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Gao Z, Qi X, Zhou H, Ju M, Wang R, Li K, Zhu Z, Liu X. ASO Visual Abstract: Individualized Choice of Simultaneous Cholecystectomy in Patients with Gastric Cancer: A Systematic Review and Meta-Analysis. Ann Surg Oncol 2023; 30:1757-1758. [PMID: 36520233 DOI: 10.1245/s10434-022-12858-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] [Imported: 08/29/2023]
Affiliation(s)
- Ziming Gao
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang City, China
| | - Xiang Qi
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang City, China
| | - Heng Zhou
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang City, China
- Department of Anesthesiology, The First Affiliated Hospital of China Medical University, Shenyang City, China
| | - Mingguang Ju
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang City, China
| | - Ruiying Wang
- Department of Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang City, China
| | - Kai Li
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang City, China
| | - Zhi Zhu
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang City, China.
| | - Xiaofang Liu
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang City, China.
- Department of Anorectal Surgery, The First Affiliated Hospital of China Medical University, Shenyang City, China.
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Gao Z, Qi X, Zhou H, Ju M, Wang R, Li K, Zhu Z, Liu X. Individualized Choice of Simultaneous Cholecystectomy in Patients with Gastric Cancer: A Systematic Review and Meta-analysis. Ann Surg Oncol 2023; 30:1744-1754. [PMID: 36404379 DOI: 10.1245/s10434-022-12792-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/25/2022] [Indexed: 11/21/2022] [Imported: 08/29/2023]
Abstract
BACKGROUND Patients undergoing gastrectomy for gastric cancer are more likely to develop gallstones than the general population. Prophylactic cholecystectomy remains controversial. METHODS Studies from 2000-2022 were systematically searched in the PubMed, EMBASE, and Cochrane Library databases. The search included simultaneous cholecystectomy or risk factors for gallstone formation with gastrectomy alone. Major prognostic factors included complications and mortality, and risk factor analyses included age, sex, TNM stage, gastrectomy type, lymph node dissection, diabetes, and duodenal exclusion. Random effects regression models were used to analyze risk estimates and data were presented as odds ratios (ORs) with corresponding 95% confidence intervals (CIs). RESULTS There were no significant differences in postoperative morbidity (OR 1.12, 95% CI 0.90-1.39; p = 0.33, I2 = 11%) and mortality (OR 1.23, 95% CI 0.62-2.43; p = 0.56, I2 = 0%) between gastrectomy alone and simultaneous cholecystectomy. Older age (OR 1.48, 95% CI 1.36-1.59; p < 0.001, I2 = 59%), male sex (OR 1.38, 95% CI 1.10-1.71; p = 0.004, I2 = 77%), total gastrectomy (OR 1.50, 95% CI 1.25-1.81; p < 0.001, I2 = 72%), diabetes mellitus (OR 1.38, 95% CI 1.17-1.63; p < 0.001, I2 = 8%), and duodenal exclusion (OR 1.77, 95% CI 1.47-2.15; p < 0.001, I2 = 30%) were risk factors for cholecystolithiasis. CONCLUSIONS Simultaneous cholecystectomy did not increase the incidence of postoperative complications or mortality. Older age, male sex, total gastrectomy, duodenal exclusion, and diabetes were risk factors for gallstone development after gastrectomy.
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Affiliation(s)
- Ziming Gao
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang City, China
| | - Xiang Qi
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang City, China
| | - Heng Zhou
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang City, China.,Department of Anesthesiology, The First Affiliated Hospital of China Medical University, Shenyang City, China
| | - Mingguang Ju
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang City, China
| | - Ruiying Wang
- Department of Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang City, China
| | - Kai Li
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang City, China
| | - Zhi Zhu
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang City, China.
| | - Xiaofang Liu
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang City, China. .,Department of Anorectal Surgery, The First Affiliated Hospital of China Medical University, Shenyang City, China.
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Xue C, Du Y, Li Y, Xu H, Zhu Z. Tumor budding as a predictor for prognosis and therapeutic response in gastric cancer: A mini review. Front Oncol 2023; 12:1003959. [PMID: 36755859 PMCID: PMC9900096 DOI: 10.3389/fonc.2022.1003959] [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: 07/26/2022] [Accepted: 12/30/2022] [Indexed: 01/24/2023] [Imported: 08/29/2023] Open
Abstract
In recent years, the role of tumor budding in gastric cancer has received increased attention across a number of disciplines. Several studies have found associations between tumor budding and the prediction of lymph node metastasis in early gastric cancer, prognosis of advanced gastric cancer, predictors of therapeutic response to immune checkpoint inhibitors, such as microsatellite instability (MSI), and therapeutic targets of molecular targeted therapy, such as human epidermal growth factor receptor 2 (HER-2). Therefore, tumor budding is a major element in the formulation of risk stratification and precision medicine strategies for patients with gastric cancer.
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Li Y, Xue C, Gao Z, Li K, Xu H, Zhu Z. Efficacy of neoadjuvant immunotherapy in advanced colorectal cancer: a meta-analysis of cross-sectional studies. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04402-6. [PMID: 36260157 DOI: 10.1007/s00432-022-04402-6] [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: 08/10/2022] [Accepted: 10/05/2022] [Indexed: 10/24/2022] [Imported: 08/29/2023]
Abstract
BACKGROUND Although neoadjuvant immunotherapy is being widely studied, there is no consensus on its efficacy in microsatellite-stable (MSS) or mismatch repair proficient (pMMR) colorectal cancer (CRC). This meta-analysis aimed to evaluate studies on neoadjuvant immunotherapy for advanced CRC to assess its efficacy and provide new clinical guidelines. METHODS We searched literature databases to identify studies that assessed the efficacy of neoadjuvant immunotherapy in advanced CRC. The outcomes evaluated were pathological complete response (pCR), major pathological response (MPR), R0 resection, and anal preservation rates. Heterogeneity among the included studies was assessed by sensitivity analysis, and publication bias was evaluated using Begg and Egger tests. RESULTS Eleven articles were included in the analysis. The pCR, MPR, R0 resection, and anal preservation rates reported in these studies were 39 and 49, 97, and 76%, respectively. The MSI-H and MSS groups had pooled pCR rates of 70 and 24%, respectively. The pCR rates for the induction, consolidation, and concurrent immuno-chemoradiotherapy (CRT) subgroups were 43, 33, and 27%, respectively, and those for the single and double immunotherapy subgroups were 34 and 40%, respectively. CONCLUSION Neoadjuvant immunotherapy combined with CRT is effective in treating MSI-H/dMMR advanced CRC. It could also be a new first-line therapeutic option for MSS/pMMR advanced CRC.
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Affiliation(s)
- Yuegang Li
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, People's Republic of China.,Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Hebei Cancer Hospital, Chinese Academy of Medical Sciences, Langfang, 065001, China
| | - Chi Xue
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Ziming Gao
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Kai Li
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Huimian Xu
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Zhi Zhu
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, People's Republic of China.
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Li Y, Du Y, Xue C, Wu P, Du N, Zhu G, Xu H, Zhu Z. Efficacy and safety of anti-PD-1/PD-L1 therapy in the treatment of advanced colorectal cancer: a meta-analysis. BMC Gastroenterol 2022; 22:431. [PMID: 36217119 PMCID: PMC9549670 DOI: 10.1186/s12876-022-02511-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 04/06/2022] [Accepted: 09/16/2022] [Indexed: 12/24/2022] [Imported: 08/29/2023] Open
Abstract
Background Immune checkpoint inhibitors have shown promise in microsatellite instability-high/mismatch repair deficient (MSI-H/dMMR) advanced colorectal cancer (CRC) immunotherapy, and many clinical trials have been conducted. Objective To evaluate the efficacy and safety of PD-1/PD-L1 inhibitors in advanced CRC. Method PubMed, Web of Science, Embase, and The Cochrane Library were searched for relevant studies up to September 2021. A retrospective cross-sectional data analysis was performed and Stata 16 software was used for analyses. Results Sixteen studies including 1503 patients were analyzed. The objective response rate (ORR) of anti-PD-1/PD-L1 was 23% (95% CI 0.14, 0.31); the overall 1-year survival rate (OSR) was 57% (95% CI 0.42, 0.73). The ORR of MSI-H/dMMR advanced CRC was 37% (95% CI 0.25, 0.48) and that of microsatellite stable/mismatch repair proficient (MSS/pMMR) disease was 11% (95% CI 0.06, 0.16). The ORR was 42% in the BRAF mutant subgroup and 19% in the RAS mutant group. The ORR was 14% in the PD-L1 ( +) subgroup and 32% in the PD-L1(-) subgroup. The rate of adverse effects was 85% (95% CI 0.80, 0.91). Conclusion Anti-PD-1/PD-L1 therapy in MSI-H/dMMR advanced CRC was associated with improved survival. Anti PD-1/PD-L1 combined with antiangiogenic drugs, targeted agents, or chemotherapy might be effective in MSS mCRC. Immunotherapy was effective for the BRAF mutant and KRAS/NRAS(RAS) mutant CRC. Low expression of PD-L1 was a potential predictive marker for positive response and outcome. The high incidence of adverse events at 85% was worthy of further investigation. Further analysis with a higher number of high-quality studies is needed to verify the conclusions.
Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02511-7.
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Affiliation(s)
- Yuegang Li
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Yuwei Du
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Chi Xue
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Pei Wu
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Nan Du
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Guolian Zhu
- Department of Surgical Oncology, The Fifth People's Hospital of Shenyang City, Shenyang, China
| | - Huimian Xu
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Zhi Zhu
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China.
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Liu W, Chen H, Zhu Z, Liu Z, Ma C, Lee YJ, Bartlett DL, Guo ZS. Ferroptosis Inducer Improves the Efficacy of Oncolytic Virus-Mediated Cancer Immunotherapy. Biomedicines 2022; 10:biomedicines10061425. [PMID: 35740445 PMCID: PMC9219720 DOI: 10.3390/biomedicines10061425] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 03/21/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 12/15/2022] [Imported: 08/29/2023] Open
Abstract
Ferroptosis is a type of programmed cell death dependent on iron and characterized by the accumulation of lipid peroxides. In this study, we explore the combination of a ferroptosis activator with an oncolytic vaccinia virus in tumor models. Erastin induced cell death in hepatoma, colon, and ovarian cancer cells, but not in melanoma cancer cells. Erastin, not the oncolytic vaccinia virus (OVV), induced the expression of key marker genes for ferroptosis in cancer cells. In hepatocellular carcinoma and colon cancer models, either erastin or OVV inhibited tumor growth, but a combination of the two yielded the best therapeutic effects, as indicated by inhibited tumor growth or regression and longer host survival. Immunological analyses indicate that erastin alone had little or no effect on systemic immunity or local immunity in the tumor. However, when combined with OV, erastin enhanced the number of activated dendritic cells and the activity of tumor-infiltrating T lymphocytes as indicated by an increase in IFN-γ+CD8+ and PD-1+CD8+ T cells. These results demonstrate that erastin can exert cytotoxicity on cancer cells via ferroptosis, but has little effect on immune activity by itself. However, when combined with an OVV, erastin promoted antitumoral immunity and efficacy by increasing the number of activated dendritic cells and promoting the activities of tumor specific CD8+ T cells in the tumor.
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Affiliation(s)
- Weilin Liu
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (W.L.); (H.C.); (Z.Z.); (Z.L.); (C.M.); (Y.J.L.)
- UPMC Hillman Cancer Center, Pittsburgh, PA 15232, USA
- Xiangya Medical College, Central South University, Changsha 410013, China
| | - Hongqi Chen
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (W.L.); (H.C.); (Z.Z.); (Z.L.); (C.M.); (Y.J.L.)
- UPMC Hillman Cancer Center, Pittsburgh, PA 15232, USA
| | - Zhi Zhu
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (W.L.); (H.C.); (Z.Z.); (Z.L.); (C.M.); (Y.J.L.)
- UPMC Hillman Cancer Center, Pittsburgh, PA 15232, USA
| | - Zuqiang Liu
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (W.L.); (H.C.); (Z.Z.); (Z.L.); (C.M.); (Y.J.L.)
- UPMC Hillman Cancer Center, Pittsburgh, PA 15232, USA
- AHN-Cancer Institute, Pittsburgh, PA 15212, USA
| | - Congrong Ma
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (W.L.); (H.C.); (Z.Z.); (Z.L.); (C.M.); (Y.J.L.)
- UPMC Hillman Cancer Center, Pittsburgh, PA 15232, USA
| | - Yong J. Lee
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (W.L.); (H.C.); (Z.Z.); (Z.L.); (C.M.); (Y.J.L.)
- UPMC Hillman Cancer Center, Pittsburgh, PA 15232, USA
| | - David L. Bartlett
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (W.L.); (H.C.); (Z.Z.); (Z.L.); (C.M.); (Y.J.L.)
- UPMC Hillman Cancer Center, Pittsburgh, PA 15232, USA
- AHN-Cancer Institute, Pittsburgh, PA 15212, USA
- Correspondence: (D.L.B.); (Z.-S.G.); Tel.: +1-412-359-3782 (D.L.B.); +1-716-845-8952 (Z.-S.G.)
| | - Zong-Sheng Guo
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (W.L.); (H.C.); (Z.Z.); (Z.L.); (C.M.); (Y.J.L.)
- UPMC Hillman Cancer Center, Pittsburgh, PA 15232, USA
- Department of Immunology, Roswell Park Cancer Institute, Buffalo, NY 14203, USA
- Correspondence: (D.L.B.); (Z.-S.G.); Tel.: +1-412-359-3782 (D.L.B.); +1-716-845-8952 (Z.-S.G.)
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Wu P, Xu HM, Zhu Z. Neoadjuvant chemotherapy without radiation as a potential alternative treatment for locally advanced rectal cancer: A meta-analysis. World J Gastrointest Oncol 2021; 13:1196-1209. [PMID: 34616523 PMCID: PMC8465444 DOI: 10.4251/wjgo.v13.i9.1196] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/01/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
BACKGROUND Neoadjuvant chemoradiotherapy (Neo-CRT) is the current standard strategy for treating locally advanced rectal cancer. However, it delays the administration of optimal chemotherapy and increases toxicity.
AIM To compare the feasibility and efficacy of neoadjuvant chemotherapy (Neo-CT) and Neo-CRT for patients with locally advanced rectal cancer.
METHODS The Cochrane, EMBASE, and PubMed databases were searched for relevant articles using MESH terms and free words. The hazard ratio of overall survival and the risk ratio (RR) for the pathological complete response, the sphincter preservation rate, and treatment-related adverse events were analyzed.
RESULTS A total of 19 studies of 60870 patients were included in the meta-analysis. There was no significant difference in overall survival [hazard ratio = 1.09, 95% confidence interval (CI) = 0.93–1.24; P = 0.19] or the pathological complete response (RR = 0.79, 95%CI = 0.61–1.03; P = 0.086) between the Neo-CT and Neo-CRT groups. As compared to the Neo-CRT group, the incidences of anastomotic fistula (RR = 0.49, 95%CI = 0.35–0.68; P = 0.000) and temporary colostomy (RR = 0.69, 95%CI = 0.58–0.83; P = 0.000) were significantly lower in the Neo-CT group, with a simultaneous increase in the sphincter preservation rate (RR = 1.07, 95%CI = 1.01–1.13; P = 0.029). However, there was no significant difference in the tumor downstaging rate, overall complications, and urinary complications.
CONCLUSION Neo-CT administration can lower the incidences of anastomotic fistula and temporary colostomy and increase the sphincter preservation rate as to compared to Neo-CRT and could provide an alternative to chemoradiotherapy for locally advanced rectal cancer.
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Affiliation(s)
- Pei Wu
- Department of Gastrointestinal Surgery, Yongchuan Hospital of Chongqing Medical University, Chongqing 402160, China
- Department of Surgical Oncology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Hui-Mian Xu
- Department of Surgical Oncology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Zhi Zhu
- Department of Surgical Oncology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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Pan S, Li K, Huang B, Huang J, Xu H, Zhu Z. Efficacy and safety of immune checkpoint inhibitors in gastric cancer: a network meta-analysis of well-designed randomized controlled trials. Ann Transl Med 2021; 9:290. [PMID: 33708917 PMCID: PMC7944325 DOI: 10.21037/atm-20-6639] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] [Imported: 08/29/2023]
Abstract
Background Immune checkpoint inhibitors (ICIs) that inhibit the programmed death 1 (PD-1)/programmed death-ligand 1 (PD-L1) and cytotoxic T-lymphocyte antigen 4 (CTLA-4) interactions have shown promising prospects as treatment options for advanced gastric cancer (AGC). This manuscript analyzed well designed clinical trials to evaluate the efficacy and safety of immunotherapy in AGC. Methods PubMed, Embase, the Cochrane Library, and Medline were searched for randomized controlled trials (RCTs) of AGC treatments that were published before April 2020. Progression-free survival (PFS), overall survival (OS), objective response rate (ORR), and treatment-related adverse events (TRAEs) were evaluated to determine the efficacy and safety of ICIs. Network meta-analysis was performed using a random-effects model under the Bayesian framework. The ability of each treatment was ranked using the surface under the cumulative ranking (SUCRA) curve. Results Our analysis included five studies having seven immunotherapy regimens and 1,730 patients. The network meta-analysis showed that nivolumab 1 mg/kg every 3 weeks plus ipilimumab 3 mg/kg every 3 weeks (88.369%) was the regimen most likely to improve PFS. Nivolumab 3 mg/kg every 3 weeks (84.563%) and nivolumab 1 mg/kg every 3 weeks plus ipilimumab 3 mg/kg every 3 weeks (84.556%) were similarly best for OS outcome with excellent tolerance. The regimen of avelumab 10 mg/kg every 2 weeks (91.167%) had the lowest TRAEs. All immunotherapies had similar response rates. Conclusions We recommend nivolumab 3 mg/kg every 2 weeks or nivolumab 1 mg/kg every 3 weeks plus ipilimumab 3 mg/kg every 3 weeks as the preferred regimen due to their high efficacies.
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Affiliation(s)
- Siwei Pan
- Department of Surgical Oncology, First Hospital of China Medical University, Shenyang, China.,Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Kai Li
- Department of Surgical Oncology, First Hospital of China Medical University, Shenyang, China.,Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Baojun Huang
- Department of Surgical Oncology, First Hospital of China Medical University, Shenyang, China.,Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jinyu Huang
- Department of Surgical Oncology, First Hospital of China Medical University, Shenyang, China.,Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Huimian Xu
- Department of Surgical Oncology, First Hospital of China Medical University, Shenyang, China.,Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhi Zhu
- Department of Surgical Oncology, First Hospital of China Medical University, Shenyang, China.,Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, China
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Gong Y, Wang X, Zhu Z. Pseudomyxoma Peritonei Originating from Transverse Colon Mucinous Adenocarcinoma: A Case Report and Literature Review. Gastroenterol Res Pract 2020; 2020:5826214. [PMID: 32714388 DOI: 10.1155/2020/5826214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/13/2020] [Accepted: 06/20/2020] [Indexed: 02/08/2023] [Imported: 08/29/2023] Open
Abstract
Background Pseudomyxoma peritonei (PMP) is a rare neoplasm involving the peritoneum. Most PMPs are low-grade appendicular mucinous neoplasms (LAMNs). There have been no reports of PMP originating from a transverse colonic mucinous adenocarcinoma and causing metastatic mucinous adenocarcinoma. Case Presentation. We report a 46-year-old woman who presented with a right abdominal mass of more than 4-month duration. Transverse colonic mucinous adenocarcinoma, PMP, and ovarian metastatic mucinous adenocarcinoma were diagnosed. The patient's diet was normal, and she had no abdominal pain or bloating. The abdomen mass increased in the month before treatment. After chemotherapy, the transverse colon mass and ovarian giant cyst were resected and about 2000 mL of gelatinous tumor tissue was removed. Postoperative histology confirmed PMP from the transverse colonic mucinous adenocarcinoma, ovarian metastatic mucinous adenocarcinoma, and mesocolon metastatic cancer. Multiple lung metastases appeared 8 months after surgery. The patient died 29 months after surgery because of an inability to eat and poor nutrition. A systematic literature review of the management and outcome of all known similar cases is also presented. Conclusions This is the first report of PMP originating from a transverse colonic mucinous adenocarcinoma. It was diagnosed during resective surgery, involved ovarian metastasis, and survival was short. We did an extensive literature review in order to describe the clinical characteristics, histopathological findings, genetic profile, and potential treatments of PMP caused by nonappendiceal mucinous adenocarcinoma.
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Zhu Z, Gong Y, Xu H. Clinical and pathological staging of gastric cancer: Current perspectives and implications. Eur J Surg Oncol 2020; 46:e14-e19. [PMID: 32732091 DOI: 10.1016/j.ejso.2020.06.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/20/2020] [Accepted: 06/05/2020] [Indexed: 02/07/2023] [Imported: 08/29/2023] Open
Abstract
Accurate categorization of invasive depth and lymph node metastasis or optimization of TNM categories is fundamentally critical for prognostic assessment and decision making regarding subsequent therapies after surgery for gastric cancer. Improving the precision of the TNM staging is the ongoing goal. The evolution of the staging system indicates that there is no "ideal staging". Every update has criticized the lack of a standard approach for the stages to date. T staging depends on the accurate determination of the depth of infiltration based on pathological continuous sections. N staging is susceptible to the influence of lymph node detection, and insufficient lymph node detection can lead to N staging migration. M staging is required to improve the detection rate of peritoneal positive free cancer cells to determine the high risk factors of peritoneal metastasis. At present, the quality of standardized pathological diagnosis of gastric cancer requires improvement. Based on a review of the literature and experience from multiple gastric cancer centers, we present a new development in TNM staging and a way to improve clinical and pathological quality control of gastric cancer.
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Affiliation(s)
- Zhi Zhu
- Department of Surgical Oncology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, PR China; Key Laboratory of Gastric Cancer Molecular Pathology of Liaoning Province, 155 Nanjing North Street, Heping District, Shenyang, 110001, PR China.
| | - Yingbo Gong
- Department of Surgical Oncology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, PR China; Key Laboratory of Gastric Cancer Molecular Pathology of Liaoning Province, 155 Nanjing North Street, Heping District, Shenyang, 110001, PR China.
| | - Huimian Xu
- Department of Surgical Oncology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, PR China; Key Laboratory of Gastric Cancer Molecular Pathology of Liaoning Province, 155 Nanjing North Street, Heping District, Shenyang, 110001, PR China.
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Gong Y, Pan S, Wang X, Zhu G, Xu H, Zhu Z. A novel lymph node staging system for gastric cancer including modified Union for cancer Control/American Joint Committee on cancer and Japanese Gastric Cancer Association criteria. Eur J Surg Oncol 2020; 46:e27-e32. [PMID: 32631708 DOI: 10.1016/j.ejso.2020.06.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/07/2020] [Accepted: 06/05/2020] [Indexed: 02/07/2023] [Imported: 08/29/2023] Open
Abstract
BACKGROUND The TNM system of the International Union for Cancer Control/American Joint Committee on Cancer (UICC/AJCC) and the Japanese Gastric Cancer Association (JGCA) systems are the most used lymph node (LN) staging systems in gastric cancer. This study estimated the influence of anatomic location-based node stations on survival and proposed a new staging method based on both the number and anatomical distribution of metastatic LNs (mLNs). METHODS Stage I-III gastric cancer patients with radical gastrectomy were retrospectively evaluated. Overall survival (OS) was estimated in 1786 patients with UICC/AJCC stage N1-N3b disease and compared with estimates obtained using JGCA group 1-3 mLN staging. RESULTS The OS of UICC/AJCC stage N1-N3b patients with group 2 JGCA mLNs was significantly worse than that of patients with only group 1 mLNs. The OS of the patients with group 2 mLNs was similar to that of patients with group 1 mLNs but in the next more advanced UICC/AJCC-N stage. The OS of patients with group 3 mLNs was worse than that of patients with any UICC/AJCC-N stage and was similar to that of N3b patients with group 2 mLNs. A new pathological node (pN) staging classification was developed that advanced the N-staging of patients with group 2 mLNs. It was a better indicator of prognosis than the eighth UICC/AJCC-N and the thirteenth JGCA group staging systems. CONCLUSIONS A simple, accurate pN staging system including both the number and location of mLNs had improved homogeneity, discriminatory ability, and gradient monotonicity.
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Affiliation(s)
- Yingbo Gong
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, PR China.
| | - Siwei Pan
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, PR China.
| | - Xin Wang
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, PR China.
| | - Guolian Zhu
- Department of Surgical Oncology, Shenyang Cancer Hospital, Shenyang, 110001, Liaoning, PR China.
| | - Huimian Xu
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, PR China.
| | - Zhi Zhu
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, PR China.
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Du N, Wu P, Wang P, Du Y, Li K, Wang Z, Xu H, Zhu Z. Reconstruction Methods and Complications of Esophagogastrostomy and Jejunal Interposition in Proximal Gastrectomy for Gastric Cancer: A Meta-Analysis. Gastroenterol Res Pract 2020; 2020:8179254. [PMID: 32411203 DOI: 10.1155/2020/8179254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 12/07/2019] [Accepted: 12/28/2019] [Indexed: 12/03/2022] [Imported: 08/29/2023] Open
Abstract
Background Proximal gastrectomy is used for the treatment of primary gastric cancer by open or laparoscopic surgery in the upper third of the stomach. Esophagogastrostomy (EG) or jejunal interposition (JI) is widely used in various reconstruction methods after proximal gastrectomy. We conducted a meta-analysis of EG and JI for treatment of gastric cancer. Materials and Methods A search of PubMed, Embase, MEDLINE, J-STAGE, and Cochrane Library identified retrospective series on EG and JI. Weight mean differences (WMDs), odds ratios (ORs), and 95% confidence intervals (CIs) were used to analyze the operation-related data and postoperative complications. Heterogeneity was evaluated by the I2 test, and potential publication bias was assessed with Egger regression tests and sensitivity analysis. Results Eight studies were selected, and 496 patients were included. EG group benefits were 44.81 min shorter operating time (P < 0.001), 56.58 mL less blood loss (P = 0.03), and 7.4 days shorter hospital stay time (P < 0.001) than the JI group. Between the two groups, there was no significant difference in anastomotic leakage; otherwise, the EG group had a lower risk of anastomotic stenosis (OR = 0.44, 95%CI = 0.20 to 0.97, P = 0.04), lower risk of intestinal obstruction (OR = 0.07, 95%CI = 0.01 to 0.43, P = 0.004), and higher risk of reflux esophagitis (OR = 2.47, 95%CI = 1.07 to 5.72, P = 0.03). Conclusion The results of our study indicated that EG has significant advantages during the perioperative period and in short-term outcomes compared to JI.
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Pan S, Wang P, Xing Y, Li K, Wang Z, Xu H, Zhu Z. Retrieved lymph nodes from different anatomic groups in gastric cancer: a proposed optimal number, comparison with other nodal classification strategies and its impact on prognosis. Cancer Commun (Lond) 2019; 39:49. [PMID: 31519217 PMCID: PMC6743096 DOI: 10.1186/s40880-019-0394-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 03/03/2019] [Accepted: 08/30/2019] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
Background The optimal number of retrieved lymph nodes (LNs) in gastric cancer (GC) is still debatable and previous studies proposing new classification alternatives mostly focused on the number of retrieved LNs without proper consideration on the anatomic nodal groups’ location. Here, we assessed the impact of retrieved LNs from different nodal location groups on the survival of GC patients. Methods Stage I–III gastric cancer patients who had radical gastrectomy were investigated. LN grouping was determined according to the 13th edition of the JCGC. The optimal cut-off values of retrieved LNs in different LN groups (Group 1 and 2) were calculated, based on which a proposed nodal classification (rN) simultaneously accounting the optimal number and location of retrieved LNs was proposed. The performance of rN was then compared to that of LN ratio, log-odds of metastatic LNs (LODDs) and the 8th edition of the Union for International Cancer Control/American Joint Committee on Cancer (UICC/AJCC) N classification. Results The optimal cut-off values for Group 1 and 2 were 13 and 9, respectively. The 5-year overall survival (OS) was higher for patients in retrieved Group 1 LNs > 13 (vs. Group 1 LNs ≤ 13, 63.2% vs. 57.9%, P = 0.005) and retrieved Group 2 LNs > 9 (vs. Group 2 LNs ≤ 9, 72.5% vs. 60.7%, P = 0.009). Patients staged as pN0–3b were sub classified using this Group 1 and 2 nodal analogy. The OS of pN0–N2 patients in retrieved Group 1 LNs > 13 or Group 2 LNs > 9 were superior to those in retrieved Group 1 LNs ≤ 13 and Group 2 LNs ≤ 9 (All P < 0.05); except for pN3 patients. The rN classification was formulated and demonstrated better 5-year OS prognostication performance as compared to the LNR, LODDs, and the 8th UICC/AJCC N staging system. Conclusions The retrieval of > 13 and > 9 LNs for Group 1 and Group 2, respectively, could represent an alternative lymph node retrieval approach in radical gastrectomy for more precise survival prognostication and minimizing staging migration, especially if > 16 LNs is found to be difficult.
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Affiliation(s)
- Siwei Pan
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, North Nanjing Street 155, Shenyang, 110001, Liaoning, P. R. China
| | - Pengliang Wang
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, North Nanjing Street 155, Shenyang, 110001, Liaoning, P. R. China
| | - Yanan Xing
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, North Nanjing Street 155, Shenyang, 110001, Liaoning, P. R. China
| | - Kai Li
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, North Nanjing Street 155, Shenyang, 110001, Liaoning, P. R. China
| | - Zhenning Wang
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, North Nanjing Street 155, Shenyang, 110001, Liaoning, P. R. China
| | - Huimian Xu
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, North Nanjing Street 155, Shenyang, 110001, Liaoning, P. R. China.
| | - Zhi Zhu
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, North Nanjing Street 155, Shenyang, 110001, Liaoning, P. R. China.
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