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Petridis AP, Koh C, Solomon M, Karunaratne S, Alexander K, Hirst N, Pillinger N, Denehy L, Riedel B, Gillis C, Carey S, McBride K, White K, Dhillon H, Campbell P, Reeves J, Biswas RK, Steffens D. An Online Preoperative Screening Tool to Optimize Care for Patients Undergoing Cancer Surgery: A Mixed-Method Study Protocol. Cancers (Basel) 2025; 17:861. [PMID: 40075708 PMCID: PMC11899389 DOI: 10.3390/cancers17050861] [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: 01/29/2025] [Revised: 02/23/2025] [Accepted: 02/25/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND/OBJECTIVE Despite surgery being the primary curative treatment for cancer, patients with compromised preoperative physical, nutritional, and psychological status are often at a higher risk for complications. While various screening tools exist to assess physical, nutritional, and psychological status, there is currently no standardised self-reporting tool, or established cut-off points for comprehensive risk assessment. This study aims to develop, validate, and implement an online self-reporting preoperative screening tool that identifies modifiable risk factors in cancer surgery patients. METHODS This mixed-methods study consists of three distinct stages: (1) Development-(i) a scoping review to identify available physical, nutritional, and psychological screening tools; (ii) a Delphi study to gain consensus on the use of available screening tools; and (iii) a development of the online screening tool to determine patients at high risk of postoperative complications. (2) Testing-a prospective cohort study determining the correlation between at-risk patients and postoperative complications. (3) Implementation-the formulation of an implementation policy document considering feasibility. CONCLUSIONS The timely identification of high-risk patients, based on their preoperative physical, nutritional, and psychological statuses, would enable referral to targeted interventions. The implementation of a preoperative online screening tool would streamline this identification process while minimising unwarranted variation in preoperative treatment optimisation. This systematic approach would not only support high-risk patients but also allow for more efficient provision of surgery to low-risk patients through effective risk stratification.
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Affiliation(s)
- Alexandria Paige Petridis
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney 2050, Australia; (A.P.P.); (M.S.); (S.K.); (K.A.); (S.C.); (K.M.); (K.W.); (P.C.)
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney 2050, Australia;
| | - Cherry Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney 2050, Australia; (A.P.P.); (M.S.); (S.K.); (K.A.); (S.C.); (K.M.); (K.W.); (P.C.)
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney 2050, Australia;
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney 2050, Australia
| | - Michael Solomon
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney 2050, Australia; (A.P.P.); (M.S.); (S.K.); (K.A.); (S.C.); (K.M.); (K.W.); (P.C.)
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney 2050, Australia;
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney 2050, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney 2050, Australia; (A.P.P.); (M.S.); (S.K.); (K.A.); (S.C.); (K.M.); (K.W.); (P.C.)
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney 2050, Australia;
| | - Kate Alexander
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney 2050, Australia; (A.P.P.); (M.S.); (S.K.); (K.A.); (S.C.); (K.M.); (K.W.); (P.C.)
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney 2050, Australia;
| | - Nicholas Hirst
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney 2050, Australia; (A.P.P.); (M.S.); (S.K.); (K.A.); (S.C.); (K.M.); (K.W.); (P.C.)
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney 2050, Australia;
| | - Neil Pillinger
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney 2050, Australia;
- Department of Anaesthesia, Perioperative Medicine, and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne 3000, Australia;
| | - Linda Denehy
- Department of Health Services Research, Allied Health, Peter MacCallum Cancer Centre, Melbourne 3000, Australia;
- Department of Physiotherapy, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne 3010, Australia
| | - Bernhard Riedel
- Department of Anaesthesia, Perioperative Medicine, and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne 3000, Australia;
- The Sir Peter MacCallum Department of Oncology, and The Department of Critical Care, The University of Melbourne, Melbourne 3010, Australia
| | - Chelsia Gillis
- School of Human Nutrition, McGill University, Montreal, QC H9X 3V9, Canada;
| | - Sharon Carey
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney 2050, Australia; (A.P.P.); (M.S.); (S.K.); (K.A.); (S.C.); (K.M.); (K.W.); (P.C.)
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney 2050, Australia;
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney 2050, Australia
| | - Kate McBride
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney 2050, Australia; (A.P.P.); (M.S.); (S.K.); (K.A.); (S.C.); (K.M.); (K.W.); (P.C.)
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney 2050, Australia
| | - Kate White
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney 2050, Australia; (A.P.P.); (M.S.); (S.K.); (K.A.); (S.C.); (K.M.); (K.W.); (P.C.)
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney 2050, Australia;
| | - Haryana Dhillon
- Faculty of Science, School of Psychology, Centre for Medical Psychology & Evidence-Based Decision-Making, The University of Sydney, Sydney 2050, Australia;
| | - Patrick Campbell
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney 2050, Australia; (A.P.P.); (M.S.); (S.K.); (K.A.); (S.C.); (K.M.); (K.W.); (P.C.)
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney 2050, Australia;
| | - Jack Reeves
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney 2007, Australia;
| | - Raaj Kishore Biswas
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2050, Australia;
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney 2050, Australia; (A.P.P.); (M.S.); (S.K.); (K.A.); (S.C.); (K.M.); (K.W.); (P.C.)
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney 2050, Australia;
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney 2050, Australia
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2
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Houvast RD, van Duijvenvoorde M, Thijse K, de Steur WO, de Geus-Oei LF, Crobach ASLP, Burggraaf J, Vahrmeijer AL, Kuppen PJK. Selecting Targets for Molecular Imaging of Gastric Cancer: An Immunohistochemical Evaluation. Mol Diagn Ther 2025; 29:213-227. [PMID: 39541080 PMCID: PMC11860997 DOI: 10.1007/s40291-024-00755-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2024] [Indexed: 11/16/2024]
Abstract
PURPOSE Tumor-targeted positron emission tomography (PET) and fluorescence-guided surgery (FGS) could address current challenges in pre- and intraoperative imaging of gastric cancer. Adequate selection of molecular imaging targets remains crucial for successful tumor visualization. This study evaluated the potential of integrin αvβ6, carcinoembryonic antigen-related cell adhesion molecule 5 (CEACAM5), epidermal growth factor receptor (EGFR), epithelial cell adhesion molecule (EpCAM) and human epidermal growth factor receptor-2 (HER2) for molecular imaging of primary gastric cancer, as well as lymph node and distant metastases. METHODS Expression of αvβ6, CEACAM5, EGFR, EpCAM and HER2 was determined using immunohistochemistry in human tissue specimens of primary gastric adenocarcinoma, healthy surrounding stomach, esophageal and duodenal tissue, tumor-positive and tumor-negative lymph nodes, and distant metastases, followed by quantification using the total immunostaining score (TIS). RESULTS Positive biomarker expression in primary gastric tumors was observed in 86% for αvβ6, 72% for CEACAM5, 77% for EGFR, 93% for EpCAM and 71% for HER2. Tumor expression of CEACAM5, EGFR and EpCAM was higher compared to healthy stomach tissue expression, while this was not the case for αvβ6 and HER2. Tumor-positive lymph nodes could be distinguished from tumor-negative lymph nodes, with accuracy ranging from 82 to 93% between biomarkers. CEACAM5, EGFR and EpCAM were abundantly expressed on distant metastases, with expression in 88-95% of tissue specimens. CONCLUSION Our findings show that CEACAM5, EGFR and EpCAM are promising targets for molecular imaging of primary gastric cancer, as well as visualization of both lymph node and distant metastases. Further clinical evaluation of PET and FGS tracers targeting these antigens is warranted.
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Affiliation(s)
- Ruben D Houvast
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | | | - Kira Thijse
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Wobbe O de Steur
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiation Science & Technology, Delft University of Technology, Delft, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands
| | - A Stijn L P Crobach
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacobus Burggraaf
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Centre for Human Drug Research, Leiden, The Netherlands
| | | | - Peter J K Kuppen
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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3
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Coffman TJ. Gastric cancer: Nursing care and impact. Nursing 2025; 55:16-22. [PMID: 39702911 DOI: 10.1097/nsg.0000000000000123] [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: 12/21/2024]
Abstract
ABSTRACT Patients with gastric cancer experience symptoms that impact adequate nutritional intake. Delayed diagnosis may result in advanced disease. Surgery, chemotherapy, biologic therapy, and radiotherapy comprise interventions. This article discusses gastric cancer incidence and risks, treatment approaches, and nursing management of patients with gastric cancer, including advanced care planning for patients with terminal diagnoses.
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Affiliation(s)
- Tammie J Coffman
- Tammie Coffman is an assistant professor at Texas Tech University School of Nursing
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4
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da Silva EL, Mesquita FP, Pinto LC, Gomes BPS, de Oliveira EHC, Burbano RMR, Moraes MEAD, de Souza PFN, Montenegro RC. Transcriptome analysis displays new molecular insights into the mechanisms of action of Mebendazole in gastric cancer cells. Comput Biol Med 2025; 184:109415. [PMID: 39566281 DOI: 10.1016/j.compbiomed.2024.109415] [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: 06/22/2024] [Revised: 10/15/2024] [Accepted: 11/08/2024] [Indexed: 11/22/2024]
Abstract
Gastric cancer (GC) is a common cancer worldwide. Therefore, searching for effective treatments is essential, and drug repositioning can be a promising strategy to find new potential drugs for GC therapy. For the first time, we sought to identify molecular alterations and validate new mechanisms related to Mebendazole (MBZ) treatment in GC cells through transcriptome analysis using microarray technology. Data revealed 1066 differentially expressed genes (DEGs), of which 345 (2.41 %) genes were upregulated, 721 (5.04 %) genes were downregulated, and 13,231 (92.54 %) genes remained unaltered after MBZ exposure. The overexpressed genes identified were CCL2, IL1A, and CDKN1A. In contrast, the H3C7, H3C11, and H1-5 were the top 3 underexpressed genes. Gene set enrichment analysis (GSEA) identified 8 pathways significantly overexpressed in the treated group (p < 0.05 and FDR<0.25). The validation of the expression of top desregulated genes by RT-qPCR confirmed the transcriptome results, where MBZ increased the CCL2, IL1A, and CDKN1A and reduced the H3C7, H3C11, and H1-5 transcript levels. Expression analysis in samples from TCGA databases correlated that the lower ILI1A and higher H3C11 and H1-5 gene expression are associated with decreased overall survival rates in patients with GC, indicating that MBZ treatment can improve the prognosis of patients. Thus, the data demonstrated that the drug MBZ alters the transcriptome of the AGP-01 lineage, mainly modulating the expression of histone proteins and inflammatory cytokines, indicating a possible epigenetic and immunological effect on tumor cells, these findings highlight new mechanisms of action related to MBZ treatment. Additional studies are still needed to better clarify the epigenetic and immune mechanism of MBZ in the therapy of GC.
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Affiliation(s)
- Emerson Lucena da Silva
- Laboratory of Pharmacogenetics, Drug Research and Development Center (NPDM), Federal University of Ceará, Cel. Nunes de Melo, Fortaleza, Brazil
| | - Felipe Pantoja Mesquita
- Laboratory of Pharmacogenetics, Drug Research and Development Center (NPDM), Federal University of Ceará, Cel. Nunes de Melo, Fortaleza, Brazil
| | - Laine Celestino Pinto
- Laboratory of Experimental Neuropathology, Biological Science Institute, Federal University of Pará, Mundurucus Street, Belém, Brazil
| | - Bruna Puty Silva Gomes
- Laboratory of Cytogenomics and Environmental Mutagenesis, Environment Section (SAMAM), Evandro Chagas Institute (IEC), Ananindeua, Brazil
| | | | - Rommel Mario Rodríguez Burbano
- Molecular Biology Laboratory, Ophir Loyola Hospital, Av. Governador Magalhães Barata, Belém, Brazil; Laboratory of Human Cytogenetics, Institute of Biological Sciences, Federal University of Pará, Augusto Correa Avenue, Belém, Brazil
| | - Maria Elisabete Amaral de Moraes
- Laboratory of Pharmacogenetics, Drug Research and Development Center (NPDM), Federal University of Ceará, Cel. Nunes de Melo, Fortaleza, Brazil
| | - Pedro Filho Noronha de Souza
- Laboratory of Pharmacogenetics, Drug Research and Development Center (NPDM), Federal University of Ceará, Cel. Nunes de Melo, Fortaleza, Brazil; Visiting Researcher at the Cearense Foundation to Support Scientific and Technological Development, Brazil; National Institute of Science and Technology in Human Pathogenic Fungi, Ribeirão Preto, Brazil.
| | - Raquel Carvalho Montenegro
- Laboratory of Pharmacogenetics, Drug Research and Development Center (NPDM), Federal University of Ceará, Cel. Nunes de Melo, Fortaleza, Brazil; Red Latinoamericana de Implementación y Validación de guias clinicas Farmacogenomicas (RELIVAF), Brazil.
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5
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Pekov SI, Bormotov DS, Bocharova SI, Sorokin AA, Derkach MM, Popov IA. Mass spectrometry for neurosurgery: Intraoperative support in decision-making. MASS SPECTROMETRY REVIEWS 2025; 44:62-73. [PMID: 38571445 DOI: 10.1002/mas.21883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/29/2024] [Accepted: 03/23/2024] [Indexed: 04/05/2024]
Abstract
Ambient ionization mass spectrometry was proved to be a powerful tool for oncological surgery. Still, it remains a translational technique on the way from laboratory to clinic. Brain surgery is the most sensitive to resection accuracy field since the balance between completeness of resection and minimization of nerve fiber damage determines patient outcome and quality of life. In this review, we summarize efforts made to develop various intraoperative support techniques for oncological neurosurgery and discuss difficulties arising on the way to clinical implementation of mass spectrometry-guided brain surgery.
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Affiliation(s)
- Stanislav I Pekov
- Skolkovo Institute of Science and Technology, Moscow, Russian Federation
- Moscow Institute of Physics and Technology, Dolgoprudny, Russian Federation
- Siberian State Medical University, Tomsk, Russian Federation
| | - Denis S Bormotov
- Moscow Institute of Physics and Technology, Dolgoprudny, Russian Federation
| | | | - Anatoly A Sorokin
- Moscow Institute of Physics and Technology, Dolgoprudny, Russian Federation
| | - Maria M Derkach
- Moscow Institute of Physics and Technology, Dolgoprudny, Russian Federation
| | - Igor A Popov
- Moscow Institute of Physics and Technology, Dolgoprudny, Russian Federation
- Siberian State Medical University, Tomsk, Russian Federation
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Gurau A, Monton O, Greer JB, Johnston FM. Comparing the Effectiveness of Open, Laparoscopic, and Robotic Gastrectomy in the United States: A Retrospective Analysis of Perioperative, Oncologic, and Survival Outcomes. J Surg Res 2024; 304:196-206. [PMID: 39551014 PMCID: PMC11645221 DOI: 10.1016/j.jss.2024.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 09/23/2024] [Accepted: 10/13/2024] [Indexed: 11/19/2024]
Abstract
INTRODUCTION Minimally invasive surgery (MIS) is increasingly used in the surgical management of gastric cancer; however, its adoption lags that of other cancers. Most randomized controlled trials comparing MIS to open gastrectomy have been conducted in Asia, with limited data from the United States. This study aimed to compare perioperative, oncologic, and survival outcomes between open, laparoscopic, and robotic gastrectomy in a large US cohort. METHODS Using the National Cancer Database, we identified patients with gastric adenocarcinoma who underwent open, laparoscopic, or robotic gastrectomy between 2010 and 2020. Multivariate regression models were used to examine the association between surgical approach and various outcomes, including 30-d readmission, length of stay (LOS), surgical margin status, lymph node yield, 30- and 90-d mortality, and overall survival (OS). The interaction between surgical approach and tumor location (distal versus proximal or gastroesophageal junction [GEJ]) was also assessed. RESULTS Of the 34,937 included patients, 64.8% underwent open gastrectomy, 25.7% underwent laparoscopic surgery, and 9.5% underwent robotic surgery. MIS was associated with lower odds of 30-d readmission (laparoscopic: odds ratio [OR] 0.78, 95% confidence interval [CI] 0.67-0.89; robotic: OR 0.75, 95% CI 0.60-0.92), positive margins (laparoscopic: OR 0.83, 95% CI 0.74-0.93; robotic: OR 0.75, 95% CI 0.62-0.90), 30-d mortality (laparoscopic: OR 0.69, 95% CI 0.55-0.85; robotic: OR 0.66, 95% CI 0.44-0.95), and 90-d mortality (laparoscopic: OR 0.74, 95% CI 0.63-0.87; robotic: OR 0.63, 95% CI 0.47-0.84), as well as improved OS (laparoscopic: hazard ratio 0.83, 95% CI 0.79-0.87; robotic: hazard ratio 0.76, 95% CI 0.69-0.83) compared to open surgery. Considering the interaction of approach with tumor location, for proximal/GEJ tumors, the associated outcome improvements with MIS were attenuated. We observe that the odds for 30-d readmission, 90-d mortality, and OS are similar to those for open operations. However, regardless of tumor location, robotic gastrectomy was associated with decreased LOS and yielded a higher lymph node count than laparoscopic or open approaches. CONCLUSIONS In this large US cohort, MIS gastrectomy was associated with improved perioperative, oncologic, and survival outcomes compared to open surgery for distal gastric cancers. However, the associated benefits of MIS were attenuated for proximal/GEJ tumors, with higher odds of readmission, mortality, and worse OS. Notably, robotic gastrectomy was associated with superior lymph node yield and LOS compared to laparoscopic and open approaches, even for proximal/GEJ tumors. These findings underscore the need for further research, especially randomized controlled trials conducted in Western populations, to definitively determine the efficacy of MIS for distal and proximal/GEJ tumors and guide surgical decision-making for gastric adenocarcinoma.
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Affiliation(s)
- Andrei Gurau
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Olivia Monton
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jonathan B Greer
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Fabian M Johnston
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
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7
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Yang T, Guo L. Advancing gastric cancer treatment: nanotechnology innovations and future prospects. Cell Biol Toxicol 2024; 40:101. [PMID: 39565472 PMCID: PMC11579161 DOI: 10.1007/s10565-024-09943-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 11/04/2024] [Indexed: 11/21/2024]
Abstract
Gastric cancer (GC) is the fifth most common cancer worldwide, particularly prevalent in Asia, especially in China, where both its incidence and mortality rates are significantly high. Meanwhile, nanotechnology has demonstrated great potential in the treatment of GC. In particular, nanodrug delivery systems have improved therapeutic efficacy and targeting through various functional modifications, such as targeting peptides, tumor microenvironment responsiveness, and instrument-based methods. For instance, silica (SiO2) has excellent biocompatibility and can be used as a drug carrier, with its porous structure enhancing drug loading capacity. Polymer nanoparticles regulate drug release rates and mechanisms by altering material composition and preparation methods. Lipid nanoparticles efficiently encapsulate hydrophilic drugs and promote cellular uptake, while carbon-based nanoparticles can be used in biosensors and drug delivery. Targets such as integrins, HER2 receptors, and the tumor microenvironment have been used to improve drug efficacy in GC treatment. Nanodrug delivery techniques not only enhance drug efficacy and delivery capabilities but also selectively target tumor cells. Currently, there is a lack of systematic summarization and synthesis regarding the relationship between nanodrug delivery systems and GC treatment, which to some extent hinders researchers and clinicians from efficiently searching for and referencing related studies, thereby reducing work efficiency. This study aims to systematically summarize the existing research on the relationship between nanodrug delivery systems and GC treatment, making it easier for professionals to search and reference, and thereby promoting further research on the role of nanodrug delivery systems and their clinical applications in GC. This review discusses the applications of functionalized nanocarriers in the treatment of GC in recent years, including surface modifications with targeted markers, the combination of phototherapy, chemotherapy, and immunotherapy, along with their advantages and challenges. It also examines the future prospects of targeted nanomaterials in GC treatment. The review particularly focuses on the combined application of nanocarriers in multiple treatment modalities, such as phototherapy, chemotherapy, and immunotherapy, demonstrating their potential in multimodal treatments. Furthermore, it thoroughly explores the specific challenges that nanocarriers face in GC treatment, such as biocompatibility, drug release control, and clinical translation issues, while providing a systematic outlook on future developments. Additionally, this study emphasizes the potential value and feasibility of nanocarriers in clinical applications, contrasting with most reviews that focus on basic research. Through these innovations, we offer new perspectives and directions for the development of nanotechnology in the treatment of GC.
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Affiliation(s)
- Tengfei Yang
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, 110004, P. R. China
| | - Lin Guo
- Department of General Surgery, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning Province, P. R. China.
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8
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Hsu JT, Lin YN, Chen YF, Kou HW, Wang SY, Chou WC, Wu TR, Yeh TS. A comprehensive overview of gastric cancer management from a surgical point of view. Biomed J 2024:100817. [PMID: 39566657 DOI: 10.1016/j.bj.2024.100817] [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: 04/30/2024] [Revised: 10/22/2024] [Accepted: 11/13/2024] [Indexed: 11/22/2024] Open
Abstract
Despite advancements in medical care, surgical technologies, and the development of novel treatments over the past decade, the prognosis for patients with gastric cancer (GC) has only modestly improved. This is primarily due to the fact that the majority of patients are diagnosed at advanced stages or present with metastatic disease. Radical resection remains the cornerstone of potentially curative treatment, yet the overall 5-year survival rate remains below 35%. The management of GC varies globally, influenced by factors such as geographical disparities, patient comorbidities and performance status, surgical approaches, and available medical resources. Multidisciplinary collaboration and a multimodal treatment approach are essential for optimizing patient outcomes. Surgeons must stay updated on emerging surgical concepts and make informed decisions regarding patient selection, timing of intervention, and the adoption of appropriate surgical techniques to improve both quality of life and prognosis. This review aims to provide a surgical perspective on the management of GC across all stages, highlighting the importance of a comprehensive treatment approach. Endoscopic resection may be a viable option for early GC in patients with minimal risk of lymph node metastasis, particularly in elderly patients with high surgical risk or severe comorbidities. For advanced GC, neoadjuvant therapy followed by surgery could be a promising strategy to improve patient outcomes. Conversion surgery offers a potential survival benefit for patients who respond to treatment with tumor downstaging. The treatment of peritoneal carcinomatosis remains challenging; however, hyperthermic intraperitoneal chemotherapy combined with complete cytoreductive surgery or pressurized intraperitoneal aerosolized chemotherapy may prolong survival or improve quality of life in highly selected patients.
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Affiliation(s)
- Jun-Te Hsu
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Yu-Ning Lin
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yi-Fu Chen
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hao-Wei Kou
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shan-Yu Wang
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wen-Chi Chou
- Department of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ting-Rong Wu
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ta-Sen Yeh
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
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9
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Chatterjee A, Roy T, Kumar Mishra V, Swarnakar S. Shatavarin-IV, a steroidal saponin from Asparagus racemosus, inhibits cell cycle progression and epithelial-to-mesenchymal transition in AGS cells under hyperglycemic conditions. Steroids 2024; 210:109487. [PMID: 39106908 DOI: 10.1016/j.steroids.2024.109487] [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: 02/06/2024] [Revised: 08/03/2024] [Accepted: 08/03/2024] [Indexed: 08/09/2024]
Abstract
Gastric cancer (GC)-diabetes co-morbidity is nowadays growing into a rising concern. However, no separate treatment procedures have been outlined for such patients. Phytochemicals and their derivatives can therefore be used as therapeutics as they have greater effectiveness, reduced toxicity, and a reduced likelihood of developing multi-drug resistance in cancer treatments. The present study intended to assess the therapeutic efficacy of Shatavarin-IV - a major steroidal saponin from the roots of Asparagus racemosus, in human gastric adenocarcinoma cell line under hyperglycemic conditions and explore its mechanism of action in controlling GC progression. For the present study, AGS cells were incubated in high glucose-containing media and the effects of Shatavarin-IV therein have been evaluated. Cell proliferation, confocal microscopic imaging, flow-cytometric analysis for cell cycle and apoptosis, immunoblotting, zymography, reverse zymography, wound-healing, colony formation, and invasion assays were performed. Shatavarin-IV has a prominent effect on AGS cell proliferation; with IC50 of 2.463 µ M under hyperglycemic conditions. Shatavarin-IV induces cell cycle arrest at the G0/G1 phase, thereby preventing hyperglycemia-induced excessive cell proliferation that later on leads to apoptotic cell death at 36 h of incubation. Shatavarin-IV further inhibits the migratory and invasive potential of AGS cells by altering the expression patterns of different EMT markers. It also inhibits MMP-9 while promoting TIMP-1 activity and expression; thereby regulating ECM turnover. This is the first report demonstrating the therapeutic efficacy of Shatavarin-IV against AGS cells grown in hyperglycemic conditions, implicating new insights into the treatment paradigm of patients with GC-diabetes co-morbidity.
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Affiliation(s)
- Abhishek Chatterjee
- Infectious Diseases and Immunology division, CSIR-Indian Institute of Chemical Biology, 4, Raja S.C. Mullick Road, Kolkata 700032, West Bengal, India
| | - Tapasi Roy
- Infectious Diseases and Immunology division, CSIR-Indian Institute of Chemical Biology, 4, Raja S.C. Mullick Road, Kolkata 700032, West Bengal, India
| | - Vineet Kumar Mishra
- Infectious Diseases and Immunology division, CSIR-Indian Institute of Chemical Biology, 4, Raja S.C. Mullick Road, Kolkata 700032, West Bengal, India
| | - Snehasikta Swarnakar
- Infectious Diseases and Immunology division, CSIR-Indian Institute of Chemical Biology, 4, Raja S.C. Mullick Road, Kolkata 700032, West Bengal, India.
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10
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Kakish H, Drigotas C, Loftus AW, Boutros CS, Doh SJ, Ammori JB, Rothermel LD, Hoehn RS. Reasons for Surgical Attrition Among Nonmetastatic Upper Gastrointestinal Cancer Patients: A Single Institutional Experience. J Surg Oncol 2024. [PMID: 39257297 DOI: 10.1002/jso.27865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/20/2024] [Accepted: 08/21/2024] [Indexed: 09/12/2024]
Abstract
INTRODUCTION Upper gastrointestinal (UGI) cancers require multidisciplinary treatment, but surgery provides the only potentially curative option. We sought to understand reasons for attrition before surgery within our regional hospital network. METHODS We performed chart reviews of patients (age 18-80) with stage I-III UGI cancers (gastroesophageal junction, gastric, and hepatopancreatobiliary adenocarcinomas) in our multihospital cancer registry from 2015 to 2021. Our primary outcome was reasons for surgical attrition. Univariable analysis identified factors related to surgical attrition and the Kaplan-Meier method estimated overall survival based on surgery receipt. RESULTS Seven hundred and ninety-two patients were included in our analysis, of whom 107 (13.5%) did not undergo curative surgery. Reasons for not undergoing surgery included medical comorbidities (30.8%), patient preference/nonmedical barriers (24.3%, which included: not interested without further explanation, worried about complications, nonadherence to appointments, insurance issues, did not wish for blood transfusion, lack of social support, preferring home care, and worried about recurrence), psychosocial (5.6%), progression while on neoadjuvant therapy or waiting for transplant (15.0% and 7.5%), poor performance status (3.7%), side effects of neoadjuvant therapy (3.7%), and death unrelated to treatment or unknown cause (9.4%). Nonsurgical management was not associated with race, socioeconomic status, or distance traveled for care. Survival was greatly improved for patients who underwent surgery (158 vs. 63 weeks, p < 0.05). CONCLUSION Nearly one in seven patients (18-80 years old) with UGI cancers evaluated at our academic cancer center did not undergo surgical resection. Reasons for surgical attrition included potentially modifiable issues, and addressing these barriers could help overcome inequities in cancer treatment and survival.
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Affiliation(s)
- Hanna Kakish
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Claire Drigotas
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Alexander W Loftus
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Christina S Boutros
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Susan J Doh
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - John B Ammori
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Luke D Rothermel
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Richard S Hoehn
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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11
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Barbaro A, Bunjo Z, Asokan G, Kanhere A, Kuan LL, Trochsler M, Kanhere H, Maddern GJ. Impact of surgical specialization on emergency upper gastrointestinal surgery outcomes: A systematic review and meta-analysis. World J Surg 2024; 48:1941-1949. [PMID: 38956401 DOI: 10.1002/wjs.12267] [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: 11/27/2023] [Accepted: 06/16/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Emergency presentations make up a large proportion of a general surgeon's workload. Patients who have emergency surgery carry a higher rate of mortality and complications. We aim to review the impact of surgical subspecialization on patients following upper gastrointestinal (UGI) emergency surgery. METHODS A systematic search of Ovid Embase, Ovid MEDLINE, and Cochrane databases using a predefined search strategy was completed reviewing studies published from 1st of January 1990 to August 27, 2023. The study was prospectively registered with PROSPERO (CRD42022359326). Studies were reviewed for the following outcomes: 30-day mortality, in-hospital mortality, conversion to open, length of stay, return to theater, and readmission. RESULTS Of 5181 studies, 24 articles were selected for full text review. Of these, seven were eligible and included in this study. There was a statistically significant improvement in 30-day mortality favoring UGI specialists (OR 0.71 [95% CI 0.55-0.92 and p = 0.009]) and in-hospital mortality (OR 0.29 [95% CI 0.14-0.60 and p = 0009]). There was a high degree of study heterogeneity in 30-day mortality; however, a low degree of heterogeneity within in-hospital mortality. There was no statistical significance when considering conversion to open and insufficient data to allow meta-analysis for return to theater or readmission rates. CONCLUSION In emergency UGI surgery, there was improved 30-day and in-hospital mortality for UGI specialists. Therefore, surgeons should consider early involvement of a subspecialist team to improve patient outcomes.
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Affiliation(s)
- Antonio Barbaro
- The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Zachary Bunjo
- The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Gayatri Asokan
- The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Akshay Kanhere
- The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Li Lian Kuan
- The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Markus Trochsler
- The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
- Division of Upper Gastrointestinal Surgery, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Harsh Kanhere
- The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
- Division of Upper Gastrointestinal Surgery, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Guy J Maddern
- The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
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12
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Zhu X, Qu Y, Zhang Y, Jin S, Wang H, Wang L, Zhuang S. Characterizing the post-traumatic growth trajectory in gastric cancer survivors: a population-based longitudinal study. Support Care Cancer 2024; 32:483. [PMID: 38958751 DOI: 10.1007/s00520-024-08697-8] [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: 02/01/2024] [Accepted: 06/25/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVES Post-traumatic growth can improve the quality of life of cancer survivors. The objective of this study was to investigate post-traumatic growth heterogeneity trajectory in perioperative gastric cancer survivors, and to identify characteristics that predict membership for each trajectory. METHODS Gastric cancer survivors (n = 403) were recruited before surgery, their baseline assessment (including post-traumatic growth and related characteristics) was completed, and post-traumatic growth levels were followed up on the day they left the intensive care unit, at discharge, and 1 month after discharge. Latent growth mixture mode was used to identify the heterogeneous trajectory of post-traumatic growth, and the core predictors of trajectory subtypes were explored using a decision tree model. RESULTS Three post-traumatic growth development trajectories were identified among gastric cancer survivors: stable high of PTG group (20.6%), fluctuation of PTG group (44.4%), persistent low of PTG group (35.0%). The decision tree model showed anxiety, coping style, and psychological resilience-which was the primary predictor-might be used to predict the PTG trajectory subtypes of gastric cancer survivors. CONCLUSIONS There was considerable variability in the experience of post-traumatic growth among gastric cancer survivors. Recognition of high-risk gastric cancer survivors who fall into the fluctuation or persistent low of PTG group and provision of psychological resilience-centered support might allow medical professionals to improve patients' post-traumatic growth and mitigate the impact of negative outcomes.
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Affiliation(s)
- Xinran Zhu
- School of Nursing, Tianjin Medical University, 22 Meteorological Station Road, Heping District, Tianjin, 300070, China
| | - Yitong Qu
- School of Nursing, Tianjin Medical University, 22 Meteorological Station Road, Heping District, Tianjin, 300070, China
| | - Yinan Zhang
- School of Nursing, Tianjin Medical University, 22 Meteorological Station Road, Heping District, Tianjin, 300070, China
| | - Shimei Jin
- School of Nursing, Tianjin Medical University, 22 Meteorological Station Road, Heping District, Tianjin, 300070, China
| | - Huiying Wang
- Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Lina Wang
- Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Shumei Zhuang
- School of Nursing, Tianjin Medical University, 22 Meteorological Station Road, Heping District, Tianjin, 300070, China.
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13
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Loyala JV, Down B, Wong E, Tan B. Treatment of Cachexia in Gastric Cancer: Exploring the Use of Anti-Inflammatory Natural Products and Their Derivatives. Nutrients 2024; 16:1246. [PMID: 38674936 PMCID: PMC11053965 DOI: 10.3390/nu16081246] [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: 03/22/2024] [Revised: 04/12/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Gastric cancer is a significant cause of cancer-related mortality worldwide. Weight loss and malnutrition associated with cancer are linked with increased mortality rates and reduced quality of life. Cancer cachexia, characterised by the loss of skeletal muscle, is associated with approximately 20% of cancer-related deaths and differs from malnutrition in that it cannot be fully reversed by nutritional support alone. It is now recognised that the primary pathophysiological process underlying cancer cachexia is chronic inflammation leading to increased calorie consumption. Current treatments that focus on nutritional supplementation, psychological counselling, appetite stimulation and reducing inflammation are lacking in efficacy. This review focuses on the evidence supporting the potential roles of natural anti-inflammatory products and their derivatives including fatty acids, probiotics, amino acids, curcumin, fucoidan, epigallocatechin-3-gallate, ginger, resveratrol and Boswellia serrata in the management of gastric cancer cachexia. (2) Results: While natural anti-inflammatory products show promise in a number of in vitro and in vivo studies, there are only a small number of human studies available. Where present, the evidence base is heterogeneous, with varying study methodologies and outcomes. (3) Conclusions: Natural anti-inflammatory products represent a potential adjunctive therapy for gastric cancer cachexia. Further research, particularly well-designed clinical trials, is needed to elucidate their optimal role, dosing and safety profiles in the management of gastric cancer cachexia.
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Affiliation(s)
- Jerocin Vishani Loyala
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK
| | - Billy Down
- High Wycombe Hospital, Buckinghamshire Healthcare NHS Trust, High Wycombe HP11 2TT, UK;
| | - Enoch Wong
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK
| | - Benjamin Tan
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK;
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14
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Reddy S, Shaheed A, Seo Y, Patel R. Development of an Artificial Intelligence Model for the Classification of Gastric Carcinoma Stages Using Pathology Slides. Cureus 2024; 16:e56740. [PMID: 38650818 PMCID: PMC11033212 DOI: 10.7759/cureus.56740] [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] [Accepted: 03/22/2024] [Indexed: 04/25/2024] Open
Abstract
This study showcases a novel AI-driven approach to accurately differentiate between stage one and stage two gastric carcinoma based on pathology slide analysis. Gastric carcinoma, a significant contributor to cancer-related mortality globally, necessitates precise staging for optimal treatment planning and patient management. Leveraging a comprehensive dataset of 3540 high-resolution pathology images sourced from Kaggle.com, comprising an equal distribution of stage one and stage two tumors, the developed AI model demonstrates remarkable performance in tumor staging. Through the application of state-of-the-art deep learning techniques on Google's Collaboration platform, the model achieves outstanding accuracy and precision rates of 100%, accompanied by notable sensitivity (97.09%), specificity (100%), and F1-score (98.31%). Additionally, the model exhibits an impressive area under the receiver operating characteristic curve (AUC) of 0.999, indicating superior discriminatory power and robustness. By providing clinicians with an efficient and reliable tool for gastric carcinoma staging, this AI-driven approach has the potential to significantly enhance diagnostic accuracy, inform treatment decisions, and ultimately improve patient outcomes in the management of gastric carcinoma. This research contributes to the ongoing advancement of cancer diagnosis and underscores the transformative potential of artificial intelligence in clinical practice.
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Affiliation(s)
- Shreya Reddy
- Biomedical Sciences, Creighton University, Omaha, USA
| | - Avneet Shaheed
- Pathology, University of Illinois at Chicago, Chicago, USA
| | - Yui Seo
- Medicine, California Northstate University College of Medicine, Elk Grove, USA
| | - Rakesh Patel
- Internal Medicine, East Tennessee State University Quillen College of Medicine, Johnson City, USA
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15
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Sharan S, Bansal S, Manaise HK, Jimenez PB, Raikot SR, Ahmed SH, Popp R, Popp K, Sukniam K, Kowkabany G, Mubarak F, Gabriel E. Time to treatment disparities in gastric cancer patients in the United States of America: a comprehensive retrospective analysis. Front Oncol 2024; 14:1292793. [PMID: 38406814 PMCID: PMC10889117 DOI: 10.3389/fonc.2024.1292793] [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: 10/24/2023] [Accepted: 01/19/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Gastric cancer ranks as the 5th most prevalent cancer and the 4th leading cause of cancer-related deaths worldwide. Various treatment modalities, including surgical resection, chemotherapy, and radiotherapy, are available for gastric cancer patients. However, disparities related to age, sex, race, socioeconomic factors, insurance status, and demographic factors often lead to delayed time to treatment. Methods In this retrospective study, conducted between 2004 and 2019, we utilized data from the National Cancer Database (NCDB) to investigate the factors contributing to disparities in the time to first treatment, surgery, chemotherapy, and radiotherapy among gastric cancer patients. Our analysis incorporated several variables, and statistical analysis was conducted to provide valuable insights into these disparities. Results We observed notable disparities in the timing of treatment for various demographic groups, including age, sex, race, insurance status, geographic location, and facility type. These disparities include longer time to treatment in males (32.67 vs 30.75), Native Americans (35.10 vs 31.09 in Asians), low-income patients (32 vs 31.15), patients getting treatment in an academic setting (36.11 vs 29.61 in community setting), significantly longer time to chemotherapy in 70+ age group (51.13 vs 40.38 in <40 y age group), black race (55.81 vs 47.05 in whites), low income people (49.64 vs 46.74), significantly longer time to radiotherapy in females (101.61 vs 79.75), blacks and Asians (109.68 and 113.96 respectively vs 92.68 in Native Americans) etc. There are various other disparities in time to surgery, chemotherapy, and radiotherapy. Conclusions Understanding these disparities is crucial in developing targeted strategies to improve timely access to appropriate treatments and enhance outcomes for gastric cancer patients. Future research with updated data and prospective study designs can provide a more comprehensive understanding of the factors influencing patient outcomes in gastric cancer.
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Affiliation(s)
- Seema Sharan
- Department of Surgery, Government Medical College and Hospital, Chandigarh, India
| | - Shivam Bansal
- Department of Surgery, Government Medical College and Hospital, Chandigarh, India
| | | | - Paola Berrios Jimenez
- Department of Surgery, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Swathi R. Raikot
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
| | | | - Reed Popp
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, United States
| | - Kyle Popp
- Department of Surgery, Florida State University, Tallahassee, FL, United States
| | - Kulkaew Sukniam
- Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | | | - Fatima Mubarak
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Emmanuel Gabriel
- Department of General Surgery, Mayo Clinic Florida, Jacksonville, FL, United States
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16
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Qu T, Zhang S, Yang S, Li S, Wang D. Utilizing serum metabolomics for assessing postoperative efficacy and monitoring recurrence in gastric cancer patients. BMC Cancer 2024; 24:27. [PMID: 38166693 PMCID: PMC10763142 DOI: 10.1186/s12885-023-11786-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE (1) This study aims to identify distinct serum metabolites in gastric cancer patients compared to healthy individuals, providing valuable insights into postoperative efficacy evaluation and monitoring of gastric cancer recurrence; (2) Methods: Serum samples were collected from 15 healthy individuals, 16 gastric cancer patients before surgery, 3 months after surgery, 6 months after surgery, and 15 gastric cancer recurrence patients. T-test and analysis of variance (ANOVA) were performed to screen 489 differential metabolites between the preoperative group and the healthy control group. Based on the level of the above metabolites in the recurrence, preoperative, three-month postoperative, and six-month postoperative groups, we further selected 18 significant differential metabolites by ANOVA and partial least squares discriminant analysis (PLS-DA). The result of hierarchical clustering analysis about the above metabolites showed that the samples were regrouped into the tumor-bearing group (comprising the original recurrence and preoperative groups) and the tumor-free group (comprising the original three-month postoperative and six-month postoperative groups). Based on the results of PLS-DA, 7 differential metabolites (VIP > 1.0) were further selected to distinguish the tumor-bearing group and the tumor-free group. Finally, the results of hierarchical clustering analysis showed that these 7 metabolites could well identify gastric cancer recurrence; (3) Results: Lysophosphatidic acids, triglycerides, lysine, and sphingosine-1-phosphate were significantly elevated in the three-month postoperative, six-month postoperative, and healthy control groups, compared to the preoperative and recurrence groups. Conversely, phosphatidylcholine, oxidized ceramide, and phosphatidylglycerol were significantly reduced in the three-month postoperative, six-month postoperative, and healthy control groups compared to the preoperative and recurrence groups. However, these substances did not show significant differences between the preoperative and recurrence groups, nor between the three-month postoperative, six-month postoperative, and healthy control groups; (4) Conclusions: Our findings demonstrate the presence of distinct metabolites in the serum of gastric cancer patients compared to healthy individuals. Lysophosphatidic acid, triglycerides, lysine, sphingosine-1-phosphate, phosphatidylcholine, oxidized ceramide, and phosphatidylglycerol hold potential as biomarkers for evaluating postoperative efficacy and monitoring recurrence in gastric cancer patients. These metabolites exhibit varying concentrations across different sample categories.
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Affiliation(s)
- Tong Qu
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, 71 Xinmin Street, 130021, Changchun, Jilin, P.R. China
| | - Shaopeng Zhang
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, 71 Xinmin Street, 130021, Changchun, Jilin, P.R. China
| | - Shaokang Yang
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, 71 Xinmin Street, 130021, Changchun, Jilin, P.R. China
| | - Shuang Li
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, 71 Xinmin Street, 130021, Changchun, Jilin, P.R. China
| | - Daguang Wang
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, 71 Xinmin Street, 130021, Changchun, Jilin, P.R. China.
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17
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Wang Y, Luo S, Wang S. Evaluation of enhanced recovery after surgery for gastric cancer patients undergoing gastrectomy: a systematic review and meta-analysis. Wideochir Inne Tech Maloinwazyjne 2023; 18:551-564. [PMID: 38239576 PMCID: PMC10793142 DOI: 10.5114/wiitm.2023.131723] [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: 07/11/2023] [Accepted: 07/25/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction For complicated surgical patients, enhanced recovery after surgery (ERAS) decreases stress and hospital stays. It accelerates recovery and lowers readmissions, morbidity, and death. ERAS's effectiveness in stomach cancer laparoscopic-assisted gastrectomy (LAG) or robotic gastrectomy is still debated. Aim This study assesses the efficacy and safety of the ERAS program for patients undergoing gastrectomy for gastric cancer. Material and methods PRISMA-compliant searches were performed in Medline, Embase, PubMed, the Web of Sciences, and the Cochrane Library databases until March 2023. The search included articles that compared ERAS protocol results for gastric cancer surgery patients to conventional care. RevMan performed meta-analysis, and the Cochrane Risk of Bias Assessment Tool assessed study quality. Results This meta-analysis contained 11 carefully chosen randomized controlled trials (RCTs) involving 1790 people. The ERAS group had 902 participants, while the traditional care group had 888. The ERAS group had a shorter post-operative hospital stay, with a weighted mean difference (WMD) of -1.12 days (95% CI: -1.89 to -0.35, p = 0.00001), I2 = 89%, and a lower number of patients with post-operative problems, with an odds ratio (OR) of 0.73 (95% CI: 0.55 to 0.97; p = 0.03), I2 = 60%. Conclusions The ERAS procedure has been shown to be effective as well as beneficial for patients undergoing either laparoscopic-assisted or robotic gastrectomy for gastric cancer, since it lowers post-operative complications and accelerates recovery with improved results.
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Affiliation(s)
- Ying Wang
- Department of General Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Shengrui Luo
- Department of Gastrointestinal Surgery, Qujing, Second People’s Hospital of Yunnan Province, Qujing, China
| | - Shanshan Wang
- Department of Hepatobiliary Surgery, The People’s Hospital of Longhua, Shenzhen, China
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18
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Huang N, He HW, He YY, Gu W, Xu MJ, Liu L. Xiaotan Sanjie recipe, a compound Chinese herbal medicine, inhibits gastric cancer metastasis by regulating GnT-V-mediated E-cadherin glycosylation. JOURNAL OF INTEGRATIVE MEDICINE 2023; 21:561-574. [PMID: 37980180 DOI: 10.1016/j.joim.2023.11.001] [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: 03/14/2023] [Accepted: 05/02/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVE Xiaotan Sanjie recipe (XTSJ), a Chinese herbal compound medicine, exerts a significant inhibitory effect on gastric cancer (GC) metastasis. This work investigated the mechanism underlying the XTSJ-mediated inhibition of GC metastasis. METHODS The effect of XTSJ on GC metastasis and the associated mechanism were investigated in vitro, using GC cell lines, and in vivo, using a GC mouse model, by focusing on the expression of Glc-N-Ac-transferase V (GnT-V; encoded by MGAT5). RESULTS The migration and invasion ability of GC cells decreased significantly after XTSJ administration, which confirmed the efficacy of XTSJ in treating GC in vitro. XTSJ increased the accumulation of E-cadherin at junctions between GC cells, which was reversed by MGAT5 overexpression. XTSJ administration and MGAT5 knockdown alleviated the structural abnormality of the cell-cell junctions, while MGAT5 overexpression had the opposite effect. MGAT5 knockdown and XTSJ treatment also significantly increased the accumulation of proteins associated with the E-cadherin-mediated adherens junction complex. Furthermore, the expression of MGAT5 was significantly lower in the lungs of BGC-823-MGAT5 + XTSJ mice than in those of BGC-823-MGAT5 + solvent mice, indicating that the ability of gastric tumors to metastasize to the lung was decreased in vivo following XTSJ treatment. CONCLUSION XTSJ prevented GC metastasis by inhibiting the GnT-V-mediated E-cadherin glycosylation and promoting the E-cadherin accumulation at cell-cell junctions. Please cite this article as: Huang N, He HW, He YY, Gu W, Xu MJ, Liu L. Xiaotan Sanjie recipe, a compound Chinese herbal medicine, inhibits gastric cancer metastasis by regulating GnT-V-mediated E-cadherin glycosylation. J Integr Med. 2023; 21(6): 561-574.
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Affiliation(s)
- Nian Huang
- Department of Integrative Medicine, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai 200433, China
| | - Hai-Wei He
- Department of Obstetrics and Gynecology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Yu-Yu He
- School of Traditional Chinese Medicine, Naval Medical University, Shanghai 200433, China
| | - Wei Gu
- School of Traditional Chinese Medicine, Naval Medical University, Shanghai 200433, China
| | - Ming-Juan Xu
- Department of Obstetrics and Gynecology, Changhai Hospital, Naval Medical University, Shanghai 200433, China.
| | - Long Liu
- Department of Traditional Chinese Medicine, Tianyou Hospital, Tongji University, Shanghai 200333, China.
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Chen W, Liu C, Liu Y, Yuan J, Wang Z. Clinicopathological features and differential diagnosis of gastric metastases. World J Surg Oncol 2023; 21:258. [PMID: 37608278 PMCID: PMC10463964 DOI: 10.1186/s12957-023-03100-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/12/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE Due to the rarity and non-specificity of symptoms, gastric metastases are often misdiagnosed, and patients are not treated promptly. The aim of this study was to study the clinicopathological features and differential diagnosis of gastric metastases. METHODS From 2004 to 2021, 14 patients were diagnosed with gastric metastases not resulting from direct invasion (GMNDI) in our hospital, and their imaging and clinicopathological features were analyzed. RESULTS PET-CT examination showed hypermetabolic nodules in the stomach. Under gastroscopy, GMNDI showed eminence, nodular or vegetable pattern mass, and ulcer. Microscopically, GMNDI showed similar pathological features and immunophenotypes to the primary tumor. In our study, the most common primary tumors were malignant melanoma (4 cases), small cell lung cancer (3 cases), and hepatocellular carcinoma (3 cases). Immunohistochemistry contributed to the pathological diagnosis and differential diagnosis of gastric metastases. Malignant melanoma expressed HMB45, MelanA, and S-100; small cell lung cancer expressed TTF-1, CD56, and CgA; hepatocellular carcinoma expressed GPC-3, hepatocyte, and Sall4. In a few cases, tumor cells may lose immune markers during metastasis. Therefore, it is necessary to combine medical history, imaging examination, and other clinical diagnosis methods in the pathological diagnosis. CONCLUSION An in-depth understanding of GMNDI is conducive to better diagnosis and treatment planning for gastric metastases and subsequent improvement in patient prognosis.
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Affiliation(s)
- Wen Chen
- Department of Pathology, The 8th Medical Center, Chinese PLA General Hospital, Beijing, 100091, China
| | - Chengyu Liu
- Department of Pathology, The 8th Medical Center, Chinese PLA General Hospital, Beijing, 100091, China
| | - Yuejiao Liu
- Department of Pathology, The 8th Medical Center, Chinese PLA General Hospital, Beijing, 100091, China
| | - Jing Yuan
- Department of Pathology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Zhanbo Wang
- Department of Pathology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
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Guo Q, Sun Q, Bian X, Wang M, Dong H, Yin H, Dai X, Fan G, Chen G. Development and validation of a multiphase CT radiomics nomogram for the preoperative prediction of lymphovascular invasion in patients with gastric cancer. Clin Radiol 2023; 78:e552-e559. [PMID: 37117048 DOI: 10.1016/j.crad.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/13/2023] [Accepted: 03/22/2023] [Indexed: 04/30/2023]
Abstract
AIM To develop a nomogram to predict lymphovascular invasion (LVI) in gastric cancer by integrating multiphase computed tomography (CT) radiomics and clinical risk factors. MATERIALS AND METHODS One hundred and seventy-two gastric cancer patients (121 training and 51 validation) with preoperative contrast-enhanced CT images and clinicopathological data were collected retrospectively. The clinical risk factors were selected by univariate and multivariate regression analysis. Radiomic features were extracted and selected from the arterial phase (AP), venous phase (VP), and delayed phase (DP) CT images of each patient. Clinical risk factors, radiomic features, and integration of both were used to develop the clinical model, radiomic models, and nomogram, respectively. RESULTS Radiomic features from AP (n=6), VP (n=6), DP (n=7) CT images and three selected clinical risk factors were used for model development. The nomogram showed better performance than the AP, VP, DP, and clinical models in the training and validation datasets, providing areas under the curves (AUCs) of 0.890 (95% CI: 0.820-0.940) and 0.885 (95% CI:0.765-0.957), respectively. All models indicated good calibration, and decision curve analysis proved that the net benefit of the nomogram was superior to that of the clinical and radiomic models throughout the vast majority of the threshold probabilities. CONCLUSIONS The nomogram integrating multiphase CT radiomics and clinical risk factors showed favourable performance in predicting LVI of gastric cancer, which may benefit clinical practice.
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Affiliation(s)
- Q Guo
- Department of Radiology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu, 215004, China
| | - Q Sun
- Department of Radiology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu, 215004, China
| | - X Bian
- Department of Radiology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu, 215004, China
| | - M Wang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu, 215004, China
| | - H Dong
- Department of Radiology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu, 215004, China
| | - H Yin
- Institute of Advanced Research, Beijing Infervision Technology Co., Ltd, Beijing, China
| | - X Dai
- Department of Pathology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu, 215004, China
| | - G Fan
- Department of Radiology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu, 215004, China
| | - G Chen
- Department of Radiology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu, 215004, China.
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21
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Liu X, Kong W, Ying R, Shan Y, Yin G. Reinforcement methods of duodenal stump after laparoscopic gastrectomy for gastric cancer: A review. Heliyon 2023; 9:e17272. [PMID: 37360094 PMCID: PMC10285238 DOI: 10.1016/j.heliyon.2023.e17272] [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: 04/25/2022] [Revised: 05/23/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
Duodenal stump fistula is a rare but dangerous complication of gastric cancer surgery. Reinforcement of the duodenal stump was suggested as a useful method to prevent the occurrence of duodenal stump fistula. Although laparoscopic surgery has been established as a safe procedure for gastric cancer, it is acknowledged that the application of duodenal stump reinforcement is a demanding process in laparoscopic radical gastrectomy. This review aims to provide a concise description of the proposed reinforcement methods of duodenal stump after laparoscopic radical gastrectomy for gastric cancer by summarizing the relevant literature written in English. The thorough knowledge of these reinforcement techniques may help surgeons to find the most suitable reinforcement method of duodenal stump for patients.
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Affiliation(s)
| | | | | | | | - Guang Yin
- Corresponding author. Department of Gastrointestinal Surgery, Zhejiang University School of Medicine, Hangzhou, China.
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22
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Magyar CTJ, Rai A, Aigner KR, Jamadar P, Tsui TY, Gloor B, Basu S, Vashist YK. Current standards of surgical management of gastric cancer: an appraisal. Langenbecks Arch Surg 2023; 408:78. [PMID: 36745231 DOI: 10.1007/s00423-023-02789-5] [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: 05/27/2022] [Accepted: 12/02/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Gastric cancer (GC) is the fifth most common malignancy worldwide and portends a grim prognosis due to a lack of appreciable improvement in 5-year survival. We aimed to analyze the available literature and summarize the current standards of surgical care for curative and palliative intent treatment of GC. METHODS We conducted a systematic search on the PubMed database for studies on the management of GC. RESULTS Endoscopic resection is an acceptable treatment option for T1a tumors. The role of optimal resection margin for GC remains unclear. D2 lymph node dissection remains the standard of care with splenectomy needed selectively for splenic hilum involvement. A distal pancreatic resection should be avoided. The advantage of bursectomy and omentectomy in GC surgery is not clear. Multi-visceral resection may be considered for locally advanced GC in carefully selected patients. Minimally invasive approaches are non-inferior to open surgery. Surgery should be abandoned prior even in metastatic GC within the frame of multimodal therapy approach. CONCLUSION Various trials have conclusively shown improved patient outcomes when well-established surgical standards are followed.
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Affiliation(s)
- Christian T J Magyar
- Department of Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Ankit Rai
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Karl R Aigner
- Department of Surgical Oncology, Medias Klinikum, Burghausen, Germany
| | | | - Tung Y Tsui
- Department of Surgery, Asklepios Harzklinik, Goslar, Germany
| | - Beat Gloor
- Department of Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Somprakas Basu
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Yogesh K Vashist
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, India.
- Department of Surgical Oncology, Medias Klinikum, Burghausen, Germany.
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23
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Zhu G, Zhou S, Shen X, Qu J. Long-Term outcomes of uncut roux-en-Y anastomosis in laparoscopic distal gastrectomy: A retrospective analysis. Front Surg 2023; 10:1090626. [PMID: 36911600 PMCID: PMC9992889 DOI: 10.3389/fsurg.2023.1090626] [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: 11/05/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
Background Uncut Roux-en-Y (U-RY) has been increasingly used in radical gastric cancer surgery, but it is still in the exploratory stage. There is insufficient evidence for its long-term efficacy. Methods From January 2012 to October 2017, a total of 280 patients diagnosed with gastric cancer were eventually included in this study. Patients undergoing U-RY were assigned to the U-RY group, while patients undergoing BillrothII with Braun (B II + Braun) were assigned to the B II + Braun group. Results There were no significant differences between the two groups in operative time, intraoperative blood loss, postoperative complications, first exhaust time, time to liquid diet, and length of postoperative hospital stay (all P > 0.05). Endoscopic evaluation was performed 1 year after surgery. Compared to B II + Braun group, the uncut Roux-en-Y group had significantly lower incidences of gastric stasis [16.3% (15/92) vs. 28.2% (42/149), χ 2 = 4.448, P = 0.035], gastritis [13.0% (12/92) vs. 24.8% (37/149), χ 2 = 4.880, P = 0.027] and bile reflux [2.2% (2/92) vs. 20.8% (11/149), χ 2 = 16.707, P < 0.001], and the differences were statistically significant. The questionnaire was completed 1 year after surgery,the QLQ-STO22 scores showed that, the uncut Roux-en-Y group had a lower pain score(8.5 ± 11.1 vs. 11.9 ± 9.7, P = 0.009) and reflux score(7.9 ± 8.5 vs. 11.0 ± 11.5, P = 0.012), and the differences were statistically significant (P < 0.05). However, there was no significant difference in overall survival (P = 0.688) and disease-free survival (P = 0.505) between the two groups. Conclusion Uncut Roux-en-Y has the advantages of better safety, better quality of life and fewer complications, and is expected to be one of the best methods for digestive tract reconstruction.
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Affiliation(s)
- Guangxu Zhu
- Department of General Surgery, Weifang People's Hospital, Weifang, China
| | - Shengjie Zhou
- Department of Anesthesiology, Weifang People's Hospital, Weifang, China
| | - Xiaoru Shen
- Department of General Surgery, Chengdu Fifth People's Hospital, Chengdu, China
| | - Jianjun Qu
- Department of General Surgery, Weifang People's Hospital, Weifang, China
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24
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Nduma BN, Ambe S, Ekhator C, Fonkem E. Falling Trend in the Epidemiology of Gastric Cancer in Mississippi From 2003 to 2019: What Mississippi Got Right. Cureus 2022; 14:e31440. [DOI: 10.7759/cureus.31440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 11/15/2022] Open
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25
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Di Carlo S, Siragusa L, Fassari A, Fiori E, La Rovere F, Izzo P, Usai V, Cavallaro G, Franceschilli M, Dhimolea S, Sibio S. Laparoscopic versus Open Total Gastrectomy for Locally Advanced Gastric Cancer: Short and Long-Term Results. Curr Oncol 2022; 29:8442-8455. [PMID: 36354725 PMCID: PMC9689079 DOI: 10.3390/curroncol29110665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/30/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Laparoscopic gastrectomy for early gastric cancer is widely accepted and routinely performed. However, it is still debated whether the laparoscopic approach is a valid alternative to open gastrectomy in advanced gastric cancer (AGC). The aim of this study is to compare short-and long-term outcomes of laparoscopic (LG) and open (OG) total gastrectomy with D2 lymphadenectomy in patients with AGC. METHODS A retrospective comparative study was conducted on patients who underwent LG and OG for ACG between January 2015 and December 2021. Primary endpoints were the following: recurrence rate, 3-year disease-free survival, 3-year and 5-year overall survival. Univariate and multivariate analysis was conducted to compare variables influencing outcomes and survival. RESULTS Ninety-two patients included: fifty-three OG and thirty-nine LG. No difference in morbidity and mortality. LG was associated with lower recurrence rates (OG 22.6% versus LG 12.8%, p = 0.048). No differences in 3-year and 5-year overall survival; 3-year disease-free survival was improved in the LG group on the univariate analysis but not after the multivariate one. LG was associated with longer operative time, lower blood loss and shorter hospital stay. Lymph node yield was higher in LG. CONCLUSION LG for AGC seems to provide satisfactory clinical and oncological outcomes in medium volume centers, improved postoperative results and possibly lower recurrence rates.
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Affiliation(s)
- Sara Di Carlo
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Leandro Siragusa
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Alessia Fassari
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Enrico Fiori
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Francesca La Rovere
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Paolo Izzo
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Valeria Usai
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Giuseppe Cavallaro
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Marzia Franceschilli
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Sirvjo Dhimolea
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Simone Sibio
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
- Correspondence:
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26
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Lianos GD, Bali CD, Schizas D, Mitsis M, Galli F, Rausei S. Management of positive peritoneal cytology gastric cancer patients. G Chir 2022; 42:e06. [DOI: 10.1097/ia9.0000000000000005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
Abstract
Prognosis of patients with stage IV gastric cancer remains up to date dramatically poor. A subgroup of these patients has only positive peritoneal cytology in the peritoneal lavage and represents a target issue of the recent ongoing research. The administration of neoadjuvant chemotherapy, either systemic or intraperitoneal or hyperthermic intraoperative peritoneal chemotherapy, with a variety of combinations of drugs has assisted some of these patients to become peritoneal cytology negative, with a significant implication in their prognosis. Staging laparoscopy is widely used to detect occult peritoneal disease and has, therefore, reduced the number of unnecessary laparotomies. However, recent reports point out a low sensitivity of staging laparoscopy and cytological exam in detecting viable cancer cells and focus on the need of more accurate methods of examining the peritoneal fluid by immunohistochemistry or molecular assays. This review focuses on the latest scientific evidence regarding the optimal management of positive peritoneal cytology gastric cancer patients.
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Affiliation(s)
- Georgios D. Lianos
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - Christina D. Bali
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Michail Mitsis
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - Federica Galli
- Department of Surgery, ASST Valle Olona, Gallarate, Italy
| | - Stefano Rausei
- Department of Surgery, ASST Valle Olona, Gallarate, Italy
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27
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Jiang F, Chen X, Shen Y, Shen X. Identification and Validation of an m6A Modification of JAK-STAT Signaling Pathway–Related Prognostic Prediction Model in Gastric Cancer. Front Genet 2022; 13:891744. [PMID: 35928449 PMCID: PMC9343854 DOI: 10.3389/fgene.2022.891744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Gastric cancer (GC) is one of the malignant tumors worldwide. Janus (JAK)–signal transduction and activator of transcription (STAT) signaling pathway is involved in cellular biological process and immune function. However, the association between them is still not systematically described. Therefore, in this study, we aimed to identify key genes involved in JAK-STAT signaling pathway and GC, as well as the potential mechanism. Methods: The Cancer Genome Atlas (TCGA) database was the source of RNA-sequencing data of GC patients. Gene Expression Omnibus (GEO) database was used as the validation set. The predictive value of the JAK-STAT signaling pathway-related prognostic prediction model was examined using least absolute shrinkage and selection operator (LASSO); survival, univariate, and multivariate Cox regression analyses; and receiver operating characteristic curve (ROC) analyses to examine the predictive value of the model. Quantitative real-time polymerase chain reaction (qRT-PCR) and chi-square test were used to verify the expression of genes in the model and assess the association between the genes and clinicopathological parameters of GC patients, respectively. Then, Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), gene set enrichment analysis, version 3.0 (GSEA), sequence-based RNA adenosine methylation site predictor (SRAMP) online websites, and RNA immunoprecipitation (RIP) experiments were used to predict the model-related potential pathways, m6A modifications, and the association between model genes and m6A. Results: A four-gene prognostic model (GHR, PIM1, IFNA8, and IFNB1) was constructed, namely, riskScore. The Kaplan–Meier curves suggested that patients with high riskScore expression had a poorer prognosis than those with low riskScore expression (p = 0.006). Multivariate Cox regression analyses showed that the model could be an independent predictor (p < 0.001; HR = 3.342, 95%, CI = 1.834–6.088). The 5-year area under time-dependent ROC curve (AUC) reached 0.655. The training test set verified these results. Further analyses unveiled an enrichment of cancer-related pathways, m6A modifications, and the direct interaction between m6A and the four genes. Conclusion: This four-gene prognostic model could be applied to predict the prognosis of GC patients and might be a promising therapeutic target in GC.
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Affiliation(s)
- Fei Jiang
- Key Laboratory of Environmental Medical Engineering and Education Ministry, Nanjing Public Health College, Southeast University, Nanjing, China
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Xiaowei Chen
- Key Laboratory of Environmental Medical Engineering and Education Ministry, Nanjing Public Health College, Southeast University, Nanjing, China
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Yan Shen
- Key Laboratory of Environmental Medical Engineering and Education Ministry, Nanjing Public Health College, Southeast University, Nanjing, China
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Xiaobing Shen
- Key Laboratory of Environmental Medical Engineering and Education Ministry, Nanjing Public Health College, Southeast University, Nanjing, China
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
- Department of Occupational and Environmental Health, School of Public Health, Southeast University, Nanjing, China
- *Correspondence: Xiaobing Shen,
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Apatinib plus chemotherapy versus chemotherapy alone as neoadjuvant therapy in locally advanced gastric carcinoma patients: a prospective, cohort study. Ir J Med Sci 2022:10.1007/s11845-022-03075-x. [PMID: 35819743 DOI: 10.1007/s11845-022-03075-x] [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: 05/24/2022] [Accepted: 06/15/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Apatinib, a small molecule targeting VEGFR2, is commonly used for advanced gastric cancer treatment. This prospective cohort study further investigated the efficacy and safety of neoadjuvant apatinib plus chemotherapy in locally advanced gastric carcinoma patients. METHODS Ninety-six locally advanced gastric carcinoma patients were divided into the apatinib plus chemotherapy group (N = 45) and chemotherapy group (N = 51) according to their chosen treatment. Apatinib was administered (375 mg/day), and S-1 plus oxaliplatin (SOX) or oxaliplatin plus capecitabine (CapOx) was given as chemotherapy, for 3 cycles with 3 weeks a cycle before surgery. RESULTS The objective response rate (62.2% vs. 37.3%, P = 0.015) and pathological response grade (P = 0.011) were better; meanwhile, the tumor-resection rate (95.6% vs. 84.3%, P = 0.143) and pathological complete response rate (23.3% vs. 9.3%, P = 0.080) exhibited increasing trends (without statistical significance) in the apatinib plus chemotherapy group compared with the chemotherapy group. Additionally, the apatinib plus chemotherapy group achieved prolonged disease-free survival (DFS) (P = 0.019) and overall survival (OS) (P = 0.047) compared with the chemotherapy group. After adjusted by multivariate Cox's regression analysis, neoadjuvant apatinib plus chemotherapy was still superior to chemotherapy regarding DFS (hazard ratio (HR): 0.277, P = 0.014) and OS (HR: 0.316, P = 0.038). Notably, the incidences of adverse events between the two groups were not different (P > 0.050). Moreover, the most common adverse events of neoadjuvant apatinib plus chemotherapy were leukopenia (42.2%), fatigue (37.8%), hypertension (37.8%), and anemia (31.1%). CONCLUSION Neoadjuvant apatinib plus chemotherapy realizes better clinical response, pathological response, survival profile, and non-inferior safety profile compared to chemotherapy in locally advanced gastric carcinoma.
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29
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Jiao YJ, Lu TT, Liu DM, Xiang X, Wang LL, Ma SX, Wang YF, Chen YQ, Yang KH, Cai H. Comparison between laparoscopic uncut Roux-en-Y and Billroth II with Braun anastomosis after distal gastrectomy: A meta-analysis. World J Gastrointest Surg 2022; 14:594-610. [PMID: 35979420 PMCID: PMC9258235 DOI: 10.4240/wjgs.v14.i6.594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/09/2022] [Accepted: 05/14/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Conventional Billroth II (BII) anastomosis after laparoscopic distal gastrectomy (LDG) for gastric cancer (GC) is associated with bile reflux gastritis, and Roux-en-Y anastomosis is associated with Roux-Y stasis syndrome (RSS). The uncut Roux-en-Y (URY) gastrojejunostomy reduces these complications by blocking the entry of bile and pancreatic juice into the residual stomach and preserving the impulse originating from the duodenum, while BII with Braun (BB) anastomosis reduces the postoperative biliary reflux without RSS. Therefore, the purpose of this study was to compare the efficacy and safety of laparoscopic URY with BB anastomosis in patients with GC who underwent radical distal gastrectomy.
AIM To evaluate the value of URY in patients with GC.
METHODS PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang, Chinese Biomedical Database, and VIP Database for Chinese Technical Periodicals (VIP) were used to search relevant studies published from January 1994 to August 18, 2021. The following databases were also used in our search: Clinicaltrials.gov, Data Archiving and Networked Services, the World Health Organization International Clinical Trials Registry Platform Search Portal (https://www.who.int/clinical-trials-registry-platform/the-ictrp-search-portal), the reference lists of articles and relevant conference proceedings in August 2021. In addition, we conducted a relevant search by Reference Citation Analysis (RCA) (https://www.referencecitationanalysis.com). We cited high-quality references using its results analysis functionality. The methodological quality of the eligible randomized clinical trials (RCTs) was evaluated using the Cochrane Risk of Bias Tool, and the non-RCTs were evaluated using the Newcastle-Ottawa scale. Statistical analyses were performed using Review Manager (Version 5.4).
RESULTS Eight studies involving 704 patients were included in this meta-analysis. The incidence of reflux gastritis [odds ratio = 0.07, 95% confidence interval (CI): 0.03-0.19, P < 0.00001] was significantly lower in the URY group than in the BB group. The pH of the postoperative gastric fluid was lower in the URY group than in the BB group at 1 d [mean difference (MD) = -2.03, 95%CI: (-2.73)-(-1.32), P < 0.00001] and 3 d [MD = -2.03, 95%CI: (-2.57)-(-2.03), P < 0.00001] after the operation. However, no significant difference in all the intraoperative outcomes was found between the two groups.
CONCLUSION This work suggests that URY is superior to BB in gastrointestinal reconstruction after LDG when considering postoperative outcomes.
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Affiliation(s)
- Ya-Jun Jiao
- School of Clinical Medicine, Ningxia Medical University, Yinchuan 750000, Ningxia Province, China
- General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
| | - Ting-Ting Lu
- Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
| | - De-Ming Liu
- School of Clinical Medicine, Ningxia Medical University, Yinchuan 750000, Ningxia Province, China
- General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
| | - Xue Xiang
- School of Clinical Medicine, Ningxia Medical University, Yinchuan 750000, Ningxia Province, China
- General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
| | - Liu-Li Wang
- General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
| | - Shi-Xun Ma
- General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
| | - Yong-Feng Wang
- General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
| | - Ya-Qiong Chen
- General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
| | - Ke-Hu Yang
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Hui Cai
- General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
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Zizzo M, Zanelli M, Sanguedolce F, Torricelli F, Morini A, Tumiati D, Mereu F, Zuliani AL, Palicelli A, Ascani S, Giunta A. Robotic versus Laparoscopic Gastrectomy for Gastric Cancer: An Updated Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060834. [PMID: 35744096 PMCID: PMC9231199 DOI: 10.3390/medicina58060834] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 12/13/2022]
Abstract
Background and Objectives: Gastrectomy with D2 lymphadenectomy is the standard surgical treatment with curative intent for patients with gastric cancer (GC). Over the last three decades, surgeons have been increasingly adopting laparoscopic surgery for GC, due to its better short-term outcomes. In particular, laparoscopic gastrectomy (LG) has been routinely used for early gastric cancer (EGC) treatment. However, LG suffers from technical limitations and drawbacks, such as a two-dimensional surgical field of view, limited movement of laparoscopic tools, unavoidable physiological tremors and discomfort for operating surgeon. Therefore, robotic surgery has been developed to address such limitations. Materials and Methods: We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines in order to investigate the benefits and harms of robotic gastrectomy (RG) compared to the LG. PubMed/MEDLINE, Scopus, Cochrane Library (Cochrane Database of Systematic Re-views, Cochrane Central Register of Controlled Trials-CENTRAL) and Web of Science (Science and Social Science Citation Index) databases were used to search all related literature. Results: The 7 included meta-analyses covered an approximately 20 years-study period (2000-2020). Almost all studies included in the meta-analyses were retrospective ones and originated from Asian countries (China and Korea, in particular). Examined overall population ranged from 3176 to 17,712 patients. If compared to LG, RG showed both operative advantages (operative time, estimated blood loss, number of retrieved lymph nodes) and perioperative ones (time to first flatus, time to restart oral intake, length of hospitalization, overall complications, Clavien-Dindo (CD) ≥ III complications, pancreatic complications), in the absence of clear differences of oncological outcomes. However, costs of robotic approach appear significant. Conclusions: It is impossible to make strong recommendations, due to the statistical weakness of the included studies. Further randomized, possibly multicenter trials are strongly recommended, if we want to have our results confirmed.
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Affiliation(s)
- Maurizio Zizzo
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.M.); (D.T.); (F.M.); (A.L.Z.); (A.G.)
- Correspondence: ; Tel.: +39-0522-296372; Fax: +39-0522-295779
| | - Magda Zanelli
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.Z.); (A.P.)
| | - Francesca Sanguedolce
- Pathology Unit, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Foggia, 71122 Foggia, Italy;
| | - Federica Torricelli
- Laboratory of Translational Research, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Andrea Morini
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.M.); (D.T.); (F.M.); (A.L.Z.); (A.G.)
| | - David Tumiati
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.M.); (D.T.); (F.M.); (A.L.Z.); (A.G.)
| | - Federica Mereu
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.M.); (D.T.); (F.M.); (A.L.Z.); (A.G.)
| | - Antonia Lavinia Zuliani
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.M.); (D.T.); (F.M.); (A.L.Z.); (A.G.)
| | - Andrea Palicelli
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.Z.); (A.P.)
| | - Stefano Ascani
- Hematology Unit, CREO, Azienda Ospedaliera di Perugia, University of Perugia, 06129 Perugia, Italy;
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 05100 Terni, Italy
| | - Alessandro Giunta
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.M.); (D.T.); (F.M.); (A.L.Z.); (A.G.)
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Kong S, Tian S, Wang Z, Shi Y, Zhang J, Zhuo H. Circular RNA circPFKP suppresses the proliferation and metastasis of gastric cancer cell via sponging miR-644 and regulating ADAMTSL5 expression. Bioengineered 2022; 13:12326-12337. [PMID: 35587154 PMCID: PMC9275984 DOI: 10.1080/21655979.2022.2073001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The treatment of gastric cancer (GC) is extremely challenging; however, the specific pathogenesis of GC remains unclear. Circular RNAs (CircRNAs) are non-coding RNAs that can regulate gene expression both transcriptionally and post-transcriptionally. However, little is known about the circRNAs that are important in the progression of GC. This study identified significantly dysregulated circRNAs by analyzing gastric cancer patients and normal control tissues. The target gene was predicted using online bioinformatics tools and verified using RNA pull-down and luciferase reporter assays. Quantitative real-time polymerase chain reaction (qRT-PCR) and western blotting were used to evaluate gene and protein expression. The malignant behavior of GC cells was determined using 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) assay, wound healing assay, Transwell invasion assay, and flow cytometry. CircPFKP is downregulated in GC tissues, and overexpression of circPFKP inhibits malignant behavior in GC cells. Bioinformatics predicted that circPFKP could bind to miR-644, and miR-644 could target disintegrin-like and metalloprotease domain-containing thrombospondin type 1 motif-like 5 (ADAMTSL5). Overexpression of circPFKP enhances the expression of ADAMTSL5 by decreasing the expression of miR-644 to suppress the growth of xenograft GC tumors in vivo and in vitro. In conclusion, the circPFKP/miR-644/ADAMTSL5 regulatory pathway inhibited the malignant progression of GC. These findings may extend our understanding of the effects of circRNAs on cancer development and provide novel targets for the diagnosis of GC.
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Affiliation(s)
- Shuai Kong
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Shubo Tian
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Zhu Wang
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yulong Shi
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jizhun Zhang
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Hongqing Zhuo
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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Li HH, Sun B, Tan C, Li R, Fu CX, Grimm R, Zhu H, Peng WJ. The Value of Whole-Tumor Histogram and Texture Analysis Using Intravoxel Incoherent Motion in Differentiating Pathologic Subtypes of Locally Advanced Gastric Cancer. Front Oncol 2022; 12:821586. [PMID: 35223503 PMCID: PMC8864172 DOI: 10.3389/fonc.2022.821586] [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: 11/24/2021] [Accepted: 01/20/2022] [Indexed: 01/02/2023] Open
Abstract
Purpose To determine if whole-tumor histogram and texture analyses using intravoxel incoherent motion (IVIM) parameters values could differentiate the pathologic characteristics of locally advanced gastric cancer. Methods Eighty patients with histologically confirmed locally advanced gastric cancer who received surgery in our institution were retrospectively enrolled into our study between April 2017 and December 2018. Patients were excluded if they had lesions with the smallest diameter < 5 mm and severe image artifacts. MR scanning included IVIM sequences (9 b values, 0, 20, 40, 60, 100, 150,200, 500, and 800 s/mm2) used in all patients before treatment. Whole tumors were segmented by manually drawing the lesion contours on each slice of the diffusion-weighted imaging (DWI) images (with b=800). Histogram and texture metrics for IVIM parameters values and apparent diffusion coefficient (ADC) values were measured based on whole-tumor volume analyses. Then, all 24 extracted metrics were compared between well, moderately, and poorly differentiated tumors, and between different Lauren classifications, signet-ring cell carcinomas, and other poorly cohesive carcinomas using univariate analyses. Multivariate logistic analyses and multicollinear tests were used to identify independent influencing factors from the significant variables of the univariate analyses to distinguish tumor differentiation and Lauren classifications. ROC curve analyses were performed to evaluate the diagnostic performance of these independent influencing factors for determining tumor differentiation and Lauren classifications and identifying signet-ring cell carcinomas. The interobserver agreement was also conducted between the two observers for image quality evaluations and parameter metric measurements. Results For diagnosing tumor differentiation, the ADCmedian, pure diffusion coefficient median (Dslowmedian), and pure diffusion coefficient entropy (Dslowentropy) showed the greatest AUCs: 0.937, 0.948, and 0.850, respectively, and no differences were found between the three metrics, P>0.05). The 95th percentile perfusion factor (FP P95th) was the best metric to distinguish diffuse-type GCs vs. intestinal/mixed (AUC=0.896). The ROC curve to distinguish signet-ring cell carcinomas from other poorly cohesive carcinomas showed that the Dslowmedian had AUC of 0.738. For interobserver reliability, image quality evaluations showed excellent agreement (interclass correlation coefficient [ICC]=0.85); metrics measurements of all parameters indicated good to excellent agreement (ICC=0.65-0.89), except for the Dfast metric, which showed moderate agreement (ICC=0.41-0.60). Conclusions The whole-tumor histogram and texture analyses of the IVIM parameters based on the biexponential model provided a non-invasive method to discriminate pathologic tumor subtypes preoperatively in patients with locally advanced gastric cancer. The metric FP P95th derived from IVIM performed better in determining Lauren classifications than the mono-exponential model.
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Affiliation(s)
- Huan-Huan Li
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Bo Sun
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Cong Tan
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Rong Li
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Cai-Xia Fu
- MR Applications Development, Siemens Shenzhen Magnetic Resonance Ltd, Shenzhen, China
| | - Robert Grimm
- MR Applications Development, Siemens Healthcare, Erlangen, Germany
| | - Hui Zhu
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Wei-Jun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
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