Gastric cancer: lessons learned from high-incidence geographic regions

Role of Confocal Laser Endomicroscopy in Early Detection of Upper Gastrointestinal Malignancy in High Risk Patients

BACKGROUND

Upper gastrointestinal malignancies are a major global health burden. Early diagnosis of upper gastrointestinal premalignant and malignant lesions is crucial for improving prognosis and reducing morbidity and mortality. The purpose of this study was to investigate the diagnostic accuracy of confocal laser endomicroscopy (CLE) in detecting upper gastrointestinal premalignant and early malignant lesions in high-risk patients, as well as diagnosing patients with inconclusive white light endoscopy (WLE) and histopathology results.

METHODS

It was a cross-sectional study that included ninety (n = 90) high-risk patients with inconclusive diagnoses of upper gastrointestinal lesions on WLE and WLE-based biopsy histopathology. These patients underwent CLE, and the definitive diagnosis was confirmed using CLE and CLE-target biopsy histopathology. Diagnostic accuracy was determined by comparing the sensitivity, specificity, predictive values, and accuracy between the procedures.

RESULT

The mean patient age was 47.43 ± 11.18 years. CLE and target biopsy confirmed that 30 (33.3%) patients had normal histology, while 60 (66.7%) patients were diagnosed with gastritis, gastric intestinal metaplasia, high-grade dysplasia, adenocarcinoma, Barrett's esophagus, and squamous cell carcinoma of the esophagus. The results of CLE were superior to those of WLE in terms of diagnostic parameters. Additionally, CLE demonstrated nearly similar results in sensitivity (98.33%), specificity (100%), positive predictive value (100%), negative predictive value (96.77%), and accuracy (98.89%) when compared to CLE-target biopsy.

CONCLUSION

CLE showed higher diagnostic accuracy in differentiating normal, premalignant and malignant lesions. It effectively diagnosed patients who initially had inconclusive WLE and/or biopsy results. Furthermore, early detection of upper gastrointestinal premalignant or malignant lesions may improve prognosis and reduce morbidity and mortality.

Trends in Incidence, Survival and Mortality of Gastric Cancer in the United States: A Population-Based Study, 2001-2015

BACKGROUND

Gastric cancer remains one of the leading causes of death, and a burden of public health in the United States (US). The aim of the study was to provide updates to gastric cancer estimates, and analyzed the long-term trends in incidence, survival, and mortality of gastric cancer in the US, which was helpful for the monitoring of the screening program and the prevention strategy.

METHODS

The incidence, and long-term trends in incidence, survival, and mortality of gastric cancer in the US from 2001 to 2015 were analyzed. The data were obtained from the Surveillance, Epidemiology, and End Results (SEER) Database. Age-adjusted incidence rates were calculated, joinpoint regression and age-period-cohort analyses were conducted. All statistical tests were 2-sided.

RESULTS

The overall age-adjusted incidence of gastric cancer decreased over the study period, with an annual percentage change (APC) of -1.4% (95% confidence interval [CI] = -1.1 to 13.3; P < 0.001). The incidence rates leveled off at an earlier age (< 45 years) and creased obviously with age. The age rate deviations increased sharply before the age of 47.5 years (age rate deviation = 0.92; 95% CI = 0.71 to 1.13). The 5-year mortality attributed to gastric cancer declined from 65.98% to 56.29% over the study period. The trend of 5-year mortality attributed to gastric cancer showed no significant fluctuation. The hazard ratio for 5-year all-cause death increased with cancer stage from 1.22 (95% CI = 1.13 to 1.33; P < 0.001) to 4.71 (95% CI = 4.40 to 5.06; P < 0.001).

CONCLUSION

During the study period, the incidence decreased, while the survival rate increased slightly. Specially, the trend of 5-year mortality attributed to gastric cancer did not vary significantly. The data demonstrated that the prognosis of gastric cancer in the US remained challenging.

Survival nomogram for different grades of gastric cancer patients based on SEER database and external validation cohort

Background

Influencing factors varied among gastric cancer (GC) for different differentiation grades which affect the prognosis accordingly. This study aimed to develop a nomogram to effectively identify the overall survival (OS).

Methods

Totally, 9,568 patients with GC were obtained from the SEER database as the training cohort and internal validation cohort. We then retrospectively enrolled patients diagnosed with GC to construct the external validation cohort from the First Affiliated Hospital of Anhui Medical University. The prognostic factors were integrated into the multivariate Cox regression to construct a nomogram. To test the accuracy of the model, we used the calibration curves, receiver operating characteristics (ROC) curves, C-index, and decision curve analysis (DCA).

Results

Race chemotherapy, tumor size, and other four factors were significantly associated with the prognosis of Grade III GC Patients. On this basis, we developed a nomogram. The discrimination of the nomogram revealed good prognostic accuracy The results of the area under the curve (AUC) calculated by ROC for five-year survival were 0.828 and 0.758 in the training set and external validation cohort, higher than that of the TNM staging system. The calibration plot revealed that the estimated risk was close to the actual risk. DCA also suggested an excellent predictive value of the nomogram. Similar results were obtained in Grade-I and Grade-II GC patients.

Conclusions

The nomogram developed in this study and other findings could help individualize the treatment of GC patients and assist clinicians in their shared decision-making with patients.