PurposeThis study was conducted to evaluate the systemic inflammatory response in colorectal cancer patients, and to estimate the usefulness of the Glasgow prognostic score (GPS) as a prognostic factor.MethodsPatients with biopsy-proven colorectal adenocarcinoma who were operated between April 2005 and December 2008 were enrolled in this study. The GPS was estimated based on the measurement of CRP and serum albumin level. The GPS was compared with other clinicopathological factors. Univariate and multivariate analyses were performed to evaluate the factors affecting cancer-specific survival.ResultsGPS was significantly higher in patients with anemia, thrombocytosis, a high neutrophil to lymphocyte ratio, tumor of the colon, and large tumor. Patient age, gender, serum CEA level, tumor gross appearance, TNM stage, and tumor differentiation were not related with the GPS. In univariate analysis, hemoglobin, CEA, gross appearance of tumor, TNM stage, tumor differentiation, and GPS were associated with cancer-specific survival. In multivariate analysis, TNM stage (III or IV : I or II; hazard ratio [HR], 12.322; P = 0.015), tumor differentiation (poorly differentiated : well or moderately differentiated; HR, 3.112; P = 0.021), and GPS (GPS 2 : GPS 0 or 1; HR, 5.168; P = 0.003) were identified as independent prognostic factors in colorectal cancer.ConclusionOur study showed that the GPS was an independent variable from tumor stage and a good and convenient prognostic factor in colorectal cancer patients.
PurposeChronic inflammation induces cancer and cancer induces local tissue damage with systemic inflammation. Therefore, the aim of this study is to investigate the potential relationship between the severity of inflammation and prognosis in cancer patients.Materials and MethodsThis study enrolled 220 patients from January 2002 to December 2006 who underwent gastric surgery. We evaluated the relationship between preoperative inflammatory parameters (erythrocyte sedimentation rate, neutrophil-to-lymphocyte ratio) and other clinicopathological factors. Survival outcomes were compared according to the extent of inflammation.ResultsSignificant elevation of erythrocyte sedimentation rate was related with old age, increased neutrophil-to-lymphocyte ratio, decreased hemoglobin, increased carcinoembryonic antigen, increased tumor size and advanced TNM stage. Neutrophil-to-lymphocyte ratio was significantly correlated with old age, increased erythrocyte sedimentation rate and advanced TNM stage. In the univariate analysis, elevated erythrocyte sedimentation rate and increased neutrophil-to-lymphocyte ratio had significantly poorer survival than those without elevation (all P<0.05). However, the multivariate analysis failed to prove erythrocyte sedimentation rate and neutrophil-to-lymphocyte ratio as independent prognostic factors.ConclusionsThe elevation of erythrocyte sedimentation rate and neutrophil-to-lymphocyte ratio were correlated with poor prognosis in the univariate analysis and there was a strong correlation between inflammatory parameters (erythrocyte sedimentation rate and neutrophil-to-lymphocyte ratio) and tumor progression. Thus, erythrocyte sedimentation rate and neutrophil-to-lymphocyte ratio are considered useful as follow-up factors.
PurposeThe aim of this study was to assess the expressions of CD44 and CD133 in colorectal cancer tissue by using immunohistochemical staining and to analyze the clinical significance of the expressions related to other clinicopathological data and survival results.MethodsOne hundred sixty-two patients with a biopsy-proven colorectal adenocarcinoma who were operated on between January 1998 and August 2004 were enrolled in this study. Immunohistochemical staining for CD44 and CD133 was performed on primary colorectal cancer tissue, metastatic lymph nodes, and synchronous and metachronous metastatic tumor tissues if available.ResultsCD44 expression was stronger in the primary tumor than in metastatic lymph nodes (P < 0.001), and CD133 expression tended to be stronger in primary tumor than in metastatic lymph nodes (P = 0.057). No significant correlation was found between the CD44 and the CD133 expressions. The cases with recurrence showed low expression of CD44 (P = 0.017). CD133 expression was lower in cases with elevated CA 19-9 serum levels (P = 0.028) and advanced T stage (P = 0.038). Multivariate analysis proved that low expression of CD44 was an independent prognosis factor for short disease-free survival (P = 0.028).ConclusionLow CD44 expression was correlated with increased tumor recurrence and short disease-free survival, and low CD133 expression was associated with advanced tumor stage. We suggest that further studies be performed to evaluate whether the immunohistochemical method for determining the CD44 and the CD133 expressions is appropriate for exploring cancer stem-cell biology in patients with colorectal cancer.
BackgroundWe conducted this retrospective study to analyze the relationship between the distance of the proximal resection margin (PRM) and the pattern of recurrence in patients with gastric cancer who underwent curative gastrectomy.MethodsIn our series, there were 774 patients who underwent curative gastrectomy for gastric adenocarcinoma. Thus, we classified our clinical series of patients into the distal gastrectomy group (n = 529) and the total gastrectomy group (n = 245). The clinical pathologic data and PRM distance were collected. Univariate and multivariate analyses were performed to evaluate association between PRM distance and locoregional recurrence.ResultsThe mean distance of the PRM was 4.03 cm in the total gastrectomy group. The distance of the PRM had a significant correlation with advanced T-stage, advanced N-stage,vascular invasion,lymphatic invasion, neural invasion, histological undifferentiation, greater tumor size, and the upper third of the tumor location. On multivariate analysis, tumor recurrence showed only the independent prognostic factor N-stage (P <0.023). The mean distance of the PRM was 6.4 cm in the distal gastrectomy group. The distance of the PRM had a significant correlation with the advanced T-stage, advanced N-stage, younger age, vascular invasion, histological undifferentiation, greater tumor size, and the middle third of tumor location. On multivariate analysis, tumor recurrence showed three independent prognostic factors, N-stage (P <0.001), vascular invasion (P = 0.009), and lower third tumor location (P = 0.035). The total gastrectomy of locoregional recurrence was related to N-stage (P = 0.039), and the distal gastrectomy of locoregional recurrence was related to T-stage (P = 0.021). Study on the disease-free survival, PRM distance, and locoregional recurrence was not statistically relevant in both the total and distal gastrectomy group (P = 0.565 and P = 0.584, respectively).ConclusionsOur results indicate that a sufficient resection margin is not the absolute factor associated with the rate of survival and recurrence, although it is a key prognostic factor. The locoregional recurrence had no significant correlation with the distance of the PRM after curative gastrectomy.
Carcinosarcoma is a rare malignant, biphasic tumor comprised of carcinoma and sarcoma components. In the gastrointestinal tract, carcinosarcoma is most frequently seen in the esophagus and rarely in the stomach. We report a 51-year-old female patient with 2-month-history of epigastric pain and dyspepsia. Endoscopic finding revealed a huge ulcerative lesion that infiltrated from the antrum to the mid-body. An endoscopically taken biopsy revealed poorly differentiated malignant round cell neoplasm. After the palliative subtotal gastrectomy, immunohistochemical studies showed two positive reactions for the epithelial marker and mesenchymal marker. Based on the above findings, the patient was diagnosed with gastric carcinosarcoma. The immunohistochemical analysis is a critical method in making an accurate diagnosis of carcinosarcoma.
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