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Gastric microbiome signature for predicting metachronous recurrence after endoscopic resection of gastric neoplasm. 预测内镜胃肿瘤切除术后复发的胃微生物组特征。
IF 6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-09-01 Epub Date: 2024-07-06 DOI: 10.1007/s10120-024-01532-3
Ho-Kyoung Lee, Cheol Min Shin, Young Hoon Chang, Hyuk Yoon, Young Soo Park, Nayoung Kim, Dong Ho Lee

Background: Changes in gastric microbiome are associated with gastric carcinogenesis. Studies on the association between gastric mucosa-associated gastric microbiome (MAM) and metachronous gastric cancer are limited. This study aimed to identify gastric MAM as a predictive factor for metachronous recurrence following endoscopic resection of gastric neoplasms.

Method: Microbiome analyses were conducted for 81 patients in a prospective cohort to investigate surrogate markers to predict metachronous recurrence. Gastric MAM in non-cancerous corporal biopsy specimens was evaluated using Illumina MiSeq platform targeting 16S ribosomal DNA.

Results: Over a median follow-up duration of 53.8 months, 16 metachronous gastric neoplasms developed. Baseline gastric MAM varied with Helicobacter pylori infection status, but was unaffected by initial pathologic diagnosis, presence of atrophic gastritis, intestinal metaplasia, or synchronous lesions. The group with metachronous recurrence did not exhibit distinct phylogenetic diversity compared with the group devoid of recurrence but showed significant difference in β-diversity. The study population could be classified into two distinct gastrotypes based on baseline gastric MAM: gastrotype 1, Helicobacter-abundant; gastrotype 2: Akkermansia-abundant. Patients in gastrotype 2 showed higher risk of metachronous recurrence than gastrotype (Cox proportional hazard analysis, adjusted hazard ratio [95% confidence interval]: 5.10 [1.09-23.79]).

Conclusions: Gastric cancer patients can be classified into two distinct gastrotype groups by their MAM profiles, which were associated with different risk of metachronous recurrence.

背景:胃微生物组的变化与胃癌的发生有关。有关胃黏膜相关胃微生物组(MAM)与远期胃癌之间关系的研究十分有限。本研究旨在确定胃微生物组是内镜下胃癌切除术后近端复发的预测因素:方法:对前瞻性队列中的 81 例患者进行了微生物组分析,以研究预测远期复发的替代标记物。使用 Illumina MiSeq 平台以 16S 核糖体 DNA 为靶标,对非癌肉体活检标本中的胃微生物组进行评估:结果:在中位 53.8 个月的随访期间,共发现了 16 例非同步性胃肿瘤。胃癌MAM基线随幽门螺杆菌感染状况而变化,但不受最初病理诊断、萎缩性胃炎、肠化生或同步病变的影响。与无幽门螺杆菌复发的群体相比,有同步复发的群体没有表现出明显的系统发育多样性,但在β-多样性方面有显著差异。根据基线胃 MAM,研究对象可分为两种不同的胃型:胃型 1:多螺旋杆菌型;胃型 2:多阿克曼型。胃型 2 患者的远期复发风险高于胃型(Cox 比例危险度分析,调整后危险度比 [95% 置信区间]:5.10 [1.09-23.10] ):5.10 [1.09-23.79]).Conclusions:根据胃癌患者的 MAM 特征可将其分为两种不同的胃型,而这两种胃型与不同的远期复发风险相关。
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引用次数: 0
Impact of chemotherapy delay on long-term prognosis of laparoscopic radical surgery for locally advanced gastric cancer: a pooled analysis of four randomized controlled trials. 化疗延迟对局部晚期胃癌腹腔镜根治术长期预后的影响:四项随机对照试验的汇总分析。
IF 6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-09-01 Epub Date: 2024-05-29 DOI: 10.1007/s10120-024-01513-6
Qing Zhong, Zhi-Yu Liu, Zhi-Xin Shang-Guan, Yi-Fan Li, Yi Li, Ju Wu, Qiang Huang, Ping Li, Jian-Wei Xie, Qi-Yue Chen, Chang-Ming Huang, Chao-Hui Zheng

Background: Adjuvant chemotherapy following curative surgery for locally advanced gastric cancer (AGC) significantly improves long-term patient prognosis. However, delayed chemotherapy (DC), in which patients are unable to receive timely treatment, is a common phenomenon in clinical practice for various reasons. This study aimed to investigate the impact of DC on the prognosis of patients with stage II-III locally AGC and explore the associated risk factors.

Methods: Data from four prospective studies were included in the pooled analysis. The planned chemotherapy (PC) group was defined as the time interval between surgery and the first chemotherapy ≤ 49 d, while the DC group was defined as the time interval between surgery and chemotherapy > 49 d. The prognosis, recurrence, and risk factors were compared, and a nomogram for predicting DC was established.

Results: In total, 596 patients were included, of whom 531 (89.1%) had PC and 65 (10.9%) had DC. Survival analysis revealed that the 5-year overall survival (OS) and disease-free survival (DFS) were significantly lower in the DC group than those in the PC group (log-rank P < 0.001). Cox univariable and multivariable analyses showed that DC was an independent risk factor for OS and DFS in stage II-III patients (P < 0.05). Based on the significant factors for DC, a prediction model was established that had a good fit, high accuracy (AUC = 0.780), and clinical applicability in both the training and validation sets.

Conclusion: Delayed chemotherapy after gastrectomy is associated with poor long-term prognosis in patients with locally advanced stage II-III GC disease. But standardized, full-cycle adjuvant chemotherapy after surgery may play a remedial role, and can to a certain extent compensate the poor effects caused by delayed chemotherapy.

背景:局部晚期胃癌(AGC)根治性手术后的辅助化疗可显著改善患者的长期预后。然而,由于各种原因,患者无法及时接受化疗的延迟化疗(DC)现象在临床实践中十分常见。本研究旨在探讨延迟化疗对II-III期局部AGC患者预后的影响,并探讨相关风险因素:方法:将四项前瞻性研究的数据纳入汇总分析。计划化疗(PC)组的定义是手术与首次化疗之间的时间间隔≤49 d,而DC组的定义是手术与化疗之间的时间间隔大于49 d。比较了预后、复发和风险因素,并建立了预测DC的提名图:共纳入 596 例患者,其中 531 例(89.1%)为 PC 型,65 例(10.9%)为 DC 型。生存期分析显示,DC 组的 5 年总生存期(OS)和无病生存期(DFS)明显低于 PC 组(对数秩 P 结论:DC 组的 5 年总生存期和无病生存期明显低于 PC 组(对数秩 P 结论:DC 组的 5 年总生存期和无病生存期明显低于 PC 组):胃切除术后延迟化疗与局部晚期II-III期GC患者的长期预后不良有关。但术后规范的全周期辅助化疗可起到补救作用,可在一定程度上弥补延迟化疗带来的不良后果。
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引用次数: 0
Early gastric cancer with RhoGAP fusion is linked to frequent nodal metastasis and a part of microtubular-mucocellular histology. RhoGAP融合的早期胃癌与频繁的结节转移和部分微管黏细胞组织学有关。
IF 6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-01 Epub Date: 2024-05-16 DOI: 10.1007/s10120-024-01507-4
Hiroto Noda, Seiji Sakata, Satoko Baba, Yuki Togashi, Kaoru Nakano, Toshiaki Hirasawa, Izuma Nakayama, Chiina Hata, Manabu Takamatsu, Emiko Sugawara, Noriko Yamamoto, Junko Fujisaki, Souya Nunobe, Katsuhiko Iwakiri, Kengo Takeuchi, Hiroshi Kawachi

Introduction: Gastric cancer with fusion genes involving the Rho GTPase-activating protein domain (RhoGAP-GC) is mainly included in the genomically stable type of The Cancer Genome Atlas classification. Clinical implications and histological characteristics of RhoGAP-GC in the early phase remain unclear.

Methods: We analyzed 878 consecutive pT1b GCs for RhoGAP and its partner genes using fluorescence in situ hybridization assay.

Results: RhoGAP fusion was detected in 57 (6.5%) GCs. Univariate analysis revealed that female sex, middle-lower third tumor location, advanced macroscopic type, tumor diameter > 2 cm, pT1b2, lymphatic invasion, venous invasion, negative EBER-ISH, and RhoGAP fusion were significantly associated with lymph node metastasis (LNM). Multivariate analysis presented RhoGAP fusion, lymphatic invasion, tumor diameter > 2 cm, advanced macroscopic type, venous invasion, and middle-lower third tumor location as independent risk factors for LNM. Notably, RhoGAP fusion had the highest odds ratio (3.92) for LNM among analyzed parameters (95% CI 2.12-7.27; p < 0.001). Compared to non-RhoGAP-GCs, RhoGAP-GCs were significantly frequent in younger females and showed the highest incidence of lymphatic invasion (56.2%) and LNM (49.1%) (p < 0.001). Histologically, microtubular architecture with pseudo-trabecular interconnection and small aggregations of tumor cells with a varied amount of cytoplasmic mucin, named "microtubular-mucocellular (MTMC) histology," was found in 93.0% (53 of 57) of RhoGAP-GCs in the intramucosal area. MTMC histology showed high sensitivity and negative predictive value (93.0% and 99.4%, respectively) for RhoGAP fusion, albeit positive predictive value is low (34.9%).

Conclusion: RhoGAP-GC is linked to a characteristic MTMC histology and a high incidence of LNM.

简介在癌症基因组图谱(The Cancer Genome Atlas)的分类中,涉及Rho GTPase-激活蛋白结构域(RhoGAP-GC)融合基因的胃癌主要属于基因组稳定型。RhoGAP-GC在早期阶段的临床意义和组织学特征仍不清楚:方法:我们使用荧光原位杂交方法分析了 878 例连续 pT1b GC 的 RhoGAP 及其伙伴基因:结果:57 例(6.5%)GCs 检测到 RhoGAP 融合。单变量分析显示,女性性别、肿瘤位置中下三度、晚期大体类型、肿瘤直径大于 2 厘米、pT1b2、淋巴侵袭、静脉侵袭、EBER-ISH 阴性和 RhoGAP 融合与淋巴结转移(LNM)显著相关。多变量分析表明,RhoGAP融合、淋巴浸润、肿瘤直径大于2厘米、晚期巨细胞型、静脉浸润和中下三分之一肿瘤位置是LNM的独立危险因素。值得注意的是,在分析的参数中,RhoGAP 融合导致 LNM 的几率比最高(3.92)(95% CI 2.12-7.27;P 结论:RhoGAP-GC 与 LNM 有关:RhoGAP-GC与MTMC组织学特征和LNM的高发生率有关。
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引用次数: 0
Claudin-18 status and its correlation with HER2 and PD-L1 expression in gastric cancer with peritoneal dissemination. 腹膜扩散的胃癌中Claudin-18的状态及其与HER2和PD-L1表达的相关性。
IF 6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-01 Epub Date: 2024-05-09 DOI: 10.1007/s10120-024-01505-6
Haruki Ogawa, Hiroyuki Abe, Koichi Yagi, Yasuyuki Seto, Tetsuo Ushiku

Background: Gastric cancer with peritoneal dissemination (PD) has a dismal prognosis, and current treatments have shown little efficacy. CLDN18.2-targeted therapies have shown promising efficacy against gastric cancers that express high levels of CLDN18. Because of the limited information regarding CLDN18.2 status in PD, we analyzed PD-positive gastric cancers for CLDN18 status in both primary and PD, along with HER2 and PD-L1 combined positive score (CPS).

Methods: Immunohistochemical analyses were performed on 84 gastric cancer cases using paired primary and PD tissue samples.

Results: At 40% cut-off, CLDN18 was positive in 57% (48/84) primary tumors and in 44% (37/84) PDs. At 75% cut-off, 28.6% (24/84) primary tumors and 20.2% (17/84) PDs were CLDN18-positive. The concordance rate between primary tumors and PD was 79.8% at 40% cut-off and 75% at 75% cut-off. When comparing biopsy and surgical specimens, the concordance rates were 87.5% at 40% cut-off and 81.3% at 75% cut-off. Within a tumor, the superficial area tended to have a higher CLDN18-positive rate than the invasive front (P = 0.001). Although HER2 -positivity was only 11.9% in this cohort, CLDN18 positivity in HER2-negative tumors (n = 74) was relatively high: 60.8% at 40% cut-off and 28.4% at 75% cut-off. Among double-negative (HER2 - and PD-L1 CPS < 1) tumors, CLDN18 positivity was 67.6% at 40% cut-off and 26.5% at 75% cut-off.

Conclusions: CLDN18 expression is generally maintained in PD and is relatively high even in double-negative tumors, making it a promising therapeutic target for PD-positive gastric cancer.

背景:伴有腹膜播散(PD)的胃癌预后很差,目前的治疗方法疗效甚微。CLDN18.2靶向疗法对高水平表达CLDN18的胃癌有很好的疗效。由于有关PD中CLDN18.2状态的信息有限,我们分析了PD阳性胃癌原发和PD中的CLDN18状态,以及HER2和PD-L1联合阳性评分(CPS):方法:使用配对的原发和PD组织样本对84例胃癌病例进行免疫组化分析:结果:以 40% 为临界值,57%(48/84)的原发肿瘤和 44%(37/84)的原发灶中 CLDN18 呈阳性。截断率为 75% 时,28.6%(24/84)的原发肿瘤和 20.2%(17/84)的原发灶中 CLDN18 呈阳性。原发性肿瘤和肺结核的一致性在 40% 截止值时为 79.8%,在 75% 截止值时为 75%。在比较活检和手术标本时,40%截断值的吻合率为87.5%,75%截断值的吻合率为81.3%。在肿瘤内部,浅表区域的 CLDN18 阳性率往往高于浸润前沿(P = 0.001)。虽然在这一队列中,HER2 阳性率仅为 11.9%,但在 HER2 阴性肿瘤(n = 74)中,CLDN18 阳性率相对较高:截断率为 40% 时为 60.8%,截断率为 75% 时为 28.4%。在双阴性(HER2 - 和 PD-L1 CPS)肿瘤中,CLDN18 的表达通常保持不变:CLDN18的表达在PD中通常保持不变,即使在双阴性肿瘤中也相对较高,这使其成为PD阳性胃癌的一个有希望的治疗靶点。
{"title":"Claudin-18 status and its correlation with HER2 and PD-L1 expression in gastric cancer with peritoneal dissemination.","authors":"Haruki Ogawa, Hiroyuki Abe, Koichi Yagi, Yasuyuki Seto, Tetsuo Ushiku","doi":"10.1007/s10120-024-01505-6","DOIUrl":"10.1007/s10120-024-01505-6","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer with peritoneal dissemination (PD) has a dismal prognosis, and current treatments have shown little efficacy. CLDN18.2-targeted therapies have shown promising efficacy against gastric cancers that express high levels of CLDN18. Because of the limited information regarding CLDN18.2 status in PD, we analyzed PD-positive gastric cancers for CLDN18 status in both primary and PD, along with HER2 and PD-L1 combined positive score (CPS).</p><p><strong>Methods: </strong>Immunohistochemical analyses were performed on 84 gastric cancer cases using paired primary and PD tissue samples.</p><p><strong>Results: </strong>At 40% cut-off, CLDN18 was positive in 57% (48/84) primary tumors and in 44% (37/84) PDs. At 75% cut-off, 28.6% (24/84) primary tumors and 20.2% (17/84) PDs were CLDN18-positive. The concordance rate between primary tumors and PD was 79.8% at 40% cut-off and 75% at 75% cut-off. When comparing biopsy and surgical specimens, the concordance rates were 87.5% at 40% cut-off and 81.3% at 75% cut-off. Within a tumor, the superficial area tended to have a higher CLDN18-positive rate than the invasive front (P = 0.001). Although HER2 -positivity was only 11.9% in this cohort, CLDN18 positivity in HER2-negative tumors (n = 74) was relatively high: 60.8% at 40% cut-off and 28.4% at 75% cut-off. Among double-negative (HER2 - and PD-L1 CPS < 1) tumors, CLDN18 positivity was 67.6% at 40% cut-off and 26.5% at 75% cut-off.</p><p><strong>Conclusions: </strong>CLDN18 expression is generally maintained in PD and is relatively high even in double-negative tumors, making it a promising therapeutic target for PD-positive gastric cancer.</p>","PeriodicalId":12684,"journal":{"name":"Gastric Cancer","volume":null,"pages":null},"PeriodicalIF":6.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11193835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140897166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prognostic value of mismatch repair deficiency in patients receiving first-line fluoropyrimidine plus platinum for metastatic, recurrent, or unresectable gastric cancer. 错配修复缺陷对接受一线氟嘧啶加铂治疗的转移性、复发性或不可切除胃癌患者的预后价值。
IF 6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-01 Epub Date: 2024-03-31 DOI: 10.1007/s10120-024-01483-9
Chung Ryul Oh, Eo Jin Kim, Heejung Chae, Young Soo Park, Min-Hee Ryu, Hyung-Don Kim, Yoon-Koo Kang

Background: We examined the impact of mismatch repair (MMR) status on efficacy of first-line fluoropyrimidine plus platinum (FP) chemotherapy in patients with HER2-negative metastatic, recurrent, or unresectable gastric cancer (mGC).

Methods: Patients with mGC receiving first-line FP between 2015 and 2018 at Asan Medical Center, Korea, were reviewed. We evaluated the clinical characteristics and the efficacy of chemotherapy according to MMR status in patients with available immunohistochemistry results.

Results: Of 895 patients, we analyzed 543 with available MMR protein expression results, and deficient MMR (dMMR) was detected in 4.4% (n = 24). Patients with dMMR exhibited a significantly higher median age than those with proficient MMR (pMMR) (64 vs. 58 years, p = 0.044). No signet ring cell carcinoma (SRCC) was detected among dMMR tumors, whereas SRCC was found in 17.5% of pMMR. Objective response rate was 27.3% in dMMR and 34.3% in pMMR (p = 0.556). No difference in progression-free survival was noted between patients with dMMR and pMMR (median, 5.6 vs. 5.8 months, p = 0.266). Patients with dMMR tended to have better overall survival than those with pMMR although this difference was not statistically significant (median, 17.9 vs. 12.2 months, p = 0.183).

Conclusions: Efficacy of first-line FP was not different by MMR status in mGC patients.

研究背景我们研究了错配修复(MMR)状态对HER2阴性转移性、复发性或不可切除胃癌(mGC)患者一线氟嘧啶加铂(FP)化疗疗效的影响:对韩国牙山医疗中心2015年至2018年间接受一线FP治疗的mGC患者进行了回顾性研究。我们根据有免疫组化结果的患者的MMR状态评估了其临床特征和化疗疗效:在895名患者中,我们分析了543名有MMR蛋白表达结果的患者,发现4.4%的患者(n = 24)存在MMR缺陷(dMMR)。dMMR 患者的中位年龄明显高于精通 MMR(pMMR)患者(64 岁对 58 岁,p = 0.044)。在dMMR肿瘤中未发现标志环细胞癌(SRCC),而在pMMR中17.5%的肿瘤中发现了SRCC。dMMR和pMMR的客观反应率分别为27.3%和34.3%(P = 0.556)。dMMR 和 pMMR 患者的无进展生存期没有差异(中位 5.6 个月对 5.8 个月,p = 0.266)。dMMR患者的总生存期往往优于pMMR患者,但这一差异无统计学意义(中位数为17.9个月 vs. 12.2个月,p = 0.183):结论:在mGC患者中,一线FP的疗效并不因MMR状态而异。
{"title":"Prognostic value of mismatch repair deficiency in patients receiving first-line fluoropyrimidine plus platinum for metastatic, recurrent, or unresectable gastric cancer.","authors":"Chung Ryul Oh, Eo Jin Kim, Heejung Chae, Young Soo Park, Min-Hee Ryu, Hyung-Don Kim, Yoon-Koo Kang","doi":"10.1007/s10120-024-01483-9","DOIUrl":"10.1007/s10120-024-01483-9","url":null,"abstract":"<p><strong>Background: </strong>We examined the impact of mismatch repair (MMR) status on efficacy of first-line fluoropyrimidine plus platinum (FP) chemotherapy in patients with HER2-negative metastatic, recurrent, or unresectable gastric cancer (mGC).</p><p><strong>Methods: </strong>Patients with mGC receiving first-line FP between 2015 and 2018 at Asan Medical Center, Korea, were reviewed. We evaluated the clinical characteristics and the efficacy of chemotherapy according to MMR status in patients with available immunohistochemistry results.</p><p><strong>Results: </strong>Of 895 patients, we analyzed 543 with available MMR protein expression results, and deficient MMR (dMMR) was detected in 4.4% (n = 24). Patients with dMMR exhibited a significantly higher median age than those with proficient MMR (pMMR) (64 vs. 58 years, p = 0.044). No signet ring cell carcinoma (SRCC) was detected among dMMR tumors, whereas SRCC was found in 17.5% of pMMR. Objective response rate was 27.3% in dMMR and 34.3% in pMMR (p = 0.556). No difference in progression-free survival was noted between patients with dMMR and pMMR (median, 5.6 vs. 5.8 months, p = 0.266). Patients with dMMR tended to have better overall survival than those with pMMR although this difference was not statistically significant (median, 17.9 vs. 12.2 months, p = 0.183).</p><p><strong>Conclusions: </strong>Efficacy of first-line FP was not different by MMR status in mGC patients.</p>","PeriodicalId":12684,"journal":{"name":"Gastric Cancer","volume":null,"pages":null},"PeriodicalIF":6.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140329769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Identification of maximal tumor size associated with negligible lymph node metastasis for endoscopic submucosal dissection of undifferentiated-type early gastric cancer. 确定未分化型早期胃癌内镜黏膜下剥离术中可忽略淋巴结转移的最大肿瘤大小。
IF 6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-01 Epub Date: 2024-04-25 DOI: 10.1007/s10120-024-01498-2
Sung Eun Oh, Soomin Ahn, Kyoung-Mee Kim, Min-Gew Choi, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Ji Yeong An

Background and aims: When treating undifferentiated-type early gastric cancer (UD-EGC) that is limited to the mucosa (clinically T1a), endoscopic submucosal dissection (ESD) can be considered if the tumor is 2 cm or less and is not ulcerated. However, there is insufficient evidence to determine the relationships between tumor size and oncological safety of ESD in UD-EGC.

Methods: The pathology reports of Korean patients who were diagnosed with UD-EGC (n = 5286) were retrospectively reviewed. The cumulative incidence of lymph node metastasis (LNM) according to tumor size was evaluated in subgroups. The tumor-size cut-off was identified as the upper limit of the 95% confidence interval (CI) of cumulative LNM incidence that did not exceed 1.0%.

Results: We identified 1516 patients with non-ulcerated T1a tumors ≤2 cm in size. Among patients without lymphatic invasion, 1.5% (95% CI 0.91-2.16%) had LNM. In patients with poorly differentiated tubular adenocarcinoma (PD), LNM increased from 0 to 0.74% based on a tumor size of 1.0 cm. Regardless of tumor size, smaller percentages of undifferentiated-type (UD) and poorly cohesive carcinoma (PCC) patients experienced LNM than did those with PD. In non-ulcerated mucosal cancer without lymphatic invasion and tumor size ≤0.9 cm, no LNM was observed in patients with UD (95% CI 0-0.53%), PCC (95% CI 0-0.59%), or PD (95% CI 0-0.86%) histologic type.

Conclusion: In patients diagnosed with non-ulcerated T1a UD-EGC, ESD can be performed if the tumor size is 0.9 cm or less, regardless of histologic type.

背景和目的:在治疗局限于粘膜(临床上为T1a)的未分化型早期胃癌(UD-EGC)时,如果肿瘤小于或等于2厘米且没有溃疡,可以考虑进行内镜下粘膜下剥离术(ESD)。然而,目前还没有足够的证据来确定 UD-EGC 中肿瘤大小与 ESD 的肿瘤学安全性之间的关系:方法:对确诊为 UD-EGC 的韩国患者(n = 5286)的病理报告进行了回顾性研究。根据肿瘤大小对亚组淋巴结转移(LNM)的累积发生率进行评估。肿瘤大小的临界值被确定为累计淋巴结转移发生率不超过1.0%的95%置信区间(CI)的上限:我们发现了1516名非溃疡性T1a肿瘤大小≤2厘米的患者。在无淋巴管侵犯的患者中,1.5%(95% CI 0.91-2.16%)的患者有LNM。在分化不良的管状腺癌(PD)患者中,以肿瘤大小为1.0厘米为基准,LNM从0%增加到0.74%。无论肿瘤大小如何,未分化型(UD)和粘连性差的腺癌(PCC)患者出现 LNM 的比例都低于分化型腺癌患者。在无淋巴侵犯、肿瘤大小≤0.9厘米的非溃疡性粘膜癌中,组织学类型为UD(95% CI 0-0.53%)、PCC(95% CI 0-0.59%)或PD(95% CI 0-0.86%)的患者未观察到LNM:结论:对于确诊为非溃疡性T1a UD-EGC的患者,如果肿瘤大小在0.9厘米或以下,无论组织学类型如何,都可以进行ESD治疗。
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引用次数: 0
Revisiting the use of the EORTC QLQ-STO22 to assess health-related quality of life of patients with gastric cancer: incorporating updated treatment options and cross-cultural perspectives. 重新审视使用 EORTC QLQ-STO22 评估胃癌患者的健康相关生活质量:纳入最新治疗方案和跨文化视角。
IF 6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-01 Epub Date: 2024-04-26 DOI: 10.1007/s10120-024-01492-8
S C Sodergren, A Hurley-Wallace, V Vassiliou, B Alkhaffaf, B Batsaikhan, A S Darlington, T Fleitas-Kanonnikof, M G Guren, M Honda, Y W Kim, S Kim, M N Krishnamurthy, S Y Loh, N S Turhal, J Zhou, K Dennis, R Krishnatry, M Terashima, G Tsironis, T Yoshikawa, M Terada

Background: The EORTC QLQ-STO22 (QLQ-STO22) is a firmly established and validated measure of health-related quality of life (HRQoL) for people with gastric cancer (GC), developed over two decades ago. Since then there have been dramatic changes in treatment options for GC. Also, East Asian patients were not involved in the development of QLQ-STO22, where GC is most prevalent and the QLQ-STO22 is widely used. A review with appropriate updating of the measure was planned. This study aims to capture HRQoL issues associated with new treatments and the perspectives of patients and health care professionals (HCPs) from different cultural backgrounds, including East Asia.

Methods: A systematic literature review and open-ended interviews were preformed to identify potential new HRQoL issues relating to GC. This was followed by structured interviews where HCPs and patients reviewed the QLQ-STO22 alongside new issues regarding relevance, importance, and acceptability.

Results: The review of 267 publications and interviews with 104 patients and 18 HCPs (48 and 9 from East Asia, respectively) generated a list of 58 new issues. Three of these relating to eating small amounts, flatulence, and neuropathy were recommended for inclusion in an updated version of the QLQ-STO22 and covered by five additional questions.

Conclusions: This study supports the content validity of the QLQ-STO22, suggesting its continued relevance to patients with GC, including those from East Asia. The updated version with additional questions and linguistic changes will enhance its specificity, but further testing is required.

背景:EORTC QLQ-STO22 (QLQ-STO22) 是二十多年前针对胃癌 (GC) 患者开发的一种与健康相关的生活质量 (HRQoL) 测量方法,已得到广泛认可和验证。此后,胃癌的治疗方案发生了巨大变化。此外,QLQ-STO22 的开发并未涉及东亚患者,而东亚是胃癌的高发区,QLQ-STO22 在东亚也得到了广泛应用。因此,我们计划对该量表进行审查并适当更新。本研究旨在了解与新疗法相关的 HRQoL 问题以及来自不同文化背景(包括东亚)的患者和医护人员(HCPs)的观点:方法:通过系统的文献综述和开放式访谈,确定与 GC 相关的潜在 HRQoL 新问题。随后进行了结构化访谈,由 HCP 和患者对 QLQ-STO22 以及相关性、重要性和可接受性方面的新问题进行回顾:结果:通过对 267 篇出版物的查阅以及对 104 名患者和 18 名高级保健人员(分别有 48 人和 9 人来自东亚)的访谈,共发现了 58 个新问题。建议将其中有关少量进食、胃肠胀气和神经病变的三个问题纳入 QLQ-STO 的更新版本22 ,并增加五个问题:本研究证实了 QLQ-STO22 的内容有效性,表明其对包括东亚在内的 GC 患者仍具有相关性。增加了问题和语言变化的更新版将提高其特异性,但仍需进一步测试。
{"title":"Revisiting the use of the EORTC QLQ-STO22 to assess health-related quality of life of patients with gastric cancer: incorporating updated treatment options and cross-cultural perspectives.","authors":"S C Sodergren, A Hurley-Wallace, V Vassiliou, B Alkhaffaf, B Batsaikhan, A S Darlington, T Fleitas-Kanonnikof, M G Guren, M Honda, Y W Kim, S Kim, M N Krishnamurthy, S Y Loh, N S Turhal, J Zhou, K Dennis, R Krishnatry, M Terashima, G Tsironis, T Yoshikawa, M Terada","doi":"10.1007/s10120-024-01492-8","DOIUrl":"10.1007/s10120-024-01492-8","url":null,"abstract":"<p><strong>Background: </strong>The EORTC QLQ-STO22 (QLQ-STO22) is a firmly established and validated measure of health-related quality of life (HRQoL) for people with gastric cancer (GC), developed over two decades ago. Since then there have been dramatic changes in treatment options for GC. Also, East Asian patients were not involved in the development of QLQ-STO22, where GC is most prevalent and the QLQ-STO22 is widely used. A review with appropriate updating of the measure was planned. This study aims to capture HRQoL issues associated with new treatments and the perspectives of patients and health care professionals (HCPs) from different cultural backgrounds, including East Asia.</p><p><strong>Methods: </strong>A systematic literature review and open-ended interviews were preformed to identify potential new HRQoL issues relating to GC. This was followed by structured interviews where HCPs and patients reviewed the QLQ-STO22 alongside new issues regarding relevance, importance, and acceptability.</p><p><strong>Results: </strong>The review of 267 publications and interviews with 104 patients and 18 HCPs (48 and 9 from East Asia, respectively) generated a list of 58 new issues. Three of these relating to eating small amounts, flatulence, and neuropathy were recommended for inclusion in an updated version of the QLQ-STO22 and covered by five additional questions.</p><p><strong>Conclusions: </strong>This study supports the content validity of the QLQ-STO22, suggesting its continued relevance to patients with GC, including those from East Asia. The updated version with additional questions and linguistic changes will enhance its specificity, but further testing is required.</p>","PeriodicalId":12684,"journal":{"name":"Gastric Cancer","volume":null,"pages":null},"PeriodicalIF":6.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11193686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140874586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
International consensus on the management of metastatic gastric cancer: step by step in the foggy landscape : Bertinoro Workshop, November 2022. 关于转移性胃癌治疗的国际共识:在迷雾中一步步前行:贝尔蒂诺罗研讨会,2022 年 11 月。
IF 6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-01 Epub Date: 2024-04-18 DOI: 10.1007/s10120-024-01479-5
Paolo Morgagni, Maria Bencivenga, Fatima Carneiro, Stefano Cascinu, Sarah Derks, Maria Di Bartolomeo, Claire Donohoe, Clarisse Eveno, Suzanne Gisbertz, Peter Grimminger, Ines Gockel, Heike Grabsch, Paulo Kassab, Rupert Langer, Sara Lonardi, Marco Maltoni, Sheraz Markar, Markus Moehler, Daniele Marrelli, Maria Antonietta Mazzei, Davide Melisi, Carlo Milandri, Paul Stefan Moenig, Bianca Mostert, Gianni Mura, Wojciech Polkowski, John Reynolds, Luca Saragoni, Mark I Van Berge Henegouwen, Richard Van Hillegersberg, Michael Vieth, Giuseppe Verlato, Lorena Torroni, Bas Wijnhoven, Guido Alberto Massimo Tiberio, Han-Kwang Yang, Franco Roviello, Giovanni de Manzoni

Background: Many gastric cancer patients in Western countries are diagnosed as metastatic with a median overall survival of less than twelve months using standard chemotherapy. Innovative treatments, like targeted therapy or immunotherapy, have recently proved to ameliorate prognosis, but a general agreement on managing oligometastatic disease has yet to be achieved. An international multi-disciplinary workshop was held in Bertinoro, Italy, in November 2022 to verify whether achieving a consensus on at least some topics was possible.

Methods: A two-round Delphi process was carried out, where participants were asked to answer 32 multiple-choice questions about CT, laparoscopic staging and biomarkers, systemic treatment for different localization, role and indication of palliative care. Consensus was established with at least a 67% agreement.

Results: The assembly agreed to define oligometastases as a "dynamic" disease which either regresses or remains stable in response to systemic treatment. In addition, the definition of oligometastases was restricted to the following sites: para-aortic nodal stations, liver, lung, and peritoneum, excluding bones. In detail, the following conditions should be considered as oligometastases: involvement of para-aortic stations, in particular 16a2 or 16b1; up to three technically resectable liver metastases; three unilateral or two bilateral lung metastases; peritoneal carcinomatosis with PCI ≤ 6. No consensus was achieved on how to classify positive cytology, which was considered as oligometastatic by 55% of participants only if converted to negative after chemotherapy.

Conclusion: As assessed at the time of diagnosis, surgical treatment of oligometastases should aim at R0 curativity on the entire disease volume, including both the primary tumor and its metastases. Conversion surgery was defined as surgery on the residual volume of disease, which was initially not resectable for technical and/or oncological reasons but nevertheless responded to first-line treatment.

背景:在西方国家,许多胃癌患者被诊断为转移性胃癌,采用标准化疗的中位总生存期不到 12 个月。最近,靶向治疗或免疫治疗等创新治疗方法被证明可以改善预后,但对于如何管理寡转移性疾病,尚未达成普遍共识。2022 年 11 月,在意大利贝尔蒂诺罗举行了一次国际多学科研讨会,以验证是否有可能至少就某些主题达成共识:研讨会采用两轮德尔菲法,要求与会者回答32道选择题,内容涉及CT、腹腔镜分期和生物标志物、不同定位的系统治疗、姑息治疗的作用和适应症。会议达成了至少67%的共识:大会一致同意将寡转移灶定义为一种 "动态 "疾病,这种疾病在接受系统治疗后要么消退,要么保持稳定。此外,寡转移灶的定义仅限于以下部位:主动脉旁结节站、肝、肺和腹膜,不包括骨骼。具体而言,以下情况应视为寡转移灶:主动脉旁结节受累,尤其是16a2或16b1;最多三个技术上可切除的肝转移灶;三个单侧或两个双侧肺转移灶;PCI≤6的腹膜癌肿。55%的参与者认为,只有在化疗后转为阴性的情况下,细胞学阳性才被视为少转移:结论:根据诊断时的评估,寡转移灶的手术治疗应以R0治愈整个病灶为目标,包括原发肿瘤及其转移灶。转化手术指的是对残余病灶进行的手术,这些病灶最初因技术和/或肿瘤学原因无法切除,但对一线治疗有反应。
{"title":"International consensus on the management of metastatic gastric cancer: step by step in the foggy landscape : Bertinoro Workshop, November 2022.","authors":"Paolo Morgagni, Maria Bencivenga, Fatima Carneiro, Stefano Cascinu, Sarah Derks, Maria Di Bartolomeo, Claire Donohoe, Clarisse Eveno, Suzanne Gisbertz, Peter Grimminger, Ines Gockel, Heike Grabsch, Paulo Kassab, Rupert Langer, Sara Lonardi, Marco Maltoni, Sheraz Markar, Markus Moehler, Daniele Marrelli, Maria Antonietta Mazzei, Davide Melisi, Carlo Milandri, Paul Stefan Moenig, Bianca Mostert, Gianni Mura, Wojciech Polkowski, John Reynolds, Luca Saragoni, Mark I Van Berge Henegouwen, Richard Van Hillegersberg, Michael Vieth, Giuseppe Verlato, Lorena Torroni, Bas Wijnhoven, Guido Alberto Massimo Tiberio, Han-Kwang Yang, Franco Roviello, Giovanni de Manzoni","doi":"10.1007/s10120-024-01479-5","DOIUrl":"10.1007/s10120-024-01479-5","url":null,"abstract":"<p><strong>Background: </strong>Many gastric cancer patients in Western countries are diagnosed as metastatic with a median overall survival of less than twelve months using standard chemotherapy. Innovative treatments, like targeted therapy or immunotherapy, have recently proved to ameliorate prognosis, but a general agreement on managing oligometastatic disease has yet to be achieved. An international multi-disciplinary workshop was held in Bertinoro, Italy, in November 2022 to verify whether achieving a consensus on at least some topics was possible.</p><p><strong>Methods: </strong>A two-round Delphi process was carried out, where participants were asked to answer 32 multiple-choice questions about CT, laparoscopic staging and biomarkers, systemic treatment for different localization, role and indication of palliative care. Consensus was established with at least a 67% agreement.</p><p><strong>Results: </strong>The assembly agreed to define oligometastases as a \"dynamic\" disease which either regresses or remains stable in response to systemic treatment. In addition, the definition of oligometastases was restricted to the following sites: para-aortic nodal stations, liver, lung, and peritoneum, excluding bones. In detail, the following conditions should be considered as oligometastases: involvement of para-aortic stations, in particular 16a2 or 16b1; up to three technically resectable liver metastases; three unilateral or two bilateral lung metastases; peritoneal carcinomatosis with PCI ≤ 6. No consensus was achieved on how to classify positive cytology, which was considered as oligometastatic by 55% of participants only if converted to negative after chemotherapy.</p><p><strong>Conclusion: </strong>As assessed at the time of diagnosis, surgical treatment of oligometastases should aim at R0 curativity on the entire disease volume, including both the primary tumor and its metastases. Conversion surgery was defined as surgery on the residual volume of disease, which was initially not resectable for technical and/or oncological reasons but nevertheless responded to first-line treatment.</p>","PeriodicalId":12684,"journal":{"name":"Gastric Cancer","volume":null,"pages":null},"PeriodicalIF":6.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11193703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Factors associated with the efficacy of first-line nivolumab plus chemotherapy in advanced gastric cancer patients with deficient mismatch repair. 错配修复缺陷晚期胃癌患者一线使用尼妥珠单抗加化疗疗效的相关因素。
IF 6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-01 Epub Date: 2024-05-23 DOI: 10.1007/s10120-024-01509-2
Young-Gyu Park, Hyung-Don Kim, Jaewon Hyung, Young Soo Park, Min-Hee Ryu

Background: We aimed to investigate clinicopathologic factors leading to different clinical outcomes in patients with deficient mismatch repair protein (d-MMR) gastric cancer (GC) treated with nivolumab plus chemotherapy (nivolumab chemotherapy).

Methods: This retrospective study included 28 patients with d-MMR advanced GC treated with first-line nivolumab chemotherapy. As a control group, 68 treated with first-line chemotherapy alone were included. Clinicopathological factors, including the neutrophil-to-lymphocyte ratio (NLR) and PD-L1 combined positive score (CPS), were analyzed with regards to the efficacy outcomes.

Results: Progression-free survival (PFS) was longer (median PFS; not reached [NR] vs. 5.2 months, hazard ratio [HR] 0.28, P < 0.001), and overall survival (OS) tended to be longer (median OS; NR vs. 17.9 months, HR 0.43, P = 0.057) in patients treated with nivolumab chemotherapy than those treated with chemotherapy. The PFS benefit of nivolumab chemotherapy over chemotherapy was pronounced in the subgroup with a lower NLR (< 3.80 [median NLR]) (HR 0.10), whereas it was less prominent in patients with a high NLR (≥ 3.80) (HR 0.58). Among patients treated with nivolumab chemotherapy, PFS was worse in patients with a higher NLR (≥ 3.80) than in those with a lower NLR (< 3.80), and survival outcomes were similar between those with PD-L1 CPS ≥ 5 and < 5.

Conclusion: Nivolumab chemotherapy was associated with better efficacy outcomes than chemotherapy alone among patients with d-MMR GC, but survival outcomes were poor even with nivolumab chemotherapy for those with a high NLR. Survival outcomes were not different according to PD-L1 CPS among d-MMR patients treated with nivolumab chemotherapy.

背景:我们旨在研究导致缺乏错配修复蛋白(d-MMR)胃癌(GC)患者接受nivolumab联合化疗(nivolumab化疗)的不同临床结局的临床病理因素:这项回顾性研究纳入了28例接受尼妥珠单抗一线化疗的d-MMR晚期胃癌患者。作为对照组,纳入了68名仅接受一线化疗的患者。研究分析了中性粒细胞与淋巴细胞比值(NLR)和PD-L1联合阳性评分(CPS)等临床病理因素对疗效的影响:结果:无进展生存期(PFS)更长(中位PFS;未达到[NR]对5.2个月,危险比[HR]0.28,P 结论:Nivolumab化疗与无进展生存期(PFS)相关:在d-MMR GC患者中,尼妥珠单抗化疗的疗效优于单纯化疗,但对于NLR较高的患者,即使使用尼妥珠单抗化疗,生存率也较低。在接受 nivolumab 化疗的 d-MMR 患者中,根据 PD-L1 CPS 的不同,生存结果也没有差异。
{"title":"Factors associated with the efficacy of first-line nivolumab plus chemotherapy in advanced gastric cancer patients with deficient mismatch repair.","authors":"Young-Gyu Park, Hyung-Don Kim, Jaewon Hyung, Young Soo Park, Min-Hee Ryu","doi":"10.1007/s10120-024-01509-2","DOIUrl":"10.1007/s10120-024-01509-2","url":null,"abstract":"<p><strong>Background: </strong>We aimed to investigate clinicopathologic factors leading to different clinical outcomes in patients with deficient mismatch repair protein (d-MMR) gastric cancer (GC) treated with nivolumab plus chemotherapy (nivolumab chemotherapy).</p><p><strong>Methods: </strong>This retrospective study included 28 patients with d-MMR advanced GC treated with first-line nivolumab chemotherapy. As a control group, 68 treated with first-line chemotherapy alone were included. Clinicopathological factors, including the neutrophil-to-lymphocyte ratio (NLR) and PD-L1 combined positive score (CPS), were analyzed with regards to the efficacy outcomes.</p><p><strong>Results: </strong>Progression-free survival (PFS) was longer (median PFS; not reached [NR] vs. 5.2 months, hazard ratio [HR] 0.28, P < 0.001), and overall survival (OS) tended to be longer (median OS; NR vs. 17.9 months, HR 0.43, P = 0.057) in patients treated with nivolumab chemotherapy than those treated with chemotherapy. The PFS benefit of nivolumab chemotherapy over chemotherapy was pronounced in the subgroup with a lower NLR (< 3.80 [median NLR]) (HR 0.10), whereas it was less prominent in patients with a high NLR (≥ 3.80) (HR 0.58). Among patients treated with nivolumab chemotherapy, PFS was worse in patients with a higher NLR (≥ 3.80) than in those with a lower NLR (< 3.80), and survival outcomes were similar between those with PD-L1 CPS ≥ 5 and < 5.</p><p><strong>Conclusion: </strong>Nivolumab chemotherapy was associated with better efficacy outcomes than chemotherapy alone among patients with d-MMR GC, but survival outcomes were poor even with nivolumab chemotherapy for those with a high NLR. Survival outcomes were not different according to PD-L1 CPS among d-MMR patients treated with nivolumab chemotherapy.</p>","PeriodicalId":12684,"journal":{"name":"Gastric Cancer","volume":null,"pages":null},"PeriodicalIF":6.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141081224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Letter to the editor: 5-year follow-up results of a JCOG1104 (OPAS-1) phase III non-inferiority trial to compare 4 courses and 8 courses of S-1 adjuvant chemotherapy for pathological stage II gastric cancer. 致编辑的信:JCOG1104(OPAS-1)III期非劣效性试验比较病理II期胃癌4个疗程和8个疗程S-1辅助化疗的5年随访结果。
IF 6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-01 Epub Date: 2024-04-11 DOI: 10.1007/s10120-024-01496-4
Hyung-Don Kim, Min-Hee Ryu, Ji Sung Lee, Yoon-Koo Kang
{"title":"Letter to the editor: 5-year follow-up results of a JCOG1104 (OPAS-1) phase III non-inferiority trial to compare 4 courses and 8 courses of S-1 adjuvant chemotherapy for pathological stage II gastric cancer.","authors":"Hyung-Don Kim, Min-Hee Ryu, Ji Sung Lee, Yoon-Koo Kang","doi":"10.1007/s10120-024-01496-4","DOIUrl":"10.1007/s10120-024-01496-4","url":null,"abstract":"","PeriodicalId":12684,"journal":{"name":"Gastric Cancer","volume":null,"pages":null},"PeriodicalIF":6.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140848476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Gastric Cancer
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