Incidence trends and mortality rates of gastric cancer in Israel

Clinical and endoscopic predictors of gastric precancerous conditions: a large population case control study

BACKGROUND

Atrophic gastritis (AG) and gastric intestinal metaplasia (GIM) are well defined intermediate precancerous conditions (PCCs) in the gastric cancer cascade. The diagnosis of PCCs may be suspected based on endoscopic findings but is established by histology. Estimates of the global prevalence of PCCs vary widely but simple clinical or endoscopic predictors of their diagnosis are ill defined. We aimed to evaluate the prevalence of gastric PCCs in our practice and to identify predictors for its diagnosis.

METHODS

We analyzed electronic reports of patients referred for gastroscopy procedures over a 5-year period and included those for whom gastric biopsies were performed. We investigated demographic, clinical, and endoscopic findings to identify possible association with histologic detection of gastric PCCs and performed multivariate analysis to identify predictors of its diagnosis.

RESULTS

A total of 4930 patients with full endoscopic and histologic data were included for the final analysis. Of these, 806 (16.3%) patients had a histologic diagnosis of gastric PCCs. Demographic and clinical variables including male sex (51.4% vs. 45.7%; P=0.003), age over 60 (69.8% vs. 45.2%; P<0.001), and anemia indication for gastroscopy (17.6% vs. 14.8%; P=0.04) were significantly associated with gastric PCCs diagnosis. Likewise, endoscopic findings of Barret's esophagus (2.6% vs. 1.3%; P=0.006), atrophic gastritis according to endoscopist's judgment (12.9% vs. 3.5%; P<0.01) and corpus predominant gastritis (22.5% vs. 14.7%; P=0.02) were significantly associated with gastric PCCs. In multivariate analysis, age>60 (please explain all acronyms HR 2.51, 95% CI 2.12-2.96), male sex (HR 1.235, 95% CI 1.05-1.44), corpus predominant (HR 1.284, 95% CI 1.04-1.57), and atrophic gastritis (HR 4, 95% CI 3.07-5.21) were independent predictors for PCCs diagnosis.

CONCLUSIONS

Not uncommonly encountered in our practice, a judicious performance of gastric biopsies to detect gastric PCCs should be adopted especially in older, male patients with endoscopic findings of corpus predominant and/or gastric atrophy.

Cancer Incidence and Mortality in Asian Countries: A Trend Analysis

Background

This study aimed to evaluate the updated burden and temporal trends of cancer incidence and mortality in Asian countries.

Methodology

The data used in this study were retrieved from the Global Cancer Observatory, Cancer Incidence in Five Continents volumes I-XI, and the World Health Organization mortality database. These data were used to calculate the Average Annual Percentage Change (AAPC), with a 95% confidence interval (CI) by joinpoint regression analysis to determine the epidemiological trend in the past decade.

Results

In 2020, the cancer incidence in Asia was 169.1 per 1 00 000, accounting for 49.3% of the global cancer incidence. The most common cancers included lung (13.8%), breast (10.8%) and colorectal (10.6%) cancers. Its mortality was 101.6 per 1 00 000 (58.3% of the global cancer death) with lung (19.2%), liver (10.5%) and stomach (9.9%) cancers being the most common causes of cancer death. The cancer incidence had been increasing in female population, with Korea (AAPC = 5.73, 95% CI [5.30, 6.17], P < .001), Japan (AAPC = 2.67, 95% CI [2.12, 3.23], P < .001) and Kuwait (AAPC = 2.08, 95% CI [.49, 3.69], P = .016) showing the most significant increases in the past decade. The incidence increase was also observed among population aged <40 years old, with Korea (female AAPC = 8.42, 95% CI [7.40, 9.45], P < .001; male AAPC = 5.28, 95% CI [4.23, 6.33], P <.001), China (female AAPC = 2.94, 95% CI [2.07, 3.81], P < .001; male AAPC = 1.37, 95% CI [.57, 2.18], P = .004) and Japan (female AAPC = 2.88, 95% CI [1.88, 3.88], P = .016; male AAPC = 1.59, 95% CI [.40, 2.78], P = .015) showing the most significant increases. However, there was an overall decreasing trend of cancer mortality.

Conclusions

There was a substantial burden of cancer incidence and mortality in Asia. Although there was a decreasing trend in cancer mortality, its incidence had been increasing especially among female and younger populations. Future studies could be done to further investigate the potential reasons for these epidemiologic trends.

Global Patterns and Trends in Gastric Cancer Incidence Rates (1988-2012) and Predictions to 2030

BACKGROUND & AIMS

The long-term trend in gastric cancer rates has rarely been reported from a global perspective. We aimed to explore the past temporal trends (1988-2012) in gastric cancer incidence rates in 43 countries and to predict future trends (2012-2030).

METHODS

Data on yearly gastric cancer incidence by age group and sex were drawn from 108 cancer registries in 43 countries in the Cancer Incidence in Five Continents Time Trends (CI5plus) database. Age-standardized incidence rates per 100,000 persons were computed from 1988-2012. The number of new cases and incidence rates were predicted to 2030 using the Bayesian age-period-cohort model.

RESULTS

Persistent decreasing trends in gastric cancer incidence rates were observed from 1988-2012 worldwide, with an overall average annual percentage change of -2.1% (95% confidence interval, -2.5--1.7). The trends will continue or remain stable until 2030 in most of the selected countries except for Ecuador and Lithuania, whose gastric cancer incidence rates will experience substantially increasing trends in the next several decades.

CONCLUSION

The incidence rates of gastric cancer are expected to decrease through 2030 in most countries except Ecuador and Lithuania. Reductions in smoking and Helicobacter pylori prevalence and improvement in diet probably contributed to the decrease. Gastric cancer still represents a major cancer burden worldwide, and the large number of gastric cancer cases worldwide may still call for lifestyle interventions in terms of smoking and diet and massive efforts for H pylori screening and treatment, especially in countries with predicted increasing incidence rates of gastric cancer.

Prevalence and determinants of serological evidence of atrophic gastritis among Arab and Jewish residents of Jerusalem: a cross-sectional study

OBJECTIVE

Understanding the correlates of premalignant gastric lesions is essential for gastric cancer prevention. We examined the prevalence and correlates of serological evidence of atrophic gastritis, a premalignant gastric condition, using serum pepsinogens (PGs) in two populations with differing trends in gastric cancer incidence.

METHODS

In a cross-sectional study, using ELISA we measured serum PGI and PGII concentrations (Biohit, Finland), Helicobacter pylori serum IgG and cytotoxin-associated gene A (CagA) antigen IgG antibodies in archived sera of 692 Jews and 952 Arabs aged 25-78 years, randomly selected from Israel's population registry in age-sex and population strata. Multivariable logistic regression analyses were performed.

RESULTS

Using cut-offs of PGI <30µg/L  or PGI:PGII <3.0, the prevalence of atrophic gastritis was higher among Arab than Jewish participants: 8.8% (95% CIs 7.2% to 10.8%) vs 5.9% (95% CI 4.4% to 7.9%), increasing with age in both groups (p<0.001 for trend). Among Jewish participants, infection with H. pylori CagA phenotype was positively related to atrophic gastritis: adjusted OR (aOR) 2.16 (95% CI 0.94 to 4.97), but not to non-CagA infections aOR 1.17 (95% CI 0.53 to 2.55). The opposite was found among Arabs: aOR 0.09 (95% CI 0.03 to 0.24) for CagA positive and aOR 0.15 (95% CI 0.06 to 0.41) for Cag A negative phenotypes (p<0.001 for interaction). Women had a higher atrophic gastritis prevalence than men. Obesity and smoking were not significantly related to atrophic gastritis; physical activity tended to be inversely associated in Arabs (p=0.08 for interaction).

CONCLUSIONS

The prevalence of atrophic gastritis was higher among Arabs than Jews and was differently associated with the CagA phenotype.

[ARTICLE WITHDRAWN] miR-630 Inhibits Epithelial-to-Mesenchymal Transition (EMT) by Regulating the Wnt/β-Catenin Pathway in Gastric Cancer Cells

THIS ARTICLE WAS WITHDRAWN BY THE PUBLISHERS IN NOVEMBER 2020.

Prospective randomized phase II study of FOLFIRI versus FOLFOX7 in advanced gastric adenocarcinoma: a Chinese Western Cooperative Gastrointestinal Oncology Group Study

Until now, no standard chemotherapy has been widely accepted for advanced gastric cancer (GC). The current research aimed to compare folinic acid, fluorouracil with irinotecan (mFOLFIRI) or with oxaliplatin (mFOLFOX7) as first-line treatments in patients with locally advanced GC in an open, randomized, phase II study. Previously untreated metastatic or recurrent GC patients with measurable disease received mFOLFIRI (arm A) or mFOLFOX7 (arm B) every 2 weeks. The defined second-line treatment was mFOLFOX7 for arm A and mFOLFIRI for arm B. Primary endpoint was progression-free survival (PFS), and secondary endpoints were overall survival (OS), disease control rate (DCR) and toxicity. The evaluable population consisted of 128 patients (54 in arm A; 74 in arm B). Median PFS of arm A was 2.9 months (m) (95% confidence interval, CI, 1.9 to 4.1 m) versus 4.1 m (95% CI, 3.2 to 4.8 m) for arm B (p = 0.109). Median OS was 9.9 months (95% CI, 6.0 to 13.5 m) for arm A versus 12.0 m for arm B (95% CI, 10.3 to 13.7m; p = 0.431). DCRs for arm A and arm B were 59.3% and 66.3%, respectively (p = 0.850). In subgroup analysis of the patients who completed both treatment lines per protocol, the median first-line PFS was 2.1 m for the mFOLFIRI/mFOLFOX7arm versus 8.0 m for the mFOLFOX7/mFOLFIRI arm (p = 0.053), and the median second-line PFS values were 1.2 m versus 5.1 m (p = 0.287). Total PFS and OS were 8.1m and 11.0 m for the mFOLFIRI/mFOLFOX7 group compared with 12.2m and 20.2 m for the mFOLFOX7/mFOLFIRI group (p = 0.008, p = 0.030). Both regimens were well-tolerated with acceptable and manageable toxicities. Hence, there was no significant difference in the PFS or DCR. However, mFOLFOX7 followed by mFOLFIRI might have a better OS.

Body mass index at adolescence and risk of noncardia gastric cancer in a cohort of 1.79 million men and women

BACKGROUND

This study assessed adolescent predictors of noncardia gastric cancer (NCGC) with a focus on the body mass index (BMI) in late adolescence.

METHODS

This study analyzed a cohort of 1,087,358 Israeli Jewish males and 707,212 Israeli Jewish females who underwent a compulsory physical examination between the ages of 16 and 19 years from 1967 to 2002. By linkage to the national cancer registry, participants were followed for NCGC through December 31, 2012. With a median follow-up of 23 years, 515 NCGC cases occurred (379 men and 136 women), and the median age was 47.0 years (interquartile range, 39.3-53.4 years). Multivariate-adjusted Cox regression was used to estimate hazard ratios (HRs) for NCGC according to the US Centers for Disease Control and Prevention BMI percentiles at the baseline (normal weight, 5th to <85th percentile; overweight, 85th to <95th percentile; and obesity, ≥95th percentile) as well as the country of birth, residential socioeconomic status (SES), and education.

RESULTS

In comparison with normal weight, adolescent obesity, but not overweight, was associated in both men and women with the risk of subsequent NCGC (unadjusted HR, 1.95; 95% confidence interval [CI], 1.25-3.06; adjusted HR, 1.78; 95% CI, 1.12-2.83). Immigration from the former Soviet Union (FSU), a low education level, and a low residential SES were also associated with the risk for NCGC with adjusted HRs of 2.67 (95% CI, 1.86-3.83), 1.85 (95% CI, 1.53-2.25), and 1.48 (95% CI, 1.13-1.93), respectively.

CONCLUSIONS

The findings suggest that adolescent obesity, but not overweight, is associated with an increased risk for NCGC. Immigration from the FSU, a low residential SES, and a low education level are also significantly associated with the risk for NCGC. Cancer 2018;124:356-63. © 2017 American Cancer Society.

Epidermal growth factor-like domain-containing protein 7 (EGFL7) enhances EGF receptor-AKT signaling, epithelial-mesenchymal transition, and metastasis of gastric cancer cells

Epidermal growth factor-like domain-containing protein 7 (EGFL7) is upregulated in human epithelial tumors and so is a potential biomarker for malignancy. Indeed, previous studies have shown that high EGFL7 expression promotes infiltration and metastasis of gastric carcinoma. The epithelial-mesenchymal transition (EMT) initiates the metastatic cascade and endows cancer cells with invasive and migratory capacity; however, it is not known if EGFL7 promotes metastasis by triggering EMT. We found that EGFL7 was overexpressed in multiple human gastric cancer (GC) cell lines and that overexpression promoted cell invasion and migration as revealed by scratch wound and transwell migration assays. Conversely, shRNA-mediated EGFL7 knockdown reduced invasion and migration. Furthermore, EGFL7-overexpressing cells grew into larger tumors and were more likely to metastasize to the liver compared to underexpressing CG cells following subcutaneous injection in mice. EGFL7 overexpression protected GC cell lines against anoikis, providing a plausible mechanism for this enhanced metastatic capacity. In excised human gastric tumors, expression of EGFL7 was positively correlated with expression levels of the mesenchymal marker vimentin and the EMT-associated transcription repressor Snail, and negatively correlated with expression of the epithelial cell marker E-cadherin. In GC cell lines, EGFL7 knockdown reversed morphological signs of EMT and decreased both vimentin and Snail expression. In addition, EGFL7 overexpression promoted EGF receptor (EGFR) and protein kinase B (AKT) phospho-activation, effects markedly suppressed by the EGFR tyrosine kinase inhibitor AG1478. Moreover, AG1478 also reduced the elevated invasive and migratory capacity of GC cell lines overexpressing EGFL7. Collectively, these results strongly suggest that EGFL7 promotes metastasis by activating EMT through an EGFR-AKT-Snail signaling pathway. Disruption of EGFL7-EGFR-AKT-Snail signaling may a promising therapeutic strategy for gastric cancer.

A comparative study on two different pathological methods to retrieve lymph nodes following gastrectomy

BACKGROUND

The number of lymph nodes harvested during gastrectomy depends on the extension of lymphadenectomy and the method of lymph node retrieval.

AIM

The objective of this study was to evaluate two methods of lymph node retrieval in specimens of gastric cancer.

METHODS

The number of lymph nodes was compared using two different techniques. The technique used in the first group was manual dissection following formalin fixation, and the techniques used in the second group was fat-clearing by acetone.

RESULTS

Both groups were comparable for demographic and pathological variables. The average number of harvested nodes was 19.3 ± 10 for the manual group as compared to 26.1 ± 14 in the acetone group (P = 0.003). The differences in the average number of positive nodes did not reach statistical significance (4.6 compared to 6.9 nodes).

CONCLUSION

The acetone clearing technique enables the evaluation of a larger number of nodes. An increase, but statistically non significant, number of positive nodes was noted in the acetone group.

Increased microRNA-630 expression in gastric cancer is associated with poor overall survival

MicroRNAs are noncoding RNAs that regulate multiple cellular processes during cancer progression. Among various microRNAs, MiR-630 has recently been identified to be implicated in many critical processes in human malignancies. We aimed to investigate the significance and prognostic value of miR-630 in human gastric cancer. Gastric cancer and adjacent normal specimens from 236 patients from who had not received neoadjuvant chemotherapy were collected. The expression of miR-630 was investigated by quantitative real-time PCR assay and its association with overall survival of patients was analyzed by statistical analysis. MiR-630 expression level was significantly elevated in gastric cancer in comparison to adjacent normal specimens. It is also proved that miR-630 expression was to be associated with gastric cancer invasion, lymph node metastasis, distant metastasis and TNM stage. In addition, survival analysis proved that elevated miR-630 expression was associated with poor overall survival of patients. Multivariate survival analysis also proved that miR-630 was an independent prognostic marker after adjusted for known prognostic factors. The present study proved the over-expression of miR-630 and its association with tumor progression in human gastric cancer. It also provided the first evidence that miR-630 expression was an independent prognostic factor for patients with gastric cancer, which might be a potential valuable biomarker for gastric cancer.

Prognostic role of human epidermal growth factor receptor in gastric cancer: a systematic review and meta-analysis

BACKGROUND AND AIMS

Human epidermal growth factor receptor (EGFR) and HER2 (ErbB2) both belong to EGFR family, which are overexpressed in a significant proportion of cases of gastric cancer (GC). Various studies have evaluated the prognostic value of EGFR or HER level in GC. However, the overall test performance remains unclear. We undertook this study to perform a systematic review and meta-analysis of prognostic cohort studies evaluating the use of EGFR or HER2 as a predictor of survival time in patients with GC.

METHODS

Eligible studies were identified through multiple search strategies. Studies were assessed for quality using the Newcastle-Ottawa Tool. Data were collected comparing overall survival (OS) in patients with high and low EGFR or HER2 level. Studies were pooled and summary hazard ratios were calculated.

RESULTS

Studies were listed twice if they provided overall survival data for both EGFR and HER2. Eight studies (seven for EGFR and eight for HER2) were included. Two distinct groups were pooled for analysis and revealed that high EGFR, HER2 levels predicted poor overall (HR = 1.66, 95% CI: 1.35-2.02) and (HR = 1.43, 95% CI: 1.09-1.88) survival. No publication bias was found.

CONCLUSIONS

This meta-analysis result suggested that EGFR or HER2 should have significant predictive ability for estimating overall survival in GC patients and may be useful for defining prognosis of GC patients.