Kazuhiko Uefuji

Expression of cyclooxygenase-2 in human gastric adenomas and adenocarcinomas.

The increased expression of cyclooxygenase (COX)‐2 has been implicated in the development and progression of colorectal cancer. We sought to determine the involvement of COX‐2 in human gastric cancer.

Surgical strategy for patients with gastric carcinoma with submucosal invasion. A multivariate analysis

Background. Early gastric cancer can be treated by endoscopic excision or simple wedge surgical resection. Standard gastrectomy often is advised if submucosal invasion is found, even though only 15–25% of these patients have lymph node metastases. In this study, the risk of lymph node involvement was examined by multivariate analysis to develop a simple discriminant function for surgical decision making in this setting.

Proposal of a risk score for recurrence in patients with curatively resected gastric cancer

In this study, 168 patients who underwent curative resection for gastric cancer with prognostic serosal invasion [ps(+)] and 150 without prognostic serosal invasion [ps(−)] were analyzed separately to determine the prognostic importance of clinicopathological factors, and identify which patients were at high risk of recurrence. A multivariate analysis of survival time using Coxs proportional hazard model revealed the important prognostic factors to be: Lymph node involvement, the classification of gross appearance, macroscopic serosal invasion, and interstitial connective tissue in the ps(+) group; and lymph node involvement, macroscopic serosal invasion, and venous invasion in the ps(−) group. We proposed a risk score of recurrence based on the results of a further multivariate analysis called Hayashis Quantification Analysis II, in which recurrence was chosen as an objective variable and the above prognostic factors were chosen as explanatory variables. Eighty-four percent of the patients with a score of 0 or higher in the ps(+) group and 83% of those with a score of +6 or higher in the ps(−) group showed recurrence. Thus, we believe that this score is useful for identifying those patients at high risk of recurrence, who should receive intensive chemotherapy even after curative resection.

Clinical and prognostic characteristics of papillary clear carcinoma of stomach

Papillary clear carcinoma (PCC), a variant of gastric papillary adenocarcinoma, demonstrates the histologic features of cancer cells with clear cytoplasm and no nuclear polarity, resembling the primitive gut epithelium of the fetus. To clarify the clinical and prognostic characteristics of PCC, we examined operative specimens from 73 patients with gastric papillary adenocarcinoma. Light microscopic examination of hematoxylin and eosin (H&E) stained sections of specimens from 15 patients revealed the features of PCC. The patients with PCC demonstrated a higher incidence of Type 3 gross appearance, tumor invasion into the muscularis propria or beyond, involvement of distal lymph nodes, liver metastasis, elevated serum AFP concentrations, and palliative resections. In two subsets of patients who underwent curative resections of tumors invading the muscularis propria or beyond, those with PCC were found to have a significantly lower survival rate than those with other types of papillary adenocarcinoma (P<0.05). PCC histology was a significant prognostic determinant according to multivariate analysis with the Cox proportional hazards model. We conclude that this subclassification of papillary adenocarcinoma, based on the cellular findings, is a useful prognostic indicator, and that intensive adjuvant therapy may be indicated for patients with the features of PCC, even if they have undergone curative resections.