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Zhang H, Tang X, Zhang J, Jiang D, Gong D, Fan Y. Serum prealbumin level as a biomarker of survival outcomes in patients with gastric cancer: a meta-analysis. Biomarkers 2024:1-8. [PMID: 39268816 DOI: 10.1080/1354750x.2024.2402419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/31/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND Previous studies have reported inconsistent results on the association between serum prealbumin level and survival outcomes in patients with gastric cancer. This meta-analysis aimed to determine the serum prealbumin level as a biomarker of survival outcomes in gastric cancer patients. METHODS Two independent reviewers conducted a thorough search of PubMed, Embase, and Web of Science databases until April 17, 2024. Studies reporting the association between serum prealbumin level and survival outcomes and presented the multivariable-adjusted relative risks for gastric cancer patients were included. The pooled HR and 95% CI were used to assess the strength of the association. RESULTS Twelve studies, with a total of 9,351 patients were included in the meta-analysis. The combined data showed that low serum prealbumin level was associated with shorter overall survival (HR 1.65; 95% CI 1.42-1.91) and disease-free survival (HR 1.39; 95% CI 1.14-1.70). Subgroup analysis showed that low serum prealbumin level significantly predicted poorer overall survival, regardless of patients' age, sample sizes, cutoff value for prealbumin level, and follow-up time. CONCLUSIONS Low serum prealbumin level is an independent prognostic biomarker for shorter survival outcomes in patients with gastric cancer. Assessing serum prealbumin levels could potentially improve risk stratification for this disease.
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Affiliation(s)
- Heng Zhang
- Department of General Surgery, Nanjing Lishui District People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Xuan Tang
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, China
| | - Junfang Zhang
- Department of Medical Nutrition, Nanjing Lishui District People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Dapeng Jiang
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, China
| | - Dandan Gong
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, China
| | - Yu Fan
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, China
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Shiraishi T, Nonaka T, Tominaga T, Takamura Y, Oishi K, Hashimoto S, Noda K, Ono R, Hisanaga M, Takeshita H, Ishii M, Oyama S, Ishimaru K, Kunizaki M, Sawai T, Matsumoto K. The C-reactive protein-albumin-lymphocyte (CALLY) index is a useful predictor of postoperative complications in patients with a colonic stent for obstructive colorectal cancer: a Japanese multicenter study. Surg Today 2024:10.1007/s00595-024-02924-9. [PMID: 39177756 DOI: 10.1007/s00595-024-02924-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Accepted: 08/03/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE The C-reactive protein-albumin-lymphocyte (CALLY) index is a novel score that offers a good reflection of nutritional status, inflammatory response, and immune system status. The CALLY index is reported to correlate with the prognosis of various carcinomas. The purpose of the present study was to investigate the association between the CALLY index and the short-term prognosis of obstructive colorectal cancer managed with a colonic stent. METHODS The subjects of this retrospective study were 263 patients who underwent colorectal resection after colonic stenting for obstructive colorectal cancer between 2016 and 2023. Patients were classified into a group with a low CALLY index (CALLY-L group, n = 85) and a group with a high (CALLY-H group, n = 178) CALLY index. RESULTS The CALLY-L group had greater blood loss (53 mL vs 20 mL, p = 0.002) and higher poor performance status (PS3; 20% vs 10.1%, p = 0.033), open surgery (21.2% vs 7.3%, p = 0.001), distant metastases (41.2% vs 20.8%, p = 0.01), and postoperative complications (30.6% vs. 18.5%, p = 0.039) than the CALLY-H group. Multivariate analysis identified a prolonged operative time (odds ratio 1.983, 95% confidence interval 1.013-3.881; p = 0.045), greater blood loss (odds ratio 2.572, 95% confidence interval 1.291-5.129; p = 0.007) and a low CALLY index (odds ratio 1.961, 95% confidence interval 1.013-3.795; p = 0.045) as independent predictors of complications. CONCLUSION The CALLY index may be a useful predictor of postoperative complications of obstructive colorectal cancer.
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Affiliation(s)
- Toshio Shiraishi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Takashi Nonaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Tetsuro Tominaga
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Yuma Takamura
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kaido Oishi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Shintaro Hashimoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Keisuke Noda
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Rika Ono
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Makoto Hisanaga
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki, 857-8511, Japan
| | - Hiroaki Takeshita
- Department of Surgery, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubara, Omura, Nagasaki, 856-8562, Japan
| | - Mitsutoshi Ishii
- Department of Surgery, Isahaya General Hospital, 24-1 Eisyohigashi, Isahaya, Nagasaki, 854-8501, Japan
| | - Shosaburo Oyama
- Department of Surgery, Ureshino Medical Center, 4279-3 Ureshino, Ureshino, Saga, 843-0393, Japan
| | - Kazuhide Ishimaru
- Department of Surgery, Saiseikai Nagasaki Hospital, 2-5-1 Katafuchi, Nagasaki, Nagasaki, 850-0003, Japan
| | - Masaki Kunizaki
- Department of Surgery, Sasebo Chuo Hospital, 15 Yamato, Sasebo, Nagasaki, 857-1195, Japan
| | - Terumitsu Sawai
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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Wei C, Ai H, Mo D, Wang P, Wei L, Liu Z, Li P, Huang T, Liu M. A nomogram based on inflammation and nutritional biomarkers for predicting the survival of breast cancer patients. Front Endocrinol (Lausanne) 2024; 15:1388861. [PMID: 39170737 PMCID: PMC11335604 DOI: 10.3389/fendo.2024.1388861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 07/24/2024] [Indexed: 08/23/2024] Open
Abstract
Background We aim to develop a new prognostic model that incorporates inflammation, nutritional parameters and clinical-pathological features to predict overall survival (OS) and disease free survival (DFS) of breast cancer (BC) patients. Methods The study included clinicopathological and follow-up data from a total of 2857 BC patients between 2013 and 2021. Data were randomly divided into two cohorts: training (n=2001) and validation (n=856) cohorts. A nomogram was established based on the results of a multivariate Cox regression analysis from the training cohorts. The predictive accuracy and discriminative ability of the nomogram were evaluated by the concordance index (C-index) and calibration curve. Furthermore, decision curve analysis (DCA) was performed to assess the clinical value of the nomogram. Results A nomogram was developed for BC, incorporating lymphocyte, platelet count, hemoglobin levels, albumin-to-globulin ratio, prealbumin level and other key variables: subtype and TNM staging. In the prediction of OS and DFS, the concordance index (C-index) of the nomogram is statistically greater than the C-index values obtained using TNM staging alone. Moreover, the time-dependent AUC, exceeding the threshold of 0.7, demonstrated the nomogram's satisfactory discriminative performance over different periods. DCA revealed that the nomogram offered a greater overall net benefit than the TNM staging system. Conclusion The nomogram incorporating inflammation, nutritional and clinicopathological variables exhibited excellent discrimination. This nomogram is a promising instrument for predicting outcomes and defining personalized treatment strategies for patients with BC.
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Affiliation(s)
- Caibiao Wei
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Huaying Ai
- Department of Injection Room, The People’s Hospital of Yingtan, Yingtan, Jiangxi, China
| | - Dan Mo
- Department of Breast, Guangxi Zhuang Autonomous Region Maternal and Child Health Care Hospital, Nanning, China
| | - Peidong Wang
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Liling Wei
- Department of Anesthesiology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhimin Liu
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Peizhang Li
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Taijun Huang
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Miaofeng Liu
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, China
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Yu W, Qiu J, Jiang X, Xie H, Cai Z, Yang B. Analysis of Grip Strength and Its Explanatory Factors in Older Patients with Gastrointestinal Tumours. Int J Gen Med 2024; 17:2993-3001. [PMID: 39011421 PMCID: PMC11247129 DOI: 10.2147/ijgm.s464858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/19/2024] [Indexed: 07/17/2024] Open
Abstract
Aim To investigate the grip strength of older patients with gastrointestinal tumours and analyse its explanatory factors. Methods A total of 170 older patients with gastrointestinal tumours admitted to the Gastrointestinal Surgery Department of a Grade-III hospital in the Zhejiang province from January 2022 to December 2022 were selected as the investigation participants. Among them, there were 102 cases of gastric cancer (60.0%) and 68 cases of colon cancer (40.0%). There were 110 male patients (64.7%) and 60 female patients (35.3%), with patient ages ranging between 64 and 82 years old. A cross-sectional survey was conducted using a general data questionnaire, grip apparatus and the Nutritional Risk Screening 2002 (NRS-2002) score. Multiple linear regression was used to analyse the explanatory factors on the grip strength of older patients with gastrointestinal tumours. Results The grip strength of older patients with gastrointestinal tumours was 25.3±5.3 kg. Multiple linear regression analysis showed that gender, age, disease, body mass index (BMI), albumin concentration and the NRS-2002 score were the main explanatory factors on grip strength (P<0.05). Conclusion Grip strength was lower in older patients with gastrointestinal tumours and was lower in females, those aged ≥70 years, patients with colorectal cancer, individuals with a BMI of <18.5, those with an albumin concentration of <35g/l and those with an NRS2002 score of ≥3. Clinical staff should dynamically evaluate the level of grip strength in patients with gastrointestinal tumors and develop individualized interventions based on the related explanatory factors.
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Affiliation(s)
- Weifei Yu
- Ningbo Hospital of Traditional Chinese Medicine, Ningbo, 315000, People’s Republic of China
| | - Jingxia Qiu
- The First Affiliated Hospital of Ningbo University(Yuehu Courtyard), Ningbo, 315000, People’s Republic of China
| | - Ximing Jiang
- The First Affiliated Hospital of Ningbo University(Yuehu Courtyard), Ningbo, 315000, People’s Republic of China
| | - Haofen Xie
- The First Affiliated Hospital of Ningbo University(Yuehu Courtyard), Ningbo, 315000, People’s Republic of China
| | - Zejun Cai
- The First Affiliated Hospital of Ningbo University(Yuehu Courtyard), Ningbo, 315000, People’s Republic of China
| | - Bin Yang
- The First Affiliated Hospital of Ningbo University(Yuehu Courtyard), Ningbo, 315000, People’s Republic of China
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Kang MK, Lee H. Impact of malnutrition and nutritional support after gastrectomy in patients with gastric cancer. Ann Gastroenterol Surg 2024; 8:534-552. [PMID: 38957563 PMCID: PMC11216795 DOI: 10.1002/ags3.12788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/03/2024] [Accepted: 02/24/2024] [Indexed: 07/04/2024] Open
Abstract
Malnutrition, characterized by altered body composition and impaired function, is particularly prevalent among gastric cancer patients, affecting up to 60% of them. Malnutrition in these patients can manifest both before and after surgery, due to factors such as gastric outlet obstruction, cancer cachexia, and anatomical changes. Notably, total gastrectomy (TG) presents the most significant nutritional challenges. However, function-preserving gastrectomy, such as pylorus-preserving gastrectomy (PPG) and proximal gastrectomy (PG), have shown promise in improving nutritional outcomes. Effective nutritional risk screening and assessment are vital for identifying patients at risk. Nutritional support not only improves nutritional parameters but also reduces complications, enhances quality of life (QoL) and survival rates. Those unable to maintain more than 50% of the recommended intake for over 7 days are recommended for nutritional support. Common methods of nutritional support include oral nutrition supplements (ONS), enteral nutrition (EN), or parenteral nutrition (PN) depending on the patient's status. Effect of perioperative nutritional support remains controversial. Preoperative interventions including ONS and PN have shown mixed results, with selective benefits in patients with sarcopenia or hypoalbuminaemia, while impact of EN in gastric outlet obstruction patients have been positive. In contrast postoperative support appears to be consistent. Tube feeding after TG has shown improvements, and ONS have been effective in reducing weight loss and improving nutritional biomarkers. PN was also associated with benefits such as weight maintenance and QoL. This review explores the mechanisms, assessment, and clinical impact of malnutrition, emphasizing the importance of nutritional support in gastric cancer patients undergoing gastrectomy.
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Affiliation(s)
- Min Kyu Kang
- Division of Gastrointestinal Surgery, Department of SurgerySeoul National University HospitalSeoulSouth Korea
| | - Hyuk‐Joon Lee
- Division of Gastrointestinal Surgery, Department of SurgerySeoul National University HospitalSeoulSouth Korea
- Department of Surgery & Cancer Research InstituteSeoul National University College of MedicineSeoulSouth Korea
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Liu C, Lu J, An L. Development and validation of nomograms for predicting the prognosis of early and late recurrence of advanced gastric cancer after radical surgery based on post-recurrence survival. Medicine (Baltimore) 2024; 103:e38376. [PMID: 39259073 PMCID: PMC11142773 DOI: 10.1097/md.0000000000038376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/21/2024] [Accepted: 05/06/2024] [Indexed: 09/12/2024] Open
Abstract
In this study, we aimed to explore the risk factors influencing post-recurrence survival (PRS) of early recurrence (ER) and late recurrence (LR) in stage advanced gastric cancer (AGC) patients after radical surgery, respectively, and to develop predictive models in turn. Medical records of 192 AGC patients who recurred after radical gastrectomy were retrospectively reviewed. They were randomly divided into the training and validation set at a ratio of 2:1. Nomograms were built based on risk factors influencing PRS of ER and LR explored by Cox regression analyses, respectively. Concordance index (C-index) values and calibration curves were used to evaluate predictive power of nomograms. Body mass index < 18.5 kg/m2, prealbumin level < 70.1 mg/L, positive lymph nodes ratio ≥ 0.486 and palliative treatment after recurrence were independent risk factors for the prognosis of ER. In contrast, prealbumin level < 170.1 mg/L, CEA ≥ 18.32 μg/L, tumor diameter ≥ 5.5 cm and palliative treatment after recurrence were independent risk factors for the prognosis of LR. The C-index values were 0.801 and 0.772 for ER and LR in the training set, respectively. The calibration curves of validation set showed a C-index value of 0.744 and 0.676 for ER and LR, respectively. Nomograms which were constructed to predict the prognosis of ER and LR of AGC after surgery showed great predictive power and could provide reference for clinicians' treatment strategies to some extent.
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Affiliation(s)
- Chenming Liu
- Department of General Surgery, Shaoxing People’s Hospital, Shaoxing, China
- Zhejiang University School of Medicine, Hangzhou, China
| | - Jialiang Lu
- Department of General Surgery, Shaoxing People’s Hospital, Shaoxing, China
- School of Medicine, Shaoxing University, Shaoxing, China
| | - Liang An
- Department of Gastrointestinal Surgery, Shaoxing People’s Hospital, Shaoxing, China
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Wang D, Wang Y, Dong L, Zhang X, Du J. Preoperatively predicting the lymph node metastasis and prognosis for gastric cancer patients. Sci Rep 2024; 14:11213. [PMID: 38755185 PMCID: PMC11099148 DOI: 10.1038/s41598-024-61671-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 05/08/2024] [Indexed: 05/18/2024] Open
Abstract
The preoperative distinguishment of lymph nodes (LN) with metastasis plays a pivotal role in guiding the surgical extension for gastric cancer (GC). We aim to identify the preparative risk factors for LN metastasis in GC patients. We retrospectively reviewed 424 patients who underwent radical GC resection in our medical center between Jan 2011 and Dec 2018. Multivariate logistic regression was employed to identify risk factors for LN metastasis, while multivariate COX regression was utilized to evaluate prognostic factors. The median overall survival of patients with or without LN metastases was 31 and 58 months, respectively. In multivariate analysis, lower albumin (OR = 0.512; P = 0.004) and prealbumin (OR = 0.367, P = 0.001) and higher CEA (OR = 3.178, P < 0.001), CA199 (OR = 2.278, P = 0.002) and platelets (OR = 1.697, P = 0.017) were found to be significantly associated with LN metastasis. In survival analysis, older age (HR = 1.712), larger tumors (HR = 1.082), higher D-dimer (HR = 1.561) and CA199 (HR = 1.553), advanced staging (stage II, HR = 3.446; stage III-IV, HR = 11.089), lower prealbumin levels (lower level for reference, HR = 0.63), and absence of adjuvant chemotherapy (HR = 0.396) was discovered to be associated with poorer overall survival (all P < 0.05). In conclusion, our results demonstrated that preoperative prealbumin-bound tumor markers can effectively predict LN metastasis. Additionally, prealbumin was found to possess prognostic value as well.
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Affiliation(s)
- Danfang Wang
- Department of Oncology, Xi'an Gaoxin Hospital, 16 Tuanjie South Road, Xi'an, 710075, Shaanxi, People's Republic of China
| | - Yaxin Wang
- Department of Oncology, Xi'an Gaoxin Hospital, 16 Tuanjie South Road, Xi'an, 710075, Shaanxi, People's Republic of China
| | - Lin Dong
- Department of Oncology, Xi'an Gaoxin Hospital, 16 Tuanjie South Road, Xi'an, 710075, Shaanxi, People's Republic of China
| | - Xin Zhang
- Department of Oncology Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jianfei Du
- Department of Oncology, Xi'an Gaoxin Hospital, 16 Tuanjie South Road, Xi'an, 710075, Shaanxi, People's Republic of China.
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Matsui R, Ida S, Ri M, Makuuchi R, Hayami M, Kumagai K, Ohashi M, Sano T, Nunobe S. Impact of preoperative prealbumin levels on long-term prognosis in patients with gastric cancer after gastrectomy: a retrospective cohort study. Gastric Cancer 2024; 27:611-621. [PMID: 38402291 DOI: 10.1007/s10120-024-01472-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 01/22/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND The relationship between preoperative prealbumin levels and long-term prognoses in patients with gastric cancer after gastrectomy has not been fully investigated. This study clarified the effect of preoperative prealbumin levels on the long-term prognosis of patients with gastric cancer after gastrectomy. METHODS This retrospective cohort study included consecutive patients who underwent radical gastrectomy for primary pStage I-III gastric cancer and whose preoperative prealbumin levels were measured between May 2006 and March 2017. Participants were categorized according to their preoperative prealbumin levels into high (≥22 mg/dL), moderate (15-22 mg/dL), and low (<15 mg/dL) groups. The overall survival (OS) in the three groups was compared using the log-rank test, and prognostic factors were identified using Cox proportional hazards regression analysis. RESULTS The median follow-up duration was 66 months. Of 4732 patients, 3649 (77.2%) were classified as high, 925 (19.6%) as moderate, and 158 (3.3%) as low. Lower prealbumin levels were associated with poorer prognoses (P < 0.001). Multivariate analysis showed that prealbumin levels of 15-22 mg/dL [hazard ratio (HR): 1.576, 95% confidence interval (CI): 1.353-1.835, P < 0.001] and <15 mg/dL (HR: 1.769, 95% CI: 1.376-2.276, P < 0.001) were independent poor prognostic factors for OS. When analyzed according to the cause of death, prealbumin levels were associated with other-cause survival, but not cancer-specific survival. CONCLUSIONS Preoperative prealbumin levels correlated with OS in patients with gastric cancer after gastrectomy; the lower the prealbumin level, the worse is the prognosis. Prealbumin levels may be associated with other-cause survival.
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Affiliation(s)
- Ryota Matsui
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Satoshi Ida
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Motonari Ri
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Rie Makuuchi
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Masaru Hayami
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Koshi Kumagai
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Takeshi Sano
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan.
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TAN J, SI J, XIAO KL, ZHANG YH, HUA Q, LI J. Association of prealbumin with short-term and long-term outcomes in patients with acute ST-segment elevation myocardial infarction. J Geriatr Cardiol 2024; 21:421-430. [PMID: 38800549 PMCID: PMC11112154 DOI: 10.26599/1671-5411.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Prealbumin is considered to be a useful indicator of nutritional status. Furthermore, it has been found to be associated with severities and prognosis of a range of diseases. However, limited data on the association of baseline prealbumin level with outcomes of patients with acute ST-segment elevation myocardial infarction (STEMI) are available. METHODS We analyzed 2313 patients admitted for acute STEMI between October 2013 and December 2020. In-hospital outcomes and mortality during the 49 months (interquartile range: 26-73 months) follow-up period were compared between patients with the low prealbumin level (< 170 mg/L) and those with the high prealbumin level (≥ 170 mg/L). RESULTS A total of 114 patients (4.9%) died during hospitalization. After propensity score matching, patients with the low prealbumin level than those with the high prealbumin level experienced higher incidences of heart failure with Killip class III (9.9% vs. 4.4%, P = 0.034), cardiovascular death (8.4% vs. 3.4%, P = 0.035) and the composite of major adverse cardiovascular events (19.2% vs. 10.3%, P = 0.012). Multivariate logistic regression analysis identified that the low prealbumin level (< 170 mg/L) was an independent predictor of in-hospital major adverse cardiovascular events (odds ratio = 1.918, 95% CI: 1.250-2.942, P = 0.003). The cut-off value of prealbumin level for predicting in-hospital death was 170 mg/L (area under the curve = 0.703, 95% CI: 0.651-0.754, P < 0.001; sensitivity = 0.544, specificity = 0.794). However, after multivariate adjustment of possible confounders, baseline prealbumin level (170 mg/L) was no longer independently associated with 49-month cardiovascular death. After propensity score matching, Kaplan-Meier survival curves revealed consistent results. CONCLUSIONS Decreased prealbumin level closely related to unfavorable short-term outcomes. However, after multivariate adjustment and controlling for baseline differences, baseline prealbumin level was not independently associated with an increased risk of long-term cardiovascular mortality in STEMI patients.
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Affiliation(s)
- Jing TAN
- Department of Cardiology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Jin SI
- Department of Geriatric Medicine, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Ke-Ling XIAO
- Department of Geriatric Medicine, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Ying-Hua ZHANG
- Department of Cardiology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Qi HUA
- Department of Cardiology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Jing LI
- Department of Geriatric Medicine, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
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Khajoueinejad N, Sarfaty E, Yu AT, Buseck A, Troob S, Imtiaz S, Mohammad A, Cha DE, Pletcher E, Gleeson E, Macfie R, Carr J, Hiotis SP, Golas B, Correa-Gallego C, Sarpel U, Magge D, Labow DM, Cohen NA. Preoperative Frailty and Malnutrition in Surgical Oncology Patients Predicts Higher Postoperative Adverse Events and Worse Survival: Results of a Blinded, Prospective Trial. Ann Surg Oncol 2024; 31:2668-2678. [PMID: 38127214 DOI: 10.1245/s10434-023-14693-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Frailty, a multidimensional state leading to reduced physiologic reserve, is associated with worse postoperative outcomes. Despite the availability of various frailty tools, surgeons often make subjective assessments of patients' ability to tolerate surgery. The Risk Analysis Index (RAI) is a validated preoperative frailty assessment tool that has not been studied in cancer patients with plans for curative-intent surgery. METHODS In this prospective, surgeon-blinded study, patients who had abdominal malignancy with plans for resection underwent preoperative frailty assessment with the RAI and nutrition assessment by measurement of albumin, prealbumin, and C-reactive protein (CRP). Postoperative outcomes and survival were assessed. RESULTS The study included 220 patients, 158 (72%) of whom were considered frail (RAI ≥21). Frail patients were more likely to be readmitted within 30 and 90 days, (16% vs. 3% [P = 0.006] and 16% vs. 5% [P = 0.025], respectively). Patients with abnormal CRP, prealbumin, and albumin experienced higher rates of unplanned intensive care unit admission (CRP [27% vs. 8%; P < 0.001], albumin [30% vs. 10%; P < 0.001], prealbumin [29% vs. 9%; P < 0.001]) and increased postoperative mortality at 90 and 180 days. Survival was similar for frail and non-frail patients. In the multivariate analysis, frailty remained an independent risk factor for readmission (hazard ratio, 5.58; 95% confidence interval, 1.39-22.15; P = 0.015). In the post hoc analysis using the pre-cancer RAI score, the postoperative outcomes did not differ between the frail and non-frail patients. CONCLUSION In conjunction with preoperative markers of nutrition, the RAI may be used to identify patients who may benefit from additional preoperative risk stratification and increased postoperative follow-up evaluation.
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Affiliation(s)
- Nazanin Khajoueinejad
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elad Sarfaty
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Allen T Yu
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alison Buseck
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samantha Troob
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sayed Imtiaz
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ayman Mohammad
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Da Eun Cha
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eric Pletcher
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elizabeth Gleeson
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rebekah Macfie
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jacquelyn Carr
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Spiros P Hiotis
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Benjamin Golas
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Camilo Correa-Gallego
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Umut Sarpel
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Deepa Magge
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Daniel M Labow
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Noah A Cohen
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Wu Z, Liu C, Ma Z, Li Z, Wang S, Chen Y, Han M, Huang S, Zhou Q, Zhang C, Hou B. A hierarchical prognostic model for Co-diabetes pancreatic adenocarcinoma. Heliyon 2023; 9:e21642. [PMID: 38027595 PMCID: PMC10663840 DOI: 10.1016/j.heliyon.2023.e21642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Co-diabetes pancreatic adenocarcinoma has a poorer prognosis than pancreatic adenocarcinoma without diabetes. This study aimed to develop a reliable prognostic model for patients with co-diabetes pancreatic adenocarcinoma. Method Overall, 169 patients with co-diabetes pancreatic adenocarcinoma were included in our study. First, the independent risk factors affecting the prognosis of patients with co-diabetes pancreatic adenocarcinoma were determined by univariate and multivariate Cox regression analyses. Based on these identified risk factors, we developed a nomogram and evaluated its predictive ability using the concordance index, receiver operating characteristic curve, calibration plot, decision curve, and net reclassification index. Results In this study, prealbumin, transferrin, carcinoembryonic antigen, distant metastasis, tumor differentiation neutrophil count, lymphocyte count and fasting blood glucose were confirmed as significant prognostic factors. Based on these predictors, a new nomogram was developed. Compared with the American Joint Committee on Cancer 8 staging system and other models, the nomogram achieved a higher concordance index in the training (0.795) and validation (0.729) queues. The area under the nomogram's curve for predicting patient survival at 0.5, 1, and 1.5 years in the training queue was >0.8. Patients were risk-stratified using the nomogram, and Kaplan-Meier survival curves of subgroups were plotted. The Kaplan-Meier curve also showed better separation than the American Joint Committee on Cancer 8 staging system, indicating that our model has a better risk hierarchical ability. Conclusions Compared to the American Joint Committee on Cancer 8 staging system and other predictive models, our model showed better predictive ability for patients with co-diabetes pancreatic adenocarcinoma. Our model will help in patients' risk stratification and improves their prognosis.
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Affiliation(s)
- Zelong Wu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Heyuan People's Hospital, Heyuan 517000, China
| | - Chunsheng Liu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Heyuan People's Hospital, Heyuan 517000, China
| | - Zuyi Ma
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100005, China
| | - Zhenchong Li
- German Cancer Research Center (DKFZ), Junior Clinical Cooperation Unit Translational Gastrointestinal Oncology and Preclinical Models, Heidelberg, Germany
| | - Shujie Wang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- Heyuan People's Hospital, Heyuan 517000, China
| | - Yubin Chen
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- Heyuan People's Hospital, Heyuan 517000, China
- South China University of Technology School of Medicine, Guangzhou 51000, China
| | - Mingqian Han
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Heyuan People's Hospital, Heyuan 517000, China
| | - Shanzhou Huang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Heyuan People's Hospital, Heyuan 517000, China
- South China University of Technology School of Medicine, Guangzhou 51000, China
| | - Qi Zhou
- Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
- Department of General Surgery, Hui Ya Hospital of the First Affiliated Hospital, Sun Yat-sen University, Huizhou, Guangdong 516081, China
| | - Chuanzhao Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Heyuan People's Hospital, Heyuan 517000, China
- South China University of Technology School of Medicine, Guangzhou 51000, China
| | - Baohua Hou
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Heyuan People's Hospital, Heyuan 517000, China
- South China University of Technology School of Medicine, Guangzhou 51000, China
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12
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Li D, Ding S, Li J, Liao X, Ru K, Liu L, Shang W. Diagnostic value of inflammatory indicators for surgical site infection in patients with breast cancer. Front Cell Infect Microbiol 2023; 13:1286313. [PMID: 37953798 PMCID: PMC10634473 DOI: 10.3389/fcimb.2023.1286313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/05/2023] [Indexed: 11/14/2023] Open
Abstract
Background Breast cancer is the most commonly diagnostic cancer in women worldwide. The main treatment for these patients is surgery. However, there is a high incidence of surgical site infection (SSI) in breast cancer patients. The aim of this study was to identify effective infection-related diagnostic markers for timely diagnosis and treatment of SSI. Methods This retrospective study included 263 breast cancer patients who were treated between July 2018 and March 2023 at the Shandong Cancer Hospital and Institute. We analyzed differences between the SSI group and control group and differences before and during infection in the SSI group. Finally, we tested the distribution of pathogenic microorganisms and their susceptibility to antibiotics. Results Compared with preoperative inflammatory indicators, white blood cells (WBC), neutrophils (NEU), absolute neutrophil count to the absolute lymphocyte count (NLR), D2 polymers (D-Dimer) and fibrinogen (FIB) were significantly increased, while lymphocytes (LYM), albumin (ALB) and prealbumin (PA) were significantly decreased in the SSI group. Compared with uninfected patients, WBC, NEU, NLR and FIB were significantly increased, ALB and PA were significantly decreased in SSI patients, while LYM and D-Dimer did not differ significantly. The distribution of infection bacteria in SSI patients showed that the proportion of patients with Staphylococcus aureus infection was as high as 70.41%; of those patients, 19.33% had methicillin-resistant Staphylococcus aureus (MRSA) infection. The area under the curves (AUCs) of the receiver operating curves (ROCs) for WBC, NEU, NLR, FIB, ALB and PA were 0.807, 0.811, 0.730, 0.705, 0.663 and 0.796, respectively. The AUCs for other inflammatory indicators were not statistically significant. There was no significant difference in antibiotic resistance for Staphylococcus aureus when compared to that of gram-positive bacteria. The resistance of gram-positive bacteria to ceftriaxone (CRO), cefoxitin (FOX), chloramphenicol (CHL), minocycline (MNO) and tetracycline (TCY) was lower than that of gram-negative bacteria, while the resistance to gentamicin (GEN) was higher. Conclusion This study demonstrated that WBC, NEU, NLR, FIB and PA have good predictive value for identifying patients at risk of SSI. The cut-off values of inflammatory indicators can be helpful in the prevention and diagnosis of SSI.
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Affiliation(s)
| | | | | | | | | | | | - Wenjing Shang
- Department of Clinical Laboratory, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
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13
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Zhang F, Huang L, Li M, Quan Z, Wang Y, Luo H, Liu J, Wang J. Effect of Pre-Operative Low Serum Pre-Albumin on Surgical Site Infection in Post-Surgery Subjects: A Systematic Review and Meta-Analysis. Surg Infect (Larchmt) 2023; 24:684-691. [PMID: 37831925 DOI: 10.1089/sur.2023.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023] Open
Abstract
Background: The correlation between pre-operative serum pre-albumin and surgical site infection (SSI) has been the focus of many studies. However, existing literature presents conflicting evidence on this association. Therefore, this meta-analysis was conducted to determine the significance of low serum pre-albumin as a prognostic factor SSI, and to assess the potential utility of pre-albumin in predicting SSI. Methods: A comprehensive literature search and analysis was conducted in PubMed, Web of Science, Cochrane of Library, Scopus, Embase, and Google Scholar databases through August 2022 to identify studies reporting low pre-operative serum pre-albumin levels in patients undergoing surgery and their association with SSIs. The pooled risk estimates were shown in odds ratio with 95% confidence interval. The random effect model was used according to the test of heterogeneity among studies. Subgroup analyses and sensitivity analyses were performed to identify the possible sources of heterogeneity. This meta-analysis was prospectively registered in the PROSPERO database (number: CRD42022376167). Results: Nine studies involving 5,306 patients were eligible. The results demonstrated an association between low pre-operative serum pre-albumin levels and a higher probability of developing SSI (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.28-3.26). Conclusions: Our findings suggest that low serum pre-albumin level may serve as an independent and valuable predictor of SSI. These results provide important insights for clinicians in identifying high-risk patients and implementing preventive measures.
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Affiliation(s)
- Fei Zhang
- Department of Family Medicine, ShengJing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Letian Huang
- Department of Oncology, ShengJing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - MingLin Li
- Department of Family Medicine, ShengJing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Ziwei Quan
- Department of Family Medicine, ShengJing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yifei Wang
- Department of Family Medicine, ShengJing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Hanyong Luo
- Department of Family Medicine, ShengJing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Jiye Liu
- Department of Family Medicine, ShengJing Hospital of China Medical University, Shenyang, Liaoning Province, China
- Department of Rehabilitation Medicine, Huludao Central Hospital, Huludao, Liaoning Province, China
| | - Jiahe Wang
- Department of Family Medicine, ShengJing Hospital of China Medical University, Shenyang, Liaoning Province, China
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14
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Liu Y, Yang Y, Tai G, Ni F, Yu C, Zhao W, Wang D. Correlation between Preoperative Platelet Count/(Lymphocyte Count × Prealbumin Count) Ratio and the Prognosis of Patients with Gastric Cancer Undergoing Radical Operation. Gastroenterol Res Pract 2023; 2023:8401579. [PMID: 37545543 PMCID: PMC10403323 DOI: 10.1155/2023/8401579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/31/2023] [Accepted: 07/02/2023] [Indexed: 08/08/2023] Open
Abstract
Objective To clarify the relationship between preoperative platelet count/(lymphocyte count × prealbumin count) ratio (PLPR) and the prognosis of patients with gastric cancer undergoing a radical operation, combined with Tumor Node Metastasis (TNM) staging, a scoring system was established to guide clinical application. Methods The clinical data of 238 patients receiving radical operations for gastric cancer were retrospectively analyzed. According to the area under the Receiver operating characteristic curve, the predictive value of the preoperative PLPR for the 5-year overall survival (OS) of gastric cancer was determined, and the best cut-off value of the ratio was corresponding to the maximum value of Yoden index. Chi-squared test was applied to analyze the correlation between the ratio and clinicopathological features. Kaplan-Meier curve was applied to analyze the influence of this ratio on 5-year OS. The Cox regression model was applied to analyze the hazards affecting the long-term survival of patients. The nomogram model was used to predict the long-term survival rate. Results The optimal cut-off point of preoperative PLPR ratio was 7.46, and the patients were segmented into two sets: one set of ratio <7.46 and another set of ratio ≥7.46. The ratio was correlated with the size of the tumor, T stage, N stage, total stage, vascular cancer thrombus, and nerve invasion. In stage I-III patients, the prognosis was better in the low-ratio set than in the high-ratio set (P < 0.001), subgroup analysis indicated the prognosis was obviously better in the low-ratio set than in the high-ratio set in stage II and III patients (P < 0.05 and P < 0.001), but there was no difference in stage I patients (P > 0.05). Age, T stage, N stage, total TNM stage, tumor size, vascular tumor thrombus, nerve invasion, preoperative neutrophil count/lymphocyte count (NLR; reference value 3.68), preoperative PLPR (reference value 7.46), preoperative platelet count/lymphocyte count (PLR; reference value 159.56), and preoperative platelet count × NLR (SII; reference value 915.48) were related to patient prognosis (P < 0.05); meanwhile age, total TNM stage, preoperative PLPR (reference value 7.46), preoperative PLR (reference value 159.56), and preoperative SII (reference value 915.48) were independent hazards for prognosis (P < 0.05). Five independent risk factors were analyzed by nomogram model to predict the 5-year OS of patients who underwent a radical operation for carcinoma of the stomach. Conclusion Preoperative PLPR ratio (reference value 7.46) is an independent risk factor for long-term prognosis in patients undergoing a radical operation for gastric cancer. The nomogram scoring system established by postoperative TNM staging combined with this ratio and age, PLR, and SII can better forecast the survival of patients who underwent radical operation for carcinoma of the stomach.
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Affiliation(s)
- Yi Liu
- Department of Radiotherapy, Affiliated Tumor Hospital of Nantong University, Nantong Tumor Hospital, Nantong, Jiangsu, China
| | - Yanguang Yang
- Department of Radiotherapy, Affiliated Tumor Hospital of Nantong University, Nantong Tumor Hospital, Nantong, Jiangsu, China
| | - Guomei Tai
- Department of Radiotherapy, Affiliated Tumor Hospital of Nantong University, Nantong Tumor Hospital, Nantong, Jiangsu, China
| | - Feng Ni
- Department of Radiotherapy, Affiliated Tumor Hospital of Nantong University, Nantong Tumor Hospital, Nantong, Jiangsu, China
| | - Cenming Yu
- Department of Radiotherapy, Affiliated Tumor Hospital of Nantong University, Nantong Tumor Hospital, Nantong, Jiangsu, China
| | - Wenjing Zhao
- Cancer Research Center Nantong, Affiliated Tumor Hospital of Nantong University, Nantong Tumor Hospital, Nantong, Jiangsu, China
| | - Ding Wang
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Nantong University, Nantong Tumor Hospital, Nantong, Jiangsu, China
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Li C, Fan Z, Guo W, Liang F, Mao X, Wu J, Wang H, Xu J, Wu D, Liu H, Wang L, Li F. Fibrinogen-to-prealbumin ratio: A new prognostic marker of resectable pancreatic cancer. Front Oncol 2023; 13:1149942. [PMID: 37051547 PMCID: PMC10083287 DOI: 10.3389/fonc.2023.1149942] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/15/2023] [Indexed: 03/28/2023] Open
Abstract
BackgroundThe fibrinogen-to-prealbumin ratio (FPR), a novel immune-nutritional biomarker, has been reported to be associated with prognosis in several types of cancer, but the role of FPR in the prognosis of resectable pancreatic cancer has not been elucidated.MethodsA total of 263 patients with resectable pancreatic cancer were enrolled in this study and were randomly divided into a training cohort (n = 146) and a validation cohort (n = 117). Receiver operating characteristic curve (ROC) was used to calculate the cut-off values of immune-nutritional markers. The least absolute shrinkage and selection operator (LASSO) regression and multivariate Cox regression were performed in the training cohort to identify the independent risk factors, based on which the nomogram was established. The performance of the nomogram was evaluated and validation by the training and validation cohort, respectively.ResultsThe optimal cutoff value for FPR was 0.29. Multivariate analysis revealed that FPR, controlling nutritional status (CONUT), carbohydrate antigen 19-9 (CA19-9), carcinoembryonic antigen (CEA), and tumor node metastasis (TNM) stage were independent predictors of overall survival (OS). The nomogram was established by involving the five factors above. The C-index of the training cohort and validation cohort were 0.703 (95% CI: 0.0.646-0.761) and 0.728 (95% CI: 0.671-0.784). Decision curve analysis and time-dependent AUC showed that the nomogram had better predictive and discriminative ability than the conventional TNM stage.ConclusionFPR is a feasible biomarker for predicting prognosis in patients with resectable pancreatic cancer. The nomogram based on FPR is a useful tool for clinicians in making individualized treatment strategies and survival predictions.
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Affiliation(s)
- Chengqing Li
- Department of Pancreatic Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhiyao Fan
- Department of Pancreatic Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenyi Guo
- Department of Pancreatic Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Feng Liang
- Department of General Surgery, Feicheng People’s Hospital, Taian, China
| | - Xincheng Mao
- Department of Hepatobiliary Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jiahao Wu
- Department of Pancreatic Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Haodong Wang
- Department of Pancreatic Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jianwei Xu
- Department of Pancreatic Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Dong Wu
- Department of Pancreatic Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Han Liu
- Department of Pancreatic Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lei Wang
- Department of Pancreatic Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Lei Wang, ; Feng Li,
| | - Feng Li
- Department of Pancreatic Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Lei Wang, ; Feng Li,
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Song S, Qiu P, Wang H, Zhang D, Qi Q, Feng L. Low preoperative serum prealbumin levels and risk of postoperative complications after transsphenoidal surgery in nonfunctioning pituitary adenoma. Neurosurg Focus 2022; 53:E6. [PMID: 36455266 DOI: 10.3171/2022.9.focus22211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/20/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE In other specialties, malnutrition has been shown to be closely linked to postoperative complications. However, there is no research on the relationship between nutritional parameters and the complications of transsphenoidal pituitary surgery. This study was designed to identify the relationship between preoperative nutritional markers and postoperative complications in nonfunctioning pituitary adenomas. METHODS This observational study included 429 patients whose first transsphenoidal surgery was performed in Shandong Provincial Hospital between January 2015 and July 2020. Preoperative prealbumin, retinol-binding protein (RBP), the prognostic nutritional index, clinicopathological data, and postoperative complication data were collected to investigate outcomes. RESULTS After multivariable adjustment, preoperative prealbumin and RBP were inversely associated with risk of complication (p value for trend = 0.006, 0.021). The increase of preoperative serum prealbumin and RBP concentration may decrease the risk of postoperative intracranial infection and hyponatremia (both OR per SD increment, < 1; p < 0.05). The increase of preoperative prealbumin may also decrease the risk of diabetes insipidus (OR per SD increment, 0.591; p = 0.001), but similar results were not obtained for the RBP (p > 0.05). Prealbumin and RBP are both useful in predicting overall complications (area under the receiver operating characteristic curve [AUC] 0.749, 0.678), especially in intracranial infection (AUC 0.794, 0.738). However, the predictive value of prealbumin was better than that of RBP. CONCLUSIONS Low preoperative prealbumin or RBP concentrations may be associated with higher surgical risk, especially for intracranial infection. This study emphasizes the suggestion that preoperative prealbumin and RBP concentrations may be vital factors in predicting operative complications of nonfunctioning pituitary adenomas.
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Affiliation(s)
- Shuaihua Song
- 1Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong
| | - Peng Qiu
- 2Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong
| | - Haoran Wang
- 3Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong; and
| | - Di Zhang
- 1Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong
| | - Qianjin Qi
- 1Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong
| | - Li Feng
- 4Department of Clinical Nutrition, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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Jung JH, Yoon SJ, Lee OJ, Shin SH, Heo JS, Han IW. Is it worthy to perform total pancreatectomy considering morbidity and mortality?: Experience from a high-volume single center. Medicine (Baltimore) 2022; 101:e30390. [PMID: 36086699 PMCID: PMC10980437 DOI: 10.1097/md.0000000000030390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/22/2022] [Indexed: 11/25/2022] Open
Abstract
Total pancreatectomy (TP) is performed for diseases of the entire pancreas. However, reluctance remains regarding TP because of the fear of high morbidity and mortality. Our retrospective study aimed to evaluate the postoperative outcomes of TP performed at a high-volume single center and to identify the risk factors associated with major morbidities and mortality after TP. A total of 142 patients who underwent elective TP at Samsung Medical Center between 1995 and 2015 were included. TP was usually planned before surgery or decided during surgery [one-stage TP], and there were some completion TP cases that were performed to manage tumors that had formed in the remnant pancreas after a previous partial pancreatectomy [2-stage TP]. The differences between the 1-stage and 2-stage TP groups were analyzed. Chronological comparison was also conducted by dividing cases into 2 periods [the early and late period] based on the year TP was performed, which divided the total number of patients to almost half for each period. Among all TP patients, major morbidity occurred in 25 patients (17.6%), the rate of re-admission within 90-days was 20.4%, and there was no in-hospital and 30-days mortality. Between the 1-stage and 2-stage TP groups, most clinical, operative, and pathological characteristics, and postoperative outcomes did not differ significantly. Chronological comparison showed that, although the incidence of complications was higher, hospitalization was shorter due to advanced managements in the late period. The overall survival was improved in the late period compared to the early period, but it was not significant. A low preoperative protein level and N2 were identified as independent risk factors for major morbidity in multivariable analysis. The independent risk factors for poor overall survival were R1 resection, adenocarcinoma, and high estimated blood loss (EBL). TP is a safe and feasible procedure with satisfactory postoperative outcomes when performed at a high-volume center. More research and efforts are needed to significantly improve overall survival rate in the future.
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Affiliation(s)
- Ji Hye Jung
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea
| | - So Jeong Yoon
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea
| | - Ok Joo Lee
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea
| | - Sang Hyun Shin
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea
| | - Jin Seok Heo
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea
| | - In Woong Han
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea
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Sugawara K, Yagi K, Aikou S, Yamashita H, Seto Y. Impacts of complications after esophageal cancer surgery on health-related quality of life and nutritional status. Gen Thorac Cardiovasc Surg 2022; 70:1048-1057. [PMID: 35788889 DOI: 10.1007/s11748-022-01846-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The long-term impacts of post-operative complications, especially pulmonary complications and anastomotic leakage, on health-related quality of life (HRQoL), nutritional status and body composition remain to be fully addressed in patients undergoing esophageal cancer surgery. METHODS Patients who underwent esophagectomy between 2015 and 2019 and survived without recurrence were eligible. HRQoL (European Organization for Research and Treatment of Cancer QLQ-C30 and the QLQ-OES18 questionnaires), nutritional and body composition data were prospectively evaluated before and at 3, 6, 12 and 24 months after surgery. Collected data were compared between patients with post-operative complications and those without. RESULTS In total, 88 patients were included. Overall complications, anastomotic leakage and pulmonary complications developed in 48 (54.5%), 20 (20.7%) and 18 (20.5%) patients, respectively. Patients with pulmonary complications had significantly more reflux-related symptoms (dry mouth; P = 0.03, coughing; P = 0.047), and more difficulties with eating at 24 months after surgery, as compared to those without such complications. Anastomotic leakage increased pain, speaking problems and dysphagia up to 6 months after surgery. Patients with pulmonary complications had significantly lower prealbumin levels (P = 0.01, 0.02 and 0.008 at 6, 12 and 24 months after surgery, respectively) and lower prognostic nutritional index values over time after surgery than those without these complications. In contrast, anastomotic leakage was not associated with poor nutritional status post-operatively. Body composition was not affected by the occurrence of complications. CONCLUSION Patients who developed post-operative complications, especially pulmonary complications, had long-lasting negative HRQoL outcomes and poor nutritional status after esophagectomy.
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Affiliation(s)
- Kotaro Sugawara
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Koichi Yagi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Susumu Aikou
- Division of Frontier Surgery, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Hiroharu Yamashita
- Department of Digestive Surgery, Surugadai Nihon University Hospital, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Gao C, Dan Zeng CD, Tong YX, Zhu L, Zhang S. Preoperative Low Prealbumin Is Associated With Recurrence in Patients With Stage II/III Gastric Cancer After Laparoscopic D2 Gastrectomy. Front Surg 2022; 9:819514. [PMID: 35433809 PMCID: PMC9010530 DOI: 10.3389/fsurg.2022.819514] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/04/2022] [Indexed: 01/27/2023] Open
Abstract
BackgroundPostoperative recurrence is associated with poor prognosis in patients with gastric cancer. This study aimed to explore predictive factors contributing to recurrence in patients with stage II/III gastric cancer after laparoscopic D2 gastrectomy.MethodsThis retrospective study was conducted at a single tertiary referral hospital. Patients diagnosed with gastric cancer who met the inclusion criteria were included in the study. The clinicopathological characteristics of the patients were collected. The patients were divided into recurrence and non-recurrence groups. The predictive factors were investigated using univariate and multivariate analyses.ResultsIn total, 462 patients were included. The incidence of recurrence was 26.4% (122/462) in all patients. The most common recurrence pattern was haematogenous recurrence. In the multivariate analysis, the independent predictive factors for recurrence were serum prealbumin level (p < 0.001), prognostic nutritional index (p = 0.001), carbohydrate antigen 19-9 (CA19-9) (p < 0.001), number of lymph node metastases (p < 0.001), signet-ring cell carcinoma (p = 0.001), tumor deposit (p = 0.001), and no/incomplete adjuvant chemotherapy (p < 0.001).ConclusionsOur findings revealed that nutritional status was an independent predictive factor for recurrence in patients with gastric cancer after D2 gastrectomy. We suggest that patients with risk factors for recurrence receive both nutritional support and intense surveillance.
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Ida S, Kumagai K, Nunobe S. Current status of perioperative nutritional intervention and exercise in gastric cancer surgery: A review. Ann Gastroenterol Surg 2022; 6:197-203. [PMID: 35261945 PMCID: PMC8889851 DOI: 10.1002/ags3.12520] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 01/04/2023] Open
Abstract
Patients with gastric cancer are often malnourished or sarcopenic during tumor progression. Perioperative malnutrition, including sarcopenia, is strongly related to postoperative complications and long-term outcomes. To improve outcomes, nutritional intervention is common for patients with gastric cancer, especially for those undergoing elective surgery. Several clinical trials evaluating perioperative nutritional intervention have set postoperative loss of body weight and lean body mass as endpoints; however, the results were inconsistent. Therefore, recently, perioperative multimodal interventions that are expected to have a synergistic effect between nutritional intervention and exercise have gained attention. Furthermore, supplementing with leucine, a branched-chain amino acid, in addition to exercise, may be promising for preventing perioperative sarcopenia. However, whether perioperative nutritional intervention and exercise has clinical benefits in gastric surgery is unclear. With the aging of gastric cancer patients, measures to address sarcopenia will become more important in the future. Understanding the significance of nutritional intervention and exercise in patients undergoing gastric cancer surgery will help achieve good outcomes.
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Affiliation(s)
- Satoshi Ida
- Department of Gastroenterological SurgeryCancer Institute Hospital of the Japanese Foundation for Cancer ResearchTokyoJapan
| | - Koshi Kumagai
- Department of Gastroenterological SurgeryCancer Institute Hospital of the Japanese Foundation for Cancer ResearchTokyoJapan
| | - Souya Nunobe
- Department of Gastroenterological SurgeryCancer Institute Hospital of the Japanese Foundation for Cancer ResearchTokyoJapan
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Huang Z, Cai P, Zhao Y, Niu D, Xu F, Lai Y, Pang J, Qi J, Wu J. Preoperative C-reactive protein to prealbumin ratio is independently associated with prognosis in patients with resectable colorectal cancer. J Surg Oncol 2022; 125:1238-1250. [PMID: 35174885 DOI: 10.1002/jso.26823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/28/2022] [Accepted: 02/08/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Increasing attention has been drawn the prognostic value of inflammatory indices for colorectal cancer (CRC). However, the prognostic value of the preoperative C-reactive protein to prealbumin ratio (CPAR) in CRC remains unclear. METHODS A retrospective study was conducted with 794 patients who had CRC and underwent radical surgical resection. The predictive performance of the inflammatory indices was analyzed and compared using the area under the time-dependent receiver operating characteristic curve. A competing risk regression model and Cox proportional hazard model were used to analyze the effects of CPAR on disease-free survival (DFS) and overall survival (OS), respectively. RESULTS Patients with high CPAR (>7.25) had poor survival outcome. The CPAR had the best predictive performance among all inflammatory indices, and was significantly associated with several characteristics of tumor invasion, including histological grade, tumor stage, and tumor size. Multivariate analysis showed that high CPAR was independently associated with poor DFS (subdistribution hazard ratio = 2.28, 95% confidence interval [CI]: 1.74-2.82) and OS (hazard ratio = 1.78, 95% CI: 1.60-1.96). CONCLUSION Preoperative CPAR assessment could serve as an effective and reliable tool for prognostic prediction in patients with resectable CRC.
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Affiliation(s)
- Zhe Huang
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Pengzhu Cai
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yumei Zhao
- Clinical Research Service Center, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Dongdong Niu
- Clinical Research Service Center, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Feipeng Xu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yousheng Lai
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jinglin Pang
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jiaming Qi
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jiayuan Wu
- Clinical Research Service Center, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.,Collaborative Innovation Engineering Technology Research Center of Clinical Medical Big Data Cloud Service in Medical Consortium of West Guangdong Province, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
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Izumi D, Ida S, Hayami M, Makuuchi R, Kumagai K, Ohashi M, Watanabe M, Sano T, Nunobe S. Increased Rate of Serum Prealbumin Level after Preoperative Enteral Nutrition as an Indicator of Morbidity in Gastrectomy for Gastric Cancer with Outlet Obstruction. World J Surg 2022; 46:624-630. [PMID: 34988604 DOI: 10.1007/s00268-021-06384-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Preoperative malnutrition is believed to contribute to increased postoperative complications. Preoperative serum prealbumin level was reported to be a predictor of nutritional status and postoperative complications after gastrointestinal surgery, including gastrectomy. Gastric outlet obstruction caused by gastric cancer leads to insufficient nutritional status. However, the impact of preoperative enteral nutrition using naso-jejunal feeding tubes for patients with gastric outlet obstruction is not fully understood. METHODS From July 2010 to June 2020, 50 patients with gastric cancer-induced outlet obstruction who underwent gastrectomy following preoperative enteral nutrition via feeding tube were included. We investigated the relationship between changes in nutritional status after preoperative enteral nutrition and postoperative complications. Postoperative complications were defined as grade ≥II based on the Clavien-Dindo classification. RESULTS The median period of preoperative enteral nutrition was 10 days. The median increase rate of the serum prealbumin level was 10.5% (interquartile range, 0.63-38.2%), and patients with an increase rate ≥ 10% were defined as the elevated group. Postoperative morbidity was significantly higher in the non-elevated group (P = 0.0031). Univariate and multivariate analyses showed that an increased rate of the serum prealbumin level was an independent risk factor of postoperative complications for patients with gastric outlet obstruction caused by gastric cancer (P = 0.0025 and P = 0.009, respectively). CONCLUSIONS Preoperative enteral nutrition improved the serum prealbumin level of patients with gastric cancer-induced outlet obstruction, and an increased rate of prealbumin can be an indicator of sufficient preoperative enteral nutrition and decreased postoperative morbidity.
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Affiliation(s)
- Daisuke Izumi
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Satoshi Ida
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
| | - Masaru Hayami
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
| | - Rie Makuuchi
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
| | - Koshi Kumagai
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
| | - Masayuki Watanabe
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
| | - Takeshi Sano
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan.
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Hara T, Kogure E, Iijima S, Fukawa Y, Kubo A, Kakuda W. Preoperative Walking Capacity Indirectly Relates to Decreased Postoperative Complications in Patients with Gastrointestinal Cancer. Prog Rehabil Med 2022; 7:20220002. [PMID: 35118212 PMCID: PMC8784540 DOI: 10.2490/prm.20220002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/28/2021] [Indexed: 02/03/2023] Open
Abstract
Objectives: Postoperative complications (PCs) in patients with gastrointestinal cancer (GIC) lead
to reduced lifespan and poor quality of life. The aim of this study was to investigate
the correlation between preoperative exercise-related factors, together with other
contributory factors, and the frequency of PCs in patients with GIC. Methods: This was a cross-sectional, three-institution study. We enrolled 299 patients who were
scheduled for elective surgery for GIC (182 men and 117 women; age, 65.7 ± 11.0 years).
PCs were graded using the Clavien–Dindo classification based on the medical records 1
month postoperatively. Exercise-related factors (the skeletal muscle index, the
isometric knee extension torque, and the 6-min walk test [6 MWT] distance) were measured
before surgery. Based on previous studies of factors contributing to complications, data
on age, sex, clinical cancer stage, comorbidities, neoadjuvant therapy, type of surgery,
surgery duration, blood loss, blood transfusion, laboratory data, respiratory function,
body mass index, and visceral fat area were collected. Results: The frequency of PCs was positively correlated with surgery duration (β=0.427) and
C-reactive protein (CRP) level on postoperative day 3 (β=0.189). The 6 MWT was
negatively correlated with the frequency of PCs through CRP level on postoperative day 3
(β=–0.035). This model demonstrated an acceptable fit to the data (goodness-of-fit
index, 0.979; adjusted goodness-of-fit index, 0.936; comparative fit index, 0.944; and
root mean square error of approximation, 0.076). Conclusions: Preoperative walking capacity was correlated with PCs in patients undergoing GIC
surgery. Prevention of PCs in patients with GIC requires the monitoring of both surgical
parameters and postoperative inflammation.
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Affiliation(s)
- Tsuyoshi Hara
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, Tochigi, Japan
| | - Eisuke Kogure
- Rehabilitation Progress Center Incorporated, Tokyo, Japan
| | - Shinno Iijima
- Division of Rehabilitation, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Yasuhisa Fukawa
- Division of Rehabilitation, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Akira Kubo
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, Tochigi, Japan
| | - Wataru Kakuda
- Department of Rehabilitation Medicine, School of Medicine, International University of Health and Welfare, Chiba, Japan
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He H, Ma Y, Zheng Z, Deng X, Zhu J, Wang Y. Early versus delayed oral feeding after gastrectomy for gastric cancer: A systematic review and meta-analysis. Int J Nurs Stud 2021; 126:104120. [PMID: 34910976 DOI: 10.1016/j.ijnurstu.2021.104120] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 10/13/2021] [Accepted: 10/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Early oral feeding has been shown to be safe and effective for most surgeries, while surgeons and nurses are still hesitant to implement it in gastric cancer patients who undergo gastrectomy. OBJECTIVES This review aimed to investigate the safety and feasibility of early versus delayed oral feeding in gastric cancer patients after gastrectomy. DESIGN A systematic review and meta-analysis of randomized controlled trials. DATA SOURCES The literature search was performed in 7 databases from inception to March 7, 2021. REVIEW METHODS Randomized controlled trials that compared the effects of early oral feeding and delayed oral feeding in gastric cancer patients who undergo gastrectomy were included. The primary outcome was hospital days, and secondary outcomes included hospital costs, postoperative complication rates, feeding intolerance rates, annal exhaust time, albumin levels and prealbumin levels. According to the presence of heterogeneity, fixed or random effect meta-analysis was applied. RESULTS Nine trials involving 1087 gastric cancer patients who undergo gastrectomy were pooled in this systemic review and meta-analysis. The results showed that early oral feeding significantly decreased hospital days (mean difference = -1.50, 95% confidence interval = -1.91 to -1.10, P < 0.001) and hospital costs (mean difference = -4.21, 95% confidence interval = -5.00 to -3.42, P < 0.001) compared to delayed oral feeding, while the incidences of postoperative complications (risk ratio = 0.96, 95% confidence interval = 0.72 to 1.26, P = 0.76) and feeding intolerance (risk ratio = 0.95, 95% confidence interval = 0.79 to 1.15, P = 0.62) were comparable between the two groups. In comparison to delayed oral feeding, early oral feeding was associated with shorter annal exhaust time (mean difference = -0.61, 95% confidence interval = -0.81 to -0.40, P < 0.001) and higher levels of albumin (mean difference = 3.77, 95% confidence interval = 2.42 to 5.12, P < 0.001) and prealbumin (mean difference = 18.11, 95% confidence interval = 15.33 to 20.88, P < 0.001). Furthermore, the results of distal gastrectomy subgroup analysis indicated that hospital days were shorter in the early oral feeding group than in the delayed oral feeding group. CONCLUSIONS For gastric cancer patients who undergo gastrectomy, early oral feeding was associated with shorter hospital days and lower hospital costs, but early oral feeding did not increase the incidences of postoperative complications or feeding intolerance. Moreover, early oral feeding also decreased the annal exhaust time but increased the levels of albumin and prealbumin.
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Affiliation(s)
- Haiyan He
- Department of Nursing, Daping Hospital, Army Medical University, Chongqing, China
| | - Yuanyuan Ma
- Department of Basic Nursing, School of Nursing, Army Medical University, Chongqing, China
| | - Zhiwei Zheng
- Department of Digestion, The 958st Hospital, Chongqing, China
| | - Xiaolian Deng
- Department of Gastrointestinal Colorectal and Anal Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Jingci Zhu
- Department of Basic Nursing, School of Nursing, Army Medical University, Chongqing, China.
| | - Yaling Wang
- Department of Nursing, Daping Hospital, Army Medical University, Chongqing, China.
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Zhang Y, Li S, Yan C, Chen J, Shan F. Perioperative Use of Glucocorticoids and Intraoperative Hypotension May Affect the Incidence of Postoperative Infection in Patients with Gastric Cancer: A Retrospective Cohort Study. Cancer Manag Res 2021; 13:7723-7734. [PMID: 34675668 PMCID: PMC8517416 DOI: 10.2147/cmar.s333414] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/20/2021] [Indexed: 12/24/2022] Open
Abstract
Background In patients undergoing surgical resection for gastric cancer, postoperative complications—in particular, postoperative infections—remain an important problem and can result in delayed recovery and increased postoperative mortality. Objective To investigate the association between perioperative anesthesia management and postoperative infectious complications in patients undergoing resection for gastric cancer. Design Retrospective cohort study. Setting A single-center study performed from April 1, 2015, to June 30, 2018, at Peking University Cancer Hospital. Patients Patients who underwent resection for gastric cancer. Main Outcome Measures Demographic information, perioperative data (including anesthesia-related data, surgery-related data, and cancer diagnosis), and information on postoperative recovery were recorded. The primary outcome was incidence of postoperative infection; the secondary outcome was length of hospital stay. The associations between perioperative factors and postoperative infectious complications were analyzed using multivariable logistic regression models and the classification tree method. Results A total of 880 patients were included in the study; of these, 111 (12.6%) had postoperative infectious complications during hospitalization, including 78 surgical site infections and 62 remote infections. After correction for confounding factors on logistic multivariable analysis, perioperative use of glucocorticoids was associated with a lower incidence of postoperative infection (hazard ratio 0.968, 95% confidence interval 0.939 to 0.997, P=0.029), and intraoperative systolic blood pressure <90 mmHg for >10 min was associated with a higher incidence of postoperative infection (hazard ratio 2.112, 95% confidence interval 1.174 to 3.801, P=0.013). In addition, older age, preoperative hypoproteinemia, and total gastrectomy were identified as independent predictors of postoperative infection. Conclusion For patients with gastric cancer, perioperative use of glucocorticoids and avoiding intraoperative hypotension may decrease the incidence of postoperative infectious complications.
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Affiliation(s)
- Yunxiao Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Shuo Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Chao Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), The First Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Jiheng Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Fei Shan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), The First Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
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Tuncer K, Sert I, Kilinc G, Tugmen C, Emiroglu M. Effect of preoperative skeletal muscle area and prognostic nutritional index values on postoperative morbidity and mortality in patients with gastric cancer: a single-center retrospective analysis. Acta Chir Belg 2021; 123:251-256. [PMID: 34486944 DOI: 10.1080/00015458.2021.1977462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The aim of this study was to determine the impact of preoperative prognostic nutritional index (PNI) value and skeletal muscle area (SMA) on short-term outcomes of patients with gastric cancer. PATIENTS AND METHODS A total of 107 patients underwent gastrectomy due to gastric cancer between January 2016 and December 2019 were retrospectively analyzed. The patients were divided into groups according to the determined PNI and SMA cutoff values. Clinicopathological features and short-term results were compared. RESULTS Overall morbidity was 29% (n = 31) in patients who underwent gastrectomy. Preoperative PNI value was ranged from 24.5 to 61.5 (median, 49.5). Preoperative SMA values were ranged respectively from 55.7 to 142 (median, 98.9) in women and 77.5 to 203.3 (median, 129.3) in men. It was observed that the risk of postoperative complications increased in patients with low PNI (OR 0.270, p = .003). The average postoperative length of hospital stay was 12.1 days. The longer postoperative hospital stay was seen in lower PNI group (PNI ≤ 48, 15.1 days vs. PNI> 48, 10 days; p = .033). Clavien-Dindo classification was high in patients with low PNI and sarcopenia (PNI ≤ 48, p = .004 and Sarcopenia, p = .006). Likewise, mortality was significantly increased in patients with low PNI and sarcopenia (PNI ≤ 48, 20% vs. PNI > 48, 0%; p < .001 and Sarcopenia, 13.7% vs. Nonsarcopenia, 3.6%; OR 0.233, p = .053). CONCLUSIONS As a result, preoperative SMA and PNI values were found closely related to the postoperative hospital stay, morbidity and mortality results of patients with gastric cancer. Preoperative nutritional support may help to overcome longer hospital stay, higher mortality and morbidity rates in patients with gastric cancer.
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Affiliation(s)
- Korhan Tuncer
- Department of General Surgery, University of Health Sciences Izmir Tepecik Training and Research Hospital, Turkey
| | - Ismail Sert
- Department of General Surgery, University of Health Sciences Izmir Tepecik Training and Research Hospital, Turkey
| | - Gizem Kilinc
- Department of General Surgery, University of Health Sciences Izmir Tepecik Training and Research Hospital, Turkey
| | - Cem Tugmen
- Department of General Surgery, University of Health Sciences Izmir Tepecik Training and Research Hospital, Turkey
| | - Mustafa Emiroglu
- Department of General Surgery, University of Health Sciences Izmir Tepecik Training and Research Hospital, Turkey
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Chen GL, Huang Y, Zhang W, Pan X, Feng WJ, Zhao XY, Zhu XD, Li WH, Huang M, Chen ZY, Guo WJ. Three-Tier Prognostic Index in Young Adults With Advanced Gastric Cancer. Front Oncol 2021; 11:667655. [PMID: 34568007 PMCID: PMC8462089 DOI: 10.3389/fonc.2021.667655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 08/17/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To characterize clinical features and identify baseline prognostic factors for survival in young adults with advanced gastric cancer (YAAGC). MATERIALS AND METHODS A total of 220 young inpatients (age less than or equal to 40 years) with an initial diagnosis of advanced gastric cancer were retrospectively enrolled in this study. RESULTS Of a consecutive cohort of 220 patients with YAAGC, the median overall survival (OS) time was 16.3 months. One-year survival rate was 43.6% (95% CI: 36.5 to 50.7). In this cohort, a female (71.4%, n = 157) predominance and a number of patients with poorly differentiated tumors (95.9%, n = 211) were observed. In the univariate analysis, OS was significantly associated with neutrophil-lymphocyte ratio (NLR) (≥3.12), hypoproteinemia (<40 g/L), presence of peritoneal or bone metastases, and previous gastrectomy of primary tumor or radical gastrectomy. In multivariate Cox regression analysis, hypoproteinemia [hazard ratio (HR) 1.522, 95% CI 1.085 to 2.137, p = 0.015] and high NLR level (HR 1.446, 95% CI 1.022 to 2.047, p = 0.021) were two independent poor prognostic factors, while previous radical gastrectomy was associated with a favorable OS (HR 0.345, 95% CI 0.205 to 0.583, p = 0.000). A three-tier prognostic index was constructed dividing patients into good-, intermediate-, or poor-risk groups. Median OS for good-, intermediate-, and poor-risk groups was 36.43, 17.87, and 11.27 months, respectively. CONCLUSIONS Three prognostic factors were identified, and a three-tier prognostic index was devised. The reported prognostic index may aid clinical decision-making, patient risk stratification, and planning of future clinical studies on YAAGC.
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Affiliation(s)
- Guang-Liang Chen
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College Fudan University, Shanghai, China
| | - Yan Huang
- Department of Oncology and Chemotherapy, Red Cross Hospital of Yulin City, Yulin, China
| | - Wen Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College Fudan University, Shanghai, China
| | - Xu Pan
- Department of Medical Oncology, Yixing Traditional Chinese Medicine Hospital, Wuxi, China
| | - Wan-Jing Feng
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College Fudan University, Shanghai, China
| | - Xiao-Ying Zhao
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College Fudan University, Shanghai, China
| | - Xiao-Dong Zhu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College Fudan University, Shanghai, China
| | - Wen-Hua Li
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College Fudan University, Shanghai, China
| | - Mingzhu Huang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College Fudan University, Shanghai, China
| | - Zhi-Yu Chen
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College Fudan University, Shanghai, China
| | - Wei-Jian Guo
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College Fudan University, Shanghai, China
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Effect of Early Peripheral Parenteral Nutrition Support in an Enhanced Recovery Program for Colorectal Cancer Surgery: A Randomized Open Trial. J Clin Med 2021; 10:jcm10163647. [PMID: 34441942 PMCID: PMC8396922 DOI: 10.3390/jcm10163647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/13/2021] [Accepted: 08/13/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Peripheral parenteral nutrition allows repletion of acute nutrient deficiencies and could prevent further nutrition deficits before and after colorectal surgery. A randomized open study was performed to evaluate the effect of perioperative peripheral parenteral nutrition (PPN) support on postoperative morbidity after colorectal cancer surgery within an enhanced recovery program. METHODS Patients were randomized into two groups: peripheral parenteral nutrition (PPN) (with Peri-Olimel N4-E) versus conventional fluid therapy (FT). Ninety-day postoperative complications, laboratory parameters, length of hospital stay, and compliance with the ERAS protocol were assessed. RESULTS A total of 158 patients were analysed. The overall 90-day complication rate was 38.6% (61 patients), and 24 patients had major complications (Clavien-Dindo III-V) (15.2%). In the multivariate analysis, the intervention (PPN vs. FC) showed a protective effect against postoperative complications (p = 0.0031, OR = 0.2 (CI: 0.08-0.87)). Following ordinal regression, PPN and early oral tolerance showed a protective effect, being less likely to develop complications or to move from minor to major complications. In patients with low compliance to ERAS during the first postoperative day, PPN showed a protective effect, preventing 28% of morbidity. CONCLUSIONS Perioperative peripheral parenteral nutrition (PPN) support with Peri-Olimel N4-E in colorectal cancer surgery associated with early oral intake could reduce postoperative complications.
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Wan GY, Yuan H, Xue H, Li HQ, Hu HY, Zhang XY. Assessment of compliance with oral nutritional supplementation and exploration of barriers and facilitators for patients after gastrectomy: A mixed-methods study. J Adv Nurs 2021; 77:2845-2859. [PMID: 33818820 DOI: 10.1111/jan.14851] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/18/2021] [Accepted: 03/21/2021] [Indexed: 01/10/2023]
Abstract
AIMS To evaluate the compliance of patients after gastrectomy in taking oral nutritional supplementation and to explore the promoting and hindering factors. DESIGN A mixed-methods design with an explanatory sequential approach was employed. METHODS We conducted a 12-week longitudinal study to evaluate the oral nutritional supplementation compliance of 122 patients after gastric cancer surgery and the factors that affected their compliance. After the quantitative phase, we selected the interview subjects and developed the interview outline based on the analysis of the quantitative results. In-depth interviews (n = 15) were conducted to explain and supplement the quantitative phase results. Data were collected from October 2019 to May 2020. RESULTS The average overall compliance rate of oral nutritional supplementation in patients with gastric cancer over 12 weeks was 30.59%. Adverse reactions to oral nutritional supplementation, the identity of the main caregivers and the patient's financial ability were independent factors that affected patient compliance. In subsequent interviews, we extracted four themes: social support plays an important role in patients taking oral nutritional supplementation, adverse reactions discourage patients from continuing to take oral nutritional supplementation, patients' attitudes affect their motivation to take oral nutritional supplementation, and the different needs of patients for oral nutritional supplementation affect patient compliance. CONCLUSION Patients' compliance with oral nutritional supplementation after gastric cancer surgery is very low. Health education should pay more attention to the management of adverse reactions and the role of patients' peers and family members. Oral nutritional supplementation products should be diversified to provide patients with more choices. IMPACT This study clarifies the factors that hinder and promote oral nutritional supplementation compliance and provides an important reference for the establishment and revision of health education strategies for patients after gastric cancer surgery.
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Affiliation(s)
- Guang-Ying Wan
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, Jilin Province, P.R. China
| | - Hua Yuan
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, Jilin Province, P.R. China
| | - Hui Xue
- Department of Histology & Embryology, College of Basic Medical Sciences, Jilin University, Changchun, Jilin Province, P.R. China
| | - Hui-Qin Li
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, Jilin Province, P.R. China
| | - Hai-Yan Hu
- Department of Gastric Colorectal Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, P.R. China
| | - Xiu-Ying Zhang
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, Jilin Province, P.R. China
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Lee B, Han HS, Yoon YS. Impact of Preoperative Malnutrition on Postoperative Long-Term Outcomes of Patients With Pancreatic Head Cancer. ANNALS OF SURGERY OPEN 2021; 2:e047. [PMID: 37638242 PMCID: PMC10455215 DOI: 10.1097/as9.0000000000000047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/24/2021] [Indexed: 12/20/2022] Open
Abstract
Objective To evaluate the association between preoperative malnutrition and long-term outcomes in patients with pancreatic head cancer who underwent curative pancreatoduodenectomy (PD). Methods From 2004 to 2018, 228 consecutive patients who underwent curative PD for pancreatic ductal adenocarcinoma were included. Preoperative malnutrition was defined by the Global Leadership Initiative in Malnutrition criteria. It is based on both phenotypic criteria (weight loss, low body mass index, and reduced muscle mass) and etiologic criteria (reduced intake or assimilation and inflammation). Results Seventy-five (32.9%) of 228 patients were classified as suffering from malnutrition. Preoperative malnutrition was associated with an increased risk of estimated blood loss (mL) (816.7 ± 875.2 vs 593.1 ± 489.9, P = 0.015) and longer hospital stay (days) (27.3 ± 15.7 vs 22.9 ± 17.7, P = 0.045). The median follow-up period was 24.5 months. The malnutrition group had poor overall survival compared with "without (WO)-malnutrition" group (P = 0.001) at 1 year (66.3% vs 81.3%), 3 years (18.0% vs 51.8%), and 5 years (12.0% vs 39.3%). The malnutrition group showed poor disease-free survival and cancer-specific survival compared with WO-malnutrition group (P = 0.001) at 1 year (38.9% vs 66.7%) and (69.0% vs 88.7%), 3 years (11.5% vs 45.1%) and (21.1% vs 61.6%), and 5 years (11.5% vs 37.3%) and (14.1% vs 51.2%). In multivariate analysis, the preoperative malnutrition was found to be the predictor of poor prognosis (harzard ratio = 2.29, 95% confidence interval = 1.60-3.29, P = 0.001). Conclusions Preoperative malnutrition is associated with poor prognosis in patients who underwent curative PD for pancreatic head cancer.
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Affiliation(s)
- Boram Lee
- From the Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Ho-Seong Han
- From the Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Yoo-Seok Yoon
- From the Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Chen C, Liu Y, Han P, Cui B. Research Progress of Preoperative FPR, FAR or AFR in Patients with Colorectal Cancer. Cancer Manag Res 2021; 13:1791-1801. [PMID: 33654428 PMCID: PMC7910077 DOI: 10.2147/cmar.s292605] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/03/2021] [Indexed: 12/12/2022] Open
Abstract
Research has confirmed that plasma albumin (Alb), prealbumin (PA) and fibrinogen (Fib) are involved in regulating the occurrence and development of various tumors. Their levels in peripheral blood are related to the survival outcome and treatment response of patients, but the accuracy and specificity of single application have yet to be fully realized. A growing amount of evidence indicates that predictors such as preoperative fibrinogen to prealbumin ratio (FPR), fibrinogen to albumin ratio (FAR) or albumin to fibrinogen ratio (AFR) are emerging as comprehensive indicators. Indeed, their components play a key regulatory role in the progression of colorectal cancer (CRC). Preoperative FPR, FAR or AFR levels, therefore, are expected to become new biomarkers for prognosis evaluation and curative effect prediction for CRC patients and are significant in the guidance they could provide for the development of individualized treatment strategies.
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Affiliation(s)
- Chen Chen
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Yanlong Liu
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Peng Han
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Binbin Cui
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, Harbin, 150081, Heilongjiang Province, People's Republic of China
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Uchida T, Sekine R, Matsuo K, Kigawa G, Umemoto T, Kijima K, Harada Y, Wakabayashi T, Takahashi Y, Shiozawa T, Oyama H, Shibata S, Tanaka K. Association between low preoperative skeletal muscle quality and infectious complications following gastrectomy for gastric cancer. Surg Today 2021; 51:1135-1143. [PMID: 33491103 DOI: 10.1007/s00595-020-02225-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/07/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE It is known that sarcopenia affects the overall short- and long-term outcomes of patients with gastric cancer (GC); however, the effect of muscle quality on infectious complications after gastrectomy for GC remains unclear. We investigated the associations between the preoperative quantity and quality of skeletal muscle on infectious complications following gastrectomy for GC. METHODS The subjects of this retrospective study were 353 GC patients who underwent radical gastrectomy between 2009 and 2018. We examined the relationships between their clinical factors, including skeletal muscle mass index and intramuscular adipose tissue content (IMAC), and infectious complications after gastrectomy. RESULTS Infectious complications developed in 59 patients (16.7%). The independent risk factors for infectious complications identified by multivariate analysis were male gender (P < 0.001), prognostic nutritional index below 45 (P = 0.006), and high IMAC (P = 0.011). Patients with a high IMAC were older and had a higher body mass index, as well as a greater age-adjusted Charlson comorbidity index, than those with low or normal IMAC. CONCLUSIONS Low skeletal muscle quality defined by a high IMAC is a risk factor for infectious complications following gastrectomy. When feasible, preoperative nutritional intervention and rehabilitation aiming to improve muscle quality could reduce infectious complications after gastrectomy for GC.
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Affiliation(s)
- Tsuneyuki Uchida
- Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, 1-30, Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 2278501, Japan.
| | - Ryuichi Sekine
- Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, 1-30, Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 2278501, Japan
| | - Kenichi Matsuo
- Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, 1-30, Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 2278501, Japan
| | - Gaku Kigawa
- Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, 1-30, Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 2278501, Japan
| | - Takahiro Umemoto
- Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, 1-30, Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 2278501, Japan
| | - Kazuhiro Kijima
- Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, 1-30, Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 2278501, Japan
| | - Yoshikuni Harada
- Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, 1-30, Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 2278501, Japan
| | - Tetsuji Wakabayashi
- Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, 1-30, Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 2278501, Japan
| | - Yuki Takahashi
- Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, 1-30, Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 2278501, Japan
| | - Toshimitsu Shiozawa
- Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, 1-30, Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 2278501, Japan
| | - Hideyuki Oyama
- Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, 1-30, Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 2278501, Japan
| | - Shiori Shibata
- Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, 1-30, Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 2278501, Japan
| | - Kuniya Tanaka
- Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, 1-30, Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 2278501, Japan
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Prognostic Significance of Preoperative Fibrinogen-to-Prealbumin Ratio in Patients with Stage I-III Colorectal Cancer Undergoing Surgical Resection: A Retrospective Cohort Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3905353. [PMID: 33521127 PMCID: PMC7817313 DOI: 10.1155/2021/3905353] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/11/2020] [Accepted: 01/04/2021] [Indexed: 11/29/2022]
Abstract
Background The objective of this study was to explore the role of preoperative fibrinogen-to-prealbumin ratio (FPR) in evaluating the prognosis of patients with stage I–III colorectal cancer (CRC). Methods This retrospective study enrolled 584 stage I–III CRC patients undergoing surgical resection. Logistic regression analysis was used to explore the correlation between FPR and postoperative complications. The Kaplan-Meier curve and Cox proportional hazards model were used to identify the prognostic factors. The nomograms were constructed based on the prognostic factors. The concordance index and calibration curve were used to determine the accuracy of the nomograms. Time-dependent receiver operating characteristic was used to compare the predictive prognostic efficacy of nomograms and TNM stage. Results FPR was determined to be an independent factor affecting postoperative complications. Patients with a low-FPR had a significantly better prognosis than those with a high-FPR (disease-free survival, p = 0.028; overall survival, p = 0.027), especially patients with stage I CRC (disease-free survival, p = 0.015; overall survival, p = 0.017). The Cox proportional hazards model identified FPR as an independent poor prognostic factor of disease-free survival (hazard ratio (HR) = 1.459, 95% confidence interval (CI) = 1.074–1.954, p = 0.011) and overall survival (HR = 1.405, 95% CI = 1.034–1.909, p = 0.030). The prognostic nomograms had good accuracy and were superior to the traditional TNM stage. Conclusions FPR is a potential indicator for predicting short- and long-term prognosis of stage I–III CRC patients undergoing surgical resection.
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Nakamichi N, Tsujiura M, Matsui T, Yamamoto T, Yoshioka A, Hiramoto H, Ouchi Y, Ishimoto T, Kosuga T, Mochizuki S, Nakashima S, Bamba M, Masuyama M, Otsuji E. The therapeutic strategy for advanced gastric cancer with pyloric stenosis and liver metastasis; successfully treated by gastro-jejunal bypass and chemotherapy first, followed by curative R0 resection. Surg Case Rep 2021; 7:6. [PMID: 33409765 PMCID: PMC7788145 DOI: 10.1186/s40792-020-00979-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/18/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The indication of surgical resection for liver metastasis from gastric cancer (GC) is still limited and controversial because of its more aggressive oncological characteristics than liver metastasis from colorectal cancer. Pyloric stenosis causes an inadequate oral intake and malnutrition in GC patients. We herein report a case of GC with these two factors that was successfully treated by the combination of gastro-jejunal bypass and chemotherapy, followed by curative R0 resection. CASE PRESENTATION A 60-year-old man was diagnosed with type 2 GC with liver metastasis and pyloric stenosis, which was confirmed as the HER2-positive type. He underwent gastrojejunostomy and received capecitabine and cisplatin (XP) + trastuzumab chemotherapy. After three courses of the XP + trastuzumab regimen, shrinkage of the primary lesion and liver metastasis was confirmed and his nutritional parameters markedly improved with a stable oral intake after bypass surgery. He underwent curative R0 resection by distal gastrectomy with D2 lymphadenectomy and partial hepatectomy. Histologically, viable tumor cells were observed in less than one-third of the primary lesion, and only scar tissue without viable cancer cells was noted in the resected liver specimen. His postoperative course was uneventful, and recurrence has not been detected in the 30 months after surgery without adjuvant chemotherapy. CONCLUSION The present case report describes a successful strategy for advanced GC with pyloric stenosis and liver metastasis.
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Affiliation(s)
- Naosuke Nakamichi
- Department of Surgery, Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan
| | - Masahiro Tsujiura
- Department of Surgery, Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan.
| | - Tomohiro Matsui
- Department of Surgery, Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan
| | - Taiga Yamamoto
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto, Kyoto, 602-8566, Japan
| | - Ayana Yoshioka
- Department of Surgery, Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan
| | - Hidekazu Hiramoto
- Department of Surgery, Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan
| | - Yoshimi Ouchi
- Department of Surgery, Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan
| | - Takeshi Ishimoto
- Department of Surgery, Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan
| | - Toshiyuki Kosuga
- Department of Surgery, Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan
| | - Satoshi Mochizuki
- Department of Surgery, Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan
| | - Susumu Nakashima
- Department of Surgery, Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan
| | - Masamichi Bamba
- Department of Diagnostic Pathology, Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan
| | - Mamoru Masuyama
- Department of Surgery, Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan
| | - Eigo Otsuji
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto, Kyoto, 602-8566, Japan
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Li Y, Wang JS, Guo Y, Zhang T, Li LP. Use of the alkaline phosphatase to prealbumin ratio as an independent predictive factor for the prognosis of gastric cancer. World J Gastroenterol 2020; 26:6963-6978. [PMID: 33311943 PMCID: PMC7701942 DOI: 10.3748/wjg.v26.i44.6963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/21/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastric cancer (GC) is characterized by a low 5-year survival rate. The prognosis is still not satisfactory although it has significantly improved due to developments in medicine. Thus, the identification of more efficient indices for the evaluation of GC prognosis is required. We propose, for the first time, that the alkaline phosphatase (ALP) to prealbumin (PA) ratio (APR) can be used as an independent prognostic factor in GC.
AIM To evaluate the prognostic value the APR in GC.
METHODS According to the exclusion strategy, we collected the preoperative serologic examination results and clinical information of 409 GC patients treated in Shandong Provincial Hospital from January to December, 2016. By calculating the APR, the neutrophil and lymphocyte ratio (NLR), C-reactive protein (CRP) and albumin (ALB) ratio, platelet and lymphocyte ratio, lymphocyte and monocyte ratio, and the relationship with clinical information, we verified the role of preoperative APR ratio in the prognosis of GC. In addition, we used a Cox model combined with the APR and tumor stage to demonstrate its efficacy in assessing the prognosis of GC patients.
RESULTS Preoperative APR was an independent prognostic factor for GC. The median age of patients in the APR-high group was greater compared with that in the APR-low group. Patients with a higher APR had a more advanced clinical stage, higher neutrophil to lymphocyte, CRP to ALB, and platelet to lymphocyte ratios, but a lower lymphocyte to monocyte ratio (P < 0.05). The APR-high group also had higher glycoprotein antigen 199 and carbohydrate antigen 125 levels than the APR-low group (P < 0.05). Median overall survival and disease-free survival were significantly longer in the APR-low group than in the APR-high group. In addition, a Cox model based on the APR and tumor stage was more effective in evaluating the prognosis of patients than models based on stage alone or stage plus the NLR.
CONCLUSION A higher APR is an independent and negative prognostic factor for GC. The prognosis of GC can be better evaluated using a Cox model based on the APR and stage.
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Affiliation(s)
- Yang Li
- Departments of Gastrointestinal, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
| | - Jin-Shen Wang
- Departments of Gastrointestinal, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
| | - Yun Guo
- Center for Reproductive Medicine, Cheeloo College of Medicine, Jinan 250012, Shandong Province, China
| | - Tao Zhang
- Department of Biostatistics, School of Public Health, Shandong University, Jinan 250012, Shandong Province, China
| | - Le-Ping Li
- Departments of Gastrointestinal, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
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Lu YX, Wang YJ, Xie TY, Li S, Wu D, Li XG, Song QY, Wang LP, Guan D, Wang XX. Effects of early oral feeding after radical total gastrectomy in gastric cancer patients. World J Gastroenterol 2020; 26:5508-5519. [PMID: 33024401 PMCID: PMC7520607 DOI: 10.3748/wjg.v26.i36.5508] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/10/2020] [Accepted: 08/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastric cancer (GC) is a heavy burden in China. Nutritional support for GC patients is closely related to postoperative rehabilitation. However, the role of early oral feeding after laparoscopic radical total gastrectomy in GC patients is unclear and high-quality research evidence is scarce.
AIM To prospectively explore the safety, feasibility and short-term clinical outcomes of early oral feeding after laparoscopic radical total gastrectomy for GC patients.
METHODS This study was a prospective cohort study conducted between January 2018 and December 2019 based in a high-volume tertiary hospital in China. A total of 206 patients who underwent laparoscopic radical total gastrectomy for GC were enrolled. Of which, 105 patients were given early oral feeding (EOF group) after surgery, and the other 101 patients were given the traditional feeding strategy (control group) after surgery. Perioperative clinical data were recorded and analyzed. The primary endpoints were gastrointestinal function recovery time and postoperative complications, and the secondary endpoints were postoperative nutritional status, length of hospital stay and expenses, etc.
RESULTS Compared with the control group, patients in the EOF group had a significantly shorter postoperative first exhaust time (2.48 ± 1.17 d vs 3.37 ± 1.42 d, P = 0.001) and first defecation time (3.83 ± 2.41 d vs 5.32 ± 2.70 d, P = 0. 004). In addition, the EOF group had a significant shorter postoperative hospitalization duration (5.85 ± 1.53 d vs 7.71 ± 1.56 d, P < 0.001) and lower postoperative hospitalization expenses (16.60 ± 5.10 K¥ vs 21.00 ± 7.50 K¥, P = 0.014). On the 5th day after surgery, serum prealbumin level (214.52 ± 22.47 mg/L vs 204.17 ± 20.62 mg/L, P = 0.018), serum gastrin level (246.30 ± 57.10 ng/L vs 223.60 ± 55.70 ng/L, P = 0.001) and serum motilin level (424.60 ± 68.30 ng/L vs 409.30 ± 61.70 ng/L, P = 0.002) were higher in the EOF group. However, there was no significant difference in the incidence of total postoperative complications between the two groups (P = 0.507).
CONCLUSION Early oral feeding after laparoscopic radical total gastrectomy can promote the recovery of gastrointestinal function, improve postoperative nutritional status, reduce length of hospital stay and expenses while not increasing the incidence of related complications, which indicates its safety, feasibility and potential benefits for gastric cancer patients.
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Affiliation(s)
- Yi-Xun Lu
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Yan-Jun Wang
- Department of Surgical Intensive Care Unit, Children’s Hospital Affiliated to Zhengzhou University, Children’s Hospital of Henan Provence, Zhengzhou 450018, Henan Province, China
| | - Tian-Yu Xie
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Shuo Li
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Di Wu
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiong-Guang Li
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Qi-Ying Song
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Li-Peng Wang
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Da Guan
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Xin-Xin Wang
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
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The Biology of Anastomotic Healing-the Unknown Overwhelms the Known. J Gastrointest Surg 2020; 24:2160-2166. [PMID: 32524361 PMCID: PMC7446770 DOI: 10.1007/s11605-020-04680-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/25/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anastomotic complications are among the most devastating consequences of gastrointestinal surgery. Despite its high morbidity, the factors responsible for anastomotic regeneration following surgical construction remain poorly understood. The aim of this review is to provide an overview of the typical and atypical factors that have been implicated in anastomotic healing. METHODS A review and analysis of select literature on anastomotic healing was performed. RESULTS The healing of an anastomotic wound mirrors the phases of cutaneous wound healing- inflammation, proliferation, and remodeling. The evidence supporting much of the traditional dogma for optimal anastomotic healing (ischemia, tension, nutrition) is sparse. More recent research has implicated atypical factors that influence anastomotic healing, including the microbiome, the mesentery, and geometry. As technology evolves, endoscopic approaches may improve anastomotic healing and in some cases may eliminate the anastomosis altogether. DISCUSSION Much remains unknown regarding the mechanisms of anastomotic healing, and research should focus on elucidating the dynamics of healing at a molecular level. Doing so may help facilitate the transition from traditional surgical dogma to evidence-based medicine in the operating room.
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Tominaga T, Nagasaki T, Akiyoshi T, Fukunaga Y, Honma S, Nagaoka T, Matsui S, Minami H, Miyanari S, Yamaguchi T, Ueno M. Prognostic nutritional index and postoperative outcomes in patients with colon cancer after laparoscopic surgery. Surg Today 2020; 50:1633-1643. [PMID: 32556551 DOI: 10.1007/s00595-020-02050-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/25/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE The prognostic nutritional index (PNI) is calculated using the serum albumin and peripheral lymphocyte counts. We sought to assess the correlation between the preoperative PNI and postoperative outcomes in patients with colon cancer treated with laparoscopic surgery. METHODS We included 896 colon cancer patients who underwent curative laparoscopic colectomy between January 2013 and March 2016. To identify any predictors of the postoperative outcomes, we compared the clinical characteristics and immunonutritional parameters, including the PNI, between patients classified as the Clavien-Dindo grade 2 or higher (n = 99) with those classified as grade 0 or 1 (n = 797). RESULTS A longer surgical time and a preoperative low PNI (< 49.8) (odds ratio; 1.913, p = 0.002) were independent predictors of postoperative complications according to a multivariate analysis. A preoperative low PNI was significantly associated with an older age, a lower performance status, a lower BMI, higher CEA levels, an advanced T status, lymph node metastasis, a longer operative time, a higher blood loss, a larger tumor size, treatment with a combined resection, a longer time to bowel recovery, a longer postoperative hospital stay, and a poor overall survival. CONCLUSIONS A preoperative low PNI was found to be significantly associated with the incidence of postoperative complications, an advanced tumor status, and a poor prognosis. Further research is needed to understand how to best clinically utilize this promising parameter.
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Affiliation(s)
- Tetsuro Tominaga
- Department of Gastroenterological Surgery, Gastroentrological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Toshiya Nagasaki
- Department of Gastroenterological Surgery, Gastroentrological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Takashi Akiyoshi
- Department of Gastroenterological Surgery, Gastroentrological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yosuke Fukunaga
- Department of Gastroenterological Surgery, Gastroentrological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Satoru Honma
- Department of Gastroenterological Surgery, Gastroentrological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tomoyuki Nagaoka
- Department of Gastroenterological Surgery, Gastroentrological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Shinpei Matsui
- Department of Gastroenterological Surgery, Gastroentrological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Hironori Minami
- Department of Gastroenterological Surgery, Gastroentrological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Shun Miyanari
- Department of Gastroenterological Surgery, Gastroentrological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tomohiro Yamaguchi
- Department of Gastroenterological Surgery, Gastroentrological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masashi Ueno
- Department of Gastroenterological Surgery, Gastroentrological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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Lui JK, Spaho L, Hakimian S, Devine M, Bui R, Touray S, Holzwanger E, Patel B, Ellis D, Fridlyand S, Ogunsua AA, Mahboub P, Daly JS, Bozorgzadeh A, Kopec SE. Pleural Effusions Following Liver Transplantation: A Single-Center Experience. J Intensive Care Med 2020; 36:862-872. [PMID: 32527176 DOI: 10.1177/0885066620932448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION This was a single-center retrospective study to evaluate incidence, prognosis, and risk factors in patients with postoperative pleural effusions, a common pulmonary complication following liver transplantation. METHODS A retrospective review was performed on 374 liver transplantation cases through a database within the timeframe of January 1, 2009 through December 31, 2015. Demographics, pulmonary and cardiac function testing, laboratory studies, intraoperative transfusion/infusion volumes, postoperative management, and outcomes were analyzed. RESULTS In the immediate postoperative period, 189 (50.5%) developed pleural effusions following liver transplantation of which 145 (76.7%) resolved within 3 months. Those who developed pleural effusions demonstrated a lower fibrinogen (149.6 ± 66.3 mg/dL vs 178.4 ± 87.3 mg/dL; P = .009), total protein (5.8 ± 1.0 mg/dL vs 6.1 ± 1.2 mg/dL; P = .04), and hemoglobin (9.8 ± 1.8 mg/dL vs 10.3 ± 1.9 mg/dL; P = .004). There was not a statistically significant difference in 1-year all-cause mortality and in-hospital mortality between liver transplant recipients with and without pleural effusions. Liver transplant recipients who developed pleural effusions had a longer hospital length of stay (16.4 ± 10.9 days vs 14.0 ± 16.5 days; P = .1), but the differences were not statistically significant. However, there was a significant difference in tracheostomy rates (11.6% vs 5.4%; P = .03) in recipients who developed pleural effusions compared to recipients who did not. CONCLUSIONS In summary, pleural effusions are common after liver transplantation and are associated with increased morbidity. Pre- and intraoperative risk factors can offer both predictive and prognostic value for post-transplantation pleural effusions. Further prospective studies will be needed to further evaluate the relevance of these findings to limit instances of postoperative pleural effusions.
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Affiliation(s)
- Justin K Lui
- Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, 12259Boston University School of Medicine, MA, USA.,Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Lidia Spaho
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA.,Division of Gastroenterology, 164186University of Massachusetts Medical School, Worcester, MA USA
| | - Shahrad Hakimian
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA.,Division of Gastroenterology, 164186University of Massachusetts Medical School, Worcester, MA USA
| | - Michael Devine
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Rosa Bui
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Sunkaru Touray
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA.,Division of Pulmonary, Allergy & Critical Care Medicine, 164186University of Massachusetts Medical School, Worcester, MA USA.,Carlsbad Medical Center, NM, USA
| | - Erik Holzwanger
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Boskey Patel
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Daniel Ellis
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Svetlana Fridlyand
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Adedotun A Ogunsua
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA.,Division of Cardiology, 12262University of Massachusetts Medical School, Worcester, MA, USA
| | - Paria Mahboub
- Division of Transplant Surgery, 12262University of Massachusetts Medical School, Worcester, MA, USA
| | - Jennifer S Daly
- Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, 12259Boston University School of Medicine, MA, USA.,Division of Infectious Diseases, 3354University of Massachusetts Medical School, Worcester, MA, USA
| | - Adel Bozorgzadeh
- Division of Transplant Surgery, 12262University of Massachusetts Medical School, Worcester, MA, USA
| | - Scott E Kopec
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA.,Division of Pulmonary, Allergy & Critical Care Medicine, 164186University of Massachusetts Medical School, Worcester, MA USA
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Liu X, Xue Z, Yu J, Li Z, Ma Z, Kang W, Ye X, Jiang L. Risk Factors for Postoperative Infectious Complications in Elderly Patients with Gastric Cancer. Cancer Manag Res 2020; 12:4391-4398. [PMID: 32606934 PMCID: PMC7293399 DOI: 10.2147/cmar.s253649] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/16/2020] [Indexed: 12/24/2022] Open
Abstract
Background Elderly patients with gastric cancer (GC) are at increased risk of infectious complications following gastrectomy. A limited set of risk factors has been identified to predict complications in these patients. To improve the safety of gastrectomy in this population, we investigated the incidence of infectious complications and associated clinicopathologic, nutritional and surgical risk factors in a cohort of elderly patients with GC. Methods Elderly GC patients (≥70 years) who underwent gastrectomy between January 2013 and December 2017 in Peking Union Medical College Hospital were included in the study. Clinicopathologic data were collected retrospectively. Severity of complications was classified using the Clavien–Dindo system. Infectious complications were assessed based on clinical diagnosis of health care-associated infection as defined by the US Centers for Disease Control and Prevention. Multivariate logistic regression analyses were performed to determine the risk factors for infectious complications. Results Three hundred thirty-one consecutive patients were included, with a median age of 74 years (range 70–88). The rate of surgical morbidity was 37.5% and the mortality rate was 1.2%. The incidence of infectious complications was 19.6%, with the most common infectious complication being pulmonary infection (11.5%). Preoperative weight loss ≥5% (odds ratio [OR] = 2.21; 95% CI, 1.15–4.28; p = 0.018), Charlson comorbidity index score ≥3 (OR = 2.83; 95% CI, 1.30–6.16; p = 0.009) and preoperative hsCRP level ≥10 mg/L (OR = 2.48; 95% CI, 1.14–5.38; p = 0.022) were independently associated with infectious complications. Conclusion Preoperative weight loss, elevated hsCRP level and comorbidity burden can be used to predict postoperative infectious complications in elderly GC patients. It is recommended to pay more attention to the treatment of elderly GC patients with these risk factors.
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Affiliation(s)
- Xiao Liu
- Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Zhigang Xue
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Jianchun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Zijian Li
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Zhiqiang Ma
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Weiming Kang
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Xin Ye
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Lin Jiang
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
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Hu Z, Li Y, Mao W, Chen B, Yang L, Meng X. Impact of Nutritional Indices on the Survival Outcomes of Patients with Colorectal Cancer. Cancer Manag Res 2020; 12:2279-2289. [PMID: 32273765 PMCID: PMC7105360 DOI: 10.2147/cmar.s243172] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/15/2020] [Indexed: 01/19/2023] Open
Abstract
Background The effect of preoperative nutritional status on the survival of patients with colorectal cancer is still unknown. The purpose of our study was to examine the impact of the prognostic nutritional index (PNI), prealbumin (PAB) and the albumin to globulin ratio (AGR) on survival outcomes in patients with colon and rectal cancer. Methods Between January 2012 and December 2013, 361 patients with colorectal cancer who underwent curative surgery in the survey and various clinical and haematological parameters were recorded. The optimal cut-off values of the PNI, PAB and AGR were determined by MedCalc software, and Cox regression analysis was performed to investigate the effect of the PNI, PAB and AGR on the overall survival (OS) of patients with colon and rectal cancer. Results In patients with colon and rectal cancer, a high PNI, PAB, and AGR correlate with higher survival times. Receiver operating characteristic (ROC) curve analysis showed that at most time points, the PNI has a higher area under the curve (AUC) in predicting colon and rectal cancer OS. Multivariate Cox regression analysis showed that of the PNI, PAB and AGR, only the PNI was an independent risk factor for OS in patients with colon and rectal cancer. Patients with a high PNI were predicted to have higher OS (hazard ratio [HR]: 0.479; 95% confidence interval [CI]: 0.233–0.985; P = 0.045) in colon cancer and higher OS (HR: 0.225; 95% CI: 0.111–0.454; P < 0.001) in rectal cancer compared with patients with a low PNI. Conclusion Preoperative PNI, PAB and AGR may be predictors of OS in patients with colon and rectal cancer after radical surgery, especially the PNI, which has a good ability to predict OS in both tumours.
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Affiliation(s)
- Zhengyu Hu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province 230032, People's Republic of China
| | - Yan Li
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province 230032, People's Republic of China
| | - Weipu Mao
- Department of Urology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200072, People's Republic of China
| | - Bo Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province 230032, People's Republic of China
| | - Lin Yang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province 230032, People's Republic of China
| | - Xiangling Meng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province 230032, People's Republic of China
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Sugawara K, Aikou S, Yajima S, Uemura Y, Okumura Y, Nishida M, Yagi K, Yamashita H, Seto Y. Pre- and post-operative low prognostic nutritional index influences survival in older patients with gastric carcinoma. J Geriatr Oncol 2020; 11:989-996. [PMID: 32146093 DOI: 10.1016/j.jgo.2020.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/21/2019] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The survival impact of the preoperative prognostic nutritional index (PNI) has been investigated in older patients with gastric carcinoma (GC), while that of the postoperative PNI has yet to be addressed. We evaluated the significance of PNI before and after surgery in older GC patients (≥75 years). MATERIALS AND METHODS In total, 309 older GC patients undergoing radical gastrectomy between 2006 and 2016 were retrospectively reviewed. The PNI was evaluated before and at six months after gastrectomy. Patients were divided into low (<45) and high (≥45) PNI groups. The impact of low PNI on overall survival (OS), cancer-specific survival (CSS), and non-GC-related death were investigated. RESULTS Low PNI was present in 134 patients (43.4%) preoperatively and 121 (39.2%) postoperatively. Low pre-PNI was independently associated with poor overall survival (P < .001). Similarly, OS was significantly stratified by post-PNI (P < .001). The significant survival difference according to post-PNI was present only in pStage I disease (P < .001). Low post-PNI independently increased the risk of non-GC-related death in a multivariable analysis (P = .002). In contrast, CSS was not stratified by post-PNI (P = .45). In the high pre-PNI group, total gastrectomy and super-older age (≥80 years) independently increased the risk of low post-PNI, which was significantly associated with poor survival outcomes. CONCLUSIONS Pre- and post-operative PNI are useful for predicting long-term outcomes in older patients with GC. Low postoperative PNI is a powerful determinant of mortality due to other diseases. Optimal perioperative management is required for those at high risk of malnutrition postoperatively.
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Affiliation(s)
- Kotaro Sugawara
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.
| | - Susumu Aikou
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan; Department of Bariatric & Metabolic Care, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Sho Yajima
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Yukari Uemura
- Biostatistics Division, Clinical Research Support Center, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Yasuhiro Okumura
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Masato Nishida
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Koichi Yagi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Hiroharu Yamashita
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
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Zu H, Wang H, Li C, Xue Y. Preoperative prealbumin levels on admission as an independent predictive factor in patients with gastric cancer. Medicine (Baltimore) 2020; 99:e19196. [PMID: 32176046 PMCID: PMC7440214 DOI: 10.1097/md.0000000000019196] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 11/28/2019] [Accepted: 01/15/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND To explore the role of preoperative prealbumin levels in predicting the prognosis of patients with gastric cancer. METHODS A total of 989 gastric cancer patients in the Affiliated Tumour Hospital of Harbin Medical University who underwent gastrectomy were included in this retrospective study. The preoperative prealbumin level, clinicopathological data, and follow-up data were recorded. According to the maximum chi-square survival correlation value, the survival of patients with low preoperative prealbumin (<140 mg/L) and high preoperative prealbumin (≥140 mg/L) were compared using the log-rank test and the Cox proportional hazard regression model. RESULTS Based on the best cut-off value of 140 mg/L, we divided the patients into the lower prealbumin group (<140 mg/L) and the higher prealbumin group (≥140 mg/L). Compared with the higher prealbumin group, the lower prealbumin group were older and had larger tumor volumes, lower hemoglobin (Hb) levels, and more upper gastric cancer tumors. The univariate analysis showed that prealbumin and other clinicopathological factors, including age, hemoglobin, tumor size, macroscopic type, cell differentiation, liver metastasis, operation type, N stage, and T stage, were significant prognostic factors. The multivariable analysis showed that age, prealbumin, macroscopic type, location, T stage, and N stage were independent prognostic factors. CONCLUSIONS The preoperative prealbumin level was an independent prognostic factor for patients with gastric cancer. The preoperative prealbumin level can be used to predict the prognosis of patients with gastric cancer and guide clinical practice.
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Affiliation(s)
| | - Huiling Wang
- Department of ICU, The First People's Hospital of Zhaoqing, Zhaoqing City, Guangdong Province
| | - Chunfeng Li
- Department of Gastroenterologic Surgery, Affiliated Tumor Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yingwei Xue
- Department of Gastroenterologic Surgery, Affiliated Tumor Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
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Wang L, Miao Y, Chen T, Sun D, Ge S, Zuo L, Liu M. Value of the preoperative prognostic nutritional index for the evaluation of patient prognosis after radical gastrectomy. Mol Clin Oncol 2020; 12:196-201. [PMID: 32064094 PMCID: PMC7016524 DOI: 10.3892/mco.2020.1980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 12/06/2019] [Indexed: 02/06/2023] Open
Abstract
Preoperative prognostic nutritional index (PNI) has been widely used for the clinical evaluation of patients with cancer. The present study assessed the prognostic value of preoperative PNI in patients after gastric cancer (GC) radical surgery. The clinical case and follow-up data of 170 patients undergoing GC radical surgery were retrospectively analyzed. The receiver operating characteristic (ROC) curve was used to compare the predictive ability of each inflammatory index: The PNI, neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR). The correlation between the preoperative PNI and overall survival (OS) was also analyzed via Kaplan-Meier (K-M) curves and multivariate Cox regression analyses. The results revealed that the optimal PNI cut-off was 46.030. According to this cut-off value, the whole sample was divided into PNI <46.030 (low PNI group) and PNI ≥46.030 (high PNI group). These groups were comprised of 102 and 68 cases, respectively. The area under the curve value of the PNI was 0.725, which was greater than that of traditional inflammatory indices, including the NLR and LMR. K-M survival analysis revealed that the 5 year survival rate of patients in the low PNI group was significantly lower than that of patients in the high PNI group (P<0.01). Univariate analysis and Cox multiple regression model analysis demonstrated that the T stage, N stage, pathological grade and PNI were independent risk factors for the 5 year survival rate after radical gastrectomy (P<0.05). In conclusion, the preoperative PNI is an independent risk factor for 5 year survival after radical gastrectomy and has clinical value for the prognostic evaluation of patients with GC.
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Affiliation(s)
- Lili Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, P.R. China
| | - Yongzhi Miao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, P.R. China
| | - Tianwen Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, P.R. China
| | - Dengzhong Sun
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, P.R. China
| | - Sitang Ge
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, P.R. China
| | - Lugen Zuo
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, P.R. China
| | - Mulin Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, P.R. China
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Tsujiura M, Hiki N, Ohashi M, Nunobe S, Kumagai K, Ida S, Ohashi T, Sano T, Yamaguchi T. Should pylorus-preserving gastrectomy be performed for overweight/obese patients with gastric cancer? Gastric Cancer 2019; 22:1247-1255. [PMID: 30888536 DOI: 10.1007/s10120-019-00951-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 03/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pylorus-preserving gastrectomy is an alternative to distal gastrectomy for early gastric cancer, and is expected to have postoperative advantages including maintenance of body weight. Overweight/obesity is a risk factor for chronic disorders, including hypertension and diabetes mellitus; in these conditions, body weight control is frequently required as part of treatment. It remains unknown whether pylorus-preserving gastrectomy should be performed in overweight/obese patients because excess body weight may be maintained postoperatively. METHODS We retrospectively investigated body weight changes and postoperative nutritional status of overweight/obese patients who underwent laparoscopic distal gastrectomy (LDG) or laparoscopic pylorus-preserving gastrectomy (LPPG) between 2006 and 2015. Among 349 overweight patients (BMI ≥ 25 kg/m2), 101 LDG and 101 LPPG cases were compared after propensity score matching to adjust for patient characteristics. RESULTS The mean relative body weight ratios (postoperative/preoperative ratios) were 87.5 ± 8.0% after LDG and 89.6 ± 6.7% after LPPG (difference not significant, p = 0.088). The prealbumin level at 2 years and hemoglobin levels at 6 months, 1 year and 2 years were significantly well maintained after LPPG than after LDG. Prealbumin and hemoglobin levels at 2 years had almost returned to baseline levels in the LPPG group. The superiority of LPPG in the hemoglobin level was confirmed regardless of reconstruction methods after LDG. CONCLUSIONS For overweight/obese patients, LDG and LPPG resulted in similar degrees of postoperative weight loss, with patients achieving near-ideal body weight. The postoperative nutritional advantages of LPPG were confirmed. LPPG seemed to be better even for overweight/obese patients who meet indication criteria.
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Affiliation(s)
- Masahiro Tsujiura
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ward, 135-8550, Tokyo, Japan
| | - Naoki Hiki
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ward, 135-8550, Tokyo, Japan.
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ward, 135-8550, Tokyo, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ward, 135-8550, Tokyo, Japan
| | - Koshi Kumagai
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ward, 135-8550, Tokyo, Japan
| | - Satoshi Ida
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ward, 135-8550, Tokyo, Japan
| | - Takuma Ohashi
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ward, 135-8550, Tokyo, Japan
| | - Takeshi Sano
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ward, 135-8550, Tokyo, Japan
| | - Toshiharu Yamaguchi
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ward, 135-8550, Tokyo, Japan
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Komatsu S, Otsuji E. Essential updates 2017/2018: Recent topics in the treatment and research of gastric cancer in Japan. Ann Gastroenterol Surg 2019; 3:581-591. [PMID: 31788646 PMCID: PMC6875932 DOI: 10.1002/ags3.12284] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/28/2019] [Accepted: 08/06/2019] [Indexed: 12/12/2022] Open
Abstract
Recent developments in diagnostic technology, accumulated clinical effort and established evidence have boosted early detection and drastically improved early and long-term outcomes of gastric cancer. However, gastric cancer continues to be one of the most aggressive and life-threatening malignancies among all cancers and is a global health problem. Between January 2017 and December 2018, various fascinating reports of managements and research were published, including the new 15th Japanese Classification of Gastric Carcinoma reflecting the 8th American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) tumor, node and metastasis (TNM) classification (October 2017) and the new Gastric Cancer Treatment Guidelines version 5 (January 2018). Moreover, pivotal molecular features of gastric cancer were clarified by the worldwide cancer genome project, and various treatment targets and biomarkers such as circulating DNAs and microRNAs were detected. Novel treatment options using programmed cell death protein 1 immune checkpoint inhibitors have been started. In this review, we summarize the recent topics of classification, guidelines, and clinical and basic research in order to bring new insights to gastric cancer treatment.
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Affiliation(s)
- Shuhei Komatsu
- Division of Digestive SurgeryDepartment of SurgeryKyoto Prefectural University of MedicineKyotoJapan
- Department of SurgeryKyoto First Red Cross HospitalKyotoJapan
| | - Eigo Otsuji
- Division of Digestive SurgeryDepartment of SurgeryKyoto Prefectural University of MedicineKyotoJapan
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Maharaj AD, Holland JF, Scarborough RO, Evans SM, Ioannou LJ, Brown W, Croagh DG, Pilgrim CHC, Kench JG, Lipton LR, Leong T, McNeil JJ, Nikfarjam M, Aly A, Burton PR, Cashin PA, Chu J, Duong CP, Evans P, Goldstein D, Haydon A, Hii MW, Knowles BPF, Merrett ND, Michael M, Neale RE, Philip J, Porter IWT, Smith M, Spillane J, Tagkalidis PP, Zalcberg JR. The Upper Gastrointestinal Cancer Registry (UGICR): a clinical quality registry to monitor and improve care in upper gastrointestinal cancers. BMJ Open 2019; 9:e031434. [PMID: 31575580 PMCID: PMC6773358 DOI: 10.1136/bmjopen-2019-031434] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The Upper Gastrointestinal Cancer Registry (UGICR) was developed to monitor and improve the quality of care provided to patients with upper gastrointestinal cancers in Australia. PARTICIPANTS It supports four cancer modules: pancreatic, oesophagogastric, biliary and primary liver cancer. The pancreatic cancer (PC) module was the first module to be implemented, with others being established in a staged approach. Individuals are recruited to the registry if they are aged 18 years or older, have received care for their cancer at a participating public/private hospital or private clinic in Australia and do not opt out of participation. FINDINGS TO DATE The UGICR is governed by a multidisciplinary steering committee that provides clinical governance and oversees clinical working parties. The role of the working parties is to develop quality indicators based on best practice for each registry module, develop the minimum datasets and provide guidance in analysing and reporting of results. Data are captured from existing data sources (population-based cancer incidence registries, pathology databases and hospital-coded data) and manually from clinical records. Data collectors directly enter information into a secure web-based Research Electronic Data Capture (REDCap) data collection platform. The PC module began with a pilot phase, and subsequently, we used a formal modified Delphi consensus process to establish a core set of quality indicators for PC. The second module developed was the oesophagogastric cancer (OGC) module. Results of the 1 year pilot phases for PC and OGC modules are included in this cohort profile. FUTURE PLANS The UGICR will provide regular reports of risk-adjusted, benchmarked performance on a range of quality indicators that will highlight variations in care and clinical outcomes at a health service level. The registry has also been developed with the view to collect patient-reported outcomes (PROs), which will further add to our understanding of the care of patients with these cancers.
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Affiliation(s)
- Ashika D Maharaj
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jennifer F Holland
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ri O Scarborough
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sue M Evans
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Liane J Ioannou
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Wendy Brown
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | | | | | - James G Kench
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | | | - Trevor Leong
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - John J McNeil
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mehrdad Nikfarjam
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Ahmad Aly
- Austin Health, Melbourne, Victoria, Australia
| | - Paul R Burton
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | | | - Julie Chu
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Cuong P Duong
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Peter Evans
- Peninsula Health, Melbourne, Victoria, Australia
| | - David Goldstein
- Nelune Comprehensive Cancer Centre, Prince of Wales, Randwick, New South Wales, Australia
| | | | - Michael W Hii
- St Vincent's Hospital, Melbourne, Victoria, Australia
| | | | - Neil D Merrett
- School of Medicine, Western Sydney University, Penrith South, New South Wales, Australia
| | - Michael Michael
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Rachel E Neale
- Population Health Division, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | | | | | - Marty Smith
- Alfred Health, Melbourne, Victoria, Australia
| | - John Spillane
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - John R Zalcberg
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
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Tanaka H, Tamura T, Toyokawa T, Muguruma K, Kubo N, Sakurai K, Ohira M. C-reactive protein elevation ratio as an early predictor of postoperative severe complications after laparoscopic gastrectomy for gastric cancer: a retrospective study. BMC Surg 2019; 19:114. [PMID: 31429742 PMCID: PMC6702707 DOI: 10.1186/s12893-019-0582-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/14/2019] [Indexed: 12/14/2022] Open
Abstract
Background In gastrectomy, postoperative elevation of C-reactive protein (CRP) is thought to be useful for predicting complications. Laparoscopic gastrectomy (LG) is less invasive than laparotomy and the elevation of CRP is also mild. Postoperative complications such as anastomotic leakage not only increase the severity of the condition, but also carry a poor prognosis when treatment is delayed. Early treatment is therefore necessary. Method This retrospective study examined the relationship between occurrence of complications and the ratio of CRP levels on postoperative days 1 and 3 (CRP ratio) for 449 gastric cancer patients who underwent LG in the Department of Gastrointestinal Surgery at Osaka City University Hospital between 2006 and 2016. Results We observed that factors associated with postoperative complications were preoperative renal failure and CRP ratio. No significant associations with surgical procedure, operation time, bleeding volume, age, obesity, measured CRP concentration, or white blood cell count were evident. The optimal cut-off for CRP ratio to predict postoperative complications from the receiver operating characteristic curve was 2.13. Conclusion Our results suggested that the risk of severe postoperative complications after LG could be predicted using the CRP ratio.
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Affiliation(s)
- Hiroaki Tanaka
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Tatsuro Tamura
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Takahiro Toyokawa
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kazuya Muguruma
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Naoshi Kubo
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Katsunobu Sakurai
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masaichi Ohira
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
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Li B, Zhang X, Xu G, Zhang S, Song H, Yang K, Dai H, Wang C. Serum prealbumin is a prognostic indicator in idiopathic pulmonary fibrosis. CLINICAL RESPIRATORY JOURNAL 2019; 13:493-498. [PMID: 31102566 DOI: 10.1111/crj.13050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/01/2019] [Accepted: 05/02/2019] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Idiopathic pulmonary fibrosis (IPF) is a fatal interstitial lung disease characterized by variable progression. The prealbumin (PA) is a parameter in a routine blood biochemistry examination. We sought to investigate the prognostic value in IPF patients. OBJECTIVES To evaluate the prognosis value in patients with IPF. METHODS Blood biochemistry examination, demographics, pulmonary function data from patients with IPF consulted in Beijing Chao-Yang Hospital and China-Japan Friendship Hospital between July 2012 and December 2016 were collected. Infection, liver and kidney dysfunction and lung transplantation are excluded from the cohort. RESULTS The result of multivariate Cox analysis showed that PA was significant prognostic indicator of survival along with BMI, FVC, serum albumin protein and serum global protein. The patients with PA concentration <0.2 mg/L had shorter survival compared with those whose PA were normal. Although the survival had no significant difference between the patients with PA concentration < 0.2 mg/L and albumin < 35 g/L and those with PA concentration < 0.2 mg/L, the average survival time of patients with PA concentration < 0.2 mg/L and albumin < 35 g/L were shorter. CONCLUSIONS Our study indicated that IPF patients with PA concentration < 0.2 mg/L have poorer outcome. Further studies are warranted to indentify PA as a predictor for IPF patients outcomes and explore the role of PA in the pathogenesis of IPF.
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Affiliation(s)
- Biyun Li
- Department of Pulmonary and Critical Care Medicine, Perking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Xinran Zhang
- Institute of Clinical Medical Sciences, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Guodong Xu
- Institute of Clinical Medical Sciences, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Shu Zhang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Huifang Song
- Department of Pulmonary and Critical Care Medicine, Inner Mongolia People's Hospital, Hohhot, China
| | - Kaiyuan Yang
- Department of Pulmonary and Critical Care Medicine, Beijing Lu-He Hospital, Capital Medical University, Beijing, China
| | - Huaping Dai
- Department of Pulmonary and Critical Care Medicine, Perking University China-Japan Friendship School of Clinical Medicine, Beijing, China.,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Perking University Health Science Center, Beijing, China
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, Perking University China-Japan Friendship School of Clinical Medicine, Beijing, China.,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Perking University Health Science Center, Beijing, China
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Hu W, Xie S, Yu F, Hao W. Characteristics of pathogens and mortality predictors of older Chinese patients with nosocomial urinary tract infections. Geriatr Gerontol Int 2019; 19:541-546. [PMID: 30950159 DOI: 10.1111/ggi.13661] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 02/12/2019] [Accepted: 02/27/2019] [Indexed: 02/05/2023]
Abstract
AIM The aim of the present study was to investigate predominant pathogens and predictors of 28-day mortality of older Chinese patients with nosocomial urinary tract infections (NUTI). METHODS We retrospectively studied 1122 older patients (aged ≥60 years) with culture-positive NUTI in Guangdong General Hospital, Guangzhou, China, from January 2009 to December 2014. The clinical features, microbial distributions and outcomes of these patients were recorded and compared between survival and death patients. Multivariate logistic regression was carried out to identify independent predictors of 28-day mortality. RESULTS The present results showed the all-cause mortality was 8.3%, and NUTI mortality was 1.43%. The proportions of Candida albicans (P = 0.004), Acinetobacter baumannii (P = 0.045) and Candida tropicalis (P < 0.001) in the death group were significantly higher than those in the survival group. Multivariate analysis showed two novel risk factors for mortality of older patients with NUTI, which were higher Charlson Comorbidity Index (odds ratio [OR] 1.205, 95% confidence interval (CI) 1.088-1.334] and lower level of serum prealbumin (OR 0.995, 95% CI 0.990-0.999). Furthermore, previous use of antibiotics (OR 1.984, 95% CI 1.106-3.559), inappropriate antimicrobial therapy (OR 1.883, 95% CI 1.144-3.098), intensive care unit stay (OR 4.082, 95% CI 2.469-6.749) and higher concentration of serum C-reactive protein (OR 1.005, 95% CI 1.001-1.010) were independent prognostic factors for 28-day mortality in older patients with NUTI. CONCLUSIONS NUTI is associated with a high 28-day in-hospital mortality rate in older patients. We should evaluate the comorbidity, nutritional status, inflammatory markers, department staying and drug sensitivity test, and choose systematic therapy strategies for these older patients with NUTI. Geriatr Gerontol Int 2019; 19: 541-546.
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Affiliation(s)
- Wenxue Hu
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Institute of Geriatrics, Guangzhou, China
| | - Shaoling Xie
- Department of Nephrology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Feng Yu
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Institute of Geriatrics, Guangzhou, China
| | - Wenke Hao
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Institute of Geriatrics, Guangzhou, China
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