Prognostic value of a predictive model comprising preoperative inflammatory response and nutritional indexes in patients with gastric cancer / 中华胃肠外科杂志

Objective: To investigate the prognostic value of preoperative inflammatory and nutritional condition detection in the postoperative survival, and establish a prognostic model for predicting the survival of patients with gastric cancer. Methods: The clinicopathological data of 1123 patients with gastric cancer who had undergone radical gastrectomy in Tianjin Medical University Cancer Institute & Hospital from January 2005 to December 2014 were retrospectively analyzed. Patients with history of other malignancy, with history of gastrectomy, who had received preoperative treatment, who died during the initial hospital stay or first postoperative month, and missing clinical and pathological information were excluded. Cox univariate and multivariate analyses were used to identify independent clinicopathological factors associated with the survival of these gastric cancer patients. Cox univariate analysis was used to identify preoperative inflammatory and nutritional indexes related to the survival of patients with gastric cancer after radical gastrectomy. Moreover, the Cox proportional regression model for multivariate survival analysis (forward stepwise regression method based on maximum likelihood estimation) was used. The independent clinicopathological factors that affect survival were incorporated into the following three new prognostic models: (1) an inflammatory model: significant preoperative inflammatory indexes identified through clinical and univariate analysis; (2) a nutritional model: significant preoperative nutritional indexes identified through clinical and univariate analysis; and (3) combined inflammatory/nutritional model: significant preoperative inflammatory and nutritional indexes identified through clinical and univariate analysis. A model that comprised only pT and pN stages in tumor TNM staging was used as a control model. The integrated area under the receiver operating characteristic curve (iAUC) and C-index were used to evaluate the discrimination of the model. Model fitting was evaluated by Akaike information criterion analysis. Calibration curves were used to assess agreement between the predicted probabilities and actual probabilities at 3-year or 5-year overall survival (OS). Results: The study cohort comprised 1 123 patients with gastric cancer. The mean age was 58.9±11.6 years, and 783 were males. According to univariate analysis, age, surgical procedure, extent of lymph node dissection, tumor location, maximum tumor size, number of examined lymph nodes, pT stage, pN stage, and nerve invasion were associated with 5-year OS after radical gastrectomy for gastric cancer (all P<0.050). Multivariate analysis further identified age (HR: 1.18, 95%CI: 1.03-1.36, P=0.019), maximum tumor size (HR: 1.19, 95%CI: 1.03-1.38, P=0.022), number of examined lymph nodes (HR: 0.79, 95%CI: 0.68-0.92, P=0.003), pT stage (HR: 1.40, 95%CI: 1.26-1.55, P<0.001) and pN stage (HR: 1.28, 95%CI: 1.21-1.35, P<0.001) as independent prognostic factors for OS of gastric cancer patients. Additionally, according to univariate survival analysis, the preoperative inflammatory markers of neutrophil count, percentage of neutrophils, neutrophil/lymphocyte ratio, platelet/neutrophil ratio and preoperative nutritional indicators of serum albumin and body mass index were potential prognostic factors for gastric cancer (all P<0.05). On the basis of the above results, three models for prediction of prognosis were constructed. Variables included in the three models are as follows. (1) Inflammatory model: age, maximum tumor size, number of examined lymph nodes, pT stage, pN stage, percentage of neutrophils, and neutrophil-lymphocyte ratio; (2) nutritional model: age, maximum tumor size, number of examined lymph nodes, pT stage, pN stage, and serum albumin; and (3) combined inflammatory/nutritional model: age, maximum tumor size, number of examined lymph nodes, pT stage, pN stage, percentage of neutrophils, neutrophil-lymphocyte ratio, and serum albumin. We found that the predictive accuracy of the combined inflammatory/nutritional model, which incorporates both inflammatory indicators and nutrition indicators (iAUC: 0.676, 95% CI: 0.650-0.719, C-index: 0.698),was superior to that of the inflammation model (iAUC: 0.662, 95% CI: 0.673-0.706;C-index: 0.675), nutritional model (iAUC: 0.666, 95% CI: 0.642-0.698, C-index: 0.672), and TNM staging control model (iAUC: 0.676, 95% CI: 0.650-0.719, C-index: 0.658). Furthermore, the combined inflammatory/nutritional model had better fitting performance (AIC: 10 762) than the inflammatory model (AIC: 10 834), nutritional model (AIC: 10 810), and TNM staging control model (AIC: 10 974). Conclusions: Preoperative percentage of neutrophils, NLR, and BMI have predictive value for the prognosis of gastric cancer patients. The inflammatory / nutritional model can be used to predict the survival and prognosis of gastric cancer patients on an individualized basis.

Clinicopathological characteristics and prognostic analysis of bone metastasis in gastric cancer patients / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological characteristics and prognostic factors of bone metastasis in gastric cancer patients.</p><p><b>METHODS</b>Clinicopathological data of 66 gastric cancer patients with bone metastasis, who were treated at the Tianjin Medical University Cancer Institute and Hospital from October 1997 to September 2011, were analyzed retrospectively. The clinicopathological characteristics of the primary cancer and bone metastasis were summarized and the prognosis was analyzed.</p><p><b>RESULTS</b>Of 66 patients, 4 underwent operation, 28 chemotherapy, 32 inhibitors of bone resorption,8 local treatment and 23 symptomatic treatment alone. The median survival time of these 66 patients was 5 months (95%CI:3.3-6.7 months). The 1-, 2- and 3-year survival rates were 9.1%, 3.0% and 1.5%, respectively. Univariate Log-rank test indicated that gender, bone metastasis combined with other distant metastasis and chemotherapy were significant prognostic factors (all P<0.05). Multivariate analysis revealed bone metastasis combined with other distant metastasis was an independent prognostic factor (P=0.011, RR=2.067, 95%CI:1.178-3.626).</p><p><b>CONCLUSIONS</b>Prognosis of patients with bone metastasis from gastric cancer is poor. Chemotherapy-based comprehensive treatment may improve the prognosis of these patients.</p>

Treatment and prognostic analysis of early stage of primary gastric diffuse large B-cell lymphoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the prognostic factors and to compare chemotherapy alone versus surgical resection plus chemotherapy for early stage primary gastric diffuse large B-cell lymphomas (DLBCL).</p><p><b>METHODS</b>Clinical data of 75 patients who were diagnosed as primary gastric DLBCL between January 1993 and August 2008 in Cancer Institute and Hospital of Tianjin Medical University were reviewed retrospectively.</p><p><b>RESULTS</b>Among these 75 patients, 20 patients received chemotherapy alone and 55 underwent surgical resection plus chemotherapy. Complete remission rates were 65.0% (13/20) and 83.6% (46/55), effective rates were 75.0% (15/20) and 92.7% (51/55), and 5-year survival rates were 86.9% and 78.7% respectively in chemotherapy alone group and resection plus chemotherapy group, while the differences were not statistically significant (all P>0.05). Multivariate Cox regression model showed that international prognosis index (IPI) was the only independent prognostic factor (P<0.05, HR=11.350, 95%CI:1.011-127.371).</p><p><b>CONCLUSIONS</b>In early stage of DLBCL, IPI is the only independent prognostic factor. The clinical outcomes are comparable between chemotherapy alone and surgical resection plus chemotherapy.</p>

Interim report of prospective clinical study of two different digestive tract reconstruction after total gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare post-operative long-term complications and quality of life of two digestive reconstruction procedures after total gastrectomy.</p><p><b>METHODS</b>A total of 109 gastric cancer patients in Tianjin Medical University Cancer Hospital from March 2012 to February 2013 were prospectively enrolled and randomly divided into functional jejunal interposition (FJI) group (52 cases) and Roux-en-Y (R-Y) group (57 cases). The post-operative complications, nutritional status, and the quality of life were compared between two groups.</p><p><b>RESULTS</b>One, 3 and 6 months after operation, the incidence of R-S syndrome in FJI group was lower as compared to R-Y group[13% (6/45) vs. 37% (18/49), 3% (1/30) vs. 42% (14/33), 5% (1/21) vs. 48% (11/23), all P<0.01], while 3 months after operation, the incidence of reflux and heartburn in FJI group was higher[53% (16/30) vs. 21% (7/33), P<0.01; 37% (11/30) vs. 12% (4/33), P<0.05]. There were no significant differences in quality of life questionnaire QLQ-C30 between R-Y and FJI groups. QLQ-STO22 stomach module revealed in FJI group, the eating score was better, but reflux score was worse as compared to R-Y group 3 months after operation (all P<0.01).</p><p><b>CONCLUSIONS</b>Functional jejunal interposition keeps intestinal continuity preserving and food duodenal passing, which is a reasonable digestive reconstruction procedure.</p>

Prognosis analysis of 310 patients with pathological stage pN3 gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological characteristics and prognostic factors of patients with pathological stage pN3 gastric cancer.</p><p><b>METHODS</b>A retrospective study of 310 patients with histologically confirmed pN3 stage gastric cancer undergoing radical gastrectomy from January 2000 to December 2006 in our department was performed. The Kaplan-Meier method was used to analyze the survival. Log-rank test and Cox regression model were carried out for univariate and multivariate analyses.</p><p><b>RESULTS</b>All the patients were followed up for 2 to 103 (mean 35.7) months. The overall 5-year survival rate was 14.6%. There were 201 cases with stage pN3a and 109 cases with stage pN3b, and the 5-year survival rates were 16.8% and 10.3% respectively (P=0.013). Univariate analysis showed that tumor location, Borrmann type, depth of tumor invasion, surgical method, metastatic lymph node ratio, and pN stage were associated with postoperative survival (all P<0.05). The multivariate analysis revealed that depth of tumor invasion, surgical method and metastatic lymph node ratio were independent prognostic factors, while the pN stage was not. The difference of 5-year survival rate between pN3a and pN3b subgroups was significant in pT4a patients (16.1% vs. 12.8%, P=0.001), while such difference was not significant in pT4b patients (8.6% vs. 3.1%, P=0.137).</p><p><b>CONCLUSIONS</b>Prognosis of patients with pN3 stage gastric cancer after radical resection is poor. Depth of tumor invasion and surgical method are independent prognostic factors for pN3 stage gastric cancer. Metastatic lymph node ratio is valuable to predict the prognosis of pN3 stage patients. The pN3 staging of the 7th UICC provides a more accurate prediction of prognosis.</p>

Risk factors for early recurrence after radical resection of proximal gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the risk factors for early recurrence (recurrence within 2 years) of proximal gastric cancer after radical resection.</p><p><b>METHODS</b>The clinical data of 367 proximal gastric cancer patients who underwent radical resection in the Cancer Institute and Hospital of Tianjin Medical University between January 2000 and May 2006 were reviewed. Among them, there are 71 patients (19.3%) with early recurrence. Univariate analysis and multivariate analysis were applied to investigate risk factors for early recurrence.</p><p><b>RESULTS</b>Univariate analysis showed that Borrmann type (P<0.01), histology type (P<0.01), depth of invasion (P<0.05), negative lymph nodes count (P<0.05) were risk factors for early recurrence of proximal gastric. On multivariate analysis, histology type (P<0.05), depth of invasion (P<0.05), negative lymph nodes counts (P<0.05) were independent risk factors for early recurrence of proximal gastric cancer. Negative lymph nodes in early recurrence patients were 8.4 ± 7.2, which were significantly less as compared to patients without early recurrence (10.7 ± 8.7) (P<0.05).</p><p><b>CONCLUSION</b>For T3 proximal gastric adenosquamous cancer, extended resection and lymphadenectomy should be considered. Intraoperative or postoperative adjuvant treatment should be administered as routine.</p>

A retrospective analysis of clinic-pathological characteristics and prognostic factors for 204 cases of primary gastric lymphoma / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the clinicopathological characteristics and prognostic factors of primary gastric lymphoma (PGL).</p><p><b>METHODS</b>The clinical data of 204 patients with PGL was reviewed and analyzed. There were 106 males and 98 females, their age were 19 to 85 years (average age was 53.7 years). The Focal areas included gastric fundus lesions 41 cases (20.1%), stomach body lesions 127 cases (62.3%), distal gastric lesions 105 cases (51.5%), cardia lesions 13 cases (6.4%), duodenal bulb lesion 1 cases (0.5%). The clinical characteristics and the outcomes in patients with influence were analysed.</p><p><b>RESULTS</b>In 204 PGL patients, the most common complaints were abdominal pain (62.3%) and weight loss (52.9%). Most of the PGL patients appeared ulcerative (76.0%) and results showed that 62.7% patients involved single location. As to the factors of cellulate grading and pathological characteristics, most patients (87.7%) show low-grade or intermediate-grade lymphoma, Musshoff stages I and II (74.0%). In 186 patients with complete follow-up data, survival rates of 1-, 3- and 5-year were 75.8%, 63.4% and 60.2% respectively. The median overall survival time was 50.0 months. In univariate survival analysis, age (χ(2) = 5.030), level of LDH (χ(2) = 40.084), cellulate grading (χ(2) = 35.238), Musshoff stage (χ(2) = 71.601), tumor diameter (χ(2) = 12.018) and option of managements (χ(2) = 14.140) were obviously correlated with the prognosis (all P < 0.05). Musshoff stage (RR = 2.230, 95%CI: 1.372 - 3.625) and cellulate grading (RR = 1.892, 95%CI: 1.010 - 3.543) were independent prognostic factors in multivariable analysis (both P < 0.05). There was no prognostic difference between surgery and chemotherapy in stage I and II (χ(2) = 1.223, P = 0.542).</p><p><b>CONCLUSIONS</b>Musshoff stage and grade malignancy are independent prognostic factors. For patients with stage I and II, surgical resection is not the first-choice for clinical therapy.</p>

Prognostic analysis of 280 patients with T4a gastric cancer who underwent curative resection / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the predicators of survival and recurrence after curative resection for gastric cancer patients with serosal invasion.</p><p><b>METHODS</b>Clinical and follow-up data of 280 patients with T4a gastric cancer(according to the 7th UICC TNM Classification for gastric cancer) who underwent curative resection for gastric cancer between January 1997 and December 2003 were analyzed retrospectively.</p><p><b>RESULTS</b>Five-year survival rate of these 280 patients was 50.0% and 158 patients (56.4%) presented with recurrence after surgery. The 3-year disease-free survival rate was 57.5%. The number of lymph node metastasis and metastatic lymph node ratio(MLR) were identified as the independent predicators for overall survival(P<0.05). The extent of lymph node metastasis was identified as the independent predicators for disease free survival (P<0.05). The extent of lymph node metastasis, the number of lymph node metastasis, and MLR were identified as the independent predicators for recurrence after surgery(P<0.05).</p><p><b>CONCLUSIONS</b>The number of lymph node metastases, extent of lymph node metastasis and MLR are independent predictors of overall survival and recurrence in T4a gastric cancer patients after curative resection.</p>

Use of uncut Roux-en-Y reconstruction after distal gastrectomy for gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy of uncut Roux-en-Y reconstruction after distal gastrectomy for gastric cancer.</p><p><b>METHODS</b>Clinical data of 419 patients who underwent distal gastrectomy for gastric cancer with complete follow-up data between March 2005 and March 2008 in the Cancer Institute and Hospital of Tianjin Medical University. Patients were divided into B I (138 cases with Billroth I reconstruction), M-B II (108 cases with modified Billroth II reconstruction), RY (46 cases with Roux-en-Y reconstruction) and Uncut RY (127 cases with uncut Roux-en-Y reconstruction) according to reconstructive methods.</p><p><b>RESULTS</b>Patients in the Uncut RY group had a larger tumor diameter, more T3, and poorer stage of disease compared to those in the B I (P<0.05). In Uncut RY group, the operative time and postoperative hospital stay were(132.6±19.2) minutes and (10.4±1.2) days respectively, shorter than those in RY group (142.5±11.7) minutes and (12.1±3.7) days(both P<0.05), alkaline reflex gastritis rate was 3.2%, lower than that in B I group (24.6%, P<0.05) and M-B II group (25.9%, P<0.05). Marginal ulcer rate in uncut RY group was lower compared to M-B II group (P=0.019), and incidence of Roux-en-Y stasis syndrome was less compared to RY group (P=0.000).</p><p><b>CONCLUSIONS</b>The uncut Roux-en-Y reconstruction is both feasible and safe. It can prevent alkaline reflex gastritis and Roux-en-Y stasis syndrome. It may be the preferred technique for reconstruction after distal gastrectomy.</p>

Prognostic factors in 138 patients with node-negative gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the risk factors for the prognosis in patients with node-negative gastric cancer.</p><p><b>METHODS</b>Clinicopathological characteristics of 138 patients with node-negative gastric carcinoma undergoing curative gastrectomy from January 2000 to December 2005 were retrospectively analyzed.</p><p><b>RESULTS</b>The overall 5-year survival rate was 62.4%. The univariate analysis revealed that tumor size, tumor location, cell differentiation, invasive depth, operative type and Lauren histologic type had significant effects on the survival. The independent prognostic factors of these patients were tumor size, cell differentiation, and serosal involvement in multivariate analyses.</p><p><b>CONCLUSION</b>For node-negative gastric cancer patients, tumor size, poor differentiation and serosal involvement are important markers to evaluate prognosis.</p>

Prognosis of patients with recurrence after curative resection of advanced gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical features and prognosis of recurrent gastric cancer.</p><p><b>METHODS</b>Clinical data of 163 patients with recurrent gastric cancer from Jan. 2001 to Jan. 2005 were reviewed. Patients were compared between those with and without symptoms.</p><p><b>RESULTS</b>Seventy-two patients(44.2%) were symptomatic, while 91(55.8%) were asymptomatic. There were significant differences in lymph node metastasis between the two groups(P<0.05). The median overall survival was significantly longer in asymptomatic patients (19.8 vs. 15.7 months, P<0.05). Post-recurrence survival was also longer in the asymptomatic group (9.5 vs. 4.8 months, P<0.01). The median recurrence-free interval in asymptomatic patients was 10.0 months, which was significantly longer than that in the symptomatic patients (9.2 months, P<0.05). On univariate survival analysis,post-gastrectomy chemotherapy (P<0.05), symptoms of recurrence(P<0.01), TNM staging(P<0.01), recurrence-free interval (P<0.01), and reoperation(P<0.01) were associated with the prognosis. On multivariable analysis, TNM staging(P<0.01), symptoms of recurrence(P<0.01), recurrence-free interval (P<0.05), and reoperation(P<0.05) were independent risk factors.</p><p><b>CONCLUSIONS</b>Patients with recurrent gastric cancer have poor prognosis. Close monitoring and active follow-up of patients with gastric cancer should be conducted during the first two years after operation. Reoperation may improve survival in patients with recurrent gastric cancer.</p>

Prognostic significance of preoperative serum albumin level in patients with gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the prognostic significance of preoperative serum albumin in patients with gastric cancer undergoing radical resection.</p><p><b>METHODS</b>A total of 146 patients with gastric cancer underwent radical resection from January 2001 to December 2003. Clinicopathological data were analyzed retrospectively. Patients were divided into two groups, including patients with a normal preoperative serum albumin level(>35 g/L, n=115) and patients with hypoalbuminemia (≤35 g/L, n=31).</p><p><b>RESULTS</b>Patients with a low albumin level were associated with a higher postoperative recurrence rate(90.3% vs. 43.5%, P<0.01). The overall 5-year survival rate in patients with a normal serum albumin level was significantly higher than that in patients with a low serum level(57.4% vs. 9.7%, P<0.01). On multivariate analysis, preoperative serum albumin level was an independent factor associated with survival(P<0.01). When stratified by nodal metastasis, normal serum albumin level was still associated with higher survival rate(P<0.05). Prognostic significance was found in patients with lower stomach cancer(P<0.01), but not in patients with cancer in the upper and middle stomach(P>0.05).</p><p><b>CONCLUSION</b>Hypoalbuminemia is associated with worse survival in patients with cancer in the lower stomach and adjuvant therapy should be considered.</p>

A retrospective analysis of clinicopathological characteristics and prognostic factors of gastric stump cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the clinicopathological characteristics and prognostic factors of gastric stump cancer(GSC).</p><p><b>METHODS</b>The clinical data of 138 patients with GSC treated from January 1992 to July 2008 were reviewed and analyzed. The patients included 122 males and 16 females with a mean age of 61.5 years, and the mean interval between the initial operation and second diagnosis was 21.9 years.</p><p><b>RESULTS</b>The endoscopy and pathological examination showed Borrmann III/IV in 127 (92.7%) patients and undifferentiated carcinoma in 115 (83.3%) patients. The resectability and radical resectability rate were 72.4% and 59.4%. The 1-, 3- and 5-year survival rates was 59.2%, 30.1% and 14.2%, respectively. The median overall survival time was 19.4 months. Univariate Log-rank test indicated that Borrmann type, histological type, tumor diameter, TNM stage, depth of invasion, number of metastatic lymph node, distant metastasis and option of treatment were significant prognostic factors for GSC. While TNM stage, depth of invasion, distant metastasis and option of treatment were prognostic factors on multivariable analysis. The median survival time of patients underwent radical resection was significantly longer (36 months) than that of patients received palliative resection (8 months, P < 0.05) and chemotherapy only (5 months, P < 0.05). Among patients with a tumor of T4 stage, the median survival time was statistically prolonged by combined evisceration (18.6 months) when compared with the patients received palliative surgery.</p><p><b>CONCLUSIONS</b>TNM stage, depth of invasion, distant metastasis and option of treatment are independent prognostic factors for GSC. Early diagnosis and radical resection may play an important role in improving the prognosis of GSC.</p>

Risk factors of early recurrence in patients with gastric cancer after curative resection / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical and pathologic influencing factors of early recurrence in patents with gastric cancer after radical gastrectomy.</p><p><b>METHODS</b>Clinicopathological data of 141 patients with recurrence after curative gastrectomy for gastric cancer from January 2001 to December 2004 were analyzed retrospectively. Risk factors correlated with tumor early recurrence and survival difference between early recurrence group (< 1 year, 82 cases) and control group (1 year after, 59 cases) were assessed.</p><p><b>RESULTS</b>The 1- and 3-year survival rates of in early recurrence group and control group were 36.6%, 2.4% and 100%, 45.8%, respectively (P < 0.05). The median survival time after recurrence in the two groups was 3, 5 months, respectively (P < 0.05). Univariate analysis showed that the age, tumor Borrmann type, tumor site, invasive depth, lymph node metastasis, pTNM stage, metastatic lymph node ratio, surgical procedure and intraperitoneal hyperthermic perfusion chemotherapy (IHPC) were significant factors associated with early recurrence after curative gastrectomy for gastric cancer (P < 0.05). Lymph node metastasis, metastatic lymph node ratio and IHPC were independent factors associate with early recurrence after curative gastrectomy on multivariate analysis (P < 0.05).</p><p><b>CONCLUSIONS</b>The patients with early recurrence after the radical gastrectomy have a poorer survival compared with cases recur later. Lymph node metastasis, metastatic lymph node ratio and IHPC are independent factors associate with early recurrence after curative gastrectomy for gastric cancer.</p>

Analysis of treatment and prognosis in 132 patients with gastric gastrointestinal stromal tumors / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological characteristics, diagnosis, treatment and prognostic factors of gastric gastrointestinal stromal tumors(GIST) in the stomach.</p><p><b>METHODS</b>The clinicopathological data of 132 patients with gastric GIST between January 1998 and December 2008 were analyzed retrospectively, and the prognostic factors were evaluated.</p><p><b>RESULTS</b>Tumor locations were the cardia or fundus (50, 37.9%), the stomach body (62, 47%),the antrum (13, 9.8%), and two regions were found in 6 cases (4.5%), three regions in 1 cases (0.8%). Tumor size ranged from 1.0 to 27.0 cm with an average of 9.4 cm. All the patients underwent complete tumor resection, including multi-organ resection in 41 cases. Thirty-four cases underwent lymph node dissection. All the lymph nodes were negative. The positive rate was 93.2% (23/132) for CD 117 and 82.6% (109/132) for CD34. The 1-,3- and 5-year survival rates of the 118 cases with follow up were 94.7%, 80.2%, and 56.6%, respectively. Univariate analysis revealed that the differences in Fletcher classification, tumor size, infiltration to surrounding tissue, preoperative metastasis, and adjuvant postoperative therapy with imatinib were related to the survival rates. Multivariate analysis demonstrated that Fletcher classification, preoperative metastasis and adjuvant postoperative therapy with imatinib were independent poor prognostic factors for survival.</p><p><b>CONCLUSIONS</b>Preoperative metastasis is an independent factor predicting poor prognosis of gastric GIST. Fletcher classification can be used to evaluate the biological behaviors and prognosis, while surgery is the main therapy and targeted therapy can improve survival of gastric GIST.</p>

Prognostic analysis on primary duodenal adenocarcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the prognostic factors of primary duodenal adenocarcinoma.</p><p><b>METHODS</b>The medical records of 67 patients with primary duodenal adenocarcinoma treated in our hospital from January 1990 to December 2005 were retrospectively analyzed. Prognostic factors were analyzed by univariable and multivariable analysis.</p><p><b>RESULTS</b>Of the 67 patients, 38 underwent curative resection and 29 underwent palliative resection. The overall 5-year survival rate was 22.4%. The survival was significantly higher in patients who underwent curative resection (5-year survival 39.5%) than that in those who underwent palliative resection(5-year survival 0) (P<0.05). Univariable analysis showed that T-stage, nodal metastasis and tumor stage had significant negative effects on the survival of patients who underwent curative resection. However, multivariable analysis revealed that T-stage and nodal metastasis were significantly associated with survival.</p><p><b>CONCLUSIONS</b>Curative resection may improve the survival. T-stage and lymph nodes metastasis are associated with decreased survival.</p>

Comparative study on four different reconstruction procedures after total gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the optimal reconstruction technique after total gastrectomy.</p><p><b>METHODS</b>A total of 159 patients with gastric cancer undergoing total gastrectomy in Tianjin Cancer Hospital between January 2005 and December 2007 were divided into 4 groups according to the reconstruction technique: group A(functional jejunal interposition with a pouch, n=46), group B(modified Braun type II(, n=38), group C (P pouch with Roux-en-Y esophagojejunostomy, n=25), group D(Roux-en-Y esophagojejunostomy, n=50). Quality of life(QOL), nutritional status 1 year after surgery, and perioperative complications were analyzed.</p><p><b>RESULTS</b>There were no significant differences in perioperative complications(P>0.05). One year after operation, QOL(Visick index) was better in group A than that in group B, C and D(P<0.05), and group D was inferior to group A, B and C(P<0.05). The increase in food intake, weight gain, hemoglobin and total protein were better in group A than those in group B, C and D(P<0.05) and group D was inferior to group A, B and C(P<0.05). The prognostic nutrition index ratio of the four groups were 1.21±0.15, 1.14±0.97, 1.15±0.16, and 1.10±0.16, respectively. Group A was better than that in group B, C and D (P<0.05) and group D was inferior to group A, B and C(P<0.05). The incidences of dumping syndrome, reflux esophagitis, Roux-en-Y stasis syndrome in group A were 4.3%(2/46), 2.2%(1/46) and 2.2%(1/46), respectively, which were significantly lower than those in other groups (P<0.05).</p><p><b>CONCLUSIONS</b>Functional jejunal interposition with a pouch is associated with improved nutritional condition and quality of life, and less perioperative complications. It is a reasonable reconstruction method after total gastrectomy.</p>

Pattern of solitary lymph node metastasis in gastric cancer and its clinical significance / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the pattern of solitary lymph node metastasis in order to offer more suitable treatment for patients with gastric cancer.</p><p><b>METHODS</b>Sixty-five patients received operation between July 1999 and June 2004 with only 1 metastatic lymph node identified by postoperative pathological examination were included in the study. Data were analyzed using the statistical software SPSS 13.0.</p><p><b>RESULTS</b>Univariable analysis showed that only the tumor diameter differed significantly between patients with skipping metastatic (SM) lymph node and those without SM (chi(2)=4.447, P=0.035). No clinicopathological factors showed statistically differences between patients with lymph node transverse metastasis (TM) and those without TM. However, both of two comparative groups showed statistically differences in long-term survival (P=0.000, P=0.000).</p><p><b>CONCLUSIONS</b>Most lymph node metastasis in gastric cancer follows the rule of "near-to-far", but some special metastasis patterns (SM, TM) are not rare. Proper lymph node dissection especially for patients with high risk should be performed to reduce tumor recurrence and improve long-time survival.</p>

Clinicopathological features and prognosis of 68 patients with metastatic ovarian tumors from the gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological features and prognosis of metastatic ovarian tumors from gastric cancer.</p><p><b>METHODS</b>Clinical data of 68 patients with metastatic ovarian carcinoma were reviewed retrospectively.</p><p><b>RESULTS</b>The median age was 46 years. The majority of these patients was in the premenopausal state (67.6%) and had bilateral ovarian involvement (64.7%). Pathological type was signet-ring cell carcinoma in 52.9% of the cases. Most of them underwent surgical treatment or chemotherapy or both. The median overall survival was 14.1 months, and the median progression-free survival was 6.7 months. The survival rates in 1-, 3- and 5-year were 54.8%, 14.9% and 0, respectively. Univariable analysis revealed that resection of gastric cancer, lymphatic metastasis, pathologic type of metastatic ovarian tumor, extent of metastatic lesion, cytoreductive surgery and chemotherapy for metastatic ovarian carcinoma were associated with the prognosis. Multivariable analysis revealed that cytoreductive surgery and extent of metastatic lesion were independent factors. Patients with metastatic lesion confined to the ovaries had a median overall survival of 16.0 months as compared to 8.6 months for those with more extensive metastases (P<0.01), and had a median progression-free survival of 8.2 months as compared to 4.1 months for those with more extensive metastases (P<0.05). Patients who underwent optimal cytoreduction(residual lesion < or =2 cm) had a median overall survival of 16.0 months as compared to 9.7 months for those who received suboptimal cytoreduction (residual lesion >2 cm) ( P<0.01). Optimal cytoreduction was also associated with a significantly longer median progression-free survival (11.0 months) as compared to suboptimal cytoreduction median progression-free survival (3.1 months) (P<0.01).</p><p><b>CONCLUSIONS</b>Prognosis of patients with metastatic ovarian carcinoma from gastric cancer is quite poor. Extent of metastatic lesion is an independent factor. Optimal cytoreduction is associated with improved survival.</p>

Prognostic analysis of liver metastasis in gastric cancer patients with radical gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To elucidate the prognostic factors of liver metastasis in gastric cancer patients with radical gastrectomy.</p><p><b>METHODS</b>Clinicopathological data of 87 liver metastasis patients, undergone radical gastrectomy for gastric cancer from 1996 to 2001, were retrospectively analyzed.</p><p><b>RESULTS</b>Of these 87 patients, the 1-, 3- and 5-year survival rates were 28.8%, 3.6% and 0 respectively and the average survival time after gastrectomy was (11.3+/-1.1) months. By univariate analysis, tumor location, tumor size, histologic differentiation, invasive depth, Lauren classification, metastasis of lymph nodes from lymphadenectomy, vascular invasion, nervous invasion, peritoneal metastasis, number of liver metastasis, liver metastatic distribution and resection of liver metastasis were found to be significant factors associated with the prognosis of liver metastatic patients after radical gastrectomy. By multivariate analysis, location, the Lauren classification, liver metastatic distribution and resection of liver metastasis were found to be independent factors associated with hepatic metastasis after radical gastrectomy.</p><p><b>CONCLUSION</b>Location of gastric cancer, Lauren classification, liver metastatic distribution and resection of liver metastasis are important factors to evaluate the prognosis of liver metastasis in gastric cancer patients with radical gastrectomy.</p>