| 【Objective】1. To explore the clinicopathological characteristics of gastric remnant cancer and identify its prognostic factors.2. To explore the pattern of lymph node metastasis of gastric remnant cancer and identify its prognostic value.3. Licochalcone A(LCA) is a flavonoid extracted from licorice root that has anti-parasitic, anti-bacterial, and anti-tumor properties. Our previous findings revealed that LCA has the potential to be used in the treatment of gastric cancer. Now we further assess the potential antitumor effects of LCA alone or in combination with 5-Fluorouracil(5-FU).【Methods】1. From January 2003 to December 2012, 85 patients with gastric remnant cancer were treated in Renji Hospital, School of Medicine, Shanghai Jiao Tong University.The medical records of 58 patients who underwent surgical resection were retrospectively analyzed.2. From January 2003 to December 2012, 85 patients with gastric remnant cancer were treated in Renji Hospital, School of Medicine, Shanghai Jiao Tong University. Among them, 40 patients who had undergone radical resection(R0 resection) and lymphadenectomy were retrospectively analysed.3. The effects of blank controls, LCA alone or in combination with 5-FU on threegastric cancer cell lines, MKN-28, SGC7901, and MKN-45 were studied usingCCK8, cell cycle analysis, apoptosis analysis.【Results】1. The gastric remnant cancer(GRC) patients accounted for 1.5% of the patients with gastric cancer during the same period. Gastric remnant cancer was likely to develop in males, and the ratio of males to females was 4.3:1. The median age was 70 years old. As compared to patients with previous gastric cancer, Billroth Ⅱ reconstruction was more common in patients with previous peptic ulcer(73.8% vs. 37.5%, p = 0.010). The interval time from first surgical resection to diagnosis of GRC was longer in cases of previous peptic ulcer than in cases of previous gastric cancer(29.2±10.6 vs. 12.7±12.9 years, p = 0.000). Tumors located in anastomotic sites were more common in Billroth Ⅱ reconstruction than in Billroth Ⅰ reconstruction(73.0% vs. 28.6%, p = 0.001). Borrmann type Ⅳ cancers had a high incidence of larger tumor size, undifferentiated pathology and diffuse tumor in whole gastric remnant.The resection and radical resection rates of GRC were 68.2%(58/85) and 55.3%(47/85), respectively. The overall 1-, 3-, and 5-year survival rates of patients who underwent radical resection were 70.2%, 38.4% and 32.4%, respectively. Univariate analysis showed that the significant factors affecting survival included tumor location, differentiation, tumor diameter, the level of ALB, serum carcino-embryonic antigen(CEA) level, depth of invasion, nodal metastasis, distant metastasis, TNM stage, curability, resection combined with organs, and Borrmann type(all p < 0.05); whereas differentiation, the level of ALB, serum CEA level and distant metastasis were independent prognostic factors in multivariable analysis(all p < 0.05).2. Lymph node metastatic rate was 62.5%(25/40), lymph node ratio was 33.5%(115/343). The LNR parameter was determined by the best cutoff approach in terms of the log-rank test,LNR interval were as follow: LNR0 0%;LNR11-17%;LNR2 18-90%;LNR3 >90%. The median survival time of patients with N0, N1, N2, N3 stage were 79.5 months,37.2 months,12.9 months,9.7 months, and the difference were significant(p=0.000). Similar, The median survival time of patients with LNR0, LNR1, LNR2, LNR3 stage were 79.5 months,30.2 months,18.0 months,4.1months, respectively, and the difference were significant(p =0.000). The lymph node ratio and lymph node metastatic rate of NO.10 and NO.11 were 66.7% and 75%, while the lymph node ratio and lymph node metastatic rate of NO.14 were 54.5% and 76.9%. The lymph node ratio of NO.14 was higher in patients with previous gastric cancer than those with previous peptic ulcer(100% vs. 47.9%,p =0.029). The lymph node ratio of NO.14 was higher in patients with Billroth Ⅱ reconstruction than those with Billroth Ⅰ reconstruction(62.2% vs.20%,p =0.038). The patients with NO.14 positive rate of lymph node metastasis had a longer median survival time than others(9.7months vs.34.8 months,p =0.000).3. LCA inhibited cell proliferation, blocked cell cycle progression at the G2/M transition, and induced apoptosis. Combination with 5-FU enhanced the antitumor effect of LCA.【Conclusion】1. The factors influencing the prognosis of GRC include differentiation, the level of ALB, serum CEA level and distant metastasis. Regular follow-up is essential for monitoring the occurrence and evaluating the prognosis of GRC after gastrectomy, regardless of peptic ulcer or gastric cancer.2. Both N stage and lymph node ratio were factors influencing the prognosis. NO.10, NO.11 and NO.14 lymph node had high rate of involvement(lymph node metastatic rate were 75.0% and 76.9%, respectively), and NO.14 lymph node had an influence on prognosis, so NO.14 lymph node should be dissected in surgery as possible.3. LCA alone or in combination with 5-FU has significant anti-tumor effects on gastric cancer cells, indicating a potential for use in the future treatment of gastric cancer, but a lot of research were needed to further confirmed. |
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