[Advances in the study of non-infectious liver diseases and precancerous lesions of hepatocellular carcinoma]

Hepatocellular carcinoma (HCC) is a major disease with a high degree of malignancy, and poor prognosis, which seriously endangers human health. Chronic viral hepatitis (HBV, HCV)-cirrhosis-liver cancer patterns of pathogenesis has been widely accepted. However, the relationship between non-infectious liver disease and HCC is not completely clear; thereby how various non-infectious liver diseases develop through precancerous lesions has attracted widespread attention to HCC. A full understanding of these precancerous lesions is likely to provide new ideas and strategies for the prevention and treatment of non-infectious liver disease-related HCC.

[Advances in the diagnostic pathological features of precancerous lesions of hepatocellular carcinoma]

The occurrence of hepatocellular carcinoma (HCC) is a multistep development process through precancerous lesions. A precancerous lesion of HCC is classified into hepatocyte dysplasia at the cytological level and dysplastic nodules at the histological level, and the corresponding lesion subtypes have different risks of canceration. Pathology is the "gold standard" for the diagnosis of early stage HCC and its precancerous lesions. However, it also faces many difficulties and challenges, such as the accumulation of experience in the pathological diagnosis, the understanding and grasp of key points of histopathological diagnosis and differential diagnosis, the combination application of immune and molecular diagnostic markers, and many others. This article briefly discusses the key points of pathological features and differential diagnosis of precancerous lesions of HCC.

Mir-421 in plasma as a potential diagnostic biomarker for precancerous gastric lesions and early gastric cancer

Objective

MicroRNA (miR)-421 plays a key role in cancer progression. It has been reported that circulating miR-421may be a potential tumor marker for the diagnosis of several cancers. However, the role of miR-421 in plasma as a potential biomarker in the diagnosis of precancerous gastric lesions (Pre) and early-stage gastric cancer (GC) remains poorly understood. In this study, we investigated miR-421 in plasma as a novel potential biomarker for the detection of precancerous gastric lesions and early-stage (GC).

Materials & Methods

The miRNA content was determined by quantitative real-time polymerase chain reaction (qRT-PCR). MiR-421 content in all subjects was normalized by endogenous miRNA (miR-16). The diagnostic value of miR-421 for Pre and GC was assessed by comparing receiver operating characteristic (ROC) analysis with traditional tumor markers, including CEA, CA125, CA153, CA211 and CA50. The correlation between the expression of miR-421 and the pathological characteristics of Pre and GC was analyzed.

Results

Elevated expression of miR-421 in plasma can robustly distinguish the normal population from Pre and GC cases, especially in the early stages of gastric cancer cases (all p < 0.05). The ROC analyses showed that the area under the ROC curve (AUC), sensitivity, accuracy and Youden index of miR-421 were superior to traditional tumor markers (CEA, CA125, CA153, CA211, and CA50) in GC diagnosis, while its specificity was higher than CEA, CA153 and CA50 (all p < 0.05). MiR-421 in plasma had higher AUC value than AFP, CA153, CA211 and CA50 in the diagnosis of Pre (all p < 0.05), while specificity, accuracy and Youden index of miR-421 was only lower than CA211. The efficiency of miR-421 in the diagnosis of GC was significantly higher than that of CA211 and CA50, and it was significantly higher than CA153, CA211 and CA50 in the diagnosis of Pre (all p < 0.05). In addition, up-regulation of miR-421 occurred initially in precancerous gastric lesions as well as in the early stage of GC.

Conclusions

Overexpression of plasma miR-421 is a novel biomarker for the detection of precancerous lesions and early gastric cancer.

[Analysis of psychological status and relevant factors of patients with esophageal and gastric cardia precancerous lesions in Linzhou of Henan]

Objective: To explore the psychological status and related factors in patients with precancerous of esophageal and gastric cardia in Linzhou of Henan. Methods: Clinical psycho-rating scale of Social Support Rating Scale (SSRS), Self-Rating Anxiety Scale (SAS, score ≥50 points with symptoms of anxiety) and Self-Rating Depression Scale (SDS, score ≥53 points with the symptoms of depression) were applied to survey life events and psychological status of subjects who aged 40-69 years old and participated in"The Early diagnosis and Early Treatment"program in Linzhou cancer hospital from July 2015 to Jan 2016. Patients with lower intraepithelial neoplasia or high-grade intraepithelial neoplasia were selected as precancerous lesions (n=118), and patients with normal grade were selected as healthy controls (n=210). Compare the differences of the scores between the two groups, and the logistic regression model was used to analyze the related factors of precancerous lesions and psychological status of the study subjects. Results: Precancerous lesions included esophageal (72 cases), gastric cardia (40 cases), esophageal and cardia dual source (6 cases); Precancerous lesions and healthy controls aged (57.17±7.71) and (53.12±7.99) years old, the difference was statistically significant (P<0.001). The anxiety and depression scale showed that the scores of SAS and SDS scores in the precancerous lesions were (37.18±10.01), (40.44±8.37) points, and (34.02±6.63), (38.49±8.73) points in control group, the difference was statistically significant (P=0.002, 0.032). While the social support total score (38.26±5.26), and subjective support score (24.08±3.83) and objective support score (7.50±1.89) in control group were all higher than those of precancerous group (36.80±6.18, 23.01±3.93, 6.93±1.57), and the difference were statistically significant (P=0.024, 0.016, 0.004). In addition, the Logistic analysis showed that subjects with low objective social support, subjective social support and anxiety symptoms were more likely to develop precancerous lesions, and the OR were 0.81, 0.72 and 1.05, respectively (P=0.028, 0.005, 0.009). Conclusion: Social support, anxiety and depression status may be related to the occurrence and development of esophageal and gastric cardia precancerous lesions.

Differences Between the Intestinal Lumen Microbiota of Aberrant Crypt Foci (ACF)-Bearing and Non-bearing Rats

BACKGROUND

Multiple factors including host-microbiota interaction could contribute to the conversion of healthy mucosa to sporadic precancerous lesions. An imbalance of the gut microbiota may be a cause or consequence of this process.

AIM

The goal was to investigate and analyze the composition of gut microbiota during the genesis of precancerous lesions of colorectal cancer.

METHODS

To analyze the composition of gut microbiota in the genesis of precancerous lesions, a rat model of 1, 2-dimethylhydrazine (DMH)-induced aberrant crypt foci (ACF) was established. The feces of these rats and healthy rats were collected for 16S rRNA sequencing.

RESULTS

The diversity and density of the rat intestinal microbiota were significantly different between ACF-bearing and non-bearing group. ACF were induced in rats treated with DMH and showed increased expression of the inflammatory cytokines IL-6, IL-8, and TNF-α. Firmicutes was the most predominant phylum in both ACF-bearing and non-bearing group, followed by Bacteroidetes. Interestingly, although the density of Bacteroidetes decreased from the fifth week to the 17th week in both groups, it was significantly reduced in ACF-bearing group at the 13th week (P < 0.01). At the genus level, no significant difference was observed in the most predominant genus, Lactobacillus. Instead, Bacteroides and Prevotella were significantly less abundant (P < 0.01), while Akkermansia was significantly more abundant (P < 0.05) in ACF-bearing group at the 13th week.

CONCLUSION

Imbalance of the intestinal microbiota existed between ACF-bearing and non-bearing rats, which could be used as biomarker to predict the genesis of precancerous lesions in the gut.

[Diagnosis and Minimally Invasive Endoscopic Treatment of Early Esophageal Cancer and Precancerous Lesions]

Esophageal cancer is a common malignancy of digestive tract, and its prognosis is closely related to early diagnosis and treatment. In recent years, with the development of endoscopic diagnosis and treatment technology, especially the breakthrough progress of new endoscopic equipments, the detection rate of early esophageal cancer and precancerous lesions is significantly improved, and more and more patients with early esophageal cancer can be treated with minimally invasive endoscopic treatment. At present, endoscopic dissection has become the preferred treatment for early esophageal cancer and precancerous lesions. The advantages is not only less traumatic than traditional surgery, but also retain the physiological structure of esophagus, achieve accurate postoperative pathology and better postoperative quality of life of patients. However, endoscopic minimally invasive treatment in progress also face new problems to be solved, such as how to deal with multifocal esophageal lesions, how to estimate esophageal lesions infiltration depth and lymph node metastasis risk accurately, how to understand the discrepancy between biopsy and postoperative pathology, how to deal with the positive resection margins as well as intraoperative and postoperative complications, how to manage endoscopic treatment of the special subpopulation of the patients, whether and when additional radical surgery should be provided to the patients with non-curative endoscopic treatment, and so on. Aiming to the above problems and the purpose to improve the prognosis and the quality of life of esophageal cancer patients, this topic includes a series studies to explore standardized treatment scheme and management strategy for postoperative complications in the endoscopic treatment of early esophageal cancer and precancerious lesions.

[Multivariate analysis of the association between consumption of fried food and gastric cancer and precancerous lesions]

Objective: To investigate the effect of fried food intake on the pathogenesis of gastric cancer and precancerous lesions. Methods: From 2005 to 2013, the residents aged 40-69 years from 11 counties/cities where cancer screening of upper gastrointestinal cancer were conducted in rural areas of Henan province as the subjects (82 367 cases). The information such as demography and lifestyle was collected. The residents were screened with endoscopic examination. The biopsy sampleswere diagnosed pathologically, according to pathological diagnosis criteria, the subjects with high risk were divided into the groups with different pathological degrees. The multivariate ordinal logistic regression analysis was used to analyze the relationship between the frequency of fried food intake and gastric cancer and precancerous lesions. Results: The study coverd 46 425 males and 35 942 females, with a age of (53.46±8.07)years. The study collected 6 707 cases of normal stomach, 2 325 cases of low grade intraepithelial neoplasia, 226 cases of high grade intraepithelial neoplasia and 331 cases of gastric cancer. Multivariate logistic regression analysis showed that, compared with those whoeat fried food less than one time per week, fried foods intake (<2 times/week: OR=1.89, 95%CI: 1.57-2.28; ≥ 2 times/week: OR=1.91, 95%CI: 1.66-2.20) were a risk factor for gastric cancer and precancerous lesions after adjustment for age, sex, marital status, educational level, body mass index (BMI), smoking and drinking status. Conclusion: The intake of fried food is a risk factor for gastric cancer and precancerous lesions. Therefore, reducing the intake of fried food can prevent the occurrence of gastric carcinoma and precancerous lesions.

TERT expression in gastric carcinogenesis: Correlation with clinical features

AIM

To investigate the expression of telomerase reverse transcriptase (TERT) mRNA in gastric cancer and precancerous lesions, and to analyze the relationship between TERT expression and clinicopathologic features and prognosis in gastric cancer.

METHODS

From September 2011 to October 2016, 102 patients with gastric cancer, 32 patients with precancerous lesions, and 30 patients with chronic non-atrophic gastritis were treated at the First Affiliated Hospital of Jiamus University. The expression of TERT mRNA in tissues was detected by real-time quantitative PCR, and the correlation of expression of TERT with clinicopathologic features and prognosis in gastric cancer was analyzed.

RESULTS

The expression of TERT in gastric cancer and precancerous lesions was significantly higher than that in chronic non-atrophic gastritis (P < 0.05). TERT expression was significantly correlated with the depth of invasion, TNM stage, vascular invasion, and lymph node metastasis (P < 0.05). The overall survival rate of gastric cancer patients with high expression of TERT was significantly lower than that of patients with low expression of TERT (HR = 0.420, 95%CI: 0.264-0.668, P < 0.001). The progression-free survival rate of gastric cancer patients with high expression of TERT was also significantly lower than that of patients with low TERT expression (HR = 0.649, 95%CI: 0.421-0.999, P = 0.049). Cox multivariate survival analysis showed that TERT expression was an independent prognostic factor for overall survival in gastric cancer.

CONCLUSION

TERT is highly expressed in gastric cancer and precancerous lesions, and high expression of TERT is significantly associated with the clinicopathologic features and prognosis of gastric cancer patients.

Epidemiologic and economic burden of HPV diseases in Spain: implication of additional 5 types from the 9-valent vaccine

Background

A new nonavalent human papillomavirus (HPV) vaccine that includes genotypes 6/11/16/18/31/33/45/52/58 has been recently approved in Spain. A previous study has shown that attributable fraction of HPV related diseases in Spain is consistent with that reported in European and global studies. The aim of the present study was to estimate the annual direct costs associated to the following HPV-related diseases: genital warts, high grade precancerous lesions and cancer of cervix, vulva, vagina, anus and penis and head and neck cancer, caused by genotypes included in the nonavalent (9vHPV) and quadrivalent vaccines (4vHPV), in Spanish men and women.

Methods

Cancer registries and epidemiological studies were used to estimate the number of new annual cases of genital warts, anogenital precancerous lesions and cancer of cervix, vulva, vagina, anus, penis and head and neck, as well as the fraction attributable to HPV infection and to genotypes targeted by both vaccines in Spain. Costs per patient for each disease were obtained from the literature. In addition, 142 specialists were surveyed to estimate cost per patient of vulvar, vaginal, anal and penile precancerous lesions. The annual burden of diseases attributable to types targeted by both vaccines was estimated and compared. All results were validated by a panel of experts.

Results

In 2016, new genital warts, precancerous lesions and cancers attributable to types targeted by the 9vHPV were estimated at 49,251, 29,405 and 3381, respectively. Among them, 12,597 new precancerous lesions and 530 new cancers were related to the 5 additional types covered by the 9vHPV. Annual cost of new cases of these diseases associated to types targeted by the 4vHPV and 9vHPV were estimated at 116.7 and 150.9 million € for the Spanish National Health Service (NHS), respectively (2017 €).

Conclusions

HPV-related diseases represent a major burden for the Spanish NHS. Annual new cases and costs related to the 5 additional types from the 9vHPV represent a significant burden compared with that associated to types included in the 4vHPV.

Electronic supplementary material

The online version of this article (10.1186/s13027-018-0187-4) contains supplementary material, which is available to authorized users.

Efficacy of narrow-band imaging in detecting early esophageal cancer and risk factors for its occurrence

OBJECTIVE

The aim of this study is to evaluate the efficacy of narrow-band imaging (NBI) in the detecting early esophageal cancer and precancerous lesions and to investigate the risk factors for its occurrence.

METHODS

The esophagus was examined with ordinary endoscopy, NBI, and iodine staining. All the lesions were confirmed by histopathologically as the gold standard; NBI and intrapapillary capillary scale (IPCL) scale were compared with pathologic diagnosis. The accuracy, sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated. Subgroup analysis was performed between the elderly vs. younger group, and head and neck squamous cell cancer (HNSCC) vs. non-HNSCC patients.

RESULTS

Ninety lesions were detected with ordinary endoscopy, 108 with NBI, and 120 with iodine staining. All esophageal cancers were detected both by NBI and by iodine staining. Accuracy, sensitivity, and specificity for esophageal cancer and precancerous lesion were 67.8%, 58.1%, and 76.6%; 92%, 89.7%, and 96%; 93.4%, 93.4%, and 93.2%, respectively. NBI endoscopy and iodine staining were superior to ordinary endoscopy for detecting esophageal cancer and precancerous lesions (p < 0.05). NBI showed better detection of esophageal neoplasms in the elderly patients (p < 0.001). The incidence of multiple squamous cell cancers (SCCs) was significantly higher in non-elderly group (p = 0.009). NBI can also detect more esophageal neoplastic lesions in patients with head and neck cancers (p = 0.003).

CONCLUSIONS

NBI endoscopy appears as effective as Lugol staining to detect and screen the early esophageal cancer. NBI shows better detection of esophageal neoplasms in the elderly patients. The incidence of multiple SCCs was much higher in non-elderly patients.

[Multivariate ordinal logistic regression analysis on the association between consumption of fried food and both esophageal cancer and precancerous lesions]

Objective: To investigate the effect of fried food intake on the pathogenesis of esophageal cancer and precancerous lesions. Methods: From 2005 to 2013, all the residents aged 40-69 years from 11 counties (cities) where cancer screening of upper gastrointestinal cancer had been conducted in rural areas of Henan province, were recruited as the subjects of study. Information on demography and lifestyle was collected. The residents under study were screened with iodine staining endoscopic examination and biopsy samples were diagnosed pathologically, under standardized criteria. Subjects with high risk were divided into the groups based on their different pathological degrees. Multivariate ordinal logistic regression analysis was used to analyze the relationship between the frequency of fried food intake and esophageal cancer and precancerous lesions. Results: A total number of 8 792 cases with normal esophagus, 3 680 with mild hyperplasia, 972 with moderate hyperplasia, 413 with severe hyperplasia carcinoma in situ, and 336 cases of esophageal cancer were recruited. Results from multivariate logistic regression analysis showed that, when compared with those who did not eat fried food, the intake of fried food (<2 times/week: OR=1.60, 95%CI: 1.40-1.83; ≥2 times/week: OR=2.58, 95%CI: 1.98-3.37) appeared a risk factor for both esophageal cancer or precancerous lesions after adjustment for age, sex, marital status, educational level, body mass index, smoking and alcohol intake. Conclusion: The intake of fried food appeared a risk factor for both esophageal cancer and precancerous lesions.

Clinical Significance of Myeloid Zinc Finger 1 Expression in the Progression of Gastric Tumourigenesis

BACKGROUND/AIMS

To investigate the clinical significance of myeloid zinc finger 1 (MZF1) expression in various gastric mucosal lesions including chronic superficial gastritis (CSG), chronic atrophic gastritis (CAG), intestinal metaplasia (IM), dysplasia (DYS) and gastric cancer (GC) in comparison with normal tissues and gastric cell lines.

METHODS

MZF1 protein expression was detected using immunohistochemical staining in 37 CSG, 88 CAG, 77 IM, 51 DYS, 165 GC and 8 normal tissue samples. Quantitative real-time PCR (qRT-PCR) and western blotting were used to detect the level of MZF1 in gastric cell lines, 15 normal tissues and 34 GC samples, as well as 2 groups of paired primary GC and adjacent normal samples.

RESULTS

Reduced MZF1 expression was detected in most GC cells and tissues. Among the gastric tissues consisting of various stages of lesions (normal, CSG, CAG, IM, DYS and GC), MZF1 protein expression was downregulated in precancerous lesions and GC. The data from clinical analyses showed that decreased MZF1 expression was correlated with tumour invasion (p = 0.044), lymph node metastasis (p = 0.048) and poor prognosis of GC patients (p = 0.003). Moreover, MZF1 was identified as an independent prognostic biomarker for GC patients in multivariate Cox regression analysis (p = 0.009).

CONCLUSION

Downregulation of MZF1 was associated with gastric tumourigenesis, which may be a novel early predictive and prognostic biomarker in GC patients.

Applications of acetic acid spray combined with narrow band imaging in diagnosis of early gastrointestinal cancers and precancerous lesions

Many new endoscopic techniques have been used for the diagnosis of early gastrointestinal cancers and precancerous lesions, such as magnifying endoscopy, narrow-band imaging (NBI), Fuji intelligent chromoendiscopy, i-scan imaging, confocal laser endomicroscopy, and chromoendoscopy (Lugol's iodine, indigo carmine, methylene blue, acetic acid, and crystal violet). Each technique has its own advantages and disadvantages (e.g., being expensive and prolonged examination duration). Spraying acetic acid onto the mucosal surface can enhance the recognition of mucosal surface architecture, and NBI has the advantage to display the microvascular morphology. Thus, acetic acid spray combined with NBI endoscopy can greatly improve the diagnosis of early gastrointestinal cancers and precancerous lesions. Since this combination has low cost and no adverse reactions, they can be used in primary hospitals without magnification endoscopy.

Efficacy of antiviral drug AV2 in the treatment of human papillomavirus-associated precancerous lesions of the uterine cervix: A randomized placebo-controlled clinical trial in Kinshasa, DR Congo. (KINVAV study)

Background

Cervical Cancer (CC) is a major public health problem in DR Congo; the high incidence of CC is due to the inexistence of effective screening programs based on cytology and/or HPV detection followed by appropriate treatments. This situation highlights the need to implement efficacious and inexpensive treatment methods. This study aims at evaluating the efficacy of a topical antiviral drug named AV2^® as a treatment for HPV-associated lesions of the cervix.

Methods

Women will undergo cytology sampling, HPV testing and Visual inspection of the cervix after application of 5% acetic acid (VIA). VIA-positive women will be randomized to one of two groups to receive treatment by either AV2^®or placebo. They will undergo control examinations after two months and after six months. In case of persistent lesions on VIA, treatment by cryotherapy will be done. The primary outcomes will be the change of lesions, the clearance of HPV DNA, and the correlation of the two 2 months after treatment with AV2^®.

Conclusion

This study is the first large-scale study in Africa to evaluate systematically the efficacy and safety of a topical antiviral drug for the treatment of HPV— associated lesions of the cervix. Its findings will direct the planning of suitable algorithms for CC screening and treatment.

Clinical trial registration

ClinicalTrials.gov – Unique identifier: NCT02346227, registered on November 8, 2014.

Hue-texture-embedded region-based model for magnifying endoscopy with narrow-band imaging image segmentation based on visual features

BACKGROUND AND OBJECTIVE

Magnification endoscopy with narrow-band imaging (ME-NBI) has become a feasible tool for detecting diseases within the human gastrointestinal tract, and is more applied by physicians to search for pathological abnormalities with gastric cancer such as precancerous lesions, early gastric cancer and advanced cancer. In order to improve the reliability of diseases detection, there is a need for applying or proposing computer-assisted methodologies to efficiently analyze and process ME-NBI images. However, traditional computer vision methodologies, mainly segmentation, do not express well to the specific visual characteristics of NBI scenario.

METHODS

In this paper, two energy functional items based on specific visual characteristics of ME-NBI images have been integrated in the framework of Chan-Vese model to construct the Hue-texture-embedded model. On the one hand, a global hue energy functional was proposed representing a global color information extracted in H channel (HSI color space). On the other hand, a texture energy was put forward presenting local microvascular textures extracted by the PIF of adaptive threshold in S channel.

RESULTS

The results of our model have been compared with Chan-Vese model and manual annotations marked by physicians using F-measure and false positive rate. The value of average F-measure and FPR was 0.61 and 0.16 achieved through the Hue-texture-embedded region-based model. And the C-V model achieved the average F-measure and FPR value of 0.52 and 0.32, respectively. Experiments showed that the Hue-texture-embedded region-based outperforms Chan-Vese model in terms of efficiency, universality and lesion detection.

CONCLUSIONS

Better segmentation results are acquired by the Hue-texture-embedded region-based model compared with the traditional region-based active contour in these five cases: chronic gastritis, intestinal metaplasia and atrophy, low grade neoplasia, high grade neoplasia and early gastric cancer. In the future, we are planning to expand the universality of our proposed methodology to segment other lesions such as intramucosal cancer etc. As long as these issues are solved, we can proceed with the classification of clinically relevant diseases in ME-NBI images to implement a fully automatic computer-assisted diagnosis system.

Estimation of the overall burden of cancers, precancerous lesions, and genital warts attributable to 9-valent HPV vaccine types in women and men in Europe

BACKGROUND

In addition to cervical cancer, human papillomavirus (HPV) is responsible for a significant proportion of cancers and precancerous lesions of the vulva, vagina, anus, penis, head and neck, as well as genital warts. We estimated the annual number of new cases of these diseases attributable to 9-valent HPV vaccine types in women and men in Europe.

METHODS

The annual number of new cancers of the cervix, vulva, vagina, anus, penis, and selected head and neck sites in the population of the European Medicines Agency territory was estimated based on age-specific incidence rates extracted from Cancer Incidence in 5 Continents, Volume X and Eurostat population data for 2015. The annual number of new cancers attributable to 9-valent HPV vaccine types was estimated by applying the HPV attributable fraction from reference publications based on a large European multicenter study. For non-cervical cancers, HPV attributable fractions were based on oncogenically-active HPV infections only (i.e., detection of HPV DNA and either mRNA and/or p16 positivity). For precancerous lesions of the cervix, vulva, vagina, and anus, and for genital warts, previously published estimations were updated for the 2015 population.

RESULTS

The annual number of new cancers attributable to 9-valent HPV vaccine types was estimated at 47,992 (95% bound: 39,785-58,511). Cervical cancer showed the highest burden (31,130 cases), followed by head and neck cancer (6,786 cases), anal cancer (6,137 cases), vulvar cancer (1,466 cases), vaginal cancer (1,360 cases), and penile cancer (1,113 cases). About 81% were estimated to occur in women and 19% in men. The annual number of new precancerous lesions (CIN2+, VIN2/3, VaIN2/3, and AIN2/3) and genital warts attributable to 9-valent HPV vaccine types was estimated at 232,103 to 442,347 and 680,344 to 844,391, respectively.

CONCLUSIONS

The burden of cancers associated with 9-valent HPV vaccine types in Europe is substantial in both sexes. Head and neck cancers constitute a heavy burden, particularly in men. Overall, about 90% of HPV-related cancers, 80% of precancerous lesions, and 90% of genital warts are expected to be attributable to 9-valent HPV vaccine types each year, demonstrating the important preventive potential of the 9-valent HPV vaccine in Europe.

Clinical significance of HIF-1α expression in gastric malignant transformation in people from high altitude area of Qinghai

AIM

To detect the expression of hypoxia inducible factor-1α (HIF-1α) in gastric malignant transformation in people from high altitude area of Qinghai, China.

METHODS

RT-PCR was used to detect the expression of HIF-1α gene in 7 cell lines and 27 pairs of GC and matched tumor adjacent normal gastric mucosa tissues. Using tissue microarray including 57 normal gastric mucosa tissues, 37 chronic atrophic gastritis tissues, 34 intestinal metaplasia tissues, and 146 gastric cancer (GC) tissues, immunohistochemistry (IHC) was performed to detect the level of HIF-1α protein expression.

RESULTS

The expression of HIF-1α at the mRNA level was different in GC cell lines. HIF-1αexpression in AGS, SGC7901, and N87 cells was higher than that in MGC803, BGC823, PAMC82 and MKN45 cells. The level of HIF-1α expression was significantly higher in GC tissues (66.6%, 18/27) compared with normal gastric mucosa tissues (26.3%, 15/57; P < 0.001). IHC data showed that the positive rate of HIF-1α was 64.8% (24/37) in chronic atrophic gastritis tissues, 61.7% (21/34) in intestinal metaplasia tissues, and 56.8% (83/146) in GC tissues, all of which were significantly higher than that in normal tissues (26.3%, 15/57). Expression of HIF-1α was positively associated with age in GC (P < 0.05). Kaplan-Meier analysis showed that patients with a low level of HIF-1α had apparently better survival than those with a high level (P < 0.0001). HIF-1α protein (RR = 3.229, 95%CI: 2.024-5.151) was identified to be an independent risk factor for the outcome of GC patients.

CONCLUSION

High HIF-1α expression is associated with gastric malignant transformation and poor prognosis in high altitude areas.

Identification of AgNORs and cytopathological changes in oral lichen planus lesions

OBJECTIVE

To evaluate cytopathological changes in epithelial cells of the oral mucosa of patients with oral lichen planus (OLP) compared with patients without OLP.

SUBJECTS AND METHODS

Swabs were collected from the oral mucosa of 20 patients with OLP (case group) and 20 patients without OLP (control group) using liquid-based cytology. After Papanicolaou staining, the smears were characterized based on Papanicolaou classification and degree of maturation. Nuclear area (NA) measurements, cytoplasmic area (CA) measurements, and the NA/CA ratio were determined from 50 epithelial cells per slide. For quantification of argyrophilic nucleolar organizer regions (AgNORs), the smears were stained with silver nitrate, and the number of AgNORs was counted in 100 cells.

RESULTS

In both groups, there was a predominance of Papanicolaou Class I nucleated cells in the superficial layer. The average values of NA (p>0.05) and CA (p=0.000) were greater in the case group (NA=521.6, CA=22,750.3) compared with the control group (NA=518.9, CA=18,348.0). The NA/CA ratio was 0.025 for the case group and 0.031 for the control group (p=0.004). There was no significant difference between the mean AgNORs values of both groups (p>0.05).

CONCLUSION

The oral mucosa of patients with OLP exhibited significant cytomorphometric changes. However, there was no evidence of malignancy.

Prevalence of oral ulcers and its association with addictions in rural population of western Uttar Pradesh and eastern Rajasthan

BACKGROUND

Head and neck cancer in Indian perspective predominantly relates to tobacco use. The present study explores the prevalence of oral ulcers and its association with addictions among the population of Uttar Pradesh and Rajasthan, India.

METHODOLOGY

The screening method in early detection of head and neck cancer is broadly symptom based. 1399 subjects from Uttar Pradesh and Rajasthan were screened by trained personnel between April and June 2015.

RESULTS

Study findings showed, mouth ulcers and trismus were common symptoms and tobacco chewing and smoking were common addictions. There were statistically significant associations among the symptoms and addictions as well as predominance in rural populations. The majority of smokers (27.1%) belonged to age ≥55 years whereas the tobacco chewers (29.2%) and alcohol abusers (45.8%) in the age group 25-34 years. Also the risk of developing mouth ulcers and trismus in this area are approximately 35 (MRR: 35.7, 95% CI: 15.5-81.9) and nearly eight (MRR: 7.7, 95% CI: 2.2-26.6) times higher respectively in males. However, joint use of smoked and smokeless tobacco increases nearly three times more risk of either mouth ulcers or trismus.

CONCLUSION

Male individuals are more exposed to certain addictions such as tobacco (smoked and smokeless) and alcohol. The prevalence of oral ulcers is primarily associated with the addictions. Therefore, these persons are more at risk of further developing head neck cancer. A large level community screening and awareness are required especially among the rural population of India.

Clinical and pathological characteristics of colorectal polyps: Analysis of 180 cases

AIM: To investigate the clinical and pathological characteristics of colorectal polyps.

METHODS: From January 2014 to March 2015, 90 patients with colorectal adenomatous polyps treated at the Affiliated Hospital of Youjiang Medical College for Nationalities were included in a study group, and 90 patients with non-adenomatous polyps were included in a control group. The clinical and pathological characteristics were compared between the two groups of patients.

RESULTS: The rate of bloody stool and average age differed significantly between the two groups (P < 0.05), although there was no significant difference in the change in stool character, anal pendant expansion, diarrhea, abdominal pain, body mass index (BMI) or gender (P > 0.05). The rates of high-grade intraepithelial neoplasia, low-grade intraepithelial neoplasia, lobulation, mucosal roughness and erosion, sessile polyps, multiple polyps, and polyps larger than 1 cm in diameter were significantly higher in the study group than in the control group (P < 0.05).

CONCLUSION: Older age and bloody stool are main risk factors for adenomatous polyps. The presence of high-grade intraepithelial neoplasia, low-grade intraepithelial neoplasia, lobulation, mucosal roughness and erosion, sessile polyps, multiple polyps, or polyps larger than 1 cm in diameter suggests the possibility of malignant transformation.

Endoscopic resection versus surgery for early gastric cancer and precancerous lesions: a meta-analysis

Aim

To compare the efficacy and safety of endoscopic resection (ER) and surgery for the treatment of early gastric cancer and precancerous lesions.

Methods

Databases, such as PubMed, EMBASE, Cochrane Library, and Science Citation Index, from 2000 to 2016, were searched for eligible articles. In this meta-analysis, the main outcome measurements were local recurrence, complications, metachronous lesions, hospital stay, and 5-year overall survival.

Results

Nine trials were identified and a total of 2748 patients were included. The rate of complication was higher in the surgery group compared with the ER group (OR 0.41; 95 % CI 0.30–0.55). The rates of local recurrence and metachronous lesions were lower in the surgery group (OR 0.03; 95 % CI 0.00–0.06; OR 8.76; 95 % CI 4.17–18.41). The hospital stay was shorter in the ER group (mean difference −6.96; 95 % CI −7.94 to −5.99). The 5-year overall survival rate did not significantly differ between the two groups (OR 1.23; 95 % CI 1.03–1.47).

Conclusions

We provided evidence that, ER was comparable to surgery in terms of the 5-year overall survival. In addition, ER had a lower rate of complications and shorter hospital stay, but a higher rate of local recurrence and metachronous lesions for the treatment of early gastric cancer and precancerous lesions.

Cytoplasmic Drosha Is Aberrant in Precancerous Lesions of Gastric Carcinoma and Its Loss Predicts Worse Outcome for Gastric Cancer Patients

BACKGROUND

The nuclear localization of Drosha is critical for its function as a microRNA maturation regulator. Dephosphorylation of Drosha at serine 300 and serine 302 disrupts its nuclear localization, and aberrant distribution of Drosha has been detected in some tumors.

AIMS

The purpose of the present study was to assess cytoplasmic/nuclear Drosha expression in gastric cancer carcinogenesis and progression.

METHODS

Drosha expression and its subcellular location was investigated by immunohistochemical staining of a set of tissue microarrays composed of normal adjacent tissues (374), chronic gastritis (137), precancerous lesions (94), and gastric adenocarcinoma (829) samples, and in gastric cancer cell lines with varying differentiation by immunofluorescence and western blot assay.

RESULTS

Gradual loss of cytoplasmic Drosha was accompanied by tumor progression in both gastric cancer tissues and cell lines, and was inversely associated with tumor volume (P = 0.002), tumor grade (P < 0.001), tumor stage (P = 0.018), and distant metastasis (P = 0.026). Aberrant high levels of cytoplasmic Drosha were apparent in intestinal metaplasia and dysplasia tissues. The levels of nuclear Drosha were sharply decreased in chronic gastritis and maintained through precancerous lesions to gastric cancer. High levels of cytoplasmic Drosha predicted longer survival (LR = 7.088, P = 0.008) in gastric cancer patients.

CONCLUSIONS

Our data provide novel insights into gastric cancer that cytoplasmic Drosha potentially plays a role in preventing carcinogenesis and tumor progression, and may be an independent predictor of patient outcome.

Latest developments in precancerous lesions of hepatocellular carcinoma

Hepatocarcinogenesis in human chronic liver diseases is a multi-step process in which hepatic precancerous lesions progress into early hepatocellular carcinoma (HCC) and progressed HCC, and the close surveillance and treatment of these lesions will help improve the survival rates of patients with HCC. The rapid development and extensive application of imaging technology have facilitated the discovery of nodular lesions of ambiguous significance, such as dysplastic nodules. Further investigations showed that these nodules may be hepatic precancerous lesions, and they often appear in patients with liver cirrhosis. Although the morphology of these nodules is not sufficient to support a diagnosis of malignant tumor, these nodules are closely correlated with the occurrence of HCC, as indicated by long-term follow-up studies. In recent years, the rapid development and wide application of pathology, molecular genetics and imaging technology have elucidated the characteristics of precancerous lesions. Based on our extensive review of the relevant literature, this article focuses on evidence indicating that high-grade dysplastic nodules are more likely to transform into HCC than low-grade dysplastic nodules based on clinical, pathological, molecular genetic and radiological assessments. In addition, evidence supporting the precancerous nature of large cell change in hepatitis B virus-related HCC is discussed.

Significance of detection of DNA ploidy and T lymphocytes in patients with gastric cancer or precancerous lesions

AIM: To investigate the distribution of DNA heteroploid in gastric cancer and precancerous lesions and its relationship with cellular immune function.

METHODS: DNA ploidy, T lymphocytes and NK cells were detected by flow cytometry in 20 cases of gastric cancer, 20 cases of precancerous lesions and 20 cases of normal gastric mucosa.

RESULTS: DNA heteroploid rate in the gastric cancer group was higher than that in the normal group (80% vs 0%, P < 0.05). DNA heteroploid rate in the gastric cancer group was associated with the degree of tissue differentiation (P < 0.05). DNA heteroploid rate in signet ring cell carcinoma was higher than that in the highly and moderately differentiated adenocarcinoma. In the precancerous lesion group, DNA heteroploid rate was significantly higher in high-grade intraepithelial neoplasia than in low-grade intraepithelial neoplasia and intestinal metaplasia (P < 0.05). The values of CD3⁺ T cells, CD4⁺ T cells, CD4⁺/CD8⁺, and NK in heteroploid were decreased compared to those in diploid (P < 0.05); the value of CD8⁺ T cells was increased in heteroploid compared with diploid.

CONCLUSION: The heteroploid rates of gastric cancer and precancerous lesion are higher than that in normal gastric mucosa. The distribution of heteroploid is associated with clinicopathologic features of gastric cancer and precancerous lesions; the immune status of different DNA ploidy types is significantly different.

A possible role of GDDR in the development of Helicobacter pylori-associated gastric cancer

Helicobacter pylori (H. pylori) infection plays an important part in the development of gastric carcinoma. GDDR has been confirmed as a tumor suppressor gene in gastric tumorigenesis. However, the underlying mechanism of GDDR in H. pylori-induced carcinogenesis is not well known. The aim of this study is to investigate the clinicopathological significance and possible molecular mechanism of GDDR in gastric cancer associated with H. pylori. Western blot, real-time quantitative PCR (qRT-PCR), and immunohistochemistry were used to detect the expression level of GDDR with or without H. pylori infection. The function and possible related molecular mechanisms of GDDR were further explored in vitro and in vivo. The variability of GDDR expression appeared in the early stage of gastric carcinogenesis with positive H. pylori infection status. GDDR might inhibit the progression of normal gastric epithelial cells to cancer cells by suppressing NF-kappaB signaling pathway, which in turn could be regulated by H. pylori infection. Our results suggested, for the first time, that the gradual change in GDDR expression might not only be directly related to H. pylori infection but also be an early molecular event in the development of gastric carcinoma.