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Recent advances in photodynamic diagnosis of gastriccancer using 5-aminolevulinic acid

World Journal of Gastroenterology 2016年第3期22卷 1289-1296页

作者： Noriaki Koizumi Yoshinori Harada Takeo Minamikawa Hideo Tanaka Eigo Otsuji Tetsuro Takamatsu Department of Pathology and Cell Regulation Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyoto 6028566Japan Division of Digestive Surgery Department of SurgeryGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyoto 6028566Japan Department of Surgery Nishijin HospitalKyoto 6028319Japan Department of Medical Photonics Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyoto 6028566Japan

Photodynamic diagnosis based on 5-aminolevulinic acidinduced protoporphyrin IX has been clinically applied in many fields based upon its evidenced efficacy and adequate safety. In order to establish a personalized medicine approach for treating gastric cancer patients, rapid intraoperative detection of malignant lesions has become important. Feasibility of photodynamic diagnosis using 5-aminolevulinic acid for gastric cancer patients has been investigated, especially for the detection of peritoneal dissemination and lymph node metastasis. This method enables intraoperative realtime fluorescence detection of peritoneal dissemination, exhibiting higher sensitivity than white light observation without histopathological examination. The method also enables detection of metastatic foci within excised lymph nodes, exhibiting a diagnostic accuracy comparable to that of a current molecular diagnostics technique. Although several complicating issues still need to be resolved, such as the effect of tissue autofluorescence and the insufficient depth penetration of excitation light, this simple and rapid method has the potential to become a useful diagnostic tool for gastric cancer, as well as urinary bladder cancer and glioma.

关键词： Gastric cancer Photodynamic diagnosis 5-aminolevulinic acid Protoporphyrin IX Lymph nodemetastasis Personalized medicine Peritoneal dissemination

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Feasible endoscopic therapy for early gastric cancer

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世界胃肠病学杂志：英文版 2015年第47期21卷 13325-13331页

作者： Tian-Jiao Guo Jin-Yu Qin Lin-Lin Zhu Jin Wang Jin-Lin Yang Yi-Ping Wang Gastroenterology Department of West China Hospital Sichuan University

AIM: To analyze the relationship between lymph node metastasis and clinical pathology of early gastric cancer(EGC) in order to provide criteria for a feasible endoscopic therapy.METHODS: Clinical data of the 525 EGC patients who underwent surgical operations between January 2009 and March 2014 in the West China Hospital of Sichuan University were analyzed retrospectively. Clinical pathological features were compared between different EGC patients with or without lymph node metastasis, and investigated by univariate and multivariate analyses for possible relationships with lymph node metastasis.RESULTS: Of the 2913 patients who underwent gastrectomy with lymph node dissection, 529 cases were pathologically proven to be EGC and 525 cases were enrolled in this study, excluding 4 cases of gastric stump carcinoma. Among 233 patients with mucosal carcinoma, 43(18.5%) had lymph node metastasis. Among 292 patients with submucosal carcinoma, 118(40.4%) had lymph nodemetastasis. Univariate analysis showed that gender, tumor size, invasion depth, differentiation type and lymphatic involvement correlated with a high risk of lymph node metastasis. Multivariate analysis revealed that gender(OR = 1.649, 95%CI: 1.091-2.492, P = 0.018), tumor size(OR = 1.803, 95%CI: 1.201-2.706, P = 0.004), invasion depth(OR = 2.566, 95%CI: 1.671-3.941, P = 0.000), histological differentiation(OR = 2.621, 95%CI: 1.624-4.230, P = 0.000) and lymphatic involvement(OR = 3.505, 95%CI: 1.590-7.725, P = 0.002) wereindependent risk factors for lymph node metastasis. Comprehensive analysis showed that lymph node metastasis was absent in patients with tumor that was limited to the mucosa, size ≤ 2 cm, differentiated and without lymphatic involvement.CONCLUSION: We propose an endoscopic therapy for EGC that is limited to the mucosa, size ≤ 2 cm, differentiated and without lymphatic involvement.

关键词： Early gastric cancer Clinical pathologicalfeatures Risk factor Endoscopic therapy Lymph nodemetastasis

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