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Did gastric cancer vary over 30 years in Japan?
was 0.186, 0.167, and 0.160% in the 3 decades, respectively. 3. The rate of early gastric cancer was 60.4, 71.4, and 77.7%, respectively. It is suspected that the increasing rate depended on the advanceof roentgenogramandendoscopyand thewidespreedknowledgeof the characteristicsof early gastric cancer. 4. There were no remarkablechanges with respect to the location of gastric cancer. 5. The rate of the differentiated type greduallydeclined : 632, 58.4, and 56.5%, respectively.CONCLUSIONS:In the past 30 years the detectedgastric cancer slightly decreasedalthough the diagnostic technologies advanced, The histology of gastric cancer gradually changed in the three decades.The gastric cancer in Japan gradually changed quantitatively and qualitatively.
1321 UrsodeoxycholicAcid Inhibits Tumor Development During Both AOM-Induced Colon Tumor Initiation And Progression Ramesh K. Wall, Debra M. Stoiber, John A. Hart, Michael D. Sitrin, Thomas A. Brasitus, Marc 8issonnette, Univ of Chicago, Chicago, IL BACKGROUND:Studies in both sporadic human colon cancer, and in experimental models of this malignancy,indicatethat bile acids, such as cholic acid, may promote colonic carcinogenesis. In contrast, we havepreviouslyshownthat the bile acid, ursodeoxycholicacid (UDCA), when administered continuously during both tumor initiation and progression/promotion, inhibited the developmentof azoxymethane(AOM)-inducedcolon cancerin rats. More recently, we have found that UDCAalso inhibited AOM-induced hyperprolifaration, as well as aberrant crypt formation and growth. In an extensionof these studieswe askedwhetherthis chemopreventive effect of UDCAwould occur if administered only during the initiation phase, or during the post-initiation (promotion/progression} phase. METHODS: Male Fisher 344 rats (180) were divided into six treatment groups: Groups1&2 received standard rat chow (AIN 76A) throughout the study. Groups 3&4 received UDCAsupplementation (0.4% w/w) only during the first 5 weeks (initiation phase). Groups 5&6 received UDCA supplementation (0.4% w/ w) only after 5 weeks (promotion/progressionphase).Two wks after starting the diets, groups 2, 4 & 6 (40 rats each) receivedazoxymethane20 mg/kg body weight per wk x 2 wks, while groups 1, 3 and 5 (20 rats each) receivedsaline (AOM-vehicle) as controls. Thirty-two wks later, rats were sacrificed and colons resected. VisibE tumors were harvested and fixed in 10% buffered formalin for histologic characterization. RESULTS:There were no significant differences in weight gain among the groups. In the carcinogen-treateddietary control group, tumor incidence was 72.3%; and tumor multiplicity was 1.9 tumors per tumor bearing rat (TBR). Compared with the AOM-treated unsupplemented group, UDCA, administered only during the initiation, or in the post initiation phase,eachsignificantly decreasedtumor incidence to 46.2% and 38.4% (p
1324 An Investigation of the Factors Influencing Serum Pepsinogen Levels in Healthy Japanese: A Prospective Study Murdani Abdullah, Fumiaki Kitahara, Tadashi Sato, Yuichirou Kojima, MasayukiA. Fujino, Yamanashi Medical Univ, YamanashiJapan Background: The usefulness of gastric cancer screening using serum pepsinogen has been recognizedand several advantagesof this method over photoflourography have been shown by our previous study. Severalfactors such as, smoking, drinking, sex and age could influence serum pepsinogenlevel. Until now, the influence of sex, age, smoking, drinking, and dietary on serum pepsinogen have been assess by cross sectional study. How ever, the influence of those factors on pepsinogenlevel should be assessedexactly by a prospectivestudy. Aim: To determinethe role of sex, age, BMI, smoking, drinking, and dietary on serum pepsinogen level by a prospective study. Methods: This prospective study was conducted on 1114 (M 338, F 776) Japanese healthy subjects live in Ryowa Town, during the period of 1996 to 2000. Pepsinogen I (PC I) to II (PC II) ratio in 2000 minus that in 1996 was defined as delta PG 1/11and compare among the groups. Data were collected using questionnaire, physical examination and serum test for pepsinogen level. Analysis were done with serum delta PG I, delta PGI/II, and severalfactors e.g. age, sex, BMI, smoking, drinking habit, dietary, using independent paired t-test, Pearson Correlation and multiple regression analyses. Results: Mean age of the subjects was 50.1 + 12.7 (minimum 19 and maximum 81). Pepsinogen I level and PG 1/11ratio decreasedsignificantly during four years of observation. Mean of delta PG 1/11was lower in the groups of current smoker, three-time meal intake daily, daily vegetable intake, salty diet and malegender. How everthese differenceswere not significant, statistically. In the groups with drinking habit and regular meat intake, there were no differences regarding the mean of delta PG 1/11.On the other hand, PG 1/11ratio decreased significantly with pmgrassion of age, while BMI, delta body weight and height have no correlation with the delta PG I and delta PG [/[I. Multiple regression analyses revealeddelta PG I and delta PG I/ II have a good correlation with the progression of age. Conclusion: The effects of sex, BMI, current smoking, drinking habit, three time meal intake daily, salt intake, daily vegetable consumption and meat intake to delta PG I and delta PG I/if were not remarkableby multiple regression analyses. Statistically delta PG I and delta PG 1/11have a good correlation with progression of age.
1322 Prognostic Factors for Survival from Esophageal Carcinoma (ECA) in the United States: The effect of tumor Size and lymph node status Mohamad A. Eloubeidi, Renee Desmond, C. Mel Wilcox, Univ of Alabamaat Birmingham, Birmingham, AL Purpose:To determine the effect of tumor length and lymph node (LN) status on survival in patients with ECA. Methods:Cases of primary incident ECA were available from the NCI Surveillance, Epidemiology and End Results (SEER) program.Patients were sub grouped as localized, regional, or distant disease. Demographic factors and tumor characteristics (morphology, histologic grade, size, primary site, depth of invasion, number of positive LN, proportion of positive LN dissected and distant metastatic site) were examined by Cox multivariable models. Tumor length was grouped into quintUes; number of involved LN was categorizedas O, --5, >5 and a proportion was computed to comparethe number of positive LN to the number of LN dissectedas -<0.10 and > 0.10.Results:Of10,441 patients diagnosed after 1988, (72.2% white, 70% male, median age 68 years), the numbers of patients staged as local, regional, distant were distributed as 25.1%, 24.1% and 23.4%, respectively. The median survival for patients with localized, regional and distant disease was 1.2,0.8 and 0.3 years, respectively. For patients with localized disease, adjusting for depth of invasion, morphology, gender and histologic grade,factors associatedwith a increasedrisk of mortality were increasingage (RR = 1.27, p = 0.0001), black race(RR = 1.38, p = 0.0014), and increased length of tumor (RR = 1.15, p =0.0001). In patients with regional disease,factors associated with an increased risk of mortality were increasing age at diagnosis (RR = 1.15,p= 0.0013), black race (p= 0.0803), tumor length (p=0.0555), depth of invasion (1,17,p=0.0013), number of positive LN (-<5 vs. >5)(RR 1.29, p =0.0124). As the ratio of positive LN relative to the number of LN dissected increased,the mortality risk significantly increased (RR 1.63, p=0.0013). In patients with distant disease,tumor size was associated with an increased risk, but not significantly so (p = 0.0830). The site of distant metastasis (other vs. LN) was associated with a significantly greater risk (RR = 1.37). Conclusions: Adjusting for depth of invasion, tumor length is a significant predictor of survival in patients with ECA. Although important, this effect is less pronounced in patients with regional and metastatic disease. In patients with regional disease,the total number of positive LN and the ratio of positive LN to the number of LN dissected portrayed poorer survival. A revised TNM classification might consider these two variables as important prognostic factors,
1325 D2 or Net D2? The Gastrectomy Question. Paul Edwards, Saboor Khan, Daljit Dhadwal, Jonathan D. Barry, Wyn G. Lewis, Royal Gwent Hosp, Newport United Kingdom Background.The best reported long term survival following surgery for gastric cancer is from centers performing radical D2 gastrectomy. Yet comparative studies from European centers report higher rates of postoperative complications following D2 gastrectomy than after the less radical D1 gastmctomy, without any benefit in survival. The aim of this study was to compare the outcome after modilied D2 gastrectomy (preserving spleen and pancreaswhere possible), performed by a specialist surgeon, with that after conventional D1 gastrectomy performed by GeneralSurgeonsfor gastric cancer in a large District GeneralHospital.Methods. Two groups of patients were studied over a period of ten years: a historical control group of 244 consecutive patients with gastric cancer of whom 49 underwent a potentially curative D1 resection (median age 69 yr, 35m) managed by 5 GeneralSurgeons, was compared with 190 consecutive patients of whom 71 underwent a potentially curative D2 resection (median age 70 yr, 47m) managed by a single surgeon with an interest in oesophagogastdccancer. Results. Among the 119 patients judged to have curable cancers, patients who underwent a O2 gastrectomy had lower operative mortality (8.4 vs 14%) and experiencedfewer complications (28 vs 37%) than patients who underwent a D1 gastrsctomy (p=n.s.). Cumulative survival at five years based on death from gastric cancer as ~e event was 53% after O2 resections compared with 14% after D1 resections (p
1323 Did Gastric Cancer Vary Over 30 Years In Japan? Hidemi Cote, Naoki Ohmiya, Kenji Kamiya, Nobuhiro Ando, Toyohiro Sakata, Tetsuo Hayakawa,NagoyaUniv Sch of Medicine, NagoyaJapan BACKGROUND:Inrecentyears Japanesepeople havechangedtheir lifestyle and eating habits. The high incidenceof gastric cancer in Japan is well-known. If the incidenceof gastric cancers in Japan varied in the past, from this knowledge we may be able to predict the tendency in the future.We investigated the incidence and characteristics of gastric cancers detected by mass screeningfor a long period. SUBJECTSand METHODS:Atotal of about 610,000 subjects receiveda preventivehealthcarecheckfrom 1971 to 2000 at Aichi PrefecturalCenterfor Health Care.Gastriccancerswere detectedby direct roentgenogramandconfirmed by endoscopy.We comparedthe averageincidenceof gastric cancers,the rate of early gastric cancer,the location of gastric cancer, and the rate of differentiated-type cancer in the first, middle, and last decades.RESULTS:I.We examinedon averageabout 21,000 persons a year. Onethousandand twenty-one gastric cancerswere diagnosedoverall. 2. The averageincidenceof gastric cancer
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1321 UrsodeoxycholicAcid Inhibits Tumor Development During Both AOM-Induced Colon Tumor Initiation And Progression Ramesh K. Wall, Debra M. Stoiber, John A. Hart, Michael D. Sitrin, Thomas A. Brasitus, Marc 8issonnette, Univ of Chicago, Chicago, IL BACKGROUND:Studies in both sporadic human colon cancer, and in experimental models of this malignancy,indicatethat bile acids, such as cholic acid, may promote colonic carcinogenesis. In contrast, we havepreviouslyshownthat the bile acid, ursodeoxycholicacid (UDCA), when administered continuously during both tumor initiation and progression/promotion, inhibited the developmentof azoxymethane(AOM)-inducedcolon cancerin rats. More recently, we have found that UDCAalso inhibited AOM-induced hyperprolifaration, as well as aberrant crypt formation and growth. In an extensionof these studieswe askedwhetherthis chemopreventive effect of UDCAwould occur if administered only during the initiation phase, or during the post-initiation (promotion/progression} phase. METHODS: Male Fisher 344 rats (180) were divided into six treatment groups: Groups1&2 received standard rat chow (AIN 76A) throughout the study. Groups 3&4 received UDCAsupplementation (0.4% w/w) only during the first 5 weeks (initiation phase). Groups 5&6 received UDCA supplementation (0.4% w/ w) only after 5 weeks (promotion/progressionphase).Two wks after starting the diets, groups 2, 4 & 6 (40 rats each) receivedazoxymethane20 mg/kg body weight per wk x 2 wks, while groups 1, 3 and 5 (20 rats each) receivedsaline (AOM-vehicle) as controls. Thirty-two wks later, rats were sacrificed and colons resected. VisibE tumors were harvested and fixed in 10% buffered formalin for histologic characterization. RESULTS:There were no significant differences in weight gain among the groups. In the carcinogen-treateddietary control group, tumor incidence was 72.3%; and tumor multiplicity was 1.9 tumors per tumor bearing rat (TBR). Compared with the AOM-treated unsupplemented group, UDCA, administered only during the initiation, or in the post initiation phase,eachsignificantly decreasedtumor incidence to 46.2% and 38.4% (p
1324 An Investigation of the Factors Influencing Serum Pepsinogen Levels in Healthy Japanese: A Prospective Study Murdani Abdullah, Fumiaki Kitahara, Tadashi Sato, Yuichirou Kojima, MasayukiA. Fujino, Yamanashi Medical Univ, YamanashiJapan Background: The usefulness of gastric cancer screening using serum pepsinogen has been recognizedand several advantagesof this method over photoflourography have been shown by our previous study. Severalfactors such as, smoking, drinking, sex and age could influence serum pepsinogenlevel. Until now, the influence of sex, age, smoking, drinking, and dietary on serum pepsinogen have been assess by cross sectional study. How ever, the influence of those factors on pepsinogenlevel should be assessedexactly by a prospectivestudy. Aim: To determinethe role of sex, age, BMI, smoking, drinking, and dietary on serum pepsinogen level by a prospective study. Methods: This prospective study was conducted on 1114 (M 338, F 776) Japanese healthy subjects live in Ryowa Town, during the period of 1996 to 2000. Pepsinogen I (PC I) to II (PC II) ratio in 2000 minus that in 1996 was defined as delta PG 1/11and compare among the groups. Data were collected using questionnaire, physical examination and serum test for pepsinogen level. Analysis were done with serum delta PG I, delta PGI/II, and severalfactors e.g. age, sex, BMI, smoking, drinking habit, dietary, using independent paired t-test, Pearson Correlation and multiple regression analyses. Results: Mean age of the subjects was 50.1 + 12.7 (minimum 19 and maximum 81). Pepsinogen I level and PG 1/11ratio decreasedsignificantly during four years of observation. Mean of delta PG 1/11was lower in the groups of current smoker, three-time meal intake daily, daily vegetable intake, salty diet and malegender. How everthese differenceswere not significant, statistically. In the groups with drinking habit and regular meat intake, there were no differences regarding the mean of delta PG 1/11.On the other hand, PG 1/11ratio decreased significantly with pmgrassion of age, while BMI, delta body weight and height have no correlation with the delta PG I and delta PG [/[I. Multiple regression analyses revealeddelta PG I and delta PG I/ II have a good correlation with the progression of age. Conclusion: The effects of sex, BMI, current smoking, drinking habit, three time meal intake daily, salt intake, daily vegetable consumption and meat intake to delta PG I and delta PG I/if were not remarkableby multiple regression analyses. Statistically delta PG I and delta PG 1/11have a good correlation with progression of age.
1322 Prognostic Factors for Survival from Esophageal Carcinoma (ECA) in the United States: The effect of tumor Size and lymph node status Mohamad A. Eloubeidi, Renee Desmond, C. Mel Wilcox, Univ of Alabamaat Birmingham, Birmingham, AL Purpose:To determine the effect of tumor length and lymph node (LN) status on survival in patients with ECA. Methods:Cases of primary incident ECA were available from the NCI Surveillance, Epidemiology and End Results (SEER) program.Patients were sub grouped as localized, regional, or distant disease. Demographic factors and tumor characteristics (morphology, histologic grade, size, primary site, depth of invasion, number of positive LN, proportion of positive LN dissected and distant metastatic site) were examined by Cox multivariable models. Tumor length was grouped into quintUes; number of involved LN was categorizedas O, --5, >5 and a proportion was computed to comparethe number of positive LN to the number of LN dissectedas -<0.10 and > 0.10.Results:Of10,441 patients diagnosed after 1988, (72.2% white, 70% male, median age 68 years), the numbers of patients staged as local, regional, distant were distributed as 25.1%, 24.1% and 23.4%, respectively. The median survival for patients with localized, regional and distant disease was 1.2,0.8 and 0.3 years, respectively. For patients with localized disease, adjusting for depth of invasion, morphology, gender and histologic grade,factors associatedwith a increasedrisk of mortality were increasingage (RR = 1.27, p = 0.0001), black race(RR = 1.38, p = 0.0014), and increased length of tumor (RR = 1.15, p =0.0001). In patients with regional disease,factors associated with an increased risk of mortality were increasing age at diagnosis (RR = 1.15,p= 0.0013), black race (p= 0.0803), tumor length (p=0.0555), depth of invasion (1,17,p=0.0013), number of positive LN (-<5 vs. >5)(RR 1.29, p =0.0124). As the ratio of positive LN relative to the number of LN dissected increased,the mortality risk significantly increased (RR 1.63, p=0.0013). In patients with distant disease,tumor size was associated with an increased risk, but not significantly so (p = 0.0830). The site of distant metastasis (other vs. LN) was associated with a significantly greater risk (RR = 1.37). Conclusions: Adjusting for depth of invasion, tumor length is a significant predictor of survival in patients with ECA. Although important, this effect is less pronounced in patients with regional and metastatic disease. In patients with regional disease,the total number of positive LN and the ratio of positive LN to the number of LN dissected portrayed poorer survival. A revised TNM classification might consider these two variables as important prognostic factors,
1325 D2 or Net D2? The Gastrectomy Question. Paul Edwards, Saboor Khan, Daljit Dhadwal, Jonathan D. Barry, Wyn G. Lewis, Royal Gwent Hosp, Newport United Kingdom Background.The best reported long term survival following surgery for gastric cancer is from centers performing radical D2 gastrectomy. Yet comparative studies from European centers report higher rates of postoperative complications following D2 gastrectomy than after the less radical D1 gastmctomy, without any benefit in survival. The aim of this study was to compare the outcome after modilied D2 gastrectomy (preserving spleen and pancreaswhere possible), performed by a specialist surgeon, with that after conventional D1 gastrectomy performed by GeneralSurgeonsfor gastric cancer in a large District GeneralHospital.Methods. Two groups of patients were studied over a period of ten years: a historical control group of 244 consecutive patients with gastric cancer of whom 49 underwent a potentially curative D1 resection (median age 69 yr, 35m) managed by 5 GeneralSurgeons, was compared with 190 consecutive patients of whom 71 underwent a potentially curative D2 resection (median age 70 yr, 47m) managed by a single surgeon with an interest in oesophagogastdccancer. Results. Among the 119 patients judged to have curable cancers, patients who underwent a O2 gastrectomy had lower operative mortality (8.4 vs 14%) and experiencedfewer complications (28 vs 37%) than patients who underwent a D1 gastrsctomy (p=n.s.). Cumulative survival at five years based on death from gastric cancer as ~e event was 53% after O2 resections compared with 14% after D1 resections (p
1323 Did Gastric Cancer Vary Over 30 Years In Japan? Hidemi Cote, Naoki Ohmiya, Kenji Kamiya, Nobuhiro Ando, Toyohiro Sakata, Tetsuo Hayakawa,NagoyaUniv Sch of Medicine, NagoyaJapan BACKGROUND:Inrecentyears Japanesepeople havechangedtheir lifestyle and eating habits. The high incidenceof gastric cancer in Japan is well-known. If the incidenceof gastric cancers in Japan varied in the past, from this knowledge we may be able to predict the tendency in the future.We investigated the incidence and characteristics of gastric cancers detected by mass screeningfor a long period. SUBJECTSand METHODS:Atotal of about 610,000 subjects receiveda preventivehealthcarecheckfrom 1971 to 2000 at Aichi PrefecturalCenterfor Health Care.Gastriccancerswere detectedby direct roentgenogramandconfirmed by endoscopy.We comparedthe averageincidenceof gastric cancers,the rate of early gastric cancer,the location of gastric cancer, and the rate of differentiated-type cancer in the first, middle, and last decades.RESULTS:I.We examinedon averageabout 21,000 persons a year. Onethousandand twenty-one gastric cancerswere diagnosedoverall. 2. The averageincidenceof gastric cancer
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