Four resections for hepatic metastasis from gastric cancer: histochemical analysis of cell proliferation, apoptosis, and angiogenesis

In a patient with gastric cancer (GC) associated with one synchronous and t hree metachronous hepatic metastases (HM), who underwent four hepatectomies , we carried out histochemical investigations regarding cell proliferation, apoptosis, and angiogenesis in the GC and HM. Tissue samples were taken fr om the primary GC and four HM. Ki-67 immunostaining was performed to evalua te cell proliferation and determine the labeling index (Ki-67 LI; ie, the p ercentage of cancer cells with nuclei stained for Ki-67). Terminal deoxynuc leotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end lab eling (TUNEL) was performed to evaluate apoptosis and determine the apoptot ic index (ie, the percentage of TUNEL-positive cells), and immunostaining f or factor VIII-related antigen was performed to evaluate angiogenesis and m easure microvessel density (MVD). The Ki-67 LI was 43.2% in the primary GC and 39.9% in the synchronous HM, and the LI increased with the number of re sections of metachronous HM. The apoptotic index was 3.36% in the primary G C, and 5.30% in the synchronous HM, and the index decreased after further r esections of the metachronous HM. The MVD was 35 in the primary GC, and 22 in the synchronous HM, and it increased with the number of resections of me tachronous HM. The primary GC in this patient may have strongly influenced the growth of HM through effects on cell proliferation, apoptosis, and angi ogenesis.