ABSTRACT
The combination of standardized D2 lymph node dissection and lymph node sorting after surgery can improve the survival of patients with gastric cancer and increase the accuracy of staging. With the development of different lymphatic tracers, individualized lymphatic navigation has become a new technical breakthrough in minimally invasive surgery for gastric cancer. Lymph node tracing is an important method to improve the quality of intraoperative lymph node dissection and correct the postoperative pathological stage. This article reviews the application status and progress of lymphatic navigation technology.
ABSTRACT
Objective:To investigate the influence of different injection time of carbon nanoparticle tracer on the acquisition of lymph nodes in adenocarcinoma of esophagogastric junc-tion (AEG) treated by neoadjuvant chemoradiotherapy (nCRT) combined with surgical resection.Methods:The prospective randomized controlled study was conducted. The clinicopathological data of 120 AEG patients who were treated by nCRT combined with surgical resection in the Fourth Hospital of Hebei Medical University from March 2020 to March 2021 were selected. Based on random number table, patients were allocated into two groups. Patients undergoing endoscopic injection of carbon nanoparticle tracer 24 hours before nCRT were allocated into the experiment group, and patients undergoing endoscopic injection of carbon nanoparticle tracer 24 hours before surgical resection were allocated into the control group. All patients received the same plan of nCRT combined with D 2 radical gastrectomy. Observation indicators: (1) grouping situations of the enrolled patients; (2) surgical and postoperative pathological situations; (3) postoperative complications and treatment. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the independent sample t test. Measurement date with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test. Comparison of ordinal data was analyzed using the non-parameter rank sum test. Results:(1) Grouping situations of the enrolled patients. A total of 120 patients were selected for eligibility. There were 85 males and 35 females, aged (60±9)years. There were 60 patients in the experiment group and 60 patients in the control group, respectively. (2) Surgical and postoperative pathological situations. Patients in the two groups underwent D 2 radical gastrectomy successfully, with R 0 resection. The number of lymph nodes harvest, the number of lymph nodes stained, the number of metastatic lymph nodes stained, the number of micro lymph nodes, the number of inferior mediastinal lymph nodes, the number of inferior mediastinal lymph nodes stained, cases in postoperative pathological stage N0, stage N1, stage N2, stage N3a were 40.6±13.9,20.1±7.7, 1.0(0,3.0), 8.1±2.8, 3.7±1.3, 2.0(1.0,2.0), 18, 13, 23, 6 in patients of the experiment group, respectively. The above indicators were 30.4±8.3, 12.7±3.5, 0(0,1.0), 6.2±2.0, 2.4±1.2, 1.0(0,1.0), 23, 21, 15, 1 in patients of the control group, respectively. There were significant differences in the above indicators between the two groups ( t=-5.01, 6.85, Z=-3.78, t=-4.04, -5.57, Z=-5.48, -2.12, P<0.05). (3) Postoperative complications and treatment. There were 5 cases of the experiment group and 7 cases of the control group with postoperative complications, showing no significant difference between the two groups ( χ2=0.37, P>0.05). The patients with postoperative complications were improved after symptomatic treatment. Conclusion:Compared with injection of carbon nanoparticle tracer 24 hours before surgical resection, injection of carbon nanoparticle tracer 24 hours before nCRT can improve the acquisition of lymph nodes in AEG treated by nCRT combined with surgical resection.
ABSTRACT
Objective:To evaluate the use of serosa muscular layers circumferential incision combined with mucosal layer cutting and closure by laparoscopic or robotic surgery for gastrointestinal mesenchymal tumors at difficult sites of the stomach.Methods:From Jul 2019 to Apr 2021, 18 gastric mesenchymal tumor patients undergoing serosa muscular layers circumferential incision combined with mucosal layer cutting and closure by laparoscopic or robotic surgery at the Department of Surgery, the Fourth Hospital of Hebei Medical University were retrospectively analyzed.Results:All 18 patients had successful surgery, including 7 cases of robotic surgery, 11 cases of laparoscopic surgery, and there was no conversion to open surgery. Tumors were at the gastric in cardia, 8 cases at the gastric body and lesser curvature in 4 cases, and at the gastric antrum in 6 cases, respectively. Eleven cases were of endogenous and 7 cases were of dumbbell type. The average operation time was (99±29) min, the intraoperative blood loss was (10±5) ml, the first time taking food per mouth was (2.0±1.0) d, and the postoperative hospital stay was (4.9 ± 1.2) d. Pathology showed gastrointestinal stromal tumor in 11 cases, leiomyoma in 5 cases and schwannoma in 2 cases. All were with negative margins. The average tumor diameter was (4.7±1.4) cm. The median follow-up time was 16.5 months, and there was no sign of tumor recurrence or metastasis.Conclusion:The serosa muscular layers circumferential incision combined with mucosal layer cutting and closure technique in laparoscopic or robotic surgery is a safe and feasible procedure for treating gastrointestinal mesenchymal tumor at difficult sites of the stomach.
ABSTRACT
Objective To investigate the clinicopathological characteristics and prognosis of patients with Borrmann type Ⅳ gastric cancer. Methods A cohort retrospective analysis of 2386 patients with gastric cancer who underwent radical surgery was used to screen out Borrmann type Ⅳ patients, and analyze their clinical features and prognostic factors. Results Among 2386 patients with gastric cancer, 363 cases (15.21%) were Borrmann type Ⅳ. Compared with non-Borrmann type Ⅳ gastric cancer patients, Borrmann type Ⅳ patients had higher rates of simultaneous liver metastasis, metachronous liver metastasis, lymph node metastasis and vascular infiltration. Moreover, the age of onset tended to be younger and the pathological type tended to be poorly differentiated-undifferentiated (all P < 0.05). The 5-year OS of the entire group was 49.32% and the 5-year DFS was 44.61%. There were significant differences in 5-year OS and DFS between Borrmann type Ⅳ and non-Borrmann type Ⅳpatients (all P < 0.001). The subgroup analyses showed that there were statistically significant differences in 5-year OS and DFS of gastric cancer patients between Borrmann type Ⅳ and non-Borrmann type Ⅳ in pT2-pT4a and pN0-pN3a stages (all P < 0.005). Multivariate analysis showed that the poorly differentiated-undifferentiated tumor, the T4a-pT4b stage of tumor invasion depth, lymph node metastasis, the ⅢA-ⅢC pTNM stage of the tumor, postoperative liver metastasis and peritoneal metastasis were independent risk factors affecting the prognosis of Borrmann type Ⅳ gastric cancer patients (all P < 0.05). Conclusion Borrmann type Ⅳ gastric cancer is prone to liver metastasis, lymph node metastasis, peritoneal metastasis and poor prognosis, and it's prognosis is affected by a variety of independent risk factors.
ABSTRACT
Objective:To investigate the clinical value of systemic immune-inflammation index (SII) based on peripheral blood neutrophils, lymphocytes and platelets counts in predicting the prognosis of patients with gastric cancer after radical resection.Methods:From January 1, 2012 to January 1, 2015, the data of 2 273 patients with gastric cancer who underwent radical surgery at the Third Department of Surgery of the Fourth Hospital of Hebei Medical University were retrospectively analyzed. SII value was calculated according to the formula (SII=neutrophil cell count (×10 9/L)×platelet cell count (×10 9/L)/lymphocyte count (×10 9/L)). According to receiver operating characteristic curve (ROC), the optimal cut-off value of SII was determined and the patients were divided into high SII group and low SII group. Chi-square test was used to compare the clinicopathological characteristics and prognosis of the two groups. Kaplan-Meier method was applied to draw survival curve, log-rank test was used for univariate survival analysis, and Cox regression model was used for multivariate survival analysis. The ROC of preoperative SII, pathological TNM stage and their combination for predicting prognosis and recurrence were drawn, and the area under the curve (AUC) values were calculated to compare the predictive power of the three. Results:According to the ROC, the optimal cut-off value of SII was 589.5, and there were 1 180 cases (51.91%) in the high SII (SII≥589.5) group and 1 093 cases (48.09%) in the low SII (SII<589.5) group. Compared with those of the low SII group, the maximum diameter of gastric cancer in the high SII group was mostly ≥5 cm (49.04%, 536/1 093 vs. 56.27%, 664/1 180), the histological types were mostly poorly differentiated to undifferentiated (55.63%, 608/1 093 vs. 61.19%, 722/1 180), the depth of tumor invasion was mainly from T4a to T4b (45.11%, 493/1 093 vs. 54.837%, 647/1 180), and the rate of lymph node metastasis, pathological TNM stage, rate of vascular infiltration, incidence of nerve invasion, Ki-67 expression level, serum carcinoembryonic antigen level and carbohydrate antigen 19-9 level in the high SII group were all higher than those in the low SII group (67.70%, 740/1 093 vs. 80.68%, 952/1 180; 57.64%, 630/1 093 vs. 71.10%, 839/1 180; 55.54%, 607/1 093 vs. 67.03%, 791/1 180; 53.89%, 589/1 093 vs. 64.32%, 759/1 180; 45.29%, 495/1 093 vs. 56.69%, 669/1 180; 56.91%, 622/1 093 vs. 63.20%, 734/1 180; 53.25%, 582/1 093 vs. 57.97%, 684/1 180), and the differences were statistically significant ( χ2=8.842, 11.097, 7.225, 21.467, 50.200, 44.984, 31.687, 25.594, 29.549, 6.612 and 5.119, all P<0.05). The 5-year overall survival rate and disease-free survival rate of the low SII group were 75.66% and 67.61%, respectively, which were both higher than those of the high SII group, (24.92% and 23.31%, respectivily), the differences were statistically significant ( χ2=620.700 and 413.00, both P<0.01). The results of multivariate Cox regression analysis showed that tumor histological type, depth of invasion, pathological TNM stage, vascular invasion and preoperative SII were independent risk factors for postoperative prognosis and recurrence of patients with gastric cancer (odds ratios were 4.126, 2.255, 5.123, 3.826, 6.126, 4.683, 2.472, 5.224, 4.416, 6.212, respectively; 95% confidence interval 2.123 to 9.721, 1.632 to 7.427, 3.325 to 10.211, 2.321 to 9.322, 4.127 to 13.782, 2.561 to 9.418, 1.322 to 6.289, 3.315 to 11.526, 2.213 to 9.382, 4.474 to 13.541; all P<0.05). The predictive power of preoperative SII (AUC=0.842, 0.815) and pathological TNM stage (AUC=0.881, 0.827) for the 5-year overall survival and disease-free survival of patients with gastric cancer after radical resection was similar, however the predictive power of combination of the two (AUC=0.943, 0.895) was higher than that of preoperative SII and pathological TNM stage alone. Conclusions:Preoperative SII is an independent risk factor for the prognosis of patients with gastric cancer after radical resection, combined with parthological TNM stage can be used as an indicator to predict the prognosis and recurrence of patients.
ABSTRACT
Objective:To explore the risk factors of lymphatic fistula after radical gastric cancer operation.Methods:We retrospectively analyze the clinicopathological data of gastric cancer patients who underwent radical surgery from May, 2019 to May, 2020 at the Third Department of Surgery, Fourth Hospital of Hebei Medical University, and analyze the risk factors impacting postoperative lymphatic leakage,for the establishment of the risk prediction scoring model.Results:A total of 487 patients with gastric cancer underwent radical gastrectomy, of which 32 patients (6.6%) had lymphatic leakage . Multivariate logistic regression analysis showed that hypoproteinemia before surgery (95% CI: 1.222-7.357, P=0.016), the lesion is located in the cardia-fundus of the stomach (95% CI: 1.117-6.788, P=0.028),stage T3-T4 (95% CI: 1.149-25.676, P=0.033), operation time ≥4 h (95% CI: 1.469-11.480, P=0.007), combined organ resection (95% CI: 1.106-12.886, P=0.034), D2+ lymph node dissection (95% CI: 1.969-11.510, P=0.001), anemia (95% CI: 1.271-9.392, P=0.015) were an independent risk factors. Equation based on multi-factor Logistic regression: logit( P)=-9.624+1.098×X 1+1.013×X 2+1.692×X 3+1.413×X 4+1.328×X 5+1.560×X 6+1.240×X 7 was estaslished, using Hosmer. Lemeshow test detects the goodness of fit of the regression equation ( P=0.348). The area under the ROC curve was 0.856 (95% CI: 0.787-0.926, P<0.001); the probability of lymphatic leakage when scores ≥4 points was 14.1%, when scores <4 points ,the probability of leakage was 2.5%. Conclusion:A risk prediction scoring model for lymphatic leakage after radical gastrectomy, can identify patients with high risk after surgery
ABSTRACT
Objective:To investigate the application value of individualized full-course nutritional intervention in neoadjuvant concurrent chemoradiotherapy (nCRT) for locally advanced Siewert type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction (AEG).Methods:The perspec-tive randomized control study was conducted. The clinicopathological data of 90 patients with locally advanced Siewert type Ⅱ and Ⅲ AEG who underwent nCRT in the Fourth Hospital of Hebei Medical University from February 2012 to December 2018 were selected. Patient were divided into two groups with 1:1 according to random number table. Patients undergoing nCRT combined with individualized full-course nutritional intervention were allocated into experimental group, and patients undergoing nCRT combined with common nutritional intervention were allocated into control group. Observation indicators: (1) grouping situations of the enrolled patients; (2) changing situations of nutritional status and quality of life of patients in nCRT and preoperative waiting period; (3) efficacy evaluation and adverse effects of nCRT; (4) surgical and recovery situations. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement date with skewed distribution were represented as M ( P25, P75) or M (range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were represented as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the non-parameter rank sum test. Repeated measurement data were analyzed using the repeated ANOVA. Results:(1) Grouping situations of the enrolled patients: a total of 90 patients were selected for eligibility. There were 77 males and 13 females, aged from 26 to 74 years, with a median age of 62 years. Of 90 patients, there were 45 cases in the experimental group and 45 cases in the control group. (2) Changing situations of nutritional status and quality of life of patients in nCRT and preoperative waiting period: ① during the nCRT treatment (week 3, week 6) and the preoperative waiting period (week 9, week 12, week 15), the body mass was (67±10)kg, (66±9)kg, (67±10)kg, (68±10)kg, (70±10)kg for the experi-mental group, respectively, and (65±9)kg, (59±8)kg, (62±8)kg, (64±8)kg, (66±9)kg for the control group. The multivariate test was conducted based on the mauchly's test of sphericity for the body mass ( χ2=195.010, P<0.05). There were significant differences in the time effect, interaction effect, intervention effect of body mass changing between the two groups ( F=93.974, 60.638, 4.144, P<0.05). ② During the nCRT treatment (week 3, week 6) and the preoperative waiting period (week 9, week 12, week 15), the total protein was (66±4)g/L, (65±4)g/L, (65±4)g/L, (68±4)g/L, (71±5)g/L for the experimental group, respectively, and (65±4)g/L, (62±5)g/L, (63±5)g/L, (65±5)g/L, (67±6)g/L for the control group. The multivariate test was conducted based on the mauchly's test of sphericity for the total protein ( χ2=652.524, P<0.05). There were significant differences in the time effect, interaction effect, interven-tion effect of total protein changing between the two groups ( F=672.507, 6.424, 5.057, P<0.05). ③ During the nCRT treatment (week 3, week 6) and the preoperative waiting period (week 9, week 12, week 15), the albumin was (40±3)g/L, (38±4)g/L, (38±4)g/L, (39±4)g/L, (40±4)g/L for the experimental group, respectively, and (39±4)g/L, (35±5)g/L, (36±4)g/L, (36±4)g/L, (37±5)g/L for the control group. The multivariate test was conducted based on the mauchly's test of sphericity for the albumin ( χ2=289.324, P<0.05). There were significant differences in the time effect, interaction effect, intervention effect of albumin changing between the two groups ( F=4 210.683, 5.013, 7.330, P<0.05). ④ During the nCRT treatment (week 3, week 6) and the preoperative waiting period (week 9, week 12, week 15), the prealbumin was (228±41)mg/L, (222±56)mg/L, (223±47)mg/L, (227±46)mg/L, (233±53)mg/L for the experimental group, respectively, and (202±49)mg/L, (174±68)mg/L, (179±54)mg/L, (185±51)mg/L, (193±57)mg/L for the control group. The multi-variate test was conducted based on the mauchly's test of sphericity for the prealbumin ( χ2=297.324, P<0.05). There were significant differences in the time effect, interaction effect, intervention effect of prealbumin changing between the two groups ( F=871.545, 6.111, 14.426, P<0.05). ⑤ During the nCRT treatment (week 3, week 6) and the preoperative waiting period (week 9, week 12, week 15), the hemoglobin was (124±14)g/L, (121±14)g/L, (125±13)g/L, (127±13)g/L, (128±13)g/L for the experimental group, respectively, and (121±18)g/L, (114±14)g/L, (116±14)g/L, (117±16)g/L, (118±22)g/L for the control group. The multivariate test was conducted based on the mauchly's test of sphericity for the hemoglobin ( χ2=257.560, P<0.05). There were significant differences in the time effect, interaction effect, intervention effect of hemoglobin changing between the two groups ( F=2 533.553, 4.142, 4.985, P<0.05). ⑥ During the nCRT treatment (week 3, week 6) and the preopera-tive waiting period (week 9, week 12, week 15), the patient-generated subjective global assessment (PG-SGA) score was 4.4±1.2,6.3±1.4, 5.5±1.4, 4.3±1.4, 3.4±1.7 for the experimental group, respec-tively, and 4.9±1.2, 7.4±1.7, 7.3±1.6, 6.3±1.4, 6.0±1.5 for the control group. The multivariate test was conducted based on the mauchly's test of sphericity for the PG-SGA score ( χ2=289.543, P<0.05). There were significant differences in the time effect, interaction effect, intervention effect of PG-SGA score changing between the two groups ( F=648.583, 41.906, 26.098, P<0.05). ⑦ During the nCRT treatment (week 3, week 6) and the preoperative waiting period (week 9, week 12, week 15), the quality of life questionnaire of stomach (QLQ-ST022) score was 13±3, 16±6, 16±4, 14±4, 12±5 for the experimental group, respectively, and 15±4, 21±6, 20±4, 17±4, 15±5 for the control group. The multivariate test was conducted based on the mauchly's test of sphericity for the QLQ-STO22 ( χ2=279.865, P<0.05). There were significant differences in the time effect, interaction effect, interven-tion effect of QLQ-STO22 changing between the two groups ( F=710.238, 7.261, 16.794, P<0.05). (3) Efficacy evaluation and adverse effects of nCRT: there were 25 patients and 20 cases of the experimental group with partial response and stable disease, showing the objective response rate and disease control rate as 55.6%(25/45)and 100.0%(45/45). There were 18 patients and 27 cases of the control group with partial response and stable disease, showing the objective response rate and disease control rate as 40.0%(18/45)and 100.0%(45/45). There was no significant difference in the nCRT efficacy between the two groups ( P>0.05). Cases with leukopenia, neutropenia, anemia, nausea, and loss of appetite were 27, 25, 19, 30, 34 for the experimental group, versus 37, 34, 29, 39, 42 for the control group, showing significant differences between the two groups ( χ2=5.409, 3.986, 4.464, 5.031, 5.414, P<0.05). (4) Surgical and recovery situations: patients of the experimental group underwent surgeries successfully. Two patients of the control group diagnosed with peritoneal metastasis after laparoscopic exploration underwent conversion therapy and no surgery, the other 43 patients underwent surgeries. The time to postoperative gastric tube removal, time to postopera-tive drainage tube removal, time to postoperative first flatus, time to postoperative first defecation, duration of postoperative hospital stay were 2.0 days (1.5 days, 3.0 days), 6.0 days (5.0 days,11.0 days), 2.0 days (1.5 days, 2.5 days), 2.0 days (1.5 days, 2.5 days), 7.0 days (6.0 days,14.0 days) for the experimental group, versus 3.0 days (2.0 days,4.0 days), 7.0 days (5.5 days,14.0 days), 2.0 days (1.5 days,3.0 days), 3.0 days (2.0 days,3.5 days), 8.0 days (6.0 days, 17.0 days) for the control group, showing significant differences between the two groups ( Z=-3.477, -4.398, -3.068, -5.786, -3.395, P<0.05). Conclusion:For AEG patients undergoing nCRT, the individualized full-course nutrition intervention involving nutritionists is beneficial to improve the nutritional status, reduce adverse reactions, and improve the quality of life of the patients, promote postoperative short-term recovery. Registry: this study was registered at clinicaltrials.gov in United States, with the registry number of NCT01962246.
ABSTRACT
Objective:To investigate the risk factors of pancreatic fistula after radical resection of gastric cancer, and to establish a risk prediction scoring model for pancreatic fistula.Methods:The clinico-pathological data of 312 patients with gastric cancer admitted to the Fourth Hospital of Hebei Medical University from January 2019 to January 2020 were retrospectively analyzed. Multiple factor logistic regression model was used to analyze the risk factors of pancreatic fistula after radical resection of gastric cancer, and a risk prediction scoring model based on the risk factors was established. Hosmer-Lemeshow test was used to detect the goodness of fit of regression equation, and receiver operating characteristics (ROC) curve was used to evaluate the distinction degree of regression equation.Results:Among 312 patients with gastric cancer, 27 cases (8.65%) had pancreatic fistula after radical resection of gastric cancer. Multiple factor logistic regression analysis showed that male patients ( OR = 5.312, 95% CI 1.532-18.420, P = 0.008), age ≥ 60 years old ( OR = 4.928, 95% CI 1.493-16.250, P = 0.009), preoperative diabetes mellitus ( OR = 3.062, 95% CI 1.091-8.589, P = 0.034), lesion location in the gastric body-gastric antrum ( OR = 3.121, 95% CI 1.052-9.251, P = 0.040), intraoperative omental bursa resection ( OR = 6.209, 95% CI 2.084-18.478, P = 0.001), intraoperative lymph node dissection at D2+ station ( OR = 3.114, 95% CI 1.044-9.281, P = 0.042), intraoperative combined organ resection ( OR = 5.063, 95% CI 1.473-17.400, P = 0.010), preoperative TNM stage Ⅲ ( OR = 4.973, 95% CI 1.189-20.792, P = 0.028) were independent risk factors for pancreatic fistula after radical resection of gastric cancer. A risk prediction equation of pancreatic fistula after radical resection of patients with gastric cancer was established: P = -8.619+1.670X 1+1.595X 2+1.119X 3+1.138X 4+1.826X 5+1.136X 6+1.622X 7+1.604X 8; factor X was set as a binomial assignment (0 or 1); X1-X8 were listed as follows respectively: gender (the male was 1), age (≥60 years old was 1), preoperative diabetes history (yes was 1), lesion location (gastric body-gastric antrum was 1), intraoperative resection of omental bursa or not (yes was 1), intraoperative lymph node dissection at D2+ station or not (yes was 1), intraoperative combined organ resection or not (yes was 1), preoperative TNM stage (stage Ⅲ was 1). The goodness of fit of regression equation was high ( P = 0.395). The area under the curve of ROC by using risk prediction scoring model to judge pancreatic fistula was 0.916 (95% CI 0.872-0.960, P<0.01). The probability of pancreatic fistula in patients with score ≥ 5 was 40.90%, and the probability of pancreatic fistula in patients with score < 5 was 3.35%. Conclusions:The occurrence of pancreatic fistula after radical resection of gastric cancer is closely related to a variety of risk factors. By establishing a risk prediction scoring model for pancreatic fistula after radical resection of gastric cancer, it is helpful to effectively identify patients with high risk of pancreatic fistula after radical surgery during the perioperative period.
ABSTRACT
Objective:To investigate the clinically relevant factors of progressive disease (PD) after neoadjuvant therapy for locally advanced gastric cancer.Methods:From Jun 2011 to Mar 2016, 569 patients with locally advanced gastric cancer(cT3/4N0/+ M0) admitted to the Fourth Hospital of Hebei Medical University were retrospectively analyzed .Results:All 569 patients completed neoadjuvant therapy, 59 patients (10.4%) had PD. Univariate analysis showed that tumor size (χ 2=10.091, P=0.001), pathological type (χ 2=4.110, P=0.043), Borrmann type (χ 2=91.941, P=0.001), pre-treatment cT stage (χ 2=7.980, P=0.005) were associated with PD after neoadjuvant therapy for gastric cancer. The results of multi-factor regression analysis showed that pathological type, Borrmann type, pre-treatment cT stage were independent factors influencing the occurrence of PD after neoadjuvant therapy for advanced gastric cancer. The overall survival and progression-free suruival time of patients with PD is significantly shorter than that of patients without PD . Conclusion:The pathological type, Borrmann typing and pre-treatment cT stage are the influencing factors for the occurrence of PD after neoadjuvant treatment in advanced gastric cancer, and the prognosis of PD patients is poor.
ABSTRACT
Objective:To explore the clinico-pathological characteristics and risk factors affecting prognosis in elderly patients with gastric cancer.Methods:A retrospective study was used to retrospectively analyze 2386 patients with gastric cancer undergoing radical surgery in Surgery Department of the Fourth Hospital of Hebei Medical University from 1 January 2012 to 1 January 2015.Patients aged 70 years and older were screened so as to analyze clinical characteristics and influencing factors for the prognosis.Results:A total of 2386 patients with gastric cancer were divided into the elderly group aged 70 years and older(342 of 2386 cases, 14.3%). There were statistically significant differences between the two groups in gender, number of concomitant diseases, NRS2002 score, PG-SGA score, tumor location, tumor diameter, histological type, Borrmann classification, tumor invasion depth staging(pT), lymph node metastasis staging(pN), the anatomic extent of tumor staging(TNM, pTNM), and Lauren classifications( P<0.05). The 981 of 2386 cases(41.4%)had postoperative complications, accompanied by 413 cases(17.3%)of surgery-related complications and 568 cases(24.0%)of non-surgery-related complications.A multivariate logistic analysis showed that the number of preoperative co-existing diseases ≥ 2 was an independent influencing factor for postoperative complications in elderly gastric cancer patients( HR=4.478, 95% CI: 1.121-7.918, P=0.006). The 5-year OS and DSS was 21.10% and 62.73% in the ≥70 years gastric cancer group, and was 54.1% and 70.0% in the <70 years gastric cancer group, respectively.The difference in the 5-year OS between the two groups was statistically significant( P<0.05), while the difference in the 5-year DSS between the two groups was not statistically significant( P>0.05). Multivariate analysis by the Cox proportional hazard model showed that the independent risk factors for the prognosis of elderly patients with gastric cancer included the low-undifferentiated histological type of the tumor( P=0.004), the depth of tumor invasion pT stage of pT4a-pT4b( P=0.007), lymph node metastasis( P=0.034), tumor pTNM stage ⅢA-ⅢC( P=0.002)and vascular tumor thrombus( P=0.034). Conclusions:Elderly patients with gastric cancer have many preoperative co-existing diseases, which increases the risk of postoperative non-surgical complications.Therefore, we should focus on the peri-operative management of their comorbid diseases so as to improve the safety and efficacy of surgery.The advanced age is not the independent risk factors for the prognosis.
ABSTRACT
Objective@#To explore the clinical significance of laparoscopic exploration combined with abdominal exfoliative cytology in the diagnosis and treatment of patients with locally advanced gastric cancer.@*Methods@#Inclusion criteria: (1) cancer confirmed by gastroscopy and pathology without preoperative anti-tumor treatment; (2) no distant metastases found in preoperative imaging examinations; (3) patients without surgical contraindications and being tolerant to surgery; (4) patients were willing to undergo laparoscopic exploration and abdominal exfoliative cytology examination, and signed informed consent. A retrospective cohort study method was used to collect and analyze the clinicopathological data of 225 patients with advanced gastric cancer based on the above inclusion criteria from a prospective, multicenter, open, randomized controlled phase III clinical trial (registration No. NCT01516944) conducted between February 2012 and December 2018 in The Fourth Hospital of Hebei Medical University, including 162 males and 63 females with age ranged from 23 to 78 years old. Forty-five patients (20.0%) were classified as Borrmann type I to II, and 180 (80.0%) were classified as type III to IV. All the patients underwent laparoscopy and peritoneal lavage cytology under general anesthesia. Laparoscopic exploration sequence: left and right diaphragm→liver and spleen→parietal peritoneum→pelvic cavity→greater omentum, small intestine, mesentery→transverse colon mesentery →stomach. Contents of exploration: (1) with or without ascites; (2) whether metastatic lesions existed in the peritoneum, mesentery, omentum and Douglas pouch; (3) whether metastasis existed on the liver surface; (4) whether the gastric lymph nodes were swollen; (5) whether infiltration occurred on the gastric serosa surface; (6) whether gastric wall was stiff. The left and right subphrenic, the abdominal and pelvic peritoneum, and the mesentery were rinsed with 500 ml of sterilized normal saline. Position of the reverse Trendelenburg was used in the Douglas pouch. The peritoneal lavage fluid under the liver and spleen fossa was collected. Cytological examination was carried out for exfoliative tumor cells. Evaluation criteria: (1) peritoneal metastasis (P): P0 meant no peritoneal metastasis, P1 meant peritoneal metastasis; (2) free peritoneal cancer cells (CY): CY0 meant no cancer cells in peritoneal lavage fluid cytology, CY1 meant cancer cells in peritoneal lavage fluid cytology. The results of patients undergoing laparoscopic exploration combined with abdominal exfoliative cytology, treatment options and prognosis were analyzed. Kaplan-Meier method was used to calculate the survival rate and a survival curve was drawn. Log-rank test was used for survival analysis.@*Results@#After laparoscopic exploration in 225 patients, clinical staging was corrected in 68 (30.2%) patients, of whom 7 (3.1%) downstaged and 61 (27.1%) increased in staging. Of 164 patients evaluated as P0CY0 after the first laparoscopy and peritoneal cytology examination, 126 underwent radical D2 surgery, and the other 38 patients were found to have later local lesions or extensive fusion of local lymph nodes, so then received neoadjuvant chemotherapy. Twenty-nine patients evaluated as P1CY0 or P1CY1 and 32 patients as P0CY1 underwent intraperitoneal hyperthermic chemotherapy+conversion therapy, and then a second laparoscopic exploration was performed to determine the treatment plan. In total, the original treatment regimens were changed after laparoscopic exploration in 99(44.0%) cases. The follow-up period ended in January 2019. The overall 2-year survival rate of 225 patients was 64.0%. As for those who were evaluated as P0CY0, P0CY1 and P1CY0-1 after the first laparoscopic exploration, the 2-year overall survival rate was 70.7%, 65.6% and 24.1%, respectively (P=0.002). The stratified analysis showed that among 180 patients with stage III tumor, after laparoscopic exploration combined with abdominal exfoliative cytology, 125 patients were found to be P0CY0, 28 were P0CY1, and 27 were P1CY0-1, whose 2-year overall survival rates were 70.4%, 64.3%, and 29.6% respectively, and the difference among these 3 groups was statistically significant (P=0.009).@*Conclusion@#Laparoscopic exploration combined with abdominal exfoliative cytology in patients with locally advanced gastric cancer has important clinical guiding significance in improving accurate staging, treatment options and prognosis evaluation, and can avoid non-therapeutic open-close abdominal surgery.
ABSTRACT
Objective:To evaluate multislices helical CT (MSCT) on the efficacy and prognosis of preoperative treatment for locally advanced gastric stromal tumors(GIST).Methods:From Oct 2012 to Oct 2014 at the Fourth Hospital of Hebei Medical University 30 patients received MSCT before and after preoperative imatinib treatment to measure the changes of the GIST longest diameter, CT value and tumor volume of the primary lesion. The correlation of Choi score, tumor volume reduction rate and histological efficacy evaluation were analyzed. ROC curve was drew. Kaplan-Meier method was used to draw survival curves, and the overall survival rates under the new classification were calculated.Results:The median time for preoperative treatment was 8 (4 to 14) months. Postoperative pathology showed 4 cases (13%) with mild effects and 3 cases (10%) with low effects. Seventeen cases (57%) with moderate effect and 6 cases (20%) with high effect. Choi score was moderately correlated with histological efficacy evaluation ( R=0.512, P<0.05), and tumor volume reduction rate was strongly correlated with histological efficacy evaluation results ( R=0.620, P<0.05). When the tumor volume reduction rate of 45.83% was used as the effective threshold, the AUC under the ROC curve was the largest, and the sensitivity and specificity were 87.0% and 85.7%, respectively. The 5-year overall survival rate of 30 patients was 87%. According to the new volume grading standard, the 5-year survival rates of the effective group and the ineffective group were 95% and 67% ( P<0.05) , respectively . Conclusion:MSCT measurement of Choi score and tumor volume reduction rate can evaluate the efficacy of preoperative treatment in patients with locally advanced GIST, and tumor volume measurement standards also have certain value in prognosis perdiction.
ABSTRACT
Objective:To explore the clinicopathological features and prognostic factors of gastric cancer patients with pathological stage T1N3M0 (pT1N3M0) according the TCC staging criteria of the 8th edition of UICC.Methods:We retrieved the clincal data from the Third Department of Surgery, the Fourth Hospital of Hebei Medical University from 2010 to 2019 for pT1N3M0 patients, and analyzed the clinical and pathological characteristics affecting the prognosis.Results:A total of 110 pT1N3M0 gastric cancer patients were recruited, including 27 cases (24.5%) at pT1aN3aM0 stage, 10 cases (9.1%) of pT1aN3bM0, 45 cases (40.9%) of pT1bN3aM0, and 28 cases (25.5%) of pT1bN3bM0. Tumors were located in the cardia-gastric fundus in 51 cases (46.4%), in body antrum in 59 cases (53.6%); In 40 cases (36.4%) with lesion diameter ≥2cm, in 70 cases (63.6%) the lesion<2 cm; 59 cases (53.6%) were with high-medium differentiated adenocarcinoma, 51 cases (46.4%) with low undifferentiated adenocarcinoma. 104 patients (94.5%) were followed up. The 2-year overall survival rate (OS) was 63.5%, and the 2-year disease-free survival rate (DFS) was 57.7%. Counting seperately the 2-year OS was 92.0%, 50.0%, 70.7%, and 30.8%; and the 2-year DFS was 88.0%, 41.7%, 65.9%, and 23.1%, respectively in the 4 respective groups. The differences in 2-year OS and DFS between the groups were statistically significant (all P<0.05). Univariate analysis showed that the patient′s age, tumor diameter, infiltration depth (T stage), histological type, lymph node metastasis (N stage), tumor marker CA19-9, CA72-4, tumor vascular thrombus and nerve invasion, Ki67 and Lauren classification were related to the prognosis (all P<0.05). Multivariate analysis showed that tumor size≥ 2cm ( P=0.003), poor tumor tissue type ( P=0.004), N3b stage ( P=0.000), tumor vascular thrombus ( P=0.001) and nerve invasion ( P=0.002) is an independent risk factor affecting the prognosis of pT1N3M0 gastric cancer patients. Conclution:Patients with pT1N3M0 stage gastric cancer have a poor prognosis, and the N3b stage is an independent risk factor affecting the prognosis.
ABSTRACT
Objective@#To evaluate the efficacy of chemotherapy and estimate the prognosis of patients with progressive gastric cancer.@*Methods@#A total of 116 patients from a prospective, multicenter, open-label, and randomized phase Ⅲ clinical trial were enrolled in the Fourth Hospital of Hebei Medical University from Dec 2012 to Jun 2015. Pre- and two weeks after neoadjuvant chemotherapy, multi-slice spiral CT was performed to calculate the percentage change of the longest diameter and tumor volume to evaluate the Recist score and tumor volume reduction rate. Spearman correlation test was used to analyze the correlation of post-volume reduction rate, Recist 1.1 score, and tumor regression grade. The ROC curve was used to find a defined value for the volume reduction rate that identifies the effectiveness of chemotherapy and assign a new grading standard. The survival curve was drawn by Kaplan-Meier method, and the relationship between the effective survival group and the ineffective group under the new grading standard was observed.@*Results@#The Recist score was moderately correlated with the pathological tumor regression scale, and the volume reduction rate after chemotherapy was strongly correlated with the pathological regression scale (R=0.579). When the tumor volume reduction rate was 12.5% as an effective threshold for evaluating neoadjuvant chemotherapy, the AUC under the ROC curve was the largest, with sensitivity and specificity of 81.1% and 75.9%, respectively. The median survival time of the effective and ineffective groups was 25 months and 18 months, respectively, and the 2-year survival rate was 73.3% and 51.2%. The total survival time of patients with effective chemotherapy was significantly longer than those with ineffective chemotherapy (P=0.003 6).@*Conclusion@#The volume measurement grading standard can predict the pathological regression of neoadjuvant chemotherapy patients, and it is superior to the Recist score in the evaluation of efficacy and prognosis.
ABSTRACT
Objective To evaluate the efficacy of chemotherapy and estimate the prognosis of patients with progressive gastric cancer.Methods A total of 116 patients from a prospective,multicenter,open-label,and randomized phase Ⅲ clinical trial were enrolled in the Fourth Hospital of Hebei Medical University from Dec 2012 to Jun 2015.Pre-and two weeks after neoadjuvant chemotherapy,multi-slice spiral CT was performed to calculate the percentage change of the longest diameter and tumor volume to evaluate the Recist score and tumor volume reduction rate.Spearman correlation test was used to analyze the correlation of post-volume reduction rate,Recist 1.1 score,and tumor regression grade.The ROC curve was used to find a defined value for the volume reduction rate that identifies the effectiveness of chemotherapy and assign a new grading standard.The survival curve was drawn by Kaplan-Meier method,and the relationship between the effective survival group and the ineffective group under the new grading standard was observed.Results The Recist score was moderately correlated with the pathological tumor regression scale,and the volume reduction rate after chemotherapy was strongly correlated with the pathological regression scale (R =0.579).When the tumor volume reduction rate was 12.5％ as an effective threshold for evaluating neoadjuvant chemotherapy,the AUC under the ROC curve was the largest,with sensitivity and specificity of 81.1％ and 75.9％,respectively.The median survival time of the effective and ineffective groups was 25 months and 18 months,respectively,and the 2-year survival rate was 73.3％ and 51.2％.The total survival time of patients with effective chemotherapy was significantly longer than those with ineffective chemotherapy (P =0.003 6).Conclusion The volume measurement grading standard can predict the pathological regression of neoadjuvant chemotherapy patients,and it is superior to the Recist score in the evaluation of efficacy and prognosis.
ABSTRACT
Objective@#The purpose of this study was to determine the effect of climbing exercise intervention on gross motor function in children aged 8 to 9 years, and to provide a theoretical basis and scientific reference for the application of climbing exercise in the improvement of children health.@*Methods@#Random sampling method was used to select 53 children aged 8-9 from a public school in Haidian District in Beijing, and children were randomly divided into control group (n=30) and exercise group (n=23), children in the exercise group received climbing exercises for 8 weeks . KTK test was used to assess gross motor development.@*Results@#After intervention, the gross motor level of male and female children in Exercise group were significantly higher than before (in male group, before intervention, KTK score：217.5±32.3，after intervention, KTK score：245.1±24.2，P<0.01；in female group, before intervention, KTK score: 219.6±30.3, after intervention, KTK score: 246.9±23.2，P<0.01); while the gross motor level in control group had no significant change compared to the intervention state before(in male group, before intervention, KTK score：219.9±26.8，after intervention, KTK score：224.8±30.2，P>0.05；in female group, before intervention, KTK score: 216.6±18.1，after intervention, KTK score:214.8±28.6，P>0.05). There were no differences of gross motor level between sham and exercise group at baseline (P>0.05). After intervention, except the MS scores (P>0.05), other test program scores were higher than those of control group (in exercise group, WB: 52.1±6.8; HH: 61.7±8.7; JS: 73.7±7.6; in control group, WB: 43.1±9.9; HH: 54.5±15.2; JS: 64.9±6.8) (P<0.01).@*Conclusion@#Our research shows that climbing exercise intervention helps promoting the children’s physical quality, and establishes substantial foundation for the formation and promotion of sports cognition and complex motor skills.
ABSTRACT
Objective To investigate the expression of TIP 30 protein in gastric cancer tissues,and effect of TIP30 over-expression on migration and invasion of gastric cancer cell line SGC7901.Methods Immunohistochemistry streptavid-in-peroxidase (SP) methods were used to detect the expression levels of TIP30 in 93 cases of gastric cancer tissues.Previously constructed pcDNA3.1-TIP30 plasmid were transiently transfected into SGC7901 cells.The proliferation of cells were detected by using MTT assay when TIP30 was overexpressed.Transwell assay to determine migration and invasion ability of SGC7901.Western blot was used to examine the changes of concentration of E-cadherin,N-cadherin and MMP9.Results The positive expression rate of TIP30 was 39％ significantly lower in gastric cancer tissues than 92％ in normal gastric mucosa tissues (x2 =32.68,P ＜ 0.05),there was a significant correlation between reduced expression of TIP30 and depth of infiltration,including nodal metastasis,TNM stage (x2 =3.535,7.421,6.754,all P ＜ 0.05);MTT showed that the proliferation of SGC7901 cells in the pcDNA3.1-TIP30 transfected group significantly decreased when TIP30 was overexpressed at respective time of 72,96 hours (t =6.528,7.249,both P ＜ 0.05),Transwell assay showed that overexpression of TIP30 significantly decreased migratory and invasive numbers of SGC7901 cells (t =5.769,P ＜ 0.05;t =7.886,P ＜ 0.05);the expression level of MMP-9 and N-cadherin in TIP30 overexpressing cells group significantly decreased (t =9.811,10.362,both P ＜ 0.05),mean while E-cadherin expression was significantly higher than before (t =6.137,P ＜ 0.05).Conclusion TIP30 protein is low expressed in gastric cancer and the overexpression of TIP30 inhibits the proliferation,migration and invasion of gastric cell line SGC7901.
ABSTRACT
Objective@#To investigate the effect of postoperative precision nutrition therapy on postoperative recovery (PR) of patients with advanced gastric cancer (AGC) after neoadjuvant chemotherapy (NC).@*Methods@#71 subjects were randomly divided into 2 groups. The 34 patients of research group were treated with postoperative precision nutrition treatment according to the indirect energy measurement method. The 31 patients of control group were treated with traditional postoperative nutrition treatment. All participants were measured for body mass index (BMI), NRS2002, PG-SGA and relevant laboratory test within the 1st day before surgery and 7th day after surgery. Moreover, the difference between two groups in short-term effects were evaluated.@*Results@#The daily energy supply of control group was 30.1%-43.74% higher than that of the experimental group (P<0.05). The resting energy expenditure (REE) of the research group after surgery was lower than that before operation. The levels of prealbumin, albumin and lymphocyte count were higher in research group than the controls at the 7th day after surgery whereas the opposite was true for the creatinine, urea nitrogen, C-reactive protein and procalcitonin (P<0.05). Similarly, the rate of malnutrition and nutritional risk became lower in the research group (P<0.05). The gastrointestinal function recovery of patients in the research group was comparable to that of the control group (P>0.05). Moreover, the complication rate and hospitalization costs of in research group were significantly lower than that of in control group (P<0.05). For patients with or without nutritional risks before surgery, the nutritional index and inflammatory index in the research group were better than those in the control group.@*Conclusion@#Postoperative precision nutrition therapy may improve the postoperative nutritional status and short-term effects of patients with AGC after NC.
ABSTRACT
<p><b>OBJECTIVE</b>To explore the value of MSCT in the preoperative TNM staging and the longest tumor diameter measurement (RESIST standard) of gastric cancer.</p><p><b>METHODS</b>Clinical data of 153 consecutive patients with biopsy-confirmed gastric carcinoma who were preoperatively evaluated with enhanced MSCT scanning in our hospital from January 2012 to March 2013 were retrospectively analyzed. Consistency comparison was performed between preoperative TNM staging and the longest tumor diameter measurement and histopathological findings.</p><p><b>RESULTS</b>T-staging consistency of Kappa value was 0.566, and accuracy was 71.2%. N-staging consistency of Kappa value was 0.284, and accuracy was 47.7%. The Kappa value of M-staging consistency was 0.893, and accuracy was 98.7%. The overall accuracy of TNM staging consistency was 66.7% (102/153) with a Kappa value of 0.573. Effective measurement of the longest cancer diameter was carried out in 53 patients. There was no significant difference between preoperative longest tumor diameter acquired by MSCT and postoperative tumor measurement [(68.8 ± 40.6) mm vs. (64.2 ± 36.2) mm, P=0.969].</p><p><b>CONCLUSION</b>MSCT is accurate in preoperative TNM staging and longest tumor diameter measurement of gastric cancer compared with postoperative pathological examination, and can provide reliable evidence for preoperative staging and neoadjuvant therapy evaluation of gastric cancer, but it is unfavorable to evaluate the lymph node metastasis.</p>
Subject(s)
Humans , Lymphatic Metastasis , Neoadjuvant Therapy , Neoplasm Staging , Retrospective Studies , Stomach Neoplasms , Tomography, X-Ray ComputedABSTRACT
<p><b>OBJECTIVE</b>To discuss the effect of modified double tracks anastomosis in patients with type Siewert II-III( adenocarcinoma of the esophagogastric junction(AEG) treated with radical gastrectomy.</p><p><b>METHODS</b>Clinical data of 763 patients with type Siewert II-III AEG undergoing radical operation in our department from January 2004 to December 2008 were analyzed retrospectively. Patients were randomized into 3 groups according to the different procedures modes: radical proximal gastrectomy with modified double tracks anastomosis(266 cases), radical proximal gastrectomy with esophageal gastric stump end-to-side anastomosis(252 cases), and radical total gastrectomy with esophageal jejunum Roux-en-Y anastomosis(245 cases). There were no significant differences in general information and biological characteristics among the 3 groups(all P>0.05). Radical degree, safety, quality of life and prognosis were compared among 3 groups.</p><p><b>RESULTS</b>There were no significant differences in postoperative complications among the three groups(P>0.05). Six months after operation, in modified double tracks anastomosis group, food intake recovery percentage was superior to the other two groups, and the Visick scores and endoscopic grading were better than esophageal gastric stump end-to-side anastomosis group(all P<0.05). There was no significant difference in recurrent rate of gastric stump between modified double tracks anastomosis group and esophageal gastric stump end-to-side anastomosis group(P>0.05). The 5-year overall survival rate of these 3 groups was 48.7%, 46.3% and 50.2% respectively, and no significant difference was found(all P>0.05).</p><p><b>CONCLUSION</b>Modified double tracks anastomosis is an ideal surgical method for type II-III AEG.</p>