Background:Elderly patients with cancer who are overweight or obese tend to show signs of inflammation or malnutrition.The albumin-to-globulin ratio(AGR)is a clinical indicator of the nutritional status and presence o...Background:Elderly patients with cancer who are overweight or obese tend to show signs of inflammation or malnutrition.The albumin-to-globulin ratio(AGR)is a clinical indicator of the nutritional status and presence of systemic inflammation in cancer patients.However,its predictive value in this specific population has not yet been elucidated.Methods:This study,comprising 917 overweight or obese elderly cancer patients,was conducted as a multicenter clinical trial.The relationship between the AGR and survival outcome was assessed using Kaplan-Meier survival curve analyses and the Cox regression model for HRs.Additionally,the prognostic value of the pretreatment AGR was validated by performing a propensity score matching analysis.Results:The optimal cutoff value for a low AGR was 1.25.A notable decrease in the risk of all-cause mortality was observed with each increase in the AGR value.Specifically,for every standard deviation increase,the HR was 0.83(95%CI:0.74–0.93,P=0.001).After adjustment,it was determined that a decreased AGR was independently linked to a worse prognosis among elderly cancer patients who were overweight or obese(HR:1.79,95%CI:1.40–2.27,P<0.001).In addition,a reduced AGR is correlated with poorer outcomes in the context of certain malignancies,particularly lung,upper gastrointestinal,and colorectal malignancies.Notably,the effect of the AGR on the overall survival was influenced by the Eastern Cooperative Oncology Group performance status.The validity of our primary findings was confirmed through a propensity score matching analysis,which accounted for potential confounding factors.Conclusions:A reduced AGR is linked to a poor prognosis,particularly when concurrent with a poor Eastern Cooperative Oncology Group performance status in overweight or obese elderly cancer patients.展开更多
Background:The Asian Working Group for Cachexia(AWGC)criteria are newly proposed diagnostic standards specifically designed for Asian populations.This research focused on validating the predictive value of the AWGC cr...Background:The Asian Working Group for Cachexia(AWGC)criteria are newly proposed diagnostic standards specifically designed for Asian populations.This research focused on validating the predictive value of the AWGC criteria for assessing the prognosis and medical burden of patients with gastric cancer.Methods:Cox proportional hazards analysis was conducted to evaluate the association between cachexia and overall survival.Logistic regression analysis was used to assess whether there was an independent association between cachexia and the 90-day mortality,the length of stay and the quality of life.Harrell’s concordance index was utilized to demonstrate the discriminative ability of different diagnostic criteria for cachexia.Results:AWGC-defined cachexia was an independent risk factor for a reduced overall survival in patients(HR=1.397,95%CI=1.209–1.615,P<0.001).The predictive accuracy of the AWGC criteria was markedly superior to that of the Fearon criteria(χ2=39.025 vs 13.877).Compared with Fearon standards,the AWGC criteria offered a 2.9%enhancement in clinical benefit(0.029,95%CI=0.048–0.008,P=0.005).Logistic regression analysis showed that only AWGC-defined cachexia was an independent risk factor for 90-day mortality(OR=2.142,95%CI=1.397–3.282,P<0.001)and prolonged hospitalization(OR=1.958,95%CI=1.587–2.416,P<0.001)in patients with gastric cancer,whereas cachexia defined by the Fearon criteria was not.Patients with AWGC-defined cachexia exhibited significant reductions in physical function,role function,emotional function,cognitive function,social functioning,and overall quality-of-life scores.Conversely,cachectic patients showed higher levels of fatigue,nausea and vomiting,pain,dyspnea,sleep disturbance,appetite loss,constipation,and financial difficulties.A multivariate logistic regression showed that patients with AWGC-defined cachexia had a 126.1%increased risk of impaired quality of life(OR=2.261,95%CI=1.859–2.749,P<0.001).Conclusions:The AWGC criteria are an effective tool for predicting adverse survival outcomes,90-day mortality,a prolonged hospital stay,and poorer quality of life in patients with gastric cancer.展开更多
Background: The purpose of this study is to evaluate the quality of life(QoL) of hospitalized patients in China suffering from digestive system malignancies and to identify potential risk factors for a decrease in QoL...Background: The purpose of this study is to evaluate the quality of life(QoL) of hospitalized patients in China suffering from digestive system malignancies and to identify potential risk factors for a decrease in QoL.Methods: The European Organization for Research and Treatment Core Quality of Life questionnaire(EORTC QLQ-C30) was applied to evaluate the QoL of 23,519 patients with six digestive malignancies(esophageal cancer, gastric cancer, colorectal cancer, liver cancer, biliary tract cancer, and pancreatic cancer). A t test or analysis of variance was employed to analyze the total EORTC QLQ-C30 scale scores and domain scores of the EORTC QLQ-C30 scale among patients in different subgroups.Results: The average QoL score was 50.4 ± 10.8. The tumor type, age, sex, and TNM stage al had an impact on QoL ratings. Colorectal cancer patients had a better total QoL score(49.3 ± 10.3) and scores in the domains of functioning, with milder symptoms, except for diarrhea. Patients with biliary tract cancer(54.2 ± 12.3) and pancreatic cancer(54.2 ± 12.3) reported a poorer QoL, significant functional impairment, and more pronounced symptoms. Patients with esophageal cancer experienced the most severe financial difficulties(35.2 ± 27.5). Patients aged ≥65 years, women, and those with TNM stage Ⅲ/Ⅳ reported lower QoL. In addition, the disparities in total QoL scores and scores in specific domains were significant among patients with some types of tumors, and based on ethnicity, educational level, occupation, treatment(s) received, and place of residence.Conclusions: There is a need to focus on elderly individuals, those with low educational levels, and patients with progressive malignant tumors and to improve routine disease monitoring and symptom management to enhance the quality of life for patients with malignancies of the digestive system.展开更多
Benign multicystic peritoneal mesothelioma(BMPM)is a rare cystic mesothelial lesion that occurs predominantly in reproductive aged women.A 56-year-old Caucasian male was admitted to our surgical department with a chie...Benign multicystic peritoneal mesothelioma(BMPM)is a rare cystic mesothelial lesion that occurs predominantly in reproductive aged women.A 56-year-old Caucasian male was admitted to our surgical department with a chief complaint of a painful mass in his right lower abdomen for almost 2 years.The physical examination revealed a palpable painful mass.Computed tomography demonstrated an irregular,cystic tumor in his right lower abdomen.There was no obvious capsule or internal septations.No enhancement after intravenous administration of contrast was noted.An exploratory laparotomy was performed,and a multicystic tumor and adherent to the caecum was noted.The walls of the cysts were thin and smooth,filled with clear fluid,and very friable.An en bloc resection of the tumor,including appendix and caecum,was performed.Histological examination revealed multiple cysts lined with flattened simple epithelial cells,and the capsule walls of the cysts were composed of fibrous tissue.Immunohistochemical analysis documented positive expression of mesothelial cells and calretinin.The final diagnosis was BMPM.The patient was well at 6-mo follow-up.BMPM is exceedingly rare lesion.A complete resection of the tumor is required.The diagnosis of BMPM is based on pathological analysis.展开更多
The characteristics of early-onset(onset age<50 years)and later-onset(onset age≥50 years)cancers differ significantly.Identifying novel risk factors for both types of cancer is crucial for increasing awareness of ...The characteristics of early-onset(onset age<50 years)and later-onset(onset age≥50 years)cancers differ significantly.Identifying novel risk factors for both types of cancer is crucial for increasing awareness of cancer prevention and for reducing its burden.This study aimed to analyze the trends in incidence and risk factors for early-onset and late-onset cancers.We conducted a prospective study by drawing data from the Kailuan Study.This study included 6,741 participants with cancer(624 with early-onset cancer and 6,117 with later-onset cancer)and 6,780 matched controls among the 186,249 participants who underwent Kailuan health examinations from 2006 to 2019.The primary outcomes were cancer incidence rates,and associated risk factors for early-and later-onset cancer.Weighted Cox regression was used to calculate hazard ratios and 95% confidence intervals of each exposure factor for early-and later-onset cancer by cancer type.Populationattributable risk proportions were used to estimate the number of cases that could be prevented by eliminating a risk factor from the population.Except for liver cancer,incidence rates for nearly all types of cancer increased during the study period.Smoking,alcohol consumption,lipid metabolism disorders,hypertension,diabetes mellitus,fatty liver,and inflammation were associated with a significantly increased risk of cancer at multiple sites,but risk factors for cancer incidence differed by site.Smoking,alcohol consumption,inflammation,and hypertension were the major contributors to preventable cancer.The incidence of several different types of cancer,including earlyonset cancer,is increasing in northeastern China.Differences in risk factors between early-onset and later-onset malignancies may contribute to the divergence in the observed changes in incidence trends between these two specific types of cancer.展开更多
Malnutrition is a common comorbidity among patients with cancer.However,no nutrition-screening tool has been recognized in this population.A quick and easy screening tool for nutrition with high sensitivity and easy-t...Malnutrition is a common comorbidity among patients with cancer.However,no nutrition-screening tool has been recognized in this population.A quick and easy screening tool for nutrition with high sensitivity and easy-to-use is needed.Based on the previous 25 nutrition-screening tools,the Delphi method was made by the members of the Chinese Society of Nutritional Oncology to choose the most useful item from each category.According to these results,we built a nutrition-screening tool named age,intake,weight,and walking(AIWW).Malnutrition was defined based on the scored patient-generated subjective global assessment(PG-SGA).Concurrent validity was evaluated using the Kendall tau coefficient and kappa consistency between the malnutrition risks of AIWW,nutritional risk screening 2002(NRS-2002),and malnutrition screening tool(MST).Clinical benefit was calculated by the decision curve analysis(DCA),integrated discrimination improvement(IDI),and continuous net reclassification improvement(c NRI).A total of 11,360 patients(male,n=6,024(53.0%)were included in the final study cohort,and 6,363 patients had malnutrition based on PG-SGA.Based on AIWW,NRS-2002,and MST,7,545,3,469,and1,840 patients were at risk of malnutrition,respectively.The sensitivities of AIWW,NRS-2002,and MST risks were 0.910,0.531,and 0.285,and the specificities were 0.768,0.946,and 0.975.The Kendall tau coefficients of AIWW,NRS-2002,and MST risks were 0.588,0.501,and 0.326,respectively.The area under the curve of AIWW,NRS-2002,and MST risks were0.785,0.739,and 0.630,respectively.The IDI,c NRI,and DCA showed that AIWW is non-inferior to NRS-2002(IDI:0.002(-0.009,0.013),c NRI:-0.015(-0.049,0.020)).AIWW scores can also predict the survival of patients with cancer.The missed diagnosis rates of AIWW,NRS-2002,and MST were 0.09%,49.0%,and 73.2%,respectively.AIWW showed a better nutritionscreening effect than NRS-2002 and MST for patients with cancer and could be recommended as an alternative nutritionscreening tool for this population.展开更多
文摘Background:Elderly patients with cancer who are overweight or obese tend to show signs of inflammation or malnutrition.The albumin-to-globulin ratio(AGR)is a clinical indicator of the nutritional status and presence of systemic inflammation in cancer patients.However,its predictive value in this specific population has not yet been elucidated.Methods:This study,comprising 917 overweight or obese elderly cancer patients,was conducted as a multicenter clinical trial.The relationship between the AGR and survival outcome was assessed using Kaplan-Meier survival curve analyses and the Cox regression model for HRs.Additionally,the prognostic value of the pretreatment AGR was validated by performing a propensity score matching analysis.Results:The optimal cutoff value for a low AGR was 1.25.A notable decrease in the risk of all-cause mortality was observed with each increase in the AGR value.Specifically,for every standard deviation increase,the HR was 0.83(95%CI:0.74–0.93,P=0.001).After adjustment,it was determined that a decreased AGR was independently linked to a worse prognosis among elderly cancer patients who were overweight or obese(HR:1.79,95%CI:1.40–2.27,P<0.001).In addition,a reduced AGR is correlated with poorer outcomes in the context of certain malignancies,particularly lung,upper gastrointestinal,and colorectal malignancies.Notably,the effect of the AGR on the overall survival was influenced by the Eastern Cooperative Oncology Group performance status.The validity of our primary findings was confirmed through a propensity score matching analysis,which accounted for potential confounding factors.Conclusions:A reduced AGR is linked to a poor prognosis,particularly when concurrent with a poor Eastern Cooperative Oncology Group performance status in overweight or obese elderly cancer patients.
基金supported by the Young Elite Scientists Sponsorship Program by CAST(No.2022QNRC001).
文摘Background:The Asian Working Group for Cachexia(AWGC)criteria are newly proposed diagnostic standards specifically designed for Asian populations.This research focused on validating the predictive value of the AWGC criteria for assessing the prognosis and medical burden of patients with gastric cancer.Methods:Cox proportional hazards analysis was conducted to evaluate the association between cachexia and overall survival.Logistic regression analysis was used to assess whether there was an independent association between cachexia and the 90-day mortality,the length of stay and the quality of life.Harrell’s concordance index was utilized to demonstrate the discriminative ability of different diagnostic criteria for cachexia.Results:AWGC-defined cachexia was an independent risk factor for a reduced overall survival in patients(HR=1.397,95%CI=1.209–1.615,P<0.001).The predictive accuracy of the AWGC criteria was markedly superior to that of the Fearon criteria(χ2=39.025 vs 13.877).Compared with Fearon standards,the AWGC criteria offered a 2.9%enhancement in clinical benefit(0.029,95%CI=0.048–0.008,P=0.005).Logistic regression analysis showed that only AWGC-defined cachexia was an independent risk factor for 90-day mortality(OR=2.142,95%CI=1.397–3.282,P<0.001)and prolonged hospitalization(OR=1.958,95%CI=1.587–2.416,P<0.001)in patients with gastric cancer,whereas cachexia defined by the Fearon criteria was not.Patients with AWGC-defined cachexia exhibited significant reductions in physical function,role function,emotional function,cognitive function,social functioning,and overall quality-of-life scores.Conversely,cachectic patients showed higher levels of fatigue,nausea and vomiting,pain,dyspnea,sleep disturbance,appetite loss,constipation,and financial difficulties.A multivariate logistic regression showed that patients with AWGC-defined cachexia had a 126.1%increased risk of impaired quality of life(OR=2.261,95%CI=1.859–2.749,P<0.001).Conclusions:The AWGC criteria are an effective tool for predicting adverse survival outcomes,90-day mortality,a prolonged hospital stay,and poorer quality of life in patients with gastric cancer.
基金supported by the National KeyResearch and Development Program(No.2022YFC2009600 andNo.2022YFC2009601).
文摘Background: The purpose of this study is to evaluate the quality of life(QoL) of hospitalized patients in China suffering from digestive system malignancies and to identify potential risk factors for a decrease in QoL.Methods: The European Organization for Research and Treatment Core Quality of Life questionnaire(EORTC QLQ-C30) was applied to evaluate the QoL of 23,519 patients with six digestive malignancies(esophageal cancer, gastric cancer, colorectal cancer, liver cancer, biliary tract cancer, and pancreatic cancer). A t test or analysis of variance was employed to analyze the total EORTC QLQ-C30 scale scores and domain scores of the EORTC QLQ-C30 scale among patients in different subgroups.Results: The average QoL score was 50.4 ± 10.8. The tumor type, age, sex, and TNM stage al had an impact on QoL ratings. Colorectal cancer patients had a better total QoL score(49.3 ± 10.3) and scores in the domains of functioning, with milder symptoms, except for diarrhea. Patients with biliary tract cancer(54.2 ± 12.3) and pancreatic cancer(54.2 ± 12.3) reported a poorer QoL, significant functional impairment, and more pronounced symptoms. Patients with esophageal cancer experienced the most severe financial difficulties(35.2 ± 27.5). Patients aged ≥65 years, women, and those with TNM stage Ⅲ/Ⅳ reported lower QoL. In addition, the disparities in total QoL scores and scores in specific domains were significant among patients with some types of tumors, and based on ethnicity, educational level, occupation, treatment(s) received, and place of residence.Conclusions: There is a need to focus on elderly individuals, those with low educational levels, and patients with progressive malignant tumors and to improve routine disease monitoring and symptom management to enhance the quality of life for patients with malignancies of the digestive system.
文摘Benign multicystic peritoneal mesothelioma(BMPM)is a rare cystic mesothelial lesion that occurs predominantly in reproductive aged women.A 56-year-old Caucasian male was admitted to our surgical department with a chief complaint of a painful mass in his right lower abdomen for almost 2 years.The physical examination revealed a palpable painful mass.Computed tomography demonstrated an irregular,cystic tumor in his right lower abdomen.There was no obvious capsule or internal septations.No enhancement after intravenous administration of contrast was noted.An exploratory laparotomy was performed,and a multicystic tumor and adherent to the caecum was noted.The walls of the cysts were thin and smooth,filled with clear fluid,and very friable.An en bloc resection of the tumor,including appendix and caecum,was performed.Histological examination revealed multiple cysts lined with flattened simple epithelial cells,and the capsule walls of the cysts were composed of fibrous tissue.Immunohistochemical analysis documented positive expression of mesothelial cells and calretinin.The final diagnosis was BMPM.The patient was well at 6-mo follow-up.BMPM is exceedingly rare lesion.A complete resection of the tumor is required.The diagnosis of BMPM is based on pathological analysis.
基金supported by the National Key Research and Development Program of China(2022YFC2009600,2022YFC2009601)to Dr.Hanping ShiThe Jiangxi Province Science Foundation for Youths(20161BAB215187)to Li Deng。
文摘The characteristics of early-onset(onset age<50 years)and later-onset(onset age≥50 years)cancers differ significantly.Identifying novel risk factors for both types of cancer is crucial for increasing awareness of cancer prevention and for reducing its burden.This study aimed to analyze the trends in incidence and risk factors for early-onset and late-onset cancers.We conducted a prospective study by drawing data from the Kailuan Study.This study included 6,741 participants with cancer(624 with early-onset cancer and 6,117 with later-onset cancer)and 6,780 matched controls among the 186,249 participants who underwent Kailuan health examinations from 2006 to 2019.The primary outcomes were cancer incidence rates,and associated risk factors for early-and later-onset cancer.Weighted Cox regression was used to calculate hazard ratios and 95% confidence intervals of each exposure factor for early-and later-onset cancer by cancer type.Populationattributable risk proportions were used to estimate the number of cases that could be prevented by eliminating a risk factor from the population.Except for liver cancer,incidence rates for nearly all types of cancer increased during the study period.Smoking,alcohol consumption,lipid metabolism disorders,hypertension,diabetes mellitus,fatty liver,and inflammation were associated with a significantly increased risk of cancer at multiple sites,but risk factors for cancer incidence differed by site.Smoking,alcohol consumption,inflammation,and hypertension were the major contributors to preventable cancer.The incidence of several different types of cancer,including earlyonset cancer,is increasing in northeastern China.Differences in risk factors between early-onset and later-onset malignancies may contribute to the divergence in the observed changes in incidence trends between these two specific types of cancer.
基金supported by the Key Research and Development Program of Beijing Municipal Science and Technology Commission(D181100000218004)General Surgery Clinical Medical Center of Yunnan Province(ZX2019-03-03)the National Key Research and Development Program of China(2022YFC2009600)。
文摘Malnutrition is a common comorbidity among patients with cancer.However,no nutrition-screening tool has been recognized in this population.A quick and easy screening tool for nutrition with high sensitivity and easy-to-use is needed.Based on the previous 25 nutrition-screening tools,the Delphi method was made by the members of the Chinese Society of Nutritional Oncology to choose the most useful item from each category.According to these results,we built a nutrition-screening tool named age,intake,weight,and walking(AIWW).Malnutrition was defined based on the scored patient-generated subjective global assessment(PG-SGA).Concurrent validity was evaluated using the Kendall tau coefficient and kappa consistency between the malnutrition risks of AIWW,nutritional risk screening 2002(NRS-2002),and malnutrition screening tool(MST).Clinical benefit was calculated by the decision curve analysis(DCA),integrated discrimination improvement(IDI),and continuous net reclassification improvement(c NRI).A total of 11,360 patients(male,n=6,024(53.0%)were included in the final study cohort,and 6,363 patients had malnutrition based on PG-SGA.Based on AIWW,NRS-2002,and MST,7,545,3,469,and1,840 patients were at risk of malnutrition,respectively.The sensitivities of AIWW,NRS-2002,and MST risks were 0.910,0.531,and 0.285,and the specificities were 0.768,0.946,and 0.975.The Kendall tau coefficients of AIWW,NRS-2002,and MST risks were 0.588,0.501,and 0.326,respectively.The area under the curve of AIWW,NRS-2002,and MST risks were0.785,0.739,and 0.630,respectively.The IDI,c NRI,and DCA showed that AIWW is non-inferior to NRS-2002(IDI:0.002(-0.009,0.013),c NRI:-0.015(-0.049,0.020)).AIWW scores can also predict the survival of patients with cancer.The missed diagnosis rates of AIWW,NRS-2002,and MST were 0.09%,49.0%,and 73.2%,respectively.AIWW showed a better nutritionscreening effect than NRS-2002 and MST for patients with cancer and could be recommended as an alternative nutritionscreening tool for this population.
