Objective To understand the changes of intestinal flora during perioperative period of colorectal cancer and the mechanism affecting the occurrence of postoperative anastomotic leakage, so as to improve perioperative management of patients and find possible measures to decrease the incidence rate of anastomotic leakage. Method The literature related to perioperative intestinal flora assessment, anastomotic healing, and anastomotic leakage of colorectal cancer in recent years was comprehensively searched in the CNKI, PubMed, and Embase databases and made an review. ResultsDue to the various perioperative interventions, the diversity and abundance of intestinal flora had changed after colorectal cancer surgery, and some conditional pathogenic bacteria such as Enterococcus faecalis, Pseudomonas aeruginosa, etc. increased obviously, which led to collagen degradation through the expression of bacterial collagenase or the excessive activation of matrix metalloproteinases in the host intestine, then might lead to the poor anastomotic healing and even the anastomotic leakage. ConclusionAlthough the evidence of effect of intestinal flora on anastomotic leakage mainly comes from animal experiments, it still shows the potential role of intestinal flora in the occurrence of anastomotic leakage after colorectal cancer surgery, and can be regulated by perioperative intervention, which suggests that it may provide a new strategy for prevention of anastomotic leakage.
Objective To summarize the stemness regulation mechanism of microRNA on invasion, metastasis and chemoresistance of gastric cancer stem cells (GCSCs), and to explore the anti-tumor therapy based on miRNA targeting GCSCs. Method The literatures about the research progress of miRNA and GCSCs at home and abroad in recent years were collected and reviewed. Results MiRNA could regulate a series of important cellular processes such as proliferation, apoptosis, differentiation and epithelial-mesenchymal transition of GCSCs by participating in the expression of related target genes, which was associated with poor prognosis and high mortality of gastric cancer patients. Silencing or restoring the expression of candidate miRNA of GCSCs could provide a novel and promising approach for the treatment of gastric cancer. Conclusions GCSCs have an important relationship with the malignant biological behavior of gastric cancer, and studies have confirmed that miRNA play an important regulatory role in GCSCs. Therefore, miRNA can be used as a potential target for the treatment of gastric cancer. By regulating the expression of specific miRNA, it can inhibit tumor invasion and metastasis, and improve the sensitivity of chemotherapy drugs.
ObjectiveTo investigate the risk factors and establish the predictive pattern of the metachronous liver metastasis after curative surgery for patientswith gastric cancer. MethodsThe clinicopathologic data of patients who underwent radical gastric cancer surgery and met the inclusion and exclusion criteria from January 1, 2015 and January 1, 2018 in the First Hospital of Lanzhou University were retrospectively analyzed. The risk factors affecting metachronous liver metastasis of gastric cancer were screened out by univariate and multivariate logistic regression analysis. And a nomogram prediction model based on the risk factors screened out was established and its predictive efficiency was evaluated. ResultsA total of 203 patients were collected in this study, of whom 41 (20.4%) developed metachronous liver metastasis of gastric cancer. The results of multivariate logistic regression analysis showed that the tumor diameter ≥5 cm, increasing intraoperative bleeding, carcinoembryonic antigen (CEA) ≥5 μg/L, and lymphovascular invasion increased the risks of metachronous liver metastasis of gastric cancer (all P<0.05). The area under the receiver operating characteristic curve and its 95% confidence interval (95%CI) of the nomogram based on these risk factors in predicting metachronous liver metastasis of gastric cancer was 0.850 (0.793, 0.908), and the consistency index (95%CI) was 0.812 (0.763, 0.859). The calibration curve for predicting the risk of metachronous liver metastasis in gastric cancer by the nomogram was close to the 45° ideal curve and had a stronger calibration (Hosmer Limeshow goodness-of-fit test, χ2=2.116, P=0.347). ConclusionsThe results of this study conclude metachronous liver metastasis of gastric cancer is not low, and the patient with lymphovascular invasion, higher level of CEA (≥5 μg/L), more intraoperative bleeding, and larger tumor diameter (≥5 cm) has a higher risk of metachronous liver metastasis of gastric cancer. The nomogram prediction model established based on these risk factors has a good predictive efficiency and can provide reference for clinicians to identify high-risk patient and take early interventions.
Objective To determine the risk factors of anastomotic leakage after elective colectomy in elderly patients with colon cancer, and to establish a model for predicting the risk of postoperative anastomotic leakage based on these factors. Methods The clinical data of 122 over 65 years old elderly patients who underwent colon cancer surgery in the First Hospital of Lanzhou University from January 2018 to December 2021 were analyzed retrospectively. Single factor analysis and multivariate logistic regression were used to analyze the potential risk factors for anastomotic leakage. A nomogram predictive model was established based on the determined independent risk factors, and the predictive performance of the model was evaluated by the receiver operating characteristic curve. Results Among the 122 patients included in this study, 10 had postoperative anastomotic leakage and 112 had no anastomotic leakage. Single factor analysis results showed that the occurrence of anastomotic leakage was associated with body mass index, smoking, combined diabetes, age-adjusted Charlson comorbidity index, intraoperative and postoperative blood transfusion within 2 days, preoperative hemoglobin, preoperative albumin, and preoperative prognostic nutritional index (P＜0.05). The results of multivariate logistic regression analysis showed that smoking [OR=15.529, 95%CI (1.529, 157.690), P=0.020], age-adjusted Charlson comorbidity index [OR=1.742, 95%CI (1.024, 2.966), P=0.041], and intraoperative and postoperative blood transfusion within 2 days [OR=82.223, 95%CI (1.265, 5 343.025), P=0.038] were independent risk factors for anastomotic leakage. A nomogram predictive model was established based on three independent risk factors. The area under the receiver operating characteristic curve of the model was 0.897 [95%CI (0.804, 0.990)], and its corrected C-index value was 0.881, indicating that the model had good predictive ability for the risk of anastomotic leakage. Conclusions Smoking, higher age-adjusted Charlson comorbidity index, and intraoperative and postoperative blood transfusion within 2 days are important risk factors for anastomotic leak in elderly patients undergoing elective colon cancer resection. This nomogram predictive model based on the combination of the three factors is helpful for surgeons to optimize treatment decisions and postoperative monitoring.
ObjectiveTo analyze the relevant risk factors affecting postoperative relapse-free survival (RFS) in the primary gastrointestinal stromal tumors (GIST) and develop a Nomogram predictive model of postoperative RFS for the GIST patients. MethodsThe patients diagnosed with GIST by postoperative pathology from January 2011 to December 2020 at the First Hospital of Lanzhou University and Gansu Provincial People’s Hospital were collected, and then were randomly divided into a training set and a validation set at a ratio of 7∶3 using R software function. The univariate and multivariate Cox regression analysis were used to identify the risk factors affecting the RFS for the GIST patients after surgery, and then based on this, the Nomogram predictive model was constructed to predict the probability of RFS at 3- and 5-year after surgery for the patients with GIST. The effectiveness of the Nomogram was evaluated using the area under the receiver operating characteristic curve (AUC), consistency index (C-index), and calibration curve, and the clinical utility of the Nomogram and the modified National Institutes of Health (M-NIH) classification standard was evaluated using the decision curve analysis (DCA). ResultsA total of 454 patients were included, including 317 in the training set and 137 in the validation set. The results of multivariate Cox regression analysis showed that the tumor location, tumor size, differentiation degree, American Joint Committee onCancer TNM stage, mitotic rate, CD34 expression, treatment method, number of lymph node detection, and targeted drug treatment time were the influencing factors of postoperative RFS for the GIST patients (P<0.05). The Nomogram predictive model was constructed based on the influencing factors. The C-index of the Nomogram in the training set and validation set were 0.731 [95%CI (0.679, 0.783)] and 0.685 [95%CI (0.647, 0.722)], respectively. The AUC (95%CI) of distinguishing the RFS at 3- and 5-year after surgery were 0.764 (0.681, 0.846) and 0.724 (0.661, 0.787) in the training set and 0.749 (0.625, 0.872) and 0.739 (0.647, 0.832) in the validation set, respectively. The calibration curve results showed that a good consistency of the 3-year and 5-year recurrence free survival rates between the predicted results and the actual results in the training set, while which was slightly poor in the validation set. There was a higher net benefit for the 3-year recurrence free survival rate after GIST surgery when the threshold probability range was 0.19 to 0.57. When the threshold probability range was 0.44 to 0.83, there was a higher net benefit for the 5-year recurrence free survival rate after GIST surgery. And within the threshold probability ranges, the net benefit of the Nomogram was better than the M-NIH classification system at the corresponding threshold probability. ConclusionsThe results of this study suggest that the patients with GIST located in the other sites (mainly including the esophagus, duodenum, and retroperitoneum), with tumor size greater than 5 cm, poor or undifferentiated differentiation, mitotic rate lower than 5/50 HPF, negative CD34 expression, ablation treatment, number of lymph nodes detected more than 4, and targeted drug treatment time less than 3 months need to closely pay attentions to the postoperative recurrence. The discrimination and clinical applicability of the Nomogram predictive model are good.