MORBIDITY AND SURVIVAL AFTER PERIOPERATIVE CHEMOTHERAPY IN GASTRIC CANCER: A STUDY USING THE BECKER'S CLASSIFICATION AND REGRESSION.

BACKGROUND: Gastric cancer is an aggressive neoplasm with a poor prognosis. The multimodal approach with perioperative chemotherapy is currently the recommended treatment for patients with locally advanced gastric cancer. This treatment induces a histopathological response expressed either through the degree of regression of the primary tumor or of the lymph nodes or through yTNM staging. Despite its advantages, there are still doubts regarding the effects of chemotherapy on postoperative morbidity and mortality. AIMS: This study aims to evaluate the impact of perioperative chemotherapy and its effect on anatomopathological results and postoperative morbidity and on patient survival. METHODS: This is an observational retrospective study on 134 patients with advanced gastric cancer who underwent perioperative chemotherapy and curative radical surgery. The degree of histological regression of the primary tumor was evaluated according to Becker's criteria; the proportion of regressed lymph nodes was determined, and postoperative complications were evaluated according to the Clavien-Dindo classification. Survival times were compared between the groups using Kaplan-Meier curves and the Mantel-Cox log-rank test. RESULTS: In all, 22.3% of the patients were classified as good responders and 75.9% as poor responders. This variable was not correlated with operative morbidity (p=1.68); 64.2% of patients had invaded lymph nodes and 46.3% had regressed lymph nodes; and 49.4% had no lymphatic invasion and 61.9% had no signs of venous invasion. Postoperative complications occurred in 30.6% of the patients. The group of good responders had an average survival of 56.0 months and the group of poor responders had 34.0 months (p=0.17). CONCLUSION: Perioperative chemotherapy induces regression in both the primary tumor and lymph nodes. The results of the operative morbidity were similar to those described in the literature. However, although the group of good responders showed better survival, this value was not significant. Therefore, further studies are needed to evaluate the importance of the degree of lymph node regression and its impact on the survival of these patients.

The impact of the prognostic nutritional index (PNI) in gastric cancer.

BACKGROUND: Regarding the assessment of patients' immune and nutritional status, prognostic nutritional index (PNI) has been reported as a predictive marker for surgical outcomes in various types of cancer. The aim of our study was to evaluate the effect of PNI in prognosis of gastric cancer patients submitted to curative-intent resectional surgery. MATERIAL AND METHODS: A retrospective analysis with 637 gastric cancer cases submitted to curative-intent surgery, between 2010 and 2017, in an upper GI surgery unit. We analyzed 396 patients that met the inclusion criteria for this study. The median follow-up was 37 (0-113) months. RESULTS: According to Youden's method, the optimal PNI cutoff for OS was 41.625 (sensitivity 89.3% and specificity 41.3%). OS was significantly shorter in the lower-PNI group of patients when compared to the higher-PNI group (40.26 vs 77.49 months; p < 0.001). Higher PNI had a positive impact on OS in univariable analysis. When adjusted to pStage, higher PNI was still significantly associated with better OS (HR 0.405; CI 95% 0.253-0.649; p < 0.001). Regarding DFS, higher PNI was associated with better DFS (HR 0.421; CI 95% 0.218-0.815; p = 0.010). Higher-PNI group had a protective effect regarding postoperative morbidity and mortality. CONCLUSIONS: In this cohort, PNI was disclosed to significantly impact GC patients' OS and DFS, including in multivariable analysis when adjusting for classical prognostic features. PNI can be used to predict patients at increased risk of postoperative morbidity and mortality. This index may be of use in identifying candidate patients who would benefit from perioperative nutritional support to improve surgical outcomes.

Morbidity and survival after perioperative chemotherapy in gastric cancer: a study using the becker's classification and regression / Morbidade e sobrevida após quimioterapia periooperatória no câncer gástrico: um estudo utilizando a classificação de becker e a regressão linfonodal

ABSTRACT BACKGROUND: Gastric cancer is an aggressive neoplasm with a poor prognosis. The multimodal approach with perioperative chemotherapy is currently the recommended treatment for patients with locally advanced gastric cancer. This treatment induces a histopathological response expressed either through the degree of regression of the primary tumor or of the lymph nodes or through yTNM staging. Despite its advantages, there are still doubts regarding the effects of chemotherapy on postoperative morbidity and mortality. AIMS: This study aims to evaluate the impact of perioperative chemotherapy and its effect on anatomopathological results and postoperative morbidity and on patient survival. METHODS: This is an observational retrospective study on 134 patients with advanced gastric cancer who underwent perioperative chemotherapy and curative radical surgery. The degree of histological regression of the primary tumor was evaluated according to Becker's criteria; the proportion of regressed lymph nodes was determined, and postoperative complications were evaluated according to the Clavien-Dindo classification. Survival times were compared between the groups using Kaplan-Meier curves and the Mantel-Cox log-rank test. RESULTS: In all, 22.3% of the patients were classified as good responders and 75.9% as poor responders. This variable was not correlated with operative morbidity (p=1.68); 64.2% of patients had invaded lymph nodes and 46.3% had regressed lymph nodes; and 49.4% had no lymphatic invasion and 61.9% had no signs of venous invasion. Postoperative complications occurred in 30.6% of the patients. The group of good responders had an average survival of 56.0 months and the group of poor responders had 34.0 months (p=0.17). CONCLUSION: Perioperative chemotherapy induces regression in both the primary tumor and lymph nodes. The results of the operative morbidity were similar to those described in the literature. However, although the group of good responders showed better survival, this value was not significant. Therefore, further studies are needed to evaluate the importance of the degree of lymph node regression and its impact on the survival of these patients.

RESUMO RACIONAL: O cancer gástrico é uma neoplasia com mau prognóstico. A abordagem multimodal com quimioterapia-perioperatória é o tratamento recomendado para os pacientes com cancer gástrico localmente avançando. Este tratamento induz uma resposta histopatológica manifestado pelo grau de regressão do tumor primário, dos gânglios linfáticos e do estadiamento ypTNM. Apesar de suas vantagens, ainda há dúvidas quanto aos efeitos da quimioterapia na morbimortalidade pós-operatória. OBJETIVOS: Avaliar o impacto da quimioterapia perioperatória e o seu efeito nos resultados anatomopatológicos, na morbidade pós-operatória e na sobrevida. MÉTODOS: Estudo observacional-retrospetivo com 134 doentes com cancer gástrico avançado, que se submeteram a quimioterapia perioperatória e cirurgia radical curativa. O grau de regressão histológico do tumor primário foi avaliado de acordo com os critérios de Becker. A proporção de gânglios regredidos foi determinada e as complicações pós-operatórias foram avaliadas com a classificação de Clavien-Dindo. Os tempos de sobrevida foram comparados entre os grupos por meio das curvas de Kaplan-Meier e do teste Mantel-Cox Log Rank. RESULTADOS: 22,3% dos doentes foram classificados como bons-respondedores e 75,9% como maus-respondedores. Esta variável e a morbidade pós-operatória não estavam relacionadas. 64,2% dos doentes apresentaram invasão ganglionar e 46,3% tinham regressão ganglionar, 49,4% não tinham invasão linfática e 61,9% não tinham sinais de invasão venosa. As complicações pós-operatórias ocorreram em 30,6% dos pacientes. O grupo dos bons respondedores apresentou uma sobrevida mediana de 56,0 meses e o grupo dos maus respondedores 34,0 meses. CONCLUSÕES: A quimioterapia perioperatória induz a regressão quer do tumor primário e dos gânglios-linfáticos. Os resultados da morbidade pós-operatória foram semelhantes aos descritos na literatura. Apesar do grupo dos bons-respondedores apresentar melhor sobrevida, este valor não foi significativo. Assim, são necessários mais estudos que avaliem a importância do grau de regressão ganglionar e o seu impacto na sobrevida.

Beyond gut microbiota: understanding obesity and type 2 diabetes.

Obesity and type 2 diabetes are metabolic diseases that have reached epidemic proportions worldwide. Although their etiology is complex, both result from interplay between behaviour, environment and genetic factors. Within ambient determinants, human overall gut bacteria have been identified as a crucial mediator of obesity and its consequences. Gut microbiota plays a crucial role in gastro-intestinal mucosa permeability and regulates the fermentation and absorption of dietary polyssacharides, which may explain its importance in the regulation of fat accumulation and the resultant development of obesity-related diseases. The main objective of this review is to address the pathogenic association between gut microbiota and obesity and to explore related innovative therapeutic targets. New insights into the role of the small bowel and gut microbiota in diabetes and obesity may make possible the development of integrated strategies to prevent and treat these metabolic disorders.