Multidisciplinary approaches in the management of advanced hepatocellular carcinoma: Exploring future directions

Recently, we read the article "Pathologically successful conversion hepatectomy for advanced giant hepatocellular carcinoma after multidisciplinary therapy: A case report and review of the literature" published in the World Journal of Gas trointestinal Oncology. The prognosis of advanced hepatocellular carcinoma (HCC) is poor, and multidisciplinary comprehensive treatment is currently the main research direction. This case report demonstrated the efficacy of the combination therapy of transcatheter arterial chemoembolization, hepatic arterial infusion chemotherapy, epclusa, lenvatinib and sintilimab for a patient with advanced HCC, and the report can serve as a reference for clinical practice. We would also like to share some of our views.

The value of endoscopically-placed metal clips for transcatheter arterial embolization in the treatment of recurrent acute non-variceal upper gastrointestinal bleeding

OBJECTIVE

Acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) is a common clinical emergency. Transcatheter arterial embolization (TAE) is usually used to locate the bleeding site and provide interventional embolization. During TAE, there is a low positive rate of angiography, and localization of the culprit vessel is difficult. The purpose of this study was to demonstrate the role of preplaced metal clips in TAE for ANVUGIB patients.

MATERIALS AND METHODS

Patients with ANVUGIB in whom bleeding sites were identified endoscopically and treated with TAE from January 1st, 2005 to July 1st, 2021 were retrospectively included. According to the presence or absence of preplaced metal clips, they were divided into two groups. The main outcome measurements included the clinical success rate and rebleeding rate. Secondary outcome measurements included the mortality rate and the need for surgery. Predictors of the clinical success rate were assessed with univariate analysis and multivariate analysis.

RESULTS

A total of 102 patients were included in this study, and all of them had undergone arterial embolization. There were 73 cases in the group with metal clips and 29 cases in the group without metal clips with consistent baseline information. The group with metal clips had a higher clinical success rate (82.2% vs. 45.0%, P < 0.001), lower rebleeding rate (8.2% vs 27.6%, P = 0.039) and additional surgery rate (11.0% vs 20.7%, P < 0.001) than the group without metal clips. In univariate analysis, ROCKALL score and preplaced metal clip marking were shown to affect clinical success rate. In multivariate analysis, metal clip marking was found to facilitate clinical success (OR = 3.750, 95CI = 1.456-9.659, P = 0.004).

CONCLUSION

In ANVUGIB patients, preplaced metal clips could improve the clinical success rate of TAE and reduce the mortality rate and the risk of rebleeding.

A platform of functional studies of ESCC-associated gene mutations identifies the roles of TGFBR2 in ESCC progression and metastasis

Genomics studies have detected numerous genetic alterations in esophageal squamous cell carcinoma (ESCC). However, the functions of these mutations largely remain elusive, partially due to a lack of feasible animal models. Here, we report a convenient platform with CRISPR-Cas9-mediated introduction of genetic alterations and orthotopic transplantation to generate a series of primary ESCC models in mice. With this platform, we validate multiple frequently mutated genes, including EP300, FAT1/2/4, KMT2D, NOTCH2, and TGFBR2, as tumor-suppressor genes in ESCC. Among them, TGFBR2 loss dramatically promotes tumorigenesis and multi-organ metastasis. Paradoxically, TGFBR2 deficiency leads to Smad3 activation, and disruption of Smad3 partially restrains the progression of Tgfbr2-mutated tumors. Drug screening with tumor organoids identifies that pinaverium bromide represses Smad3 activity and restrains Tgfbr2-deficient ESCC. Our studies provide a highly efficient platform to investigate the in vivo functions of ESCC-associated mutations and develop potential treatments for this miserable malignancy.

Dasatinib suppresses invasion and induces apoptosis in nasopharyngeal carcinoma

Dasatinib, an orally available tyrosine kinas inhibitor (TKI), potently inhibits SRC which was found to activate RTKs that induce trastuzumab de novo and acquired resistance. To evaluate the potential of Dasatinib in the treatment of Nasopharyngeal Carcinoma, we used a variety of assays to measure its effects on cell proliferation, apoptosis, and migration. This work aimed to test the antitumor effects of the inhibitor in vitro to determine whether in vivo analyses were warranted. Cell growth rate and 50% inhibitory concentration was calculated by MTT assay. Dasatinib-induced apoptotic cells were investigated by Annexin V/PI staining. Proteins from cell extracts were analyzed by Western blot. Cell motility was investigated by Transwell. Our study showed that Dasatinib significantly inhibited CNE2 proliferation and induced apoptosis in vitro. Phospho-AKT, phospho-MEK, phospho-ERK expression was significantly reduced when treated with dasatinib which means the downregulated RAS/RAF/MEK/ERK and PI3K/AKT pathway activity. Dasatinib significantly inhibited the motility of CNE2 as well as Phospho-FAK expression. Dasatinib exhibit antitumor effects of nasopharyngeal carcinoma by downregulating MAPK and PI3K/AKT pathways activity and FAK phosphorylation. This suggests that dasatinib would have therapeutic activity against NPC.

Managing crawling-type gastric adenocarcinoma with endoscopic techniques and postoperative monitoring

Crawling-type gastric adenocarcinoma is a rare subtype of gastric cancer with diagnostic and therapeutic challenges due to its flat, ill-defined lesions. Advanced diagnostic techniques, such as narrow-band imaging and linear endoscopic ultrasonography, improve detection, but endoscopic submucosal dissection poses a risk of incomplete resection. Despite negative resection margins, vigilant postoperative monitoring is crucial due to the potential for recurrence. This letter highlights the importance of refined diagnostic criteria, individualized treatment approaches, and continuous follow-up to optimize management of this unique gastric cancer subtype.

Effectiveness and safety of full-thickness versus circular muscle myotomy in peroral endoscopic myotomy: a retrospective single-center analysis of 152 patients

BACKGROUND

Achalasia is a primary esophageal motility disorder, which shows impaired relaxation of the lower esophageal sphincter (LES) and the absence of peristalsis, leading to dysphagia, weight loss, and chest pain. In recent years, peroral endoscopic myotomy (POEM) has become a popular method for treating achalasia. However, the effectiveness and safety of full-thickness myotomy (FTM) versus circular muscle myotomy (CMM) in POEM require further investigation.

METHODS

This retrospective single-center analysis studied 152 patients who underwent POEM surgery at the General Hospital of the Western Theater Command from May 2014 to May 2023. Patients were divided into two groups based on the depth of myotomy: the FTM group and the CMM group. Parameters such as surgical success rate, procedure time, and myotomy length were evaluated, and treatment efficacy was assessed based on the Eckardt score. Postoperative complications and efficacy were also monitored.

RESULTS

Technical success was achieved in both groups, with shorter procedure times in the FTM group (P < 0.05). There were no significant differences in postoperative Eckardt scores and symptom improvement between the FTM and CMM groups. The incidence of adverse events was similar in both groups. The incidence of gastroesophageal reflux disease (GERD) seemed to be higher in the FTM group, although this difference was not statistically significant (P = 0.051).

CONCLUSION

For patients with achalasia, there were no significant differences in short-to-medium-term treatment efficacy and safety between FTM and CMM in POEM. Although FTM significantly reduced procedure time, it may lead to a higher incidence of GERD. More cases are needed in the future to explore the more appropriate myotomy for different achalasia subtypes.

Magnet-assisted diverticuloplasty for treating the symptomatic esophageal diverticulum: a case series (with video)

BACKGROUND

The development of the magnetic compression technique (MCT) for the gastrointestinal (GI) tract has been widely applied in the treatment of biliary strictures, esophageal atresia, and GI anastomoses. Our team combined the MCT and minimally invasive endoscopic operation to propose a novel alternative procedure called magnet-assisted diverticuloplasty (MAD) for treating various esophageal diverticula. This case series aimed to report the effectiveness, safety, and our experience of MAD.

METHODS

This retrospective case series included patients with symptomatic esophageal diverticulum (SED) who underwent MAD between November 2017 and June 2022 in West China Hospital, Sichuan University. The patients' symptomatic scores were accessed by Eckardt symptomatic scores. The telephone follow-up period ended in March 2023. The primary outcome of the study was clinical success. Secondary outcomes included the technical success of MAD, procedure time, hospitalization, recurrence, and adverse events.

RESULTS

We reported 6 patients with SED who underwent MAD (3 with Zenker's, 1 with middle, and 2 with lower esophageal diverticulum). The technical success rate was 100% (6/6) and no adverse events were reported. The median procedural duration was 22.5 min (interquartile range (IQR) 18.5). The mean hospitalization was 2 days (range 1-3). The median time of follow-up endoscopy was on postoperative day 18 (IQR 31), revealing a shortened diverticular septum under endoscopic examination. After a median telephone follow-up of 23 months (IQR 36), the median total symptomatic score decreased significantly from 4.00 (IQR 3.25) to 1.00 (IQR 2.00) (P = 0.015). The clinical success rate was 83.3% (5/6), and only one patient had recurrent symptoms two years after MAD.

CONCLUSION

MAD provided a novel method for treating SED. Our limited experience suggested that MAD could be minimally invasive and effective. More extensive, multicenter prospective studies were needed to assess this technique further.

Overexpression of periostin is significantly correlated to the tumor angiogenesis and poor prognosis in patients with esophageal squamous cell carcinoma

Recent studies have found that periostin (PN), as a kind of secreted glycoprotein, is closely related to the metastatic potential and prognosis of many kinds of tumors. This study aimed to examine the expression of PN in patients with esophageal squamous cell carcinoma (ESCC) and explore the relationship of PN expression with clinicopathologic factors, tumor angiogenesis and prognosis. The results showed that increased PN protein expression was prevalent in ESCC and was significantly associated with lymphatic metastasis (P=0.008), tumor differentiation (P=0.04), venous invasion (P=0.014) and TNM stage (P=0.001). Additionally, expression of PN was found to be an independent prognostic factor in ESCC patients. High expression of PN protein is closely correlated to the tumor progression and angiogenesis and poor survival of ESCC. Taken together, PN is a promising biomarker to identify individuals with poor prognostic potential and concludes the possibility of its use as a prognostic marker in patients with ESCC.

[Capecitabine combined with cisplatin as first-line therapy in Chinese patients with advanced gastric carcinoma-a phase II clinical study]

OBJECTIVE

To evaluate the effectiveness and safety of the combination chemotherapy of capecitabine (X) with fractionated administration of cisplatin (C) in Chinese patients with advanced gastric cancer (AGC).

METHODS

141 patients with AGC were enrolled between July 2002 and August 2004. All patients had measurable tumor according to the criteria of RECIST, Karnofsky performance status > or = 60, adequate bone marrow, renal and hepatic functions. Prior radiotherapy or adjuvant chemotherapy was not permitted. Patients received oral administration of capecitabine at a dose of 1000 mg/m(2) twice a day on D1-D14, and intravenous infusion of fractionated cisplatin at a dose of 20 mg/m(2)/day on D1-D5. The regimen was repeated every 3 weeks, totally for 6 cycles.

RESULTS

Of the 141 evaluable patients, there were 104 men and 37 women, with a median age of 54 years (range, 23 - 80 years). Metastases before chemotherapy were detected in lymph nodes (46.8%), liver (40.4%), lung (5.7%) and other area (10.6%). The median treatment duration was 6 cycles (range, 3 - 6 cycles). The objective response rate (RR) was 36.2% (51/141). The median follow-up period was 17.5 months. The median time to progress (TTP) was 9.0 months, and the median overall survival (OS) was 12.0 months. The most common treatment-related adverse events (grade 3/4) were: hand-foot syndrome (HFS) (2.1%), leucopenia (0.7%), abnormal alanine transaminase elevation (2.8%). There was no treatment-related death.

CONCLUSION

Capecitabine combined with fractionated cisplatin is highly effective and well tolerated as a first-line treatment for advanced gastric cancer, with comparable results to 5-Fu plus cisplatin combination therapy.