Metabolomic machine learning predictor for diagnosis and prognosis of gastric cancer.

Gastric cancer (GC) represents a significant burden of cancer-related mortality worldwide, underscoring an urgent need for the development of early detection strategies and precise postoperative interventions. However, the identification of non-invasive biomarkers for early diagnosis and patient risk stratification remains underexplored. Here, we conduct a targeted metabolomics analysis of 702 plasma samples from multi-center participants to elucidate the GC metabolic reprogramming. Our machine learning analysis reveals a 10-metabolite GC diagnostic model, which is validated in an external test set with a sensitivity of 0.905, outperforming conventional methods leveraging cancer protein markers (sensitivity < 0.40). Additionally, our machine learning-derived prognostic model demonstrates superior performance to traditional models utilizing clinical parameters and effectively stratifies patients into different risk groups to guide precision interventions. Collectively, our findings reveal the metabolic landscape of GC and identify two distinct biomarker panels that enable early detection and prognosis prediction respectively, thus facilitating precision medicine in GC.

Total Lymph Node Yield Is Associated with Prolonged Survival after Neoadjuvant Chemotherapy in ypN0 Gastric Cancer Patients.

INTRODUCTION: Lymph node status after neoadjuvant chemotherapy (NAC) plays the main role in predicting the survival of gastric cancer (GC) patients who underwent curative gastrectomy after NAC. NAC can reduce the number of involved lymph nodes. However, it is unknown whether other variables are associated with the survival outcomes for ypN0 GC patients. It is unknown whether lymph node yield (LNY) has prognostic value in ypN0 GC patients treated with NAC plus surgery. METHODS: In this retrospective study, we reviewed the data of patients treated with NAC plus gastrectomy and identified those with ypN0 disease. The LNY cut-off was calculated using the X-tile program to determine the greatest actuarial survival difference. Patients were categorized into the downstaged N0 (cN+/ypN0) and natural N0 (cN0/ypN0) groups based on nodal status. Multivariate analysis was used to identify the prognostic factors and the association between LNY and prognosis. RESULTS: A total of 211 GC patients with ypN0 status were included. The optimal LNY cut-off was 23. Kaplan-Meier analysis revealed no significant difference in overall survival between the natural and downstaged N0 groups, while ypN0 GC patients with an LNY of ≥24 had significantly longer overall survival than those with an LNY of ≤23. Univariate analysis identified that LNY, cT stage, tumor location, ypT stage, perineural invasion, lymphovascular invasion, tumor size, Mandard tumor regression grade, and extent of gastrectomy were significantly associated with overall survival. Multivariate analysis confirmed that perineural invasion (hazard ratio, 4.246; p < 0.001), lymphovascular invasion (hazard ratio, 2.694; p = 0.048), and an LNY of ≥24 (hazard ratio, 0.394; p = 0.011) were independent prognostic factors. CONCLUSIONS: Patients with natural and downstaged ypN0 GC had similar overall survival after NAC. LNY was an independent prognostic factor in these patients, and an LNY of ≥24 predicted prolonged overall survival.

scRNA-seq of gastric tumor shows complex intercellular interaction with an alternative T cell exhaustion trajectory.

The tumor microenvironment (TME) in gastric cancer (GC) has been shown to be important for tumor control but the specific characteristics for GC are not fully appreciated. We generated an atlas of 166,533 cells from 10 GC patients with matched paratumor tissues and blood. Our results show tumor-associated stromal cells (TASCs) have upregulated activity of Wnt signaling and angiogenesis, and are negatively correlated with survival. Tumor-associated macrophages and LAMP3+ DCs are involved in mediating T cell activity and form intercellular interaction hubs with TASCs. Clonotype and trajectory analysis demonstrates that Tc17 (IL-17+CD8+ T cells) originate from tissue-resident memory T cells and can subsequently differentiate into exhausted T cells, suggesting an alternative pathway for T cell exhaustion. Our results indicate that IL17+ cells may promote tumor progression through IL17, IL22, and IL26 signaling, highlighting the possibility of targeting IL17+ cells and associated signaling pathways as a therapeutic strategy to treat GC.

Laparoscopic vs open total gastrectomy for advanced gastric cancer following neoadjuvant therapy: A propensity score matching analysis.

BACKGROUND: Laparoscopic total gastrectomy (LTG) has drawn increasing attention over the years. Although LTG has shown surgical benefits compared to open TG (OTG) in early stage gastric cancer (GC), little is known about the surgical and oncological outcomes of LTG for advanced GC following neoadjuvant therapy (NAT). AIM: To compare the long- and short-term outcomes of advanced GC patients who underwent LTG vs OTG following NAT. METHODS: Advanced GC patients who underwent TG following NAT between April 2011 and May 2018 at the Cancer Hospital of the Chinese Academy of Medical Sciences were enrolled and stratified into two groups: LTG and OTG. Propensity score matching analysis was performed at a 1:1 ratio to overcome possible bias. RESULTS: In total, 185 patients were enrolled (LTG: 78; OTG: 109). Of these, 138 were paired after propensity score matching. After adjustment for propensity score matching, baseline parameters were similar between the two groups. Compared to OTG, LTG was associated with a significantly shorter length of hospital stay (P = 0.012). The rates of R0 resection, lymph node harvest, and postoperative morbidity did not significantly differ between the two groups. Overall survival (OS) outcomes were comparable between the two groups. Pathological T and N stages were found to be independent risk factors for OS. CONCLUSION: LTG can be a feasible method for advanced GC patients following NAT, as it appears to be associated with better short- and comparable long-term outcomes compared to OTG.

Retrospective analysis of surgically treated pT4b gastric cancer with pancreatic head invasion.

BACKGROUND: For advanced gastric cancer patients with pancreatic head invasion, some studies have suggested that extended multiorgan resections (EMR) improves survival. However, other reports have shown high rates of morbidity and mortality after EMR. EMR for T4b gastric cancer remains controversial. AIM: To evaluate the surgical approach for pT4b gastric cancer with pancreatic head invasion. METHODS: A total of 144 consecutive patients with gastric cancer with pancreatic head invasion were surgically treated between 2006 and 2016 at the China National Cancer Center. Gastric cancer was confirmed in 76 patients by postoperative pathology and retrospectively analyzed. The patients were divided into the gastrectomy plus en bloc pancreaticoduodenectomy group (GP group) and gastrectomy alone group (GA group) by comparing the clinicopathological features, surgical outcomes, and prognostic factors of these patients. RESULTS: There were 24 patients (16.8%) in the GP group who had significantly larger lesions (P < 0.001), a higher incidence of advanced N stage (P = 0.030), and less neoadjuvant chemotherapy (P < 0.001) than the GA group had. Postoperative morbidity (33.3% vs 15.3%, P = 0.128) and mortality (4.2% vs 4.8%, P = 1.000) were not significantly different in the GP and GA groups. The overall 3-year survival rate of the patients in the GP group was significantly longer than that in the GA group (47.6%, median 30.3 mo vs 20.4%, median 22.8 mo, P = 0.010). Multivariate analysis identified neoadjuvant chemotherapy [hazard ratio (HR) 0.290, 95% confidence interval (CI): 0.103-0.821, P = 0.020], linitis plastic (HR 2.614, 95% CI: 1.024-6.675, P = 0.033), surgical margin (HR 0.274, 95% CI: 0.102-0.738, P = 0.010), N stage (HR 3.489, 95% CI: 1.334-9.120, P = 0.011), and postoperative chemoradiotherapy (HR 0.369, 95% CI: 0.163-0.836, P = 0.017) as independent predictors of survival in patients with pT4b gastric cancer and pancreatic head invasion. CONCLUSION: Curative resection of the invaded pancreas should be performed to improve survival in selected patients. Invasion of the pancreatic head is not a contraindication for surgery.

Modified Systemic Inflammation Score Is an Independent Predictor of Long-Term Outcome in Patients Undergoing Surgery for Adenocarcinoma of the Esophagogastric Junction.

Background: The modified systemic inflammation score (mSIS), which is calculated by a composite score of the lymphocyte-to-monocyte ratio and the albumin content in serum, is identified as the new score to predict the prognosis for various cancers. However, its significance for patients with adenocarcinoma of esophagogastric junction (AEJ), who receive surgery, remains unclear. Methods: This study retrospectively analyzed 317 patients with AEJ receiving surgery between September 2010 and December 2016. The associations between the mSIS and the clinicopathological features, overall survival (OS), as well as relapse-free survival (RFS), were assessed. In addition, the time-dependent receiver operating characteristic (t-ROC) curve analysis was performed for comparing the value of those scoring systems in predicting patient prognosis. Results: Of the 317 cases, 119 were rated as mSIS 0, 123 as mSIS 1, and 75 as mSIS 2. Besides, mSIS was significantly related to age and tumor size. On multivariate analysis, mSIS was identified as a predictor to independently predict OS (p < 0.001) along with RFS (p < 0.001), and a significantly strong correlation was observed at the advanced pTNM stages based on the mSIS system. In the subgroup analysis of adjuvant chemotherapy and surgery alone, mSIS was still the predictor for independently predicting patient OS (p < 0.001) together with RFS (p < 0.001) for the two groups. T-ROC analysis showed that mSIS was more accurate than controlling nutritional status score in predicting OS and RFS. Conclusions: The mSIS can serve as an easy, useful scoring system to independently predict the preoperative survival for AEJ cases undergoing surgery.

Feasibility of totally laparoscopic gastrectomy without prophylactic drains in gastric cancer patients.

BACKGROUND: Prophylactic drains have been used to remove intraperitoneal collections and detect complications early in open surgery. In the last decades, minimally invasive gastric cancer surgery has been performed worldwide. However, reports on routine prophylactic abdominal drainage after totally laparoscopic distal gastrectomy are few. AIM: To evaluate the feasibility performing totally laparoscopic distal gastrectomy without prophylactic drains in selected patients. METHODS: Data of patients with distal gastric cancer who underwent totally laparoscopic distal gastrectomy with and without prophylactic drainage at China National Cancer Center/Cancer Hospital from February 2018 to August 2019 were reviewed. The outcomes between patients with and without prophylactic drainage were compared. RESULTS: A total of 457 patients who underwent surgery for gastric cancer were identified. Of these, 125 patients who underwent totally laparoscopic distal gastrectomy were included. After propensity score matching, data of 42 pairs were extracted. The incidence of concurrent illness was higher in the drain group (42.9% vs 31.0%, P = 0.258). The overall postoperative complication rates were 19.5% and 10.6% in the drain (n = 76) and no-drain groups (n = 49), respectively; there were no significant differences between the two groups (P > 0.05). The difference between the two groups based on the need for percutaneous catheter drainage was also not significant (9.8% vs 6.4%, P = 0.700). However, patients with a larger body mass index (≥ 29 kg/m2) were prone to postoperative complications (P = 0.042). In addition, the number of days from surgery until the first flatus (4.33 ± 1.24 d vs 3.57 ± 1.85 d, P = 0.029) was greater in the drain group. CONCLUSION: Omitting prophylactic drainage may reduce surgery time and result in faster recovery. Routine prophylactic drains are not necessary in selected patients. A prophylactic drain may be useful in high-risk patients.

Prognostic Impact of Preoperative Naples Prognostic Score in Gastric Cancer Patients Undergoing Surgery.

Background: The Naples prognostic score (NPS) is established according to nutritional or inflammatory state, which has been identified as a new prognostic score for various malignant tumors. However, its prognosis prediction effect on gastric cancer (GC) patients is still unknown so far. The present work aimed to examine the NPS function in the prediction of GC prognosis. Methods: In this study, patients undergoing surgery with no preoperative therapy were retrospectively examined from June 2011 to August 2019. Typically, the total cholesterol level, serum albumin content, neutrophil-to-lymphocyte ratio and lymphocyte-to-monocyte ratio were determined to calculate the NPS. Besides, the prognostic value of NPS was evaluated by survival analyses. Time-dependent receiver operating characteristic (t-ROC) curve analysis was also carried out to compare the prognostic value of the scoring systems. Results: Altogether 1,283 cases were enrolled into the present work. NPS was markedly related to age, gender, tumor size, body mass index, vascular invasion, perineural invasion, and pTNM stage. Upon multivariate analysis, NPS was identified as an independent prognostic factor for the prediction of overall survival (OS) (P < 0.001). In subgroup analyses stratified by adjuvant chemotherapy or surgery alone, NPS was still the independent prognostic factor for OS in both groups (both P < 0.001). Furthermore, NPS exhibited higher accuracy in the prediction of OS than additional prognostic factors, as revealed by the results of t-ROC curve analysis. Conclusions: NPS is a simple and useful scoring system that can be used to independently predict the survival of GC cases undergoing surgery.

Low body mass index is an independent predictor of poor long-term prognosis among patients with resectable gastric cancer.

BACKGROUND: The association between body mass index (BMI) and clinical outcomes remains unclear among patients with resectable gastric cancer. AIM: To investigate the relationship between BMI and long-term survival of gastric cancer patients. METHODS: This retrospective study included 2526 patients who underwent radical gastrectomy for gastric cancer between September 2013 and June 2018. The patients were divided into four groups: Group A (low BMI, < 18.5 kg/m2), group B (normal BMI, 18.5-24.9 kg/m2), group C (overweight, 25-29.9 kg/m2), and group D (obese, ≥ 30 kg/m2). Clinicopathological findings and survival outcomes were recorded and analyzed. RESULTS: Preoperative weight loss was more common in the low-BMI group, while diabetes was more common in the obese group. Upper-third gastric cancer accounted for a large proportion of cases in the higher BMI groups. Major perioperative complications tended to increase with BMI. The 5-year overall survival rates were 66.4% for group A, 75.0% for group B, 77.1% for group C, and 78.6% for group D. The 5-year overall survival rate was significantly lower in group A than in group C (P = 0.008) or group D (P = 0.031). Relative to a normal BMI value, a BMI of < 18.5 kg/m2 was associated with poor survival (hazard ratio: 1.558, 95% confidence interval: 1.125-2.158, P = 0.008). CONCLUSION: Low BMI, but not high BMI, independently predicted poor survival in patients with resectable gastric cancer.

Adjuvant chemotherapy indications for stage I gastric cancer patients with negative lymph node.

PURPOSE: Whether adjuvant chemotherapy (AC) has a survival benefit for pathological stage Ⅰ (T1N0 and T2N0) gastric cancer (GC) patients with negative lymph node (N0) remains controversial. METHODS: Patients with surgically resected, histologically confirmed pT1N0 and pT2N0 GC between January 2011 and December 2017 at the National Cancer Center, China, were retrospectively reviewed. RESULTS: A total of 1601 patients who met the inclusion criteria were identified. Independent risk factors for reduced overall survival (OS) identified in the Cox regression analysis were male sex (hazard ratio [HR] 1.454, 95% confidence interval [CI] 1.127-1.876), age ≥ 65 years (HR 1.367; 95% CI 1.071-1.744 ), T2 stage (HR 1.283; 95% CI 1.005-1.638), tumor size > 3 cm (HR 1.704; 95% CI 1.346-2.158), examined lymph nodes (EN) ≤ 15 (HR 1.327; 95% CI 1.058-1.664), and non-signet ring cell carcinoma (Non-SRCC) (HR 1.639; 95% CI 1.123-2.392). While only T2 stage (HR 1.410; 95% CI 1.026-1.936), tumor size > 3 cm (HR 1.755; 95% CI 1.285-2.397), examined lymph nodes (EN) ≤ 15 (HR 1.489; 95% CI 1.101-2.015) were independent risk factors for cause-specific survival (CSS). We divided patients with pT2N0 into four sub-categories according to two significant prognostic factors (size and EN) and found that only patient in group 3 (EN ≤ 15, size >3 cm) with improved CSS benefit from AC (p = 0.049). More significant CSS benefit from AC was identified in Non-SRCC patients within group 3 (p = 0.034). CONCLUSION: An additional survival benefit related to AC is expected for selected pT2N0 patients. Non-SRCC patients with EN ≤ 15 and tumor size >3 cm may be particularly appropriate candidates for AC.

Survival outcomes and prognostic indicators for gastric cancer patients with positive peritoneal wash cytology but no peritoneal metastasis after radical gastrectomy.

BACKGROUND: Positive peritoneal wash cytology with no peritoneal metastasis (CY1P0) is a special type of distant gastric cancer metastasis, which describes a patient with positive peritoneal lavage cytology, but no definitive peritoneal metastasis, and there are no widely accepted treatment guidelines. We enrolled 48 primary CY1P0 gastric cancer patients treated by radical gastrectomy in this study. Our study illustrated the efficacy of radical gastrectomy for CY1P0 gastric cancer patients, and suggested that the pathological N factor and vascular invasion were significant independent risk factors for overall survival (OS). AIM: To assess the survival of CY1P0 gastric cancer patient post-radical gastrectomy, and to identify factors associated with long-term prognosis. METHODS: Our study included 48 patients with primary CY1P0 gastric cancer who had radical gastrectomies at the Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China between 2013 and 2018. R0 resection was achieved in all 48 patients. Twelve patients received neoadjuvant chemotherapy. Thirty patients received adjuvant chemotherapy and four received adjuvant chemoradiotherapy. OS statistics were available for 48 patients. Follow-up continued through March 2020. Univariate and multivariate analyses were performed using a Cox proportional hazards model to identify prognostic factors. RESULTS: Median OS was 22.0 mo (95% confidence interval: 13.366-30.634 mo) post-surgery. Univariate analyses demonstrated that tumor site (P = 0.021), pathological N factor (P = 0.001), pathological T factor (P = 0.028), vascular invasion (P = 0.046), and the level of CA199 prior to initiating therapy (P = 0.002) were significant risk factors for OS. Multivariate analyses demonstrated that pathological N factor (P = 0.001) and vascular invasion (P = 0.031) were significant independent risk factors for OS. CONCLUSION: This study suggested that radical gastrectomy may be efficient for CY1P0 gastric cancer patient post-radical gastrectomy and the pathological N factor and vascular invasion are significant independent risk factors for OS.

Indications for adjuvant chemotherapy in patients with pT1N1M0 gastric cancer: a single-center experience.

PURPOSE: Whether adjuvant chemotherapy (AC) has a survival benefit for all patients with pathological stage pT1N1M0 (Stage IB) gastric cancer (GC) remains controversial. METHODS: All patients with surgically resected, histologically confirmed pT1N1M0 GC between January 2011 and December 2017 at the National Cancer Center, China, were retrospectively reviewed. RESULTS: A total of 179 patients with pT1N1M0 were identified. Survival analysis showed that both overall survival (OS) and cause-specific survival (CSS) were significantly different between patients treated with and without AC (p < 0.01). Independent risk factors for reduced OS identified in the Cox regression analysis in patients with pT1N1M0 cancer were sex (male sex, hazard ratio [HR] 2.470, 95% confidence interval [CI] 1.294-4.718), examined lymph nodes (EN) (EN ≤ 15, HR 2.402; 95% CI 1.329-4.341), and AC (treated without AC, HR 2.554; 95% CI 1.393-4.681), which were also independent risk factors for reduced CSS. We divided patients with pT1N1M0 into three risk categories (high, moderate, and low) according to two significant prognostic factors (sex and EN) and found that both OS and CSS were significantly different between the three risk groups (p < 0.05). CONCLUSION: An additional survival benefit related to AC is expected for selected pT1N1M0 patients. Male patients with EN ≤ 15 may be particularly appropriate candidates for AC.

Clinical Outcomes of Proximal Gastrectomy versus Total Gastrectomy for Proximal Gastric Cancer: A Systematic Review and Meta-Analysis.

INTRODUCTION: The extent of optimal gastric resection for proximal gastric cancer (PGC) continues to remain controversial, and a final consensus is yet to be met. The current study aimed to compare the perioperative outcomes, postoperative complications, and overall survival (OS) of proximal gastrectomy (PG) versus total gastrectomy (TG) in the treatment of PGC through a meta-analysis. METHODS: We systematically searched PubMed, Embase, The Cochrane Library, and Web of Science for articles published in English since database establishment to October 2019. Evaluated endpoints were perioperative outcomes, postoperative complications, and long-term survival outcomes. RESULTS: A total of 2,896 patients in 25 full-text articles were included, of which one was a prospective randomized study, one was a clinical phase III trial, and the rest were retrospective comparative studies. The PG group showed a higher incidence of anastomotic stenosis (OR = 2.21 [95% CI: 1.08-4.50]; p = 0.03) and reflux symptoms (OR = 3.33 [95% CI: 1.85-5.99]; p < 0.001) when compared with the TG group, while no difference was found in PG patients with double-tract reconstruction (DTR). The retrieved lymph nodes were clearly more in the TG group (WMD = -10.46 [95% CI: -12.76 to -8.17]; p < 0.001). The PG group was associated with a better 5-year OS relative to TG with 11 included studies (OR = 1.35 [95% CI: 1.03-1.77]; p = 0.03). After stratification for early gastric cancer and PG with DTR groups, however, there was no significant difference between the 2 groups (OR = 1.35 [95% CI: 0.59-2.45]; p = 0.62). CONCLUSION: In conclusion, PG was associated with a visible improved long-term survival outcome for all irrespective of tumor stage, while a similar 5-year OS for only early gastric cancer patients between the 2 groups. Future randomized clinical trials of esophagojejunostomy techniques, such as DTR following PG, are expected to prevent postoperative complications and assist surgeons in the choice of surgical approach for PGC patients.

Feasibility and nutritional impact of laparoscopic assisted tailored subtotal gastrectomy for middle-third gastric cancer.

BACKGROUND: Laparoscopic assisted total gastrectomy (LaTG) is associated with reduced nutritional status, and the procedure is not easily carried out without extensive expertise. A small remnant stomach after near-total gastrectomy confers no significant nutritional benefits over total gastrectomy. In this study, we developed a modified laparoscopic subtotal gastrectomy procedure, termed laparoscopic-assisted tailored subtotal gastrectomy (LaTSG). AIM: To evaluate the feasibility and nutritional impact of LaTSG compared to those of LaTG in patients with advanced middle-third gastric cancer (GC). METHODS: We retrospectively analyzed surgical and oncological outcomes and postoperative nutritional status in 92 consecutive patients with middle-third GC who underwent radical laparoscopic gastrectomy at Department of Pancreatic Stomach Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College between 2013 and 2017. Of these 92 patients, 47 underwent LaTSG (LaTSG group), and the remaining underwent LaTG (LaTG group). RESULTS: Operation time (210 ± 49.8 min vs 208 ± 50.0 min, P > 0.05) and intraoperative blood loss (152.3 ± 166.1 mL vs 188.9 ± 167.8 mL, P > 0.05) were similar between the groups. The incidence of postoperative morbidities was lower in the LaTSG group than in the LaTG group (4.2% vs 17.8%, P < 0.05). Postoperatively, nutritional indices did not significantly differ, until postoperative 12 mo. Albumin, prealbumin, total protein, hemoglobin levels, and red blood cell counts were significantly higher in the LaTSG group than in the LaTG group (P < 0.05). No significant differences in Fe or C-reaction protein levels were found between the two groups. Endoscopic examination demonstrated that reflux oesophagitis was more common in the LaTG group (0% vs 11.1%, P < 0.05). Kaplan-Meier analysis showed a significant improvement in the overall survival (OS) and disease free survival (DFS) in the LaTSG group. Multivariate analysis showed that LaTSG was an independent prognostic factor for OS (P = 0.048) but not for DFS (P = 0.054). Subgroup analysis showed that compared to LaTG, LaTSG improved the survival of patients with stage III cancers, but not for other stages. CONCLUSION: For advanced GC involving the middle third stomach, LaTSG can be a good option with reduced morbidity and favorable nutritional status and oncological outcomes.

Treatment strategies for gastric cancer during the COVID-19 pandemic.

The coronavirus disease 2019 pandemic has become a major global public health problem. Governments are taking the necessary steps to reduce the movement of people to contain the spread of the virus. However, these measures have caused considerable distress to patients with gastric cancer who are newly diagnosed or are undergoing treatment. In addition to the cancer, they must deal with longer waiting times for surgery and poor communication with doctors. Furthermore, gastric cancer patients generally have low immunity and a poor nutritional status, so they are a high-risk group for infection with the novel coronavirus. Therefore, it is necessary to formulate reasonable outpatient management strategies to reduce the adverse effects of the pandemic on their treatment. We summarize the management strategies for patients with gastric cancer during the pandemic.

Development and characterization of a mouse model of duodenogastric reflux.

AIMS: Rat models of duodenogastric reflux have been used to study gastric stump cancer (GSC), but the underlying molecular mechanisms are poorly understood. Unlike rats, mice can be genetically modified, providing a superior model for studying the molecular mechanisms underlying GSC development, which is associated with duodenogastric reflux. This study aimed at developing a mouse model of duodenogastric reflux. MAIN METHOD: C57BL/6 mice were randomly assigned to the control (n = 6), sham operation (n = 9), or gastrojejunostomy group (n = 12). Mice were sacrificed at 1, 3, and 6 months after surgery. Stomach tissue was stained with hematoxylin and eosin. Lesions were classified as chronic inflammation, intestinal metaplasia, or atypical hyperplasia. KEY FINDINGS: Nine mice underwent gastrojejunostomy without mortality. The animals in the gastrojejunostomy group exhibited chronic inflammation at 1, 3, and 6 months after surgery, showing intestinal metaplasia (n = 2) and atypical hyperplasia (n = 1) at 3 months and intestinal metaplasia (n = 2) and atypical hyperplasia (n = 2) at 6 months. The mice in the control group did not exhibit chronic inflammation or intestinal metaplasia, whereas those in the sham operation group exhibited chronic inflammation at 1, 3, and 6 months after surgery, without intestinal metaplasia or atypical hyperplasia. Intestinal metaplasia or atypical hyperplasia were more common in the gastrojejunostomy group than in the sham operation group (p = 0.012). SIGNIFICANCE: A duodenogastric reflux mouse model can be created using gastrojejunostomy without gastrectomy.

Gastric Signet Ring Cell Carcinoma: Current Management and Future Challenges.

Recent advances in the epidemiology, pathology, molecular mechanisms, and combined modality therapy (CMT) fields have shown that gastric signet ring cell carcinoma (GSRC) should be considered a distinct cancerous entity. Clinical management of this cancer is challenging, with chemoradioresistance and poor outcomes in advanced stages. Pathological and molecular sets of GSRC demonstrate different features of poor cohesion and differentiation according to the WHO, Japanese Gastric Cancer Association, and Laurén classifications. These features also result in poor response to adjuvant and neoadjuvant chemoradiotherapy. Certain studies of GSRC showed the disputed effectiveness of hyperthermic intraperitoneal chemotherapy and immunotherapy. Our aim was to discuss how an improved understanding of these therapeutic benefits may provide better treatment selection for patients, and therefore improve survival. The challenges in the new understanding of GSRC in routine practice and pathology, and the current limitations of treatment will also be discussed.

Improving survival of stage II-III primary gastric signet ring cell carcinoma by adjuvant chemoradiotherapy.

BACKGROUND: There is no consistent evidence about the appropriate treatment strategies for gastric signet ring cell carcinoma (GSRC) to improve prognosis. We conducted a population-based study to examine the effects of combined modality therapies on survival outcomes using the Surveillance, Epidemiology, and End Results (SEER) data. METHODS: Analyses included stage II-III primary GSRC patients who were diagnosed between 2006 and 2016. Therapies were categorized as gastrectomy group, adjuvant chemotherapy (CT) group, neoadjuvant radiotherapy (RT) group, and adjuvant chemoradiotherapy (CRT) group. Survival analyses were conducted by Kaplan-Meier method and Cox proportional hazards models and subgrouped by gender, tumor site, stage at diagnosis, and number of lymph nodes removed. RESULTS: Of the 1717 cases of stage II-III primary GSRC, the mean (SD) age was 59.6 (13.3) years, and over a half were male (52.8%). A total of 39.9% patients received adjuvant CRT and the 5-year overall survival (OS) rate was 34.6%. The median OS of patients treated with adjuvant CRT was significantly longer than that of the gastrectomy group (33 months vs 24 months, aHR = 0.71, 95% CI: 0.59, 0.84). Although the crude model showed a significant association between adjuvant CT and total survival (cHR = 0.81, 95% CI: 0.68, 0.96), the effect measure turned null in the multivariable and sub-group analysis. We did not find the significant effect of neoadjuvant RT. CONCLUSIONS: In this study, GSRC patients with stage II-III experienced improved overall survival after receiving adjuvant CRT, which provides several treatment implications. More clinical trials will be needed to verify the conclusion derived from this study.

Artificial intelligence in gastric cancer: a systematic review.

OBJECTIVE: This study aims to systematically review the application of artificial intelligence (AI) techniques in gastric cancer and to discuss the potential limitations and future directions of AI in gastric cancer. METHODS: A systematic review was performed that follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pubmed, EMBASE, the Web of Science, and the Cochrane Library were used to search for gastric cancer publications with an emphasis on AI that were published up to June 2020. The terms "artificial intelligence" and "gastric cancer" were used to search for the publications. RESULTS: A total of 64 articles were included in this review. In gastric cancer, AI is mainly used for molecular bio-information analysis, endoscopic detection for Helicobacter pylori infection, chronic atrophic gastritis, early gastric cancer, invasion depth, and pathology recognition. AI may also be used to establish predictive models for evaluating lymph node metastasis, response to drug treatments, and prognosis. In addition, AI can be used for surgical training, skill assessment, and surgery guidance. CONCLUSIONS: In the foreseeable future, AI applications can play an important role in gastric cancer management in the era of precision medicine.