Comparable long-term outcomes after endoscopic therapy and gastrectomy of early adenocarcinoma of esophagogastric junction: a population-based study.

BACKGROUND AND AIMS: Current guidelines recommend consideration of endoscopic therapy (ET) when treating selected early gastric cancers. However, clinical decision-making on ET versus gastrectomy for early adenocarcinoma of esophagogastric junction (AEGJ) remains challenging because of uncertain long-term outcomes. METHODS: We performed a retrospective cohort study using the Surveillance, Epidemiology, and End Results database from 2004 to 2017 of early AEGJ patients underwent ET or gastrectomy. Multivariate models were used to compare cancer-specific survival (CSS). RESULTS: Of 881 included early AEGJ patients, 227 (36.2%) patients underwent ET and 654 (63.8%) patients underwent gastrectomy. Early AEGJ patients who underwent ET experienced a similar hazard of cancer-specific death compared with those underwent gastrectomy in both multivariate Cox regression (HR [hazard ratio], 0.93; 95% CI [confidence interval], 0.55-1.56; P = 0.78) and the multivariate competing risk model (subdistribution HR [SHR], 0.86; 95% CI 0.50-1.45; P = 0.56). Propensity score matching was used, 210 patients underwent ET were matched with 210 patients underwent gastrectomy. Patients underwent ET experienced a similar hazard of cancer-specific death compared with those underwent gastrectomy in both multivariate Cox regression (HR, 0.97; 95% CI 0.53-1.77; P = 0.92) and the multivariate competing risk model (SHR, 0.96; 95% CI 0.52-1.77; P = 0.89). CONCLUSION: Early AEGJ patients who received ET or gastrectomy had comparable long-term outcomes, which lend support to the role of ET in the treatment of these patients.

Epidemiology, clinical presentation, treatment, and follow-up of chronic mercury poisoning in China: a retrospective analysis.

BACKGROUND: There are no reports on the incidence of chronic mercury poisoning in a large population in China. This study investigated the epidemiology, clinical manifestations, treatment, and follow-up of Chinese patients with chronic mercury poisoning. METHODS: Data for 288 mercury poisoning patients were collected at our hospital from July 2014 to September 2019, including sex, age, admission time, blood mercury content, urine mercury content, creatinine, urinary mercury/creatinine ratio, 24-h urinary protein levels, electromyography (EMG) findings, renal biopsy, and follow-up. Patient characteristics were evaluated by statistical and correlation analyses. RESULTS: First, mercury poisoning in China mainly occurred through occupational exposure and the inappropriate use of mercury-containing cosmetics and Chinese folk remedies (CFRs). Second, the most common symptoms were nervous system (50.3 %), kidney (16.4 %) and breathing (8.0 %). Mercury poisoning-induced Nephrotic syndrome (NS) and peripheral neuropathy are common long-term complications. The complications of occupational and cosmetics-induced mercury poisoning are consistent with international belief. However, the NS caused by CFRs is mainly membranous nephropathy and the probability of peripheral neuropathy caused by CFRs is higher than other pathogens. Third, follow-up data shows that 13 patients with EMG-confirmed neurological injury, 10 showed full recovery after 38.50 ± 8.03 months. Furthermore, among 18 patients with NS, 15 had normal urine protein and serum albumin levels after 22.67 ± 10.26 months. CONCLUSIONS: Regulation of skin-lightening cosmetic products, safety surveillance of CFRs, and prevention and control of occupational exposure must be improved to decrease the incidence of mercury poisoning in China.

Influence of Tumor Location on Lymph Node Metastasis and Survival for Early Gastric Cancer: a Population-Based Study.

BACKGROUND: The question that whether the criteria for endoscopic resection of early gastric non-cardia cancer (GNCC) is appropriate for early gastric cardia cancer (GCC) remains unclear. Thus, our aim was to evaluate the influence of tumor location on lymph node metastasis (LNM) and overall survival (OS) for early gastric cancer (GC). METHODS: A total of 5440 early GC patients in the Surveillance, Epidemiology, and End Results (SEER) database were identified. Multivariable analysis was performed to evaluate the influence of tumor location on LNM and OS for early GC. RESULTS: The rate of LNM was 17.48% for early GCC patients (232/1327) and 18.62% for early GNCC patients (766/4113). The early GCC patients experienced no significantly different risk of LNM compared with the early GNCC patients (adjusted OR 0.92, 95% CI 0.76-1.12, P = 0.405). The early GC patients were further stratified by node status. Tumor location was not a predictor of OS for node-negative early GC patients (adjusted HR 1.07, 95% CI 0.96-1.21, P = 0.225) but a predictor of OS for node-positive early GC patients (adjusted HR 1.80, 95% CI 1.48-2.20, P < 0.001). CONCLUSIONS: Tumor location was not a predictor of LNM for early GC patients. Moreover, tumor location was not a predictor of OS for node-negative early GC patients. Thus, the criteria for endoscopic resection of early GNCC might be appropriate for the treatment of early GCC.