Diagnosis Of Gastric Adenocarcinoma Research Articles

Clinical presentation and delay to diagnosis and treatment in Mexican patients with gastric cancer.

291 Background: Gastric cancer is the fifth leading cause of cancer-related deaths in Mexico. Diagnosis is often made at advanced stages, resulting in a poor prognosis. The delay from the onset of the first symptom to diagnosis and treatment could influence the poor prognosis of gastric cancer patients (pts) in our country. In Mexico, information on this topic is limited. We aim to investigate the time delay between the onset of symptoms, histological diagnosis, and initiation of oncological treatment in pts with gastric adenocarcinoma. Methods: We conducted a retrospective review of the clinical records at our institution of all pts with confirmed histological diagnosis of gastric adenocarcinoma (GC) treated between Jan 2005 and Dec 2017. Overall Survival (OS) was estimated using the Kaplan-Meier method. Groups were compared using Log-Rank test. Results: We included 270 pts with confirmed histopathological diagnosis of GC, 53.3% (n=144) women, median age 58 years (IQR 25-75); 44% (n=121) reported family history of cancer, 39.6% (n=107) smoking, H. pylori infection was documented in 22% (n=61). Symptoms before diagnosis were present in 98.5% (n=266) of pts, most common were: weight loss 77.4% (n=209), fatigue 51.9% (n=140), early satiety 51.1% (n=138), nausea 48.9% (n=132), vomiting 48.1% (n=130), dysphagia 21.5% (n=58), and gastrointestinal bleeding 37.8% (n=102). The most common method for histological diagnosis was endoscopy with biopsy in 86.7% (n=234). The median time between the onset of symptoms and histopathological diagnosis was 4.21 (IQR 2.25–8.48) months (m), between the onset of symptoms and the initiation of oncological treatment 5.28 (IQR 2.86–9.52) m, and between histopathological diagnosis and oncological treatment 0.60 (IQR 0.13–1.21) m. 72.6% (n=196) of cases were stage IV, 14.1% (n=38) stage III, 8.1% (n=22) stage II, 4.8% (n=13) and stage 0 or I. The median OS for the entire cohort was 7.2 m, 3.7 m for stage IV, 17.3 m for stage III, and 84 m for stage I. Median OS for stage II was not reached, and it was 58% at 5 years. Symptoms associated with worse or better survival are shown in table. Conclusions: Reducing delays in histopathological diagnosis from symptom onset could lead to earlier detection and curative treatments. Identifying alarm signs and appropriate patient navigation would enable earlier diagnosis and early treatment. [Table: see text]

Impact of DNA mismatch repair status on prognosis of patients with locally advanced gastric cancer in a Mexican population.

408 Background: Gastric cancer (GC) is among the five most frequent and mortal cancers in the world. In Mexico, GC is the second cause of death from cancer in men between 30 and 59 years old. The role of deficient DNA mismatch repair (dMMR)/microsatellite instability-high (MSI-H) in locally advanced gastric cancer (LAGC) is still controversial. We aimed to evaluate the overall survival (OS) of patients with LAGC, according to MMR status and treatment. Methods: Retrospective study included patients from the National Cancer Institute of México, with locally advanced gastric adenocarcinoma diagnosis between 2008 and 2017. The Kaplan Meier, Log Rank, and Cox Regression methods were used to analyze the relation between MMR status and overall survival in LAGC. MMR status was assessed using immunohistochemistry. Results: A total of 103 patients with LACG were enrolled for analysis. The prevalence of dMMR in GC was 13.59% (n=14). The median OS was 101.9 months in the dMMR group vs. 86.2 months in the proficient MMR (pMMR) group (HR 0.54, 95% CI 0.19 - 1.52, p=0.23), with a 3-year OS of 71.4% vs 65.1% respectively. Survival was also analyzed according to MMR status and choosing treatment. OS was 106.8 months in the dMMR surgery alone group, 78.4 months in the dMMR group treated with both surgery and chemotherapy, 33.1 months for pMMR group with surgery alone, and 89.2 months in the pMMR group treated with surgery plus chemotherapy (p=0.014). Conclusions: In this analysis, OS tended to improve in dMMR group. pMMR surgery alone patients had a superior OS than other groups, while adding chemotherapy to surgery treatment seems to have a role only in pMMR patients. [Table: see text]

Tick tock on the stomach clock: Factors affecting time to diagnosis of gastric adenocarcinoma at an urban cancer center with a large East Asian patient population.

e18508 Background: Gastric cancer is the fifth most common cancer in the world and disproportionately affects the East Asian population. Various factors contribute to this disparity such as genetics and environmental exposure. Given that language barriers can contribute to reduced quality of healthcare delivery, screening rates, and patient safety, it is important to assess the impact of language on the diagnosis of gastric cancer. Tufts Medical Center’s proximity to Boston’s Chinatown make our patient population unique for analysis of these factors. Here we present a single-institution experience of the factors affecting gastric adenocarcinoma time to diagnosis. Methods: We used ICD-10 codes to retrospectively identify patients at Tufts Medical Center with a diagnosis of gastric cancer between January 2011 and December 2021. We excluded patients that did not have a diagnosis of gastric adenocarcinoma or lacked adequate clinical documentation. We recorded demographic, clinical, and treatment characteristics including race (White, Asian, or other), primary language (English, Asian or other), presenting symptoms, enrollment in hospice, and interpreter status (certified, non-certified, none, or not applicable). Certified interpreters included professional medical services for in-person, video, or phone interpreters. Non-certified interpreters included family members, physicians fluent in the language, or others. We assessed the impact of these on the time between initial presentation to the healthcare system and eventual diagnosis of gastric cancer. Results: 80 patients were included in the analysis. Mean days to diagnosis by race were as follows: White (40), Asian (43), other (25), p = 0.20. Mean days to diagnosis based on language were as follows: English (40), Asian (43), other (6), p = 0.07. Mean days to diagnosis based on interpreter status were as follows: certified (19), non-certified (13), none (73), NA (40) (p = 0.05). When pairwise comparison was done, there was no difference between certified and non-certified interpreter (p = 0.40). There was no difference between certified interpreter and no interpreter (p = 0.06). There was a statistically significant difference between non-certified interpreter and no interpreter (p = 0.04). Presenting symptoms and eventual enrollment in hospice did not significantly impact time to diagnosis. Conclusions: We saw a shorter time from initial presentation to diagnosis of gastric adenocarcinoma in non-English speaking patients who used an interpreter at the initial visit compared to those who did not. One should always consider interpreter availability as an important part of reducing health disparities.

Dissecting the genetic heterogeneity of gastric cancer.

Gastric cancer (GC) is clinically heterogenous according to location (cardia/non-cardia) and histopathology (diffuse/intestinal). We aimed to characterize the genetic risk architecture of GC according to its subtypes. Another aim was to examine whether cardia GC and oesophageal adenocarcinoma (OAC) and its precursor lesion Barrett's oesophagus (BO), which are all located at the gastro-oesophageal junction (GOJ), share polygenic risk architecture. We did a meta-analysis of ten European genome-wide association studies (GWAS) of GC and its subtypes. All patients had a histopathologically confirmed diagnosis of gastric adenocarcinoma. For the identification of risk genes among GWAS loci we did a transcriptome-wide association study (TWAS) and expression quantitative trait locus (eQTL) study from gastric corpus and antrum mucosa. To test whether cardia GC and OAC/BO share genetic aetiology we also used a European GWAS sample with OAC/BO. Our GWAS consisting of 5816 patients and 10,999 controls highlights the genetic heterogeneity of GC according to its subtypes. We newly identified two and replicated five GC risk loci, all of them with subtype-specific association. The gastric transcriptome data consisting of 361 corpus and 342 antrum mucosa samples revealed that an upregulated expression of MUC1, ANKRD50, PTGER4, and PSCA are plausible GC-pathomechanisms at four GWAS loci. At another risk locus, we found that the blood-group 0 exerts protective effects for non-cardia and diffuse GC, while blood-group A increases risk for both GC subtypes. Furthermore, our GWAS on cardia GC and OAC/BO (10,279 patients, 16,527 controls) showed that both cancer entities share genetic aetiology at the polygenic level and identified two new risk loci on the single-marker level. Our findings show that the pathophysiology of GC is genetically heterogenous according to location and histopathology. Moreover, our findings point to common molecular mechanisms underlying cardia GC and OAC/BO. German Research Foundation (DFG).

A low cumulative perioperative prognostic nutritional index predicts poor long-term outcomes in patients with gastric cancer: A single-center retrospective study in Japan.

Perioperative surgical stress and systemic inflammation resulting from complex interactions between cancer and the host play an important role in cancer progression. This retrospective study compared the prognostic impact of various perioperative cumulative inflammation- and nutrition-based markers in patients with gastric cancer (GC). This study included 301 patients with a histopathological diagnosis of gastric adenocarcinoma who underwent curative surgery. Perioperative cumulative markers were calculated using the newly developed trapezoidal area method. The cumulative prognostic nutritional index (cum-PNI) had the highest area under the receiver operating characteristic (ROC) curve for predicting the overall survival (OS) as well as the relapse-free survival (RFS). The cum-PNI was significantly correlated with tumor-related factors, including tumor size, depth of invasion, lymph node metastasis, lymphatic involvement, vascular involvement, and TNM stage classification. The cum-PNI was also significantly correlated with surgical factors, including surgical approach, gastrectomy, lymphadenectomy, intraoperative blood loss, and postoperative complications. Furthermore, the OS and RFS were poorer in patients with a low cum-PNI (< 236.3) than in those with a high cum-PNI (> 236.3). A multivariate analysis indicated that a low cum-PNI was an independent prognostic indicator in patients with GC. The cum-PNI might be useful for predicting the prognosis and guiding the perioperative management of patients with GC.

Data-independent acquisition mass spectrometry identification of extracellular vesicle biomarkers for gastric adenocarcinoma.

Early diagnosis of gastric adenocarcinoma (GAC) can effectively prevent the progression of the disease and significantly improve patient survival. Currently, protein markers in clinical practice barely meet patient needs; it is therefore imperative to develop new diagnostic biomarkers with high sensitivity and specificity. In this study, we extracted extracellular vesicles (EV) from the sera of 33 patients with GAC and 19 healthy controls, then applied data-independent acquisition (DIA) mass spectrometry to measure protein expression profiles. Differential protein expression analysis identified 23 proteins showing expression patterns across different cancer stages, from which 15 proteins were selected as candidate biomarkers for GAC diagnosis. From this subset of 15 proteins, up to 6 proteins were iteratively selected as features and logistic regression was used to distinguish patients from healthy controls. Furthermore, serum-derived EV from a new cohort of 12 patients with gastric cancer and 18 healthy controls were quantified using the same method. A classification panel consisting of GSN, HP, ORM1, PIGR, and TFRC showed the best performance, with a sensitivity and negative predictive value (NPV) of 0.83 and 0.82. The area under curve (AUC) of the receiver operating characteristic (ROC) is 0.80. Finally, to facilitate the diagnosis of advanced stage GAC, we identified a 3-protein panel consisting of LYZ, SAA1, and F12 that showed reasonably good performance with an AUC of 0.83 in the validation dataset. In conclusion, we identified new protein biomarker panels from serum EVs for early diagnosis of gastric cancer that worth further validation.

Early-Onset Gastric Cancer from a Geographic Area of High Gastric Cancer Incidence in North-East India: a Retrospective Study.

We aim to report about the clinico-pathological characteristics of early-age gastric cancer in North-East India. It is a retrospective and observational study conducted in a tertiary care cancer centre in North-East India. We reviewed physical case records and the hospital electronic medical record system. The study population included all patients of age 40years or less, with a confirmed diagnosis of gastric adenocarcinoma, who received treatment in the institute. The duration of the study was from 2016 to 2020. Data was collected using a pre-designed proforma, and the results were presented as percentages, ratios, median values and range. A total of 79 patients with early-age gastric cancer were found during the study period. There was female preponderance (45:34). Out of the total, 43% presented in stage IV. Most of them had good performance status (87.3% had ECOG 0-2), and none of them had documented co-morbid illness. Poorly differentiated adenocarcinoma and signet ring cell carcinoma were seen in 36.7% and 25.3% patients, respectively. Only 25 patients (31.6%) underwent definitive surgery, and they had a high nodal burden with a median metastatic lymph nodal ratio of 0.35 (range 0 to 0.91). Out of them, 40% developed systemic recurrence within a short span of time (median time to recurrence being 9.5months). Peritoneal recurrence was the most common site of failure (80%). Early-age gastric cancer has been associated with aggressive pathological features and poor clinical outcomes in North-East India.

Gastric Cancer: Emerging Trends in Prevention, Diagnosis, and Treatment.

Gastric adenocarcinoma (GC) is the fourth leading cause of global cancer mortality, and the leading infection-associated cancer. Helicobacter pylori is the dominant risk factor for GC and classified as an IARC class I carcinogen. Surveillance of gastric premalignant conditions is now indicated in high-risk patients. Upper endoscopy is the gold standard for GC diagnosis, and image-enhanced endoscopy increases the detection of gastric premalignant conditions and early gastric cancer (EGC). Clinical staging is crucial for treatment approach, defining early gastric cancer, operable locoregional disease, and advanced GC. Endoscopic submucosal dissection is the treatment of choice for most EGC. Targeted therapies are rapidly evolving, based on biomarkers including MSI/dMMR, HER2, and PD-L1. These advancements in surveillance, diagnostic and therapeutic strategies are expected to improve GC survival rates in the near term.

Aspirin Use and Gastric Adenocarcinoma—Reply

We appreciate Lai and colleagues’ interest in our study in which we reported associations between aspirin use and gastric adenocarcinoma in two large prospective cohort studies of U.S. men and women (1). Lai and colleagues calculated that comparing aspirin users with nonusers, the absolute rate difference was 2/100,000 person-years with a number-needed-to-treat (NNT) of 50,000 in women. Perhaps a more clinically interpretable metric of absolute risk would be based on persons at risk rather than person-years using an estimate calculated according to the mean follow-up time (30.6 years) of cohort participants. We would then estimate the risk of gastric cancer was 0.0018 [125 cases/(2,097,414 person-years/30.6 years)] among nonregular aspirin users, and 0.0012 [51 cases/(1,258,158 person-years/30.6 years)] among regular users. This translates to an NNT of 1,714, suggesting one case of gastric cancer could potentially be prevented by treating 1,714 women with aspirin regularly. Nonetheless, we concur that public health recommendations should weigh potential complications associated with aspirin use such as upper gastrointestinal bleeding against the absolute benefits.In the case that exposure status is determined after the start of follow-up of a cohort, immortal time bias can be introduced if the person-time in the interval between the start of follow-up and when exposure data are collected is misattributed or ignored completely (2). In our study, person-time was accrued only from the return of a baseline questionnaire when the participants were first queried about aspirin use, to the date of gastric adenocarcinoma diagnosis, death, or the end of follow-up, whichever came first. We then updated aspirin use with each biennial questionnaire cycle as a time-varying variable. Thus, our results were not influenced by immortal time bias.Aspirin has been found to inhibit the growth of Helicobacter pylori (H. pylori) in a dose–response manner and enhance its susceptibility to antimicrobial agents (3). Consistently, we observed that aspirin use was associated with a lower risk of H. pylori infection among women. However, the hypothesis of inhibitory effects of aspirin on H. pylori and gastric cancer is speculative, and more evidence is needed to understand potential mechanisms. In addition, aspirin and salicylic acid, its primary bioactive metabolite, can influence other bacteria through both antimicrobial and regulatory effects, and manipulation of microbiota has been proposed as a mechanism for aspirin chemoprevention (4).A.T. Chan reports personal fees from Bayer Pharma AG and Boehringer Ingelheim, grants and personal fees from Pfizer Inc., and grants from Zoe, Ltd. outside the submitted work. No disclosures were reported by the other author.See the original Letter to the Editor, p. 553

Validity of Check Point Inhibitor (PD-1 and PD-L1) in Diagnosis of Gastric Adenocarcinoma Using Modified Tissue Elisa

Background: Checkpoint inhibitors (PD-1, PD-L1) are revolutionizing the oncology disease management process. Despite the fact that gastric cancer is a common malignancy with a poor prognosis, relatively little attention has been drawn and attracted to the treatment and diagnosis of this disease by using checkpoint inhibitor. James P. Allison and Tasuku Honjo were awarded the the Nobel Prize in Physiology and Medicine for their developments in fundamental science enabling checkpoint inhibitor therapies. Checkpoint inhibitor overexpression has been related to gastric cancer progression and clues for developing therapeutic goals as well as may provide diagnostic markers for gastric cancer. Aims: The aims of this study are firstly to detection of Checkpoint Inhibitors (PD-1, PD-L1) as novel diagnostics and prognostics markers first time in the world. Secondly, to investigate the validity of using (a modified tissue ELISA method) as a rapid, sensitive, low cost and specific diagnostic method in patients with gastric cancer. Patients and methods: Thirty gastric cancer patients were among patients who attending the Histopathology section -GIT hospital and Histopathology department- Teaching laboratories/ medical city teaching complex Baghdad / Ministry of Health, during the period from August 2020 to April 2021. Another 30 patients diagnosed with benign tumor, In addition, 30 apparently healthy people were chosen as a healthy control group. For these three groups, PD-1, PD-L1, using tissue ELISA technique was carried out. Results: The current study showed that the mean values of PD-1 in tissues of gastric cancer patients (133.413±53.126) was significantly higher (P=0.0001) in it in comparison to both benign tumor group (29.905±12.634) and control healthy group (21.775±12.489); for PD-L1 that the mean values of PD-L1 in tissues of gastric cancer patients (151.175±47.641) was significantly higher (P=0.0001) in it in comparison to both benign tumor group (72.565±9.945) and control healthy group (82.102±12.642); using receiver operating characteristic curve (ROC) area, which showed that area under the curve for PD-1 was (1.000) (p value 0.0001), while area under the curve for PDL-1 was (0.913) (p value 0.0001) and The cut off value for PD-1 associated with highest sensitivity and specificity (100%) was 40.2 ng/ml. The cut off value for PDL-1 associated with sensitivity (80%) and specificity (80%) was 51.6ng/ml. Conclusions: The present study showed that Checkpoint inhibitors (PD-1, PD-L1) values were significantly higher in patients affect with malignant gastric adenocarcinoma which may check a possible role of this marker in the progressing of the disease, furthermore the maximum sensitivity obtained from Checkpoint inhibitors (PD-1, PD-L1) was by using a cut off values equal to (40.2 ng/ml; 51.6 ng/ml) respectively. Therefore, Checkpoint inhibitors (PD-1, PD-L1) may be promising diagnostic tools especially at early stages and among patients at in promotion risk. Keywords: Checkpoint inhibitors (PD-1, PD-L1), gastric cancer.

Combined analysis of preoperative and postoperative lymphocyte-C-reactive protein ratio precisely predicts outcomes of patients with gastric cancer

BackgroundThe systemic inflammatory response resulting from the complex interactions between cancer and the host plays an important role in cancer development. Recently, the lymphocyte-C-reactive protein ratio (LCR), which is a hematological and biochemical marker that reflects the systemic inflammatory response and nutritional status, has been reported to be associated with poor survival. Similar results were observed in patients with certain cancer types. However, these studies focused on the preoperative LCR, and thus far, no studies have reported the relationship between postoperative LCR and prognosis in patients with gastric cancer (GC).MethodsThis study enrolled 455 patients with a histopathological diagnosis of gastric adenocarcinoma who underwent curative surgery at our institution between 2005 and 2018. The relationship between both the preoperative and postoperative LCR and the prognosis of patients with GC was retrospectively investigated.ResultsPreoperative LCR showed significant correlations with tumor-related factors, such as tumor size, depth of invasion, and lymph node metastasis. By contrast, no correlation was observed between postoperative LCR and tumor-related factors. The 5 year survival rate was significantly worse in patients with low preoperative LCR than in those with high preoperative LCR (65.4% vs. 83.9%, p < 0.0001). Similarly, the 5 year survival rate was also significantly worse in patients with low postoperative LCR than in those with high postoperative LCR (67.0% vs. 84.1%, p < 0.0001). Furthermore, combination analysis of the pre- and postoperative LCR revealed that the prognosis of patients with both low pre- and postoperative LCR was worse in patients with GC (5 year survival rate was 52.0%). A multivariate analysis indicated that a low pre- and postoperative LCR and age and lymph node metastasis were independent prognostic indicators.ConclusionsThe combination of preoperative and postoperative LCR appears to be useful in predicting the prognosis of patients with GC.

Diagnosis of gastric adenocarcinoma by a subcutaneous metastasis

Diagnosis of gastric adenocarcinoma by a subcutaneous metastasis

Gastric adenocarcinoma presenting as bloody ascites

A 71-year-old male presented to hospital with 3 months of increasing abdominal distention and pain. CT showed large volume ascites and gastric wall thickening in the antrum. He had no history of significant alcohol use or other risk factors for cirrhosis. He underwent paracentesis, and 3 litres of homogenously bloody ascites fluid was removed. Ascites cytology showed discohesive malignant cells. Upper endoscopy showed a 10 cm circumferential gastric mass. Biopsies revealed a diagnosis of gastric adenocarcinoma. The presence of homogenously bloody ascites can be a startling finding to healthcare providers. The differential diagnosis for bloody ascites includes hepatocellular carcinoma or other malignancy, hemorrhagic pancreatitis, perforated ulcers/varices, blunt trauma, and iatrogenic (suggested by recent paracentesis, transjuglar intrahepatic portosystemic shunt, or other procedure). The presence of bloody ascites in an otherwise relatively asymptomatic individual should prompt a search for malignancy. This case highlights a rare presentation of gastric adenocarcinoma as bloody ascites.

Prognostic implications of tumor-infiltrating lymphocytes in association with programmed cell death ligand 1 expression in remnant gastric cancer.

Remnant gastric cancer (RGC) is usually associated with a worse prognosis. As they are less common and very heterogeneous tumors, new prognostic and reliable determinants are required to predict patients' clinical course for RGC. This study aimed to investigate the tumor-infiltrating lymphocytes (TILs) and programmed cell death ligand 1 (PD-L1) status as prognostic biomarkers in a cohort of patients with RGC to develop an immune-related score. Patients with gastric cancer (GC) who underwent curative intent gastrectomy were retrospectively investigated. RGC resections with histological diagnosis of gastric adenocarcinoma were enrolled in the study. The risk score based on immune parameters was developed using binary logistic regression analysis. RGCs were divided into high-risk (HR), intermediate-risk (IR), and low-risk (LR) groups based on their immune score. The markers (CD3+, CD4+/CD8+ T cells and PD-L1) were selected for their potential prognostic, therapeutic value, and evaluated by immunohistochemistry (IHC). A total of 42 patients with RGC were enrolled in the study. The score based on immune parameters exhibited an accuracy of 79% [the area under the receiver operating characteristic curve (AUC)=0.79, 95% confidence interval (95% CI), 0.63-0.94, P=0.002], and the population was divided into 3 prognostic groups: 10 (23.8%) patients were classified as LR, 15 (35.7%) as IR, and 17 (40.5%) as HR groups. There were no differences in clinicopathological and surgical characteristics between the three groups. In survival analysis, HR and IR groups had worse disease-free survival and overall survival rates compared to the LR group. In the multivariate analysis, lymph node metastasis and the immune score risk groups were independent factors related to worse survival. A scoring system with immune-related markers was able to distinguish prognostic groups of RGC associated with survival. Accordingly, tumor-infiltrating immune lymphocytes and PD-L1 status may serve as a potential prognostic biomarker for patients with RGC.

P-OGC55 Current treatment modalities and median survival for patients with gastric and oesophagogastric cancers with isolated peritoneal metastasis

Abstract Background Gastric cancer with peritoneal metastases carries a median survival of only 3-7 months without treatment. Meanwhile, cancers arising from the oesophago-gastric junction (OGJ) are rapidly increasing in incidence in the Western population and are also commonly associated with peritoneal metastases. In order to measure the efficacy of emerging modes of treatment for peritoneal disease, it is essential to describe the treatments patients currently receive and the impact of these on survival – data for which is poorly described in the literature and lacking in the UK setting. Methods This was a single hospital-based retrospective cohort study covering the period from March 2012 to January 2020 at a tertiary referral centre. 50 patients were identified from multidisciplinary team (MDT) meeting records receiving a diagnosis of gastric adenocarcinoma with isolated peritoneal disease. 31 patients were identified receiving a diagnosis of true (Siewert II or III) junctional adenocarcinoma with isolated peritoneal disease. We calculated median survival time for all patients and also by treatment modality. Results Mean age of patients with gastric adenocarcinoma and isolated peritoneal disease was 71 years (range 44-90). Overall median survival was 6.6 months (IQR 2.4-19.3). Median survival was 11.2 months (IQR 3.7-21.5) for patients receiving systemic chemotherapy (n = 26) and 2.4 months (IQR 1.2-5.1) for patients receiving best supportive care alone (n = 15). Mean age of patients with junctional adenocarcinomas and isolated peritoneal disease was 70 years (range 37-89). Overall median survival was 7 months (IQR 3-19). Median survival was 10.5 months (IQR 6.5-20.5) for patients receiving systemic chemotherapy (n = 20) and 3.5 months (IQR 2-6) for patients receiving best supportive care alone (n = 6). Conclusions Our results demonstrate the poor prognosis of both gastric and oesophagogastric cancer patients with isolated peritoneal disease. Prognosis figures are comparable between the two cancer types. Findings are in line with previous studies performed outside the UK which have shown that available treatments extend survival by no more than 3-9 months, highlighting the desperate need for new treatment modalities.

Performance of quantitative CT texture analysis in differentiation of gastric tumors.

To examine the computed tomography (CT) images of patients with a diagnosis of gastric tumor by texture analysis and to investigate its place in differential diagnosis. Contrast enhanced venous phase CT images of 163 patients with pathological diagnosis of gastric adenocarcinoma (n = 125), gastric lymphoma (n = 12) and gastrointestinal stromal tumors (n = 26) were retrospectively analyzed. Pixel size adjustment, gray-level discretization and gray-level normalization procedures were applied as pre-processing steps. Region of interest (ROI) was determined from the axial slice that represented the largest lesion area and a total of 40 texture features were calculated for each patient. Texture features were compared between the tumor subtypes and between adenocarcinoma grades. Statistically significant texture features were combined into a single parameter by logistic regression analysis. The sensitivity and specificity of these features and the combined parameter were measured to differentiate tumor subtypes by receiver-operating characteristic curve (ROC) analysis. Classifications between adenocarcinoma versus lymphoma, adenocarcinoma vs. gastrointestinal stromal tumor (GIST) and well-differentiated adenocarcinoma versus poorly differentiated adenocarcinoma using texture features yielded successful results with high sensitivity (98, 91, 96%, respectively) and specificity (75, 77, 80%, respectively). CT texture analysis is a non-invasive promising method for classifying gastric tumors and predicting gastric adenocarcinoma differentiation.

Clinicopathological features of gastric adenocarcinoma with enteroblastic differentiation: a report of twelve cases

Objective: To investigate the clinicopathological features, immunophenotype, diagnosis and differential diagnosis of gastric adenocarcinoma with enteroblastic differentiation (GAED). Methods: Twelve cases of GAED diagnosed in Fujian Provincial Hospital from August 2019 to August 2020 were collected. HE staining, immunohistochemistry and HER2 gene amplification were evaluated. In addition, 343 cases of gastric adenocarcinoma diagnosed in the same period were used as the control group to compare the clinicopathological differences between them. Results: The 12 cases of GAED included 10 males and 2 females, aged 59-75 years (median 66.5 years). The main clinical manifestations were abdominal pain, melena with hematemesis; nine tumors were ulcerative and three were protuberant. The tumor diameter ranged from 1.5 to 9.5 cm (median 6.0 cm). Histologically, the tumor cells were arranged in tubular, papillary, cribriform, or adenoid structures. The cells were cuboidal to columnar, with relatively distinct cell boundaries and abundant clear or slightly eosinophilic cytoplasm. Immunohistochemically, tumor cells were positive for SALL4 (12/12), glypican-3 (9/12), AFP (5/12), CDX2 (8/12), CD10 (3/12), p53 mutated (10/12), HER2 (2/12, 3+), and both cases showed HER2 gene amplification by fluorescence in situ hybridization. Compared with common gastric adenocarcinoma, GAED showed higher rate of vascular invasion and tumor progression (P<0.05), but there were no significant differences in age, sex, degree of differentiation, nerve invasion, lymph node metastasis, pT stage, pN stage and pM stage (P>0.05). Conclusions: GAED is a rare type of gastric adenocarcinoma. Pathologically, GAED has both embryonal and intestinal phenotypes. In terms of biological behavior, it is more invasive. GAED needs to be distinguished from common gastric adenocarcinoma in clinical diagnosis.

Does the Albumin to Globulin Ratio Predict Short-term Complications in Gastric Cancer Patients?

Objective: Gastric cancer (GC) is a cancer with poor prognosis despite advances in diagnosis and treatment methods, and postoperative morbidity and mortality rates are high. The aim of this study was to evaluate the predictive and early prognostic effect of the pre-treatment albumin to globulin ratio (AGR) in patients with gastric adenocarcinoma (GAC).&#x0D; &#x0D; Methods: The study included male and female patients who were operated on with the diagnosis of GAC in our general surgery clinic between January 2016 and November 2020. The demographic and postoperative histopathological findings, postoperative complications, and in-hospital mortality findings of the patients were evaluated retrospectively from the hospital data.&#x0D; &#x0D; Results: Evaluation was made of a total of 70 patients operated on with the diagnosis of GAC. In the ROC curve analysis applied to the AGR ratio, the optimum cut-off value was 1.54. A statistically significant difference was found between the high (≥1.54) and low ( 65 years, high American Society of Anesthesiologist (ASA) score, and low AGR (p = 0.035, p

Improved prognosis in gastric adenocarcinoma among metformin users in a population-based study.

Metformin may improve the prognosis in gastric adenocarcinoma, but the existing literature is limited and contradictory. This was a Swedish population-based cohort study of diabetes patients who were diagnosed with gastric adenocarcinoma in 2005-2018 and followed up until December 2019. The data were retrieved from four national health data registries: Prescribed Drug Registry, Cancer Registry, Patient Registry and Cause of Death Registry. Associations between metformin use before the gastric adenocarcinoma diagnosis and the risk of disease-specific and all-cause mortality were assessed using multivariable Cox proportional hazard regression. The hazard ratios (HRs) and 95% confidence intervals (CIs) were adjusted for sex, age, calendar year, comorbidity, use of non-steroidal anti-inflammatory drugs or aspirin, and use of statins. Compared with non-users, metformin users had a decreased risk of disease-specific mortality (HR 0.79, 95% CI 0.67-0.93) and all-cause mortality (HR 0.78, 95% CI 0.68-0.90). The associations were seemingly stronger among patients of female sex (HR 0.66, 95% CI 0.49-0.89), patients with tumour stage III or IV (HR 0.71, 95% CI 0.58-0.88), and those with the least comorbidity (HR 0.71, 95% CI 0.57-0.89). Metformin use may improve survival in gastric adenocarcinoma among diabetes patients.

10-years follow-up of patients with stomach cancer - diagnostic defects &amp; dyspepsia as the earliest “alarm symptom”; results of the ”RADIUS” program (“early diagnosis of stomach cancer in dyspepsia”)

In 2019, a retrospective analysis of medical records for 10 previous years (2019-2009) was conducted for 426 patients with confirmed malignant neoplasm (MN) of the stomach registered in 125 outpatient and polyclinic medical and preventive treatment facilities in 12 cities of the Russian Federation. The average age of patients at the time of diagnosis was 61.9 years, the life expectancy after diagnosis being 2.2 years. In 67.4% of patients the diagnosis was made at stages III and IV of the disease. All patients had a history of any upper digestive tract pathology. The record of H. pylori c examination was detected in 16.9% of patients, all of them with positive results. In 64,3% of esophagogastroduodenoscopy (EGDS) protocols there were visible changes in the gastric mucosa. Dynamic EGDS control was performed irregularly. During the whole period of observation, an average of 2.5 biopsies per patient were taken during EGDS. In the clinical diagnosis of “chronic gastritis” morphological examination was performed in 70.0% of patients. Classical “warning signs” were registered on the average 2.4 years before the diagnosis of gastric cancer. Dyspepsia syndrome was registered 4.6 years before cancer verification. The correlation between dyspepsia and the timing of cancer diagnosis was confirmed. Thus, the dyspepsia syndrome can be categorized as “early warning signs”. For the diagnosis of gastric adenocarcinoma, 3D correlation analysis showed a correlation between the number of biopsy samples taken, the number of “warning signs” and the number of years lived after the diagnosis of malignant neoplasms.