101
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Xie C, Subhash VV, Datta A, Liem N, Tan SH, Yeo MS, Tan WL, Koh V, Yan FL, Wong FY, Wong WK, So J, Tan IB, Padmanabhan N, Yap CT, Tan P, Goh LK, Yong WP. Melanoma associated antigen (MAGE)-A3 promotes cell proliferation and chemotherapeutic drug resistance in gastric cancer. Cell Oncol (Dordr) 2016; 39:175-86. [PMID: 26868260 DOI: 10.1007/s13402-015-0261-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Melanoma-associated antigen (MAGE)-A3 is a member of the family of cancer-testis antigens and has been found to be epigenetically regulated and aberrantly expressed in various cancer types. It has also been found that MAGE-A3 expression may correlate with an aggressive clinical course and with chemo-resistance. The objectives of this study were to assess the relationship between MAGE-A3 promoter methylation and expression and (1) gastric cancer patient survival and (2) its functional consequences in gastric cancer-derived cells. METHODS Samples from two independent gastric cancer cohorts (including matched non-malignant gastric samples) were included in this study. MAGE-A3 methylation and mRNA expression levels were determined by methylation-specific PCR (MSP) and quantitative real-time PCR (qPCR), respectively. MAGE-A3 expression was knocked down in MKN1 gastric cancer-derived cells using miRNAs. In addition, in vitro cell proliferation, colony formation, apoptosis, cell cycle, drug treatment, immunohistochemistry and Western blot assays were performed. RESULTS Clinical analysis of 223 primary patient-derived samples (ntumor = 161, nnormal = 62) showed a significant inverse correlation between MAGE-A3 promoter methylation and expression in the cancer samples (R = -0.63, p = 5.99e-19). A lower MAGE-A3 methylation level was found to be associated with a worse patient survival (HR: 1.5, 95 % CI: 1.02-2.37, p = 0.04). In addition, we found that miRNA-mediated knockdown of MAGE-A3 expression in MKN1 cells caused a reduction in its proliferation and colony forming capacities, respectively. Under stress conditions MAGE-A3 was found to regulate the expression of Bax and p21. MAGE-A3 knock down also led to an increase in Puma and Noxa expression, thus contributing to an enhanced docetaxel sensitivity in the gastric cancer-derived cells. CONCLUSIONS From our results we conclude that MAGE-A3 expression is regulated epigenetically by promoter methylation, and that its expression contributes to gastric cell proliferation and drug sensitivity. This study underscores the potential implications of MAGE-A3 as a therapeutic target and prognostic marker in gastric cancer patients.
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Affiliation(s)
- Chen Xie
- Department of Haematology-Oncology, National University Hospital, Level 7, NUHS Tower Block, 1E, Kent Ridge Road, Singapore, 119228, Singapore
| | - Vinod Vijay Subhash
- Department of Haematology-Oncology, National University Hospital, Level 7, NUHS Tower Block, 1E, Kent Ridge Road, Singapore, 119228, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Arpita Datta
- Department of Physiology, National University of Singapore, Singapore, Singapore
| | - Natalia Liem
- Department of Haematology-Oncology, National University Hospital, Level 7, NUHS Tower Block, 1E, Kent Ridge Road, Singapore, 119228, Singapore
| | - Shi Hui Tan
- Department of Haematology-Oncology, National University Hospital, Level 7, NUHS Tower Block, 1E, Kent Ridge Road, Singapore, 119228, Singapore.,Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Mei Shi Yeo
- Department of Haematology-Oncology, National University Hospital, Level 7, NUHS Tower Block, 1E, Kent Ridge Road, Singapore, 119228, Singapore
| | - Woei Loon Tan
- Department of Haematology-Oncology, National University Hospital, Level 7, NUHS Tower Block, 1E, Kent Ridge Road, Singapore, 119228, Singapore
| | - Vivien Koh
- Department of Haematology-Oncology, National University Hospital, Level 7, NUHS Tower Block, 1E, Kent Ridge Road, Singapore, 119228, Singapore
| | - Fui Leng Yan
- Department of Haematology-Oncology, National University Hospital, Level 7, NUHS Tower Block, 1E, Kent Ridge Road, Singapore, 119228, Singapore
| | - Foong Ying Wong
- Department of Haematology-Oncology, National University Hospital, Level 7, NUHS Tower Block, 1E, Kent Ridge Road, Singapore, 119228, Singapore
| | - Wai Keong Wong
- Departments of Pathology and General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jimmy So
- Departments of Medicine, Surgery, and Pathology, National University Health System, Singapore, Singapore
| | - Iain Beehuat Tan
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Nisha Padmanabhan
- Department of Cancer and Stem Cell Biology, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Celestial T Yap
- Department of Physiology, National University of Singapore, Singapore, Singapore.,National University Cancer Institute, Singapore, Singapore
| | - Patrick Tan
- Department of Cancer and Stem Cell Biology, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Liang Kee Goh
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Wei Peng Yong
- Department of Haematology-Oncology, National University Hospital, Level 7, NUHS Tower Block, 1E, Kent Ridge Road, Singapore, 119228, Singapore. .,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.
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102
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Chia NY, Tan P. Molecular classification of gastric cancer. Ann Oncol 2016; 27:763-9. [PMID: 26861606 DOI: 10.1093/annonc/mdw040] [Citation(s) in RCA: 195] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/19/2016] [Indexed: 12/14/2022] Open
Abstract
Gastric cancer (GC), a heterogeneous disease characterized by epidemiologic and histopathologic differences across countries, is a leading cause of cancer-related death. Treatment of GC patients is currently suboptimal due to patients being commonly treated in a uniform fashion irrespective of disease subtype. With the advent of next-generation sequencing and other genomic technologies, GCs are now being investigated in great detail at the molecular level. High-throughput technologies now allow a comprehensive study of genomic and epigenomic alterations associated with GC. Gene mutations, chromosomal aberrations, differential gene expression and epigenetic alterations are some of the genetic/epigenetic influences on GC pathogenesis. In addition, integrative analyses of molecular profiling data have led to the identification of key dysregulated pathways and importantly, the establishment of GC molecular classifiers. Recently, The Cancer Genome Atlas (TCGA) network proposed a four subtype classification scheme for GC based on the underlying tumor molecular biology of each subtype. This landmark study, together with other studies, has expanded our understanding on the characteristics of GC at the molecular level. Such knowledge may improve the medical management of GC in the future.
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Affiliation(s)
- N-Y Chia
- Cancer and Stem Cell Biology Program, Duke-National University of Singapore Graduate Medical School
| | - P Tan
- Cancer and Stem Cell Biology Program, Duke-National University of Singapore Graduate Medical School Genome Institute of Singapore, Agency for Science, Technology, and Research Cancer Science Institute of Singapore, National University of Singapore Cellular and Molecular Research, National Cancer Centre Singapore, Singapore
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103
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Endoscopic evaluation of patients with dyspepsia in a secondary referral hospital in Egypt. ALEXANDRIA JOURNAL OF MEDICINE 2015. [DOI: 10.1016/j.ajme.2013.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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104
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Mansour-Ghanaei F, Joukar F, Rajpout Y, Hasandokht T. Screening of precancerous gastric lesions by serum pepsinogen, gastrin-17, anti-helicobacter pylori and anti- CagA antibodies in dyspeptic patients over 50 years old in Guilan Province, north of Iran. Asian Pac J Cancer Prev 2015; 15:7635-8. [PMID: 25292040 DOI: 10.7314/apjcp.2014.15.18.7635] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the value of serum gastric markers to differentiate between patients with precancerous lesions and nonatrophic chronic gastritis. MATERIALS AND METHODS Serum samples of 128 patients with dyspepsia who were candidates for endoscopic examination were tested for pepsinogen (PG I and PG II), PG I/II ratio, gastrin 17(G-17), anti-Helicobacter pylori (anti-H pylori ) and anti- CagA antibodies. Two sample t-tests, chi-square tests and Pearson's correlation analyses were used for analysis using SPSS (version 20). RESULTS PGI, PG I/II ratio values were decreased significantly in the precancerous lesion group (0.05, 0.001 respectively). The frequency of H pylori infection was significantly (p=0.03) different between the two groups ofthe study. CONCLUSIONS We suggest PGI and the PG I/II ratio as valuable markers for screening of premalignant gastric lesions.
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Affiliation(s)
- Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center (GLDRC), Guilan University of Medical Sciences, Rasht, IranE-mail : ,
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105
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Sgroi MD, Smith BR. Weight Loss and Early Satiety. Surgery 2015. [DOI: 10.1007/978-1-4939-1726-6_50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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106
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Li QQ, Lu ZH, Yang L, Lu M, Zhang XT, Li J, Zhou J, Wang XC, Gong JF, Gao J, Li J, Li Y, Shen L. Neutrophil count and the inflammation-based glasgow prognostic score predict survival in patients with advanced gastric cancer receiving first-line chemotherapy. Asian Pac J Cancer Prev 2014; 15:945-50. [PMID: 24568523 DOI: 10.7314/apjcp.2014.15.2.945] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To explore the value of systemic inflammatory markers as independent prognostic factors and the extent these markers improve prognostic classification for patients with inoperable advanced or metastatic gastric cancer (GC) receiving palliative chemotherapy. METHODS We studied the prognostic value of systemic inflammatory factors such as circulating white blood cell count and its components as well as that combined to form inflammation-based prognostic scores (Glasgow Prognostic Score (GPS), Neutrophil-Lymphocyte Ratio (NLR), Platelet Lymphocyte Ratio (PLR), Prognostic Index (PI) and Prognostic Nutritional Index (PNI)) in 384 patients with inoperable advanced or metastatic gastric cancer (GC) receiving first-line chemotherapy. Univariate and multivariate analyses were performed to examine the impact of inflammatory markers on overall survival (OS). RESULTS Univariate analysis revealed that an elevated white blood cell, neutrophil and/or platelet count, a decreased lymphocyte count, a low serum albumin concentration, and high CRP concentration, as well as elevated NLR/PLR , GPS, PI, PNI were significant predictors of shorter OS. Multivariate analysis demonstrated that only elevated neutrophil count (HR 3.696, p=0.003) and higher GPS (HR 1.621, p=0.01) were independent predictors of poor OS. CONCLUSION This study demonstrated elevated pretreatment neutrophil count and high GPS to be independent predictors of shorter OS in inoperable advanced or metastatic GC patients treated with first-line chemotherapy. Upon validation of these data in independent studies, stratification of patients using these markers in future clinical trials is recommended.
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Affiliation(s)
- Qing-Qing Li
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing, China E-mail :
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da Costa WL, Coimbra FJF, Ribeiro HSC, Diniz AL, de Godoy AL, de Farias IC, Begnami MDFS, Soares FA. Total gastrectomy for gastric cancer: an analysis of postoperative and long-term outcomes through time: results of 413 consecutive cases in a single cancer center. Ann Surg Oncol 2014; 22:750-7. [PMID: 25366586 DOI: 10.1245/s10434-014-4212-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND Advanced gastric cancer in the upper or middle third of the stomach is routinely treated with a total gastrectomy, albeit in some cases with higher morbidity and mortality. The aim of this study was to describe the morbimortality and survival results in total gastrectomy in a single center. METHODS This retrospective study included patients with gastric adenocarcinoma treated with a total gastrectomy at a single Brazilian cancer center between January 1988 and December 2011. Clinical, surgical, and pathology information were analyzed through time, with three 8-year intervals being established. Prognostic factors for survival were evaluated only among the patients treated with curative intent. RESULTS The study comprised 413 individuals. Most were male and their median age was 59 years. The majority of patients had weight loss and were classified as American Society of Anesthesiologists 2. A curative resection was performed in 336 subjects and a palliative resection was performed in 77 subjects. Overall morbidity was 37.3% and 60-day mortality was 6.5%. Temporal analysis identified more advanced tumors in the first 8-year period along with differences in the surgical procedure, with more limited lymph node dissections. In addition, a significant decrease in mortality was observed, from 13 to 4%. With a median follow-up of 74 months among living patients, median survival was 56 months, and 5-year overall survival was 49.2%. Weight loss, lymphadenectomy, tumor size, and T and N stages were prognostic factors in multivariate analysis. CONCLUSIONS Total gastrectomy is a safe and feasible treatment in experienced hands. Advances in surgical technique and perioperative care have improved outcomes through time.
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Affiliation(s)
- Wilson Luiz da Costa
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil,
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108
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Guedes MTDS, de Jesus JP, de Souza Filho O, Fontenele RM, Sousa AI. Clinical and epidemiological profile of cases of deaths from stomach cancer in the National Cancer Institute, Brazil. Ecancermedicalscience 2014; 8:445. [PMID: 25114717 PMCID: PMC4118726 DOI: 10.3332/ecancer.2014.445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Stomach cancer is the third most common cause of death worldwide, mainly affecting people with low socioeconomic status. In Brazil, we expect 20,390 new cases of stomach cancer in 2014, in both sexes, and according to the proportional distribution of the ten most prevalent types of cancer (except non-melanoma skin cancer) expected for 2014, this type of cancer was estimated to be the fourth most common in men and sixth in women. AIM To investigate and analyse the clinical and epidemiological profile of deaths caused by stomach adenocarcinoma in patients enrolled in the National Cancer Institute, Brazil. METHODS Cross-sectional study, with samples which consisted of data from the medical records of deaths from stomach cancer, enrolled in the period from 1 February 2009 to 31 March 2012 and who had died as of 30 April 2012. STATISTICAL ANALYSIS USED The Epi Info ®, version 7. RESULTS We included 264 cases, mostly male. The mean age was 61.7 years. They were smokers, drinkers, white, and married, with elementary education and an income of one minimum salary. They had advanced stage disease (E IV), with symptoms characteristic of this phase, and the majority died within six months. CONCLUSION The findings are similar to other studies. The advanced stage of the disease at the time of admission of the patients reflects the difficulty for users of the Unified Health System to access early diagnosis, demonstrating the need for efforts to identify groups and risk factors for the development of gastric cancer. Training of health professionals will facilitate planning and implementation of programmes for the prevention and control of disease, considering socioeconomic conditions, as seen in the sample, which is common among most users.
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Affiliation(s)
- Maria Teresa dos Santos Guedes
- Coordenadora de Enfermagem do Banco Nacional de Tumores e DNA/INCA, Mestre em Enfermagem/UNIRIO, Praça Cruz Vermelha, nº 23, Térreo, Centro-RJ, CEP 20230-130, Brazil
| | - José Paulo de Jesus
- Médico cirurgião e Chefe da Seção de Cirurgia Abdominopélvica do HC I/INCA, Brazil
| | - Odilon de Souza Filho
- Médico cirurgião da Seção de Cirurgia Abdominopélvica do HC I/INCA, Doutorando da Universidade de São Paulo, Brazil
| | - Raquel Malta Fontenele
- Enfermeira, Mestre em Enfermagem pela Universidade Federal do Rio de Janeiro (UFRJ), Docente da Escola de Enfermagem Aurora de Afonso Costa da Universidade Federal Fluminense, Bolsista do Banco Nacional de Tumores e DNA/INCA, Brazil
| | - Ana Inês Sousa
- Enfermeira, Doutora em Ciências pela Fundação Oswaldo Cruz, Docente da Escola de Enfermagem Anna Nery da Universidade Federal do Rio de Janeiro (UFRJ), Brazil
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Lin LL, Huang HC, Juan HF. Deciphering molecular determinants of chemotherapy in gastrointestinal malignancy using systems biology approaches. Drug Discov Today 2014; 19:1402-9. [PMID: 24793142 DOI: 10.1016/j.drudis.2014.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/15/2014] [Accepted: 04/24/2014] [Indexed: 12/26/2022]
Abstract
Gastrointestinal cancers are asymptomatic in early tumor development, leading to high mortality rates. Peri- or postoperative chemotherapy is a common strategy used to prolong the life expectancy of patients with these diseases. Understanding the molecular mechanisms by which anticancer drugs exert their effect is crucial to the development of anticancer therapies, especially when drug resistance occurs and an alternative drug is needed. By integrating high-throughput techniques and computational modeling to explore biological systems at different levels, from gene expressions to networks, systems biology approaches have been successfully applied in various fields of cancer research. In this review, we highlight chemotherapy studies that reveal potential signatures using microarray analysis, next-generation sequencing (NGS), proteomic and metabolomic approaches for the treatment of gastrointestinal cancers.
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Affiliation(s)
- Li-Ling Lin
- Institute of Molecular and Cellular Biology, Department of Life Science, National Taiwan University, Taipei, Taiwan
| | - Hsuan-Cheng Huang
- Institute of Biomedical Informatics, Center for Systems and Synthetic Biology, National Yang-Ming University, Taipei, Taiwan.
| | - Hsueh-Fen Juan
- Institute of Molecular and Cellular Biology, Department of Life Science, National Taiwan University, Taipei, Taiwan; Genome and Systems Biology Degree Program, National Taiwan University, Taipei, Taiwan; Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan.
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110
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Gikas A, Triantafillidis JK. The role of primary care physicians in early diagnosis and treatment of chronic gastrointestinal diseases. Int J Gen Med 2014; 7:159-73. [PMID: 24648750 PMCID: PMC3958525 DOI: 10.2147/ijgm.s58888] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Chronic gastrointestinal disorders are a source of substantial morbidity, mortality, and cost. They are common in general practice, and the primary care physician (PCP) has a central role in the early detection and management of these problems. The need to make cost-effective diagnostic and treatment decisions, avoid unnecessary investigation and referral, provide long-term effective control of symptoms, and minimize the risk of complications constitute the main challenges that PCPs face. The literature review shows that, although best practice standards are available, a considerable number of PCPs do not routinely follow them. Low rates of colorectal cancer screening, suboptimal testing and treatment of Helicobacter pylori infection, inappropriate use of proton pump inhibitors, and the fact that most PCPs are still approaching the irritable bowel disease as a diagnosis of exclusion represent the main gaps between evidence-based guidelines and clinical practice. This manuscript points out that updating of knowledge and skills of PCPs via continuing medical education is the only way for better adherence with standards and improving quality of care for patients with gastrointestinal diseases.
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111
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Baroudi O, Chaaben AB, Mezlini A, Moussa A, Omrane I, Jilson I, Benammar-Elgaaied A, Chabchoub S. Impact of lifestyle factors and nutrients intake on occurrence of gastrointestinal cancer in Tunisian population. Tumour Biol 2014; 35:5815-22. [DOI: 10.1007/s13277-014-1771-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 02/18/2014] [Indexed: 01/24/2023] Open
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112
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Shafaghi A, Mansour-Ghanaei F, Joukar F, Sharafkhah M, Mesbah A, Askari K, Geranmayeh S, Mehrvarz A, Souti F, Sokhanvar H, Fakhrieh S, Aminian K, Yousefi-Mashhour M, Khosh-Sorur M, Rasoulian J. Serum gastrin and the pepsinogen I/II ratio as markers for diagnosis of premalignant gastric lesions. Asian Pac J Cancer Prev 2014; 14:3931-6. [PMID: 23886209 DOI: 10.7314/apjcp.2013.14.6.3931] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Iran is a country with very high incidences of stomach cancer, especially in Northern parts. Here we assessed prognostic value of serum screening biomarkers among people >50 years old for early detection of precancerous lesions in a hot spot for gastric carcinoma in Guilan Province, North Iran. METHODS A cross- sectional population-based survey was conducted on 1,390 residents of Lashtenasha city with the mean age (SD) of 61.8 (9.02) years old (50.8% females) to assess the association of gastrin and the pepsinogen (PG) I/II ratio with premalignant gastric lesions. Blood samples were taken for CBC, blood group, and serologic exams (PGI, PGII, and gastrin 17) from each subject. Expert gastroenterologists performed upper GI endoscopy and ROC curves were generated to determine appropriate cutoff points. RESULTS Mean values of PGI, PGII, PGI/PGII and gastrin were significantly different between patients with and without atrophy or metaplasia (P<0.05). To diagnose atrophy and intestinal metaplasia, a significantly higher AUC was observed for the PGI/PGII ratio (70 and 72%, respectively) compared to the PGI (56, 55%), PGII (63, 64%) and gastrin (59, 61%) (all p<0.001). CONCLUSIONS Biomarker tests such as the PGI/II ratio can be used in the screening and diagnosis of subjects at high gastric cancer risk in our region.
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Affiliation(s)
- Afshin Shafaghi
- Division of Gastroenterology and Hepatology, Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Xu J, Evans TJ, Coon C, Copley-Merriman K, Su Y. Measuring patient-reported outcomes in advanced gastric cancer. Ecancermedicalscience 2013; 7:351. [PMID: 24062809 PMCID: PMC3776644 DOI: 10.3332/ecancer.2013.351] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Indexed: 12/19/2022] Open
Abstract
Background Gastric cancer (GC), one of the most common cancers in the world, is often diagnosed at an advanced stage and associated with a poor prognosis. Quality of life and patient-reported outcomes (PROs) are important considerations when treating GC patients. The aim of this study was to identify existing PRO instruments that would be appropriate for use in GC trials. Methods Data were obtained from a systematic literature review and interviews with clinical experts. A literature search was conducted using OVID (EMBASE and MEDLINE) and yielded 1,008 abstracts; 92 assessed PROs in an advanced GC. Results Key symptoms and functional impacts identified through the literature and expert input included abdominal pain or pain at the site of distant metastases, dysphagia and other symptoms related to eating, and digestive symptoms. The liver and lungs were the most frequent locations of metastases, leading to dyspnea, abdominal fullness, and jaundice. Symptoms related to changes in bowel habits appeared to be more frequent and pronounced in Asian patients, possibly due to the higher prevalence of GC in the body of the stomach in this population. The five most commonly used PRO instruments were identified, but their validity in advanced-stage GC patients remains unclear. Conclusions The symptoms and functional impacts identified here should be confirmed with robust input from advanced-stage GC patients. Optimal measurement of PROs in GC should account for patient burden and possible differences between Asian and non-Asian patients.
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Affiliation(s)
- Jianming Xu
- Beijing 307 Hospital Cancer Center, Beijing 100071, China
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Chang L, Guo F, Wang Y, Lv Y, Huo B, Wang L, Liu W. MicroRNA-200c regulates the sensitivity of chemotherapy of gastric cancer SGC7901/DDP cells by directly targeting RhoE. Pathol Oncol Res 2013; 20:93-8. [PMID: 23821457 DOI: 10.1007/s12253-013-9664-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 06/03/2013] [Indexed: 02/08/2023]
Abstract
Gastric cancer remains a worldwide burden as the second leading cause of cancer-related death. Drug resistance of chemotherapy looms as a major clinical obstacle to successful treatment. Recent evidence indicated that miRNA-200c can restore the sensitivity of NSCLC cells to cisplatin and cetuximab. The expression of miRNA-200c and RhoE were investigated in gastric cancer tissues and cells (SGC7901 and SGC7901/DDP) by qRT-PCR. A luciferase reporter assay was done to understand the potential correlation between miRNA-200c and RhoE. Pre-miR-200c was transfected in SGC7901/DDP cells to confirm whether miRNA-200c could regulate RhoE expression. RhoE was knocked down to explore the role of RhoE on sensitivity of chemotherapy in gastric cancer by MTT. Western blot analysis was performed to further explore the mechanism of RhoE in regulating drug resistance. The results showed that miRNA-200c was significantly lower in cancerous tissues than those in the paired normal tissues, whereas the expression of RhoE was just the opposite. The significant difference of miRNA-200c and RhoE were observed between SGC7901 cells and SGC7901/DDP cells. miRNA-200c has target sites in the 3'-UTR of RhoE mRNA by luciferase reporter assay. Transfection of pre-miR-200c reduces RhoE expression. Meanwhile, the knockdown of RhoE enhanced the sensitivity of SGC7901/DDP cells and changed expression of some genes. These suggested that miRNA-200c regulated the sensitivity of chemotherapy to cisplatin (DDP) in gastric cancer by possibly targeting RhoE.
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Affiliation(s)
- Liang Chang
- Department of Medical Oncology, Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei Province, China
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115
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Florou D, Patsis C, Ardavanis A, Scorilas A. Effect of doxorubicin, oxaliplatin, and methotrexate administration on the transcriptional activity of BCL-2 family gene members in stomach cancer cells. Cancer Biol Ther 2013; 14:587-96. [PMID: 23792648 DOI: 10.4161/cbt.24591] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Defective apoptosis comprises the main reason for tumor aggressiveness and chemotherapy tolerance in solid neoplasias. Among the BCL-2 family members, whose mRNA or protein expression varies considerably in different human malignancies, BCL2L12 is the one for which we have recently shown its propitious prognostic value in gastric cancer. The purpose of the current work was to investigate the expression behavior of BCL2L12, BAX, and BCL-2 in human stomach adenocarcinoma cells following their exposure to anti-tumor substances. The 3-(4,5-dimethyl thiazol-2-yl)-2,5-diphenyl tetrazolium bromide and trypan blue methods assessed the impact of doxorubicin, oxaliplatin and methotrexate on AGS cells' viability and growth. Following isolation from cells, total RNA was reverse-transcribed to cDNA. Quantification of target genes' expression was performed with real-time PCR using SYBR Green detection system. The relative changes in their mRNA levels between drug-exposed and untreated cells were calculated with the comparative Ct method (2(-ddCt)). All three drugs, as a result of their administration to AGS cancer cells for particular time intervals, provoked substantial fluctuations in the transcriptional levels of the apoptosis-related genes studied. While BAX was principally upregulated, striking similar were the notable changes regarding BCL-2 and BCL2L12 expression in our cellular system. Our findings indicate the growth suppressive effects of doxorubicin, oxaliplatin and methotrexate treatment on stomach carcinoma cells and the implication of BCL2L12, BAX, and BCL-2 expression profiles in the molecular signaling pathways triggered by chemotherapy.
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Affiliation(s)
- Dimitra Florou
- Department of Biochemistry and Molecular Biology, Faculty of Biology, University of Athens, Athens, Greece
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Chang HS, Park EC, Chung W, Nam CM, Choi KS, Cho E, Cho WH. Comparing endoscopy and upper gastrointestinal X-ray for gastric cancer screening in South Korea: a cost-utility analysis. Asian Pac J Cancer Prev 2013; 13:2721-8. [PMID: 22938448 DOI: 10.7314/apjcp.2012.13.6.2721] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are limited data evaluating the cost-effectiveness of gastric cancer screening using endoscopy or upper gastrointestinal x-ray in the general population. OBJECTIVE To evaluate the cost- effectiveness of population-based screening for gastric cancer in South Korea by decision analysis. METHODS A time-dependent Markov model for gastric cancer was constructed for healthy adults 30 years of age and older, and a deterministic sensitivity analysis was performed. Cost-utility analysis with multiple strategies was conducted to compare the costs and effects of 13 different screening alternatives with respect to the following eligibility criteria: age at the beginning of screening, screening interval, and screening method. The main outcome measurement was the incremental cost-effectiveness ratio. RESULTS The results revealed that annual endoscopic screening from ages 50-80 was the most cost-effective for the male population. In the females, biennial endoscopy screening from ages 50-80 was calculated as the most cost-effective strategy among the 12 screening alternatives. The most cost-effective screening strategy may be adjustable according to the screening costs and the distribution of cancer stage at screening. The limitation was that effectiveness data were obtained from published sources. CONCLUSIONS Using the threshold of $19,162 per quality-adjusted life year on the basis of the Korean gross domestic product (2008), as suggested by the World Health Organization, endoscopic gastric cancer screening starting at the age of 50 years was highly cost-effective in the Korean population. The national recommendation for gastric cancer screening should consider the starting age of screening, the screening interval, and the screening modality.
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Affiliation(s)
- Hoo-Sun Chang
- Department of Preventive Medicine, Yonsei University, Seoul, Korea
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Hamzat H, Sun H, Ford JC, Macleod J, Soiza RL, Mangoni AA. Inappropriate prescribing of proton pump inhibitors in older patients: effects of an educational strategy. Drugs Aging 2013; 29:681-90. [PMID: 22775478 DOI: 10.1007/bf03262283] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND An increasing number of older patients are prescribed proton pump inhibitors (PPIs). However, the extent of inappropriate PPI prescribing in this group is largely unknown. OBJECTIVE We sought to identify clinical and demographic factors associated with inappropriate PPI prescribing in older patients and to assess the effects of a targeted educational strategy in a controlled hospital environment. METHODS Clinical and demographic characteristics and full medication exposure on admission were recorded in 440 consecutive older patients (mean ± SD age 84 ± 7 years) admitted to a teaching hospital between 1 February 2011 and 30 June 2011. A 4-week educational strategy to reduce inappropriate PPI prescribing during hospital stay, either by stopping or reducing PPI doses, was conducted within the study period. The main outcome measures of the study were the incidence of inappropriate PPI prescribing and the effects of interventions to reduce it. RESULTS On admission, PPIs were established therapy in 164 patients (37%). This was considered inappropriate in 100 patients (61%). Lower Charlson Comorbidity Index score (odds ratio [OR] 0.76; 95% CI 0.57, 0.94; p = 0.006) and history of dementia (OR 1.65; 95% CI 1.28, 1.83; p = 0.005) were independently associated with inappropriate PPI prescribing. Interventions to reduce inappropriate PPI prescribing occurred more frequently during and after the education phase (frequency of interventions in patients with inappropriate PPI prescribing: pre-education phase 9%, during education phase 43%, and post-education phase 46%, p = 0.006). Prescribing interventions were not associated with acid rebound symptoms. CONCLUSIONS Inappropriate PPI prescribing in older patients is frequent and independently associated with co-morbidities and dementia. A targeted in-hospital educational strategy can significantly and safely reduce inappropriate PPI prescribing in the short term.
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Affiliation(s)
- Hanifat Hamzat
- Division of Applied Medicine, University of Aberdeen, Aberdeen, UK
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Clinically significant endoscopic findings in a multi-ethnic population with uninvestigated dyspepsia. Dig Dis Sci 2012; 57:3205-12. [PMID: 22688184 DOI: 10.1007/s10620-012-2256-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 05/15/2012] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The proportion of clinically significant endoscopic findings (CSEF) in dyspepsia affects the initial management of this condition. With the changing epidemiology of organic upper gastrointestinal diseases in Asia, current data on CSEF remains uncertain. METHODS A cross-sectional study of consecutive adult patients attending an open access endoscopy list for the primary indication of dyspepsia was conducted. Independent epidemiological and clinical factors for CSEF were determined prospectively. RESULTS Data for 1167/1208 (96.6 %) adults (mean age 49.7 ± 15.9 years, 42.4 % males, ethnic distribution: 30.5 % Malays, 36.9 % Chinese and 30.8 % Indians) were analysed between January 2007 and August 2008. Three-hundred and eight (26.4 %) patients were found to have CSEF, most often those with age ≥45 years (30.3 vs 19 %, P < 0.0001), male gender (34.1 vs 20.7 % female, P < 0.0001), lower education levels (i.e. primary or no education), smoking (36.7 vs 24.9 %, P = 0.003), H. pylori infection (40.6 vs 21.8 %, P < 0.0001), and duration of dyspepsia ≤5 months (32.8 vs 24.4 %, P = 0.006). Age ≥ 45 years (OR 1.82, 95 % CI = 1.38-2.48), male gender (OR 1.84, 95 % CI = 1.53-2.59), H. pylori infection (OR 2.36, 95 % CI = 1.83-3.26), and duration of dyspepsia ≤5 months (OR 1.44, 95 % CI = 1.13-2.03) were subsequently identified as independent risk factors for CSEF. CONCLUSION CSEF are found in 26.4 % of Asian adults with uninvestigated dyspepsia. Duration of symptoms <5 months, among other recognised factors, is predictive of CSEF.
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Eroglu C, Orhan O, Karaca H, Unal D, Dikilitas M, Ozkan M, Kaplan B. The effect of being overweight on survival in patients with gastric cancer undergoing adjuvant chemoradiotherapy. Eur J Cancer Care (Engl) 2012; 22:133-40. [PMID: 22989187 DOI: 10.1111/ecc.12010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The aim of this study was to examine the effect of being overweight on survival in patients with gastric cancer undergoing adjuvant chemoradiotherapy and chemotherapy. In this study 152 patients were evaluated. Radiotherapy dose was 45 Gy given in 5 weeks. 5-FU 425 mg/m(2) and folinic acid 20 mg/m(2) were administered weekly during the radiotherapy and four cycles with 4-week intervals as consolidation chemotherapy after radiotherapy. Patients were assigned into two groups according to their body mass index: overweight (body mass index ≥25 kg/m(2)) and normal weight (body mass index <25.0 kg/m(2)). The median overall survival was 39 months vs. 18 months and median disease-free survival was 27 months vs. 13 months in the overweight and normal-weight groups respectively (P = 0.004 and P = 0.006 respectively). The 5-year survival was better in the patients with overweight than those with normal weight (42% vs. 17%; P = 0.004). The overall survival was significantly better with being overweight and early pathological stage (P = 0.016 and P = 0001 respectively). Overall survival, disease-free survival and long-term survival in patients with gastric cancer undergoing adjuvant treatment were better in overweight than normal-weight patients. Moreover, it was shown that body mass index and pathological stage were associated to survival and prognosis.
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Affiliation(s)
- C Eroglu
- Department of Radiation Oncology, Erciyes University Medical Faculty, Kayseri, Turkey.
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Lee HY, Choi KS, Jun JK, Hahm MI, Park EC. Time to follow up after an abnormal finding in organized gastric cancer screening in Korea. BMC Cancer 2012; 12:400. [PMID: 22963347 PMCID: PMC3517455 DOI: 10.1186/1471-2407-12-400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 09/03/2012] [Indexed: 01/07/2023] Open
Abstract
Background The prognosis for an abnormal medical finding is affected by both early detection and adherence to the presecribed schedule for follow-up examinations. In this study, we examined the time to follow up after an abnormal finding and determined the risk factors related to delays in follow up in a population-based screening program. Methods The study population consisted of patients who were newly diagnosed with gastric cancer through a gastric cancer screening program sponsored by the National Cancer Screening Program (NCSP) in 2005. Due to the skewed nature of the distribution of time to follow up, medians and interquartile ranges (IQR) are presented, and we analyzed the number of days preceding the follow-up time as a binary variable (≤90 days or >90 days). We used logistic regression analyses to evaluate the risk factors for a long delay. Results The median number of days to follow-up initiation after an abnormal finding was 11 (IQR 7–27); 13.9% of the patients with gastric cancer obtained their follow-up evaluation more than 90 days. Age, type of health insurance, screening method, and screening results were risk factors for delays in follow up. Conclusions This study examined delays from the time of the discovery of an abnormal finding to time of the follow-up evaluation. Because inadequate follow up of abnormal exam results undermines the potential benefits of cancer screening, it is important to organize services that minimize delays between cancer screening and treatment.
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Affiliation(s)
- Hoo-Yeon Lee
- Department of Preventive Medicine & Institute of Health Services Research, College of Medicine, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-749, Korea
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The kallikrein-related peptidase 13 (KLK13) gene is substantially up-regulated after exposure of gastric cancer cells to antineoplastic agents. Tumour Biol 2012; 33:2069-78. [DOI: 10.1007/s13277-012-0466-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 07/11/2012] [Indexed: 01/07/2023] Open
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Mansour-Ghanaei F, Joukar F, Soati F, Mansour-Ghanaei A, Naserani SB. Knowledge about Gastric Carcinoma in North of Iran, A High Prevalent Region for Gastric Carcinoma: A Population-Based Telephone Survey. Asian Pac J Cancer Prev 2012; 13:3361-6. [DOI: 10.7314/apjcp.2012.13.7.3361] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Blankart CR. Does healthcare infrastructure have an impact on delay in diagnosis and survival? Health Policy 2012; 105:128-37. [PMID: 22296953 DOI: 10.1016/j.healthpol.2012.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 12/20/2011] [Accepted: 01/09/2012] [Indexed: 10/14/2022]
Abstract
INTRODUCTION The objectives of this study were to evaluate whether healthcare infrastructure impacts delay in diagnosis, and to determine whether healthcare infrastructure and delay in diagnosis impacts survival in gastric cancer. METHODS Administrative data from 2175 gastric cancer patients was analyzed using two Cox proportional hazard models with (i) delay in diagnosis and (ii) survival as dependent variables. Density of general practitioners, density of gastroenterologists, characteristics of specialty treatment centers, demographic information, and comorbidities were included in the models. Differentiation was made between urban and rural areas. RESULTS The likelihood of being diagnosed increased with an increase in general practitioners (p<0.0001) and gastroenterologists (p<0.0001) in rural areas. In urban areas a higher density of general practitioners reduced delay in diagnosis (p=0.0262), while a higher density of gastroenterologists did not (p=0.2480). The number of gastric cancer cases performed in hospital had a positive impact on survival (p<0.0001), while outpatient infrastructure did not. CONCLUSION Delay in diagnosis can be reduced by higher availability of general practitioners and gastroenterologists in rural areas. Given the already very high density of physicians in urban areas there is no effect of additional gastroenterologists. As learning effects can be observed with increased hospital volumes, minimum volumes for treatment of gastric cancer may be defined.
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Bones J, Byrne JC, O'Donoghue N, McManus C, Scaife C, Boissin H, Nastase A, Rudd PM. Glycomic and glycoproteomic analysis of serum from patients with stomach cancer reveals potential markers arising from host defense response mechanisms. J Proteome Res 2011; 10:1246-65. [PMID: 21142185 DOI: 10.1021/pr101036b] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Despite the reduced incidence of gastric cancer in the developed world, a diagnosis of stomach carcinoma still carries a poor prognosis due to the asymptomatic nature of the disease in the early stages, subsequent advanced stage diagnosis, and a low 5 year survival rate. Endoscopy remains the primary standard for diagnosis of stomach carcinoma and the current marker, carbohydrate antigen 19-9 (CA19-9) lacks the levels of sensitivity and specificity required in order to make it clinically useful for diagnostic monitoring. Therefore, there is a current need for additional markers to improve the diagnostic accuracy for the early stages of stomach cancer. Together, glycomic, proteomic, and glycoproteomic analyses of serum have the potential to identify such probable markers. A discovery study is reported here using preoperative serum from 80 stomach cancer patients, 10 patients bearing benign stomach disease, and 20 matched controls. Glycomic analysis of the total and immunoaffinity depleted serum revealed statistically significant increases in the levels of sialyl Lewis X epitopes (SLe(X)) present on triantennary glycans accompanied by increased levels of core fucosylated agalactosyl biantennary glycans present on IgG (referred to as the IgG G0 glycoform) which are associated with increasing disease pathogenesis. Protein expression analysis using 2D-DiGE returned a number of differentially expressed protein candidates in the depleted serum, many of which were shown to carry triantennary SLe(X) during subsequent glycomic investigations. Biological pathway analysis of the experimental data returned complement activation and acute phase response signaling as the most significantly altered pathways in the stomach cancer patient serum. Upon the basis of these findings, it is suggested that increased expression of IgG G0 and complement activation are a host response to the presence of the stomach tumor while the increased expression of SLe(X) and acute phase response proteins is a result of pro-inflammatory cytokine signaling, including IL-6, during carcinogenesis. The approach presented herein provides an insight into the underlying mechanisms of disease and the resulting changes in the glycome and glycoproteome offer promise as potential markers for diagnosis and prognostic monitoring in stomach cancer.
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Affiliation(s)
- Jonathan Bones
- NIBRT Dublin-Oxford Glycobiology Laboratory, The National Institute for Bioprocessing Research and Training, University College Dublin, Belfield, Dublin 4, Ireland
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Liu J, Zhang ZQ, Chen X, Fu YH, Zhang Y. Gastroscopic and clinical diagnosis of early gastric cancer in elderly patients: an analysis of 124 cases. Shijie Huaren Xiaohua Zazhi 2010; 18:2137-2140. [DOI: 10.11569/wcjd.v18.i20.2137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinicopathologic characteristics of early gastric cancer (EGC) in elderly patients.
METHODS: The clinical data for 124 elderly patients who were endoscopically diagnosed with EGC from May 1985 to December 2009 were retrospectively analyzed.
RESULTS: The mean age of these patients was 72.1 years. Elderly EGC patients usually had non-specific symptoms and physical signs. The tumors, most of which belonged to type IIb and IIc, were mainly located in the gastric sinus. Tumor diameter was usually less than 2 cm. Adenocarcinoma was the most common pathological type. Lymph node metastasis was noted in 3.2% (4/124) of patients.
CONCLUSION: There are usually no typical symptoms in elderly EGC patients. Mass screening by gastroscopy in combination with pathological examination is the most effective method to find EGC in elderly patients.
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Abstract
IMPORTANCE OF THE FIELD Gastric cancer is one of the most common causes of cancer death worldwide. P21-activated kinases (PAKs), regulators of cancer-cell signalling networks, play fundamental roles in a range of cellular processes through their binding partners or kinase substrates. AREAS COVERED IN THIS REVIEW The complex regulation of PAKs through their upstream or downstream effectors in human cancers, especially in gastric cancer, are described and the identified inhibitors of PAKs are summarized. WHAT THE READERS WILL GAIN The structural differences and activation mechanisms between two subgroups of PAK are described. Both groups of PAKs play complicated and important roles in human gastric cancer, which indicated a possible way for us to identify the specific inhibitors targeting PAKs for gastric cancer. TAKE HOME MESSAGE PAKs play important roles in progression of many cancer types, the full mechanisms of PAKs in gastric cancer are still unclear. It seems there are different roles for two groups of PAKs in cancers. Group I PAKs play their functions mostly through their specific substrates, however, many binding partners that are independent of phosphorylation by group II PAKs were identified. Finding specific inhibitors of PAKs will help us discover the roles of PAKs and target these kinases in human gastric cancer.
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Affiliation(s)
- Xiaodong Li
- Department of Cell Biology, China Medical University, Key Laboratory of Cell Biology, Ministry of Public Health, Shenyang, Liaoning 110001, P. R. China.
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Abstract
GOAL To assess the clinical and endoscopic presentation of primary gastric lymphoma. BACKGROUND Remission rate and long-term survival in patients with gastric lymphoma mainly depend on disease stage at diagnosis. Series reporting clinical and endoscopic presentation of gastric lymphoma are generally small and heterogeneous. STUDY Systematic review with pooled-data analysis assessing clinical and endoscopic presentation of primary gastric lymphoma. RESULTS Data regarding 2000 patients were collected. Overall, males were slightly more prevalent, alarm symptoms were absent in near half of the patients, lymphoma was diagnosed in a stage >I in one-third of the patients, and Helicobacter pylori infection was present in 88.8% of considered patients. At endoscopy, the ulcerative type was the most frequent presentation, although low-grade lymphoma was diagnosed on normal/hyperemic gastric mucosa in 9% of cases. Patients with high-grade lymphoma presented alarm symptoms (anemia and/or melena and/or hemorrhage, persistent vomiting, weight loss), an exophytic or ulcerative lesion, a stage III-IV, and a H. pylori negative status more frequently than low-grade lymphoma cases. CONCLUSIONS Our pooled-data analysis showed that gastric lymphoma is still disappointingly diagnosed in an advanced stage in a large number of patients. This is probably due to presence of nonspecific symptoms at initial clinical presentation and/or a normal appearing mucosa at endoscopic observation in the early stages.
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Zullo A, Hassan C, Cristofari F, Perri F, Morini S. Gastric low-grade mucosal-associated lymphoid tissue-lymphoma: Helicobacter pylori and beyond. World J Gastrointest Oncol 2010; 2:181-6. [PMID: 21160595 PMCID: PMC2998825 DOI: 10.4251/wjgo.v2.i4.181] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Revised: 10/18/2009] [Accepted: 10/25/2009] [Indexed: 02/05/2023] Open
Abstract
The stomach is the most frequently involved site for extranodal lymphomas, accounting for nearly two-thirds of all gastrointestinal cases. It is widely accepted that gastric B-cell, low-grade mucosal-associated lymphoid tissue (MALT)-lymphoma is caused by Helicobacter pylori (H. pylori) infection. MALT-lymphomas may engender different clinical and endoscopic patterns. Often, diagnosis is confirmed in patients with only vague dyspeptic symptoms and without macroscopic lesions on gastric mucosa. H. pylori eradication leads to lymphoma remission in a large number of patients when treatment occurs at an early stage (I-II1). Neoplasia confined to the submucosa, localized in the antral region of the stomach, and without API2-MALT1 translocation, shows a high probability of remission following H. pylori eradication. When both bacterial infection and lymphoma recur, further eradication therapy is generally effective. Radiotherapy, chemotherapy and, in selected cases, surgery are the available therapeutic options with a high success rate for those patients who fail to achieve remission, while data on immunotherapy with monoclonal antibodies (rituximab) are still scarce. The 5-year survival rate is higher than 90%, but careful, long-term follow-up is required in these patients since lymphoma recurrence has been reported in some cases.
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Affiliation(s)
- Angelo Zullo
- Angelo Zullo, Cesare Hassan, Francesca Cristofari, Sergio Morini, Gastroenterology and Digestive Endoscopy, "Nuovo Regina Margherita" Hospital, 00153 Roma, Italy
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Beyer-Westendorf J, Werth S, Halbritter K, Weiss N. Cancer in males and risk of venous thromboembolism. Thromb Res 2010; 125 Suppl 2:S155-9. [DOI: 10.1016/s0049-3848(10)70035-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Heise K, Bertran E, Andia ME, Ferreccio C. Incidence and survival of stomach cancer in a high-risk population of Chile. World J Gastroenterol 2009; 15:1854-62. [PMID: 19370783 PMCID: PMC2670413 DOI: 10.3748/wjg.15.1854] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the incidence and survival rate of stomach cancer (SC) and its associated factors in a high risk population in Chile.
METHODS: The population-based cancer registry of Valdivia, included in the International Agency for Research on Cancer system, covers 356 396 residents of Valdivia Province, Southern Chile. We studied all SC cases entered in this Registry during 1998-2002 (529 cases). Population data came from the Chilean census (2002). Standardized incidence rates per 100 000 inhabitants (SIR) using the world population, cumulative risk of developing cancer before age 75, and rate ratios by sex, age, ethnicity and social factors were estimated. Relative survival (Ederer II method) and age-standardized estimates (Brenner method) were calculated. Specific survival rates (Kaplan-Meier) were measured at 3 and 5 years and survival curves were analyzed with the Logrank and Breslow tests. Survival was studied in relation to demographics, clinical presentation, laboratory results and medical management of the cases. Those variables significantly associated with survival were later included in a Cox multivariate model.
RESULTS: Between 1998 and 2002, 529 primary gastric cancers occurred in Valdivia (crude incidence rate 29.2 per 100
000 inhabitants). Most cases were male (69.0%), residents of urban areas (57.5%) and Hispanic (83.2%), with a low education level (84.5% < 8 school years). SC SIR was higher in men than women (40.8 and 14.8 respectively, P < 0.001), risk factors were low education RR 4.4 (95% CI: 2.9-6.8) and 1.6, (95% CI: 1.1-2.1) for women and men respectively and Mapuche ethnicity only significant for women (RR 2.2, 95% CI: 1.2-3.7). Of all cases, 76.4% were histologically confirmed, 11.5% had a death certificate only (DCO), 56.1% were TNM stage IV; 445 cases (84.1%) were eligible for survival analysis, all completed five years follow-up; 42 remained alive, 392 died of SC and 11 died from other causes. Specific 5-year survival, excluding cases with DCO, was 10.6% (95% CI: 7.7-13.5); 5-year relative survival rate was 12.3% (95% CI: 9.1-16.1), men 10.9% (95% CI: 7.4-15.2) and women 16.1% (95% CI: 9.5-24.5). Five-year specific survival was higher for patients aged < 55 years (17.3%), with intestinal type of cancer (14.6%), without metastasis (22.2%), tumor size < 4 cm (60.0%), without lymphatic invasion (77.1%), only involvement of the mucous membrane (100%). Statistically significant independent prognostic factors were: TNM staging, diffuse type, metastasis, supraclavicular adenopathy, palpable tumor, and hepatitis or ascites.
CONCLUSION: Social determinants are the main risk factors for SC, but not for survival. An advanced clinical stage at consultation is the main cause of poor SC survival.
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Duration of symptoms, stage at diagnosis and relative survival in colon and rectal cancer. Eur J Cancer 2009; 45:2383-90. [PMID: 19356923 DOI: 10.1016/j.ejca.2009.03.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 03/08/2009] [Accepted: 03/12/2009] [Indexed: 12/15/2022]
Abstract
In colorectal cancer, the relation between duration of symptoms and stage at presentation and prognosis is not yet settled. All 1263 patients treated for colorectal cancer at Levanger Hospital, 1980-2004, and 2892 patients treated in Norway during 2004 were included. The association between symptom duration as an explanatory variable and tumour stage as a dependent variable was analysed using a proportional odds logistic regression model. Known duration of symptoms was divided into four categories: <1 week, 1-8 weeks, 2-6 months and >6 months. There was an inverse relationship between symptom duration and colon cancer TNM-stage, OR=0.73 (95% CI 0.63-0.84), p<0.001 (Levanger Hospital) and 0.84 (0.75-0.95), p=0.004 (Norway 2004), where the OR is per category of symptom duration. Duration of symptoms were also inversely associated with T-stage, N-stage and M-stage in colon cancer. These relationships were not found for rectal cancer. In colon cancer the relative five-year survival for the four intervals of symptom duration was 44%, 39%, 54% and 66%, p<0.001, in Levanger, 1980-2004, and four-year survival was 46%, 62%, 75% and 74%, p<0.001, in Norway 2004, respectively. For rectal cancer survival was not dependent on symptom duration. In a multivariate analysis of relative survival of patients with colon cancer, duration of symptoms was associated with survival independent of tumour differentiation and TNM-stage. Increasing duration of symptoms was positively associated with less advanced disease and better survival in colon cancer, but not in rectal cancer.
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