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Chen YW, Xu LQ, Yi B. Early recognition of risk of critical adverse events based on deep neural decision gradient boosting. Front Public Health 2023; 10:1065707. [PMID: 36777782 PMCID: PMC9909024 DOI: 10.3389/fpubh.2022.1065707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/30/2022] [Indexed: 01/27/2023] Open
Abstract
Introduction Perioperative critical events will affect the quality of medical services and threaten the safety of patients. Using scientific methods to evaluate the perioperative risk of critical illness is of great significance for improving the quality of medical services and ensuring the safety of patients. Method At present, the traditional scoring system is mainly used to predict the score of critical illness, which is mainly dependent on the judgment of doctors. The result is affected by doctors' knowledge and experience, and the accuracy is difficult to guarantee and has a serious lag. Besides, the statistical prediction method based on pure data type do not make use of the patient's diagnostic text information and cannot identify comprehensive risk factor. Therefore, this paper combines the text features extracted by deep neural network with the pure numerical type features extracted by XGBOOST to propose a deep neural decision gradient boosting model. Supervised learning was used to train the risk prediction model to analyze the occurrence of critical illness during the perioperative period for early warning. Results We evaluated the proposed methods based on the real data of critical illness patients in one hospital from 2014 to 2018. The results showed that the critical disease risk prediction model based on multiple modes had faster convergence rate and better performance than the risk prediction model based on text data and pure data type. Discussion Based on the machine learning method and multi-modal data of patients, this paper built a prediction model for critical adverse events in patients, so that the risk of critical events can be predicted for any patient directly based on the preoperative and intraoperative characteristic data. At present, this work only classifies and predicts the occurrence of critical illness during or after operation based on the preoperative examination data of patients, but does not discuss the specific time when the patient was critical illness, which is also the direction of our future work.
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Affiliation(s)
- Yu-wen Chen
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Science, Chongqing, China
| | - Lin-quan Xu
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Science, Chongqing, China
| | - Bin Yi
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University, Chongqing, China,*Correspondence: Bin Yi ✉
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Seely KD, Morgan AD, Hagenstein LD, Florey GM, Small JM. Bacterial Involvement in Progression and Metastasis of Colorectal Neoplasia. Cancers (Basel) 2022; 14:1019. [PMID: 35205767 PMCID: PMC8870662 DOI: 10.3390/cancers14041019] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 02/06/2023] Open
Abstract
While the gut microbiome is composed of numerous bacteria, specific bacteria within the gut may play a significant role in carcinogenesis, progression, and metastasis of colorectal carcinoma (CRC). Certain microbial species are known to be associated with specific cancers; however, the interrelationship between bacteria and metastasis is still enigmatic. Mounting evidence suggests that bacteria participate in cancer organotropism during solid tumor metastasis. A critical review of the literature was conducted to better characterize what is known about bacteria populating a distant site and whether a tumor depends upon the same microenvironment during or after metastasis. The processes of carcinogenesis, tumor growth and metastatic spread in the setting of bacterial infection were examined in detail. The literature was scrutinized to discover the role of the lymphatic and venous systems in tumor metastasis and how microbes affect these processes. Some bacteria have a potent ability to enhance epithelial-mesenchymal transition, a critical step in the metastatic cascade. Bacteria also can modify the microenvironment and the local immune profile at a metastatic site. Early targeted antibiotic therapy should be further investigated as a measure to prevent metastatic spread in the setting of bacterial infection.
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Affiliation(s)
- Kevin D. Seely
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT 84738, USA; (A.D.M.); (L.D.H.)
| | - Amanda D. Morgan
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT 84738, USA; (A.D.M.); (L.D.H.)
| | - Lauren D. Hagenstein
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT 84738, USA; (A.D.M.); (L.D.H.)
| | - Garrett M. Florey
- College of Osteopathic Medicine, Rocky Vista University, Parker, CO 80134, USA;
| | - James M. Small
- Department of Biomedical Sciences, Rocky Vista University, Parker, CO 80134, USA;
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Wang X, Jia R, Chen K, Wang J, Jiang K, Wang Z. RORα and REV-ERBα are Associated With Clinicopathological Parameters and are Independent Biomarkers of Prognosis in Gastric Cancer. Technol Cancer Res Treat 2021; 20:15330338211039670. [PMID: 34931925 PMCID: PMC8721360 DOI: 10.1177/15330338211039670] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Retinoid-related orphan receptor alpha (RORα) and nuclear receptor subfamily 1 group D member 1 (REV-ERBα) play critical roles in many human cancers. Whether RORα and REV-ERBα expression levels are associated with clinical characteristics are poorly understood, and they may be independent predictors of overall survival (OS) and progression-free survival (PFS) in gastric cancer (GC). This study aimed to investigate the correlation of RORα and REV-ERBα expression levels with clinicopathological parameters, OS, and PFS in GC. Immunohistochemistry and quantitative reverse transcription-polymerase chain reaction (qRT-PCR) were employed to assess the expression levels of RORα and REV-ERBα, which were downregulated in GC tissues compared with normal gastric tissues (P < .001; P < .001) and were associated with several clinicopathological parameters, including histological grade (P = .032; P < .001), preoperative carcinoembryonic antigen (CEA) levels (P = .004; P < .001), and tumor-node-metastasis (TNM) stage (P = .015; P < .001). Additionally, low RORα and REV-ERBα expression levels were associated with poor OS and PFS in GC patients, respectively (P < .001; P = .001). Furthermore, univariate Cox regression model analysis showed that histological grade (P < .001; P < .001), preoperative CEA levels (P < .001; P = .001), TNM stage (P < .001; P < .001), lymph node metastasis (P = .002; P = .002), RORα expression levels (P = .001; P < .001), and REV-ERBα expression levels (P < .001; P = .001) were associated with OS and PFS in GC. Multivariate Cox regression model analysis indicated that RORα expression levels and REV-ERBα expression levels are independent factors of OS and PFS in GC. Besides, RORα and REV-ERBα expression may be positively correlated (χ2 = 6.835; P = .009), and GC patients with both high RORα and REV-ERBα expression levels had the best prognosis. In conclusion, RORα and REV-ERBα may coparticipate in tumor activities and show potential to estimate the prognosis of GC.
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Affiliation(s)
- Xiaoshan Wang
- 36639The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Ru Jia
- 36639The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Ke Chen
- 36639The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Jingjing Wang
- 36639The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Kai Jiang
- 36639The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Zhengguang Wang
- 36639The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
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Lieto E, Auricchio A, Tirino G, Pompella L, Panarese I, Del Sorbo G, Ferraraccio F, De Vita F, Galizia G, Cardella F. Naples Prognostic Score Predicts Tumor Regression Grade in Resectable Gastric Cancer Treated with Preoperative Chemotherapy. Cancers (Basel) 2021; 13:cancers13184676. [PMID: 34572903 PMCID: PMC8471422 DOI: 10.3390/cancers13184676] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/29/2021] [Accepted: 09/14/2021] [Indexed: 02/03/2023] Open
Abstract
Simple Summary Multimodal treatment of locally advanced gastric cancer is still debated today due to controversial results in different trials. Nevertheless, perioperative chemotherapy with radical surgery certainly shows a better long-term outcome than surgery alone, so much so it is the main multimodal treatment offered in Europe, at the present. Tumor regression grade is the objective response to preoperative chemotherapy and its extent, in terms of reduction of neoplastic cells in the resected specimen, is strongly affected by Lauren’s classification, TNM stage, and tumor grading. Therefore, since this information can be achieved only after surgical resection, the return of chemotherapy is quite unpredictable in advance and, in about half cases, it is definitely ineffective. Naples Prognostic Score, that mirrors the immune–nutritional conditions, tested on 59 consecutive advanced gastric cancer patients undergoing multimodal treatment, showed a strong power in predicting tumor regression grade and therefore is strictly correlated with long-term outcome and survival. Abstract Despite recent progresses, locally advanced gastric cancer remains a daunting challenge to embrace. Perioperative chemotherapy and D2-gastrectomy depict multimodal treatment of gastric cancer in Europe, shows better results than curative surgery alone in terms of downstaging, micrometastases elimination, and improved long-term survival. Unfortunately, preoperative chemotherapy is useless in about 50% of cases of non-responder patients, in which no effect is registered. Tumor regression grade (TRG) is directly related to chemotherapy effectiveness, but its understanding is achieved only after surgical operation; accordingly, preoperative chemotherapy is given indiscriminately. Conversely, Naples Prognostic Score (NPS), related to patient immune-nutritional status and easily obtained before taking any therapeutic decision, appeared an independent prognostic variable of TRG. NPS was calculated in 59 consecutive surgically treated gastric cancer patients after neoadjuvant FLOT4-based chemotherapy. 42.2% of positive responses were observed: all normal NPS and half mild/moderate NPS showed significant responses to chemotherapy with TRG 1–3; while only 20% of the worst NPS showed some related benefits. Evaluation of NPS in gastric cancer patients undergoing multimodal treatment may be useful both in selecting patients who will benefit from preoperative chemotherapy and for changing immune-nutritional conditions in order to improve patient’s reaction against the tumor.
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Affiliation(s)
- Eva Lieto
- Division of GI Tract Surgical Oncology, Department of Translational Medical Sciences, Vanvitelli University, 80132 Napoli, Italy; (A.A.); (G.D.S.); (G.G.); (F.C.)
- Correspondence:
| | - Annamaria Auricchio
- Division of GI Tract Surgical Oncology, Department of Translational Medical Sciences, Vanvitelli University, 80132 Napoli, Italy; (A.A.); (G.D.S.); (G.G.); (F.C.)
| | - Giuseppe Tirino
- Division of Medical Oncology, Department of Precision Medicine, Vanvitelli University, 80132 Napoli, Italy; (G.T.); (L.P.); (F.D.V.)
| | - Luca Pompella
- Division of Medical Oncology, Department of Precision Medicine, Vanvitelli University, 80132 Napoli, Italy; (G.T.); (L.P.); (F.D.V.)
| | - Iacopo Panarese
- Division of Pathology, Department of Mental and Physical Health and Rehabilitation Medicine, Vanvitelli University, 80132 Napoli, Italy; (I.P.); (F.F.)
| | - Giovanni Del Sorbo
- Division of GI Tract Surgical Oncology, Department of Translational Medical Sciences, Vanvitelli University, 80132 Napoli, Italy; (A.A.); (G.D.S.); (G.G.); (F.C.)
| | - Francesca Ferraraccio
- Division of Pathology, Department of Mental and Physical Health and Rehabilitation Medicine, Vanvitelli University, 80132 Napoli, Italy; (I.P.); (F.F.)
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, Vanvitelli University, 80132 Napoli, Italy; (G.T.); (L.P.); (F.D.V.)
| | - Gennaro Galizia
- Division of GI Tract Surgical Oncology, Department of Translational Medical Sciences, Vanvitelli University, 80132 Napoli, Italy; (A.A.); (G.D.S.); (G.G.); (F.C.)
| | - Francesca Cardella
- Division of GI Tract Surgical Oncology, Department of Translational Medical Sciences, Vanvitelli University, 80132 Napoli, Italy; (A.A.); (G.D.S.); (G.G.); (F.C.)
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Inflammation-based assessment for the risk stratification of mortality in patients with heart failure. Sci Rep 2021; 11:14989. [PMID: 34294776 PMCID: PMC8298574 DOI: 10.1038/s41598-021-94525-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 03/16/2021] [Indexed: 01/08/2023] Open
Abstract
The Glasgow Prognostic Score (GPS) has been established as a useful resource to evaluate inflammation and malnutrition and predict prognosis in several cancers. However, its prognostic significance in patients with heart failure (HF) is not well established. To investigate the association between the GPS and mortality in patients with HF, we assessed 870 patients who were 20 years old and more and had been admitted for acute decompensated HF. The GPS ranged from 0 to 2 points as previously reported. Over the 18-month follow-up (follow-up rate, 83.9%), 143 patients died. Increasing GPS was associated with higher HF severity assessed by New York Heart Association functional class and B-type natriuretic peptide (BNP) levels. Kaplan–Meier analysis showed significant associations for mortality and increased GPS. In multivariate analysis, compared to the GPS 0 group, the GPS 2 group was associated with high mortality (hazard ratio 2.92, 95% confidence interval 1.77–4.81, p < 0.001) after adjustment for age, sex, blood pressure, HF history, HF severity, hemoglobin, renal function, sodium, BNP, left ventricular ejection fraction, and anti-HF medications. In conclusion, high GPS was significantly associated with worse prognosis in patients with HF. Inflammation-based assessment by the GPS may enable simple evaluation of HF severity and prognosis.
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Tokuyama N, Takegawa N, Nishikawa M, Sakai A, Mimura T, Kushida S, Tsumura H, Yamamoto Y, Miki I, Tsuda M. Pretreatment Glasgow prognostic score as a predictor of outcomes in nivolumab-treated patients with advanced gastric cancer. PLoS One 2021; 16:e0247645. [PMID: 33635904 PMCID: PMC7909621 DOI: 10.1371/journal.pone.0247645] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 02/11/2021] [Indexed: 12/02/2022] Open
Abstract
In Japan, South Korea, and Taiwan, nivolumab might provide overall survival benefits for patients with advanced gastric cancer. However, it is effective only in a limited number of patients. The Glasgow prognostic score is an indicator of the systematic inflammatory response and nutritional status. This study aimed to investigate the ability of the Glasgow prognostic score and other markers to predict the outcomes of patients treated with nivolumab. We reviewed the medical records of patients treated for advanced gastric cancer and who received nivolumab between February 2015 and June 2019 at Hyogo Cancer Center. The patients were categorized into two groups according to their Glasgow prognostic scores. Overall, 53.3% and 46.7% of the patients were assigned to groups with Glasgow prognostic scores of 0 and 1/2, respectively. The median durations of progression-free and overall survival of the participants were 2.3 and 5.7 months, respectively. The patients with a Glasgow prognostic score of 0 had significantly higher median overall survival than those with scores of 1 or 2 (16.4 vs. 4.2 months; p = 0.0006). This observation suggests that a pretreatment Glasgow prognostic score of 0 is associated with better outcomes, and this scoring system may be used as a predictor of outcomes in patients with advanced gastric cancer treated with nivolumab.
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Affiliation(s)
- Nagahiro Tokuyama
- Department of Gastroenterology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Naoki Takegawa
- Department of Gastroenterology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Michiko Nishikawa
- Department of Gastroenterology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Aya Sakai
- Department of Gastroenterology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Takuya Mimura
- Department of Gastroenterology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Saeko Kushida
- Department of Gastroenterology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Hidetaka Tsumura
- Department of Gastroenterology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Yoshinobu Yamamoto
- Department of Gastroenterology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Ikuya Miki
- Department of Gastroenterology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Masahiro Tsuda
- Department of Gastroenterology, Hyogo Cancer Center, Akashi, Hyogo, Japan
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A Nomogram Based on Clinicopathologic Features and Preoperative Hematology Parameters to Predict Occult Peritoneal Metastasis of Gastric Cancer: A Single-Center Retrospective Study. DISEASE MARKERS 2020; 2020:1418978. [PMID: 33376558 PMCID: PMC7746455 DOI: 10.1155/2020/1418978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/22/2020] [Accepted: 11/22/2020] [Indexed: 01/19/2023]
Abstract
Background In patients with gastric cancer (GC), peritoneal metastasis is an indication of the end stage and often indicates a poor outcome. The diagnosis of peritoneal metastasis, especially occult peritoneal metastasis (OPM), remains a challenge for surgeons. This study was designed to explore the relationship between OPM and clinicopathological characteristics and preoperative hematological parameters in patients with GC and to develop a nomogram to predict the probability of OPM before surgery. Methods A total of 672 patients with GC from our center were included, including 583 OPM-negative and 89 OPM-positive patients. These patients were divided into training and validation groups based on when they received treatment. OPM was diagnosed during surgery in patients without any signs of metastasis through imaging examination. Predictive factors were screened by least absolute shrinkage and selection operator logistic regression of all 18 characteristics. The nomogram of OPM was constructed based on these filtered variables. The discriminative and calibration performance of the model were simultaneously evaluated. Results A total of six variables, including tumor size, degree of differentiation, depth of invasion, Glasgow prognosis score, and plasma levels of CA125 and fibrinogen, were selected for integration into the final predictive nomogram. The area under curve (AUC) of the nomogram with six factors was 0.906 (95% confidence interval (CI): 0.872-0.941) and 0.889 (95% CI: 0.795-0.984) in the training and validation groups, respectively. Calibration plots of the nomogram in the two sets revealed a good consistency between predicted and actual probabilities. Decision curve analysis showed that the nomogram had a positive net benefit among all threshold probabilities between 0% and 82%. This nomogram was superior to models incorporating only clinicopathologic or hematologic features. Conclusion Both clinicopathological and preoperative hematological parameters are significantly associated with OPM. The nomogram constructed with six factors could be used to calculate the probability of OPM and identify the high-risk population in GC. This may be helpful for early detection of OPM in patients with GC.
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Peri-operative Outcomes and Survival Following Palliative Gastrectomy for Gastric Cancer: a Systematic Review and Meta-analysis. J Gastrointest Cancer 2020; 52:41-56. [PMID: 32959118 PMCID: PMC7900337 DOI: 10.1007/s12029-020-00519-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Many patients with gastric cancer present with late stage disease. Palliative gastrectomy remains a contentious intervention aiming to debulk tumour and prevent or treat complications such as gastric outlet obstruction, perforation and bleeding. METHODS We conducted a systematic review of the literature for all papers describing palliative resections for gastric cancer and reporting peri-operative or survival outcomes. Data from peri-operative and survival outcomes were meta-analysed using random effects modelling. Survival data from patients undergoing palliative resections, non-resective surgery and palliative chemotherapy were also combined. This study was registered with the PROSPERO database (CRD42019159136). RESULTS One hundred and twenty-eight papers which included 58,675 patients contributed data. At 1 year, there was a significantly improved survival in patients who underwent palliative gastrectomy when compared to non-resectional surgery and no treatment. At 2 years following treatment, palliative gastrectomy was associated with significantly improved survival compared to chemotherapy only; however, there was no significant improvement in survival compared to patients who underwent non-resectional surgery after 1 year. Palliative resections were associated with higher rates of overall complications versus non-resectional surgery (OR 2.14; 95% CI, 1.34, 3.46; p < 0.001). However, palliative resections were associated with similar peri-operative mortality rates to non-resectional surgery. CONCLUSION Palliative gastrectomy is associated with a small improvement in survival at 1 year when compared to non-resectional surgery and chemotherapy. However, at 2 and 3 years following treatment, survival benefits are less clear. Any survival benefits come at the expense of increased major and overall complications.
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Yamaguchi Y, Katata Y, Sano F, Tanioka H, Okawaki M, Yamamura M, Nagasaka T. Adoptive immunotherapy for gastric cancer using zoledronate-activated killer cells: A prospective observational study. Mol Clin Oncol 2020; 13:55. [PMID: 32905239 PMCID: PMC7468212 DOI: 10.3892/mco.2020.2125] [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: 01/14/2020] [Accepted: 07/08/2020] [Indexed: 12/28/2022] Open
Abstract
For several years, adoptive immunotherapy (AIT) has been performed using autologous zoledronate-activated killer (ZAK) cells to develop a novel modality for cancer treatment. In the current study, data from 50 patients with incurable gastric cancer were analyzed. Patients were treated with AIT using intravenous ZAK cells every 3-4 weeks in combination with chemotherapy of the physician’s choice. The possible clinical benefits were subsequently examined. The median overall survival (OS) time of all patients was 7.5 months. In patients that received 5 or more rounds of treatment, the OS was 13.5 months. Additionally, the OS times of 1st, 2nd or later line chemotherapy with ZAK cell AIT were 27.3 months and 13.3 months, respectively. No objective response was observed and the disease control rate was 67.9%. No severe adverse event was recorded. Functional Assessment of Cancer Therapy-Biologic Response Modifier analysis revealed possible improvement of quality of life after ZAK cell AIT. Univariate analysis revealed a significant positive association between longer survival times and baseline lymphocyte percentages in white blood cell counts (P<0.001), serum albumin (P=0.001), C-reactive protein (P=0.006), carbohydrate antigen (CA)19-9 (P=0.010), neutrophil-lymphocyte ratio (P<0.001) and Glasgow prognostic score (GPS). Only the GPS value (P=0.024) was a significant survival marker when analyzed using the multivariate Cox proportional hazards model. Although the results cannot provide a definitive conclusion, the current suggested that ZAK cell AIT in combination with chemotherapy is safe, feasible and may be a promising treatment option for patients with incurable gastric cancer. The GPS value at baseline may be a potential biomarker for chemo-immunotherapy.
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Affiliation(s)
- Yoshiyuki Yamaguchi
- Department of Clinical Oncology, Kawasaki Medical School and Hospital, Kurashiki, Okayama 701-0192, Japan
| | - Yousuke Katata
- Department of Clinical Oncology, Kawasaki Medical School and Hospital, Kurashiki, Okayama 701-0192, Japan
| | - Fuminori Sano
- Department of Clinical Oncology, Kawasaki Medical School and Hospital, Kurashiki, Okayama 701-0192, Japan
| | - Hiroaki Tanioka
- Department of Clinical Oncology, Kawasaki Medical School and Hospital, Kurashiki, Okayama 701-0192, Japan
| | - Makoto Okawaki
- Department of Clinical Oncology, Kawasaki Medical School and Hospital, Kurashiki, Okayama 701-0192, Japan
| | - Masahiro Yamamura
- Department of Clinical Oncology, Kawasaki Medical School and Hospital, Kurashiki, Okayama 701-0192, Japan
| | - Takeshi Nagasaka
- Department of Clinical Oncology, Kawasaki Medical School and Hospital, Kurashiki, Okayama 701-0192, Japan
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Kim MR, Kim AS, Choi HI, Jung JH, Park JY, Ko HJ. Inflammatory markers for predicting overall survival in gastric cancer patients: A systematic review and meta-analysis. PLoS One 2020; 15:e0236445. [PMID: 32716955 PMCID: PMC7384660 DOI: 10.1371/journal.pone.0236445] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/05/2020] [Indexed: 12/18/2022] Open
Abstract
Systemic inflammatory biomarkers have begun to be used in clinical practice to predict prognosis and survival of cancer patients, but the approach remains controversial. We conducted a meta-analysis to determine the predictive value of the c-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and Glasgow prognostic score (GPS)/modified Glasgow prognostic score (mGPS) in the clinical outcome of gastric cancer (GC) patients. We searched literature databases to identify relevant studies. All articles identified in the search were independently reviewed based on predetermined selection criteria. Meta-analysis was conducted to calculate the hazard ratio (HR) and 95% confidence intervals (CI) of overall survival of the included studies. A total of 41 eligible cohort studies, involving a total of 18,348 patients meeting the inclusion criteria, were considered for meta-analysis. Increases in CRP (HR = 1.654, 95% CI: 1.272–2.151), NLR (HR = 1.605, 95% CI: 1.449–1.779), and GPS/mGPS (HR = 1.648, 95% CI: 1.351–2.011) were significantly associated with poorer survival in patients with GC. Substantial heterogeneities were noted in all three markers (I2 = 86.479%, 50.799%, 69.774%, in CRP, NLR, and GPS/mGPS, respectively). Subgroup analysis revealed a significant positive correlation between each marker and poor survival, regardless of country, study quality, cancer stage, study design, or the inclusion of patients undergoing chemotherapy. This meta-analysis demonstrates that CRP, NLR, and GPS/mGPS are associated with poor survival in patients with GC. Further prospective studies using standardized measurements are warranted to conclude the prognostic value of various inflammatory markers.
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Affiliation(s)
- Mi-Rae Kim
- Department of Family Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - A-Sol Kim
- Department of Family Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Department of Family Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Hye-In Choi
- Department of Family Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jae-Hun Jung
- Department of Family Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Ji Yeon Park
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Gastric Cancer Center, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Hae-Jin Ko
- Department of Family Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
- Department of Family Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- * E-mail:
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Nakajima TE, Yamaguchi K, Boku N, Hyodo I, Mizusawa J, Hara H, Nishina T, Sakamoto T, Shitara K, Shinozaki K, Katayama H, Nakamura S, Muro K, Terashima M. Randomized phase II/III study of 5-fluorouracil/l-leucovorin versus 5-fluorouracil/l-leucovorin plus paclitaxel administered to patients with severe peritoneal metastases of gastric cancer (JCOG1108/WJOG7312G). Gastric Cancer 2020; 23:677-688. [PMID: 32036492 DOI: 10.1007/s10120-020-01043-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 01/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Oral fluoropyrimidine plus cisplatin is often not tolerated by patients with severe peritoneal metastases of gastric cancer. Combination of 5-fluorouracil (5-FU), l-leucovorin (l-LV), and paclitaxel (FLTAX) has promising activity for such patients. We conducted a phase II/III study comparing FLTAX with 5-FU/l-LV. METHODS Eligibility criteria included: unresectable or recurrent gastric adenocarcinoma; 20-75 years; performance status (PS) 0-2; peritoneal metastases + ; massive ascites and/or inadequate oral intake; no prior chemotherapy. Patients were randomly assigned to receive 5-FU/l-LV or FLTAX. The primary endpoint of phase III was overall survival: UMIN000010949. RESULTS We enrolled 101 patients. Early deaths occurred in patients with PS 2 having massive ascites and inadequate oral intake simultaneously; the protocol was amended to exclude such patients. Median survival times were 6.1 and 7.3 months for the 5-FU/l-LV and the FLTAX arms, respectively (HR 0.792; 80% CI 0.596-1.053; one-sided p = 0.1445). FLTAX arm had longer progression-free survival (PFS) [1.9 vs 5.4 months (HR 0.64; 95% CI, 0.43-0.96; p = 0.029)]. Grade 3/4 adverse events such as leucopenia and anorexia were more frequently observed in the 5-FU/l-LV arm. In the 5-FU/l-LV arm, two deaths were treatment-related. In the 5-FU/l-LV and FLTAX arms, 12 and 3 deaths occurred within 30 days after the last protocol treatment, respectively. CONCLUSIONS Chemotherapy was indicated for patients with severe peritoneal metastases excluding patients with PS 2 having massive ascites and inadequate oral intake simultaneously. FLTAX did not confer a significant survival benefit but may be preferred because of longer PFS and acceptable toxicity.
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Affiliation(s)
- Takako Eguchi Nakajima
- Department of Clinical Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Kensei Yamaguchi
- Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Narikazu Boku
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Ichinosuke Hyodo
- Department of Gastroenterology, University of Tsukuba, Tsukuba, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group (JCOG) Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroki Hara
- Department of Gastroenterology, Saitama Cancer Center, Saitama, Japan
| | - Tomohiro Nishina
- Department of Gastrointestinal Medical Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Takeshi Sakamoto
- Department of Gastroenterology, Hyogo Cancer Center, Akashi, Japan
| | - Kohei Shitara
- Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Katsunori Shinozaki
- Division of Clinical Oncology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Hiroshi Katayama
- Japan Clinical Oncology Group (JCOG) Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | | | - Kei Muro
- Department of Clinical Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Masanori Terashima
- Department of Gastrointestinal Oncology, Shizuoka Cancer Center, Nagaizumi, Japan
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Hirahara N, Matsubara T, Fujii Y, Kaji S, Hyakudomi R, Yamamoto T, Uchida Y, Miyazaki Y, Ishitobi K, Kawabata Y, Tajima Y. Preoperative geriatric nutritional risk index is a useful prognostic indicator in elderly patients with gastric cancer. Oncotarget 2020; 11:2345-2356. [PMID: 32595832 PMCID: PMC7299529 DOI: 10.18632/oncotarget.27635] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/25/2020] [Indexed: 12/28/2022] Open
Abstract
Background: The geriatric nutritional risk index (GNRI) was developed to evaluate the prognosis in elderly hospitalized patients at risk of malnutrition and related morbidity and mortality. This study aimed to evaluate the relationship between preoperative GNRI and long-term outcomes in elderly gastric cancer patients. Materials and Methods: We retrospectively reviewed 297 consecutive patients aged ≥ 65 years who underwent laparoscopic gastrectomy with R0 resection and evaluated their overall survival (OS) and cancer-specific survival (CSS). Results: In the univariate analyses, OS was significantly associated with the American Society of Anesthesiologists Physical Status (ASA-PS), tumor size, tumor differentiation, pathological stage, carcinoembryonic antigen (CEA), C-reactive protein, postoperative complications, and GNRI, whereas in the univariate analyses of CSS, ASA-PS, tumor size, tumor differentiation, pathological stage, CEA, postoperative adjuvant chemotherapy, and GNRI were significantly associated with poor prognosis. In the multivariate analysis, ASA-PS, tumor differentiation, pathological stage, and GNRI were significant independent prognostic factors of OS, whereas ASA-PS, pathological stage, and CEA were significant independent prognostic factors of CSS. Conclusions: GNRI is significantly associated with OS and CSS in elderly gastric cancer patients and is an independent predictor of OS. It is a simple, cost-effective, and promising nutritional index for predicting OS in elderly patients.
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Affiliation(s)
- Noriyuki Hirahara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Takeshi Matsubara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yusuke Fujii
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Shunsuke Kaji
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Ryoji Hyakudomi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Tetsu Yamamoto
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yuki Uchida
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yoshiko Miyazaki
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Kazunari Ishitobi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yasunari Kawabata
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
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Puhr HC, Pablik E, Berghoff AS, Jomrich G, Schoppmann SF, Preusser M, Ilhan-Mutlu A. Viennese risk prediction score for Advanced Gastroesophageal carcinoma based on Alarm Symptoms (VAGAS score): characterisation of alarm symptoms in advanced gastro-oesophageal cancer and its correlation with outcome. ESMO Open 2020; 5:e000623. [PMID: 32188713 PMCID: PMC7078766 DOI: 10.1136/esmoopen-2019-000623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The prognostic value of symptoms at disease presentation of advanced gastro-oesophageal cancer is unknown. Thus, the aim of this study was to characterise these symptoms and correlate them with the outcome, so new prognostic markers can be defined. METHODS We analysed clinical data including symptoms, therapies and survival of patients with stage IV gastro-oesophageal cancer treated between 2002 and 2018 at the Vienna General Hospital, Austria. Initial symptoms as well as stenosis in endoscopy and HER2 positivity were evaluated in a cross-validation model to ascertain the impact of each variable on patient survival. RESULTS In total, 258 patients were evaluated. Five factors (stenosis in endoscopy, weight loss, HER2 positivity, dyspepsia, ulcer or active bleeding) have proven to be statistically relevant prognostic factors and were given a count of +1 and -1, if applicable. The resulting score ranges between -3 and +2. The survival probability for 180 days with a score of -3/-2, -1, 0, +1 and +2 is 90%, 80%, 73%, 72% and 42%, whereas for 2 years, it is 30%, 30%, 8%, 7% and 3%, respectively. The median overall survival of a score of -3/-2, -1, 0, +1 and +2 was 579 (95% CI 274 to not measurable), 481 (95% CI 358 to 637), 297 (95% CI 240 to 346), 284 (95% CI 205 to 371), 146 (95% CI 120 to 229) days, respectively. CONCLUSION The data from this retrospective study indicate that the Viennese risk prediction score for Advanced Gastroesophageal carcinoma based on Alarm Symptoms score provides independent prognostic information that may support clinical decision making at diagnosis of advanced gastro-oesophageal cancer. Our findings should be evaluated in prospective studies.
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Affiliation(s)
- Hannah Christina Puhr
- Division of Oncology, Medical University of Vienna, Vienna, Austria
- Gastroesophageal Tumors Unit, Comprehensive Cancer Center, Vienna, Austria, Austria
| | - Eleonore Pablik
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Wien, Austria
| | | | - Gerd Jomrich
- Gastroesophageal Tumors Unit, Comprehensive Cancer Center, Vienna, Austria, Austria
- Department of Surgery, Medical University of Vienna, Wien, Austria
| | - Sebastian Friedrich Schoppmann
- Gastroesophageal Tumors Unit, Comprehensive Cancer Center, Vienna, Austria, Austria
- Department of Surgery, Medical University of Vienna, Wien, Austria
| | - Matthias Preusser
- Division of Oncology, Medical University of Vienna, Vienna, Austria
- Gastroesophageal Tumors Unit, Comprehensive Cancer Center, Vienna, Austria, Austria
| | - Aysegül Ilhan-Mutlu
- Division of Oncology, Medical University of Vienna, Vienna, Austria
- Gastroesophageal Tumors Unit, Comprehensive Cancer Center, Vienna, Austria, Austria
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Significance of the Glasgow Prognostic Score in Predicting the Postoperative Outcome of Patients with Stage III Gastric Cancer. J Clin Med 2019; 8:jcm8091448. [PMID: 31547247 PMCID: PMC6780196 DOI: 10.3390/jcm8091448] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/02/2019] [Accepted: 09/10/2019] [Indexed: 12/24/2022] Open
Abstract
This study aimed at investigating the ability of a preoperative Glasgow prognostic score (GPS) to predict postoperative complications and survival outcomes in patients with stage III gastric cancer undergoing D2 gastrectomy. We retrospectively reviewed data from 272 such patients, treated between 2010 and 2016, at a Taiwanese medical center. The patients were categorized according to their GPS. In total, 36.8%, 48.5%, and 14.7% of the patients were assigned to groups with a GPS of 0, 1, and 2, respectively. Overall surgical complication rates in these groups were 30%, 45.5%, and 52.5% (p = 0.016); postoperative intensive care unit admission rates were 10%, 14.4%, and 22.5% (p = 0.15); postoperative 30-day re-admission rates were 6%, 15.2%, and 20% (p = 0.034); and the in-hospital mortality rates were 1.0%, 1.5%, and 10.0%, respectively (p = 0.006). The median survival times of the patients were 42.9 months (95% confidence interval [CI], 29.1-56.6), 22.6 months (95% CI, 19.3-25.8), and 16.6 months (95% CI, 7.8-25.4), respectively (p< 0.001). A significant correlation was observed between the preoperative GPS, short-term postoperative complications, and long-term survival outcomes in patients with gastric cancer undergoing D2 gastrectomy. These findings recommend the usage of the GPS as a predictive and prognostic factor in patients with gastric cancer considering surgical resection.
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15
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Li YF, Nie RC, Wu T, Li SM, Chen S, Wang W, Chen XJ, Chen GM, Chen YB, Zhou ZW, Yuan SQ. Prognostic Value of the Nutritional Risk Screening 2002 Scale in Metastatic Gastric Cancer: A Large-Scale Cohort Study. J Cancer 2019; 10:112-119. [PMID: 30662531 PMCID: PMC6329866 DOI: 10.7150/jca.27729] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/05/2018] [Indexed: 12/26/2022] Open
Abstract
Background: The prognostic value of the nutritional risk screening 2002 (NRS 2002) scale in metastatic gastric cancer remains unclear. We aimed to explore the role of NRS 2002 in metastatic gastric cancer. Methods: In this study, 1664 metastatic gastric cancer patients at our institution between 2000 and 2015 were retrospectively analyzed. The characteristics and clinical outcomes of the included patients were analyzed. Results: Receiver operating characteristic (ROC) curves showed that the regrouping NRS 2002 scale (≤ 3 vs. > 3) provided a similar risk stratification predicting 2-year overall survival (OS) (area under the curves [AUCs]: 0.563 vs. 0.564, P > 0.05) but a better stratification predicting the risk of complications of palliative surgery (AUCs: 0.563 vs. 0.522, P = 0.050) than the original NRS 2002 scale (< 3 vs. ≥ 3). Patients with NRS 2002 > 3 tended to have higher postoperative morbidity (13.3% vs. 8.5%, P = 0.027) and mortality (5.3% vs. 2.0%, P = 0.013) and shorter progression-free survival (PFS) (median PFS: 6.70 vs. 7.70 months, P = 0.002) and overall survival (OS) (median OS: 9.03 vs. 12.63 months, P < 0.001) than those with NRS 2002 ≤ 3. Multivariable analysis demonstrated that the regrouping NRS 2002 scale was the independent prognostic factor for PFS (hazard ratio [HR]: 1.16, P = 0.028) and OS (HR: 1.29, P < 0.001). Conclusions: The present study indicated that the NRS 2002 scale (regrouping scale) was an independent prognostic factor to predict the morbidity, mortality and survival outcomes for metastatic gastric cancer.
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Affiliation(s)
- Yuan-Fang Li
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Run-Cong Nie
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ting Wu
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Shu-Man Li
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Shi Chen
- Department of Gastric Surgery, The 6th Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Wang
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xiao-Jiang Chen
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Guo-Ming Chen
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ying-Bo Chen
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhi-Wei Zhou
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Shu-Qiang Yuan
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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16
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Wang X, Wang N, Wei X, Yu H, Wang Z. REV-ERBα reduction is associated with clinicopathological features and prognosis in human gastric cancer. Oncol Lett 2018; 16:1499-1506. [PMID: 30008829 PMCID: PMC6036475 DOI: 10.3892/ol.2018.8809] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 04/13/2018] [Indexed: 01/05/2023] Open
Abstract
Gastric cancer is a serious threat to human health. Nuclear receptor subfamily 1 group D member 1 (REV-ERBα) is a member of the nuclear hormone receptor family that regulates lipid metabolism, inflammatory responses and circadian rhythms. However, the role of REV-ERBα in the pathogenesis of human gastric cancer is unclear. The present study employed gastric cancer tissues from 74 patients and determined the association between REV-ERBα expression with clinicopathological variables and prognosis. Furthermore, the association between REV-ERBα and apoptosis in undifferentiated and moderately differentiated human gastric cancer cells was determined. It was identified that REV-ERBα expression was decreased in gastric cancer, which was positively associated with poor differentiation (P=0.009), T stage (P=0.001), Tumor-Node-Metastasis (TMN) stage (P=0.001) and lymph node metastasis (P=0.007). In the survival analysis, the 3- and 5-year survival times of patients were significantly associated with REV-ERBα expression (P=0.009 and P=0.002, respectively). Low REV-ERBα expression was associated with poor prognosis (P<0.05). Concurrently, cleaved caspase-3 expression was downregulated, whereas expression levels of Bcl-2 and the Bcl-2/Bax ratio were upregulated in gastric cancer tissues compared with normal tissues. REV-ERBα activator GSK4112 caused apoptosis in SGC-7901 and BGC-823 cell lines. REV-ERBα levels were decreased in human gastric cancer, which was associated with poor differentiation, TMN stages and poor prognosis. REV-ERBα is a potential biomarker for tumor development and prognosis, and a potential therapeutic target for gastric cancer.
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Affiliation(s)
- Xiaoshan Wang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Nana Wang
- Laboratory of Pathophysiology, School of Life Sciences, Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Xiang Wei
- Laboratory of Molecular Biology, Department of Biochemistry, Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Haoyuan Yu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Zhengguang Wang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China
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