Journal of Gastrointestinal Cancer最新文献

Background: This study evaluated the efficacy and safety of a regimen consisting of sintilimab, nanoparticle polymeric micellar paclitaxel (NPMP) and S-1 in HER2-negative advanced gastric cancer (AGC).

Method: In this real-world study, patients with HER2-negative AGC received first-line sintilimab plus NPMP and S-1. The primary endpoint was overall survival (OS) and progression free survival (PFS), while objective response rate (ORR), disease control rate (DCR), and safety were evaluated as secondary endpoints.

Results: Among 33 enrolled patients, 14 patients (42.4%) achieved partial response (PR), 17 (51.5%) maintained stable disease (SD), 2 (6.1%) showed progressive disease (PD). ORR and DCR were 42.4% and 93.9%. Median OS reached 15.4 months (95%CI: 13.0-17.6), median PFS was 7.8 months (95%CI: 5.8-9.3). Subgroup analysis revealed significant differences in OS and PFS according to PD-L1 expression and cycles of treatment. Observed adverse events (AEs) were fatigue (60.6%), leukopenia (54.5%),anemia (51.5%),thrombocytopenia (36.4%),nausea (30.3%) and vomiting (15.1%). Most toxicities were manageable and predominantly grade 1-2.

Conclusions: The combination of sintilimab, NPMP and S-1 demonstrates promising antitumor effects and controllable toxicity as first-line treatment in patients with HER2-negative with AGC.

Purpose: The REGARD trial resulted in insurance approval for ramucirumab monotherapy; however, it did not include Japanese patients. Subsequent phase II trials and retrospective studies have examined Japanese cohorts, but reports identifying prognostic factors remain limited.

Methods: A total of 27 patients across six institutions received ramucirumab monotherapy as a second-line treatment for gastric cancer between September 2017 and December 2019.

Results: The median age of 27 patients was 74 years (range: 36-90). Eighteen patients were male, and ten had intestinal-type gastric cancer. Metastases were observed in 6 patients in the liver, 3 in the lung, 18 in lymph nodes, and 14 in the peritoneum. Third-line chemotherapy was administered to 6 patients. The response rate was 3.7%, and the disease control rate was 18.5%. The median progression-free survival was 2.1 months, and the median overall survival was 3.0 months. Of the 27 patients, 6 received third-line treatment and 4 received nivolumab alone. Overall survival did not differ significantly between patients who received third-line treatment and those who did not. The median progression-free survival showed no significant differences based on tumor markers (carcinoembryonic antigen and CA19-9), age, histology, or metastases in the lung, lymph nodes, or peritoneum. In contrast, liver metastases were associated with poorer progression-free survival (HR:4.735 (95% CI: 1.508-14.86) and overall survival HR:2.906 (95% CI: 1.031-8.189).

Conclusions: Ramucirumab monotherapy is selected for patients with poor general condition, but it is suggested to have a poor prognosis, particularly in cases with liver metastases.

Purpose: Gastrointestinal (GI) cancers significantly contribute to the global cancer burden, yet their epidemiological trends among adolescents and young adults (AYAs: aged 15-39 years) remain understudied. This study provides the first comprehensive analysis of global burden, temporal trends (1990-2021), and projections to 2045 for GI cancers in AYAs.

Methods: Using the Global Burden of Disease (GBD) 2021 dataset, we analyzed age-standardized incidence rates (ASIR), death rates (ASDR), disability-adjusted life-years (DALYs), and estimated annual percentage changes (EAPC). Bayesian age-period-cohort modeling was employed for projections to 2045.

Results: In 2021, there were 156,033 new GI cancer cases, 84,623 deaths, and 4.9 million DALYs among AYAs globally. From 1990 to 2021, ASIR for colorectal and gallbladder cancers increased (EAPCs:0.55[95%CI:0.44, 0.67] and 0.13[0.05, 0.20], respectively), while ASIR for other GI cancers declined (e.g., stomach cancer:-2.75 [- 2.94, - 2.57]). East Asia bore the highest burden. Projections suggest a stabilization of overall ASIR and ASDR by 2045, though liver and gallbladder cancers are expected to rise.

Conclusions: The burden of GI cancers among AYAs remains substantial and is projected to persist, highlighting the need for targeted early-detection strategies and age-specific prevention programs, especially in high-risk regions.

Background: Oligometastasisdisease (OMD) is an intermediate stage between localised disease and widespread metastasis. No standard OMD definition exists for gallbladder cancer (GBC). This review examines OMD definitions in GBC, treatment challenges, current strategies like systemic therapy, immunotherapy, surgery, loco-regional therapy, emerging approaches, and future directions for GBC patients with OMD.

Materials and methods: A literature review of GBC and oligometastasiswas conducted using PubMed and Google Scholar through July 2025.

Results: Metastatic GBC has a poor prognosis; however, a combination of systemic and immunotherapy can slightly improve survival, ranging from 11.3 to 12.7 months. OMD is a subgroup of patients (with 1-3 liver metastases, para-aortic lymph nodes, metastasis limited to adherent omentum, and/or up to three peritoneal deposits) who experience better survival with consolidative treatment, including neoadjuvant therapy followed by curative resection (such as minor hepatectomy, para-aortic lymphadenectomy) and adjuvant therapy. Reported survival rates at 1, 3, and 5 years range from 20 to 64.0%, 5.7-17%, and 0-23%. Risk factors like extensive hepatic lobectomy and portal vein resection in cholestatic liver increase morbidity and mortality. Elevated preoperative tumour markers (CEA, CA 19 - 9) are associated with poorer survival.

Conclusion: There is no standard definition of OMD in GBC. Our review emphasises the need to develop a standardised definition of OMD in GBC and for multidisciplinary evaluation and well-designed clinical trials to expand therapeutic options and to optimise patient outcomes.

Objective: To analyze the long-term trends, age- and sex-specific patterns, and attributable risk factors of the colorectal cancer (CRC) burden in the Chinese population aged ≥ 60 years from 1990 to 2021, so as to provide a scientific basis for targeted prevention and control in this aging population.

Methods: Data on the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of CRC in China from 1990 to 2021 were extracted from the Global Burden of Disease (GBD) 2021 database, along with corresponding age-standardized rates. Temporal trends were analyzed using Joinpoint regression, and risk factors were assessed via population attributable fraction (PAF), with stratified comparisons by age and sex.

Results: From 1990 to 2021, the age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) of CRC in China increased by 65.13% and 141.23%, respectively, while the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) decreased by 11.94% and 15.08%, respectively. The average annual percentage changes (AAPCs) were as follows: ASIR 1.67%, ASPR 2.95%, ASMR - 0.45%, and ASDR - 0.54%. In 2021, metabolic risk factors (high BMI and high fasting plasma glucose) showed the largest increase in PAF (up 5.4% since 1990) in the 60-74 age group, with high BMI alone accounting for a PAF of 7.7%. The combined PAF for smoking and alcohol use was 19.2% in men versus only 2.0% in women, indicating substantial sex-based disparities in behavioral risks. Dietary factors remained the leading risk category, though their composition shifted: excessive red meat consumption accounted for a PAF of 16.0%, while inadequate calcium intake contributed 7.1%-8.1%, with no marked sex differences.

Conclusion: From 1990 to 2021, men aged 60-74 bore the heaviest burden of CRC in China, which was associated with a combination of metabolic factors (high BMI, high blood glucose), behavioral factors (smoking, alcohol use), and dietary factors (excessive red meat intake). This demographic should be prioritized for CRC screening and benefit from integrated interventions such as chronic disease management, smoking and alcohol cessation, and dietary modifications.

Purpose: Despite achieving sustained virologic response (SVR) after treatment with direct-acting antivirals (DAAs), patients with hepatitis C virus (HCV)-related cirrhosis remain at risk of hepatocellular carcinoma (HCC) development. Glypican-3 (GPC-3) is a heparan sulfate proteoglycan with oncogenic role in HCC. This study aimed to assess the diagnostic and prognostic value of serum GPC-3 in patients with HCV-related cirrhosis who achieved SVR following DAA therapy.

Methods: We conducted a retrospective, observational study including 832 patients with HCV-related cirrhosis treated with DAAs between 2014 and 2024. Patients were divided into two cohorts: cohort A (n = 551) without HCC at enrolment and cohort B (n = 281) with established HCC. Serum GPC-3 was measured using a commercially available enzyme immunoassay (CanAg Glypican-3 EIA, Fujirebio Diagnostics AB, Gothenburg, Sweden).

Results: We analyzed 832 single serum samples: collected at SVR12 in Cohort A and at HCC diagnosis in Cohort B. GPC-3 levels were significantly higher in patients with HCC compared to those without (95, 50-185 pg/mL vs. 48, 29-79 pg/mL; p < 0.001), with moderate diagnostic accuracy (AUC = 0.711). During follow-up (37, 20-51 months), GPC-3 levels did not predict the development of de novo HCC in cohort A. However, in cohort B, GPC-3 > 150 pg/mL was independently associated with reduced survival (adjusted HR = 1.68, 95% CI 1.03-2.67, p = 0.036).

Conclusions: While GPC-3 may be of limited utility for predicting HCC occurrence in patients cured of HCV, it could represent a valuable prognostic factor able to predict survival of patients with established HCC.

Purpose: Secondary malignant neoplasms of the liver are more common than primary liver cancers but remain understudied. This study provides the first nationwide analysis of liver metastases-related mortality trends and disparities in the US.

Methods: This study analyzed CDC WONDER mortality data (1999-2023) and US Cancer Statistics incidence data for adults ≥ 45 years. Liver metastases-related (ICD-10: C78.7) mortality was stratified by demographics, geographic regions, and primary site of malignancy. Age-adjusted mortality and incidence rates (AAMRs, AAIRs) and crude mortality rates (CMRs) were reported per 100,000 population. Temporal trends were analyzed using Joinpoint regression to calculate annual and average annual percentage changes (APC, AAPC).

Results: Liver metastases-related AAMR rose from 23.8 (1999) to 25.1 (2023) (AAPC = 0.22%*, 95% CI: 0.14-0.29). Males accounted for 51.3% of the 597,332 deaths and had higher AAMRs than females throughout. Lung (25.6%) and colon (24.6%) cancers were the leading primary sites causing deaths related to liver metastases. AAIRs and AAMRs (irrespective of metastasis) declined for most primary cancers. CMRs had an increasing trend, with nearly a 10-fold difference between ages 45-54 and 85+. Non-Hispanic (NH) Blacks had the highest AAMR with a declining trend (AAPC=-0.66%*), while NH Whites saw a significant increase (AAPC = 0.49%*). The West showed the biggest regional increase (AAPC = 1.24%*). AAMR rose the most in Vermont (AAPC = 5.30%*). Rural areas consistently had higher AAMRs (1999-2020).

Conclusion: Mortality from liver metastases has risen among older US adults, with notable demographic and geographic disparities. Improved survival among patients with primary cancers means more individuals are living long enough to experience recurrence and develop late liver metastases, underscoring the need for enhanced detection, surveillance, and management.

Neuroendocrine neoplasms (NENs) are rare cancers. CD31/PECAM1 is an adhesion molecule that modulates endothelial cell-to-cell contact. Increased CD31 expression is a marker for tumor growth, and cancer aggressiveness. The purpose of this study was to better understand the prognostic value of CD31 expression in primary and metastatic NEN tumors in terms of correlations with overall survival and pathological metrics, tumor grade, and tumor primary/metastatic location. As NENs are highly vascular tumors, the hypothesis is that CD31 staining is an important prognostic biomarker and target. This is based on prior correlations between CD31 staining and 3-year recurrence-free survival in pancreas NENs.

Methods: NEN tumors, surgically removed within our dedicated multi state southern regional neuroendocrine program, are routinely stained for CD31. Quantification of CD31 staining was performed by staff pathologists and documented in the pathology report within the patient medical record and stored in the rare cancer program RedCap database. The database covers surgical activity between 2004 and 2024. The database was queried for NET patients with quantified CD31 levels (number of positive vessels per high power field (HPF)) in primary or metastatic NEN tumors. CD31 levels were cross referenced against demographics, tumor grade, primary and metastatic tumor location, and overall survival.

Results: Nine hundred and thirteen NET patients were identified. Primary tumor: Small Bowel (74%), Pancreas (15%), Lung (2%), Stomach (5%), & Rectum (4%).

Demographics: Female 59±8.6%, Non-Hispanic 93.4±2%, White/Caucasian 70.4±14.3%, & Black/African American 21.6±16%. Grade: G1 45±8%, G2 44±3.6, G3 11±5.8%. There were no statistical differences in CD31 staining levels (cells/HPF) between (1) NEN tumors from small bowel (33 ± 17), pancreas (39.7 ± 34), lung (44 ± 27), stomach (39 ± 27), and rectum (32 ± 19) (p > 0.05), (2) tumor grade (G1. 31 ± 16; G2. 30 ± 16; and G3. 25 ± 12) (p > 0.05), (3) between matched primary and metastatic tumors (lymph node metastasis. 29 ± 16 vs. primary tumor 30 ± 14 (p = 0.46); liver metastasis 30 ± 18 vs. primary tumor 32 ± 17 (p = 0.17), & (4) no correlation between CD31 staining and overall survival (r = 0.01).

Conclusion: NEN tumors are highly vascularized and consistently positive for CD31. Despite reports that CD31/PACAM1 is important to cell adhesion and tumor phenotype, there was no identifiable measurable impact of high CD31 levels on NEN. Nor was there a prognostic clinical value for CD31 staining quantification.

Background: Colorectal cancer (CRC) is the third most common malignancy and the second leading cause of cancer-related mortality worldwide. A significant proportion of patients present as emergencies with obstruction, perforation, or bleeding, necessitating emergency colorectal surgery (EMCRS). This study aimed to compare the outcomes of patients undergoing EMCRS with those undergoing elective colorectal surgery (ELCRS).

Methods: This retrospective-prospective cohort study included patients undergoing curative CRC resections at a tertiary center in Southern India between January 2010 and June 2022. Patients with metastatic disease or palliative procedures were excluded. Propensity score matching (PSM) was performed (1:1) based on age, sex, tumor location, and stage. Outcomes assessed included postoperative complications, inpatient mortality, disease-free survival (DFS), and overall survival (OS).

Results: Among 558 patients (106 EMCRS, 305 ELCRS), 106 matched pairs were analysed. Before PSM, EMCRS had significantly higher morbidity (71.4% vs. 40.7%, p < 0.001) and mortality (17.9% vs. 2.3%, p < 0.001). After PSM, EMCRS continued to show increased severe complications (Clavien-Dindo IV/V), sepsis, pulmonary and cardiac complications, and higher inpatient mortality (17.9% vs. 0.9%, p < 0.001). However, long-term outcomes were not significantly different (DFS: 58 ± 3 vs. 55.5 ± 4.7 months, p = 0.19; OS: 67.5 ± 2.9 vs. 69.7 ± 4.9 months, p = 0.391).

Conclusion: EMCRS is linked to significantly worse short-term outcomes. The difference in long-term survival appears to stem from advanced disease at presentation rather than the emergency nature of surgery. Enhanced screening and preoperative optimization strategies may help improve patient outcomes.