Diagnosis Of Gastrointestinal Cancer Research Articles

Risk of cancer in patients with constipation.

Background: It remains unclear whether constipation is associated with cancer. We evaluated the risk of malignancies in patients with constipation requiring hospitalization.Methods: Using Danish medical registries, we calculated cumulative incidences and standardized incidence ratios (SIRs) for cancer. SIRs were computed as the observed number of gastrointestinal (GI) cancers and selected non-GI cancers in patients with constipation compared with the expected number based on national incidence rates by sex, age, and calendar year (1978–2013).Results: We identified 1,75,901 patients with constipation (59% females, median age 54 years). The cumulative incidences of GI cancers and non-GI cancers after 15 years of follow-up were 2.5% and 2.6%, respectively. During the first year of follow-up, the SIR for any GI cancer was 5.0 (95% confidence interval (CI): 4.8–5.3), driven by colon and pancreas cancers and higher for younger age groups. Beyond 1 year of follow-up, the risk declined to near unity for colorectal cancer. The risk of other GI cancers (including cancers of the esophagus, stomach, small intestine, liver, and pancreas) remained moderately increased (overall SIR =1.3, 95% CI: 1.2–1.4). Except for ovarian cancer (SIR =7.3, 95% CI: 6.3–8.4), the risk of non-GI cancers was only slightly increased during the first year of follow-up and declined to unity thereafter.Conclusions: Patients with constipation had increased short-term risk of a diagnosis of GI cancer. Beyond 1 year of follow-up, a moderately elevated risk persisted only for GI cancers other than colorectal cancer. The risk of non-GI cancers was elevated only during the first year of follow-up, particularly for ovarian cancer.

Utility of a standardized training program for endoscopic diagnosis of early gastrointestinal neoplasia.

Background and study aims Image enhanced endoscopy (IEE) allows endoscopists to improve recognition and characterization of gastrointestinal neoplasia. The Asian Novel Bio-Imaging and Intervention Group (ANBIG) conducted a standardized training program in endoscopic diagnosis and treatment of early gastrointestinal cancers in Asia. We embarked on a study to investigate the effect of this module on endoscopic diagnosis of early gastrointestinal neoplasia. Methods This prospectively collected database was from workshops conducted on training for endoscopic diagnosis of early gastrointestinal neoplasia. All workshops were conducted in a standardized format, which included a pretest, a learning phase consisting of didactic lectures, case discussion, and live demonstration followed by a post-test to assess knowledge gained. The pretest and post-training tests were standardized questions addressing four domains, including basic knowledge of imaging and diagnosis of esophageal, gastric, and colonic neoplasia. Results From November 2013 to November 2016, 41 ANBIG workshops were conducted in 13 countries. A total of 1863 delegates and 40 faculty participated in these workshops. Of the delegates, 627 completed both tests. There was a significant improvement after training in all domains of the tests. There was a trend in general lack of knowledge across all domains for delegates from “low” healthcare cost countries before training. All delegates demonstrated significant improvement in knowledge of all domains after the workshop irrespective of whether they were from “high” or “low” healthcare cost per capita countries. Conclusion A standardized teaching program on IEE improved the diagnostic ability and quality of endoscopists in recognizing early gastrointestinal neoplasia in Asia.

Laparoscopic fluorescence image-guided photothermal therapy enhances cancer diagnosis and treatment.

Endoscopy is the gold standard investigation in the diagnosis of gastrointestinal cancers and the management of early and pre-malignant lesions either by resection or ablation. Recently gold nanoparticles have shown promise in cancer diagnosis and therapeutics (theranostics). The combination of multifunctional gold nanoparticles with near infrared fluorescence endoscopy for accurate mapping of early or pre-malignant lesions can potentially enhance diagnostic efficiency while precisely directing endoscopic near infrared photothermal therapy for established cancers. The integration of endoscopy with near infrared fluorescence imaging and photothermal therapy was aided by the accumulation of our multifunctionalized PEG-GNR-Cy5.5-anti-EGFR-antibody gold nanorods within gastrointestinal tumor xenografts in BALB/c mice. Control mice (with tumors) received either gold nanorods or photothermal therapy, while study mice received both treatment modalities. Local (tumor-centric) and systemic effects were examined for 30 days. Clear endoscopic near infrared fluorescence signals were observed emanating specifically from tumor sites and these corresponded precisely to the tumor margins. Endoscopic fluorescence-guided near infrared photothermal therapy successfully induced tumor ablations in all 20 mice studied, with complete histological clearance and minimal collateral damage. Multi-source analysis from histology, electron microscopy, mass spectrometry, blood, clinical evaluation, psychosocial and weight monitoring demonstrated the inherent safety of this technology. The combination of this innovative nanotechnology with gold standard clinical practice will be of value in enhancing the early optical detection of gastrointestinal cancers and a useful adjunct for its therapy.

Diagnostic and Prognostic Performance of Serum Vascular Endothelial Growth Factor, Vascular Endothelial Growth Factor Receptor 2, and Osteopontin for Gastrointestinal Cancers.

Biomarkers for early diagnosis and follow-up of cancers are still underutilized in clinical management. Thus, seeking new biomarkers with better sensitivity and specificity is still a challenge. VEGF, VEGFR2, and OPN are newly emerging biomarkers with clinical potential. ELISA was used to analyze serum VEGF, VEGFR2, and OPN from 75 gastrointestinal cancer patients and 75 control subjects. The correlation of pre-operative serum VEGF, VEGFR2, and OPN levels with CEA, Ki-67 as well as clinical features (age, gender, tumor size, TNM stage, tumor stage, lymph node involvement, metastasis, and histological grading) in these patients. The pre-operative and post-operative serum VEGF and VEGFR2 levels and the post-operative OPN level in patients were significantly higher than in controls (p = 0.000, for all mentioned). The post-operative VEGF and OPN levels were significantly higher than that of pre-operative (p = 0.000 and 0.007, respectively). There was no correlation between pre-operative serum VEGF, VEGFR2, and OPN levels and serum CEA concentration. The pre-operative serum VEGF level was significantly correlated with the tumor Ki-67 scores; however, there was no correlation between serum VEGFR2 and OPN and Ki-67 scores. Univariate logistic regression analysis revealed that serum VEGF level was significantly higher in patients with advanced TNM (III - IV) stage and with lymph node involvement than in patients with low TNM stage (I - II) and with no lymph node involvement. High OPN level was correlated with metastasis. Multivariate logistic regression analysis results showed that serum VEGF and VEGFR2 were the two most important factors for the diagnosis of gastrointestinal cancers in this study (p = 0.000, for both). Combinatorial analysis of the biomarkers improved the performance of the assays. Serum VEGF and VEGFR2 are potential biomarkers for the diagnosis and prognosis evaluation of gastrointestinal cancers, while serum OPN is a potential biomarker for the prognostication of gastrointestinal cancers.

Pre-Chemotherapy Levels of Hemostatic Biomarkers and Prediction of Prognosis in Newly Diagnosed Metastatic Cancer Patients from the Hypercan Study

IntroductionPatients with cancer commonly present with laboratory evidence of hypercoagulability. The HYPERCAN study (ClinicalTrials.gov, ID# NCT02622815) is an ongoing Italian prospective, multicenter, observational study, evaluating the predictive value of thrombotic markers for early cancer diagnosis in healthy subjects and for cancer prognosis and venous thromboembolism in patients with newly diagnosed cancer disease (Thromb Res, 2016).In this analysis of the HYPERCAN study, in a subcohort of consecutive patients with newly diagnosed metastatic non-small cell lung (NSCL) or gastrointestinal (GI) cancers, we aimed to assess whether the pre-chemotherapy levels of thrombotic biomarkers may be predictive of early disease progression (EDP, i.e. within 6 months) and early deaths (i.e. within 1 year).MethodsThe study cohort included 401 patients [median age: 65 (34-88) years] with metastatic NSCL (n=241) or GI (n=160) cancer. Clinical data were recorded at enrollment and during follow-up visits, disease progression being monitored by imaging. Fibrinogen (Clauss method, IL Werfen, Italy), d-dimer (immuneturbidimetric assay, IL Werfen, Italy), and thrombin generation (TG) potential (CAT assay, Stago, France) were measured in plasma samples collected at patient enrollment, before starting any curative chemotherapy and from a control group of 108 healthy subjects. The study protocol is approved by the local Ethics Committee. Informed written consent is obtained from all study subjects. Data are expressed as median (5th-95th percentile).ResultsSignificantly higher plasma levels of fibrinogen, D-dimer and TG potential were observed in the cohort of cancer patients compared to healthy controls (p<0.01). Among cancer types, fibrinogen levels were significantly greater in NSCL as compared to GI cancer patients [479 (258-934) vs 402 (220-668) mg/dl), p<0.001]. After two year follow up, the cumulative incidence of EDP was 31% (CI 95% 27-36). Of interest, patients with EDP (n=125) vs those without EDP were characterized by significantly (p<0.05) greater pre-chemotherapy levels of leucocytes [9.1 (5.6-21.4) vs 8.4 (4.6-18.2) x109/L], platelets [305 (131-586) vs 283 (148-513) x109/L], fibrinogen [475 (290-913) vs 421 (226-814) mg/dl], and TG endogenous thrombin potential (ETP) [1,919 (1,137-3,086) vs 1,752 (1,264-2,559) nM*min]. In GI cancer, but not in lung cancer patients, multivariate Cox regression analysis according to site of primary tumor identified d-dimer and TG ETP plasma levels, together with GI cancer diagnosis, as independent risk factors for EDP.Concerning mortality, after two year follow-up, the cumulative incidence of overall survival at one year was 63% (CI 95% 58-67), early deaths = 37%. The group of patients who deceased during the first year (n=145) showed significantly (p<0.01) higher leucocyte count [9.7 (5.4-21.6) vs 8 (4.6-16.1) x109/L], plasma fibrinogen [486 (250-846) vs 402 (223-816) mg/dl] and d-dimer [515 (97-3,174) vs 286 (55-1,456) ng/ml] levels. In GI cancer, multivariate Cox regression analysis identified d-dimer and TG ETP plasma levels, leucocytes and platelet counts, and GI cancer diagnosis, as independent risk factors for mortality within 1 year. Differently, none of the hemostatic biomarkers were predictive for mortality in NSCL cancer patients.ConclusionsThe current analysis of prospectively collected data shows the utility of detecting circulating thrombotic biomarkers in specific cancer types. In particular, in GI metastatic cancer, the levels of D-dimer and TG before starting chemotherapy, together with having a GI cancer, could predict EDP (within 6 months) and early deaths (within 12 months). This was not the case for NSCL cancer. Currently, new tests involving other coagulation biomarkers are ongoing and will be evaluated.Project funded by AIRC “5xMILLE” n. 12237 grant from the “Italian Association for Cancer Research (AIRC)”.* On behalf of the HYPERCAN investigators. DisclosuresNo relevant conflicts of interest to declare.

A qualitative study on the attitudes of patients with gastrointestinal cancer toward being informed of the truth.

ObjectiveThe aim of this study is to investigate the attitudes of hospitalized patients with gastrointestinal cancer toward being informed of the truth and to provide references for informing patients of their gastrointestinal cancer diagnosis.MethodsNine patients with gastrointestinal cancer were selected for this study by using a purposive sampling technique from a general surgery ward in a tertiary-level general hospital in Zhejiang Province from June 2016 to October 2016. Semi-structured, in-depth interviews were conducted, and the descriptive phenomenological method (developed by Amedeo Giorgi) was used to analyze the interview data.ResultsFive themes were developed through reading, analysis, reflection, and classification of the data: Theme 1, guessing the diagnosis of gastrointestinal cancer before being informed of the truth; Theme 2, eagerness to know the diagnosis results; Theme 3, expectations related to beginning treatment for cancer; Theme 4, stress and anxiety during treatment; and Theme 5, providing patients with hope and optimism at the early diagnosis stage.ConclusionPatients have a strong desire to survive and can confidently confront their gastrointestinal cancer diagnosis. Medical staff should carefully select the appropriate time to inform patients of their diagnosis by evaluating their attitudes toward being informed, thereby actively meeting patients’ needs for information and treatment.

The Early Diagnosis of Gastrointestinal Cancers: From Canine Sniffing to Volatile Gas Analysis

The Early Diagnosis of Gastrointestinal Cancers: From Canine Sniffing to Volatile Gas Analysis

In vivo photoacoustic/ultrasonic dual-modality endoscopy with a miniaturized full field-of-view catheter.

Endoscopy is an essential clinical tool for the diagnosis of gastrointestinal (GI) tract cancer. A photoacoustic system that elegantly combines optical and ultrasound endoscopy advantages by providing high-sensitivity functional information and large imaging depth is a potentially powerful tool for GI tract imaging. Recently, several photoacoustic endoscopic imaging systems have been proposed and developed. However, the relatively large size and rigid length of the catheter make it difficult to translate them into wide clinical applications; while the existing system of a relatively small catheter, capable of in vivo animal imaging, is unable to acquire full (360°) field-of-view cross-section images. In this study, we developed a photoacoustic/ultrasonic dual-modality endoscopic system and a corresponding miniaturized, encapsulated imaging catheter, which provides a full 360° field-of-view. The diameter of the catheter is 2.5 mm, which is compatible with the 2.8-mm instrumental channel of a conventional clinical optical endoscope. Using this system, we demonstrate in vivo 3-dimensional endoscopic photoacoustic/ultrasonic imaging of the colorectum of a healthy Sprague Dawley rat, by depicting vasculature and morphology of the GI tract. The significantly improved imaging field of view, reduced catheter size, high-quality imaging results suggest that the developed photoacoustic/ultrasonic dual-modality endoscopy has a great potential to be translated into a broad range of clinical applications in gastroenterology.

Epigenomic biomarkers for prognostication and diagnosis of gastrointestinal cancers.

Altered epigenetic regulation is central to many human diseases, including cancer. Over the past two decade, major advances have been made in our understanding of the role of epigenetic alterations in carcinogenesis, particularly for DNA methylation, histone modifications and non-coding RNAs. Aberrant hypermethylation of DNA at CpG islands is a well-established phenomenon that mediates transcriptional silencing of tumor suppressor genes, and it is an early event integral to gastrointestinal cancer development. As such, detection of aberrant DNA methylation is being developed as biomarkers for prognostic and diagnostic purposes in gastrointestinal cancers. Diverse tissue types are suitable for the analyses of methylated DNA, such as tumor tissues, blood, plasma, and stool, and some of these markers are already utilized in the clinical setting. Recent advances in the genome-wide epigenomic approaches are enabling the comprehensive mapping of the cancer methylome, thus providing new avenues for mining novel biomarkers for disease prognosis and diagnosis. Here, we review the current knowledge on DNA methylation biomarkers for the prognostication and non-invasive diagnosis of gastrointestinal cancers and highlight their clinical application.

Lifestyle and outcomes after gastrointestinal cancer: A prospective cohort study (LOGIC).

180 Background: The number of individuals living after a diagnosis of gastrointestinal (GI) cancer is increasing. Emerging data suggest modifiable lifestyle factors impact survival after colorectal cancer (CRC), however very little is known about survivorship in other GI cancers. Given the common thread of multimodality therapy among many GI cancer survivors, there is a paucity of data on sexual function, fertility, anxiety/depression, changes in comorbidities, and quality of life after cancer treatment. Additionally, existing cohort studies of GI survivors are primarily European, and further data are needed from survivor populations in the US . Methods: Patients of the University of California, San Francisco GI Oncology Survivorship Clinic who are designated disease-free are recruited by mail or in clinic. We send secure online questionnaires to participants every six months for five years and annually thereafter. At varying intervals, questionnaires solicit sociodemographics, diet, physical activity, fertility, medical and smoking history, fear of cancer recurrence, sexual health, quality of life, psychological well-being, and sleep quality. Pathoclinical disease characteristics, treatment, and recurrence status are abstracted from the medical record at baseline and updated annually. Results: Between February and August 2017, 111 patients were enrolled; 68% of participants completed ≥1 and 57% completed all baseline questionnaires. Most patients had a history of colon cancer (52%, n = 58) or rectal cancer (31%, n = 34). Other diseases include: anal cancer (12%, n = 13), gastrointestinal stromal tumor (3%, n = 3), and other GI cancers (3%, n = 3). Fifty-eight percent of patients were female, 76% identified as white and median age at diagnosis was 55 (range 20-81). Median time from initial GI cancer diagnosis to study entry was 27 months. Following the initial recruitment wave of established patients, the average rate of enrollment is ~3 patients/week. Conclusions: Results from this ongoing cohort study will improve our understanding of modifiable risk factors for GI cancer recurrence and key survivorship issues related to psychological well-being, sexual function, fertility management, and quality of life.

Reimagining the diagnostic pathway for gastrointestinal cancer.

A crisis is looming for the diagnosis of gastrointestinal cancers, one grounded only partly in the steady increase in their overall incidence. Public demand for diagnostic tests to be undertaken early and at lower levels of risk is reflected in early diagnosis being a widely held policy objective for reasons of both clinical outcome and patient experience. In the UK, urgent referrals for suspected lower gastrointestinal cancer have increased by 78% in the past 6 years, with parallel increases in endoscopy and imaging activity. Such growth in demand is unsustainable with current models of care. If gastrointestinal cancer diagnosis is to be affordable, the roles of professionals and their interactions with each other will need to be reframed while retaining public confidence in the process. In this Perspective, we consider how the relationship between medical specialists and generalists could be redefined to make better use of the skills of each while delivering optimal clinical outcomes and a good patient experience.

Evaluation of New Technologies in Gastrointestinal Endoscopy.

Background:Gastrointestinal (GI) tumors are the most commonly diagnosed cancers worldwide and the second leading cause of cancer-related death. Endoscopy is the gold standard for diagnosis of GI cancers. Early diagnosis of GI tumors by endoscopy at the precancerous or early stage may decrease the prevalence and mortality rate of GI cancers. The preventive role of endoscopic interventions and the limitations of conventional white-light endoscopy have given rise to myriad innovations. Chromoendoscopy with dye injection can be used to detect lesions at an early stage. However, the prolonged procedure duration and steep learning curve are disadvantages of chromoendoscopy. Recent technological advances in imaging enhancement have enabled detection of GI lesions without the need for dye injection, using digital chromoendoscopy systems, of which flexible spectral-imaging color enhancement, narrow-band imaging, and I-Scan are the most frequently used. The combination of endoscopic image magnification and high-definition optical systems using digital endoscopic methods has increased the diagnostic value of endoscopy. The development of confocal laser endomicroscopy has also improved in vivo endoscopic diagnosis. This review focuses on the latest technological innovations in endoscopy.

Macro and micro spectroscopy parameters of cancerous and healthy gastrointestinal tissues

New more sensitive diagnostic modalities, for either analysis of biopsy tissue samples or on site, in vivo microscopy tissue examination, emerge to aid the detection and accurate diagnosis of gastrointestinal cancer. One of the most intensively investigated techniques is the fluorescence spectroscopy approach. We present our investigation of the detailed macro and micro fluorescence characteristics of ex-vivo fresh and fixed tissue samples. The fluorescence spectra of unprocessed cancerous and healthy gastrointestinal (GIT) tissue, obtained with two approaches fluorescence and synchronous fluorescence spectroscopy were compared with microspectroscopy performed with laser scanning confocal fluorescence microscopy (LSCFM) system in Lambda-scan regime over fixed tissue samples. The evaluated optical macro- and micro- spectroscopy characteristics are presented and disscused in order to improve the current understanding of the origin of autofluorescence contrast between healthy and cancerous tissues and its application for improvement of the existing diagnostic modalities.

Utilizing biomarkers in colorectal cancer: an interview with Ajay Goel.

Ajay Goel speaks to Rachel Jenkins, Commissioning Editor. Ajay Goel, PhD, is a Professor and Director, Center for Gastrointestinal Research, and Director, Center for Translational Genomics and Oncology, at the Baylor Scott & White Research Institute, Baylor University Medical Center in Dallas, Texas. Dr Goel has spent more than 20 years researching cancer and has been the lead author or contributor to over 240 scientific articles published in peer-reviewed international journals and several book chapters. He is also a primary inventor on more than 15 international patents aimed at developing various biomarkers for the diagnosis, prognosis and prediction of gastrointestinal cancers. He is currently using advanced genomic and transcriptomic approaches to develop novel DNA- and miRNA-based biomarkers for the early detection of colorectal cancers. In addition, he is researching the prevention of gastrointestinal cancers using integrative and alternative approaches, including botanical products such as curcumin (from turmeric) and boswellia. Dr Goel is a member of the American Association for Cancer Research (AACR) and the American Gastroenterology Association (AGA) and is on the international editorial boards of several journals including Gastroenterology, Clinical Cancer Research, Carcinogenesis, PLoS ONE, Scientific Reports, Epigenomics, Future Medicine, Alternative Therapies in Heath and Medicine and World Journal of Gastroenterology. He is also actively involved in peer-reviewing activities for more than 100 international scientific journals and various grant review panels of various national and international funding organizations. His research has been actively funded by various private and federal organizations, including funding from the National Cancer Institute (NCI) at the NIH, American Cancer Society (ACS) and other state organizations. He has won more than dozen awards and honors, including the Union of European Gastroenterology Federation's Distinguished Researcher Award, multiple Poster of Distinction Awards from the AGA, and Visiting Professorships from various national and international academic institutions and academic bodies. Some of his key research interests include: Understanding the basic genetics and epigenetic basis of gastrointestinal cancers; Use of epigenetic markers, both DNA and RNA, for the early detection of colorectal, pancreatic and other gastrointestinal cancers; Personalized medicine and treatment of gastrointestinal cancers; Chemoprevention, using complementary and alternative approaches using nutraceuticals such as curcumin, green tea, resveratrol and other botanicals.

Palliative Care Utilization among Patients Admitted for Gastrointestinal and Thoracic Cancers.

Although a growing body of literature recommends the early initiation of palliative care (PC), the use of PC remains variable. The current study sought to describe the use of PC and to identify factors associated with the use of inpatient PC. Retrospective, cross-sectional analysis of data from the National Inpatient Sample. Patients admitted with a primary diagnosis of gastrointestinal and/or thoracic cancer from 2012 to 2013. In-hospital length of stay (LOS), morbidity, mortality, and total charges. A total of 282,899 patients were identified who met inclusion criteria of whom, 24,100 (8.5%) patients received a PC consultation during their inpatient admission. Patients who received PC were more likely to have a longer LOS (LOS >14 days: 5.4% vs. 9.4%) and were more likely to develop a postoperative complication (28.3% vs. 45.9%, both p < 0.001). Inpatient mortality was significantly higher among patients who had received PC than those who did not (5.4% vs. 44.1%, p < 0.001). On multivariable analysis, patient age (age ≥75 years: Odds Ratio [OR] = 2.54, 95% CI: 2.33-2.78), comorbidity (CCI >6: OR = 2.60, 95% CI: 2.48-2.74), and admission to larger hospitals (reference small: OR = 1.20, 95% CI: 1.14-1.25) were associated with greater odds of receiving PC (all p < 0.05). Patients who underwent a major operation during their inpatient admission demonstrated 79% lower odds of receiving PC (OR = 0.21, 95% CI: 0.20-0.22, p < 0.001). Among patients admitted for cancer, PC services were used in 8.5% of patients during their inpatient admission with surgical patients being 79% less likely to receive a PC consultation. Further research is required to delineate the barriers to the use of PC so as to promote the use of PC among high-risk patients.

Applications of acetic acid spray combined with narrow band imaging in diagnosis of early gastrointestinal cancers and precancerous lesions

Applications of acetic acid spray combined with narrow band imaging in diagnosis of early gastrointestinal cancers and precancerous lesions

Sarcopenia Is Associated with Quality of Life and Depression in Patients with Advanced Cancer.

Patients with advanced cancer often experience muscle wasting (sarcopenia), yet little is known about the characteristics associated with sarcopenia and the relationship between sarcopenia and patients' quality of life (QOL) and mood. As part of a randomized trial, we assessed baseline QOL (Functional Assessment of Cancer Therapy-General [FACT-G]) and mood (Hospital Anxiety and Depression Scale [HADS]) in patients within 8 weeks of diagnosis of incurable lung or gastrointestinal cancer, and prior to randomization. Using computed tomography scans collected as part of routine clinical care, we assessed sarcopenia at the level of the third lumbar vertebra with validated sex-specific cutoffs. We used logistic regression to explore characteristics associated with presence of sarcopenia. To examine associations between sarcopenia, QOL and mood, we used linear regression, adjusted for patients' age, sex, marital status, education, and cancer type. Of 237 participants (mean age = 64.41 ± 10.93 years), the majority were male (54.0%) and married (70.5%) and had lung cancer (56.5%). Over half had sarcopenia (55.3%). Older age (odds ratio [OR] = 1.05, p = .002) and education beyond high school (OR = 1.95, p = .047) were associated with greater likelihood of having sarcopenia, while female sex (OR = 0.25, p < .001) and higher body mass index (OR = 0.79, p < .001) correlated with lower likelihood of sarcopenia. Sarcopenia was associated with worse QOL (FACT-G: B = -4.26, p = .048) and greater depression symptoms (HADS-depression: B = -1.56, p = .005). Sarcopenia was highly prevalent among patients with newly diagnosed, incurable cancer. The associations of sarcopenia with worse QOL and depression symptoms highlight the need to address the issue of sarcopenia early in the course of illness. This study found that sarcopenia, assessed using computed tomography scans acquired as part of routine clinical care, is highly prevalent in patients with newly diagnosed, incurable cancer. Notably, patients with sarcopenia reported worse quality of life and greater depression symptoms than those without sarcopenia. These findings highlight the importance of addressing muscle loss early in the course of illness among patients with incurable cancer. In the future, investigators should expand upon these findings to develop strategies for assessing and treating sarcopenia while striving to enhance the quality of life and mood outcomes of patients with advanced cancer.

Correlation of DAPK1 methylation and the risk of gastrointestinal cancer: A systematic review and meta-analysis.

ObjectiveOne of the critical mechanisms of gastrointestinal cancer pathogenesis is the silencing of death associated protein kinase 1 (DAPK1), which could be caused by aberrant methylation of the promoter. However, the relationship between DAPK1 methylation and the risk of gastrointestinal cancer is still controversial. Hence, we conducted this study to determine the potential correlation.MethodsEligible publications were searched in the Pubmed, Embase, and Cochrane Library through November 2016 according to the inclusion criteria and exclusion criteria. Revman 5.3 and Stata 12.0 software were used to analyze the relevant data regarding the association between the frequency of DAPK1 methylation and gastrointestinal cancer.ResultsA total of 22 studies with 2406 patients were included in this meta analysis. Methylation of DAPK1 was positively related with the risk of gastrointestinal cancer (odds ratio [OR] = 5.35, 95% confidence interval [CI]: 2.76–10.38, P<0.00001, random effects model). The source of heterogeneity was analyzed by sensitivity analysis and subgroup analysis. After omitting one heterogeneous study, the I2 decreased and the OR increased in pooled analysis. Also, the heterogeneity decreased most significantly in the subgroup of studies that had a sample size of less than 60 cases. Then, the correlations between DAPK1 methylation and clinicopathological features of gastrointestinal cancer were assessed. DAPK1 methylation was positively correlated with the lymph node (N) stage (positive vs. negative, OR = 1.45, 95%CI: 1.01–2.06, P = 0.04, fixed effects model) and poor differentiation (OR = 1.55, 95%CI: 1.02–2.35, P = 0.04, fixed effects model) in gastric cancer, and the association was significant among Asian patients. However, among cases of gastrointestinal cancer, the association between DAPK1 methylation and tumor (T) stage, N stage, distant metastasis (M) stage, and cancer differentiation were not statistically significant.ConclusionsDAPK1 methylation is a potential biomarker for the early diagnosis of gastrointestinal cancer. Further analysis of the clinicopathological features indicated that aberrant methylation of DAPK1 is positively associated with the tumorigenesis of gastrointestinal cancer, and metastasis of gastric cancer.

Additional Benefits of Routine Drugs on Gastrointestinal Cancer: Statins, Metformin, and Proton Pump Inhibitors

Background: Commonly used medications including statins, metformin, and proton pump inhibitors (PPIs) effectively reduce the risk of esophageal, gastric, and colorectal cancer (CRC). Summary: A number of observational studies and meta-analyses have shown that long-term statin use significantly reduces the incidence of gastrointestinal (GI) cancer. Moreover, statin use after GI cancer diagnosis has been significantly associated with better prognosis in large-scale cohort studies. Metformin was rigorously evaluated in a population-based study and meta-analysis, and was found to have an unexpected benefit in the prevention and prolonged survival of CRC patients with type 2 diabetes mellitus. In contrast, few studies have demonstrated the chemopreventive effect of metformin for esophageal and gastric cancer. Recent observational studies have demonstrated that PPIs effectively reduce the progression of nondysplastic Barrett's esophagus into esophageal adenocarcinoma in a dose-dependent manner. However, the association between chronic PPI use and CRC or gastric cancer risk is still controversial. It was expected that these 3 routinely used medicines would show a synergistic effect with conventional systemic chemotherapy in advanced GI cancers. However, recent phase III studies failed to show significantly better outcomes. Key Messages: Further studies are needed to identify “additional” anticancer effects of these commonly used medicines.

Evaluation of EGF, EGFR, and E-cadherin as potential biomarkers for gastrointestinal cancers

Summary Biomarkers for early diagnosis and prognostic evaluation of cancers are still unsatisfactory in clinical management. The seeking of new biomarkers with better performance is still a challenge. EGF, EGFR, and E-cad are soluble biomarkers with clinical potential. ELISA was used to analyze serum EGF, EGFR, and E-cad from 58 gastrointestinal cancer patients and 20 control subjects. Immunohistochemistry was used to analyze Ki-67 expression in tumors. The results were correlated with clinical features. This study found that the preoperative and postoperative serum EGF and EGFR levels were significantly higher than in controls. The preoperative EGF and E-cad levels were significantly higher than postoperative levels. There was no correlation between EGF, EGFR, and E-cad levels and serum CEA or tumor Ki-67 scores. The serum EGF level was significantly higher in high TNM stage, with lymph node involvement patients than in low TNM stage, no lymph node involvement patients. Serum EGF and EGFR are potential biomarkers for the diagnosis and screening of gastrointestinal cancers. Inter-combination analysis of three biomarkers has improved the performance of the assays.