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Objective:To probe into the potential prognostic value of lymphocyte subsets in gastric cancer.Methods:This study included patients who underwent radical gastrectomy for gastric cancer from Aug 2014 to Dec 2016. The immunological differences was analyzed in different infiltration patterns. The overall survival of patients was analyzed by Kaplan-Meier method and Log-rank test. COX regression was performed to assess independent prognostic factors of the patients, and finally constructed nomogram.Results:The median number of peripheral CD4 and CD19 cells in infiltration pattern c was 750 (94-2 504) cells/μl and 186 (17-820) cells/μl; the median number of peripheral CD4 and CD19 cells in infiltration pattern a was 802 (203-2 071) cells/μl and 213 (5-948) cells/μl, the number of peripheral CD4,CD19 cells in infiltration pattern c was lower than that in infiltration pattern a, with statistically significant differences (CD4: Z=-3.061, P=0.002; CD19: Z=-2.016 , P=0.044). CD19 lymphocytes ( P=0.023) were associated with infiltration pattern a, CD8 lymphocytes ( P=0.027) were associated with infiltration pattern b, and CD4 lymphocytes ( P=0.026) were independent risk factors associated with the prognosis of infiltration pattern c. A nomogram can be constructed to evaluate the prognosis of patients. Conclusion:There are differences in the number of peripheral lymphocyte subsets in patients with different INF types. A nomogram can be constructed from lymphocyte subsets and clinicopathological features to assess patient prognosis.
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Objective:To compare the prognosis difference between proximal gastrectomy (PG) and total gastrectomy (TG) in patients with advanced upper gastric cancer.Methods:This study included patients of upper gastric cancer admitted from Jan 2011 to Dec 2016 undergoing radical resection at Harbin Medical University Cancer Hospital. Patients were divided into TG group (178 cases) and PG group (185 cases).Results:Comapared to PG group , more TG patients were with tumor diameter >4 cm, Borrmann type Ⅲ and postoperative stage Ⅲ ( χ2=9.687, P=0.002; χ2=24.897, P=0.001; χ2=6.257 P=0.044).The 5-year overall survival (OS) of the PG group and the TG group were 64.3% (95% CI: 45.1%-50.5%) and 60.6% (95% CI: 41.3%-47.6%) ( P=0.297).After propensity score matching, the OS between the two groups was not statistically significant ( P=0.876).Subgroup analysis of chemotherapy showed that the difference in survival between TG group and PG group was not statistically significant ( P=0.309). Conclusion:There was no difference in survival between PG and TG in patients with advanced upper gastric cancer.
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Objective:To construct a double-line mixed teaching mode and to explore its application effect on the practice teaching of medical students in the department of surgical oncology.Methods:A total of 80 clinical medicine students were selected and randomly divided into a routine group and a research group, with 40 students in each group. The routine group implemented regular teaching, and the research group developed "double-line mixed teaching" mode. After teaching, the students' theoretical and practical skills assessment results, changes in medical students' abilities and their satisfaction with teaching were compared between the two groups. SPSS 19.0 was used for t test and chi-square test. Results:The theoretical and practical skill assessment scores of the research group were significantly higher than those of the routine group [(91.59±3.65) score vs. (84.67±4.34) scores, (86.05±4.16) scores vs. (74.73± 4.69) scores] ( P<0.05). The scores of medical humanistic spirit, clinical thinking ability, scientific research thinking ability, critical thinking and innovation ability of the two groups after teaching were all higher than those before teaching, and the above-mentioned ability scores of the research group were all higher than those of the routine group after teaching ( P<0.05). The satisfaction rates of the students in the research group regarding teaching content and form, improving self-study ability, strengthening understanding and mastering of knowledge, deepening practical experience, and improving collaboration ability were all higher than those of students in the routine group (87.50% vs. 67.50%; 82.50% vs. 60.00%; 90.00% vs. 67.50%; 92.50% vs. 75.00%; 95.00% vs. 77.50%), and the differences were statistically significant ( P<0.05). Conclusion:Constructing double-line mixed teaching mode in the practice teaching of medical students in the department of surgical oncology can improve the performance of theoretical and practical skills assessment, as well as improve the various abilities of medical students, and can obtain high satisfaction with the teaching mode.
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Objective:To investigate whether adjuvant chemotherapy could be beneficial for patients with pT1N1M0 (stage ⅠB) gastric cancer.Methods:From Jan 2010 to Dec 2016, 185 patients with pT1N1M0 gastric cancer who were surgically resected at Henan Cancer Hospital were retrospectively analyzed. The patients were divided into chemotherapy group ( n=100) and non chemotherapy group ( n=85). Results:For disease-free survival (DFS) analysis, univariate survival analysis showed that age, examined lymph nodes, vascular invasion, nerve invasion and adjuvant chemotherapy were associated with DFS (all P<0.05); multivariate analysis showed that lymph node resection ≥ 16 ( HR=0.363, 95% CI: 0.160-0.827, P=0.016), vascular invasion ( HR=4.117, 95% CI: 1.796-9.436, P=0.001) and postoperative chemotherapy ( HR=4.530, 95% CI: 1.932-10.622, P=0.001) were independent risk factors for DFS. For disease-specific survival (DSS) analysis, univariate survival analysis showed that lymph node resection, vascular invasion, nerve invasion and adjuvant chemotherapy were associated with DSS; multivariate analysis showed that lymph node resection ≥ 16 ( HR=0.344, 95% CI: 0.144-0.822, P=0.016), vascular invasion ( HR=5.113, 95% CI: 2.029-12.887, P=0.001) and postoperative chemotherapy ( HR=4.694, 95% CI: 1.854-11.888, P=0.001)were independent risk factors for DSS. According to examined lymph nodes and vascular invasion , pT1N1M0 patients were divided into three risk categories (high, medium and low). DFS and DSS were significantly different among the three risk groups (all P<0.001, respectively). Conclusion:pT1N1M0 gastric cancer patients are expected to benefit from adjuvant chemotherapy. Patients with less than 16 lymph nodes and vascular invasion may be particularly suitable for adjuvant chemotherapy.
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Objective@#To study the relationship of liver function index alanine aminotransferase and aspartate aminotransferase ratio (LSR) with clinicopathological factors in patients with gastric cancer and its clinical significance in predicting the survival of patients.@*Methods@#A retrospective case-control study was used. Retrospective analysis was conducted on 891 patients with advanced gastric cancer who underwent gastric cancer surgery at the Gastrointestinal Surgery Department of Harbin Medical University Cancer Hospital from January 2007 to December 2010, having complete postoperative clinicopathological and follow-up data. Case inclusion criteria: (1) preoperative definite diagnosis of gastric cancer, residual gastric cancer and other gastric tumors were excluded; (2) no neoadjuvant therapy before surgery; (3) no other serious diseases such as acute coronary heart disease, cirrhosis, chronic renal failure, etc.; (4) radical gastrectomy was performed, palliative treatment or open laparotomy cases were excluded; (5) complete postoperative pathological data, complete follow-up information; (6) cause of death was associated with gastric cancer. Blood examination was performed during hospitalization. The best cut-off points of LSR, hemoglobin, lymph node metastasis rate, maximum diameter of tumors, alkaline phosphatase, glutamyl transpeptidase, total bilirubin and lactate dehydrogenase were obtained by using receiver operating characteristic curve(ROC). Patients were divided into two groups according to best LSR cut-off points. The relationship between LSR and clinicopathological factors was analyzed, and the overall survival rate of different LSR groups was compared. Relevant clinical factors and LSR were included in the univariate and multivariate survival analysis using the Cox method.@*Results@#The best cut-off point of LSR in ROC curve was 1.43, and 682 cases in LSR<1.43 group, 209 cases in LSR≥1.43 group. The best cut-off points of hemoglobin, lymph node metastasis rate, maximum diameter of tumors, alkaline phosphatase, glutamyl transpeptidase, total bilirubin and lactate dehydrogenase were 130.2 g/L, 18.0%, 4.75 cm, 68.1 U/L, 16.55 U/L, 5.58 μmol/L and 135.8 U/L, respectively. Between patients with LSR<1.43 and LSR≥1.43, age (χ2=4.412, P=0.036), depth of tumor invasion (χ2=64.306, P<0.001), histological type (χ2=8.026, P=0.005), alkaline phosphatase (χ2=8.217, P=0.004), glutamyl transpeptidase (χ2=33.207, P<0.001), total bilirubin (χ2=14.012, P<0.001) and lactate dehydrogenase (χ2=63.630, P<0.001) were significantly different. The 1-, 3- and 5-year survival rates of LSR<1.43 group and LSR≥1.43 group were 70.8%, 31.3%, 25.0% and 64.9%, 24.4%, 11.3% respectively, whose difference was significant (χ2=10.140, P=0.001). Univariate analysis showed that age, hemoglobin, TNM stage, depth of invasion, lymph node metastasis rate, lymph node metastasis, histological type, maximum diameter of tumors, glutamyl transferase, total bilirubin and LSR were associated with overall survival of gastric cancer (all P<0.05). Multivariate analysis showed that tumor TNM stage (HR=1.605, 95%CI: 1.332 to 1.936, P<0.001), tumor invasion depth (HR=1.299, 95%CI: 1.168 to 1.445, P<0.001), lymph node metastasis rate (HR=2.400, 95%CI:1.873 to 3.076, P<0.001), lymph node metastasis (HR=1.263, 95%CI: 1.106 to 1.478, P=0.007), maximum tumor diameter (HR=1.375, 95%CI: 1.134 to 1.669, P=0.001), and LSR (HR=1.427, 95%CI: 1.190 to 1.711, P<0.001) were independent risk factors for the prognosis of patients with gastric cancer.@*Conclusions@#LSR is an independent risk factor for the prognosis of gastric cancer patients, and the detection is simple and easy. It is a potential marker for the prognosis of gastric cancer. Therefore, in the preoperative comprehensive management stage, it should be possible to restore and improve the liver function in order to obtain a better prognosis of gastric cancer and prolong the survival time of patients.
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Objective:To compare the ability of platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) in evaluating the prognosis of patients with TNM stageⅠto Ⅲ gastric cancer.Methods:From May 2001 to December 2013, the clinicopathological data of 645 patients with gastric cancer treated at Harbin Medical University Cancer Hospital were retrospectively analyzed. Chi-square test was used to analyze the differences between NLR, and PLR and clinicopathological characteristics of patients. Kaplan-Meier method and log-rank test were performed to compare the overall survival of patients. Cox proportional hazards regression model was performed to analyze the prognosis of gastric cancer patients. The ability of NLR and PLR to evaluate the prognosis of gastric cancer was compared by receiver operating characteristic curve.Results:The cutoff values of PLR and NLR were 141.50 and 1.94, respectively. PLR was associated with gender, resection method, maximum diameter of tumor, whether chemotherapy, T-stage, N-stage, TNM stage, tumor location, white blood cell, hemoglobin, albumin, and whether total gastrectomy ( χ2=9.224, 10.577, 28.825, 6.831, 29.059, 28.637, 30.748, 18.023, 24.320, 77.274, 9.021 and 10.745, all P<0.05). NLR were associated with resection method, maximum diameter of tumor, T-stage, N-stage and TNM stage, white blood cell, hemoglobin and albumin ( χ2=14.563, 12.092, 22.697, 44.735, 34.151, 7.949, 9.611 and 7.498, all P<0.05). The results of multivariate analysis showed that resection method, whether chemotherapy, T-stage, N-stage, PLR and whether total gastrectomy were all independent risk factors for gastric cancer patients ( χ2=23.653, 22.023, 16.697, 24.038, 4.110 and 22.364, all P<0.05). The five-year cumulative survival rate of the patients with PLR<141.50 was higher than that of patients with PLR≥141.50 (55.4% vs. 30.5%), and the difference was statistically significant ( χ2=47.968, P<0.01). The AUC value of PLR in prognostic evaluation of gastric cancer was 0.629, which was higher than that of NLR (0.596, P<0.01). Conclusion:PLR is better than NLR in the prognostic evaluation of gastric cancer patients.
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Objective:To evaluate the effect of vascular infiltration on the prognosis of patients with early gastric cancer.Methods:A retrospective study was performed on 625 pathologically confirmed early gastric cancer patients at the Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital from Jan 2005 to Jan 2014. χ 2 test was used to analyze the relationship between vascular invasion and clinicopathological characteristics; COX proportional hazards model was used to analyze the effect of vascular invasion on the prognosis of patients with early gastric cancer; Kaplan-Meier method was used for survival analysis. Results:There were 625 patients, including 240 (38.4%) in T1a stage and 385(61.6%) in T1b stage. 59 patients (9.4%) had vascular infiltration. Vascular invasion was related to age (χ 2=12.143, P<0.001), depth of tumor invasion (χ 2=27.538, P<0.001) and lymph node metastasis (χ 2=86.846, P<0.001). Multivariate analysis showed that age ( HR=4.370, P<0.001), positive lymph node metastasis ( HR=2.500, P<0.001) and vascular invasion ( HR=2.356, P=0.007) are independent factors affecting the prognosis. The overall 5-year survival rate for the entire group was 84.6%, that without vascular infiltration was 86.0%, significantly higher than 71.2% of those with vascular infiltration ( P=0.001). Conclusion:Age, tumor invasion depth and lymph node metastasis are risk factors for vascular invasion which in early gastric cancer predicts poor prognosis.
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Objective To study the relationship between preoperative serum ALT and clinicopathological factors in patients with gastric cancer after radical gastrectomy.Methods At the Department of Gastrointestinal Surgery,Tumor Hospital of Harbin Medical University from Jan 2008 to Dec 2010,491 patients were grouped according to ROC curve cut-off point of serum ALT.The relationship between ALT and clinical factors was analyzed,and single-factor and multi-factor survival analysis was performed.Results There were 201 patients with ALT ≤ 20.05 U/L,and 290 patients with ALT ＞ 20.05 U/L Serum ALT was associated with age (x2 =11.231,P ＜ 0.001),depth of tumor invasion (x2 =23.178,P＜0.001),GGT(x2 =19.190,P＜0.001) and AST(x2 =30.771,P＜0.001).The 1-,3-,and 5-year survival rates of patients with ALT ≤ 20.05U/L and ALT ＞ 20.05U/L were 83.5％,51.4％,42.1％ and 66.2％,27.4％,15.7％.There was significant difference between the two groups (x2 =41.711,P＜0.001).Muhivariate analysis showed that tumor TNM stage(HR =1.882,95％ CI:1.468-2.413,P ＜0.001),tumor infiltration depth (HR =1.161,95％ CI:1.020-1.322,P =0.024),lymph node metastasis (HR =1.177,95％ CI:1.042-1.329,P =0.009),Hb (HR =0.726,95％ CI:0.579-0.909,P =0.005),neutrophil to lymphocyte rate(HR =1.275,95％ CI:1.002-1.623,P =0.048) and ALT(HR =2.191,95％ CI:1.754-2.738,P ＜ 0.001) were independent risk factors for the prognosis.Conclusions Serum ALT is an independent risk factor for the prognosis of gastric cancer patients after radical gastrectomy.
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Objective@#To investigate the relationship between body mass index (BMI) and clinicopathological characteristics and prognosis of gastric cancer patients.@*Methods@#The clinical data of 788 patients with advanced gastric cancer were retrospectively analyzed. According to WHO weight standard, BMI<18.5 kg/m2 was the low weight group, BMI 18.5~< 25.0 kg/m2 was the normal weight group, BMI ≥ 25.0 kg/m2 was the overweight group. The low weight group included 127 cases, the normal weight group included 540 cases and the overweight group included 121 cases. The relationship between different BMI groups and clinicopathological characteristics of patients was analyzed. Cox multivariate regression model was used to analyze the independent factor of the prognosis of patients.@*Results@#The average BMI of 788 patients was 21.70 kg/m2. The patients′ BMI was significantly correlated with depth of invasion, maximum diameter of tumors, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) (all P<0.05). BMI was marginally correlated with gender, age, smoking, alcohol consumption, TNM stage, lymph node metastasis and histological type (all P>0.05). Furthermore, BMI was significantly correlated with prealbumin, prognostic nutritional index, total protein, albumin and hemoglobin levels (all P<0.05). BMI was also significantly correlated with intraoperative bleeding volume, operation time, number of lymph node resection, number of lymph node metastasis and lymph node metastatic ratio (all P<0.05). The median survival time of the entire group was 35.3 months. The median survival time of patients in low weight group, normal weight group, and overweight group was 21.0 months, 26.3 months, and 31.2 months, respectively, the differences were statistically significant (P<0.001). Cox multivariate analysis showed that TNM stage, depth of tumor invasion, lymph node metastasis, PLR and BMI were independent risk factors of the prognosis of patients with gastric cancer (all P<0.05).@*Conclusions@#BMI is associated with the nutritional status, intraoperative blood loss, operative time, and lymph node metastatic ratio of patients with gastric cancer. BMI is an independent risk factor of the prognosis of patients with gastric cancer. The overall survival time of patients with low body weight is shorter than those of normal weight and overweight patients.
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Objective To evaluate serum albumin (ALB) combined with hemoglobin (Hb) (ALB-Hb) in the prediction of prognosis of patients with proximal gastric cancer.Methods Clinial data of 311 patients with stage Ⅰ-Ⅲ proximal gastric cancer who underwent radical surgery were retrospectively analyzed in Harbin Medical University Cancer Hospital from Sep 2001 to Nov 2014.The preoperative ALB-Hb was calculated as following:patients with both elevated serum albumin (≥40.25 g/L) and hemoglobin (≥120 in male or ≥110 g/L infemale) were given a score of 0,and patients with only one or none were given a score of 1 or2,respectively.The ALB-HB scores of 0 points had 175 cases (56.2％),1 point had 87 cases (28.0％),and 2 points had 49 cases (15.8％).The optimal cut-off value of serum albumin,platelet count and maximum tumor diameter were defined by ROC curve;Pearson correlation was used to evaluate the correlation coefficient between serum albumin and HB;Survival analysis was analyzed by Kaplan-Meier method.The prognostic factors for patients with proximal gastric cancer was analyzed by COX proportional hazards model.The ROC curve was used to compare the prognostic value of serum albumin,hemoglobin,and ALB-Hb.Results Patients with ALB-Hb score of 2 were associated with age,serum platelet level,and maximum tumor diameter (all P ＜ 0.05).The median survival time was 41 months (3-134 months).233 cases (74.9％) died and 78 cases (25.1％) survived as of Jan 2018.There was a significant difference in overall survival (OS) among A1B-Hb scores of 0,1,and 2 (P =0.011).Univariate analysis demonstrated that platelet count,ALB-Hb score,maximum tumor diameter,and clinical stage were related to the prognosis of patients with proximal gastric cancer (all P ＜ 0.05).By multivariate analysis there were statistically significant differences in pathological parameters:ALB-Hb score (HR =1.249,95％ CI 1.047-1.489,P =0.013),maximum tumor diameter (HR =1.352,95％ CI 1.016-1.799,P=0.038) and TNM clinical stage (HR=1.667 95％ CI 1.266-2.194,P＜0.001) is an independent risk factor for prognosis.ALB-Hb score compared to serum albumin and hemoglobin alone,has a higher AUC value (P =0.019).Conclusions The preoperative ALB-Hb score is superior to serum albumin or hemoglobin alone in assessing the prognosis for patients with stage Ⅰ,Ⅱ,and Ⅲ proximal gastric cancer.
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Objective To study the relationship between preoperative systemic immune inflammatory index (SII) and the prognosis of postoperative patients. Methods A retrospective analysis was made on 1 509 patients with gastric cancer who underwent gastric cancer surgery at the Department of Gastrointestinal Surgery,Affiliated Tumor Hospital of Harbin Medical University from Jan 1991 to Dec 2012.The SII values [SII =(platelets x neutrophils) / lymphocytes] were calculated and grouped according to the SII mean.The relationship between SII and clinical factors was analyzed.Results Preoperative mean SII was 570.5,substratified into SII ＜ 570.5 group (871 cases),and SII ＞ 570.5 group (638 cases).There was a statistically significant difference between SII level and gender(x2 =4.239,P =0.040),tumor maximum diameter(x2 =31.852,P ＜ 0.001),total serum protein (x2 =7.962,P =0.005),Alb/Glob ratio(x2 =26.127,P＜ 0.001) and Hb(x2 =64.647,P＜ 0.001).The 1-,3-,and 5-year survival rates were 77.1％,42.4％,31.4％ and 68.9％,28.1％,19.8％,respectively(x2 =39.557,P ＜ 0.001).Multivariate analysis showed that tumor TNM stage (HR =1.592,95％ CI:1.401-1.809,P ＜ 0.001),infiltration depth(HR =1.256,95％ CI:1.145-1.377,P ＜ 0.001),lymph node metastasis(HR =1.177,95 ％ CI:1.042-1.329,P =0.009),tumor maximum diameter (HR =1.151,95 ％ CI:1.006-1.317,P =0.040),Hb(HR =0.832,95％ CI:0.737-0.940,P =0.003) and SII (HR =1.337,95％ CI:1.187-1.505,P ＜ 0.001) were independent risk factors for the prognosis of patients with gastric cancer.Conclusions SII is an independent risk factor for the prognosis of patients with gastric cancer.Preoperative SII ＞ 570.5 indicates poor prognosis.
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OBJECTIVE@#To compare the clinicopathological features and the prognosis between patients with adenocarcinoma of esophagogastric junction (AEG) and with adenocarcinoma of gastric antrum (AGA), and to investigate the prognostic factors of AEG and AGA.@*METHODS@#A retrospective cohort study was performed on clinicopathological data of 239 AEG patients (AEG group) and 313 AGA patients selected simultaneously (AGA group) undergoing operation at Harbin Medical University Cancer Hospital from January 2001 to December 2012.@*INCLUSION CRITERIA@#(1) receiving radical surgery (R0 resection); (2) AEG or AGA confirmed by pathological examination of postoperative tissue specimens; (3) without preoperative neoadjuvant radiotherapy or chemotherapy; (4) complete clinicopathological and follow-up data; (5) patients who died of non-tumor-related causes were excluded. Chi-square test and independent samples t-test were used to determine differences in clinicopathological factors between two groups. The overall survival (OS) of patients was compared by Kaplan-Meier method and Log-rank test. Multivariate prognosis analysis was performed using Cox proportional hazards regression model.@*RESULTS@#As compared to AGA group, AEG group had higher proportion of male [82.0%(196/239) vs. 65.2%(204/313),χ²=19.243,P0.05). The 5-year OS rate was 33.5% and 56.9% in AEG group and AGA group respectively and the median OS was 60.0(3.0-60.0) months and 33.6(3.0-60.0) months respectively; the difference was statistically significant (P<0.001). In AEG group, univariate analysis showed that differences of hemoglobin level (5-year OS rate: 24.0% for <130 g/L, 39.9% for ≥130 g/L, P=0.006), tumor diameter (5-year OS rate: 41.9% for <5 cm,28.8% for ≥5 cm, P=0.014), N stage (5-year OS rate: 42.2% for N0, 40.9% for N1, 31.7% for N2, 15.8% for N3a, 9.0% for N3b, P<0.001) and TNM stage (5-year OS rate: 56.2% for stage I, 38.5% for stage II, 28.3% for stage III,P=0.017) were statistically significant (all P<0.05); multivariate analysis revealed that the worse N stage was an independent risk factor of prognosis survival for AEG patients(HR=1.404,95%CI:1.164-1.693, P<0.001), and serum hemoglobin level ≥130 g/L was an independent protective factor of prognosis survival for AEG patients (HR=0.689,95%CI:0.501-0.946,P=0.021). In AGA group, univariate analysis showed that differences of serum albumin (5-year OS rate: 49.1% for <40 g/L, 61.1% for ≥ 40 g/L, P=0.021), tumor diameter (5-year OS rate: 74.2% for <5 cm, 39.9% for ≥ 5 cm, P<0.001), T stage (5-year OS rate: 98.3% for T1,83.3% for T2,50.0% for T3,36.8% for T4, P<0.001), N stage (5-year OS rate: 89.0% for N0, 62.3% for N1, 50.0% for N2, 33.9% for N3a, 10.3% for N3b, P<0.001) and TNM stage (5-year OS rate: 97.3% for stage I, 75.8% for stage II, 32.8% for stage III, P<0.001) were statistically significant (all P<0.05); multivariate analysis revealed that the worse T stage (HR=1.516,95%CI:1.060-2.167,P=0.023) and the worse N stage (HR=1.453,95%CI:1.209-1.747,P<0.001) were independent risk factors for prognosis of AGA patients.@*CONCLUSIONS@#As compared to AGA, AEG presents have poorer prognosis,and is easier to present with later pathological stage and larger tumor diameter. N stage and hemoglobin level are independent factors associated with the OS of AEG patients. T stage and N stage are independent factors associated with the OS of AGA patients.
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Adult , Aged , Female , Humans , Male , Middle Aged , Adenocarcinoma , Mortality , Pathology , General Surgery , Esophagogastric Junction , Pathology , General Surgery , Kaplan-Meier Estimate , Neoplasm Staging , Prognosis , Pyloric Antrum , Pathology , General Surgery , Retrospective Studies , Stomach Neoplasms , Mortality , Pathology , General SurgeryABSTRACT
PURPOSE: Fibrinogen and platelets have been reported to play important roles in tumorigenesis and cancer progression. The aim of this research was to investigate the combination of functions of fibrinogen, platelets, and mean platelet volume (MPV) in predicting the survival of patients with gastric cancer (GC). MATERIALS AND METHODS: A retrospective study was conducted with 1,946 patients with GC and 299 patients with benign gastric tumor to analyze their fibrinogen, platelet, and MPV levels, and other clinicopathological characteristics along with their prognoses. Several indicators were evaluated along with fibrinogen, platelets, and MPV and their prognostic abilities were assessed. Univariate and multivariate survival analyses were conducted to determine the independent risk factors for overall survival. RESULTS: Increased levels of fibrinogen, platelets, and MPV were observed with the progress of the GC stages. Elevated fibrinogen, platelets, and the combined indicators, including fibrinogen*MPV (FM), platelet*fibrinogen*MPV (PFM), fibrinogen/MPV (FMR), platelet*fibrinogen (PF), platelet*fibrinogen/MPV (PFMR), platelet*MPV (PM), and platelet/MPV (PMR), foreboded poor prognosis. Meanwhile fibrinogen and FMR can be considered as independent risk factors for overall survival in patients with non-metastatic GC. But these indicators can hardly predict survival of patients in stage IV. CONCLUSIONS: Elevated fibrinogen, platelets, and MPV levels were in accordance with advanced stages, and fibrinogen, platelet, and MPV, in combination, can be used to predict survival of patients with non-metastatic GC. FMR was an independent prognostic factor for overall survival of patients with GC.
Subject(s)
Humans , Blood Platelets , Carcinogenesis , Fibrinogen , Mean Platelet Volume , Prognosis , Retrospective Studies , Risk Factors , Stomach NeoplasmsABSTRACT
Objective To evaluate the prognostic value of prognostic nutritional index (PNI) in gastric cancer patients with peritoneal metastasis.Methods 287 gastric cancer patients with peritoneal metastasis were enrolled from Jan 2010 to Dec 2016.Results Compared with PNI ＞ 45,patients in PNI≤45 group were elder [(59 ± 11) vs.(54 ± 11),t =3.734,P =0.000],lower albumin [(35 ± 4) g/L vs.(42 ± 4)g/L,t =15.988,P =0.003)],lower plasm hemoglobin concentration [(110 ± 22)g/L vs.(129 ±24) g/L,t =6.245,P =0.000),higher platelet count/lymphocyte count ratio [PLR,(210 ± 89) vs.(150 ± 66),t =6.547,P =0.000],higher neutrophil count/lymphocyte count ratio [NLR,(3.7 ± 2.9)vs.(2.4 ± 1.2),t =4.628,P =0.000],lower percentage of pallative gastrectomy (45.5％ to 58.5％,x2 =4.45,P =0.035).Logistic regression analysis showed that age ＞ 58-years,NLR ＞ 2.87,PLR ＞ 170,hemoglobin ≤ 130 g/L,local organ infiltration were risk factors leading to low-PNI (all P ＜ 0.05).The median survival time for all patients was 8.7 months.Univariate analysis revealed that,PNI ＞ 45,serum albumin ＞ 40 g/L,no ascites,lower-grade of peritoneal metastasis,pallative gastrectomy,postoperation chemotherapy were positively associated with better prognosis (all P ＜ 0.05).Multivariate analysis demonstarted that,PNI (HR =0.717,P =0.039).Grade of peritoneal metastasis (HR =1.206,P =0.044),pallative gastrectomy (HR =1.529,P =0.001) were independent prognostic risk factors for the patients with peritoneal metastasis.Conclusion PNI are both predictors of nutrition assessment and of prognosis for gastric cancer patients with peritoneal metastasis.
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Objective The objective of this study was to investigate the expression of SRC1 protein in gastric cancer,and its correlation with clinicopathological parameters and prognosis.Methods Thirty-six gastric cancer tissues and matched paracancerous tissues were collected.The expressions of SRC1 at levels of mRNA and protein were detected by qRT-PCR and Western blot.The ex-pression of SRC1 protein in 286 cases of gastric cancer was detected by immunohistochemistry.The relationship between the expres-sion of SRC1 protein and the clinicopathologic parameters of gastric cancer and the prognosis of the patients were analyzed.Results The expression of SRC1 at levels of mRNA and protein were significantly lower in gastric cancer tissues than that in the normal gastric tissues(P=0.004).There was no significant correlation between the expression of SRC1 protein in gastric cancer tissues and the clin-icopathological parameters of gastric cancer patients.Kaplan-Meier survival curve analysis showed that the 5-year survival rate of SRC1 overexpressing group was significantly higher than that in the low expression group(P=0.009).Cox regression analysis showed that the low expression of SRC1,tumor invasion of T4a~T4b,lymph node metastasis N,and distant metastasis M1 were independent prognosis predictors of total survival time(P<0.05 or P<0.001).The low expression of SRC1 protein was associated with poor prog-nosis in gastric cancer.Conclusion The expression of SRC1 protein is low in gastric cancer.The SRC1 expression may be an inde-pendent prognostic factor for gastric cancer.The overexpression of SRC1 may be related to the development of gastric cancer,which may serve as a marker of tumor suppressor gene and prognosis of gastric cancer patients.
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<p><b>OBJECTIVE</b>To compare clinicopathological features and prognosis between patients with carcinoma in the remnant stomach (CRS) and with gastric cancer, and to investigate the prognostic factors in CRS patients.</p><p><b>METHODS</b>A retrospective cohort study was performed on clinicopathological data of 96 CRS patients (CRS group) and selected 440 patients with gastric cancer (GC group) treated at Harbin Medical University Cancer Hospital from January 1977 to December 2017.</p><p><b>INCLUSION CRITERIA</b>(1) undergoing gastrectomy; (2) diagnosed with CRS or gastric cancer through electronic gastroscopies and pathology; (3) without preoperative neoadjuvant radiotherapy or chemotherapy; (4) complete clinicopathological and follow-up data. The patients who died of other reasons or were lost during follow-up were excluded. Chi-square test and independent samples t-test were used to determine differences in clinicopathological factors between two groups. Survival analysis was conducted using the Kaplan-Meier method, and Log-rank test was used to compare survival difference between two groups. The prognosis of CRS patients was analyzed using Cox proportional hazards regression model.</p><p><b>RESULTS</b>As compared to GC group, CRS group had a higher proportion of female [30.2%(29/96) vs. 13.2%(58/ 440), χ=14.095, P=0.000], younger age [(56.4±10.1) years vs. (60.0±9.9) years, t=2.838, P=0.005], more distant metastasis and local organ infiltration [25.0%(24/96) vs. 16.1%(71/440), χ=4.246, P=0.039; 64.6% (62/96) vs. 24.5% (108/440), χ=58.331, P=0.000], lower prognostic nutritional index [(48.0±6.7) vs. (50.4±6.9), t=3.093, P=0.002], lower serum hemoglobin level [(115.0±24.7) g/L vs. (127.9±24.6) g/L, t=4.634, P=0.000], lower serum albumin level [(40.0±4.9) g/L vs. (41.2±5.0) g/L, t=2.038, P=0.042], and earlier occurrence of symptoms [(1.9±1.4) months vs. (3.7±3.2) months, t=5.431, P=0.000]. However, there were no statistically significant differences in TNM staging, postoperative hospital stay, and total hospitalization days between the two groups (all P>0.05). During follow-up, 24(25.0%) patients developed recurrence or distant metastasis and 68 (70.8%) patients died of tumor progression in CRS group, while 71(16.1%) patients developed recurrence or distant metastasis and 378(85.9%) patients died of tumor progression in GC group. The 5-year survival rate of CRS patients was 23.4%, which was higher than 15.0% of gastric cancer patients (P=0.032). Univariate analysis showed that the CRS patients with radical operation (P=0.000), earlier TNM stage (P=0.000), non-distant metastasis (P=0.022), serum hemoglobin level >130 g/L(P=0.013), and serum album level >40 g/L (P=0.042) had better prognosis. Multivariate analysis, enrolling above 5 factors, showed that TNM staging (HR=2.363, 95%CI: 1.478-3.776, P=0.000) and serum hemoglobin level >130 g/L(HR=0.449, 95%CI: 0.244-0.827, P=0.010) were independent factors influencing prognosis of CRS patients.</p><p><b>CONCLUSIONS</b>Although CRS patients have better prognosis than gastric cancer patients, but local organ invasion and distant metastasis occurs more readily. TNM staging and serum hemoglobin level are independent prognostic factors for CRS patients.</p>
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Aged , Female , Humans , Male , Middle Aged , Gastrectomy , Gastric Stump , Pathology , General Surgery , Lymphatic Metastasis , Multivariate Analysis , Neoplasm Recurrence, Local , Neoplasm Staging , Prognosis , Proportional Hazards Models , Retrospective Studies , Stomach Neoplasms , Pathology , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To investigate the relationship of prognostic nutritional index (PNI) with clinicopathological factors and the clinical significance of PNI in predicting the survival in patients with advanced gastric cancer.</p><p><b>METHODS</b>Clinicopathological and follow-up data of 1150 patients with advanced gastric cancer who underwent radical gastrectomy from January 2007 to December 2010 at the Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital were analyzed retrospectively. The PNI value was calculated [PNI=absolute value of lymphocyte(10/L)×5 + serum albumin (g/L)] and was grouped according to the mean value of PNI. Relationships of PNI with gender, age, tumor size, depth of invasion, tumor differentiation, tumor stage, tumor location, lymph node metastasis and tumor marker detection level were analyzed. At the same time, for the survival analysis of patients, log-rank method was used for univariate analysis, and Cox method was used for multivariate analysis.</p><p><b>RESULTS</b>Of 1150 cases, 846 were males and 304 were females with an average age of 62 (24 to 88) years. The average maximum diameter of tumor was 5.4(1.0 to 20.0) cm. Tumor of 159 cases located in the gastric fundus, 221 cases in the gastric body, 705 cases in the gastric antrum and 65 cases in the whole stomach. Well differentiated tumors were found in 198 cases and poorly differentiated tumors in 952 cases. As for depth of tumor invasion, 165 cases were T2, 343 cases were T3 and 642 cases were T4. According to TNM stage, 53 cases were stage I(, 397 cases were stage II( and 700 cases were stage III(. The average lymph node metastasis rate was 25.0%, meanwhile lymph node metastasis was N0 in 296 cases, N1 in 246 cases, N2 in 277 cases and N3 in 331 cases. Blood examination showed hemoglobin ≤130 g/L in 544 cases and >130 g/L in 606 cases; carcinoembryonic antigen ≤5 μg/L in 903 cases and >5 μg /L in 247 cases; carbohydrate antigen 19-9 ≤37 kU/L in 927 cases and >37 kU/L in 223 cases. In whole patients, the mean value of PNI was 51.81(24.5 to 80.4), PNI ≤51.81 group had 563 cases, and PNI >51.81 group had 587 cases. Between PNI ≤51.81 group and PNI >51.81 group, age (χ=22.661, P=0.000), tumor location (χ=8.979, P=0.030), tumor size (χ=34.509, P=0.000), tumor stage (χ=11.644, P=0.003), depth of tumor invasion (χ=21.681, P=0.000) and hemoglobin (χ=112.262, P=0.000) were significantly different. Patients were followed up for an average of 45.1 months (4 to 108). The 5-year survival rate was 37.7% in PNI ≤51.81 group, while it was 47.0% in PNI >51.81 group, whose difference was statistically significant (χ=8.326, P=0.004). Univariate analysis showed that patients with PNI ≤51.81(P=0.004), deeper tumor invasion (P=0.000), more metastatic lymph nodes (P=0.000), later TNM stage (P=0.000), lymph node metastasis rate >25.02%(P=0.000), hemoglobin ≤130 g/L(P=0.011), the maximum tumor diameter >5.4 cm (P=0.000), tumor undifferentiated (P=0.001), CEA >5 μg /L (P=0.000), CA199 >37 kU/L(P=0.000) and tumors locating in whole stomach (P=0.000) had poorer prognosis. Multivariate analysis showed that the age (HR=1.195, 95%CI: 1.019 to 1.401, P=0.028), the depth of tumor invasion(HR=1.429, 95%CI: 1.231 to 1.658, P=0.000), the number of metastatic lymph node (HR=1.536, 95%CI:1.330 to 1.774, P=0.000), the lymph node metastasis rate (HR=1.376, 95%CI:1.102 to 1.717, P=0.005), tumor TNM stage (HR=1.387, 95%CI: 1.026 to 1.876, P=0.033) and tumor size(HR=1.182, 95%CI: 1.005 to 1.390, P=0.043) were independent prognostic factors of gastric cancer patients, while PNI (HR=0.913, 95%CI: 0.774 to 1.076, P=0.278) was not an independent risk prognostic factor of gastric cancer patients.</p><p><b>CONCLUSIONS</b>Although the PNI is not an independent risk factor of overall survival in patients with advanced gastric cancer, it is still an indicator of survival in patients with gastric cancer. Improving preoperative nutritional status in patients with gastric cancer may contribute to a better prognosis.</p>
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Objective The aims of this study were to investigate the prognostic value of CEA and CA19-9 expression in advanced gastric cancer and the prognostic factors of advanced gastric cancer.Methods A total of 255 patients with advanced gastric cancer who underwent radical R0 radical surgery were enrolled in the Department of Gastrointestinal Surgery,Harbin Medical University Cancer Hospital from January 2010 to December 2010,and were divided into group A(CEA0.05).The 1-year,3-year and 5-year survival rates of group A were higher than those of group B and group C(P>0.05).The factors affecting the prognosis of gastric cancer included the degree of tumor differentiation,pathological T staging,pathological TNM staging,the total number of lymph nodes,the number of positive lymph nodes and lymph node metastasis.Conclusion Combined detection of CEA and CA19-9 expression indicates a certain reference value for prognosis of gastric cancer.
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Objective To investigate the clinical efficacy of SOX and XELOX in neoadjuvant chemo-therapy for advanced gastric carcinoma .Methods Seventy-five cases with advanced gastric carcinoma were se-lected from our hospital from Feb 1,2011 to Oct 1,2015.SOX and XELOX were used to these patients treatment . The relationship between SOX and XELOX with tumor stage ,clinical curative effect evaluation ,operation ,postop-erative pathology ,adverse reaction ,survival analysis with advanced gastric carcinoma had been analyzed retrospec -tively.Results The efficacy of SOX and XELOX were 47.22%,41.03%.Compared with the two groups ,the CT curative effect evaluation,effective rate,disease control rate had no significant differences (P>0.05).The median survival time of DFS and OS were significant between the two groups (P<0.05).Conclusion The SOX and XELOX for neoadjuvant chemotherapy of advanced gastric carcinoma treatment is safety and effective , and the XELOX is better than SOX in terms of long -term effect,prognosis and clinical benefits .
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Objective To explore the intraoperative process and determine that the stomach resection margin is accurate so as to ensure the quality of operation and improve the patients′survival rate .Method Nor-mally,tissue samples were continuously collected from two sides of visualized tumor edge as center .Specifically, the tissue samples were collected from upper side when tumor located at gastric antrum ,collected from lower side when tumor located at gastric cardia ,and collected from distant side when tumor located at gastric body .All sam-ples were processed with paraffin embedding ,staining,and were judged by the distance of tumor cell infiltration . Results The mucosa infiltration distance was more than 5 cm in 5 cases,more than 3 cm but less than 5 cm in 5 cases,and less than 3 cm in 118 cases.A total of 218 cases had less 0 cm mucosa infiltration distance ,which was visualized distance less than the microscopic .The serosa infiltration distance was more than 5 cm in 6cases,more than 3 cm but less than 5cm in 19 cases,and more or equal than 0 cm in 251 cases.A total of 95 cases had less 0 cm infiltration distance .The results of the single factor analysis showed that whether the general observed infil -tration distance of the mucosal membrane was greater than what observed under the microscope ,is associated with gender,age, maximum diameter,thickness of the tumor,external quality,and TNM stage.It significantly demon-strated the relationship of microscopic mucous membrane infiltration distance with sex , vertical diameter , thick-ness,stroma mass,and TNM stage.Stroma membrane infiltration distance significantly correlated with vertical di-ameter,the largest diameter,thickness,gross type,histological type,stroma mass,and TNM stage.Conclusion The infiltration of distance was less than 5 cm among ninety nine percent of patients with gastric cancer .There-fore,enlarged resection of 5 cm from visualized margin of tumor is necessary for operative treatment .There are as-sociations between tumor infiltration distance and vertical diameter ,thickness,stroma mass,manner of infiltration, and TNM stage .