Exploring the intricacies of antimicrobial resistance: Understanding mechanisms, overcoming challenges, and pioneering innovative solutions

Antimicrobial resistance (AMR) poses a growing global threat. This review examines AMR from diverse angles, tracing the story of antibiotic resistance from its origins to today's crisis. It explores the rise of AMR, from its historical roots to the urgent need to counter this escalating menace. The review explores antibiotic classes, mechanisms, resistance profiles, and genetics. It details bacterial resistance mechanisms with illustrative examples. Multidrug-resistant bacteria spotlight AMR's resilience. Modern AMR control offers hope through precision medicine, stewardship, combination therapy, surveillance, and international cooperation. Converging traditional and innovative treatments presents an exciting frontier as novel compounds seek to enhance antibiotic efficacy. This review calls for global unity and proactive engagement to address AMR collectively, emphasizing the quest for innovative solutions and responsible antibiotic use. It underscores the interconnectedness of science, responsibility, and action in combatting AMR. Humanity faces a choice between antibiotic efficacy and obsolescence. The call is clear: unite, innovate, and prevail against AMR.

Decoding the role of intratumoral microbiota in gastric cancer

Intratumoral microbiota are increasingly recognized for their impact on gastric cancer, with growing evidence highlighting their complexity and significance. This review synthesizes current knowledge on the origins, heterogeneity, detection, and mechanistic roles of intratumoral microbiota in gastric carcinogenesis. In gastric cancer, intratumoral microbiota can originate from mucosal disruption and may migrate from normal adjacent tissues or be influenced by the TME. It exhibits spatial and functional heterogeneity within gastric cancer. Despite challenges in the detection of intratumoral microbiota, advances in deep sequencing and spatial omics have enhanced our understanding of microbial diversity and functionality. Mechanistically, intratumoral microbiota influence gastric cancer development through genetic and epigenetic alterations, signaling pathway modulation, metabolic reprogramming, and regulation of chronic inflammation and immune responses. These insights underscore the microbiota's dual function in both promoting and hindering tumor advancement. Therapeutically, the microbiota's impact on chemotherapy resistance and immune modulation presents opportunities for novel interventions. Integrating microbiome analysis into cancer research and leveraging microbial therapies may enable more effective, personalized treatment strategies. Future research should further elucidate the intricate microbe-tumor interactions to advance clinical applications and improve outcomes for gastric cancer patients.

Joint Nasogastric Tube Versus Traditional Decompression Nasogastric Tube to Guided OGT-Overlap Esophagojejunostomy in Laparoscopic Total Gastrectomy: A Randomized Controlled Trial

BACKGROUND

Our team pioneered the use of a joint nasogastric tube (JNT) for pairing overlap-esophagojejunostomy guiding tube (OGT) in an OGT-overlap esophagojejunostomy, demonstrating its safety and efficacy.

OBJECTIVE

We aimed to compare the safety and efficacy of a novel technique, the JNT, with traditional nasogastric tubing (TNT) in guiding OGT-overlap esophagojejunostomy.

METHODS

From January 2023 to January 2024, a total of 108 gastric/gastroesophageal junction (G/GEJ) cancer patients undergoing laparoscopic total gastrectomy (LTG) were eligible for inclusion in this study; however, 2 patients were excluded as they underwent hyperthermic intraperitoneal chemotherapy (HIPEC) after surgery. Patients were randomized into two groups: the JNT-OGT-overlap esophagojejunostomy group (JNT group; n = 53) or the TNT-OGT-overlap esophagojejunostomy group (TNT group; n = 53).

RESULTS

The JNT group had a significantly higher success rate for nasogastric tube (NT) insertion into the esophageal stump on the first attempt (90.6% vs. 58.5%; p < 0.001). Additionally, the insertion times were reduced by 6/7 of their original duration (15 [21] vs. 100 [120] sec; p < 0.001)], and connection times for OGT and NT were shortened to 2/5 of their original duration (90 [63] vs. 220 [130] sec; p < 0.001). Esophagojejunostomy time was also shorter in the JNT group (17.4 vs. 21.7 min; p < 0.001). Two cases were converted from TNT to JNT due to the failure of TNT to guide the esophageal stump entry hole for more than 5 min, which was resolved promptly by the JNT. Postoperative complications (18.9% vs. 20.8%; p = 0.807), particularly esophagojejunal anastomotic leakage (EJAL; 5.7% vs. 3.8%; p =1.000), and complication severity classification (p = 0.315) were comparable between the two groups.

CONCLUSIONS

The JNT technique significantly and safely improved the efficiency of OGT-overlap esophagojejunostomy compared with TNT, suggesting a well-tolerated and efficient new strategy for esophagojejunostomy.

The role of ICG NIRL fluorescence imaging in the surgical treatment of digestive system tumors (Review)

Indocyanine green (ICG) is a relatively non‑toxic fluorescent dye with a history of safe use, which has fueled the development of new applications for ICG. Research on the use of ICG near‑infrared light (NIRL) fluorescence imaging during oncologic surgery has increased, revealing its role in tumor identification and localization, lymph node navigational resection and blood perfusion assessment. The purpose of the present review was to provide a comprehensive overview of advances in the clinical application of ICG NIRL fluorescence imaging during gastrointestinal tumor surgery. The present review discusses the techniques, outcomes, limitations and key considerations necessary for clinical practice, aiming to provide a valuable resource for professionals in the field.

Prognostic impact of histopathological features and serum inflammatory markers in patients with gastric cancer undergoing neoadjuvant therapy

BACKGROUND

Neoadjuvant therapies induce tumor regression, resulting in improved surgical resection and pathologic complete response rates, as well as long-term disease-free and overall survival (OS). In addition to the tumor regression score, serum inflammatory markers, including neutrophil, lymphocyte, platelet, and serum albumin levels, are used to determine prognosis.

AIM

To investigate the effect of histological features and serum inflammatory markers on the prognosis of gastric cancer following neoadjuvant treatment.

METHODS

Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and serum albumin levels were retrospectively recorded for 177 patients receiving neoadjuvant 5-fluorouracil, leucovorin, oxaliplatin and docetaxel chemotherapy. Disease-free and OS were analyzed based on tumor histopathological features, type of surgery, regression scores, and serum inflammatory markers.

RESULTS

Patients over 65 years of age, those with lymphovascular or perineural invasion, hypoalbuminemia, and those who did not receive adjuvant therapy were found to be at higher risk for shorter recurrence/relapse intervals [hazard ratio (HR): 1.64, P = 0.04; HR: 4.20, P < 0.001; HR: 1.87, P = 0.03; HR: 3.5, P < 0.001; and HR: 2.73, P = 0.01, respectively]. Lymphovascular invasion, R1 resection, lack of adjuvant treatment, and hypoalbuminemia negatively influenced OS (HR: 3.68, P < 0.003; HR: 2.37, P = 0.01; HR: 3.99, P < 0.001; and HR: 2.50, P = 0.01, respectively). No effect of NLR and PLR was observed.

CONCLUSION

Current neoadjuvant therapies prolong disease-free and OS. The practical application of serum inflammatory markers (NLR and PLR) is limited due to the lack of standard cut-off values. Nutritional status, hypoalbuminemia, and incomplete perioperative chemotherapy have been associated with poor prognosis.

Minimally invasive lymphadenectomy for gastric cancer: Could the robotic approach provide any benefits than laparoscopy?

Gastrectomy is the cornerstone of treatment for gastric cancer. Since the introduction of minimally invasive techniques, the main challenge for surgeons has been to achieve the same surgical radicality, adequate lymphadenectomy, and negative resection margins as with the open approach. Previous Eastern trials showed non-inferiority of laparoscopic gastrectomy, whereas Western trials reported a higher number of complications. This may depend on the different eligibility criteria to select patients and surgeons. Currently, the increased availability of robotic systems has led to renewed enthusiasm. We present a critical review of published randomized control trials (up to October 2024) to investigate the real benefits of robotic compared to open and laparoscopic approaches. Robotic gastrectomy has shown similar oncological outcomes in survival and lymph node retrieval, particularly in suprapancreatic stations, with the advantage of a more acceptable rate of pancreatic fistula and feasible anastomotic reconstruction. Some clinical situations, such as postchemotherapy interstitial fibrosis and distortion of anatomical planes, may increase the technical difficulty. Only four published trials assessed the implications of a pre-operative therapy, with no robotic surgery cases. Robotic systems may reduce intraoperative blood loss, the risk of conversion and allow more extensive lymphadenectomies in cancers with a high risk of extraperigastric metastases, or with clinically proven para-aortic node metastases, although clinical trials evaluating robotic gastrectomy after neoadjuvant therapy have not yet been published.

Impact of visceral fat distribution on postoperative complications in high-aged patients undergoing gastric cancer surgery: A cross-sectional study

BACKGROUND

The annual incidence of gastric cancer in elderly patients is increasing. Despite the continuous progress in treatment methods, the prognosis of elderly patients remains poor, and postoperative complications are frequent. Obesity is believed to be associated with the risk of gastric cancer and postoperative prognosis; however, the effect of visceral fat distribution on postoperative complications of gastric cancer in elderly patients remains unclear.

AIM

To explore the effect of visceral fat distribution on postoperative complications of gastric cancer in elderly patients.

METHODS

A total of 163 elderly patients treated at the Affiliated Longyan First Hospital of Fujian Medical University after radical gastrectomy between January 2021 and January 2024 were enrolled. The patients' visceral and subcutaneous fat distributions were measured and divided into a high visceral fat area (VFA-H) group and a low visceral fat area (VFA-L) group, with a critical value of 100 cm². The t-test and χ² test were used to calculate and analyze the relationship between visceral fat area (VFA) and complications. Independent risk factors for postoperative complications were analyzed using binary logistic regression analysis.

RESULTS

Compared with the VFA-L group, the incidence of postoperative complications was higher in the VFA-H group (27.8% vs 6.4%, P < 0.001), and the operation time was longer (268.55 ± 63.41 vs 224.31 ± 51.89, P < 0.001). The amount of blood loss was more (163.77 ± 105.27 mL vs 127.93 ± 98.26 mL, P < 0.001). Logistic regression analysis showed that VFA [odds ratio (OR): 2.597, 95%CI: 1.479-4.853, P = 0.004], total fat area (OR: 1.655, 95%CI: 1.076-4.040, P = 0.013), and the visceral subcutaneous fat area ratio (OR: 2.046, 95%CI: 1.196-5.640, P = 0.008) were independent risk factors for postoperative complications.

CONCLUSION

This study showed that postoperative complications are closely related to fat distribution in elderly patients with gastric cancer undergoing gastrectomy. A high VFA is associated by a high incidence of postoperative complications.

Prevalence and risk factors of Helicobacter pylori infection in Xinjiang Uygur Autonomous Region: A cross-sectional study of all age groups

BACKGROUND

Helicobacter pylori (H. pylori) infection rates have been changing with different populations and geographic areas. Currently, there is still a lack of comprehensive survey data on the H. pylori infection rate and its risk factors in the natural population of Xinjiang Uygur Autonomous Region.

AIM

To understand the H. pylori infection and risk factors in Xinjiang Uygur Autonomous Region for the prevention and control strategies.

METHODS

This study comprehensively collected the survey data on H. pylori infection in 15 regions of Xinjiang Uygur Autonomous Region by using the method of stratified random cluster sampling. A total of 4361 individuals from the general population were selected as research subjects, and questionnaire surveys and blood tests for H. pylori antibodies were conducted.

RESULTS

The overall H. pylori infection rate in Xinjiang Uygur Autonomous Region was 70.79% (3087/4361). The H. pylori infection rate showed a trend of first increasing and then decreasing with the increase of age, and the difference was statistically significant (P < 0.05). The analysis of the H. pylori infection rates among different ethnic groups showed that the infection rates of ethnic minorities such as Uyghur, Kirgiz, and Tajik were significantly higher than those of Han and Hui ethnic groups, and the difference was statistically significant (P < 0.01). Multivariate analysis showed that altitude, regular consumption of beef, mutton, dried nuts, barbecue foods, and drinking river water were positively correlated with the H. pylori infection rate.

CONCLUSION

This study indicates that the overall H. pylori infection rate in Xinjiang Uygur Autonomous Region is relatively high, with obvious regional and ethnic differences, which are closely related to the sanitation conditions and eating habits.

Prophylactic drain placement versus non-drainage following gastric cancer surgery: A systematic review and meta-analysis of randomized controlled trials

Gastric cancer remains a significant global health burden and a leading cause of cancer-related deaths. Surgical resection is the primary curative treatment, but postoperative complications can negatively impact outcomes. Prophylactic drainage (PD) has been widely used to reduce these complications by facilitating early detection and management of fluid collections. This study evaluates the role of PD following gastric cancer surgery through a systematic review and meta-analysis of randomized controlled trials (RCTs). We searched PubMed, Web of Science, Scopus, and Cochrane databases up to January 15, 2025, and analyzed dichotomous data using risk ratio (RR) and continuous data using mean difference (MD), both with 95 % confidence intervals (CI), using R version 4.3 (PROSPERO ID: CRD42025650045). Four RCTs involving 728 patients were included. The analysis revealed that PD was associated with a significantly lower risk of mortality compared to no drainage (RR: 0.45 [95 % CI: 0.21-0.94]; P = 0.03). However, there were no significant differences between the drainage and non-drainage groups in the incidence of intra-abdominal abscess (RR: 1.23 [95 % CI: 0.49-3.06]; P = 0.66), surgical-site infection (RR: 0.93 [95 % CI: 0.56-1.52]; P = 0.76), pulmonary infection (RR: 0.66 [95 % CI: 0.37-1.18]; P = 0.16), duodenal stump leakage (RR: 1.54 [95 % CI: 0.51-4.71]; P = 0.45), anastomotic leakage (RR: 1.47 [95 % CI: 0.64-3.39]; P = 0.37), or reoperation rates (RR: 0.95 [95 % CI: 0.40-2.27]; P = 0.90). Additionally, no significant differences were observed in the length of hospital stay (MD: 0.10 [95 % CI: -0.39 to 0.58]; P = 0.70) or time to the first soft diet (MD: 0.21 [95 % CI: -0.09 to 0.50]; P = 0.17). In conclusion, PD following gastric cancer surgery is associated with a reduced risk of mortality but does not significantly impact the incidence of perioperative complications or recovery metrics. These findings suggest that while PD may offer a survival benefit, it does not appear to reduce common postoperative complications or accelerate recovery.

The highs and lows of monoamine oxidase as molecular target in cancer: an updated review

The global burden of cancer as a major cause of death and invalidity has been constantly increasing in the past decades. Monoamine oxidases (MAO) with two isoforms, MAO-A and MAO-B, are mammalian mitochondrial enzymes responsible for the oxidative deamination of neurotransmitters and amines in the central nervous system and peripheral tissues with the constant generation of hydrogen peroxide as the main deleterious ancillary product. However, given the complexity of cancer biology, MAO involvement in tumorigenesis is multifaceted with different tumors displaying either an increased or decreased MAO profile. MAO inhibitors are currently approved for the treatment of neurodegenerative diseases (mainly, Parkinson's disease) and as secondary/adjunctive therapeutic options for the treatment of major depression. Herein, we review the literature characterizing MAO's involvement and the putative role of MAO inhibitors in several malignancies, and also provide perspectives regarding the potential biomarker role that MAO could play in the future in oncology.

Influence of surgical timing post-neoadjuvant chemotherapy on survival outcomes in breast cancer patients: A comprehensive systematic review and meta-analysis

BACKGROUND

Increasing evidence supports the use of neoadjuvant chemotherapy (NAC) prior to surgery for breast cancer. However, the optimal timing between NAC and surgery had yet to be fully elucidated. This meta-analysis aims to assess how the optimal interval time (OTT) between NAC and surgery affects outcomes in breast cancer, providing additional evidence for clinical practice and future research.

METHODS

PubMed, Web of Science and Cochrane Library databases in English were systematically searched for this systematic review. All included studies investigated the variations in surgical timing following NAC and their effects on breast cancer outcomes. The endpoints included the rate of pathological complete response (pCR), overall survival (OS), recurrence free survival (RFS), and disease-free survival (DFS). This study has been registered with PROSPERQ.

RESULTS

Eleven eligible studies were identified, encompassing a total of 10,834 cases, all of which received surgery post-NAC. All studies were retrospective in nature. Ultimately, compared to intervals within 4 weeks, patients who underwent surgery>8weeks post-NAC demonstrated a statistically significant worse OS (HR = 1.21, 95 % CI: 1.06-1.40, p = 0.333 for heterogeneity). No significant difference of OS was observed between patients with OTT of 4-8 weeks vs < 4 weeks. Notably, patients with an OTT of 4-8 weeks (HR = 1.18, 95 % CI: 1.10-1.26, I2 = 0.0 %, p = 0.931 for heterogeneity) and>8weeks (HR = 1.21, 95 % CI: 1.13-1.29, I2 = 36.2 %, p = 0.195 for heterogeneity) exhibited decreasing RFS, compared with those with OTTs of<4 weeks. DFS and pCR rates were similar in>8weeks vs < 4 weeks and 4-8weeks vs < 4 weeks.

CONCLUSION

Our systematic review and meta-analysis indicate that the optimal interval following NAC for breast cancer patients might be within four weeks, as delays exceeding eight weeks could be associated with poorer clinical outcomes. However, additional research is necessary to validate these preliminary findings.

Association of Hemoglobin, albumin, lymphocyte, and platelet scores with the risk of overactive bladder syndrome in U.S. adults: A Nationwide cross-sectional study

Objective

The pathogenesis of overactive bladder (OAB) is associated with inflammation, yet specific indicators remain unclear. This study aimed to evaluate the association between the hemoglobin, albumin, lymphocyte, and platelet (HALP) score-a composite marker of inflammation and nutritional status-and the risk of OAB in a nationally representative adult population in the United States.

Method

We analyzed data from 24,939 participants in the U.S. National Health and Nutrition Examination Survey (NHANES) between 2005 and 2016. Participants were categorized into quartiles based on HALP scores. Weighted multivariable logistic regression models were used to examine the association between HALP scores and the risk of OAB, adjusting for relevant covariates. Additionally, smooth curve fitting was performed to assess nonlinear relationships.

Result

After adjusting for confounders, higher HALP scores were significantly associated with a lower risk of OAB (odds ratio [OR] 0.965, 95 % confidence interval [CI]: 0.951-0.980). Participants in the highest HALP quartile had a 20 % lower likelihood of OAB compared to those in the lowest quartile (OR 0.800, 95 % CI: 0.729-0.878). A nonlinear inverse relationship was observed between HALP score and OAB risk.

Conclusion

In this large, population-based study, higher HALP scores were independently associated with a lower risk of OAB among U.S. adults. These findings suggest that the HALP score may serve as a useful marker in the prediction and early identification of individuals at risk for OAB.

Diagnostic performance of fluorescent lymphography-guided lymph node dissection during minimally invasive gastrectomy following chemotherapy

INTRODUCTION

Fluorescent lymphography-guided lymph node dissection (FL) using indocyanine green (ICG) during radical gastrectomy for gastric cancer has shown enhanced lymph node (LN) retrieval and high sensitivity in detecting LN metastases. However, the impact of FL during gastrectomy following chemotherapy remains uncertain because changes in the ICG injection site due to tumor shrinkage may potentially visualize different lymphatic drainage from the tumor. This study aimed to assess the diagnostic performance of FL during gastrectomy after preoperative chemotherapy.

MATERIALS AND METHODS

This retrospective study included patients who underwent minimally invasive gastrectomy with FL following chemotherapy between January 2013 and February 2024. Patients were categorized according to their tumor response after chemotherapy based on endoscopic, radiologic, and pathological findings.

RESULTS

Of 29 patients, 9.4 (range 8-12) LN stations containing 6.9 (range 3-11) fluorescent LN stations, which had 56.3 (range 33-99) LNs including 33.4 (range 11-68) fluorescent LNs, were retrieved per patient. While 52 metastatic LN stations were fluorescent, three non-fluorescent metastatic LN stations were identified in one patient (3.4 %). FL showed 94.5 % (52/55) sensitivity and 95.9 % (70/73) negative predictive value for detecting metastatic LN stations. There was no significant difference in the number of retrieved LNs and the sensitivity for detecting metastatic LN stations between responders and non-responders.

CONCLUSION

Tumor response after chemotherapy did not influence the diagnostic performance of FL. The diagnostic performance of FL during gastrectomy following chemotherapy was acceptable. Similar to upfront surgery, FL can be safely applied even after chemotherapy.

Comparison of short- and long-term outcomes for robotic versus laparoscopic gastrectomy in elderly patients with gastric cancer: a multicenter cohort study

BACKGROUND

There is limited evidence from large-scale multicenter studies regarding the short- and long-term efficacy of robotic gastrectomy (RG) in elderly patients diagnosed with gastric cancer (GC). As such, this retrospective investigation compared short-term outcomes and long-term oncological prognoses of RG versus (vs.) laparoscopic gastrectomy (LG) in a representative sample of this population.

METHODS

Data from 1393 patients ≥ 65 years of age diagnosed with GC, who underwent radical gastrectomy at 8 large tertiary hospitals in China between August 2016 and June 2019, were analyzed. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were used to reduce confounding bias.

RESULTS

After IPTW and PSM adjustments, baseline characteristics between the RG and LG groups were comparable (standardized mean difference < 0.10). After IPTW adjustment, mean blood loss in the RG group was significantly less than that in the LG group (89.36 vs. 103.39 mL; p = 0.046) as was mean length of hospital stay (9.62 vs. 10.47 days; p = 0.017). There were no statistical differences in postoperative complications between the RG and LG groups (p > 0.05), nor in 3y-DFS (IPTW-adjusted: 74.5% vs. 74.6%, p = 0.957; PSM-adjusted: 76.8% vs. 79.3%, p = 0.323) or 3y-OS (IPTW-adjusted: 75.9% vs. 77.0%, p = 0.640; PSM-adjusted: 77.9% vs. 80.9%, p = 0.235). Similarly, there were no significant differences in postoperative recurrence rates between the RG and LG groups (IPTW-adjusted: 21.1% vs. 20.5%, p = 0.640; PSM-adjusted: 77.9% vs. 80.9%, p = 0.235).

CONCLUSION

RG yielded superior short-term outcomes compared with LG in elderly patients diagnosed with GC, while achieving comparable long-term outcomes and demonstrating safety and effectiveness.

Association between HALP and all-cause and specific mortality in US adult with nonalcoholic fatty liver disease cirrhosis: a cohort study of National Health and Nutrition Examination Survey 2005-2018

BACKGROUND AND AIMS

Nonalcoholic fatty liver disease (NAFLD) cirrhosis is a significant health concern with a major impact on global morbidity and mortality. This study investigates the association of hemoglobin, albumin, lymphocyte, and platelet (HALP) with all-cause mortality, cardiovascular disease mortality, and cancer-related mortality in patients with NAFLD cirrhosis.

METHODS

This retrospective cohort study used data from the National Health and Nutrition Examination Survey, assessing 11 550 adults. NAFLD cirrhosis was defined by a hepatic steatosis index greater than 36 and a NAFLD fibrosis score greater than 0.676 in participants without viral hepatitis or excessive alcohol use. The HALP score was categorized into low (<32), moderate (32-48.3), and high (>48.3). Logistic and weighted Cox regression analyses were conducted, along with subgroup and restricted cubic spline analyses.

RESULTS

Higher HALP scores were associated with lower all-cause mortality. Subgroup analyses revealed significant interactions with gender and age, showing a decreased risk of all-cause mortality in males and individuals aged 40 and above with higher HALP scores. A U-shaped relationship between HALP scores and all-cause mortality was observed.

CONCLUSION

The study demonstrates that HALP is associated with a lower risk of all-cause mortality in the NAFLD cirrhosis population, suggesting that HALP may be a useful predictor of mortality risk.

Association between hemoglobin, albumin, lymphocyte, and platelet score and all-cause and cardiovascular mortality among population with diabetes: Evidence from the NHANES 2003-2016

INTRODUCTION

This study investigated the relationship between the Hemoglobin, Albumin, Lymphocyte, and Platelets (HALP) score and all-cause and cardiovascular mortality risk in diabetes patients.

METHODS

An analysis included 2154 individuals with diabetes from the 2003-2016 National Health and Nutrition Examination Survey (NHANES), with mortality data tracked until December 31, 2019. Cox regression models were adopted to evaluate the association of HALP score with mortality. The nonlinear relationship was examined using restricted cubic splines (RCS), and a two-segmented Cox proportional risk model analyzed data around identified threshold values.

RESULTS

During a median follow-up of 90 months, 565 (26.23 %) deaths occurred, of which 166 (7.71 %) caused by cardiovascular disease. In the Cox regression models, participants in the highest quartile of HALP score had lower risks of all-cause mortality (HR = 0.59,95 % CI:0.43-0.83, p = 0.002) and cardiovascular mortality (HR = 0.38,95 % CI:0.22-0.66, p < 0.001) compared to the lowest quartile. Based on the restricted cubic splines (RCS) curve, a L-shaped relationship was found, with thresholds of 49.81 for all-cause and 48.78 for cardiovascular mortality. HALP scores below these thresholds were associated with increased mortality (p < 0.001).

CONCLUSION

HALP score may serve as a valuable clinical indicator for predicting mortality risk in diabetes patients.

A cross-sectional study examining the relationship between the advanced lung cancer inflammation index and prostate cancer

BACKGROUND

Prostate cancer (PCa), a significant health concern among middle-aged and elderly men globally, has increasingly been associated with metabolic and inflammatory processes. The advanced lung cancer inflammation index (ALI), a novel marker reflecting nutritional and inflammatory status, has not yet been thoroughly investigated in the context of PCa. This study investigated the potential link between ALI and PCa.

METHODS

We first conducted a cross-sectional study utilizing data from the National Health and Nutrition Examination Survey (NHANES). The relationship between ALI and PCa was examined by NHANES-provided survey weights. Smoothed curve fitting and threshold effect analyses were conducted to evaluate possible nonlinear associations. Then we analyzed the correlation between the prognosis of PCa patients and ALI.

RESULTS

Out of 15,042 adult participants, 683 (4.54%) were diagnosed with PCa. The risk of PCa decreased across increasing quartiles of ALI. Multivariate logistic regression analysis revealed that compared to participants in the lowest ALI quartile (Q1: 2.89-41.94), those in higher quartiles (Q2: 41.94-59.08, Q3: 59.08-80.88, and Q4: ≥80.88) had progressively lower odds of developing PCa in both unadjusted and adjusted models. Smoothed curve fitting indicated a U-shaped relationship between ALI and PCa. Longitudinal follow-up data indicated that lower ALI values were positively correlated with a poor survival in cancer patients.

CONCLUSION

Our study revealed a non-linear relationship between ALI and the risk of PCa development. Specifically, there was a negative correlation between ALI and PCa risk when the ALI value was < 100. Furthermore, we found that lower ALI levels are strongly associated with a poor survival in cancer patients. Additional large-scale prospective studies are needed to confirm these findings and investigate the underlying mechanisms.

Dynamic key vascular anatomy dataset for D2 lymph node dissection during laparoscopic gastric cancer surgery

Gastric cancer (GC) is the fifth most common malignant tumor worldwide. Surgical resection remains the primary treatment for GC, with laparoscopic surgery recommended by several international guidelines. Due to complex perigastric vessels, standard D2 lymph node dissection (LND) in laparoscopic GC (LapGC) surgery is challenging. Careful dissection is required to expose, dissect, and ligate vessels without injury, ensuring radical LND. Computer vision has the potential to assist in the identification of key vessels during LapGC surgery, thereby reducing the risk of vascular injury. However, existing publicly available surgical anatomy datasets mainly focus on organ segmentation and simple surgeries. To address the clinical challenges and research needs outlined above, we present the LapGC Key Vascular Anatomy Dataset (LapGC-KVAD-30). This dataset was extracted from thirty complete surgical videos and contains annotations for fifteen types of key vessels across eight D2 LND scenes. The LapGC-KVAD-30 uniquely contains 5303 frames that showcase the dynamic process of key vessels from initial appearance to full exposure (or ligation), providing essential information for effective and safe LND.

The Role of Preoperative Immunonutritional Scores in Predicting Complications After Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease

Background: Parkinson's disease (PD) is a progressive neurodegenerative disorder associated with systemic inflammation, immune dysregulation, and malnutrition, all of which may influence surgical outcomes. Subthalamic nucleus deep brain stimulation (STN DBS) is a widely used treatment for advanced PD, yet postoperative complications remain a concern. This study evaluates the predictive value of preoperative immunonutritional markers-including the Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score, Aggregate Index of Systemic Inflammation (AISI), Lymphocyte-to-Monocyte Ratio (LMR), and systemic inflammatory response syndrome (SIRS)-for the risk of extracranial complications following STN DBS. Methods: A retrospective cohort study was conducted on 138 PD patients who underwent STN DBS. Clinical and laboratory data were analyzed to assess the association between preoperative immunonutritional markers and postoperative complications, including infections, wound healing disturbances, and surgical revisions. Logistic regression and receiver operating characteristic (ROC) analysis were performed to evaluate the predictive power of these markers. Results: SIRS emerged as the strongest predictor of complications (aOR = 6.99, 95% CI = 1.844-26.509), emphasizing the critical role of systemic inflammation in surgical outcomes. HALP, AISI, and LMR also demonstrated significant predictive potential, with HALP (AUC = 0.69) and LMR (AUC = 0.73) being the most robust predictors of complications. While albumin alone was not a significant predictor, it correlated with inflammatory markers and comorbidities, underscoring its role in broader risk assessments. Conclusions: This study underscores the value of preoperative immunonutritional markers in predicting complications following STN DBS in PD patients. Incorporating these markers into clinical risk stratification may enhance preoperative planning and personalized postoperative care, ultimately improving surgical outcomes. These findings, while promising, warrant validation through prospective, multicenter studies to refine predictive models and enhance patient outcomes.

Visceral adiposity index (VAI) association with suicidal ideation among U.S. adults: a cross-sectional study using NHANES 2005-2018 data

BACKGROUND AND OBJECTIVE

Suicidal ideation (SI) poses a significant public health challenge, and understanding its predictors, especially modifiable factors like visceral obesity, is essential for prevention. The purpose of this study is to investigate the association between the visceral adiposity index (VAI) and suicidal ideation (SI) among adults in the United States.

METHODS

A cross-sectional study using NHANES data from 2005-2018 included adults aged 18 and above with complete SI and VAI data. Suicidal thoughts were evaluated using item 9 from the Patient Health Questionnaire-9 (PHQ-9), while VAI was calculated using gender-specific formulas based on waist circumference, body mass index (BMI), total triglycerides (TG), and high-density lipoproteins (HDL-C). Multivariate logistic regression analysis was implemented after adjusting for several factors to assess the relationship between VAI and SI. Additionally, subgroup analysis and interaction testing were employed to investigate the consistency of this relationship with other demographic parameters.

RESULT

Our study included a cohort of 15,830 participants, of whom 3.59% exhibited signs of suicidal ideation. Following multivariate logistic regression analysis, we observed a significant positive association between VAI and SI (odds ratio [OR] = 1.03; 95% CI 1.01, 1.04; P = 0.0057), which remained significant after adjusting for various confounding factors. Moreover, utilizing a two-segment linear regression approach, we uncovered a nonlinear relationship between VAI and SI, demonstrating a U-shaped pattern with a critical point at 5.28.

CONCLUSION

Elevated levels of VAI were consistently associated with an increased probability of SI, and this association remained consistent across various demographic variables. Level of evidence Level V-cross-sectional observational study.

HALP Score for Predicting Renal Relapse in Lupus Nephritis: A Nested Case-Control Study

OBJECTIVE

To evaluate the HALP (hemoglobin-albumin-lymphocyte-platelet) score at lupus nephritis (LN) diagnosis in predicting renal relapse (RR).

METHODS

Nested case-control study, including patients aged ≥18 years with diagnosis of LN between 2010 and 2022. Two patient sets were included: training and validation. Each set had 2 groups of patients: RR and non-RR. Data were obtained from clinical records. The optimal cutoff value of the HALP score at LN diagnosis was established to predict RR. Cox regression analysis was used to associate HALP score at diagnosis with RR.

RESULTS

We included 53 LN patients in the training set and 74 LN patients in the validation set. The optimal cutoff value for HALP score at diagnosis was 23.5, with an area under the curve of 0.896, sensitivity of 91.9%, and specificity of 97.3% in the validation set. The median age of patients in this set was 31.0 years, mostly female (93%). In the validation set, LN patients with HALP score at diagnosis ≤23.5 compared with higher HALP score subjects showed a significantly higher baseline SLEDAI-2K (18 [interquartile range {IQR}, 14-20] vs. 14 [IQR, 11-17], p < 0.001), Systemic Lupus Collaborating Clinics/American College of Rheumatology Damage Index at the end of the follow-up (1 [IQR, 0-4] vs. 0 [IQR, 0-1], p = 0.002), chronicity index in renal biopsy (2 [IQR, 1-4] vs. 1 [IQR, 1-2], p = 0.030), and significantly reduced time to RR (4.2 vs. 12.9 years, p < 0.001). A HALP score at diagnosis ≤23.5 was associated with RR (hazard ratio, 18.2; 95% confidence interval, 5.3-30.1; p < 0.001).

CONCLUSION

A HALP score ≤23.5 at LN diagnosis was an independent risk factor for RR.

Laparoscopic gastrectomy reduced peritoneal recurrence in Borrmann type IV gastric cancer: a retrospective cohort study with propensity score matching

BACKGROUND

Current evidence on the surgical and oncological safety of laparoscopic surgery in patients with Borrmann type IV (B-IV) advanced gastric cancer (AGC) remains insufficient. This study aimed to compare the surgical and prognostic outcomes of laparoscopic gastrectomy (LG) and open gastrectomy (OG) in patients with B-IV AGC.

METHODS

Patients with primary B-IV gastric cancer who underwent LG or OG between 2003 and 2019 were retrospectively analyzed. We conducted 1:1 propensity score matching using covariates including sex, age, body mass index, operation type, clinical T and N stages, pathological TNM stage, tumor size, and tumor location. Surgical outcomes, postoperative complications, 5-year survival and recurrence outcomes, and risk factors for peritoneal recurrence were compared between the two groups.

RESULTS

Of 401 patients enrolled, 106 from each of the LG and OG groups were matched, with all standardized differences < 0.1. The LG had significantly fewer wound infections (P = 0.029), intra-abdominal abscesses (P = 0.035) and a lower peritoneal recurrence rate (5-year cumulative incidence: 48.8% vs. 62.8%, P = 0.032; hazard ratio, 0.66; 95% confidence interval, 0.45-0.96) compared to the OG group, along with a trend toward improved 5-year overall survival (LG vs. OG: 37.0% vs. 26.2%, P = 0.174; hazard ratio, 0.78; 95% confidence interval, 0.55-1.11). Multivariate analyses revealed a 32.6% decrease in the hazard ratio for peritoneal recurrence in the LG group (P = 0.048).

CONCLUSIONS

LG significantly reduced peritoneal recurrence with fewer wound and intra-abdominal infectious complications in patients with B-IV AGC.

Harnessing technologies to unravel gastric cancer heterogeneity

Gastric cancer arises from complex carcinogenic factor interactions, with limited treatment options due to the lack of targetable driver gene mutations and significant tumor heterogeneity. Recent studies have provided promising novel approaches to improve our understanding of gastric cancer heterogeneity through integrated characterization, combining genomics with emerging technologies. Delineating the molecular changes and targeting specific molecular subtypes will enhance the efficacy of gastric cancer treatment and improve clinical outcomes. This review provides a comprehensive overview of current technologies used in gastric cancer research, highlighting key discoveries and treatment strategies driven by these innovations. Finally, we discuss the emerging technology-guided directions and potential breakthroughs that could enhance the understanding of gastric cancer tumor heterogeneity, ultimately improving clinical outcomes.

Correlation analyses of ultrasonographic and histopathological characteristics of porta hepatis lymph nodes in biliary atresia

BACKGROUND

To perform correlation analyses between the ultrasonographic characteristics of porta hepatis lymph nodes (PHLNs) and the pathological features of PHLNs and the liver in biliary atresia (BA).

METHODS

We analyzed the clinical ultrasonographic characteristics of PHLNs in 27 patients with BA, along with specific pathological features, including pathological size, the number of bile granules, the number of germinal centers, the proportion of lymphocytes, and the analysis of liver biopsy specimens. A series of correlation analyses were then performed between ultrasonography data, pathological features, and prognosis.

RESULTS

The level of ultrasound echogenicity of PHLNs was positively correlated with the number of bile granules (r = 0.377, p = 0.004), while ultrasound and pathological size were also positively correlated with the number of germinal centers (r = 0.591, p = 0.001; r = 0.459, p = 0.016, respectively). No significant correlations were detected between the stage of liver fibrosis and pathological features or postoperative jaundice (all p > 0.05). Different types of lymphocytes proliferating in the livers, and CD8 + cells were positively correlated with the pathological size of PHLNs (r = 0.390, p = 0.045; r = 0.424, p = 0.028, respectively), and the number of germinal centers(r = 0.554, p = 0.003; r = 0.482, p = 0.011, respectively).The ultrasonographic and pathological size of PHLNs were only positively correlated with the serum levels of direct bilirubin(r = 0.431, p = 0.025; r = 0.593, p = 0.001, respectively).Finally, the pathological size of PHLNs and the number of CD8 + cells in the liver were negatively correlated with the reduction of jaundice following Kasai portoenterostomy (KPE) surgery (r=-0.385, p = 0.047; r=-0.567, p = 0.0411; r=-0.002, p = 0.033, respectively).

CONCLUSIONS

Analyses demonstrated that the ultrasonographic features of PHLNs are significantly correlated with pathological features of PHLNs and the liver. In addition, the enlargement of PHLNs might represent a prognostic predictor following KPE surgery.

Safety and efficacy of indocyanine green-guided laparoscopic lymphadenectomy for locally advanced gastric cancer: The CLASS-11 clinical trials

We report the short-term results of indocyanine green (ICG)-guided laparoscopic lymphadenectomy for gastric cancer (GC). The primary outcome is 3-year disease-free survival. In this analysis, we present short-term secondary outcomes focused on the number of lymph nodes (LNs) retrieved and the diagnostic value of fluorescent status for metastatic LNs, excluding long-term outcomes. A total of 1,006 patients are included in the per-protocol analysis. The mean number of LNs retrieved in the ICG group is significantly higher than that in the non-ICG group. The negative predictive value is 93.9% for nonfluorescent stations, and the sensitivity of ICG for detecting all metastatic LN stations is 91.6%. ICG technology is safe and feasible for laparoscopic lymphadenectomy in GC and can noticeably increase the number of LNs retrieved. Further follow-up is necessary to warrant whether ICG can improve long-term survival of GC. The Chinese Laparoscopic Gastrointestinal Surgery Study (CLASS)-11 trial has been registered at ClinicalTrials.gov as NCT04593615.

A short-term prognostic model based on urinary IgG, CO2CP and TP for newly diagnosed multiple myeloma

This study aimed to establish a short-term risk assessment model for patients with newly diagnosed multiple myeloma (NDMM), to augment the current prognosis assessments of MM patients. This model serves as a reference for evaluating the short-term remission of patients. Between January 2013 and March 2023, a total of 232 NDMM patients were enrolled in the Hematology department. The cohort between January 2013 and October 2020 was selected as the training set (n=165) and the cohort between November 2020 and March 2023 was used as the internal validation set (n=67). Using univariate and multivariate forward stepwise Cox analysis, the determined prognostic factors were urinary immunoglobulin G (IgG), carbon dioxide combining power (CO2CP), and total protein (TP). A 3-prognostic factor Nomogram model was established based on Cox regression. The area under the curve (AUC) of the Nomogram in 4-, 5- and 6-month complete remission (CR) was 0.777, 0.722, and 0.708, and the C index was 0.691 (0.661-0.721). Kaplan-Meier curve analysis indicated that the CR rate of the high-risk group was lower than the low-risk group (training set P<0.001, internal validation set P=0.018), which exhibited a better stratification of patients than the International Staging System (ISS, training set P=0.850, internal validation set P=0.900), Revised International Staging System (R-ISS, training set P=0.740, internal validation set P=0.720) and the Second Revision of the ISS (R2-ISS, training set P=0.480, internal validation set P=0.590). This study effectively constructed a Nomogram for short-term risk assessment of NDMM patients based on three widely used clinical markers, thereby enriching factors related to NDMM prognosis and aiding in the evaluation of the short-term complete remission.

Could the HALP score indicate poor prognosis in colorectal cancer patients?

Objective

Colorectal cancer (CRC) is a major health problem worldwide. According to estimates for the year 2030, cancer will be the number one cause of death for both genders. CRC is the third most common type of cancer and the second most common cause of cancer-related deaths. Various parameters are needed to provide information about the course and prognosis of the disease.

Material and Methods

The study included 103 patients diagnosed with CRC between 2017 and 2023. The patients' HALP scores were retrospectively analyzed together with clinical data. The relationship between survival times, disease stage, and treatment response was examined.

Results

The obtained data showed that low HALP scores were associated with worse overall survival. Although the HALP score cut-off value was found to be different in various studies conducted on benign or malignant diseases, a low HALP score indicates a poor prognosis. In our study, a HALP score below 23 was found to be associated with low overall survival.

Conclusion

This study suggests that a low HALP score is associated with poor prognosis and could serve as a valuable prognostic marker in the clinical management of CRC patients. However, certain limitations must be considered. While albumin is a marker of systemic inflammation and nutritional status, its specificity is limited in acute and chronic inflammatory conditions, which may impact the prognostic value of the HALP score. Further investigation into the biological mechanisms underlying this relationship and the potential of the HALP score in predicting treatment response would enhance its clinical applicability.

Examining more than 35 lymph nodes improves the staging and survival in resectable advanced gastric cancer: a multi-institutional study in China

PURPOSE

More examined lymph nodes (ELN) are correlated with better staging and a better prognosis of gastric cancer, although the optimal number of ELNs remains under dispute. This study explored the optimal number of ELNs for resectable advanced gastric cancer (AGC).

METHODS

Clinicopathological characteristics and survival data of 4739 AGC patients were collected from 3 GC centers in China. The series of odds ratios (ORs) for negative-to-positive node stage migration and hazard ratios (HRs) for the disease-specific survival with more ELNs were fitted using locally weighted scatterplot smoothing (LOWESS). The structural breakpoints were determined using the Chow test. A Kaplan-Meier survival analysis was used to validate the cutoff ELN count.

RESULTS

With increasing numbers of ELNs, the cohort exhibited significant proportional increases in stage migration (OR = 1.006, p = 0.024) and serial improvements in survival (HR = 0.979, p < 0.001) per additional ELN after adjusting for covariates. The optimal ELN count was identified as 36, which was further validated with good discrimination for survival stratification in an external cohort that included 5796 patients from the SEER database.

CONCLUSION

Having more than 35 LNs to examine could achieve more accurate staging and a better survival for AGC patients with stage N0-N2 disease.

Association between hemoglobin, albumin, lymphocyte, and platelet scores and all-cause and cardiovascular mortality among adults with atherosclerotic cardiovascular disease in the United States: An analysis of NHANES

Atherosclerotic cardiovascular disease (ASCVD) remains the foremost cause of mortality in the United States. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score, a straightforward and economical indicator, combines inflammatory and nutritional status. However, its association with ASCVD incidence and long-term mortality is uncertain. We conducted a cross-sectional study using US National Health and Nutrition Examination Survey data from 1999 to 2020, with mortality data collected until December 31, 2019, via the National Death Index. Weighted multivariable logistic regression was employed to assess the association between HALP scores and ASCVD prevalence. Kaplan-Meier analyses and weighted multivariate-adjusted Cox analyses were utilized to examine the relationship between HALP scores and all-cause and cardiovascular disease (CVD) mortality among patients with ASCVD. Restricted cubic spline curve (RCS) analysis was used to identify nonlinear relationships, and multisubgroup and sensitivity analyses were conducted to ensure the robustness of the results. This cohort study comprised 41,147 participants, including 4047 with ASCVD (prevalence: 7.7%). Over a median follow-up of 85 (49, 131) months, 1726 deaths occurred among patients with ASCVD, with 575 attributed to CVD. Multivariable-adjusted modeling showed no association between HALP score and ASCVD incidence. However, multivariable-adjusted Cox regression and RCS analyses revealed a nonlinear relationship between HALP scores and all-cause mortality and CVD mortality in patients with ASCVD (all P for nonlinearity < 0.001). Higher HALP scores were significantly associated with reduced all-cause and CVD mortality in patients with ASCVD (all P for trend < 0.05). Our results indicate a significant nonlinear association between HALP scores and all-cause as well as cardiovascular mortality in patients with ASCVD. Higher HALP scores are linked to decreased all-cause mortality and CVD mortality.

Serum miR-30c serves as potential biomarkers for the diagnosis and prognosis of gastric cancer

Gastric cancer (GC)，the fourth leading cause of cancer-related deaths globally and thus early detection, is considered critical for diagnosis and treatment of this disease. It is well known that measurement of microRNA (miRNA) may serve as diagnostic and prognostic biomarker for GC. The aim of this study was to determine whether miR-30c was present in patients with gastric cancer and to correlate relative expression with patient survival. A total of 162 GC patients and 150 healthy controls were recruited. miR-30c levels were quantified in serum using quantitative real-time PCR(QRT-PCR). The sensitivity and specificity of circulating miR-30c was compared to carbohydrate antigen (CA) CA72-4, CA19-9, and carcinoembryonic antigen (CEA), 3 known markers associated with GC. QRT-PCR demonstrated downregulation of gene expression of miR-30c in GC patients. Downregulation of miR-30c gene expression was significantly correlated with stage of cancer, lymphatic metastasis, and distal metastasis. The sensitivity to detect GC of miR-30c, CA72-4, CA19-9, and CEA in serum of GC was 80%, 43%, 21%, and 42%, respectively, while specificity was 89%, 57%, 30%, and 78% respectively. Kaplan-Meier survival analysis showed that the presence of low gene expression of miR-30c was effective in predicting poor prognosis in GC patients. Our data suggest that circulating serum miR-30c concentrations may serve as a reliable biomarker for GC occurrence. (212words).

Risk factors for pneumonia after radical gastrectomy for gastric cancer: a systematic review and meta-analysis

OBJECTIVE

The objective is to systematically gather relevant research to determine and quantify the risk factors and pooled prevalence for pneumonia after a radical gastrectomy for gastric cancer.

METHODS

The reporting procedures of this meta-analysis conformed to the PRISMA 2020. Chinese Wan Fang data, Chinese National Knowledge Infrastructure (CNKI), Chinese Periodical Full-text Database (VIP), Embase, Scopus, CINAHL, Ovid MEDLINE, PubMed, Web of Science, and Cochrane Library from inception to January 20, 2024, were systematically searched for cohort or case-control studies that reported particular risk factors for pneumonia after radical gastrectomy for gastric cancer. The pooled prevalence of pneumonia was estimated alongside risk factor analysis. The quality was assessed using the Newcastle-Ottawa Scale after the chosen studies had been screened and the data retrieved. RevMan 5.4 and R 4.4.2 were the program used to perform the meta-analysis.

RESULTS

Our study included data from 20,840 individuals across 27 trials. The pooled prevalence of postoperative pneumonia was 11.0% (95% CI = 8.0% ~ 15.0%). Fifteen risk factors were statistically significant, according to pooled analyses. Several factors were identified to be strong risk factors, including smoking history (OR 2.71, 95% CI = 2.09 ~ 3.50, I2 = 26%), prolonged postoperative nasogastric tube retention (OR 2.25, 95% CI = 1.36-3.72, I2 = 63%), intraoperative bleeding ≥ 200 ml (OR 2.21, 95% CI = 1.15-4.24, I2 = 79%), diabetes mellitus (OR 4.58, 95% CI = 1.84-11.38, I2 = 96%), male gender (OR 3.56, 95% CI = 1.50-8.42, I2 = 0%), total gastrectomy (OR 2.59, 95% CI = 1.83-3.66, I2 = 0%), COPD (OR 4.72, 95% CI = 3.80-5.86, I2 = 0%), impaired respiratory function (OR 2.72, 95% CI = 1.58-4.69, I2 = 92%), D2 lymphadenectomy (OR 4.14, 95% CI = 2.29-7.49, I2 = 0%), perioperative blood transfusion (OR 4.21, 95% CI = 2.51-7.06, I2 = 90%), and hypertension (OR 2.21, 95% CI = 1.29-3.79, I2 = 0%). Moderate risk factors included excessive surgery duration (OR 1.51, 95% CI = 1.25-1.83, I2 = 90%), advanced age (OR 1.91, 95% CI = 1.42-2.58, I2 = 94%), nutritional status (OR 2.62, 95% CI = 1.55-4.44, I2 = 71%), and history of pulmonary disease (OR 1.61, 95% CI = 1.17-2.21, I2 = 79%).

CONCLUSIONS

This study identified 15 independent risk factors significantly associated with pneumonia after radical gastrectomy for gastric cancer, with a pooled prevalence of 11.0%. These findings emphasize the importance of targeted preventive strategies, including preoperative smoking cessation, nutritional interventions, blood glucose and blood pressure control, perioperative respiratory training, minimizing nasogastric tube retention time, and optimizing perioperative blood transfusion strategies. For high-risk patients, such as the elderly, those undergoing prolonged surgeries, experiencing excessive intraoperative blood loss, undergoing total gastrectomy, or receiving open surgery, close postoperative monitoring is essential. Early recognition of pneumonia signs and timely intervention can improve patient outcomes and reduce complications.

Hemoglobin, Albumin, Lymphocyte and Platelet Score as a Novel Predictor of Mortality and Rebleeding in Patients with Upper Gastrointestinal Bleeding

Purpose

Upper gastrointestinal bleeding (UGIB) poses significant risks of morbidity and mortality, necessitating effective risk stratification tools. Traditional scoring systems such as the Rockall (RS), Glasgow-Blatchford (GBS), and AIMS65 have limitations in accurately predicting mortality and rebleeding. The Hemoglobin, Albumin, Lymphocyte, Platelet (HALP) score, initially developed for cancer prognosis, has demonstrated prognostic value in various conditions. This study aims to evaluate whether the HALP score, when assessed at admission, aligns with the Rockall score and can be used to predict rebleeding and 30- day mortality in UGIB patients.

Patients and Methods

This retrospective study included 256 patients with confirmed UGIB admitted to a tertiary hospital in Istanbul, Turkey, between 2017 and 2024. Patient data, including demographics, vital signs, laboratory parameters, endoscopic findings, and clinical outcomes, were collected. The HALP score was calculated at admission to the emergency department. ROC curve analysis assessed the predictive accuracy of the HALP score for 30-day mortality, rebleeding, and its performance was compared with the Rockall score.

Results

The predictive performance of the HALP and Rockall scores for 30-day mortality and rebleeding was evaluated using ROC analysis, with AUC values of 0.772 (95% CI: 0.715-0.822) and 0.770 (95% CI: 0.714-0.820) for mortality prediction, respectively (p = 0.9801). For rebleeding prediction, the Rockall score had a higher AUC (0.739, 95% CI: 0.681-0.792) than the HALP score (0.688, 95% CI: 0.627-0.744), though the difference was not statistically significant (p = 0.2969).

Conclusion

The results of this study demonstrate that the HALP score can be used for prognosis prediction in UGIB, exhibiting comparable sensitivity and specificity to the Rockall score. Its ease of calculation using routine laboratory parameters offers a practical complement to existing scoring systems.

Short-term outcomes of minimally invasive gastrectomy in population with obesity versus population without obesity: the obesity paradox

This study aims to compare the short-term outcomes after minimally invasive gastrectomy between obese and non-obese population. Our analysis included data of 713 patients from ten departments of surgery. They were divided in non-obese group and obese group with 617 and 96 patients respectively. Significant differences were found in terms of mortality at 90 days (obese: 0 vs non-obese: 27, p = 0.037). Intraoperative data showed no significant differences in terms of conversion (obese: 4 vs non-obese: 43, p = 0.303). About postoperative complications, significant differences between the two groups were found only in terms of surgical infection (obese: 13 vs non-obese: 38, p = 0.009). About oncological outcomes, no differences were found about retrieved lymph nodes (obese: 30.71 ± 18.44 vs non-obese: 32.93 ± 17.62, p = 0.596) and about surgical radicality (R0) (obese:94 vs non-obese:594, p = 0.415). Obesity doesn't worsen postoperative outcomes and minimally invasive gastrectomy in obese patients is related to a lower postoperative mortality.

The prognostic value of halp score in predicting the efficacy of nivolumab treatment in metastatic malignant melanoma patients: A real-life, retrospective, single center analysis

Patients with metastatic malignant melanoma have a survival rate of less than one year. Nivolumab, a monoclonal antibody against programmed cell death 1 (PD-1) receptor, has improved survival in patients without BRAF mutations. The HALP score, calculated from hemoglobin, albumin, lymphocyte, and platelet levels, provides information about a patient immune and nutritional status. High HALP scores have been associated with a better prognosis in various cancers. This study aimed to investigate the effect of high HALP scores on response to nivolumab treatment in patients with metastatic malignant melanoma. A retrospective study was conducted on 44 patients with metastatic malignant melanoma treated with nivolumab at Adana City Training and Research Hospital between 2014 and 2021. Patients who received dabrafenib-trametinib before nivolumab treatment were excluded. The HALP scores were calculated using laboratory parameters before the first nivolumab treatment. Statistical analyses were performed using SPSS version 25.0. The study included 22 female and 22 male patients with a mean age of 61.4 ± 15.6 years. Of the patients, 10 (27.2%) had a positive BRAF mutation, whereas 34 (77.3%) did not. The HALP score cutoff value was determined as 30.1. Patients with high HALP scores had significantly longer progression-free survival (PFS) and overall survival (OS) compared to those with low HALP scores (PFS: median 5.8 vs 3.1 months, P = .041; OS: median 54.9 vs 14.4 months, P = .005). In this study, we found that high HALP scores were significantly associated with longer PFS and OS in metastatic malignant melanoma patients receiving nivolumab treatment. HALP score was associated with both PFS and OS in patients with metastatic malignant melanoma treated with nivolumab. This immuno-nutritional parameter may be useful in various cancers; however, further prospective studies with larger patient cohorts are needed for clinical application.

MARMOT: A multifaceted R pipeline for analysing spectral flow cytometry data from subcutaneously growing murine gastric organoids

The analysis of murine immune cell types is a critical component of immunological research, necessitating precise and reproducible methodologies. Here, we present a comprehensive protocol and pipeline designed to streamline the process from murine gastric organoid transplant sample preparation to figure generation. This pipeline includes a detailed staining panel tailored for murine immune cells, ensuring accurate and comprehensive identification of various cell types. Additionally, it integrates an R-based analysis script (MARMOT Pipeline), encompassing data processing and visualisation. A key feature of this pipeline is its ability to produce publication-quality figures with minimal direct R coding, thus making advanced data analysis accessible to researchers with limited programming experience. Additionally, figures can be customised using a provided Shiny application. This approach both enhances the efficiency of data analysis and enables the reproducibility required for high-quality scientific research.

Radiomics analysis of dual-energy CT-derived iodine maps for differentiating between T1/2 and T3/4a in gastric cancer: A multicenter study

OBJECTIVE

To investigate the value of radiomic analysis of dual-energy CT (DECT)-derived iodine maps (IMs) for the differentiation between T1/2 and T3/4a stage tumors in gastric cancer (GC).

METHODS

A total of 263 patients who received upfront surgery and were pathologically confirmed with gastric adenocarcinoma were enrolled in this study. Dual-phase enhanced CT scans with gemstone spectral imaging (GSI) mode were performed within two weeks before surgery. 151 patients were retrospectively collected for the training (n = 105) and validation (n = 46) cohorts, and 112 patients were prospectively collected for the external test1 (n = 68) and external test2 (n = 44) cohorts. According to the postoperative pathological T stage, patients were classified into T1/2 and T3/4a stage groups. Clinical characteristics were recorded and quantitative iodine concentration (IC) of tumors was measured. Radiomics features were extracted from the venous phase (VP) IMs by three-dimensional region of interest (3D-ROI) segmentation. Feature selection was performed using the least absolute shrinkage and selection operator. Four machine learning algorithms, including random forest, logistic regression, naive Bayes, and support vector machine, were used to construct radiomics models. Finally, the most valuable clinical characteristics, DECT parameters, and the best radiomics model were combined to build a nomogram. The diagnostic performance of nomogram was evaluated by the area under receiver operating characteristic curve (AUC), calibration curve, and decision curve.

RESULTS

The nomogram combined tumor clinical T stage (cT), tumor thickness, venous-phase iodine concentration (ICVP), normalized arterial-phase iodine concentration (nICAP), and Radscore (derived from logistic regression model). This integrated model demonstrated favorable performance in the differentiation between T1/2 and T3/4a stage tumors in GC, with AUCs of 0.892 (95 %CI: 0.829-0.956), 0.846 (95 %CI: 0.734-0.958), 0.894 (95 %CI: 0.818-0.970) and 0.821 (95 %CI: 0.689-0.952) observed for the training, validation, external test 1, and external test 2 cohorts, respectively. Hosmer-Lemeshow test showed a good fit (all P > 0.05). Decision curves confirmed that the nomogram provided more net clinical benefit than the default simple strategy over a wide range of threshold probabilities.

CONCLUSION

We have developed and validated a multidimensional personalized nomogram that integrates a radiomics model based on DECT-derived IMs, DECT quantitative parameters, and traditional clinical features. The proposed model demonstrated favorable performance in preoperative identification of T3/4a stage tumors in GC.

Single-cell and spatial RNA sequencing identify divergent microenvironments and progression signatures in early- versus late-onset prostate cancer

The clinical and pathological outcomes differ between early-onset (diagnosed in men ≤55 years of age) and late-onset prostate cancer, potentially attributed to the changes in hormone levels and immune activities associated with aging. Exploring the heterogeneity therein holds potential for developing age-specific precision interventions. Here, through single-cell and spatial transcriptomic analyses of prostate cancer tissues, we identified that an androgen response-related transcriptional meta-program (AR-MP) might underlie the age-related heterogeneity of tumor cells and microenvironment. APOE+ tumor-associated macrophages infiltrated AR-MP-activated tumor cells in early-onset prostate cancer, potentially facilitating tumor progression and immunosuppression. By contrast, inflammatory cancer-associated fibroblasts in late-onset prostate cancer correlated with downregulation of AR-MP of tumor cells and increased epithelial-to-mesenchymal transition and pre-existing castration resistance, which may also be linked to smoking. This study provides potential insights for tailoring precision treatments by age groups, emphasizing interventions that include targeting AR and tumor-associated macrophages in young patients but anchoring epithelial-to-mesenchymal transition and inflammatory cancer-associated fibroblasts in old counterparts.

Impact of indocyanine green angiography on anastomotic dehiscence rate in colorectal surgery: a systematic review and meta-analysis of randomized studies

Anastomotic dehiscence, a feared complication in colorectal surgery, motivates the search for effective strategies to mitigate its risk. This meta-analysis encompasses all published randomized trials investigating and comparing the impact of indocyanine green (ICG) angiography on this complication. With four studies and 1,109 patients, the intraoperative ICG angiography group demonstrated a significant reduction in the overall rate of anastomotic dehiscence compared to the non-angiography group (7.3% vs. 11.5%; OR: 0.6; 95% CI: 0.4-0.9; p = 0.03). These differences were maintained in rectal surgery subgroup, with no prolongation of surgical time or increase in morbidity and mortality. There were no differences in the left colon surgery group. The evidence provided by this meta-analysis would support the effectiveness of ICG angiography in reducing the incidence of anastomotic leakage in colorectal surgery, advocating for its integration into routine surgical practice.

Comparison of short- and long-term outcomes of robotic versus laparoscopic gastrectomy for locally advanced gastric cancer after neoadjuvant therapy: a high-volume center retrospective study with propensity score matching

BACKGROUND

Although neoadjuvant therapy (NAT) for advanced gastric cancer (AGC) can benefit patient survival, few studies have compared the short- and long-term outcomes of robotic and laparoscopic gastrectomy for AGC after NAT.

METHODS

The clinical data of 321 AGC patients who received NATs and who underwent robotic gastrectomy (RG, n = 109) or laparoscopic gastrectomy (LG, n = 212) between May 2017 and September 2022 were collected and analyzed retrospectively at our center. After propensity score matching (PSM) for 1:1 matching to eliminate bias, both groups had 106 cases. Short-term clinical outcomes and long-term survival-related indicators were compared between the two groups of patients.

RESULTS

A total of 212 patients were included in the groups after matching. There were fewer overall complications (13.2% vs. 28.3%, P = 0.007) and surgical complications (8.5% vs. 17.9%, P = 0.043) in the RG group than in the LG group. Compared with the LG group, the RG group had more harvested overall lymph nodes (35.25 ± 4.99 vs. 31.45 ± 6.31, P < 0.001) and more suprapancreatic lymph nodes (13.12 ± 4.38 vs. 10.05 ± 4.13, P < 0.001). Patients in the RG group had significantly shorter surgery times (217.62 ± 47.49 vs. 267.25 ± 70.68, P < 0.001) and less blood loss (46.51 ± 27.02 vs. 70.75 ± 37.25, P < 0.001) than patients in the LG group. The RG group had significantly faster bowel function recovery, earlier liquid diet, and shorter hospital stay. Compared with LG, RG had a better 3-year RFS (75.5% vs. 62.3%, P = 0.017).

CONCLUSION

Compared with laparoscopic surgery, robotic surgery significantly increased the number of lymph node dissected, reduced intraoperative blood loss, and postoperative surgical complications rate. Although RG did not statistically improve 3-year overall survival, there was a significant improvement in RFS and could be an alternative surgical method for GC patients after NAC.

Characteristic features and prognostic factors in gastric cancer patients with bone metastases: multicenter experience

We evaluated the incidence, clinicopathological features, prognostic factors, progression-free survival (PFS) and overall survival (OS) of patients with gastric cancer and bone metastases. The medical records of 110 patients with bone metastases were retrospectively analyzed. In our study, the incidence of bone metastases was 3.2%. The median patient age was 60 years. A total of 68 (61.8%) patients exhibited synchronous metastases, and 42 (38.2%) patients developed metachronous metastases. Alkaline phosphatase (ALP) levels were high in 54 (49%) patients. At the median follow-up time of 9.8 months, median PFS and OS times were 4.7 and 6.3 months, respectively. The median interval from the diagnosis to bone metastases was 9.3 months. Univariate analysis showed that Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≥2, stage at diagnosis, time of metastases, number of metastases, presence of extraskeletal metastases, use of zoledronic acid treatment, palliative chemotherapy post-bone metastases and radiotherapy to bone metastases were significant prognostic indicators for PFS. Additionally, ECOG PS ≥2, stage at diagnosis, time of metastases, number of metastases, presence of extraskeletal metastases, zoledronic acid treatment, palliative chemotherapy post-bone metastases, and radiotherapy to bone metastases significantly influenced OS. Moreover, in multivariate analysis, ECOG PS, time of metastases, presence of extra-bone metastases, and the use of palliative chemotherapy after bone metastases were found to be independent prognostic factors for PFS. Moreover, ECOG PS, time of metastases, and use of palliative chemotherapy after bone metastases were significantly independent prognostic indicators for OS. Our findings show that the presence of synchronous metastases, use of palliative chemotherapy, use of zoledronic acid after bone metastases, and ALP level within the normal range were significantly associated with prolonged OS in gastric cancer patients with bone metastases.

Association of hemoglobin, albumin, lymphocyte and platelet (HALP) score with testicular tumor aggressiveness and prognosis

BACKGROUND

The hemoglobin, albumin, lymphocyte and platelet (HALP) score integrates readily available blood markers that reflect systemic inflammation, nutritional status, and immune response, all of which can influence cancer progression. This study investigated the association between the HALP score and clinicopathological characteristics in patients with testicular tumor.

METHODS

Data of patients who underwent radical orchiectomy for testicular tumors between January 2020 and January 2024 were reviewed. Preoperative serum tumor markers, hemogram parameters and albumin levels were recorded. Tumor stages were recorded from postoperative radiological imaging and serum tumor markers. The association between postoperative results and HALP score was analyzed.

RESULTS

A total of 74 male patients were included in the study. The mean age of the patients was 30.27 ± 6.42 years. The mean HALP score in the patient group with metastasis and retroperitoneal lypmh node invasion (RPLNI) was statistically significantly lower than the patients without metastasis and RPLNI. HALP score decreased statistically significantly with increasing tumor T stage, N stage and M stage. In addition, the mean HALP score values of patients who received chemotherapy, developed progression and mortality were statistically significantly lower than those of patients who did not.

CONCLUSIONS

Lower HALP scores are significantly associated with advanced disease and poorer prognosis in patients with testicular tumor. The HALP score, composed of routinely measured blood markers, may serve as a convenient and cost-effective prognostic tool to identify patients at higher risk and guide personalized management strategies.

Real-time ancillary diagnostics for intraoperative assessment of intestinal viability in horses-looking for answers across species

Clinical intestinal viability assessment is associated with significant limitations, and there is an undisputable need for ancillary diagnostics during colic surgery. Human and companion animal surgeons struggle with similar intraoperative issues, yet there is little exchange between specialists. Therefore, this narrative review aimed to create an overview of real-time ancillary diagnostics with the potential for intraoperative intestinal viability assessment in horses. Most real-time ancillary diagnostics can be classified as either tissue perfusion or oxygenation assessments. Intestinal perfusion may be quantified using dark field microscopy, laser Doppler flowmetry, or fluorescence angiography (FA). In particular, indocyanine green FA has gained popularity in human medicine and is increasingly employed to predict intestinal injury. Intestinal oxygen saturation can be measured by pulse oximetry or mixed tissue oximetry. The latter can be conducted using visible light or near-infrared spectrophotometry, and these measurements correlate with clinical outcomes in various species. Other real-time diagnostics include thermography and techniques currently under development, such as laser speckle flowgraphy or photoacoustic imaging. The modalities discussed are minimally invasive and may be used for intraoperative assessments of the intestine. However, limitations include the occurrence of artifacts and the subjective nature of some modalities. Techniques such as indocyanine green FA and tissue oximetry are already available in veterinary practice and have the potential for use during colic surgery. However, blinded clinical trials are lacking in all species, and more research is needed to determine the accuracy and cutoff values in equine-specific intestinal lesions.

Possibly more favorable short-term outcomes with minimally invasive surgery than with open surgery in total gastrectomy for locally advanced gastric cancer: A single high-volume center study

Background

Minimally invasive total gastrectomy (MTG) requires advanced surgical skills and is still associated with a higher rate of postoperative complications than other types of gastrectomy. Additionally, the short-term outcomes of MTG compared to open total gastrectomy (OTG) for locally advanced gastric cancer have yet to be demonstrated.

Methods

We retrospectively compared short-term outcomes between MTG and OTG for locally advanced gastric and esophago-gastric junctional cancer, performed at the Cancer Institute Hospital, Tokyo, during the period from January 2017 to March 2024. Propensity score matching (PSM) was conducted to adjust for potential confounders.

Results

In total, 359 patients were included, with 190 remaining after PSM, resulting in 95 in each group. The MTG group experienced a significantly lower incidence of postoperative complications of Clavien-Dindo classification (C-D) ≥3 than the OTG group (3.2% vs. 11.6%, p = 0.026). Moreover, the rate of postoperative intra-abdominal infectious complications (IAIC) was significantly lower in the MTG than in the OTG group (C-D ≥ 2; 7.4% vs. 17.9%, p = 0.029 and C-D ≥ 3; 2.1% vs. 9.5%, p = 0.030, respectively). Subgroup analyses showed the odds ratios for IAIC with C-D ≥ 2 to be more favorable for the MTG than the OTG group in male patients, those ≥70 years of age, patients without esophageal invasion, those without neoadjuvant chemotherapy, those diagnosed with cT≥3, and patients not undergoing combined resection of other organs except for the gallbladder or spleen.

Conclusions

MTG for locally advanced gastric cancer may provide improved short-term outcomes compared to OTG, when performed or supervised by surgeons with high proficiency in laparoscopic techniques.

Spectral CT-based nomogram for preoperative prediction of Lauren classification in locally advanced gastric cancer: a prospective study

OBJECTIVES

To develop a nomogram based on clinical features and spectral quantitative parameters to preoperatively predict the Lauren classification for locally advanced gastric cancer (LAGC).

METHODS

Patients diagnosed with LAGC by postoperative pathology who underwent abdominal triple-phase enhanced spectral computed tomography (CT) were prospectively enrolled in this study between June 2023 and December 2023. All the patients were categorized into intestinal- and diffuse-type groups according to the Lauren classification. Traditional characteristics, including demographic information, serum tumor markers, gastroscopic pathology, and image semantic features, were collected. Spectral quantitative parameters, including iodine concentration (IC), effective atomic number (Zeff), and slope of the energy spectrum curve from 40 keV to 70 keV (λ), were measured three times for each patient by two blinded radiologists in arterial/venous/delayed phases (AP/VP/DP). Differences in traditional features and spectral quantitative parameters between the two groups were compared using univariable analysis. Independent predictors of the Lauren classification of LAGC were screened using multivariable logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was used to assess the discriminating capability. Ultimately, the nomogram, including clinical features and spectral CT quantitative parameters, was developed.

RESULTS

Gender, nIC in AP (APnIC), and λ in DP (λd) were independent predictors for Lauren classification. The nomogram based on these indicators produced the best performance with an area under the curve of 0.841 (95% confidence interval: 0.749-0.932), specificity of 85.3%, accuracy of 76.4%, and sensitivity of 68.4%.

CONCLUSION

The nomogram based on clinical features and spectral CT quantitative parameters exhibits great potential in the preoperative and non-invasive assessment of Lauren classification for LAGC.

KEY POINTS

Question Can the proposed nomogram, integrating clinical features and spectral quantitative parameters, preoperatively predict the Lauren classification in locally advanced gastric cancer (LAGC)? Findings The nomogram, based on gender, arterial phase normalized iodine concentration, and slope of the energy spectrum curve in the delayed phase showed satisfactory predictive ability. Clinical relevance The established nomogram could contribute to guiding individualized treatment strategies and risk stratification in patients by predicting the Lauren classification for LAGC before surgery.

HALP score as a prognostic marker for overall survival in advanced pancreatic cancer

Introduction

Pancreatic cancer is the leading cause of cancer-related deaths worldwide and most of the patients diagnosed at an advanced stage. Clinicians need simple, effective, and repeatable tools to predict the prognosis. This study aimed to evaluate the relationship between the HALP score and prognosis in patients with advanced pancreatic cancer.

Methods

Patients diagnosed with advanced pancreatic cancer at three centers in Turkey between 2009 and 2023 were included in this retrospective study. Demographic features, blood parameters, treatment received, treatment responses, and survival were recorded.

Results

227 patients were included in the study. The median overall survival (OS) for the entire cohort was 10.4 months. The median OS was 8.7 months in the low-HALP group and 11.2 months in the high- HALP group. Patients in the low-HALP group had a significantly shorter median OS than those in the high-HALP group (log rank p=0.001).

Conclusion

The HALP score is a reliable and practical tool that can be utilized in clinical practice to predict prognosis in patients with advanced pancreatic cancer.

Association between Hemoglobin-albumin-lymphocyte-platelet score and all-cause or cardiovascular mortality in patients with diabetes or prediabetes: mediated effects of renal function

OBJECTIVE

Hemoglobin-albumin-lymphocyte-platelet (HALP) score is considered to be a comprehensive indicator of inflammation and nutrition. We aimed to investigate the relationship of HALP score and the risk of all-cause and cardiovascular disease (CVD) mortality in patients with diabetes (DM) or prediabetes (PDM).

METHODS

6,869 participants with DM or PDM from the National Health and Nutrition Examination Survey (NHANES) 2005 to 2018 were enrolled. The colleration of HALP score with all-cause and CVD mortality was evaluated using Kaplan-Meier, Cox regression and restricted cubic spline (RCS) methods. The predictive value of HALP score for mortality was evaluated by time-dependent-receiver-operating-characteristic (ROC) curves. Finally, subgroup and interaction analysis were performed.

RESULTS

1203 deaths from all-cause and 399 deaths from CVD were observed. Cox regression analyses showed that the HALP score was negatively correlated with both all-cause and CVD mortality risk. RCS curves showed a nonlinear relationship between HALP score and all-cause or CVD mortality risk, and both the dose-response curves are L-shaped. For all-cause mortality risk, the AUC was 0.805, 0.799, and 0.816 for 3, 5, and 10 years survival, respectively, and for CVD mortality risk, the AUC was 0.839, 0.850, and 0.837 for 3, 5, and 10 years of survival, respectively. Mediation analysis showed that serum creatinine and urea nitrogen partially mediate the relationship between HALP and mortality risk.

CONCLUSION

HALP score is negatively correlated with all-cause and CVD mortality risk, and serves as a valuable predictor of all-cause and CVD mortality risk in patients with DM or PDM.

CLINICAL TRIAL NUMBER

Not applicable.

Habitat radiomics assists radiologists in accurately diagnosing lymph node metastasis of adenocarcinoma of the esophagogastric junction

OBJECTIVES

This study aimed to develop a habitat radiomics (HR) model capable of preoperatively predicting lymph node metastasis (LNM) in adenocarcinoma of the esophagogastric junction (AEG) and to implement its use in clinical practice.

METHODS

In this retrospective analysis, 337 patients from three centers were enrolled and divided into three cohorts: training, validation, and test (208, 52, and 77 patients, respectively). We constructed HR models, conventional radiomics models, and combined models to identify LNM in AEG. The area under the curve (AUC) was employed to identify the optimal model, which was then evaluated for assisting radiologists in the empirical and RADS groups in diagnosing LNM. Finally, the prediction process of the optimal model was visualized using SHAP plots.

RESULTS

The HR model demonstrated superior performance, achieving the highest AUC values of 0.876, 0.869, and 0.795 in the training, validation, and test cohorts, respectively. Regardless of seniority, the empirical group of radiologists showed a significant improvement in the AUC and accuracy when using the HR model, compared to working alone (p < 0.05). Furthermore, the RADS group radiologists exhibited strong reclassification ability, effectively reevaluating patients with false-negative LN initially classified as Node-RADS score 1 or 2 by themselves.

CONCLUSION

The HR model facilitates the accurate prediction of LNM in AEG and holds potential as a valuable tool to augment radiologists' diagnostic capabilities in daily clinical practice.

CRITICAL RELEVANCE STATEMENT

The habitat radiomics model could accurately predict the lymph node status of adenocarcinoma in the esophagogastric junction and assist radiologists in improving diagnostic efficacy, which lays the foundation for accurate staging and effective treatment.

KEY POINTS

Accurate lymph node diagnosis in esophagogastric junction adenocarcinoma is beneficial for prognosis. Habitat radiomics model accurately predicted and assisted physicians in diagnosing lymph nodes. The habitat model effectively reclassified false-negative lymph nodes at Node-RADS 1 and 2.

Efficacy and safety of XELOX combined with neoadjuvant radiotherapy versus neoadjuvant chemotherapy in locally advanced gastric cancer

BACKGROUND

The work aimed to compare the efficacy and safety of chemotherapy regimen (oxaliplatin + capecitabine, XELOX) combined with neoadjuvant radiotherapy (NART) and neoadjuvant chemotherapy (NACT) in locally advanced gastric cancer.

METHODS

We retrospectively analyzed clinical data from patients with locally advanced gastric cancer who underwent radical gastrectomy with D2 lymph node dissection at our center between January 2019 and December 2020. The study compared tumor markers, postoperative pathology, short-term efficacy, postoperative complications, and hospital stay between the chemoradiotherapy (CRT, XELOX + NART) group and the NACT-only group. Pearson correlation coefficients was used to analyze the correlations between clinical variables and tumor biomarkers. Inverse probability weighting (IPW) was used to adjust for confounding factors.

RESULTS

A total of 409 patients were included, with 369 (90.2%) in the NACT group and 40 (9.8%) in the CRT group. Significant correlations were found between clinical variables and tumor biomarkers, which may help identify potential prognostic factors for gastric cancer treatment. After IPW adjustment, baseline characteristics were similar between groups. The negative conversion rate of CEA-positive patients was significantly higher in the CRT group (38.1% vs. 11.8%, P < 0.001). The rate of pathological complete response was also higher in the CRT group (15.8% vs. 4.7%, P = 0.017). Postoperative pathological stages ypT0 and T1 were observed in 35.5% of the CRT group compared to 13.5% in the NACT group (P = 0.031). The CRT group had a lower average number of lymph nodes dissected (17 vs. 24, P < 0.001) but a higher ypN0 rate (60.3% vs. 39.8%, P = 0.024). The proportion of patients with tumor regression grade (TRG) 0-1 was higher in the CRT group (60.3% vs. 24.3%, P = 0.003). The R0 resection rate after IPW was 100% in the CRT group versus 96.5% in the NACT group (P = 0.001). No significant differences were found between the CRT and NACT groups in nerve invasion, vascular embolus, peritoneal invasion, bone marrow suppression, nausea, vomiting, esophagitis, diarrhea, other adverse reactions, postoperative complications, or average hospitalization time. The CRT group showed superior disease-free survival while no overall survival advantage (P < 0.05).

CONCLUSIONS

The XELOX regimen combined with neoadjuvant chemoradiotherapy provided superior downstaging, short-term pathological response, and local control benifits compared to perioperative chemotherapy alone, with similar surgical safety profiles.

Optimizing surgical timing following neoadjuvant therapy for gastric Cancer: Insights from a multicenter retrospective analysis

BACKGROUND

Neoadjuvant therapy (NAT) is a cornerstone in the treatment of locally advanced gastric cancer, improving surgical outcomes and survival. However, the optimal timing for surgery following NAT remains controversial. This study evaluates the impact of the interval between NAT and surgery on overall survival (OS) and explores associated clinicopathological factors.

METHODS

A retrospective analysis of 893 patients undergoing NAT and curative surgery for gastric adenocarcinoma across three centers in China was conducted. Surgical intervals were categorized (∼28 days, 29-42 days, >42 days). Survival analyses employed restricted cubic spline (RCS) models, Kaplan-Meier methods, and Cox proportional hazards regression.

RESULTS

Patients operated on within 28 days post-NAT had the most favorable OS, while intervals longer than 28 days were independently associated with worse outcomes. RCS analysis revealed increased risks for intervals longer than 28 days. Prolonged intervals showed declining effectiveness in tumor regression. Stratified analyses indicated that patients with poor NAT response (TRG 3) particularly benefited from surgery within 4 weeks, while delays were detrimental.

CONCLUSIONS

Timely surgery, especially within 4 weeks post-NAT, optimizes survival outcomes, particularly in patients with limited NAT response. This study underscores the need for individualized surgical timing and calls for prospective multicenter validation.