RESUMO
INTRODUCTION AND AIMS: Gastric adenocarcinoma is among the high-ranking tumors, with respect to frequency and mortality, worldwide. The inflammatory process and immune system activity are associated with oncologic control. Our aim was to identify whether the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and other variables are prognostic factors for survival in patients with metastatic gastric cancer in a Mexican population. MATERIAL AND METHODS: Patients diagnosed with metastatic gastric adenocarcinoma, hospitalized within the time frame of December 2011 to 2021, were analyzed. The NLR, PLR, and albumin and hemoglobin levels obtained from blood samples were calculated. Functional status (ECOG and Karnofsky), sex, histology, and the presence of signet ring cells were also considered possible prognostic factors. Each factor's prognostic value for overall survival was determined through univariate and multivariate analyses. RESULTS: The study included 956 patients diagnosed with metastatic gastric cancer, of whom 494 (51.7%) were men and 462 (48.3%) were women. The main histologic finding was diffuse adenocarcinoma (nâ¯=â¯619, 64.7%), followed by intestinal adenocarcinoma (nâ¯=â¯293, 30.6%), and the presence of signet ring cells was found in 659 (68.9%) patients. Diagnostic laparoscopy was performed on 238 patients (24.9%) to confirm peritoneal carcinomatosis. The multivariate analysis showed that an NLR above 3.2 (HR 1.51, 95% CI 1.27-1.8; pâ¯<â¯0.001), albumin below 3.5â¯g/dl (HR 1.25, CI 1.06-1.47; pâ¯=â¯0.006), and an ECOG performance status of 2 or higher (HR 1.39, CI 1.10-1.76; pâ¯=â¯0.005) were independent factors that predicted a lower survival rate, whereas a Karnofsky score above 70% (HR 0.69, CI 0.53-0.91; pâ¯=â¯0.008) was associated with a better survival rate. Lastly, the PLR was not statistically significant in the multivariate analysis. CONCLUSIONS: The NLR, nutritional status assessed through albumin measurement, and functional status can act as independent prognostic survival factors in hospitalized Mexican patients diagnosed with metastatic gastric adenocarcinoma and be taken into account during therapeutic decision-making.
Assuntos
Adenocarcinoma , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Neoplasias Gástricas/sangue , Masculino , Feminino , México/epidemiologia , Adenocarcinoma/mortalidade , Adenocarcinoma/secundário , Adenocarcinoma/sangue , Pessoa de Meia-Idade , Prognóstico , Idoso , Adulto , Idoso de 80 Anos ou mais , Estudos Retrospectivos , Neutrófilos , Metástase Neoplásica , Linfócitos/patologia , Taxa de SobrevidaRESUMO
When producing activated carbons from agricultural by-products, certain properties, such as yield and specific surface area, are very important for obtaining an economical and promising adsorbent material. Nevertheless, many researchers have not simultaneously optimized these properties and have obtained different optimal conditions for the production of activated carbon that either increases specific surface area but decreases yield or vice versa. In this research, the production of activated carbon from barley husks (BH) by chemical activation with zinc chloride was optimized by using a 2(3) factorial design with replicates at the central point, followed by a central composite design with two responses (the yield and iodine number) and three factors (the activation temperature, activation time, and impregnation ratio). Both responses were simultaneously optimized by using the desirability functions approach to determine the optimal conditions of this process. The findings reveal that after the simultaneous dual optimization, the maximal response values were obtained at an activation temperature of 436 °C, an activation time of 20 min, and an impregnation ratio of 1.1 g ZnCl2/g BH, although the results after the single optimization of each response were quite different. At these conditions, the predicted values for the iodine number and yield were 829.58 ± 78.30 mg/g and 46.82 ± 2.64%, respectively, whereas experimental tests produced values of 901.86 mg/g and 48.48%, respectively. Moreover, activated carbons from BH obtained at the optimal conditions primarily developed a porous structure (mesopores > 71% and micropores > 28%), achieving a high surface area (811.44 m(2)/g) that is similar to commercial activated carbons and lignocellulosic-based activated carbons. These results imply that the pore width and surface area are large enough to allow the diffusion and adsorption of pollutants inside the adsorbent particles. In summary, two responses were optimized to determine the optimal conditions for the production of activated carbons because it is possible to increase both the specific surface area and yield.