Journal of Gastrointestinal Cancer最新文献

Background: Colorectal cancer (CRC) remains a leading cause of cancer-related mortality worldwide. Early detection of precancerous lesions such as adenomas and polyps is vital for prevention, yet standard colonoscopy may miss up to 26% of adenomas. Artificial intelligence (AI)-assisted colonoscopy has emerged as a promising tool to enhance lesion detection. This meta-analysis provides an updated synthesis of randomized controlled trials (RCTs) evaluating the diagnostic performance of AI-assisted versus standard colonoscopy.

Methods: Following PRISMA guidelines, a comprehensive search of PubMed, Cochrane, Web of Science, and Scopus identified 38 RCTs including 29,745 participants. Pooled risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup analyses by geographical region and AI manufacturer were performed to explore heterogeneity. Certainty of evidence was rated using the GRADE approach, and publication bias was assessed through funnel plots and Egger's test.

Results: AI-assisted colonoscopy significantly improved adenoma detection rate (ADR: RR = 1.19, 95% CI 1.14-1.25) and polyp detection rate (PDR: RR = 1.19, 95% CI 1.13-1.25), while reducing adenoma miss rate (AMR: RR = 0.52, 95% CI 0.38-0.72) and polyp miss rate (PMR: RR = 0.53, 95% CI 0.33-0.88). The mean number of adenomas per colonoscopy increased (MD = 0.20, 95% CI 0.14-0.25). AI modestly prolonged withdrawal time (MD = 0.46 min, 95% CI 0.26-0.66). No significant difference was observed for carcinoma detection (RR = 1.12) or advanced adenoma miss rate (RR = 0.67). Sessile serrated lesion detection showed a nonsignificant trend toward improvement (RR = 1.13), becoming significant after outlier exclusion (RR = 1.23). Subgroup analyses revealed higher ADR improvement in East Asian studies and with specific AI systems (e.g., Wision AI). Egger's test suggested minor small-study effects for ADR and withdrawal time.

Conclusions: AI-assisted colonoscopy substantially enhances adenoma and polyp detection while reducing miss rates. However, its benefit for carcinoma and sessile serrated lesion detection remains uncertain. Further standardized RCTs with long-term follow-up are warranted to confirm its role in colorectal cancer screening.

Objective: The development of treatments for advanced gastric cancer (AGC) has made significant advances over the past decade. Although clinical trials for novel drugs targeting HER2-positive AGC are ongoing, current clinical management still faces challenges. Therefore, further comparison of the effectiveness of such combination therapies is needed.

Methods: comprehensive search was conducted in the PubMed, Embase, and Cochrane databases, with the search cut-off date set to May 2025. Outcomes were evaluated using indicators such as progression-free survival (PFS) and overall survival (OS).

Results: Our study included only randomized controlled trials comparing combination regimens of targeted and/or immunotherapy, involving 3,231 patients across eight different interventions.The network meta-analysis revealed that no treatment regimen demonstrated a statistically significant improvement in OS or PFS. However, a trend toward improved PFS was observed with HLX22 plus HLX02 and chemotherapy compared to trastuzumab-based chemotherapy, although the difference was not statistically significant (MD=-0.94, 95% CI: -5.26-3.37). Pembrolizumab in combination with trastuzumab and chemotherapy significantly improved the objective response rate (ORR).Cumulative ranking probabilities indicated that trastuzumab plus chemotherapy may be associated with the longest PFS, while chemotherapy alone ranked highest in OS, though all confidence intervals included the null value.

Conclusion: No first-line regimen significantly improved OS or PFS in HER2-positive advanced gastric cancer. However, HLX22-based and immune-combination strategies show potential clinical value-particularly in enhancing ORR-and merit further investigation.

Background: The impact of neoadjuvant chemotherapy (NAC) on perioperative and functional outcomes for patients undergoing laparoscopic radical resection for rectal cancer remains incompletely understood. This study aimed to compare surgical, biochemical, functional, and immunologic outcomes between patients receiving NAC and those undergoing surgery alone.

Methods: In this retrospective cohort study, 231 patients who underwent laparoscopic radical resection for rectal cancer between January 2020 and January 2025 were analyzed. Patients were assigned to either the NAC group (n = 112, mFOLFOX6 regimen) or the non-NAC group (n = 115) based on preoperative chemotherapy status. Baseline characteristics, surgical and recovery parameters, serum tumor biomarkers (CEA, CA19-9, AFP), anorectal dynamics, and immune cell subsets (CD3+, CD4+, CD4+/CD8+) were measured at specified time points. Postoperative complications and adverse reactions were recorded.

Results: Baseline demographic and clinical characteristics were similar between groups. The NAC group demonstrated a higher rate of anus preservation (54.46% vs. 39.13%; P = 0.021), shorter postoperative recovery times, and reduced hospital stay compared to the non-NAC group (all P < 0.05). At 7 days and 6 months postoperatively, the NAC group had significantly lower levels of CEA, CA19-9, and AFP (all P < 0.05). Anorectal dynamic assessment showed improved functional recovery in the NAC group at 7 days postoperatively. However, the NAC group exhibited a greater reduction in peripheral CD3+, CD4+, and CD4+/CD8 + levels postoperatively (P < 0.05) and higher rates of leukopenia (8.04% vs. 0.87%; P = 0.021) and neutropenia (7.14% vs. 0.87%; P = 0.037). Major postoperative complication rates did not differ significantly between groups.

Conclusion: Neoadjuvant chemotherapy prior to laparoscopic radical resection for rectal cancer was associated with improved anus preservation, enhanced postoperative recovery, and greater biochemical and functional benefits without increasing major complication rates, although it was linked to higher hematologic adverse events and postoperative declines in immune cell counts.

Trial registration: Not applicable.

Background: Approximately 35% of patients do not receive adjuvant chemotherapy (AC) after surgery for stage III colorectal cancer (CRC). We aimed to investigate the association between receipt of AC and sociodemographic and treatment factors.

Methods: A retrospective case-control analysis of patients with stage III CRC who underwent radical resection was performed using data from the SEER registry (2010-2020). The main exposure was socioeconomic determinants, and the main outcome was receipt of AC. Multivariable binary logistic regression analyses were used to assess independent predictors of AC receipt.

Results: A total of 81,720 patients (52.4% male; median age, 65 years) were included. Overall, 70.6% of tumors were colonic and 29.4% rectal. 41.7% of patients did not receive AC. Independent socioeconomic determinants of AC receipt were age < 50 years (OR: 2.36, p < 0.001), male sex (OR: 0.931, p = 0.002), Black race (OR: 1.12, p = 0.002), Hispanic ethnicity (OR: 1.13, p < 0.001), household income <$50,000 (OR: 1.16, p = 0.001), non-metropolitan residence (OR: 1.09, p = 0.035), and unmarried status (single-OR: 0.778, p < 0.001, divorced-OR: 0.87, p < 0.001, widowed-OR: 0.313, p < 0.001). Tumor characteristics associated with AC receipt included tumor location and size, perineural invasion, number of positive lymph nodes, and CEA levels. Neoadjuvant chemotherapy (OR: 0.37, 95%CI: 0.28-0.48) and neoadjuvant radiation therapy (OR: 0.42, 95%CI: 0.38-0.46) were associated with lower odds of receiving AC in patients with colon and rectal cancer, respectively.

Conclusions: Receipt of AC was less likely among elderly males and those who received neoadjuvant treatments. Black and Hispanic patients and patients with low household income were more likely to receive AC.

Background: Mismatch repair-deficient (dMMR) and microsatellite instability-high (MSI-H) colorectal cancers demonstrate exceptional responsiveness to immune checkpoint inhibitors; however, evidence for the efficacy of neoadjuvant immunotherapy remains limited. This review consolidates all prospective trials evaluating neoadjuvant immune checkpoint blockade in non-metastatic dMMR/MSI-H colorectal cancer.

Methods: This systematic review followed the PRISMA guidelines and was registered with the PROSPERO database (CRD420251074066). A comprehensive search of PubMed, Embase, CENTRAL, and ClinicalTrials.gov was conducted until May 2025. Prospective interventional studies involving neoadjuvant immunotherapy in adults with stage II-III dMMR/MSI-H colorectal adenocarcinoma were included in this review. The primary outcomes were pathological complete response (pCR), major pathological response (MPR), and clinical complete response (cCR). The risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions tool.

Results: Eight prospective phase 2 trials encompassing 352 patients with stage II-III dMMR/MSI-H colorectal cancer were included. The pCR rates ranged from 41 to 90%, with the highest responses in patients with colon cancer receiving dual checkpoint blockade (nivolumab plus ipilimumab: 90% pCR, 95% MPR). In rectal cancer, 100% of patients receiving dostarlimab (n = 16) and 46% of those in the camrelizumab plus apatinib group (n = 24/52) achieved cCR with organ preservation. MPR was observed in 80-95% of the studies. Grade ≥ 3 adverse events occurred in 3-34% of patients, with no treatment-related deaths reported. At the median follow-up (8-26 months), disease-free survival exceeded 98% in most cohorts. Watch-and-wait strategies are durable, with no local regrowth in patients with complete clinical response (cCR).

Conclusions: Neoadjuvant immune checkpoint inhibition demonstrates high pathological and clinical response rates in dMMR/MSI-H colorectal cancer, with organ preservation achievable in selected rectal cancer patients. Neoadjuvant immunotherapy may become an alternative to surgery as the primary treatment for MSI-H/dMMR colorectal cancer if long-term quality of life is superior and toxicity and cost are competitive with standard surgical approaches. However, longer follow-up, predictive biomarkers, and randomized comparisons with upfront surgery are required before its routine clinical use.

Background: Gemcitabine-cisplatin doublet is a standard first-line regimen for metastatic gallbladder cancer (GBC), though prospective real-world data remains scarce. We evaluated the efficacy, safety, and prognostic factors in the North Indian patients.

Methods: Between March 2021 and December 2022, all patients with histologically proven metastatic GBC were prospectively enrolled. Eligible patients had ECOG 1-2 and adequate organ function. Gemcitabine 1000 mg/m² (days 1, 8) and cisplatin 75 mg/m² (days 1-2) were given every 3 weeks for up to 6 cycles, until progression or intolerance. Patients receiving ≥ 2 cycles were evaluable for efficacy. Responses were assessed by RECIST 1.1. Kaplan-Meier, univariate, and multivariate analyses were performed.

Results: Sixty-three patients were included in the study (Mean Age 56 years; 62% female). ORR was 63.5%; DCR 84.5%. Median PFS was 5.0 months; median OS 11.0 months. Six-month OS was 82.1%, 12-month OS 36.9%. Independent predictors of PFS included % change in CA19-9, platelet-lymphocyte ratio, alkaline phosphatase, and extra-abdominal disease. Neutropenia (any grade 73%, grade 3-4: 27%) was the most common toxicity; G-CSF was used therapeutically in 41%. Non-hematological AEs were mild-to-moderate. No treatment-related deaths occurred.

Conclusion: Gemcitabine-cisplatin remains effective and tolerable in metastatic GBC. Despite the emergence of Gemcitabine-Cisplatin with durvalumab as new standard, this prospective dataset provides valuable real-world outcomes from a high-incidence region with limited access to immunotherapy.

Background: Routine endoscopic re-evaluation of gastric ulcers (GUs) is widely recommended to exclude malignancy. However, in modern practice, particularly in low-to-intermediate gastric cancer prevalence settings, the diagnostic yield, cost-effectiveness, and necessity of universal surveillance are increasingly debated.

Objective: To evaluate compliance with British and Irish guidelines recommending repeat gastroscopy for GUs, identify predictors of malignancy, and assess the diagnostic yield and healthcare cost of ulcer re-evaluation in a large tertiary centre.

Methods: We retrospectively analysed 2132 index GUs from 56,874 gastroscopies performed between May 2006 and August 2024. Demographic, endoscopic, and histological data were collected. Malignancy outcomes were determined by cross-referencing with histology databases. Binary logistic regression identified predictors of malignancy. Surveillance rates, ulcer healing, and inflation-adjusted costs were assessed.

Results: Eighty-six ulcers (4%) were diagnosed as gastric malignancies. Of these, 96% were identified at index histology; three were diagnosed at short-interval re-evaluation following inadequate or false-negative biopsies. No malignancies were detected during routine surveillance of benign-appearing ulcers with adequate histology. Macroscopic concern was the strongest predictor of malignancy (odds ratio 66.9, p < 0.01), alongside older age, male sex, and non-antral ulcer location. Surveillance was performed in 59% of benign ulcers at a mean interval of 12.5 weeks. None of the 837 patients with benign ulcers who did not undergo re-evaluation developed gastric cancer during 19 years of follow-up. Re-evaluation procedures represented 2.5% of total endoscopy workload, at a cumulative cost of €1,028,016.

Conclusion: Routine re-evaluation of GUs that appear benign and have adequate negative histology provided minimal diagnostic benefit while generating significant healthcare costs. A selective approach, focusing on ulcers with suspicious endoscopic features, inadequate biopsies, or unresolved symptoms, would better allocate resources and avoid unnecessary procedures.