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Li Q, Xu WY, Sun NN, Feng QX, Zhu ZN, Hou YJ, Sang ZT, Li FY, Li BW, Xu H, Liu XS, Zhang YD. MRI versus Dual-Energy CT in Local-Regional Staging of Gastric Cancer. Radiology 2024; 312:e232387. [PMID: 39012251 DOI: 10.1148/radiol.232387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
Background Preoperative local-regional tumor staging of gastric cancer (GC) is critical for appropriate treatment planning. The comparative accuracy of multiparametric MRI (mpMRI) versus dual-energy CT (DECT) for staging of GC is not known. Purpose To compare the diagnostic accuracy of personalized mpMRI with that of DECT for local-regional T and N staging in patients with GC receiving curative surgical intervention. Materials and Methods Patients with GC who underwent gastric mpMRI and DECT before gastrectomy with lymphadenectomy were eligible for this single-center prospective noninferiority study between November 2021 and September 2022. mpMRI comprised T2-weighted imaging, multiorientational zoomed diffusion-weighted imaging, and extradimensional volumetric interpolated breath-hold examination dynamic contrast-enhanced imaging. Dual-phase DECT images were reconstructed at 40 keV and standard 120 kVp-like images. Using gastrectomy specimens as the reference standard, the diagnostic accuracy of mpMRI and DECT for T and N staging was compared by six radiologists in a pairwise blinded manner. Interreader agreement was assessed using the weighted κ and Kendall W statistics. The McNemar test was used for head-to-head accuracy comparisons between DECT and mpMRI. Results This study included 202 participants (mean age, 62 years ± 11 [SD]; 145 male). The interreader agreement of the six readers for T and N staging of GC was excellent for both mpMRI (κ = 0.89 and 0.85, respectively) and DECT (κ = 0.86 and 0.84, respectively). Regardless of reader experience, higher accuracy was achieved with mpMRI than with DECT for both T (61%-77% vs 50%-64%; all P < .05) and N (54%-68% vs 51%-58%; P = .497-.005) staging, specifically T1 (83% vs 65%) and T4a (78% vs 68%) tumors and N1 (41% vs 24%) and N3 (64% vs 45%) nodules (all P < .05). Conclusion Personalized mpMRI was superior in T staging and noninferior or superior in N staging compared with DECT for patients with GC. Clinical trial registration no. NCT05508126 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Méndez and Martín-Garre in this issue.
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Affiliation(s)
- Qiong Li
- From the Departments of Radiology (Q.L., W.Y.X., N.N.S., Q.X.F., Z.N.Z., Y.J.H., Z.T.S., X.S.L., Y.D.Z.) and General Surgery (F.Y.L., B.W.L., H.X.), the First Affiliated Hospital with Nanjing Medical University, No. 300 Guangzhou Rd, Nanjing 210009, China
| | - Wei-Yue Xu
- From the Departments of Radiology (Q.L., W.Y.X., N.N.S., Q.X.F., Z.N.Z., Y.J.H., Z.T.S., X.S.L., Y.D.Z.) and General Surgery (F.Y.L., B.W.L., H.X.), the First Affiliated Hospital with Nanjing Medical University, No. 300 Guangzhou Rd, Nanjing 210009, China
| | - Na-Na Sun
- From the Departments of Radiology (Q.L., W.Y.X., N.N.S., Q.X.F., Z.N.Z., Y.J.H., Z.T.S., X.S.L., Y.D.Z.) and General Surgery (F.Y.L., B.W.L., H.X.), the First Affiliated Hospital with Nanjing Medical University, No. 300 Guangzhou Rd, Nanjing 210009, China
| | - Qiu-Xia Feng
- From the Departments of Radiology (Q.L., W.Y.X., N.N.S., Q.X.F., Z.N.Z., Y.J.H., Z.T.S., X.S.L., Y.D.Z.) and General Surgery (F.Y.L., B.W.L., H.X.), the First Affiliated Hospital with Nanjing Medical University, No. 300 Guangzhou Rd, Nanjing 210009, China
| | - Zhen-Ning Zhu
- From the Departments of Radiology (Q.L., W.Y.X., N.N.S., Q.X.F., Z.N.Z., Y.J.H., Z.T.S., X.S.L., Y.D.Z.) and General Surgery (F.Y.L., B.W.L., H.X.), the First Affiliated Hospital with Nanjing Medical University, No. 300 Guangzhou Rd, Nanjing 210009, China
| | - Ya-Jun Hou
- From the Departments of Radiology (Q.L., W.Y.X., N.N.S., Q.X.F., Z.N.Z., Y.J.H., Z.T.S., X.S.L., Y.D.Z.) and General Surgery (F.Y.L., B.W.L., H.X.), the First Affiliated Hospital with Nanjing Medical University, No. 300 Guangzhou Rd, Nanjing 210009, China
| | - Zi-Tong Sang
- From the Departments of Radiology (Q.L., W.Y.X., N.N.S., Q.X.F., Z.N.Z., Y.J.H., Z.T.S., X.S.L., Y.D.Z.) and General Surgery (F.Y.L., B.W.L., H.X.), the First Affiliated Hospital with Nanjing Medical University, No. 300 Guangzhou Rd, Nanjing 210009, China
| | - Feng-Yuan Li
- From the Departments of Radiology (Q.L., W.Y.X., N.N.S., Q.X.F., Z.N.Z., Y.J.H., Z.T.S., X.S.L., Y.D.Z.) and General Surgery (F.Y.L., B.W.L., H.X.), the First Affiliated Hospital with Nanjing Medical University, No. 300 Guangzhou Rd, Nanjing 210009, China
| | - Bo-Wen Li
- From the Departments of Radiology (Q.L., W.Y.X., N.N.S., Q.X.F., Z.N.Z., Y.J.H., Z.T.S., X.S.L., Y.D.Z.) and General Surgery (F.Y.L., B.W.L., H.X.), the First Affiliated Hospital with Nanjing Medical University, No. 300 Guangzhou Rd, Nanjing 210009, China
| | - Hao Xu
- From the Departments of Radiology (Q.L., W.Y.X., N.N.S., Q.X.F., Z.N.Z., Y.J.H., Z.T.S., X.S.L., Y.D.Z.) and General Surgery (F.Y.L., B.W.L., H.X.), the First Affiliated Hospital with Nanjing Medical University, No. 300 Guangzhou Rd, Nanjing 210009, China
| | - Xi-Sheng Liu
- From the Departments of Radiology (Q.L., W.Y.X., N.N.S., Q.X.F., Z.N.Z., Y.J.H., Z.T.S., X.S.L., Y.D.Z.) and General Surgery (F.Y.L., B.W.L., H.X.), the First Affiliated Hospital with Nanjing Medical University, No. 300 Guangzhou Rd, Nanjing 210009, China
| | - Yu-Dong Zhang
- From the Departments of Radiology (Q.L., W.Y.X., N.N.S., Q.X.F., Z.N.Z., Y.J.H., Z.T.S., X.S.L., Y.D.Z.) and General Surgery (F.Y.L., B.W.L., H.X.), the First Affiliated Hospital with Nanjing Medical University, No. 300 Guangzhou Rd, Nanjing 210009, China
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Méndez RJ, Martín-Garre S. MRI for Local-Regional Staging of Gastric Cancer: A Promising Approach. Radiology 2024; 312:e241384. [PMID: 39012248 DOI: 10.1148/radiol.241384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Affiliation(s)
- Ramiro J Méndez
- From the Department of Radiology, Hospital Clínico San Carlos, C. Martín Lagos S/N, 28040 Madrid, Spain; and Department of Radiology, Rehabilitation, and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain
| | - Susana Martín-Garre
- From the Department of Radiology, Hospital Clínico San Carlos, C. Martín Lagos S/N, 28040 Madrid, Spain; and Department of Radiology, Rehabilitation, and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain
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Xu YF, Ma HY, Huang GL, Zhang YT, Wang XY, Wei MJ, Pei XQ. Double contrast-enhanced ultrasonography improves diagnostic accuracy of T staging compared with multi-detector computed tomography in gastric cancer patients. World J Gastroenterol 2024; 30:3005-3015. [PMID: 38946876 PMCID: PMC11212705 DOI: 10.3748/wjg.v30.i23.3005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 04/24/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Gastric cancer (GC) is the most common malignant tumor and ranks third for cancer-related deaths among the worldwide. The disease poses a serious public health problem in China, ranking fifth for incidence and third for mortality. Knowledge of the invasive depth of the tumor is vital to treatment decisions.
AIM To evaluate the diagnostic performance of double contrast-enhanced ultrasonography (DCEUS) for preoperative T staging in patients with GC by comparing with multi-detector computed tomography (MDCT).
METHODS This single prospective study enrolled patients with GC confirmed by preoperative gastroscopy from July 2021 to March 2023. Patients underwent DCEUS, including ultrasonography (US) and intravenous contrast-enhanced ultrasonography (CEUS), and MDCT examinations for the assessment of preoperative T staging. Features of GC were identified on DCEUS and criteria developed to evaluate T staging according to the 8th edition of AJCC cancer staging manual. The diagnostic performance of DCEUS was evaluated by comparing it with that of MDCT and surgical-pathological findings were considered as the gold standard.
RESULTS A total of 229 patients with GC (80 T1, 33 T2, 59 T3 and 57 T4) were included. Overall accuracies were 86.9% for DCEUS and 61.1% for MDCT (P < 0.001). DCEUS was superior to MDCT for T1 (92.5% vs 70.0%, P < 0.001), T2 (72.7% vs 51.5%, P = 0.041), T3 (86.4% vs 45.8%, P < 0.001) and T4 (87.7% vs 70.2%, P = 0.022) staging of GC.
CONCLUSION DCEUS improved the diagnostic accuracy of preoperative T staging in patients with GC compared with MDCT, and constitutes a promising imaging modality for preoperative evaluation of GC to aid individualized treatment decision-making.
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Affiliation(s)
- Yan-Fen Xu
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Hui-Yun Ma
- Department of Radiology, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Gui-Ling Huang
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Yu-Ting Zhang
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Xue-Yan Wang
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Ming-Jie Wei
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Xiao-Qing Pei
- Department of Medical Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
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Kwak S, Duncan M, Johnston FM, Bever K, Cha E, Fishman EK, Gawande R. Cross-sectional imaging of gastric cancer: pearls, pitfalls and lessons learned from multidisciplinary conference. Abdom Radiol (NY) 2024:10.1007/s00261-024-04392-8. [PMID: 38886219 DOI: 10.1007/s00261-024-04392-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 06/20/2024]
Abstract
Gastric cancer is rising in prevalence associated with high mortality, primarily due to late-stage detection, underscoring the imperative for early and precise diagnosis. Etiology involves an interplay of genetic susceptibilities and environmental factors with a prominent role of Helicobacter pylori infection. Due to its often-delayed symptom presentation, prompt and accurate diagnosis is necessary. A multimodal imaging approach, including endoscopic ultrasound (EUS), multi-detector computed tomography (MDCT), and magnetic resonance imaging (MRI) is critical for accurate staging. Each modality contributes unique advantages and limitations, highlighting the importance of integrating diagnostic strategy. Moreover, multidisciplinary conferences offer a vital collaborative platform, bringing together specialists from diverse fields for treatment planning. This synergistic approach not only enhances diagnostic precision but also improves patient outcome. This review highlights the critical role of imaging in diagnosis, staging, and management and advocates for interdisciplinary collaboration in early detection and comprehensive management of gastric cancer, aiming to reduce mortality.
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Affiliation(s)
- Stephen Kwak
- Johns Hopkins University, 1800 Orleans St., Baltimore, MD, 21287, USA.
| | - Mark Duncan
- Johns Hopkins University, 1800 Orleans St., Baltimore, MD, 21287, USA
| | - Fabian M Johnston
- Johns Hopkins University, 1800 Orleans St., Baltimore, MD, 21287, USA
| | - Katherine Bever
- Johns Hopkins University, 1800 Orleans St., Baltimore, MD, 21287, USA
| | - Eumee Cha
- Johns Hopkins University, 1800 Orleans St., Baltimore, MD, 21287, USA
| | - Elliot K Fishman
- Johns Hopkins University, 1800 Orleans St., Baltimore, MD, 21287, USA
| | - Rakhee Gawande
- Johns Hopkins University, 1800 Orleans St., Baltimore, MD, 21287, USA
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Wang W, Li C, Dai Y, Wu Q, Yu W. Unraveling metabolic characteristics and clinical implications in gastric cancer through single-cell resolution analysis. Front Mol Biosci 2024; 11:1399679. [PMID: 38831933 PMCID: PMC11145399 DOI: 10.3389/fmolb.2024.1399679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/30/2024] [Indexed: 06/05/2024] Open
Abstract
Background: Gastric cancer is a highly prevalent malignant neoplasm. Metabolic reprogramming is intricately linked to both tumorigenesis and cancer immune evasion. The advent of single-cell RNA sequencing technology provides a novel perspective for evaluating cellular metabolism. This study aims to comprehensively investigate the metabolic pathways of various cell types in tumor and normal samples at high resolution and delve into the intricate regulatory mechanisms governing the metabolic activity of malignant cells in gastric cancer. Methods: Utilizing single-cell RNA sequencing data from gastric cancer, we constructed metabolic landscape maps for different cell types in tumor and normal samples. Employing unsupervised clustering, we categorized malignant cells in tumor samples into high and low metabolic subclusters and further explored the characteristics of these subclusters. Results: Our research findings indicate that epithelial cells in tumor samples exhibit significantly higher activity in most KEGG metabolic pathways compared to other cell types. Unsupervised clustering, based on the scores of metabolic pathways, classified malignant cells into high and low metabolic subclusters. In the high metabolic subcluster, it demonstrated the potential to induce a stronger immune response, correlating with a relatively favorable prognosis. In the low metabolic subcluster, a subset of cells resembling cancer stem cells (CSCs) was identified, and its prognosis was less favorable. Furthermore, a set of risk genes associated with this subcluster was discovered. Conclusion: This study reveals the intricate regulatory mechanisms governing the metabolic activity of malignant cells in gastric cancer, offering new perspectives for improving prognosis and treatment strategies.
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Affiliation(s)
- Wenyue Wang
- School of Life Sciences, Tianjin University, Tianjin, China
- HIM-BGI Omics Center, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences (CAS), Hangzhou, China
| | - Conghui Li
- Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Yuting Dai
- HIM-BGI Omics Center, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences (CAS), Hangzhou, China
- Center for Advanced Interdisciplinary Science and Biomedicine of IHM, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Qingfa Wu
- HIM-BGI Omics Center, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences (CAS), Hangzhou, China
- Center for Advanced Interdisciplinary Science and Biomedicine of IHM, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
- Department of Pharmacy, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Weiqiang Yu
- HIM-BGI Omics Center, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences (CAS), Hangzhou, China
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Kim HD, Ryu MH, Kang YK. Adjuvant treatment for locally advanced gastric cancer: an Asian perspective. Gastric Cancer 2024; 27:439-450. [PMID: 38489111 DOI: 10.1007/s10120-024-01484-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/21/2024] [Indexed: 03/17/2024]
Abstract
Standard adjuvant treatment for locally advanced gastric cancer (LAGC) is regionally different. Whereas perioperative chemotherapy is the standard in Western populations, D2 gastrectomy followed by adjuvant chemotherapy has been the standard in East Asia. Recently, the pivotal phase 3 PRODIGY and RESOLVE studies have demonstrated survival benefits of adding neoadjuvant chemotherapy to surgery followed by adjuvant chemotherapy over up-front surgery followed by adjuvant chemotherapy in Asian patients. Based on these results, neoadjuvant chemotherapy is considered one of the viable options for patients with LAGC. In this review, various aspects of neoadjuvant chemotherapy will be discussed for its optimal application in Asia. Candidates for neoadjuvant chemotherapy should be carefully chosen in consideration of the inaccurate aspects of radiological clinical staging and its potential benefit over up-front surgery followed by a decision on adjuvant chemotherapy according to the pathological stage. Efforts should continuously be made to optimally apply neoadjuvant chemotherapy to patients with LAGC, considering various factors, including a more accurate radiological assessment of the tumor burden and the optimization of post-operative chemotherapy. Future neoadjuvant trials involving novel agents for Asian patients should be designed based on proven Asian regimens rather than adopting Western regimens.
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Affiliation(s)
- Hyung-Don Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88,Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Min-Hee Ryu
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88,Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Yoon-Koo Kang
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88,Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Chen C, Song YL, Wu ZY, Chen J, Zhang Y, Chen L. Diagnostic value of conventional endoscopic ultrasound for lymph node metastasis in upper gastrointestinal neoplasia: A meta-analysis. World J Gastroenterol 2023; 29:4685-4700. [PMID: 37662859 PMCID: PMC10472901 DOI: 10.3748/wjg.v29.i30.4685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/16/2023] [Accepted: 07/27/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Upper gastrointestinal neoplasia mainly includes esophageal cancer and gastric cancer, both of which have high morbidity and mortality. Lymph node metastasis (LNM), as the most common metastasis mode of both diseases, is an important factor affecting tumor stage, treatment strategy and clinical prognosis. As a new fusion technology, endoscopic ultrasound (EUS) is becoming increasingly used in the diagnosis and treatment of digestive system diseases, but its use in detecting LNM in clinical practice remains limited. AIM To evaluate the diagnostic value of conventional EUS for LNM in upper gastrointestinal neoplasia. METHODS Using the search mode of "MeSH + Entry Terms" and according to the predetermined inclusion and exclusion criteria, we conducted a comprehensive search and screening of the PubMed, EMBASE and Cochrane Library databases from January 1, 2000 to October 1, 2022. Study data were extracted according to the predetermined data extraction form. The quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool, and the results of the quality assessment were presented using Review Manager 5.3.5 software. Finally, Stata14.0 software was used for a series of statistical analyses. RESULTS A total of 22 studies were included in our study, including 2986 patients. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic score and diagnostic odds ratio of conventional EUS in the diagnosis of upper gastrointestinal neoplasia LNM were 0.62 [95% confidence interval (CI): 0.50-0.73], 0.80 (95%CI: 0.73-0.86), 3.15 (95%CI: 2.46-4.03), 0.47 (95%CI: 0.36-0.61), 1.90 (95%CI: 1.51-2.29) and 6.67 (95%CI: 4.52-9.84), respectively. The area under the summary receiver operating characteristic curve was 0.80 (95%CI: 0.76-0.83). Sensitivity analysis indicated that the results of the meta-analysis were stable. There was considerable heterogeneity among the included studies, and the threshold effect was an important source of heterogeneity. Univariable meta-regression and subgroup analysis showed that tumor type, sample size and EUS diagnostic criteria were significant sources of heterogeneity in specificity (P < 0.05). No significant publication bias was found. CONCLUSION Conventional EUS has certain clinical value and can assist in the detection of LNM in upper gastrointestinal neoplasia, but it cannot be used as a confirmatory or exclusionary test.
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Affiliation(s)
- Cong Chen
- Institute of Gastroenterology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Ya-Lan Song
- Institute of Gastroenterology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Zhen-Yu Wu
- Institute of Gastroenterology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Jing Chen
- Institute of Gastroenterology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Yao Zhang
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Lei Chen
- Institute of Gastroenterology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
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Varga Z, Bíró A, Török M, Tóth D. A combined approach for individualized lymphadenectomy in gastric cancer patients. Pathol Oncol Res 2023; 29:1611270. [PMID: 37456519 PMCID: PMC10338685 DOI: 10.3389/pore.2023.1611270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
Introduction: Gastric cancer ranks as the fifth most common cancer globally. The presence of lymph node metastasis is a significant prognostic factor influencing survival. Postoperative morbidity and nodal staging accuracy are heavily affected by the extent of lymph node dissection. Our study aimed to explore the potential integration of two contemporary methods, sentinel node navigation surgery (SNNS) and the Maruyama Computer Program (MCP), to improve the accuracy of nodal staging. Materials and methods: We conducted a prospective data collection involving patients with gastric adenocarcinoma from 2008 to 2018 at the Department of Surgery, University of Debrecen, Hungary. Data from 100 consecutive patients were collected. The primary and secondary endpoints included evaluating the rate of node-negative patients and the diagnostic accuracy of our combined approach. Results: Sentinel node mapping was successful in 97 out of 100 patients. We found that using the threshold value of the Maruyama Index (MI) ≥ 28, all metastatic stations of sentinel-node-negative patients could be identified. Our method achieved 100% sensitivity and negative predictive value, with a specificity of 60.42% (95% CI = 46.31%-72.98%). Discussion: The combined application of SNNS and MCP has proven to be an effective diagnostic technique in the synergistic approach for identifying metastasis-positive lymph node stations. Despite its limitations, this combination may assist clinicians in customizing lymphadenectomy for gastric cancer patients.
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Affiliation(s)
- Zsolt Varga
- Department of Surgery, University of Debrecen, Debrecen, Hungary
| | - Adrienn Bíró
- Department of Surgery, Moritz Kaposi General Hospital, Kaposvár, Hungary
| | - Miklós Török
- Department of Pathology, University of Debrecen, Debrecen, Hungary
| | - Dezső Tóth
- Department of Surgery, University of Debrecen, Debrecen, Hungary
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Giandola T, Maino C, Marrapodi G, Ratti M, Ragusi M, Bigiogera V, Talei Franzesi C, Corso R, Ippolito D. Imaging in Gastric Cancer: Current Practice and Future Perspectives. Diagnostics (Basel) 2023; 13:diagnostics13071276. [PMID: 37046494 PMCID: PMC10093088 DOI: 10.3390/diagnostics13071276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/19/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Gastric cancer represents one of the most common oncological causes of death worldwide. In order to treat patients in the best possible way, the staging of gastric cancer should be accurate. In this regard, endoscopy ultrasound (EUS) has been considered the reference standard for tumor (T) and nodal (N) statuses in recent decades. However, thanks to technological improvements, computed tomography (CT) has gained an important role, not only in the assessment of distant metastases (M status) but also in T and N staging. In addition, magnetic resonance imaging (MRI) can contribute to the detection and staging of primary gastric tumors thanks to its excellent soft tissue contrast and multiple imaging sequences without radiation-related risks. In addition, MRI can help with the detection of liver metastases, especially small lesions. Finally, positron emission tomography (PET) is still considered a useful diagnostic tool for the staging of gastric cancer patients, with a focus on nodal metastases and peritoneal carcinomatosis. In addition, it may play a role in the treatment of gastric cancer in the coming years thanks to the introduction of new labeling peptides. This review aims to summarize the most common advantages and pitfalls of EUS, CT, MRI and PET in the TNM staging of gastric cancer patients.
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Wu LL, Xin JY, Wang JJ, Feng QQ, Xu XL, Li KY. Prospective Comparison of Oral Contrast-Enhanced Transabdominal Ultrasound Imaging With Contrast-Enhanced Computed Tomography in Pre-operative Tumor Staging of Gastric Cancer. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:569-577. [PMID: 36369213 DOI: 10.1016/j.ultrasmedbio.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/22/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
The aim of this prospective study was to compare the diagnostic accuracy of oral contrast-enhanced transabdominal ultrasound imaging (OCTU) with that of contrast-enhanced computed tomography (CT) for the pre-operative tumor staging of gastric cancer, with post-operative pathology as the standard. We included 108 cases of gastric cancer with simultaneous OCTU and enhanced CT pre-operative tumor staging diagnoses. Results were compared with post-operative pathology based on the eighth edition of the American Joint Committee on Cancer tumor-node-metastasis staging guidelines for gastric cancer. The accuracy of each tumor stage was obtained by comparing OCTU and enhanced CT diagnoses with post-operative pathology. The McNemar test was used to compare the overall accuracy of the two methods. There was no statistical difference in accuracy between OCTU (72.2%) and enhanced CT (75.9%, p = 0.644) for overall pre-operative tumor staging diagnosis. For stages T1 to T4, the accuracy rates of OCTU were 84.2%, 81.8%, 69.4% and 65.5%, respectively, and those for enhanced CT were 52.6%, 72.7%, 87.8% and 72.4%, respectively. OCTU is comparable to enhanced CT in the preoperative overall T-stage diagnosis of gastric cancer.
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Affiliation(s)
- Ling-Ling Wu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jun-Yi Xin
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jing-Jing Wang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qun-Qun Feng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiao-Li Xu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Kai-Yan Li
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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11
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Kim TH, Kim IH, Kang SJ, Choi M, Kim BH, Eom BW, Kim BJ, Min BH, Choi CI, Shin CM, Tae CH, Gong CS, Kim DJ, Cho AEH, Gong EJ, Song GJ, Im HS, Ahn HS, Lim H, Kim HD, Kim JJ, Yu JI, Lee JW, Park JY, Kim JH, Song KD, Jung M, Jung MR, Son SY, Park SH, Kim SJ, Lee SH, Kim TY, Bae WK, Koom WS, Jee Y, Kim YM, Kwak Y, Park YS, Han HS, Nam SY, Kong SH. Korean Practice Guidelines for Gastric Cancer 2022: An Evidence-based, Multidisciplinary Approach. J Gastric Cancer 2023; 23:3-106. [PMID: 36750993 PMCID: PMC9911619 DOI: 10.5230/jgc.2023.23.e11] [Citation(s) in RCA: 72] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 02/09/2023] Open
Abstract
Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.
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Affiliation(s)
- Tae-Han Kim
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - In-Ho Kim
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Joo Kang
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center Seoul, Seoul, Korea
| | - Miyoung Choi
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea
| | - Baek-Hui Kim
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Bum Jun Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Seoul, Korea
| | - Chang In Choi
- Department of Surgery, Pusan National University Hospital, Pusan, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seungnam, Korea
| | - Chung Hyun Tae
- Department of Internal Medicine, Ewha Woman’s University College of Medicine, Seoul, Korea
| | - Chung sik Gong
- Division of Gastrointestinal Surgery, Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Jin Kim
- Department of Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Eun Jeong Gong
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Geum Jong Song
- Department of Surgery, Soonchunhyang University, Cheonan, Korea
| | - Hyeon-Su Im
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hye Seong Ahn
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyun Lim
- Department of Gastroenterology, Hallym University Sacred Heart Hospital, University of Hallym College of Medicine, Anyang, Korea
| | - Hyung-Don Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Joon Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Jeong Won Lee
- Department of Nuclear Medicine, Catholic Kwandong University, College of Medicine, Incheon, Korea
| | - Ji Yeon Park
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jwa Hoon Kim
- Division of Oncology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyoung Doo Song
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | - Minkyu Jung
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Mi Ran Jung
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Sang-Yong Son
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Shin-Hoo Park
- Department of Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Soo Jin Kim
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Sung Hak Lee
- Department of Hospital Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Woo Kyun Bae
- Division of Hematology-Oncology, Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Yeseob Jee
- Department of Surgery, Dankook University Hospital, Cheonan, Korea
| | - Yoo Min Kim
- Department of Surgery, Severance Hospital, Seoul, Korea
| | - Yoonjin Kwak
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Sook Han
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
| | - Su Youn Nam
- Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital and Seoul National University College of Medicine Cancer Research Institute, Seoul, Korea.
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12
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Harold KM, MacCuaig WM, Holter-Charkabarty J, Williams K, Hill K, Arreola AX, Sekhri M, Carter S, Gomez-Gutierrez J, Salem G, Mishra G, McNally LR. Advances in Imaging of Inflammation, Fibrosis, and Cancer in the Gastrointestinal Tract. Int J Mol Sci 2022; 23:16109. [PMID: 36555749 PMCID: PMC9781634 DOI: 10.3390/ijms232416109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Gastrointestinal disease is prevalent and broad, manifesting itself in a variety of ways, including inflammation, fibrosis, infection, and cancer. However, historically, diagnostic technologies have exhibited limitations, especially with regard to diagnostic uncertainty. Despite development of newly emerging technologies such as optoacoustic imaging, many recent advancements have focused on improving upon pre-existing modalities such as ultrasound, computed tomography, magnetic resonance imaging, and endoscopy. These advancements include utilization of machine learning models, biomarkers, new technological applications such as diffusion weighted imaging, and new techniques such as transrectal ultrasound. This review discusses assessment of disease processes using imaging strategies for the detection and monitoring of inflammation, fibrosis, and cancer in the context of gastrointestinal disease. Specifically, we include ulcerative colitis, Crohn's disease, diverticulitis, celiac disease, graft vs. host disease, intestinal fibrosis, colorectal stricture, gastric cancer, and colorectal cancer. We address some of the most recent and promising advancements for improvement of gastrointestinal imaging, including unique discussions of such advancements with regard to imaging of fibrosis and differentiation between similar disease processes.
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Affiliation(s)
- Kylene M. Harold
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | | | | | | | - Kaitlyn Hill
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Alex X. Arreola
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Malika Sekhri
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Steven Carter
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Jorge Gomez-Gutierrez
- Department of Child Health, School of Medicine, University of Missouri, Columbia, MO 65211, USA
| | - George Salem
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Girish Mishra
- Wake Forest Baptist Health, Winston-Salem, NC 27157, USA
| | - Lacey R. McNally
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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13
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Cao R, Tang L, Fang M, Zhong L, Wang S, Gong L, Li J, Dong D, Tian J. Artificial intelligence in gastric cancer: applications and challenges. Gastroenterol Rep (Oxf) 2022; 10:goac064. [PMID: 36457374 PMCID: PMC9707405 DOI: 10.1093/gastro/goac064] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/27/2022] [Accepted: 10/18/2022] [Indexed: 08/10/2023] Open
Abstract
Gastric cancer (GC) is one of the most common malignant tumors with high mortality. Accurate diagnosis and treatment decisions for GC rely heavily on human experts' careful judgments on medical images. However, the improvement of the accuracy is hindered by imaging conditions, limited experience, objective criteria, and inter-observer discrepancies. Recently, the developments of machine learning, especially deep-learning algorithms, have been facilitating computers to extract more information from data automatically. Researchers are exploring the far-reaching applications of artificial intelligence (AI) in various clinical practices, including GC. Herein, we aim to provide a broad framework to summarize current research on AI in GC. In the screening of GC, AI can identify precancerous diseases and assist in early cancer detection with endoscopic examination and pathological confirmation. In the diagnosis of GC, AI can support tumor-node-metastasis (TNM) staging and subtype classification. For treatment decisions, AI can help with surgical margin determination and prognosis prediction. Meanwhile, current approaches are challenged by data scarcity and poor interpretability. To tackle these problems, more regulated data, unified processing procedures, and advanced algorithms are urgently needed to build more accurate and robust AI models for GC.
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Affiliation(s)
| | | | - Mengjie Fang
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, P. R. China
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, P. R. China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Engineering Medicine, Beihang University, Beijing, P. R. China
| | - Lianzhen Zhong
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, P. R. China
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, P. R. China
| | - Siwen Wang
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, P. R. China
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, P. R. China
| | - Lixin Gong
- College of Medicine and Biological Information Engineering School, Northeastern University, Shenyang, Liaoning, P. R. China
| | - Jiazheng Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Radiology Department, Peking University Cancer Hospital & Institute, Beijing, P. R. China
| | - Di Dong
- Corresponding authors. Di Dong, CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, 95 Zhongguancun East Road, Beijing 100190, P. R. China. Tel: +86-13811833760; ; Jie Tian, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Engineering Medicine, Beihang University, Beijing, P. R. China. Tel: +86-10-82618465;
| | - Jie Tian
- Corresponding authors. Di Dong, CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, 95 Zhongguancun East Road, Beijing 100190, P. R. China. Tel: +86-13811833760; ; Jie Tian, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Engineering Medicine, Beihang University, Beijing, P. R. China. Tel: +86-10-82618465;
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14
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Determinants of clinical outcomes of gastric cancer patients treated with neoadjuvant chemotherapy: a sub-analysis of the PRODIGY study. Gastric Cancer 2022; 25:1039-1049. [PMID: 35920999 DOI: 10.1007/s10120-022-01325-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/16/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND In this post hoc analysis of the PRODIGY study, we aimed to investigate factors associated with survival outcomes and provide evidence for designing optimal perioperative treatment strategies for gastric cancer patients receiving neoadjuvant chemotherapy. PATIENTS AND METHODS A total of 212 patients in the neoadjuvant chemotherapy group of the PRODIGY study were included as the study population. The prognostic impact of clinicopathologic factors, including the initial radiological clinical stage (cStage) and post-neoadjuvant chemotherapy pathological stage (ypStage), was analyzed. RESULTS The median age was 58 years. The majority of patients (77.4%) had cStage III disease, and about 10% and 25% had ypStage 0 and I disease, respectively. According to the initial cStage, progression-free survival (PFS) and overall survival (OS) were significantly different (P < 0.01). PFS and OS were also different according to the ypStage (P < 0.01). In multivariate analyses, cStage IIIC disease (vs. cStage II) and ypStage II and III disease (vs. ypStage 0/I) were independent factors for poor survival outcomes. Based on the patterns of PFS and OS according to both cStage and ypStage, three patient groups were defined. These groups showed distinct PFS and OS (P < 0.01) with 5-year PFS rates of 95.7%, 77.9%, and 31.3% and 5-year OS rates of 95.7%, 82.4%, and 42.5%, respectively. CONCLUSIONS Both initial cStage and ypStage were independent factors for survival outcomes of gastric cancer patients treated with neoadjuvant chemotherapy. Efforts should be made to develop optimal peri-operative treatment strategies for patients at different risks according to cStage and ypStage.
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15
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Application of Endoscopic Ultrasound Combined with Multislice Spiral CT in Diagnosis and Treatment of Patients with Gastrointestinal Eminence Lesions. DISEASE MARKERS 2022; 2022:1417104. [PMID: 35811661 PMCID: PMC9259227 DOI: 10.1155/2022/1417104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/21/2022] [Accepted: 05/17/2022] [Indexed: 11/18/2022]
Abstract
Objective To evaluate the application of endoscopic ultrasound (EUS) combined with multislice spiral CT (MSCT) in the diagnosis and treatment of patients with gastric eminence lesions. Methods A total of 160 patients with gastric eminence lesions enrolled in our hospital from June 2018 to June 2021 were included and received EUS and MSCT. The results of the two examinations and the postoperative pathological results were compared. Results The common pathological types of gastric eminence lesions include polyps and stromal tumors, with the most common sites of lesions in the gastric antrum, followed by the fundus of the stomach and the gastric body. Gastric eminence lesions mostly originate from the mucosal layer and muscularis mucosa, accounting for 83.13% of the total. With pathological results as the gold standard, the detection rate of MSCT was 90.63%, and that of EUS was 78.13%. With the joint diagnosis as a reference, the receiver operating curve (ROC) revealed a higher diagnostic efficiency of MSCT and EUS. Conclusion The accuracy of MSCT in the diagnosis of gastric eminence lesions is significantly higher than that of EUS, both of which can offer useful guidance for the choice of endoscopic treatment methods. The combination of MSCT and EUS examination before endoscopic gastroscopy may provide a better treatment efficacy on gastric protruding lesions with high safety.
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16
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Genomically Silent Refractory Gastric Cancer in a Young Patient Exhibits Overexpression of CXCL5. Curr Oncol 2022; 29:4725-4733. [PMID: 35877235 PMCID: PMC9320515 DOI: 10.3390/curroncol29070375] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/02/2022] [Accepted: 07/05/2022] [Indexed: 12/16/2022] Open
Abstract
Gastric cancer is the third leading cause of cancer-related deaths, with more than one million new cases and approximately 841,000 deaths annually worldwide. We report a case of a young patient (25 years old) with an aggressive form of gastric cancer. The patient had previously been treated for Helicobacter pylori (H. pylori), which is a main risk factor for developing gastric cancer. Genetic testing showed an E-cadherin (CDH1) germline mutation of unknown significance. After eight cycles of chemotherapy, a positron emission tomography (PET) scan showed disease progression with an enlarging hypermetabolic right adnexal mass suspicious for metastatic disease. Tumor pathology demonstrated invasive and poorly differentiated gastric carcinoma. The analysis of the tumor biopsy indicated the very high expression of a chemokine, C-X-C motif chemokine 5 (CXCL5). The combination of H. pylori infection with an existence of a rare CDH1 mutation could have contributed to this aggressive gastric cancer.
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17
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Schön F, Sinzig R, Walther F, Radosa CG, Nebelung H, Eberlein-Gonska M, Hoffmann RT, Kühn JP, Blum SFU. Value of Clinical Information on Radiology Reports in Oncological Imaging. Diagnostics (Basel) 2022; 12:diagnostics12071594. [PMID: 35885499 PMCID: PMC9321157 DOI: 10.3390/diagnostics12071594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 11/16/2022] Open
Abstract
Radiological reporting errors have a direct negative impact on patient treatment. The purpose of this study was to investigate the contribution of clinical information (CI) in radiological reporting of oncological imaging and the dependence on the radiologists’ experience level (EL). Sixty-four patients with several types of carcinomas and twenty patients without tumors were enrolled. Computed tomography datasets acquired in primary or follow-up staging were independently analyzed by three radiologists (R) with different EL (R1: 15 years; R2: 10 years, R3: 1 year). Reading was initially performed without and 3 months later with CI. Overall, diagnostic accuracy and sensitivity for primary tumor detection increased significantly when receiving CI from 77% to 87%; p = 0.01 and 73% to 83%; p = 0.01, respectively. All radiologists benefitted from CI; R1: 85% vs. 92%, p = 0.15; R2: 77% vs. 83%, p = 0.33; R3: 70% vs. 86%, p = 0.02. Overall, diagnostic accuracy and sensitivity for detecting lymphogenous metastases increased from 80% to 85% (p = 0.13) and 42% to 56% (p = 0.13), for detection of hematogenous metastases from 85% to 86% (p = 0.61) and 46% to 60% (p = 0.15). Specificity remained stable (>90%). Thus, CI in oncological imaging seems to be essential for correct radiological reporting, especially for residents, and should be available for the radiologist whenever possible.
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Affiliation(s)
- Felix Schön
- Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus Dresden, TU Dresden, 01307 Dresden, Germany; (R.S.); (C.G.R.); (H.N.); (R.-T.H.); (J.-P.K.); (S.F.U.B.)
- Correspondence: ; Tel.: +49-351-458-19089
| | - Rebecca Sinzig
- Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus Dresden, TU Dresden, 01307 Dresden, Germany; (R.S.); (C.G.R.); (H.N.); (R.-T.H.); (J.-P.K.); (S.F.U.B.)
| | - Felix Walther
- Quality and Medical Risk Management, University Hospital Carl Gustav Carus Dresden, TU Dresden, 01307 Dresden, Germany; (F.W.); (M.E.-G.)
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus Dresden, University Hospital Carl Gustav Carus Dresden, TU Dresden, 01307 Dresden, Germany
| | - Christoph Georg Radosa
- Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus Dresden, TU Dresden, 01307 Dresden, Germany; (R.S.); (C.G.R.); (H.N.); (R.-T.H.); (J.-P.K.); (S.F.U.B.)
| | - Heiner Nebelung
- Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus Dresden, TU Dresden, 01307 Dresden, Germany; (R.S.); (C.G.R.); (H.N.); (R.-T.H.); (J.-P.K.); (S.F.U.B.)
| | - Maria Eberlein-Gonska
- Quality and Medical Risk Management, University Hospital Carl Gustav Carus Dresden, TU Dresden, 01307 Dresden, Germany; (F.W.); (M.E.-G.)
| | - Ralf-Thorsten Hoffmann
- Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus Dresden, TU Dresden, 01307 Dresden, Germany; (R.S.); (C.G.R.); (H.N.); (R.-T.H.); (J.-P.K.); (S.F.U.B.)
| | - Jens-Peter Kühn
- Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus Dresden, TU Dresden, 01307 Dresden, Germany; (R.S.); (C.G.R.); (H.N.); (R.-T.H.); (J.-P.K.); (S.F.U.B.)
| | - Sophia Freya Ulrike Blum
- Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus Dresden, TU Dresden, 01307 Dresden, Germany; (R.S.); (C.G.R.); (H.N.); (R.-T.H.); (J.-P.K.); (S.F.U.B.)
- Quality and Medical Risk Management, University Hospital Carl Gustav Carus Dresden, TU Dresden, 01307 Dresden, Germany; (F.W.); (M.E.-G.)
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Tham E, Sestito M, Markovich B, Garland-Kledzik M. Current and future imaging modalities in gastric cancer. J Surg Oncol 2022; 125:1123-1134. [PMID: 35481912 DOI: 10.1002/jso.26875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 12/24/2022]
Abstract
Gastric adenocarcinoma treatment can include endoscopic mucosal resection, surgery, chemotherapy, radiation, and palliative measures depending on staging. Both invasive and noninvasive staging techniques have been used to dictate the best treatment pathway. Here, we review the current imaging modalities used in gastric cancer as well as novel techniques to accurately stage and screen these patients.
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Affiliation(s)
- Elwin Tham
- Department of Surgical Oncology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Michael Sestito
- Department of Surgical Oncology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Brian Markovich
- Department of Diagnostic Radiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Mary Garland-Kledzik
- Department of Surgical Oncology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
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Zhang Y, Yuan N, Zhang Z, Du J, Wang T, Liu B, Yang A, Lv K, Ma G, Lei B. Unsupervised Domain Selective Graph Convolutional Network for Preoperative Prediction of Lymph Node Metastasis in Gastric Cancer. Med Image Anal 2022; 79:102467. [PMID: 35537338 DOI: 10.1016/j.media.2022.102467] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 12/24/2022]
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20
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Radiological criteria for selecting candidates for neoadjuvant chemotherapy for gastric cancer: an exploratory analysis from the PRODIGY study. Gastric Cancer 2022; 25:170-179. [PMID: 34476643 DOI: 10.1007/s10120-021-01243-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND In this exploratory analysis from the PRODIGY study, we aimed to define the radiological criteria to identify patients with gastric cancer who may derive maximal clinical benefit from neoadjuvant chemotherapy. PATIENTS AND METHODS There were 246 patients allocated to receive surgery followed by adjuvant S-1 (SC group) and 238 allocated to receive neoadjuvant chemotherapy (CSC group). As the PRODIGY's radiological method of lymph node (LN) evaluation considers short diameter and morphology (the size and morphology method), a method considering only short diameter was also employed. In the SC group, the correlation between radiologic and pathologic findings was analyzed. The hazard ratio (HR) for the progression-free survival (PFS) of the CSC group was analyzed in subgroups with different cT/N stages. RESULTS cT4 disease showed a sensitivity of 85.6% for detecting pT4 and had a low proportion of pathologic stage (pStage) I disease (4.5%). Among the criteria determined by different cT/N stages by each method of LN positivity, those involving cT4Nany or cT4N + by both methods had a minimal proportion of pStage I disease (≤ 5%), while cT4Nany by both methods and cT4N + by the size and morphology method exhibited ≥ 75.9% sensitivity for detecting pStage III disease. The relative risk reduction in PFS of the CSC group was greatest in patients meeting the cT4Nany criterion defined by both methods (HR 0.67, 95% confidence interval 0.48-0.93). CONCLUSIONS The cT4Nany criterion, regardless of the radiological method used for LN evaluation, may help select patients with resectable gastric cancer for neoadjuvant chemotherapy.
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21
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Kim HY, Chang W, Lee YJ, Park JH, Cho J, Na HY, Ahn H, Hwang SI, Lee HJ, Kim YH, Lee KH. Adrenal Nodules Detected at Staging CT in Patients with Resectable Gastric Cancers Have a Low Incidence of Malignancy. Radiology 2021; 302:129-137. [PMID: 34665031 DOI: 10.1148/radiol.2021211210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Guidelines recommending additional imaging for adrenal nodules lack relevant epidemiologic evidence. Purpose To measure the prevalence of adrenal nodules detected at staging CT in patients with potentially resectable gastric cancer and the proportion of patients with malignant nodules among them. Materials and Methods This retrospective study included 10 250 consecutive patients (median age, 63 years; interquartile range, 53-71 years; 6884 men) who underwent staging CT and had potentially resectable gastric cancer in a tertiary center (May 2003 to December 2018). All 10 250 CT studies were retrospectively reviewed, and patients with adrenal nodules (or thickening ≥10 mm) were identified to measure the prevalence of adrenal nodules. Among patients with adrenal nodules, the per-patient proportions of malignant nodules, adrenal metastasis from gastric cancer, and additional adrenal examinations were measured. A secondary analysis was performed by using data from the original CT reports. The same metrics that were used in the retrospective review were assessed. Results The prevalence of adrenal nodules was 4.5% (95% CI: 4.1, 4.9; 462 of 10 250). The proportions of malignant nodules and adrenal metastasis from gastric cancer were 0.4% ( 95% CI: 0.1, 1.6; two of 462) and 0% (95% CI: 0.0, 0.8; 0 of 462), respectively. A total of 27% of the patients (95% CI: 23, 31; 123 of 462) underwent additional adrenal examination. According to original CT reports, the prevalence of adrenal nodules and the proportions of malignant nodules, adrenal metastases from gastric cancer, and additional adrenal examination were 2.7% (95% CI: 2.4, 3.0; 272 of 10 250), 0.7% (95% CI: 0.1, 2.6; two of 272), 0% (95% CI: 0.0, 1.4; 0 of 272), and 42.6% (95% CI: 36.7, 48.8; 116 of 272), respectively. Conclusion Although adrenal nodules were detected frequently on staging CT images of patients with otherwise resectable gastric cancer, these nodules were rarely malignant. ©RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Baumgarten in this issue.
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Affiliation(s)
- Hae Young Kim
- From the Departments of Radiology (H.Y.K., W.C., Y.J.L., J.H.P., J.C., H.A., S.I.H., H.J.L., Y.H.K., K.H.L.) and Pathology (H.Y.N.), Seoul National University Bundang Hospital, 82 Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, Korea (H.Y.N.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea (K.H.L.); Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (H.J.L., Y.H.K., K.H.L.); and Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea (K.H.L.)
| | - Won Chang
- From the Departments of Radiology (H.Y.K., W.C., Y.J.L., J.H.P., J.C., H.A., S.I.H., H.J.L., Y.H.K., K.H.L.) and Pathology (H.Y.N.), Seoul National University Bundang Hospital, 82 Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, Korea (H.Y.N.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea (K.H.L.); Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (H.J.L., Y.H.K., K.H.L.); and Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea (K.H.L.)
| | - Yoon Jin Lee
- From the Departments of Radiology (H.Y.K., W.C., Y.J.L., J.H.P., J.C., H.A., S.I.H., H.J.L., Y.H.K., K.H.L.) and Pathology (H.Y.N.), Seoul National University Bundang Hospital, 82 Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, Korea (H.Y.N.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea (K.H.L.); Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (H.J.L., Y.H.K., K.H.L.); and Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea (K.H.L.)
| | - Ji Hoon Park
- From the Departments of Radiology (H.Y.K., W.C., Y.J.L., J.H.P., J.C., H.A., S.I.H., H.J.L., Y.H.K., K.H.L.) and Pathology (H.Y.N.), Seoul National University Bundang Hospital, 82 Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, Korea (H.Y.N.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea (K.H.L.); Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (H.J.L., Y.H.K., K.H.L.); and Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea (K.H.L.)
| | - Jungheum Cho
- From the Departments of Radiology (H.Y.K., W.C., Y.J.L., J.H.P., J.C., H.A., S.I.H., H.J.L., Y.H.K., K.H.L.) and Pathology (H.Y.N.), Seoul National University Bundang Hospital, 82 Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, Korea (H.Y.N.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea (K.H.L.); Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (H.J.L., Y.H.K., K.H.L.); and Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea (K.H.L.)
| | - Hee Young Na
- From the Departments of Radiology (H.Y.K., W.C., Y.J.L., J.H.P., J.C., H.A., S.I.H., H.J.L., Y.H.K., K.H.L.) and Pathology (H.Y.N.), Seoul National University Bundang Hospital, 82 Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, Korea (H.Y.N.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea (K.H.L.); Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (H.J.L., Y.H.K., K.H.L.); and Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea (K.H.L.)
| | - Hyungwoo Ahn
- From the Departments of Radiology (H.Y.K., W.C., Y.J.L., J.H.P., J.C., H.A., S.I.H., H.J.L., Y.H.K., K.H.L.) and Pathology (H.Y.N.), Seoul National University Bundang Hospital, 82 Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, Korea (H.Y.N.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea (K.H.L.); Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (H.J.L., Y.H.K., K.H.L.); and Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea (K.H.L.)
| | - Sung Il Hwang
- From the Departments of Radiology (H.Y.K., W.C., Y.J.L., J.H.P., J.C., H.A., S.I.H., H.J.L., Y.H.K., K.H.L.) and Pathology (H.Y.N.), Seoul National University Bundang Hospital, 82 Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, Korea (H.Y.N.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea (K.H.L.); Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (H.J.L., Y.H.K., K.H.L.); and Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea (K.H.L.)
| | - Hak Jong Lee
- From the Departments of Radiology (H.Y.K., W.C., Y.J.L., J.H.P., J.C., H.A., S.I.H., H.J.L., Y.H.K., K.H.L.) and Pathology (H.Y.N.), Seoul National University Bundang Hospital, 82 Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, Korea (H.Y.N.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea (K.H.L.); Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (H.J.L., Y.H.K., K.H.L.); and Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea (K.H.L.)
| | - Young Hoon Kim
- From the Departments of Radiology (H.Y.K., W.C., Y.J.L., J.H.P., J.C., H.A., S.I.H., H.J.L., Y.H.K., K.H.L.) and Pathology (H.Y.N.), Seoul National University Bundang Hospital, 82 Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, Korea (H.Y.N.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea (K.H.L.); Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (H.J.L., Y.H.K., K.H.L.); and Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea (K.H.L.)
| | - Kyoung Ho Lee
- From the Departments of Radiology (H.Y.K., W.C., Y.J.L., J.H.P., J.C., H.A., S.I.H., H.J.L., Y.H.K., K.H.L.) and Pathology (H.Y.N.), Seoul National University Bundang Hospital, 82 Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, Korea (H.Y.N.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea (K.H.L.); Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (H.J.L., Y.H.K., K.H.L.); and Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea (K.H.L.)
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Fang T, Liang TT, Wang YZ, Wu HT, Liu SH, Wang C. Synchronous concomitant pancreatic acinar cell carcin and gastric adenocarcinoma: A case report and review of literature. World J Clin Cases 2021; 9:8509-8517. [PMID: 34754861 PMCID: PMC8554415 DOI: 10.12998/wjcc.v9.i28.8509] [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] [Received: 04/05/2021] [Revised: 07/19/2021] [Accepted: 08/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Multiple primary malignant tumors are two or more malignancies in an individual without any relationship between the neoplasms. In recent years, an increasing number of cases have been reported. However, concomitant primary gastric and pancreatic cancer reported a relatively small incidence, involving no pancreatic acinar cell carcinoma reports. Here, we present the first case of concomitant pancreatic acinar cell carcinoma and gastric adenocarcinoma.
CASE SUMMARY A 69-year-old male presented to our department with a history of vomiting, epigastric pain, and weight loss. Imaging revealed space-occupying lesions in the stomach and the tail of the pancreas, respectively. The patient underwent laparoscopic radical gastrectomy and pancreatectomy simultaneously. The pathologies of surgical specimens were completely different: The resected gastric specimen was moderate to poorly differentiated adenocarcinoma, whereas the pancreatic tumor was consistent with acinar cell carcinoma. The patient was treated with six cycles of oxaliplatin and S-1 chemotherapy. As of March 2021, the patient was healthy without any recurrence or metastasis. After thoroughly reviewing the literature on simultaneous pancreatic and gastric cancers at home and abroad, we discussed the clinical characteristics of these rare synchronous double cancers. Most of the cases had undergone surgery and adjuvant chemotherapy, and all of the cases were pathologically confirmed by the postoperative specimen.
CONCLUSION Synchronous pancreatic acinar cells and gastric adenocarcinoma can occur and should be considered when tumors are found in these organs.
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Affiliation(s)
- Tian Fang
- Department of Oncology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Ting-Ting Liang
- Department of Oncology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Yi-Zhuo Wang
- Department of Oncology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Hai-Tao Wu
- Department of Oncology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Shu-Han Liu
- Department of Oncology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Chang Wang
- Department of Oncology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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Zhang Y, Zhang J, Yang L, Huang S. A meta-analysis of the utility of transabdominal ultrasound for evaluation of gastric cancer. Medicine (Baltimore) 2021; 100:e26928. [PMID: 34397938 PMCID: PMC8360412 DOI: 10.1097/md.0000000000026928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 07/27/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Clinical discovery/staging of gastric cancer (GC) is crucial in designing the treatment strategies and largely decides GC patients' survival. Endoscopic ultrasonography (EUS) and computed tomography (CT) are 2 useful GC diagnosis tools. High doses of radiation associated with CT make its use limited, while the process of EUS is stressful, time-consuming, and challenging. Transabdominal ultrasound (TAUS) is a promising candidate to address these shortcomings. This study aimed to meta-analyze the diagnostic accuracy and sensitivity of TAUS in discriminating between advanced and early GCs, as well as compare its utility with other imaging techniques.Methods: Literature searches were conducted using PubMed, Web of Science, Embase, and Cochrane Library databases up to 2019. Data were analyzed using RevMan software (Cochrane Collaboration, Oxford, UK), and pooled estimates of accuracy, sensitivity, and other features were acquired. Seven papers were eventually selected for meta-analysis. RESULTS TAUS had distinct diagnostic efficacies for early and advanced GC patients. The accuracy and sensitivity were significantly higher in the advanced group. A high color Doppler vascularity index and a lesion larger than 1 cm were 2 features of advanced GC. Moreover, TAUS had a comparable (but slightly higher) accuracy than CT and EUS. CONCLUSIONS TAUS is more accurate and sensitive in diagnosing advanced GC compared to early GC. More features of advanced GC are required to improve the recognition ability. At least, TAUS can be considered as a complementary imaging diagnostic tool to CT and EUS.
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Affiliation(s)
- Yuqin Zhang
- Department of Radiology, Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Minhou County, China
| | | | - Liu Yang
- Unimed Scientific Inc., Wuxi, China
| | - Songxiong Huang
- Health Management Center, Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, No. 282, Wusi Road, Minhou County, China
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24
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Shimada H, Fukagawa T, Haga Y, Okazumi S, Oba K. Clinical TNM staging for esophageal, gastric, and colorectal cancers in the era of neoadjuvant therapy: A systematic review of the literature. Ann Gastroenterol Surg 2021; 5:404-418. [PMID: 34337289 PMCID: PMC8316742 DOI: 10.1002/ags3.12444] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/06/2021] [Accepted: 01/26/2021] [Indexed: 12/12/2022] Open
Abstract
AIM Clinical staging is vital for selecting appropriate candidates and designing neoadjuvant treatment strategies for advanced tumors. The aim of this review was to evaluate diagnostic abilities of clinical TNM staging for gastrointestinal, gastrointestinal cancers. METHODS We conducted a systematic review of recent publications to evaluate the accuracy of diagnostic modalities on gastrointestinal cancers. A systematic literature search was performed in PubMed/MEDLINE using the keywords "TNM staging," "T4 staging," "distant metastases," "esophageal cancer," "gastric cancer," and "colorectal cancer," and the search terms used in Cochrane Reviews between January 2005 to July 2020. Articles focusing on preoperative diagnosis of: (a) depth of invasion; (b) lymph node metastases; and (c) distant metastases were selected. RESULTS After a full-text search, a final set of 55 studies (17 esophageal cancer studies, 26 gastric cancer studies, and 12 colorectal cancer studies) were used to evaluate the accuracy of clinical TNM staging. Positron emission tomography-computed tomography (PET-CT) and/or magnetic resonance imaging (MRI) were the best modalities to assess distant metastases. Fat and fiber mode of CT may be useful for T4 staging of esophageal cancer, CT was a partially reliable modality for lymph node staging in gastric cancer, and CT combined with MRI was the most reliable modality for liver metastases from colorectal cancer. CONCLUSION The most reliable diagnostic modality differed among gastrointestinal cancers depending on the type of cancer. Therefore, we propose diagnostic algorithms for clinical staging for each type of cancer.
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Affiliation(s)
- Hideaki Shimada
- Department of Gastroenterological SurgeryToho University Graduate School of MedicineTokyoJapan
| | - Takeo Fukagawa
- Department of SurgeryTeikyo University School of MedicineTokyoJapan
| | - Yoshio Haga
- Department of SurgeryJapan Community Healthcare Organization Amakusa Central General HospitalAmakusaJapan
| | - Shin‐ichi Okazumi
- Department of Gastroenterological SurgeryToho University Graduate School of MedicineTokyoJapan
- Department of SurgeryToho University Sakura Medical CenterSakuraJapan
| | - Koji Oba
- Department of BiostatisticsSchool of Public HealthGraduate School of MedicineThe University of TokyoTokyoJapan
- Interfaculty Initiative in Information StudiesGraduate School of Interdisciplinary Information StudiesThe University of TokyoTokyoJapan
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Ray-Offor E, Obiorah CC. Topography and Morphology of Gastric Cancer in Nigeria: A Dual Institution Review of 622 Upper Gastrointestinal Endoscopies. Cureus 2021; 13:e14693. [PMID: 34055537 PMCID: PMC8153965 DOI: 10.7759/cureus.14693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction Gastric cancer is a leading cause of cancer mortality worldwide. The burden of this disease is highest in developing countries of East Asia, Eastern Europe, and parts of Central and Southern America. Africa, despite having a similar high profile of Helicobacter pylori infection with East Asia, has a reported low prevalence of gastric cancer. There is a paucity of data on the natural history and endoscopic presentation of gastric cancer in West Africa. Aim To study the topography and morphology of gastric cancer from two institutions in Southern Nigeria. Methods A cross-sectional retrospective study of 622 consecutive cases of upper gastrointestinal (GI) endoscopy performed in two referral endoscopy facilities in Port Harcourt, Rivers State, Nigeria from February 2012 to January 2021. Variables collated from centre records included age, sex, ethnicity, symptoms, site, endoscopic classification, and histology of gastric cancers. Statistical analysis was performed using IBM SPSS version 20 (IBM Corp., Armonk, NY). Results There were 17 (2.7%) cases of histologically confirmed gastric cancer. The age range of patients was from 34 years to 99 years (mean 60.7 ± 14.6 years). There were nine males and eight females (M:F ratio of 1.1:1). Antrum and cardia were predominantly affected in 10 (60.0%) and seven (6.7%) cases, respectively. Borrmann type 1 advanced gastric tumor was seen in seven (53.8%) and adenocarcinoma, the predominant histology, in 14 (82.4%) cases. Helicobacter pylori was detected in a sole case of gastric cancer. Conclusion Gastric cancer is uncommon in our environment and with a delayed presentation. A predominance of gastric antrum topography and exophytic growth morphology is the pattern.
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Affiliation(s)
- Emeka Ray-Offor
- Digestive Disease Unit, Oak Endoscopy Centre, Port Harcourt, NGA.,Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, NGA
| | - Christopher C Obiorah
- Department of Anatomical Pathology, University of Port Harcourt Teaching Hospital, Port Harcourt, NGA
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Lin M, Chen QY, Zheng CH, Li P, Xie JW, Wang JB, Lin JX, Huang CM. Effect of Preoperative Tumour Under-Staging on the Long-Term Survival of Patients Undergoing Radical Gastrectomy for Gastric Cancer. Cancer Res Treat 2021; 53:1123-1133. [PMID: 33677846 PMCID: PMC8524019 DOI: 10.4143/crt.2020.651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 03/04/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose This study aimed to evaluate the effect of preoperative tumor staging deviation (PTSD) on the long-term survival of patients undergoing radical gastrectomy for gastric cancer (RGGC). Materials and Methods Clinicopathological data of 2,346 patients who underwent RGGC were retrospectively analyzed. The preoperative tumor-lymph node-metastasis (TNM) under-staging group (uTNM) comprised patients who had earlier preoperative TNM than postoperative TNM, and the no preoperative under-staging group (nTNM) comprised the remaining patients. Results There were 1,031 uTNM (44.0%) and 1,315 nTNM cases (56.0%). Cox prognostic analysis revealed that PTSD independently affected the overall survival (OS) after surgery. The 5-year OS was lower in the uTNM group (41.8%) than in the nTNM group (71.6%). The patients less than 65 years old, with lower American Society of Anaesthesiologists score, 2–5 cm tumor located at the lower stomach, and cT1 or cN0 preoperative staging would more likely undergo D1+ lymph node dissection (LND) in uTNM (p < 0.05). Logistic analyses revealed that tumor size > 2 cm and body mass index ≤ 22.72 kg/m2 were independent risk factors of preoperative TNM tumor under-staging in patients with cT1N0M0 staging (p < 0.05). Conclusion Underestimated tumor staging is not rare, which possibly results in inadequate LND and affects the long-term survival for patients undergoing RGGC. D2 LND should be carefully performed in patients who are predisposed to this underestimation.
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Affiliation(s)
- Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
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Zhang Z, Zheng B, Chen W, Xiong H, Jiang C. Accuracy of 18F-FDG PET/CT and CECT for primary staging and diagnosis of recurrent gastric cancer: A meta-analysis. Exp Ther Med 2021; 21:164. [PMID: 33456531 PMCID: PMC7792481 DOI: 10.3892/etm.2020.9595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/08/2020] [Indexed: 02/06/2023] Open
Abstract
Contrast-enhanced computed tomography (CECT) is commonly used for staging and diagnosing recurrent gastric cancer. Recently, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET)/CT gained popularity as a diagnostic tool owing to advantages including dual functional and anatomical imaging, which may facilitate early diagnosis. The diagnostic performance of 18F-FDG PET/CT and CECT has been assessed in several studies but with variable results. Therefore, the present meta-analysis aimed to evaluate the accuracy of 18F-FDG PET/CT and CECT for primary TNM staging and the diagnosis of recurrent gastric cancers. A systematic search of the PubMed Central, Medline, Scopus, Cochrane and Embase databases from inception until January 2020 was performed. The Quality Assessment of Diagnostic Accuracy Study-2 tool was used to determine the quality of the selected studies. Pooled estimates of sensitivity and specificity were calculated. A total of 58 studies comprising 9,997 patients were included. Most studies had a low risk of bias. The sensitivity and specificity for nodal staging of gastric cancer were 49% (95% CI, 37-61%) and 92% (95% CI, 86-96%) for 18F-FDG PET/CT, respectively, and 67% (95% CI, 57-76%) and 86% (95% CI, 81-89%) for CECT, respectively. For metastasis staging, the sensitivity and specificity were 56% (95% CI, 40-71%) and 97% (95% CI, 87-99%) for 18F-FDG PET/CT, respectively, and 59% (95% CI, 41-75%) and 96% (95% CI, 83-99%) for CECT, respectively. For diagnosing cancer recurrence, the pooled sensitivity and specificity were 81% (95% CI, 72-88%) and 83% (95% CI, 74-89%) for 18F-FDG PET/CT, respectively, and 59% (95% CI, 41-75%) and 96% (95% CI, 83-99%) for CECT, respectively. Both 18F-FDG PET/CT and CECT were deemed highly useful for diagnosing recurrent gastric cancer due to their high sensitivities and specificities. However, these techniques cannot be used to exclude or confirm the presence of lymph node metastases or recurrent gastric cancer tumors, but can be used for the confirmation of distal metastasis.
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Affiliation(s)
- Zhicheng Zhang
- Department of Radiology, The Ninth People's Hospital of Chongqing, Chongqing 400700, P.R. China
| | - Bo Zheng
- Department of Radiology, The Ninth People's Hospital of Chongqing, Chongqing 400700, P.R. China
| | - Wei Chen
- Department of Radiology, The Ninth People's Hospital of Chongqing, Chongqing 400700, P.R. China
| | - Hui Xiong
- Department of Radiology, The Ninth People's Hospital of Chongqing, Chongqing 400700, P.R. China
| | - Caiming Jiang
- Department of Radiology, The Ninth People's Hospital of Chongqing, Chongqing 400700, P.R. China
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Endoscopic Ultrasound vs. Computed Tomography for Gastric Cancer Staging: A Network Meta-Analysis. Diagnostics (Basel) 2021; 11:diagnostics11010134. [PMID: 33467164 PMCID: PMC7829791 DOI: 10.3390/diagnostics11010134] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 12/19/2022] Open
Abstract
Gastric cancer preoperative staging is of outmost importance to assure proper management of the disease. Providing a relevant clinical stage relies on different imaging methods such as computed tomography (CT) or endoscopic ultrasound (EUS). We aimed to perform a network meta-analysis for gastric cancer clinical stage diagnostic tests, thus comparing the diagnostic accuracy of EUS vs. multidetector CT (MDCT) and EUS vs. EUS + MDCT. We plotted study estimates of pooled sensitivity and specificity on forest plots and summary receiver operating characteristic space to explore between-study variation in the performance of EUS, MDCT and EUS + MDCT for T1–T4, N0–N3, M0–M1 when data were available. Exploratory analyses were undertaken in RevMan 5. We included twelve studies with 2047 patients. Our results suggest that EUS was superior to MDCT in preoperative T1 and N staging. MDCT is more specific for the M stage but no significant difference in sensitivity was obtained. When comparing EUS vs. EUS + MDCT for T1 both sensitivity and specificity were not relevant. No significant differences were observed in T2–T4 stages. Even though EUS helped differentiate between the presence of invaded nodules, N stages should be carefully assessed by both methods since there is not sufficient data.
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Liu J, Huang X, Chen S, Wu G, Xie W, Franco JPC, Zhang C, Huang L, Tian C, Tang W. Nomogram based on clinical characteristics for preoperative prediction of perineural invasion in gastric cancer. J Int Med Res 2020; 48:300060519895131. [PMID: 31939330 PMCID: PMC7114279 DOI: 10.1177/0300060519895131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Gastric cancer (GC) has a poor prognosis and high rate of recurrence. Perineural invasion (PNI) is a prognostic factor in GC that is associated with a high risk of systemic recurrence. Preoperative identification of PNI may facilitate patient stratification and optimal preoperative treatment. We therefore developed and validated a nomogram for the preoperative prediction of PNI. Methods We retrospectively collected clinical data from 261 GC patients, who were randomly assigned to training (n = 185) and validation (n = 76) sets. The least absolute shrinkage and selection operator regression model was used to identify potentially relevant clinical parameters, and multivariable logistic regression analysis was used to develop the nomogram. Results The nomogram consisted of body mass index, immunoglobulin A level, and computed tomography-based T- and N-stages. Good calibration was observed for both the training and validation sets, with areas under the curve of 0.77 and 0.79, respectively. Decision curve analysis revealed that the nomogram was clinically relevant. Conclusion We developed and validated a nomogram for the preoperative prediction of PNI in patients with GC. Our nomogram may facilitate the identification of high-risk patients and optimization of preoperative decision-making.
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Affiliation(s)
- Jungang Liu
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region, P.R. China
| | - Xiaoliang Huang
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region, P.R. China
| | - Shaomei Chen
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region, P.R. China
| | - Guo Wu
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region, P.R. China
| | - Weishun Xie
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region, P.R. China
| | - Jeen P C Franco
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region, P.R. China
| | - Chuqiao Zhang
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region, P.R. China
| | - Lingxu Huang
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region, P.R. China
| | - Chao Tian
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region, P.R. China
| | - Weizhong Tang
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region, P.R. China
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Diaz LI, Mony S, Klapman J. Narrative review of the role of gastroenterologist in the diagnosis, treatment and palliation in gastric and gastroesophageal cancer. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1106. [PMID: 33145325 PMCID: PMC7575985 DOI: 10.21037/atm-20-4143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal cancer (EC) and gastric cancer (GC) carry a high mortality rate. Unfortunately, a majority of patients are asymptomatic and at the time of diagnosis, the disease may invariably be in its advanced stages with limited curative options. Thus, it is imperative to recognize certain risk factors including gastroesophageal reflux disease (GERD), male gender, pre-existing Barrett’s esophagus, smoking history, obesity, Helicobacter pylori infection, atrophic gastritis among others for both EC and GC, intervene on time with screening and surveillance modalities if indicated and optimize treatment plans. With advances in endoscopic techniques, early neoplastic lesions are increasingly managed by gastroenterologists, offering an alternative to surgery. The gold standard for diagnosis of EC and GC is high definition endoscopy with adequate targeted biopsies. Endoscopic ultrasound (EUS) is a key in the staging of early cancers dictating the pathway for treatment options. We also play a key role in palliation cases with the aim to reduce the symptoms like nausea, vomiting and even when possible, restore oral intake and improve nutrition in both advanced GC and EC. This review article discusses the risk factors, diagnostic and endoscopic treatment modalities of early EC and GC and palliation of advanced cancer where gastroenterologists play a key role.
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Affiliation(s)
- Liege I Diaz
- Department of Endoscopic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Shruti Mony
- Division of Digestive Diseases and Nutrition, University of South Florida, Tampa, FL, USA
| | - Jason Klapman
- Department of Endoscopic Oncology, Moffitt Cancer Center, Tampa, FL, USA
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Sun RJ, Fang MJ, Tang L, Li XT, Lu QY, Dong D, Tian J, Sun YS. CT-based deep learning radiomics analysis for evaluation of serosa invasion in advanced gastric cancer. Eur J Radiol 2020; 132:109277. [PMID: 32980726 DOI: 10.1016/j.ejrad.2020.109277] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/14/2020] [Accepted: 09/07/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE This work aimed to develop and validate a deep learning radiomics model for evaluating serosa invasion in gastric cancer. MATERIALS AND METHODS A total of 572 gastric cancer patients were included in this study. Firstly, we retrospectively enrolled 428 consecutive patients (252 in the training set and 176 in the test set I) with pathological confirmed T3 or T4a. Subsequently, 144 patients who were clinically diagnosed cT3 or cT4a were prospectively allocated to the test set II. Histological verification was based on the surgical specimens. CT findings were determined by a panel of three radiologists. Conventional hand-crafted features and deep learning features were extracted from three phases CT images and were utilized to build radiomics signatures via machine learning methods. Incorporating the radiomics signatures and CT findings, a radiomics nomogram was developed via multivariable logistic regression. Its diagnostic ability was measured using receiver operating characteristiccurve analysis. RESULTS The radiomics signatures, built with support vector machine or artificial neural network, showed good performance for discriminating T4a in the test I and II sets with area under curves (AUCs) of 0.76-0.78 and 0.79-0.84. The nomogram had powerful diagnostic ability in all training, test I and II sets with AUCs of 0.90 (95 % CI, 0.86-0.94), 0.87 (95 % CI, 0.82-0.92) and 0.90 (95 % CI, 0.85-0.96) respectively. The net reclassification index revealed that the radiomics nomogram had significantly better performance than the clinical model (p-values < 0.05). CONCLUSIONS The deep learning radiomics model based on CT images is effective at discriminating serosa invasion in gastric cancer.
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Affiliation(s)
- Rui-Jia Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
| | - Meng-Jie Fang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Lei Tang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
| | - Xiao-Ting Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
| | - Qiao-Yuan Lu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
| | - Di Dong
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China; Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, 100191, China; Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710126, China.
| | - Ying-Shi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
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Zhu M, Cao B, Li X, Li P, Wen Z, Ji J, Min L, Zhang S. Risk factors and a predictive nomogram for lymph node metastasis of superficial esophagogastric junction cancer. J Gastroenterol Hepatol 2020; 35:1524-1531. [PMID: 32023349 DOI: 10.1111/jgh.15004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/03/2020] [Accepted: 01/31/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIM No predictive model for lymph node metastasis (LNM) of superficial esophagogastric junction (EGJ) cancer exists. This study aimed to evaluate incidence, identify risk factors, and develop a predictive nomogram for LNM in patients with superficial EGJ cancers. METHODS Data were extracted from the Surveillance, Epidemiology, and End Results database for model development and internal validation. Another data set was obtained from two hospitals for external validation. A nomogram was developed based on independent risk factors that resulted from a multivariate logistic regression analysis. Internal and external validations were performed to assess the performance of nomogram model by receiver operating characteristic and calibration plot. RESULTS Prevalence of LNM was 11.41% for intramucosal cancer and increased to 26.50% for submucosal cancer. On the multivariate analysis, large tumor size (odds ratio [OR] = 1.42; P < 0.001), moderately and poorly/un-differentiated pathological type (OR = 5.62 and 7.67; P = 0.024 and 0.008, respectively), and submucosal invasion (OR = 2.73; P = 0.004) were independent risk factors of LNM. The nomogram incorporating these three predictors demonstrated good discrimination (area under the estimated receiver operating characteristic curve [AUC]: 0.74; 95% confidence interval [95%CI]: 0.68, 0.80) and calibration (mean absolute error was 0.012). Moreover, the discrimination in the internal and external validation sets was good (AUC: 0.73 [95%CI: 0.66, 0.81] and 0.74 [95%CI: 0.60, 0.89], respectively). Nomogram provided better clinical usefulness as assessed by a decision curve analysis. CONCLUSIONS Prevalence of LNM in superficial EGJ cancer was high. The first risk-predictive nomogram model for LNM of superficial EGJ cancer may help clinicians to decide optimal treatment option preoperatively.
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Affiliation(s)
- Min Zhu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China
| | - Bin Cao
- Department of Endocrinology, Beijing Key Laboratory of Diabetes Research and Care, Center for Endocrine Metabolism and Immune Diseases, Lu He Hospital, Capital Medical University, Beijing, China
| | - Xiao Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China
| | - Peng Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China
| | - Zixian Wen
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Jiafu Ji
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Li Min
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China
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Abstract
Gastric cancer is the fifth most common malignancies and the third leading cause of cancer-related death worldwide, with more than 40% of new cases occurring in China. With the advancement of treatment methods, the application of adjuvant therapy and targeted drugs, the prognosis of patients with gastric cancer has been significantly improved. In recent years, more and more studies have reported that magnetic resonance imaging (MRI) showed great value in the clinical application among patients with gastric cancer, including preoperative staging, treatment response evaluation, predicting prognosis and histopathological features, treatment guidance, and molecular imaging. The remarkable research progress of MRI in gastric cancer will provide new evaluation and treatment approaches for clinical diagnosis and treatment. This article aims to review the current status of the application and research progress of MRI in patients with gastric cancer.
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Affiliation(s)
- Yingjing Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jianchun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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sun Z, Hu S, Li J, Wang T, Xie Z, Jin L. An application study of CT perfusion imaging in assessing metastatic involvement of perigastric lymph nodes in patients with T1 gastric cancer. Br J Radiol 2020; 93:20190790. [PMID: 31778314 PMCID: PMC7055441 DOI: 10.1259/bjr.20190790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 10/30/2019] [Accepted: 11/25/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To assess metastatic involvement of perigastric lymph nodes (PLNs) in patients with T1 gastric cancer by using CT perfusion imaging (CTPI). METHODS A total of 82 annotated PLNs of 33 patients with T1 gastric cancer confirmed by endoscopic ultrasonography underwent CTPI and portal phase CT scan before operation. The scan data were post-processed to acquire perfusion maps and calculate perfusion parameters including blood flow (BF) and permeability surface (PS). A radiologist measured the short axis diameters and perfusion parameters of PLNs. According to the post-operative pathology result, PLNs were divided into two groups: metastatic and inflammatory LNs. Perfusion parameters values and the size of PLNs between two groups were respectively compared statistically by t-test, and a receiver operating characteristic curve analysis was used to determine the optimal diagnostic cut-off value with sensitivity, specificity and area under the curve. RESULTS Examined 82 PLNs were metastatic in 45 (54.9%) and inflammatory in 37 (45.1%). The mean values of perfusion parameters and the short axis diameters in metastatic and inflammatory PLNs, respectively, were BF of 97.48 vs 81.21 ml/100 mg /min (p < 0.001), PS of 45.11 vs 36.80 ml/100 mg /min (p < 0.001), and the size of 1.51 cm vs 1.29 cm (p = 0.059). The sensitivity of 84.4%, specificity of 67.6% and area under the curve of 0.826 for BF with cut-off value of 88.89 ml/100 mg /min for differentiating metastatic from inflammatory nodes were higher than those of PS or the size of PLNs (p < 0.001). CONCLUSION CT perfusion parameters values were different between metastatic and inflammatory PLNs in T1 gastric cancer. BF value may be the most reliable diagnostic marker of metastatic PLNs, and it is helpful for clinicians to choose treatment modality or management plan in T1 gastric cancer patients. ADVANCES IN KNOWLEDGE CTPI gives information on vascularization of LNs.BF value might be a more effective marker than PS or the size of LNs for differentiating metastatic from inflammatory LNs in patients with T1 gastric cancer.
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Affiliation(s)
- zongqiong sun
- Department of Radiology, Affiliated Hospital of Jiangnan University, The Fourth People’s Hospital of Wuxi City, Jiangsu Province, 214062, China
| | - Shudong Hu
- Department of Radiology, Affiliated Hospital of Jiangnan University, The Fourth People’s Hospital of Wuxi City, Jiangsu Province, 214062, China
| | - Jie Li
- Department of Intervention, Affiliated Hospital of Jiangnan University, The Fourth People’s Hospital of Wuxi City, Jiangsu Province, 214062, China
| | - Teng Wang
- Department of Oncology, Affiliated Hospital of Jiangnan University, The Fourth People’s Hospital of Wuxi City, Jiangsu Province, 214062, China
| | - Zhihui Xie
- Department of Surgical Gastroenterology, Affiliated Hospital of Jiangnan University, The Fourth People’s Hospital of Wuxi City, Jiangsu Province, 214062, China
| | - Linfang Jin
- Department of Pathology, Affiliated Hospital of Jiangnan University, The Fourth People’s Hospital of Wuxi City, Jiangsu Province, 214062, China
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Wang XZ, Zeng ZY, Ye X, Sun J, Zhang ZM, Kang WM. Interpretation of the development of neoadjuvant therapy for gastric cancer based on the vicissitudes of the NCCN guidelines. World J Gastrointest Oncol 2020; 12:37-53. [PMID: 31966912 PMCID: PMC6960069 DOI: 10.4251/wjgo.v12.i1.37] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 09/09/2019] [Accepted: 09/26/2019] [Indexed: 02/05/2023] Open
Abstract
Gastric cancer is one of the most common digestive system tumors in China, and locally advanced gastric cancer (LAGC) accounts for a high proportion of newly diagnosed cases. Although surgery is the main treatment for gastric cancer, surgical excision alone cannot achieve satisfactory outcomes in LAGC patients. Neoadjuvant therapy (NAT) has gradually become the standard treatment for patients with LAGC, and this treatment can not only achieve tumor downstaging and improve surgical rate and the R0 resection rate, but it also significantly improves the long-term prognosis of patients. Peri/preoperative neoadjuvant chemotherapy and preoperative chemoradiotherapy are both recommended according to a large number of studies, and the regimens have also been evolved in the past decades. Since the NCCN guidelines for gastric cancer are one of the most authoritative evidence-based guidelines worldwide, here, we demonstrate the development course and major breakthroughs of NAT for gastric cancer based on the vicissitudes of the NCCN guidelines from 2007 to 2019, and also discuss the future of NAT.
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Affiliation(s)
- Xian-Ze Wang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Zi-Yang Zeng
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Xin Ye
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Juan Sun
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Zi-Mu Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Wei-Ming Kang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
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The Role of Hospital Transfer in Reexamination Computed Tomography Scans: A Nationwide Cohort Study of Gastric Cancer Patients Undergoing Surgery. Healthcare (Basel) 2019; 8:healthcare8010002. [PMID: 31861601 PMCID: PMC7151052 DOI: 10.3390/healthcare8010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/11/2019] [Accepted: 12/17/2019] [Indexed: 11/22/2022] Open
Abstract
Because the high-cost of medical imaging can cause a tremendous economic burden across the health care system, we investigated factors associated with taking additional computed tomography (CT) scans. Data of gastric cancer patients were eligible for analysis if the patient underwent a gastrectomy during the study period (2002–2013). We defined initial CT scans as those taken within 90 days from the surgery date. If there was an additional CT scan between the date of an initial CT scan and the surgery date, we regarded it as a reexamination. We used multivariate logistic regression analysis for reexamination CT scans. Among 3342 gastrectomy patients, 1165 participants underwent second CT scans. Transfer experience (adjusted odds ratio (OR) = 23.87, 95% confidence interval (CI) = 18.15–31.39) was associated with higher OR for reexamination. Among transferred patients, an increased number per 100 beds at the initial CT hospital was associated with a decreased OR for reexamination (OR = 0.88, 95% CI = 0.83–0.94), but increased beds in surgery hospitals was related to an increased OR for reexamination (OR = 1.29, 95% CI = 1.20–1.36). In our study, transfer experience, initial CT scan in a low-volume hospital, and surgical treatment in a high-volume hospital were associated with reexamination CT scans.
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Chen J, Zhou C, He M, Zhen Z, Wang J, Hu X. A Meta-Analysis And Systematic Review Of Accuracy Of Endoscopic Ultrasound For N Staging Of Gastric Cancers. Cancer Manag Res 2019; 11:8755-8764. [PMID: 31632135 PMCID: PMC6774993 DOI: 10.2147/cmar.s200318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 09/12/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Endoscopic ultrasonography (EUS) is widely used as a staging modality for gastric cancer. However, the results of studies on the use of EUS for N staging in gastric cancer vary. This study aimed at studying the overall diagnostic accuracy of EUS for N staging of gastric cancer. METHODS Published studies were identified through searching the MEDLINE, Web of Science, EMBASE, SpringerLink and ScienceDirect databases. A bivariate random effect model was used to estimate the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). A hierarchical summary receiver operating characteristic curves (HSROC) based on the pooled data was also computed. RESULTS Fifty studies (5223 patients) were included in this analysis. The pooled sensitivity, specificity, PLR, NLR and DOR of EUS for N staging were 0.82 (95% CI 0.78 to 0.85), 0.68 (0.63 to 0.73), 2.6 (2.2 to 3.0), 0.27 (0.22 to 0.32), and 10 (8 to 12), respectively. The area under the HSROC was 0.83. CONCLUSION The EUS may provide a clinically useful tool to guide physicians in the N staging of gastric cancer. However, physicians must note that the EUS has a relatively low specificity.
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Affiliation(s)
- Jiafei Chen
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Chaoyang Zhou
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Min He
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Zhiming Zhen
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Jie Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Xiaofei Hu
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
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Sun Z, Liu H, Yu J, Huang W, Han Z, Lin T, Chen H, Zhao M, Hu Y, Jiang Y, Li G. Frequency and Prognosis of Pulmonary Metastases in Newly Diagnosed Gastric Cancer. Front Oncol 2019; 9:671. [PMID: 31417862 PMCID: PMC6683847 DOI: 10.3389/fonc.2019.00671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/09/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose: The purpose of this study was to analyze the frequency and prognosis of pulmonary metastases in newly diagnosed gastric cancer using population-based data from SEER. Methods: Patients with gastric cancer and pulmonary metastases (GCPM) at the time of diagnosis in advanced gastric cancer were identified using the Surveillance, Epidemiology and End Result (SEER) database of the National Cancer Institute from 2010 to 2014. Multivariable logistic regression was performed to identify predictors of the presence of GCPM at diagnosis. Receiver operator characteristics analysis was performed to significant predictors on multivariable logistic regression and was then assessed with Delong's test. Multivariable Cox regression was developed to identify factors associated with all-cause mortality and gastric cancer-specific mortality. Survival curves were obtained according to the Kaplan-Meier method and compared using the log-rank test. Results: We identified 1,104 patients with gastric cancer and pulmonary metastases at the time of diagnosis, representing 6.02% of the entire cohort and 15.19% of the subset with metastatic disease to any distant site. Among the entire cohort, multivariable logistic regression identified six factors (younger, upper 1/3 of stomach, intestinal-type, T4 staging, N1 staging, and presence of more extrapulmonary metastases to liver, bone, and brain) as positive predictors of the presence of pulmonary metastases at diagnosis. The value of AUC for the multivariable logistic regression model was 0.775. Median survival among the entire cohort with GCPM was 3.0 months (interquartile range: 1.0-9.0 mo). Multivariable Cox model in SEER cohort confirmed five factors (diagnosis at previous period, black race, adverse pathology grade, absence of chemotherapy, and presence of more extrapulmonary metastases to liver, bone, and brain) as negative predictors for overall survival. Conclusions: The findings of this study provided population-based estimates of the frequency and prognosis for GCPM at time of diagnosis. The multivariable logistic regression model had an acceptable performance to predict the presence of PM. These findings may provide preventive guidelines for the screening and treatment of PM in GC patients. Patients with high risk factors should be paid more attention before and after diagnosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Yuming Jiang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Zheng XH, Zhang W, Yang L, Du CX, Li N, Xing GS, Tian YT, Xie YB. Role of D2 gastrectomy in gastric cancer with clinical para-aortic lymph node metastasis. World J Gastroenterol 2019; 25:2338-2353. [PMID: 31148905 PMCID: PMC6529887 DOI: 10.3748/wjg.v25.i19.2338] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/17/2019] [Accepted: 04/29/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Owing to the technical difficulty of pathological diagnosis, imaging is still the most commonly used method for clinical diagnosis of para-aortic lymph node metastasis (PALM) and evaluation of therapeutic effects in gastric cancer, which leads to inevitable false-positive findings in imaging. Patients with clinical PALM may have entirely different pathological stages (stage IV or not), which require completely different treatment strategies. There is no consensus on whether surgical intervention should be implemented for this group of patients. In particular, the value of D2 gastrectomy in a multidisciplinary treatment (MDT) approach for advanced gastric cancer with clinical PALM remains unknown.
AIM To investigate the value of D2 gastrectomy in a MDT approach for gastric cancer patients with clinical PALM.
METHODS In this real-world study, clinico-pathological data of all gastric cancer patients treated at the Cancer Hospital, Chinese Academy of Medical Sciences between 2011 and 2016 were reviewed to identify those with clinically enlarged PALM. All the clinico-pathological data were prospectively documented in the patient medical record. For all the gastric cancer patients with advanced stage disease, especially those with suspicious distant metastasis, the treatment methods were determined by a multidisciplinary team.
RESULTS In total, 48 of 7077 primary gastric cancer patients were diagnosed as having clinical PALM without other distant metastases. All 48 patients received chemotherapy as the initial treatment. Complete or partial response was observed in 39.6% (19/48) of patients in overall and 52.1% (25/48) of patients in the primary tumor. Complete response of PALM was observed in 50.0% (24/48) of patients. After chemotherapy, 45.8% (22/48) of patients received D2 gastrectomy, and 12.5% (6/48) of patients received additional radiotherapy. The postoperative major complication rate and mortality were 27.3% (6/22) and 4.5% (1/22), respectively. The median overall survival and progression-free survival of all the patients were 18.9 and 12.1 mo, respectively. The median overall survival of patients who underwent surgical resection or not was 50.7 and 12.8 mo, respectively. The 3-year and 5-year survival rates were 56.8% and 47.3%, respectively, for patients who underwent D2 resection. Limited PALM and complete response of PALM after chemotherapy were identified as favorable factors for D2 gastrectomy.
CONCLUSION For gastric cancer patients with radiologically suspicious PALM that responds well to chemotherapy, D2 gastrectomy could be a safe and effective treatment and should be adopted in a MDT approach for gastric cancer with clinical PALM.
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Affiliation(s)
- Xiao-Hao Zheng
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wen Zhang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Lin Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Chun-Xia Du
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ning Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Gu-Sheng Xing
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yan-Tao Tian
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yi-Bin Xie
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Jiang Y, Wang W, Chen C, Zhang X, Zha X, Lv W, Xie J, Huang W, Sun Z, Hu Y, Yu J, Li T, Zhou Z, Xu Y, Li G. Radiomics Signature on Computed Tomography Imaging: Association With Lymph Node Metastasis in Patients With Gastric Cancer. Front Oncol 2019; 9:340. [PMID: 31106158 PMCID: PMC6498894 DOI: 10.3389/fonc.2019.00340] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 04/12/2019] [Indexed: 12/24/2022] Open
Abstract
Background: To evaluate whether radiomic feature-based computed tomography (CT) imaging signatures allow prediction of lymph node (LN) metastasis in gastric cancer (GC) and to develop a preoperative nomogram for predicting LN status. Methods: We retrospectively analyzed radiomics features of CT images in 1,689 consecutive patients from three cancer centers. The prediction model was developed in the training cohort and validated in internal and external validation cohorts. Lasso regression model was utilized to select features and build radiomics signature. Multivariable logistic regression analysis was utilized to develop the model. We integrated the radiomics signature, clinical T and N stage, and other independent clinicopathologic variables, and this was presented as a radiomics nomogram. The performance of the nomogram was assessed with calibration, discrimination, and clinical usefulness. Results: The radiomics signature was significantly associated with pathological LN stage in training and validation cohorts. Multivariable logistic analysis found the radiomics signature was an independent predictor of LN metastasis. The nomogram showed good discrimination and calibration. Conclusions: The newly developed radiomic signature was a powerful predictor of LN metastasis and the radiomics nomogram could facilitate the preoperative individualized prediction of LN status.
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Affiliation(s)
- Yuming Jiang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Key Laboratory of Liver Disease Research, The 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wei Wang
- Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Chuanli Chen
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaodong Zhang
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Xuefan Zha
- School of Biomedical Engineering and Guangdong Provincal Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China
| | - Wenbing Lv
- School of Biomedical Engineering and Guangdong Provincal Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China
| | - Jingjing Xie
- Center for Drug and Clinical Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Weicai Huang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zepang Sun
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanfeng Hu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jiang Yu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Tuanjie Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhiwei Zhou
- Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yikai Xu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Daryabari SS, Safaralizadeh R, Hosseinpourfeizi M, Moaddab Y, Shokouhi B. Overexpression of SSH1 in gastric adenocarcinoma and its correlation with clinicopathological features. J Gastrointest Oncol 2018; 9:728-733. [PMID: 30151269 DOI: 10.21037/jgo.2018.03.09] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Gastric adenocarcinoma is known to be the fourth most common cancer type and the second cause of cancer-related deaths. Movement and invasion of cancer cells is one of the major characteristics of the cancer phenotype that various types of network regulate this. Expression levels of slingshot diphosphatase 1 (SSH1) gene has been modulated in this pathway. SSH1 acts as a dephosphorylation and activator of cofilin that this regulating and activating by SSH1 can play a major role in the mobility and migration of the cell. The aim of this study was to compare the expression level of SSH1 genes between tumor and corresponding adjacent non tumor gastric tissues and healthy tissue of gastric adenocarcinoma. Methods In this study, mRNA of 40 gastric adenocarcinoma and corresponding adjacent non tumor gastric tissues and 15 healthy biopsy samples was extracted, then after cDNA synthesis, real-time polymerase chain reaction was performed to measure gene expression. Results According to REST analysis, the relative expression of SSH1 was significantly increased in gastric cancer tissues compared to the corresponding adjacent non tumor gastric tissue samples and normal tissue. Nevertheless, the result revealed no substantial correlation between the expression levels of SSH1 with clinical features. The biomarker index for SSH1 was obtained as 0.89. Conclusions The results obtained from investigating SSH1 expression are indicative of significant changes in the expression of this gene in gastric adenocarcinoma. This gene can also be used as a biomarker for gastric cancer.
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Affiliation(s)
| | - Reza Safaralizadeh
- Department of Animal Biology, Faculty of Natural Sciences, University of Tabriz, Tabriz, Iran
| | | | - Yaghoub Moaddab
- Liver and Gastroenterology Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behrooz Shokouhi
- Pathology Department, Tabriz University of Medical Sciences, Tabriz, Iran
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De Souza Albuquerque MS, Da Silva-Filho AF, Ferraz Cordeiro M, Deodato de Souza MDF, Quirino MWL, Amorim Lima LR, Da Rocha Pitta MG, Martins MR, De Melo Rêgo MJB. GalNAc-T15 in gastric adenocarcinoma: Characterization according to tissue architecture and cellular location. Eur J Histochem 2018; 62:2931. [PMID: 29943957 PMCID: PMC6038116 DOI: 10.4081/ejh.2018.2931] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/02/2018] [Accepted: 06/04/2018] [Indexed: 02/08/2023] Open
Abstract
Gastric cancer (GC) is the second most common cause of cancer-related deaths in the world. This study aims to investigate the differential tissue expression of ppGalNAc-T15 and to evaluate its possible association with clinical-pathological parameters and outcome of gastric adenocarcinoma patients. For these 70 patients were evaluated the expression by immunohistochemistry to ppGalNAc-T15. Our results showed that 33 (47.1%) patients were ppGalNAC-T15+ positive and 37 (52.9%) negative. Positive staining for ppGalNAc-T15 was significantly present in patients older than 60 years (P=0.0306) and submitted to total gastrectomy (P=0.0087). Also, some results remained at the limit of significance as surgical standing (P=0.0562) and histological grade (P=0.0549). Therefore, the ppGalNAc-T15 immunoreactivity can be useful to understand the prognosis of patients with gastric cancer.
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Chen S, Nie RC, OuYang LY, Li YF, Xiang J, Zhou ZW, Chen Y, Peng JS. Nomogram analysis and external validation to predict the risk of lymph node metastasis in gastric cancer. Oncotarget 2017; 8:11380-11388. [PMID: 28077786 PMCID: PMC5355272 DOI: 10.18632/oncotarget.14535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 12/27/2016] [Indexed: 12/26/2022] Open
Abstract
Aim To identify risk factors for lymph node metastasis using a nomogram for gastric cancer patients to predict lymph node metastasis. Results The Chi-square test and the logistic regression showed that the Boarrmann type, preoperative CA199 level, T stage and N stage by CT scan were independent risk factors. The concordance index (C-index) was 0.786 in the internal validation of the Nomogram model. In the external validation, the C-index was 0.809, and the AUC was 0.894. The total accuracy of the prediction was 82.2%, and the false-negative rate was 5.4% with a cut-off value set at 0.109. Materials and Methods The study consisted of 451 patients with a histological diagnosis of gastric cancer with 0 or 1 lymph node metastasis from the Sun Yat-sen University Cancer Center as the development set, and the validation set consisted of 186 gastric cancer patients from the Sixth Affiliated Hospital of Sun Yat-Sen University. A Chi-square test and a logistic regression analysis were used to compare the clinicopathological variables and lymph node metastasis. The C-index and ROC curve were computed for comparisons of the nomogram's predictive ability. Conclusions We developed and validated a nomogram to predict lymph node metastasis in gastric cancer before surgery. This nomogram can be broadly applied, even in general hospitals, and is useful for decisions regarding treatment programs for patients.
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Affiliation(s)
- Shi Chen
- The 6th Affiliated Hospital, Sun Yat-Sen University, YuanCun ErHeng Road, TianHe District, 510655, Guangzhou, China
| | - Run-Cong Nie
- Department of Gastropancreatic Surgery, Sun Yat-Sen University Cancer Center, 510060, Guangzhou, China
| | - Li-Ying OuYang
- Department of Intensive Care Unit, Sun Yat-Sen University Cancer Center, 510060, Guangzhou, China
| | - Yuan-Fang Li
- Department of Gastropancreatic Surgery, Sun Yat-Sen University Cancer Center, 510060, Guangzhou, China
| | - Jun Xiang
- The 6th Affiliated Hospital, Sun Yat-Sen University, YuanCun ErHeng Road, TianHe District, 510655, Guangzhou, China
| | - Zhi-Wei Zhou
- Department of Gastropancreatic Surgery, Sun Yat-Sen University Cancer Center, 510060, Guangzhou, China
| | - YingBo Chen
- Department of Gastropancreatic Surgery, Sun Yat-Sen University Cancer Center, 510060, Guangzhou, China
| | - Jun-Sheng Peng
- The 6th Affiliated Hospital, Sun Yat-Sen University, YuanCun ErHeng Road, TianHe District, 510655, Guangzhou, China
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Luo M, Lv Y, Guo X, Song H, Su G, Chen B. Value and impact factors of multidetector computed tomography in diagnosis of preoperative lymph node metastasis in gastric cancer: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e7769. [PMID: 28816957 PMCID: PMC5571694 DOI: 10.1097/md.0000000000007769] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Multidetector computed tomography (MDCT) exhibited wide ranges of sensitivities and specificities for lymph node assessment of gastric cancer (GC) in several individual studies. This present meta-analysis was carried out to evaluate the value of MDCT in diagnosis of preoperative lymph node metastasis (LNM) and to explore the impact factors that might explain the heterogeneity of its diagnostic accuracy in GC. METHODS A comprehensive search was conducted to collect all the relevant studies about the value of MDCT in assessing LNM of GC within the PubMed, Cochrane library and Embase databases up to Feb 2, 2016. Two investigators independently screened the studies, extracted data, and evaluated the quality of included studies. The sensitivity, specificity, and area under ROC curve (AUC) were pooled to estimate the overall accuracy of MDCT. Meta-regression and subgroup analysis were carried out to identify the possible factors influencing the heterogeneity of the accuracy. RESULTS A total of 27 studies with 6519 subjects were finally included. Overall, the pooled sensitivity, specificity, and AUC were 0.67 (95% CI: 0.56-0.77), 0.86 (95% CI: 0.81-0.90), and 0.86 (95% CI: 0.83-0.89), respectively. Meta-regression revealed that MDCT section thickness, proportion of serosal invasion, and publication year were the main significant impact factors in sensitivity, and MDCT section thickness, multiplanar reformation (MPR), and reference standard were the main significant impact factors in specificity. After the included studies were divided into 2 groups (Group A: studies with proportion of serosa-invasive GC subjects ≥50%; Group B: studies with proportion of serosa-invasive GC subjects <50%), the pooled sensitivity in Group A was significantly higher than in Group B (0.84 [95% CI: 0.75-0.90] vs 0.55 [95% CI: 0.41-0.68], P < .01). For early gastric cancer (EGC), the pooled sensitivity, specificity, and AUC were 0.34 (95% CI: 0.15-0.61), 0.91 (95% CI: 0.84-0.95), and 0.83 (95% CI: 0.80-0.86), respectively. CONCLUSION To summarize, MDCT tends to be adequate to assess preoperative LNM in serosa-invasive GC, but insufficient for non-serosa-invasive GC (particularly for EGC) owing to its low sensitivity. Proportion of serosa-invasive GC subjects, MDCT section thickness, MPR, and reference standard are the main factors influencing its diagnostic accuracy.
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Affiliation(s)
- Mingxu Luo
- Department of Gastrointestinal Surgery, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian
| | - You Lv
- Department of Gastrointestinal Surgery, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian
| | - Xiuyu Guo
- Department of Radiology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian
| | - Hongmei Song
- Department of Oncology, Renmin Hospital of Shiyan, Hubei University of Medicine, Shiyan, Hubei, China
| | - Guoqiang Su
- Department of Gastrointestinal Surgery, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian
| | - Bo Chen
- Department of Gastrointestinal Surgery, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian
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Nie RC, Yuan SQ, Chen XJ, Chen S, Xu LP, Chen YM, Zhu BY, Sun XW, Zhou ZW, Chen YB. Endoscopic ultrasonography compared with multidetector computed tomography for the preoperative staging of gastric cancer: a meta-analysis. World J Surg Oncol 2017; 15:113. [PMID: 28577563 PMCID: PMC5457601 DOI: 10.1186/s12957-017-1176-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 05/22/2017] [Indexed: 02/07/2023] Open
Abstract
Background The current study sought to perform a meta-analysis to compare the preoperative staging of endoscopic ultrasonography (EUS) and multidetector computed tomography (MDCT) in gastric carcinoma. Methods Articles published between January 1, 2000, and April 1, 2016, that compared EUS with MDCT were included, and data were presented as 2 × 2 tables. The sensitivities, specificities and summary receiver operating characteristic (ROC) curves for T and N staging were calculated using a bivariate mixed effects model. Data were weighted by generic variance and then pooled by random-effects modeling. Results Eight studies comprising 1736 patients were included in this meta-analysis. For T1 staging, the sensitivity value for EUS (82%) was significantly higher than that for MDCT (41%) (relative risk (RR): 2.06, 95% confidence interval (CI) 1.07–3.94; P = 0.030). For lymph node involvement, the sensitivity value for EUS (91%) was also significantly higher than that for MDCT (77%) (RR 1.14, 95% CI 1.05–1.23; P = 0.001). However, the specificity values of both EUS and MDCT were quite low, at 49 and 63%, respectively. No significant differences in T2–4 staging between EUS and MDCT were noted. Conclusion This meta-analysis indicates that EUS may be superior to MDCT in preoperative T1 and N staging. Additionally, the low specificity values of EUS and MDCT for N staging merits attention.
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Affiliation(s)
- Run-Cong Nie
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 E Dongfeng Road, Guangzhou, Guangdong, 510060, China
| | - Shu-Qiang Yuan
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 E Dongfeng Road, Guangzhou, Guangdong, 510060, China
| | - Xiao-Jiang Chen
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 E Dongfeng Road, Guangzhou, Guangdong, 510060, China
| | - Shi Chen
- Department of Gastric Surgery, The 6th Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li-Pu Xu
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 E Dongfeng Road, Guangzhou, Guangdong, 510060, China
| | - Yong-Ming Chen
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 E Dongfeng Road, Guangzhou, Guangdong, 510060, China
| | - Bao-Yan Zhu
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 E Dongfeng Road, Guangzhou, Guangdong, 510060, China
| | - Xiao-Wei Sun
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 E Dongfeng Road, Guangzhou, Guangdong, 510060, China
| | - Zhi-Wei Zhou
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 E Dongfeng Road, Guangzhou, Guangdong, 510060, China
| | - Ying-Bo Chen
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 E Dongfeng Road, Guangzhou, Guangdong, 510060, China.
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Berlth F, Chon SH, Chevallay M, Jung MK, Mönig SP. Preoperative staging of nodal status in gastric cancer. Transl Gastroenterol Hepatol 2017; 2:8. [PMID: 28217758 DOI: 10.21037/tgh.2017.01.08] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/04/2017] [Indexed: 12/21/2022] Open
Abstract
An accurate preoperative staging of nodal status is crucial in gastric cancer, because it has a great impact on prognosis and therapeutic decision-making. Different staging methods have been evaluated for gastric cancer in order to predict nodal involvement. So far, no technique could meet the necessary requirements, which include a high detection rate of infiltrated lymph nodes and a low frequency of false-positive results. This article summarizes different staging methods used to assess lymph node status in patients with gastric cancer, evaluates the evidence, and proposes to establish new methods.
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Affiliation(s)
- Felix Berlth
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Seung-Hun Chon
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Mickael Chevallay
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Minoa Karin Jung
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Stefan Paul Mönig
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland
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18FDG-PET-CT improves specificity of preoperative lymph-node staging in patients with intestinal but not diffuse-type esophagogastric adenocarcinoma. Eur J Surg Oncol 2017; 43:196-202. [DOI: 10.1016/j.ejso.2016.08.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 08/12/2016] [Indexed: 01/01/2023] Open
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Li Z, Li Z, Jia S, Bu Z, Zhang L, Wu X, Li S, Shan F, Ji X, Ji J. Depth of tumor invasion and tumor-occupied portions of stomach are predictive factors of intra-abdominal metastasis. Chin J Cancer Res 2017; 29:109-117. [PMID: 28536489 PMCID: PMC5422412 DOI: 10.21147/j.issn.1000-9604.2017.02.03] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Objective Diagnostic laparoscopy is recommended for the pretherapeutic staging of gastric cancer to detect any unexpected or unconfirmed intra-abdominal metastasis. The aim of this study was to evaluate the role and indications of diagnostic laparoscopy in the detection of intra-abdominal metastasis. Methods Standard diagnostic laparoscopy with peritoneal cytology examination was performed prospectively on patients who were clinically diagnosed with primary local advanced gastric cancer (cT≥2M0). We calculated the rate of intra-abdominal metastases identified by diagnostic laparoscopy, and examined the relationship between peritoneal dissemination (P) and cytology results (CY). Split-sample method was applied to find clinical risk factors for intra-abdominal metastasis. Multivariate logistic regression analysis and receiver-operator characteristic (ROC) analysis were performed in training set to find out risk factors of intra-abdominal metastasis, and then validate it in testing set. Results Out of 249 cM0 patients, 51 (20.5%) patients with intra-abdominal metastasis were identified by diagnostic laparoscopy, including 20 (8.0%) P1CY1, 17 (6.8%) P0CY1 and 14 (5.6%) P1CY0 patients. In the training set, multivariate logistic regression analysis and ROC analysis showed that the depth of tumor invasion on computer tomography (CT) scan ≥21 mm and tumor-occupied ≥2 portions of stomach are predictive factors of metastasis. In the testing set, when diagnostic laparoscopy was performed on patients who had one or two of these risk factors, the sensitivity and positive predictive value for detecting intra-abdominal metastasis were 90.0% and 32.1%, respectively. Conclusions According to our results, depth of tumor invasion and tumor-occupied portions of stomach are predictive factors of intra-abdominal metastasis.
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Affiliation(s)
- Ziyu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Zhemin Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Shuqin Jia
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center for Molecular Diagnostics, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Zhaode Bu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Lianhai Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Xiaojiang Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Shuangxi Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Fei Shan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Xin Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Jiafu Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
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Nagpal P, Prakash A, Pradhan G, Vidholia A, Nagpal N, Saboo SS, Kuehn DM, Khandelwal A. MDCT imaging of the stomach: advances and applications. Br J Radiol 2016; 90:20160412. [PMID: 27785936 DOI: 10.1259/bjr.20160412] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The stomach may be involved by a myriad of pathologies ranging from benign aetiologies like inflammation to malignant aetiologies like carcinoma or lymphoma. Multidetector CT (MDCT) of the stomach is the first-line imaging for patients with suspected gastric pathologies. Conventionally, CT imaging had the advantage of simultaneous detection of the mural and extramural disease extent, but advances in MDCT have allowed mucosal assessment by virtual endoscopy (VE). Also, better three-dimensional (3D) post-processing techniques have enabled more robust and accurate pre-operative planning in patients undergoing gastrectomy and even predict the response to surgery for patients undergoing laparoscopic sleeve gastrectomy for weight loss. The ability of CT to obtain stomach volume (for bariatric surgery patients) and 3D VE images depends on various patient and protocol factors that are important for a radiologist to understand. We review the appropriate CT imaging protocol in the patients with suspected gastric pathologies and highlight the imaging pearls of various gastric pathologies on CT and VE.
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Affiliation(s)
- Prashant Nagpal
- 1 Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.,2 Department of Radiodiagnosis, Lok Nayak Jai Prakash Hospital, Maulana Azad Medical College, Delhi, India
| | - Anjali Prakash
- 2 Department of Radiodiagnosis, Lok Nayak Jai Prakash Hospital, Maulana Azad Medical College, Delhi, India
| | - Gaurav Pradhan
- 2 Department of Radiodiagnosis, Lok Nayak Jai Prakash Hospital, Maulana Azad Medical College, Delhi, India
| | - Aditi Vidholia
- 3 Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Nishant Nagpal
- 4 Department of Gastroenterology, Fortis Flt. Lt. Rajan Dhall Hospital, Delhi, India
| | - Sachin S Saboo
- 5 Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, TX, USA
| | - David M Kuehn
- 1 Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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