Tumor budding in gastric cancer.

The tumor, nodes, metastasis (TNM) staging system has long been the gold standard for the classification and prognosis of solid tumors. However, the TNM staging system is not without limitations. Prognostic heterogeneity exists within patients at the same stage. Therefore, the pursuit of other biomarkers with the potential to classify patients with cancer has never stopped. One of them, tumor budding (TB), has gained much success in colorectal cancer. In recent years, TB in gastric cancer has attracted much attention from researchers, beginning to reveal the molecular and biological aspects of this phenomenon in gastric cancer, and has emerged as a promising prognostic biomarker in gastric cancer, predicting disease progression and unfavorable survival. Therefore, it is time and essential to provide a holistic overview of TB in gastric cancer, which has not been achieved and is the aim of this review.

Enhanced Recovery After Surgery protocol for elderly gastric cancer patients: A prospective study for safety and efficacy.

BACKGROUND: Enhanced Recovery After Surgery (ERAS) has been used to improve surgical outcomes in recent years. However, its safety and efficacy in elderly patients with gastric cancer remain unclear. The aim of this study was to reveal the safety and efficacy of the ERAS protocol in elderly patients with gastric cancer. METHODS: Elderly gastric cancer patients (age≥70 years) who underwent gastrectomy were divided into the ERAS group and the conventional group. Postoperative complications, postoperative hospital stay, hospitalization expenses, and readmission rates were compared between the two groups. RESULTS: From December 2019 to January 2021, 100 eligible patients were enrolled in our study. All baseline data were balanced between the ERAS group and the conventional group. There was no significant difference in terms of complications (18% vs. 16%, P = 0.14) between the two groups. The most common complication was pneumonia. Four patients were observed in the conventional group and three patients in the ERAS group. The postoperative hospital stay was shorter in the ERAS group (8.2 vs. 10.4, P = 0.001). CONCLUSIONS: The ERAS protocol could be safely used in elderly gastric cancer patients undergoing gastrectomy and shorten postoperative hospital stay.

Laparoscopic proximal gastrectomy with double-tract reconstruction for upper third gastric cancer.

BACKGROUND: Proximal gastrectomy with double-tract reconstruction (DTR) has been used for upper third gastric cancer as a function-preserving procedure. However, the safety and feasibility of laparoscopic proximal gastrectomy (LPG) with DTR remain uncertain. This study compared open proximal gastrectomy (OPG) with DTR and LPG with DTR for proximal gastric cancer. METHODS: Sixty-four patients who had undergone OPG with DTR and forty-six patients who had undergone LPG with DTR were enrolled in this case-control study. The clinical characteristics, surgical outcomes and postoperative nutrition index were analysed retrospectively. RESULTS: The operation time was significantly longer in the LGP group than in the OPG group (258.3 min vs 205.8 min; p = 0.00). However, the time to first flatus and postoperative hospital stay were shorter in the LPG group [4.0 days vs 3.5 days (p = 0.00) and 10.6 days vs 9.2 days (p = 0.001), respectively]. No significant difference was found between the two groups in the number of retrieved lymph nodes, complications or reflux oesophagitis. The nutrition status was assessed using the haemoglobin, albumin, prealbumin and weight levels from pre-operation to six months after surgery. No significant difference was found between the groups. CONCLUSION: LPG with DTR can be safely performed for proximal gastric cancer patients by experienced surgeons.

Conversion therapy for advanced gastric cancer with trastuzumab combined with chemotherapy: A case report.

Gastric cancer is a common cancer of the gastrointestinal tract and the second most prevalent cause of cancer-associated mortality globally. Gastric cancer-associated mortality is increased in China compared with that in other countries. Key contributors to the poor prognosis of gastric cancer include late clinical presentation and genetic heterogeneity. Treatment based on the subtype of gastric cancer is important for effective therapy. The overexpression of the erb-b2 receptor tyrosine kinase 2 (ERBB2) gene and protein is associated with gastric cancer in humans. Chemotherapy and targeted therapy may control tumor growth and recurrence, which is an important function of conversion surgery. The present study reported a patient diagnosed with gastric cancer with multiple abdominal cavity and retroperitoneal lymph node metastases. ERBB2 amplification and overexpression were identified in both case reports presented. The patients were treated with four cycles of oxaliplatin, capecitabine and trastuzumab. Computed tomography revealed the lymph node metastases decreased in size following treatment, and surgical resection was performed. The four cycles of oxaliplatin, capecitabine and trastuzumab were continued subsequent to surgical resection at the administered dose. No recurrence was observed for >1 year after surgery. Trastuzumab combined with oxaliplatin and capecitabine as a conversion therapy regime for ERBB2-overexpressing advanced gastric adenocarcinoma increased the likelihood of successful surgical resection, and prolonged progression-free survival.

Overexpression of MPC1 inhibits the proliferation, migration, invasion, and stem cell-like properties of gastric cancer cells.

Invasion and metastasis are major malignant characteristics of human gastric cancer (GC), but the molecular mechanisms underlying the invasion and metastasis of GC cells remain elusive. MPC1, a key factor that controls pyruvate transportation through the inner mitochondrial membrane, was reported to be downregulated and correlated with poor prognosis in several cancers. However, the effects of MPC1 on human GC have not been illustrated. In this study, we investigated the potential role of MPC1 in the proliferation, migration, invasion, and stem cell-like properties of human GC cells and evaluated its prognostic significance for patients with GC. We found that MPC1 protein and mRNA levels were significantly decreased in GC tissues and cell lines. Low MPC1 expression was associated with tumor T stage, N stage, and advanced tumor node metastasis stage. Decreased MPC1 expression was an independent prognostic marker and correlated with poor overall survival of patients with GC. Furthermore, overexpression of MPC1 inhibited the proliferation, migration, invasion, and stem cell-like properties of GC cells. These findings suggest that MPC1 may be a novel prognostic marker and a potential therapeutic target in human GC.

Splenosis with lower gastrointestinal bleeding mimicking colonical gastrointestinal stromal tumour.

BACKGROUND: Splenosis refers to the heterotopic transplantation of splenic tissue following splenic trauma or splenectomy. Splenosis is typically asymptomatic and is often identified incidentally. CASE PRESENTATION: We report a case of splenosis with colon and stomach invasion presenting as lower gastrointestinal bleeding and mimicking colonic gastrointestinal stromal tumour (GIST). The importance of suspicion for splenosis in patients with a history of splenic injury should be highlighted. Computed tomography (CT)-guided biopsy, nuclear scintigraphy and ferumoxide-enhanced magnetic resonance imaging (MRI) can support an accurate diagnosis. CONCLUSIONS: An accurate diagnosis of splenosis is important to avoid unnecessary operations, especially in patients with previous histories of splenic trauma or splenectomy.

Comparison between total laparoscopy and laparoscopy-assisted distal gastrectomy for gastric cancer. A meta-analysis based on Japanese and Korean articles.

OBJECTIVES: To assess the safety and feasibility of total laparoscopy distal gastrectomy (TLDG). METHODS: This meta-analysis was conducted between April and July 2013 in Sichuan Cancer Hospital, Chengdu, China. We searched PubMed, EMBASE and China Knowledge Resource Integrated Database updated until May 2013. Eight retrospective studies and one prospective study involving 2,046 total patients were included. RESULTS: The results showed that TLDG was associated with lower blood loss (mean difference=-22.39, p=0.04). and a greater number of harvested lymph nodes (mean difference=2.74, p=0.02). There was no significant difference between the 2 groups in operation time, time to first flatus, length of postoperative hospital stay, and postoperative complications. CONCLUSION: Compared with laparoscopy-assisted distal gastrectomy, TLDG resulted in reduced blood loss, and a greater number of harvested lymph nodes. Total laparoscopy distal gastrectomy is safe and feasible for gastric cancer. 

Proximal gastrectomy with jejunal interposition and TGRY anastomosis for proximal gastric cancer.

AIM: To compare the short-term outcomes of patients who underwent proximal gastrectomy with jejunal interposition (PGJI) with those undergoing total gastrectomy with Roux-en-Y anastomosis (TGRY). METHODS: From January 2009 to January 2011, thirty-five patients underwent PGJI, and forty-one patients underwent TGRY. The surgical efficacy and short-term follow-up outcomes were compared between the two groups. RESULTS: There were no differences in the demographic and clinicopathological characteristics. The mean operation duration and postoperative hospital stay in the PGJI group were statistically longer than those in the TGRY group (P = 0.00). No anastomosis leakage was observed in two groups. No statistically significant difference was found in endoscopic findings, Visick grade or serum albumin level. The single-meal food intake in the PGJI group was more than that in the TGRY group (P = 0.00). The PG group showed significantly better hemoglobin levels in the second year (P = 0.02). The two-year survival rate was not significantly different (PGJI vs TGRY, 93.55% vs 92.5%, P = 1.0). CONCLUSION: PGJI is a safe, radical surgical method for proximal gastric cancer and leads to better outcomes in terms of the single-meal food intake and hemoglobin level, compared with TGRY in the short term.

[Relationship of IFRD1-rs3807213 gene polymorphism with the risk of gastric cancer among Chinese].

OBJECTIVE: To investigate the association between rs3807213 gene polymorphism in interferon related developmental regulator 1 gene (IFRD1) and the risk of gastric cancer among Chinese. METHODS: There were 53 gastric cancer patients and 50 healthy people included in this case-control study. The blood samples were collected from each observed object and genotype (AA, AC, CC) of IFRD1 rs3807213 SNP was detected after polymerase chain reaction (PCR). The relationships of rs3807213 gene polymorphism with gastric cancer risk, clinic and pathologic features were analyzed. RESULTS: Patients with stomach cancer had a significantly higher frequency of rs3807213 C allele distributions (OR = 3.759, 95% CI = 1.521-9.294; P = 0.003) than the controls. Compared with control group, patients with gastric cancer had a significantly higher frequency of rs3807213 CC genotype (OR = 4.028, 95% CI = 1.513-10.720; P = 0.004). When stratified by pathological stage of gastric cancer, there was no significant difference observed. CONCLUSION: IFRD1-rs3807213 polymorphism may be associated with the increased risk of gastric cancer.

Is dietary fat associated with the risk of colorectal cancer? A meta-analysis of 13 prospective cohort studies.

BACKGROUND: The results of animal studies suggest there is a significant role for dietary fat in the development of colorectal cancer (CRC). However, inconsistent results have been reported by epidemiological studies. AIM OF STUDY: To evaluate the association between total dietary fat and risk of colorectal cancer development using a meta-analysis based on prospective cohort studies. METHODS: Published literature was retrieved from Medline, Embase and CNKI (China Knowledge Resource Integrated Database) databases updated to 1st May, 2009. Overall, thirteen prospective cohort studies with 3,635 cases and 459,910 participants were included. RESULTS: The combined relative risk (RR) [95% confidence interval (95%CI)] for the risk of CRC was 0.99 (0.89,1.09) when the highest level of total dietary fat was versus (vs.) the lowest level. Stratified analyses according to gender, ethnicity, country and age showed that the highest level of total dietary fat did not increase the risk of CRC [RR (95%CI): 0.89 (0.77,1.03) for males; 1.09 (0.94,1.26) for females; 1.08 (0.94,1.25) for Caucasians; 0.90 (0.77,1.04) for Asians; 1.13 (0.94,1.36) for Americans; 0.92 (0.81,1.04) for individuals older than 40]. Besides those, the highest level of total fat diet also did not increase the risk of neither colon cancer [RR (95%CI): 0.96 (0.82,1.13)] nor rectal cancer [RR (95%CI):1.07 (0.63,1.82)]. Furthermore, neither animal fat nor plant fat were associated with the risk of CRC [RR (95%CI): 1.05 (0.91-1.22) for animal fat and 0.96 (0.82-1.11) for plant fat]. CONCLUSIONS: This meta-analysis suggests that dietary fat may not be associated with the increased risk of CRC. More well-designed studies with larger population performed among Asians are needed to further evaluate the associations. In addition, probable bias caused by measurement error should be noticed in this meta-analysis, and measurement error needs to be adjusted in the future studies.