Effect of prehabilitation on postoperative outcomes in patients with upper gastrointestinal tract cancer: meta-analysis

Nonpharmacological Interventions for Sleep in People With Upper Gastrointestinal Cancer: A Systematic Review and Meta-Analysis.

Background: The performance of methylated SEPT9 (mSEPT9) in lower gastrointestinal (GI) cancer (colorectal cancer) has been extensively investigated; however, its performance in upper GI cancer (esophageal cancer and gastric cancer) and the comparison with lower GI cancer have rarely been studied. Methods: A total of 1854 subjects, including 344 upper GI cancer patients, 459 lower GI cancer patients, and 1051 noncancer subjects, were recruited in this prospective cohort study. A modified single polymerase chain reaction test for detecting mSEPT9 was used for plasma detection. Results: The sensitivity of mSEPT9 for upper and lower GI cancers was 45.3% and 74.8%, and the corresponding specificities were 85.6% and 86.5%, with areas under curve (AUC) of 0.71 and 0.80, respectively. mSEPT9 exhibited lower sensitivity in stage I than stage II-IV cancer, while no difference in sensitivity was observed for different locations in upper or lower GI cancer. No difference in sensitivity was found among gross classifications, pathological classifications, and differentiation in upper GI cancer, but a higher sensitivity in infiltrative cancer and moderate and poorly differentiated cancers was observed in the lower GI. No difference in sensitivity was found between male and female in both cancers, while sensitivity increased with age for both cancers. Cancer antigen 724 (CA724) showed the highest sensitivity for upper GI cancers, and carcinoembryonic antigen (CEA) showed the highest sensitivity for lower GI cancers. The combination of CA724 with mSEPT9 increased the sensitivity to 67.5% in upper GI cancers, and the combination of mSEPT9 with CEA increased the sensitivity to 85.4% in lower GI cancers, with an AUC of 0.90 and 0.95, respectively. Conclusions: mSEPT9 exhibited a higher sensitivity in lower GI cancers than upper GI cancers. The combination of mSEPT9 with protein markers significantly enhanced the detection sensitivity in both cancers.

There is no consensus on the efficacy of perioperative immunonutrition in patients with upper gastrointestinal (GI) cancer surgery. We clarified the impact of perioperative immunonutrition on postoperative outcomes in patients with upper GI cancers. We searched MEDLINE (PubMed), MEDLINE (OVID), EMBASE, Cochrane Central Register of Controlled Trials, Web of Science Core Selection, and Emcare from 1981–2022 using search terms related to immunonutrition and upper GI cancer. We included randomized controlled trials. Intervention was defined as immunonutritional therapy, including arginine, n-3 omega fatty acids, or glutamine during the perioperative period. The control was defined as standard nutritional therapy. The primary outcomes were infectious complications, defined as events with a Clavien–Dindo classification grade ≥ II that occurred within 30 days after surgery. After screening, 23 studies were included in the qualitative synthesis and in the quantitative synthesis. The meta-analysis showed that immunonutrition reduced infectious complications (relative risk ratio: 0.72; 95% confidence interval: 0.57–0.92; certainty of evidence: Moderate) compared with standard nutritional therapy. In conclusion, nutritional intervention with perioperative immunonutrition in patients with upper GI cancers significantly reduced infectious complications. The effect of immunonutrition for upper GI cancers in reducing the risk of infectious complications was about 30%.

Background:The goal of this study was to comprehensively evaluate the analgesic and antiemetic effects of adjuvant dexmedetomidine (DEX) for breast cancer surgery using a meta-analysis.Methods:Electronic databases were searched to collect the studies that performed randomized controlled trials. The effect size was estimated by odd ratio (OR) or standardized mean difference (SMD). Statistical analysis was performed using the STATA 13.0 software.Results:Twelve published studies involving 396 DEX treatment patients and 395 patients with control treatment were included. Pooled analysis showed that the use of DEX significantly prolonged the time to first request of analgesia (SMD = 1.67), decreased the postoperative requirement for tramadol (SMD = −0.65) and morphine (total: SMD = −2.23; patient-controlled analgesia: SMD = −1.45) as well as intraoperative requirement for fentanyl (SMD = −1.60), and lower the pain score at 1 (SMD = −0.30), 2 (SMD = −1.45), 4 (SMD = −2.36), 6 (SMD = −0.63), 8 (SMD = −2.47), 12 (SMD = −0.81), 24 (SMD = −1.78), 36 (SMD = −0.92), and 48 (SMD = −0.80) hours postoperatively compared with the control group. Furthermore, the risks to develop postoperative nausea/vomiting (PONV) (OR = 0.38) and vomiting (OR = 0.54) were significantly decreased in the DEX group compared with the control group. The pain relief at early time point (2, 6, 12, 24 hours postoperatively) and the decrease in the incidence of PONV were especially obvious for the general anesthesia subgroup (P < .05) relative to local anesthesia subgroup (P >.05).Conclusion:DEX may be a favorable anesthetic adjuvant in breast cancer surgery, which could lower postoperative pain and the risk to develop PONV. DEX should be combined especially for the patients undergoing general anesthesia.

ObjectiveExplore the influence of family history of upper gastrointestinal (UGI) cancer on UGI cancer death, based on the Linxian Dysplasia Nutrition Intervention Trial (NIT) cohort.MethodsFamily history of UGI cancer was defined as at least one first-degree relative (parent, child, or sibling) had a history of esophageal or gastric cancer. Cancer death was carried out by ICD-10 code. Family history information was collected at baseline and cancer deaths were assessed at each annual follow-up. The COX proportional risk model was used to estimate the hazard ratio (HR) and 95% confidence interval (95% CI). We compared the positive family history group with the negative to determine the risk of family history on UGI cancer death. The effect of category of relatives, number of relatives with UGI cancer, and diagnosis age of relatives on the UGI death risk were further analyzed. Interaction and stratification analyses were done to see the subgroup effects. Sensitivity analyses were also conducted by exclusion of individuals who were followed up less than three years. We considered controlling of covariates including: gender, age (continuity), community, education level, number of siblings (continuity), BMI (continuity), smoking, alcohol use, fresh fruit intake, fresh vegetable intake, hot beverage intake, edible oil intake, meat intake, and moldy staple food intake. All food intake variables were converted into categorical variables.ResultsFrom1985 to2015, we followed up total 3,318 individuals with 898 UGI cancer deaths (537 from ESCC, 77 from GNCC, and 284 from GCC). In a single factor analysis, family history of UGI cancer increased the risk of death of esophageal squamous cell carcinoma (ESCC) by 27% (HR=1.270, 95%CI1.072-1.504). No associations were observed in gastric cardia carcinoma (GCC) and gastric non-cardia carcinoma (GNCC). After adjusting for multi-factor, a family history of UGI cancer risk of death increased by 31.9% from ESCC (HR=1.319,95%CI:1.110-1.567). Subgroup analysis of different types of relatives with UGI cancers, UGI cancers in the mother (HR=1.457,95%CI:1.200-1.768), brother (HR=1.522,95%CI:1.117-2.073), and sister (HR=1.999,95%CI:1.419-2.817) were independent risk factors for ESCC death, while the father was not. In addition, 2 relatives with UGI cancer (HR=1.495, 95%, CI:1.110-2.013) and ≥3 relatives with UGI cancer (HR=2.836, 95%CI:1.842-4.367) significantly increased the risk of ESCC death, and the trend test was statistically significant (P<0.001). Relatives’ diagnostic age of 51-60 years (HR=1.322, 95%CI:1.046-1.672) and 41-50 years (HR=1.442, 95%CI:1.078-1.930) were the risk factors for ESCC death, with statistical significance in the trend test (P=0.010). No statistically significant result of the family history effect on the risk of death from GCC or GNCC was found. Sensitivity analysis of 80% of subjects, randomly selected, did not change the results.ConclusionA family history of UGI cancer may predict the risk of death from ESCC but not from GCC or GNCC. UGI cancer in the mother may predict the risk of death from ESCC, but not father, which indicates gender differences. Gender and smoking are the interaction items with family history in a similar extent. In the subgroup, the risk of ESCC death is more distinct by family history in younger, female, and better-lifestyle individuals, which indicates the unique role of genetic factors.

Direct oral anticoagulant-associated bleeding complications in patients with gastrointestinal cancer and venous thromboembolism

BackgroundAlthough, family history of cancer is an important risk factor for upper gastrointestinal cancers development, but limited information is available on the upper gastrointestinal cancers associated with family history in Iran. The purpose of this study was to define upper gastrointestinal cancers risk associated with family history of cancer.MethodsThis study was conducted as a case control study. A total number of 1,010 cases of upper gastrointestinal cancer and 1,010 healthy controls were recruited. For family history of cancer, questions were asked about any malignant tumor in first and second degree relatives. Adjusted odds ratio estimates for the association family history and upper gastrointestinal cancers risk and corresponding 95% confidence intervals were obtained.ResultsA family history of any malignant tumor in relatives was associated with 1.3 fold increased risks of upper gastrointestinal cancers. A first-degree family history of esophageal and gastric cancer was significantly associated with upper gastrointestinal cancers development, with an adjusted OR of 4.7(CI 95%: 2.6-8.4). ConclusionOur findings suggested that risk for upper gastrointestinal cancers increases among individuals with family history of cancer. Therefore, appropriate screening strategies especially in relatives of patients should be considered to prevent and control of disease.

Clinical Outcomes for Patients with Brain Metastases from Upper Gastrointestinal Cancer Treated with Stereotactic Radiosurgery

Background and study aims: Upper gastrointestinal (UGI) cancer in the Western world usually presents at an advanced stage, when opportunities for curative therapy are limited. The failure to detect subtle, early-stage UGI cancer at endoscopy may contribute to a poor prognosis. We undertook a meta-analysis of studies of endoscopic miss rates for UGI cancer to quantify how often opportunities to diagnose cancer at an earlier stage are missed.Patients and methods: A MEDLINE search was conducted to identify relevant studies, and a meta-analysis was conducted. “Missed” UGI cancer was defined as cancer that had not been diagnosed by UGI endoscopy performed within 3 years before the diagnosis. Random effects meta-analysis was used to determine the event rate of missed UGI cancer.Results: Ten studies were identified that included 3,787 patients with UGI cancer. Four hundred eighty-seven UGI cancers were missed at endoscopy within 3 years before diagnosis. Marked heterogeneity was observed between studies (I2, 94.4 %; P < 0.001). On random effects meta-analysis, the pooled miss rates were 6.4 % (95 % confidence interval [CI], 4.3 % – 9.5 %) within 1 year and 11.3 % (95 % CI, 7.5 % – 16.6 %) within 3 years before diagnosis. There appeared to be no difference between the miss rates of oesophageal (44 %) and gastric (51 %) cancer (P = 0.42).Conclusion It appears that 11.3 % of UGI cancers are missed at endoscopy up to 3 years before diagnosis. To ameliorate the poor prognosis of patients with UGI cancer in the Western world, efforts should be made to improve the quality of UGI endoscopy and create opportunities for earlier diagnosis.

Near-term prognostic impact of integrated muscle mass and function in upper gastrointestinal cancer

ObjectiveThe objective of this study was to investigate family history (FH) of upper gastrointestinal (UGI) cancer and risk of esophageal squamous cell carcinoma (ESCC), gastric cardia carcinoma (GCC), and gastric non-cardia carcinoma (GNCC) in the Linxian General Population Nutrition Intervention Trial (NIT) cohort. Methods: This prospective analysis was conducted using the Linxian NIT cohort data. Subjects with FH of UGI cancer was treated as an exposed group while the remainders were considered as a comparison group. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between FH of UGI cancer and risk of UGI cancer incidence and mortality were estimated using Cox proportional hazards models.ResultsThere were 5,680 newly diagnosed UGI cancer cases during the follow-up period, with a total of 4,573 UGI cancer deaths occurred, including 2,603 ESCC, 1,410 GCC, and 560 GNCC deaths. A positive FH of UGI cancer was associated with a significantly increased risk of ESCC and GCC (Incidence: HRESCC = 1.45, 95%CI: 1.35–1.56; HRGCC = 1.27, 95%CI: 1.15–1.40; Mortality: HRESCC = 1.40, 95%CI: 1.30–1.52; HRGCC = 1.27, 95%CI: 1.14–1.42) after adjusting for age at baseline, gender, smoking status, alcohol drinking, education level, and frequency of fresh fruit and vegetable consumption. Subjects with FH in both parents had the highest risk of ESCC and GCC incidence (HRESCC = 1.65, 95%CI: 1.40–1.95; HRGCC = 1.42, 95%CI: 1.12–1.81) and deaths (HRESCC = 1.65, 95%CI: 1.38–1.97; HRGCC = 1.42, 95%CI: 1.09–1.85). Spouse diagnosed with UGI cancer did not increase the risk of any UGI cancers of the subjects. In subgroup analysis, FH of UGI cancer was shown to significantly increase the risk of GCC in non-drinkers (Incidence: HR = 1.31, 95%CI: 1.17–1.47; Mortality: HR = 1.33, 95%CI: 1.17–1.50). No associations were observed for risk of GNCC. Sensitivity analysis by excluding subjects who were followed up less than three years did not materially alter our results.ConclusionOur data point to the role of the FH of UGI cancer to the risk of ESCC and GCC incidence and mortality. The influence of family history on the risk of UGI cancer varies from different types of family members.

A Functional Polymorphism of Toll-Like Receptor 4 Gene Increases Risk of Gastric Carcinoma and Its Precursors

Introduction The epidemiology of upper gastrointestinal (UGI) cancer is rapidly changing. Current guidelines for red flag symptoms for UGI cancer were drawn up using evidence from a past age. With the exception of dysphagia, many of the symptoms are non-specific for UGI cancer in particular dyspepsia, particularly with the rapidly declining prevalence of H. pylori and its associated gastric cancers. Aims To determine the value of individual UGI cancer red flag symptoms alone or in combination in predicting the presence of UGI and non-UGI cancers. Method Our routine practice is to investigate all patients referred under the urgent suspected cancer (USC) pathway with an oesophagogastroduodenoscopy (OGD) and a computed tomography (CT) scan if over 50 years of age and symptoms are not purely oesophageal. A retrospective case review between October 2013 to March 2014 of all referrals on the USC pathway to our district general hospital with a case review of all the UGI cancers detected by our service over a one year period (October 2013–2014). Clinical follow-up after referral was a minimum of 11 months. Results 391 patients (20–96 age range) were seen under the USC pathway between October 2013–March 2014. In total 372 and 177 patients were investigated with an OGD and a CT scan respectively; 289 and 161 respectively were patients over the age of 50. 19 cancers were detected giving a detection rate of 4.75%. Of those only nine were UGI cancers (three gastric, six oesophageal). Other cancers found included three colorectal, one pancreatic, three lung, one cholangiocarcinoma, one ovarian and one peritoneal. The table shows the symptoms distribution for both UGI and non-UGI cancers. Isolated red flag symptoms had poor predictive power. Weight loss and dysphagia in combination with other symptoms had the best predictive value. There was a similar number of UGI cancers (23) and non UGI cancers (19). Analysis of all UGI cancers n = 47 over the course of one year not necessarily presenting through the USC route (October 2013–2014) revealed that isolated dyspepsia was found in only two of 47 patients compared to iron deficiency anaemia, weight loss and dysphagia which were the sole presenting symptoms in seven, four and three patients respectively, reinforcing the findings from the USC referrals. Conclusion In modern times, isolated UGI cancer red flag symptoms particularly dyspepsia are poorly predictive of UGI cancer, and equally well predict the presence of cancer outside the UGI tract. CT scanning should be a routine part of evaluation of UGI cancer referrals in the over 50’s. Disclosure of interest None Declared.

Upper gastrointestinal (UGI) cancers are highly prevalent in China and have been linked to dietary factors, yet the impact of overall diet quality remains underexplored. This study aimed to assess the association between Chinese diet quality, as measured by the Chinese Diet Balance Index 2016 (DBI-16) and plant-based diet index (PDI), and UGI cancer risks in high-risk populations. We conducted a prospective cohort study from 2017 to 2019 in five high-risk regions of China. Diet quality was assessed using DBI-16 and PDI. Diet quality was evaluated using DBI-16, which includes higher bound scores (HBS), lower bound scores (LBS), and diet quality distance (DQD), alongside the PDI, which distinguishes between overall, healthy, and unhealthy PDI. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox regression analysis. Over a median follow-up of 55 months, 790 cases of UGI cancers were recorded. A high HBS (excessive intake) was associated with a lower risk of UGI cancers (HR = 0.57, 95% CI: 0.41-0.81) and esophageal cancer (HR = 0.51, 95% CI: 0.32-0.80). Conversely, significant dietary imbalance (high DQD) increased UGI cancer risk (HR = 1.59, 95% CI: 1.08-2.36), while severe inadequate intake (high LBS) was only associated with an increased risk of esophageal cancer (HR = 2.16, 95% CI: 1.00-4.65). A higher overall PDI was protective against UGI cancers (HRQ4vs.Q1 = 0.69, 95% CI: 0.49-0.98), whereas an unhealthy PDI increased the risk (HRQ4vs.Q1 = 1.92, 95% CI: 1.38-2.67). The study concludes that unbalanced diets elevate UGI cancer risk, while balanced, plant-based diets reduce it. Promoting healthier dietary habits may benefit high-risk populations.

BackgroundMetabolic syndrome in patients with schizophrenia is a major health concern. The efficacy and safety of adjunctive rosuvastatin in treating dyslipidemia were controversial.AimsTo assess the efficacy and safety of adjunctive rosuvastatin for dyslipidemia in patients with schizophrenia.MethodsWe systematically searched for relevant controlled clinical trials from the following databases: PubMed, PsycINFO, Cochrane Library, China Knowledge Network, WanFang Database and Chinese Biomedical Database up to September 28, 2017. Standardized mean difference (SMD) and risk ratio (RR) along with their 95% confidence intervals (CIs) were calculated. The quality of the included studies was assessed using the Cochrane risk of bias assessment tool. The GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system recommendation grading method was used as the reference standard.ResultsFour studies (n=274) comparing rosuvastatin (n=138) and control (n=136) groups were identified and analyzed. Adjunctive rosuvastatin showed greater efficacy than control group in low density lipoprotein cholesterol (LDL-C) [4 trials, n=272, SMD: -1.31 (95%CI: -1.93, -0.70), I2=81%], total cholesterol (2 trials, n=164, SMD: -2.00 (95%CI: -2.79, -1.21); I2=76%) and triglycerides (2 trials, n=164, SMD: -1.05 (95%CI: -1.38, -0.72); I2=0%), but not in high density lipoprotein cholesterol (2 trials, n=164, SMD: 0.14 (95%CI: -0.16, 0.45); I2=0%). After removing one study without randomization for LDL-C, significance remained [3 trials, n=172, SMD:-1.07 (95%CI: -1.60, -0.53); I2=63%]. No significant group differences regarding body weight (3 trials, n=208, SMD: -0.40 (95%CI:-1.29, 0.49); I2=89%), body mass index (2 trials, n=164, SMD: -0.34 (95%CI: -1.23, 0.56); I2=87%), waist circumference (3 trials, n=208, SMD): -0.43 (95%CI: -1.31, 0.46); I2=89%), and fasting glucose (4 trials, n=272, SMD: -0.25 (95%CI: -0.65, 0.15); I2=62%) were observed. The adverse reactions and any cause discontinuation rate were similar between the groups. According to the GRADE approach, the evidence levels of main outcomes were rated as “very low” (35.3%) to “low” (64.7%). Of them, the primary outcome (LDL-C) was rated as “very low “.ConclusionsThe data available on the effectiveness and safety of adjunctive rosuvastatin in treating dyslipidemia for patients with schizophrenia is insufficient to come to a definitive interpretation about its efficacy and safety. Further high quality RCTs with extended treatment duration are warranted to confirm the findings.Review registrationPROSPERO: CRD42017078230