra‐abdominal and abdominal wall desmoids: A 20‐year experience at a single institution

Previous reports even large studies discussing the prognosis of desmoids have included tumors from intra‐ and extra‐abdominal sites as well as incomplete resection. The purpose of this study was to explore prognostic factors associated with the recurrence free survival (RFS) rate in surgically treated extra‐abdominal and abdominal wall desmoids.

Fibroblast growth factor receptor 4 regulates proliferation and antiapoptosis during gastric cancer progression

Fibroblast growth factor receptor 4 (FGFR4) belongs to the tyrosine kinase receptor family. Little is known about the effect of FGFR4 on gastric cancer (GC). Therefore, the objective of the current study was to elucidate the role of FGFR4 in the tumorigenesis and progression of GC.

Prognostic factors influencing event-free survival and treatments in desmoid-type fibromatosis: analysis from a large institution

BACKGROUND Prognostic factors and optimal management of desmoid tumors have been discussed for decades. The authors present the results of a large series of patients with desmoid tumors treated at a single institution to investigate the prognostic factors influencing event-free survival (EFS) and suitable treatments for these rare tumors. METHODS Two hundred fourteen patients with desmoid tumors admitted to the surgical department were included, of whom 20 were recommended for a policy of watchful waiting. The following clinical parameters were studied: admission status, age, sex, tumor site, tumor size, margin status, and therapeutic strategy. Univariate and multivariate analysis were performed for EFS. RESULTS Forty-two patients had local recurrence. One patient died of intra-abdominal disease. The 5-year and 10-year EFS rates were 78.8% and 77.9%, respectively. In univariate analysis, admission status, tumor site, tumor size, and group (R0 vs R1 and R0 vs R2) had significant impacts on EFS. EFS discrepancy was not significant between R1 and R2 or biopsy groups. In multivariate analysis, tumor size and admission status had independent value. The median delay to progression for patients undergoing watchful waiting was comparable with that for the surgical group. CONCLUSIONS This study demonstrates that tumor size and a history of recurrence are independent predictors of EFS. Surgery is warranted if it can be R0 and function sparing. Nonsurgical modalities or a policy of watchful waiting may be a better choice for unresectable disease.

Prognostic analysis of familial gastric cancer in Chinese population.

The aim of this study was firstly to elucidate the prognosis of familial gastric cancer (FGC) in Chinese population.

Defining a High-Risk Subgroup of Pathological T2N0 Gastric Cancer by Prognostic Risk Stratification for Adjuvant Therapy

BackgroundAdjuvant therapy is not usually recommended in AJCC T2N0M0 gastric cancer, yet sometimes is indicated for high-risk patients. The purpose of this study is to stratify the risk of pathological T2N0 gastric cancer after gastrectomy based on clinicopathological factors so as to predict prognosis and guide treatment.MethodsWe analyzed our documented clinical database of 233 patients with T2N0M0 gastric cancer who underwent radical resection between 2000 and 2007. No adjuvant chemotherapy was applied.ResultsFor the entire study group, the overall 5-year survival rate was 88.5%. Multivariate analysis indicated there were three tumor characteristics which were independent prognostic factors: lymphatic and/or blood vessel invasion (p = 0.025), tumor diameter (p = 0.004), and perineural invasion (p = 0.009). Three risk groups were created based on weighted variables with overall 5-year survival of 97.7%, 83%, and 50.3% as low-risk, intermediate-risk, and high-risk groups, respectively (p < 0.001).ConclusionPatients with T2N0 gastric cancer have a favorable prognosis after radical resection. A prognostic risk model of patients with pT2N0 gastric cancer undergoing radical resection is constructed based on lymphatic and/or blood vessel invasion, tumor diameter, and perineural invasion. The prognostic risk model identifies a small subgroup of patients with an increased risk of death, suggesting adjuvant therapy may be considered for these patients.

Impact of lymphatic and/or blood vessel invasion in stage II gastric cancer

AIM To determine the prognostic value of lymphatic and/or blood vessel invasion (LBVI) in patients with stage II gastric cancer. METHODS From January 2001 to December 2006, 487 patients with histologically confirmed primary gastric adenocarcinoma were diagnosed with stage II gastric cancer according to the new 7th edition American Joint Committee on Cancer stage classification at the Department of Gastric Cancer and Soft Tissue Surgery, Fudan University Shanghai Cancer Center. All patients underwent curative gastrectomy with standard lymph node (LN) dissection. Fifty-one patients who died in the postoperative period, due to various complications or other conditions, were excluded. Clinicopathological findings and clinical outcomes were analyzed. Patients were subdivided into four groups according to the status of LBVI and LN metastases. These four patient groups were characterized with regard to age, sex, tumor site, pT category, tumor grading and surgical procedure (subtotal resection vs total resection), and compared for 5-year overall survival by univariate and multivariate analysis. RESULTS The study was composed of 320 men and 116 women aged 58.9 ± 11.5 years (range: 23-88 years). The 5-year overall survival rates were 50.7% and the median survival time was 62 mo. Stage IIa cancer was observed in 334 patients, including 268 T3N0, 63 T2N1, and three T1N2, and stage IIb was observed in 102 patients, including 49 patients T3N1, 51 T2N2, one T1N3, and one T4aN0. The incidence of LBVI was 28.0% in stage II gastric cancer with 19.0% (51/269) and 42.5% (71/167) in LN-negative and LN-positive patients, respectively. In 218 patients (50.0%), there was neither a histopathologically detectable LBVI nor LN metastases (LBVI(-)/LN(-), group I); in 51 patients (11.7%), LBVI with no evidence of LN metastases was detected (LBVI(+)/LN(-), group II). In 167 patients (38.3%), LN metastases were found. Among those patients, LBVI was not determined in 96 patients (22.0%) (LBVI(-)/LN(+), group III), and was determined in 71 patients (16.3%) (LBVI(+)/LN(+), group IV). Correlation analysis showed that N category and the number of positive LNs were significantly associated with the presence of LBVI (P < 0.001). The overall 5-year survival was significantly longer in LN-negative patients compared with LN-positive patients (56.1% vs 42.3%, P = 0.015). There was a significant difference in the overall 5-year survival between LBVI-positive and LBVI-negative tumors (39.6% vs 54.8%, P = 0.006). Overall 5-year survival rates in each group were 58.8% (I), 45.8% (II), 45.7% (III) and 36.9% (IV), and there was a significant difference in overall survival between the four groups (P = 0.009). Multivariate analysis in stage II gastric cancer patients revealed that LBVI independently affected patient prognosis in LN-negative patients (P = 0.018) but not in LN-positive patients (P = 0.508). CONCLUSION In LN-negative stage II gastric cancer patients, LBVI is an additional independent prognostic marker, and may provide useful information to identify patients with poorer prognosis.

Poor prognostic factors in patients with stage I gastric cancer according to the seventh edition TNM classification: A comparative analysis of three subgroups

The purpose of this study was to investigate the prognosis of stage I gastric cancer and to compare clinicopathologic characteristics by subgroup.

Study on the different expression of molecular markers between cardiac cancer and distal gastric cancer and their correlations with clinicopathological features.

Background and Aim: Currently, few studies have reported the different expression of molecular markers between distal gastric cancer and cardiac cancer. Here, we sought to make an investigation about it by a retrospective analysis. Methods: The expression of 8 proteins, including epidermal growth factor receptor, glutathione S-transferase π (GST-π), cyclin D1, Neu/Her-2, C-myc, p53, p27 and p21, were evaluated in 110 cases with cardiac cancer and 101 cases with distal gastric cancer who underwent curative surgery at the Cancer Hospital, Fudan University, in 2005 by immunohistochemistry method. Results: The TNM stage, differentiation grade, invasion depth and lymph node metastasis were significantly different between cardiac cancer and distal gastric cancer. p21 (p = 0.034), Neu (p = 0.017), and GST-π (p = 0.003) were expressed in relatively higher levels in cardiac cancer than in distal gastric cancer. Furthermore, the clinical pathological parameters were significantly correlated with the expression of molecules mentioned above. Conclusion: Different molecular mechanisms may be involved in the tumorigenesis and development of cardiac cancer and distal gastric cancer.

CT Scan is not Everything in the Evaluation of a Patient with Gastrointestinal Tumors (GIST) Under Imatinib Therapy

To the Editor: A number of clinical studies have shown dramatic clinical and radiographic responses to imatinib mesylate in patients with gastrointestinal stromal tumors (GISTs). The degree and pattern of enhancement observed on CT scans are useful for differentiating malignant from benign tumors and identifying posttreatment changes. In contrast to minor tumour shrinkage visualized by imaging modalities, histological examinations demonstrate obviously dormant or apoptotic-like tumour cells embedded in hyaline-degenerated tissue [1].Here we report a patient who received resection after imatinib therapy, in whom the tumor response evaluated through CT scans was in contradiction of the findings of histopathological examination. In December 2004, a 41-year-old male was referred to our hospital with presence of a submucosal tumor of the stomach by Upper gastrointestinal endoscopy. He underwent a partial proximal gastrectomy combined with a distal pancreaticosplenectomy and partial epinephroectomy, and the tumor was radically resected. The tumor was diagnosed as GIST for been composed of affluent spindle cells (Fig. 1), and positive staining for CD117 and CD34. The adjuvant treatment with imatinib for 400 mg per day was started one month after the operation. The patient responded to the imatinib therapy well, and there was no tumors recurred through CT scan during the treatment. Ten months later, the administration was discontinued because of economic aspects, possibly due to moderate adverse effects of the imatinib. The patient was followed up through CT scan in outpatient department every three months. In February 2008, a new nodule located between the residual stomach and liver, adhering to the inferior caval vein,about 10 cm in diameter, was detected by CT scan (Fig. 2). We thus restarted the administration of imatinib at that time. Six months after restarting the imatinib treatment, an abdominal CT depicted a smaller nodule with 6 cm in diameter in the same place (Fig. 3), with the same tumor density and tumor vessels as before. Since the recurrent tumor was limited, the patient underwent complete surgical resection in August 2008. Histologically, the GIST cells disappeared in the samples from the second resection, instead of much collagen with hyaline degeneration, among them exist a few small vessles (Fig. 4), thus the recurrent tumor under imatinib therapy was diagnosed as abdominal cavity reactiveness fibropseudoneoplasm. The immunohistochemical examinations revealed the tumor to show negative staining for CD117,CD34. After this operation, the imatinib treatment was discontinued, and the patient was closely followed up by CT scan every six months and there has been no recurrence (for the 16 months, cross out) until now since the second operation. Imatinib mesylate is a small molecule, which selectively inhibits the enzymatic activity of several tyrosine kinases, and provides a clinical benefit in about 85% of patients with advanced GISTs [2], with 5% of those with a CR C. M. Wang :H. Fu :G. F. Zhao :Y. Q. Shi (*) Abdominal Department, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai 200032, People’s Republic of China e-mail: shiyingqiang@yeah.net