Prognostic Role of Intragastric Cytopathology and Microbiota in Surgical Patients with Stomach Cancer

Background:

In the last decade, analysis of malignant cells and flora in gastric lavage (GL) has provided interesting data on pathogenesis of gastric cancer (GC). For this study, combining such two aspects into one cyto-microbiologic category, we tested the prognostic role of the presence/absence of cancer cells (GL1/GL0) and bacterial microbiota (MB1/MB0) in our GC population.

Material and Methods:

Between April 2012 and August 2019, 79 surgical patients with GC were prospectively investigated with the determination of GL MB.

Results:

Compared with GL1 MB0, GL1 MB1 strongly correlated with advanced GC, portended poorer overall survival (OS) (45.8 months vs 20.5 months, P = 0.049), and resulted a significant (P = 0.008) and an independent (P = 0.013) prognostic factor unfavorable for OS.

Conclusion:

In the light of our results, the cyto-microbiologic parameter of GL MB should be used to gain a better prognosis of GC patients. Administration of antimicrobial treatment for MB1 subjects should be entertained because it could reduce the risk of oncogenesis.

Long non-coding RNAs in the gastric juice of gastric cancer patients

Differently from other digestive malignancies, gastric cancer (GC) carcinogenesis seems more heterogeneous and unclear. This entails failing in identification of reliable serum tumor markers for screening early GC (EGC) as well as persisting ominous prognosis of this disease. Recently, investigation of human noncoding genome, especially long noncoding molecules (lncRNAs), has provided promising data. As for GC, however, since the current information on GC-specific lncRNAs is still scarce and comes largely from analyses performed on tissue or serum of affected patients, we decided to review the current literature dealing with expression of such molecules in the gastric juice (GJ) of GC patients. In the case of GC, in fact, several cytological and molecular works have already demonstrated GJ to be an interesting biological material for improving clinicopathologic and prognostic knowledge of this cancer. For this review, we burrowed into the literature on lncRNAs expressed in GJ of GC patients. PubMed, Science Direct, Scopus, Web of Science, Google Scholar and ResearchGate were the search engines entertained. As of 2018, only seven studies have been reported. LINC00152, AA174084, UCA1, RMRP, ABHD11-AS1, LINC00982 and H19 were the GJ lncRNAs examined. Following our review, we can conclude that, due to their high specificity and reliability, GJ lncRNAs should deserve a prominent role in the field of GC research: importantly, they could be used for screening EGC, ameliorating the existing methods of staging (which are still far from being completely accurate), improving the prognostic capacity of the current diagnostic armamentarium and, finally, providing new and valuable therapeutic targets.

Lymph node ratio is a stronger prognostic factor than microsatellite instability in colorectal cancer patients: results from a 7 years follow-up study

BACKGROUND

The presence of high microsatellite instability (MSI-H) in colorectal cancers has been generally associated with better survival, opposite an increased ratio between metastatic lymph-nodes and nodes sampled in the specimen (LNR) has been associated with a worse outcome. The study aims to detect the incidence and prognostic significance of MSI and LNR in a consecutive series of 119 colorectal cancers.

METHODS

119 consecutive colorectal cancer patients undergone resection at our Department were enrolled from 2000 to 2004. The MSI status has been evaluated by amplification of target sequences. The LNR has been calculated and patients stratified into 4 groups on the basis of the ratio values. Clinical/pathological data were collected and analyzed; the overall, disease free and disease specific survivals were analyzed by the Kaplan-Meier and Cox regression analyses (mean follow-up: 81 months).

RESULTS

MSI-H was detected in 11.7% of the cases and patients were compared with the microsatellite stable (MSS) group. We observed a higher prevalence of right colon localizations (p 0.01) and locally advanced tumors (p 0.0012) in the MSI-H subgroup. Kaplan-Meier analysis documented no significant difference comparing MSS patients vs MSI-H, although the latter showed a better survival trend (p ns); worse survivals were observed according with the LNR stratification (p < 0.0001). Multivariate analysis documented a statistical value associated with the LNR sub-groups in relationship with survival.

CONCLUSION

According to our results the MSI-H status was associated with particular features (right locations/locally advanced tumors). The results of a long-term follow-up indicate a trend for better survival in MSI-H vs MSS patients. Notably, an increased LNR is associated with worse survivals, both at the univariate and multivariate analysis, displaying this ratio as the strongest prognostic factor of cancer-related survival.

Molecular markers in colorectal cancer: clinical relevance in stage II colon cancer

SUMMARY Colorectal cancer is the second most common cause of cancer death in developed countries. Adjuvant chemotherapy is standard for stage III colorectal cancer but its use in stage II is controversial. Several clinicopathological factors have been described to define a high-risk group among stage II colon cancers, which can aid the selection of patients who may benefit from chemotherapy. Local tumor invasion (T4), high histological grade, obstruction and perforation at diagnosis, and number of lymph nodes removed are the most widely accepted factors. Several molecular factors have been also investigated as prognostic candidate biomarkers. DNA ploidy, KRAS and TP53 mutations, thymidylate synthase, dihydropyrimidine dehydrogenase, thymidine phosphorylase, loss of heterozygosity on chromosome 18q and microsatellite instability have been widely investigated. The aim of this review is to analyze the current evidence and clinical applications of the classical molecular biomarkers as well as new ones such as BRAF, circulating tumor cells, genome expression signatures and DNA methylation.