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A mathematical simulation model to determine the optimal endoscopic screening strategy for detection of H. pylori-naïve gastric neoplasms. 通过数学模拟模型确定检测幽门螺杆菌未感染胃肿瘤的最佳内镜筛查策略。
IF 6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-27 DOI: 10.1007/s10120-024-01525-2
Fumiaki Ishibashi, Kosuke Okusa, Yoshitaka Tokai, Toshiaki Hirasawa, Tomohiro Kawakami, Kentaro Mochida, Yuka Yanai, Chizu Yokoi, Yuko Hayashi, Shun-Ichiro Ozawa, Koji Uraushihara, Yohei Minato, Hiroyuki Nakanishi, Hiroya Ueyama, Mikinori Kataoka, Yuzo Toyama, Yuji Mizokami, Sho Suzuki

Background: The effectiveness of esophagogastroduodenoscopy (EGD) screening in cohorts with low Helicobacter pylori prevalence is unknown. This study aimed to develop an optimally efficient EGD screening strategy for detecting H. pylori-naïve gastric neoplasms (HpNGNs).

Methods: EGD data of 12 institutions from 2016 to 2022 were retrospectively analyzed. Age-related HpNGN prevalence, tumor growth rate, missing rate, and detection threshold size were calculated from the databases. Subsequently, using clinical data, a novel mathematical model that simultaneously simulated demographic changes and HpNGN detection was developed. Screening strategies using different starting ages (40/45/50 years) and intervals (2/5/10 years) were also compared. The detection rates of all tumors occurring within the virtual cohort and number-needed-to-test (NNT) were measured as outcomes.

Results: Data of 519,368 EGDs and 97 HpNGNs (34 pure signet ring cell carcinomas, 26 gastric adenocarcinomas of the fundic gland type, 30 foveolar gastric adenoma-Raspberry type, and seven undifferentiated-type cancer cases) were analyzed. A virtual cohort with a 70-year time horizon was used to simulate the occurrence, growth, and detection of 346,5836 people. Among the strategies with detection rate > 50%, the screening strategy with a 5-year interval starting at 45 years of age had the lowest NNT. Adopting this strategy, most HpNGNs were detected at < 20 mm in size, and the deep submucosal invasion rate was less than 30%.

Conclusions: A mathematical simulation model revealed that screening every 5 years starting at 45 years of age could efficiently assist in identifying HpNGNs at an early stage.

背景:在幽门螺杆菌感染率较低的人群中进行食管胃十二指肠镜(EGD)筛查的有效性尚不清楚。本研究旨在制定一种最佳高效的胃肠镜筛查策略,以检测幽门螺杆菌未感染的胃肿瘤(HpNGNs):方法:回顾性分析了 12 家机构 2016 年至 2022 年的胃肠道造影数据。从数据库中计算出与年龄相关的 HpNGN 患病率、肿瘤生长率、缺失率和检测阈值大小。随后,利用临床数据建立了一个新型数学模型,该模型可同时模拟人口统计学变化和 HpNGN 检测。同时还比较了采用不同起始年龄(40/45/50 岁)和间隔时间(2/5/10 年)的筛查策略。结果测量了虚拟队列中所有肿瘤的检出率和检测所需次数(NNT):结果:分析了 519,368 例胃肠道造影和 97 例 HpNGN(34 例纯标志环细胞癌、26 例胃底腺型腺癌、30 例泡状胃腺瘤-覆盆子型和 7 例未分化型癌症)的数据。研究使用了一个时间跨度为 70 年的虚拟队列,模拟了 3465836 人的发病、增长和检测情况。在检出率大于 50%的策略中,从 45 岁开始间隔 5 年的筛查策略的 NNT 最低。采用这种策略,大多数 HpNGN 在得出结论时就能被检测出来:数学模拟模型显示,从 45 岁开始每 5 年筛查一次可有效帮助早期发现 HpNGN。
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引用次数: 0
Safety and feasibility of single-incision laparoscopic distal gastrectomy in overweight and obese gastric cancer patients: a propensity score-matched analysis. 超重和肥胖胃癌患者单切口腹腔镜远端胃切除术的安全性和可行性:倾向评分匹配分析。
IF 6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-09-01 Epub Date: 2024-07-18 DOI: 10.1007/s10120-024-01530-5
Eunju Lee, Yun-Suhk Suh, Mira Yoo, Duyeong Hwang, So Hyun Kang, Sangjun Lee, Young Suk Park, Sang-Hoon Ahn, Seong-Ho Kong, Do Joong Park, Hyuk-Joon Lee, Hyung-Ho Kim, Han-Kwang Yang

Background: The technical challenges and safety concerns of single-incision laparoscopic gastrectomy for overweight and obese gastric cancer patients remain unclear. This study aimed to evaluate the safety and feasibility of single-incision laparoscopic distal gastrectomy (SIDG) compared to multiport laparoscopic distal gastrectomy (MLDG) in overweight and obese gastric cancer patients.

Methods: This study retrospectively analyzed overweight and obese patients (body mass index ≥ 25 kg/m2) and pathologic stage T1 primary gastric adenocarcinoma treated with either SIDG or MLDG. The SIDG and MLDG groups were propensity score matched at a 1:2 ratio using age, sex, height, body weight, American Society of Anesthesiologists classification, year of surgery, pathologic N stage, and anastomosis method as covariates.

Results: After 1:2 matching, the study included patients who underwent SIDG (n = 179) and MLDG (n = 358). No significant difference in the number of retrieved lymph nodes was found between the SIDG and MLDG groups (52.8 ± 19.3 vs. 53.9 ± 21.0, P = 0.56). Operation times were significantly shorter in the SIDG group (170.8 ± 60.0 min vs. 186.1 ± 52.6 min, P = 0.004). The postoperative hospital length of stay was comparable between the 2 groups (SIDG: 5.9 ± 3.4 days vs. MLDG: 6.3 ± 5.1 days, P = 0.23), as was postoperative complication rate (SIDG: 13.4% vs. MLDG: 12.8%, P = 0.89).

Conclusions: SIDG was shown to be as safe and feasible as MLDG for overweight and obese gastric cancer patients, with comparable early postoperative complication rates without compromising operation time compared to MLDG.

背景:对超重和肥胖胃癌患者进行单切口腹腔镜胃切除术的技术挑战和安全问题仍不清楚。本研究旨在评估单切口腹腔镜远端胃切除术(SIDG)与多孔腹腔镜远端胃切除术(MLDG)在超重和肥胖胃癌患者中的安全性和可行性:本研究对超重和肥胖(体重指数≥ 25 kg/m2)且病理分期为 T1 的原发性胃腺癌患者接受 SIDG 或 MLDG 治疗的情况进行了回顾性分析。以年龄、性别、身高、体重、美国麻醉医师协会分类、手术年份、病理 N 分期和吻合方法为协变量,按 1:2 的比例对 SIDG 组和 MLDG 组进行倾向评分匹配:经过1:2配对后,研究纳入了接受SIDG(n = 179)和MLDG(n = 358)手术的患者。SIDG组和MLDG组取回的淋巴结数量无明显差异(52.8 ± 19.3 vs. 53.9 ± 21.0,P = 0.56)。SIDG 组的手术时间明显更短(170.8 ± 60.0 分钟 vs 186.1 ± 52.6 分钟,P = 0.004)。两组的术后住院时间相当(SIDG:5.9 ± 3.4 天 vs MLDG:6.3 ± 5.1 天,P = 0.23),术后并发症发生率也相当(SIDG:13.4% vs MLDG:12.8%,P = 0.89):结论:对于超重和肥胖的胃癌患者,SIDG与MLDG一样安全可行,与MLDG相比,术后早期并发症发生率相当,且不影响手术时间。
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引用次数: 0
An artificial intelligence system for comprehensive pathologic outcome prediction in early gastric cancer through endoscopic image analysis (with video). 通过内窥镜图像分析预测早期胃癌综合病理结果的人工智能系统(附视频)。
IF 6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-09-01 Epub Date: 2024-07-02 DOI: 10.1007/s10120-024-01524-3
Seunghan Lee, Jiwoon Jeon, Jinbae Park, Young Hoon Chang, Cheol Min Shin, Mi Jin Oh, Su Hyun Kim, Seungkyung Kang, Su Hee Park, Sang Gyun Kim, Hyuk-Joon Lee, Han-Kwang Yang, Hey Seung Lee, Soo-Jeong Cho

Background: Accurate prediction of pathologic results for early gastric cancer (EGC) based on endoscopic findings is essential in deciding between endoscopic and surgical resection. This study aimed to develop an artificial intelligence (AI) model to assess comprehensive pathologic characteristics of EGC using white-light endoscopic images and videos.

Methods: To train the model, we retrospectively collected 4,336 images and prospectively included 153 videos from patients with EGC who underwent endoscopic or surgical resection. The performance of the model was tested and compared to that of 16 endoscopists (nine experts and seven novices) using a mutually exclusive set of 260 images and 10 videos. Finally, we conducted external validation using 436 images and 89 videos from another institution.

Results: After training, the model achieved predictive accuracies of 89.7% for undifferentiated histology, 88.0% for submucosal invasion, 87.9% for lymphovascular invasion (LVI), and 92.7% for lymph node metastasis (LNM), using endoscopic videos. The area under the curve values of the model were 0.992 for undifferentiated histology, 0.902 for submucosal invasion, 0.706 for LVI, and 0.680 for LNM in the test. In addition, the model showed significantly higher accuracy than the experts in predicting undifferentiated histology (92.7% vs. 71.6%), submucosal invasion (87.3% vs. 72.6%), and LNM (87.7% vs. 72.3%). The external validation showed accuracies of 75.6% and 71.9% for undifferentiated histology and submucosal invasion, respectively.

Conclusions: AI may assist endoscopists with high predictive performance for differentiation status and invasion depth of EGC. Further research is needed to improve the detection of LVI and LNM.

背景:根据内镜检查结果准确预测早期胃癌(EGC)的病理结果对于决定内镜切除还是手术切除至关重要。本研究旨在开发一种人工智能(AI)模型,利用白光内镜图像和视频评估 EGC 的综合病理特征:为了训练该模型,我们回顾性地收集了4336张图像,并前瞻性地纳入了153个视频,这些图像和视频均来自接受内镜或手术切除的EGC患者。我们使用一组相互排斥的 260 张图像和 10 段视频,对模型的性能进行了测试,并与 16 位内镜医师(9 位专家和 7 位新手)的性能进行了比较。最后,我们使用来自另一家机构的 436 张图像和 89 段视频进行了外部验证:经过训练后,该模型使用内窥镜视频对未分化组织学的预测准确率为 89.7%,对粘膜下侵犯的预测准确率为 88.0%,对淋巴管侵犯(LVI)的预测准确率为 87.9%,对淋巴结转移(LNM)的预测准确率为 92.7%。在测试中,未分化组织学模型的曲线下面积值为 0.992,粘膜下侵犯为 0.902,LVI 为 0.706,LNM 为 0.680。此外,该模型在预测未分化组织学(92.7% 对 71.6%)、粘膜下浸润(87.3% 对 72.6%)和 LNM(87.7% 对 72.3%)方面的准确率明显高于专家。外部验证显示,未分化组织学和粘膜下侵犯的准确率分别为 75.6% 和 71.9%:结论:人工智能可以帮助内镜医师对EGC的分化状态和侵犯深度进行高度预测。还需进一步研究,以提高对 LVI 和 LNM 的检测能力。
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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。
{"title":"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.","authors":"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","doi":"10.1007/s10120-024-01513-6","DOIUrl":"10.1007/s10120-024-01513-6","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":12684,"journal":{"name":"Gastric Cancer","volume":" ","pages":"1100-1113"},"PeriodicalIF":6.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141161725","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
Comparative effectiveness of sodium-glucose cotransporter-2 inhibitors for new-onset gastric cancer and gastric diseases in patients with type 2 diabetes mellitus: a population-based cohort study. 钠-葡萄糖共转运体-2抑制剂对2型糖尿病患者新发胃癌和胃病的疗效比较:一项基于人群的队列研究。
IF 6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-10 DOI: 10.1007/s10120-024-01512-7
Oscar Hou In Chou, Vinod Kumar Chauhan, Cheuk To Skylar Chung, Lei Lu, Teddy Tai Loy Lee, Zita Man Wai Ng, Karin Kai Wing Wang, Sharen Lee, Haipeng Liu, Ronald Ting Kai Pang, Apichat Kaewdech, Bernard Man Yung Cheung, Gary Tse, Jiandong Zhou

Objective: To compare the risks of gastric cancer and other gastric diseases in patients with type-2 diabetes mellitus (T2DM) exposed to sodium-glucose cotransporter 2 inhibitors (SGLT2I), dipeptidyl peptidase-4 inhibitors (DPP4I) or glucagon-like peptide-1 receptor agonists (GLP1a).

Design: This was a population-based cohort study of prospectively collected data on patients with T2DM prescribed SGLT2I, DPP4I or GLP1a between January 1st 2015 and December 31st 2020 from Hong Kong. The outcomes were new-onset gastric cancer, peptic ulcer (PU), acute gastritis, non-acute gastritis, and gastroesophageal reflux disease (GERD). Propensity score matching (1:1) using the nearest neighbour search was performed, and multivariable Cox regression was applied. A three-arm comparison between SGLT2I, DPP4I and GLP1a was conducted using propensity scores with inverse probability of treatment weighting.

Results: A total of 62,858 patients (median age: 62.2 years old [SD: 12.8]; 55.93% males; SGLT2I: n = 23,442; DPP4I: n = 39,416) were included. In the matched cohort, the incidence of gastric cancer was lower in SGLT2I (Incidence rate per 1000 person-year, IR: 0.32; 95% confidence interval, CI 0.23-0.43) than in DPP4I (IR per 1000 person-year: 1.22; CI 1.03-1.42) users. Multivariable Cox regression found that SGLT2I use was associated with lower risks of gastric cancer (HR 0.30; 95% CI 0.19-0.48), PU, acute gastritis, non-acute gastritis, and GERD (p < 0.05) compared to DPP4I use. In the three-arm analysis, GLP1a use was associated with higher risks of gastric cancer and GERD compared to SGLT2I use.

Conclusions: The use of SGLT2I was associated with lower risks of new-onset gastric cancer, PU, acute gastritis, non-acute gastritis, and GERD after matching and adjustments compared to DPP4I use. SGLT2I use was associated with lower risks of GERD and gastric cancer compared to GLP1a use.

目的比较使用钠-葡萄糖共转运体2抑制剂(SGLT2I)、二肽基肽酶-4抑制剂(DPP4I)或胰高血糖素样肽-1受体激动剂(GLP1a)的2型糖尿病(T2DM)患者罹患胃癌和其他胃部疾病的风险:这是一项基于人群的队列研究,前瞻性地收集了2015年1月1日至2020年12月31日期间香港T2DM患者服用SGLT2I、DPP4I或GLP1a的数据。研究结果包括新发胃癌、消化性溃疡(PU)、急性胃炎、非急性胃炎和胃食管反流病(GERD)。采用近邻搜索法进行倾向得分匹配(1:1),并应用多变量 Cox 回归。使用倾向评分和治疗反概率加权法对 SGLT2I、DPP4I 和 GLP1a 进行了三臂比较:共纳入 62858 名患者(中位年龄:62.2 岁[SD:12.8];55.93% 为男性;SGLT2I:n = 23442;DPP4I:n = 39416)。在匹配队列中,SGLT2I 用户的胃癌发病率(每千人年发病率,IR:0.32;95% 置信区间,CI 0.23-0.43)低于 DPP4I 用户(每千人年发病率,IR:1.22;CI 1.03-1.42)。多变量 Cox 回归发现,使用 SGLT2I 与较低的胃癌(HR 0.30;95% CI 0.19-0.48)、PU、急性胃炎、非急性胃炎和胃食管反流病风险相关(P 结论:SGLT2I 与胃食管反流病的相关性较低:与使用 DPP4I 相比,经过匹配和调整后,使用 SGLT2I 与较低的新发胃癌、PU、急性胃炎、非急性胃炎和胃食管反流病风险相关。与使用 GLP1a 相比,使用 SGLT2I 可降低胃食管反流病和胃癌的风险。
{"title":"Comparative effectiveness of sodium-glucose cotransporter-2 inhibitors for new-onset gastric cancer and gastric diseases in patients with type 2 diabetes mellitus: a population-based cohort study.","authors":"Oscar Hou In Chou, Vinod Kumar Chauhan, Cheuk To Skylar Chung, Lei Lu, Teddy Tai Loy Lee, Zita Man Wai Ng, Karin Kai Wing Wang, Sharen Lee, Haipeng Liu, Ronald Ting Kai Pang, Apichat Kaewdech, Bernard Man Yung Cheung, Gary Tse, Jiandong Zhou","doi":"10.1007/s10120-024-01512-7","DOIUrl":"10.1007/s10120-024-01512-7","url":null,"abstract":"<p><strong>Objective: </strong>To compare the risks of gastric cancer and other gastric diseases in patients with type-2 diabetes mellitus (T2DM) exposed to sodium-glucose cotransporter 2 inhibitors (SGLT2I), dipeptidyl peptidase-4 inhibitors (DPP4I) or glucagon-like peptide-1 receptor agonists (GLP1a).</p><p><strong>Design: </strong>This was a population-based cohort study of prospectively collected data on patients with T2DM prescribed SGLT2I, DPP4I or GLP1a between January 1st 2015 and December 31st 2020 from Hong Kong. The outcomes were new-onset gastric cancer, peptic ulcer (PU), acute gastritis, non-acute gastritis, and gastroesophageal reflux disease (GERD). Propensity score matching (1:1) using the nearest neighbour search was performed, and multivariable Cox regression was applied. A three-arm comparison between SGLT2I, DPP4I and GLP1a was conducted using propensity scores with inverse probability of treatment weighting.</p><p><strong>Results: </strong>A total of 62,858 patients (median age: 62.2 years old [SD: 12.8]; 55.93% males; SGLT2I: n = 23,442; DPP4I: n = 39,416) were included. In the matched cohort, the incidence of gastric cancer was lower in SGLT2I (Incidence rate per 1000 person-year, IR: 0.32; 95% confidence interval, CI 0.23-0.43) than in DPP4I (IR per 1000 person-year: 1.22; CI 1.03-1.42) users. Multivariable Cox regression found that SGLT2I use was associated with lower risks of gastric cancer (HR 0.30; 95% CI 0.19-0.48), PU, acute gastritis, non-acute gastritis, and GERD (p < 0.05) compared to DPP4I use. In the three-arm analysis, GLP1a use was associated with higher risks of gastric cancer and GERD compared to SGLT2I use.</p><p><strong>Conclusions: </strong>The use of SGLT2I was associated with lower risks of new-onset gastric cancer, PU, acute gastritis, non-acute gastritis, and GERD after matching and adjustments compared to DPP4I use. SGLT2I use was associated with lower risks of GERD and gastric cancer compared to GLP1a use.</p>","PeriodicalId":12684,"journal":{"name":"Gastric Cancer","volume":" ","pages":"947-970"},"PeriodicalIF":6.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11335951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141295913","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
Outcomes after gastrectomy according to the Gastrectomy Complications Consensus Group (GCCG) in the Dutch Upper GI Cancer Audit (DUCA). 根据荷兰上消化道癌症审计(DUCA)中的胃切除术并发症共识小组(GCCG)得出的胃切除术后结果。
IF 6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-28 DOI: 10.1007/s10120-024-01527-0
Maurits R Visser, Daan M Voeten, Suzanne S Gisbertz, Jelle P Ruurda, Mark I van Berge Henegouwen, Richard van Hillegersberg

Background: In 2019, the Gastrectomy Complications Consensus Group (GCCG) published a standardized set of complications aiming toward uniform reporting of post-gastrectomy complications. This study aimed to report outcomes after gastrectomy in the Netherlands according to GCCG definitions and compare them to previously reported national results and the European database reported by the GCCG.

Methods: This nationwide, population-based cohort study included all patients undergoing gastrectomy for gastric cancer registered in the DUCA in 2020-2021. Postoperative morbidity and 30-day/in-hospital mortality were analyzed according to the GCCG definitions. For all patients, baseline characteristics and outcomes were compared with the GCCG cohort consisting of 27 European expert centers (GASTRODATA; 2017-2018).

Results: In 2020-2021, 782 patients underwent gastrectomy in the Netherlands. Variation was seen in baseline characteristics between the Dutch and the GCCG cohort (N = 1349), most notably in minimally invasive surgery (80.6% vs 19.6%, p < 0.001). In the Netherlands, 223 (28.5%) patients developed a total of 407 complications, the most frequent being non-surgical infections (28.5%) and anastomotic leakage (13.4%). The overall complication and 30-day mortality rates were similar between the Dutch and GCCG cohort (28.5% vs 29.8%, p = 0.563; 3.7% vs 3.6%, p = 0.953). Higher surgical and endoscopic/radiologic reintervention rates were observed in the Netherlands compared to the GCCG cohort (10.7% vs 7.8%, p = 0.025; 10.9% vs 2.9%, p < 0.001).

Conclusion: Reporting outcomes according to the standardized GCCG definitions allows for international benchmarking. Postoperative outcomes were comparable between Dutch and GCCG cohorts, but both exceed the international benchmark for expert gastrectomy care, highlighting targets for national and international quality improvement.

背景:2019年,胃切除术并发症共识小组(GCCG)发布了一套标准化并发症,旨在统一报告胃切除术后并发症。本研究旨在根据 GCCG 的定义报告荷兰胃切除术后的结果,并将其与之前报告的国家结果和 GCCG 报告的欧洲数据库进行比较:这项以人口为基础的全国性队列研究纳入了 2020-2021 年在 DUCA 登记的所有胃癌胃切除术患者。根据 GCCG 的定义分析了术后发病率和 30 天/住院死亡率。所有患者的基线特征和结果均与由27个欧洲专家中心组成的GCCG队列(GASTRODATA;2017-2018年)进行了比较:2020-2021年,荷兰共有782名患者接受了胃切除术。荷兰和GCCG队列(N = 1349)的基线特征存在差异,最明显的是微创手术(80.6% vs 19.6%,P 结论:荷兰和GCCG队列(N = 1349)的基线特征存在差异,最明显的是微创手术(80.6% vs 19.6%,P 结论:荷兰和GCCG队列的基线特征存在差异:根据标准化的 GCCG 定义报告疗效有助于制定国际基准。荷兰队列和 GCCG 队列的术后疗效相当,但都超过了胃切除术专家护理的国际基准,突出了国家和国际质量改进的目标。
{"title":"Outcomes after gastrectomy according to the Gastrectomy Complications Consensus Group (GCCG) in the Dutch Upper GI Cancer Audit (DUCA).","authors":"Maurits R Visser, Daan M Voeten, Suzanne S Gisbertz, Jelle P Ruurda, Mark I van Berge Henegouwen, Richard van Hillegersberg","doi":"10.1007/s10120-024-01527-0","DOIUrl":"10.1007/s10120-024-01527-0","url":null,"abstract":"<p><strong>Background: </strong>In 2019, the Gastrectomy Complications Consensus Group (GCCG) published a standardized set of complications aiming toward uniform reporting of post-gastrectomy complications. This study aimed to report outcomes after gastrectomy in the Netherlands according to GCCG definitions and compare them to previously reported national results and the European database reported by the GCCG.</p><p><strong>Methods: </strong>This nationwide, population-based cohort study included all patients undergoing gastrectomy for gastric cancer registered in the DUCA in 2020-2021. Postoperative morbidity and 30-day/in-hospital mortality were analyzed according to the GCCG definitions. For all patients, baseline characteristics and outcomes were compared with the GCCG cohort consisting of 27 European expert centers (GASTRODATA; 2017-2018).</p><p><strong>Results: </strong>In 2020-2021, 782 patients underwent gastrectomy in the Netherlands. Variation was seen in baseline characteristics between the Dutch and the GCCG cohort (N = 1349), most notably in minimally invasive surgery (80.6% vs 19.6%, p < 0.001). In the Netherlands, 223 (28.5%) patients developed a total of 407 complications, the most frequent being non-surgical infections (28.5%) and anastomotic leakage (13.4%). The overall complication and 30-day mortality rates were similar between the Dutch and GCCG cohort (28.5% vs 29.8%, p = 0.563; 3.7% vs 3.6%, p = 0.953). Higher surgical and endoscopic/radiologic reintervention rates were observed in the Netherlands compared to the GCCG cohort (10.7% vs 7.8%, p = 0.025; 10.9% vs 2.9%, p < 0.001).</p><p><strong>Conclusion: </strong>Reporting outcomes according to the standardized GCCG definitions allows for international benchmarking. Postoperative outcomes were comparable between Dutch and GCCG cohorts, but both exceed the international benchmark for expert gastrectomy care, highlighting targets for national and international quality improvement.</p>","PeriodicalId":12684,"journal":{"name":"Gastric Cancer","volume":" ","pages":"1124-1135"},"PeriodicalIF":6.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11335793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141467434","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
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。
{"title":"Gastric microbiome signature for predicting metachronous recurrence after endoscopic resection of gastric neoplasm.","authors":"Ho-Kyoung Lee, Cheol Min Shin, Young Hoon Chang, Hyuk Yoon, Young Soo Park, Nayoung Kim, Dong Ho Lee","doi":"10.1007/s10120-024-01532-3","DOIUrl":"10.1007/s10120-024-01532-3","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Method: </strong>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.</p><p><strong>Results: </strong>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]).</p><p><strong>Conclusions: </strong>Gastric cancer patients can be classified into two distinct gastrotype groups by their MAM profiles, which were associated with different risk of metachronous recurrence.</p>","PeriodicalId":12684,"journal":{"name":"Gastric Cancer","volume":" ","pages":"1031-1045"},"PeriodicalIF":6.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141544761","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
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。
{"title":"Early gastric cancer with RhoGAP fusion is linked to frequent nodal metastasis and a part of microtubular-mucocellular histology.","authors":"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","doi":"10.1007/s10120-024-01507-4","DOIUrl":"10.1007/s10120-024-01507-4","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>We analyzed 878 consecutive pT1b GCs for RhoGAP and its partner genes using fluorescence in situ hybridization assay.</p><p><strong>Results: </strong>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%).</p><p><strong>Conclusion: </strong>RhoGAP-GC is linked to a characteristic MTMC histology and a high incidence of LNM.</p>","PeriodicalId":12684,"journal":{"name":"Gastric Cancer","volume":" ","pages":"772-784"},"PeriodicalIF":6.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140957145","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
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":" ","pages":"811-818"},"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。
{"title":"Identification of maximal tumor size associated with negligible lymph node metastasis for endoscopic submucosal dissection of undifferentiated-type early gastric cancer.","authors":"Sung Eun Oh, Soomin Ahn, Kyoung-Mee Kim, Min-Gew Choi, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Ji Yeong An","doi":"10.1007/s10120-024-01498-2","DOIUrl":"10.1007/s10120-024-01498-2","url":null,"abstract":"<p><strong>Background and aims: </strong>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.</p><p><strong>Methods: </strong>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%.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":12684,"journal":{"name":"Gastric Cancer","volume":" ","pages":"850-857"},"PeriodicalIF":6.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140858442","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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