Search

Background/purpose: The choice of endoscopic submucosal dissection (ESD) as first line treatment for selected early gastric cancer (EGC) patients was proved as effective as surgical treatment in studies over many countries. Yet there is no such cohort comparison in Taiwan. This study is aimed to describe our experience in ESD treated EGC and to compare the outcomes with those underwent surgical treatment.Methods: This was a retrospective cohort study reviewing the patients with EGC underwent ESD and surgical treatments in a single tertiary referral center in Taiwan. The primary endpoint was disease specific survival. Recurrence free survival and length of hospital stay were also compared.Results: The disease specific survival between indicated ESD and surgery showed no significant difference (cumulative survival 100% vs. 97.03%, p = 0.39), so as the recurrence free survival (cumulative survival 92.31% vs. 94.06%, p = 0.60). In subgroup analyses of ESD treated patients, a non-significant recurrence rate difference between indicated and non-indicated ESD was found (cumulative recurrence 7.69% vs. 20%, p = 0.39) and a higher recurrence rate in patients with non-R0 resection compared with R0 resection (cumulative recurrence 0% vs. 40%, p < 0.01). However, the shorter duration of hospital stay in ESD group was noted in comparison to surgery (mean 5.67 days vs. 15.75 days, p < 0.01). The ESD patients have minor complications including bleeding, perforation and fever than surgery.Conclusion: ESD is a reasonable first line treatment in selected early gastric cancer in additional to surgery. Pre-treatment evaluation and post-ESD review of curability is crucial to further surveillance program or definite therapy including surgery. [ABSTRACT FROM AUTHOR]

Background Helicobacter pylori infection increases the risk of gastric cancer. The study aimed to compare cost-effectiveness ratios of H. pylori test-and-treat programs to prevent gastric cancer in Taiwan, referring to the nationwide reimbursement database and expected years of life lost. Materials and Methods During 1998-2009, there were 12,857 females and 24,945 males with gastric adenocarcinoma in Taiwan National Cancer Registry. They were followed up to 2010 and linked to the reimbursement database of National Health Insurance and the national mortality registry to determine lifetime health expenditures and expected years of life lost. Cost-effectiveness ratios of H. pylori test-and-treat programs for prevention of gastric adenocarcinoma were compared between screenings with 13C-urea breath test and with anti- H. pylori IgG. Results The test-and-treat program with anti- H. pylori IgG to prevent gastric adenocarcinoma had lower incremental cost-effectiveness ratios than that with 13C-urea breath test in both sexes (females: 244 vs 1071 US dollars/life-year; males: 312 vs 1431 US dollars/life-year). Cost saving would be achieved in an endemic area where H. pylori prevalence was >73.5%, or by selecting subpopulations with high absolute risk reduction rates of cancer after eradication. Moreover, expected years of life lost of gastric adenocarcinoma were higher and the incremental cost-effectiveness ratios of test-and-treat programs were more cost-effective in young adults (30-69 y/o) than in elders (≥70 y/o). Conclusions The test-and-treat program with anti- H. pylori IgG shall be cost-effective to prevent gastric adenocarcinoma in a high endemic area, especially beginning at 30 years of age when H. pylori prevalence rates become stabilized. [ABSTRACT FROM AUTHOR]

Background: Epidemiological data concerning the association between diabetes and the subsequent development of gastric cancer are controversial. This population-based retrospective cohort study investigated the subsequent risk of gastric cancer for diabetic patients. Methods: From claims data of the universal health insurance of Taiwan, we identified 19,625 persons aged ≥20 years newly diagnosed with diabetes during 2000-2005. A comparison group ( n = 78,500), frequency matched by age, sex, and calendar year, was randomly selected from people without diabetes. Incidence and hazard ratios (HR) of gastric cancer were ascertained during the follow-up period until 2008. We also explored associations of antidiabetic medicines with the incidence of gastric cancer. Results: During the follow-up period, 47 subjects in the diabetic group and 216 subjects in the comparison group suffered gastric cancer, with the incidence rates of 4.34 and 4.86 per 10,000 person-years, respectively. During the first 4 years after diabetes diagnosis, the incidence of gastric cancer was relatively low in diabetic patients [adjusted HR = 0.63; 95 % confidence interval (CI) = 0.42-0.97]. However, after that time, the diabetic group had a 76 % (95 % CI = 1.06-2.91) higher risk of developing gastric cancer than the comparison group. In diabetic patients, alpha-glucosidase inhibitors were associated with a significantly decreased risk of gastric cancer (adjusted HR = 0.38; 95 % CI = 0.15-0.96). Conclusions: Our findings suggested that the association between diabetes and subsequent risk of gastric cancer may vary over time. Increased risk of gastric cancer was observed in patients with longer duration of diabetes. [ABSTRACT FROM AUTHOR]

When a study population is relatively healthy, such as an occupational population, epidemiological studies are likely to underestimate risk. We used a case study on the cancer risk of workers with exposure to acid mists, a well-documented carcinogen, to demonstrate that using proportional mortality ratios (PMRs) is more appropriate than mortality ratios in assessing risk in terms of mortality. The study included 10,229 employees of a telecommunication company who worked in buildings with battery rooms. In these buildings, the battery rooms had the highest levels of sulfuric acid in the air (geometric mean = 10.7 μg/m 3 ). With the general population in Taiwan as a reference, a decreased standardized mortality ratio (0.42, p < 0.01) from all causes combined, between 1 January 1985 and 31 December 1996, was observed, indicating a healthy worker effect. When we reanalyzed the data using standardized PMR, elevated risks were observed for all cancers combined (1.46, p = 0.01) and cancers of the digestive organs and peritoneum (1.61, p = 0.02), especially stomach cancer (2.94, p = 0.01). The results showed that PMR can detect increases in mortality when a study population is generally healthier than the comparison population and call for further studies on the possible carcinogenic effects of low-level acid mist exposures on the stomach.

Background/purpose: Lanyu Island is a closed environment inhabited by the Yami people, Taiwan's smallest and most primitive tribe. This study assessed the prevalence and risk factors of Helicobacter pylori infection among Lanyu Island residents., Methods: A cross-sectional study was conducted among the inhabitants of Lanyu Island, using the (13)C urea breath test to determine the prevalence of H. pylori. All study participants completed a form requesting demographic data and anthropometric measurements and a questionnaire evaluating socioeconomic characteristics and personal habits. Multiple logistic regression analyses were used to identify independent factors of H. pylori infections, and a two-sided p < 0.05 was considered significant., Results: Among 796 participants, the mean age was 45 ± 13.2 years, with a range of 12-89 years. The overall prevalence of H. pylori infection was 72.1%, and there was no significant difference between genders. The H. pylori-infected group contained higher proportions of Yami people, married individuals, as well as higher rates of alcohol consumption and betel chewing, but lower family incomes and education levels. Multiple logistic models found that Yami ethnicity [odds ratio (OR) = 2.567, 95% confidence interval (CI): 1.344-4.905], alcohol consumption (OR = 1.641, 95% CI: 1.151-2.341), and marital status (OR = 1.779, 95% CI: 1.043-3.032] were associated with H. pylori infection., Conclusion: This cross-sectional study identified a high prevalence of H. pylori infection on Lanyu Island. When investigating H. pylori infection status in a closed environment, such as Lanyu Island, it is important to consider all factors relating to the host population, including environment and lifestyle., (Copyright © 2013. Published by Elsevier B.V.)

Seven new compounds, including three new flavans [tupichinol A-C (1-3)], three new spirostanol sapogenins [tupichigenin D-F (4-6)], and one new pregnane genin [tupipregnenolone (7)], together with 18 known compounds, were isolated from the underground parts of Tupistra chinensis. The structures of the new compounds were elucidated by spectroscopic analysis and chemical evidence. The structures and relative stereochemistry of 1 and 9 were further confirmed by single-crystal X-ray crystallographic analysis. Compounds Delta(25(27))-pentrogenin, 10, and ranmogenin A showed 100%, 96%, and 80% inhibition, respectively, against human gastric tumor (NUGC) cells at a concentration of 50 microM. Delta(25(27))-pentrogenin showed 100% inhibition against human nasopharyngeal carcinoma (HONE-1) cells at a concentration of 50 microM.

Bioassay-directed fractionation of the methanolic extract of the leaves and flowers of Viburnum odoratissimum resulted in the isolation of two new diterpenes, vibsanol A (1) and vibsanol B (2), together with two new triterpenoids, 6beta-hydroxylup-20(29)-en-3-oxo-27,28-dioic acid (3) and 6alpha-hydroxylup-20(29)-en-3-oxo-27,28-dioic acid (4). In addition, the known terpenoids vibsanins B and E, and 6alpha-hydroxylup-20(29)-en-3-oxo-28-oic acid, were also isolated. The structures of the new compounds were established by chemical and spectroscopic means. Vibsanol A (1) and compound 3 exhibited significant cytotoxicity against human gastric (NUGC) tumor cells.

Gastric cancer is one of the most frequent malignant diseases in Taiwan. However, the result of treatment was poor. Since two years ago, we adopted the 'extended radical operation' for gastric cancer, in order to improve the post operative survival of patients with gastric cancer. For evaluating the results and prognosis, we used microcomputer and commercial software to design a computerized database for gastric cancer. The whole system includes three main operations. (1) Basic File Maintenance. (2) Data Analysis and Statistics. (3) Follow-up Data Managements. The operation is under Chinese system with pull-down menu and on-screen help. Rapid and accurate data analysis are the main advantages, and automatic plotting of data to bar/line chart is one of the characteristics by using this computerized database. Other characteristics include error-trapped function, item coding and data transformation.

In a consecutive series of 562 patients with pathologically documented hepatocellular carcinoma (HCC), 12 patients (2.1%) were found to have a second primary malignancy elsewhere. Of these, eight were male, four female, with ages ranging from 49 to 76 years (mean 60.7 +/- 9.3 years). The associated cancers included eight cases of gastric cancers, an esophageal cancer, a stump cancer, a case of myelocytic leukemia and a histiocytic lymphoma. Eight cases had both malignancies diagnosed at the same admission. In the other four, HCC were detected after an interval of 4, 10, 12 and 39 months. Two had received previous chemotherapy or radiotherapy. Fifty percent of the 12 patients were hepatitis B surface antigen (HBsAg) positive. Their liver function tests and alpha-fetoprotein levels were consistent with those of patients with HCC alone. The results suggest that the occurrence of HCC concomitant with or arising after another primary malignancy in Taiwan is not rare.