It was generally believed that the prognosis of gastric neuroendocrine carcinoma (GNEC) was worse than gastric adenocarcinoma (GAC). However, almost all previous studies compared the prognosis of GNEC and GAC based on East Asians. In this study, we evaluated the clinicopathological features and prognosis of GNEC and GAC in Whites. Patients with GNEC and GAC were identified from 2000 to 2018 in the Surveillance, Epidemiology, and End Results (SEER) database. We used propensity score matching (PSM) analysis to match the age, sex, TNM stage, and treatments received between GNEC and GAC, then compared the overall survival (OS) and cancer-specific survival (CSS) in the two types. A total of 392 cases of GNEC and 12,835 cases of GAC in Whites were recognized. After PSM, the 5-year OS rates of GNEC and GAC were 50.3% and 43.0%, respectively (p = 0.010). The 5-year CSS rates of GNEC and GAC were 57.4% and 50.1%, respectively (p = 0.012). Besides, multivariable cox regression analyses showed that GNEC was an independent predictor of improved OS (HR 0.719; 95% CI 0.607–0.853) and CSS (HR 0.691; 95% CI 0.571–0.835) in the matched data. The prognosis of GNEC was better than GAC in Whites, showing significant ethnic differences. Appropriate treatments and follow-up strategies for GNEC in Whites are probably different from East Asians. The potential genetic and molecular mechanisms need to be further explored.

Background: There was no consistent evidence of whether perioperative blood transfusion (PBT) affects the long-term survival of gastric cancer (GC) patients after undergoing gastrectomy. This study aimed to investigate the effects of PBT on the long-term survival of GC patients, as well as to determine the threshold of PBT and provide evidence for future surgical practice. Methods: We performed this real-world study of GC patients undergoing gastrectomy at China National Cancer Center from January 1, 2000 to December 30, 2019. Overall survival (OS) curves were plotted using the Kaplan–Meier method and compared statistically using the log-rank test. Univariate and multivariate Cox proportional hazard models were used to determine the risk factors for OS. Results: In total, 13 470 GC patients undergoing gastrectomy from 2000 to 2019 were included, of whom 3465 (34.6%) GC patients received PBT. PBT ratios declined from 29.1% (114/392) in 2000 to 11.2% in 2019 (149/1178), with the highest blood transfusion ratio in 2005 at 43.7% (220/504). For patients transfused with red blood cells, the median value of hemoglobin (Hb) before transfusion in the PBT group decreased from 110 g/l in 2000 to 87 g/l in 2019. Compared with patients who not receiving PBT, PBT group are more likely to be older (≥65, 39.1% vs. 30.1%, P<0.001), open operation (89.7% vs. 78.1%, P2, 25.3% vs. 14.9%, P<0.001) and in the later pTNM stage (pTNM stage III, 68.5% vs. 51.5%, P<0.001). Results of multivariable Cox regression analysis showed that PBT was an independent prognostic factor for worse OS in GC patients undergoing gastrectomy [HR=1.106, 95% confidence interval (CI): 1.01–1.211, P=0.03). After stratified according to tumor stage, we found that PBT group had a worse prognosis only in pTNM stage III (HR=1.197, 95% CI: 1.119–1.281, P<0.001). OS was obviously poor in the PBT group when Hb levels were higher than 90 g/l (90 g/l<Hb≤120 g/l: HR=1.196, 95% CI: 1.090–1.313, P120 g/l: HR=1.207, 95% CI: 1.098–1.327, P<0.001), while there was no difference between the two groups when Hb levels were lower than or equal to 90 g/l (Hb≤90 g/l: HR=1.162, 95% CI: 0.985–1.370, P=0.075). Conclusion: In conclusion, PBT was an independent prognostic factor for worse OS. Blood transfusion might not be recommended for GC patients with perioperative minimum Hb values higher than 90 g/l.

Background: Gastroparesis is a significant early complication following radical distal gastrectomy (RDG) for gastric cancer. However, the full spectrum of clinical characteristics, recovery duration, and prognostic implications of postoperative gastroparesis (PGS) has yet to be elucidated clearly. Methods: Patients who underwent RDG for gastric cancer were identified from the National Cancer Center (NCC) of China between 2010 and 2020. Propensity score matching (PSM) was used to adjust for selection biases. Logistic regression models or Cox proportional hazards models were employed to identify risk factors or prognostic factors, respectively. Results: Among the 4649 patients who underwent RDG, 104 cases (2.2%) developed PGS. Age ≥ 60 years [odds ratio (OR), 1.600 (1.075–2.380), P = 0.020], smoking history [OR, 2.793 (1.842–4.234), P < 0.001], long operative time [OR, 1.005 (1.001–1.008), P = 0.004], intraoperative blood transfusion [OR, 2.183 (1.371–3.477), P = 0.001], low tumor differentiation [OR, 3.019 (1.877–4.856), P < 0.001], and absence of neoadjuvant therapy [OR, 4.610 (1.443–14.724), P = 0.010] were identified as independent risk factors for PGS. The median recovery time for PGS was 19 (interquartile range (IQR): 13–30) days. Multivariate analysis revealed that a greater distance from cardia to anastomosis [OR, 1.795 (1.252–2.573), P = 0.001] and older age [OR, 1.058 (1.002–1.117), P = 0.042] were associated with prolonged recovery time of PGS. No significant differences in in-hospital mortality ( P = 0.479) and overall survival (OS) ( P = 0.503) were observed between the PGS and non-PGS groups. Furthermore, multivariate analysis indicated that patients with longer PGS recovery time had worse OS compared to patients with shorter PGS recovery time [hazard ratio (HR), 0.487 (0.245–0.967), P = 0.040] and non-PGS patients [HR, 0.506 (0.281–0.911), P = 0.023]. Conclusion: Age, smoking history, operative time, intraoperative blood transfusion, tumor differentiation, and neoadjuvant therapy were independent risk factors for PGS after RDG. Notably, a greater distance from cardia to anastomosis was significantly associated with prolonged recovery time of PGS. Furthermore, longer PGS recovery time independently predicted poorer OS, highlighting the significance of early intervention for PGS.