Prognostic Significance of Preoperative and Postoperative Evaluation of Combined Tumor Markers for Patients With Colon Cancer.

BACKGROUND: The combined value of the tumor markers carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) in patients with colon cancer (CC) is unclear. This study aimed to investigate the role of composite tumor markers in the prognosis of CC. METHODS: Patients who underwent curative resection of colon adenocarcinoma were enrolled. The tumor marker status before and after the operation was used to divide the patients into groups according to the number of tumor markers with abnormal expression, and recurrence-free survival (RFS) and overall survival (OS) of different groups were compared. The impact of changes in composite tumor markers in the perioperative period on outcomes was further explored. RESULTS: Ultimately, 531 patients were enrolled in the study. As the number of preoperative and postoperative elevated tumor markers increased, both RFS and OS rates became lower (both P<0.05). Further analysis revealed that the number of elevated tumor markers after resection can significantly affect the outcomes (both P<0.05). In patients with abnormal preoperative tumor markers, normalization of markers after surgery was a protective factor for prognosis (both P<0.05), and patients with postoperative elevated levels of both tumor markers had a 5.5-fold and 6-fold increase in the risk of recurrence and death. In addition, patients with elevated markers after surgery had a high risk of recurrence within 5 years after colectomy. CONCLUSIONS: Postoperative tumor markers had a better ability to differentiate postoperative outcomes in patients with CC than preoperative tumor markers. Patients whose tumor markers normalized after surgery had a better prognosis.

Does three-dimensional surgery affect recurrence patterns in patients with gastric cancer after laparoscopic R0 gastrectomy? Results from a 3-year follow-up phase III trial.

BACKGROUND: Numerous studies have shown that the short-term efficacy of three-dimensional (3D) laparoscopic radical gastrectomy (LG) is comparable to that of two-dimensional (2D)-LG. Whether 3D-LG affects the recurrence patterns of gastric cancer (GC) patients has not been investigated. METHODS: From January 2015 to April 2016, a total of 419 patients were recruited for a phase III clinical trial (NCT02327481), which compared the short-term outcomes between the 2D and 3D groups. The long-term efficacy including recurrence patterns was compared between the 2D and 3D groups in this retrospective study. Multivariate analyses were performed to determine whether 3D-LG affects the recurrence patterns. RESULTS: Ultimately, 401 patients were analyzed (197 in the 2D-LG group and 204 in the 3D-LG group), and no differences were observed in the clinicopathological data between the two groups. There were no significant differences between the two groups in the recurrence types, first recurrence time or recurrence-free survival (RFS) (all p > 0.05). According to the 7th American Joint Committee on Cancer tumor-node-metastasis (TNM) staging system, both groups were stratified into pathological stages I, II, and III. The stratified analysis showed no significant differences in RFS or overall survival (OS) among patients in each subgroup (all p > 0.05). The multivariate analysis of RFS showed that tumor diameter, pTNM stage, lymphovascular invasion, and adjuvant chemotherapy were independent factors (all p < 0.05). The multivariate analysis of post-recurrence survival (PRS) showed that adjuvant chemotherapy was an independent protective factor (p = 0.043). CONCLUSIONS: 3D-LG for GC did not differ significantly from 2D-LG in the effects on 3-year recurrence patterns, RFS and OS, which provides more tumor-related evidence for 3D technology. And due to the technological similarity, it may have certain reference value for robotic-assisted gastrectomy. Further multicenter, large-scale clinical trials are warranted.

Effect of sarcopenia on short- and long-term outcomes in patients with gastric neuroendocrine neoplasms after radical gastrectomy: results from a large, two-institution series.

BACKGROUND: The relationship between sarcopenia and the prognoses of patients with gastric neuroendocrine neoplasms (g-NENs) is unclear. This study was designed to explore the effects of sarcopenia on short-term and long-term outcomes of patients with g-NENs after radical gastrectomy. METHODS: This study retrospectively collected data from 138 patients with g-NENs after radical gastrectomy. The skeletal muscle index (SMI) diagnostic threshold for sarcopenia was determined using X-tile software. Cox regression analyses were performed to determine the independent risk factors for 3-year overall survival (OS) and 3-year recurrence-free survival (RFS). RESULTS: In this study, 59 patients (42.8%) were diagnosed with sarcopenia. Among patients in the sarcopenia group and nonsarcopenia group, the incidences of total postoperative complications were 33.9 and 30.4%, incidences of serious postoperative complications were 0 and 3.7%, incidences of postoperative surgical complications were 13.6 and 15.2%, and incidences of postoperative systemic complications were 20.3 and 15.2%, respectively (all p > 0.05). The 3-year OS and RFS rates were significantly worse in the sarcopenia group than in the nonsarcopenia group (OS: 42.37% vs 65.82%, p = 0.004; RFS: 52.54% vs 68.35%, p = 0.036). The multivariate analysis revealed a relation between sarcopenia and the long-term prognoses of patients with g-NENs. A stratified analysis based on the pathological type revealed that the Kaplan-Meier curve was only significantly different in patients with gastric mixed adenoneuroendocrine carcinoma (gMANEC) (OS: 40.00% vs 71.79%, p = 0.007; RFS: 51.43% vs 74.36%, p = 0.026); furthermore, the multivariate analysis identified sarcopenia as an independent risk factor for patients with gMANEC (p < 0.05). CONCLUSIONS: Sarcopenia is not related to the short-term prognoses of patients with g-NENs. Sarcopenia is an independent risk factor for patients with gMANEC after radical surgery.

"Five-step" laparoscopic lymph node dissection for remnant gastric cancer following Billroth-II gastrectomy: A safe and feasible procedure.

BACKGROUND: Laparoscopic surgery (LS) for remnant gastric cancer (RGC) is gaining interest [1-3]. However, due to adhesions to adjacent organs, displacement of anatomical structures, and changes in lymphatic flow triangulation, LS for RGC is considered challenging. In this study, we report our experience performing laparoscopic lymph node dissection for RGC following Billroth-II gastrectomy. METHODS: The procedure was separated into five steps: (1) exploration and separation of adhesions and the greater omentum; (2) dissection of the lymph nodes (LNs) in the suprapancreatic area; (3) exposing the right side of the esophagus; (4) exposing the left gastroepiploic vessels and dissection of the LNs in the splenic hilar area; and (5) exposing the left side of the esophagus. The above procedure was performed for 45 RGC patients with stage cT1-4aN0/+ disease from January 2008 to June 2017. RESULTS: There were no conversions to open surgery. The mean operation time was 195.0 ±â€¯52.5 min, the mean blood loss was 104.3 ±â€¯90.4 ml, and the mean times to first flatus, fluid diet, and soft diet were 3.6 ±â€¯1.1 days, 4.5 ±â€¯1.4 days, and 9.0 ±â€¯5.1 days, respectively. A mean of 19.8 ±â€¯12.7 LNs were retrieved. The overall postoperative morbidity rate, major postoperative morbidity [4] rate and mortality rate were 22.2%, 11.1%, and 0%, respectively. At a median follow-up of 47 months, the cumulative 3-year overall survival rate was 56.8%. CONCLUSIONS: This novel "five-step" laparoscopic lymph node dissection approach was technically safe and feasible in RGC patients following Billroth-II gastrectomy.

A novel prognosis prediction model after completion gastrectomy for remnant gastric cancer: Development and validation using international multicenter databases.

BACKGROUND: Examined lymph node counts of remnant gastric cancer patients are often insufficient, and the prognostic ability of tumor-node-metastasis staging is therefore limited. This study aimed to create a simple and universally applicable prediction model for RGC patients after completion of gastrectomy. METHODS: A 5-year overall survival prediction model for remnant gastric cancer patients was developed using a test dataset of 148 consecutive patients. Model coefficients were obtained based on the Cox analysis of clinicopathological factors. Prognostic performance was assessed with the concordance index (C-index) and decision curve analysis. For internal validation, the bootstrap method and calibration assessment were used. The model was validated using 2 external cohorts from China (First Affiliated Hospital of Fujian Medical University, n = 46) and the United States (Mayo Clinic, n = 20). RESULTS: Depth of tumor invasion, number of metastatic lymph nodes, distant metastasis, and operative time were independent prognostic factors. Our model's C-index (0.761) showed better discriminatory power than that of the eighth tumor-node-metastasis staging system (0.714, P = .001). The model calibration was accurate at predicting 5-year survival. Decision curve analysis showed that the model had a greater benefit, and the results were also confirmed by bootstrap internal validation. In external validation, the C-index and decision curve analysis showed good prognostic performances in patient datasets from 2 participating institutions. Moreover, we verified the reliability of the model in an analysis of patients with different examined lymph node counts (>15 or ≤15). CONCLUSION: Utilizing clinically practical information, we developed a universally applicable prediction model for accurately determining the 5-year overall survival of remnant gastric cancer patients after completion of gastrectomy. Our predictive model outperformed tumor-node-metastasis staging in diverse international datasets regardless of examined lymph node counts.

The predictive value of the preoperative C-reactive protein-albumin ratio for early recurrence and chemotherapy benefit in patients with gastric cancer after radical gastrectomy: using randomized phase III trial data.

BACKGROUND: The definition and predictors of early recurrence (ER) for gastric cancer (GC) patients after radical gastrectomy are unclear. METHODS: A minimum-p value approach was used to evaluate the optimal cutoff value of recurrence-free survival to determine ER and late recurrence (LR). Receiver operating characteristic curves were generated for inflammatory indices. Potential risk factors for ER were assessed with a Cox regression model. A decision curve analysis was performed to evaluate the clinical utility. RESULTS: A total of 401 patients recruited in a clinical trial (NCT02327481) from January 2015 to April 2016 were included in this study. The optimal length of recurrence-free survival to distinguish between ER (n = 44) and LR (n = 52) was 12 months. Factors associated with ER included a preoperative C-reactive protein-albumin ratio (CAR) ≥ 0.131, stage III and postoperative adjuvant chemotherapy (PAC) > 3 cycles. The risk model consisting of both the CAR and TNM stage had a higher predictive ability and better clinical utility than TNM stage alone. Further stratification analysis of the stage III patients found that for the patients with a CAR < 0.131, both PAC with 1-3 cycles (p = 0.029) and > 3 cycles (p < 0.001) could reduce the risk of ER. However, for patients with a CAR ≥ 0.131, a benefit was observed only if they received PAC > 3 cycles (54.2% vs 16.0%, p = 0.004), rather than 1-3 cycles (58.3% vs 54.2%, p = 0.824). CONCLUSIONS: A recurrence-free interval of 12 months was found to be the optimal threshold for differentiating between ER and LR. Preoperative CAR was a promising predictor of ER and PAC response. PAC with 1-3 cycles may not exert a protective effect against ER for stage III GC patients with CAR ≥ 0.131.

A novel TNM staging system for gastric cancer based on the metro-ticket paradigm: a comparative study with the AJCC-TNM staging system.

BACKGROUND: The metro-ticket prognostic tool for hepatocellular carcinoma has been proven to predict outcome, but a similar concept has not been investigated for GC. The objective of the current study was to apply the principles of the metro-ticket paradigm to develop a novel TNM staging system (nTNM) for gastric cancer (GC). METHODS: The nTNM considered the distance from the origin on a Cartesian plane incorporating the pN (x-axis) and pT (y-axis) stages. GC patients undergoing radical resection at Fujian Medical University Union Hospital (FMUUH) (n = 4267) were included. The nTNM was validated using 2 external cohorts from the Sun Yat-sen University Cancer Center (SYSUCC) (n = 1800) and Surveillance, Epidemiology, and End Results (SEER) (n = 3227) databases. RESULTS: nTNM classes with the same distance from the origin have same stage; the stage increases with this distance. Among all patients, 48.0% (n = 2049) were restaged in the nTNM compared with the 7th edition of the AJCC-TNM classification; 26.2% (n = 1116) were downstaged in the nTNM compared with the 8th edition. The nTNM provides significant survival differences between stages (all P < 0.001). The survival difference between stages IB and IIA was especially large for the nTNM (P < 0.001) compared to the 7th and 8th editions (P = 0.073). The concordance index and hazard ratio increased successively with the nTNM stage. Similar findings were observed in both external cohorts. CONCLUSION: Compared with the AJCC-TNM classification, the nTNM for GC is easier to remember and provides some improvements; therefore, the nTNM may be considered for adoption in future editions of the AJCC-TNM classification.

Novel abdominal negative pressure lavage-drainage system for anastomotic leakage after R0 resection for gastric cancer.

BACKGROUND: Anastomotic leakage (AL) is a severe complication associated with high morbidity and mortality after radical gastrectomy (RG) for gastric cancer (GC). We hypothesized that a novel abdominal negative pressure lavage-drainage system (ANPLDS) can effectively reduce the failure-to-rescue (FTR) and the risk of reoperation, and it is a feasible management for AL. AIM: To report our institution's experience with a novel ANPLDS for AL after RG for GC. METHODS: The study enrolled 4173 patients who underwent R0 resection for GC at our institution between June 2009 and December 2016. ANPLDS was routinely used for patients with AL after January 2014. Characterization of patients who underwent R0 resection was compared between different study periods. AL rates and postoperative outcome among patients with AL were compared before and after the ANPLDS therapy. We used multivariate analyses to evaluate clinicopathological and perioperative factors for associations with AL and FTR after AL. RESULTS: AL occurred in 83 (83/4173, 2%) patients, leading to 7 deaths. The mean time of occurrence of AL was 5.6 days. The AL rate was similar before (2009-2013, period 1) and after (2014-2016, period 2) the implementation of the ANPLDS therapy (1.7% vs 2.3%, P = 0.121). Age and malnourishment were independently associated with AL. The FTR rate and abdominal bleeding rate after AL occurred were respectively 8.4% and 9.6% for the entire period; however, compared with period 1, this significantly decreased during period 2 (16.2% vs 2.2%, P = 0.041; 18.9% vs 2.2%, P = 0.020, respectively). Moreover, the reoperation rate was also reduced in period 2, although this result was not statistically significant (13.5% vs 2.2%, P = 0.084). Additionally, only ANPLDS therapy was an independent protective factor for FTR after AL (P = 0.04). CONCLUSION: Our experience demonstrates that ANPLDS is a feasible management for AL after RG for GC.

CRP/prealbumin, a novel inflammatory index for predicting recurrence after radical resection in gastric cancer patients: post hoc analysis of a randomized phase III trial.

BACKGROUND: Serum prealbumin (PALB) can predict the prognosis of patients with gastric cancer (GC). However, the prognostic value of combination of C-reactive protein and PALB (CRP/PALB) remains unclear. METHODS: A total of 419 gastric cancer patients included in a clinical trial (NCT02327481) were analyzed. The present study is a substudy of the trial. Receiver operating characteristic (ROC) curves were generated, and by calculating the areas under the curve (AUC) and the C-index, the discriminative ability of each inflammatory index was compared, including CRP/PALB, C-reactive protein/albumin, Glasgow prognostic score (GPS), modified GPS, systemic immune-inflammation index, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio. RESULTS: Ultimately, 401 patients were included in this study. The optimal cutoff value of CRP/PALB was 17.7. According to this cutoff point, the entire sample was divided into a CRP/PALB < 17.7 (LCP) group and a CRP/PALB ≥ 17.7 (HCP) group, comprising 245 and 156 patients, respectively. There were 54 and 22 patients experienced recurrence in the HCP and LCP group, respectively, p < 0.001. Compared with traditional inflammatory indices, CRP/PALB had the highest AUC (0.707) and C-index (0.716), all p < 0.05. The post-recurrence survival (PRS) of patients in the HCP group was significantly shorter than that in the LCP group (p = 0.010), especially for pathological stage III patients (p = 0.015) or patients with distant (p = 0.018) or local (p = 0.023) recurrences. CONCLUSIONS: The predictive value of preoperative CRP/PALB for the recurrence of GC is significantly better than traditional inflammatory indices. HCP significantly reduces the PRS, especially for pathological stage III patients or patients with distant or local recurrences.

Comparison of short-term and long-term efficacy of laparoscopic and open gastrectomy in high-risk patients with gastric cancer: a propensity score-matching analysis.

BACKGROUND: To determine whether laparoscopic surgery can be used in high-risk patients with gastric cancer. METHODS: The clinicopathological data of 3743 patients with primary gastric adenocarcinoma, collected from January 2007 to December 2014, were retrospectively analyzed. Patients who had ≥ 1 of the following conditions were defined as high-risk patients: (1) age ≥ 80 years; (2) BMI ≥ 30 kg/m2; (3) ASA (American Society of Anesthesiologists) grade ≥ 3; or (4) clinical T stage 4 (cT4). Propensity score matching (PSM) was used to reduce confounding bias; then, we compared the short-term and long-term efficacy of laparoscopic gastrectomy (LG) with open gastrectomy (OG) in high-risk patients with gastric cancer. RESULTS: A total of 1296 patients were included in PSM. After PSM, no significant difference in clinicopathological data was observed between the LG group (n = 341) and the OG group (n = 341). The operative time (181.70 vs. 266.71 min, p < 0.001) and blood loss during the operation (68.11 vs. 225.54 ml, p < 0.001) in the LG group were significantly lower than those in the OG group. In the LG and OG groups, postoperative complications occurred in 39 (11.4%) and 63 (18.5%) patients, respectively, p = 0.010. Multivariate analysis showed that laparoscopic surgery was an independent protective factor against postoperative complications (p = 0.019). The number of risk factors was an independent risk factor for postoperative complications (p = 0.021). The 5-year overall survival rate in the LG group was comparable to that in the OG group (55.0 vs. 52.0%, p = 0.086). Hierarchical analysis further confirmed that the LG and OG groups exhibited comparable survival rates among patients with stages cI, pI, cII, pII, cIII, and pIII (all p > 0.05). CONCLUSIONS: For high-risk patients with gastric cancer, LG not only exhibits better short-term efficacy than OG but also has a comparable 5-year survival rate to OG.

Preoperative skeletal muscle index vs the controlling nutritional status score: Which is a better objective predictor of long-term survival for gastric cancer patients after radical gastrectomy?

Skeletal muscle index (SMI) and the controlling nutritional status (CONUT) score are useful for evaluating nutritional status, which is closely associated with cancer prognosis. This study compared the prognostic value of these indicators in patients with gastric cancer (GC) after radical gastrectomy (RG). We retrospectively enrolled 532 patients between 2010 and 2011. SMI was measured via CT images to determine low SMI. The CONUT score was calculated based on serum albumin, total lymphocyte count, and cholesterol. Patients were grouped according to SMI and the CONUT score based on previous research. Spearman's correlation coefficient, the Kaplan-Meier method, and Cox regression were used. There was no significant correlation between SMI and the CONUT score. Five-year overall survival (OS) and recurrence-free survival (RFS) in patients with low SMI were significantly worse than those in patients with high SMI (P < .001). The normal nutrition group had better OS and RFS than did the light and moderate or severe malnutrition groups (P < .05), but the OS and RFS were not significantly different between the light and moderate or severe malnutrition groups (P = .726). Univariate analysis showed that SMI and the CONUT score were associated with OS and RFS, but only SMI remained prognostic in multivariate analysis. Preoperative SMI based on CT images is a more objective predictor than the CONUT score of long-term survival in GC after RG, but this finding must be confirmed by prospective trials.

Development and External Validation of a Simplified Nomogram Predicting Individual Survival After R0 Resection for Gastric Cancer: An International, Multicenter Study.

BACKGROUND: Previous studies have developed three nomograms for the individual prediction of overall survival after gastric cancer surgery. In this study, the performance of these nomograms was evaluated and compared with that of a simplified nomogram in a multinational cohort of patients. METHODS: Clinical data from patients who underwent resection (R0) with curative intent for GC at three specialized centers (two from China and one from Italy) and data from the Surveillance, Epidemiology, and End Results database were retrospectively analyzed. RESULTS: The study analyzed 9810 patients, and the simplified nomogram was developed based on the following factors present in all models: age, sex, depth of invasion, and number of metastatic lymph nodes. In the decision curve analyses, the simplified nomogram demonstrated similar net benefit gains relative to previous models. The discriminative ability of the simplified nomogram was similar to those of the three existing nomograms, and calibration of the simplified nomogram resulted in a predicted survival similar to the actual survival. The predictive ability of the simplified nomogram was superior to that of the American Joint Committee on Cancer (AJCC) stage using Eastern and Western validation data (p < 0.01). Additionally, the simplified nomogram predicted the probabilities within each AJCC stage to illustrate the heterogeneity of risk within each stage. CONCLUSION: The novel simplified nomogram simplifies the assessment of individual survival after R0 resection for GC without sacrificing predictive ability. It also has potential for use with other databases and for clinical applications.

Is the 8th Edition of the AJCC TNM Staging System Sufficiently Reasonable for All Patients with Noncardia Gastric Cancer? A 12,549-Patient International Database Study.

BACKGROUND: The aim of this work is to compare the prognostic ability between the 7th and 8th editions of the American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) classification for gastric cancer (GC). METHODS: A total of 10,194 noncardia GC patients were identified from the Surveillance, Epidemiology, and End Results database from 1988 to 2008. Concordance index (C-index), bayesian information criterion (BIC), and time-dependent receiver operating characteristic (t-ROC) analyses were used. External validation was performed using a dataset (n = 2355) derived from Fujian Medical University Union Hospital. RESULTS: Overall survival for all five AJCC N categories differed significantly when patients were subgrouped into ≤ 15 versus >15 examined lymph nodes (eLNs). The prognostic ability of the 8th edition (C-index 0.716) was not improved over the 7th edition (C-index 0.716). Subgroup analysis showed superior performance of the 8th over the 7th edition in patients with > 15 eLNs (C-index 0.742 vs. 0.735); however, the two editions showed similar performance for patients with ≤ 15 eLNs (C-index 0.713 vs. 0.713). The BIC and t-ROC analyses were consistent. To better predict the prognosis of patients with ≤ 15 eLNs, we established a novel prognostic model based on independent prognostic factors (C-index 0.735). BIC analysis showed that this new model was better than the 7th and 8th editions. Similar results were obtained from the validation set. CONCLUSIONS: The 8th edition of the AJCC TNM classification shows better prognostic ability than the 7th edition in noncardia GC patients with > 15 eLNs, but no improvement was found in patients with ≤ 15 eLNs; therefore, a novel prognostic model is proposed.

A Novel Preoperative Skeletal Muscle Measure as a Predictor of Postoperative Complications, Long-Term Survival and Tumor Recurrence for Patients with Gastric Cancer After Radical Gastrectomy.

BACKGROUND: Increasing numbers of studies have shown that skeletal muscle measures are closely associated with tumors. This study explored the relationship between skeletal muscle measures and short- and long-term outcomes after radical gastrectomy (RG) for gastric cancer (GC). METHODS: The study analyzed 221 GC patients who underwent RG between December 2009 and December 2010. The total psoas area (TPA) and psoas density [Hounsfield unit average calculation (HUAC)] were measured. The total psoas gauge (TPG) was created by multiplying TPA × HUAC. Low TPA, low HUAC, and low TPG were defined in the categorical analyses as the lowest quartile. Logistic regression modeling, the Kaplan-Meier method, and three-step multivariate analysis were used. RESULTS: The median follow-up period was 64 months. Compared with low TPA and low HUAC, only low TPG was an independent risk factor for postoperative complications. The univariate analysis showed that low TPA, low HUAC, and low TPG were predictors of overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CCS) after surgery. The result of the three-step multivariate analysis demonstrated that low TPG was an independent risk factor for OS, RFS, and CCS. Moreover, the prognostic value of TPG was superior to that of TPA and HUAC. The patients with low TPG experienced significantly more postoperative liver recurrence than the patients with high TPG (p = 0.011). CONCLUSION: Compared with preoperative skeletal muscle quantity (TPA) and quality (HUAC), TPG can more accurately predict complications and prognosis after RG. In addition, TPG may be an indicator for the early detection of liver recurrence after RG.

Recovery of sympathetic nerve function after lumbar sympathectomy is slower in the hind limbs than in the torso.

Local sympathetic denervation by surgical sympathectomy is used in the treatment of lower limb ulcers and ischemia, but the restoration of cutaneous sympathetic nerve functions is less clear. This study aims to explore the recovery of cutaneous sympathetic functions after bilateral L2-4 sympathectomy. The skin temperature of the left feet, using a point monitoring thermometer, increased intraoperatively after sympathectomy. The cytoplasm of sympathetic neurons contained tyrosine hydroxylase and dopamine ß-hydroxylase, visualized by immunofluorescence, indicated the accuracy of sympathectomy. Iodine starch test results suggested that the sweating function of the hind feet plantar skin decreased 2 and 7 weeks after lumbar sympathectomy but had recovered by 3 months. Immunofluorescence and western blot assay results revealed that norepinephrine and dopamine ß-hydroxylase expression in the skin from the sacrococcygeal region and hind feet decreased in the sympathectomized group at 2 weeks. Transmission electron microscopy results showed that perinuclear space and axon demyelination in sympathetic cells in the L5 sympathetic trunks were found in the sympathectomized group 3 months after sympathectomy. Although sympathetic denervation occurred in the sacrococcygeal region and hind feet skin 2 weeks after lumbar sympathectomy, the skin functions recovered gradually over 7 weeks to 3 months. In conclusion, sympathetic functional recovery may account for the recurrence of hyperhidrosis after sympathectomy and the normalization of sympathetic nerve trunks after incomplete injury. The recovery of sympathetic nerve function was slower in the limbs than in the torso after bilateral L2-4 sympathectomy.

A Novel Prognostic Scoring System Based on Preoperative Sarcopenia Predicts the Long-Term Outcome for Patients After R0 Resection for Gastric Cancer: Experiences of a High-Volume Center.

BACKGROUND: The relationship between sarcopenia and prognosis of gastric cancer (GC) is unclear. This study aimed to develop a prognostic scoring system combining sarcopenia with preoperative clinical parameters for patients with GC to predict 3-year overall survival (OS) and 3-year recurrence-free survival (RFS). METHODS: In this study, 924 patients with GC who underwent radical gastrectomy were retrospectively analyzed. The data were divided into a training set and a validation set. Sarcopenia was diagnosed by the cutoff value of the skeletal muscle index (SMI) obtained by X-tile software. The study used COX regression to identify preoperative risk factors associated with 3-year OS and RFS. RESULTS: In the training set, 103 patients (14.8%) were sarcopenic based on the cutoff value of the SMI (32.5 cm2/m2 for men and 28.6 cm2/m2 for women). Multivariate analysis showed the following preoperative risk factors for the training set: sarcopenia and preoperative T (cT) and N (cN) stages. A prognostic scoring system was developed based on these findings. The 3-year OS rates were 89% for the low-risk patients, 77.9% for the intermediate-risk patients, and 54.8% for the high-risk patients (P < 0.001), and the 3-year RFS rates were respectively 86.9, 75.3 and 49.3% (P < 0.001). The area under the receiver operating characteristic curves were 0.708 for the 3-year OS rates and 0.713 for the 3-year RFS rates. The observed and predicted incidence rates for 3-year OS and RFS in the validation set did not differ significantly. CONCLUSIONS: The prognostic scoring system combining sarcopenia with the cT and cN system can accurately predict 3-year OS and RFS rates after radical gastrectomy for GC.

[Expression and significance of mRNA and protein of eIF4E, p-eIF4E and MCl-1 in pathological scar].

OBJECTIVE: To study the expression of eIF4E, p-eIF4E (Ser 209) and Mcl-1 gene in the pathological scars and to investigate its role and its probable mechanism in the pathogenesis of abnormal scar. METHODS: Quantitative real-time PCR and Western Blot was performed to detect the expression and distribution of mRNA and protein of eIF4E and Mcl-1 in hypertrophic scar (10 cases), keloid (10 cases), normal scar (10 cases), and normal skin (10 cases). Western Blot was performed to detect the expression and distribution of protein of p-eIF4E in hypertrophic scar (10 cases), keloid (10 cases), normal scar (10 cases), and normal skin (10 cases). RESULTS: The expression of eIF4E mRNA and protein were 1.38 +/- 0.45, 1.23 +/- 0.23 in the normal skin (10 cases); 5.400 +/- 0.450, 5.460 +/- 0.460 in normal scar (10 cases); 0.597 +/- 0.060, 0.590 +/- 0.040 in hypertrophic scar (10 cases) and 0.694 +/- 0.066, 0.697 +/- 0.022 in keloid (10 cases). The expression of p-eIF4E protein in the normal skin (10 cases), normal scar (10 cases), hypertrophic scar (10 cases), and keloid (10 cases) were 0.202 +/- 0.037, 0.216 +/- 0.019, 0.426 +/- 0.026, 0.433 +/- 0.027. The expression of Mcl-1 mRNA and protein were 1.510 +/- 0.660, 1.400 +/- 0.530 in the normal skin (10 cases); 6.65 +/- 0.85, 7.23 +/- 1.53 in normal scar (10 cases); 0.589 +/- 0.059, 0.660 +/- 0.063 in hypertrophic scar (10 cases) and 0.870 +/- 0.118, 0.914 +/- 0.064 in the keloid (10 cases). The positive rate of mRNA and protein of eIF4E and Mcl-1 was not statistically different between the hypertrophic scar and keloid (P > 0.05), while they were all remarkably significant between normal scar and abnormal scar (P < 0.05). The phosphorylation of eIF4E in pathological scar was higher than that in control group. In pathological scar, mRNA and protein of eIF4E and Mcl-1 showed a strong positive correlation. CONCLUSIONS: The result indicates that the expression of eIF4E, p-eIF4E and Mcl-1 is increased in pathological scar. eIF4E plays an important role in pathological scar. Its activity is regulated by its phosphorylation. Therefore, eIF4E, p-eIF4E and Mcl-1 overexpression may play an important role in the proliferation of fibroblasts and in the pathogenesis of pathological scar.