The Prognostic Analysis Of Gastric Cancer And Peritoneal Carcinomatosis

Part ?:Long tarm follow up and retrospective study on 533 gastric cancer casesObjective Gastric cancer (GC) is the third leading cause of cancer death and the outcome of GC patients is poor. The aim of the study is to study the prognostic factors of gastric cancer patients who had curative intent or palliative resection, completed clinical database and follow-up.Methods This retrospective study analyzed 533 GC patients from three tertiary referral teaching hospitals from January 2004 to December 2010 who had curative intent or palliative resection, complete clinical database and follow-up information. The GC-specific overall survival (OS) status was determined by the Kaplan-Meier method, and univariate analysis was conducted to identify possible factors for survival. Multivariate analysis using the Cox proportional hazard model and a forward regression procedure was conducted to define independent prognostic factors.Results By the last follow-up,533 GC patients were included for final analysis. The median follow-up time was 38.6 mo (range 6.9-100.9 mo), and the median OS was 25.3 mo (95% CI: 23.1-27.4 mo). The estimated 1-,2-,3-and 5-year OS rates were 78.4%,61.4%,53.3% and 48.4%, respectively. Univariate analysis identified the following prognostic factors:hospital, age, gender, cancer site, surgery type, resection type, other organ resection, HIPEC, LN status, tumor invasion, distant metastases, TNM stage, postoperative SAE, systemic chemotherapy and IP chemotherapy. In multivariate analysis, seven factors were identified as independent prognostic factors for long term survival, including resection type, HIPEC, LN status, tumor invasion, distant metastases, postoperative SAE and systemic chemotherapy.Conclusions Resection type, HIPEC, postoperative SAE and systemic chemotherapy were four independent prognostic factors that could be intervened for GC patients.Part ?:lymph node ratio may be a better prognosticator than lymph node status for gastric cancerObjective To identify whether LNR could be a better prognosticator than pN for GC.Method Log-rank test, Kaplan-Meier survival curve, Cox proportional hazard model and ROC curve analyses were used for gastric cancer to compare LNR and pN.Results Of 613 GC patients,138 patients who had> 15 lymph nodes resection and radical resection were enrolled into the final study. By the time of last follow-up (median follow-up: 38.3 mo, range:9.9-97.7 mo), the median OS was 23.9 mo (95% CI:18.8-29.0 mo). The 1-, 2-,3-and 5-year survival rates were 76.8%,57.2%,50.0% and 46.4%, respectively. The cutoff points were 0,0.5 and 0.8 (R0:LNR= 0; R1:LNR?0.5; R2:0.5> LNR?0.8; and R3: LNR> 0.8). In univariate and multivariate analysis, both LNR and pN were independent prognostic factors. LNR could better differentiate patients than LN in terms of OS. And TRM staging system was better to predict the clinical outcomes than TNM staging system, and LNR was better to PN.Conclusions LNR was a better prognosticator than PN for GC.Part ?:Quantum dot-based multiplexed imaging in malignant ascites:a new model for malignant ascites classificationObjective The aims of this study are to establish a new method for simultaneously detecting the interactions between cancer cells and immunocytes in malignant ascites (MA) and to propose a new model for MA classification.Methods A QD-based multiplexed imaging technical was developed for simultaneous in situ imaging of cancer cells, lymphocytes, and macrophages. This method was applied to MA samples from 20 patients with peritoneal carcinomatosis (PC) from gastrointestinal and gynecological origins. The staining features of MA and the interactions between cancer cells and immunocytes in the ascites were further analyzed and correlated with clinical features.Results The QD-based multiplexed imaging technique was applied to MA cytology, different features of interactions and quantitative relations between cancer cells and immunocytes were observed. On the basisi fo these features, MA could be classified into immunocytes-dominant type, immunocytes-reactive type, cancer cells-dominant type and cell deletion type, the four categories were statistically different in terms of the ratio of cancer cells to immunocytes (P<0.001). Moreover, in the MA, the ratio of cancer cells to immunocytes was higher for patients with gynecological and gastric cancers than for those with colorectal cancer.Conclusions The newly developed QD-based multiplexed imaging technique was able to better reveal the interactions between cancer cells and immunocytes. This advancement allows for better MA classification and, thereby, allows for treatment decisions to be more individualized.