Gastric cancer in India: epidemiology and standard of treatment

Correlation between Tomographic and Histopathological Staging in Upfront Resected Gastric Cancer: Enhancing Diagnostic Accuracy in the Era of Perioperative Therapy

PURPOSE

This study aimed to assess the diagnostic accuracy of multidetector contrast-enhanced computerised tomography (MDCT) and to establish a correlation between radiological and histopathological staging in upfront resected localised gastric cancers (GC).

METHODS

All consecutive patients of resectable, localised GC who underwent upfront elective resection between 2010 and 2022 were included. The initial clinical staging determined during multidisciplinary meetings was compared with the pathological stage obtained after surgery. Subsequently, a retrospective, blinded review was conducted to assign a revised clinical staging, and accuracy was correlated.

RESULTS

The analysis of 138 patients revealed varying accuracy of MDCT in determining the T stage (66.9% for T1/T2, 64.6% for T3, and 87.2% for T4) and N stage (60.8% for N0, 63.7% for N1, and 83.2% for N2). The accuracy for stage group ranged from 71 to 78.65%. There was weak agreement observed between the T, N, and overall stage on clinicopathological correlation. However, a blinded radiology review by oncoradiologists resulted in improved accuracy, particularly in T1/T2 disease, and also improved pathological stage correlation.

CONCLUSIONS

Although MDCT is a valuable initial staging tool for gastric cancer, we found weak agreement between the clinical and the pathological stages in upfront resected gastric cancers. By implementing an expert radiology review and standardising scanning and reporting protocols, we can significantly improve the accuracy and correlation of MDCT with pathology, even for T1/T2 disease. This may help in better selecting patients for upfront surgery versus perioperative chemotherapy, especially in resource-constrained settings.

Time trends in stomach cancer mortality across the BRICS: an age-period-cohort analysis for the GBD 2021

Objectives

Stomach cancer is one of the leading causes of cancer death, and its epidemiologic characteristics are regionally heterogeneous worldwide. The BRICS nations (Brazil, Russian Federation, India, China, and South Africa) have markedly increasing influences on the international stage. We aim to investigate time trends in stomach cancer mortality among the BRICS countries from 1982 to 2021.

Methods

Data for this study were obtained from the Global Burden of Disease (GBD) 2021 public dataset to investigate the deaths, all-age mortality rate, and age-standardized mortality rate (ASMR) of stomach cancer. The age-period-cohort (APC) model was employed to estimate net drift, local drift, age-specific curves, and period (cohort) relative risks, and the Bayesian generalized linear model was employed to evaluate the relationship between food intake and mortality rate.

Results

In 2021, there were approximately 572,000 stomach cancer deaths across the BRICS, accounting for 59.9% of global death. Russian Federation exhibited the most significant reduction in ASMR of stomach cancer among the BRICS. In contrast, China continued to report the highest number of stomach cancer deaths. The risk of mortality associated with stomach cancer exhibited a marked increase with advancing age, both within these countries and at the global level. PUFA, sodium, calcium and trans fat may have an impact on the mortality rate of stomach cancer. Favorable trends in period and birth cohort effects were observed in these five nations over the past decades.

Conclusion

BRICS countries have made varying progress in reducing stomach cancer mortality. Given the diverse environments, it is recommended to progressively develop customized stomach cancer prevention strategies, utilizing available resources. Healthcare services should be extended to all age groups, with a particular emphasis on vulnerable populations.

Validation of salivary microRNA 301a as a potential non-invasive diagnostic biomarker in gastric carcinoma

Context

Early detection of cancer is key to good prognosis and improved survival rate. Gastric cancer (GC) is fatal and presents with poor prognosis as it is usually diagnosed only at advanced stages. Saliva is emerging as a preferred diagnostic tool due to its advantages of being non-invasive, easy to collect, and cost-effective. Salivary microRNAs (miRNA) are more reliable due to their stability, resistance to degradation and its abundant involvement in cancer progression.

Aim

To estimate and validate the potential of salivary miRNA 301a in the diagnosis of Gastric cancer.

Methods and Materials

This Cross-sectional study comprised of 60 GC patients (Group I) and 60 normal controls (Group II). Fold change (FC) values of serum and salivary miRNA301a levels were estimated using the Real Time-Polymerisation Chain Reaction (RT-PCR) and compared between the study groups. Correlation between the serum and salivary miRNA301a levels was also evaluated. MiRNA301a levels were compared and correlated, with the clinical stage and histopathological grades of GC.

Results

The mean FC of serum (Mean ± SD = 2.62 ± 0.75, Mean Rank = 90.5) and salivary (Mean ± SD = 2.03 ± 0.56, Mean Rank = 90.5) miRNA301a was significantly higher in Gastric cancer patients compared to controls (Mean ± SD = 0.99 ± 0.004, Mean Rank = 30.5). Salivary miRNA301a levels exhibited significant positive correlation with serum miRNA301a in gastric cancer patients (r = 0.941). The mean FC of serum and salivary microRNA 301a exhibited significant correlation with the clinical stages and histopathological grades of GC.

Conclusion

Salivary miRNA301a is a potential reliable diagnostic tool for early screening of Gastric cancer.

Clinicopathological features and survival outcomes for gastric adenocarcinoma: Real-world single-center data

INTRODUCTION

Gastric cancer is the fifth most-common cancer and fourth common cause for cancer-related deaths globally. Surgery preceded or followed by chemotherapy or chemoradiotherapy is considered an optimal treatment for locally advanced gastric cancer. This study is a real-world data from a tertiary referral institute in southern India, in its experience with treating gastric adenocarcinoma over a period of four years with a minimum of two-year follow-up.

METHODS

This was a retrospective analysis of data of patients with histologically proven gastric adenocarcinoma enrolled in the Department of Medical Oncology from 2015 to 2018. The demographic details, presentation, staging, treatment received and outcomes of patients with gastric adenocarcinoma were collected and analyzed in this study.

RESULTS

Total 488 patients with gastric adenocarcinoma were included for the study. The stage-wise distribution of patients revealed early and locally advanced (45%) and metastatic (55%). The peritoneum and liver were the common sites of metastasis. The treatment distribution of these patients included perioperative chemotherapy followed by surgery (25 [5%]), surgery followed by adjuvant chemotherapy (65 [13%]), surgery alone (16 [3%]), perioperative chemotherapy alone (23 [4%]), palliative chemotherapy (274 [56%]) and supportive care (85 [17%]). The median overall survival for curative, palliative and supportive treatment was 23 (18-28), nine (7.6-10.4) and four (2.7-5.3) months, respectively. The two-year overall survival in the intention to treat population in the primary surgery (n = 81) and perioperative chemotherapy groups (n = 66) was 67.4% vs. 29.9% (p < 0.0001), respectively.

CONCLUSION

This study highlights the advanced nature of the presentation of gastric cancer patients and the poor rate of treatment completion. The median survival rates in curative patients remain to be dismally poor. The treatment sequence in curable gastric cancer of surgery followed by adjuvant chemotherapy vs. perioperative chemotherapy followed by surgery needs to be explored in our country.

Role of CYFRA 21-1 and CEA as prognostic and predictive markers in locally advanced and metastatic gastric carcinoma

PURPOSE

Tumor-associated serum markers have demonstrated predictive and prognostic value in patients being treated for malignancies. However, the clinical importance of tumor markers in gastric cancers (GC) is poorly standardized.

OBJECTIVES

The objective is to assess the clinical utility of cytokeratin-19 fragment (CYFRA 21-1) and carcinoembryonic antigen (CEA) as serum tumor markers in advanced GC.

METHODS

In this prospective study, CYFRA 21-1 and CEA levels were measured at baseline and after three cycles of chemotherapy in patients with advanced GC. The association of tumor marker levels with prognosis and decline of tumor markers with radiological overall response rates (ORR) and survival were analyzed.

RESULTS

In the 105 patients, the proportion of patients with elevated baseline CYFRA 21-1 and CEA levels was 55% (N = 58) and 37% (N = 39) based on predefined cutoffs. Response assessment was done for 61 patients who received a minimum of three cycles of chemotherapy. A 15% and 13% reduction of serum levels from baseline for CYFRA 21-1 and CEA were selected for defining "CYFRA 21-1 response" and "CEA-response," respectively. Both responses were significant predictors of radiological ORR. The median overall survival (OS) was 9.6 months in the entire cohort and 13 months for patients who received at least three cycles of chemotherapy. In multivariate analysis, baseline CEA levels and ECOG status were significant predictors of OS. In a subset analysis of patients receiving palliative chemotherapy, any of the tumor marker responses predicted improved 1-year OS.

CONCLUSION

In advanced GC, CYFRA 21-1 and CEA decline from baseline appeared to be reliable surrogate markers of chemotherapy efficacy and improved survival.

Ferroptosis and circular RNAs: new horizons in cancer therapy

Cancer poses intricate challenges to treatment due to its complexity and diversity. Ferroptosis and circular RNAs (circRNAs) are emerging as innovative therapeutic avenues amid the evolving landscape of cancer therapy. Extensive investigations into circRNAs reveal their diverse roles, ranging from molecular regulators to pivotal influencers of ferroptosis in cancer cell lines. The results underscore the significance of circRNAs in modulating molecular pathways that impact crucial aspects of cancer development, including cell survival, proliferation, and metastasis. A detailed analysis delineates these pathways, shedding light on the molecular mechanisms through which circRNAs influence ferroptosis. Building upon recent experimental findings, the study evaluates the therapeutic potential of targeting circRNAs to induce ferroptosis. By identifying specific circRNAs associated with the etiology of cancer, this analysis paves the way for the development of targeted therapeutics that exploit vulnerabilities in cancer cells. This review consolidates the existing understanding of ferroptosis and circRNAs, emphasizing their role in cancer therapy and providing impetus for ongoing research in this dynamic field. See also the graphical abstract(Fig. 1).

Homology Modeling, Screening, and Identification of Potential FOXO6 Inhibitors Curtail Gastric Cancer Progression: an In Silico Drug Repurposing Approach

Gastric cancer is the world's second leading cause of cancer-related fatalities, with the epidemiology changing over the previous several decades. FOXOs are the O subfamily of the forkhead box (FOX) transcription factor family, which consists of four members: FOXO1, FOXO3, FOXO4, and FOXO6. FOXO6 mRNA and protein levels are increased in gastric cancer tissues. FOXO6 forced overexpression enhances gastric cancer cell growth, while knockdown decreases proliferation. In our study, the GEPIA, Kaplan-Meier, KEGG, and STRING databases were used to determine FOXO6 mRNA expression, overall survival ratio, interactive pathways, and top 10 associated proteins in gastric cancer respectively. Due to the lack of a solved structure for FOXO6, homology modeling was performed to obtain a 3D structure model, and we used anti-cancer drugs and small molecules to target FOXO6 for identifying a potential selective FOXO6 inhibitor. The chemical composition of the proteins and ligands has a significant impact on docking procedure performance. With this in mind, a critical evaluation of the performance of three regularly used docking routines was carried out: MVD, AutoDock Vina in PyRx, and ArgusLab. The binding affinities, docking scores, and intermolecular interactions were used as assessment criteria. In the study, the porfimer sodium showed excellent binding affinity to the FOXO6 protein. The major three docking software packages were used to analyze the scoring/H-bonding energy and intermolecular interactions. Based on the results, we concluded that FOXO6 was upregulated in gastric cancer and the ligand porfimer sodium emerges as a promising potential FOXO6 inhibitor to curtail gastric cancer progression.

Two web-based dynamic prediction models for the diagnosis and prognosis of gastric cancer with bone metastases: evidence from the SEER database

Purpose

Our aim was to identify the clinical characteristics and develop and validate diagnostic and prognostic web-based dynamic prediction models for gastric cancer (GC) with bone metastasis (BM) using the SEER database.

Method

Our study retrospectively analyzed and extracted the clinical data of patients aged 18-85 years who were diagnosed with gastric cancer between 2010 and 2015 in the SEER database. We randomly divided all patients into a training set and a validation set according to the ratio of 7 to 3. Independent factors were identified using logistic regression and Cox regression analyses. Furthermore, we developed and validated two web-based clinical prediction models. We evaluated the prediction models using the C-index, ROC, calibration curve, and DCA.

Result

A total of 23,156 patients with gastric cancer were included in this study, of whom 975 developed bone metastases. Age, site, grade, T stage, N stage, brain metastasis, liver metastasis, and lung metastasis were identified as independent risk factors for the development of BM in GC patients. T stage, surgery, and chemotherapy were identified as independent prognostic factors for GC with BM. The AUCs of the diagnostic nomogram were 0.79 and 0.81 in the training and test sets, respectively. The AUCs of the prognostic nomogram at 6, 9, and 12 months were 0.93, 0.86, 0.78, and 0.65, 0.69, 0.70 in the training and test sets, respectively. The calibration curve and DCA showed good performance of the nomogram.

Conclusions

We established two web-based dynamic prediction models in our study. It could be used to predict the risk score and overall survival time of developing bone metastasis in patients with gastric cancer. In addition, we also hope that these two web-based applications will help physicians comprehensively manage gastric cancer patients with bone metastases.

Imaging Recommendations for Diagnosis, Staging, and Management of Gastric Cancer

Gastric cancer is the second most common cause of cancer-related death in Indian men and women aged between 15 and 44 years. Most patients present at an advanced stage of disease. Surgically resectable disease usually requires a standard gastric resection and D2 lymphadenectomy. Imaging, especially with computed tomography scan of abdomen as well as thorax, is necessary for localization, nodal mapping, and metastatic workup of gastric cancer. In this review, we discuss current imaging recommendations for gastric carcinoma.

Ex Situ In Vivo Technique of Spleen-Preserving Splenic Hilar Lymph Node Dissection in Operable Proximal Gastric Adenocarcinoma

D2 gastrectomy is the globally accepted standard surgical procedure for operable gastric cancer, and lymph node (LN) dissection is considered as the critical part of radical surgery and closely related to the prognosis. The splenic hilar LN (SHLN) or level 10 are to be removed during standard D2 total gastrectomy. In situ and ex situ spleen-preserving lymphadenectomies have been the most common dissection approaches for SHLNs. No study exists which compares the outcomes of these techniques in Indian population. This study is aimed to analyse the operative outcomes of ex situ in vivo technique of spleen-preserving splenic hilar lymph node dissection in patients who underwent D2 total gastrectomy for operable proximal gastric cancer in comparison with in situ in vivo technique of splenic hilar lymph node dissection. We reviewed prospectively collected data from 17 patients with operable proximal gastric cancer between September 2016 and April 2019 who underwent D2 total gastrectomy with splenic hilar lymph node dissection and studied the preoperative demographic factors, operative and postoperative outcomes comparing the different operative techniques. Patients with oesophago-gastric junction involvement, direct splenic or other adjacent organ invasion requiring multivisceral resection and gastric stump carcinoma were excluded. Overall, 17 patients underwent D2 total gastrectomy for operable gastric cancer. Mean age of presentation was 54.7 years including 13 males and 4 females. Five patients had middle third and 12 patients had upper third cancer. All patients had splenic hilar nodal clearance as follows: in situ - 14 and ex situ - 3 patients. R0 resection was achieved in all patients. Lymph node harvest tends to be higher with lower operative time and blood loss in patients with ex situ technique compared to in situ technique with similar morbidity. Ex situ in vivo technique of spleen-preserving splenic hilar lymph node dissection can be considered as both safe and feasible procedure for operable proximal gastric cancer patients in experienced centres to achieve better lymph node yield with no significant increase in morbidity.

Evaluating the Association of Genetic Polymorphism of Cytochrome p450 (CYP2C9*3) in Gastric Cancer Using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP)

Background and aim

As a distinguished system, the cytochrome P450 (CYP) enzyme superfamily is involved in the biotransformation of several endogenous and exogenous substances including drugs, toxins, and carcinogens. Reports on the role of CYP enzyme in gastric cancer (GC) from the Eastern region of India are scarce. The present study aimed to evaluate the effect of single nucleotide polymorphisms (SNP) in cytochrome P450 family 2 subfamily C member 9 (CYP2C9*3) among cases with gastric malignancy.

Material and methods

The current study is a cross-sectional observational study carried out among 113 GC cases attending the Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India, and Srirama Chandra Bhanja Medical College and Hospital, Cuttack, India. Two ml of venous blood was collected from the confirmed cases of GC. The samples were subjected to genomic DNA isolation followed by polymerase chain reaction (PCR) and restriction fragment length polymorphism (PCR-RFLP).

Results

The prevalence of both homozygous and heterozygous mutation in GC cases is 4% and 8%, respectively. The overall association of cytochrome P450 family 2 subfamily C member 9 (CYP2C9) mutation in GC cases is 12% whereas 88% were detected as wild/standard type. The mutation CYP2C9 SNP has been seen in Helicobacter pylori-infected cases and as well as those without H. pylori infection.

Conclusions

The CYP2C9*3 genetic polymorphism might play a significant role as a risk factor for the development of gastric malignancy irrespective of H. pylori infection, among the eastern Indian population.

20-Year Trends in Detection Rates of Cardia Cancer via Endoscopic Surveillance in Tianjin, China: A Hospital-Based Study

Background

To analyze the time trends in cardia cancer detection rates using endoscopic surveillance from 1999 to 2019 in a high-volume Chinese hospital.

Methods

In this retrospective, single-center study, data were collected from the Endoscopy Center of the Department of Gastroenterology, Tianjin Medical University General Hospital, from 1999 to 2019. Cases of cardia cancer (n = 1567) were extracted from a database of patients who underwent endoscopy. Clinical and epidemiological characteristics of patients with cardia cancer were analyzed, including sex, age, and proportion of early gastric cancer and degree of tumor differentiation. The joinpoint regression method was used to identify change points in incidence trends. Annual percent change (APC) values, with 95% confidence intervals (CI), were calculated for time periods before and after change points.

Results

Of the 343942 patients who underwent endoscopy during 1999–2009, 1567 (4.6%) were identified with cardia cancer. The overall cardia adenocarcinoma detection rate decreased significantly from 1999 to 2004 (APC = −37.3, 95% CI: -20.9, -6.4), followed by a relatively slower decline rate from 2004 to 2019 (APC = −7.7, 95% CI: -4.4, -7.6). The crude rate of detection of early cardia cancer could not be determined by joinpoint analysis. Rates of detection reduced significantly in patients aged 60–69 and 70-79 years (APC = −8.3, 95% CI: -9.8, -6.8 and APC = −7.3, 95% CI: -8.8, -5.8, respectively). The detection rate in males decreased rapidly from 1999 to 2004 (APC = −35.9, 95% CI: -18.2, 5.6, P < 0.05), while the decline rate was relatively slow from 2005 to 2019 (APC = −6.9, 95% CI: -3.4, -6.1, P < 0.05). Among females, the detection rates also decreased from 1999 to 2004 (APC = −21.2, 95% CI: -28.1, -13.7), but remained stable from 2007 to 2019 (APC = −3.8, 95% CI: -7.9, -0.5). Detection of poorly differentiated cardia cancer also declined from 2009 to 2019 (APC = −12.8, 95% CI: -15.3, -10.0).

Conclusions

The detection rate of cardia cancer among gastric cancers has been stable from 2008 to 2019. The trend of detection rate of early cardia cancer showed no significant statistical meaning; hence, it remains necessary to carefully observe the cardia area during endoscopy examination.

Mutants of Helicobacter pylori IMPDH: Kinetics and in silico Studies to Determine the Structural and Functional Role of Key Amino Acids

The emergence of antibiotic-resistant strains of Helicobacter pylori necessitates the development of novel therapeutic strategies to fight against its infection. Recently, the enzyme inosine-5'-monophosphate dehydrogenase (IMPDH) has emerged as a promising target to treat bacterial infections due to its crucial role in the de novo purine biosynthesis pathway. The differences between the prokaryotic and eukaryotic IMPDHs, in the NAD + binding domain and flap region, allow the identification of pathogen-specific inhibitors. In the present study, seven point mutants of wild type Helicobacter pylori IMPDH are constructed by site-directed mutagenesis, and characterized using in silico and kinetic studies. Point mutations in the NAD + binding domain and the flap region are shown to impart significant changes in the enzyme's structure and function. In addition, the product inhibition characteristics of the Arg396-Tyr397 dyad (RY dyad) show that both the residues are important for water activation in the reaction. The results obtained are beneficial for the design and development of small molecule inhibitors, capable of species-specific inhibition.

A Pilot Study of Perioperative Cisplatin-Capecitabine Chemotherapy With Preoperative Chemoradiation for Resectable Gastric Cancers

OBJECTIVES

The standard of care for resectable gastric cancers (GCs) includes perioperative chemotherapy (CT) or postoperative chemo/chemoradiotherapy (CRT) strategies. Poor treatment compliance postsurgery suggests that intensified surgical adjuvant treatment is more likely deliverable preceding surgery and, therefore, the safety and efficacy of perioperative cisplatin-capecitabine (CX) with preoperative chemoradiation (preopCRT) were ascertained.

MATERIALS AND METHODS

Between January 2017 and December 2018, 28 potentially resectable locally advanced GC patients were offered neoadjuvant CT-2 cycles of CX at 3-weekly intervals, followed by preopCRT 45 Gy/25 fractions/5 weeks and concurrent capecitabine, followed by surgical resection and 3 adjuvant cycles of CX.

RESULTS

Neoadjuvant CT was commenced in 28 patients (100%), preopCRT in 18 patients (64%), and surgery performed in 13 patients (46%). At each treatment step, decreasing patient numbers were due mainly to disease progression (12 [43%]) or other reasons, including (3 [11%]) from treatment-related toxicity. The R0 resection rate was 92% (12/13); a median of 18 nodes was obtained after D2 nodal clearance in 92% (12/13). There were 20%/4%/4% grade 3/4/5 toxicities. The median radiotherapy dose/duration was 45 Gy/5.4 weeks. Adjuvant CT was started in 11 patients (39%) and the third cycle was received by 7 patients (25%). No tumor (ypT0N0) was noted in 23% of the operated patients (3/13), or 11% of the intention-to-treat population (3/28). The median, 1-year, and 2-year survivals were 12 months, 53%, and 32%, respectively.

CONCLUSIONS

Intensified preoperative treatment is doable in relatively unselected advanced GC patients in real-world settings of a public-sector hospital from a low-middle-income country. Disease progression during preoperative therapy allows patients destined for early clinical evidence of disease dissemination to avoid futile surgery, as opposed to a surgery-first strategy, without an overt increase in surgical morbidity or mortality, with encouraging R0 resection rates.

Comparisons of effects of SOX and mFOLFOX6 chemotherapy regimens on patients with locally advanced gastric cancer

The neoadjuvant chemotherapy plays an important role in locally advanced gastric cancer, but its efficacy, safety profiles and clinical outcomes among different regimens still remain controversial. In this study, totally 231 eligible patients with locally advanced gastric cancer were enrolled. These patients were divided into the observation group (SOX regimen, n = 123) and control group (mFOLFOX6 regimen, n = 108) according to different chemotherapy regimens. Then, the differences in chemotherapy efficacy, adverse reactions, surgical characteristics, complications and survival condition were compared. No significant differences were observed in clinical efficacy of chemotherapy, the rate of D2 lymph node clearance, R0 resection, complications, responses of neoadjuvant chemotherapy and survival condition between two groups (P > 0.05). The incidence of abdominal pain, diarrhoea, nausea and vomiting in the observation group were significantly lower than those in the control group (16.26% vs 29.63%, χ² = 5.893, P < 0.05; 11.38% vs 26.85%, χ² = 9.084, P < 0.05; 35.77% vs 53.70%, χ² = 7.499, P < 0.05). The SOX regimen and mFOLFOX6 regimen have similar chemotherapy efficacy for locally advanced gastric cancer, but SOX regimen has a lower risk of gastrointestinal adverse reactions comparing with mFOLFOX6 regimen.

Comparative Proteomic Analysis Reveals Novel Biomarkers for Gastric Cancer in South Indian Tamil Population

BACKGROUND

Gastric cancer (GC) remains a major global health problem due to a poor understanding of its progression at the molecular level and a lack of early detection or diagnosis. Early detection is highly crucial for improving prognosis. The incidence of GC is very high in countries like India due to the limitations among the established biomarkers for GC owing to poor sensitivity and specificity.

OBJECTIVE

To identify the novel biomarkers from serum samples obtained from GC patients when compared with healthy subjects.

METHODS

Serum samples from GC patients were analyzed by two-dimensional gel electrophoresis (2DGE) coupled with tandem mass spectrometry (MS), including both matrix-assisted laser desorption/ionization-time of flight (MALDI-ToF) and liquid chromatography-MS (LC-MS/MS) analysis. Identified proteins were further analyzed by gene ontology and protein interaction studies.

RESULTS

A total of 73 protein spots were detected in 2DGE image analysis. Among them, seven differentially-expressed proteins were identified using MS analyses, which included serotransferrin/transferrin, albumin, ceruloplasmin, C-reactive protein (CRP), fibrinogen γ-chain (FGG), and two unreported novel proteins, immunoglobulin kappa constant (IgκC) region and Homo sapiens zinc finger protein 28 (ZNF28) homolog. Among these proteins, serotransferrin, albumin, ceruloplasmin, FGG, and ZNF28 were down-regulated in GC samples (p < 0.05), while IgκC region and CRP were up-regulated significantly.

CONCLUSION

Most of the differentially expressed proteins were involved in angiogenesis, plasminogen-activating cascade, and blood coagulation pathways which are known to play a critical role in gastric tumorigenesis. Our current results provide a panel of candidate biomarkers for GC with novel biomarkers which were not reported earlier.

Association between serum 25-hydroxy vitamin D level and gastric adenocarcinoma - a cross sectional study

Introduction

Vitamin D is found to have anti-cancer properties. Although the preventive role of vitamin D in cancer is proven, its role in gastric cancer is equivocal.

Aim

To evaluate vitamin D deficiency in patients with gastric adenocarcinoma and its relationship with the disease characteristics.

Material and methods

This single-centre, prospective, cross sectional study was carried out from February 2017 to December 2018. Serum 25-hydroxy vitamin D levels of 94 patients with gastric adenocarcinoma and 94 age- and sex-matched healthy controls were estimated. Among cases, vitamin D levels and disease characteristics such as TNM stage, tumour grade, clinical stage and patient demographics were analysed.

Results

The vitamin D levels among cases (13.83 ±5.97 ng/ml) were significantly lower (p < 0.0001) than the control group (29.15 ±4.13 ng/ml). Vitamin D deficiency was found in 88% of cases and in 3% of controls. Among cases, age, T stage and clinical stage had a significant inverse relationship with vitamin D levels. Cases with distant metastasis and cases with pain had significantly lower levels of vitamin D compared to the cases without distant metastasis and without pain respectively. Other study parameters did not have a significant relationship with vitamin D.

Conclusions

Vitamin D deficiency is associated with occurrence of gastric adenocarcinoma and correlates with the disease severity. However, to assign a causal relationship and to study the beneficial effect of vitamin D in gastric cancer, further research is needed.

Age-Based Trends of Gastric Adenocarcinoma in the United States

BACKGROUND

Recent studies have shown an increase in the incidence of gastric cancer (GC) among young adults in Asia and Latin America. However, it is unknown if a similar trend is happening in the United States (US).

METHODS

A retrospective review of the National Cancer Data Base was conducted to identify patients diagnosed with gastric adenocarcinoma between the years of 2004 and 2013.

RESULTS

A total of 93 734 patients were included. The 2 age groups below 40 did not see a change in GC incidence; however, age groups above 40 had increasing incidence. Patients aged 18-25 had the largest proportion of stage 4 disease and a poor survival (median 11.5 months), compared to older patients.

CONCLUSION

Despite the increasing trend of GC among individuals, the incidence of GC among young adults is not increasing. However, this subpopulation presents at more advanced stages (clinical stage 4) and thus has worse survival.

Clinicopathological Characteristics and Incidence of Gastric Cancer in Eastern India: A Retrospective Study

PURPOSE

To study the association of gastric cancer with various clinicopathological traits in eastern India which can be used as an important factor for further analysis, understanding of the diseases and amelioration of patients.

METHODS

The retrospective study includes the patients who underwent subtotal or total gastrectomy from surgical oncology department of Chittaranjan National Cancer Institute (hospital) of West Bengal, India between 2014 and 2018. The study includes 751 gastric cancer patients from Chittaranjan National Cancer Institute. We used electronic hospital records to collect data on various clinical parameters and other information. We used Microsoft Office Excel 2007 spreadsheets for the statistical analyses.

RESULTS

Incidence of gastric cancer is associated with mid age (40-59 years) group male patients and lymph node metastasis. Frequency of gastric cancer is highest in the antrum (42.21%). Of the mid age group gastric cancer patients, 35.02% were having much high risk of developing diffused type of adenocarcinoma (P < 0.00001). Tobacco intake in form of smoking was found as an important risk factor in gastric cancer development with risk ratio and odds ratio of 1.18 and 3.14 respectively.

CONCLUSION

Collectively, the results of the present study confirm that incidence of diffused type of gastric cancer is increasing as an alarming rate in mid age group male patients and tobacco intake in the form of smoking as an independent risk factor for this type of cancer in eastern India. This result can be used to manage gastric carcinoma in future prospective clinical studies and in patient's improvement.

Age-Based Trends of Gastric Adenocarcinoma in the United States

BACKGROUND

Recent studies have shown an increase in the incidence of gastric cancer (GC) among young adults in Asia and Latin America. However, it is unknown if a similar trend is happening in the United States.

METHODS

A retrospective review of the National Cancer Database was conducted to identify patients diagnosed with gastric adenocarcinoma between the years of 2004 and 2013.

RESULTS

A total of 93 734 patients were included. The two age groups below 40 did not see a change in GC incidence; however, age groups above 40 had increasing incidence. Patients aged 18 to 25 had the largest proportion of stage 4 disease and a poor survival (median 11.5 months), compared to older patients.

CONCLUSION

Despite the increasing trend of GC among individuals, the incidence of GC among young adults is not increasing. However, this subpopulation presents at more advanced stages (clinical stage 4) and thus has worse survival.

Dietary Risk Factors Associated with Development of Gastric Cancer in Nepal: A Hospital-Based Case-Control Study

Objectives

Gastric cancer (GC) is one of the most prevalent neoplasms and a leading cause of mortality globally. To our knowledge, its relationship with dietary factors is not adequately studied and understood in the Nepalese context. This study is aimed at exploring the relationship between the possible dietary risk factors responsible for gastric cancer in Nepal.

Methods

A hospital-based matched case-control study was conducted in two specialized cancer hospitals in Nepal. A total of 237 participants (79 cases and 158 controls) were included in the study. Patients diagnosed within one year (incidence case) with histologically confirmed gastric cancer were taken as cases, and healthy visitors of gastric and nongastric cancer patients without past and present history or not a suspected information of gastric cancer were included as controls. A face-to-face interview was conducted using a semi-structured food frequency questionnaire. Backward stepwise conditional logistic regression was used to estimate the magnitude of the association between the independent variables and gastric cancer. Results were presented as the crude odds ratio (COR) and adjusted odds ratio (AOR) with 95% confidence intervals (CI). A P value < 0.05 was considered statistically significant.

Results

In the adjusted multivariable conditional logistic regression model, an increased risk of gastric cancer was more likely to have higher odds among those respondents who had a high consumption of processed meat (AOR = 3.99, 95% CI: 0.90-17.66), preferences of a high amount of fats/oil (AOR = 4.64, 95% CI: 1.56-13.72), and preferences of high amounts of salts (AOR = 4.18, 95% CI: 1.30-13.44). Conversely, those respondents who consumed higher amounts of fruits (AOR = 0.21, 95% CI: 0.07-0.65) were seen to have lower odds of gastric cancer.

Conclusions

Our study found an increased risk of gastric cancer with frequent consumption of red meat, processed meat, high preferences of salt, fats/oil, and condiments. Regular consumption of fruits had a protective effect against gastric cancer. Providing nutrition education, public awareness, and lifestyle modification are primary steps to promote the avoidance of risk factors and change unhealthy dietary habits to prevent gastric cancer in Nepal.

mRNA Expression Analysis of E-Cadherin, VEGF, and MMPs in Gastric Cancer: a Pilot Study

Gastric cancer (GC) is a serious fatal cancer on a global scale because of its presentation at advanced stage. The expressions of vascular endothelial growth factor (VEGF), E-cadherin, and matrix metalloproteinases (MMPs) in other cancers have been reported. However, its expression and underlying mechanisms are little known in gastric cancer in Indian context. In this study, we detected mRNA expression of VEGF, E-cadherin, and MMPs (MMP-1, MMP-2, and MMP-9) in 73 gastric cancer tissues and 27 normal controls by reverse-transcriptase polymerase chain reaction (RT-PCR). Receiver operator characteristics analysis was done for determining the diagnostic utility of VEGF, MMPs and E-cadherin with respect to the sensitivity and specificity. The association of VEGF, MMPs, and E-cadherin expression with the clinicopathological characteristics and the prognosis was subsequently analyzed. The mRNA expression results showed that E-cadherin was significantly downregulated in 47.9% of GC in comparison to control. There was no change in VEGF expression observed in 90.4% GC cases. MMP-1, MMP-2, and MMP-9 were overexpressed in 13.7%, 28.8%, and 11% of GC, respectively, with significant change in MMP-2 (p ≤ 0.0001) and MMP-9 (p = 0.027) in comparison to control. Our results strengthen the necessity of more studies to elucidate the prophetic role of these genes in the development of gastric cancer.

Oral rinses in growth inhibition and treatment of Helicobacter pylori infection

BACKGROUND

Helicobacter pylori (H. pylori) is well-known for its role in chronic gastritis and gastric cancer. Eradication of these carcinogenic bacteria from the gut is one of the challenges for clinicians. The complexity of treatment mainly owes to antibiotic resistance and relapse due to an additional reservoir in the oral cavity. Our study emphases the isolation of H. pylori from distinct habitats of the gut microenvironment (gastric biopsy and gastric juice) and its subsequent characterization. We have also evaluated the effect of various oral rinses on isolated H. pylori from different anatomical locations of included subjects.

RESULTS

The possible strains isolated from two different habitats of the same subject shows a striking difference in their growth pattern. Promisingly, some of the included oral rinses are efficient in growth inhibition as per recommended 30 s treatment. The subsequent evaluation shows that oral rinse B (among A-E) is most effective and down-regulates the expression of one of the potent H. pylori gene, CagA, in the infected gastric adenocarcinoma (AGS) cells.

CONCLUSION

Our study, for the first time, revealed that H. pylori, isolated from the different habitat of the same subject, show a different growth pattern. The expression of H. pylori pathogenic gene (CagA) was down-regulated by the use of oral rinses. Hence, oral rinses will reduce the H. pylori in the oral cavity and help to control its migration from oral to the gastric compartment and may be used as an adjuvant treatment option for its re-infection.