BACKGROUND Lymph node status is a critical prognostic factor in gastric cancer(GC),but stage migration may occur in pathological lymph nodes(pN)staging.To address this,alternative staging systems such as the positive ...BACKGROUND Lymph node status is a critical prognostic factor in gastric cancer(GC),but stage migration may occur in pathological lymph nodes(pN)staging.To address this,alternative staging systems such as the positive lymph node ratio(LNR)and log odds of positive lymph nodes(LODDS)were introduced.AIM To assess the prognostic accuracy and stratification efficacy of three nodal staging systems in GC.METHODS A systematic review identified 12 studies,from which hazard ratios(HRs)for overall survival(OS)were summarized.Sensitivity analyses,subgroup analyses,publication bias assessments,and quality evaluations were conducted.To enhance comparability,data from studies with identical cutoff values for pN,LNR,and LODDS were pooled.Homogeneous stratification was then applied to generate Kaplan-Meier(KM)survival curves,assessing the stratification efficacy of three staging systems.RESULTS The HRs and 95%confidence intervals for pN,LNR,and LODDS were 2.16(1.72-2.73),2.05(1.65-2.55),and 3.15(2.15-4.37),respectively,confirming all three as independent prognostic risk factors for OS.Comparative analysis of HRs demonstrated that LODDS had superior prognostic predictive power over LNR and pN.KM curves for pN(N0,N1,N2,N3a,N3b),LNR(0.1/0.2/0.5),and LODDS(-1.5/-1.0/-0.5/0)revealed significant differences(P<0.001)among all prognostic stratifications.Mean differences and standard deviations in 60-month relative survival were 27.93%±0.29%,41.70%±0.30%,and 26.60%±0.28%for pN,LNR,and LODDS,respectively.CONCLUSION All three staging systems are independent prognostic factors for OS.LODDS demonstrated the highest specificity,making it especially useful for predicting outcomes,while pN was the most effective in homogeneous stratification,offering better patient differentiation.These findings highlight the complementary roles of LODDS and pN in enhancing prognostic accuracy and stratification.展开更多
BACKGROUND Duodenal stump fistula(DSF)is a rare yet serious complication following gastric cancer surgery.The risk factors associated with DSF,as well as the predictive models,remain insufficiently elucidated.AIM To i...BACKGROUND Duodenal stump fistula(DSF)is a rare yet serious complication following gastric cancer surgery.The risk factors associated with DSF,as well as the predictive models,remain insufficiently elucidated.AIM To identify DSF risk factors following radical gastrectomy with Roux-en-Y anastomosis,develop a predictive model,and evaluate impact on prognosis.METHODS This retrospective cohort study was conducted on patients undergoing radical gastrectomy with Roux-en-Y anastomosis for gastric cancer at Juntendo University from 2015 to 2021(n=325).Univariate and multivariate analyses were performed to identify the risk factors associated with DSF.Based on the independent risk factors,a predictive nomogram was developed and subsequently evaluated using receiver operating characteristic curve analysis.Kaplan-Meier survival curves were utilized to assess the impact of DSF on overall survival(OS),cancerspecific survival(CSS),and disease-free survival(DFS).RESULTS Among the 325 patients analyzed,DSF was observed in 7(2.2%)cases.No DSF was observed in 110 patients where the duodenal stump suturing fixation technique to the jejunal wall was used.Multivariate analysis confirmed that age[odds ratio(OR)=1.17,P=0.015]and obstructive ventilatory failure(OVF)(OR=14.03,P=0.001)were independent risk factors for DSF.The predictive nomogram was constructed based on age and OVF,which exhibited strong performance(area under the curve=0.90,95%confidence interval:0.82-0.99).Kaplan-Meier analysis revealed a statistically significant reduction in CSS for patients with DSF,whereas no significant differences were observed in OS or DFS.CONCLUSION Age and OVF are independent risk factors for DSF,which worsens CSS.A nomogram predicts DSF accurately,and innovative surgical techniques may reduce its occurrence.展开更多
基金the Clinical Medical Team Introduction Program of Suzhou,No.SZYJTD201804.
文摘BACKGROUND Lymph node status is a critical prognostic factor in gastric cancer(GC),but stage migration may occur in pathological lymph nodes(pN)staging.To address this,alternative staging systems such as the positive lymph node ratio(LNR)and log odds of positive lymph nodes(LODDS)were introduced.AIM To assess the prognostic accuracy and stratification efficacy of three nodal staging systems in GC.METHODS A systematic review identified 12 studies,from which hazard ratios(HRs)for overall survival(OS)were summarized.Sensitivity analyses,subgroup analyses,publication bias assessments,and quality evaluations were conducted.To enhance comparability,data from studies with identical cutoff values for pN,LNR,and LODDS were pooled.Homogeneous stratification was then applied to generate Kaplan-Meier(KM)survival curves,assessing the stratification efficacy of three staging systems.RESULTS The HRs and 95%confidence intervals for pN,LNR,and LODDS were 2.16(1.72-2.73),2.05(1.65-2.55),and 3.15(2.15-4.37),respectively,confirming all three as independent prognostic risk factors for OS.Comparative analysis of HRs demonstrated that LODDS had superior prognostic predictive power over LNR and pN.KM curves for pN(N0,N1,N2,N3a,N3b),LNR(0.1/0.2/0.5),and LODDS(-1.5/-1.0/-0.5/0)revealed significant differences(P<0.001)among all prognostic stratifications.Mean differences and standard deviations in 60-month relative survival were 27.93%±0.29%,41.70%±0.30%,and 26.60%±0.28%for pN,LNR,and LODDS,respectively.CONCLUSION All three staging systems are independent prognostic factors for OS.LODDS demonstrated the highest specificity,making it especially useful for predicting outcomes,while pN was the most effective in homogeneous stratification,offering better patient differentiation.These findings highlight the complementary roles of LODDS and pN in enhancing prognostic accuracy and stratification.
基金Supported by the China Scholarship Council Fund,No.202308050094.
文摘BACKGROUND Duodenal stump fistula(DSF)is a rare yet serious complication following gastric cancer surgery.The risk factors associated with DSF,as well as the predictive models,remain insufficiently elucidated.AIM To identify DSF risk factors following radical gastrectomy with Roux-en-Y anastomosis,develop a predictive model,and evaluate impact on prognosis.METHODS This retrospective cohort study was conducted on patients undergoing radical gastrectomy with Roux-en-Y anastomosis for gastric cancer at Juntendo University from 2015 to 2021(n=325).Univariate and multivariate analyses were performed to identify the risk factors associated with DSF.Based on the independent risk factors,a predictive nomogram was developed and subsequently evaluated using receiver operating characteristic curve analysis.Kaplan-Meier survival curves were utilized to assess the impact of DSF on overall survival(OS),cancerspecific survival(CSS),and disease-free survival(DFS).RESULTS Among the 325 patients analyzed,DSF was observed in 7(2.2%)cases.No DSF was observed in 110 patients where the duodenal stump suturing fixation technique to the jejunal wall was used.Multivariate analysis confirmed that age[odds ratio(OR)=1.17,P=0.015]and obstructive ventilatory failure(OVF)(OR=14.03,P=0.001)were independent risk factors for DSF.The predictive nomogram was constructed based on age and OVF,which exhibited strong performance(area under the curve=0.90,95%confidence interval:0.82-0.99).Kaplan-Meier analysis revealed a statistically significant reduction in CSS for patients with DSF,whereas no significant differences were observed in OS or DFS.CONCLUSION Age and OVF are independent risk factors for DSF,which worsens CSS.A nomogram predicts DSF accurately,and innovative surgical techniques may reduce its occurrence.
