Cardia Cancer Research Articles

Reverse resistance to immune checkpoint inhibitor in a patient with recurrent cardia cancer by intratumoral injection of recombinant human adenovirus type 5: a case report and literature review

Advanced metastatic cardia cancer is an intractable malignance with poor prognosis. It is often accompanied by upper digestive tract obstruction, which seriously affects the quality of patients. Therefore, effective relief of eating obstruction is an important goal in the treatment of cardia cancer. Immune checkpoint inhibitors (ICIs) have shown significant efficacy in cardia cancer, but only a small percentage of patients will benefit from them due to immune resistance. Oncolytic viruses have been shown to enhance the efficacy of ICIs by altering the immune microenvironment. This indicates that oncolytic virus has the potential value of overcoming the immune resistance of cardia cancer. Here, we present a case with local recurrent and multiple metastatic cardia cancer accompanied by eating obstruction. After 4 cycles of chemotherapy plus ICI therapy, the patient´s metastases were significant shrink, but the recurrent carida lesion were almost unchanged. Then we implemented exploratory local injection of recombinant human adenovirus type 5(H101) into recurrent cardia lesion by painless gastroscopy. Surprisingly, the cardia lesion shrank significantly, and the eating obstruction was greatly relieved. We also observed a significant increase of infiltrated CD4+T cells in biopsy tissues after H101 treatment. Our study not only conformed the value of oncolytic viruses to reverse ICI resistance in patients with gastric cancer, but also revealed its underlying impact on immune microenvironment.

Centralization of gastric cancer surgery- impact on treatment strategies and survival - a national population-based cohort study

BackgroundCentralized surgery care improves results of curative resection in rare malignancies. Less is known of secondary effects of such centralization on all patients, including patients receiving palliative or no tumor treatment. This population-based cohort study aimed to evaluate effects of centralization on survival and treatment decision in all gastric cancer patients in Sweden between 2006-2016. MethodsAll patients diagnosed with gastric cancer, including cardia cancer Siewert III, were identified using National Registry for Esophageal and Gastric Cancer (NREV) in Sweden. Patients diagnosed at a local hospital performing low-volume curative gastric cancer surgery before centralization were compared to patients in the same communities after curative cases were referred elsewhere. Survival differences were investigated with multivariate cox-regression models and probability of curative care with multivariate logistical regression. Results4547 patients diagnosed at 49 hospitals were included, whereof 28 stopped performing curative gastric cancer surgery during the study period. After centralization, 8 hospitals performed curative gastric cancer surgery, and the median overall survival increased from 7.9 to 9.1 months. Resection rates fell from 36% to 30%. Treatment recommendations made at multidisciplinary cancer conference increased from 23% to 80%, where any active tumor treatment (curative and palliative) recommendation increased from 68% to 73%. No significant difference in treatment strategy or time to surgery was found between the groups. No difference in overall survival was found between the groups. ConclusionDuring the centralization of gastric cancer surgery, survival, multidisciplinary treatment decisions and active treatment increased, with no detrimental effects on populations outside the major centers’ primary uptake areas.

Esophagojejunostomy using a circular stapler vs. a linear stapler for gastric cardia cancer patients: impact of upper margin length and tumor size on the survival rate.

The incidence of gastric cancer is concomitantly rising with gastric cardia cancer worldwide. While the improvement of gastric cancer surgical techniques is glowing, this study assesses the impact of the upper margin length and tumor size on the survival rate for gastric cardia cancer patients who underwent total laparoscopic total gastrectomy(TLTG) or laparoscopic assisted total gastrectomy(LATG). A total of 63 patients with gastric cardia cancer who underwent laparoscopic total gastrectomy were retro-prospectively collected from January 2021 to May 2023. While assessing the impact of upper margin length and tumor size on the survival rate, esophagojejunostomy using a linear stapler has been compared to a circular stapler. The sixty-three patients met inclusion criteria; 32 (51%) underwent LATG and 31 (49%) underwent TLTG. Their mean age was 65 years (range, 45-77). The blood loss means in LATG and TLTG was 74.69 and 50.16 ml, respectively (p = 0.005), and surgery duration was higher in LATG than LATG with respective means of 247 min and 222.42 min. (p = 0.006). However, the tumor size means (p = 0.5), and upper margin length means (p = 0.052) were not significantly different in the LATG and TLTG groups, respectively. The number of resected and assessed lymph node was adequate in the LATG and TLTG groups. The current study still does not find an independent related risk from the upper margin length and tumor size to the survival rate according to the multiple regression analysis (p = 0.080). The upper margin length and tumor size do not have a relationship with the survival rate of the compared esophagojejunostomy (EJS) methods. The EJS using a linear stapler requires a shorter surgery duration and less blood loss than EJS using a circular stapler.

A clinical case of acute intestinal obstruction as a result of dislocation of the esophageal self-expanding nitinol stent

INTRODUCTION: Covered esophageal self-expanding stents are often used to palliate dysphagia in patients with unresectable esophageal and gastric cardia cancer. Migration of an esophageal stent is a common occurrence in these patients. One of rare complications that can be caused by stent dislocation is intestinal obstruction. The article describes a case of intestinal obstruction in result of migration of a fully covered nitinol esophageal stent. Patient K., 53 years old, was admitted to hospital in a severe condition with complaints of vomiting, abdominal pain and stool retention that had persisted for four days. The patient refused esophagogastroduodenoscopy. A plain abdominal X-ray did not reveal any free gas. In the mesogastrium, numerous pneumatized loops of small intestine with horizontal fluid levels were identified. For life indications, the patient, after preoperative preparation was taken to the emergency operating room; resection of the terminal part of small intestine was performed with placement of an ileostomy and gastrostomy. Taking into account difficulties of diagnosis (refusal of esophagogastroduodenoscopy by the patient and low informative value of X-ray examination), severity of the patient’s condition (due to a malignant neoplasm and intestinal obstruction), anatomical peculiarities (location of the esophageal stent 30 cm from the ileocecal angle, which would complicate potential application of enteroenteroanastomosis), the chosen tactics was to refuse application of enteroenteroanastomosis and exteriorize ileostomy and gastrostomy. CONCLUSION: Acute intestinal obstruction is a threatening complication of migration of an esophageal stent. Patients with placed esophageal stents require careful monitoring, use of a sparing diet and additional methods of stent fixation, which will help reduce the frequency of stent migration and associated complications.

Visceral to subcutaneous fat area ratio predicts early postoperative small bowel obstruction after total gastrectomy for cardia cancer.

We aimed to investigate the relationship between the visceral to subcutaneous fat area ratio (V/S ratio) and incidence of early postoperative small bowel obstruction (EPSBO) following total gastrectomy for cardia cancer. We conducted a retrospective analysis among patients with cardia cancer who underwent elective total gastrectomy with esophagojejunostomy Roux-en-Y anastomosis at Nanjing Yimin Hospital between November 2019 and April 2024. Preoperative, intraoperative, and postoperative factors were meticulously monitored. The V/S ratio was calculated using computed tomography scans at the umbilical level with Slice-O-Matic software (Tomovision, Montreal, Canada). Statistical analyses included logistic regression and receiver operating characteristic (ROC) curve analysis. Among 175 patients, 27 (15.4%) developed EPSBO. The V/S ratio was significantly higher in the EPSBO group (1.76 ± 1.05 vs. 1.01 ± 0.54). Logistic regression identified the V/S ratio as a significant predictor of EPSBO (odds ratio [OR] = 1.612, 95% [CI]: 1.102-1.605). ROC curve analysis demonstrated high sensitivity (92%) and specificity (100%) for the V/S ratio in predicting EPSBO, with a 0.83 AUC. Our findings indicated a higher V/S ratio was a significant predictor of EPSBO following total gastrectomy for cardia cancer. Preoperative assessment of the V/S ratio can inform risk stratification and guide targeted interventions to improve postoperative outcomes.

Sex disparity in the association between metabolic-anthropometric phenotypes and risk of obesity-related cancer: a prospective cohort study

BackgroundSex disparity between metabolic-obesity (defined by body mass index, BMI) phenotypes and obesity-related cancer (ORC) remains unknown. Considering BMI reflecting overall obesity but not fat distribution, we aimed to systematically assess the association of our newly proposed metabolic-anthropometric phenotypes with risk of overall and site-specific ORC by sex.MethodsA total of 141,579 men (mean age: 56.37 years, mean follow-up time: 12.04 years) and 131,047 women (mean age: 56.22 years, mean follow up time: 11.82 years) from the UK Biobank was included, and designated as metabolic-anthropometric phenotypes based on metabolic status (metabolically healthy/unhealthy), BMI (non-obesity/obesity) and body shape (pear/slim/apple/wide). The sex-specific association of different phenotypes with overall and site-specific ORC was assessed by hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazards regression models.ResultsWe found metabolically unhealthy and/or obesity phenotypes conveyed a higher risk in men than in women for overall ORC and colorectal cancer compared with metabolically healthy non-obesity phenotype (Pinteraction < 0.05). Of note, metabolically healthy obesity phenotype contributed to increased risks of most ORC in men (HRs: 1.58 ~ 2.91), but only correlated with higher risks of endometrial (HR = 1.89, 95% CI: 1.54–2.32) and postmenopausal breast cancers (HR = 1.17, 95% CI: 1.05–1.31) in women. Similarly, even under metabolically healthy, men carrying apple and wide shapes phenotypes (metabolically healthy apple/wide and metabolically healthy non-obesity apple/wide) suffered an increased risk of ORC (mainly colorectal, liver, gastric cardia, and renal cancers, HRs: 1.20 ~ 3.81) in comparison with pear shape or non-obesity pear shape.ConclusionsThere was a significant sex disparity between metabolic-anthropometric phenotypes and ORC risk. We advised future ORC prevention and control worth taking body shape and sex disparity into account.

803. 2-YEAR RESULTS IN ESOPHAGOGASTRIC JUNCTION CANCER TREATMENT

Abstract Background Esophagogastric junction (EGJ), also known as cardia, tumors have unique characteristics with a widespread of lymph node (LN) metastatic patterns influenced by the extent of esophageal involvement. Besides, there is no worldwide consensus about its classification and the optimal lymphadenectomy and surgical resection extend. Recently, mapping the distribution of LN metastasis in these patients could provide some insights about the extent that should be the target. Furthermore, the balance between resection extension and the procedure safety is also difficult to achieve. This work aims to review the last 2 years of EGJ tumor treatment in a single oncological center. Methods We present a retrospective, single center study that included all the patients with EGJ cancer undergone surgical resection between 2022 and 2023. These tumors were classified using our modified Siewert (mSiewert) classification based on mapping endoscopy with measures of the full extension and not only the tumor’s epicenter. Patient demographics, tumor characterization, neoadjuvant treatment, surgical procedure and postoperative results were assessed, alongside with pathological and oncological metrics as recurrence, disease-free survival (DFS) and overall survival (OS). Results We included 64 cardia cancer patients who underwent a curative treatment strategy, with a median age of 68 years, mostly men (87.5%), with a median BMI of 25 kg/m2. 68.2% were classified as ECOG-PS 0 however 62.5% were classified as ASA III-IV. Most tumors were moderately (39.2%) or poorly (31.4%) differentiated adenocarcinomas. Majority were locally advanced (cT3, 78.1%) and in stage III (85.9%). Regarding tumor location, 49.2% were classified as mSiewert I-II (49.2%), followed by I-II-III (18%) and II-III (18%). 36.1% had esophageal involvement ≥4cm, 87.5% received neoadjuvant treatment split between the CROSS and FLOT protocols. Our resection rate was 85.9%. We mostly performed Mckeown esophagectomy (49.1%) and transhiatal esophagectomy (18.2%). We had a 12.7% admission rate to the intensive care unit and a 27.3% major complication rate (Clavien-Dindo ≥ 3b). Anastomotic dehiscence occurred in 16.4% of cases, with hospital mortality rate of 3.6%. The median hospital stay was 6 days, with a 16.4% readmission rate. Pathological staging revealed that 47.3% were stage III, with a median lymph node yield of 28 and a 98.2% R0 resection rate. Most patients received adjuvant treatment, primarily FLOT protocol or Nivolumab, in 38.2% and 29.1%, respectively. The recurrence rate was 28%, with a median time to recurrence of 26 weeks, mainly occurring as distant metastasis pattern (64.3%). One-year overall survival (OS) was 88.7%, and one-year disease-free survival (DFS) was 66.4%, with a median follow-up time of 48 weeks and only a 3.6% loss to follow-up rate. Conclusion This study highlights the unit’s adaptation of EGJ tumor treatment to new insights, emphasizing the importance of comprehensive classification and multimodal and multidisciplinary approach to enhance patient outcomes.

Developing a prognostic signature: identifying differentially expressed genes in cardia and non-cardia gastric cancer for immunity and therapeutic sensitivity analysis.

Gastric cancer (GC) can be anatomically categorized into two subtypes; that is, cardia gastric cancer (CGC) and non-cardia gastric cancer (NCGC), which have distinct molecular mechanisms and prognoses. At present, the majority of pharmacological interventions for GC adhere to non-specific treatment regimens. The stratification of GC based on molecular disparities between CGC and NCGC has important clinical guidance value and could help in the development of precision therapies tailored to individual patient needs. Nevertheless, research in this specialized field remains notably limited. This study aims to investigate the molecular differences between CGC and NCGC and to leverage these differences to develop a prognostic risk scoring model (PRSM). We used patient data from The Cancer Genome Atlas (TCGA) and performed a differentially expressed gene (DEG) analysis between CGC and NCGC. A PRSM was developed from the prognosis-associated DEGs identified through Cox regression analyses and was well validated using Gene Expression Omnibus (GEO) data. A total of 339 DEGs were identified between CGC and NCGC, and four prognosis-associated genes were used to construct the PRSM. Using the risk coefficients and expression levels of signature genes, a median risk score (RS) was calculated to classify patients into high- and low-risk groups. The high-risk group had a significantly worse prognosis than the low-risk group. An in-depth analysis revealed that TP53 mutations were more prevalent in the high-risk group, and MUC16 mutations were more prevalent in the low-risk group. A gene set enrichment analysis (GSEA) and the CIBERSORT algorithm were used to assess the differences in the significantly enriched pathways and immune microenvironment in the high- and low-risk groups, respectively. The inhibitory concentration (IC50) values of the chemotherapy drugs for GC also varied between the two groups. This study elucidated the unique molecular characteristics of GC subtypes based on the anatomical site and provided a preliminary contribution for the development of precision medicine for GC.

Epidemiology of Gastric Cancer-Changing Trends and Global Disparities.

Overall, the past century has seen a substantial decline in gastric cancer, attributable to decreases in risk factors such as H. pylori infection, tobacco smoking, and the intake of salt-preserved food. One potential preventive strategy for those at high risk is H. pylori eradication for infected subjects, but confirmation of this effect awaits longer follow-up. Obesity continues to advance and may cause increases in cardia cancer, particularly in Western populations, and careful monitoring of this outcome is warranted in both Western and Asian populations. These changes in gastric cancer epidemiology foreshadow a new era in gastric cancer control and warrant further monitoring of descriptive patterns and risk factors.

Hiatal hernia after laparoscopic radical gastrectomy for cardia cancer Case report

To analyze the occurrence and clinical features of hiatal hernias following laparoscopic radical gastrectomy for cardia cancer, and discuss potential causes and methods of prevention and treatment

Association of glucose-lowering drug target and risk of gastrointestinal cancer: a mendelian randomization study

Background & AimsGlucose-lowering drug is associated with various cancers, but the causality with gastrointestinal cancer risk is rarely reported. We aimed to explore the causality between them in this Mendelian randomization (MR) study.MethodsTwo-sample MR, summary-data-based (SMR), mediation MR, and colocalization analyses was employed. Ten glucose-lowering drug targets (PPARG, DPP4, GLP1R, INSR, SLC5A2, ABCC8, KCNJ11, ETFDH, GPD2, PRKAB1) and seven types of gastrointestinal cancer (anal carcinoma, cardia cancer, gastric cancer, hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), pancreatic cancer, rectum cancer) were included. Patients with gastrointestinal cancers from six different large GWAS databases, including the UK Biobank and Finnish cohorts were incorporated, for discovery and external validation. Meta-analysis was employed to integrate the results from both discovery and validation cohorts, thereby ensuring the reliability of findings.ResultsABCC8/KCNJ11 were associated with pancreatic cancer risk in both two-sample MR (odds ratio (OR): 15.058, per standard deviation unit (SD) change of glucose-lowering durg target perturbation equivalent to 1 SD unit of HbA1c lowering; 95% confidence interval (95% CI): 3.824–59.295; P-value = 0.0001) and SMR (OR: 1.142; 95% CI: 1.013–1.287; P-value = 0.030) analyses. The mediation effect of body mass index (OR: 0.938; 95% CI: 0.884–0.995; proportion of mediation effect: 3.001%; P-value = 0.033) on ABCC8/KCNJ11 and pancreatic cancer was uncovered. Strong connections of DPP4 with anal carcinoma (OR: 0.123; 95% CI: 0.020–0.745; P-value = 0.023) and ICC (OR: 7.733; 95% CI: 1.743–34.310; P-value = 0.007) were detected. PPARG was associated with anal carcinoma (OR: 12.909; 95% CI: 3.217–51.795; P-value = 0.0003), HCC (OR: 36.507; 95% CI: 8.929-149.259; P-value < 0.0001), and pancreatic cancer (OR: 0.110; 95% CI: 0.071–0.172; P-value < 0.0001). SLC5A2 was connected with pancreatic cancer (OR: 8.096; 95% CI: 3.476–18.857; P-value < 0.0001). Weak evidence indicated the connections of GLP1R, GPD2, and PRKAB1 with anal carcinoma, cardia cancer, ICC, and rectum cancer. In addition, the corresponding results were consistently validated in both the validation cohorts and the integrated outcomes.ConclusionsSome glucose-lowering drugs were associated with gastrointestinal cancer risk, which might provide new ideas for gastrointestinal cancer treatment.

Survival risk prediction of gastric cardia cancer-based on a dynamic modular neural network

Gastric cardia cancer is a high-incidence malignant tumour, which seriously endangers human health and life safety. The patient prognosis of gastric cardia cancer is affected by diet, physical condition, regional environment, medical history and other factors. Traditional prediction methods cannot fully reflect the prognosis characteristics and survival risks of all patients. Therefore, this paper proposes a data-driven method for the survival risk of cardiac cancer based on an adaptive particle swarm optimization algorithm (APSO) and a dynamic modular neural network (DMNN). First, the article uses density clustering to cluster 293 patients’ blood characteristics and generate different sub-networks. Second, the weight is calculated through the APSO algorithm and the sub-network output is obtained by the integration algorithm. At last, the effectiveness of this network is verified through a 50% cross-validation of training sets and test sets. The results show that the survival prediction based on the APSO-DMNN data-driven method shows good classification performance and accuracy.

Genome-wide DNA methylation and transcriptomic patterns of precancerous gastric cardia lesions.

Intestinal metaplasia (IM) and intraepithelial neoplasia (IEN) are considered precursors of gastric cardia cancer (GCC). Here, we investigated the histopathologic and molecular profiles of precancerous gastric cardia lesions (PGCLs) and biomarkers for risk stratification of gastric cardia IM. We conducted a hospital-based evaluation (n = 4578) for PGCL profiles in high-incidence and non-high-incidence regions for GCC in China. We next performed 850K methylation arrays (n = 42) and RNA-seq (n = 44) in tissues with PGCLs. We then examined the protein expression of candidate biomarker using immunohistochemistry. Of the 4578 participants, 791 were diagnosed with PGCLs (600 IM, 62 IM with IEN, and 129 IEN). We found that individuals from high-incidence regions (26.7%) were more likely to develop PGCLs than those from non-high-incidence areas (13.5%). DNA methylation and gene expression alterations, indicated by differentially methylated probes (DMPs) and differentially expressed genes (DEGs), exhibited a progressive increase from type I IM (DMP = 210, DEG = 24), type II IM (DMP = 3402, DEG = 129), to type III IM (DMP = 3735, DEG = 328), peaking in IEN (DMP = 47 373, DEG = 2278). Three DEGs with aberrant promoter methylation were identified, shared exclusively by type III IM and IEN. Of these DEGs, we found that OLFM4 expression appears in IMs and increases remarkably in IENs (P < .001). We highlight that type III IM and IEN share similar epigenetic and transcriptional features in gastric cardia and propose biomarkers with potential utility in risk prediction.

Forty years of Helicobacter pylori infection and changes in findings at esophagogastroduodenoscopy.

It is 40 years since the discovery of Helicobacter pylori infection. Over that time major changes have occurred in esophagogastroduodenoscopy (EGD) findings. The aim of this review is to describe these changes, and the important role H. pylori infection has played in their evolution. References were identified through searches of PubMed using the search terms-endoscopy time trends, peptic ulcer disease, gastroesophageal reflux disease, upper gastrointestinal cancer, gastric polyps, H. pylori, eosinophilic gastrointestinal disorders, and celiac disease, from 1970 through December 2021. The prevalence of H. pylori infection has fallen and consequently, H. pylori-positive peptic ulcer disease has become rare. Gastroesophageal reflux disease is now the commonest disorder diagnosed at EGD, and Barrett's esophagus has increased in parallel. Cancer of the distal stomach has fallen while esophageal adenocarcinoma and reflux-related cardia cancer have risen. Gastric polyps have changed from hyperplastic and adenomas to sporadic fundic gland polyps. Antimicrobial resistance has made H. pylori infection more difficult to eradicate. Eosinophilic gastrointestinal disorders, particularly eosinophilic esophagitis, have emerged as important new allergic disorders. Celiac disease has changed and increased. EGD findings appear to have changed from features suggesting a H. pylori-positive "phenotype" 40 years ago to a H. pylori-negative "phenotype" today. These changes have major implications for the management of gastrointestinal disorders.

290. RISK OF ESOPHAGEAL CANCER AFTER BARIATRIC SURGERY: COMPARISON BETWEEN SLEEVE GASTRECTOMY AND GASTRIC BYPASS AT 10 YEARS, A NATIONWIDE STUDY

Abstract Backgroud The risk of esophageal cancer after bariatric surgery is a matter of debate. Several studies have reported that bariatric surgery patients have a lower risk of cancer. However, esophageal cancer is associated with gastroesophageal reflux disease, which may increase after bariatric surgery and in particular after sleeve gastrectomy. Objectives The objective of this study is to evaluate the risk of esophageal cancer after two bariatric procedures: sleeve gastrectomy (SG) and gastric bypass (GBP). Methods Data from patients operated on for bariatric surgery between 2007 and 2020 in France were extracted from a national discharge database (PMSI). Adult patients operated on for SG or GBP were included and followed up until December 2020. Patients were divided into two groups according to the procedure initially performed. The endpoints were the occurrence of esophageal and cardia cancers. To assess the effect of the type of bariatric procedure on the development of cancer, a multivariate analysis was performed using a marginal Cox model after matching on propensity score (PS). In the sensitivity analysis, we used different models: standard Cox regression, Cox regression adjusted on propensity score, and Cox model with adjustment for inverse probability of treatment weighting. Results Of the 367,169 patients included, 68.7% were SGs and 31.3% were GBPs. The two groups differed at inclusion in terms of age, sex, BMI, and comorbidities. Median follow-up was 6.0 years (IQR 3.0–8.0 years) for the entire cohort, and approximately 35,000 patients were followed for at least 10 years. A total of 88 esophageal cancers were identified, including 64 after SG and 24 after GBP. In multivariate analysis, no significant difference was found between SG and GBP on cancer incidence (HR 1.6, 95%CI 0.9–2.7, p = 0.09 for OS versus GBP). No differences were found in sensitivity analyses. Conclusion In this large national cohort of bariatric surgery patients, no significant differences were found in the incidence of esophageal and cardia cancer between OS and GBP.

Changing trends in gastric and colorectal cancer among surgical patients over 85 years old: A multicenter retrospective study, 2001-2021.

Whether patients over 85 years old with gastrointestinal cancer should undergo surgery remains controversial. We aimed to describe the changing trends of characteristics to provide more information to decision makers, and strive to find appropriate surgical plan. To describe the changing trends of characteristics to provide more information to decision makers, and strive to find appropriate surgical plan. A total of 218 gastric cancer (GC) patients and 563 colorectal cancer (CRC) patients who underwent surgery between 2001 and 2021 were enrolled in this retrospective analysis. Changes in clinicopathological features, surgical treatments, and survival status were analyzed longitudinally at 5-year intervals. Only 14 GC patients underwent laparoscopic surgery where 219 CRC patients had this procedure. Cardia and esophagogastric junction cancer increased in GC patients, and the proportion of sigmoid colon cancer decreased in CRC patients. Pulmonary infection gradually became the most common postoperative complication, its incidence in period 4 reached 48.79%. However, the incidence of anastomotic leakage decreased from 26.79% to 9.38% (P < 0.01). Additionally, 30-d mortality significantly decreased from 32.14% to 9.01%. Increases were observed in 5-year overall survival (OS) in GC patients from period 1 to period 4 (18.18% vs 33.32%, respectively) and CRC patients (0 vs 36.32%, respectively). Disease-free survival (DFS) also increased in GC and CRC patients (7.14% vs 27.74% and 0 to 36.03%, respectively). The average survival time of GC patients following radial lymphadenectomy was higher than in patients that underwent limited lymphadenectomy (26 vs 22 mo, respectively), the same was seen in CRC patients (44 vs 33 mo, respectively). This advantage was particularly evident in patients with TNM I, but not in patients with TNM II/III period cancer. The safety as well as effectiveness of surgery in ultra-elderly patients is increasing. Radical lymphadenectomy has advantages in patients with TNM I gastrointestinal cancer, but not TNM II/III.

Effectiveness of oral famotidine in reducing the hematologic complications of radiotherapy in patients with esophageal and cardia cancers: a randomized controlled trial

BackgroundChemoradiotherapy complications has always been of great concern to both clinicians and patients during the course of treatment. The purpose of the present study was to examine the effectiveness of oral famotidine on the reduction of hematologic complications of patients with esophageal and gastric cardia cancers undergoing radiotherapy.MethodsA single-blind controlled trial was conducted on 60 patients with esophageal and cardia cancers, who were undergoing chemoradiotherapy. Patients were randomly assigned to 2 groups with 30 patients to receive either 40 mg of oral famotidine (daily and 4 h before each session) or placebo. Complete blood count with differential, platelet counts, and hemoglobin levels were obtained weekly during treatment. The main outcome variables were lymphocytopenia, granulocytopenia, thrombocytopenia, and anemia.ResultsThe findings indicated a significant effect of famotidine on reduction of thrombocytopenia among intervention group compared to control group (P < 0.0001). Even so, the effect of intervention was not significant for other outcome variables (All, P ≥ 0.05). The lymphocyte (P = 0.007) and platelet (P = 0.004) counts were also significantly greater in famotidine group in comparison with placebo group at the end of the study.ConclusionAs evidenced by the findings of the current study, famotidine might be recommended as an effective radioprotective agent among patients with esophageal and gastric cardia cancers to prevent Leukocyte and platelet reduction to some extent.Trial registration This study was prospectively registered at irct.ir (Iranian Registry of Clinical Trials) with the code IRCT20170728035349N1, 2020-08-19.

Gastric Cancer Risk in Association with Underweight, Overweight, and Obesity: A Systematic Review and Meta-Analysis.

This study aimed to investigate the risk of gastric cancer (GC) in abnormal body mass index (BMI) groups. A systematic search was carried out on Embase, PubMed/Medline, and Scopus from January 2000 to January 2023. The pooled risk ratio (RR) with a 95% confidence interval (CI) was assessed using a random-effect model. Thirteen studies with total of 14,020,031 participants were included in this systematic review. The pooled RR of GC was 1.124 (95% CI, 0.968-1.304, I2: 89.08%) in underweight class, 1.155 (95% CI, 1.051-1.270, I2: 95.18%) in overweight class, and in 1.218 (95% CI, 1.070-1.386, I2: 97.65%) obesity class. There is no difference between cardia and non-cardia gastric cancer, while non-Asian race and female gender have higher risk of cancer, as Meta-regression of obesity and overweight classes showed. These findings suggest that there is a positive association between excess body weight and the risk of GC, with a higher impact in women than men and in non-Asian than Asian populations. Since abnormal weight is tied to various diseases, including GC, healthcare experts, and policymakers should continue interventions aiming to achieve a normal BMI range.

Disparities and access to thoracic surgeons among esophagectomy patients in the United States.

Esophagectomy is a complex operation with significant morbidity and mortality. Previous studies have shown that sub-specialization is associated with improved esophagectomy outcomes. We hypothesized that disparities would exist among esophagectomy patients regarding access to thoracic surgeons based on demographic, geographic, and hospital factors. The Premier Healthcare Database was used to identify adult inpatients receiving esophagectomy for esophageal and gastric cardia cancer, Barrett's esophagus, and achalasia from 2015 to 2019 using ICD-10 codes. Patients were categorized as receiving their esophagectomy from a thoracic versus non-thoracic provider. Survey methodology was used to correct for sampling error. Backwards selection from bivariable analysis was used in a survey-weighted multivariable logistic regression to determine predictors of esophagectomy provider specialization. During the study period, 960 patients met inclusion criteria representing an estimated population size of 3894 patients. Among them, 1696 (43.5%) were performed by a thoracic surgeon and 2199 (56.5%) were performed by non-thoracic providers. On multivariable analysis, factors associated with decreased likelihood of receiving care from a thoracic provider included Black (OR 0.41, p < 0.001), Other (OR 0.21, p < 0.001), and Unknown race (OR 0.22, p = 0.04), and uninsured patients (OR 0.53, p = 0.03). Urban hospital setting was associated with an increased likelihood of care by a thoracic provider (OR 4.43, p = 0.001). In this nationally representative study, Nonwhite race, rural hospital setting, and lower socioeconomic status were factors associated with decreased likelihood of esophagectomy patients receiving care from a thoracic surgeon. Efforts to address these disparities and provide appropriate access to thoracic surgeons is warranted.

Body mass index and esophageal and gastric cancer: A pooled analysis of 10 population-based cohort studies in Japan.

The effect of body mass index (BMI) on esophageal and gastric carcinogenesis might be heterogeneous, depending on subtype or subsite. However, findings from prospective evaluations of BMI associated with these cancers among Asian populations have been inconsistent and limited, especially for esophageal adenocarcinoma and gastric cardia cancer. We performed a pooled analysis of 10 population-based cohort studies to examine this association in 394,247 Japanese individuals. We used Cox proportional hazards regression to estimate study-specific hazard ratios (HRs) and 95% confidence intervals (CIs), then pooled these estimates to calculate summary HRs with a random effects model. During 5,750,107 person-years of follow-up, 1569 esophageal cancer (1038 squamous cell carcinoma and 86 adenocarcinoma) and 11,095 gastric (728 cardia and 5620 noncardia) cancer incident cases were identified. An inverse association was observed between BMI and esophageal squamous cell carcinoma (HR per 5-kg/m2 increase 0.57, 95% CI 0.50-0.65), whereas a positive association was seen in gastric cardia cancer (HR 1.15, 95% CI 1.00-1.32). A nonsignificant and significant positive association for overweight or obese (BMI ≥25 kg/m2 ) relative to BMI <25 kg/m2 was observed with esophageal adenocarcinoma (HR 1.32, 95% CI 0.80-2.17) and gastric cardia cancer (HR 1.24, 95% CI 1.05-1.46), respectively. No clear association with BMI was found for gastric noncardia cancer. This prospective study-the largest in an Asian country-provides a comprehensive quantitative estimate of the association of BMI with upper gastrointestinal cancer and confirms the subtype- or subsite-specific carcinogenic impact of BMI in a Japanese population.