Cardia Cancer Research Articles

P-296 Neoadjuvant chemotherapy in locally advanced cardia tumor

The gastroesophageal junction (GEJ) and gastric cardia are anatomical sites with a high incidence of Adenocarcinoma. In Iran, gastric cancer is ranked as the most prevalent malignancy amongst men and third amongst women. Additionally, it has the highest mortality rate of all malignancies in Iran(WHO). Neoadjuvant chemotherapy has proven efficient in decreasing tumor size and lymph node involvement, thus facilitating the process of surgery, reducing tumor recurrence, and increasing the life span. This study investigates the tumor response to neoadjuvant chemotherapy and feasibility of surgery following it and patients' tolerance to FLOT regimen in locally advanced gastric cardia cancers. This cross-sectional study enrolled 28 patients with cardia adenocarcinoma referred to Bouali Hospital for 14 months. The inclusion criteria were locally advanced adenocarcinoma of the cardia confirmed by pathology report and endosonography (EUS), performance status(PS) < 2 (ECOG criteria), and the patient’s consent to the treatment. Patients with T3 or T4 with or without lymph node involvement and T1 or T2 with lymph node involvement were categorized as locally advanced A chemotherapy regimen (FLOT) was administered for three cycles before surgery, each lasting 48 hours and two weeks apart. Two to three weeks after the third cycle of chemotherapy, all patients were reassessed by endoscopy and EUS for tumor response to neoadjuvant chemotherapy. Among the 28 participants, 19 (67.9%) were male, and 9 (32.1%) were female. The mean age was 64.42 (SD=13.71) years. All patients in the study had T3 (71.1% ) and T4 (28.6%), while after receiving chemotherapy, only 7.2% of patients had T3 and T4 (p-value 0.005). FLOT regimen was relatively well tolerated. Serious complications that made us interrupt or postpone the treatment were not seen. Leukopenia and fever occurred 6-10 days post-chemotherapy in 11 patients. We could do surgery for 26 of our patients. One patient denied doing an operation, and the other had a problem with anesthesia. Neoadjuvant chemotherapy with FLOT regimen is relatively well tolerated in our patients with locally advanced gastric adenocarcinoma and, in most cases, decreased the cardia tumor's size and lymph node involvement.

Tea consumption and gastric cancer: a pooled analysis from the Stomach cancer Pooling (StoP) Project consortium.

Evidence from epidemiological studies on the role of tea drinking in gastric cancer risk remains inconsistent. We aimed to investigate and quantify the relationship between tea consumption and gastric cancer in the Stomach cancer Pooling (StoP) Project consortium. A total of 9438 cases and 20,451 controls from 22 studies worldwide were included. Odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) of gastric cancer for regular versus non-regular tea drinkers were estimated by one and two-stage modelling analyses, including terms for sex, age and the main recognised risk factors for gastric cancer. Compared to non-regular drinkers, the estimated adjusted pooled OR for regular tea drinkers was 0.91 (95% CI: 0.85-0.97). When the amount of tea consumed was considered, the OR for consumption of 1-2 cups/day was 1.01 (95% CI: 0.94-1.09) and for >3 cups/day was 0.91 (95% CI: 0.80-1.03). Stronger inverse associations emerged among regular drinkers in China and Japan (OR: 0.67, 95% CI: 0.49-0.91) where green tea is consumed, in subjects with H. pylori infection (OR: 0.68, 95% CI: 0.58-0.80), and for gastric cardia cancer (OR: 0.64, 95% CI: 0.49-0.84). Our results indicate a weak inverse association between tea consumption and gastric cancer.

Trends in age-standardised net survival of stomach cancer by subsite and stage: A population-based study in Osaka, Japan, 2001-2014

IntroductionThe burden of stomach cancer remains high, particularly among Asian countries. Although Japan is known to achieve high survival from stomach cancer, little is known regarding the survival trends for recent years and survival by subsite and stage. We report age-standardised 1-, 3-, 5- and 10-year net survival for patients diagnosed with stomach cancer in Osaka, Japan. MethodsWe analysed patients diagnosed with primary stomach cancer and registered in the population-based cancer registry in Osaka Prefecture between 2001 and 2014. We used the non-parametric Pohar Perme method to derive net survival for each year. Both cohort and period approaches were used. Age was standardised using weights of the external population of the International Cancer Survival Standard. Multiple imputation was applied to handle missing information on subsite and stage before estimating age-standardised net survival by subsite (cardia and non-cardia) and stage (localised, regional and distant metastasis). We then examined general trends in the cohort-based survival estimates, as well as by subsite and stage, using linear regression. ResultsA total of 97,276 patients were included in the analysis. Age-standardised net survival improved steadily (mean annual absolute change ≥1.2%). Net survival for both subsites improved, but cardia cancer showed 7–23% lower survival than non-cardia cancer throughout the study period. Five-year net survival remained high (≥80%) in the localised stage from the beginning of this study. Net survival increased steeply (≥1.4% per year) in the regional stage. Although 1-year net survival increased by 14% in the distant stage, 5-year and 10-year net survival remained below 10%. ConclusionAge-standardised net survival for stomach cancer in Japan improved during the study period owing to an increase in the number of patients with localised stage at diagnosis and improved treatment. Monitoring both short- and long-term survival should be continued as management of stomach cancer progresses.

Evaluation of increased microRNA-21 in the serum of patients with cardia cancer.

MicroRNAs are a new group of regulatory RNAs that are about 22 nucleotides long. MicroRNAs are also involved in many human cancers and can actually act as oncogenes and suppressors. In this study, the relationship between miR-21 levels in the serum of sick and healthy individuals and the relationship between high concentrations of this microRNA and tumor staging and cancer progression was performed for the first time in Iran on gastric cardia cancer. This study was performed on 40 patients with gastric cardia cancer and 40 patients who were selected as a control group. The control group was selected from those who presented due to gastrointestinal disorders but were diagnosed as healthy or non-cancerous. Their serum miR-21 was measured using the Real-Time PCR technique. The relationship between the concentration of this microRNA in serum with tumor staging and cancer progression was evaluated. Findings showed that increasing the concentration of miR-21 in serum samples, serum miR-21 in patients was about 3.5 times that of controls (P <0.0001), and serum miR-21 in patients was significantly related to staging tumor showed (P = 0.01), indicating a significant and direct relationship between miR-21 and tumor growth, which indicates the importance of this microRNA in the progression of gastric cancer. Given the role of miR-21 in the progression of gastric cardia cancer and its association with clinic-pathological factors, it can be introduced as a new diagnostic marker. It can also be used as a non-invasive method in the early diagnosis of gastric cancer patients. In this study, miR-21 has an oncogenic role that can be measured in patients' serum to assess the progression of gastric cancer.

Diet and Risk of Gastric Cancer: An Umbrella Review.

Several dietary exposures have been associated with gastric cancer (GC), but the associations are often heterogenous and may be afflicted by inherent biases. In the context of an Umbrella Review (UR), we provide an overview and a critical evaluation of the strength and quality, and evidence classification of the associations of diet-related exposures in relation to the risk of GC. We searched PubMed and Scopus for eligible meta-analyses of observational studies published in English from inception to 12 December 2021, and for any identified association, we applied robust epidemiological validity evaluation criteria and individual study quality assessment using AMSTAR. We screened 3846 titles/abstracts and assessed 501 full articles for eligibility, of which 49 were included in the analysis, investigating 147 unique exposures in relation to GC, cardia (GCC) or non-cardia (GNCC) cancer. Supported by suggestive evidence, positive associations were found comparing the highest vs. lowest categories for: heavy (>42 g/day) alcohol consumption (Relative Risk (RR) = 1.42, 95% Confidence Interval (CI): 1.20–1.67), salted fish consumption (RR = 1.56, 95% CI:1.30–1.87) and waist circumference (RR = 1.48, 95% CI:1.24–1.78) and an inverse association for the healthy lifestyle index (RR = 0.60, 95% CI:0.48–0.74) in relation to GC. Additionally, a positive association was found comparing obese individuals (Body Mass Index (BMI) ≥ 30) to normal-weight individuals (BMI: 18.5–25) (RR = 1.82, 95% CI:1.32–2.49) in relation to GCC. Most of the meta-analyses were of medium-to-high quality (median items: 7.0, interquartile range: 6–9). Maintaining a normal body weight and adopting healthy dietary choices, in particular, limiting the consumption of salt-preserved foods and alcohol, can reduce the risk of gastric cancer.

20-Year Trends in Detection Rates of Cardia Cancer via Endoscopic Surveillance in Tianjin, China: A Hospital-Based Study.

Background To analyze the time trends in cardia cancer detection rates using endoscopic surveillance from 1999 to 2019 in a high-volume Chinese hospital. Methods In this retrospective, single-center study, data were collected from the Endoscopy Center of the Department of Gastroenterology, Tianjin Medical University General Hospital, from 1999 to 2019. Cases of cardia cancer (n = 1567) were extracted from a database of patients who underwent endoscopy. Clinical and epidemiological characteristics of patients with cardia cancer were analyzed, including sex, age, and proportion of early gastric cancer and degree of tumor differentiation. The joinpoint regression method was used to identify change points in incidence trends. Annual percent change (APC) values, with 95% confidence intervals (CI), were calculated for time periods before and after change points. Results Of the 343942 patients who underwent endoscopy during 1999–2009, 1567 (4.6%) were identified with cardia cancer. The overall cardia adenocarcinoma detection rate decreased significantly from 1999 to 2004 (APC = −37.3, 95% CI: -20.9, -6.4), followed by a relatively slower decline rate from 2004 to 2019 (APC = −7.7, 95% CI: -4.4, -7.6). The crude rate of detection of early cardia cancer could not be determined by joinpoint analysis. Rates of detection reduced significantly in patients aged 60–69 and 70-79 years (APC = −8.3, 95% CI: -9.8, -6.8 and APC = −7.3, 95% CI: -8.8, -5.8, respectively). The detection rate in males decreased rapidly from 1999 to 2004 (APC = −35.9, 95% CI: -18.2, 5.6, P < 0.05), while the decline rate was relatively slow from 2005 to 2019 (APC = −6.9, 95% CI: -3.4, -6.1, P < 0.05). Among females, the detection rates also decreased from 1999 to 2004 (APC = −21.2, 95% CI: -28.1, -13.7), but remained stable from 2007 to 2019 (APC = −3.8, 95% CI: -7.9, -0.5). Detection of poorly differentiated cardia cancer also declined from 2009 to 2019 (APC = −12.8, 95% CI: -15.3, -10.0). Conclusions The detection rate of cardia cancer among gastric cancers has been stable from 2008 to 2019. The trend of detection rate of early cardia cancer showed no significant statistical meaning; hence, it remains necessary to carefully observe the cardia area during endoscopy examination.

Estimating and testing sequential causal effects based on alternative G-formula: an observational study of the influence of early diagnosis on survival of cardia cancer

Cancer diagnosis is part of a complex stochastic process, in which patients' personal and social characteristics influence the choice of diagnosing methods, diagnosing methods in turn influence the initial assessment of cancer stage, cancer stage in turn influences the choice of treating methods, and treating methods in turn influence cancer outcomes such as cancer survival. To evaluate the performance of diagnoses, one needs to estimate and test the sequential causal effect (SCE) under a specified regime of diagnoses and treatments in such a complex observational study, where the data-generating mechanism is unknown and modeling is needed for statistical inference. In this article, we introduce a method of statistical modeling to estimate and test SCEs under regimes of treatments (diagnoses and treatments in cancer diagnosis) in complex observational studies. By applying the alternative G-formula, we express the SCE in terms of the point effects of treatments in the sequence, so that the modeling can be conducted via the point effects in the framework of single-point causal inference. We illustrate our method by a medical example of cancer diagnosis with data from a Swedish prognosis study of cardia cancer.

Bone Metastasis From Gastric Adenocarcinoma-What Are the Risk Factors and Associated Survival? A Large Comprehensive Population-Based Cohort Study.

BackgroundWhile bone metastasis is not common in gastric adenocarcinoma (GaC), it can have important impacts on prognosis. This large cohort study aimed at exploring factors associated with bone metastasis in GaC and investigating the time-dependent cumulative mortalities and prognostic factors in GaC patients with bone metastasis at the population level.MethodsData on patients with GaC diagnosed in 2010–2016 were retrieved from a large population-based database. We explored factors associated with bone metastasis using the multivariable-adjusted logistic model. We then calculated the time-dependent cancer-specific mortalities in GaC patients with bone metastasis using the cumulative incidence function and compared mortalities across subgroups using Gray’s test. We further assessed factors associated with mortality using the multivariable-adjusted Fine–Gray subdistribution hazard model.ResultsTogether 11,072 eligible patients with metastatic GaC were enrolled, which comprised 1,511 (14%) people with bone metastasis and 9,561 (86%) with other metastasis, encompassing 6,999 person-years of follow-up. Bone metastasis was more frequently detected in 2014 or later, in younger patients, in patients with gastric cardia cancers, in people with signet-ring cell carcinoma, and in those with poorly differentiated/undifferentiated cancers; it was less commonly observed in black patients. Bone metastasis was associated with more frequent brain and lung metastases. The median survival of patients with bone metastasis was 4 months; the 6-month and 3-year cancer-specific cumulative mortalities were 56% and 85%, respectively. In patients receiving chemotherapy, American Indians/Alaskan Natives, patients with gastric antrum/pylorus cancers, and those with positive lymph nodes had higher mortality risks, while those undergoing resection had lower mortality hazards.ConclusionIn GaC patients, bone metastasis was associated with various clinicopathologic factors including age, ethnicity, tumor location, histology, differentiation, and metastasis to other sites. Patients with bone metastasis had poor prognosis which was associated with ethnicity, tumor location, lymph node involvement, and treatment. Our findings provide important hints for tailed patient management and for further mechanistic investigations.

Changing trends in gastric cancer incidence and mortality: the role of upper endoscopy in low-risk countries.

Gastric cancer, which is diagnosed in approximately one million new patients annually, is a significant contributor to global cancer burden and cancer-related mortality [1]. East Asia, eastern Europe, and Latin America have the highest incidences, while North America and most of western Europe have relatively low incidences [2]. This geographical variation is thought to be associated with several different predisposing and etiologic factors among the countries, such as tumor biology, Helicobacter pylori (H. pylori) infection rate, cigarette smoking, and a high sodium diet with salt-preserved foods. Global age-standardized gastric cancer incidence has steadily declined over the past century, particularly in high-risk countries such as Korea and Japan. This trend has been linked to a decline in noncardia cancer because of the eradication of H. pylori [2]. Contrarily, in countries with low gastric cancer incidence, such as those in western Europe and the USA, the decline in gastric cancer has reduced, especially in the middle-aged population [1] [2]. This phenomenon may also be related to changes in H. pylori infection patterns or the increased proportion of cardia cancer related to epidemic obesity and gastroesophageal reflux disease [1]. As with incidence, global gastric cancer mortality has also decreased [2]. Improvements in surgical techniques and the development of chemotherapy regimens have led to better survival outcomes. Above all, early detection of cancer is a crucial factor contributing to the decline in mortality.

Epidemiology of Gastric Cancer in Korea: Trends in Incidence and Survival Based on Korea Central Cancer Registry Data (1999-2019).

This study investigated the trends of gastric cancer in Korea by adding the latest updated gastric cancer data from 2019. Gastric cancer incidence between 1999 and 2019 was reviewed using data from the Korea Central Cancer Registry. The study period was divided into 3 periods: period I (1999–2005), period II (2006–2012), and period III (2013–2019). The incidence, mortality, tumor location, histology, stage, and treatment were analyzed. Between 1999 and 2019, 577,502 patients were newly diagnosed with gastric cancer in Korea, accounting for 33.2% of patients aged ≥70 years. The age-standardized incidence rate (per 100,000) significantly decreased from 2011 (43.0) to 2019 (29.6), with an annual percent change of −4.50. Additionally, the age-standardized mortality rate (per 100,000) markedly decreased from 1999 (23.9) to 2019 (6.7). The proportions of patients with cardia and fundus cancers remained consistent. The proportion of localized stage cases increased, while those of regional and distant stages decreased. The rate of surgical treatment increased in localized and regional stages from 2006 to 2019. The overall 5-year relative survival (5YRS) rate of gastric cancer (per 100,000) increased from 55.7% in period I to 77.0% in period III. From 2013 to 2019, the 5YRS rates of patients (per 100,000) who underwent surgical treatment were 100.6% and 70.5% in the localized and regional stages, respectively. The results of this study demonstrated several changes in the epidemiology of gastric cancer in Korea. This study provides information to help understand the current trends in gastric cancer in Korea.

The Distinct Impact of TAM Infiltration on the Prognosis of Patients With Cardia and Non-Cardia Gastric Cancer and Its Association With H. pylori Infection.

BackgroundIn stage III gastric cancer (GC), the role of tumor-associated macrophages (TAMs) and Helicobacter pylori (H. pylori) infection impact tumor progression; however, the specific mechanisms remain controversial. We speculated whether this controversy is caused by differences in the location of TAM infiltration (in the core (CT) and invasive margin (MI) of primary tumors) and the topographical subsites of GC (cardia and non-cardia). Therefore, in this study, we investigated TAMs in different locations and H. pylori infection status as prognostic biomarkers for GC.MethodsImmunohistochemical staining for CD68 (pan-macrophage), CD163 (M2-like macrophage), and H. pylori in 200 samples (100 cases of cardia-GC [CGC] and 100 cases of non-cardia GC [NCGC]) was performed. We compared the number of CD68+ and CD163+ macrophages that infiltrated the CT and MI in patients with the prognosis of CGC and NCGC, respectively. In addition, we analyzed the relationship between H. pylori status and the prognosis of patients with GC in different locations, as well as the correlation with TAM infiltration.ResultsThe distribution of TAMs had distinct characteristics in CGC and NCGC, especially differences between CT and MI subtype. A Kaplan–Meier analysis showed that a high number of CD68+ macrophages that infiltrated the CT in CGC was associated with a better prognosis, whereas infiltration at the MI in NCGC indicated a poor prognosis. Furthermore, a high number of CD163+ macrophages infiltrating the MI resulted in a poor prognosis in CGC and NCGC cohorts. Considering the larger differences in the relationship between the infiltration of CD68+ macrophages at different locations and prognosis, we divided the GC cases into marginal and central GC, based on this difference. This resulted in an accurate estimation of the prognosis. Moreover, positive H. pylori status in central GC was significantly associated with a better prognosis and TAM infiltration.ConclusionTAMs in different locations and H. pylori status were identified as independent prognostic markers, with an obvious correlation between them. Therefore, it is important to clarify the impact of TAM location on the prognosis of patients with GC, which contributes to the development of potential therapeutic strategies.

The relative and attributable risks of cardia and non-cardia gastric cancer associated with Helicobacter pylori infection in China: a case-cohort study

SummaryBackgroundHelicobacter pylori infection is a major cause of non-cardia gastric cancer (NCGC), but its causal role in cardia gastric cancer (CGC) is unclear. Moreover, the reported magnitude of association with NCGC varies considerably, leading to uncertainty about population-based H pylori screening and eradication strategies in high-risk settings, particularly in China, where approximately half of all global gastric cancer cases occur. Our aim was to assess the associations of H pylori infection, both overall and for individual infection biomarkers, with the risks of NCGC and CGC in Chinese adults.MethodsA case-cohort study was done in adults from the prospective China Kadoorie Biobank study, aged 30–79 years from ten areas in China (Qingdao, Haikou, Harbin, Suzhou, Liuzhou, Henan, Sichuan, Hunan, Gansu, and Zhejiang), and included 500 incident NCGC cases, 437 incident CGC cases, and 500 subcohort participants who were cancer-free and alive within the first two years since enrolment in 2004–08. H pylori biomarkers were measured in stored baseline plasma samples using a sensitive immunoblot assay (HelicoBlot 2.1), with adapted criteria to define H pylori seropositivity. Cox regression was used to estimate adjusted hazard ratios (HRs) for NCGC and CGC associated with H pylori infection. These values were used to estimate the number of gastric cancer cases attributable to H pylori infection in China.FindingsOf the 512 715 adults enrolled in the China Kadoorie Biobank between June, 2004, and July, 2008, 500 incident NCGC cases, 437 incident CGC cases, and 500 subcohort participants were selected for analysis. The seroprevalence of H pylori was 94·4% (95% CI 92·4–96·4) in NGCG, 92·2% (89·7–94·7) in CGC, and 75·6% (71·8–79·4) in subcohort participants. H pylori infection was associated with adjusted HRs of 5·94 (95% CI 3·25–10·86) for NCGC and 3·06 (1·54–6·10) for CGC. Among the seven individual infection biomarkers, cytotoxin-associated antigen had the highest HRs for both NCGC (HR 4·41, 95% CI 2·60–7·50) and CGC (2·94, 1·53–5·68). In this population, 78·5% of NCGC and 62·1% of CGC cases could be attributable to H pylori infection. H pylori infection accounted for an estimated 339 955 cases of gastric cancer in China in 2018.InterpretationAmong Chinese adults, H pylori infection is common and is the cause of large numbers of gastric cancer cases. Population-based mass screening and the eradication of H pylori should be considered to reduce the burden of gastric cancer in high-risk settings.FundingCancer Research UK, Wellcome Trust, UK Medical Research Council, British Heart Foundation, Kadoorie Charitable Foundation, National Key Research and Development Program of China, and National Natural Science Foundation of China.

Impact of Coronavirus Disease 2019 on the Diagnosis and Therapy for Barrett’s Esophagus and Esophageal Cancer in the United States

Impact of Coronavirus Disease 2019 on the Diagnosis and Therapy for Barrett’s Esophagus and Esophageal Cancer in the United States

Carcinoid of the Operated Stomach: Difficulties in Diagnosis

Gastric neuroendocrine tumors commonly called carcinoids arise from enterochromaffin cells of the stomach and are rare. Recently, their incidence has increased, which may be due to the improvement of diagnostic and therapeutic capabilities. The article describes a rare clinical case of gastric carcinoid 23 years after surgical removal of gastric cardia cancer.

Metabolic Syndrome and Risk of Gastrointestinal Cancers: An Investigation Using Large-scale Molecular Data

Background & AimsGastrointestinal cancer risk is influenced by the presence of metabolic syndrome (MetS). However, previous epidemiologic studies lacked full serological biomarker data for the classification of MetS, and the interaction of MetS with germline cancer risk variants is unknown.MethodsWe investigated the associations between MetS and gastrointestinal cancer risk (overall, colorectal, pancreatic, esophageal adenocarcinoma, esophageal squamous cell carcinoma, stomach cardia, stomach non-cardia, hepatocellular carcinoma, and intrahepatic bile duct cancer) in 366,016 United Kingdom Biobank participants with comprehensive serum biomarker and genotype data. MetS status was determined by 3 different definitions at baseline, and, in 15,152 participants, at a repeat assessment after a median of 4.3 years of follow-up. Multivariable hazard ratios and 95% confidence intervals for cancer outcomes were estimated using Cox proportional hazards models. Analyses stratified by polygenic risk score were conducted for colorectal and pancreatic cancers.ResultsDuring a median follow-up of 7.1 years, 4238 incident cases of a gastrointestinal cancer occurred. MetS at baseline was associated with higher risk of overall gastrointestinal cancer by any definition (hazard ratio, 1.21; 95% confidence interval, 1.13–1.29, harmonized definition). MetS was associated with increased risks of colorectal cancer, colon cancer, rectal cancer, hepatocellular carcinoma, pancreatic cancer in women, and esophageal adenocarcinoma in men. Associations for colorectal cancer and pancreatic cancer did not differ by polygenic risk score strata (P-heterogeneity 0.70 and 0.69, respectively), and 80% of participants with MetS at baseline retained this status at the repeat assessment.ConclusionsThese findings underscore the importance of maintaining good metabolic health in reducing the burden of gastrointestinal cancers, irrespective of genetic predisposition.

S1386 Diverging Patterns of Cardia and Non-Cardia Gastric Adenocarcinoma Incidence by Race and Age in the United States From 2000-2018

Introduction: Gastric adenocarcinoma is the fifth-leading cause of cancer incidence and fourth-leading cause of cancer mortality worldwide. In the United States (US), racial groups differ in their incidence of cardia (CGA) and non-cardia (NCGA) gastric adenocarcinomas. There have been few studies published observing secular trends in incidence of both CGA and NCGA stratified by race in the US. Methods: Age-adjusted incidence rates and trends of CGA and NCGA in adults aged ≥ 25 years were calculated using data form 18 registries reporting to the Surveillance, Epidemiology, and End Results (SEER) Program from years 2000-2018. Race/ethnicity was classified as non-Hispanic White, non-Hispanic Black, American Indian/Alaskan Native, Asians/Pacific Islanders, and Hispanic. Analysis was also stratified by age (25-49 and ≥50). We used joinpoint regression to assess annual percent change (APC), average annual percent change (AAPC), and corresponding 95% confidence intervals (CIs). Results: The incidence of NCGA decreased in all racial groups, regardless of age, across the study period. The incidence of CGA also decreased in all racial groups among individuals ≥50 (Table 1). However, among individuals 25-49, the incidence of CGA is increasing among non-Hispanic Whites (AAPC = 1.0, 95% CI; 0.3, 1.7), Asian/Pacific Islanders (AAPC = 2.5, 95% CI; -0.3, 5.4), and Hispanics (AAPC = 2.3, 95% CI; 0.9, 3.8) (Figure 1). Conclusion: NCGA incidence is decreasing in all racial and age groups. By contrast, CGA incidence in increasing in the young among certain racial/ethnic groups. Clinicians and policy makers must be cognizant of these recent and worrisome trends. Moreover, appropriate cancer prevention programs are needed to target these at-risk populations.Table 1.: Average annual percent change in cardia and non-cardia gastric cancer incidence rates by race and age: SEER 2000-2018 SEER, Surveillance, Epidemiology and End Results; AAPC, average annual percent change. † Lack of data to analyze AAPC.Figure 1.: Age- and race-specific cardia gastric cancer incidence trends in the SEER data, 2000-2018 A. Non-Hispanic Whites aged 25-49 B. Non-Hispanic Asian/Pacific Islanders aged 25-49 C. Hispanics aged 25-49 D. Non-Hispanic Whites aged ≥50 E. Non-Hispanic Asian/Pacific Islanders aged ≥50 F. Hispanics aged ≥50

545 INCIDENCE OF INVOLVEMENT OF PARATRACHEAL LYMPHNODES IN SIEWERT AEG-I TUMORS

Abstract Transthoracic esophagectomy with 2-field-lymphadenectomy (LAD) is the state of the art treatment of resectable adenocarcinoma of the distal esophagus (Siewert-Stein AEG type I) and may be performed in AEG II cardia cancers. However, it remains unclear whether paratracheal LAD contributes to a survival benefit. In this study we collected data regarding lymph node involvement of paratracheal nodes. Methods From 2014 to 2019 consecutive patients were included in the prospective analysis. Patients underwent hybrid or open Ivor Lewis esophagectomy and 2-field LAD. Paratracheal tissue was removed from the right side of the trachea along the superior vena cava above the azygos vein up to the the upper thoracic aperture. Paratracheal lymph nodes were histologically evaluated separately from the nodes of other stations. Results Ninety-five consecutive patients (12 were female, mean age 67, sd 10, AEG I 84, AEG II 11) were included in the prospective observation study. Seventy-two and 5 patients preoperatively received chemotherapy or radiochemotherapy, respectively. All of them underwent transthoracic esophagectomy (Ivor Lewis 93, McKeown 2—because of coexisting ultralong segment Barrett esophagus). Overall the mean (sd) lymph node count was 37 (12). In the right paratracheal region we found a median of 6 lymph nodes (range;1–22). In 42 (44%) patients positive lymph nodes were recorded, but there was no case with right paratracheal node involvement. Conclusion In the present study paratracheal lymph node involvement was evaluated after transthoracic esophagecotmy with 2-field lymphadenectomy. Remarkably, despite a high proportion of overall lymphatic involvement we did not observe any paratracheal nodal metastasis. Larger studies may show whether paratracheal lyphmadenectomy is necessary during radical esophagectomy for AEG I and AEG II cancers.

Coffee consumption and gastric cancer: a pooled analysis from the Stomach cancer Pooling Project consortium.

This study aimed to evaluate and quantify the relationship between coffee and gastric cancer using a uniquely large dataset from an international consortium of observational studies on gastric cancer, including data from 18 studies, for a total of 8198 cases and 21 419 controls. A two-stage approach was used to obtain the pooled odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) for coffee drinkers versus never or rare drinkers. A one-stage logistic mixed-effects model with a random intercept for each study was used to estimate the dose-response relationship. Estimates were adjusted for sex, age and the main recognized risk factors for gastric cancer. Compared to never or rare coffee drinkers, the estimated pooled OR for coffee drinkers was 1.03 (95% CI, 0.94-1.13). When the amount of coffee intake was considered, the pooled ORs were 0.91 (95% CI, 0.81-1.03) for drinkers of 1-2 cups per day, 0.95 (95% CI, 0.82-1.10) for 3-4 cups, and 0.95 (95% CI, 0.79-1.15) for five or more cups. An OR of 1.20 (95% CI, 0.91-1.58) was found for heavy coffee drinkers (seven or more cups of caffeinated coffee per day). A positive association emerged for high coffee intake (five or more cups per day) for gastric cardia cancer only. These findings better quantify the previously available evidence of the absence of a relevant association between coffee consumption and gastric cancer.

Gastrointestinal hemorrhage in the setting of gastrointestinal cancer: Anatomical prevalence, predictors, and interventions.

BACKGROUNDGastrointestinal hemorrhage (GIH) is a common complication with gastrointestinal cancers (GIC). There is no comprehensive research that examines GIH in different types of GIC. AIMTo study the prevalence, predictors, and interventions of GIH based on the anatomical location of GIC.METHODSThis is a retrospective analysis of the 2016-2018 National Inpatient Sample database, the largest inpatient care database in the United States. All adult inpatients (≥ 18-year-old) were included. ICD-10-CM codes were used to identify patients with GIH and GIC. Prevalence of GIH was obtained based on the anatomical location of GIC. Predictors of GIH in the GIC population were studied using multivariate analysis. Interventions including endoscopy were compared to the non-intervention group to determine the differences in inpatient mortality.RESULTSOut of a total of 18173885 inpatients, 321622 (1.77%) cases had a diagnosis of GIC. Within GIC patients, 30507 (9.5%) inpatients had GIH, which was significantly (P < 0.001) more than the prevalence of GIH in patients without GIC (3.4%). The highest to lowest GIH rates are listed in the following order: Stomach cancer (15.7%), liver cancer (13.0%), small bowel cancer (12.7%), esophageal cancer (9.1%), colorectal cancer (9.1%), pancreatic cancer (7.2%), bile duct cancer (6.0%), and gallbladder cancer (5.1%). Within gastric cancer, the GIH rate ranged from 14.8% in cardia cancer to 25.5% in fundus cancer. Within small bowel cancers, duodenal cancers had a higher GIH rate (15.6%) than jejunal (11.1%) and ileal cancers (5.7%). Within esophageal cancers, lower third cancers had higher GIH (10.7%) than the middle third (8.0%) or upper third cancers (6.2%). When studying the predictors of GIH in GIC, socioeconomic factors such as minority race and less favorable insurances (Medicaid and self-pay) were associated with significantly higher GIH on multivariate analysis (P < 0.01). Chemotherapy and immunotherapy were also identified to have a lower risk for GIH [odds ratios (OR) = 0.74 (0.72-0.77), P < 0.001]. Out of 30507 GIC inpatients who also had GIH, 16267 (53.3%) underwent an endoscopic procedure, i.e., upper endoscopy or colonoscopy. Inpatient mortality was significantly lower in patients who underwent endoscopy compared to no endoscopy [5.5% vs 14.9%, OR = 0.42 (0.38-0.46), P < 0.001].CONCLUSIONThe prevalence of GIH in patients with GIC varies significantly based on the tumor’s anatomical location. Endoscopy, which appears to be associated with a substantial reduction in inpatient mortality, should be offered to GIC patients with GIH. Nevertheless, the decision on intervention in the GIC population should be tailored to individual patient's goals of care, the benefit on overall care, and long-term survival.

Colorectal cancer in the Linxian China Nutrition Intervention Trial: Risk factors and intervention results.

BackgroundColorectal cancer (CRC) is among the most common cancers in economically developed countries and developing world. While dietary factors are associated with risk of CRC in the West and urban China, little is known about risk or protective factors in rural China.MethodsThe Linxian General Population Nutrition Intervention Trial (NIT) cohort was established over 30 years ago to test whether daily multivitamin/mineral supplements could reduce the incidence and mortality of esophageal/gastric cardia cancer. The cohort included a total of 29,553 healthy participants 40–69 years old who were randomly assigned to supplements or placebos via a 24 fractional factorial study design. We examined risk factors for the development of CRC as well as the effects of four different nutritional factors (Factor A: retinol, zinc; B: riboflavin, niacin; C: ascorbic acid, molybdenum; D: selenium, alpha-tocopherol, beta-carotene,) on CRC incidence following 5.25 years of supplementation in this randomized, placebo-controlled intervention trial.ResultsCRC risk increased with age and height as well as piped water usage, family history of CRC, and consumption of foods cooked in oil, eggs, and fresh fruits. No effect on CRC was seen for any of these four intervention factors tested in both genders, but CRC was reduced 37% in females who received Factor D (selenium/alpha-tocopherol/beta-carotene) (RR = 0.63, 95% CI = 0.43–0.92, P = 0.016) compared to females who did not receive Factor D.ConclusionsIn this undernourished rural Chinese population, CRC risk factors in this Chinese cohort showed both similarities and differences compared to Western and urban Asian Chinese populations. Intervention results suggested a potential benefit for women supplemented with selenium/alpha-tocopherol/beta-carotene.