Gastrointestinal Tumors Research Articles

Early-Onset Gastrointestinal Cancers: A Review.

Early-onset gastrointestinal (GI) cancer is typically defined as GI cancer diagnosed in individuals younger than 50 years. The incidence of early-onset GI cancer is rising globally, and early-onset GI cancers represent the most rapidly increasing early-onset cancer in the US. Worldwide, among early-onset GI cancers reported in 2022, colorectal cancer (CRC) was the most common (54.3%; 184 709 cases), followed by gastric cancer (23.8%; 80 885 cases), esophageal cancer (13.2%; 45 056 cases), and pancreatic cancer (8.6%; 29 402 cases). In the US, among early-onset GI cancers reported in 2022, 20 805 individuals were diagnosed with early-onset CRC, 2689 with early-onset gastric, 2657 with early-onset pancreatic, and 875 with early-onset esophageal cancer. Most early-onset GI cancers are associated with modifiable risk factors including obesity, poor-quality diet (eg, sugar-sweetened beverages, ultraprocessed foods), sedentary lifestyle, cigarette smoking, and alcohol consumption. Nonmodifiable risk factors include family history, hereditary syndromes (eg, Lynch syndrome), and inflammatory bowel disease for patients with early-onset CRC. Approximately 15% to 30% of early-onset GI cancers have pathogenic germline variants in genes such as DNA mismatch repair genes and BRCA1/2. All patients with early-onset GI cancers should undergo germline and somatic genetic testing to guide treatment, screen for other cancers (eg, endometrial cancer in Lynch syndrome), and assess familial risk. Treatment for early-onset GI cancers are similar to later-onset GI cancers and may include chemotherapy, surgery, radiation, and therapies such as poly-adenosine diphosphate ribose polymerase inhibitors for BRCA-associated pancreatic cancer. Compared with GI cancers diagnosed after age 50 years, patients with early-onset GI cancers typically receive more treatments but often have similar or shorter survival. Specialized centers and multidisciplinary teams can support patients with challenges around fertility preservation, parenting with cancer, financial difficulty, and psychosocial distress. Currently, screening is not recommended for most early-onset GI cancers, although in the US, screening for CRC is recommended for average-risk individuals starting at age 45 years. High-risk individuals (eg, those with Lynch syndrome, a first-degree relative with CRC, or advanced colorectal adenoma) should begin CRC screening earlier, at an age determined by the specific risk factor. Early-onset GI cancers, typically defined as cancer diagnosed in individuals younger than 50 years, are among the largest subset of early-onset cancers globally. Treatment is similar to later-onset GI cancers and typically involves a combination of chemotherapy, surgery, and radiation, depending on the cancer type and stage. The prognosis for patients with early-onset GI cancers is similar to or worse than that for patients with later-onset GI cancers, highlighting the need for improved methods of prevention and early detection.

CD8 + T Cells in Gastrointestinal Cancer: a Perspective on Targeting MicroRNA.

Gastrointestinal cancer, which is highly prevalent globally, constitutes a major threat to human health and life. The discovery of PD-L1/PD-1 has revolutionized immunotherapy, which has led to a shift in attention toward the antitumor functions of CD8 + T cells. CD8 + T cells are crucial effector cells in antitumor immunity, yet their functionality undergoes profound changes within the tumor microenvironment (TME). In the TME, gene mutations in cancer cells serve as initiating factors, remodeling the functions of various cells and the composition of noncellular substances. Cancer cells induce functional changes in other cells within the TME to favor their survival, notably impacting crucial antitumor effector cells such as CD8 + T cells, thereby furthering tumor progression. However, how tumor cells remodel CD8 + T cells remains inadequately understood, and targeted therapies against immune checkpoints face increasing challenges. An increasing number of findings suggest that miRNAs play a critical role in the process of remodeling CD8 + T cell function in tumors. Tumor cells regulate the expression of their own miRNAs to control the expression of surface molecules, modulate the release of secreted factors, or, through miRNA-containing exosomes, communicate with and remodel the function of CD8 + T cells. Elucidating the communication between CD8 + T cells and gastrointestinal cancer cells from a miRNA perspective to explain the shift of CD8 + T cells toward favorable types of tumors may inspire new therapeutic strategies. KEY MESSAGES: MicroRNAs regulate CD8+ T cells function in gastrointestinal cancers. MicroRNAs involve in crosstalk of gastrointestinal cancers with CD8+ T cells. MicroRNAs involve in crosstalk of the gastrointestinal immune microenvironment with CD8+ T cells. Focus on the application of targeted microRNA drugs and microRNA delivery strategies in gastrointestinal cancers.

Intravenous thrombolysis in the context of stroke and cancer.

Cancer patients are at an increased risk for ischemic and hemorrhagic strokes. Ischemic stroke in this population often presents with distinctive features, such as cryptogenic etiology and multiple ischemic lesions, and is driven by cancer-associated coagulopathy, complicating management strategies. We reviewed current literature on intravenous thrombolysis (IVT) for acute ischemic stroke in cancer patients through PubMed search with no time limits. We included international guidelines, meta-analyses, cohort studies, and case series to evaluate its safety and efficacy. This descriptive review aims to evaluate the risks and benefits of thrombolytic treatment in patients with acute stroke and cancer. Despite limited high-quality evidence (no randomized trial), studies suggest that IVT is generally safe and effective in cancer patients with ischemic stroke. However, treatment should be individualized, considering specific contraindications and the patient's tumor characteristics. The 2019 American Heart Association/American Stroke Association guidelines contraindicate IVT in patients with gastrointestinal or intra-axial tumors; conversely, these conditions are not explicitly mentioned in the 2021 European Stroke Organization guidelines, as recent studies have not proven them to be at higher risk per se. Particular attention should be given to coagulation abnormalities, recent surgery, and concomitant medications. Thus, cautious and multidisciplinary management is needed. Further research is essential to define risk stratification for this complex population better. Multicentered, well-designed prospective studies are crucial and should also differentiate patients based on tumor site, histology, and molecular characteristics that could impact both thrombotic and hemorrhagic risk.

Frequency of Chronic Liver Disease Due to Chemotherapy-Associated Liver Injury in Patients with Gastrointestinal Cancers.

Chronic liver disease (CLD) has been reported in long-term survivors of gastrointestinal (GI) cancers treated with irinotecan- and/or oxaliplatin-based chemotherapy. This study aims to investigate the frequency and clinical consequences of CLD in GI cancer patients treated with chemotherapy and its potential impact on survival. We retrospectively reviewed patients with GI cancers treated at AMO Oncology Clinic from 2017 to 2022. CLD evaluation was performed in patients without prior liver disease who survived ≥ 12months after chemotherapy. Diagnosis was based on imaging findings of cirrhosis or portal hypertension (PH), histologic evidence of advanced fibrosis, or esophagogastric varices on endoscopy. A total of 328 patients (165 males; mean age 64 ± 13years) were included. Most had colorectal cancer (58%) and TNM stage III or IV disease (69.6%). They received a median of 15.5 (8-28) chemotherapy cycles, mainly with oxaliplatin (86%), 5-fluorouracil (76%), irinotecan (49%), and capecitabine (43%). After a mean follow-up of 30.5 (21-49) months, CLD was identified in 47 patients (14.3%). Overall survival did not differ significantly between those with and without CLD (77.0 [51-102] vs. 85.7 [69-102] months, p = 0.385). CLD was associated with a greater number of chemotherapy agents (4 vs. 3, p = 0.002), cycles (21 vs. 13, p = 0.005), and exposure to 5-FU (89% vs. 73%, p = 0.02) and irinotecan (66% vs. 46%, p = 0.01). Among patients with GI cancer receiving chemotherapy, CLD was relatively frequent but no difference in survival was observed. As PH complications may occur, screening for CLD should be recommended for long-term survivors.

Histoculture drug response assay predicts chemotherapy efficacy and improves survival in gastrointestinal cancers

BackgroundThe high incidence, substantial mortality, and marked heterogeneity in chemotherapy responses among gastrointestinal tumors accentuate the imperative for individualized treatment strategies. This study aims to evaluate the reliability and clinical significance of the histoculture drug response assay (HDRA) in predicting chemotherapy sensitivity and prognosis. Specifically, it focuses on Chinese patients diagnosed with gastrointestinal cancers.MethodsThis study enrolled 283 patients with gastrointestinal tumors, comprising 124 esophageal cancer cases, 92 gastric/cardia cancer cases, and 67 colorectal cancer cases. Immunohistochemistry was conducted to assess tumor structure integrity and the expression of Ki - 67, CD31, and E - cadherin before and after the HDRA assay. HDRA evaluated the efficacy and inhibition rates of single and combination chemotherapy regimens. Moreover, the effect of HDRA - guided treatment on patient survival was analyzed.ResultsThe results indicated that HDRA effectively preserved the three-dimensional structure and microenvironment of gastrointestinal tumors, as no significant changes were observed in the expression of Ki-67, CD31, or E-cadherin. Furthermore, combination regimens showed significantly higher efficacy and inhibition rates than single - agent therapies. Notably, platinum-based combination therapy was most effective in esophageal cancer. Survival analysis revealed that esophageal and gastric cancer patients receiving HDRA - sensitive regimens (HDRA group) had significantly longer disease - free survival (DFS) compared to those on non - sensitive regimens (N - HDRA group) and untreated patients. Cox regression analysis indicated that HDRA-guided treatment serves as a protective factor for DFS (hazard ratio, HR<1).ConclusionIn summary, the HDRA assay represents a reliable assay for accurately evaluating chemotherapy regimens, thereby furnishing guidance for individualized treatment in gastrointestinal cancer patients.

Postoperative pulmonary complications of desflurane- versus sevoflurane-based general anesthesia in patients with chronic obstructive pulmonary disease or asthma undergoing gastrointestinal cancer surgery: a nationwide retrospective cohort study

Abstract Purpose Desflurane and sevoflurane are widely used for general anesthesia; however, it remains uncertain if sevoflurane might be preferable for patients with chronic respiratory inflammatory diseases. This study compared postoperative outcomes of desflurane and sevoflurane following gastrointestinal cancer surgery in patients with chronic obstructive pulmonary disease (COPD) or asthma. Methods We conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination database (April 2011–March 2022), identifying patients with COPD or asthma who underwent gastrointestinal cancer surgery. The primary outcome was postoperative pulmonary complications, including pneumonia, respiratory failure, mechanical ventilation > 24 h, and unplanned reintubation within 7 days after surgery. Secondary outcomes were in-hospital mortality and postoperative stay. We conducted propensity score overlap weighting and instrumental variable analyses adjusted for confounders. Results We identified 24,243 COPD and 16,199 asthma patients. Propensity score overlap weighting showed no significant association between desflurane and increased postoperative pulmonary complications in COPD [adjusted risk difference (aRD) − 0.57%; 99% confidence interval (CI), − 1.8% to 0.60%] or asthma (aRD, − 0.62%; 99% CI, − 1.8% to 0.59%). In-hospital mortality did not differ significantly between groups in COPD (aRD, − 0.24%; 99% CI, − 0.76% to 0.29%) or asthma (aRD, 0.07%; 99% CI, − 0.45% to 0.59%). The postoperative stay also showed no significant association between the desflurane and sevoflurane groups. Conclusions Desflurane-based anesthesia was not associated with increased postoperative pulmonary complications and mortality compared to sevoflurane in patients with chronic respiratory diseases undergoing gastrointestinal cancer surgery. However, further studies using reliable diagnostic criteria to assess COPD or asthma are warranted.

Is endoscopic treatment a useful therapeutic option for esophageal gastrointestinal stromal tumors?

Decisions regarding the management of patients with esophageal gastrointestinal tumors (EGISTs) are very challenging, as there are still no clear guidelines on the treatment of these tumors due to their rarity. Surgery remains the standard treatment, but it is known that surgical procedures performed on the esophagus are related to a high risk of serious postoperative complications and impaired quality of life. Endoscopic resection is both safe and effective for patients with low-risk EGISTs. This article presents the current therapeutic options in patients with EGISTs, including both the endoscopic and surgical approach, and discusses the results, strengths and limitations of the recent article by Xu et al regarding the endoscopic treatment outcome of EGISTs.

Associations between blood metabolite levels and gastrointestinal cancer risk: A preliminary untargeted metabolomics study

BACKGROUND Gastrointestinal cancers are among the most commonly diagnosed cancers globally. Traditional Chinese medicine (TCM) offers distinct advantages in preventing and treating these cancers. AIM To investigate the metabolic basis of a common TCM syndrome in gastrointestinal cancers, exploring underlying metabolic mechanisms and identifying potential biomarkers. METHODS Thirty healthy controls (normal group), 30 patients with gastric cancer (GC), and 30 patients with colorectal cancer (CRC) were enrolled in 2023. Plasma metabolic profiles were detected using gas chromatography-mass spectrometry and liquid chromatography-mass spectrometry, and pathway enrichment analysis was conducted using the Kyoto Encyclopedia of Genes and Genomes. RESULTS Metabolic profiling revealed distinct alterations in gastrointestinal cancers. CRC samples exhibited 455 differentially expressed metabolites (234 upregulated and 221 downregulated). Similarly, GC samples exhibited 459 differentially expressed metabolites (251 upregulated and 208 downregulated). Additionally, 352 shared metabolites were identified among gastrointestinal cancers. Enrichment analysis highlighted the involvement of these shared metabolites in 10 metabolic pathways. CONCLUSION To some extent, this study revealed the metabolomic characteristics of spleen deficiency and blood stasis toxin (PXYD) syndrome in gastrointestinal cancers. It provides the rationale for the "same treatment for different diseases" approach in PXYD syndrome of gastrointestinal cancers, and for identifying potential metabolomics-based biomarkers.

Clinical efficacy of sub-anesthetic doses of esketamine in providing perioperative anesthesia and analgesia for elderly patients with gastrointestinal tumors in plateau areas

To investigate the clinical anesthetic and analgesic effects of sub-anesthetic doses of esketamine in elderly patients with gastrointestinal tumors during the perioperative period in plateau areas, a prospective study was conducted to include elderly patients (≥60 years) undergoing laparoscopic radical resection of gastrointestinal tumors under general anesthesia at the Affiliated Hospital of Qinghai University from June 2023 to October 2024. They were randomly divided into an experimental group and a control group. The experimental group received an intravenous infusion of esketamine at 0.2 mg·kg⁻¹·h⁻¹ from 10 min before anesthesia induction until 10 min before the end of surgery, while the control group was administered an equal-volume infusion of normal saline at the same rate during the same period. The perioperative clinical data and differences in anesthesia and pain-related indicators at different time points were compared between the two groups. Finally, 67 patients were included for analysis, including 33 patients in the control group [23 males, aged (68.8±6.2) years] and 34 patients in the experimental group [24 males, aged (67.7±5.1) years]. There were no significant differences in age, gender, American Society of Anesthesiologists classification, and operation duration between the two groups (all P>0.05). The mean arterial pressure in the experimental group was higher than that in the control group at 1 min of pneumoperitoneum and 30 min of extubation [(87.6±8.5) mmHg vs (81.7±8.8) mmHg; (95.6±10.3) mmHg vs (90.1±9.0) mmHg (1 mmHg=0.133 kPa), all P<0.05]. The visual analog scale for pain in the experimental group was lower than that in the control group at 2, 12, and 24 h after surgery (all P<0.05). The amount of propofol, remifentanil, norepinephrine, and fluid infusion in the experimental group were all lower than those in the control group (all P<0.05), and the recovery time of spontaneous breathing [(8.6±2.6) min vs (13.4±4.1) min, P<0.05] and the awakening time [(11.6±3.5) min vs (16.4±5.2) min, P<0.05] were both shorter than those in the control group. This study suggests that in elderly patients with gastrointestinal tumors undergoing general anesthesia in plateau areas, the combination of sub-anesthetic doses of esketamine can improve the efficacy of anesthesia and analgesia without affecting recovery, and reduce the amount of other anesthetic drugs used.

CO52 | The impact of &lt;i&gt;KRAS&lt;/i&gt; mutations on the risk of recurrent venous thromboembolism in patients with cancer-associated thrombosis and gastrointestinal neoplasms

Background: KRAS mutant malignant cells can lead to overexpression of tissue factor (TF), a main contributor to cancer associated thrombosis (CAT). The relationship between KRAS mutations and the risk of recurrent venous thromboembolism (VTE) in gastrointestinal cancer patients with established CAT is not well established. Aims: to assess the role of KRAS mutation status on VTE recurrence in patients with gastrointestinal cancers and CAT. Design: retrospective single centre study with one year follow-up. Results: We enrolled 138 patients, (M/F:72/66, mean age 62 years; range: 19–85). Cancers types were: oesophageal or duodenal or ileal in 20, pancreatic or biliary or stomach in 59, colon-rectal in 59. KRAS was mutated in 30 patients (wild type in 56, not available in 52). Follow-up at one year was available in 115. There were 25 proximal DVTs, 12 calf DVT, 38 isolated PE, 40 proximal or calf DVT with PE. At 12 months 38 patients died (27%). During one year follow-up, we observed 18 recurrent episodes of VTE (15.6%) of which 12 were DVT, 3 were PE and 3 progressions of previous DVT. Among patients with mutated KRAS, we observed 6 recurrent events (20%) while 6 events were observed in patients with wild type KRAS (11%) ( P=ns), while 6 events occurred in patients in whom KRAS mutation status was not available (11.56%). Conclusions: Our data are preliminary and show a trend in an increased risk of recurrent VTE in patients with CAT and gastro-intestinal cancers with KRAS mutations. Larger studies are required to confirm this observation.

Effects of student standardized patients combined with situational simulation on teaching outcomes of acute and severe gastrointestinal tumors

BACKGROUND Student standardized patients (SSPs) can serve as valuable tools in teaching acute and severe gastrointestinal tumors. AIM To explore the effect of SSP on scenario simulation teaching and its impact on teaching outcomes. METHODS From July 2021 to June 2024, 200 nursing interns were taught about severe gastrointestinal tumor disease. In July 2022 the SSP scenario simulation teaching method was introduced to an observation group of 100 students. A control group of 100 students was taught using traditional methods from July 2021 to June 2022. The traditional teaching included classroom theoretical instruction, laboratory practical teaching, and course assessments. During the practical laboratory sessions, students performed operations using simulation mannequins, and course assessments were based on theoretical test scores combined with practical assessments using the mannequins. The teaching effects of both groups were compared in terms of comprehensive quality and student satisfaction. RESULTS The observation group exhibited significantly higher theoretical and operational scores (P &lt; 0.05), a notably livelier classroom atmosphere (P &lt; 0.05), and a higher learning satisfaction than the control group (98.00% vs 91.00%) (P &lt; 0.05). CONCLUSION SSP combined with scenario simulation teaching enhanced the effectiveness of acute and severe gastrointestinal tumor disease education, improved students’ overall quality, and increased their learning satisfaction, making it a valuable approach for wider adoption.

Risk factors and outcomes of thyroid immune-related adverse events following PD-1/PD-L1 inhibitors treatment in a large tertiary Chinese center.

To investigate the clinical characteristics, related risk factors and outcomes of thyroid immune-related adverse events (irAEs) in patients with malignant solid tumor treated with programmed cell death-1 (PD-1) or programmed cell death-ligand 1 (PD-L1) inhibitors in a large tertiary Chinese center. We retrospectively analyzed the clinical data of 1151 patients with malignant solid tumors who received PD-1 or PD-L1 inhibitors treatment and underwent thyroid function evaluation in a large 3A hospital of Beijing from September 2019 to December 2023. According to the thyroid status after receiving PD-1/PD-L1 inhibitors treatment, patients were divided into normal thyroid group and thyroid irAEs group. The clinical characteristics, including age, gender, tumor type, previous anti-cancer treatment history and thyroid function status were evaluated. After the occurrence of thyroid irAEs, thyroid function evaluation, onset time, and survival outcomes were analyzed. Risk factors that may contribute to the thyroid irAEs were further explored by logistic regression. Out of 1151 patients treated with a PD-1/PD-L1 inhibitor, 257 (22.3%) developed new thyroid irAEs, with the vast majority (98.0%) being hypothyroidism (193/257, 75.1%) and Grade1-2 (252/257, 98.0%), including 252 Hashimoto's thyroiditis (98.0%), 3 subacute thyroiditis (1.17%) and 2 Graves' disease (0.78%). There was a significant difference in the number of treatment cycles of PD-1/PD-L1 inhibitors between the two groups (P = 0.001). In multivariate analysis, gastrointestinal cancer, radiotherapy history, targeted therapy history, positive TgAb and TPOAb at baseline were associated with thyroid irAEs caused by PD-1/PD-L1 inhibitors. Absence of thyroid irAEs predicted increased mortality overall (HR = 2.935, P = 0.024) and particularly in gastrointestinal cancers (HR = 9.453, P = 0.007), despite comparable crude mortality (5.84% vs. 5.82%, P = 0.228). No association was observed in lung/other tumors. Thyroid function recovery occurred in 36.2% of patients, and treatment interruption due to thyroid irAEs was rare (3.5%). In our group, 22.3% patients treated with PD-1/PD-L1 inhibitors developed thyroid irAEs. The main subtype of thyroid irAEs was hypothyroidism (75.1%). Patients with gastrointestinal cancer, previous radiotherapy, history of targeted therapy, and baseline TgAb or TPOAb positivity may increase the risk of thyroid irAEs. Thyroid irAEs was associated with a trend for a survival benefit in patients with gastrointestinal cancer.

Flavonoid-mediated modulation of ferroptosis: therapeutic potential in gastrointestinal cancers.

Flavonoid-mediated modulation of ferroptosis: therapeutic potential in gastrointestinal cancers.

Improvement of fatigue due to placebo in blinded and open labeled cancer fatigue treatment trials.

Improvement of fatigue due to placebo in blinded and open labeled cancer fatigue treatment trials.

Screening for Financial Toxicity and Health-Related Social Risks in Patients With GI Cancer: Results From a Large Cancer Center.

Patients with GI cancers often face significant financial toxicity (FT) and health-related social risks (HRSRs), yet best practices for screening remain unclear. This study aimed to evaluate the prevalence of FT and HRSR and identify associated factors. From June 2022 to August 2023, patients were screened using the Comprehensive Score for Financial Toxicity (COST), patient-reported HRSR (eg, housing, food insecurity), and quality of life (QOL). Multivariate regressions were used to assess predictors of FT and HRSR, adjusting for several variables. Among 8,335 patients with GI cancer, 45% had a COST score of <26, indicating FT. In adjusted linear regression, FT was associated with racial/ethnic minority status (β, 4.20; P < .001), advanced disease (stage III [β, 1.33; P < .001]; IV [β, 1.56; P < .001]), recent treatment (β, 3.23; P < .001), and anal (β, 1.97; P = .003), esophageal (β, 1.66; P = .005), or hepatobiliary cancer (β, 1.05; P = .031). Older age (≥65 years [β, -5.17; P < .001]), higher income ($100,000-$200,000 [β, -1.81; P < .001]; >$200,000 [β, -3.80; P < .001]), and private insurance (β, -1.70; P < .001) were protective. Twenty-eight percent reported at least one HRSR. HRSRs were associated with minority status (odds ratio [OR], 2.14; P < .001), advanced disease (stage III [OR, 1.31; P = .001]; IV [OR, 1.24; P = .010]), recent treatment (OR, 1.20; P = .001), and gastric cancer (OR, 1.25; P = .027). Lower HRSR was associated with older age (OR, 0.59; P < .001), higher income ($100,000-$200,000 [OR, 0.66; P < .001]; >$200,000 [OR, 0.48; P < .001]), and private insurance (OR, 0.64; P < .001). Sex was not a predictor. Worst FT was associated with decreased QOL (β, -0.98; P < .001) and reduced medication adherence (β, 0.11; P < .001). High levels of FT and HRSR were observed in patients with GI cancer. Early intervention to address financial and social burdens may improve both disease and survivorship outcomes.

Comparative clinical outcomes of home parenteral nutrition in adults with gastrointestinal or gynecologic cancers versus non-cancer patients: a prospective cohort study using propensity score matching from the Canadian HPN registry.

Home parenteral nutrition (HPN) is indicated for patients with intestinal failure, but its use in cancer patients requires careful consideration due to the unique challenges and complexities involved. This prospective cohort study analyzed data from cancer patients receiving HPN, recorded in the Canadian HPN Registry from 2003 to 2022. Patients were divided into two groups: those with gastrointestinal or gynecologic cancer and a propensity score-matched cohort of non-cancer patients. The objective was to assess survival rates by performance status and prescription decade in both groups. Secondary objectives were to compare complications between the groups. A total of 400 HPN patients were enrolled: 200 cancer patients (128 gastrointestinal, 72 gynecologic) and 200 matched non-cancer patients. Median age (interquartile range) was 58 (16) years for cancer and 56 (19) for non-cancer groups, with 71.5% and 66.5% female, respectively. Median survival was 1.71 years (95% confidence interval (CI), 0.81-2.61) for gastrointestinal cancer, 0.99 years (95% CI, 0.36-1.6) for gynecologic cancer, and 3.89 years (95% CI, 2.72-5.06) for non-cancer patients (p-value < 0.001). Survival showed no improvement over two decades. Patients with Karnofsky Performance Scale (KPS) ≤ 50 had shorter survival. Catheter complications and HPN-related hospitalizations were similar, but HPN-related liver disease was more common in non-cancer patients (16.5% vs. 9%, p-value = 0.025). Survival for patients with gastrointestinal and gynecologic cancer and co-existing intestinal failure has not improved over the past two decades, with poorer outcomes observed in those with low KPS. Complication rates were similar in both groups. Graphical abstract: Created in BioRender. Unhapipatpong, C. (2025) https://BioRender.com/l25d998 .

The state of cancer research and its association with the cancer burden in Ecuador: a bibliometric study

PurposeCancer has emerged as a major public health concern in Ecuador, reflecting global trends. Thus, it is imperative to understand the country´s cancer research landscape. We aim to conduct a bibliometric analysis of Ecuadorian cancer research publications from 2008 to 2021 to identify research trends, institutional contributions, international collaborations, and the association with the national cancer burden.MethodsArticles were retrieved from Scopus, PubMed, and LILACS databases. Descriptive statistics and chi-square tests were employed to analyze different bibliometric indicators.ResultsA marked increase in cancer-related research output was observed, particularly after 2014. The most common study designs were case reports (n = 244, 30.7%), cross-sectional studies (n = 174, 21.9%) and review articles (n = 131, 16.5%). Universities were the main contributors to national cancer research, accounting for 32.4% (n = 256) of all publications, with private institutions more frequently publishing in higher-ranked journals. Collaborative efforts between universities and hospitals represented 25.3% (n = 200) of publications, though 45.1% of these were indexed in the lowest SCImago Journal Rank quartile (Q4). The most frequently studied cancer types by body location/system were gastrointestinal, gynecologic, and breast cancer. This trend contrasts with national cancer statistics reported in 2022, in which the most common cancer types were breast, prostate (genitourinary), and stomach (gastrointestinal) cancers.ConclusionOur study provides a comprehensive overview of oncology research in Ecuador over a 14-year period. While research output has increased, there remains a need to enhance research quality and ensure closer alignment with the country’s primary cancer burdens to better inform national cancer control strategies.

Mutational signatures in appendiceal adenocarcinomas: potential for future personalization in hyperthermic intraperitoneal chemotherapy?

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has become increasingly utilized in the treatment of appendiceal adenocarcinoma (AA) with peritoneal metastases. There are multiple intraperitoneal chemotherapeutic agents and protocols used at different centers, however there is little data available to guide clinicians on the optimal treatment strategy for individual patients. While it is often treated with paradigms extrapolated from colorectal cancer, AA has been shown to have a distinct mutational profile. Commonly mutated genes in AA such as KRAS and GNAS have been targeted by recently described systemic therapies for various tumors with positive results, suggesting that there may be a role for a patient-centered approach to HIPEC as well. Data specific to AA remains limited, however ongoing research into novel strategies such as next-generation sequencing of tumor samples and in vitro testing of patient-derived organoids for a variety of gastrointestinal cancers with peritoneal metastases has shown promise in personalizingHIPEC regimens.

Abstract A046: Cell states and neighborhoods in distinct clinical stages of primary and metastatic esophageal adenocarcinoma

Abstract Esophageal adenocarcinoma (EAC) is a highly lethal cancer of the upper gastrointestinal tract with rising incidence in western populations. To decipher EAC disease progression and therapeutic response, we performed multiomic analyses of a cohort of primary and metastatic EAC tumors, incorporating single-nuclei transcriptomic and chromatin accessibility sequencing, along with spatial profiling. We recovered tumor microenvironmental features previously described to associate with therapy response. We subsequently identified five malignant cell programs, including undifferentiated, intermediate, differentiated, epithelial-to-mesenchymal transition, and cycling programs, which were associated with differential epigenetic plasticity and clinical outcomes, and for which we inferred candidate transcription factor regulons. Furthermore, we revealed diverse spatial localizations of malignant cells expressing their associated transcriptional programs and predicted their significant interactions with microenvironmental cell types. We validated our findings in three external single-cell RNA-seq and three bulk RNA-seq studies. Altogether, our findings advance the understanding of EAC heterogeneity, disease progression, and therapeutic response. Citation Format: Josephine Yates, Camille Mathey-Andrews, Jihye Park, Amanda Garza, Andreanne Gagne, Samantha Hoffman, Kevin Bi, Breanna Titchen, Connor Hennessey, Joshua Remland, Matthew Carnes, Erin Shannon, Sabrina Camp, Siddhi Balamurali, Shweta Kiran Cavale, Zhixin Li, Akhouri Kishore Raghawan, Agnieszka Kraft, Genevieve Boland, Andrew J. Aguirre, Nilay S. Sethi, Valentina Boeva, Eliezer M. Van Allen. Cell states and neighborhoods in distinct clinical stages of primary and metastatic esophageal adenocarcinoma [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Artificial Intelligence and Machine Learning; 2025 Jul 10-12; Montreal, QC, Canada. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(13_Suppl):Abstract nr A046.

Triterpenoid derivatives inhibit Gli-mediated transcription in human glioblastoma cell line via direct interaction with Gli1.

Triterpenoid derivatives inhibit Gli-mediated transcription in human glioblastoma cell line via direct interaction with Gli1.