Journal of Gastrointestinal Cancer最新文献

Purpose: Pancreatoduodenectomy (PD) remains the cornerstone surgical treatment for resectable periampullary and pancreatic malignancies, with improving survival due to advances in oncologic surgery and perioperative management. Emerging evidence, however, identifies metabolic dysfunction-associated steatotic liver disease (MASLD) as a relevant postoperative complication that may adversely influence long-term outcomes. This review aims to summarizethe incidence, pathophysiology, clinical implications, and management strategies of de novo MASLD following PD in patients with gastrointestinal malignancies.

Methods: A narrative review of clinical and translational studies was conducted focusing on hepatic steatosis, metabolic derangements, pancreatic exocrine and endocrine insufficiency, and chemotherapy-related liver injury after PD. Particular attention was given to studies evaluating postoperative nutritional status, liver-related morbidity, and implications for oncologic therapy.

Results: De novo MASLD develops in approximately 8-37% of patients within the first year after PD. Unlike classical metabolic MASLD, postoperative disease is predominantly driven by exocrine pancreatic insufficiency, malabsorption, intestinal dysbiosis, and altered gut-liver signaling, leading to hepatic lipotoxicity and inflammation. Progression to metabolic dysfunction-associated steatohepatitis, fibrosis, or cirrhosis has been reported, potentially limiting tolerance to adjuvant chemotherapy. Early pancreatic enzyme replacement therapy improves nutritional parameters and may reduce hepatic steatosis, while duodenum-preserving pancreatic head resection appears to attenuate metabolic sequelae.

Conclusion: MASLD represents a distinct and clinically significant postoperative complication following PD with potential impact on oncologic outcomes. Systematic hepatic monitoring and multidisciplinary management should be integrated into postoperative care pathways for patients with gastrointestinal cancers.

Purpose: To assess how obstructive jaundice and socioeconomic determinants (residence, literacy, gender) affect treatment initiation and curative surgical eligibility among patients with gallbladder cancer in North India.

Methods: In this prospective observational cohort, adults with radiological or histological gallbladder cancer presenting between September 2023 and May 2024 were enrolled at a tertiary cancer centre. Baseline demographics, stage, obstructive jaundice status, biliary drainage (PTBD/ERCP), treatment initiation, and surgical eligibility were recorded. Associations were examined using chi-square and relative risk, followed by multivariable logistic regression including variables with p < 0.10.

Results: Of 1,500 enrolled patients, 1,409 were evaluable; 643 (45.6%) had obstructive jaundice. Treatment non-initiation occurred in 330/643 (51.3%) with obstructive jaundice versus 24/766 (3.1%) without obstructive jaundice (p < 0.001). Curative surgery was feasible in 51/643 (7.9%) with obstructive jaundice compared with 223/766 (29.1%) without obstructive jaundice (RR 0.27; 95% CI 0.20-0.36). Illiteracy (57.6%) and rural residence (69.4%) predominated. On multivariable analysis, independent predictors of treatment non-initiation were obstructive jaundice (aOR 11.2; 95% CI 7.6-16.5), metastatic disease at presentation (aOR 3.9; 95% CI 2.1-7.4), rural residence (aOR 2.7; 95% CI 1.9-3.9), and illiteracy (aOR 1.8; 95% CI 1.3-2.6).

Conclusion: Obstructive jaundice and socioeconomic disadvantage synergistically drive early care discontinuity and reduce curative opportunities in gallbladder cancer, supporting decentralized decompression, patient navigation, and socioeconomic support in high-incidence regions.

Introduction and importance: Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), is increasingly used for glycemic control, weight loss, and cardiovascular risk reduction. While GLP-1 RAs are commonly associated with acute pancreatitis, emerging reports suggest a possible association with pancreatic cystic lesions, even in patients without typical risks factors such as alcohol, gallstones, or hereditary syndromes.

Case presentation: We present two cases of middle-age female patients without prior compline or pancreatic disease who developed large distal pancreatic mucinous cystic neoplasms following GLP-1 Ras use. Both underwent imaging and aspiration, which revealed elevated carcinoembryonic antigen (CEA) levels. Surgical management consisted of distal pancreatectomy and splenectomy. Pathology confirmed MCN with no malignancy. Both patients had uneventful recovery.

Discussion: These two cases suggest a possible association between GLP-1 receptor agonists, and the development of pancreatic mucinous cystic neoplasms (MCNs) in patients without prior pancreatic disease or conventional risk factors. While causality cannot be established, the temporal relationship, absence of alternative etiologies, and supportive literature suggest a possible drug-related effect. Preclinical studies have implicated GLP-1 RAs in pancreatic ductal hyperplasia and cyst formation, and recent clinical reports reinforce these findings. As semaglutide use expands, clinicians should be vigilant for structural pancreatic changes, and further studies are warranted to elucidate underlying mechanisms and clinical implications.

Conclusion: These cases raise concern regarding a potential association between semaglutide therapy and mucinous cystic neoplasms. Increased vigilance and further observational studies are warranted to evaluate this potential adverse effect.

Purpose: Bile acids (BAs) are important molecules in the carcinogenesis of pancreatic cancer (PC). The BA profile in pancreatic diseases and its role in PC remain unclear.

Methods: The concentrations of 63 BAs in serum were measured in a total of 421 participants from three medical centers using targeted metabolomics. The concentrations of seven common types of BAs in serum were determined and compared. The least absolute shrinkage and selection operator algorithm analysis was used to confirm the independent predictors and build a metabolite panel for prediction and discrimination.

Results: A panel of two BA metabolites DCA and ω-MCA showed high diagnostic performance for PC versus healthy controls with an AUC of 0.914 (95% CI 0.873-0.956) in the validation cohort and achieved a 94.20% positive rate in the validation cohort. This diagnostic panel correlated with advanced clinical stage (p = 0.006) and poorer overall survival (HR = 3.11, 95% CI 0.79-12.23, p = 0.006). Importantly, biliary obstruction altered total BA concentrations (2.4-fold increase, p < 0.001) but did not change BA compositional proportions (p > 0.05). Additionally, ω-MCA, GCA-3S, GCDCA-3S, UDCA, and secondary BAs may distinguish PC from pancreatic benign tumors. GLCA was able to differentiate PC from pancreatic premalignant lesions. TLCA, 3-oxoLCA, and NorCA can effectively separate PC from chronic pancreatitis.

Conclusion: BAs are potential diagnostic and prognostic biomarkers for PC, which may also be helpful in differentiating pancreatic diseases.

Background: Sphincter-preserving surgery for rectal cancer is associated with long-term bowel dysfunction, yet data on outcomes in patients managed with watch-and-wait is limited. This study compared bowel function in rectal cancer survivors managed with watch-and-wait versus sphincter-preserving surgery and evaluated the performance of two instruments: the Memorial Sloan Kettering Bowel Function Instrument (MSK-BFI) and the Low Anterior Resection Syndrome (LARS) score within each cohort.

Patients and methods: In this cross-sectional study, rectal cancer survivors treated with long-course chemoradiotherapy between 2011 and 2019 at Flinders Medical Centre were recruited. Participants without stomas completed the MSK-BFI, LARS, and comorbidity questionnaires. Demographics and clinical data were obtained from medical records. Outcomes were compared between the sustained watch-and-wait (WW) and surgical (SURG) cohorts. Associations were examined using regression models. Instrument comparisons were performed in each cohort using factor analysis.

Results: Of the 190 eligible survivors, 67 participants were included (WW, n=33; SURG, n=34). Surgery was associated with significantly worse bowel function across MSK-BFI domains and higher rates of Any LARS (91% vs. 67%) and Major LARS (70% vs. 36%). Female sex was independently associated with poorer bowel function. Factor analysis revealed that one factor accounted for bowel function in the SURG cohort, whereas two factors were required in the WW cohort, indicating greater complexity.

Conclusion: Surgery and female sex are associated with significantly worse bowel function in rectal cancer survivors. The WW cohort demonstrated more complex symptom patterns, supporting concurrent use of MSK-BFI and LARS until a WW-specific tool is developed. A larger, prospective study is underway to investigate the findings further.

Intrahepatic cholangiocarcinoma (iCCA) represents an aggressive primary hepatic malignancy with limited non-surgical therapeutic options. This review examines the evolution of transarterial radioembolization (TARE) with Yttrium-90 microspheres from palliative intervention to curative-intent therapy, driven by advances over the past few decades. Partition-model dosimetry demonstrates superior survival compared to empiric approaches (14.9 versus 5.5 months, P < 0.001), establishing the critical importance of individualized treatment planning. In first-line settings, multimodal strategies combining TARE with systemic therapy achieve median overall survival of 32.5 months, with intensive protocols demonstrating objective response rates of 39-85% and downstaging to curative resection in 22-54% of patients. Ablative radiation segmentectomy delivers tumor doses exceeding 190 Gy, achieving objective response rates of 94%, median survival of up to 72 months in early-stage disease. TARE-based bridging to liver transplantation yields 5-year survival of 57% from time of transplant listing. Optimal outcomes are observed for tumor burden below 25%, preserved hepatic function, favorable performance status, and personalized dosimetry delivering ≥205 Gy to tumor. Contemporary TARE represents a transformative paradigm in liver-directed therapy for appropriately selected iCCA patients.

Background: Pancreatic cancer (PC) remains one of the most lethal malignancies with limited treatment options, particularly in advanced stages. Emerging immunotherapeutic strategies, such as Gamma Delta (γδ) T cell therapy paired with microbiota management, have demonstrated promise.

Case presentation: We report a case of a 75-year-old male diagnosed with advanced-stage and poorly differentiated PC who demonstrated significant clinical improvement following a novel therapeutic approach combining fecal microbiota transplantation (FMT), γδ T cell therapy, and pembrolizumab. Initial chemotherapy and radiotherapy were discontinued due to adverse effects. Pre-treatment the CA19-9 (1206 U/mL), tumor markers were significantly elevated with CEA, CA15-3 and CA125 all within normal limits. No pathogenic mutations (e.g., BRCA1/2, PALB2) were identified. A comprehensive assessment revealed tumor progression, immunosuppression, and gut microbiota dysbiosis, resulting in FMT and γδ T cell therapy being introduced alongside pembrolizumab.

Outcomes: The combination therapy resulted in the clearance of circulating tumor cells (CTCs), normalization of CA19-9 to 72 U/mL, improved clinical symptoms, and a marked reduction in tumor size, as confirmed by CT. Tolerability was excellent with no serious adverse events occurred.

Conclusion: This case suggests that FMT combined with γδ T cell therapy may be a promising immunotherapeutic strategy for advanced PC. Further studies are needed to validate these findings.

Background: We analyzed China's colorectal cancer (CRC) burden from 1990 to 2023, focusing on incidence, mortality, disability-adjusted life years (DALYs), prevalence, and risk-attributable burden, to assess temporal trends and evaluate future prevention needs.

Methods: Using Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 estimates, we summarized all-age numbers and age-standardized rates (ASR) by sex. Joinpoint log-linear models calculated the average annual percent change (AAPC), and risk-attributable deaths and DALYs were profiled for 2023. And we conducted a brief sensitivity comparison of trends for 2010-2019 and 2019-2023 for both sexes combined. All results are model-based estimates and are reported with uncertainty intervals (UIs).

Results: In 2023, China was estimated to have 611,364 incident CRC cases (95% UI 493,490-771,955), 258,088 deaths (225,359-305,788), 3,375,669 prevalent cases (2,710,191-4,159,613), and 6,279,382 DALYs (5,563,225-7,428,441). Over 1990-2023, ASIR and ASPR increased, while ASMR and ASDR declined. Males consistently had higher rates than females, and burden rose steeply with age. AAPCs showed an increase in incidence across the 15-49, 50-74, and ≥ 75 years age groups, particularly in those aged 75 years and older. Mortality and DALY rates declined at younger ages and were stable at ≥ 75. In 2023, the risk-attributable CRC burden was concentrated in dietary risks and metabolic and behavioural risks, including high fasting plasma glucose, smoking, alcohol use, and low physical activity. The brief pre- and post-2019 comparison suggested broadly similar directions with wide uncertainty.

Conclusions: GBD 2023 estimates indicate that CRC remains a growing challenge in China, with rising ASIR and ASPR despite declining ASMR and ASDR. Prevention and screening planning should prioritise modifiable risks and strengthen service resilience, while interpreting model-based estimates in light of their uncertainty.