Resectable gastric signet ring cell carcinoma: clinicopathological characteristics and survival outcomes

Background:Gastric signet ring cell carcinoma (SRCC) appears to have clinical features and survival rates particularly different from other histological types. The aim of this study was to investigate clinicopathological features and survival outcomes of SRCC and to compare them with non-signet ring cell carcinoma (NSRCC).Methods:We retrospectively studied 145 patients with non-metastatic gastric carcinoma who underwent gastrectomy in our institute from 2005 to 2015. Among them, 36 patients (9.4%) with SRCC were compared to 109 patients (90.6%) with NSRCC.Results:Patients with SRCC presented at a younger age (p=0.001) with more advanced stage III-IV disease (p=0.005) and advanced N stages with a higher rate of pN3 (p=0.0001), a higher number of invaded lymph nodes (p=0.002) and a higher rate of patients with a lymph node ratio exceeding 25% (63.9% vs 36.7, p=0.004). After a median follow up of 35.30 months, there was no significant difference in the 5 years overall (OS) survival between SRCC and NSRCC ((36.7% vs 45.7%, p=0.206).However, the 5 years progressive free survival (PFS) was significantly decreased in case of SRCC (38.7% vs 50.9%, p=0.038) with a higher rate of metastasis in (52.9% vs 29.5%, p=0.013) and peritoneal recurrence (35.3% vs 9.5%, p<0.0001). The main prognostic factors of PFS and OS in SRCC were tumoral stenosis, hypoprotidemia, tumor size, depth of invasion (p=0.001), perineural and lymphovascular invasion, the UICC stage and complete surgical resection.Conclusion:Gastric SRCC have a particular clinicopathological behavior compared to NSRCC suggesting its more aggressive character

Determinants of surgical morbidity in gastric cancer: experience of a single center and literature review

Background:This study aimed to evaluate the severity of intraoperative and post-operative complications of gastric cancer surgery and to investigate the predictive factors correlated to surgical morbidity.Methods:We included 145 patients operated for gastric cancer. We investigated the risk factors associated with complications, length of hospital stay, operative time, and intraoperative blood transfusion (BT). Significant risk factors were analyzed by multiple logistic regression analysis.Results:Postoperative complications occurred in 32 patients (22.1 %) and the rate of major complications was 7.6%. The rate of anastomotic fistula was 6.9% and was correlated to diabetes, tumor size, operative time, surgical margin, and extended lymphadenectomy. The mean risk factors for postoperative morbidity were the presence of comorbidities and ASA score (p = 0.021), intraoperative BT (p = 0.045) and prolonged operative time (p = 0.055).Conclusion:Surgical morbidity of gastric cancer is correlated to the extent of resection as well as the clinical and histological characteristics

Chemoradiotherapy or chemotherapy as adjuvant treatment for resected gastric cancer: should we use selection criteria?

Background: The management of gastric adenocarcinoma is essentially based on surgery followed by adjuvant treatment. Adjuvant chemotherapy (CT) as well as chemoradiotherapy (CTRT) have proven their effectiveness in survival outcomes compared to surgery alone. However, there is little data comparing the two adjuvant approaches. This study aimed to compare the prognosis and survival outcomes of patients with gastric adenocarcinoma operated and treated by adjuvant radio-chemotherapy or chemotherapy Materials and methods: We retrospectively evaluated 80 patients with locally advanced gastric cancer (LGC) who received adjuvant treatment. We compared survival outcomes and patterns of recurrence of 53 patients treated by CTRT and those of 27 patients treated by CT.  Results: After a median follow-up of 38.48 months, CTRT resulted in a significant improvement of the 5-year PFS (60.9% vs. 36%, p = 0.03) and the 5-year OS (55.9% vs. 33%, p = 0.015) compared to adjuvant CT. The 5-year OS was significantly increased by adjuvant CTRT (p = 0.046) in patients with lymph node metastasis, and particularly those with advanced pN stage (p = 0.0078) and high lymph node ratio (LNR) exceeding 25% (p = 0.012). Also, there was a significant improvement of the PFS of patients classified pN2–N3 (p = 0.022) with a high LNR (p = 0.018). CTRT was also associated with improved OS and PFS in patients with lymphovascular and perineural invasion (LVI and PNI) compared to chemotherapy. Conclusion: There is a particular survival benefit of adding radiotherapy to chemotherapy in patients with selected criteria such as lymph node involvement, high LNR LVI, and PNI

Cancers primitifs de la verge: à propos de 11 cas et revue de la littérature

Le cancer de la verge est une pathologie rare en Tunisie ou la circoncision est de pratique courante. Il s'agit dans 95% des cas d'un carcinome épidermoïde. Le traitement repose essentiellement sur la chirurgie. Nous rapportons rétrospectivement les caractères épidémiologique, clinique, thérapeutique et évolutif de 11 cas de cancers primitifs de la verge

Nutraceutical potentialities of Tunisian Argan oil based on its physicochemical properties and fatty acid content as assessed through Bayesian network analyses

Abstract Background Argan oil is traditionally produced by cold pressing in South-western Morocco where rural population uses it as edible oil as well as for its therapeutic properties which give them in counterpart valuable income. Given the economical interest of this oil, several attempts of fraudulency have been registered in the world global market leading to loss of authenticity. Our purpose is to launch a program of Tunisian Argan oil valorization since trees from this species have been introduced sixty years ago in Tunisia. The first step was thus to characterize the physicochemical properties and determine the chemical composition of Tunisian Argan oil in order to assess its quality. Methods Physicochemical parameters of oil quality were determined according to the international standard protocols. Fatty acid content analysis of Argan oils was performed by gas chromatography coupled to mass spectrophotometry. A comparative study was realized among Tunisian, Moroccan and Algerian samples differing also by their extraction procedure. The impact of geographical localisation on the fatty acids composition was studied by statistical and modeling Bayesian analyses. Results Physicochemical parameters analysis showed interestingly that Tunisian Argan oil could be classified as extra virgin oil. Argan oil is mainly composed by unsaturated fatty acids (80%), mainly oleic and linoleic acid (linoleic acid was positively influenced by the geographical localization (r = 0.899, p = 0.038) and the P/S index (r = 0.987, p = 0.002)) followed by saturated fatty acids (20%) with other beneficial compounds from the unsaponifiable fraction like polyphenols and carotenoids. Together with fatty acid content, these minor components are likely to be responsible for its nutraceutical properties and beneficial effects. Conclusion Tunisian Argan oil displayed valuable qualitative parameters proving its competitiveness in comparison with Moroccan and Algerian oils, and could be therefore considered as extra virgin edible oil for nutraceutical purposes as well as for cosmetic use

Estimation and comparison of reference evapotranspiration using different methods to determine olive trees irrigation schedule in different bioclimatic stages of Tunisia

[eng] The study of olive trees water requirements allows a better water management by using more accurate methods including maximum parameters of the continuum soil-plant- atmosphere. The Penman-Monteith equations is consideredas the most rational approach and the most reliable for calculating evapotranspiration. Only this approach necessarily requires an important number of climate parameters. The use of other equations, less complicated and using less climate parameters may be a reliable and efficient alternative. This experimental study was carried out on two cultivars cv. 'Meski' and cv. 'Chemlali' conducted in the intensive system in different bioclimatic stages (Subhumid, Semi-Arid and Arid) in Tunisia. This work aims to estimate olive trees water needs using evapotranspiration calculation in three different bioclimatic stages. For that, we compared the Penman-Monteith formula with Blaney-Criddel, Hargreaves-Temperature, Hargreaves- Radiation and Priestley-Taylor formulas to estimate reference evapotranspiration (ET0). Results show that ET0 values calculated by Priestley-Taylor and Blaney-Criddel formulas were more or less similar to Penman-Monteith. The ET0 values found by Hargreaves-Temperature and Hargreaves-Radiation were twice the values calculated by Penman-Monteith formula. We also found good correlations between the reference evapotranspiration calculated by the Penman-Monteith equation and that calculated by Priestley-Taylor and Blaney-Criddel equations in all bioclimatic stages (R2 more than 0.85, p < 1%). The ET0 sensitivity analysis has shown that solar radiation and air temperature (energetic climatic parameters) have the dominant effect on the ET0 at the level of the different climatic regions. Accordingly, in the case of lack of some climatic parameters and in sub-humid, semi-arid and arid conditions and for the different phenological stages of the olive tree, we can use Priestley-Taylor and/or Blaney-Criddle formulas to estimate water needs

Better prediction of Mediterranean olive production using pollen-based models

Olive oil is a major economic resource of the Mediterranean region. Olive crop management can be improved by models that forecast the variable reproductive biology of olive tree. However, the processes controlling olive harvest are complex on large scales. Here, we study the parameters that influence olive fruit production for developing accurate forecasting models. Seventeen aerobiological sampling points have monitored olive pollen grains in Spain, Italy and Tunisia from 1993 to 2012. Six crop models have been developed at two provinces and country scales. The modelling has been done in two steps: (1) typification and (2) modelling by partial least square regression. Results show that higher pollen indexes and water availability during spring are related to an increase of final fruit production in all the studied area. Higher pollen indexes are also positively correlated with air temperature during early spring and autumn. Furthermore, a decrease of fruit production is related with increasing air temperature during winter and summer. To conclude, we have designed accurate models that allow accurate predictions of olive production