Journal of Gastrointestinal Cancer最新文献

Introduction: Total neoadjuvant treatment (TNT) has become the standard of care for locally advanced rectal cancer (LARC), leading to increased rates of complete clinical response and expanding the potential for organ preservation through non-operative management (NOM) protocols. Despite these advances, tumor regrowth remains a concern, necessitating vigilant surveillance to ensure early detection. However, adherence to surveillance protocols is often suboptimal, and the factors influencing tumor regrowth during NOM have not been well defined. This study aims to identify predictors of tumor regrowth in patients undergoing NOM after TNT.

Method: We conducted a retrospective review of patients with LARC who completed TNT at a single institution between 2019 and 2024. Patients who achieved sustained complete clinical response (cCR) for at least 12 months, as well as those who experienced tumor regrowth following cCR, were included. Patients with suspected regrowth who subsequently underwent surgery and were found to have a pathologic complete response (pCR) were excluded. Univariate analyses were performed to compare demographic, histopathologic, biochemical, clinical, radiological, and treatment-related factors between patients who experienced tumor regrowth and those who did not. The primary objective of our study was to identify predictors of tumor regrowth.

Results: Among 137 patients with LARC, 44 patients (32.1%) achieved cCR following completion of TNT. Of these, 10 patients experienced tumor regrowth and subsequently underwent surgery, with histopathology revealing a pCR in 2 cases. Currently, 11 patients remain in their first year of NOM, and 3 patients were lost to follow-up. In total, 20 patients sustained cCR. A total of 28 patients (25% female) with a mean age of 62.4 years (± 13) were included in the univariate analysis. No statistically significant differences were observed in demographic, histopathologic, biochemical, clinical, radiological, or treatment-related factors between patients who experienced tumor regrowth and those who did not (Table 1).

Conclusion: This study did not identify any predictors of tumor regrowth in patients undergoing NOM after TNT. The limited number of events severely restricted the power to detect statistically meaningful associations. Nevertheless, this area warrants further investigation to better tailor surveillance strategies and optimize NOM recommendations.

Background: Both alcohol fatty liver disease (AFLD) and non-alcohol fatty liver disease (NAFLD) are established risk factors for liver cancer development. We conduct a comparative analysis between AFLD and NAFLD to determine which condition contributes a greater burden to liver cancer incidence.

Methods: Data were obtained from the TriNetX research network. Individuals aged ≥ 20 years with newly diagnosed fatty liver disease between 2008 and 2021 were included. Participants were categorized into two groups: AFLD and NAFLD. Patients with a history of hepatic cirrhosis, liver cancer, hepatitis B, or hepatitis C before the index date were excluded. Propensity score matching was performed based on age, sex, and comorbidities, resulting in a balanced 1:1 matched cohort. Comparative analyses were conducted between the AFLD and NAFLD cohorts to assess differences in liver cancer risk profiles.

Results: A total of 13,998 AFLD and 1,165,365 NAFLD cases were analyzed. After propensity score matching, both cohorts consist of 13,998 individuals. At the 2- and 3-year follow-ups, the risk became statistically significant and showed a progressive increase, with relative risks approaching a two-fold elevation in the AFLD group. Cumulatively, by the final follow-up, AFLD patients demonstrated a markedly higher incidence of liver cancer (0.950% vs. 0.493%), confirming a sustained and significantly elevated risk even after adjustment for baseline characteristics.

Conclusion: Patients with AFLD exhibited an approximately two-fold increased risk of liver cancer development over a 3-year follow-up period compared to those with NAFLD. This finding underscores the urgent need for comprehensive recognition and mitigation of alcohol-associated hepatocarcinogenesis.

Purpose: This study evaluates the effectiveness of laparoscopic dog ear region removal as a modified double-stapling anastomosis (DSA) technique to reduce the risk of anastomotic leakage (AL) after colorectal cancer surgery.

Methods: We retrospectively analyzed 216 colorectal cancer patients who underwent laparoscopic anterior resection between January 2022 and June 2024. Patients were divided into two groups: the non-dog ear group (n = 104), which underwent dog ear area resection before DSA, and the DSA group (n = 112), which received conventional treatment.

Results: Baseline demographics, comorbidities, tumor characteristics, and preoperative treatments were comparable between the two groups (all p > 0.05). There were no significant differences in operative time (non-dog ear: 213.57 ± 57.06 min vs. DSA: 210.23 ± 65.11 min, p = 0.688) or overall complication rates (9.62% vs. 17.85%, p = 0.080). However, the non-dog ear group had significantly lower AL incidence (1.92% vs. 8.04%, p = 0.041) and shorter postoperative hospitalization and drainage tube removal times.

Conclusions: In this retrospective study, laparoscopic "dog ear" resection before DSA was associated with reduced AL risk and did not compromise surgical safety in colorectal cancer surgery, suggesting it may be a feasible refinement to standard procedures. These associations, however, require validation through prospective studies.

Purpose: The impact of age, comorbidities and geriatric syndromes is often overlooked during tumor board (TB) decisions. We investigated how frequently age, comorbidities, functional and nutritional parameters, and frailty are mentioned when deciding treatments for older adults with gastrointestinal (GI) cancers, and the impact these variables have on adherence to TB decisions and treatment guidelines from the European Society for Medical Oncology (ESMO).

Methods: Cross-sectional study of data from patients aged ≥ 65 years presented before the GI-TB of a tertiary cancer center between July 2019 and December 2022 based on electronic health records and TB documentation. Mention of age, comorbidity, functional and nutritional parameters, and frailty at decision-making, and adherence to TB decisions and treatment guidelines were assessed.

Results: 418 patients with a mean age of 77 years and Charlson Comorbidity Index (CCI) of 8.6 were included. Geriatric variables were mentioned in 43.8% of cases. Among these, comorbidities were mentioned in 17.2%, whereas age was mentioned in 14.6%. Adherence to TB decisions was 82%, whereas adherence to ESMO guidelines was 69%. Mention of age and comorbidity was associated with a 2-fold and 3-fold reduction in the likelihood of adherence to ESMO guidelines (p = 0.02 and 0.001, respectively). This association was not found when analysing adherence to TB decisions.

Conclusions: Geriatric variables, despite being often neglected at the time of defining treatment for the older adult with cancer, can have an effect on oncologic decision-making. Our findings underscore the need for integrating assessment of geriatric variables into oncologic care to support individualized, guideline-concordant treatment planning that reflects the complexity and needs of this population.

Purpose: Adenocarcinoma of pancreas is a lethal malignancy with multimodality treatment used in various combinations to improve survival. This study aimed to evaluate resectability rates, R0 resection status, and local progression-free survival (LPFS) in borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) patients treated with neoadjuvant chemotherapy (NACT) followed by either stereotactic body radiotherapy (SBRT) or conventional chemoradiation (CRT).

Methods: In this single institution prospective study, 20 pancreatic cancer patients (15 LAPC and 5 BRPC) received NACT (modified FOLFIRINOX or Gemcitabine with nab-paclitaxel), followed by random assignment (1:1) to SBRT (33-42 Gy/5-6 fractions) or CRT (45 Gy in 25 fractions with Capecitabine). After restaging, patients who were eligible underwent surgery, while others continued chemotherapy. Toxicity, quality of life (QoL), and haematological parameters (NLR, PLR) were assessed.

Results: Resectability was observed in 15% of patients, all from the SBRT arm. All patients who underwent resection were LAPC at diagnosis. The mean overall survival (OS) and local progression-free survival (LPFS) in the SBRT group were 21.8 months and 14 months, respectively, with a median OS of 15 months and median LPFS of 11 months. In comparison, the CRT group had a mean OS and LPFS of 13 months and 8.6 months, respectively, with a median OS of 12 months and median PFS of 7 months. One-year OS was 80% in the SBRT arm and 45% in the CRT arm. QOL improved in both arms, with better scores in the SBRT group. SBRT had no grade 3 or 4 toxicities. Lower NLR and PLR values correlated with better outcomes.

Conclusion: SBRT showed superior resectability, survival outcomes, and QoL compared to CRT in patients with BRPC and LAPC. However, due to the study's small sample size and single-centre design, these findings are hypothesis-generating and warrant validation in larger multicentre trials.

Background: Biliary carcinomas are aggressive cancers with a high mortality rate. When metastatic, biliary cancers are associated with a short survival and low response to treatments. The first line therapy of metastatic biliary carcinomas consists of a platinum doublet chemotherapy combination with an immune checkpoint inhibitor and results in a median overall survival in the range of approximately 12-13 months, with 20% to 25% of patients surviving at 2 years. Second line chemotherapy options based on fluoropyrimidines are associated with a median survival of less than 6 months. Genomic studies in recent years have clarified molecular aspects of biliary cancers and have confirmed the molecular heterogeneity between the intrahepatic, extrahepatic and gallbladder primary sites.

Methods: Publicly available genomic cohorts of biliary cancer primary locations were interrogated for common mutations and copy number alterations with a focus on receptor tyrosine kinases and their signal transduction pathways.

Results: Specific mutations and structural alterations have different prevalence depending on the primary location. Alterations in receptor tyrosine kinases and the transduction pathways originating from them show differential prevalence in the primary locations of the biliary cancers and create diverse treatment opportunities that can be harnessed for drug development. Approximately 49% of intrahepatic, 57.6% of gallbladder, and 66% of extrahepatic carcinomas harbor RTK pathway alterations.

Conclusions: Targeted therapies for individual components of these kinase receptors and pathways, including FGFR2, HER2, BRAF and others, have already been introduced in clinical practice for the treatment of patients with biliary tumors bearing alterations in these genes. The findings underscore the need for primary site-driven genomic testing to guide therapy selection. The current analysis discusses strategies to create opportunities for clinically available targeted therapies.

Background: Gastric cancer (GC) is the fifth most common cancer and a leading cause of cancer-related death. Peritoneal metastases occur in up to 25% of patients, with nearly half developing malignant ascites (MA), which arises from lymphatic obstruction, vascular permeability, and immune dysregulation. Median overall survival (OS) in this setting is poor (2-8 months). This systematic review and meta-analysis evaluate the prognostic impact of ascites in metastatic GC.

Materials and methods: PubMed, Embase, and Cochrane were searched for studies reporting OS in metastatic GC patients with and without ascites. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using fixed and random-effects models in RStudio 4.2.3.

Results: Overall, 14 studies involving 2179 patients, with 1208 having ascites, were included in the analysis. Of these, 13 were retrospective studies and 1 was a prospective study. The presence of ascites was associated with a significantly worse prognosis compared to its absence (HR 1.8418; 95% CI 1.5657-2.1667; P < 0.001). Similarly, the comparison of massive type ascites with mild to moderate type shows a worse outcome for the higher grade of ascites (HR 1.8597; 95% CI 1.4633-2.3635; P < 0.001). Comparing no to moderate ascites vs massive ascites, the massive type also shows a significantly lower overall survival (HR 2.5114; 95% CI 1.5409-4.0931; P < 0.001).

Conclusions: This meta-analysis suggests that the presence of ascites and its grades are essential prognostic factors for metastatic gastric cancer, significantly worsening overall survival.

Objective: This systematic review and meta-analysis evaluated whether spleen-preserving surgery with gastrectomy reduces the risk of intra-and postoperative complications compared with splenectomy in patients with proximal gastric cancer.

Background: Total gastrectomy with splenic hilar lymph node dissection, often involving splenectomy, is the standard approach for proximal gastric cancer. However, the effect of splenectomy on patient outcomes remains unclear.

Methods: We searched PubMed, Scopus, Cochrane, and Web of Science databases for studies comparing spleen preservation and splenectomy in total gastrectomy. Randomized clinical trials (RCTs) and observational studies were included in this study. Risk Ratios (RR) and Mean Differences (MD) with 95% confidence intervals (CI) were calculated. Heterogeneity was assessed using the I² test, and statistical significance was set at p < 0.05.

Results: Ten studies with 2 221 patients were included, 1 RCT and 9 retrospective cohort studies. Of these, 1 173 (52.81%) underwent spleen-preserving surgery, and 1 048 (47.19%) underwent splenectomy. Spleen-preserving surgery was associated with reduced pancreatic fistula (RR 0.30; p < 0.000001), blood loss (MD -172.47; p = 0.012396), anastomotic leak (RR 0.51; p = 0.006769), intra-abdominal abscess (RR 0.40; p = 0.000160), and complications according to the Clavien-Dindo classification (RR 0.50; p = 0.010315). Other outcomes, such as the length of hospital stay, operative time, pulmonary complications, and wound infection showed no significant differences.

Conclusion: Spleen-preserving gastrectomy reduces postoperative complications compared with splenectomy, supporting its use as the safer approach in proximal gastric cancer whenever oncologic safety is ensured.

Colorectal cancer (CRC) is the third most commonly diagnosed cancer and remains a leading cause of cancer-related mortality, particularly among younger men. Approximately one-third of colorectal cancers occur in the rectum. For patients with locally advanced rectal cancer, neoadjuvant therapy is considered the standard treatment approach. Despite advances in therapeutic approaches, improvements in the 5-year survival rate have been modest. Accurate assessment of tumor response to neoadjuvant therapy (NAT) is critical for guiding subsequent treatment strategies, especially when considering eligibility for non-operative management (NOM). Common evaluation methods include digital rectal examination (DRE), magnetic resonance imaging (MRI), and high-definition flexible endoscopy (HDFE). Tumor regression grading (TRG) systems-both histopathological (pTRG) and MRI-based (mrTRG)-are valuable tools for quantifying treatment response and predicting long-term outcomes. However, resistance to NAT remains a significant clinical challenge and is driven by a complex interplay of molecular mechanisms. Genetic factors, such as RAS mutations, have been linked to resistance to chemoradiotherapy (CRT), while tumors exhibiting microsatellite instability (MSI-high) tend to respond poorly to CRT but may show favorable outcomes with immune checkpoint inhibitors. Epigenetic pathways, including dysregulation of Wnt/β-catenin and PI3K/AKT signaling, along with alterations in DNA damage repair mechanisms, further influence CRT sensitivity. The tumor microenvironment also plays a pivotal role in modulating therapy response. Elements such as immune cell infiltration, hypoxia, angiogenesis, and the presence of cancer-associated fibroblasts (CAFs) contribute to a pro-resistance landscape. Moreover, emerging evidence suggests that gut microbiota composition-particularly an enrichment of Bacteroides species-is associated with diminished response to NAT. Understanding these multifaceted biological interactions is essential for developing personalized and more effective therapeutic strategies, with the goal of enhancing response to NAT and ultimately improving clinical outcomes in patients with rectal cancer.

Purpose: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death worldwide, yet mortality outcomes in patients with HCC can vary widely. Socioeconomic disparities are known to influence health outcomes in patients with various cancers. We aim to investigate the relationship between socioeconomic status as measured by the Area Deprivation Index (ADI) and risk of mortality and Barcelona Clinic Liver Cancer (BCLC) stage at the time of diagnosis in patients with HCC.

Methods: A retrospective cross-sectional study of patients treated for HCC at an academic liver center between January 1, 2016, and December 31, 2020. The primary outcome was time to cause-specific death. The secondary outcome was BCLC stage at the time of HCC diagnosis.

Results: A total of 980 patients (median age 66 years; interquartile range 61-72) were included. ADI was not a significant predictor of mortality across all ADI quintiles. Severity of HCC at diagnosis was associated with increasing deprivation at the state level ADI (P < 0.5 at all quintiles) but not the national ADI level. Advanced BCLC stage (C and D) was significantly associated with cause-specific death in patients with HCC in both models (hazard ratio, 1.94, 95% CI, 1.44-2.62; P < 0.001; hazard ratio, 1.94; 95% CI, 1.44-2.61; P < 0.001).

Conclusion: In patients with HCC treated at an academic liver center, ADI was associated with the severity of cancer at HCC diagnosis; however, mortality risk remained consistent across all ADI quintiles. Access to centers that provide coordinated, multidisciplinary HCC care may help mitigate the impact of socioeconomic disparities on HCC mortality.