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Risk Factors for lymph node metastasis in Undifferentiated-Type Gastric Carcinoma
Myeong-Cherl Kook 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.1
Undifferentiated-type carcinoma has a high incidence of lymph node metastasis. The independent risk factors for lymph nodemetastasis in undifferentiated-type carcinoma are invasion depth, tumor size, lymphovascular invasion, and presence of ulcer. In thecases that meet the curative resection criteria, no lymph node metastasis was observed in the Japanese studies, but some metastaseswere observed in Korean studies. After performing curative endoscopic submucosal dissection, the survival rate is similar to thatof gastrectomy. The discrepancy between endoscopy and pathology is high in undifferentiated-type carcinoma. The tumor size inendoscopy is a significant risk factor for non-curative resection, and when the tumor size is small, the non-curative resection rate issignificantly reduced. Lymphovascular invasion can be assessed in pathologic examination and D2-40 stain is helpful. The presenceof ulcer should be determined by pathology, but ulcer’s omission in pathology report makes the analysis diffcult. Undifferentiatedtypecarcinomas with differentiated-type components show higher lymph node metastasis rate than that of pure undifferentiatedtypecarcinomas. The lymph node metastasis rate of signet ring cell type is lower than that of other undifferentiated-type carcinomasand is similar to differentiated-type carcinomas. The application of these additional histologic findings may improve the indication ofendoscopic submucosal dissection.
Clinical implications of proliferation activity in T1 or T2 male gastric cancer patients
김영우,엄방울,Myeong-Cherl Kook,김한성,김미경,Hai-Li Hwang,Vishal Chandra,Shiv Poojan,송유라,고재수,배창대,노정실,홍경만 생화학분자생물학회 2015 Experimental and molecular medicine Vol.47 No.-
Proliferation activity has already been established as a prognostic marker or as a marker for anticancer drug sensitivity. In gastric cancer, however, the prognostic significance of proliferation activity is still being debated. Several studies evaluating proliferation activity using Ki-67 have shown controversial results in terms of the relationship between proliferation activity and overall survival (OS) or drug sensitivity in gastric cancer patients. Because cytoskeleton-associated protein 2 (CKAP2) staining has recently been introduced as a marker of proliferation activity, we analyzed 437 gastric cancer tissues through CKAP2 immunohistochemistry, and we evaluated the chromatin CKAP2-positive cell count (CPCC) for proliferation activity. Although the CPCC did not show any significant correlation with OS in the male, female or total number of cases, it did show a significant correlation in the T1 or T2 male patient subgroup, according to log-rank tests (P=0.001) and univariate analysis (P=0.045). Additionally, multivariate analysis with the Cox proportional hazard regression model showed a significant correlation between the CPCC and OS (P=0.039) for the co-variables of age, gender, T stage, N stage, histology, tumor location, tumor size and adjuvant chemotherapy. In male gastric cancer cell lines, faster-growing cancer cells showed higher sensitivity to cisplatin than slow-growing cells. Thus our study indicates that CPCC-measured proliferation activity demonstrates a significantly worse prognosis in T1 or T2 male gastric cancer patients. The CPCC will help to more precisely classify gastric cancer patients and to select excellent candidates for adjuvant chemotherapy, which in turn will facilitate further clinical chemotherapeutic trials.
Kim, Young-Il,Kook, Myeong-Cherl,Choi, Jee Eun,Lee, Jong Yeul,Kim, Chan Gyoo,Eom, Bang Wool,Yoon, Hong Man,Ryu, Keun Won,Kim, Young-Woo,Choi, Il Ju The Korean Gastric Cancer Association 2020 Journal of gastric cancer Vol.20 No.2
Purpose: The guidelines for pathological evaluation of early gastric cancer (EGC) recommend wider section intervals for surgical specimens (5-7 mm) than those for endoscopically resected specimens (2-3 mm). Studies in surgically resected EGC specimens showed not negligible lymph node metastasis risks in EGCs meeting the expanded criteria for endoscopic submucosal dissection (ESD). Materials and Methods: This retrospective study included 401 EGC lesions with an endoscopic size of ≤ 30 mm detected in 386 patients. Pathological specimens obtained by ESD or surgery were cut into 2-mm section intervals for reference. Submucosal or lymphovascular invasion (LVI) was evaluated arbitrarily in 4- or 6-mm section intervals. McNemar's tests compared the differences between submucosal and LVI. Results: Submucosal invasion was detected in 29.2% (117/401) and LVI in 9.5% (38/401) at 2-mm interval. The submucosal invasion detection rates in 4-mm intervals decreased to 88.0% or 90.6% (both P<0.001), while the LVI detection rates decreased to 86.8% or 57.9% (P=0.025 and P<0.001, respectively). In 6-mm intervals, the submucosal and LVI detection rates decreased further to 72.7-80.3% (P<0.001 for all three sets) and 55.3-63.2% (P<0.001 for all three sets), respectively. Among 150 out-of-indication cases at 2-mm interval, 4-10 (2.7%-6.7%) at 4-mm intervals, and 10-17 (6.7%-11.3%) at 6-mm intervals were misclassified as lesions meeting the curative resection criteria due to the underestimation of submucosal or LVI. Conclusions: After ESD, the 2-mm wide section interval was suitable for the pathological evaluation of focal submucosal or LVI. Thus, if an EGC lesion meets the expanded criteria for the ESD specimen pathological evaluation, it could be safely followed up.
<i>Helicobacter pylori</i> Therapy for the Prevention of Metachronous Gastric Cancer
Choi, Il Ju,Kook, Myeong-Cherl,Kim, Young-Il,Cho, Soo-Jeong,Lee, Jong Yeul,Kim, Chan Gyoo,Park, Boram,Nam, Byung-Ho New England Journal of Medicine 2018 The New England journal of medicine Vol.378 No.12
<P>Patients with early gastric cancer who received H. pylori treatment had lower rates of metachronous gastric cancer and more improvement from baseline in the grade of gastric corpus atrophy than patients who received placebo.</P>