It is time for a proper staging system for adenocarcinoma of the gastroesophageal junction

High expression of cAMP-responsive element-binding protein 1 (CREB1) is associated with metastasis, tumor stage and poor outcome in gastric cancer

cAMP responsive element binding protein 1 (CREB1) has been reported to be implicated in tumor development and progression of human cancers. However, the clinical significance and regulatory mechanisms of CREB1 expression in gastric cancer remain largely unknown. In the present study, immunohistochemistry was performed to detect the expression of CREB1 protein in 185 primary gastric cancer tissues, 50 secondary lymph node metastatic foci and 50 nontumorous gastric tissues. A prognostic model combining CREB1 expression with TNM tumor stage was constructed by logistic regression analysis. Regulation of CREB1 by miRNAs was investigated by luciferase reporter assay and Western blot. It was shown that CREB1 was highly expressed and correlated with lymph node metastasis, distant metastasis and tumor stage and poor outcome in gastric cancer. The prognostic model was proven to be an independent prognosis predictor and performed better than CREB1 or tumor stage alone. CREB1 was identified as a direct target of miR-27b and miR-200b, and down-regulated by miR-27b/miR-200b. We conclude that CREB1 is a promising biomarker to predict tumor metastasis and patient outcome in gastric cancer, and the miR-27b/miR-200b-CREB1 pathway may serve as a potential molecular target for the treatment of gastric cancer.

Clinicopathological and prognostic analysis of 319 cases of advanced esophageal gastric adenocarcinoma

AIM: To explore the clinicopathological features and prognostic factors in patients with advanced oesophagogastric adenocarcinoma (OGA), and to assess the applicability of the AJCC TNM staging guideline (7^th edition) in OGA.

METHODS: The clinical data for 319 cases of surgically removed advanced OGA were retrospectively reviewed, and survival analysis was made by the Kaplan-Meier method.

RESULTS: The 1-, 3-, and 5-year survival rates were 62%, 44% and 35%, respectively. Patients with localized OGA had a higher survival rate than those with infiltrative disease. Diameter of tumor, grade, infiltration depth and lymph node metastasis were significantly correlated with lower survival rate (all P < 0.01). Patients with the Lauren infiltration subtype had a lower survival rate than those with intestinal and mixed subtypes. The survival rate had no difference among patients with stages N1-N3 disease (N staging according to AJCC guideline), but was significantly lower in patients with more than 10 metastatic lymph nodes than in those with less than 10 metastatic lymph nodes.

CONCLUSION: Tumor diameter, infiltration depth, grade and Lauren classification are associated with prognosis in patients with esophagogastric adenocarcinoma. N staging according to AJCC guideline (7^th Ed) can not reveal prognostic significance, which suggests that OGA should have unique staging guidelines instead of referring to gastric or esophageal adenocarcinomas.

Gastric cardia carcinoma is associated with the promoter -77T>C gene polymorphism of X-ray cross-complementing group 1 (XRCC1)

PURPOSE

X-ray repair cross complementing group 1 (XRCC1) is one of the major DNA repair proteins involved in the bas-excision repair pathway. Several single-nucleotide polymorphisms in the XRCC1 gene are identified and related with increased cancer risk development. In particular, the -77T>C polymorphism located on the promoter region relates with lung cancer risk development. The aim of this study is to analyze the -77T>C allelic frequencies in a population composed of 456 primary gastric cancer patients (GC) and 507 blood donor controls.

METHODS

GC patients were observed at the University of Siena, Italy; clinicopathological data and family history were available for the cancer group. The control group is composed of blood donors. Constitutional genomic DNA was PCR amplified, and XRCC1 -77T>C was detected using restriction enzyme BsrB I and analyzed in a 3% agarose gel.

RESULTS

The -77C>C homozygous genotype was significantly associated with increased risk of gastric cardia carcinoma (p = 0.023) with an odds ratio of 1.65 (95% confidence interval 1.14 to 2.4). In the family history stratification, we report a significant association (p = 0.043) between the -77T>C polymorphism and GC cases with familial lung cancer aggregation.

CONCLUSIONS

Our results suggest that the XRCC1 -77T>C polymorphism is a relevant host susceptibility factor for gastric cardia cancer development and specific subsets of familial clustering of GC.