Combining systemic inflammatory response index and albumin fibrinogen ratio to predict early serious complications and prognosis after resectable gastric cancer

BACKGROUND Gastric cancer has a high incidence and fatality rate,and surgery is the preferred course of treatment.Nonetheless,patient survival rates are still low,and the incidence of major postoperative complications cannot be disregarded.The systemic inflammatory response,nutritional level,and coagulation status are key factors affecting the postoperative recovery and prognosis of gastric cancer patients.The systemic inflammatory response index(SIRI)and the albumin fibrinogen ratio(AFR)are two valuable comprehensive indicators of the severity and prognosis of systemic inflammation in various medical conditions.AIM To assess the clinical importance and prognostic significance of the SIRI scores and the AFR on early postoperative outcomes in patients undergoing radical gastric cancer surgery.METHODS We conducted a retrospective analysis of the clinicopathological characteristics and relevant laboratory indices of 568 gastric cancer patients from January 2018 to December 2019.We calculated and compared two indicators of inflammation and then examined the diagnostic ability of combined SIRI and AFR values for serious early postoperative complications.We scored the patients and categorized them into three groups based on their SIRI and AFR levels.COX analysis was used to compare the three groups of patients the prognostic value of various preoperative SIRI-AFR scores for 5-year overall survival(OS)and disease-free survival(DFS).RESULTS SIRI-AFR scores were an independent risk factor for prognosis[OS:P=0.004;hazards ratio(HR)=3.134;DFS:P<0.001;HR=3.543]and had the highest diagnostic power(area under the curve:0.779;95%confidence interval:0.737-0.820)for early serious complications in patients with gastric cancer.The tumor-node-metastasis stage(P=0.001),perioperative transfusion(P=0.044),positive carcinoembryonic antigen(P=0.014)findings,and major postoperative complications(P=0.011)were factors associated with prognosis.CONCLUSION Preoperative SIRI and AFR values were significantly associated with early postoperative survival and the occurrence of severe complications in gastric cancer patients.

Serum tumor markers (carcinoembryonic antigen, carbohydrate antigen 19-9, carbohydrate antigen 72-4, carbohydrate antigen 24-2, ferritin) and gastric cancer prognosis correlation

BACKGROUND Gastric cancer is a kind of malignant tumor which is prevalent all over the world.Although some progress has been made in the treatment of gastric cancer,its prognosis is still not optimistic,so it is of great significance to find reliable prog-nostic indicators to guide the treatment and management of patients with gastric cancer.AIM To explore the relationship between serum levels of five biomarkers[carcinoem-bryonic antigen(CEA),carbohydrate antigen(CA)19-9,CA72-4,CA24-2,and ferritin]and prognosis in patients with gastric cancer.METHODS This study included 200 patients with gastric adenocarcinoma,and conducted an in-depth analysis of their baseline characteristics,relationship between tumor markers and staging,and prognosis.The study found that CA19-9 has a signi-ficant correlation with tumor stage,the average levels of CA24-2,CEA,CA72-4 and ferritin were slightly increased disregarding the stage of tumor.Survival analysis showed that increases in CEA,CA19-9,CA24-2,and ferritin were all associated with shortened overall survival of patients.Further multivariate ana-lysis revealed that elevated serum CA72-4 levels were an inde-pendent adverse prognostic factor.RESULTS This study reveals that there is a significant correlation between the expression levels of serum tumor markers CEA,CA19-9,CA72-4,CA24-2 and ferritin in patients with gastric cancer and prognosis,and can be used as important indicators for prognostic evaluation of gastric cancer.In particular,markers that appear abnormally elevated initially may help identify gastric cancer patients with poor prognosis.CONCLUSION Serum CEA and CA19-9 play an important role in the prognosis assessment of gastric cancer,and are effective tools to guide clinical practice and optimize individualized treatment strategies for gastric cancer patients.

Postoperative decrease of serum albumin predicts shortterm complications in patients undergoing gastric cancer resection

AIM To find an accurate and simple predictor for postoperative short-term complications after gastrectomy. METHODS Two hundred and twenty-three patients undergoing gastric cancer resection between October 1,2015 and September 30,2016 were enrolled in this study. Univariate and multivariate analyses were used toidentify risk factors for complications after gastrectomy. The cutoff values and diagnostic accuracy were examined by receiver operating characteristic curves.RESULTS Sixty-two(27.8%) patients had short-term complications after gastric cancer resection. The postoperative decrease in serum albumin(?ALB) was an independent risk factor for complications(OR = 17.957,95%CI: 6.073-53.095,P < 0.001). The cutoff value was 14.0% and the area under the curve was higher than that of C-reactive protein on postoperative day 3(area under the curve: 0.806 vs 0.709). Patients with ?ALB ≥ 14.0% were more likely to have short-term complications after gastrectomy(46.7% vs 5.0%,P < 0.001),prolonged hospital stay(17.2 ± 10.8 d vs 14.1 ± 4.2 d,P = 0.007) and higher comprehensive complication index(P < 0.001) than those with ?ALB < 14.0%.CONCLUSION Postoperative ?ALB with a cutoff of 14.0% can be used to recognize patients who have high risk of short-term complications following gastric cancer resection.

Serum HER2 as a predictive biomarker for tissue HER2 status and prognosis in patients with gastric cancer

AIM To investigate the association between serum human epidermal growth factor receptor 2(HER2) extracellular domain(ECD) and tissue HER2 status, and the prognostic value of serum HER2 ECD in patients with gastric cancer.METHODS A total of 239 patients with gastric cancer were enrolled from December 2012 to June 2013. Serum HER2 ECD was determined by chemiluminescent assay, and tissue HER2 status was evaluated by immunohistochemistry and fluorescence in situ hybridization assay. A receiver operating characteristic(ROC) curve was plotted to identify the optimal cut-off value for serum HER2 ECD assay for predicting survival in gastric cancer patients.RESULTS Serum HER2 ECD was significantly correlated with tissue HER2 status(P < 0.001), tumor size(P < 0.001), and intestinal type of gastric cancer(P =0.021). Serum HER2 ECD levels differed significantly between patients with HER2-positive tissue expression and those with HER2-negative tissue expression. ROC analysis yielded an area under the curve value of 0.79(95%CI: 0.71-0.87, P < 0.001), with a sensitivity and specificity of 0.54(95%CI: 0.37-0.70) and 0.93(95%CI: 0.88-0.96), respectively. With a cut-off value of 24.75 ng/m L, high serum HER2 ECD had a negative impact on overall survival of the patients(HR: 1.93, 95%CI: 1.32-4.38, P = 0.006). CONCLUSION Serum HER2 ECD could be a highly specific surrogate biomarker for tissue HER2 status in gastric cancer. Optimal cut-off criteria for predicting survival should be established.

Hemoglobin, albumin, lymphocyte, and platelet score as a predictor of prognosis in metastatic gastric cancer

BACKGROUND The hemoglobin,albumin,lymphocyte,and platelet(HALP)score,derived from a composite evaluation of markers reflecting the tumor-inflammation relationship and nutritional status,has been substantiated as a noteworthy prognostic determinant for diverse malignancies.AIM To investigate how the HALP score relates to prognosis in patients with metastatic gastric cancer.METHODS The cutoff values for the HALP score,neutrophil/lymphocyte ratio,and platelet/lymphocyte ratio were determined using receiver operating characteristic analysis.Low HALP scores were defined as those less than 24.79 and high HALP scores as those greater than 24.79.RESULTS The study cohort comprised 147 patients and 110 of them(74.8%)were male.The patients'median age was 63(22-89)years.The median overall survival was significantly superior in the patients with high HALP scores than in those with low HALP scores(10.4 mo vs 7.5 mo,respectively;P<0.001)CONCLUSION The HALP score was found to be a prognostic factor in patients with metastatic gastric cancer.

Prognostic significance of perioperative tumor marker levels in stage Ⅱ/Ⅲ gastric cancer

AIM To evaluate the prognostic significance of perioperative carcinoembryonic antigen(CEA) and carbohydrate antigen 19-9(CA19-9) levels in stage Ⅱ/Ⅲ gastric cancer.METHODS From a multi-institutional retrospective database compiled by integrating clinical data from nine institutions, data of 998 patients who underwent curative resection for stage Ⅱ/Ⅲ gastric cancer between 2010 and 2014 were retrieved and analyzed. The prognostic impact of the preoperative and postoperative levels and chronological changes in CEA, CA19-9 and their combination were evaluated. To test whether postoperative adjuvant chemotherapy alters the prognostic impact of perioperative CEA and CA19-9 levels, the hazard ratios for mortality were compared between patients who underwent surgery alone and patients who underwent surgery followed by adjuvant chemotherapy.RESULTS The prognostic impact of postoperative CEA and CA19-9 was superior to that of the preoperative levels. Multivariable analysis identified high postoperative CEA and CA19-9 levels as independent prognostic factors for overall survival.Disease-free survival rates clearly decreased in a stepwise manner in association with postoperative CEA and CA19-9 levels, and patients with high levels of both markers showed significantly poorer prognosis than other patient groups. When we analyzed perioperative changes in serum CEA and CA19-9 levels, patients with high levels before and after surgery had the worst disease-free survival rates among all patient groups. Patients with normalized CEA levels after surgery had a significantly lower disease-free survival rate than those with normal perioperative levels, whereas patients with normalized CA19-9 levels after surgery had equivalent survival to those with normal perioperative levels. The prognostic impact of high CEA levels was observably smaller in patients who underwent adjuvant chemotherapy than in patients who underwent surgery alone, whereas that of high CA19-9 was greater in patients who underwent adjuvant chemotherapy. High postoperative CEA levels were significantly associated with an increased prevalence of liver, lung and bone recurrences, and high postoperative CA19-9 levels were significantly associated with increased frequencies of lymph node and liver recurrences.CONCLUSION The evaluation of serum CEA and CA 19-9 levels both before and after surgery provides useful information for precise risk stratification after curative gastrectomy.

Laparoscopic vs open surgery for gastric cancer: Assessing time, recovery, complications, and markers

BACKGROUND Gastric cancer(GC)is one of the most common cancers worldwide.Morbidity and mortality have increased in recent years,making it an urgent issue to address.La-paroscopic radical surgery(LRS)is a crucial method for treating patients with GC;However,its influence on tumor markers is still under investigation.The data of 194 patients treated at Chongqing University Cancer Hospital bet-ween January 2018 and January 2019 were retrospectively analyzed.Patients who underwent traditional open surgery and LRS were assigned to the control(n=90)and observation groups(n=104),respectively.Independent sample t-tests andχ2 tests were used to compare the two groups based on clinical efficacy,changes in tumor marker levels after treatment,clinical data,and the incidence of posto-perative complications.To investigate the association between tumor marker levels and clinical efficacy in patients with GC,three-year recurrence rates in the two groups were compared.RESULTS Patients in the observation group had a shorter duration of operation,less in-traoperative blood loss,an earlier postoperative eating time,and a shorter hospital stay than those in the control group(P<0.05).No significant difference was observed between the two groups regarding the number of lymph node dissections(P>0.05).After treatment,the overall response rate in the control group was significantly lower than that in the observation group(P=0.001).Furthermore,after treatment,the levels of carbohydrate antigen 19-9,cancer antigen 72-4,carcinoembryonic antigen,and cancer antigen 125 decreased significantly.The observation group also exhibited a significantly lower incidence rate of postoperative complications compared to the control group(P<0.001).Additionally,the two groups did not significantly differ in terms of three-year survival and recurrence rates(P>0.05).CONCLUSION LRS effectively treats early gastric cancer by reducing intraoperative bleeding,length of hospital stays,and postoperative complications.It also significantly lowers tumor marker levels,thus improving the short-term prognosis of the disease.

Prognostic significance of the preoperative hemoglobin to albumin ratio for the short-term survival of gastric cancer patients

BACKGROUND Hemoglobin and albumin are associated with the prognosis of gastric cancer(GC)patients. However, the prognostic value of the hemoglobin to albumin ratio(HAR) for the short-term survival of GC patients with D2 radical resection has not been studied.AIM To investigate the significance of the HAR in evaluating the short-term survival of GC patients after D2 radical resection and to construct a nomogram to predict the prognosis in GC patients after surgery, thus providing a reference for the development of postoperative individualized treatment and follow-up plans.METHODS Cox regression and Kaplan-Meier analysis was used for prognostic analysis.Logistic regression was used to analyze the relationships between HAR and the clinicopathological characteristics of the GC patients. A prognostic nomogram model for the short-term survival of GC patients was constructed by R software.RESULTS HAR was an independent risk factor for the short-term survival of GC patients.GC patients with a low HAR had a poor prognosis(P < 0.001). Low HAR was markedly related to high stage [odds ratio(OR) = 0.45 for Ⅱ vs Ⅰ;OR = 0.48 for Ⅲ vs Ⅰ], T classification(OR = 0.52 for T4 vs T1) and large tumor size(OR = 0.51 for ≥4 cm vs < 4 cm)(all P < 0.05). The nomogram model was based on HAR, age,CA19-9, CA125 and stage, and the C-index was 0.820.CONCLUSION Preoperative low HAR was associated with short-term survival in GC patients.The prognostic nomogram model can accurately predict the short-term survival of GC patients with D2 radical resection.

Inflammatory and nutritional markers in colorectal cancer: Implications for prognosis and treatment

The prognosis of colorectal cancer(CRC)patients with peritoneal metastasis remains poor despite advancements in detection and treatment.Preoperative inflammatory and nutritional markers have emerged as significant predictors of prognosis in CRC,potentially guiding treatment decisions and improving patient outcomes.This editorial explores the prognostic value of markers such as the neutrophil-to-lymphocyte ratio,hemoglobin,and serum albumin levels.By integrating these markers into prognostic models,clinicians can better stratify patients,personalize treatment strategies,and ultimately enhance clinical outcomes.This review highlights the importance of these markers in providing a comprehensive assessment of patient condition and underscores the need for further research to validate their clinical utility and uncover underlying mecha-nisms.

Value of Preoperative Hematological Parameters in the Prognosis of Gastric Cancer Patients Undergoing a Total Gastrectomy

Objective This study aimed to evaluate the relationships between the albumin/globulin ratio(AGR),neutrophil/lymphocyte ratio(NLR),and platelet/lymphocyte ratio(PLR)and clinicopathological information for gastric cancer patients.In addition,the prognostic values of these hematological parameters for resectable gastric cancer patients undergoing a total gastrectomy were determined.Methods A total of 245 patients with gastric cancer who underwent a total gastrectomy at our hospital between January 1,2005,and December 30,2015,were enrolled into this study.The preoperative AGR,NLR,and PLR in the serum samples of the patients were measured.The relationships between the hematological parameters and the disease-free survival(DFS)as well as overall survival(OS)were analyzed by statistical analysis.Results The cutoff values of AGR,NLR,and PLR were 1.57,3.5,and 193,respectively.Univariate analyses demonstrated that a low AGR,a high NLR,and a high PLR were significant risk factors for a poor prognosis.According to multivariate analysis,a high PLR was found to be independently associated with a poor survival.Additionally,when age was considered as a stratified factor,univariate analyses demonstrated that a low AGR had the tendency to be correlated with a shorter DFS in nonelderly patients(<65 years old).A low AGR was significantly correlated with a shorter DFS and OS in elderly patients(≥65 years old).Conclusion AGR,NLR,and PLR are independent risk factors associated with a poor gastric cancer survival by univariate analysis,and AGR is an independent risk factor for predicting DFS and OS in elderly patients(≥65 years old)with gastric cancer after total gastrectomy.

Serum albumin as a prognostic predictor reflecting host immunity in patients with non-small cell lung cancer

Objective:Serum albumin(ALB)can transport nutrients to circulating and local immune cells by passing through blood vessels and has attracted attention as a prognostic predictor of non-small cell lung cancer(NSCLC)because it reflects the host immunity from peripheral blood(PBL)to the tumor microenvironment. Methods:Clinical data regarding the PBL and tumor tissues were obtained at The First Hospital of Jilin University between February 2009 and March 2017.We detected indices of glucose and lipid metabolism,classified and counted PBL lymphocytes using flow cy-tometry,determined the tumor-infiltrating lymphocytes by quantitative immunofluorescence,and analyzed the T-cell receptor(TCR)rep-ertoire by high-throughput sequencing of the TCR β-chain.The correlations between ALB and metabolic immune indices were analyzed by t tests and Pearson chi-square test. Results:A total of 211 enrolled NSCLC patients were divided into a relatively high-ALB group(>41.75 g/L,n = 56)and a low-ALB group(≤41.75 g/L,n = 155);patients with high ALB had lower Treg cells(P<0.05)and more CD8+ cytotoxic T cells in the PBL(P<0.01)and a higher proportion of stromal CD8+ tumor-infiltrating lymphocytes(P = 0.047)than patients with low ALB.High ALB was also significantly related to more diversity in the TCR repertoire(P = 0.0021,r2 = 0.5481).Moreover,ALB was identified as an in-dependent prognostic factor based on a multivariate Cox regression analysis(P = 0.032;hazard ratio(HR)= 1.804;95%confidence interval(CI)= 1.035-3.146).The median overall survival in patients with low ALB vs high ALB was 28.2 vs 42.2 months(P=0.0142),respectively.Among patients with nonmetastatic NSCLC(stage Ⅰ-Ⅲ),there was a higher incidence of distant metastasis in the low-ALB group than that in the high-ALB group(41.3%and 22.2%,P=0.043).A low ALB also had a strong association with a higher risk for disease progression(P<0.001)and death(P<0.01;HR = 0.555;95%CI= 0.312-0.988). Conclusions:Albumin could affect the host immunity,and high ALB predicted a reduced risk of distant metastasis and improved the prognosis in NSCLC patients.

Preoperative Serum Krebs Von Den Lungen-6 and Surfactant Protein-D Levels in Non-Small Cell Lung Cancer Patients with Interstitial Pneumonia

We retrospectively analyzed the prognostic significance of preoperative serum Krebs von den Lungen-6 (KL-6) surfactant protein-D (SP-D) levels in non-small cell lung cancer (NSCLC) patients with interstitial pneumonia (IP). We enrolled 41 NSCLC patients with IP who have undergone curative surgery. Prognostic significance of serum KL-6 and SP-D levels was examined. We found a significant relationship between serum KL-6 and SP-D levels in NSCLC patients with IP. However, the 5-year survival of patients with high serum KL-6 level was poor, whereas serum SP-D level was not related to patients’ survival. Univariate analysis revealed that there was a trend towards an association between serum KL-6 level and patients’ prognosis but this did not reach statistical significance. This might be due to small number of study patients. In conclusion, there is a possibility that serum KL-6 level is a prognostic marker regardless of the presence of IP.

CpG island methylator phenotype and Helicobacter pylori infection associated with gastric cancer

AIM： To investigate the association between the CpG island methylator phenotype （CIMP） and serum Helico- bacter pylori （H. pylori） levels for clinical prediction of gastric cancer （GC） progression. METHODS： We analyzed the serum ClMP status of 75 patients with GC using a methylation marker panel and a methylation-specific polymerase chain reaction. Serum samples from 40 healthy persons were examined at the same time. The genes examined were APC, WIF-1, RUNX-3, DLC-1, SFRP-1, DKK and E-cad. H. pylori infec- tion in serum was assayed with an anti-H, pylori immu- noglobulin G antibody test and a rapid urease test. RESULTS： The frequencies of high-level methylation in GC tissues for the seven genes were： 48% for APC, 57.33% for WIF-1, 56% for RUNX-3, 50.67% for DLC-1, 52% for SFRP-1, 54.67% for DKK, and 48% for E-cad.The frequencies in GC serum were 30.67% for APC, 34.67% for WIF-1, 37.33% for RUNX-3, 29.33% for DLC-1, 33.33% for SFRP-1, 32% for DKK, and 26.67% for E-cad. CIMP＋ （defined as ≥ 3 methylated genes） was associated with 47 （62.67%） GC tissue samples and 44 （58.67%） GC serum samples. CIMP＋ was not associated with non-neoplastic mucosal tissues or the serum of healthy persons. Of the 75 GC cases, 51 （68%） were H. pylori＋, and 24 （32%） were H. pylori-. Of the 51 H. pylori＋ cases, 36 were CIMP＋ and 15 were CIMP-. In contrast, for the 24 H. pylori- cases, 11 were CIMP＋, and 13 were CIMP-. The difference was signifi- cant between the H. pylori＋ and H. pylori- groups χ2 = 4.27, P 〈 0.05）. Of the 51 H. pylori＋ GC patients, 34 were CIMP＋ and 17 were CIMP-, while among the 24 H. pylori- GC cases, 10 were CIMP＋ and 14 were CIMP-. The difference was significant between the H. pylori＋ and H. pylori- groups （χ2 = 4.21, P 〈 0.05）. A 2-year follow-up showed significant difference in the rates of metastasis and recurrence between H. pylori＋/CIMP＋ cases and the H. pylori＋/CIMP- cases or CIMP- cases associated with H. pylori assayed in serum （P 〈 0.05）. However, there were no significant differences in sur- vival rates between the two groups. CONCLUSION： H. pylori＋/CIMP＋ cases are associ- ated with higher rates of metastasis and recurrence thanH, pylori＋/CIMP- cases. Serum may be useful for examining CIMP status.

Potential prognostic,diagnostic and therapeutic markers for human gastric cancer

The high incidence of gastric cancer (GC) and its consequent mortality rate severely threaten human health. GC is frequently not diagnosed until a relatively advanced stage. Surgery is the only potentially curative treatment. Thus, early screening and diagnosis are critical for improving prognoses in patients with GC. Gastroscopy with biopsy is an appropriate method capable of aiding the diagnosis of specific early GC tumor types; however, the stress caused by this method together with it being excessively expensive makes it difficult to use it as a routine method for screening for GC on a population basis. The currently used tumor marker assays for detecting GC are simple and rapid, but their use is limited by their low sensitivity and specificity. In recent years, several markers have been identi&#x0fb01;ed and tested for their clinical relevance in the management of GC. Here, we review the serum-based tumor markers for GC and their clinical significance, focusing on discoveries from microarray/proteomics research. We also review tissue-based GC tumor markers and their clinical application, focusing on discoveries from immunohistochemical research. This review provides a brief description of various tumor markers for the purposes of diagnosis, prognosis and therapeutics, and we include markers already in clinical practice and various forthcoming biomarkers.

Multivariate Analysis of Prognosis in Patients with Pancreatic Cancer

Objective Pancreatic cancer is a highly malignant digestive system tumor. The prognosis of pancreatic cancer may be affected by many factors. But there is a lack of research on the multivariate analysis of prognostic factors of pancreatic cancer. This study aimed to explore the factors that multivariate influence the prognosis of pancreatic cancer. Methods We conducted a retrospective cohort study using electronic medical record database from The First Hospital of Jilin University from January 2014 to December 2016. Clinical information, such as TNM stage, serum tumor markers, serum albumin and the patient-generated subjective global assessment (PG-SGA), were collected. Kaplan- Meier method was used to calculate survival rate. The survival curve was compared with the Log-rank test. A multivariate analysis was performed for each prognostic factor using the Cox proportional hazards model. The significance level was 0.05. Results 1. The median overall survival time (OS) of 493 patients was 10 months. The 1-year, 2-year, and 3-year cumulative survival rates were 41.5%, 20.6%, and 9.9%, respectively. Univariate survival analysis revealed that TNM stage (P < 0.001), treatment regimen (P < 0.001), CA125 (P < 0.001), the level of serum albumin (P = 0.014), and nutritional status (P = 0.006) were significantly correlated with prognosis of pancreatic cancer. COX proportional hazards regression model showed that TNM stage (P = 0.038), Carbonhydrate antigen 125 (CA125)(P = 0.003) and the level of serum albumin were independent factors affecting the median OS. The prognosis of patients with Ⅳ stage, elevated levels of serum albumin group and elevated levels of CA125 group were poor. 2. Seventy-three patients with pancreatic cancer underwent surgical resection. The median postoperative survival time was 28 months. The 1-year, 2-year, and 3-year cumulative survival rates were 74.4%, 47.7%, and 21.4%, respectively. Univariate analysis revealed that TNM stage (P = 0.032), pathological type (P = 0.012), hypoglycemia (P = 0.040), CA125 (P < 0.001), were significantly correlated with prognosis of pancreatic cancer. COX proportional hazards regression model showed that TNM stage (P = 0.008), pathological type (P = 0.045) and CA125 (P = 0.017), were independent prognostic factors after resection of pancreatic cancer. The prognosis of patients with advanced stage, non-ductal adenocarcinoma and elevated levels of CA125 group was poor. Conclusions 1. TNM stage, CA125 and serum albumin are independent prognostic factors for the overall survival of patients with pancreatic cancer. 2. TNM stage, pathological type, and CA125 are independent prognostic factors for the postoperative survival time in patients with pancreatic cancer after resection.

C反应蛋白与白蛋白比值联合握力和血清前白蛋白在食管癌患者中的应用价值

目的 探讨C反应蛋白与白蛋白比值(CAR)联合握力和血清前白蛋白对食管癌患者生存期及营养不良的预测价值。方法 回顾性选取212例食管癌患者作为研究对象,收集患者的基本资料和治疗前CAR、握力、血清前白蛋白检测结果,评估患者营养不良情况并随访总生存期。采用受试者工作特征(ROC)曲线评估治疗前CAR、握力和血清前白蛋白水平对患者营养不良的预测价值,采用Kaplan-Meier生存曲线及Cox回归模型分析治疗前CAR、握力和血清前白蛋白水平对患者生存预后的预测价值。结果 ROC曲线分析结果显示,握力预测食管癌患者营养不良的曲线下面积(0.625)最大,其后依次为血清前白蛋白、CAR(分别为0.604、0.594);根据约登指数确定CAR、握力、血清前白蛋白的最佳截断值分别为0.732、23.1 kg、0.190 g/L,三者联合预测营养不良的灵敏度高达80.7%。Kaplan-Meier生存曲线分析结果显示,CAR增高(≥0.732)、握力降低(<23.1 kg)、血清前白蛋白水平降低(<0.190 g/L)患者的总生存期分别短于CAR<0.732、握力≥23.1 kg、血清前白蛋白水平≥0.190 g/L的患者,差异有统计学意义(P<0.01);多因素Cox回归分析结果显示,治疗前CAR增高(≥0.732)、握力降低(<23.1 kg)、血清前白蛋白水平降低(<0.190 g/L)是食管癌患者生存预后不良的独立危险因素(P<0.05)。结论 治疗前CAR、握力和血清前白蛋白是评估食管癌患者营养状态和生存预后的重要指标,三者联合检测有助于营养不良的早期诊断与及时干预,或可改善食管癌患者的生存预后。

胃癌患者术前红细胞分布宽度与白蛋白比值变化及其临床意义

目的探讨胃癌患者术前红细胞分布宽度与白蛋白比值(RDW/Alb)变化及其临床意义。方法回顾性收集53例预后良好的胃癌患者的临床资料纳入预后良好组,收集同期53例预后不良的胃癌患者的临床资料纳入预后不良组。由研究者查阅入选者的基线资料并做详细统计,观察2组患者术前RDW/Alb表达情况,分析术前RDW/Alb与胃癌患者腹腔镜根治术治疗预后的关系,并绘制受试者工作特征(ROC)曲线分析术前RDW/Alb对胃癌患者腹腔镜胃癌根治术治疗预后的预测价值。结果预后不良组TNM分期为Ⅲa期占比以及术前RDW、RDW/Alb、癌胚抗原(CEA)均高于预后良好组,术前Alb低于预后良好组,差异有统计学意义(P<0.05);2组患者年龄、性别、体重指数、肿瘤位置、手术时间、术中出血量对比,差异无统计学意义(P>0.05)。经COX生存回归分析,结果显示,TNM分期为Ⅲa期、术前RDW、RDW/Alb及CEA高表达为胃癌患者腹腔镜胃癌根治术治疗预后的危险因子(HR>1,P<0.05);术前Alb高表达为其保护因子(HR<1,P<0.05)。绘制ROC曲线,结果显示,术前RDW、Alb、RDW/Alb预测胃癌患者腹腔镜胃癌根治术治疗预后的价值的AUC均>0.7,具有一定的预测价值,其中RDW/Alb预测价值最高。结论术前RDW/Alb与胃癌患者腹腔镜胃癌根治术治疗预后有关,可作为胃癌患者预后的预测指标。

帕博利珠单抗联合白蛋白紫杉醇与卡培他滨方案治疗进展期胃癌患者的疗效评估

目的探讨帕博利珠单抗联合白蛋白紫杉醇与卡培他滨方案在治疗进展期胃癌中的疗效。方法选取2019年10月至2022年9月西安交通大学附属红会医院收治的122例进展期胃癌患者进行随机对照试验,按照随机数字表法分为两组,各61例。对照组男48例、女13例,年龄(62.45±5.47)岁,接受卡培他滨方案联合白蛋白紫杉醇治疗;观察组男47例、女14例,年龄(63.14±5.65)岁,在对照组基础上增加帕博利珠单抗治疗。每3周为1个疗程,治疗2个疗程。对比两组患者临床疗效、治疗前后血清肿瘤标志物[糖类抗原724(CA-724)、糖类抗原199(CA-199)、血管内皮生长因子(VEGF)、肿瘤坏死因子-α(TNF-α)]、不良反应及预后情况。采用t检验、χ^(2)检验。结果观察组总有效率为68.85%(42/61),高于对照组的47.54%(29/61),差异有统计学意义(χ^(2)=5.509,P=0.019)。治疗前,两组患者CA-724、CA-199、VEGF、TNF-α水平比较,差异均无统计学意义(均P>0.05);治疗6周后,观察组CA-724、CA-199、VEGF、TNF-α水平均低于对照组[(17.56±2.22)μg/L比(22.53±2.49)μg/L、(21.56±3.21)U/ml比(27.52±3.44)U/ml、(271.64±21.22)ng/L比(281.33±24.15)ng/L、(15.08±2.53)μg/L比(19.54±3.68)μg/L],差异均有统计学意义(t=11.636、9.893、2.354、7.800,均P<0.05)。观察组治疗期间Ⅲ~Ⅳ级血小板减少事件发生率为4.92%(3/61),低于对照组的18.03%(11/61),差异有统计学意义(χ^(2)=5.164,P=0.023);两组患者粒细胞减少、腹泻、甲状腺功能减退发生率比较,差异均无统计学意义(均P>0.05)。随访1年,观察组生存率为95.08%(58/61),高于对照组的83.61%(51/61),差异有统计学意义(χ^(2)=4.218,P=0.039)。结论帕博利珠单抗联合白蛋白紫杉醇治疗进展期胃癌的疗效良好,可有效降低血清肿瘤标志物水平。

乳酸代谢相关的SERPINE1基因与胃癌患者临床预后的关系

目的探讨乳酸代谢相关的SERPINE1基因与胃癌(GC)临床预后的关系。方法该研究纳入了2018年1月至2020年12月在该院接受手术切除治疗的89例GC患者。在初步实验中,该文分析了来自Ⅰ期(n=12)和Ⅳ期(n=12)GC患者的24份血清样本中5个乳酸代谢相关的基因(F5、MTTP、SERPINE1、CYP19A1、SLC52A3)的水平。在第二步中,将初步试验中Ⅳ期GC患者和Ⅰ期GC患者血清中发生显著改变的候选基因在一个更大的独立队列中进行验证,该队列包括65例GC患者和22例健康对照者的血清样本。结果在初步实验中分析的乳酸代谢相关的基因(F5、MTTP、SERPINE1、CYP19A1、SLC52A3)中,与Ⅰ期GC相比,在Ⅳ期患者的血清中SERPINE1显著上调(P<0.001)。GC患者血清SERPINE1的表达水平显著低于健康对照组,差异有统计学意义(P<0.0001)。此外,SERPINE1表达水平随着肿瘤TNM分期的进展而升高(P<0.05)。基于受试者工作特征曲线分析血清SERPINE1对总生存(OS)率的最大预测值[曲线下面积为0.725,截断值为0.0021],将GC患者分为高表达组(n=39)或低表达组(n=26)。与血清SERPINE1低表达组相比,血清SERPINE1高表达组静脉浸润、T3/T4期、淋巴结转移、远处转移例数显著增加,差异有统计学意义(P<0.05)。SERPINE1低表达的GC患者的OS率明显高于SERPINE1高表达的患者,差异有统计学意义(P<0.05)。多变量分析显示,血清SERPINE1高表达(HR=4.51,95%CI:1.23~23.69,P=0.021)是预测GC患者不良预后的独立预后标志物。结论血清乳酸代谢相关的SERPINE1基因可作为GC预后的可靠生物标志物。

腹腔镜辅助胃癌根治术在胃癌治疗中的应用价值

目的分析腹腔镜辅助胃癌根治术在胃癌治疗中的应用价值。方法选取宁夏医科大学总医院胃肠外科2021年10月—2023年10月胃癌患者110例,按照随机数字表法分为2组,各55例。对照组采取开腹胃癌根治术,观察组采取腹腔镜辅助胃癌根治术。比较2组各指标差异。结果观察组手术时间[(212.4±20.6)min]长于对照组[(176.4±30.6)min],术中出血量、术后并发症发生率[(250.3±23.6)mL、1.8%]低于对照组[(330.6±35.6)mL、14.6%],切口长度、下床活动时间、住院时间[(3.5±0.6)cm、(36.6±4.2)h、(8.6±2.2)d]短于对照组[(8.8±1.2)cm、(45.6±5.8)h、(11.4±3.6)d],差异均有统计学意义(P<0.05)。手术前,2组CRP、IL-6相比,差异无统计学意义(P>0.05);手术后,观察组CRP、IL-6[(26.5±5.2)mg/L、(65.3±5.3)pg/mL]低于对照组[(58.5±8.6)mg/L、(78.5±10.6)pg/mL],差异均有统计学意义(P<0.05)。结论腹腔镜辅助胃癌根治术的疗效与安全性高,可减轻手术引起的机体损伤,促使患者早期出院。