[Long-term efficacy of robotic radical total gastrectomy for gastric cancer and analysis of prognostic factors].

Objective: To analyze long-term outcomes and prognostic factors of gastric cancer patients after robotic radical total gastrectomy. Methods: A retrospective case-control study was conducted. Inclusion criteria: (1) receiving robotic radical total gastrectomy; (2) gastric adenocarcinoma was confirmed by postoperative pathology; (3) no previous history of other malignant tumors; (4) no preoperative chemotherapy or radiation therapy performed. Exclusion criteria: (1) age <18 years old or age >80 years old;(2)distant metastasis before surgery, or palliative surgery; (3) conversion to laparotomy;(4) R1 or R2 resection; (5)emergency surgery; (6) remnant gastric cancer or recurrence; (7)died of severe complications during hospitalization or within 1 month after surgery. Overall survival rates (OS) and disease-free survival rates (DFS) were evaluated using the Kaplan-Meier method. Cox regression analysis was used to identify prognosis factors for overall survival. Results: According to the above criteria, 166 gastric cancer patients who underwent robotic radical total gastrectomy between March 2010 and November 2018 were included in this study. Roux-en-Y reconstruction was performed in all patients. Reconstruction were achieved using extracorporeal method through a minilaparotomy in 149 case and intracorporeal anastomosis in 17 cases. The number of harvested lymph nodes was (34.8±17.5), and the number of harvested lymph nodes at group 2 was (10.1±6.7). The number of patients with lymph node metastasis of group 2 was 73 (44.0%). The median follow-up time was 25 months (range 2-109). There were 55 (33.1%) cases of recurrence during follow-up. The 3- and 5-year overall survival rates were 55.8% and 46.2% respectively. The 3- and 5-year disease-free survival rates were 53.4% and 45.4% respectively. The 5-year overall survival rates grouped based on TNM stage were 78.9% for stage I, 58.5% for stage II, and 37.1% for stage III. The 5-year disease-free survival rates grouped based on TNM stage were 78.9% for stage I, 59.2% for stage II, and 34.6% for stage III. Univariate analysis suggested that TNM stage, the number of harvested lymph nodes and number of harvested lymph nodes at group 2 were associated with overall survival rates (all P<0.05). Multivariate analyses revealed that TNM stage (P<0.001; stage IIIB: HR=5.357, 95%CI:1.182 to 24.275; stage IIIC: HR=11.937, 95%CI: 2.677 to 53.226) and number of harvested lymph nodes at group 2 (P=0.034; 6-10: HR=0.562,95%CI:0.326 to 0.969; >10: HR=0.388, 95%CI: 0.176 to 0.857) were independent prognostic factors for overall survival. Conclusion: The long-term outcomes of robotic radical total gastrectomy were satisfactory. TNM stage and number of harvested lymph nodes at group 2 were independent prognostic factors for overall survival.

Circular RNA hsa_circ_0006168 contributes to cell proliferation, migration and invasion in esophageal cancer by regulating miR-384/RBBP7 axis via activation of S6K/S6 pathway.

OBJECTIVE: Esophageal cancer (EC) ranks as the sixth leading cause of cancer-related mortality worldwide. Circular RNAs (circRNAs) are involved in the pathogenesis of different cancers. However, the regulatory mechanism of circ_0006168 in EC progression is still unclear. MATERIALS AND METHODS: The expression of circ_0006168, microRNA (miR)-384, and retinoblastoma binding protein 7 (RBBP7) in tumors and cells was measured by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). The stability of circ_0006168 was analyzed after RNase R treatment. 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) assay was conducted to evaluate cell viability. Transwell assay was applied to determine cell migration and invasion. Glucose consumption and lactate production were detected using glucose detection and lactic acid detection kits. The interaction between miR-384 and circ_0006168 or RBBP7 was certified by Dual-Luciferase reporter system. Protein expression of pyruvate kinase (PK), RBBP7, S6 ribosomal protein kinase (S6K), phosphorylated S6K (p-S6K), S6, phosphorylated S6 (p-S6) was analyzed by Western blot. RESULTS: Circ_0006168 and RBBP7 were over-expressed while miR-384 was low-expressed in EC tumors and cells. The repression of circ_0006168 attenuated cell proliferation, migration, invasion, and glycolysis in EC. Of note, circ_0006168 functioned as a sponge while RBBP7 acted as a target of miR-384 in EC. Rescue experiment revealed that miR-384 inhibitor abrogated circ_0006168 silencing-induced repression on cell proliferation, migration, and invasion in EC. Meanwhile, upregulation of RBBP7 restored the inhibition of miR-384 on EC cell progression. Moreover, circ_0006168 was able to improve RBBP7 level by interacting with miR-384. Also, circ_0006168 could activate S6K/S6 pathway by regulating RBBP7 expression. CONCLUSIONS: Abundance of circ_0006168 contributes to cell proliferation, migration, invasion, and glycolysis in EC by competitively sponging miR-384 to facilitate RBBP7 expression, representing prospective targets for EC therapy.

[Status of non-steroidal anti-inflammatory drugs use in areas with a high incidence of upper gastrointestinal cancer in China: a multi-center cross-sectional survey].

Objective: To describe the status of non-steroidal anti-inflammatory drugs (NSAIDs) use in areas with a high incidence of upper gastrointestinal cancer in China. Methods: This study was based on the National Key Research and Development Program of "National Precision Medicine Cohort of Esophageal Cancer" and "Study on Identification and Prevention of High-risk Populations of Gastrointestinal Malignancies (Esophageal cancer, Gastric cancer and Colorectal cancer)" . From January 2017 to August 2018, 212 villages or communities with a high incidence of esophageal cancer or gastric cancer were selected from 12 regions in 6 provinces. A total of 35 910 residents aged between 40 and 69 years old who met the inclusion criteria and signed the informed consent were investigated and enrolled in this study. The use of NSAIDs, demographic characteristics, health-related habits, height, weight, and blood pressure were collected by the questionnaire and physical examination. The status of main NSAIDs (aspirin, acetaminophen and ibuprofen) use with the difference varying in genders, age groups and regions were analyzed by using χ(2) test and Cochran-Armitage trend analysis method. Results: Of 35 910 subjects, the mean age was (54.6±7.1) years old and males accounted for 43.42% (15 591). The overall prevalence of NSAIDs intake was 4.56% (1 638), but it significantly varied in different provinces (P<0.001). The overall prevalence of NSAIDs intake was 4.87% (1 750) in females, which was significantly higher than that in males 4.24% (1 524) (P<0.001). The prevalence of NSAIDs intake increased with age (P for trend <0.001). As the frequency of NSAIDs intake increased, the incidence of gastrointestinal symptoms, gastrointestinal ulcers and black stools increased (P for trend <0.05 for all). Conclusion: The use of NSAIDs is prevalent in some areas with a high incidence of upper gastrointestinal cancer in China. The increased use of NSAIDs may lead to more adverse effects related to the gastrointestinal tract.

Incidence and mortality of nasopharyngeal carcinoma: interim analysis of a cluster randomized controlled screening trial (PRO-NPC-001) in southern China.

BACKGROUND: Previous mass screening studies have shown that IgA antibodies against Epstein-Barr Virus (EBV) can facilitate early detection of nasopharyngeal carcinoma (NPC), but the impact of EBV-antibody screening for NPC-specific mortality remains unknown. PATIENTS AND METHODS: A prospective, cluster randomized, controlled trial for NPC screening (PRO-NPC-001) was conducted in 3 selected towns of Zhongshan City and 13 selected towns of Sihui City in southern China beginning in 2008. Serum samples of the screening group were tested for two previously selected anti-EBV antibodies. Subjects with serological medium risk were subsequently retested annually for 3 years, and those with serological high risk were referred to otorhinolaryngologists for diagnostic check-up. An interim analysis was carried out to evaluate the primary end points of the NPC-specific mortality and the early diagnostic rate, and the secondary end point of the NPC incidence, through linkage with the database of Zhongshan City. RESULTS: Among 70 296 total subjects, 29 413 screened participants (41.8% of the total subjects) in the screening group and 50 636 in the control group, 153 (43.3 per 100 000 person-year), 62 (55.3 per 100 000 person-year) and 99 (33.1 per 100 000 person-year) NPC cases were identified. The early diagnostic rates of NPC were significantly higher in the participants (79.0%, P < 0.0001) and the screening group (45.9%, P < 0.0001) compared with the control group (20.6%). Although no differences were found between NPC-specific mortality of the screening group and the control group [relative risk (RR)= 0.82, 95% confidence interval (CI) 0.37-1.79], lower NPC-specific mortality was noticed among participants from the screening group versus the control group (RR = 0.22, 95% CI 0.09-0.49). CONCLUSION: IgA antibodies against EBV can identify high-risk population and was effective in screening for early asymptomatic NPC. Although the mortality reduction was not significant in the primary end point, we noted encouraging evidence of a mortality reduction in screening participants in this interim analysis. CLINICAL TRIAL NUMBER: NCT00941538.

The joint impact of smoking plus alcohol drinking on treatment of pulmonary tuberculosis.

Tuberculosis, smoking, and alcohol drinking are major public health and social issues worldwide. We investigated the joint effect of smoking plus alcohol drinking on TB treatment. Retrospective study was conducted among TB patients in 49 units from eight provinces in China. All patients enrolled were classified into four groups according to their smoking and/or alcohol status. Current smokers plus drinkers belonged to group 1; ex-smokers plus ex-drinkers were in group 2; current smokers and ex-drinkers, current smokers and never drinkers, ex-smokers and current drinkers, ex-smokers and never drinkers, never smokers and current drinkers, and never smokers and ex-drinkers belonged to group 3; while the never smokers plus never drinkers were in group 4. We used a chi-square test to compare adverse drug reaction, lesions absorption and cavities of lung, sputum culture at the end of the second month, and treatment outcomes among the four groups. Among the 1256 participants enrolled in the study, 6.1% (76/1256) were current smokers plus drinkers; 25.9% (325/1256) were ex-smokers plus drinkers; 29.1% (366/1256) were current/never/ex-smokers and/or drinkers, and 38.9% (489/1256) were never smokers plus drinkers, respectively. Compared to the never smokers and drinkers, smoker plus drinker TB patients were more likely to experience adverse drug reaction (x2 = 8.480, P = 0.037), less proportion of lesions absorption in lungs (x2 = 10.330, P = 0.016), lower proportion of culture conversion (x2 = 18.83, P = 0.04), and more unfavorable outcomes. Smoking plus alcohol drinking adversely affect response against TB treatment, which increase adverse drug reactions, sputum culture-positive rate at the end of the second month, and failure rate of pulmonary tuberculosis patients.

Population-based cohort study of diabetes mellitus and mortality in gastric adenocarcinoma.

BACKGROUND: Gastric adenocarcinoma is a common cause of cancer death globally. It remains unclear whether coexisting diabetes mellitus influences survival in patients with this tumour. A cohort study was conducted to determine whether coexisting diabetes increases mortality in gastric adenocarcinoma. METHODS: This nationwide population-based cohort study included all patients diagnosed with gastric adenocarcinoma in Sweden between 1990 and 2014. Cox proportional hazards regression and competing risks regression were used to assess the influence of coexisting diabetes on disease-specific mortality in gastric adenocarcinoma with adjustment for sex, age, calendar year and co-morbidity (Charlson Co-morbidity Index score excluding diabetes). RESULTS: Among 23 591 patients with gastric adenocarcinoma, 2806 (11·9 per cent) had coexisting diabetes. Overall, patients with diabetes had a moderately increased risk of disease-specific mortality after diagnosis of gastric adenocarcinoma compared with those without diabetes, as shown by both Cox regression (hazard ratio (HR) 1·17, 95 per cent c.i. 1·11 to 1·22) and competing risks regression (sub-HR 1·08, 1·02 to 1·13). The HRs for disease-specific mortality were notably increased in diabetic patients without other co-morbidity (HR 1·23, 1·15 to 1·32) and in diabetic patients who had surgery with curative intent (HR 1·27, 1·16 to 1·38). CONCLUSION: These findings indicate a worse prognosis in patients with gastric adenocarcinoma and coexisting diabetes compared with those without diabetes.

[Relation between waist circumference and risk of male lung cancer incidence: a prospective cohort study].

Objective: To investigate the association between waist circumference and risk of male lung cancer incidence. Methods: Since May 1, 2006, all the male employees including the retirees in Kailuan Group had been recruited into a Chinese Kailuan Male Cohort study. Information on anthropometries including body weight, height and waist circumference were collected at the baseline investigation, as well as information on newly-diagnosed lung cancer cases during the follow-up period. Waist circumference was grouped by quintiles of the population waist circumference distribution and categorized into the following five groups: <80, 80-, 85-, 90- and ≥95 cm, with the relevant normal group, the second quintile group (80-cm), serving as the referent category. Multivariable Cox proportional hazards regression models were used to evaluate the association between levels of waist circumference and risk of lung cancer. Results: A total of 105 386 males were recruited in the study, with 739 651.13 person-years of follow-up and an average follow-up period of 7.00 years. By the end of 2014, a total of 707 lung cancer cases were identified in the cohort study. Compared with males having the 80-cm of waist circumference, the hazard ratio (HR) and 95% confidence intervals (CI) of lung cancer were 1.17(0.90-1.52), 0.96(0.74-1.23), 0.94(0.72-1.21) and 0.80(0.63-1.03) for the <80, 85-, 90- and ≥95 cm of waist circumference, after adjustment for potential confounding factors including age, education level, smoking status and pack-year amount, alcohol consumption, physical activities, environment for working place and the prevalence on diabetes. The inverse association existed in smokers (≥95 cm compared to 80-cm of waist circumference: HR=0.69, 95%CI: 0.48-0.99) and alcohol drinkers (≥95 cm compared to 80-cm of waist circumference: HR=0.65, 95%CI: 0.45-0.94) when analysis was conducted in subgroups stratified by smoking or alcohol drinking status. Conclusion: Waist circumference might be inversely associated with male lung cancer risk.

[A prospective follow-up study on the association between serum level of C-reactive protein and risk of digestive system cancers in Chinese women].

Objective: It has been reported by some prospective studies that C-reactive protein (CRP) is associated with cancer risk. However, the correlation between CRP and digestive system cancers has not been evaluated in Chinese females. We conducted a large population-based cohort study to investigate whether elevated level of CRP in serum is associated with an increased risk of digestive system cancers in Chinese women. Methods: From the Chinese Kailuan Female Cohort, 19, 437 women were enrolled in this study in July 2006, and all of the subjects were followed up through 2014. At the baseline investigation, the serum levels of high-sensitivity CRP (hsCRP) were tested for all subjects, and demographic information and risk factor data were collected. Multivariable Cox proportional hazards regression model was used to calculate the hazard ratios (HR) and 95% confidence intervals (95% CI) for the baseline levels of hsCRP after adjusting for age, marital status, smoking, drinking, body mass index (BMI), diabetes and physical activity, and risk of digestive system tumors (including colorectal cancer, stomach cancer, pancreas cancer, liver and gallbladder cancer, and other cancers). Results: By Dec 31, 2014, a total of 100 incident cancer cases were observed, including 47 colorectal cancers, 17 stomach cancers, and altogether 29 pancreas, liver and gallbladder cancers. All the subjects investigated were divided into three groups according to the level of hsCRP (<1 mg/L, 1-3 mg/L and >3 mg/L). The 8-year cumulative incidence of digestive system cancers were 405/100 000, 520/100 000 and 787/100 000 in these 3 groups, respectively (Log rank test χ2 = 8.37, P=0.015). Compared to those with lower hsCRP levels (<1 mg/L), the women with higher hsCRP (>3 mg/L) had a significantly increased risk of pancreas, liver and gallbladder cancers (HR = 2.70, 95% CI = 1.06-6.91; Ptrend = 0.036). Conclusions: Elevated levels of hsCRP at baseline may be associated with increased risk of certain digestive system cancers.

[Association between body mass index and risk of lung cancer in non-smoking males: a prospective cohort study].

Objective: To assess the association between baseline body mass index (BMI) and risk of lung cancer in non-smoking males. Methods: A dynamic non-smoking male cohort was established on May, 2006. Baseline information on demography, lifestyle, such as smoking status and alcohol consumption, anthropometry, such as body height and weight, were collected during the baseline interview, and the information of newly-diagnosed lung cancer cases were also collected during the follow-up period. Multivariable Cox proportional-hazards regression model was used to analyze the association between baseline BMI and lung cancer in non-smoking males. Results: By December 31, 2011, a total of 48 799 male non-smokers had been assessed in the study and there were 214 620.18 person-years of follow-up and 4.40 years of average follow-up period. During follow-up, 198 lung cancer cases were identified among the 48 799 non-smoking males. Compared with those with normal BMI (kg/m2) (18.5≤BMI<24.0), the hazard ratio (95%CI) of lung cancer were 1.14(0.53-2.45), 0.57(0.41-0.78) and 0.61(0.38-0.97) for underweight (BMI<18.5), overweight (24.0≤BMI<28.0) and obese males (≥28.0), respectively, after adjustment for potential confounding factors, including age, education level, alcohol consumption, physical activity, history of diabetes and work environment. Baseline BMI was negatively associated with the risk of lung cancer in non-smoking males and the risk would be reduced by 22% (HR=0.78, 95% CI: 0.64-0.95) for per 5 kg/m2 BMI increase. The negative association between BMI and risk of lung cancer was significant among non-smoking males who aged ≥50 years, and in those who had physical exercise <4 times/week, never drunk and worked above the coal mine, and for per 5 kg/m2 BMI increase, the risk of lung cancer would be reduced by 26%(HR=0.74, 95%CI: 0.60-0.92), 24%(HR=0.76, 95%CI: 0.62-0.95), 20% (HR=0.80, 95%CI: 0.65-1.00) and 23% (HR=0.77, 95%CI: 0.61-0.97), respectively. The result was similar after excluding the cancer patients newly diagnose within 1-year and their contribution person years. Conclusion: Baseline BMI might be negatively associated with risk of lung cancer in non-smoking males.

[Body mass index and the risk of lung cancer incidence in smokers: a prospective cohort study].

OBJECTIVE: To investigate the effect of baseline body mass index (BMI) on the risk of lung cancer incidence in male smokers. METHODS: All the male employees and retirees of the Kailuan Group were recruited in the Chinese Kailuan Male Cohort Study, and they had been experienced routine physical examinations every two years since May, 2006. Up to 31st December 2011, a total of 3 rounds physical examinations had been completed. A total of 42 718 male smokers candidates from the Chinese Kailuan Male Cohort Study were enrolled in the present study. The date of entering this study was defined as that of taking first check-up, and the date of end-of-observation was defined as that of cancer diagnosis, death or end of follow-up (31 December 2011). Information on demographics, lifestyle such as smoking, alcohol consumption, anthropometries such as height and weight, as well as the information of newly-diagnosed cancer cases, were collected at the baseline investigation. Multivariable Cox proportional hazards regression models were used to investigate the association between levels of the baseline BMI and risk of lung cancer. RESULTS: Of the 42 718 male smokers, there were 181 998.09 person-years of follow-up, taking 4.26 years of average follow-up period. During follow-up, 234 new lung cancer cases were identified among the 42 718 male smokers and the crude incidence density was 128.57/100 000. After the factors adjustment for age, education level, alcohol consumption, physical activity, work environment and cumulative smoking levels (pack-years), compared with subjects of normal BMI group, hazard ratio and 95% confidence intervals of lung cancer for subjects of underweight, overweight, and obesity were 1.63 (0.79-3.37), 0.79 (0.57-1.09) and 0.50 (0.27-0.91), respectively. After the facotors adjustment for age, education level, alcohol consumption, physical activity, work environment and cumulative smoking levels (pack-years), compared with subjects of normal BMI, hazard ratio and 95% confidence intervals of lung cancer for subjects of obesity among subjects who aged 50 years or above, smoked more than 20 pack-years, and exercised less than 4 times per week were 0.33 (0.15-0.71), 0.27 (0.10-0.75), and 0.44 (0.20-0.96), respectively. Obesity subjects who worked above the well had decreased risk of lung cancer (HR=0.38, 95% CI: 0.15-0.96) compared with normal BMI ones who worked above the well. CONCLUSION: BMI was negatively correlated with the risk of lung cancer in male smokers. As for male smokers, one of the most effective approaches to prevent and control the lung cancer has been shown to quit smoking and keep fit.