Prognostic value and nomograms of proximal margin distance in gastric cancer with radical distal gastrectomy

Objective:The proximal margin(PM)distance for distal gastrectomy(DG)of gastric cancer(GC)remains controversial.This study investigated the prognostic value of PM distance for survival outcomes,and aimed to combine clinicopathologic variables associated with survival outcomes after DG with different PM distance for GC into a prediction nomogram.Methods:Patients who underwent radical DG from June 2004 to June 2014 at Department of General Surgery,Nanfang Hospital,Southern Medical University were included.The first endpoints of the prognostic value of PM distance(assessed in 0.5 cm increments)for disease-free survival(DFS)and overall survival(OS)were assessed.Multivariate analysis by Cox proportional hazards regression was performed using the training set,and the nomogram was constructed,patients were chronologically assigned to the training set for dates from June 1,2004 to January 30,2012(n=493)and to the validation set from February 1,2012 to June 30,2014(n=211).Results:Among 704 patients with p TNM stage I,p TNM stage II,T1-2,T3-4,N0,differentiated type,tumor size≤5.0 cm,a PM of(2.1-5.0)cm vs.PM≤2.0 cm showed a statistically significant difference in DFS and OS,while a PM>5.0 cm was not associated with any further improvement in DFS and OS vs.a PM of 2.1-5.0 cm.In patients with p TNM stage III,N1,N2-3,undifferentiated type,tumor size>5.0 cm,the PM distance was not significantly correlated with DFS and OS between patients with a PM of(2.1-5.0)cm and a PM≤2 cm,or between patients with a PM>5.0 cm and a PM of(2.1-5.0)cm,so there were no significant differences across the three PM groups.In the training set,the C-indexes of DFS and OS,were 0.721 and 0.735,respectively,and in the validation set,the C-indexes of DFS and OS,were 0.752 and 0.751,respectively.Conclusions:It is necessary to obtain not less than 2.0 cm of PM distance in early-stage disease,while PM distance was not associated with long-term survival in later and more aggressive stages of disease because more advanced GC is a systemic disease.Different types of patients should be considered for removal of an individualized PM distance intra-operatively.We developed a universally applicable prediction model for accurately determining the 1-year,3-year and 5-year DFS and OS of GC patients according to their preoperative clinicopathologic characteristics and PM distance.

Ship Size and Service Configuration in Container Shipping

This study analyzes the effect of ship size on the liner service configuration by establishing an economic model. The service configuration is characterized by the distance of service and the number of calling ports. A study ease is presented for illustration. At last such a conclusion is drawn that given a fixed profit, the ship size will change with the extension of service in the same direction, while the change rate of ship size is a little higher than that of the extension of service.