The optimal lymphadenectomy for gastric cancer (GC) with pyloric invasion is controversial because the pattern of lymph node metastasis is different from that of distal GC. The rate of lymph node metastasis into the posterior area of the pancreatic head and hepatoduodenal ligament is high. This study evaluated the estimated benefit of radical gastrectomy with D2-plus lymphadenectomy in patients with pyloric invasion. All patients with GC invading the pylorus who underwent curative surgical resection with D2-plus lymphadenectomy between February 2013 and September 2015 were enrolled in the study. The index of estimated benefit from lymph node dissection (IEBLD) was calculated by multiplying the incidence of metastasis to each lymph node station by the 3-year overall survival (OS) rate of patients with metastasis to that station. In total, 128 patients were eligible. The rate of lymph node metastasis and the 3-year OS rate (and IEBLD) of the patients with metastasis to lymph nodes were 14.3 and 44.4% (5.56) for No. 8p, 10.9 and 35.7% (3.89) for No. 12b, 9.5 and 33.3% (3.13) for No. 12p, 18.8 and 54.2% (10.19) for No. 13, and 21.8 and 53.6% (11.68) for No. 14v, respectively. In radical gastrectomy for GC with pyloric invasion, some survival benefit was observed with dissection of the No. 13 and No. 14 lymph nodes, but there was no survival benefit with dissection of the No. 8p lymph nodes. The No. 12b and No. 12p lymph nodes may be better to dissect in cT3 GC patients with pyloric invasion. http://ClinicalTrials.gov Identifier: NCT01836991. Date of registration: April 17, 2013.

/pdf/evaluation-of-d2-plus-radical-resection-for-gastric-cancer-3ilw66ueo8.pdf

Evaluation of D2-plus radical resection for gastric cancer with pyloric invasion

The Influence of Group No.8p Lymph Node Dissection on the Prognosis of Advanced Gastric Cancer

BACKGROUND D2 lymph node dissection for advanced gastric cancer is advocated, and station 8p lymph node should be considered in selected patients, which is, however, technically difficult. AIM To introduce a new and easy-to-perform procedure for dissection of the lymph nodes superior to the pancreas. METHODS A series of patients who underwent laparoscopic gastrectomy for gastric cancer were retrospectively included with utilization of a new procedure for superior pancreatic lymphadenectomy (LND) with portal vein priority via the posterior common hepatic artery approach (SPLD-PPPH) based on a newly defined portal triangle. The surgical outcome of the patients, as well as the efficacy and safety of SPLD-PPPH are reported. RESULTS A total of 51 patients were included with most of them being male (n = 34, 66.7%). According to the 8th edition of AJCC TNM staging, there were four (7.8%) patients in stage I, 13 (25.5%) in stage II, 33 (64.7%) in stage III and one (2.0%) in stage IV. The average duration for LND was about 1 h (67.7 ± 6.9 min). After surgery, four patients developed morbidities, but all were treated successfully with no perioperative mortality. Among the 51 patients included, the percentage of patients who had lymph node metastasis at station 8p was 9.8%. Of note, with a total of 14 lymph nodes harvested at station 8p, the incidence of nodal metastasis was 14.3%. CONCLUSION About one in 10 patients with advanced gastric cancer had nodal metastasis at station 8p. The new approach of SPLD-PPPH is safe and effective for D2+ LND during laparoscopic radical gastrectomy.

https://doi.org/10.12998/wjcc.v10.i6.1834

Superior pancreatic lymphadenectomy with portal vein priority via posterior common hepatic artery approach in laparoscopic radical gastrectomy

Research has confirmed that plasma albumin (Alb), prealbumin (PA) and fibrinogen (Fib) are involved in regulating the occurrence and development of various tumors. Their levels in peripheral blood are related to the survival outcome and treatment response of patients, but the accuracy and specificity of single application have yet to be fully realized. A growing amount of evidence indicates that predictors such as preoperative fibrinogen to prealbumin ratio (FPR), fibrinogen to albumin ratio (FAR) or albumin to fibrinogen ratio (AFR) are emerging as comprehensive indicators. Indeed, their components play a key regulatory role in the progression of colorectal cancer (CRC). Preoperative FPR, FAR or AFR levels, therefore, are expected to become new biomarkers for prognosis evaluation and curative effect prediction for CRC patients and are significant in the guidance they could provide for the development of individualized treatment strategies.

/pdf/research-progress-of-preoperative-fpr-far-or-afr-in-patients-2kln105jf5.pdf

Research Progress of Preoperative FPR, FAR or AFR in Patients with Colorectal Cancer.

Background: A worldwide outbreak of coronavirus disease 2019 (COVID-19) has resulted in millions of deaths. Ferroptosis is a form of iron-dependent cell death which is characterized by accumulation of lipid peroxides on cellular membranes, and is related with many physiological and pathophysiological processes of diseases such as cancer, inflammation and infection. However, the role of ferroptosis in COVID-19 has few been studied. Material and Method: Based on the RNA-seq data of 100 COVID-19 cases and 26 Non-COVID-19 cases from GSE157103, we identified ferroptosis related differentially expressed genes (FRDEGs, adj.P-value < .05) using the “Deseq2” R package. By using the “clusterProfiler” R package, we performed Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment. Next, a protein-protein interaction (PPI) network of FRDEGs was constructed and top 30 hub genes were selected by cytoHubba in Cytoscape. Subsequently, we established a prediction model for COVID-19 by utilizing univariate logistic regression and the least absolute shrinkage and selection operator (LASSO) regression. Based on core FRDEGs, COVID-19 patients were identified as two clusters using the “ConsenesusClusterPlus” R package. Finally, the miRNA-mRNA network was built by Targetscan online database and visualized by Cytoscape software. Results: A total of 119 FRDEGs were identified and the GO and KEGG enrichment analyses showed the most important biologic processes are oxidative stress response, MAPK and PI3K-AKT signaling pathway. The top 30 hub genes were selected, and finally, 7 core FRDEGs (JUN, MAPK8, VEGFA, CAV1, XBP1, HMOX1, and HSPB1) were found to be associated with the occurrence of COVID-19. Next, the two patterns of COVID-19 patients had constructed and the cluster A patients were likely to be more severe. Conclusion: Our study suggested that ferroptosis was involved in the pathogenesis of COVID-19 disease and the functions of core FRDEGs may become a new research aspect of this disease.

The Biological Processes of Ferroptosis Involved in Pathogenesis of COVID-19 and Core Ferroptoic Genes Related With the Occurrence and Severity of This Disease

Objective
To analyze the feasibility of No.8p lymphadenectomy for the patients with advanced gastric cancer and to preliminaryly explore its value in improving prognosis.


Methods
Clinical data of 1158 patients with advanced gastric cancer undergoing radical gastrectomy plus D2 or above D2 lymphadenectomy (No.8 lymphadenectomy) from July 2003 to July 2013 at Department of Gastrointestinal Surgery, Fujian Cancer Hospital were collected. A retrospective cohort study was carried out. Among 1158 patients, 343 patients from July 2003 to June 2008 only received No.8a lymph node dissection (No.8a group) , and 815 patients from July 2008 to July 2013 received No.8a+No.8p lymph node dissection (No.8a+No.8p group) . Patients in No.8a group received the dissection of the lymph nodes in the upper margin of the pancreas and the front of total hepatic artery, and those in No.8a+No.8p group, on the basis of No.8a group, received the dissection of lymph nodes in the common hepatic artery and the left lymph nodes behind the hepatic artery and the portal vein. The metastasis degree and metastasis rate of lymph node (No.8a and No.8p) , as well as intraoperative and postoperative presentations in both groups were investigated. The prognosis of two groups were analyzed with Kaplan-Meier method and Log-rank test.


Results
Among 1158 patients with advanced gastric cancer, 849 were males and 309 were females with aged 17 to 83 (58.5 ±11.7) years. Radical distal gastrectomy was performed in 325 cases (28.1%) and radical total gastrectomy in 833 cases (71.9%) . All the patients completed operations successfully. A total of 2587 No.8a lymph nodes were removed, and the lymph node metastasis rate and metastasis degree of No.8a were 20.6% (239/1158) and 13.0% (336/2587) , respectively. A total of 2170 No.8p lymph nodes were removed, and the lymph node metastasis rate and metastasis degree of No.8p were 10.9% (89/815) and 7.2% (156/2170) , respectively. The operation time of the No.8a+No.8p group was longer than that of No.8a group[ (180.2±40.3) minutes vs. (168.4±41.8) minutes], and the difference was statistically significant (t=-4.627, P=0.000) . However, intraoperative blood loss[ (222.8±92.8) ml vs. (215.6±91.1) ml], postoperative 1-day peritoneal drainage volume[ (257.7±120.0) ml vs. (270.3±121.0) ml], time to withdraw of gastric tube[ (2.1±0.9) days vs. (2.2±0.8) days], time to withdraw of peritoneal tube[ (6.8±1.1) days vs. (6.9±1.1) days], time to withdraw of nasal feeding tube[ (6.5±1.2) days vs. (6.4±1.1) days], the morbidity of complications [19.8% (68/343) vs. 16.0% (130/815) ] and postoperative hospital stay[ (8.1±3.0) days vs. (8.3±3.1) days] in No.8a group and No.8a+No.8p group were not significantly different (all P>0.05) . The average follow-up period was 41 (2 to 144) months. The median postoperative survival was 83.0 months, and the 1-, 2-, and 5-year survival rates were 90.9%, 78.8% and 56.9% in No.8a group respectively. The median survival was 94.8 months, 1-, 2-, and 5-survival rates were 94.9%, 82.3% and 63.0% in No.8a+No.8p group respectively. The survival rate of No.8a+No.8p group was significantly higher than that of No.8a group (P=0.016) . The stratified analysis showed that in stage II patients, the survival rate of No.8a+No.8p lymph node dissection was significantly higher than that of only No.8a lymph node dissection (P=0.021) , but difference of survival between two groups was not significantly different in stage I patients (P=0.469) and stage III patients (P=0.820) .


Conclusion
For the patients with advanced gastric cancer, the dissection of No.8a+No.8p is safe and feasible, and may improve the prognosis, especially for those with stage II, suggesting that No.8a+No.8p lymphadenectomy should be performed for selected patients with advanced gastric cancer.


Key words: 
Stomach neoplasms; Lymph node excision; Prognosis

Feasibility of No.8p lymphadenectomy for the patients with advanced gastric cancer

Effect of perineural invasion in prognosis of 1 801 patients undergoing radical resection of gastric cancer

MicroRNA-451 (miR-451) is lowly expressed in stomach cancer cells and improves their metastatic ability by down-regulating extracellular signal-regulated kinase 2 (ERK2). Many studies have found that caveolin-1 (CAV1) plays an important role in cancer progression. Additionally, miR-451 has been reported to regulate the expression of CAV1 in chronic obstructive pulmonary disease. Therefore, this study aims to determine if miR-451 regulates the biological functions of stomach cancer cells by regulating CAV1 expression. Through a bioinformatics analysis, we found that miR-451a regulates CAV1 expression, and miR-451a expression is relatively low in stomach cancer cells. Next, we confirmed that miR-451a negatively regulates CAV1 expression using a dual-luciferase reporter assay. Then MTT, 5-ethynyl-2'-deoxyuridine (EdU), propidium iodide (PI), an Annexin V-FITC/PI apoptosis kit, and transwell assays were used to measure the changes in cell proliferation, the cell cycle, apoptosis, cell migration, and invasiveness in stomach cancer cells overexpressing miR-451a or both miR-451a and CAV1. It was found that increasing the miR-451a expression in stomach cancer cells inhibits cell growth, migration, and invasiveness, and promotes apoptosis. After restoring the CAV1 expression, these biological processes resumed. In summary, in stomach cancer cells, the overexpression of miR-451a can restrain cell growth and promote apoptosis, so it is a potential treatment for stomach cancer.

MicroRNA-451a targets caveolin-1 in stomach cancer cells.

Objective
To evaluate the clinicopathologic characteristics and prognosis of gastric stump cancer in relation to serum albumin level.


Methods
The clinical data of 149 gastric stump cancer patients treated from Jan 1999 to Jun 2015 were analyzed. Patients were divided into normal serum albumin group (>35 g/L, n=81) and group of hypoalbuminemia (≤35 g/L, n=68).


Results
Clinicopathologic characteristics, tumor size, depth of invasion, lymph node status and TNM stage were significantly different between the two groups (P<0.05). Univariate analysis showed that factors that influence prognosis were serum albumin level, tumor size, serosal invasion, tumor location and tumor curative resection rate (all P<0.05). Cox′s proportional hazard regression model showed that serum albumin level and tumor curative resection rate were independent prognostic factors for survival, lymph node matastasis(2.2±4.3) vs. (4.1±4.4)were significantly different between the two groups (P<0.05). The overall 5-year survival rate was 44.1%. The 5-year survival rate were 54.0% for normal albumin group and 32.2% for hypoalbuminemic group, P=0.011.


Conclusion
Lower preoperative serum albumin level is associated with poorer prognosis in gastric stump cancer patients.


Key words: 
Stomach neoplasms; Serum albumin; Pathology, clinical; Prognosis

Association of preoperative serum albumin level with clinicopathologic features and prognosis in gastric stump cancer

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Feasibility of No.8p lymphadenectomy for the patients with advanced gastric cancer

Effect of perineural invasion in prognosis of 1 801 patients undergoing radical resection of gastric cancer

MicroRNA-451a targets caveolin-1 in stomach cancer cells.

Association of preoperative serum albumin level with clinicopathologic features and prognosis in gastric stump cancer