Endoscopic and contrast abdominal CT findings of peri-anastomotic tumor recurrence in patients diagnosed with AGC (each horizontal row of photos are from the same patient).

<p>A. Obstruction below the anastomosis site due to external compression B. Hyperemic and slightly elevated erosion, below the anastomosis site (missed by follow-up contrast abdominal CT scan) C. Stricture of the anastomosis site D. Subepithelial-like mass lesion, above the anastomosis site E. Prominent soft tissue density around the peri-anastomosis site F. No definite abnormal findings around the anastomosis site (missed by follow-up contrast abdominal CT scan) G. Low attenuation wall thickening at the anastomosis site H. Mild wall thickening just above the anastomosis site.</p

Baseline characteristics of the patients.

<p>Baseline characteristics of the patients.</p

The pattern of tumor recurrence.

<p>The pattern of tumor recurrence.</p

AGC patients with anastomosis site recurrence.

<p>AGC patients with anastomosis site recurrence.</p

The mean follow-up period and the follow-up status of both patients.

<p>The mean follow-up period and the follow-up status of both patients.</p

Baseline characteristics of the tumors.

<p>Baseline characteristics of the tumors.</p

Adjuvant therapy of both EGC and AGC.

<p>Adjuvant therapy of both EGC and AGC.</p

Flow of patients in this study.

<p>Flow of patients in this study.</p

The incidence of VTE according to clinical parameters.

*<p>Fisher's exact test, ^†linear-by-linear association.</p>‡<p>Subtotal gastrectomy was conducted in 271 patients and proximal gastrectomy in 11 patients.</p><p>Abbreviations: VTE, venous thromboembolism; BMI, body mass index; WBC, white bleed cell.</p

Impact of Intratumoral Expression Levels of Fluoropyrimidine-Metabolizing Enzymes on Treatment Outcomes of Adjuvant S-1 Therapy in Gastric Cancer

<div><p>We analyzed the expression levels of fluoropyrimidine-metabolizing enzymes (thymidylate synthase [TS], dihydropyrimidine dehydrogenase [DPD], thymidine phosphorylase [TP] and orotate phosphoribosyltransferase [OPRT]) to identify potential biomarkers related to treatment outcomes in gastric cancer (GC) patients receiving adjuvant S-1 chemotherapy. In this study, 184 patients who received curative gastrectomy (D2 lymph node dissection) and adjuvant S-1 were included. Immunohistochemistry and quantitative reverse transcription polymerase chain reaction were performed to measure the protein and mRNA levels of TS, DPD, TP, and OPRT in tumor tissue. In univariate analysis, low intratumoral DPD protein expression was related to poorer 5-year disease-free survival (DFS; 78% vs. 88%; P = 0.068). Low intratumoral DPD mRNA expression (1st [lowest] quartile) was also related to poorer DFS (69% vs. 90%; P < 0.001) compared to high intratumoral DPD expression (2nd to 4th quartiles). In multivariate analyses, low intratumoral DPD protein or mRNA expression was related to worse DFS (P < 0.05), irrespective of other clinical variables. TS, TP, and OPRT expression levels were not related to treatment outcomes. Severe non-hematologic toxicities (grade ≥ 3) had a trend towards more frequent development in patients with low intratumoral DPD mRNA expression (29% vs. 16%; P = 0.068). In conclusion, GC patients with high intratumoral DPD expression did not have inferior outcome following adjuvant S-1 therapy compared with those with low DPD expression. Instead, low intratumoral DPD expression was related to poor DFS.</p></div