Prognostic value of preoperative immune-nutritional scoring systems in remnant gastric cancer patients undergoing surgery

BACKGROUND Remnant gastric cancer(GC)is defined as GC that occurs five years or more after gastrectomy.Systematically evaluating the preoperative immune and nutritional status of patients and analyzing its prognostic impact on postoperative remnant gastric cancer(RGC)patients are crucial.A simple scoring system that combines multiple immune or nutritional indicators to identify nutritional or immune status before surgery is necessary.AIM To evaluate the value of preoperative immune-nutritional scoring systems in predicting the prognosis of patients with RGC.METHODS The clinical data of 54 patients with RGC were collected and analyzed retrospectively.Prognostic nutritional index(PNI),controlled nutritional status(CONUT),and Naples prognostic score(NPS)were calculated by preoperative blood indicators,including absolute lymphocyte count,lymphocyte to monocyte ratio,neutrophil to lymphocyte ratio,serum albumin,and serum total cholesterol.Patients with RGC were divided into groups according to the immune-nutritional risk.The relationship between the three preoperative immune-nutritional scores and clinical characteristics was analyzed.Cox regression and Kaplan–Meier analysis was performed to analyze the difference in overall survival(OS)rate between various immune-nutritional score groups.RESULTS The median age of this cohort was 70.5 years(ranging from 39 to 87 years).No significant correlation was found between most pathological features and immune-nutritional status(P>0.05).Patients with a PNI score<45,CONUT score or NPS score≥3 were considered to be at high immune-nutritional risk.The areas under the receiver operating characteristic curves of PNI,CONUT,and NPS systems for predicting postoperative survival were 0.611[95%confidence interval(CI):0.460–0.763;P=0.161],0.635(95%CI:0.485–0.784;P=0.090),and 0.707(95%CI:0.566–0.848;P=0.009),respectively.Cox regression analysis showed that the three immunenutritional scoring systems were significantly correlated with OS(PNI:P=0.002;CONUT:P=0.039;NPS:P<0.001).Survival analysis revealed a significant difference in OS between different immune-nutritional groups(PNI:75 mo vs 42 mo,P=0.001;CONUT:69 mo vs 48 mo,P=0.033;NPS:77 mo vs 40 mo,P<0.001).CONCLUSION These preoperative immune-nutritional scores are reliable multidimensional prognostic scoring systems for predicting the prognosis of patients with RGC,in which the NPS system has relatively effective predictive performance.

Changes of inducible protein-10 and regulated upon activation, normal T cell expressed and secreted protein in acute rejection of pancreas transplantation in rats

AIM： To investigate the role of IFN-T inducible protein -10 （IP-10） and regulated upon activation, normal T cell expressed and secreted （RANTES） protein in acute pancreatic allograft rejection in rats. METHODS： An experimental model was established using pancreas transplantation diabetic SD rats as the recipient, induced by applying streptozocin （STZ）. Pancreas transplantation was performed with a physiologic method of portal venous and enteric drainage. Rats were divided into two groups, isograft group （group A, n = 24） and allograft group （group B, n = 24） in which either healthy SD rats or Wistar rats served as donors, respectively. Twelve diabetic or healthy SD rats were used as controls. At d 1, 4, 7, and 10 post transplantation, serum IP-10 and RANTES were assessed by ELISA and their expression in the allografts was determined by immunohistochemistry. RESULTS： In group B （allograft group）, the development of acute rejection was significantly correlated with increased serum concentration and tissue expression of IP-10 and RANTES, with a peak level at d 7 post transplantation. In contrast, there was no obvious change before and after transplantation in group A （isograft group）. CONCLUSION： Our study suggests a possible role of IP-10 and RANTES in acute rejection and early monitoring of chemokines may be helpful in predicting the outcome of pancreas transplantation.

Expression of granulocyte colony-stimulating factor receptor in rectal cancer

AIM: To evaluate whether granulocyte colony-stimulating factor receptor (G-CSFR) expression before preoperative irradiation can predict the radiosensitivity of rectal cancer.

Early rejection and pathological changes in combined pancreaticoduodenal and kidney allotransplantation in pigs

Objective: To study the markers of early rejection and pathological changes in simultaneous pancreati- coduodenal and kidney transplantation (SPKT). Methods: Thirty hybrid pigs were used as donors and recipients. A renoportal end-to-end anastomosis be- tween the left renal vein and the distal end of the portal vein was performed. Two vascular end-to-side anastomoses between the donor portal vein and recip- ient inferior vena cava, and between the donor aortic segment including the celiac and superior mesenteric, and left renal arteries and recipient abdominal aorta were carried out. Pancreas exocrine secretion drain- age was established with duodenocystostomy. Ureter- ostomosis of the graft was performed. Urine amylase level, fasting blood glucose and urine volumes of kid- ney allograft were monitored, and pathological chan- ges of graft were observed. Results: Of 15 recipients, 2 died of disturbance of in- ternal environment and anastomotic bleeding, re- spectively. Satisfactory results were obtained in the remaining 13 recipients. The changes of urine amyl- ase concentration were prior to those of fasting blood glucose and urine volumes of kidney allograft. The degree of rejection of the kidney allograft was more severe than that of the pancreas and duodenum al- lograft. Conclusions: Urine amylase is the early marker of a- cute rejection in SPKT with bladder drainage of pan- creatic exocrine secretion. The pathological change of kidney allograft is most significant in SPKT.