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Jia PF, Li YR, Wang LY, Lu XR, Guo X. Radiomics in esophagogastric junction cancer: A scoping review of current status and advances. Eur J Radiol 2024; 177:111577. [PMID: 38905802 DOI: 10.1016/j.ejrad.2024.111577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 06/03/2024] [Accepted: 06/14/2024] [Indexed: 06/23/2024]
Abstract
PURPOSE This scoping review aimed to understand the advances in radiomics in esophagogastric junction (EGJ) cancer and assess the current status of radiomics in EGJ cancer. METHODS We conducted systematic searches of PubMed, Embase, and Web of Science databases from January 18, 2012, to January 15, 2023, to identify radiomics articles related to EGJ cancer. Two researchers independently screened the literature, extracted data, and assessed the quality of the studies using the Radiomics Quality Score (RQS) and the METhodological RadiomICs Score (METRICS) tool, respectively. RESULTS A total of 120 articles were retrieved from the three databases, and after screening, only six papers met the inclusion criteria. These studies investigated the role of radiomics in differentiating adenocarcinoma from squamous carcinoma, diagnosing T-stage, evaluating HER2 overexpression, predicting response to neoadjuvant therapy, and prognosis in EGJ cancer. The median score percentage of RQS was 34.7% (range from 22.2% to 38.9%). The median score percentage of METRICS was 71.2% (range from 58.2% to 84.9%). CONCLUSION Although there is a considerable difference between the RQS and METRICS scores of the included literature, we believe that the research value of radiomics in EGJ cancer has been revealed. In the future, while actively exploring more diagnostic, prognostic, and biological correlation studies in EGJ cancer, greater emphasis should be placed on the standardization and clinical application of radiomics.
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Affiliation(s)
- Ping-Fan Jia
- Department of Medical Imaging, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Yu-Ru Li
- Department of Medical Imaging, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Lu-Yao Wang
- Department of Medical Imaging, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Xiao-Rui Lu
- Department of Medical Imaging, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Xing Guo
- Department of Medical Imaging, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China.
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Baker WA, Laan D. Laparoscopy With Percutaneous Transgastric Endoscopy for the Assessment of Gastric Cancer in the Excluded Stomach of a Roux-en-Y Gastric Bypass Patient. Cureus 2024; 16:e62727. [PMID: 39036261 PMCID: PMC11259526 DOI: 10.7759/cureus.62727] [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: 05/02/2024] [Accepted: 06/17/2024] [Indexed: 07/23/2024] Open
Abstract
Primary adenocarcinoma in the excluded stomach of Roux-en-Y gastric bypass (RYGB) patients is extremely rare. As such, the most effective diagnostic approach has not yet been determined. In typical patients, endoscopic ultrasound (EUS) is the first-line technique for evaluating suspected gastric cancer. However, RYGB patients require a more personalized approach. Endoscopic evaluation of the excluded stomach in RYGB patients, whether by EUS-directed, enteroscopy-assisted, or percutaneous means, is undoubtedly more complex than in patients with normal anatomy. In addition, gastric cancer is often diagnosed at an advanced stage due to its asymptomatic early course. With the added complexity of endoscopy in RYGB patients, a laparoscopic-assisted endoscopic approach may have a more favorable diagnostic and therapeutic utility in the case of gastric remnant malignancy in RYGB patients. The following case describes this comprehensive laparoscopic and endoscopic approach for the diagnosis of gastric cancer of the excluded stomach in an RYGB patient.
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Affiliation(s)
- William A Baker
- Bariatric and General Surgery, USA Health Providence Hospital, Mobile, USA
| | - Danuel Laan
- Bariatric and General Surgery, USA Health Providence Hospital, Mobile, USA
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Gao Z, Yu Z, Zhang X, Chen C, Pan Z, Chen X, Lin W, Chen J, Zhuge Q, Shen X. Development of a deep learning model for early gastric cancer diagnosis using preoperative computed tomography images. Front Oncol 2023; 13:1265366. [PMID: 37869090 PMCID: PMC10587601 DOI: 10.3389/fonc.2023.1265366] [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: 07/22/2023] [Accepted: 09/15/2023] [Indexed: 10/24/2023] Open
Abstract
Background Gastric cancer is a highly prevalent and fatal disease. Accurate differentiation between early gastric cancer (EGC) and advanced gastric cancer (AGC) is essential for personalized treatment. Currently, the diagnostic accuracy of computerized tomography (CT) for gastric cancer staging is insufficient to meet clinical requirements. Many studies rely on manual marking of lesion areas, which is not suitable for clinical diagnosis. Methods In this study, we retrospectively collected data from 341 patients with gastric cancer at the First Affiliated Hospital of Wenzhou Medical University. The dataset was randomly divided into a training set (n=273) and a validation set (n=68) using an 8:2 ratio. We developed a two-stage deep learning model that enables fully automated EGC screening based on CT images. In the first stage, an unsupervised domain adaptive segmentation model was employed to automatically segment the stomach on unlabeled portal phase CT images. Subsequently, based on the results of the stomach segmentation model, the image was cropped out of the stomach area and scaled to a uniform size, and then the EGC and AGC classification models were built based on these images. The segmentation accuracy of the model was evaluated using the dice index, while the classification performance was assessed using metrics such as the area under the curve (AUC) of the receiver operating characteristic (ROC), accuracy, sensitivity, specificity, and F1 score. Results The segmentation model achieved an average dice accuracy of 0.94 on the hand-segmented validation set. On the training set, the EGC screening model demonstrated an AUC, accuracy, sensitivity, specificity, and F1 score of 0.98, 0.93, 0.92, 0.92, and 0.93, respectively. On the validation set, these metrics were 0.96, 0.92, 0.90, 0.89, and 0.93, respectively. After three rounds of data regrouping, the model consistently achieved an AUC above 0.9 on both the validation set and the validation set. Conclusion The results of this study demonstrate that the proposed method can effectively screen for EGC in portal venous CT images. Furthermore, the model exhibits stability and holds promise for future clinical applications.
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Affiliation(s)
- Zhihong Gao
- Zhejiang Engineering Research Center of Intelligent Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhuo Yu
- School of Information and Safety Engineering, Zhongnan University of Economics and Law, Wuhan, China
| | - Xiang Zhang
- Wenzhou Data Management and Development Group Co., Ltd., Wenzhou, Zhejiang, China
| | - Chun Chen
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhifang Pan
- Zhejiang Engineering Research Center of Intelligent Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaodong Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weihong Lin
- Zhejiang Engineering Research Center of Intelligent Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jun Chen
- Zhejiang Engineering Research Center of Intelligent Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qichuan Zhuge
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xian Shen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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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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Tang YH, Ren LL, Mao T. Update on diagnosis and treatment of early signet-ring cell gastric carcinoma: A literature review. World J Gastrointest Endosc 2023; 15:240-247. [PMID: 37138936 PMCID: PMC10150283 DOI: 10.4253/wjge.v15.i4.240] [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: 11/26/2022] [Revised: 02/02/2023] [Accepted: 03/30/2023] [Indexed: 04/14/2023] Open
Abstract
Gastric signet-ring cell gastric carcinoma (GSRC) is an unfavorable subtype of gastric cancer (GC) that presents with greater invasiveness and poorer prognosis in advanced stage than other types of GC. However, GSRC in early stage is often considered an indicator of less lymph node metastasis and more satisfying clinical outcome compared to poorly differentiated GC. Therefore, the detection and diagnosis of GSRC at early stage undoubtedly play a crucial role in the management of GSRC patients. In recent years, technological advancement in endoscopy including narrow-band imaging and magnifying endoscopy has significantly improved the accuracy and sensitivity of the diagnosis under endoscopy for GSRC patients. Researches have confirmed that early stage GSRC that meets the expanded criteria of endoscopic resection showed comparable outcomes to surgery after receiving endoscopic submucosal dissection (ESD), indicating that ESD could be considered standard treatment for GSRC after thorough selection and evaluation. This article summarizes the current knowledge and updates pertaining to the endoscopic diagnosis and treatment of early stage signet-ring cell gastric carcinoma.
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Affiliation(s)
- Yun-He Tang
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Lin-Lin Ren
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Tao Mao
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
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Watanabe A, McKendry GJ, Yip L, Donnellan F, Hamilton TD. Risk of lymph node metastasis in early gastric cancer for a Western population. J Surg Oncol 2023; 127:791-797. [PMID: 36583664 DOI: 10.1002/jso.27192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Endoscopic resection (ER) of early gastric cancer (EGC) is increasingly used in Eastern countries due to their low rates of lymph node metastasis (LNM); however, there is a paucity of evidence in Western countries. We investigated LNM and its effect on overall survival (OS) in Western patients with EGC. METHODS Patients diagnosed with T1 gastric cancer between 2000 and 2017 were retrospectively evaluated. Univariate Kaplan-Meier, multivariate logistic and Cox-regression models were used to assess the associations between clinical characteristics, LNM, and OS. RESULTS Among 86 patients, median age was 68 years and 72% were male. Node positivity was 30%. Two percent of patients met the classical guidelines for ER and all were node-negative, while 16% met expanded criteria of which 14% were node-positive. T1b disease (odds ratio [OR] 41.2 [95% confidence interval [CI] 1.62-1048], p = 0.02) and lymphovascular/perineural invasion (OR 18.0 [95% CI 2.41-134], p = 0.01) were predictive of node positivity. The 5-year OS for node-negative and node-positive patients was 84% and 53% (p = 0.004), respectively. CONCLUSIONS The risk of LNM in Western patients with EGC is higher; therefore, generalizability of the expanded criteria for ER should be interpreted with caution.
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Affiliation(s)
- Akie Watanabe
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Geoffrey J McKendry
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lily Yip
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fergal Donnellan
- Division of Gastroenterology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Trevor D Hamilton
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Zhang X, Yang D, Wei Z, Yan R, Zhang Z, Huang H, Wang W. Establishment of a nomogram for predicting lymph node metastasis in patients with early gastric cancer after endoscopic submucosal dissection. Front Oncol 2022; 12:898640. [PMID: 36387114 PMCID: PMC9651963 DOI: 10.3389/fonc.2022.898640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/20/2022] [Indexed: 01/19/2023] Open
Abstract
Background Endoscopic submucosal dissection (ESD) has been accepted as the standard treatment for the appropriate indication of early gastric cancer (EGC). Determining the risk of lymph node metastasis (LNM) is critical for the following treatment selection after ESD. This study aimed to develop a predictive model to quantify the probability of LNM in EGC to help minimize the invasive procedures. Methods A total of 952 patients with EGC who underwent radical gastrectomy were retrospectively reviewed. LASSO regression was used to help screen the potential risk factors. Multivariate logistic regression was used to establish a predictive nomogram, which was subjected to discrimination and calibration evaluation, bootstrapping internal validation, and decision curve analysis. Results Results of multivariate analyses revealed that gender, fecal occult blood test, CEA, CA19-9, histologic differentiation grade, lymphovascular invasion, depth of infiltration, and Ki67 labeling index were independent prognostic factors for LNM. The nomogram had good discriminatory performance, with a concordance index of 0.816 (95% CI 0.781–0.853). The validation dataset yielded a corrected concordance index of 0.805 (95% CI 0.770–0.842). High agreements between ideal curves and calibration curves were observed. Conclusions The nomogram is clinically useful for predicting LNM after ESD in EGC, which is beneficial to identifying patients who are at low risk for LNM and would benefit from avoiding an unnecessary gastrectomy.
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Affiliation(s)
- Xin Zhang
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Dejun Yang
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Ziran Wei
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Ronglin Yan
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Zhengwei Zhang
- Department of Pathology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Hejing Huang
- Department of Ultrasound, Second Affiliated Hospital of Naval Medical University, Shanghai, China
- *Correspondence: Hejing Huang, ; Weijun Wang,
| | - Weijun Wang
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Naval Medical University, Shanghai, China
- *Correspondence: Hejing Huang, ; Weijun Wang,
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Ni Z, Wu B, Li M, Han X, Hao X, Zhang Y, Cheng W, Guo C. Prediction Model and Nomogram of Early Recurrence of Hepatocellular Carcinoma after Radiofrequency Ablation Based on Logistic Regression Analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1733-1744. [PMID: 35690523 DOI: 10.1016/j.ultrasmedbio.2022.04.217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/19/2022] [Accepted: 04/27/2022] [Indexed: 06/15/2023]
Abstract
The purpose of this study was to screen for high-risk factors leading to the early recurrence of hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA) and to construct a prediction model and nomogram. This retrospective study included 108 patients with primary HCC who underwent RFA treatment at the Harbin Medical University Cancer Hospital between January 2018 and June 2019. Four risk factors were screened for using univariate and multivariate logistic regression analyses: number of tumors (hazard ratio [HR] = 14.684, 95% confidence interval [CI]: 1.099-196.215, p = 0.042), neutrophil-to-lymphocyte ratio (NLR) (HR = 2.178, 95% CI: 1.003-4.730, p = 0.049), contrast-enhanced ultrasound (CEUS) performance (HR = 6.482, 95% CI: 1.161-36.184, p = 0.033) and α-fetoprotein (AFP) level (HR = 1.001, 95% CI: 1.000-1.003, p = 0.040). We established a prediction model: Logit(p) = -3.096 + 2.827 × (number of tumors >1 = 1) + 1.851 × (CEUS revealing rapid enhancement of blood flow signal in the arterial phase and clearance in the portal phase = 1) + 1.941 × (NLR >1.55 = 1) + 0.257 × (AFP >32.545 = 1). Through clinical decision curve analysis, the model's threshold was 0.043-0.873, indicating a high clinical value. Patients with a high AFP level, typical CEUS enhancement pattern, multiple tumors and elevated NLR are more likely to relapse early.
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Affiliation(s)
- ZiHao Ni
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - BoLin Wu
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Meng Li
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xue Han
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - XiaoWen Hao
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yue Zhang
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Wen Cheng
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - CunLi Guo
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China.
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Kotecha K, Singla A, Townend P, Merrett N. Association between neutrophil-lymphocyte ratio and lymph node metastasis in gastric cancer: A meta-analysis. Medicine (Baltimore) 2022; 101:e29300. [PMID: 35758361 PMCID: PMC9276313 DOI: 10.1097/md.0000000000029300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION AND AIM The prognostic role of neutrophil to lymphocyte ratio (NLR) has been explored extensively in the literature. The aim of this meta-analysis was to evaluate the link between NLR and lymph node metastasis in gastric cancer. A method for increasing specificity and sensitivity of pre-treatment staging has implications on treatment algorithms and survival. SEARCH STRATEGY The relevant databases were searched as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart. After selection, 12 full text articles that met the inclusion criteria were included for quantitative analysis. 2 × 2 squares were generated using lymph node positive/negative, and NLR high/low data. The effect size for each study was calculated using the DerSimonian-Laird random effects model. P values were calculated using the chi-square method. Finally publication bias was evaluated. All statistics were calculated using R Studio. RESULTS Meta-analysis showed a 1.90 times (odds ratio, with 95% CI 1.52-2.38) increase in risk of positive lymph node status with high neutrophil to lymphocyte ratio. This has significant implications for cancer screening and staging, as NLR is a highly reproducible, cost-effective, and widely available prognostic factor for gastric cancer patients. Additionally, high or low NLR values may have implications for management pathways. Patients with lymph node metastasis can be offered neoadjuvant chemotherapy, avoiding salvage therapy in the form of adjuvant chemoradiotherapy, which is poorly tolerated. CONCLUSION This meta-analysis shows an association between NLR and positive lymph node status in gastric cancer patients with implications for staging, as well as preoperative personalisation of therapy.
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Affiliation(s)
- Krishna Kotecha
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, NSW, Australia
| | - Animesh Singla
- Department of Vascular Surgery, Royal North Shore Hospital, NSW, Australia
| | - Philip Townend
- Department of Upper Gastrointestinal Surgery, Gold Coast University Hospital, Southport, QLD, Australia
| | - Neil Merrett
- Department of Upper Gastrointestinal Surgery, Bankstown Hospital, Bankstown, NSW, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
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Xue XQ, Wang B, Yu WJ, Zhang FF, Niu R, Shao XL, Shi YM, Yang YS, Wang JF, Li XF, Wang YT. Relationship between total lesion glycolysis of primary lesions based on 18F-FDG PET/CT and lymph node metastasis in gastric adenocarcinoma: a cross-sectional preliminary study. Nucl Med Commun 2022; 43:114-121. [PMID: 34406147 DOI: 10.1097/mnm.0000000000001475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We explored the relationship between lymph node metastasis (LNM) and total lesion glycolysis (TLG) of primary lesions determined by 18fluoro-2-deoxyglucose PET/computed tomography (18F-FDG PET/CT) in patients with gastric adenocarcinoma, and evaluated the independent effect of this association. METHODS This retrospective study included 106 gastric adenocarcinoma patients who were examined by preoperative 18F-FDG PET/CT imaging between April 2016 and April 2020. We measured TLG of primary gastric lesions and evaluated its association with LNM. Multivariate logistic regression and a two-piece-wise linear regression were performed to evaluate the relationship between TLG of primary lesions and LNM. RESULTS Of the 106 patients, 75 cases (71%) had LNM and 31 cases (29%) did not have LNM. Univariate analyses revealed that a per-SD increase in TLG was independently associated with LNM [odds ratio (OR) = 2.37; 95% confidence interval (CI), 1.42-3.98; P = 0.0010]. After full adjustment of confounding factors, multivariate analyses exhibited that TLG of primary lesions was still significantly associated with LNM (OR per-SD: 2.20; 95% CI, 1.16-4.19; P = 0.0164). Generalized additive model indicated a nonlinear relationship and saturation effect between TLG of primary lesions and LNM. When TLG of primary lesions was <23.2, TLG was significantly correlated with LNM (OR = 1.26; 95% CI, 1.07-1.48; P = 0.0053), whereas when TLG of primary lesions was ≥ 23.2, the probability of LNM was greater than 60%, gradually reached saturation effect, as high as 80% or more. CONCLUSIONS In this preliminary study, there were saturation and segmentation effects between TLG of primary lesions determined by preoperative 18F-FDG PET/CT and LNM. When TLG of primary lesions was ≥ 23.2, the probability of LNM was greater than 60%, gradually reached saturation effect, as high as 80% or more. TLG of primary lesions is helpful in the preoperative diagnosis of LNM in patients with gastric adenocarcinoma.
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Affiliation(s)
- Xiu-Qing Xue
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou
- Department of Nuclear Medicine, The First People's Hospital of Yancheng City, Yancheng
- Department of Nuclear Medicine, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School
| | - Bing Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou
| | - Wen-Ji Yu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou
| | - Fei-Fei Zhang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou
| | - Rong Niu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou
| | - Xiao-Liang Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou
| | - Yun-Mei Shi
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou
| | - Yan-Song Yang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou
| | - Jian-Feng Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou
| | - Xiao-Feng Li
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou
| | - Yue-Tao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou
- Department of Nuclear Medicine, Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu, 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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12
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Seifert H, Fusaroli P, Arcidiacono PG, Braden B, Herth F, Hocke M, Larghi A, Napoleon B, Rimbas M, Ungureanu BS, Sãftoiu A, Sahai AV, Dietrich CF. Controversies in EUS: Do we need miniprobes? Endosc Ultrasound 2021; 10:246-269. [PMID: 34380805 PMCID: PMC8411553 DOI: 10.4103/eus-d-20-00252] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This is the fifth in a series of papers entitled "Controversies in EUS." In the current paper, we deal with high-resolution catheter probes, otherwise known as EUS miniprobes (EUS-MPs). The application of miniprobes for early carcinomas in the entire intestinal tract, for subepithelial lesions, and for findings in the bile duct and pancreatic duct as well as endobronchial use is critically discussed. Submucous lesions, especially in the colon, but also early carcinomas in special cases are considered the most important indications. The argument is illustrated by numerous examples.
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Affiliation(s)
- Hans Seifert
- Department of Gastroenterology, Evangelisches Krankenhaus, Oldenburg; Universitatsklinik fur Innere Medizin - Gastroneterologie, Hepatologie; Klinikum Oldenburg, Germany
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna/Imola Hospital, Imola, Italy
| | - Paolo Giorgio Arcidiacono
- Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Barbara Braden
- Translational Gastroenterology Unit I, John Radcliffe Hospital I, Oxford, OX3 9DU, UK
| | - Felix Herth
- 2nd Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center (TLRCH), Member of the German Lung Research Foundation (DZL), University of Heidelberg, Heidelberg, Germany
| | - Michael Hocke
- Department of Medicine, Helios Klinikum Meiningen, Meiningen, Germany
| | - Alberto Larghi
- Digestive Endoscopy Unit, IRCCS Foundation University Hospital, Policlinico A. Gemelli, Rome, Italy
| | - Bertrand Napoleon
- 2nd Digestive Endoscopy Unit, HopitalPrivé J Mermoz Ramsay Générale de Santé, Lyon, France
| | - Mihai Rimbas
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest; Department of Internal Medicine, Carol Davila University of Medicine Bucharest, Romania
| | - Bogdan Silvio Ungureanu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Adrian Sãftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Anand V Sahai
- Center Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Christoph F Dietrich
- Department of Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland; Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 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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Marghalani AM, Bin Salman TO, Faqeeh FJ, Asiri MK, Kabel AM. Gastric carcinoma: Insights into risk factors, methods of diagnosis, possible lines of management, and the role of primary care. J Family Med Prim Care 2020; 9:2659-2663. [PMID: 32984103 PMCID: PMC7491774 DOI: 10.4103/jfmpc.jfmpc_527_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/26/2020] [Accepted: 05/11/2020] [Indexed: 01/06/2023] Open
Abstract
Gastric carcinoma represents the second most common type of malignancy that contributes to cancer-related mortality worldwide. However, the geographic incidence of gastric carcinoma had changed over the last few decades, possibly due to increased hygiene, increased awareness of the importance of healthy nutrition, and increased rates of eradication of Helicobacter pylori infection. Gastric carcinoma consists of two pathological variants, intestinal and diffuse. Early cases of gastric carcinoma may be asymptomatic. However, advanced cases may present with significant weight loss, dysphagia, abdominal pain, vomiting, and even severe upper gastrointestinal bleeding. Patients at high risk of developing gastric carcinoma should be adequately screened at primary healthcare centers for early detection and effective management. Lines of treatment vary according to the stage of the disease but surgical resection of the tumor with regional lymphadenectomy remains the gold standard of therapy. This review sheds light on gastric carcinoma given the recent trends regarding its prevalence, risk factors, types, clinical picture, methods of diagnosis, possible lines of management, and the role of primary care.
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Affiliation(s)
| | | | - Fawaz J Faqeeh
- Pharm D, College of Pharmacy, Taif University, Taif, KSA
| | | | - Ahmed M Kabel
- Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, KSA, Egypt.,Department of Pharmacology, Faculty of Medicine, Tanta University, Tanta, Egypt
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