World Journal of Gastrointestinal Oncology最新文献

Background: Well-differentiated small bowel mesenteric liposarcoma (LPS) is rare, with high malignancy, poor prognosis, and high preponderance to local recurrence.

Case summary: Here we described a 71-year-old male, who complains of persistent abdominal distension for a month. The clinical manifestation is a huge abdominal mass occupying almost the entire abdomen. Physical examination indicated palpable massive mass in the abdomen, hard texture, indefinable boundary, poor mobility. The abdominal enhanced computed tomography at another hospital scan showed multiple abdominal masses originating from the small bowel mesentery. Abdominal and pelvic magnetic resonance imaging at our hospital showed multiple masses in the abdominal and pelvic cavities, indicating that the tumor originated from the mesentery or peritoneum. Results of exploratory laparotomy indicated that the tremendous mass primarily results from the mesentery of the small intestine, occupying the entire abdominal cavity in a polymorphic and lobulated shape. The patient underwent complete surgical resection of the tumor, and the weight of the tumor was approximately 11 kg. The histopathological examination of the resected specimens confirmed the diagnosis of well-differentiated LPS of the small bowel mesentery.

Conclusion: Completed surgical resection was cornerstone, and histopathological and molecular confirmations were crucial. The necessity of adjuvant therapy should be phrased as a potential consideration to improve patient's survival time.

Background: Early screening, preoperative staging, and diagnosis of lymph node metastasis are crucial for improving the prognosis of gastric cancer (GC).

Aim: To evaluate the diagnostic value of combined multidetector computed tomography (MDCT) and gastrointestinal endoscopy for GC screening, preoperative staging, and lymph node metastasis detection, thereby providing a reference for clinical diagnosis and treatment.

Methods: In this retrospective study clinical and imaging data of 134 patients with suspected GC who were admitted between January 2023 and October 2024 were initially reviewed. According to the inclusion and exclusion criteria, 102 patients were finally enrolled in the analysis. All enrolled patients had undergone both MDCT and gastrointestinal endoscopy examinations prior to surgical intervention. Preoperative clinical staging and lymph node metastasis findings were compared with pathological results.

Results: The combined use of MDCT and gastrointestinal endoscopy demonstrated a sensitivity of 98.53%, specificity of 97.06%, accuracy of 98.04%, positive predictive value of 98.53%, and negative predictive value of 97.06% for diagnosing GC. These factors were all significantly higher than those of MDCT or endoscopy alone (P < 0.05). The accuracy rates of the combined approach for detecting clinical T and N stages were 97.06% and 92.65%, respectively, outperforming MDCT alone (86.76% and 79.41%) and endoscopy alone (85.29% and 70.59%) (P < 0.05). Among 68 patients with confirmed GC, 50 (73.53%) were pathologically diagnosed with lymph node metastasis. The accuracy for detecting lymph node metastasis was 66.00% with endoscopy, 76.00% with MDCT, and 92.00% with the combined approach, all with statistically significant differences (P < 0.05).

Conclusion: The combined application of MDCT and gastrointestinal endoscopy enhanced diagnostic accuracy for GC, provided greater consistency in preoperative staging, and improved the detection of lymph node metastasis, thereby demonstrating significant clinical utility.

Wu et al recently applied multi-region 16S rRNA sequencing to characterize the gastric cancer microbiome, demonstrating improved taxonomic resolution and detection sensitivity over conventional single-region approaches. While the study represents a valuable methodological step forward, it remains limited by single-center design, lack of quantitative calibration, and insufficient control for contamination and inter-laboratory variability. This editorial critically appraises these methodological gaps and emphasizes that future efforts must focus on harmonized, consensus-driven workflows to ensure reproducibility and clinical reliability. The translational potential of multi-region 16S lies in moving from descriptive microbial profiling to actionable clinical integration, particularly for recurrence prediction, treatment-response monitoring, and perioperative complication risk assessment. By addressing these methodological, economic, and ethical challenges, the field can advance toward evidence-based and clinically deployable microbiome-guided precision oncology.

Background: Chemotherapy with an immune checkpoint inhibitor is one of the standard regimens for treating advanced gastric cancer (AGC). Ascites and peritoneal dissemination are common complications and poor prognostic factors of AGC; however, reports regarding its efficacy and safety in patients with AGC and massive ascites are limited.

Aim: To evaluate the safety and efficacy of nivolumab combined with chemotherapy in patients with AGC and ascites.

Methods: We retrospectively collected clinical data from 124 patients with AGC who received chemotherapy plus nivolumab as first-line treatment from July 2017 to December 2024. Based on computed tomography scans, massive or moderate ascites were classified as high ascites burden (HAB), whereas mild or no ascites were classified as low ascites burden.

Results: Ascites was detected in 47 patients (38%); 26 (21%) were classified into the HAB group. Patients in the HAB group exhibited a significantly poorer performance status, a higher prevalence of diffuse-type histology, and lower programmed cell death ligand 1 (PD-L1) expression. Combination therapy with FOLFOX and neutropenia was significantly more common in the HAB group. Progression-free survival (PFS) (4.4 months vs 9.3 months, P = 0.0012) and overall survival (OS) (7.3 months vs 21.2 months, P < 0.0001) were significantly poorer in the HAB group. However, an improvement in ascites was observed in 61.5% of patients in the HAB group. PD-L1 expression did not correlate with either PFS or OS in the HAB group.

Conclusion: Nivolumab plus chemotherapy demonstrated modest efficacy and acceptable toxicity in patients with AGC and HAB.

Background: Elderly patients with colorectal cancer (CRC) can judge the risk of postoperative complications and oncological outcomes due to visceral obesity, which can provide data reference for the early prediction of prognosis.

Aim: To explore the effect of visceral obesity on postoperative complications and oncological outcomes in elderly patients with CRC.

Methods: A total of 150 elderly patients who underwent radical surgery for CRC at Inner Mongolia Medical University and Inner Mongolia Autonomous Region People's Hospital from January 2021 to June 2024 were retrospectively analyzed. Patients were divided into the abdominal [visceral fat area (VFA) ≥ 100.00 cm², n = 80] and non-abdominal (VFA < 100.00 cm², n = 70) obesity groups according to the VFA measured by preoperative computed tomography. The two groups showed no significant differences in age, sex, tumor location, tumor-node-metastasis stage, and underlying disease (P > 0.05). All patients underwent standardized laparoscopic assisted surgery and received unified perioperative management. Complications, nutritional status, changes in biochemical indicators, and tumor recurrence and metastasis were evaluated postoperatively.

Results: The overall incidence of postoperative complications was significantly higher in the abdominal obesity group than in the non-abdominal obesity group (P < 0.05). The pulmonary infection on postoperative day (POD) 3 (P = 0.038), anastomotic leakage on POD 7 (P = 0.042), and moderate-to-severe complications (Clavien-Dindo class III, P = 0.03) were significantly different. With respect to biochemical indicators, the white blood cell count, neutrophil percentage, and C-reactive protein level in the abdominal obesity group continuously increased after surgery (P < 0.05); the albumin level on POD 1 was even lower (P = 0.024). Regarding tumor markers, carcinoembryonic antigen (P = 0.039) and carbohydrate antigen 19-9 (P = 0.048) levels were significantly higher in the abdominal obesity group at 3 months after surgery, and local recurrence rates were higher than those in the non-abdominal obesity group at 30 days and 3 months after surgery (P < 0.05). Abdominal obesity was an independent risk factor for postoperative complications (odds ratio: 3.843, P = 0.001), overall survival [hazard ratio (HR): 1.937, P = 0.011], and disease-free survival (HR: 1.769, P = 0.018).

Conclusion: Visceral obesity significantly increases the risk of postoperative complications in elderly patients with CRC and may adversely affect short-term tumor prognosis. Preoperative risk identification and interventions for abdominal obesity should be strengthened to improve perioperative safety and postoperative rehabilitation quality.

We read with great interest the investigation of Kang et al related the applications of the multiparametric magnetic resonance imaging-based predictive model for assessing chemotherapy efficacy in colorectal cancer patients with gene mutations. The authors focused on decision-making based on the integration of tumor differentiation, signal intensity ratio, margin distance, and magnetic resonance imaging-detected lymph node metastasis. Indeed, these multiparameter predictive models could also be used for diagnosis as an alternative to invasive tissue examination methods. However, progress in this field enables us to shift the paradigm to radiology biopsies, particularly given the nonlinear effects of various radiation sources.

Radiofrequency ablation (RFA), particularly endoscopic ultrasound-guided RFA (EUS-RFA), has emerged as a promising minimally invasive approach for the treatment of pancreatic cancer, especially in patients with locally advanced or unresectable disease. This review outlines recent technological developments in EUS-RFA, including innovations in energy delivery systems, probe design, and real-time thermal monitoring, which have improved the precision and safety of the procedure. Clinical studies combining EUS-RFA with chemotherapy have demonstrated encouraging outcomes, with improvements in overall survival, progression-free survival, tumor necrosis, and symptom control compared to chemotherapy alone. Additionally, RFA-induced tumor antigen release and modulation of the tumor microenvironment suggest a potential synergistic role with immunotherapy. Despite its promise, the widespread adoption of EUS-RFA is limited by a lack of large-scale randomized controlled trials and standardized treatment protocols.

Background: Rhabdomyosarcoma (RMS) is a type of malignant tumor originating from rhabdomyocytes or mesenchymal cells differentiating into rhabdomyocytes. Hepatic pleomorphic RMS is a rare malignant liver tumor. Hepatic sarcomatoid carcinoma is also a rare epithelial malignant tumor originating from the liver; it is characterized by the coexistence of both carcinomatous and sarcomatoid spindle cell components.

Case summary: This paper reports a special case of an elderly woman whose initial liver puncture biopsy showed pleomorphic RMS. After chemotherapy with the vincristine + doxorubicin + cyclophosphamide regimen, the alpha-fetoprotein level increased significantly. Therefore, a second liver puncture was performed, the pathological result of which was hepatic sarcomatoid carcinoma. Next-generation sequencing revealed MET gene amplification with an average copy number of 9 in the tumor tissue; however, both fluorescence in situ hybridization and immunohistochemical tests were negative for MET amplification. The treatment regimen was adjusted to chemotherapy combined with immunotherapy; however, the disease progressed rapidly, and the overall survival was only 6 months.

Conclusion: By sharing the diagnosis and treatment process of this patient and reviewing the relevant literature, we aim to help clinicians enhance their understanding of two rare diseases, namely pleomorphic RMS and sarcomatoid carcinoma of the liver.