Objective:The previously integrated tumor-inflammation-nutrition(HI-GC)score has demonstrated dynamic monitoring value for recurrence and clinical decision-making in patients with postsurgical gastric cancer(GC).Howev...Objective:The previously integrated tumor-inflammation-nutrition(HI-GC)score has demonstrated dynamic monitoring value for recurrence and clinical decision-making in patients with postsurgical gastric cancer(GC).However,its failure to incorporate clinical-pathological factors limits its capacity for baseline risk assessment.This study aimed to develop a model that accurately identifies patients for adjuvant chemotherapy and dynamically evaluates recurrence risk.Methods:This retrospective,multicenter,longitudinal cohort study,spanning nine hospitals,included 7,085patients with GC post-radical gastrectomy.A baseline prognostic model was constructed using 117 machinelearning algorithms.The dynamic survival decision tree model(dy SDT)was employed to combine the baseline model with the HI-GC score.Results:A Cox regression model incorporating six factors was used to create a nomogram[Harrell's C-index:training cohort:0.765;95%confidence interval(95%CI):0.747,0.783;validation set:0.810;95%CI:0.747,0.783],including p T stage,positive lymph node ratio,p N stage,tumor size,age,and adjuvant chemotherapy.The best-performing machine learning model exhibited similar predictive accuracy to the nomogram(C-index:0.770).For the short-term dy SDT at 1 month,the mortality hazard ratios(HRs)for groups IIa,IIb,andⅢwere 2.61(95%CI:2.24,3.04),5.02(95%CI:4.15,6.06),and 8.88(95%CI:7.57,10.42),respectively,compared to group I.Stratified analysis revealed a significant interaction between adjuvant chemotherapy and overall survival in each subgroup(P<0.001).The long-term dy SDT at 1 year showed HRs of 3.25(95%CI:2.12,4.97)for group II,6.73(95%CI:4.29,10.56)for groupⅢa,and 17.88(95%CI:10.71,29.84)for groupⅢb.Conclusions:The dy SDT effectively stratifies mortality risk and provides valuable assistance in clinical decision-making after gastrectomy.展开更多
Objective:The systemic inflammation index and body mass index(BMI)are easily accessible markers that can predict mortality.However,the prognostic value of the combined use of these two markers remains unclear.The goal...Objective:The systemic inflammation index and body mass index(BMI)are easily accessible markers that can predict mortality.However,the prognostic value of the combined use of these two markers remains unclear.The goal of this study was therefore to evaluate the association of these markers with outcomes based on a large cohort of patients with gastric cancer.Methods:A total of 2,542 consecutive patients undergoing radical surgery for gastric or gastroesophageal junction adenocarcinoma between 2009 and 2014 were included.Systemic inflammation was quantified by the preoperative neutrophil-to-lymphocyte ratio(NLR).High systemic inflammation was defined as NLR≥3,and underweight was defined as BMI<18.5 kg/m2.Results:Among 2,542 patients,NLR≥3 and underweight were common[627(25%)and 349(14%),respectively].In the entire cohort,NLR≥3 or underweight independently predicted overall survival(OS)[hazard ratio(HR):1.236,95%confidence interval(95%CI):1.069–1.430;and HR:1.600,95%CI:1.350–1.897,respectively]and recurrence-free survival(RFS)(HR:1.230,95%CI:1.054–1.434;and HR:1.658,95%CI:1.389–1.979,respectively).Patients with both NLR≥3 and underweight(vs.neither)had much worse OS(HR:2.445,95%CI:1.853–3.225)and RFS(HR:2.405,95%CI:1.802–3.209).Furthermore,we observed similar results in subgroup analyses according to pathological stage,age,and postoperative chemotherapy.Conclusions:Our results showed that preoperative elevated NLR and decreased BMI had a significant negative effect on survival.Underweight combined with severe inflammation could enhance prognostication.Taking active therapeutic measures to reduce inflammation and increase nutrition may help improve outcomes.展开更多
Background:Carbohydrate drinking 2-3 hours before surgery has been widely adopted in colorectal operations.However,there is lit-tle direct evidence regarding its application in gastric cancer surgery.We aimed to evalu...Background:Carbohydrate drinking 2-3 hours before surgery has been widely adopted in colorectal operations.However,there is lit-tle direct evidence regarding its application in gastric cancer surgery.We aimed to evaluate the gastric residual volume,safety,and effectiveness of drinking 250 mL of 5%glucose solution 2-3 hours before elective gastric cancer surgery.Methods:We conducted an investigator-initiated,multicenter,randomized-controlled,parallel group,and equivalence trial.Eighty-eight patients with gastric adenocarcinoma were randomized into study or control group.Patients in the control group followed the traditional routine of 6-8 hours preoperative fasting,while those in the study group drank 250 mL of 5%glucose solution 2-3 hours be-fore surgery.Immediately following tracheal intubation,gastric contents were aspirated through gastroscopy.The primary outcome was preoperative gastric residual volume.Results:Eighty-three patients were eventually analysed in the study(42 in the study group and 41 in the control group).Two groups were comparable at baseline characteristics.There were no statistical differences in residual gastric fluid volumes(35.86±27.13 vs 27.70±20.37 mL,P=0.135)and pH values(2.81±1.99 vs 2.66±1.68,P=0.708)between the two groups.Preoperative discomfort was significantly more decreased in the study group than in the control group(thirst score:1.49±1.23 vs 4.14±2.07,P<0.001;hunger score:1.66±1.18 vs 3.00±2.32,P=0.007).There was no statistical difference in the incidence of postoperative complications(19.05%vs 17.07%,P=0.815).Conclusions:Drinking 250 mL of 5%glucose solution 2-3 hours before surgery in elective gastric cancer patients shows benefits in lowering thirst and hunger scores without increasing gastric residual volume and perioperative complications.展开更多
To the Editor:Probiotics are a promising treatment modality for functional constipation(FC);however,the factors affecting individual responses to probiotics remain unclear.Growing evidence has identified that there is...To the Editor:Probiotics are a promising treatment modality for functional constipation(FC);however,the factors affecting individual responses to probiotics remain unclear.Growing evidence has identified that there is a strong relationship among the gut microbiota and constipation and related gut-brain axis.[1]The gut microbiota may modulate the gut functions via gut metabolites or trigger the release of gut hormones,such as peptide YY,gastric inhibitory polypeptide,and 5-hydroxytryptamine.[2]In turn,gut hormones affect gut secretion,motility,and sensation through their receptors located on epithelial,enteric,and smooth muscle cells.[2]Based on these findings,exogenous probiotics have been used in patients with constipation;however,few have produced consistent results.[3]In this study,we investigated the efficacy and safety of several specific probiotics strains for constipation,and also examined the potential reasons for the individualized effects of probiotics,which may facilitate interventional decisionmaking for FC patients.展开更多
基金supported by the Noncommunicable Chronic Diseases-National Science and Technology Major Project(No.2023ZD0501400)the National Key R&D Program of China(No.2022YFC2505100)the National Natural Science Foundation of China(No.82202837,82421002 and 82350122)。
文摘Objective:The previously integrated tumor-inflammation-nutrition(HI-GC)score has demonstrated dynamic monitoring value for recurrence and clinical decision-making in patients with postsurgical gastric cancer(GC).However,its failure to incorporate clinical-pathological factors limits its capacity for baseline risk assessment.This study aimed to develop a model that accurately identifies patients for adjuvant chemotherapy and dynamically evaluates recurrence risk.Methods:This retrospective,multicenter,longitudinal cohort study,spanning nine hospitals,included 7,085patients with GC post-radical gastrectomy.A baseline prognostic model was constructed using 117 machinelearning algorithms.The dynamic survival decision tree model(dy SDT)was employed to combine the baseline model with the HI-GC score.Results:A Cox regression model incorporating six factors was used to create a nomogram[Harrell's C-index:training cohort:0.765;95%confidence interval(95%CI):0.747,0.783;validation set:0.810;95%CI:0.747,0.783],including p T stage,positive lymph node ratio,p N stage,tumor size,age,and adjuvant chemotherapy.The best-performing machine learning model exhibited similar predictive accuracy to the nomogram(C-index:0.770).For the short-term dy SDT at 1 month,the mortality hazard ratios(HRs)for groups IIa,IIb,andⅢwere 2.61(95%CI:2.24,3.04),5.02(95%CI:4.15,6.06),and 8.88(95%CI:7.57,10.42),respectively,compared to group I.Stratified analysis revealed a significant interaction between adjuvant chemotherapy and overall survival in each subgroup(P<0.001).The long-term dy SDT at 1 year showed HRs of 3.25(95%CI:2.12,4.97)for group II,6.73(95%CI:4.29,10.56)for groupⅢa,and 17.88(95%CI:10.71,29.84)for groupⅢb.Conclusions:The dy SDT effectively stratifies mortality risk and provides valuable assistance in clinical decision-making after gastrectomy.
基金supported by the National Major Research and the Innovation Program of China(Grant No.2016YFC1303200)the National Key R&D Program of China(Grant No.2017YFC0908300)the National Natural Science Foundation of China(Grant No.81972761)。
文摘Objective:The systemic inflammation index and body mass index(BMI)are easily accessible markers that can predict mortality.However,the prognostic value of the combined use of these two markers remains unclear.The goal of this study was therefore to evaluate the association of these markers with outcomes based on a large cohort of patients with gastric cancer.Methods:A total of 2,542 consecutive patients undergoing radical surgery for gastric or gastroesophageal junction adenocarcinoma between 2009 and 2014 were included.Systemic inflammation was quantified by the preoperative neutrophil-to-lymphocyte ratio(NLR).High systemic inflammation was defined as NLR≥3,and underweight was defined as BMI<18.5 kg/m2.Results:Among 2,542 patients,NLR≥3 and underweight were common[627(25%)and 349(14%),respectively].In the entire cohort,NLR≥3 or underweight independently predicted overall survival(OS)[hazard ratio(HR):1.236,95%confidence interval(95%CI):1.069–1.430;and HR:1.600,95%CI:1.350–1.897,respectively]and recurrence-free survival(RFS)(HR:1.230,95%CI:1.054–1.434;and HR:1.658,95%CI:1.389–1.979,respectively).Patients with both NLR≥3 and underweight(vs.neither)had much worse OS(HR:2.445,95%CI:1.853–3.225)and RFS(HR:2.405,95%CI:1.802–3.209).Furthermore,we observed similar results in subgroup analyses according to pathological stage,age,and postoperative chemotherapy.Conclusions:Our results showed that preoperative elevated NLR and decreased BMI had a significant negative effect on survival.Underweight combined with severe inflammation could enhance prognostication.Taking active therapeutic measures to reduce inflammation and increase nutrition may help improve outcomes.
基金supported by the National Natural Science Foundation of China[grant numbers 82172637 and 81702319]the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences[grant number 2021-JKCS-004]+1 种基金the Guangdong Provincial Key Laboratory of Digestive Cancer Research[grant number 2021B1212040006]Research startup fund of part-time PI,SAHSYSU[grant number ZSQYJZPI202010].
文摘Background:Carbohydrate drinking 2-3 hours before surgery has been widely adopted in colorectal operations.However,there is lit-tle direct evidence regarding its application in gastric cancer surgery.We aimed to evaluate the gastric residual volume,safety,and effectiveness of drinking 250 mL of 5%glucose solution 2-3 hours before elective gastric cancer surgery.Methods:We conducted an investigator-initiated,multicenter,randomized-controlled,parallel group,and equivalence trial.Eighty-eight patients with gastric adenocarcinoma were randomized into study or control group.Patients in the control group followed the traditional routine of 6-8 hours preoperative fasting,while those in the study group drank 250 mL of 5%glucose solution 2-3 hours be-fore surgery.Immediately following tracheal intubation,gastric contents were aspirated through gastroscopy.The primary outcome was preoperative gastric residual volume.Results:Eighty-three patients were eventually analysed in the study(42 in the study group and 41 in the control group).Two groups were comparable at baseline characteristics.There were no statistical differences in residual gastric fluid volumes(35.86±27.13 vs 27.70±20.37 mL,P=0.135)and pH values(2.81±1.99 vs 2.66±1.68,P=0.708)between the two groups.Preoperative discomfort was significantly more decreased in the study group than in the control group(thirst score:1.49±1.23 vs 4.14±2.07,P<0.001;hunger score:1.66±1.18 vs 3.00±2.32,P=0.007).There was no statistical difference in the incidence of postoperative complications(19.05%vs 17.07%,P=0.815).Conclusions:Drinking 250 mL of 5%glucose solution 2-3 hours before surgery in elective gastric cancer patients shows benefits in lowering thirst and hunger scores without increasing gastric residual volume and perioperative complications.
基金National Natural Science Foundation of China(Nos.81900483 and 81730016)National Clinical Research Center for Digestive Diseases,Xi’an,China(No.2015BAI13 B07)
文摘To the Editor:Probiotics are a promising treatment modality for functional constipation(FC);however,the factors affecting individual responses to probiotics remain unclear.Growing evidence has identified that there is a strong relationship among the gut microbiota and constipation and related gut-brain axis.[1]The gut microbiota may modulate the gut functions via gut metabolites or trigger the release of gut hormones,such as peptide YY,gastric inhibitory polypeptide,and 5-hydroxytryptamine.[2]In turn,gut hormones affect gut secretion,motility,and sensation through their receptors located on epithelial,enteric,and smooth muscle cells.[2]Based on these findings,exogenous probiotics have been used in patients with constipation;however,few have produced consistent results.[3]In this study,we investigated the efficacy and safety of several specific probiotics strains for constipation,and also examined the potential reasons for the individualized effects of probiotics,which may facilitate interventional decisionmaking for FC patients.
