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Wen H, Deng G, Shi X, Liu Z, Lin A, Cheng Q, Zhang J, Luo P. Body mass index, weight change, and cancer prognosis: a meta-analysis and systematic review of 73 cohort studies. ESMO Open 2024; 9:102241. [PMID: 38442453 PMCID: PMC10925937 DOI: 10.1016/j.esmoop.2024.102241] [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: 08/21/2023] [Revised: 11/19/2023] [Accepted: 01/09/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Identifying the association between body mass index (BMI) or weight change and cancer prognosis is essential for the development of effective cancer treatments. We aimed to assess the strength and validity of the evidence of the association between BMI or weight change and cancer prognosis by a systematic evaluation and meta-analysis of relevant cohort studies. METHODS We systematically searched the PubMed, Web of Science, EconLit, Embase, Food Sciences and Technology Abstracts, PsycINFO, and Cochrane databases for literature published up to July 2023. Inclusion criteria were cohort studies with BMI or weight change as an exposure factor, cancer as a diagnostic outcome, and data type as an unadjusted hazard ratio (HR) or headcount ratio. Random- or fixed-effects models were used to calculate the pooled HR along with the 95% confidence interval (CI). RESULTS Seventy-three cohort studies were included in the meta-analysis. Compared with normal weight, overweight or obesity was a risk factor for overall survival (OS) in patients with breast cancer (HR 1.37, 95% CI 1.22-1.53; P < 0.0001), while obesity was a protective factor for OS in patients with gastrointestinal tumors (HR 0.67, 95% CI 0.56-0.80; P < 0.0001) and lung cancer (HR 0.67, 95% CI 0.48-0.92; P = 0.01) compared with patients without obesity. Compared with normal weight, underweight was a risk factor for OS in patients with breast cancer (HR 1.15, 95% CI 0.98-1.35; P = 0.08), gastrointestinal tumors (HR 1.54, 95% CI 1.32-1.80; P < 0.0001), and lung cancer (HR 1.28, 95% CI 1.22-1.35; P < 0.0001). Compared with nonweight change, weight loss was a risk factor for OS in patients with gastrointestinal cancer. CONCLUSIONS Based on the results of the meta-analysis, we concluded that BMI, weight change, and tumor prognosis were significantly correlated. These findings may provide a more reliable argument for the development of more effective oncology treatment protocols.
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Affiliation(s)
- H Wen
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong
| | - G Deng
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong; The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong
| | - X Shi
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong
| | - Z Liu
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (Beijing), Beijing Institute of Lifeomics, Beijing; Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - A Lin
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong.
| | - Q Cheng
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China.
| | - J Zhang
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong.
| | - P Luo
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong.
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Wu H, Zhang J, Zhou B. Lifestyle factors on the long-term survival of gastric cancer patients after radical resection: A cohort study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2024; 29:11. [PMID: 38524749 PMCID: PMC10956563 DOI: 10.4103/jrms.jrms_375_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/24/2023] [Accepted: 11/09/2023] [Indexed: 03/26/2024]
Abstract
Background This retrospective cohort study aimed to evaluate the effect of lifestyle factors (e.g., smoking, drinking, physical exercise, and sleep duration) on the long-term survival of gastric cancer (GC) patients after radical resection. Materials and Methods GC patients after radical resection were enrolled from January 2016 to December 2017. Their baseline clinical data, lifestyle factors, and prognosis were collected. The primary endpoint was all-cause death. The relationship between the variables and survival was examined using the Cox proportional hazards model. Results A total of 309 patients were enrolled and 296 patients were followed up for a median of 54.0 months, with 130 confirmed deaths. Older age (>60 years) (hazard ratio [HR]: 1.307, 95% confidence interval [CI]: 1.056-2.161, P = 0.006), advanced tumor, node, and metastasis stage (P < 0.05), poorly pathological differentiation (HR: 1.765, 95% CI: 1.080-2.884, P = 0.023), history of smoking (P < 0.001), never physical exercise (HR: 2.057, 95% CI: 1.170-3.617, P = 0.012), long sleep duration (≥8 h) (HR: 4.160, 95% CI: 1.501-11.533, P = 0.006), and short sleep duration (<6 h) (HR: 3.417, 95% CI: 1.312-8.900, P = 0.012) were independent indicators of a poor overall survival in GC patients after radical resection. Conclusion Smoking cessation, proper sleep duration, and regular physical exercise habits can improve the long-term survival of GC patients after radical resection.
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Affiliation(s)
- Huadong Wu
- Department of Gastrointestinal Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jinjia Zhang
- Department of General Practice, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Baojun Zhou
- Department of Gastrointestinal Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Wiebe N, Lloyd A, Crumley ET, Tonelli M. Associations between body mass index and all-cause mortality: A systematic review and meta-analysis. Obes Rev 2023; 24:e13588. [PMID: 37309266 DOI: 10.1111/obr.13588] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/12/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023]
Abstract
Fasting insulin and c-reactive protein confound the association between mortality and body mass index. An increase in fat mass may mediate the associations between hyperinsulinemia, hyperinflammation, and mortality. The objective of this study was to describe the "average" associations between body mass index and the risk of mortality and to explore how adjusting for fasting insulin and markers of inflammation might modify the association of BMI with mortality. MEDLINE and EMBASE were searched for studies published in 2020. Studies with adult participants where BMI and vital status was assessed were included. BMI was required to be categorized into groups or parametrized as non-first order polynomials or splines. All-cause mortality was regressed against mean BMI squared within seven broad clinical populations. Study was modeled as a random intercept. β coefficients and 95% confidence intervals are reported along with estimates of mortality risk by BMIs of 20, 30, and 40 kg/m2 . Bubble plots with regression lines are drawn, showing the associations between mortality and BMI. Splines results were summarized. There were 154 included studies with 6,685,979 participants. Only five (3.2%) studies adjusted for a marker of inflammation, and no studies adjusted for fasting insulin. There were significant associations between higher BMIs and lower mortality risk in cardiovascular (unadjusted β -0.829 [95% CI -1.313, -0.345] and adjusted β -0.746 [95% CI -1.471, -0.021]), Covid-19 (unadjusted β -0.333 [95% CI -0.650, -0.015]), critically ill (adjusted β -0.550 [95% CI -1.091, -0.010]), and surgical (unadjusted β -0.415 [95% CI -0.824, -0.006]) populations. The associations for general, cancer, and non-communicable disease populations were not significant. Heterogeneity was very large (I2 ≥ 97%). The role of obesity as a driver of excess mortality should be critically re-examined, in parallel with increased efforts to determine the harms of hyperinsulinemia and chronic inflammation.
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Affiliation(s)
- Natasha Wiebe
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Anita Lloyd
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ellen T Crumley
- Rowe School of Business, Dalhousie University, Halifax, Nova Scotia, Canada
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Li L, Li W, Xu D, He H, Yang W, Guo H, Liu X, Ji W, Song C, Xu H, Li W, Shi H, Cui J. Association Between Visceral Fat Area and Cancer Prognosis: A Population-Based Multicenter Prospective Study. Am J Clin Nutr 2023; 118:507-517. [PMID: 37422158 DOI: 10.1016/j.ajcnut.2023.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/17/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND Diverse indicators have been used to represent adipose tissue, while the relationship between body adipose mass and the prognosis of patients with cancer remains controversial. OBJECTIVE This study aimed to explore the indicators of optimal body composition that represent body fat mass to predict risk of cancer-related mortality. METHODS We conducted a population-based multicenter prospective cohort study of patients with initial cancer between February 2012 and September 2020. Clinical information, body composition indicators, hematologic test results, and follow-up data were collected. Body composition indicators were analyzed using principal component analysis to select the most representative indicators, and the cutoff value was set according to the optimal stratification method. The hazard ratio (HR) for mortality was calculated using Cox proportional hazards regression models. RESULTS Among 14,018 patients with complete body composition data, visceral fat area (VFA) is a more optimal indicator for body fat content (principal component index: 0.961) than body mass index (principal component index: 0.850). The cutoff points for VFA in terms of time to mortality were 66 cm2 and 102 cm2 for gastric/esophageal cancer and other cancers, respectively. Among the 2788 patients treated systemically, multivariate analyses demonstrated that a lower VFA was associated with a higher risk of death in patients with cancer of diverse types (HR: 1.33; 95% CI: 1.08, 1.64; P = 0.007), especially gastric cancer (HR: 2.13; 95% CI: 1.3, 3.49; P = 0.003), colorectal cancer HR: 1.81; 95% CI: 1.06, 3.08; P = 0.030) and nonsmall-cell lung cancer (HR: 1.27; 95% CI: 1.01, 1.59; P = 0.040). CONCLUSION VFA is an independent prognostic indicator of muscle mass in patients with diverse types of cancer, particularly gastric, colorectal, and nonsmall-cell lung cancers. TRIAL REGISTRATION NUMBER ChiCTR1800020329.
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Affiliation(s)
- Lingyu Li
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Wenqian Li
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Dongsheng Xu
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Hua He
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Wang Yang
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Hanfei Guo
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Xiangliang Liu
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Wei Ji
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Chunhua Song
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Hongxia Xu
- Department of Nutrition, Daping Hospital & Research Institute of Surgery, Third Military Medical University, Chongqing, China
| | - Wei Li
- Cancer Center, The First Hospital of Jilin University, Changchun, China.
| | - Hanping Shi
- Departments of Gastrointestinal Surgery and Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
| | - Jiuwei Cui
- Cancer Center, The First Hospital of Jilin University, Changchun, China.
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Ishida Y, Maeda K, Nonogaki T, Shimizu A, Ueshima J, Nagano A, Kato R, Matsuyama R, Mori N. Body mass index and weight loss predict mortality in older patients with chronic kidney disease. Geriatr Gerontol Int 2022; 22:984-985. [PMID: 36184574 DOI: 10.1111/ggi.14488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Yuria Ishida
- Department of Nutrition, Aichi Medical University Hospital, Nagakute, Japan.,Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Keisuke Maeda
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan.,Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Tomoyuki Nonogaki
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Japan
| | - Akio Shimizu
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan.,Department of Health Science, Faculty of Health and Human Development, The University of Nagano, Nagano, Japan
| | - Junko Ueshima
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan.,Department of Clinical Nutrition and Food Service, NTT Medical Center Tokyo, Tokyo, Japan
| | - Ayano Nagano
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan.,Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
| | - Ryoko Kato
- Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Remi Matsuyama
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan.,Nutritional Therapy Support Center, Aichi Medical University Hospital, Nagakute, Japan
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Tiengo T, Fernandes GA, Curado MP. Gastric adenocarcinoma: 1-year overall survival, disability-adjusted life years, years of life lost, and prognostic factors—a single-institution experience. Front Oncol 2022; 12:918833. [PMID: 36158672 PMCID: PMC9493081 DOI: 10.3389/fonc.2022.918833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/26/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To analyze factors affecting 1-year overall survival and burden of gastric adenocarcinoma in a single-institution cohort. Methods A prospective cohort study of gastric adenocarcinoma patients from a cancer center in São Paulo, Brazil, was conducted between February 2016 and July 2019. Overall survival was analyzed at 12 months post-diagnosis using the Kaplan–Meier method. A log-rank test was applied to compare curves. Sociodemographic and clinicopathological features were assessed to detect prognostic factors using univariate and multivariable Cox regression analyses to calculate hazard ratio (HR) and its confidence intervals (CIs). Disability-adjusted life years (DALY) constituted the sum of years of life lost (YLL) plus years lived with disability (YLD). YLL represented the sum of years lost before the age of 76.6 years. YLD was calculated as the number of cases multiplied by the duration and burden of the disease. YLL per death was calculated as the mean YLL for each individual. Results Overall survival at 1-year follow-up was 80.8%. The multivariable model adjusted for age and sex identified cerebrovascular disease (HR 8.5, 95% CI 3.3–21.8), stage III/IV (HR 5.7, 95% CI 2.3–13.7), diabetes (HR 3.2, 95% CI 1.5–6.6), and<9 years of education (HR 2.9, 95% CI 1.5–5.8) as prognostic factors. Out of the 214 treated cases, there was 700.72 DALY during the first year, of which 90.55% corresponded to YLL and 9.45% to YLD. The average YLL per death was 15.48 and was higher among women (19.24 YLL per death). Conclusion At a single cancer center, 1-year overall survival probability was approximately 80% in patients with gastric adenocarcinoma. Patients with a higher risk of death had cerebrovascular disease, advanced clinical staging, diabetes, and/or lower educational level. Approximately 700 years of DALY was documented, with women having the highest YLL per death. Because this study was conducted at a single cancer center, the results might not be representative of a general population. To the best of our knowledge, this study was the first to assess gastric adenocarcinoma DALY, YLL, and YLL per death in the first year of follow-up in a hospital cohort in Brazil.
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Affiliation(s)
- Tatiane Tiengo
- Post Graduation Program A.C. Camargo Cancer Center, São Paulo, Brazil
- *Correspondence: Maria Paula Curado, ; Tatiane Tiengo,
| | | | - Maria Paula Curado
- Nucleus of Epidemiology and Statistics in Cancer, A. C. Camargo Cancer Center, São Paulo, Brazil
- *Correspondence: Maria Paula Curado, ; Tatiane Tiengo,
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7
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Cancer Burden in China during 1990–2019: Analysis of the Global Burden of Disease. BIOMED RESEARCH INTERNATIONAL 2022; 2022:3918045. [PMID: 35463971 PMCID: PMC9023157 DOI: 10.1155/2022/3918045] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 04/01/2022] [Indexed: 02/08/2023]
Abstract
This study reports the risk factors, trends, and burden of cancer in China from 1990 to 2019 from the Global Burden of Diseases. The incidence, mortality, and DALY of all cancers in China for the past 30 years were analyzed. In 2019, the age-standardized rates (ASRs) of cancer incidence, mortality, and DALY in China were 232.42/100 000, 136.72/100 000, and 3288.22/100 000, respectively. The five cancers with the highest age-standardized incidence rates were lung, stomach, colorectal, breast, and prostate cancers. From 1990 to 2019, the number of new cancer cases, deaths, and DALY increased by 168.78%, 86.89%, and 51.20%, respectively. The ASR increased by 22.21% for incidence and decreased by 19.01% and 27.19% for mortality and DALY, respectively, and their corresponding average annual percent change values were 0.71, -0.80, and -1.26, respectively. The main risk factors for cancer in China were smoking, air pollution, dietary factors, and alcohol use. From 1990 to 2019, the cancer incidence rate was on the rise, and cancer mortality and DALY rates were declining; however, these characteristics vary by cancer site. Therefore, current prevention strategies should be reoriented, and specific strategies for cancers in different sites should be established to prevent the increase in cancer cases.
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Niu P, Huang H, Zhao L, Wang T, Zhang X, Wang W, Zhang Y, Guo C, Zhao D, Chen Y. Clinicopathological characteristics, survival outcomes, and genetic alterations of younger patients with gastric cancer: Results from the China National Cancer Center and
cBioPortal
datasets. Cancer Med 2022; 11:3057-3073. [PMID: 35486034 PMCID: PMC9385592 DOI: 10.1002/cam4.4669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/28/2022] [Accepted: 03/02/2022] [Indexed: 11/30/2022] Open
Abstract
Background The survival outcomes of younger patients with gastric cancer (GC) have remained controversial. This study explores the clinicopathological characteristics, survival outcomes, and genetic alterations of younger and older patients with GC. Methods Patients with GC were identified from the China National Cancer Center Gastric Cancer Database (NCCGCDB) during 1998–2018. Survival analysis was conducted using Kaplan–Meier estimates and Cox proportional hazards models. Sequencing datasets were enrolled from The Cancer Genome Atlas (TCGA) and Memorial Sloan–Kettering Cancer Center (MSKCC) databases. Results A total of 1146 younger (<40 years of age) and 16,988 older (≥40 years of age) cases were included in the study. Younger patients had more poorly differentiated lesions than older patients (53.7% vs. 33.8%, respectively; p < 0.0001), and were more often pTNM stage IV (19.5% vs. 11.8%, respectively; p < 0.001). The 5‐year overall survival (OS) of patients from the NCCGCDB increased from 1998 to 2018. Younger patients with pTNM stage III had a lower survival rate than older patients (p = 0.014), while no differences by age were observed at other stages. The mutation frequency of the LRP1B, GNAS, APC, and KMT2D genes was higher for older than younger patients (p < 0.05 for all genes). While not significantly different, younger patients from the TCGA and MSKCC databases were more likely to have CDH1, RHOA, and CTNNB1 gene mutations. Conclusions A stable proportion and improved survival of younger patients were reported using NCCGCDB data. Younger patients with pTNM stage III had lower rates of survival than older patients. Distinct molecular characteristics were identified in younger GC patients which may partly explain the histopathology and prognosis specific to this subpopulation.
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Affiliation(s)
- Penghui Niu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Huang Huang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Lulu Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Tongbo Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Xiaojie Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Wanqing Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Yawei Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Chunguang Guo
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Dongbing Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Yingtai Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
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Duan X, Shan L, Shi S, Xu B, Chen X, Di J, Chen B, Li X, Liu S, Wang Y, Yang W. GBAP1 polymorphisms (rs140081212, rs1057941 and rs2990220) contribute to reduced risk of gastric cancer. Future Oncol 2022; 18:1861-1872. [PMID: 35156841 DOI: 10.2217/fon-2021-0973] [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: 11/21/2022] Open
Abstract
Aim: This study was designed to evaluate the contribution of GBAP1 variants to gastric cancer (GC) risk in a Chinese Han population. Methods: The genotypes of GBAP1 polymorphisms were detected using the Agena MassARRAY platform. Logistic regression analysis was used to calculate odds ratios (ORs) and 95% CIs. Results: GBAP1 rs140081212 (OR = 0.51, p = 4.50 × 10-07), rs1057941 (OR = 0.48, p = 1.19 × 10-08) and rs2990220 (OR = 0.46, p = 7.34 × 10-09) contribute to reduced GC risk, especially gastric adenocarcinoma. Interestingly, the contribution of GBAP1 variants to GC susceptibility was associated with age, sex, BMI, smoking and drinking. Conclusion: This research suggested that GBAP1 polymorphisms might provide a protective effect against GC occurrence in a Chinese Han population.
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Affiliation(s)
- Xianglong Duan
- Key Laboratory of Molecular Mechanism and Intervention Research for Plateau Diseases of Tibet Autonomous Region, School of Medicine, XizangMinzu University, Xianyang, Shaanxi, 712082, China.,Department of Rehabilitation Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710068, China
| | - Liang Shan
- Department of Rehabilitation Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710068, China
| | - Shuai Shi
- Second Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710068, China
| | - Boyu Xu
- Second Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710068, China
| | - Xin Chen
- Second Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710068, China
| | - Jinqin Di
- Second Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710068, China
| | - Bopeng Chen
- Second Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710068, China
| | - Xiaoqing Li
- Department of Dermatology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710068, China
| | - Sida Liu
- Second Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710068, China
| | - Yuhe Wang
- Key Laboratory of Molecular Mechanism and Intervention Research for Plateau Diseases of Tibet Autonomous Region, School of Medicine, XizangMinzu University, Xianyang, Shaanxi, 712082, China
| | - Wei Yang
- Key Laboratory of Molecular Mechanism and Intervention Research for Plateau Diseases of Tibet Autonomous Region, School of Medicine, XizangMinzu University, Xianyang, Shaanxi, 712082, China
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10
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Ge Y, Zhang X, Liang W, Tang C, Gu D, Shi J, Wei X. OncoVee™-MiniPDX-Guided Anticancer Treatment for Gastric Cancer Patients With Synchronous Liver Metastases: A Retrospective Cohort Analysis. Front Oncol 2022; 11:757383. [PMID: 35047388 PMCID: PMC8761725 DOI: 10.3389/fonc.2021.757383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/03/2021] [Indexed: 12/21/2022] Open
Abstract
Background It is estimated that 35% of gastric cancer patients appear with synchronous distant metastases—the vast majority of patients presenting with metastatic hepatic disease. How to choose the most appropriate drugs or regimens is crucial to improve the prognosis of patients. We conducted this retrospective cohort analysis to evaluate the efficacy of OncoVee™-MiniPDX-guided treatment for these patients. Methods Gastric cancer patients with liver metastases (GCLM) were enrolled. Patients were divided into MiniPDX and control group according to their wishes. In the observation group, the OncoVee™-MiniPDX model was conducted to screen the most sensitive drug or regimens to determine the clinical administration. Meanwhile, patients were treated with regular medications in the control group according to the guidelines without the MiniPDX model. The primary endpoint was overall survival (OS), and the secondary outcomes included objective response rate (ORR), disease control rate (DCR), and progression-free survival (PFS). Results A total of 68 patients with GCLM were included, with the observation and control groups of 21 and 47 patients, respectively. The baseline characteristics of patients were balanced between these two groups. MiniPDX drug sensitivity tests were associated with the increased use of targeted drugs when compared with the control group (33.3 vs. 0%, p=0.032). Median OS was estimated to be 9.4 (95% CI, 7.9–11.2) months and 7.9 (95% CI, 7.2–8.7) months in the observation and control group, respectively. Both univariate (control group vs. MiniPDX group: HR=2.586, 95% CI= 1.362–4.908, p=0.004) and multivariate regression analyses (Control group vs. MiniPDX group: adjusted HR (aHR)=4.288, 95% CI= 1.452–12.671, p=0.008) showed the superiority of the observation group on OS. Similarly, MiniPDX-based regiments significantly improve the PFS of these cases (median PFS 6.7 months vs. 4.2 months, aHR=2.773, 95% CI=1.532–3.983, p=0.029). ORR and DCR were also improved in MiniPDX group comparing with control group (ORR, 57.14 vs. 25.53%, p=0.029; DCR: 85.71 vs. 68.08%, p=0.035). Conclusion OncoVee™-MiniPDX model, which was used to select drugs to guide antitumor treatment, was promising to prolong survival and improve the response rate of patients with GCLM. Further well-designed studies are needed to confirm the clinical benefits of MiniPDX.
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Affiliation(s)
- Yutong Ge
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xin Zhang
- Department of Gastrointestinal Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Wei Liang
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Cuiju Tang
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Dongying Gu
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Junfeng Shi
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaowei Wei
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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11
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Chen H, Sun Q, Zhang C, She J, Cao S, Cao M, Zhang N, Adiila AV, Zhong J, Yao C, Wang Y, Xia H, Lan L. Identification and Validation of CYBB, CD86, and C3AR1 as the Key Genes Related to Macrophage Infiltration of Gastric Cancer. Front Mol Biosci 2021; 8:756085. [PMID: 34950700 PMCID: PMC8688826 DOI: 10.3389/fmolb.2021.756085] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/08/2021] [Indexed: 12/12/2022] Open
Abstract
Gastric cancer (GC) is rampant around the world. Most of the GC cases are detected in advanced stages with poor prognosis. The identification of marker genes for early diagnosis is of great significance. Studying the tumor environment is helpful to acknowledge the process of tumorigenesis, development, and metastasis. Twenty-two kinds of immune cells were calculated by CIBERSORT from Gene Expression Omnibus (GEO) database. Subsequently, higher infiltration of macrophages M0 was discovered in GC compared with normal tissues. WGCNA was utilized to construct the network and then identify key modules and genes related to macrophages in TCGA. Finally, 18 hub genes were verified. In the PPI bar chart, the top 3 genes were chosen as hub genes involved in most pathways. On the TIMER and THPA websites, it is verified that the expression levels of CYBB, CD86, and C3AR1 genes in tumor tissues were higher than those in normal tissues. These genes may work as biomarkers or targets for accurate diagnosis and treatment of GC in the future. Our findings may be a new strategy for the treatment of GC.
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Affiliation(s)
- Haiyan Chen
- Institute for Cancer Research, School of Basic Medical Science of Xi'an Jiaotong University, Xi'an, China
| | - Qi Sun
- Department of Pathology, School of Basic Medical Sciences and Sir Run Run Hospital and Key Laboratory of Antibody Technique of National Health Commission, Nanjing Medical University, Nanjing, China
| | - Cangang Zhang
- Department of Pathogenic Microbiology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University, Xi'an, China
| | - Junjun She
- Department of High Talent and General Surgery and Center for Gut Microbiome Research and Med-X Institute, the First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Shuai Cao
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Meng Cao
- Institute for Cancer Research, School of Basic Medical Science of Xi'an Jiaotong University, Xi'an, China
| | - Nana Zhang
- Institute for Cancer Research, School of Basic Medical Science of Xi'an Jiaotong University, Xi'an, China
| | - Ayarick Vivian Adiila
- Institute for Cancer Research, School of Basic Medical Science of Xi'an Jiaotong University, Xi'an, China
| | - Jinjin Zhong
- Institute for Cancer Research, School of Basic Medical Science of Xi'an Jiaotong University, Xi'an, China
| | - Chengyun Yao
- Jiangsu Cancer Hospital and the Affiliated Cancer Hospital of Nanjing Medical University and Jiangsu Institute of Cancer Research, Nanjing, China
| | - Yili Wang
- Institute for Cancer Research, School of Basic Medical Science of Xi'an Jiaotong University, Xi'an, China
| | - Hongping Xia
- Department of Pathology, School of Basic Medical Sciences and Sir Run Run Hospital and Key Laboratory of Antibody Technique of National Health Commission, Nanjing Medical University, Nanjing, China.,Department of High Talent and General Surgery and Center for Gut Microbiome Research and Med-X Institute, the First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Linhua Lan
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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12
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Wang Q, Liang J, Hu X, Gu S, Xu Q, Yan J. Early B-cell factors involve in the tumorigenesis and predict the overall survival of gastric cancer. Biosci Rep 2021; 41:228969. [PMID: 34100918 PMCID: PMC8239495 DOI: 10.1042/bsr20210055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 02/05/2023] Open
Abstract
Gastric cancer (GC) is a heavy health burden around the world, which is the fifth most frequent tumor and leads to the third most common cancer-related deaths. It is urgent to identify prognostic markers as the guideline for personalized treatment and follow-up. We accessed the prognostic value of Early B-cell factors (EBFs) in GC. A total of 415 GC tissues and 34 normal tissues from The Cancer Genome Atlas Stomach Adenocarcinoma (TCGA-STAD) cohort, 616 external patients from GSE15459, GSE22377, GSE51105, GSE62245 were enrolled for analysis. Univariate and multivariate Cox regression analyses were employed to evaluate the sole and integrative prognostic value of EBFs, respectively. Genetic alterations, DNA methylation of EBFs were also evaluated, as well as the involved signaling pathways. We revealed that increased EBFs associated with the poor prognosis of GC patients, the prognostic model was established in TCGA-STAD cohort, and validated in Gene Expression Omnibus (GEO) cohorts, with effectiveness in both HER2 positive and negative patients. DNA methylation was involved in the impact on prognosis. Cell cycle, immune-associated, and MAPK pathways were influenced by EBFs. Anti-CTLA4 immunotherapy is more suitable for EBFs determining high-risk groups, but not anti-PD-1/PD-L1 therapy. 5-Fluorouracil, methotrexate, vorinostat are suitable to inhibit the function of EBFs. Our new findings provide novel insight into the prediction of prognosis and clinical treatment of GC patients based on EBFs.
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Affiliation(s)
- Qing Wang
- Department of Biliary-Pancreatic Minimally Invasive Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong, China
| | - Jiahong Liang
- Department of Biliary-Pancreatic Minimally Invasive Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong, China
| | - Xianyu Hu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, China
| | - Songgang Gu
- Department of Biliary-Pancreatic Minimally Invasive Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong, China
| | - Qiaodong Xu
- Department of Biliary-Pancreatic Minimally Invasive Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong, China
| | - Jiang Yan
- Department of Biliary-Pancreatic Minimally Invasive Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong, China
- Correspondence: Jiang Yan ()
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13
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Gu L, Zhang Y, Hong J, Xu B, Yang L, Yan K, Zhang J, Chen P, Zheng J, Lin J. Prognostic Value of Pretreatment Overweight/Obesity and Adipose Tissue Distribution in Resectable Gastric Cancer: A Retrospective Cohort Study. Front Oncol 2021; 11:680190. [PMID: 34249721 PMCID: PMC8264507 DOI: 10.3389/fonc.2021.680190] [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: 03/13/2021] [Accepted: 06/09/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND This is a study aimed at exploring the relationship between pretreatment overweight/obesity, adipose tissue distribution, and long-term prognosis of gastric cancer. METHODS A total of 607 gastric cancer patients were involved in the retrospective cohort study. Overweight/obese patients were defined as body mass index (BMI) greater than 25 kg/m2, and adipose tissue distribution parameters, including visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and VAT/SAT ratio were measured at the level of the third lumbar vertebra using computerized tomography images within 15 days before the surgery. Multiple Cox regression models were applied to evaluate the association between overweight/obesity and disease-specific survival (DSS) of gastric cancer, and covariates including age, gender, T stage, N stage, and chemotherapy were adjusted. Furthermore, multiple Cox regression models were performed to evaluate the association between adipose tissue distribution parameters and DSS of gastric cancer; except for covariates mentioned above, overweight/obesity was adjusted additionally. RESULTS Overweight/obesity was a predictive factor (HR = 0.61, 95% CI: 0.37-0.99) for the prognosis of gastric cancer. After additionally adjusting for overweight/obesity, high SAT percentage was an independent protective factor (HR = 0.59, 95% CI: 0.36-0.96), while high VAT percentage (HR = 1.68, 95% CI: 1.06-2.68) and high VAT/SAT ratio (HR = 1.99, 95% CI: 1.19-3.34) were independent risk factors for DSS of gastric cancer. Compared with other patients (overweight/obesity with low VAT/SAT ratio group, non-overweight/obesity or high VAT/SAT ratio group), patients in the non-overweight/obesity with high VAT/SAT ratio group had a worse prognosis (HR = 1.89, 95% CI: 1.28-2.77). CONCLUSION These results suggest that overweight/obesity is a predictive factor for the prognosis of gastric cancer. The VAT/SAT ratio could be used as a promising prognostic factor for gastric cancer. Therefore, in preoperative evaluation of gastric cancer patients, attention should be paid not only to BMI but also to adipose tissue distribution.
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Affiliation(s)
- Lihu Gu
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | | | - Jiaze Hong
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Binbin Xu
- Department of Nutrition, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | | | - Kun Yan
- Department of Radiology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Jingfeng Zhang
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
- Department of Radiology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Ping Chen
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Jianjun Zheng
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
- Department of Radiology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Jie Lin
- Department of Thoracic Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
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14
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Al-Awwad N, Allehdan S, Al-Jaberi T, Hushki A, Albtoush Y, Bani-Hani K, Tayyem RF. Dietary and Lifestyle Factors Associated with Gastric and Pancreatic Cancers: A Case-Control Study. Prev Nutr Food Sci 2021; 26:30-39. [PMID: 33859957 PMCID: PMC8027043 DOI: 10.3746/pnf.2021.26.1.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/20/2021] [Accepted: 01/20/2021] [Indexed: 12/21/2022] Open
Abstract
Gastric cancer (GC) and pancreatic cancer (PC) are the third and seventh most likely cancers to cause death worldwide. We aimed to determine the dietary and lifestyle factors of patients with GC or PC and their associated risk among Jordanians. This case-control study enrolled 587 adults (patients with PC, 101; patients with GC, 172; healthy controls, 314) between March 2015 and August 2018, who were assessed using interview-based personal and physical activity questionnaires. Multivariable logistic regression models were taken as measures for predictors of GC and PC risk. We showed that GC and PC patients had higher pre-diagnosis body-mass indexes, a greater proportion smoked and had a family history of cancer than controls. Furthermore, consumption of two snacks [odds ratios (OR)=0.44, 95% confidence intervals (CI): 0.23~0.85], three snacks (OR=0.04, 95% CI: 0.01~0.23) and no meals eaten outside (OR=0.31, 95% CI: 0.09~0.99) showed a protective effect against GC, and consumption of three snacks (OR=0.08, 95% CI: 0.02~0.40) reduced significantly the risk of PC. These results suggest that bodyweight, physical activity, smoking, and family history of cancer are among factors that affect GC and PC risk among Jordanians.
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Affiliation(s)
- Narmeen Al-Awwad
- Department of Clinical Nutrition and Dietetics, Faculty of Applied Health Sciences, The Hashemite University, Zarqa 13133, Jordan
| | - Sabika Allehdan
- Department of Clinical Nutrition and Dietetics, Faculty of Applied Health Sciences, The Hashemite University, Zarqa 13133, Jordan
| | - Tareq Al-Jaberi
- Department of Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Ahmad Hushki
- Gastroenterology Division, King Hussein Cancer Center, Amman 11941, Jordan
| | - Yazan Albtoush
- Gastroenterology Division, Al-Bashir Hospital, Amman 11152, Jordan
| | - Kamal Bani-Hani
- Department of General and Special Surgery, Faculty of Medicine, The Hashemite University, Zarqa 13133, Jordan
| | - Reema Fayez Tayyem
- Department of Human Nutrition, College of Health Science, Qatar University, Doha 2713, Qatar
- Correspondence to Reema Fayez Tayyem, Tel: +962-7-9790-2535, E-mail:
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15
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Nie K, Zheng Z, Wen Y, Shi L, Xu S, Wang X, Zhou Y, Fu B, Li X, Deng Z, Pan J, Jiang X, Jiang K, Yan Y, Zhuang K, Huang W, Liu F, Li P. Construction and validation of a TP53-associated immune prognostic model for gastric cancer. Genomics 2020; 112:4788-4795. [PMID: 32858135 DOI: 10.1016/j.ygeno.2020.08.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/05/2020] [Accepted: 08/20/2020] [Indexed: 02/07/2023]
Abstract
Increasing evidence indicates that TP53 mutation impacts the patients' prognosis by regulating the gastric cancer (GC) immunophenotype. An immune prognostic signature (IPS) was constructed based on TP53 status. The effects of the IPS on the immune microenvironment of GC were analyzed. We also constructed a nomogram integrating the IPS and other clinical factors. An IPS was constructed in the TCGA cohort and validated in the meta-GEO cohort. TP53 mutation resulted in the downregulation of the immune response in GC. Concretely, high-risk patients were characterized by increased monocyte, macrophage M0 and T cell follicular helper infiltration; increased stromal score, ESTIMATE score and immune score; higher TIM3 and BTLA expression; and decreased dendritic cell and T cell CD4 memory-activated infiltration and tumor purity. The nomogram also showed good predictive performance. These results suggest that the IPS is an effective prognostic indicator for GC patients, which might provide a theoretical foundation for immunotherapy.
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Affiliation(s)
- Kechao Nie
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China; Department of Integrated Traditional Chinese & Western Medicine, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Zhihua Zheng
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China
| | - Yi Wen
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China
| | - Laner Shi
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China
| | - Shjie Xu
- Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China
| | - Xueqi Wang
- Department of The Spleen and Stomach, Qingyuan Traditional Chinese Medicine Hospital, Qingyuan 511500, Guangdong, China
| | - Yingsheng Zhou
- University of Chinese Academy of Sciences-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Bin Fu
- Hospital of Traditional Chinese Medicine of Zhongshan, Zhongshan 528400, China
| | - Xiushen Li
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China
| | - Zhitong Deng
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China
| | - Jinglin Pan
- Department of Gastroenterology, Hainan Provincial Hospital of Traditional Chinese Medicine, Haikou, Hainan, China
| | - Xiaotao Jiang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China
| | - Kailin Jiang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China
| | - Yanhua Yan
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China
| | - Kunhai Zhuang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China.
| | - Wei Huang
- Department of Integrated Traditional Chinese & Western Medicine, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China.
| | - Fengbin Liu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China.
| | - Peiwu Li
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China.
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