Gastric Carcinoma Patients Research Articles

Relationship between blood group and gastric carcinoma in Erbil city: A case-control study

Background and objective: Gastric carcinoma can be caused by the interaction between environmental factors and genetic variations. The relationship between ABO blood groups and carcinogenesis or progression of human tumors has been reported by many investigations. This study aimed to understand the correlation between ABO blood groups and the risk of developing gastric carcinoma. Methods: This case-control study included the ABO blood group and rhesus system of 92 patients diagnosed with gastric carcinoma at Erbil city from 2017 to 2019. Informed consent was obtained from all patients. As a control, the blood group from 260 healthy blood donors was collected from Erbil blood bank. Results: Of 92 patients, 58.7% were males, and 41.3% were females. The mean age was 62 (28 - 97) years. Regarding the type of gastric carcinoma, 58.7% were intestinal, and 41.3% were diffuse type. Blood group and rhesus system of patients and control were compared. Blood group O was 47.8% in cases versus 40.8% in control and 42.6% in all participants, followed by blood group A (31.5% of gastric carcinoma patients and 26.5% of control with a total of 27.8% of all participants). Regarding the Rhesus system, 92.4% of cases were Rh+, and 7.6% were Rh- compared with 92.9% Rh+and 7.1% Rh- in control. None of them was statistically significant. Conclusion: There was no statistically significant association between blood groups and gastric carcinoma, although blood group O was more common, followed by A. Keywords: Gastric carcinoma; ABO blood group; Erbil.

A Recombinant Human Adenovirus Type 5 (H101) Combined With Chemotherapy for Advanced Gastric Carcinoma: A Retrospective Cohort Study.

BackgroundThis retrospective cohort study aimed to evaluate the clinical outcomes of H101 combined with chemotherapy for advanced gastric carcinoma (GC) patients.MethodsThe advanced GC patients, who were treated with H101 and/or chemotherapy, were enrolled and divided into three groups according to treatment method. The clinical characteristics of patients, clinical short-term and long-term outcomes, followed up, and complication were analyzed.ResultsA total of 95 patients (30 patients in group A were treated with H101, 33 in group B patients were treated with chemotherapy, 32 patients in group C were treated with H101 combined with chemotherapy) were retrospectively reviewed. The disease control rate (DCR) and overall response rate (ORR) were significantly greater in group C (81.3% and 50.0%) than in groups A (63.3% and 30.0%) and B (66.7% and 33.3%, all p < 0.05). The 1- and 2-year survival rates and progression-free survival were significantly greater in group C than in groups A and B (all p < 0.05). There was no significant difference in complication among the three groups. At dose levels of 0.5 × 1012 vp/day, 1.0 × 1012 vp/day, and 1.5 × 1012 vp/day, complications were not increased as increased of dose.ConclusionsH101 combined with chemotherapy may be a potential therapeutic option for patients with advanced GC, and prospective studies with proper assessment of toxicity will be needed in the future.

A Novel Ferroptosis-Related Gene Risk Signature for Predicting Prognosis and Immunotherapy Response in Gastric Cancer.

Background Gastric cancer (GC) is the third leading cause of cancer death worldwide with complicated molecular and cellular heterogeneity. Iron metabolism and ferroptosis play crucial roles in the pathogenesis of GC. However, the prognostic role and immunotherapy biomarker potential of ferroptosis-related genes (FRGs) in GC still remains to be clarified. Methods We comprehensively analyzed the prognosis of different expression FRGs, based on gastric carcinoma patients in the TCGA cohort. The functional enrichment and immune microenvironment associated with these genes in gastric cancer were investigated. The prognostic model was constructed to clarify the relation between FRGs and the prognosis of GC. Meanwhile, the ceRNA network of FRGs in the prognostic model was performed to explore the regulatory mechanisms. Results Gastric carcinoma patients were classified into the A, B, and C FRGClusters with different features based on 19 prognostic ferroptosis-related differentially expressed genes in the TCGA database. To quantify the FRG characteristics of individual patients, FRGScore was constructed. And the research shows the GC patients with higher FRGScore had worse survival outcome. Moreover, thirteen prognostic ferroptosis-related differentially expressed genes (DEGs) were selected to construct a prognostic model for GC survival outcome with a superior accuracy in this research. And we also found that FRG RiskScore can be an independent biomarker for the prognosis of GC patients. Interestingly, GC patients with lower RiskScore had less immune dysfunction and were more likely to respond to immunotherapy according to TIDE value analysis. Finally, a ceRNA network based on FRGs in the prognostic model was analyzed to show the concrete regulation mechanisms. Conclusions The ferroptosis-related gene risk signature has a superior potent in predicting GC prognosis and acts as the biomarkers for immunotherapy, which may provide a reference in clinic.

Inflammation-Related Long Non-Coding RNA Signature Predicts the Prognosis of Gastric Carcinoma.

Background: Gastric carcinoma (GC) is a molecularly and phenotypically highly heterogeneous disease, making the prognostic prediction challenging. On the other hand, Inflammation as part of the active cross-talk between the tumor and the host in the tumor or its microenvironment could affect prognosis. Method: We established a prognostic multi lncRNAs signature that could better predict the prognosis of GC patients based on inflammation-related differentially expressed lncRNAs in GC. Results: We identified 10 differently expressed lncRNAs related to inflammation associated with GC prognosis. Kaplan-Meier survival analysis demonstrated that high-risk inflammation-related lncRNAs signature was related to poor prognosis of GC. Moreover, the inflammation-related lncRNAs signature had an AUC of 0.788, proving their utility in predicting GC prognosis. Indeed, our risk signature is more precise in predicting the prognosis of GC patients than traditional clinicopathological manifestations. Immune and tumor-related pathways for individuals in the low and high-risk groups were further revealed by GSEA. Moreover, TCGA based analysis revealed significant differences in HLA, MHC class-I, cytolytic activity, parainflammation, co-stimulation of APC, type II INF response, and type I INF response between the two risk groups. Immune checkpoints revealed CD86, TNFSF18, CD200, and LAIR1 were differently expressed between lowand high-risk groups. Conclusion: A novel inflammation-related lncRNAs (AC015660.1, LINC01094, AL512506.1, AC124067.2, AC016737.1, AL136115.1, AP000695.1, AC104695.3, LINC00449, AC090772.1) signature may provide insight into the new therapies and prognosis prediction for GC patients.

Predictive and Prognostic Value of an MicroRNA Signature for Gastric Carcinoma Undergoing Adjuvant Chemotherapy.

Gastric carcinoma (GC) is one of the most common cause of tumor-related death. Chemotherapy resistance usually occurs, leading to cancer relapse and poor survival of GC patients. To investigate the role of miRNAs in chemotherapy resistance for GC patients, we conducted an integrated analysis of miRNA expression and survival information using data obtained from The Cancer Genome Atlas project. Genome-wide screening of chemotherapy response-specific miRNAs was performed using Cox proportional hazards regression analyses for patients who received chemotherapy or those who had never received chemotherapy, respectively. A four-miRNA expression signature (involving two protective miRNAs, miR-200b and miR-103a, and two risk ones miR-199 and miR-152) was predicted as a specific indicator for GC chemoresistance (p = 0.00053; hazard ratio = 8.63), outperforming those clinicopathological factors. Functional experiments confirmed the roles of these signature miRNAs in regulation of chemotherapy response. Functional enrichment of these signature miRNAs and risk score revealed positive association with epithelial-mesenchymal transition (EMT), and negative association with cell cycle checkpoint and DNA damage response. Furthermore, the immune infiltration-miRNA functional network analysis revealed transformation from activated effector cells to resting immunosuppressive cells are preferred in GCs with adverse chemotherapy response. In summary, our work identifies a four-miRNA expression signature as a promising chemoresistance biomarker in GC, which provides novel insights into developing new strategies to overcome GC chemoresistance.

MRNA microarray profiling identifies a novel circulating HTRA2 for detection of gastric cancer.

BackgroundmRNAs have been shown to be critical biomarkers or therapeutic targets for human diseases. However, only a few of them have been studied as blood‐based biomarkers for gastric carcinoma (GC) detection.MethodsmRNA expression profiles for GC were screened using plasma samples from 10 GC patients with different TNM stages and 5 healthy individuals as controls. One candidate tumor‐related mRNA named HTRA2 was then evaluated in GC samples with quantitative real‐time polymerase chain reaction (qRT‐PCR). TCGAportal, UALCAN, and TISCH database were used to explore the function of HTRA2 in GC. Finally, the effect generated by HTRA2 expression on cell proliferating, invading, and migrating processes was assessed in vitro with knockdown and over‐expression strategies.ResultsHTRA2 displayed noticeable increase inside GC plasma compared with control cases. Higher expression of HTRA2 displayed a correlation to higher clinicopathological stage and worse prognosis. HTRA2 knocking down down‐regulated GC cells' proliferating, invading, and migrating states, while HTRA2 over‐expression exerted the inconsistent influence. HTRA2 protein, which may interact with PINK1, PARL, and CYCS, was mainly located in the mitochondria of cells and primarily involved cellular response and metabolic signaling pathway. Immune factors may interact with HTRA2 in GC, and HTRA2 was found noticeably linked with immunosuppressor such as CD274, IDO1, and TIGIT.ConclusionOne plasma HTRA2 can be an emerging diagnosis‐related biomarker to achieve GC detecting process, but the particular regulatory effect still needs to be further explored.

A potential novel biomarker in predicting lymph node metastasis of gastric signet ring cell carcinoma: A derived monocyte to lymphocyte ratio

BackgroundThis study is designed to evaluate the predictive value of derived monocyte to lymphocyte ratio (dMLR), neutrophil to lymphocyte ratio (NLR) and eosinophil to lymphocyte ratio (ELR) for lymph node metastasis (LNM) in gastric signet ring cell carcinoma (SRCC) patients. MethodsWe carried out a retrospective analysis for 203 eligible patients who underwent radical gastrectomy between January 2011 and September 2020. ResultsThe diagnostic sensitivity and specificity for dMLR were 60.3% and 72.2%, respectively; while for NLR and ELR were 64.1% and 66.6%, and 91.6% and 23.6%, respectively. The dMLR and NLR were identified as independent predictors of LNM, but ELR was not. A nomogram was developed incorporating dMLR and clinical characteristics with AUC of 0.868, and the outcome of DCA supported good clinical benefit. ConclusionsdMLR is a promising novel preoperative biomarker to predict LNM of gastric SRCC.

Epstein-Barr Virus miR-BART1-3p Regulates the miR-17-92 Cluster by Targeting E2F3.

Epstein-Barr virus (EBV) is associated with several tumors and generates BamHI A rightward transcript (BART) microRNAs (miRNAs) from BART transcript introns. These BART miRNAs are expressed at higher levels in EBV-associated epithelial malignancies than in EBV-infected B lymphomas. To test the effects of EBV miRNA on the cell cycle and cell growth, we transfected miR-BART1-3p, a highly expressed EBV-associated miRNA, into gastric carcinoma cells. We found that miR-BART1-3p induced G0/G1 arrest and suppressed cell growth in gastric carcinoma cells. As our microarray analyses showed that E2F3, a cell cycle regulator, was inhibited by EBV infection, we hypothesized that miR-BART1-3p regulates E2F3. Luciferase assays revealed that miR-BART1-3p directly targeted the 3′-UTR of E2F3 mRNA. Both E2F3 mRNA and encoded protein levels were reduced following miR-BART1-3p transfection. In contrast, E2F3 expression in AGS-EBV cells transfected with a miR-BART1-3p inhibitor was enhanced. As E2F3 has been shown to regulate the expression of highly conserved miR-17-92 clusters in vertebrates, we examined whether this expression is affected by miR-BART1-3p, which can downregulate E2F3. The expression of E2F3, miR-17-92a-1 cluster host gene (MIR17HG), and miR-17-92 cluster miRNAs was significantly reduced in EBV-associated gastric carcinoma (EBVaGC) patients compared with EBV-negative gastric carcinoma (EBVnGC) patients. Further, miR-BART1-3p as well as the siRNA specific to E2F3 inhibited the expression of the miR-17-92 cluster, while inhibition of miR-BART1-3p enhanced the expression of the miR-17-92 cluster in cultured GC cells. Our results suggest a possible role of miR-BART1-3p in cell cycle regulation and in regulation of the miR-17-92 cluster through E2F3 suppression.

The multidisciplinary management of gastric cancer: Experience from a tertiary comprehensive hospital in Shanghai, China

Gastric cancer is a heterogeneous disease which requires a multimodal approach of management. The Department of Gastrointestinal Surgery at Changhai Hospital, a tertiary hospital in Shanghai, established the gastric cancer multidisciplinary team (MDT) clinic based on the guidance of MDT culture in the year of 2017. Our MDT discussion followed a weekly consultation model, with the full-board discussion held once a month, and mini-board communication and discussion made once a week. The stages of MDT management are: pre-operative treatment plan and preparation, post-operative treatment plan, and follow-up treatment and evaluation. As of March 2021, a total of 296 patients visited the MDT clinic. Majority of the patients were gastric carcinoma patients (273/296, 92.2%). Here, we shared our gastric cancer MDT experiences and summarized our strengths and proposed directions for improvement.

Role of miR-138 on Radio Sensitivity of Gastric Carcinoma Cells and Its Molecular Mechanism

To explore FOXP4 and miR-138 in gastric carcinoma (GC) and its related mechanisms. Sixty-eight GC patients from January 2018 to January 2019 were selected as group A, and 66 healthy people as group B. GC cells and gastric mucosal epithelial cells were purchased, sh-FOXP4, si-FOXP4, NC, miR-138-inhibitor, and miR-138-mimics were transfected into MKN-45 and NCI-N87 cells. The FOXP4 and miR-138 expression levels in samples were tested by qRT-PCR, and N-cadherin, vimentin, Fibronectin, Slug, E-Cadherin and Y-catenin downstream proteins in cells were detected by WB. The proliferation was tested by MTT assay, invasion was tested by Transwell assay, and apoptosis was detected by flow cytometry assay. F0XP4 was highly expressed in GC, miR-138 was poorly expressed in GC, and AUC of FOXP4 and miR-138 was &gt; 0.8. FOXP4 and miR-138 were tied to the age, gender, tumor invasion, differentiation degree, tumor location and TNM stage of GC patients. Silent expression of FOXP4 and overexpression of miR-138 can promote apoptosis, inhibit cell growth and epithelial-mesenchymal transition (ETM). The two also can inhibit N-cadherin, vimentin, Fibronectin and Slug proteins, and promote E-Cadherin and y-catenin. Dual luciferase report confirmed that FOXP4 and miR-138 had targeted relationship. In terms of radiological parameters, the SF2 and D0 (Gy) values of transfected miR-138mimic+pcDNA3. 1-FOXP4 were dramatically higher than those of transfected miR-138mimic+pcDNA3. 1 cells, and SER was lower than those of transfected miR-138 mimic+ pcDNA3. 1 cells (P&lt;0.05), suggesting FOXP4 partially adjusted the radiosensitization role of miR-138. In conclusion, miR-138 can regulate EMT of GC cells by adjusting F0XP4 and enhance radiosensitivity of those cells.

PRE-OPERATIVE EVALUATION AND TUMOUR-NODE-METASTASIS STAGING OF GASTRIC CARCINOMA USING 16 SLICE MULTIDETECTOR-ROW COMPUTED TOMOGRAPHY

OBJECTIVE: To evaluate pre-operative tumour-node-metastasis staging (TNM) staging, metastases status and detection of role of multidetector-row computed tomography (MDCT) in gastric carcinoma patients in Pakistan.&#x0D; METHODS: This cross-sectional study, spanned over 14 months (January 2018-February 2019), was conducted at Radiology Department of Kuwait Teaching Hospital. Sample size was 173. Patients, selected through non-probability consecutive sampling technique, irrespective of gender, aged over 18 years and having clinically and histopathologically diagnosed with gastric carcinoma were included in the study. MDCT of patients was done. SPSS Version-24 was utilized for data analysis. Chi-square test was applied with p-value ≤0.05 was considered significant.&#x0D; RESULTS: Out of total 173 patients with gastric carcinoma, 121 (69.9%) were males and 52 (30.1%) were females. Mean age of patients was 48.5±1.2 years. Majority of patients were in T4a stage (n=64; 37%) followed T4b, T3, T0, T1 &amp; T2 (24.9%, 17.3%, 11% and 9.8%) respectively. N0 stage with no nodal metastases was 40.5% followed by N1 stage (1-2 lymph nodes), N2 stage (3-6 lymph nodes), N3a stage (7-15 lymph nodes) and N3b stage (more than 15 lymph nodes) with 25.4%, 19.7%, 5.8% and 8.7% respectively. M1 stage with distant metastases was in 76 (43.9%) patients. Age and gender had insignificant association with TNM system (p&gt;0.05).&#x0D; CONCLUSION: Multi detector row computed tomography was effective in pre-operative evaluation and TNM staging of gastric carcinoma. Lymph node detection on MDCT can further be utilized for fine needle biopsies if required.

Circular analyses of dates on patients with gastric carcinoma

Dates have great importance in cancer diseases. However, the date variables themselves are not analyzed. This study aims to evaluate the descriptive statistics of diagnosis, operation, and last examination dates in gastric carcinoma patients by circular analysis methods. Totally 502 gastric carcinoma patients were enrolled in the study. The mean month of diagnosis date was found in nearly November (∼10.86) for females and May (∼5.17) for male patients. The mean month of operation date was found March (∼3.24) for females, and July & August (∼7.79) for males. The mean month of the last examination date was found as February & March (∼2.61) for females, and May (∼4.85) for males. Moreover, the mean day of the week for diagnosis date was found Thursday (∼5.50) for both female and male patients. The fitting of distributions of all variables was checked, also, according to von Mises, Rayleigh, and Kuiper’s tests. When the days and months were analyzed by classical descriptive statistics, the results were obtained completely different from the circular analyses results. Therefore, the dates and times should be analyzed in certain diseases to give an idea for physicians.

Effectiveness of an Instructional Program on Gastric Carcinoma Patients Knowledge Undergoing Chemotherapy toward Self Care after Gastrectomy at Oncology Unit of ALHaboby Teaching Hospital in AL-Naseria City

Aims: To determine the effectiveness of instructional program on self-care knowledge patientsundergoing chemotherapy after gastrectomy. Methods: Pre-experimental pre-post test design wasconducted in Al-Naseria City. The data collection process uses the interview technique and analyzedthrough the descriptive statistic. Results: There is statistically significance differences between preposttest knowledge, which mean effectiveness of instructional program knowledge of self care aftergastrectomy. Conclusion: In the post-test, there was a big difference in the patients’ knowledge leveltowards self-care. Establishing specialized centers to educate patients importance of early detection ofcancer.

Comparison of Clinical Efficacy Between Laparoscopic and Open Distal Gastrectomy in the Treatment of Gastric Carcinoma: A Meta-Analysis

Objectives: The purpose of this article was to systematically evaluate the clinical efficacy of laparoscopy-assisted distal gastrectomy (LDG) and open distal gastrectomy (ODG) in the treatment of gastric carcinoma (GC). Methods: PubMed, Web of Science, Embase, CNKI, and Wanfang databases were systematically searched for relevant articles on surgical treatment of GC published from 2010 to 2020. GC patients in the treatment group received LDG, whereas those in the control group received ODG. The evaluation criteria of these two surgical methods included operation time, intraoperative blood loss, postoperative first exhaust time, number of dissected lymph nodes, postoperative hospital stay, and incidence of complications. Results: A total of 18 studies, with 2102 patients, which met the criteria were included in this meta-analysis. The analysis results showed that in comparison with the control group, both the incidence rate of complications (odds ratio = 0.31, 95% confidence interval, CI [0.23 to 0.41]) and intraoperative blood loss (standardized mean difference, SMD = -2.72, 95% CI [-3.43 to -2.00]) were lower in the treatment group. In addition, in comparison with the control group, LDG led to an increase in the number of dissected lymph nodes (SMD = 0.08, 95% CI [-1.10 to 0.25], P = .403) and associated with shorter hospital stay (SMD = -1.42, 95% CI [-1.90 to -0.94]) and earlier postoperative first exhaust time (SMD = -2.12, 95% CI [-2.86 to -1.38]). Conclusion: LDG can significantly reduce the incidence of complications of GC, intraoperative blood loss, postoperative exhaust time, and hospital stay, whereas increase the number of lymph node dissection. Therefore, LDG is worthy of clinical application.

Diagnostic and prognostic value of MATN3 expression in gastric carcinoma: TCGA database mining.

Globally, the high morbidity and mortality of gastric carcinoma (GC) have been one of the great challenges facing humanity. However, the early diagnosis of GC is still unknown. Matrilin-3 (MATN3) is a member of the extracellular matrix (ECM) protein family. Previous studies have reported a correlation between the expression of MATN3 and bone disease. However, the role of MATN3 in GC has not been reported in depth, which can have a possible far-reaching implication for GC. We explored the diagnostic and prognostic value and pathway enrichment of MATN3 expression in GC. Limma package conducted by R was used to analysis the difference expression data of MATN3 from The Cancer Genome Atlas (TCGA). The receiver operating characteristic (ROC) curve analysis was used to estimate the diagnostic value of MATN3 expression. univariate and multivariate analysis were used to assess the prognostic value of MATN3, and gene set enrichment analysis (GSEA) to identify the enriched signaling pathways. MATN3 was found to be significantly higher in GC tissue samples. GC patients with high MATN3 expression had poor prognosis. Then, GSEA showed that the gene sets were correlated with signaling pathways including ECM receptor interaction, hypertrophic cardiomyopathy (HCM), and glycosaminoglycan biosynthesis chondroitin sulfate, among others. The study suggests that MATN3 can serve as a potential diagnostic and prognostic biomarker for GC.

A Critical Assessment of the Association between HLA-G Expression by Carcinomas and Clinical Outcome

Human leukocyte antigen-G (HLA-G) conveys immunological tolerance at the maternal-foetal interface. HLA-G expression by tumour cells may also play such a role, resulting in tumour immune evasion, making HLA-G a potential target for immunotherapies. The aim of this review was to determine to what extent it is justified that HLA-G expression is considered as a target for immune checkpoint inhibiting therapy by critically assessing the association between HLA-G expression by carcinomas and clinical outcome of patients. The used HLA-G-detecting mAb, HLA-G quantification methods and statistically significant HLA-G-associated clinicopathological parameters are discussed. Tumour HLA-G expression correlated with poor clinical outcome in breast, esophageal, gastric and hepatocellular carcinoma patients. Tumour HLA-G expression was not associated with clinical outcome in ovarian and oral carcinoma patients. Cervical, colorectal, lung, and pancreatic carcinoma patients presented discrepant and therefore inconclusive results regarding the association between tumour HLA-G expression and clinical outcome. These disparities might partly be the result of differences in the methodological approach to quantify HLA-G expression between studies. Therefore, implementation of universal methodological procedures is strongly advised. Overall, HLA-G expression did not univocally result in poor clinical outcome of carcinoma patients. This implies that tumour HLA-G expression is not necessarily part of an inhibited tumour-immune response and tumour progression. Consequently, it remains elusive whether HLA-G expression by carcinomas functions as an immune checkpoint molecule affecting a tumour-immune response. It may also reflect derailed control of gene expression in tumours, with no real functional consequences.

Radiotherapy Improves the Prognosis in Signet Ring Cell Carcinoma and Non-Signet Ring Cell Gastric Adenocarcinoma Patients: A SEER Database Analysis

Objective: To investigate the effect of radiotherapy on prognosis in gastric signet ring cell carcinoma (SRCC) and gastric non-signet ring cell adenocarcinoma (NSRCC) patients. Methods: A total of 23,971 patients diagnosed with gastric cancer were collected from 2004 to 2013 by SEER database, including 17,679 NSRCC patients and 6,292 SRCC patients. Patients were divided to two groups and compared according to whether radical gastrectomy was performed on them. After clinic pathological characteristics of the two groups were balanced by the propensity score matching (PSM) method, survival rates of the two groups were then compared. Results: The Over Survival (OS) and Cancer-Specific Survival (CSS) time of SRCC and NSRCC patients in the radiotherapy groupwere significantly better than those in the non-radiotherapy group. But the clinical and pathological characteristics (gender, age, pathological differentiation degree, T stage, N stage, and metastasis) of the two groups were significantly unbalanced (p&lt;0.001). After 1:1 PSM matching, it was found that radiotherapy had no significant effect on OS and CSS time of NSRCC patients, but radiotherapy could significantly improve OS and CSS time of SRCC patients. Conclusion: SRCC patients are more sensitive to radiotherapy than NSRCC patients. Although the prognosis of SRCC is far less than that of NSRCC patients, the treatment strategy of surgical resection of primary lesions combined with radiotherapy should be recommend for SRCC patients, and whether radiotherapy benefits NSRCC patients still needs to be further studied.

Prognostic Significance of Signet-Ring Cell Components in Patients With Gastric Carcinoma of Different Stages.

Background: Gastric carcinoma (GC), which contains signet ring cell (SRC) components are frequently observed in postoperative pathological assessment. This study aims to study the prognostic significance of SRC components in GC patients.Methods: From 2003 to 2017, surgically resected primary GC patients were retrospectively reviewed. All enrolled patients were divided into three groups according to the proportion of SRC. The overall survival (OS) and disease-free survival (DFS) of GC patients with different tumor stages were analyzed.Results: Patients with SRC or mixed-SRC were more associated with female, younger age, middle or lower third of the stomach, larger tumor, higher pN stage, and more lymphovascular invasion. For GC patients in stage I, multivariate survival analysis showed that age >60, SRC components >50%, and pT stage were independent prognostic factors for OS (all p < 0.05). The 5-year OS of patients with SRC were higher than that of patients with pure adenocarcinoma (p = 0.021). For GC patients in stage II/III, multivariate survival analysis showed that age >60, SRC proportion, surgical types, Borrmann's type, pT stage, pN stage, and lymphovascular invasion were independent prognostic factors for OS (all p < 0.05). The 5-year OS/DFS of patients with SRC were lower than that of patients with pure adenocarcinoma (p < 0.001).Conclusions: SRC seemed to be a favorable prognostic factor in GC patients in stage I. However, for GC patients in stage II/III, the SRC components were associated with poor prognosis, independent of other clinicopathological factors.

The New American Joint Committee on Cancer T staging system for stomach: increased complexity without clear improvement in predictive accuracy for endoscopic ultrasound

BackgroundThe efficacy of endoscopic ultrasound (EUS) for determining the T category of gastric cancer is variable. The aim of this study was to evaluate the superiority of EUS by using the 6th edition American Joint Committee on Cancer (AJCC) staging system for stomach cancer compared to the new 7th/8th edition.MethodsA retrospective analysis of clinical and EUS imaging features of 348 gastric carcinoma patients who underwent radical resection were retrospectively analyzed. Differences between the 6th and 7th/8th edition T staging systems for preoperative EUS evaluation were compared.ResultsThe accuracy of EUS T staging was 72.4% for the 7th/8th edition and 78.4% for the 6th edition. T3 stage accuracy was significantly worse when the T3 group status was changed. The tumor location, echoendoscope type, and histological type were associated with inaccuracy. We further analyzed the EUS image features for each tumor T stage and found that an indistinctly visible muscularis propria (MP) or with obvious thickening was considered an indicator of lesions involved in the MP with a sensitivity of 81.3%; an MP completely disappeared and accompanied with a serosal layer intact may be a marker that the lesion invaded to the subserosa. We also found that irregularities in the outer edge of the gastric wall were markers of gastric serosal layer penetration with a positive predictive value of 92.2%.ConclusionsThe increased complexity of the 7th/8th edition T staging system is accompanied by worsening of the predictive accuracy for EUS as compared to the 6th edition. Furthermore, the tumor location, echoendoscope type, histological type, and EUS image features for each tumor T stage should warrant attention.

Assessment of copy number in protooncogenes are predictive of poor survival in advanced gastric cancer

The copy number (CN) gain of protooncogenes is a frequent finding in gastric carcinoma (GC), but its prognostic implication remains elusive. The study aimed to characterize the clinicopathological features, including prognosis, of GCs with copy number gains in multiple protooncogenes. Three hundred thirty-three patients with advanced GC were analyzed for their gene ratios in EGFR, GATA6, IGF2, and SETDB1 using droplet dPCR (ddPCR) for an accurate assessment of CN changes in target genes. The number of GC patients with 3 or more genes with CN gain was 16 (4.8%). Compared with the GCs with 2 or less genes with CN gain, the GCs with 3 or more CN gains displayed more frequent venous invasion, a lower density of tumor-infiltrating lymphocytes, and lower methylation levels of L1 or SAT-alpha. Microsatellite instability-high tumors or Epstein–Barr virus-positive tumors were not found in the GCs with 3 or more genes with CN gain. Patients of this groups also showed the worst clinical outcomes for both overall survival and recurrence-free survival, which was persistent in the multivariate survival analyses. Our findings suggest that the ddPCR-based detection of multiple CN gain of protooncogenes might help to identify a subset of patients with poor prognosis.