title: Combined epithelial-mesenchymal transition with cancer stem cell-like marker as predictors of recurrence after radical resection for gastric cancer.
abstract: BACKGROUND
  The aim of the study was to identify the incidence and the predictors of recurrence after curative resection and the clinical significance of epithelial-mesenchymal transition (EMT) and stem cell-like phenotypes in gastric cancer.
  
  
  METHODS
  In a total of 1,463 patients that underwent curative resection for gastric cancer between January 2001 and January 2008 at Drum Tower Hospital, 402 (27.5%) experienced recurrence. They were divided into early recurrence (within two years) and late recurrence (more than two years). The clinicopathological characteristics, including five EMT-related proteins (Snail-1, ZEB-1, E-cadherin, vimentin, and β-catenin) and the gastric cancer stem cell markers CD44 and CD54, therapeutic modalities, survival time after recurrence, and recurrence patterns were compared between the two groups.
  
  
  RESULTS
  Loss of E-cadherin expression and aberrant expression of vimentin and the known gastric cancer stem cell maker CD44 were significantly associated with aggressive clinicopathologic features. Multivariate analysis showed that stage III gastric cancer patients with early recurrence had larger tumors and more lymph node metastasis, coupled with aberrant expression EMT and cancer stem cell marker, than patients with late recurrence. Early recurrence was associated with more distant metastasis than late recurrence and patients tended to die within two years of recurrence.
  
  
  CONCLUSIONS
  Combined EMT with cancer stem cell-like marker is a predictor of recurrence after radical resection for gastric cancer. Advanced TNM stage was associated with early cancer death after recurrence.
authors.forename: Gui-fang
authors.initials: GF
authors.lastname: Xu
authors.affiliation: Department of General Surgery, Drum Tower Clinical College of Nanjing Medical University, 321 Zhongshan Road, Nanjing 210008, China. zhangweijie1616@163.com.
authors.forename: Wei-jie
authors.initials: WJ
authors.lastname: Zhang
authors.forename: Qi
authors.initials: Q
authors.lastname: Sun
authors.forename: Xinyun
authors.initials: X
authors.lastname: Xu
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Zou
authors.forename: Wenxian
authors.initials: W
authors.lastname: Guan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism*; D002681:China / Q000453:epidemiology; D058750:Epithelial-Mesenchymal Transition; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D007124:Immunoenzyme Techniques; D015994:Incidence; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000453:epidemiology* / Q000378:metabolism / Q000401:mortality; D009367:Neoplasm Staging; D014411:Neoplastic Stem Cells / Q000378:metabolism / Q000473:pathology*; D010534:Peritoneal Neoplasms / Q000378:metabolism / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D011379:Prognosis; D013274:Stomach Neoplasms / Q000378:metabolism / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate; D046888:Tissue Array Analysis
chemical_list: D014408:Biomarkers, Tumor