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Akihiro Nakajo

Publications and source records attributed to Akihiro Nakajo.

At least 19 recordsLinked to original sources
PubMed2006

[Combination chemotherapy study of biweekly paclitaxel and S-1 administration in patients with advanced gastric cancer].

In the present article, we report the results of phase I/II combination chemotherapy study of biweekly paclitaxel and S-1 administration in patients with advanced gastric cancer. In the phase I study, we could determine the recommended dose for the phase II study with paclitaxel and S-1 to be 120 mg/m2 and 80 mg/m2, respectively. The side effect was not so severe. The overall response was 53%. In conclusion, biweekly paclitaxel and S-1 administration can be safely combined for the treatment of advanced gastric cancer. This combined therapy represents a novel and active treatment regimen with low toxicity and can be defined as safe and effective. Now we are analyzing the result of the phase II study.

Administration, Oral↗
PubMed2005

[Radiation therapy leading to complete response of residual lymph node metastasis in advanced gastric cancer].

A 74-year-old male was admitted to Sendai Saiseikai Hospital with a complaint of upper abdominal pain. Gastrointestinal fibroscopy showed type 2 gastric cancer in the lower third of the stomach,and distal gastrectomy and D 2 lymph node dissection were performed. Metastatic lymph node 8 a had severely infiltrated the pancreas, and pancreatoduodenectomy was required to complete the curative surgery. However, because of preoperative complications of interstitial pneumonia, metastatic node 8 a remained untreated. Postoperatively, radiation therapy (38 Gy plus a boost of 18 Gy) for residual lymph node metastasis was performed over a one-month period. The metastatic node underwent complete regression following radiation therapy, and the patient was discharged without any adverse effects. He received TS-1 medication as postoperative adjuvant therapy. Four years have passed since the complete regression of the lymph node,and the patient has shown no signs of relapse. Therefore, our case suggests that postoperative radiation therapy can be a useful tool for treatment of residual lymph node metastasis in gastric cancer.

Aged↗
PubMed2003

Disseminated cancer cells in the blood and expression of sialylated antigen in gastric cancer.

BACKGROUND: In gastric cancer, disseminated cancer cells (DCC) can be detected in peripheral blood using bio-molecular techniques. It is known that patients having DCC exhibit a high occurrence of postoperative relapse in gastrointestinal cancer. However, more than half of gastric cancer patients having positive DCC do not show cancer relapse. Sialylated Lewis antigens are considered to be crucial molecules in the metastasis of disseminated cancer. The current study investigated whether combination analysis of DCC and sialylated Lewis antigen are useful in estimating the recurrence risk of gastric cancer. PATIENTS AND METHODS: Subjects were 106 consecutive gastric cancer patients who underwent curative gastrectomy. DCC in the peripheral blood were detected using the carcinoembryonic antigen (CEA)-mRNA by RT-PCR method. Sialylated Lewis antigen expression (sLeA and sLeX) of the primary tumor was assessed immunohistochemically. RESULTS: Of 106 gastric cancer patients, 43 (40%) were positive for DCC. Immunohistochemically, 53 (50%) and 49 (46%) patients were positive for sLeA and sLeX, respectively. The presence of DCC did not correlate with sLeA and sLeX expression in gastric cancer. Postoperative tumors were present in 19 patients (7 hematogenous and 12 non-hematogenous), 12 of which were positive for DCC. Six sLeA-positive patients (26%) with DCC and 13 sLeX-positive patients (57%) with DCC suffered from postoperative recurrence of gastric cancer. The p value of CEA-mRNA and sLeX combination analysis was more significant (p<0.01) than that of CEA-mRNA alone (p=0.02). CONCLUSION: Analyzing both DCC and sLeX expression in gastric cancer may enable more accurate prediction of postoperative recurrence.

Adult↗
PubMed2003

Distribution of lymph node metastasis including micrometastasis in gastric cancer with submucosal invasion.

The purpose of this retrospective study was to analyze the distribution of lymph node metastases, including micrometastases, according to the location of the gastric cancer with submucosal invasion. A total of 118 patients with submucosal gastric cancer were enrolled in this study. The distribution of lymph node metastases was examined according to tumor location. Immunohistochemical examination using anti-cytokeratin antibody was performed to examine nodal micrometastases in 118 patients. Lymph node metastasis was found in 19.5% (23/118) of the patients. Significant differences were found for tumor size and depth, lymphatic invasion, and venous invasion for patients with and without nodal metastasis. The distribution of lymph node metastasis for tumors at upper or middle portions of the stomach was mainly found along the left gastric artery. The distribution of lymph node metastasis for tumors in the lower and lesser curvature varied. Immunohistochemical analysis found that 15 of 23 patients with lymph node metastasis found by histologic examination had micrometastases. The presence of two or more lymph node micrometastases was found in these 15 patients, and they were distributed in another stations, including distant nodes. The incidence of micrometastasis was 24.2% (23/95) in pN0 patients. Lymph node micrometastases were confined to regional nodes near the primary tumor. When planning minimally invasive treatment for submucosal gastric cancer, it is important to understand the distribution of lymph node metastasis, including micrometastasis, according to tumor location.

Adenocarcinoma↗
PubMed2003

Clinical significance of circulating tumor cells in blood by molecular detection and tumor markers in esophageal cancer.

BACKGROUND: The clinical significance of circulating tumor cells in the blood during surgery has not been elucidated in esophageal squamous cell carcinoma (ESCC). We evaluated the relationship between circulating tumor cells and clinicopathologic findings, compared with that of serum squamous cell carcinoma (SCC) antigen and carcinoembryonic antigen (CEA), in ESCC. METHODS: Blood samples from 54 consecutive patients were obtained from the peripheral artery and the superior vena cava at three points in time: immediately before surgery, and before and after tumor resection. CEA-specific reverse transcriptase-polymerase chain reaction (RT-PCR), which can quantify circulating tumor cells in blood, was performed. The preoperative values of serum SCC antigen and CEA were also obtained for all patients. RESULTS: CEA messenger RNA (CEA mRNA) was detected in the blood of 31 out of 54 patients (57.4%). CEA mRNA positivity was detected most frequently after tumor resection and correlated with nodal status and stage grouping. The incidence of total recurrence and blood-borne recurrence was significantly greater in patients with CEA mRNA positivity than in those with CEA mRNA negativity (P =.036 and.0026, respectively). Preoperative serum levels of SCC antigen and CEA did not correlate with clinicopathologic findings and tumor recurrence. CONCLUSIONS: CEA mRNA detected by RT-PCR was more predictive of tumor recurrence than serum tumor markers. Effective adjuvant therapy is recommended for patients with CEA mRNA positive expression.

Adult↗
PubMed2003

Clinical significance of CEA-mRNA expression in peritoneal lavage fluid from patients with gastric cancer.

Peritoneal dissemination is one of the most common modes of gastric cancer recurrence even after curative resection. Cytological examination of peritoneal lavage fluid is useful for detection of free cancer cells in the peritoneal cavity. However, some patients with negative cytological findings have peritoneal metastases of their gastric cancer. The purpose of the present study was to investigate the incidence and clinical significance of metastases harbored in the peritoneal cavity of patients with gastric carcinoma. Peritoneal lavage fluid was collected from the left subphrenic or Douglas cavities of 136 gastric cancer patients without macroscopic peritoneal metastases and 31 patients with benign disease. Peritoneal lavage fluid was examined by both conventional cytological examination (Papanicolaou and Giemsa staining), and carcinoembryonic antigen (CEA)-specific reverse transcription-polymerase chain reaction (RT-PCR). Among 136 gastric cancer patients, 5 patients (3.6%) were positive for free cancer cells by cytological examination and 30 (22.1%) were positive by RT-PCR. A difference in positivity between the left subphrenic and Douglas cavity was found in 18 patients by RT-PCR. The frequency of RT-PCR results increased according to lymph node metastases, lymphatic invasion, depth of tumor invasion and stage grouping. The incidence of peritoneal recurrence was significantly higher in patients with positivity than those with negativity by RT-PCR (p<0.0001). Among cytologically negative patients, survival was significantly shorter in patients with positive than in those with negative CEA-mRNA expression (p<0.0001). The technique of RT-PCR was more sensitive than cytological examination in the detection of cancer cells and prediction of peritoneal recurrence. Adjuvant therapy may be advisable for the gastric cancer patients with positive findings of peritoneal lavage by RT-PCR.

Carcinoembryonic Antigen↗
PubMed2003

Clinical impact of micrometastasis of the lymph node in gastric cancer.

Micrometastasis in regional lymph nodes has been observed immunohistochemically, but the biological and clinical roles of minute nodal invasion of carcinoma in gastric cancer remain unclear. We used the anti-cytokeratin (AE1/AE3) antibody to immunohistochemically detect nodal micrometastatic lesions that could not be identified by routine pathological examination. A total of 4203 lymph nodes were examined in 180 gastric cancer patients. Lymph node metastasis was found in 36 of the 180 patients by routine pathological evaluation. Immunohistochemically micrometastasis was detected in the lymph nodes of 19 node-negative patients. Micrometastasis was not detected in any of the mucosal gastric cancer patients who underwent lymph node dissection. Gastric cancer patients with more than six metastatic lymph nodes all had nodal micrometastasis. Patients with micrometastasis had a significantly poorer survival rate than those without micrometastasis (P < 0.05). Based on the present results the presence of lymph node micrometastasis may provide a more accurate indication for surgical outcome in gastric cancer patients at the same clinical stage.

Adult↗
PubMed2003

Molecular detection of free cancer cells in pleural lavage fluid from esophageal cancer patients.

The clinical significance of free cancer cells in pleural lavage fluid detected by molecular methods during surgery remains uncertain in esophageal squamous cell cancer (ESCC). We therefore evaluated the relationship between free cancer cells and clinicopathological findings, and compared the reverse transcriptase-polymerase chain reaction (RT-PCR) method with conventional cytological examination. Pleural lavage fluid from 38 consecutive patients was obtained at two time points; immediately after thoracotomy and before thorax closure. Papanicolaou and Giemsa staining as well as carcinoembryonic antigen (CEA)-specific RT-PCR were performed. The positivity rates obtained using cytological examination and CEA-mRNA expression were 5.3 and 15.8%, respectively. Positive results were observed in pleural lavage fluid after tumor resection. No significant differences in clinicopathologic factors were seen, irrespective of CEA-mRNA expression status. Among the 5 patients exhibiting CEA-mRNA positivity, 2 experienced hematogenous recurrence, 2 experienced mixed recurrence and 1 experienced pleural dissemination. With regard to mode of recurrence and mean period between surgery and relapse, no significant differences were seen between CEA-mRNA-positive and CEA-mRNA-negative patients. Although disease recurred in almost all patients exhibiting CEA-mRNA expression, due to the relatively small sample in the present study the clinical significance must be investigated further in a larger number of patients.

Adult↗
PubMed2002

CD3-zetachain expression of intratumoral lymphocytes is closely related to survival in gastric carcinoma patients.

BACKGROUND: Impaired or reduced CD3 zeta chain (CD3-zeta) expression in T cells has been identified in various cancers and may be associated with an ineffective immune response. The clinical significance of CD3-zeta chain expression in tumor-infiltrating lymphocytes (TILs) in gastric carcinoma remains unclear. METHODS: The authors immunohistochemically investigated CD3-zeta expression in TILs in 185 patients who had undergone curative gastrectomy. CD3-zeta/CD3 epsilon (CD3-epsilon) ratios were calculated. Patients were divided into two groups: a normal CD3-zeta group (n = 121) and a reduced CD3-zeta group (n = 64). Patients with a zeta per epsilon ratio of greater than 66% were placed in the normal CD3-zeta group. RESULTS: Patients in the normal CD3-zeta group had fewer lymph node metastasis (P < 0.01) and a shallower depth of invasion (P < 0.05) than those in the reduced CD3-zeta group. The 5-year survival rate was 72% in the normal CD3-zeta group, which was significantly better than that in the reduced CD3-zeta group (55%; P < 0.01). When stratified according to clinical stage, the prognostic value was significantly different only in Stage IV patients. Multivariate analysis showed that CD3-zeta expression was an independent prognostic factor (P = 0.03) next to depth of invasion and lymph node involvement. CONCLUSIONS: Reduced CD3-zeta expression in TILs was strongly correlated with progressive disease in gastric carcinomas. CD3-zeta expression in TILs is considered an immunologic, independent prognostic marker in gastric carcinoma patients. CD3-zeta normalization with cytokine treatment may lead to prolonged survival in advanced gastric carcinoma patients.

Adult↗
PubMed2002

Intraoperative molecular detection of circulating tumor cells by reverse transcription-polymerase chain reaction in patients with biliary-pancreatic cancer is associated with hematogenous metastasis.

BACKGROUND: Circulating tumor cells in the blood were frequently detected by reverse transcription-polymerase chain reaction during operation in patients with biliary-pancreatic cancer. We investigated the relationship between circulating tumor cells during operation and hematogenous metastases. METHODS: Blood samples from 67 patients with biliary-pancreatic cancer were obtained from the portal vein, peripheral artery, and superior vena cava during operation. After total RNA was extracted from each blood sample, carcinoembryonic antigen (CEA)-specific reverse transcription-polymerase chain reaction was performed. RESULTS: Intraoperative CEA-messenger RNA (mRNA) expression was detected in the blood of 32 (47.8%) of 67 patients with biliary-pancreatic cancer, although it was not detected in the blood obtained from 20 healthy volunteers or 15 patients with benign disease of the biliary pancreas. The incidence (37.5%) of hematogenous metastases after surgery in the CEA-mRNA-positive group (n = 32) was significantly higher than that (11.4%) in the negative group (n = 35; P =.01). In stage I, II, and III patients, survival of the CEA-mRNA-positive group was significantly worse compared with that of negative group (P =.03). CONCLUSIONS: Intraoperative molecular detection of circulating tumor cells in patients with biliary-pancreatic cancer relates to a high risk of hematogenous metastasis and is associated with unfavorable prognosis even after curative resection.

Adult↗
PubMed2002

Lymph node micrometastasis and lymphatic mapping determined by reverse transcriptase-polymerase chain reaction in pN0 gastric carcinoma.

BACKGROUND: The purposes of this study were to examine lymph node micrometastasis (LMM) by reverse transcriptase-polymerase chain reaction (RT-PCR) method, and clarify the initial nodes involved by metastatic disease according to tumor location. METHODS: We examined 312 lymph nodes obtained from 50 patients with node-negative gastric carcinoma. RT-PCR and immunohistochemistry were performed. The clinical characteristics of LMM were investigated, and the map of LMM was made according to tumor location. RESULTS: The number of patients and LMM detected by RT-PCR was 14 and 17 and by immunohistochemistry was 7 and 8, respectively. RT-PCR was a more sensitive method than immunohistochemistry. LMM by RT-PCR correlated with depth of tumor invasion and lymphatic invasion. Regarding pT1 tumor, 9 patients with LMM had tumors that were of the macroscopically depressed type and 2 cm or more in diameter. According to the lymphatic map, right pericardial lymph nodes and lymph nodes along the lesser curvature were the initial nodes involved in the upper third of the stomach. Right pericardial lymph nodes, lymph nodes along the lesser curvature, and infrapyloric nodes were more important initial metastatic sites in the middle third of the stomach, and lymph nodes along the lesser curvature and infrapyloric nodes in the lower third. CONCLUSIONS: We demonstrated the relationship between LMM and clinicopathologic factors, especially in pT1 tumor. The mapping of LMM may prove useful for selecting the optimal treatment.

Aged↗
PubMed1999

Paraaortic lymph node micrometastasis and tumor cell microinvolvement in advanced gastric carcinoma.

BACKGROUND: Paraaortic lymph node dissection in advanced gastric carcinoma is controversial. The purpose of this study was to investigate the incidence and significance of micrometastasis (MM) or tumor cell microinvolvement (TCM) in these critical lymph nodes.METHODS: A total of 2339 lymph nodes, including 390 paraaortic nodes, obtained from 47 patients with advanced gastric carcinoma were examined immunohistochemically, using cytokeratin antibody.RESULTS: Lymph node metastasis was found in 95 of the 390 paraaortic nodes of 14 patients by routine histological examination. MM or TCM was immunohistochemically detected in 45 of the 295 negative paraaortic lymph nodes from 15 of 33 patients (MM, n = 5; TCM, n = 10). The 5-year-survival rate in the paraaortic node-negative group and cytokeratin-positive group was significantly higher that that of the hematoxilin and eosin-positive group. The total number of lymph node metastases by hematoxylin and eosin staining and the pathological lymph node compartments, by cytokeratin-positive nodes, were prognostic factors by multivariate analysis.CONCLUSIONS: We demonstrated a high rate of MM or TCM in the paraaortic lymph nodes and suggest that such harbored metastases are related to the prognosis of patients with advanced gastric carcinoma. On the basis of this study, a multi-institutional study should be considered.

Journal Article↗
PubMedDate not supplied

Bone marrow micrometastasis detected by RT-PCR in esophageal squamous cell carcinoma.

The clinical implications of bone marrow micrometastases (BMM) detected by RT-PCR in esophageal squamous cell carcinoma (ESCC) have not been elucidated. We evaluated the relation between the presence of BMM, both before and after surgery, and clinicopathologic findings in patients with ESCC. Bone marrow samples from 48 patients with ESCC were obtained from the iliac crest before and after surgery. After total RNA was extracted from each bone marrow sample, carcinoembryonic antigen (CEA)-specific RT-PCR was performed. BMM was detected by RT-PCR in 10 of the 48 patients. Four patients each had positive signals only before or only after surgery and 2 patients had positive signals both before and after surgery. There were no significant differences in clinicopathologic factors, including neoadjuvant therapy, between patients with BMM and without BMM. To date, the rates of recurrent disease in patients with BMM and without BMM are 80% (8/10) and 50% (19/38), respectively, a difference which is not significant. The 4-year survival rates of patients with BMM and without BMM are 10.0% and 47.3%, respectively. Recurrence and survival rates were poorer in patients with RT-PCR positivity, although the differences were not significant. A larger study is required to clarify the clinical impact of BMM.

Aged↗
PubMedDate not supplied

Perioperative detection of circulating cancer cells in patients with colorectal hepatic metastases.

BACKGROUND/AIMS: Surgical resection is the most effective therapy for metastatic colorectal cancer to the liver. However, the selection criteria for patients who may benefit from partial hepatectomy are not fully defined. The aim of this study was to evaluate the usefulness of perioperative molecular detection of circulating cancer cells in predicting clinical outcome in patients with colorectal metastatic liver cancer. METHODOLOGY: Blood samples were obtained perioperatively from the portal vein, peripheral artery, and superior vena cava in 16 consecutive patients with colorectal liver metastases who have undergone partial hepatic resection. We analyzed circulating cancer cells using a carcinoembryonic antigen-specific nested reverse transcriptase-polymerase chain reaction. RESULTS: Positive carcinoembryonic antigen-mRNA expression was detected in 7 (43.8%) of 16 patients. Six (85.7%) of those 7 patients had hematogenous rerecurrences during the 1- to 3-year follow-up period. None of 9 negative-patients showed re-recurrence (p < 0.01). Among the 9 of 16 patients receiving postoperative adjuvant chemotherapy, no clear effect was noted regarding re-recurrence in the positive carcinoembryonic antigen-mRNA patients. CONCLUSIONS: These results suggest that the molecular detection of circulating cancer cells at the time of surgery for colorectal liver metastases could be one measure of high-risk patients for hematogenous re-recurrence after partial hepatic resection.

Carcinoembryonic Antigen↗
PubMedDate not supplied

Clinical and pathological features in T-cell gastric lymphoma associated with human T-cell leukemia virus type 1 (HTLV-1) in comparison with B-cell gastric lymphoma.

BACKGROUND/AIMS: We investigated clinical features of T-cell gastric lymphomas associated with human T-cell leukemia virus type 1 (HTLV-1). METHODOLOGY: Ninety patients with gastric lymphoma who underwent gastrectomy were included in this study. They were divided into T-cell and B-cell gastric lymphomas according to the immunohistochemical expression of surface T-cell or B-cell markers. Clinicopathological features and surgical outcome were compared between T-cell and B-cell gastric lymphomas. Correlation between T-cell gastric lymphoma and Epstein-Barr virus, p53, MIB-1, and CD44 variant 6 on lymphoma cells was evaluated in 60 patients by in situ hybridization and immunohistochemical examination. Anti-adult T-cell leukemia antigen was evaluated in 74 patients in the blood serum were evaluated. RESULTS: Nine of the 90 patients were classified as T-cell gastric lymphoma. Patients with T-cell gastric lymphoma had significantly more nodal involvement and poorer resectability than those with B-cell gastric lymphoma. Positivity of serum anti-adult T-cell leukemia antigen was significantly higher in T-cell lymphoma patients (100%) than in B-cell lymphoma patients (41%). However, there was no significant difference in Epstein-Barr virus positivity and expression of p53, MIB-1, CD44 variant 6 between T-cell and B-cell lymphomas. The five-year-survival rate in patients with T-cell gastric lymphomas was 0% and whereas that in B-cell gastric lymphoma was 45%, there was a significant difference between the two groups (p < 0.01). Two patients with T-cell lymphoma who underwent emergency gastrectomy died in hospital during follow-up. CONCLUSIONS: The surgical outcome of patients with T-cell lymphoma with anti-adult T-cell leukemia antigen tended to be very poor, despite curative resection. Thus, intensive chemotherapy is recommended for the patients with HTLV-1 associated T-cell gastric lymphoma.

Biomarkers, Tumor↗
PubMedDate not supplied

Tumor-associated macrophage (TAM) infiltration in gastric cancer.

BACKGROUND: Tumor-associated macrophages (TAMs) are defined as macrophages that migrate into the tumor stroma. TAMs are known to directly or indirectly affect immune suppression. TAMs have not previously been reported in gastric cancer. MATERIALS AND METHODS: Using anti-CD68 antibodies, we immunohistochemically evaluated TAM infiltration in 97 gastric cancer patients who underwent tumor resection. Furthermore, CD3-zeta chain expression of tumor infiltrating lymphocytes (TILs) from the same section was also examined. According to the degree of TAM infiltration, 97 patients were divided into two groups (high TAM group, more than 200 positive cells; low TAM group, less than 200 positive cells). Clarification of the clinicopathological features of TAM-positive gastric cancer was attempted. RESULTS: TAM infiltration in the tumor nest ranged from 0 to 621 cells (average 187). The degree of infiltration positively correlated with depth of invasion, nodal status and clinical stage. Patients in the high TAM group had lower CD3-zeta expression by TILs than patients in the low TAM group. CD3-zeta expression by TILs negatively correlated with infiltration of TAMs (p < 0.01). Patients with a high TAM count had poorer surgical outcomes than those with a low TAM count. CONCLUSION: From the results of the current study, TAM infiltration may be used as a prognostic marker in gastric cancer. Negative correlation between TAM infiltration and CD3-zeta expression by TILs suggests that TAMs may be responsible for the immunological inactivity of T cells in gastric cancer.

Adult↗
PubMedDate not supplied

Clinical merit of subdividing gastric cancer according to invasion of the muscularis propria.

BACKGROUND/AIMS: In TNM classification, carcinoma that has invaded the muscularis propria (mp) and cancer that has invaded the subserosa are both categorized as T2 cancer. However, some mp gastric cancer patients have a good postoperative course, similar to that of early gastric cancer patients. We performed a retrospective analysis of 74 patients with mp gastric cancer, based on the depth of mp invasion. METHODOLOGY: The clinicopathologic features of 74 cases of gastric cancer invading the mp (but no further) were subdivided according to depth of invasion, retrospectively reviewed and compared with surgical features of 165 patients with gastric cancer invading the submucosa (sm gastric cancer). For each tumor, we evaluated the degree of tumor invasion in the mp layer at a magnification of x100, using the section that showed the greatest extent of invasion. The patients were classified into 2 groups: mp1, tumor was limited to the first of the 3 mp layers; mp2, tumor had expanded beyond the first layer. RESULTS: Of the 74 mp gastric cancer patients, 30 were classified as mp1 and 44 were classified as mp2. Patients with mp1 gastric cancer had significantly more macroscopic signs of early gastric cancer, a lower frequency of lymph node metastasis, and a higher rate of operative cure than patients with mp2 gastric cancer. The incidence of lymph node metastasis among mp1 gastric cancer patients was almost equal to that of the 165 sm gastric cancer patients. The 5-year survival rate of mp1 patients was significantly better than that of mp2 patients (p<0.05), but was similar to that of the 165 sm gastric cancer patients (84%) (p<0.05). CONCLUSIONS: There were clear differences in clinical features between the mp1 and mp2 gastric cancer patients. Subdivision of mp gastric cancer according to depth of invasion may enable more precise prognosis and treatment of mp gastric cancer patients. The clinicopathological findings and surgical outcome of the mp1 patients were similar to those of the sm gastric cancer patients. Thus, mp1 patients may require treatment that is similar to treatment administered to patients with early gastric cancer.

Adult↗