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Multidisciplinary comprehensive treatment of massive hepatocellular carcinoma with hemorrhage:A case report and review of literature

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World Journal of Gastrointestinal Oncology 2024年第5期16卷 2225-2232页

作者： Xian-Shuai Kou Fan-Fan Li Yun Meng Jian-Ming Zhao Sheng-Fen Liu Lan Zhang The First Clinical Medical College Gansu University of Chinese MedicineLanzhou 730000Gansu ProvinceChina department of Thoracic Surgery The First Hospital of Lanzhou UniversityLanzhou 730000Gansu ProvinceChina department of Surgery Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina department of Orthopedics Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina

BACKGROUND Hepatocellular carcinoma(HCC),a major contributor to cancer-related deaths,is particularly prevalent in Asia,largely due to hepatitis B virus *** prognosis is generally *** case report contributes to the medical literature by detailing a unique approach in treating a large HCC through multidisciplinary collaboration,particularly in patients with massive HCC complicated by ruptured bleeding,a scenario not extensively documented *** SUMMARY The patient presented with large HCC complicated by intratumoral *** involved a multidisciplinary approach,providing individualized *** strategy included drug-eluting bead transarterial chemoembolization,sorafenib-targeted therapy,laparoscopic partial hepatectomy,and standardized sintilimab monoclonal antibody *** months after treatment,the patient achieved complete radiological remission,with significant symptom *** studies showed no lesions or recurrence,and clinical assessments confirmed complete *** report is notable as possibly the first docu-mented case of successfully treating such complex HCC conditions through integrated multidisciplinary efforts,offering new insights and a reference for future similar *** This study demonstrated effective multidisciplinary treatment for massive HCC with intratumoral bleeding,providing insights for future similar cases.

关键词： Hepatocellular carcinoma Transarterial chemoembolization Sintilimab Sorafenib Translational therapy Multidisciplinary team Case report

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Present situation of minimally invasive surgical treatment for early gastric cancer

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World Journal of Gastrointestinal Oncology 2024年第4期16卷 1154-1165页

作者： Chun-Yan Li Yi-Feng Wang Li-Kang Luo Xiao-Jun Yang The First Clinical Medical School Lanzhou UniversityLanzhou 730000Gansu ProvinceChina The First Clinical Medicine College Gansu University of Chinese MedicineLanzhou 730000Gansu ProvinceChina General Surgery Clinical Centre Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina The Second department of General Surgery Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina Lanzhou University People's Clinical hospital Lanzhou 730000Gansu ProvinceChina gansu Research Center of Prevention and Control Project for Digestive Oncology Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina gansu Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina

Minimally invasive surgery is a kind of surgical operation,which is performed by using professional surgical instruments and equipment to inactivate,resect,repair or reconstruct the pathological changes,deformities and wounds in human body through micro-trauma or micro-approach,in order to achieve the goal of treatment,its surgical effect is equivalent to the traditional open surgery,while avoiding the morbidity of conventional surgical *** addition,it also has the advantages of less trauma,less blood loss during operation,less psychological burden and quick recovery on patients,and these minimally invasive techniques provide unique value for the examination and treatment of gastric cancer *** minimally invasive surgical techniques have developed rapidly and offer numerous options for the treatment of early gastric cancer(EGC):endoscopic mucosal resection(EMR),underwater EMR(UEMR),endoscopic submucosal dissection(ESD),endoscopic full-thickness resection(EFTR),endoscopic submu-cosal excavation(ESE),submucosal tunnel endoscopic resection,laparoscopic and endoscopic cooperative surgery(LECS);Among them,EMR,EFTR and LECS technologies have a wide range of applications and different modific-ations have been derived from their respective surgical operations,such as band-assisted EMR(BA-EMR),conven-tional EMR(CEMR),over-the-scope clip-assisted EFTR,no-touch EFTR,the inverted LECS,closed LECS,and so *** new and improved minimally invasive surgeries are more precise,specific and effective in treating different types of EGC.

关键词： Minimally invasive surgery Early gastric cancer Endoscopic mucosal resection Endoscopic full-thickness resection Laparoscopic and endoscopic cooperative surgery

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Analysis of the potential biological value of pyruvate dehydrogenase E1 subunitβin human cancer

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World Journal of Gastrointestinal Oncology 2024年第1期16卷 144-181页

作者： Yao Rong Song-Hua Liu Ming-Zheng Tang Zhi-Hang Wu Guo-Rong Ma Xiao-Feng Li Hui Cai First Clinical Medical College Gansu University of Chinese MedicineLanzhou 730000Gansu ProvinceChina General Surgery Clinical Medical Center Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in gansu Province Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina

BACKGROUND The pyruvate dehydrogenase E1 subunitβ(PDHB)gene which regulates energy metabolism is located in ***,few studies have elucidated the role and mechanism of PDHB in different *** To comprehensive pan-cancer analysis of PDHB was performed based on bioinformatics approaches to explore its tumor diagnostic and prognostic value and tumor immune relevance in *** vitro experiments were performed to examine the biological regulation of PDHB in liver *** Pan-cancer data related to PDHB were obtained from the cancer Genome Atlas(TCGA)*** of the gene expression profiles of PDHB was based on TCGA and Genotype Tissue Expression Dataset *** regression analysis and Kaplan-Meier methods were used to assess the correlation between PDHB expression and survival prognosis in cancer *** correlation between PDHB and receiver operating characteristic diagnostic curve,clinicopathological staging,somatic mutation,tumor mutation burden(TMB),microsatellite instability(MSI),DNA methylation,and drug susceptibility in pan-cancer was also *** algorithms were used to analyze the correlation between PDHB and immune cell infiltration and tumor chemotaxis environment,as well as the co-expression analysis of PDHB and immune checkpoint(ICP)*** expression and functional phenotype of PDHB in single tumor cells were studied by single-cell sequencing,and the functional enrichment analysis of PDHB-related genes was *** study also validated the level of mRNA or protein expression of PDHB in several ***,in vitro experiments verified the regulatory effect of PDHB on the proliferation,migration,and invasion of liver *** PDHB was significantly and differently expressed in most *** was significantly associated with prognosis in patients with a wide range of cancers,including kidney renal clear cell carcinoma,kidney renal papillary cell carcinoma,breast invasive carcinom

关键词： Cuprotosis Pyruvate dehydrogenase E1 subunitβ Pan-cancer Prognosis Liver cancer

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Comprehensive analysis of the potential pathogenesis of COVID-19 infection and liver cancer

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World Journal of Gastrointestinal Oncology 2024年第2期16卷 436-457页

作者： Yao Rong Ming-Zheng Tang Song-Hua Liu Xiao-Feng Li Hui Cai First Clinical Medical College Gansu University of Chinese MedicineLanzhou 730000Gansu ProvinceChina General Surgery Clinical Medical Center Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in gansu Province Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina

BACKGROUND A growing number of clinical examples suggest that coronavirus disease 2019(COVID-19)appears to have an impact on the treatment of patients with liver cancer compared to the normal population,and the prevalence of COVID-19 is significantly higher in patients with liver ***,this mechanism of action has not been *** sets for COVID-19(GSE180226)and liver cancer(GSE87630)were obtained from the Gene Expression Omnibus *** identifying the common differentially expressed genes(DEGs)of COVID-19 and liver cancer,functional enrichment analysis,protein-protein interaction network construction and scree-ning and analysis of hub genes were ***,the validation of the differential expression of hub genes in the disease was performed and the regulatory network of transcription factors and hub genes was *** Of 518 common DEGs were obtained by screening for functional *** hub genes including aurora kinase B,cyclin B2,cell division cycle 20,cell division cycle associated 8,nucleolar and spindle associated protein 1,etc.,were further identified from DEGs using the“cytoHubba”*** enrichment analysis of hub genes showed that these hub genes are associated with P53 signalling pathway regulation,cell cycle and other functions,and they may serve as potential molecular markers for COVID-19 and liver ***,we selected 10 of the hub genes for in vitro expression validation in liver cancer *** Our study reveals a common pathogenesis of liver cancer and *** common pathways and key genes may provide new ideas for further mechanistic studies.

关键词： COVID-19 Liver cancer Differentially expressed genes Hub genes Pathogenesis

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Clinical analysis of multiple primary gastrointestinal malignant tumors:A 10-year case review of a single-center

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World Journal of Gastrointestinal Oncology 2024年第4期16卷 1204-1212页

作者： Cheng-Lou Zhu Ling-Zhi Peng The First School of Clinical Medicine Lanzhou UniversityLanzhou 730000Gansu ProvinceChina department of Surgical Oncology Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina

BACKGROUND Multiple primary malignant tumors(MPMTs)was first described by Billroth as early as 1889,with the first report published by Warren and Gates in *** then,numerous cases have been reported.A literature review of 1104269 patients with cancer revealed that the incidence of MPMTs ranged from 0.73 to 11.7%.In recent years,however,there has been a significant upward trend in the incidence of this phenomenon,which may be associated with many different factors,including the advancement of modern diagnostic procedures facilitating the examination and diagnosis of more MPMTs,increased exposure to chemotherapy and radiotherapy that exacerbate the risk of new malignant tumors in patients with cancer,and prolonged survival of patients with cancer allowing sufficient time for the development of new primary *** To analyze the incidence,clinical features,treatment factors,prevalence,and prognosis of patients with MPMTs in the gastrointestinal tract treated in a single ***,we analyzed the different tumor combinations,time interval between the occurrence of tumors,and *** This retrospective cohort study analyzed 8059 patients with pathologically confirmed gastrointestinal malignant tumors treated at the gansu Province hospital in Lanzhou,gansu,China between June 2011 and June *** these,85 patients had *** clinical features,treatment factors,prevalence,and prognosis of this latter cohort were *** The incidence of MPMTs in patients with gastrointestinal malignant tumors was 1.05%(85/8059),including 83 double primary malignant tumors and two triple primary malignant tumors of which 57(67.06%)were synchronous MPMTs(SMPMTs)and 28(32.94%)were metachronous MPMTs(MMPMTs).The most frequent associations were found between the rectum colon cancers within the SMPMT category and the gastric-colon cancers within the MMPMT *** the MMPMTs,the median interval was 53 *** overall 1-,3-and 5-year survival rates f

关键词： Multiple primary malignant tumors Clinical characteristics Gastrointestinal tract Prognosis Epidemiology

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Systemic inflammatory response index is a predictor of prognosis in gastric cancer patients: Retrospective cohort and meta-analysis

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World Journal of Gastrointestinal Surgery 2024年第2期16卷 382-395页

作者： Jing-Yao Ren Meng Xu Xiang-Dong Niu Shi-Xun Ma Ya-Jun Jiao Da Wang Miao Yu Hui Cai School of Clinical Medicine Ningxia Medical UniversityYinchuan 750000Ningxia Hui autonomous regionChina gansu provincial hospital Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina General Surgery Clinical Medical Center Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina Medical College of Jiangsu University Jiangsu UniversityZhenjiang 212013Jiangsu ProvinceChina Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in gansu Province Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina

BACKGROUND The systemic inflammatory response index(SIRI)has been demonstrated to make a significant difference in assessing the prognosis of patients with different solid ***,research is needed to ascertain the accuracy and reliability of applying the SIRI to patients who undergo robotic radical gastric cancer *** To validate the applicability of the SIRI in assessing the survival of gastric cancer patients and evaluate the clinical contribution of preoperative SIRI levels to predicting long-term tumor outcomes in patients,who received robotic radical gastric cancer *** Initially,an exhaustive retrieval was performed in the PubMed,the Cochrane Library,EMBASE,Web of Science,and Scopus databases to identify relevant ***,a meta-analysis was executed on 6 cohort studies iden-tifying the value of the SIRI in assessing the survival of gastric cancer ***,the clinical data of 161 patients undergoing robotic radical gastric cancer surgery were retrospectively analyzed to evaluate their clinicopathological characteristics and relevant laboratory *** association between preoperative SIRI levels and 5-year overall survival(OS)and disease-free survival(DFS)was *** The findings demonstrated an extensive connection between SIRI values and the outcome of patients with gastric *** SIRI levels were identified as an independent hazard feature for both OS and DFS among those who received robotic surgery for gastric *** levels in gastric cancer patients were observed to be associated with the presence of comorbidities,T-stage,carcinoembryonic antigen levels,the development of early serious postoperative complications,and the rate of lymph node *** SIRI values are correlated with adverse in the gastric cancer population and have the potential to be utilized in predicting long-term oncological survival in patients who undergo robotic radical gastric canc

关键词： Systemic inflammatory response index Prognosis Gastric cancer Complications Meta-analysis

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Circulating RNA ZFR promotes hepatocellular carcinoma cell proliferation and epithelial-mesenchymal transition process through miR-624-3p/WEE1 axis

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Hepatobiliary & Pancreatic Diseases International 2024年第1期23卷 52-63页

作者： Li Zhang Sai He Hao Guan Yao Zhao Di Zhang department of General Surgery the Second Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710004China department of Breast cancer Shaanxi Provincial Cancer HospitalXi’an 710000China

Background:Hepatocellular carcinoma(HCC),the most common type of primary liver cancer,is the fourth leading cause of cancer-related deaths *** evidence shows that the expression of circulating RNA ZFR(circZFR)is upregulated in HCC ***,the molecular mechanism of circZFR in HCC is ***:Quantitative reverse transcriptase polymerase chain reaction(qRT-PCR)was employed to detect the expression of circZFR,microRNA-624-3p(miR-624-3p)and WEE1 in HCC tissues and *** R assay and actinomycin D treatment assay were used to analyze the characteristics of *** functional analysis,the capacities of colony formation,cell proliferation,cell apoptosis,migration and invasion were assessed by colony formation assay,5-ethynyl-2-deoxyuridine(EdU)assay,flow cytometry assay and transwell *** blot was used to examine the protein levels of WEE1 and epithelial-mesenchymal transition(EMT)-related *** interactions between miR-624-3p and circZFR or WEE1 were validated by dual-luciferase reporter assay and RNA immunoprecipitation(RIP)*** models were established to determine the role of circZFR in ***:circZFR and WEE1 were upregulated,while miR-624-3p expression was reduced in HCC tissues and *** could sponge miR-624-3p,and WEE1 was a downstream gene of *** of circZFR significantly reduced the malignant behaviors of HCC and that co-transfection with miR624-3p inhibitor restored this *** of WEE1 abolished the inhibitory effect of miR624-3p mimic on HCC ***,circZFR acted as a competitive endogenous RNA(ceRNA)to regulate WEE1 expression by targeting ***,in vivo studies have illustrated that circZFR knockdown inhibited tumor ***:circZFR knockdown reduced HCC cell proliferation,migration and invasion and promoted apoptosis by regulating the miR-624-3p/WEE1 axis,suggesting that the circZFR/miR-624-3p/WEE1 axis might

关键词： Hepatocellular carcinoma circZFR miR-624-3p WEE1 Liver cancer

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Efficacy and safety of extracorporeal shock wave therapy combined with sodium hyaluronate in treatment of knee osteoarthritis:a systematic review and Meta-analysis

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Journal of Traditional Chinese Medicine 2024年第2期44卷 243-250页

作者： ZHOU Mingwang DONG Zhuanli WEI Changhao FENG Lufang WANG Xiaoping LIU Haiping JI Xing YANG Kehu LI Shenghua department of Orthopaedics Gansu Provincial Hospital of Traditional Chinese MedicineLanzhou 730050China department of Quality Management Lanzhou Petrochemical General HospitalLanzhou 730050China department of Orthopaedics Lanzhou Petrochemical General HospitalLanzhou 730050China Evidence-Based Social Science Research Center School of Public HealthLanzhou UniversityLanzhou730000China Evidence-Based Medicine Center School of Basic Medical SciencesLanzhou UniversityLanzhou 730000China Key Laboratory of Evidence Based Medicine and Knowledge Translation of gansu Province Lanzhou 730000China Center for Translational Medicine Gansu Provincial Hospital of Traditional Chinese MedicineLanzhou 730050China department of Orthopaedics Gansu Provincial Hospital of Traditional Chinese MedicineLanzhou 730000China

OBJECTIVE:To assess the efficacy and safety of extracorporeal shockwave therapy(ESWT)combined with sodium hyaluronate(HA)for the treatment of knee osteoarthritis(KOA).METHODS:PubM ed,Embase,the Cochrane Library,Web of Science,China National Knowledge Infrastructure,Wanfang database,China Science and Technology Journal Database,and SinoMed were searched from inception to July *** quality of the randomized controlled trials was evaluated independently by two reviewers according to the criteria in the Cochrane Collaboration for Systematic *** identified articles were then screened individually using EndnoteX9 for eligibility in this *** heterogeneity among the articles was evaluated using ***:A total of 17 studies,comprising 2000 individuals,were included in this *** results showed that a significant improvement was observed in knee pain and function based on the clinical efficacy of ESWT combined with *** analysis of clinical efficacy showed that[relative risk(RR)=1.21,95%confidence interval(CI)(1.12,1.30),P<0.01].Statistical analysis of visual analog scale showed that[standardized mean difference(SMD)=-2.84,95%CI(-4.01,-1.66),P<0.01].Western Ontario and McMaster University osteoarthritis index statistical analysis showed that[SMD=-1.57,95%CI(-2.52,-0.61),P<0.01].Lysholm score statistical analysis showed that[SMD=1.71,95%CI(0.98,2.44),P<0.01].In addition,only minor side effects,such as redness and swelling of the skin,were ***:Medium to low quality evidence showed that ESWT combined with HA offers an inexpensive,welltolerated,safe,and effective method to improve pain and functionality in patients with ***,tightly controlled,randomized,large multicenter trials are warranted to validate the current findings.

关键词： osteoarthritis knee randomized controlled trial extracorporeal shockwave therapy hyaluronic acid Meta-analysis

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Combining systemic inflammatory response index and albumin fibrinogen ratio to predict early serious complications and prognosis after resectable gastric cancer

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World Journal of Gastrointestinal Oncology 2024年第3期16卷 732-749页

作者： Jing-Yao Ren Da Wang Li-Hui Zhu Shuo Liu Miao Yu Hui Cai School of Clinical Medicine Ningxia Medical UniversityYinchuan 750000Ningxia Hui Autonomous RegionChina General Surgery Clinical Medical Center Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in gansu Province Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina Medical College of Jiangsu University Jiangsu UniversityZhenjiang 212013Jiangsu ProvinceChina The First Clinical Medical School Lanzhou UniversityLanzhou 730000Gansu ProvinceChina

BACKGROUND Gastric cancer has a high incidence and fatality rate,and surgery is the preferred course of ***,patient survival rates are still low,and the incidence of major postoperative complications cannot be *** systemic inflammatory response,nutritional level,and coagulation status are key factors affecting the postoperative recovery and prognosis of gastric cancer *** systemic inflammatory response index(SIRI)and the albumin fibrinogen ratio(AFR)are two valuable comprehensive indicators of the severity and prognosis of systemic inflammation in various medical *** To assess the clinical importance and prognostic significance of the SIRI scores and the AFR on early postoperative outcomes in patients undergoing radical gastric cancer *** We conducted a retrospective analysis of the clinicopathological characteristics and relevant laboratory indices of 568 gastric cancer patients from January 2018 to December *** calculated and compared two indicators of inflammation and then examined the diagnostic ability of combined SIRI and AFR values for serious early postoperative *** scored the patients and categorized them into three groups based on their SIRI and AFR *** analysis was used to compare the three groups of patients the prognostic value of various preoperative SIRI-AFR scores for 5-year overall survival(OS)and disease-free survival(DFS).RESULTS SIRI-AFR scores were an independent risk factor for prognosis[OS:P=0.004;hazards ratio(HR)=3.134;DFS:P<0.001;HR=3.543]and had the highest diagnostic power(area under the curve:0.779;95%confidence interval:0.737-0.820)for early serious complications in patients with gastric *** tumor-node-metastasis stage(P=0.001),perioperative transfusion(P=0.044),positive carcinoembryonic antigen(P=0.014)findings,and major postoperative complications(P=0.011)were factors associated with *** Preoperative SIRI and AFR values were s

关键词： Inflammation Albumin fibrinogen ratio Gastric cancer Complications Prognosis

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Preoperative neutrophil-to-lymphocyte ratio predicts symptomatic anastomotic leakage in elderly colon cancer patients: Multicenter propensity score-matched analysis

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World Journal of Gastrointestinal Surgery 2024年第2期16卷 438-450页

作者： Chao-Yang Wang Xiao-Long Li Xiao-Long Ma Xiong-Fei Yang Yong-Yong Liu Yong-Jiang Yu department of Clinical Medicine The First Clinical Medical College of Lanzhou UniversityLanzhou 730000Gansu ProvinceChina department of Gastrointestinal Surgery First Hospital of Lanzhou UniversityLanzhou 730000Gansu ProvinceChina department of Clinical Medicine Gansu University of Chinese MedicineLanzhou 730000Gansu ProvinceChina department of Anorectology Gansu Provincial People’s HospitalLanzhou 730000Gansu ProvinceChina department of General Surgery The Second Hospital Affiliated to Lanzhou UniversityLanzhou 730000Gansu ProvinceChina

BACKGROUND The neutrophil-to-lymphocyte ratio(NLR),a composite inflammatory biomarker,is associated with the prognosis in patients with colorectal ***,whether the NLR can be used as a predictor of symptomatic postoperative ana-stomotic leakage(AL)in elderly patients with colon cancer is *** To assess the role of the NLR in predicting the occurrence of symptomatic AL after surgery in elderly patients with colon *** Data from elderly colon cancer patients who underwent elective radical colectomy with anastomosis at three centers between 2018 and 2022 were retrospectively *** operating characteristic curve analysis was performed to determine the best predictive cutoff value for the ***-two covariates were matched using a 1:1 propensity score matching method,and univariate and multivariate logistic regression analyses were used to determine risk factors for the development of postoperative *** Of the 577 patients included,36(6.2%)had symptomatic *** optimal cutoff value of the NLR for predicting AL was *** propensity score matching,the incidence of AL was significantly greater in the≥2.66 NLR subgroup than in the<2.66 NLR subgroup(11.5%vs 2.5%;P=0.012).Univariate logistic regression analysis revealed statistically significant correlations between blood transfusion intraoperatively and within 2 d postoper-atively,preoperative albumin concentration,preoperative prognostic nutritional index,and preoperative NLR and AL occurrence(P<0.05);multivariate logistic regression analysis revealed that an NLR≥2.66[odds ratio(OR)=5.51;95%confidence interval(CI):1.50-20.26;P=0.010]and blood transfusion intraoperatively and within 2 d postoperatively(OR=2.52;95%CI:0.88-7.25;P=0.049)were risk factors for the occurrence of symptomatic *** A preoperative NLR≥2.66 and blood transfusion intraoperatively and within 2 d postoperatively are associated with a higher incidence of postoperative symptomatic AL in elderly

关键词： Colon cancer Anastomotic leak Neutrophil-to-lymphocyte ratio Propensity score-matched

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