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The predictive role of submucosal invasion and metastatic spread to local lymph nodes at early gastric cancer was analyzed. Material from 32 patients was morphologically and immunohistochemically analyzed. The prognostic value of the depth of invasion, tenascin and positive MMP2 and MMP9 staining, proliferative activity and microvascular solidity in the lesion were studied. Watch lymph nodes were detected in 22 patients with the diagnosed early gastric cancer. The method is appropriate only by early cancer and in combination with other macro- and microscopic factors. Its' efficacy was 100% in the group of the early cancer (n=15), whereas in the group with the locally spread cancer the sensitivity, accuracy and specificity were 76, 71 and 100%, respectively. Though larger series are necessary to make definite conclusions about the predictive value of watch nodes in gastric cancer.

The study was made of 568 cases of "initial" cancer cases, 825 morphological substrates of the polyps and 90 ones of chronic gastric ulcer. Chronic gastritis was the most frequent precancer disease (88.7% of cases). Malignant polyps accounted for 10.7% and chronic ulcer for 0.6% of cases. Relevant criteria for risk groups are proposed. Severe epithelial dysplasia as a morphological manifestation of gastric precancer can serve a marker of the risk of malignant transformation.

25 cases of advanced stomach carcinoma were studied immunomorphologically with the use of the antibodies panel to the carcinoembryonic antigen and meconian antigen B1, collagen types IV, I and III, laminin, Ki-67, P-105, factor VIII. Secretory and proliferative activity of tumor cells was shown unrelated to histological structure and degree of tumor differentiation. The more was proliferative activity the weaker was the secretory function. Formation of the basal membrane (BM), the degree of collagen formation and angiogenesis in the tubular adenocarcinoma did not depend on the differentiation level and the degree of tumor cells secretory activity. On the contrary, carcinoid component was characterized by pronounced angiogenesis and tendency to correlation between the degree of differentiation and the degree of BM formation. Stomach carcinoma is a heterogeneous group of tumors whose various morphological features may have an independent prognostic value.

The results of treatment of 394 patients with gastric cancer were analysed to compare the effectiveness of surgical and two variants of combined treatment (preoperative irradiation with intensive-concentrated IKK method and dynamic DFD dose-fractioning). The advantages of combined treatment over surgical treatment are demonstrated. The 3-year survival in the combined treatment is 70.2%, in surgical treatment 34.5 +/- 6.2%. The advantages of SDF preoperative irradiation over IKK irradiation are revealed, that is proved by the increase of the 3-year survival rate (76 vs. 56.7%), and decrease in the rate of recurrence from 50 to 27.3%. The addition of metronidazol leads to increase of anticancer effectiveness, that is proved with the examination of tumor pathomorphosis and the rates of survival.

The analysis of 49 cases of T1 initial signet-ring cell carcinoma of the stomach showed the intestinal differentiation to be a main type of differentiation making doubtful Lauren's classification of the stomach carcinoma. This differentiation proceeds in various directions as indicated by the presence of different types of mucins, antigens and endocrine granules. The presence of the endocrine granules and characteristic structural arrangement allow singling out neuroendocrine tumours (24.5%) from the group of signet-ring cell carcinomas. It is emphasized that thorough morphological preoperative control is necessary in the choice of treatment.

129 cases of non-malignant gastric lesions and 171 cases of gastric carcinoma were studied immunohistochemically for pepsinogen C. PgC was constantly expressed at the bottom of the gastric glands irrespective of the disease. PgC was much more frequently observed in cancer patients (p < 0.001). PgC-positive were carcinoma tissues (38%), particularly of the intestinal type (53.4%), but also in mixed (40%) and diffuse (15.5%) types. PgC-negative carcinomas were more frequently observed in combination with PgC-positive areas of the surface epithelium (p < 0.001) and intestinal metaplasia (p < 0.05). PgC-positive dysplastic foci were observed in both groups of PgC-positive and PgC-negative malignant tumours.

Morphology of the neuroendocrine stomach tumours, including carcinoid tumours (CT) and so-called carcinoids of complex structure is studied (189 tumours of patients operated in the Institute), 164 tumours are studied using routine histological methods including Grimelius methods. Immunophenotyping with the use of antibodies to VIII type keratin, carcinoembryonic antigen, meconial intestinal antigen B1MA, Factor VIII, IV-type collagen and laminin were performed in 25 cases. Neuroendocrine carcinomas represented a group of 86 tumours (45.5%), 28 (14.4%) of them were carcinoid tumours and 58 (30.7%)--complex carcinoids. Among CT, moderately differentiated tumours predominated (18), 4 tumours were poorly differentiated and there was a combination of structures in 6 tumours. The conclusion is made that neuroendocrine stomach carcinomas are epithelial tumours with a complex functional differentiation manifesting in different types of secretion: neuroendocrine and non-endocrine characteristic of stomach epithelium.

The oncological substantiation of endoscopic and economical surgical treatment of T1N0-1M0 gastric carcinoma in 46 patients was appraised. The results were studied with due regard for the peculiarities of early gastric carcinoma (EGC) revealed in 290 patients after standard surgical management. It was established that organ-preserving treatment of ECG is possible--5-years survival was 96.2%. Endoscopic removal can be considered radical only in T1P1 tumors without invasion of the lymphatic vessels of the wall and was of a multistage character in 86.2% of cases. Careful surveillance after its completion is necessary. Surgical treatment in indicated in repeated recurrences; they were encountered in 44.8% of cases. The causes of the recurrences were noncoincidence of the macroscopic and histological boundaries of the tumor (33.6%), multicentric growth (30.4%), and invasion of the submucosa. Metastases are encountered in the lymph nodes in 9.1% of cases in economical treatment. In T1N0-1M0P1-2 carcinoma, absence of multicentric growth, and III degree dysplasia in the surrounding mucosa (reflecting increased risk of multicentric growth) the volume of organ resection may be limited on condition that P1 lymphadenectomy is performed. The results of organ-preserving treatment are comparable with those of surgical treatment conducted in a standard volume.

The expression of specific-pregnancy beta 1-globulin (SP1) was studied in gastric mucosa with chronic gastritis. The expression of SP1 was revealed in focus of intestinal metaplasia, dysplasia as well as in cover epithelial cells.

An indirect immunofluorescent method with polyclonal antibodies to thymidine was used to assess the proliferative activity (PA--percent of cells in the S-phase of the cell cycle) of 79 stomach tumors from primary cancer patients. Stomach cancer PA was shown to vary from 0.1 to 69.7%. PA did not depend either on a tumor size or a degree of the involvement of regional lymph nodes. The mean PA of well-differentiated adenocarcinoma was slightly lower (14.9 +/- 4.7%) than that of low differentiated ones. Of 79 patients a tumor process was interpreted as a resectable one in 62. They were given preoperative irradiation at a total focal dose of 36 Gy followed by operation. In addition to initial investigation PA in tumor biopsy specimens was assessed after delivering a dose of 12 Gy. PA changes at the beginning of a course of irradiation were compared with a degree of a radiation injury of tumor tissue after a course of irradiation was discontinued in 32 (explorative laparotomy was performed in 30). It was shown that tumor radioresistance could be predicted in unchanged PA indices of their increase at the beginning of a course of irradiation with the probability of 95%.

The location of embryonic prealbumin (EPA) was investigated by indirect immune peroxidase test in gastric mucosa: 16 cases of chronic gastritis without malignant tumour and in 48 cases of gastric carcinoma. EPA in the mucosa was found in 35% cases of carcinoma outside the tumour and 31.3% cases of mucosa without tumour. The highest expression of EPA was found in stromal component of hyperplastic polyp without malignancy. Comparison of EPA and carcinoembryonic antigen in tissue did not reveal the presence of correlation between these oncofetal markers. Most likely this antigen is of a reactive nature and it can not be used for the evaluation of the probability of gastric mucosa malignant transformation.

Immunologic techniques were used to examine localization of the intestinal antigen beta-2-MA in 87 cases of malignant gastric tumors and 25 cases of non-neoplastic diseases of the stomach. The antigen was identified in 46.4% of gastric carcinomas. The presence of the antigen was not found to be related to a histological type of cancer. The beta-2-MA antigen was detected in the areas of intestinal metaplasia alone in 48% of the cases and in combination with malignant tumors in 50.9%. The antigen was found to be more common in the mucosa adjacent to those of diffuse cancer than in the mucosa located around cancer of intestinal type (p less than 0.01). beta-2-MA is one of the antigens showing intestine-differentiated cells in a number of gastric tumors and may be useful for immunological studies of gastric neoplastic types.