Gastrointestinal Malignancy In Patients Research Articles

Analysis of immune-related adverse events in gastrointestinal malignancy patients treated with immune checkpoint inhibitors.

Immune checkpoint inhibitors are becoming an increasingly common treatment for advanced gastrointestinal cancer, but the possibility of immune-related adverse events has raised concerns. This study aimed to evaluate the risks of immune-related adverse events between patients who received immune checkpoint inhibitors and those who received chemotherapy among different types of gastrointestinal cancer. The study utilized data from the multicenter TriNetX database in the United States covering the period between 2015 and 2022. Hazard ratios and 95% confidence intervals were used to describe the relative hazard of immune-related adverse events based on comparing time-to-event rates. Our study revealed that the incidence of immune-related adverse events was significantly higher in patients who received immune checkpoint inhibitors and chemotherapy compared to those who received chemotherapy only in treating gastrointestinal cancer. CTLA-4 inhibitors tended to have a higher rate of immune-related adverse events compared to PD-1/PD-L1 inhibitors. Our study found a lower mortality rate among patients who developed immune-related adverse events compared to those who did not after propensity score matching (HR, 0.661; 95% CI 0.620-0.704; p < .01). We provide important real-world data on the incidence and impact of immune-related adverse events in patients with advanced gastrointestinal cancer treated with immune checkpoint inhibitors. Our study's results support clinicians in making informed decisions about the potential benefits and risks of immune checkpoint inhibitor therapy for patients with gastrointestinal cancer.

Prognostic significance of the systemic inflammation response index in gastrointestinal malignancy patients: a pooled analysis of 10,091 participants.

Background: We performed a meta-analysis to investigate the association of the systemic inflammation response index (SIRI) with long-term survival outcomes in patients with gastrointestinal malignancy. Methods: PubMed, Web of Science and Embase were searched for relevant studies evaluating the prognostic significance of the SIRI in gastrointestinal malignancies until May 2023. Results: 30 studies with 10,091 patients were included. The pooled results identified that patients in the high SIRI group had a worse overall survival and disease-free survival, which was observed across various tumor types, tumor stages and primary treatments. Conclusion: An elevated SIRI is negatively associated with worse survival outcomes of gastrointestinal malignancy patients and can be used as a risk stratification index for gastrointestinal malignancies.

Value of [68Ga]Ga‐FAPI‐04 PET imaging in acute coronary syndrome complicated by suspected gastrointestinal malignancies

AbstractEarly diagnosis of gastrointestinal malignancies in patients with acute coronary syndrome (ACS) is often delayed. The present study aims to demonstrate the value of [68Ga]Ga‐FAPI‐04 PET imaging in ACS with suspected gastrointestinal malignancies. Twelve ACS patients with suspected gastrointestinal malignancies were enrolled, including ST‐elevation myocardial infarction (STEMI) (n = 5), non‐ST‐elevation myocardial infarction (NSTEMI) (n = 5), and unstable angina (UA) (n = 2). All patients underwent coronary angiography (CAG) and [68Ga]Ga‐FAPI‐04 PET/MR or PET/CT within 1 week. All five STEMI and five NSTEMI patients had high [68Ga]Ga‐FAPI‐04 uptake in the injured myocardium compared to remote area (TBR: 2.10 ± 0.72 vs. 0.62 ± 013; p &lt; .001), correlated with peak cTnI level (R = .82, p = .004). No [68Ga]Ga‐FAPI‐04 in the myocardium was found in UA patients. NSTEMI displayed a similar myocardial [68Ga]Ga‐FAPI‐04 intensity as STEMI (p = .42). Compared with STEMI, NSTEMI patients had a significantly delayed door‐to‐balloon time for reperfusion treatment (p = .023). High uptake of [68Ga]Ga‐FAPI‐04 in the gastrointestinal tract was detected in three patients. Because of no myocardial [68Ga]Ga‐FAPI‐04 expression, they discontinued antiplatelet therapy and underwent endoscopy. The rectal, colon, and gastric cancer diagnoses were made by biopsy. The other nine patients showed no accumulation of [68Ga]Ga‐FAPI‐04 beyond the heart, and invasive tumor examinations were delayed. During a median 6‐month follow‐up, no tumor formation was observed. [68Ga]Ga‐FAPI‐04 PET imaging is valuable to assess injured myocardium, detect tumors, and guide invasive examinations in ACS patients with suspected gastrointestinal malignancies.

S3084 Metastatic Pancreatic Tail Adenocarcinoma Presenting With Multiple Hepatosplenic Abscesses: A Case Report

Introduction: Pancreatic cancer is the third leading cause of cancer-related deaths in the United States. It is often detected in advanced stages and may present in unusual ways such as pyogenic liver abscesses (PLA) or splenic abscesses which may be a diagnostic and therapeutic challenge. Case Description/Methods: A 78-year-old dialysis-dependent man with a history of end stage renal disease, hypertension and cerebrovascular accident was evaluated for diffuse abdominal pain and altered mental status for one day. The examination was pertinent for generalized weakness and altered sensorium. Laboratory tests revealed transaminitis and leukocytosis. Computed tomography (CT) of the abdomen and pelvis showed multiple hypoattenuating hepatic foci with hepatosplenomegaly. A set of blood cultures grew Clostridium inoculum. A pyogenic liver abscess was diagnosed, drained percutaneously and the culture grew pansensitive Escherichia coli. A follow up CT of the abdomen and pelvis revealed a large splenic abscess. Exploratory laparotomy, splenectomy, liver biopsy and peritoneal lavage were performed. Immunostaining of the sample was positive for CK7, CK20 and CDX2. Pancreaticobiliary adenocarcinoma metastatic to the spleen and liver was confirmed by pathology. CA 19-9 and CA 125 were elevated. A repeat CT of the abdomen with pancreatic protocol showed a pancreatic tail mass. Vancomycin resistant Enterococcus faecium grew on peritoneal fluid culture. Daptomycin and ceftriaxone were started. The patient improved clinically but he was deemed unsuitable for further invasive procedures or chemotherapy. (Figure) Discussion: Uncommon presentations of pancreatic adenocarcinoma include gastrointestinal (GI) bleeding from metastasis and acute abdomen from splenic infarct. PLA is associated with GI malignancies including pancreatic cancer. Some experts recommend cancer evaluation for GI malignancies in patients with PLA. Mucosal barrier breach by cancer cells, translocation of bacteria into the circulation and inoculation at metastatic sites are possible explanations for developing liver and splenic abscesses. Dialysis is also a risk factor for hepatosplenic abscess. In an elderly patient with hepatosplenic abscess and elevated tumor markers, a thorough evaluation for GI malignancies including pancreatic cancer should be done.Figure 1.: Image 1 shows cancer in the spleen. Images 2-3 show positive immunostains for CK7 in image 2, CK20 in image 3. Image 4 shows the cancer in the liver biopsy (no normal liver is present). Image 5 shows non-enhancing hypoattenuated foci in the right and left lobes of the liver most consistent with multifocal liver abscesses. Image 6 shows splenomegaly with multiple hypoattenuated foci and a mass within the tail of the pancreas.

S131 Clinical Application of Circulating Tumor DNA in Gastrointestinal Cancer Patients

Introduction: Circulating tumor DNA (ctDNA) derived from apoptotic tumor cells is rapidly emerging as a non-invasive biomarker to detect the presence of tumor at a molecular level and guide therapy. In this study, we present our experience with this novel marker in gastrointestinal malignancy (GIM) patients. Methods: We included all patients with GIM for whom ctDNA was ordered from January 2020 to July 2021 at our center. Patient demographics, tumor type, pathology, stage, and radiographic findings were collected. Descriptive statistics were employed to report findings. Results: We identified 62 GIM patients for whom ctDNA was ordered. Results for 6 patients were not reported due to insufficient tumor tissue. Of the 56 patients for whom ctDNA results were available, 46 (82%) had colorectal adenocarcinoma (CRC) and the rest had other GI malignancies. Of the overall cohort of 56 evaluable patients, 21 (37.5%) had metastatic disease. Imaging findings paralleled ctDNA levels and correlated with tumor burden in 30 patients (53.5%). In 13 patients (23.2%), undetectable CT DNA levels influenced decisions regarding systemic therapy in addition to acting as a surrogate for treatment response. We discontinued maintenance therapy in 5 metastatic CRC patients with negative ctDNA and imaging. These patients have been off treatment for > 12 months without evidence of recurrence. We also truncated or skipped adjuvant treatment in 6 Stage III CRC patients with negative ctDNA and imaging who had significant post-operative complications or were otherwise considered high risk for severe toxicity. In one CRC patient, ctDNA was found to be undetectable post neoadjuvant therapy which corroborated with pathological complete response on surgical pathology report. 5 patients (9.09 %) had false-negative results and 1 patient had falsely elevated levels. In 6 other patients, we could not draw significant conclusions due to the availability of only a single value. Conclusion: Our experience suggests that ctDNA is not only a sensitive tool to assess tumor burden, but can also help guide therapy in locally advanced and metastatic CRC patients. However, further prospective studies are needed to improve the accuracy of test results and integrate ctDNA in day-to-day clinical practice.

Value of age and alarm features for predicting upper gastrointestinal malignancy in patients with dyspepsia: an endoscopic database review of 4664 patients in Thailand

ObjectiveAge and alarm features are commonly used as indicators for endoscopy in dyspeptic patients; however, the age cut-off and the predictive value of these parameters for identifying upper gastrointestinal (UGI)...

Gastrointestinal Cancer Surgery During COVID Times

COVID pandemic has taken the whole world off guard, and it has lasting serious implications on every aspect of human life. Surgical services for our elective cases are suffering. There are a lot of issues related to gastrointestinal (GI) cancer patients in these COVID times. It is difficult to decide whether to operate on these patients taking the risk or delay the surgery with attendant risk of cancer progression or use some alternative protocols. Here, we aim to offer guidance for the prioritization of surgical services to further minimize the effect of the COVID-19 pandemic across various overburdened surgical units and to preserve the surgical workforce with special emphasis on GI malignancy patients.

Identification of upper gastrointestinal malignancy in patients with uncomplicated dyspepsia referred under the two-week-wait cancer pathway: a single-centre, 10-year experience.

In the United Kingdom, the National Institute for Health and Care Excellence 2015 guidance recommend that for suspected gastric or oesophageal cancer, general practitioners consider a non-urgent, direct-access endoscopy in patients over 55 years with only uncomplicated treatment-resistant dyspepsia. In practice, patients are referred under the urgent 2-week-wait cancer pathway. We compared the frequency of gastric or oesophageal carcinoma in patients referred to our centre on the 2-week-wait pathway with uncomplicated dyspepsia to those who have a combination of additional alarm symptoms. The four most common indications for endoscopy referral on the 2-week-wait pathway and all combinations of those indications were examined: Dyspepsia ('ulcer-like', 'non-ulcer-like' or 'reflux-like' dyspepsia), anaemia, weight loss or dysphagia. Over 10 years, 9012 two-week-wait gastroscopies were performed, and a tumour was identified in 256 patients (2.84%). One thousand and three hundred six gastroscopies performed for uncomplicated dyspepsia and only 6 patients (0.46%) had a tumour. Therefore, uncomplicated dyspepsia alone had a poor positive predictive value of detecting gastric or oesophageal cancer. Our findings suggest dyspepsia had no significant cumulative effect on the number of patients with anaemia or weight loss found to have a lesion at endoscopy but indeed significantly decreased the likelihood of finding a tumour in those with dysphagia. Dyspepsia as a parameter to investigate gastric or oesophageal cancer contributes significantly to the growth in number of 2-week-wait referrals at a time when endoscopy units battle to meet demand. Our data show patients with uncomplicated dyspepsia rarely have gastric or oesophageal cancer and should not undergo endoscopies under the urgent 2-week-wait pathway.

Role of feeding procedures in upper gastro-intestinal malignancy patients undergoing radiotherapy

Background: Malnutrition in cancer patients can limit their response to treatment, surgery, chemotherapy and radiotherapy. Oral supplementation is not feasible in patients with cancers of oral cavity, oropharynx, hypopharynx, oesophagus and oesophagogastric junction (OG junction) who undergo radiotherapy or chemotherapy or in the palliative setting due to the growth itself. To compare open feeding gastrostomy with feeding jejunostomy in terms of improvement in the nutritional status of the cancer patient.Methods: This prospective comparative study was done in patients with gastro-intestinal malignancies who underwent feeding gastrostomy and jejunostomy before radiotherapy were studied.Results: In 26 patients, 8 patients underwent FG and 18 patients FJ procedure. There was no statistical difference in the increase or decrease in BMI between the two arms. There was an increase in serum albumin level following the feeding procedures both FG and FJ. 71.4% of patients in the FJ arm expressed a feeling of satiety at three months compared to FG arm where only 28.6% of patients were satisfied.Conclusions: In our study, patients in both FG and FJ arms were able to maintain the BMI and serum albumin levels so as to complete radiotherapy. Feeding jejunostomy as enteral nutrition access still plays a role in developing countries with limited resources to enable these patients to complete the planned treatment.

Strategy of surgical management on abdominal aortic aneurysm combined with gastrointestinal malignancy

The incidence of concomitant abdominal aortic aneurysm (AAA) combined with gastrointestinal malignancy is rare, but it still represents an issue of controversy regarding the optimal treatment. It is unclear whether to treat the AAA and gastrointestinal malignancy simultaneously or in a staged manner as both options offer advantages but also carry some substantial risks. This study attempts a historical review of the surgical practice during the past decades by reviewing the existing literatures on this topic. In general, the most symptomatic lesion or the most life threatening condition should be treated firstly. Large aneurysm should usually be resected in preference to gastrointestinal malignancy unless the tumor is locally advanced, perforated or likely to result in intestinal obstruction. If both lesions are complicated there may be a case for simultaneous treatment. The evolution of vascular stents and the reported efficacy of endovascular aortic repair (EVAR) provide an alternative method for treating high risk patients. If the anatomical criteria are satisfied, EVAR combined with laparoscopic operation could become the optimal solution for the concomitant AAA and gastrointestinal malignancy patients, especially those who require minimally invasive treatment. Key words: Abdominal aortic aneurysm; Gastrointestinal malignancy; Surgical procedures, operative; Endovascular aortic repair

Randomized phase II study of TJ-54 (Yokukansan) for postoperative delirium in gastrointestinal malignancy patients.

115 Background: Delirium is one of the common postoperative complications. When postoperative delirium occurred, the patient management becomes much more difficult, leading to functional recovery delay, and is also associated with postoperative mortality and morbidity. Although many attempts to prevent and treat delirium have been developed, a higher level of evidence is needed. In the present study, we evaluated the efficacy and safety of TJ-54 (Yokukansan; one of the traditional Japanese medicines, Kampo) for the prevention and/or treatment of postoperative delirium in a randomized phase III trial for the patients receiving surgery for gastrointestinal malignancy. Methods: Patients 70 years of age or older, who were received surgery for gastrointestinal malignancy were eligible in this study. The 167 eligible patients were randomly assigned on a 1:1 ratio to receive TJ-54 or control during their perioperative care (between day 7 before surgery and day 4 after surgery). The signs and symptoms of delirium were assessed with using Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV by the investigator during perioperative period. Results: We analyzed 167 eligible gastrointestinal malignancy patients (TJ-54; 83, control; 84). There were no disparities between the two PPS randomized groups. The incidence of delirium was 7.2% (6 patients) in the TJ-54 group and 10.7% (9 patients) in the control group with no significant difference (p=0.431), also no significant difference was observed in duration of delirium between the two groups (p=0.477). The ratio of patients who needed some kind of the medication which including treatment of delirium were significantly less in the TJ-54 group than in the control group (p=0.037). Conclusions: In this study, TJ-54 did not demonstrate the contribution to prevention of occurring delirium in the patients receiving surgery for gastrointestinal malignancy. However, TJ-54 might be effective in reducing the medication for treating delirium after surgery for gastrointestinal malignancy. Clinical trial information: 000005423.

Endoscopy is of low yield in the identification of gastrointestinal neoplasia in patients with dermatomyositis: A cross-sectional study.

AIMTo determine the prevalence of gastrointestinal neoplasia among dermatomyositis patients who underwent an esophagogastroduodenoscopy and/or colonoscopy.METHODSA cross-sectional study examining the results of upper endoscopy and colonoscopy in adults with dermatomyositis at an urban, university hospital over a ten year period was performed. Chart review was performed to confirm the diagnosis of dermatomyositis. Findings on endoscopy were collected and statistical analyses stratified by age and presence of symptoms were performed.RESULTSAmong 373 adult patients identified through a code based search strategy, only 163 patients had dermatomyositis confirmed by chart review. Of the 47 patients who underwent upper endoscopy, two cases of Barrett’s esophagus without dysplasia were identified and there were no cases of malignancy. Of the 67 patients who underwent colonoscopy, no cases of malignancy were identified and an adenoma was identified in 15% of cases. No significant differences were identified in the yield of endoscopy when stratified by age or presence of symptoms.CONCLUSIONThe yield of endoscopy is low in patients with dermatomyositis and is likely similar to the general population; we identified no cases of malignancy. A code based search strategy is inaccurate for the diagnosis of dermatomyositis, calling into question the results of prior population-based studies. Larger studies with rigorously validated search strategies are necessary to understand the risk of gastrointestinal malignancy in patients with dermatomyositis.

Diagnostic value of alarm symptoms for upper GI malignancy in patients referred to GI clinic: A 7 years cross sectional study.

Background:Early upper gastrointestinal (UGI) cancer detection had led to organ-preserving endoscopic therapy. Endoscopy is a suitable method of early diagnosis of UGI malignancies. In Iran, exclusion of malignancy is the most important indication for endoscopy. This study is designed to see whether using alarm symptoms can predict the risk of cancer in patients.Materials and Methods:A total of 3414 patients referred to a tertiary gastrointestinal (GI) clinic in Isfahan, Iran, from 2009 to 2016 with dyspepsia, gastroesophageal reflux disease (GERD), and alarm symptoms, such as weight loss, dysphagia, GI bleeding, vomiting, positive familial history for cancer, and anorexia. Each patient had been underwent UGI endoscopy and patient data, including histology results, had been collected in the computer. We used logistic regression models to estimate the diagnostic accuracy of each alarm symptoms.Results:A total of 3414 patients with alarm symptoms entered in this study, of whom 72 (2.1%) had an UGI malignancy. According to the logistic regression model, dysphagia (P < 0.001) and weight loss (P < 0.001) were found to be significant positive predictive factors for malignancy. Furthermore, males were in a significantly higher risk of developing UGI malignancy. Through receiver operating characteristic curve and the area under the curve (AUC) with adequate overall calibration and model fit measures, dysphagia and weight loss as a related cancer predictor had a high diagnostic accuracy (accuracy = 0. 72, AUC = 0. 881). Using a combination of age, alarm symptoms will lead to high positive predictive value for cancer.Conclusion:We recommend to do an early endoscopy for any patient with UGI symptoms and to take multiple biopsies from any rudeness or suspicious lesion, especially for male gender older than 50, dysphagia, or weight loss.

Myeloid-derived suppressor cells in gastrointestinal cancers: A systematic review.

Gastrointestinal (GI) cancers are a heterogeneous group of cancers originating from the digestive system. Considering key roles of myeloid-derived suppressor cells (MDSCs) in the immunosuppression network, levels of MDSCs in patients with cancer are assumed to be of prognostic and predictive value. In this systematic review, we aimed to evaluate the clinical relevancy of MDSCs and their relationship with clinical features and prognosis of GI malignancies in patients with GI cancers. We searched Medline, Scopus, DART, OpenGrey, and ProQuest without applying any language filter up to 1 August 2015. Two of the authors independently reviewed search results for irrelevant and duplicate studies and extracted data from studies. We used tabulation to synthesize the findings of the studies and transformed data into a common rubric and calculated a weighted treatment effect across studies using Review Manager. We found 1238 references in five databases, and after exclusion of irrelevant and duplicate studies, 17 studies with a total number of 1115 patients with GI cancers were included. A meta-analysis of three studies showed associations of high MDSC levels with higher mortality during follow-up periods (hazard ratio = 3.35; 95% confidence interval = 1.46-7.68, P = 0.0004). A meta-analysis of four studies showed that patients with higher levels of MDSC had higher odds of having an advanced cancer (odds ratio = 2.64; 95% confidence interval = 1.53-4.53; P = 0.0004). There were also significant associations between MDSC levels and relapse, tumor progression, lymph node involvement, and metastasis. In conclusion, results of this systematic review based on the available literature suggest that MDSC levels are of clinical relevancy and prognostic and predictive value.

The predictive value of alarm features for upper gastrointestinal malignancy: a single-center retrospective study

Objective To determine the diagnostic accuracy of alarm features in predicting upper gastro intestinal malignancy in patients who received gastroscopy examination. Methods A retrospective analysis of patients who underwent gastroscopy from Oct 2014 to Oct 2015 was conducted. Biopsy or surgical pathological findings served as the golden standard. The main outcome measure was the diagnostic accuracy of alarm features. Results Among 921 gastrointestinal outpatients, 39 patients (4.2%) with malignancy were detected, including 13 (33.3%) with esophageal cancer, 24 (61.5%) with gastric cancer and 2 (5.1%) with duodenal ampulla cancer. 36 patients (92.3%) were found with advanced cancer. In 137 patients who had alarm features, 21 (15.3%) were found to have malignancy and all were advanced. The sensitivity, specificity, positive predictive value and negative predictive value of alarm features were 53.8% (21/39), 86.8% (766/882), 15.3% (21/137) and 97.7% (766/784), respectively. Conclusions Alarm features have a definite but limited value in predicting upper gastrointestinal malignancy. Non-invasive screening methods for Chinese patients are still needed to reduce unnecessary endoscopy workload. Key words: Esophageal neoplasms; Stomach neoplasms; Ampulla cancer; Gastroscopes; Alarm feature

Effect of Medications on Risk of Cancer in Patients With Inflammatory Bowel Diseases: A Population-Based Cohort Study from Olmsted County, Minnesota

ObjectivesTo estimate the overall risk of cancer in a population-based cohort of patients with inflammatory bowel disease (IBD) and how IBD-related medications modify this risk. MethodsWe identified all incident cancers (excluding nonmelanoma skin cancer) after IBD diagnosis in a cohort of 839 patients diagnosed as having IBD from January 1, 1940, through December 31, 2004, in Olmsted County, Minnesota, and followed up for a median 18 years through December 31, 2011 (122 patients taking biologic agents at last follow-up). We calculated standardized incidence ratios (SIRs) with 95% CIs of all cancers and compared cancer risk in patients treated with immunomodulators (IMMs) and biologics with that of patients not exposed to these medications, using an incidence rate ratio (IRR). ResultsOne hundred nine patients developed 135 cancers. The 10-year cumulative probability of cancer was 3.8%. Patients with Crohn disease (SIR, 1.6; 95% CI, 1.2-2.1) but not ulcerative colitis (SIR, 1.1; 95% CI, 0.8-1.4) had an increased overall risk of cancer compared with the general population. Patients treated with IMMs (relative to IMM-naive patients) had an increased risk of melanoma (IRR, 5.3; 95% CI, 1.1-24.8) (and a numerically higher risk of hematologic malignant tumors [IRR, 4.2; 95% CI, 0.9-19.2]), although this risk returned to baseline on discontinuation of IMM treatment. Patients treated with biologics (relative to biologic-naive patients) had a numerically higher risk of hematologic malignant tumors (IRR, 5.3; 95% CI, 0.7-40.5). There was no significant increase in the risk of gastrointestinal malignancies in patients with IBD compared with the general population. ConclusionsWe observed an increased risk of melanoma in IMM-treated patients with IBD, and this risk returned to baseline after discontinued use of the medications.

Mo2002 Streptococcus Bovis Bacteremia and Gastrointestinal Malignancy: Dogma Revisited

BACKGROUND: Streptococcus bovis bacteremia (SBB) has been associated with gastrointestinal (GI) malignancies, namely colorectal cancer. For this reason, screening colonoscopy for SBB patients is recommended in current practice. However, these recommendations are primarily based on data from case reports and case series. AIM: Determine the incidence of gastrointestinal malignancies in patients with SBB in a regional population-based setting. METHODS: We performed a retrospective cohort study on data from January 2000 December 2013 from a regional, integrated healthcare system in Southern California. All adult patients with positive S. bovis blood cultures were identified. New cases of GI malignancy were identified through an internal prospective cancer registry. Incidence rates (IR) of primary GI malignancies (e.g. colorectal, esophageal, gastric, small intestinal, pancreatic, hepatocellular carcinoma, cholangiocarcinoma, gallbladder, and appendiceal) among the SBB patients were compared to the ageand sex-matched reference population. A priori, we planned to evaluate the impact of S. bovis subspecies on the risk of malignancy. Patients were censored based on death, loss to follow-up, or study end. RESULTS: 356 cases (209 male, 58.7%) with a mean follow-up of 8.75 years (3,115 person-years) of SBB were identified, and among these, 54 new cases of primary GI malignancy were identified. The reference population consisted of 13,976,494 patients with a mean follow-up of 2.76 years (38,630,000 person-years), and among these, 33,208 primary GI malignancies developed. The age-sex adjusted incidence rates for the SBB and the reference populations to develop any GI malignancy were 1301.26 per 100,000 (95% CI 700.28-1902.23) and 85.94 per 100,000 (95% CI 84.99-86.89), respectively; the overall standardized incidence rate ratio (SIRR) for risk of any GI malignancy was 15.14 (95% CI 9.54-24.03; p<0.0001). More specifically, for colon cancer (n= 23 cases in the SBB population), the SIRR was 17.10 (95% CI 8.4134.76; p<0.0001). The highest SIRRs were associated with hepatocellular carcinoma (n=7, SIRR=20.49 (95% CI 8.01-52.40, p<0.0001)) and with gastric cancer (n=5, SIRR=25.75 (95% CI 5.21-127.28, p=0.0001)). We were unable to evaluate the impact of S. bovis subspecies as sub-speciation was not routinely performed. CONCLUSION: To our knowledge, this is the largest longitudinal cohort study to date to systematically evaluate the incidence of gastrointestinal malignancy in patients with SBB. We have confirmed that SBB is associated with an increased risk for colon cancer. However, the greatest increase in relative risk was for primary liver and stomach cancers.

Mo2003 Long-Term Prospective Observational Study of Cancer Risk Among Pantoprazole Users

BACKGROUND: Streptococcus bovis bacteremia (SBB) has been associated with gastrointestinal (GI) malignancies, namely colorectal cancer. For this reason, screening colonoscopy for SBB patients is recommended in current practice. However, these recommendations are primarily based on data from case reports and case series. AIM: Determine the incidence of gastrointestinal malignancies in patients with SBB in a regional population-based setting. METHODS: We performed a retrospective cohort study on data from January 2000 December 2013 from a regional, integrated healthcare system in Southern California. All adult patients with positive S. bovis blood cultures were identified. New cases of GI malignancy were identified through an internal prospective cancer registry. Incidence rates (IR) of primary GI malignancies (e.g. colorectal, esophageal, gastric, small intestinal, pancreatic, hepatocellular carcinoma, cholangiocarcinoma, gallbladder, and appendiceal) among the SBB patients were compared to the ageand sex-matched reference population. A priori, we planned to evaluate the impact of S. bovis subspecies on the risk of malignancy. Patients were censored based on death, loss to follow-up, or study end. RESULTS: 356 cases (209 male, 58.7%) with a mean follow-up of 8.75 years (3,115 person-years) of SBB were identified, and among these, 54 new cases of primary GI malignancy were identified. The reference population consisted of 13,976,494 patients with a mean follow-up of 2.76 years (38,630,000 person-years), and among these, 33,208 primary GI malignancies developed. The age-sex adjusted incidence rates for the SBB and the reference populations to develop any GI malignancy were 1301.26 per 100,000 (95% CI 700.28-1902.23) and 85.94 per 100,000 (95% CI 84.99-86.89), respectively; the overall standardized incidence rate ratio (SIRR) for risk of any GI malignancy was 15.14 (95% CI 9.54-24.03; p<0.0001). More specifically, for colon cancer (n= 23 cases in the SBB population), the SIRR was 17.10 (95% CI 8.4134.76; p<0.0001). The highest SIRRs were associated with hepatocellular carcinoma (n=7, SIRR=20.49 (95% CI 8.01-52.40, p<0.0001)) and with gastric cancer (n=5, SIRR=25.75 (95% CI 5.21-127.28, p=0.0001)). We were unable to evaluate the impact of S. bovis subspecies as sub-speciation was not routinely performed. CONCLUSION: To our knowledge, this is the largest longitudinal cohort study to date to systematically evaluate the incidence of gastrointestinal malignancy in patients with SBB. We have confirmed that SBB is associated with an increased risk for colon cancer. However, the greatest increase in relative risk was for primary liver and stomach cancers.

Prognostic and Predictive Value of the Peritoneal Cancer Index in Primary Advanced Epithelial Ovarian Cancer Patients After Complete Cytoreductive Surgery: Study of Tumor Bank Ovarian Cancer

The peritoneal cancer index (PCI) is used to refer gastrointestinal malignancy patients to either palliative or curative management of their peritoneal carcinomatosis. The aim of this retrospective study was to evaluate the prognostic value of the PCI in patients with primary advanced epithelial ovarian cancer (EOC) after complete cytoreductive surgery. PCI quantitatively assesses cancer distribution on the peritoneum by calculating tumor sizes in each of 13 abdominopelvic regions. Correlation between PCI score and clinical factors were analyzed using Kendall's tau b. Univariate and multivariate survival analyses were performed with the Kaplan-Meier method and Cox regression model, respectively. We retrospectively enrolled 80 consecutive patients with primary EOC treated in our gynecology department. All patients underwent complete cytoreductive surgery. Patients whose history included interval tumor debulking and completion cytoreductive surgery were excluded. Most tumors were of a serous histological subtype (96.3%). Median age at diagnosis was 58.0years. Their median PCI score was 12.0 (range 3-32). We found statistical correlations between PCI and ascites (p=0.001), surgery duration (p<0.001), T status of TNM staging (p=0.036), and preoperative CA 125 (p=0.025). In the univariate analysis, higher PCI scores were related to poor overall (OS) and progression-free (PFS) survival rates (p=0.036 and p<0.001, respectively). Multivariate analysis showed that the association remained significant only for PFS (p=0.005), not for OS (p=0.162). PCI did not portend OS in patients with primary ovarian cancer. Further prospective and multicenter studies are needed to validate these results.

A Patient with Advanced Gastric Cancer Presenting with Extremely Large Uterine Fibroid Tumor

Introduction. Uterine fibroid tumors (uterine leiomyomas) are the most common benign uterine tumors. The incidence of uterine fibroid tumors increases in older women and may occur in more than 30% of women aged 40 to 60. Many uterine fibroid tumors are asymptomatic and are diagnosed incidentally. Case Presentation. A 44-year-old woman was admitted to our hospital with general weakness, dyspepsia, abdominal distension, and a palpable abdominal mass. An abdominal computed tomography scan showed a huge tumor mass in the abdomen which was compressing the intestine and urinary bladder. Gastroduodenal endoscopic and biopsy results showed a Borrmann type IV gastric adenocarcinoma. The patient was diagnosed with gastric cancer with disseminated peritoneal carcinomatosis. She underwent a hysterectomy with both salphingo-oophorectomy and bypass gastrojejunostomy. Simultaneous uterine fibroid tumor with other malignancies is generally observed without resection. But in this case, a surgical resection was required to resolve an intestinal obstruction and to exclude the possibility of a metastatic tumor. Conclusion. When a large pelvic or ovarian mass is detected in gastrointestinal malignancy patients, physicians try to exclude the presence of a Krukenberg tumor. If the tumors cause certain symptoms, surgical resection is recommended to resolve symptoms and to exclude a metastatic tumor.