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1.
Medicine (Baltimore) ; 99(30): e21324, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791727

RESUMO

BACKGROUND: To systematically evaluate whether the expression level of long non-coding RNA activated by transforming growth factor-ß (lncRNA-ATB) is correlated with the prognosis of digestive system cancer (DSC) patients. METHODS: PubMed, Embase, Cochrane Library, Web of Science, Springerlink, Nature, and Karger databases were searched up to April 20, 2019 by 2 experienced researchers independently. The quality of studies was assessed with the Newcastle-Ottawa scale. The Review Manager 5.2 and STATA 12.0 software were used for this meta-analysis. RESULT: Eleven studies with 1227 DSC patients were included in the meta-analysis. Except for pancreatic cancer, high expression of lncRNA-ATB was associated with lymph node metastasis (risk ratio (RR) = 1.26, 95% confidence interval (CI): 1.12-1.42, P < .001), advanced clinical staging (RR = 1.44, 95%CI: 1.23-1.69, P < .001), reduced overall survival rate (OS) (hazard ratio (HR) = 2.33, 95%CI: 1.22-4.50, P = .01), and recurrence-free survival (RFS) (HR = 2.61, 95%CI: 1.46-4.65, P = .001) compared with low lncRNA-ATB expression in DSCs. CONCLUSIONS: High expression of lncRNA-ATB was significantly correlated with poor prognosis for most DSCs. The expression level of lncRNA-ATB could be a promising prognostic biomarker for DSC patients.


Assuntos
Biomarcadores Tumorais/metabolismo , Neoplasias do Sistema Digestório/genética , RNA Longo não Codificante/genética , Fator de Crescimento Transformador beta/genética , Idoso , Estudos de Casos e Controles , Neoplasias do Sistema Digestório/epidemiologia , Neoplasias do Sistema Digestório/mortalidade , Neoplasias do Sistema Digestório/patologia , Feminino , Humanos , Metástase Linfática/genética , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Taxa de Sobrevida
2.
Am Surg ; 86(3): 228-231, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32223802

RESUMO

Estimated blood loss (EBL) is an increasingly important factor used to predict outcomes, such as morbidity and mortality, length of stay, and readmissions, after major abdominal operations. However, blood loss is difficult to estimate, with frequent under- and overestimations, consequences of which can be potentially dangerous for individual patients and confounding for scoring systems relying on EBL. We hypothesized that EBL is often inaccurate and have prospectively enrolled consecutive patients undergoing major elective intra-abdominal operations. Actual hemoglobin levels were measured and used to calculate the measured blood loss (MBL), which was compared with the EBL, as estimated both by surgeons (sEBL) and anesthesiologists (aEBL). Of 23 eligible cases at interim analysis, pancreaticoduodenectomy (n = 8) was the most common, followed by colectomy (n = 3), hepatectomy (n = 3) and gastrectomy (n = 2), biliary excision and reconstruction (n = 2), combined gastrectomy + colectomy (n = 1), radical nephrectomy (n = 1), open cholecystectomy (n = 1), pancreatic debridement (n = 1), and exploratory laparotomy (n = 1). aEBL overestimated MBL by 192 mL (143%) on average. The aEBL was significantly greater than the MBL (P = 0.004), whereas the sEBL was significantly less than the MBL (P = 0.009). In conclusion, surgeons significantly underestimate and anesthesiologists significantly overestimate EBL. This finding impacts not only immediate patient care but also the interpretation of scoring systems relying on EBL.


Assuntos
Perda Sanguínea Cirúrgica/fisiopatologia , Causas de Morte , Neoplasias do Sistema Digestório/cirurgia , Procedimentos Cirúrgicos Eletivos/métodos , Melhoria de Qualidade , Cavidade Abdominal/cirurgia , Adulto , Idoso , Perda Sanguínea Cirúrgica/mortalidade , Estudos de Coortes , Neoplasias do Sistema Digestório/mortalidade , Neoplasias do Sistema Digestório/patologia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de Risco , Análise de Sobrevida
3.
Cancer Sci ; 110(12): 3639-3649, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31605436

RESUMO

The digestive system cancers are aggressive cancers with the highest mortality worldwide. In this study, we undertook a systematic investigation of the tumor immune microenvironment to identify diagnostic and prognostic biomarkers. The fraction of 22 immune cell types of patients were estimated using CIBERSORT. The least absolute shrinkage and selection operator (LASSO) analysis was carried out to identify important immune predictors. By comparing immune cell compositions in 801 tumor samples and 46 normal samples, we constructed the diagnostic immune score (DIS), showing high specificity and sensitivity in the training (area under the receiver operating characteristic curve [AUC] = 0.929), validation (AUC = 0.935), and different cancer type cohorts (AUC > 0.70 for all). We also established the prognostic immune score (PIS), which was an effective prognostic factor for relapse-free survival in training, validation, and entire cohorts (P < .05). In addition, PIS provided a higher net benefit than TNM stage. A composite nomogram was built based on PIS and patients' clinical information with well-fitted calibration curves (c-index = 0.84). We further used other cohorts from Gene Expression Omnibus databases and obtained similar results, confirming the reliability and validity of the DIS and PIS. In addition, the unsupervised clustering analysis using immune cell proportions revealed 6 immune subtypes, suggesting that the immune types defined as having relatively high levels of M0 or/and M1 macrophages were the high-risk subtypes of relapse. In conclusion, this study comprehensively analyzed the tumor immune microenvironment and identified DIS and PIS for digestive system cancers.


Assuntos
Neoplasias do Sistema Digestório/imunologia , Idoso , Biomarcadores Tumorais/análise , Neoplasias do Sistema Digestório/diagnóstico , Neoplasias do Sistema Digestório/mortalidade , Feminino , Humanos , Macrófagos/imunologia , Masculino , Pessoa de Meia-Idade , Nomogramas , Prognóstico , Modelos de Riscos Proporcionais , Microambiente Tumoral
4.
Curr Med Sci ; 39(5): 694-701, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31612385

RESUMO

Long noncoding RNA (lncRNA) urothelial carcinoma associated 1 (UCA1) has been reported to be highly expressed in many kinds of cancers. This meta-analysis summarized its potential prognostic value in digestive system malignancies. A meta-analysis was performed through a comprehensive search in PubMed, EMBASE, the Cochrane Library, Web of Science and Chinese National Knowledge Infrastructure (CNKI) for suitable articles on the prognostic impact of UCA1 in digestive system malignancies from inception to June 27, 2019. Pooled hazard ratios (HRs) with 95% confidence interval (95%CI) were calculated to summarize the effect. Sixteen studies were included in the study, with a total of 1504 patients. A significant association was observed between UCA1 abundance and poor overall survival (OS), and shorter disease-free survival (DFS) for patients with digestive system malignancies, with pooled HR of 2.07 (95%CI: 1.74-2.47), and of 2.50 (95%CI: 1.62-3.86). Subgroup analysis and sensitivity analysis suggested the reliability of our findings. It is suggested that UCA1 abundance may serve as a reliable predictive factor for poor prognosis in patients with digestive system malignancies.


Assuntos
Biomarcadores Tumorais/genética , Neoplasias do Sistema Digestório/diagnóstico , Regulação Neoplásica da Expressão Gênica , RNA Longo não Codificante/genética , Biomarcadores Tumorais/metabolismo , Neoplasias do Sistema Digestório/genética , Neoplasias do Sistema Digestório/mortalidade , Neoplasias do Sistema Digestório/patologia , Intervalo Livre de Doença , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prognóstico , Modelos de Riscos Proporcionais , RNA Longo não Codificante/metabolismo
5.
Anticancer Res ; 39(10): 5551-5557, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31570449

RESUMO

BACKGROUND/AIM: Digestive system cancers are the leading cause of cancer mortality and have poor survival particularly in men. The study aimed to assess the association between pre-diagnosis cardiorespiratory fitness (CRF) and cancer mortality in a pilot sample of men who developed digestive system cancers. PATIENTS AND METHODS: Pre-diagnosis CRF (treadmill exercise test) was assessed in 342 men (68.9±21.8 years) who developed digestive system cancers during 6.7±5 years from baseline evaluation. Cox multivariable hazard models were analyzed for total cancer mortality. RESULTS: During 7.2±5 years follow-up from baseline, 120 participants died from cancer. Compared to low CRF, moderate and high CRF levels were associated with 57% [0.43, 95%CI=0.24-0.74] and 73% [0.27, 95%CI=0.12-0.59] reduced risks for cancer mortality, respectively (p trend=0.002). Survival time from baseline was longer among those with moderate [13.5 (range=12.1-14.9) years] and high [16.1 (range=14.0-18.2) years] compared to low CRF [7.9 (range=5.7-10.1) years]. CONCLUSION: Higher pre-diagnosis CRF is independently associated with lower risk of cancer mortality and longer survival in men who later developed digestive system cancers.


Assuntos
Aptidão Cardiorrespiratória/fisiologia , Neoplasias do Sistema Digestório/mortalidade , Neoplasias do Sistema Digestório/fisiopatologia , Idoso , Índice de Massa Corporal , Teste de Esforço/métodos , Humanos , Masculino , Projetos Piloto , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco
6.
Ann Surg ; 270(5): 775-782, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31498184

RESUMO

OBJECTIVES: We aimed to examine whether the improved outcome of a digestive cancer procedure in high-volume hospitals is specific or correlates with that of other digestive cancer procedures, and determine if the discriminant cut-off of hospital volume may influence postoperative mortality (POM) regardless of the procedure. BACKGROUND: Performing complex surgeries in tertiary centers is associated with improved outcome. However, the association between POM and hospital volume of nonspecific procedures is unknown. METHODS: Patients who underwent colectomy, proctectomy, esophagectomy, gastrectomy, pancreatectomy, and hepatectomy for cancer between 2012 and 2017 were identified in the French nationwide database. Chi-square automatic interaction detector was used to identify the cut-off values of the annual caseload affecting the 90-day POM. A common threshold was estimated by minimization of chi-square distance taking into account the specific mortality of each procedure. RESULTS: Overall, 225,752 patients were identified. Hospitals were categorized according to the procedure volume (colectomy: ≥80 cases/yr, proctectomy: ≥35/yr, esophagectomy: ≥41/yr, gastrectomy: ≥16/yr, pancreatectomy: ≥26/yr, and hepatectomy: ≥76/yr). The overall 90-day POM was 5.1% and varied significantly with volume. The benefits of high volume were transferable across procedures. High-volume hospitals for colorectal cancer surgery significantly influenced the risk of death after hepatectomy (P < 0.001) and pancreatectomy (P < 0.001). The common threshold for all procedures that influenced POM was 199 cases/yr (odds ratio 1.29, P < 0.001). CONCLUSION: In digestive cancer surgery, the volume-POM relationship of one procedure was associated with the volume of other procedures. Thus, tertiary hospitals should be defined according to the common threshold of different procedures.


Assuntos
Causas de Morte , Neoplasias do Sistema Digestório/mortalidade , Neoplasias do Sistema Digestório/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Complicações Pós-Operatórias/mortalidade , Adulto , Fatores Etários , Idoso , Estudos de Coortes , Neoplasias do Sistema Digestório/patologia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Mortalidade Hospitalar/tendências , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Análise de Sobrevida , Estados Unidos
7.
Surgery ; 166(2): 177-183, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31160060

RESUMO

BACKGROUND: Certain behavioral traits and inadequate social support are known risk factors for complications after cancer surgery. Despite their importance, it is unclear whether conventional patient preoperative evaluation captures them. This study was conducted to assess concordance between documentation and patient survey of selected risk factors and to determine whether failure to document affected postoperative outcomes. METHODS: Adult patients at a tertiary academic medical center were surveyed before abdominal cancer surgery to assess 6 psychosocial risk factors. Risk factors were also assessed by retrospective chart review and compared with survey results through concordance measures. Thirty-day postoperative complications were abstracted by chart review. Rates of major complications for those with and without clinically missed risk factors were compared. RESULTS: Comparisons between chart review and screening survey revealed poor-to-moderate positive agreement (0%-47%) for 5 risk factors and strong negative agreement (82%-99%) among all risk factors. Kappa analysis demonstrated poor-to-fair agreement among 5 risk factors (κ = 0.112-0.423). The overall complication rate was 36%. The complication rate for patients with at least 1 clinically missed risk factor was 49% vs 24% in those without (P = .021), with a similar effect replicated for each individual risk factor. CONCLUSION: This study shows a high level of discordance between formal screening and routine clinician documentation in a preoperative setting for psychosocial risk factors. There is a significant association between missing these risk factors and worse postoperative outcomes. Future work should examine whether structured screening of psychosocial risk factors may improve preoperative risk stratification through proactive interventions.


Assuntos
Neoplasias do Sistema Digestório/cirurgia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Complicações Pós-Operatórias/mortalidade , Cuidados Pré-Operatórios/métodos , Psicologia , Centros Médicos Acadêmicos , Idoso , Estudos de Coortes , Bases de Dados Factuais , Neoplasias do Sistema Digestório/diagnóstico , Neoplasias do Sistema Digestório/mortalidade , Neoplasias do Sistema Digestório/psicologia , Intervalo Livre de Doença , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Complicações Pós-Operatórias/psicologia , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida
8.
Orthop Surg ; 11(3): 414-421, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30985091

RESUMO

OBJECTIVE: To investigate whether visceral metastases have a significant impact on survival in patients with metastasis-related spinal cord compression (MSCC), and to determine the difference in prognosis between patients with and without visceral metastases. METHODS: Three institutional databases were searched to identify all patients who had undergone spinal surgery for spinal metastases between March 2002 and June 2010. Data on patient characteristics including pre- and post-operative medical conditions, were collected from medical records or by telephone follow-up. Survival data were obtained either from medical records or by searching a governmental cancer registry. RESULTS: The mean age of study patients was 59.6 ± 10.5 years (range, 18-84 years), of whom 102 were male and 67 female. The median and mean postoperative survival times were 7.0 ± 0.5 (95% CI 6.0-8.0) months and 12.6 ± 1.2 (95% CI 10.1-15.0) months, respectively, in all patients, being 5.0 ± 0.5 (95% CI 4.0-6.0) months and 10.8 ± 2.4 (95% CI 6.1-15.5) months, respectively, for patients with visceral metastases and 7.0 ± 0.8 (95% CI 5.4-8.6) months and 13.0 ± 1.4 (95%CI 10.3-15.6) months, respectively, for patients without visceral metastases (P = 0.87). These survival times did not differ significantly between groups. Multivariate Cox proportional hazard regressions showed that visceral metastases had no statistically significant association with survival (P = 0.277), whereas rate of growth of primary tumor (P = 0.003), preoperative Karnofsky performance status (KPS) (P < 0.001), change in KPS (P < 0.001), and Frankel grade (P = 0.091) were independent prognostic factors in the whole cohort (P = 0.005). Changes in KPS (P = 0.001) and major complications (P = 0.003) were significantly associated with survival in patients with visceral metastases, whereas rate of growth of primary tumor (P = 0.016), change in KPS (P = 0.001), and preoperative KPS (P < 0.001) were significantly associated with survival in patients without visceral metastases. CONCLUSIONS: Visceral metastases do not appear to predict the prognosis of patients with MSCC; thus, more aggressive surgery should be considered in patients with MSCC who have visceral metastases. Additionally, prognostic factors differ according to visceral metastases status in these patients.


Assuntos
Neoplasias do Sistema Digestório/mortalidade , Neoplasias do Sistema Digestório/secundário , Compressão da Medula Espinal/etiologia , Neoplasias da Coluna Vertebral/mortalidade , Neoplasias da Coluna Vertebral/secundário , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Compressão da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/cirurgia , Análise de Sobrevida , Adulto Jovem
9.
BMC Cancer ; 19(1): 177, 2019 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-30808336

RESUMO

BACKGROUND: Previous studies have highlighted cytokine growth differentiation factor 15 (GDF-15) as a potential biomarker for digestive system tumors (DST). This study sought to assess the feasibility of using GDF-15 as a diagnostic and prognostic biomarker in DST. METHODS: Eligible studies from multiple online databases were reviewed. Meta-analyses of diagnostic parameters were carried out using standard statistical methods. Study-specific hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to estimate the strength of the relationship between GDF-15 levels and clinical prognosis. RESULTS: We identified 17 eligible studies comprising 3966 patients with DST. The sensitivity, specificity, and area under the curve (AUC) for the discriminative performance of GDF-15 as a diagnostic biomarker were 0.74 (95% CI: 0.68-0.80), 0.83 (95% CI: 0.75-0.89), and 0.84, respectively. Moreover, increased GDF-15 expression levels were markedly associated with unfavorable overall survival (OS) in patients with DST (HR = 2.34, 95% CI: 2.03-2.70, P < 0.001; I2 = 0.0%) and colorectal cancer (CRC) (HR = 2.27, 95% CI: 1.96-2.63, P < 0.001; I2 = 0.0%). Stratification by cancer type, test matrix, ethnicity, and cut-off setting also illustrated the robustness of the diagnostic value of GDF-15 in DST. CONCLUSION: Collectively, our data suggest that GDF-15 expression level may have value as a diagnostic and prognostic biomarker, independent of other, traditional biomarkers.


Assuntos
Biomarcadores Tumorais/metabolismo , Neoplasias Colorretais/diagnóstico , Neoplasias do Sistema Digestório/diagnóstico , Fator 15 de Diferenciação de Crescimento/metabolismo , Neoplasias Colorretais/mortalidade , Neoplasias do Sistema Digestório/mortalidade , Humanos , Prognóstico , Modelos de Riscos Proporcionais , Análise de Sobrevida
10.
Pathol Res Pract ; 215(3): 414-426, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30455130

RESUMO

Malignant tumors of the digestive tract include esophageal, gastric, and colorectal carcinomas, which all have high global mortality rates. A clinical role for small nuclear RNA (snRNA), a type of small non-coding RNA, has not yet been documented for digestive tract pan-adenocarcinomas. Therefore, the aim of the study was to identify differentially expressed snRNAs and to explore their prognostic implications in pan-adenocarcinomas from the esophagus, stomach, colon, and rectum. The pan-carcinoma RNA-sequencing data of four types of digestive tract cancers with 1, 102 cases obtained from The Cancer Genome Atlas (TCGA) project were analyzed and the differentially expressed snRNAs were evaluated using the edgeR package. The prognostic value of each of the selected snRNAs was determined by univariate and multivariate Cox regression analyses. All the digestive tract pan-adenocarcinomas showed differential expression of three snRNAs: the up-regulated RNU1-106 P and RNU6-850 P and the down-regulated RNU6-529 P. Interestingly, RNU6-101 P appeared to be a risk factor for esophageal adenocarcinoma (ESAD) and RNVU1-4 was potentially a protective factor for stomach adenocarcinoma (STAD) survival. This consistent finding of differential expression of all three snRNAs in all four types of digestive system cancers suggests potential roles for these snRNAs in the tumorigenesis of digestive system cancers. RNU6-101 P could play a pivotal role in the progression of ESAD and RNVU1-4 could perform a protective role in STAD. However, since the current findings were based on RNA-sequencing data mining, more studies are needed for verification.


Assuntos
Adenocarcinoma/genética , Biomarcadores Tumorais/genética , Neoplasias do Sistema Digestório/genética , RNA Nuclear Pequeno/análise , Adenocarcinoma/mortalidade , Neoplasias do Sistema Digestório/mortalidade , Humanos , Estimativa de Kaplan-Meier , Prognóstico , Modelos de Riscos Proporcionais , Análise de Sequência de RNA
11.
J Cell Physiol ; 234(7): 10926-10933, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30569489

RESUMO

Homeobox transcript antisense intergenic RNA (HOTAIR), one of the well-known long noncoding RNAs (lncRNAs), plays an important role in initiation and development of various tumors. Elevated level of HOTAIR is associated with metastatic behavior of primary tumor and poor outcome in several cancers. Therefore, we conducted a meta-analysis to clearly measure the prognostic impact of HOTAIR in patients with digestive system carcinomas. Fourteen studies including 2,666 patients with five different type of digestive system cancers were selected to be entered in meta-analysis. Finding demonstrated that HOTAIR overexpression could predict unfavorable outcome in digestive system carcinomas (hazard ratio [HR] = 2.4, 95% confidence interval [CI]: 2.0-2.9; p < 0.001; fixed-effect model). In stratified analysis, increased level of HOTAIR predicted poor overall survival in gastric cancer (HR = 2.1, 95% CI: 1.6-2.9; p < 0.001), colorectal cancer (HR = 4.1, 95% CI: 1.6-10.2; p = 0.002), esophageal squamous cell carcinoma (HR = 2.3, 95% CI: 1.7-3.0; p < 0.001), and hepatocellular carcinoma (HR = 3.4, 95% CI: 1.9-6.1; p < 0.001). Our meta-analysis results clearly support the prognostic value of HOTAIR to predict unfavorable prognostic outcomes in diverse digestive system carcinomas.


Assuntos
Biomarcadores Tumorais/genética , Carcinoma/genética , Neoplasias do Sistema Digestório/genética , RNA Longo não Codificante/genética , Idoso , Carcinoma/mortalidade , Carcinoma/patologia , Carcinoma/terapia , Neoplasias do Sistema Digestório/mortalidade , Neoplasias do Sistema Digestório/patologia , Neoplasias do Sistema Digestório/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco
12.
Medicine (Baltimore) ; 97(41): e12455, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30313035

RESUMO

BACKGROUND: Digestive system cancers are recognized as associated with high morbidity and mortality. It is generally accepted that N-myc downstream-regulated gene 1 (NDRG1) is aberrantly overexpressed or downregulated in digestive system cancers, and its prognostic value remains controversial. Accordingly, we herein conducted a meta-analysis to explore whether NDRG1 expression is correlated with overall survival (OS) and clinicopathological characteristics of patients with digestive system cancers. METHODS: We systematically searched PubMed, EMBASE, and Web of Science for eligible studies up to June 6, 2017. In all, 19 publications with 21 studies, were included. RESULTS: The pooled results showed that low NDRG1 expression was significantly associated with worse OS in colorectal cancer (pooled HR = 1.67, 95% CI: 1.22-2.28, P < .001) and pancreatic cancer (pooled HR = 1.87, 95% CI: 1-3.5, P < .0001). Moreover, the relationships between low NDRG1 expression and higher OS ratio of patients with liver cancer (pooled HR = 0.44, 95% CI: 0.32-0.62, P = .009) and gallbladder cancer (pooled HR = 0.56, 95% CI: 0.23-1.38, P = .01) were observed. Nevertheless, no significant association was observed between low NDRG1 expression and OS in gastric cancer (pooled HR = 0.81, 95% CI: 0.45-1.43, P = .46) or esophageal cancer (pooled HR = 0.76, 95% CI: 0.26-2.24, P = .62). CONCLUSION: The prognostic significance of NDRG1 expression varies according to cancer type in patients with DSCs. Considering that several limitations existed in this meta-analysis, more studies are required to further assess the prognostic value of NDRG1 expression in patients with DSCs and relevant mechanisms.


Assuntos
Biomarcadores Tumorais/metabolismo , Carcinoma/diagnóstico , Carcinoma/mortalidade , Proteínas de Ciclo Celular/metabolismo , Neoplasias do Sistema Digestório/diagnóstico , Neoplasias do Sistema Digestório/mortalidade , Peptídeos e Proteínas de Sinalização Intracelular/metabolismo , Carcinoma/metabolismo , Neoplasias do Sistema Digestório/metabolismo , Regulação para Baixo , Humanos , Prognóstico , Análise de Sobrevida , Regulação para Cima
13.
Psychooncology ; 27(9): 2274-2280, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29956393

RESUMO

OBJECTIVE: Previous studies have suggested that suicide rates are elevated among cancer patients relative to the general population. In this analysis, we comprehensively evaluated characteristics associated with higher suicide rates among patients with cancers of the digestive system. METHODS: Using the United States Surveillance, Epidemiology, and End Results database, we identified all patients diagnosed with digestive system cancers during 2000 to 2014. Patients were classified as having died of suicide if their cause of death in Surveillance, Epidemiology, and End Results was listed as "suicide and self-inflicted injury." Suicide rates were compared to age-, sex-, and race-adjusted rates in the general population. RESULTS: A total of 881 suicides were identified among 856 293 patients diagnosed with digestive system cancers. The suicide rate in this population was 32.8 per 100 000 person-years and was nearly twice that in the general population (standardized mortality ratio [SMR] = 1.91; 95% CI, 1.79-2.04). Suicide rates were significantly elevated for all cancer sites but were highest for esophageal (SMR = 5.03), pancreatic (SMR = 5.28), stomach (SMR = 2.84), and liver (SMR = 2.14) cancers. Standardized mortality ratios for suicide were highest within the first 5 years of diagnosis and increased with age at diagnosis for all sites except colon and stomach. CONCLUSIONS: Patients with cancers of the digestive system have a higher incidence of suicide than the general population. Suicide rates among esophageal and pancreatic cancer patients are more than 5 times general population rates. The involvement of psychiatrists and other mental health professionals may be a critical component of cancer care for these high-risk patient subgroups.


Assuntos
Neoplasias do Sistema Digestório/mortalidade , Suicídio/estatística & dados numéricos , Adulto , Distribuição por Idade , Idoso , Causas de Morte , Neoplasias do Sistema Digestório/psicologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Programa de SEER , Estados Unidos/epidemiologia
14.
Biosci Rep ; 38(3)2018 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-29752340

RESUMO

Increasing studies are indicating that long non-coding RNA (lncRNA) X-inactive specific transcript (XIST) is associated with the prognosis of cancer patients. However, the results have been disputed. Therefore, we aimed to further explore the prognostic value and clinical significance of XIST in various types of cancers. Then, we focussed our research on the comparison of the predictive value of XIST between digestive system tumors and non-digestive system tumors. We performed a systematic search by looking up PubMed, Embase, Cochrane Library, Web of Science, and Medline (up to 3 January 2018). Fifteen studies which matched our inclusion criteria with a total of 920 patients for overall survival and 867 patients for clinicopathological characteristics were included in this meta-analysis. Pooled hazard ratios (HR) and odds ratios (ORs) with their corresponding 95% confidence intervals (95% CIs) were calculated to summarize the effects. Our results suggested that high expression levels of XIST were associated with unfavorable overall survival in cancer patients (pooled HR = 1.81, 95% CI: 1.45-2.26). Additionally, we found that XIST was more valuable in digestive system tumors (pooled HR = 2.24, 95% CI: 1.73-2.92) than in non-digestive system tumors (pooled HR = 1.22, 95% CI: 0.60-2.45). Furthermore, elevated expression levels of XIST were connected with distant metastasis and tumor stage. XIST was correlated with poor prognosis, which suggested that XIST might serve as a novel predictive biomarker for cancer patients, especially for patients of digestive system tumors.


Assuntos
Biomarcadores Tumorais/genética , Neoplasias do Sistema Digestório/genética , Regulação Neoplásica da Expressão Gênica , RNA Longo não Codificante/genética , Biomarcadores Tumorais/metabolismo , Neoplasias do Sistema Digestório/diagnóstico , Neoplasias do Sistema Digestório/metabolismo , Neoplasias do Sistema Digestório/mortalidade , Humanos , Metástase Linfática , Estadiamento de Neoplasias , Razão de Chances , Prognóstico , RNA Longo não Codificante/metabolismo , Análise de Sobrevida
15.
World J Gastroenterol ; 24(17): 1881-1887, 2018 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-29740203

RESUMO

Olfactomedin-4 (OLFM4, GW112, hGC-1) is a glycoprotein belonging to the olfactomedin family. The expression of OLFM4 is strong in the small intestine, colon and prostate, and moderate in the stomach and bone marrow. Previous studies have revealed that OLFM4 is closely associated with many digestive diseases. Up-regulation of OLFM4 has been detected in the Helicobacter pylori (H. pylori)-infected gastric mucosa, inflammatory bowel disease tissue and gastrointestinal malignancies, including gastric cancer, colorectal cancer, pancreatic cancer and gallbladder cancer. Down-regulation of OLFM4 has also been detected in some cases, such as in poorly differentiated, advanced-stage and metastatic tumors. Studies using OLFM4-deficient mouse models have revealed that OLFM4 acts as a negative regulator of H. pylori-specific immune responses and plays an important role in mucosal defense in inflammatory bowel disease. Patients with OLFM4-positive gastric cancer or colorectal cancer have a better survival rate than OLFM4-negative patients. However, the prognosis is worse in pancreatic cancer patients with high levels of expression of OLFM4. The NF-κB, Notch and Wnt signaling pathways are involved in the regulation of OLFM4 expression in digestive diseases, and its role in pathogenesis is associated with anti-inflammation, apoptosis, cell adhesion and proliferation. OLFM4 may serve as a potential specific diagnostic marker and a therapeutic target in digestive diseases. Further studies are required to explore the clinical value of OLFM4.


Assuntos
Neoplasias do Sistema Digestório/patologia , Gastroenteropatias/patologia , Trato Gastrointestinal/patologia , Fator Estimulador de Colônias de Granulócitos/metabolismo , Infecções por Helicobacter/patologia , Animais , Biomarcadores/metabolismo , Neoplasias do Sistema Digestório/tratamento farmacológico , Neoplasias do Sistema Digestório/etiologia , Neoplasias do Sistema Digestório/mortalidade , Regulação para Baixo , Gastroenteropatias/tratamento farmacológico , Gastroenteropatias/etiologia , Gastroenteropatias/mortalidade , Trato Gastrointestinal/imunologia , Trato Gastrointestinal/microbiologia , Glicoproteínas/genética , Glicoproteínas/imunologia , Glicoproteínas/metabolismo , Fator Estimulador de Colônias de Granulócitos/genética , Fator Estimulador de Colônias de Granulócitos/imunologia , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/etiologia , Helicobacter pylori/imunologia , Humanos , Camundongos , Terapia de Alvo Molecular/métodos , Prognóstico , Transdução de Sinais , Taxa de Sobrevida , Regulação para Cima
16.
Hepatobiliary Pancreat Dis Int ; 17(2): 163-168, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29567046

RESUMO

BACKGROUND: Postoperative pancreatic fistula (POPF) is a severe complication of the pancreaticoduodenectomy (PD). Recently, we introduced a method of suspender pancreaticojejunostomy (PJ) to the PD. In this study, we retrospectively analyzed various risk factors for complications after PD. We also introduced and assessed the suspender PJ to demonstrate its advantages. METHODS: Data from 335 patients with various periampullary lesions, who underwent the Whipple procedure (classic Whipple procedure or pylorus-preserving) PD by either traditional end-to-side invagination PJ or suspender PJ, were analyzed. The correlation between either perioperative or postoperative complications and corresponding PD approaches was evaluated by univariate analysis. RESULTS: A total of 147 patients received the traditional end-to-side invagination PJ, and 188 patients were given the suspender PJ. Overall, 51.9% patients had various complications after PD. The mortality rate was 2.4%. The POPF incidence in patients who received the suspender PJ was 5.3%, which was significantly lower than those who received the traditional end-to-side invagination PJ (18.4%) (P < 0.001). Univariate analysis showed that PJ approach and the pancreas texture were significantly associated with the POPF incidence rate (P < 0.01). POPF was a risk factor for both postoperative abdominal cavity infection (OR = 8.34, 95% CI: 3.99-17.42, P < 0.001) and abdominal cavity hemorrhage (OR = 4.86, 95% CI: 1.92-12.33, P = 0.001). CONCLUSIONS: Our study showed that the impact of the pancreas texture was a major risk factor for pancreatic leakage after a PD. The suspender PJ can be easily accomplished and widely applied and can effectively decrease the impact of the pancreas texture on pancreatic fistula after a PD and leads to a lower POPF incidence rate.


Assuntos
Neoplasias do Sistema Digestório/cirurgia , Fístula Pancreática/cirurgia , Pancreaticoduodenectomia/efeitos adversos , Pancreaticojejunostomia/métodos , Idoso , Distribuição de Qui-Quadrado , China/epidemiologia , Neoplasias do Sistema Digestório/mortalidade , Neoplasias do Sistema Digestório/patologia , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Fístula Pancreática/diagnóstico por imagem , Fístula Pancreática/etiologia , Fístula Pancreática/mortalidade , Pancreaticoduodenectomia/mortalidade , Pancreaticojejunostomia/efeitos adversos , Pancreaticojejunostomia/mortalidade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
17.
HPB (Oxford) ; 20(8): 759-767, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29571615

RESUMO

BACKGROUND: In the mandatory nationwide Dutch Pancreatic Cancer Audit, rates of major complications and Failure to Rescue (FTR) after pancreatoduodenectomy between low- and high-mortality hospitals are compared, and independent predictors for FTR investigated. METHODS: Patients undergoing pancreatoduodenectomy in 2014 and 2015 in The Netherlands were included. Hospitals were divided into quartiles based on mortality rates. The rate of major complications (Clavien-Dindo ≥3) and death after a major complication (FTR) were compared between these quartiles. Independent predictors for FTR were identified by multivariable logistic regression analysis. RESULTS: Out of 1.342 patients, 391 (29%) developed a major complication and in-hospital mortality was 4.2%. FTR occurred in 56 (14.3%) patients. Mortality was 0.9% in the first hospital quartile (4 hospitals, 327 patients) and 8.1% in the fourth quartile (5 hospitals, 310 patients). The rate of major complications increased by 40% (25.7% vs 35.2%) between the first and fourth hospital quartile, whereas the FTR rate increased by 560% (3.6% vs 22.9%). Independent predictors of FTR were male sex (OR = 2.1, 95%CI 1.2-3.9), age >75 years (OR = 4.3, 1.8-10.2), BMI ≥30 (OR = 2.9, 1.3-6.6), histopathological diagnosis of periampullary cancer (OR = 2.0, 1.1-3.7), and hospital volume <30 (OR = 3.9, 1.6-9.6). CONCLUSIONS: Variations in mortality between hospitals after pancreatoduodenectomy were explained mainly by differences in FTR, rather than the incidence of major complications.


Assuntos
Neoplasias do Sistema Digestório/cirurgia , Falha da Terapia de Resgate/tendências , Disparidades em Assistência à Saúde/tendências , Mortalidade Hospitalar/tendências , Avaliação de Processos e Resultados em Cuidados de Saúde/tendências , Pancreaticoduodenectomia/mortalidade , Complicações Pós-Operatórias/mortalidade , Indicadores de Qualidade em Assistência à Saúde/tendências , Idoso , Neoplasias do Sistema Digestório/mortalidade , Neoplasias do Sistema Digestório/patologia , Feminino , Humanos , Masculino , Auditoria Médica/tendências , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Países Baixos/epidemiologia , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/tendências , Medição de Risco , Fatores de Risco , Fatores de Tempo
18.
Technol Cancer Res Treat ; 17: 1533034618756783, 2018 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29444619

RESUMO

HOX transcript antisense intergenic RNA has been reported to serve as an important prognostic biomarker in several types of cancers. However, the clinical value of HOX transcript antisense intergenic RNA in digestive cancers remains unclear. Therefore, we tried to investigate the clinical role of expression of HOX transcript antisense intergenic RNA as a prognostic indicator in digestive cancers by a meta-analysis. Literature collection was performed by searching the PubMed, Embase, Web of Science, and Cochrane Library databases (up to October 7, 2017). A quantitative meta-analysis was conducted to assess the eligible articles on the prognostic value of HOX transcript antisense intergenic RNA in digestive cancers. The pooled hazard ratios or odds ratios with 95% confidence intervals were used to evaluate the association between expression of HOX transcript antisense intergenic RNA and clinical outcomes. A total of 1844 patients from 22 studies were included in this meta-analysis. The results found a significant association between expression of HOX transcript antisense intergenic RNA and poor overall survival in digestive cancers (pooled hazard ratio = 2.19, 95% confidence interval, 1.86-2.57, P < .001). Furthermore, subgroup analysis showed that tumor type, region, Newcastle-Ottawa scale, and sample size did not alter the predictive value of HOX transcript antisense intergenic RNA as an independent factor for patients' survival. In addition, we also revealed that the clinicopathological characteristics such as differentiation, lymph node metastasis, tumor node metastasis (TNM) stage, and distant metastasis were positively related to expression of HOX transcript antisense intergenic RNA digestive cancers. In conclusion, our results suggested high expression of HOX transcript antisense intergenic RNA was correlated with poor clinical outcomes and may serve as a novel prognostic biomarker for patients with digestive cancers.


Assuntos
Biomarcadores Tumorais , Neoplasias do Sistema Digestório/genética , RNA Longo não Codificante/genética , Neoplasias do Sistema Digestório/diagnóstico , Neoplasias do Sistema Digestório/mortalidade , Regulação Neoplásica da Expressão Gênica , Estudos de Associação Genética , Predisposição Genética para Doença , Humanos , Gradação de Tumores , Estadiamento de Neoplasias , Razão de Chances , Prognóstico , Modelos de Riscos Proporcionais , Viés de Publicação , Curva ROC , Análise de Sobrevida
19.
World J Gastroenterol ; 24(1): 69-75, 2018 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-29358883

RESUMO

AIM: To study the safety of insertion of metallic stents in elderly patients with unresectable distal malignant biliary obstruction. METHODS: Of 272 patients with unresectable distal malignant biliary obstruction, 184 patients under the age of 80 were classified into Group A, and 88 subjects aged 80 years or more were classified into Group B. The safety of metallic stent insertion, metal stent patency period, and the obstruction rate were examined in each group. RESULTS: In Group B, patients had a significantly worse performance status, high blood pressure, heart disease, cerebrovascular disease, and dementia; besides the rate of patients orally administered antiplatelet drugs or anticoagulants tended to be higher (P < 0.05). Metallic stents were successfully inserted in all patients. The median patency period was 265.000 ± 26.779 (1-965) d; 252.000 ± 35.998 (1-618) d in Group A and 269.000 ± 47.885 (1-965) d in Group B, with no significant difference between the two groups. Metallic stent obstruction occurred in 82 of the 272 (30.15%) patients; in 53/184 (28.80%) patients in Group A and in 29/88 (32.95%) of those in Group B, showing no significant difference between the two groups. Procedural accidents due to metal stent insertion occurred in 24/272 (8.8%) patients; in 17/184 (9.2%) of patients in Group A and in 7/88 (8.0%) of those in Group B, with no significant difference between the two groups, either. CONCLUSION: These results suggested that metallic stents can be safely inserted to treat unresectable distal malignant biliary obstruction even in elderly patients aged 80 years or more.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Colestase/terapia , Neoplasias do Sistema Digestório/complicações , Drenagem/instrumentação , Metais , Stents , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/mortalidade , Colestase/diagnóstico por imagem , Colestase/etiologia , Colestase/mortalidade , Neoplasias do Sistema Digestório/mortalidade , Drenagem/efeitos adversos , Drenagem/mortalidade , Feminino , Humanos , Japão , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Desenho de Prótese , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
20.
J Ayub Med Coll Abbottabad ; 30(4): 571-575, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30632340

RESUMO

BACKGROUND: Obstructive jaundice due to malignancies of the biliary tree, gall bladder and pancreas account for a significant number of patients managed by tertiary centres. Management options are curative or palliative, depending on disease stage. This study was performed to see the effectiveness of treatment modalities for these patients and eventual outcome. METHODS: This cross-sectional analytical study was conducted at the Department of Gastroenterology and Hepatology, Shaikh Zayed Hospital Lahore, from January 2015 to June 2016. All adult patients aged 18 and above of either sex presenting with obstructive jaundice secondary to malignant disease originating from the gallbladder, biliary-tree or pancreas were included in the study. The disease was staged after admission. The patients then underwent endoscopic, surgical or percutaneous drainage and were followed up for a period of one year. RESULTS: Two hundred & sixty-two patients presenting with jaundice due to malignancy arising from the biliary tree, gall bladder or pancreas were enrolled between January 2015 and June 2016, 141 (53.8%) males and 121 (46.2%) females. Eighty (30.5%) had cholangiocarcinoma, 70 (26.7%), had gall bladder tumours, 61 (23.3%) pancreatic cancer and 51(19.5%) had ampullary tumours. 31 (11.8%) patients had disease qualifying curative surgical resection. One hundred & eighty-five (70.6%) patients underwent palliative therapy in the form of percutaneous in 86 (32.9%) and endoscopic drainage in 126 (48.1%). Twenty-eight (10.7%) patients refused all treatment. Eighteen (6.9%) patients died before undergoing any therapeutic intervention. Thirty-three (12.6%) died during hospital stay. Survival at 3, 6 and 12 months was 49.2% (129 patients), 28.2% (74 patients) and 8.4% (22 patients), respectively. These 22 included all patients who had undergone curative resection. We attributed the largest number of deaths, 197 (75.2%) patients, to metastatic/advanced disease and associated complications. CONCLUSIONS: The results showed that patients with advanced disease who were only eligible for palliative therapy, at first presentation, constituted the majority of patients. These patients require skilled endoscopy and interventional radiology teams for successful biliary drainage.


Assuntos
Neoplasias do Sistema Digestório/complicações , Neoplasias do Sistema Digestório/mortalidade , Icterícia Obstrutiva/etiologia , Estudos Transversais , Neoplasias do Sistema Digestório/cirurgia , Drenagem , Feminino , Humanos , Icterícia Obstrutiva/terapia , Masculino , Paquistão/epidemiologia , Cuidados Paliativos
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