title: Prediction of sites of recurrence in gastric carcinoma using immunohistochemical parameters.
abstract: 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.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Tottori University School of Medicine, Yonago, Japan. sai10@grape.med.tottori-u.ac.jp
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Saito
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Osaki
authors.forename: Daiki
authors.initials: D
authors.lastname: Murakami
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Shingo
authors.initials: S
authors.lastname: Kanaji
authors.forename: Shotaro
authors.initials: S
authors.lastname: Ohro
authors.forename: Shigeru
authors.initials: S
authors.lastname: Tatebe
authors.forename: Shunichi
authors.initials: S
authors.lastname: Tsujitani
authors.forename: Masahide
authors.initials: M
authors.lastname: Ikeguchi
mesh_terms: 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
chemical_list: D053773:Transforming Growth Factor beta1; D016159:Tumor Suppressor Protein p53; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A