ObjectiveTo study the clinical significance of the 3-hydroxyisobutyrate dehydrogenase (HIBADH) expressions in gastric adenocarcinoma tissues and its biological function in gastric cancer cells.MethodsSeventy-six patients with gastric adenocarcinoma who were hospitalized in Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiaotong University, School of Medicine between January 2006 and December 2007 were recruited in our research. Immunohistochemical (IHC) staining was used to detect the HIBADH protein in primary gastric adenocarcinoma tissues, adjacent tissues, and metastatic lymph node tissues of gastric cancer. Then, the relationships among the expression of HIBADH protein, the clinical features, and the prognosis were analyzed. The MKN45 gastric cancer cell line of HIBADH overexpression was picked up and constructed as stable HIBADH knockdown cell lines. The biological function of HIBADH protein in gastric cancer cells was confirmed through in vitro experiments such as cell proliferation assay, migration and invasion assay, and scratch-wound assay.ResultsThe positive expression rate of HIBADH protein in the 76 gastric adenocarcinoma tissues was significantly higher than that of the adjacent tissues (χ2=54.738, P<0.001). Moreover, the higher expression level of HIBADH protein was related to the larger tumor diameter, the higher tumor lymphatic invasion rate, the later pT stage, the higher the lymph node metastasis rate, and the later pTNM stage (P<0.05). HIBADH protein was also highly expressed in lymph nodes with metastatic carcinoma, and positiverate was 100% (48/48). The 10-year survival rate of patients in the HIBADH protein positive group and HIBADH protein negative group were 16.4% and 69.4%, respectively, which showed the latter group had a longer survival time (χ2=19.612, P<0.001). The migration capacity, invasion capacity, and scratch-wound capacity of the MKN45 cells were significantly decreased after HIBADH protein knockdown (P<0.05), but the proliferation capacity of the cells was not significantly changed (P>0.05).ConclusionsThe overexpression of HIBADH protein in gastric cancer suggests later tumor stage and poor prognosis. Inhibition expression of HIBADH protein can reduce the motility capacity of gastric cancer cells.
ObjectiveTo investigate the expression and clinical significance of octamer-binding transcription factor 4(Oct-4) in gastric cancer (GC) tissues with meta-analysis. MethodsPubMed, EMBASE, Web of Science, CBM, VIP, CNKI, and WanFang Database were searched from their establishment to Oct.2012 for related studies, to investigate the relationship between expression of Oct-4 and the clinicopathological characteristics of GC.After evaluating methodo-logical quality of studies that met the inclusion criteria, RevMan 5.1 software was used to data analysis. ResultsEight studies which enrolled 623 cases of GC were identified.The results of the meta-analysis showed that, as for the positive expression rate of Oct-4, there were significant differences between GC tissues and normal stomach tissues (OR=37.50, 95% CI: 4.76-295.51, P < 0.01), as well as the cell differentiation (OR=0.27, 95% CI: 0.16-0.45, P < 0.01), for that the positive expression rate of Oct-4 in low differentiation of gastric cancer tissues was higher than those of moderate-high differentation group.But there were no significant differences between GC tissues with lymph node metastasis and non-lymph node metastasis (OR=2.09, 95% CI: 0.63-6.94, P=0.23), as well as Ⅰ-Ⅱ stage and Ⅲ-Ⅳ stage (OR=0.62, 95% CI: 0.25-1.54, P=0.30) of GC tissues. ConclusionsOct-4 may participate in the whole course of carcinogenesis of GC, but the relationship between expression of Oct-4 and lymph node metastasis as well as the TNM stage of GC is unclear, which needs more high quality studies to explore the question clearly.
To investigate the relationship between clinicopathological features and lymph node metastasis in the primary gastric cancer and affer the basis for deciding appropriate extent of lymph node dissection, a total of 192 patients who underwent curative gastrectomy and lymph node dissection for gastric cancer were analyzed retrospectively. Result: The total rate of lymph node metastasis was 60.4%, with 28.9% of the resected lymph nodes involved. The lymph node metastasis of C, M, A region and the whole stomach were 64.6%, 57.7%, 59.1% and 90.9% respectively. The rates of the lymph node metastasis increased successively in carcinoma of early, middle and late stages (Ｐ＜0.05), the rate of the infiltrative tumor (Borr Ⅲ，Ⅳ) being 76.5% which was significantly higher than that of the circumscribed tumor (Borr Ⅰ，Ⅱ) (43.2%)。 Relating with the tumor size ＜4cm in diameter showed lesser rate, while 4-8 cm and ＞8cm in diameter showed increasingly higher metastaticrate (Ｐ＜0.01). As a result, we should decide the appropriate extent of lymph node dissection during the operation on the basis of clinicopathological stages, type of Borrmann’s, site and maximum diameter of gastric cancer along with the state of lymph node metastasis in carcinoma of different region of the stomach.
Objective To compare the effectiveness between a new hand-sewn intestinal anastomosis and stapled anastomosis during Roux-en-Y anastomosis of gastric cancer. Methods Retrospectively, we collected 200 gastric cancer patients who underwent radical distal or total gastrectomy from January 2014 to June 2017 in our hospital, and divided them into observation group (new hand-sewn anastomosis, n=100) and control group (stapled anastomosis, n=100) according to the type of anastomosis. The time and cost taken to perform the anastomosis, the incidence of postoperative complications (including anastomotic leakage, bleeding, and stenosis), and hospital stay were compared. Results The cost of anastomosis in the observation group was significantly lower than that of the control group [(194.1±13.5) RMB vs (5 270.3±852.7) RMB, P<0.001], and the time taken to perform was just slightly longer in the observation group [(8.34 ± 0.65) minvs (8.29±0.61 ) min, P=0.540], additionally the incidences between the observation group and the control group, in regards to anastomotic bleeding [0 (0/100) vs 3% (3/100), P=0.246], leakage [0 (0/100) vs 1% (1/100), P=1.000], stenosis [0 (0/100) vs 2% (2/100), P=0.497], and hospital stay [(18.8±7.4) d vs (19.2±6.2) d, P=0.175], showed no significant difference between the 2 groups. Conclusion The new hand-sewn anastomosis technology is safe and effective, easy to learn, and it can save money and time, which is worth promoting.
ObjectiveTo understand the mechanisms of malnutrition in patients with gastric cancer (GC) and which affecting on therapy outcomes, and explore effective nutritional intervention strategies so as to improve general therapy outcomes for patients with GC. MethodThe literature on studies relevant malnutrition in the patients with GC both domestically and internationally was reviewed and analyzed. ResultsThe mechanisms of malnutrition in the patients with GC are complex and diverse, including abnormal tumor metabolism, side effects of treatment, psychological and economic factors, etc. The malnutrition made the mortality and recurrence rates increase, hospital stay prolong, and medical costs elevate, meanwhile led to the multiple complications. The use of various screening tools could effectively assess the malnutrition status at the different therapy stages, then the individualized nutritional therapy plans could be developed based on the assessment results. These plans included oral nutrition, enteral nutrition, parenteral nutrition, and immunonutrition. ConclusionsMalnutrition severely affects the treatment outcomes and quality of life of patients with GC. It is necessary to timely screen and assess. The reasonable nutritional support plan should be chosen based on the patient’s individualized situation. Future research should be needed to explore the long-term efficacy and safety of nutritional support, optimize the application of immunonutrition and parenteral nutrition, and enhance the general treatment outcomes for patients with GC.
Objective To investigate the relationship of vascular endothelial growth factor (VEGF), microvessel density (MVD) and progression of gastric carcinoma (GC). Methods The expression of VEGF and MVD in archival waxembedded specimens of 80 cases of GC and 20 gastric benign disease (GBD) were examined by using immunohistochemical staining. ResultsThe positive expression rate (PER) of VEGF in GC was 75.0%, and in GBD 5.0% (P＜0.05). The PER of VEGF in GC with invasive serosa was 95.5%, in those without serosal invasion 50.0% (P＜0.05). 82.8% was the PER of VEGF in GC with lymph node metastasis, 54.5% without lymph node metastasis (P＜0.05).The PER of VEGF in GC accompanied by distant metastasis was 100%, higher than that without distant metastasis (71.0%, P＜0.05). PER of VEGF in pTNM Ⅰ+Ⅱ was 53.1%, in Ⅲ+Ⅳ 89.6% (P＜0.05). MVD correlated significantly with depth of invasion, lymph node metastasis,distant metastasis and pTNM stages (P＜0.05). There was correlationship between MVD and VEGF (P＜0.05).Conclusion VEGF expression upregulation and MVD contribute to the progression of gastric carcinoma.
ObjectiveTo explore the diagnostic value of “Four-Step Procedure” of laparoscopic exploration in patients with peritoneal metastasis of gastric cancer.MethodsWe retrospectively collected the data of 409 gastric adenocarcinoma patients from July 2016 to August 2020 who underwent “Four-Step Procedure” of laparoscopic exploration in West China Hospital. The descriptive case series study was conducted to analyze the outcome of laparoscopic exploration combined with CY (cytology test), stepwise treatment plans, and the rates of CY1 and P1 (peritoneal metastasis) among cT3–4 patients during different periods. SPSS 22.0 software was used to conduct the univariate and multivariate logistic regression to analyze the high risk factors associated with P1 and (or) CY1.ResultsA total of 409 gastric adenocarcinoma patients who underwent laparoscopic exploration were enrolled in our study. Among them, 65 patients were confirmed to be P1 and (or) CY1. Stratified analysis by cT and cN staging showed that there were 7 (7.4%) and 55 (27.9%) patients with peritoneal metastasis in cT3 staging and cT4 staging, respectively. After laparoscopic exploration, 168 patients received laparoscopic gastrectomy, 35 patients received laparotomy, 143 patients received neo-adjuvant chemotherapy, and 63 patients received conversion therapy. The bar chart showed an ascending tendency in the diagnosis rate of P1 over time among cT3–4 patients. Multivariate logistic regression analysis showed that ascites was an independent risk factor of CY1 and (or) P1 (P<0.001). Additionally, the postoperative complication rate was 2.9% in the patients who merely underwent laparoscopic exploration, including 4 patients with pulmonary infection and 2 patients with urinary retention.Conclusions“Four-Step Procedure” of laparoscopic exploration is reliable and feasible for gastric cancer. “Four-Step Procedure” of laparoscopic exploration has high diagnostic value for peritoneal metastasis of gastric cancer. Our study shows that most of peritoneal metastasis distribute in cT3 and cT4 patients. For these patients, laparoscopic exploration should be recommended to identify if peritoneal metastasis exists and avoid unnecessary laparotomy.