Prediction of sites of recurrence in gastric carcinoma using immunohistochemical parameters.
OBJECTIVE
To improve prognosis of patients with gastric cancer, it is important to detect recurrences at an early stage following surgery. If the site of recurrence can be predicted, recurrent disease can be easier detected at an early stage. However, this is difficult to achieve using normal clinicopathological factors. We aimed to predict sites of recurrence in patients with advanced gastric carcinoma who underwent curative resection.


METHODS
Expressions of vascular endothelial growth factor (VEGF), transforming growth factor (TGF)-ss1, and p53, together with density of microvessels (MVs), and dendritic cell (DC) infiltration were examined by immunohistochemistry to evaluate their relationships with recurrence patterns in patients with advanced gastric carcinoma (n = 92).


RESULTS
All immunohistochemical parameters closely correlated with prognosis (TGF-ss1, P = 0.008; VEGF, P < 0.001; p53, P = 0.028; MV, P < 0.001; DC, P < 0.001). Multivariate analysis showed that DC infiltration (P = 0.02; HR, 2.52; 95%CI, 1.16-5.48), MV density (P = 0.023; HR, 2.48; 95%CI, 1.13-5.44), VEGF expression (P = 0.002; HR, 3.27; 95%CI, 1.52-7.05), and lymph node metastasis (P < 0.0001; HR, 2.09; 95%CI, 1.49-2.93) were independent prognostic factors. A multivariate logistic regression analysis indicated that DC infiltration (P = 0.004; Odds ratio, 4.25; 95%CI, 1.51-11.96) and lymph node metastasis (P = 0.01; Odds ratio, 3.37; 95%CI, 1.31-8.66) provided significant estimates of relative risks for development of peritoneal recurrence. Upon development of hematogenous recurrence, VEGF expression significantly indicated relative risks (P < 0.001; Odds ratio, 7.26; 95%CI, 1.41-37.3). Moreover, p53 expression closely correlated with lymph node recurrence (P = 0.042; Odds ratio, 11; 95%CI, 1.26-95.7).


CONCLUSIONS
Assessment of immunohistochemical parameters can predict sites of recurrence in gastric carcinomas, and thus contributes to improve prognosis.
Saito
Hiroaki
H
Department of Surgery, Division of Surgical Oncology, Tottori University School of Medicine, Yonago, Japan. sai10@grape.med.tottori-u.ac.jp
Osaki
Tomohiro
T
Murakami
Daiki
D
Sakamoto
Teruhisa
T
Kanaji
Shingo
S
Ohro
Shotaro
S
Tatebe
Shigeru
S
Tsujitani
Shunichi
S
Ikeguchi
Masahide
M
D000230:Adenocarcinoma / Q000378:metabolism / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003713:Dendritic Cells / Q000473:pathology; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007150:Immunohistochemistry; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010534:Peritoneal Neoplasms / Q000175:diagnosis / Q000556:secondary*; D011237:Predictive Value of Tests; D011379:Prognosis; D013274:Stomach Neoplasms / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D053773:Transforming Growth Factor beta1 / Q000096:biosynthesis; D016159:Tumor Suppressor Protein p53 / Q000096:biosynthesis; D042461:Vascular Endothelial Growth Factor A / Q000096:biosynthesis
D053773:Transforming Growth Factor beta1; D016159:Tumor Suppressor Protein p53; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A