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Koopaie M, Ghafourian M, Manifar S, Younespour S, Davoudi M, Kolahdooz S, Shirkhoda M. Evaluation of CSTB and DMBT1 expression in saliva of gastric cancer patients and controls. BMC Cancer 2022; 22:473. [PMID: 35488257 PMCID: PMC9055774 DOI: 10.1186/s12885-022-09570-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 04/19/2022] [Indexed: 01/07/2023] Open
Abstract
Background Gastric cancer (GC) is the fifth most common cancer and the third cause of cancer deaths globally, with late diagnosis, low survival rate, and poor prognosis. This case-control study aimed to evaluate the expression of cystatin B (CSTB) and deleted in malignant brain tumor 1 (DMBT1) in the saliva of GC patients with healthy individuals to construct diagnostic algorithms using statistical analysis and machine learning methods. Methods Demographic data, clinical characteristics, and food intake habits of the case and control group were gathered through a standard checklist. Unstimulated whole saliva samples were taken from 31 healthy individuals and 31 GC patients. Through ELISA test and statistical analysis, the expression of salivary CSTB and DMBT1 proteins was evaluated. To construct diagnostic algorithms, we used the machine learning method. Results The mean salivary expression of CSTB in GC patients was significantly lower (115.55 ± 7.06, p = 0.001), and the mean salivary expression of DMBT1 in GC patients was significantly higher (171.88 ± 39.67, p = 0.002) than the control. Multiple linear regression analysis demonstrated that GC was significantly correlated with high levels of DMBT1 after controlling the effects of age of participants (R2 = 0.20, p < 0.001). Considering salivary CSTB greater than 119.06 ng/mL as an optimal cut-off value, the sensitivity and specificity of CSTB in the diagnosis of GC were 83.87 and 70.97%, respectively. The area under the ROC curve was calculated as 0.728. The optimal cut-off value of DMBT1 for differentiating GC patients from controls was greater than 146.33 ng/mL (sensitivity = 80.65% and specificity = 64.52%). The area under the ROC curve was up to 0.741. As a result of the machine learning method, the area under the receiver-operating characteristic curve for the diagnostic ability of CSTB, DMBT1, demographic data, clinical characteristics, and food intake habits was 0.95. The machine learning model’s sensitivity, specificity, and accuracy were 100, 70.8, and 80.5%, respectively. Conclusion Salivary levels of DMBT1 and CSTB may be accurate in diagnosing GCs. Machine learning analyses using salivary biomarkers, demographic, clinical, and nutrition habits data simultaneously could provide affordability models with acceptable accuracy for differentiation of GC by a cost-effective and non-invasive method.
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Affiliation(s)
- Maryam Koopaie
- Department of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghafourian
- Department of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheila Manifar
- Department of Oral Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, North Kargar St, P.O.Box:14395-433, Tehran, 14399-55991, Iran.
| | - Shima Younespour
- Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansour Davoudi
- Department of Computer Science and Engineering and IT, School of Electrical and Computer Engineering, Shiraz University, Shiraz, Iran
| | - Sajad Kolahdooz
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mohammad Shirkhoda
- Department of General Oncology, Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
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Miura S, Wakahara T, Yamauchi S, Yasuhara Y, Mukubo H, Kanemitsu K, Iwasaki T, Sasako M, Kakeji Y. The Amount and Concentration of Drain Amylase Together Predict Postoperative Pancreatic Fistula after Gastric Cancer Surgery More Accurately than the Concentration Alone. Oncology 2022; 100:363-369. [PMID: 35340009 DOI: 10.1159/000524301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/11/2022] [Indexed: 11/19/2022]
Abstract
Introduction The drain amylase concentration (dAmy-C) is a useful marker for predicting pancreatic fistula after gastric cancer surgery. However, dAmy-C might be reduced in cases of high drainage volume. Therefore, we hypothesized that we could accurately assess the amount of amylase leaked from the pancreas by multiplying dAmy-C by the daily drainage volume. In this study, we investigated the clinical utility of the amount of drain amylase (A-dAmy: concentration × volume) for predicting pancreatic fistula. And, we investigated the clinical utility of the combination of dAmy-C and A-dAmy for predicting pancreatic fistula. Methods We investigated patients who underwent gastrectomy for gastric cancer at Yodogawa Christian Hospital between 2012 and 2020. The optimal cut-off levels of dAmy-C and A-dAmy on postoperative day 1 for predicting Clavien-Dindo grade II or higher pancreatic fistula were calculated using receiver operating characteristic (ROC) curves. And, we calculate the positive predictive value and negative predictive value for predicting pancreatic fistula using these cut-off levels. Results A total of 448 patients were eligible for analysis. Twenty-two patients experienced Clavien-Dindo grade II or higher pancreatic fistula. ROC curves identified 1,615 IU/L as the optimal cut-off level of dAmy-C predicting pancreatic fistula. When the simple cut-off level of dAmy-C was 1,600 IU/L, the positive predictive value for was 22.8% and the negative predictive value was 99.7%. ROC curves identified 177.52 IU as the optimal cut-off level of A-dAmy predicting pancreatic fistula. When the simple cut-off level of A-dAmy was 177 IU, the positive predictive value was 21.2% and the negative predictive value was 99.7%. Using these two cut-off levels together, the positive predictive value was 34.4% and the negative predictive value was 99.7%. Conclusion A-dAmy could predict and exclude pancreatic fistula after gastrectomy as with dAmy-C. The combination of dAmy-C and A-dAmy predict pancreatic fistula more accurately than dAmy-C alone.
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Affiliation(s)
- Susumu Miura
- Department of Surgery, Yodogawa Christian Hospital, Osaka, Japan
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Hyogo, Japan
| | | | - Saya Yamauchi
- Department of Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Yuki Yasuhara
- Department of Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Hideyo Mukubo
- Department of Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | | | - Takeshi Iwasaki
- Department of Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Mitsuru Sasako
- Department of Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Hyogo, Japan
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Kim DH, Park JH, Kim TH, Jung EJ, Jeong CY, Ju YT, Kim JY, Park TJ, Lee YJ, Jeong SH. Risk Factors for Reoperation Following Radical Gastrectomy in Gastric Cancer Patients. Am Surg 2021:31348211050842. [PMID: 34814762 DOI: 10.1177/00031348211050842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Reoperation due to elective surgery complications is very mentally, physically, and economically detrimental to patients. This study investigated the potential risk factors associated with early reoperation after radical gastrectomy in gastric cancer patients and included an in-depth analysis of these risk factors. METHODS This retrospective study reviewed 1568 patients with gastric cancer. Grade 3 or greater complications were defined as severe. Any factors related to reoperation after radical gastrectomy were analyzed in patients with severe local complications. RESULTS Among 1537 patients undergoing radical gastrectomy, 115 (7.5%) patients had severe postoperative complications, 98 (6.38%) of whom experienced severe local complications. The most common local complication was anastomotic leakage (31, 2.02%), followed by intra-abdominal abscess (30, 1.95%), pancreatic leakage (22, 1.43%), duodenal stump leakage (18, 1.17%), intra-abdominal bleeding (12, .78%), intraluminal bleeding (8, .52%), small bowel obstruction (5, .32%), and chyle leakage (3, .19%). Of these patients, 26 (1.69%) underwent reoperation, and 6 (.39%) died. In the univariate analysis of clinical factors related to reoperation, intra-abdominal bleeding and small bowel obstruction were risk factors for reoperation, and intra-abdominal bleeding (odds ratio [OR] = 9.57, confidence interval [CI] = 2.65-40.20, P < .001) and small bowel obstruction (OR = 19.14, CI = 2.60-390.13, P = .011) were independent risk factors associated with reoperation in the multivariate analysis. CONCLUSION Intra-abdominal bleeding and small bowel obstruction are independent risk factors for reoperation following radical gastrectomy. Patients with postoperative intra-abdominal bleeding and small bowel obstruction need to be warned about reoperation.
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Affiliation(s)
- Dong-Hwan Kim
- Department Surgery, 90162Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Ji-Ho Park
- Department Surgery, 90162Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Tae Han Kim
- Department Surgery, 553954Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Eun-Jung Jung
- Department Surgery, 553954Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Chi-Young Jeong
- Department Surgery, 90162Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Young-Tae Ju
- Department Surgery, 90162Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Ju-Yeon Kim
- Department Surgery, 90162Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Tae-Jin Park
- Department Surgery, 553954Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Young-Joon Lee
- Department Surgery, 553954Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Sang-Ho Jeong
- Department Surgery, 553954Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea
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Kim J, Han SH, Kim HI. Detection of sarcopenic obesity and prediction of long-term survival in patients with gastric cancer using preoperative computed tomography and machine learning. J Surg Oncol 2021; 124:1347-1355. [PMID: 34490899 PMCID: PMC9290491 DOI: 10.1002/jso.26668] [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: 06/17/2021] [Revised: 07/27/2021] [Accepted: 08/29/2021] [Indexed: 12/30/2022]
Abstract
Background Previous studies evaluating the prognostic value of computed tomography (CT)‐derived body composition data have included few patients. Thus, we assessed the prevalence and prognostic value of sarcopenic obesity in a large population of gastric cancer patients using preoperative CT, as nutritional status is a predictor of long‐term survival after gastric cancer surgery. Methods Preoperative CT images were analyzed for 840 gastric cancer patients who underwent gastrectomy between March 2009 and June 2018. Machine learning algorithms were used to automatically detect the third lumbar (L3) vertebral level and segment the body composition. Visceral fat area and skeletal muscle index at L3 were determined and used to classify patients into obesity, sarcopenia, or sarcopenic obesity groups. Results Out of 840 patients (mean age = 60.4 years; 526 [62.6%] men), 534 (63.5%) had visceral obesity, 119 (14.2%) had sarcopenia, and 48 (5.7%) patients had sarcopenic obesity. Patients with sarcopenic obesity had a poorer prognosis than those without sarcopenia (hazard ratio [HR] = 3.325; 95% confidence interval [CI] = 1.698–6.508). Multivariate analysis identified sarcopenic obesity as an independent risk factor for increased mortality (HR = 2.608; 95% CI = 1.313–5.179). Other risk factors were greater extent of gastrectomy (HR = 1.928; 95% CI = 1.260–2.950), lower prognostic nutritional index (HR = 0.934; 95% CI = 0.901–0.969), higher neutrophil count (HR = 1.101; 95% CI = 1.031–1.176), lymph node metastasis (HR = 6.291; 95% CI = 3.498–11.314), and R1/2 resection (HR = 4.817; 95% CI = 1.518–9.179). Conclusion Body composition analysis automated by machine learning predicted long‐term survival in patients with gastric cancer.
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Affiliation(s)
- Jaehyuk Kim
- Molecular Imaging, Medical Biophysics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,CAE Group, Hardware Solution Team, Health and Medical Equipment Business, Samsung Electronics Co. Ltd., Seoul, South Korea
| | - Seung Hee Han
- Molecular Imaging, Medical Biophysics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Hyoung-Il Kim
- Molecular Imaging, Medical Biophysics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.,Division of Upper Gastrointestinal Surgery, Gastric Cancer Center, Yonsei Cancer Center, Seoul, South Korea
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Nakauchi M, Vos EL, Tang LH, Gonen M, Janjigian YY, Ku GY, Ilson DH, Maron SB, Yoon SS, Brennan MF, Coit DG, Strong VE. Association of Obesity with Worse Operative and Oncologic Outcomes for Patients Undergoing Gastric Cancer Resection. Ann Surg Oncol 2021; 28:7040-7050. [PMID: 33830355 PMCID: PMC8987625 DOI: 10.1245/s10434-021-09880-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/05/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND How obesity has an impact on operative and oncologic outcomes for gastric cancer patients is unclear, and the influence of obesity on response to neoadjuvant chemotherapy (NAC) has not been evaluated. METHODS Patients who underwent curative gastrectomy for primary gastric cancer between 2000 and 2018 were retrospectively identified. After stratification for NAC, operative morbidity, mortality, overall survival (OS), and disease-specific survival (DSS) were compared among three body mass index (BMI) categories: normal BMI (< 25 kg/m2), mild obesity (25-35 kg/m2), and severe obesity (≥ 35 kg/m2). RESULTS During the study period, 984 patients underwent upfront surgery, and 484 patients received NAC. Tumor stage did not differ among the BMI groups. However, the rates of pathologic response to NAC were significantly lower for the patients with severe obesity (10% vs 40%; p < 0.001). Overall complications were more frequent among the obese patients (44.3% for obese vs 24.9% for normal BMI, p < 0.001). Intraabdominal infections were also more frequent in obese patients (13.9% for obese vs 4.7% for normal BMI, p = 0.001). In the upfront surgery cohort, according to the BMI, OS and DSS did not differ, whereas in the NAC cohort, severe obesity was independently associated with worse OS [hazard ratio (HR) 1.87; 95% confidence interval (CI) 1.01-3.48; p = 0.047] and disease-specific survival (DSS) (HR 2.08; 95% CI 1.07-4.05; p = 0.031). CONCLUSION For the gastric cancer patients undergoing curative gastrectomy, obesity was associated with significantly lower rates of pathologic response to NAC and more postoperative complications, as well as shorter OS and DSS for the patients receiving NAC.
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Affiliation(s)
- Masaya Nakauchi
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elvira L Vos
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laura H Tang
- Gastrointestinal Pathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yelena Y Janjigian
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Geoffrey Y Ku
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David H Ilson
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Steven B Maron
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sam S Yoon
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Murray F Brennan
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel G Coit
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vivian E Strong
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Kim EY, Jun KH, Kim SY, Chin HM. Body mass index and skeletal muscle index are useful prognostic factors for overall survival after gastrectomy for gastric cancer: Retrospective cohort study. Medicine (Baltimore) 2020; 99:e23363. [PMID: 33217879 PMCID: PMC7676598 DOI: 10.1097/md.0000000000023363] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Among patients undergoing gastrectomy for gastric cancer, the impact of anthropometric indices on surgical outcomes is not well-established. The aim of this study was to evaluate the prognostic significance of the skeletal muscle index (SMI) and body mass index (BMI) on overall survival (OS) in patients with gastric cancer.A total of 305 patients who underwent curative gastrectomy for gastric adenocarcinoma between January 2005 and March 2008 were enrolled. Patients were classified into groups based on the SMI and BMI. The SMI was measured by preoperative abdominal computed tomography (CT). The SMI groups were classified based on gender-specific cut-off values obtained by means of optimum stratification. BMI groups were divided according to the World Health Organization definition of obesity for Asians.The mean SMI was 58.2 cm/m and the mean BMI was 23.2 kg/m. One hundred fifteen (37.7%) patients had sarcopenia based on the diagnostic cut-off values (56.2 cm/m for men and 53.6 cm/m for women). Apart from gender, there were no significant differences in patient characteristics or surgical outcomes between the SMI groups. In the underweight group, tumor (T) stage, tumor-node-metastasis (TNM) stage, number of retrieved lymph nodes, D2 dissection, and hospital stay were significantly increased compared with the overweight/obese group. High and low BMI, and low SMI, were independent prognostic factors for OS (hazard ratio [HR] = 2.355, 1.736, and 1.607, respectively; P = .009, .023, and .033, respectively).SMI and BMI did not impact perioperative morbidity in patients undergoing gastrectomy for gastric cancer. Both SMI and BMI are useful prognostic factors for OS in gastric cancer patients after gastrectomy.
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Affiliation(s)
| | - Kyong Hwa Jun
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Shinn Young Kim
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung Min Chin
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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