Comportamiento clínico epidemiológico del cáncer gástrico en el Hospital Calixto García / Clinical-Epidemiological Characteristics of Gastric Cancer in Calixto Garcia Hospital

Introducción: El cáncer de estómago representa la segunda causa de muerte relacionada con neoplasias en el mundo, es responsable del 8 al 10 por ciento de todas las muertes por cáncer. A pesar de un marcado descenso en su incidencia, constituye una de las principales causas de muerte por cáncer en Cuba y el mundo. Objetivo: Describir el comportamiento clínico epidemiológico en los pacientes con cáncer gástrico. Métodos: Se realizó un estudio observacional, descriptivo, transversal de los pacientes con diagnóstico de cáncer gástrico que acudieron a consulta en el Hospital Universitario General Calixto García, en el período comprendido entre enero de 2014 y diciembre de 2018. El universo estuvo constituido por 146 pacientes. Los datos fueron obtenidos de las historias clínicas y procesados mediante estadística descriptiva. Resultados: De los pacientes estudiados, 67,6 por ciento pertenecían al sexo masculino y tenían entre 60 y 79 años; 51,7 por ciento presentó como factor de riesgo el hábito de fumar. Un total de 124 pacientes padecieron de dolor abdominal. El 100 por ciento de los exámenes complementarios realizados fueron endoscopia y biopsia. Se observó el adenocarcinoma moderadamente diferenciado en un total de 80 pacientes. Al 100 por ciento se le realizó tratamiento quirúrgico. La técnica quirúrgica más empleada fue la gastrectomía subtotal. Conclusiones: Las edades avanzadas de la vida, los antecedentes de úlcera gástrica, el tabaquismo y el alcoholismo son factores epidemiológicos característicos de la población de enfermos aquejados de cáncer gástrico. Los elementos clínicos identificados fueron los habitualmente descritos en la literatura médica. La cirugía en la actualidad es la única modalidad con potencial curativo(AU)

Introduction: Stomach cancer accounts for the second cause of death related to neoplasms worldwide; it is responsible for 8 percent to 10 percent of all cancer deaths. In spite of a marked decrease in its incidence, it constitutes one of the main causes of cancer death in Cuba and worldwide. Objective: To describe the clinical-epidemiological characteristics of patients with gastric cancer. Methods: An observational, descriptive and cross-sectional study was carried out with patients with a diagnosis of gastric cancer who attended consultation at Calixto García General University Hospital in the period from January 2014 to December 2018. The universe consisted of 146 patients. The data were obtained from medical records and processed by descriptive statistics. Results: Of the patients studied, 67.6 percent were male and aged 60-79 years. 51.7 percent presented smoking as a risk factor. A total of 124 patients suffered from abdominal pain. 100 percent of the complementary examinations performed were endoscopy and biopsy. Moderately differentiated adenocarcinoma was observed in a total of 80 patients. The surgical treatment was performed in 100 percent. The most commonly used surgical technique was subtotal gastrectomy. Conclusions: The research suggests that, currently, early diagnosis and surgery is the only modality with curative potential, being able to raise the quality of life, as well as to improve morbidity and mortality rates in the population(AU)

Analysis of risk factors of thrombocytopenia toxicityduring concurrent chemoradiation of gastric cancer / 中华放射肿瘤学杂志

Objective:To investigate the related risk factors of thrombocytopenia grade 2+ G2(+ )] in patients with gastric cancer during chemoradiotherapy.Methods:The pre-treatmentclinical data, hematologic parameters, and the correlation between dose distribution of vertebrae andTPG2(+ ) in non-metastaticgastric adenocarcinoma patients receiving concurrent chemoradiation in Sun Yat-sen University Cancer Center were retrospectively analyzed.Results:A total of 58 patients were included, including 23 cases (40%) in theTPG2(+ ) group and 35(60%) in the TPG2(-) group. There was no statistical difference in baseline clinical data between two groups (all P>0.05). Univariate Logistic regression analysis showed that several baseline parameters including platelet count (PLT), basophil count (BA), lactate dehydrogenase (LDH) and length of CTV (LCTV), the number of vertebrae (VBN), vertebral body volume (VBV), D max, D mean, V 5Gy, V 10Gy, V 20Gy, V 30Gy and V 40Gywere correlated with TPG2(+ )(all P<0.05). However, the multivariate Logistic regressionanalysisshowed that low PLT ( P=0.048), high LDH ( P=0.028), increased LCTV ( P=0.013), high V 20Gy/VBN ( P=0.030) were associated with the risk of TPG2(+ ). Conclusion:In gastric adenocarcinoma patients treated with chemoradiotherapy, correction of PLT reduction before treatment, avoidinglonger CTV and controlled V 20Gy correction for vertebral number may reduce significant thrombocytopenia induced by chemoradiotherapy.

Evaluation of pancreatic subclinical dysfunction and sparing of pancreas after intensity-modulated radiation therapy for gastric cancer / 中华放射肿瘤学杂志

Objective:To evaluate the pancreatic subclinical dysfunction after intensity-modulated radiation therapy (IMRT) for gastric cancer by analyzing biochemical indexes and pancreatic volume changes, and to reduce the dose of pancreas by dosimetric prediction and dose limitation.Methods:30 patients with gastric cancer who received 45 Gy postoperative adjuvant radiotherapy were retrospectively selected. The pancreas was delineated and its dose and anatomical relationship with planning target volume (PTV) were evaluated. Fasting blood glucose, serum lipase and amylase, and pancreatic volume changes before and after radiotherapy were analyzed. The correlation between the changes of biochemical indexes and volume and pancreatic dose was evaluated by Pearson analysis. The threshold of the dosimetric prediction was obtained by receiver operating characteristic (ROC) curve. Finally, the feasibility of dosimetric limitation in IMRT was assessed.Results:The pancreatic volume of 30 patients was 37.6 cm 3, and 89.0% of them were involved in PTV. D mean of the pancreas was 45.92 Gy, and 46.45 Gy, 46.46 Gy and 45.80 Gy for the pancreatic head, body and tail, respectively. The fasting blood glucose level did not significantly change. The serum lipase levels were significantly decreased by 66% and 77%(both P<0.001), and the serum amylase levels were significantly declined by 24% and 38%(both P<0.001) at 6 and 12 months after radiotherapy. Pancreatic volumes of 22 patients was decreased by 47% within 18 months after radiotherapy. ROC curve analysis showed that pancreatic V 45Gy had the optimal predictive value for the decrease by 1/3 of serum lipase and amylase levels at 6 months and serum amylase level at 12 months after radiotherapy, and the cut-off value was V 45Gy<85%. Pancreatic D mean yielded the optimal predictive value for the decrease by 2/3 of serum lipase level at 12 months after radiotherapy, and the cut-off value was D mean<45.01 Gy. After" whole pancreas" and" outside PTV pancreas" dose limit, V 45Gy of the pancreas was decreased by 11% and 7%, D mean of the pancreas was declined by 2% and 2%, and D mean of the pancreatic tail was decreased by 3%, respectively. Conclusions:Serum lipase and amylase levels significantly decline at 6 and 12 months after adjuvant radiotherapy for gastric cancer, and pancreatic volume is decreased significantly within 18 months after radiotherapy. Pancreatic V 45Gy<85% and D mean<45.01 Gy are the dose prediction values for the decrease of serum lipase and amylase levels. The dose can be reduced to certain extent by dosimetric restriction.

Total neoadjuvant therapy for locally advanced gastric cancer: an interim study of phase Ⅱ clinical trial / 中华放射肿瘤学杂志

Objective:To evaluate the safety and preliminary efficacy of total neoadjuvant therapy (TNT) model of" neoadjuvant chemoradiotherapy plus consolidation neoadjuvant chemotherapy (CNCT) followed by surgery" for locally advanced gastric cancer.Methods:From 2018 to 2020, 28 patients clinically diagnosed with locally advanced gastric adenocarcinoma or Siewert Ⅱ/Ⅲ adenocarcinoma gastroesophageal junction cancer were prospectively enrolled. The neoadjuvant chemoradiotherapy (NCRT) was delivered with a total dose of 45 Gy, 1.8 Gy/f. Concurrent chemotherapy was S-1 at a dose of 40-60 mg twice daily. Then, patients received four to six cycles of CNCT of SOX regimen at three weeks after neoadjuvant chemoradiotherapy. D 2 lymphadenectomy was performed at 4-6 weeks after CNCT. Results:A total of 28 patients completed the whole therapy. Grade 3 or above adverse events occurred in 3 cases (11%) during CCRT, including thrombocytopenia, leukopenia and anorexia; 2 cases (7%) developed leukopenia and 3 cases (11%) of thrombocytopenia during CNCT. Twenty patients (71%) completed the surgery. The proportion of patients with pathological complete remission (pCR) was 50%. Three patients experienced surgical complications including anastomotic leak, anastomotic stenosis and intra-abdominal sepsis. All were recovered after symptomatic treatment.Conclusion:Interim analysis results demonstrate that TNT can yield significant down-staging for patients with locally advanced gastric cancer, which causes tolerable adverse events and postoperative complications.

Primary nonlymphoid gastrointestinal neoplasms in dogs in Rio Grande do Sul / Neoplasmas gastrointestinais primários não linfoides em cães no Rio Grande do Sul

Gastrointestinal neoplasms (GIN) are uncommon in dogs, but they mainly show malignant behavior and poor prognosis. The types of GIN in dogs and their frequency, as well as their epidemiological and histopathological characteristics were analyzed through a retrospective study of biopsies from 24.711 dogs from 2005 to 2017. Additionally, histological sections of neoplasms were subjected to immunohistochemistry (IHC) using antibodies against pancytokeratin, vimentin, smooth muscle actin, c-Kit, S-100, CD31, CD79αcy, and neuron-specific enolase. Of the total samples from dogs analyzed, 88 corresponded to GIN. Neoplasms occurred more frequently in purebred dogs (64.8%, 57/88), males (53.4%, 47/88), with a median age of 10 years. The intestine was affected by 84.1% (74/88) of the cases. Of these, the large intestine was the most affected (67.6%, 50/74). Most of the neoplasms had malignant behavior (88.6%, 78/88). Regarding the classification of neoplasms, 46.6% (41/88) of the diagnoses corresponded to epithelial, 46.6% (41/88) were mesenchymal, 5.7% (5/88) were hematopoietic, and 1.1% (1/88) was neuroendocrine. The most frequently diagnosed neoplasms were papillary adenocarcinoma (19.3%, 17/88), leiomyosarcoma (17.0%, 15/88), gastrointestinal stromal tumors (GISTs) (12.5%, 11/88), and leiomyoma (5.0%, 8/88). Adenocarcinomas were located mainly in the rectum, whereas leiomyosarcomas and GISTs developed mainly in the cecum. Epithelial neoplasms showed a greater potential for lymphatic invasion whereas mesenchymal neoplasms appeared to be more expansive with intratumoral necrosis and hemorrhage. Immunohistochemistry was found to be an important diagnostic technique for the identification of infiltrating cells in carcinomas and an indispensable technique for the definitive diagnosis of sarcomas.(AU)

Neoplasmas gastrointestinais (NGI) são pouco comuns em cães, mas possuem principalmente comportamento maligno e prognóstico reservado. Os tipos de NGI em cães e sua frequência, bem como características epidemiológicas e histopatológicas foram analisados por meio de um estudo retrospectivo dos exames de biópsias de 24.711 cães entre os anos de 2005 a 2017. Adicionalmente, cortes histológicos de NGI foram submetidos à técnica de imuno-histoquímica (IHQ), utilizando os anticorpos anti-pancitoqueratina, vimentina, actina de músculo liso, c-Kit, S-100, CD31, CD79αcy e enolase neurônio específica. Do total de cães analisados, 88 corresponderam a NGI não linfoides. Os neoplasmas ocorreram com maior frequência em cães de raça pura (64,8%, 57/88), machos (53,4%, 47/88), com mediana de idade de 10 anos. O intestino foi acometido em 84,1% dos casos (74/88). Destes, o intestino grosso foi o segmento mais afetado (67,6%, 50/74). A maior parte dos neoplasmas tinha comportamento maligno (88,6%, 78/88). Quanto à classificação, 46,6% (41/88) dos diagnósticos corresponderam a neoplasmas epiteliais, 46,6% (41/88) mesenquimais, 5,7% (5/88) hematopoiéticos e 1,1% (1/88), neuroendócrino. Os neoplasmas mais frequentemente diagnosticados foram adenocarcinoma papilar (19,3%, 17/88), leiomiossarcoma (17,0%, 15/88), tumor estromal gastrointestinal (GIST) (12,5%, 11/88) e leiomioma (12,5%, 8/88). Adenocarcinomas localizavam-se principalmente no reto, enquanto leiomiossarcoma e GISTs desenvolveram-se principalmente no ceco. Os neoplasmas epiteliais demonstraram um potencial maior de invasão linfática enquanto que os mesenquimais aparentaram ser mais expansivos, com necrose e hemorragia intratumorais. A imuno-histoquímica mostrou ser uma técnica diagnóstica importante para a identificação de células neoplásicas infiltravas no caso dos carcinomas e uma técnica indispensável para o diagnóstico definitivo de sarcomas.(AU)

Chain-mediated effects of resilience and ruminant meditation on post-gastrectomy stress perception and post-traumatic growth in postoperative patients with gastric cancer / 中国实用护理杂志

Objective@#To analyze the correlation between pressure perception, psychological resilience, ruminant meditation and post-traumatic growth in postoperative patients with gastric cancer after gastrectomy.@*Methods@#Totally 384 patients with gastric cancer who underwent total gastrectomy or subtotal gastrectomy from January 2015 to January 2018 in 6 major hospitals in Lianyungang were selected as the subjects,who are measured at pressure perception, post-traumatic growth, post-traumatic growth and event-related ruminative.@*Results@#In postoperative patients with gastric cancer, ruminant meditation and psychological resilience all partially had mediation effect between pressure perception and post-traumatic growth (P<0.05), mediation effect was 0.34 and 0.31, accounting for 19.9% and 18.1% of the total effect. They had chain mediation effect with pressure perception and post-traumatic growth (P<0.05), mediation effect was 0.17, accounting for 10.0% of the total effect.@*Conclusion@#Psychological resilience and ruminant meditation can reduce stress perception, increase post-traumatic growth, and play a part of mediating effect and chain mediating effect between stress perception and post-traumatic growth in Patients with gastric cancer after gastrectomy.

Barreras para la atención en salud del cáncer gástrico, Santander, Colombia. Etapa exploratoria / Barriers to Health Care for Gastric Cancer Patients in Santander, Colombia: Exploratory Stage

Resumen Introducción: el cáncer gástrico es un problema de salud pública; ocupa el quinto y tercer lugar en incidencia y mortalidad mundial, respectivamente. Objetivo: describir las barreras para la atención en salud percibidas por el adulto con cáncer gástrico, su cuidador y el médico tratante en el departamento de Santander, Colombia-etapa exploratoria en el período 2015-2016. Metodología: estudio cualitativo utilizando algunas técnicas del proceso de análisis de la teoría fundamentada a partir de la aplicación de entrevistas semiestructuradas que fueron codificadas y categorizadas con el software N-VIVO 10. Resultados: Emergieron 13 categorías, 182 códigos descritos en 6 ejes: el primero relacionado con el significado del cáncer y sus barreras; el segundo con las principales barreras para la atención en salud, cuyo orden de mayor a menor frecuencia fue: administrativas, económicas, culturales, de conocimiento, de comunicación e institucionales; el tercero es las estrategias para superar las barreras; el cuarto, las estrategias para disminuirlas; el quinto, sentimientos y el rol de la familia; y el sexto, necesidades del paciente. Conclusión: la fragmentación y segmentación del sistema de salud impone barreras que limitan el diagnóstico temprano del cáncer gástrico y su manejo oportuno. Además, amenazan la calidad de vida del adulto enfermo y su familia.

Abstract Introduction: Gastric cancer is a public health problem that ranks fifth in world incidence and third in mortality. Objective: The aim of the exploratory stage of this study was to describe the barriers to health care perceived by adults with gastric cancer, their caregivers, and their attending physicians in the department of Santander, Colombia in 2015 and 2016. Methodology: This is a qualitative study using process techniques and grounded theory analysis based on semi-structured interviews that were codified and categorized with N-VIVO 10. Results: Thirteen categories and 182 codes described along 6 axes emerged. The first axis is related to the meaning of cancer and its barriers. The second is related to the primary barriers to health care which are, in order from most frequent to least frequent: administrative, economic, cultural, knowledge, communication and institutional. The third axis consists of strategies to overcome barriers. The fourth consists of strategies to diminish barriers. The fifth is related to feelings and the role of the family, and the sixth contains the patient's needs. Conclusion: Fragmentation and segmentation of the health care system imposes barriers that limit early diagnosis of gastric cancer and timely management. In addition, they threaten the quality of life of the sick adult and her or his family.

Trends and Outcomes of Non-compliance with Treatment for Gastric Cancer in Korea over the 16 years from 1999 to 2015

PURPOSE: The aim of this study was to evaluate the trend of non-compliance with treatment (NCT) among gastric cancer patients in the Korean population. MATERIALS AND METHODS: Using data from the Korea Central Cancer Registry from 1999 to 2015, patients who did not receive any treatment for gastric cancer within 4 months after diagnosis were defined as the NCT group. The annual incidence rate, distributions according to age group and stage, and 5-year relative survival of the patients exhibiting NCT were analyzed. RESULTS: The number of NCT patients was 5,871 (30.6%) in 1999 and continuously decreased to 4,434 (15.3%) in 2015. Between 2006 and 2015, the proportions of NCT patients decreased from 72.9% to 55.0% among those 80 years old or older and from 9.2% to 5.4% among patients younger than 40 years. In patients with distant metastases, this proportion decreased from 35.5% to 32.7%, and this proportion also decreased from 17.6% to 8.2% among those with localized disease. The 5-year relative survival rates of NCT patients between 2011 and 2015 were significantly lower than those of the treated patients in each stage (60.2% vs. 99.7%, 13.8% vs. 67.1%, and 2.0% vs. 8.3% among those with localized, regional, and distant disease, respectively). CONCLUSIONS: The proportion of NCT gastric cancer patients has decreased during the last 16 years. However, considerable numbers of elderly patients are still NCT. There must be a strategy to decrease NCT and improve the nationwide survival rate of patients with gastric cancer.

Association between circular RNAs expression in serum and gastric cancer / 中华流行病学杂志

Objective@#To analyze the association between circular RNAs expression in serum and gastric cancer and evaluate the potential of the related markers in early diagnosis of gastric cancer.@*Methods@#Forty eight gastric cancer cases in Linqu County People’s Hospital were selected as case group, and 48 controls matched by age and sex were randomly selected in the gastric cancer screening cohort during the same period. The expression levels of hsa_circ_002059, hsa_circ_0000096 and hsa_circ_0001895 were detected by quantitative real-time PCR. The results were compared between case group and control group.@*Results@#The positive expression rates of hsa_circ_002059, hsa_circ_0000096 and hsa_circ_0001895 were 70.8%, 47.9%, 75.0% in case group, slightly higher than those in control group (58.3%, 31.3%, 60.4%), although P values were all more than 0.05. The expression level medians of the 3 candidate circRNAs expression levels were 1.60% (0-5.64%), 0 (0-0.61%), 0.91% (0.06%-1.88%) in case group, while 0.05% (0-6.07%), 0 (0-0.34%), 0.42% (0-1.39%) in control group, respectively. Conditional logistic regression analysis showed that the association strength of high expressions of 3 candidate circRNAs with gastric cancer showed an increase trend, but the differences had no significance after adjusted by Helicobacter pylori infection, smoking and drinking status (all P>0.05). Further analysis by combining the 3 candidate circRNAs showed the increased strength of association between circRNAs and gastric cancer with the elevated number of positive circRNAs in serum (trend test P=0.040) compared with circRNAs negative persons.@*Conclusion@#Our study preliminarily suggested that the expression of hsa_circ_002059, hsa_circ_0000096 and hsa_circ_0001895 in serum might be correlated with gastric cancer.

Body mass index and the risk of gastric cancer in males: a prospective cohort study / 中华流行病学杂志

Objective@#To investigate the association between BMI and gastric cancer risk in Chinese males.@*Methods@#Data on body weight, body height and incidence of gastric cancer were collected on a biennial basis in males in Kailuan Cohort during 2006-2015. In addition, electronic databases of hospitals affiliated to Kailuan Group, insurance system of Kailuan Group and medical insurance system of Tangshan were used for supplementary information. Males with normal body weight (18.5 kg/m2≤BMI<24.0 kg/m2) were used as controls. Cox proportional hazards regression model was used to evaluate the association between baseline BMI and the risk of gastric cancer in males through the calculations of hazard ratio and 95% confidence interval.@*Results@#A total of 109 600 males were included and 272 new gastric cancer cases were identified in Kailuan male cohort study, with a follow-up of 860 399.79 person-years during 2006-2015. The median follow-up period was 8.8 years. When compared with normal weight, the hazard ratios (HR) of underweight (BMI≤18.5 kg/m2) for gastric cancer risk were 2.11 (95%CI: 1.23-3.62) after adjusting for potential confounding factors (age, education level, smoking status, alcohol drinking status, dust exposure, salty food intake, tea drinking status). However, overweight or obesity showed no significant association with gastric cancer risk. The stratified analyses based on age, education level, status on smoking, alcohol drinking, tea drinking and dust exposure indicated that underweight showed significant association with gastric cancer risk in those with older age, those with high education level, non-smokers, non-alcohol drinkers, non-tea drinkers and those with dust exposure.@*Conclusion@#Underweight might increase the risk of gastric cancer in males in China, and this positive association might be associated with age, education level, status on smoking, alcohol-drinking, tea-drink, and dust exposure.

Epidemiological characteristics of gastric cancer in China, 2015 / 中华流行病学杂志

Objective@#To estimate the morbidity and mortality of gastric cancer and its distribution in China in 2015 and provide information for future cancer prevention and control study and policy decision.@*Methods@#In 2018, a total of 501 cancer registry systems reported data to the office of National Central Cancer Registry, and the data from 368 cancer registry systems met the criteria. The overall, gender specific, age specific and area specific morbidity and mortality rates of gastric cancer in China were estimated based on national population data in 2015. Chinese standard population in 2000 and World Segi’s population data were used to calculate the age-standardized rates (ASR) of morbidity and mortality, including ASR of China and the world.@*Results@#In 2015, the qualified 368 cancer registry system covered a total of 309 553 499 population in China, including 156 934 140 males and 152 619 359 females. We estimated that there were 403 000 new gastric cancer cases, with the crude morbidity rate of 29.31 per 100 000, ASR China of 18.68 per 100 000, ASR world of 18.57 per 100 000, and a cumulative rate of 2.29% for 0-74 years. There were 290 900 new gastric cancer deaths, with the crude mortality rate of 21.16 per 100 000, ASR China of 13.08 per 100 000, ASR world of 12.92 per 100 000, and a cumulative rate of 1.5% for 0-74 years. Gastric cancer ranked second as the most common cancers and third as the most common cancer causes of death in China. In general, both the morbidity rate (ASR China, male: 26.54 per 100 000; female: 11.09 per 100 000; rural area: 21.82 per 100 000; urban area: 16.37 per 100 000) and mortality rate (ASR China, male: 18.75 per 100 000; female: 7.72 per 100 000; rural area: 15.84 per 100 000; urban area: 11.05 per 100 000) were higher in males than those in females, and higher in rural area than those in urban area. The morbidity and mortality rates of gastric cancer increased from the age of 40 years and peaked in age group of 80-years. The case number of gastric cancer significantly increased from the age group of 50-years, peaked at 60-70 years, and the majority of cases occured in age group of 55-80 years. There was an overall consistent trend of the age-specific morbidity and mortality rates across different subgroups by sex and geographic areas, with the rates were higher in males than those in females, and higher in rural area than that in urban area.@*Conclusions@#The incidence of gastric cancer varied with sex, age and areas (urban area and rural area). The present analysis provides the latest data on the prevalence of gastric cancer in China, which can help optimize the current screening guidelines and the prevention and control strategies of gastric cancer to reduce the disease burden caused by gastric cancer in China.

Effect of perioperative and postoperative chemotherapy on the prognosis of patients with advanced gastric carcinoma after resection / 中国实用外科杂志

OBJECTIVE: To explore the effect of perioperative and postoperative chemotherapy on the prognosis of patients with advanced gastric cancer after resection. METHODS: From January 2004 to December 2016, a retrospective cohort of 277 stage IV gastric cancer patients after surgical treatment of gastric resection was enrolled in Department of General Surgery,Nanfang Hospital, Southern Medical University. Among them, 228 underwent surgical resection combined with postoperative adjuvant chemotherapy(postoperative chemotherapy group, group A), and preoperative chemotherapy plus surgery resection and postoperative chemotherapy in 49 cases(perioperative chemotherapy group, group B). After generating propensity scores with eight covariates, including gender, age, biological classifications, completion of chemotherapy, depth of tumor infiltration, lymph nodemetastasis, the extent of lymph nodes dissection and type of gastrectomy, 49 patients in group A were one-to-one matched with 49 patients in group B. Kaplan-merier method was used for survival analysis, and Cox proportional risk regression model was used to analyze independent survival risk factors of patients with advanced gastric cancer undergoing surgical resection. RESULTS: Before propensity scores matching(PSM), biological classifications(P<0.001),the completion of chemotherapy(P<0.001), depth of tumor infiltration(P<0.001), lymph node metastasis(P=0.049), the extent of lymphnode dissection(P=0.001) and the type of gastrectomy(P=0.001) significantly differed between two groups. While after PSM, only the completion of chemotherapy were vital different between two groups. After PSM,median survival time of group A and B were 16(95% CI 10.36-21.64) vs 29(95% CI 17.24-40.76) months, which showed not significant difference(P=0.191). The univariate analysis showed that biological classifications, the completion of chemotherapy, lymph node metastasis and the extent of lymphnode dissection were survival prognosis factors. And the multivariate analysis showed that the chemotherapy cycles≤ 2 cycles, lymph node metastasis and the extent of lymphadenectomyless than D2 were independent poor prognostic factors for advanced gastric cancer patients performed with gastrectomy. Notably, the order of chemotherapy and surgery was not independent variate of prognosis(perioperative chemotherapy vs. postoperative chemotherapy: HR 0.986,95%CI 0.539-1.806,P=0.964). CONCLUSION: Perioperative chemotherapy is not the independent variable to improve prognosis of resected advanced gastric cancer patients.Nonetheless, perioperative chemotherapy could benefit patient's chemotherapy tolerance and compliance, which could be attributed to the superiority in survival compared to postoperative chemotherapy. The finding could offer reference and guidance for further design of perspective studies for advanced gastric cancer patients.

Progress in gastric cancer screening with serum markers, endoscopy and imaging / 中华全科医师杂志

The morbidity and mortality of gastric cancer are high in China.It is of great significance to explore a screening scheme for gastric cancer that suits Chinese conditions.This article reviews the risk factors,the status of screening at home and abroad and the commonly used screening methods of gastric cancer.The articlealso recommends a screening model,in which endoscopic and imaging examination are applied for high-risk population identified by detection of the serum markers such as pepsinogen,gastrin-17 and Helicobacter pylori antibody.

Development of Chinese gastric cancer surgery: opportunities and challenges / 中国肿瘤临床

With the approaches of artificial intelligence and big data, the development of cancer genomics and updating of imaging technology, gastric cancer surgery is facing great challenges and opportunities. The main focus is on laparoscopic surgery technology, enhanced recovery after surgery, multidisciplinary comprehensive treatment, and precision medicine. Considering the common de-mand for reduced complication rate among doctors and patients, laparoscopic surgery has become widely popular owing to its advan-tages of small incision and rapid recovery. Furthermore, the development of artificial intelligence and big data has raised a new chal-lenge in routine diagnosis and treatment. As a result, we encourage multicenter cooperation, and data standardization and sharing. At present, completion of the transition from empirical medicine to evidence-based medicine and promotion of the individualization and standardization of gastric cancer treatment are needed.

Adjuvant chemoradiotherapy after subtotal or total gastrectomy and d2 limphadenectomy increases survival in advanced gastric cancer? / A quimiorradioterapia adjuvantes após gastrectomia subtotal e total com linfadenectomia d2 aumentam a sobrevida no câncer gástrico avançado?

ABSTRACT Background: The treatment of advanced gastric cancer with curative intent is essentially surgical and chemoradiotherapy is indicated as neo or adjuvant to control the disease and prolong survival. Aim: To assess the survival of patients undergoing subtotal or total gastrectomy with D2 lymphadenectomy followed by adjuvant chemoradiotherapy. Methods: Were retrospectively analyzed 87 gastrectomized patients with advanced gastric adenocarcinoma, considered stages IB to IIIC and submitted to adjuvant chemoradiotherapy (protocol INT 0116). Tumors of the esophagogastric junction, with peritoneal implants, distant metastases, and those that had a compromised surgical margin or early death after surgery were excluded. They were separated according to the extention of the gastrectomy and analyzed for tumor site and histopathology, lymph node invasion, staging, morbidity and survival. Results: The total number of patients who successfully completed the adjuvant treatment was 45 (51.7%). Those who started treatment and discontinued due to toxicity, tumor-related worsening, or loss of follow-up were 10 (11.5%) and reported as incomplete adjuvant. The number of patients who refused or did not start adjuvant treatment was 33 (48.3%). Subtotal gastrectomy was indicated in 60 (68.9%) and total in 27 (31.1%) and this had a shorter survival. The mean resected lymph nodes was 30.8. Staging and number of lymph nodes affected were predictors of worse survival and the more advanced the tumor. Patients undergoing adjuvant therapy with complete chemoradiotherapy showed a longer survival when compared to those who did it incompletely or underwent exclusive surgery. On the other hand, comparing the T4b (IIIB + IIIC) staging patients who had complete adjuvance with those who underwent the exclusive operation or who did not complete the adjuvant, there was a significant difference in survival. Conclusion: Adjuvant chemoradiotherapy presents survival gain for T4b patients undergoing surgical treatment with curative intent.

RESUMO Racional: O tratamento do câncer gástrico avançado com intenção curativa é essencialmente cirúrgico e a quimiorradioterapia está indicada como neo ou adjuvância para controlar a doença e prolongar a sobrevida. Objetivos: Avaliar a sobrevida dos doentes submetidos à gastrectomia subtotal ou total com linfadenectomia D2 seguidos de quimiorradioterapia adjuvante. Métodos: Foram analisados retrospectivamente 87 gastrectomizados portadores de adenocarcinoma gástrico avançado considerandos estádios IB até IIIC e submetidos à quimiorradioterapia adjuvante (protocolo INT 0116). Foram excluídos os tumores da transição esofagogástrica, com implantes peritoneais, metástases à distância e os que após a operação apresentaram margem cirúrgica comprometida ou óbito precoce. Foram separados quanto à extensão da gastrectomia e analisados em relação ao local e histopatologia do tumor, invasão linfonodal, estadiamento, morbidade e sobrevida. Resultados: O número de doentes que conseguiu completar o esquema adjuvante na sua totalidade foi de 45 (51,7%). Os que iniciaram o tratamento e interromperam por toxicidade, piora relacionada ao tumor, ou perda de seguimento foram 10 (11,5%) e relacionados como adjuvância incompleta. O número de doentes que recusou ou não iniciou o tratamento adjuvante foi de 33 (48,3%). A gastrectomia subtotal foi indicada em 60 (68,9%) e a total em 27 (31,1%) e esta apresentou menor sobrevida. A média de linfonodos ressecados foi de 30,8. O estadiamento e o número de linfonodos acometidos foram preditores de pior sobrevida e quanto mais avançado foi o tumor. Os pacientes submetidos à terapia adjuvante com quimiorradioterapia completa mostraram sobrevida maior quando comparados àqueles que a fizeram de forma incompleta ou submetidos à operação exclusiva. Por outro lado, comparando-se os doentes estádios T4b (IIIB + IIIC) que tiveram adjuvância completa com os submetidos à operação exclusiva ou que não completaram a adjuvância, houve significativa diferença na sobrevida. Conclusão - A quimiorradioterapia adjuvante apresenta ganho de sobrevida para doentes em estádio T4b submetidos ao tratamento cirúrgico com intenção curativa.

Total omentectomy in gastric cancer surgery: is it always necessary? / Omentectomia total na cirurgia do câncer gástrico: é ela sempre necessária?

ABSTRACT Background: Traditionally, total omentectomy is performed along with gastric resection and extended lymphadenectomy in gastric cancer (GC) surgery. However, solid evidences regarding its oncologic benefit is still scarce. Aim: To evaluate the incidence of metastatic omental lymph nodes (LN) in patients undergoing curative gastrectomy for GC, as well as its risk factors and patients' outcomes. Methods: All consecutive patients submitted to D2/modified D2 gastrectomy due to gastric adenocarcinoma from March 2009 to April 2016 were retrospectively reviewed from a prospective collected database. Results: Of 284 patients included, five (1.8%) patients had metastatic omental LN (one: pT3N3bM0; two: pT4aN3bM0; one: pT4aN2M0 and one pT4bN3bM0). Four of them deceased and one was under palliative chemotherapy due relapse. LN metastases in the greater omentum significantly correlated with tumor's size (p=0.018), N stage (p<0.001), clinical stage (p=0.022), venous invasion growth (p=0.003), recurrence (p=0.006), site of recurrence (peritoneum: p=0.008; liver: p=0.023; ovary: p=0.035) and death (p=0.008). Conclusion: The incidence of metastatic omental LN of patients undergoing radical gastrectomy due to GC is extremely low. Total omentectomy may be avoided in tumors smaller than 5.25 cm and T1/T2 tumors. However, the presence of lymph node metastases in the greater omentum is associated with recurrence in the peritoneum, liver, ovary and death.

RESUMO Racional: Tradicionalmente a omentectomia total é realizada juntamente com a ressecção gástrica associada à linfadenectomia na cirurgia do câncer gástrico. No entanto, evidências sólidas em relação ao seu benefício oncológico são escassas . Objetivo: Avaliar a incidência de metástases em linfonodos do omento maior em pacientes submetidos à gastrectomia potencialmente curativa por câncer gástrico, assim como, avaliar os fatores de risco para a ocorrência e a evolução dos pacientes. Métodos: Pacientes consecutivos submetidos à gastrectomia D2/D2 modificada devido ao adenocarcinoma gástrico foram analisados retrospectivamente a partir de um banco de dados. Resultados: Dos 284 pacientes, cinco (1,8%) tinham linfonodos metastáticos no omento maior (um pT3N3bM0; dois pT4aN3bM0; um pT4aN2M0 e um pT4bN3bM0). Quatro faleceram e um estava em tratamento paliativo com quimioterapia devido à recidiva da doença. Os linfonodos metastáticos no omento maior tiveram correlação significativa com o tamanho do tumor (p=0,018), estádio N (p<0,001), estádio clínico (p=0,022), invasão venosa (p=0,003), recorrência (p=0,006), local de recorrência (peritônio p=0,008; fígado p=0,023; ovário p=0,035) e óbito (p=0,008). Conclusão: A incidência de linfonodos metastático no omento maior de pacientes submetidos à gastrectomia radical por câncer gástrico é baixa. A omentectomia total pode ser evitada em tumores menores que 5,25 cm e estádios T1/T2. Entretanto, a presença de metástases linfonodais no omento maior está associada à recidiva no peritônio, fígado, ovário e óbito.

Expression of CBX8 in gastric adenocarcinoma and the relationship with clinicopathologic characters and survival prognosis / 临床与实验病理学杂志

Purpose To explore the expression of CBX8 in gastric adenocarcinoma tissue and its clinical significance.Methods 119 cases of primary gastric adenocarcinoma treated by surgery and corresponding adjacent normal tissues were collected. The protein expression levels of CBX8 in gastric adenocarcinoma and their corresponding adjacent normal tissue was determined using tissue microarray and immunohistochemistry PV 6000 method staining. The relationship between CBX8 expression and clinicopathologic characters and survival prognosis was analyzed. Results The positive expression rate of CBX8 in gastric cancer and their corresponding adjacent normal tissue was 46.2％ (55/119) and 13.4％ (16/119) respectively. There was statistically significant difference between two groups (χ2=30.53, P < 0.01). The expression of CBX8 in gastric adenocarcinoma tissue was obviously correlated with the differentiation, clinical staging, and lymph node metastasis (P < 0.05). The high expression rate of CBX8 in the poorly differentiated gastric adenocarcinoma was lower than moderately differentiated and well differentiated group. The high expression rate of CBX8 in stage Ⅰ + Ⅱ gastric adenocarcinoma was higher than that in stage Ⅲ + Ⅳ. The gastric adenocarcinoma patients with high expression of CBX8 had low metastasis rate. Cox multivariate analysis showed CBX8, clinical staging, and lymphatic metastasis were independent predictors of overall survival and disease-free survival (P < 0.05). Kaplan-Meier analysis showed that the patients with higher expression of CBX8 had both longer overall survival time (P = 0.004) and disease-free survival time (P =0.004). Conclusion The expression of CBX8 may be involved in the tumorigenesis and progression of gastric adenocarcinoma. CBX8 is one of the independent predictor of prognosis, and the detecting of CBX8 expression may have important clinical value for the evaluation of gastric adenocarcinoma. CBX8 may became a new target for target therapy of gastric adenocarcinoma.

Progress in multidrug resistance of gastric cancer / 肿瘤研究与临床

Chemotherapy is one of the main treatments for gastric cancer, but its drug resistance often limits the effectiveness of chemotherapy, leading to treatment failure. Drug resistance can be divided into primary drug resistance and secondary resistance. It has showed that several factors were involved in the multidrug resistance of gastric cancer, including the expression of drug resistance-related proteins, abnormalities of apoptosis-related genes, dysfunction of DNA damage repair, epithelial-mesenchymal transition and non-coding RNA. The solution to improve the efficacy of chemotherapy is to overcome drug resistance or delay drug resistance. This article will explore the progress in multi-drug resistance of gastric cancer.

Correlation between ATF5 protein expression level and drug sensitivity of gastric cancer AGS cells / 实用医学杂志

Objective To explore the correlation between ATF5 protein expression level and drug sensitivity of gastric cancer AGS cells.Methods We established the high,middle and low ATF5 expression groups by transfecting the AGS cells with ATF5 pcDNA3.1 plasmid,ATF5 siRNA and empty plasmid using the liposome transfection technique.Then we detected the expression of the ATF5 protein of the 3 groups using the Western Blot.The drug sensitivity of AGS cells in 3 groups to paclitaxel and cisplatin was detected using the MTT experiments and plate clone formation experiments then the correlation between ATF5 protein expression level and drug sensitivity of gastric cancer AGS cells was analyzed.Results With the effect of paclitaxel or cisplatin on AGS cells in 3 groups,the surviving fraction and the IC50 of high ATF5 expression group were higher than those of control group,which indicated statistical significance (all P ＜ 0.05);while the surviving fraction and the IC50 of low ATF5 expression group were lower than those of control group (all P ＜ 0.05,P cisplatin =0.00,P paclitaxel =0.002).We found that cell clone formation of AGS cells to paclitaxel and cisplatin was significantly increased after the transfection with ATF5 protein plasmid and decreased after transfection with ATF5 siRNA plasmid (all P ＜ 0.05).Conclusion The expression of ATF5 protein is related to the drug sensitivity of gastric cancer AGS cells that upregulation of ATF5 protein expression can decrease the drug sensitivity of AGS cells to paclitaxel and cisplatin in gastric cancer.

MSCT features of gastric schwannoma and misdiagnosis analysis / 实用放射学杂志

Objective To explore the MSCT features,diagnostic values and the misdiagnosis causes of gastric schwannomas.Methods T he CT images,pathological and clinical data of 9 misdiagnosis cases of gastric schwannomas were analyzed retrospectively,which were later confirmed by the operation and pathology.The study examined the CT findings in the following aspects:the lesion location, size,contour,border,growth pattern,enhanced pattern,hemorrhage,necrosis,calcification,and the presence and absence of perirenal lymph nodes.Results The gastric schwannomas were ovoid or round,with well-defined boundaries.Tumors were found in the gastric body in 6 cases(4 cases in the large gastric curvature and 2 in the small gastric curvature),the gastric antrum in 2 cases and the gastric fundus in 1 case.The largest lesion diameters ranged from 2.5 to 7.4 cm,with an average diameter of 3.2 cm.Extracavitary growth was found in 2 cases,intracavitary growth in 2 cases and both intracavitary and extracavitary growth in 5 cases.The density of the tumor was low and evenly distributed,without cystic change,necrosis or calcification.2 cases were found to have ulcer formation. Another 2 cases were found to have enlarged lymph nodes,which were pathologically confirmed to be reactive hyperplasia.In the CT contrast enhancement,mild homogeneous enhancement was found in 4 cases in the arterial phase,but no obvious enhancement was found in the other 5 cases.In the venous phase,all the cases were found to have moderate homogeneous enhancement.4 cases were found to have further enhancement in the delay phase.Conclusion The gastric schwannomas appears to be homogeneous soft tissue mass on the MSCT,with clear boundaries and low-density and without hemorrhagic necrosis or cystic lesions.MSCT examination can help to locate and characterize gastric schwannomas,and to observe the relationship between the tumor and the surrounding tissue structure.