1
|
Huang L, Wang L, Shi Y, Zhao Y, Xu C, Zhang J, Hu W. Brain metastasis from gastric adenocarcinoma: A large comprehensive population-based cohort study on risk factors and prognosis. Front Oncol 2022; 12:897681. [PMID: 36338733 PMCID: PMC9635449 DOI: 10.3389/fonc.2022.897681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 09/14/2022] [Indexed: 01/19/2023] Open
Abstract
Aims Although brain metastasis from gastric adenocarcinoma (GaC) is rare, it may significantly affect survival and quality of life. The aim of this large, comprehensive, population-based cohort investigation was to investigate factors that were associated with brain metastasis from GaC and to explore the prognostic factors and time-dependent cumulative mortalities among cases with GaC and brain involvement. Methods Population-based information on cases with GaC diagnosed from 2010 to 2016 was obtained from a large-scale database. Factors that were associated with brain metastasis were investigated utilizing multivariable logistic regression. Time-dependent tumor-specific mortalities of cases with GaC and brain involvement were then computed utilizing the cumulative incidence functions (CIFs), and mortalities were compared between subgroups utilizing Gray's test. Factors that were associated with death were further evaluated utilizing multivariable Fine-Gray subdistribution hazard regression. Results Together, 28,736 eligible cases were included, which comprised 231 (1%) cases with brain metastasis and 10,801 (38%) with metastasis to other sites, encompassing a follow-up of 39,168 person-years. Brain metastasis occurred more often among younger patients (within overall cancers), in cases with stomach cardia tumors, within cases with signet-ring cell carcinoma (within overall cancers), and within cases with positive lymph nodes (within overall tumors); it was less often detected among black people. Brain involvement was associated with more lung and bone metastases. The median survival time of cases having brain metastasis was only 3 months; the 6- and 12-month tumor-specific cumulative mortalities were 57% and 71%, respectively. Among cases with GaC and brain metastasis, those with gastric cardia cancers (when receiving radiotherapy), those undergoing resection, and those receiving chemotherapy had lower mortality risks, while younger patients (when receiving chemotherapy or radiotherapy) and people with positive lymph nodes (when receiving radiotherapy) had higher death hazards. Conclusion Among patients with GaC, brain metastasis was correlated with several clinical and pathological variables, including ethnicity, age, cancer histology, location, lymph node involvement, and metastases to other sites. Cases having brain metastasis had poor survival that was correlated with age, cancer location, lymph node metastasis, and management. These findings offer vital clues for individualized patient care and future mechanistic explorations.
Collapse
Affiliation(s)
- Lei Huang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Medical Center on Aging of Ruijin Hospital (MCARJH), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Wang
- Medical Center on Aging of Ruijin Hospital (MCARJH), Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Shi
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yajie Zhao
- Medical Center on Aging of Ruijin Hospital (MCARJH), Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenying Xu
- Medical Center on Aging of Ruijin Hospital (MCARJH), Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Zhang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Jiao Tong University, Shanghai, China
| | - Weiguo Hu
- Medical Center on Aging of Ruijin Hospital (MCARJH), Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
2
|
Huang L, Shi Y. Editorial: The use of chemotherapy in treating gastric cancers. Front Oncol 2022; 12:974023. [PMID: 35957891 PMCID: PMC9360789 DOI: 10.3389/fonc.2022.974023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/06/2022] [Indexed: 01/28/2023] Open
Affiliation(s)
- Lei Huang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Medical Center on Aging of Ruijin Hospital, Medical Center on Aging of Ruijin Hospital (MCARJH), Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Lei Huang, ; Yan Shi,
| | - Yan Shi
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Lei Huang, ; Yan Shi,
| |
Collapse
|
3
|
Huang L, Zhao Y, Shi Y, Hu W, Zhang J. Bone Metastasis From Gastric Adenocarcinoma-What Are the Risk Factors and Associated Survival? A Large Comprehensive Population-Based Cohort Study. Front Oncol 2022; 12:743873. [PMID: 35402215 PMCID: PMC8989732 DOI: 10.3389/fonc.2022.743873] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 02/28/2022] [Indexed: 01/19/2023] Open
Abstract
Background While bone metastasis is not common in gastric adenocarcinoma (GaC), it can have important impacts on prognosis. This large cohort study aimed at exploring factors associated with bone metastasis in GaC and investigating the time-dependent cumulative mortalities and prognostic factors in GaC patients with bone metastasis at the population level. Methods Data on patients with GaC diagnosed in 2010–2016 were retrieved from a large population-based database. We explored factors associated with bone metastasis using the multivariable-adjusted logistic model. We then calculated the time-dependent cancer-specific mortalities in GaC patients with bone metastasis using the cumulative incidence function and compared mortalities across subgroups using Gray’s test. We further assessed factors associated with mortality using the multivariable-adjusted Fine–Gray subdistribution hazard model. Results Together 11,072 eligible patients with metastatic GaC were enrolled, which comprised 1,511 (14%) people with bone metastasis and 9,561 (86%) with other metastasis, encompassing 6,999 person-years of follow-up. Bone metastasis was more frequently detected in 2014 or later, in younger patients, in patients with gastric cardia cancers, in people with signet-ring cell carcinoma, and in those with poorly differentiated/undifferentiated cancers; it was less commonly observed in black patients. Bone metastasis was associated with more frequent brain and lung metastases. The median survival of patients with bone metastasis was 4 months; the 6-month and 3-year cancer-specific cumulative mortalities were 56% and 85%, respectively. In patients receiving chemotherapy, American Indians/Alaskan Natives, patients with gastric antrum/pylorus cancers, and those with positive lymph nodes had higher mortality risks, while those undergoing resection had lower mortality hazards. Conclusion In GaC patients, bone metastasis was associated with various clinicopathologic factors including age, ethnicity, tumor location, histology, differentiation, and metastasis to other sites. Patients with bone metastasis had poor prognosis which was associated with ethnicity, tumor location, lymph node involvement, and treatment. Our findings provide important hints for tailed patient management and for further mechanistic investigations.
Collapse
Affiliation(s)
- Lei Huang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yajie Zhao
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Medical Center on Aging of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Shi
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiguo Hu
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Medical Center on Aging of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Zhang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,State Key Laboratory of Oncogenes and Related Genes, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
4
|
Expression and significance of Her2 and Ki-67 in gastric adenocarcinoma without distant metastasis: a cohort study. BMC Gastroenterol 2020; 20:343. [PMID: 33059614 PMCID: PMC7566118 DOI: 10.1186/s12876-020-01484-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 10/06/2020] [Indexed: 01/19/2023] Open
Abstract
Background The significance of human epidermal growth factor receptor 2 (Her2) and nucleus-associated antigen Ki-67 expression remains controversial in gastric adenocarcinoma (GaC). The aim of this study was to investigate the expression and clinicopathologic and prognostic significance of Her2 and Ki-67 in resected GaC without distant metastasis. Methods Malignant tissues and clinicopathologic data were obtained from 195 patients with resected non-metastatic GaC. Immunohistochemistry staining was performed to examine the expression of Her2 and Ki-67; their association with clinicopathologic factors were investigated using logistic regression, and their association with survival was explored using Kaplan–Meier analysis and Cox proportional hazards regression. Results Her2 was majorly expressed in cell membrane and Ki-67 in cell nucleus in non-metastatic GaC. Stronger Her2 expression was significantly associated with better tumor differentiation, neurovascular invasion, less advanced pathological tumor (pT) stage, and more advanced pathological node (pN) stage; while Ki-67 expression was not significantly associated with any investigated clinicopathologic factors. Patients with both negative Her2 and negative Ki-67 expression had poorer tumor differentiation, and more advanced pT and pathological tumor-node-metastasis (pTNM) stages; the association with pT and pTNM stages were further confirmed by multivariable analyses, especially in node-negative disease. Her2 or Ki-67 alone was not significantly associated with pTNM stage. A strongly positive (+++) Her2 expression was associated with poorer survival in multivariable analysis only (P = 0.047); while Ki-67 or combined expression was not significantly associated with prognosis. Conclusions In non-metastatic GaC, Her2 expression and combined expression of Her2 and Ki-67 were associated with several clinicopathologic factors including tumor differentiation and stage, and only a +++ Her2 expression was associated with poorer prognosis in multivariable analysis with marginal significance in this study; while Ki-67 alone had both limited clinicopathologic and prognostic values.
Collapse
|
5
|
Zheng Z, Shang Y, Xu R, Zhang H, Yin J, Zhang J, Zhang Z. Risk factors and prognosis in patients with adenocarcinoma of esophagogastric junction with lymph node metastasis of Siewert II/III. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:1262-1269. [PMID: 32509102 PMCID: PMC7270673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
Adenocarcinoma of the esophagogastric junction (AEG) has a high incidence, while the extent of lymph node dissection and prognosis are still controversial. This study aimed to explore the risk factors of lymph node metastasis and prognosis in Siewert II/III AEG patients. Between July 2013 and May 2017, a total of 65 patients who underwent surgical operation in Beijing Friendship Hospital were retrospectively reviewed. The patients were followed up until September 2017. Data were analyzed using logistic regression. Survival analyses were performed using Kaplan-Meier. Multivariate analysis revealed that histologic classification (OR=3.437, 95% CI: 1.046~11.294, P=0.042) and intravascular cancer embolus (OR=6.614, 95% CI: 1.942~22.524, P=0.003) were correlated with lymph node metastasis. The lymph nodes No. 1, 2, 3, 7, 11 and 110 indicated higher metastatic rate. The 3-year overall survival analysis revealed that lymph node metastasis (P=0.167) and tumor stage (P=0.429) exhibited no significant differences. Findings suggest that histologic type and vascular neoplasia are independent risk factors for lymph node metastasis. For Siewert II/III AEG patients, it is reasonable to perform radical gastrectomy combined with D2 lymph node dissection. For No. 110 lymph nodes should be dissected routinely. However, the long-term prognosis remains to be further studied.
Collapse
Affiliation(s)
- Zhi Zheng
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical UniversityBeijing, China
- Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive DiseasesBeijing, China
| | - Yuxi Shang
- Department of Hepatology, Fuxing Hospital, Eighth Clinical Medical College, Capital Medical UniversityBeijing, China
| | - Rui Xu
- Department of Pathology, Beijing Friendship Hospital, Capital Medical UniversityBeijing, China
| | - Haiqiao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical UniversityBeijing, China
- Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive DiseasesBeijing, China
| | - Jie Yin
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical UniversityBeijing, China
- Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive DiseasesBeijing, China
| | - Jun Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical UniversityBeijing, China
- Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive DiseasesBeijing, China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical UniversityBeijing, China
- Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive DiseasesBeijing, China
| |
Collapse
|
6
|
Huang L, Chen L, Gui ZX, Liu S, Wei ZJ, Xu AM. Preventable lifestyle and eating habits associated with gastric adenocarcinoma: A case-control study. J Cancer 2020; 11:1231-1239. [PMID: 31956369 PMCID: PMC6959061 DOI: 10.7150/jca.39023] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/14/2019] [Indexed: 01/19/2023] Open
Abstract
Background: Besides the well-established risk factors for gastric adenocarcinoma (GaC), many other etiological factors remain largely unexplored. This large comprehensive case-control study aimed to investigate the preventable lifestyle and eating habits associated with GaC. Methods: Consecutive patients with primary microscopically-confirmed GaC diagnosed in 2016-2018 were matched by sex, age, height, and socioeconomic status at a 1:1 ratio with healthy controls. Association of GaC versus control with investigated factors was assessed using the multivariable-adjusted conditional logistic regression for paired samples. Results: Together 302 GaC patients and 302 healthy controls were investigated. Participants receiving higher education and those eating majorly vegetables had less frequently GaC. The majorly frying cooking habit was associated with a higher incidence of GaC. People complaining about poor sleep quality had more often GaC. The more often one smoked, the more often he/she had GaC. A higher frequency for having pickled food was associated with more frequent GaC, while having more frequently vegetables/fruit, beans, or kelps was associated with less often GaC. A greater preference for sour or bitter taste was associated with less frequent GaC. The frequencies of thin liquid intake after meal, swallowing hot food without adequate cooling, doing other things while eating, eating overnight food, and eating midnight snack were all positively associated with GaC, while going to bed regularly was associated with less often GaC. Conclusions: Education level, sleep quality, smoking, the frequencies of use of several foods and seasonings, the preference for specific tastes, and various eating and living habits were associated with GaC. The findings offer important hints for further prospective investigations and for easy effective GaC-preventative strategy-making.
Collapse
Affiliation(s)
- Lei Huang
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University
| | - Lei Chen
- Second Clinical Medicine College of Anhui Medical University
| | - Zhong-Xuan Gui
- Second Clinical Medicine College of Anhui Medical University
| | - Shun Liu
- Second Clinical Medicine College of Anhui Medical University
| | - Zhi-Jian Wei
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University
| | - A-Man Xu
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University
| |
Collapse
|
7
|
Huang L, Liu H, Yu J, Lin T, Hu YF, Li TJ, Li GX. Long-Term Outcomes in Laparoscopic D2 Gastrectomy for Gastric Cancer: a Large Comprehensive Study Proposing Novel Hypotheses. J Gastrointest Surg 2019; 23:1349-1361. [PMID: 30478532 DOI: 10.1007/s11605-018-4008-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/09/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The long-term outcomes of laparoscopic gastrectomy (LG) versus open gastrectomy (OG) for gastric cancer (GC) remain obscure, especially for advanced cancer and disease affecting the upper stomach and in older patients. This study aimed to comprehensively assess the long-term efficacy of LG for GC using a large prospective database. METHODS Totally, 1877 consecutive patients (1186 receiving LG and 691 OG) operated in 2004-2016 were analyzed, with a median follow-up of 63 months. Association of LG versus OG with disease-specific survival (DSS) and disease-free survival (DFS) overall and in various subgroups were investigated using multivariable Cox regression. Propensity score matching (PSM) was performed for sensitivity analysis. RESULTS Before PSM, overall, there was no significant association of LG versus OG with survival after multivariable adjustment; however, in subgroup analyses, LG was associated with superior DSS in patients aged ≥ 70 years and those with upper GC. No significant associations regarding DFS were observed overall or in stratifications. PSM analyses revealed that LG was associated with better DSS also in patients aged ≥ 70 years (hazard ratio (HR) = 0.33, 95% confidence interval (CI) = 0.15-0.72) and in those with upper GC (HR = 0.51, 95% CI = 0.29-0.91), and with better DFS in those with upper GC (HR = 0.60, 95% CI = 0.37-0.99). Multivariable analysis showed that age, hepatitis B, performance status, tumor histology, stage, and vascular invasion were significantly associated with post-LG survival. LG-specific nomograms were then constructed with concordance indexes of 0.814 (DSS) and 0.809 (DFS) and excellent calibration. CONCLUSIONS In this large institutional analysis, while LG for GC was associated with DSS and DFS similar to those for OG overall, non-inferior LG-associated survival especially DSS was observed in some subgroups rarely investigated in prospective or randomized settings. There could still be biases even after PSM due to confounders not accounted for in this observational study. However, these findings offer novel hypotheses for further validation.
Collapse
Affiliation(s)
- Lei Huang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
| | - Hao Liu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Jiang Yu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Tian Lin
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Yan-Feng Hu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Tuan-Jie Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
| | - Guo-Xin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
| |
Collapse
|
8
|
Zhang JW, Huang L, Xu AM. Preoperative monocyte-lymphocyte and neutrophil-lymphocyte but not platelet-lymphocyte ratios are predictive of clinical outcomes in resected patients with non-metastatic Siewert type II/III adenocarcinoma of esophagogastric junction: a prospective cohort study (the AMONP corhort). Oncotarget 2017; 8:57516-57527. [PMID: 28915691 PMCID: PMC5593663 DOI: 10.18632/oncotarget.15497] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/07/2017] [Indexed: 12/26/2022] Open
Abstract
AIMS To propectively reveal the clinicopathological and prognostic significances of monocyte-lymphocyte ratio (MLR), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in resected patients with non-metastatic Siewert type II/III adenocarcinoma of esophagogastric junction (AEG). METHODS A total of 611 patients diagnosed with Siewert type II/III AEG and undergoing surgery between 2006 and 2011 were prospectively followed-up until April 2016. Associations between preoperative peripheral MLR, NLR, and PLR and clinicopathological parameters were quantified using the multivariate Logistic regression model with adjustment. The correlation between the 3 ratios and cancer-specific survival (CSS) was investigated using the univariate and adjusted multivariate Cox regression models with stratifications. The periodical survival rates for the low- and high-level arms were obtained using the Kaplan-Meier method. RESULTS We set the medians (0.223, 2.22, and 124.4) as the cut-off values of preoperative MLR, NLR, and PLR, respectively. MLR was higher in male patients and those > 63 years; PLR was higher in patients with type II tumors. The (marginally-)significantly inverse ratio-CSS association was detected in male patients, those ≤ 63 years, those with type III tumors, and those with pTNM stage III tumors for MLR, and in female patients, those > 63 years, those with type III tumors, those with vessel invasion, and those with stage III tumors for NLR, but was generally negative concerning PLR. The association majorly existed in type III and pTNM stage III tumors. CONCLUSION MLR and NLR might be prognostic factors for patients with non-metastatic Siewert type II/III AEG, while PLR had limited significance.
Collapse
Affiliation(s)
- Jia-Wei Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lei Huang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A-Man Xu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China
| |
Collapse
|
9
|
Huang L, Wei ZJ, Li TJ, Jiang YM, Xu AM. A prospective appraisal of preoperative body mass index in D2-resected patients with non-metastatic gastric carcinoma and Siewert type II/III adenocarcinoma of esophagogastric junction: results from a large-scale cohort. Oncotarget 2017; 8:68165-68179. [PMID: 28978106 PMCID: PMC5620246 DOI: 10.18632/oncotarget.19251] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/16/2017] [Indexed: 02/06/2023] Open
Abstract
Objective To prospectively investigate associations of presurgical body mass index (BMI) with clinicopathological factors and its prognostic significance in radically D2-resected patients with non-metastasized gastric cancer (GC) and Siewert type II/III adenocarcinoma of esophagogastric junction (AEG). Methods A large prospective cohort consisting of radically-resected GC and AEG patients was analyzed. Follow-up was successful in 671 out of 700 patients, who were categorized into underweight (BMI<18.5), normal-weight (BMI=18.5-22.9), overweight (BMI=23-24.9), and obese (BMI≥25) groups according to Asian standards. BMI-associated factors were explored using multivariable logistic regression with adjustment. Cancer-specific survival analyses were conducted applying both univariable and multivariable Cox regression methods. Results Pre-operation, higher hemoglobin levels and smaller anemia proportions were observed in larger BMI groups. Higher BMI tended to be associated with higher neutrophil-lymphocyte ratios (NLRs). Patients with higher BMI had smaller tumors and more often stage I tumors, but longer surgical time and postsurgical stay. In multivariable analyses, higher hemoglobin levels, upper tumor location, poorer differentiation, and higher NLR were significantly associated with higher BMI. Overall, survival analyses revealed no significant role of BMI. However, in further stratifications after adjustment, compared to patients with normal BMI, obese patients had better survival in women, but worse in those with AEG; underweight was associated with reduced mortality risk in tumors differentiated well to moderately; overweight patients had increased death hazard when having thrombocytopenia. Conclusion Overall, preoperative BMI had limited prognostic significance in operated GC patients. However, under specific conditions (e.g., female, AEG, good differentiation, and thrombocytopenia), BMI might indicate postoperative survival.
Collapse
Affiliation(s)
- Lei Huang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhi-Jian Wei
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tuan-Jie Li
- Department of General Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, China
| | - Yu-Ming Jiang
- Department of General Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, China
| | - A-Man Xu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Department of General Surgery, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China
| |
Collapse
|
10
|
Ding BC, Xu AM, Ye ZQ, Han WX, Wei ZJ, Chen ZM, Yuan X, Liu H. Value of transabdominal ultrasoud in preoperative assessment of adenocarcinoma of the esophagogastric junction. Shijie Huaren Xiaohua Zazhi 2016; 24:3612-3617. [DOI: 10.11569/wcjd.v24.i24.3612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the value of transabdominal ultrasound (TUS) in the preoperative assessment of adenocarcinoma of the esophagogastric junction (AEG).
METHODS A total of 65 patients who underwent TUS and computed tomography (CT) preoperatively and were pathologically diagnosed with AEG after surgery from December 2014 to May 2016 were included in this study. The TUS or CT results were compared with pathological findings.
RESULTS With regard to Siewert's classification, the diagnostic accuracy of TUS in AEG was 90.8% (85.7% for type Ⅰ and 92.2% for non-type Ⅰ). The accuracy of TUS and CT in T-staging of AEG was 33.8% and 63.1%, respectively, and there was a significant difference between the two diagnostic modalities (P < 0.05), although there was no significant difference in accuracy of N-staging and M-staging between CT and TUS (P > 0.05). For those who were preoperatively diagnosed with poorly differentiated adenocarcinoma, there was no significant difference in the accuracy of T-staging of AEG between TUS and CT (P > 0.05).
CONCLUSION TUS is an available tool for the typing of AEG, which is useful for deciding surgical approaches. TUS has high value in preoperative N- and M-staging, and for patients who are preoperatively diagnosed with poorly differentiated adenocarcinoma, both TUS and CT can be used in preoperative TNM-staging.
Collapse
|
11
|
Huang L, Xu AM, Peng Q. CD147 and MMP-9 expressions in type II/III adenocarcinoma of esophagogastric junction and their clinicopathological significances. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:1929-1937. [PMID: 25973085 PMCID: PMC4396308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 01/28/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To investigate CD147 and matrix metalloproteinase-9 (MMP-9) expressions in type II/III adenocarcinoma of esophagogastric junction (AEG), and their clinicopathological significances. METHODS Seventy-four patients clinically and pathologically diagnosed with type II/III AEG were analyzed, each undergoing radical total gastrectomy and Roux-en-Y esophagojejunostomy. The avidin streptavidin-perosidase immunohistochemistry technique was used to detect CD147 and MMP-9 in type II/III AEGs and 20 para-tumor controls, and their correlations with clinicopathological data and their reciprocal relationship were then analyzed. Kaplan-Meier survival analysis was conducted to reveal their prognostic significances. SPSS 20.0 was used for data analysis. A difference was statistically significant with P < 0.05, and very significant with P < 0.01. RESULTS In type II/III AEG CD147 and MMP-9 were mainly expressed on cellular membrane of in tumor cell cytoplasm. MMP-9 expression was significantly stronger at tumor-stroma junction and front edge of invasion. Their positive rates were significantly higher in malignant tissues than para-tumor tissues (P < 0.01 for both). There existed a significant positive correlation between both expressions (P < 0.05). They were significantly more highly expressed in cancers with lymphatic metastasis (P < 0.01 for both), at TNM III/IV stages (P < 0.01 for both), and with poor differentiation grade (P < 0.05 for both). Higher CD147 and MMP-9 expression rates were correlated with inferior postsurgical survivals (P < 0.05 for both). CONCLUSIONS CD147 and MMP-9 could be novel biomarkers for type II/III AEG, and potentially predict tumor progression and prognosis. They are worth further investigation.
Collapse
Affiliation(s)
- Lei Huang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical UniversityHefei, China
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of Anhui Medical UniversityHefei, China
| | - A-Man Xu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical UniversityHefei, China
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of Anhui Medical UniversityHefei, China
| | - Qiang Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical UniversityHefei, China
| |
Collapse
|