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Faa G, Fraschini M, Didaci L, Saba L, Scartozzi M, Orvieto E, Rugge M. "Artificial histology" in colonic Neoplasia: A critical approach. Dig Liver Dis 2025; 57:663-668. [PMID: 39616091 DOI: 10.1016/j.dld.2024.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2024] [Revised: 11/01/2024] [Accepted: 11/06/2024] [Indexed: 03/01/2025]
Abstract
BACKGROUND The histological assessment of colorectal precancer and cancer lesions is challenging and primarily impacts the clinical strategies of secondary colon cancer prevention. Artificial intelligence (AI) models may potentially assist in the histological diagnosis of this spectrum of phenotypical changes. OBJECTIVES To provide a current overview of the evidence on AI-based methods for histologically assessing colonic precancer and cancer lesions. METHODS Based on the available studies, this review focuses on the reliability of AI-driven models in ranking the histological phenotypes included in colonic oncogenesis. RESULTS This review acknowledges the efforts to shift from subjective pathologists-based to more objective AI-based histological phenotyping. However, it also points out significant limitations and areas that require improvement. CONCLUSIONS Current AI-driven methods have not yet achieved the expected level of clinical effectiveness, and there are still significant ethical concerns that need careful consideration. The integration of "artificial histology" into diagnostic practice requires further efforts to combine advancements in engineering techniques with the expertise of pathologists.
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Affiliation(s)
- Gavino Faa
- Department of Medical Sciences and Public Health, Università degli Studi di Cagliari, 09123 Cagliari, Italy; Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA, 19122 USA.
| | - Matteo Fraschini
- Department of Electrical and Electronic Engineering, Università degli Studi di Cagliari, 09123 Cagliari, Italy.
| | - Luca Didaci
- Department of Electrical and Electronic Engineering, Università degli Studi di Cagliari, 09123 Cagliari, Italy.
| | - Luca Saba
- Department of Radiology, University Hospital, Università degli Studi di Cagliari, 40138 Cagliari, Italy.
| | - Mario Scartozzi
- Medical Oncology Unit, University Hospital of Cagliari, Università degli Studi di Cagliari, 09123 Cagliari, Italy.
| | - Enrico Orvieto
- Department of Pathology, ULSS 8 Berica, San Bortolo Hospital, 36100 Vicenza, Italy.
| | - Massimo Rugge
- Department of Medicine - DIMED; General Anatomic Pathology and Cytopathology Unit, Università degli Studi di Padova, 35121 Padova, Italy.
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Minami R, Noma E, Moriguchi Y, Horiguchi S, Iizuka T. Differences in the Microvascular Arrangement Lead to Improved Clinical Diagnostics of Esophageal Neoplasms: A Single-Center Retrospective Study. Diagnostics (Basel) 2024; 14:2852. [PMID: 39767213 PMCID: PMC11675139 DOI: 10.3390/diagnostics14242852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Revised: 12/11/2024] [Accepted: 12/17/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND/OBJECTIVES Superficial esophageal cancer is diagnosed by evaluating the vascular architecture, including dilation, tortuosity, caliber change, and shape, of a lesion. However, this diagnosis is subjective and requires extensive experience. Endoscopically distinguishing squamous intraepithelial neoplasia (SIN) from esophageal cancer is difficult. Thus far, only a few studies have described the endoscopic findings of SIN. Therefore, the present study aimed to investigate whether endoscopic observation of the vascular architecture of tumors is useful in differentiating SIN from superficial esophageal cancer (SCC). METHODS This study included 141 patients who were histopathologically diagnosed with SIN or SCC between 2007 and 2023. Based on endoscopic images, patients were divided into those with a regular vascular arrangement (regular group) and those with an irregular vascular arrangement (irregular group). After evaluating the clinical characteristics, propensity score matching was used to assess the association between the groups and their pathological diagnoses. RESULTS Of the 141 patients, 44 and 97 were in the regular and irregular groups, respectively, with a ratio of 1:2. After propensity score matching, 33 and 66 patients were included in the regular and irregular groups, respectively. There were no significant differences between the groups after matching for age, alcohol consumption, smoking status, lesion site, sex, or lesion size. The regular group had significantly more patients with SIN, whereas the irregular group had significantly more patients with esophageal cancer (p < 0.001). CONCLUSIONS The regularity of the vascular architecture may be useful for endoscopically distinguishing between SIN and esophageal cancer.
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Affiliation(s)
- Ryogo Minami
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo 113-8677, Japan; (R.M.)
| | - Eriko Noma
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo 113-8677, Japan; (R.M.)
| | - Yoshiaki Moriguchi
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo 113-8677, Japan; (R.M.)
| | - Shinichiro Horiguchi
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo 113-8677, Japan
| | - Toshiro Iizuka
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo 113-8677, Japan; (R.M.)
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Pacheco RR, Kim H, Choi WT, Kook MC, Cho MY, Karamchandani DM, Lee MJ, Kim BH, Lee SH, Yang Z, Kim J, Lagana SM, Lee H. Unravelling interobserver variability in gastrointestinal glandular neoplasia: a contemporary study of US and Korean pathologists. J Clin Pathol 2024; 77:842-847. [PMID: 37739770 DOI: 10.1136/jcp-2023-209048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Abstract
AIMS Interobserver variability in the assessment of gastric neoplasia biopsies between most Western and Eastern (predominantly represented by Japanese in the literature) pathologists has been documented. It is unknown if such variability exists between the US and Korean pathologists in the current era. METHODS Ten gastrointestinal (GI) pathologists from the USA (n=5) and South Korea (n=5) evaluated 100 scanned images of gastric (n=50) and colorectal (n=50) neoplasia biopsies and answered multiple questionnaires. Consensus was defined as the answer chosen by the majority. Cohen's (κc) and Fleiss' kappa (κf) values were calculated between the consensus of the two groups and among the raters, respectively. RESULTS Both groups reached a consensus in the majority of cases (74%-100%) with slight to perfect intergroup (κc=0.049-1.000) and no to substantial intragroup (κf=-0.083 to 0.660) agreements. For gastric neoplasia, Korean pathologists relied heavily on cytoarchitectural atypia, whereas the US pathologists focused on stromal invasion when diagnosing adenocarcinoma. For colorectal neoplasia, the Korean pathologists identified concurrent intramucosal carcinoma when diagnosing invasive adenocarcinoma, while the presence of desmoplasia was a prerequisite for the diagnosis of invasive adenocarcinoma for the US pathologists. CONCLUSIONS For GI neoplasia biopsy interpretation, the diagnostic approach of Korean pathologists is similar to that of Eastern/Japanese pathologists. Consensus outperformed kappa statistics in capturing the magnitude of inter-rater and intergroup reliability, highlighting the potential benefit of consensus meetings to decrease the gap between Western and Eastern diagnostic approaches.
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Affiliation(s)
- Richard R Pacheco
- Pathology and Laboratory Medicine, Albany Medical Center, Albany, New York, USA
| | - Hyunki Kim
- Pathology, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea
| | - Won-Tak Choi
- Pathology, University of California, San Francisco, California, USA
| | - Myeong-Cherl Kook
- Pathology/Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Mee-Yon Cho
- Department of Pathology, Yonsei University College of Medicine, Wonju, Gangwon-do, Korea
| | - Dipti M Karamchandani
- Department of Pathology, Division of Anatomic Pathology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Michael J Lee
- Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Baek-Hui Kim
- Pathology, Korea University Guro Hospital, Seoul, Korea
| | - Sung-Hak Lee
- Hospital Pathology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Zhaohai Yang
- Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jihun Kim
- Department of Pathology, University of Ulsan College of Medicine, Seoul, Korea
| | - Stephen M Lagana
- Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Hwajeong Lee
- Pathology and Laboratory Medicine, Albany Medical Center, Albany, New York, USA
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Wang H, Nguyen M, Gupta S, Sidhu M, Cronin O, O'Sullivan T, Whitfield A, Lee EYT, Burgess NG, Bourke MJ. Long-term outcomes after endoscopic submucosal dissection for relative indication early gastric cancer in nonsurgical candidates. Gastrointest Endosc 2024; 100:647-659. [PMID: 38580133 DOI: 10.1016/j.gie.2024.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND AND AIMS Endoscopic submucosal dissection (ESD) is effective in treating early gastric cancer (EGC). Its role in patients with comorbidities along with more advanced disease is unknown. We sought to evaluate this in a large Western cohort. METHODS Consecutive patients who underwent ESD for EGC in a single tertiary Western endoscopy center over 10 years were prospectively analyzed. The primary outcomes were long-term overall survival (OS) and disease-free survival (DFS) up to 5 years. Secondary outcomes were efficacy and serious adverse events (SAEs). RESULTS ESD for 157 cases of EGC in 149 patients was performed in an elderly and comorbid cohort with a mean age of 73.7 years and age-adjusted Charlson Comorbidity Index of 4.2. Over a median follow-up of 51.6 months, no significant differences were found in 5-year OS (88.9% vs 77.9%, P = .290) and DFS (83.2% vs 75.1%, P = .593) between absolute indication EGC and relative indication (RI) EGC. The absolute indication EGC cohort achieved higher en bloc (96.3% vs 87.5%, P = .069) and R0 resection rates (93.6% vs 62.5%, P < .001) when compared with RI EGC. No significant differences were found in SAEs (7.3% vs 12.5%, P = .363). No mortality or surgical resection ensued from adverse events from ESD. CONCLUSIONS ESD safely confers DFS in poor surgical candidates with RI EGC in a large Western cohort. Patients who are elderly and/or with comorbidities or who decline surgical resection may benefit from ESD and avoid the risks of surgery and its long-term sequelae. (Clinical trial registration number: NCT02306707.).
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Affiliation(s)
- Hunter Wang
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Melinda Nguyen
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Sunil Gupta
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Mayenaaz Sidhu
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Oliver Cronin
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Timothy O'Sullivan
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Anthony Whitfield
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Eric Y T Lee
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas G Burgess
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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Li L, Jiang D, Liu H, Guo C, Zhang Q, Li X, Chen X, Chen Z, Feng J, Tan S, Huang W, Huang J, Xu C, Liu CY, Yu W, Hou Y, Ding C. Comprehensive Proteogenomic Profiling Reveals the Molecular Characteristics of Colorectal Cancer at Distinct Stages of Progression. Cancer Res 2024; 84:2888-2910. [PMID: 38861363 PMCID: PMC11372369 DOI: 10.1158/0008-5472.can-23-1878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 02/13/2024] [Accepted: 06/07/2024] [Indexed: 06/13/2024]
Abstract
Colorectal cancer is the second most common malignant tumor worldwide. Analysis of the changes that occur during colorectal cancer progression could provide insights into the molecular mechanisms driving colorectal cancer development and identify improved treatment strategies. In this study, we performed an integrated multiomic analysis of 435 trace tumor samples from 148 patients with colorectal cancer, covering nontumor, intraepithelial neoplasia (IEN), infiltration, and advanced stage colorectal cancer phases. Proteogenomic analyses demonstrated that KRAS and BRAF mutations were mutually exclusive and elevated oxidative phosphorylation in the IEN phase. Chr17q loss and chr20q gain were also mutually exclusive, which occurred predominantly in the IEN and infiltration phases, respectively, and impacted the cell cycle. Mutations in TP53 were frequent in the advanced stage colorectal cancer phase and associated with the tumor microenvironment, including increased extracellular matrix rigidity and stromal infiltration. Analysis of the profiles of colorectal cancer based on consensus molecular subtype and colorectal cancer intrinsic subtype classifications revealed the progression paths of each subtype and indicated that microsatellite instability was associated with specific subtype classifications. Additional comparison of molecular characteristics of colorectal cancer based on location showed that ANKRD22 amplification by chr10q23.31 gain enhanced glycolysis in the right-sided colorectal cancer. The AOM/DSS-induced colorectal cancer carcinogenesis mouse model indicated that DDX5 deletion due to chr17q loss promoted colorectal cancer development, consistent with the findings from the patient samples. Collectively, this study provides an informative resource for understanding the driving events of different stages of colorectal cancer and identifying the potential therapeutic targets. Significance: Characterization of the proteogenomic landscape of colorectal cancer during progression provides a multiomic map detailing the alterations in each stage of carcinogenesis and suggesting potential diagnostic and therapeutic approaches for patients.
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Affiliation(s)
- Lingling Li
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Human Phenome Institute, Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Dongxian Jiang
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Human Phenome Institute, Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hui Liu
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Human Phenome Institute, Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chunmei Guo
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Human Phenome Institute, Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiao Zhang
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Human Phenome Institute, Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xuedong Li
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Human Phenome Institute, Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaojian Chen
- Department of Colorectal and Anal Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zheqi Chen
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Human Phenome Institute, Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jinwen Feng
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Human Phenome Institute, Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Subei Tan
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Human Phenome Institute, Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen Huang
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Human Phenome Institute, Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jie Huang
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Human Phenome Institute, Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chen Xu
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Human Phenome Institute, Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chen-Ying Liu
- Department of Colorectal and Anal Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Yu
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Human Phenome Institute, Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yingyong Hou
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Human Phenome Institute, Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chen Ding
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Human Phenome Institute, Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
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Cheung KS, Chan AOO, Yu Wong BC. Intestinal‐type Gastric Cancer. GASTROINTESTINAL ONCOLOGY ‐ A CRITICAL MULTIDISCIPLINARY TEAM APPROACH 2E 2024:120-138. [DOI: 10.1002/9781119756422.ch7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Ishikawa T, Okimoto K, Matsumura T, Ogasawara S, Fukuda Y, Kitsukawa Y, Yokoyama Y, Kanayama K, Akizue N, Iino Y, Ohta Y, Ishigami H, Taida T, Tsuchiya S, Saito K, Kamezaki H, Kobayashi A, Kikuchi Y, Tada M, Shiko Y, Ozawa Y, Kato J, Yamaguchi T, Kato N. Risk factors of unintentional piecemeal resection in endoscopic mucosal resection for colorectal polyps ≥ 10 mm. Sci Rep 2024; 14:493. [PMID: 38177176 PMCID: PMC10766986 DOI: 10.1038/s41598-023-50815-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 12/26/2023] [Indexed: 01/06/2024] Open
Abstract
This study aimed to investigate the lesion and endoscopist factors associated with unintentional endoscopic piecemeal mucosal resection (uniEPMR) of colorectal lesions ≥ 10 mm. uniEPMR was defined from the medical record as anything other than a preoperatively planned EPMR. Factors leading to uniEPMR were identified by retrospective univariate and multivariate analyses of lesions ≥ 10 mm (adenoma including sessile serrated lesion and carcinoma) that were treated with endoscopic mucosal resection (EMR) at three hospitals. Additionally, a questionnaire survey was conducted to determine the number of cases treated by each endoscopist. A learning curve (LC) was created for each lesion size based on the number of experienced cases and the percentage of uniEPMR. Of 2557 lesions, 327 lesions underwent uniEPMR. The recurrence rate of uniEPMR was 2.8%. Multivariate analysis showed that lesion diameter ≥ 30 mm (odds ratio 11.83, 95% confidence interval 6.80-20.60, p < 0.0001) was the most associated risk factor leading to uniEPMR. In the LC analysis, the proportion of uniEPMR decreased for lesion sizes of 10-19 mm until 160 cases. The proportion of uniEPMR decreased with the number of experienced cases in the 20-29 mm range, while there was no correlation between the number of experienced cases and the proportion of uniEPMR ≥ 30 mm. These results suggest that 160 cases seem to be the minimum number of cases needed to be proficient in en bloc EMR. Additionally, while lesion sizes of 10-29 mm are considered suitable for EMR, lesion sizes ≥ 30 mm are not applicable for en bloc EMR from the perspective of both lesion and endoscopist factors.
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Affiliation(s)
- Tsubasa Ishikawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba-City, 260-8670, Japan
| | - Kenichiro Okimoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba-City, 260-8670, Japan.
| | - Tomoaki Matsumura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba-City, 260-8670, Japan
| | - Sadahisa Ogasawara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba-City, 260-8670, Japan
- Translational Research and Development Center, Chiba University Hospital, Chiba, Japan
| | - Yoshihiro Fukuda
- Department of Gastroenterology, Seikei-kai Chiba Medical Center, Chiba, Japan
| | - Yoshio Kitsukawa
- Department of Gastroenterology, Chiba Municipal Aoba Hospital, Chiba, Japan
| | - Yuya Yokoyama
- Department of Gastroenterology, Chibaken Saiseikai Narashino Hospital, Chiba, Japan
| | - Kengo Kanayama
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba-City, 260-8670, Japan
| | - Naoki Akizue
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba-City, 260-8670, Japan
| | - Yotaro Iino
- Department of Gastroenterology, Kimitsu Chuo Hospital, Chiba, Japan
| | - Yuki Ohta
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba-City, 260-8670, Japan
| | - Hideaki Ishigami
- Department of Gastroenterology, Chiba Rosai Hospital, Chiba, Japan
| | - Takashi Taida
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba-City, 260-8670, Japan
| | - Shin Tsuchiya
- Department of Gastroenterology, Funabashi Central Hospital, Chiba, Japan
| | - Keiko Saito
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba-City, 260-8670, Japan
| | - Hidehiro Kamezaki
- Department of Gastroenterology, Eastern Chiba Medical Center, Chiba, Japan
| | - Akitoshi Kobayashi
- Department of Gastroenterology, Funabashi Municipal Medical Center, Chiba, Japan
| | - Yasuharu Kikuchi
- Department of Gastroenterology, Numazu City Hospital, Shizuoka, Japan
| | - Minoru Tada
- Department of Gastroenterology, National Hospital Organization Chiba Medical Center, Chiba, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yoshihito Ozawa
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Jun Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba-City, 260-8670, Japan
| | - Taketo Yamaguchi
- Department of Gastroenterology, Funabashi Central Hospital, Chiba, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba-City, 260-8670, Japan
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Wei Y, Min C, Zhao C, Li Y, Wang X, Jing X, Yu Y, Li X, Yin X. Endoscopic characteristics and high-risk background mucosa factors of early gastric cancer after helicobacter pylori eradication: a single-center retrospective study. Front Oncol 2023; 13:1272187. [PMID: 37849804 PMCID: PMC10577436 DOI: 10.3389/fonc.2023.1272187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/30/2023] [Indexed: 10/19/2023] Open
Abstract
Purpose Gastric cancer still develops after successful Helicobacter pylori(Hp)eradication. In this study, we aimed to explore the characteristics and risks of mucosal factors. Methods A total of 139 early gastric cancers (EGC) diagnosed in 133 patients after successful eradication from January 2016 to December 2021 were retrospectively included in the Hp-eradication EGC group and 170 EGCs diagnosed in 158 patients were included in the Hp-positive EGC group. We analyzed the clinical, pathological, and endoscopic characteristics between the two groups to identify the features of EGC after Hp eradication. Another 107 patients with no EGC after Hp eradication were enrolled in a Hp-eradication non-EGC group. The background mucosal factors between the Hp-eradication EGC group and the Hp-eradication non-EGC group were compared to analyze the high-risk background mucosal factors of EGC after eradication. In addition, we divided the EGC group after Hp eradication into IIc type and non-IIc type according to endoscopic gross classification to assess the high-risk background factors of IIc-type EGC after Hp eradication. Results The endoscopic features of EGC after Hp eradication included location in the lower part of the stomach (p=0.001), yellowish color (p= 0.031), and smaller size (p=0.001). The moderate/severe gastric atrophy (GA), intestinal metaplasia (IM) in the corpus, severe diffuse redness, and map-like redness were risk factors for EGC after eradication (p=0.001, p=0.001, p=0.001, and p= 0.005, respectively). The Kyoto classification total score in the EGC group was higher than the non-EGC group (4 vs.3 p<0.001). A multivariate analysis revealed that depressed erosion (OR=3.42, 95% CI 1.35-8.65, p= 0.009) was an independent risk factor for IIc-type EGC after Hp eradication. Conclusion EGC after eradication are smaller and yellowish lesions located in the lower part of the stomach. The risk background mucosal factors include moderate/severe GA, IM in the corpus, severe diffuse redness, and map-like redness. The Kyoto classification total score of 4 or more after successful eradication treatment might indicate EGC risk. In addition, the IIc-type EGC should be cautioned in the presence of depressed erosion after Hp eradication.
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Affiliation(s)
- Yali Wei
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Congcong Min
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Chongguang Zhao
- Department of Clinical Medicine, Qingdao University Medical College, Qingdao, Shandong, China
| | - Yubei Li
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xiaowei Wang
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xue Jing
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yanan Yu
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xiaoyu Li
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xiaoyan Yin
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Murakami D, Yamato M, Amano Y, Nishino T, Arai M. Variation in the rate of detection of minute and small early gastric cancers at diagnostic endoscopy may reflect the performance of individual endoscopists. BMJ Open Gastroenterol 2023; 10:e001143. [PMID: 37407230 PMCID: PMC10335432 DOI: 10.1136/bmjgast-2023-001143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/18/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE The documented variation in gastric cancer (GC) detection among endoscopists has often been dismissed as a coincidental artefact of the low incidence of gastric neoplasms; it is not considered associated with differences in physicians' performance of the esophagogastroduodenoscopy procedure. This study is to confirm whether significant variations among endoscopists in early GC detection suggest the individual performance of the upper endoscopy. DESIGN A retrospective observational study at a single centre in Japan assessed the results of 218 early GCs detected during 25 688 routine esophagogastroduodenoscopies by 12 endoscopists. The main outcome was the rate of early GC detection for each endoscopist under the same circumstances. Other measures included the major diameters and locations of the lesions, Helicobacter pylori infection status, and baseline patient characteristics that could affect the prevalence of GC. RESULTS The early GC detection rates exhibited wide variation among endoscopists (0.09%-2.87%) despite performing routine esophagogastroduodenoscopies in a population with a similar background. Endoscopists were assigned to a low-detection group (n=6; detection rate: 0.47% (range: 0.09%-0.55%)) and a high-detection group (n=5; detection rate: 0.83% (range: 0.63%-1.12%)), with the single highest detector analysed separately due to his distinct detection rate (2.87%). Endoscopists in the high-detection group had better detection rates for minute (major diameter ≤5 mm) and small (major diameter 6-10 mm) GCs than the low-detection group (0.19%/0.23% vs 0.085%/0.098%). These differences were significant (p<0.01), although there were no significant differences in detection of larger tumours (major diameter ≥11 mm; 0.40% vs 0.28%; p=0.13). The tumour location and H. pylori status were similar in the low-detection group, high-detection group and for the highest detector. CONCLUSION Significant variation in the detection of hard-to-find, smaller GCs may reflect individual performance of the examination.
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Affiliation(s)
- Daisuke Murakami
- Department of Gastroenterology, Tokyo Women's Medical University Yachiyo Medical Centre, Yachiyo, Chiba, Japan
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
- Department of Gastroenterology and Endoscopy, New Tokyo Hospital, Mtsudo, Chiba, Japan
| | - Masayuki Yamato
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
| | - Yuji Amano
- Department of Gastroenterology and Endoscopy, New Tokyo Hospital, Mtsudo, Chiba, Japan
| | - Takayoshi Nishino
- Department of Gastroenterology, Tokyo Women's Medical University Yachiyo Medical Centre, Yachiyo, Chiba, Japan
| | - Makoto Arai
- Department of Gastroenterology, Tokyo Women's Medical University Yachiyo Medical Centre, Yachiyo, Chiba, Japan
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10
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Li L, Jiang D, Zhang Q, Liu H, Xu F, Guo C, Qin Z, Wang H, Feng J, Liu Y, Chen W, Zhang X, Bai L, Tian S, Tan S, Xu C, Song Q, Liu Y, Zhong Y, Chen T, Zhou P, Zhao JY, Hou Y, Ding C. Integrative proteogenomic characterization of early esophageal cancer. Nat Commun 2023; 14:1666. [PMID: 36966136 PMCID: PMC10039899 DOI: 10.1038/s41467-023-37440-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/16/2023] [Indexed: 03/27/2023] Open
Abstract
Esophageal squamous cell carcinoma (ESCC) is malignant while the carcinogenesis is still unclear. Here, we perform a comprehensive multi-omics analysis of 786 trace-tumor-samples from 154 ESCC patients, covering 9 histopathological stages and 3 phases. Proteogenomics elucidates cancer-driving waves in ESCC progression, and reveals the molecular characterization of alcohol drinking habit associated signatures. We discover chromosome 3q gain functions in the transmit from nontumor to intraepithelial neoplasia phases, and find TP53 mutation enhances DNA replication in intraepithelial neoplasia phase. The mutations of AKAP9 and MCAF1 upregulate glycolysis and Wnt signaling, respectively, in advanced-stage ESCC phase. Six major tracks related to different clinical features during ESCC progression are identified, which is validated by an independent cohort with another 256 samples. Hyperphosphorylated phosphoglycerate kinase 1 (PGK1, S203) is considered as a drug target in ESCC progression. This study provides insight into the understanding of ESCC molecular mechanism and the development of therapeutic targets.
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Affiliation(s)
- Lingling Li
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Institute of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai, 200433, China
| | - Dongxian Jiang
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, 200032, China
| | - Qiao Zhang
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Institute of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai, 200433, China
| | - Hui Liu
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Institute of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai, 200433, China
| | - Fujiang Xu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Chunmei Guo
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Institute of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai, 200433, China
| | - Zhaoyu Qin
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Institute of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai, 200433, China
| | - Haixing Wang
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, 200032, China
| | - Jinwen Feng
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Institute of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai, 200433, China
| | - Yang Liu
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Institute of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai, 200433, China
| | - Weijie Chen
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, 200032, China
| | - Xue Zhang
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, 200032, China
| | - Lin Bai
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Institute of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai, 200433, China
| | - Sha Tian
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Institute of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai, 200433, China
| | - Subei Tan
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Institute of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai, 200433, China
| | - Chen Xu
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, 200032, China
| | - Qi Song
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, 200032, China
| | - Yalan Liu
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, 200032, China
| | - Yunshi Zhong
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, 200032, China
| | - Tianyin Chen
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, 200032, China
| | - Pinghong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital Fudan University, Shanghai, 200032, China.
| | - Jian-Yuan Zhao
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Institute of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai, 200433, China.
- Institute for Development and Regenerative Cardiovascular Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
- Department of Anatomy and Neuroscience Research Institute , School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, 450001, China.
| | - Yingyong Hou
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, 200032, China.
| | - Chen Ding
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Institute of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai, 200433, China.
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11
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Gudenkauf FJ, Mehta A, Ferri L, Aihara H, Draganov PV, Yang DJ, Jue TL, Munroe CA, Boparai ES, Mehta NA, Bhatt A, Kumta NA, Othman MO, Mercado M, Javaid H, Aadam AA, Siegel A, James TW, Grimm IS, DeWitt JM, Novikov A, Schlachterman A, Kowalski T, Samarasena J, Hashimoto R, Chehade NEH, Lee JG, Chang K, Su B, Ujiki MB, Sharaiha RZ, Carr-Locke DL, Chen A, Chen M, Chen YI, Tomizawa Y, von Renteln D, Kumbhari V, Khashab MA, Bechara R, Karasik M, Patel NJ, Fukami N, Nishimura M, Hanada Y, Song LMWK, Laszkowska M, Wang AY, Hwang JH, Friedland S, Sethi A, Ngamruengphong S. Factors Associated With Advanced Histological Diagnosis and Upstaging After Endoscopic Submucosal Dissection of Superficial Gastric Neoplasia. TECHNIQUES AND INNOVATIONS IN GASTROINTESTINAL ENDOSCOPY 2023; 25:2-10. [DOI: 10.1016/j.tige.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
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12
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Oncological outcome of proximal and middle extrahepatic bile duct cancer according to surgical extent (Is hilar resection oncologically acceptable in proximal and middle extrahepatic bile duct cancer?). HPB (Oxford) 2022; 24:2167-2174. [PMID: 36253267 DOI: 10.1016/j.hpb.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/30/2022] [Accepted: 09/28/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND For proximal to middle bile duct cancer, it is controversial whether bile duct resection alone is sufficient, or whether hepatic or pancreatic resection should be accompanied by initial planning. This study aimed to determine the optimal surgical extent based on oncological outcomes in patients with proximal to middle bile duct cancer. METHODS Patients who underwent surgery for proximal to middle extrahepatic bile duct cancer, hilar resection, or combined resection of other organs were included. Clinicopathological characteristics and survival analyses were compared according to operation type. RESULTS Among 156 patients in total, R0 rate was 56.7% for hilar resection and 82.7% for other organ resection. Although hilar resection was associated with shorter hospital stay and fewer overall complications, operation type did not affect overall survival (p = 0.259) and disease-free-survival (p = 0.774). Overall survival differed according to R status (5YSR 49.8 vs. 27.1%; p = 0.012). CONCLUSION In proximal to middle extrahepatic bile duct cancer, surgery should be tailored to achieve R0 resection according to the extent of the disease rather than uniformly resecting extensively with other organ resections. Hilar resection could be selected if R0 resection is feasible, considering the lower morbidity with similar long-term survival.
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13
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Association Between Family History of Gastric Cancer and the Risk of Gastric Cancer and Adenoma: A Nationwide Population-Based Study. Am J Gastroenterol 2022; 117:1255-1263. [PMID: 35613561 DOI: 10.14309/ajg.0000000000001837] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/29/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION A family history of gastric cancer (GC) is a well-known risk factor for GC. However, the association between family history of GC and the risk of GC and gastric adenoma according to the affected family members is unclear. METHODS We analyzed the data of participants aged ≥40 years who underwent national GC screening between 2013 and 2014. Participants with and without a family history of GC among first-degree relatives were matched by age and sex in a 1:4 ratio. RESULTS During a median follow-up of 4.9 years, 0.96% and 0.46% of 896,721 participants with a family history of GC and 0.65% and 0.32% of 3,586,884 participants without a family history of GC developed GC and gastric adenoma, respectively. A family history of GC among any first-degree relative was a risk factor for GC (adjusted hazard ratio [HR] 1.48, 95% confidence interval 1.45-1.52) and gastric adenoma (HR 1.44, 95% confidence interval 1.39-1.50). The HRs for GC and gastric adenoma were higher in participants with a family history of GC in parents and siblings (2.26 and 2.19, respectively) than in those with a family history of GC in parents only (1.40 and 1.41, respectively) or siblings only (1.59 and 1.47, respectively). The HRs for GC in participants with vs without a family history of GC were 1.62, 1.55, and 1.42 in the 40-49, 50-59, and ≥60 years' age groups of participants, respectively. Similarly, the HRs for gastric adenoma increased with decreasing age of participants. DISCUSSION A family history of GC was a risk factor for both GC and gastric adenoma. The risk of GC and gastric adenoma of the participants was higher when both parents and siblings had GC.
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14
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Tamura N, Sakaguchi Y, Furutani W, Matsui M, Nagao S, Sakuma N, Fukagawa K, Miura Y, Mizutani H, Ohki D, Kataoka Y, Saito I, Ono M, Minatsuki C, Tsuji Y, Ono S, Kodashima S, Abe H, Ushiku T, Yamamichi N, Koike K, Fujishiro M. Magnifying endoscopy with narrow-band imaging is useful in differentiating gastric cancer from matched adenoma in white light imaging. Sci Rep 2022; 12:8349. [PMID: 35589745 PMCID: PMC9120519 DOI: 10.1038/s41598-022-12315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/09/2022] [Indexed: 11/29/2022] Open
Abstract
This study assessed the effect of magnifying endoscopy with narrow-band imaging (M-NBI) on the endoscopic differential diagnosis between intramucosal gastric carcinomas and adenomas with matched characteristics. Associations between magnified endoscopic findings and pathological high-grade cellular and architectural atypia were also investigated. In total, the records of 50 adenomas and 50 intramucosal well-differentiated adenocarcinomas matched by tumor size (≥ 20 mm or < 20 mm), shape (depression or non-depression), and color (red or non-red) were extracted. Fourteen endoscopists diagnosed adenoma or cancer in the 100 cases with conventional white light imaging (C-WLI), then did the same with C-WLI + M-NBI.The cancer diagnostic sensitivity, specificity, and accuracy were assessed. The sensitivity of C-WLI + M-NBI for cancer diagnosis was 79.9% compared to 71.6% with C-WLI (p < 0.001). There were no significant differences in specificity (40.1% vs. 36.3%, p = 0.296) and accuracy (55.9% vs. 58.1%, p = 0.163). High-grade cytological or architectural atypia was diagnosed more often with irregular microvascular pattern (IMVP) or microsurface pattern (IMSP), respectively, than the low-grade forms. In conclusion, IMVP and IMSP correlate with high-grade cytological and architectural atypia. M-NBI is useful in differentiating intramucosal carcinoma from adenoma and can reduce underdiagnosis of cancer.
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Affiliation(s)
- Naoki Tamura
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Tokyo, 113-8655, Japan
| | - Yoshiki Sakaguchi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Tokyo, 113-8655, Japan.
| | - Wakiko Furutani
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Tokyo, 113-8655, Japan
| | - Maki Matsui
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Tokyo, 113-8655, Japan
| | - Sayaka Nagao
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Tokyo, 113-8655, Japan
| | - Nobuyuki Sakuma
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Tokyo, 113-8655, Japan
| | - Kazushi Fukagawa
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Tokyo, 113-8655, Japan
| | - Yuko Miura
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Tokyo, 113-8655, Japan
| | - Hiroya Mizutani
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Tokyo, 113-8655, Japan
| | - Daisuke Ohki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Tokyo, 113-8655, Japan
| | - Yosuke Kataoka
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Tokyo, 113-8655, Japan
| | - Itaru Saito
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Tokyo, 113-8655, Japan
| | - Masayoshi Ono
- Department of Gastroenterology, Hokkaido University Hospital, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Chihiro Minatsuki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Tokyo, 113-8655, Japan
| | - Yosuke Tsuji
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Tokyo, 113-8655, Japan
| | - Satoshi Ono
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Tokyo, 113-8655, Japan
| | - Shinya Kodashima
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Tokyo, 113-8655, Japan
| | - Hiroyuki Abe
- Department of Pathology, The University of Tokyo Hospital, 7-3-1, Hongo, Tokyo, 113-8655, Japan
| | - Tetsuo Ushiku
- Department of Pathology, The University of Tokyo Hospital, 7-3-1, Hongo, Tokyo, 113-8655, Japan
| | - Nobutake Yamamichi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Tokyo, 113-8655, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Tokyo, 113-8655, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Tokyo, 113-8655, Japan
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Cai F, Dong Y, Wang P, Zhang L, Yang Y, Liu Y, Wang X, Zhang R, Liang H, Sun Y, Deng J. Risk assessment of lymph node metastasis in early gastric cancer: Establishment and validation of a Seven-point scoring model. Surgery 2022; 171:1273-1280. [PMID: 34865863 DOI: 10.1016/j.surg.2021.10.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 10/10/2021] [Accepted: 10/25/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Treatment options for early gastric cancer have evolved toward achieving accurate evaluation of lymph node metastasis. This study aimed to investigate risk factors of lymph node metastasis in patients with early gastric cancer and establish a risk score model to guide the selection of optimal treatment. METHODS The clinicopathological characteristics of 351 patients with early gastric cancer from January 2016 to December 2018 were reviewed retrospectively. On the basis of the independent risk factors determined by multivariate binary logistic regression analysis, we established a risk score model for predicting lymph node metastasis and then verified it. The receiver operating characteristic curves were plotted using the test and validation sets. The area under the receiver operating characteristic curve was used to assess the discriminant ability of the model. RESULTS Lymph node metastasis was observed in 10.5% (37/351) of early gastric cancer cases. Patients with early gastric cancer were grouped based on the independent risk factors for lymph node metastasis (tumor size, depth, histological type, and lymphovascular involvement) determined by multivariate analysis. A 7-point risk score model was established to predict the risk of lymph node metastasis. The area under the receiver operating characteristic curve in the development and validation sets were 0.839 (95% confidence interval, 0.769%-0.910%) and 0.820 (95% confidence interval, 0.711%-0.930%), respectively. CONCLUSION A feasible risk score model for lymph node metastasis was established to guide the optimal treatment of patients with early gastric cancer early gastric cancer.
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Affiliation(s)
- Fenglin Cai
- Department of Gastroenterology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, P.R. China
| | - Yinping Dong
- Department of Gastroenterology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, P.R. China
| | - Pengliang Wang
- Department of Gastroenterology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, P.R. China
| | - Li Zhang
- Department of Gastroenterology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, P.R. China
| | - Yang Yang
- Department of Anesthesiology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, P.R. China
| | - Yong Liu
- Department of Gastroenterology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, P.R. China
| | - Xuejun Wang
- Department of Gastroenterology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, P.R. China
| | - Rupeng Zhang
- Department of Gastroenterology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, P.R. China
| | - Han Liang
- Department of Gastroenterology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, P.R. China
| | - Yan Sun
- Department of Pathology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, P.R. China
| | - Jingyu Deng
- Department of Gastroenterology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, P.R. China.
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Gao C, Dan Zeng CD, Tong YX, Zhu L, Zhang S. Preoperative Low Prealbumin Is Associated With Recurrence in Patients With Stage II/III Gastric Cancer After Laparoscopic D2 Gastrectomy. Front Surg 2022; 9:819514. [PMID: 35433809 PMCID: PMC9010530 DOI: 10.3389/fsurg.2022.819514] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/04/2022] [Indexed: 01/27/2023] Open
Abstract
BackgroundPostoperative recurrence is associated with poor prognosis in patients with gastric cancer. This study aimed to explore predictive factors contributing to recurrence in patients with stage II/III gastric cancer after laparoscopic D2 gastrectomy.MethodsThis retrospective study was conducted at a single tertiary referral hospital. Patients diagnosed with gastric cancer who met the inclusion criteria were included in the study. The clinicopathological characteristics of the patients were collected. The patients were divided into recurrence and non-recurrence groups. The predictive factors were investigated using univariate and multivariate analyses.ResultsIn total, 462 patients were included. The incidence of recurrence was 26.4% (122/462) in all patients. The most common recurrence pattern was haematogenous recurrence. In the multivariate analysis, the independent predictive factors for recurrence were serum prealbumin level (p < 0.001), prognostic nutritional index (p = 0.001), carbohydrate antigen 19-9 (CA19-9) (p < 0.001), number of lymph node metastases (p < 0.001), signet-ring cell carcinoma (p = 0.001), tumor deposit (p = 0.001), and no/incomplete adjuvant chemotherapy (p < 0.001).ConclusionsOur findings revealed that nutritional status was an independent predictive factor for recurrence in patients with gastric cancer after D2 gastrectomy. We suggest that patients with risk factors for recurrence receive both nutritional support and intense surveillance.
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Thiong’o GM, Rutka JT. Digital Twin Technology: The Future of Predicting Neurological Complications of Pediatric Cancers and Their Treatment. Front Oncol 2022; 11:781499. [PMID: 35127487 PMCID: PMC8807511 DOI: 10.3389/fonc.2021.781499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/29/2021] [Indexed: 11/28/2022] Open
Abstract
Healthcare technologies have seen a surge in utilization during the COVID 19 pandemic. Remote patient care, virtual follow-up and other forms of futurism will likely see further adaptation both as a preparational strategy for future pandemics and due to the inevitable evolution of artificial intelligence. This manuscript theorizes the healthcare applications of digital twin technology. Digital twin is a triune concept that involves a physical model, a virtual counterpart, and the interplay between the two constructs. This interface between computer science and medicine is a new frontier with broad potential applications. We propose that digital twin technology can exhaustively and methodologically analyze the associations between a physical cancer patient and a corresponding digital counterpart with the goal of isolating predictors of neurological sequalae of disease. This proposition stems from the premise that data science can complement clinical acumen to scientifically inform the diagnostics, treatment planning and prognostication of cancer care. Specifically, digital twin could predict neurological complications through its utilization in precision medicine, modelling cancer care and treatment, predictive analytics and machine learning, and in consolidating various spectra of clinician opinions.
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Affiliation(s)
- Grace M. Thiong’o
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- *Correspondence: Grace M. Thiong’o,
| | - James T. Rutka
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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18
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Moore JL, Davies AR, Santaolalla A, Van Hemelrijck M, Maisey N, Lagergren J, Gossage JA, Kelly M, Baker CR. Clinical Relevance of the Tumor Location-Modified Laurén Classification System for Gastric Cancer in a Western Population. Ann Surg Oncol 2022; 29:3911-3920. [PMID: 35041098 PMCID: PMC9072452 DOI: 10.1245/s10434-021-11252-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
Background The Tumor Location-Modified Laurén Classification (MLC) system combines Laurén histologic subtype and anatomic tumor location. It divides gastric tumors into proximal non-diffuse (PND), distal non-diffuse (DND), and diffuse (D) types. The optimum classification of patients with Laurén mixed tumors in this system is not clear due to its grouping with both diffuse and non-diffuse types in previous studies. The clinical relevance of the MLC in a Western population has not been examined. Methods A cohort study investigated 404 patients who underwent gastrectomy for gastric adenocarcinoma between 2005 and 2020. The classification of Laurén mixed tumors was evaluated using receiver operating characteristic (ROC) curve analysis and comparison of clinicopathologic characteristics (chi-square). Survival analysis was performed using multivariable Cox regression. Results The ROC curve analysis demonstrated a slightly higher area under the curve value for predicting survival when Laurén mixed tumors were grouped with intestinal-type rather than diffuse-type tumors (0.58 vs 0.57). Survival, tumor recurrence, and resection margin positivity in mixed tumors also was more similar to intestinal type. Distal non-diffuse tumors had the best 5-year survival (DND 64.7 % vs PND 56.1 % vs diffuse 45.1 %; p = 0.006) and were least likely to have recurrence (DND 27.0 % vs PND 34.3 % vs diffuse 48.3 %; p = 0.001). Multivariable analysis demonstrated that MLC was an independent prognostic factor for survival (PND: hazard ratio [HR], 1.64; 95 % confidence interval [CI], 1.16–2.32 vs diffuse: HR, 2.20; 95 % CI, 1.56–3.09) Conclusions The MLC was an independent prognostic marker in this Western cohort of patients with gastric adenocarcinoma. The patients with PND and D tumors had worse survival than those with DND tumors.
Supplementary Information The online version contains supplementary material available at 10.1245/s10434-021-11252-y.
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Affiliation(s)
- J L Moore
- Department of Upper Gastrointestinal and General Surgery, St. Thomas' Hospital, London, UK. .,School of Cancer and Pharmaceutical Sciences, King's College, London, UK.
| | - A R Davies
- Department of Upper Gastrointestinal and General Surgery, St. Thomas' Hospital, London, UK.,School of Cancer and Pharmaceutical Sciences, King's College, London, UK
| | - A Santaolalla
- School of Cancer and Pharmaceutical Sciences, King's College, London, UK.,Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College, London, UK
| | - M Van Hemelrijck
- School of Cancer and Pharmaceutical Sciences, King's College, London, UK.,Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College, London, UK
| | - N Maisey
- Department of Medical Oncology, St. Thomas' Hospital, London, UK
| | - J Lagergren
- Department of Upper Gastrointestinal and General Surgery, St. Thomas' Hospital, London, UK.,School of Cancer and Pharmaceutical Sciences, King's College, London, UK.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - J A Gossage
- Department of Upper Gastrointestinal and General Surgery, St. Thomas' Hospital, London, UK.,School of Cancer and Pharmaceutical Sciences, King's College, London, UK
| | - M Kelly
- Department of Upper Gastrointestinal and General Surgery, St. Thomas' Hospital, London, UK.,School of Cancer and Pharmaceutical Sciences, King's College, London, UK
| | - C R Baker
- Department of Upper Gastrointestinal and General Surgery, St. Thomas' Hospital, London, UK.,School of Cancer and Pharmaceutical Sciences, King's College, London, UK
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19
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Tseng J, Miller JP, Johnson J, Waters K, Gangi A, Gong J, Burch M. Disparities and survival in newly diagnosed gastric cancer in Hispanic patients in the United States: a propensity score matched analysis. J Gastrointest Oncol 2021; 12:1308-1325. [PMID: 34532090 DOI: 10.21037/jgo-21-207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/30/2021] [Indexed: 11/06/2022] Open
Abstract
Background The burden of gastric cancer involving Hispanic patients in the United States is growing as both the population and the incidence of gastric cancer in this group increases. This burden is compounded by presentation with advanced disease and socioeconomic challenges shaping cancer care. We sought to describe the demographics, socioeconomic factors, treatment, and survival experience of Hispanic patients with gastric adenocarcinoma. Methods Patients with gastric adenocarcinoma diagnosed between 2004 and 2015 (n=90,737) in the National Cancer Database were retrospectively identified. Patients of Hispanic ethnicity were compared against non-Hispanic white patients. Surgical cohort was further analyzed, and 1:1 propensity score matching was used to balance covariates between Hispanic and non-Hispanic white surgical patients. Survival was compared using Kaplan-Meier method. Cox regression was used to determine prognostic factors for survival. Results Compared to non-Hispanic white patients, Hispanic patients are more likely to be younger, female, and healthier. They were more likely to be uninsured, reside in poorer neighborhoods and reside in areas with lower rates of education. Hispanic patients were more likely to live in a metropolitan area, travel shorter distances for healthcare, and receive treatment at an academic and high volume centers. Hispanic patients were more likely to have higher stage disease presentation, higher grade tumors, lymphovascular invasion, and poorly cohesive adenocarcinoma. Hispanic patients were more likely to receive surgery, but less likely to receive adjuvant therapy. In Cox regression of all patients, unmatched surgical patients, and matched surgical patients, Hispanic ethnicity was an independent prognostic factor of improved survival. Conclusions Hispanic patients with gastric adenocarcinoma present with several unfavorable clinicopathologic and socioeconomic factors. Paradoxically, these patients demonstrate improved survival. Further study is warranted to characterize disease biology in this population.
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Affiliation(s)
- Joshua Tseng
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - James P Miller
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jeffrey Johnson
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kevin Waters
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alexandra Gangi
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jun Gong
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Miguel Burch
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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20
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Tanabe H, Mizukami Y, Takei H, Tamamura N, Omura Y, Kobayashi Y, Murakami Y, Kunogi T, Sasaki T, Takahashi K, Ando K, Ueno N, Kashima S, Yuzawa S, Hasegawa K, Sumi Y, Tanino M, Fujiya M, Okumura T. Clinicopathological characteristics of Epstein-Barr virus and microsatellite instability subtypes of early gastric neoplasms classified by the Japanese and the World Health Organization criteria. J Pathol Clin Res 2021; 7:397-409. [PMID: 33750036 PMCID: PMC8185367 DOI: 10.1002/cjp2.209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/16/2021] [Accepted: 02/25/2021] [Indexed: 12/13/2022]
Abstract
Gastric cancer is a heterogenous disease with different phenotypes, genotypes, and clinical outcomes, including sensitivity to treatments and prognoses. Recent medical advances have enabled the classification of this heterogenous disease into several groups and the consequent analysis of their clinicopathological characteristics. Gastric cancer associated with Epstein-Barr virus (EBV) and microsatellite-unstable tumors are considered to be the two major subtypes as they are clearly defined by well-established methodologies, such as in situ hybridization and polymerase chain reaction-based analyses, respectively. However, discrepancies in the histological diagnosis of gastric neoplasms remain problematic, and international harmonization should be performed to improve our understanding of gastric carcinogenesis. We re-evaluated Japanese cases of early gastric cancer according to the current World Health Organization (WHO) criteria and classified them into genomic subtypes based on microsatellite instability (MSI) and EBV positivity to determine the initial genetic events in gastric carcinogenesis. A total of 113 Japanese early gastric cancers (including low- and high-grade dysplasias) treated with endoscopic resection over 5 years were archived in our hospital. A histological re-evaluation according to the WHO criteria revealed 54 adenocarcinomas, which were divided into 6 EBV-positive (11.1%), 7 MSI-high (MSI-H, 13.0%), and 41 microsatellite stable cases (75.9%). MSI-H adenocarcinoma was confirmed by an immunohistochemistry assay of mismatch repair proteins. Programmed death-ligand 1 immunostaining with two antibodies (E1L3N and SP263) was positive in tumor cells of one MSI-H adenocarcinoma case (1/7, 14.3%). The proportion of stained cells was higher with clone SP263 than with E1L3N. Histologically, EBV-positive carcinomas were poorly differentiated (83.8%), and MSI-H cancers were frequent in well to moderately differentiated adenocarcinoma (85.7%), indicating that the EBV-positive subtype presented with high-grade morphology even when an early lesion. Our study indicates that the WHO criteria are useful for subdividing Japanese early gastric cancers, and this subdivision may be useful for comparative analysis of precursor lesions and early carcinoma.
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Affiliation(s)
- Hiroki Tanabe
- Division of Gastroenterology and Hematology/Oncology, Department of MedicineAsahikawa Medical UniversityAsahikawaJapan
| | - Yusuke Mizukami
- Division of Gastroenterology and Hematology/Oncology, Department of MedicineAsahikawa Medical UniversityAsahikawaJapan
| | - Hidehiro Takei
- Department of Diagnostic Pathology, Asahikawa Medical University HospitalAsahikawa Medical UniversityAsahikawaJapan
| | - Nobue Tamamura
- Division of Gastroenterology and Hematology/Oncology, Department of MedicineAsahikawa Medical UniversityAsahikawaJapan
| | - Yuhi Omura
- Department of Bio SystemsHitachi High‐Tech CorporationTokyoJapan
| | - Yu Kobayashi
- Division of Gastroenterology and Hematology/Oncology, Department of MedicineAsahikawa Medical UniversityAsahikawaJapan
| | - Yuki Murakami
- Division of Gastroenterology and Hematology/Oncology, Department of MedicineAsahikawa Medical UniversityAsahikawaJapan
| | - Takehito Kunogi
- Division of Gastroenterology and Hematology/Oncology, Department of MedicineAsahikawa Medical UniversityAsahikawaJapan
| | - Takahiro Sasaki
- Division of Gastroenterology and Hematology/Oncology, Department of MedicineAsahikawa Medical UniversityAsahikawaJapan
| | - Keitaro Takahashi
- Division of Gastroenterology and Hematology/Oncology, Department of MedicineAsahikawa Medical UniversityAsahikawaJapan
| | - Katsuyoshi Ando
- Division of Gastroenterology and Hematology/Oncology, Department of MedicineAsahikawa Medical UniversityAsahikawaJapan
| | - Nobuhiro Ueno
- Division of Gastroenterology and Hematology/Oncology, Department of MedicineAsahikawa Medical UniversityAsahikawaJapan
| | - Shin Kashima
- Division of Gastroenterology and Hematology/Oncology, Department of MedicineAsahikawa Medical UniversityAsahikawaJapan
| | - Sayaka Yuzawa
- Department of Diagnostic Pathology, Asahikawa Medical University HospitalAsahikawa Medical UniversityAsahikawaJapan
| | - Kimiharu Hasegawa
- Division of Gastrointestinal Surgery, Department of SurgeryAsahikawa Medical UniversityAsahikawaJapan
| | - Yasuo Sumi
- Division of Gastrointestinal Surgery, Department of SurgeryAsahikawa Medical UniversityAsahikawaJapan
| | - Mishie Tanino
- Department of Diagnostic Pathology, Asahikawa Medical University HospitalAsahikawa Medical UniversityAsahikawaJapan
| | - Mikihiro Fujiya
- Division of Gastroenterology and Hematology/Oncology, Department of MedicineAsahikawa Medical UniversityAsahikawaJapan
| | - Toshikatsu Okumura
- Division of Gastroenterology and Hematology/Oncology, Department of MedicineAsahikawa Medical UniversityAsahikawaJapan
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21
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Jeon JW, Kim SJ, Jang JY, Kim SM, Lim CH, Park JM, Hong SJ, Kim CG, Jeon SW, Lee SH, Sung JK, Baik GH. Clinical Outcomes of Endoscopic Resection for Low-Grade Dysplasia and High-Grade Dysplasia on Gastric Pretreatment Biopsy: Korea ESD Study Group. Gut Liver 2021; 15:225-231. [PMID: 32773388 PMCID: PMC7960976 DOI: 10.5009/gnl19275] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 03/26/2020] [Accepted: 04/11/2020] [Indexed: 12/24/2022] Open
Abstract
Background/Aims Some cases of gastric low-grade dysplasia (LGD) and high-grade dysplasia (HGD) on forceps biopsy (FB) are diagnosed as gastric cancer (GC) after endoscopic resection (ER). This study aims to evaluate the clinical outcomes of ER for gastric LGD and HGD on pretreatment FB and to identify the factors that predict pathologic upstaging to GC. Methods Patients who underwent ER for LGD and HGD on pretreatment FB from March 2005 to February 2018 in 14 hospitals in South Korea were enrolled, and the patients’ medical records were reviewed retrospectively. Results This study included 2,150 cases of LGD and 1,534 cases of HGD diagnosed by pretreatment FB. In total, 589 of 2,150 LGDs (27.4%) were diagnosed as GC after ER. Helicobacterpylori infection, smoking history, tumor location in the lower third of the stomach, tumor size >10 mm, depressed lesion, and ulceration significantly predicted GC. A total of 1,115 out of 1,534 HGDs (72.7%) were diagnosed with GC after ER. Previous history of GC, H. pylori infection, smoking history, tumor location in the lower third of the stomach, tumor size >10 mm, depressed lesion, and ulceration were significantly associated with GC. As the number of risk factors predicting GC increased in both LGD and HGD on pretreatment FB, the rate of upstaging to GC after ER increased. Conclusions A substantial proportion of LGDs and HGDs on pretreatment FB were diagnosed as GC after ER. Accurate ER procedures such as endoscopic submucosal dissection should be recommended in cases of LGD and HGD with factors predicting pathologic upstaging to GC.
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Affiliation(s)
- Jung Won Jeon
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Soo Jin Kim
- Institute of Medical Science, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jae Young Jang
- Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Sun-Moon Kim
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Chul-Hyun Lim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Myung Park
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Su Jin Hong
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Chan Gyoo Kim
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Seong Woo Jeon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Si Hyung Lee
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Jae Kyu Sung
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Gwang Ho Baik
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea.,Institute for Liver and Digestive Diseases, Hallym University College of Medicine, Chuncheon, Korea
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22
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Yang K, Lu L, Liu H, Wang X, Gao Y, Yang L, Li Y, Su M, Jin M, Khan S. A comprehensive update on early gastric cancer: defining terms, etiology, and alarming risk factors. Expert Rev Gastroenterol Hepatol 2021; 15:255-273. [PMID: 33121300 DOI: 10.1080/17474124.2021.1845140] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Early gastric cancer (EGC) is a well-defined gastric malignancy that is limited to the mucosa or submucosa, irrespective of lymph node metastasis. At an early stage, gastric cancer often does not cause symptoms until it becomes advanced, and it is a heterogeneous disease and usually encountered in its late stages. AREA COVERED This comprehensive review will provide a novel insight into the evaluation of EGC epidemiology, defining terms, extensive etiology and risk factors, and timely diagnosis since prevention is an essential approach for controlling this cancer and reducing its morbidity and mortality. EXPERT OPINION The causative manner of EGC is complex and multifactorial. In recent years, researchers have made significant contributions to understanding the etiology and pathogenesis of EGC, and standardization in the evaluation of disease activity. Though the incidence of this cancer is steadily declining in some advanced societies owing to appropriate interventions, there remains a serious threat to health in developing nations. Early detection of resectable gastric cancer is crucial for better patient outcomes.
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Affiliation(s)
- Kuo Yang
- Department of Digestive Diseases, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital , Tianjin, PR, China
| | - Lijie Lu
- Department of Digestive Diseases, Dongfang Hospital of Beijing University of Chinese Medicine , Beijing, PR, China
| | - Huayi Liu
- Department of Digestive Diseases, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital , Tianjin, PR, China
| | - Xiujuan Wang
- Department of Digestive Diseases, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital , Tianjin, PR, China
| | - Ying Gao
- Department of Digestive Diseases, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital , Tianjin, PR, China
| | - Liu Yang
- Department of Digestive Diseases, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital , Tianjin, PR, China
| | - Yupeng Li
- Department of Digestive Diseases, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital , Tianjin, PR, China
| | - Meiling Su
- Department of Digestive Diseases, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital , Tianjin, PR, China
| | - Ming Jin
- Department of Digestive Diseases, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital , Tianjin, PR, China
| | - Samiullah Khan
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital , Tianjin, PR, China
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23
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Koulis A, Busuttil RA, Boussioutas A. Premalignant lesions of the stomach and management of early neoplastic lesions. RESEARCH AND CLINICAL APPLICATIONS OF TARGETING GASTRIC NEOPLASMS 2021:185-216. [DOI: 10.1016/b978-0-323-85563-1.00013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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24
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Clinicopathological features and lymph node metastasis risk in early gastric cancer with WHO criteria in China: 304 cases analysis. Ann Diagn Pathol 2020; 50:151652. [PMID: 33157382 DOI: 10.1016/j.anndiagpath.2020.151652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 08/25/2020] [Accepted: 09/14/2020] [Indexed: 12/19/2022]
Abstract
AIMS The aim of this research was to identify the clinicopathological characteristics of early gastric cancer (EGC) based on the WHO criteria, and to analyze predictors for lymph node metastasis (LNM) in EGC in a Chinese study population. METHODS We retrospectively collected data of 304 Chinese EGC patients, including 265 patients undergoing radical gastrectomy and 39 patients undergoing endoscopic resection. Histological features were accessed by three experienced pathologists. Univariate analysis and multivariate analysis were used to identify the correlation between clinicopathological features and LNM. RESULTS Among the 304 cases with EGC, the rate of well differentiated tubular adenocarcinoma was 11.2%, significantly lower than that of Japanese and South Korean, which was 24.8% and 19.9% respectively (p<0.001 and p = 0.006), but similar to that of a Western result, which was 11.9% (p = 0.860). Among the 265 patients who underwent gastrectomy, 18.5% of the patients had LNM. Univariate analysis showed that macroscopic type, differentiation degree, invasion depth, infiltration pattern (INF), lymphovascular invasion and ulceration were related to LNM. Multivariate analysis revealed that lymphovascular invasion (p < 0.001, OR = 6.549), ulceration (p = 0.035, OR = 2.527) and INF c (p = 0.042, OR = 3.424) were the independent risk factors of LNM in EGC. CONCLUSIONS The pathological diagnosis standard of well differentiated tubular adenocarcinoma in China significantly differs from that in Japan and South Korea, but is similar to western countries. LNM is more likely to occur in EGCs with lymphovascular invasion, ulceration and INF c.
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25
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Ma S, Zhang YM, Dou LZ, Liu H, Ma FH, Wang GQ, Tian YT. Efficacy and Feasibility of Indocyanine Green for Mapping Lymph Nodes in Advanced Gastric Cancer Patients Undergoing Laparoscopic Distal Gastrectomy. J Gastrointest Surg 2020; 24:2306-2309. [PMID: 32607859 DOI: 10.1007/s11605-020-04706-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 06/18/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Shuai Ma
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yue-Ming Zhang
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Li-Zhou Dou
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hao Liu
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Fu-Hai Ma
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Gui-Qi Wang
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yan-Tao Tian
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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26
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Saito Y, Ono A. Endoscopic submucosal dissection is not for the interest of endoscopists but for the patients cure. Dig Endosc 2020; 32:888-890. [PMID: 32274837 DOI: 10.1111/den.13687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Akiko Ono
- Department of Gastroenterology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
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27
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Cheng J, Xu X, Zhuang Q, Luo S, Gong X, Wu X, Wan X, Zhou H. Endoscopic acanthosis nigricans appearance: A novel specific marker for diagnosis of low-grade intraepithelial neoplasia. J Gastroenterol Hepatol 2020; 35:1372-1380. [PMID: 32020670 DOI: 10.1111/jgh.15000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/11/2020] [Accepted: 01/31/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM At present, there is no recognized diagnostic criteria for gastric low-grade intraepithelial neoplasia (LGIN). The purpose of this study was to determine whether an "endoscopic acanthosis nigricans appearance (EANA)" could be a useful endoscopic marker for distinguishing LGIN lesions from peripheral non-neoplastic tissues. METHODS A retrospective study was conducted on 638 cases of suspected superficial lesions with endoscopic images from white light endoscopy and magnifying endoscopy combined with narrow band imaging. According to the pathological results of accurate biopsies, those lesions were divided into three groups: a control group, an LGIN group, and an early gastric cancer (EGC) group. RESULTS According to the presence of EANAs, the sensitivity, specificity, positive predictive value, and negative predictive value for differentiating between the LGIN and control groups were 24.8%, 97.3%, 78.3%, and 76.6%, respectively. The sensitivity (84.1%) and negative predictive value (92.4%) were significantly improved by combining EANA with types IV-VI pit pattern. The intervening part and mean gray value of glands, representing microsurface features and microvascular variation, were significantly larger or higher in EANA lesions than in the surrounding non-neoplastic mucosa. LGIN with EANA was more likely to be present in lesions of type 0-IIa. In addition, the prevalence of EANAs in EGC was 16.7%. CONCLUSION An EANA could be used as an auxiliary indicator for a diagnosis of LGIN in suspected lesions. It could also play a potential assistive role in the diagnosis of EGC lesions.
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Affiliation(s)
- Jinnian Cheng
- Department of Gastroenterology, Shanghai General Hospital, Nanjing Medical University, Shanghai, China
| | - Xianjun Xu
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Zhuang
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Gastroenterology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Shengzheng Luo
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyuan Gong
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaowan Wu
- Department of Gastroenterology, Shanghai General Hospital, Nanjing Medical University, Shanghai, China
| | - Xinjian Wan
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Gastroenterology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hui Zhou
- Department of Gastroenterology, Shanghai General Hospital, Nanjing Medical University, Shanghai, China.,Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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28
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Fujita R, Nagahama M, Yamamoto Y, Takahashi H, Yamamura M, Kawase S, Satake Y. Contributions from Japan to gastrointestinal endoscopy training and development: Special report. Dig Endosc 2020; 32:699-705. [PMID: 32103548 DOI: 10.1111/den.13652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Rikiya Fujita
- Division of Gastroenterology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Masatsugu Nagahama
- Division of Gastroenterology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Yorimasa Yamamoto
- Division of Gastroenterology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Hiroshi Takahashi
- Division of Gastroenterology, Showa University Fujigaoka Hospital, Kanagawa, Japan
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29
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Nishimura M, Saito Y, Nakanishi Y, Shia J, Lauwers GY, Wallace MB. Pathology definitions and resection strategies for early colorectal neoplasia: Eastern versus Western approaches in the post-Vienna era. Gastrointest Endosc 2020; 91:983-988. [PMID: 31874160 DOI: 10.1016/j.gie.2019.12.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 12/07/2019] [Indexed: 12/11/2022]
Abstract
There is a well-known discrepancy between East and West classifications of colorectal neoplasm, especially "intramucosal carcinoma," categorized as subgroup 4.4 in the Vienna classification, usually recognized as high-grade dysplasia in the United States and as carcinoma in situ in Japan. Focusing on management, in the current National Comprehensive Cancer Network algorithm, high-grade dysplasia, carcinoma in situ, and intramucosal carcinoma are managed similarly, whereas submucosal invasion by carcinoma requires en bloc resection. To bridge the differences with regard to these conceptual problems in the definition and management of carcinoma in situ and intramucosal carcinoma, endoscopists and pathologists from Japan and the United States gathered and discussed from their perspectives how to accurately assess specimens of en bloc/piecemeal resection and to effectively predict lymph node metastasis risk.
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Affiliation(s)
- Makoto Nishimura
- Gastroenterology, Hepatology and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yutaka Saito
- Endoscopy Division, National Cancer Hospital, Tokyo, Japan
| | - Yukihiro Nakanishi
- Department of Pathology, Moffitt Cancer Center; Associate Professor, Departments of Pathology, Cell Biology & Oncologic Sciences, University of South Florida
| | - Jinru Shia
- Gastrointestinal Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gregory Y Lauwers
- Department of Pathology, Moffitt Cancer Center; Associate Professor, Departments of Pathology, Cell Biology & Oncologic Sciences, University of South Florida
| | - Michael B Wallace
- H. Lee Moffitt Cancer Center & Research Institute and University of South Florida, Tampa, Florida, USA, Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
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30
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Chen J, Zhao G, Wang Y. Analysis of lymph node metastasis in early gastric cancer: a single institutional experience from China. World J Surg Oncol 2020; 18:57. [PMID: 32197625 PMCID: PMC7085136 DOI: 10.1186/s12957-020-01834-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 03/17/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Lymph node metastasis (LNM) has a strong influence on the prognosis of patients with early gastric cancer (EGC). The aim of this study was to reveal the incidence of LNM and evaluate risk factors for LNM to determine the appropriate treatment for EGC in a Chinese population. METHODS Patients who underwent radical gastrectomy with lymph node dissection for EGC between 2012 and 2017 were retrospectively analyzed. Univariate and multivariate analyses were conducted to identify clinicopathological features that were risk factors for LNM. RESULTS A total of 1033 patients with EGC were enrolled. Of these patients, 668 (64.7%) were men, and 365 (35.3%) were women, ranging in age from 19 to 82 years (mean 56.9 ± 10.9 years). LNM was detected in 173(16.7%) patients with EGC. Among 508 patients with mucosal cancer, 44 (8.7%) patients had LNM. In 525 patients with submucosal cancer, the incidence of LNM was 24.6% (129/525). The age, gender, tumor size, type of differentiation, Lauren classification, and lymphovascular and perineural invasion showed a significant correlation with the rate of LNM in EGC by univariate and multivariate analyses. Patients with submucosal gastric cancer had an older age, a higher proportion of proximal lesion, larger tumor size, more frequent lymphovascular invasion, perineural invasion, and more LNM than patients with mucosal gastric cancer. CONCLUSIONS Our study revealed a relatively high incidence of LNM in EGC, compared with Japanese and Korean cohorts. Female sex, large tumor size, undifferentiated-type, and lymphovascular invasion were independent risk factors for LNM in EGC. Radical gastrectomy with lymphadenectomy should be performed in EGC patients with a high risk of LNM.
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Affiliation(s)
- Jinggui Chen
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dongan Road, Shanghai, 200032, People's Republic of China
| | - Guangfa Zhao
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dongan Road, Shanghai, 200032, People's Republic of China
| | - Yanong Wang
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Shanghai, 200032, People's Republic of China.
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dongan Road, Shanghai, 200032, People's Republic of China.
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31
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Uno Y. Prevention of gastric cancer by Helicobacter pylori eradication: A review from Japan. Cancer Med 2019; 8:3992-4000. [PMID: 31119891 PMCID: PMC6639173 DOI: 10.1002/cam4.2277] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/10/2019] [Accepted: 05/11/2019] [Indexed: 02/06/2023] Open
Abstract
Japan introduced a Helicobacter pylori eradication therapy strategy in 2013, with the aim of decreasing the number of gastric cancer‐related death, the number of new cases of gastric cancer, and associated medical costs. Five years have passed since then, but no reduction in the annual number of gastric cancer has been observed. In addition, it was suggested that the number of deaths due to gastric cancer could be reduced to 30,000 a year by 2020, but the annual death toll in 2017 remained at more than 45,000. Based on the above evidence, it was examined whether it was possible to reach the target value based on the data from the last 5 years. The number of deaths per year in 2020 is predicted to be more than 40,000, which is clearly different from the target value. Logically, the effect of the strategy might appear by 2023. However, there is a possibility that the risk of gastric cancer may increase in some populations due to the influence of proton pump inhibitors and dysbiosis in the gastric microbiome. To solve these problems, combined therapy with PPIs and aspirin for patients after H pylori eradication should be considered.
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32
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Mueller JL, Kim DH, Stapleton S, Cauley CE, Chang DC, Park CH, Song KY, Mullen JT. Nature versus nurture: the impact of nativity and site of treatment on survival for gastric cancer. Gastric Cancer 2019; 22:446-455. [PMID: 30167904 DOI: 10.1007/s10120-018-0869-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The prognosis of gastric cancer patients is better in Asia than in the West. Genetic, environmental, and treatment factors have all been implicated. We sought to explore the extent to which the place of birth and the place of treatment influences survival outcomes in Korean and US patients with localized gastric cancer. METHODS Patients with localized gastric adenocarcinoma undergoing potentially curative gastrectomy from 1989 to 2010 were identified from the SEER registry and two single institution databases from the US and Korea. Patients were categorized into three groups: Koreans born/treated in Korea (KK), Koreans born in Korea/treated in the US (KUS), and White Americans born/treated in the US (W), and disease-specific survival rates compared. RESULTS We identified 16,622 patients: 3,984 (24.0%) KK, 1,046 (6.3%) KUS, and 11,592 (69.7%) W patients. KK patients had longer unadjusted median (not reached) and 5-year disease-specific survival (81.6%) rates than KUS (87 months, 55.9%) and W (35 months, 39.2%; p < 0.001 for all comparisons) patients. This finding persisted on subset analyses of patients with stage IA tumors, without cardia/GEJ tumors, with > 15 examined lymph nodes, and treated at a US center of excellence. On multivariable analysis, KUS (HR 2.80, p < 0.001) and W (HR 5.79, p < 0.001) patients had an increased risk of mortality compared to KK patients. CONCLUSIONS Both the place of birth and the place of treatment significantly contribute to the improved prognosis of patients with gastric cancer in Korea relative to those in the US, implicating both nature and nurture in this phenomenon.
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Affiliation(s)
- Jessica L Mueller
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Codman Institute for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Danbee H Kim
- Codman Institute for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Sahael Stapleton
- Codman Institute for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Christy E Cauley
- Codman Institute for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - David C Chang
- Codman Institute for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Cho Hyun Park
- Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, Republic of Korea
| | - Kyo Young Song
- Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, Republic of Korea.
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Codman Institute for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USA
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Kim JM, Sohn JH, Cho MY, Kim WH, Chang HK, Jung ES, Kook MC, Jin SY, Chae YS, Park YS, Kang MS, Kim H, Lee JH, Park DY, Kim KM, Kim H, Suh YJ, Seol SY, Jung HY, Kim DH, Lee NR, Park SH, You JH. Inter-observer Reproducibility in the Pathologic Diagnosis of Gastric Intraepithelial Neoplasia and Early Carcinoma in Endoscopic Submucosal Dissection Specimens: A Multi-center Study. Cancer Res Treat 2019; 51:1568-1577. [PMID: 30971066 PMCID: PMC6790834 DOI: 10.4143/crt.2019.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/29/2019] [Indexed: 01/15/2023] Open
Abstract
PURPOSE The diagnostic criteria of gastric intraepithelial neoplasia (IEN) are controversial across the world. We investigated how many discrepancies occur in the pathologic diagnosis of IEN and early gastric carcinoma in endoscopic submucosal dissection (ESD) specimens, and evaluated the reasons of the discordance. Materials and Methods We retrospectively reviewed 1,202 ESD specimens that were originally diagnosed as gastric IEN and early carcinoma at 12 institutions. RESULTS The final consensus diagnosis of carcinoma were 756 cases, which were originally 692 carcinomas (91.5%), 43 high-grade dysplasias (5.7%), 20 low-grade dysplasias (2.6%), and 1 others (0.1%), respectively. High- and low-grade dysplasia were finally made in 63 and 342 cases, respectively. The diagnostic concordance with the consensus diagnosis was the highest for carcinoma (91.5%), followed by low-grade dysplasia (86.3%), others (63.4%) and high-grade dysplasia (50.8%). The general kappa value was 0.83, indicating excellent concordance. The kappa values of individual institutions ranged from 0.74 to 1 and correlated with the proportion of carcinoma cases. The cases revised to a final diagnosis of carcinoma exhibited both architectural abnormalities and cytologic atypia. The main differential points between low- and high-grade dysplasias were the glandular distribution and glandular shape. Additional features such as the glandular axis, surface maturation, nuclear stratification and nuclear polarity were also important. CONCLUSION The overall concordance of the diagnosis of gastric IEN and early carcinoma in ESD specimens was excellent. It correlated with the proportion of carcinoma cases, demonstrating that the diagnostic criteria for carcinoma are more reproducible than those for dysplasia.
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Affiliation(s)
- Joon Mee Kim
- Department of Pathology, Inha University School of Medicine, Incheon, Korea
| | - Jin Hee Sohn
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mee-Yon Cho
- Department of Pathology, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
| | - Woo Ho Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Kyung Chang
- Department of Pathology, Kosin University College of Medicine, Busan, Korea
| | - Eun Sun Jung
- Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - So-Young Jin
- Department of Pathology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Yang Seok Chae
- Department of Pathology, Korea University College of Medicine, Seoul, Korea
| | - Young Soo Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Seon Kang
- Department of Pathology, Inje University Busan Paik Hospital, Busan, Korea
| | - Hyunki Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hyuk Lee
- Department of Pathology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Do Youn Park
- Department of Pathology, Pusan National University College of Medicine, Busan, Korea
| | - Kyoung Mee Kim
- Department of Pathology, Samsung Medical Cancer, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hoguen Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Ju Suh
- Department of Pathology, Department of Biomedical Sciences, Inha University School of Medicine, Incheon, Korea
| | - Sang Yong Seol
- Department of Pathology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Hwoon-Yong Jung
- Department of Pathology, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Asan Digestive Disease Research Institute, Seoul, Korea
| | - Deuck-Hwa Kim
- Department of Pathology, Department of Statistics, Inha University, Incheon, Korea
| | - Na Rae Lee
- Department of Pathology, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Seung-Hee Park
- Department of Pathology, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Ji Hye You
- Department of Pathology, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
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Lin JX, Yi BC, Yoon C, Li P, Zheng CH, Huang CM, Yoon SS. Comparison of Outcomes for Elderly Gastric Cancer Patients at Least 80 Years of Age Following Gastrectomy in the United States and China. Ann Surg Oncol 2018; 25:3629-3638. [PMID: 30218243 PMCID: PMC6292729 DOI: 10.1245/s10434-018-6757-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to compare gastric cancer (GC) patients aged 80 years or older undergoing gastrectomy at two high-volume cancer centers in the US and China. METHODS Patients aged ≥ 80 years who underwent R0 resection at Memorial Sloan Kettering Cancer Center (MSKCC) in New York, USA (n = 159), and Fujian Medical University Union Hospital (FMUUH) in Fujian, China (n = 118) from January 2000 to December 2013 were included. Demographic, surgical, and pathologic variables were compared, and factors associated with survival were determined via multivariate analysis. RESULTS The number of patients increased annually in the FMUUH cohort but not in the MSKCC cohort. Patients at MSKCC were slightly older (mean age 83.7 vs. 82.7 years), more commonly female (38 vs. 19%), and had higher average body mass index (BMI; 26 vs. 23). Treatment at FMUUH more frequently employed total gastrectomy (59 vs. 20%) and laparoscopic surgery (65 vs. 7%), and less frequently included adjuvant therapy (11 vs. 18%). In addition, FMUUH patients had larger tumors of more advanced T, N, and TNM stage. Morbidity (35 vs. 25%, p = 0.08) and 30-day mortality (2.5 vs. 3.3%, p = 0.67) were similar between the cohorts. For each TNM stage, there was no significant difference between MSKCC and FMUUH patients in 5-year overall survival and disease-specific survival (DSS). TNM stage was the only independent predictor of DSS for both cohorts. CONCLUSIONS Patients ≥ 80 years of age selected for gastrectomy for GC at MSKCC and FMUUH had acceptable morbidity and mortality, and DSS was primarily dependent on TNM stage.
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Affiliation(s)
- Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Brendan C Yi
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Changhwan Yoon
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
| | - Sam S Yoon
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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35
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Yang L, Jin P, Wang X, Zhang T, He YQ, Zhao XJ, Li N, Yang GZ, Sheng JQ. Risk factors associated with histological upgrade of gastric low-grade dysplasia on pretreatment biopsy. J Dig Dis 2018; 19:596-604. [PMID: 30187683 DOI: 10.1111/1751-2980.12669] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/18/2018] [Accepted: 09/02/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Histological discrepancies between biopsy and resection specimens are common. In this study, we aimed to analyze the risk factors predicting histological upgrade or downgrade of biopsy-diagnosed gastric low-grade dysplasia (LGD). METHODS The medical records of patients with 104 biopsy-diagnosed gastric LGD from January 2011 to December 2017 were collected. The association of endoscopic characteristics with histological discrepancies between the biopsy and resection specimens was analyzed. The risk factors for histological upgrade were studied using the multivariate analysis. RESULTS Among the 104 lesions, 88 were removed by endoscopic resection and 16 were monitored. The upgrade and downgrade rates of the pathological diagnosis were 48.9% and 12.5%, respectively. Lesion size >20 mm, surface redness and positive results in magnifying endoscopy with narrow band imaging (ME-NBI) were risk factors for histological upgrade. Compared with the negative ME-NBI group, the positive ME-NBI group had a higher upgrade rate (56.8% vs 7.1%) but a lower downgrade rate (2.7% vs 64.3%). In addition, 11 of the 16 the gastric LGD with negative ME-NBI findings were monitored, and all 11 lesions regressed to gastritis during follow-up. CONCLUSIONS Endoscopic resection should be recommended in cases of LGD showing surface redness, with a lesion size of >20 mm or positive ME-NBI result, whereas regular follow-up may be an option for LGD with negative ME-NBI result.
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Affiliation(s)
- Lang Yang
- Department of Gastroenterology, PLA Army General Hospital, Beijing, China
| | - Peng Jin
- Department of Gastroenterology, PLA Army General Hospital, Beijing, China
| | - Xin Wang
- Department of Gastroenterology, PLA Army General Hospital, Beijing, China
| | - Tong Zhang
- Department of Pathology, PLA Army General Hospital, Beijing, China
| | - Yu Qi He
- Department of Gastroenterology, PLA Army General Hospital, Beijing, China
| | - Xiao Jun Zhao
- Department of Gastroenterology, PLA Army General Hospital, Beijing, China
| | - Na Li
- Department of Gastroenterology, PLA Army General Hospital, Beijing, China
| | - Guang Zhi Yang
- Department of Pathology, PLA Army General Hospital, Beijing, China
| | - Jian Qiu Sheng
- Department of Gastroenterology, PLA Army General Hospital, Beijing, China
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Wechsler J, Zanetti R, Schrameck C, Rosso S, Pippione M, Linares J, Laurent R, Ortuño G, Boi S, Gafà L, Joris F, Spatz A, Barnéon G, Sacerdote C, Sancho-Garnier H. Reproducibility of Histopathologic Diagnosis and Classification of Non-Melanocytic Skin Cancer: A Panel Exercise in the Framework of the Multicenter Southern European Study Helios. TUMORI JOURNAL 2018; 87:95-100. [PMID: 11401214 DOI: 10.1177/030089160108700206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background The reproducibility of histologic diagnoses, and in particular of the distinction between basal and squamous cell forms, has been evaluated in the framework of a multicenter case-control study (in Italy, France, Spain and Switzerland) aimed to assess the causes of non-melanocytic skin cancers. Methods A panel composed of 10 pathologists from the collaborating centers was appointed. A total of 1774 slides of routine diagnoses were blindly reviewed by a second panelist; discordant diagnoses underwent a third examination. Controversial and interesting cases were discussed during general sessions. Results The results showed a high degree of concordance (99.5%), with a Cohen's kappa of 0.85 (95% CI, 0.77–0.94) in the assessment of malignancy of lesions. The concordance in the distinction between large morphologic groups, basal cell carcinoma and squamous cell carcinoma was also high (Cohen's kappa = 0.85; 95% CI, 0.82–0.89). The assessment of histologic subtypes, degree of invasion and differentiation showed a lower degree of concordance, presumably as a consequence of a weaker consistency in the relevant classifications. Conclusions The reproducibility study has therefore validated the epidemiologic study and in particular allowed to correct some misclassifications that could have lessened the analysis of the case-control study. In general, because of its characteristics (number of pathologists and variety of their origins, the large number of cases examined, blind examination of histologic slides), the conclusions of the study may show a certain degree of generalization, at least with regard to the countries represented. Routine histologic diagnoses of cutaneous carcinoma showed a high degree of reliability with reference to the assessment of malignancy and the distinction between basal and squamous cell carcinoma morphotypes.
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Affiliation(s)
- J Wechsler
- Service d'Anatomie et Cytologie Pathologiques, Hĵpital Henry Mondor, Créteil, France
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Shimamura Y, Iwaya Y, Goda K, Teshima CW. Endoscopic treatment of Barrett's esophagus: What can we learn from the Western perspective? Dig Endosc 2018; 30:182-191. [PMID: 28816408 DOI: 10.1111/den.12950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/14/2017] [Indexed: 02/08/2023]
Abstract
The incidence of Barrett's esophagus (BE)-related neoplasia in Western countries has increased in the past several decades and, even in Eastern countries, it appears to be increasing. Endoscopic therapies are the first-line treatment for BE-related neoplasia; however, there is still no standardized treatment strategy. Most of the data have been published from Western countries where the ultimate goal of treatment is complete eradication of BE mucosa removing subtle synchronous lesions and preventing metachronous neoplasia. A multimodality approach that combines endoscopic resection and radiofrequency ablation (RFA) has been widely accepted in the West. In contrast, the lack of access to RFA treatment in the East has meant that endoscopic resection is the only feasible option. There is a wide divergence in treatment strategies for BE-related neoplasia between the East and the West. It is very important to consider these basic differences in the context of the currently available evidence to date. Therefore, the purpose of this article is to review the recent literature and to provide an overview of the endoscopic treatment options for BE.
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Affiliation(s)
- Yuto Shimamura
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada.,Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Yugo Iwaya
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Kenichi Goda
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Christopher W Teshima
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
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Sugai T, Eizuka M, Arakawa N, Osakabe M, Habano W, Fujita Y, Yamamoto E, Yamano H, Endoh M, Matsumoto T, Suzuki H. Molecular profiling and comprehensive genome-wide analysis of somatic copy number alterations in gastric intramucosal neoplasias based on microsatellite status. Gastric Cancer 2018; 21:765-775. [PMID: 29468422 PMCID: PMC6097076 DOI: 10.1007/s10120-018-0810-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/09/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND We attempted to identify the molecular profiles of gastric intramucosal neoplasia (IMN; low-grade dysplasia, LGD; high-grade dysplasia, HGD; intramucosal cancer, IMC) by assessing somatic copy number alterations (SCNAs) stratified by microsatellite status (microsatellite stable, MSS; microsatellite instable, MSI). Thus, microsatellite status was determined in 84 tumors with MSS status and 16 tumors with MSI status. METHODS One hundred differentiated type IMNs were examined using SCNAs. In addition, genetic mutations (KRAS, BRAF, PIK3CA, and TP53) and DNA methylation status (low, intermediate and high) were also analyzed. Finally, we attempted to identify molecular profiles using a hierarchical clustering analysis. RESULTS Three patterns could be categorized according to SCNAs in IMNs with the MSS phenotype: subgroups 1 and 2 showing a high frequency of SCNAs, and subgroup 3 displaying a low frequency of SCNAs (subgroup 1 > 2 > 3 for SCNA). Subgroup 1 could be distinguished from subgroup 2 by the numbers of total SCNAs (gains and losses) and SCN gains (subgroup 1 > 2). The SCNA pattern of LGD was different from that of HGD and IMC. Moreover, IMNs with the MSI phenotype could be categorized into two subtypes: high frequency of SCNAs and low frequency of SCNAs. Genetic mutations and DNA methylation status did not differ among subgroups in IMNs. CONCLUSION Molecular profiles stratified by SCNAs based on microsatellite status may be useful for elucidation of the mechanisms of early gastric carcinogenesis.
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Affiliation(s)
- Tamotsu Sugai
- 0000 0000 9613 6383grid.411790.aDepartment of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, 19-1, Uchimaru, Morioka, 020-8505 Japan
| | - Makoto Eizuka
- 0000 0000 9613 6383grid.411790.aDepartment of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, 19-1, Uchimaru, Morioka, 020-8505 Japan
| | - Noriyuki Arakawa
- 0000 0000 9613 6383grid.411790.aDepartment of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, 19-1, Uchimaru, Morioka, 020-8505 Japan
| | - Mitsumasa Osakabe
- 0000 0000 9613 6383grid.411790.aDepartment of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, 19-1, Uchimaru, Morioka, 020-8505 Japan
| | - Wataru Habano
- 0000 0000 9613 6383grid.411790.aDepartment of Pharmacodynamics and Molecular Genetics, School of Pharmacy, Iwate Medical University, 19-1, Uchimaru, Morioka, 020-8505 Japan
| | - Yasuko Fujita
- 0000 0000 9613 6383grid.411790.aDepartment of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, 19-1, Uchimaru, Morioka, 020-8505 Japan
| | - Eiichiro Yamamoto
- 0000 0001 0691 0855grid.263171.0Department of Molecular Biology, Sapporo Medical University, School of Medicine, Cyuuouku, Sapporo, 060-0061 Japan
| | - Hiroo Yamano
- 0000 0001 0691 0855grid.263171.0Department of Gastroenterology, Sapporo Medical University, School of Medicine, Cyuuouku, Sapporo, 060-0061 Japan
| | - Masaki Endoh
- 0000 0000 9613 6383grid.411790.aDivision of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, 19-1, Uchimaru, Morioka, 020-8505 Japan
| | - Takayuki Matsumoto
- 0000 0000 9613 6383grid.411790.aDivision of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, 19-1, Uchimaru, Morioka, 020-8505 Japan
| | - Hiromu Suzuki
- 0000 0001 0691 0855grid.263171.0Department of Molecular Biology, Sapporo Medical University, School of Medicine, Cyuuouku, Sapporo, 060-0061 Japan
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Uesugi N, Sugai T, Sugimoto R, Eizuka M, Fujita Y, Sato A, Osakabe M, Ishida K, Koeda K, Sasaki A, Matsumoto T. Clinicopathological and molecular stability and methylation analyses of gastric papillary adenocarcinoma. Pathology 2017; 49:596-603. [PMID: 28830689 DOI: 10.1016/j.pathol.2017.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 02/07/2023]
Abstract
The molecular alterations and pathological features of gastric papillary adenocarcinoma (GPA) remain unknown. We examined GPA samples and compared their molecular and pathological characteristics with those of gastric tubular adenocarcinoma (GTA). Additionally, we identified pathological and molecular features of GPA that vary with microsatellite stability. In the present study, samples from 63 GPA patients and 47 GTA patients were examined using a combination of polymerase chain reaction (PCR)-microsatellite assays and PCR-pyrosequencing in order to detect microsatellite instability (microsatellite instability, MSI; microsatellite stable, MSS), methylation status (low methylation, intermediate methylation and high methylation level), and chromosomal AI in multiple cancer-related loci. Additionally, the expression levels of TP53 and Her2 were evaluated using immunohistochemistry. GTA and GPA are statistically different in their frequency of pathological features, including mucinous, poorly differentiated and invasive micropapillary components. Clear genetic patterns differentiating GPA and GTA could not be identified with a hierarchical cluster analysis, but microsatellite stability was linked with TP53 and Her2 overexpression. Methylation status in GPA was also associated with the development of high microsatellite instability. However, no pathological differences were associated with microsatellite stability. We suggest that although molecular alterations in a subset of GPAs are closely associated with microsatellite stability, they play a minor role in GPA carcinogenesis.
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Affiliation(s)
- Noriyuki Uesugi
- Department of Molecular Diagnostic Pathology, Iwate Medical University, Morioka, Japan
| | - Tamotsu Sugai
- Department of Molecular Diagnostic Pathology, Iwate Medical University, Morioka, Japan.
| | - Ryo Sugimoto
- Department of Molecular Diagnostic Pathology, Iwate Medical University, Morioka, Japan
| | - Makoto Eizuka
- Department of Molecular Diagnostic Pathology, Iwate Medical University, Morioka, Japan
| | - Yasuko Fujita
- Department of Molecular Diagnostic Pathology, Iwate Medical University, Morioka, Japan
| | - Ayaka Sato
- Department of Molecular Diagnostic Pathology, Iwate Medical University, Morioka, Japan
| | - Mitsumasa Osakabe
- Department of Molecular Diagnostic Pathology, Iwate Medical University, Morioka, Japan
| | - Kazuyuki Ishida
- Department of Molecular Diagnostic Pathology, Iwate Medical University, Morioka, Japan
| | - Keisuke Koeda
- Department of Surgery, Iwate Medical University, Morioka, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University, Morioka, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Morioka, Japan
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Mikhaleva LM, Biryukov AE. [Morphological and immunohistochemical features of severe gastric dysplasia and early gastric cancer]. Arkh Patol 2017; 79:22-28. [PMID: 28791995 DOI: 10.17116/patol201779422-28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIM to investigate the morphological and immunohistochemical features of severe gastric dysplasia (SGD) and early gastric cancer (EGC). MATERIAL AND METHODS The fragments of gastric tumor tissue with adjacent mucosal portions from 50 patients aged from 34 to 79 years (mean age 63.8 years), which had been removed during organ-sparing endoscopic surgery, were histologically, histochemical, and immunohistochemically (IHC) examined. RESULTS In EGC, there was a preponderance of intestinal-type cancer; the adjacent mucosal areas showed foci of SGD and colonic metaplasia in 100%. Cancer emboli were absent in the lumen of blood and lymphatic vessels in EGC at a рТ1а stage. Relapse of cancer occurred in 10% of the patients with EGC within 6-24 months after endoscopic dissection. CONCLUSION Complex morphological and IHC examination allows timely diagnosis of SGD and EGC, namely: the ability to assess the histologic type and depth of invasion of EGC, the presence or absence of cancer emboli in the blood and lymphatic vessels, which is crucial in determining treatment policy and prognosis. The immunophenotype of SGD and EGC with a number of antibodies (Abs) (cytokeratins 7, 8/18, mucins 1, 2 and 5AC, and p53) was assessed, the most significant ones of which were, in our opinion, Abs to p53 and mucin 5AC.
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Affiliation(s)
- L M Mikhaleva
- Research Institute of Human Morphology, Russian Academy of Medical Sciences, Moscow, Russia; City Clinical Hospital Thirty-One, Moscow Health Department, Moscow, Russia
| | - A E Biryukov
- Research Institute of Human Morphology, Russian Academy of Medical Sciences, Moscow, Russia; City Clinical Hospital Thirty-One, Moscow Health Department, Moscow, Russia
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Ishihara R, Oyama T, Abe S, Takahashi H, Ono H, Fujisaki J, Kaise M, Goda K, Kawada K, Koike T, Takeuchi M, Matsuda R, Hirasawa D, Yamada M, Kodaira J, Tanaka M, Omae M, Matsui A, Kanesaka T, Takahashi A, Hirooka S, Saito M, Tsuji Y, Maeda Y, Yamashita H, Oda I, Tomita Y, Matsunaga T, Terai S, Ozawa S, Kawano T, Seto Y. Risk of metastasis in adenocarcinoma of the esophagus: a multicenter retrospective study in a Japanese population. J Gastroenterol 2017; 52:800-808. [PMID: 27757547 DOI: 10.1007/s00535-016-1275-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/07/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Little is known about the specific risks of metastasis in esophageal adenocarcinoma in relation to invasion depth or other pathologic factors. METHODS We conducted a multicenter retrospective study in 13 high-volume centers in Japan from January 2000 to October 2014 to elucidate the risk of metastasis of esophageal adenocarcinoma. A total of 458 patients (217 surgically resected and 241 endoscopically resected) with esophageal adenocarcinoma or esophagogastric adenocarcinoma involving the esophagus were included. Metastasis was considered positive if there was histologically confirmed metastasis in the surgical specimen or clinically confirmed metastasis during follow-up. Metastasis was considered negative if no metastasis was identified in resected specimens and during follow-up in patients treated surgically or no metastasis during follow-up for >5 years in patients treated by endoscopic resection. RESULTS Metastasis was identified in 72 patients. Multivariate analysis confirmed lymphovascular involvement [odds ratio (OR) 6.20; 95 % confidence interval (CI) 3.12-12.32; p < 0.001], a poorly differentiated component (OR 3.69; 95 % CI 1.92-7.10; p < 0.001), and lesion size >30 mm (OR 3.12; 95 % CI 1.63-5.97; p = 0.001) as independent risk factors for metastasis. No metastasis was detected in patients with mucosal cancer without lymphovascular involvement and a poorly differentiated component (0/186 lesions) or in patients with cancer invading the submucosa (1-500 µm) without lymphovascular involvement, a poorly differentiated component, and ≤30 mm (0/32 lesions). CONCLUSIONS Mucosal and submucosal cancers (1-500 µm invasion) without risk factors have a low incidence of metastasis and may thus be good candidates for endoscopic resection.
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Affiliation(s)
- Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 3-3 Nakamichi 1-chome, Higashinari-ku, Osaka, 537-8511, Japan.
| | - Tsuneo Oyama
- Department of Endoscopy, Saku Central Hospital Advanced Care Center, Saku, Japan
| | - Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroaki Takahashi
- Department of Gastroenterology, Keiyukai Daini Hospital, Sapporo, Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Junko Fujisaki
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Mitsuru Kaise
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Kenichi Goda
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenro Kawada
- Department of Esophageal and General Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Manabu Takeuchi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Rie Matsuda
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Dai Hirasawa
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Masayoshi Yamada
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Junichi Kodaira
- Department of Gastroenterology, Keiyukai Daini Hospital, Sapporo, Japan
| | - Masaki Tanaka
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masami Omae
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akira Matsui
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 3-3 Nakamichi 1-chome, Higashinari-ku, Osaka, 537-8511, Japan
| | - Akiko Takahashi
- Department of Endoscopy, Saku Central Hospital Advanced Care Center, Saku, Japan
| | - Shinichi Hirooka
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Saito
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yosuke Tsuji
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuki Maeda
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Hiroharu Yamashita
- Department of Gastrointestinal Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Ichiro Oda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuhiko Tomita
- Department of Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Takashi Matsunaga
- Department of Medical Informatics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Soji Ozawa
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Tatsuyuki Kawano
- Department of Esophageal and General Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, The University of Tokyo Hospital, Tokyo, Japan
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Suda K, Kitagawa Y. How Do We Bridge the West and the East in the Treatment for Gastric Cancer? Ann Surg Oncol 2017; 24:864-865. [PMID: 27783165 DOI: 10.1245/s10434-016-5647-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Indexed: 08/29/2023]
Affiliation(s)
- Koichi Suda
- Cancer Center/Department of Surgery, School of Medicine, Keio University, Tokyo, Japan.
| | - Yuko Kitagawa
- Cancer Center/Department of Surgery, School of Medicine, Keio University, Tokyo, Japan
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Abstract
CONTEXT -The diagnosis of gastric epithelial lesions is difficult in clinical practice, even with the recent developments and advances in endoscopic modalities, owing to the diverse morphologic features of the lesions, lack of standardized diagnostic criteria, and the high intraobserver and interobserver variabilities in the nonneoplastic (regenerative)-neoplastic spectrum. OBJECTIVE -To provide an overview of the current concepts and unresolved issues surrounding the diagnosis of diseases in the nonneoplastic-neoplastic spectrum, and to discuss some noteworthy properties and histologic features of gastric epithelial lesions. DATA SOURCES -A comprehensive assessment of the medical literature on gastric epithelial lesions was performed; we also interjected our own experiences into the discussion. Sources included original studies, review articles, and textbooks related to the field. CONCLUSIONS -Our literature review revealed that clear cell changes and micropapillary carcinoma components in gastric carcinomas are associated with poor clinical outcomes and should hence be included in pathologic reports. Moreover, we suggest a stepwise biopsy-endoscopic resection modality for the diagnosis of borderline neoplasia-nonneoplasia cases.
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Affiliation(s)
| | - Do Youn Park
- From the Department of Pathology, Pusan National University Hospital and Pusan National University School of Medicine, and the Biomedical Research Institute, Pusan National University Hospital, Pusan, Korea
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44
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Russo A, Li P, Strong VE. Differences in the multimodal treatment of gastric cancer: East versus west. J Surg Oncol 2017; 115:603-614. [PMID: 28181265 DOI: 10.1002/jso.24517] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 11/27/2016] [Accepted: 11/27/2016] [Indexed: 02/06/2023]
Abstract
There has been a great deal of interest about varying treatment paradigms of gastric cancer in Eastern and Western countries. Differences in tumor biology, screening initiatives, surgical approach, extent of lymphadenectomy, and neoadjuvant versus adjuvant chemotherapy regimens have been studied and documented in the literature. The purpose of this review is to give an updated report on the current status and management differences in the treatment of gastric cancer between Eastern and Western countries.
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Affiliation(s)
- Ashley Russo
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ping Li
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Vivian E Strong
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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45
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Uedo N, Yao K. Endoluminal Diagnosis of Early Gastric Cancer and Its Precursors: Bridging the Gap Between Endoscopy and Pathology. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 908:293-316. [PMID: 27573777 DOI: 10.1007/978-3-319-41388-4_14] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although dye-based and image-enhanced endoscopic techniques have revolutionized endoscopic diagnosis, conventional white light endoscopy still plays an important role in the diagnosis of early gastric cancer (EGC) during routine endoscopy. Chromoendoscopy reveals morphological characteristics of the mucosal lesions by enhancing mucosal contrast, while narrow-band imaging (NBI) facilitates detailed evaluation of the vascular architecture and surface features. Positive diagnostic findings of EGC on white light imaging and indigo carmine chromoendoscopy are a sharply demarcated lesion and irregularity in surface morphology or color. Magnifying NBI further improves diagnostic accuracy of white light imaging and chromoendoscopy. We review our approach to the endoscopic diagnosis of (pre-)malignant lesions in the stomach and discuss in detail novel endoscopic microvascular architectural patterns which further leverage diagnostic biopsy yield. We expect that further improvement of endoscopic techniques and correlative studies will close the gap between endoscopy and pathology.
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Affiliation(s)
- Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Disease, 3-3 Nakamichi 1-chome, Higashinari-ku, Osaka, 537-8511, Japan.
| | - Kenshi Yao
- Department of Endoscopy, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka, 818-8502, Japan
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Glória L, Bossard N, Bouvier AM, Mayer-da-Silva A, Faivre J, Miranda A. Trends in net survival from stomach cancer in six European Latin countries: results from the SUDCAN population-based study. Eur J Cancer Prev 2017; 26 Trends in cancer net survival in six European Latin Countries: the SUDCAN study:S32-S39. [PMID: 28005603 DOI: 10.1097/cej.0000000000000309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Gastric cancers are a clinical challenge. The aim of the SUDCAN collaborative study was to compare the net survival from gastric cancer between six European Latin countries (Belgium, France, Italy, Portugal, Spain and Switzerland) and explore the trends in net survival and in the dynamics of the excess mortality rates (EMRs) up to 5 years after diagnosis. The data were extracted from the EUROCARE-5 database. First, net survival was studied over the period 2000-2004 using the Pohar-Perme estimator. For trend analyses, the study period was specific to each country. The results are reported from 1992 to 2004 in France, Italy, Spain and Switzerland and from 2000 to 2004 in Belgium and Portugal. These trend analyses were carried out using a flexible excess rate modelling strategy. There were little differences between countries in age-standardized net survival for stomach cancer (2000-2004). The 5-year net survival ranged between 26 (Spain) and 32% (Italy). There was a small increase in the age-standardized net survival at 1 year between 1992 and 2004. The increase was also observed in the 5-year net survival, except in France, where the increase was less marked. A slight decrease in the EMR between 1992 and 2004 was limited to the 24 months after diagnosis. In addition, the decrease in the EMR was the same whatever the year of diagnosis. There were minor differences in survival from stomach cancer between European Latin countries. A slight improvement in the 5-year net survival was observed in all countries and the major gain was observed during the 24 months after diagnosis. Development of innovative treatments is needed to improve the prognosis.
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Affiliation(s)
- Luísa Glória
- aDepartment of Epidemiology and South Regional Cancer Registry (ROR-Sul), Portuguese Institute of Oncology, Francisco Gentil, E.P.E, Lisbon, Portugal bDepartment of Biostatistics, University Hospital of Lyon cUniversity of Lyon, Lyon dUniversity of Lyon 1 eCNRS, UMR 5558, Biometry and Evolutionary Biology Laboratory (LBBE), BioMaths-Health Department Villeurbanne fDigestive Cancer Registry of Burgundy, INSERM U866, CHU Dijon, University of Burgundy, Dijon, France
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47
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Itabashi M, Nasierowska-Guttmejer A, Shimoda T, Majewski P, Rezner W, Sikora K, Śrutek E, Stęplewska K, Swatek J, Szumilo J, Wierzchniewska-Ławska A, Wronecki L, Zembala-Nożyńska E, Arai T, Fujita M, Kawachi H, Unakami M, Kamoshida T. The importance of the concept and histological criteria of "intraepithelial squamous cell carcinoma" of the esophagus: in comparison between Western and Japanese criteria. Esophagus 2017; 14:333-342. [PMID: 28983230 PMCID: PMC5603644 DOI: 10.1007/s10388-017-0583-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 05/31/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND There are differences in the histological diagnostic criteria for early stage gastrointestinal carcinoma between Western and Japanese pathologists. Western histological criteria of carcinoma are "presence of stromal invasion of neoplastic cells", while Japanese criteria are "the degree of cytological and structural abnormality of neoplastic cells, regardless of stromal invasion". The aim of the present study is to clarify and review the present status of the Western and Japanese histological criteria of early stage esophageal squamous cell carcinoma (SCC) and also to clarify their significance and accuracy. METHODS Twenty-nine Polish, German, and Japanese pathologists participated in this study. A total of 18 histological slides of biopsy, endoscopic submucosal dissection (ESD), and surgical resection of esophageal squamous lesions were diagnosed using a virtual slide system. RESULTS Most of noninvasive (intraepithelial) carcinomas diagnosed by Japanese pathologists were diagnosed as high- or low-grade dysplasia (intraepithelial neoplasia) or reactive atypia by the majority of Polish and German pathologists. Diagnoses of not only high-grade dysplasia but also low-grade dysplasia or reactive lesion by Western criteria were given for many biopsy specimens of cases in which the corresponding ESD or surgical specimens showed definite stromal invasion. CONCLUSION There still exist differences in the histological diagnostic criteria for early stage esophageal carcinoma between Western and Japanese pathologists. The Japanese diagnostic criteria could improve agreement of diagnoses between biopsy and resected specimens of esophageal SCC. Moreover, diagnostic approaches using Western criteria may cause delay in the early diagnosis and treatment of esophageal SCC.
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Affiliation(s)
- Masayuki Itabashi
- Pathology and Cytology Center, LSI Medience Corporation, 4-25-11 Azusawa, Itabashi-ku, Tokyo, 174-0051 Japan
| | | | | | - Przemysław Majewski
- Department of Clinical Pathomorphology, Poznań University of Medical Sciences, Poznań, Poland
| | - Witold Rezner
- Department of Pathology, Holycross Cancer Centre, Kielce, Poland
| | | | - Ewa Śrutek
- Oncology Center in Bydgoszcz, Bydgoszcz, Poland
| | | | - Jarosław Swatek
- Department of Clinical Pathomorphology, Medical University of Lublin, Lublin, Poland
| | - Justyna Szumilo
- Department of Clinical Pathomorphology, Medical University of Lublin, Lublin, Poland
| | | | - Lech Wronecki
- Department of Clinical Pathomorphology, Medical University of Lublin, Lublin, Poland
| | - Ewa Zembala-Nożyńska
- Department of Tumor Pathology, M.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Tomio Arai
- Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Masahiro Fujita
- Department of Health Sciences, Nayoro City University, Hokkaido, Japan
| | - Hiroshi Kawachi
- Department of Pathology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | - Toshiro Kamoshida
- Endoscopy Division and Department of Internal Medicine, Hitachi General Hospital, Hitachi, Ibaraki-ken Japan
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Abangah G, Rahmani A, Hafezi-Ahmadi MR, Emami T, Asadollahi K, Jaafari-Haidarlo A, Moradkhani A. Precancerous histopathologic lesions of upper gastrointestinal tract among dyspeptic patients upon endoscopic evaluations. J Gastrointest Cancer 2016; 47:1-7. [PMID: 26454647 DOI: 10.1007/s12029-015-9760-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Gastric cancer is one of the most important causes of morbidity and mortality worldwide which is influenced by different risk factors. This study aimed to investigate the effects of various factors associated with precancerous lesions among dyspeptic patients. METHODS Among dyspeptic patients admitted to gastrointestinal clinics in Ilam city, west of Iran, 1123 were investigated during 2008 to 2011. All patients were evaluated by endoscopy and their biopsy samples were examined for histological differentiations and their pathology reports were classified according to Sydney criteria. RESULTS One thousand out of 1123 admitted dyspeptic patients were finally analyzed. The mean age of participants was 48 years (ranged 21-84 years), and 64.8% of patients were male. The frequency of patients with atrophy, metaplasia, or both was 14.4%, adenocarcinoma 1.2%, and polyp hyperplasia 0.7%, respectively. The highest frequency was related to those with chronic gastritis accompanied by Helicobacter pylori infection with a figure of 80.8%. The frequency of precancerous lesions among smokers compared to non-smokers was higher significantly (p < 0.03). Though non-significant, BMI was associated with the higher risk of premalignant lesions among dyspeptic patients by an increasing manner. CONCLUSION Chronic gastritis accompanied with H. pylori infection was revealed as the most prevalent variable among dyspeptic patients. Also, higher BMI compared to normal and smokers compared to non-smokers were more involved by precancerous lesions.
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Affiliation(s)
- Ghobad Abangah
- Department of Gastroenterology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Asghar Rahmani
- Student Researches Committee, Ilam University of Medical Sciences, Ilam, Iran
| | | | - Tayebeh Emami
- Student Researches Committee, Ilam University of Medical Sciences, Ilam, Iran
| | - Khairollah Asadollahi
- Department of Social Medicine, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran.
| | - Ali Jaafari-Haidarlo
- Department of Gastroenterology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Atefeh Moradkhani
- Student Researches Committee, Ilam University of Medical Sciences, Ilam, Iran
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Kim YW, Joo J, Yoon HM, Eom BW, Ryu KW, Choi IJ, Kook MC, Schuhmacher C, Siewert JR, Reim D. Different survival outcomes after curative R0-resection for Eastern Asian and European gastric cancer: Results from a propensity score matched analysis comparing a Korean and a German specialized center. Medicine (Baltimore) 2016; 95:e4261. [PMID: 27428238 PMCID: PMC4956832 DOI: 10.1097/md.0000000000004261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Several retrospective analyses on patients who underwent gastric cancer (GC) surgery revealed different survival outcomes between Eastern (Korean, Japanese) and Western (USA, Europe) countries due to potential ethnical and biological differences. This study investigates treatment outcomes between specialized institution for GC in Korea and Germany.The prospectively documented databases of the Gastric Cancer Center of the National Cancer Center, Korea (NCCK) and the Department of Surgery of the Technische Universitaet Muenchen (TUM), Germany were screened for patients who underwent primary surgical resection for GC between 2002 and 2008. Baseline characteristics were compared using χ testing, and 2 cohorts were matched using a propensity score matching (PSM) method. Patients' survival was estimated using Kaplan-Meier method, and multivariable Cox proportional hazard model was used for comparison.Three thousand seven hundred ninety-five patients were included in the final analysis, 3542 from Korea and 253 from Germany. Baseline characteristics revealed statistically significant differences for age, tumor location, pT stage, grading, lymphatic vessel infiltration (LVI), comorbidities, number of dissected lymph nodes (LN), postoperative complications, lymph-node ratio stage, and application of adjuvant chemotherapy. After PSM, 171 patients in TUM were matched to NCCK patients, and baseline characteristics for both cohorts were well balanced. Patients in Korea had significantly longer survival than those in Germany both before and after PSM. When the analysis was performed for each UICC stage separately, same trend was found over all UICC stages before PSM. However, significant difference in survival was observed only for UICC I after PSM.This analysis demonstrates different survival outcomes after surgical treatment of GC on different continents in specialized centers after balancing of baseline characteristics by PSM.
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Affiliation(s)
- Young-Woo Kim
- Center for Gastric Cancer, Research Institute & Hospital
| | - Jungnam Joo
- Biometric Research Branch, National Cancer Center Korea, Goyang-si Gyeonggi-do, Republic of Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, Research Institute & Hospital
| | - Bang Wool Eom
- Center for Gastric Cancer, Research Institute & Hospital
| | - Keun Won Ryu
- Center for Gastric Cancer, Research Institute & Hospital
| | - Il Ju Choi
- Center for Gastric Cancer, Research Institute & Hospital
| | | | - Christoph Schuhmacher
- Klinikum Rechts der Isar der Technischen Universität München, Department of Surgery, Munich, Germany
| | - Joerg Ruediger Siewert
- Klinikum Rechts der Isar der Technischen Universität München, Department of Surgery, Munich, Germany
- University Hospital of Freiburg, Freiburg, Germany
| | - Daniel Reim
- Center for Gastric Cancer, Research Institute & Hospital
- Klinikum Rechts der Isar der Technischen Universität München, Department of Surgery, Munich, Germany
- Correspondence: Daniel Reim, Chirurgische Klinik, Klinikum Rechts der Isar, Technische Universitaet Muenchen, Munich, Germany (e-mail: )
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50
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Chapelle N, Bouvier AM, Manfredi S, Drouillard A, Lepage C, Faivre J, Jooste V. Early Gastric Cancer: Trends in Incidence, Management, and Survival in a Well-Defined French Population. Ann Surg Oncol 2016; 23:3677-3683. [PMID: 27216743 DOI: 10.1245/s10434-016-5279-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Little is known about the epidemiology of early gastric cancer (EGC) in Western countries. The aim of this study was to analyze trends in the incidence, management, and survival of EGC in a well-defined population over a 30 year period. METHODS Data were obtained from the population-based cancer Registry of Burgundy (France). Incidence rates were calculated by sex, age, and 10 year period of diagnosis. Net survival rates were calculated and a multivariate relative survival analysis performed. RESULTS EGC represented 6.7 % of gastric cancer diagnosed between 1982 and 2011. Age-standardized incidence rates were higher in men (0.79/100,000) than in women (0.40/100,000). Between the periods 1982-1991 and 2002-2011, it decreased from 0.97 to 0.53 per 100,000 in men and from 0.44 to 0.30 per 100,000 in women. Overall, 19 % of the tumors were limited to the mucosa, 69 % to the submucosa, and 15 % invaded lymph nodes. Node invasion and male sex were the only significant prognostic factors. Five-year net survival was 50 % in node-positive patients and 85 % in node-negative patients (p < 0.001). In multivariate analysis, the relative risk of death in men compared to women was 2.3 and was 10.4 in patients with positive nodes compared to patients with negative nodes. CONCLUSIONS EGCs are rare in France. The prognosis is favorable, except for node-positive cancers, which may benefit from the recently developed adjuvant chemotherapy for gastric cancer.
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Affiliation(s)
- Nicolas Chapelle
- Registre Bourguignon des Cancers Digestifs, INSERM, LNC UMR866, Dijon, France.,Université Bourgogne Franche-Comté, LNC UMR866, Dijon, France.,CHU Dijon Bourgogne, Dijon, France
| | - Anne-Marie Bouvier
- Registre Bourguignon des Cancers Digestifs, INSERM, LNC UMR866, Dijon, France.,Université Bourgogne Franche-Comté, LNC UMR866, Dijon, France.,CHU Dijon Bourgogne, Dijon, France
| | - Sylvain Manfredi
- Registre Bourguignon des Cancers Digestifs, INSERM, LNC UMR866, Dijon, France.,Université Bourgogne Franche-Comté, LNC UMR866, Dijon, France.,CHU Dijon Bourgogne, Dijon, France
| | - Antoine Drouillard
- Registre Bourguignon des Cancers Digestifs, INSERM, LNC UMR866, Dijon, France.,Université Bourgogne Franche-Comté, LNC UMR866, Dijon, France.,CHU Dijon Bourgogne, Dijon, France
| | - Come Lepage
- Registre Bourguignon des Cancers Digestifs, INSERM, LNC UMR866, Dijon, France.,Université Bourgogne Franche-Comté, LNC UMR866, Dijon, France.,CHU Dijon Bourgogne, Dijon, France
| | - Jean Faivre
- Registre Bourguignon des Cancers Digestifs, INSERM, LNC UMR866, Dijon, France.,Université Bourgogne Franche-Comté, LNC UMR866, Dijon, France.,CHU Dijon Bourgogne, Dijon, France
| | - Valerie Jooste
- Registre Bourguignon des Cancers Digestifs, INSERM, LNC UMR866, Dijon, France. .,Université Bourgogne Franche-Comté, LNC UMR866, Dijon, France. .,CHU Dijon Bourgogne, Dijon, France.
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