Biomedical subjects

S Kikuchi

Publications and source records attributed to S Kikuchi.

655 records · Page 37Linked to original sources

PubMedDate not supplied

Tumor volume as an indicator of nodal status in advanced gastric carcinoma.

BACKGROUND: The significance of tumor volume as an indicator of lymph node metastasis in advanced gastric cancer remains to be clarified. MATERIALS AND METHODS: Tumor volume was measured from continuous tissue sections taken from 60 patients with advanced gastric cancer (34 males and 26 females, aged 35 to 81 years; average 57.3 years) using a computer generated surface rendering method. The tumor volume and conventional clinicopathological factors were then analyzed with respect to the prevalence of lymph node metastasis. RESULTS: Lymph node metastasis was detected in 26 patients (43%). Of 28 patients with a tumor > or = 2000 mm3, lymph node metastasis was observed in 17 patients (61%): n1, 12 patients; n2, 3 patients; n3, 2 patients. Of 32 patients with a tumor < 2000 mm3, lymph node metastasis was observed in 9 patients (28%): n1, 6 patients; n2, 3 patients. A significant difference was found in the prevalence of lymph node metastasis between the two groups (p = 0.011). Furthermore, only tumor volume was an independent variable associated with lymph node metastasis according to logistic regression analysis (p = 0.013, odds ratio: 0.253, 95% confidence interval: 0.086-0.747). CONCLUSION: Tumor volume appears to be an important indicator of lymph node metastasis in advanced gastric cancer. However, this factor cannot be used to introduce the option of limited lymphadenectomy for such patients.

Adult↗

PubMedDate not supplied

A new staging system based on tumor volume in gastric cancer.

BACKGROUND: Development of a more appropriate staging system for gastric cancer may prove useful in clinical practice. MATERIALS AND METHODS: A total of 171 patients with solitary carcinoma of the stomach (112 males and 59 females; age range, 20 to 84 years; mean, 57.7 years) who underwent curative surgery were examined. The volume of each tumor was measured from serial tumor tissue sections using a computer software program. The utility of a new staging system based on tumor volume was assessed with respect to patient survival in comparison with other clinicopathological factors and conventional staging. RESULTS: Significant differences in survival time were found for depth of invasion (T1 vs T2 or T3; p=0.008), nodal status (n0 vs n1 or n2; p=0.032), tumor volume (< or = 2,000 mm vs >2,000 mm3; p<0.001) and stage (stage I vs stage II, III or IV; p =0. 003). However, multivariate analysis only identified tumor volume as a significant prognostic factor in the present study (p <0.001; relative risk 10.351). CONCLUSION: The above findings suggest that a new staging system based on tumor volume may have advantages over the conventional staging system in the assessment of gastric cancer.

Adult↗

PubMedDate not supplied

Recent results in the surgical treatment of gastric cancer according to the Japanese and TNM classification.

BACKGROUND: Recent outcomes based on surgical long-term follow-up of patients with gastric cancer using current staging systems have not been fully evaluated. MATERIALS AND METHODS: A total of 1357 patients with primary gastric carcinoma (911 males and 446 females, ranging in age from 20 to 87 years; average 59.1 years) who had undergone gastric resection between 1986 and 1996 were examined with respect to their clinicopathological features, surgical procedures and patient survival according to Japanese and UICC-TNM classifications. RESULTS: The 5-year survival rate was 95.3% for stage Ia, 85.5% for stage Ib, 73.8% for stage II, 45.7% for stage IIIa, 20.9% for stage IIIb, 17.3% for stage IVa and 5.8% for stage IVb (8.8% for IVa and IVb) on the Japanese classification. By way of contrast, the 5-year survival rate was 95.6% for stage Ia, 85.0% for stage Ib, 72.1% for stage II, 49.3% for stage IIIa, 30.2% for stage IIIb and 12.0% for stage IV on the TNM classification. CONCLUSION: Although minor problems are associated with both the Japanese and TNM classification systems, both appear to be clinically significant and appropriate independent predictors of prognosis. The findings of the present study provide important information for comparing results among different institutes and for introducing new clinical trials for gastric cancer at the beginning of the new century.

Adult↗

PubMedDate not supplied

Factors associated with pN3 stage tumors according to the TNM classification in advanced gastric cancer.

BACKGROUND/AIMS: The aim of the present study was to analyze factors associated with pN3-stage tumors, as classified according to the TNM Classification of Malignant Tumors, in patients who undergo curative resection for advanced gastric cancer. METHODOLOGY: A total of 391 patients with advanced gastric cancer (247 males and 144 females; average age, 59.2 years) were enrolled in the present study. The numbers of dissected regional lymph nodes and positive nodes were assessed, and node stage was determined according to TNM. Patient survival and factors associated with pN3-stage tumors were then analyzed. RESULTS: The 5-year survival rate was 82.9% for the 132 N0 patients, 66.4% for the 154 N1 patients, 41.1% for the 64 N2 patients and 21.1% for the 41 N3 patients. A significant difference was found between some of the curves (N0 and N1, p = 0.0012; N1 and N2, p = 0.0007; N2 and N3, p = 0.0055). In logistic regression analysis, independent factors associated with advanced gastric cancers with a pN3-stage tumor were tumor diameter (> 6 cm vs. < or = 6 cm, p = 0.0037), number of dissected nodes (> 30 vs. < or = 30, p = 0.0143), depth of invasion (T3 or T4 vs. T2, p = 0.0028) and microscopic type (undifferentiated vs. differentiated, p = 0.0147). CONCLUSIONS: The results of the present study suggest that tumor diameter (> 6 cm), depth of invasion (T3 or T4) and microscopic type (undifferentiated type) are the most reliable indicators of pN3-stage tumors in patients who undergo curative resection for advanced gastric cancer.

Adult↗

PubMedDate not supplied

Ischemic contracture in the lower limb.

Twenty cases of ischemic contracture in the lower limb demonstrate that the age distribution may be higher than that of patients with similar lesions in the upper limbs. Non-traumatic and traumatic causes are encountered equally frequently. Pain is one of the most important symptoms associated with long standing lesions. The ischemic lesion develops most frequently and severely in the anterior compartment of the leg. The functional prognosis is poor when both nerves are affected and when the deformity is severe.

Adolescent↗

PubMedDate not supplied

Results of resection of gastric cancer with distant metastases.

BACKGROUND/AIMS: The present study was carried out in order to examine the outcome of resection in cases of gastric cancer with distant metastases. METHODOLOGY: The survival rates of two hundred and eighty-one patients who had undergone resection for primary carcinomas of the stomach, and who had distant metastases according to the TNM classification, were studied. RESULTS: The 5-year survival rates for patients with metastasis to the peritoneum or group 3 nodes were 8.9% and 15.3% respectively and were significantly higher than the survival rates for patients with metastasis to the liver (0%), to group 4 nodes (2.2%) or to more than one site among the liver, lymph nodes and peritoneum (3.5%). Moreover, the 5-year survival rates for patients with metastasis to the peritoneum and N3 nodes increased significantly to 29.4% and 24.2%, respectively, when curative surgery was performed. CONCLUSIONS: The findings of the present study suggests that metastases to the adjacent peritoneum or group 3 nodes have a greater chance of being cured using radical surgery, and that gastrectomy with extended lymphadenectomy (D2-D3) may be used for advanced gastric cancer if there is no gross evidence of metastasis to the distant peritoneum, liver or group 4 nodes.

Case-Control Studies↗

PubMedDate not supplied

Gastric cancer with metastases to the distant peritoneum: a 20-year surgical experience.

BACKGROUND/AIMS: The efficacy of palliative gastrectomy in gastric cancer with peritoneal metastases remains uncertain. The aim of the present study was to evaluate the benefits of gastrectomy on the postoperative course of patients with gastric cancer and simultaneous metastases to the distant peritoneum. METHODOLOGY: A total of 122 patients who had gastric cancer and metastases to the distant peritoneum were studied with respect to survival. RESULTS: The extent of peritoneal metastases did not significantly affect the prognosis. Moreover, multivariate analysis indicated that surgery without gastrectomy was the only significant prognostic factor (relative risk, 2.587). CONCLUSIONS: Our results suggest that the decision to perform gastrectomy does not depend on the extent of peritoneal metastasis in gastric cancer. Furthermore, palliative gastrectomy, if feasible, seems to have a beneficial effect on the postoperative course and is indicated for patients regardless of metastasis to the peritoneum, if the primary tumor is surgically resectable and there is no evidence of liver metastasis.

Female↗