Primary Stomach Cancer Research Articles

The risk and distribution of second primary cancers according to subsite of primary stomach cancer: a retrospective cohort population-based study

Background: The development of second primary cancers (SPCs) following a diagnosis of stomach cancer presents a significant clinical challenge, with varying risks depending on the anatomic subsite of the primary tumor, patient demographics, and treatment modalities. This study aims to assess the risk of SPCs in stomach cancer survivors, focusing on differences across anatomic subsites, gender, age, and treatment periods. Methods: We conducted a retrospective cohort study using data from stomach cancer patients, analyzing the incidence of SPCs based on the anatomic location of the primary tumor, with stratifications by gender, age, latency period, and year of diagnosis. Standardized incidence ratios (SIRs) were calculated to compare the observed SPC rates with those expected in the general population. Results: Elevated stomach SPC risk was observed across most anatomic subsites, particularly in the body (SIR 8.84) and fundus (SIR 7.34). Females exhibited higher SIRs compared to males, especially in the fundus (SIR 13.33 for females vs. 4.55 for males). Younger patients (<50 years) had significantly higher SPC risks, particularly for cancers originating in the fundus (SIR 49.56). Notably, patients diagnosed after 2010 showed the highest SIRs, indicating a potential impact of advances in diagnostic and therapeutic modalities. Non-stomach SPCs, including colorectal, lung, and thyroid cancers, were significantly elevated, with distinct patterns based on the primary tumor site. Conclusions: The study highlights the critical role of primary tumor location, gender, age, and treatment era in determining SPC risk in stomach cancer survivors. These findings underscore the need for tailored surveillance strategies to manage long-term cancer risks in this population.

Surgically treated brain metastases of gastric origin: a case series and systematic review

BackgroundThe incidence of brain metastases from gastric origin is less than 1% in those with primary gastric cancer. Given this exceedingly rare presentation, there is limited literature describing the outcomes of their neurosurgical treatment. We wish to identify the role of surgical intervention for brain lesions in metastatic gastric cancer via institutional case series and systematic review. MethodsThis study was divided into two sections: (1) a retrospective, single-center patient series assessing outcomes of neurosurgical treatment modalities in patients with malignancy arising from the stomach with brain metastases and (2) a systematic review abiding by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines between the years of 1980 and 2021 assessing outcomes of patients with primary stomach cancer with metastasis to the brain treated with surgery. ResultsFour patients with gastric brain metastases were treated at our institution, and 16 patients were identified in literature from a total of 9 studies and case reports. The mean age at the time of stomach cancer diagnosis was 57.3 years, with a mean time to brain metastases of 14.8 months. The primary gastric cancer was most commonly adenocarcinoma (70%). Patients most presented with single lesions (58%) and were treated with multimodal neurosurgical intervention (65%). Mean overall survival following neurosurgery was 12.45 months. ConclusionBrain metastases from gastric origin are extremely rare. Surgical resection of metastatic brain lesions should be considered as a treatment modality in surgical candidates. Future attention should be given to the effect of adjuvant therapies and surgical techniques on survival and quality of life.

Trends in age-standardised net survival of stomach cancer by subsite and stage: A population-based study in Osaka, Japan, 2001-2014

IntroductionThe burden of stomach cancer remains high, particularly among Asian countries. Although Japan is known to achieve high survival from stomach cancer, little is known regarding the survival trends for recent years and survival by subsite and stage. We report age-standardised 1-, 3-, 5- and 10-year net survival for patients diagnosed with stomach cancer in Osaka, Japan. MethodsWe analysed patients diagnosed with primary stomach cancer and registered in the population-based cancer registry in Osaka Prefecture between 2001 and 2014. We used the non-parametric Pohar Perme method to derive net survival for each year. Both cohort and period approaches were used. Age was standardised using weights of the external population of the International Cancer Survival Standard. Multiple imputation was applied to handle missing information on subsite and stage before estimating age-standardised net survival by subsite (cardia and non-cardia) and stage (localised, regional and distant metastasis). We then examined general trends in the cohort-based survival estimates, as well as by subsite and stage, using linear regression. ResultsA total of 97,276 patients were included in the analysis. Age-standardised net survival improved steadily (mean annual absolute change ≥1.2%). Net survival for both subsites improved, but cardia cancer showed 7–23% lower survival than non-cardia cancer throughout the study period. Five-year net survival remained high (≥80%) in the localised stage from the beginning of this study. Net survival increased steeply (≥1.4% per year) in the regional stage. Although 1-year net survival increased by 14% in the distant stage, 5-year and 10-year net survival remained below 10%. ConclusionAge-standardised net survival for stomach cancer in Japan improved during the study period owing to an increase in the number of patients with localised stage at diagnosis and improved treatment. Monitoring both short- and long-term survival should be continued as management of stomach cancer progresses.

Metastatic Carcinoma of the Breast Mimicking Clinically and Histologically a Primary Gastric Carcinoma: A Case Report

The stomach is one of the frequent sites of metastasis from invasive lobular carcinoma of the breast. The clinical presentation and the endoscopic findings for metastasis carcinoma are nonspecific and may mimic that of a primary gastric tumor. The distinction between these two neoplasms may be very difficult but essential as the basis of the treatment is different. Histological and immunohistochemical analyses are the gold standard for establishing the diagnosis of the primary site. We report the case of a 68-yearold patient with metastatic breast cancer mimicking a primary stomach cancer.

Decisional balance, self-leadership, self-efficacy, planning, and stages of change in adopting exercise behaviors in patients with stomach cancer: A cross-sectional study.

Previous studies have suggested the benefits of regular exercise in motivating the survivors of cancer; however, most survivors are insufficiently active, showing high rates of nonadherence to physical activity guidelines. Using the I-Change model, this study sought to determine the association of decisional balance and self-efficacy for exercise, planning, and self-leadership with the stages of change in exercise behavior among patients with stomach cancer. This cross-sectional study was conducted in February 2021 and included 145 patients diagnosed with primary stomach cancer via quota sampling in South Korea. Sociodemographics, comorbidity, decisional balance for exercise, self-efficacy for exercise, planning, self-leadership, and stages of change in exercise behavior were assessed. Of the participants, 4% were in the precontemplation stage of exercise behavior, 10% contemplation, 37% preparation, 23% action, and 27% maintenance. The male sex (p=0.043), higher self-efficacy for resisting relapse (p<0.0001), higher coping planning (p=0.029), and higher self-leadership for behavior awareness and volition (p=0.023) were associated with more readiness for changes in exercise behavior. From the results obtained using the I-Change model, self-efficacy for resisting relapse to previous habits, coping planning, and behavior awareness and volition were associated with more readiness for changes in exercise behavior. These findings may help reduce stomach cancer survivors' nonadherence to physical activity guidelines.

Retraction Note: Evaluation of PAX8 expression promotes the proliferation of stomach Cancer cells

PAX8 was not only a mitotic factor, but identified as a transcription factor involved in the prognosis of human tumor patients. Elucidating the function of PAX8 on the pathology of stomach cancer was meaningful. PAX8 was found to be upregulated in primary stomach cancer tissue and the TCGA stomach cancer dataset. Interestingly, SOX13 and PAX8 showed consistent expression patterns, and the combined high PAX8 and SOX18 expression induced a worse prognosis of stomach cancer patients. SOX13 was further identified as a transcription factor of PAX8, and further affect Aurora B and Cyclin B1 expression, two cell cycle related factors of the downstream of PAX8, including. Furthermore, PAX8 depletion inducted G1-phase arrest and the decrease of EdU incorporation, cell viability and colony formation can be rescued by SOX13 overexpression. SOX13 participated in the elevated expression of PAX8, which promote the proliferation of stomach cancer cells. Therefore, SOX13 mediated PAX8 expression was recognized as a tumor-promoting role in stomach cancer.

Gastrointestinal Cancer Survival and Radiation Exposure among Atomic Bomb Survivors: The Life Span Study.

Radiation exposure is an established risk factor for the development of several forms of cancer, including gastrointestinal cancers. However, few studies have investigated the relationship between prediagnostic radiation exposure and survival after cancer diagnosis. Participants in the Life Span Study (LSS) of atomic bomb survivors who were diagnosed with a first primary invasive stomach, colon, or rectal cancer between 1958 and 2009 were followed for mortality during 1958-2014. Cox regression models were used to calculate HRs and 95% confidence intervals (CI) for associations of radiation dose from atomic bomb exposure with survival (cancer-specific and overall) after cancer diagnosis. Analyses were adjusted for city of primary exposure, sex, age at diagnosis, and year of diagnosis. We identified 7,728 eligible patients with cancer for analysis. We observed no statistically significant associations between radiation dose and cancer-specific survival among LSS participants with a gastrointestinal cancer. Higher radiation doses (≥1 Gy) were suggestively, but not significantly, associated with modestly poorer cancer-specific survival for colon cancer only (HR, 1.38; 95% CI, 0.90-2.12), and were associated with poorer overall survival regardless of cancer site. Although radiation exposure is associated with increased risk of gastrointestinal cancer incidence and mortality, study results are inconclusive about an association between prediagnostic radiation exposure and survival after gastrointestinal cancer diagnosis. Radiation exposure from the atomic bomb before gastrointestinal cancer diagnosis was not associated with cancer survival, but should be evaluated in relation to survival for other cancer types.

Stomach cancer on the territory of the Far Eastern Federal District

Objective: General indexes of the disease and death rate among the Far East region due to stomach cancer during the last decade (2008–2017).Methods: Disease and death rates, statistical reports of patients with oncology and official documents by public health authorities were analyzed.Results: there were 25,155 new registered cancer cases in Far East region in 2017. It’s 26.6% higher than 10 years ago. 128,776 patients (2.1% of the region population) were under outpatient observation. In the structure of primary morbidity stomach cancer takes the fourth place, and in overall death-rate it’s on the 2nd place, going after trachea, bronchial and lung tumor. The number of patients having I–II phase of stomach cancer had increased from 2008 to 2017, the disease rate among women significantly decreased. The percentage of actively defined cases has increased by several orders for ten years. However the index of accumulation of contingents of the diseased with stomach cancer has decreased. The rate of morphological confirmation of such diagnosis turned out to be lower than the average rate in Russia. The proportion of the diseased registered for 5 years or more has exceeded average numbers. The death rate was the highest during the 1st year of being diagnosed. It can be explained by a very high rate of neglecting.Conclusions: comparing the increasing number of cancer diseased in Far Eastern Region, the constant decrease of the disease and death rates were noticed at the beginning of the 21st century. This fact can’t be explained by an exact reason now.

Analysis on the relationship between smoking status and the onset age of onset and the direct medical expenditure expenses of gastric cancer patients

Objective: To investigate the relationship between smoking status and the onset age of stomach cancer patients and estimate the patients' direct medical cost burden of stomach cancer due to smoking in Anhui province. Methods: The information about the primary stomach cancer patients and their direct treatment expenditures in 10 cancer-registered areas in Anhui were collected in 2017. The association between smoking status and the age of onset of stomach cancer patients was analyzed by univariate regression and multivariate logistic regression models. The median and smoking-attributed risk method was used to describe the direct treatment expenditure of stomach cancer patients in Anhui due to smoking. Results: A total of 736 patients with stomach cancer were analyzed in this study. Univariate regression analysis showed that rural household registration (t=2.091, P=0.037), smoking (t=-2.357, P=0.001 9) and alcohol consumption (t=-2.036, P=0.042) were related to the age of onset of stomach cancer. After adjusting for gender, alcohol consumption, body mass index and household registration type, the risk of early stomach cancer in people who quitted smoking cessation was lower than that in smokers (OR=0.36, 95%CI: 0.17-0.75). The total direct medical cost burden of 736 newly diagnosed stomach cancer patients was 6.939 6 million RMB. The direct medical expenditure in stomach cancer patients who had smoking behavior was higher than that in stomach cancer patients who quitted smoking and never smoked. Conclusions: Smoking is one of the risk factors for the earlier onset of stomach cancer in Anhui. It is necessary to strengthen tobacco control to reduce the economic burden of patients with stomach cancer.

Современные аспекты профилактики рака желудка

Objective of the Review: to analyse available data on stomach cancer prevention. Key Points. Key risk factors for stomach cancer are male gender, age of &gt;50 years old, Helicobacter pylori and smoking. A number of international consensus opinions regulate screening, diagnostics and treatment of precancer changes in stomach; it is assumed to reduce the incidence of this disease. H. pylori eradication is the key method of primary stomach cancer prevention. Modern studies demonstrate that the optimal method of H. pylori eradication is the therapy with bismuth medication, proton pump inhibitor, amoxycillin and clarithromycin for 10–14 days. Conclusion. The most efficient method of stomach cancer prevention is H. pylori eradication, smoking cessation, diet with plenty of vegetables and fruit. Secondary prevention is optimisation of diagnostics, follow-up and treatment of precancer stomach conditions. Keywords: stomach cancer, gastratrophia, Helicobacter pylori, prevention.

RETRACTED ARTICLE: Evaluation of PAX8 expression promotes the proliferation of stomach Cancer cells

BackgroundPAX8 was not only a mitotic factor, but identified as a transcription factor involved in the prognosis of human tumor patients. Elucidating the function of PAX8 on the pathology of stomach cancer was meaningful.ResultsPAX8 was found to be upregulated in primary stomach cancer tissue and the TCGA stomach cancer dataset. Interestingly, SOX13 and PAX8 showed consistent expression patterns, and the combined high PAX8 and SOX18 expression induced a worse prognosis of stomach cancer patients. SOX13 was further identified as a transcription factor of PAX8, and further affect Aurora B and Cyclin B1 expression, two cell cycle related factors of the downstream of PAX8, including. Furthermore, PAX8 depletion inducted G1-phase arrest and the decrease of EdU incorporation, cell viability and colony formation can be rescued by SOX13 overexpression.ConclusionsSOX13 participated in the elevated expression of PAX8, which promote the proliferation of stomach cancer cells. Therefore, SOX13 mediated PAX8 expression was recognized as a tumor-promoting role in stomach cancer.

Abstract 4157: Idenitificaiton of pathogenic germline variants of patients with double primary cancer of stomach and colon

Abstract Purpose: The incidence of multiple primary cancers has increased as survival of cancer patients has improved. The most common type of multiple primary cancers is the combination of stomach and colon cancer in Korea. Patients affected by two primary cancers at early age would be mainly related to their own genetic risk, however, germline variant of patients with double primary cancer have not been well evaluated. Methods: Patient who is with pathologically confirmed cancers in both stomach and colon in Severance hospital between January, 2000 and December, 2016 were enrolled in this study. The patients were classified into two groups: early-age group was defined as both cancers were diagnosed before 55-years, and others were considered as late-age group. The overall early-age group (n=19) and randomly selected a fourth of late-age group (n=36) were enrolled in this study. The DNA was extracted from an archived formalin fixed paraffin embedded normal mucosa that was retrospectively reviewed. Target sequencing analysis focused on 65 genes that are known to be related to hereditary cancer was conducted. The characteristics of both cancers and family history were also evaluated. Results: Overall 11 pathogenic/likely pathogenic germline variants (PGVs) were detected in nine patients (16.4%, 9/55, MLH1 [n=7], BLM [n=1], BRCA1 [n=1], MSH6 [n=1], and MSH2 [n=1]). The incidence of PGVs was 36.8% (7/19) and 5.6% (2/36) in early and late-age group, respectively (p&amp;lt;0.001). The early-age (Odds ratio[OR]: 9.92, 95% confidence interval [CI]: 1.81-54.49, p=0.008), Amsterdam_II criteria (OR: 24.29, 95% CI: 2.45-241.36, p=0.006), multiple lesions either gastric and colon cancer (OR: 13.13, 95% CI: 2.48-69.55, p=0.002) and mucinous/poorly differentiated histology of colon cancer (OR: 10.75, 95% CI: 1.48-78.06, p=0.019) were significant risk factors of PGVs in patients with double primary cancer at stomach and colon. Conclusions: The Lynch syndrome related PGVs were identified in patients with double primary cancer at stomach and colon. Patients with double primary cancers at stomach and colon related to early age, multiple lesions, family history especially Amsterdam_II criteria, and poorly differentiated histology of colon cancer would be good candidate for genetic evaluation. Citation Format: Yoon Young Choi, Ji Soo Park, Seung-Tae Lee, Su-Jin Shin, Jae Eun Lee, Jeong-Hyeon Jo, Eun Ji Nam, Taeil Son, Hyoung-Il Kim, Woo Jin Hyung, Sung Hoon Noh, Jae-Ho Cheong. Idenitificaiton of pathogenic germline variants of patients with double primary cancer of stomach and colon [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4157.

Prognostic and influential factors of gastric stump cancer

Gastric stump cancer was first defined as cancer occurring in the remnant stomach 5 years or later following distal subtotal gastrectomy of a benign stomach tumor. This definition was expanded to include malignant gastric cancer recurrence following distal gastrectomy and heterochronous gastric adenocarcinoma. Evidence regarding whether patients with gastric stump cancer had the same prognosis as those with primary gastric cancer has been inconsistent. Nonetheless, considering the notable differences regarding risk factors, treatment strategies, and lymph node metastasis status, gastric stump cancer should be differentiated from primary stomach cancer. Overall, the prognosis of gastric stump cancer is influenced by clinicopathological characteristics such as primary tumor features, location of gastric stump cancer, histological type, invasion depth, lymph node metastasis, and distant metastasis, as well as treatment factors such as treatment strategy, dissection range, and lymph node resection range. In previous studies on gastric stump cancer, the sample size was limited, and future studies with larger sample size are needed to further validate the prognostic factors of gastric stump cancer.

Simultaneous laparoscopic distal gastrectomy (uncut Roux-en-Y anastomosis), right hemi-colectomy and radical rectectomy (Dixon) in a synchronous triple primary stomach, colon and rectal cancers patient.

Gastric and colorectal cancers are both one of the most common tumors worldwide, while the morbidity of multiple synchronous primary tumors are really rare, and triple synchronous primary cancers are considered has a lower incidence. In this report, we demonstrate a rare case of synchronous triple primary cancers involving gastric, colon and rectal, and the laparoscopic operation procedure of the patient. A 49-year-old male diagnosed with synchronous triple primary gastric, colon and rectal cancer, underwent simultaneous laparoscopic distal gastrectomy (uncut Roux-en-Y anastomosis, D2), right hemi-colectomy and radical rectectomy (Dixon). The operation lasts 305 min with about 300 mL blood lost. The patient discharged from hospital on the 12th day without any complication. Laparoscopic surgery is a safe and feasible way in synchronous gastrointestinal triple primary cancers. Nevertheless, because of the rare incidence, many details and specific condition should be considered during the peri-operative period of this multiple synchronous cancers patient.

The effects of HOXB7 in the promotion of migration, invasion and anti-apoptosis in gastric cancer.

46 Background: HOX genes, a subset of the homeobox gene family, are known to be aberrantly expressed in various types of cancers. Among them, HOXB7 recently has been reported to be highly expressed in esophageal or colorectal cancers. We aimed in this study to demonstrate the critical roles of HOXB7 in development and progression of gastric cancer. Methods: We screened gene and protein expression of HOXB7 in various gastric cancer cell lines, and also compared gene expression level of HOXB7 among chronic gastritis, intestinal metaplasia and gastric cancer tissues. To figure out the oncogenic effects of HOXB7 in vitro, we performed annexin-V assay, wound closure assay and Matrigel invasion assay. We performed Western blot analysis to examine the impact of HOXB7 on AKT pathway. Results: Both mRNA and protein was substantially expressed in stomach cancer cell lines (SNU-638, SNU-719, MKN-28, MKN-45, AGS, KATO-III, NCI-N87), however, they were nearly abolished in normal gastric tissues. Gene expression was significantly higher in primary or metastatic stomach cancer, compared with chronic gastritis or intestinal metaplasia. Knockdown of HOXB7 by transfection with siRNA in AGS and SNU-638 cells significantly inhibited migration and invasion, and showed anti-apoptotic effect. Because a previous study demonstrated that enforced expression of HOXB7 could enhance PI3K/AKT pathway activity in colon cancer cells (Liao W.T. et al, Clin Cancer Res; 17(11) June 1, 2011), we investigated the modulation of AKT/PTEN pathway by HOXB7 and observed that knockdown of HOXB7 significantly downregulated phospho-AKT and upregulated PTEN in both cell lines. Furthermore, target gene products of AKT pathway including cyclin D1, survivin, Bcl-xL and MMP-9 were significantly downregulated by siHOXB7. Conclusions: Our findings suggest that HOXB7 might play a crucial role in migration, invasion and anti-apoptotic effect via modulating AKT/PTEN pathway.

위암 환자의 진단 경로에 따른 병기 및 관련요인의 차이

본 연구는 위암 진단 당시 진단 경로에 따라 병기 및 관련요인의 차이가 있는지 비교하기 위해 시행되었다. 조사대상 은 충남대학교 병원에서 위암에 대해 진단 받은 뒤 수술하기 위해 내원한 환자 375명으로 하였으며, 자료 수집은 2010년 8월 1일부터 2013년 3월 31일까지 표준화된 자기기입식 설문지를 사용하여 수집하였다. 증상군과 검진군간에 영향을 미치 는 요인의 위험도를 측정하기 위해 로지스틱회귀분석을 사용 하였다. 연구결과, 검진군에서의 조기위암의 비율이 증상군에 서 보다 유의하게 높아(p=0.001) 조기검진의 중요성을 시사해 주었다. 또한 증상군은 검진군에 비해 병기가 상대적으로 높았 다.(p=0.001). 앞으로 위암 선별검사가 널리 시행되고 대규모의 전향적인 연구가 뒷받침 되면 우리나라에 가장 적절한 검사 및 간격에 대한 추정까지도 가능할 것이다.

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.

Increased stomach cancer risk following radiotherapy for testicular cancer.

Background:Abdominal radiotherapy for testicular cancer (TC) increases risk for second stomach cancer, although data on the radiation dose–response relationship are sparse.Methods:In a cohort of 22 269 5-year TC survivors diagnosed during 1959–1987, doses to stomach subsites were estimated for 92 patients who developed stomach cancer and 180 matched controls. Chemotherapy details were recorded. Odds ratios (ORs) were estimated using logistic regression.Results:Cumulative incidence of second primary stomach cancer was 1.45% at 30 years after TC diagnosis. The TC survivors who received radiotherapy (87 (95%) cases, 151 (84%) controls) had a 5.9-fold (95% confidence interval (CI) 1.7–20.7) increased risk of stomach cancer. Risk increased with increasing stomach dose (P-trend<0.001), with an OR of 20.5 (3.7–114.3) for ⩾50.0 Gy compared with <10 Gy. Radiation-related risks remained elevated ⩾20 years after exposure (P<0.001). Risk after any chemotherapy was not elevated (OR=1.1; 95% CI 0.5–2.5; 14 cases and 23 controls).Conclusions:Radiotherapy for TC involving parts of the stomach increased gastric cancer risk for several decades, with the highest risks after stomach doses of ⩾30 Gy. Clinicians should be aware of these excesses when previously irradiated TC survivors present with gastrointestinal symptoms and when any radiotherapy is considered in newly diagnosed TC patients.

Survival and surgical outcomes of cardiac cancer of the remnant stomach in comparison with primary cardiac cancer

BackgroundAlthough cardiac cancer of the remnant stomach and primary cardiac cancer both occur in the same position, their clinical characteristics and outcomes have not been compared previously. The objective of this study was designed to evaluate the prognosis of cardiac cancer of the remnant stomach in comparison with primary cardiac cancer.MethodsIn this retrospective comparative study, clinical data and prognosis were compared in 48 patients with cardiac cancer of the remnant stomach and 96 patients with primary cardiac cancer who underwent radical resection from January 1995 to June 2007. Clinicopathologic characteristics, survival times, mortality, and complications were analyzed.ResultsThe 5-year survival rate was significantly higher in patients with primary cardiac cancer than in those with cardiac cancer of the remnant stomach (28.4% vs. 16.7%, P = 0.035). Serosal invasion, lymph node metastasis and tumor location were independent prognostic factors for survival. Subgroup analysis, however, showed similar survival rates in patients with primary cardiac cancer and cardiac cancer of the remnant stomach without serosal invasion (25.0% vs. 43.8%, P = 0.214) and without lymph node metastasis (25.0% vs. 38.8%, P = 0.255), as well as similar complication rates (20.8% vs. 11.5%, P = 0.138).ConclusionAlthough the survival rates after radical resection in patients with cardiac cancer of the remnant stomach were poorer than in those with primary cardiac cancer, they were similar in survival rates when patients without serosal invasion or lymph node metastasis. Therefore, early detection is an important way to improve overall survival in cardiac cancer of the remnant stomach.