ObjectiveTo investigate the value of metastatic lymph node ratio (abbreviation: rN) in the prognosis of patients with gastric cancer.MethodsThe clinical data of 255 patients with gastric cancer who underwent the radical gastrec-tomy in the First Department of General Surgery of Lanzhou University Second Hospital from January 2014 to July 2019 were retrospectively reviewed. The survival analysis was performed using Kaplan-Meier survival curves and Cox regression model. The receiver operating characteristic (ROC) curve was used to compare the accuracy of rN stage and N stage for prognosis judgment of patients with gastric cancer, and the Spearman correlation analysis method was used to analyze the correlation between rN or number of metastatic lymph node and total number of lymph nodes detected.ResultsThe univariate survival analysis showed that the vascular invasion, nerve invasion, histologic grade, tumor diameter, T stage, N stage, and rN stage were significantly associated with the prognosis of patients with gastric cancer (P<0.05); The multivariate survival analysis demonstrated that the prognosis model based on the rN stage had a higher HR value (1.756 versus 1.610) and a smaller –2 log likelihood value (648.548 versus 649.469) than the N stage. Correlation analysis results showed that rN was indepen-dent of the number of lymph nodes detected when the number was <15 and ≥15 (rs=0.275, P=0.058; rs=0.075, P=0.285). In addition, when the number of lymph nodes detected was <15 and ≥15, the rN staging could accurately stratify the prognosis of gastric cancer patients (χ2=11.24, P=0.009; χ2=30.25, P<0.001). ROC curve analysis results showed that when the number of lymph nodes detected was less than 15, rN stage had a higher area under ROC curve value ［0.863, 95%CI (0.752, 0.974) and 0.813, 95%CI (0.687, 0.938)］ as compared with N stage.ConclusionrN stage might be more accurate than N stage in predicting prognosis of patients with gastric cancer when number of lymph nodes harvested is less than 15.
ObjectiveTo investigate relationship between galectin-1 (Gal-1) and invasion and metastasis of gastric cancer.MethodThe related literatures on the relationship between the Gal-1 and the invasion and metastasis of gastric cancer in recent years were reviewed.ResultsThe expression of Gal-1 in the gastric cancer tissue was closely related to the invasion, metastasis ability, immunosuppression, and angiogenesis of tumor cells, and played the important role in the progression and evolution of the gastric cancer. The expression of Gal-1 was higher, the malignancy of the tumor was higher, and the prognosis of the patient was worse.ConclusionExpression of Gal-1 can promote invasion and metastasis of gastric cancer, but further clinical trials need to be verified.
ObjectiveTo evaluate safety and effectiveness of stent placement and emergency surgery in treatment of proximal colon cancer obstruction.MethodsThe PubMed, Embase, Cochrane Library, ClinicalTrials, CNKI, CBM, Wanfang Data, etc. were searched comprehensively. The literatures of Chinese and English randomized controlled trial and retrospective comparative study of stent placement and emergency surgery for the proximal colon cancer obstruction were retrieved. The RevMan 5.3 and Stata 12.0 softwares were used. The meta-analysis was made on the safety and effectiveness of these two treatments.ResultsA total of 9 literatures involving 636 patients were included, all of them were the retrospective studies, 4 of them only reported the clinical success rate and technical success rate. The technical success rate of stent placement was 0.94 [95% CI (0.91, 0.96)]. The clinical success rate was 0.90 [95% CI (0.87, 0.93)]. Compared with the emergency surgery group, the total complication rate and the temporary stoma rate were lower [OR=0.32, 95% CI (0.11, 0.94), P=0.04; OR=0.18, 95% CI (0.05, 0.65), P=0.009] and the hospital stay was shorter [MD=–2.97, 95% CI (–4.52, –1.41), P=0.000 2] in the stent placement group. The perioperative mortality rate, laparoscopic surgery rate, 5-year disease-free survival rate, and 5-year overall survival rate had no significant differences between these two groups (P>0.05).ConclusionCompared with emergency surgery, endoscopic stent placement for treatment of proximal colon cancer obstruction has a lower incidence of complications, temporary colostomy rate, shorter hospital stay, and it has no significant differences in mortality, laparoscopic surgery rate, and survival rate.
ObjectiveTo evaluate prognostic value of change of immune status in locally advanced gastric cancer (LAGC) patients. Methods We retrospective collected 210 LAGC patients who underwent treatment in our department from January 2013 to December 2018, then we collected lymphocyte-to-monocyte ratio (LMR) and cLMR (change of lymphocyte-to-monocyte ratio, cLMR) before operation and after three cycles of adjuvant chemotherapy. We had developed a new immune state change score (ICS) based on preoperative LMR (pLMR) and cLMR, and explored its prognostic value. The definition of ICS in this study was: ICS=1, pLMR≤4.53 and cLMR≤1; ICS=2, pLMR≤4.53 and cLMR>1, or pLMR>4.53 and cLMR≤1; ICS=3, pLMR>4.53 and cLMR>1. Results The results of multivariate Cox proportional hazard regression model showed that ICS was an influencing factor for overall survival [ICS=2, RR=0.397, 95%CI (0.260, 0.608), P<0.001; ICS=3, RR=0.080, 95%CI (0.040, 0.162), P<0.001), patients with ICS scores of 2 and 3 had better overall survival. In addition, the prognostic accuracy of ICS was superior to pLMR and Clmr, and the C-index of ICS [0.806, 95%CI (0.746, 0.865)] was higher than that of pLMR [0.717, 95%CI (0.635, 0.799), P=0.003)] and cLMR [0.723, 95%CI (0.641, 0.806), P=0.005)]. Based on this, a Nomogram model included ICS, CEA, and pTNM staging was constructed to predict the 3-year and 5-year survival rates of patients. The calibration curve and C-index [0.821, 95%CI (0.783, 0.859)] showed high discrimination and accuracy of Nomogram, and decision curve analysis confirmed that the model had good clinical application value. Conclusions The dynamic changes in the patient’s immune status before and after adjuvant therapy are related to the overall survival of LAGC patients. As an evaluating system which combined the cLMR and pLMR, ICS can better predict the prognosis of LAGC patients.