Insulin Resistance Is Associated with Early Gastric Cancer: A Prospective Multicenter Case Control Study

Hye Jung Kwon,Moo In Park,박선자,문원,김성은,김재현,Youn Jung Choi,Sang Kil Lee 거트앤리버 소화기연관학회협의회 2019 Gut and Liver Vol.13 No.2

Background/Aims: Recently, increased body weight has been found to be associated with an increasing risk of several cancers, including gastric cancer. The true pathogenic role of hyperglycemia in the development of gastric cancer remains unclear as hyperglycemia and its associated conditions may work as carcinogenic factors. The goal of this study was to clarify the factors associated with early gastric cancer and evaluate a homeostasis model assessment of the insulin resistance (HOMA-IR) index, fasting glucose, and lipid profile as predictors of early gastric cancer. Methods: A total of 63 patients with early gastric cancer between November 2012 and March 2013 were included. Preoperative serum lipid profile levels and serum fasting glucose were examined prospectively in patients with early gastric cancer. The same number of controls were evaluated and matched to the early gastric cancer group for age and gender. We performed multivariate logistic regression analysis to identify independent risk factors for early gastric cancer. Results: Univariate analysis showed that risk for early gastric cancer was associated with diastolic blood pressure (BP), total cholesterol, fasting glucose, and HOMA-IR. In the multivariate-adjusted model, higher total cholesterol, fasting glucose, body mass index, and diastolic BP were strongly associated with an increased risk of early gastric cancer. Conclusions: Hyperglycemia, a lower high-density lipoprotein cholesterol level, and a low HOMA-IR level appear to be associated with early gastric cancer risk.

조기위암의 임상적 고찰

송훤택(Hwun Taig Song),김창덕(Chang Duck Kim),류호상(Ho Sang Ryu),현진해(Jin Hae Hyun) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.5

N/A Gastric cancer is the leading cause of cancer death in Korea. The high mortality rate of gas- tric cancer is partly attributed to its late detection and the perfomance of surgery at an advanced stage of disease. So, its early detection and treatment of gastric carcinoma will im- prove the current unfavourable prognosis of gastric cancer. Progress in diagnostic endoscopy has made it possible to detect the early gastric cancer which has excellent postoperative out- come because of its high curability. In this retrospective study, 181 cases of early gastric cancer which have been resected at the Korea University Anam Hospital from January, 1982 to December 1992 were reviewed with emphasis on incidence, macroscopic classification, clinical significance, and prognosis in order to elucidate the clincal picture of early gastric cancer. The proportion of early gastric cancer was 8.1% of all gastric cancer and 0.29% of total patients who underwent gastrofiberscopy. The ratio of male to female was 1.8: 1, and the peak age of incidence was 6th decade(35.4%). The lesion was most commonly found in antrum(51.1%) and lesser cur- vature side(73.1%). EGC type II< was the most common macroscopic type(31.3%). The size of lesion was mostly less than 3cm(68.1%) and the larger lesions showed the higher rate of in- vasion to submucosa and lymph node metastasis. The percentage of lymph node metastasis was much higher in lesion infiltrating to submucosa(20.0%) than mucosa confined cancer. According to cancer cell type, tubular adenocarcinoma was most common(74.8%). There was no correlation between cancer cell type and the incidence of lymph node metastasis. The diag- nostic accuracy by gastrofiberscopic observation was 83.5%. The 5 year survival rate of total early gastric cancer patient was 94.2%.(Korean J Gastroenterol 1994; 26: 789 799)

위암의 임상 특징 및 최근 치료 동향

서지현 ( Ji Hyun Seo ),김나영 ( Na Young Kim ),이동호 ( Dong Ho Lee ),김진욱 ( Jin Wook Kim ),황진혁 ( Jin Hyeok Hwang ),박영수 ( Young Soo Park ),김선미 ( Sun Mi Kim ),김형호 ( Hyng Ho Kim ),박란영 ( Ran Young Park ),이경수 ( Kyo 대한내과학회 2006 대한내과학회지 Vol.71 No.2

목적: 본 연구는 위암의 전반적인 임상양상과 진단경로에 따른 조기위암의 진단율 및 이에 따른 치료방법의 변화를 알아보았다. 방법: 분당서울대학교병원에서 2003년 5월부터 2004년 4월까지 1년간 조직학적으로 위암이 진단된 환자 231명을 대상으로 하여 후향적으로 조기위암의 진단율과 진단경로에 따른 임상양상과 근치적 치료법의 새로운 경향 등을 살펴보고 근치적 수술이 시행된 예에서 현재까지의 추적관찰을 시행하였다. 결과: 231명의 위암 환자 중 조기위암의 진단률은 42.0% (97명)이었다. 진단된 위암 환자는 남자가 여자보다 1.92배 많았으며 60대 이상의 고령의 환자가 64.9%를 차지하였다. 231명의 환자 중 43명이 건강검진에서 진단되었는데, 건강검진에서 진단된 43명 중 34명(79.1%)이 조기위암이었고, 건강검진에서 진단된 조기위암 환자의 72% (31명)에서 증상이 없었다. 231명의 위암 환자 중 169명이 근치적 치료를 받았는데 최소 침습적 위암수술방법인 복강경하 위절제술은 조기위암 환자의 61.9%에서 시행되어졌고 진행암에서는 10%에서 시행되었다. 근치적 수술 후의 림프절 구득률은 개복 위절제술(36.0±15.2)에서 복강경하 위절제술(27.9±10.3)보다 유의하게 많았다. 근치적 치료를 받았던 169명의 환자들의 평균 추적관찰 기간은 약 17개월이었는데 치료 방법에 무관하게 조기위암 환자에서는 재발이 없었다. 결론: 이상의 결과로 보아 조기위암 진단에 있어서 건강검진의 중요성을 알 수 있었고, 조기위암의 경우 복강경하 위절제술이 유용한 치료법임을 알 수 있었다. 향후 전향적인 대규모 연구와 생존율에 대한 장기간의 추적연구가 필요하리라 생각된다. Background: Gastric cancer is the most common malignancy in Korea. The purpose of this study is to evaluate the chronological changes of clinical feature and usefulness of recent treatment modalities such as laparoscopic assisted gastrectomy and endoscopic gastric mucosal resection (EMR). Methods: We analyzed the clinical characteristics of the gastric cancer patients who were diagnosed as gastric cancer by pathology from May 2003 to May 2004 in Seoul National University Bundang Hospital. In addition, we classified the curable treatment modalities depending on whether it was early gastric cancer or advanced gastric cancer. Results: The total number of patients was 231, and the proportion of early gastric cancer was 97 patients (42.0%). Forty three patients (18.6%) were diagnosed through health screening test. Curative treatment was performed in 169 patients (73.2%): that is, radical subtotal gastrectomy in 158 (68.4%), and EMR in 11 (4.8%). Among 158 patients who underwent curative radical surgery, 67 patients (42.4%) had been operated on laparoscopic gastrectomy (laparoscopic-assisted distal gastrectomy or laparoscopic wedge resection). There was no cancer recurrence in the early gastric cancer after curative treatment regardless of treatment modality during mean follow-up period of 15.9 months. Conclusions: These results seem to support the usefulness of health screening test for early detection of gastric cancer. Laparoscopic gastrectomy could be the primary choice for the early gastric cancer.(Korean J Med 71:149-157, 2006)

조기위암의 임상적 연구

박태준,양은수,류종철,박태군,이희승,신원창,이진호,김관엽 인제대학교 1994 仁濟醫學 Vol.15 No.1

1989년 9월부터 1993년 7월까지 인제대학교 의과대학 상계백병원에서 실시한 위내시경 소견이 조기위암이며 내시경 직시하 생검결과 선암으로 판명되어, 근치적 위절제술을 시행받은 23명의 환자에서 임상적 특징을 알아보고, 문헌고찰과 함께 보고하는 바이다. The incidence and mortality rate of stomach cancer ranks well ahead of all malignancies in Korea. The prognosis is excellent in early gastric cancer of which the overall 5 years survival rate of 85∼95% is comparative with that of advanced gastric cancer of 15∼49%. So early detection with very sensitive mordality of gastroscope and surgery is the only premise to decrease the mortality rate of gastric cancer. This report deals with the clinical aspects of 23 cases of early gastric cancer, which were confirmed with histopathologic examination of resected stomach during the 4 years from September 1989 to July 1993 at Sanggye Paik hospital, Seoul, Korea. Out of 23 cases of early gastric cancer, 14 cases were male, 9 cases were female, and the male to female ratio was 1.6 : 1. The most common type of early gastric cancer was talc type(43.5%), IIc and its combined type comprised most of them(87.0%). The most prevalent sloe of lesion was gastric angle(43.5%) and the most common direction was lesser curvature(73.9%) 19 cases of 23(78.3%) were between 1∼3cm in size, and there was no statistical significance between the size of the lesion and lymph node metastasis. Of the 9 cases with mucosal lesion, there were 2 cases with lymph node metastasis(22.2%), but 7cases(50.0% ) of 14 cases with submucosal lesion presented lymph node metastasis. Diagnostic accuracy of endoscopy on detection of early gastric cancer was 17 cases(73.9%) of total 23 cases in our study. As with other report, histopathulogic examination of resected stomach revealed adenocarcinoma, tubular type as the most common type. Frequent complaint of patients with early gastric cancer was epigastric pain(65.2%), and duration of the symptom was less than 12 months in 17 cases(73.1%) of 23 patients with early gastric cancer.

미소위암 8예에 대한 임상적 고찰

김영경(Young Kyung Kim),이동기(Dong Ki Lee),이성우(Seong Woo Lee),김준명(Jun Myeong Kim),이상철(Sang Chul Lee),권상옥(Sang Ok Kwon),장우익(Woo Ick Jang),조미연(Mee Yen Cho) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.6

N/A Background/Aims: The aim of this study is to investigate the clinical characteristics of minute gastric cancer, less than 5mm in the largest diameter of the lesion. Methods: We reviewed 8 patients of minute gastric cancer among 100 patients of early gastric cancer(EGC) and 474 patients of advanced gastric cancer who received operation at our hospital from January 1989 to July 1993. Results: The incidence of minute gastric cancer was 8% among early gastric cancer and 1.4% among stomach cancer who received operation. The patients ages ranged from 32 to 74 years old (mean age 60) and most frequently found in their six and seven decade in 75%(6/8). The ratio of male to female was 1.7:1. The multiplicity of minute gastric cancer was 37.5%(3/8), relatively higher than that of EGC 6%(6/100). Before operation we observed 7 lesions of minute gastric cancer by endoscopy. In Suzukis endoscopic classification for minute gastric cancer, most common type of the lesion was depressed type in 4(57.1%), and flat type in 2(28.6%) and elevated type in one(14.2%) patient. The location of minute gastric cancer was antrum in 4, body in 3 and fundus in one. The histologic type of minute gastric cancer was moderate to well differentiated adenocarcinoma in 7, signet ring cell carcinoma in one. The depth of invasion of minute gastric cancer was mucosal cancer in 7, submucosal cancer in one. There was no lymph node metastasis in all minute gastric cancers. Conclusions Almost minute gastric cancers were confined to the mucosa with rare lymph node metastasis. These characteristics of minute gastric cancer may provide the opinion less invasive operation or endoscopic treatment with curative aim. Further study is warranted to assess its significance of endoscopic treatment for minute gastric cancer. (Korean J Gastroenterol 1995;27: 635 - 644)

Risk of Lymph Node Metastases from Early Gastric Cancer in Relation to Depth of Invasion: Experience in a Single Institution

Wang, Zheng,Ma, Li,Zhang, Xing-Mao,Zhou, Zhi-Xiang Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.13

Background: An accurate assessment of potential lymph node metastasis is important for the appropriate treatment of early gastric cancers. Therefore, this study analyzed predictive factors associated with lymph node metastasis and identified differences between mucosal and submucosal gastric cancers. Materials and Methods: A total of 518 early gastric cancer patients who underwent radical gastrectomy were reviewed in this study. Clinicopathological features were analyzed to identify predictive factors for lymph node metastasis. Results: The rate of lymph node metastasis in early gastric cancer was 15.3% overall, 3.3% for mucosal cancer, and 23.5% for submucosal cancer. Using univariate analysis, risk factors for lymph node metastasis were identified as tumor location, tumor size, depth of tumor invasion, histological type and lymphovascular invasion. Multivariate analysis revealed that tumor size >2 cm, submucosal invasion, undifferentiated tumors and lymphovascular invasion were independent risk factors for lymph node metastasis. When the carcinomas were confined to the mucosal layer, tumor size showed a significant correlation with lymph node metastasis. On the other hand, histological type and lymphovascular invasion were associated with lymph node metastasis in submucosal carcinomas. Conclusions: Tumor size >2 cm, submucosal tumor, undifferentiated tumor and lymphovascular invasion are predictive factors for lymph node metastasis in early gastric cancer. Risk factors are quite different depending on depth of tumor invasion. Endoscopic treatment might be possible in highly selective cases.

조기 위암 - 임파절 전이와 수술 성적 -

강남부(Nam Poo Kang),최성양(Seong Yang Choi),양두현(Doo Hyun Yang) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.5

N/A A retrospective study of early gastric cancer (84 patients) was done to evaluate the incidence of lymph nodc metastasis and the results of surgical treatment: during 10 years from Jan. 1983 to Dec. 1992. Out of 731 consecutive cases of gastric carcinoma diagnosed during that period, 84 cases (11.5%) was fulfilled the criteria of early gastric cancer. The peak incidence of age was sixth decade (38.1%) and the ratio of male to female was 2,1:1. The incidence of early gastric canrer among the total case of gastric cancer was 6.9% in 1983, but is increasing tendency nowadays. The rate of lymph node metastasis was 4% in mucosa cancer and 13.6% in submueosal cancer. Lymph node metastasis was noted in the case of depressed type over 4.1 cm in size of miscosal type, and depressed type in any size of submucosal type. The incidence of lymph node metastasis was highest in the early gastric cancer which developed in antrum. The histologic type which had most common lymph node metastasis was poorly differentiated adenocavcinoma and the next type was moderately differentiated adenocarcinoma. 80 cases oi early gastric cancer underwent radical subtotal gastrectomy with R2 dissection and 4 c ases underwent rardical proximal gastrectomy due to high location. Kaplan-Meier estimate 5 year survival rate was 100% in mucosal cancer, 92.8%; in submucosal cancer, 85.7.% in lymph node metastatic group and 95.8% in lymph node negative group.

조기위장관암 내시경 치료 임상진료지침

박찬혁,양동훈,김정욱,김지현,김지현,민양원,이시형,배정호,정현수,최기돈,박준철,이혁,곽민섭,김번,이현정,이혜승,최미영,박동아,이종열,변정식,박찬국,조주영,이수택,전훈재 대한상부위장관ㆍ헬리코박터학회 2020 Korean Journal of Helicobacter Upper Gastrointesti Vol.20 No.2

Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.

조기 위암의 임상적 고찰

윤석진(Seok Jin Yoon),박경남(Kyung Nam Park),기춘석(Choon Suhk Kee),이민호(Min Ho Lee),함준수(Joon Soo Hahm),이옥찬(Ock Chan Lee),이상(Sang Lee) 대한내과학회 1994 대한내과학회지 Vol.47 No.3

N/A Background: Stomach cancer is one of the most prevalent malignancy in Korea and usually has poor prognosis. However, the prognosis for the early gastric cancer has been reported excellent and this is why it has been emphasized on the early diagnosis and treatment of this grave problem. Method: The authors reviewed 319 cases of early gastric cancer which had been confirmed by surgery and pathologic examination from March 1974 to February 1993 at Hanyang University Hospital. Results: The incidence of early gastric cancer was 6. 0% of all gastric cancer and 17.6% of gastric resection for stomach cancer, and there was no annual increase in incidence of early gastric cancer. The greatest prevalence was in 5th decade (29.4%), and male to female ratio was 2.1:1 with male preponderance. The common sites were gastric antrum (55.7%), body (24.1%) and angle (18.8%) and along the lesser curvature (60.5%). The size of the lesions varied from smaller than 1.0 cm to larger than 5 cm but there was no significant difference between the size of the lesion and the depth of invasion or the lymph node involvement. In 141 case (44.2%), the lesions confined to mucosa, while 178 cases (55.7%) were extended to submucosa. The metastasis to lymph nodes were detected in 13 cases of mucosal cancer and 34 cases of patients with submucosal cancer, and there was statistically significant difference. According to the histopathologic type by WHO classification, signet ring cell was the most common (42.9%), The most frequently encountered types by macroscopic classification were type IIc and its variants, accounting for over 57.9% of the cases. Fnllow up studies were possible in 161 cases from August 1986 to February 1993, and 5yr-survival rate was 98.1%.

Is Surgical Treatment Necessary after Non-curative Endoscopic Resection for Early Gastric Cancer?

Lee, Ji-Ho,Kim, Jae-Hun,Kim, Dae-Hwan,Jeon, Tae-Yong,Kim, Dong-Heon,Kim, Gwang-Ha,Park, Do-Yoon The Korean Gastric Cancer Association 2010 Journal of gastric cancer Vol.10 No.4

Purpose: Additional surgery is commonly recommended in gastric cancer patients who have a high risk of lymph node metastasis or a positive resection margin after endoscopic resection. We conducted this study to determine factors related to residual cancer and to determine the appropriate treatment strategy. Materials and Methods: A total of 28 patients who underwent curative gastrectomy due to non-curative endoscopic resection for early gastric cancer between January 2006 and June 2009 were enrolled in this study. Their clinicopathological findings were reviewed retrospectively and analyzed for residual cancer. Results: Of the 28 patients, surgical specimens showed residual cancers in eight cases (28.6%) and lymph node metastasis in one case (3.8%). Based on results of the endoscopic resection method, the rate of residual cancer was significantly different between the en-bloc resection group (17.4%) and the piecemeal resection group (80.0%). The rate of residual cancer was significantly different between the diffuse type group (100%) and the intestinal type group (20%). The rate of residual cancer in the positive lateral margin group (25.0%) was significantly lower than that in the positive vertical margin group (33.3%) or in the positive lateral and vertical margin group (66.7%). Conclusions: We recommended that patients who were lateral and vertical margin positive, had a diffuse type, or underwent piecemeal endoscopic resection, should be treated by surgery. Minimal invasive procedures can be considered for patients who were lateral margin positive and intestinal type through histopathological examination after en-bloc endoscopic resection.