1.Epidemiological characteristics of pertussis among individuals aged 18 years and below in Zhejiang Province from 2016 to 2023
WANG Linxi ; ZHU Yao ; WU Beibei ; HE Hanqing
Journal of Preventive Medicine 2026;38(2):135-139
Objective :
To analyze the epidemiological characteristics of pertussis among the population aged ≤18 years in Zhejiang Province from 2016 to 2023, so as to provide a basis for optimizing pertussis prevention and control measures as well as immunization strategies.
Methods:
Data on pertussis cases among individuals aged ≤18 years in Zhejiang Province from 2016 to 2023 were collected through the Infectious Disease Reporting Information System of Chinese Disease Prevention and Control Information System. Vaccination records were obtained from the specialized pertussis epidemiological survey conducted in Zhejiang Province. The descriptive epidemiological method was employed to analyze the epidemiological characteristics of pertussis among the population aged ≤18 years, as well as the interval between disease onset and the last immunization among breakthrough cases.
Results:
A total of 7 431 pertussis cases aged ≤18 years were reported in Zhejiang Province from 2016 to 2023, with an average annual reported incidence of 8.68/105. The overall trend showed no statistical significance (P>0.05). The reported incidence remained relatively low from 2016 to 2021, consistently below 10.00/105. In contrast, the incidence rose to 33.98/105 in 2022 and 13.39/105 in 2023. The peak incidence period was from April to August, during which 4 024 cases were reported, accounting for 54.15%. Hangzhou City, Wenzhou City, and Ningbo City reported the highest number of cases, with 3 844, 1 581, and 646 cases, representing 51.73%, 21.28%, and 8.69%, respectively. In terms of average annual incidence, Hangzhou City, Wenzhou City, and Huzhou City ranked the highest, with rates of 33.98/105, 12.38/105, and 12.27/105, respectively. Among age groups, the highest reported incidence was observed in children aged 0-<1 years, at 48.87/105. From 2016 to 2023, the incidence in the 5-<10 years and 10-18 years age groups showed upward trends (AAPC=108.193%, 106.709%, both P<0.05). The proportion of cases in the 5-<10 years age group also increased during this period (P<0.05). A total of 109 breakthrough pertussis cases were identified. The median interval between disease onset and the last immunization was 4.00 (interquartile range, 4.00) years. The numbers of cases with intervals of 1-<2 years and ≥6 years were both relatively high, comprising 25 cases and 37 cases, which accounted for 22.94% and 33.94%, respectively.
Conclusions
From 2016 to 2021, the reported incidence of pertussis in Zhejiang Province remained relatively stable. However, a sharp increase was observed in 2022. The disease peaked during spring and summer. Key populations for targeted prevention and control included children aged 0-<1 year, 5-<10 years, and 10-18 years. The interval between disease onset and the last immunization among breakthrough pertussis cases exhibited a bimodal distribution.
2.NUP62 alleviates senescence and promotes the stemness of human dental pulp stem cells via NSD2-dependent epigenetic reprogramming.
Xiping WANG ; Li WANG ; Linxi ZHOU ; Lu CHEN ; Jiayi SHI ; Jing GE ; Sha TIAN ; Zihan YANG ; Yuqiong ZHOU ; Qihao YU ; Jiacheng JIN ; Chen DING ; Yihuai PAN ; Duohong ZOU
International Journal of Oral Science 2025;17(1):34-34
Stem cells play a crucial role in maintaining tissue regenerative capacity and homeostasis. However, mechanisms associated with stem cell senescence require further investigation. In this study, we conducted a proteomic analysis of human dental pulp stem cells (HDPSCs) obtained from individuals of various ages. Our findings showed that the expression of NUP62 was decreased in aged HDPSCs. We discovered that NUP62 alleviated senescence-associated phenotypes and enhanced differentiation potential both in vitro and in vivo. Conversely, the knocking down of NUP62 expression aggravated the senescence-associated phenotypes and impaired the proliferation and migration capacity of HDPSCs. Through RNA-sequence and decoding the epigenomic landscapes remodeled induced by NUP62 overexpression, we found that NUP62 helps alleviate senescence in HDPSCs by enhancing the nuclear transport of the transcription factor E2F1. This, in turn, stimulates the transcription of the epigenetic enzyme NSD2. Finally, the overexpression of NUP62 influences the H3K36me2 and H3K36me3 modifications of anti-aging genes (HMGA1, HMGA2, and SIRT6). Our results demonstrated that NUP62 regulates the fate of HDPSCs via NSD2-dependent epigenetic reprogramming.
Humans
;
Dental Pulp/cytology*
;
Nuclear Pore Complex Proteins/genetics*
;
Cellular Senescence/genetics*
;
Stem Cells/metabolism*
;
Epigenesis, Genetic
;
Cell Proliferation
;
Cell Differentiation
;
Histone-Lysine N-Methyltransferase/metabolism*
;
Cells, Cultured
;
Cellular Reprogramming
;
Cell Movement
;
Proteomics
3.Bioinformatics analysis of acute kidney injury based on pathway-associated deep neural network
Shuifen LIANG ; Wei GANG ; Wei CHEN ; Caiming ZHONG ; Linxi HUANG ; Yuanjun WANG ; Zhiyong GUO
Academic Journal of Naval Medical University 2025;46(9):1148-1158
Objective To screen for key genes and important pathways common for different etiologies of acute kidney injury(AKI)by pathway-associated deep neural network and multiple machine learning algorithms.Methods AKI microarray datasets GSE30718,GSE37838,GSE53769,GSE108113,GSE125779,GSE99325,and GSE174020 downloaded from the Gene Expression Omnibus(GEO)database were merged,including 60 kidney samples from AKI patients and 79 kidney samples from healthy controls.They were divided(8∶2)into training sets and test sets,and were used to train and evaluate pathway-associated deep neural network and 4 machine learning algorithms,including least absolute shrinkage and selection operator(LASSO),random forest(RF),support vector machine-recursive feature elimination(SVM-RFE),and extreme gradient boosting(XgBoost),to screen for common key genes and pathways of different etiologies of AKI.The downloaded datasets GSE99340 and GSE1563 were merged,including 43 kidney samples from AKI patients and 36 kidney samples from healthy controls,which were used as external validation sets for LASSO model and nomogram performance test based on the final screened genes.The pathway-associated deep neural network and machine learning algorithms were evaluated using receiver operating characteristic curves,precision,recall,accuracy,and F1-score.The immune cell infiltration characteristics were explored in AKI via cell-type identification by estimating relative subsets of RNA transcripts(CIBERSORT),and Pearson correlation coefficients were used to evaluate the correlation between the final screened common key genes and immune cell infiltration levels.Results The pathway-associated deep neural network trained by 5-fold cross validation produced an area under curve(AUC)of 0.914 5±0.007 0,a precision of 0.750 0±0.044 0,a recall of 0.923 1±0.048 0,an accuracy of 0.838 7±0.016 0,and an F1-score of 0.827 6±0.020 0 in the test set,yielding a robust and highly accurate classification performance for AKI,and identified key pathways and a subset of candidate genes.The 4 machine learning algorithms all achieved high discriminative performance for AKI in the test set with AUC≥0.860,precision≥0.750,recall≥0.800,and F1-score≥0.774,and screened 7 common key genes for AKI with different etiologies,including CD86,C-X-C motif chemokine ligand 10(CXCL10),dynamin 2(DNM2),proto-oncogene FOS,transcription factor 12(TCF12),VGF nerve growth factor inducible(VGF),and A kinase anchoring protein 5(AKAP5).Based on the final screened common key genes,the LASSO model had an AUC of 0.940 4 for the test set and an AUC of 0.944 4 for the external validation,and the model showed a very high discriminatory ability for the AKI,which demonstrated the overall regulatory performance of the genes.The nomogram constructed based on the screened 7 genes demonstrated the highest classification performance with an AUC of 0.928 9,validating the outstanding contribution and overall action performance of the screened individual genes.Immune cell infiltration analysis showed that there were significant differences in B cells na?ve,mast cells activated,monocytes,macrophages M1,B cells memory,and dendritic cells activated between AKI samples and healthy control samples(all P<0.05).Macrophages M1 and monocytes were positively correlated with CD86 and CXCL10,mast cells activated were positively correlated with FOS,and B cells na?ve were negatively correlated with CD86 and CXCL10(all P<0.01).Mast cells activated were positively correlated with VGF and negatively correlated with CD86 and TCF12,while memory B cells were positively correlated with CD86(all P<0.05).Conclusion Strategy combining pathway-associated deep neural network and multiple machine learning classifiers can mine high-value key genes from high-dimensional,complex and heterogeneous transcriptomic data as potential targets for therapeutic interventions in AKI.
4.Overexpression of lncRNA HEM2M alleviates liver injury in mice with non-alcoholic fatty liver disease
Xiang KONG ; Teng ZHANG ; Yan ZHANG ; Linxi GAO ; Wen WANG ; Mengyan WANG ; Guodong WANG ; Kun LÜ
Journal of Southern Medical University 2024;44(1):1-8
Objective To explore the effects of long non-coding RNA(lncRNA)HEM2M overexpression on liver injury in mice with non-alcoholic fatty liver disease(NAFLD).Methods Wild-type C57BL/6(WT)mice and myeloid cell-specific HEM2M knock-in(MYKI)mice were fed normal(ND)or high-fat diet(HFD)for 12 weeks.After intraperitoneal glucose tolerance and insulin tolerance tests,the mice were euthanized for detection of liver function indicators in the serum and liver tissue.HE staining and F4/80 immunohistochemical staining were used to examine liver pathologies,and the levels of IL-6,IL-1β,and TNF-α in the liver tissues were determined with ELISA.The mRNA expressions of HEM2M and the markers of M1 macrophages(TNF-α,iNOS,and IL-6)and M2 macrophages(Arg-1,YM-1,and IL-10)were detected using qRT-PCR,and the protein expressions of P-AKT,T-AKT,NLRC4,caspase-1 and GSDMD were assayed using immunoblotting.Caspase-1 activity in the liver tissues was determined with colorimetric measurement and immunofluorescence assay.Results Compared with HFD-fed WT mice,MYKI mice with HFD feeding showed milder liver function damage(P<0.01),alleviated hepatic steatosis,and reduced liver macrophage infiltration,glucose tolerance impairment and insulin resistance(P<0.01).The levels of IL-6,IL-1β,and TNF-α and mRNA expressions of M1 type macrophage markers were significantly decreased(P<0.01)and those of M2 type markers increased(P<0.01)in the liver tissues of HFD-fed MYKI mice,which also showed reduced NLRC4 inflammasome activity,caspase-1 activation,and GSDMD-N protein expression compared with their WT counterparts(P<0.05).Conclusion Overexpression of HEM2M reduces the production of hepatic inflammatory factors,improves insulin resistance and inhibits hepatic NLRC4 inflammasome activation,which leads to reduced hepatic pyroptosis and liver injury in NAFLD mice.
5.A multicenter survey on nurses'knowledge and practice of children's sleep management in pediatric ICU
Xiaorui FAN ; Ying GU ; Jing HU ; Shaodan QI ; Linxi HE ; Wenlan ZHANG ; Linjuan WANG ; Weijie SHEN ; Yuxia YANG
Chinese Journal of Nursing 2024;59(4):447-454
Objective To investigate the current status of nurses'knowledge,attitude and practice regarding sleep management of critically ill children in pediatric ICU,and to analyze its impact factors.Methods A self-designed questionnaire on general information and a questionnaire on knowledge and practical behaviors of pediatric ICU nurses on child's sleep management were used.In March 2023,902 pediatric ICU nurses from 24 hospitals in China were surveyed using a convenient sampling method,and the impact factors were analyzed using multiple stepwise linear regression.Results 893 valid questionnaires were collected and the recovery rate of valid questionnaires was 99.00%.Nurses in pediatric ICU scored(33.71±7.76)in knowledge dimension,(37.38±4.86)in attitude dimension and(80.60±16.78)in practice dimension,with a total score of(151.78±24.27).The scores of knowledge and attitude,knowledge and practice,attitude and practice are all positively correlated(r=0.393,P<0.001;r=0.495,P<0.001;r=0.320,P<0.001).The results of multiple stepwise linear regression analysis showed that gender,region,whether they had received sleep management training were the influencing factors of pediatric ICU nurses'total score of knowledge,attitude and practice towards children's sleep management(P<0.05).Conclusion Nurses in pediatric ICU are positive about sleep management for critically ill children,but their knowledge and practice levels need to improve.Nursing managers should strengthen the theoretical knowledge and practical behavioral training of pediatric ICU nurses on child sleep management,develop scientific sleep management plans,and guide nurses to make reasonable evaluation and interventions to improve children's sleep quality.
6.Rapid discovery of a novel"green"and natural GST inhibitor for sensitizing hepatocellular carcinoma to Cisplatin by visual screening strategy
Mao LINXI ; Qin YAN ; Fan JIALONG ; Yang WEI ; Li BIN ; Cao LIANG ; Yuan LIQIN ; Wang MENGYUN ; Liu BIN ; Wang WEI
Journal of Pharmaceutical Analysis 2024;14(5):693-706
Over-expression of glutathione S-transferase(GST)can promote Cisplatin resistance in hepatocellular carcinoma(HCC)treatment.Hence,inhibiting GST is an attractive strategy to improve Cisplatin sensi-tivity in HCC therapy.Although several synthesized GST inhibitors have been developed,the side effects and narrow spectrum for anticancer seriously limit their clinical application.Considering the abundance of natural compounds with anticancer activity,this study developed a rapid fluorescence technique to screen"green"natural GST inhibitors with high specificity.The fluorescence assay demonstrated that schisanlactone B(hereafter abbreviated as C1)isolated from Xue tong significantly down-regulated GST levels in Cisplatin-resistant HCC cells in vitro and in vivo.Importantly,C1 can selectively kill HCC cells from normal liver cells,effectively improving the therapeutic effect of Cisplatin on HCC mice by down-regulating GST expression.Considering the high GST levels in HCC patients,this compound demon-strated the high potential for sensitizing HCC therapy in clinical practice by down-regulating GST levels.
7.Prognosis and its influencing factors in patients with non-gastric gastrointestinal stromal tumors at low risk of recurrence: a retrospective multicenter study in China
Linxi YANG ; Weili YANG ; Xin WU ; Peng ZHANG ; Bo ZHANG ; Junjun MA ; Xinhua ZHANG ; Haoran QIAN ; Ye ZHOU ; Tao CHEN ; Hao XU ; Guoli GU ; Zhidong GAO ; Gang ZHAI ; Xiaofeng SUN ; Changqing JING ; Haibo QIU ; Xiaodong GAO ; Hui CAO ; Ming WANG
Chinese Journal of Gastrointestinal Surgery 2024;27(11):1123-1132
Objective:To investigate the prognosis and the factors that influence it in patients with non-gastric gastrointestinal stromal tumors (GISTs) who are at low risk of recurrence.Methods:This was a retrospective cohort study. Clinicopathologic and prognostic data from patients with non-gastric GISTs and at low risk of recurrence (i.e., very low-risk or low-risk according to the 2008 version of the Modified NIH Risk Classification), who attended 18 medical centers in China between January 2000 and June 2023, were collected. We excluded patients with a history of prior malignancy, concurrent primary malignancy, multiple GISTs, and those who had received preoperative imatinib. The study cohort comprised 1,571 patients with GISTs, 370 (23.6%) of whom were at very low-risk and 1,201 (76.4%) at low-risk of recurrence. The cohort included 799 (50.9%) men and 772 (49.1%) women of median age 57 (16–93) years. Patients were followed up to July 2024. The prognosis and its influencing factors were analyzed. Receiver operating characteristic curves for tumor diameter and Ki67 were established, and the sensitivity, specificity, area under the curve (AUC) and optimal cut-off value with 95% confidence intervals were calculated. Propensity score matching was implemented using the 1:1 nearest neighbor matching method with a matching tolerance of 0.02.Results:With a median follow-up of 63 (12–267) months, the 5- and 10-year overall survival (OS) rates of the 1,571 patients were 99.5% and 98.0%, respectively, and the 5- and 10-year disease-free survival (DFS) rates were 96.3% and 94.4%, respectively. During postoperative follow-up, 3.8% (60/1,571) patients had disease recurrence or metastasis, comprising 0.8% (3/370) in the very low-risk group and 4.7% (57/1,201) in the low-risk group. In the low-risk group, recurrence or metastasis occurred in 5.5% (25/457) of patients with duodenal GISTs, 3.9% (25/645) of those with small intestinal GISTs, 9.2% (6/65) of those with rectal GISTs, and 10.0% (1/10) of those with colonic GISTs. Among the 60 patients with metastases, 56.7% (34/60) of the metastases were located in the abdominal cavity, 53.3% (32/60) in the liver, and 3.3% (2/60) in bone. During the follow-up period, 13 patients (0.8%) died of disease. Receiver operating characteristic curves were plotted for tumor diameter and Ki67 and assessed using the Jordon index. This showed that the difference in DFS between the two groups was statistically significant when the cutoff value for tumor diameter was 3.5 cm (AUC 0.731, 95% CI: 0.670–0.793, sensitivity 77.7%, specificity 64.1%). Furthermore, the difference in DFS between the two groups was statistically significant when the cutoff value for Ki67 was 5% (AUC 0.693, 95% CI: 0.624–0.762, sensitivity 60.7%, specificity 65.3%). Multifactorial analysis revealed that tumor diameter ≥3.5 cm, Ki67 ≥5%, and R1 resection were independent risk factors for DFS in patients with non-gastric GISTs at low risk of recurrence (all P<0.05). Furthermore, age >57 years, Ki67 ≥5%, and R1 resection were also independent risk factors for OS in patients with non-gastric GISTs at low risk of recurrence (all P<0.05). We also grouped the patients according to whether they had received postoperative adjuvant treatment with imatinib for 1 or 3 years. This yielded 137 patients in the less than 1-year group, 139 in the 1-year plus group; and 44 in both the less than 3 years and 3-years plus group. After propensity score matching for age, tumor diameter, Ki67, and resection status, the differences in survival between the two groups were not statistically significant (all P>0.05). The 10-year DFS and OS were 87.5% and 95.5%, respectively, in the group treated with imatinib for less than 1 year and 88.5% and 97.8%, respectively, in the group treated for more than 1 year. The 10-year DFS and OS were 89.6% and 92.6%, respectively, in the group treated with imatinib for less than 3 years and 88.0% and 100.0%, respectively, in the group treated with imatinib for more than 3 years. Conclusion:The overall prognosis of primary, non-gastric, low recurrence risk GISTs is relatively favorable; however, recurrences and metastases do occur. Age, tumor diameter, Ki67, and R1 resection may affect the prognosis. For some patients with low risk GISTs, administration of adjuvant therapy with imatinib for an appropriate duration may help prevent recurrence and improve survival.
8.Long-term prognosis of surgical treatment for peri-gastric cardial gastrointestinal stromal tumors
Tian KUANG ; Linxi YANG ; Ming WANG ; Hui CAO
Chinese Journal of Gastrointestinal Surgery 2024;27(11):1141-1147
Objective:To explore the long-term prognosis of surgical treatment for peri-gastric cardial gastrointestinal stromal tumors (GISTs).Methods:In this retrospective cohort study, we analyzed selected data of patients with peri-gastric cardial GISTs who had undergone radical surgery in Renji Hospital, Shanghai Jiao Tong University School of Medicine, from May 1998 to December 2020. Inclusion criteria comprised radical surgery, pathologically confirmed primary gastric GIST; tumor involving the cardia or within 5 cm of the cardia dentate line; and relatively complete clinical data, including adjuvant therapy and follow-up information. Exclusion criteria comprised presence of multiple GISTs or a history of other malignancies and evidence of distant metastasis or local invasion either preoperatively or intraoperatively. The study cohort comprised 170 patients, including 98 men (57.6%), with a median age of 62 years (range: 30–85 years). Tumors were located less than 2 cm from the dentate line in 97 patients and 2 to 5 cm from it in 73. Tumor growth patterns were intraluminal in 85 patients, extraluminal in 61, and both intraluminal and extraluminal in 24. Tumor diameters were ≤2.0 cm in 11 patients, 2.1–5.0 cm in 90, 5.1–10.0 cm in 60, and >10.0 cm in nine. Mitosis counts (per 50 high-power fields) were ≤5 in 129 patients, 5–10 in 21, and >10 in 20. Risk stratification categorized patients as at extremely low risk in 10 patients, at low risk in 79, at intermediate risk in 43, and at high risk in 38. The guidelines for treatment were adhered to in 128 patients; 21 of 38 high-risk patients had received imatinib for ≥3 years. Primary outcomes included surgical procedure, overall survival (OS), and disease-free survival (DFS). Data were analyzed using SPSS 28.0 and R studio.Results:Ninety of the patients had undergone open surgery, including five total gastrectomies, 49 proximal gastrectomies, and 36 local resections. In addition, 80 patients had undergone laparoscopic local resections. The median follow-up time was 82.5 months (range 13–278 months). The OS rates at 1, 3, 5, and 10 years were 100.0%, 98.2%, 96.9%, and 89.6%, respectively. The DFS rates at 1, 3, 5, and 10 years were 99.4%, 95.9%, 92.0%, and 88.0%, respectively. After adjusting for tumor diameter, mitotic count, adjuvant therapy, distance from the cardia, and growth pattern using propensity score matching, we found no statistically significant differences in DFS and OS between proximal gastrectomy and partial resection, or between open local resection and laparoscopic local resection (all P>0.05). Conclusions:Surgical treatment of peri-gastric cardial GISTs has a favorable long-term prognosis. The oncological efficacy of proximal gastrectomy and partial resection, whether performed via laparoscopic or open approaches, appears comparable for treatment of peri-gastric cardial GISTs.
9.Prognosis and its influencing factors in patients with non-gastric gastrointestinal stromal tumors at low risk of recurrence: a retrospective multicenter study in China
Linxi YANG ; Weili YANG ; Xin WU ; Peng ZHANG ; Bo ZHANG ; Junjun MA ; Xinhua ZHANG ; Haoran QIAN ; Ye ZHOU ; Tao CHEN ; Hao XU ; Guoli GU ; Zhidong GAO ; Gang ZHAI ; Xiaofeng SUN ; Changqing JING ; Haibo QIU ; Xiaodong GAO ; Hui CAO ; Ming WANG
Chinese Journal of Gastrointestinal Surgery 2024;27(11):1123-1132
Objective:To investigate the prognosis and the factors that influence it in patients with non-gastric gastrointestinal stromal tumors (GISTs) who are at low risk of recurrence.Methods:This was a retrospective cohort study. Clinicopathologic and prognostic data from patients with non-gastric GISTs and at low risk of recurrence (i.e., very low-risk or low-risk according to the 2008 version of the Modified NIH Risk Classification), who attended 18 medical centers in China between January 2000 and June 2023, were collected. We excluded patients with a history of prior malignancy, concurrent primary malignancy, multiple GISTs, and those who had received preoperative imatinib. The study cohort comprised 1,571 patients with GISTs, 370 (23.6%) of whom were at very low-risk and 1,201 (76.4%) at low-risk of recurrence. The cohort included 799 (50.9%) men and 772 (49.1%) women of median age 57 (16–93) years. Patients were followed up to July 2024. The prognosis and its influencing factors were analyzed. Receiver operating characteristic curves for tumor diameter and Ki67 were established, and the sensitivity, specificity, area under the curve (AUC) and optimal cut-off value with 95% confidence intervals were calculated. Propensity score matching was implemented using the 1:1 nearest neighbor matching method with a matching tolerance of 0.02.Results:With a median follow-up of 63 (12–267) months, the 5- and 10-year overall survival (OS) rates of the 1,571 patients were 99.5% and 98.0%, respectively, and the 5- and 10-year disease-free survival (DFS) rates were 96.3% and 94.4%, respectively. During postoperative follow-up, 3.8% (60/1,571) patients had disease recurrence or metastasis, comprising 0.8% (3/370) in the very low-risk group and 4.7% (57/1,201) in the low-risk group. In the low-risk group, recurrence or metastasis occurred in 5.5% (25/457) of patients with duodenal GISTs, 3.9% (25/645) of those with small intestinal GISTs, 9.2% (6/65) of those with rectal GISTs, and 10.0% (1/10) of those with colonic GISTs. Among the 60 patients with metastases, 56.7% (34/60) of the metastases were located in the abdominal cavity, 53.3% (32/60) in the liver, and 3.3% (2/60) in bone. During the follow-up period, 13 patients (0.8%) died of disease. Receiver operating characteristic curves were plotted for tumor diameter and Ki67 and assessed using the Jordon index. This showed that the difference in DFS between the two groups was statistically significant when the cutoff value for tumor diameter was 3.5 cm (AUC 0.731, 95% CI: 0.670–0.793, sensitivity 77.7%, specificity 64.1%). Furthermore, the difference in DFS between the two groups was statistically significant when the cutoff value for Ki67 was 5% (AUC 0.693, 95% CI: 0.624–0.762, sensitivity 60.7%, specificity 65.3%). Multifactorial analysis revealed that tumor diameter ≥3.5 cm, Ki67 ≥5%, and R1 resection were independent risk factors for DFS in patients with non-gastric GISTs at low risk of recurrence (all P<0.05). Furthermore, age >57 years, Ki67 ≥5%, and R1 resection were also independent risk factors for OS in patients with non-gastric GISTs at low risk of recurrence (all P<0.05). We also grouped the patients according to whether they had received postoperative adjuvant treatment with imatinib for 1 or 3 years. This yielded 137 patients in the less than 1-year group, 139 in the 1-year plus group; and 44 in both the less than 3 years and 3-years plus group. After propensity score matching for age, tumor diameter, Ki67, and resection status, the differences in survival between the two groups were not statistically significant (all P>0.05). The 10-year DFS and OS were 87.5% and 95.5%, respectively, in the group treated with imatinib for less than 1 year and 88.5% and 97.8%, respectively, in the group treated for more than 1 year. The 10-year DFS and OS were 89.6% and 92.6%, respectively, in the group treated with imatinib for less than 3 years and 88.0% and 100.0%, respectively, in the group treated with imatinib for more than 3 years. Conclusion:The overall prognosis of primary, non-gastric, low recurrence risk GISTs is relatively favorable; however, recurrences and metastases do occur. Age, tumor diameter, Ki67, and R1 resection may affect the prognosis. For some patients with low risk GISTs, administration of adjuvant therapy with imatinib for an appropriate duration may help prevent recurrence and improve survival.
10.Long-term prognosis of surgical treatment for peri-gastric cardial gastrointestinal stromal tumors
Tian KUANG ; Linxi YANG ; Ming WANG ; Hui CAO
Chinese Journal of Gastrointestinal Surgery 2024;27(11):1141-1147
Objective:To explore the long-term prognosis of surgical treatment for peri-gastric cardial gastrointestinal stromal tumors (GISTs).Methods:In this retrospective cohort study, we analyzed selected data of patients with peri-gastric cardial GISTs who had undergone radical surgery in Renji Hospital, Shanghai Jiao Tong University School of Medicine, from May 1998 to December 2020. Inclusion criteria comprised radical surgery, pathologically confirmed primary gastric GIST; tumor involving the cardia or within 5 cm of the cardia dentate line; and relatively complete clinical data, including adjuvant therapy and follow-up information. Exclusion criteria comprised presence of multiple GISTs or a history of other malignancies and evidence of distant metastasis or local invasion either preoperatively or intraoperatively. The study cohort comprised 170 patients, including 98 men (57.6%), with a median age of 62 years (range: 30–85 years). Tumors were located less than 2 cm from the dentate line in 97 patients and 2 to 5 cm from it in 73. Tumor growth patterns were intraluminal in 85 patients, extraluminal in 61, and both intraluminal and extraluminal in 24. Tumor diameters were ≤2.0 cm in 11 patients, 2.1–5.0 cm in 90, 5.1–10.0 cm in 60, and >10.0 cm in nine. Mitosis counts (per 50 high-power fields) were ≤5 in 129 patients, 5–10 in 21, and >10 in 20. Risk stratification categorized patients as at extremely low risk in 10 patients, at low risk in 79, at intermediate risk in 43, and at high risk in 38. The guidelines for treatment were adhered to in 128 patients; 21 of 38 high-risk patients had received imatinib for ≥3 years. Primary outcomes included surgical procedure, overall survival (OS), and disease-free survival (DFS). Data were analyzed using SPSS 28.0 and R studio.Results:Ninety of the patients had undergone open surgery, including five total gastrectomies, 49 proximal gastrectomies, and 36 local resections. In addition, 80 patients had undergone laparoscopic local resections. The median follow-up time was 82.5 months (range 13–278 months). The OS rates at 1, 3, 5, and 10 years were 100.0%, 98.2%, 96.9%, and 89.6%, respectively. The DFS rates at 1, 3, 5, and 10 years were 99.4%, 95.9%, 92.0%, and 88.0%, respectively. After adjusting for tumor diameter, mitotic count, adjuvant therapy, distance from the cardia, and growth pattern using propensity score matching, we found no statistically significant differences in DFS and OS between proximal gastrectomy and partial resection, or between open local resection and laparoscopic local resection (all P>0.05). Conclusions:Surgical treatment of peri-gastric cardial GISTs has a favorable long-term prognosis. The oncological efficacy of proximal gastrectomy and partial resection, whether performed via laparoscopic or open approaches, appears comparable for treatment of peri-gastric cardial GISTs.


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