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Subasinghe D, Mahesh PKB, Wijesinghe GK, Sivaganesh S, Samarasekera A, Lokuhetty MDS. Delay in diagnosis to treatment and impact on survival of gastric adenocarcinoma in a low income setting without screening facility. Sci Rep 2023; 13:20628. [PMID: 37996431 PMCID: PMC10667260 DOI: 10.1038/s41598-023-47415-y] [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: 07/01/2022] [Accepted: 11/03/2023] [Indexed: 11/25/2023] Open
Abstract
The treatment modality of gastric adenocarcinoma (GCA) depends on the stage of the disease at the clinical presentation. Long delays are probably an unfavorable factor for the patient's prognosis. A prospective longitudinal, study involving 145 consecutive GCA was conducted at the National Hospital of Sri Lanka (NHSL). The overall delay (in weeks) was recorded for each patient and divided into four periods-patient, endoscopy, pathology and treatment. The median and Interquartile Range (IQR) duration of delays were calculated and differences were explored with chi square test and Mann Whitney U test Survival analysis was done with Kaplan Meier technique and Cox regression. The median duration of delays for patient, endoscopy, histology reporting delay, other histology delay (specimen transfer delay and report receipt delay) and treatment were 18 (IQR 14-27), 2 (IQR 2-3), 3 (IQR 2-3), 2 (IQR 1-2) and 6 (IQR 4-8) weeks respectively. Delayed patient presentation to hospital was associated with significant adverse median survival 16 (IQR 11.5-22.5) weeks versus 20 (IQR 16-27.5) weeks, p = 0.004. Delay in initiating treatment was associated with significantly lower median survival 04 (IQR 4-6) weeks versus 06 (IQR 4-8) weeks, p = 0.003. Over 60% of both proximal and distal GCA presented at an advanced radiological stage (stage III/IV). The Kaplan Meier analysis showed that the higher hazard function was associated with a higher tumour stage and undergoing chemotherapy. Age of the patient and the treatment modality were significant predictors of the survival. Patient delay and delay in initiation of definitive treatment are the most important factors that adversely affect the outcomes of GCA. Public health interventions aiming to shorten the patient delay time with proper referral for specialist care would play an important role. Also, it is important to minimize these preventable delays and there should be time limits in producing the histopathology report and to establish online portals of hospital and laboratory information systems for easy access of histology reports in future.
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Affiliation(s)
- D Subasinghe
- Department of Surgery, Faculty of Medicine, University of Colombo, University Surgical Unit, The National Hospital of Sri Lanka, Colombo, Sri Lanka.
| | - P K B Mahesh
- Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka
| | - G K Wijesinghe
- Department of Pathology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - S Sivaganesh
- Department of Surgery, Faculty of Medicine, University of Colombo, University Surgical Unit, The National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - A Samarasekera
- Department of Pathology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - M D S Lokuhetty
- Department of Pathology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Li Z, Zheng H, Zhao Z, Chen G, Wang Z, Amin B, Zhang N. Identification of optimal primary tumor resection candidates for metastatic gastric cancer: Nomograms based on propensity score matching. Cancer Med 2023. [PMID: 37096953 DOI: 10.1002/cam4.5983] [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: 09/21/2022] [Revised: 03/28/2023] [Accepted: 04/08/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND This study sought to develop and validate nomograms for screening patients with metastatic gastric cancer (mGC) who are candidates for primary tumor resection (PTR) and evaluating the prognosis of mGC patients after PTR. METHODS From 2010 to 2016, we screened mGC patients with complete data from the Surveillance, Epidemiology, and End Results (SEER) database. Depending on whether or not PTR was performed, we categorized patients into surgery and non-surgery groups. A 1:1 propensity score matching (PSM) analysis was used to balance the characteristics of the two groups. The endpoints were overall survival (OS) and cancer-specific survival (CSS). Two predictive nomograms were developed using logistic regression to assess the likelihood of benefit. Two additional prognostic nomograms were developed to assess prognosis in mGC patients after PTR by Cox regression. Finally, nomograms were evaluated using a variety of methodologies. RESULTS Our study included 3594 mGC patients who met the criteria. PTR was associated with improved OS and CSS time (median OS time after PSM: 15 vs. 7 months, P < 0.05; median CSS time after PSM: 17 vs. 7 months, P < 0.05). The OS-related predictive nomogram, including age, histologic type, grade, T stage, and chemotherapy, was developed. Moreover, the CSS-related predictive nomogram, including age, histologic type, grade, and chemotherapy, was developed. Sex, histologic type, grade, T stage, N stage, and chemotherapy were found to be correlated with OS. Furthermore, the CSS correlated with histologic type, grade, T stage, N stage, and chemotherapy. Both predictive and prognostic nomograms were found to be valuable and reliable after different types of validation. CONCLUSION Predictive nomograms were developed and validated for identifying the optimal PTR mGC candidates. Prognostic nomograms were developed and validated for assessing the prognosis of mGC patients after PTR.
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Affiliation(s)
- Zhehong Li
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Honghong Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ziming Zhao
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Guanyang Chen
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zheng Wang
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Buhe Amin
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Nengwei Zhang
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Gojayev A, Erşen O, Mercan Ü, Yüksel C, Yalkın Ö, Bayar S, Ünal AE, Demirci S. Evaluation of Peroperative and Oncological Results in Laparoscopic Surgery of Gastric Cancer in Elderly Patients: Single-Center Study. J Laparoendosc Adv Surg Tech A 2020; 31:657-664. [PMID: 32924787 DOI: 10.1089/lap.2020.0472] [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: 12/23/2022] Open
Abstract
Introduction: Laparoscopic treatment of gastric cancer in elderly patients is still controversial. The aim of this retrospective study is to evaluate the safety and feasibility of laparoscopic gastrectomy in elderly gastric cancer patients based on the long- and short-term results of laparoscopic surgery. Materials and Methods: The data of 163 patients who underwent laparoscopic gastrectomy for gastric cancer. Patients were categorized into two groups by age based on World Health Organization (WHO) criteria: elderly (≥65 years, 80 cases) and nonelderly (<65 years, 83 cases). Patient characteristics and clinicopathological findings, surgical findings, short- and long-term results were compared between the two groups. Results: The patients in the study group were in the age range of 22-87 years and 80 (49%) patients were found out to be 65 years old or older. When all complications were categorized according to Clavien-Dindo (C-D) classification, >3 serious complication rates were similar between groups (P = .421). Although the length of hospital stay and the need for intensive care were higher in the elderly group, the difference was not significant (P = .066; P = .072). There was no significant difference between the two in terms of in-hospital mortality (P = .364). No statistically significant differences were found in the rates of overall survival (nonelderly group; 61.17 ± 3.34, 95% confidence interval [CI]: 54.61-67.74 versus elderly group; 56.48 ± 3.80, 95% CI: 49.03-63.93; P = .176) and disease-specific survival (nonelderly group; 64.24 ± 3.15, 95% CI: 58.06-70.40 versus elderly group; 61.93 ± 3.57, 95% CI: 54.93-68.93; P = .363) between the age groups. Conclusion: In conclusion, although laparoscopic gastrectomy is a feasible and safe method in elderly gastric cancer patients, further randomized prospective studies are needed.
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Affiliation(s)
- Afig Gojayev
- General Surgery Department, Surgical Oncology Clinic, Ankara University Medicine Faculty, Ankara, Turkey
| | - Ogün Erşen
- General Surgery Department, Surgical Oncology Clinic, Ankara University Medicine Faculty, Ankara, Turkey
| | - Ümit Mercan
- General Surgery Department, Surgical Oncology Clinic, Ankara University Medicine Faculty, Ankara, Turkey
| | - Cemil Yüksel
- General Surgery Department, Surgical Oncology Clinic, Ankara University Medicine Faculty, Ankara, Turkey
| | - Ömer Yalkın
- Department of General Surgery, Bursa City Hospital, Bursa, Turkey
| | - Sancar Bayar
- General Surgery Department, Surgical Oncology Clinic, Ankara University Medicine Faculty, Ankara, Turkey
| | - Ali Ekrem Ünal
- General Surgery Department, Surgical Oncology Clinic, Ankara University Medicine Faculty, Ankara, Turkey
| | - Salim Demirci
- General Surgery Department, Surgical Oncology Clinic, Ankara University Medicine Faculty, Ankara, Turkey
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Jiang W, Mao Q, Wu X, Yu W, Chen D. Laparoscopic radical resection of gastric cancer and metachronous colon cancer-a case report. Transl Cancer Res 2020; 9:2053-2059. [PMID: 35117554 PMCID: PMC8799175 DOI: 10.21037/tcr.2020.01.44] [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: 08/22/2019] [Accepted: 12/13/2019] [Indexed: 01/17/2023]
Abstract
Due to the favorable prognosis of gastric cancer (GC), the incidence of second primary cancer (SPC) accompanied with GC has increased. Here, we reported a case of a 69-year-old male patient with metachronous GC and colon cancer, who had undergone laparoscopic radical resection of distal GC 4 years ago. During this hospitalization, the patient underwent laparoscopic radical resection of left hemicolectomy for metachronous colon cancer. Few literatures have reported that patients with metachronous GC and colon cancer can receive laparoscopic surgery successfully. The patient recovered well and was discharged on day 10 post-operation. The pathologic specimen was identified as metachronous colon cancer. We concluded that GC patients need regular standard follow-up programs after undergoing operations. For multiple primary cancers (MPCs), treatments need to be individualized and comprehensive. Laparoscopic surgery is recommended as an appropriate option.
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Affiliation(s)
- Wenbin Jiang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Qijiang Mao
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Xiaoli Wu
- Department of Gastroenterology, Shuanglin People's Hospital of Nanxun, Huzhou 313012, China
| | - Weihua Yu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Dingwei Chen
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
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5
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Feng L, Li J, Li F, Li H, Bei S, Zhang X, Yang Z. Long noncoding RNA VCAN-AS1 contributes to the progression of gastric cancer via regulating p53 expression. J Cell Physiol 2019; 235:4388-4398. [PMID: 31637706 DOI: 10.1002/jcp.29315] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 09/30/2019] [Indexed: 12/30/2022]
Abstract
Gastric cancer (GC) is one of the most frequent malignancies worldwide. Long noncoding RNAs (lncRNAs) are found to be largely implicated in various cancers, including GC. However, the function of lncRNA VCAN antisense RNA 1 (VCAN-AS1) in GC remains unclear. Herein, we observed a low level of VCAN-AS1 in normal gastric tissues through NCBI and UCSC, and that VCAN-AS1 upregulation in GC tissues was related to poor prognosis by TCGA. Furthermore, VCAN-AS1 was found markedly enhanced in GC tissues and cell lines, while its upregulation was related with clinical outcomes of GC patients. Besides this, silencing VCAN-AS1 represses cell proliferation, migration, and invasion but enhances apoptosis. More important, we discovered that VCAN-AS1 expression was negatively correlated with wild-type p53 levels in GC tissues and that p53 was negatively modulated by VCAN-AS1 in GC cells. Furthermore, p53 suppression reversed the repression of VCAN-AS1 silence on the biological processes of AGS cells. Intriguingly, we identified that both VCAN-AS1 and TP53 can bind with eIF4A3, one of the core proteins in the exon junction complex. Also, we confirmed that VCAN-AS1 negatively regulates TP53 expression by competitively binding with eIF4A3. Our findings disclosed that VCAN-AS1 contributes to GC progression through interacting with eIF4A3 to downregulate TP53 expression, indicating that VCAN-AS1 is a novel therapeutic strategy for GC treatment.
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Affiliation(s)
- Li Feng
- Endoscopy Center, Minhang Hospital, Fudan University, Shanghai, China
| | - Jian Li
- Endoscopy Center, Minhang Hospital, Fudan University, Shanghai, China
| | - Fan Li
- Endoscopy Center, Minhang Hospital, Fudan University, Shanghai, China
| | - Huanqin Li
- Endoscopy Center, Minhang Hospital, Fudan University, Shanghai, China
| | - Songhua Bei
- Endoscopy Center, Minhang Hospital, Fudan University, Shanghai, China
| | - Xiaohong Zhang
- Endoscopy Center, Minhang Hospital, Fudan University, Shanghai, China
| | - Zhen Yang
- Surgical Department, Minhang Hospital, Fudan University, Shanghai, China
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6
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Li Q, Zou J, Jia M, Li P, Zhang R, Han J, Huang K, Qiao Y, Xu T, Peng R, Song Q, Fu Z. Palliative Gastrectomy and Survival in Patients With Metastatic Gastric Cancer: A Propensity Score-Matched Analysis of a Large Population-Based Study. Clin Transl Gastroenterol 2019; 10:1-8. [PMID: 31116140 PMCID: PMC6602769 DOI: 10.14309/ctg.0000000000000048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 03/12/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The role of palliative gastrectomy in the management of metastatic gastric cancer remains inadequately clarified. METHODS We analyzed patients with metastatic gastric cancer enrolled in the Surveillance, Epidemiology, and End Results registry from January 2004 to December 2012. Propensity score (PS) analysis with 1:1 matching and the nearest neighbor matching method was performed to ensure well-balanced characteristics of the groups of patients who undergone gastrectomy and those without gastrectomy. Data were analyzed by Kaplan-Meier and Cox proportional hazards regression models to evaluate the overall survival and cancer-specific survival rates with corresponding 95% confidence intervals (CIs). RESULTS In general, receiving any kind of gastrectomy was associated with an improvement in survival in the multivariate analyses (hazard ratio [HR]os = 0.64, 95% CI = 0.59-0.70, HRcss = 0.63, 95% CI = 0.57-0.68) and PS matching (PSM) analyses (HRos = 0.63, 95% CI = 0.56-0.70, HRcss = 0.62, 95% CI = 0.55-0.70). After PSM, palliative gastrectomy was found to be associated with remarkably improved survival for patients with stage M1 with only 1 metastasis but not associated with survival of patients with stage M1 with extensive metastasis (≥2 metastatic sites). DISCUSSION The results obtained from the Surveillance, Epidemiology, and End Results database suggest that patients with metastatic gastric cancer might benefit from palliative gastrectomy on the basis of chemotherapy. However, a PSM cohort study of this kind still has a strong selection bias and cannot replace a properly conducted randomized controlled trial.
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Affiliation(s)
- Qin Li
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jiahua Zou
- Huanggang Cancer Center, Huanggang Hospital of Traditional Chinese Medicine, Huanggang, Hubei, China
| | - Mingfang Jia
- Department of Health Management, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ping Li
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Rui Zhang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jianglong Han
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Kejie Huang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yunfeng Qiao
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tangpeng Xu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ruan Peng
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qibin Song
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhenming Fu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
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7
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Sheng S, Chen Y, Li C. Outcomes of Laparoscopic Total Gastrectomy for Elderly Gastric Cancer Patients. J Cancer 2018; 9:4398-4403. [PMID: 30519345 PMCID: PMC6277644 DOI: 10.7150/jca.26858] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/10/2018] [Indexed: 12/22/2022] Open
Abstract
Purpose: The purpose of this study was to compare the short- and long-term outcomes after laparoscopic total gastrectomy (LTG) between elderly and non-elderly patients with gastric cancer. Methods: A retrospective analysis was performed using clinical and follow-up data from 168 patients treated with LTG for gastric cancer at our institution from January 2010 to December 2017. For this study, the short- and long-term outcomes (including tumor recurrence rate, disease-free survival rate, and overall survival rate) were compared between the elderly group (≥70 years) and non-elderly group (<70 years). Results: The preoperative American Society of Anesthesiologists score and Charlson Comorbidity Index were higher in the elderly group than in the non-elderly group, while there was no significant difference between the two groups in terms of operation duration, intraoperative blood loss, and rate of conversion to laparotomy. The incidence of postoperative 30-day complications in the elderly group was higher than that in the non-elderly group due to a higher incidence of pulmonary infection, while the incidence of major complications was similar in both groups. The tumor recurrence rate was also similar in both groups. There was no statistically significant difference between the two groups in terms of 5-year disease-free survival and 5-year overall survival rate. Conclusions: LTG is safe and feasible for elderly patients with gastric cancer and is associated with relatively good long-term outcomes.
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Affiliation(s)
- Shihou Sheng
- Department of Gastrointestinal Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130000, People's Republic of China
| | - Yahong Chen
- Department of Gastrointestinal Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130000, People's Republic of China
| | - Chunsheng Li
- Department of Gastrointestinal Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130000, People's Republic of China
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Human Epidermal Growth Factor Receptor-2 in Sri Lankan Gastric Carcinoma Patients with Clinicopathological Association and Survival. Dig Dis Sci 2017; 62:2498-2510. [PMID: 28612195 DOI: 10.1007/s10620-017-4647-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/06/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND HER2 protein expression indicates adverse prognosis in gastric adenocarcinoma (GCa). GCa HER2 positivity ranges from 10 to 22.8%. Similar data are scarce in South Asia and unavailable in Sri Lanka. AIM To evaluate HER2 protein expression, its clinicopathological relationship and survival in a Sri Lankan GCa cohort. METHODS One hundred consecutive GCa patients were recruited prospectively for 2 years. Histological diagnosis was confirmed on endoscopic biopsies/gastrectomy specimens. Clinicopathological and overall survival data were collected. HER2 expression was assessed using immunohistochemistry. 2+ and 3+ scores were considered positive. HER2 expression and clinicopathological parameters were analyzed by Chi-squared test and multivariate analysis with logistic regression using SPSS-21. Kaplan-Meier method and log-rank test were used for survival analysis. RESULTS Study includes 56 biopsies and 44 resections. Male/female ratio was 1.9:1. Mean age of diagnosis was 61.1 years (range 32-82). Majority tumors were proximally located (58%). HER2 positivity was 9%. Even though intestinal subtype predominated HER2 positivity was mostly among diffuse variant (14.8%). In multivariate analysis, mitotic count >5/hpf, high nuclear grade and tumor necrosis were significantly associated with HER2 positivity, while poor differentiation, signet cells, extracellular mucin, perineural invasion and pathological nodal metastasis (all p < 0.05) showed a correlation in univariate analysis. Mean follow-up duration was 37.4 weeks (range 0-104). HER2 positivity was associated with a significantly lower median overall survival (p = 0.046). CONCLUSION GCa HER2 positivity was 9%, associated with a lower median overall survival. Adverse histological features had a positive correlation with HER2 positivity. These histological features could direct patients for confirmatory HER2 testing in limited resource settings.
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Zhou X, Xu L, Huang Z, Zhang L, Zhang H, Zhu W, Liu P. The hematologic markers as prognostic factors in patients with resectable gastric cancer. Cancer Biomark 2017; 17:359-367. [PMID: 27434296 DOI: 10.3233/cbm-160648] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recently, many studies have investigated the value of the hematologic markers in the prognosis of gastric cancer (GC). However, most studies only focused on the pre-operative markers. The aim of this study was to investigate the prognostic value of the hematologic markers of resectable GC patients at three different periods of the treatment (preoperative, postoperative and before the first chemotherapy). METHODS Clinical data from 451 GC patients were retrospectively collected. Hematologic markers including leukocyte, neutrophil, lymphocyte, red blood cell (RBC), platelet, mean platelet volume (MPV), neutrophil proportion (NP), lymphocyte proportion (LP), neutrophil lymphocyte ratio (NLR), and platelet lymphocyte ratio (PLR) were adopted as potential prognostic biomarkers. The Kaplan-Meier method and Cox regression model were applied to reveal the prognostic significance of the hematologic markers. RESULTS Preoperative PLR was independently associated with overall survival (OS) via multivariate analysis (hazard ratio, 1.399; 95% confidence interval, 1.015-1.928; p = 0.04). Elevated PLR predicted a larger tumor size (P< 0.001), deeper tumor invasion (P= 0.035) and elevated level of CEA (P= 0.012). CONCLUSIONS Although only high preoperative PLR could serve as an independent unfavorable prognostic factor, other markers such as preoperative and postoperative NLR could also provide additionally prognostic information.
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Affiliation(s)
- Xin Zhou
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lei Xu
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zebo Huang
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lan Zhang
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Huo Zhang
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wei Zhu
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ping Liu
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Abstract
Gastric cancer (GC) is third leading cause of cancer-related death. Only 28.3% of new GC cases survive more than 5 years. Although incidence has declined in the United States, an increase is estimated for 2016. Risk factors include sex (risk is higher in men), Helicobacter pylori infection, heredity, and lifestyle. GC is usually diagnosed between the ages of 60-80 years. Prognosis of GC is largely dependent on the tumor stage at diagnosis and classification as intestinal or diffuse type; diffuse-type GC has worse prognosis. Chemoprevention has been shown to decrease risk, but is currently not used clinically.
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Affiliation(s)
- Juan M Marqués-Lespier
- Division of Gastroenterology, Department of Medicine, University of Puerto Rico School of Medicine, San Juan, PR 00935, USA
| | - María González-Pons
- University of Puerto Rico Comprehensive Cancer Center, San Juan, PR 00935, USA
| | - Marcia Cruz-Correa
- Departments of Medicine, Surgery, and Biochemistry, University of Puerto Rico, Medical Sciences Campus, San Juan, PR 00935, USA.
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11
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Barros RHDO, Penachim TJ, Martins DL, Andreollo NA, Caserta NMG. Multidetector computed tomography in the preoperative staging of gastric adenocarcinoma. Radiol Bras 2015; 48:74-80. [PMID: 25987747 PMCID: PMC4433295 DOI: 10.1590/0100-3984.2014.0021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 10/02/2014] [Indexed: 12/18/2022] Open
Abstract
Objective To evaluate the role of multidetector computed tomography in the preoperative
investigation of tumor invasion depth and lymph node and metastatic involvement
according to the TNM classification, in patients with gastric adenocarcinoma. Materials and Methods Fifty-four patients with biopsy-confirmed gastric cancer underwent preoperative
staging with 64-channel multidetector computed tomography. Two independent
radiologists analyzed the images and classified the findings. Sensitivity,
specificity, accuracy and overall accuracy were calculated for each observer. The
interobserver agreement was also evaluated. Results The accuracy in the classification of categories T ranged from 74% to 96% for
observer 1 and from 80% to 92% for observer 2. The overall accuracy was 70% for
both observers. The weighted kappa index was 0.75, consistent with a significant
interobserver agreement. The accuracy in the classification of lymph node
involvement (category N) ranged from 55% to 79% for observer 1 and from 73% to 82%
for observer 2. The evaluation of metastatic involvement showed an overall
accuracy of 89.6% for both observers. Conclusion 64-channel multidetector computed tomography demonstrated clinically relevant
accuracy in the preoperative staging of gastric adenocarcinoma as regards invasion
depth (T category) and metastatic involvement (M category).
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Affiliation(s)
| | - Thiago José Penachim
- MDs., Radiologists at Hospital de Clínicas - Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
| | - Daniel Lahan Martins
- MDs., Radiologists at Hospital de Clínicas - Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
| | - Nelson Adami Andreollo
- PhD, Full Professor, Department of Surgery - Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
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12
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Ghoneum MH, Badr El-Din NK, Abdel Fattah SM, Pan D, Tolentino L. Hydroferrate fluid, MRN-100, provides protection against chemical-induced gastric and esophageal cancer in Wistar rats. Int J Biol Sci 2015; 11:295-303. [PMID: 25678848 PMCID: PMC4323369 DOI: 10.7150/ijbs.10586] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 12/09/2014] [Indexed: 12/30/2022] Open
Abstract
In the current study, we examined the protective effect of hydroferrate fluid MRN-100 against the carcinogen methylnitronitrosoguanidine (MNNG)-induced gastric and esophageal cancer in rats. MRN-100 is an iron-based compound composed of bivalent and trivalent ferrates. At 33 weeks post treatment with MNNG, rats were killed and examined for the histopathology of esophagus and stomach; liver, spleen, and total body weight; and antioxidant levels in the blood and stomach tissues. Results showed that 17/20 (85%) gastroesophageal tissues from carcinogen MNNG-treated rats developed dysplasia and cancer, as compared to 8/20 (40%) rats treated with MNNG plus MRN-100. In addition, MRN-100 exerted an antioxidant effect in both the blood and stomach tissues by increasing levels of GSH, antioxidant enzymes SOD, CAT, and GPx, and total antioxidant capacity (TAC) level. This was accompanied by a reduction in the total free-radical and malondialdehyde levels. Furthermore, MRN-100 protected against body and organ weight loss. Thus, MRN-100 exhibited significant cancer chemopreventive activity by protecting tissues against oxidative damage in rats, which may suggest its effectiveness as an adjuvant for the treatment of gastric/esophageal carcinoma.
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Affiliation(s)
- Mamdooh H Ghoneum
- 1. Department of Otolaryngology, Charles Drew University of Medicine and Science, 1731 E. 120th Street, Los Angeles, CA 90059, USA
| | - Nariman K Badr El-Din
- 2. Department of Zoology, Faculty of Science, University of Mansoura, Mansoura 35516, Egypt
| | - Salma M Abdel Fattah
- 3. Drug and Radiation Research Department, National Center for Radiation and Research Technology, P.O. Box 29 Nasr City, Cairo, Egypt
| | - Deyu Pan
- 4. Department of Internal Medicine, Charles Drew University of Medicine and Science, 1731 E. 120th Street, Los Angeles, CA 90059, USA
| | - Lucilene Tolentino
- 5. Department of Pathology, Charles Drew University of Medicine and Science, 1731 E. 120th Street, Los Angeles, CA 90059, USA
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13
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Sun LB, Zhao GJ, Ding DY, Song B, Hou RZ, Li YC. Comparison between better and poorly differentiated locally advanced gastric cancer in preoperative chemotherapy: a retrospective, comparative study at a single tertiary care institute. World J Surg Oncol 2014; 12:280. [PMID: 25200958 PMCID: PMC4177253 DOI: 10.1186/1477-7819-12-280] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/02/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Gastric cancer is the third leading cause of cancer-related mortality in China, and the long-term survival for locally advanced gastric cancer is very poor. Simple surgery cannot yield an ideal result because of the high recurrence rate after tumor resection. Preoperative chemotherapy could help to reduce tumor volume, improve the R0 resection rate (no residual tumor after surgery), and decrease the risk of local tumor recurrence. The aim of this study was to evaluate the influence of pathological differentiation in the effect of preoperative chemotherapy for patients with locally advanced gastric cancer. METHODS Patients with locally advanced gastric cancer (n = 32) received preoperative chemotherapy under the XELOX (capecitabine plus oxaliplatin) regimen. According to pathological examination, patients' tumors were classified into better (well and moderate) and poorly differentiated (lower differentiated and undifferentiated) groups, and the clinical response rate, type of gastrectomy, and negative tumor residual rate were compared between the two groups of patients. Morphological changes and toxic reactions were monitored after chemotherapy. RESULTS The results showed that the clinical response rate in the better differentiated group was significantly higher than that in the poorly differentiated group (100% versus 25%, P = 0.000). The partial gastrectomy rate in the better differentiated group was significantly higher than that in the poorly differentiated group (87.5% versus 25% P = 0.000). A significant shrinking of tumor and necrosis of tumor tissues caused by chemotherapy could be observed. CONCLUSIONS In conclusion, the better differentiated group with locally advanced gastric cancer is suitable for preoperative chemotherapy under the XELOX regimen, and as a result of effective preoperative chemotherapy, much more gastric tissue can be preserved for the better differentiated group.
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Affiliation(s)
- Li-Bo Sun
- >Department of Gastrointestinal Surgery, China-Japan Union Hospital, Jilin University, No. 126, Xiantai Street, Changchun, 130033 China
| | - Guo-Jie Zhao
- >Department of Gastrointestinal Surgery, China-Japan Union Hospital, Jilin University, No. 126, Xiantai Street, Changchun, 130033 China
| | - Da-Yong Ding
- >Department of Gastrointestinal Surgery, China-Japan Union Hospital, Jilin University, No. 126, Xiantai Street, Changchun, 130033 China
| | - Bin Song
- >Department of Gastrointestinal Surgery, China-Japan Union Hospital, Jilin University, No. 126, Xiantai Street, Changchun, 130033 China
| | - Rui-Zhi Hou
- >Department of Gastrointestinal Surgery, China-Japan Union Hospital, Jilin University, No. 126, Xiantai Street, Changchun, 130033 China
| | - Yong-Chao Li
- >Department of Gastrointestinal Surgery, China-Japan Union Hospital, Jilin University, No. 126, Xiantai Street, Changchun, 130033 China
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14
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Chen DW, Pan Y, Yan JF, Mou YP. Laparoscopic resection of synchronous gastric cancer and primary small intestinal lymphoma: A case report. World J Gastroenterol 2014; 20:6353-6356. [PMID: 24876758 PMCID: PMC4033475 DOI: 10.3748/wjg.v20.i20.6353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 02/09/2014] [Accepted: 03/05/2014] [Indexed: 02/06/2023] Open
Abstract
Synchronous gastric cancer and primary small intestinal lymphoma are extremely rare. A 49-year-old woman was referred to our hospital with a history of upper abdominal pain for two weeks and was diagnosed with synchronous cancer. During hospitalization, the patient underwent laparoscopic distal gastrectomy + resection of bilateral ovaries + partial resection of both small intestine and descending colon. Pathological examination revealed a synchronous cancer consisting of early gastric cancer with poorly differentiated adenocarcinoma located in mucosa, with lymph node metastasis (3+/29) (T1N1M0, stage IB); and diffuse large B cell lymphoma of small intestine involving descending colon and bilateral ovaries, with lymph node metastasis (2+/5) (Ann Arbor IIE). The patient recovered well, without any obvious complications and was discharged on post-operative day 7. The patient received six cycles of chemotherapy after operation. She has been doing well with no evidence of recurrence for 13 mo.
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15
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Zhang G, Qu Y, Dang S, Yang Q, Shi B, Hou P. Variable copy number of mitochondrial DNA (mtDNA) predicts worse prognosis in advanced gastric cancer patients. Diagn Pathol 2013; 8:173. [PMID: 24144008 PMCID: PMC4015835 DOI: 10.1186/1746-1596-8-173] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 10/11/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Change of mitochondrial DNA (mtDNA) copy number is widely reported in various human cancers, including gastric cancer, and is considered to be an important hallmark of cancers. However, there is remarkably little consensus on the value of variable mtDNA content in the prognostic evaluation of this cancer. METHODS Using real-time quantitative PCR approach, we examined mtDNA copy number in a cohort of gastric cancers and normal gastric tissues, and explored the association of variable mtDNA content with clinical outcomes of gastric cancer patients. RESULTS Our data showed that the majority of gastric cancer patients had low mtDNA content as compared to control subjects although the relative mean mtDNA content was higher in the former than the latter. Moreover, we found that variable mtDNA content was strongly associated with lymph node metastasis and cancer-related death of the patients with late-stage tumors. Notably, variable mtDNA content did not affect overall survival of gastric cancer patients, however, we found that increased mtDNA content was associated with poor survival in the patients with late-stage tumors. CONCLUSION In this study, we demonstrated that variable mtDNA content markedly increased the risk of lymph node metastasis and high mortality of the patients with late-stage tumors. Additionally, we found a strong link between increased mtDNA content and worse survival of the patients with late-stage tumors. Taken together, variable mtDNA content may be a valuable poor prognostic factor for advanced gastric cancer patients. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1344721463103353.
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Affiliation(s)
| | | | | | | | | | - Peng Hou
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an 710061, the People's Republic of China.
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