The neutrophil-lymphocyte ratio (NLR) and the platelet-lymphocyte ratio (PLR) are markers of systemic inflammation. However, there is little evidence of the value of inflammation in the early diagnosis of gastric cancer (GC). A total of 2,606 patients diagnosed with GC in the past three years and 3,219 healthy controls over the same period were included in this study. Peripheral blood samples were obtained to analyze the NLR, PLR, carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA19-9). The optimal cutoff levels for the NLR and PLR were defined by receiver operating characteristic (ROC) curve analysis (NLR=2.258, PLR=147.368). The value of different biomarkers for diagnosing GC was compared by the area under the curve (AUC). The NLR and PLR showed diagnostic sensitivity in GC (AUC=0.715, AUC=0.707). Using the Bonferroni correction, the NLR and PLR were superior to CEA and CA19-9 in the diagnosis of GC (P<0.0001). The systemic inflammatory markers were significantly higher in the early stage of GC than tumor markers. After grouping patients and healthy controls by gender, we found that the diagnostic significance of combined NLR and PLR for GC was greater in male patients than in female patients (P<0.0001). The diagnostic value of the NLR and PLR in GC is higher than that of the traditional tumor markers CEA and CA19-9. Systemic markers of inflammation are more valuable in male than female patients.

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While the governance of Western megaprojects is indirectly influenced by governments through legislation and regulations, the Chinese state actively oversees and controls projects of societal importance. To provide clarity on the role of the state in Chinese megaprojects, we carried out a case study focusing on EXPO 2010 Shanghai. Our analysis revealed that through a project-specific organization Construction Headquarter (CHQ), the Chinese state executes administrative strength, forces authorities to temporarily integrate their processes for the benefit of the project, influences contractor and resource selection decisions, induces leadership accountability, and promotes shared project values.

Over the past two decades, project governance has attracted increasing attention from researchers and practitioners worldwide and has become an important research area of project management. However, an inclusive quantitative and systematic analysis of the state-of-the-art recently available research in this field is still missing. This study attempts to map the global research on project governance through a state-of-the-art review. A total of 285 bibliographic records were retrieved from the Web of Science Core Collection database and analyzed by the visual analytic tool—CiteSpace. The results indicated that there has been an increasing research interest in project governance. The most productive and the most highly cited author in the area of project governance is Müller R., and most of the existing project governance research achievements are from Australia, China, USA, and Norway. By synthetically analyzing the keywords, future research might focus on governance of megaprojects and project success. Additionally, 9 knowledge domains of project governance were identified, including conceptual framework, public projects, governance structure, governance context, megaproject governance, contractual and relational governance, sustainability, portfolio governance, and project success. This study contributes to the body of knowledge by mapping the existing project governance research. It is particularly helpful to new and early-stage researchers who plan to do research on project governance, as it can provide them an overview of project governance research, including key authors, main institutions, hot topics, and knowledge domains. Moreover, the findings from the study are beneficial to industry practitioners as well, as they can help industry practitioners understand the latest development of governance theory and practice and thereby help them locate the best governance strategies for project management.

Background: Emerging evidence indicates that the tumor microenvironment (TME) influences tumor progression through the various cells it contains. Tumor-associated neutrophils (TANs) and cancer-associated fibroblasts (CAFs) are prominent constituents of diverse malignant solid tumors and are crucial in the TME and cancer evolution. However, the relationships and combined prognostic value of these two cell types are not known in gastric adenocarcinoma (GAC). Materials and Methods: In total, 215 GAC patients who underwent curative surgery were enrolled. TANs were assessed by immunohistochemical staining for CD66b, and CAFs were evaluated by immunohistochemical staining for α-smooth muscle actin (α-SMA). Results: The percentages of patients with high-density TANs and CAFs in GAC tissue were 47.9% (103/215) and 43.3% (93/215), respectively. The densities of TANs and CAFs in GAC tissue samples were markedly elevated and independently correlated with GAC clinical outcomes. A strong correlation (R = .348, P < .001) was detected between TANs and CAFs in GAC. The combination of TANs and CAFs produced a more exact outcome than either factor alone. Patients with an α-SMA low CD66b high (hazard ratio [HR] = 1.791; 95% CI: 1.062-3.021; P = .029), α-SMA high CD66b low (HR = 2.402; 95% CI: 1.379-4.183; P = .002), or α-SMA high CD66b high (HR = 3.599; 95% CI: 2.330-5.560; P < .001) phenotype were gradually correlated with poorer disease-free survival than the subset of patients with an α-SMA low CD66b low phenotype. The same results were observed for disease-specific survival in the subgroups.Noticeably, in stage II-III patients with the α-SMA low CD66b low phenotype, an advantage was obtained with postoperative chemotherapeutics, and the risk of a poor prognosis was reduced compared with stage II-III patients with the α-SMA low CD66b high , α-SMA high CD66b low or α-SMA high CD66b high phenotype (HR: 0.260, 95% CI: 0.124-0.542, P < .001 for disease-free survival; and HR: 0.258, 95% CI: 124-0.538, P < .001 for disease-specific survival). |CONG et al.

The Warburg effect, one of the hallmarks of tumors, produces large amounts of lactate and generates an acidic tumor microenvironment via using glucose for glycolysis. As a metabolite, lactate not only serves as a substrate to provide energy for supporting cell growth and development but also acts as an important signal molecule to affect the biochemical functions of intracellular proteins and regulate the biological functions of different kinds of cells. Notably, histone lysine lactylation (Kla) is identified as a novel post-modification and carcinogenic signal, which provides the promising and potential therapeutic targets for tumors. Therefore, the metabolism and functional mechanism of lactate are becoming one of the hot fields in tumor research. Here, we review the production of lactate and its regulation on immunosuppressive cells, as well as the important role of Kla in hepatocellular carcinoma. Lactate and Kla supplement the knowledge gap in oncology and pave the way for exploring the mechanism of oncogenesis and therapeutic targets. Research is still needed in this field.

BACKGROUND Borrmann classification (types I-IV) for the detection of advanced gastric cancer has been accepted worldwide, and lymphatic and/or blood vessel invasion (LBVI) status is related to the poor prognosis after gastric cancer. AIM To evaluate the significance of Borrmann type combined with LBVI status in predicting the prognosis of advanced gastric cancer. METHODS We retrospectively studied the clinicopathological characteristics and long-term survival data of 2604 patients who were diagnosed with advanced gastric adenocarcinoma at Harbin Medical University Cancer Hospital from January 2009 to December 2013. Categorical variables were evaluated by the Pearson’s χ 2 test, the Kaplan-Meier method was used to identify differences in cumulative survival rates, and the Cox proportional hazards model was used for multivariate prognostic analysis. RESULTS A total of 2604 patients were included in this study. The presence of LVBI [LBVI (+)] and Borrmann type ( P = 0.001), tumor location ( P < 0.001), tumor size ( P < 0.001), histological type ( P < 0.001), tumor invasion depth ( P < 0.001), number of metastatic lymph nodes ( P < 0.001), and surgical method ( P < 0.001) were significantly correlated with survival. When analyzing the combination of the Borrmann classification and LBVI status, we found that patients with Borrmann type III disease and LBVI (+) had a similar 5-year survival rate to those with Borrmann IV + LBVI (-) (16.4% vs 13.1%, P = 0.065) and those with Borrmann IV + LBVI (+) (16.4% vs 11.2%, P = 0.112). Subgroup analysis showed that the above results were true for any pT stage and any tumor location. Multivariate Cox regression analysis showed that Borrmann classification ( P = 0.023), vascular infiltration ( P < 0.001), tumor size ( P = 0.012), pT stage ( P < 0.001), pN stage ( P < 0.001), and extent of radical surgery ( P < 0.001) were independent prognostic factors for survival. CONCLUSION Since patients with Borrmann III disease and LBVI (+) have the same poor prognosis as those with Borrmann IV disease, more attention should be paid to patients with Borrmann III disease and LBVI (+) during diagnosis and treatment, regardless of the pT stage and tumor location, to obtain better survival results.

ObjectivesThis study analyses the cost-effectiveness of annual low-dose CT (LDCT) screening of high-risk cancer populations in Chinese urban areas.DesignWe used a Markov model to evaluate LDCT screening from a sociological perspective.SettingThe data from two large lung cancer screening programmes in China were used.ParticipantsThe sample consisted of 100 000 smokers who underwent annual LDCT screening until age 76.InterventionThe study comprises five screening strategies, with the initial screening ages in both the screening strategies and their corresponding non-screening strategies being 40, 45, 50, 55 and 60 years, respectively.Primary and secondary outcome measuresThe incremental cost-effectiveness ratio (ICER) between screening and non-screening strategies at the same initial age was evaluated.ResultsIn the baseline scenario, compared with those who were not screened, the specific mortality from lung cancer decreased by 18.52%–23.13% among those who underwent screening. The ICER of LDCT screening ranges from US$13 056.82 to US$15 736.06 per quality-adjusted life year, which is greater than one but less than three times the gross domestic product per capita in China. An initial screening age of 55 years is the most cost-effective strategy.ConclusionsBaseline analysis shows that annual LDCT screening of heavy smokers in Chinese urban areas is likely to be cost-effective. The sensitivity analysis reveals that sensitivity, specificity and the overdiagnosis rate influence the cost-effectiveness of LDCT screening. All scenarios tested demonstrate cost-effectiveness, except for the combination of worst values of sensitivity, specificity and overdiagnosis. Therefore, the cost-effectiveness of a screening strategy depends on the performance of LDCT screenings.