Journal of gastrointestinal oncology最新文献

Background: Metastatic colon cancer (MCC) is a debilitating condition with a poor prognosis. Currently, there is limited data that investigates MCC in relation to mismatch repair (MMR) status. The aims of this study are to compare sociodemographic and clinicopathologic features and mortality between patients with MMR-proficient (MMR-P) and MMR-deficient (MMR-D) MCC.

Methods: We performed an 8-year retrospective review of the National Cancer Database (NCDB) to identify patients age ≥18 years with MCC and reported MMR status. Data collection included sociodemographic characteristics, primary tumor sites and histopathologic features, and treatment modalities. Outcomes included 90-day, 180-day, 1-year, and 2-year overall mortality. Bivariate logistic regression and multivariate Cox regression identified differences between MMR-P and MMR-D and identified predictors of mortality, respectively.

Results: A total of 10,922 MCC cases were identified; 8,796 (80.53%) were MMR-P and 2,126 (19.47%) were MMR-D. MMR-D was independently associated with older age at diagnosis, female sex, mucinous adenocarcinoma, medullary carcinoma, and lymph-vascular invasion. MMR-P was independently associated with perineural invasion and left-sided colonic primary tumor predominance. When adjusted for demographics, histology, and treatment modalities, MMR-D was associated with mortality at 180 days, 1 year, and 2 years.

Conclusions: Our study identified several key sociodemographic and clinicopathologic features of MMR-D MCC. MMR-D appears to confer increased overall mortality at 180 days, 1 year, and 2 years after diagnosis in MCC.

Background: As the population of elderly patients with esophageal cancer (EC) increases, it becomes more important to understand the prognostic factors. The aim of the present study is to identify prognostic factors among elderly (>60 years) patients with EC receiving neoadjuvant therapy.

Methods: Patients with EC (>60 years) receiving neoadjuvant chemotherapy (nCT) or chemoradiotherapy (nCRT) diagnosed between 2004 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were included and divided into a training group and a validation group. Nomograms were constructed based on the Cox proportional risk model. Receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and integrated discrimination improvement (IDI) were used to evaluate the nomogram model. We determined the optimal cutoff value for the scores in terms of overall survival (OS) by X-tile software and divided patients into three different risk groups.

Results: A total of 1,392 patients were included [training group (n=976) and a validation group (n=416)]. Male, T stage, M stage, and N stage were revealed as independent risk factors for poor prognosis (P<0.05). There was no significant difference between nCT and nCRT in prognosis. A novel nomogram model was established based on the above factors. The ROC curve indicated a moderate discriminative power of the nomogram. The DCA demonstrated the clinical value of the nomogram. The nomogram model was superior to the tumor-node-metastasis (TNM) staging system, with an IDI value of 0.006 (P=0.02). Patients classified as low-risk had a better OS, with P values of <0.001 and <0.001 in the validation cohort and training cohort, respectively.

Conclusions: The established nomogram and risk-stratification system were able to improve the precision of prognosis prediction for elderly EC patients.

Background: Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related death globally and accounts for 75% to 90% of primary liver cancer cases. The high mortality rate of HCC, coupled with the absence of reliable prognostic biomarkers, makes its treatment and prognosis evaluation challenging. The features of the T cell-inflamed microenvironment include active interferon (IFN)-γ signaling and the presence of cytotoxic effector molecules, antigen presentation, and T-cell activating cytokines. Although these features are closely associated with anticancer immunity, their specific roles in HCC remain unclear. This study aimed to investigate the role and prognostic significance of T-cell inflammation (TCI) in HCC patients, providing new insights for clinical diagnosis and treatment strategies.

Methods: We integrated single-sample gene set enrichment analysis (ssGSEA) and weighted gene coexpression network analysis (WGCNA) to identify the genes associated with TCI at both the single-cell and bulk-transcriptome levels. The HCC TCI-related score (HTCIRS) was developed and assessed with 10 different machine learning algorithms and their combinations, which was followed by validation of the key gene KLF2 in clinical samples and tissue microarrays (TMAs).

Results: We identified 65 genes associated with TCI, of which 36 were significantly correlated with overall survival (OS). The HTCIRS demonstrated excellent performance in prognostic prediction, revealing differences in biological functions and immune cell infiltration between different risk groups within the tumor microenvironment (TME). Furthermore, KLF2 was identified to be linked to the prognosis of patients with HCC.

Conclusions: The TCI-related score proposed in this study serves as an important tool for prognostic prediction and personalized treatment of patients with HCC, with KLF2 emerging as a potential biomarker for predicting the prognosis of patients with HCC.

Background: Hepatocellular carcinoma (HCC) is a significant health problem associated with several risk factors, increasingly driven by non-alcoholic steatohepatitis and metabolic syndrome. This association poses a challenge for the primary treatments of HCC, which may include immune checkpoint inhibitors and vascular endothelial growth factor inhibitors, due to their potential cardiotoxic effect. Therefore, it is imperative to balance the therapeutic effects of these agents with their potential cardiovascular adverse events.

Case description: We describe the case of a man in his seventies with advanced HCC and significant cardiovascular comorbidities who was treated with atezolizumab and bevacizumab. Despite achieving a clinical and radiologic complete response, the patient experienced a deterioration in cardiac function after 16 months, necessitating the discontinuation of bevacizumab. The patient continued to respond well to atezolizumab, but unfortunately, he passed away due to a cardiac event after 4 years of follow-up.

Conclusions: Careful risk stratification and optimization of modifiable risk factors is of uttermost importance in management of HCC. Close monitoring, comprehensive patient management in a cardio-oncology clinic is also vital, particularly for patients at high risk of developing cardiovascular adverse events. The delicate balance between the efficacy of cancer treatments and their potential cardiotoxicity is one of the principal determinants of outcomes of patients diagnosed with HCC.

Background: Esophageal squamous cell carcinoma (ESCC) is a highly prevalent and malignant form of esophageal tumor associated with high rates of patient mortality for which there remains a persistent lack of effective targets for therapeutic interventional efforts. This study was developed with the goal of exploring the expression and functional role of RBM15 in ESCC.

Methods: This study was developed with the goal of exploring the expression and functional role of RBM15 in ESCC. To establish the prognostic and therapeutic significance of RBM15 in this cancer, data from the Gene Expression Omnibus (GEO), The Cancer Genome Atlas (TCGA), and UCSC Xena databases were leveraged. Immunohistochemical analyses were used to assess RBM15 expression in postoperative ESCC tumor tissue samples, and the correlations between such expression and patient outcomes were assessed. The effects of RBM15 on ESCC cell proliferative, migratory, and invasive activity were assessed with Cell Counting Kit-8 (CCK8) and Transwell assay approaches. Together, these experiments revealed RBM15 upregulation in ESCC relative to paracancerous tissues, while confirming that it was associated with favorable patient outcomes. RBM15 was also found to suppress ESCC cell proliferation, migration, and invasivity.

Results: We suggest that RBM15 may be a clinically relevant prognostic factor in ESCC such that new therapeutic interventions based on low levels of RBM15 have the potential to be developed for the improved management of ESCC in the future.

Conclusions: The results of the present study provide confirmation that high levels of RBM15 expression are protective and associated with better ESCC patient prognostic outcomes. Pan-cancer analyses performed herein also revealed the correlations between RBM15 expression and prognosis in various cancers.

Background: The impact of prolonged surgical waiting time (SWT) on the prognosis of pancreatic ductal adenocarcinoma (PDAC) remains controversial. This study aimed to explore the impact of prolonged SWT on PDAC-specific mortality (PSM).

Methods: The data of patients with stage I-II primary PDAC who received radical resection were obtained from the Surveillance, Epidemiology, and End Results database. The trends analysis was performed to explore the association between the year of diagnosis and SWT. The Fine-Gray multivariate competing risk analysis was performed to determine the impact of prolonged SWT on PSM.

Results: A total of 8,562 patients were included in this study. In general, SWT had an increasing trend from 2007 to 2017. Multivariate survival analysis showed that SWT of ≥1 month and <2 months was not associated with PSM, while SWT of ≥2 months and <4 months was associated with a lower risk of PSM.

Conclusions: We found that prolonged SWT does not affect or worsen PSM of patients with stage I-II PDAC who underwent successful radical resection. Our findings offer useful evidence about the association between prolonged SWT and PSM, which may relieve patients' and doctors' psychological stress related to delayed surgery to some extent.

Background: Regorafenib, approved in China for the third-line treatment of patients with metastatic colorectal cancer (mCRC), targets multiple tyrosine kinases. We retrospectively evaluated the efficacy and safety of regorafenib, both as monotherapy and in combination with capecitabine or immune checkpoint inhibitors (ICIs), as a second-line treatment for patients unable to access hospital-based care due to limited hospital visits during the coronavirus disease 2019 (COVID-19) pandemic.

Methods: Retrospective analysis was conducted on individual patient data from Peking University Third Hospital, covering the period from January 2020 to September 2023. The primary endpoint was progression-free survival (PFS), with secondary endpoints including overall survival (OS) and safety.

Results: The study comprised 31 patients with a median age of 65 years. The median PFS (mPFS) was 6.0 months, while the median OS (mOS) was 20.0 months. Compared to those treated with regorafenib alone, patients treated with regorafenib plus capecitabine/ICIs tended to have a longer PFS (8.0 vs. 4.0 months) and OS (27.0 vs. 15.0 months). Liver metastases [hazard ratio (HR) =2.515, 95% confidence interval (CI): 1.037-6.100; P=0.04] and prior bevacizumab treatment (HR =2.613, 95% CI: 1.168-5.846; P=0.02) were identified as independent prognostic factors for PFS. Frequent grade 3/4 adverse drug reactions (ADRs) included hand-foot skin reactions (HFSRs), fatigue, hypertension, and proteinuria.

Conclusions: This single-center, retrospective study indicates that regorafenib, alone or combined with chemotherapy/immunotherapy, is a feasible and safe second-line treatment for mCRC for situations where hospital access is limited, such as during the COVID-19 pandemic. Additional prospective studies are required to investigate the advantages of combination therapies.

Background: Classic Hodgkin lymphoma (CHL) is an extremely common non-acquired immunodeficiency syndrome (AIDS) defining malignancy and its incidence is rising. CHL is usually present in the lymph node and extranodal involvement is rare. Primary CHL of the gastrointestinal (GI) tract is exceedingly rare.

Case description: In this case, a patient with human immunodeficiency virus (HIV)/AIDS and disseminated leishmaniasis presented with a small bowel mass leading to bowel perforation. Histologically, the small bowel mass showed a transmural infiltrate of scattered large atypical multinucleated cells surrounded by histiocytes and T-cells. Initial differential diagnosis was wide due to the unusual presentation and cytologic atypia of the tumor cells. Identifying the Hodgkins Reed-Sternberg (HRS) cells with their unique immunophenotype was key for diagnosis.

Conclusions: It is critical to identify secondary CHL in HIV/AIDS patients especially in the presence of immunodeficiency and disseminated opportunistic infection. Extranodal primary GI tract CHL is exceedingly rare and thus awareness of this entity, which can mimic many other tumors, especially in immunocompromised individuals, is important. Special stains and cultures are helpful for the diagnosis, and antimicrobial therapy will induce successful clinical outcome. Overall, the unusual combination of acute clinical presentation, leishmaniasis, and HIV made the histological recognition of CHL crucial to avoid misdiagnosis and guide successful clinical management.

Background: Hepatocellular carcinoma (HCC) constitutes approximately 75-85% of primary liver cancers and is a heavy burden on public health. Many innovative prediction systems have integrated radiomics, artificial intelligence, pathological information, or even genetic information for the stratification and prognosis prediction of patients with HCC. However, these systems still lack practical and clinical applications. Classical HCC staging systems remain the mainstream tool for stratification and prediction of treatment efficacy to date; although, variable characteristics and emphases between different classical HCC staging systems render its clinical selection inconsistent and therefore may be unreliable. In this study, we aimed to compare the predictive performance of classical liver cancer staging systems, including China Liver Cancer (CNLC), Barcelona Clinic Liver Cancer (BCLC), Hong Kong Liver Cancer (HKLC), modified Japanese Integrated Staging (mJIS), modified Cancer of the Liver Italian Program (mCLIP), and Tumor-Node-Metastasis (TNM) staging system, for the efficacy and prognosis of transcatheter arterial chemoembolization (TACE) in HCC patients.

Methods: A total of 148 patients with HCC who received TACE as the initial therapy between 02/01/2019 and 08/31/2022 were retrospectively included. Patients' clinical information, laboratory and imaging data, were collected. Cox regression analysis was applied to identify independent risk factors for progression-free survival (PFS) and overall survival (OS). Six liver cancer staging systems, including the CNLC, BCLC, HKLC, mJIS, mCLIP, and TNM staging system, were applied for the staging of every enrolled patient. The PFS and OS of patients with HCC following initial TACE in different staging systems were assessed, and the predictive performance of different systems was evaluated using the concordance index.

Results: The presence of portal vein tumor thrombus (PVT), alpha fetoprotein (AFP) ≥400 ng/mL, and ineffective initial TACE treatment were independent risk factors for overall disease progression, while the presence of PVT and ineffective initial TACE treatment were independent risk factors for death. In the prediction of PFS and OS, CNLC, BCLC, HKLC, mJIS, and mCLIP all showed good predictive ability, but the predictive ability of the TNM staging system was relatively poor.

Conclusions: The CNLC, BCLC, HKLC, mJIS, and mCLIP staging systems provide comparable predictive value for the prognosis after the initial TACE, while the TNM staging system has poor predictive ability due to its exclusion of hepatic function.

Background: The RTOG 85-01 trial established that definitive concurrent chemoradiotherapy (CCRT) is the standard treatment for inoperable, locally advanced esophageal carcinoma, as well as for patients who decline surgery. The present study aims to compare the impact of three treatment modalities, CCRT, induction chemotherapy (ICT) followed by CCRT (ICT + CCRT), and CCRT followed by consolidation chemotherapy (CCT) (CCRT + CCT), on the survival of patients with inoperable esophageal squamous cell carcinoma (ESCC).

Methods: This retrospective analysis was conducted with 391 patients with ESCC who underwent radical CCRT with induction or CCT or CCRT only from January 2016 to October 2020 at the Fourth Hospital of Hebei Medical University in Shijiazhuang, Hebei province, China. Propensity score matching (PSM) analyses were performed. The primary outcome measure was efficacy included overall survival (OS) and progression-free survival (PFS). The final follow-up date ended on 31 May 2024.

Results: It showed a significantly better survival curve for OS in the CCRT + CCT group than the CCRT group (P=0.02, χ²=5.503). It showed a significantly better survival curve for PFS in the CCRT + CCT group than the CCRT group (P=0.002, χ²=9.788). It showed a significantly better survival curve for OS in the CCRT + CCT group than the ICT + CCRT group (P=0.046, χ²=3.986). It showed a significantly better survival curve for PFS in the CCRT + CCT group than the ICT + CCRT group (P=0.01, χ²=6.610). No significant differences were showed in treatment-related adverse events. Lesion length, N-staging, and combination of radiotherapy and chemotherapy were the independent prognostic factors for OS and PFS.

Conclusions: For inoperable ESCC patients, CCRT + CCT showed the best OS and PFS rates than ICT + CCRT and CCRT. There were no significant differences in treatment-related adverse events. Lesion length, N-staging, and combination of radiotherapy and chemotherapy were the independent prognostic factors for OS and PFS.