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1.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(11): 1115-1118, 2019 Nov 06.
Artigo em Chinês | MEDLINE | ID: mdl-31683397

RESUMO

Objective: To evaluate the effectiveness and benefit of the upper gastrointestinal cancer screening in Yangzhong city, Jiangsu province, from 2009 to 2015. Methods: From 2009 to 2015, 31 natural villages with high-incidence of upper gastrointestinal cancer were selected from Baqiao town, Youfang town and Xinglong sub-district in Yangzhong city. 13 776 residents aged 40 to 69 years old were recruited and screened for upper gastrointestinal cancer by using endoscopic examination and pathological diagnosis. Two economic evaluation methods, cost-effectiveness analysis and cost-benefit analysis, were performed to evaluate the current screening schemes. Results: The mean age of all respondents were (53.60±8.14) years old and the males accounted for 43.64% (6 012). A total of 502 cases of upper gastrointestinal tract lesions were detected, including 100 cases of cancer (62 cases of esophagus, gastric/cardiac early stage cancer, 38 cases of advanced stage cancer), 38 cases of severe esophageal hyperplasia/carcinoma in situ, and 15 cases of high-grade intraepithelial neoplasia in stomach/cardia, the detection rate was 0.73%, 0.28% and 0.11%, respectively; the early diagnosis rate was 75.16% (115/153). The cost of a precancerous lesion, a case diagnosed at the early stage and a positive case identified through the upper gastrointestinal cancer screening in Yangzhong City was 10 037.17, 30 460.64 and 22 895.25 RMB, respectively. The early detection cost index from 2009 to 2015 was 0.52, 0.56, 0.48, 0.48, 0.21, 0.30, and 0.26, respectively. The effectiveness-cost ratio from 2009 to 2015 was 3.41, 2.77, 2.66, 2.58, 4.99, 3.12, and 3.48, respectively. Conclusions: The project of early diagnosis and treatment of upper gastrointestinal tract cancer in Yangzhong city has achieved good results and benefits.


Assuntos
Cárdia/patologia , Detecção Precoce de Câncer/economia , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/economia , Programas de Rastreamento/economia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/economia , Adulto , Idoso , China/epidemiologia , Análise Custo-Benefício , Neoplasias Esofágicas/etnologia , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Neoplasias Gástricas/etnologia
2.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(11): 1119-1123, 2019 Nov 06.
Artigo em Chinês | MEDLINE | ID: mdl-31683398

RESUMO

Objective: To investigate the association between the promoter region-938 polymorphism of B-cell lymphoma/leukemia-2 (Bcl-2) gene and the esophageal cancer (EC) and gastric cardia adenocarcinoma (GCA) in Hebei Province. Methods: From 2007 to 2010, 145 esophageal cancer patients and 169 cardiaccancer patientsfrom the outpatient department of the Fourth Hospital of Hebei Medical Universitywereselected in a case group, and 195 non-tumor patients were selected in a control group during the same period. A questionnaire survey was used to collect information of research subjects. Pathological tissues were collected to extract genomic DNA and detect the genotype of bcl-2 gene -938. A multivariate logistic regression model was used to analyze the association between the bcl-2 gene locus 938 CC genotype and the EC and GCA. The interaction between age, gender, smoking, drinking, upper gastrointestinal family history and the bcl-2 gene locus 938 CC genotype was analyzed by likelihood ratio test. Results: The age of the esophageal and cardiac cancer groups was (56.3±8.3) and (57.1±8.4) years old, and that of the control group was (54.7±7.1) years old. The proportion of the bcl-2 gene locus 938 CC genotype in the esophageal group [48.3% (70/145)] and the cardiac cancer group [48.5% (82/169)] was higher than that in the control group [33.8% (66/195)] (both P values<0.05).Compared with the AA genotype, the risk of esophageal cancer and cardiac cancerin people with the CC genotype was 2.386 (1.20-4.76) and 2.564 (1.27-5.18) respectively. In the population with CC genotype, compared with the positive family history, drinking, and male, the negative family history, non-drinking, and female had a higher risk of esophageal cancer; compared with the non-smoking, negative family history, non-drinking and male, the smoking, positive family history, drinking, and female had a higher risk of cardiac cancer (all the P interaction values were <0.05). Conclusion: People with bcl-2 gene locus 938 CC genotype in Hebei Provincewere more likely to suffer from the esophageal and gastric cardia adenocarcinoma.


Assuntos
Adenocarcinoma/genética , Cárdia/patologia , Neoplasias Esofágicas/genética , Genes bcl-2/genética , Predisposição Genética para Doença , Polimorfismo de Nucleotídeo Único/genética , Neoplasias Gástricas/genética , Adenocarcinoma/epidemiologia , Adenocarcinoma/patologia , Idoso , Estudos de Casos e Controles , China/epidemiologia , Neoplasias Esofágicas/epidemiologia , Neoplasias Esofágicas/patologia , Feminino , Genótipo , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/patologia
3.
Z Gastroenterol ; 57(8): 952-959, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31398766

RESUMO

AIMS: The aim of this study was to evaluate the short-term complications of submucosal tunneling endoscopic resection (STER) for large submucosal tumors (SMTs) originating from the muscularis propria (MP) layer in the esophagus and gastric cardia. METHODS: We performed 286 cases of STER from September 2012 to December 2017. The clinical data of patients with SMTs originating from the MP layer of 3.0-7.0 cm, who underwent STER procedure at the endoscopy center of Tianjin Medical University General Hospital, were collected retrospectively. Epidemiological data, tumor location, tumor size, procedure-related parameters, complications, and follow-up were included. RESULTS: A total of 27 (9.4 % [27/286]) patients were large-size SMTs, with a mean age of 51.9 ±â€Š9.4 years. The male/female ratio was 19:8. Of the 27 SMTs, 23 were located in the esophagus and 4 in the gastric cardia. The mean tumor size was 4.0 ± 1.1 cm. The en bloc resection rate was 85.2 % (23/27), and the complete resection rate was 100 % (27/27). Intra-operative perforation occurred in 2 patients (7.4 %) and post-operative perforation occurred in 2 patients (7.4 %). No other complications were observed. The average cost of the procedure was $3357.99 ± $1171.60 per inpatient stay (including both the procedure and an additional inpatient stay). The mean follow-up time was 15 ±â€Š10.1 months. No recurrence and metastasis occurred during the follow-up period. CONCLUSIONS: There is low risk of STER for the large-sized SMTs in the esophagus and gastric cardia, and the most common complication occurred during or after the procedure is perforation.


Assuntos
Cárdia/patologia , Ressecção Endoscópica de Mucosa/métodos , Neoplasias Esofágicas/cirurgia , Junção Esofagogástrica/cirurgia , Gastrectomia/métodos , Mucosa Gástrica/patologia , Mucosa Gástrica/cirurgia , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Neoplasias Esofágicas/patologia , Esôfago , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Resultado do Tratamento
4.
Gastroenterology ; 157(2): 349-364.e1, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31082367

RESUMO

In patients with Barrett's esophagus (BE), metaplastic columnar mucosa containing epithelial cells with gastric and intestinal features replaces esophageal squamous mucosa damaged by gastroesophageal reflux disease. This condition is estimated to affect 5.6% of adults in the United States, and is a major risk factor for esophageal adenocarcinoma. Despite the prevalence and importance of BE, its pathogenesis is incompletely understood and there are disagreements over the cells of origin. We review mechanisms of BE pathogenesis, including transdifferentiation and transcommitment, and discuss potential cells of origin, including basal cells of the squamous epithelium, cells of esophageal submucosal glands and their ducts, cells of the proximal stomach, and specialized populations of cells at the esophagogastric junction (residual embryonic cells and transitional basal cells). We discuss the concept of metaplasia as a wound-healing response, and how cardiac mucosa might be the precursor of the intestinal metaplasia of BE. Finally, we discuss shortcomings in current diagnostic criteria for BE that have important clinical implications.


Assuntos
Esôfago de Barrett/patologia , Células Epiteliais/patologia , Mucosa Esofágica/patologia , Adenocarcinoma/patologia , Adenocarcinoma/prevenção & controle , Esôfago de Barrett/diagnóstico , Esôfago de Barrett/epidemiologia , Cárdia/citologia , Cárdia/patologia , Transdiferenciação Celular , Progressão da Doença , Mucosa Esofágica/citologia , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/prevenção & controle , Junção Esofagogástrica/citologia , Junção Esofagogástrica/patologia , Mucosa Gástrica/citologia , Mucosa Gástrica/patologia , Humanos , Metaplasia/patologia , Estados Unidos , Cicatrização/fisiologia
6.
World J Gastroenterol ; 25(14): 1640-1652, 2019 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-31011251

RESUMO

The gravest prognostic factor in early gastric cancer is lymph-node metastasis, with an incidence of about 10% overall. About two-thirds of early gastric cancer patients can be diagnosed as node-negative prior to treatment based on clinic-pathological data. Thus, the tumor can be resected by endoscopic submucosal dissection. In the remaining third, surgical resection is necessary because of the possibility of nodal metastasis. Nevertheless, almost all patients can be cured by gastrectomy with D1+ lymph-node dissection. Laparoscopic or robotic gastrectomy has become widespread in East Asia because perioperative and oncological safety are similar to open surgery. However, after D1+ gastrectomy, functional symptoms may still result. Physicians must strive to minimize post-gastrectomy symptoms and optimize long-term quality of life after this operation. Depending on the location and size of the primary lesion, preservation of the pylorus or cardia should be considered. In addition, the extent of lymph-node dissection can be individualized, and significant gastric-volume preservation can be achieved if sentinel node biopsy is used to distinguish node-negative patients. Though the surgical treatment for early gastric cancer may be less radical than in the past, the operative method itself seems to be still in transition.


Assuntos
Ressecção Endoscópica de Mucosa/métodos , Gastrectomia/métodos , Excisão de Linfonodo/métodos , Tratamentos com Preservação do Órgão/métodos , Neoplasias Gástricas/cirurgia , Cárdia/patologia , Cárdia/cirurgia , Ressecção Endoscópica de Mucosa/efeitos adversos , Gastrectomia/efeitos adversos , Humanos , Excisão de Linfonodo/efeitos adversos , Metástase Linfática/patologia , Estadiamento de Neoplasias , Tratamentos com Preservação do Órgão/efeitos adversos , Prognóstico , Piloro/patologia , Piloro/cirurgia , Qualidade de Vida , Biópsia de Linfonodo Sentinela , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Resultado do Tratamento
7.
World J Gastroenterol ; 25(2): 245-257, 2019 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-30670913

RESUMO

AIM: To evaluate the effectiveness and safety of submucosal tunneling endoscopic resection (STER) and compare its outcomes in esophageal and cardial submucosal tumors (SMTs) of the muscularis propria (MP) layer. METHODS: From May 2012 to November 2017, 173 consecutive patients with upper gastrointestinal (GI) SMTs of the MP layer underwent STER. Overall, 165 patients were included, and 8 were excluded. The baseline characteristics of the patients and SMTs were recorded. The en bloc resection rate, complete resection rate, residual rate, and recurrence rate were calculated to evaluate the effectiveness of STER, and the complication rate was recorded to evaluate its safety. Effectiveness and safety outcomes were compared between esophageal and cardial SMTs. RESULTS: One hundred and twelve men and 53 women with a mean age of 46.9 ± 10.8 years were included. The mean tumor size was 22.6 ± 13.6 mm. Eleven SMTs were located in the upper esophagus (6.7%), 49 in the middle esophagus (29.7%), 46 in the lower esophagus (27.9%), and 59 in the cardia (35.7%). Irregular lesions accounted for 48.5% of all lesions. STER achieved an en bloc resection rate of 78.7% (128/165) for GI SMTs with an overall complication rate of 21.2% (35/165). All complications resolved without intervention or were treated conservatively without the need for surgery. The en bloc resection rates of esophageal and cardial SMTs were 81.1% (86/106) and 72.1% (42/59), respectively (P = 0.142), and the complication rates were 19.8% (21/106) and 23.7% (14/59), respectively, (P = 0.555). The most common complications for esophageal SMTs were gas-related complications and fever, while mucosal injury was the most common for cardial SMTs. CONCLUSION: STER is an effective and safe therapy for GI SMTs of the MP layer. Its effectiveness and safety are comparable between SMTs of the esophagus and cardia.


Assuntos
Ressecção Endoscópica de Mucosa/métodos , Neoplasias Esofágicas/cirurgia , Recidiva Local de Neoplasia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Neoplasias Gástricas/cirurgia , Adulto , Cárdia/patologia , Ressecção Endoscópica de Mucosa/efeitos adversos , Neoplasias Esofágicas/patologia , Esofagectomia/efeitos adversos , Esofagectomia/métodos , Esofagoscopia/efeitos adversos , Esofagoscopia/métodos , Feminino , Seguimentos , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Mucosa Gástrica/cirurgia , Gastroscopia/efeitos adversos , Gastroscopia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Liso/patologia , Músculo Liso/cirurgia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/prevenção & controle , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Resultado do Tratamento
8.
Gastric Cancer ; 22(4): 705-722, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30656427

RESUMO

BACKGROUND: Semaphorin 3B (SEMA3B) is frequently inactivated in several carcinomas. However, as the host gene of miR-6872, the roles of SEMA3B, antisense lncRNA SEMA3B-AS1, and miR-6872 in gastric cardia adenocarcinoma (GCA) tumorigenesis have not been clarified. METHODS: The expression levels of SEMA3B, SEMA3B-AS1, and miR-6872 were respectively detected by qRT-PCR, western blot, or immunohistochemical staining assays. The methylation status was determined by BGS and BS-MSP methods. In vitro assays were preformed to explore the biological effects of SEMA3B, SEMA3B-AS1, and miR-6872-5p in gastric cancer cells. Chromatin immunoprecipitation assay was used to detect the binding of protein to DNA. The interaction of SEMA3B-AS1 with MLL4 was identified by RNA immunoprecipitation and RNA pull-down assays. RESULTS: Frequent downregulation of SEMA3B, SEMA3B-AS1, and miR-6872 was detected in GCA tissues and gastric cancer cells. Aberrant hypermethylation of the promoter region was more tumor specific and was negatively correlated with the expression level of SEMA3B, SEMA3B-AS1, and miR-6872-5p. Transcription factor Sp1 activated SEMA3B or SEMA3B-AS1 transcription and CpG sites hypermethylation within promoter region eliminated Sp1 binding ability. Overexpression of SEMA3B and SEMA3B-AS1 inhibited gastric cancer cell proliferation, migration, and invasion in vitro. SEMA3B-AS1 induced the expression of SEMA3B by interacting with MLL4. ZNF143 might be the target gene of miR-6872-5p and miR-6872-5p functioning synergistically with SEMA3B to suppress cell invasion. Furthermore, SEMA3B, SEMA3B-AS1, and miR-6872-5p expression levels were associated with GCA patients' survival. CONCLUSIONS: SEMA3B, SEMA3B-AS1, and miR-6872 may act as tumor suppressors and may serve as potential targets for antitumor therapy.


Assuntos
Adenocarcinoma/patologia , Cárdia/patologia , Glicoproteínas de Membrana/genética , MicroRNAs/genética , RNA Antissenso/genética , RNA Longo não Codificante/genética , Semaforinas/genética , Neoplasias Gástricas/patologia , Adenocarcinoma/genética , Adenocarcinoma/metabolismo , Adulto , Idoso , Biomarcadores Tumorais/genética , Cárdia/metabolismo , Movimento Celular , Proliferação de Células , Metilação de DNA , Progressão da Doença , Sinergismo Farmacológico , Feminino , Seguimentos , Regulação Neoplásica da Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Neoplasias Gástricas/genética , Neoplasias Gástricas/metabolismo , Taxa de Sobrevida , Células Tumorais Cultivadas
9.
Nat Commun ; 10(1): 39, 2019 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-30604760

RESUMO

The human gastric mucosa is the most active layer of the stomach wall, involved in food digestion, metabolic processes and gastric carcinogenesis. Anatomically, the human stomach is divided into seven regions, but the protein basis for cellular specialization is not well understood. Here we present a global analysis of protein profiles of 82 apparently normal mucosa samples obtained from living individuals by endoscopic stomach biopsy. We identify 6,258 high-confidence proteins and estimate the ranges of protein expression in the seven stomach regions, presenting a region-resolved proteome reference map of the near normal, human stomach. Furthermore, we measure mucosa protein profiles of tumor and tumor nearby tissues (TNT) from 58 gastric cancer patients, enabling comparisons between tumor, TNT, and normal tissue. These datasets provide a rich resource for the gastrointestinal tract research community to investigate the molecular basis for region-specific functions in mucosa physiology and pathology including gastric cancer.


Assuntos
Mucosa Gástrica/metabolismo , Proteínas de Neoplasias/análise , Proteoma/análise , Neoplasias Gástricas/patologia , Biópsia , Carcinogênese/patologia , Cárdia/metabolismo , Cárdia/patologia , Conjuntos de Dados como Assunto , Fundo Gástrico/metabolismo , Fundo Gástrico/patologia , Mucosa Gástrica/patologia , Gastroscopia , Humanos , Proteínas de Neoplasias/metabolismo , Proteoma/metabolismo , Proteômica/métodos , Antro Pilórico/metabolismo , Antro Pilórico/patologia , Piloro/metabolismo , Piloro/patologia
11.
Gastrointest Endosc ; 89(4): 759-768, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30447215

RESUMO

BACKGROUND AND AIMS: There is controversy about finding intestinal metaplasia (IM) of the gastric cardia on biopsy. The most recent American College of Gastroenterology guideline comments that IM cardia is not more common in patients with Barrett's esophagus (BE). It provides limited guidance on whether the cardia should be treated when patients with BE undergo endoscopic eradication therapy (EET) and whether the cardia should undergo biopsy after ablation. The aims of our study were to determine the frequency in the proximal stomach of (1) histologic gastric cardia mucosa and (2) IM cardia. A third aim was to explore the frequency of advanced pathology (dysplasia and adenocarcinoma) in the cardia after patients with BE have undergone EET. METHODS: Consecutive patients undergoing esophagogastroduodenoscopy between January 2008 and December 2014 who had proximal stomach biopsies were included. Patients who had histologically confirmed BE were compared with those without BE. RESULTS: Four hundred sixty-two patients, 289 with BE and 173 without BE, were included. Histologically confirmed cardiac mucosa was found in 81.6% of all patients. This was more frequent in those with versus without BE (86% vs 75%; odds ratio [OR], 2.06; 95% confidence interval [CI], 1.28-3.32; P = .003). IM cardia was more common in the BE group (17% vs 7%; OR, 2.67; 95% CI, 1.38-5.19; P = .004). Advanced pathology was more likely in the patients with BE who had undergone EET. CONCLUSIONS: Cardiac mucosa is present in most patients who undergo endoscopy for upper GI symptoms. IM cardia is more common in patients with BE than those without. Advanced histologic changes in the cardia were seen only in the subgroup of patients with BE who had undergone EET.


Assuntos
Adenocarcinoma/patologia , Esôfago de Barrett/patologia , Cárdia/patologia , Mucosa Gástrica/patologia , Neoplasias Gástricas/patologia , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/epidemiologia , Idoso , Esôfago de Barrett/diagnóstico por imagem , Esôfago de Barrett/epidemiologia , Esôfago de Barrett/cirurgia , Cárdia/diagnóstico por imagem , Endoscopia do Sistema Digestório , Feminino , Mucosa Gástrica/diagnóstico por imagem , Humanos , Masculino , Metaplasia/diagnóstico por imagem , Metaplasia/epidemiologia , Metaplasia/patologia , Imagem de Banda Estreita , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/epidemiologia
12.
Dig Dis Sci ; 64(2): 524-531, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30390236

RESUMO

BACKGROUND: Gastric subepithelial tumors originating from muscularis propria (MP) are usually benign, but some have malignant potential. AIMS: The aim of this study was to evaluate the utility of endoscopic enucleation for the diagnosis and treatment of MP tumors. PATIENTS AND METHODS: From January 2010 to February 2018, eighty patients with gastric MP tumors underwent endoscopic enucleation at our hospital. Band ligation and resection (BLR) or endoscopic muscularis resection (EMD) was performed based on considerations of tumor size (≤ 12 mm or > 12 mm). Tumor characteristics, procedure times, complete resection rates, adverse events and recurrence were analyzed. RESULTS: Eighty patients with 82 lesions were eligible for inclusion in this study. BLR was used to treat 41 lesions. For these lesions, mean tumor size was 9.5 mm, median procedural time was 17.6 min (range 4-52), and the endoscopic complete resection rate was 100% (41/41). Perforation was developed in four patients, and was closed by endoscopic clipping. EMD was used to treat 41 lesions. Median procedure time was 66.1 min (range 12-260) and the endoscopic complete resection rate was 85.4% (35/41). Perforation occurred in eight patients, four patients received endoscopic treatment and four underwent surgery. Tumor recurrence was not observed in any patient over follow-up (mean 26.3 months). CONCLUSION: Endoscopic enucleation appears to offer an effective, relatively safe means for diagnosing and treating gastric subepithelial tumors originating from the MP, and BLR provides a straightforward, effective, and relatively safe treatment for small MP tumors (≤ 12 mm).


Assuntos
Mucosa Gástrica/cirurgia , Tumores do Estroma Gastrointestinal/cirurgia , Gastroscopia/métodos , Leiomioma/cirurgia , Neurilemoma/cirurgia , Neoplasias Gástricas/cirurgia , Adulto , Cárdia/patologia , Cárdia/cirurgia , Feminino , Fundo Gástrico/patologia , Fundo Gástrico/cirurgia , Tumores do Estroma Gastrointestinal/patologia , Humanos , Leiomioma/patologia , Ligadura , Masculino , Pessoa de Meia-Idade , Neurilemoma/patologia , Antro Pilórico/patologia , Antro Pilórico/cirurgia , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Carga Tumoral
13.
J Laparoendosc Adv Surg Tech A ; 29(3): 374-378, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30289344

RESUMO

BACKGROUND: Total-laparoscopic intragastric surgery (T-LIGS) has gradually been accepted for the treatment of endogenous gastric submucosal tumors. However, it is difficult to perform T-LIGS when the tumor is located at the esophagogastric junction (cardia endogenous gastric submucosal tumor [CEGSMT]) without special laparoscopic instruments that are not available in most developing countries. We have successfully treated 12 cases of CEGSMTs using conventional laparoscopic instruments and achieved acceptable outcomes. This study was conducted to evaluate the surgical techniques for CEGSMT management. METHODS: A retrospective analysis was conducted involving all the CEGSMT patients who were treated with T-LIGS in the General Surgery Department of Guangdong General Hospital from August 2014 to June 2016. RESULTS: There were 12 patients successfully treated with T-LIGS. The surgical time ranged from 56 to 108 minutes, and the blood loss was 5-70 mL. The distance to the tumor from the dentate line was 12-24 mm, and the tumor diameter was 17-28 mm. The tumor margins were 9-15 mm, and the eating time was 2-4 days. The drainage tube indwelling time was 2-4 days, and the discharge time was 4-6 days. The follow-up exams revealed no recurrences, dysphagia, acid reflux, or other digestive symptoms. CONCLUSIONS: It is safe and feasible to perform T-LIGS using conventional laparoscopic instruments to treat CEGSMTs. We suggest that T-LIGS can be performed for endogenous mucosal tumors within 3 cm from the cardiac dentate line and less than 3 cm in size.


Assuntos
Cárdia/patologia , Endoscopia Gastrointestinal/métodos , Laparoscopia/métodos , Neoplasias Gástricas/cirurgia , Adulto , Cárdia/cirurgia , Endoscopia Gastrointestinal/efeitos adversos , Feminino , Mucosa Gástrica/patologia , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Resultado do Tratamento
14.
Surg Oncol ; 27(4): 642, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30449486

RESUMO

BACKGROUND: Gastrointestinal tract involvements of metastatic melanoma are rare; 7% of gastrointestinal tract metastases of melanoma concerns the stomach [1]. Actually, bleeding from gastric melanoma metastasis is very rare. For the first time in Literature, this video shows a laparoscopic intragastric resection [2] of a cardial lesion of melanoma. A 64-year old patient with history of a skin melanoma resection with lung and liver metastatic disease confirmed by FDG PET, stable after repeated cycles of Pembrolizumab, presented anemia with gastrointestinal bleeding signs. Endoscopy and CT scans documented a 4-cm subcardial metastatic melanoma lesion. Endoscopic ultrasound evaluation confirmed no full-thickness involvement of gastric wall. Patient refused blood transfusions because Jehovah's Witness. Since the tumor position so close to the cardias contraindicated both typical endoscopic and laparoscopic approaches, we proposed laparoscopic intragastric solution in order to avoid risk related to a total gastrectomy. METHODS: Procedure was performed by 3 intragastric trocars placed under endoscopic view. The primary surgical intent was to excise the tumor in order to avoid further bleeding. Actually, during dissection we verified the possibility to radically resect the lesion. After removal (with partial fragmentation) of the lesion, residual free fragments have been accurately removed to reduce the risks of tumor implantation on gastric mucosa and a mucosal suture was completed. Two-layer running sutures were applied on gastric holes. After completion of procedure, suture and cardial gastric wall were tested for leakage with satisfying result. Finally, lesser sac was opened up to expose the right diaphragmatic pillar in order to exclude eventual posterior gastric wall damage. RESULTS: Pathologic evaluation demonstrated a diffuse submucosal invasion by melanoma, confirming that R0 resection was achieved. CONCLUSIONS: In the general strategy of a palliation treatment of a largely metastastic tumor, the specific aim of this procedure was to stop gastric bleeding and to allow the continuation of systemic therapies effective in the disease control. After 6 months from surgery, patient resumed chemotherapy without any documented gastric recurrence.


Assuntos
Cárdia/cirurgia , Gastrectomia/métodos , Laparoscopia/métodos , Melanoma/cirurgia , Neoplasias Gástricas/cirurgia , Cárdia/patologia , Humanos , Melanoma/patologia , Pessoa de Meia-Idade , Prognóstico , Neoplasias Gástricas/secundário
15.
J Dig Dis ; 19(12): 730-736, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30270559

RESUMO

Gastric cancer is common in China. At present, early detection with prompt resection of early gastric carcinoma (EGC) is crucial for improving patient's survival. Because of high heterogeneity of EGC in Chinese patients we reviewed recent clinicopathological and molecular evidence and proposed a grouping EGC in three subgroups according to their location for appropriate management. In group 1 (cardia), most patients with EGC in this small location were elderly men. The tumors originated in the cardiac mucosa with a high proportion of cases with slightly elevated gross patterns and intestinal adenocarcinoma histology with moderate to well differentiation. Poorly cohesive carcinoma was infrequent. As the risk for lymph node metastasis in this kind of tumor was significantly lower than that in the distal stomach, endoscopic therapy is preferred. Group 2 (fundus-corpus), many patients with EGC in this large location were young women. The EGCs originated in the oxyntic mucosa with pure and mixed poorly cohesive carcinomas that are more commonly present in this area than in any other. Most tumors were poorly differentiated with a high risk for lymph node metastasis. Thus, endoscopic therapy may be appropriate for intramucosal, but not for submucosal, carcinoma. Group 3 (antrum-pylorus). EGC tumors arose from the antral mucosa, primarily because of Helicobacter pylori infection, following the Correa gastric cancer tumorigenetic pathway. Erosive and ulcerated gross patterns were most frequently observed. While most EGCs in this location were mainly intestinal adenocarcinomas, poorly differentiated EGCs were substantial in number. Because the risk of lymph node metastasis remains to be illustrated, clinical management requires an individualized approach. This preliminary observation requires verification in large nationwide multicenter studies.


Assuntos
Neoplasias Gástricas/terapia , Idoso , Cárdia/patologia , Feminino , Fundo Gástrico/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Antro Pilórico/patologia , Neoplasias Gástricas/classificação , Neoplasias Gástricas/patologia
16.
Sci Rep ; 8(1): 14584, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-30275518

RESUMO

As a chromosome stabilizer, telomeres play an essential part in maintaining the stability and integrity of human genome. Shortened telomeres have been associated with the development of cancers but it is still largely unclear whether leukocyte telomere length contributes to predisposition of gastric cardia adenocarcinoma (GCA). We conducted a case-control study consisting of 524 GCA cases and 510 controls to assess the association between telomere length in peripheral blood leukocytes and GCA risk in a Chinese Han population. The GCA patients had significantly overall shorter relative leukocyte telomere length (RTL) (median ± SD: 1.10 ± 0.54) when compared with the controls (1.24 ± 0.58). Individuals with the shortest quartile of RTL performed a doubled GCA risk (OR = 2.18; 95% CI = 1.47-3.22, P = 9.90 × 10-5) when compared with those with the highest quartile. We also found that telomere shortening and smoking have a significantly synergistic effect in intensifying risk of GCA (OR = 7.03, 95% CI = 4.55-10.86, P = 1.43 × 10-18). These findings indicate that short RTL contributes to increased susceptibility of gastric cardia adenocarcinoma and might be a promising marker to identify high-risk individuals combined with lifestyle risk factors.


Assuntos
Adenocarcinoma/epidemiologia , Cárdia/patologia , Predisposição Genética para Doença , Leucócitos/patologia , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/patologia , Telômero , Adenocarcinoma/genética , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , China , Grupos Étnicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Neoplasias Gástricas/genética , Adulto Jovem
17.
Cancer Biomark ; 23(2): 193-203, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30198863

RESUMO

BACKGROUND: Circulating microRNAs (miRNAs) have been implicated as novel biomarkers for various types of cancers. The aim of the study is to identify serum miRNAs with potential in detecting gastric cardia adenocarcinoma (GCA). METHODS: A three-phase study was designed with 102 GCA patients and 84 cancer-free controls. In the screening phase (3 GCA pools vs. 1 normal control (NC) pool), a total of 35 miRNAs were identified using quantitative reverse transcription polymerase chain reaction (qRT-PCR) based Exiqon panel. Subsequently, these miRNAs were further assessed by qRT-PCR in the training phase (30 GCAs vs. 30 NCs) and testing phase (72 GCAs vs. 54 NCs). Finally, the expression levels of the identified miRNAs were assessed in GCA tissues and exosomes. RESULTS: Five up-regulated miRNAs (miR-200a-3p, miR-296-5p, miR-132-3p, miR-485-3p and miR-22-5p) were identified in serum of the GCA patients compared with NCs. The areas under the receiver operating characteristic curve (AUCs) of the five-miRNA panel were 0.766 and 0.724 for the training and testing phases, respectively. In addition, miR-200a-3p, miR-296-5p, miR-485-3p and miR-22-5p were significantly up-regulated in GCA tissues. However, none of the miRNAs in the exosomes showed different expression between GCA patients and NCs. CONCLUSIONS: We identified a five-miRNA panel in peripheral serum samples as a non-invasive biomarker in detection of GCA.


Assuntos
Biomarcadores Tumorais , Cárdia/patologia , MicroRNA Circulante , MicroRNAs/genética , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/genética , Adenocarcinoma/sangue , Adenocarcinoma/diagnóstico , Adenocarcinoma/genética , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Biologia Computacional/métodos , Feminino , Perfilação da Expressão Gênica , Humanos , Biópsia Líquida , Masculino , MicroRNAs/sangue , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Curva ROC , Reação em Cadeia da Polimerase em Tempo Real , Neoplasias Gástricas/sangue
18.
Int J Cancer ; 143(11): 2749-2757, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-29992560

RESUMO

The role of alcoholic beverages in the etiology of gastric cancer is unclear. Recent summaries showed a positive association between higher alcohol intake and gastric cancer risk, but the magnitude of association is small, there is moderate heterogeneity among studies, and most cases were from Asian populations. We prospectively investigated the associations of alcohol consumption with gastric cardia adenocarcinoma (GCA) and gastric noncardia adenocarcinoma (GNCA) in 490,605 adults, aged 50-71 years at baseline who participated in the NIH-AARP diet and health study. Alcohol consumption in the past year was assessed at baseline by questionnaire and defined as total grams of ethanol intake per day or as a categorical variable: nondrinker, up to or including one drink per day, one to three drinks per day and greater than three drinks per day. We used multivariable-adjusted Cox proportional hazards regression to calculate the hazard ratios (HR) and 95% confidence intervals (CI) for associations between alcohol intake and risk of gastric adenocarcinomas. Through 2011, 662 incident cases of GCA and 713 of GNCA occurred. We found no association between higher alcohol consumption and GCA or GNCA, when examined as total alcoholic beverage intake or individual beverage types of beer, wine and liquor. Furthermore, we observed no association by stratum of sex, ethnic group, educational level or smoking status. We did, however, observe lower risk of GNCA among participants who drank up to one drink per day (HR = 0.81, 95% CI: 0.67-0.97) compared to nondrinkers. In conclusion, alcohol consumption was not associated with increased risk of GCA or GNCA in this large U.S. cohort.


Assuntos
Adenocarcinoma/etiologia , Consumo de Bebidas Alcoólicas/efeitos adversos , Cárdia/patologia , Neoplasias Gástricas/etiologia , Adenocarcinoma/patologia , Idoso , Dieta/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Neoplasias Gástricas/patologia , Inquéritos e Questionários
19.
Ann Surg Oncol ; 25(9): 2693-2702, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29987609

RESUMO

BACKGROUND: Gastric adenocarcinoma is the second most common cancer-related death globally. Assessing survival trends can help evaluate changes in detection and treatment. We aimed to determine recent prognosis trends in gastric non-cardia and cardia adenocarcinoma in an unselected cohort with complete follow-up. METHODS: Population-based nationwide cohort study, including 17,491 patients with gastric non-cardia adenocarcinoma and 4698 with cardia adenocarcinoma recorded in the Swedish Cancer Registry in 1990-2013 with follow-up until 2017. Observed and relative 5-year survival was calculated and stratified by resectional surgery and no such surgery. Prognostic factors were evaluated using multivariable Cox regression. RESULTS: The relative overall 5-year survival remained stable at 18% for gastric non-cardia adenocarcinoma throughout the study period and increased from 12 to 18% for cardia adenocarcinoma. Concurrently, the proportion of patients who underwent resectional surgery decreased from 49 to 38% for non-cardia adenocarcinoma and from 48 to 33% for cardia adenocarcinoma. The relative postoperative 5-year survival increased from 33 to 44% for non-cardia adenocarcinoma and from 21 to 43% for cardia adenocarcinoma, whereas in nonoperated patients it decreased from 3 to 2% in non-cardia adenocarcinoma and increased from 3 to 5% in cardia adenocarcinoma. Poor prognostic factors were higher tumor stage, older age, and more comorbidity. CONCLUSIONS: Despite decreasing resectional rates, the 5-year overall survival has remained unchanged for gastric non-cardia adenocarcinoma and improved for cardia adenocarcinoma over the last two decades in Sweden and is now similar for these sublocations. The postoperative survival has improved for both sublocations, but particularly for cardia adenocarcinoma.


Assuntos
Adenocarcinoma/mortalidade , Cárdia/patologia , Sistema de Registros/estatística & dados numéricos , Neoplasias Gástricas/mortalidade , Adenocarcinoma/epidemiologia , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Idoso de 80 Anos ou mais , Cárdia/cirurgia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Taxa de Sobrevida , Suécia/epidemiologia
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