Prognostic value of three different lymph node staging systems in the survival of patients with gastric cancer following D2 lymphadenectomy.

The log odds of positive lymph nodes (LODDS) was defined as the log of the ratio between the number of positive lymph nodes and the number of negative lymph nodes, which is a novel and promising nodal staging system for gastric cancer. Here, we aimed to compare the prognostic effect of pN, lymph node ratio (LNR) and LODDS. The association between overall survival and pN, LNR and LODDS was retrospectively analysed. The discriminatory ability and monotonicity of gradients (linear trend χ (2) score), homogeneity ability (likelihood ratio test) and prognostic stratification ability (Akaike information criterion [AIC] and receiver operating characteristic [ROC] curve) were compared among three lymph node staging systems. The pN, LNR and LODDS were all identified as independent prognostic factors for gastric cancer patients in the multivariate analysis. LODDS showed the best prognostic performance (linear trend χ (2) score 266.743, likelihood ratio χ (2) test score 427.771, AIC value 5670.226, area under the curve (AUC) 0.793), followed by LNR and pN. In patients with different levels of retrieved lymph nodes (≤10, 11-14, 15-25 and >25), LODDS was the most powerful for prognostic prediction and discrimination of the heterogeneity among the subgroups. Significant differences in survival were observed among patients in different LODDS subgroups after being classified according to the pN and LNR classifications. LODDS appears to be a more powerful system for predicting the overall survival of gastric cancer patients, as compared to LNR and pN, and may serve as an alternative nodal staging system for gastric cancer.

CD44, Sonic Hedgehog, and Gli1 Expression Are Prognostic Biomarkers in Gastric Cancer Patients after Radical Resection.

Aim. CD44 and Sonic Hedgehog (Shh) signaling are important for gastric cancer (GC). However, the clinical impact, survival, and recurrence outcome of CD44, Shh, and Gli1 expressions in GC patients following radical resection have not been elucidated. Patients and Methods. CD44, Shh, and Gli1 protein levels were quantified by immunohistochemistry (IHC). The association between CD44, Shh, and Gli1 expression and clinicopathological features or prognosis of GC patients was determined. The biomarker risk score was calculated by the IHC staining score of CD44, Shh, and Gli1 protein. Results. The IHC positive staining of CD44, Shh, and Gli1 proteins was correlated with larger tumour size, worse gross type and histological type, and advanced TNM stage, which also predicted shorter overall survival (OS) and disease-free survival (DFS) after radical resection. Multivariate analysis indicated the Gli1 protein and Gli1, CD44 proteins were predictive biomarkers for OS and DFS, respectively. If biomarker risk score was taken into analysis, it was the independent prognostic factor for OS and DFS. Conclusions. CD44 and Shh signaling are important biomarkers for tumour aggressiveness, survival, and recurrence in GC.

Gastric Mucinous Cancer Histology: Clinicopathological Characteristics and Prognostic Value.

MC tended toward worse tumor biological behavior and long-term survival outcome compared to WMDC. Moreover, MC also showed worse clinicopathological features and survival outcome in some selected patients. For these reasons, MC should be deemed as a special histological type of gastric cancer with worse clinicopathological features and survival outcome.

Impact of clinicopathological features and extent of lymph node dissection on the prognosis in early gastric cancer patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the impact of clinicopathological features and extent of lymph node dissection on the prognosis in early gastric cancer (EGC) patients.</p><p><b>METHODS</b>A total of 142 EGC cases screened from database of gastric cancer of Sun Yat-sen University, from Aug. 1994 to Jan. 2010, were included in this study. According to the lymph node metastasis status, they were divided into lymph node negative (n = 116) and lymph node positive (n = 26) groups. The clinicopathological features of the two groups and the impact of extent of lymph node dissection on the prognosis were analyzed.</p><p><b>RESULTS</b>There were no significant differences in age, gender, tumor size and location, Borrmann typing, WHO TNM staging, histological typing, and CEA value between the two groups (P > 0.05). The TNM stages in the lymph node positive group were higher than that in the lymph node negative group (P < 0.001). Between the cases who underwent D1 (n = 21) and D2 (n = 121) dissection, there were no significant differences in postoperative hospital days, blood transfusion volume, and operation time (P > 0.05). The median numbers of LN dissected in D1 and D2 cases were 4 (0 to 16) and 20 (12 to 30), with a significant difference (P = 0.000), but the number of positive LN without significant difference (P = 0.502). The postoperative complication rates were 9.5% in the D1 and 3.3% in the D2 dissection groups, without a significant difference (P = 0.128). The median survival time of the lymph node negative and positive groups was 156 vs. 96 months (P = 0.010). In cases who received D2 and D1 lymph node dissection, the median survival time (MST) was 156 vs. 96 months (P = 0.0022). In the lymph node positive group, D2 dissection prolonged survival time significantly than D1 dissection (96 vs. 27months) (P = 0.001). Cox regression analysis showed that the extent of lymph node dissection and LN metastasis were independent prognostic factors for EGC patients.</p><p><b>CONCLUSIONS</b>It is not able to accurately assess the LN metastasis status preoperatively according to the routine clinicopathological features. For the patients with unknown LN metastasis status, D2 dissection should be the first choice. Comparing with D1 dissection, the morbidity of D2 dissection are not increased, but survival time is prolonged.</p>

Clinicopathological features and prognosis of young patients with gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the clinicopathological characteristics and analyze the prognostic factors of young patients with gastric cancer.</p><p><b>METHODS</b>A total of 99 patients with the age less than or equal to 40 were admitted in The First Affiliated Hospital of Sun Yat-sen University from August 2001 to December 2009. Their clinicopathological and follow-up data were compared with middle-aged and elderly patients with the age more than 40.</p><p><b>RESULTS</b>There were statistically significant differences in gender, tumor location, Borrmann type, histological type, differentiated histology, depth of invasion, peritoneal metastasis between young patients and elder ones. The 5-year survival rates of young and elder patients were 49.1% and 44.4% respectively, and the difference was not statistically significant (P>0.05). Univariate and multivariate analyses showed that TNM stage (P=0.014) and surgical methods (P=0.012) were independent predictive factors of survival for young patients. For the young patients, the 5-year survival rate was 56.7% after curative resection, 11.1% after palliative resection. Those who underwent palliative surgery or biopsy alone died within 1 year after surgery. The difference between difference surgical procedures in survival were statistically significant (P<0.05).</p><p><b>CONCLUSIONS</b>As compared to elder patients, young patients with gastric cancer have special clinicopathological features. However, no significant difference of survival rate is found between the young and the elder patients. TNM stage and surgical methods are independent prognostic factors of young patients with gastric cancer. Radical resection appears to confer the only chance of prolonged survival.</p>

Meta-analysis of pancreaticoduodenectomy prospective controlled trials: pancreaticogastrostomy versus pancreaticojejunostomy reconstruction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pancreaticogastrostomy (PG) has been proposed as an alternative to pancreaticojejunostomy (PJ), assuming that postoperative complications are less frequent. The aim of this research was to compare the safety of PG with PJ reconstruction after pancreaticoduodenectomy.</p><p><b>METHODS</b>Articles of prospective controlled trials published until the end of December 2010 comparing PJ and PG after PD were searched by means of MEDLINE, EMBASE, Cochrane Controlled Trials Register databases, and Chinese Biomedical Database. After quality assessment of all included prospective controlled trials, meta-analysis was performed with Review Manager 5.0 for statistic analysis.</p><p><b>RESULTS</b>Overall, six articles of prospective controlled trials were included. Of the 866 patients analyzed, 440 received PG and 426 were treated by PJ. Meta-analysis of six prospective controlled trials (including RCT and non-randomized prospective trial) revealed significant difference between PJ and PG regarding postoperative complication rates (OR, 0.53; 95%CI, 0.30 - 0.95; P = 0.03), pancreatic fistula (OR, 0.47; 95%CI, 0.22 - 0.97; P = 0.04), and intra-abdominal fluid collection (OR, 0.42; 95%CI, 0.25 - 0.72; P = 0.001). The difference in mortality was of no significance. Meta-analysis of four randomized controlled trials (RCT) revealed significant difference between PJ and PG regarding intra-abdominal fluid collection (OR, 0.46; 95% CI, 0.26 - 0.79; P = 0.005). The differences in pancreatic fistula, postoperative complications, delayed gastric emptying, and mortality were of no significance.</p><p><b>CONCLUSIONS</b>Meta-analysis of six prospective controlled trials (including randomized controlled trials (RCT) and non-randomized prospective trial) revealed significant difference between PJ and PG regarding overall postoperative complications, pancreatic fistula, and intra-abdominal fluid collection. Meta-analysis of four RCT revealed significant difference between PJ and PG with regard to intra-abdominal fluid collection. The results suggest that PG may be as safe as PJ.</p>

Fast track surgery accelerates the postoperative rehabilitation and recovery of insulin sensitivity in elective operation for colorectal carcinoma: a randomized controlled clinical trial / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of fast track surgery on postoperative insulin sensitivity on the basis of clinical benefits in patients undergoing elective open colorectal resection.</p><p><b>METHODS</b>During May 2008 to December 2008, Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups: a fast track group (35 cases) and a conventional care group (35 cases). All included patients received elective open colorectal resection with combined tracheal intubation and general anesthesia. Clinical parameters, stress markers and insulin sensitivity were evaluated in both groups.</p><p><b>RESULTS</b>The 62 patients finally completed the study, 32 cases in the fast-track group and 30 cases in the conventional care group. The speed of recovery of postoperative insulin sensitivity on 7 days postoperative in the fast-track group (97% ± 9%) was significantly faster than the conventional care group (88.5% ± 9.0%, t = 2.552, P = 0.016). The hospitalization days in the fast-track group was 6 days (M(50)), and it was significantly shorter than the conventional care group ((11.7 ± 3.8) days, Z = 4.360, P = 0.000). The time of recovery of bowel function were faster in the fast-track group (time to pass flatus was 2 days (M(50))) than the conventional care group (4 days, Z = 3.976, P = 0.000). The Infectious complication rate in the fast-track group (2/32) is lower than the other group (8/30, P = 0.040).</p><p><b>CONCLUSION</b>Fast track surgery accelerates recovery of postoperative insulin sensitivity in elective surgery for colorectal carcinoma with a lower rate of postoperative infectious complications and a shorter length of postoperative hospital stay.</p>

Impact of different gastrectomy and reconstruction methods on prognosis and quality of life in proximal gastric cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the impact of different gastrectomy and reconstruction method on prognosis and quality of life in proximal gastric cancer.</p><p><b>METHODS</b>The 265 cases of proximal gastric cancer received radical resection, according to gastrectomy or reconstruction method, were divided into proximal gastrectomy/gastroesophagostomy group (PG) (n = 63) and total gastrectomy/esophagojejunostomy group (TG) (n = 202). The clinical pathologic features, prognosis, postoperative quality of life in 2 groups were compared.</p><p><b>RESULTS</b>There had no significant differences in age, gender, CEA value between two groups (all P > 0.05). In PG and TG group, tumor size (cm), ratio of organic invasion, lymph nodes metastasis, distal metastasis, TNM IV stage, Borrmann typing, poor or undifferentiated carcinoma was 2.9 ± 1.9 vs. 4.8 ± 2.8, 9.5% vs. 32.2%, 64.7% vs. 70.6%, 0 vs. 8.4%, 6.9% vs. 31.8%, 44.4% vs. 69.2%, 31.7% vs. 53.7%, respectively, all with significant difference (t = -6.260, χ(2) = 29.473, 14.559, 5.665, 32.483, 12.588, 10.954, all P < 0.05). In PG and TG group, the ratio of D3 and D3(+) resection, multi-visceral resection, complications was 0 vs. 13.8%, 9.5% vs. 38.6%, 7.9% vs. 1.5% respectively, showed increasing range of resection and decreasing complications significantly in TG group (all P < 0.05). The median survival time (months) was 62.5 vs. 78.9 in TG and PG group respectively, without significant difference (P > 0.05). In 2 groups, the evaluation index of post-operative quality of life without significant differences (P > 0.05).</p><p><b>CONCLUSIONS</b>For proximal gastric cancer, although the cases received TG with worse clinicopathological features, which prognosis was similar to that received PG. The postoperative quality of life without significant difference between the cases received gastroesophagostomy and esophagojejunostomy.</p>

Fast track surgery accelerates the recovery of postoperative insulin sensitivity / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Few clinical studies or randomized clinical trial results have reported the impact of fast track surgery on postoperative insulin sensitivity. This study aimed to investigate the effects of fast track surgery on postoperative insulin sensitivity in patients undergoing elective open colorectal resection.</p><p><b>METHODS</b>Controlled, randomized clinical trial was conducted from November 2008 to January 2009 with one-month post-discharge follow-up. Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups: a fast track group (35 cases) and a conventional care group (35 cases). All included patients received elective open colorectal resection with combined tracheal intubation and general anesthesia. Clinical parameters (complication rates, return of gastrointestinal function and postoperative length of stay), stress index and insulin sensitivity were evaluated in both groups perioperatively.</p><p><b>RESULTS</b>Sixty-two patients finally completed the study, 32 cases in the fast-track group and 30 cases in the conventional care group. Our findings revealed a significantly faster recovery of postoperative insulin sensitivity on postoperative day 7 in the fast-track group than that in the conventional care group. We also found a significantly shorter length of postoperative stay and a significantly faster return of gastrointestinal function in patients undergoing fast-track rehabilitation.</p><p><b>CONCLUSION</b>Fast track surgery accelerates the recovery of postoperative insulin sensitivity in elective surgery for colorectal carcinoma with a shorter length of postoperative hospital stay.</p>

Clinical analysis of imatinib in patients with advanced gastrointestinal stromal tumor / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and influencing factors of imatinib in patients with advanced gastrointestinal stromal tumor(GIST).</p><p><b>METHODS</b>From April 2004 to January 2010, clinicopathological data of 73 adult patients with advanced GIST treated with imatinib at the First Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. The treatment outcomes and associated factors were investigated.</p><p><b>RESULTS</b>Treatment outcomes included complete response in 1(1.4%) patients, partial response in 53(72.6%), stable disease in 14(19.2%), and primary resistant in 5(6.8%). All the patients had routine followed up, the length of which ranged from 12 to 76 (median 32) months. The median progression-free survival was 45.0 months(95% confidence interval, 34.2-55.8). The progression-free survival(PFS) rate was 87.7% in 1 year, 63.6% in 3 year, and 39.6% in 5 years. On multivariate analysis, both mutation status and patient performance were independent factors influencing the efficacy of imatinib treatment(both P<0.01). PFS was significantly better in patients with c-kit exon 11 mutations than those with exon 9 mutations, and better in lower ECOG scales than in higher ones.</p><p><b>CONCLUSION</b>Imatinib is effective in treating patients with advanced GIST, c-kit exon 9 mutations and poor performance status predict an adverse survival benefit of imatinib therapy.</p>

Comparison of nutritional status between pancreaticojejunostomy and pancreaticogastrostomy following pancreaticoduodenectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the nutritional status between pancreaticojejunostomy(PJ) and pancreaticogastrostomy(PG) following pancreaticoduodenectomy.</p><p><b>METHODS</b>A retrospective clinical analysis was performed on 37 patients undergoing pancreaticoduodenectomy(PD) for duodenal carcinoma and pancreatic non-epithelial tumor with PG(n=19) and PJ(n=18) in the First Hospital of Sun Yat-sen University from April 2006 to December 2010. All the patients had a needle catheter jejunostomy inserted at the conclusion of laparotomy. Postoperative early enteral nutrition and parenteral nutrition was performed for all the patients. Nutritional status of two groups was compared in body mass index (BMI), serum nutritional parameters such as albumin, transferrin and prealbumin before surgery and on 1, 3, and 6 months postoperatively.</p><p><b>RESULTS</b>There were no significant differences between PG and PJ groups in operative time, blood loss, pancreatic fistula, perioperative death, or postoperative length of hospital stay. One month after surgery, there were no significant differences in BMI [(17.1±7.0) vs. (19.0±4.8) kg/m(2), P>0.05], albumin [(30.1±0.5) vs. (32.1±1.3) g/L, P>0.05], transferrin [(1.89±0.57) vs. (2.01±0.61) g/L, P>0.05] and prealbumin[(0.18±0.05) vs. (0.18±0.09) g/L, P>0.05]. These parameters were decreased at 1 month after surgery, and gradually recovered to baseline or higher than the preoperative levels at 6 months after surgery. However, the differences were still not statistically significant between two groups.</p><p><b>CONCLUSIONS</b>The influence of PJ and PG on the postoperative nutritional status are comparable.</p>

Astrocyte-elevated gene-1 overexpression is associated with poor prognosis in gastric cancer.

Astrocyte-elevated gene-1 (AEG-1) plays an important role in diverse cancers and its up-regulation is associated with poor survival of patients. However, the status of AEG-1 expression and its significance in gastric cancer are still unclear. In this study, the expression of AEG-1 was studied in different gastric cancer cell lines and gastric cancer tissues. Expression of AEG-1 was significantly higher in gastric cancer tissues than that in normal tissues. Overexpression of AEG-1 was found in 62.9% of gastric cancers and significantly associated with TNM stage and Ki-67 proliferation index (P < 0.01). For survival study, overexpression of AEG-1 was significantly associated with poor survival (P < 0.01). Further multivariate analysis suggested that AEG-1 overexpression was an independent prognostic factor for the disease. We demonstrated that inhibition of AEG-1 expression by specific siRNA clearly inhibited SGC-7901 cell growth and enhanced cell apoptosis (P < 0.01). Inhibition of AEG-1 reduced phosphorylation of AKT and glycogen synthase kinase (GSK)-3ß (Ser 9) and decreased the level of ß-catenin, lymphoid enhancer binding factor 1 (LEF1), and Cyclin D1. This indicated that AEG-1 may play a role in Wnt/ß-catenin-mediated cancer progression. Taken together, overexpression of AEG-1 could be a useful prognostic factor in patients with gastric cancer. Targeted inhibition of AEG-1 may provide a novel therapeutic strategy for gastric cancer.

Giant epithelial splenic cyst / 中华医学杂志(英文版)

Splenic cysts are unusual in daily surgical practice and less than 1000 cases have been reported. Primary, true or epithelial splenic cysts, are even rarer. Usually, most of the cysts are asymptomatic until of significant size, at which time they are then detected incidentally on ultrasonography or CT scan. We report a case of a 25-year-old woman with giant epithelial splenic cyst with about 3000 ml of clear-yellow fluid was collected from the cyst. The splenectomy specimen measured 205 mm × 192 mm × 137 mm and weighed 4000 g.

Spleen-preserving distal pancreatectomy with conservation of the spleen vessels / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Distal pancreatectomy traditionally included splenectomy; the spleen, however, is an important organ in the immunologic defense of the host and is worthy of preservation. The aim of this research was to study the feasibility, safety and clinical effects of spleen and splenic vessel-preserving distal pancreatectomy.</p><p><b>METHODS</b>A retrospective review was performed for 26 patients undergoing distal pancreatectomy for benign or low grade malignant disease with splenectomy (n = 13) or splenic preservation (n = 13) at the First Hospital of Sun Yat-sen University and Guangdong General Hospital in Southern China from May 2002 to April 2009.</p><p><b>RESULTS</b>All 26 pancreatectomies with splenectomy or splenic preservation were performed successfully. There was no statistically significant difference between two groups in mean operative time ((172 ± 47) minutes vs. (157 ± 52) minutes, P > 0.05), intraoperative estimated blood loss ((183 ± 68) ml vs. (160 ± 51) ml, P > 0.05), incidence of noninfectious and infection complication and mean length of postoperative hospital stay ((10.1 ± 2.2) days vs. (12.1 ± 4.6) days, P > 0.05). The platelet counts examined one week after operation were significantly higher in the distal pancreatectomy with splenectomy group than the other group ((37.3 ± 12.8) × 10(9)/L vs. (54.7 ± 13.2) × 10(9)/L, P < 0.05).</p><p><b>CONCLUSIONS</b>Spleen-preserving distal pancreatectomy appears to be a feasible and safe procedure. In selected cases of benign or low-grade malignant disease, spleen-preserving distal pancreatectomy is recommended.</p>

Rectal non-Hodgkin lymphoma with concomitant rectal adenocarcinoma: a case report and literature review / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To report a case of rectal non-Hodgkin lymphoma with concomitant rectal adenocarcinoma.</p><p><b>METHODS</b>Clinical records of a 71 years old male patient with rectal non-Hodgkin lymphoma with concomitant rectal adenocarcinoma admitted on May 19, 2010 to the First Affiliated Hospital of Sun Yet-sen University were retrospectively reviewed. Clinical manifestations, diagnosis, and treatment as well as postoperative pathology were summarized.</p><p><b>RESULTS</b>The preoperative diagnosis of the patient was severe atypical adenomatous hyperplasia with focal carcinogenesis, and the preoperative staging was T2N0-1M0. The patient underwent a Parks procedure (rectal resection and colo-anal anastomosis) and subtotal resection of left lateral liver. The operation was successful, postoperative recovery uneventful. Postoperative pathology showed moderately differentiated tubular adenocarcinoma with deep muscular invasion, and non-Hodgkin lymphoma with marginal zone cell. Both the distal and proximal resection margins were negative and no vascular and neural invasion were seen. Immunohistochemical staining indicated L26(+), Bcl-2(+), Bcl-6(+), CD3(-), CD23(-), CK epithelial cells(+), and M-CEA luminal border(+). The pathological and immunohistochemistry results of liver specimens showed hepatic mucosa-associated marginal zone lymphoma.</p><p><b>CONCLUSIONS</b>Rectal adenocarcinoma and lymphoma occurring at the same site simultaneously is extremely rare with unique pathologic features.</p>

(-)-Epigallocatechin-3-gallate reduces vascular endothelial growth factor expression in gastric cancer cells via suppressing activity / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the molecular mechanism involved in the downregulation of vascular endothelial growth factor(VEGF) expression through the suppression of signal transducer and activator of transcription 3(Stat3) by(-)-Epigallocatechin-3-gallate (EGCG).</p><p><b>METHODS</b>After human gastric cancer cells (AGS) were treated with IL-6 (50 μg/L) and EGCG(0, 5, 10, 25 or 50 μmol/L), the expression levels of VEGF, total Stat3(tStat3), and activated Stat3(pStat3) in tumor cells were examined by Western blotting. The influence of the inhibitor of Stat3 pathway on the IL-6-induced VEGF expression was investigated. VEGF protein level in tumor cell culture medium was determined by ELISA and VEGF mRNA expression in tumor cells by RT-PCR. Tumor cell nuclear extract was prepared and nuclear expression of pStat3 was detected. Stat3-DNA binding activity was examined with chromatin immunoprecipitation (ChIP) assay.</p><p><b>RESULTS</b>IL-6 significantly increased VEGF expression in AGS gastric cancer cells. Compared with the group without IL-6, the expression and secretion of VEGF protein, and mRNA expression increased by 2.4 fold,2.8 fold, and 3.1 fold(all P<0.01), respectively. EGCG treatment markedly reduced VEGF protein, release and mRNA expression in a dose-dependent manner. When compared with the control group induced by IL-6, EGCG and AG490(a Stat3 pathway inhibitor) significantly inhibited VEGF expression induced by IL-6 (P<0.01). EGCG dose-dependently inhibited pStat3 induced by IL-6(P<0.05), but not tStat3 (P>0.05). Stat3 nuclear translocation and Stat3-DNA binding activity in AGS cells or that induced by IL-6 were directly inhibited by EGCG(P<0.05).</p><p><b>CONCLUSION</b>EGCG reduces expression of VEGF in gastric cancer cells through the inhibition of Stat3 activity.</p>

Neutrophil-lymphocyte ratio as a prognostic factor in gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore whether neutrophil-lymphocyte ratio (NLR) is an effective prognostic marker in gastric cancer.</p><p><b>METHODS</b>Clinical data of 775 patients with gastric cancer in the First Affiliated Hospital of Sun Yat-sen University from 1994 to 2006 were analyzed retrospectively. According to preoperative NLR, the patients were divided into the low NLR group (NLR≤3.79, n=652) and the high NLR group (NLR>3.79, n=123). The 5-year survival rates of two groups of different TNM stage, different surgical intervention were separately analyzed.</p><p><b>RESULTS</b>The 5-year survival rates in the low NLR group and high NLR group were 44.0% and 12.2% respectively (P<0.01). In different TNM stages: stage I (97.8% vs 33.3%), stage II (55.4% vs 32.0%), stage IIIA (30.2% vs 11.1%), stage IIIB (15.5% vs 8.3%), stage IV (10.7% vs 2.1%), and in different surgical intervention: D1 curative gastrectomy (93.3% 33.3%), D2 group (51.3% vs 20.4%), D3 group (42.4% vs 10.5%), D4 group (14.3% vs 2.0%), and in palliative operation group (8.3% vs 2.2%). There were significant differences of 5-year survival rate in TNM staging and surgical procedures between the high and low NLR groups (all P<0.05).</p><p><b>CONCLUSION</b>Preoperative NLR may be a prognostic marker in patients with gastric cancer.</p>

Effects of diabetes mellitus on prognosis of the patients with colorectal cancer undergoing resection: a cohort study with 945 patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Diabetes mellitus plays an important role in cancer prevalence and outcomes. The aim of this study was to evaluate the influence of DM on stages and outcomes among patients with colorectal cancer.</p><p><b>METHODS</b>The study enrolled 945 patients who were diagnosed as having colorectal carcinoma from August 1994 to December 2002. In the cohort, 26 patients were diagnosed as having DM. With a median follow-up of 45.8 months, differences in overall survival and disease-free survival between the diabetes and non-diabetes groups were analyzed.</p><p><b>RESULTS</b>Kaplan and Meier analysis showed that there were no significant differences between the two groups in overall survival rates at 3 years or 5 years. At 5 years, patients with DM, compared with patients without diabetes, experienced a significantly lower disease-free survival rate (34.2% diabetics vs. 55.1% non-diabetics; P = 0.025).</p><p><b>CONCLUSIONS</b>DM was associated with an increased risk of recurrence in patients with colorectal cancer.</p>

Comparison of clinicopathological characteristics and prognosis of mucinous and poorly differentiated gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological characteristics between mucinous gastric cancer (MGC) and poorly differentiated gastric cancer(PDGC) and factors associated with prognosis.</p><p><b>METHODS</b>Medical records of 1016 consecutive patients with gastric cancer were retrospectively reviewed. Sixty-eight patients with MGC and 508 with PDGC were identified. Clinicopathologic characteristics and overall survival data were analyzed.</p><p><b>RESULTS</b>As compared to PDGC patients, patients with MGC were significantly older [(59.2±11.9) years vs. (54.1±13.2) years], had significantly more distant metastasis(36.8% vs. 23.8%), more peritoneal seeding(29.4% vs. 16.9%), and less radical resection(60.3% vs. 76.6%). There were no significant differences in 5-year survival rate between MGC and PDGC patients(29.4% vs. 35.5%). However, for tumors in the middle third of the stomach, the survival rate of MGC patients was lower than that of PDGC. Using a Cox proportional hazard ratio model, lymph node involvement and radical resection were independent prognostic factors for survival of MGC patients, while tumor invasion, lymph node involvement, and radical resection were associated with survival in patients with PDGC.</p><p><b>CONCLUSION</b>Although MGC and PDGC differ in age, frequencies of peritoneal seeding, distant metastasis, and rate of radical resection, overall survival is comparable.</p>

Efficacy of tyrosine kinase inhibitor therapy combined with surgical resection in patients with metastatic gastrointestinal stromal tumor / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical effect of surgery following systemic targeted therapy of tyrosine kinase inhibitors (TKIs) in patients with metastatic gastrointestinal stromal tumors (GIST).</p><p><b>METHODS</b>From June 2007 to December 2009, data of 15 consecutive patients with metastatic GIST treated with imatinib/sunitinib followed by surgery were retrospectively analyzed.</p><p><b>RESULTS</b>Disease responses to TKI treatment was categorized into controlled disease (including partial response and stable disease) (6, 40.0%), limited progression (4, 26.7%), and generalized progression (5, 33.3%), respectively. Surgeries were performed after mean 12 months following TKI therapies. Gross complete resection or optimal debulking with minimal residual disease were managed to performed in 8/10 patients with disease controlled and limited progression, while optimal debulking only achieved in 2/5 patients with generalized progression. Surgical morbidity was 20.0% (3/15). After operation, patients with disease controlled and limited progression had a median progression-free survival of 25.0 months and 2-year overall survival rate of 100%. In contrast, for patients with generalized progression, the median progression- free survival was 3 months (P<0.01), and median overall survival 10.5 months.</p><p><b>CONCLUSIONS</b>Patients with metastatic GIST who have controlled disease or limited progression to TKI therapy can benefit from surgical resection. Surgery should be selective in patients with generalized progression since surgery hardly improves survival in these patients.</p>