Survival in patients with stage IV noncardia gastric cancer - the influence of DNA ploidy and Helicobacter Pyloriinfection

BACKGROUND: Palliative surgery followed by postoperative chemotherapy is a challenging approach in the treatment of stage IV gastric cancer yet patients must be carefully selected on the basis of likely clinical benefit. METHODS: The records of 218 patients with histological diagnosis of gastric adenocarcinoma who underwent palliative surgery followed by postoperative chemotherapy were retrospectively reviewed. Twelve potential prognostic variables including tumour DNA index and serum IgG anti- Helicobacter pylori (HP) antibodies were evaluated for their influence on overall survival by multivariate analysis. RESULTS: The median survival was 13.25 months [95% Confidence Interval (CI) 12.00, 14.50]. Three factors were found to have an independent effect on survival: performance status (PS) [PS 60–70 vs. 90–100 Hazard Ratio (HR) 1.676; CI 1.171-2.398, p = 0.005], liver metastases (HR 1.745; CI 1.318-2.310, p < 0.001), and DNA Index as assessed by Image cytometry (2.2-3.6 vs. >3.6 HR 3.059; CI 2.185-4.283, p < 0.001 and <2.2 vs. >3.6 HR; 4.207 CI 2.751-6.433 <0.001). HP infection had no statistically significant effect on survival by either univariate or multivariate analysis. CONCLUSION: Poor pre-treatment PS, the presence of liver metastasis and high DNA Index were identified factors associated with adverse survival outcome in patients with Stage IV gastric cancer treated with palliative gastrectomy and postoperative chemotherapy. HP infection had no influence on survival of these patients

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6&nbsp;years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P &lt; 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100&nbsp;years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

Favoring D2-Lymphadenectomy in Gastric Cancer

The role of extended lymphadenectomy in the surgical treatment of gastric cancer has been debated for many years. So far six prospective randomized trials and a number of meta-analyses comparing D1- to D2-lymphadenectomy in open surgery have been published with contradicting results. The possible oncologic benefit of radical lymphadenectomy has been blurred by a number of reasons. In most of the trials the strategies under comparison were made similar after protocol violations. Imperfect design of the trials could not exclude the influence of cofounding factors. Inappropriate endpoints could not detect evidently the difference between the two surgical strategies. On the other hand radical lymphadenectomy was characterized by increased morbidity and mortality. This was mostly caused by the addition of pancreatico-splenectomy in all D2-dissections, even when not indicated. A careful analysis of the available evidence indicates that D2-lymphadenectomy performed by adequately trained surgeons without resection of the pancreas and/or spleen, unless otherwise indicated, decreases Gastric Cancer Related Deaths and increases Disease Specific Survival. This evidence is not compelling but cannot be ignored. D2-lymphadendctomy is nowadays considered to be the standard of care for resectable gastric cancer

Yeast saccharomyces cerevisiag as an experimental model for the study of antineoplastic agents

ΣΤΗ ΔΙΑΤΡΙΒΗ ΑΥΤΗ ΜΕΛΕΤΗΘΗΚΕ Η ΕΠΙΔΡΑΣΗ ΤΩΝ ΑΝΤΙΝΕΟΠΛΑΣΜΑΤΙΚΩΝ ΠΑΡΑΓΟΝΤΩΝ ΕΠΙ ΤΟΥ S.CEREEVISIAE.ΠΡΟΣΔΙΟΡΙΣΘΗΚΑΝ ΟΙ MIC,MCC,EC50 ΚΑΙ ΟΙ ΚΑΜΠΥΛΕΣ ΕΠΙΒΙΩΣΗΣ ΜΕΤΑ ΤΗΝ ΕΚΘΕΣΗ ΜΙΑΣ ΣΕΙΡΑΣ ΣΤΕΛΕΧΩΝ ΣΕ ΔΙΑΦΟΡΟΥΣ ΠΑΡΑΓΟΝΤΕΣ.ΤΟ ΣΤΕΛΕΧΟΣ ATCC2366 ΕΠΙΛΕΧΘΗΚΕ ΓΙΑ ΠΕΡΑΙΤΕΡΩ ΜΕΛΕΤΗ.Η ΕΠΙΒΙΩΣΗ ΚΑΙ Η ΑΝΑΠΤΥΞΗ ΤΩΝ ΚΑΛΛΙΕΡΓΕΙΩΝ ΤΟΥ ΕΛΑΤΤΩΝΟΝΤΑΝ ΑΠΟ ΤΙΣ ΑΔΡΙΑΜΥΚΙΝΗ, 5-ΦΘΟΡΙΟΥΡΑΚΙΛΗ, ΚΑΙ CIS-ΠΛΑΤΙΝΗ ΑΝΑΛΟΓΑ ΜΕ ΤΗ ΔΙΑΡΚΕΙΑ ΤΗΣ ΕΠΙΔΡΑΣΗΣ ΤΟΥΣ ΑΛΛΑ ΟΧΙ ΤΗ ΣΥΓΚΕΝΤΡΩΣΗ ΤΟΥΣ.Η ΜΥΤΟΜΥΚΙΝΗ-C ΕΛΛΑΤΩΝΕ ΤΗΝ ΕΠΙΒΙΩΣΗ ΟΠΩΣ ΚΑΙ Η ΜΕΘΟΤΡΕΞΑΤΗ ΠΟΥ ΟΜΩΣ ΔΕΝ ΜΕΤΕΒΑΛΛΕ ΣΗΜΑΝΤΙΚΑ ΤΗΝ ΑΝΑΠΤΥΞΗ ΤΗΣ ΚΑΛΛΙΕΡΓΕΙΑΣ.ΣΤΟ ΑΠΛΟ ΜΙΚΡΟΣΚΟΠΙΟ Η ΜΟΡΦΟΛΟΓΙΑ ΤΩΝ ΚΥΤΤΑΡΩΝ ΔΕΝ ΕΠΗΡΕΑΣΤΗΚΕ ΑΠΟ ΤΗΝ ΑΔΡΙΑΜΥΚΙΝΗ ΚΑΙ ΤΗ ΦΘΟΡΙΟΟΥΡΑΚΙΛΗ, ΕΝΩ Η ΜΕΘΟΤΡΕΞΑΤΗ ΚΑΙ Η CIS-ΠΛΑΤΙΝΗ ΠΡΟΚΑΛΕΣΑΝ ΤΟ ΣΧΗΜΑΤΙΣΜΟ ΚΥΤΤΑΡΩΝ ''ΔΙΚΗΝ ΑΛΤΗΡΑ'' ΚΑΤΑ ΠΟΣΟΣΤΟ ΑΝΑΛΟΓΟ ΜΕ ΤΗ ΜΕΙΩΣΗ ΤΗΣ ΕΠΙΒΙΩΣΗΣ ΚΑΙ ΤΗΣ ΑΝΑΠΤΥΞΗΣ.Η ΤΑΧΕΙΑ ΚΥΤΤΑΡΟΚΤΟΝΟΣ ΔΡΑΣΗ ΤΗΣ ΑΔΡΙΑΜΥΚΙΝΗΣ ΗΤΑΝ ΜΕΓΑΛΥΤΕΡΗ ΣΕ ΚΥΤΤΑΡΑ ΕΚΤΟΣ ΚΥΤΤΑΡΙΚΟΥ ΚΥΚΛΟΥ ΚΑΙ ΑΠΟΔΟΘΗΚΕ ΕΝ ΜΕΡΕΙ ΣΤΗ ΓΕΝΕΣΗ ΕΛΕΥΘΕΡΩΝ ΡΙΖΩΝ ΠΟΥ ΠΙΘΑΝΟΤΑΤΑ ΔΕΣΜΕΥΕ Η ΔΙΠΥΡΙΔΑΜΟΛΗ ΑΥΞΟΝΑΝΤΑΣ ΤΗΝ ΕΠΙΒΙΩΣΗ.Η ΜΥΚΗΤΟΣΤΑΤΙΚΗ ΔΡΑΣΗ ΤΗΣ ΦΘΟΡΙΟΟΥΡΑΚΙΛΗΣ ΑΠΟΔΟΘΗΚΕ ΣΤΗ ΔΙΑΤΑΡΑΧΗ ΤΟΥ ΜΕΤΑΒΟΛΙΣΜΟΥ ΑΛΛΩΝ ΜΑΚΡΟΜΟΡΙΩΝ ΠΕΡΑΝ ΤΟΥ DNA, ΕΝΩ Η ΣΥΝΕΡΓΕΙΑ ΤΗΣ ΜΕ ΤΗ ΔΙΠΥΡΙΔΑΜΟΛΗ ΙΣΩΣ ΠΡΟΕΚΥΠΤΕ ΑΠΟ ΤΗΝ ΑΝΑΣΤΟΛΗ ΤΗΣ ΠΕΡΜΕΡΜΕΑΣΗΣ ΚΥΤΟΣΙΝΗΣ- ΠΟΥΡΙΝΩΝ.Η ΚΥΤΤΑΡΟΚΤΟΝΟΣ ΜΕΘΟΤΡΕΞΑΤΗ ΕΜΦΑΝΙΣΕ ΣΥΝΕΡΓΕΙΑ ΜΕ ΤΙΣ ΔΙΠΥΡΙΔΑΜΟΛΗ ΚΑΙ ΘΕΟΦΥΛΛΙΝΗ ΙΣΩΣ ΛΟΓΩ ΑΝΑΣΤΟΛΗΣ ΤΗΣ ΒΙΟΣΥΝΘΕΣΗΣ ΤΩΝ ΠΡΟΔΡΟΜΩΝ ΤΟΥ DNA.ΔΕΝ ΚΑΤΕΣΤΕΙ ΣΑΦΕΣ ΑΝ Η CIS-ΠΛΑΤΙΝΗ ΗΤΑΝ ΚΥΤΤΑΡΟΚΤΟΝΟΣ 'Η ΟΧΙ ΕΝΩ Η ΣΥΝΕΡΓΕΙΑ ΤΗΣ ΜΕ ΤΗ ΘΕΟΦΥΛΛΙΝΗ ΙΣΩΣ ΟΦΕΙΛΕΤΑΙ ΣΤΗ ΔΙΑΤΑΡΑΧΗ ΤΟΥ ΜΕΤΑΒΟΛΙΣΜΟΥ ΤΗΣ ΓΟΥΑΝΙΝΗΣ 'Η ΣΤΗΝ ΠΑΡΑΚΑΜΨΗ ΤΩΝ ΣΗΜΕΙΩΝ ΕΛΕΓΧΟΥ - ''CHECKPOINTS''.ΤΑ ΕΥΡ

Lymph node, peritoneal and bone marrow micrometastases in gastric cancer: Their clinical significance

The 7th TNM classification clearly states that micrometastases detected by morphological techniques (HE stain and immunohistochemistry) should always be reported and calculated in the staging of the disease (pN1mi or M1), while patients in whom micrometastases are detected by non-morphological techniques (e.g., flow cytometry, reverse-transcriptase polymerase chain reaction) should still be classified as N0 or M0. In gastric cancer patients, micrometastases have been detected in lymph nodes, the peritoneal cavity and bone marrow. However, the clinical implications and/or their prognostic significance are still a matter of debate. Current literature suggests that lymph node micrometastases should be encountered for the loco-regional staging of the disease, while skip lymph node micrometastases should also be encountered in the total number of infiltrated lymph nodes. Peritoneal fluid cytology examination should be obligatorily performed in pT3 or pT4 tumors. A positive cytology classifies gastric cancer patients as stage IV. Although a curative resection is not precluded, these patients face an overall dismal prognosis. Whether patients with a positive cytology should be treated similarly to patients with macroscopic peritoneal recurrence should be evaluated further. Gastric cancer cells are detected with high incidence in the bone marrow. However, the published results make comparison of data between groups almost impossible due to severe methodological problems. If these methodological problems are overcome in the future, specific target therapies may be designed for specific groups of patients

Lymph node, peritoneal and bone marrow micrometastases in gastric cancer: Their clinical significance

The 7th TNM classification clearly states that micro-metastases detected by morphological techniques (HE stain and immunohistochemistry) should always be reported and calculated in the staging of the disease (pN1mi or M1), while patients in whom micrometastases are detected by non-morphological techniques (e.g., flow cytometry, reverse-transcriptase polymerase chain reaction) should still be classified as N0 or M0. In gastric cancer patients, micrometastases have been detected in lymph nodes, the peritoneal cavity and bone marrow. However, the clinical implications and/or their prognostic significance are still a matter of debate. Current literature suggests that lymph node micrometastases should be encountered for the loco-regional staging of the disease, while skip lymph node micrometastases should also be encountered in the total number of infiltrated lymph nodes. Peritoneal fluid cytology examination should be obligatorily performed in pT3 or pT4 tumors. A positive cytology classifies gastric cancer patients as stage.. Although a curative resection is not precluded, these patients face an overall dismal prognosis. Whether patients with a positive cytology should be treated similarly to patients with macroscopic peritoneal recurrence should be evaluated further. Gastric cancer cells are detected with high incidence in the bone marrow. However, the published results make comparison of data between groups almost impossible due to severe methodological problems. If these methodological problems are overcome in the future, specific target therapies may be designed for specific groups of patients. (C) 2012 Baishideng. All rights reserved

Neutrophils to lymphocytes ratio as a useful prognosticator for stage II colorectal cancer patients

Abstract Background The incidence of colorectal cancer (CRC) is expected to increase by 80% in year 2035. Even though advantages in treatment of CRC have being made over the last decades, the outcome remains poor. Recently, several inflammatory markers including pretreatment neutrophil to lymphocyte ratio (NLR), have being used as prognostic factors, since host inflammatory response to cancer is believed to determine disease progression. The aim of this study is to evaluate the prognostic significance of pretreatment NLR, in terms of overall survival (OS), 5-year survival, disease-free survival (DFS) and recurrence, in CRC patients who underwent curative resection. Methods We retrospectively reviewed 296 patients, who were submitted to elective surgery as first therapeutic option in curative intent, between January 2010 and December 2015. Pretreatment NLR, as well as demographics, clinical, histopathologic, and laboratory data were analyzed. Univariate and multivariate analyses were conducted to identify prognostic factors associated with OS, 5-year survival, DFS and recurrence. Results The cutoff point of NLR was calculated with Kaplan-Meier curves and log-rank test to 4.7. Univariate and multivariate analyses disclosed elevated NLR as a significant dismal prognostic factor for DFS (HR 1.88; 95% CI 1.01–3.52; p = 0.048), 5-year survival (HR 2.14; 95% CI 1.12–4.10; p = 0.021) and OS (HR 2.11; 95% CI 1.11–4.03; p = 0.023). In a subgroup analysis, in patients with stage II CRC, NLR > 4.7 was a stronger poor predictor for DFS (HR 2.76; 95% CI 1.07–7.13; p = 0.036), 5-year survival (HR 3.84; 95% CI 1.39–10.63; p = 0.01) and OS (HR 3.62; 95% CI 1.33–4.82; p = 0.012). After adjusting stage for gender, age, location of the primary tumor, differentiation, as well as the presence of perineural, vascular, and lymphovascular invasion, the significance of NLR > 4.7 became more prominent for DFS (HR 2.85; 95% CI 1.21–6.73; p = 0.0176), 5-year survival (HR 4.06; 95% CI 1.66–9.93; p = 0.002) and OS (HR 4.07; 95% CI 1.69–9.91; p = 0.002) in stage II patients. Conclusion Pretreatment NLR > 4.7 is a poor prognostic factor for DFS, 5-year survival and OS in CRC patients undergoing curative resection. The dismal prognostic effect of NRL is magnified in Stage II CRC patients