Background/Aims: A specific preoperative work-up was used to access a limited number of high-risk lymph nodes with RT-qPCR for micrometastatic sentinel lymph node involvement. We validated our protocol with IHC screening for micrometastases and long-term survival analysis. Methodology: From the 32 patients included 22 were node-negative patients. With a specific preoperative protocol sentinel lymph nodes (1-2 per patient) were extracted for further RT-qPCR analysis for CEA and CK20 expression. In 10 patients from the study group, the remaining lymph nodes around the extracted sentinel lymph node from the first compartment were additionally screened using IHC for missed micrometastases. Results: Micrometastases were detected in seven of 22 (31.8%) node-negative patients. RT-qPCR identified micrometastases in four of 10 haematoxylineosin- negative lymph nodes (40%), and in three of eight IHC negative lymph nodes (37.5%). The cumulative 3-year survival for the study group was 80.8%. The 3-year survival in the RT-qPCR-negative group was 90%, compared with 66.7% in the RT-qPCR-positive group (p=0.289). Conclusions: Encouraged by these results, we will include more patients in our focused sentinel lymph node protocol. With a refinement of our method, we believe the focused sentinel lymph node protocol can be implemented for intraoperative tailoring of extent of lymphadenectomy.
COBISS.SI-ID: 4548671
Gastric cancer is the fifth most prevalent male cancer and the sixth most prevalent female cancer. Although its prevalence is slowly declining in western countries, the montality associated with it is still high and even reaches the incidence found in some endemic areas. These facts are daunting, especially considering the fact that in the majority of cases in Slovenia diagnosis is still made in a desperate stage. A slightly positive trend toward early diagnosis has been seen in recent years, but these patients represent less than a quarter of all cases. The multimodal approach to treatment has enabled long term survival of gastric cancer patients. In specialized centers, the 10-year survival after curable resections has been reported to be 36 %. These outstanding results are also matched in Slovenia, owing to interdisciplinary cooperation, continuous education, keeping up with oncological trends, and, finally, our own research. At the undisputed top are the Japanese with a cumulative 5-year survival of 70 %. Their results are a milestone that will be difficult for others to reach and the reasons for this are diverse. In the following article, the authors provide a comprehensive overview of gastric cancer disease from the surgical perspective, substantiated by experiance from the treatment of 772 patients at the Maribor University Clinical Centre in the period from 1 January 1992 to 31 July 2009. In 657 cases, R0 resection was accomplished and the 5-year survival for the studied 18-year period in patients with curable resection amounted to 42 %.
COBISS.SI-ID: 3820607
Background: The concept of sentinel lymph node screening has been recently introduced in gastric cancer treatment. Even through micrometastases can be shown reliably by imunohystochemistry, such staining methods are lengthy and laborious, which precludes its intraoperative use. In this study, the clinical and prognostic implications of a new single sentinel lymph node screening for micrometastases concept were evaluated on a small study group. Methods: Twenty-three patients were included in our study. Nine were selected as a control group. The first stained lymph node was defined as the true sentinel lymph node. This lymph node was sent separately for RT-qPCR analysis to determine CEA and CK-20 expression as markers of micrometastases. Patient and tumor characteristics were analysed and possible correlations with micrometastatic involvement were determined. Results: Fourteen patients were found to be N0. Four patients (28.6 %) had micrometastases. Micrometastases were more prominent in patients with diffuse gastric cancer, with higher CA 19–9 values. Patients with micrometastases were also found to be older than those without them. Conclusions: Even through these results indicate the potential use of a single SNL in intraoperative decision making, the sensitivity and specificity of our method has to be evaluated on a larger series, supported by long-term recurrence and survival results.
COBISS.SI-ID: 4529983
Background: The relationship between prognosis and age of patients with gastric carcinoma is controversial. The purpose of this study was to define the clinicopathological features and prognosis of gastric cancer in young Slovenian adults. Methods: Between January 1992 and January 2009, 772 patients with resected gastric cancer were enrolled in a prospective database. The findings for 58 (7.5 %) patients aged 45 years or less were compared with those of 714 patients aged between 46 and 86 years. Results: We found significant differences in their ASA scores (p ( 0.001): the majority of patients in the younger group scored ASA I (93 %), while most of the patients in the older group scored ASA II or III (72 %). In the younger group there were significantly more Lauren diffuse-type carcinomas (63 % versus 36 %; P = 0.007), total gastrectomies (79 % versus 55 %; P = 0.003), and harvested lymph nodes (26 ± 19 versus 21 ± 14; P = 0.02). There were no statistically significant differences in curative resections (86 % versus 85 %), TNM stage distribution and in the rate of perioperative surgical and non-surgical morbidity and mortality. Actuarial 5-year survival rates for the younger and the older groups were 43.8 % and 34.1 % respectively (P = 0.05). Actuarial 10-year survival rates for the younger and the older groups were 37 % and 23.7 % respectively (P = 0.05). The factors associated with adverse 5-year survival in multivariate analysis were higher TNM UICC stage, non-curative resection, higher ASA scores, and N2–3 lymph node metastases. Conclusions: Differences in the ASA scores between the two groups were expected. A second feature was the predominance of the Lauren diffuse type in the younger group. A higher portion of total gastrectomies and harvested lymph nodes were the consequences of the more aggressive surgical approach in younger patients. Survival was better in the younger group of patients, although the outcome is probably more related to stage of the disease at diagnosis than to age.
COBISS.SI-ID: 27863001
Background/Aims: The purpose of this study was to examine the validity of the clinical risk score (CRS) for a selection of patients for surgery. Methodology: In the period of January 1996 to June 2007, 169 patients underwent their first surgical and/or local ablative therapy for CRLM. This study assesses five preoperative prognostic criteria which define the CRS (nodal status of the primary tumor, the disease-free interval, the number of hepatic metastases, the preoperative CEA level, and the size of the largest metastasis). In the present study was analyzed the calculated CRS with respect to patient's postoperative survival. Results: An individual CRS was found to be predictive of survival. CRS stratified into two groups (CRS scores 0-2 and 3-5) were also found to be predictive of survival, with 5-year survival rates of 41% and 13%, respectively. CRS stratified into three groups (CRS scores 0-1; 2-3 and 4-5) were found predictive of survival as well, with 5-year survival rates of 72.7%, 21% and 4.6%, respectively. Conclusions: Immediate hepatic resection is reasonable in patients with CRS 0 to 1. In patients with CRS 2 to 3, chemotherapy may be required in addition to hepatic resection. In patients with CRS 4 to 5, hepatic resection is probably reasonable only if there is a response to chemotherapy.
COBISS.SI-ID: 3494719