Influence of the coronavirus disease 2019 pandemic on gastric cancer: associations with diagnostic delays, clinicopathological features, and 3-year survival

To investigate the relationship of ABO blood group with the clinicopathological characteristics in patients with gastric cancer and to assess whether the ABO blood group was associated with prognosis. Clinicopathological and follow-up data of 2838 patients with gastric cancer who underwent radical gastrectomy in our department from June 2008 to October 2013 were analyzed retrospectively. The distribution of ABO blood group under different clinicopathological characteristics and the overall 5-year survival of ABO blood group were compared. There were no significant differences in clinicopathological characteristics among patients with different ABO blood groups (all P>0.05). The 5-year overall survival(OS) rates were 57.3% for patients with blood type A, 54.7% for type B, 57.4% for type O, and 53.5% for type AB. Though there was no significance difference of survival among ABO blood groups(P=0.722), while the subgroup analysis indicated that stage III( patients of blood group Non-AB had a poorer OS compared to those of blood group AB(25.2% vs. 44.7%, P=0.014); smoking patients of blood group Non-AB had a poorer OS compared to those of blood group AB(53.4% vs. 74.9%, P=0.044). Neither clinicopathological characteristics nor overall survival are associated with the ABO blood group, however, stage III( and smoking patients of blood group Non-AB have a poorer OS compared to those of blood group AB.

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To investigate the value of preoperative abdominal contrast-enhanced multiple-row detector computed tomography (ceMDCT) in predicting the postoperative 1-year disease-free survival (DFS) for gastric cancer. Between January 2009 and December 2015, 237 gastric cancer patients at Peking University People's Hospital with complete preoperative clinical, image and follow-up data were enrolled in this retrospective study. (1) primary gastric cancer was confirmed by pathology; (2) radical gastrectomy and D2 lymph node dissection were performed;(3) patients underwent preoperative ceMDCT. Patients with gastric stump cancer, concurrent metastasis, other malignancies, and undergoing neoadjuvant treatment were excluded. According to ceMDCT examination with or without ctEMVI (extramural venous invasion), patients were divided into ctEMVI-positive and ctEMVI-negative group. ctEMVI-positive was defined as that there was a continuous tubular and nodular soft tissue filling defect from the tumor to the adjacent blood vessel lumen in ceMDCT, suggesting the tumor directly invaded the blood vessels outside the muscularis propria of the gastrointestinal smooth muscle. Log-rank test was used to compare differences in 1-year DFS between ctEMVI-positive group and ctEMVI-negative group. According to the 8th edition of the American Joint Committee on Cancer (AJCC), the T staging in ceMDCT (ctT) and lymph node metastasis (lymph nodes with shorter diameter > 8 mm) were determined. The patients were subdivided into four subgroups, ctT4N(+), ctT4N(-), ctT1-3N(+), and ctT1-3N(-), to further compare the difference in postoperative 1-year DFS between ctEMVI-positive and -negative patients in each subgroups. Kaplan-Meier univariate analysis was performed on preoperative imaging data (ctT, ctN, ctEMVI, tumor location/growth pattern, and ctSize). Cox proportional hazard regression was used to find the independent risk factors of 1-year DFS rate. According to the number of independent risk factors, the patients were classified to different risk stratifications. The difference of 1-year DFS rate between different risk stratifications was compared. According to the results of ceMDCT, 72 patients (30.4%) were divided into the ctEMVI-positive group and 165 patients(69.6%) into the ctEMVI-negative group. The ctEMVI-positive group had significantly lower 1-year DFS rate (55.3%) than the ctEMVI-negative group (90.2%) (χ²=40.17, P<0.001). The 1-year DFS in the ctEMVI-positive ctT4N(+) subgroup was 34.5%, which was significantly lower than that of the ctMVI-negative ctT4N(+) subgroup (85.3%) (χ²=19.13, P<0.001). In the ctEMVI-positive ctT1-3N(-) subgroup, the 1-year DFS was 77.8%, which was also significantly lower than 98.5% of the ctEMVI-negative ctT1-3N(-) subgroup(χ²=15.09, P=0.003). In Cox proportional hazards regression analysis, ctT, ctN and ctEMVI were identified as independent prognostic factors of 1-year DFS with hazard ratio (HR) of 3.351(95%CI:1.249-8.986, P=0.017), 1.987(95%CI:1.085-3.637, P=0.027) and 3.398(95%CI:1.785-6.469, P<0.001), respectively. Risk classification was carried out according to the number of independent risk factors (ctT, ctN and ctEMVI). Grade 0 had no independent risk factors, grade 1 had one independent risk factor, grade 2 had two independent factors and grade 3 had 3 independent risk factors. The risk grading result showed that the numbers of patients form grade 0 to 3 were 71, 65, 68, 33, respectively, and the 1-year DFS rates were 98.5%, 82.1%, 79.0%, 34.5%, respectively(P<0.001). With the increase of the number of independent risk factors, 1-year DFS rate decreased gradually in patients with gastric cancer (P<0.001). Differences of 1-year DFS between grade 0 and grade 1(P=0.002), between grade 2 and grade 3(P<0.001) were both significant. Meanwhile the difference between grade 1 and grade 2 was not significant (P=0.578). ctEMVI, ctT and ctN defined by preoperative ceMDCT are independent risk factors for the prognosis of gastric cancer. With the increase of risk factors, the 1-year DFS decreases gradually.

To study the clinicopathological features and prognosis of gastric stump cancer (GSC) following subtotal gastrectomy for gastric cancer, to compare the clinicopathologic differences between narrow GSC and generalized GSC, and to compare the prognosis between GSC and primary proximal gastric cancer (PPGC) after radical resection. Literatures of GSC-associated clinical study were searched by computer from the Cochrane Library, Medline, PubMed, CNKI, Wanfang and VIP databases, and the retrieval period was from the establishment of database to December 31, 2017. (1) GSC was defined as a carcinoma arising in the gastric remnant after radical gastrectomy for gastric cancer, and confirmed by the pathological or histological examination, the elapsed time from the initial operation was not considered in the definition. (2) Retrospective or prospective clinical cohort study. (3) Study included at least one of below items: gender, anastomotic type in gastric cancer surgery, the interval between the initial surgery and diagnosis of GSC, the location, treatment, pathological differentiation, pathologic stage, lymph node metastasis rate and prognosis of GSC. (4) When similar studies were reported by the same institution or author, either the better quality study or the newest publication was chosen. (1) Abstracts, reviews, case reports, meeting record, editorials and repeated research. (2) Studies including patients with initial non-gastric cancer. In this study, gastric stump cancer(GSC) after gastric cancer was divided into two groups: the incidence without limit interval time (generalized GSC group) and above 10 years (narrow GSC group). Selective trials were Meta-analyzed by the Stata13.0 software and statistical analysis was performed using SPSS 21.0 software. A total of 27 literatures were finally enrolled, which comprised 1463 GSC patients, including 1146 males and 317 females. The generalized group and narrow GSC group had 921 and 542 patients respectively. The generalized GSC group and the narrow GSC group did not significantly differ in terms of previous reconstruction mode, types of differentiation, pathologic T staging, postoperative pathology tumor-node-metastases staging, and distant metastasis rate (χ2=2.341, 0.926, 0.350, 0.965, 2.311 respectively, all P>0.05). As compared to generalized GSC group, narrow GSC group had higher ratio of male patients (82.8% vs. 75.7%, χ2=9.909, P=0.002), more lesions locating in anastomotic stoma (37.8% vs. 26.1%, χ2=18.091, P=0.000), higher ratio of patients undergoing radical resection (84.2% vs. 70.3%, χ2=11.738, P=0.001), higher positive rate of postoperative lymph node (45.8% vs. 34.5%, χ2=6.319, P=0.012), and larger size of tumor [(5.9±2.2) cm vs. (4.5±1.9) cm, t=9.151, P=0.000]. The overall 5-year survival rate and postoperative pathology stage III(-IIII( survival ratio in narrow GSC group were higher compared to general GSC group (42.7% vs. 30.6% and 27.5% vs. 18.1%, respectively), which were significantly different (χ2=10.938, P=0.000; χ2=4.128, P=0.042), while the postoperative pathology stage I(-II( survival ratio was not significantly different between two groups (67.3% vs. 67.0% respectively, χ2=0.015, P=0.92). There was no significant difference in the 5-year survival rate between GSC with radical resection and PPGC(RR=1.04, 95%CI:0.79-1.36, P=0.805) and the 5-year survival rate of same postoperative pathology stage was not significantly different between two groups (I(-II( stage: RR=1.08, 95%CI:0.93-1.26, P=0.328; III(-IIII( stage: RR=0.59, 95%CI:0.33-1.04, P=0.111). There are some different clinicopathological features between the generalized and the narrow GSC after gastric cancer surgery. The prognosis of GSC after radical resection is similar to primary proximal gastric cancer.

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Background: Diagnostic and treatment delays are contributing factors to the increasing incidence and mortality of breast cancer worldwide, including in Indonesia. The study aimed to discern the underlying factors contributing to diagnostic and treatment delays in breast cancer patients. Methods: This study uses a descriptive method. Primary data collection through guided interviews using questionnaires to 40 breast cancer patients who underwent treatment. This study was conducted at the University Andalas Hospital from January 2022 to September 2022. Results: The breast cancer diagnostic delay is caused by poor knowledge (52.5%), negative attitudes and behaviors (57.5%), a strong fear of breast cancer (55.0%), good social support (65.0%), and the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on breast cancer examination (75.0%). The breast cancer treatment delay is due to poor knowledge (52.5%), positive attitudes and behaviors (52.5%), a strong fear of breast cancer treatment (55.0%), good social support (67.5%), the impact of the COVID-19 pandemic on breast cancer treatment (75.0%). Conclusions: The overview of factors causing diagnostic delay and treatment delays in breast cancer patients is dominated by negative categories, particularly in terms of knowledge, attitudes and behaviors, fear, and the COVID-19 pandemic. Only social support is positive, falling into a good category, as well as the attitudes and behaviors related to breast cancer treatment, which are also categorized as good.

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Robotic gastrectomy (RG) has been reported to be technically feasible and safe for patients with gastric cancer. However, 5-year long-term survival and recurrence outcomes for advanced gastric cancer have rarely been reported. This study aimed to compare the long-term oncologic outcomes between RG and laparoscopic gastrectomy (LG) for gastric cancer. The general clinicopathological data of 1905 consecutive patients who underwent RG and LG were retrospectively collected at the Chinese People's Liberation Army General Hospital between November 2011 and October 2017. Propensity score matching (PSM) was used to match groups. The primary endpoints were 5-year disease-free survival (DFS) and overall survival (OS). After PSM, a well-balanced cohort of 283 patients in the RG group and 701 patients in the LG group were included in the analysis. The 5-year cumulative DFS rates were 67.28% in the robotic group and 70.41% in the laparoscopic group. The 5-year OS rate was 69.01% in the robotic group and 69.58% in the laparoscopic group. No significant differences in Kaplan-Meier survival curves for DFS (HR = 1.08, 95% CI 0.83-1.39, Log-rank P = 0.557) and OS (HR = 1.02, 95% CI 0.78-1.34, Log-rank P = 0.850) were observed between the 2 groups. In the subgroup analyses for potential confounding variables, there were no significant differences in 5-year DFS and 5-year OS survival between the 2 groups (P > 0.05), except for patients with pathological stage III and pathological stage N3 (P < 0.05). For patients with early gastric cancer, robotic and laparoscopic approaches have similar long-term survival. For patients with advanced gastric cancer, further studies need to be conducted to assess the long-term survival outcomes of RG.

Objecitve To evaluate the impact of adding methotrexate into DIA chemotherapy regimen (cisplatin, theraru-bicin and ifosfamide) on 3-year disease-free and overall survival of patients with IIB osteosarcoma in extremities. Methods Retro-spectively analyzed 34 cases of IIB limb osteosarcoma according to the Musculoskeletal Tumor Society (MSTS) surgical staging system with pathologically diagnosed concurrent chemotherapy and comprehensive surgical treatment from May 2008 to April 2014. There were 20 males and 14 females, with an average age of 19.5±7.7 years (ranged from 9 to 44 years). 28 patients underwent limb salvage surgery, and 6 patients received amputation. Tumor site included distal femur in 21 patients, proximal tibia in 9 patients, other sites in 4 patients. Seventeen patients underwent cisplatin, THP and ifosfamide (DIA) regimen of chemotherapy. The other 17 patients underwent cisplatin, THP, ifosfamide and methotrexate (MDIA) regimen. Patients charts were reviewed to get demographic data including age, gender, site, tumor size, surgery type, chemotherapy regimen, alkaline phosphatase, lactase dehydrogenase. The prognostic value of these factors on 3 years disease free survival and overall survival were calculated with Kaplan-Meier method and compared with Log-Rank test between different groups in univariate comparison and COX model for multivariate analysis was used to determine whether these demographic factors are independent prognostic factor for survival. Results Two patients had local recurrence, 7 patients had metastasis, and 2 patients had both local recurrence and metastasis. The 3-year survival of the whole group was 67.6% (23/34). Seven patients died during follow-up. The overall survival was 79.4% (27/34). The 3-year disease-free survival in DIA group and MDIA group was 70.6% (12/17) and 64.7% (11/17), respectively. The 3-year overall survival was 82.4% (14/17) and 76.5% (13/17) in DIA group and MDIA group, respectively. Univariate analysis showed that there was no significant difference in either 3-year disease-free survival (χ2=0.113, P=0.737) or overall survival (χ2=0.197, P=0.657) between DIA and MDIA. Age was significantly correlated with prognostic in univariate analysis (χ2=5.869, P=0.015), while gender, tumor site, tumor size, surgery type, ALP, LDH was not correlated with disease-free survival. Kaplan-meier analysis with Log-Rank test showed age (χ2=6.134, P=0.013) and tumor size (χ2=5.108, P=0.024) were statistically correlated with overall survival. Multivariate analysis with COX model showed that chemotherapy regimen was not an independent prognostic factor for 3-year disease-free survival or overall survival. Age was an independent prognostic factor for 3-year disease-free survival (HR=5.836, P=0.017). Conclusion The addition of MTX on the basis of DIA chemotherapy regimen did not significantly improve the 3-year disease-free survival and overall survival of stage IIB limb osteosarcoma. Key words: Osteosarcoma; Extremities; Antineoplastic combined chemotherapy protocols; Survival rate

Objective To investigate the associations between expression of Tensin1 protein and clinicpathological characteristics and prognoses of gastric cancer (GC) patients. Methods The retrospective case-control study was conducted. The clinicopathological data of 163 GC patients who were admitted to the Affiliated Hospital of Jiangsu University between July 31, 2011 and December 31, 2013 were collected. The GC tissues and adjacent normal tissues were taken to paraffin imbedding, and then were detected by immunohistochemistry. Observation indicator: (1) expressions of Tensin1 protein in GC tissues and adjacent normal tissues; (2) association between expression of Tensin1 protein in GC tissues and clinicopathological characteristics; (3) follow-up and survival situations; (4) prognostic factors analysis. Follow-up using telephone interview was performed to detect survival up to January 1, 2017. Measurement data with skewed distribution were described as M (range). Count data were analyzed using the chi-square test or pairing chi-square test. The survival curve and rate were respectively drawn and calculated using the Kaplan-Meier method, and Log-rank test was used for survival analysis. The univariate analysis and multivariate analysis were done using the COX roportional hazard model. Results (1) Expressions of Tensin1 protein in GC tissues and adjacent normal tissues: immunohistochemistry showed that Tensin1 protein in GC tissues and adjacent normal tissues mainly expressed in cytoplasm. Of 163 patients, 154 (66 with high expression and 88 with low expression) and 9 had respectively positive and negative expressions of Tensin1 protein in GC tissues; 79 (37 with high expression and 42 with low expression) and 84 had respectively positive and negative expressions of Tensin1 protein in adjacent normal tissues, with statistically significant differences in positive expression ratio and expression levels (χ2=64.65, 12.93, P<0.05). (2) Association between expression of Tensin1 protein in GC tissues and clinicopathological characteristics: high expression rate of Tensin1 protein in GC tissues were respectively 31.34%(21/67) in GC patients with tumor metastases and 46.88%(45/96) in GC patients without tumor metastasis, with a statistically significant difference (χ2=3.95, P<0.05). (3) Follow-up and survival situations: all the 163 patients were followed up for 3.3-64.7 months, with a median time of 28.7 months. The 3-year cumulative disease-free survival rate and cumulative overall survival rate in GC tissues were 63.12%, 74.22% in 66 patients with high expression of Tensin1 protein and 47.30%, 55.74% in 97 patients with low and negative expressions of Tensin1 protein, showing statistically significant differences in above indicators (χ2=4.58, 4.11, P<0.05). Survival analysis of subgroups showed that 3-year cumulative disease-free survival rate in GC tissues of patients with maximum tumor dimension ≥ 5 cm, nerve and / or vascular invasions and stage Ⅲ of TNM staging were 45.98%, 62.79%, 52.75% in patients with high expression of Tensin1 protein and 18.11%, 31.10%, 32.80% in patients with low and negative expressions of Tensin1 protein, with a statistically significant difference (χ2=5.85, 7.89, 4.96, P<0.05). The 3-year cumulative overall survival rate was respectively 66.00%, 75.75%, 67.93% in patients with high expression of Tensin1 protein and 30.74%, 40.15%, 44.67% in patients with low and negative expressions of Tensin1 protein, with statistically significant differences (χ2=7.59, 9.62, 4.32, P<0.05). (4) Prognostic factors analysis: results of univariate analysis showed that maximum tumor dimension, histological grade, nerve and / or vascular invasions, postoperative TNM staging, postoperative adjuvant chemotherapy and expression of Tensin1 protein were related factors affecting prognoses of GC patients [hazard ratio (HR)=3.66, 2.45, 2.17, 3.36, 0.41, 0.54, 95% confidence interval (CI): 2.09-6.41, 1.43-4.19, 1.17-4.04, 1.52-7.41, 0.23-0.72, 0.31-0.96, P<0.05]. Results of multivariate analysis showed that maximum tumor dimension ≥ 5 cm and grade Ⅲ of histological grade were independent risk factors affecting prognoses of GC patients (HR=3.21, 2.17, 95%CI: 1.63-6.32, 1.18-3.99, P<0.05), and postoperative adjuvant chemotherapy and high expression of Tensin1 protein were independent protective factors affecting prognoses of GC patients (HR=0.50, 0.44, 95%CI: 0.28-0.90, 0.24-0.82, P<0.05). Conclusion High expression of Tensin1 protein may inhibit GC metastasis, and it is also an independent protective factor affecting prognoses of GC patients. Key words: Gastric neoplasms; Tensin1; Clinicopathological characteristics; Prognosis; Survival rate

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