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Cao Z, Wang Z, Yang L, Li T, Tao X, Niu X. Reshaping the immune microenvironment and reversing immunosenescence by natural products: Prospects for immunotherapy in gastric cancer. Semin Cancer Biol 2025; 110:1-16. [PMID: 39923925 DOI: 10.1016/j.semcancer.2025.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Revised: 01/25/2025] [Accepted: 02/03/2025] [Indexed: 02/11/2025]
Abstract
Gastric cancer (GC) represents a global health-care challenge. Recent progress in immunotherapy has elicited attracted considerable attention as a viable treatment option through modulating the host immune system and unleashing pre-existing immunity, which has profoundly revolutionized oncology, especially GC. Nonetheless, low clinical response and intrinsic and acquired resistance remain persistently challenging. The microenvironment of GC comprising multifarious stromal cell types has remarkable immunosuppressive elements that may impact the efficacy of immunotherapy. Immunosenescence is increasingly regarded as a factor that contributes to cancer development, remodels the tumor microenvironment and affects the efficacy of immunotherapy. Natural products are at the forefront of traditional medicine. Senotherapeutics is a class of drugs and natural products capable of delaying, preventing, or reversing the senescence process (i.e., senolytics) or suppressing senescence-associated secretory phenotype (i.e., senomorphics). Emerging evidence supports that natural products can improve the efficacy of existing immunotherapy and expand their indications in GC mainly based upon remodeling the immunosuppressive microenvironment and reversing immunosenescence. The review provides an integrated review of previously reported and ongoing clinical trials with immunotherapeutic regimens in GC and discusses current challenges. Next, we focus on natural compounds that exert anti-GC functions and possess immunomodulatory properties. More attention is paid to the potential of these natural compounds in modulating the immune microenvironment and immunosenescence. Lastly, we discuss the nanomedicine that can overcome the deficiencies of natural products. Altogether, our review suggests the enormous potential of natural compounds in GC immunotherapy, and provides an important direction for future research.
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Affiliation(s)
- Zhipeng Cao
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, Liaoning 110122, China
| | - Zhilin Wang
- Department of Pain Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Li Yang
- Department of Anesthesiology, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning 110032, China
| | - Tian Li
- Tianjin Key Laboratory of Acute Abdomen Disease-Associated Organ Injury and ITCWM Repair, Institute of Integrative Medicine of Acute Abdominal Diseases, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin 300100, China.
| | - Xueshu Tao
- Department of Pain Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China.
| | - Xing Niu
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, Liaoning 110122, China.
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2
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García Megías I, Almeida LS, Calapaquí Terán AK, Pabst KM, Herrmann K, Giammarile F, Delgado Bolton RC. FAPI radiopharmaceuticals in nuclear oncology and theranostics of solid tumours: are we nearer to surrounding the hallmarks of cancer? Ann Nucl Med 2025; 39:407-423. [PMID: 40069442 PMCID: PMC12014767 DOI: 10.1007/s12149-025-02022-x] [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: 11/21/2024] [Accepted: 01/22/2025] [Indexed: 04/05/2025]
Abstract
[18F]FDG PET/CT is the most widely used PET radiopharmaceutical in oncology, but it is not exempt of diagnostic limitations. FAPI have emerged as a great tool in the management of several different solid tumours in which [18F]FDG is not able to provide enough information. The aim of this work was to evaluate the available evidence on diagnostic and therapeutic applications of PET/CT with FAPI radiopharmaceuticals. We underwent a non-systematic review focusing in the utility of FAPI radiopharmaceuticals in PET/CT diagnosis and in the treatment of several malignancies. FAPI radiopharmaceuticals present characteristics that can potentially overcome some known diagnostic limitations of [18F]FDG. FAPI radiopharmaceuticals present a high target-to-background ratio (TBR) in many solid tumours such as oesophageal cancer, gastric cancer, pancreatic cancer, hepatic cancer, colorectal cancer, breast cancer, ovarian, cervical cancer, and head and neck cancer. Available evidence suggests the high TBR improves sensitivity and specificity compared to [18F]FDG, especially for the detection of lymphadenopathies and peritoneal metastases, and may improve patient management and radiation treatment planning. Moreover, it is important to underline the potential theranostic application of FAPI radiopharmaceuticals.
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Affiliation(s)
- Irene García Megías
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain
- Department of Nuclear Medicine, University Hospital of Toledo, Toledo, Spain
| | - Ludmila Santiago Almeida
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain
- Division of Nuclear Medicine, Department of Anesthesiology, Oncology and Radiology, Faculty of Medical Sciences, Campinas University, Campinas, Brazil
| | - Adriana K Calapaquí Terán
- Servicio Cántabro de Salud, Santander, España
- Department of Pathology, University Hospital "Marqués de Valdecilla", Santander, Spain
- Instituto de Investigación Sanitaria Valdecilla, IDIVAL, Santander, Spain
| | - Kim M Pabst
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Francesco Giammarile
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency (IAEA), Vienna, Austria
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain.
- Servicio Cántabro de Salud, Santander, España.
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Infante JR, Quirós J, Barco R, Bejarano C, Agudo E, Fernández J, Baena A, Utrera A, Martínez A, Durán C, Serrano J. Correlation between metabolic response determined with [ 18F]FDG PET/CT and pathological response after neoadjuvant treatment and surgery in patients with esophageal cancer. Rev Esp Med Nucl Imagen Mol 2025; 44:500088. [PMID: 39855559 DOI: 10.1016/j.remnie.2025.500088] [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: 09/18/2024] [Revised: 11/26/2024] [Accepted: 11/29/2024] [Indexed: 01/27/2025]
Abstract
AIM To assess the correlation between the result of the PET/CT study with [18F]FDG and the histological outcome in patients with esophageal cancer undergoing chemoradiotherapy and subsequent surgery. MATERIAL AND METHODS 41 patients (35 men) diagnosed with esophageal cancer during a 10-year interval were retrospectively evaluated. PERCIST criteria and SULpeak (ΔSULpeak) variation between pre- and post-treatment PET/CT studies were used. After neoadjuvant treatment and subsequent surgery, histological response and patient survival were determined, correlating the findings with the result of the metabolic study. Different parameters related to patient and tumors lesion characteristics were compared with respect to histologic response. ROC curves and the Kaplan-Meier method were applied for the analysis of prognostic factors and survival curves. RESULTS The mean follow-up was 34.9 months, with 21 relapses-progressions and 25 deaths. Significant differences were demonstrated between histologic responses regarding PERCIST criteria and ΔSULpeak. Both showed adequate sensitivity and moderate specificity in relation to their histological correlation. No significant differences were found with respect to other parameters studied. Survival analysis showed significantly different progression-free survival curves for the ΔSULpeak and histologic outcome. CONCLUSION PERCIST criteria and ΔSULpeak differentiated between patients with and without histological response. ΔSULpeak and histological results proved to be prognostic factors. The results could help to personalize treatment and, together with other determinations, allow an active surveillance approach could be contemplated.
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Affiliation(s)
- J R Infante
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - J Quirós
- Servicio de Oncología Radioterápica, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - R Barco
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - C Bejarano
- Servicio de Anatomía Patológica, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - E Agudo
- Servicio de Oncología Radioterápica, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - J Fernández
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - A Baena
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - A Utrera
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - A Martínez
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - C Durán
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - J Serrano
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain.
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Luo HL, Luo HL. Analysis of the effect of multi-channel continuous nursing intervention on patients post-radical gastrectomy. World J Gastrointest Surg 2025; 17:100848. [PMID: 40291863 PMCID: PMC12019047 DOI: 10.4240/wjgs.v17.i4.100848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Revised: 02/08/2025] [Accepted: 03/10/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND Radical gastrectomy (RGE) for gastric carcinoma (GC) has exerted definite therapeutic efficacy in treating patients with GC. However, a notable risk of postoperative complications (POCs) persists among middle-aged and elderly patients with compromised physiological functions. Hence, developing and implementing reliable nursing interventions to optimize the comprehensive management of these patients is deemed imperative. AIM To analyze the association of multi-channel continuous nursing intervention with POCs, negative emotions (NEs), and quality of life (QoL) of patients undergoing RGE for GC. METHODS This retrospective study selected 99 patients who underwent RGE for GC in our hospital from May 2020 to May 2023. Participants were categorized into the control (n = 49 cases) and research groups (n = 50 cases) receiving routine and multi-channel continuous nursing care, respectively. Comparative analysis involved data on postoperative rehabilitation (time to first anal exhaust, oral feeding and ambulation, and hospital stay), complications (nausea and vomiting, delayed gastric emptying, and abdominal distension), NEs [Self-rating Anxiety (SAS)/Depression Scale (SDS)], treatment compliance, self-efficacy, and QoL [World Health Organization QoL Brief Version (WHOQOL-BREF)]. RESULTS Compared to the control group, the research group demonstrated earlier first postoperative anal exhaust, oral feeding, and ambulation, shorter hospital stay, lower POC rate, and more reduced SAS and SDS scores postintervention, which was significantly lower than the baseline. The treatment compliance scores were significantly higher in the research group than in the control group in terms of medication adherence, daily exercise, reasonable diet, and regular review. Further, the research group demonstrated increased self-efficacy scores in terms of positive attitude, self-stress relief, and self-decision-making, as well as the overall score postintervention, which were higher than the control group. Moreover, the research group reported notably higher WHOQOL-BREF scores in domains such as physiology, psychology, social relations, and environment. CONCLUSION Multi-channel continuous nursing intervention prevents POCs in patients undergoing RGE for GC as well as significantly alleviates patients' NEs and boosts their QoL.
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Affiliation(s)
- Huan-Li Luo
- Department of Nursing, Henan Vocational College of Nursing, Anyang 455000, Henan Province, China
| | - Huan-Ling Luo
- Department of International Education, Henan Vocational College of Nursing, Anyang 455000, Henan Province, China
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Puygrenier P, Al Taweel B, Herrero A, Gaillard M. Unplanned hospital readmission of older adults having undergone digestive surgery. J Visc Surg 2025:S1878-7886(25)00066-9. [PMID: 40221328 DOI: 10.1016/j.jviscsurg.2025.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2025]
Abstract
Decreasing the risk of unplanned hospital readmission in older adults is of major concern in public health. If this risk is heightened in comparison with the general population in those having undergone digestive surgery, it is due not only to more frequent occurrence of postoperative complications, but also to overall frailty, which combines comorbidities, functional disorders and dependency. Moreover, given that any unplanned readmission is a major event in the life of an elderly patient, counteraction to its consequences (immobilization syndrome, malnutrition, cognitive disorders, loss of autonomy…) must be considered by the entire surgical team, in coordination with geriatric specialists, as the priority. Readmission prevention is based on a dedicated, comprehensive geriatric assessment accompanied by an individualized, multidisciplinary prehabilitation program. The intervention of geriatricians before and after surgery is likely to improve perioperative management of the elderly patient, thereby reducing the frequency and impact of hospital readmission.
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Affiliation(s)
- Pierre Puygrenier
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Hôpital Cochin, AP-HP Université Paris Cité, Paris, France
| | - Bader Al Taweel
- Department of Hepatobiliopancreatic Surgery and Hepatic Transplantation, Hôpital Saint-Eloi, Montpellier, France
| | - Astrid Herrero
- Department of Hepatobiliopancreatic Surgery and Hepatic Transplantation, Hôpital Saint-Eloi, Montpellier, France
| | - Martin Gaillard
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Hôpital Cochin, AP-HP Université Paris Cité, Paris, France.
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Delrue C, De Bruyne S, Speeckaert MM. The Promise of Infrared Spectroscopy in Liquid Biopsies for Solid Cancer Detection. Diagnostics (Basel) 2025; 15:368. [PMID: 39941298 PMCID: PMC11818004 DOI: 10.3390/diagnostics15030368] [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: 12/16/2024] [Revised: 01/15/2025] [Accepted: 02/01/2025] [Indexed: 02/16/2025] Open
Abstract
Attenuated total reflection-Fourier transform infrared (ATR-FTIR) spectroscopy has shown significant promise in the context of liquid biopsy, offering a potential tool for cancer diagnostics. Unlike traditional tissue biopsies, which may not fully capture the clonal heterogeneity of tumors, liquid biopsy reflects the dynamic state of the disease and its progression more comprehensively. Biofluids such as serum and plasma are low-cost, minimally invasive diagnostic media with well-established clinical uses. This review assesses the use of ATR-FTIR spectroscopy to detect biochemical changes in biofluids linked to various malignancies, including breast, ovarian, endometrial, prostate, bladder, kidney, pancreatic, colorectal, hepatic, esophageal, gastric, lung, and brain cancers. While ATR-FTIR offers the advantages of rapid, minimally invasive detection and real-time disease monitoring, its integration into clinical practice faces challenges, particularly in terms of reproducibility due to variability in sample preparation, spectral acquisition, and data processing. The translation of ATR-FTIR into routine diagnostics will require validation through large-scale cohort studies and multicenter trials to ensure its clinical reliability and effectiveness.
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Affiliation(s)
- Charlotte Delrue
- Department of Nephrology, Ghent University Hospital, 9000 Ghent, Belgium;
| | - Sander De Bruyne
- Department of Diagnostic Sciences, Ghent University, 9000 Ghent, Belgium;
- Department of Laboratory Medicine, AZ Sint-Blasius, 9200 Dendermonde, Belgium
| | - Marijn M. Speeckaert
- Department of Nephrology, Ghent University Hospital, 9000 Ghent, Belgium;
- Research Foundation-Flanders (FWO), 1000 Brussels, Belgium
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7
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Wang J, de Jongh C, Wu Z, de Groot EM, Markar SR, Brenkman HJF, van Hillegersberg R, Ruurda JP. Impact of pre-treatment waiting intervals on short-term postoperative outcomes in neoadjuvant chemotherapy followed by gastrectomy: A population-based study using the Dutch Upper Gastrointestinal Cancer Audit (DUCA) data. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025:109595. [PMID: 39894712 DOI: 10.1016/j.ejso.2025.109595] [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: 05/10/2024] [Revised: 12/29/2024] [Accepted: 01/10/2025] [Indexed: 02/04/2025]
Abstract
INTRODUCTION The pre-treatment waiting interval of gastric cancer patients receiving neoadjuvant chemotherapy (nCT) followed by gastrectomy includes pre-nCT (diagnosis to nCT) and preoperative (diagnosis to surgery) waiting intervals. This study aimed to investigate the impact of these two distinct intervals on short-term postoperative outcomes. METHODS Patients (cT1-4aN0-3M0) who underwent nCT plus gastrectomy were included using the Dutch national DUCA-database. Multivariate logistic regression was used to determine the impact of the two waiting intervals upon short-term postoperative outcomes: pre-nCT waiting intervals (≤5, 5-8 and 8-12 weeks) and preoperative waiting intervals (≤17, 17-22, and >22 weeks). RESULTS Between 2010 and 2021, 1242 patients were included. Compared to the pre-nCT waiting interval ≤5 weeks, the longer intervals (5-8 and 8-12 weeks) were not associated with worse 30-day mortality (p-value = 0.707; p-value = 0.900), overall complications (p-value = 0.733; p-value = 0.453), pulmonary complications (p-value = 0.250; p-value = 0.238), gastrointestinal complications (p-value = 0.396; p-value = 0.992), re-interventions (p-value = 0.407; p-value = 0.072) and 30-day readmission (p-value = 0.992; p-value = 0.664). Compared to the preoperative waiting interval ≤17 weeks, the longer intervals (17-22 and > 22 weeks) were also not associated with worse 30-day mortality (p-value = 0.926; p-value = 0.732), overall complications (p-value = 0.286; p-value = 0.510), pulmonary complications (p-value = 0.912; p-value = 0.351), gastrointestinal complications (p-value = 0.765; p-value = 0.882), re-interventions (p-value = 0.617; p-value = 0.800) and 30-day readmission (p-value = 0.592; p-value = 0.782). CONCLUSION A longer pre-nCT or preoperative waiting interval is not associated with worse short-term postoperative outcomes in Western gastric cancer patients undergoing nCT plus gastrectomy.
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Affiliation(s)
- Jingpu Wang
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Cas de Jongh
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Zhouqiao Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Eline M de Groot
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sheraz R Markar
- Nuffield Department of Surgical Science, University of Oxford, UK
| | - Hylke J F Brenkman
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
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8
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Boyle E, Elliott JA. Novel nutrition strategies in gastric and esophageal cancer. Expert Rev Gastroenterol Hepatol 2025; 19:89-104. [PMID: 39864091 DOI: 10.1080/17474124.2025.2457444] [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: 09/12/2024] [Revised: 12/16/2024] [Accepted: 01/20/2025] [Indexed: 01/28/2025]
Abstract
INTRODUCTION Advances in treatment strategies for gastric and esophageal cancer have led to improved long-term outcomes, however the local and systemic effects of the primary tumor, neoadjuvant therapies and surgery, result in specific nutritional challenges. Comprehensive nutritional evaluation and support represents a core component of multidisciplinary holistic care for this patient population. AREAS COVERED We provide a detailed overview of nutritional challenges in gastric and esophageal cancer, with a focus on malignant obstruction, preoperative optimization and survivorship. We discuss current management strategies and evidence base, and describe future therapeutic targets. EXPERT OPINION Data to support the optimal management of malignant dysphagia and obstruction, particularly regarding patient reported outcomes, is currently lacking. The advantages of nutritional optimization in the pre- and immediate postoperative phase are well described, but further research is needed to inform optimal personalised strategies. Emerging data regarding the physiologic regulation of appetite and body weight have provided key insights and informed the development of novel therapeutic targets to improve nutritional status among patients undergoing treatment for oesophageal and gastric cancer.
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Affiliation(s)
- Ellen Boyle
- Department of Surgery, Trinity St. James's Cancer Institute, Dublin, Ireland
| | - Jessie A Elliott
- Department of Surgery, Trinity St. James's Cancer Institute, Dublin, Ireland
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Eom SS, Ryu KW, Han HS, Kong SH. A Comprehensive and Comparative Review of Global Gastric Cancer Treatment Guidelines: 2024 Update. J Gastric Cancer 2025; 25:153-176. [PMID: 39822173 PMCID: PMC11739642 DOI: 10.5230/jgc.2025.25.e10] [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: 12/18/2024] [Revised: 12/19/2024] [Accepted: 12/20/2024] [Indexed: 01/19/2025] Open
Abstract
Differences in demographics, medical expertise, and patient healthcare resources across countries have led to significant variations in guidelines. In light of these differences, in this review, we aimed to explore and compare the most recent updates to gastric cancer treatment from five guidelines that are available in English. These English-version guidelines, which have been recently published and updated for journal publication, include those published in South Korea in 2024, Japan in 2021, China in 2023, the United States in 2024, and Europe in 2024. The South Korean and Japanese guidelines provide a higher proportion of content to endoscopic and surgical treatments, reflecting their focus on minimally invasive techniques, function-preserving surgeries, and systemic therapy. The Chinese guidelines provide recommendations addressing not only surgical approaches but also perioperative chemotherapy and palliative systemic therapy. Meanwhile, in the United States and European guidelines, a higher proportion of the content is dedicated to perioperative and palliative systemic therapy, aligning with their approaches to advanced-stage disease management. All guidelines address surgical and systemic chemotherapy treatments; however, the proportion and emphasis of content vary based on the patient distribution and treatment approaches specific to each country. With emerging research findings on gastric cancer treatment worldwide, the national guidelines are being progressively revised and updated. Understanding the commonalities and differences among national guidelines, along with the underlying evidence, can provide valuable insights into the treatment of gastric cancer.
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Affiliation(s)
- Sang Soo Eom
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Hye Sook Han
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital and Seoul National University College of Medicine Cancer Research Institute, Seoul, Korea.
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10
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Liu B, Sun Y, Wang W, Ren J, Wang D. BHLHE40-mediated transcriptional activation of GRIN2D in gastric cancer is involved in metabolic reprogramming. Funct Integr Genomics 2024; 24:214. [PMID: 39546079 DOI: 10.1007/s10142-024-01495-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 10/25/2024] [Accepted: 11/01/2024] [Indexed: 11/17/2024]
Abstract
Gastric cancer (GC) is the third leading cause of death in developed countries. The reprogramming of energy metabolism represents a hallmark of cancer, particularly amplified dependence on aerobic glycolysis. Here, we aimed to illustrate the functional role of glutamate ionotropic receptor N-methyl-D-aspartate type subunit 2D (GRIN2D) in the regulation of glycolysis in GC and the mechanisms involved. Differentially expressed genes were analyzed using the GEO and GEPIA databases, followed by prognostic value prediction using the Kaplan-Meier Plotter database. The effect of GRIN2D knockdown on the malignant behavior and glycolysis of GC cells was explored. GRIN2D expression was upregulated in GC cells and promoted the malignant behavior of GC cells by activating glycolysis. Class E basic helix-loop-helix protein 40 (BHLHE40) was overexpressed in GC cells and mediated transcriptional activation of GRIN2D. The anti-tumor effects of BHLHE40 knockdown on GC cells in vitro and in vivo were reversed by GRIN2D overexpression. Knockdown of GRIN2D or BHLHE40 downregulated the expression of mRNA of electron transport chain subunits and phosphorylation of p38 MARK and inhibited calcium efflux in GC cells. Overexpression of GRIN2D promoted calcium efflux, phosphorylation of p38 MARK protein, and proliferation of GES1 cells. Altogether, the findings derived from this study suggest that BHLHE40 knockdown suppresses the growth, mobility, and glycolysis of GC cells by inhibiting GRIN2D transcription and disrupting the BHLHE40/GRIN2D axis may be an attractive therapeutic strategy for GC.
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Affiliation(s)
- Bin Liu
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No. 98, Nantong West Road, Guangling District, Yangzhou, Jiangsu, 225001, P.R. China
| | - Yuanlin Sun
- Department of Gastrointestinal Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University & Shandong Academy of Medical Science, Jinan, Shandong, 270000, P.R. China
| | - Wei Wang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No. 98, Nantong West Road, Guangling District, Yangzhou, Jiangsu, 225001, P.R. China
| | - Jun Ren
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No. 98, Nantong West Road, Guangling District, Yangzhou, Jiangsu, 225001, P.R. China
| | - Daorong Wang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No. 98, Nantong West Road, Guangling District, Yangzhou, Jiangsu, 225001, P.R. China.
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11
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Baldi L, D'Incà M, Wildner J, Tecce F, De Pasca R, Finotto S, Díaz Crescitelli ME, Di Leo S, Ghirotto L. Defining a balance by compromising with fear: A grounded theory study on returning to eating after a total gastrectomy. Palliat Support Care 2024; 22:1252-1262. [PMID: 38251442 DOI: 10.1017/s1478951523002031] [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] [Indexed: 01/23/2024]
Abstract
OBJECTIVES Gastric cancer patients undergoing total gastrectomy face nutrition-related complications and worsening quality of life after surgery. In this context, gastrectomized cancer patients are required to cope with new conditions. Little is known about their accommodating feeding to the new life condition as a negotiated process among stakeholders in real contexts. This study aimed to investigate the shaping of this process as influenced by the perspectives of patients, health-care professionals (HPs), and caregivers (CGs). METHODS A constructivist grounded theory study, through semi-structured interviews and interpretative coding, was designed to answer the following research question: "what is the process of returning to eating and feeding after a gastrectomy?" RESULTS The final sample included 18 participants. "Defining a balance by compromising with fear" is the core category explaining returning to eating as a process negotiated by all actors involved, with patients trying to find a feeding balance through a multi-layer compromise: with the information received by HPs, the proprioception drastically altered by gastric resection, new dietary habits to accept, and complex and often minimized conviviality. This process involves 4 main conceptual phases: relying on the doctors' advice, perceptive realignment, rearranging food intake, and food-regulated social interaction. Those categories are also shaped by the fear of being unwell from eating and the constant fear of tumor relapse. SIGNIFICANCE OF RESULTS Multiple actors can meet patients' and their CGs' nutritional, care, and psychosocial needs. A multidisciplinary approach involving nutritionists, psychologists, occupational therapists, social workers, and anthropologists can be key to effectively managing these patients' survivorship care. We suggest training all the professionals on the first level of nutritional counseling.
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Affiliation(s)
- Licia Baldi
- Oncological Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marco D'Incà
- Oncological Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Jürgen Wildner
- Department of Primary Care, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Romina De Pasca
- Medical Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Finotto
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Pad. De Sanctis, Reggio Emilia, Italy
| | | | - Silvia Di Leo
- Psycho-Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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12
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Visser MR, Voeten DM, Gisbertz SS, Ruurda JP, Achiam MP, Nilsson M, Markar SR, Pera M, Rosati R, Piessen G, Nafteux P, Gutschow CA, Grimminger PP, Räsänen JV, Reynolds JV, Johannessen HO, Vieira P, Weitzendorfer M, Kechagias A, van Berge Henegouwen MI, van Hillegersberg R. Western European Variation in the Organization of Esophageal Cancer Surgical Care. Dis Esophagus 2024; 37:doae033. [PMID: 38670807 PMCID: PMC11360861 DOI: 10.1093/dote/doae033] [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: 08/09/2023] [Revised: 03/21/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024]
Abstract
Reasons for structural and outcome differences in esophageal cancer surgery in Western Europe remain unclear. This questionnaire study aimed to identify differences in the organization of esophageal cancer surgical care in Western Europe. A cross-sectional international questionnaire study was conducted among upper gastrointestinal (GI) surgeons from Western Europe. One surgeon per country was selected based on scientific output and active membership in the European Society for Diseases of the Esophagus or (inter)national upper GI committee. The questionnaire consisted of 51 structured questions on the structural organization of esophageal cancer surgery, surgical training, and clinical audit processes. Between October 2021 and October 2022, 16 surgeons from 16 European countries participated in this study. In 5 countries (31%), a volume threshold was present ranging from 10 to 26 annual esophagectomies, in 7 (44%) care was centralized in designated centers, and in 4 (25%) no centralizing regulations were present. The number of centers performing esophageal cancer surgery per country differed from 4 to 400, representing 0.5-4.9 centers per million inhabitants. In 4 countries (25%), esophageal cancer surgery was part of general surgical training and 8 (50%) reported the availability of upper GI surgery fellowships. A national audit for upper GI surgery was present in 8 (50%) countries. If available, all countries use the audit to monitor the quality of care. Substantial differences exist in the organization and centralization of esophageal cancer surgical care in Western Europe. The exchange of experience in the organizational aspects of care could further improve the results of esophageal cancer surgical care in Europe.
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Affiliation(s)
- Maurits R Visser
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, the Netherlands
| | - Daan M Voeten
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Michael P Achiam
- Department of Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Magnus Nilsson
- Department of Upper Gastrointestinal Diseases, Karolinska University Hospital and Department of Clinical Science Technology and Interventions, Stockholm, Sweden
| | - Sheraz R Markar
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Manuel Pera
- Section of Gastrointestinal Surgery, Hospital del Mar, Department of Surgery, Universitat Autònoma de Barcelona, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
| | - Philippe Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Christian A Gutschow
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Peter P Grimminger
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jari V Räsänen
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland
| | - John V Reynolds
- Trinity St. James’s Cancer Institute, St. James’s Hospital, Dublin, Ireland
| | | | - Pedro Vieira
- Digestive Cancer Unit, Champalimaud Clinical Centre – Champalimaud Foundation, Lisbon, Portugal
| | | | | | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands
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13
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Hemminki K, Zitricky F, Försti A, Hemminki O, Liska V, Hemminki A. Survival improvements in esophageal and gastric cancers in the Nordic countries favor younger patients. Cancer Med 2024; 13:e7365. [PMID: 39096090 PMCID: PMC11297530 DOI: 10.1002/cam4.7365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 08/04/2024] Open
Abstract
Esophageal cancer (EC) and gastric cancer (GC) are fatal cancers with a relatively late age of onset. Age is a negative risk factor for survival in many cancers and our aim was to analyze age-specific survival in EC and GC using the recently updated NORDCAN database. NORDCAN data originate from the Danish, Finnish, Norwegian, and Swedish nationwide cancer registries covering years 1972 through 2021 inviting for comparison of 50-year survival trends between the countries. Relative 1- and 5-year survival and 5/1-year conditional survival (i.e., survival in those who were alive in Year 1 to survive additional 4 years) were analyzed. Survival in EC showed large gains for patients below age 80 years, 5-year survival in Norwegian men reaching 30% and in women over 30% but for 80-89 year old survival remained at 10%. In contrast, hardly any gain was seen among the 80-89 year patients for 1-year survival and small gains in 5 year and 5/1-year survival. Survival gaps between age-groups increased over time. For GC there was also a clear age-related negative survival gradient but the survival gaps between the age groups did not widen over time; Norwegian male and female 5-year survival for 80-89 year old was about 20%. The age-specific survival difference in GC arose in Year 1 and did not essentially increase in 5-year survival. While there were differences in survival improvements between the countries, poor survival of the 80-89 year old patients was shared by all of them. To conclude, survival has improved steadily in younger GC and EC patients in most Nordic countries. While the 80-89 year old population accounts for nearly a quarter of all patients and their poor survival depressed overall survival, which can therefore be increased further by improving diagnostics, treatment and care of elderly EC and GC patients.
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Affiliation(s)
- Kari Hemminki
- Biomedical Center, Faculty of Medicine in PilsenCharles UniversityPilsenCzech Republic
- Division of Cancer EpidemiologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
| | - Frantisek Zitricky
- Biomedical Center, Faculty of Medicine in PilsenCharles UniversityPilsenCzech Republic
| | - Asta Försti
- Hopp Children's Cancer Center (KiTZ)HeidelbergGermany
- Division of Pediatric NeurooncologyGerman Cancer Research Center (DKFZ), German Cancer Consortium (DKTK)HeidelbergGermany
| | - Otto Hemminki
- Department of UrologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Cancer Gene Therapy Group, Translational Immunology Research ProgramUniversity of HelsinkiHelsinkiFinland
| | - Vaclav Liska
- Biomedical Center, Faculty of Medicine in PilsenCharles UniversityPilsenCzech Republic
- Department of Surgery, University Hospital, Faculty of Medicine in PilsenCharles UniversityPilsenCzech Republic
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research ProgramUniversity of HelsinkiHelsinkiFinland
- Comprehensive Cancer CenterHelsinki University HospitalHelsinkiFinland
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14
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Su L, Zhang J, Jia L, Dou W, Li M, Zhang Y, Chang J, Sheng Y. Adherence with oral nutritional supplements and influencing factors in postoperative patients with digestive tract tumors: a cross-sectional study. Support Care Cancer 2024; 32:501. [PMID: 38985345 DOI: 10.1007/s00520-024-08711-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 07/02/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE This study aims to use structural equation modeling to explore the pathways and effect sizes of factors influencing the adherence of postoperative patients with digestive tract tumor to oral nutritional supplements, providing a theoretical basis for future nursing intervention measures. METHODS A total of 300 postoperative patients with digestive tract tumor within 30 days after surgery were conveniently sampled. Surveys were conducted using a General Information Questionnaire, Morisky Medication Adherence Scale, Digestive System Tumor Patient Nutrition Knowledge-Attitude-Behavior Questionnaire, Multidimensional Social Perception Scale, Beliefs about Medical Questionnaire, and General Self-Efficacy Scale. Structural equation modeling was employed to analyze the factors and pathways affecting adherence with oral nutritional supplements. RESULTS The adherence score of postoperative patients with digestive tract tumor to oral nutritional supplements was 1.61 ± 1.38. The structural equation model had a good fit (χ2/df = 2.685, GFI = 0.930, CFI = 0.913, AGFI = 0.887, IFI = 0.915, and RMSEA = 0.075). Nutrition knowledge, social support, medication beliefs, and self-efficacy were found to be factors influencing adherence with oral nutritional supplements in postoperative patients with digestive tract tumor, with total effects of 0.539, 0.264, 0.215, and 0.180, respectively. Nutrition knowledge indirectly affected adherence through self-efficacy and medication beliefs, while social support indirectly affected adherence through self-efficacy. CONCLUSION Adherence with oral nutritional supplements in postoperative patients with digestive tract tumor is at a low level. Improving social support, enhancing patients nutrition knowledge, increasing self-efficacy, and strengthening medication beliefs are effective ways to improve patient adherence.
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Affiliation(s)
- Liqing Su
- Shanghai Jiao Tong University, School of Nursing, No.227, Chongqing South Road, Huangpu District, Shanghai, 200025, China
| | - Jie Zhang
- Department of Nursing, Shanghai General Hospital, No.650, Xin Song Jiang Road, Songjiang District, Shanghai, 201620, China
- Shanghai Jiao Tong University, School of Nursing, No.227, Chongqing South Road, Huangpu District, Shanghai, 200025, China
| | - Lei Jia
- Department of Nursing, Shanghai General Hospital, No.650, Xin Song Jiang Road, Songjiang District, Shanghai, 201620, China
| | - Wenyue Dou
- Department of Nursing, Shanghai General Hospital, No.650, Xin Song Jiang Road, Songjiang District, Shanghai, 201620, China
- Shanghai Jiao Tong University, School of Nursing, No.227, Chongqing South Road, Huangpu District, Shanghai, 200025, China
| | - Mengxue Li
- Shanghai Jiao Tong University, School of Nursing, No.227, Chongqing South Road, Huangpu District, Shanghai, 200025, China
| | - Yumeng Zhang
- Shanghai Jiao Tong University, School of Nursing, No.227, Chongqing South Road, Huangpu District, Shanghai, 200025, China
| | - Jian Chang
- Shanghai General Hospital, Shanghai Jiao Tong University School of Nursing, No.100, Haining Road, Hongkou District, Shanghai, 200080, China.
| | - Yi Sheng
- Department of Nursing, Shanghai General Hospital, No.650, Xin Song Jiang Road, Songjiang District, Shanghai, 201620, China.
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15
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Mansour N, Heinrich K, Zhang D, Winkelmann M, Ingenerf M, Gold L, Klambauer K, Rudelius M, Klauschen F, von Bergwelt-Baildon M, Ricke J, Heinemann V, Westphalen CB, Kunz WG. Patient eligibility for trials with imaging response assessment at the time of molecular tumor board presentation. Cancer Imaging 2024; 24:70. [PMID: 38849902 PMCID: PMC11157753 DOI: 10.1186/s40644-024-00708-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 05/11/2024] [Indexed: 06/09/2024] Open
Abstract
PURPOSE To assess the eligibility of patients with advanced or recurrent solid malignancies presented to a molecular tumor board (MTB) at a large precision oncology center for inclusion in trials with the endpoints objective response rate (ORR) or duration of response (DOR) based on Response Evaluation Criteria in Solid Tumors (RECIST version 1.1). METHODS Prospective patients with available imaging at the time of presentation in the MTB were included. Imaging data was reviewed for objectifiable measurable disease (MD) according to RECIST v1.1. Additionally, we evaluated the patients with MD for representativeness of the identified measurable lesion(s) in relation to the overall tumor burden. RESULTS 262 patients with different solid malignancies were included. 177 patients (68%) had MD and 85 (32%) had non-measurable disease (NMD) at the time point of MTB presentation in accordance with RECIST v1.1. MD was not representative of the overall tumor burden in eleven patients (6%). The main reasons for NMD were lesions with longest diameter shorter than 10 mm (22%) and non-measurable peritoneal carcinomatosis (18%). Colorectal cancer and malignant melanoma displayed the highest rates of MD (> 75%). In contrast, gastric cancer, head and neck malignancies, and ovarian carcinoma had the lowest rates of MD (< 55%). In case of MD, the measurable lesions were representative of the overall tumor burden in the vast majority of cases (94%). CONCLUSION Approximately one third of cancer patients with advanced solid malignancies are not eligible for treatment response assessment in trials with endpoints ORR or DOR at the time of MTB presentation. The rate of patients eligible for trials with imaging endpoints differs significantly based on the underlying malignancy and should be taken under consideration during the planning of new precision oncology trials.
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Affiliation(s)
- Nabeel Mansour
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Kathrin Heinrich
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Cancer Center München-LMU (CCCM LMU), LMU Munich, Munich, Germany
| | - Danmei Zhang
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Cancer Center München-LMU (CCCM LMU), LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK partner site Munich), Heidelberg, Germany
| | - Michael Winkelmann
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Maria Ingenerf
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Lukas Gold
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Konstantin Klambauer
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Martina Rudelius
- Institute of Pathology, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Frederick Klauschen
- Institute of Pathology, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Michael von Bergwelt-Baildon
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Cancer Center München-LMU (CCCM LMU), LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK partner site Munich), Heidelberg, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Volker Heinemann
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Cancer Center München-LMU (CCCM LMU), LMU Munich, Munich, Germany
| | - C Benedikt Westphalen
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Cancer Center München-LMU (CCCM LMU), LMU Munich, Munich, Germany
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
- Comprehensive Cancer Center München-LMU (CCCM LMU), LMU Munich, Munich, Germany.
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16
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Su L, Zhang J, Jia L, Dou W, Li M, Zhang Y, Chang J. Compliance with oral nutritional supplements and its influencing factors in postoperative patients with digestive tract tumors: a cross-sectional study. BMC Nurs 2024; 23:380. [PMID: 38840132 PMCID: PMC11151578 DOI: 10.1186/s12912-024-02010-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 05/13/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Oral nutritional supplements are one of the preferred methods of nutritional support for postoperative patients. This study aims to investigate the current status of oral nutritional supplements compliance in postoperative patients with digestive tract tumors and its influencing factors. METHODS Convenience sampling was employed to select 242 patients who underwent surgery for digestive tract tumors at a tertiary hospital in Shanghai from October 2022 to July 2023 as the study subjects. Data following a normal distribution were analyzed using independent sample t-tests, ANOVA single-factor analysis, Pearson correlation analysis, and multiple linear regression analysis to determine the factors influencing compliance with oral nutritional supplements. RESULTS A total of 252 questionnaires were distributed, with 10 invalid questionnaires excluded, resulting in an effective questionnaire rate of 96.03%. The compliance score for oral nutritional supplements in postoperative patients with digestive tract tumors was (2.40 ± 1.45), General Self-efficacy Scale (GSES) score was (24.72 ± 4.86), Multidimensional Scale of Perceived Social Support Scale (MSPSS) score was (58.67 ± 11.09), and Belief about Medicines Questionnaire Scale (BMQ) score was (0.17 ± 2.78). Multiple linear regression analysis revealed that age, adverse reactions, educational level, self-efficacy, medication beliefs, and social support were factors influencing compliance with oral nutritional supplements in postoperative patients with digestive tract tumors (P < 0.05). CONCLUSION Our study revealed that the compliance to oral nutritional supplements among postoperative patients with digestive tract tumors was at a moderate level and was closely associated with age, educational level, adverse reactions to oral nutritional supplements, medication beliefs, social support, and self-efficacy. Nursing staff should conduct nursing assessments based on the specific circumstances of patients and their families, provide personalized health education management plans based on the patients' educational level, enhance patients' nutrition knowledge, improve patient self-efficacy, and enhance social support for patients, while further improving patient nutrition management.
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Affiliation(s)
- Liqing Su
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Zhang
- Department of Nursing, Shanghai General Hospital, Shanghai, China
| | - Lei Jia
- Department of Nursing, Shanghai General Hospital, Shanghai, China
| | - Wenyue Dou
- Department of Nursing, Shanghai General Hospital, Shanghai, China
| | - Mengxue Li
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Yumeng Zhang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Chang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China.
- Department of Nursing, Shanghai General Hospital, Shanghai, China.
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17
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Bos J, Groen-van Schooten TS, Brugman CP, Jamaludin FS, van Laarhoven HWM, Derks S. The tumor immune composition of mismatch repair deficient and Epstein-Barr virus-positive gastric cancer: A systematic review. Cancer Treat Rev 2024; 127:102737. [PMID: 38669788 DOI: 10.1016/j.ctrv.2024.102737] [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: 02/13/2024] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Gastric cancer (GC), known for its unfavorable prognosis, has been classified in four distinct molecular subtypes. These subtypes not only exhibit differences in their genome and transcriptome but also in the composition of their tumor immune microenvironment. The microsatellite instable (MSI) and Epstein-Barr virus (EBV) positive GC subtypes show clear clinical benefits from immune checkpoint blockade, likely due to a neoantigen-driven and virus-driven antitumor immune response and high expression of immune checkpoint molecule PD-L1. However, even within these subtypes response to checkpoint inhibition is variable, which is potentially related to heterogeneity in the tumor immune microenvironment (TIME) and expression of co-inhibitory molecules. We conducted a systematic review to outline the current knowledge about the immunological features on the TIME of MSI and EBV + GCs. METHODS A systematic search was performed in PubMed, EMBASE and Cochrane Library. All articles from the year 1990 and onwards addressing immune features of gastric adenocarcinoma were reviewed and included based on predefined in- and exclusion criteria. RESULTS In total 5962 records were screened, of which 139 were included that reported immunological data on molecular GC subtypes. MSI and EBV + GCs were reported to have a more inflamed TIME compared to non-MSI and EBV- GC subtypes. Compared to microsatellite stable (MSS) tumors, MSI tumors were characterized by higher numbers of CD8 + and FoxP3 + T cells, and tumor infiltrating pro- and anti-inflammatory macrophages. HLA-deficiency was most common in MSI tumors compared to other molecular GC subtypes and associated with lower T and B cell infiltrates compared to HLA-proficient tumors. EBV + was associated with a high number of CD8 + T cells, Tregs, NK cells and macrophages. Expression of PD-L1, CTLA-4, Granzyme A and B, Perforin and interferon-gamma was enriched in EBV + tumors. Overall, MSI tumors harbored a more heterogeneous TIME in terms of immune cell composition and immune checkpoints compared to the EBV + tumors. DISCUSSION AND CONCLUSION MSI and EBV + GCs are highly Handbook for Conducting a Literature-Based Health Assessment Using OHAT Approach for Systematic Review and Evidence Integration.; 2019pro-inflammatory immune cell populations. Although studies on the direct comparison of EBV + and MSI tumors are limited, EBV + tumors show less intra-subgroup heterogeneity compared to MSI tumors. More studies are needed to identify how Intra-subgroup heterogeneity impacts response to immunotherapy efficacy.
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Affiliation(s)
- J Bos
- Amsterdam UMC Location University of Amsterdam, Department of Medical Oncology, Meibergdreef 9, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, the Netherlands; Oncode Institute, Amsterdam, the Netherlands
| | - T S Groen-van Schooten
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, the Netherlands; Oncode Institute, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Medical Oncology, De Boelelaan 1117, Amsterdam, the Netherlands
| | - C P Brugman
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, the Netherlands; Oncode Institute, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Medical Oncology, De Boelelaan 1117, Amsterdam, the Netherlands
| | - F S Jamaludin
- Amsterdam UMC Location University of Amsterdam, Medical Library AMC, Meibergdreef 9, Amsterdam, the Netherlands
| | - H W M van Laarhoven
- Amsterdam UMC Location University of Amsterdam, Department of Medical Oncology, Meibergdreef 9, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, the Netherlands
| | - S Derks
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, the Netherlands; Oncode Institute, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Medical Oncology, De Boelelaan 1117, Amsterdam, the Netherlands.
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18
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Qian Z, Wu F, Feng G, Lin W, Cai X, Wu J, Ke K, Ye Z, Xu G. A prognostic risk model based on lactate metabolism and transport-related lncRNAs for gastric adenocarcinoma. Biomarkers 2024; 29:211-221. [PMID: 38629165 DOI: 10.1080/1354750x.2024.2341411] [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: 09/17/2023] [Accepted: 04/04/2024] [Indexed: 05/15/2024]
Abstract
BACKGROUND Increased lactate levels and metastasis in tumours are strongly associated with dismal outcomes. But prognostic value of lactate metabolism and transport-related lncRNAs in gastric adenocarcinoma (GA) patients remains unaddressed. METHODS Gene expression data of GA were provided by The Cancer Genome Atlas. Lactate metabolism and transport-related gene data were accessed from GSEA. LncRNAs related to lactate metabolism and transport were identified by correlation analysis. A prognostic model was built by regression analysis. Validity of prognostic model was confirmed through survival analysis and receiver operating characteristic (ROC) curve. Immunity of each risk group was evaluated by immune correlation analysis .LncRNA-mRNA network was built by correlation analysis using Cytoscape software. RESULTS A 12-gene prognostic model based on lactate metabolism and transport-related lncRNAs was built in GA. Median riskscore was utilized to classify GA samples into high- and low-risk groups. Survival analysis and ROC curves demonstrated validity of prognostic model. Most immune checkpoint molecules and TIDE scores were lower in the low-risk group. LINC01303 and LINC01545 may be the key prognostic factors in patients with GA. CONCLUSION This study successfully built a prognostic model of lactate metabolism and transport-related lncRNAs in GA. The findings guide prognostic management of GA patients.
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Affiliation(s)
- Zhenyuan Qian
- General Surgery, Cancer Center, Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Fang Wu
- General Surgery, Cancer Center, Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Guoqing Feng
- Department of General Surgery, Haining Traditional Chinese Medicine Hospital, Haining, Jiaxing, Zhejiang, China
| | - Wenfa Lin
- Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China
| | - Xufan Cai
- Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China
| | - Jianzhang Wu
- General Surgery, Cancer Center, Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Kun Ke
- General Surgery, Cancer Center, Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zaiyuan Ye
- General Surgery, Cancer Center, Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Guoxi Xu
- Department of Gastrointestinal Surgery, Jinjiang Municipal Hospital, Jinjiang, Quanzhou, Fujian, China
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19
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Kim HD, Ryu MH, Kang YK. Adjuvant treatment for locally advanced gastric cancer: an Asian perspective. Gastric Cancer 2024; 27:439-450. [PMID: 38489111 DOI: 10.1007/s10120-024-01484-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/21/2024] [Indexed: 03/17/2024]
Abstract
Standard adjuvant treatment for locally advanced gastric cancer (LAGC) is regionally different. Whereas perioperative chemotherapy is the standard in Western populations, D2 gastrectomy followed by adjuvant chemotherapy has been the standard in East Asia. Recently, the pivotal phase 3 PRODIGY and RESOLVE studies have demonstrated survival benefits of adding neoadjuvant chemotherapy to surgery followed by adjuvant chemotherapy over up-front surgery followed by adjuvant chemotherapy in Asian patients. Based on these results, neoadjuvant chemotherapy is considered one of the viable options for patients with LAGC. In this review, various aspects of neoadjuvant chemotherapy will be discussed for its optimal application in Asia. Candidates for neoadjuvant chemotherapy should be carefully chosen in consideration of the inaccurate aspects of radiological clinical staging and its potential benefit over up-front surgery followed by a decision on adjuvant chemotherapy according to the pathological stage. Efforts should continuously be made to optimally apply neoadjuvant chemotherapy to patients with LAGC, considering various factors, including a more accurate radiological assessment of the tumor burden and the optimization of post-operative chemotherapy. Future neoadjuvant trials involving novel agents for Asian patients should be designed based on proven Asian regimens rather than adopting Western regimens.
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Affiliation(s)
- Hyung-Don Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88,Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Min-Hee Ryu
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88,Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Yoon-Koo Kang
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88,Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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20
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Giammarile F, Knoll P, Kunikowska J, Paez D, Estrada Lobato E, Mikhail-Lette M, Wahl R, Holmberg O, Abdel-Wahab M, Scott AM, Delgado Bolton RC. Guardians of precision: advancing radiation protection, safety, and quality systems in nuclear medicine. Eur J Nucl Med Mol Imaging 2024; 51:1498-1505. [PMID: 38319322 PMCID: PMC11043166 DOI: 10.1007/s00259-024-06633-w] [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: 12/18/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND In the rapidly evolving field of nuclear medicine, the paramount importance of radiation protection, safety, and quality systems cannot be overstated. This document provides a comprehensive analysis of the intricate regulatory frameworks and guidelines, meticulously crafted and updated by national and international regulatory bodies to ensure the utmost safety and efficiency in the practice of nuclear medicine. METHODS We explore the dynamic nature of these regulations, emphasizing their adaptability in accommodating technological advancements and the integration of nuclear medicine with other medical and scientific disciplines. RESULTS Audits, both internal and external, are spotlighted for their pivotal role in assessing and ensuring compliance with established standards, promoting a culture of continuous improvement and excellence. We delve into the significant contributions of entities like the International Atomic Energy Agency (IAEA) and relevant professional societies in offering universally applicable guidelines that amalgamate the latest in scientific research, ethical considerations, and practical applicability. CONCLUSIONS The document underscores the essence of international collaborations in pooling expertise, resources, and insights, fostering a global community of practice where knowledge and innovations are shared. Readers will gain an in-depth understanding of the practical applications, challenges, and opportunities presented by these regulatory frameworks and audit processes. The ultimate goal is to inspire and inform ongoing efforts to enhance safety, quality, and effectiveness in nuclear medicine globally.
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Affiliation(s)
- Francesco Giammarile
- Department of Nuclear Science and Applications, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria.
| | - Peter Knoll
- Department of Nuclear Science and Applications, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Jolanta Kunikowska
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
| | - Diana Paez
- Department of Nuclear Science and Applications, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Enrique Estrada Lobato
- Department of Nuclear Science and Applications, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Miriam Mikhail-Lette
- Department of Nuclear Science and Applications, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Richard Wahl
- Washington University in St Louis School of Medicine, St. Louis, USA
- The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Ola Holmberg
- Department of Nuclear Safety and Security, Radiation Safety and Monitoring Section, International Atomic Energy Agency, Vienna, Austria
| | - May Abdel-Wahab
- Department of Nuclear Science and Applications, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Andrew M Scott
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Australia
- Olivia Newton-John Cancer Research Institute, Melbourne, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Australia
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), La Rioja, Logroño, Spain
- Servicio Cántabro de Salud, Santander, Spain
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21
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Paredero-Pérez I, Jimenez-Fonseca P, Cano JM, Arrazubi V, Carmona-Bayonas A, Covela-Rúa M, Fernández-Montes A, Martín-Richard M, Gironés-Sarrió R. State of the scientific evidence and recommendations for the management of older patients with gastric cancer. J Geriatr Oncol 2024; 15:101657. [PMID: 37957106 DOI: 10.1016/j.jgo.2023.101657] [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: 04/25/2023] [Revised: 07/25/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
Gastric cancer is one of the most frequent and deadly tumours worldwide. However, the evidence that currently exists for the treatment of older adults is limited and is derived mainly from clinical trials in which older patients are poorly represented. In this article, a group of experts selected from the Oncogeriatrics Section of the Spanish Society of Medical Oncology (SEOM), the Spanish Group for the Treatment of Digestive Tumours (TTD), and the Spanish Multidisciplinary Group on Digestive Cancer (GEMCAD) reviews the existing scientific evidence for older patients (≥65 years old) with gastric cancer and establishes a series of recommendations that allow optimization of management during all phases of the disease. Geriatric assessment (GA) and a multidisciplinary approach should be fundamental parts of the process. In early stages, endoscopic submucosal resection or laparoscopic gastrectomy is recommended depending on the stage. In locally advanced stage, the tolerability of triplet regimens has been established; however, as in the metastatic stage, platinum- and fluoropyrimidine-based regimens with the possibility of lower dose intensity are recommended resulting in similar efficacy. Likewise, the administration of trastuzumab, ramucirumab and immunotherapy for unresectable metastatic or locally advanced disease is safe. Supportive treatment acquires special importance in a population with different life expectancies than at a younger age. It is essential to consider the general state of the patient and the psychosocial dimension.
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Affiliation(s)
- Irene Paredero-Pérez
- Lluís Alcanyís de Játiva Hospital, Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Valencia, Spain
| | - Paula Jimenez-Fonseca
- Asturias Central University Hospital (HUCA), Health Research Institute of the Principality of Asturias (ISPA), Spanish Cooperative Group for the Treatment of Digestive Tumours (TTD), Oviedo, Spain
| | - Juana María Cano
- Ciudad Real University Hospital, Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Ciudad Real, Spain.
| | - Virginia Arrazubi
- Navarra University Hospital, Navarra Institute for Health Research (IdiSNA), Spanish Society of Medical Oncology (SEOM), Pamplona, Spain
| | - Alberto Carmona-Bayonas
- IMIB Morales Meseguer University Hospital, Murcia University (UMU), Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Murcia, Spain
| | - Marta Covela-Rúa
- Lucus Agusti University Hospital (HULA), Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Lugo, Spain
| | - Ana Fernández-Montes
- Ourense University Hospital Complex (CHUO), Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Orense, Spain
| | - Marta Martín-Richard
- Institut Català d'Oncologia (ICO) - Duran i Reynals University Hospital, Multidisciplinary Spanish Group of Digestive Cancer (GEMCAD), Barcelona, Spain.
| | - Regina Gironés-Sarrió
- Polytechnic la Fe University Hospital, Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Valencia, Spain
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Jiang T, Xu L, Qu X, Li R, Cheng Y, He H. Hsa_circ_0014606 Derived from Exosomes Promotes Gastric Carcinoma Tumorigenesis and Proliferation by Sponging miR-514b-3p to Upregulate HNRNPC. Dig Dis Sci 2024; 69:811-820. [PMID: 38217675 DOI: 10.1007/s10620-023-08254-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/14/2023] [Indexed: 01/15/2024]
Abstract
Gastric cancer is a common malignant tumor, and due to its insidious onset and limited screening methods, most patients are diagnosed with advanced disease and have a poor prognosis. The circRNA in exosomes has an essential role in cancer diagnosis and treatment. However, the part of hsa_circ_0014606 within exosomes in gastric cancer progression is unclear. Firstly, we extracted exosomes from the serum of gastric cancer patients and healthy individuals by ultracentrifugation and analyzed the expression of hsa_circ_0014606 in both exosomes; then knocked down hsa_circ_0014606 in vivo and in vitro, respectively, to observe its effect on the physiological function of gastric cancer cells; finally, we used bioinformatics to screen hsa_circ_0014606 targeting miRNAs and mRNAs, and experiments were performed to verify the interrelationship between the three. The results showed that the level of hsa_circ_0014606 in the serum exosomes of gastric cancer patients was significantly higher than that of the healthy population. The knockdown of hsa_circ_0014606 slowed the proliferation of gastric cancer cells, significantly reduced migration and invasion ability, accelerated apoptosis, and reduced tumor size in mice. In addition, the expression of hsa_circ_0014606 was negatively correlated with the expression of miR-514b-3p and positively correlated with the expression of heterogeneous nuclear ribonucleoprotein C (HNRNPC). In conclusion, hsa_circ_0014606 exerted a pro-cancer effect indirectly through miR-514b-3p targeting gene HNRNPC, and this study provides a new potential target for treating gastric cancer.
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Affiliation(s)
- Tao Jiang
- Department of Otolaryngology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Lingling Xu
- Department of Medical Oncology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Xiaona Qu
- Department of Medical Oncology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Rui Li
- Department of Otolaryngology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Ye Cheng
- Department of Medical Oncology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Hongmei He
- Department of Medical Oncology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China.
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23
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Kulasegaran S, Wang Y, Woodhouse B, MacCormick A, Srinivasa S, Koea J. Quality Performance Indicators for the Surgical Management of Oesophageal Cancer: A Systematic Literature Review. World J Surg 2023; 47:3262-3269. [PMID: 37865917 PMCID: PMC10694097 DOI: 10.1007/s00268-023-07216-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND The objective of this systematic review was to identify pre-existing quality performance indicators (QPIs) for the surgical management of oesophageal cancer (OC). These QPIs can be used to objectively measure and compare the performance of individual units and capture key elements of patient care to improve patient outcomes. METHODS A systematic literature search of PubMed, MEDLINE, Scopus and Embase was conducted. Articles reporting on the quality of healthcare in relation to oesophageal neoplasm or cancer and the surgical treatment of OC available until the 1st of March 2022 were included. RESULTS The final list of articles included retrospective reviews (n = 13), prospective reviews (n = 8), expert guidelines (n = 1) and consensus (n = 1). The final list of QPIs was categorized as process, outcome or structural measures. Process measures included multidisciplinary involvement, availability of multimodality diagnostic and treatment pathways and surgical metrics. Outcome measures included reoperation and readmission rates, the achievement of RO resection and length of hospital stay. Structural measures include multidisciplinary meetings. CONCLUSIONS This systematic review summarizes QPIs for the surgical treatment of OC. The data will serve as an introduction to establishing a quality initiative project for OC resections.
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Affiliation(s)
| | - Yijiao Wang
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
| | - Braden Woodhouse
- Department of Oncology, The University of Auckland, Auckland, New Zealand
| | - Andrew MacCormick
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Sanket Srinivasa
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Jonathan Koea
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
- Department of Surgery, The University of Auckland, Auckland, New Zealand
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24
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Muttillo EM, La Franca A, Stefanelli S, Coppola A, Li Causi FS, Giannella RA, Pino E, Castagnola G, Scarinci A, Balducci G, Mercantini P. Oncological Adequacy of Laparoscopic Surgery for Bulky Gastric Cancer: Results of a Western Single-Center Series. Life (Basel) 2023; 13:2243. [PMID: 38137844 PMCID: PMC10744348 DOI: 10.3390/life13122243] [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: 10/12/2023] [Revised: 11/18/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Gastric cancer is increasing worldwide and one million new cases were estimated globally in 2020. Use of the laparoscopic approach is increasing especially for subtotal gastrectomy. However, to date, solid data on locally advanced bulky tumors are lacking. The aim of this study is to assess the role of laparoscopic surgery in bulky gastric tumors. METHODS We performed an observational retrospective single-center analysis. The following data were collected and analyzed for each patient: demographics, tumor-related data, intra-operative data, peri-operative data, and pathological data. Statistical analysis was conducted, including descriptive statistics and chi-squared test, to analyze the differences between categorical variables. RESULTS O the 116 patients who underwent gastric surgery, 49 patients were included in the study protocol. All patients had bulky gastric tumors. Eighteen patients underwent laparoscopic gastrectomy and 31 open gastrectomy. The median number of lymph nodes removed was 28.5 (15-46) in the laparoscopic group and 23.05 (6-62) in the open group (p = 0.04). In total, 5.6% of patients of the laparoscopic group had <16 lymph nodes harvested and 35.5% in the open group (p = 0.035). No statistical differences were found between the open and laparoscopic groups in terms of surgical margins (p = 0.69). CONCLUSIONS Laparoscopic surgery is still a subject of debate in locally advanced bulky gastric cancer. Limited data are available concerning Western patients. This study showed superiority in terms of the quality of lymphadenectomy and non-inferiority in terms of radical resection margins.
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Affiliation(s)
- Edoardo Maria Muttillo
- Department of Medical Surgical Science and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, 00198 Rome, Italy; (E.M.M.); (A.L.F.); (S.S.); (F.S.L.C.); (R.A.G.)
| | - Alice La Franca
- Department of Medical Surgical Science and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, 00198 Rome, Italy; (E.M.M.); (A.L.F.); (S.S.); (F.S.L.C.); (R.A.G.)
| | - Silvia Stefanelli
- Department of Medical Surgical Science and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, 00198 Rome, Italy; (E.M.M.); (A.L.F.); (S.S.); (F.S.L.C.); (R.A.G.)
| | - Alessandro Coppola
- Department of Surgery, Sapienza University of Rome, Viale Regina Elena 291, 00161 Rome, Italy
| | - Francesco Saverio Li Causi
- Department of Medical Surgical Science and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, 00198 Rome, Italy; (E.M.M.); (A.L.F.); (S.S.); (F.S.L.C.); (R.A.G.)
| | - Rachele Anna Giannella
- Department of Medical Surgical Science and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, 00198 Rome, Italy; (E.M.M.); (A.L.F.); (S.S.); (F.S.L.C.); (R.A.G.)
| | - Elena Pino
- Department of Medical Surgical Science and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, 00198 Rome, Italy; (E.M.M.); (A.L.F.); (S.S.); (F.S.L.C.); (R.A.G.)
| | - Giorgio Castagnola
- Department of Medical Surgical Science and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, 00198 Rome, Italy; (E.M.M.); (A.L.F.); (S.S.); (F.S.L.C.); (R.A.G.)
| | - Andrea Scarinci
- Department of Medical Surgical Science and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, 00198 Rome, Italy; (E.M.M.); (A.L.F.); (S.S.); (F.S.L.C.); (R.A.G.)
| | - Genoveffa Balducci
- Department of Medical Surgical Science and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, 00198 Rome, Italy; (E.M.M.); (A.L.F.); (S.S.); (F.S.L.C.); (R.A.G.)
| | - Paolo Mercantini
- Department of Medical Surgical Science and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, 00198 Rome, Italy; (E.M.M.); (A.L.F.); (S.S.); (F.S.L.C.); (R.A.G.)
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25
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Wang X, Liu X, Gu Z, Li X, Shu Y. Experiences and requirements in nutritional management of patients with esophageal cancer: a systematic review and qualitative meta-synthesis. Support Care Cancer 2023; 31:633. [PMID: 37843658 PMCID: PMC10579144 DOI: 10.1007/s00520-023-08100-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE Nutritional management of patients with esophageal cancer is a significant issue. This systematic review aimed to comprehensively synthesize qualitative research evidence on the experiences and requirements in nutritional management from the perspective of patients with esophageal cancer. METHODS A systematic review and meta-synthesis of qualitative studies were conducted. Studies written in Chinese or English were retrieved from nine databases, namely, PubMed, Web of Science, Cochrane Library, CINAHL, Embase, CNKI, WanFang, VIP, and SinoMed, from inception to December 23, 2022. After screening the titles, abstracts, and full texts, 19 articles were finally included for quality assessment and meta-synthesis. RESULTS Three comprehensive themes were derived. These were dietary experiences (perception of symptoms and dietary behaviors), emotional experiences (negative and positive emotions), and social support (inappropriate social support and inadequate nutritional management). CONCLUSIONS The experiences and requirements of esophageal cancer patients in terms of nutritional management during treatment and rehabilitation were reviewed and factors influencing nutritional management were discussed. The findings suggested that medical institutions should expedite the development of comprehensive nutritional management systems, create conducive nutritional environmental facilities, and establish interdisciplinary teams to implement personalized comprehensive interventional models for the management of patient nutrition. These steps would maximize the effectiveness of nutritional therapy, promote early patient recovery, and bridge the gap between healthcare professionals and patients in the understanding of nutritional management.
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Affiliation(s)
- Xinwei Wang
- School of Nursing and Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China
| | - Xingyu Liu
- School of Nursing and Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China
| | - Zhie Gu
- Northern Jiangsu People's Hospital, 98 Nantong West Road, Yangzhou, 225001, Jiangsu Province, China
| | - Xiaojie Li
- School of Nursing and Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China
| | - Yusheng Shu
- Northern Jiangsu People's Hospital, 98 Nantong West Road, Yangzhou, 225001, Jiangsu Province, China.
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26
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Iezadi S, Ebrahimi N, Ghamari SH, Esfahani Z, Rezaei N, Ghasemi E, Moghaddam SS, Azadnajafabad S, Abdi Z, Varniab ZS, Golestani A, Langroudi AP, Dilmaghani-Marand A, Farzi Y, Pourasghari H. Global and regional quality of care index (QCI) by gender and age in oesophageal cancer: A systematic analysis of the Global Burden of Disease Study 1990-2019. PLoS One 2023; 18:e0292348. [PMID: 37788249 PMCID: PMC10547202 DOI: 10.1371/journal.pone.0292348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/19/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND The aim of this study was to examine the quality of care by age and gender in oesophageal cancer using Global Burden of Disease (GBD) database. METHODS Patients aged 20 and over with oesophageal cancer were included in this longitudinal study using GBD 1990-2019 data. We used the Socio-Demographic Index (SDI) to classify the regions. We used Principal Component Analysis (PCA) method to calculate the Quality of Care Index (QCI). The QCI was rescaled into a 0-100 single index, demonstrating that the higher the score, the better the QC. RESULTS The age-standardized QCI for oesophageal cancer dramatically increased from 23.5 in 1990 to 41.1 in 2019 for both sexes, globally. The high SDI regions showed higher QCI than the rest of the regions (45.1 in 1990 and 65.7 in 2019) whereas the low SDI regions had the lowest QCI, which showed a 4.5% decrease through the years (from 13.3 in 1990 to 12.7 in 2019). Globally, in 2019, the QCI showed the highest scores for patients aged 80-84, reported 48.2, and the lowest score for patients aged 25-29 reported 31.5, for both sexes. Globally, in 2019, age-standardized Gender Disparity Ratio (GDR) was 1.2, showing higher QCI in females than males. CONCLUSION There were fundamental differences in the QCI both globally and regionally between different age groups as well as between males and females. To achieve the goal of providing high-quality services equally to people in need in all over the world, health systems need to invest in effective diagnostic services, treatments, facilities, and equipment and to plan for screening and surveillance of high-risk individuals.
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Affiliation(s)
- Shabnam Iezadi
- Research Center for Emergency and Disaster Resilience, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran
- Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Narges Ebrahimi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed-Hadi Ghamari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Esfahani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zhaleh Abdi
- National Institute of Health Research (NIHR), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Zahra Shokri Varniab
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Golestani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashkan Pourabhari Langroudi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezou Dilmaghani-Marand
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Yosef Farzi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Pourasghari
- Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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27
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Sposito C, Maspero M, Conalbi V, Magarotto A, Altomare M, Battiston C, Cantù P, Mazzaferro V. Impact of Indocyanine Green Fluorescence Imaging on Lymphadenectomy Quality During Laparoscopic Distal Gastrectomy for Gastric Cancer (Greeneye): An Adaptative, Phase 2, Clinical Trial. Ann Surg Oncol 2023; 30:6803-6811. [PMID: 37442913 PMCID: PMC10506942 DOI: 10.1245/s10434-023-13848-y] [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: 03/30/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Indocyanine green (ICG)-guided lymphadenectomy using near-infrared visualization (NIR) may increase nodal yield during gastrectomy. The purpose of this study was to evaluate the clinical benefit of NIR visualization on the quality of D2 lymphadenectomy during laparoscopic distal gastrectomy. METHODS This single-arm, open-label, Simon's two-stage, adaptive, phase 2 trial included patients who underwent laparoscopic distal gastrectomy for gastric adenocarcinoma. Endoscopic peritumoral injection of ICG was performed 24 ± 6 h before surgery. Intraoperatively, after standard D2 lymphadenectomy and specimen extraction, NIR was used for eventual completion lymphadenectomy. The primary endpoint was clinical benefit of NIR (i.e., at least one additional harvested station containing lymph nodes, with negative points for every harvested station with no lymph nodes at final pathology). RESULTS We enrolled 18 patients (61% female, median age 69 years). With NIR, an extra 23 stations were harvested: 9 contained no lymph nodes, 12 contained nonmetastatic lymph nodes, and 2 contained metastatic lymph nodes. The most commonly visualized station with NIR were station 6 (8 patients) and 1 (4 patients). The total number of harvested nodes per patient was 32 (interquartile range [IQR] 26-41), with a median of 1 (IQR 0-1) additional lymph node after NIR. Overall, seven (39%) patients had a clinical benefit from NIR, of which two (11%) had one metastatic lymph node harvested with NIR. CONCLUSIONS NIR visualization improves the quality of D2 lymphadenectomy in distal gastrectomy for gastric cancer. Considering the limited improve in the number of harvested lymph nodes, its real oncological benefit is still questionable.
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Affiliation(s)
- Carlo Sposito
- Upper GI Surgery and HPB Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
| | - Marianna Maspero
- Upper GI Surgery and HPB Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Valeria Conalbi
- Upper GI Surgery and HPB Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Andrea Magarotto
- Gastroenterology and Digestive Endoscopy, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Michele Altomare
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Carlo Battiston
- Upper GI Surgery and HPB Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Paolo Cantù
- Gastroenterology and Digestive Endoscopy, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Vincenzo Mazzaferro
- Upper GI Surgery and HPB Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Zacharakis G, Almasoud A, Arahmane O, Alzahrani J, Al-Ghamdi S. Epidemiology, Risk Factors for Gastric Cancer and Surveillance of Premalignant Gastric Lesions: A Prospective Cohort Study of Central Saudi Arabia. Curr Oncol 2023; 30:8338-8351. [PMID: 37754520 PMCID: PMC10528333 DOI: 10.3390/curroncol30090605] [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: 06/21/2023] [Revised: 08/08/2023] [Accepted: 09/08/2023] [Indexed: 09/28/2023] Open
Abstract
(1) Background: Saudi Arabia (SA) is a country with a low incidence of gastric cancer (GC). In this study, we sought to assess the epidemiology of GC, its clinicopathological profiles, and its association with risk factors as well as to identify premalignant gastric lesions (PGL) and examine neoplastic progression. (2) Methods: This five-year prospective study screened for GC and PGL in asymptomatic Saudi patients, aged 45-75 years (n = 35,640) and living in Al Kharj, Riyadh province in central SA. Those who were positive in a high-sensitivity guaiac fecal occult blood test (HSgFOBT+) and had negative results in colonoscopy offered to undergo upper GI endoscopy (n = 1242). Factors associated with GC were examined. (3) Results: The five-year participation rate was 87% (1080/1242). The incidence rate of GC was 26.9 new cases per 100,000 population per year (9.6 new cases per year/total population at risk-35,640), and it was 8.9 cases per 1000 persons per year among the 1080 subjects with HSgFOBT+ and negative colonoscopy results. The five-year mortality rate was 67% among patients with GC (n = 48), 3.0% among participants in the gastric screening program (n = 1080) and 0.09% among the original population participating in the colorectal screening program (n = 35,640). Intestinal-type adenocarcinoma was the most frequent type (77%), with the tumor most commonly located in the antrum (41%). Overall, 334 participants had PGL, and seven of them (2.1%) showed neoplastic progression to GC during the follow-up. Factors associated with GC were age, Helicobacter pylori (HP) infection, obesity (body mass index BMI > 30), smoking, a diet of salty preserved foods, low income and a family history of GC. (4) Conclusions: The incidence of GC is low in central SA, but screening for PGL and GC among patients with HSgFOBT+ and negative colonoscopy may prevent or result in the early treatment of GC. HP eradication, normal body weight, not smoking and adhering to a healthy diet can reduce the risk of GC. The resulting data provide important input for the improvement of national guidelines.
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Affiliation(s)
- Georgios Zacharakis
- Endoscopy Unit, Department of Internal Medicine, College of Medicine, Prince Sattam Bin, Abdulaziz University, PrinceSattam Bin Abdulaziz University Hospital, Al-Kharj 16278, Saudi Arabia
| | - Abdulaziz Almasoud
- Department of Gastroenterology, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia;
- Endoscopy Unit, Al-Kharj Military Hospital, Al-Kharj 11494, Saudi Arabia
| | - Omar Arahmane
- Endoscopy Unit, King Khaled Hospital and Prince Sultan Centre for Health Care, Al-Kharj 11942, Saudi Arabia;
| | - Jamaan Alzahrani
- Department of Family and Community Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia; (J.A.); (S.A.-G.)
| | - Sameer Al-Ghamdi
- Department of Family and Community Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia; (J.A.); (S.A.-G.)
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Yordanagil M, Ercan M, Senturk A, Elcin B. Prognostic significance of common hepatic artery lymph node metastasis in gastric cancer. Langenbecks Arch Surg 2023; 408:247. [PMID: 37365328 DOI: 10.1007/s00423-023-02996-0] [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: 04/25/2023] [Accepted: 06/21/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE The number of lymph nodes is used to determine the prognosis in patients with gastric cancer undergoing D2 lymph node dissection. However, a group of extraperigastric lymph nodes, including lymph node 8a, are also considered to be effective in prognosis. In our clinical experience, in most patients during D2 lymph node dissection, the lymph nodes are removed en-bloc with the specimen and are not marked separately. The aim was to analyze the importance and prognostic impact of 8a lymph node metastasis in patients with gastric cancer. METHODS Patients who underwent gastrectomy and D2 lymph node dissection for gastric cancer between 2015 and 2022 were included in the study. Patients were divided into two groups based on metastasis to the 8a lymph node: metastatic and nonmetastatic. The effect of clinicopathologic features and the prevalence of lymph node metastasis on the prognosis of the two groups were analyzed. RESULTS The present study included 78 patients. The mean number of dissected lymph nodes was 27 (IQR, 15-62). There were 22 (28.2%) patients in the 8a lymph node metastatic group. Patients with 8a lymph node metastatic disease had shorter overall survival and shorter disease-free survival. Those with metastatic 8a lymph nodes among pathologic N2/3 patients had shorter overall and disease-free survival rates (p < 0.05). CONCLUSION In conclusion, we believe that anterior common hepatic artery (8a) LN metastasis is a key factor that negatively affects both disease-free and overall survival in patients with locally advanced gastric cancer.
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Affiliation(s)
- Mevlut Yordanagil
- Department of Surgical Oncology, Sakarya University Training and Research Hospital, Sakarya, Turkey.
| | - Metin Ercan
- Department of Surgical Oncology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Adem Senturk
- Department of Surgical Oncology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Bilge Elcin
- Department of Pathology, Sakarya University Training and Research Hospital, Sakarya, Turkey
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30
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Kitti PM, Faltinova M, Kauppi J, Räsänen J, Saarto T, Seppälä T, Anttonen AM. Chemoradiation for oesophageal cancer: the choice of treatment modality. Radiat Oncol 2023; 18:93. [PMID: 37259100 DOI: 10.1186/s13014-023-02290-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/25/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Locally advanced oesophageal cancer can be treated with definitive chemoradiation (dCRT) or with neoadjuvant chemoradiation followed by surgery (nCRT + S), but treatment modality choice is not always clear. The aim of this study was to investigate the factors associated with the choice of treatment modality in locally advanced oesophageal cancer. METHODS This was a retrospective cohort study of 149 patients treated with dCRT(n = 85) or nCRT + S (n = 64) for oesophageal cancer in Helsinki University Hospital in 2008-2018. Logistic regression was used to analyse factors associated with choice of treatment modality and to compare dosimetric factors with postoperative complications. Multivariate analyses identified factors associated with survival. RESULTS Surgery was performed after chemoradiation as planned on 64/91 patients (70%). 28/64 had pathological complete response (44%). Probability of nCRT + S was higher in stages I-III versus IV (OR 3.62, 95% CI 1.53-8.53; P = .003), ECOG 0-1 versus 2 (OR 6.99, 95% CI 1.81-26.96; P = .005) or in the middle/lower vs upper oesophageal tumours (OR 5.61, 95% CI 1.83-17.16, P = .003). Probability for surgery was lower, if patient had lost > 10% of body weight (OR 0.46, 95% CI 0.21-0.98, P = 0.043). Patients in the nCRT + S group had significantly better median overall survival (mOS) and local control than the dCRT group (60 vs. 10 months, P < .001 and 53 vs. 6 months, P < 0.0001, respectively). 10/85 (12%) patients died within three months after dCRT. In multivariate analysis, nCRT + S was associated with improved mOS (HR 0.28, 95% CI 0.17-0.44, P < .001). Current smokers had worse mOS (HR 2.02, 95% CI 1.04-3.92, P = .037) compared to never-smokers. No significant dosimetric factor associated with postoperative complications was found. CONCLUSION The overall clinical status of the patients and the stage of the cancer guide the choice of treatment modalities, leading to overtreatment. Patients with better prognoses were more likely operated after chemoradiation, although there is no evidence of OS benefit in previous randomized trials. On the other hand, the prognosis was poor for patients with poor general health and advanced cancers, despite the chemoradiation. Thus, there are signs of overtreatment. MDT practice should be recommended to optimise the choice of treatment modalities. Smoking status is an independent factor associated with survival.
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Affiliation(s)
- Pauliina M Kitti
- Department of Oncology, HUS Comprehensive Cancer Centre and University of Helsinki, Paciuksenkatu 3, PL 180, 00029 HUS, Helsinki, Finland.
| | - Maria Faltinova
- Department of Oncology, HUS Comprehensive Cancer Centre and University of Helsinki, Paciuksenkatu 3, PL 180, 00029 HUS, Helsinki, Finland
| | - Juha Kauppi
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jari Räsänen
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tiina Saarto
- Department of Oncology, HUS Comprehensive Cancer Centre and University of Helsinki, Paciuksenkatu 3, PL 180, 00029 HUS, Helsinki, Finland
| | - Tiina Seppälä
- Department of Oncology, HUS Comprehensive Cancer Centre and University of Helsinki, Paciuksenkatu 3, PL 180, 00029 HUS, Helsinki, Finland
| | - Anu M Anttonen
- Department of Oncology, HUS Comprehensive Cancer Centre and University of Helsinki, Paciuksenkatu 3, PL 180, 00029 HUS, Helsinki, Finland
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Hemminki K, Försti A, Liska V, Kanerva A, Hemminki O, Hemminki A. Long-term survival trends in solid cancers in the Nordic countries marking timing of improvements. Int J Cancer 2023; 152:1837-1846. [PMID: 36571455 DOI: 10.1002/ijc.34416] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/12/2022] [Accepted: 12/19/2022] [Indexed: 12/27/2022]
Abstract
Survival studies are an important indicator of the success of cancer control. We analyzed the 5-year relative survival in 23 solid cancers in Denmark, Finland, Norway and Sweden over a 50-year period (1970-2019) at the NORDCAN database accessed from the International Agency for Research on Cancer website. We plotted survival curves in 5-year periods and showed 5-year periodic survival. The survival results were summarized in four groups: (1) cancers with historically good survival (>50% in 1970-1974) which include melanoma and breast, endometrial and thyroid cancers; (2) cancers which constantly improved survival at least 20% units over the 50 year period, including cancers of the stomach, colon, rectum, kidney, brain and ovary; (3) cancer with increase in survival >20% units with changes taking place in a narrow time window, including oral, oropharyngeal, testicular and prostate cancers; (4) the remaining cancers with <20% unit improvement in survival including lung, esophageal, liver, pancreatic, bladder, soft tissue, penile, cervical and vulvar cancers. For cancers in groups 1 and 2, the constant development implied multiple improvements in therapy, diagnosis and patient care. Cancers in group 3 included testicular cancers with known therapeutic improvements but for the others large incidence changes probably implied that cancer stage (prostate) or etiology (oropharynx) changed into a more tractable form. Group 4 cancers included those with dismal survival 50 years ago but a clear tendency upwards. In 17 cancers 5-year survival reached between 50% and 100% while in only six cancers it remained at below 50%.
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Affiliation(s)
- Kari Hemminki
- Biomedical Center and Faculty of Medicine, Pilsen, Charles University in Prague, Pilsen, Czech Republic.,Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Asta Försti
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Vaclav Liska
- Biomedical Center and Faculty of Medicine, Pilsen, Charles University in Prague, Pilsen, Czech Republic.,Department of Surgery, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Anna Kanerva
- Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland.,Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Otto Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland.,Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland.,Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
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Development of a Core Set of Self-Management Support Needs of Esophageal Cancer Patients: Results from a Delphi Study among Healthcare Professionals. Eur J Cancer Care (Engl) 2023. [DOI: 10.1155/2023/3164450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Objective. We aimed to gain consensus on HCPs’ perspectives on self-management support information needs of patients with esophageal cancer during the preoperative phase. Methods. Based on the literature, observations of clinical consultations, and hospital patient information leaflets, a survey was created. HCPs were surveyed twice about their opinion on importance of information, from “not essential” to “absolutely essential,” using Delphi methods. Topics were included in the second round if predetermined criteria were met. To be included in the final list, topics had to meet criteria for consensus and stability. Results. 64 information items and 6 sources of support were identified. Survey response rates were 59% (68 out of 116, first round) and 75% thereafter. The final list included 33 topics, including logistical information, expectations for future health condition, complications, follow-up care, nutrition during treatment, and nutrition during recovery as topics with 100% agreement. Consensus on the source of support was reached for face-to-face contact, written information, information video, and a case manager. Conclusion. This study provides a list of important topics, from the perspectives of HCPs, to guide the systematic provision of education to support EC patients’ self-management during the preoperative phase. Additionally, the most preferred sources of support were face-to-face contact and a case manager.
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Hemminki K, Tichanek F, Försti A, Hemminki O, Hemminki A. Survival in gastric and esophageal cancers in the Nordic countries through a half century. Cancer Med 2023; 12:10212-10221. [PMID: 36846972 DOI: 10.1002/cam4.5748] [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: 05/29/2022] [Revised: 01/08/2023] [Accepted: 02/16/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Gastric cancer (GC) and esophageal cancer (EC) are among the most fatal cancers and improving survival in them is a major clinical challenge. Nordic cancer data were recently released up to year 2019. These data are relevant for long-term survival analysis as they originate from high-quality national cancer registries from countries with practically free access to health care, thus documenting 'real-world' experience for entire populations. PATIENTS/METHODS Data were obtained for Danish (DK), Finnish (FI), Norwegian (NO), and Swedish (SE) patients from the NORDCAN database from years 1970 through 2019. Relative 1- and 5-year survival were analyzed, and additionally the difference between 1- and 5-year survival was calculated as a measure of trends between years 1 and 5 after diagnosis. RESULTS Relative 1-year survival for Nordic men and women in GC was 30% in period 1970-74 and it increased close to 60%. Early 5-year survival ranged between 10 and 15% and the last figures were over 30% for all women and NO men while survival for other men remain below 30%. Survival in EC was below that in GC, and it reached over 50% for 1-year survival only for NO patients; 5-year survival reached over 20% only for NO women. For both cancers, the difference between 1- and 5-year survival increased with time. Survival was worst among old patients. CONCLUSION GC and EC survival improved over the 50-year period but the increase in 5-year survival was entirely explained by gains in 1-year survival, which improved at an accelerated pace in EC. The likely reasons for improvements are changes in diagnosis, treatment, and care. The challenges are to push survival past year 1 with attention to old patients. These cancers have a potential for primary prevention through the avoidance of risk factors.
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Affiliation(s)
- Kari Hemminki
- Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czech Republic.,Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Filip Tichanek
- Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czech Republic.,Institute of Pathological Physiology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Asta Försti
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Otto Hemminki
- Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland.,Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
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Okada G, Matsumoto Y, Habu D, Matsuda Y, Lee S, Osugi H. Effects of body composition on early postoperative discharge and postoperative complications in patients with esophageal cancer. Nutr Clin Pract 2023. [PMID: 36811490 DOI: 10.1002/ncp.10968] [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: 11/09/2022] [Revised: 12/22/2022] [Accepted: 01/21/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Patients with esophageal cancer are prone to nutrition deterioration during the perioperative period and have a high incidence of postoperative complications, prolonging hospitalization. Decreased muscle mass is a known contributor to this deterioration, but there is insufficient evidence on the effects of preoperative maintenance and improvement of muscle mass. In this study, we evaluated the relationship between body composition, early postoperative discharge, and postoperative complications in patients with esophageal cancer. METHODS This was a retrospective cohort study. Patients were divided into an early discharge group and a control group, who were discharged ≤21 days postoperatively and >21 days, respectively. The relationship of body composition to postoperative complications and discharge time in patients was evaluated via multivariate logistic regression using isotemporal substitution (IS) models. RESULTS The early discharge group comprised 31 of the 117 patients (26%) included. This group had significantly lower incidences of sarcopenia and postoperative complications than the control group. In logistic regression analyses estimating the effect of changes in body composition using the IS models, preoperative replacement of 1 kg of body fat with 1 kg of muscle mass was associated with significantly higher odds of early discharge (odds ratio [OR], 1.28; 95% CI, 1.03-1.59) and lower odds of postoperative complications (OR, 0.81; 95% CI, 0.66-0.98). CONCLUSION In patients with esophageal cancer, a preoperative increase in muscle mass may reduce postoperative complications and hospital stay duration.
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Affiliation(s)
- Genya Okada
- Department of Health Sciences, Prefectural University of Hiroshima, Minami-ku, Hiroshima, Japan
| | - Yoshinari Matsumoto
- Department of Nutrition, Graduate School of Human Life and Ecology, Osaka Metropolitan University, Habikino-shi, Osaka, Japan
| | - Daiki Habu
- Department of Nutritional Medicine, Graduate School of Human Life and Ecology, Osaka Metropolitan University, Sumiyoshi-ku, Osaka, Japan
| | - Yasunori Matsuda
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka Metropolitan University, Abeno-ku, Osaka, Japan.,Department of Surgery, Osaka Saiseikai Nakatsu Hospital, Kita-ku, Japan
| | - Shigeru Lee
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka Metropolitan University, Abeno-ku, Osaka, Japan
| | - Harushi Osugi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka Metropolitan University, Abeno-ku, Osaka, Japan.,Institute of Gastroenterology, Tokyo Women's Medical University, Sinjuku-ku, Tokyo, Japan
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Kayikcioglu E, Yüceer RO, Cetin B, Yüceer K, Karahan N. Prognostic value of claudin 18.2 expression in gastric adenocarcinoma. World J Gastrointest Oncol 2023; 15:343-351. [PMID: 36908327 PMCID: PMC9994048 DOI: 10.4251/wjgo.v15.i2.343] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/02/2023] [Accepted: 01/23/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Claudin 18.2 (CLDN18.2) is a cell surface protein expressed by gastric cancer cells. The monoclonal antibody zolbetuximab binds CLDN18.2-positive cancer cells and causes cancer cell death. A few studies researched the prognostic effect of CLDN18.2 expression in metastatic gastric adenocarcinoma.
AIM To identify the prognostic value of CLDN18.2 expression in patients with metastatic gastric adenocarcinoma.
METHODS This study was conducted with 65 patients over the age of 18 who were diagnosed with metastatic gastric adenocarcinoma. We investigated the effect of CLDN18.2 expression on clinicopathological characteristics (age, sex, histological grade, Lauren classification, family history, metastatic site, HER2 expression) and prognosis for patients with metastatic gastric adenocarcinoma.
RESULTS CLDN18.2 expression was positive in 73.8% (48) of the patients. During the median 17.7-mo follow-up period, 89.2% (58) of the patients died. Median progression-free survival and overall survival (OS) were 6 mo (95% confidence interval: 1.6-10.4) and 12 mo (95% confidence interval: 7.5-16.5). There was no statistically significant correlation between CLDN18.2 expression and clinicopathological characteristics of the patients. In univariate and multivariate Cox regression analysis, there was no correlation between clinicopathological characteristics of patients and progression-free survival or OS.
CONCLUSION CLDN18.2 expression was quite high in patients with gastric adenocarcinoma, identifying the proportion of the patients in whom zolbetuximab would be efficacious. There is no statistically significant correlation with clinicopathological characteristics and OS. CLDN18.2 is not a prognostic marker in patients with gastric adenocarcinoma, although it is predictive.
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Affiliation(s)
- Erkan Kayikcioglu
- Department of Medical Oncology, Suleyman Demirel University, Isparta 32260, Turkey
| | | | - Bulent Cetin
- Department of Internal Medicine, Suleyman Demirel University, Faculty of Medicine, Isparta 32360, Turkey
| | - Kamuran Yüceer
- Department of Internal Medicine, Suleyman Demirel University, Faculty of Medicine, Isparta 32360, Turkey
| | - Nermin Karahan
- Department of Pathology, Suleyman Demirel University, Isparta 32360, Turkey
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The Concept of Strength Through Synergy Applied to the Search of Powerful Prognostic Biomarkers in Gastroesophageal Cancer: An Example Based on Combining Clinicopathological Parameters, Imaging-Derived Sarcopenia Measurements, and Radiomic Features. Clin Nucl Med 2023; 48:156-157. [PMID: 35961366 DOI: 10.1097/rlu.0000000000004357] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
ABSTRACT Integrating clinical and pathological data together with imaging-derived information, such as radiomics and sarcopenia status, creating new combined biomarkers that increase the prognostic value compared with each of them used independently. The concept of strength through synergy, applicable in so many areas of life, is also demonstrated in this area of science and opens up innumerable pathways for improving patient care in cancer. This is as an example on how we can explore and make the most of all the information we already have (clinical, pathological, imaging), without the need for new invasive tests.
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Briggs E, de Kamps M, Hamilton W, Johnson O, McInerney CD, Neal RD. Machine Learning for Risk Prediction of Oesophago-Gastric Cancer in Primary Care: Comparison with Existing Risk-Assessment Tools. Cancers (Basel) 2022; 14:cancers14205023. [PMID: 36291807 PMCID: PMC9600097 DOI: 10.3390/cancers14205023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Oesophago-gastric cancer is one of the commonest cancers worldwide, yet it can be particularly difficult to diagnose given that initial symptoms are often non-specific and routine screening is not available. Cancer risk-assessment tools, which calculate cancer risk based on symptoms and other risk factors present in the primary care record, can aid decisions on referrals for cancer investigations, facilitating earlier diagnosis. Diagnosing common cancers earlier could help improve survival rates. Using UK primary care electronic health record data, we compared five different machine learning techniques for probabilistic classification of cancer patients against a current widely used UK primary care cancer risk-assessment tool. The machine learning algorithms outperformed the current risk-assessment tool, with a higher overall accuracy and an ability to reasonably identify 11–25% more cancer patients. We conclude that machine-learning-based risk-assessment tools could help better identify suitable patients for further investigation and support earlier diagnosis. Abstract Oesophago-gastric cancer is difficult to diagnose in the early stages given its typical non-specific initial manifestation. We hypothesise that machine learning can improve upon the diagnostic performance of current primary care risk-assessment tools by using advanced analytical techniques to exploit the wealth of evidence available in the electronic health record. We used a primary care electronic health record dataset derived from the UK General Practice Research Database (7471 cases; 32,877 controls) and developed five probabilistic machine learning classifiers: Support Vector Machine, Random Forest, Logistic Regression, Naïve Bayes, and Extreme Gradient Boosted Decision Trees. Features included basic demographics, symptoms, and lab test results. The Logistic Regression, Support Vector Machine, and Extreme Gradient Boosted Decision Tree models achieved the highest performance in terms of accuracy and AUROC (0.89 accuracy, 0.87 AUROC), outperforming a current UK oesophago-gastric cancer risk-assessment tool (ogRAT). Machine learning also identified more cancer patients than the ogRAT: 11.0% more with little to no effect on false positives, or up to 25.0% more with a slight increase in false positives (for Logistic Regression, results threshold-dependent). Feature contribution estimates and individual prediction explanations indicated clinical relevance. We conclude that machine learning could improve primary care cancer risk-assessment tools, potentially helping clinicians to identify additional cancer cases earlier. This could, in turn, improve survival outcomes.
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Affiliation(s)
- Emma Briggs
- School of Computing, University of Leeds, Leeds LS2 9JT, UK
- Correspondence:
| | - Marc de Kamps
- School of Computing, University of Leeds, Leeds LS2 9JT, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds LS2 9NL, UK
- The Alan Turing Institute, London NW1 2DB, UK
| | - Willie Hamilton
- Department of Health and Community Sciences, University of Exeter, Exeter EX1 2LU, UK
| | - Owen Johnson
- School of Computing, University of Leeds, Leeds LS2 9JT, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds LS2 9NL, UK
| | - Ciarán D. McInerney
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield S10 2TN, UK
| | - Richard D. Neal
- Department of Health and Community Sciences, University of Exeter, Exeter EX1 2LU, UK
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Lordick F, Carneiro F, Cascinu S, Fleitas T, Haustermans K, Piessen G, Vogel A, Smyth EC. Gastric cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2022; 33:1005-1020. [PMID: 35914639 DOI: 10.1016/j.annonc.2022.07.004] [Citation(s) in RCA: 618] [Impact Index Per Article: 206.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- F Lordick
- Department of Medicine II (Oncology, Gastroenterology, Hepatology, Pulmonology and Infectious Diseases), University Cancer Center Leipzig (UCCL), University Medical Center, Leipzig, Germany
| | - F Carneiro
- Department of Pathology, Centro Hospitalar Universitário de São João (CHUSJ), Porto; Faculty of Medicine, University of Porto (FMUP), Porto; Instituto de Investigação e Inovação em Saúde (i3S)/Institute of Molecular Pathology and Immunology, University of Porto (Ipatimup), Porto, Portugal
| | - S Cascinu
- Department of Medical Oncology, Comprehensive Cancer Center, Università Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - T Fleitas
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - K Haustermans
- Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - G Piessen
- University of Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, Lille;; CNRS, UMR9020, Lille; Inserm, U1277, Lille; CHU Lille, Department of Digestive and Oncological Surgery, Lille, France
| | - A Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - E C Smyth
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Anconina R, Ortega C, Metser U, Liu ZA, Elimova E, Allen M, Darling GE, Wong R, Taylor K, Yeung J, Chen EX, Swallow CJ, Jang RW, Veit-Haibach P. Combined 18 F-FDG PET/CT Radiomics and Sarcopenia Score in Predicting Relapse-Free Survival and Overall Survival in Patients With Esophagogastric Cancer. Clin Nucl Med 2022; 47:684-691. [PMID: 35543637 DOI: 10.1097/rlu.0000000000004253] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study was to determine if radiomic features combined with sarcopenia measurements on pretreatment 18 F-FDG PET/CT can improve outcome prediction in surgically treated adenocarcinoma esophagogastric cancer patients. PATIENTS AND METHODS One hundred forty-five esophageal adenocarcinoma patients with curative therapeutic intent and available pretreatment 18 F-FDG PET/CT were included. Textural features from PET and CT images were evaluated using LIFEx software ( lifexsoft.org ). Sarcopenia measurements were done by measuring the Skeletal Muscle Index at L3 level on the CT component. Univariable and multivariable analyses were conducted to create a model including the radiomic parameters, clinical features, and Skeletal Muscle Index score to predict patients' outcome. RESULTS In multivariable analysis, we combined clinicopathological parameters including ECOG, surgical T, and N staging along with imaging derived sarcopenia measurements and radiomic features to build a predictor model for relapse-free survival and overall survival. Overall, adding sarcopenic status to the model with clinical features only (likelihood ratio test P = 0.03) and CT feature ( P = 0.0037) improved the model fit for overall survival. Similarly, adding sarcopenic status ( P = 0.051), CT feature ( P = 0.042), and PET feature ( P = 0.011) improved the model fit for relapse-free survival. CONCLUSIONS PET and CT radiomics derived from combined PET/CT integrated with clinicopathological parameters and sarcopenia measurement might improve outcome prediction in patients with nonmetastatic esophagogastric adenocarcinoma.
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Affiliation(s)
- Reut Anconina
- From the Department of Medical Imaging, Sunnybrook Health Sciences Centre
| | - Claudia Ortega
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network
| | - Ur Metser
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network
| | | | - Elena Elimova
- Medical Oncology, Princess Margaret Cancer Centre, University Health Network
| | - Michael Allen
- Medical Oncology, Princess Margaret Cancer Centre, University Health Network
| | - Gail E Darling
- Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University Health Network
| | | | - Kirsty Taylor
- Medical Oncology, Princess Margaret Cancer Centre, University Health Network
| | - Jonathan Yeung
- Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University Health Network
| | - Eric X Chen
- Medical Oncology, Princess Margaret Cancer Centre, University Health Network
| | - Carol J Swallow
- Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Raymond W Jang
- Medical Oncology, Princess Margaret Cancer Centre, University Health Network
| | - Patrick Veit-Haibach
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network
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Brennan L, Sadeghi F, O’Neill L, Guinan E, Smyth L, Sheill G, Smyth E, Doyle SL, Timon CM, Connolly D, O’Sullivan J, Reynolds JV, Hussey J. Telehealth Delivery of a Multi-Disciplinary Rehabilitation Programme for Upper Gastro-Intestinal Cancer: ReStOre@Home Feasibility Study. Cancers (Basel) 2022; 14:2707. [PMID: 35681687 PMCID: PMC9179413 DOI: 10.3390/cancers14112707] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Telehealth has enabled access to rehabilitation throughout the pandemic. We assessed the feasibility of delivering a multi-disciplinary, multi-component rehabilitation programme (ReStOre@Home) to cancer survivors via telehealth. METHODS This single-arm mixed methods feasibility study recruited participants who had completed curative treatment for oesophago-gastric cancer for a 12-week telehealth rehabilitation programme, involving group resistance training, remotely monitored aerobic training, one-to-one dietetic counselling, one-to-one support calls and group education. The primary outcome was feasibility, measured by recruitment rates, attendance, retention, incidents, acceptability, Telehealth Usability Questionnaire (TUQ) and analysis of semi-structured interviews. RESULTS Characteristics of the twelve participants were: 65.42 ± 7.24 years; 11 male; 10.8 ± 3.9 months post-op; BMI 25.61 ± 4.37; received neoadjuvant chemotherapy 7/12; received adjuvant chemotherapy 4/12; hospital length of stay 16 days (median). Recruitment rate was 32.4%, and retention rate was 75%. Mean attendance was: education 90%; dietetics 90%; support calls 84%; resistance training 78%. Mean TUQ score was 4.69/5. Adaptations to the planned resistance training programme were required. Participants reported that ReStOre@Home enhanced physical and psychological wellbeing, and online delivery was convenient. Some reported a preference for in-person contact but felt that the online group sessions provided adequate peer support. CONCLUSION Telehealth delivery of ReStOre@Home was most feasible in individuals with moderate to high levels of digital skills. Low level of digitals skills was a barrier to recruitment and retention. Participants reported high levels of programme adherence and participant satisfaction. Adaptations to future programmes, including introducing elements of in-person contact, are required.
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Affiliation(s)
- Louise Brennan
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland; (F.S.); (L.O.); (L.S.); (E.S.); (J.H.)
- Trinity St. James’s Cancer Institute, D08 NHY1 Dublin, Ireland; (E.G.); (G.S.); (D.C.); (J.O.); (J.V.R.)
| | - Fatemeh Sadeghi
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland; (F.S.); (L.O.); (L.S.); (E.S.); (J.H.)
- Trinity St. James’s Cancer Institute, D08 NHY1 Dublin, Ireland; (E.G.); (G.S.); (D.C.); (J.O.); (J.V.R.)
| | - Linda O’Neill
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland; (F.S.); (L.O.); (L.S.); (E.S.); (J.H.)
- Trinity St. James’s Cancer Institute, D08 NHY1 Dublin, Ireland; (E.G.); (G.S.); (D.C.); (J.O.); (J.V.R.)
| | - Emer Guinan
- Trinity St. James’s Cancer Institute, D08 NHY1 Dublin, Ireland; (E.G.); (G.S.); (D.C.); (J.O.); (J.V.R.)
- School of Medicine, Trinity College, D08 W9RT Dublin, Ireland
| | - Laura Smyth
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland; (F.S.); (L.O.); (L.S.); (E.S.); (J.H.)
- Trinity St. James’s Cancer Institute, D08 NHY1 Dublin, Ireland; (E.G.); (G.S.); (D.C.); (J.O.); (J.V.R.)
| | - Grainne Sheill
- Trinity St. James’s Cancer Institute, D08 NHY1 Dublin, Ireland; (E.G.); (G.S.); (D.C.); (J.O.); (J.V.R.)
- Physiotherapy Department, St. James Hospital, D08 NHY1 Dublin, Ireland
| | - Emily Smyth
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland; (F.S.); (L.O.); (L.S.); (E.S.); (J.H.)
- Trinity St. James’s Cancer Institute, D08 NHY1 Dublin, Ireland; (E.G.); (G.S.); (D.C.); (J.O.); (J.V.R.)
| | - Suzanne L. Doyle
- School of Biological and Health Sciences, Technological University Dublin, D07 ADY7 Dublin, Ireland;
| | - Claire M. Timon
- Centre for eIntegrated Care, School of Nursing, Psychotherapy and Community Health, Dublin City University, D09 X984 Dublin, Ireland;
| | - Deirdre Connolly
- Trinity St. James’s Cancer Institute, D08 NHY1 Dublin, Ireland; (E.G.); (G.S.); (D.C.); (J.O.); (J.V.R.)
- Discipline of Occupational Therapy, Trinity College, D08 W9RT Dublin, Ireland
| | - Jacintha O’Sullivan
- Trinity St. James’s Cancer Institute, D08 NHY1 Dublin, Ireland; (E.G.); (G.S.); (D.C.); (J.O.); (J.V.R.)
- Department of Surgery, Trinity Translational Medicine Institute, Trinity College Dublin, St James’s Hospital Dublin, D08 W9RT Dublin, Ireland
| | - John V. Reynolds
- Trinity St. James’s Cancer Institute, D08 NHY1 Dublin, Ireland; (E.G.); (G.S.); (D.C.); (J.O.); (J.V.R.)
- Department of Surgery, Trinity Translational Medicine Institute, Trinity College Dublin, St James’s Hospital Dublin, D08 W9RT Dublin, Ireland
| | - Juliette Hussey
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland; (F.S.); (L.O.); (L.S.); (E.S.); (J.H.)
- Trinity St. James’s Cancer Institute, D08 NHY1 Dublin, Ireland; (E.G.); (G.S.); (D.C.); (J.O.); (J.V.R.)
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Delgado Bolton RC, Calapaquí Terán AK, Fanti S, Giammarile F. New Biomarkers With Prognostic Impact Based on Multitracer PET/CT Imaging in Neuroendocrine Neoplasms: The Light Leading Out of the Darkness in Challenging Tumors. Clin Nucl Med 2022; 47:219-220. [PMID: 35067540 DOI: 10.1097/rlu.0000000000004062] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The search for new biomarkers in cancer is currently one of the most widely sought end points in medical imaging, with the aim of improving the management decisions based on reliable indicators of prognosis, being neuroendocrine neoplasms a challenging group of tumors under investigation. Multitracer PET/CT imaging, in which different radiotracers supply information of different metabolic aspects of the tumor, can help classify and select the most appropriate therapy, providing basic aspects that will probably allow the generation of new imaging biomarkers useful in patient management.
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Affiliation(s)
- Roberto C Delgado Bolton
- From the Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja
| | | | - Stefano Fanti
- Nuclear Medicine Unit, University Hospital, Policlinico S. Orsola-Malpighi, Bologna, Italy
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Mazzei MA, Bagnacci G, Gentili F, Capitoni I, Mura G, Marrelli D, Petrioli R, Brunese L, Cappabianca S, Catarci M, Degiuli M, De Manzoni G, De Prizio M, Donini A, Romario UF, Funicelli L, Laghi A, Minetti G, Morgagni P, Petrella E, Pittiani F, Rausei S, Romanini L, Rosati R, Ianora AAS, Tiberio GAM, Volterrani L, Roviello F, Grassi R. Structured and shared CT radiological report of gastric cancer: a consensus proposal by the Italian Research Group for Gastric Cancer (GIRCG) and the Italian Society of Medical and Interventional Radiology (SIRM). Eur Radiol 2022; 32:938-949. [PMID: 34383148 PMCID: PMC8359760 DOI: 10.1007/s00330-021-08205-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/15/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Written radiological report remains the most important means of communication between radiologist and referring medical/surgical doctor, even though CT reports are frequently just descriptive, unclear, and unstructured. The Italian Society of Medical and Interventional Radiology (SIRM) and the Italian Research Group for Gastric Cancer (GIRCG) promoted a critical shared discussion between 10 skilled radiologists and 10 surgical oncologists, by means of multi-round consensus-building Delphi survey, to develop a structured reporting template for CT of GC patients. METHODS Twenty-four items were organized according to the broad categories of a structured report as suggested by the European Society of Radiology (clinical referral, technique, findings, conclusion, and advice) and grouped into three "CT report sections" depending on the diagnostic phase of the radiological assessment for the oncologic patient (staging, restaging, and follow-up). RESULTS In the final round, 23 out of 24 items obtained agreement ( ≥ 8) and consensus ( ≤ 2) and 19 out 24 items obtained a good stability (p > 0.05). CONCLUSIONS The structured report obtained, shared by surgical and medical oncologists and radiologists, allows an appropriate, clearer, and focused CT report essential to high-quality patient care in GC, avoiding the exclusion of key radiological information useful for multidisciplinary decision-making. KEY POINTS • Imaging represents the cornerstone for tailored treatment in GC patients. • CT-structured radiology report in GC patients is useful for multidisciplinary decision making.
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Affiliation(s)
- Maria Antonietta Mazzei
- Department of Medical, Surgical and Neuro Sciences, University of Siena and Department of Radiological Sciences, Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy
- SIRM, Italian College of Computed Tomography, Italian Society of Medical and Interventional Radiology, Milan, Italy
| | - Giulio Bagnacci
- Department of Medical, Surgical and Neuro Sciences, University of Siena and Department of Radiological Sciences, Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy
- SIRM, Italian College of Computed Tomography, Italian Society of Medical and Interventional Radiology, Milan, Italy
| | - Francesco Gentili
- SIRM, Italian College of Computed Tomography, Italian Society of Medical and Interventional Radiology, Milan, Italy.
- Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
| | - Iacopo Capitoni
- Department of Medical, Surgical and Neuro Sciences, University of Siena and Department of Radiological Sciences, Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Gianni Mura
- Department of Surgery, Division of General Surgery, Arezzo Hospital, Arezzo, Italy
| | - Daniele Marrelli
- Department of Medicine, Surgery and Neuroscience, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Roberto Petrioli
- Department of Oncology, Unit of Medical Oncology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Luca Brunese
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
- SIRM, Italian College of Oncology, Italian Society of Medical and Interventional Radiology, Milan, Italy
| | - Salvatore Cappabianca
- SIRM, Italian College of Oncology, Italian Society of Medical and Interventional Radiology, Milan, Italy
- Division of Radiology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Marco Catarci
- FACS; UOC Chirurgia Generale; Ospedale Sandro Pertini - ASL Roma 2, Roma, Italy
| | - Maurizio Degiuli
- Surgical Oncology and Digestive Surgery Unit, Department of Oncology, University of Turin; San Luigi University Hospital, Orbassano, Italy
| | | | - Marco De Prizio
- Department of Surgery, Division of General Surgery, Arezzo Hospital, Arezzo, Italy
| | - Annibale Donini
- Department of Surgery and Biomedical Sciences, University of Perugia, Perugia, Italy
| | | | - Luigi Funicelli
- SIRM, Italian College of Computed Tomography, Italian Society of Medical and Interventional Radiology, Milan, Italy
- SIRM, Italian College of Oncology, Italian Society of Medical and Interventional Radiology, Milan, Italy
- Digestive Surgery, IEO European Institute of Oncology - IRCCS, Milan, Italy
| | - Andrea Laghi
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
- SIRM, Italian College of Gastroenterology, Italian Society of Medical and Interventional Radiology, Milan, Italy
| | - Giuseppe Minetti
- SIRM, Italian College of Computed Tomography, Italian Society of Medical and Interventional Radiology, Milan, Italy
- Radiology Department, Ospedale Policlinico San Martino, IRCCS per L'Oncologia e le Neuroscienze, Genoa, Italy
| | - Paolo Morgagni
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Enrico Petrella
- Radiology Unit, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Frida Pittiani
- SIRM, Italian College of Computed Tomography, Italian Society of Medical and Interventional Radiology, Milan, Italy
- Department of Radiology, ASST Spedali Civili Brescia, Brescia, Italy
| | - Stefano Rausei
- Department of Surgery, ASST Valle Olona, Gallarate, Varese, Italy
| | | | - Riccardo Rosati
- Endocrine Unit, Department of Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Amato Antonio Stabile Ianora
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari, Bari, Italy
| | - Guido A M Tiberio
- Surgical Unit, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Luca Volterrani
- Department of Medical, Surgical and Neuro Sciences, University of Siena and Department of Radiological Sciences, Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy
- SIRM, Italian College of Oncology, Italian Society of Medical and Interventional Radiology, Milan, Italy
| | - Franco Roviello
- Department of Medicine, Surgery and Neuroscience, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Roberto Grassi
- Division of Radiology, University of Campania Luigi Vanvitelli, Naples, Italy
- SIRM Foundation, Italian Society of Medical and Interventional Radiology, Milan, Italy
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Dal Cero M, Rodríguez-Santiago J, Miró M, Castro S, Miranda C, Santamaría M, Gobbini Y, Garsot E, Pujadas M, Luna A, Momblán D, Balagué C, Aldeano A, Olona C, Molinas J, Pulido L, Sánchez-Cano JJ, Güell M, Salazar D, Gimeno M, Grande L, Pera M. Evaluation of data quality in the Spanish EURECCA Esophagogastric Cancer Registry. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:3081-3087. [PMID: 33933340 DOI: 10.1016/j.ejso.2021.04.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/27/2021] [Accepted: 04/19/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although the number of nationwide clinical registries in upper gastrointestinal cancer is increasing, few of them perform regular clinical audits. The Spanish EURECCA Esophagogastric Cancer Registry (SEEGCR) was launched in 2013. The aim of this study was to assess the reliability of the data in terms of completeness and accuracy. METHODS Patients who were registered (2014-2017) in the online SEEGCR and underwent esophagectomy or gastrectomy with curative intent were selected for auditing. Independent teams of surgeons visited each center between July 2018 and December 2019 and checked the reliability of data entered into the registry. Completeness was established by comparing the cases reported in the registry with those provided by the Medical Documentation Service of each center. Twenty percent of randomly selected cases per hospital were checked during on-site visits for testing the accuracy of data (27 items per patient file). Correlation between the quality of the data and the hospital volume was also assessed. RESULTS Some 1839 patients from 19 centers were included in the registry. The mean completeness rate in the whole series was 97.8% (range 82.8-100%). For the accuracy, 462 (25.1%) cases were checked. Out of 12,312 items, 10,905 were available for verification, resulting in a perfect agreement of 95% (87.1-98.7%). There were 509 (4.7%) incorrect and 35 (0.3%) missing entries. No correlation between hospital volume and the rate of completeness and accuracy was observed. CONCLUSIONS Our results indicate that the SEEGCR contains reliable data.
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Affiliation(s)
- M Dal Cero
- Section of Gastrointestinal Surgery, Hospital del Mar, Universitat Autònoma de Barcelona, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - J Rodríguez-Santiago
- Service of Surgery, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain
| | - M Miró
- Service of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - S Castro
- Service of Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - C Miranda
- Service of Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - M Santamaría
- Service of Surgery, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Y Gobbini
- Service of Surgery, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - E Garsot
- Service of Surgery, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - M Pujadas
- Service of Surgery, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - A Luna
- Service of Surgery, Hospital Universitari Parc Taulí de Sabadell, Sabadell, Barcelona, Spain
| | - D Momblán
- Service of Gastrointestinal Surgery, Hospital Clinic, Barcelona, Spain
| | - C Balagué
- Service of Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A Aldeano
- Service of Surgery, Hospital General de Granollers, Granollers, Barcelona, Spain
| | - C Olona
- Service of Surgery, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - J Molinas
- Service of Surgery, Hospital Universitari de Vic, Vic, Barcelona, Spain
| | - L Pulido
- Service of Surgery, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - J J Sánchez-Cano
- Service of Surgery, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - M Güell
- Service of Surgery, Hospital de Sant Joan de Deu de Manresa, Manresa, Spain
| | - D Salazar
- Service of Surgery, Hospital Universitari de Igualada, Igualada, Spain
| | - M Gimeno
- Section of Gastrointestinal Surgery, Hospital del Mar, Universitat Autònoma de Barcelona, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - L Grande
- Section of Gastrointestinal Surgery, Hospital del Mar, Universitat Autònoma de Barcelona, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - M Pera
- Section of Gastrointestinal Surgery, Hospital del Mar, Universitat Autònoma de Barcelona, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
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Dal Cero M, Román M, Grande L, Yarnoz C, Estremiana F, Gantxegi A, Codony C, Gobbini Y, Garsot E, Momblan D, González-Duaigües M, Luna A, Pérez N, Aldeano A, Fernández S, Olona C, Hermoso J, Pulido L, Sánchez-Cano JJ, Güell M, Salazar D, Gimeno M, Pera M. Textbook outcome and survival after gastric cancer resection with curative intent: A population-based analysis. Eur J Surg Oncol 2021; 48:768-775. [PMID: 34753620 DOI: 10.1016/j.ejso.2021.10.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/20/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND The concept of textbook outcome (TO) has been proposed for analyzing quality of surgical care. This study assessed the incidence of TO among patients undergoing curative gastric cancer resection, predictors for TO achievement, and the association of TO with survival. METHOD All patients with gastric and gastroesophageal junction cancers undergoing curative gastrectomy between January 2014-December 2017 were identified from a population-based database (Spanish EURECCA Registry). TO included: macroscopically complete resection at the time of operation, R0 resection, ≥15 lymph nodes removed and examined, no serious postoperative complications (Clavien-Dindo ≥II), no re-intervention, hospital stay ≤14 days, no 30-day readmissions and no 90-day mortality. Logistic regression was used to assess the adjusted achievement of TO. Cox survival regression was used to compare conditional adjusted survival across groups. RESULTS In total, 1293 patients were included, and TO was achieved in 541 patients (41.1%). Among the criteria, "macroscopically complete resection" had the highest compliance (96.5%) while "no serious complications" had the lowest compliance (63.7%). Age (OR 0.53 for the 65-74 years and OR 0.34 for the ≥75 years age group), Charlson comorbidity index ≥3 (OR 0.53, 95%CI 0.34-0.82), neoadjuvant chemoradiotherapy (OR 0.24, 95%CI 0.08-0.70), multivisceral resection (OR 0.55, 95%CI 0.33-0.91), and surgery performed in a community hospital (OR 0.65, CI95% 0.46-0.91) were independently associated with not achieving TO. TO was independently associated with conditional survival (HR 0.67, 95%CI 0.55-0.83). CONCLUSION TO was achieved in 41.1% of patients who underwent gastric cancer resection with curative intent and was associated with longer survival.
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Affiliation(s)
- Mariagiulia Dal Cero
- Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Hospital del Mar Medical Research Institute (IMIM). Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Román
- Department of Epidemiology and Evaluation, Hospital Universitario del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Luis Grande
- Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Hospital del Mar Medical Research Institute (IMIM). Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Concepción Yarnoz
- Department of Surgery, Hospital Universitario de Navarra, Pamplona, Spain
| | - Fernando Estremiana
- Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Amaia Gantxegi
- Department of Surgery, Hospital Vall d'Hebron, Barcelona, Spain
| | - Clara Codony
- Department of Surgery, Hospital Universitari Josep Trueta, Girona, Spain
| | - Yanina Gobbini
- Department of Surgery, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Elisenda Garsot
- Department of Surgery, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Dulce Momblan
- Department of Surgery, Hospital Clinic, Barcelona, Spain
| | | | - Alexis Luna
- Department of Surgery, Hospital Universitari Parc Taulí de Sabadell, Sabadell, Barcelona, Spain
| | - Noelia Pérez
- Department of Surgery, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain
| | - Aurora Aldeano
- Department of Surgery, Hospital General de Granollers, Granollers, Barcelona, Spain
| | | | - Carles Olona
- Department of Surgery, Hospital Universitari de Tarragona, Joan XXIII, Tarragona, Spain
| | - Judit Hermoso
- Department of Surgery, Hospital Universitari de Vic, Vic, Barcelona, Spain
| | - Laura Pulido
- Department of Surgery, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | | | - Mercè Güell
- Department of Surgery, Althaia Xarxa Assistencial i Universitária de Manresa, Manresa, Spain
| | - David Salazar
- Department of Surgery, Hospital Universitari de Igualada, Igualada, Barcelona, Spain
| | - Marta Gimeno
- Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Hospital del Mar Medical Research Institute (IMIM). Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Pera
- Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Hospital del Mar Medical Research Institute (IMIM). Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain.
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45
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Delgado Bolton RC, Calapaquí Terán AK, Pellet O, Ferrero A, Giammarile F. The Search for New 2-18F-FDG PET/CT Imaging Biomarkers in Advanced Ovarian Cancer Patients: Focus on Peritoneal Staging for Guiding Precision Medicine and Management Decisions. Clin Nucl Med 2021; 46:906-907. [PMID: 34238809 DOI: 10.1097/rlu.0000000000003784] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Roberto C Delgado Bolton
- From the Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja, Logroño, La Rioja
| | | | - Olivier Pellet
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Annamaria Ferrero
- Academic Division Gynaecology and Obstetrics, University of Torino, Mauriziano Hospital, Torino, Italy
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Lee KC, Sokas CM, Streid J, Senglaub SS, Coogan K, Walling AM, Cooper Z. Quality Indicators in Surgical Palliative Care: A Systematic Review. J Pain Symptom Manage 2021; 62:545-558. [PMID: 33524478 DOI: 10.1016/j.jpainsymman.2021.01.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/09/2021] [Accepted: 01/19/2021] [Indexed: 02/05/2023]
Abstract
CONTEXT Defining high quality palliative care in seriously ill surgical patients is essential to provide patient-centered surgical care. Quality indicators specifically for seriously ill surgical patients are necessary in order to integrate palliative care into existing surgical quality improvement programs. OBJECTIVES To identify existing quality indicators that measure palliative care delivery in seriously ill surgical patients, characterize their development, and assess their methodological quality. METHODS A PRISMA-guided systematic review included studies that reported on the development process and characteristics of palliative care quality indicators and guidelines in adult surgical patients. Relevant measures were categorized into the previously defined National Consensus Project domains of palliative care and the Donabedian quality framework, and assessed for methodological quality. RESULTS There were 263 unique measures identified from 26 studies, of which 70% were process measures. Indicators addressing Care of the Patient Near the End of Life (31.5%) and Physical Aspects of Care (20.8%) were the most common. Indicators addressing Spiritual (2.6%) and Cultural Aspects of Care (1.2%) were the least common. Methodological quality varied widely across studies. Although most studies defined a purpose for the indicators and used scientific evidence, many studies lacked input from target populations and few had discussed the practical application of indicators. CONCLUSION This review was a key step that informed efforts to develop quality indicators for seriously ill surgical patients. Few indicators addressed non-physical aspects of suffering and no indicators were identified addressing palliative surgery. Future attention is needed toward the development and practical application of palliative care quality indicators in surgical patients.
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Affiliation(s)
- Katherine C Lee
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Surgery, University of California, San Diego, California, USA
| | - Claire M Sokas
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jocelyn Streid
- Department of Anesthesiology and Perioperative Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Steven S Senglaub
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kathleen Coogan
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anne M Walling
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, California, USA; Greater Los Angeles Veterans Affairs Healthcare System, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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47
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Okada G, Matsumoto Y, Habu D, Matsuda Y, Lee S, Osugi H. Relationship between GLIM criteria and disease-specific symptoms and its impact on 5-year survival of esophageal cancer patients. Clin Nutr 2021; 40:5072-5078. [PMID: 34455266 DOI: 10.1016/j.clnu.2021.08.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/26/2021] [Accepted: 08/16/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND & AIMS Malnutrition is common in patients with esophageal cancer, which affects their prognosis. The global leadership initiative on malnutrition (GLIM) criteria was recently proposed as the world's first diagnostic criteria for malnutrition. However, the association between esophageal cancer patients and the GLIM criteria is unclear. The purpose of this study was to evaluate the percentage of patients diagnosed with malnutrition preoperatively using the GLIM criteria, assess the impact of disease-specific symptoms on the severity of malnutrition, and assess the prognostic relevance of GLIM defined malnutrition in patients with esophageal cancer. METHODS This was a retrospective single-center cohort study. Preoperative nutritional status of patients with esophageal cancer hospitalized between June 2009 and July 2011 was evaluated according to the GLIM criteria. Factors related to severe malnutrition as per the GLIM criteria were analyzed using multivariable logistic regression analysis. The association between the severity of malnutrition based on the GLIM criteria and 5-year survival was assessed using a multivariable Cox proportional hazard model. RESULTS Overall, 117 esophageal cancer patients were nutritionally assessed. The percentage of moderate malnutrition and severe malnutrition was 21% and 23%, respectively. Subjective dysphagia [odds ratio (OR): 7.39, 95% confidence interval (CI): 1.46-37.52] and subjective esophageal obstruction (OR: 10.49, 95% CI: 3.47-31.70) were independent risk factors for severe malnutrition. The hazard ratio (HR) for 5-year mortality tended to be higher for moderate malnutrition (HR: 2.12, 95% CI: 0.91-4.95); however, it was not significantly associated with either moderate malnutrition or severe malnutrition (HR: 1.30, 95% CI: 0.52-3.27). Cases that were censored during the follow-up period probably affected the survival results. CONCLUSION Subjective feelings of dysphagia and esophageal obstruction might be related to malnutrition severity in esophageal cancer patients. Malnutrition assessed by the GLIM criteria was not significantly associated with 5-year survival.
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Affiliation(s)
- Genya Okada
- Graduate School of Health Sciences, Prefectural University of Hiroshima, 1-1-71 Ujina-higashi, Minami-ku Hiroshima, 734-8558, Japan; Department of Nutritional Medicine, Graduate School of Human Life Science, Osaka City University, 3-3-138 Sugimoto-cho, Sumiyoshi-ku Osaka, 558-8585, Japan.
| | - Yoshinari Matsumoto
- Department of Nutritional Medicine, Graduate School of Human Life Science, Osaka City University, 3-3-138 Sugimoto-cho, Sumiyoshi-ku Osaka, 558-8585, Japan; Search Institute for Bone and Arthritis Disease (SINBAD), Shirahama Foundation for Health and Welfare, 1447 Shirahama-cho, Nishimuro-gun Wakayama, 649-2211, Japan.
| | - Daiki Habu
- Department of Nutritional Medicine, Graduate School of Human Life Science, Osaka City University, 3-3-138 Sugimoto-cho, Sumiyoshi-ku Osaka, 558-8585, Japan.
| | - Yasunori Matsuda
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku Osaka, 545-8585, Japan; Department of Surgery, Osaka Saiseikai Nakatsu Hospital, 2-10-39 Shibata, Kita-ku Osaka, 530-0012, Japan.
| | - Shigeru Lee
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku Osaka, 545-8585, Japan.
| | - Harushi Osugi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku Osaka, 545-8585, Japan; Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Sinjuku-ku Tokyo, 162-8666, Japan.
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Is Sarcopenic Obesity an Indicator of Poor Prognosis in Gastric Cancer Surgery? A Cohort Study in a Western Population. J Gastrointest Surg 2021; 25:1388-1403. [PMID: 32661833 DOI: 10.1007/s11605-020-04716-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 06/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The prognostic value of sarcopenic obesity in gastric cancer surgery remains debated. We aimed to evaluate the impact on outcomes of body composition and sarcopenic obesity after gastrectomy for gastric cancer. METHODS A retrospective review of prospectively maintained database of patients undergoing gastrectomy for gastric cancer from 2010 to 2017 was performed. Skeletal muscle mass and visceral adipose tissue were evaluated by preoperative computed tomography to define sarcopenia and obesity. Patients were classified in body composition groups according to the presence or absence of sarcopenia and obesity. Prognostic factors for survival were assessed by multivariate Cox analysis. RESULTS Of the 198 patients undergoing gastrectomy for gastric cancer, 90 (45.4%) patients were sarcopenic, 130 (67.7%) obese, and in the subclassification for body composition categories: 33 (17%) nonsarcopenic nonobesity, 75 (38%) non sarcopenic obesity, 35 (17%) sarcopenic nonobesity, and 55 (28%) sarcopenic obesity. No category of body composition was a predictor of postoperative complications and worse overall and disease-free survival outcomes. Multivariable analysis identified ASA III classification, preoperative weight loss > 10%, postoperative surgical re-intervention, and advanced tumor stage as independent prognostic factors for overall survival, and patients aged 75 years or older, preoperative weight loss > 10%, elevated netrophil-lymphocyte ratio, and advanced tumor stage as independent prognostic factors for disease-free survival. CONCLUSIONS Sarcopenia, obesity, and sarcopenic obesity were not associated with worse outcomes after gastric cancer surgery.
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Daniels SL, Lee MJ, Moug S, Wilson TR, Burton M, George J, Brown SR, Wyld L. Protocol for a multi-centre observational and mixed methods pilot study to identify factors predictive of poor functional recovery after major gastrointestinal surgery and strategies to enhance uptake of perioperative optimization: Optimizing the care and treatment pathways for older patients facing major gastrointestinal surgery (OCTAGON). Colorectal Dis 2021; 23:1552-1561. [PMID: 33638249 DOI: 10.1111/codi.15603] [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: 09/21/2020] [Revised: 01/21/2021] [Accepted: 02/21/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION National datasets report large variations in outcomes from older people (≥65 years) between different UK surgical units. This implies that not all patients receive the same level of care or access to resources, such as rehabilitation or allied health professional input. This might impact functional decline. AIMS Our aim is to evaluate the baseline status of older patients facing major gastrointestinal surgery and the impact of variation in perioperative assessment and provision of perioperative support on functional outcomes. Patients' experiences and views of assessment and optimization will be explored via integrated qualitative semi-structured interviews. METHODS AND ANALYSIS This multi-centre, pilot cohort study will include patients ≥65 years presenting via both elective and emergency pathways at three to five South Yorkshire NHS hospitals (Clinical Trials registration NCT04545125). The primary outcome is functional recovery measured using the World Health Organization Disability Assessment Schedule 2.0 at 6 weeks post-operation. Secondary outcomes include feasibility, quality of life, length of stay and complication rate. An opportunistic sample size of 120 has been estimated and will inform the design of a future, adequately powered study. For the qualitative study, 20-30 semi-structured patient interviews will be undertaken with patients from the cohort study to explore experiences of assessment and optimization. Interviews will be digitally recorded, transcribed verbatim and analysed according to the framework approach. ETHICS AND DISSEMINATION This study has been approved by the National Health Service Research Ethics Committee and is registered centrally with Health Research Authority. It has been adopted by the National Institute for Health Research Portfolio scheme. Dissemination will be via international and national surgical and geriatric conferences.
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Affiliation(s)
- Sarah L Daniels
- General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,University of Sheffield, Sheffield, UK
| | - Matthew J Lee
- General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,University of Sheffield, Sheffield, UK
| | - Susan Moug
- Royal Alexandra Hospital, NHS Greater Glasgow and the Clyde, Glasgow, UK.,University of Glasgow, Glasgow, UK
| | - Tim R Wilson
- University of Sheffield, Sheffield, UK.,Doncaster and Bassetlaw, NHS Foundation Trust, Doncaster, UK
| | | | - Jayan George
- General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Steven R Brown
- General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,University of Sheffield, Sheffield, UK
| | - Lynda Wyld
- University of Sheffield, Sheffield, UK.,Doncaster and Bassetlaw, NHS Foundation Trust, Doncaster, UK
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Lawler M, Oliver K, Gijssels S, Aapro M, Abolina A, Albreht T, Erdem S, Geissler J, Jassem J, Karjalainen S, La Vecchia C, Lievens Y, Meunier F, Morrissey M, Naredi P, Oberst S, Poortmans P, Price R, Sullivan R, Velikova G, Vrdoljak E, Wilking N, Yared W, Selby P. The European Code of Cancer Practice. J Cancer Policy 2021; 28:100282. [DOI: 10.1016/j.jcpo.2021.100282] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/19/2021] [Accepted: 03/31/2021] [Indexed: 12/11/2022]
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