Journal of Gastrointestinal Cancer最新文献

Purpose: Five-year survival for pancreatic adenocarcinoma (PDAC) is < 10% but can vary by a patient's race, socioeconomic status (SES), and the factors related to the neighborhood where a patient lives (nSES) . Prolonged time from diagnosis to first treatment (T2T) is another important disparity indicator. Here, we examined the effect of race, nSES, and patient-level clinical factors on T2T and survival in metastatic PDAC (mPDAC) patients.

Methods: Patients with mPDAC treated at an academic cancer center between 2010 and 2018 (n = 334) were evaluated for nSES measures related to racial concentration, neighborhood deprivation, stability, immigration status, and transportation access from the US Census. We assessed and reported the effects of nSES and patient-level variables (age, race, gender, Charlson Comorbidity Index (CCI), etc.) on T2T and survival using univariate and multivariate Cox proportional hazards regression, hazard ratios (HR), confidence intervals (CI).

Results: 82.9% of the patients were White; 17.1% were Black. Median T2T was 26 days with no significant difference in T2T and survival by race. In multivariable models, no nSES variables were significantly associated with T2T. T2T did not significantly impact survival; however, receipt of chemotherapy (HR = 0.14 [95% CI = 0.06, 0.30]) was associated with better survival outcomes.

Conclusion: Among patients with mPDAC, T2T was not associated with race/ethnic disparities or survival in a mostly White, high SES population treated at a comprehensive cancer center. Future investigations into pancreatic cancer disparities may be warranted in other hospital settings and in larger, more diverse study samples.

Purpose: We designed this study to evaluate the relationship between radiation proctopathy (RP) and the risk of colon and rectal cancer in prostate cancer patients.

Methods: This is a retrospective cohort study evaluating patients with prostate cancer who received pelvic radiation therapy between January 2004 and January 2024. The study aims to compare the incidence of post-radiation rectal and colon cancer between patients who developed RP and patients who did not. We excluded patients with a previous history of colon cancer, colectomy, or inflammatory bowel disease.

Results: In total, 12,629 met the inclusion criteria, 533 patients were diagnosed with RP, and 12,096 were without. We observed a higher incidence of colorectal cancer (3.75% vs. 0.63%), colon cancer (2.06% vs 0.40%), and rectal cancer (1.69% vs 0.23%) in patients with RP compared to those without PR (p < 0.001) during the follow-up period of 81 months for the RP group and 68 months for the non-RP group. PR was associated with colon and rectal cancer with an HR of 4.43 (95% CI, 2.29-8.57; p < 0.0001) and 7.27 (95% CI, 3.43-15.43; p < 0.0001), respectively.

Conclusions: RP is an independent risk factor for developing rectal and colon cancer after pelvic radiation therapy in patients with prostate cancer.

Purpose: Locally advanced carcinoma colon may need en-bloc resection with microscopic negative margin.

Methods: We report our novel technique of internal iliac artery transposition to reconstruct the external iliac artery in a case of locally advanced colonic cancer involving the external iliac artery. In this case, adenocarcinoma of the right colon was seen involving the lower pole of the right kidney, right psoas muscle, right ureter and rt sided external iliac vessels.

Results: Right hemicolectomy was done with right nephrectomy along with resection of the right external iliac artery. The right internal iliac artery was used for the reconstruction of the right external iliac artery.

Conclusion: Internal iliac artery used as a replacement for excised external iliac artery seems to be a valid alternative to synthetic grafts and femoral-femoral bypass.

Purpose: Concurrent Chemo-radiotherapy (CRT) offers attractive approaches providing the opportunity of cure, as well as organ preservation for patients with esophageal cancer and has now become the standard treatment for locally advanced unresectable esophageal cancers. However, one of the major concerns associated with CRT is the potential for treatment-related side effects, including strictures and fistula formation. This study aims to identify the predictors of stricture formation following definitive CRT in esophageal carcinoma.

Materials and methods: 79 patients who underwent definitive CRT for carcinoma esophagus, post cricoid area and gastro-esophageal junction (GEJ), from 2013 to 2023 were included in the study. The medical records of these patients were reviewed to collect data including the following parameters: age, gender, grade of dysphagia at presentation, stage of the disease, circumferential involvement by disease, treatment technique used, dose of radiation, and concurrent chemotherapy used. These factors were then correlated to development of radiation induced stricture.

Result: The median follow-up period was 22.5 months in survivors. Median overall survival was 47 months. The post-treatment stricture occurred in 22 patients (27.85%). The median time to develop a stricture after completing treatment was 4.5 months. In multivariate analysis, factors significantly correlated with post treatment stenosis were stage T4 (P = 0.012) and concurrent chemotherapy with carboplatin and paclitaxel (p=0.034). Other factors like patient age, sex, stage group, length of the involved segment, maximum tumor thickness, RT technique, and radiation dose were not associated with stricture risk.

Conclusion: This study suggested that patients with T4 stage and patients receiving concurrent carboplatin and paclitaxel chemotherapy have higher risk of developing treatment-related esophageal stenosis.

Background: Adjuvant chemotherapy is recommended as an option for patients who have high-risk features. It remains unclear whether all patients with high-risk stage II colon cancer benefit from adjuvant therapy. The primary aim of this study is to evaluate the association between adjuvant chemotherapy and overall survival in patients with high-risk stage II colon cancer.

Methods: Utilizing the Surveillance, Epidemiology and End Results (SEER) database from 2010 to 2019, adult patients with high-risk stage II colon cancer defined as T4 tumor classification, perineural invasion, less than 12 lymph nodes harvested, and poorly differentiated histology. 1:1 ratio propensity matching was used to adjust for confounding variables. Survival differences based on receipt of adjuvant systemic therapy were summarized using a log rank test. Cox proportion hazard regression was used to evaluate overall survival.

Results: Of the 11,619 patients who met inclusion criteria, 2775 (24%) received adjuvant chemotherapy. Patients were more likely to receive adjuvant therapy if they were younger, married or partnered, or had left-sided lesions. Kaplan-Meier estimates showed an improvement in overall survival (log-rank test < 0.001). On pair-stratified Cox proportional hazards regression, adjuvant chemotherapy receipt was associated with 30% lower mortality hazard (hazard ratio [HR] 0.70; 95% CI 0.62, 0.80; p < 0.001). However, on landmark analysis, after excluding patients surviving < 3 months, adjuvant chemotherapy was no longer associated with mortality hazard (HR 0.90; 95% CI 0.79, 1.04; p = 0.144).

Conclusion: The findings from this large SEER database study provide support for not undergoing adjuvant chemotherapy to patients with high-risk stage II colon cancer.

Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal cancers, with a 5-year survival rate that has improved only marginally over the past 30 years, despite numerous clinical trials. PDAC poses several unique challenges, including early metastatic spread and a predilection for liver metastasis. It is also highly resistant to anti-tumor immunity and immunotherapy due to its dense and immunosuppressive tumor microenvironment, low immunogenicity, and systemic immune suppression. PDAC has a low mutational burden, defective antigen presentation, and immune checkpoint molecule upregulation, which reduce immune recognition. Together, these factors leave PDAC as an "immune cold" tumor with minimal cytotoxic T-cell activity. Novel therapeutic approaches are urgently needed to reinvigorate anti-tumor immunity. Recent advances, such as adjuvant personalized mRNA neoantigen vaccines and mutant-KRAS targeted vaccines, have demonstrated sustained vaccine-induced T cell responses that are associated with improved recurrence-free survival in surgically resected PDAC. Combining different vaccine approaches with optimal sequencing of chemotherapy, surgery, radiotherapy, and other immunotherapies may further enhance outcomes. PDAC vaccines represent a promising strategy for overcoming PDAC's resistance to conventional therapies, with ongoing trials exploring their potential to improve long-term survival.

Currently, those recommended to undergo pancreatic cancer (PC) surveillance include appropriately aged individuals at high risk of PC due to an identifiable genetic susceptibility or those without identifiable genetic susceptibility who nonetheless have a strong family history of PC. With increases in identification of individuals at high risk for PC and increased use of PC surveillance in clinical practice, there has been increasing debate about who should undergo surveillance as well as how surveillance should be performed including use of imaging and blood-based testing. Furthermore, there is increasing interest in the outcomes of PC surveillance in high-risk individuals with some studies demonstrating that surveillance leads to downstaging of PC and improvements in survival. In this review, we summarize the current state of PC surveillance in high-risk individuals, providing an overview of the risk factors associated with PC, selection of high-risk individuals for PC surveillance, and the current, but non-uniform, recommendations for performing PC surveillance. Additionally, we review approaches to apply various imaging and blood-based tests to surveillance and the outcomes of PC surveillance.

Background: Docetaxel-cisplatin-5-fluorouracil (DCF) is a new standard neoadjuvant therapy for locally advanced esophageal squamous cell carcinoma (ESCC) in Japan. However, some patients experience recurrence and require further systemic platinum-containing chemotherapy. It is unclear whether such regimens are appropriate after a poor histopathological response to neoadjuvant DCF.

Methods: Data were retrospectively collected on patients with recurrence of ESCC treated with palliative chemotherapy after neoadjuvant DCF at our institution between February 2014 and June 2022. We defined patients with a grade 0-1 histopathological response as insufficient responders (IRs) and those with grade 2-3 as good responders (GRs). The correlation between the histopathological response and the response to palliative chemotherapy was investigated.

Results: Thirty-two patients (median age 63.5 years, range 46-76) were included. Performance status was 0 in 12 (37.5%), 1 in 16 (50.0%), and 2 in 4 (12.5%). Histopathological response grades 0/1/2/3 were 3.1%/68.7%/21.9%/6.3%, respectively. Platinum-containing chemotherapy was administered to 13 patients (56.5%) in the IR group and 9 (100%) in the GR group. The overall response rate was 34.8%, and median progression-free survival was 2.431 months in the IR group and 44.4% and 4.041 months, respectively, in the GR group. Multivariate analysis identified a chemotherapy-free interval of < 6 months as an independent prognostic factor (HR 4.096, 95% CI 1.116-15.037) but not the histopathological response (HR 1.137, 95% CI 0.309-4.177).

Conclusions: Histopathological response to neoadjuvant DCF therapy did not affect the efficacy of first-line chemotherapy for recurrent ESCC.

Background: Pancreaticoduodenectomy (PD) is a complex operation associated with high morbidity, especially in the setting of hepatic fibrosis/cirrhosis and portal hypertension. Portal hypertension can be a near-certain contraindication for PD, potentially precluding patients with resectable malignancy from a curative operation. Transjugular intrahepatic portosystemic shunt (TIPS) is an artificial path between the portal vein and suprahepatic veins for decreasing the portal pressure, defined as a hepatic venous pressure gradient > 5 mmHg. TIPS can be used as a bridge to facilitate the safe performance of PD.

Methods: This is a single-institution retrospective analysis of patients treated with TIPS prior to PD from July 2011 to July 2022. The patient's preoperative management, perioperative course, and postoperative complications were analyzed and reported.

Results: Out of 1140 patients in a pancreatic resection database, four underwent preoperative TIPS before PD. The cohort included two males and two females, with a mean age of 66 years and body mass index of 30.2. All patients had portal hypertension, with a reduction in the mean gradient following TIPS, 13 mmHg to 2.5 mmHg. Three patients had cirrhosis, and one had portal thrombosis. The median estimated blood loss and operative time were 275 mL and 267 min, respectively. Postoperatively, one patient experienced a grade IIIa complication and three developed hepatic encephalopathy at a median of 98 days. All patients received chemo-radiation (two neoadjuvant, three adjuvant) and developed recurrent metastatic disease at a median of 13.5 months. Median overall survival was 21.8 months.

Conclusion: TIPS in patients with portal hypertension should be considered as a bridge to a safe PD for patients with peri-ampullary adenocarcinoma.

Background: Low-density lipoprotein cholesterol (LDL) is associated with the occurrence of colorectal cancer (CRC). This study aims to investigate its prognostic role and associated clinicopathological factors in the metastatic setting.

Methods: Patients with newly diagnosed synchronous metastatic CRC were included. Patients were grouped according to the serum LDL levels at the diagnosis (≤ 130 mg/dL: Normal-LDL, > 130 mg/dL: High-LDL). LDL-associated clinicopathological factors, progression-free survival (PFS), and overall survival (OS) were assessed.

Results: A total of 90 patients were included. 44.4% (n = 40) was in the normal-LDL and 56.6% (n = 50) in the high-LDL group. Colonic localization of the primary tumor was more frequent in the high-LDL group (90% vs. 67.5%, p = 0.009). The high-LDL group more frequently had local treatments [metastasectomy (26% vs. 2.5%, p = 0.002) and embolization-ablation (38% vs. 17.5%, p = 0.033)]. Despite higher curative intent with local treatments in the high-LDL group, PFS [10.03 months (95% Confidence Interval (CI):6.97-14.77) vs 9.63 mo. (95% CI: 7.93-14.00), p = 0.872] and OS [20.87 mo. (95% CI: 14.87-36.47) vs. 17.63 mo. (95% CI: 14.30-43.03), p = 0.925] did not differ from the normal-LDL. Among patients treated without any curative intent, high LDL was associated with significantly worse PFS [4.97 mo. (95% CI: 3.00-7.73) vs. 8.43 mo. (95% CI: 6.10-9.90), p = 0.048].

Conclusion: This study suggests that serum LDL is associated with colonic primary localization in synchronous metastatic CRC. Levels > 130 mg/dL at diagnosis may be associated with worse survival and may be further investigated as a biomarker. Larger, multicenter and prospective studies are needed.