World Journal of Gastrointestinal Oncology最新文献

This editorial comments on Yang et al's article that reported a correlation between dynamic contrast-enhanced ultrasound (CEUS) quantitative parameters and Ki67/tumor differentiation. The validation of CEUS as a diagnostic modality in this study deserves merit. However, it raises interesting points of discussion: (1) Since pancreatic cancer is an overarching term that includes conventional pancreatic ductal adenocarcinoma (PDAC), other subtypes, and neuroendocrine neoplasms (NENs), the inclusion/exclusion criteria require better clarification; (2) Most PDACs are grade 1-2 which contrasts with Yang et al's study where 46% were grade 3; (3) Ki67 is officially recognized for grading NENs, but not for PDAC; (4) Hotspots are selected for the Ki67 grading of NENs. However, for other tumors (e.g., breast carcinoma), the average count or hotspots are used; (5) There is no agreement for defining high-grade Ki67 cut-off for non-NENs; reports range from 10% to 50%; and (6) Ki67 reflects cellular proliferation but is not always the most important indicator for biologic aggressiveness. That notwithstanding, since the ratification of Ki67 for prognosis in NENs was based on survival outcomes, the real gold standard should be survival, instead of using Ki67 as a surrogate gold standard. In conclusion, the validation of CEUS parameters for PDAC is a work in progress. CEUS is valuable in assessing PDAC but should be viewed as augmenting other modalities such as computed tomography, magnetic resonance imaging, positron emission tomography and endoscopic ultrasound.

Background: The gastric microbiome is closely associated with gastric cancer, and single-region 16S rRNA sequencing has limitations in analyzing its characteristics, necessitating the search for a better sequencing method.

Aim: To evaluate the effectiveness of multi-region 16S rRNA gene sequencing in studying the microbiome of gastric cancer tissues.

Methods: Patients with gastric cancer (n = 118) who underwent surgery at Liyang People's Hospital from January 2022 to December 2024 were enrolled. Fifty-nine paraffin-embedded and 59 fresh tissue samples were obtained. The ZymoBIOMICS^TM microbial community standard and Escherichia coli ATCC 25922 were used as positive controls. Multi-region and single-region 16S rRNA gene sequencing were performed. Species identification, detection rates at varying microbial abundances, operational taxonomic unit (OTU) counts, and alpha diversity indices in gastric cancer tissues were compared between the two methods.

Results: Multi-region 16S rRNA sequencing identified more species (eight species and eight genera) in the positive controls compared with single-region sequencing (one species and six genera). Detection rates at concentrations of 10³, 10², and 10 CFU/mg were significantly higher using multi-region sequencing (P < 0.05). Multi-region sequencing also revealed significantly higher OTU counts and alpha diversity indices (Shannon, Simpson, and Chao1) in gastric cancer tissues (P < 0.05).

Conclusion: Compared with single-region sequencing, multi-region 16S rRNA gene sequencing demonstrates superior species resolution and detection sensitivity, providing a more comprehensive profile of microbial diversity in gastric cancer tissues.

This editorial discusses Alpsoy et al's significant study of prognosis of pancreatic ductal adenocarcinoma (PDAC), which lacks histopathological markers. This study evaluated the synergistic prognolymphocytes. Peritumoral budding is significantly correlated with tumor volume, while intratumoral budding is closely related to lymph node metastasis. Peritumoral budding and intratumoral budding are confirmed as independent adverse prognostic factors, and their high levels of expression are associated with immature stromal phenotypes, suggesting the key role of epithelial-mesenchymal transition. These breakthrough findings provide a new multidimensional biomarker system for the prognostic assessment of PDAC, and promote the clinical transformation process of incorporating tumor budding indicators into the pathological reporting process. However, the complexity and spatiotemporal heterogeneity of the tumor microenvironment require us to go beyond traditional morphological analysis and move towards multiomics integration and dynamic monitoring. Through standardized pathological assessment, innovative treatment strategies and interdisciplinary collaboration, it is expected to transform tumor microenvironment-related markers into clinically applicable indicators, ultimately improving the treatment predicament of PDAC. This editorial intended to summarize relevant studies and share some of our views, in order to offer perspectives for future research.

Colorectal cancer (CRC) exhibits profound lipid metabolic reprogramming, a hallmark of malignant transformation that supports tumorigenesis, immune evasion, and therapeutic resistance. Dysregulated lipid metabolism in CRC involves altered fatty acid synthesis, uptake, oxidation, and cholesterol metabolism, which collectively drive cancer cell proliferation, metastasis, and interactions with the tumor microenvironment (TME). This review synthesizes current insights into lipid metabolic rewiring in CRC, its role in shaping immunosuppressive TME dynamics, and emerging therapeutic strategies targeting lipid pathways.

Background: Well-differentiated rectal neuroendocrine tumors (rNETs) represent approximately 28% of gastrointestinal neuroendocrine tumors, with a rising incidence over recent decades. However, data from Perú remains limited.

Aim: To assess overall survival (OS) in patients with rNETs and describe the clinical and pathological characteristics of the study population.

Methods: This retrospective study included patients diagnosed with rNETs at the Instituto Nacional de Enfermedades Neoplásicas between 2009 and 2024. Qualitative variables were evaluated using the χ ² test through contingency tables. OS was estimated using the Kaplan-Meier method, and differences between groups were assessed with the log-rank test. Cox proportional hazards models were used to evaluate variables associated with OS. All statistical analyses were conducted using R software.

Results: A total of 52 patients were included, with a mean age of 51.9 years (range: 27-74 years) and composed of 65.4% females. The most common stage at diagnosis was stage I (48.1%), followed by stage IV (36.5%). The median OS within the study population was 76 months. The 5-year OS for grade 1 tumors was 92.9% compared to 32.6% for grade 2 tumors (P = 0.00032). The median OS was 48 months for tumors exceeding 20 mm in size, whereas it was not reached for tumors measuring 20 mm or less (P = 0.0056). Similarly, the median OS for patients classified as lymph node involvement 1 was 46 months, while it was estimated at 112 months for those classified as lymph node involvement 0 (P = 0.0063).

Conclusion: rNETs exceeding 2 cm in size, classified as grade 2, or presenting with lymph node involvement 1 status were correlated with advanced disease stages and diminished survival outcomes.

Background: Childhood intestinal lymphoma is characterized by its insidious onset and the absence of specific clinical symptoms. The thinner abdominal wall in children significantly aids in the ultrasound visualization of the abdominal cavity and intestines. Although many typical cases of intestinal lymphoma can be diagnosed through ultrasound, physicians often either overlook these values or assume that ultrasound has limited diagnostic value for intestinal lymphoma.

Aim: To clarify the diagnosis of intestinal lymphoma and classify its severity using ultrasound, as well as to correlate this with prognosis.

Methods: The correlation between ultrasound diagnostic outcomes, laboratory indicators, and clinical prognosis was analyzed to demonstrate the effectiveness of ultrasound in assessing the severity of intestinal lymphoma and to provide new evidence for the diagnosis and treatment of the disease in children. A retrospective analysis was conducted on the sonographic images and case data of 28 children diagnosed with intestinal lymphoma and confirmed by surgical pathology. Additionally, we sought to determine the correlation between ultrasonic classification of lymphoma, lactate dehydrogenase (LDH) values, pathological classification, and prognosis.

Results: Ultrasound was utilized to categorize 28 cases of intestinal lymphoma into focal segmental (15 cases) and extensive (13 cases) types. Ultrasound classification and LDH levels were significantly correlated with prognosis (P < 0.05), while pathological type, age, gender, and treatment modality showed no significant correlation (P > 0.05). Among ultrasound manifestations, there was a significant difference in LDH levels between the segmental and extensive groups (P < 0.05). The prognosis for children with extensive intestinal lymphoma was poorer than that for children with localized segmental intestinal lymphoma (P < 0.05).

Conclusion: Ultrasound can be used in the diagnosis and classification of intestinal lymphoma in children. Extensive intestinal lymphoma is associated with significantly elevated LDH and poor prognosis.

The initiation and progression of colorectal cancer (CRC) are profoundly influenced by the complex interplay between the gut microbiota and the immune system, underscoring the clinical importance of exploring the bidirectional regulatory mechanisms of the microbiota-immune axis within the CRC immune microenvironment. Emerging evidence indicates that the composition and functional capacity of the gut microbiota play a vital role in modulating the host's immune responses, while the immune system, in turn, can reciprocally regulate the structure and function of the microbiota. Despite significant insights into the role of the microbiota-immune axis in CRC progression, several critical questions remain unanswered-including how microbial heterogeneity affects therapeutic outcomes and the specific consequences of dysregulated regulatory mechanisms on the immune microenvironment. This review aims to provide a comprehensive analysis of the compositional features of the CRC immune microenvironment, examine the bidirectional molecular mechanisms underpinning the microbiota-immune axis, and evaluate the potential of targeted therapeutic strategies, thereby offering novel research perspectives and clinical applications for CRC treatment.

In this paper, we focus on compelling evidence showing that MEX3A is significantly overexpressed in hepatocellular carcinoma (HCC) and correlates with poor prognosis. A recent study by Ji et al highlights MEX3A's role in driving proliferation and migration via the RORA/β-catenin axis and epithelial-mesenchymal transition, positioning it as a potential biomarker and therapeutic target. This study addresses a critical gap in understanding HCC pathogenesis and offers valuable mechanistic insights.

Background: Postoperative patients with gastrointestinal tumors are at high risk for poor wound healing and psychological distress, such as anxiety and depression, which can negatively impact recovery and quality of life. Multidisciplinary team (MDT) collaborative nursing has emerged as a comprehensive care approach that may address both physical and psychological needs.

Aim: To explored the impact of MDT collaborative nursing on wound healing and anxiety/depression symptoms in postoperative patients with gastrointestinal tumors.

Methods: A retrospective analysis was conducted on 364 patients with gastrointestinal tumours admitted to our hospital between January 2022 and December 2024. Based on differing postoperative nursing approaches, two groups were established: the MDT group (n = 196) and the control group (n = 168). The control group received conventional nursing interventions, while the MDT group received MDT collaborative nursing. The study compared wound healing outcomes, pre-intervention and one-month post-intervention Hospital Anxiety and Depression Scale (HADS) scores, Functional Assessment of Cancer Therapy-General (FACT-G) quality of life scores, and complication rates between the two groups.

Results: The MDT group demonstrated a Grade A wound healing rate of 88.27% and total treatment compliance of 99.49%, both significantly higher than the control group (75.00% and 95.83%, respectively). The complication incidence rate was 3.06% in the MDT group, lower than the control group (8.93%), with all differences statistically significant (P < 0.05). After one month of intervention, patients in the MDT group demonstrated lower Anxiety Self-Rating Scale and Depression Self-Rating Scale scores on the HADS scale compared to the control group. Conversely, their scores on the FACT-G scale for physical, social/family, emotional, and functional domains were higher than those in the control group, with all differences being statistically significant (P < 0.05).

Conclusion: MDT collaborative care promotes wound healing in patients undergoing gastrointestinal tumour surgery, alleviates anxiety and depressive symptoms, enhances treatment adherence and quality of life, and reduces the incidence of complications.

Biliary tract cancer (BTC) is a rare disease with few available treatment options. Tumor malignancy and surgical invasiveness vary depending on the site of the lesion. Perioperative mortality remains high, particularly in patients with hilar cholangiocarcinoma and gallbladder cancer. Benchmark cases from high-volume centers have reported high surgical complications (87%) and 3-month mortality rates (13%). Japanese studies of hepatopancreatoduodenectomy have reported that although the complication rate is higher in high-volume centers than in other institutions, the mortality rate is low; operative safety depends on adequate liver volume after resection by portal vein embolization, cholangitis reduction, and comprehensive management of postoperative complications. Robot-assisted surgery is increasingly common in patients treated with pancreaticoduodenectomy even after distal pancreatectomy. However, many challenges exist due to device and visibility issues. Recently, adjuvant chemotherapies have been developed for the treatment of BTC. The introduction of immune checkpoint inhibitors and discovery of oncogenic driver genes have increased the number of promising treatment options. Innovations in targeted drug therapy, including fibroblast growth factor receptor inhibitors and immune checkpoint inhibitors, have shown efficacy and broadened the treatment options for unresectable BTC. Therefore, a multidisciplinary treatment strategy based on surgical intervention is desirable.