DataSheet_1_Combining prognostic nutritional index (PNI) and controlling nutritional status (CONUT) score as a valuable prognostic factor for overall survival in patients with stage I–III colorectal cancer.docx

Background and aimsThis study compared the prognostic significance of various nutritional and inflammatory indicators such as neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio, prognostic nutritional index, and controlling nutritional status score. In addition, we aimed to establish a more accurate prognostic indicator.MethodsWe retrospectively evaluated 1112 patients with stage I–III colorectal cancer between January 2004 and April 2014. The controlling nutritional status scores were classified as low (0–1), intermediate (2–4), and high (5–12) scores. The cut-off values for prognostic nutritional index and inflammatory markers were calculated using the X-tile program. P-CONUT, a combination of prognostic nutritional index and the controlling nutritional status score, was suggested. The integrated areas under the curve were then compared.ResultsThe multivariable analysis showed that prognostic nutritional index was an independent prognostic factor for overall survival, whereas the controlling nutritional status score, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and platelet-to-lymphocyte ratio were not. The patients were divided into three P-CONUT groups as follows: G1, controlling nutritional status (0–4) and high prognostic nutritional index; G2, controlling nutritional status (0–4) and low prognostic nutritional index; and G3, controlling nutritional status (5–12) and low prognostic nutritional index. There were significant survival differences between the P-CONUT groups (5-year overall survival of G1, G2, and G3 were 91.7%, 81.2%, and 64.1%, respectively; p ConclusionPrognostic effect of P-CONUT may be better than inflammatory markers such as neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio. Thus, it could be used as a reliable nutritional risk stratification tool in patients with colorectal cancer.</p

A case of gastric cancer metastasis to the breast in a female with <i>BRCA2</i> germline mutation and literature review

<p><b>Introduction:</b> Gastric cancer is a deadly disease. Common sites of distant metastasis of gastric cancer are the peritoneum, liver, lymph nodes, and lung. The breast is a rare site of metastasis in gastric cancer which occurs in males dominantly.</p> <p><b>Patients and methods:</b> Here, we report the first case of metastatic gastric cancer to the breast in a patient with the breast cancer 2 (<i>BRCA2)</i> germline mutation. A 34-year-old female was admitted to the hospital with dyspepsia and a palpable mass in the left breast. Gastric cancer was confirmed to be signet ring cell adenocarcinoma. The breast mass exhibited histological properties consistent with gastric cancer. Immunohistochemistry results showed the breast tumor was CDX-2 and CK20-positive, but ER-, CK7-, and GATA3-negative. The <i>BRCA1</i> gene had a wild-type sequence, but a heterozygous variant was discovered in <i>BRCA2</i> in exon 10 (c.1744A > C, p.T582P); the significance of this variant is unknown.</p> <p><b>Results:</b> The patient received palliative XELOX (capecitabine + oxaliplatin) with radiation therapy to the stomach. The breast tumor resolved completely, but the overall response was partial.</p> <p><b>Conclusion:</b> Gastric cancer metastasis to the breast is rare, but should be considered in young female patients with signet ring cell type gastric cancer.</p