Identification of prognostic factors for survival in patients with metastatic gastric adenocarcinoma in a Mexican population

INTRODUCTION AND AIMS

Gastric adenocarcinoma is among the high-ranking tumors, with respect to frequency and mortality, worldwide. The inflammatory process and immune system activity are associated with oncologic control. Our aim was to identify whether the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and other variables are prognostic factors for survival in patients with metastatic gastric cancer in a Mexican population.

MATERIAL AND METHODS

Patients diagnosed with metastatic gastric adenocarcinoma, hospitalized within the time frame of December 2011 to 2021, were analyzed. The NLR, PLR, and albumin and hemoglobin levels obtained from blood samples were calculated. Functional status (ECOG and Karnofsky), sex, histology, and the presence of signet ring cells were also considered possible prognostic factors. Each factor's prognostic value for overall survival was determined through univariate and multivariate analyses.

RESULTS

The study included 956 patients diagnosed with metastatic gastric cancer, of whom 494 (51.7%) were men and 462 (48.3%) were women. The main histologic finding was diffuse adenocarcinoma (n = 619, 64.7%), followed by intestinal adenocarcinoma (n = 293, 30.6%), and the presence of signet ring cells was found in 659 (68.9%) patients. Diagnostic laparoscopy was performed on 238 patients (24.9%) to confirm peritoneal carcinomatosis. The multivariate analysis showed that an NLR above 3.2 (HR 1.51, 95% CI 1.27-1.8; p < 0.001), albumin below 3.5 g/dl (HR 1.25, CI 1.06-1.47; p = 0.006), and an ECOG performance status of 2 or higher (HR 1.39, CI 1.10-1.76; p = 0.005) were independent factors that predicted a lower survival rate, whereas a Karnofsky score above 70% (HR 0.69, CI 0.53-0.91; p = 0.008) was associated with a better survival rate. Lastly, the PLR was not statistically significant in the multivariate analysis.

CONCLUSIONS

The NLR, nutritional status assessed through albumin measurement, and functional status can act as independent prognostic survival factors in hospitalized Mexican patients diagnosed with metastatic gastric adenocarcinoma and be taken into account during therapeutic decision-making.

Image-guided moderately hypofractionated radiotherapy for localized prostate cancer: a multicentric retrospective study (IPOPROMISE)

BACKGROUND

Moderate hypofractionated radiotherapy is a treatment option for the cure of localized prostate cancer (PCa) patients based on the results of randomized prospective trials, but there is a clinical concern about the relatively short length of follow-up, and real-world results on outcome and toxicity based on cutting-edge techniques are lacking. The objective of this study is to present the long-term results of a large multicentric series.

MATERIALS AND METHODS

We retrospectively evaluated 1325 PCa patients treated with daily volumetric image-guided hypofractionated radiotherapy between 2007 and 2020 in 16 Centers. For survival endpoints, we used Kaplan-Meier survival curves and fitted univariate and multivariable Cox's proportional hazards regression models to study the association between the clinical variables and each survival type.

RESULTS

At the end of the follow-up, 11 patients died from PCa. The 15-year values of cancer-specific survival (CSS) and biochemical relapse-free survival (b-RFS) were 98.5% (95%CI 97.3-99.6%) and 85.5% (95%CI 81.9-89.4%), respectively. The multivariate analysis showed that baseline PSA, Gleason score, and the use of androgen deprivation therapy were significant variables for all the outcomes. Acute gastrointestinal (GI) and genitourinary (GU) toxicities of grade ≥ 2 were 7.0% and 16.98%, respectively. The 15-year late grade ≥ 2 GI and GU toxicities were 5% (95%CI 4-6%) and 6% (95%CI 4-8%), respectively.

CONCLUSION

Real-world long-term results of this multicentric study on cutting-edge techniques for the cure of localized PCa demonstrated an excellent biochemical-free survival rate of 85.5% at 15 years, and very low rates of ≥ G3 late GU and GI toxicity (1.6% and 0.9% respectively), strengthening the results of the available published trials.

Mechanical stimulation devices for mechanobiology studies: a market, literature, and patents review

Significant advancements in various research and technological fields have contributed to remarkable findings on the physiological dynamics of the human body. To more closely mimic the complex physiological environment, research has moved from two-dimensional (2D) culture systems to more sophisticated three-dimensional (3D) dynamic cultures. Unlike bioreactors or microfluidic-based culture models, cells are typically seeded on polymeric substrates or incorporated into 3D constructs which are mechanically stimulated to investigate cell response to mechanical stresses, such as tensile or compressive. This review focuses on the working principles of mechanical stimulation devices currently available on the market or custom-built by research groups or protected by patents and highlights the main features still open to improvement. These are the features which could be focused on to perform, in the future, more reliable and accurate mechanobiology studies.

Graphic abstract

Selective Laser Melting of Ti6Al4V sub-millimetric cellular structures: Prediction of dimensional deviations and mechanical performance

Ti6Al4V sub-millimetric cellular structures arise as promising solutions concerning the progress of conventional orthopedic implants due to its ability to address a combination of mechanical, physical and topological properties. Such ability can improve the interaction between implant materials and surrounding bone leading to long-term successful orthopedic implants. Selective Laser Melting (SLM) capability to produce high quality Ti6Al4V porous implants is in great demand towards orthopedic biomaterials. In this study, Ti6Al4V cellular structures were designed, modeled, SLM produced and characterized targeting orthopedic implants. For that purpose, a set of tools is proposed to overcome SLM limited accuracy to produce porous biomaterials with desired dimensions and mechanical properties. Morphological analyses were performed to evaluate the dimensional deviations noticed between the model CAD and the SLM produced structures. Tensile tests were carried out to estimate the elastic modulus of the Ti6Al4V cellular structures. The present work proposes a design methodology showing the linear correlations found for the dimensions, the porosity and the elastic modulus when comparing the model CAD designs with Ti6Al4V structures by SLM.

Tribological behavior of bioactive multi-material structures targeting orthopedic applications

The following study proposes a multi-material solution in which Ti6Al4V cellular structures produced by Selective Laser Melting are impregnated with bioactive materials (hydroxyapatite or β-tricalcium phosphate) using press and sintering technique. To assess the tribological response of these structures, an alumina plate was used as a counterpart in a flat-on-flat reciprocating sliding test. Ti6Al4V cellular structures impregnated with bioactive materials displayed the highest wear resistance when compared with the unreinforced structures. Among the bioactive structures, Ti6Al4V cellular structures impregnated with βTCP were the ones with higher wear resistance, having the lowest weight loss. Hence, these structures are promising multifunctional solutions for load-bearing applications by gathering suitable mechanical properties (strength and stiffness); bioactive properties and in addition an improved wear performance.