Prognostic nutritional index predicts postoperative complications and long-term outcomes of gastric cancer

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.

Novel immunological and nutritional-based prognostic index for gastric cancer

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.

Prognostic value of systemic immune.inflammation index in patients with gastric cancer

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.

Prognostic nutritional index is an independent prognostic factor for gastric cancer patients with peritoneal dissemination

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.

THE MIB-1 PROLIFERATION INDEX AND MICROVESSEL COUNT IN EARLY GASTRIC CANCER:ASSOCIATION WITH LYMPH NODE METASTASIS

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.

Impact of being overweight on the surgical outcomes of patients with gastric cancer: A meta-analysis

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.

Histone deacetylase inhibitor pre-treatment enhances the efficacy of DNA-interacting chemotherapeutic drugs in gastric cancer

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.

Risk factors for tuberculosis after gastrectomy in gastric cancer

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.

Optimizing outcomes for patients with gastric cancer peritoneal carcinomatosis

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.

基于生物信息学分析干性相关基因TCEAL7作为胃癌预后标志物的研究

目的:在胃癌(gastric cancer,GC)中寻找与基于mRNA表达水平的干性指数(mRNA expression-based stemness in-dex,mRNAsi)相关的基因,并探讨其功能。方法:通过癌症基因组图谱(The Cancer Genome Atlas,TCGA)数据库和GSE66229数据集进行生物信息学分析。通过实时定量聚合酶链反应(qRT-PCR)和免疫组织化学评估组织和细胞系中TCEAL7的表达。采用过表达TCEAL7的GC细胞研究TCEAL7对GC细胞增殖、迁移和侵袭能力以及干性特征的影响。结果:TCEAL7在GC中表达下调。但TCEAL7的高表达与较差的预后相对应。过表达TCEAL7抑制GC细胞的增殖、迁移和侵袭能力,减弱成球能力并减少干细胞样CD44^(high)/CD24^(high)细胞的数量。包含临床特征和TCEAL7表达的列线图对于预测GC患者预后有很好的准确性和区分度。结论:TCEAL7被鉴定为在GC中与mRNAsi相关的预后因子,它降低了肿瘤细胞的恶性程度,并减弱了细胞的干性特征。

老年营养风险指数对新辅助化疗后胃癌患者疗效的预测价值

目的:探讨老年营养风险指数(geriatric nutritional risk index,GNRI)对接受新辅助化疗的老年胃癌患者近远期疗效的临床价值。方法:回顾性分析2014年1月至2019年12月期间在我院接受新辅助化疗后行腹腔镜胃癌根治术的230例老年胃癌患者的临床病理资料,应用受试者工作特征(receiver operating characteristic,ROC)曲线评估新辅助化疗前后GNRI对患者近远期疗效的预测效能,分别应用Logistic回归模型和Cox回归模型分析近远期疗效的影响因素。构建各因素和GNRI的交互项并计算交互项检验P值,分析GNRI在各亚组人群中的远期预后价值。结果:与新辅助前GNRI、新辅助前后GNRI变化值相比,新辅助后GNRI预测术后并发症、3年总体生存和3年无病生存的AUC值均最高,分别为0.692、0.703和0.702;与高GNRI组的患者相比,低GNRI组的患者首次下床时间、首次排气时间、首次进食时间、术后住院天数均明显延长,且并发症发生率明显升高(33.6%vs 20.5%),差异均具有统计学意义(P<0.05)。多因素分析结果显示,低GNRI是术后并发症发生和远期预后不良的独立危险因素(P<0.05)。另外,亚组分析结果显示,GNRI在ypI-II期的患者中具体更加显著的远期生存价值(交互性P<0.05)。结论:新辅助化疗后GNRI是影响老年胃癌患者术后近远期疗效的独立预后因素,GNRI较高的患者术后并发症少、恢复快、且具有更长的生存期。

体素内不相干运动对不同Ki-67指数胃癌的诊断价值

目的探讨体素内不相干运动(intravoxel incoherent motion,IVIM)参数与胃癌Ki-67表达的相关性。方法选取我院经手术病理证实的胃癌(gastric cancer,GC)患者54例,受试者术前均接受3.0T MRI常规及IVIM扫描,分别测量并计算患者的IVIM参数,包括ADC、真扩散系数(pure water diffusion coefficient,D)、灌注分数(perfusion fraction,f)及伪扩散系数(pseudo-diffusion coefficient,D^(*)),同时获取术后胃癌的免疫组化Ki-67的表达值。依据Ki-67指数的表达值将患者分为低表达组(Ki-67指数<50%,25例)与高表达组(Ki-67指数≥50%,29例)。组间参数的差异比较采用ANOVA检验(正态分布)或Kruskal-Wallis H检验(非正态分布);使用Spearman相关性分析针对参数与Ki-67表达进行相关性分析;应用ROC曲线分析参数的诊断效率。结果除D*外,低表达组ADC、D、f值均高于高表达组(P<0.05);ADC、D及f与Ki-67的表达呈负相关,D与Ki-67相关性最高。ADC、D、f的AUC值分别为0.919、0.923、0.884;阈值分别为12.00、10.60、2.93;敏感性分别为91.67%、95.83%、87.50%;特异性分别为83.33%、87.50%、81.82%。结论除D^(*)值外,ADC、D和f值与胃癌的Ki-67表达水平呈负相关。因此,IVIM判断胃癌增殖性的效果优于DWI,并为判断预后提供更加完善的信息。

丙泊酚硬膜外麻醉和复合全身麻醉在胃癌根治术患者中应用效果的比较

目的比较丙泊酚硬膜外麻醉和复合全身麻醉在胃癌根治术患者中的应用效果。方法依据麻醉方式的不同将132例胃癌根治术患者分为对照组(n=65,丙泊酚硬膜外麻醉)和观察组(n=67,丙泊酚复合全身麻醉),比较两组患者的手术指标[心率(HR)、平均动脉压(MAP)、脑氧代谢率(CMRO_(2))、脑血流量(CBF)、颅内压(ICP)]、围手术期麻醉指标、认知障碍[简易智力状态检查量表(MMSE)]和躁动情况[躁动行为量表(ABS)]及不良反应发生情况。结果麻醉后30min,观察组患者HR明显低于对照组,MAP、CMRO_(2)、CBF、ICP均明显高于对照组,差异均有统计学意义(P<0.01)。观察组患者的麻醉起效时间、完全阻滞时间、自主呼吸恢复时间和定向力恢复时间均明显短于对照组,差异均有统计学意义(P<0.01)。术后1、3、24h观察组患者MMSE评分均明显高于对照组,ABS评分均明显低于对照组,差异均有统计学意义(P<0.01)。观察组患者的不良反应总发生率为13.43%,低于对照组患者的29.23%,差异有统计学意义(P<0.05)。结论与丙泊酚硬膜外麻醉相比,丙泊酚复合全身麻醉应用于胃癌根治术患者中具有更好的麻醉效果和安全性,对患者中枢神经功能的影响较小,能减少患者术后认知障碍和躁动情况,促进患者术后快速恢复。

基于预后营养指数的分级营养支持对胃癌根治性手术患者营养状态、睡眠的影响

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。

预后营养指数在胃癌根治术后患者预后评估中的价值

目的探索预后营养指数(PNI)的动态变化在胃癌根治术后患者预后评估中的价值。方法收集2015年1月至2017年6月徐州医科大学附属医院收治的经病理检查明确诊断且行胃癌根治术的178例胃癌患者的临床资料。采用ROC曲线确定术前PNI(PNI1)和术后PNI(PNI2)的最佳截断值,并依次分组。采用Kaplan-Meier生存曲线分析不同分组间的无病生存率及总生存率。采用Cox回归分析影响患者预后的因素。结果PNI1最佳截断值48.95,PNI2最佳截断值46.85。根据最佳截断值分A组(PNI1>48.95且PNI2>46.85)、B组[B1组(PNI1≤48.95且PNI2>46.85)和B2组(PNI1>48.95且PNI2≤46.85)]和C组(PNI1≤48.95且PNI2≤46.85)。3组5年无病生存率分别为82.2%、39.6%、7.2%,5年总生存率分别为88.9%、60.2%、32.0%。Cox多因素分析显示,PNI是评估胃癌根治术后患者预后的独立影响因素。结论联合术前和术后PNI构建PNI评分系统预测胃癌根治术后患者预后具有更高的效能,可为临床治疗胃癌和改善患者预后提供参考。

超声双重造影参数、预后营养指数对胃癌伴腹膜转移患者预后的预测价值分析

目的探讨超声双重造影(DCEUS)参数、预后营养指数(PNI)对胃癌伴腹膜转移患者预后的预测价值。方法选取2021年1月至2022年1月新疆克孜勒苏柯尔克孜自治州人民医院收治的90例胃癌伴腹膜转移患者作为观察组,另选取同期新疆克孜勒苏柯尔克孜自治州人民医院收治的90例未伴腹膜转移的胃癌患者作为对照组,比较分析两组DCEUS参数,包括基础强度(BI)、峰值强度(PI)、开始增强时间(RT)、到达峰值时间(TTP)、增强强度(EI)及PNI。同时分析胃癌伴腹膜转移患者的生存状况,DCEUS参数、PNI与胃癌伴腹膜转移患者临床病理因素的关系及对这类患者预后的预测价值。结果观察组DCEUS参数BI、PI、EI高于对照组,RT、TTP及PNI低于对照组,差异均有统计学意义(P<0.05)。胃癌伴腹膜转移患者DCEUS参数BI、PI、EI、RT、TTP与肿瘤T分期、腹膜转移分级、有无腹水、血清癌胚抗原、糖类抗原19-9水平及姑息性胃切除联合术后化疗评分有关(P<0.05),PNI与腹膜转移分级、血红蛋白、血小板与淋巴细胞比值、中性粒细胞与淋巴细胞比值、白蛋白及姑息性胃切除联合术后化疗评分有关(P<0.05)。观察组90例患者中位生存时间为11.7个月,1年生存率仅47.78%;Kaplan-Meier曲线分析显示,BI、PI、EI高水平患者1年生存率低于低水平患者,RT、TTP及PNI高水平患者1年生存率高于低水平患者,差异均有统计学意义(P<0.05)。多因素Cox回归分析结果显示,肿瘤T分期、腹膜转移分级、姑息性胃切除联合术后化疗评分、BI、PI、EI为胃癌伴腹膜转移患者预后的独立危险因素(P<0.05),白蛋白、RT、TTP及PNI为独立保护因素(P<0.05)。受试者操作特征曲线分析显示,BI、PI、EI、RT、TTP及PNI联合预测胃癌伴腹膜转移患者预后的曲线下面积为0.909,明显大于各指标单独预测(P<0.05)。结论DCEUS参数BI、PI、EI、RT、TTP及PNI与胃癌伴腹膜转移病情进展有一定关系,联合预测胃癌伴腹膜转移患者预后的价值较为可靠,具有重要的临床意义。

Nutritional risk index as a predictor of postoperative wound complications after gastrectomy

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.

标准化模式联合3H干预对胃癌手术患者睡眠质量、心理状态及应激反应指标的影响

目的 探讨标准化模式联合3H干预对胃癌手术患者睡眠质量、心理状态及应激反应指标的影响。方法 根据干预方式的不同将80例胃癌手术患者分为常规组(n=39,常规干预)和3H组(n=41,标准化模式联合3H干预)。比较两组患者的术后恢复指标、睡眠质量[匹兹堡睡眠质量指数(PSQI)]、心理状态[抑郁自评量表(SDS)和焦虑自评量表(SAS)]、应激反应指标[白细胞介素-6(IL-6)、C反应蛋白(CRP)]及并发症发生情况。结果 3H组患者首次排气时间、首次进食时间、首次下床活动时间、术后住院时间均明显短于常规组,差异均有统计学意义(P﹤0.01)。干预后,两组患者PSQI、SDS、SAS评分均低于本组干预前,3H组患者PSQI、SDS、SAS评分均低于常规组,差异均有统计学意义(P﹤0.05)。干预后,两组患者IL-6、CRP水平均高于本组干预前,3H组患者IL-6、CRP水平均低于常规组,差异均有统计学意义(P﹤0.05)。3H组患者的并发症总发生率明显低于常规组(P﹤0.01)。结论 标准化模式联合3H干预可改善胃癌手术患者的睡眠质量及心理状态,降低应激反应指标,缩短住院时间,有利于患者术后康复。

Impact of body mass index on short-term outcomes of laparoscopic gastrectomy in Asian patients: A meta-analysis

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.

Growth hormone receptor expression in human primary gastric adenocarcinoma

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.