Background: Gastric cancer (GC) is associated with poor survival despite curative-intent surgical resection and systemic therapy. Our objective is to examine the impact of histology on prognosis as well as the impact of linitis plastica (LP) on survival. Methods:The GC database at a single institution was evaluated for patients who underwent resection from 2000 to 2015. Clinicopathologic characteristics were examined and descriptive statistics was used to analyze four groups of patients based on Lauren classification: intestinal (n=93), diffuse (n=20), diffuse with signetring cell features (n=57), and LP (n=40). LP patients had diffuse GC but also presented with circumferential infiltration of the gastric wall for at least a third of the stomach length on endoscopy or imaging. Fisher's exact test was used to compare groups; Cox regression was used for multivariate analysis and Kaplan-Meier method for survival. Results: Of 210 patients who underwent gastric resection, 112 (53%) were male with mean age 65.3 years (SD ±14.6 years). Intestinal GC patients were older at diagnosis but other patient demographics were similar between all groups. LP patients had a higher rate of R1 resection despite higher rates of total gastrectomy (P<0.01). Rates of perineural invasion (PNI) and nodal metastasis were higher in LP (P<0.001). The majority of intestinal GC patients (79%) had stage I/II disease compared to 70% of LP patients with stage III disease.Median overall survival (OS) was 13.7 months for LP, 79 months for intestinal, 97 months for signetring cell, and not reached for diffuse GC (P<0.001). When stratified by stage, there were no significant differences in survival by histology for stage II and stage III patients. However, by Cox regression analysis, factors associated with worse survival included lymphovascular invasion (LVI), nodal disease, and presence of LP. Neutrophil-lymphocyte ratio (NLR), neoadjuvant and adjuvant therapy, and tumor regression grade did not influence survival on multivariate analysis. Conclusions:Intestinal GC is thought to have a better prognosis. Interestingly, this study demonstrates similar outcomes in patients with intestinal, diffuse, and signet-ring cell GC. However, a subset of diffuse GC-LP was associated with an infiltrative pattern of disease characterized by PNI and LVI. Despite controlling for poor prognostic markers, LP was independently associated with a worse prognosis. More research is needed to identify methods of earlier diagnosis and effective systemic therapy to treat this aggressive disease.

Patients undergoing pancreatectomy for benign disease have a significant risk of developing NAFLD but the frequency is lower than previously reported in cohorts that included individuals with malignant disease. Highest risk was observed in individuals who underwent pancreaticoduodenectomy or developed pancreatic atrophy. Further investigations to define the mechanisms that promote steatosis and interventions to prevent subsequent morbidity from NAFLD are warranted.

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Aim/Background: We investigated the prevalence and associated factors of vitamin D deficiency among Hong Kong advanced cancer patients receiving palliative care. Methods: This was a prospective cross-sectional study performed in Caritas Medical Centre. Consecutive Chinese advanced cancer patients receiving palliative care service were enrolled. Demographic data, functional status, symptom burden were assessed by Palliative Performance Scale (PPS), Charlson Comorbidity Index (CCI), Edmonton Symptom Assessment System (ESAS) and Hospital Anxiety and Depression Scale (HADS). Complete blood count, liver/renal function and vitamin D level were checked. Patients with vit D deficiency were given vitamin D supplement and followed up for 90 days. The results of first 50 patients were analysed. Results: The mean age was 70.2 years [SD 13.1], with 68% were male. Most common primary sites were colorectal (18%) and lung (12%), while 86% patients had metastatic disease. Mean age-adjusted CCI was 9 [SD 2.0]. Deficiency occured in 35 (70%) patients. It was associated with "use of nifedipine" ( p = 0.041), "not taking vitamin D″