Journal of Gastrointestinal Cancer最新文献

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.

Purpose: This study examined the impact of abdominal aortic calcification, a known risk factor for cardiovascular disease, on the prognosis of patients undergoing radical surgery for gastric cancer.

Methods: The effects of abdominal aortic calcification on clinical outcomes, prognosis, and recurrence patterns were analyzed in 516 patients who underwent radical surgery for gastric cancer between 2010 and 2017.

Results: After propensity score matching, patients with higher abdominal aortic calcification had significantly poorer overall survival (OS; P = 0.020), disease specific survival (DSS; P = 0.013), and recurrence-free survival (RFS; P = 0.017) than those with lower calcification levels. Multivariate Cox regression analysis identified a higher degree of abdominal aortic calcification as an independent risk factor for poor OS (hazard ratio, 2.57; 95% confidence interval, 1.56-4.22; P < 0.001), DSS (hazard ratio, 4.32; 95% confidence interval, 1.84-10.12; P < 0.001) and RFS (hazard ratio, 2.63; 95% confidence interval, 1.60-4.33; P < 0.001). High abdominal aortic calcification was also a risk factor for peritoneal dissemination recurrence in gastric cancer.

Conclusion: A high degree of abdominal aortic calcification was linked to poor prognosis and might increase peritoneal dissemination recurrence following curative resection for gastric cancer. Thus, abdominal aortic calcification may serve as a novel clinical tool for predicting the prognosis of patients with gastric cancer.

Background: Differentiating between pancreatic cancer (PC) and benign pancreatic lesions is challenging, leading to misdiagnosis and unnecessary pancreatoduodenectomy (PD). This systematic review and meta-analysis aimed to determine the prevalence of PC misdiagnosis in PD.

Methods: A systematic review was conducted following PRISMA guidelines and was prospectively registered on PROSPERO (CRD42024510669). We included 21 studies comprising 13,660 patients who underwent PD for suspected malignancy. A random-effects meta-analysis with 95% confidence interval (CI) was used to calculate the pooled prevalence of misdiagnosis and risk ratios of surgical complications or clinical manifestations.

Results: The pooled prevalence of misdiagnosed cancer cases was 8.35% (95% CI: 7.26-9.59). Chronic pancreatitis was the most common benign condition mistaken for cancer, with a pooled prevalence of 40.69% (95% CI 28.47-58.15). The most frequently reported preoperative symptoms included abdominal pain (62.54%), jaundice (52.05%), and weight loss (52.71%). Misdiagnosis was associated with abdominal pain as a clinical presentation, whereas jaundice was more common in malignancy (OR 2.21, 95% CI 1.15-4.24). Malignant pathology was associated with higher risks of postoperative pancreatic fistula (RR 2.01, 95% CI 1.18-3.43) and mortality (RR 2.57, 95% CI 1.06-6.24). Misdiagnoses were more prevalent among younger male patients, with females comprising 39.86% (95% CI 31.18-46.48) of the cohort.

Discussion: Pancreatic cancer misdiagnosis leading to surgical intervention remains a prevalent condition, with young male patients without weight loss being the most affected population and chronic pancreatitis the major differential diagnosis.

Purpose: To elucidate the correlation between perioperative serum albumin concentrations and clinical outcomes in patients with colorectal carcinoma.

Methods: This retrospective cohort investigation encompassed 2,217 individuals diagnosed with colorectal cancer who underwent surgical intervention between 2008 and 2019. Subjects were stratified into four cohorts based on pre- and post-operative albumin levels: persistently normal (A), initially low with normalization (B), initially normal with subsequent decline (C), and persistently low (D). Overall survival (OS) and recurrence-free survival (RFS) were assessed utilizing Kaplan-Meier estimates and Cox proportional hazards regression analysis.

Results: Significant heterogeneity in baseline characteristics was observed among the cohorts. Five-year OS rates were 82.8%, 78.5%, 73.9%, and 52.2% for groups A, B, C, and D, respectively (p < 0.0001). Multivariate analysis revealed that hypoalbuminemia, both pre- and post-operatively, served as an independent prognostic factor for diminished OS (HR 2.23, 95% CI 1.52-3.87, p = 0.005), but not RFS. Additional variables associated with inferior OS included advanced age (> 65 years), N2 stage disease, perineural invasion, and elevated postoperative carcinoembryonic antigen (CEA) levels. Restricted cubic spline analysis unveiled a non-linear relationship between albumin fluctuations and OS.

Conclusion: Perioperative serum albumin concentrations demonstrate prognostic utility in patients with colorectal carcinoma. Hypoalbuminemia, both before and after surgical intervention, is associated with abbreviated OS. Incorporation of albumin levels into prognostic models may facilitate the optimization of individualized treatment strategies and potentially ameliorate patient outcomes.

Background: Lymph node metastasis (LNM) is a poor prognostic factor in intrahepatic cholangiocarcinoma (iCCA). However, the clinical benefit of R0 resection in patients with LNM is uncertain. This study evaluates the influence of LNM on the prognostic significance of resection margin (RM) status in iCCA.

Methods: A retrospective analysis was conducted on 170 patients who underwent curative-intent liver resection for iCCA. Patients were categorized into LNM-negative (n = 87) and LNM-positive (n = 83) groups. Survival outcomes were compared based on RM status (R0 vs. R1 resection) in each group. Prognostic factors were analyzed using multivariable Cox proportional hazards regression.

Results: LNM-positive patients had significantly worse survival than LNM-negative patients (median survival time (MST): 9.8 vs. 19.9 months, p < 0.001). In LNM-negative patients, R0 resection showed a clinically meaningful, albeit not statistically significant, survival benefit (MST: 21.0 vs. 16.9 months, p = 0.145). However, in LNM-positive patients, R0 and R1 resections had comparable survival outcomes (MST: 11.1 vs. 9.0 months, p = 0.329). Multiple tumors were an independent poor prognostic factor in LNM-negative patients (HR 4.155, p = 0.004), while adjuvant therapy significantly improved survival in LNM-positive patients (HR 0.529, p = 0.009).

Conclusion: Our findings support a tailored surgical strategy. For LNM-negative patients, achieving an R0 resection remains critical. Conversely, for LNM-positive patients, resection margin status did not influence survival, and the surgical focus should shift towards a safe resection that preserves the patient's fitness for essential multimodal therapy, which was independently associated with improved survival.

Gastric cancer with peritoneal involvement is becoming increasingly common, particularly among younger patients with diffuse-type disease. This aggressive subtype carries a high symptom burden and severely impacts quality of life (QoL). Novel therapeutic strategies targeting peritoneal metastases, including normothermic intraperitoneal and systemic chemotherapy (NIPS), pressurised intraperitoneal aerosol chemotherapy (PIPAC), and cytoreductive surgery with HIPEC, are reshaping the treatment landscape. Among these, only NIPS has demonstrated a clear overall survival benefit, as shown in the phase III DRAGON-01 trial. PIPAC and CRS with HIPEC hold promise and are currently being investigated in randomised studies. However, patient-reported outcomes (PROs) remain inconsistently captured. For example, neither DRAGON-01 nor PHOENIX-GC reported QoL data despite their clinical impact. By contrast, PERISCOPE II and PIPAC VER-ONE have incorporated PRO measures, including EORTC QLQ-C30 and QLQSTO22, which are expected to provide more patient-centred insights. These instruments, while valuable, may not fully capture peritoneal-specific symptoms, highlighting the need for tailored tools. Routine integration and standardised reporting of PROs are critical to ensure that survival gains are accompanied by meaningful improvements in patient experience. As therapeutic strategies evolve, embedding PROs in trial design is essential for delivering value-based, patient-centred care in gastric cancer with peritoneal metastases. [KD1]LE: Structured abstract is required in this type of journal. Please consider providing the aforesaid.