Types Of Gastrointestinal Cancers Research Articles

Study on direct medical cost of inpatient treatment for gastrointestinal cancers at Hue University of Medicine and Pharmacy Hospital

Background: Gastrointestinal cancers, including liver cancer, colorectal cancer, and stomach cancer, are the most common cancers in the world as well as in Vietnam, posing a leading threat to human health. The cost of treating these cancers is a major problem that burdens not only patients but also healthcare systems. The study aims to analyze treatment costs for the four most common types of gastrointestinal cancer nowadays. Materials and method: A cross-sectional study was conducted to collect data from 300 medical records of inpatients with gastrointestinal cancers at the hospital of Hue University of Medicine and Pharmacy in 2021. Results: The average direct medical cost per inpatient admission was 14,239,915 VND (95% CI: 12,502,135 - 15,977,695 VND) in 2021. The cost per inpatient admission for liver cancer treatment was the highest, by 20,267,780 VND (95% CI: 16,036,541- 24,499,018 VND). The cost of drugs accounted for the highest proportion (38.1%), followed by the cost of medical supplies (14.7%). There is a statistically significant difference between the median cost of groups classified by age, metastasis, comorbidity, and length of hospital stay. Conclusion: Direct medical costs for patients with four common types of gastrointestinal cancers impose a considerable economic burden on patients and the health system. Further cost analysis studies need to be conducted. Strategies to decrease the economic burden of gastrointestinal, such as screening programs, and improving awareness of the prevention of cancer should be developed in Vietnam. Key words: direct medical costs, gastrointestinal cancer, Hospital of Hue University of Medicine and Pharmacy.

Current status and perspectives of genetic testing in gastrointestinal cancer (Review).

Genetic testing has become widespread in daily medical care for gastrointestinal (GI) cancers. However, unlike breast cancer and non-small cell lung cancer, in which personalized medicine targeting various driver genes is standardized, the incidence of targeted gene abnormalities in GI cancers is low. Nevertheless, such abnormalities may be linked to therapeutic agents and the further development of therapeutic agents for personalized medicine for GI cancers is desired. A liquid biopsy is of great benefit in offering clinical decision support, in applications such as GI cancer screening, surgical interventions, monitoring disease status and enhancing patient survival outcomes, all of which would contribute to personalized medicine. Germline genetic testing is required for several types of GI cancer, which shows clinical indications of hereditary predisposition. The increasing use of multigene panel testing has redefined gene-cancer associations, and consequently the estimate of cancer risk that vary from low to high penetrance. Comprehensive genetic testing can enable the detection of novel treatment targets and the discovery of undefined multiple diagnostic/predictive markers, which may enhance the molecular-level understanding of GI cancers. Genetic testing can also aid the design of more appropriate and adequate genomic-driven therapies for patients who may benefit from other standardized therapeutic methods.

Symptom trajectory for patients utilizing remote symptom monitoring during gastrointestinal cancer treatment.

345 Background: Use of electronic patient-reported outcome data allows patients to report symptoms in real time. This analysis aims to better understand the trajectory for symptoms reported via Remote Symptom Monitoring (RSM) by patients receiving gastrointestinal (GI) cancer treatment. Methods: This retrospective cohort study included patients initiating GI cancer treatment (chemotherapy, targeted therapy, and immunotherapy) between August 2022 and April 2023 at USA Health Mitchell Cancer Institute (MCI). Patients were eligible if they were starting a new treatment or had started treatment in the past 30 days. Patients received a weekly symptom survey over the course of 24 weeks through text message or e-mail. Patients were monitored for a total of 24 weeks regardless of their enrollment date. Patients reported symptoms as mild, moderate, severe, or very severe. All moderate and severe alerts were sent to the clinical nurse via the electronic medical record (EMR) to be acknowledged. After enrollment, health information including age, race, sex, zip code, ethnicity, cancer type, and cancer stage were extracted from the EMR. Descriptive statistics were calculated to examine frequencies of reported symptoms and their severity over time. Results: Of 75 GI patients approached, 63 patients (84%) were enrolled in RSM; 44% were female; 30% of patients were Black or African American, and median age was 65 (range 30-82). GI cancer types varied; Pancreatic (21%), Rectal (13%), Colorectal (14%), Colon (13%), Gastric (11%), Liver (11%), and other (17%). Over 24 weeks, 424 alerts were reported. Pain (31%), nausea and vomiting (21%), and decreased appetite (17%) were the most reported symptoms. 311 alerts were moderate (73%) and 113 were severe (27%). At week 0 (baseline; n = 63) 37 moderate alerts and 21 severe alerts were reported. At week 24 (final week; n = 63) 7 moderate alerts and 6 severe alerts were reported. Overall, there was a decreasing trajectory from week to week for moderate and severe alerts, with outliers noted at weeks 8 and 20. Conclusions: Findings suggest that RSM allows for an improvement in symptom trajectory for GI cancer patients based on the decrease in moderate and severe alerts reported from baseline to week 24. This decrease suggests that reported symptoms are being appropriately monitored and addressed by the patient's clinical care team due to improvement of symptoms or improvement of symptom management. Future research is needed to determine the benefits of prolonged RSM utilization by patient-reported quality of life as well as survival rate.

Evaluation of serum nickel levels in some Syrian patients with gastrointestinal cancers

Gastrointestinal cancers describe malignant changes that affect the organs of the digestive system and its ancillary organs and are responsible for more cancers and cancer-related deaths than any other system in the body. Nickel is widely used in various industries, causing many human cancers through different mechanisms. Our present study is designed to estimate nickel concentrations in serum samples from patients with different types of gastrointestinal cancers. The study was carried out in 45 patients with many types of gastrointestinal cancers at Al-Biruni University Hospital for Cancerous Diseases in Syria compared with 35 healthy controls. All measurements of serum were done with a graphite atomic absorption spectrophotometer equipped with a deuterium lamp. Our results showed that patients with gastrointestinal cancers had significantly higher serum levels of Ni than healthy controls (p < 0.0001), and there were no statistically significant differences between the four types of gastrointestinal cancers included in the study (p > 0.05). The increase in serum nickel concentrations has a direct effect on the incidence of gastrointestinal cancers by influencing the mechanisms that induce cancer by nickel.

Raman spectroscopy and Raman optical activity of blood plasma for differential diagnosis of gastrointestinal cancers

Improving the early diagnosis of gastrointestinal cancers is a crucial step in reducing their mortality. Given the non-specificity of the initial symptoms, the ability of any diagnostic method to differentiate between various types of gastrointestinal cancers also needs to be addressed. To detect disease-specific alterations in biomolecular structure and composition of the blood plasma, we have implemented an approach combining Raman spectroscopy and its conformation-sensitive polarized version, Raman optical activity, to analyze blood plasma samples of patients suffering from three different types of gastrointestinal cancer – hepatocellular, colorectal and pancreatic. First, we aimed to discriminate any type of gastrointestinal cancer from healthy control individuals; inthenext step, the focus was on differentiating among the three cancer types studied. The more straightforward of the two statistical approaches tested, the combination of linear discriminant analysis and principal component analysis applied to the entire spectral dataset, allowed the discrimination of cancer and control samples with 87% accuracy. The three gastrointestinal cancers were classified with an overall accuracy of 76%. The second method, the linear discriminant analysis applied to a selection of spectral bands, yielded even higher values. Cancer and control samples were distinguished with 89% accuracy and hepatocellular, colorectal and pancreatic cancer with an overall accuracy of 87%. The results obtained in our study suggest that the proposed approach may become a disease-specific diagnostic tool in daily clinical practice.

Epidemiological and pathological characteristics of spinal metastases from gastrointestinal cancers - a series of 40 cases.

Spinal metastases from gastrointestinal (GI) cancer are rare and as a result there are only case reports or small series in the literature. The aim of our work was to identify the demographic aspects, the location, and the histopathological aspects of spinal metastases from GI cancers diagnosed and treated in a reference Hospital in Romania over a period of nine years, and comparing the data obtained with those from the recent literature. This is a retrospective case series study on spinal metastases from GI cancers, developed in patients older than 18 years that were surgically treated between January 2013 and December 2021 within three Neurosurgery Clinics from Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania, which is a tertiary Hospital in Romania regarding the surgical treatment of spinal metastases. We included in our study the patient's demographic data (age and gender), clinical data (location of spinal metastases), radiological investigations and pathological features of the lesions. Regarding the immunohistochemical stainings, the following antibodies were used: anti-cytokeratin (CK)7, anti-CK20, anti-CK19, anti-caudal-type homeobox 2 (CDX2), anti-human epidermal growth factor receptor 2 (HER2), and anti-Ki67. Our series included 40 adult patients (≥18 years old) with a male:female ratio of 3:1, in favor of male patients. The mean age of all patients was 66.42 years. The primary sites of spinal metastases from GI cancers were from all segments of the GI system: the most frequent, however, was from the colorectal level (40%) and the least from the oral cavity level (2.5%). The most common site of spinal metastases from GI cancer was predominantly lumbar region (47.5%), and the most frequent histological type was adenocarcinoma (57.5%), followed by hepatocellular carcinoma (27.5%), pancreatic ductal carcinoma (5%) and squamous cell carcinoma (2.5%). Our results have important clinical implications because they suggest that there are certain subsets of patients with certain types of GI cancers that cause metastases in certain regions of the spine.

Incidence and Patterns of Digestive Organ Cancer in Georgia: Insights from a Population-Based Registry Study in 2021.

Digestive organ cancer, also known as gastrointestinal (GI) cancer, refers to cancer that occurs in the digestive tract. In this population-based registry study, we aimed to investigate the incidence of GI in Georgia and to identify any patterns in the occurrence of different types of this disease. The study included all cases of GI cancer that were diagnosed in Georgia in 2021. We analyzed 1635 patients' data to determine the overall and age-standardized incidence of GI cancer in the country. The analyses were performed for esophagus, stomach, colon, rectum, anus, liver and intrahepatic bile ducts, gallbladder, and pancreas separately. The descriptive statistics used in the study-specifically counts, means, proportions, and rates-were calculated using the statistical software STATA version 17.0. (StataCorp, College Station, TX, USA). The results of the study showed that the incidence of digestive organ cancer in Georgia was similar to the global average. However, there were some notable differences in the specific types of GI cancer that were most common in the country. Overall, this study provides important insights into the incidence of digestive organ cancer in Georgia and highlights the need for further research to better understand the factors that contribute to this disease.

Cytochrome P2E1 (CYP2E1) Gene Polymorphism as a Potential Prognostic Biomarker in Colorectal Cancer.

Colon cancer is the most common type of gastrointestinal cancer. Genetic factors have been shown to have a role in the development of colorectal cancers. The aim of this study was to assess the expression of Cytochrome P2E1 (CYP2E1) gene polymorphism as a potential prognostic biomarker in the diagnosis, treatment, and prognosis evaluation of patients with colorectal cancer. in this cross-sectional study, all of our 100 patients with colorectal cancer who underwent surgical operation were included. DNA was extracted from the tumor specimens to assess Cytochrome P2E1 (CYP2E1) Gene polymorphism by Conventional-PCR. RFLP-PCR method was used for RsaI polymorphism evaluation. Patients' characteristics were also recorded and their associations with CYP2E1 were assessed. One hundred tumor specimens were assessed. In total, 88 had wild-type, 8 had purely a 96 bp insertion in CYP2E1, and 4 were partially mutated by a single allele insertion. Generally, 10% of samples had positive results for the RsaI polymorphism. There were no statistically significant associations between CYP2E1 gene polymorphism and number of lymph nodes removed during the operation (P = 0.353), number of positive lymph nodes (P = 0.668), tumor specificity including mucinous or non-mucinous (P = 0.053), tumor invasion (P = 0.074), grading (P = 0.898), differentiation (P = 0.941), tumor location (P = 0.42) or staging (P = 0.182). There was no association between RsaI type CYP2E1 polymorphism and colorectal cancer risk. Our study does not support the use of this biomarker to evaluate the prognosis of colon cancer.

Efficacy and safety of naldemedine treatment for opioid-induced constipation in gastrointestinal cancer: a retrospective analysis.

Gastrointestinal cancers are one of the most common cancer cases worldwide. Cancer treatment is multidisciplinary, which includes opioid pain management. Opioid analgesics cause opioid-induced constipation (OIC) with the onset of effect. Naldemedine, a peripheral opioid receptor antagonist, is an OIC-modifying agent, but no focused efficacy and safety analysis has been conducted for its use in gastrointestinal cancers. We retrospectively evaluated patients with gastrointestinal cancer treated with naldemedine at ten institutions in Japan from June 2017 to August 2019. Patients with gastrointestinal cancer who initiated treatment with opioids during hospitalization and were treated with naldemedine for the first time were included in the study. The gastrointestinal cancer types included were esophageal, gastric, small bowel, and colorectal cancers. We assessed the defecation frequency before and after the initiation of naldemedine use. Responders were defined as patients who defecated three or more times/week, with an increase from the baseline of one or more bowel movements/week over seven days after starting naldemedine. Thirty-three patients were observed for one week before and after starting naldemedine. Twentyone patients had an increase in defecation frequency of at least three times per week or at least once per week above the baseline. The response rate was 63.6% (95% CI: 46.6-77.9%). The median number of bowel movements for a week before and after the initiation of naldemedine treatment was 3 (range, 0-13) and 7 (range, 1-39), respectively, in the overall population (n=33), with a significant increase in defecation frequency following naldemedine administration (Wilcoxon signed rank test, P<0.005). Diarrhea was the predominant gastrointestinal symptom, with 13 (39.4%) patients experiencing grade 1 and none experiencing grade 3 or grade 4 adverse events. The frequency of other grade 1 adverse events was low abdominal pain in two patients, nausea in two patients, and anorexia in one patient, without any grade 2-4 adverse events. The results of the study suggest that naldemedine is effective and safe in clinical practice for gastrointestinal cancer treatment.

Identification of miR-143-3p as a diagnostic biomarker in gastric cancer

BackgroundGastric cancer (GC) is among the most common types of gastrointestinal cancers and has a high incidence and mortality around the world. To suppress the progression of GC, it is essential to develop diagnostic markers. MicroRNAs regulate GC development, but a clearer insight into their role is needed before they can be applied as a molecular markers and targets.MethodsIn this study, we assessed the diagnostic value of differentially expressed microRNAs as potential diagnostic biomarkers for GC using data for 389 tissue samples from the Cancer Genome Atlas (TCGA) and 21 plasma samples from GC patients.ResultsThe expression of hsa-miR-143-3p (also known as hsa-miR-143) was significantly downregulated in GC according to the TCGA data and plasma samples. The 228 potential target genes of hsa-miR-143-3p were analyzed using a bioinformatics tool for miRNA target prediction. The target genes correlated with extracellular matrix organization, the cytoplasm, and identical protein binding. Furthermore, the pathway enrichment analysis of target genes showed that they were involved in pathways in cancer, the phosphoinositide 3-kinase (PI3K)–protein kinase B (Akt) signaling pathway, and proteoglycans in cancer. The hub genes in the protein–protein interaction (PPI) network, were matrix metallopeptidase 2 (MMP2), CD44 molecule (CD44), and SMAD family member 3 (SMAD3).ConclusionsThis study suggests that hsa-miR-143-3p may be used as a diagnostic marker for GC, contributing via the pathways involved in the development of GC.

Detection and localization of gastrointestinal cancers based on multi-dimentional signatures from a single cfDNA targeted sequencing assay.

4169 Background: Five major gastrointestinal (GI) cancers - colorectal (CRC), gastric (GC), liver (LC), esophageal (EC), and pancreatic cancer (PC) - are responsible for hundreds of thousands of mortalities annually worldwide. Unfortunately, there is a lack of cost-effective, blood-based screening method for their early detection. To address this issue, we aimed to develop GutSeer, a noninvasive, targeted methylation sequencing-based test by leveraging methylation and fragmentomic signatures carried by cell-free DNA (cfDNA). Methods: The panel of GutSeer consists of 1656 target regions which were either differentially methylated between healthy and cancer samples, or distinctively methylated in a specific GI cancer. Cancer and healthy participants were recruited and randomly divided into a training and a validation cohort. Their plasma DNA samples were analyzed to generate DNA methylation and fragmentomic features. These multi-dimensional features were integrated to build ensemble stacked machine learning models to differentiate cancer against healthy, and to determine the tissue-of-origin (TOO) of the cancer. Results: A total of 1844 cases (787 healthy, 342 LC, 239 GC, 209 EC, 180 CRC, and 87 PC cases) were recruited for this study. A cancer- vs-healthy model achieved an AUC of 0.94 and 0.95 (sensitivity of 77.7% and 77.1% under the specificity around 96%) using either methylation or fragmentomic features only, respectively. Combining both methylation and fragmentomic features further improved performances, achieving an AUC of 0.96 (sensitivity = 86.2% at a specificity of 96.7%). For individual type of cancer, GutSeer has a sensitivity of 93.3% for CRC, 81.1% for EC, 70.3% for GC, 96.5% for LC, and 86.4% for PC. An independent test using 629 benign cases as controls achieved a specificity of 87.1%. A separate TOO model was built using all features and achieved an overall accuracy of 82% for all cancer cases (66.7% for CRC, 87.0% for GC and EC combined, 89.0% for LC, and 63.2% for PC). Same as the cancer detection model, using multi-dimensional features in TOO prediction yielded higher accuracy than when models using only methylation or fragmentomics features (accuracy = 75.6% or 75.4%, respectively). When compared with whole-genome sequencing (WGS) based approaches, GutSeer showed a comparable performance in cancer detection but a higher accuracy in TOO identification, further confirming its effectiveness for detection of GI cancers. Conclusions: GutSeer, a non-invasive test integrating multi-dimensional features, was demonstrated to detect and localize the 5 main types of GI cancer with high accuracy. Our results further showed that a reasonably sized panel can perform comparably or even better than WGS-based methods in cancer detection and TOO localization, indicating GutSeer may be a low-cost solution for blood-based early screening for GI cancers.

The emerging role of circulating tumor DNA in non-colorectal gastrointestinal cancers.

Assays to detect circulating tumor DNA (ctDNA) have multiple clinically important applications in management of multiple types of gastrointestinal cancers. Different methodologies of ctDNA detection have varying sensitivities and potential applications in different contexts. For patients with localized cancers treated for curative intent, ctDNA detection is associated with prognosis in multiple cancer types, and persistent detection of ctDNA after surgical resection is highly concerning for minimal residual disease (MRD) and forebodes impending radiographic and clinical recurrence. CtDNA assays for comprehensive genomic profiling (CGPs) enable genotyping of cancers in the absence of tumor tissue data, and longitudinal testing can also characterize clonal evolution and emergence of putative resistance mechanisms upon treatment with targeted agents. These applications have proven instructive in patients with HER2-amplified gastric and esophageal cancers and in patients with FGFR2 fusion cholangiocarcinomas. In this review, we summarize data supporting the role of ctDNA as a novel predictive and prognostic biomarker and potential impacts on current management of patients with pancreatic, gastroesophageal, and hepatobiliary cancers.

Cell-free RNA for the liquid biopsy of gastrointestinal cancer.

Gastrointestinal (GI) cancer includes many cancer types, such as esophageal, liver, gastric, pancreatic, and colorectal cancer. As the cornerstone of personalized medicine for GI cancer, liquid biopsy based on noninvasive biomarkers provides promising opportunities for early diagnosis and dynamic treatment management. Recently, a growing number of studies have demonstrated the potential of cell-free RNA (cfRNA) as a new type of noninvasive biomarker in body fluids, such as blood, saliva, and urine. Meanwhile, transcriptomes based on high-throughput RNA detection technologies keep discovering new cfRNA biomarkers. In this review, we introduce the origins and applications of cfRNA, describe its detection and qualification methods in liquid biopsy, and summarize a comprehensive list of cfRNA biomarkers in different GI cancer types. Moreover, we also discuss perspective studies of cfRNA to overcome its current limitations in clinical applications. This article is categorized under: RNA in Disease and Development > RNA in Disease.

Functional Proteomic Profiling Analysis in Four Major Types of Gastrointestinal Cancers.

Gastrointestinal (GI) cancer accounts for one in four cancer cases and one in three cancer-related deaths globally. A deeper understanding of cancer development mechanisms can be applied to cancer medicine. Comprehensive sequencing applications have revealed the genomic landscapes of the common types of human cancer, and proteomics technology has identified protein targets and signalling pathways related to cancer growth and progression. This study aimed to explore the functional proteomic profiles of four major types of GI tract cancer based on The Cancer Proteome Atlas (TCPA). We provided an overview of functional proteomic heterogeneity by performing several approaches, including principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA), t-stochastic neighbour embedding (t-SNE) analysis, and hierarchical clustering analysis in oesophageal carcinoma (ESCA), stomach adenocarcinoma (STAD), colon adenocarcinoma (COAD), and rectum adenocarcinoma (READ) tumours, to gain a system-wide understanding of the four types of GI cancer. The feature selection approach, mutual information feature selection (MIFS) method, was conducted to screen candidate protein signature subsets to better distinguish different cancer types. The potential clinical implications of candidate proteins in terms of tumour progression and prognosis were also evaluated based on TCPA and The Cancer Genome Atlas (TCGA) databases. The results suggested that functional proteomic profiling can identify different patterns among the four types of GI cancers and provide candidate proteins for clinical diagnosis and prognosis evaluation. We also highlighted the application of feature selection approaches in high-dimensional biological data analysis. Overall, this study could improve the understanding of the complexity of cancer phenotypes and genotypes and thus be applied to cancer medicine.

Association of obesity with the occurrence of Gastrointestinal cancer- A meta-analysis

Obesity is a risk factor for many diseases especially cancer. Numerous studies have been performed to examine the relation between obesity and different types of gastrointestinal cancer. However, involvement of obesity in overall gastrointestinal cancer risk is not very clear. Therefore, a meta-analysis was performed to investigate the association of obesity and overall gastrointestinal cancer risk. A thorough systematic search were performed on PubMed, MEDLINE and other databases and relevant studies were identified and scrutinised. A random effect model was used to calculate the correlation using risk ratio (RR) at 95% confidence interval. Publication bias was assessed by funnel plots. A total of 56 studies were used to perform meta-analysis. The pooled risk ratio calculated showed a significant relation between obesity and gastrointestinal cancer risk (RR = 1.742, 95% CI =1.54 - 1.96, P&lt; 0.001). Subgroup analysis was also performed for different types of gastrointestinal cancer such as oesophageal cancer, stomach cancer, liver cancer, pancreatic cancer, and colorectal cancer. The pooled risk ratio for each type of gastrointestinal cancer was found to be RR = 2.376 (oesophageal cancer), RR = 1.131 (stomach cancer), RR = 1.976 (liver cancer), RR = 1.474 (pancreatic cancer), and RR = 1.428 (colorectal cancer). There was observed no significant bias in the study. This study suggested that obesity is significantly associated with risk of gastrointestinal cancer especially oesophageal cancer. However, further investigations and large clinical trials are required to make an impactful and conclusive statement about this association.

LncRNA HCG11 Promotes Colorectal Cancer Cell Malignant Behaviors via Sponging miR-26b-5p.

Colorectal cancer (CRC) is a type of gastrointestinal cancer with an increasing incidence. Long noncoding RNAs (lncRNAs) have raised great concern because of wide participation in human diseases, including cancers. However, whether lncRNA HLA complex group 11 (HCG11) played a functional role in CRC remained to be elucidated. Herein, we utilized qRT-PCR to analyze the expression of HCG11 and found that HCG11 was highly expressed in CRC cells. Besides, HCG11 knockdown suppressed cell proliferation, migration, and invasion but facilitated cell apoptosis. Furthermore, supported by bioinformatics analyses and mechanism assays, HCG11, mainly located in cell cytoplasm, was confirmed to competitively bind to miR-26b-5p to modulate the expression of the target messenger RNA (mRNA), namely, cAMP-regulated phosphoprotein 19 (ARPP19). ARPP19 was detected to be upregulated in CRC cells, and ARPP19 silence was verified to inhibit the malignant behaviors of CRC cells. Rescue experiments validated that miR-26b-5p inhibition or ARPP19 overexpression could countervail the inhibitory influences of HCG11 silence on CRC cell biological behaviors in vitro. To conclude, HCG11, upregulated in CRC cells, could promote cell proliferation, migration, and invasion and inhibit cell apoptosis via targeting miR-26b-5p/ARPP19 axis.

Artificial intelligence in pancreatic cancer: diagnosis, limitations, and the future prospects-a narrative review.

This review aims to explore the role of AI in the application of pancreatic cancer management and make recommendations to minimize the impact of the limitations to provide further benefits from AI use in the future. A comprehensive review of the literature was conducted using a combination of MeSH keywords, including "Artificial intelligence", "Pancreatic cancer", "Diagnosis", and "Limitations". The beneficial implications of AI in the detection of biomarkers, diagnosis, and prognosis of pancreatic cancer have been explored. In addition, current drawbacks of AI use have been divided into subcategories encompassing statistical, training, and knowledge limitations; data handling, ethical and medicolegal aspects; and clinical integration and implementation. Artificial intelligence (AI) refers to computational machine systems that accomplish a set of given tasks by imitating human intelligence in an exponential learning pattern. AI in gastrointestinal oncology has continued to provide significant advancements in the clinical, molecular, and radiological diagnosis and intervention techniques required to improve the prognosis of many gastrointestinal cancer types, particularly pancreatic cancer.

Use of positron emission tomography-computed tomography (PET-CT) scan in patients with gastrointestinal (GI) cancer at the University Hospital of Montreal (CHUM).

793 Background: In the province of Quebec, Canada, PET-CT scan recommendations are published by the Institut national d’excellence en santé et en services sociaux (INESSS). These recommendations are based on evidence-based literature and publications from oncology societies (ASCO, NCCN...) Judicious use of PET-CT scans is particularly important in a public health system for appropriate allocation of resources. An analysis conducted by INESSS in 2017 demonstrated a remarkable use of 507 PET-CT scans per 100,000 persons in Quebec, an incidence more than twice as high as other provinces, and equivalent to that of the United States (510 per 100,000 person). Methods: We present a retrospective quality control study in which all PET-CT scans completed for oncologic purposes for patients of 18 years or older at CHUM between September 1st and November 30th, 2019, were included. Patients who had a PET-CT scan for non-oncologic purposes or weren’t followed at the CHUM were excluded. We reviewed disease characteristics of patients, and adherence to 2017 INESSS guidelines. All cancer types were analysed and classified according to imaging reason (staging, response to treatment, follow up). We herein report the use of PET-CT in GI cancers and how it compares to INESSS recommendation . Results: A total of 2331 PET-CT scans were completed in the studied period. Among them 975 PET-CT scans fit our inclusion criteria. 155 patients (16%) underwent PET-CT scans for GI cancers. Only 35% followed INESSS recommendations, 44% did not, and 21% had GI cancer types without revised clear recommendations from INESSS. Among specialists, surgeons requested most PET-CT scans (66%), but surgeons, oncologists, and gastroenterologist were equally non-adherent to guidelines (44, 45, and 43% respectively). Strikingly, 43% of PET-CT scans for GI cancers were prescribed for cancer follow up, yet 83% did not follow guidelines. Most PET-CT scans were used for colorectal (41%) or gastroesophageal cancers (28%), and only 40 and 53% followed guidelines, respectively. 49.7% of PET-CT scans did not result in treatment modification. Conclusions: In our university hospital, more than 40% of PET-CT scans prescribed don’t follow INESSS recommendations. In the interest of proper resource allocation in a public health care system, we recommend guideline adherence and discussion in multidisciplinary Tumour Boards prior to off-label use of PET-CT scans.

Development and Validation of a Machine Learning Model for Detection and Classification of Tertiary Lymphoid Structures in Gastrointestinal Cancers

Tertiary lymphoid structures (TLSs) are associated with a favorable prognosis and improved response to cancer immunotherapy. The current approach for evaluation of TLSs is limited by interobserver variability and high complexity and cost of specialized imaging techniques. To develop a machine learning model for automated and quantitative evaluation of TLSs based on routine histopathology images. In this multicenter, international diagnostic/prognostic study, an interpretable machine learning model was developed and validated for automated detection, enumeration, and classification of TLSs in hematoxylin-eosin-stained images. A quantitative scoring system for TLSs was proposed, and its association with survival was investigated in patients with 1 of 6 types of gastrointestinal cancers. Data analysis was performed between June 2021 and March 2022. The diagnostic accuracy for classification of TLSs into 3 maturation states and the association of TLS score with survival were investigated. A total of 1924 patients with gastrointestinal cancer from 7 independent cohorts (median [IQR] age ranging from 57 [49-64] years to 68 [58-77] years; proportion by sex ranging from 214 of 409 patients who were male [52.3%] to 134 of 155 patients who were male [86.5%]). The machine learning model achieved high accuracies for detecting and classifying TLSs into 3 states (TLS1: 97.7%; 95% CI, 96.4%-99.0%; TLS2: 96.3%; 95% CI, 94.6%-98.0%; TLS3: 95.7%; 95% CI, 93.9%-97.5%). TLSs were detected in 62 of 155 esophageal cancers (40.0%) and up to 267 of 353 gastric cancers (75.6%). Across 6 cancer types, patients were stratified into 3 risk groups (higher and lower TLS score and no TLS) and survival outcomes compared between groups: higher vs lower TLS score (hazard ratio [HR]; 0.27; 95% CI, 0.18-0.41; P < .001) and lower TLS score vs no TLSs (HR, 0.65; 95% CI, 0.56-0.76; P < .001). TLS score remained an independent prognostic factor associated with survival after adjusting for clinicopathologic variables and tumor-infiltrating lymphocytes (eg, for colon cancer: HR, 0.11; 95% CI, 0.02-0.47; P = .003). In this study, an interpretable machine learning model was developed that may allow automated and accurate detection of TLSs on routine tissue slide. This model is complementary to the cancer staging system for risk stratification in gastrointestinal cancers.

Expression And Prognostic Role of PRDX1 In Gastrointestinal Cancers.

Esophageal, gastric, liver, and colorectal cancers represent four prevalent gastrointestinal cancers that pose substantial threats to global health due to their high morbidity and mortality rates. Peroxiredoxin 1 (PRDX1), a significant component of the PRDXs family, primarily functions to counteract the peroxides produced by metabolic activities in the body, thereby maintaining the dynamic equilibrium of peroxides in vivo. Intriguingly, PRDX1 expression correlates strongly with cancer's onset, progression, and prognosis. This study mainly applied bioinformatics methods to analyze PRDX1's expression, diagnosis, and prognosis in gastrointestinal cancers and to summarize current research advancements. Evidence from the bioinformatics database suggested that the high expression of PRDX1 was a prominent characteristic of these four gastrointestinal cancers, with this observation reaching statistical significance. The high expression of PRDX1 in gastrointestinal cancer cells also confirms this result. Notably, the primary alteration in PRDX1 within these cancers is the presence of genetic mutations. PRDX1 demonstrated the highest diagnostic efficacy for colorectal cancer. Nevertheless, elevated PRDX1 levels only significantly diminished the survival time of liver cancer patients, exerting no statistically significant impact on the survival duration of patients afflicted by the other three types of gastrointestinal cancers. Recent research has indicated variability in PRDX1 expression across different cancer types, with high expression being predominantly observed in these four gastrointestinal cancers and, in most instances, unfavorable prognosis. These findings broadly align with the results derived from bioinformatics. This research underscores the high expression of PRDX1 in gastrointestinal cancers, its relevance to the diagnosis and prognosis monitoring of these cancers, and its potential to guide clinical treatment for these cancers.