Lifestyle factors and long-term survival of gastric cancer patients:A large bidirectional cohort study from China

BACKGROUND Lifestyle factors such as body mass index(BMI),alcohol drinking,and cigarette smoking,are likely to impact the prognosis of gastric cancer,but the evidence has been inconsistent.AIM To investigate the association of lifestyle factors and long-term prognosis of gastric cancer patients in the China National Cancer Center.METHODS Patients with gastric cancer were identified from the China National Cancer Center Gastric Cancer Database 1998-2018.Survival analysis was performed via Kaplan-Meier estimates and Cox proportional hazards models.RESULTS In this study,we reviewed 18441 cases of gastric cancer.Individuals who were overweight or obese were associated with a positive smoking and drinking history(P=0.002 and P<0.001,respectively).Current smokers were more likely to be current alcohol drinkers(61.3%vs 10.1%vs 43.2%for current,never,and former smokers,respectively,P<0.001).Multivariable results indicated that BMI at diagnosis had no significant effect on prognosis.In gastrectomy patients,factors independently associated with poor survival included older age(HR=1.20,95%CI:1.05-1.38,P=0.001),any weight loss(P<0.001),smoking history of more than 30 years(HR=1.14,95%CI:1.04-1.24,P=0.004),and increasing pTNM stage(P<0.001).CONCLUSION In conclusion,our results contribute to a better understanding of lifestyle factors on the overall burden of gastric cancer and long-term prognosis.In these patients,weight loss(both in the 0 to 10%and>10%groups)but not BMI at diagnosis was related to survival outcomes.With regard to other factors,smoking history of more than 30 years conferred a worse prognosis only in patients who underwent gastrectomy.Extensive efforts are needed to elucidate mechanisms targeting the complex effects of lifestyle factors.

Mixed large and small cell neuroendocrine carcinoma of the stomach:A case report and review of literature

BACKGROUND Gastric neuroendocrine carcinoma(GNEC)is a rare histological subtype of gastric cancer,which is categorized into small cell and large cell neuroendocrine carcinomas.It is characterized by strong invasiveness and poor prognosis.Mixed large and small cell neuroendocrine carcinoma(L/SCNEC)is an extremely rare pathological type of gastric cancer,and there have been no reports on this situation until now.CASE SUMMARY Herein,we first present a 57-year-old patient diagnosed with L/SCNEC of the stomach.A 57-year-old Chinese male presented with epigastric discomfort.Outpatient gastroscopic biopsy was performed,and pathological examination revealed that the cardia was invaded by adenocarcinoma.The patient underwent laparoscopic-assisted radical proximal subtotal gastrectomy and was diagnosed with L/SCNEC.He refused adjuvant treatment and was followed up every 3 mo.Eight months after the operation,the patient showed no evidence of local recurrence or distant metastasis.CONCLUSION We advocate conducting further genomic studies to explore the origin of gastric large cell and small cell neuroendocrine carcinoma and using different chemotherapy schemes according to large or small cell neuroendocrine carcinoma of the stomach for clinical research to clarify the heterogeneity of GNEC and improve the prognosis of patients with GNEC.