Safety and efficacy of a programmed cell death 1 inhibitor combined with oxaliplatin plus S-1 in patients with Borrmann large type III and IV gastric cancers

BACKGROUND Gastric cancer(GC)is the fifth most common and the fourth most lethal malignant tumour in the world.Most patients are already in the advanced stage when they are diagnosed,which also leads to poor overall survival.The effect of posto-perative adjuvant chemotherapy for advanced GC is unsatisfactory with a high rate of distant metastasis and local recurrence.AIM To investigate the safety and efficacy of a programmed cell death 1(PD-1)inhibitor combined with oxaliplatin and S-1(SOX)in the treatment of Borrmann large type III and IV GCs.METHODS A retrospective analysis(IRB-2022-371)was performed on 89 patients with Borrmann large type III and IV GCs who received neoadjuvant therapy(NAT)from January 2020 to December 2021.According to the different neoadjuvant treatment regimens,the patients were divided into the SOX group(61 patients)and the PD-1+SOX(P-SOX)group(28 patients).RESULTS The pathological response(tumor regression grade 0/1)in the P-SOX group was significantly higher than that in the SOX group(42.86%vs 18.03%,P=0.013).The incidence of ypN0 in the P-SOX group was higher than that in the SOX group(39.29%vs 19.67%,P=0.05).The use of PD-1 inhibitors was an independent factor affecting tumor regression grade.Meanwhile,the use of PD-1 did not increase postoperative complications or the adverse effects of NAT.CONCLUSION A PD-1 inhibitor combined with SOX could significantly improve the rate of tumour regression during NAT for patients with Borrmann large type III and IV GCs.

Subtotal gastrectomy combined with chemotherapy: An effective therapy for patients with circumscribed Borrmann type Ⅳ gastric cancer

BACKGROUND Although Borrmann type Ⅳ(B-4) gastric cancer has a higher mortality rate and presents distant metastasis easily, especially peritoneal metastasis, when diagnosed, some B-4 patients were found to have no distant metastasis by preoperative detection and underwent curative surgery, which was defined as circumscribed B-4 in our study. In this study, we focused on the circumscribed B-4 patients without distant metastasis during surgery to identify factors related to prognosis and postoperative peritoneal cavity metastasis(PPCM), which is important for selecting an appropriate therapeutic strategy.AIM To identify factors related to the prognosis and PPCM of B-4 patients.METHODS A total of 117 B-4 patients who underwent gastrectomy between January 2005 and December 2012 were included in this study. Survival analysis was performed using Kaplan–Meier analysis and Cox multivariate models. Pearson correlation analyses were performed to identify the factors related to PPCM. All statistical analyses were performed using SPSS 20.0.RESULTS Lymph node status, gastrectomy type, and postoperative chemotherapy were independent prognostic factors in 117 circumscribed B-4 patients. Subtotal gastrectomy combined with chemotherapy could significantly improve the longterm survival time. Six patients who were diagnosed with pN0 and received the combination therapy had a 3-year survival rate of 100% and a median survival of 77.7 mo. Even for patients with metastatic lymph nodes(n = 13), the combination therapy also increased the 3-year overall survival rate to 57.1%. In addition, positive lymph node status was the only factor(P = 0.005) correlated with PPCM in certain B-4 patients, and chemotherapy was useful for suppressing PPCM in patients with subtotal gastrectomy but not in those with total gastrectomy.CONCLUSION Lymph node status is an independent prognostic factor for circumscribed B-4 patients. In addition, subtotal gastrectomy and postoperative chemotherapy could effectively improve prognosis and even suppress PPCM.

Retrospective evaluation of lymphatic and blood vessel invasion and Borrmann types in advanced proximal gastric cancer

BACKGROUND The Borrmann classification system is used to describe the macroscopic appearance of advanced gastric cancer,and Borrmann typeⅣdisease is independently associated with a poor prognosis.AIM To evaluate the prognostic significance of lymphatic and/or blood vessel invasion(LBVI)combined with the Borrmann type in advanced proximal gastric cancer(APGC).METHODS The clinicopathological and survival data of 440 patients with APGC who underwent curative surgery between 2005 and 2012 were retrospectively analyzed.RESULTS In these 440 patients,LBVI+status was associated with Borrmann typeⅣ,low histological grade,large tumor size,and advanced pT and pN status.The 5-year survival rate of LBVI+patients was significantly lower than that of LBVI– patients,although LBVI was not an independent prognostic factor in the multivariate analysis.No significant difference in the prognosis of patients with Borrmann typeⅢ/LBVI+disease and patients with Borrmann typeⅣdisease was observed.Therefore,we proposed a revised Borrmann typeⅣ(r-BorⅣ)as Borrmann typeⅢplus LBVI+,and found that r-BorⅣwas associated with poor prognosis in patients with APGC,which outweighed the prognostic significance of pT status.CONCLUSION LBVI is related to the prognosis of APGC,but is not an independent prognostic factor.LBVI status can be used to differentiate Borrmann typesⅢandⅣ,and the same approach can be used to treat r-BorⅣand Borrmann typeⅣ.

Astragaloside Ⅳ inhibits pathological functions of gastric cancer-associated fibroblasts

AIM To investigate the inhibitory effect of astragaloside IV on the pathological functions of cancer-associated fibroblasts,and to explore the underlying mechanism.METHODS Paired gastric normal fibroblast(GNF) and gastric cancer-associated fibroblast(GCAF) cultures were established from resected tissues. GCAFs were treated with vehicle control or different concentrations of astragaloside Ⅳ. Conditioned media were prepared from GNFs,GCAFs,control-treated GCAFs,and astragaloside Ⅳ-treated GCAFs,and used to culture BGC-823 human gastric cancer cells. Proliferation,migration and invasion capacities of BGC-823 cells were determined by MTT,wound healing,and Transwell invasion assays,respectively. The action mechanism of astragaloside Ⅳ was investigated by detecting the expression of micro RNAs and the expression and secretion of the oncogenic factor,macrophage colonystimulating factor(M-CSF),and the tumor suppressive factor,tissue inhibitor of metalloproteinase 2(TIMP2),in different groups of GCAFs. The expression of the oncogenic pluripotency factors SOX2 and NANOG in BGC-823 cells cultured with different conditioned media was also examined.RESULTS GCAFs displayed higher capacities to induce BGC-823 cell proliferation,migration,and invasion than GNFs(P < 0.01). Astragaloside Ⅳ treatment strongly inhibited the proliferation-,migration-and invasion-promoting capacities of GCAFs(P < 0.05 for 10 μmol/L,P < 0.01 for 20 μmol/L and 40 μmol/L). Compared with GNFs,GCAFs expressed a lower level of micro RNA-214(P < 0.01) and a higher level of micro RNA-301 a(P < 0.01). Astragaloside Ⅳ treatment significantly upregulated micro RNA-214 expression(P < 0.01) and down-regulated micro RNA-301 a expression(P < 0.01) in GCAFs. Reestablishing the micro RNA expression balance subsequently suppressed M-CSF production(P < 0.01) and secretion(P < 0.05),and elevated TIMP2 production(P < 0.01) and secretion(P < 0.05). Consequently,the ability of GCAFs to increase SOX2 and NANOG expression in BGC-823 cells was abolished by astragaloside Ⅳ.CONCLUSION Astragaloside Ⅳ can inhibit the pathological functions of GCAFs by correcting their dysregulation of micro RNA expression,and it is promisingly a potent therapeutic agent regulating tumor microenvironment.

Macroscopic appearance of TypeⅣand giant Type Ⅲ is a high risk for a poor prognosis in pathological stage Ⅱ/Ⅲ advanced gastric cancer with postoperative adjuvant chemotherapy

AIM To evaluate whether a high risk macroscopic appearance(Type Ⅳ and giant Type Ⅲ) is associated with a dismal prognosis after curative surgery, because its prognostic relevance remains elusive in pathological stage Ⅱ/Ⅲ(p Stage Ⅱ/Ⅲ) gastric cancer.METHODS One hundred and seventy-two advanced gastric cancer(defined as pT2 or beyond) patients with p Stage Ⅱ/Ⅲ who underwent curative surgery plus adjuvant S1 chemotherapy were evaluated, and the prognostic relevance of a high-risk macroscopic appearance was examined. RESULTS Advanced gastric cancers with a high-risk macroscopic appearance were retrospectively identified by preoperative recorded images. A high-risk macroscopic appearance showed a significantly worse relapse free survival(RFS)(35.7%) and overall survival(OS)(34%) than an average risk appearance(P = 0.0003 and P < 0.0001, respectively). A high-risk macroscopic appearance was significantly associated with the 13^(th) Japanese Gastric Cancer Association(JGCA) pT(P = 0.01), but not with the 13^(th) JGCA pN. On univariate analysis for RFS and OS, prognostic factors included 13^(th) JGCA p Stage(P < 0.0001)and other clinicopathological factors including macroscopic appearance. A multivariate Cox proportional hazards model for univariate prognostic factors identified highrisk macroscopic appearance(P = 0.036, HR = 2.29 for RFS and P = 0.021, HR = 2.74 for OS) as an independent prognostic indicator. CONCLUSION A high-risk macroscopic appearance was associated with a poor prognosis, and it could be a prognostic factor independent of 13^(th) JGCA stage in p Stage Ⅱ/Ⅲ advanced gastric cancer.

Prognostic significance of Borrmann type combined with vessel invasion status in advanced gastric cancer

BACKGROUND Borrmann classification(types I-IV)for the detection of advanced gastric cancer has been accepted worldwide,and lymphatic and/or blood vessel invasion(LBVI)status is related to the poor prognosis after gastric cancer.AIM To evaluate the significance of Borrmann type combined with LBVI status in predicting the prognosis of advanced gastric cancer.METHODS We retrospectively studied the clinicopathological characteristics and long-term survival data of 2604 patients who were diagnosed with advanced gastric adenocarcinoma at Harbin Medical University Cancer Hospital from January 2009 to December 2013.Categorical variables were evaluated by the Pearson’sχ^2 test,the Kaplan-Meier method was used to identify differences in cumulative survival rates,and the Cox proportional hazards model was used for multivariate prognostic analysis.RESULTS A total of 2604 patients were included in this study.The presence of LVBI[LBVI(+)]and Borrmann type(P=0.001),tumor location(P<0.001),tumor size(P<0.001),histological type(P<0.001),tumor invasion depth(P<0.001),number of metastatic lymph nodes(P<0.001),and surgical method(P<0.001)were significantly correlated with survival.When analyzing the combination of the Borrmann classification and LBVI status,we found that patients with Borrmann type Ⅲ disease and LBVI(+)had a similar 5-year survival rate to those with Borrmann IV+LBVI(-)(16.4%vs 13.1%,P=0.065)and those with Borrmann IV+LBVI(+)(16.4%vs 11.2%,P=0.112).Subgroup analysis showed that the above results were true for any pT stage and any tumor location.Multivariate Cox regression analysis showed that Borrmann classification(P=0.023),vascular infiltration(P<0.001),tumor size(P=0.012),pT stage(P<0.001),pN stage(P<0.001),and extent of radical surgery(P<0.001)were independent prognostic factors for survival.CONCLUSION Since patients with Borrmann Ⅲ disease and LBVI(+)have the same poor prognosis as those with Borrmann IV disease,more attention should be paid to patients with Borrmann Ⅲ disease and LBVI(+)during diagnosis and treatment,regardless of the pT stage and tumor location,to obtain better survival results.

超声内镜和多层螺旋CT对BorrmannⅣ型胃癌术前分期的比较研究

目的对超声内镜(EUS)和多层螺旋CT(MSCT)检查在BorrmannⅣ型胃癌术前分期中的作用进行比较。方法回顾性分析48例BorrmannⅣ型胃癌患者的影像学术前TNM分期,并与术后病理分期进行比较。结果 EUS和MSCT检查对T分期的准确率分别为54.2%和79.2%(P=0.009),分层分析表明MSCT对T3、T4分期的准确率高于EUS(T3:84.6%vs 57.7%,P=0.032;T4:82.4%vs 41.2%,P=0.032)。两者对N分期的准确率,均为56.3%(P=1.000),无明显差异,EUS和MSCT对淋巴转移检查的特异度和灵敏度分别为83.3%/72.2%和66.7%/91.7%。结论 EUS更适合对早期胃癌分期,而已浸润至浆膜层及有远处转移的BorrmannⅣ型胃癌患者,应优先选择MSCT检查进行分期。

超声定位下凿洞式深挖活检对Borrmann Ⅳ型胃癌诊断价值的探讨

目的:探讨超声内镜定位下凿洞式深挖活检对BorrmannⅣ型胃癌诊断的价值。方法:回顾性分析病理确诊的53例BorrmannⅣ型胃癌的临床资料,比较常规活检及超声内镜定位下凿洞式深挖活检对BorrmannⅣ型胃癌的诊断结果。结果:常规胃镜首次活检诊断BorrmannⅣ型胃癌阳性率30.2%(16/53),活检阴性患者多次重复活检阳性率13.5%(5/37),常规内镜活检总阳性率为39.6%(21/53)。46例BorrmannⅣ型胃癌患者行超声内镜检查,诊断与病理符合率为95.5%(44/46)。21例多次活检阴性患者行超声内镜定位下凿洞式深挖活检,术后标本送病理检查阳性率61.9%(13/21)。仅2例患者活检后创面少量渗血,所有患者术后观察无出血、穿孔等并发症发生。结论:超声内镜定位下凿洞式深挖活检显著提高BorrmannⅣ型胃癌临床内镜活检阳性率,为BorrmannⅣ型胃癌的诊断提供了更有效的病理确诊依据。该操作安全性高,费用少,值得临床推广。

Borrmann Ⅳ型胃癌18例误诊分析

目的分析BorrmannⅣ型胃癌的临床特点、误诊原因及防治策略。方法回顾性分析1996年1月-2013年1月南昌解放军第94医院肿瘤科经病理学证实的BorrmannⅣ型胃癌误诊患者18例临床资料,并复习相关文献。结果 BorrmannⅣ型胃癌患者18例中男7例,女11例,年龄30~71岁;病程1周~3个月,均曾接受1~2次胃镜检查。误诊为慢性胃炎7例,消化性溃疡6例,结核性腹膜炎2例,卵巢癌3例。18例经上消化道造影或腹部CT检查和体检提示有异常,再次行胃镜检查或手术而确诊,其中中分化腺癌1例,低分化腺癌6例,黏液腺癌2例,印戒细胞癌6例,未分化癌3例。接受胃癌姑息性手术9例,行卵巢转移癌姑息性手术2例,行全身化疗和腹腔灌注化疗12例。最长生存期为23个月,9例生存期不超过1年。结论胃镜联合上消化道造影、腹部CT和超声内镜检查可提高BorrmannⅣ型胃癌的检出率,以手术为主的综合治疗可改善患者生存期。

BorrmannⅣ型胃癌超声内镜诊断价值的研究

目的:评价超声内镜(EUS)对 BorrmannⅣ型胃癌的诊断效果。材料与方法:138例胃癌病例术前均经内镜和病理活检检查。其中36例胃镜疑为 BorrmannⅣ型胃癌的病例术前同时做了 EUS 检查,结果与术后外科病理诊断进行对照。结果:胃镜检出的138例胃癌中,Borrmann Ⅰ型、Ⅱ型和Ⅲ型胃癌内镜活检多能明确诊断,第1次活检确诊率达88.5%以上。再次内镜活检取材,97.4%以上的病例能确诊。36例内镜可疑为 BorrmannⅥ型胃癌首次活检14例(38.9%)为粘膜炎症反应,未见癌瘤细胞。虽经再次活检,仍有12例(33.3%)未能获得明确诊断.该型胃癌在 EUS 下声像图常有特征性的变化,表现为大部分或全胃壁弥漫性全层增厚,粘膜下层尤明显,回声减弱。增厚的胃壁并无明显结构紊乱,其层次尚可辨认。根据这一特征,36例内镜疑诊为该型的胃癌病变均行 EUS 检查,均作出了正确的诊断,确诊率达100%。结论:EUS 能显示 BorrmannⅣ型胃癌特征性的变化,用于该型胃癌的诊断,优于内镜及活检检查。

CT影像组学对原发性胃淋巴瘤与Borrmann Ⅳ型胃癌的鉴别诊断价值

目的:探讨基于CT图像的影像组学标签鉴别原发性胃淋巴瘤与Borrmann Ⅳ型胃癌的可行性。方法:回顾性分析2009年1月至2017年4月在中南大学湘雅三医院经病理证实为原发性胃淋巴瘤或Borrmann Ⅳ型胃癌且术前进行过腹部CT增强扫描的71例患者,其中原发性胃淋巴瘤患者28例,Borrmann Ⅳ型胃癌患者43例。采用基于Matlab 2017a软件的特征提取算法提取影像组学特征,并利用logistic回归模型进行特征筛选以建立CT影像组学标签。通过纳入胃周脂肪浸润、胃壁柔软性、腹部淋巴结及周围脏器转移、腹水、黏膜白线征和病灶厚度等征象,构建CT征象诊断模型。应用受试者工作特征(receiver operating characteristic,ROC)曲线评估影像组学标签和CT征象诊断模型的分类性能。结果:从每个患者CT扫描的肿瘤区域中提取32个三维特征,通过降维发现2个特征是最重要的鉴别诊断因子并建立了影像组学标签;CT征象诊断模型由腹水、胃周脂肪浸润、胃壁柔软性及黏膜白线征组成。影像组学标签和CT征象诊断模型的曲线下面积(area under curve,AUC)分别为0.964和0.867;准确性分别为94.4%和80.2%;敏感性分别为93.0%和74.4%;特异性分别为96.4%和89.3%。经Delong检验,影像组学标签的诊断效能高于CT征象诊断模型(P<0.001)。结论:基于CT图像的影像组学标签能够较准确地鉴别Borrmann Ⅳ型胃癌与原发性胃淋巴瘤,为临床辅助诊断提供有利的手段。

MSCT影像组学对BorrmannⅣ型胃癌与原发性胃淋巴瘤的鉴别诊断价值

【目的】探讨CT影像组学模型鉴别BorrmannⅣ型胃癌与原发性胃淋巴瘤的价值。【方法】回顾性收集2008年6月至2018年4月经手术或内镜病理确诊的BorrmannⅣ型胃癌或原发性胃淋巴瘤的病例共186例,其中BorrmannⅣ型胃癌132例,原发性胃淋巴瘤54例。采用计算机软件对CT动脉期、静脉期图像提取放射组学特征,再选择Lasso Logistic回归方法进行特征筛选,并建立CT影像组学模型,此外亦筛选CT主观征象构建CT主观征象模型,并同时利用CT主观征象及组学特征构建联合模型。应用受试者工作特征(ROC)曲线评估CT主观征象模型、组学模型以及联合模型的性能。【结果】浆膜亮线征、浆膜侧不规则结节状外突两个征象进入了CT主观征象模型,而在组学特征中分别选出9个静脉期特征、8个动脉期特征以及14个动静脉期组合特征与病灶相关,分别构建相应组学模型。鉴别BorrmannⅣ型胃癌与原发性胃淋巴瘤,CT主观征象模型的截断值为0.188时,曲线下面积(AUC)为0.846,敏感性为61.9%,特异性为81.7%,准确性为76.5%;组学模型中的动脉期、静脉期以及动静脉期的截断值分别为-0.315、-0.669和-0.858,AUC分别为0.864、0.955和0.890,敏感性分别为71.4%、95.2%和81.0%,特异性分别为85.0%、88.3%和80.0%,准确性分别为81.5%、90.1%和80.3%;联合模型中的动脉期、静脉期以及动静脉期的截断值分别为0.257、0.556和0.497,AUC分别为0.883、0.956和0.918,敏感性分别为71.4%、90.5%和71.4%,特异性为85.0%、93.3%和90.0%,准确性为81.5%、92.6%和85.2%。经统计检验,模型诊断效能:联合模型>组学模型>CT主观征象模型(P<0.001),CT静脉期图像对于鉴别诊断2种肿瘤效能更好。【结论】基于CT动、静脉期的影像组学模型能够较准确地鉴别BorrmannⅣ型胃癌与原发性胃淋巴瘤。

Role of Helicobacter pylori in gastric cancer:Updates

Helicobacter pylori(H. pylori) infection is highly prevalent in human,affecting nearly half of the world's population; however,infection remains asymptomatic in majority of population. During its co-existence with humans,H. pylori has evolved various strategies to maintain a mild gastritis and limit the immune response of host. On the other side,presence of H.pylori is also associated with increased risk for the development of various gastric pathologies including gastric cancer(GC). A complex combination of host genetics,environmental agents,and bacterial virulence factors are considered to determine the susceptibility as well as the severity of outcome in a subset of individuals. GC is one of the most common cancers and considered as the third most common cause of cancer related death worldwide. Many studies had proved H. pylori as an important risk factor in the development of non-cardia GC. Although both H. pylori infection and GC are showing decreasing trends in the developed world,they still remain a major threat to human population in the developing countries. The current review attempts to highlight recent progress in the field of research on H. pylori induced GC and aims to provide brief insight into H. pylori pathogenesis,the role of major virulence factors of H. pylori that modulates the host environment and transform the normal gastric epithelium to neoplastic one. This review also emphasizes on the mechanistic understanding of how colonization and various virulence attributes of H. pylori as well as the host innate and adaptive immune responses modulate the diverse signaling pathways that leads to different disease outcomes including GC.

Pathological diagnosis is maybe non-essential for special gastric cancer: Case reports and review

Histopathological results are critical for the diagnosis and surgical decision regarding gastric cancer. How-ever, opposite opinions from radiology and pathology can sometimes affect clinical decisions. The two cases reported in this article were both highly suspected as gastric cancer by clinical manifestations and radiologic findings, although both showed negative results in the first biopsy examination. One was confirmed as gastric cancer by the time of the 6 th biopsy, while the other was still negative even after 8 biopsies. With a definite pathologic result and the agreement of the patient for the latter case, both of them finally received surgery. Postoperative pathological examination revealed find-ings that were the same as Borrmann type Ⅳ gastric cancer. We believed that duplicate biopsies under ra-diologic guidance were necessary for highly suspected gastric cancer cases in the absence of a definite pathol-ogy result, and patients should be under close follow-up. We propose that, if gastric cancer is highly sus-pected when typical radiology changes of widely diffuse gastric parietal lesions suffice to exclude lymphoma and other similar situations, and even in absence of a posi-tive biopsy result, a diagnostic laparotomy under lapa-roscopy and even radical gastrectomy may be reason-ably performed by an experienced gastric cancer center with the agreement of the patient after being decided by a multidisciplinary discussion team.

胃镜与螺旋CT特异性诊断Borrmann Ⅳ型胃癌的临床分析

目的:探讨BorrmannⅣ型胃癌胃镜(EG)和螺旋CT(MSCT)的特征,比较胃镜与螺旋CT在术前特异性诊断BorrmannⅣ型胃癌的准确性。方法:回顾性分析笔者所在医院2005年5月-2015年5月10年间收治的53例BorrmannⅣ型胃癌患者的胃镜及螺旋CT资料,以术后病理结果为标准,比较胃镜与螺旋CT在术前特异性诊断BorrmannⅣ型胃癌的准确性。结果:胃镜下肿瘤主要以胃窦部病变为主(37.7%),伴胃腔缩小、狭窄变形(52.8%),胃壁僵硬,充气后明显不张(50.9%),活检病理以低分化腺癌为主(50.9%)。螺旋CT 49例(92.5%)表现为胃壁局限性或广泛性不规则增厚,病灶与正常胃壁分界不清,增强后显示增厚胃壁明显强化;29例(54.7%)表现为病变处胃浆膜面毛糙,与周围脂肪间隙模糊不清或消失。MSCT术前诊断BorrmannⅣ型胃癌的准确性显著高于EG加活检,差异有统计学意义(P<0.05)。结论:BorrmannⅣ型胃癌具有一定的胃镜及影像学特征,在术前特异性诊断中,螺旋CT准确性明显高于胃镜。

腹腔热灌注化疗治疗不同Borrmann分型进展期胃癌的临床效果及对肿瘤标志物的影响

目的探讨腹腔热灌注化疗(HIPEC)对于不同Borrmann分型进展期胃癌的疗效及对血清肿瘤标志物的影响。方法回顾性分析上海中医药大学附属曙光医院2011年1月至2016年1月收治的165例行腹腔镜下胃癌根治术患者的临床资料,将术后行常规静脉化疗的82例患者为对照组,行静脉化疗联合HIPEC的83例患者为观察组,比较两组患者的近期临床疗效,治疗前后血清肿瘤标志物[糖类抗原72-4(CA72-4)、糖类抗原19-9(CA19-9)、癌胚抗原(CEA)]水平变化情况,不良反应及并发症发生情况以及术后5年复发转移及生存情况。结果治疗后,观察组患者的疾病控制率及治疗有效率均高于对照组,差异具有统计学意义(P<0.05),治疗期间两组患者病死率差异无统计学意义(P>0.05)。两组患者不良反应及并发症发生率差异无统计学意义(P>0.05)。对于BorrmannⅠ型、Ⅱ型患者,两组复发转移率及5年生存率差异无统计学意义(P>0.05);对于BorrmannⅢ型、Ⅳ型患者,观察组的复发转移率低于对照组,5年生存率高于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者CA72-4、CA19-9、CEA水平差异无统计学意义(P>0.05),治疗后,两组患者CA72-4、CA19-9、CEA水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。结论对进展期胃癌患者行胃癌根治术联合HIPEC治疗,可提高BorrmannⅢ、Ⅳ型患者的5年生存率,降低5年内复发率,降低血清肿瘤标志物水平,且并发症及不良反应的发生率未增加,安全性较高。

参虎半夏汤提高ⅢB-Ⅳ期胃癌化疗疗效及部分机制研究

目的:评价参虎半夏汤联合CF/DCF方案治疗胃癌患者的临床疗效,探讨其相关作用机制。方法:选取2012年3月至2014年2月期间河南省中医院收治的气虚毒蕴型ⅢB-Ⅳ期胃癌病患者66例,随机分成观察组(参虎半夏汤联合化疗)和对照组(化疗),每组33例。观察2组临床症状、E-cadherin、波形蛋白Vimentin浓度等临床检测指标的变化。结果:治疗后较治疗前比较:观察组的KPS评分、生活症状积分、生存期、肿瘤大小及E-cadherin表达均高于对照组,差异有显著统计学意义(P<0.01);中医症状积分、波形蛋白Vimentin蛋白的表达均低于对照组,差异有显著统计学意义(P<0.01)。结论:参虎半夏汤可能通过诱导E-cadherin表达,抑制波形蛋白Vimentin表达,抑制肿瘤细胞侵袭浸润,减小瘤体,进而改善气虚毒蕴型ⅢB-Ⅳ期胃癌患者的预后。

64排螺旋CT对Ⅳ期胃癌术前分期的价值

目的评价64排螺旋CT对Ⅳ期胃癌术前分期的准确性。方法收集2007年7月至2008年4月期间我院胃肠外科收治的49例Ⅳ期胃癌患者的临床资料,对其中术前行64排螺旋CT(64MDCT)检查的29例患者进行回顾性分析并按日本胃癌规约对肿瘤进行分期。将CT术前分期结果与临床-手术-病理分期结果进行对照分析。结果本组病例经64MDCT术前分期,其中65.2%(15/23)T分期准确,47.8%(11/23)N分期准确,70.8%(17/24)M分期准确,58.6%TNM分期准确(17/29)。而腹膜转移患者中6/9未能经术前64MDCT检出。结论64MDCT可以对Ⅳ期胃癌进行较准确的分期,其分期准确率降低的主要原因为腹膜转移的漏诊,但64MDCT分期降低并不增加剖腹探查率。

血清Reg Ⅳ蛋白在胃癌患者血清中的表达

目的检测RegⅣ蛋白在胃癌患者血清中的表达,探讨其作为浸润性胃癌检测标志物的可能性。方法酶联免疫分析法定量检测64例胃癌患者血清中RegⅣ蛋白的表达水平。结果肿瘤浸润至肌层(T_2)和浆膜层(T_3)的胃癌患者血清RegⅣ蛋白水平要显著高于肿瘤局限在黏膜层和黏膜下层(T_1)者(P<0.01);有淋巴结转移者血清RegⅣ蛋白水平要高于无淋巴结转移者(P<0.05);病理Ⅲ期患者血清RegⅣ蛋白水平高于病理Ⅰ期患者(P<0.05)。结论 RegⅣ蛋白可能与胃癌的生长侵袭有关。

血清胃蛋白酶原与再生基因Ⅳ联合检验对胃癌早期诊断的应用价值

目的探讨血清胃蛋白酶(PG)与再生基因Ⅳ(RegⅣ)联合检验在胃癌早期诊断中的临床价值。方法选取2015~2016年收治的400例胃病患者,根据病理检查的诊断结果分为胃癌组27例,良性胃病组373例,另选取同期健康体检100例作为对照组。对比观察各组患者血清PG、RegⅣ、CA19-9、CEA水平,分析PG与RegⅣ联合检测的诊断效能。结果胃癌组患者血清PGⅠ、PGⅡ、PGⅠ/PGⅡ水平明显低于良性胃病组和健康对照组(P<0.05);RegⅣ、CA19-9、CEA水平明显高于良性胃病组和健康对照组明显升高(P<0.05)。以病理诊断结果为金标准,PG与RegⅣ联合检测诊断胃癌的敏感度为85.19%、特异度为78.82%,均高于CA19-9联合CEA检测(P<0.05)。结论 PG与RegⅣ联合检测对于胃癌早期有较高的灵敏度与特异度,可以作为胃癌早期诊断的有效辅助指标。