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Statin use in relation to long-term survival after gastrectomy for gastric adenocarcinoma: a Swedish population-based cohort study. 他汀类药物的使用与胃腺癌胃切除术后长期生存的关系:一项基于瑞典人群的队列研究。
IF 7.4 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-01 Epub Date: 2024-03-02 DOI: 10.1007/s10120-024-01487-5
Dag Holmberg, Joonas H Kauppila, Johannes Asplund, Wilhelm Leijonmarck, Fredrik Mattsson, Jesper Lagergren

Background: Studies have suggested that medication with statins improves survival in patients with gastric cancer, but methodological issues have limited the interpretability and prohibited conclusive results. We aimed to provide valid evidence as to whether statin use improves survival of gastric adenocarcinoma.

Methods: This nationwide and population-based cohort study included virtually all patients who underwent curatively intended surgery (gastrectomy) for gastric adenocarcinoma in Sweden between 2006 and 2015 with follow-up throughout 2019 for disease-specific mortality and 2020 for all-cause mortality. Data came from medical records and national healthcare registries. The exposure was statin use during the year prior to gastrectomy which was compared to no such use during the same period. The outcomes were 5-year disease-specific mortality (main) and 5-year all-cause mortality (secondary). Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI), adjusted for age, sex, education, calendar year, comorbidity, low-dose aspirin use, tumour sublocation, pathological tumour stage, neoadjuvant chemotherapy, annual surgeon volume, and surgical radicality.

Results: Among 1515 participating patients, the mean age was 69 years and 58.4% were men. Statin use, identified in 399 (26.3%) patients, was not associated with any statistically significantly decreased 5-year disease-specific mortality (HR 0.99, 95% CI 0.82-1.21) or 5-year all-cause mortality (HR 0.94, 95% CI 0.79-1.12). No risk reductions were found across subgroups of age, sex, aspirin user status, or tumour stage, or in patients with long-term preoperative of postoperative use of statins, all with point estimates close to 1.

Conclusions: Perioperative use of statins does not seem to improve the 5-year survival in patients who undergo gastrectomy with curative intent for gastric adenocarcinoma in Sweden.

背景:研究表明,他汀类药物可提高胃癌患者的生存率,但由于方法学问题,其可解释性受到限制,无法得出结论。我们旨在为他汀类药物是否能提高胃腺癌患者的生存率提供有效证据:这项基于人口的全国性队列研究纳入了 2006 年至 2015 年期间在瑞典接受胃腺癌根治性手术(胃切除术)的几乎所有患者,并在 2019 年和 2020 年分别对其疾病特异性死亡率和全因死亡率进行了随访。数据来自医疗记录和国家医疗登记。研究对象是胃切除术前一年使用他汀类药物的患者,并与同期未使用他汀类药物的患者进行比较。研究结果为5年疾病特异性死亡率(主要)和5年全因死亡率(次要)。经调整年龄、性别、教育程度、日历年、合并症、低剂量阿司匹林使用情况、肿瘤亚定位、肿瘤病理分期、新辅助化疗、外科医生年工作量和手术根治率后,多变量考克斯回归得出了危险比(HR)及95%置信区间(CI):在 1515 名参与研究的患者中,平均年龄为 69 岁,58.4% 为男性。399名(26.3%)患者使用了他汀类药物,但5年疾病特异性死亡率(HR 0.99,95% CI 0.82-1.21)或5年全因死亡率(HR 0.94,95% CI 0.79-1.12)均未出现统计学意义上的显著下降。在不同年龄、性别、阿司匹林使用者状况或肿瘤分期的亚组中,或在术前术后长期使用他汀类药物的患者中,均未发现风险降低的情况,其点估计值均接近1.结论:在瑞典,围手术期使用他汀类药物似乎并不能提高胃腺癌根治性胃切除术患者的5年生存率。
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引用次数: 0
Ethnic‑specific associations between body mass index and gastric cancer: a Mendelian randomization study in European and Korean populations. 体重指数与胃癌之间的种族特异性关联:欧洲和韩国人群的孟德尔随机研究。
IF 7.4 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-01 Epub Date: 2024-03-18 DOI: 10.1007/s10120-024-01491-9
Zhe Wang, Da Li, Cheng Zhang
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引用次数: 0
Correction: Resistance to FGFR1-targeted therapy leads to autophagy via TAK1/AMPK activation in gastric cancer. 更正:胃癌患者对 FGFR1 靶向疗法的抗药性通过 TAK1/AMPK 激活导致自噬。
IF 7.4 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-01 DOI: 10.1007/s10120-024-01489-3
Rui Peng, Yan Chen, Liangnian Wei, Gang Li, Dongju Feng, Siru Liu, Runqiu Jiang, Shaojiang Zheng, Yun Chen
{"title":"Correction: Resistance to FGFR1-targeted therapy leads to autophagy via TAK1/AMPK activation in gastric cancer.","authors":"Rui Peng, Yan Chen, Liangnian Wei, Gang Li, Dongju Feng, Siru Liu, Runqiu Jiang, Shaojiang Zheng, Yun Chen","doi":"10.1007/s10120-024-01489-3","DOIUrl":"10.1007/s10120-024-01489-3","url":null,"abstract":"","PeriodicalId":12684,"journal":{"name":"Gastric Cancer","volume":" ","pages":"643-645"},"PeriodicalIF":7.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140184158","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
Perioperative chemotherapy with docetaxel plus oxaliplatin and S-1 (DOS) versus oxaliplatin plus S-1 (SOX) for the treatment of locally advanced gastric or gastro-esophageal junction adenocarcinoma (MATCH): an open-label, randomized, phase 2 clinical trial. 多西他赛+奥沙利铂和S-1(DOS)与奥沙利铂+S-1(SOX)围术期化疗治疗局部晚期胃癌或胃食管交界处腺癌(MATCH):一项开放标签、随机、2 期临床试验。
IF 7.4 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-01 Epub Date: 2024-03-08 DOI: 10.1007/s10120-024-01471-z
Zhichao Jiang, Yibin Xie, Wen Zhang, Chunxia Du, Yuxin Zhong, Yuelu Zhu, Liming Jiang, Lizhou Dou, Kang Shao, Yongkun Sun, Qi Xue, Yantao Tian, Shugeng Gao, Dongbing Zhao, Aiping Zhou

Background: It remains unclear whether addition of docetaxel to the combination of a platinum and fluoropyrimidine could provide more clinical benefits than doublet chemotherapies in the perioperative treatment for locally advanced gastric/gastro-esophageal junction (LAG/GEJ) cancer in Asia. In this randomized, phase 2 study, we assessed the efficacy and safety of perioperative docetaxel plus oxaliplatin and S-1 (DOS) versus oxaliplatin plus S-1 (SOX) in LAG/GEJ adenocarcinoma patients.

Methods: Patients with cT3-4 Nany M0 G/GEJ adenocarcinoma were randomized (1:1) to receive 4 cycles of preoperative DOS or SOX followed by D2 gastrectomy and another 4 cycles of postoperative chemotherapy. The primary endpoint was major pathological response (MPR).

Results: From Aug, 2015 to Dec, 2019,154 patients were enrolled and 147 patients included in final analysis, with a median age of 60 (26-73) years. DOS resulted in significantly higher MPR (25.4 vs. 11.8%, P = 0.04). R0 resection rate, the 3-year PFS and 3-year OS rates were 78.9 vs. 61.8% (P = 0.02), 52.3 vs. 35% (HR 0.667, 95% CI: 0.432-1.029, Log rank P = 0.07) and 57.5 vs. 49.2% (HR 0.685, 95% CI: 0.429-1.095, Log rank P = 0.11) in the DOS and SOX groups, respectively. Patients who acquired MPR experienced significantly better survival. DOS had similar tolerance to SOX.

Conclusions: Perioperative DOS improved MPR significantly and tended to produce longer PFS compared to SOX in LAG/GEJ cancer in Asia, and might be considered as a preferred option for perioperative chemotherapy and worth further investigation.

背景:在亚洲,在局部晚期胃癌/胃食管交界处癌(LAG/GEJ)围手术期治疗中,在铂类和氟嘧啶类药物的组合中添加多西他赛是否能比双药化疗带来更多临床益处,目前仍不清楚。在这项随机2期研究中,我们评估了多西他赛+奥沙利铂和S-1(DOS)与奥沙利铂+S-1(SOX)在LAG/GEJ腺癌患者围手术期的疗效和安全性:cT3-4 Nany M0 G/GEJ腺癌患者随机(1:1)接受4个周期的术前DOS或SOX治疗,然后进行D2胃切除术和4个周期的术后化疗。主要终点为主要病理反应(MPR):2015年8月至2019年12月,154名患者入组,147名患者纳入最终分析,中位年龄为60(26-73)岁。DOS导致的MPR明显更高(25.4% vs. 11.8%,P = 0.04)。DOS组和SOX组的R0切除率、3年PFS和3年OS率分别为78.9% vs. 61.8%(P = 0.02)、52.3% vs. 35%(HR 0.667,95% CI:0.432-1.029,Log rank P = 0.07)和57.5% vs. 49.2%(HR 0.685,95% CI:0.429-1.095,Log rank P = 0.11)。获得 MPR 的患者生存率明显更高。DOS与SOX的耐受性相似:亚洲 LAG/GEJ 癌患者围手术期 DOS 能明显改善 MPR,与 SOX 相比,DOS 往往能延长 PFS,可作为围手术期化疗的首选方案,值得进一步研究。
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引用次数: 0
Specific lineage transition of tumor-associated macrophages elicits immune evasion of ascitic tumor cells in gastric cancer with peritoneal metastasis. 胃癌腹膜转移时,肿瘤相关巨噬细胞的特异性细胞系转变引起腹腔肿瘤细胞的免疫逃避。
IF 7.4 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-01 Epub Date: 2024-03-09 DOI: 10.1007/s10120-024-01486-6
Yilin Li, Lei Jiang, Yang Chen, Yanyan Li, Jiajia Yuan, Jialin Lu, Zizhen Zhang, Shengde Liu, Xujiao Feng, Jiaxin Xiong, Yan Jiang, Xiaotian Zhang, Jian Li, Lin Shen

Background: Gastric cancer with peritoneal metastasis (PM-GC), recognized as one of the deadliest cancers. However, whether and how the tumor cell-extrinsic tumor microenvironment (TME) is involved in the therapeutic failure remains unknown. Thus, this study systematically assessed the immunosuppressive tumor microenvironment in ascites from patients with PM-GC, and its contribution to dissemination and immune evasion of ascites-disseminated tumor cells (aDTCs).

Methods: Sixty-three ascites and 43 peripheral blood (PB) samples from 51 patients with PM-GC were included in this study. aDTCs in ascites and circulating tumor cells (CTCs) in paired PB were immunophenotypically profiled. Using single-cell RNA transcriptional sequencing (scRNA-seq), crosstalk between aDTCs and the TME features of ascites was inspected. Further studies on the mechanism underlying aDTCs-immune cells crosstalk were performed on in vitro cultured aDTCs.

Results: Immune cells in ascites interact with aDTCs, prompting their immune evasion. Specifically, we found that the tumor-associated macrophages (TAMs) in ascites underwent a continuum lineage transition from cathepsinhigh (CTShigh) to complement 1qhigh (C1Qhigh) TAM. CTShigh TAM initially attracted the metastatic tumor cells to ascites, thereafter, transitioning terminally to C1Qhigh TAM to trigger overproliferation and immune escape of aDTCs. Mechanistically, we demonstrated that C1Qhigh TAMs significantly enhanced the expression of PD-L1 and NECTIN2 on aDTCs, which was driven by the activation of the C1q-mediated complement pathway.

Conclusions: For the first time, we identified an immunosuppressive macrophage transition from CTShigh to C1Qhigh TAM in ascites from patients with PM-GC. This may contribute to developing potential TAM-targeted immunotherapies for PM-GC.

背景:胃癌腹膜转移(PM-GC)是公认的最致命癌症之一。然而,肿瘤细胞外肿瘤微环境(TME)是否以及如何参与治疗失败仍是未知数。因此,本研究系统评估了PM-GC患者腹水中的免疫抑制性肿瘤微环境及其对腹水播散肿瘤细胞(aDTCs)扩散和免疫逃避的贡献:对腹水中的aDTCs和配对PB中的循环肿瘤细胞(CTCs)进行免疫表型分析。通过单细胞 RNA 转录测序(scRNA-seq),检测了腹水中 aDTCs 与 TME 特征之间的相互影响。在体外培养的aDTCs上进一步研究了aDTCs与免疫细胞串扰的机制:结果:腹水中的免疫细胞与 aDTCs 相互作用,促使它们逃避免疫。具体而言,我们发现腹水中的肿瘤相关巨噬细胞(TAMs)经历了从高猫蛋白酶(CTShigh)到高补体1q(C1Qhigh)TAM的连续系转变。CTShigh TAM最初吸引腹水中的转移性肿瘤细胞,随后最终过渡到C1Qhigh TAM,从而引发aDTCs的过度增殖和免疫逃逸。从机理上讲,我们发现高C1Q TAM能显著增强aDTCs上PD-L1和NECTIN2的表达,而这是由C1q介导的补体途径激活所驱动的:我们首次在 PM-GC 患者腹水中发现了巨噬细胞从 CTShigh 向 C1Qhigh TAM 的免疫抑制转变。这可能有助于开发针对 PM-GC 的潜在 TAM 靶向免疫疗法。
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引用次数: 0
Long-term oncological outcomes of 3D versus 2D laparoscopic gastrectomy for gastric cancer: a randomized clinical trial. 三维与二维腹腔镜胃切除术治疗胃癌的长期肿瘤治疗效果:随机临床试验。
IF 7.4 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-01 Epub Date: 2024-02-20 DOI: 10.1007/s10120-024-01470-0
Qing Zhong, Jun-Yu Chen, Zhi-Xin Shang-Guan, Zhi-Yu Liu, Guang-Tan Lin, Dong Wu, Yi-Ming Jiang, Jia-Bin Wang, Jian-Xian Lin, Qi-Yue Chen, Ju-Li Lin, Jian-Wei Xie, Ping Li, Jun Lu, Chang-Ming Huang, Chao-Hui Zheng

Background: Laparoscopy-assisted gastrectomy (LG) is rapidly gaining popularity owing to its minimal invasiveness. Previous studies have found that compared with two-dimensional (2D)-LG, three-dimensional (3D)-LG showed better short-term outcomes. However, the long-term oncological outcomes in patients with locally resectable gastric cancer (GC) remain controversial.

Methods: In this noninferiority, open-label, randomized clinical trial, a total of 438 eligible GC participants were randomly assigned in a 1:1 ratio to either 3D-LG or 2D-LG from January 2015 to April 2016. The primary endpoint was operating time, while the secondary endpoints included 5-year overall survival (OS), disease-free survival (DFS), and recurrence pattern.

Results: Data from 401 participants were included in the per-protocol analysis, with 204 patients in the 3D group and 197 patients in the 2D group. The 5-year OS and DFS rates were comparable between the 3D and 2D groups (5-year OS: 70.6% vs. 71.1%, Log-rank P = 0.743; 5-year DFS: 68.1% vs. 69.0%, log-rank P = 0.712). No significant differences were observed between the 3D and 2D groups in the 5-year recurrence rate (28.9% vs. 28.9%, P = 0.958) or recurrence time (mean time, 22.6 vs. 20.5 months, P = 0.412). Further stratified analysis based on the type of gastrectomy, postoperative pathological staging, and preoperative BMI showed that the 5-year OS, DFS, and recurrence rates of the 3D group in each subgroup were similar to those of the 2D group (all P > 0.05).

Conclusions: For patients with locally resectable GC, 3D-LG performed by experienced surgeons in high-volume professional institutions can achieve long-term oncological outcomes comparable to those of 2D-LG.

Registration number: NCT02327481 ( http://clinicaltrials.gov ).

背景:腹腔镜辅助胃切除术(LG)因其微创性而迅速普及。以往的研究发现,与二维(2D)胃切除术相比,三维(3D)胃切除术的短期疗效更好。然而,局部可切除胃癌(GC)患者的长期肿瘤治疗效果仍存在争议:在这项非劣效性、开放标签、随机临床试验中,从2015年1月到2016年4月,共有438名符合条件的GC参与者按1:1的比例被随机分配到3D-LG或2D-LG中。主要终点是手术时间,次要终点包括5年总生存期(OS)、无病生存期(DFS)和复发模式:来自401名参与者的数据被纳入按方案分析,其中三维组204名患者,二维组197名患者。三维组和二维组的 5 年 OS 和 DFS 率相当(5 年 OS:70.6% vs. 71.1%,Log-rank P = 0.743;5 年 DFS:68.1% vs. 69.0%,Log-rank P = 0.712)。在5年复发率(28.9% vs. 28.9%,P = 0.958)或复发时间(平均时间22.6个月 vs. 20.5个月,P = 0.412)方面,3D组和2D组之间未观察到明显差异。根据胃切除术类型、术后病理分期和术前体重指数进行的进一步分层分析表明,各亚组中三维组的5年OS、DFS和复发率与二维组相似(P均>0.05):结论:对于局部可切除的 GC 患者,由经验丰富的外科医生在大样本量的专业机构进行 3D-LG 治疗,可获得与 2D-LG 相媲美的长期肿瘤治疗效果:NCT02327481 ( http://clinicaltrials.gov ).
{"title":"Long-term oncological outcomes of 3D versus 2D laparoscopic gastrectomy for gastric cancer: a randomized clinical trial.","authors":"Qing Zhong, Jun-Yu Chen, Zhi-Xin Shang-Guan, Zhi-Yu Liu, Guang-Tan Lin, Dong Wu, Yi-Ming Jiang, Jia-Bin Wang, Jian-Xian Lin, Qi-Yue Chen, Ju-Li Lin, Jian-Wei Xie, Ping Li, Jun Lu, Chang-Ming Huang, Chao-Hui Zheng","doi":"10.1007/s10120-024-01470-0","DOIUrl":"10.1007/s10120-024-01470-0","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopy-assisted gastrectomy (LG) is rapidly gaining popularity owing to its minimal invasiveness. Previous studies have found that compared with two-dimensional (2D)-LG, three-dimensional (3D)-LG showed better short-term outcomes. However, the long-term oncological outcomes in patients with locally resectable gastric cancer (GC) remain controversial.</p><p><strong>Methods: </strong>In this noninferiority, open-label, randomized clinical trial, a total of 438 eligible GC participants were randomly assigned in a 1:1 ratio to either 3D-LG or 2D-LG from January 2015 to April 2016. The primary endpoint was operating time, while the secondary endpoints included 5-year overall survival (OS), disease-free survival (DFS), and recurrence pattern.</p><p><strong>Results: </strong>Data from 401 participants were included in the per-protocol analysis, with 204 patients in the 3D group and 197 patients in the 2D group. The 5-year OS and DFS rates were comparable between the 3D and 2D groups (5-year OS: 70.6% vs. 71.1%, Log-rank P = 0.743; 5-year DFS: 68.1% vs. 69.0%, log-rank P = 0.712). No significant differences were observed between the 3D and 2D groups in the 5-year recurrence rate (28.9% vs. 28.9%, P = 0.958) or recurrence time (mean time, 22.6 vs. 20.5 months, P = 0.412). Further stratified analysis based on the type of gastrectomy, postoperative pathological staging, and preoperative BMI showed that the 5-year OS, DFS, and recurrence rates of the 3D group in each subgroup were similar to those of the 2D group (all P > 0.05).</p><p><strong>Conclusions: </strong>For patients with locally resectable GC, 3D-LG performed by experienced surgeons in high-volume professional institutions can achieve long-term oncological outcomes comparable to those of 2D-LG.</p><p><strong>Registration number: </strong>NCT02327481 ( http://clinicaltrials.gov ).</p>","PeriodicalId":12684,"journal":{"name":"Gastric Cancer","volume":" ","pages":"598-610"},"PeriodicalIF":7.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139912412","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
Adjuvant treatment for locally advanced gastric cancer: an Asian perspective. 局部晚期胃癌的辅助治疗:亚洲视角。
IF 7.4 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-01 Epub Date: 2024-03-15 DOI: 10.1007/s10120-024-01484-8
Hyung-Don Kim, Min-Hee Ryu, Yoon-Koo Kang

Standard adjuvant treatment for locally advanced gastric cancer (LAGC) is regionally different. Whereas perioperative chemotherapy is the standard in Western populations, D2 gastrectomy followed by adjuvant chemotherapy has been the standard in East Asia. Recently, the pivotal phase 3 PRODIGY and RESOLVE studies have demonstrated survival benefits of adding neoadjuvant chemotherapy to surgery followed by adjuvant chemotherapy over up-front surgery followed by adjuvant chemotherapy in Asian patients. Based on these results, neoadjuvant chemotherapy is considered one of the viable options for patients with LAGC. In this review, various aspects of neoadjuvant chemotherapy will be discussed for its optimal application in Asia. Candidates for neoadjuvant chemotherapy should be carefully chosen in consideration of the inaccurate aspects of radiological clinical staging and its potential benefit over up-front surgery followed by a decision on adjuvant chemotherapy according to the pathological stage. Efforts should continuously be made to optimally apply neoadjuvant chemotherapy to patients with LAGC, considering various factors, including a more accurate radiological assessment of the tumor burden and the optimization of post-operative chemotherapy. Future neoadjuvant trials involving novel agents for Asian patients should be designed based on proven Asian regimens rather than adopting Western regimens.

局部晚期胃癌(LAGC)的标准辅助治疗因地区而异。在西方国家,围手术期化疗是标准治疗,而在东亚地区,D2胃切除术后辅助化疗一直是标准治疗。最近,PRODIGY 和 RESOLVE 两项关键性三期研究表明,在亚洲患者中,在手术后辅助化疗的基础上增加新辅助化疗比先行手术后辅助化疗更有利于患者生存。基于这些结果,新辅助化疗被认为是LAGC患者的可行方案之一。在这篇综述中,我们将讨论新辅助化疗的各个方面,以便在亚洲实现最佳应用。新辅助化疗的候选者应谨慎选择,考虑到放射学临床分期的不准确性及其与先期手术相比的潜在益处,然后根据病理分期决定是否进行辅助化疗。考虑到各种因素,包括对肿瘤负荷进行更准确的放射学评估和优化术后化疗,应继续努力优化 LAGC 患者的新辅助化疗。未来针对亚洲患者的新辅助化疗试验应基于成熟的亚洲方案,而不是采用西方方案。
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引用次数: 0
Patient metabolic profile defined by liver and muscle 18F-FDG PET avidity is independently associated with overall survival in gastric cancer. 根据肝脏和肌肉 18F-FDG PET 反应活性确定的患者代谢特征与胃癌患者的总生存期有独立关联。
IF 7.4 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-01 Epub Date: 2024-03-04 DOI: 10.1007/s10120-024-01485-7
Gerardo A Vitiello, Vetri Sudar Jayaprakasam, Laura H Tang, Mark A Schattner, Yelena Y Janjigian, Geoffrey Y Ku, Steven B Maron, Heiko Schoder, Steven M Larson, Mithat Gönen, Jashodeep Datta, Daniel G Coit, Murray F Brennan, Vivian E Strong

Background: PET-CT-based patient metabolic profiling is a novel concept to incorporate patient-specific metabolism into gastric cancer care.

Methods: Staging PET-CTs, demographics, and clinicopathologic variables of gastric cancer patients were obtained from a prospectively maintained institutional database. PET-CT avidity was measured in tumor, liver, spleen, four paired muscles, and two paired fat areas in each patient. The liver to rectus femoris (LRF) ratio was defined as the ratio of SUVmean of liver to the average SUVmean of the bilateral rectus femoris muscles. Kaplan-Meier and Cox-proportional hazards models were used to identify the impact of LRF ratio on OS.

Results: Two hundred and one patients with distal gastroesophageal (48%) or gastric (52%) adenocarcinoma were included. Median age was 65 years, and 146 (73%) were male. On univariate analysis, rectus femoris PET-CT avidity and LRF ratio were significantly associated with overall survival (p < 0.05). LRF ratio was significantly higher in males, early-stage cancer, patients with an ECOG 0 or 1 performance status, patients with albumin > 3.5 mg/dL, and those with moderately differentiated tumor histology. In multivariable regression, gastric cancer stage, albumin, and LRF ratio were significant independent predictors of overall survival (LRF ratio HR = 0.73 (0.56-0.96); p = 0.024). Survival curves showed that the prognostic impact of LRF was associated with metastatic gastric cancer (p = 0.009).

Conclusions: Elevated LRF ratio, a patient-specific PET-CT-based metabolic parameter, was independently associated with an improvement in OS in patients with metastatic gastric cancer. With prospective validation, LRF ratio may be a useful, host-specific metabolic parameter for prognostication in gastric cancer.

背景:基于 PET-CT 的患者代谢谱分析是将患者特异性代谢纳入胃癌治疗的新概念:基于 PET-CT 的患者代谢谱分析是将患者特异性代谢纳入胃癌治疗的一个新概念:方法:从前瞻性维护的机构数据库中获取胃癌患者的分期 PET-CT、人口统计学和临床病理学变量。对每位患者的肿瘤、肝脏、脾脏、四块成对的肌肉和两块成对的脂肪区域的 PET-CT 阳性进行了测量。肝脏与股直肌 (LRF) 的比值定义为肝脏 SUVmean 与双侧股直肌平均 SUVmean 的比值。采用Kaplan-Meier和Cox比例危险模型确定LRF比值对OS的影响:共纳入211例远端胃食管癌(48%)或胃腺癌(52%)患者。中位年龄为65岁,146人(73%)为男性。单变量分析显示,股直肌 PET-CT 阳性率和 LRF 比率与总生存率(p 3.5 mg/dL)和中度分化肿瘤组织学显著相关。在多变量回归中,胃癌分期、白蛋白和LRF比值是总生存率的重要独立预测因素(LRF比值HR = 0.73 (0.56-0.96); p = 0.024)。生存曲线显示,LRF的预后影响与转移性胃癌有关(p = 0.009):患者特异性 PET-CT 代谢参数 LRF 比值升高与转移性胃癌患者 OS 的改善有独立相关性。经过前瞻性验证,LRF比值可能是一个有用的、用于胃癌预后的宿主特异性代谢参数。
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引用次数: 0
Correction: Ubiquitous mitochondrial creatine kinase promotes the progression of gastric cancer through a JNK-MAPK/JUN/HK2 axis regulated glycolysis. 更正:无处不在的线粒体肌酸激酶通过 JNK-MAPK/JUN/HK2 轴调控糖酵解促进胃癌的进展。
IF 7.4 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-01 DOI: 10.1007/s10120-024-01490-w
Yushuai Mi, Quanhui Li, Bingtian Liu, Dehai Wang, Ziping Liu, Tianshi Wang, Yuan Wang, Yifeng Zang, Yan Zhou, Yugang Wen, Yinlu Ding
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引用次数: 0
Racial disparities of gastric cancer in the USA: an overview of epidemiology, global screening guidelines, and targeted screening in a heterogeneous population. 美国胃癌的种族差异:流行病学、全球筛查指南和异质人群针对性筛查概述。
IF 7.4 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-01 Epub Date: 2024-03-04 DOI: 10.1007/s10120-024-01475-9
Jean Woo Mok, Yeong Ha Oh, Deepa Magge, Sekhar Padmanabhan

Gastric cancer is the fifth most common cancer diagnosis and fourth leading cause of cancer-related death globally. The incidence of gastric cancer in the USA shows significant racial and ethnic disparities with gastric cancer incidence in Korean Americans being over five times higher than in non-Hispanic whites. Since gastric cancer is not common in the USA, there are no current screening guidelines. In countries with higher incidences of gastric cancer, screening guidelines have been implemented for early detection and intervention and this has been associated with a reduction in mortality. Immigrants from high incidence countries develop gastric cancer at lower rates once outside of their country of origin, but continue to be at higher risk for developing gastric cancer. This risk does seem to decrease with subsequent generations. With increasing availability of endoscopy, initiating gastric cancer screening guidelines for high-risk groups can have the potential to improve survival by diagnosing and treating gastric cancer at an earlier stage. This article aims to provide context to gastric cancer epidemiology globally, review risk factors for developing gastric cancer, highlight racial and ethnic disparities in gastric cancer burden in the USA, examine current guidelines that exist in high incidence countries, and suggest future studies examining the efficacy of additional screening in high-risk populations to reduce gastric cancer mortality and disparate burden on ethnic minorities in the USA.

胃癌是全球第五大最常见的癌症诊断和第四大癌症相关死亡原因。在美国,胃癌的发病率显示出明显的种族和民族差异,韩裔美国人的胃癌发病率是非西班牙裔白人的五倍多。由于胃癌在美国并不常见,因此目前没有筛查指南。在胃癌发病率较高的国家,已经实施了筛查指南以进行早期检测和干预,这与死亡率的降低有关。来自高发病率国家的移民一旦离开原籍国,患胃癌的比例就会降低,但患胃癌的风险仍然较高。这种风险似乎随着后代的增加而降低。随着内镜检查的普及,针对高危人群启动胃癌筛查指南有可能通过早期诊断和治疗胃癌来提高生存率。本文旨在介绍全球胃癌流行病学的背景,回顾罹患胃癌的风险因素,强调美国胃癌负担中的种族和民族差异,研究高发病率国家的现行指南,并就未来研究提出建议,探讨在高危人群中开展额外筛查的有效性,以降低胃癌死亡率和美国少数民族的不平等负担。
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引用次数: 0
期刊
Gastric Cancer
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