Prognostic value of a predictive model comprising preoperative inflammatory response and nutritional indexes in patients with gastric cancer / 中华胃肠外科杂志

Objective: To investigate the prognostic value of preoperative inflammatory and nutritional condition detection in the postoperative survival, and establish a prognostic model for predicting the survival of patients with gastric cancer. Methods: The clinicopathological data of 1123 patients with gastric cancer who had undergone radical gastrectomy in Tianjin Medical University Cancer Institute & Hospital from January 2005 to December 2014 were retrospectively analyzed. Patients with history of other malignancy, with history of gastrectomy, who had received preoperative treatment, who died during the initial hospital stay or first postoperative month, and missing clinical and pathological information were excluded. Cox univariate and multivariate analyses were used to identify independent clinicopathological factors associated with the survival of these gastric cancer patients. Cox univariate analysis was used to identify preoperative inflammatory and nutritional indexes related to the survival of patients with gastric cancer after radical gastrectomy. Moreover, the Cox proportional regression model for multivariate survival analysis (forward stepwise regression method based on maximum likelihood estimation) was used. The independent clinicopathological factors that affect survival were incorporated into the following three new prognostic models: (1) an inflammatory model: significant preoperative inflammatory indexes identified through clinical and univariate analysis; (2) a nutritional model: significant preoperative nutritional indexes identified through clinical and univariate analysis; and (3) combined inflammatory/nutritional model: significant preoperative inflammatory and nutritional indexes identified through clinical and univariate analysis. A model that comprised only pT and pN stages in tumor TNM staging was used as a control model. The integrated area under the receiver operating characteristic curve (iAUC) and C-index were used to evaluate the discrimination of the model. Model fitting was evaluated by Akaike information criterion analysis. Calibration curves were used to assess agreement between the predicted probabilities and actual probabilities at 3-year or 5-year overall survival (OS). Results: The study cohort comprised 1 123 patients with gastric cancer. The mean age was 58.9±11.6 years, and 783 were males. According to univariate analysis, age, surgical procedure, extent of lymph node dissection, tumor location, maximum tumor size, number of examined lymph nodes, pT stage, pN stage, and nerve invasion were associated with 5-year OS after radical gastrectomy for gastric cancer (all P<0.050). Multivariate analysis further identified age (HR: 1.18, 95%CI: 1.03-1.36, P=0.019), maximum tumor size (HR: 1.19, 95%CI: 1.03-1.38, P=0.022), number of examined lymph nodes (HR: 0.79, 95%CI: 0.68-0.92, P=0.003), pT stage (HR: 1.40, 95%CI: 1.26-1.55, P<0.001) and pN stage (HR: 1.28, 95%CI: 1.21-1.35, P<0.001) as independent prognostic factors for OS of gastric cancer patients. Additionally, according to univariate survival analysis, the preoperative inflammatory markers of neutrophil count, percentage of neutrophils, neutrophil/lymphocyte ratio, platelet/neutrophil ratio and preoperative nutritional indicators of serum albumin and body mass index were potential prognostic factors for gastric cancer (all P<0.05). On the basis of the above results, three models for prediction of prognosis were constructed. Variables included in the three models are as follows. (1) Inflammatory model: age, maximum tumor size, number of examined lymph nodes, pT stage, pN stage, percentage of neutrophils, and neutrophil-lymphocyte ratio; (2) nutritional model: age, maximum tumor size, number of examined lymph nodes, pT stage, pN stage, and serum albumin; and (3) combined inflammatory/nutritional model: age, maximum tumor size, number of examined lymph nodes, pT stage, pN stage, percentage of neutrophils, neutrophil-lymphocyte ratio, and serum albumin. We found that the predictive accuracy of the combined inflammatory/nutritional model, which incorporates both inflammatory indicators and nutrition indicators (iAUC: 0.676, 95% CI: 0.650-0.719, C-index: 0.698),was superior to that of the inflammation model (iAUC: 0.662, 95% CI: 0.673-0.706;C-index: 0.675), nutritional model (iAUC: 0.666, 95% CI: 0.642-0.698, C-index: 0.672), and TNM staging control model (iAUC: 0.676, 95% CI: 0.650-0.719, C-index: 0.658). Furthermore, the combined inflammatory/nutritional model had better fitting performance (AIC: 10 762) than the inflammatory model (AIC: 10 834), nutritional model (AIC: 10 810), and TNM staging control model (AIC: 10 974). Conclusions: Preoperative percentage of neutrophils, NLR, and BMI have predictive value for the prognosis of gastric cancer patients. The inflammatory / nutritional model can be used to predict the survival and prognosis of gastric cancer patients on an individualized basis.

Interim report of prospective clinical study of two different digestive tract reconstruction after total gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare post-operative long-term complications and quality of life of two digestive reconstruction procedures after total gastrectomy.</p><p><b>METHODS</b>A total of 109 gastric cancer patients in Tianjin Medical University Cancer Hospital from March 2012 to February 2013 were prospectively enrolled and randomly divided into functional jejunal interposition (FJI) group (52 cases) and Roux-en-Y (R-Y) group (57 cases). The post-operative complications, nutritional status, and the quality of life were compared between two groups.</p><p><b>RESULTS</b>One, 3 and 6 months after operation, the incidence of R-S syndrome in FJI group was lower as compared to R-Y group[13% (6/45) vs. 37% (18/49), 3% (1/30) vs. 42% (14/33), 5% (1/21) vs. 48% (11/23), all P<0.01], while 3 months after operation, the incidence of reflux and heartburn in FJI group was higher[53% (16/30) vs. 21% (7/33), P<0.01; 37% (11/30) vs. 12% (4/33), P<0.05]. There were no significant differences in quality of life questionnaire QLQ-C30 between R-Y and FJI groups. QLQ-STO22 stomach module revealed in FJI group, the eating score was better, but reflux score was worse as compared to R-Y group 3 months after operation (all P<0.01).</p><p><b>CONCLUSIONS</b>Functional jejunal interposition keeps intestinal continuity preserving and food duodenal passing, which is a reasonable digestive reconstruction procedure.</p>

Risk factors of early recurrence in patients with gastric cancer after curative resection / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical and pathologic influencing factors of early recurrence in patents with gastric cancer after radical gastrectomy.</p><p><b>METHODS</b>Clinicopathological data of 141 patients with recurrence after curative gastrectomy for gastric cancer from January 2001 to December 2004 were analyzed retrospectively. Risk factors correlated with tumor early recurrence and survival difference between early recurrence group (< 1 year, 82 cases) and control group (1 year after, 59 cases) were assessed.</p><p><b>RESULTS</b>The 1- and 3-year survival rates of in early recurrence group and control group were 36.6%, 2.4% and 100%, 45.8%, respectively (P < 0.05). The median survival time after recurrence in the two groups was 3, 5 months, respectively (P < 0.05). Univariate analysis showed that the age, tumor Borrmann type, tumor site, invasive depth, lymph node metastasis, pTNM stage, metastatic lymph node ratio, surgical procedure and intraperitoneal hyperthermic perfusion chemotherapy (IHPC) were significant factors associated with early recurrence after curative gastrectomy for gastric cancer (P < 0.05). Lymph node metastasis, metastatic lymph node ratio and IHPC were independent factors associate with early recurrence after curative gastrectomy on multivariate analysis (P < 0.05).</p><p><b>CONCLUSIONS</b>The patients with early recurrence after the radical gastrectomy have a poorer survival compared with cases recur later. Lymph node metastasis, metastatic lymph node ratio and IHPC are independent factors associate with early recurrence after curative gastrectomy for gastric cancer.</p>

Comparative study on four different reconstruction procedures after total gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the optimal reconstruction technique after total gastrectomy.</p><p><b>METHODS</b>A total of 159 patients with gastric cancer undergoing total gastrectomy in Tianjin Cancer Hospital between January 2005 and December 2007 were divided into 4 groups according to the reconstruction technique: group A(functional jejunal interposition with a pouch, n=46), group B(modified Braun type II(, n=38), group C (P pouch with Roux-en-Y esophagojejunostomy, n=25), group D(Roux-en-Y esophagojejunostomy, n=50). Quality of life(QOL), nutritional status 1 year after surgery, and perioperative complications were analyzed.</p><p><b>RESULTS</b>There were no significant differences in perioperative complications(P>0.05). One year after operation, QOL(Visick index) was better in group A than that in group B, C and D(P<0.05), and group D was inferior to group A, B and C(P<0.05). The increase in food intake, weight gain, hemoglobin and total protein were better in group A than those in group B, C and D(P<0.05) and group D was inferior to group A, B and C(P<0.05). The prognostic nutrition index ratio of the four groups were 1.21±0.15, 1.14±0.97, 1.15±0.16, and 1.10±0.16, respectively. Group A was better than that in group B, C and D (P<0.05) and group D was inferior to group A, B and C(P<0.05). The incidences of dumping syndrome, reflux esophagitis, Roux-en-Y stasis syndrome in group A were 4.3%(2/46), 2.2%(1/46) and 2.2%(1/46), respectively, which were significantly lower than those in other groups (P<0.05).</p><p><b>CONCLUSIONS</b>Functional jejunal interposition with a pouch is associated with improved nutritional condition and quality of life, and less perioperative complications. It is a reasonable reconstruction method after total gastrectomy.</p>

Comparison of the prognostic value of UICC and JGCA lymph node staging criteria for gastric cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To compare the correlation of prognosis with UICC or JGCA lymph node staging criteria for gastric cancer and evaluate the value of application of those two TNM staging systems in prognosis prediction.</p><p><b>METHODS</b>From January 1996 to December 2005, 395 gastric cancer patients who underwent D2 or D2 plus radical gastrectomy with > or = 15 lymph nodes removed were enrolled into this study. The data were analyzed by both UICC and JGCA lymph node staging criteria, respectively. Kaplan-Meier method was applied to analyze the survival rates, and Log-rank test was performed to assess the statistical significance among groups.</p><p><b>RESULTS</b>Compared with the survival curve based on JGCA lymph node staging criteria, UICC lymph node staging system showed a much more significant difference among N subgroups, and similar result was also found in the patients with T3 disease. The N subgroups stratified by UICC criteria were re-staged with JGCA, while the N subgroups by JGCA criteria with UICC. Though the difference among subgroups were not statistically significant in either group, it was greater based on UICC criteria than that based on JGCA. No significant difference was found in the 5-year survival rates of stage I , II, III and IV based on either UICC or JGCA TNM staging criteria.</p><p><b>CONCLUSION</b>Our results show that UICC staging system is more predictive and relevant to prognosis than JGCA staging system for gastric cancer, and D2 or D2 plus radical gastrectomy with at least or more than 15 lymph nodes removed is required when UICC-TNM gastric cancer staging criteria is applied.</p>

Expression change of apoptosis-associated genes after hyperthermia, chemotherapy and radiotherapy in human colon cancer-transplanted nude mice / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the expression change of apoptosis-associated genes in human colon cancer cells transplanted into nude mice after hyperthermia, chemotherapy and radiotherapy.</p><p><b>METHODS</b>Human colon cancer cell line HT29 was transplanted into the hind limbs of nude mice. Under the laboratory-simulated condition of hyperthermia(43 degree centigrade, 60 min), actual radiation doses and MMC doses were calculated in reference to the clinical practice. The mice were divided into 6 groups according to the treatment approaches: hyperthermia (group A), chemotherapy (group B), radiotherapy (group D), thermochemotherapy (group C), thermoradiotherapy (group E) and thermochemoradiotherapy (group F). The mice were sacrificed at different time points and the tumor tissues were taken for further procedures. The morphologic changes of P53, Bcl-2 and Bax expression in membrane, cytoplasm and nucleus of tumor cell after treatment were observed by immunohistochemistry stain (SP method).</p><p><b>RESULTS</b>All of the six approaches of treatment could down-regulate the expression of P53 and Bcl-2, and up-regulate the expression of Bax in different levels. There was no significant difference in the amount of reduction of P53 expression among group A, C and E. The extent of reduction in the above mentioned groups was significantly different as compared to group B and D. By comparing to group D, the extent of reduction of P53 expression was greater in group B. Down-regulation of Bcl-2 could be enhanced when hyperthermia was combined with chemotherapy (group C) or radiation (group E), but more obvious down-regulation was found in group E as compared to group C. Hyperthermia itself could not obviously up-regulate Bax expression, and it occurred at last. Bax expression increased more by chemotherapy treatment (group B) than that by radiation (group D). By comparing to group C, the greater increase occurred in group E.</p><p><b>CONCLUSIONS</b>Hyperthermia enhances the effects of radiosensitivity and chemosensitivity on tumors by changing the expression of apoptosis-associated genes P53, Bcl-2 and Bax. Hyperthermia combined with chemotherapy and/or radiation has a greater effect on down-regulation of P53 and Bcl-2 expression and up-regulation of Bax expression than any single therapy.</p>

Analysis of the risk factors of upper urinary tract dilatation due to spinal cord injury / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the urodynamic risk factors of upper urinary tract dilatation (UUTD) secondary to spinal cord injury (SCI).</p><p><b>METHODS</b>Ninety-six SCI patients of Tangshan earthquake were divided into 2 groups by ultrasonography: 16 SCI patients (group A) with UUTD and 80 SCI patients (group B) without UUTD received urodynamic test. Responses were evaluated using single and multiple analysis after examination.</p><p><b>RESULTS</b>The incidence of male was significantly higher than that of female. Residual urine volume, maximum cystometric capacity, detrusor leak point pressure and the incidence of bladder low compliance in group A were significantly higher than those in group B. There were no significant differences in age, the incidence of detrusor hyperreflexia, relative safe bladder capacity, the incidence of detrusor-sphincter dyssynergia, maximum flow rate and maximum urethral closure pressure between 2 groups. Bladder low compliance was cardinal risk factors according to Logistic regression analysis.</p><p><b>CONCLUSION</b>An early urodynamic examination and treatment for SCI patients are important to prevent from bladder low compliance and upper urinary tract damage.</p>

Management of nonfunctioning islet cell tumors of the pancreas / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the clinical and pathological features in order to investigate appropriate way of diagnosis and treatment for non-functional islet cell tumors of the pancreas (NFICT).</p><p><b>METHODS</b>The data and experience of surgically treated 43 patients with pathologically confirmed NFICT over the last 30 years were retrospectively reviewed. The survival rate was estimated using Kaplan-Meier method and the potential risk factors affecting survival were compared with Log rank test.</p><p><b>RESULTS</b>There were 7 males and 36 females in this series with a mean age of 31.6 years ranged from 8 to 67 years. Twenty-eight patients were diagnosed as having non-functional islet cell carcinomas of the pancreas (NFICC) and 15 patients benign islet cell tumors. The most common symptoms in NFICT were abdominal pain 55.8%, nausea and/or vomiting (32.6%), fatigue (25.6%) and abdominal mass (23.3%). Preoperatively, all of those were found to have a mass in their pancrease by ultrasonic and computed tomography examination, with 21 in the head, 10 in the body and 6 in the tail of the pancreas. Multicemtric tumor were found in one patient. Thirty-nine of these 43 patients (90.7%) underwent surgical resection, with a curative resection in 30 (69.8%) and palliative in 9 (20.9%). The resectability and curative resection rate in 28 patients with nonfunctioning islet cell carcinomas of the pancreas was 78.6% and 60.7%, respectively. None of the 15 patients with benign nonfunctioning islet cell tumor of the pancreas died of this disease. While the overall cumulative 5- and 10-year survival rate in 28 patients with non-functional islet cell carcinomas of the pancreas was only 58.1% and 29.0%, respectively. Curative resection, female, younger than 30 years old and mass diameter < 10 cm were found to be positive prognostic factors. But multivariate Cox regression analysis indicated that radical resection was the only independent prognostic factor (P = 0.007).</p><p><b>CONCLUSION</b>Nonfunctioning islet cell tumor of the pancreas is frequently found in young female. Surgical resection, especially curative resection can achieve satisfactory long-term survival.</p>

Study on the anticancer activities of the Clematis manshrica saponins in vivo / 中国中药杂志

<p><b>OBJECTIVE</b>To study the anticancer activity of the Clematis manshrica saponins in vivo.</p><p><b>METHOD</b>Anticancer activities were tested in mice with experimental tumor (S180, HepA and P388) in vivo.</p><p><b>RESULT</b>The Clematis manshrica saponins showed a significant anticancer activities on Sarcoma-180, HepA and P388 implanted in mice. In S180 sarcoma, the average tumor inhibition rates were 42.78%, 52.06% and 58.25% (P < 0.05-0.01) respectively; The mean inhibition rates were 37.44%, 52.05% and 59.36% (P < 0.05-0.001) in Hep A tumor separately; while in P388 tumor, the mean inhibition rates were 34.50%, 46.78% and 54.39% (P < 0.05-0.01), respectively.</p><p><b>CONCLUSION</b>The results indicate that Clematis manshrica has obvious antitumor effects against various transplanted tumor in mice.</p>

Malignant fibrous histiocytoma of the retroperitoneum: an analysis of 31 cases / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the diagnosis and treatment of malignant fibrous histiocytoma of the retroperitoneum (MFHR).</p><p><b>METHODS</b>The clinicopathological features, treatment and prognosis of 31 patients with MFHR were retrospectively analyzed.</p><p><b>RESULTS</b>The mean age of the patients was 52.7 +/- 14.1 years. Male:Female = 22:9. The primary symptoms were abdominal mass and pain. The average diameter of tumor was 15 cm. The histopathologic types of the tumor were inflammatory, storiform-pleomorphic, myxoid and giant cell in 16, 10, 4 and 1 cases. The overall survival rate of 1-, 3- and 5-year was 61.3% +/- 9.8%, 31.6% +/- 11.3% and 21.1% +/- 11.4% with a median survival time of 17.0 +/- 6.3 months. Complete resection of the tumor was the major prognostic factor. Postoperative radiotherapy of 20 - 45 Gy was able to prolong the median survival from 12.1 +/- 11.6 months of surgery alone to 26.4 +/- 22.0 months of surgery plus postoperative radiotherapy though without statistical significance (P = 0.051). Postoperative CHOP chemotherapy was not shown to be beneficial.</p><p><b>CONCLUSION</b>Chemotherapy remains the important method of cure. The survival in patients with MFHR might be improved by complete resection combined with chemotherapy or/and radiotherapy.</p>