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ABSTRACT Background: Diet is one of the most important modifiable risk factors for the incidence of gastric cancer. Objective: To carry out an exploratory analysis on the dietary patterns of individuals with gastric adenocarcinoma (AdG) in the Central Brazil region. Methods: This is a case-control study carried out from April 2019 to July 2022, in three reference centers for cancer treatment in Goiânia-GO. The cases were patients diagnosed with AdG, the control 1 dyspeptic patients submitted to upper digestive endoscopy and the control 2 patients without gastric complaints. In the three groups, patients aged 18 to 75 years and of both sexes were recruited. To assess food consumption, a Food Frequency Questionnaire validated for the Brazilian population was used. Dietary patterns were identified by Exploratory Factor Analysis (EFA), using principal component analysis as the extraction method, followed by Varimax rotation. Results: The commonality values in the EFA for the foods/food groups consumed by the cases and controls were above 0.30 for all variables. The variance explained by the model was 66.7% for cases, 60.3% for control 1 and 59.7% for control 2. Three eating patterns were identified in cases, control 1 and control 2 that explained 34, 87%, 35.41% and 33.25% respectively of the total variance. The first pattern ("healthy") was characterized by the consumption of vegetables, fruits, meat and cheese; the second ("unhealthy") for sausages, pizzas, snacks, ketchup, sweet drinks and instant noodles and the third ("prudent") rice, beans, meat and fried fish and pasta. Conclusion: This study identified three dietary patterns among patients with AdG and controls in the Central Brazil region. According to the identified patterns, it will be possible to establish a relationship between diet and other epidemiological measures aimed at the prevention of gastric cancer.
RESUMO Contexto: A dieta é um dos fatores de risco modificáveis mais importante para a incidência de câncer gástrico. Objetivo: Realizar uma análise exploratória sobre os padrões alimentares de indivíduos com adenocarcinoma gástrico (AdG) na região Brasil central. Métodos: Este é um estudo de caso-controle realizado no período de abril de 2019 a julho de 2022, em três centros de referência para o tratamento para câncer em Goiânia-GO. Os casos foram pacientes diagnosticados com AdG, o controle 1 pacientes dispépticos submetidos a endoscopia digestiva alta e o controle 2 pacientes sem queixas gástricas. Nos três grupos foram recrutados pacientes de 18 a 75 anos e de ambos os sexos. Para avaliar o consumo alimentar foi utilizado um Questionário de Frequência Alimentar validado para a população brasileira. Os padrões alimentares foram identificados por Análise Fatorial Exploratória (AFE), utilizando a análise de componentes principais como método de extração, seguida pela rotação Varimax. Resultados: Os valores de comunalidade na AFE para os alimentos/grupos alimentares consumidos pelos casos e controles ficaram acima de 0,30 para todas as variáveis. A variância explicada pelo modelo foi de 66,7%, para casos, 60,3% para o controle 1 e 59,7% para o controle 2. Foram identificados três padrões alimentares nos casos, controle 1 e controle 2 que explicaram 34,87%, 35,41% e 33,25% respectivamente da variância total. O primeiro padrão ("saudável") foi caracterizado pelo consumo de vegetais, frutas, carne e queijos; o segundo ("não saudável") por embutidos, pizzas, snacks, ketchup, bebidas doces e macarrão instantâneo e o terceiro ("prudente") arroz, feijão, carnes e peixes fritos e massas. Conclusão: Esse estudo identificou três padrões alimentares entre os pacientes com AdG e os controles na região Brasil central. De acordo com os padrões identificados, será possível estabelecer uma relação entre a dieta e outras medidas epidemiológicas destinadas à prevenção do câncer gástrico.
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Introducción. El diagnóstico adecuado de los tumores de la unión esofagogástrica es esencial para el tratamiento de estos pacientes. La clasificación propuesta por Siewert-Stein define las características propias, factores de riesgo y estrategias quirúrgicas según la localización. El objetivo de este estudio fue describir las características de los pacientes con adenocarcinoma de la unión esofagogástrica tratados en nuestra institución. Métodos. Estudio retrospectivo, descriptivo, de corte longitudinal, que incluyó los pacientes con diagnóstico de adenocarcinoma de la unión esofagogástrica intervenidos quirúrgicamente en el Instituto Nacional de Cancerología, Bogotá, D.C., Colombia, entre enero de 2012 y mayo de 2017. Resultados. Se operaron 59 pacientes (84,7 % hombres), con una edad media de 62,5 años. En su orden de frecuencia los tumores fueron tipo II (57,6 %), tipo III (30,7 %) y tipo I (11,9 %). El 74,6 % recibieron neoadyuvancia y se realizó gastrectomía total en el 73 % de los pacientes. La concordancia diagnóstica moderada con índice Kappa fue de 0,56, difiriendo con la endoscópica en 33,9 %. El 10,2 % de los pacientes presentó algún tipo de complicación intraoperatoria. La supervivencia a tres años en los tumores tipo II fue del 89,6 % y del 100 % en aquellos con respuesta patológica completa. Conclusión. Es necesario el uso de diferentes estrategias para un proceso diagnóstico adecuado en los tumores de la unión esofagogástrica. En esta serie, los pacientes Siewert II, aquellos que recibieron neoadyuvancia y los que obtuvieron una respuesta patológica completa, tuvieron una mejor supervivencia a tres años
Introduction: Proper diagnosis of gastroesophageal junction tumors is essential for the treatment of these patients. The classification proposed by Siewert-Stein defines its own characteristics, risk factors and surgical strategies according to the location. This study describes the characteristics of patients with adenocarcinoma of the esophagogastric junction treated at our institution. Methods. Retrospective, descriptive, longitudinal study, which includes patients diagnosed with adenocarcinoma of the esophagogastric junction who underwent surgery at the National Cancer Institute in Bogotá, Colombia, between January 2012 and May 2017. Results. Fifty-nine patients (84.7% men) were operated on, with a mean age of 62.5 years. In their order of frequency, the tumors were type II (57.6%), type III (30.7%) and type I (11.9%). 74.6% received neoadjuvant therapy and total gastrectomy was performed in 73% of the cases. The moderate diagnostic concordance with the Kappa index was 0.56, differing from the endoscopic one in 33.9%. 10.2% of the patients presented some type of intraoperative complication. Three-year survival in type II tumors was 89.6% and 100% in those with complete pathologic response. Conclusion. The use of different strategies is necessary for an adequate diagnostic process in tumors of the esophagogastric junction. In this series, Siewert II patients, those who received neoadjuvant therapy, and those who obtained a complete pathological response had a better three-year survival
Subject(s)
Humans , Esophageal Neoplasms , Esophagogastric Junction , Stomach Neoplasms , Survival , ClassificationABSTRACT
Introducción: La úlcera gástrica perforada es la complicación ulcerativa más frecuente después del sangrado y la más grave de todas. A medida que se desarrolla el proceso inflamatorio la lesión gástrica evoluciona pasando por los siguientes estadíos: gastritis superficial, gastritis atrófica crónica, metaplasia intestinal, displasia y finalmente cáncer. En este proceso de evolución natural de la enfermedad radica la importancia de realizar una biopsia durante el abordaje quirúrgico de la úlcera gástrica perforada. Objetivos: Determinar la prevalencia de neoplasia en úlceras gástrica perforada en el servicio de Cirugía General del Hospital Central del Instituto de Previsión Social en el periodo 2015-2020. Materiales y métodos: Se llevó a cabo un estudio observacional descriptivo de corte transversal con datos retrospectivos. Resultados: Se incluyeron 50 pacientes sometidos a cirugía por úlcera gástrica perforada. El promedio de edad fue 67,1 ±17,1 años, el 60% correspondían al sexo masculino; en el 94% se realizó reavivamiento de bordes y en el 6% antrectomía. Con respecto al diagnóstico anatomopatológico, en el 90% se confirmó proceso infamatorio, la prevalencia de neoplasia fue del 6% y en el total de los pacientes postoperados por úlcera gástrica perforada se constató un 46% de mortalidad. Conclusión: La prevalencia de neoplasia fue mínima en los pacientes sometidos a cirugía por úlcera gástrica perforada. Se identificó un alto porcentaje de mortalidad en los pacientes postoperados por úlcera gástrica perforada. El promedio de edad fue 67,1 años y predominó el sexo masculino. El procedimiento quirúrgico más frecuente fue el reavivamiento de bordes y el diagnóstico anatomopatológico más prevalente fue proceso inflamatorio.
Introduction: Perforated gastric ulcer is the most frequent ulcerative complication after bleeding and the most serious of all; as inflammation progresses, gastric lesion evolves, beginning with superficial gastritis, then chronic atrophic gastritis, intestinal metaplasia, dysplasia, and finally cancer; hence the importance of performing a biopsy in the surgical approach of perforated gastric ulcer. Objectives: To determine the prevalence of neoplasia in perforated gastric ulcers in the General Surgery service of the Hospital Central del Instituto de Previsión Social in the period 2015-2020. Materials and methods: An observational descriptive cross-sectional study with retrospective data was carried out. Results: 50 patients who underwent surgery for perforated gastric ulcer were included. The average age was 67.1 ± 17.1 years, 60% were male; 94% underwent edge revival and 6% antrectomy. Regarding the anatomopathological diagnosis, 90% confirmed the inflammatory process, the prevalence of neoplasia was 6%, and in the total number of postoperative patients for perforated gastric ulcer, 46% mortality was confirmed. Conclusion: The average age was 67.1 years and the male sex predominated. The most frequent surgical procedure was edge revival and the most prevalent pathological diagnosis was inflammatory process. The prevalence of neoplasia was minimal in patients undergoing surgery for perforated gastric ulcer. A high percentage of mortality was identified in postoperative patients for perforated gastric ulcer.
Subject(s)
Stomach Ulcer , Neoplasms , General Surgery , BiopsyABSTRACT
Objective: To evaluate the efficacy and influencing factors of programmed death protein 1 (PD-1) monoclonal antibody rechallenge therapy in advanced gastric cancer (GC). Methods: The clinical data of patients with advanced GC who were treated with anti-PD-1 rechallenge in Henan Cancer Hospital from January 2020 to December 2021 were collected retrospectively. The progression-free survival (PFS) was defined as the time from the first or second used of anti-PD-1 treatment to the date of disease progression or the last follow-up, named PFS(1) and PFS(2), respectively. Kaplan-Meier method and Log rank test were used for survival analysis, Cox proportional hazard model was used to analyze the influencing factors. Results: A total of 60 patients with anti-PD-1 rechallenge therapy were collected, the median follow-up time was 12.2 months. The median progression-free survival (PFS(2)) of anti-PD-1 rechallenge therapy was 2.9 months, the objective response rate (ORR) was 16.7%, and the disease control rate (DCR) was 55.0%. The median PFS(2) of the first and second anti-PD-1 identical and different rechallenge treatment was 3.5 months and 1.9 months (P=0.007) respectively. The median PFS(2) of positive PD-L1 expression in rechallenge therapy was 3.4 months, ORR was 22.7%, and DCR was 63.6%; the median PFS(2) was 4.5 months, ORR was 27.3%, and DCR was 54.5% in patients with median PFS(1)≥6 months. Multivariate analysis showed that peritoneal metastasis was independently associated with anti-PD-1 rechallenge therapy with PFS(2) (HR=2.327, 95% CI, 1.066-5.082, P=0.034). The incidence of adverse reactions in grade 1-2 and grade 3-4 of anti-PD-1 rechallenge therapy was 83.3%, and 35.0%, respectively, and the safety was controllable. Conclusion: Rechallenge therapy with anti-PD-1 is a feasible treatment in advanced GC, but the screening of suitable population for rechallenge therapy still needs prospective data analysis and verification.
Subject(s)
Humans , Stomach Neoplasms/pathology , Retrospective Studies , Prospective Studies , Antibodies, Monoclonal/therapeutic use , Immunotherapy/adverse effectsABSTRACT
Objective:To assess the diagnostic efficacy of upper gastrointestinal endoscopic image assisted diagnosis system (ENDOANGEL-LD) based on artificial intelligence (AI) for detecting gastric lesions and neoplastic lesions under white light endoscopy.Methods:The diagnostic efficacy of ENDOANGEL-LD was tested using image testing dataset and video testing dataset, respectively. The image testing dataset included 300 images of gastric neoplastic lesions, 505 images of non-neoplastic lesions and 990 images of normal stomach of 191 patients in Renmin Hospital of Wuhan University from June 2019 to September 2019. Video testing dataset was from 83 videos (38 gastric neoplastic lesions and 45 non-neoplastic lesions) of 78 patients in Renmin Hospital of Wuhan University from November 2020 to April 2021. The accuracy, the sensitivity and the specificity of ENDOANGEL-LD for image testing dataset were calculated. The accuracy, the sensitivity and the specificity of ENDOANGEL-LD in video testing dataset for gastric neoplastic lesions were compared with those of four senior endoscopists.Results:In the image testing dataset, the accuracy, the sensitivity, the specificity of ENDOANGEL-LD for gastric lesions were 93.9% (1 685/1 795), 98.0% (789/805) and 90.5% (896/990) respectively; while the accuracy, the sensitivity and the specificity of ENDOANGEL-LD for gastric neoplastic lesions were 88.7% (714/805), 91.0% (273/300) and 87.3% (441/505) respectively. In the video testing dataset, the sensitivity [100.0% (38/38) VS 85.5% (130/152), χ2=6.220, P=0.013] of ENDOANGEL-LD was higher than that of four senior endoscopists. The accuracy [81.9% (68/83) VS 72.0% (239/332), χ2=3.408, P=0.065] and the specificity [ 66.7% (30/45) VS 60.6% (109/180), χ2=0.569, P=0.451] of ENDOANGEL-LD were comparable with those of four senior endoscopists. Conclusion:The ENDOANGEL-LD can accurately detect gastric lesions and further diagnose neoplastic lesions to help endoscopists in clinical work.
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Objective:To explore the effects of knocking down glycine cleavage system H protein (GCSH) on proliferation, apoptosis, oxidative stress and migration of gastric cancer SNU-1 cells in vitro. Methods:SNU-1 cells were cultured in vitro and divided into control group (no transfection) , negative control group (transfection of negative control siRNA) and GCSH knockdown group (transfection of GCSH siRNA) . Quantitative PCR was used to detect the knockdown effect. Immunofluorescence was used to observe the morphology of cells in each group. CCK-8 was used to test the proliferation of SNU-1 cells. Flow cytometry was used to detect the apoptosis and oxidative stress level, and scratch test was used to detect the cell migration. Results:Quantitative PCR experiment showed that the relative expression levels of GCSH in the control group, negative control group and GCSH knockdown group were 1.29±0.16, 1.36±0.17 and 0.32±0.04, respectively ( F=90.32, P<0.001) . There was no significant difference between the control group and negative control group ( P=0.497) . Compared to the negative control group, the GCSH knockdown group was significantly decreased ( P<0.001) . Immunofluorescence experiment showed no significant difference in the morphology of cells among the groups. The CCK-8 experiment results showed that the cell proliferation activities of the control group, negative control group and GCSH knockdown group were 2.63±0.12, 2.61±0.14, 2.45±0.14, respectively ( F=6.35, P=0.005) . There was no significant difference between the control group and negative control group ( P=0.751) , and the GCSH knockdown group significantly decreased compared to the negative control group ( P=0.011) . The results of flow cytometry showed that the early stage apoptosis rates of SNU-1 cells in the control group, negative control group and GCSH knockdown group were (13.38±0.45) %, (12.86±0.65) %, (20.04±3.61) %, respectively ( F=15.37, P<0.001) . There was no significant difference between the control group and negative control group ( P=0.559) . Compared to the negative control group, the GCSH knockdown group significantly increased ( P=0.002) . The late stage apoptosis rates of the three groups were (2.21±0.25) %, (2.68±0.45) %, (5.67±1.67) %, respectively ( F=18.24, P<0.001) . There was no significant difference between the control group and negative control group ( P=0.356) . Compared to the negative control group, the GCSH knockdown group showed a significant increase ( P=0.024) . The reactive oxygen species positive rates in the control group, negative control group and GCSH knockdown group were (26.98±8.79) %, (28.27±5.63) %, (48.41±0.94) %, respectively ( F=22.56, P<0.001) . There was no significant difference between the control group and negative control group ( P=0.950) . Compared to the negative control group, the GCSH knockdown group significantly increased ( P<0.001) . The cell migration rates of the control group, negative control group and GCSH knockdown group were (48.29±5.79) %, (51.66±2.29) %, (14.01±1.56) %, respectively ( F=148.80, P<0.001) . There was no significant difference between the control group and negative control group ( P=0.328) . Compared with the negative control group, the GCSH knockdown group significantly decreased ( P<0.001) . Conclusion:Knock down of GCSH gene can inhibit the proliferation and migration, increase cell apoptosis rate and oxidative stress of SNU-1 cells in vitro. GCSH gene may be a potential target for the treatment of gastric cancer.
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Objective: To explore whether hsa_circ_0000670 promotes the progression of gastric cancer by regulating the miR-515-5p/SIX1 molecular axis. Methods: The gastric cancer and adjacent normal tissues of 35 gastric cancer patients admitted to Rugao Hospital Affiliated to Nantong University from 2014 to 2015 were collected. The expression levels of circ_0000670, miR-515-5p and Sine oculis homeobox 1 (SIX1) in gastric cancer tissues and cells were detected by quantitative real-time polymerase chain reaction (qRT-PCR) and western blot. The correlations between circ_0000670 and miR-515-5p, miR-515-5p and SIX1, circ_0000670 and SIX1 were analyzed by the Pearson method. Patients were divided into low circ_0000670 expression group (17 cases) and high circ_0000670 expression group (18 cases) based on the median of circ_0000670 expression level, and Kaplan-Meier was used to analyze the 5-year survival of patients. Cell proliferation was assessed via clone formation assay. Cell cycle and apoptosis were detected by flow cytometry. Wound healing and Transwell assays were used to detect cell migration and invasion ability. The targeting relationship between miR-515-5p and circ_0000670 or SIX1 was confirmed by the dual luciferase reporter assay. Nude mice were injected into HGC-27 cells transfected with sh-NC or sh-circ_0000670, and the volume and weight of the transplanted tumor were measured, also, the levels of circ_0000670, miR-515-5p and SIX1 in the transplanted tumor tissue were detected. Results: The expression levels of circ_0000670 and SIX1 in gastric cancer tissues and cell lines were significantly increased (P<0.05), while the expression levels of miR-515-5p were significantly decreased (P<0.05). The survival rate of patients in the low circ_0000670 expression group (82.4%) was significantly higher than that in the high circ_0000670 expression group (28.7%, P=0.034). Circ_0000670 was negatively correlated with miR-515-5p (r=-0.846, P<0.001), and miR-515-5p was negatively correlated with SIX1 (r=-0.615, P<0.001), but circ_0000670 was positively correlated with SIX1 (r=0.814, P<0.001). Transfection of si-circ_0000670 or miR-515-5p mimic could significantly reduce the number of clone-forming cells, migration distance, migration and invasion cells (P<0.05), and increase the ratio of G(0)/G(1) phase cells, apoptosis rate and the protein level of E-cadherin (P<0.05), decreased the proportion of S-phase cells and the protein level of Vimentin (P<0.05). The dual luciferase report assay confirmed that circ_0000670 could target miR-515-5p, and miR-515-5p could bind to SIX1. Co-transfection of si-circ_0000670 and miR-515-5p inhibitor could significantly attenuate the effects of si-circ_0000670 on cell proliferation, migration, invasion, cell cycle and apoptosis (P<0.05). Co-transfection of miR-515-5p mimic and pcDNA-SIX1 could significantly reduce the effects of miR-515-5p mimic on cell proliferation, migration, invasion, cell cycle and apoptosis (P<0.05). Compared with the sh-NC group [volume=(596.20±125.46) mm(3) and weight=(538.00±114.39) g], the volume and weight of transplanted tumors in the sh-circ_0000670 group [volume=(299.20±47.58) mm 3 and weight=(289.80±48.73 g)] were significantly reduced (P<0.05), the expression levels of circ_0000670 and SIX1 were significantly reduced (P<0.05), and the expression level of miR-515-5p was significantly increased (P<0.05). Conclusion: Knockdown of circ_0000670 could inhibit cell proliferation, migration, invasion of gastric cancer cells, induce cell cycle arrest in G(0)/G(1) phase and promote cell apoptosis by regulating the miR-515-5p/SIX1 axis.
Subject(s)
Animals , Mice , Cell Cycle , Cell Line, Tumor , Cell Proliferation , Mice, Nude , MicroRNAs/genetics , Stomach Neoplasms/geneticsABSTRACT
Resumen Introducción: la infección por Helicobacter pylori tiene una alta prevalencia y distribución a nivel mundial. Por su asociación con el desarrollo de adenocarcinoma gástrico, las actualizaciones sobre su prevalencia son de interés para el médico internista o gastroenterólogo, así como para la generación de políticas públicas. Este estudio midió la prevalencia de H. pylori y evaluó su asociación con hallazgos endoscópicos e histopatológicos en adultos con indicación de endoscopia de vías digestivas altas (EVDA). Metodología: estudio de cohorte analítica para describir la prevalencia de H. pylori y evaluar factores de riesgo asociados a esta infección en pacientes adultos sometidos a EVDA ambulatoria por cualquier indicación médica en la unidad de endoscopia de un hospital universitario de cuarto nivel de complejidad entre junio y diciembre de 2020. Se describen hallazgos endoscópicos, histopatológicos y la prevalencia de H. pylori. Para explorar los factores de riesgo se usó la prueba chi cuadrado (χ2) para evaluar diferencias en las proporciones y las pruebas t de Student y U de Mann-Whitney para las variables continuas según su distribución. Resultados: 613 pacientes cumplieron los criterios de selección y fueron incluidos en el análisis. La indicación más frecuente de EVDA fue dispepsia. La prevalencia de H. pylori fue de 38,5% (intervalo de confianza [IC] 95%: 34,7%-42,4%). Conclusión: H. pylori es un tema de gran interés en las patologías gastrointestinales. La búsqueda endoscópica debe ser en el antro y cuerpo. Su presencia fue mayor en pacientes con esófago normal, gastritis nodular folicular, úlcera duodenal e inflamación aguda al estudio histológico. Se requieren más estudios que complementen el comportamiento epidemiológico local.
Abstract Introduction: Helicobacter pylori infection has a high prevalence and distribution worldwide. Due to its association with the development of gastric adenocarcinoma, updates on its prevalence are of interest to the internist or gastroenterologist and policymaking. This study measured the prevalence of H. pylori and evaluated its association with endoscopic and histopathological findings in adults with an indication for upper GI endoscopy (EGD). Materials and methods: This analytical cohort study describes the prevalence of H. pylori and assesses risk factors associated with this infection in adult patients undergoing outpatient EGD for any medical indication in the endoscopy unit of a quaternary care university hospital between June and December 2020. Endoscopic and histopathological findings and the prevalence of H. pylori are described. To explore the risk factors, the chi-square (χ2) test was used to evaluate differences in proportions and the Student's t and Mann-Whitney U tests for continuous variables according to their distribution. Results: 613 patients met the selection criteria and were included in the analysis. The most frequent indication for EGD was dyspepsia. The prevalence of H. pylori was 38.5% (95% confidence interval [CI]: 34.7-42.4%). Conclusion: H. pylori is a topic of great interest in gastrointestinal pathologies. The endoscopic search should take place in the antrum and body. Its presence was most common in patients with a normal esophagus, follicular nodular gastritis, duodenal ulcer, and acute inflammation upon the histological study. More studies are required to complement the local epidemiological behavior.
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ABSTRACT Background: Endoscopic treatment of precancerous lesions and early gastric cancer has been widely accepted in recent years. Endoscopic submucosal dissection (ESD), following established indication criteria, can lead to cure of the disease in more than 90% of cases. Objective: This study aimed to analyze the use of ESD in patients with early gastric cancer and precancerous lesions, as well as the results of the procedure, its complications and effectiveness in controlling the disease. Methods: This is a retrospective cohort study composed of 41 patients aged from 53 to 87 years (mean age: 65 years; 58.53% male) who were analyzed from 2008 to 2019. The variables collected from the medical records were: comorbidities, classification of the lesion regarding resection criteria, type of resection, histology, degree of invasion, resection margin, complications, disease recurrence. Statistical analysis was performed using the Kruskal-Wallis test, the McNemar's test, and the Mann-Whitney test, with 5% statistical significance (P<0.05). Results: The most frequent site of the lesion was the gastric antrum and the predominant presentation by the Japanese or Paris classification was the one with depressed components in 56.09%. Adenocarcinoma occurred in 75.6% of the biopsies, and the remainder were adenomas without neoplasia. En-bloc resection occurred in 97.57% of cases, and compromise of the safety margin occurred in one patient. The main pre-existing comorbidity was liver cirrhosis in 29.26% of cases. There was a significant increase in post- ESD adenocarcinoma compared to pre-resection diagnosis. The mean follow-up time was 38.4 months, with one recurrence (2.43%) and two metachronous lesions (4.87%). Complications during and after the procedure occurred in three patients (7.31%), being due to bleeding (two cases) and perforation (one case). There was one death due to a cardiac event not directly related to the procedure. Conclusion: Endoscopic submucosal dissection proved to be a safe procedure, with a low complication and recurrence rate. Its recommendation must occur within the established criteria; however, it can be indicated for patients outside the criteria, if there is a high risk for surgical treatment.
RESUMO Contexto: O tratamento endoscópico das lesões pré-cancerosas e do câncer gástrico precoce tem sido amplamente aceito nos últimos anos. A dissecção endoscópica da submucosa (submucosectomia), obedecendo a critérios estabelecidos de indicação, pode levar a cura da doença em mais de 90% dos casos. Objetivo: Este estudo teve como objetivo analisar o uso da dissecção submucosa endoscópica em pacientes com câncer gástrico precoce e lesões pré-cancerosas, bem como os resultados do procedimento, suas complicações e eficácia no controle da doença. Métodos: Foram analisados 41 pacientes, com idade variando de 53 a 87 anos (média de 65 anos), sendo 58,53% do sexo masculino, no período de 2008 a 2019, sendo este estudo do tipo coorte retrospectivo. As variáveis coletadas dos prontuários foram: comorbidades, classificação da lesão quanto aos critérios de ressecção, tipo de ressecção, histologia, grau de invasão, margem de resseção, complicações, recidiva de doença. A análise estatística foi feita com o uso do teste de Kruskal-Wallis, teste de McNemar e teste de Mann-Whitney, com significância estatística de 5% (P<0,05). Resultados: O local mais frequente da lesão foi o antro gástrico e a apresentação predominante pela classificação japonesa ou de Paris foram os com componentes deprimidos em 56,09%. O adenocarcinoma ocorreu em 75,6% das biópsias e o restante foram adenomas sem neoplasia. A ressecção em bloco ocorreu em 97,57% dos casos, e o comprometimento da margem de segurança ocorreu em um paciente. A principal comorbidade pré-existente foi a cirrose hepática em 29,26% dos casos. Houve um aumento significativo de adenocarcinoma após dissecção endoscópica da submucosa em comparação ao diagnóstico pré ressecção. O tempo médio de seguimento foi de 38,4 meses, sendo registrado uma recidiva (2,43%) e duas lesões metacrônicas (4,87%). As complicações durante e após o procedimento ocorreram em 3 (7,31%) pacientes, sendo por sangramento (dois casos) e perfuração (um caso). Houve um óbito por evento cardiológico, não relacionado diretamente com o procedimento. Conclusão: A ressecção endoscópica da submucosa mostrou ser procedimento seguro, com baixa taxa de complicação e de recidiva. A sua indicação deve ser dentro dos critérios estabelecidos, entretanto, pode ser indicada em pacientes fora de critérios, se há alto risco para o tratamento cirúrgico.
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Resumen Objetivo: Generar recomendaciones basadas en la evidencia, para la prevención primaria y secundaria, el tratamiento de las lesiones preneoplásicas y el diagnóstico temprano del cáncer gástrico en población adulta, con el propósito de reducir la carga de la enfermedad. Materiales y métodos: El grupo desarrollador estuvo integrado por profesionales de la salud y tomadores de decisiones. Se construyeron preguntas clínicas contestables y se realizó la graduación de los desenlaces. Se elaboró la búsqueda de la información en MEDLINE; EMBASE y CENTRAL, siendo actualizada el 18 de octubre de 2018. La pesquisa también abarcó otras fuentes de información como la Revista Colombiana de Gastroenterología y la lectura en "bola de nieve" de las referencias incluidas. Se contactó a expertos en la materia con el objetivo de identificar estudios relevantes no publicados. Para la construcción de las recomendaciones, se realizó un consenso acorde con los lineamientos propuestos por la metodología GRADE, sopesando los beneficios, los efectos adversos derivados de la intervención, las preferencias de los pacientes y el potencial impacto de las intervenciones sobre los costos. Resultados: Se presenta la versión corta de la "Guía de práctica clínica para la prevención primaria, secundaria y diagnóstico temprano de cáncer gástrico", junto con su evidencia de soporte y respectivas recomendaciones. Conclusiones: Como recomendación central para la implementación, se recomienda erradicar la infección por H. pylori en los pacientes con o sin factores de riesgo, como estrategia de prevención de las condiciones precursoras de cáncer gástrico. La Guía deberá actualizarse en tres años.
Abstract Objetive: Generate recommendations for primary and secondary prevention, treatment of gastric preneoplastic lesions, and early diagnosis of gastric cancer in the adult population, to increase the detection of gastric cancer in early stages. Material and methods: The developer group was made up of health professionals, decision-makers, and a representative of the patients. Answerable clinical questions were constructed and outcomes were graded. The search for information in MEDLINE was carried out; EMBASE and CENTRAL, being updated on October 18, 2018. The search also covered other sources of information such as the Colombian Journal of Gastroenterology and the "snowball" reading of the references included. Experts in the field were contacted to identify studies. For the construction of the recommendations, a consensus was made according to the guidelines proposed by the GRADE methodology, weighing the benefits, the adverse effects derived from the intervention, the preferences of the patients, and the potential impact of the interventions on costs. Results: The short version of the "Clinical practice guidelines for the primary, secondary, and early diagnosis of gastric cancer" is presented together with its supporting evidence and respective recommendations. Conclusions: As a central recommendation for implementation, it is recommended to eradicate H. pylori infection in patients with or without risk factors in whom it is detected to prevent gastric cancer precursor conditions. The Guide will need to be updated in three years.
Subject(s)
Humans , Primary Prevention , Stomach Neoplasms , Consensus , Precancerous Conditions , Risk Factors , Costs and Cost Analysis , Early Diagnosis , Secondary PreventionABSTRACT
Gastric cancer is one of the most common gastrointestinal malignancies, and the incidence and mortality of gastric cancer remain high in China. In recent years, with the rapid popularization of laparoscopic technology, fluorescent laparoscopic technology is increasingly getting mature, providing a new method for accurate clinical tracing of lymph nodes and prediction of tumor metastasis lymph nodes. A large number of scientific research experiments and clinical trials have shown that, laparoscopic lymph node diagnosis technology based on the fluorescent indocyanine green (ICG) can significantly improve the efficiency of lymphadenectomy and prediction accuracy of lymph node metastasis, and can reveal a more accurate scope of lymphadenectomy in gastric cancer for surgeons, so as to avoid excessive adenectomy as well as iatrogenic injuries on patients. Although the status of the technology in gastric cancer surgery mentioned above continues improving, the overall operation process details of ICG fluorescence imaging, standardized fluorescence detecting equipment, and postoperative pathological examination process still need to be further optimized.
Subject(s)
Humans , Coloring Agents , Gastrectomy , Indocyanine Green , Laparoscopy , Lymph Node Excision/methods , Lymph Nodes/pathology , Sentinel Lymph Node Biopsy/methods , Stomach Neoplasms/surgeryABSTRACT
Objective: Systematically summarize the research progress of clinical trials of gastric cancer oncology drugs and the overview of marketed drugs in China from 2012 to 2021, providing data and decision-making evidence for relevant departments. Methods: Based on the registration database of the drug clinical trial registration and information disclosure platform of Food and Drug Administration of China and the data query system of domestic and imported drugs, the information on gastric cancer drug clinical trials, investigational drugs and marketed drugs from January 1, 2012 to December 31, 2021 was analyzed, and the differences between Chinese and foreign enterprises in terms of trial scope, trial phase, treatment lines and drug type, effect and mechanism studies were compared. Results: A total of 114 drug clinical trials related to gastric tumor were registered in China from 2012 to 2021, accounting for 3.7% (114/3 041) of all anticancer drug clinical trials in the same period, the registration number showed a significant growth rate after 2016 and reached its peak with 32 trials in 2020. Among them, 85 (74.6%, 85/114) trials were initiated by Chinese pharmaceutical enterprise. Compared with foreign pharmaceutical enterprise, Chinese pharmaceutical enterprise had higher rates of phase I trials (35.3% vs 6.9%, P=0.001), but the rate of international multicenter trials (11.9% vs 67.9%, P<0.001) was relatively low. There were 76 different drugs involved in relevant clinical trials, of which 65 (85.5%) were targeted drugs. For targeted drugs, HER2 is the most common one (14 types), followed by PD-1 and multi-target VEGER. In the past ten years, 3 of 4 marketed drugs for gastric cancer treatment were domestic and included in the national medical insurance directory. Conclusions: From 2012 to 2021, China has made some progress in drug research and development for gastric carcinoma. However, compared with the serious disease burden, it is still insufficient. Targeted strengthening of research and development of investment in many aspects of gastric cancer drugs, such as new target discovery, matured target excavating, combination drug development and early line therapy promotion, is the key work in the future, especially for domestic companies.
Subject(s)
Humans , China , Gastrointestinal Agents/therapeutic use , Gastrointestinal Neoplasms , Pharmaceutical Preparations , United States , United States Food and Drug AdministrationABSTRACT
Objective: To investigate the relationship between the expression of integrin α 6 (ITGA6), miR-4484 and the pathologic stage of gastric cancer. Methods: Gastric cancer tissues and normal gastric mucosa tissues adjacent to cancer (>5 cm from tumor margin) of 30 patients with primary gastric cancer who underwent direct surgical resection without adjuvant therapy from June to September 2017 in West China Hospital of Sichuan University were selected. Real-time quantitative polymerase chain reaction (PCR) was used to detect the expression levels of miR-4484 and ITGA6, western blot was used to detect the expression level of ITGA6 protein, dual luciferase reporter gene was used to verify the relationship between ITGA6 and miR-4484. Spearman's correlation analysis was used to determine the relationship between miR-4484 and ITGA6 expression levels in gastric cancer tissues. Results: The expression level of ITGΑ6 in gastric cancer (32.30±13.47) was higher than that in matched normal gastric tissues (24.55±10.25, P=0.015), the area under the receiver operating characteristic (ROC) curve was 0.660 and the diagnostic sensitivity and specificity were 43.3% and 96.7%, respectively. The expression level of miR-4484 in gastric cancer (4.11±2.87) was lower than that of matched normal gastric tissues (5.75±2.80, P=0.029), the area under the ROC curve was 0.690 and the diagnostic sensitivity and specificity were 30.0% and 86.7%, respectively. The expression level of miR-4484 was negatively correlated with ITGA6 in gastric cancer tissues (r=-0.621, P<0.001). The expression level of ITGA6 protein in gastric cancer tissues (0.65±0.19) was higher than that in normal adjacent tissues (0.26±0.12, P<0.001). Compared with ITGA6 3'UTR wild-type+ miR-NC group, ITGA6 3'UTR wild-type+ miRNA mimics group had lower luciferase activity (50.69±5.10, 34.00±1.19, P<0.001), while the luciferase activity of ITGA6 3'UTR wild-type+ ASO miR-4484 group was higher than that of ITGA6 3'UTR wild-type+ miR-NC group (82.44±6.37, 50.69±5.10, P<0.001), indicated that ITGA6 was the direct target gene of miR-4484. The expression levels of miR-4484 in T1, T2, T3 and T4 (4a and 4b) gastric cancer tissues were 9.98±2.24, 5.28±2.03, 2.92±2.04 and 4.11±2.87, respectively, with statistical significance (P<0.001). The expression levels of ITGA6 in N0, N1, N2 and N3 gastric cancer tissues were 29.55±8.32, 21.71±3.75, 24.60±8.79 and 40.69±15.83, respectively, with statistical significance (P=0.022). The expression levels of miR-4484 in N0, N1, N2 and N3 gastric cancer tissues were 5.01±3.52, 5.48±2.76, 5.88±1.83 and 2.30±1.56, respectively, with statistical significance (P=0.032). The expression levels of ITGA6 in M0 and M1 gastric cancer tissues were 26.28±7.66 and 52.08±8.12, respectively, with statistical significance (P<0.001). The expression levels of miR-4484 in M0 and M1 gastric cancer tissues were 4.95±2.74 and 1.34±0.80, respectively, with statistical significance (P<0.001). Conclusions: ITGA6 is upregulated in gastric cancer tissues, while miR-4484 is downregulated in the gastric cancer group, and its expression level is related to the clinicopathological features of gastric cancer. ITGA6 is the direct target gene of miR-4484, implicates that miR-4484 may inhibit the invasion and metastasis of gastric cancer by regulating the expression of ITGA6. Both miR-4484 and ITGA6 may be the new prognostic markers and potential therapeutic targets of gastric cancer.
Subject(s)
Humans , 3' Untranslated Regions , China , Integrin alpha6/genetics , MicroRNAs/genetics , Stomach Neoplasms/pathologyABSTRACT
Gastric cancer is one of the most common malignancies and is the third leading cause of cancer-related deaths worldwide, constituting a serious threat to human health. Long non-coding RNA (lncRNA) is involved in the occurrence and development of gastric cancer at multiple levels and plays critical regulatory roles. It plays important roles in the diagnosis, treatment and prognostic assessment of gastric cancer. This review focuses on the recent research advances in the clinical applications of lncRNA in gastric cancer.
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Objective:To investigate the effect and molecular mechanism of procyanidin on the proliferation, apoptosis and reactive oxygen species (ROS) level of gastric cancer cell line SNU-1 in vitro. Methods:SNU-1 cells were divided into control group and 12.5, 50.0, 200.0 μg/ml procyanidin groups. The effect of procyanidin on the proliferation of SNU-1 cells was detected by CCK-8 assay. The apoptosis level and ROS positive rate of cells were detected by flow cytometry, and 2 mmol/L glutathione was added to SNU-1 cells added with 200.0 μg/ml procyanidin to detect the apoptosis level and ROS positive rate of cells. The expression of apoptosis-related protein in cells was detected by Western blotting.Results:The results of CCK-8 experiment showed that the proliferation activities of SNU-1 cells in the control group and the 12.5, 50.0, 200.0 μg/ml procyanidin groups were 3.69±0.30, 3.29±0.41, 0.91±0.39, 0.45±0.22 respectively, with a statistically significant difference ( F=279.84, P<0.001) . Compared with the control group, the proliferation activities of SNU-1 cells in the three procyanidin groups were significantly inhibited ( P=0.006, P<0.001, P<0.001) . The results of flow cytometry showed that the early apoptosis rates of SNU-1 cells in the control group and the 12.5, 50.0, 200.0 μg/ml procyanidin groups were (0.00±0.00) %, (0.00±0.00) %, (0.09±0.07) % and (0.45±0.22) % respectively, with a statistically significant difference ( F=7.14, P=0.003) . The 50.0 and 200.0 μg/ml procyanidin groups increased significantly compared with the control group ( P=0.003, P=0.007) . The late apoptosis rates of SNU-1 cells in the four groups were (0.00±0.00) %, (0.01±0.00) %, (6.98±0.77) % and (33.32±2.78) % respectively, with a statistically significant difference ( F=654.28, P=0.003) . The 50.0 and 200.0 μg/ml procyanidin groups increased significantly compared with the control group ( P<0.001, P<0.001) . The positive rates of ROS in SNU-1 cells in the four groups were (0.02±0.01) %, (0.10±0.05) %, (1.15±0.26) % and (1.58±0.22) % respectively, with a statistically significant difference ( F=162.24, P<0.001) . The 50.0 and 200.0 μg/ml procyanidin groups increased significantly compared with the control group ( P<0.001, P<0.001) . The positive rates of ROS in SNU-1 cells in the 200.0 μg/ml procyanidin group and the glutathione intervention group were (1.25±0.63) % and (0.13±0.02) % respectively, with a statistically significant difference ( t=5.39, P=0.001) . The early apoptosis rates of the two groups were (10.56±3.24) % and (2.09±0.24) % respectively, and the late apoptosis rates were (29.65±6.01) % and (23.63±1.52) % respectively, with statistically significant differences ( t=2.61, P=0.048; t=3.97, P=0.012) . The expressions of Bcl-2 protein in SNU-1 cells in the control group and the 12.5, 50.0, 200.0 μg/ml procyanidin groups were 1.00±0.00, 0.83±0.05, 0.60±0.14 and 0.41±0.23 respectively, with a statistically significant difference ( F=10.63, P=0.004) . The 50.0 and 200.0 μg/ml procyanidin groups decreased significantly compared with the control group ( P<0.001, P<0.001) . Conclusion:Procyanidin can inhibit proliferation and promote apoptosis of gastric cancer SNU-1 cells in vitro, which may be achieved by increasing intracellular ROS levels and reducing Bcl-2 protein expression.
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Gastric cancer (GC) is a major digestive tract malignancy in China, which seriously threatens the health of Chinese population. A large number of researches have demons-trated that screening, early detection and early treatment are effective in reducing the incidence and mortality of GC. The development of the guideline for GC screening, early detection and early treatment in line with epidemic characteristics of GC in China will greatly promote the homogeneity and standardization, and improve the effect of GC screening. This guideline was commissioned by the Bureau of Disease Control and Prevention of the National Health Commission. The National Cancer Center of China initiated and convened a working group comprising multidisciplinary experts. Following the World Health Organization Handbook for Guideline Development, this guideline combined the most up-to-date evidence of GC screening, China′s national conditions, and practical experience in cancer screening. This guideline provided evidence-based recommendations with respect to the screening population, technology and procedure management, aiming to improve the effect of GC screening and provide scientific evidence for the GC prevention and control in China.
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Gastric cancer is one of the common malignant tumors with a high incidence in China. With the deepening of the research on tumor molecular biology, molecular targeted therapy has shown its advantages, and immunotherapy has attracted much attention. Yes-associated protein (YAP) is an effector protein that plays a major role in Hippo pathway, and it can regulate the growth of cells after binding with transcription factors in the nucleus. In recent years, many studies have shown that the high expression of YAP is closely related to the occurrence, development and metastasis of gastric cancer, and may be an important target of chemotherapy resistance. The further study can provide reference for clinical treatment.
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The miR-34 family plays an important role in gastric cancer, and the inactivation or reduced expression of the miR-34 family is detected in gastric cancer cell lines and gastric cancer tissues compared with normal gastric mucosa tissues, indicating it is associated with the occurrence and development of gastric cancer. Studies have shown that miR-34 plays a key role in inhibiting gastric cancer progression by regulating IGF2BP3, survivin, Bcl-2 and epithelial-mesenchymal transition-related pathway, indicating that miR-34 is an important target for gastric cancer treatment. In terms of clinical treatment, miR-34 has not only been proved to have radiochemotherapy sensitization, but also achieved good curative effect in tumor clinical trials. With the emergence of miR-34 vectors targeting gastric cancer, it is possible to use it for gastric cancer treatment. Deep understanding of the molecular basis and clinical efficacy of miR-34 for gastric cancer treatment can help to evaluate the potential of the miR-34 family as a new therapeutic target for gastric cancer.
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Objective:To compare the clinical efficacy and safety of continuous dosing or alternate-day dosing of apatinib combined with SOX regimen as first-line treatment for patients with advanced gastric cancer.Methods:A total of 52 patients with human epidermal growth factor receptor 2 (HER2) negative and inoperable locally advanced or advanced gastric cancer who were pathologically diagnosed from January 2018 to January 2021 in the Second Affiliated Hospital of Shandong First Medical University were collected. The patients were divided into continuous dosing group and alternate-day dosing group by random number table method. The continuous dosing group received apatinib (250 mg, once a day) combined with SOX regimen (S-1+oxaliplatin); the alternate-day dosing group received apatinib (250 mg, once every other day) combined with SOX regimen. Twenty-one days were a cycle, and the efficacy was evaluated after 2 cycles. After 4-6 cycles, patients with stable disease received apatinib and S-1 for maintenance therapy. The therapeutic effects and adverse reactions of the two groups were compared.Results:The curative effect could be evaluated in 51 patients, including 26 in the continuous dosing group and 25 in the alternate-day dosing group. The disease control rates in the continuous dosing group and the alternate-day dosing group were 84.6% (22/26) and 76.0% (19/25) ( χ2 = 0.60, P = 0.499), and the median progression-free survival time was 7.50 months (95% CI 6.17-8.83 months) and 8.30 months (95% CI 6.99-9.61 months) ( χ2 = 0.71, P = 0.401), and the median overall survival time was 15.50 months (95% CI 11.30-19.69 months) and 15.60 months (95% CI 13.63-17.57 months) ( χ2 = 1.82, P = 0.177). The main adverse reactions in the two groups were leukopenia, thrombocytopenia, hypertension, nausea, vomiting, fatigue, hand-foot syndrome, proteinuria, liver and kidney damage. The incidence rates of ≥grade 3 adverse reactions in the continuous dosing group and the alternate-day dosing group were 42.3% (11/26) and 12.0% (3/25), and the difference was statistically significant ( χ2 = 4.46, P = 0.035). Conclusions:The efficacy of continuous dosing or alternate-day dosing of apatinib combined with SOX regimen as first-line treatment for advanced gastric cancer is similar, but the incidence of ≥grade 3 adverse reactions in alternate-day dosing group is lower, which improves the compliance and tolerance of patients.
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Objective:To explore the effects of intravenous combined epidural anesthesia on perioperative hemodynamic indexes, cardiac function and immune function during laparoscopic surgery in elderly gastric cancer patients complicated with coronary heart disease.Methods:A total of 94 elderly gastric cancer patients with coronary heart disease who were admitted to Shanxi Province Cancer Hospital from January 2017 to June 2021 were selected. They were divided into the total intravenous anesthesia group (control group) and intravenous combined epidural anesthesia group (observation group) by random envelope lottery, with 47 cases in each group. Hemodynamic indexes, cardiac function, immune function, pain and sedation scores were compared between the two groups.Results:When pneumoperitoneum was established (T 1) and the left gastric artery was immediately free during operation (T 2), systolic blood pressure in the observation group was (136.6±9.9) mmHg (1 mmHg = 0.133 kPa) and (133.9±9.4) mmHg, and diastolic blood pressure was (74.6±4.6) mmHg and (80.7±6.0) mmHg; heart rate was (79.8±4.0) times/min and (80.9±2.7) times/min, respectively. The systolic blood pressure of the control group was (159.3±7.6) mmHg and (162.5±8.5) mmHg, and the diastolic blood pressure was (91.2±5.2) mmHg and (88.3±4.7) mmHg, respectively. The heart rate was (106.2±3.3) times/min and (101.9±4.0) times/min, respectively; compared with the control group at the same time point, the observation group had lower blood pressure and slower heart rate ( t values were 4.25, 2.53, 6.40, 6.81, 1.85, and 1.35, all P < 0.05). The blood concentrations of cardiac troponin and creatine kinase isoenzyme in the control group were (0.143±0.052) ng/ml and (5.65±0.77) mg/L at 12 h (T 4) after surgery, which were higher than those in the observation group [(0.098±0.015) ng/ml and (3.08±1.06) mg/L] ( t values were 4.32 and 10.19, both P < 0.05). The intraoperative utilization rate of vasoactive drugs and the incidence of electrocardiogram abnormalities in the observation group were 19.1% (9/47) and 25.5% (12/47), which were lower than those in the control group [48.9% (23/47) and 55.3% (26/47)] ( χ2 values were 8.49 and 8.66, both P < 0.05). Compared with 1 day before operation (T 5), the proportion of CD4 + T cells increased and the proportion of CD8 + T cells decreased in control group at 3 days after operation (T 6) (both P < 0.05). The pain score and sedation score of the observation group at 12 h (T 4) and 1 day after surgery (T 7) were better than those of the control group (all P < 0.05). Conclusions:Laparoscopic radical gastrectomy with intravenous combined epidural anesthesia in elderly gastric cancer patients with coronary heart disease can achieve better anesthesia effect, and can provide better protection for the patient's cardiac function and immune function.