BACKGROUND Gastric cancer(GC)is a prevalent malignancy with a substantial health burden and high mortality rate,despite advances in prevention,early detection,and treatment.Compared with the global average,Asia,notabl...BACKGROUND Gastric cancer(GC)is a prevalent malignancy with a substantial health burden and high mortality rate,despite advances in prevention,early detection,and treatment.Compared with the global average,Asia,notably China,reports disproportionately high GC incidences.The disease often progresses asymptoma-tically in the early stages,leading to delayed diagnosis and compromised out-comes.Thus,it is crucial to identify early diagnostic biomarkers and enhance treatment strategies to improve patient outcomes and reduce mortality.METHODS Retrospectively analyzed the clinical data of 148 patients with GC treated at the Civil Aviation Shanghai Hospital between December 2022 and December 2023.The associations of coagulation indices-partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),fibrinogen,fibrinogen degradation products(FDP),fasting blood glucose,and D-dimer(D-D)with TNM stage and distant metastasis were examined.RESULTS Prolongation of APTT,PT,and TT was significantly correlated with the GC TNM stage.Hence,abnormal coagulation system activation was closely related to disease progression.Elevated FDP and D-D were significantly associated with distant metastasis in GC(P<0.05),suggesting that increased fibrinolytic activity contributes to increased metastatic risk.CONCLUSION Our Results reveal coagulation indices,FDPs as GC biomarkers,reflecting abnormal coagulation/fibrinolysis,aiding disease progression,metastasis prediction,and helping clinicians assess thrombotic risk for early intervention and personalized treatment plans.展开更多
AIM: To investigate the clinical relevance and prognosis regarding survival according to the changes of the tumor-node-metastasis(TNM) in gastric cancer patients. METHODS: We retrospectively studied 347 consecutive su...AIM: To investigate the clinical relevance and prognosis regarding survival according to the changes of the tumor-node-metastasis(TNM) in gastric cancer patients. METHODS: We retrospectively studied 347 consecutive subjects who underwent surgery for gastric adenocarcinoma at the Division of General Surgery, Hospital of Busto Arsizio, Busto Arsizio, Italy between June 1998 and December 2009. Patients who underwent surgery without curative intent, patients with tumors of the gastric stump and patients with tumors involving the esophagus were excluded for survival analysis. Patients were staged according to the 6thand 7thedition TNM criteria; 5-year overall survival rates were investigated, and the event was defined as death from any cause. RESULTS: After exclusion, our study population included 241 resected patients with curative intent for gastric adenocarcinoma. The 5-year overall survival(5-year OS) rate of all the patients was 52.8%. Thediagnosed stage differed in 32% of 241 patients based on the TNM edition used for the diagnosis. The patients in stage Ⅱ according to the 6thedition who were reclassified as stage Ⅲ had significantly worse prognosis than patients classified as stage Ⅱ(5-year OS, 39% vs 71%). According to the 6thedition, 135 patients were classifed as T2, and 75% of these patients migrated to T3 and exhibited a significantly worse prognosis than those who remained T2, regardless of lymph node involvement(37% vs 71%). The new N1 patients exhibited a better prognosis than the previous N1 patients(67% vs 43%). CONCLUSION: 7thTNM allows new T2 and N1 patients to be selected with better prognosis, which leads to different staging. New stratification is important in multimodal therapy.展开更多
AIM:To investigate the impact of surgical procedures on prognosis of gallbladder cancer patients classified with the latest tumor-node-metastasis(TNM)staging system.METHODS:A retrospective study was performed by revie...AIM:To investigate the impact of surgical procedures on prognosis of gallbladder cancer patients classified with the latest tumor-node-metastasis(TNM)staging system.METHODS:A retrospective study was performed by reviewing 152 patients with primary gallbladder carcinoma treated at Peking Union Medical College Hospital from January 2003 to June 2013.Postsurgical follow-up was performed by telephone and outpatient visits.Clinical records were reviewed and patients were grouped based on the new edition of TNM staging system(AJCC,seventh edition,2010).Prognoses were analyzed and compared based on surgical operations including simple cholecystectomy,radical cholecystectomy(or extended radical cholecystectomy),and palliative surgery.Simple cholecystectomy is,by definition,resection of the gallbladder fossa.Radical cholecystectomy involves a wedge resection of the gallbladder fossa with 2 cm nonneoplastic liver tissue;resection of a suprapancreatic segment of the extrahepatic bile duct and extended portal lymph node dissection may also be considered based on the patient's circumstance.Palliative surgery refers to cholecystectomy with biliary drainage.Data analysis was performed with SPSS 19.0 software.KaplanMeier survival analysis and Logrank test were used for survival rate comparison.P<0.05 was consideredstatistically significant.RESULTS:Patients were grouped based on the new 7th edition of TNM staging system,including 8 cases of stage 0,10 cases of stageⅠ,25 cases of stageⅡ,21 cases of stageⅢA,21 cases of stageⅢB,24 cases of stageⅣA,43 cases of stageⅣB.Simple cholecystectomy was performed on 28 cases,radical cholecystectomy or expanded gallbladder radical resection on 57 cases,and palliative resection on 28 cases.Thirty-nine cases were not operated.Patients with stages 0 andⅠdisease demonstrated no statistical significant difference in survival time between those receiving radical cholecystectomy and simple cholecystectomy(P=0.826).The prognosis of stageⅡpatients with radical cholecystectomy was better than that of simple cholecystectomy.For stageⅢpatients,radical cholecystectomy was significantly superior to other surgical options(P<0.05).For stageⅣA patients,radical cholecystectomy was not better than palliative resection and non-surgical treatment.For stageⅣB,patients who underwent palliative resection significantly outlived those with non-surgical treatment(P<0.01)CONCLUSION:For stages 0 andⅠpatients,simple cholecystectomy is the optimal surgical procedure,while radical cholecystectomy should be actively operated for stagesⅡandⅢpatients.展开更多
BACKGROUND Oral contrast-enhanced ultrasound(OCEUS)is widely used in the noninvasive diagnosis and screening of gastric cancer(GC)in China.AIM To investigate the clinical application of OCEUS in evaluating the preoper...BACKGROUND Oral contrast-enhanced ultrasound(OCEUS)is widely used in the noninvasive diagnosis and screening of gastric cancer(GC)in China.AIM To investigate the clinical application of OCEUS in evaluating the preoperative T staging of gastric cancer.METHODS OCEUS was performed before the operation,and standard ultrasound images were retained.The depth of infiltration of GC(T-stage)was evaluated according to the American Joint Committee on Cancer 8th edition of the tumor-nodemetastasis staging criteria.Finally,with postoperative pathological staging as the gold standard reference,the sensitivity,specificity,negative predictive value,positive predictive value,and diagnostic value of OCEUS T staging were evaluated.RESULTS OCEUS achieved diagnostic accuracy rates of 76.6%(T1a),69.6%(T1b),62.7%(T2),60.8%(T3),88.0%(T4a),and 88.7%(T4b),with an average of 75.5%.Ultrasonic T staging sensitivity exceeded 62%,aside from T1b at 40.3%,while specificity was over 91%,except for T3 with 83.5%.The Youden index was above 60%,with T1b and T2 being exceptions.OCEUS T staging corresponded closely with pathology in T4b(kappa>0.75)and moderately in T1a,T1b,T2,T3,and T4a(kappa 0.40-0.75),registering a concordance rate exceeding 84%.CONCLUSION OCEUS was effective,reliable,and accurate in diagnosing the preoperative T staging of GC.As a noninvasive diagnostic technique,OCEUS merits clinical popularization.展开更多
Gastric cancer is one of the most common and fatal cancers. The importance of accurate staging for gastric cancer has become more critical due to the recent introduction of less invasive treatment options, such as end...Gastric cancer is one of the most common and fatal cancers. The importance of accurate staging for gastric cancer has become more critical due to the recent introduction of less invasive treatment options, such as endoscopic mucosal resection or laparoscopic surgery. The tumor-node-metastasis staging system is the generally accepted staging system for predicting the prognosis of patients with gastric cancer. Multidetector row computed tomography (MDCT) is a widely accepted imaging modality for the preoperative staging of gastric cancer that can simultaneously assess locoregional staging, including the gastric mass, regional lymph nodes, and distant metastasis. The diagnostic performance of MDCT for T- and N-staging has been improved by the technical development of isotropic imaging and 3D reformation. Although magnetic resonance imaging (MRI) was not previously used to evaluate gastric cancer due to the modality’s limitations, the development of high-speed sequences has made MRI a feasible tool for the staging of gastric cancer.展开更多
AIM To analyze the survival trends in colorectal cancer(CRC) based on the different classifications recommended by the seventh and eighth editions of the American Joint Committee on Cancer staging system(AJCC-7^(th) a...AIM To analyze the survival trends in colorectal cancer(CRC) based on the different classifications recommended by the seventh and eighth editions of the American Joint Committee on Cancer staging system(AJCC-7^(th) and AJCC-8^(th)).METHODS The database from our institution was queried to identify patients with pathologically confirmed stage 0-Ⅳ CRC diagnosed between 2006 and 2012. Data from 2080 cases were collected and 1090 cases were evaluated through standardized inclusion and exclusion criteria. CRC was staged by AJCC-7^(th) and then restaged by AJCC-8^(th). Five-year disease-free survival(DFS) and overall survival(OS) were compared. SPSS 21.0 software was used for all data. DFS and OS were compared and analyzed by Kaplan-Meier and Log-rank test.RESULTS Linear regression and automatic linear regression showed lymph node positive functional equations by tumornode-metastasis staging from AJCC-7^(th) and tumornode-metastasis staging from AJCC-8^(th). Neurological invasion, venous infiltration, lymphatic infiltration, and tumor deposition put forward stricter requirements for pathological examination in AJCC-8^(th) compared to AJCC-7^(th). After re-analyzing our cohort with AJCC-8^(th),the percentage of stage ⅣB cases decreased from 2.8% to 0.8%. As a result 2% of the cases were classified under the new ⅣC staging. DFS and OS was significantly shorter(P = 0.012) in stage ⅣC patients compared to stage ⅣB patients.CONCLUSION The addition of stage ⅣC in AJCC-8^(th) has shown that peritoneal metastasis has a worse prognosis than distant organ metastasis in our institution's CRC cohort. Additional datasets should be analyzed to confirm these findings.展开更多
Pathologic assessment of colorectal cancer specimens plays an essential role in patient management,informing prognosis and contributing to therapeutic decision making.The tumor-node-metastasis(TNM)staging system is a ...Pathologic assessment of colorectal cancer specimens plays an essential role in patient management,informing prognosis and contributing to therapeutic decision making.The tumor-node-metastasis(TNM)staging system is a key component of the colorectal cancer pathology report and provides important prognostic information.However there is significant variation in outcome of patients within the same tumor stage.Many other histological features such as tumor budding,vascular invasion,perineural invasion,tumor grade and rectal tumor regression grade that may be of prognostic value are not part of TNM staging.Assessment of extramural tumor deposits and peritoneal involvement contributes to TNM staging but there are some difficulties with the definition of both of these features.Controversies in colorectal cancer pathology reporting include the subjective nature of some of the elements assessed,poor reporting rates and reproducibility and the need for standardized examination protocols and reporting.Molecular pathology is becoming increasingly important in prognostication and prediction of response to targeted therapies but accurate morphology still has a key role to play in colorectal cancer pathology reporting.展开更多
Hepatocellular carcinoma(HCC)is one of the most common malignancies and a leading cause of cancer-related death worldwide.Surgery remains the primary and most successful therapy option for the treatment of early-and m...Hepatocellular carcinoma(HCC)is one of the most common malignancies and a leading cause of cancer-related death worldwide.Surgery remains the primary and most successful therapy option for the treatment of early-and mid-stage HCCs,but the high heterogeneity of HCC renders prognostic prediction challenging.The construction of relevant prognostic models helps to stratify the prognosis of surgically treated patients and guide personalized clinical decision-making,thereby improving patient survival rates.Currently,the prognostic assessment of HCC is based on several commonly used staging systems,such as Tumor-Node-Metastasis(TNM),Cancer of the Liver Italian Program(CLIP),and Barcelona Clinic Liver Cancer(BCLC).Given the insufficiency of these staging systems and the aim to improve the accuracy of prognostic prediction,researchers have incorporated further prognostic factors,such as microvascular infiltration,and proposed some new prognostic models for HCC.To provide insights into the prospects of clinical oncology research,this review describes the commonly used HCC staging systems and new models proposed in recent years.展开更多
BACKGROUND Gallbladder carcinoma(GBC)carries a poor prognosis and requires a prediction method.Gamma-glutamyl transferase–to–platelet ratio(GPR)is a recently reported cancer prognostic factor.Although the mechanism ...BACKGROUND Gallbladder carcinoma(GBC)carries a poor prognosis and requires a prediction method.Gamma-glutamyl transferase–to–platelet ratio(GPR)is a recently reported cancer prognostic factor.Although the mechanism for the relationship between GPR and poor cancer prognosis remains unclear,studies have demonstrated the clinical effect of both gamma-glutamyl transferase and platelet count on GBC and related gallbladder diseases.AIM To assess the prognostic value of GPR and to design a prognostic nomogram for GBC.METHODS The analysis involved 130 GBC patients who underwent surgery at Peking Union Medical College Hospital from December 2003 to April 2017.The patients were stratified into a high-or low-GPR group.The predictive ability of GPR was evaluated by Kaplan–Meier analysis and a Cox regression model.We developed a nomogram based on GPR,which we verified using calibration curves.The nomogram and other prognosis prediction models were compared using timedependent receiver operating characteristic curves and the concordance index.RESULTS Patients in the high-GPR group had a higher risk of jaundice,were older,and had higher carbohydrate antigen 19-9 levels and worse postoperative outcomes.Univariate analysis revealed that GPR,age,body mass index,tumor–node–metastasis(TNM)stage,jaundice,cancer cell differentiation degree,and carcinoembryonic antigen and carbohydrate antigen 19-9 levels were related to overall survival(OS).Multivariate analysis confirmed that GPR,body mass index,age,and TNM stage were independent predictors of poor OS.Calibration curves were highly consistent with actual observations.Comparisons of timedependent receiver operating characteristic curves and the concordance index showed advantages for the nomogram over TNM staging.CONCLUSION GPR is an independent predictor of GBC prognosis,and nomogram-integrated GPR is a promising predictive model for OS in GBC.展开更多
BACKGROUND T1b gallbladder carcinoma(GBC)is defined as a tumor that invades the perimuscular connective tissue without extension beyond the serosa or into the liver.However,controversy still exists over whether patien...BACKGROUND T1b gallbladder carcinoma(GBC)is defined as a tumor that invades the perimuscular connective tissue without extension beyond the serosa or into the liver.However,controversy still exists over whether patients with T1b GBC should undergo cholecystectomy alone or radical GBC resection.AIM To explore the optimal surgical approach in patients with T1b gallbladder cancer of different pathological grades.METHODS Patients with T1bN0M0 GBC who underwent surgical treatment between 2000 and 2017 were included in the Surveillance,Epidemiology,and End Results database.The Kaplan-Meier method and log-rank test were used to analyze the overall survival(OS)and disease-specific survival(DSS)of patients with T1b GBC of different pathological grades.Cox regression analysis was used to identify independent predictors of mortality and explore the selection of surgical methods in patients with T1b GBC of different pathological grades and their relationship with prognosis.RESULTS Of the 528 patients diagnosed with T1bN0M0 GBC,346 underwent simple cholecystectomy(SC)(65.5%),131 underwent SC with lymph node resection(SC+LN)(24.8%),and 51 underwent radical cholecystectomy(RC)(9.7%).Without considering the pathological grade,both the OS(P<0.001)and DSS(P=0.003)of T1b GBC patients who underwent SC(10-year OS:27.8%,10-year DSS:55.1%)alone were significantly lower than those of patients who underwent SC+LN(10-year OS:35.5%,10-year DSS:66.3%)or RC(10-year OS:50.3%,10-year DSS:75.9%).Analysis of T1b GBC according to pathological classification revealed no significant difference in OS and DSS between different types of procedures in patients with grade Ⅰ T1b GBC.In patients with grade Ⅱ T1b GBC,obvious survival improvement was observed in the OS(P=0.002)and DSS(P=0.039)of those who underwent SC+LN(10-year OS:34.6%,10-year DSS:61.3%)or RC(10-year OS:50.5%,10-year DSS:78.8%)compared with those who received SC(10-year OS:28.1%,10-year DSS:58.3%).Among patients with grade Ⅲ or Ⅳ T1b GBC,SC+LN(10-year OS:48.5%,10-year DSS:72.2%),and RC(10-year OS:80%,10-year DSS:80%)benefited OS(P=0.005)and DSS(P=0.009)far more than SC(10-year OS:20.1%,10-year DSS:38.1%)alone.CONCLUSION Simple cholecystectomy may be an adequate treatment for grade Ⅰ T1b GBC,whereas more extensive surgery is optimal for grades Ⅱ-Ⅳ T1b GBC.展开更多
Background:Currently,there is no formal consensus regarding a standard classification for gastric cancer(GC)patients with<16 retrieved lymph nodes(rLNs).Here,this study aimed to validate a practical lymph node(LN)s...Background:Currently,there is no formal consensus regarding a standard classification for gastric cancer(GC)patients with<16 retrieved lymph nodes(rLNs).Here,this study aimed to validate a practical lymph node(LN)staging strategy to homogenize the nodal classification of GC cohorts comprising of both<16(Limited set)and≥16(Adequate set)rLNs.Methods:All patients in this study underwent R0 gastrectomy.The overall survival(OS)difference between the Limited and Adequate set from a large Chinese multicenter dataset was analyzed.Using the 8th American Joint Committee on Cancer(AJCC)pathological nodal classification(pN)for GC as base,a modified nodal classification(N’)resembling similar analogy as the 8th AJCC pN classification was developed.The performance of the proposed and 8th AJCC GC subgroups was compared and validated using the Surveillance,Epidemiology,and End Results(SEER)dataset comprising of 10,208 multi-ethnic GC cases.Results:Significant difference in OS between the Limited and Adequate set(corresponding N0–N3a)using the 8th AJCC system was observed but the OS of N0_(limited)vs.N1_(adequate),N1_(limited)vs.N2_(adequate),N2_(limited)vs.N3_(aadequate),and N3_(alimited)vs.N3_(badequate)subgroups was almost similar in the Chinese dataset.Therefore,we formulated an N’classification whereby only the nodal subgroups of the Limited set,except for pT1N0M0 cases as they underwent less extensive surgeries(D1 or D1+gastrectomy),were re-classified to one higher nodal subgroup,while those of the Adequate set remained unchanged(N’0=N0_(adequate)+pT1N0M0_(limited),N’1=N1_(adequate)+N0_(limited)(excluding pT1N0M0_(limited)),N’2=N2_(adequate)+N1_(limited),N’3a=N3_(aadequate)+N2_(limited),and N’3b=N3_(badequate)+N3_(alimited)).This N’classification demonstrated less heterogeneity in OS between the Limited and Adequate subgroups.Further analyses demonstrated superior statistical performance of the pTN’M system over the 8th AJCC edition and was successfully validated using the SEER dataset.Conclusion:The proposed nodal staging strategy was successfully validated in large multi-ethnic GC datasets and represents a practical approach for homogenizing the classification of GC cohorts comprising of patients with<16 and≥16 rLNs.展开更多
BACKGROUND Conventional clinical guidelines recommend that at least 12 lymph nodes shouldbe removed during radical rectal cancer surgery to achieve accurate staging.Thecurrent application of neoadjuvant therapy has ch...BACKGROUND Conventional clinical guidelines recommend that at least 12 lymph nodes shouldbe removed during radical rectal cancer surgery to achieve accurate staging.Thecurrent application of neoadjuvant therapy has changed the number of lymphnode dissection.AIM To investigate factors affecting the number of lymph nodes dissected afterneoadjuvant chemoradiotherapy in locally advanced rectal cancer and to evaluatethe relationship of the total number of retrieved lymph nodes(TLN)with diseasefreesurvival(DFS)and overall survival(OS).METHODS A total of 231 patients with locally advanced rectal cancer from 2015 to 2017 wereincluded in this study.According to the American Joint Committee on Cancer(AJCC)/Union for International Cancer Control(UICC)tumor-node-metastasis(TNM)classification system and the NCCN guidelines for rectal cancer,thepatients were divided into two groups:group A(TLN≥12,n=177)and group B(TLN<12,n=54).Factors influencing lymph node retrieval were analyzed byunivariate and binary logistic regression analysis.DFS and OS were evaluated byKaplan-Meier curves and Cox regression models.RESULTS The median number of lymph nodes dissected was 18(range,12-45)in group A and 8(range,2-11)in group B.The lymph node ratio(number of positive lymphnodes/total number of lymph nodes)(P=0.039)and the interval betweenneoadjuvant therapy and radical surgery(P=0.002)were independent factors ofthe TLN.However,TLN was not associated with sex,age,ASA score,clinical T orN stage,pathological T stage,tumor response grade(Dworak),downstaging,pathological complete response,radiotherapy dose,preoperative concurrentchemotherapy regimen,tumor distance from anal verge,multivisceral resection,preoperative carcinoembryonic antigen level,perineural invasion,intravasculartumor embolus or degree of differentiation.The pathological T stage(P<0.001)and TLN(P<0.001)were independent factors of DFS,and pathological T stage(P=0.011)and perineural invasion(P=0.002)were independent factors of OS.Inaddition,the risk of distant recurrence was greater for TLN<12(P=0.009).CONCLUSION A shorter interval to surgery after neoadjuvant chemoradiotherapy for rectalcancer under indications may cause increased number of lymph nodes harvested.Tumor shrinkage and more extensive lymph node retrieval may lead to a morefavorable prognosis.展开更多
BACKGROUND In recent years, the incidence of types Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction(AEG) has shown an obvious upward trend worldwide. The prognostic prediction after radical resection of AEG ha...BACKGROUND In recent years, the incidence of types Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction(AEG) has shown an obvious upward trend worldwide. The prognostic prediction after radical resection of AEG has not been well established.AIM To establish a prognostic model for AEG(types II and III) based on routine markers.METHODS A total of 355 patients who underwent curative AEG at The First Affiliated Hospital of Anhui Medical University from January 2014 to June 2015 were retrospectively included in this study. Univariate and multivariate analyses were performed to identify the independent risk factors. A nomogram was constructed based on Cox proportional hazards models. The new score models was analyzed by C index and calibration curves. The receiver operating characteristic(ROC) curve was used to compare the predictive accuracy of the scoring system and tumor-node-metastasis(TNM) stage. Overall survival was calculated using the Kaplan-Meier curve amongst different risk AEG patients.RESULTS Multivariate analysis showed that TNM stage(hazard ratio [HR] = 2.286, P = 0.008), neutrophil-tolymphocyte ratio(HR = 2.979, P = 0.001), and body mass index(HR = 0.626, P = 0.026) were independent prognostic factors. The new scoring system had a higher concordance index(0.697),and the calibration curves of the nomogram were reliable. The area under the ROC curve of the new score model(3-year: 0.725, 95% confidence interval [CI]: 0.676-0.777;5-year: 0.758, 95%CI:0.708-0.807) was larger than that of TNM staging(3-year: 0.630, 95%CI: 0.585-0.684;5-year: 0.665,95%CI: 0.616-0.715).CONCLUSION Based on the serum markers and other clinical indicators, we have developed a precise model to predict the prognosis of patients with AEG(types II and III). The new prognostic nomogram could effectively enhance the predictive value of the TNM staging system. This scoring system can be advantageous and helpful for surgeons and patients.展开更多
Objectives:Most patients with gallbladder cancer(GBC)present with advanced-stage disease and have a poor prognosis.Radical resection remains the only therapeutic option to improve survival in patients with GBC.This st...Objectives:Most patients with gallbladder cancer(GBC)present with advanced-stage disease and have a poor prognosis.Radical resection remains the only therapeutic option to improve survival in patients with GBC.This study aimed to analyze the prognostic factors in patients with stageⅣGBC and to identify a subgroup of patients who might benefit from RO resection.Methods:A total of 285 patients with stageⅣGBC were retrospectively analyzed at our institution from January 2008 to December 2012.Factors potentially influencing the prognosis of GBC after surgery were analyzed by univariate and multivariate analyses.Results:The 1-,3-,and 5-year overall survival rates were 6.6%(15/229),0.9%(2/229),and 0(0/229),respectively.Ascites(relative risk[RR]=1.631,95%confidence interval[C/]:1.221-2.180,P=0.001),pathological grade(RR=1.337,95%Cl:1.050-1.702,P=0.018),T stage(RR=1.421,95%Cl:1.099-1.837,P=0.000),M stage(RR=1.896,95%Cl:1.409-2.552,P=0.000),and surgery(RR=1.542,95%Cl:1.022-2.327,P=0.039)were identified as independent risk factors influencing prognosis.The median survival time(MST)was significantly higher in patients undergoing R0 resection than in those undergoing R1/R2 resection(6.0 vs.2.7 months;P<0.001).In subgroup analyses,stage IVA patients benefited from R0 resection(MST for R0 vs.R1/R2,11.0 vs.4.0 months;P=0.003),while R0 resection had a significant survival benefit than R1/R2 resection in patient with stage IVB GBC without distant metastasis(MST for R0 vs.R1/R2,6.0 vs.3.0 months;P=0.007).Conclusion:Ascites,pathological grade,T stage,M stage,and surgery were independent risk factors influencing prognosis in patients with stageⅣGBC.N2 lymph node metastasis did not preclude curative resection,and radical resection should be considered in patients with stageⅣGBC without distant metastasis once R0 margin was achieved.展开更多
文摘BACKGROUND Gastric cancer(GC)is a prevalent malignancy with a substantial health burden and high mortality rate,despite advances in prevention,early detection,and treatment.Compared with the global average,Asia,notably China,reports disproportionately high GC incidences.The disease often progresses asymptoma-tically in the early stages,leading to delayed diagnosis and compromised out-comes.Thus,it is crucial to identify early diagnostic biomarkers and enhance treatment strategies to improve patient outcomes and reduce mortality.METHODS Retrospectively analyzed the clinical data of 148 patients with GC treated at the Civil Aviation Shanghai Hospital between December 2022 and December 2023.The associations of coagulation indices-partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),fibrinogen,fibrinogen degradation products(FDP),fasting blood glucose,and D-dimer(D-D)with TNM stage and distant metastasis were examined.RESULTS Prolongation of APTT,PT,and TT was significantly correlated with the GC TNM stage.Hence,abnormal coagulation system activation was closely related to disease progression.Elevated FDP and D-D were significantly associated with distant metastasis in GC(P<0.05),suggesting that increased fibrinolytic activity contributes to increased metastatic risk.CONCLUSION Our Results reveal coagulation indices,FDPs as GC biomarkers,reflecting abnormal coagulation/fibrinolysis,aiding disease progression,metastasis prediction,and helping clinicians assess thrombotic risk for early intervention and personalized treatment plans.
文摘AIM: To investigate the clinical relevance and prognosis regarding survival according to the changes of the tumor-node-metastasis(TNM) in gastric cancer patients. METHODS: We retrospectively studied 347 consecutive subjects who underwent surgery for gastric adenocarcinoma at the Division of General Surgery, Hospital of Busto Arsizio, Busto Arsizio, Italy between June 1998 and December 2009. Patients who underwent surgery without curative intent, patients with tumors of the gastric stump and patients with tumors involving the esophagus were excluded for survival analysis. Patients were staged according to the 6thand 7thedition TNM criteria; 5-year overall survival rates were investigated, and the event was defined as death from any cause. RESULTS: After exclusion, our study population included 241 resected patients with curative intent for gastric adenocarcinoma. The 5-year overall survival(5-year OS) rate of all the patients was 52.8%. Thediagnosed stage differed in 32% of 241 patients based on the TNM edition used for the diagnosis. The patients in stage Ⅱ according to the 6thedition who were reclassified as stage Ⅲ had significantly worse prognosis than patients classified as stage Ⅱ(5-year OS, 39% vs 71%). According to the 6thedition, 135 patients were classifed as T2, and 75% of these patients migrated to T3 and exhibited a significantly worse prognosis than those who remained T2, regardless of lymph node involvement(37% vs 71%). The new N1 patients exhibited a better prognosis than the previous N1 patients(67% vs 43%). CONCLUSION: 7thTNM allows new T2 and N1 patients to be selected with better prognosis, which leads to different staging. New stratification is important in multimodal therapy.
基金Supported by Capital Special Research Project for Health Development(2014-2-4012)State Natural Research Funding,No.81372578+2 种基金National Natural Science Foundation of China,No.30970623 and No.91229120International Science and Technology Cooperation Projects,No.2010DFA31840 and No.2010DFB33720Program for New Century Excellent Talents in University,No.NCET-11-0288
文摘AIM:To investigate the impact of surgical procedures on prognosis of gallbladder cancer patients classified with the latest tumor-node-metastasis(TNM)staging system.METHODS:A retrospective study was performed by reviewing 152 patients with primary gallbladder carcinoma treated at Peking Union Medical College Hospital from January 2003 to June 2013.Postsurgical follow-up was performed by telephone and outpatient visits.Clinical records were reviewed and patients were grouped based on the new edition of TNM staging system(AJCC,seventh edition,2010).Prognoses were analyzed and compared based on surgical operations including simple cholecystectomy,radical cholecystectomy(or extended radical cholecystectomy),and palliative surgery.Simple cholecystectomy is,by definition,resection of the gallbladder fossa.Radical cholecystectomy involves a wedge resection of the gallbladder fossa with 2 cm nonneoplastic liver tissue;resection of a suprapancreatic segment of the extrahepatic bile duct and extended portal lymph node dissection may also be considered based on the patient's circumstance.Palliative surgery refers to cholecystectomy with biliary drainage.Data analysis was performed with SPSS 19.0 software.KaplanMeier survival analysis and Logrank test were used for survival rate comparison.P<0.05 was consideredstatistically significant.RESULTS:Patients were grouped based on the new 7th edition of TNM staging system,including 8 cases of stage 0,10 cases of stageⅠ,25 cases of stageⅡ,21 cases of stageⅢA,21 cases of stageⅢB,24 cases of stageⅣA,43 cases of stageⅣB.Simple cholecystectomy was performed on 28 cases,radical cholecystectomy or expanded gallbladder radical resection on 57 cases,and palliative resection on 28 cases.Thirty-nine cases were not operated.Patients with stages 0 andⅠdisease demonstrated no statistical significant difference in survival time between those receiving radical cholecystectomy and simple cholecystectomy(P=0.826).The prognosis of stageⅡpatients with radical cholecystectomy was better than that of simple cholecystectomy.For stageⅢpatients,radical cholecystectomy was significantly superior to other surgical options(P<0.05).For stageⅣA patients,radical cholecystectomy was not better than palliative resection and non-surgical treatment.For stageⅣB,patients who underwent palliative resection significantly outlived those with non-surgical treatment(P<0.01)CONCLUSION:For stages 0 andⅠpatients,simple cholecystectomy is the optimal surgical procedure,while radical cholecystectomy should be actively operated for stagesⅡandⅢpatients.
文摘BACKGROUND Oral contrast-enhanced ultrasound(OCEUS)is widely used in the noninvasive diagnosis and screening of gastric cancer(GC)in China.AIM To investigate the clinical application of OCEUS in evaluating the preoperative T staging of gastric cancer.METHODS OCEUS was performed before the operation,and standard ultrasound images were retained.The depth of infiltration of GC(T-stage)was evaluated according to the American Joint Committee on Cancer 8th edition of the tumor-nodemetastasis staging criteria.Finally,with postoperative pathological staging as the gold standard reference,the sensitivity,specificity,negative predictive value,positive predictive value,and diagnostic value of OCEUS T staging were evaluated.RESULTS OCEUS achieved diagnostic accuracy rates of 76.6%(T1a),69.6%(T1b),62.7%(T2),60.8%(T3),88.0%(T4a),and 88.7%(T4b),with an average of 75.5%.Ultrasonic T staging sensitivity exceeded 62%,aside from T1b at 40.3%,while specificity was over 91%,except for T3 with 83.5%.The Youden index was above 60%,with T1b and T2 being exceptions.OCEUS T staging corresponded closely with pathology in T4b(kappa>0.75)and moderately in T1a,T1b,T2,T3,and T4a(kappa 0.40-0.75),registering a concordance rate exceeding 84%.CONCLUSION OCEUS was effective,reliable,and accurate in diagnosing the preoperative T staging of GC.As a noninvasive diagnostic technique,OCEUS merits clinical popularization.
文摘Gastric cancer is one of the most common and fatal cancers. The importance of accurate staging for gastric cancer has become more critical due to the recent introduction of less invasive treatment options, such as endoscopic mucosal resection or laparoscopic surgery. The tumor-node-metastasis staging system is the generally accepted staging system for predicting the prognosis of patients with gastric cancer. Multidetector row computed tomography (MDCT) is a widely accepted imaging modality for the preoperative staging of gastric cancer that can simultaneously assess locoregional staging, including the gastric mass, regional lymph nodes, and distant metastasis. The diagnostic performance of MDCT for T- and N-staging has been improved by the technical development of isotropic imaging and 3D reformation. Although magnetic resonance imaging (MRI) was not previously used to evaluate gastric cancer due to the modality’s limitations, the development of high-speed sequences has made MRI a feasible tool for the staging of gastric cancer.
文摘AIM To analyze the survival trends in colorectal cancer(CRC) based on the different classifications recommended by the seventh and eighth editions of the American Joint Committee on Cancer staging system(AJCC-7^(th) and AJCC-8^(th)).METHODS The database from our institution was queried to identify patients with pathologically confirmed stage 0-Ⅳ CRC diagnosed between 2006 and 2012. Data from 2080 cases were collected and 1090 cases were evaluated through standardized inclusion and exclusion criteria. CRC was staged by AJCC-7^(th) and then restaged by AJCC-8^(th). Five-year disease-free survival(DFS) and overall survival(OS) were compared. SPSS 21.0 software was used for all data. DFS and OS were compared and analyzed by Kaplan-Meier and Log-rank test.RESULTS Linear regression and automatic linear regression showed lymph node positive functional equations by tumornode-metastasis staging from AJCC-7^(th) and tumornode-metastasis staging from AJCC-8^(th). Neurological invasion, venous infiltration, lymphatic infiltration, and tumor deposition put forward stricter requirements for pathological examination in AJCC-8^(th) compared to AJCC-7^(th). After re-analyzing our cohort with AJCC-8^(th),the percentage of stage ⅣB cases decreased from 2.8% to 0.8%. As a result 2% of the cases were classified under the new ⅣC staging. DFS and OS was significantly shorter(P = 0.012) in stage ⅣC patients compared to stage ⅣB patients.CONCLUSION The addition of stage ⅣC in AJCC-8^(th) has shown that peritoneal metastasis has a worse prognosis than distant organ metastasis in our institution's CRC cohort. Additional datasets should be analyzed to confirm these findings.
文摘Pathologic assessment of colorectal cancer specimens plays an essential role in patient management,informing prognosis and contributing to therapeutic decision making.The tumor-node-metastasis(TNM)staging system is a key component of the colorectal cancer pathology report and provides important prognostic information.However there is significant variation in outcome of patients within the same tumor stage.Many other histological features such as tumor budding,vascular invasion,perineural invasion,tumor grade and rectal tumor regression grade that may be of prognostic value are not part of TNM staging.Assessment of extramural tumor deposits and peritoneal involvement contributes to TNM staging but there are some difficulties with the definition of both of these features.Controversies in colorectal cancer pathology reporting include the subjective nature of some of the elements assessed,poor reporting rates and reproducibility and the need for standardized examination protocols and reporting.Molecular pathology is becoming increasingly important in prognostication and prediction of response to targeted therapies but accurate morphology still has a key role to play in colorectal cancer pathology reporting.
基金supported by the Guangxi Scholarship Fund of Guangxi Education Department,the Guangxi Med‑ical University Training Program for Distinguished Young Scholars,the Advanced Innovation Teams and Xinghu Scholars Program of Guangxi Medical University,the Guangxi Med‑ical and Health Key Discipline Construction Project,and the Science and Technology Plan Project of Qingxiu District,Nanning(Nos.2020037,2020038,2021007,2021010,and 2021012),China.
文摘Hepatocellular carcinoma(HCC)is one of the most common malignancies and a leading cause of cancer-related death worldwide.Surgery remains the primary and most successful therapy option for the treatment of early-and mid-stage HCCs,but the high heterogeneity of HCC renders prognostic prediction challenging.The construction of relevant prognostic models helps to stratify the prognosis of surgically treated patients and guide personalized clinical decision-making,thereby improving patient survival rates.Currently,the prognostic assessment of HCC is based on several commonly used staging systems,such as Tumor-Node-Metastasis(TNM),Cancer of the Liver Italian Program(CLIP),and Barcelona Clinic Liver Cancer(BCLC).Given the insufficiency of these staging systems and the aim to improve the accuracy of prognostic prediction,researchers have incorporated further prognostic factors,such as microvascular infiltration,and proposed some new prognostic models for HCC.To provide insights into the prospects of clinical oncology research,this review describes the commonly used HCC staging systems and new models proposed in recent years.
基金Supported by CAMS Innovation Fund for Medical Sciences,No.2016-I2M-1-001Tsinghua University-Peking Union Medical College Hospital Cooperation Project,No.PTQH201904552。
文摘BACKGROUND Gallbladder carcinoma(GBC)carries a poor prognosis and requires a prediction method.Gamma-glutamyl transferase–to–platelet ratio(GPR)is a recently reported cancer prognostic factor.Although the mechanism for the relationship between GPR and poor cancer prognosis remains unclear,studies have demonstrated the clinical effect of both gamma-glutamyl transferase and platelet count on GBC and related gallbladder diseases.AIM To assess the prognostic value of GPR and to design a prognostic nomogram for GBC.METHODS The analysis involved 130 GBC patients who underwent surgery at Peking Union Medical College Hospital from December 2003 to April 2017.The patients were stratified into a high-or low-GPR group.The predictive ability of GPR was evaluated by Kaplan–Meier analysis and a Cox regression model.We developed a nomogram based on GPR,which we verified using calibration curves.The nomogram and other prognosis prediction models were compared using timedependent receiver operating characteristic curves and the concordance index.RESULTS Patients in the high-GPR group had a higher risk of jaundice,were older,and had higher carbohydrate antigen 19-9 levels and worse postoperative outcomes.Univariate analysis revealed that GPR,age,body mass index,tumor–node–metastasis(TNM)stage,jaundice,cancer cell differentiation degree,and carcinoembryonic antigen and carbohydrate antigen 19-9 levels were related to overall survival(OS).Multivariate analysis confirmed that GPR,body mass index,age,and TNM stage were independent predictors of poor OS.Calibration curves were highly consistent with actual observations.Comparisons of timedependent receiver operating characteristic curves and the concordance index showed advantages for the nomogram over TNM staging.CONCLUSION GPR is an independent predictor of GBC prognosis,and nomogram-integrated GPR is a promising predictive model for OS in GBC.
基金Supported by the National Natural Science Foundation of China,No.81773126,No.81560475,and No.82160486.
文摘BACKGROUND T1b gallbladder carcinoma(GBC)is defined as a tumor that invades the perimuscular connective tissue without extension beyond the serosa or into the liver.However,controversy still exists over whether patients with T1b GBC should undergo cholecystectomy alone or radical GBC resection.AIM To explore the optimal surgical approach in patients with T1b gallbladder cancer of different pathological grades.METHODS Patients with T1bN0M0 GBC who underwent surgical treatment between 2000 and 2017 were included in the Surveillance,Epidemiology,and End Results database.The Kaplan-Meier method and log-rank test were used to analyze the overall survival(OS)and disease-specific survival(DSS)of patients with T1b GBC of different pathological grades.Cox regression analysis was used to identify independent predictors of mortality and explore the selection of surgical methods in patients with T1b GBC of different pathological grades and their relationship with prognosis.RESULTS Of the 528 patients diagnosed with T1bN0M0 GBC,346 underwent simple cholecystectomy(SC)(65.5%),131 underwent SC with lymph node resection(SC+LN)(24.8%),and 51 underwent radical cholecystectomy(RC)(9.7%).Without considering the pathological grade,both the OS(P<0.001)and DSS(P=0.003)of T1b GBC patients who underwent SC(10-year OS:27.8%,10-year DSS:55.1%)alone were significantly lower than those of patients who underwent SC+LN(10-year OS:35.5%,10-year DSS:66.3%)or RC(10-year OS:50.3%,10-year DSS:75.9%).Analysis of T1b GBC according to pathological classification revealed no significant difference in OS and DSS between different types of procedures in patients with grade Ⅰ T1b GBC.In patients with grade Ⅱ T1b GBC,obvious survival improvement was observed in the OS(P=0.002)and DSS(P=0.039)of those who underwent SC+LN(10-year OS:34.6%,10-year DSS:61.3%)or RC(10-year OS:50.5%,10-year DSS:78.8%)compared with those who received SC(10-year OS:28.1%,10-year DSS:58.3%).Among patients with grade Ⅲ or Ⅳ T1b GBC,SC+LN(10-year OS:48.5%,10-year DSS:72.2%),and RC(10-year OS:80%,10-year DSS:80%)benefited OS(P=0.005)and DSS(P=0.009)far more than SC(10-year OS:20.1%,10-year DSS:38.1%)alone.CONCLUSION Simple cholecystectomy may be an adequate treatment for grade Ⅰ T1b GBC,whereas more extensive surgery is optimal for grades Ⅱ-Ⅳ T1b GBC.
基金the National Natural Science Foundation of China(81802451)the China Postdoctoral Science Foundation(2017M622879)+1 种基金the Natural Science Foundation of Guangdong Province(2114050002182,2018A030313827 and 2021A1515011327)the Young Teacher Training Program of Sun Yat-sen University(19ykpy172).
文摘Background:Currently,there is no formal consensus regarding a standard classification for gastric cancer(GC)patients with<16 retrieved lymph nodes(rLNs).Here,this study aimed to validate a practical lymph node(LN)staging strategy to homogenize the nodal classification of GC cohorts comprising of both<16(Limited set)and≥16(Adequate set)rLNs.Methods:All patients in this study underwent R0 gastrectomy.The overall survival(OS)difference between the Limited and Adequate set from a large Chinese multicenter dataset was analyzed.Using the 8th American Joint Committee on Cancer(AJCC)pathological nodal classification(pN)for GC as base,a modified nodal classification(N’)resembling similar analogy as the 8th AJCC pN classification was developed.The performance of the proposed and 8th AJCC GC subgroups was compared and validated using the Surveillance,Epidemiology,and End Results(SEER)dataset comprising of 10,208 multi-ethnic GC cases.Results:Significant difference in OS between the Limited and Adequate set(corresponding N0–N3a)using the 8th AJCC system was observed but the OS of N0_(limited)vs.N1_(adequate),N1_(limited)vs.N2_(adequate),N2_(limited)vs.N3_(aadequate),and N3_(alimited)vs.N3_(badequate)subgroups was almost similar in the Chinese dataset.Therefore,we formulated an N’classification whereby only the nodal subgroups of the Limited set,except for pT1N0M0 cases as they underwent less extensive surgeries(D1 or D1+gastrectomy),were re-classified to one higher nodal subgroup,while those of the Adequate set remained unchanged(N’0=N0_(adequate)+pT1N0M0_(limited),N’1=N1_(adequate)+N0_(limited)(excluding pT1N0M0_(limited)),N’2=N2_(adequate)+N1_(limited),N’3a=N3_(aadequate)+N2_(limited),and N’3b=N3_(badequate)+N3_(alimited)).This N’classification demonstrated less heterogeneity in OS between the Limited and Adequate subgroups.Further analyses demonstrated superior statistical performance of the pTN’M system over the 8th AJCC edition and was successfully validated using the SEER dataset.Conclusion:The proposed nodal staging strategy was successfully validated in large multi-ethnic GC datasets and represents a practical approach for homogenizing the classification of GC cohorts comprising of patients with<16 and≥16 rLNs.
基金Supported by National Key Research and Development Plan"Research on Prevention and Control of Major Chronic Non-Communicable Diseases",No.2019YFC1315705The Medicine and Health Technology Innovation Project of Chinese Academy of Medical Sciences,No.2017-12M-1-006.
文摘BACKGROUND Conventional clinical guidelines recommend that at least 12 lymph nodes shouldbe removed during radical rectal cancer surgery to achieve accurate staging.Thecurrent application of neoadjuvant therapy has changed the number of lymphnode dissection.AIM To investigate factors affecting the number of lymph nodes dissected afterneoadjuvant chemoradiotherapy in locally advanced rectal cancer and to evaluatethe relationship of the total number of retrieved lymph nodes(TLN)with diseasefreesurvival(DFS)and overall survival(OS).METHODS A total of 231 patients with locally advanced rectal cancer from 2015 to 2017 wereincluded in this study.According to the American Joint Committee on Cancer(AJCC)/Union for International Cancer Control(UICC)tumor-node-metastasis(TNM)classification system and the NCCN guidelines for rectal cancer,thepatients were divided into two groups:group A(TLN≥12,n=177)and group B(TLN<12,n=54).Factors influencing lymph node retrieval were analyzed byunivariate and binary logistic regression analysis.DFS and OS were evaluated byKaplan-Meier curves and Cox regression models.RESULTS The median number of lymph nodes dissected was 18(range,12-45)in group A and 8(range,2-11)in group B.The lymph node ratio(number of positive lymphnodes/total number of lymph nodes)(P=0.039)and the interval betweenneoadjuvant therapy and radical surgery(P=0.002)were independent factors ofthe TLN.However,TLN was not associated with sex,age,ASA score,clinical T orN stage,pathological T stage,tumor response grade(Dworak),downstaging,pathological complete response,radiotherapy dose,preoperative concurrentchemotherapy regimen,tumor distance from anal verge,multivisceral resection,preoperative carcinoembryonic antigen level,perineural invasion,intravasculartumor embolus or degree of differentiation.The pathological T stage(P<0.001)and TLN(P<0.001)were independent factors of DFS,and pathological T stage(P=0.011)and perineural invasion(P=0.002)were independent factors of OS.Inaddition,the risk of distant recurrence was greater for TLN<12(P=0.009).CONCLUSION A shorter interval to surgery after neoadjuvant chemoradiotherapy for rectalcancer under indications may cause increased number of lymph nodes harvested.Tumor shrinkage and more extensive lymph node retrieval may lead to a morefavorable prognosis.
基金Supported by the Natural Science Foundation of Anhui Province,No. 2108085QH337。
文摘BACKGROUND In recent years, the incidence of types Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction(AEG) has shown an obvious upward trend worldwide. The prognostic prediction after radical resection of AEG has not been well established.AIM To establish a prognostic model for AEG(types II and III) based on routine markers.METHODS A total of 355 patients who underwent curative AEG at The First Affiliated Hospital of Anhui Medical University from January 2014 to June 2015 were retrospectively included in this study. Univariate and multivariate analyses were performed to identify the independent risk factors. A nomogram was constructed based on Cox proportional hazards models. The new score models was analyzed by C index and calibration curves. The receiver operating characteristic(ROC) curve was used to compare the predictive accuracy of the scoring system and tumor-node-metastasis(TNM) stage. Overall survival was calculated using the Kaplan-Meier curve amongst different risk AEG patients.RESULTS Multivariate analysis showed that TNM stage(hazard ratio [HR] = 2.286, P = 0.008), neutrophil-tolymphocyte ratio(HR = 2.979, P = 0.001), and body mass index(HR = 0.626, P = 0.026) were independent prognostic factors. The new scoring system had a higher concordance index(0.697),and the calibration curves of the nomogram were reliable. The area under the ROC curve of the new score model(3-year: 0.725, 95% confidence interval [CI]: 0.676-0.777;5-year: 0.758, 95%CI:0.708-0.807) was larger than that of TNM staging(3-year: 0.630, 95%CI: 0.585-0.684;5-year: 0.665,95%CI: 0.616-0.715).CONCLUSION Based on the serum markers and other clinical indicators, we have developed a precise model to predict the prognosis of patients with AEG(types II and III). The new prognostic nomogram could effectively enhance the predictive value of the TNM staging system. This scoring system can be advantageous and helpful for surgeons and patients.
基金Dr.Zhi-Min Geng was supported by National Natural Science Foundation of China(81572420)Natural Science Basic Research Plan in Shaanxi Province of China(2016MSZD-S-4-1).
文摘Objectives:Most patients with gallbladder cancer(GBC)present with advanced-stage disease and have a poor prognosis.Radical resection remains the only therapeutic option to improve survival in patients with GBC.This study aimed to analyze the prognostic factors in patients with stageⅣGBC and to identify a subgroup of patients who might benefit from RO resection.Methods:A total of 285 patients with stageⅣGBC were retrospectively analyzed at our institution from January 2008 to December 2012.Factors potentially influencing the prognosis of GBC after surgery were analyzed by univariate and multivariate analyses.Results:The 1-,3-,and 5-year overall survival rates were 6.6%(15/229),0.9%(2/229),and 0(0/229),respectively.Ascites(relative risk[RR]=1.631,95%confidence interval[C/]:1.221-2.180,P=0.001),pathological grade(RR=1.337,95%Cl:1.050-1.702,P=0.018),T stage(RR=1.421,95%Cl:1.099-1.837,P=0.000),M stage(RR=1.896,95%Cl:1.409-2.552,P=0.000),and surgery(RR=1.542,95%Cl:1.022-2.327,P=0.039)were identified as independent risk factors influencing prognosis.The median survival time(MST)was significantly higher in patients undergoing R0 resection than in those undergoing R1/R2 resection(6.0 vs.2.7 months;P<0.001).In subgroup analyses,stage IVA patients benefited from R0 resection(MST for R0 vs.R1/R2,11.0 vs.4.0 months;P=0.003),while R0 resection had a significant survival benefit than R1/R2 resection in patient with stage IVB GBC without distant metastasis(MST for R0 vs.R1/R2,6.0 vs.3.0 months;P=0.007).Conclusion:Ascites,pathological grade,T stage,M stage,and surgery were independent risk factors influencing prognosis in patients with stageⅣGBC.N2 lymph node metastasis did not preclude curative resection,and radical resection should be considered in patients with stageⅣGBC without distant metastasis once R0 margin was achieved.
