World Journal of Gastrointestinal Oncology最新文献

Background: The clinical and pathological characteristics of primary gastric small cell carcinoma (GSCC) resemble those of small cell lung cancer, which is less sensitive to chemotherapy and has a poor prognosis. Currently, platinum-etoposide chemotherapy is a primary chemotherapy regimen for small cell carcinoma, but it is still imperfect. Programmed cell death ligand 1 (PD-L1) inhibitors are recommended for the treatment of small cell lung cancer. However, to determine whether PD-L1 inhibitors are optimal for metastatic GSCC requires more clinical data.

Case summary: A 67-year-old male experienced upper abdominal pain without any obvious cause for 1 week. Gastroscopy examination revealed a mass in the gastric body. Pathological examination of the biopsy specimen combined with immunohistochemistry showed a high-grade neuroendocrine carcinoma (small cell carcinoma). Genetic tests showed TP53, CREBBP, RB1, ABCB1, DNMT3A, and HGF gene mutations. Computed tomography (neck + chest + abdomen) showed multiple enlarged lymph nodes, occupying space in the greater curvature of the stomach and intrahepatic metastases. A regimen consisting of cisplatin and etoposide combined with durvalumab was administered every three weeks as palliative chemotherapy, for seven cycles. Durvalumab was then maintained every three weeks. However, the tumor recurred two months after the completion of chemotherapy. A regimen consisting of carboplatin and irinotecan combined with durvalumab was then given every three weeks. The tumor in the gastric body and liver shrank significantly, and the patient did not report any specific discomfort.

Conclusion: GSCC is a highly malignant tumor with a poor prognosis. Whether immune-related drugs are optimal for metastatic GSCC requires further exploration.

Patients with inflammatory bowel disease (IBD) have an increased risk of developing colorectal cancer, which may ultimately result in peritoneal metastases (PM). PM in patients with IBD is by nature difficult to treat due to the chronic inflammation and immunosuppression inherent in IBD. This minireview compiled existing evidence on management approaches to PM in patients with IBD, including surgical procedures, systemic treatment, and novel therapies. A literature review was conducted by searching PubMed and Scopus through June 2025 for studies addressing PM in IBD-associated colorectal or small bowel cancer. Literature specific to PM in IBD is sparse, comprising primarily two small retrospective cohort series comparing outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) in patients with and without IBD. These studies indicated that in high-volume centers with careful preoperative optimization perioperative morbidity and mortality rates for patients with IBD undergoing CRS/HIPEC were similar to those without IBD. However, median overall survival (approximately 19.6-24.0 months) and disease-free survival were consistently shorter and rates of early peritoneal recurrence were higher in patients with IBD. Although CRS/HIPEC can be performed safely in selected patients with IBD and PM, long-term oncologic outcomes appear inferior compared to populations without IBD, likely reflecting later-stage presentation, distinct tumor biology, and IBD-related factors.

Background: Colorectal cancer (CRC) is one of the most common causes of cancer mortality worldwide. The transcription factor Myc-associated zinc finger protein (MAZ) has been implicated in cancer progression. However, its precise function and mechanisms in CRC remain unclear.

Aim: To investigate the role and mechanism of the MAZ/ubiquitin-like with PHD and RING finger domains 1 (UHRF1)/esophageal cancer-related gene 4 (ECRG4) axis in CRC metastasis.

Methods: Western blot, quantitative reverse transcription polymerase chain reaction (PCR) and transwell were performed to evaluate the impact of MAZ knockdown on CRC cell migration and invasion. A xenograft tumor metastasis model was established by injecting MAZ-deficient CRC cells into nude mice to assess in vivo metastatic potential. Dual-luciferase reporter assay was performed to determine the role of MAZ and its downstream target, UHRF1. Chromatin immunoprecipitation-quantitative PCR and methylation-specific PCR were used to analyze whether UHRF1 regulated ECRG4 through DNA methylation.

Results: MAZ was highly upregulated in CRC cells and promoted CRC migration, invasion, epithelial-mesenchymal transition (EMT) and metastasis. Mechanistically, MAZ transcriptionally activated UHRF1, which in turn led to DNA methylation of ECRG4. Knockdown of MAZ suppressed CRC migration and invasion was reversed by overexpression of UHRF1. Loss of UHRF1 upregulated ECRG4, inhibited EMT, and reduced cell migration and invasion. However, simultaneous knockdown of ECRG4 partially reversed these effects.

Conclusion: MAZ promotes CRC cell migration, invasion, and EMT by transcriptionally activating UHRF1, which downregulates ECRG4 through DNA methylation.

Background: Pancreatic carcinoma is recognized as one of the most prothrombotic malignancies, carrying a high risk of thrombotic events, which may even precede the diagnosis of the underlying occult tumor. Acute renal infarction (ARI) as the initial presenting feature in patients with pancreatic cancer is a rare occurrence, and misdiagnosis is common during early evaluation.

Case summary: We report a patient who presented with ARI as the initial manifestation prior to the diagnosis of pancreatic cancer. The 50-year-old male was admitted to our emergency department with sharp, left-sided abdominal pain and was subsequently transferred to our department following the detection of a pancreatic space-occupying lesion on computed tomography (CT). CT angiography promptly identified the cause of his pain, confirming right renal infarction. Urgent interventional treatment was initiated to alleviate symptoms and restore renal perfusion. Despite aggressive thrombolytic and anticoagulant therapy, the thrombotic event rapidly worsened, leading to multiple cerebral infarctions. The patient's condition ultimately deteriorated under palliative care.

Conclusion: This case illustrates that arterial thromboembolism, when diagnosed at an advanced stage of pancreatic cancer, appears to be a terminal event that portends a poor prognosis. Establishing an arterial thrombosis prediction model will potentially identify the profile of high-risk patients with thrombotic consequences for primary prevention.

Background: Esophageal cancer is a clinically common malignant tumor of the digestive system. In 2022, it ranked fifth among the leading causes of cancer-related deaths in China. Its predominant symptom is dysphagia, and approximately 30%-40% of patients are prone to developing postoperative recurrent stenosis, necessitating repeated esophageal dilation, which significantly affects patients' quality of life. The self-dilation technique, performed by patients, enables preventive esophageal dilation and aims to reduce the frequency of recurrent stenosis.

Case summary: We report the case of a 61-year-old man who underwent repeated esophageal dilations following endoscopic submucosal dissection. During his eighth hospital admission, a multidisciplinary management team was established to implement an evidence-based self-help balloon dilation technique, facilitate early identification of nursing concerns and complications, and provide transitional care following discharge. The patient reported a high level of satisfaction during the hospital stay. During the 6-month follow-up after discharge, the patient's quality of life improved, with a substantial reduction in dysphagia. The esophageal stricture was successfully dilated from 5 mm to 6 mm, the interval between readmissions was prolonged, and the patient's weight increased from 49 kg to 50 kg.

Conclusion: The establishment of a multidisciplinary case management team, combined with the implementation of a self-help balloon dilation technique, early identification and management of nursing issues and complications, and personalized extended care, can significantly enhance patient satisfaction during hospitalization, improve quality of life, and extend the interval between readmissions. These strategies can provide valuable practical guidance for the clinical treatment and nursing of patients with recurrent esophageal stenosis.

Background: Early metastasis and recurrence are risk factors that negatively affect the prognosis of advanced hepatocellular carcinoma (HCC). Alpha fetoprotein (AFP) is currently the most prevalent serum biomarker for detecting HCC and predicting tumor recurrence. However, its sensitivity and specificity are not sufficient, especially in patients who are AFP negative.

Aim: To detect folate receptor (FR)-positive circulating tumor cells (CTCs) and explore their role in the diagnosis and staging of HCC.

Methods: This work is a retrospective study that included 128 consecutive patients with benign or malignant disease of the liver from 2020 to 2021. FR + CTCs were collected from 3 mL of peripheral blood via immunomagnetic depletion of leukocytes. After ligand-target polymerase chain reaction, the number of FR + CTCs was measured. Receiver operating characteristic curves were used to determine the threshold of sensitivity and specificity of FR + CTCs. The Youden index was used to identify the optimal cutoff point and diagnostic efficiency of FR + CTCs counts. Univariate and multivariate Cox proportional hazards regression analyses were performed to evaluate the associations of biomarkers or clinical parameters with disease-free survival (DFS).

Results: The FR + CTCs counts showed excellent diagnostic efficacy in patients with HCC, with high sensitivity (0.905) and specificity (0.773) compared with patients with benign disease. Compared with that of the AFP level, the area under the receiver operating characteristic curve of the FR + CTC count is significantly greater (0.900 compared with 0.730, P < 0.05). FR + CTC levels were significantly correlated with macrovascular invasion, tumor size, tumor number, and extrahepatic tumor stage in HCC patients. FR + CTC counts were correlated with DFS in HCC patients after R0 resection. Univariate analysis of DFS revealed that the FR + CTC count, tumor number, Barcelona Clinic Liver Cancer stage and extrahepatic metastasis status were correlated with DFS. Multivariate analysis of DFS revealed that the FR + CTC count and tumor number were correlated with DFS.

Conclusion: Ligand-target polymerase chain reaction is a sensitive tool for quantifying the number of FR + CTCs in HCC patients. These findings could provide new insight for stratifying HCC patients and predicting the recurrence of HCC.

Background: Total neoadjuvant therapy (TNT) has been proposed as an advancement over standard long-course chemoradiotherapy (LCCRT) for the treatment of locally advanced rectal cancer (LARC). It has been suggested that TNT enhances resectability, improves treatment compliance, increases the rate of pathological complete response, and reduces the risk of systemic recurrence. However, concerns have been raised that the prolonged interval to surgery associated with TNT, particularly in regimens such as the Rectal Cancer and Preoperative Induction Therapy Followed by Dedicated Operation (RAPIDO) protocol, may exacerbate fibrosis, leading to more technically challenging resections and poorer surgical outcomes.

Aim: To compare the early surgical outcomes of LARC patients treated with TNT-RAPIDO vs LCCRT.

Methods: A single-center, retrospective cohort study was conducted of patients with LARC treated with TNT-RAPIDO or standard LCCRT followed by surgical resection between 2014 and 2024. A total of 99 patients with LARC were analyzed, including 29 treated with TNT-RAPIDO and 70 treated with standard LCCRT. Demographics, clinicopathological characteristics and early post-operative outcomes were compared between both groups.

Results: Both groups were comparable in terms of demographics and clinicopathological characteristics. The median interval from initiation of neoadjuvant therapy to surgery was significantly longer in the TNT group compared to the LCCRT group (29.5 weeks vs 19.5 weeks, P < 0.001). Operative time and intraoperative complications were comparable. While the TNT group had a significantly higher lymph node harvest (40.7 vs 23.4, P < 0.001), the number of positive nodes was not significantly different. R0 resection rates were similar (93.1% vs 90%, P = 0.625). There was no difference in post-operative morbidity and 30-day mortality between both groups. The TNT group had a significantly shorter total stoma duration (27.1 weeks vs 42.5 weeks, P = 0.013) and a lower rate of permanent stoma formation (13.8% vs 35.7%, P = 0.013).

Conclusion: Compared with LCCRT, TNT-RAPIDO does not compromise operative time, complication rates, or oncological quality of resection and may confer a shorter total stoma duration and a lower permanent stoma rate.

Zhou et al's investigation on the creation of a non-invasive deep learning (DL) method for colorectal tumor immune microenvironment evaluation using preoperative computed tomography (CT) radiomics published in the World Journal of Gastrointestinal Oncology is thorough and scientific. The study analyzed preoperative CT images of 315 confirmed colorectal cancer patients, using manual regions of interest to extract DL features. The study developed a DL model using CT images and histopathological images to predict immune-related indicators in colorectal cancer patients. Pathological (tumor-stroma ratio, tumor-infiltrating lymphocytes infiltration, immunohistochemistry, tumor immune microenvironment and immune score) parameters and radiomics (CT imaging and model construction) data were combined to generate artificial intelligence-powered models. Clinical benefit and goodness of fit of the models were assessed using receiver operating characteristic, area under curve and decision curve analysis. The developed DL-based radiomics prediction model for non-invasive evaluation of tumor markers demonstrated potential for personalized treatment planning and immunotherapy strategies in colorectal cancer patients. The study, involving a small group from a single medical center, lacks inclusion/exclusion criteria and should include clinicopathological features for valuable therapeutic practice insights in colorectal cancer patients.

Background: Colorectal cancer (CRC) is a prevalent gastrointestinal malignancy with a typically unfavorable prognosis following the onset of liver metastases.

Aim: To develop and validate a new clinical prediction model to accurately forecast overall survival (OS) in CRC patients following surgical treatment for liver metastasis.

Methods: This study included 1059 patients diagnosed with CRC liver metastases (CRLM) at the Xijing Hospital between 2010 and 2022. The patients were randomly divided into training and validation cohorts at a 7:3 ratio. Key clinical predictors were identified using least absolute shrinkage and selection operator (LASSO) regression combined with a Cox proportional hazards model, leading to the establishment of a prediction model and preparation of a nomogram to enhance its clinical utility. Decision curve analysis (DCA) and Kaplan-Meier survival analysis were employed to evaluate the precision and predictive performance of the model.

Results: The LASSO-Cox regression analysis revealed multiple pivotal clinical biomarkers significantly linked to CRLM, including gamma-glutamyl transferase levels, blood chloride concentration, activated partial thromboplastin time, N stage, and vascular invasion. The model's receiver operating characteristic curve area under the curve exceeded 0.7 for both the training and validation groups with moderate-to-good predictive accuracy. Furthermore, DCA validated the nomogram's effectiveness for OS prediction. Kaplan-Meier risk stratification demonstrated markedly improved OS among patients classified as low-risk compared to those categorized as high-risk (P < 0.001), highlighting its clinical utility for risk assessment and treatment guidance.

Conclusion: The nomogram prediction model constructed in this study has good predictive value and can effectively assess the survival rate of patients with CRLM.