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Human papillomavirus (HPV) infection plays a significant role in the development and progression of head and neck squamous cell carcinoma (HNSCC). Expression of miR-21 has a prognostic role in a wide variety of cancers. The upregulation of miR-21 suppresses a number of target genes, including phosphatase tensin homologue (PTEN) and programmed cell death 4 (PDCD4). We investigated the association between the expression of miR-21 and the clinical features of HNSCC using stratified analysis based on HPV infection status. HPV status and miR-21 expression in HNSCC tissues from 167 patients were evaluated using in situ hybridization. The expression of PDCD4 and PTEN was examined by immunohistochemistry. The up-regulation of stromal miR-21 expression occurred in 40.6% of HPV-negative samples and 28.3% of the HPV-positive group. In HPV-stratified multivariate analysis, high miR-21 expression was associated with poor cancer-specific survival in HPV-negative tumors, but not in HPV-positive tumors. There was a significant association between miR-21 and cytoplasmic PDCD4 overexpression in HPV-negative HNSCCs. We suggest that stromal miR-21 expression is an independent prognostic factor in HPV-negative tumors and miR-21 may play different roles depending on HPV infection status.

Background CD133 has been suggested to be a cancer stem cell (CSC) marker in various types of cancers. The present study assessed the relationship between CD133 expression and clinicopathological features of gastric cancer. In addition, the prognostic value of CD133 for gastric cancer was evaluated. Methods In total, 100 advanced gastric cancer patients who received curative gastrectomy and adjuvant chemotherapy were included. CD133 expression was determined by immunohistochemistry and clinicopathological results, including survival, were analyzed. Results CD133 was expressed in 23% of advanced gastric cancer patients (23/100). CD133 expression was significantly associated with serosal exposure (P = 0.036), venous invasion (P = 0.047), well and moderate differentiation (P = 0.002), and intestinal-type Lauren classification (P = 0.001). CD133-positive patients had a significantly worse 5-year disease-free (28.1% vs. 65.8%, P = 0.002) and overall (47.5% vs. 74.0%, P = 0.037) survival rate than those who were CD133-negative. A multivariate analysis suggested that CD133 expression significantly affected the 5-year disease-free and overall survival. Conclusions CD133 may play an important role in chemoresistance and recurrence, thus representing a promising predictive marker for the prognosis of gastric cancer. J. Surg. Oncol. 2012; 106: 999–1004. © 2012 Wiley Periodicals, Inc.

Background and Objectives Leakage has been shown to adversely affect survival in patients undergoing surgery for gastrointestinal malignancies. However, the effect of leakage following radical gastrectomy in patients with gastric cancer remains unclear. Methods In total, 478 patients with advanced gastric cancer who underwent surgery with curative intent were reviewed. Anastomosis or duodenal stump leakage was diagnosed clinically or radiologically. Risk factors for leakage were evaluated by univariate and multivariate analyses. The impact of leakage on patient survival was analyzed using the Kaplan–Meier method. Results Leakage was diagnosed in 32 of 478 patients (6.7%); 14 patients (2.9%) exhibited esophagojejunal anastomotic leakage, 14 (2.9%) showed duodenal stump leakage, and four (0.8%) showed gastroduodenal anastomotic leakage. Poor performance status [odds ratio (OR): 4.01, 95% confidence interval (CI): 1.80–8.93] and tumor location (OR: 3.74, 95% CI: 1.56–8.89) were risk factors for postoperative leakage. Overall mean survival of patients with leakage was significantly lower than that of patients without leakage (30.5 vs. 96.2 months; P

Background and Objectives Laparoscopy-assisted distal gastrectomy (LADG) has been established as an alternative treatment for early gastric cancer (EGC) because of excellent short-term results. However, only a few reports have considered the long-term outcomes of LADG. In this study, we investigated the 3-year outcome and survival of patients who underwent LADG. Methods We assessed 182 patients with gastric adenocarcinoma who underwent LADG. The indication for LADG was confined to EGCs (T1N0 or T1N1 cases). The clinicopathological characteristics and long-term survival data of all patients were analyzed. Results The overall morbidity and mortality rates of the patients were 11% and 0%, respectively. An analysis of the final pathological stages of the patients revealed that 160 had stage Ia, 20 had stage Ib, and only 2 had stage II. The median follow-up period was 44 months (range, 2–73 months), and there were two recurrences. Five patients died of other causes, but no patients died of a gastric cancer recurrence. The 3-year overall and disease-specific survival rates were 97.3% and 100%, respectively. Conclusions LADG for EGC is acceptable in terms of both short- and long-term outcomes. Thus, LADG can be considered a primary treatment for EGC. J. Surg. Oncol. 2011; 104:511–515. © 2011 Wiley-Liss, Inc.

Background The present study was designed to evaluate the feasibility and impact of the “intragastric” approach to laparoscopic wedge resection as a surgical option for the treatment of suspected small sized gastric submucosal tumors (SMTs) located at the level of Z-line. Methods We reviewed six patients who underwent laparoscopic intragastric resection of a suspected gastric SMT. In all cases, tumor mass was located just below the Z-line. The patients' clinicopathologic characteristics and surgical outcomes were prospectively recorded and reviewed. Results All six patients were underwent successfully laparoscopic wedge resection by the intragastric approach using a balloon-type trocar. No case was required open conversion. The mean operation time was 128 min, and the mean hospital stay was 4 days. Five cases were proven to have leiomyoma, and one case was found to have gastrointestinal stromal tumor with low risk. The mean tumor size was 2.7 cm. Conclusion Laparoscopic resection through the “intragastric” approach is a safe and feasible option for gastric SMTs located at the level of Z-line. J. Surg. Oncol. 2011; 104:312–315. © 2011 Wiley-Liss, Inc.

BACKGROUND: The seventh edition of the American Joint Committee on Cancer (AJCC) TNM classification for gastric cancer was published in 2010 and included major revisions. The aim of the current study was to evaluate the validity of the seventh edition TNM classification for gastric cancer based on an Asian population. METHODS: A total of 2916 gastric cancer patients who underwent R0 surgical resection from 1989 through 2008 in a single institute were included, and were analyzed according to the seventh edition of the TNM classification for validation. RESULTS: When adjusted using the seventh edition of the TNM classification, upstaging was observed in 771 patients (26.4%) and downstaging was observed in 178 patients (6.1%) compared with the sixth edition of the TNM classification. The relative risk (RR) of seventh edition pT classification was found to be increased with regular intensity compared with the sixth edition pT classification. The RR of seventh edition pN classification was found to be increased with irregular intensity compared with the sixth edition pN classification. In survival analysis, there were significant differences noted for each stage of disease, but only a marginal difference was demonstrated between stage IA and stage IB (P = .049). In the hybrid TNM classification, which combines the seventh edition pT classification and the sixth edition pN classification, both pT and pN classifications demonstrated a more ideal distribution of the RR, and 5-year survival rates also showed a significant difference for each stage (P

Background The aim of the present study was to evaluate the histopathological characteristics of gastric submucosal tumors (SMTs) according to their location. Methods A retrospective analysis of a prospective database of 151 consecutive patients who underwent surgery for gastric SMTs between 2001 and 2009 was performed. Results Of 151 gastric SMTs, 100 (66.2%) were gastrointestinal stromal tumors, 21 (13.9%) were leiomyomas, and 30 (19.9%) were other benign tumors. Leiomyoma was the most common neoplasm at the cardia (55.2%; P

Background and Objectives The aim of this study is to investigate predictive factors for unexpected peritoneal seeding from clinically resectable advanced gastric cancers to suggest the indications for staging laparoscopy (SL). Methods A total of consecutive 589 gastric cancer patients who were clinically diagnosed with advanced gastric cancer with no metastatic disease underwent operations at Seoul St. Mary's Hospital. Results A total of 72 patients (including 35 patients with seeding to distant peritoneum) were surgically diagnosed with peritoneal seeding. Borrmann type 3 (OR: 4.475) or type 4 (OR: 8.243) cancer, tumor invasion of T3 (OR: 2.794) or T4 (OR: 6.841) and tumor size (4 cm ≤ tumor size