Experimental study on effect of recombinant human growth hormone combined with chemotherapy on stomach neoplasms implanted in nude mice

Objective: To investigate the effect of different doses of recombined growth hormone (rhGH) on stomach neo- plasms implanted in nude mice, and its efficacy in combining with chemotherapy (flurouracil, 5-FU). Methods: Human stom- ach neoplasms model was established in nude mice. The nude mice were divided into control group, moderate-dose of rhGH group, low-dose rhGH group, 5-FU group, moderate-dose rhGH/5-FU group, and low-dose rhGH/5-FU group. The results of each group were observed after ten days. Results: After therapy, the body mass of rhGH groups was significantly increased compared with control group (P<0.05), the body mass of rhGH/5-FU groups was significantly increased compared with 5-FU group (P<0.05), but it was no significant difference between rhGH/5-FU groups and control group (P>0.05). The average tumor mass and volume of rhGH groups were not significantly increased compared with control group (P>0.05), but they were significantly reduced in 5-FU group and rhGH/5-FU groups (P<0.05). They were no significant difference between rhGH/5- FU groups and 5-FU group (P>0.05). After treatment, the percentages of S, G0/G1 and G2/M phases and proliferation index (PI) were not significantly changed in rhGH groups compared with control group (P>0.05), and the same with rhGH/5-FU groups compared with 5-FU group (P>0.05). The difference caused by dose of rhGH was not significant. Conclusion: rhGH enhances body mass, does not stimulate tumor growth, and has no adverse effects on tumor bearing nude mice. Combined with flurouracil, rhGH does not influence the efficacy of chemotherapy, and has no effect on tumor cell cycle kinetics.

Diagnostic value of conventional endoscopic ultrasound for lymph node metastasis in upper gastrointestinal neoplasia:A metaanalysis

BACKGROUND Upper gastrointestinal neoplasia mainly includes esophageal cancer and gastric cancer,both of which have high morbidity and mortality.Lymph node metastasis(LNM),as the most common metastasis mode of both diseases,is an important factor affecting tumor stage,treatment strategy and clinical prognosis.As a new fusion technology,endoscopic ultrasound(EUS)is becoming increasingly used in the diagnosis and treatment of digestive system diseases,but its use in detecting LNM in clinical practice remains limited.AIM To evaluate the diagnostic value of conventional EUS for LNM in upper gastrointestinal neoplasia.METHODS Using the search mode of“MeSH+Entry Terms”and according to the predetermined inclusion and exclusion criteria,we conducted a comprehensive search and screening of the PubMed,EMBASE and Cochrane Library databases from January 1,2000 to October 1,2022.Study data were extracted according to the predetermined data extraction form.The quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool,and the results of the quality assessment were presented using Review Manager 5.3.5 software.Finally,Stata14.0 software was used for a series of statistical analyses.RESULTS A total of 22 studies were included in our study,including 2986 patients.The pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic score and diagnostic odds ratio of conventional EUS in the diagnosis of upper gastrointestinal neoplasia LNM were 0.62[95%confidence interval(CI):0.50-0.73],0.80(95%CI:0.73-0.86),3.15(95%CI:2.46-4.03),0.47(95%CI:0.36-0.61),1.90(95%CI:1.51-2.29)and 6.67(95%CI:4.52-9.84),respectively.The area under the summary receiver operating characteristic curve was 0.80(95%CI:0.76-0.83).Sensitivity analysis indicated that the results of the meta-analysis were stable.There was considerable heterogeneity among the included studies,and the threshold effect was an important source of heterogeneity.Univariable meta-regression and subgroup analysis showed that tumor type,sample size and EUS diagnostic criteria were significant sources of heterogeneity in specificity(P<0.05).No significant publication bias was found.CONCLUSION Conventional EUS has certain clinical value and can assist in the detection of LNM in upper gastrointestinal neoplasia,but it cannot be used as a confirmatory or exclusionary test.

Ultraslim endoscopy with flexible spectral imaging color enhancement for upper gastrointestinal neoplasms

AIM:To conduct a preliminary study on the effect of flexible spectral imaging color enhancement (FICE) used in combination with ultraslim endoscopy by focusing on the enhanced contrast between tumor and non-tumor lesions. METHODS: We examined 50 lesions of 40 patients with epithelial tumors of the upper gastrointestinal tract before endoscopic submucosal dissection using ultraslim endoscopy with conventional natural color imag ing and with FICE imaging. We retrospectively invest igated the effect of the use of FICE on endoscopic diagn osis in comparison with normal light. RESULTS: Visibility of the epithelial tumors of the upper gastrointestinal tract with FICE was superior to normal light in 54% of the observations and comparable to normal light in 46% of the observations. There was no lesion for which visibility with FICE was inferior to that with normal light. FICE visualized 69.6% of hyperemic lesions and 58.8% of discolored lesions better than conventional endoscopy with natural color imaging. FICE sign if icantly improved the visibility of lesions with hyp ere mia or discoloration compared with normocolored lesions. CONCLUSION: This study suggests that the use of FICE would improve the ability of ultraslim endoscopy to detect epithelial tumors of the upper gastrointestinal tract.

Clinicopathological characteristics of clinical early gastric cancer in the upper-third stomach

AIM: To elucidate the clinicopathological characteristics of clinically early gastric cancer in the upper-third stomach and to clarify treatment precautions.METHODS: A total of 683 patients with clinical early gastric cancer were enrolled in this retrospective study, 128 of whom had gastric cancer in the upper-third stomach(U group). All patients underwent a double contrast barium examination, endoscopy, and computed tomography(CT), and were diagnosed preoperatively based on the findings obtained. The clinicopathological features of these patients were compared with those of patients with gastric cancer in the middle- and lower-third stomach(ML group). We also compared clinicopathological factors between accurate-diagnosis and under-diagnosis groups in order to identify factors affecting the accuracy of a preoperative diagnosis of tumor depth.RESULTS: Patients in the U group were older(P = 0.029), had a higher ratio of males to females(P = 0.015), and had more histologically differentiated tumors(P = 0.007) than patients in the ML group. A clinical under-diagnosis occurred in 57 out of 683 patients(8.3%), and was more frequent in the U group than in the ML group(16.4% vs 6.3%, P < 0.0001). Therefore, the rates of lymph node metastasis and lymphatic invasion were slightly higher in the U group than in the ML group(P = 0.071 and 0.082, respectively). An under-diagnosis was more frequent in histologically undifferentiated tumors(P = 0.094) and in those larger than 4 cm(P = 0.024). The medianfollow-up period after surgery was 56 mo(range, 1-186 mo). Overall, survival and disease-specific survival rates were significantly lower in the U group than in the ML group(P = 0.016 and 0.020, respectively). However, limited operation-related cancer recurrence was not detected in the U group in the present study.CONCLUSION: Clinical early gastric cancer in the upper-third stomach has distinguishable characteristics that increase the risk of a clinical under-diagnosis, especially in patients with larger or undifferentiated tumors.

Laparoscopic spleen-preserving splenic hilar lymphadenectomy in 108 consecutive patients with upper gastric cancer

AIM: To evaluate the feasibility and short-term efficacy of laparoscopic spleen-preserving splenic hilar (No. 10) lymphadenectomy to treat advanced upper gastric cancer (AUGC).

Minimally invasive surgery for upper gastrointestinal cancer: Our experience and review of the literature

Minimally invasive surgery (MIS) for upper gastrointestinal (GI) cancer, characterized by minimal access, has been increasingly performed worldwide. It not only results in better cosmetic outcomes, but also reduces intraoperative blood loss and postoperative pain, leading to faster recovery; however, endoscopically enhanced anatomy and improved hemostasis via positive intracorporeal pressure generated by CO2 insufflation have not contributed to reduction in early postoperative complications or improvement in long-term outcomes. Since 1995, we have been actively using MIS for operable patients with resectable upper GI cancer and have developed stable and robust methodology in conducting totally laparoscopic gastrectomy for advanced gastric cancer and prone thoracoscopic esophagectomy for esophageal cancer using novel technology including da Vinci Surgical System (DVSS). We have recently demonstrated that use of DVSS might reduce postoperative local complications including pancreatic fistula after gastrectomy and recurrent laryngeal nerve palsy after esophagectomy. In this article, we present the current status and future perspectives on MIS for gastric and esophageal cancer based on our experience and a review of the literature.

Ecologic study of serum selenium and upper gastrointestinal cancers in Iran

AIM:Both observational and experimental studies have shown that higher selenium status reduces the risk of upper gastrointestinal cancers in selenium deficient populations. Recent cancer registry data have shown very different rates of esophageal cancer(EC)and gastric cancer(GC)in four Provinces of Iran,namely Ardabil,Mazandaran,Golestan, and Kerman.The aim of this study was to have a preliminary assessment of the hypothesis that high rates of EC in Golestan and high rates of GC in Ardabil may be partly attributable to selenium deficiency. METHODS:We measured serum selenium in 300 healthy adults from An:labil(n=100),Mazandaran(n=50),Golestan (n=100),and Kerman(n=50),using inductively coupled plasma,with dynamic reaction cell,mass spectrometry(ICP- DRC-MS)at the US Centers for Disease Control(Atlanta, Georgia). RESULTS:The median serum selenium concentrations were very different in the four Provinces.The medians(IQR)for selenium in Ardabil,Mazandarn,Golestan,and Kerman were 82(75-94),123(111-132),155(141-173),and 119 (110-128)μg/L,respectively(P<0.001).The results of linear regression showed that the Province variable,by itself, explained 76% of the variance in log selenium(r^2=0.76). The proportion of the populations with a serum selenium more than 90 μg/L(the concentration at which serum selenoproteins are saturated)was 100% in Golestan, Kerman,and Mazandaran but only 29% in Ardabil. CONCLUSION:Our findings suggest that selenium defidency is not a major contributor to the high incidence of EC seen in northeastern Iran,but it may play a role in the high incidence of GC in Ardabil Province. Nouarie M,Pourshams A,Kamangar F,Sotoudeh M,Derakhshan MH,Akbari MR,Fakheri H,Zahedi MJ,Caldwell K,Abner CC, Taylor PR,Malekzadeh R,Dawsey SM.Ecologic study of serum

Photodynamic therapy for middle-advanced stage upper gastrointestinal carcinomas: A systematic review and meta-analysis

AIM To determine the therapeutic effect of photodynamic therapy(PDT) for middle-advanced stage upper gastrointestinal carcinomas. METHODS We searched PubM ed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Database from inception to April 2018 for randomized controlled studies. These studies compared PDT with other palliative therapies(radiotherapy, chemotherapy, or Nd:YAG laser) and compared PDT, radiotherapy, or chemotherapy alone with PDT combined with chemotherapy/radiotherapy. In our meta-analysis, both fixed and random effects models were used to estimate the risk ratio(RR) for dichotomous outcomes(the response rate and one-year survival rate).RESULTS Ten random controlled clinical studies with 953 patients were included in the analysis. The effective rate for PDT was better than that of radiotherapy or Nd:YAG laser for the treatment of middle-advanced upper gastrointestinal carcinomas [RR = 1.36; 95% confidence interval(CI): 1.13-1.65; P = 0.001]. In addition, PDT combined with chemotherapy had significantly better efficacy and a higher one-year survival rate than PDT or chemotherapy alone(significant remission rate, RR = 1.62; 95%CI: 1.34-1.97; P < 0.00001; one-year survival rate, RR = 1.81; 95%CI: 1.13-2.89; P = 0.01).CONCLUSION PDT is a useful method for the treatment of middleadvanced stage upper gastrointestinal carcinomas. PDT combined with chemotherapy or radiotherapy can enhance its efficacy and prolong survival time.

Epidemiology of upper gastrointestinal cancers in Iran:A Sub site analysis of 761 cases

AIM： To define the sub site distribution of upper gastrointestinal cancers in three provinces of Iran. METHODS： The study was carried out in three provinces in Iran： Ardabil, Golestan, and Tehran. In Arbabil and Golestan, the data was collected from the sole referral center for gastrointestinal cancers and the local cancer registry. For Tehran province, data from two major private hospitals were used. All gastric and esophageal cancer patients diagnosed during the period from September 2000 and April 2002 were included in the study.RESULTS： A total of 761 patients with upper gastrointestinal cancers were identified, 314 from Ardabil, 261 from Golestan, and 186 from Tehran. In Tehran, the relative rate of cancer increased from the upper esophagus to the distal stomach. In Golestan, the reverse pattern was observed. In Ardabil, the mid portion （distal esophagus and proximal stomach） was involved most frequently.CONCLUSION： There were considerable variations in the sub site of upper gastrointestinal cancers in the three provinces studied, We cannot provide any explanation for this variation, Further research aimed at explaining the discrepancies in sub site distribution of upper gastrointestinal cancers may help identify important risk factors.

Metastatic stomach lymphoepithelioma-like carcinoma and immune checkpoint inhibitor therapy:A case report

BACKGROUND Pulmonary lymphoepithelioma-like carcinoma(PLELC)is a rare type of nonsmall-cell lung cancer.Stomach lymphoepithelioma-like carcinoma(LELC)metastasis secondary to PLELC has not been reported recently.CASE SUMMARY A 64-year-old female was admitted to our hospital for a regular gastroscopy examination with a 6-year history of surgical resection for left PLELC.Positron emission tomography/computed tomography suggested high accumulation of 18F-fludeoxyglucose in the gastric cardia region.Upper gastrointestinal endoscopy confirmed a large mass at the stomach fundus.Immunohistochemistry(IHC)of the biopsy suggested metastatic stomach LELC.Proximal gastrectomy showed that this 6.5 cm×5.0 cm mass was located in the stomach fundus near the cardia.Histopathological examination showed a poorly differentiated carcinoma with prominent lymphoplasmacytic infiltration.IHC demonstrated that the tumor was positive for CK(AE1/AE3),p63,p40,p53,Ki-67(70%),and EGFR(3+)and negative for CK7,CK20,Her2,and CD10.In situ hybridization analysis showed positive staining Epstein-Barr virus-encoded RNA.Tumor programmed cell death ligand 1(PD-L1)expression score was 98%,and the combined positive score was 100,with no evidence of microsatellite instability.Thus,the patient was unequivocally diagnosed with metastatic stomach LELC secondary to pulmonary LELC.After discharge,this patient underwent PD-1 inhibitor treatment(toripalimab,240 mg)every 3 wk for ten cycles,and she has had no tumor recurrence.CONCLUSION For gastric LELC metastasis,PD-1 inhibitor therapy could become a new therapeutic approach,though there is still no evidence from large data sets to support this.

Gastric leiomyoma presenting as an endophytic growth of cardia of the stomach: A case report

Gastric leiomyomas are rare submucosal neoplasms arising from smooth muscle cells.It accounts for approximately 2.5%of all gastric tumours,is slow growing and rarely causes symptoms such as upper abdominal discomfort and dyspepsia.1 On imaging,they appear similar to gastrointestinal stromal tumours(GISTs)and can be intraluminal or extraluminal.Diagnosis is mostly confirmed by histopathological examination of the tumour.Surgical resection of the tumour is the main treatment option.Here,we present a case of laparoscopic resection of an endophytic gastric tumour that turned out to be a leiomyoma.

RECONSTRUCTION OF ESOPHAGUS WITH WHOLE STOMACH THROUGH ESOPHAGEAL BED AFTER RESECTION OF THE UPPER ESOPHAGEAL CARCINOMA A REPORT OF 160 CASES

From September 1985 to December 1992, 160 cases of reconstruction of the esophagus with the whole stomach through the esophageal bed after resection of the upper esophageal carcinoma were performed with neither operative mortality nor intrathoracic complications. The leakage rate of the cervical anastomosis with Gambee's single layer method was 1.2%. The main steps of the operative procedure consisted of : (1) making a right thoracotomy for dissecting and removing the entire thoracic esophagus; (2) laparotomy for mobilizing the whole stomach, constricting it to tube shape and doing a pyloroplasty; and (3) pulling up the mobilized tube-like stomach through the posterior mediastinal space(i.e. the esophageal bed) out of the left neck incision and then the esophagogastrostomy with Gambee's single layer anastomosis was performed.

Extraskeletal Ewing sarcoma of the stomach:A rare case report

BACKGROUND Extraskeletal Ewing sarcoma(EES)is a rare and highly malignant small round cell tumor associated with a poor clinical outcome.Ewing sarcoma(ES)involving the stomach is an uncommon presentation and can be easily confused with other small round cell tumors.We herein present a rare case of ES involving the gastric area.CASE SUMMARY We report a case of gastric ES in a 19-year-old female patient who initially presented with a complaint of a tender epigastric mass for 5 d.Contrast-enhanced abdominal computed tomography revealed a soft-tissue-density mass with a diameter of 8.5 cm between the liver and stomach;the mass was connected to the gastric antrum.Then,the mass was surgically excised completely.Upon histopathological,immunophenotype and molecular analysis,the mass was identified to be a primary gastric ES.CONCLUSION EES is an aggressive tumor with poor prognosis.Therefore,early diagnosis and timely intervention are essential for a good prognosis.It is imperative for us to raise awareness about this rare tumor.Surgical resection is still the best treatment option.

Underwater endoscopic mucosal resection for neoplasms in the pyloric ring of the stomach: Four case reports

BACKGROUND Tumors located in the pylorus are technically more complex to resect by endoscopic resection,as the anatomical characteristics of this region can affect the adequate assessment of margins and performance of the procedure.We reported the results of underwater endoscopic mucosal resection(UEMR)of benign mucosal neoplasms located in the pyloric ring.CASE SUMMARY This case series describes 4 patients with 4 mucosal neoplasms located in the pyloric ring.The diameter of each neoplasm was less than 15 mm.We performed UEMR for the lesions.Water immersion enabled slight floating of the lesions,resulting in easy identification.We achieved en bloc resection with a snare and electrosurgical unit.All procedure were performed within 3 min without adverse events.Pathologic examination showed low-grade dysplasia with clear resection margins in one case and hyperplastic polyps in three cases.CONCLUSION UEMR can be an effective and safe treatment method for neoplasms in the gastric pyloric ring.

胃肝样腺癌的CT特征

目的分析胃肝样腺癌的临床和CT特征,提高对本病的认识。资料与方法回顾性分析2012年9月—2023年4月苏州大学附属第一医院经病理证实的38例胃肝样腺癌患者的临床病理资料、实验室检查、CT资料,分析病灶大小、形态、密度、边界、强化方式、转移及侵犯等情况,总结其临床及CT特征。结果38例患者中,血清甲胎蛋白水平升高24例,免疫组化甲胎蛋白表达阳性32例。CT表现为胃壁增厚,门静脉期病变最大截面长径2.38~11.95cm,中位数为5.200(3.365,7.215)cm,23例伴溃疡,20例内见坏死,25例周围侵犯,14例出现肝脏转移,5例出现门静脉系统癌栓。结论胃肝样腺癌为罕见肿瘤,血清甲胎蛋白常增高,CT增强检查肿瘤常较大,可见坏死,渐进性或持续强化,易发生转移、侵犯门静脉,认识这些特征有助于提高诊断水平。

PLR、NLR、CRP联合评估进展期胃癌腹膜腔转移的价值研究

目的探讨血小板计数/淋巴细胞计数(platelet count/lymphocyte count,PLR)、中性粒细胞计数/淋巴细胞计数(neutrophil count/lymphocyte count,NLR)、C反应蛋白(C-reactive protein,CRP)评估进展期胃癌腹膜腔转移的价值。方法回顾性选取江苏省徐州市肿瘤医院进展期胃癌患者124例,根据是出现腹膜腔转移分为腹腔转移组36例、非腹腔转移组88例。比较2组临床资料、病理学参数及CRP、PLR、NLR,Logistic分析进展期胃癌腹膜腔转移影响因素,构建Logistic回归模型,受试者工作特征(receiver operating characteristics,ROC)曲线评估其对腹膜腔转移的预测价值。结果腹腔转移组肿瘤直径大于非腹腔转移组,浸润深度、TNM分期及PLR、NLR、CRP水平高于腹腔转移组,组织学分化程度低于非腹腔转移组(P<0.05);排除PLR、NLR和CRP之外的混杂因素肿瘤大小、浸润深度、TNM分期和组织学分化,建立Logistic模型,对其行多因素分析,显示PLR、NLR和CRP是进展期胃癌腹膜腔转移的危险因素(P<0.05);构建风险预测模型:logit(p)=PLR×1.416+NLR×1.149+CRP×1.088;模型预测价值:ROC分析,logit(p)>0.5时,AUC值为0.755,χ^(2)为10.212,诊断敏感度为80.95%,特异度为61.64%。结论进展期胃癌腹膜腔转移与PLR、NLR、CRP水平及相关临床特征相关,根据PLR、NLR、CRP和相关临床因素构建的预测模型对其具有较高预测价值,可为临床决策提供依据。

Advances in the study of gastric organoids as disease models

Gastric organoids are models created in the laboratory using stem cells and sophisticated three-dimensional cell culture techniques.These models have shown great promise in providing valuable insights into gastric physiology and advanced disease research.This review comprehensively summarizes and analyzes the research advances in culture methods and techniques for adult stem cells and induced pluripotent stem cell-derived organoids,and patient-derived organoids.The potential value of gastric organoids in studying the pathogenesis of stomach-related diseases and facilitating drug screening is initially discussed.The construction of gastric organoids involves several key steps,including cell extraction and culture,three-dimensional structure formation,and functional expression.Simulating the structure and function of the human stomach by disease modeling with gastric organoids provides a platform to study the mechanism of gastric cancer induction by Helicobacter pylori.In addition,in drug screening and development,gastric organoids can be used as a key tool to evaluate drug efficacy and toxicity in preclinical trials.They can also be used for precision medicine according to the specific conditions of patients with gastric cancer,to assess drug resistance,and to predict the possibility of adverse reactions.However,despite the impressive progress in the field of gastric organoids,there are still many unknowns that need to be addressed,especially in the field of regenerative medicine.Meanwhile,the reproducibility and consistency of organoid cultures are major challenges that must be overcome.These challenges have had a significant impact on the development of gastric organoids.Nonetheless,as technology continues to advance,we can foresee more comprehensive research in the construction of gastric organoids.Such research will provide better solutions for the treatment of stomach-related diseases and personalized medicine.

661例胃癌患者临床病理特征分析

目的探讨新乡医学院第一附属医院收治的胃癌的临床病理特征。方法回顾性分析2019年5月至2023年4月该院收治的661例连续胃癌手术病例临床病理资料。统计分析年龄、性别、癌肿部位、pT分期、淋巴结转移及脉管癌栓、神经侵犯情况。结果661例胃癌病例中男性499例,女性162例。661例胃癌患者年龄多处于46岁~75岁之间,56岁~70岁为发病高峰,平均年龄为(63.03±9.07)岁,其中男性平均年龄为(63.23±8.95)岁,女性平均年龄为(62.42±9.44)岁。不同性别组年龄相比差异无统计学意义(P>0.05)。癌肿部位以食管胃结合部腺癌为主(72.61%),不同性别组胃癌癌肿分布部位差异无统计学意义(P>0.05)。组织学类型以腺癌为主(98.18%);分化程度以低-中分化胃癌为主(88.65%)。胃癌T分期pT3组和pT4a组分别占39.49%和31.47%,随着pT分期的升高,淋巴结转移、神经侵犯、脉管癌栓阳性率逐渐增高,其中,pT3组与pT2组相比,淋巴结转移、神经侵犯、脉管癌栓阳性率差异均有统计学意义(P<0.05)。胃癌癌肿部位不同,淋巴结转移、神经侵犯、脉管癌栓阳性率无显著差别(P>0.05)。结论该院收治的胃癌的临床病理特征如下:多见于中老年男性;以食管胃结合部腺癌为主;分化程度以低-中分化腺癌为主,且与胃癌的原发部位无关;T分期多为T3和T4a期;淋巴结转移、神经侵犯、脉管癌栓的发生与T分期呈正相关,但不同部位胃癌的淋巴结转移、神经侵犯和脉管癌栓发生无明显差异。

Construction and validation of a risk-prediction model for anastomotic leakage after radical gastrectomy: A cohort study in China

Objectives:Anastomotic leakage(AL)stands out as a prevalent and severe complication following gastric cancer surgery.It frequently precipitates additional serious complications,significantly influencing the overall survival time of patients.This study aims to enhance the risk-assessment strategy for AL following gastrectomy for gastric cancer.Methods:This study included a derivation cohort and validation cohort.The derivation cohort included patients who underwent radical gastrectomy at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,from January 1,2015 to December 31,2020.An evidence-based predictor questionnaire was crafted through extensive literature review and panel discussions.Based on the questionnaire,inpatient data were collected to form a model-derivation cohort.This cohort underwent both univariate and multivariate analyses to identify factors associated with AL events,and a logistic regression model with stepwise regression was developed.A 5-fold cross-validation ensured model reliability.The validation cohort included patients from August 1,2021 to December 31,2021 at the same hospital.Using the same imputation method,we organized the validation-queue data.We then employed the risk-prediction model constructed in the earlier phase of the study to predict the risk of AL in the subjects included in the validation queue.We compared the predictions with the actual occurrence,and evaluated the external validation performance of the model using model-evaluation indicators such as the area under the receiver operating characteristic curve(AUROC),Brier score,and calibration curve.Results:The derivation cohort included 1377 patients,and the validation cohort included 131 patients.The independent predictors of AL after radical gastrectomy included age65 y,preoperative albumin<35 g/L,resection extent,operative time240 min,and intraoperative blood loss90 mL.The predictive model exhibited a solid AUROC of 0.750(95%CI:0.694e0.806;p<0.001)with a Brier score of 0.049.The 5-fold cross-validation confirmed these findings with a calibrated C-index of 0.749 and an average Brier score of 0.052.External validation showed an AUROC of 0.723(95%CI:0.564e0.882;p?0.006)and a Brier score of 0.055,confirming reliability in different clinical settings.Conclusions:We successfully developed a risk-prediction model for AL following radical gastrectomy.This tool will aid healthcare professionals in anticipating AL,potentially reducing unnecessary interventions.

1例初始表现为急性弥散性血管内凝血的胃低分化腺癌伴多发转移:^(18)F-FDG PET/CT显像所见

患者女,20岁,无明显诱因阵发性下腹部疼痛伴牙龈出血、皮肤散在瘀斑及肛门坠胀感9天;既往体健。查体:贫血貌,全身皮肤散在片状瘀斑,四肢皮肤干燥;腹部柔软,无压痛及反跳痛。实验室检查:红细胞2.49×10^(12)/L,血小板36×10^(9)/L,血红蛋白70 g/L,血浆鱼精蛋白副凝固实验(+),D-二聚体>20 mg/L,纤维蛋白原降解产物>150.00 mg/L,糖类抗原12573.40 U/ml。