Jingyu Deng

Superiority of the Ratio Between Negative and Positive Lymph Nodes for Predicting the Prognosis for Patients With Gastric Cancer

BackgroundThis study aimed to elucidate the prognostic prediction superiority of the ratio between negative and positive lymph nodes (RNP) in gastric cancer (GC).MethodsThe clinicopathologic data of 1,563 GC patients were analyzed to demonstrate the prognostic significances of the RNP stage. The tumor RNP metastasis (TRNPM) classification system also was evaluated to determine the potential superiorities of the prognostic prediction for GC patients.ResultsIn the univariate survival analysis, both RNP stage and TRNPM classification were demonstrated to be relative factors in the overall survival (OS) of GC patients. Like the tumor-node-metastasis (TNM) and positive and dissected lymph node (TRPDM) classifications, the TRNPM classification was identified as an independently prognostic predictor of GC patients using multivariate survival analysis. However, TRNPM classification has smaller Akaike information criterion and Bayesian information criterion values than the TNM and TRPDM classifications, and TRNPM classification was demonstrated to be the most intensive indicator for the OS of GC patients using the case–control matched approach, which represented the comparative superiorities of prognostic prediction of TRNPM classification.ConclusionThe RNP stage should be considered as the optimal variable for evaluating the prognosis of GC in the clinic.

N stages of the seventh edition of TNM Classification are the most intensive variables for predictions of the overall survival of gastric cancer patients who underwent limited lymphadenectomy

The objective of this study was to explore the prognostic prediction rationality of the seventh edition N stage for gastric cancer (GC) patients who underwent the limited lymphadenectomy. Clinicopathological data of 769 GC patients who underwent the curative resection between 1997 and 2006 were analyzed for demonstration that the seventh edition N stage had the significant superiorities of prognostic prediction to the patients who underwent the limited lymphadenectomy. Although the extent of lymphadenectomy was associated with the overall survival (OS) of gastric cancer (GC) patients, the N stages of the seventh edition of the TNM Classification were identified as the most intensively independent predictors of GC prognosis. Using stratum analysis, the 5-year survival rate of patients who underwent limited lymphadenectomy was observed to be significantly different from that of patients who underwent extended lymphadenectomy, regardless of the extent of lymph node metastasis. Multinomial logistic regression analysis revealed that combining the extents of lymph node metastasis and lymphadenectomy could improve the prediction accuracy of patient survival status. Case control analysis showed that regardless of the extent of lymphadenectomy, the seventh edition N stages featured significant superiority for OS evaluation of GC patients. The seventh edition N stage had the prediction rationality for the OS of GC patients who underwent the limited lymphadenectomy.

Feasibility of laparoscopic gastrectomy for elderly gastric cancer patients: meta-analysis of non-randomized controlled studies

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

Prognostic value of surgical margin status in gastric cancer patients

It has been reported that positive surgical margin is one of the most significant risk factors for local recurrence and poor survival. However, the survival of gastric cancer (GC) patients with positive margin is still controversial.

Re-evaluating the prognostic validity of the negative to positive lymph node ratio in node-positive gastric cancer patients

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

The survival decrease in gastric cancer is associated with the methylation of B-cell CLL/lymphoma 6 member B promoter

The methylation of B-cell CLL/lymphoma 6 member B (BCL6B) DNA promoter was detected in several malignancies. Here, we quantitatively detect the methylated status of CpG sites of BCL6B DNA promoter of 459 patients with gastric cancer (GC) by using bisulfite gene sequencing. We show that patients with three or more methylated CpG sites in the BCL6B promoter were significantly associated with poor survival. Furthermore, by using the Akaike information criterion value calculation, we show that the methylated count of BCL6B promoter was identified to be the optimal prognostic predictor of GC patients.

Mediation of the malignant biological characteristics of gastric cancer cells by the methylated CpG islands in RNF180 DNA promoter

We previously demonstrated that the methylation of ring finger protein 180 (RNF180) DNA promoter was specific to gastric cancer tissues. We reported that four hypermethylated CpG islands, namely, CpG-116, CpG-80, CpG+97, and CpG+102, in RNF180 promoter were significantly associated with the postoperative overall survival of gastric cancer patients. Correlation analysis revealed that the methylated status of CpG islands was significantly associated with the lymph node metastasis of gastric cancer. We formulated four types of MGC-803 cells with the specific demethylation of one of the four CpG islands through vector transfection method. Conventional detections for the biological characteristics of cancer cells showed that 1) the methylation of CpG+102 island in RNF180 DNA promoter could remarkably influence the comprehensively malignant biological characteristics of gastric cancer cells, including their proliferation, invasion, cell cycle, anti-apoptosis, and tumorigenicity. 2) The CpG+97 island, in addition to the CpG+102 island, should be considered as the other key methylated locus in RNF180 DNA promoter to mediate the malignant biological characteristics of gastric cancer cells. The methylated status of the key CpG islands of RNF180 DNA promoter may be used to predict the variations of the malignant biological characteristics of gastric cancer cells. The proposed method is a promising molecular therapy for gastric cancer.

A novel nomogram individually predicting disease-specific survival after D2 gastrectomy for advanced gastric cancer

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