1.
5-Year Survival of Gastric Cancer Patients after Radical
Surgery was Significantly Depended on Tumor Characteristics,
Blood Cell Circuit, Cell Ratio Factors, Hemostasis System
and Adjuvant Treatment
OBJECTIVE: This study aimed to determine homeostasis and tumor
factors for 5-year survival (5YS) of gastric cancer (GC) patients (GCP) (T1-
4N0-2M0) after complete en block (R0) gastrectomies and D2-4 lymph
node dissections.
METHODS: We analyzed data of 715 consecutive GCP (age=57.1±9.6
years; tumor size-D=5.6±3.1 cm) radically operated (R0) and monitored in
1975-2015 (m=488, f=227; total gastrectomy=145, distal gastrectomy=420,
proximal gastrectomy=150, combined gastrectomy with resection of 1-6
adjacent organs (pancreas, liver, diaphragm, colon transversum,
splenectomy, small intestine, kidney, adrenal gland, etc.)=232; T1=196,
T2=203, T3=167, T4=149; M1=0; N0=376, N1=100, N2=239; G1=199,
G2=132, G3=384; early GC=125, invasive GC=590; only surgery-S=569,
adjuvant treatment-AT=146 (chemoimmunotherapy: 5-FU +
thymalin/taktivin). Survival curves were estimated by the Kaplan-Meier
method. Differences in curves between groups of GCP were evaluated
using a log-rank test. Cox modeling, clustering, SEPATH, Monte Carlo,
bootstrap simulation and neural networks computing were used to
determine any significant dependence.
RESULTS: For total of 715 GCP overall life span (LS) was 2060.6±2267.7
days, (median=1022 days) and cumulative 5-year survival (5YS) reached
55.1%, 10 years – 48.7%, 20 years – 37.6%. 272 GCP lived more than 5
years without GC progressing, 149 – 10 years, 35 - 20 years. 281 GCP died
because of GC during the first 5 years after surgery. 5YS was superior
significantly after AT (69.8%) compared with S (52.4%) (P=0.002 by log-
rank test). Cox modeling displayed that 5YS significantly depended on:
phase transition (PT) early-invasive GC in term of synergetics, PT N0-N12,
G, blood cell circuit, cell ratio factors (CRF) (ratio between cancer cells
and blood cells subpopulations), sex, AT, residual nitrogen, hemorrhage
time, prothrombin index, procedure type (P=0.000-0.048). Neural networks
computing, genetic algorithm selection and bootstrap simulation revealed
relationships between 5YS and PT early-invasive GC (rank=1), PT N0-N12
(rank=2), D (3), erythrocytes/cancer cells-CC (4), AT (5), healthy cells/CC
(6), prothrombin index (7), thrombocytes/cancer cells (8), monocytes/CC
(9), stick neutrophils/CC (10), eosinophils/CC (11), leucocytes/CC (12),
segmented neutrophils/CC (13), lymphocytes/CC (14). Correct prediction
of 5YS was 100% by neural networks computing.
CONCLUSIONS: 5YS of GCP after radical surgery was significantly
depended on tumor characteristics, blood cell circuit, CRF, hemostasis
system and AT.
Oleg Kshivets, MD, PhD Surgery Department, Medical Center, Anapa, Russia P-258
Cox Regression
Parameter
Estimate
Standard
Error
Chi-square P value
95%
Lower CL
95%
Upper CL
Hazard Ratio
Eosinophils (%) -0.54001 0.263410 4.20278 0.040358 -1.0563 -0.02373 0.583
Segmented Neutrophils (%) -0.48036 0.247618 3.76331 0.052389 -0.9657 0.00496 0.619
Lymphocytes (%) -0.49636 0.251277 3.90206 0.048227 -0.9889 -0.00387 0.609
ESS -0.01579 0.005293 8.90242 0.002848 -0.0262 -0.00542 0.984
Hemorrhage Time 0.00123 0.000391 9.87506 0.001675 0.0005 0.00199 1.001
Residual Nitrogen 0.04625 0.009859 22.00602 0.000003 0.0269 0.06557 1.047
Prothrombin Index 0.01794 0.005229 11.77447 0.000600 0.0077 0.02819 1.018
PT N0---N12 0.81004 0.132049 37.63086 0.000000 0.5512 1.06885 2.248
Sex 0.34302 0.127690 7.21628 0.007225 0.0927 0.59329 1.409
G1-3 0.14158 0.069223 4.18338 0.040822 0.0059 0.27726 1.152
Adjuvant Chemoimmunotherapy -0.74498 0.196078 14.43549 0.000145 -1.1293 -0.36067 0.475
PT Early---Invasive Cancer 1.05392 0.339457 9.63932 0.001905 0.3886 1.71924 2.869
Leucocytes (tot) -3.97989 1.108824 12.88300 0.000332 -6.1531 -1.80664 0.019
Eosinophils (tot) 4.35950 1.145350 14.48761 0.000141 2.1147 6.60434 78.218
Stick Neutrophils (tot) 3.72513 1.090917 11.66003 0.000639 1.5870 5.86329 41.477
Segmented Neutrophils (tot) 3.98772 1.105228 13.01803 0.000309 1.8215 6.15393 53.932
Lymphocytes (tot) 3.96596 1.116264 12.62298 0.000381 1.7781 6.15379 52.771
Monocytes (tot) 4.24914 1.155433 13.52425 0.000236 1.9845 6.51375 70.045
Thrombocytes/CC 0.00138 0.000685 4.07046 0.043639 0.0000 0.00272 1.001
Leucocytes/CC 8.12117 2.770057 8.59527 0.003370 2.6920 13.55038 3364.943
Eosinophils/CC -9.36552 2.878071 10.58913 0.001138 -15.0064 -3.72460 0.000
Stick Neutrophils/CC -7.58172 2.883567 6.91314 0.008556 -13.2334 -1.93003 0.001
Segmented Neutrophils/CC -8.23960 2.783007 8.76564 0.003070 -13.6942 -2.78500 0.000
Lymphocytes/CC -8.01138 2.756945 8.44421 0.003662 -13.4149 -2.60787 0.000
Monocytes/CC -9.46646 3.001900 9.94449 0.001613 -15.3501 -3.58284 0.000
Operation Type 0.16080 0.077795 4.27221 0.038741 0.0083 0.31327 1.174
Stick Neutrophils (%) -0.45056 0.246290 3.34666 0.067342 -0.9333 0.03216 0.637
Monocytes (%) -0.46372 0.261830 3.13667 0.076550 -0.9769 0.04946 0.629
Neural Networks:
Baseline Error=0.000;
Area under ROC Curve=1.000;
Correct Classification Rate=100%
Rank Sensitivity
PT Early---Invasive Cancer 1 11004
PT N0---N12 2 10821
Tumor Size 3 8971
Erythrocytes/Cancer Cells 4 6231
Adjuvant Chemoimmunotherapy 5 5762
Healthy Cells/Cancer Cells 6 5558
Prothrombin Index 7 3778
Thrombocytes/Cancer Cells 8 3350
Monocytes/Cancer Cells 9 2884
Stick Neutrophils/Cancer Cells 10 2799
Eosinophils/Cancer Cells 11 2302
Leucocytes/Cancer Cells 12 1981
Segmented Neutrophils/ Cancer Cells 13 1714
Lymphocytes/Cancer Cells 14 1474
Bootstrap Simulation Rank Kendall’Tau-A P<
PT N0---N12 1 -0.206 0.000
Tumor Size 2 -0.200 0.000
Residual Nitrogen 3 -0.188 0.000
T1-4 4 -0.185 0.000
PT Early---Invasive Cancer 5 -0.162 0.000
Healthy Cells/Cancer Cells 6 0.157 0.000
Leucocytes/Cancer Cells 7 0.150 0.000
Lymphocytes/Cancer Cells 8 0.136 0.000
Seg.Neutrophils/Cancer Cells 9 0.135 0.000
Erythrocytes/Cancer Cells 10 0.134 0.000
Tumor Growth 11 -0.127 0.000
Thrombocytes/Cancer Cells 12 0.126 0.000
Localization 13 -0.109 0.000
Coagulation Time 14 -0.108 0.000
Chlorides 15 0.106 0.000
G1-3 16 -0.102 0.000
Monocytes/Cancer Cells 17 0.092 0.01
Operation Type 18 -0.079 0.01
Histology 19 -0.073 0.01
ESS 20 0.071 0.05
Prothrombin Index 21 0.067 0.05
Glucose 22 0.065 0.05