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Gong EJ, Bang CS, Lee JJ. Computer-aided diagnosis in real-time endoscopy for all stages of gastric carcinogenesis: Development and validation study. United European Gastroenterol J 2024. [PMID: 38400815 DOI: 10.1002/ueg2.12551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/14/2024] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVE Using endoscopic images, we have previously developed computer-aided diagnosis models to predict the histopathology of gastric neoplasms. However, no model that categorizes every stage of gastric carcinogenesis has been published. In this study, a deep-learning-based diagnosis model was developed and validated to automatically classify all stages of gastric carcinogenesis, including atrophy and intestinal metaplasia, in endoscopy images. DESIGN A total of 18,701 endoscopic images were collected retrospectively and randomly divided into train, validation, and internal-test datasets in an 8:1:1 ratio. The primary outcome was lesion-classification accuracy in six categories: normal/atrophy/intestinal metaplasia/dysplasia/early /advanced gastric cancer. External-validation of performance in the established model used 1427 novel images from other institutions that were not used in training, validation, or internal-tests. RESULTS The internal-test lesion-classification accuracy was 91.2% (95% confidence interval: 89.9%-92.5%). For performance validation, the established model achieved an accuracy of 82.3% (80.3%-84.3%). The external-test per-class receiver operating characteristic in the diagnosis of atrophy and intestinal metaplasia was 93.4 ± 0% and 91.3 ± 0%, respectively. CONCLUSIONS The established model demonstrated high performance in the diagnosis of preneoplastic lesions (atrophy and intestinal metaplasia) as well as gastric neoplasms.
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Affiliation(s)
- Eun Jeong Gong
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, Korea
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Korea
| | - Chang Seok Bang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, Korea
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Korea
- Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Jae Jun Lee
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Korea
- Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Chuncheon, Korea
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Chuncheon, Korea
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2
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Rogers JE, Ajani J. Evidence to Date on the Therapeutic Potential of Zolbetuximab in Advanced Gastroesophageal Adenocarcinoma. Curr Oncol 2024; 31:769-777. [PMID: 38392051 PMCID: PMC10888045 DOI: 10.3390/curroncol31020057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
Gastric adenocarcinoma (GAC) continues to be a prevalent worldwide malignancy and a leading cause of cancer death, and it is frequently cited as incurable. Targeted therapy in GAC has lagged behind other solid tumors. The human epidermal growth factor receptor-2 (HER-2) represented the single target in GACs for many years, seen in approximately 20% of patients with advanced GAC. Recent advances in management now include the addition of immunotherapy checkpoint inhibition to select front-line advanced GACs. Unfortunately, outcomes remain poor for most patients. We anticipate finding a key to future discoveries in GACs in next-generation sequencing and more targeted approaches. Claudin 18.2 (CLDN18.2) has emerged as a therapeutic target in GACs. CLDN18.2 is reportedly expressed in 14-87% of GACs, and CLDN18.2 is available for monoclonal antibody (mAb) binding as it is expressed on the outer cell membrane. Here, we review the exploration of CLDN18.2 as a target in GACs via the use of zolbetuximab (IMAB362). Zolbetuximab is now under priority FDA review for GACs, and we eagerly await the review outcome.
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Affiliation(s)
- Jane E. Rogers
- U.T. M.D. Anderson Cancer Center Pharmacy Clinical Programs, Houston, TX 77030, USA;
| | - Jaffer Ajani
- U.T. M.D. Anderson Cancer Center Department of Gastrointestinal Medical Oncology, Houston, TX 77030, USA
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Wang H, Ahn JY, Noh JH, Na HK, Jung KW, Lee JH, Kim DH, Choi KD, Song HJ, Lee GH, Jung HY. Clinical outcomes of argon plasma coagulation for the treatment of gastric low grade dysplasia. Gastrointest Endosc 2024:S0016-5107(24)00045-2. [PMID: 38272278 DOI: 10.1016/j.gie.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 12/18/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND & AIMS Argon plasma coagulation (APC) could be considered a treatment modality for small gastric low grade dysplasia (LGD) instead of endoscopic resection (ER). Our study investigated the clinical outcomes of APC for treating gastric LGD and associated variables with local recurrence. METHODS This study included 911 patients who underwent APC for gastric neoplasms at the tertiary hospital from July 2007 to March 2022 with a minimal follow-up of 12 months. 112 subjects without any information about H. pylori infection status, 164 subjects who underwent APC for salvage therapy, 5 subjects with high grade dysplasia, and 12 subjects with cancer were excluded. Through a retrospective review of medical data, the clinical outcomes and variables associated with the local recurrence were analyzed. RESULTS A total of 618 patients with LGD (median age of 64 years old) were followed up for a median of 30 months and local recurrence has happened in 21 patients (3.4%). Multivariate analysis showed lesion size (hazard ratio 1.06, 95% confidential interval 1.01-1.12) was associated with the local recurrence. Among 557 lesions smaller than 10 mm, local recurrence was found in 14 cases (2.6%) and local recurrence was in 7 cases (9.5%) of 109 tumors larger than 10 mm (p <0.004). CONCLUSIONS In gastric LGD smaller than 10 mm without scars, APC is a good treatment modality in place of ER. However, when a lesion is larger, APC should be selected carefully with close monitoring.
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Affiliation(s)
- Hoyoung Wang
- Department of gastroenterology, Ulsan University Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yong Ahn
- Department of gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Jin Hee Noh
- Department of gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Kyoung Na
- Department of gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Wook Jung
- Department of gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Lee
- Department of gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kim
- Department of gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Don Choi
- Department of gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho June Song
- Department of gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gin Hyug Lee
- Department of gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Zou TH, Gao QY, Liu SD, Li YQ, Meng XJ, Zhang GX, Tian ZB, Zou XP, He S, Hou XH, Lin R, Li JN, Zhou ZY, Li Y, Wang MC, Wang BM, Tian DA, Chen SJ, Cao Q, Li LP, Wang ZR, Shen XZ, Liu BR, Yan XY, Chen YX, Fang JY. Effectiveness and safety of Moluodan in the treatment of precancerous lesions of gastric cancer: A randomized clinical trial. J Dig Dis 2024; 25:27-35. [PMID: 38342693 DOI: 10.1111/1751-2980.13251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE To investigate the clinical potential and safety of Moluodan to reverse gastric precancerous lesions. METHODS Patients aged 18-70 years diagnosed with moderate-to-severe atrophy and/or moderate-to-severe intestinal metaplasia, with or without low-grade dysplasia, and negative for Helicobacter pylori were recruited in this randomized, double-blind, parallel-controlled trial. The primary outcome was the improvement of global histological diagnosis at 1-year follow-up endoscopy using the operative link for gastritis assessment, the operative link for gastric intestinal metaplasia assessment, and the disappearance rate of dysplasia. RESULTS Between November 3, 2017 and January 27, 2021, 166 subjects were randomly assigned to the Moluodan group, 168 to the folic acid group, 84 to the combination group, and 84 to the high-dose Moluodan group. The improvement in global histological diagnosis was achieved in 60 (39.5%) subjects receiving Moluodan, 59 (37.8%) receiving folic acid, 26 (32.1%) receiving the combined drugs, and 36 (47.4%) receiving high-dose Moluodan. Moluodan was non-inferior to folic acid (95% confidence interval: -9.2 to 12.5; P = 0.02). High-dose Moluodan had a trend for better protective efficacy, though there was no statistical significance. The disappearance rate of dysplasia was 82.8% in the Moluodan group, which was superior to folic acid (53.9%; P = 0.006). No drug-related serious adverse events were observed. CONCLUSIONS One pack of Moluodan three times daily for 1 year was safe and effective in reversing gastric precancerous lesions, especially dysplasia. Doubling its dose showed a better efficacy trend.
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Affiliation(s)
- Tian Hui Zou
- Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, State Key Laboratory of Systems Medicine for Cancer, NHC Key Laboratory of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qin Yan Gao
- Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, State Key Laboratory of Systems Medicine for Cancer, NHC Key Laboratory of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Si De Liu
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Yan Qing Li
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Xiang Jun Meng
- Department of Gastroenterology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Gut Microecology and Associated Major Diseases Research; Center for Digestive Diseases Research and Clinical Translation of Shanghai Jiaotong University, Shanghai, China
| | - Guo Xin Zhang
- Department of Gastroenterology and Hepatology, Jiangsu Province Hospital, Nanjing, Jiangsu Province, China
| | - Zi Bin Tian
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Xiao Ping Zou
- Division of Gastroenterology and Hepatology, The Affiliated Drum Tower of Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Song He
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao Hua Hou
- Department of Gastroenterology and Hepatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Rong Lin
- Department of Gastroenterology and Hepatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Jing Nan Li
- Department of Gastroenterology and Hepatology, Peking Union Medical College Hospital, Beijing, China
| | - Zhong Yin Zhou
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Yan Li
- Department of Gastroenterology and Hepatology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Meng Chun Wang
- Department of Gastroenterology and Hepatology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Bang Mao Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - De An Tian
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Shu Jie Chen
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Qian Cao
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Liang Ping Li
- Department of Digestive Diseases, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Zhi Rong Wang
- Department of Gastroenterology, Tongji Hospital of Tongji University, Shanghai, China
| | - Xi Zhong Shen
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bing Rong Liu
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xiao Yan Yan
- Department of Biostatistics, Peking University Clinical Research Institute, Beijing, China
| | - Ying Xuan Chen
- Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, State Key Laboratory of Systems Medicine for Cancer, NHC Key Laboratory of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing-Yuan Fang
- Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, State Key Laboratory of Systems Medicine for Cancer, NHC Key Laboratory of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Wang G, Liu X, Zhou J. Differentiating gastric schwannoma from gastric stromal tumor (≤5 cm) by histogram analysis based on iodine-based material decomposition images: a preliminary study. Front Oncol 2023; 13:1243300. [PMID: 38044988 PMCID: PMC10691544 DOI: 10.3389/fonc.2023.1243300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
Objective This study aims to investigate the value of histogram analysis based on iodine-based material decomposition (IMD) images obtained through dual-energy computed tomography (DECT) to differentiate gastric schwannoma (GS) from gastric stromal tumor (GST) (≤5 cm) preoperatively. Methods From January 2015 to January 2023, 15 patients with GS and 30 patients with GST (≤5 cm) who underwent biphasic contrast-enhanced scans using DECT were enrolled in this study. For each tumor, we reconstructed IMD images at the arterial phase (AP) and venous phase (VP). Nine histogram parameters were automatically extracted and selected using MaZda software based on the IMD of AP and VP, respectively, including mean, 1st, 10th, 50th, 90th, and 99th percentile of the iodine concentration value (Perc.01, Perc.10, Perc.50, Perc.90, and Perc.99), variance, skewness, and kurtosis. The extracted IMD histogram parameters were compared using the Mann-Whitney U-test. The optimal IMD histogram parameters were selected using receiver operating characteristic (ROC) curves. Results Among the IMD histogram parameters of AP, the mean, Perc.50, Perc.90, Perc.99, variance, and skewness of the GS group were lower than that of the GST group (all P < 0.05). Among the IMD histogram parameters of VP, Perc.90, Perc.99, and the variance of the GS group was lower than those of the GST group (all P < 0.05). The ROC analysis showed that Perc.99 (AP) generated the best diagnostic performance with the area under the curve, sensitivity, and specificity being 0.960, 86.67%, and 93.33%, respectively, when using 71.00 as the optimal threshold. Conclusion Histogram analysis based on IMD images obtained through DECT holds promise as a valuable tool for the preoperative distinction between GS and GST (≤5 cm).
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Affiliation(s)
- Gang Wang
- Department of Radiology, Lanzhou University First Hospital, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
| | - Xianwang Liu
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Junlin Zhou
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
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Gong EJ, Bang CS, Lee JJ, Jeong HM, Baik GH, Jeong JH, Dick S, Lee GH. Clinical Decision Support System for All Stages of Gastric Carcinogenesis in Real-Time Endoscopy: Model Establishment and Validation Study. J Med Internet Res 2023; 25:e50448. [PMID: 37902818 PMCID: PMC10644184 DOI: 10.2196/50448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 10/12/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Our research group previously established a deep-learning-based clinical decision support system (CDSS) for real-time endoscopy-based detection and classification of gastric neoplasms. However, preneoplastic conditions, such as atrophy and intestinal metaplasia (IM) were not taken into account, and there is no established model that classifies all stages of gastric carcinogenesis. OBJECTIVE This study aims to build and validate a CDSS for real-time endoscopy for all stages of gastric carcinogenesis, including atrophy and IM. METHODS A total of 11,868 endoscopic images were used for training and internal testing. The primary outcomes were lesion classification accuracy (6 classes: advanced gastric cancer, early gastric cancer, dysplasia, atrophy, IM, and normal) and atrophy and IM lesion segmentation rates for the segmentation model. The following tests were carried out to validate the performance of lesion classification accuracy: (1) external testing using 1282 images from another institution and (2) evaluation of the classification accuracy of atrophy and IM in real-world procedures in a prospective manner. To estimate the clinical utility, 2 experienced endoscopists were invited to perform a blind test with the same data set. A CDSS was constructed by combining the established 6-class lesion classification model and the preneoplastic lesion segmentation model with the previously established lesion detection model. RESULTS The overall lesion classification accuracy (95% CI) was 90.3% (89%-91.6%) in the internal test. For the performance validation, the CDSS achieved 85.3% (83.4%-97.2%) overall accuracy. The per-class external test accuracies for atrophy and IM were 95.3% (92.6%-98%) and 89.3% (85.4%-93.2%), respectively. CDSS-assisted endoscopy showed an accuracy of 92.1% (88.8%-95.4%) for atrophy and 95.5% (92%-99%) for IM in the real-world application of 522 consecutive screening endoscopies. There was no significant difference in the overall accuracy between the invited endoscopists and established CDSS in the prospective real-clinic evaluation (P=.23). The CDSS demonstrated a segmentation rate of 93.4% (95% CI 92.4%-94.4%) for atrophy or IM lesion segmentation in the internal testing. CONCLUSIONS The CDSS achieved high performance in terms of computer-aided diagnosis of all stages of gastric carcinogenesis and demonstrated real-world application potential.
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Affiliation(s)
- Eun Jeong Gong
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, Republic of Korea
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Chang Seok Bang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, Republic of Korea
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Jae Jun Lee
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea
- Department of Anesthesiology, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Hae Min Jeong
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Gwang Ho Baik
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, Republic of Korea
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Pinheiro RN, Mucci S, Zanatto RM, Picanço Junior OM, Bottino AAG, Fontoura RP, Lopes Filho GDJ. Influence of the centralizing gastric cancer surgery on the health-related quality of life in Brazil. J Gastrointest Oncol 2023; 14:1235-1249. [PMID: 37435209 PMCID: PMC10331736 DOI: 10.21037/jgo-22-1114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/17/2023] [Indexed: 07/13/2023] Open
Abstract
Background The assessment of health-related quality of life (QoL) has improved the treatment of gastric cancer. Aiming to compare the influence of skilled surgeons in general hospitals versus specialized hospitals in cancer in Brazil, this study evaluated the relationship between quality of life and types of hospitals (general or cancer) in treating patients with gastric adenocarcinoma operated by surgeons with specific training in Surgical Oncology. Methods This was a cross-sectional study involving 104 patients. Inferential analyses were used to compare two Brazilian general hospitals and a cancer center, evaluating scores of the SF-36 and FACT-Ga QoL questionnaires (Kruskal-Wallis test, Mann-Whitney test); gender, smoking, and Helicobacter pylori tests status (Pearson's Chi-Square test); ethnicity, alcoholism, location of the tumor in the stomach, Lauren's histological types, and type of surgery (Fisher's exact test), number of lymph nodes resected by Surgical Oncologists [Analysis of Variance (ANOVA) with a Fixed Factor], and comparative survival analysis (Log-Rank test). Results Patients treated at a cancer hospital had higher scores of the FACT-Ga (FACT-G total score, P=0.023; physical well-being, PWB, P=0.006; and functional well-being, FWB, P=0.011). The mean scores of the SF-36 questionnaire showed similar behavior but without reaching a significant difference. Patients operated by Surgical Oncologists at the cancer hospital had better scores in emotional well-being FACT-Ga domain (EWB, P=0.034 and P=0.047) compared to those operated by Surgical Oncologists in general hospitals. There was no significant difference in survival among the three hospitals (P=0.214). Conclusions In this study, it was possible to suggest the relationship between QoL assessment scores with the centralization of care at specialized cancer hospital in the treatment of patients with gastric adenocarcinoma undergoing surgery with curative intent in Brazil.
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Affiliation(s)
- Rodrigo Nascimento Pinheiro
- Interdisciplinary Surgical Science Postgraduate Program, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Surgical Oncology, Base Hospital of the Federal District, Brasília, Federal District, Brazil
| | - Samantha Mucci
- Interdisciplinary Surgical Science Postgraduate Program, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Department of Psychiatry, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Renato Morato Zanatto
- Interdisciplinary Surgical Science Postgraduate Program, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Surgical Oncology, Amaral Carvalho Cancer Hospital, Jaú, São Paulo, Brazil
| | | | | | - Renata Pereira Fontoura
- Surgical Oncology, Base Hospital of the Federal District, Brasília, Federal District, Brazil
| | - Gaspar de Jesus Lopes Filho
- Interdisciplinary Surgical Science Postgraduate Program, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
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Liu Y, Song C, Tian Z, Shen W. Ten-Year Multicenter Retrospective Study Utilizing Machine Learning Algorithms to Identify Patients at High Risk of Venous Thromboembolism After Radical Gastrectomy. Int J Gen Med 2023; 16:1909-1925. [PMID: 37228741 PMCID: PMC10202705 DOI: 10.2147/ijgm.s408770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023] Open
Abstract
Purpose This study aims to construct a machine learning model that can recognize preoperative, intraoperative, and postoperative high-risk indicators and predict the onset of venous thromboembolism (VTE) in patients. Patients and Methods A total of 1239 patients diagnosed with gastric cancer were enrolled in this retrospective study, among whom 107 patients developed VTE after surgery. We collected 42 characteristic variables of gastric cancer patients from the database of Wuxi People's Hospital and Wuxi Second People's Hospital between 2010 and 2020, including patients' demographic characteristics, chronic medical history, laboratory test characteristics, surgical information, and patients' postoperative conditions. Four machine learning algorithms, namely, extreme gradient boosting (XGBoost), random forest (RF), support vector machine (SVM), and k-nearest neighbor (KNN), were employed to develop predictive models. We also utilized Shapley additive explanation (SHAP) for model interpretation and evaluated the models using k-fold cross-validation, receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and external validation metrics. Results The XGBoost algorithm demonstrated superior performance compared to the other three prediction models. The area under the curve (AUC) value for XGBoost was 0.989 in the training set and 0.912 in the validation set, indicating high prediction accuracy. Furthermore, the AUC value of the external validation set was 0.85, signifying good extrapolation of the XGBoost prediction model. The results of SHAP analysis revealed that several factors, including higher body mass index (BMI), history of adjuvant radiotherapy and chemotherapy, T-stage of the tumor, lymph node metastasis, central venous catheter use, high intraoperative bleeding, and long operative time, were significantly associated with postoperative VTE. Conclusion The machine learning algorithm XGBoost derived from this study enables the development of a predictive model for postoperative VTE in patients after radical gastrectomy, thereby assisting clinicians in making informed clinical decisions.
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Affiliation(s)
- Yuan Liu
- Department of General Surgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, People’s Republic of China
| | - Chen Song
- Department of General Surgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, People’s Republic of China
| | - Zhiqiang Tian
- Department of General Surgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, People’s Republic of China
| | - Wei Shen
- Department of General Surgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, People’s Republic of China
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Shen WN, Qu XD, Chen SS, Liu YH, Gao MJ, Shi YQ. Relationship between gastric xanthoma, gastric precancerous lesions, and gastric cancer: A retrospective study. J Dig Dis 2023; 24:340-347. [PMID: 37417403 DOI: 10.1111/1751-2980.13202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 06/27/2023] [Accepted: 07/05/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To evaluate the relationship between gastric cancer and its precancerous lesions and gastric xanthoma. METHODS Medical records of 47 736 patients who underwent gastroscopy in our center from January 2020 to December 2021 were reviewed. Patients' age, sex, endoscopic and histopathological findings, and the presence, number and location of gastric xanthoma were recorded. To investigate the detection rate of gastric xanthoma at different stages of gastric lesions, the participants were further divided into the chronic gastritis group (n = 42 758), the precancerous lesion group (n = 3672), and the gastric cancer group (n = 1306), respectively. RESULTS The overall detection rate of gastric xanthoma was 2.85%, and it was most commonly observed in the gastric antrum (52.50%). In addition, gastric xanthoma was more common in men and more likely to be single lesion. It was most detected in the precancerous lesion group (8.39%), followed by the gastric cancer group (5.44%), and least in the chronic gastritis group (2.29%). Multivariate analysis showed that gastric xanthoma was closely related to precancerous lesions (odds ratio [OR] 3.197, 95% confidence interval [CI] 2.791-3.662, P < 0.001) and gastric cancer (OR 1.794, 95% CI 1.394-2.309, P < 0.001). CONCLUSION Gastric xanthoma is closely related to gastric precancerous lesions and gastric cancer.
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Affiliation(s)
- Wei Na Shen
- Xi'an Medical University, Xi'an, Shaanxi Province, China
| | - Xiao Dong Qu
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi Province, China
| | - Sha Sha Chen
- Xi'an Medical University, Xi'an, Shaanxi Province, China
| | - Yu Huan Liu
- Xi'an Medical University, Xi'an, Shaanxi Province, China
| | - Meng Jie Gao
- Xi'an Medical University, Xi'an, Shaanxi Province, China
| | - Yong Quan Shi
- Xi'an Medical University, Xi'an, Shaanxi Province, China
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi Province, China
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10
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Oura M, Saito H, Nishikawa Y. Shortage of Nab-paclitaxel in Japan and around the World: Issues in Global Information Sharing. JMA J 2023; 6:192-195. [PMID: 37179729 PMCID: PMC10169259 DOI: 10.31662/jmaj.2022-0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/12/2023] [Indexed: 05/15/2023] Open
Abstract
There was a global shortage of nab-paclitaxel (AbraxaneⓇ), a major antineoplastic agent, for a long period (from October 2021 to June 2022) because of manufacturing problems. Japan was one of the first affected countries by the depletion, and the medical institutes started to save the use of the drug in August 2021; numerous patients with gastric, breast, and lung cancer who potentially could receive benefits failed to be treated with the antineoplastic agent; thus, they opted for alternative treatments. Meanwhile, the hospitals in the United States and some countries continued to consume nab-paclitaxel at a regular pace as usual and then the worldwide depletion occurred in October 2021. Early communications about the drug shortage between authorities worldwide might have soothed the depletion; effective platforms for global information sharing would be necessary in order to secure the access to anticancer agents.
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Affiliation(s)
- Mitsuaki Oura
- Department of Internal Medicine, Takeda General Hospital, Fukushima, Japan
| | - Hiroaki Saito
- Department of Internal Medicine, Soma Central Hospital, Fukushima, Japan
| | - Yoshitaka Nishikawa
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
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11
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Liu XR, Li LS, Liu F, Li ZW, Liu XY, Zhang W, Peng D. Short-Term and Long-Term Outcomes of Liver Cirrhosis in Gastric Neoplasm Patients Undergoing Endoscopic Submucosal Dissection. J Laparoendosc Adv Surg Tech A 2023. [PMID: 36946655 DOI: 10.1089/lap.2023.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Purpose: The purpose of this study was to explore whether liver cirrhosis (LC) influences short-term and long-term outcomes in gastric neoplasm patients who undergo endoscopic submucosal dissection (ESD). Materials and Methods: Eligible studies were identified in three databases, including PubMed, Embase, and the Cochrane Library on December 18, 2022. Clinical characteristics, short-term outcomes, and long-term outcomes were compared between an LC group and a no liver cirrhosis (NLC) group. For continuous variables, the mean difference (MD) and standard deviation (SD) were pooled. For discontinuous variables, raw data from the 2 × 2 tables or odds ratio (OR) and 95% confidence intervals (CIs) were pooled. Forest plots were used to show the results, and a funnel plot was used to evaluate publication bias. Data analyses were performed by STATA SE 16.0 software. Results: Six retrospective studies involving 1616 gastric neoplasm patients were included in the study. Clinical characteristics, including age, gender, location, macroscopic type, invasion depth, differentiation, and ulceration, were found to be not significantly different between the LC group and the NLC group (P > .05). Moreover, LC was not a risk factor for short-term outcomes, including operative time (MD = 0.15, 95% CI = -0.02 to 0.32, I2 = 0.00%, P = .09), en bloc resection (OR = 0.87, 95% CI = 0.43-1.75, I2 = 0.00%, P = .69), R0 resection (OR = 0.77, 95% CI = 0.42-1.43, I2 = 8.97%, P = .41), bleeding (OR = 1.10, 95% CI = 0.62-1.93, I2 = 0.00%, P = .75), and perforation (OR = 1.62, 95% CI = 0.45-5.84, I2 = 0.00%, P = .46). However, gastric cancer patients with LC exhibited a higher recurrence rate (OR = 3.40, 95% CI = 1.09-10.61, I2 = 0.00%, P = .04) after ESD. Conclusion: Surgeons performing ESD in gastric neoplasm patients should pay more attention to long-term effects.
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Affiliation(s)
- Xu-Rui Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lian-Shuo Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fei Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zi-Wei Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-Yu Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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12
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Seyyedsalehi MS, Mohebbi E, Tourang F, Sasanfar B, Boffetta P, Zendehdel K. Association of Dietary Nitrate, Nitrite, and N-Nitroso Compounds Intake and Gastrointestinal Cancers: A Systematic Review and Meta-Analysis. Toxics 2023; 11:toxics11020190. [PMID: 36851064 PMCID: PMC9962651 DOI: 10.3390/toxics11020190] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/16/2023] [Accepted: 01/27/2023] [Indexed: 05/13/2023]
Abstract
N-nitroso compounds (NOCs) are a class of chemical carcinogens found in various environmental sources such as food, drinking water, cigarette smoke, the work environment, and the indoor air population. We conducted a systematic review and meta-analysis to investigate the links between nitrate, nitrite, and NOCs in food and water and the risk of gastrointestinal (GI) cancers, including esophageal cancer (EC), gastric cancer (GC), colorectal cancer (CRC), and pancreatic cancer (PC). A systematic search of the literature in Scopus, PubMed, Google Scholar, Web of Science, ScienceDirect, and Embase was performed for studies on the association between NOCs in drinking water and food sources and GI cancers. Forest plots of relative risk (RR) were constructed for all the cancer sites and the intake sources. The random-effects model was used to assess the heterogeneity between studies. Forty articles were included after removing duplicate and irrelevant articles. The meta-analysis indicated that the intake of high dose vs. low dose of these compounds was significantly associated with the overall GI cancer risk and nitrite (RR = 1.18, 95% CI = 1.07-1.29), and N-nitrosodimethylamine (NDMA) (RR = 1.32, 95% CI = 1.06-1.65). We found that dietary nitrite intake increased GC (RR = 1.33, 95% CI = 1.02-1.73), and EC (RR = 1.38, 95% CI = 1.01-1.89). Additionally, dietary NDMA intake increased the risk of CRC (RR = 1.36, 95% CI = 1.18-1.58). This meta-analysis provides some evidence that the intake of dietary and water nitrate, nitrite, and NOCs may be associated with GI cancers. In particular, dietary nitrite is linked to GC and EC risks and dietary NDMA intake is associated with CRC.
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Affiliation(s)
- Monireh Sadat Seyyedsalehi
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran 1419733141, Iran
| | - Elham Mohebbi
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran 1419733141, Iran
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA
| | - Fatemeh Tourang
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran 1419733141, Iran
| | - Bahareh Sasanfar
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran 1419733141, Iran
| | - Paolo Boffetta
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY 11794, USA
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran 1419733141, Iran
- Cancer Biology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran 1419733141, Iran
- Correspondence:
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13
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Rogers JE, Ajani JA. Recent advances in the management of gastric adenocarcinoma patients. Fac Rev 2023; 12:2. [PMID: 36873983 PMCID: PMC9975945 DOI: 10.12703/r/12-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Gastric adenocarcinomas are a significant cause of cancer and cancer death, globally. The curative approach for those with diagnosed localized disease is with surgical resection and an adjunctive approach of perioperative chemotherapy, postoperative adjuvant therapy, or postoperative chemoradiation. Unfortunately, a universal standard approach is lacking for adjunctive therapy which in part has limited the progress achieved in this area. Metastatic disease is common in the Western world at diagnosis. Metastatic disease is treated palliatively with systemic therapy. Targeted therapy has stalled in approvals in gastric adenocarcinomas. Recently, we have seen the exploration of promising targets along with the addition of immune checkpoint inhibitors in select patients. Here, we review recent advances seen in gastric adenocarcinomas.
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Affiliation(s)
- Jane E Rogers
- Pharmacy Clinical Programs, U.T. M.D. Anderson Cancer Center, Houston, TX, USA
| | - Jaffer A Ajani
- Department of Gastrointestinal Medical Oncology, U.T. M.D. Anderson Cancer Center, Houston, TX, USA
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14
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Kim SJ, Lee J, Baek DY, Lee JH, Hong R. Early gastric neoplasms are significant risk factor for colorectal adenoma: A prospective case-control study. Medicine (Baltimore) 2022; 101:e29956. [PMID: 35960053 PMCID: PMC9371521 DOI: 10.1097/md.0000000000029956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Although gastric cancer patients have a high incidence and risk of colorectal cancer, evidence is lacking regarding whether early gastric neoplasms (EGNs), such as gastric adenomas and early gastric cancer, are risk factors for colorectal adenoma. This study aimed to investigate the incidence of colorectal adenomas in patients with EGN. This prospective study was conducted between January 2015 and December 2016. Of the 307 patients who underwent gastric endoscopic submucosal dissection for EGN, 110 patients were enrolled in the EGN group, and 110 age- and sex-matched healthy persons from the screening population were included in the control group in a 1:1 ratio. Demographic factors and results of colonoscopy, including quality assessment, were collected, and analyzed. No significant differences in the quality of colonoscopy, including bowel preparation, cecal intubation rate, and withdrawal time between the 2 groups, were observed. The incidence of colorectal adenoma was significantly higher in the EGN group than in the control group (55.5% vs 26.4%, P = .001). Multivariate analysis confirmed that old age (odds ratio: 1.04, 95% confidence interval: 1.01-1.08, P = .005) and a history of EGN (odds ratio: 4.99, 95% confidence interval: 2.60-9.57, P = .001) were independent risk factors for colorectal adenoma. This is the first prospective study to reflect the quality indicator of colonoscopy and confirmed that old age and a history of EGN are significant risk factors for colorectal adenomas. Therefore, more stringent colonoscopy surveillance should be considered in elderly patients with EGN.
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Affiliation(s)
- Seong-Jung Kim
- Department of Internal Medicine, College of Medicine, Chosun University, Gwang-ju, Republic of Koreaand
| | - Jun Lee
- Department of Internal Medicine, College of Medicine, Chosun University, Gwang-ju, Republic of Koreaand
- * Correspondence: Jun Lee, MD, PhD, Department of Internal Medicine, College of Medicine, Chosun University, 309, Pilmun-daero, Dong-gu, Gwangju 61452, Republic of Korea. e-mail:
| | - Dae Youb Baek
- Department of Internal Medicine, College of Medicine, Chosun University, Gwang-ju, Republic of Koreaand
| | - Jun Hyung Lee
- Department of Internal Medicine, College of Medicine, Chosun University, Gwang-ju, Republic of Koreaand
| | - Ran Hong
- Department of Pathology, College of Medicine, Chosun University, Gwangju, Republic of Korea
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15
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Lin GR, Chen WR, Zheng PH, Chen WS, Cai GY. Circular RNA circ_0006089 promotes the progression of gastric cancer by regulating the miR-143-3p/PTBP3 axis and PI3K/AKT signaling pathway. J Dig Dis 2022; 23:376-387. [PMID: 35844201 DOI: 10.1111/1751-2980.13116] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 07/04/2022] [Accepted: 07/16/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Circular RNAs (circRNAs) play pivotal roles in malignancies including gastric cancer (GC). We aimed to investigate the biological function and regulatory mechanism of circ_0006089 in GC. METHODS Circ_0006089, microRNA (miR)-143-3p, and polypyrimidine tract-binding protein 3 (PTBP3) expressions were measured via quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) in GC cell lines. Cell proliferative capacity was determined by colony formation and CCK-8 assays. Flow cytometry was employed for measuring cell apoptosis. Cell invasion and migration were measured via transwell and wound-healing assays. Western blot analysis was utilized for detecting protein expressions of E-cadherin, N-cadherin, vimentin, PTBP3, PI3K, p-PI3K, AKT, and p-AKT. Dual-reporter luciferase analysis was conducted to confirm the association between miR-143-3p and circ_0006089 or PTBP3. The role of circ_0006089 in vivo was detected via establishing a mice xenograft model. RESULTS Circ_0006089 expression was increased in GC. Circ_0006089 downregulation suppressed the proliferation and metastasis and induced apoptosis of GC cells, which was counteracted by miR-143-3p inhibition or PTBP3 overexpression. In addition, circ_0006089 overexpression could promote GC progression. MiR-143-3p specially bound to circ_0006089 and PTBP3 was targeted by miR-143-3p. Moreover, circ_0006089 could regulate PTBP3 expression and the PI3K/AKT pathway by sponging miR-143-3p. Circ_0006089 knockdown also suppressed tumor growth. CONCLUSION Circ_0006089 regulated miR-143-3p/PTBP3/PI3K/AKT pathway to facilitate GC progression.
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Affiliation(s)
- Guang Rong Lin
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Wei Rong Chen
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Pei Hong Zheng
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Wei Shan Chen
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Gao Yang Cai
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
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16
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Xu Y, Yan L, Chen T, Hu P, Bai J, Ye T, Long Q, Tang Q. Prognosis of patients with poorly differentiated gastric neuroendocrine neoplasms: a multi-center study in China. Future Oncol 2022; 18:2465-2473. [PMID: 35730464 DOI: 10.2217/fon-2022-0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: The incidence of poorly differentiated gastric neuroendocrine neoplasms (G-NENs) has been increasing during the past decades. Methods: A total of 183 patients diagnosed with poorly differentiated G-NENs were enrolled from eight hospitals during 2010-2019 in China. All cases included have accepted abdominal surgery in tertiary hospitals. Result: T3 (HR: 2.66, p = 0.019), T4 (HR: 3.62, p = 0.005), stage IV (HR: 5.67, p < 0.001), vascular invasion (HR: 1.59, p = 0.048) were independent risk factors for poor prognosis of poorly differentiated G-NENs. In stratified analysis, for patients with stage III tumors, those treated with chemotherapy had significantly longer survival than those accepting surgery alone. Conclusion: T3/T4 stage, TNM stage IV and vascular invasion were independent negative prognostic factors for patients with poorly differentiated G-NENs. Patients with stage III tumors can benefit from chemotherapy. Highly selected patients with stage IV tumors may also benefit from surgery.
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Affiliation(s)
- Yanling Xu
- Department of Geriatric gastroenterology, The First Affiliated Hospital of Nanjing Medical University, 210029.,Department of General Practice, The First Affiliated Hospital of Nanjing Medical University, 210029
| | - Lijun Yan
- Department of Geriatric gastroenterology, The First Affiliated Hospital of Nanjing Medical University, 210029
| | - Tiaotiao Chen
- Department of Geriatric gastroenterology, The First Affiliated Hospital of Nanjing Medical University, 210029
| | - Ping Hu
- Department of Geriatric gastroenterology, The First Affiliated Hospital of Nanjing Medical University, 210029.,Neuroendocrine Tumor Diagnosis & Treatment Center of Jiangsu Province, 210029
| | - Jianan Bai
- Department of Geriatric gastroenterology, The First Affiliated Hospital of Nanjing Medical University, 210029.,Neuroendocrine Tumor Diagnosis & Treatment Center of Jiangsu Province, 210029
| | - Tian Ye
- Department of Geriatric gastroenterology, The First Affiliated Hospital of Nanjing Medical University, 210029.,Neuroendocrine Tumor Diagnosis & Treatment Center of Jiangsu Province, 210029
| | - Qin Long
- Department of Geriatric gastroenterology, The First Affiliated Hospital of Nanjing Medical University, 210029.,Neuroendocrine Tumor Diagnosis & Treatment Center of Jiangsu Province, 210029
| | - Qiyun Tang
- Department of Geriatric gastroenterology, The First Affiliated Hospital of Nanjing Medical University, 210029.,Neuroendocrine Tumor Diagnosis & Treatment Center of Jiangsu Province, 210029
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17
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Xu JX, Yu JN, Wang XJ, Xiong YX, Lu YF, Zhou JP, Zhou QM, Yang XY, Shi D, Huang XS, Fan SF, Yu RS. A radiologic diagnostic scoring model based on CT features for differentiating gastric schwannoma from gastric gastrointestinal stromal tumors. Am J Cancer Res 2022; 12:303-314. [PMID: 35141019 PMCID: PMC8822295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/27/2021] [Indexed: 06/14/2023] Open
Abstract
We aimed to further explore the CT features of gastric schwannoma (GS), propose and validate a convenient diagnostic scoring system to distinguish GS from gastric gastrointestinal stromal tumors (GISTs) preoperatively. 170 patients with submucosal tumors pathologically confirmed (GS n=35; gastric GISTs n=135) from Hospital 1 were analyzed retrospectively as the training cohort, and 72 patients (GS=11; gastric GISTs=61) from Hospital 2 were enrolled as the validation cohort. We searched for significant CT imaging characteristics and constructed the scoring system via binary logistic regression and converted regression coefficients to weighted scores. The ROC curves, AUCs and calibration tests were carried out to evaluate the scoring models in both the training cohort and the validation cohort. For convenient assessment, the system was further divided into four score ranges and their diagnostic probability of GS was calculated respectively. Four CT imaging characteristics were ultimately enrolled in this scoring system, including transverse position (2 points), location (5 points), perilesional lymph nodes (6 points) and pattern of enhancement (2 points). The AUC of the scoring model in the training cohort were 0.873 (95% CI, 0.816-0.929) and the cutoff point was 6 points. In the validation cohort, the AUC was 0.898 (95% CI, 0.804-0.957) and the cutoff value was 5 points. Four score ranges were as follows: 0-3 points for very low probability of GS, 4-7 points for low probability; 8-9 points for middle probability; 10-15 points for very high probability. A convenient scoring model to preoperatively discriminate GS from gastric GISTs was finally proposed.
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Affiliation(s)
- Jian-Xia Xu
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University318 Chao-Wang Road, Hangzhou 310005, Zhejiang Province, China
| | - Jie-Ni Yu
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University88 Jie-Fang Road, Hangzhou 310009, Zhejiang Province, China
| | - Xiao-Jie Wang
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University88 Jie-Fang Road, Hangzhou 310009, Zhejiang Province, China
| | - Yan-Xi Xiong
- Department of Radiology, Renmin Hospital, Hubei University of MedicineShiyan 442000, Hubei Province, China
| | - Yuan-Fei Lu
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University88 Jie-Fang Road, Hangzhou 310009, Zhejiang Province, China
| | - Jia-Ping Zhou
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University88 Jie-Fang Road, Hangzhou 310009, Zhejiang Province, China
| | - Qiao-Mei Zhou
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University88 Jie-Fang Road, Hangzhou 310009, Zhejiang Province, China
| | - Xiao-Yan Yang
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University88 Jie-Fang Road, Hangzhou 310009, Zhejiang Province, China
| | - Dan Shi
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University88 Jie-Fang Road, Hangzhou 310009, Zhejiang Province, China
| | - Xiao-Shan Huang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University318 Chao-Wang Road, Hangzhou 310005, Zhejiang Province, China
| | - Shu-Feng Fan
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University318 Chao-Wang Road, Hangzhou 310005, Zhejiang Province, China
| | - Ri-Sheng Yu
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University88 Jie-Fang Road, Hangzhou 310009, Zhejiang Province, China
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18
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Kumar L, Kholmurodova F, Bull J, Bright T, Watson DI, Shenfine J. Comparison of oesophageal and gastric cancer in the evaluation of urgent endoscopy referral criteria. ANZ J Surg 2021; 91:1515-1520. [PMID: 34124837 DOI: 10.1111/ans.16984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/25/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The objective of the study is to identify differences in epidemiology and clinical presentation between oesophageal and gastric cancer and to evaluate the sensitivity of the Australian urgent endoscopy referral guidelines. METHODS Design; Observational cohort study from February 2013 to October 2018. SETTING A single tertiary specialist oesophago-gastric cancer centre: Flinders Medical Centre, South Australia. PARTICIPANTS Patients with oesophageal and gastric cancer that had surgery with curative intent 61.9% oesophageal cancer, 38.1% gastric cancer. MAIN OUTCOME MEASURES Differences between oesophageal and gastric cancer in terms of demographical variables, first presenting symptoms and sensitivity of the Australian urgent endoscopy referral guidelines. RESULTS Oesophageal cancer presented at a median age of 64.4 years old, with a male: female ratio of 6:1, and dysphagia as the first presenting symptom in 61%. Gastric cancer presented at a median age of 69.5, with a 2:1 male: female ratio and predominantly non-specific symptoms-blood loss (36%), weight loss, nausea, and anorexia (21%) and epigastric pain (13%). The Australia urgent endoscopy referral guidelines had 76% sensitivity for oesophageal cancer detection compared with a 33% sensitivity for gastric cancer in this cohort. Delays from symptom onset to referral occurred for most patients with timeframes over four times the recommended 2-week timeframe. CONCLUSION There should be a separate urgent referral guideline for oesophageal and gastric cancer. These should include dysphagia for oesophageal cancer and blood loss (anaemia, haematemesis, melaena) for gastric cancer. Delays from symptom onset to referral indicate the need for further education of the public and general practitioners on symptoms warranting urgent referral.
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Affiliation(s)
- Liana Kumar
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Feruza Kholmurodova
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, South Australia, Australia
| | - Jeff Bull
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Tim Bright
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - David I Watson
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Jonathan Shenfine
- Upper Gastrointestinal Surgery Unit, Jersey General Hospital, Jersey, UK
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19
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Zhang LY, Zhang J, Li D, Liu Y, Zhang DL, Liu CF, Wang N, Wu SR, Lu WQ, Guo JZ, Shi YQ. Bile reflux is an independent risk factor for precancerous gastric lesions and gastric cancer: An observational cross-sectional study. J Dig Dis 2021; 22:282-290. [PMID: 33793080 PMCID: PMC8252397 DOI: 10.1111/1751-2980.12986] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/03/2021] [Accepted: 03/29/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To identify whether bile reflux on endoscopy and other related variables are risk factors for precancerous gastric lesions and gastric cancer (GC). METHODS A multicenter, cross-sectional and observational study was conducted in five centers in China from June to October 2019, 1162 patients were recruited and divided into the chronic gastritis (CG), the precancerous lesion (low-grade intraepithelial neoplasia and intestinal metaplasia), and GC groups (including high-grade intraepithelial neoplasia). All participants underwent detailed interviews, endoscopy and biopsy, and completed questionnaires. Odds ratio and 95% confidence interval were calculated with multivariate logistic regression models with or without adjustment for Helicobacter pylori infection. RESULTS We recruited 668 patients with CG, 411 with precancerous lesions and 83 with GC. By comparing the CG and precancerous lesion groups, independent risk factors for cancerous gastric lesions were the grade of bile reflux, patient's age, dietary habits and family history of GC. Similar results were obtained when comparing the CG and GC groups. In addition, bile reflux was confirmed as an independent risk factor for progression from precancerous lesions to cancer. CONCLUSIONS Bile reflux on endoscopy as well as age, dietary habits and a family history of GC were independent risk factors for the development of precancerous gastric lesions and GC.
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Affiliation(s)
- Lu Yao Zhang
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive DiseasesAir Force Medical UniversityXi'anShaanxi ProvinceChina
| | - Jian Zhang
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive DiseasesAir Force Medical UniversityXi'anShaanxi ProvinceChina,Department of GastroenterologyAir Force Hospital of Northern Theater of PLAShenyangLiaoning ProvinceChina
| | - Dan Li
- Department of General PracticeFirst Affiliated Hospital of Xi'an Medical UniversityXi'anShaanxi ProvinceChina
| | - Yuan Liu
- Department of Emergency MedicineShaanxi Xin'an Central HospitalXi'anShaanxi ProvinceChina
| | - Dong Ling Zhang
- Department of General PracticeFirst Affiliated Hospital of Xi'an Medical UniversityXi'anShaanxi ProvinceChina
| | - Cai Fang Liu
- Department of PediatricsFirst Affiliated Hospital of Xi'an Medical UniversityShaanxi ProvinceChina
| | - Na Wang
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive DiseasesAir Force Medical UniversityXi'anShaanxi ProvinceChina
| | - Si Ran Wu
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive DiseasesAir Force Medical UniversityXi'anShaanxi ProvinceChina
| | - Wen Quan Lu
- Department of GastroenterologySecond Affiliated Hospital of Zhengzhou UniversityZhengzhouHenan ProvinceChina
| | - Jing Zhi Guo
- Department of AnesthesiologyXijing Hospital, Air Force Medical UniversityXi'anShaanxi ProvinceChina
| | - Yong Quan Shi
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive DiseasesAir Force Medical UniversityXi'anShaanxi ProvinceChina
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20
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Bang CS, Lim H, Jeong HM, Hwang SH. Use of Endoscopic Images in the Prediction of Submucosal Invasion of Gastric Neoplasms: Automated Deep Learning Model Development and Usability Study. J Med Internet Res 2021; 23:e25167. [PMID: 33856356 PMCID: PMC8085753 DOI: 10.2196/25167] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/09/2020] [Accepted: 03/16/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In a previous study, we examined the use of deep learning models to classify the invasion depth (mucosa-confined versus submucosa-invaded) of gastric neoplasms using endoscopic images. The external test accuracy reached 77.3%. However, model establishment is labor intense, requiring high performance. Automated deep learning (AutoDL) models, which enable fast searching of optimal neural architectures and hyperparameters without complex coding, have been developed. OBJECTIVE The objective of this study was to establish AutoDL models to classify the invasion depth of gastric neoplasms. Additionally, endoscopist-artificial intelligence interactions were explored. METHODS The same 2899 endoscopic images that were employed to establish the previous model were used. A prospective multicenter validation using 206 and 1597 novel images was conducted. The primary outcome was external test accuracy. Neuro-T, Create ML Image Classifier, and AutoML Vision were used in establishing the models. Three doctors with different levels of endoscopy expertise were asked to classify the invasion depth of gastric neoplasms for each image without AutoDL support, with faulty AutoDL support, and with best performance AutoDL support in sequence. RESULTS The Neuro-T-based model reached 89.3% (95% CI 85.1%-93.5%) external test accuracy. For the model establishment time, Create ML Image Classifier showed the fastest time of 13 minutes while reaching 82.0% (95% CI 76.8%-87.2%) external test accuracy. While the expert endoscopist's decisions were not influenced by AutoDL, the faulty AutoDL misled the endoscopy trainee and the general physician. However, this was corrected by the support of the best performance AutoDL model. The trainee gained the most benefit from the AutoDL support. CONCLUSIONS AutoDL is deemed useful for the on-site establishment of customized deep learning models. An inexperienced endoscopist with at least a certain level of expertise can benefit from AutoDL support.
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Affiliation(s)
- Chang Seok Bang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea.,Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, Republic of Korea.,Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea.,Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea
| | - Hyun Lim
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Hae Min Jeong
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Sung Hyeon Hwang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
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21
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Dijksterhuis WPM, Kalff MC, Wagner AD, Verhoeven RHA, Lemmens VEPP, van Oijen MGH, Gisbertz SS, van Berge Henegouwen MI, van Laarhoven HWM. Gender Differences in Treatment Allocation and Survival of Advanced Gastroesophageal Cancer: a Population-Based Study. J Natl Cancer Inst 2021; 113:1551-1560. [PMID: 33837791 PMCID: PMC8562959 DOI: 10.1093/jnci/djab075] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/01/2020] [Accepted: 04/07/2021] [Indexed: 12/12/2022] Open
Abstract
Background Biological sex and gender have been reported to affect incidence and overall survival (OS) of curatively treated gastroesophageal cancer. The aim of this study was to compare palliative treatment allocation and OS between women and men with advanced gastroesophageal cancer. Methods Patients with an unresectable or metastatic esophageal (including cardia) adenocarcinoma (EAC) or squamous cell carcinoma (ESCC) or gastric adenocarcinoma (GAC) diagnosed in 2015-2018 were identified in the Netherlands Cancer Registry. Treatment allocation was compared using χ2 tests and multivariable logistic regression analyses, and OS using the Kaplan-Meier method with log-rank test and Cox proportional hazards analysis. All statistical tests were 2-sided. Results Of patients with EAC (n = 3077), ESCC (n = 794), and GAC (n = 1836), 18.0%, 39.4%, and 39.1% were women, respectively. Women less often received systemic treatment compared with men for EAC (42.7% vs 47.4%, P = .045) and GAC (33.8% vs 38.8%, P = .03) but not for ESCC (33.2% vs 39.5%, P = .07). Women had a lower probability of receiving systemic treatment for GAC in multivariable analyses (odds ratio [OR] = 0.79, 95% confidence interval [CI] = 0.62 to 1.00) but not for EAC (OR = 0.86, 95% CI = 0.69 to 1.06) and ESCC (OR = 0.81, 95% CI = 0.57 to 1.14). Median OS was lower in women with EAC (4.4 vs 5.2 months, P = .04) but did not differ after adjustment for patient and tumor characteristics and systemic treatment administration. Conclusions We observed statistically significant and clinically relevant gender differences in systemic treatment administration and OS in advanced gastroesophageal cancer. Causes of these disparities may be sex based (ie, related to tumor biology) as well as gender based (eg, related to differences in treatment choices).
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Affiliation(s)
- Willemieke P M Dijksterhuis
- Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Marianne C Kalff
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Anna D Wagner
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Rob H A Verhoeven
- Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Valery E P P Lemmens
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Public Health, Erasmus MC, Erasmus University, Rotterdam, The Netherlands
| | - Martijn G H van Oijen
- Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Suzanne S Gisbertz
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Mark I van Berge Henegouwen
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
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22
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Rao W, Xie M, Zang YJ, Zhi KQ. Chronic atrophic gastritis and Helicobacter pylori infection status in liver transplant recipients. Transpl Infect Dis 2020; 23:e13513. [PMID: 33207018 DOI: 10.1111/tid.13513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/31/2020] [Accepted: 11/08/2020] [Indexed: 11/29/2022]
Abstract
AIM To investigate the abnormalities of the upper gastrointestinal tract in liver transplant (LT) recipients, especially the prevalence of Helicobacter pylori infection and the incidence of chronic atrophic gastritis (CAG), and to explore the efficacy and safety of H pylori eradication treatment. METHODS Endoscopic screening was performed prospectively on LT recipients who received regular follow-up in our center. A group of healthy subjects with same age and sex was selected as a control group at a ratio of 1:3 with propensity score matching. All H pylori-positive recipients received Bismuth-containing quadruple therapy (esomeprazole 20 mg + clarithromycin 500 mg + amoxicillin 1 g + bismuth 220 mg, all of the medicines were applied twice daily, for 14 days). RESULT The prevalence of H pylori infection was significantly lower in LT group than control group [12/102 (11.8%) vs 98/306 (32.0%), P < .001], whereas the prevalence of CAG was similar between the two groups [48/102 (47.1%) vs 138/306 (45.1%), P = .731]. Meanwhile, the incidence of reflux esophagitis [18/102 (17.6%) vs 31/306 (10.1%), P = .043] and bile regurgitation [19/102 (18.6%) vs 30/306 (9.8%), P = .018] were higher in LT group. No correlation between the incidence of upper gastroduodenal abnormalities and postoperative time after liver transplantation was found. The success rate of H pylori eradication therapy was 100% (10/10). The blood concentration of immunosuppressants was 1.7-3.6 times above baseline values during H pylori eradication therapy; however, no severe adverse effects were observed during the proceed with dose adjustments of the immunosuppressants. CONCLUSION Although the prevalence of H pylori infection was lower in LT recipients than in control subjects, the prevalence of CAG was like that of the general population. H pylori eradication therapy was safe and effective after liver transplantation in our preliminary study.
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Affiliation(s)
- Wei Rao
- Division of Hepatology, Liver Disease Center, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.,Department of Organ Transplantation, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Man Xie
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yun-Jin Zang
- Division of Hepatology, Liver Disease Center, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.,Department of Organ Transplantation, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Ke-Qian Zhi
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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23
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Abstract
RATIONALE Primary gastric squamous cell carcinoma (SCC) is rarely encountered clinically. SCC, which presents as a submucosal tumor, is even rarer. Without the support of pathological evidence, it is difficult to make a correct preoperative diagnosis. Due to limited clinical data, the pathogenesis and treatment of gastric SCC remain unclear. PATIENT CONCERNS A 69-year-old man was admitted to our hospital with unexplained weight loss. Endoscopy revealed a submucosal mass without any ulcer on its surface located on the body of the stomach. The results of 2 gastroscopic mucosal biopsies were chronic inflammation. DIAGNOSES The clinical diagnosis by computed tomography (CT) and gastroscopy was gastrointestinal stromal tumor (GIST) preoperatively. The postoperative pathological examination demonstrated this tumor as moderately differentiated SCC. INTERVENTIONS Total gastrectomy, distal pancreatectomy, and splenectomy were performed. OUTCOMES The patient was discharged 7 days after the surgery without any complications. The follow-up CT scan showed no evidence of metastatic disease 6 months after surgery. LESSONS Large primary gastric SCC could present as a submucosal mass. Gastroscopic mucosal biopsy may not be able to get tumor tissue due to inflammatory reaction.
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Affiliation(s)
- Lei Gao
- Qilu Medical College of Shandong University
| | - Xiaolong Tang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan China
| | - Hui Qu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan China
| | - Qingsi He
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan China
| | - Guorui Sun
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan China
| | - Jingbo Shi
- Qilu Medical College of Shandong University
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24
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Liu YZ, Lv XH, Deng K, Yang JL. Efficacy and safety of endoscopic submucosal tunnel dissection vs endoscopic submucosal dissection for early superficial upper gastrointestinal precancerous lesions and tumors: A meta-analysis. J Dig Dis 2020; 21:480-489. [PMID: 32579253 DOI: 10.1111/1751-2980.12915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/03/2020] [Accepted: 06/21/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Endoscopic submucosal tunnel dissection (ESTD) is a new treatment for superficial upper gastrointestinal precancerous lesions and tumors. However, its safety and efficacy for treating these lesions is still uncertain. This meta-analysis aimed to compare the efficacy and safety of ESTD with those of endoscopic submucosal dissection (ESD) in treating early superficial upper gastrointestinal precancerous lesions and tumors. METHODS Electronic databases, including EMBASE, PubMed, Cochrane Library and the Web of Science, were systematically searched for articles published up to 1 April 2020. The primary outcomes were complete and en bloc resection rates of the lesions. The secondary outcomes included operation time, speed of dissection, complication and recurrence rates. The Newcastle-Ottawa quality assessment scale was used to evaluate the quality of the studies. RESULTS Seven studies were included in the final meta-analysis. The complete and en bloc resection rates of early superficial esophageal lesions as well as the en bloc resection rate of early superficial gastric lesions were similar between the ESTD and ESD groups. Compared with the ESD group, the ESTD group had a higher en bloc resection rate for early superficial gastric lesions. A faster dissection speed was observed in both superficial esophageal and gastric lesions. In gastric lesions, the operation time of the ESTD group was shorter than that of the ESD group, while it did not differ for esophageal lesions. There were no obvious differences in bleeding and perforation rates between the groups. CONCLUSION As an endoscopic technique for treating early superficial upper gastrointestinal lesions, ESTD is as safe as and more effective than ESD, especially for gastric lesions.
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Affiliation(s)
- Yu Zhi Liu
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Xiu He Lv
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Kai Deng
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Jin Lin Yang
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
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25
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Cho BJ, Bang CS, Lee JJ, Seo CW, Kim JH. Prediction of Submucosal Invasion for Gastric Neoplasms in Endoscopic Images Using Deep-Learning. J Clin Med 2020; 9:jcm9061858. [PMID: 32549190 PMCID: PMC7356204 DOI: 10.3390/jcm9061858] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/31/2020] [Accepted: 06/09/2020] [Indexed: 02/06/2023] Open
Abstract
Endoscopic resection is recommended for gastric neoplasms confined to mucosa or superficial submucosa. The determination of invasion depth is based on gross morphology assessed in endoscopic images, or on endoscopic ultrasound. These methods have limited accuracy and pose an inter-observer variability. Several studies developed deep-learning (DL) algorithms classifying invasion depth of gastric cancers. Nevertheless, these algorithms are intended to be used after definite diagnosis of gastric cancers, which is not always feasible in various gastric neoplasms. This study aimed to establish a DL algorithm for accurately predicting submucosal invasion in endoscopic images of gastric neoplasms. Pre-trained convolutional neural network models were fine-tuned with 2899 white-light endoscopic images. The prediction models were subsequently validated with an external dataset of 206 images. In the internal test, the mean area under the curve discriminating submucosal invasion was 0.887 (95% confidence interval: 0.849–0.924) by DenseNet−161 network. In the external test, the mean area under the curve reached 0.887 (0.863–0.910). Clinical simulation showed that 6.7% of patients who underwent gastrectomy in the external test were accurately qualified by the established algorithm for potential endoscopic resection, avoiding unnecessary operation. The established DL algorithm proves useful for the prediction of submucosal invasion in endoscopic images of gastric neoplasms.
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Affiliation(s)
- Bum-Joo Cho
- Medical Artificial Intelligence Center, Hallym University Medical Center, Anyang 14068, Korea;
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
- Division of Biomedical Informatics, Seoul National University Biomedical Informatics (SNUBI), Seoul National University College of Medicine, Seoul 03080, Korea;
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon 24253, Korea;
- Correspondence: (B.-J.C.); (C.S.B.); Tel.: +82-31-380-3835 (B.-J.C.); +82-33-240-5821 (C.S.B.)
| | - Chang Seok Bang
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon 24253, Korea;
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 24253, Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24253, Korea
- Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Chuncheon 24253, Korea
- Correspondence: (B.-J.C.); (C.S.B.); Tel.: +82-31-380-3835 (B.-J.C.); +82-33-240-5821 (C.S.B.)
| | - Jae Jun Lee
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon 24253, Korea;
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Chuncheon 24253, Korea
| | - Chang Won Seo
- Medical Artificial Intelligence Center, Hallym University Medical Center, Anyang 14068, Korea;
| | - Ju Han Kim
- Division of Biomedical Informatics, Seoul National University Biomedical Informatics (SNUBI), Seoul National University College of Medicine, Seoul 03080, Korea;
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26
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Iwamuro M, Miyahara K, Sakaguchi C, Takenaka R, Kobayashi S, Mouri H, Tanaka S, Toyokawa T, Tanaka S, Nishimura M, Yamauchi K, Tanaka T, Okada H. Diagnostic Role of 18F-Fluorodeoxyglucose Positron Emission Tomography in Gastric Mesenchymal Tumors. J Clin Med 2020; 9:jcm9051301. [PMID: 32370028 PMCID: PMC7290475 DOI: 10.3390/jcm9051301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 01/26/2023] Open
Abstract
There have been no comparative studies investigating the results of 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) in patients with gastric mesenchymal tumors, including leiomyomas, leiomyosarcomas, schwannomas, and gastrointestinal stromal tumors (GISTs). We retrospectively reviewed the data of 142 patients with pathologically diagnosed gastric mesenchymal tumors treated at 11 institutions. We analyzed the correlation between the maximum standardized uptake value (SUVmax) evaluated using fluorodeoxyglucose-positron emission tomography (FDG-PET) and the tumor size. The correlation between the SUVmax and mitotic index was also investigated in GISTs. The SUVmax (mean ± standard deviation) was 0.5 ± 0.6 in very low-risk GISTs (n = 42), 2.1 ± 0.7 in low-risk GISTs (n = 26), 4.9 ± 0.8 in intermediate-risk GISTs (n = 22), 12.3 ± 0.8 in high-risk GISTs (n = 20), 1.0 ± 1.0 in leiomyomas (n = 15), 6.9 ± 1.2 in schwannomas (n = 10), and 3.5 in a leiomyosarcoma (n = 1). The SUVmax of GISTs with an undetermined risk classification was 4.2 ± 1.3 (n = 8). Linear associations were observed between the SUVmax and tumor size in GISTs, leiomyomas, and schwannomas. The SUVmax of GISTs with a high mitotic index was significantly higher than that of GISTs with a low mitotic index (9.6 ± 7.6 vs. 2.4 ± 4.2). In conclusion, we observed positive correlations between the SUVmax and tumor size in GISTs, leiomyomas, and schwannomas. The SUVmax also positively correlated with the mitotic index and risk grade in GISTs. Schwannomas showed a higher FDG uptake than GISTs and leiomyomas.
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Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan;
- Correspondence: ; Tel.: +81-86-235-7219; Fax: +81-86-225-5991
| | - Koji Miyahara
- Department of Internal Medicine, Hiroshima City Hospital, Hiroshima 730-8518, Japan;
| | - Chihiro Sakaguchi
- Department of Endoscopy, National Hospital Organization Shikoku Cancer Center, Matsuyama 791-0280, Japan;
| | - Ryuta Takenaka
- Department of Internal Medicine, Tsuyama Chuo Hospital, Tsuyama 708-0841, Japan;
| | - Sayo Kobayashi
- Department of Internal Medicine, Fukuyama City Hospital, Fukuyama 721-8511, Japan;
| | - Hirokazu Mouri
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama 710-8602, Japan;
| | - Shigetomi Tanaka
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu 760-8557, Japan;
| | - Tatsuya Toyokawa
- Department of Gastroenterology, Fukuyama Medical Center, Fukuyama 720-8520, Japan;
| | - Shouichi Tanaka
- Department of Gastroenterology, Iwakuni Clinical Center, Iwakuni, Yamaguchi 740-8510, Japan;
| | - Mamoru Nishimura
- Department of Internal Medicine, Okayama City Hospital, Okayama 700-0962, Japan;
| | - Kenji Yamauchi
- Department of Gastroenterology, Mitoyo General Hospital, Kan-onji 769-1695, Japan;
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan;
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan;
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27
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The Chicago Consensus on peritoneal surface malignancies: Management of gastric metastases. Cancer 2020; 126:2541-2546. [PMID: 32282074 DOI: 10.1002/cncr.32868] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/09/2019] [Accepted: 09/14/2019] [Indexed: 12/29/2022]
Abstract
The Chicago Consensus Working Group provides multidisciplinary recommendations for the management of gastric cancer specifically as it relates to the management of peritoneal surface malignancy. These guidelines are developed with input from leading experts, including surgical oncologists, medical oncologists, pathologists, radiologists, palliative care physicians, and pharmacists. These guidelines recognize and address the emerging need for increased awareness of the appropriate management of peritoneal surface disease. They are not intended to replace the quest for higher levels of evidence.
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Affiliation(s)
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- Chicago Consensus Working Group, Chicago, Illinois
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28
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Li D, Zhang J, Yao WZ, Zhang DL, Feng CC, He Q, Lv HH, Cao YP, Wang J, Qi Y, Wu SR, Wang N, Zhao J, Shi YQ. The relationship between gastric cancer, its precancerous lesions and bile reflux: A retrospective study. J Dig Dis 2020; 21:222-229. [PMID: 32187838 PMCID: PMC7317534 DOI: 10.1111/1751-2980.12858] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 03/09/2020] [Accepted: 03/16/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the relationship between gastric cancer (GC) and precancerous lesions and bile reflux. METHODS Medical records of 30 465 participants who underwent gastroscopy between January and December 2018 in our center were reviewed. Their age, sex, time of endoscopy, endoscopic/histologic diagnosis and grade of bile reflux were recorded. The participants were further divided into the chronic gastritis group (n = 27 807), a precancerous lesion group (n = 1943) and a GC group (n = 715). The χ2 tests and hierarchical analyses were performed. RESULTS Patients aged 18-27 years had a higher bile reflux rate than those aged 28-37 and 68-75 years (P < 0.001), while it did not differ between patients aged <50 years and those over 50 years (P = 0.639). It was lower in men than in women (P < 0.001). The bile reflux rate did not differ in terms of months, seasons and half of the year (all P > 0.05), but differed between morning and afternoon when they underwent the endoscopy (P = 0.000). There was an interrelationship between the severity of gastric mucosal disease and bile reflux grade (r = 0.171). After excluding the effects of sex, age and time of endoscopy on bile reflux, bile reflux rate in chronic gastritis and precancerous lesions was lower than in gastric cancer (P < 0.01). CONCLUSIONS Bile reflux may be a risk factor for gastric cancer and precancerous lesions. A high grade of bile reflux may be associated with the progression of gastric mucosal diseases.
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Affiliation(s)
- Dan Li
- Xi'an Medical UniversityXi'anShaanxi ProvinceChina
| | - Jian Zhang
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive DiseasesAir Force Military Medical UniversityXi'anShaanxi ProvinceChina
| | - Wen Zhu Yao
- Xi'an Medical UniversityXi'anShaanxi ProvinceChina
| | - Dong Lin Zhang
- Division of General MedicineThe First Affiliated Hospital of Xi'an Medical UniversityXi'anShaanxi ProvinceChina
| | | | - Qi He
- Xi'an Medical UniversityXi'anShaanxi ProvinceChina
| | - Huan Huan Lv
- Xi'an Medical UniversityXi'anShaanxi ProvinceChina
| | - Ya Ping Cao
- Xi'an Medical UniversityXi'anShaanxi ProvinceChina
| | - Jie Wang
- Xi'an Medical UniversityXi'anShaanxi ProvinceChina
| | - Ying Qi
- Xi'an Medical UniversityXi'anShaanxi ProvinceChina
| | - Si Ran Wu
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive DiseasesAir Force Military Medical UniversityXi'anShaanxi ProvinceChina
| | - Na Wang
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive DiseasesAir Force Military Medical UniversityXi'anShaanxi ProvinceChina
| | - Jing Zhao
- Division of GastroenterologySecond Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxi ProvinceChina
| | - Yong Quan Shi
- Xi'an Medical UniversityXi'anShaanxi ProvinceChina,State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive DiseasesAir Force Military Medical UniversityXi'anShaanxi ProvinceChina
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29
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Wu ZP, Fang HX. Expression of SIRT5 protein in gastric cancer cells. J BIOL REG HOMEOS AG 2020; 33:1675-1683. [PMID: 31970975 DOI: 10.23812/19-184-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this paper was to investigate the dynamic trend of SIRT5 (Sirtuins 5) protein expression in gastric cancer cells, for which a hypoxic gastric cancer cell line was established. Afterward, the parental gastric cancer cell group and hypo group were designed, and the levels of related proteins and mRNAs were detected by using Western blot along with real-time quantitative fluorescence PCR (RT-PCR). The results showed that the expression of SIRT5 in hypoxic gastric cancer cells increased significantly, which could increase the phosphorylation level of c-MET (hepatocyte growth factor receptor) and promote the migration of gastric cancer cells. When the expression of SIRT5 protein was observed under hypoxic conditions, SIRT5 silencing significantly reduced the migration ability of MGC803/hypo cells. It could be predicted that SIRT5-mediated protein desuccinylation played an important role in promoting the migration of hypoxic gastric cancer cells. Therefore, the migration rate of gastric cancer cells could be affected by controlling the expression of SIRT5 protein, which provides a novel idea for the treatment of gastric cancer in the future.
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Affiliation(s)
- Z P Wu
- Department of Gastroenterology, The First People's Hospital of Fuyang, Hangzhou, Zhejiang, China
| | - H X Fang
- Department of Gastroenterology, The First People's Hospital of Fuyang, Hangzhou, Zhejiang, China
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30
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Barchi LC, Ramos MFKP, Dias AR, Andreollo NA, Weston AC, LourenÇo LG, Malheiros CA, Kassab P, Zilberstein B, Ferraz ÁAB, Charruf AZ, Brandalise A, Silva AMD, Alves B, Marins CAM, Leite CV, Bresciani CJC, Szor D, Mucerino DR. II BRAZILIAN CONSENSUS ON GASTRIC CANCER BY THE BRAZILIAN GASTRIC CANCER ASSOCIATION. Arq Bras Cir Dig 2020; 33:e1514. [PMID: 32844884 PMCID: PMC7448865 DOI: 10.1590/0102-672020190001e1514] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Since the publication of the first Brazilian Consensus on Gastric Cancer (GC) in 2012 carried out by the Brazilian Gastric Cancer Association, new concepts on diagnosis, staging, treatment and follow-up have been incorporated. AIM This new consensus is to promote an update to professionals working in the fight against GC and to provide guidelines for the management of patients with this condition. METHODS Fifty-nine experts answered 67 statements regarding the diagnosis, staging, treatment and prognosis of GC with five possible alternatives: 1) fully agree; 2) partially agree; 3) undecided; 4) disagree and 5) strongly disagree A consensus was adopted when at least 80% of the sum of the answers "fully agree" and "partially agree" was reached. This article presents only the responses of the participating experts. Comments on each statement, as well as a literature review, will be presented in future publications. RESULTS Of the 67 statements, there was consensus in 50 (74%). In 10 declarations, there was 100% agreement. CONCLUSION The gastric cancer treatment has evolved considerably in recent years. This consensus gathers consolidated principles in the last decades, new knowledge acquired recently, as well as promising perspectives on the management of this disease.
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Affiliation(s)
- Leandro Cardoso Barchi
- Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | - André Roncon Dias
- Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | - Paulo Kassab
- Department of Surgery, Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Bruno Zilberstein
- Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
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31
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Zhan MN, Yu J, Luo RK, Hou YY. Malignant gastrointestinal neuroectodermal tumor, presenting as a second malignancy after gastric adenocarcinoma: a case report and literature review. J Gastrointest Oncol 2019; 10:1144-1150. [PMID: 31949932 DOI: 10.21037/jgo.2019.08.04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Malignant gastrointestinal neuroectodermal tumor (GNET), is a rare soft tissue sarcoma. Here we report a case of GNET arising in the intestine of a 33-year-old female, who had been treated for gastric adenocarcinoma with surgery and chemotherapy at the age of 19, in 2001. Since then, she underwent follow-up care annually and kept disease free. Nevertheless, in 2015 she presented with vomiting and was found to have a mass in the small intestine. Surgical excision was performed. Histologically, the tumor was characterized by polygonal cells with clear or eosinophilic cytoplasm, and variably scattered osteoclast-like multinucleated giant cells. Immunohistochemically, the tumor cells showed diffuse and strong expression for S100, but AE1/AE3 cytokeratin, HMB-45 and Melan-A were negative. Genetically, EWSR1 gene rearrangement was detected by fluorescence in situ hybridization (FISH). All these alterations were different from primary gastric adenocarcinoma. Moreover, the tumor gave metastases to ileal mesentery and lung in 1 and 4 years later, respectively. In summary, this is the first report of primary intestinal GNET with multiple metastases in a young woman who had a known history of chemotherapy for gastric adenocarcinoma. In consistence with previous literature, which reported a secondary GNET following chemotherapy for hepatoblastoma, we speculate that the chemotherapy might trigger the rearrangement of EWSR1 and then promote the tumorigenesis of GNET.
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Affiliation(s)
- Meng-Na Zhan
- Department of Pathology, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200023, China
| | - Juan Yu
- Department of Pathology, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200023, China
| | - Rong-Kui Luo
- Department of Pathology, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200023, China
| | - Ying-Yong Hou
- Department of Pathology, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200023, China.,Department of Pathology, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
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32
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Abstract
Diabetes mellitus (DM) is a common worldwide endocrine disorder characterized by hyperglycemia resulting from defects in insulin secretion and insulin action or both. A number of clinical studies have investigated diabetes and its causal relation with neoplasm. Several epidemiological studies have found that diabetic patients have an increased risk of different types of cancers, for example liver, pancreas, gastric (stomach), colorectum, kidney, and breast, and it is predicted that hyperglycemic state observed in diabetic milieu enhances the cancer risk in prediabetic and diabetic individuals. To explore the strength of evidence and biases in the claimed associations between type 2 DM (T2DM) and risk of developing cancer, an umbrella review of the evidence across published meta-analyses or systematic reviews is performed. The concurrence of T2DM with the growing burden of cancer globally has generated interest in defining the epidemiological and biological relationships between these medical conditions. Through this review, it was found that diabetes could be related to cancer. Yet, the results from most of the studies are obscure and conflicting and need a robust research so that the link between diabetes and cancer could be firmly and impeccably documented.
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Affiliation(s)
- Manal Abudawood
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, KSA
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33
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Pinheiro RN, Mucci S, Zanatto RM, Picanço Junior OM, Bottino AAG, Fontoura RP, Lopes Filho GDJ. Quality of life as a fundamental outcome after curative intent gastrectomy for adenocarcinoma: lessons learned from patients. J Gastrointest Oncol 2019; 10:989-998. [PMID: 31602337 DOI: 10.21037/jgo.2019.06.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Gastric cancer has an important epidemiologic impact, and the main curative therapeutic modality for gastric cancer is surgical resection. However, even curative intent therapy can have negative effects on the quality of life (QoL) of these patients, which is undesirable; thus, it is difficult to balance the standardized treatment reported in the literature and treatment response to achieve full patient satisfaction. The purpose of our study was to evaluate the QoL and identify the association of scores on the Functional Assessment of Cancer Therapy-Gastric (FACT-Ga) and Short Form 36 Health Survey version 2 (SF36v2) questionnaires with sociodemographic, clinical and anatomopathological aspects of gastric adenocarcinoma patients undergoing curative surgery. Methods This was a cross-sectional study involving 104 patients from three regions of Brazil. Inferential analyses were used to compare (multiple regression and Mann-Whitney or Kruskal-Wallis tests) the relationships between these scores and variables (Spearman's coefficient). Results In the multiple regression analysis, we found correlations between Helicobacter pylori status and physical well-being (PWB) (P=0.026), between gender and emotional well-being (EWB) (P=0.008), between Lauren's histology and physical functioning (P=0.009), as well as the Short Form 36 Health Survey version 2 (SF-36v2) role-physical (P=0.027), between the tumor site and EWB (P=0.038), between the SF-36v2 mental health and N (the lower the staging, the better the score, P=0.006) and between the SF-36v2 mental health and lymph nodes removed (P=0.029). According to the Mann-Whitney or Kruskal-Wallis test, women had worse FACT-Ga total (P=0.049), PWB (P=0.005), EWB (P=0.007), gastric cancer subscale (GaCS, P=0.011), trial outcome index (TOI, P=0.030) and mental health scores than men (P=0.011). Patients with distal tumors had better scores (FACT-Ga, P=0.018; GaCS, P=0.014; TOI, P=0.020) than patients with proximal tumors. Patients with tumors located in the cardia had better physical functioning than those with proximal tumors (P=0.042). Patients who underwent partial gastrectomy had better FACT-Ga total scores (P=0.011), PWB (P=0.033), GaCS scores (P=0.006) and TOI scores (P=0.008) than those who underwent total gastrectomy. Patients who did not receive adjuvant therapy had worse bodily pain as reported on the SF-36v2 than those who received therapy (P=0.048). According to Spearman's coefficient, a higher lymph node stage corresponded to worse FACT-Ga total (s=-0.200, P=0.034), GaCS (s=-0.206, P=0.037), TOI (s=-0.216; P=0.028) and vitality (s=-0.215, P=0.029) scores. A longer time after treatment corresponded to a better SF-36v2 role-physical domain score (s=0.223; P=0.023). Conclusions The type of treatment instituted, postoperative time and sociodemographic and anatomopathological factors influence the QoL.
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Affiliation(s)
- Rodrigo Nascimento Pinheiro
- Postgraduate Program in Interdisciplinary Surgical Science, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Federal District Surgical Oncology Unity, Base Hospital Institute, Brasília, Brazil.,Academic League of Oncology, Base Hospital Institute, Brasília, Brazil
| | - Samantha Mucci
- Postgraduate Program in Interdisciplinary Surgical Science, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Psychiatry Department, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Renato Morato Zanatto
- Postgraduate Program in Interdisciplinary Surgical Science, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Amaral Carvalho Cancer Hospital, Jaú, São Paulo, Brazil
| | - Olavo Magalhães Picanço Junior
- Postgraduate Program in Interdisciplinary Surgical Science, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,High Complexity Unity in Oncology, Alberto Lima Hospital, Federal University of Amapá, Macapá, Brazil
| | | | | | - Gaspar de Jesus Lopes Filho
- Postgraduate Program in Interdisciplinary Surgical Science, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
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Dijksterhuis WPM, Verhoeven RHA, Slingerland M, Haj Mohammad N, de Vos-Geelen J, Beerepoot LV, van Voorthuizen T, Creemers GJ, van Oijen MGH, van Laarhoven HWM. Heterogeneity of first-line palliative systemic treatment in synchronous metastatic esophagogastric cancer patients: A real-world evidence study. Int J Cancer 2019; 146:1889-1901. [PMID: 31340065 PMCID: PMC7027521 DOI: 10.1002/ijc.32580] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/26/2019] [Accepted: 06/13/2019] [Indexed: 12/16/2022]
Abstract
The optimal first-line palliative systemic treatment strategy for metastatic esophagogastric cancer is not well defined. The aim of our study was to explore real-world use of first-line systemic treatment in esophagogastric cancer and assess the effect of treatment strategy on overall survival (OS), time to failure (TTF) of first-line treatment and toxicity. We selected synchronous metastatic esophagogastric cancer patients treated with systemic therapy (2010-2016) from the nationwide Netherlands Cancer Registry (n = 2,204). Systemic treatment strategies were divided into monotherapy, doublet and triplet chemotherapy, and trastuzumab-containing regimens. Data on OS were available for all patients, on TTF for patients diagnosed from 2010 to 2015 (n = 1,700), and on toxicity for patients diagnosed from 2010 to 2014 (n = 1,221). OS and TTF were analyzed using multivariable Cox regression, with adjustment for relevant tumor and patient characteristics. Up to 45 different systemic treatment regimens were found to be administered, with a median TTF of 4.6 and OS of 7.5 months. Most patients (45%) were treated with doublet chemotherapy; 34% received triplets, 10% monotherapy and 10% a trastuzumab-containing regimen. The highest median OS was found in patients receiving a trastuzumab-containing regimen (11.9 months). Triplet chemotherapy showed equal survival rates compared to doublets (OS: HR 0.92, 95%CI 0.83-1.02; TTF: HR 0.92, 95%CI 0.82-1.04) but significantly more grade 3-5 toxicity than doublets (33% vs. 21%, respectively). In conclusion, heterogeneity of first-line palliative systemic treatment in metastatic esophagogastric cancer patients is striking. Based on our data, doublet chemotherapy is the preferred treatment strategy because of similar survival and less toxicity compared to triplets.
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Affiliation(s)
- Willemieke P M Dijksterhuis
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Rob H A Verhoeven
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marije Slingerland
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nadia Haj Mohammad
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Judith de Vos-Geelen
- Division of Medical Oncology, Department of Internal Medicine, GROW - School for Oncology and Developmental Biology, Maastricht UMC+, Maastricht, The Netherlands
| | - Laurens V Beerepoot
- Department of Medical Oncology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | | | - Geert-Jan Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - Martijn G H van Oijen
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Uemura N, Oda I, Saito Y, Ono H, Fujisaki J, Matsuhashi N, Ohata K, Yahagi N, Yada T, Satoh M, Tajiri H, Inomata M, Kitano S. Efficacy and safety of 0.6% sodium alginate solution in endoscopic submucosal dissection for esophageal and gastric neoplastic lesion: A randomized controlled study. Dig Endosc 2019; 31:396-404. [PMID: 30667557 PMCID: PMC6850280 DOI: 10.1111/den.13352] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 01/17/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Sodium alginate (SA) solution has characteristic viscoelasticity. We aimed to determine efficacy and safety of 0.6% SA for submucosal injection during endoscopic submucosal dissection (ESD) in patients with localized neoplastic lesion in the esophageal and gastric mucosa. METHODS We conducted a randomized controlled study at six major hospitals in Japan including 130 patients with endoscopically localized neoplastic lesion in the esophageal and gastric mucosa and eligible for ESD. Patients were randomly assigned to SA or 0.4% sodium hyaluronate (SH) group (control); ESD was performed using a submucosal injection of SA/SH. As a primary outcome measure, non-inferiority of SA against SH was investigated using en bloc complete resection in ESD and formation and maintenance of mucosal elevation upon injection as an efficacy index. Adverse events during the study were evaluated as safety outcome measures. This study was registered with Pharmaceuticals and Medical Devices Agency (clinical trial no. 28-277/2016-18; clinical trial identification no. KP2013-009_C001). RESULTS Efficacy rate of submucosal injection during ESD was 91.7% (55/60) and 88.7% (55/62) in the SA and SH groups, respectively, demonstrating non-inferiority of SA against SH. Adverse events for which a causal relationship with submucosal injection solution could not be eliminated were noted in 8.2% (5/61) and 4.7% (3/64) in the SA and SH groups, respectively, but symptoms disappeared without treatment/after drug administration in both groups. CONCLUSIONS In Japan, 0.4% SH is the only commercially approved formulation for submucosal injection during ESD. The study results may expand submucosal injection solution options in clinical practice.
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Affiliation(s)
- Naomi Uemura
- Kohnodai HospitalNational Center for Global Health and MedicineChibaJapan
| | - Ichiro Oda
- Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
| | - Yutaka Saito
- Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
| | - Hiroyuki Ono
- Division of EndoscopyShizuoka Cancer CenterShizuokaJapan
| | - Junko Fujisaki
- Department of GastroenterologyCancer Institute Hospital AriakeTokyoJapan
| | | | - Ken Ohata
- Department of GastroenterologyNTT Medical Center TokyoTokyoJapan
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive TreatmentCancer CenterKeio University School of MedicineTokyoJapan
| | - Tomoyuki Yada
- Department of Gastroenterology and HepatologyKohnodai HospitalNational Center for Global Health and MedicineChibaJapan
| | - Masahiro Satoh
- Department of Research and DevelopmentKaigen Pharma Co. LtdHokkaidoJapan
| | - Hisao Tajiri
- Department of Innovative Interventional Endoscopy ResearchThe Jikei University School of MedicineTokyoJapan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric SurgeryOita UniversityFaculty of MedicineOitaJapan
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Iwamuro M, Tanaka T, Nishida K, Kanzaki H, Kawano S, Kawahara Y, Yoshino T, Okada H. Two cases of gastric mucosa-associated lymphoid tissue (MALT) lymphoma masquerading as follicular gastritis. Ecancermedicalscience 2019; 13:933. [PMID: 31281430 PMCID: PMC6605631 DOI: 10.3332/ecancer.2019.933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Indexed: 12/21/2022] Open
Abstract
In this report, we describe two cases of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) of the stomach, which presented with multiple small, whitish nodules in the gastric body. The endoscopic appearance was similar to that of lymphoid follicular hyperplasia found in follicular gastritis or nodular gastritis. Both patients were positive for Helicobacter pylori, and the eradication treatment resulted in complete remission of the lymphoma. However, recurrence was noted in one patient. These cases indicate that, although infrequent, gastric MALT lymphoma can show a nodular appearance resembling that of follicular gastritis.
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Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Kenji Nishida
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Hiromitsu Kanzaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Seiji Kawano
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Yoshiro Kawahara
- Department of Endoscopy, Okayama University Hospital, Okayama 700-8558, Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
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37
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Bang CS, Lee JJ, Baik GH. Prediction of Chronic Atrophic Gastritis and Gastric Neoplasms by Serum Pepsinogen Assay: A Systematic Review and Meta-Analysis of Diagnostic Test Accuracy. J Clin Med 2019; 8:jcm8050657. [PMID: 31083485 PMCID: PMC6572271 DOI: 10.3390/jcm8050657] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 05/06/2019] [Accepted: 05/08/2019] [Indexed: 12/16/2022] Open
Abstract
Serum pepsinogen assay (sPGA), which reveals serum pepsinogen (PG) I concentration and the PG I/PG II ratio, is a non-invasive test for predicting chronic atrophic gastritis (CAG) and gastric neoplasms. Although various cut-off values have been suggested, PG I ≤70 ng/mL and a PG I/PG II ratio of ≤3 have been proposed. However, previous meta-analyses reported insufficient systematic reviews and only pooled outcomes, which cannot determine the diagnostic validity of sPGA with a cut-off value of PG I ≤70 ng/mL and/or PG I/PG II ratio ≤3. We searched the core databases (MEDLINE, Cochrane Library, and Embase) from their inception to April 2018. Fourteen and 43 studies were identified and analyzed for the diagnostic performance in CAG and gastric neoplasms, respectively. Values for sensitivity, specificity, diagnostic odds ratio, and area under the curve with a cut-off value of PG I ≤70 ng/mL and PG I/PG II ratio ≤3 to diagnose CAG were 0.59, 0.89, 12, and 0.81, respectively and for diagnosis of gastric cancer (GC) these values were 0.59, 0.73, 4, and 0.7, respectively. Methodological quality and ethnicity of enrolled studies were found to be the reason for the heterogeneity in CAG diagnosis. Considering the high specificity, non-invasiveness, and easily interpretable characteristics, sPGA has potential for screening of CAG or GC.
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Affiliation(s)
- Chang Seok Bang
- Department of Internal Medicine, Hallym University College of Medicine, Sakju-ro 77, Chuncheon, Gangwon-do 24253, Korea.
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon 24253, Korea.
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24253, Korea.
| | - Jae Jun Lee
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon 24253, Korea.
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Chuncheon 24253, Korea.
| | - Gwang Ho Baik
- Department of Internal Medicine, Hallym University College of Medicine, Sakju-ro 77, Chuncheon, Gangwon-do 24253, Korea.
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24253, Korea.
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Graham Martínez C, Knijn N, Verheij M, Nagtegaal ID, van der Post RS. Tumour deposits are a significant prognostic factor in gastric cancer - a systematic review and meta-analysis. Histopathology 2019; 74:809-816. [PMID: 30376189 PMCID: PMC6850601 DOI: 10.1111/his.13781] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/29/2018] [Indexed: 12/11/2022]
Abstract
AIMS Tumour deposits (TDs) are clusters of cancer cells in the soft tissue that are discontinuous from the primary tumour. In this review we are exploring their relevance for prognosis in patients with gastric cancer. METHODS AND RESULTS A literature search was performed to identify studies providing data on TDs and prognosis in gastric cancer patients. Eight papers were included in the meta-analysis, which was carried out in terms of risk ratios (RR) and hazard ratios (HR) with 95% confidence interval (95% CI). Of 7445 patients, 1551 had TDs (20.9%). TDs were associated with a decreased overall survival (OS) in univariate (HR = 2.82, 95% CI = 1.9-4.3) and multivariate analyses (HR = 1.65, 95% CI = 1.3-2.1). TDs were also associated with known prognostic factors such as synchronous metastatic disease (RR = 9.5), invasion depth (RR = 1.8), lymph node metastasis (RR = 1.7), lymphatic invasion (RR = 1.7), vascular invasion (RR = 2.6) and poor differentiation (RR = 1.2). CONCLUSIONS We found a strong indication that TDs are independent predictors of prognosis in patients with gastric cancer; hence, TDs should be included in the staging of gastric cancers.
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Affiliation(s)
| | - Nikki Knijn
- Department of PathologyRadboud university medical centreNijmegenthe Netherlands
| | - Marcel Verheij
- Department of RadiotherapyRadboud University Medical CentreNijmegenthe Netherlands
| | - Iris D Nagtegaal
- Department of PathologyRadboud university medical centreNijmegenthe Netherlands
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Zhang QW, Zhang XT, Gao YJ, Ge ZZ. Endoscopic management of patients with early gastric cancer before and after endoscopic resection: A review. J Dig Dis 2019; 20:223-228. [PMID: 30756514 DOI: 10.1111/1751-2980.12715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 12/11/2022]
Abstract
With the wide application of endoscopic resection for early gastric cancer (EGC) by not only Asian endoscopists but also those from Western countries, reviews on standardized treatment processes before and after endoscopic resection are nevertheless lacking. In this article we provide a narrative review of studies on the selection of appropriate EGC for endoscopic resection and the follow-up strategies for those with histologically confirmed EGC after endoscopic resection. EGC should be comprehensively assessed before endoscopic resection, including its exact margin, invasive depth and risk of lymph node metastasis (LNM). While the curative resection status of EGC may be evaluated after endoscopic resection based on the newly developed eCura system, although this needs to be further verified. Surveillance with endoscopy and computed tomography scan is necessary for patients with an EGC level A or B. An additional endoscopic resection is recommended for patients with a level-C1 EGC. For patients with a level-C2 EGC, close follow-up is suggested for low-risk tumors of level C2 and additional surgery for those at high risks. Further postoperative strategy is suggested based on comprehensive assessment of the risk of LNM, patient's quality of life and wishes.
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Affiliation(s)
- Qing Wei Zhang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xin Tian Zhang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yun Jie Gao
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhi Zheng Ge
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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40
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Bang CS, Lee JJ, Baik GH. Diagnostic performance of serum pepsinogen assay for the prediction of atrophic gastritis and gastric neoplasms: Protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e14240. [PMID: 30681610 PMCID: PMC6358409 DOI: 10.1097/md.0000000000014240] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Serum pepsinogen assay (sPGA) combining concentration of pepsinogen I (PG I), and the ratio of PG I/II is the noninvasive biomarker for predicting chronic atrophic gastritis (CAG) and neoplasms reflecting mucosal secretory status. Although various cut-off values have been suggested, PG I ≤70 ng/mL and PG I/II ≤3 have been widely accepted. However, previous studies for diagnostic test accuracy presented only pooled outcomes, which cannot discriminate the diagnostic validity of sPGA with cut-off of PG I ≤70 ng/mL and PG I/II ≤3. METHODS We will search the core databases [MEDLINE (through PubMed), the Cochrane Library, and Embase] from their inception to December 2018 by 2 independent evaluators. The P.I.C.O. is as follows; Patients: who have histologically proven CAG or gastric neoplasms, Intervention: sPGA with cut-off of PG I ≤70 ng/mL and/or PG I/II ≤3, Comparison: none, Outcome: diagnostic performance indices of sPGA for CAG and gastric neoplasms (sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios) (if, true/false positive, true/false negative values are presented, diagnostic performance indices will be calculated). All types of study design with full text will be sought and included. The risk of bias will be assessed using the QUADAS-2 tool. Descriptive data synthesis is planned and quantitative synthesis (bivariate and HSROC model) will be used if the included studies are sufficiently homogenous. Publication bias will be assessed. RESULTS The results will provide clinical evidence for diagnostic validity of sPGA. CONCLUSION This study will provide evidence of sPGA for predicting CAG and gastric neoplasms.
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Affiliation(s)
- Chang Seok Bang
- Department of Internal Medicine
- Institute of New Frontier Research
| | - Jae Jun Lee
- Institute of New Frontier Research
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Chuncheon, Korea
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41
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Sun J, Xu Z, Lv H, Wang Y, Wang L, Ni Y, Wang X, Hu C, Chen S, Teng F, Chen W, Cheng X. eIF5A2 regulates the resistance of gastric cancer cells to cisplatin via induction of EMT. Am J Transl Res 2018; 10:4269-4279. [PMID: 30662669 PMCID: PMC6325524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 11/16/2018] [Indexed: 06/09/2023]
Abstract
Cisplatin is the first-line chemotherapy drug for gastric cancer (GC), but treatment failure often occurs due to development of resistance. The mechanism of cisplatin resistance remains a mystery. Eukaryotic translation initiation factor 5A2 (eIF5A2) is an important tumor-promoting factor and has been rarely studied in GC. This study aimed to investigate the role of eIF5A2 in cisplatin resistance of GC cells and its relationship with epithelial-mesenchymal transition (EMT). We found that it is negative correlation between cisplatin resistance and eIF5A2's expression in GC cells. Silencing of eIF5A2 enhanced the sensitivity of GC cells to cisplatin, while overexpression of eIF5A2 decreased sensitivity. Cisplatin treatment induced gene expression changes consistent with EMT. EMT was blocked and the sensitivity of GC cells to cisplatin was increased by inhibiting the expression of Twist, indicating that EMT regulates the sensitivity of GC cells to cisplatin. Knockdown of eIF5A2 was associated with upregulation of the epithelial markers E-cadherin and β-catenin, while the expression of mesenchymal markers vimentin and N-cadherin decreased, indicating that eIF5A2 can reverse the EMT process and block the effect of cisplatin on EMT-related markers. Knockdown or overexpression of eIF5A2 did not affect the sensitivity of gastric cancer cells to cisplatin by Twist siRNA. Altogether, these data suggest that eIF5A2 regulates the resistance of gastric cancer cells to cisplatin by mediating EMT, and support the conclusion that eIF5A2 may be a molecular target for anti-tumor therapy.
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Affiliation(s)
- Jiancheng Sun
- First Clinical Medical College, Zhejiang Chinese Medical UniversityHangzhou 310053, Zhejiang, P.R. China
| | - Zhiyuan Xu
- Key Laboratory of Integrated Traditional Chinese and Western Medicine for Diagnosis and Treatment of Digestive System TumorHangzhou, Zhejiang, P.R. China
- Department of Gastrointestinal Surgery, Zhejiang Hospital of Traditional Chinese Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhou 310006, Zhejiang, P.R. China
| | - Hang Lv
- Key Laboratory of Integrated Traditional Chinese and Western Medicine for Diagnosis and Treatment of Digestive System TumorHangzhou, Zhejiang, P.R. China
| | - Yiping Wang
- Key Laboratory of Integrated Traditional Chinese and Western Medicine for Diagnosis and Treatment of Digestive System TumorHangzhou, Zhejiang, P.R. China
| | - Lijing Wang
- Department of Medical Imaging, Zhejiang Provincial Tumor HospitalHangzhou 310022, Zhejiang, P.R. China
| | - Yixiu Ni
- First Clinical Medical College, Zhejiang Chinese Medical UniversityHangzhou 310053, Zhejiang, P.R. China
| | - Xiaofeng Wang
- First Clinical Medical College, Zhejiang Chinese Medical UniversityHangzhou 310053, Zhejiang, P.R. China
| | - Can Hu
- First Clinical Medical College, Zhejiang Chinese Medical UniversityHangzhou 310053, Zhejiang, P.R. China
| | - Shangqi Chen
- First Clinical Medical College, Zhejiang Chinese Medical UniversityHangzhou 310053, Zhejiang, P.R. China
| | - Fei Teng
- First Clinical Medical College, Zhejiang Chinese Medical UniversityHangzhou 310053, Zhejiang, P.R. China
| | - Wei Chen
- Cancer Institute of Integrated Traditional Chinese and Western Medicine, Key Laboratory of Cancer Prevention and Therapy Combining Traditional Chinese and Western Medicine, Zhejiang Academy of Traditional Chinese MedicineHangzhou 310012, Zhejiang, P.R. China
| | - Xiangdong Cheng
- Key Laboratory of Integrated Traditional Chinese and Western Medicine for Diagnosis and Treatment of Digestive System TumorHangzhou, Zhejiang, P.R. China
- Department of Abdominal Surgery, Zhejiang Cancer Hospital1# Banshan Road, Hangzhou 310022, Zhejiang, P.R. China
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42
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Huang Q, Li R, Xu GF, Zhou D, Fan XS, Zou XP. Emerging evidence supports grouping by location of early gastric carcinoma for appropriate clinical management in Chinese patients. J Dig Dis 2018; 19:730-736. [PMID: 30270559 DOI: 10.1111/1751-2980.12674] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 09/12/2018] [Accepted: 09/21/2018] [Indexed: 12/11/2022]
Abstract
Gastric cancer is common in China. At present, early detection with prompt resection of early gastric carcinoma (EGC) is crucial for improving patient's survival. Because of high heterogeneity of EGC in Chinese patients we reviewed recent clinicopathological and molecular evidence and proposed a grouping EGC in three subgroups according to their location for appropriate management. In group 1 (cardia), most patients with EGC in this small location were elderly men. The tumors originated in the cardiac mucosa with a high proportion of cases with slightly elevated gross patterns and intestinal adenocarcinoma histology with moderate to well differentiation. Poorly cohesive carcinoma was infrequent. As the risk for lymph node metastasis in this kind of tumor was significantly lower than that in the distal stomach, endoscopic therapy is preferred. Group 2 (fundus-corpus), many patients with EGC in this large location were young women. The EGCs originated in the oxyntic mucosa with pure and mixed poorly cohesive carcinomas that are more commonly present in this area than in any other. Most tumors were poorly differentiated with a high risk for lymph node metastasis. Thus, endoscopic therapy may be appropriate for intramucosal, but not for submucosal, carcinoma. Group 3 (antrum-pylorus). EGC tumors arose from the antral mucosa, primarily because of Helicobacter pylori infection, following the Correa gastric cancer tumorigenetic pathway. Erosive and ulcerated gross patterns were most frequently observed. While most EGCs in this location were mainly intestinal adenocarcinomas, poorly differentiated EGCs were substantial in number. Because the risk of lymph node metastasis remains to be illustrated, clinical management requires an individualized approach. This preliminary observation requires verification in large nationwide multicenter studies.
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Affiliation(s)
- Qin Huang
- Department of Pathology, Nanjing Drum Tower Hospital Affiliated to Nanjing, University Medical School, Nanjing, Jiangsu Province, China.,Department of Pathology and Laboratory Medicine, Veterans Affairs Boston Healthcare System, Harvard Medical School and Brigham and Women's Hospital, West Roxbury, Massachusetts, USA
| | - Rui Li
- Department of Gastroenterology, The Affiliated First Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Gui Fang Xu
- Department of Gastroenterology, Nanjing Drum Tower Hospital Affiliated to Nanjing, University Medical School, Nanjing, Jiangsu Province, China
| | - Dan Zhou
- Quality Care Medical Consulting, LLC, Lexington, Massachusetts, USA
| | - Xiang Shan Fan
- Department of Pathology, Nanjing Drum Tower Hospital Affiliated to Nanjing, University Medical School, Nanjing, Jiangsu Province, China
| | - Xiao Ping Zou
- Department of Gastroenterology, Nanjing Drum Tower Hospital Affiliated to Nanjing, University Medical School, Nanjing, Jiangsu Province, China
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43
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Aziz M, Madan R, Bansal A. Hereditary Diffuse Gastric Cancer: More than What Meets the Endoscopic Eye. Kans J Med 2018; 11:120-121. [PMID: 30937153 PMCID: PMC6276965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Muhammad Aziz
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Rashna Madan
- Department of Pathology, University of Kansas Medical Center, Kansas City, KS
| | - Ajay Bansal
- Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS
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44
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Kukar M, Gabriel E, Ben-David K, Hochwald SN. Laparoscopic proximal gastrectomy for gastric neoplasms. J Surg Oncol 2018; 118:95-100. [PMID: 29920681 DOI: 10.1002/jso.25123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/08/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND For cancers of the distal gastroesophageal junction or the proximal stomach, proximal gastrectomy can be performed. It is associated with several perioperative benefits compared with total gastrectomy. The use of laparoscopic proximal gastrectomy (LPG) has become an increasingly popular approach for select tumors. METHODS We describe our method of LPG, including the preoperative work-up, illustrated depictions of the key steps of the surgery, and our postoperative pathway. RESULTS A total of 6 patients underwent LPG between July, 2013 to June, 2017. Five patients had early-stage adenocarcinoma, and 1 patient had a gastrointestinal stromal tumor. The median age of the cohort was 70, and each patient had significant comorbidities. Conversion to open was required for 1 patient. All patients had negative final margins and an adequate lymph node dissection (median number of nodes examined was 15, range 12-22). The median postoperative length of stay was 7 days (range 4-7). Two patients developed anastomotic strictures requiring intervention, and 1 patient experienced significant reflux. At a median follow-up of 11 months, there was 1 recurrence. Three patients were alive without evidence of disease, and 2 patients died from other causes. CONCLUSIONS For carefully selected patients, LPG is a safe and reasonable alternative to total gastrectomy, which is associated with similar oncologic outcomes and low morbidity.
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Affiliation(s)
- Moshim Kukar
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York
| | - Emmanuel Gabriel
- Department of Surgery, Section of Surgical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Kfir Ben-David
- Department of Surgery, Mount Sinai Medical Center, Miami Beach, Florida
| | - Steven N Hochwald
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York
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45
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Jaruvongvanich V, Sempokuya T, Wijarnpreecha K, Ungprasert P. Continued versus interrupted aspirin use and bleeding risk after endoscopic submucosal dissection of gastric neoplasms: a meta-analysis. Ann Gastroenterol 2018; 31:344-349. [PMID: 29720860 PMCID: PMC5924857 DOI: 10.20524/aog.2018.0251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 12/22/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Balancing the risk of bleeding and thromboembolic events for patients who use aspirin and need to undergo endoscopic submucosal dissection (ESD) for gastric neoplasms is a delicate process. The current guidelines from different associations provide inconsistent recommendations. METHODS MEDLINE and EMBASE databases were searched through August 2017 for studies that compared the risk of post-ESD bleeding in patients who continued aspirin vs. those who discontinued aspirin preoperatively. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using a random-effect model, generic inverse variance method. The between-study heterogeneity was quantified using the Q statistic and I2 . RESULTS A total of five studies that included 700 patients were identified. Our meta-analysis could not demonstrate a significantly increased risk of post-ESD bleeding among the aspirin-continued group compared to the aspirin-interrupted group, the pooled OR being 1.81 (95%CI 0.85-3.83). The statistical heterogeneity was insignificant, with an I2 of 25%. Nine thrombotic events occurred in the aspirin-interrupted group whereas none occurred in the aspirin-continued group. CONCLUSIONS This meta-analysis could not demonstrate that continuation of aspirin significantly increases the risk of post-ESD bleeding. However, the analysis was restricted by the small sample size and the observational nature of the primary studies. Randomized controlled trials are still needed to clarify this risk.
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Affiliation(s)
- Veeravich Jaruvongvanich
- Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA (Veeravich Jaruvongvanich, Tomoki Sempokuya)
- Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand (Veeravich Jaruvongvanich)
| | - Tomoki Sempokuya
- Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA (Veeravich Jaruvongvanich, Tomoki Sempokuya)
| | - Karn Wijarnpreecha
- Department of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, NY, USA (Karn Wijarnpreecha)
| | - Patompong Ungprasert
- Department of Division of Clinical Epidemiology, Siriraj Medical Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (Patompong Ungprasert)
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46
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Chew T, Bright T, Price TJ, Watson DI, Devitt PG. Follow-Up Practices of Surgeons and Medical Oncologists in Australia and New Zealand Following Resection of Esophagogastric Cancers. Ann Thorac Cardiovasc Surg 2017; 23:217-222. [PMID: 28819089 DOI: 10.5761/atcs.oa.17-00049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Follow-up practices for patients who have undergone surgical resection of esophagogastric malignancies are variable and poorly documented. To better understand practice, a questionnaire was used to survey surgeons and medical oncologists to determine whether any consensus exists. METHODS An opt-in online questionnaire was sent to esophagogastric surgeons and medical oncologists via the membership lists for the Australian and New Zealand Gastric and Oesophageal Surgery Association (ANZGOSA), the Australian Gastro-Intestinal Trials Groups (AGITG), and the Medical Oncology Group of Australia (MOGA). The questionnaire proposed five clinical scenarios and provided a range of follow-up options for each scenario. Clinicians were asked to indicate which best matched their clinical practice. RESULTS Most clinicians follow patients for at least 3-5 years following resection of gastric or esophageal cancer. In total, 52% perform routine surveillance imaging, with individual scenarios not altering this. Tumor markers are infrequently used. Endoscopy and routine blood tests are used by around half the respondents. CONCLUSION There was little consensus about the use of investigations to monitor patients following esophagogastric cancer surgery. Choices do not follow guidelines or evidence. The identified patterns of postoperative surveillance practice appear not to be evidence based, and generally do not match recently published Australian guidelines.
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Affiliation(s)
- Tim Chew
- Discipline of Surgery, Adelaide University, Royal Adelaide Hospital, Adelaide, Australia
| | - Tim Bright
- Department of Surgery, Flinders University, Flinders Medical Centre, Adelaide, Australia
| | - Timothy J Price
- Department of Medical Oncology, the Queen Elizabeth Hospital, Adelaide, Australia
| | - David I Watson
- Department of Surgery, Flinders University, Flinders Medical Centre, Adelaide, Australia
| | - Peter G Devitt
- Discipline of Surgery, Adelaide University, Royal Adelaide Hospital, Adelaide, Australia
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47
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Iwamuro M, Tanaka T, Kanzaki H, Kawano S, Kawahara Y, Iwasaki Y, Okada H. Deterioration of duodenal lymphangiectasia after radiotherapy for gastric MALT lymphoma. Ecancermedicalscience 2017; 11:752. [PMID: 28798810 PMCID: PMC5533599 DOI: 10.3332/ecancer.2017.752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Indexed: 12/19/2022] Open
Abstract
A 68-year-old Japanese woman underwent radiotherapy for gastric lymphoma. Although lymphangiectasia was sparsely observed in the second portion of the duodenum before radiotherapy, the number of pinpoint white spots obviously increased after the treatment. Although the duodenal lymphangiectasia gradually progressed, the patient had no features of protein-losing enteropathy. This case highlights the importance of endoscopic observation of the duodenum after irradiation to the abdomen as radiotherapy may secondarily cause intestinal lymphangiectasia.
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Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan.,Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Hiromitsu Kanzaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Seiji Kawano
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Yoshiro Kawahara
- Department of Endoscopy, Okayama University Hospital, Okayama 700-8558, Japan
| | - Yoshiaki Iwasaki
- Health Service Centre, Okayama University, Okayama 700-0082, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
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48
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Ahn SY, Kim J, Kim MA, Choi J, Kim WH. Increased HGF Expression Induces Resistance to c-MET Tyrosine Kinase Inhibitors in Gastric Cancer. Anticancer Res 2017; 37:1127-1138. [PMID: 28314274 DOI: 10.21873/anticanres.11426] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/16/2017] [Accepted: 02/22/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Increased expression of hepatocyte growth factor (HGF) and MET proto-oncogene (c-MET) is associated with poor prognosis in various cancer types. Recently, it was reported that the expression of HGF induces resistance to tyrosine kinase inhibitors (TKIs) targeting epidermal growth factor receptor, human epidermal receptor receptor 2, and b-raf proto-oncogene. Here, we investigated the effects of HGF overexpression in gastric cancer cells in the absence or presence of c-MET TKIs. MATERIALS AND METHODS The effects of c-MET TKIs in gastric cancer cells with and without c-MET overexpression were determined in gastric cancer cell lines with various cell biology methods. RESULTS Compared to the control, cells with induced expression of HGF showed increase in anchorage-independent colony formation (p<0.001). The c-MET TKIs inhibited HGF/c-MET downstream signaling, cell proliferation, migration and invasion, and triggered cell-cycle arrest in Hs746T cells. However, HGF-transfected cells were less affected. CONCLUSION c-MET TKIs had inhibitory effects only on cells overexpressing c-MET. Furthermore, overexpression of HGF resulted in resistance to c-MET TKIs through an autocrine manner in gastric cancer cells.
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Affiliation(s)
- So Yeong Ahn
- Cancer Research Institute, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jin Kim
- Cancer Research Institute, College of Medicine, Seoul National University, Seoul, Republic of Korea.,Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min A Kim
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jiwoon Choi
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woo Ho Kim
- Cancer Research Institute, College of Medicine, Seoul National University, Seoul, Republic of Korea .,Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
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49
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Postlewait LM, Baptiste GG, Ethun CG, Le N, Cardona K, Russell MC, Willingham FF, Kooby DA, Staley CA, Maithel SK. A 15-year experience with gastric neuroendocrine tumors: Does type make a difference? J Surg Oncol 2016; 114:576-580. [PMID: 27393718 DOI: 10.1002/jso.24369] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/21/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gastric neuroendocrine tumors (GNETs) are rare and classified into three types by disease etiology and typical behavior. METHODS The aim was to describe outcomes after GNET resection at a single institution from 2000 to 2014, stratified by tumor type. Given the small patient number, P-values were not assigned. RESULTS Of 22 patients, 12 patients (55%) had Type 1, none (0%) had Type 2, and 10 (45%) had Type 3 tumors. Compared to Type 3, Type 1 patients were younger (mean age: 52 vs. 59 years) with similar rates of endoscopic resection (25% vs. 20%). Type 1 GNETs often had multiple tumors (60% vs. 10%) and were not poorly differentiated (0% vs. 11%). Only 33% of Type 1 had nodal metastases compared to 71% of Type 3. Type 1 GNETs presented with metastatic disease less often (17% vs. 40%). Three year recurrence-free survival was 33% for Type 1 compared to 86% for Type 3. Disease-specific survival at 3-years was 100% and 75% for Types 1 and 3, respectively. CONCLUSION Type 1 GNETs are often indolent and multifocal without nodal involvement, but have high recurrence risk. Type 3 is more aggressive with increased nodal involvement; nodal evaluation should be routinely performed. Determination of GNET type is paramount to treating patients with this rare disease. J. Surg. Oncol. 2016;114:576-580. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Lauren M Postlewait
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Gillian G Baptiste
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Cecilia G Ethun
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Nina Le
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Kenneth Cardona
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Maria C Russell
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Field F Willingham
- Division of Gastroenterology, Department of Internal Medicine, Emory University, Atlanta, Georgia
| | - David A Kooby
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Charles A Staley
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Shishir K Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
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50
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Iwamuro M, Kimura K, Kondo E, Nada T, Nakamura E, Takata K, Tanaka T, Otsuka F, Yoshino T, Okada H. Endoscopic detection of the gastric lesions of peripheral T-cell lymphoma. Ecancermedicalscience 2016; 10:625. [PMID: 26981154 PMCID: PMC4778693 DOI: 10.3332/ecancer.2016.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Indexed: 11/06/2022] Open
Abstract
An 82-year-old Japanese man presented with a gastric involvement of peripheral T-cell lymphoma, not otherwise specified. Although gastrointestinal lesions were not detected on computed tomography, oesophagogastroduodenoscopy revealed a slight elevation of the gastric mucosa, with changes in mucosal colour and the presence of abnormal microvessels. This led to the prompt detection of gastric involvement in lymphoma. This case highlights the usefulness of detailed observation of the gastric mucosa for the endoscopic detection of gastric involvement of peripheral T-cell lymphoma.
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Affiliation(s)
- Masaya Iwamuro
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan; Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Kosuke Kimura
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Eisei Kondo
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Takahiro Nada
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Eri Nakamura
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Katsuyoshi Takata
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan; Department of Endoscopy, Okayama University Hospital, Okayama 700-8558, Japan
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