Objective
This study aimed to investigate the predictive value of preoperative serum CA19-9 level for lymph node micrometastasis in patients with lymph node metastasis-negative gastric cancer and its effect on prognosis.
Methods
Clinicopathological data were retrospectively collected from 176 cases of gastric cancer who underwent D2 radical surgery in our hospital between January 2006 and December 2011, and also collected the patients’ lymph node tissue specimens. All patients were confirmed by pathologic examination of lymph node metastasis-negative. Quantitative real-time PCR (qRT-PCR) was used to detect the presence of lymph node micrometastasis in lymph node tissues. Sixty cases of gastric cancer were selected to construct the receiver operating characteristic curve (ROC) of preoperative serum CA19-9 level to predict lymph node micrometastasis, then established the threshold value. The remaining 116 cases were used to validate the rationality of this threshold. In addition, we explored the impact of preoperative serum CA19-9 level on the prognosis of patients with lymph node metastasis-negative gastric cancer, and explored the risk factors of lymph node micrometastasis.
Results
① Results of ROC curve: the preoperative serum CA19-9 level of 15.5 U/mL was the threshold for predicting lymph node micrometastasis, with a sensitivity of 93.1%, specificity of 63.6%, and area under the curve (AUC) of 0.84 (P=0.003). With 15.5 U/mL as the threshold, 116 patients were divided into positive group and negative group. The lymph node micrometastasis rates in the 2 groups were different, which was higher in the positive group than that in the negative group (P<0.001). ② Effect of preoperative serum CA19-9 level on prognosis: the patients were divided into the positive group and the negative group with 15.5 U/mL as the threshold, and the log-rank test showed that the survival of the negative group was better than that of the positive group (P=0.001). ③ The risk factors for lymph node micrometastasis: the logistic regression model showed that preoperatively positive serum CA19-9 was an independent risk factor for lymph node micrometastasis in patients with gastric cancer [OR=1.860, 95% CI was (1.720, 2.343), P<0.001].
Conclusion
Preoperative serum CA19-9 level can be used to predict lymph node micrometastasis in lymph node metastasis-negative patients with gastric cancer.
Objective
To study relationship between integrins and carcinogenesis, development, treatment or prognosis of gastric cancer.
Methods
The literatures about integrins and gastric cancer in recent years were reviewed and analyzed.
Results
The current study found that the β1 subunit integrins and αν subline integrins are closely associated with the gastric cancer. The β1 subunit integrins are associated with the invasion and metastasis of the gastric cancer, the αν subline integrins are associated with the typing, grading, and staging of the gastric cancer, and the ανβ3, ανβ5 and ανβ6 are associated with the prognosis of the gastric cancer, further more, the ανβ6 could be used as an independent effective prognostic factor.
Conclusions
Integrins are associated with occurrence, development, treatment, and prognosis of gastric cancer. It′s mechanism such as signal transduction pathway is not completely clarified. With further in-depth research, it′s molecular mechanism would be gradually elucidated and provide new ideas and methods for diagnosis, treatment, and prognosis of gastric cancer.
ObjectiveTo investigate the expression level and the clinical significance of Traf-2 and Nck-interacting protein kinase (TNIK) in gastric cancer tissues.MethodsWe retrospectively collected 78 cases of gastric cancer and its adjacent tissues which were diagnosed by surgery and pathology, all the patients received surgery in the Department of General Surgery in Luoyang Central Hospital Affiliated to Zhengzhou University, from July 2014 to December 2017, as well as 42 cases of gastric ulcer tissues in the same period. The expression of TNIK protein was detected by using immunohistochemical method and Western blot method in 78 cases of human gastric cancer tissues, corresponding adjacent normal tissues, and 42 cases of gastric ulcer tissues, the relationship between expression of TNIK protein and clinicopathologial features of gastric cancer was explored.ResultsThe positive expression rate of TNIK protein in gastric cancer tissues was 66.67% (52/78), and adjacent cancer tissues showed low expression rate of 11.54% (9/78), while it was 21.43% (9/42) in gastric ulcer tissues. On the positive expression rate of TNIK protein, gastric cancer tissues compared with adjacent cancer tissues and gastric ulcer tissues, the difference was statistically significant (P<0.05), however, there was no statistically significant difference between adjacent cancer tissues and gastric ulcer tissues (P>0.05). Western blot method showed that the expression level of TNIK protein in gastric cancer tissues was all significantly higher than that in adjacent cancer tissues and gastric ulcer tissues, the differences were statistically significant (P<0.05), but the difference was not significant when compared the adjacent cancer tissues and gastric ulcer tissues (P=0.772). The expression of TNIK protein was irrelevent to sexual distinction, CEA value, tumor diameter, and pathological type (P>0.05), while it was closely related to patients’ age, TNM stage, differentiation grade, distant metastasis, and lymph node metastasis (P<0.05). The prognosis of patients with positive expression of TNIK protein was worse than that of patients with negative expression of TNIK protein (P<0.05).ConclusionTNIK protein is highly expressed in gastric cancer tissues, which is associated with poorly prognostic factors and poor prognosis, and it may be a therapeutic target in patients with gastric cancer.
ObjectiveTo summarize the research progress of preoperative regional-arterial chemotherapy in advanced gastric cancer.
MethodThe literatures about the research progress of preoperative regional-arterial chemotherapy in the advanced gastric cancer were reviewed.
ResultsThe preoperative regional-arterial chemotherapy in the advanced gastric cancer could decrease the tumour stage, improve the R0 resection rate and the long-term survival rate, effectively improve the drug concentrations of tumor and portal vein, and not only kill or damage cancer cells directly, but also prevent the metastasis of liver and lymph nodes effectively, and reduce the side effects, cause the nuclear pyknosis and fracture of cancer cells in a short time. The course of preoperative regional-arterial chemotherapy in the advanced gastric cancer generally was 4-9 weeks, and then whether the surgery treatment was decided to undergo according to the results of the curative effect evaluation.
ConclusionsThe preoperative regional-arterial chemotherapy in the advanced gastric cancer has more advantages than intravenous chemotherapy, further research of multicenter and large clinical trials, would inaugurate a wider application prospects.
ObjectiveTo explore expression, clinical and biological significance of plasma miRNA-196a from patients with advanced gastric cancer.MethodsReal time quantitative RT-PCR (qRT-PCR) method was used to detect the miRNA-196a levels in tissues and plasma from 75 gastric cancer patients and 35 benign gastric lesions controls. Then clinic pathological correlations of plasma miRNA-196a in 75 gastric cancer patients were analyzed. Twenty-five gastric cancer patients were randomized selected from 75 patients, to compare plasma miRNA-196a levels between preoperation and postoperation. Meanwhile, the effect of miRNA-196a on the invasion ability of gastric cancer MGC-803 cell line was observed in vitro.ResultsThe levels of miRNA-196a in both plasma and tissues from 75 gastric cancer patients were significantly increased compared with 35 benign gastric lesions controls (P<0.000 1). Clinic pathological data of 75 gastric cancer patients showed that the expressions of miRNA-196a were significantly up-regulated in gastric cancer patients with serosal invasion (P<0.001), lymph node metastasis (P=0.004), distant metastasis (P<0.001) and late clinical stage (P<0.001). The expression of miRNA-196a in peripheral plasma of patients with gastric cancer was significantly down regulated after operation (P<0.000 1). In vitro, overexpression of miRNA-196a significantly increased the invasion ability of MGC-803 cells (P<0.05), whereas knockdown of endogenous miRNA-196a significantly inhibited the invasion ability of MGC-803 cells (P<0.05).ConclusionsThe expression of miRNA-196a is up-regulated not only in peripheral plasma of patients with gastric cancer, but also with the progression of gastric cancer (serosal invasion, lymph node metastasis and distant metastasis). The up-regulation of miRNA-196a expression in peripheral plasma is mainly due to the release of primary tumor tissue. miRNA-196a is expected to be a prognostic marker and a potential therapeutic target for advanced gastric cancer.
ObjectiveTo investigate the risk factors of hepatoduodenal lymph node (HDLN) metastasis in patients with advanced gastric cancer and its effect on prognosis.
MethodsClinical datas of patients with advanced gastric cancer who underwent D2 radical gastrectomy for gastric cancer and HDLN dissection between Jan 2011 and Nov 2013 in department of general surgery of Ankang Central Hospital were retrospectively reviewed. Multivariate logistic regression analysis was performed to identify the independent risk factors associated with HDLN metastasis. Survival curves were performed to compare the survival rate of patients with or without HDLN metastasis and of patients with HDLN metastasis or with other lymph node metastasis. A Cox proportional hazards model was used for the multivariate analysis of risk factors for death in advanced gastric cancer.
ResultsThe incidence of HDLN metastasis was 10.7% in patients with advanced gastric cancer. Multivariate logistic regression analyses revealed that the middle or lower stomach cancer (OR=6.014, P=0.002) and stage T3 or T4 (OR=5.133, P=0.021) were independent risk factors for HDLN metastasis. The 2-year overall survival (OS) rate was 36.7% in patients with HDLN metastasis. It was lower in patients with HDLN metastasis compared with those without (P=0.002). Limited to node-positive patients, patients with HDLN metastasis demonstrated decreased 2-year OS rate compared with node-positive patients without HDLN metastasis (P=0.027). Cox proportional hazard analysis identified poorly differentiated or undifferentiated cancer, stage of T3 or T4, and HDLN metastasis were independent poor prognostic factors in the patients with advanced gastric cancer (P < 0.05).
ConclusionsCancer located in the middle or lower stomach, and stage T3 or T4 were independent risk factors for HDLN metastasis in patients with advanced gastric cancer. HDLN metastasis demonstrated a poor prognosis.
Objective
To review recent advancement of the relationship between obesity and gastric cancer.
Method
We searched PubMed, Medline, EMBASE, Cochrane Library databases, CNKI, and WanFang database for recent clinical trials about the impact of obesity on occurrence, surgery outcomes, and prognosis of gastric cancer.
Results
Obesity significantly increased the risk of adenocarcinoma of esophagogastric junction (AEG), increased difficulty in radical operation of gastric cancer and complications of perioperative period, but it had no effect on the long-term operative outcomes. The association between obesity and the survival of gastric cancer was not clear. However, the better survival was observed in most researches of gastric cancer patients with excess body weight.
Conclusions
The relationship between obesity and gastric cancer is very complex, and there is no consistent conclusion. A reasonable body weight by a healthy lifestyle is expected to decline the incidence of AEG.
ObjectiveTo understand the mechanisms of malnutrition in patients with gastric cancer (GC) and which affecting on therapy outcomes, and explore effective nutritional intervention strategies so as to improve general therapy outcomes for patients with GC. MethodThe literature on studies relevant malnutrition in the patients with GC both domestically and internationally was reviewed and analyzed. ResultsThe mechanisms of malnutrition in the patients with GC are complex and diverse, including abnormal tumor metabolism, side effects of treatment, psychological and economic factors, etc. The malnutrition made the mortality and recurrence rates increase, hospital stay prolong, and medical costs elevate, meanwhile led to the multiple complications. The use of various screening tools could effectively assess the malnutrition status at the different therapy stages, then the individualized nutritional therapy plans could be developed based on the assessment results. These plans included oral nutrition, enteral nutrition, parenteral nutrition, and immunonutrition. ConclusionsMalnutrition severely affects the treatment outcomes and quality of life of patients with GC. It is necessary to timely screen and assess. The reasonable nutritional support plan should be chosen based on the patient’s individualized situation. Future research should be needed to explore the long-term efficacy and safety of nutritional support, optimize the application of immunonutrition and parenteral nutrition, and enhance the general treatment outcomes for patients with GC.
Objective
To explore relationship between long non-coding RNA maternally expressed gene 3 (MEG3) polymorphisms and risk of gastric cancer.
Methods
One hundred and seventy-two Han patients with gastric cancer (gastric cancer group) and 224 Han individuals for physical examination (control group) in the Yunnan Cancer Hospital from March 2013 to October 2017 were selected as subjects. The rs7158663 and rs4081134 polymorphisms of the MEG3 were genotyped by using a TaqMan technique. The associations between the 2 polymorphisms and the risk of the gastric cancer and its clinical features were analyzed using the SPSS software.
Results
The frequencies of the AG+AA genotype and the A allele of the MEG3 rs7158663 in the gastric cancer group were significantly higher than those in the control group using the GG genotype and G allele as a reference respectively ［adjusted OR=1.71, 95%CI (1.14, 2.56), P=0.010; adjusted OR=1.58, 95%CI (1.15, 2.19), P=0.005］ after the Chi-square test and the adjustment of age and gender. The frequencies of the AG+AA genotype and the A allele of the MEG3 rs4081134 had no significant differences between the gastric cancer group and the control group (P>0.017). Moreover, the polymorphisms of the MEG3 rs7158663 and rs4081134 were not associated with the clinical features of the gastric cancer (P>0.017).
Conclusion
MEG3 rs7158663 AG+AA genotype might be one of susceptibility gene of gastric cancer in Chinese Han population.
ObjectiveTo explore risk factors for sarcopenia after radical gastrectomy for gastric cancer in older patients. MethodsOlder patients who underwent radical gastrectomy for gastric cancer at Tangshan People’s Hospital from January 2022 to June 2023 were retrospectively collected. The occurrence of sarcopenia was recorded, and factors influencing its development were analyzed. Factors with statistical significance in univariate analysis and clinical relevance were included in a multivariate binary logistic regression model. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminatory ability of significant predictors for sarcopenia occurrence. ResultsA total of 300 older patients underwent radical gastrectomy for gastric cancer were enrolled. Sarcopenia occurred in 74 patients (incidence rate: 24.67%). Multivariate binary logistic regression analysis identified the following independent risk factors for sarcopenia (all P<0.05): American Society of Anesthesiologists (ASA) classification Ⅲ, postoperative chemotherapy, geriatric nutritional risk index (GNRI) <89, body mass index (BMI) <18.5 kg/m2, lack of exercise habits, and lower values of serum total protein, grip strength, skeletal muscle mass index (SMI), 6-meter walking speed, and short physical performance battery (SPPB) score. Among these, factors with an area under the ROC curve (AUC) >0.7 were serum total protein, SMI, and 6-meter walking speed. The combined model integrating all ten factors achieved an AUC of 0.937 (sensitivity 96.65%; specificity 89.71%; Youden index 0.864). ConclusionsThis study reveals a high incidence of sarcopenia after radical gastrectomy in older patients with gastric cancer. The risk of sarcopenia is multifactorial, involving surgical tolerance (ASA classification), postoperative therapy (chemotherapy), nutritional status (GNRI and BMI), exercise habits, and various muscle-related functional indicators (serum total protein, grip strength, SMI, walking speed, and SPPB score). The combined predictive model shows potential for early identification of high-risk patients.
