• 제목/요약/키워드: Stage IV gastric cancer

검색결과 84건 처리시간 0.028초

Upper Endoscopy up to 3 Years Prior to a Diagnosis of Gastric Cancer Is Associated With Lower Stage of Disease in a USA Multiethnic Urban Population, a Retrospective Study

  • Shah, Shailja C.;Nakata, Chiaki;Polydorides, Alexandros D.;Peek, Richard M. Jr;Itzkowitz, Steven H.
    • Journal of Preventive Medicine and Public Health
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    • 제52권3호
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    • pp.179-187
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    • 2019
  • Objectives: In the USA, certain races and ethnicities have a disproportionately higher gastric cancer burden. Selective screening might allow for earlier detection and curative resection. Among a USA-based multiracial and ethnic cohort diagnosed with non-cardia gastric cancer (NCGC), we aimed to identify factors associated with curable stage disease at diagnosis. Methods: We retrospectively identified endoscopically diagnosed and histologically confirmed cases of NCGC at Mount Sinai Hospital in New York City. Demographic, clinical, endoscopic and histologic factors, as well as grade/stage of NCGC at diagnosis were documented. The primary outcome was the frequency of curable-stage NCGC (stage 0-1a) at diagnosis in patients with versus without an endoscopy negative for malignancy prior to their index exam diagnosing NCGC. Additional factors associated with curable-stage disease at diagnosis were determined. Results: A total of 103 racially and ethnically diverse patients were included. Nearly 38% of NCGC were stage 0-Ia, 34% stage Ib-III, and 20.3% stage IV at diagnosis. A significantly higher frequency of NCGC was diagnosed in curable stages among patients who had undergone an endoscopy that was negative for malignancy prior to their index endoscopy that diagnosed NCGC, compared to patients without a negative endoscopy prior to their index exam (69.6% vs. 28.6%, p=0.003). A prior negative endoscopy was associated with 94.0% higher likelihood of diagnosing curable-stage NCGC (p=0.003). No other factors analyzed were associated with curablestage NCGC at diagnosis. Conclusions: Endoscopic screening and surveillance in select high-risk populations might increase diagnoses of curable-stage NCGC. These findings warrant confirmation in larger, prospective studies.

한약에 의한 진행성 위선암의 퇴축에 대한 증례보고 - 8년간의 추적조사를 통한 후향적 증례연구 (A Case of Regression of Advanced Gastric Cancer by Herbal Medicine - A Retrospective Case Study with 8-years Follow-up)

  • 박정석;이연월;조정효;손창규;조종관;유화승
    • 대한한방내과학회지
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    • 제28권1호
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    • pp.193-198
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    • 2007
  • Objective : The aim is to derive further studies evaluating the effectiveness of oriental medical treatment on advanced gastric cancer (AGC) patients. We present a case of a stage IV AGC patient who has survived over 8 years. Methods : We followed up all documents related to the patient. We prescribed to the patient HangAmDan (HAD) three times a day over five years. Abdomen CT was performed to evaluate the therapeutic efficacy. Results : The patient has survived over 8 years. Abdomen CT has shown complete regression. Conclusion : This case may give us the possibility of that oriental medical treatment offers potential benefits for patients with AGC.

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Advanced Gastric Cancer Associated with Disseminated Intravascular Coagulation Successfully Treated with 5-fluorouracil and Oxaliplatin

  • Lee, Dong Seok;Yoo, Seung Jin;Oh, Ho Suk;Kim, Eun Jung;Oh, Kwang Hoon;Lee, Sang Jin;Park, Jong Kyu;Ahn, Yong Chel;Eom, Dae-Woon;Ahn, Heui June
    • Journal of Gastric Cancer
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    • 제13권2호
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    • pp.121-125
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    • 2013
  • Gastric cancer patients with acute disseminated intravascular coagulation experiences a rare but severe complication resulting in a dismal prognosis. We report a case of advanced gastric cancer complicated with disseminated intravascular coagulation with intractable tumor bleeding which was successfully treated with chemotherapy consisting of 5-fluorouracil and oxaliplatin. The patient was a 63-yearold man who complained of abdominal pain, melena, and dyspnea on 24 November 2010. We diagnosed stage IV gastric cancer complicated by disseminated intravascular coagulation. Gastric tumor bleeding was not controlled after procedures were repeated three times using gastrofiberscopy. With the patient's consent, we selected the 5-fluorouracil and oxaliplatin combination chemotherapy for treatment. After one cycle of 5-fluorouracil and oxaliplatin therapy, symptoms of bleeding improved and the disseminated intravascular coagulation process was successfully controlled. The primary tumor and multiple metastatic bone lesions were remarkably shrunken and metabolically remitted after eight cycles of chemotherapy. In spite of progression, systemic chemotherapy is effective in disease control; further, the patient gained the longest survival time among cases of gastric cancer with disseminated intravascular coagulation.

The Fibrinogen to Mean Platelet Volume Ratio Can Predict Overall Survival of Patients with Non-Metastatic Gastric Cancer

  • Song, Shubin;Cong, Xiliang;Li, Fengke;Xue, Yingwei
    • Journal of Gastric Cancer
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    • 제18권4호
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    • pp.368-378
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    • 2018
  • Purpose: Fibrinogen and platelets have been reported to play important roles in tumorigenesis and cancer progression. The aim of this research was to investigate the combination of functions of fibrinogen, platelets, and mean platelet volume (MPV) in predicting the survival of patients with gastric cancer (GC). Materials and Methods: A retrospective study was conducted with 1,946 patients with GC and 299 patients with benign gastric tumor to analyze their fibrinogen, platelet, and MPV levels, and other clinicopathological characteristics along with their prognoses. Several indicators were evaluated along with fibrinogen, platelets, and MPV and their prognostic abilities were assessed. Univariate and multivariate survival analyses were conducted to determine the independent risk factors for overall survival. Results: Increased levels of fibrinogen, platelets, and MPV were observed with the progress of the GC stages. Elevated fibrinogen, platelets, and the combined indicators, including fibrinogen*MPV (FM), platelet*fibrinogen*MPV (PFM), fibrinogen/MPV (FMR), platelet*fibrinogen (PF), platelet*fibrinogen/MPV (PFMR), platelet*MPV (PM), and platelet/MPV (PMR), foreboded poor prognosis. Meanwhile fibrinogen and FMR can be considered as independent risk factors for overall survival in patients with non-metastatic GC. But these indicators can hardly predict survival of patients in stage IV. Conclusions: Elevated fibrinogen, platelets, and MPV levels were in accordance with advanced stages, and fibrinogen, platelet, and MPV, in combination, can be used to predict survival of patients with non-metastatic GC. FMR was an independent prognostic factor for overall survival of patients with GC.

위전절제술 시 식도측 절제연 암 침윤의 예후적 가치 (Prognostic Value of Esophageal Resectionline Involvement in a Total Gastrectomy for Gastric Cancer)

  • 권성준
    • Journal of Gastric Cancer
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    • 제1권3호
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    • pp.168-173
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    • 2001
  • Purpose: A positive esophageal margin is encountered in a total gastrectomy not infrequently. The aim of this retrospective review was to evaluate whether a positive esophageal margin predisposes a patient to loco-regional recurrence and whether it has an independent impact on long-term survival. Materials and Methods: A retrospective review of 224 total gastrectomies for adenocarcinomas was undertaken. The Chisquare test was used to determine the statistical significance of differences, and the Kaplan-Meier method was used to calculate survival rates. Significant differences in the survival rates were assessed using the log-rank test, and independent prognostic significance was evaluated using the Cox regression method. Results: The prevalence of esophageal margin involvement was $3.6\%$ (8/224). Univariate analysis showed that advanced stage (stage III/IV), tumor size ($\geq$5 cm), tumor site (whole or upper one-third of the stomach), macroscopic type (Borrmann type 4), esophageal invasion, esophageal margin involvement, lymphatic invasion, and venous invasion affected survival. Multivariate analysis demonstrated that TNM stage, venous invasion, and esophageal margin involvement were the only significant factors influencing the prognosis. All patients with a positive esophageal margin died with metastasis before local recurrence became a problem. A macroscopic proximal distance of more than 6 cm of esophagus was needed to be free of tumors, excluding one exceptional case which involved 15 cm of esophagus. Conclusion: All of the patients with a positive proximal resection margin after a total gastrectomy had advanced disease with a poor prognosis, but they were not predisposed to anastomotic recurrence. Early detection and extended, but reasonable, surgical resection of curable lesions are mandatory to improve the prognosis.

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위암 환자에서 p53과 HSP27의 임상병리학적 의의 (Clinicopathological Significance of p53 and HSP27 in Gastric-cancer Patients)

  • 이하균;권성준;백승삼
    • Journal of Gastric Cancer
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    • 제4권3호
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    • pp.169-175
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    • 2004
  • Purpose: The tumor suppressor gene p53 has been shown to be a factor in the carcinogenesis or progression of gastric cancer. The mutant p53 has been reported to cause a higher risk of lymph-node metastasis. Futhermore, mutation of the p53 has been linked to a poor prognosis for gastric cancer. The heat shock protein-27 (HSP27), a stress protein, has also been reported to be a poor prognostic factor in ovarian and breast cancers. However, in gastric-cancer patients, controversies exist as to its influence on the prognosis. In the present study, we used an immunohistochemical stain to observe the effects of p53 and HSP27 on the clinicopathological factors and on the prognosis for gastric-cancer patients. Materials and Methods: To evaluate the significance of p53 and HSP27 in gastric cancer patients, we analyzed 212 cases of gastric cancer (stage I.IV). Tissue samples of 212 patients were stained immunohistochemically for the mutant p53 protein and for HSP27. The correlations between protein expression and the clinicopathological factors were investigated. Results: The overall expression rates for p53 and HSP27 were $36.9\%\;and\;27.8\%$, respectively. p53 and HSP27 were correlated to each other because the HSP27 expression rate was higher in the p53-positive group (P=0.046). Statistically, the p53 and the HSP27 expression rates were significantly increased in the case of tumor invasiveness, lymphatic metastasis and vessel involvement. Therefore, they play a role in cancer progression. The 5-year survival rates of the p53-positive and the p53-negative groups were $62.8\%\;and\;60.1\%$, respectively (P=0.793) while the 5-year survival rates for the HSP27-positive and HSP27-negative groups were $54.2\%\;and\;63.1\%$, respectively (P=0.090). Conclusion: p53 and HSP27 were correlated to each other in our immunohistochemical study of gastric carcinomas and they were not independent prognostic factors in gastric- cancer patients. However, further studies are needed to determine their prognostic values for gastric-cancer patients.

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Bone Metastasis in Gastric Cancer Patients

  • Ahn, Jae-Bong;Ha, Tae-Kyung;Kwon, Sung-Joon
    • Journal of Gastric Cancer
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    • 제11권1호
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    • pp.38-45
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    • 2011
  • Purpose: Bone metastasis from stomach cancer occurs only rarely and it is known to have a very poor prognosis. This study examined the clinical characteristics and prognosis of patients who were diagnosed with stomach cancer and bone metastasis. Materials and Methods: The subjects were 19 patients who were diagnosed with stomach cancer at Hanyang University Medical Center from June 1992 to August 2010 and they also had bone metastasis. The survival rate according to many clinicopathologic factors was retrospectively analyzed. Results: 11 patients out of 18 patients (61%) who received an operation were in stage IV and the most common bone metastasis location was the spine. Bone scintigraphy was mostly used for diagnosing bone metastasis and PET-CT and magnetic resonance imaging were used singly or together. The serum alkaline phosphatase at the time of diagnosis had increased in 12 cases and there were clinical symptoms (bone pain) in 16 cases. Treatment was given to 14 cases and it was mostly radiotherapy. There were 2 cases of discovering bone metastasis at the time of diagnosing stomach cancer. The interval after operation to the time of diagnosing bone metastasis for the 18 cases that received a stomach cancer operation was on average $14.9{\pm}17.3$ months and the period until death after the diagnosis of bone metastasis was on average $3.8{\pm}2.6$ months. As a result of univariate survival rate analysis, the group that was treated for bone metastasis had a significantly better survival period when the bone metastasis was singular rather than multiple, as compared to the non-treatment group, yet both factors were not independent prognosis factors on multivariate survival analysis. Conclusions: An examination to confirm the status of bone metastasis when conducting a radio-tracer test after the initial diagnosis and also after an operation is needed for stomach cancer patients, and bone scintigraphy is the most helpfully modality. Making the diagnosis at the early stage and suitable treatments are expected to enhance the survival rate and improve the quality of life even for the patients with bone metastasis.

pT1N3 위암 (pT1N3 Gastric Cancer)

  • 안대호;권성준;윤효영;송영진;목영재;한상욱;김욱
    • Journal of Gastric Cancer
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    • 제6권2호
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    • pp.109-113
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    • 2006
  • 목적: 위내시경의 보급으로 조기위암의 빈도가 증가하고 축소치료가 활성화되고 있다. 이러한 치료는 장점도 있으나 림프절 곽청의 측면에서 제한점이 있다. 림프절 전이를 동반하는 조기위암의 대부분은 UICC-TNM 분류의 N1 또는 N2이지만 드물게 N3의 보고도 있다. pT1N3 위암은 증례보고는 있지만 review논문은 없어서 특성을 이해하거나 치료방침을 세우기가 어렵고 UICC-TNM에서 4기로 예후가 나쁜 위암으로 분류되어 있으나 객관적인 증거는 없다. 저자들은 국내 6개 대학에서 9예의 pT1N3 위암 치험예를 모아서 문헌 고찰과 함께 분석하였다. 대상 및 방법: 분당차병원,한양의대,충북의대,고려의대 구로병원, 아주의대, 가톨릭의대 성가병원의 6개 병원에서 기간은 서로 다르지만 의무기록 분석이 가능하였던 기간동안 수술을 받았던 2,772예의 조기위암 중에서 UICC-TNM의 pT1N3 위암 9예를 분석하였다. 비교 대조군은 분당 차병원에서 수술을 받은 210예의 조기위암 환자이다. 결과: 9예는 전체 조기 위암 2,772예의 0.32%이며 남자는 3명, 여자는 6명이었고 평균연령은 57세였다. 점막암이 2예, 점막하층암이 7예이고 전이된 림프절의 수는 18에서 52개로 평균 27개였다. 5예는 표층 팽창형으로 대조군에 비해서 많았고 종양의 크기도 N3군이 N0, N1, N2군보다 컸다. 7예에서 림프관 침윤이 있었으며 대조군에 비하여 높았다. 1예는 대동맥주위 림프절 전이가 있어서 비치유 절제가 되었고 2예에서 조기재발이 있는 등 예후가 불량하였다. 결론: pT1N3 위암의 위험 인자로는 여성, 점막하층암, 종양의 크기, 림프관 침윤을 들 수 있다. pT1N3 위암의 존재는 조기위암의 축소 치료 시 주의를 요하며 예후가 불량하기 때문에 적극적인 항암 보조 요법이 필요할 것으로 생각된다.

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Evaluating Direct Costs of Gastric Cancer Treatment in Iran - Case Study in Kerman City in 2015

  • Izadi, Azar;Sirizi, Mohammad Jaffari;Esmaeelpour, Safa;Barouni, Mohsen
    • Asian Pacific Journal of Cancer Prevention
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    • 제17권6호
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    • pp.3007-3013
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    • 2016
  • Background: Gastrointestinal cancers are common malignancies associated with high mortality rates. Healthcare systems are always faced with high costs of treatment of gastrointestinal cancers including stomach cancer. Identification and prioritization of these costs can help determine economic burden and then improve of health planning by policy-makers. This study was performed in 2015 in Kerman City aimed at estimating the direct hospital costs for patients with gastric cancer. Materials and Methods: In this cross-sectional study, the medical records of 160 patients with stomach cancer admitted from 2011 to 2014 to Shafa Hospital were examined, the current stage of the disease and the patients' health status were identified, and the direct costs related to the type of treatment in the public and private sectors were calculated. SPSS-19 was used for statistical analysis of the data. Results: Of the patients studied, 103 (65%) were men and 57 (35%) were women. The mean age of patients was 65 years. Distribution into four stages of the disease was 5%, 20%, 30%, and 45%, respectively. Direct costs in four stages of the disease were calculated as 2191.07, 2642.93, 2877, and 2674.07 USD (63,045,879, 76,047,934, 82,783,019, and 76,943,800 IRR), respectively. The highest percentage of costs was related to surgery in Stage I and to medication in Stages II, III, and IV. According to the results of direct costs of treatment for stomach cancer in Kerman, the mean total cost of treating a patient in the public sector was estimated at 74,705,158 IRR, of which averages of 60,141,384 IRR and 14,563,774 IRR were the shares of insurance and patients, respectively. Conclusions: The high prevalence and diagnosis of disease in old age and at advanced stages of disease impose great costs on the patients and the health system. Early diagnosis through screening and selecting an appropriate treatment method might largely ameliorate the economic burden of the disease.

Effects of Screening on Gastric Cancer Management: Comparative Analysis of the Results in 2006 and in 2011

  • Kim, Yun Gyoung;Kong, Seong-Ho;Oh, Seung-Young;Lee, Kyung-Goo;Suh, Yun-Suhk;Yang, Jun-Young;Choi, Jeongmin;Kim, Sang Gyun;Kim, Joo-Sung;Kim, Woo Ho;Lee, Hyuk-Joon;Yang, Han-Kwang
    • Journal of Gastric Cancer
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    • 제14권2호
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    • pp.129-134
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    • 2014
  • Purpose: This study aimed to analyze the effect of screening by using endoscopy on the diagnosis and treatment of gastric cancer. Materials and Methods: The clinicopathologic characteristics of gastric cancer were compared in individuals who underwent an endoscopy because of symptoms (non-screening group) or for screening purposes (screening group). The distributions of gastric cancer stages and treatment modalities in 2006 and 2011 were compared. Results: The proportion of patients in the screening group increased from 45.1% in 2006 to 65.4% in 2011 (P<0.001). The proportion of stage I cancers in the entire patient sample also increased (from 60.5% in 2006 to 70.6% in 2011; P=0.029). In 2011, the percentages of patients with cancer stages I, II, III, and IV were 79.9%, 8.2%, 10.9%, and 1.1%, respectively, in the screening group, and 47.9%, 10.8%, 29.8%, and 11.5%, respectively, in the non-screening group. The proportion of laparoscopic and robotic surgeries increased from 9.6% in 2006 to 48.3% in 2011 (P<0.001), and endoscopic submucosal dissection increased from 9.8% in 2006 to 19.1% 2011 (P<0.001). Conclusions: The proportion of patients diagnosed with gastric cancer by using the screening program increased between 2006 and 2011. This increase was associated with a high proportion of early-stage cancer diagnoses and increased use of minimally invasive treatments.