Journal of Gastrointestinal Cancer最新文献

Background: Metastatic disease traditionally classifies gastric cancer as stage M1, precluding surgical intervention and enrolling patients in palliative treatment protocols. This principle holds regardless of the number, the location, and the quantity of metastatic sites. "Oligometastatic disease" is an intermediate state between localized and widely spread gastric cancer.

Methods: Locoregional treatments may offer long survival or even cure in highly selected cases. There are no evidence-based guidelines for the appropriate management of this clinical entity. Tailored strategic techniques are required to incorporate surgical treatment, when applicable, into the management protocols of these patients. The surgical approach (following neoadjuvant treatment) aiming at R0 resection of neoplasms that are technically or oncologically unresectable, or only borderline resectable at initial evaluation is defined as "conversion therapy".

Results: The surgical approach aims at locoregional control of the disease, radical resection of all cancer sites, adequate lymph node cleansing and uncomplicated anastomosis. Disease progression is a clear indication of palliative treatment. In this article, we aim to provide an extensive literature search about current status of oligometastatic gastric disease multimodal treatment.

Conclusions: Given the malignancy potential of gastric cancer, the decision for an operative approach should be made with strict criteria by experienced surgeons and rational oncologists.

Background: Gastric cancer remains one of the leading causes of cancer-related mortality worldwide, with surgical intervention being a critical aspect of treatment. Lymphadenectomy plays a significant role in managing gastric cancer, with the extent of lymph node removal often influencing survival outcomes. Recent advancements in laparoscopic surgery have introduced the use of indocyanine green (ICG) fluorescence guidance to improve the accuracy and effectiveness of lymphadenectomy. However, the comparative efficacy of ICG-guided laparoscopic lymphadenectomy versus conventional techniques remains a topic of ongoing investigation.

Aim: This study aims to evaluate the effectiveness and surgical outcomes of ICG-guided laparoscopic lymphadenectomy compared to conventional laparoscopic lymphadenectomy in patients with gastric cancer.

Methods: A systematic review and meta-analysis, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements, was conducted (PROSPERO: CRD420251039604). A literature review was performed (sources: PubMed, Embase, and Cochrane Library databases; end-of-search date: April 22, 2025) and quality assessment was performed using the ROB 2 and Newcastle-Ottawa Scale. A random-effects model was used to pool the data for the meta-analyses.

Results: A total of 3996 patients from ten studies were analyzed, with 1870 undergoing ICG-guided surgery and 2126 in the non-ICG group. ICG use was associated with significantly improved 1-year (RR = 1.04) and 2-year (RR = 1.09) overall survival, and a greater number of retrieved lymph nodes (MD = 6.00). While intraoperative blood loss was significantly reduced with ICG (MD =  - 14.44 mL), no significant differences were observed in metastatic lymph node count, postoperative complications, operative time, or hospital stay.

Conclusions: ICG-guided surgery in gastric cancer is associated with improved short- and mid-term overall survival and enhanced lymph node retrieval. It also significantly reduces intraoperative blood loss without increasing postoperative complications, operative time, or hospital stay. These findings support the clinical value of ICG in improving surgical outcomes.

Background: Colorectal cancer (CRC) ranks as the third most prevalent cancer globally and poses a considerable public health challenge; concurrently, Clostridioides difficile infection (CDI) represents a significant hospital-acquired infection, with a rising incidence observed among cancer patients.

Aim: To examine the relationship between CDI and CRC, it will address the risk factors associated with CDI in patients with CRC, clinical outcomes, recent findings regarding the influence of CDI on CRC, and the current strategies for management.

Results: Risk factors including gut microbiota dysbiosis, surgical interventions, chemotherapy, immunotherapy, prolonged hospitalization, and antibiotic exposure elevate susceptibility to CDI in CRC patients. Additionally, CDI correlates with more complex treatment regimens and longer hospital stays in this demographic. Furthermore, recent studies indicate that the incidence of CDI may increase the risk of CRC development.

Conclusion: The prevention, diagnosis, and treatment of CDI in CRC patients are critical for enhancing outcomes. A comprehensive understanding of the bidirectional relationship between CDI and CRC can guide the development of management strategies for this important clinical issue.

Purpose: Primary malignant melanoma of the oesophagus is extremely rare. Given this, there is a paucity of evidence to guide treatment decisions. Traditionally, treatment has included standard modalities of surgery, chemotherapy, and/or radiotherapy. Immunotherapy has revolutionised the treatment of cutaneous melanoma; however, molecular studies have provided conflicting results regarding whether the underlying mechanisms driving melanoma response to immunotherapy are reproduced in mucosal and, more specifically, oesophageal melanomas. The evidence base for treatment decisions in primary malignant melanoma of the oesophagus remains limited due to the small number of reported cases, with only 374 cases reported in the world literature up to 2022.

Case report and literature review: We present the case of an 81-year-old Caucasian female patient, previously in good health aside from gastro-oesophageal reflux. The patient presented with dysphagia and proceeded to CT and endoscopy showing a large mid-to-distal oesophageal mass. Endoscopic biopsies revealed a poorly differentiated epithelioid malignancy, with immunohistochemical studies confirming melanoma. FDG-PET revealed metastatic deposits in the skeleton as well as mesenteric nodes. The patient was commenced on treatment with ipilimumab and nivolumab 18 days following diagnosis. Despite receiving only one cycle of immunotherapy, the patient demonstrated remarkable resolution of symptoms as well as complete resolution of PET-avidity of all local and metastatic disease and remains in remission 2 years following diagnosis. Scoping review of the literature identified just three case series and 18 case reports of patients with primary oesophageal melanoma treated with immunotherapy This case is now the third case reported in the literature of patients with oesophageal melanoma metastatic at diagnosis, who have entered long-term complete remission following sole treatment with immunotherapy and the only case to enter remission following a single cycle of treatment.

Conclusion: We report our experience with one of the few reported cases of metastatic primary malignant melanoma of the oesophagus treated with immunotherapy, with encouraging results. We would encourage reporting of further cases in order to better understand the role of immunotherapy in oesophageal melanoma.

Introduction: Incretin-based therapies, including glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dipeptidyl peptidase-4 inhibitors (DPP-4Is), are widely used in the management of type 2 diabetes mellitus (T2DM). However, concerns have emerged regarding their potential association with an increased risk of cholangiocarcinoma (CCA), and current evidence remains inconclusive. This review aims to evaluate and clarify the association between incretin-based therapies and the risk of CCA in patients with T2DM.

Methods: This review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD42025641616). A comprehensive search was performed across PubMed, ProQuest, EBSCOhost, Wiley, and SAGE databases. Eligible observational studies reporting the association between incretin-based therapies and CCA were included. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Pooled hazard ratios (HRs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using RevMan with a random-effects model.

Result: Four studies (three cohort and one case-control) were included. The pooled HRs showed no significant association between incretin-based therapies and CCA risk, with estimates of 1.07 (95% CI: 0.70-1.63) for GLP-1RAs and 1.05 (95% CI: 0.83-1.34) for DPP-4Is. Pooled RR analyses yielded similarly non-significant results. All included studies were assessed as having a low risk of bias according to the NOS.

Conclusion: Incretin-based therapies do not significantly increase the risk of CCA in T2DM patients. Within the limitations of the available observational evidence, these findings provide reassurance regarding their safety profile, while highlighting the need for ongoing pharmacovigilance and further large-scale studies to confirm these results.

Introduction: Chemotherapy-associated cognitive impairment (CACI) is a common yet underdiagnosed condition among elderly cancer patients. Glial fibrillary acidic protein (GFAP), a marker of astrocytic activation, has emerged as a potential indicator of neuroinflammation.

Materials and methods: This observational case-control study included 41 elderly patients with stage II-III colon, gastric, or pancreatic cancer who received 12 cycles of adjuvant chemotherapy, and 30 age- and sex-matched healthy controls. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) at baseline, mid-treatment, and 3 months post-treatment. Quality of life was evaluated using the Functional Assessment of Cancer Therapy-General (FACT-G). Serum GFAP and C-reactive protein (CRP) levels were measured at baseline and follow-up.

Results: Post-treatment MMSE scores significantly declined in the patient group (mean = 24.87 ± 2.14 vs. baseline = 26.92 ± 0.99, p < 0.001), with 51% of patients showing cognitive impairment. GFAP levels increased significantly in cognitively impaired patients (from 374.64 ± 142.14 to 464.79 ± 181.94 ng/ml, p < 0.001), while ROC analysis identified a GFAP cut-off of 337 ng/ml with 94.74% sensitivity and 92.48% specificity for predicting CACI. Logistic regression showed that both elevated follow-up GFAP levels were independent predictors of CACI.

Discussion: Elevated serum follow-up GFAP levels are significantly associated with cognitive impairment following chemotherapy in elderly patients with gastrointestinal cancers, suggesting a role for astrocytic activation in CACI pathogenesis. GFAP may serve as a promising biomarker for risk stratification and early intervention.

Background: This comprehensive review sought to investigate the correlation between PLR and LMR with overall longevity (OS), recurrence-free interval (DFS), and malignancy-related survival (CSS) among individuals diagnosed with colorectal carcinoma.

Methods: A comprehensive review of relevant studies was carried out using prominent digital repositories to locate research articles that provided hazard estimates (HRs) for PLR and LMR in individuals diagnosed with colorectal cancer. Potential publication bias was examined through graphical funnel plot assessments, while additional subgroup analyses were conducted based on patient demographics and consideration of C-index.

Results: Nineteen studies were included for PLR and OS analysis, showing that high PLR was associated with increased mortality risk (HR = 1.23, 95%CI = 1.04-1.44, p = 0.01). For LMR and OS, 14 studies were analyzed, indicating that low LMR was linked to higher mortality risk (HR = 1.63, 95%CI = 1.29-2.06, p < 0.0001). Subgroup analyses showed stronger associations in the western population and studies with C-index adjustments. Regarding DFS, no significant association was found with PLR (HR = 1.14, 95%CI = 0.93-1.40, p = 0.21), while low LMR increased recurrence risk (HR = 1.31, 95%CI = 1.15-1.48, p < 0.0001). High PLR and low LMR were associated with worse CSS, with no significant heterogeneity observed.

Conclusion: Elevated PLR and reduced LMR are linked to unfavorable survival prospects in individuals with colon malignancy.

Purpose: Tumor progression is influenced by both tumor-intrinsic and host-related factors. Among the latter, cachexia-a multifactorial syndrome involving progressive skeletal muscle loss-has garnered increasing attention for its prognostic relevance. However, objective assessment of cachexia remains difficult. The cachexia index (CXI) has emerged as a novel biomarker for its evaluation. This study aimed to assess the relationship between cachexia and long-term prognosis following curative surgery for colorectal cancer (CRC) using a modified index.

Methods: We retrospectively analyzed 298 patients who underwent curative colorectal cancer resection at Osaka City University Hospital between January 2017 and December 2019. A modified version of CXI, termed the P-CXI, was calculated using the psoas muscle index (cm²/m²), serum albumin (g/dL), and neutrophil-to-lymphocyte ratio (NLR): P-CXI = (psoas muscle index × albumin) / NLR. Patients were stratified into high and low P-CXI groups. Prognostic value for relapse-free survival (RFS) and overall survival (OS) was evaluated using univariate and multivariate Cox regression analyses.

Results: The low P-CXI group (n = 170) had significantly shorter RFS and OS compared to that of the high P-CXI group (p = 0.001 and p < 0.001, respectively). Multivariate analysis identified low P-CXI as an independent poor prognostic factor for RFS (HR: 2.627, 95% CI 1.363-5.063, p = 0.004) and OS (HR: 5.370, 95% CI 1.806-15.96, p = 0.002), along with older age, T4 tumors, and elevated CA 19-9.

Conclusion: Cachexia, as quantified by P-CXI, was significantly associated with worse long-term outcomes after curative CRC resection. P-CXI may serve as a simple and objective prognostic marker.

Introduction: Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the fifth most common cancer worldwide. For patients with unresectable, localized, intermediate-stage HCC, the standard treatment is transarterial chemoembolization (TACE).

Methods: Given the recent advances in systemic treatments for HCC with immunotherapy and targeted therapies, several studies have explored the potential benefits of combining TACE with systemic therapy, owing to the possible synergistic effects. This review analyzes recent clinical studies of patients with unresectable HCC who received TACE in combination with different classes of systemic therapies.

Conclusion: Collectively, these studies suggest that combining TACE with systemic therapy may enhance treatment response and improve survival outcomes.

Purpose: Fear of progression (FOP) leads to poor clinical outcomes in patients with gastric cancer. This study aimed to clarify the profiles and factors that influence FOP among patients after endoscopic submucosal dissection (ESD) for early gastric cancer.

Methods: A cross-sectional study was conducted with 262 patients who underwent ESD for early gastric cancer. The convenience sampling method was used to select patients in the gastroenterology outpatient departments of two Grade III and Class A hospitals in Zhejiang Province as survey subjects. A general information questionnaire and the Fear of Progression Questionnaire-Short Form, Perceived Social Support Scale, Herth Hope Index, Brief Illness Perception Questionnaire, and Medical Coping Modes Questionnaire were used to collect the data. Latent profile analysis was used to explore the latent profiles of FOP in patients after ESD for early gastric cancer.

Results: A total of 262 patients were included in the study. Male patients accounted for 59.2% of the cohort, while those aged 50-59 years constituted 52.7%. Pathological type showed that 65.3% of patients had well-differentiated adenocarcinoma. Latent profile analysis identified two subgroups of FOP: low FOP (55.3%) and high FOP (44.7%). Patients who were female, younger, had no religious belief, and had a lower Herth Hope Index and a higher avoidance dimension score and a higher submission dimension score were prone to severe FOP.

Conclusion: Research indicates that female patients, younger patients, those without religious beliefs, individuals with lower hope scores, and patients employing avoidance or compliance coping strategies are more prone to severe FOP. Physicians and nurses should pay close attention to these characteristics and provide early intervention.