Is ERAS effective and safe in laparoscopic gastrectomy for gastric carcinoma? A meta-analysis.

BACKGROUND: It is still unclear whether enhanced recovery after surgery is effective and safe in laparoscopic gastrectomy for gastric carcinoma. METHODS: Cochrane library databases, Medline, Embase, and Pubmed were searched from January 1, 1986, to December 31, 2016. Randomized controlled trials (RCTs) comparing fast-track recovery with conventional recovery strategies in laparoscopic radical gastrectomy for gastric carcinoma were included. The main outcomes measured were postoperative hospital stay, time to first flatus, hospital charge, and overall complication rate. RESULTS: Six RCTs with 400 patients were included in this study. Fast-track surgery has shorter postoperative hospital stays (weighted mean difference (WMD) - 2.65; 95% CI, - 4.01 to - 1.29, z = 3.82, P < 0.01) and less hospitalization expenditure (WMD - 523.43; 95% CI, - 799.79 to - 247.06, z = 3.71, P < 0.01) than conventional recovery strategies. There was no significant difference with respect to duration to first flatus (WMD - 17.72; 95% CI, - 39.46-4.02, z = 1.60, P = 0.11) and complication rate (OR 1.57; 95% CI, 0.82-2.98, z = 1.37, P = 0.17). CONCLUSIONS: Enhanced recovery after surgery is effective and safe and is thus recommended in laparoscopic radical gastrectomy for gastric carcinoma.

[Cross-sectional study of characteristics and prognosis of patients with familial gastric cancer].

OBJECTIVE: To screen and collect the familial gastric cancer (FGC) kindreds for exploring its clinicopathological characteristics and prognosis. METHODS: A cross-sectional study was performed among 3640 patients with gastric cancer at 5 hospitals in Guangdong province between 2000 and 2007 and FGC kindreds were diagnosed according to the Amsterdam criteria. Their pedigree features and cancer incidence were analyzed. Clinical characteristics and prognosis were compared between FGC and sporadic gastric cancer (SGC) patients. Survival curves and overall five-year survival rates were established according to the Kaplan-Meier and Log-rank methods. Hazard ratios for death were calculated by Cox regression analysis. RESULTS: A total of 112 FGC kindreds (3.1%) were diagnosed among 3640 gastric cancer patients. In these 112 FGC families, 182 malignant tumors were diagnosed in the first- and second-degree relatives. Gastric cancer (n = 154, 84.6%), esophageal cancer (n = 8, 4.4%) and lung cancer (n = 6, 3.3%) were most common tumors. Tumor types in male proband families did not differ from those in female counterparts (P = 0.644). Most tumors occurred in the first-degree relatives and the ratio of male-to-female was 106:44. The mean age of FGC patients at 54 years was 10 years younger than that of SGC patients. No differences existed in tumor size, tumor location, Borrmann type, pT or pN between the FGC and SGC patients. The overall 5-year survival was 56.0% for FGC patients and 48.8% for SGC patients. Univariable (P = 0.287) and multivariable (HR = 1.101, P = 0.807) analyses demonstrated that FGC was not a significant prognostic factor. CONCLUSIONS: Gastric cancer is the most common cancer in FGC families. The first-degree male relatives are at a high risk of developing gastric cancer. Not particular clinical characteristics but pedigree examination facilitates the diagnosis of FGC.

[Value of spiral CT plus endoscopic ultrasonography (EUS) and spiral CT plus PET-CT in the preoperative assessment of gastric cancer invasion to the pancreas].

OBJECTIVE: To evaluate the value of EUS and PET-CT in combination with spiral CT in preoperative assessment of gastric cancer invasion to the pancreas. METHODS: Sixty advanced gastric cancer patients with suspected pancreatic invasion detected by spiral CT were selected in this study. All the 60 cases were then examined by EUS and 14 of them by PET-CT. The results were compared and evaluated with the findings during surgical operation and pathological results. RESULTS: The rate of correct preoperative diagnosis of pancreatic invasion by spiral CT in advanced gastric cancer patients was 63.3%, with an overdiagnosis rate of 36.7%. The diagnostic accuracy was increased to 87.8% and overdiagnosis reduced to 7.3%, when combined with EUS. There was a significant difference in diagnostic accuracy between spiral CT alone and spiral CT combined with EUS (P<0.01), but no significant difference between spiral CT alone and spiral CT combined with PET-CT (P>0.05). Spiral CT-EUS was more valuable in assessment of tumor location and invasion than PET-CT (P<0.01). CONCLUSION: The accuracy of spiral CT alone in the preoperative assessment of advanced gastric cancer with invasion to the pancreas is not high enough yet at present. Spiral CT combined with EUS can provide more accurate information on the tumor location, invasion site and extent of gastric cancer invasion to the pancreas, and reduce the overstaging rate caused by spiral CT alone. However, spiral CT combined with PET-CT does not show such improvement significantly.

[Associations of E-cadherin gene (CDH1) and hereditary gastric cancer in China].

OBJECTIVE: To investigate the protein expression, methylation promoter, somatic and germ-line mutations of E-cadherin gene (CDH1) in hereditary gastric cancer in China and to investigate its possible roles. METHODS: Eight probands diagnosed with ICG-HGC criterion were enrolled in our database from June 1994 to October 2007. Tumor tissues were detected for CDH1 expression by using immunohistochemistry (IHC) methods. CDH1 DNA sequencing was performed for all its 16 exons both in tumor and normal tissues of the same patients to detect somatic and germ-line mutations. Methylation promoter study was performed by using specific primers and polymerase chain reaction (PCR) methods. RESULTS: IHC analysis confirmed that the CDH1 expression was negative in 7 probands and downregulated in the other on proband. Six mutations in five probands were found with DNA sequencing: two silent mutations and four missense mutations. All six mutations were absent in normal tissues, thereby excluded its presence in germ-line cells. Both DNA missense mutations and gene silencing through promoter methylation was found in 4 probands. Two probands has only promoter methylation and one proband had only silent mutation. No DNA missense mutations or promoter methylation was found in one proband. CONCLUSIONS: CDH1 gene germ-line mutations are relatively rare in hereditary gastric cancer in China, and whereas CDH1 somatic mutations and promoter methylation synergistically induce CDH1 downregulation in these patients.

Comparison of patients by family history with gastric and non-gastric cancer.

AIM: To compare the gastric cancer (GC) patients by their family history with gastric and non-GC. METHODS: Positive family histories within second-degree relatives and clinicopathological features were obtained for 256 patients. RESULTS: Of the 256 probands, 112 (76 male, 36 female) were incorporated into familial GC (FGC) group: at least two GC members; 144 (98 male, 46 female) were included in the non-FGC group (relatives only affected with non-GCs). Of 399 tumors in relatives (181 from FGC against 212 from non-FGC), GC was the most frequent, followed by esophageal, hepatocellular, and colorectal cancer. Nasopharyngeal cancer was next to lung cancer but prior to breast and urogenital cancers. Most affected members aggregated within first-degree relatives (FGC: 66 siblings, 48 fathers, 31 mothers, four offspring; non-FGC: 56 fathers, 55 siblings, 43 mothers, and 15 offspring). The ratio of males to females in affected first-degree relatives was usually higher in male probands. Paternal history of GC was a slight risk for GC in males (OR = 1.19, 95% CI: 0.53-2.69), while risk of GC by maternal history of non-GCs was increased in females (OR = 0.46, 95% CI: 0.22-0.97). Diffuse-GC was the major histological type in all subgroups. Difference in tumor sites between the two groups was derived from an excess of upper sites in non-FGC female probands. CONCLUSION: Distribution of associated non-GCs in a family history of GC may vary with geographic areas. GC may have different genetic and/or environmental etiology in different families, and a certain subtype may be inherited in a female-influenced fashion.

Methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphisms and the risk of primary hepatocellular carcinoma (HCC) in a Chinese population.

OBJECTIVES: Methylenetetrahydrofolate reductase (MTHFR), which is expressed in the liver, may be involved in both DNA methylation and DNA synthesis. It is also indicated as a potential risk factor of liver cancer in patients with chronic liver disease. To date, no study has been conducted on MTHFR and hepatocellular carcinoma (HCC) using a population-based design. The objective of this study was to evaluate the effects of polymorphisms of the MTHFR gene on the risk of primary liver cancer and their possible effect modifications on various environmental risk factors. METHODS: A population-based case-control study was conducted in Taixing, China. MTHFR C677T and A1298C were assayed by PCR-RFLP techniques. RESULTS: The frequency of MTHFR 677 C/C wild homozygotes genotype was 25.8% in cases, which was lower than that in controls (34.5%). The adjusted odds ratios (ORs) for the MTHFR 677 C/T and T/T genotype were 1.66(95% CI: 1.06-2.61), 1.21(95% CI: 0.65-2.28) respectively when compared with the MTHFR 677 C/C genotype. Subjects carrying any T genotype have the increased risk of 1.55(95% CI: 1.01-2.40) for development of primary hepatocellular carcinoma. A high degree of linkage disequilibrium was observed between the C677T and A1298C polymorphisms, with the D' of 0.887 and p < 0.01. The MTHFR 677 any T genotype was suggested to have potentially more than multiplicative interactions with raw water drinking with p-value for adjusted interaction of 0.03. CONCLUSION: We observed that the MTHFR 677 C/T genotype was associated with an increased risk of primary liver cancer in a Chinese population. The polymorphism of MTHFR 677 might modify the effects of raw water drinking on the risk of primary hepatocellular carcinoma.

Dietary mineral and trace element intake and squamous cell carcinoma of the esophagus in a Chinese population.

Few studies have been conducted in low-selenium areas of China to assess the relationships between dietary intake of selenium and zinc and the risk of squamous cell carcinoma of the esophagus (SCCE). We studied dietary mineral and trace element intake and risk of SCCE in a population- based, case-control study in Taixing, China, in 2000. A total of 218 SCCE patients and 415 population healthy controls were interviewed using a standard dietary and health questionnaire. The median and quartiles were calculated to represent the average level and distribution of selected dietary minerals and trace elements estimated by the Chinese Standard Tables of Food Composition. The adjusted odds ratios (ORs) comparing the highest with the lowest quartiles were 0.30 (95% confidence intervals, CIs = 0.13-0.67) for selenium intake and 0.28 (95% CI = 0.11-0.70) for zinc intake with obvious dose-dependent patterns (P values for trend = 0.01). The adjusted OR for the combined effect of selenium and zinc intake was 0.53 (95% CI = 0.29-0.96) after controlling for potential confounding factors, including age, gender, educational level, body mass index, and total energy intake. Our results suggested that the potential joint effect of zinc and selenium might contribute to SCCE risk. Increased dietary intake of selenium and zinc may decrease the risk of SCCE in a low-selenium area of China.

Dietary selenium intake and genetic polymorphisms of the GSTP1 and p53 genes on the risk of esophageal squamous cell carcinoma.

Few studies have assessed potential effect modifications by polymorphisms of susceptibility genes on the association between selenium intake and esophageal squamous cell carcinoma (ESCC). We studied the joint effects of dietary selenium and the GSTP1 and p53 polymorphisms on ESCC risk in a population-based case-control study with 218 ESCC cases and 415 controls in Taixing City, China. Dietary selenium intake was estimated from a food frequency questionnaire with 97 food items. GSTP1 and p53 polymorphisms were detected by RFLP-PCR assays. Logistic regression analyses were done to estimate odds ratios (OR) and 95% confidence intervals (95% CI). Reduced ESCC risk was observed among individuals in the highest quartile of dietary selenium intake (adjusted OR, 0.31; 95% CI, 0.13-0.70) with a dose-dependent gradient (P(trend) = 0.01). The p53 Pro/Pro genotype was associated with increased risk of ESCC compared with the Arg/Arg genotype (adjusted OR, 2.02; 95% CI, 1.19-3.42). When combined with selenium consumption, an obvious increased risk was observed among individuals with the p53 Pro/Pro or GSTP1 Ile/Ile genotype with adjusted ORs of 3.19 (95% CI, 1.74-5.84) and 1.90 (95% CI, 1.03-3.51), respectively. Among smokers and alcohol drinkers, elevation of ESCC risk was more prominent among p53 Pro/Pro individuals who consumed a low level of dietary selenium (adjusted OR, 3.59; 95% CI, 1.49-8.66 for smokers and 6.19; 95% CI, 1.83-20.9 for drinkers). Our study suggests that the effect of dietary selenium on the risk of ESCC may be modulated by tobacco smoking, alcohol drinking, and p53 Pro/Pro and GSTP1 Ile/Ile genotypes.

Green tea drinking and multigenetic index on the risk of stomach cancer in a Chinese population.

The purpose of our study was to examine the roles of green tea drinking, other risk and protective factors, and polymorphism of susceptibility genes such as GSTM1, GSTT1, GSTP1, and p53 codon 72 and their possible joint effects on the risk of stomach cancer. A population-based case-control study was conducted in Taixing, China, including 206 newly diagnosed cases with stomach cancer and 415 healthy control subjects. Epidemiological data were collected by in-person interviews using a standard questionnaire. Polymorphisms of susceptibility genes were assayed by PCR-RFLP techniques. A multigenetic index was created by summing up the number of risk genotypes. The data were analyzed using the logistic regression model. A reverse association between green tea drinking and risk of stomach cancer was observed with an adjusted odds ratio (OR) of 0.59 (95% confidence interval [CI] = 0.34-1.01). Dose-response relationship was shown (p-trend < 0.05). A higher score on the multigenetic index was associated with increased risk of stomach cancer with an adjusted OR of 2.21 (95% CI = 1.02-4.79) for those with at least 3 risk genotypes compared to those with <2 risk genotypes. Green tea drinking was suggested to have more than multiplicative interactions with alcohol consumption with an adjusted OR for interaction of 4.57 (95% CI = 1.62-12.89), and with higher multigenetic index with adjusted OR for interaction of 2.31 (95% CI = 0.88-6.03). The protective effect of green tea drinking was observed on the risk of stomach cancer and the possible effect modification by susceptibility genes was suggested.

[A case-control study on the relationship between methyl-tetra-hydrofolic acid reductase 677 gene polymorphism and the risk of stomach cancer].

OBJECTIVE: To explore the relationship between methyl-tetra-hydrofolic acid (MTHFR) 677 gene polymorphism and the risk of stomach cancer. METHODS: A population based case-control study was conducted and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used to detect its genotypes. RESULTS: Among cases with stomach cancer, the frequency of C/C, C/T, T/T genotype were 25.8%, 54.6%, 19.6%, compared with controls as 34.5%, 50.9%, 14.6% respectively. Using C/C genotype as reference, the OR of C/T or T/T genotype was 1.52 (95% CI: 1.04 - 2.23). 53.3% C and 46.7% T allele were distributed in stomach cancer cases, while 60.0% C and 40.0% T in controls. The OR for T allele in relation to C allele was 1.31 (1.02 - 1.69) when C allele was used as reference. In addition, the present study showed that MTHFR677 AnyT genotype might interact with smoking, moldy food intake, wheat porridge intake, eating salty food and Hp CagA infection to increase the risk of stomach cancer. No interaction was observed between MTHFR677 AnyT genotype and alcohol drinking or green tea intake. CONCLUSION: MTHFR677 AnyT genotype, might increase the risk of stomach cancer development and the genotype might also interact with other environmental risk factors to increase the risk of stomach cancer.

[A new statistical method on familial correlation dealing with family data from case-control studies].

OBJECTIVE: This paper presents a statistical method of familial correlation on family data from case-control studies. METHODS: Marginal mean models of the probands and the relatives conditional on the proband's disease status, as well as the marginal association model of the relatives were modeled integrately. Conditional odds-ratio and marginal odds-ratio were used to measure the familial correlation. RESULTS: The parameter's interpretation in the model was in accordance with sample characteristics. This method is more efficient due to making fully use of information of the probands and relatives. In addition, the method has all advantages of GEE2. CONCLUSION: The method in this paper efficiently and conveniently analyzes the family data from case-control studies to estimate the familial correlation on disease.

[Study on the protective effect of green tea on gastric, liver and esophageal cancers].

OBJECTIVE: To assess the protective effect of drinking green tea on the development of gastric, liver and esophageal cancers. METHODS: A population based study was conducted in Taixing, Jiangsu province, including 206, 204, 218 cases, respectively, and 415 population controls. RESULTS: Green tea decreased the development of gastric cancer risk by 40%. Dose-response relationships were observed between the length of time, concentration and quantity of green tea drinking and its protective effects on gastric cancer. For individuals who drink green tea for more than 250 g per month, the risk of gastric cancer reduced about 60%. Green tea might have protective effect on liver cancer. However, no protective effect of green tea was observed on esophageal cancer. CONCLUSION: Green tea drinking might be a protective factor for gastric cancer. However, the protective effects of green tea on liver and esophageal cancer were not obvious.

[A case-control study on drinking green tea and decreasing risk of cancers in the alimentary canal among cigarette smokers and alcohol drinkers].

OBJECTIVE: To explore the role of green tea in decreasing the risks of gastric cancer, liver cancer, esophageal cancer among alcohol drinkers or cigarette smokers. METHODS: A population based case-control study was conducted in Taixing, Jiangsu province. RESULTS: In Taixing city, identified cases of stomach, liver and esophageal cancers were chosen with informed consent. The numbers were 206, 204, 218 respectively. Controls were chosen from normal population having lived in the area for longer than 10 years, also with informed consent. Green tea drinking seemed to have decreased 81%, 78%, 39% risk for the development of gastric cancer, liver cancer and esophageal cancer among alcohol drinkers. It might also have decreased 16%, 43%, 31% on the risks of developing the three kinds of cancers among cigarette smokers. Interaction assessment showed that drinking green tea could significantly decrease the risk of gastric cancer and liver cancer among alcohol drinkers, with ORs of interaction item 0.23 (95% CI: 0.10 - 0.55) and 0.25 (95% CI: 0.11 - 0.57) respectively. CONCLUSION: Habit of drinking green tea seemed to have significant protective effects on the development of both gastric and liver cancer among alcohol drinkers while, green tea also having some protective effect on esophageal cancer among alcohol drinkers and on three kinds of cancers among cigarette smokers.