Journal of Gastrointestinal Cancer最新文献

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.

Purpose: Neoadjuvant chemoradiotherapy (NACRT) is standard for locally advanced rectal cancer. Accurate response assessment is essential, particularly to identify complete responders eligible for organ-preserving strategies. While MRI is widely used, 18 F-FDG PET-CT has been proposed as a complementary modality. This study compared MRI-based Tumor Regression Grade (mrTRG) and PET-CT parameters in predicting pathological response.

Methods: A retrospective analysis was conducted at Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, from January 2013 to May 2024. A total of 268 patients underwent MRI and PET-CT before and after NACRT, followed by surgery. Response was categorized using mrTRG and pathological TRG (pTRG). PET-CT response was assessed by changes in SUVmax. Diagnostic accuracy of mrTRG and PET-CT was evaluated using statistical tests, kappa agreement, and ROC curves.

Results: Of 268 patients, 27.2% were classified as good responders (mrTRG 1-2), whereas 46.2% had good pathological response (pTRG 0-1). The correlation between mrTRG and pTRG was weak (kappa = 0.215). PET-CT showed a mean SUVmax reduction of 58.2%, with greater decline in responders. However, ROC analysis demonstrated poor discriminative ability (AUC = 0.502), indicating no advantage over MRI. Combining MRI and PET-CT imaging slightly improved accuracy in matching pathological grading (κ = 0.36).

Conclusion: MRI remains the preferred modality for post-NACRT response assessment in rectal cancer, showing moderate predictive accuracy. PET-CT, despite reflecting metabolic changes, is not reliable in distinguishing complete responders. A combined multimodal approach may improve evaluation and support individualized treatment planning.

Hepatocellular carcinoma (HCC) continues to rank among the most common causes of cancer-associated deaths, especially since a large number of patients cannot undergo curative resection or transplantation. For HCC patients, transarterial radioembolization (TARE) with yttrium-90 microspheres has become a rapidly emerging multipurpose treatment. For patients with early-stage disease, radiation segmentectomy, which is frequently used as a bridge or downstaging strategy to transplant, is a curative-intent treatment comparable to thermal ablation. For patients with inadequate future liver remnant, radiation lobectomy is a two-fold solution to local tumor control and hypertrophy of the resectable contralateral liver. TARE, in the intermediate and advanced stages of HCC, provides long-term disease control and maintains liver function, and is frequently used as an alternative or in combination with systemic treatment. Personalized dosimetry is an advancement in treatment planning, and the combination of TARE with immunotherapy is a promising area of exploration. Overall, the evolution of radio-embolization from a purely palliative to a disease-modifying curative option, greater use in more stages of the disease, and more positive outcomes than in the past, marks a significant achievement in the treatment of HCC.

Introduction: Curative treatment for pancreatic cancer relies on surgical resection combined with systemic chemotherapy, administered either before (neoadjuvant) or after (adjuvant) surgery. However, a considerable proportion of patients undergoing upfront resection fail to receive adjuvant chemotherapy, which negatively impacts survival. Identifying modifiable preoperative factors contributing to this omission could improve postoperative outcomes. This study investigated potential prehabilitation targets associated with the omission of adjuvant chemotherapy following pancreatic cancer surgery.

Methods: We conducted a post-hoc analysis of a prospective observational cohort including all patients who underwent pancreaticoduodenectomy at the Regional Academic Cancer Centre Utrecht between 2016 and 2022. The primary outcome was omission of adjuvant chemotherapy. Associations between prehabilitation-related factors-smoking, alcohol use, nutritional status, anemia, mobility, muscle strength, mental stress, and exocrine pancreatic insufficiency-were assessed using logistic regression. As a secondary analysis, we examined the relationship between these factors and major postoperative complications, a known determinant of chemotherapy omission.

Results: In total, 214 patients were included of which 115 patients (54%) were male with a median age of 70 years (± 7 years). A total of 70/214 patients (33%) did not start with adjuvant chemotherapy. Only smoking was independently associated with omitting chemotherapy (adjusted odds ratio (aOR) 2.98, 95% confidence interval (CI) 1.25-7.13, P < 0.01). Patients who suffered from major postoperative complications were less likely to receive adjuvant chemotherapy (aOR 2.36, 95%CI 1.07-5.18, P = 0.03). Again, only smoking was associated with a major postoperative complication (aOR 2.27, 95% CI 1.08-4.76).

Conclusion: Smoking is a modifiable prehabilitation target linked to both omission of adjuvant chemotherapy and increased risk of major postoperative complications following pancreatic surgery.

Purpose: Despite advances in oncology regimens and standardization of technical approaches such as total mesorectal excision (TME), local recurrences (LR) remain a significant concern in rectal cancer. This may be due to the complex interplay of genetic mutations driving the disease progression, leading to recurrence associated morbidity and mortality. The association of KRAS mutations on local recurrences in locally advanced rectal cancer (LARC) patients has been less investigated.

Methods: Patients from a single-center retrospective database with LARC (2018-2023) were identified and divided into two cohorts: KRAS mutated and KRAS wild-type. A propensity score was used to match the two groups, adjusting for cT/pT stage, tumour grade, extra-mural vessel invasion, lymphovascular/perineural invasion, surgical margins, TME quality, tumour budding, neoadjuvant/adjuvant radiotherapy. Propensity score matching was assessed with Chi-squared tests. Univariate Cox regression analyses were performed to assess KRAS mutations' influence on LR.

Results: 136 patients were included (68 KRAS mutated; 68 KRAS wild-type). The overall LR rate was 8.1%. Adjusted Cox regression analysis revealed that the mutations in codon 13 of KRAS (G13D/G13C) were a significant risk factor for LR (HR = 7.06, p-value = 0.001), with a 33.3% LR rate in those patients. Conversely, other KRAS mutations did not appear to be risk factors for LR (p-value > 0.05).

Conclusion: This study suggests codon 13 KRAS mutations may be associated with LR in LARC. However, given the small number patients and events, these findings should be cautiously interpreted until confirmed by larger studies. Preoperative genetic testing for KRAS mutations is suggested to enhance risk stratification.

Purpose: This study aimed to investigate the effects of concomitant proton pump inhibitor (PPI) use on the effectiveness of nivolumab in Japanese patients with advanced gastric cancer.

Methods: A single-center, retrospective, observational study was conducted at Keio University Hospital, Japan. We reviewed the medical records of consecutive patients with advanced gastric cancer treated with nivolumab monotherapy between September 2017 and March 2024 and compared treatment efficacy and safety with or without the concomitant use of PPIs. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Univariable and multivariable Cox proportional hazards models were used to estimate the hazard ratio (HRs) and 95% confidence intervals (CIs).

Results: Of the 84 patients included in this study, 46 were treated with PPIs. The median PFS was 2.1 (95% CI, 1.4-3.3) months in the PPI group and 4.4 (95% CI, 1.8-6.6) months in the non-PPI group (crude HR, 1.84; 95% CI, 1.15-2.95). The corresponding median OS was 5.3 (95% CI, 3.2-7.3) months and 7.3 (95% CI, 5.6-18.1) months (crude HR, 1.78; 95% CI, 1.10-2.89). Multivariable analysis revealed that PPI use significantly shortened both PFS and OS (adjusted HR, 1.79; 95% CI, 1.08-2.97 and adjusted HR, 1.72; 95% CI, 1.03-2.86, respectively).

Conclusion: Concomitant use of PPI may reduce the effectiveness of nivolumab in patients with advanced gastric cancer.

Background: The proportion of elderly patients among those diagnosed with gastric cancer (GC) is increasing worldwide. Given that physiological reserves are often diminished in this population, reliable tools for preoperative risk stratification are essential to inform therapeutic decision-making. Lung age, a spirometry-derived clinical parameter, has been associated with postoperative outcomes in some malignancies; however, its relevance in GC remains unclear. This study retrospectively evaluated the prognostic significance of lung age in elderly GC patients undergoing curative gastrectomy.

Methods: A total of 155 GC patients aged ≥ 70 years who underwent R0 gastrectomy were analyzed. The age gap (AG), defined as the difference between lung age and chronological age, was examined in relation to clinicopathological characteristics, postoperative complications, and survival outcomes.

Results: AG was significantly associated with postoperative complications. In univariate analyses, AG showed significant associations with overall survival (OS) and non-GC-related mortality, but not with cancer-specific survival. In multivariate analysis, AG was not an independent predictor of OS; however, it remained an independent predictor of non-GC-related death, whether analyzed as a dichotomous variable (hazard ratio [HR] 3.14, 95% confidence interval [CI] 1.33-7.38, p = 0.009) or as a continuous variable (HR 1.25 per 10-year increase, 95% CI 1.01-1.54, p = 0.036).

Conclusion: The discrepancy between lung and chronological age may serve as a useful predictor of long-term outcomes, particularly non-GC-related mortality, in elderly patients undergoing curative gastrectomy. This metric may support risk stratification and inform surgical strategies in this vulnerable population.

Purpose: Colorectal cancer remains a leading cause of cancer deaths, highlighting the need for early detection. Cologuard^®, a non-invasive stool DNA test, detects biomarkers for CRC and precancerous lesions but requires follow-up colonoscopy and has a high false-positive rate. This study evaluates colonoscopy follow-up rates and diagnostic outcomes after positive Cologuard^® results.

Methods: We conducted a retrospective cohort study using the TriNetX database, a global federated real-world data platform, to analyze patients aged ≥ 18 years who tested positive on Cologuard. The primary outcome was whether patients underwent an endoscopic procedure (colonoscopy) within 12 months of a positive result. The secondary outcome was the diagnoses made during follow-up colonoscopy, including malignant neoplasms (colorectal cancer) and benign neoplasms (polyps).

Results: A total of 3,916 patients underwent Cologuard^® testing, with 61.3% being female, 35% male, and 3.7% other genders. Of the 385 patients who tested positive for Cologuard^® (mean age 65 ± 8.75 years), 171 (44%) underwent follow-up colonoscopy within 12 months. Of these, 10 cases (5.8%) were diagnosed with malignant neoplasms, and 56 cases (32.7%) were diagnosed with benign neoplasms (polyps).

Conclusion: The study found poor follow-up adherence, with only 44% completing colonoscopy and a high false positive rate with just 38.5% of positive Cologuard^® results showing significant lesions. These findings emphasize the need for better patient education, streamlined care pathways, and improved communication to enhance follow-up compliance.

Background: Colorectal cancer (CRC) is the most prevalent malignant tumor of the digestive system globally, ranking third in incidence and second in mortality. The rates among individuals under 50 years (termed early-onset CRC, EO-CRC) have risen by approximately 2% annually over the past decade. We aim to compare clinicopathological profiles between EO-CRC and late-onset CRC (LO-CRC) patients, with a subsequent focus on identifying preoperative predictors of lymph node metastasis (LNM) in EO-CRC.

Methods: In this retrospective study, 3920 CRC patients were selected. The preoperative and postoperative clinicopathological features were retrospectively studied. Univariate analysis and multivariate analysis were performed using binary logistic regression to determine the predictive factors for LNM. Odds ratio (OR) and 95% confidence interval (CI) were calculated.

Results: 3327 (84.9%) patients were diagnosed with LO-CRC, while 593 (15.1%) patients were identified with EO-CRC. Compared to LO-CRC, EO-CRC patients exhibited significantly more aggressive tumor characteristics, including larger tumor size (p = 0.002), higher rates of poor differentiation(p < 0.001), advanced T stage (p = 0.016), N2 stage (p = 0.004), elevated perineural invasion (p < 0.001) and lymphovascular invasion (LVI) (p = 0.002). Multivariate analysis revealed elevated carbohydrate antigen 19 - 9 (CA19-9) (p < 0.001, OR = 2.433), T3/T4 stage classification (p = 0.001, OR = 2.323), nerve invasion (p = 0.001, OR = 2.482), and LVI (p = 0.003, OR = 2.180) were independent risk factors of LNM. In contrast, high microsatellite instability (MSI-H) (p < 0.001, OR = 0.371) seemed to be an independent protective factor.

Conclusion: These findings refine our understanding of metastatic drivers in EO-CRC and underscore the need for age-specific risk assessment tools. A significant potential of MSI-H status was indicated in the treatment of patients with EO-CRC.