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Long-term oncological outcomes of 3D versus 2D laparoscopic gastrectomy for gastric cancer: a randomized clinical trial. 三维与二维腹腔镜胃切除术治疗胃癌的长期肿瘤治疗效果:随机临床试验。
IF 7.4 1区 医学 Q1 Medicine Pub Date : 2024-05-01 Epub Date: 2024-02-20 DOI: 10.1007/s10120-024-01470-0
Qing Zhong, Jun-Yu Chen, Zhi-Xin Shang-Guan, Zhi-Yu Liu, Guang-Tan Lin, Dong Wu, Yi-Ming Jiang, Jia-Bin Wang, Jian-Xian Lin, Qi-Yue Chen, Ju-Li Lin, Jian-Wei Xie, Ping Li, Jun Lu, Chang-Ming Huang, Chao-Hui Zheng

Background: Laparoscopy-assisted gastrectomy (LG) is rapidly gaining popularity owing to its minimal invasiveness. Previous studies have found that compared with two-dimensional (2D)-LG, three-dimensional (3D)-LG showed better short-term outcomes. However, the long-term oncological outcomes in patients with locally resectable gastric cancer (GC) remain controversial.

Methods: In this noninferiority, open-label, randomized clinical trial, a total of 438 eligible GC participants were randomly assigned in a 1:1 ratio to either 3D-LG or 2D-LG from January 2015 to April 2016. The primary endpoint was operating time, while the secondary endpoints included 5-year overall survival (OS), disease-free survival (DFS), and recurrence pattern.

Results: Data from 401 participants were included in the per-protocol analysis, with 204 patients in the 3D group and 197 patients in the 2D group. The 5-year OS and DFS rates were comparable between the 3D and 2D groups (5-year OS: 70.6% vs. 71.1%, Log-rank P = 0.743; 5-year DFS: 68.1% vs. 69.0%, log-rank P = 0.712). No significant differences were observed between the 3D and 2D groups in the 5-year recurrence rate (28.9% vs. 28.9%, P = 0.958) or recurrence time (mean time, 22.6 vs. 20.5 months, P = 0.412). Further stratified analysis based on the type of gastrectomy, postoperative pathological staging, and preoperative BMI showed that the 5-year OS, DFS, and recurrence rates of the 3D group in each subgroup were similar to those of the 2D group (all P > 0.05).

Conclusions: For patients with locally resectable GC, 3D-LG performed by experienced surgeons in high-volume professional institutions can achieve long-term oncological outcomes comparable to those of 2D-LG.

Registration number: NCT02327481 ( http://clinicaltrials.gov ).

背景:腹腔镜辅助胃切除术(LG)因其微创性而迅速普及。以往的研究发现,与二维(2D)胃切除术相比,三维(3D)胃切除术的短期疗效更好。然而,局部可切除胃癌(GC)患者的长期肿瘤治疗效果仍存在争议:在这项非劣效性、开放标签、随机临床试验中,从2015年1月到2016年4月,共有438名符合条件的GC参与者按1:1的比例被随机分配到3D-LG或2D-LG中。主要终点是手术时间,次要终点包括5年总生存期(OS)、无病生存期(DFS)和复发模式:来自401名参与者的数据被纳入按方案分析,其中三维组204名患者,二维组197名患者。三维组和二维组的 5 年 OS 和 DFS 率相当(5 年 OS:70.6% vs. 71.1%,Log-rank P = 0.743;5 年 DFS:68.1% vs. 69.0%,Log-rank P = 0.712)。在5年复发率(28.9% vs. 28.9%,P = 0.958)或复发时间(平均时间22.6个月 vs. 20.5个月,P = 0.412)方面,3D组和2D组之间未观察到明显差异。根据胃切除术类型、术后病理分期和术前体重指数进行的进一步分层分析表明,各亚组中三维组的5年OS、DFS和复发率与二维组相似(P均>0.05):结论:对于局部可切除的 GC 患者,由经验丰富的外科医生在大样本量的专业机构进行 3D-LG 治疗,可获得与 2D-LG 相媲美的长期肿瘤治疗效果:NCT02327481 ( http://clinicaltrials.gov ).
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引用次数: 0
Patient metabolic profile defined by liver and muscle 18F-FDG PET avidity is independently associated with overall survival in gastric cancer. 根据肝脏和肌肉 18F-FDG PET 反应活性确定的患者代谢特征与胃癌患者的总生存期有独立关联。
IF 7.4 1区 医学 Q1 Medicine Pub Date : 2024-05-01 Epub Date: 2024-03-04 DOI: 10.1007/s10120-024-01485-7
Gerardo A Vitiello, Vetri Sudar Jayaprakasam, Laura H Tang, Mark A Schattner, Yelena Y Janjigian, Geoffrey Y Ku, Steven B Maron, Heiko Schoder, Steven M Larson, Mithat Gönen, Jashodeep Datta, Daniel G Coit, Murray F Brennan, Vivian E Strong

Background: PET-CT-based patient metabolic profiling is a novel concept to incorporate patient-specific metabolism into gastric cancer care.

Methods: Staging PET-CTs, demographics, and clinicopathologic variables of gastric cancer patients were obtained from a prospectively maintained institutional database. PET-CT avidity was measured in tumor, liver, spleen, four paired muscles, and two paired fat areas in each patient. The liver to rectus femoris (LRF) ratio was defined as the ratio of SUVmean of liver to the average SUVmean of the bilateral rectus femoris muscles. Kaplan-Meier and Cox-proportional hazards models were used to identify the impact of LRF ratio on OS.

Results: Two hundred and one patients with distal gastroesophageal (48%) or gastric (52%) adenocarcinoma were included. Median age was 65 years, and 146 (73%) were male. On univariate analysis, rectus femoris PET-CT avidity and LRF ratio were significantly associated with overall survival (p < 0.05). LRF ratio was significantly higher in males, early-stage cancer, patients with an ECOG 0 or 1 performance status, patients with albumin > 3.5 mg/dL, and those with moderately differentiated tumor histology. In multivariable regression, gastric cancer stage, albumin, and LRF ratio were significant independent predictors of overall survival (LRF ratio HR = 0.73 (0.56-0.96); p = 0.024). Survival curves showed that the prognostic impact of LRF was associated with metastatic gastric cancer (p = 0.009).

Conclusions: Elevated LRF ratio, a patient-specific PET-CT-based metabolic parameter, was independently associated with an improvement in OS in patients with metastatic gastric cancer. With prospective validation, LRF ratio may be a useful, host-specific metabolic parameter for prognostication in gastric cancer.

背景:基于 PET-CT 的患者代谢谱分析是将患者特异性代谢纳入胃癌治疗的新概念:基于 PET-CT 的患者代谢谱分析是将患者特异性代谢纳入胃癌治疗的一个新概念:方法:从前瞻性维护的机构数据库中获取胃癌患者的分期 PET-CT、人口统计学和临床病理学变量。对每位患者的肿瘤、肝脏、脾脏、四块成对的肌肉和两块成对的脂肪区域的 PET-CT 阳性进行了测量。肝脏与股直肌 (LRF) 的比值定义为肝脏 SUVmean 与双侧股直肌平均 SUVmean 的比值。采用Kaplan-Meier和Cox比例危险模型确定LRF比值对OS的影响:共纳入211例远端胃食管癌(48%)或胃腺癌(52%)患者。中位年龄为65岁,146人(73%)为男性。单变量分析显示,股直肌 PET-CT 阳性率和 LRF 比率与总生存率(p 3.5 mg/dL)和中度分化肿瘤组织学显著相关。在多变量回归中,胃癌分期、白蛋白和LRF比值是总生存率的重要独立预测因素(LRF比值HR = 0.73 (0.56-0.96); p = 0.024)。生存曲线显示,LRF的预后影响与转移性胃癌有关(p = 0.009):患者特异性 PET-CT 代谢参数 LRF 比值升高与转移性胃癌患者 OS 的改善有独立相关性。经过前瞻性验证,LRF比值可能是一个有用的、用于胃癌预后的宿主特异性代谢参数。
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引用次数: 0
Adjuvant treatment for locally advanced gastric cancer: an Asian perspective. 局部晚期胃癌的辅助治疗:亚洲视角。
IF 7.4 1区 医学 Q1 Medicine Pub Date : 2024-05-01 Epub Date: 2024-03-15 DOI: 10.1007/s10120-024-01484-8
Hyung-Don Kim, Min-Hee Ryu, Yoon-Koo Kang

Standard adjuvant treatment for locally advanced gastric cancer (LAGC) is regionally different. Whereas perioperative chemotherapy is the standard in Western populations, D2 gastrectomy followed by adjuvant chemotherapy has been the standard in East Asia. Recently, the pivotal phase 3 PRODIGY and RESOLVE studies have demonstrated survival benefits of adding neoadjuvant chemotherapy to surgery followed by adjuvant chemotherapy over up-front surgery followed by adjuvant chemotherapy in Asian patients. Based on these results, neoadjuvant chemotherapy is considered one of the viable options for patients with LAGC. In this review, various aspects of neoadjuvant chemotherapy will be discussed for its optimal application in Asia. Candidates for neoadjuvant chemotherapy should be carefully chosen in consideration of the inaccurate aspects of radiological clinical staging and its potential benefit over up-front surgery followed by a decision on adjuvant chemotherapy according to the pathological stage. Efforts should continuously be made to optimally apply neoadjuvant chemotherapy to patients with LAGC, considering various factors, including a more accurate radiological assessment of the tumor burden and the optimization of post-operative chemotherapy. Future neoadjuvant trials involving novel agents for Asian patients should be designed based on proven Asian regimens rather than adopting Western regimens.

局部晚期胃癌(LAGC)的标准辅助治疗因地区而异。在西方国家,围手术期化疗是标准治疗,而在东亚地区,D2胃切除术后辅助化疗一直是标准治疗。最近,PRODIGY 和 RESOLVE 两项关键性三期研究表明,在亚洲患者中,在手术后辅助化疗的基础上增加新辅助化疗比先行手术后辅助化疗更有利于患者生存。基于这些结果,新辅助化疗被认为是LAGC患者的可行方案之一。在这篇综述中,我们将讨论新辅助化疗的各个方面,以便在亚洲实现最佳应用。新辅助化疗的候选者应谨慎选择,考虑到放射学临床分期的不准确性及其与先期手术相比的潜在益处,然后根据病理分期决定是否进行辅助化疗。考虑到各种因素,包括对肿瘤负荷进行更准确的放射学评估和优化术后化疗,应继续努力优化 LAGC 患者的新辅助化疗。未来针对亚洲患者的新辅助化疗试验应基于成熟的亚洲方案,而不是采用西方方案。
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引用次数: 0
Correction: Ubiquitous mitochondrial creatine kinase promotes the progression of gastric cancer through a JNK-MAPK/JUN/HK2 axis regulated glycolysis. 更正:无处不在的线粒体肌酸激酶通过 JNK-MAPK/JUN/HK2 轴调控糖酵解促进胃癌的进展。
IF 7.4 1区 医学 Q1 Medicine Pub Date : 2024-05-01 DOI: 10.1007/s10120-024-01490-w
Yushuai Mi, Quanhui Li, Bingtian Liu, Dehai Wang, Ziping Liu, Tianshi Wang, Yuan Wang, Yifeng Zang, Yan Zhou, Yugang Wen, Yinlu Ding
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引用次数: 0
Racial disparities of gastric cancer in the USA: an overview of epidemiology, global screening guidelines, and targeted screening in a heterogeneous population. 美国胃癌的种族差异:流行病学、全球筛查指南和异质人群针对性筛查概述。
IF 7.4 1区 医学 Q1 Medicine Pub Date : 2024-05-01 Epub Date: 2024-03-04 DOI: 10.1007/s10120-024-01475-9
Jean Woo Mok, Yeong Ha Oh, Deepa Magge, Sekhar Padmanabhan

Gastric cancer is the fifth most common cancer diagnosis and fourth leading cause of cancer-related death globally. The incidence of gastric cancer in the USA shows significant racial and ethnic disparities with gastric cancer incidence in Korean Americans being over five times higher than in non-Hispanic whites. Since gastric cancer is not common in the USA, there are no current screening guidelines. In countries with higher incidences of gastric cancer, screening guidelines have been implemented for early detection and intervention and this has been associated with a reduction in mortality. Immigrants from high incidence countries develop gastric cancer at lower rates once outside of their country of origin, but continue to be at higher risk for developing gastric cancer. This risk does seem to decrease with subsequent generations. With increasing availability of endoscopy, initiating gastric cancer screening guidelines for high-risk groups can have the potential to improve survival by diagnosing and treating gastric cancer at an earlier stage. This article aims to provide context to gastric cancer epidemiology globally, review risk factors for developing gastric cancer, highlight racial and ethnic disparities in gastric cancer burden in the USA, examine current guidelines that exist in high incidence countries, and suggest future studies examining the efficacy of additional screening in high-risk populations to reduce gastric cancer mortality and disparate burden on ethnic minorities in the USA.

胃癌是全球第五大最常见的癌症诊断和第四大癌症相关死亡原因。在美国,胃癌的发病率显示出明显的种族和民族差异,韩裔美国人的胃癌发病率是非西班牙裔白人的五倍多。由于胃癌在美国并不常见,因此目前没有筛查指南。在胃癌发病率较高的国家,已经实施了筛查指南以进行早期检测和干预,这与死亡率的降低有关。来自高发病率国家的移民一旦离开原籍国,患胃癌的比例就会降低,但患胃癌的风险仍然较高。这种风险似乎随着后代的增加而降低。随着内镜检查的普及,针对高危人群启动胃癌筛查指南有可能通过早期诊断和治疗胃癌来提高生存率。本文旨在介绍全球胃癌流行病学的背景,回顾罹患胃癌的风险因素,强调美国胃癌负担中的种族和民族差异,研究高发病率国家的现行指南,并就未来研究提出建议,探讨在高危人群中开展额外筛查的有效性,以降低胃癌死亡率和美国少数民族的不平等负担。
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引用次数: 0
Clinical practice guidelines for esophagogastric junction cancer: Upper GI Oncology Summit 2023. 食管胃交界癌临床实践指南:2023 年上消化道肿瘤学峰会。
IF 7.4 1区 医学 Q1 Medicine Pub Date : 2024-05-01 Epub Date: 2024-02-22 DOI: 10.1007/s10120-023-01457-3
Yuko Kitagawa, Satoru Matsuda, Takuji Gotoda, Ken Kato, Bas Wijnhoven, Florian Lordick, Pradeep Bhandari, Hirofumi Kawakubo, Yasuhiro Kodera, Masanori Terashima, Kei Muro, Hiroya Takeuchi, Paul F Mansfield, Yukinori Kurokawa, Jimmy So, Stefan Paul Mönig, Kohei Shitara, Sun Young Rha, Yelena Janjigian, Daisuke Takahari, Ian Chau, Prateek Sharma, Jiafu Ji, Giovanni de Manzoni, Magnus Nilsson, Paulo Kassab, Wayne L Hofstetter, Elizabeth Catherine Smyth, Sylvie Lorenzen, Yuichiro Doki, Simon Law, Do-Youn Oh, Khek Yu Ho, Tomoyuki Koike, Lin Shen, Richard van Hillegersberg, Hisato Kawakami, Rui-Hua Xu, Zev Wainberg, Naohisa Yahagi, Yeong Yeh Lee, Rajvinder Singh, Min-Hee Ryu, Ryu Ishihara, Zili Xiao, Chika Kusano, Heike Irmgard Grabsch, Hiroki Hara, Ken-Ichi Mukaisho, Tomoki Makino, Mitsuro Kanda, Eisuke Booka, Sho Suzuki, Waku Hatta, Motohiko Kato, Akira Maekawa, Akihito Kawazoe, Shun Yamamoto, Izuma Nakayama, Yukiya Narita, Han-Kwang Yang, Masahiro Yoshida, Takeshi Sano
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引用次数: 0
Dietary intake of vitamin C and gastric cancer: a pooled analysis within the Stomach cancer Pooling (StoP) Project. 膳食中维生素 C 的摄入量与胃癌:胃癌汇总(StoP)项目的汇总分析。
IF 7.4 1区 医学 Q1 Medicine Pub Date : 2024-05-01 Epub Date: 2024-03-04 DOI: 10.1007/s10120-024-01476-8
Michele Sassano, Monireh Sadat Seyyedsalehi, Giulia Collatuzzo, Claudio Pelucchi, Rossella Bonzi, Monica Ferraroni, Domenico Palli, Guo-Pei Yu, Zuo-Feng Zhang, Lizbeth López-Carrillo, Nuno Lunet, Samantha Morais, David Zaridze, Dmitry Maximovich, Vicente Martín, Gemma Castano-Vinyals, Jesús Vioque, Sandra González-Palacios, Mary H Ward, Reza Malekzadeh, Mohammadreza Pakseresht, Raul Ulises Hernández-Ramirez, Malaquias López-Cervantes, Eva Negri, Federica Turati, Charles S Rabkin, Shoichiro Tsugane, Akihisa Hidaka, Areti Lagiou, Pagona Lagiou, M Constanza Camargo, Maria Paula Curado, Stefania Boccia, Carlo La Vecchia, Paolo Boffetta

Background: Previous studies suggest that dietary vitamin C is inversely associated with gastric cancer (GC), but most of them did not consider intake of fruit and vegetables. Thus, we aimed to evaluate this association within the Stomach cancer Pooling (StoP) Project, a consortium of epidemiological studies on GC.

Methods: Fourteen case-control studies were included in the analysis (5362 cases, 11,497 controls). We estimated odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for the association between dietary intake of vitamin C and GC, adjusted for relevant confounders and for intake of fruit and vegetables. The dose-response relationship was evaluated using mixed-effects logistic models with second-order fractional polynomials.

Results: Individuals in the highest quartile of dietary vitamin C intake had reduced odds of GC compared with those in the lowest quartile (OR: 0.64; 95% CI: 0.58, 0.72). Additional adjustment for fruit and vegetables intake led to an OR of 0.85 (95% CI: 0.73, 0.98). A significant inverse association was observed for noncardia GC, as well as for both intestinal and diffuse types of the disease. The results of the dose-response analysis showed decreasing ORs of GC up to 150-200 mg/day of vitamin C (OR: 0.54; 95% CI: 0.41, 0.71), whereas ORs for higher intakes were close to 1.0.

Conclusions: The findings of our pooled study suggest that vitamin C is inversely associated with GC, with a potentially beneficial effect also for intakes above the currently recommended daily intake (90 mg for men and 75 mg for women).

背景:以往的研究表明,膳食中的维生素 C 与胃癌(GC)呈反向关系,但大多数研究并未考虑水果和蔬菜的摄入量。因此,我们旨在胃癌汇集(StoP)项目(胃癌流行病学研究联盟)中评估这种相关性:分析包括 14 项病例对照研究(5362 例病例,11497 例对照)。我们估算了膳食中维生素 C 摄入量与 GC 之间关系的几率比(ORs)和相应的 95% 置信区间(CIs),并对相关混杂因素以及水果和蔬菜的摄入量进行了调整。剂量-反应关系采用二阶分数多项式混合效应逻辑模型进行评估:结果:膳食维生素 C 摄入量最高四分位数的人与最低四分位数的人相比,患 GC 的几率有所降低(OR:0.64;95% CI:0.58,0.72)。对水果和蔬菜摄入量进行额外调整后,OR 值为 0.85(95% CI:0.73,0.98)。在非心绞痛性 GC 以及肠道型和弥漫型 GC 中均观察到了明显的负相关。剂量反应分析的结果显示,维生素 C 摄入量达到 150-200 毫克/天时,GC 的 ORs 下降(OR:0.54;95% CI:0.41,0.71),而维生素 C 摄入量越高,ORs 越接近 1.0:我们的汇总研究结果表明,维生素 C 与 GC 呈反向关系,摄入量超过目前推荐的每日摄入量(男性 90 毫克,女性 75 毫克)也可能产生有益影响。
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引用次数: 0
Diagnostic performance of deep-learning-based virtual chromoendoscopy in gastric neoplasms. 基于深度学习的虚拟色内镜在胃肿瘤中的诊断性能。
IF 7.4 1区 医学 Q1 Medicine Pub Date : 2024-05-01 Epub Date: 2024-01-19 DOI: 10.1007/s10120-024-01469-7
Sho Suzuki, Yusuke Monno, Ryo Arai, Masaki Miyaoka, Yosuke Toya, Mitsuru Esaki, Takuya Wada, Waku Hatta, Ayaka Takasu, Shigeaki Nagao, Fumiaki Ishibashi, Yohei Minato, Kenichi Konda, Takahiro Dohmen, Kenji Miki, Masatoshi Okutomi

Backgrounds: Cycle-consistent generative adversarial network (CycleGAN) is a deep neural network model that performs image-to-image translations. We generated virtual indigo carmine (IC) chromoendoscopy images of gastric neoplasms using CycleGAN and compared their diagnostic performance with that of white light endoscopy (WLE).

Methods: WLE and IC images of 176 patients with gastric neoplasms who underwent endoscopic resection were obtained. We used 1,633 images (911 WLE and 722 IC) of 146 cases in the training dataset to develop virtual IC images using CycleGAN. The remaining 30 WLE images were translated into 30 virtual IC images using the trained CycleGAN and used for validation. The lesion borders were evaluated by 118 endoscopists from 22 institutions using the 60 paired virtual IC and WLE images. The lesion area concordance rate and successful whole-lesion diagnosis were compared.

Results: The lesion area concordance rate based on the pathological diagnosis in virtual IC was lower than in WLE (44.1% vs. 48.5%, p < 0.01). The successful whole-lesion diagnosis was higher in the virtual IC than in WLE images; however, the difference was insignificant (28.2% vs. 26.4%, p = 0.11). Conversely, subgroup analyses revealed a significantly higher diagnosis in virtual IC than in WLE for depressed morphology (41.9% vs. 36.9%, p = 0.02), differentiated histology (27.6% vs. 24.8%, p = 0.02), smaller lesion size (42.3% vs. 38.3%, p = 0.01), and assessed by expert endoscopists (27.3% vs. 23.6%, p = 0.03).

Conclusions: The diagnostic ability of virtual IC was higher for some lesions, but not completely superior to that of WLE. Adjustments are required to improve the imaging system's performance.

背景:循环一致性生成对抗网络(CycleGAN)是一种深度神经网络模型,可进行图像到图像的转换。我们利用 CycleGAN 生成了虚拟的靛蓝胭脂红(IC)胃肿瘤色内镜图像,并将其诊断性能与白光内镜(WLE)进行了比较:方法: 我们获得了 176 名接受内镜切除术的胃肿瘤患者的 WLE 和 IC 图像。我们使用训练数据集中 146 个病例的 1,633 张图像(911 张 WLE 和 722 张 IC),利用 CycleGAN 开发了虚拟 IC 图像。剩下的 30 张 WLE 图像则使用训练好的 CycleGAN 转换成 30 张虚拟 IC 图像,并用于验证。来自 22 个机构的 118 名内镜医师使用 60 张配对的虚拟 IC 和 WLE 图像对病灶边界进行了评估。比较了病变区域吻合率和全病变诊断成功率:结果:根据病理诊断,虚拟 IC 的病灶面积吻合率低于 WLE(44.1% 对 48.5%,P 结论:虚拟 IC 的病灶面积吻合率低于 WLE(44.1% 对 48.5%,P 结论):虚拟 IC 对某些病变的诊断能力较高,但并不完全优于 WLE。需要进行调整以提高成像系统的性能。
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引用次数: 0
Impact of preoperative prealbumin levels on long-term prognosis in patients with gastric cancer after gastrectomy: a retrospective cohort study. 胃切除术后胃癌患者术前白蛋白水平对长期预后的影响:一项回顾性队列研究。
IF 7.4 1区 医学 Q1 Medicine Pub Date : 2024-05-01 Epub Date: 2024-02-24 DOI: 10.1007/s10120-024-01472-y
Ryota Matsui, Satoshi Ida, Motonari Ri, Rie Makuuchi, Masaru Hayami, Koshi Kumagai, Manabu Ohashi, Takeshi Sano, Souya Nunobe

Background: The relationship between preoperative prealbumin levels and long-term prognoses in patients with gastric cancer after gastrectomy has not been fully investigated. This study clarified the effect of preoperative prealbumin levels on the long-term prognosis of patients with gastric cancer after gastrectomy.

Methods: This retrospective cohort study included consecutive patients who underwent radical gastrectomy for primary pStage I-III gastric cancer and whose preoperative prealbumin levels were measured between May 2006 and March 2017. Participants were categorized according to their preoperative prealbumin levels into high (≥22 mg/dL), moderate (15-22 mg/dL), and low (<15 mg/dL) groups. The overall survival (OS) in the three groups was compared using the log-rank test, and prognostic factors were identified using Cox proportional hazards regression analysis.

Results: The median follow-up duration was 66 months. Of 4732 patients, 3649 (77.2%) were classified as high, 925 (19.6%) as moderate, and 158 (3.3%) as low. Lower prealbumin levels were associated with poorer prognoses (P < 0.001). Multivariate analysis showed that prealbumin levels of 15-22 mg/dL [hazard ratio (HR): 1.576, 95% confidence interval (CI): 1.353-1.835, P < 0.001] and <15 mg/dL (HR: 1.769, 95% CI: 1.376-2.276, P < 0.001) were independent poor prognostic factors for OS. When analyzed according to the cause of death, prealbumin levels were associated with other-cause survival, but not cancer-specific survival.

Conclusions: Preoperative prealbumin levels correlated with OS in patients with gastric cancer after gastrectomy; the lower the prealbumin level, the worse is the prognosis. Prealbumin levels may be associated with other-cause survival.

背景:胃切除术后胃癌患者术前白蛋白水平与长期预后之间的关系尚未得到充分研究。本研究阐明了术前白蛋白水平对胃切除术后胃癌患者长期预后的影响:这项回顾性队列研究纳入了2006年5月至2017年3月间因原发性I-III期胃癌接受根治性胃切除术的连续患者,并对其术前白蛋白水平进行了测量。根据术前白蛋白水平将参与者分为高(≥22 mg/dL)、中(15-22 mg/dL)和低(结果:中位随访时间为 66 个月。在 4732 名患者中,有 3649 人(77.2%)被归类为高,925 人(19.6%)被归类为中,158 人(3.3%)被归类为低。较低的术前白蛋白水平与较差的预后有关(P 结论:术前白蛋白水平越低,预后越差:术前白蛋白水平与胃切除术后胃癌患者的预后相关;术前白蛋白水平越低,预后越差。术前白蛋白水平可能与其他原因导致的生存率有关。
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引用次数: 0
Genome-wide 5-hydroxymethylcytosines in circulating cell-free DNA as noninvasive diagnostic markers for gastric cancer 循环细胞游离 DNA 中的全基因组 5-羟甲基胞嘧啶是胃癌的非侵入性诊断标记物
IF 7.4 1区 医学 Q1 Medicine Pub Date : 2024-04-07 DOI: 10.1007/s10120-024-01493-7
Yingli Fu, Jing Jiang, Yanhua Wu, Donghui Cao, Zhifang Jia, Yangyu Zhang, Dongming Li, Yingnan Cui, Yuzheng Zhang, Xueyuan Cao

Background

5-Hydroxymethylcytosine-enriched gene profiles and regions show tissue-specific and tumor specific. There is a potential value to explore cell-free DNA 5-hydroxymethylcytosine feature biomarkers for early gastric cancer detection.

Methods

A matched case‒control study design with 50 gastric cancer patients and 50 controls was performed to sequence the different 5-hydroxymethylcytosine modification features of cell free DNA. Significantly differential 5-hydroxymethylcytosine modification genes were identified to construct a gastric cancer diagnostic model. Data set from GEO was used as an external testing set to test the robustness of the diagnostic model.

Results

Accounting for more than 90% of 5-hydroxymethylcytosine peaks were distributed in the gene body in both the gastric cancer and control groups. The diagnostic model was developed based on five different 5-hydroxymethylcytosine modification genes, FBXL7, PDE3A, TPO, SNTG2 and STXBP5. The model could effectively distinguish gastric cancer patients from controls in the training (AUC = 0.95, sensitivity = 88.6%, specificity = 94.3%), validation (AUC = 0.87, sensitivity = 73.3%, specificity = 93.3%) and testing (AUC = 0.90, sensitivity = 81.9%, specificity = 90.2%) sets. The risk scores of the controls from the model were significantly lower than those of gastric cancer patients in both our own data (P < 0.001) and GEO external testing data (P < 0.001), and no significant difference between different TNM stage patients (P = 0.09 and 0.66). Furthermore, there was no significant difference between the healthy control and benign gastric disease patients in the testing set from GEO (P = 0.10).

Conclusions

The characteristics of 5-hydroxymethylcytosine in cell free DNA are specific to gastric cancer patients, and the diagnostic model constructed by five genes’ 5-hydroxymethylcytosine features could effectively identify gastric cancer patients.

背景5-羟甲基胞嘧啶富集的基因图谱和区域具有组织特异性和肿瘤特异性。方法采用匹配的病例对照研究设计,以50名胃癌患者和50名对照组为研究对象,对细胞游离DNA的不同5-羟甲基胞嘧啶修饰特征进行测序。确定了具有显著差异的 5-羟甲基胞嘧啶修饰基因,从而构建了胃癌诊断模型。结果90%以上的5-羟甲基胞嘧啶峰分布在胃癌组和对照组的基因体内。根据五个不同的5-羟甲基胞嘧啶修饰基因FBXL7、PDE3A、TPO、SNTG2和STXBP5建立了诊断模型。在训练集(AUC = 0.95,灵敏度 = 88.6%,特异度 = 94.3%)、验证集(AUC = 0.87,灵敏度 = 73.3%,特异度 = 93.3%)和测试集(AUC = 0.90,灵敏度 = 81.9%,特异度 = 90.2%)中,该模型能有效区分胃癌患者和对照组。在我们自己的数据(P <0.001)和 GEO 外部检测数据(P <0.001)中,模型中对照组的风险评分明显低于胃癌患者,不同 TNM 分期患者之间也无明显差异(P = 0.09 和 0.66)。结论 细胞游离 DNA 中 5- 羟甲基胞嘧啶的特征对胃癌患者具有特异性,由 5 个基因的 5- 羟甲基胞嘧啶特征构建的诊断模型可有效识别胃癌患者。
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Gastric Cancer
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