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Background and Objectives Current preoperative N staging does not offer an accurate estimation of lymph node involvement. We establish a new scoring system for predicting N stages to guide a rational lymphadenectomy for gastric cancer. Methods Variables correlated with N stages were selected by multivariate stepwise logistic regression analysis. Variables granted the different scores according to the odds ratio (OR). Receiver operating characteristic (ROC) analysis was used to generate scoring ranges from N0 to N3. The agreement between predicted N staging and actual pN classification was analyzed using kappa statistics. Results Tumor size, depth of invasion, and histological types were selected to establish the scoring system. Scores 0–4, 5–7, 8–9, and 10–13 were postulated to predict N0-3, respectively. The predicted N stage has good agreement with the actual pN classifications. The negative predictive values for N0-3 were 87.0, 86.4, 90.4, and 90.2%; the positive predictive values were 74.7, 62.8, 57.3, and 69.6%, respectively. The accuracy is 82% for N0-1, and 83.7% for N2-3. Conclusions The new scoring system can predict the N stage of gastric cancer. With its good negative predictive value, it is possible to minimize the potential hazards of applying a more extensive lymph node dissection than necessary. J. Surg. Oncol. 2006;93:534–540. © 2006 Wiley-Liss, Inc.

To evaluate the changing trends in clinicopathological characteristics of patients with gastric carcinoma undergoing surgery between 1979 and 2008.Two thousand seven hundred and fifteen patients with gastric cancer who received operation in Liaocheng People's hospital between 1979 and 2008 were analyzed retrospectively, and were compared to 168 patients between 1974 and 1978. Categorical data were evaluated with Chi-squared or Fisher's exact test. Quantitative data were analyzed with nonparametric test. Time series analysis was used to evaluate the changing trend of data.The male to female ratio during 1979-2008 was 3.393, which was higher than that (1.897) during 1974-1978 (χ2=12.193, P0.01). The median age (59 years) during 1979-2008 was higher than that (53.5 years) during 1974-1978 (z=-6.294 P0.01). Comparing the tumor distribution of gastric cancer during 1979-2008 with that during 1974-1978, proportion of gastric cardia and fundus cancer was higher (45.7% vs. 13.0%, χ2=56.596, P0.01), while the proportion of gastric antrum cancer was lower (44.9% vs. 73.2%, χ2=53.980, P0.01). There was no significant difference in gastric body cancer (13.8% vs. 9.4%, χ2=2.026, P=0.155). Compared to 1994-1998, there were more poorly differentiated adenocarcinomas during 2004-2008 (62.1% vs. 51.7%, χ2=12.267, P0.01), and there were less tubular adenocarcinomas during 2004-2008 (23.9% vs. 31.8%, χ2=8.78, P0.01). Time series analysis showed the patient age during 1979 to 2008 increased (Root mean square error=1.275, R-square=0.702), gastric cardia and fundus cancer was increasing and antrum cancer was decreasing (Root mean square error=0.055, R-square=0.798).In the past 30 years from 1979 to 2008, the male to female ratio and the median age of surgical patients with gastric cancer increased with time. The gastric cardia and fundus cancer increased over time, however antrum cancer decreased with time. In the past 15 years from 1994 to 2008, the proportion of poorly differentiated adenocarcinoma increased, and that of tubular adenocarcinoma declined.

To investigate the clinicopathologic characteristics of familiar gastric cancer (FGC) in Chinese.A family with FGC was screened. China National Knowledge Infrastructure was retrieved, and fifteen families with FGC were collected. Systematic literature review was carried out on these sixteen families.There were 63 cases of FGC in these 16 families, 38 males and 25 females, aged 54 (30 - 72). The mean age of the parental patients was 61, older than that of the filial patients (43 years, Z = 3.494, P0.01). There was a correlation between the ages of sibling patients (r(s) = 0.664, P0.01). Among the 44 cases with clearly described tumor location, the tumor was located in the gastric antrum in 21 patients (47.7%). Among the 8 families with complete records of tumor location, 4 families showed consistent tumor location. Accompanying other malignant tumors were seen in 7 families, 5 being tumors in the alimentary canal.The onset age of filial patients with FGC is younger than that of the parental patients in Chinese. The onset ages of the sibling cases are significantly correlated. In a specific family the tumor is nearly located at the same places. And most of tumors are located in gastric antrum.Most of the accompanying tumors are alimentary canal tumors.

To establish a preoperative scoring system to predict the lymph node metastases (N) in gastric cancers.The clinicopathologic data of 291 cases with gastric cancer were analyzed retrospectively. The factors influencing significantly actual lymph node status (pN) were selected through the univariate and the multivariate analysis, and the score of each factor was identified. Scores predicting different N stages were identified using receiver operating characteristic curves. The N stages defined by the score system were compared with the actual pN status using kappa statistics and diagnostic test.Tumor size, depth of invasion and histopathological types were selected to establish the scoring system. According to this score system, scores 0-4 predict N0, scores 5-7 predict N1, scores 8-9 predict N2 and scores 10-13 predict N3. There was a good agreement between N stages predicted by the scoring system and the actual pN status (weighted kappa = 0.605, u = 14.548, P0.0001). The crude agreement, positive predictive value and negative predictive value of the scoring system were 82.8%, 65.6% and 88.5%, respectively.The scoring system can provide accurate and reliable information to predict the lymph node metastases of gastric cancers preoperatively. It is simple and practical to use in clinical work and can help surgeons to choose an optimal extent of lymph node dissection for gastric cancer.

To evaluate the value of the metastatic lymph node ratio (MLR) in predicting the postoperatively survival time of patients with T(3) gastric carcinoma.Eighty-nine patients with T(3) gastric carcinoma who underwent curative gastrectomy were analyzed retrospectively. The correlations between MLR, positive nodes and the total lymph nodes (15 or more) in histologic examination were analyzed using Spearman's correlation analysis. The influence of MLR and positive nodes on survival time of patients was identified with univariate Kaplan-Meier survival analysis and multivariate Cox proportional hazard model analysis. The predicting accuracy of MLR to death of patients within 2 years postoperatively was determined by receiver working characteristic curve and was compared with that of positive nodes.(1) The MLR did not correlate with the total lymph nodes in histologic examination (Spearman's correlation coefficient was -0.0022, P0.05), whereas positive lymph nodes did (correlation coefficient was 0.2504, P0.05). (2) Kaplan-Meier survival analysis identified that the MLR influenced significantly the survival time postoperatively (Log-rank chi(2) = 35.7470, P0.01). Cox proportional hazard model showed the high MLR was an independent poor prognostic factor (chi(2) = 7.9708, P0.01). (3) There was not difference between the area under the receiver working curve of MLR and positive nodes to predict the death of patients within 2 years postoperatively (P0.05).The MLR in T(3) gastric carcinoma is not correlated with the number of total lymph nodes examined on the condition that 15 or more lymph nodes were assessed in pathology. The predicting accuracy of MLR to death of patients with T(3) gastric carcinoma within 2 years postoperatively is same as, but not better than that of positive nodes if the extent of lymphadenectomy is optimal.

To investigate the distribution of sentinel lymph nodes in gastric cancer, and evaluate clinicopathologic characteristics leading its metastasis.The location of metastatic lymph nodes was analyzed retrospectively in 27 patients of gastric carcinoma with solitary lymph node metastases, and in 80 cases metastasis was limited to only 1 station in Japanese nodal classification. The clinicopathologic characteristics of the patients with solitary lymph node metastases and 111 cases without lymph node metastases were compared.Twenty-five in 27 cases with solitary lymph node metastases were limited in level I. Skip metastasis occurred in 2 cases. Sentinel lymph nodes of 16 cases in 21 patients with the tumors in the lower and middle third stomach were located in less curvature (No. 3) and in greater curvature (No. 4). Sentinel lymph nodes of 3 cases in 6 patients in the upper third stomach were located in right cardia (No. 1). Multivariate analysis showed that the frequency of sentinel lymph node metastasis of pT(3) lesion was significantly higher than that of pT(1) lesion with an odds ratio of 4.926 (P0.01). The frequency of sentinel lymph node metastasis in the tumor located in the upper third stomach was significantly higher than that in lower third stomach, with an odds ratio of 4.381 (P0.05). Early gastric cancer had lower risk for sentinel lymph node metastasis than that in Borrmann type I cancer, with an odds ratio of 0.082 (P0.05).Majority of sentinel lymph nodes are located in the regional perigastric lymph node groups close to the tumor. Skip metastasis is rare. Depth of invasion and location of tumor are correlated with sentinel lymph node metastasis. Sentinel lymph node assessment can instruct to determine extent of lymph node dissection for gastric cancer.

To evaluate the value of serum TR(6) for the diagnosis and TNM classification in patients with gastric carcinoma.Serum TR(6) levels were measured using ELISA method in 31 gastric cancer patients, 19 patients with nonmalignant conditions and 29 healthy individuals. TR(6) expression in tumor mass was studied with immunohistochemistry. TR(6) gene copy number in tumor tissues was evaluated by real time PCR.Ninety-seven point nine percent (47 of 48 cases) of healthy individuals and patients with nonmalignant conditions were serum TR(6)-negative. In contrast, 71% (22 of 31 cases) of gastric cancer patients were serum TR(6)-positive. Serum TR(6) positiveness was closely correlated with tumor differentiation status and TNM classification. TR(6) gene amplification did not occur in gastric carcinoma.Serum TR(6) levels were correlated significantly with TNM stage and histopathological type of tumor. This can help to determine the pre-operative TNM classification and to choose the optimal extent of lymph node dissection for gastric cancer.

Background Few studies to date have evaluated gastric cancer(GC)-related malignant neoplasm family history (MN-FH), and their findings have been largely inconsistent. The aim of this study is to evaluate the prevalence of MN-FH and its relation to the clinicopathologic features of GC. Methods A total of 104 hospitalized patients with primary gastric adenocarcinoma was prospectively analyzed from 2008 to 2009. Positive MN-FH was defined as MN-affected first- and second-degree relatives of the current GC cases. The relation between prevalence of positive MN-FH and clinicopathologic features in the current GC patients was assessed using the Chi-square test with Cramer’s V coefficient. Results Thirty-seven (35.6%) of the GC patients had positive MN-FH, with 42 associated tumors in first- and second-degree relatives. Twenty-six (61.9%) of the associated tumors were located in the digestive system, including the esophagus (26.2%), stomach (23.8%), liver (9.5%) and colon (2.4%). Lung cancers were the most prevalent non-digestive system-associated tumors (9.5%). Correlation analysis revealed no significant relations with prevalence of MN-FH and any of the clinicopathologic features (all, P > 0.05), including sex (V = 0.044), age (V = 0.060) and histological subtypes (V = 0.109). Conclusions More than one-third of the GC patients in our hospital had positive MN-FH. The most frequent forms of MN-FH were esophageal cancer and GC. The prevalence of positive MN-FH was not correlated to any of the clinicopathologic features, including sex, age and histological subtypes in the study population of GC patients.