Outcome after gastrectomy in gastric cancer patients with type 2 diabetes

AIM: To evaluate the prognosis of type Ⅱ diabetes mellitus (T2DM) after gastrectomy and related factors in gastric cancer patients. METHODS: 403 gastric cancer patients with T2DM were studied, who underwent gastrectomy between May 2003 and September 2009. A review of medica records and telephone interviews was performed in this cross-sectional study. The factors included in the statistical analysis were as follows: gender, age, type of surgery, preoperative body mass index (BMI), current BMI, BMI reduction ratio, preoperative insulin or oral diabetic medicine requirement, follow-up duration, and current state of diabetes. Assessment of diabetes status after surgery was classified into four categories according to the change in hypoglycemic agents after surgery and present status of T2DM: resolution, improvement, same, and worse.(± 20.6 mo), preoperative BMI was 24.7 kg/m2 (± 3.0 kg/m2), and BMI reduction ratio was 9.8% (± 8.6%). After surgery, T2DM was cured in 58 patients (15.1%) and was improved in 117 patients (30.4%). According to the type of surgery, the BMI reduction ratio was signif icantly higher in the total gastrectomy and Roux-en-Y reconstruction group [14.2% ± 9.2% vs 9.2% ± 7.7% (Billroth Ⅱ group), P < 0.001] and signif icantly lower in the subtotal gastrectomy and Billroth Ⅰ reconstruction group [7.6% ± 8.0%, 9.2% ± 7.7% (Billroth Ⅱ group), P < 0.001]. The BMI reduction ratio, follow-up duration after surgery, type of surgery, extent of gastrectomy, and performance of duodenal bypass were signif icantly correlated to the course of T2DM (P < 0.05). The BMI reduction ratio was the most influential factor on T2DM status. In a subgroup analysis of patients with a BMI reduction ratio of 10% or less (n = 206), T2DM was cured in 15 (7.6%) patients and was improved in 57 (28.8%) patients after surgery, and only the duration of surgery was signif icantly correlated to T2DM status (P = 0.022).

Influence of a microscopic positive proximal margin in the treatment of gastric adenocarcinoma of the cardia

AIM： To investigate the influence of a positive proximal margin in total gastrectorny patients with gastric adenocarcinorna of the cardia. METHODS： Medical records of 191 patients with total gastrectornies for adenocarcinorna of the cardia between 1995 and 2000 were reviewed. The clinicopathologic features associated with a positive margin were determined, and the predictors for survival were analyzed. RESULTS： The incidence of positive proximal margin was 8.4% （16/191）. The positive margins were associated with advanced diseases. The tumor size and the depth of tumor invasion were independent risk factors for a positive margin. The mean survival in the positive margin group was 33.9 mo as compared.with 62.4 mo in the negative group （P 〈 0.001）. However, the difference in survival lost significance in subgroup analysis according to stage. Multivariate analysis identified that a positive margin was not an independent prognostic factor for survival. CONCLUSION： A positive margin is more of an indication of advanced disease in patients with gastric adenocarcinoma of the cardia rather than an independent prognostic factor for survival.

Single patient classifier as a prognostic biomarker in pT1N1 gastric cancer:Results from two large Korean cohorts

Objective:Benefits of adjuvant treatment in pT1 N1 gastric cancer(GC)remain controversial.Additionally,an effective biomarker for early GC is the need of the hour.The prognostic and predictive roles of single patient classifier(SPC)were validated in stageⅡ/ⅢGC.In this study,we aimed to elucidate the role of SPC as a biomarker for pT1 N1 GC.Methods:The present retrospective biomarker study(NCT03485105)enrolled patients treated for pT1 N1 GC between 1996 and 2012 from two large hospitals(the Y cohort and S cohort).For SPC,mRNA expression of four classifier genes(GZMB,WARS,SFRP4 and CDX1)were evaluated by real-time reverse transcription-polymerase chain reaction assay.The SPC was revised targeting pT1 stages and the prognosis was stratified as high-and lowrisk group by the expression of SFRP4,a representative epithelial-mesenchymal transition marker.Results:SPC was evaluated in 875 patients(n=391 and 484 in the Y and S cohorts,respectively).Among 864 patients whose SPC result was available,41(4.7%)patients experience GC recurrence.According to revised SPC,254(29.4%)patients were classified as high risk[123(31.5%)and 131(27.1%)in the Y and S cohorts,respectively].The high risk was related to frequent recurrence in both Y and S cohort(log-rank P=0.023,P<0.001,respectively),while there was no difference by GZMB and WARS expression.Multivariable analyses of the overall-cohort confirmed the high risk of revised SPC as a significant prognostic factor[hazard ratio(HR):4.402(2.293-8.449),P<0.001]of GC.A significant difference was not detected by SPC in the prognosis of patients in the presence and absence of adjuvant treatment(log-rank P=0.670).Conclusions:The present study revealed the revised SPC as a prognostic biomarker of pT1 N1 GC and suggested the use of the revised SPC for early-stage GC as like stageⅡ/Ⅲ.

Deciphering metastatic route-specific signals and their microenvironment interactions in peritoneal metastasis of gastric cancer

Gastric cancer(GC)is a pervasive global malignancy with high mortality rates due to distant metastasis[1].GC metastasis can occur via hematogenous route,peri-toneal route,and specifically through ovarian spread in females[2].Among these,peritoneal metastasis is the most prevalent and challenging condition to treat[3].The Cancer Genome Atlas(TCGA)has uncovered four molec-ular subtypes of GC:microsatellite instability,Epstein-Barr virus-related,chromosomal instability,and genomically stable[4].

Intercellular communications and metabolic reprogramming as new predictive markers for immunotherapy responses in gastric cancer

Dear Editor,Immune-directed therapeutic approaches have changed the paradigm of cancer treatment.The tumor-immune microenvironment[1]is a dynamic milieu consisting of heterogeneous metabolic conditions such as low oxygen,nutrient deficiency,acidity,and interactions between multiple cell types.In particular,immune cells in the tumor microenvironment are vulnerable to cellular dysfunctions(because of metabolic reprogramming[2])and engage in intercellular communications with neighboring cells.

Two distinct stem cell-like subtypes of hepatocellular carcinoma with clinical significance and their therapeutic potentials

Dear Editor Hepatocellular carcinoma(HCC)is among the most com-mon cancers worldwide,causing about 600,000 deaths annully[1].In HCC,stem cell-like characteristics,which drive early recurrence and therapy resistance,are major contributors to poor prognosis[2].In this current study,we integrated and analyzed gene expression data from human fetal liver cells and primary HCC tumors(n=1231)and.uncovered two clinically and biologically distinct hepatic stem cell(HS)subtypes,potential biomarkers associated with these subtypes,and a potential new therapeutic inter-vention for these subtypes.