Objective To compare the effect of laparoscopic surgery and open surgery on the blood coagulation state in patients with gastric cancer, and to provide evidence for the prevention measurement of thrombosis in perioperative period. Methods One hundred patients with gastric cancer who received treatment in our hospital from Feb. 2014 to Aug. 2014, were randomly divided into laparoscopy group and laparotomy group, 50 patients in each group. The patients in laparotomy group were treated by traditionally open surgery, while patients in the laparoscopy group accepted laparoscopic surgery. The clinically therapeutic effect of 2 groups was compared. Results ① Operative indexes. The operation time, blood loss, anal exhaust time, hospital stay, and morbidity of laparoscopy group were all lower than those of laparotomy group (P<0.05). ② Coagulation function. Compared with preoperative indexes, the prothrombin time (PT) at 24 h after operation in laparoscopy group and laparotomy group were both shorter (P<0.05), but there was no significant difference in activated partial thromboplastin time (APTT) and international normalized ratio (INR) between the 2 time points (before operation and 24 h after operation) in both 2 groups (P>0.05). Both at 2 time points (before operation and 24 h after operation), there was no significant difference in PT, APTT, and INR between 2 groups (P>0.05). ③ Fibrinolysis indexes. Compared with preoperative indexes, the fibrinogen (FIB) and D-dimer at 24 h after operation in laparoscopy group and laparotomy group were higher (P<0.05). The FIB and D-dimer at 24 h after operation in laparoscopy group were both higher than those of laparotomy group (P<0.05). ④ Follow-up results. There was no significant difference in metastasis rate, recurrence rate, and mortality between the 2 groups (P>0.05), but the incidence of thrombus was higher in laparoscopy group than that of laparotomy group (P<0.05). Conclusions In the treatment of patients with gastric cancer, laparoscopic surgery has the advantages of less trauma, less blood loss, less complications, and so on. Laparoscopic surgery and open surgery both can lead to hypercoagulable state, but the effect of laparoscopic surgery is stronger than open surgery.
ObjectiveTo onstructe a prognostic model for gastric cancer based on disulfidoptosis-related genes. MethodsFirstly, transcriptome data and clinical data were obtained from the TCGA and GEO databases to explore the expression of disulfidoptosis-related genes in gastric cancer tissues and normal tissues, as well as their impact on the overall survival (OS) of gastric cancer patients. Subsequently, two clusters of disulfidoptosis-related gene were determined by consensus clustering, key genes were further selected by using LASSO regression, and a multivariate Cox proportional hazards regression model was constructed to predict OS. ResultsAmong the 24 kinds of disulfidoptosis-associated genes, 16 exhibited statistically significant differences in expression between gastric cancer tissues and normal tissues (P<0.05), and results of univariate Cox proportional hazards regression model showed that 9 kinds of disulfidoptosis-associated genes were associated with OS (P<0.05). The 24 kinds of disulfidoptosis-associated genes were grouped into 2 clusters by using the consensus clustering algorithm, with 299 differentially expressed genes between the two clusters. In the training set, 14 genes were determined by using LASSO regression to construct the OS prediction model, and risk scores were calculated. The OS of the high-risk group was significantly worse than that of the low-risk group (P<0.05), and this prediction model also had a high area under the curve value in the validation set. ConclusionsThe OS prediction model based on disulfidoptosis-associated genes can predict the prognosis of gastric cancer patients.
ObjectiveTo summarize advances of neoadjuvant chemotherapy (NACT) in treatment for locally advanced gastric cancer (AGC) in recent years, in order to providing reference for development of NACT and application of clinical research.MethodThe domestic and foreign literatures about the NACT for the AGC were reviewed.ResultsThe efficacy and safety of NACT had been affirmed, but there were still many questions in the clinical practice, such as the selection of NACT regimen, indications, number of chemotherapy cycles, whether to combine targeted therapy, the selection of treatment and restaging after the NACT, and relevant researches were still underway.ConclusionsTherapy methods of AGC are varied and NACT has an obvious effect, which has become one of the most important treatments for AGC. However, there are still many problems in clinical practice, further research is needed.
Objective To investigate association between –174C/G genetic polymorphism of interleukin-6 (IL-6) and susceptibility to gastric cancer by conducting a meta-analysis. Methods Such databases as PubMed, Embase, The Cochrane Library, Web of Science, CNKI, VIP, and Wanfang Data were searched from inception to January 2017 to collect case-control studies about the correlation between the –174C/G genetic polymorphism of IL-6 and susceptibility to gastric cancer. For the population genotype distributions of both the gastric cancer group and the control group, their odds ratios (OR) and 95% confidence intervals (CI) were taken as the effect indexes were applied to conduct meta-analysis in the homozygote model (CC vs. GG), heterozygote model (GC vs. GG), dominant model (CC+CG vs. GG), recessive model (CG+GG vs. CC), and allelic genetic model (C vs. G). Two reviewers independently screened the literatures, extracted the data, and evaluated the quality of the included studies. The meta-analysis was performed using Stata 12.0 software. Results Thirteen articles were included in the final meta-analysis, covering a total of 2 062 gastric cancer cases and 3 152 controls. The results of meta-analysis showed that there was no correlation between the IL-6 –174C/G genetic polymorphism and the risk of gastric cancer〔CC vs. GG: OR=1.33, 95% CI (0.92, 1.94); GC vs. GG: OR=1.32, 95% CI (0.96, 1.82); CC+CG vs. GG: OR=1.32, 95% CI (0.97, 1.80); CG+GG vs. CC: OR=0.89, 95% CI (0.67, 1.17); C vs. G: OR=1.22, 95% CI (0.98, 1.54)〕. But the results of the subgroup analysis showed there was a significant association between the IL-6 –174 C/G genetic polymorphism and the risk of gastric cancer in Asians〔CC vs. GG: OR=1.80, 95% CI (1.29, 2.50); GC vs. GG: OR=1.51, 95% CI (1.20, 1.90); CC+CG vs. GG: OR=1.60, 95% CI (1.30, 1.96); CG+GG vs. CC: OR=0.60, 95% CI (0.44, 0.83); C vs. G: OR=1.59, 95% CI (1.24, 2.03)〕. However, no association was found in Europeans〔CC vs. GG: OR=1.11, 95% CI (0.90, 1.39); GC vs. GG: OR=1.16, 95% CI (0.98, 1.37); CC+CG vs. GG: OR=1.12, 95% CI (0.96, 1.32); CG+GG vs. CC: OR=1.07, 95% CI (0.88, 1.30); C vs. G: OR=1.04, 95% CI (0.78, 1.41)〕 . Conclusion IL-6 –174C/G genetic polymorphism is associated with susceptibility to gastric cancer in Asians, which is not associated with susceptibility to gastric cancer in Europeans.
Objective To summarize application status of carbon nanomaterial in gastric cancer therapy. Method The relevant literatures about the application of the carbon nanomaterial in the gastric cancer were reviewed. Results The carbon nanomaterial was as a lymph tracer with good effects for dying and tracing, which could improve the number of lymph nodes and the detection rate of metastasis lymph nodes. As be made as a transition of chemotherapy drugs, the carbon nanomaterial could improve the concentration of the drug in the lymph node, then inhibit the gastric cancer cell to spread. Conclusion Carbon nanomaterial provides an effective help in treatment for gastric cancer, but whether it could improve prognosis of patient with gastric cancer remains to be studied.
ObjectiveTo investigate the effect of omega-3 polyunsaturated fatty acids on delirium in elderly patients after taking gastric cancer surgery.MethodsA prospective study was conducted. Elderly patients with gastric cancer undergoing radical gastrectomy in West China Hospital of Sichuan University from June 2015 to June 2018 were divided into experimental group and control group for the purpose of research. All patients were operated by the same group of surgeons and anesthesiologists. Patients in the experimental group received intravenous infusion of 10% fish fat emulsion (Ewing) 100 mL daily from the first day after operation extra to routine treatment; patients in the control group received routine treatment after operation. The postoperative delirium, inflammation, complications, hospital stay, andre-admission on 30 days were compared between the two groups.ResultsA total of 205 patients were under research. The results were as follows. ① There were 47 delirium patients in the control group and 22 delirium patients in the experimental group. The difference between the two groups was statistically significant (P<0.001). There were 32 cases and 19 cases discovered with delirium in the control group and the experimental group during 1-3 days after operation; there were 19 cases and 6 cases were detected with delirium in the control group and the experimental group during 4-7 days after operation, respectively. The difference was considered statistically significant (P<0.05). ② Inflammation indexes of the experimental group were significantly lower than those of the control group on the 3rd and 7th day after operation, including count of WBC, C-reactive protein, interleukin-6, tumor necrosis factor-α, and platelet crit, and the difference were statistically significant (P<0.05). ③ Postoperative fever occurred in 46 patients in the experimental group, while 71 patients in the control group. The difference was statistically significant (P<0.01). ④ There were 2 cases of incision liquefaction in the control group and 1 case of mild chylous leakage in the experimental group. There was no significant difference in incision liquefaction rate and chylous leakage rate between the two groups (P>0.05). ⑤ The average hospitalization time of the experimental group was shorter than that of the control group ［(8±1) d vs. (9±2) d］. The difference was considered statistically significant (P<0.01).Conclusionω-3 polyunsaturated fatty acids can reduce postoperative delirium and improve short-term prognosis in elderly patients with gastric cancer by controlling inflammation and stress response.
Objective To investigate the relationship between the expression of mast cell expressed membrane protein 1 (MCEMP1) in gastric cancer and its relationship with prognosis and tumor immune infiltration. Methods Transcriptome expression profile data and clinical data information of gastric cancer and normal samples were downloaded from TCGA database, and differentially expressed genes in gastric cancer tumor microenvironment were extracted using R 4.0.5 software. Protein-protein interaction network of differentially expressed genes was constructed by using STRING online website, protein-protein interaction network and univariate Cox proportional hazards regression analysis were used for cross-tabulation analysis to obtain key genes. Kruskal-Wallis rank sum test was used to investigate the correlation between key genes and clinicopathological features. The possible signaling pathways involved in key genes were predicted by gene set enrichment analysis. We further analyzed the relationship between expression of key gene and the level of immune infiltration and immune molecules in gastric cancer by TISIDB online database and CIBERSORT algorithm. Results A total of 760 differentially expressed genes in gastric cancer were found and a key gene of MCEMP1 was derived from cross-tabulation analysis based on the results of protein-protein interaction network and univariate Cox proportional hazards regression analysis. Expression of MCEMP1 was significantly upregulated in gastric cancer tissues (P<0.001), and survival analysis showed that the overall survival rate of the group with high expression level of MCEMP1 was lower than that of low expression [HR=1.176, 95%CI (1.066, 1.297）, P=0.046]. Expression of MCEMP1 also correlated with age, T-stage, and clinical stage of gastric cancer (P<0.05) , and expression of MCEMP1 was significantly associated with a variety kinds of immune cells and expression of immune molecules (P<0.05). Conclusion MCEMP1 is a potential prognostic marker for gastric cancer and is associated with immune infiltration in gastric cancer.
Pathological images of gastric cancer serve as the gold standard for diagnosing this malignancy. However, the recurrence prediction task often encounters challenges such as insignificant morphological features of the lesions, insufficient fusion of multi-resolution features, and inability to leverage contextual information effectively. To address these issues, a three-stage recurrence prediction method based on pathological images of gastric cancer is proposed. In the first stage, the self-supervised learning framework SimCLR was adopted to train low-resolution patch images, aiming to diminish the interdependence among diverse tissue images and yield decoupled enhanced features. In the second stage, the obtained low-resolution enhanced features were fused with the corresponding high-resolution unenhanced features to achieve feature complementation across multiple resolutions. In the third stage, to address the position encoding difficulty caused by the large difference in the number of patch images, we performed position encoding based on multi-scale local neighborhoods and employed self-attention mechanism to obtain features with contextual information. The resulting contextual features were further combined with the local features extracted by the convolutional neural network. The evaluation results on clinically collected data showed that, compared with the best performance of traditional methods, the proposed network provided the best accuracy and area under curve (AUC), which were improved by 7.63% and 4.51%, respectively. These results have effectively validated the usefulness of this method in predicting gastric cancer recurrence.
ObjectiveTo understand the research progress on micronutrient deficiency after gastrectomy for gastric cancer in order to provide a new ideas for its prevention and treatment. MethodThe literature on reseach relevant micronutrient deficiency after gastrectomy for gastric cancer in recent years at home and abroad was searched and reviewed. ResultsThe micronutrient deficiency after partial or total gastrectomy was more common for the patients with gastric cancer, especially some key nutrients such as iron, zinc, copper, fat soluble vitamins (vitamins A, D, E), vitamin B12, folate, and so on. The main reason for the micronutrient deficiency was due to the changes of the anatomical structure or physiological function of the gastrointestinal tract caused by surgery, as most micronutrients were absorbed through the duodenum or jejunum, bypassing the main absorption site of micronutrients after total or partial gastrectomy; In addition, preoperative malnutrition, neoadjuvant therapy, early and late postoperative complications, as well as postoperative adjuvant therapy, and reduced gastric acid secretion, might all lead to the micronutrient absorption disorders. There was also limited literature on the micronutrient supplementation after gastrectomy for gastric cancer, but some researchers still supported providing nutritional support before and after surgery for the gastric cancer patients with severe malnutrition. There was few literature reported on the adverse consequences of nutritional support for the gastric cancer patients underwent gastrectomy. ConclusionsAt present, there is still limited literature on the study of micronutrient deficiency and supplementation after gastrectomy for gastric cancer. With the increasing attention of clinician to the impact of micronutrients on diseases or health, the European Society for Extraintestinal and Enteral Nutrition developed the “ESPEN micronutrition guidelines” in 2022 and “Expert consensus on micronutrients deficiency and supplementation in malignant tumors” was published in China at 2024. In the current situation where relevant research is insufficient, it is recommended that clinicians refer to this guideline or expert consensus and provide personalized intervention for patients with micronutrient deficiencies based on their clinical conditions.
ObjectiveTo systemically evaluate safety and effectiveness of laparoscopy-assisted distal gastrectomy (LADG) and conventional open distal gastrostomy(CODG) with D2 lymph node dissection for Chinese patients with distal gastric cancer. MethodsLiterature were searched in PubMed database, the Cochrane Library, China science citation database (CSCD), Wanfang database, China science and technology journal database (CSTJ), China biomedical literature database (CBM), and China academic journal network publishing database (CAJD) to identify clinical random controlled trials, comparing safety and effectiveness of LADG and CODG with D2 lymph node dissection for Chinese patients with distal gastric cancer. The retrieval time was from the inception to Jun. 2013. Meta-analysis was performed by Review Manager 5.2 software. ResultsA total of 7 clinical random controlled trials including 548 patients were analyzed. Compared with CODG group, LADG group had less blood loss (MD=-94.02, 95% CI:-140.96--47.07), shorter postoperative hospital stay(MD=-3.66, 95% CI:-5.76--1.57), earlier postoperative ambulation time(MD=-1.95, 95% CI:-2.74--1.17), earlier postoperative exhaust time (MD=-1.67, 95% CI:-2.05--1.30), lower incidence of complications(OR=0.26, 95% CI:0.14-0.51), P<0.050. But the operation time was longer in LADG group (MD=35.01, 95% CI:10.41-59.61, P=0.005). There was no significant difference between LADG group and CODG group on number of lymph node which were dissected during the operation (MD=-0.24, 95% CI:-0.99-0.51, P=0.530). ConclusionThe short-term outcome and safety of LADG for Chinese patients with distal gastric cancer is superior to CODG, but LADG prolongs the operation time and its long-term outcome should be proved by further outcomes of clinical controlled trials.