World Journal of Gastrointestinal Oncology最新文献

Gallbladder carcinoma (GBC) is the most common malignant tumor of biliary tract, with poor prognosis due to its aggressive nature and limited therapeutic options. Early detection of GBC is a major challenge, with most GBCs being detected accidentally during cholecystectomy procedures for gallbladder stones. This letter comments on the recent article by Deqing et al in the World Journal of Gastrointestinal Oncology, which summarized the various current methods used in early diagnosis of GBC, including endoscopic ultrasound (EUS) examination of the gallbladder for high-risk GBC patients, and the use of EUS-guided elastography, contrast-enhanced EUS, trans-papillary biopsy, natural orifice transluminal endoscopic surgery, magnifying endoscopy, choledochoscopy, and confocal laser endomicroscopy when necessary for early diagnosis of GBC. However, there is a need for novel methods for early GBC diagnosis, such as the use of artificial intelligence and non-coding RNA biomarkers for improved screening protocols. Additionally, the use of in vitro and animal models may provide critical insights for advancing early detection and treatment strategies of this aggressive tumor.

Pediatric pancreatic tumors, though rare, pose significant diagnostic and management challenges. The recent, 22-year nationwide survey on pediatric pancreatic tumors in Japan by Makita et al offers valuable insights into this uncommon entity, revealing striking geographical variations and questioning current treatment paradigms. This editorial commentary analyzes the study's key findings, including the predominance of solid pseudopapillary neoplasms and their younger age of onset, which contrast sharply with Western data. It explores the implications for clinical practice and research, emphasizing the need for population-specific approaches to diagnosis and treatment. The revealed limited institutional experience and surgical management patterns prompt a reevaluation of optimal care delivery for these complex cases, suggesting benefits of centralizing healthcare services. Furthermore, the commentary advocates for international collaborative studies to elucidate the genetic, environmental, and lifestyle factors influencing the development and progression of pediatric pancreatic tumors across diverse populations. It also outlines future directions, calling for advancements in precision medicine and innovative care delivery models to improve global patient outcomes. Unraveling Makita et al's findings within the broader landscape of pediatric oncology can stimulate further research and clinical advancements in managing pancreatic and other rare tumors in children.

Background: Gallbladder neuroendocrine carcinoma (NEC) represents a subtype of gallbladder malignancies characterized by a low incidence, aggressive nature, and poor prognosis. Despite its clinical severity, the genetic alterations, mechanisms, and signaling pathways underlying gallbladder NEC remain unclear.

Case summary: This case study presents a rare instance of primary gallbladder NEC in a 73-year-old female patient, who underwent a radical cholecystectomy with hepatic hilar lymphadenectomy and resection of liver segments IV-B and V. Targeted gene sequencing and bioinformatics analysis tools, including STRING, GeneMANIA, Metascape, TRRUST, Sangerbox, cBioPortal and GSCA, were used to analyze the biological functions and features of mutated genes in gallbladder NEC. Twelve mutations (APC, ARID2, IFNA6, KEAP1, RB1, SMAD4, TP53, BTK, GATA1, GNAS, and PRDM3) were identified, and the tumor mutation burden was determined to be 9.52 muts/Mb via targeted gene sequencing. A protein-protein interaction network showed significant interactions among the twelve mutated genes. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses were used to assess mutation functions and pathways. The results revealed 40 tumor-related pathways. A key regulatory factor for gallbladder NEC-related genes was identified, and its biological functions and features were compared with those of gallbladder carcinoma.

Conclusion: Gallbladder NEC requires standardized treatment. Comparisons with other gallbladder carcinomas revealed clinical phenotypes, molecular alterations, functional characteristics, and enriched pathways.

Background: Transforming growth factor-β (TGF-β) superfamily plays an important role in tumor progression and metastasis. Activin A receptor type 1C (ACVR1C) is a TGF-β type I receptor that is involved in tumorigenesis through binding to different ligands.

Aim: To evaluate the correlation between single nucleotide polymorphisms (SNPs) of ACVR1C and susceptibility to esophageal squamous cell carcinoma (ESCC) in Chinese Han population.

Methods: In this hospital-based cohort study, 1043 ESCC patients and 1143 healthy controls were enrolled. Five SNPs (rs4664229, rs4556933, rs77886248, rs77263459, rs6734630) of ACVR1C were assessed by the ligation detection reaction method. Hardy-Weinberg equilibrium test, genetic model analysis, stratified analysis, linkage disequilibrium test, and haplotype analysis were conducted.

Results: Participants carrying ACVR1C rs4556933 GA mutant had significantly decreased risk of ESCC, and those with rs77886248 TA mutant were related with higher risk, especially in older male smokers. In the haplotype analysis, ACVR1C T_rs4664229A_rs4556933T_rs77886248C_rs77263459A_rs6734630 increased risk of ESCC, while T_rs4664229G_rs4556933T_rs77886248C_rs77263459A_rs6734630 was associated with lower susceptibility to ESCC.

Conclusion: ACVR1C rs4556933 and rs77886248 SNPs were associated with the susceptibility to ESCC, which could provide a potential target for early diagnosis and treatment of ESCC in Chinese Han population.

Background: Owing to the absence of specific symptoms in early-stage gastric cancer, most patients are diagnosed at intermediate or advanced stages. As a result, treatment often shifts from surgery to other therapies, with chemotherapy and targeted therapies being the primary options for advanced gastric cancer treatment.

Aim: To investigate both treatment efficacy and immune modulation.

Methods: A total of 116 patients with advanced gastric cancer, admitted from January 2021 to December 2023, were selected and divided into two groups of 58 each using the random number table method. The control group received FOLFOX4 chemotherapy (oxaliplatin + calcium + folinate + 5-fluorouracil) combined with intravenous sindilizumab. The observation group received the same treatment as the control group, supplemented by oral administration of Senqi Shiyiwei granules. Both groups underwent treatment cycles of 3 weeks, with a minimum of two cycles. The therapeutic efficacy, immune mechanisms, and treatment-related toxicity and side effects were compared between the groups.

Results: The objective remission rate in the observation group (55.17%) was higher than that of the control group (36.21%) (P < 0.05). After two treatment cycle, CD3+, CD4+, and CD4+/CD8+ levels were higher in the observation group compared to the control group, while CD8+, regulatory T cells, and natural killer cells were lower (P < 0.05). Additionally, the incidence of leukopenia, nausea, and vomiting was lower in observed group (P < 0.05). No significant differences were observed in the incidence of other adverse reactions (P > 0.05).

Conclusion: Adjuvant therapy with Shenqixian granules may enhance the efficacy of simudizumab combined with FOLFOX4 chemotherapy in advanced gastric cancer and the immune function by increasing immune cell counts, making it a valuable option in clinical treatment.

In this editorial, we will discuss the article by Tang et al published in the recent issue of the World Journal of Gastrointestinal Oncology. They explored an innovative approach to enhancing gemcitabine (GEM) delivery and efficacy using human bone marrow mesenchymal stem cells (HU-BMSCs)-derived exosomes. The manufacture of GEM-loaded HU-BMSCs-derived exosomes (Exo-GEM) has been optimized. The Tang et al's study demonstrated that Exo-GEM exhibits enhanced cytotoxicity and apoptosis-inducing effects compared to free GEM, highlighting the potential of exosome-based drug delivery systems as a more effective and targeted approach to chemotherapy in pancreatic cancer. Additional in vivo studies are required to confirm the safety and effectiveness of Exo-GEM before it can be considered for clinical use.

Background: Microvascular invasion (MVI) is a significant risk factor for recurrence and metastasis following hepatocellular carcinoma (HCC) surgery. Currently, there is a paucity of preoperative evaluation approaches for MVI.

Aim: To investigate the predictive value of texture features and radiological signs based on multiparametric magnetic resonance imaging in the non-invasive preoperative prediction of MVI in HCC.

Methods: Clinical data from 97 HCC patients were retrospectively collected from January 2019 to July 2022 at our hospital. Patients were classified into two groups: MVI-positive (n = 57) and MVI-negative (n = 40), based on postoperative pathological results. The correlation between relevant radiological signs and MVI status was analyzed. MaZda4.6 software and the mutual information method were employed to identify the top 10 dominant texture features, which were combined with radiological signs to construct artificial neural network (ANN) models for MVI prediction. The predictive performance of the ANN models was evaluated using area under the curve, sensitivity, and specificity. ANN models with relatively high predictive performance were screened using the DeLong test, and the regression model of multilayer feedforward ANN with backpropagation and error backpropagation learning method was used to evaluate the models' stability.

Results: The absence of a pseudocapsule, an incomplete pseudocapsule, and the presence of tumor blood vessels were identified as independent predictors of HCC MVI. The ANN model constructed using the dominant features of the combined group (pseudocapsule status + tumor blood vessels + arterial phase + venous phase) demonstrated the best predictive performance for MVI status and was found to be automated, highly operable, and very stable.

Conclusion: The ANN model constructed using the dominant features of the combined group can be recommended as a non-invasive method for preoperative prediction of HCC MVI status.

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, with advanced stages posing significant treatment challenges. Although hepatic arterial infusion chemotherapy (HAIC) has emerged as a promising modality for treating advanced HCC, particularly in Asian clinical practice, its adoption in Western medicine remains limited due to a lack of large-scale randomized controlled trials. This editorial reviews and comments on the meta-analysis conducted by Zhou et al, which evaluates the efficacy and safety of HAIC and its combination strategies for advanced HCC. The authors performed a comprehensive meta-analysis of various clinical trials and cohort studies comparing HAIC and its combinations to other first-line treatments, such as sorafenib and transarterial chemoembolization (TACE). In this work, HAIC showed significantly better results regarding overall survival and progression-free survival compared to sorafenib or TACE alone and their combination. HAIC in combination with lenvatinib, ablation, programmed cell death 1 inhibitors, and radiotherapy further enhanced patient outcomes, indicating a synergistic effect. This editorial focuses on the critical role of multimodal treatment strategies in managing advanced HCC. It advocates for a paradigm shift towards integrated treatment approaches to enhance survival rates and improve the quality of life in patients with advanced HCC.

This study examines the pivotal findings of the network meta-analysis of Zhou et al, which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinoma (HCC). This meta-analysis suggests that therapeutic combinations have greater efficacy than do standard treatments. The article highlights the key insights that have the potential to shift current clinical practice and enhance outcomes for patients with advanced HCC. Additionally, this article discusses further research that can be conducted to optimize these treatments and achieve personalized care for patients with HCC.

In this editorial, we comment on the article by Mu et al, published in the recent issue of the World Journal of Gastrointestinal Oncology. We pay special attention to the immune tolerance mechanism caused by hepatitis B virus (HBV) infection, the pathogenesis of hepatocellular carcinoma (HCC), and the role of antiviral therapy in treating HCC related to HBV infection. HBV infection leads to systemic innate immune tolerance by directly inhibiting pattern recognition receptor recognition and antiviral signaling pathways, as well as by inhibiting the immune functions of macrophages, natural killer cells and dendritic cells. In addition, HBV leads to an immunosuppressive cascade by expressing inhibitory molecules to induce exhaustion of HBV-specific cluster of differentiation 8 + T cells, ultimately leading to long-term viral infection. The loss of immune cell function caused by HBV infection ultimately leads to HCC. Long-term antiviral therapy can improve the prognosis of patients with HCC and prevent tumor recurrence and metastasis.