A comparison of four common malnutrition risk screening tools for detecting cachexia in patients with curable gastric cancer.

OBJECTIVE: Although there is international consensus regarding the importance of cachexia, no tools exist, to our knowledge, for cachexia screening among patients with cancer. The aim of this study was to evaluate whether patients with cancer and cachexia could be identified using the four most commonly used nutritional screening tools: the Malnutrition Universal Screening Tool (MUST), the Nutritional Risk Screening (NRS)-2002, the Malnutrition Screening Tool (MST), and the Short Nutritional Assessment Questionnaire (SNAQ). METHODS: Clinical data were prospectively collected for patients who underwent elective radical gastrectomy for gastric cancer in two large centers between August 2014 and February 2018. Patients were also screened using the MUST, NRS-2002, MST, and SNAQ tools. The screening results were subsequently compared with the international consensus diagnostic criteria for cancer cachexia. RESULTS: A total of 1001 patients were evaluated, including 363 patients (36.3%) with cancer cachexia. Among the patients "at nutritional risk" based on each tool, the proportions of cachexia were 87.3% for the MUST tool, 84.3% for the MST tool, 76.6% for the NRS-2002 tool, and 54.3% for the SNAQ tool. The MST tool provided the largest area under the curve for identifying cancer cachexia (0.914; P < 0.001). CONCLUSION: Among the tools examined, the MST had the greatest ability to detect cancer cachexia among patients with gastric cancer.

UCA1 promotes cell proliferation and invasion of gastric cancer by targeting CREB1 sponging to miR-590-3p.

Long noncoding RNAs (lncRNAs) have emerged as regulators in a variety of biological processes, including carcinogenesis in human cancer. UCA1 has been reported to be upregulated in gastric cancer (GC); however, the underlying functional roles of UCA1 in GC have not been established. In the current study, we showed that UCA1 is significantly higher in GC tissues and cells compared with adjacent normal tissues and a gastric epithelium cell line, respectively. Higher UCA1 expression was associated with lymph node metastasis, TNM stage, and poor overall survival (OS) in GC patients. In vitro functional studies confirmed that UCA1 promotes cell proliferation, colony formation ability, and cell invasion in GC cells. We demonstrated that knockdown of UCA1 inhibits tumor growth in vivo. The double luciferase reporter, RNA-binding protein immunoprecipitation assay, and RNA pull down assay demonstrated that miR-590-3p serves as a target for UCA1. UCA1 promoted cell proliferation and invasion by negatively regulating miR-590-3p expression. Moreover, we demonstrated that CREB1 is a downstream target of miR-590-3p and UCA1 activates CREB1 expression by sponging to miR-590-3p. Thus, these results showed that UCA1 functions as an oncogene in GC and may be a target for treatment of GC.

Impact of visceral fat on surgical complications and long-term survival of patients with gastric cancer after radical gastrectomy.

BACKGROUND/OBJECTIVES: The aim of this study was to examine the impact of visceral fat on surgical complications and long-term survival for patients undergoing radical gastrectomy. SUBJECTS/METHODS: From 2009 to 2013, 859 patients who underwent curative resection for gastric cancer were enrolled from a prospectively maintained database. Visceral fat area (VFA) was assessed by preoperative CT scans. Patients were divided into two groups by VFA. Perioperative variables and postoperative outcomes were compared between the high VFA group and low VFA group. Univariable and multivariable analysis were performed to investigate independent risk factors of postoperative complications and survival. RESULTS: Some 859 patients were included in the study, 308 of whom were classified as high VFA. High VFA was correlated with advance age (P = 0.020), higher albumin levels (P = 0.001), hemoglobin levels (P < 0.05), ASA grade (P = 0.043) and Charlson Comorbidity Index (P = 0.004). Relative to patients with low VFA, those with high VFA had longer surgical durations (P = 0.004), higher rate of postoperative complications (P = 0.004), and longer hospital stays (P = 0.004). High VFA was identified as the only determinant for surgical complications by logistic regression analysis (OR, 2.236, 95% CI, 1.537-3.254; P < 0.001). Cox proportional hazards regression revealed no correlation between VFA and overall survival (OS) or disease-free survival (DFS). CONCLUSIONS: Increased VFA independently predicts surgical complications in patients after gastrectomy. However, VFA is not a prognostic biomarker of OS or DFS in patients with gastric cancer.

Effect of surgery-induced acute muscle wasting on postoperative outcomes and quality of life.

BACKGROUND: Gastrectomy results in a significant loss of body composition in the long term, but the acute skeletal muscle wasting after gastrectomy has been rarely investigated. Moreover, the association between postoperative muscle wasting and quality of life (QOL) has never been reported. In the present study, we aimed to investigate the risk factors for acute muscle wasting after gastric cancer surgery and its effect on QOL and short-term postoperative outcomes. METHODS: We conducted a prospective study of patients who underwent curative gastrectomy for gastric cancer between June 2015 and December 2015. Skeletal muscle mass was measured by computed tomography within 1 month before and 1 week after surgery. QOL was assessed 1, 3, and 6 months postoperatively. Univariate and multivariate analyses were performed to identify the risk factors for clinically relevant muscle wasting (muscle wasting ≥10%). RESULTS: A total of 110 patients were included, in which 35 patients had muscle wasting ≥10% within 1 week after surgery. Age ≥65 years and diabetes were independent risk factors for muscle wasting ≥10%. Patients with muscle wasting ≥10% had a poorer QOL in terms of fatigue and physical functioning at 1 and 3 months postoperatively, as well as a higher incidence of postoperative complications, a higher incidence of handgrip strength reduction ≥10%, longer hospital stays, and higher costs. CONCLUSIONS: Age ≥65 years and diabetes were independently associated with clinically relevant muscle wasting within 1 week after gastric cancer surgery. Clinically relevant muscle wasting was associated with a poorer QOL and short-term outcomes after surgery.

MicroRNA-106b in cancer-associated fibroblasts from gastric cancer promotes cell migration and invasion by targeting PTEN.

It is well established that the interaction between cancer cells and microenvironment has a critical role in tumor development, but the roles of miRNAs in this interaction are rarely known. Here, we have shown that miR-106b is up-regulated in cancer associated fibroblasts compared with normal fibroblasts established from patients with gastric cancer, the expression level of miR-106b is associated with poor prognosis of patients, and CAFs with down-regulated miR-106b could significantly inhibit gastric cancer cell migration and invasion by targeting PTEN. Taken together, these data suggest that miR-106b might be a novel candidate target for the treatment of gastric cancer.

Methionine synthase A2756G polymorphism and risk of colorectal adenoma and cancer: evidence based on 27 studies.

Methionine synthase (MTR), which plays a central role in maintaining adequate intracellular folate, methionine and normal homocysteine concentrations, was thought to be involved in the development of colorectal cancer (CRC) and colorectal adenoma (CRA) by affecting DNA methylation. However, studies on the association between MTR A2756G polymorphism and CRC/CRA remain conflicting. We conducted a meta-analysis of 27 studies, including 13465 cases and 20430 controls for CRC, and 4844 cases and 11743 controls for CRA. Potential sources of heterogeneity and publication bias were also systematically explored. Overall, the summary odds ratio of G variant for CRC was 1.03 (95% CI: 0.96-1.09) and 1.05 (95% CI: 0.99-1.12) for CRA. No significant results were observed in heterozygous and homozygous when compared with wild genotype for these polymorphisms. In the stratified analyses according to ethnicity, source of controls, sample size, sex, and tumor site, no evidence of any gene-disease association was obtained. Results from the meta-analysis of four studies on MTR stratified according to smoking and alcohol drinking status showed an increased CRC risk in heavy smokers (OR = 2.06, 95% CI: 1.32-3.20) and heavy drinkers (OR = 2.00, 95% CI: 1.28-3.09) for G allele carriers. This meta-analysis suggests that the MTR A2756G polymorphism is not associated with CRC/CRA susceptibility and that gene-environment interaction may exist.

[Short-term outcome of laparoscopic gastric bypass and minigastric bypass on obesity patients with type 2 diabetes mellitus].

OBJECTIVE: To evaluate the short-term outcome of laparoscopic gastric bypass on obesity patients with type 2 diabetes mellitus. METHODS: Seven obesity patients with type 2 diabetes mellitus received laparoscopic gastric bypass(n=1) or laparoscopic minigastric bypass(n=6), and their data of treatment outcomes were analyzed. RESULTS: The operations were all successfully performed without any complications. The average operation time was 125 minutes(range: 100 to 170 minutes). The patients underwent 1-18 months follow-up after operation. Diabetic indicators returned to normal without any medication and body weight reduced by on average of 24.3 kg. CONCLUSION: Laparoscopic gastric bypass and minigastric bypass have good short-term outcome in the treatment of obesity patients with type 2 diabetes mellitus.

[Effects of duodenal-jejunal bypass and sleeve gastrectomy on the expression of liver glucokinase in diabetic rats].

OBJECTIVE: To investigate the effects of duodenal-jejunal bypass(DJB) and sleeve gastrectomy(SG) on the expression of liver glucokinase(GCK) in diabetic rats. METHODS: Animal models of Goto-Kakizaki rats and Sprague-Dawley rats were established by DJB and SG. Results of fasting glycemia and insulin were compared. Liver tissue was harvested 8 weeks postoperatively.Quantitative real-time PCR and Western blot were used to detect liver GCK mRNA and protein expression after operation. RESULTS: Fasting plasma glucose levels of DJB group and SG group in GK rats were markedly declined 3 day and 1, 2, 4, 6, 8 weeks postoperatively(all P <0.01), while Sham group only dropped 3 day and 1 week postoperatively, and there were no significant differences 2 weeks postoperatively(P >0.05). Fasting plasma glucose levels of each group in SD rats did not change after operation. In GK rats, GCK mRNA level (1.45 +/-0.29) and protein expression (494.25 +/-30.25) after DJB were higher than Sham group (1.05 +/-0.19 and 409.13 +/-26.86) and control group (1.04 +/-0.17 and 404.75 +/-30.90). GCK mRNA level and protein expression after SG were 0.65 +/-0.25 and 345.25 +/-28.13 respectively, which were significantly lower than those in control group(all P <0.01). All the groups in SD rats experienced similar GCK expression change. CONCLUSION: Both DJB and SG can decrease the plasma glucose levels of GK rats, while there are different effects on the expression of liver GCK.

[Application of neoadjuvant chemotherapy in laparoscopic gastrectomy for advanced gastric cancer].

OBJECTIVE: To explore the benefit of neoadjuvant chemotherapy in advanced gastric cancer patients treated by laparoscopy. METHODS: Fifteen patients with histologically proved gastric adenocarcinomas (stages II(, III(, IIII(M(0)) were treated with FOLFOX7 neoadjuvant chemotherapy followed by laparoscopy between June 2005 and March 2007( trial group). Thirty patients were assigned to the control group with only laparoscopic treatment in the same period. The clinicopathological data were compared between two groups. RESULTS: All the patients in trial group accepted four cycles of preoperative chemotherapy and the toxicity was less than grade 3. Two of them achieved complete response, 10 achieved partial response and 3 kept stable disease. Ten patients of trial group underwent laparoscopic-assisted radical gastrectomy. The rates of R(0)-resection(80.0%) and pN(0) (60.0%) in trial group were significantly higher than those in control group(46.7% and 20.0%), while the rate of positive lymph node 11.0%(34/309) was significantly lower than that of control group 23.8%(142/596). The operation time and postoperative complication were similar in two groups. CONCLUSIONS: Advanced gastric cancer after neoadjuvant chemotherapy can be down-regulated in the stage, increase the rate of R(0)-resection, diminish the infiltration extent of tumor, decrease the metastasis of lymph node, and increase the possibility of laparoscopic radical gastrectomy.