Journal of Gastrointestinal Cancer最新文献

Purpose: Patients undergoing cholecystectomy for a presumed benign disease may present with histopathology report revealing carcinoma in the gallbladder specimen, in which case it is referred to as incidental gallbladder cancer (IGBC). This review highlights the approach to evaluation and management of these patients.

Methods: Available literature from various sources has been reviewed and presented in a narrative format.

Results: Early referral to a tertiary centre for appropriate staging and definitive management is paramount. Once distant metastasis is ruled out, re-resection is indicated in patients with pathological T-stage ≥T1b with the aim to attain R0 resection, and perform complete staging lymphadenectomy, and has been shown to confer survival benefit. Feasibility and safety of minimally invasive approaches have been demonstrated in recent years. Role of peri-operative chemo(radio)-therapy in IGBC remains uncertain and prospective trials are warranted.

Conclusion: IGBC is being increasingly diagnosed as the number of cholecystectomies for presumed benign diseases is steadily increasing globally. Overall prognosis depends on the stage and is especially poor in those with residual disease at re-operation.

Introduction: The number of urgent referrals for suspected colorectal cancer in the NHS is constantly on the rise placing significant strain on endoscopy services. Alternatives or adjuncts to colonoscopy are the need of the hour. CT colonography (CTC) is gaining popularity demonstrating comparable sensitivity albeit concerns regarding missed lesions especially in the anorectum. In theory, this can be overcome by combining flexible sigmoidoscopy with CTC, and this is still in practice in some centres in the UK. The UK Bowel Cancer Screening Programme (UK BCSP) guidelines however suggest that additional endoscopy is not required alongside CTC to improve diagnostic yield. This study primarily aims to determine the need to perform flexible sigmoidoscopy/endoscopy in conjunction with CTC, in a view to reduce the number of unwarranted endoscopic investigations.

Methods: A single tertiary centre analysis was performed from 2019 to 2022 comprising of symptomatic/high risk patients referred to the colorectal clinic on the 2-week wait pathway, patients under polyp/cancer surveillance and patients undergoing endoscopic investigations following inpatient admission. Findings on endoscopy were compared with those on CTC with significant findings being defined as polypoidal lesions ≥ 5 mm, benign and malignant. Classification matrices were generated for each outcome, and sensitivity analysis was performed.

Results: A total of 480 patients were included with a median age of 71 years and a male-to-female ratio of 1:1.02. The incidence of histologically proven malignancy was 30/480 (6.3%). The sensitivity of CTC for detection of malignancy in relation to histology was 93.3% (confidence interval (CI) 77.9%, 99.2%) while that for endoscopy was higher at 96.7% (CI 82.8%, 99.9%). For the detection of polyps ≥ 5 mm, the relative sensitivity and specificity of CTC with respect to endoscopy were 77.7% (CI 68.9%, 85.0%) and 98.9% (CI 97.3%, 99.7%). Overall, 2 cancers and 25 polyps were missed by CTC. In total, 70.3% of these missed lesions were in the transverse colon, descending and the sigmoid colon (left-sided lesions).

Conclusion: Among patients undergoing investigation for suspected colorectal cancer, CTC demonstrated high sensitivity for malignancy but was less reliable than endoscopy for detecting significant polyps (≥ 5 mm). Our findings suggest that although CTC is effective as a standalone investigation, selective endoscopic assessment may still be necessary to optimise diagnostic yield.

Patients with hepatopancreatobiliary (HPB) cancers may experience financial toxicity as a result of diagnosis and treatment. We characterized the prevalence and predictors of financial toxicity among United States (U.S.) HPB cancer patients using the National Health Interview Survey. Outcomes were delaying medical care due to cost or being unable to afford necessary medical care within the past 12 months. Prevalence was estimated in univariable analyses and sociodemographic predictors were identified in multivariable analyses. Among 5,630,270 U.S. adults with self-reported HPB cancer, 567,531 (10.1%) delayed medical care due to cost and 474,632 (8.4%) were unable to afford necessary medical care within the past 12 months. Uninsured patients were more likely to delay care due to cost (aOR 14.38, 95% CI 4.81-43.01) or to be unable to afford necessary medical care (aOR 19.93, 95% CI 6.45-61.55). Non-White race (aOR 2.01, 95% CI 1.06-3.81) was a risk factor for delaying care due to cost, whereas household income < 200% of the federal poverty level (aOR 2.69, 95% CI 1.20-6.04) was associated with inability to afford necessary medical care. Patients who had received surgery within the past 12 months were not at higher odds of either financial toxicity outcome. Targeted interventions to mitigate financial toxicity among at-risk patients are warranted to alleviate the financial burden of HPB cancer care.

Background: Biliary tract cancer (BTC) represents a heterogeneous disease spectrum associated with an unfavorable prognosis. A combination of immunotherapy and chemotherapy has become a new standard strategy for advanced BTC. However, understanding the association between genomic alterations and outcomes of immunotherapy in BTC is crucial for further improving clinical benefits.

Method: Patients with metastatic BTC were included in this study retrospectively, who received PD-1/PD-L1 (ICI) antibodies combined with chemotherapy. The primary endpoint was progression-free survival (PFS), and the secondary endpoints included overall response rate (ORR) and disease control rate (DCR). Additionally, we conducted exploratory analysis of genomic alterations and biomarkers.

Results: Ninety-one patients were enrolled in this study. The patients were divided into two groups: albumin paclitaxel + S1 (AS) + PD-1 (n = 56) group and GC + ICI (n = 35) group. There were no significant differences in terms of PFS, ORR, and DCR between the two groups. Regarding biomarker analysis, 44 patients had positive PD-L1 expression, with a mPFS of 4.8 months and an ORR of 15.9%. Surprisingly, 29 patients had negative PD-L1 expression, with a mPFS of 9.9 months and an ORR of 27.6%. The average tumor mutational burden (TMB) was 4.5 mutations per megabase (mut/MB) for patients with microsatellite-stable (MSS) tumors. There was no significant difference in PFS between patients with TMB high and low (cutoff = 4.5 mut/MB). Genomic analysis revealed TP53 (n = 13, 43.3%), KRAS (n = 8, 26.7%), NTRK1/2/3 (n = 8, 26.7%), isocitrate dehydrogenase (IDH) 1/2 (n = 6, 20.0%), PIK3CA (n = 6, 20.0%), BRCA2 (n = 5, 16.7%), MDM2/4 (n = 5, 16.7%), and BRAF (n = 4, 13.3%) as the most common gene alterations. MDM2/4 mutations were associated with shorter survival (p < 0.05).

Conclusion: GC plus immunotherapy is still the standard of care for late stage BTC. PD-L1 expression and TMB were not good predictors for selecting patients who would benefit more from immunotherapy plus chemotherapy.

Background and aims: Currently, there are no biomarkers with high accuracy in the detection of pancreatic cancer. This article aims to evaluate the performance of a novel diagnostic model based on a combination of biomarkers in the washing fluid obtained by EUS-FNA with imaging examination in pancreatic cancer.

Methods: This study included 59 patients with pancreatic lesions who underwent EUS-FNA and were categorized into malignant and benign groups on the basis of pathology diagnosis. The levels of CEA, CA19-9, CA125, CA724, CYFRA 21-1, IMP3, SMAD4, and S100P in EUS-FNA washing fluid were detected by ELISA. We attempted to construct a new diagnostic method by combining the above biomarkers with EUS, CT, MRI, and PET-CT.

Results: CEA, CA19-9, CA724, CA125, and CYFRA 21-1 showed statistical significance in the diagnosis of pancreatic cancer (AUC > 0.7, p < 0.05). CA724 had a specificity of up to 100% in the group with positive EUS diagnosis. If at least two positive imaging results (EUS/CT/MRI/PET-CT) combined with at least one tumor marker (CEA/CA199/CA724) in series, the sensitivity was 88.57% and the specificity was 91.67%.

Conclusions: Combining the tumor markers CEA, CA19-9, CA724, CA125, and CYFRA 21-1 in the washing fluid of EUS-FNA with commonly used imaging methods can help distinguish benign and malignant pancreatic lesions.

Introduction: Metastatic and recurrent gastrointestinal stromal tumors (GISTs) present challenging clinical management. Imatinib is the standard first-line therapy, improving survival and reducing tumor burden in the neoadjuvant use, facilitating surgical intervention. This systematic review and meta-analysis assessed the efficacy of neoadjuvant imatinib in metastatic/recurrent GISTs, highlighting its potential to enhance surgical outcomes and overall patient management.

Methods: A systematic search was conducted in PubMed, Embase and Scopus (end-of-search: February 13, 2025) for records on neoadjuvant imatinib therapy in recurrent/metastatic GISTs. Pooled proportions and 95% confidence intervals were calculated with common-effect and random-effects models. Subgroup and meta-regression analysis were performed, addressing heterogeneity and examining any potential association between the factors that varied and the outcomes reported. The present meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.

Results: The search identified 957 articles, and 14 were analyzed. The meta-analysis of proportions indicated that 2-year and 5-year PFS were 76% (95% CI 58-88%) and 43% (95% CI 17-74%), respectively, while 2-year and 5-year OS were 84% (95% CI 78-89%) and 60% (95% CI 51-68%), respectively. The pooled R0 resection rate was 82% (95% CI 64-92%), associated positively with that of radiological partial response (PR) (β = 3.92, p < 0.001). Further meta-regression analysis yielded no significant association with preoperative imatinib duration.

Conclusion: The present meta-analysis of trials and studies on metastatic or recurrent GISTs highlights key insights into post-surgery patient outcomes following neoadjuvant treatment with imatinib. Pooled effect estimates revealed promising 2-year and 5-year PFS rates of 76% and 43%, respectively, and 2-year and 5-year OS rates of 84% and 60%, respectively. Furthermore, the high pooled R0 resection rate of 82% emphasizes a substantial surgical efficacy in this population, while it was significantly correlated with successful R0 resections in patients with favorable outcomes.

Purpose: Increased level of circulating myeloid -derived suppressor cells (MDSCs) in colorectal cancer (CRC) patients has been associated with higher tumor stage and poorer survival due to poorer response to therapeutic agents. However, studies reported inconsistent results on how chemotherapeutic agents affecting the depletion of two major types of MDSCs, polymophonuclear MDSC (PMN-MDSC) and monocytic MDSC (M-MDSC). The present study aims to learn deeper on the dynamic changes of circulating MDSCs, especially in response to oxaliplatin-based treatment in CRC patients.

Methods: This was a prospective study that recruited 30 treatment-naive patients with varying stages of CRC who were scheduled to receive oxaliplatin-based chemotherapy. Blood sampling was conducted prior to and at several time points during and after chemotherapy. Multicolor flow cytometry assay was used to analyse the proportion of HLA-DR^- and CD33⁺ with CD15⁺ (PMN-MDSCs) or CD14⁺ (M-MDSCs) cells within peripheral blood mononuclear cells (PBMCs). Other essential tumor biomarkers such as carcinoembryonic antigen (CEA) and tumor-infiltrating lymphocytes (TILs) were also assessed. As a control, 14 healthy subjects were recruited in this study.

Results: Indonesian treatment-naive CRC patients exhibited significantly higher circulating PMN-MDSCs compared to healthy subjects (p = 0.003), while M-MDSCs levels showed no significant difference between the groups (p = 0.890). Following chemotherapy, the MDSCs level demonstrated dynamic changes. Interestingly, a subgroup of CRC patients with decreased in both PMN- and M-MDSCs levels on D-14 of chemotherapy consistently showed a significant reduction in MDSCs levels during and after therapy completion compared to baseline (p = 0.0078).

Conclusions: Circulating MDSCs level, particularly PMN-MDSCs, in CRC patients, was significantly higher compared to healthy subjects. Changes in both circulating PMN- and M-MDSCs levels at D-14 chemotherapy might have prognostic value in oxaliplatin-based chemotherapy.

Background: Gastric cancer (GC) is one of the most prevalent cancers worldwide, with high mortality and economic burden. Early detection through cost-effective screening strategies can improve patient outcomes and optimize healthcare resource allocation. This systematic review evaluates the cost-effectiveness of various GC screening approaches.

Methods: A comprehensive search was conducted in Web of Science, Scopus, PubMed, Embase, the NHS Economic Evaluation Database, and Google Scholar for studies published between 1990 and 2023. Relevant studies were selected based on predefined inclusion and exclusion criteria. The CHEERS 2022 checklist was used to assess study quality.

Results: A total of 6027 studies were retrieved, and after a two-phase screening and quality assessment, 47 studies were included. Most studies originated from China, Japan, the USA, Singapore, and South Korea. Findings indicate that screening is generally more cost-effective than no screening. Endoscopy was more cost-effective than upper gastrointestinal (UGI) X-ray but not superior to Helicobacter pylori (H. pylori) screening, serum pepsinogen (PG) testing, or novel risk scoring methods. H. pylori screening was more cost-effective than endoscopy and symptomatic treatment but not superior to serum PG testing and risk scoring methods. Urea breath test (UBT)-based H. pylori screening was less cost-effective than most alternatives.

Conclusions: Selecting cost-effective GC screening strategies can improve early detection rates and reduce healthcare costs. Policymakers should consider population-specific factors when implementing screening programs to maximize health benefits and economic efficiency.