Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 109
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
J Cancer Res Clin Oncol ; 146(2): 515-528, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31813005

RESUMO

PURPOSE: The present study aims to validate possible stage migration of lymph node metastasis related to the insufficient examined lymph node (ELN) count in pN3a gastric cancer (GC) patients. METHODS: 1976 pN3 patients who underwent the R0 surgery in three high-capacity institutions in China were enrolled to explore the stage migration of nodal involvement, and 3146 pN3 cases from the Surveillance, Epidemiology, and End Results (SEER) Program Registry were used as an external validation cohort. RESULTS: After the propensity score matching of the Chinese cohort, the ELN count, as an independent predictor for GC outcome, was confirmed to be associated with the stage migration of lymph node metastasis in pN3a patients based on the univariate and multivariate survival analyses. Logistic regress was adopted to elucidate that the ELN count was an independent factor related to the long-term survival status of GC patients after curative surgery. Likelihood ratio test showed that the ELN count had the smallest Bayesian information criterion value among the clinicopathologic variables, corresponding to an efficient model to predict outcomes. Subsequently, stage migration of lymph node metastasis was predominantly detected in pN3a patient sub-group with insufficient (less than 16) ELN count, who presented with similar prognosis as the pN3b patients (P = 0.463) as per the stratum analysis with Kaplan-Meier. These methods were further validated using data from the SEER cohort, and the similar promising results were obtained. CONCLUSION: pN3a patients with insufficient ELN count should be considered as pN3b cases to achieve accurate prognostic evaluation after curative gastrectomy.

2.
Int J Surg ; 74: 44-52, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31874262

RESUMO

OBJECTIVE: To examine the prognostic value of negative lymph node (NLN) count in stage III gastric cancer (GC) patients after curative gastrectomy. METHODS: The clinicopathological data of 2942 stage III patients who underwent curative gastrectomy between 2001 and 2011 were analyzed. Only patients with ≥16 examined lymph nodes (ELNs) were included. After cut-point survival analysis, the 2942 patients were divided into three subgroups with NLN counts of 0, 1-9, and ≥10. Survival differences among the subgroups were analyzed to assess the effects of NLN count on stage migration and overall survival (OS) in stage III GC patients. Spearman's correlation coefficient was used to assess the relationships between the ELN count and the positive lymph node (PLN) count, the ELN count and the NLN count, and the NLN count and the PLN count. RESULTS: Survival analyses revealed that the NLN count was significantly associated with OS (P = 0.001) and was an independent predictor (P < 0.01) of prognosis in stage III GC patients. Subgroup analysis showed that the prognostic evaluation accuracy was highest when the NLN count was ≥10 for stage III patients. Stage migrations were mainly detected in the following pathological tumor-node (pTN) subgroups: pT2N3a with 1-9 NLNs and pT2N3b with ≥10 NLNs, and pT3N3a with 1-9 NLNs and pT3N3b with ≥10 NLNs. NLN count was positively correlated with the ELN and the PLN counts for pT2N3 and pT3N3 stage GC patients (r = 0.694 and r = 0.881 for pT2N3 patients; r = 0.685 and r = 0.902 for pT3N3 patients, respectively; P < 0.001). These findings indicate that the NLN count may be a useful prognostic predictor in stage III GC patients. CONCLUSIONS: The NLN count may improve the prognostic prediction efficiency of the tumor-node-metastasis (TNM) classification for GC, especially for stage III patients, and should be recommended for clinical applications.

3.
Chin J Cancer Res ; 31(3): 453-462, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31354214

RESUMO

Objective: Multidetector-row computed tomography (MDCT) and serum tumor biomarkers are commonly used to evaluate the preoperative lymph node metastasis and the clinical staging of gastric cancer (GC). This study intends to evaluate the clinical predictive value of MDCT and serum tumor biomarkers in lymph node metastasis of GC. Methods: The clinicopathologic data of 445 GC patients who underwent radical gastrectomy were retrospectively analyzed to evaluate the diagnostic value of MDCT and serum tumor biomarkers in lymph node metastatic staging of GC before surgery. Results: With the multinomial logistic regression analysis, the independent relative factors of lymph node metastasis of GC were identified as tumor size, depth of tumor invasion, vessel invasion, vascular embolus, and soft tissue invasion. The optimal critical value of the short diameter of lymph nodes detected by MDCT scanning for evaluation of preoperative lymph node metastasis was 6.0 mm, with 75.7% as predictive accuracy of lymph node metastasis compared to the postoperative pathological results of GC patients. In addition, the critical value of the short diameter of lymph nodes combined with serum tumor biomarkers [including carbohydrate antigen (CA)-724 and CA-199] could show an enhancement of predictive sensitivity of lymph node metastasis (up to 89.3%) before surgery. Conclusions: MDCT combined with serum tumor biomarkers should be adopted to improve preoperative sensitivity and accuracy of lymph node metastasis for GC patients.

4.
Stem Cell Res Ther ; 10(1): 159, 2019 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159888

RESUMO

OBJECTIVE: To investigate the potential effect of IP7 on the autophagy and apoptosis of bone marrow mesenchymal stem cells (BM-MSCs) caused by hypoxia. METHODS: BM-MSCs isolated from adult male C57BL/6 mice were exposed to normoxic condition and hypoxic stress for 6 h, 12 h, and 24 h, respectively. Then, flow cytometry detected the characteristics of BM-MSCs. Furthermore, N6-(p-nitrobenzyl) purine (TNP) was administrated to inhibit inositol pyrophosphates (IP7). TUNEL assay determined the apoptosis in BM-MSCs with hypoxia. Meanwhile, RFP-GFP-LC3 plasmid transfection and transmission microscope was used for measuring autophagy. In addition, Western blotting assay evaluated protein expressions. RESULTS: Hypoxic injury increased the autophagy and apoptosis of BM-MSCs. At the same time, hypoxic injury enhanced the production of IP7. Moreover, hypoxia decreased the activation of Akt/mTOR signaling pathway. At last, TNP (inhibitor of IP7) repressed the increased autophagy and apoptosis of BM-MSCs under hypoxia. CONCLUSION: The present study indicated that hypoxia increased autophagy and apoptosis via IP7-mediated Akt/mTOR signaling pathway of BM-MSCs. It may provide a new potential therapy target for myocardial infarction (MI).

5.
Gastroenterol Rep (Oxf) ; 7(3): 193-198, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31217983

RESUMO

Background: In addition to the stepwise manner of lymph-node metastasis from the primary tumour, the skip lymph-node metastasis (SLNM) was identified as a low-incidence metastasis of gastric cancer (GC). So far, both the mechanism and outcome of SLNM have not been elucidated completely. The purpose of this study was to analyse the clinical significance and the potential mechanism of SLNM in GC patients who had lymph-node metastasis. Methods: Clinicopathological data and follow-up information of 505 GC patients who had lymph-node metastasis were analysed to demonstrate the significance of SLNM in evaluating the prognostic outcome. According to the pathological results, all GC patients who had lymph-node metastasis were categorized into three groups: patients with the perigastric lymph-node metastasis, patients with the perigastric and extragastric lymph-node metastasis and patients with SLNM.Results: Among the 505 GC patients who had lymph-node metastasis, 24 (4.8%) had pathologically identified SLNM. The location of lymph-node metastasis was not significantly associated with 5-year survival rate and overall survival (OS) (P = 0.194). The stratified survival analysis results showed that the status of SLNM was significantly associated with the OS in patients with pN1 GC (P = 0.001). The median OS was significantly shorter in 19 pN1 GC patients with SLNM than in 100 patients with perigastric lymph-node metastasis (P < 0.001). The case-control matched logistic regression analysis results showed that tumour size (P = 0.002) was the only clinicopathological factor that may predict SLNM in pN1 GC patients undergoing curative surgery. Among the 19 pN1 GC patients with SLNM, 17 (89.5%) had metastatic lymph nodes along the common hepatic artery, around the celiac artery or in the hepatoduodenal ligament. Conclusions: SLNM may be considered a potentially practicable indicator for prognosis among various subgroups of pN1 GC patients.

6.
Chin J Cancer Res ; 30(5): 477-491, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30510359

RESUMO

Objective: To validate the necessity of increasing the examined lymph node (ELN) count for enhancing the accuracy of prognostic evaluation of gastric cancer (GC) patients after curative gastrectomy in multiple medical centers of China. Methods: The clinicopathological data of 7,620 patients who underwent the curative resection for GC between 2001 and 2011 were included to demonstrate whether the ELN count is indispensable for enhancing the accuracy of prognostic evaluation of GC patients after surgery. After a meticulous stratification by using the cut-point survival analysis, all included 7,620 patients were allocated into three groups as: less than 16 (<16), between 16 and 30 (16-30), and more than 30 (>30) ELNs. Survival differences among various subgroups of GC patients were analyzed to assess the impact of the ELN count on the stage migration in accordance with the overall survival (OS) of GC patients. Results: Survival analyses revealed that the ELN count was positively correlated with the OS (P=0.001) and was an independent prognostic predictor (P<0.01) of 7,620 GC patients. Stratum analysis showed that the accuracy of prognostic evaluation could be enhanced when the ELN count was no less than 16 (≥16) for node-negative patients and >30 for node-positive patients. Stage migrations were mainly detected in the various subgroups of patients with specific pN stages as follows: pN0 with 16-30 ELNs (pN016-30) and pN0 with >30 ELNs (pN0 >30), pN0 with <16 ELNs (pN0 <16) and pN1>30, pN1<16 and pN216-30, pN116-30 and pN2>30, pN3a<16 and pN3b16-30, and pN3a<16 and pN3b>30. These findings indicate that increasing the ELN count is a prerequisite to guarantee precisely prognostic evaluation of GC patients. Conclusions: The ELN count should be proposed to be >30 for acquiring the accurate prognostic evaluation for GC patients, especially for node-positive patients.

7.
Cancer Commun (Lond) ; 38(1): 67, 2018 11 19.
Artigo em Inglês | MEDLINE | ID: mdl-30454049

RESUMO

BACKGROUND: The 8th edition of the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) pathological tumor-node-metastasis (pTNM) staging system may have increased accuracy in predicting prognosis of gastric cancer due to its important modifications from previous editions. However, the homogeneity in prognosis within each subgroup classified according to the 8th edition may still exist. This study aimed to compare and analyze the prognosis prediction abilities of the 8th and 7th editions of AJCC/UICC pTNM staging system for gastric cancer and propose a modified pTNM staging system with external validation. METHODS: In total, clinical data of 7911 patients from three high-capacity institutions in China and 10,208 cases from the Surveillance, Epidemiology, and End Results (SEER) Program Registry were analyzed. The homogeneity, discriminatory ability, and monotonicity of the gradient assessments of the 8th and 7th editions of AJCC/UICC pTNM staging system were compared using log-rank χ2, linear-trend χ2, likelihood-ratio χ2 statistics and Akaike information criterion (AIC) calculations, on which a modified pTNM classification with external validation using the SEER database was proposed. RESULTS: Considerable stage migration, mainly for stage III, between the 8th and 7th editions was observed in both cohorts. The survival rates of subgroups of patients within stage IIIA, IIIB, or IIIC classified according to both editions were significantly different, demonstrating poor homogeneity for patient stratification. A modified pTNM staging system using data from the Chinese cohort was then formulated and demonstrated an improved homogeneity in these abovementioned subgroups. This staging system was further validated using data from the SEER cohort, and similar promising results were obtained. Compared with the 8th and 7th editions, the modified pTNM staging system displayed the highest log-rank χ2, linear-trend χ2, likelihood-ratio χ2, and lowest AIC values, indicating its superior discriminatory ability, monotonicity, homogeneity and prognosis prediction ability in both populations. CONCLUSIONS: The 8th edition of AJCC/UICC pTNM staging system is superior to the 7th edition, but still results in homogeneity in prognosis prediction. Our modified pTNM staging system demonstrated the optimal stratification and prognosis prediction ability in two large cohorts of different gastric cancer populations.


Assuntos
Adenocarcinoma/patologia , Neoplasias Gástricas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Reprodutibilidade dos Testes , Adulto Jovem
8.
Zhonghua Wei Chang Wai Ke Za Zhi ; 21(10): 1154-1160, 2018 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-30370515

RESUMO

OBJECTIVE: To investigated the characteristics and regularity of lymph node metastasis around gastric cancer in order to provide reference for standardized and optimal surgical treatment. METHODS: A retrospective case series study was carried out on 1456 patients with gastric cancer undergoing surgical treatment at the Affiliated Tumor Hospital of Tianjin Medical University from March 2003 to August 2011. The number of harvested lymph node and metastasis status of various lymph node station were determined by routine pathological examination of specimens, including resected gastric tissue and dissected lymph node tissue, according to the 13th version of the Japanese Gastric Cancer Treatment Guidelines. Tumor T, N and M staging was performed to evaluate lymphatic metastasis status of different locations of gastric cancer according to the TNM staging criteria of the 8th edition of the American Joint Committee on Cancer (AJCC). The influence of gender, age, tumor diameter, Borrmann type, T staging and M staging, tumor differentiation degree, invasion of vessels, lymphatic vessels and nerves, radical surgical degree and other clinical factors on lymph node metastasis was analyzed. RESULTS: A total of 1062 cases(72.9%) had lymph node metastasis in the 1456 patients with gastric cancer. A total of 9766 lymph nodes were positive for metastasis. Lymph node metastasis occurred in 11 of 44 (25.0%) patients with early gastric cancer and in 1051 of 1412 (74.4%) patients with advanced gastric cancer. The largest number of lymph node metastases was found in No.3 station [653 cases (44.8%)], followed by No.6 [437 cases(30.0%)], No.7 [345 cases (23.7%)], No.1 [304 cases (20.9%)], No.4sb [290 cases (19.9%)]. No.14v lymph node metastasis was observed in 23 cases, of whom No.6 (16 cases, 69.6%), No.8a (15 cases, 65.2%) and No.3 (12 cases, 52.2%) developed simultaneous metastasis. As for different locations of gastric cancer, stations with more lymph node metastasis in 309 patients with proximal gastric cancer were No.3 (133 cases, 43.0%), No.1 (96 cases, 31.1%), No.2 (90 cases, 29.1%) and No.7 (89 cases, 28.8%); in 144 patients with middle gastric cancer were No.3 (68 cases, 47.2%), No.6 (50 cases, 34.7%), No.7 (40 cases, 27.8%) and No.4sb (38 cases, 26.4%); in 700 patients with distal gastric cancer were No.3(287 cases, 41.0%), No.6 (265 cases, 37.8%), No.4sb (138 cases, 19.7%) and No.8a (138 cases, 19.7%); in 303 cases with diffuse-type gastric cancer were No.3 (165 cases, 54.4%), No.6 (100 cases, 33.0%), No.7 (88 cases, 29.0%), No.1 (84 cases, 27.7%) and No.4sb (72 cases, 23.8%). The incidence of lymph node skip metastasis was 7.2% (105/1456) in whole group. Positive lymph node metastasis was associated with tumor size (RR=2.016, 95%CI: 1.550-2.621, P=0.000), tumor differentiation(RR=1.631, 95%CI:1.405-1.894, P=0.000), tumor T staging (RR=1.886, 95%CI: 1.629-2.184, P=0.000), tumor M staging (RR=3.671, 95%CI:1.265-10.660, P=0.017) and radical surgery(RR=3.819, 95%CI: 2.023-7.207, P=0.000). CONCLUSIONS: The main direction of peripheral lymph node drainage in gastric cancer is lesser curvature, and then the left gastric artery, the common hepatic artery and the peripheral lymph nodes of the celiac axis, and finally the peripheral lymph nodes of the abdominal aorta. Therefore the No.6 station lymph node adjacent to the perigastric area, the No.7, No.8 and No.9 lymph nodes should be the focus of the radical surgical dissection of gastric cancer. Tumor size, differentiation degree, invasion depth and distant metastasis have significant association with lymph node metastasis. For patients with adverse factors, radical surgery is necessary to ensure efficacy.


Assuntos
Excisão de Linfonodo , Metástase Linfática , Neoplasias Gástricas , Gastrectomia , Humanos , Linfonodos/patologia , Metástase Linfática/patologia , Estadiamento de Neoplasias , Estudos Retrospectivos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologia
9.
Zhonghua Wei Chang Wai Ke Za Zhi ; 21(10): 1183-1190, 2018 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-30370518

RESUMO

So far, the category based on the number of metastatic lymph nodes (eg. pN stage) has been demonstrated to be the optimal staging of lymph node metastasis after curative surgery for gastric cancer. Although pN stage has been updating since 1992, it has been still controversial to guarantee the acquisition for the accurate information of lymph node metastasis from gastric cancer. Generally, stage migration of lymph node metastasis means that number of metastatic lymph node is positively correlated with the extent of lymphadenectomy, and with the expansion of lymphadenectomy extent, occurrence of stage migration of lymph node metastasis may decrease gradually or be avoided (Will-Roger phenomena). Stage migration of lymph node metastasis is considered to have a significant impact on the pathologic stage, prognostic evaluation and strategy formulation of adjuvant therapy. Actually, stage migration of lymph node metastasis may be induced by individual difference in patients, disease stage, special biological behaviors of tumor, extent of lymphadenectomy, procedures of lymph node examination and so on, which may undermine the accurate staging of lymph node metastasis from gastric cancer in clinic. The specification procedures for lymph node examination following the radical lymphadenectomy for gastric cancer are not only the necessary method to figure out the comprehensive information of lymph node metastasis from patients but also the essential evidence to embody the high quality of curative gastrectomy for patients, which may provide the optima database for the further precise diagnosis and treatment of gastric cancer.


Assuntos
Excisão de Linfonodo , Linfonodos , Estadiamento de Neoplasias , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Gastrectomia/normas , Humanos , Linfonodos/patologia , Prognóstico
10.
Stem Cell Res Ther ; 9(1): 284, 2018 10 25.
Artigo em Inglês | MEDLINE | ID: mdl-30359321

RESUMO

BACKGROUND: Treatment with bone marrow mesenchymal stem cells (BM-MSCs) has been demonstrated to be an excellent cellular-based therapeutic strategy for treating myocardial infarction (MI). However, most of the patients suffering with MI are elderly. Hypoxic conditions can cause apoptosis of BM-MSCs, and this type of apoptosis is more prevalent in aged BM-MSCs. Decreased autophagy is one of the mechanisms underlying aging. The aim of this study is to uncover whether the increased hypoxic injury of aged BM-MSCs is due to autophagy and whether reducing autophagy diminishes the tolerance of hypoxia in aged BM-MSCs. METHODS: Young and aged BM-MSCs were isolated from male young and aged GFP/Fluc transgenic C57BL/6 mice respectively and then exposed to hypoxia and serum deprivation (H/SD) injury. The apoptosis level induced by H/SD was measured by terminal deoxynucleotidy transferase-mediated dUTP nick end-labeling (TUNEL) assay. Additionally, autophagy was analyzed via transfection with plasmids encoding green fluorescent protein-microtubule-associated protein lightchain3 (GFP-LC3), and autophagic vacuoles were visualized with transmission electron microscopy. Meanwhile, protein expression was measured by western blot analysis. Autophagic activity was manipulated by the administration of IGF-1 (insulin-like growth factor siRNA) and 3-methyladenine (3MA). Furthermore, young, aged, and the IGF-1 siRNA-transfected aged BM-MSCs were transplanted to myocardial infarcted adult C57BL/6 mice respectively. In vivo longitudinal in vivo bioluminescence imaging (BLI) of transplanted BM-MSCs was performed to monitor the survival of transplanted BM-MSCs in each groups. RESULTS: Aged BM-MSCs exhibited a higher rate of apoptosis compared with young BM-MSCs under hypoxic conditions. Additionally, the level of autophagy was lower in aged BM-MSCs compared with young BM-MSCs under normoxic and hypoxic conditions. Meanwhile, hypoxia decreased the activity of the protein kinase B (Akt) and mammalian target of rapamycin (mTOR) signaling pathway in young and aged BM-MSCs, but aged BM-MSCs exhibited a relatively stronger Akt/mTOR activity compared with young BM-MSCs. In addition, IGF-1 knockdown significantly decreased the level of apoptosis in aged BM-MSCs under normoxic and hypoxic conditions. IGF-1 knockdown also decreased the activity of the Akt/mTOR signaling pathway and increased the level of autophagy in aged BM-MSCs under hypoxic condition. Furthermore, IGF-1 knockdown protected aged BM-MSCs from hypoxic injury by increasing the level of autophagy, thereby promoting the survival of aged BM-MSCs after myocardial infarction transplantation. CONCLUSION: This study demonstrates that reducing autophagy decreases the hypoxia tolerance of aged BM-MSCs. Maintaining optimal levels of autophagy may serve as a new strategy in treating MI by BM-MSC transplantation in aged patients.


Assuntos
Autofagia/genética , Fator de Crescimento Insulin-Like I/genética , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/efeitos dos fármacos , Infarto do Miocárdio/terapia , Oxigênio/farmacologia , Adenina/análogos & derivados , Adenina/farmacologia , Fatores Etários , Animais , Apoptose/genética , Autofagia/efeitos dos fármacos , Células da Medula Óssea/citologia , Células da Medula Óssea/efeitos dos fármacos , Células da Medula Óssea/metabolismo , Hipóxia Celular , Senescência Celular , Regulação da Expressão Gênica , Humanos , Fator de Crescimento Insulin-Like I/antagonistas & inibidores , Fator de Crescimento Insulin-Like I/metabolismo , Masculino , Células-Tronco Mesenquimais/citologia , Células-Tronco Mesenquimais/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Proteínas Associadas aos Microtúbulos/genética , Proteínas Associadas aos Microtúbulos/metabolismo , Infarto do Miocárdio/genética , Infarto do Miocárdio/metabolismo , Infarto do Miocárdio/patologia , Cultura Primária de Células , Proteínas Proto-Oncogênicas c-akt/genética , Proteínas Proto-Oncogênicas c-akt/metabolismo , RNA Interferente Pequeno/genética , RNA Interferente Pequeno/metabolismo , Transdução de Sinais , Serina-Treonina Quinases TOR/genética , Serina-Treonina Quinases TOR/metabolismo
11.
Cancer Commun (Lond) ; 38(1): 23, 2018 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-29764518

RESUMO

BACKGROUND: Few studies have shown nomograms that may predict disease-specific survival (DSS) probability after curative D2 gastrectomy for advanced gastric cancer (AGC), particularly among Chinese patients. This study sought to develop an elaborative nomogram that predicts long-term DSS for AGC in Chinese patients. METHODS: A retrospective study was conducted on 6753 AGC patients undergoing D2 gastrectomy between January 1, 2000 and December 31, 2012 from three large medical hospitals in China. We assigned patients from Sun Yat-sen University Cancer Center to the training set, and patients from the First Affiliated Hospital of China Medical University and Tianjin Medical University Cancer Hospital to two separate external validation sets. A multivariate survival analysis was performed using Cox proportional hazards regression model in a training set, and a nomogram was constructed. Harrell's C-index was used to evaluate discrimination and calibration plots were used to validate similarities between survival probabilities predicted by the nomogram model and actual survival rates in two validation sets. RESULTS: The multivariate Cox regression model identified age, tumor size, location, Lauren classification, lymphatic/venous invasion, depth of invasion, and metastatic lymph node ratio as covariates associated with survival. In the training set, the nomogram exhibited superior discrimination power compared with the 8th American Joint Committee on Cancer TNM classification (Harrell's C-index, 0.82 vs. 0.74; P < 0.001). In two validation sets, the nomogram's discrimination power was also excellent relative to TNM classification (C-index, 0.83 vs. 0.75 and 0.81 vs. 0.74, respectively; P < 0.001 for both). After calibration, the nomogram produced survival predictions that corresponded closely with actual survival rate. CONCLUSIONS: The established nomogram was able to predict 3-, 5-, and 10-year DSS probabilities for AGC patients. Validation revealed that this nomogram exhibited excellent discrimination and calibration capacity, suggesting its clinical utility.


Assuntos
Gastrectomia/métodos , Nomogramas , Neoplasias Gástricas/cirurgia , Idoso , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Neoplasias Gástricas/mortalidade , Taxa de Sobrevida
12.
Zhonghua Wei Chang Wai Ke Za Zhi ; 21(2): 228-235, 2018 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-29492923

RESUMO

Gastric cancer is one of the most important diseases that endangers people's health. Beside gastric adenocarcinoma, gastric carcinoma also includes the following types: adenosquamous carcinoma, squamous carcinoma, gastric neuroendocrine tumor, gastric hepatoid adenocarcinoma, AFP-producing gastric cancer, EBV-associated gastric cancer, lymphoepithelioma-like carcinoma, undifferentiated-type gastric cancer, gastric carcinosarcoma and so on. The adenosquamous carcinoma, squamous carcinoma of stomach, gastric hepatoid adenocarcinoma, AFP-producing gastric cancer and gastric carcinosarcoma mainly occurred in old men, while the linitisplastica gastric cancer was common in young women. It refers to the gastric cancers that are clinically rare and have lower incidence, unique histological and pathological features, however, without obviously clinical manifestations. The clinically uncommon gastric cancers are easy to be misdiagnosed or missed, and further to miss the optimal opportunity for treatment due to the unclearly specific pathogenesis and disease progression. With the development of studies on the clinically uncommon gastric carcinoma, although people have a further knowledge of its pathologic features, methods of diagnosis and treatment, the diagnosis and treatment standards for the clinically uncommon gastric cancer has not yet been established and unified. The therapeutic principle of the clinically uncommon gastric cancers is also the radical surgery, radiotherapy and chemotherapy as the main comprehensive treatment supplemented by individualized treatment. With lucubrating the pathogenesis of them, specific diagnostic methods and treatment measures are new hope for improving the diagnosis and treatment of the clinically uncommon gastric cancers. So, the further researches on the clinically uncommon gastric cancers and exploring their etiology, pathogenesis, histological and pathological features have important significance to their diagnosis and treatment. This article makes a summary of the clinically uncommon gastric cancers with the aspects of epidemiology, histology, pathology, diagnosis, treatment, to provide reference to clinical diagnosis and scientific studies.


Assuntos
Adenocarcinoma , Carcinoma de Células Escamosas , Neoplasias Gástricas , Adenocarcinoma/diagnóstico , Adenocarcinoma/patologia , Adenocarcinoma/terapia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Feminino , Humanos , Masculino , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologia , Neoplasias Gástricas/terapia , alfa-Fetoproteínas/metabolismo
13.
Zhonghua Wei Chang Wai Ke Za Zhi ; 21(1): 53-60, 2018 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-29354900

RESUMO

OBJECTIVE: To study the risk factor of perioperative complication in gastric cancer patients with radical therapy and its influence on prognosis. METHODS: Clinical, pathological and follow-up data of 1 148 gastric cancer patients undergoing radical gastrectomy at Tianjin Medical University Affiliated Tumor Hospital between January 2009 and August 2011 were retrospectively collected. Pearson 2 test and Logistic regression analysis were used to analyze the risk factor of perioperative complication. Cox regression analysis was used to evaluate the influence of perioperative complications on the prognosis in patients after radical gastrectomy. Kaplan-Meier survival curve was applied to calculate the survival. RESULTS: Of 1 148 patients, 851 were male, 297 were female, age ranged from 19 to 89 (average 59.9) years. Perioperative complication occurred in 312 cases (27.2%), including 140 cases of pulmonary infection and 53 cases of abdominal infection. Multivariate Logistic regression analysis showed that ≥65 years old (OR:0.736, 95%CI: 0.558 to 0.971, P=0.030), serum albumin less than 35 g/L(OR:2.626, 95%CI: 1.479 to 4.665, P=0.001), Borrmann type IIII((OR: 0.748, 95%CI: 0.610 to 0.917, P=0.005), tumor site at upper 1/3 of stomach (OR:1.326, 95%CI:1.167 to 1.506, P=0.000), combined organ resection(OR:0.624, 95%CI:0.428 to 0.909, P=0.014) were independent risk factors of perioperative complication. Tumor site at upper 1/3 of stomach (OR:1.649, 95%CI: 1.368 to 1.988, P=0.000), ≥65 years old (OR:0.548, 95%CI:0.379 to 0.792, P=0.001), without intraoperative chemotherapy (OR:1.671, 95%CI:1.146 to 2.437, P=0.008) were independent risk factors of perioperative pulmonary infection; Borrmann type IIII((OR:0.576, 95%CI:0.369 to 0.900, P=0.015), with intraoperative chemotherapy (OR:0.431, 95%CI:0.230 to 0.810, P=0.009), intraoperative blood loss ≥400 ml(OR:0.411, 95%CI:0.176 to 0.959, P=0.040) and combined organ resection (OR:0.412, 95%CI:0.215 to 0.789, P=0.008) were independent risk factors of perioperative intraperitoneal infection. Cox regression analysis revealed that without intraoperative chemotherapy, proximal subtotal or total gastrectomy, TNM stage III(, N3 stage lymph node metastasis, positive soft tissue outside lymph node, combined organ resection and organ failure were independent risk factors affecting the prognosis of gastric cancer patients after radical resection (all P<0.05), however the perioperative complication was not independent risk factor affecting the prognosis (P=0.259). The median survival time was 35 months, and 5-year survival rate was around 38.7%. The median survival time of gastric cancer patients with operative complications and without complications were 28.0 and 36.5 months, and the 5-year survival rates were 37.2% and 39.3%, whose difference was not statistically significant (P=0.259). CONCLUSION: There is a higher risk of perioperative complication in those gastric cancer patients with old age, preoperative low serum albumin level, tumor site at upper 1/3 of stomach, Borrmann type IIII(, intraoperative combined organ resection, while the perioperative complication has no significant effects on the long-term survival.


Assuntos
Gastrectomia/efeitos adversos , Complicações Intraoperatórias , Complicações Pós-Operatórias , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Adulto Jovem
14.
Cancer ; 124(5): 916-924, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29205321

RESUMO

BACKGROUND: Conditional survival estimates, which take into consideration the changing risk with increasing survival time, provide a dynamic survival probability and more accurate survival information for clinician decision making. The objective of the current study was to evaluate the conditional disease-specific survival (DSS) for patients with gastric cancer who underwent curative surgery in China. METHODS: In total, 7658 patients with gastric cancer from a multi-institutional cohort in China were included in the analyses. Actuarial DSS was estimated using the Kaplan-Meier method. Three-year conditional DSS (CDS3 ) of patients who had already survived for x years was estimated as CDS3 = DSS(x + 3)/DSS(x). Cox proportional hazards regression analyses were used to identify the factors related to DSS. RESULTS: The 1-year, 3-year, and 5-year actuarial DSS rates were 88.2%, 64.5%, and 54.6%, respectively. By using CDS estimates, the probabilities that patients would remain alive for an additional 3 years given that they had already survived for 1, 3, and 5 years were 66.6%, 80.2%, and 88.3%, respectively. Patients who had unfavorable tumor characteristics diagnosed initially at surgery had the greatest improvement in CDS and the largest survival gap between actuarial DSS and CDS. CONCLUSIONS: The current results indicate that CDS estimates for Chinese patients with gastric cancer who underwent surgery were dynamic and increased with time elapsed. Patients who had unfavorable tumor characteristics had the greatest improvement in CDS. This valuable information could provide more a precise evaluation of long-term prognosis and may serve as an important prognostic index in clinical practice. Cancer 2018;124:916-24. © 2017 American Cancer Society.


Assuntos
Gastrectomia/métodos , Neoplasias Gástricas/cirurgia , Idoso , Grupo com Ancestrais do Continente Asiático , China , Estudos de Coortes , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Neoplasias Gástricas/etnologia , Neoplasias Gástricas/patologia
15.
Oncotarget ; 8(31): 51878-51887, 2017 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-28881697

RESUMO

The aim of this meta-analysis was to determine the feasibility of laparoscopic gastrectomy (LG) for elderly gastric cancer patients by comparing laparoscopic and conventional open gastrectomies (OG). Comprehensive search of the PubMed, EMBASE, and Cochrane Library databases revealed nine non-randomized controlled studies that compared LG and OG in elderly gastric cancer patients We then analyzed dichotomous or continuous parameters using odds ratios (ORs) or weighted mean differences (WMDs). Overall survival was estimated using hazard ratios (HRs) with a fixed effects or random effects model. We observed that the age distribution was similar between the LG and OG patient groups (WMD -0.22 95% CI, -1.26-0.82). LG patients experienced less blood loss (WMD -119.14 95% CI, -204.17--34.11) and had shorter hospital stays (WMD -3.48 95% CI, -5.41--1.56), but endured longer operation times (WMD 10.87 95% CI, 2.50-19.24). Postoperatively, LG patients exhibited lower incidences of postoperative morbidities (OR 0.59 95% CI, 0.43-0.79), surgery related morbidities (OR 0.58 95% CI, 0.41-0.81) and systemic morbidities (OR 0.56 95% CI, 0.38-0.82). We observed no differences between the LG and OG patient groups regarding anastomotic leakage (OR 0.69 95% CI, 0.34-1.41), mental disease (OR 0.72 95% CI, 0.37-1.41) and long term effects (HR 0.98 95% CI, 0.74-1.32). We therefore conclude that laparoscopic gastrectomy might be technically feasible for elderly gastric cancer patients.

17.
Zhonghua Wei Chang Wai Ke Za Zhi ; 20(2): 207-212, 2017 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-28226357

RESUMO

OBJECTIVE: To investigate the clinicopathological characteristics, diagnosis, treatment and prognosis of patients with primary gastric adenosquamous cell carcinoma. METHODS: A total of 5 562 patients with gastric neoplasm were admitted in Tianjin Medical University Cancer Institute and Hospital from January 2001 to January 2011. Among them 42 patients were diagnosed as primary gastric adenosquamous cell carcinoma, accounting for 0.76% of all the patients. The clinicopathological and follow-up data of these 42 patients with primary gastric adenosquamous cell carcinoma were retrospectively analyzed, and Cox proportional hazard model was used to analyze the prognostic factors of gastric adenocarcinoma squamous cell carcinoma. RESULTS: Among above 42 patients, 32 were male and 10 were female, with a male-to-female ratio of 3.2/1.0 and the average age was 63 years (range: 46 to 77 years). Five patients (11.9%) were confirmed as adenosquamous cell carcinoma by preoperative pathological examination, while other 37 patients were diagnosed as adenocarcinoma preoperatively. According to the 7th edition AJCC TNM classification system for gastric adenocarcinoma, 5 patients (11.9%) were in stage II(, 30 patients (71.4%) in stage III( and 7 patients (16.7%) in stage IIII(. The maximum tumor diameter was > 5 cm in 18 patients (42.9%). Borrmann type III(-IIII( was found in 29 patients (69.0%), and poorly differentiated (or undifferentiated) tumor was found in 32 patients (76.2%). Radical operations were performed in 31 patients (73.8%), the reasons of non radical operations included infiltration of pancreas in 3 patients, infiltration of radices mesocili transvers in 1 patient and classification of stage IIII( in 7 patients. Lymph node dissection was performed in 37 patients, 83.8% of them (31/37) was found with lymphatic metastases. Twenty-five patients received adjuvant chemotherapy except for 7 patients in stage IIII( and 10 patients who refused adjuvant chemotherapy. All the patients had an average survival time of 36.4 months and median survival time of 28.0 months, and the overall 1-, 3- and 5-year survival rates were 82.2%, 42.3% and 18.2% respectively. Univariate analysis revealed that tumor size (χ2=4.039, P=0.044), Borrmann type (χ2=18.728, P=0.000), tumor differentiation (χ2=19.612, P=0.000), radical gastectomy (χ2=41.452, P=0.000), lymph node metastasis (χ2=9.689, P=0.002) and clinical stage (χ2=26.277, P=0.000) were associated with postoperative survival. Multivariate analysis revealed that tumor differentiation (HR=10.560, 95%CI:2.263-49.281, P=0.003), radical gastrectomy (HR=4.309, 95%CI:1.311-14.168, P=0.016) and clinical stage (HR=2.392, 95%CI:1.022-5.600, P=0.044) were independent prognosis factors. CONCLUSIONS: Primary gastric adenosquamous cell carcinoma is rare with poor prognosis. Radical gastrectomy is recommended. Tumor differentiation, radical gastrectomy and clinical stage are important indicators to evaluate prognosis of primary gastric adenosquamous cell carcinoma.


Assuntos
Adenocarcinoma/diagnóstico , Adenocarcinoma/mortalidade , Adenocarcinoma/terapia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/terapia , Prognóstico , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/terapia , Taxa de Sobrevida , Adenocarcinoma/patologia , Idoso , Carcinoma de Células Escamosas/patologia , Quimioterapia Adjuvante/estatística & dados numéricos , Feminino , Gastrectomia/métodos , Gastrectomia/estatística & dados numéricos , Humanos , Excisão de Linfonodo/estatística & dados numéricos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Gradação de Tumores/estatística & dados numéricos , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias/estatística & dados numéricos , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Neoplasias Gástricas/patologia
18.
Surgery ; 161(6): 1588-1596, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28111043

RESUMO

BACKGROUND: Lymph node status is one of the most important clinical outcome determinants in gastric cancer patients. Categorization based on the metastatic node count alone, however, would presumably be influenced by the extent of lymphadenectomy and the stage migration phenomenon. METHODS: We statistically analyzed relevant clinicopathologic data of 351 gastric cancer patients with node metastasis who had undergone R0 surgery to compare the reliability of the negative to positive lymph nodes ratio to those of other classifications of lymph node metastasis for predicting outcomes. RESULTS: Survival analyses demonstrated the negative to positive lymph nodes ratio to be an independent predictor of overall survival in the 351 gastric cancer patients (hazard ratio = 0.414; P < .001) and revealed significant superiority (P < .001) for evaluating overall survival based on direct comparison with other categories of lymph node metastasis applying case-control matching. In addition, the negative to positive lymph nodes ratio was found to correlate significantly with the number of negative lymph nodes (P < .001), pN stage (P < .001), and the positive to dissected lymph nodes ratio (P < .001) by multinomial logistic regression analysis. Finally, the interplay effect analyses revealed the negative to positive lymph nodes ratio to yield information similar to that provided by the positive to dissected lymph nodes ratio (R2 = 1.000), while providing more information on both the number of dissected lymph nodes and the number of negative lymph nodes than the positive to dissected lymph nodes ratio. CONCLUSION: The negative to positive lymph nodes ratio, which reflects comprehensive information on dissected, positive, and negative node counts, appears to be a useful alternative for predicting the outcomes of node-positive gastric cancer patients.


Assuntos
Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Linfonodos/patologia , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Adenocarcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Gastrectomia/métodos , Humanos , Imuno-Histoquímica , Japão , Linfonodos/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Prognóstico , Modelos de Riscos Proporcionais , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Neoplasias Gástricas/cirurgia , Análise de Sobrevida , Resultado do Tratamento
19.
Ann Surg Oncol ; 24(3): 745-753, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27770340

RESUMO

BACKGROUND: This study aims to elucidate whether increasing the number of examined lymph nodes (NELN) is mandatory for the accurate prognosis of node-negative gastric cancer (GC) patients after curative gastrectomy in Eastern countries (China and Japan). METHODS: The clinicopathological data of 2455 GC patients (including 1137 node-negative cases) were included to demonstrate whether a minimum NELN is inevitable for guaranteeing the accurate prognosis of node-negative GC patients after curative gastrectomy. RESULTS: Survival analyses revealed that the NELN significantly positively correlated with overall survival (p < 0.001) and was an independent prognostic predictor (hazard ratio 0.447; p = 0.025) of 1137 node-negative GC patients. Stratum analysis within the Kaplan-Meier method showed that sex, tumor size, and extent of lymphadenectomy did not affect the NELN in predicting the prognosis of all node-negative GC patients. Stage migration was mainly detected in the subgroup of node-negative GC Chinese patients who presented considerably lower mean NELN and more advanced staging than patients from Japan. The NELN was identified as the most intensively independent predictor of prognosis of 600 node-negative GC patients from China, with the smallest Akaike information criterion (176.964) and Bayesian information criterion values (194.552). These findings indicate that increasing the NELN is a prerequisite to guaranteeing precise TNM classification. CONCLUSIONS: The NELN should be considered a mandatory requirement for improving the accuracy of prognostic evaluation of GC patients, especially for advanced-stage patients.


Assuntos
Excisão de Linfonodo/métodos , Linfonodos/patologia , Neoplasias Gástricas/patologia , Idoso , China , Feminino , Gastrectomia , Humanos , Japão , Estimativa de Kaplan-Meier , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/cirurgia , Taxa de Sobrevida
20.
Chin J Cancer Res ; 28(4): 397-403, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27647967

RESUMO

Based upon studies from randomized clinical trials, the extended (D2) lymph node dissection is now recommended as a standard procedure for local advanced gastric cancer worldwide. However, the rational extent lymphadenectomy for local advanced gastric cancer has remained a topic of debate in the past decades. Due to the limitation of low metastatic rate in para-aortic nodes (PAN) in JCOG9501, the clinical benefit of D2+ para-aortic nodal dissection (PAND) for patients with stage T4 and/or stage N3 disease, which is very common in China and other countries except Japan and Korea, cannot be determined. Furthermore, the role of splenectomy for complete resection of No.10 and No.11 nodes has been controversial, and however, the final results from the randomized trial of JCOG0110 have yet to be completed. Gastric cancer with the No.14 and No.13 lymph node metastasis is defined as M1 stage in the current version of the Japanese classification. We propose that D2+No.14v and +No.13 lymphadenectomy may be an option in a potentially curative gastrectomy for tumors with apparent metastasis to the No.6 nodes or infiltrate to duodenum. The examined lymph node and extranodal metastasis are significantly associated with the survival of gastric cancer patients.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA