Gastric Cancer最新文献

The term early gastric cancer (EGC), defined as carcinoma confined to the mucosa or submucosa irrespective of lymph node status, has been widely accepted worldwide. In contrast, the terminology surrounding advanced gastric cancer remains inconsistent across regions. In Western oncology, "advanced cancer" often denotes unresectable or metastatic disease, whereas "early-stage cancer" may include resectable stage II-III tumors. This semantic discrepancy has led to confusion in international communication, clinical trials, and guideline interpretation. We propose a three-tier terminology-early gastric cancer, locally advanced gastric cancer, and advanced gastric cancer-to align the Japanese pathological concept with global clinical staging practice and therapeutic intent.

Background: Large type 3 (≥ 8 cm) and type 4 gastric cancers are associated with extremely poor prognoses. The phase III JCOG0501 trial, which evaluated neoadjuvant S-1 plus cisplatin, failed to demonstrate any survival benefits. Docetaxel, oxaliplatin, and S-1 (DOS) have been explored as more effective perioperative regimens for these tumors.

Methods: Eligible patients had large type 3 or type 4 gastric cancer without distant metastases, except for positive peritoneal cytology (CY). Patients received three cycles of neoadjuvant DOS (docetaxel 40 mg/m², oxaliplatin 100 mg/m², and oral S-1 at 80 mg/m²/day for 14 days), followed by gastrectomy with ≥ D2 lymphadenectomy and one year of adjuvant docetaxel plus S-1. The primary endpoint was the 3 year progression-free survival (PFS) rate, with an expected value of 60% and a threshold of 45%. A one-sample log-rank test was performed with an α level of 0.10.

Results: Of the 48 patients enrolled, 27 had type 4 tumors (56.2%), and 10 (20.8%) had CY1. Overall, 91.7% of patients completed neoadjuvant DOS. R0 resection rate was achieved in 89.6% of patients, a pathological response grade ≥ 1b in 66.7%, and negative CY conversion in 80.0%. The 3-year PFS rate was 37.5% (95% confidence interval [CI], 24.1-50.6%; 80% CI 28.6-46.4%; p = 0.960), and the 3-year overall survival rate was 52.1% (95% CI 37.2-65.0%).

Conclusions: Although neoadjuvant DOS therapy demonstrated favorable pathological responses, the 3-year PFS did not exceed the predefined threshold, and a survival benefit was not demonstrated.

Background: There is substantial global variation in demographics, disease burden, and treatment for gastric cancer patients. Benchmarking is an instrument to assess such variation and enables to investigate to which extent case-mix and treatments explain differences in outcomes. We aimed to evaluate hospital-level variation in surgical outcomes following gastrectomy for gastric cancer before and after adjusting for case-mix and treatment-related factors.

Methods: Data were retrieved from the GastroBenchmark and GASTRODATA databases, including consecutive gastric cancer resections performed between 2017 and 2021 from 43 centers. Patients who underwent a (sub)total gastrectomy for adenocarcinoma were identified. Outcomes included 30-day mortality, severe complications (Clavien-Dindo grade ≥ 3a), > 15 lymph nodes retrieved, negative resection margin (R0), prolonged hospitalization (> 14 days), readmissions (< 30 days), reoperations, and escalation of care. We assessed absolute inter-hospital variation for outcomes, and estimated outcomes using mixed-effect logistic regression models with a random intercept. We estimated crude, case-mix adjusted, and case-mix and treatment adjusted hospital effects. The conditional and marginal pseudo-R² were used to quantify the variance in outcome explained by case-mix and treatment-related factors.

Results: A total of 7818 patients from 41 hospitals were included, with contributions ranging from 12 to 2554 patients per hospital (IQR: 49-146). Observed 30-day mortality and severe complications ranged from 0 to 9.7% (IQR: 3.2%) and 5.3 to 31% (IQR: 7.7%), respectively. Larger variation between hospitals was observed for retrieval of > 15 lymph nodes (IQR: 12.3%), prolonged hospitalization (IQR: 14.4%) and readmissions (IQR 11.3%). This variation was reduced in the crude model, while adjusting for case-mix and treatment-related factors did not significantly reduce variation for any outcome. Case-mix factors had a limited contribution to the explained variance, except for 30-day mortality (33.9%) and negative resection margins (31.7%). Adding treatment-related factors increased the explained variance for 30-day mortality by 40.8%, but had low impact (< 10%) on the variance in most surgical outcomes.

Conclusions: Case-mix and treatment factors are not the primary drivers of variation in surgical outcomes following gastrectomy. Case-mix adjustment can improve the validity of global comparisons for 30-day mortality, but does not seem essential for comparing other investigated outcomes.

Background: Steatotic liver disease (SLD) has emerged as a heterogeneous condition with distinct subtypes defined by metabolic dysfunction and alcohol exposure. We aimed to investigate the associations of SLD subtypes-metabolic dysfunction-associated steatotic liver disease (MASLD), MASLD with elevated alcohol intake (MetALD), and alcohol-related liver disease (ALD)-with the risk of gastric cancer (GC) and esophageal cancer (EC) in a nationwide cohort.

Methods: We analyzed a cohort of 362,285 individuals aged ≥ 40 years using the Korean National Health Insurance Service claims data. Participants underwent screening in 2009-2010 with follow-up through 2019. They were categorized into no SLD, MASLD, MetALD, or ALD. Cox proportional hazards models adjusted for demographic, clinical, and lifestyle factors estimated hazard ratios (HRs) for GC and EC. Subgroup analyses were conducted by alcohol intake levels and cardiometabolic burden.

Results: Over 10 years, 4,842 participants (1.98%) developed GC or EC. The risk of GC increased progressively across SLD subtypes, with HRs of 1.09 (95% CI: 1.02-1.16) for MASLD, 1.31 (1.16-1.48) for MetALD, and 1.40 (1.16-1.68) for ALD. For EC, MASLD was not significant associated (HR 0.81, 95% CI: 0.63-1.05), whereas risks were significantly elevated in MetALD (1.68, 1.17-2.42) and ALD (2.18, 1.36-3.49).

Conclusions: GC risk is modestly increased in MASLD and more pronounced in alcohol-related SLD subtypes, whereas EC risk is primarily driven by alcohol exposure. These findings indicate that GC is influenced by both metabolic dysfunction and alcohol, while alcohol plays the predominant role in EC.