AIM:To investigate the impact of prognostic nutritional index(PNI)on the postoperative complications and long-term outcomes in gastric cancer patients undergoing total gastrectomy.METHODS:The data for 386 patients wit...AIM:To investigate the impact of prognostic nutritional index(PNI)on the postoperative complications and long-term outcomes in gastric cancer patients undergoing total gastrectomy.METHODS:The data for 386 patients with gastric cancer were extracted and analyzed between January2003 and December 2008 in our center.The patients were divided into two groups according to the cutoff value of the PNI:those with a PNI≥46 and those with a PNI<46.Clinicopathological features were compared between the two groups and potential prognostic factors were analyzed.The relationship between postoperative complications and PNI was analyzed by logistic regression.The univariate and multivariate hazard ratios were calculated using the Cox proportional hazard model.RESULTS:The optimal cutoff value of the PNI was set at 46,and patients with a PNI≥46 and those with a PNI<46 were classified into PNI-high and PNI-low groups,respectively.Patients in the PNI-low group were more likely to have advanced tumor(T),node(N),and TNM stages than patients in the PNI-high group.The low PNI is an independent risk factor for the incidence of postoperative complications(OR=2.223).The 5-year overall survival(OS)rates were 54.1%and21.1%for patients with a PNI≥46 and those with a PNI<46,respectively.The OS rates were significantly lower in the PNI-low group than in the PNI-high group among patients with stagesⅡ(P=0.001)andⅢ(P<0.001)disease.CONCLUSION:The PNI is a simple and useful marker not only to identify patients at increased risk for postoperative complications,but also to predict long-term survival after total gastrectomy.The PNI should be included in the routine assessment of advanced gastric cancer patients.展开更多
AIM: To assess the prognostic significance of immunological and nutritional-based indices, including the prognostic nutritional index(PNI), neutrophillymphocyte ratio(NLR), and platelet-lymphocyte ratio in gastric can...AIM: To assess the prognostic significance of immunological and nutritional-based indices, including the prognostic nutritional index(PNI), neutrophillymphocyte ratio(NLR), and platelet-lymphocyte ratio in gastric cancer.METHODS: We retrospectively reviewed 632 gastric cancer patients who underwent gastrectomy between1998 and 2008. Areas under the receiver operating characteristic curve were calculated to compare the predictive ability of the indices, together with estimating the sensitivity, specificity and agreement rate.Univariate and multivariate analyses were performed to identify risk factors for overall survival(OS). Propensity score analysis was performed to adjust variables to control for selection bias.RESULTS: Each index could predict OS in gastric cancer patients in univariate analysis, but only PNI had independent prognostic significance in multivariate analysis before and after adjustment with propensity scoring(hazard ratio, 1.668; 95% confidence interval:1.368-2.035). In subgroup analysis, a low PNI predicted a significantly shorter OS in patients with stage Ⅱ-Ⅲ disease(P = 0.019, P < 0.001), T3-T4 tumors(P <0.001), or lymph node metastasis(P < 0.001). Canton score, a combination of PNI, NLR, and platelet, was a better indicator for OS than PNI, with the largest area under the curve for 12-, 36-, 60-mo OS and overall OS(P = 0.022, P = 0.030, P < 0.001, and P = 0.024,respectively). The maximum sensitivity, specificity, and agreement rate of Canton score for predicting prognosis were 84.6%, 34.9%, and 70.1%, respectively.CONCLUSION: PNI is an independent prognostic factor for OS in gastric cancer. Canton score can be a novel preoperative prognostic index in gastric cancer.展开更多
Background:Inflammation-based indexes have been used to predict survival and recurrence in cancer patients.Systemic immune-inflammation index(Sll) was reported to be associated with prognosis in some malignant tumors....Background:Inflammation-based indexes have been used to predict survival and recurrence in cancer patients.Systemic immune-inflammation index(Sll) was reported to be associated with prognosis in some malignant tumors.In the present study,we aimed to explore the association between Sll and the prognosis of patients with gastric cancer.Methods:We retrospectively analyzed data from 444 gastric cancer patients who underwent gastrectomy at the First Affiliated Hospital of Sun Yat-sen University between January 1994 and December 2005.Preoperative Sll was calculated.The Chi square test or Fisher's exact test was used to determine the relationship between preoperative Sll and clinicopathologic characteristics.Overall survival(OS) rates were estimated using the Kaplan-Meier method,and the effect of Sll on OS was analyzed using the Cox proportional hazards model.Receiver operating characteristic(ROC)curves were used to compare the predictive ability of Sll,NLR,and PLR.Results:Sll equal to or higher than 660 was significantly associated with old age,large tumor size,unfavorable Borrmann classification,advanced tumor invasion,lymph node metastasis,distant metastasis,advanced TNM stage,and high carcino-embryonic antigen level,high neutrophil-lymphocyte ratio,and high platelet-lymphocyte ratio(all P<0.05).High Sll was significantly associated with unfavorable prognosis(P<0.001) and Sll was an independent predictor for OS(P=0.015).Subgroups analysis further showed significant associations between high Sll and short OS in stage Ⅰ,Ⅱ,Ⅲ subgroups(all P<0.05).Sll was superior to NLR and PLR for predicting OS in patients with gastric cancer.Conclusion:Preoperative Sll level is an independent prognostic factor for OS in patients with gastric cancer.展开更多
Objective: The predictive and prognostic role of prognostic nutritional index(PNI) in gastric cancer patients with peritoneal dissemination remains unclear. This study aims to explore the role of the PNI in predict...Objective: The predictive and prognostic role of prognostic nutritional index(PNI) in gastric cancer patients with peritoneal dissemination remains unclear. This study aims to explore the role of the PNI in predicting outcomes of gastric cancer patients with peritoneal dissemination.Methods: A total of 660 patients diagnosed with gastric adenocarcinoma with peritoneal metastasis between January 2000 and April 2014 at Sun Yat-sen University Cancer Center and the Sixth Affiliated Hospital of Sun Yatsen University were retrospectively analyzed. The clinicopathologic characteristics and clinical outcomes of patients with peritoneal dissemination were analyzed.Results: Compared with PNI-high group, PNI-low group was correlated with advanced age(P=0.036), worse performance status(P0.001), higher frequency of ascites(P0.001) and higher frequency of multisite distant metastasis(P0.001). Kaplan-Meier survival curves showed that PNI-high group had a significantly longer median overall survival than PNI-low group(13.13 vs. 9.03 months, P0.001). Multivariate survival analysis revealed that Borrmann type IV(P=0.014), presence of ascites(P=0.017) and lower PNI(P=0.041) were independent poor prognostic factors, and palliative surgery(P0.001) and first-line chemotherapy(P0.001) were good prognostic factors. For patients receiving palliative surgery, the postoperative morbidity rates in the PNI-low group and PNIhigh group were 9.1% and 9.9%, respectively(P=0.797). The postoperative mortality rate was not significantly different between PNI-low and PNI-high groups(2.3% vs. 0.9%, P=0.362).Conclusions: PNI is a useful and practical tool for evaluating the nutritional status of gastric cancer patients with peritoneal dissemination, and is an independent prognostic factor for these patients.展开更多
Objective Tumors with accelerated growth or high malignancy are thought to undergo active angio- genesis. Whereas by far, there is few study concerning the combination of MIB-1 proliferation index (MIB-1 PI) and tumor...Objective Tumors with accelerated growth or high malignancy are thought to undergo active angio- genesis. Whereas by far, there is few study concerning the combination of MIB-1 proliferation index (MIB-1 PI) and tumor angiogenesis in carcinomas to show their significance in relate to clinicopathological parameters. In the present study, we evaluated the significance or MIB-1 PI and angiogenesis in early stage of gastric cancer. Our focus was es- pecially on the combination of MIB-1 PI and angiogenesis in relate to lymph node metastasis. Method Specimens from 95 patients with early gastric cancer were studied by means or immunohistochemistry using monoclonal MIB-1 and factor Ⅷ related antigen antibodies. Results The mean MIB-1 PI and microvessel count were 22.9% and 34.7, respectively. The MIB-1 PI did not correlate with microvessel count. Both correlated with depth of tumor invasion, lymphatic vessel invasion and lymph node metastasis. Multivarlate analysis showed that combined high MIB-1 PI/hy- pervascularity, as well as lymphatic vessel invasion and tumor size were independent factors that impact on lymph node metastasis. Conclusion A combination of the high MIB-1 PI/hypervascularity is a factor that related to lymph node metastasis in early gastric cancer.展开更多
AIM: To investigate the effect of being overweight on the surgical results of patients with gastric cancer. METHODS: Comprehensive electronic searches of the PubMed, Web of Science, and Cochrane Library databases were...AIM: To investigate the effect of being overweight on the surgical results of patients with gastric cancer. METHODS: Comprehensive electronic searches of the PubMed, Web of Science, and Cochrane Library databases were conducted. Studies were identified that included patients with surgical complications from gastric cancer who were classified as normal weight [body mass index (BMI) < 25 kg/m 2 ] or overweight (BMI ≥ 25 kg/m 2 ). The operative time, retrieved lymph nodes, blood loss, and long-term survival were analyzed. A subgroup analysis was conducted based on whether patients received laparoscopic or open gastrectomy procedures. All statistical tests were performed using ReviewerManager 5.1.2 software. RESULTS: This meta-analysis included 23 studies with 20678 patients (15781 with BMI < 25 kg/m 2 ; 4897 with BMI ≥ 25 kg/m 2 ). Overweight patients had significantly increased operation times [MD: -29.14; 95%CI: -38.14-(-20.21); P < 0.00001], blood loss [MD: -194.58; 95%CI: -314.21-(-74.95); P = 0.001], complications (RR: 0.75; 95%CI: 0.66-0.85; P < 0.00001), anastomosis leakages (RR: 0.59; 95%CI: 0.42-0.82; P = 0.002), and pancreatic fistulas (RR: 0.486; 95%CI: 0.34-0.63; P < 0.00001), whereas lymph node retrieval was decreased significantly in the overweight group (MD: 1.69; 95%CI: 0.75-2.62; P < 0.0001). In addition, overweight patients had poorer long-term survival (RR: 1.14; 95%CI: 1.07-1.20; P < 0.0001). No significant difference was detected for the mortality and length of hospital stay. CONCLUSION: This meta-analysis demonstrates that a high BMI not only increases the surgical difficulty and complications but also impairs the long-term survival of patients with gastric cancer.展开更多
BACKGROUND The prognosis of gastric cancer continues to remain poor,and epigenetic drugs like histone deacetylase inhibitors(HDACi)have been envisaged as potential therapeutic agents.Nevertheless,clinical trials are f...BACKGROUND The prognosis of gastric cancer continues to remain poor,and epigenetic drugs like histone deacetylase inhibitors(HDACi)have been envisaged as potential therapeutic agents.Nevertheless,clinical trials are facing issues with toxicity and efficacy against solid tumors,which may be partly due to the lack of patient stratification for effective treatments.To study the need of patient stratification before HDACi treatment,and the efficacy of pre-treatment of HDACi as a chemotherapeutic drug sensitizer.METHODS The expression activity of class 1 HDACs and histone acetylation was examined in human gastric cancer cells and tissues.The potential combinatorial regime of HDACi and chemotherapy drugs was defined on the basis of observed drug binding assays,chromatin remodeling and cell death.RESULTS In the present study,the data suggest that the differential increase in HDAC activity and the expression of class 1 HDACs are associated with hypoacetylation of histone proteins in tumors compared to normal adjacent mucosa tissue samples of gastric cancer.The data highlights for the first time that pretreatment of HDACi results in an increased amount of DNA-bound drugs associated with enhanced histone acetylation,chromatin relaxation and cell cycle arrest.Fraction-affected plots and combination index-based analysis show that pre-HDACi chemo drug combinatorial regimes,including valproic acid with cisplatin or oxaliplatin and trichostatin A with epirubicin,exhibit synergism with maximum cytotoxic potential due to higher cell death at low combined doses in gastric cancer cell lines.CONCLUSION Expression or activity of class 1 HDACs among gastric cancer patients present an effective approach for patient stratification.Furthermore,HDACi therapy in pretreatment regimes is more effective with chemotherapy drugs,and may aid in predicting individual patient prognosis.展开更多
AIM: To examine incidence of tuberculosis(TB) in gastrectomy patients and investigate the risk factors for developing TB after gastrectomy in patients with gastric cancer.METHODS: A retrospective cohort study of gastr...AIM: To examine incidence of tuberculosis(TB) in gastrectomy patients and investigate the risk factors for developing TB after gastrectomy in patients with gastric cancer.METHODS: A retrospective cohort study of gastrectomy patients with gastric cancer was performed at a university-affiliated hospital in Seoul, South Korea between January 2007 and December 2009. We reviewed patient medical records and collected data associated with the risk of TB, surgery, and gastric cancer. Standardized incidence ratios(SIRs) of TB were calculated to compare the incidence of TB in gastrectomy patients with that in the general Korean population, and risk factors for TB after gastrectomies were analyzed.RESULTS: Among the 1776 gastrectomy patients, 0.9%(16/1776) developed post-gastrectomy TB, with an incidence of 223.7 cases per 100000 patients per year. The overall incidence of TB in gastrectomy patients, adjusted by sex and age, was significantly higher thanthat in the general population(SIR = 2.22, 95%CI: 1.27-3.60). Previous TB infection [odds ratio(OR) = 7.1, P < 0.001], lower body mass index(BMI)(kg/m2; OR = 1.21, P = 0.043) and gastrectomy extent(total gastrectomy vs subtotal gastrectomy)(OR = 3.48, P = 0.017) were significant risk factors for TB after gastrectomy in a multivariate analysis.CONCLUSION: TB incidence after gastrectomy is higher than that in the general population. Previous TB infection, lower BMI, and total gastrectomy are risk factors for TB after gastrectomy in patients with gastric cancer.展开更多
Peritoneal carcinomatosis (PC) from gastric cancer has traditionally been considered a terminal progression of the disease and is associated with poor survival out-comes. Positive peritoneal cytology similarly worsens...Peritoneal carcinomatosis (PC) from gastric cancer has traditionally been considered a terminal progression of the disease and is associated with poor survival out-comes. Positive peritoneal cytology similarly worsens the survival of patients with gastric cancer and treatment options for these patients have been limited. Recent ad-vances in multimodality treatment regimens have led to innovative ways to care for and treat patients with this disease burden. One of these advances has been to use neoadjuvant therapy to try and convert patients with positivecytologyorlow-volume PC to negative cytolo-gy with no evidence of active peritoneal disease.These strategies include the use of neoadjuvant systemic chemotherapy alone,using neoadjuvant laparoscopic heated intraper itoneal chemotherapy(NLHIPEC)after systemic chemotherapy,or using neoadjuvant intra-peritoneal and systemic chemother apy(NIPS)in a bi-dir ectional manner. For patients with higher volume PC,cytoreductive surgery (CRS) and hyperthermic intrape-ritoneal chemotherapy(HIPEC)have been mainstays of treatment. When used together, CRS and HIPEC can improve overall outcomes in properly selected patients,but overall survival outcomes remain unacceptably low.The extent of peritoneal disease, commonly measured by the peritoneal carcinomatosis index (PCI), and the com-pleteness of cytor eduction,has been shown to greatly impact outcomes in patients undergoing CRS and HIPEC.The uses of NLHIPEC and NLHIPEC plus NIPS have both been shown to decrease the PCI and thus increase the opportunity for complete cytoreduction. Newer therapies like pressurized intraperitoneal aerosol chemother apy and immunotherapy, such as catumaxomab, along with improved systemic chemotherapeutic regimens, are being explored with great interest.There is exciting progress being made in the management of PC from gastric can-cer and its’ treatment is no longer futile.展开更多
目的:分析基于预后营养指数(PNI)的分级营养支持在胃癌根治术患者中的应用效果。方法:选取2022年3月至2023年10月霞浦县医院收治的行根治性手术的胃癌患者58例作为研究对象,随机分为观察组和对照组,每组29例。对照组围术期接受常规营养...目的:分析基于预后营养指数(PNI)的分级营养支持在胃癌根治术患者中的应用效果。方法:选取2022年3月至2023年10月霞浦县医院收治的行根治性手术的胃癌患者58例作为研究对象,随机分为观察组和对照组,每组29例。对照组围术期接受常规营养支持,观察组接受基于PNI的分级营养支持。比较2组患者术后营养状态、免疫状态、术后康复及睡眠质量。结果:观察组术后7 d PNI高于对照组,血清前白蛋白、转铁蛋白、IgG、IgM显著较高(P<0.05)。观察组术后肛门排气时间、恢复经口进食时间、住院时间短于对照组(P<0.05)。观察组术后阿森斯失眠量表评分低于对照组(P<0.05)。结论:基于PNI的分级营养支持可改善胃癌根治术患者免疫与营养状态,加快术后康复,减少睡眠障碍。展开更多
AIM:To investigate the correlation between the nutritional risk index (NRI) and postoperative wound complications.METHODS:From January 2008 through June 2008,669 patients who underwent curative gastrectomy for gastric...AIM:To investigate the correlation between the nutritional risk index (NRI) and postoperative wound complications.METHODS:From January 2008 through June 2008,669 patients who underwent curative gastrectomy for gastric cancer were included in a retrospective study.Medical records of consecutive patients were collected and analyzed to determine postoperative wound complication rates.The NRI was assessed on the fifth postoperative day and other possible risk factors for the incidence of wound complications were analyzed to identify the factors affecting postoperative wound complications.Patients with other postoperative complications were excluded from the study.RESULTS:On the 5th postoperative day,the NRI showed a malnutrition rate of 84.6% among postoperative patients.However,postoperative wound complications occurred in only 66/669 (9.86%) patients.Of the patients with wound complications,62/66 (94%) belonged to the malnourished group (NRI < 97.5),and 4/66 (6%) patients to the non-malnourished group (NRI ≥ 97.5).The only factor correlated with wound complications was the NRI on the 5th postoperative day (odds ratio of NRI ≥ 97.5 vs NRI < 97.5:0.653;95% confidence interval:0.326-0.974;P=0.014) according to univariate analysis as well as multivariate analysis.CONCLUSION:This study suggests that malnutrition immediately after surgery may play a significant role in the development of wound complications.展开更多
AIM To perform a meta-analysis to investigate the correlation between body mass index(BMI) and the shortterm outcomes of laparoscopic gastrectomy(LG) for gastric cancer(GC) in Asian patients. METHODS The Pub Med, Coch...AIM To perform a meta-analysis to investigate the correlation between body mass index(BMI) and the shortterm outcomes of laparoscopic gastrectomy(LG) for gastric cancer(GC) in Asian patients. METHODS The Pub Med, Cochrane, EMBASE, and Web of Science databases were searched for studies that focused on the impact of obesity on the short-term outcomes of LG for GC in Asian patients who were classified into a high BMI(BMI ≥ 25 kg/m^2) or low BMI group(BMI < 25 kg/m^2). The results are expressed using the pooled odds ratio(OR) for binary variables and standard mean difference(SMD) for continuous variables with 95%confidence interval(CI), and were calculated according to the fixed-effects model while heterogeneity was not apparent or a random-effects model while heterogeneity was apparent.RESULTS Nine studies, with a total sample size of 6077, were included in this meta-analysis. Compared with the low BMI group, the high BMI group had longer operative time(SMD = 0.26, 95%CI: 0.21 to 0.32, P < 0.001), greater blood loss(SMD = 0.19, 95%CI: 0.12 to 0.25, P < 0.001), and fewer retrieved lymph nodes(SMD =-0.13, 95%CI: 0.18 to 0.07, P < 0.001). There was no significant difference between the high and low BMI groups in postoperative complications(OR = 1.12, 95%CI: 0.95 to 1.33, P = 0.169), the duration of postoperative hospital stay(SMD = 0.681, 95%CI:-0.05 to 0.07, P = 0.681), postoperative mortality(OR = 1.95, 95%CI: 0.78 to 4.89, P = 0.153), or time to resuming food intake(SMD = 0.00, 95%CI:-0.06 to 0.06, P = 0.973).CONCLUSION Our meta-analysis provides strong evidence that despite being associated with longer operative time, greater blood loss, and fewer retrieved lymph nodes, BMI has no significant impact on the short-term outcomes of LG for GC in Asian patients, including postoperative complications, the duration of postoperative hospital stay, postoperative mortality, and time to resuming food intake. BMI may be a poor risk factor for shortterm outcomes of LG. Other indices should be taken into account.展开更多
The aim of this study was to determine the expression of growth hormone receptor(GHR) in patients with pri-mary gastric adenocarcinoma.We investigated 48 specimens of primary gastric adenocarcinoma and their cor-res...The aim of this study was to determine the expression of growth hormone receptor(GHR) in patients with pri-mary gastric adenocarcinoma.We investigated 48 specimens of primary gastric adenocarcinoma and their cor-responding normal gastric mucosa.Immunohistochemistry and reverse transcription-polymerase chain reaction(RT-PCR) were used to detect the expression of GHR.Immunohistochemical analyses revealed that GHR was expressed in human primary gastric adenocarcinoma(36/48,75.0%) and appeared to be upregulated,compared to the normal mucosa(28/48,58.3%,P 〈 0.001).A significant correlation was found between GHR expression and tumor stage(P 〈 0.001) and tumor differentiation(P 〈 0.001).The average positive rate of ki-67 in GHR-positive tumors was 16.06%,while the positive rate in GHR-negative tumors was 6.17%(P 〈 0.01).The average apoptosis index(AI) of GHR-positive tumors was 3.36%,which was significantly lower than that(7.33%) of GHR-negative tumors.In addition,27 of 48 cases of tumors had GHR mRNA expression,while only 17 of all 48 cases of normal mucosa did so.Our results indicate that the frequency of GHR was significantly higher in primary gastric adeno-carcinoma than that in normal gastric mucosa.GHR expression was significantly correlated with tumor differen-tiation and tumor grade.This finding supported a possible role of growth hormone in primary gastric adenocarci-noma pathophysiology.展开更多
基金Supported by National Basic Research Program of China(973 Program),No.2010CB529301the Key Program for Anticancer Research of Tianjin Municipal Science and Technology Commission,No.12ZCDZSY16400
文摘AIM:To investigate the impact of prognostic nutritional index(PNI)on the postoperative complications and long-term outcomes in gastric cancer patients undergoing total gastrectomy.METHODS:The data for 386 patients with gastric cancer were extracted and analyzed between January2003 and December 2008 in our center.The patients were divided into two groups according to the cutoff value of the PNI:those with a PNI≥46 and those with a PNI<46.Clinicopathological features were compared between the two groups and potential prognostic factors were analyzed.The relationship between postoperative complications and PNI was analyzed by logistic regression.The univariate and multivariate hazard ratios were calculated using the Cox proportional hazard model.RESULTS:The optimal cutoff value of the PNI was set at 46,and patients with a PNI≥46 and those with a PNI<46 were classified into PNI-high and PNI-low groups,respectively.Patients in the PNI-low group were more likely to have advanced tumor(T),node(N),and TNM stages than patients in the PNI-high group.The low PNI is an independent risk factor for the incidence of postoperative complications(OR=2.223).The 5-year overall survival(OS)rates were 54.1%and21.1%for patients with a PNI≥46 and those with a PNI<46,respectively.The OS rates were significantly lower in the PNI-low group than in the PNI-high group among patients with stagesⅡ(P=0.001)andⅢ(P<0.001)disease.CONCLUSION:The PNI is a simple and useful marker not only to identify patients at increased risk for postoperative complications,but also to predict long-term survival after total gastrectomy.The PNI should be included in the routine assessment of advanced gastric cancer patients.
基金Supported by National Natural Science Foundation of China,Nos.81101865 and 81272637Doctoral Fund of the Ministry of Education of China,No.20110171120064+1 种基金Natural Science Foundation of Guangdong Province,No.S2013020012724Clinical Medicine Research Project 5010 of Sun Yat-sen University,No.2010006
文摘AIM: To assess the prognostic significance of immunological and nutritional-based indices, including the prognostic nutritional index(PNI), neutrophillymphocyte ratio(NLR), and platelet-lymphocyte ratio in gastric cancer.METHODS: We retrospectively reviewed 632 gastric cancer patients who underwent gastrectomy between1998 and 2008. Areas under the receiver operating characteristic curve were calculated to compare the predictive ability of the indices, together with estimating the sensitivity, specificity and agreement rate.Univariate and multivariate analyses were performed to identify risk factors for overall survival(OS). Propensity score analysis was performed to adjust variables to control for selection bias.RESULTS: Each index could predict OS in gastric cancer patients in univariate analysis, but only PNI had independent prognostic significance in multivariate analysis before and after adjustment with propensity scoring(hazard ratio, 1.668; 95% confidence interval:1.368-2.035). In subgroup analysis, a low PNI predicted a significantly shorter OS in patients with stage Ⅱ-Ⅲ disease(P = 0.019, P < 0.001), T3-T4 tumors(P <0.001), or lymph node metastasis(P < 0.001). Canton score, a combination of PNI, NLR, and platelet, was a better indicator for OS than PNI, with the largest area under the curve for 12-, 36-, 60-mo OS and overall OS(P = 0.022, P = 0.030, P < 0.001, and P = 0.024,respectively). The maximum sensitivity, specificity, and agreement rate of Canton score for predicting prognosis were 84.6%, 34.9%, and 70.1%, respectively.CONCLUSION: PNI is an independent prognostic factor for OS in gastric cancer. Canton score can be a novel preoperative prognostic index in gastric cancer.
基金supported by the National Natural Science Foundation of China(Grant No.81372341)the PhD Start-up Fund of the Natural Science Foundation of Guangdong Province,China(Grant No.2014A030310111)the"3&3"project of the First Affiliated Hospital of Sun Yat-sen University
文摘Background:Inflammation-based indexes have been used to predict survival and recurrence in cancer patients.Systemic immune-inflammation index(Sll) was reported to be associated with prognosis in some malignant tumors.In the present study,we aimed to explore the association between Sll and the prognosis of patients with gastric cancer.Methods:We retrospectively analyzed data from 444 gastric cancer patients who underwent gastrectomy at the First Affiliated Hospital of Sun Yat-sen University between January 1994 and December 2005.Preoperative Sll was calculated.The Chi square test or Fisher's exact test was used to determine the relationship between preoperative Sll and clinicopathologic characteristics.Overall survival(OS) rates were estimated using the Kaplan-Meier method,and the effect of Sll on OS was analyzed using the Cox proportional hazards model.Receiver operating characteristic(ROC)curves were used to compare the predictive ability of Sll,NLR,and PLR.Results:Sll equal to or higher than 660 was significantly associated with old age,large tumor size,unfavorable Borrmann classification,advanced tumor invasion,lymph node metastasis,distant metastasis,advanced TNM stage,and high carcino-embryonic antigen level,high neutrophil-lymphocyte ratio,and high platelet-lymphocyte ratio(all P<0.05).High Sll was significantly associated with unfavorable prognosis(P<0.001) and Sll was an independent predictor for OS(P=0.015).Subgroups analysis further showed significant associations between high Sll and short OS in stage Ⅰ,Ⅱ,Ⅲ subgroups(all P<0.05).Sll was superior to NLR and PLR for predicting OS in patients with gastric cancer.Conclusion:Preoperative Sll level is an independent prognostic factor for OS in patients with gastric cancer.
基金supported in part by a grant from National Natural Science Foundation of China(No.81302144)the Guangdong Science and Technology Department(No.2012B061700087)
文摘Objective: The predictive and prognostic role of prognostic nutritional index(PNI) in gastric cancer patients with peritoneal dissemination remains unclear. This study aims to explore the role of the PNI in predicting outcomes of gastric cancer patients with peritoneal dissemination.Methods: A total of 660 patients diagnosed with gastric adenocarcinoma with peritoneal metastasis between January 2000 and April 2014 at Sun Yat-sen University Cancer Center and the Sixth Affiliated Hospital of Sun Yatsen University were retrospectively analyzed. The clinicopathologic characteristics and clinical outcomes of patients with peritoneal dissemination were analyzed.Results: Compared with PNI-high group, PNI-low group was correlated with advanced age(P=0.036), worse performance status(P0.001), higher frequency of ascites(P0.001) and higher frequency of multisite distant metastasis(P0.001). Kaplan-Meier survival curves showed that PNI-high group had a significantly longer median overall survival than PNI-low group(13.13 vs. 9.03 months, P0.001). Multivariate survival analysis revealed that Borrmann type IV(P=0.014), presence of ascites(P=0.017) and lower PNI(P=0.041) were independent poor prognostic factors, and palliative surgery(P0.001) and first-line chemotherapy(P0.001) were good prognostic factors. For patients receiving palliative surgery, the postoperative morbidity rates in the PNI-low group and PNIhigh group were 9.1% and 9.9%, respectively(P=0.797). The postoperative mortality rate was not significantly different between PNI-low and PNI-high groups(2.3% vs. 0.9%, P=0.362).Conclusions: PNI is a useful and practical tool for evaluating the nutritional status of gastric cancer patients with peritoneal dissemination, and is an independent prognostic factor for these patients.
文摘Objective Tumors with accelerated growth or high malignancy are thought to undergo active angio- genesis. Whereas by far, there is few study concerning the combination of MIB-1 proliferation index (MIB-1 PI) and tumor angiogenesis in carcinomas to show their significance in relate to clinicopathological parameters. In the present study, we evaluated the significance or MIB-1 PI and angiogenesis in early stage of gastric cancer. Our focus was es- pecially on the combination of MIB-1 PI and angiogenesis in relate to lymph node metastasis. Method Specimens from 95 patients with early gastric cancer were studied by means or immunohistochemistry using monoclonal MIB-1 and factor Ⅷ related antigen antibodies. Results The mean MIB-1 PI and microvessel count were 22.9% and 34.7, respectively. The MIB-1 PI did not correlate with microvessel count. Both correlated with depth of tumor invasion, lymphatic vessel invasion and lymph node metastasis. Multivarlate analysis showed that combined high MIB-1 PI/hy- pervascularity, as well as lymphatic vessel invasion and tumor size were independent factors that impact on lymph node metastasis. Conclusion A combination of the high MIB-1 PI/hypervascularity is a factor that related to lymph node metastasis in early gastric cancer.
文摘AIM: To investigate the effect of being overweight on the surgical results of patients with gastric cancer. METHODS: Comprehensive electronic searches of the PubMed, Web of Science, and Cochrane Library databases were conducted. Studies were identified that included patients with surgical complications from gastric cancer who were classified as normal weight [body mass index (BMI) < 25 kg/m 2 ] or overweight (BMI ≥ 25 kg/m 2 ). The operative time, retrieved lymph nodes, blood loss, and long-term survival were analyzed. A subgroup analysis was conducted based on whether patients received laparoscopic or open gastrectomy procedures. All statistical tests were performed using ReviewerManager 5.1.2 software. RESULTS: This meta-analysis included 23 studies with 20678 patients (15781 with BMI < 25 kg/m 2 ; 4897 with BMI ≥ 25 kg/m 2 ). Overweight patients had significantly increased operation times [MD: -29.14; 95%CI: -38.14-(-20.21); P < 0.00001], blood loss [MD: -194.58; 95%CI: -314.21-(-74.95); P = 0.001], complications (RR: 0.75; 95%CI: 0.66-0.85; P < 0.00001), anastomosis leakages (RR: 0.59; 95%CI: 0.42-0.82; P = 0.002), and pancreatic fistulas (RR: 0.486; 95%CI: 0.34-0.63; P < 0.00001), whereas lymph node retrieval was decreased significantly in the overweight group (MD: 1.69; 95%CI: 0.75-2.62; P < 0.0001). In addition, overweight patients had poorer long-term survival (RR: 1.14; 95%CI: 1.07-1.20; P < 0.0001). No significant difference was detected for the mortality and length of hospital stay. CONCLUSION: This meta-analysis demonstrates that a high BMI not only increases the surgical difficulty and complications but also impairs the long-term survival of patients with gastric cancer.
基金Supported by TMH-IRG(account number-466/2012 and 164/2016)LTMT grant for project funding+1 种基金ACTREC-TMC for funding to Gupta labsupported by ACTREC fellowships
文摘BACKGROUND The prognosis of gastric cancer continues to remain poor,and epigenetic drugs like histone deacetylase inhibitors(HDACi)have been envisaged as potential therapeutic agents.Nevertheless,clinical trials are facing issues with toxicity and efficacy against solid tumors,which may be partly due to the lack of patient stratification for effective treatments.To study the need of patient stratification before HDACi treatment,and the efficacy of pre-treatment of HDACi as a chemotherapeutic drug sensitizer.METHODS The expression activity of class 1 HDACs and histone acetylation was examined in human gastric cancer cells and tissues.The potential combinatorial regime of HDACi and chemotherapy drugs was defined on the basis of observed drug binding assays,chromatin remodeling and cell death.RESULTS In the present study,the data suggest that the differential increase in HDAC activity and the expression of class 1 HDACs are associated with hypoacetylation of histone proteins in tumors compared to normal adjacent mucosa tissue samples of gastric cancer.The data highlights for the first time that pretreatment of HDACi results in an increased amount of DNA-bound drugs associated with enhanced histone acetylation,chromatin relaxation and cell cycle arrest.Fraction-affected plots and combination index-based analysis show that pre-HDACi chemo drug combinatorial regimes,including valproic acid with cisplatin or oxaliplatin and trichostatin A with epirubicin,exhibit synergism with maximum cytotoxic potential due to higher cell death at low combined doses in gastric cancer cell lines.CONCLUSION Expression or activity of class 1 HDACs among gastric cancer patients present an effective approach for patient stratification.Furthermore,HDACi therapy in pretreatment regimes is more effective with chemotherapy drugs,and may aid in predicting individual patient prognosis.
文摘AIM: To examine incidence of tuberculosis(TB) in gastrectomy patients and investigate the risk factors for developing TB after gastrectomy in patients with gastric cancer.METHODS: A retrospective cohort study of gastrectomy patients with gastric cancer was performed at a university-affiliated hospital in Seoul, South Korea between January 2007 and December 2009. We reviewed patient medical records and collected data associated with the risk of TB, surgery, and gastric cancer. Standardized incidence ratios(SIRs) of TB were calculated to compare the incidence of TB in gastrectomy patients with that in the general Korean population, and risk factors for TB after gastrectomies were analyzed.RESULTS: Among the 1776 gastrectomy patients, 0.9%(16/1776) developed post-gastrectomy TB, with an incidence of 223.7 cases per 100000 patients per year. The overall incidence of TB in gastrectomy patients, adjusted by sex and age, was significantly higher thanthat in the general population(SIR = 2.22, 95%CI: 1.27-3.60). Previous TB infection [odds ratio(OR) = 7.1, P < 0.001], lower body mass index(BMI)(kg/m2; OR = 1.21, P = 0.043) and gastrectomy extent(total gastrectomy vs subtotal gastrectomy)(OR = 3.48, P = 0.017) were significant risk factors for TB after gastrectomy in a multivariate analysis.CONCLUSION: TB incidence after gastrectomy is higher than that in the general population. Previous TB infection, lower BMI, and total gastrectomy are risk factors for TB after gastrectomy in patients with gastric cancer.
文摘Peritoneal carcinomatosis (PC) from gastric cancer has traditionally been considered a terminal progression of the disease and is associated with poor survival out-comes. Positive peritoneal cytology similarly worsens the survival of patients with gastric cancer and treatment options for these patients have been limited. Recent ad-vances in multimodality treatment regimens have led to innovative ways to care for and treat patients with this disease burden. One of these advances has been to use neoadjuvant therapy to try and convert patients with positivecytologyorlow-volume PC to negative cytolo-gy with no evidence of active peritoneal disease.These strategies include the use of neoadjuvant systemic chemotherapy alone,using neoadjuvant laparoscopic heated intraper itoneal chemotherapy(NLHIPEC)after systemic chemotherapy,or using neoadjuvant intra-peritoneal and systemic chemother apy(NIPS)in a bi-dir ectional manner. For patients with higher volume PC,cytoreductive surgery (CRS) and hyperthermic intrape-ritoneal chemotherapy(HIPEC)have been mainstays of treatment. When used together, CRS and HIPEC can improve overall outcomes in properly selected patients,but overall survival outcomes remain unacceptably low.The extent of peritoneal disease, commonly measured by the peritoneal carcinomatosis index (PCI), and the com-pleteness of cytor eduction,has been shown to greatly impact outcomes in patients undergoing CRS and HIPEC.The uses of NLHIPEC and NLHIPEC plus NIPS have both been shown to decrease the PCI and thus increase the opportunity for complete cytoreduction. Newer therapies like pressurized intraperitoneal aerosol chemother apy and immunotherapy, such as catumaxomab, along with improved systemic chemotherapeutic regimens, are being explored with great interest.There is exciting progress being made in the management of PC from gastric can-cer and its’ treatment is no longer futile.
文摘目的:分析基于预后营养指数(PNI)的分级营养支持在胃癌根治术患者中的应用效果。方法:选取2022年3月至2023年10月霞浦县医院收治的行根治性手术的胃癌患者58例作为研究对象,随机分为观察组和对照组,每组29例。对照组围术期接受常规营养支持,观察组接受基于PNI的分级营养支持。比较2组患者术后营养状态、免疫状态、术后康复及睡眠质量。结果:观察组术后7 d PNI高于对照组,血清前白蛋白、转铁蛋白、IgG、IgM显著较高(P<0.05)。观察组术后肛门排气时间、恢复经口进食时间、住院时间短于对照组(P<0.05)。观察组术后阿森斯失眠量表评分低于对照组(P<0.05)。结论:基于PNI的分级营养支持可改善胃癌根治术患者免疫与营养状态,加快术后康复,减少睡眠障碍。
文摘AIM:To investigate the correlation between the nutritional risk index (NRI) and postoperative wound complications.METHODS:From January 2008 through June 2008,669 patients who underwent curative gastrectomy for gastric cancer were included in a retrospective study.Medical records of consecutive patients were collected and analyzed to determine postoperative wound complication rates.The NRI was assessed on the fifth postoperative day and other possible risk factors for the incidence of wound complications were analyzed to identify the factors affecting postoperative wound complications.Patients with other postoperative complications were excluded from the study.RESULTS:On the 5th postoperative day,the NRI showed a malnutrition rate of 84.6% among postoperative patients.However,postoperative wound complications occurred in only 66/669 (9.86%) patients.Of the patients with wound complications,62/66 (94%) belonged to the malnourished group (NRI < 97.5),and 4/66 (6%) patients to the non-malnourished group (NRI ≥ 97.5).The only factor correlated with wound complications was the NRI on the 5th postoperative day (odds ratio of NRI ≥ 97.5 vs NRI < 97.5:0.653;95% confidence interval:0.326-0.974;P=0.014) according to univariate analysis as well as multivariate analysis.CONCLUSION:This study suggests that malnutrition immediately after surgery may play a significant role in the development of wound complications.
基金Supported by the Project of Science and Technology Research Program of Fujian Province,No.2016B044the Fujian Provincial Natural Science Foundation,No.2017J01279+2 种基金the Nursery Garden Scientific Research Fund of Fujian Medical University,No.2015MP024Startup Fund for Scientific Research,Fujian Medical University,the Fujian Provincial Health Department Youth Foundation Project,No.2017-1-51the National Clinical Key Specialty Construction Project(General Surgery)of China
文摘AIM To perform a meta-analysis to investigate the correlation between body mass index(BMI) and the shortterm outcomes of laparoscopic gastrectomy(LG) for gastric cancer(GC) in Asian patients. METHODS The Pub Med, Cochrane, EMBASE, and Web of Science databases were searched for studies that focused on the impact of obesity on the short-term outcomes of LG for GC in Asian patients who were classified into a high BMI(BMI ≥ 25 kg/m^2) or low BMI group(BMI < 25 kg/m^2). The results are expressed using the pooled odds ratio(OR) for binary variables and standard mean difference(SMD) for continuous variables with 95%confidence interval(CI), and were calculated according to the fixed-effects model while heterogeneity was not apparent or a random-effects model while heterogeneity was apparent.RESULTS Nine studies, with a total sample size of 6077, were included in this meta-analysis. Compared with the low BMI group, the high BMI group had longer operative time(SMD = 0.26, 95%CI: 0.21 to 0.32, P < 0.001), greater blood loss(SMD = 0.19, 95%CI: 0.12 to 0.25, P < 0.001), and fewer retrieved lymph nodes(SMD =-0.13, 95%CI: 0.18 to 0.07, P < 0.001). There was no significant difference between the high and low BMI groups in postoperative complications(OR = 1.12, 95%CI: 0.95 to 1.33, P = 0.169), the duration of postoperative hospital stay(SMD = 0.681, 95%CI:-0.05 to 0.07, P = 0.681), postoperative mortality(OR = 1.95, 95%CI: 0.78 to 4.89, P = 0.153), or time to resuming food intake(SMD = 0.00, 95%CI:-0.06 to 0.06, P = 0.973).CONCLUSION Our meta-analysis provides strong evidence that despite being associated with longer operative time, greater blood loss, and fewer retrieved lymph nodes, BMI has no significant impact on the short-term outcomes of LG for GC in Asian patients, including postoperative complications, the duration of postoperative hospital stay, postoperative mortality, and time to resuming food intake. BMI may be a poor risk factor for shortterm outcomes of LG. Other indices should be taken into account.
文摘The aim of this study was to determine the expression of growth hormone receptor(GHR) in patients with pri-mary gastric adenocarcinoma.We investigated 48 specimens of primary gastric adenocarcinoma and their cor-responding normal gastric mucosa.Immunohistochemistry and reverse transcription-polymerase chain reaction(RT-PCR) were used to detect the expression of GHR.Immunohistochemical analyses revealed that GHR was expressed in human primary gastric adenocarcinoma(36/48,75.0%) and appeared to be upregulated,compared to the normal mucosa(28/48,58.3%,P 〈 0.001).A significant correlation was found between GHR expression and tumor stage(P 〈 0.001) and tumor differentiation(P 〈 0.001).The average positive rate of ki-67 in GHR-positive tumors was 16.06%,while the positive rate in GHR-negative tumors was 6.17%(P 〈 0.01).The average apoptosis index(AI) of GHR-positive tumors was 3.36%,which was significantly lower than that(7.33%) of GHR-negative tumors.In addition,27 of 48 cases of tumors had GHR mRNA expression,while only 17 of all 48 cases of normal mucosa did so.Our results indicate that the frequency of GHR was significantly higher in primary gastric adeno-carcinoma than that in normal gastric mucosa.GHR expression was significantly correlated with tumor differen-tiation and tumor grade.This finding supported a possible role of growth hormone in primary gastric adenocarci-noma pathophysiology.