Associations between plasma markers and symptoms of anxiety and depression in patients with breast cancer.

BACKGROUND AND PURPOSE: Among patients with solid tumors, those with breast cancer (BC) experience the most severe psychological issues, exhibiting a high global prevalence of depression that negatively impacts prognosis. Depression can be easily missed, and clinical markers for its diagnosis are lacking. Therefore, this study in order to investigate the diagnostic markers for BC patients with depression and anxiety and explore the specific changes of metabolism. METHOD AND RESULTS: Thirty-eight BC patients and thirty-six matched healthy controls were included in the study. The anxiety and depression symptoms of the participants were evaluated by the 17-item Hamilton Depression Scale (HAMD-17) and Hamilton Anxiety Scale (HAMA). Plasma levels of glial fibrillary acidic protein (GFAP) and lipocalin-2 (LCN2) were evaluated using enzyme linked immunosorbent assay, and plasma lactate levels and metabolic characteristics were analyzed. CONCLUSION: This study revealed that GFAP and LCN2 may be good diagnostic markers for anxiety or depression in patients with BC and that plasma lactate levels are also a good diagnostic marker for anxiety. In addition, specific changes in metabolism in patients with BC were preliminarily explored.

Short-Term Outcomes and Multidimensional Factors Associated With Preoperative Sedentary Behavior Among Chinese Older Adults With Gastric Cancer: An Observational Study.

PURPOSE: The current study aimed to examine the short-term outcomes and multidimensional factors associated with preoperative sedentary behavior among Chinese older adults with gastric cancer. METHOD: An observational study was conducted among older adults with gastric cancer in a tertiary hospital in Jiangsu, China. A total of 393 participants were enrolled by convenience sampling. Sedentary behavior was assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Logistic regression was applied to explore the relationship between preoperative sedentary behavior and short-term outcomes. Univariate and multivariate analyses were used to determine the factors associated with participants' sedentary behavior. RESULTS: Preoperative sedentary behavior was related to multiple outcomes, including total complications, prolonged length of stay, and increased hospitalization costs. Two or more comorbidities and depression were risk factors for sedentary behavior. High-density lipoprotein; female sex; and high school, middle school, and primary school and below educational levels were protective factors for sedentary behavior. CONCLUSION: Health care professionals need to simultaneously concentrate on multidimensional aspects linked to sedentary behavior to successfully administer behavioral interventions for enhancing older adults' overall prognosis. [Journal of Gerontological Nursing, xx(x), xx-xx.].

Predictive value of preoperative handgrip strength on postoperative outcomes in patients with gastrointestinal tumors: a systematic review and meta-analysis.

PURPOSE: This systematic review and meta-analysis aimed to explore the predictive value of preoperative handgrip strength on postoperative outcomes in patients with gastrointestinal tumors. METHODS: Databases including Cochrane Library, Pubmed, Embase, Web of Science, and CINAHL Complete were searched for articles published from the establishment of database until August 7, 2021. Two researchers independently screened the literature, extracted the data, and evaluated the quality. RESULTS: Eight studies were included, involving five prospective and three retrospective cohort studies with 2291 participants. The prevalence of preoperative low handgrip strength ranged from 11.8 to 62.7%. Preoperative low handgrip strength was associated with an increased risk of total complications (OR = 2.23, 95%CI = 1.43-3.50), pneumonia (OR = 5.16, 95%CI = 3.17-8.38), ileus (OR = 2.48, 95%CI = 1.09-5.65), and short-term mortality (OR = 7.28, 95%CI = 1.90-27.92). CONCLUSION: This systematic review and meta-analysis indicated that preoperative HGS had important value to predict certain adverse postoperative outcomes among patients with GI tumors. Low handgrip strength criteria, definition of total complications, and country are the potential sources of heterogeneity, and more research are required to test and update these results.

Effects of prehabilitation on postoperative outcomes in frail cancer patients undergoing elective surgery: a systematic review and meta-analysis.

PURPOSE: This systematic review and meta-analys is aimed to explore the effects of prehabilitation on postoperative outcomes in frail cancer patients. METHODS: A comprehensive literature search was conducted using PubMed, Cochrane Library, Embase, Web of Science, CINAHL Complete, and other databases from database inception to 15 March 2022. Studies were included if they consisted of a prehabilitation intervention in frail cancer patients undergoing elective surgery. RESULTS: A total of 9 studies encompassing 1313 patients were included in the review. Through meta-analysis, prehabilitation has a positive impact on total complications (RR = 0.83, 95% CI = 0.73 to 0.94, P = 0.004), severe complications (RR = 0.62, 95% CI = 0.43 to 0.90, P = 0.01), and the average length of hospital stay (MD = - 1.36, 95% CI = - 2.38 to - 0.35, P = 0.008). But it had no differences in 30-day and 3-month mortality and 30-day and 3-month readmission rates. Through qualitative synthesis, two studies found that prehabilitation had a favorable tendency to promote functional recovery compared with the control group. CONCLUSION: Prehabilitation had a positive effect on postoperative complications and the average length of hospital stay in frail cancer patients. A personalized and supervised multimodal prehabilitation program with exercise at its core may be more beneficial for them. More studies with extensive follow-up are needed to confirm and update the findings of these results.

Chemoradiotherapy with extended nodal irradiation and/or erlotinib in locally advanced oesophageal squamous cell cancer: long-term update of a randomised phase 3 trial.

BACKGROUND: To report the long-term outcomes of a phase III trial designed to test two hypotheses: (1) elective nodal irradiation (ENI) is superior to conventional field irradiation (CFI), and (2) chemoradiotherapy plus erlotinib is superior to chemoradiotherapy in locally advanced oesophageal squamous cell cancer (ESCC). METHODS: Patients with locally advanced ESCC were randomly assigned (1:1:1:1 ratio) to one of the four groups: A: radiotherapy adoption of ENI with two cycles of concurrent TP chemotherapy (paclitaxel and cisplatin) plus erlotinib; B: radiotherapy adoption of ENI with two cycles of concurrent TP; C: radiotherapy adoption of CFI with two cycles of concurrent TP plus erlotinib and D: radiotherapy adoption of CFI with two cycles of concurrent TP. A total of 60 Gy of radiation doses was delivered over 30 fractions. We explored the impact of epidermal growth factor receptor (EGFR) expression on the efficacy of erlotinib plus chemoradiotherapy. RESULTS: A total of 352 patients (88 assigned to each treatment group) were enrolled. The 5-year survival rates were 44.9%, 34.8%, 33.8% and 19.6% in groups A, B, C and D, respectively (P = 0.013). ENI significantly improved OS compared with standard CFI (median, 38.5 vs 22.6 months; HR, 0.74; P = 0.018). The addition of erlotinib significantly improved OS (median, 39.4 vs 27.4 months; HR, 0.75; P = 0.025). Patients with overexpressing EGFR treated with erlotinib had a better OS and PFS than those without erlotinib. CONCLUSIONS: Concurrent chemoradiotherapy with ENI and/or erlotinib improved long-term survival in locally advanced ESCC. CLINICAL TRIAL REGISTRATION: Trial registration: NCT00686114.

Bevacizumab in combination with anticancer drugs for previously treated advanced non-small cell lung cancer.

Non-small cell lung cancer (NSCLC) accounts for about 85% of all lung cancer cases. Patients with NSCLC often have an advanced disease at the time of diagnosis, with a 1-year survival rate about 10-15% under the best support treatment. As therapeutic methods for lung cancer developed rapidly in recent years, the prognosis of stage IIIB or IV NSCLC also improve to a large extend. Bevacizumab is a monoclonal antibody against VEGFR which inhibits abnormal vascular growth in malignant tumors. In October 2006, bevacizumab was approved by the U.S. Food and Drug Administration (FDA) for first-line use in advanced NSCLC. For patients with advanced NSCLC who failed in previously platinum-based chemotherapy, bevacizumab also showed enhancing efficacy to antitumor drugs recommended by the latest NCCN guideline. This review intends to present the recent progress and prospects of bevacizumab in second- or third-line treatment for patients with refractory NSCLC.

The efficacy and safety of pemetrexed plus bevacizumab in previously treated patients with advanced non-squamous non-small cell lung cancer (ns-NSCLC).

Bevacizumab (Bev), a monoclonal antibody against vascular endothelial growth factor, when combined with standard first-line chemotherapy, shows impressive clinical benefit in advanced non-squamous non-small cell lung cancer (ns-NSCLC). Our study aims to investigate whether the addition of Bev to pemetrexed improves progression-free survival (PFS) in advanced ns-NSCLC patients after the failure of at least one prior chemotherapy regimens. Patients with locally advanced, recurrent, or metastatic ns-NSCLC, after failure of platinum-based therapy, with a performance status 0 to 2, were eligible. Patients received 500 mg/m(2) of pemetrexed intravenously (IV) day 1 with vitamin B12, folic acid, and dexamethasone and Bev 7.5 mg/kg IV day 1 of a 21-day cycle until unacceptable toxicity, disease progression or the patient requested therapy discontinuation. The primary end point was PFS. Between December 2011 and October 2013, 33 patients were enrolled, with median age of 55 years and 36.4% men. Twenty-three patients (69.7%) had received two or more prior regimens, and 28 patients (84.8%) had received chemotherapy containing pemetrexed. The median number of the protocol regimens was 4. Median PFS was 4.37 months (95% CI 2.64-6.09 months). Median overall survival (OS) was 15.83 months (95% CI 10.52-21.15 months). Overall response rates were 6.45%. Disease control rate was 54.84%. No new safety signals were detected. No patient experienced drug-related deaths. The combination of Bev and pemetrexed every 21 days is effective in ns-NSCLC patients who failed of prior therapies with improved PFS. Toxicities are similar with historical data of these two agents and are tolerable. Our results may provide more a regimen containing Bev and pemetrexed for Chinese clinical practice in previously treated ns-NSCLC.

Comprehensive assessment of the association between XPD rs13181 polymorphism and lung cancer risk.

Xeroderma pigmentosum group D (XPD) rs13181 may reduce DNA repair capacity (DRC) through modifying XPD protein product. Reduced DRC is reportedly related to an increase in the risk of lung cancer. To precisely estimate the association between XPD rs13181 and lung cancer risk, we carried out the current meta-analysis. We searched multiple databases (up to 31 October 2013) for studies investigating the association of XPD rs13181 and lung cancer. Odds ratio (OR) was estimated with the fixed effect model to assess the association. Heterogeneity between studies was measured using Q test. Subgroup analyses were conducted by ethnicity, histological type, and sample size. Meta-analysis of 30 studies suggested that individuals carrying Gln/Gln genotype were more likely than the individuals with Lys/Lys or Lys/Gln + Lys/Lys genotypes (homozygous model, OR 1.18, 95 % confidence interval (CI) 1.07-1.31; recessive model, OR 1.17, 95 % CI 1.06-1.29) to develop lung cancer, without any substantial heterogeneity. This significantly increased risk was also revealed in the individuals harboring Gln/Gln + Lys/Gln genotypes (dominant model, OR 1.07, 95 % CI 1.01-1.12). Further stratification by histological type, ethnicity, and sample size yielded statistically significant estimates in subgroup of Caucasian subjects, non-small cell lung cancer, and relatively large studies, but borderline association in Asians. Our analyses demonstrate that XPD rs13181 may be associated with an increase in the risk of lung cancer among Caucasian populations.

Predictive performance of different measures of frailty (CFS, mFI-11, mFI-5) on postoperative adverse outcomes among colorectal cancer patients: a diagnostic meta-analysis.

PURPOSE: To clarify the predictive performance of different measures of frailty, including Clinical Frailty Scale (CFS), 11-factor modified Frailty Index (mFI-11), and 5-factor modified Frailty Index (mFI-5), on adverse outcomes. METHODS: PubMed, Embase, Web of Science, and other databases were retrieved from the inception of each database to June 2023. The pooled sensitivity, specificity, and the area under the summary receiver operating curve (SROC) values were analyzed to determine the predictive power of CFS, mFI-11, and mFI-5 for adverse outcomes. RESULTS: A total of 25 studies were included in quantitative synthesis. The pooled sensitivity values of CFS for predicting anastomotic leakage, total complications, and major complications were 0.39, 0.57, 0.45; pooled specificity values were 0.70, 0.58, 0.73; the area under SROC values were 0.58, 0.6, 0.66. The pooled sensitivity values of mFI-11 for predicting total complications and delirium were 0.38 and 0.64; pooled specificity values were 0.83 and 0.72; the area under SROC values were 0.64 and 0.74. The pooled sensitivity values of mFI-5 for predicting total complications, 30-day mortality, and major complications were 0.27, 0.54, 0.25; pooled specificity values were 0.82, 0.84, 0.81; the area under SROC values were 0.63, 0.82, 0.5. CONCLUSION: The results showed that CFS could predict anastomotic leakage, total complications, and major complications; mFI-11 could predict total complications and delirium; mFI-5 could predict total complications and 30-day mortality. More high-quality research is needed to support the conclusions of this study further.

Exploring the economic toxicity experiences and coping styles of patients with colorectal cancer fistula in Jiangsu province, China: a qualitative study.

OBJECTIVES: In recent years, economic toxicity has significantly affected the physical and mental health as well as the quality of life of patients with colorectal cancer. However, this issue has not garnered adequate attention from healthcare professionals. This study aims to investigate the experiences of economic toxicity and coping strategies among patients with colorectal cancer fistula. The findings are intended to inform the development of suitable and effective intervention programmes to address economic toxicity within this patient population. DESIGN: A descriptive phenomenological approach was employed in this qualitative research, using a semistructured method for data collection and analysis of interview data. Traditional content analysis methods were applied, encompassing coding, categorisation and theme distillation. Data analysis continued until thematic saturation was achieved, with no new themes emerging. SETTING: Nanjing Medical University Lianyungang Clinical Medical College. PARTICIPANTS: A total of 21 patients with colorectal cancer fistula were selected as interview subjects through purposive sampling. The selection took place from May 2022 to May 2023, involving patients during their stay at a tertiary hospital in Lianyungang city, Jiangsu province, China. RESULTS: In total, three pieces and eight subthemes were distilled: subjective feelings (worries about treatment costs, concerns about uncertainty about the future, worries about daily life), coping styles (coping alone, unwillingness to help, prepurchased insurance, dealing with illness, giving up treatment, inability to afford costs) and needs and aspirations (need for health policies, need for social support). CONCLUSIONS: Patients with colorectal cancer fistulae experience economic toxicity, leading to significant impairment in both physical and mental health. Despite employing various coping strategies, healthcare professionals must prioritise addressing the economic toxicity issue in patients. Implementing rational and effective interventions can greatly assist patients in effectively managing economic toxicity.

Association of metabolic syndrome and frailty with postoperative complications in older gastric cancer patients: A body composition perspective.

OBJECTIVES: To compare the characteristics of body compositions between metabolic syndrome (MetS) and frailty, and determine the independent and overlapping of MetS and frailty with postoperative complications among older patients with gastric cancer. DESIGN: A prospectively observational study. SETTING AND PARTICIPANTS: Two hundred and eighty six older patients from 60 to 80 years undergoing radical gastrectomy for the first time. MEASUREMENTS: MetS was diagnosed by the criteria from the 2020 edition of Chinese guideline for the prevention and treatment of type 2 diabetes mellitus, and frailty was defined by frailty phenotype. An InBody770 impedance analyzer was used to measure body compositions and with 10 fat- and muscle-related indicators being included in this study. Based on the presence of frailty and MetS, patients were divided into the frailty group, MetS group, frailty+MetS group, and normal group, and the body compositions indicators of these groups were compared. Clavien-Dindo classification was used to grade the severity of postoperative complications. Univariate and multivariate regression models were performed to explore the independent and joint association of MetS and frailty with postoperative complications. RESULTS: The incidence rate of MetS, frailty, and frailty+MetS being 20.3%, 15.7%, and 4.2% respectively. Compared with the normal group, both fat and muscle compositions were decreased significantly in the frailty group (p < 0.05), while the statistically significant difference of fat-to-muscle mass ratio (FMR) and skeletal muscle mass to visceral fat area ratio (SVR) were not observed (p > 0.05). In contrast, except SVR, the other indicators of the MetS group were higher than the normal group (p < 0.05). As to the frailty+MetS group, there was a significant increase in fat compositions and FMR, as well as a significant decline in SVR (p < 0.05), while the difference of muscle compositions was not statistically significant (p > 0.05). There was an association of frailty with postoperative total (OR = 3.068, 95% CI: 1.402-6.713) and severe (OR = 9.423, 95% CI: 2.725-32.589) complications, but no association was found of MetS alone. MetS coexisting with frailty was associated with the highest risk of both total (OR = 3.852, 95% CI: 1.020-14.539) and severe (OR = 12.096, 95% CI: 2.183-67.024) complications. CONCLUSIONS: Both frailty and MetS coexisting with frailty had adverse effects on postoperative complications, which appeared greatly different characteristics in body compositions and therefore reinforced the importance of targeted nutritional or metabolic intervention. Although MetS alone were not significantly associated with postoperative complications, it is essential to focus on the causal relationship and development trend between MetS and frailty to prevent MetS from shifting into frailty, considering the highest risk in their coexistence state.

Exploring the developmental changes in and the relationship between resilience and anxiety and depression in older gastric cancer survivors: A latent growth mixture model and random intercept cross-lagged panel model analysis.

OBJECTIVES: This study aims to investigate the independent and joint trajectories of resilience, anxiety, and depression symptoms and research the interaction between older gastric cancer survivors' resilience and anxiety-depression during the period of 1 year after surgery. METHODS: The participants were 381 older gastric cancer survivors, with a mean age of 69 years. Resilience, anxiety, and depression symptoms were assessed immediately after surgery, and at 3, 6, and 12 months post-surgery, respectively. A longitudinal design was employed to capture the dynamic changes in resilience, anxiety, and depression levels among older gastric cancer survivors post-surgery. Latent growth mixture model and random intercept cross-lagged panel model were used to analyse the trajectories of resilience and anxiety-depression and the interaction between them. RESULTS: Two latent trajectories were identified for the resilience, four latent trajectories were identified for the anxiety, and five latent trajectories were identified for the depression, respectively, with three joint trajectories identified: gradual-increasing resilience, gradual-decreasing anxiety, and depression group (10.0%); gradual-decreasing resilience, gradual-increasing anxiety, and depression group (21.2%); and rapid-growth resilience, rapid-decline anxiety, and depression group (68.8%). Resilience among older gastric cancer survivors exhibits significant bidirectional and negative predictive effects on anxiety and depression. CONCLUSIONS: Individual differences in resilience, anxiety, and depression trajectories exist among older gastric cancer survivors, with heterogeneous joint progression patterns, and the relationship between resilience and anxiety-depression appears bidirectional. More sophisticated intervention programmes tailored to the unique characteristics of the relevant trajectories are necessary to enhance resilience and mitigate the risk of anxiety and depression.

A dynamic online nomogram for predicting the heterogeneity trajectories of frailty among elderly gastric cancer survivors.

BACKGROUND: Frailty is very common among older people with gastric cancer and seriously affects their prognosis. The development of frailty is continuous and dynamic, increasing the difficulty and burden of care. OBJECTIVES: The aims of this study were to delineate the developmental trajectory of frailty in older people with gastric cancer 1 year after surgery, identify heterogeneous frailty trajectories, and further explore their predictors to construct a nomogram for prediction. DESIGN: We conducted a prospective longitudinal observation study. Clinical evaluation and data collection were performed at discharge, and at 1, 3, 6, and 12 months. SETTING AND PARTICIPANTS: This study was conducted in a tertiary hospital and 381 gastric cancer patients over 60 years who underwent radical gastrectomy completed the 1-year follow-up. METHODS: A growth mixture model (GMM) was used to delineate the frailty trajectories, and identify heterogeneous trajectories. A regression model was performed to determine their predictors and further construct a nomogram based on the predictors. Bootstrap with 1000 resamples was used for internal validation of nomogram, a receiver operating characteristic (ROC) curve to evaluate discrimination, calibration curves to evaluate calibration and decision curve analysis (DCA) to evaluate the clinical value. RESULTS: GMM identified three classes of frailty trajectories: "frailty improving", "frailty persisting" and "frailty deteriorating". The latter two were referred to as heterogeneous frailty trajectories. Regression analysis showed 8 independent predictors of heterogeneous frailty trajectories and a nomogram was constructed based on these predictors. The area under ROC curve (AUC) of the nomogram was 0.731 (95 % CI = 0.679-0.781), the calibration curves demonstrated that probabilities predicted by the nomogram agreed well with the actual observation with a mean absolute error of 0.025, and the DCA of nomogram indicated that the net benefits were higher than that of the other eight single factors. CONCLUSIONS: Older gastric cancer patients have heterogeneous frailty trajectories of poor prognosis during one-year postoperative survival. Therefore, early assessment to predict the occurrence of heterogeneous frailty trajectories is essential to improve the outcomes of elderly gastric cancer patients. Scientific and effective frailty interventions should be further explored in the future to improve the prognosis of older gastric cancer patients. CONTRIBUTION OF THE PAPER STATEMENTS: This study constructed a static and dynamic online nomogram with good discrimination and calibration, which can help to screen high-risk patients, implement preoperative risk stratification easily and promote the rational allocation of medical resources greatly. REGISTRATION: ClinicalTrials.gov (Number: NCT05982899). TWEETABLE ABSTRACT: Our findings identified three frailty trajectories and constructed a nomogram to implement preoperative risk stratification and improve patient outcomes.

Exploration of frailty trajectories and their associations with health outcomes in older gastric cancer survivors undergoing radical gastrectomy: A prospective longitudinal observation study.

BACKGROUND: Frailty is commom among gastric cancer survivors and increases the burden of care. AIMS: Our aims were to identify the frailty trajectories and investigate their associations with health outcomes in older gastric cancer survivors. METHODS: We finally recruited 381 patients aged ≧60 who underwent radical gastrectomy and recorded frailty at discharge from the hospital, 1, 3, 6, and 12 months after surgery. Growth mixture modeling was used to investigate the frailty trajectories and linear regression models were used to examine their associations with health outcomes. RESULTS: Three classes of frailty trajectories were identified: the "improving frailty", "maintaining frailty" and "deteriorating frailty". Compared with class 1, patients who followed class 2 and class 3 frailty trajectories were more likely to have more severe disability (ß = -14.22, 95 % CI: -17.92, -10.61, P < 0.001; ß = -48.34, 95 % CI: -52.25, -44.42, P < 0.001), worse quality of life (ß = 10.89, 95 % CI: 7.71,14.08, P < 0.001; ß = 34.82, 95 % CI: 31.46, 38.19, P < 0.001), and more frequency readmission within 1 year (ß = 1.02, 95 % CI: 0.98, 1.06, P < 0.001; ß = 2.10, 95 % CI: 2.01, 2.14, P < 0.001) after controlling potential confounders. However, class 2 and class 3 have no significant difference from class 1 in the total hospitalization costs (ß = 1672.12, 95 % CI: -7145.95, 10496.19, P = 0.709; ß = 7651.60, 95 % CI: -1670.28, 16793.47, P = 0.107). CONCLUSIONS: Our study suggested the significant prognostic heterogeneity in frailty trajectories, and what we need to do is to identify patients with heterogeneous trajectory and intervene in them to reduce adverse outcomes, promote rational use of resources, and reduce the burden of care.

Preoperative low absolute and relative handgrip strength as predictors of postoperative short-term outcomes: a prospective study based on patients aged 60 years and older with gastric cancer.

PURPOSE: This study aimed to determine the association of absolute and relative HGS indicators with postoperative short-term outcomes in older patients with gastric cancer. METHODS: The prospective, single-center, observational study involved 230 patients (age ≥ 60 years) who underwent radical gastrectomy. Absolute HGS was directly obtained from results measured by a hand dynamometer, while relative HGS was calculated as the value of absolute HGS divided by body mass index (BMI), appendicular skeletal muscle mass index (ASMI) and age, respectively. Low absolute HGS was defined according to the criterion in AWGS 2019 consensus and the first gender-specific quartile. Low relative handgrip strength was defined if it was below the first gender-specific quartile of the distribution. Postoperative outcomes included total complications, malnutrition and length of hospital stay. Univariate and multivariate regression models were performed to investigate and compare the predictive values of different HGS indicators. RESULTS: For the five HGS indicators, multivariate analyses showed that low absolute HGS (AWGS consensus), low HGS/BMI and HGS/age were independent risk factors for both postoperative total complications (absolute HGS(AWGS consensus): OR 2.03, 95%CI:1.05-3.93; HGS/BMI: OR 2.12, 95%CI 1.05-4.28; HGS/age: OR 2.79, 95%CI 1.40-5.54) and malnutrition (absolute HGS(AWGS consensus): OR 2.01, 95%CI 1.10-3.67; HGS/BMI: OR 2.28, 95%CI 1.20-4.33; HGS/age: OR 2.70, 95%CI 1.42-5.14). Low absolute HGS (quartile) was an independent risk factor for malnutrition (OR 1.96, 95%CI 1.04-3.71). Moreover, Low HGS/age was associated with lengthened postoperative hospital stay (OR 2.07, 95%CI 1.12-3.85). CONCLUSIONS: Except HGS/ASMI, both absolute and relative HGS indicators were associated with postoperative short-term outcomes. Particularly, HGS/age revealed relatively better predictive value for the studied outcomes.

Preoperative low handgrip strength (HGS) with HGS asymmetry is associated with adverse outcomes among older adults with gastric cancer.

INTRODUCTION: This study aimed to explore the associations of low hand grip strength (HGS), HGS asymmetry, their combinations, and frailty on hospital readmissions, total complications, and prolonged length of stay (PLOS) among older adults with gastric cancer. MATERIALS AND METHODS: This study included 342 patients with gastric cancer aged ≥60 years who were scheduled to undergo radical surgery. The Tilburg Frailty Indicator (TFI) was used to collect information on frailty. HGS was measured twice for each hand using an electronic handgrip dynamometer. The highest HGS readings on each hand were used for calculating the HGS asymmetry ratio: non-dominant HGS (kg)/dominant HGS (kg). The Fine and Gray proportional subdistribution hazard model and the logistic regression model were used for the analyses, with covariates adjusted. RESULTS: Low HGS (subdistribution hazard ratios [SHR] = 2.10, 95% confidence interval [CI] = 1.05-3.93, P = 0.036) and low HGS with HGS asymmetry (SHR = 3.95, 95% CI = 1.50-10.36, P = 0.005) were significantly associated with hospital readmissions. Frailty was associated with total complications (odds ratio [OR] = 2.87, 95% CI = 1.61-5.13, P < 0.001) and PLOS (OR = 1.98, 95% CI = 1.19-3.29, P < 0.001). Low HGS, HGS asymmetry, and their combinations were not significantly associated with total complications and PLOS. DISCUSSION: Preoperative low HGS and low HGS with HGS asymmetry were associated with hospital readmissions, while frailty was associated with total complications and PLOS among older adults with gastric cancer. In the future, more rigorously designed studies are needed to verify our results further to improve preoperative clinical assessment and frailty evaluation among older adults with gastric cancer.

BMI trajectories, associations with outcomes and predictors in elderly gastric cancer patients undergoing radical gastrectomy: a prospective longitudinal observation study.

OBJECTIVES: Elderly gastric cancer patients undergoing radical gastrectomy are prone to experience unexpected weight loss. Preoperative weight risk prediction may be a promising way to prevent weight loss and improve prognosis. The objectives of this study were to explore the BMI trajectory of elderly gastric cancer patients one year after surgery, evaluate theirs the association with outcomes, and explore their related predictors, so as to provide evidence for weight management and prognosis improvement. METHODS: 412 gastric cancer patients were included and recorded BMI at 6 time points. The trajectories of BMI were analyzed by growth mixture modeling, and the associations of BMI trajectories with outcomes as well as their predictors were investigated by regression models. RESULTS: We identified 3 classes of BMI trajectories: the "slow-decreasing BMI", "rapid-decreasing BMI" and "maintaining BMI". Compared with class1, patients in class 2 were more likely to have a higher frequency of readmission within 1-year(ß = 0.59, 95%CI: 0.29, 0.89, P < 0.001) and a higher rate of mortality within 1-year(ß = 24.74, 95%CI: 9.60, 63.74, P < 0.001) ; patients in class 3 were more likely to have a higher quality of life (ß=-10.46, 95%CI: -17.70, -3.22, P = 0.005) and fewer readmission times within one year (ß=-0.43, 95%CI: -0.77, -0.09, P = 0.015). Predictors of decreasing BMI trajectories were TNM stage, comorbidity, anxiety, family cohesion and social support(P < 0.05). CONCLUSIONS: Our findings can provide a basis for screening high-risk elderly gastric cancer patients with poor prognosis, implementing risk stratification, formulating accurate weight management programs and improving prognosis. IMPLICATIONS FOR CANCER SURVIVORS: The results of our study can provide gastric cancer survivors with preoperative risk screening based on predictive factors so that nutritional support and weight management can be implemented in a timely manner to improve prognosis.

A web-based calculator combining Geriatric Nutritional Risk Index (GNRI) and Tilburg Frailty Indicator (TFI) predicts postoperative complications among young elderly patients with gastric cancer.

AIM: Nutritional status and frailty are significant indicators reflecting physiological reserve. We sought to establish and validate a web-based calculator containing the Geriatric Nutritional Risk Index (GNRI) and the Tilburg Frailty Indicator (TFI) together with general clinical information to predict total complications among elderly patients with gastric cancer. METHODS: This was a prospective cohort study of 582 elderly patients with gastric cancer in a tertiary hospital in China. Nutritional status and frailty were assessed by the GNRI and the TFI, respectively. The nomogram was built and further converted into a web-based calculator. The receiver operating characteristic analysis was performed to evaluate the discrimination of the nomogram. Calibration was assessed using the calibration curve and Hosmer-Lemeshow test via the bootstrap resampling procedure. The decision curve analyses (DCAs) were employed to quantify the net benefits of a certain threshold probability for assessing the clinical values. RESULTS: The GNRI (odds ratio [OR], 0.921; 95% confidence interval [CI], 0.895-0.949; P < 0.001), the TFI (OR, 1.243; 95% CI, 1.113-1.386; P < 0.001), surgical approach (OR, 1.913; 95% CI, 1.073-3.408; P = 0.028) and comorbidity (OR = 1.599, 95%CI = 1.028-2.486, P = 0.037) were independently associated with total complications. The nomogram demonstrated good discrimination (area under the receiver operating characteristic curve: training cohort, 0.735; validation cohort, 0.777) and calibration (P = 0.135). The DCA curves of the nomogram also showed good positive net benefits. CONCLUSIONS: The web-based calculator incorporating the GNRI, the TFI, surgical approach, and comorbidity could successfully predict total complications among elderly patients with gastric cancer with good accuracy in a convenient manner. Geriatr Gerontol Int 2023; 23: 205-212.

Adverse outcomes and health-ecological influencing factors of preoperative frailty among elderly patients with gastric cancer.

PURPOSE: Frailty is defined as a state of decreased physiologic reserves arising from cumulative deficits in multiple homeostatic systems, which is important in the field of clinical oncology. We aimed to explore the relationship between preoperative frailty and adverse outcomes, and systematically analyze the factors influencing frailty based on the health ecology model among elderly gastric cancer patients. METHODS: A observational study was conducted to select 406 elderly patients who would undergo gastric cancer surgery at a tertiary hospital. The logistic regression model was used to examine the relationship between preoperative frailty and adverse outcomes, including total complications, prolonged length of stay (PLOS), and 90-day hospital readmission. Based on the health ecology model, the factors which may influence frailty were collected from four levels. Univariate and multivariate analysis were utilized to determine the factors influencing preoperative frailty. RESULTS: Preoperative frailty was associated with total complications (odds ratio [OR] 2.776, 95% confidence interval [CI] 1.588-4.852), PLOS (OR 2.338, 95%CI 1.342-4.073), and 90-day hospital readmission (OR 2.640, 95% CI 1.275-5.469). Besides, nutritional risk (OR 4.759, 95% CI 2.409-9.403), anemia (OR 3.160, 95% CI 1.751-5.701), number of comorbidity ≥ 2 (OR 2.318, 95% CI 1.253-4.291), low physical activity level (OR 3.069, 95% CI 1.164-8.092), apathetic attachment (OR 2.656, 95% CI 1.457-4.839), personal monthly income ≤ 1000 yuan (OR 2.033, 95% CI 1.137-3.635) and anxiety (OR 2.574, 95% CI 1.311-5.053) were independent risk factors for frailty. High physical activity level (OR 0.413, 95% CI 0.208-0.820) and improved objective support (OR 0.818, 95% CI 0.683-0.978) were independent protective factors for frailty. CONCLUSIONS: Preoperative frailty was associated with multiple adverse outcomes and could be affected by factors of different dimensions from the health ecology perspective, including nutrition, anemia, comorbidity, physical activity, attachment style, objective support, anxiety, and income, which can guide the formation of a comprehensive prehabilitation for frailty among elderly gastric cancer patients.

Cancer-associated fibroblasts: An emerging target against esophageal squamous cell carcinoma.

Esophageal squamous cell carcinoma (ESCC) is one of the most common human malignancies worldwide and is associated with high morbidity and mortality. More than 70% of ESCC patients are diagnosed at the intermediate or advanced stage. Concurrent chemoradiotherapy is the standard treatment regimen for patients with advanced ESCC. However, ESCC patients show a poor 5-year survival rate of around 20%. Cancer-associated fibroblasts (CAFs) are a major component of the tumor microenvironment and control tumor initiation and progression. CAFs create a pro-survival and immunosuppressive microenvironment by crosstalk with cancer cells. Moreover, CAFs lead the collective invasion of cancer cells of the epithelial phenotype by remodeling the extracellular matrix. In this review, we highlight the impact of CAFs on ESCC, including induction of chemo- and radio-resistance, migration, invasion, and immune escape. The origin of CAFs and the influence of ESCC cells on CAF activation are also described. Furthermore, we highlight the clinical prospects and future trends of CAFs-targeted therapies in ESCC. A better understanding of the molecular biology of CAFs may contribute to the development of novel anti-ESCC strategies.