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2.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(10): 939-943, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33053988

RESUMO

The surgical treatment of early gastric cancer (EGC) is undergoing the development of minimally invasive, precise and individualized treatment. The concept is changing from simple emphasis on radical treatment to giving consideration to both radical treatment and functional preservation. Combined laparoscopy-endoscopy local resection can achieve accurate resection of the lesions of EGC and solve the problem of lymph node dissection which cannot be performed in endoscopic mucosal dissection (ESD). At present, there are several methods of combined laparoscopy-endoscopy local resection for EGC, such as laparoscopy-assisted endoscopic full-thickness resection (EFTR), endoscopy-assisted wedge resection (EAWR), combined laparoscopic and endoscopic approach for neoplasia with a non-exposure technique (CLEAN-NET), and non-exposed endoscopic wall-inversion surgery (NEWS). These methods of local resection have the advantages of minimal invasion, shorter operation time, and less blood loss compared to conventional gastrectomy. Concerning the issue of lymph node dissection in combined laparoscopy-endoscopy surgery, sentinel node navigation can be the solution, although cumbersome intraoperative lymph node tracing, operative failure and false negative still exist. As a developing treatment for EGC, combined laparoscopy-endoscopy local resection will have a good application prospect in the future.


Assuntos
Gastrectomia/métodos , Laparoscopia , Neoplasias Gástricas , Detecção Precoce de Câncer , Endoscopia , Humanos , Excisão de Linfonodo , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgia
3.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(10): 984-989, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33053994

RESUMO

Objective: To investigate the clinical value of carbon nanoparticles zonal tracer technique in lymph node retrieval of gastric cancer (GC). Methods: A retrospective cohort study was carried out. Clinicopathological data of GC patients who underwent radical D2 resection with carbon nanoparticles tracer in The First Affiliated Hospital of Hainan Medical University and Hainan Cancer Hospital from December 2015 and February 2019 were collected. Those with postoperative pathology of T1-2, Borrmann IV type GC, distant metastasis, preoperative neoadjuvant chemotherapy and incomplete data were excluded. A total of 181 patients were enrolled in this study, including 113 cases from the First Affiliated Hospital of Hainan Medical University and 68 cases from Hainan Cancer Hospital. Patients were categorized into two groups based on the methods of carbon nanoparticles tracer: zonal tracer group and traditional tracer group. In the traditional tracer group, 0.1-0.3 ml of carbon nanoparticle was injected subserously at the upper, lower, left and right 4 injection points 0.5 cm away from the edge of the tumor in the normal serous membrane. In the zonal tracer group, on the basis of the traditional tracer group, 0.1-0.3 ml of carbon nanoparticle was injected subserously at the first branch of the suprapyloric right gastric artery into the stomach, the first branch of the subpyloric right gastroepiploic artery into the stomach, the first branch of the minor curvature left gastric artery into the stomach and the first branch of the greater curvature left gastroepiploic artery into the stomach, respectively. The display of lymphatic vessels in each location and lymph nodes in each group by the tracing method was observed. The number of black-stained lymph nodes, the black staining rate of lymph nodes, the total number of detected lymph nodes, the total number of positive lymph nodes, and the metastatic rate of lymph node were compared between the two groups. Results: Eighty-nine patients were assigned to zonal tracer group, and 92 patients to traditional tracer group. There were no significant differences in baseline information between the two groups (all P>0.05). The median number of black-stained lymph nodes (median: 25.0 vs. 13.5, Z=-7.158, P<0.001) and the black staining rate of lymph nodes [(70.8±12.0)% vs. (47.1±15.7)%, t=11.399, P<0.001) in the zonal tracer group were significantly higher than those in the traditional tracer group. The total detected number of lymph nodes (37.5±11.5 vs. 29.6±11.8, t=4.581, P<0.001) and the total number of negative lymph nodes (31.3±12.5 vs. 24.9±11.1, t=3.621, P<0.001) were significantly higher in the zonal tracer group than those in the traditional tracer group. There were no significant differences in the total number of positive lymph nodes (median: 4.0 vs. 3.0, Z=-1.485, P=0.137), lymph node metastatic rate [78.7% (70/89) vs. 72.8% (67/92), χ(2)=0.834, P=0.361] and metastatic degree [median: 11% vs. 10%, Z=-0.483, P=0.629] between the two groups. Conclusion: The carbon nanoparticles zonal tracer method can increase the black-staining rate of lymph nodes and the detected number of lymph nodes, thus improving the accuracy of gastric cancer staging.


Assuntos
Nanopartículas , Neoplasias Gástricas , Materiais Biocompatíveis , Carbono , Humanos , Excisão de Linfonodo , Linfonodos , Metástase Linfática , Estudos Retrospectivos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia
4.
Zhonghua Yi Xue Za Zhi ; 100(38): 3001-3004, 2020 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-33086451

RESUMO

Objective: To investigate the clinical characteristics, treatment and prognosis of gastric cancer complicated with immediate double primary cancer. Methods: The clinical data of patients who met the diagnostic criteria of gastric cancer with immediate double primary cancer from January 2016 to June 2019 were analyzed retrospectively. Results: There were 29 cases of gastric cancer with immediate double primary carcinoma, accounting for 1.7% of the 1 741 patients with gastric cancer in the same period. Of these, 17 (58.6%) were more than 70 years of age. 25 cases (86.2%) were male. The postoperative pathological staging was mainly for early gastric cancer (63.2%). Colorectal cancer accounted for 8 cases (27.6%), followed by esophageal cancer in 7 cases (24.1%). The others included 6 cases of lung cancer (20.7%), 2 cases of pancreatic cancer (6.9%), 2 cases of prostate cancer (6.9%), 1 case of non-Hodgkin's lymphoma (3.4%), 1 case of ampullary tumor (3.4%), 1 case of bile duct carcinoma (3.4%) and 1 case of laryngeal carcinoma (3.4%). The prognosis of the surgical treatment group was significantly better than that of the non-surgical treatment group (median survival time: 21.0 months vs 13.0 months, P=0.014). Conclusion: Gastric cancer complicated with immediate double primary cancer mostly occurs in elderly men and early gastric cancer patients. In the complicated tumor, colorectal cancer is the main cause, so we should pay attention to the screening of digestive system. Radical surgery should be performed as far as possible for each primary tumor.


Assuntos
Neoplasias Colorretais , Neoplasias do Ducto Colédoco , Neoplasias Gástricas , Idoso , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/diagnóstico
5.
Medicine (Baltimore) ; 99(41): e22497, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031286

RESUMO

RATIONALE: Paragangliomas (PGLs) are rare neuroendocrine tumors that are strongly influenced by genetics, and succinate dehydrogenase-deficient PGLs appear to constitute one of the most important categories. Interestingly, somatic PGLs only possess genomic alterations involving the SDHB and SDHD subunits, and no SDHA alterations have been described. Here, we are presenting the clinical and genetic analyses of 2 cases with the first somatic SDHA variant identified in PGLs. PATIENT CONCERNS: Here, we reported 2 family members with the diagnosis of PGL. Patient 1 is a 55-year-old woman with a functionally perigastric PGL that co-occurred with a gastric gastrointestinal stromal tumor (GIST), and patient 2 is a 43-year-old woman with a nonfunctionally pericardial PGL, who was the younger sister of the first patient. DIAGNOSES: Imaging surveys of the 2 cases depicted the presence of a perigastric and a pericardial mass, respectively. A diagnosis of paragangliomas was established by immunohistochemistry (IHC). INTERVENTIONS: Both patients underwent single-stage resection of the lesion after preoperative oral α-adrenoceptor therapy for 2 weeks. We later performed comprehensive genomic profiling on the tumor samples, including PGL and GIST from patient 1 and PGL from patient 2, and searched for novel actionable mutations, including in all succinate dehydrogenase subunits, as the IHC results were negative for SDHB. OUTCOMES: Both patients had an uneventful recovery after surgery and the sequencing showed a novel somatic variant in the SDHA gene on chromosome 5q11 (c.1945_1946delTT). Regular follow-up with biochemical testing and image studies showed no evidence of recurrence after a year for patient 1 and 6 years for patient 2. LESSONS: PGLs often lead to considerable diagnostic difficulty due to their multiple anatomical locations and variable symptoms, as presented by our cases. The comprehensive use of images and plasma/urine catecholamine measurement can aid the diagnosis of PGLs. In addition, our findings also demonstrate the usefulness and importance of genetic analysis of SDHA mutations in patients exhibiting SDHB IHC-negative PGL. Additional studies utilizing comprehensive genomic profiling are needed to identify the group of PGLs harboring this SDHA genomic alteration.


Assuntos
Complexo II de Transporte de Elétrons/genética , Tumores do Estroma Gastrointestinal/genética , Neoplasias Primárias Múltiplas/genética , Paraganglioma Extrassuprarrenal/genética , Neoplasias Gástricas/genética , Adulto , Feminino , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/patologia , Testes Genéticos , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Mutação , Paraganglioma Extrassuprarrenal/diagnóstico , Paraganglioma Extrassuprarrenal/patologia , Irmãos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologia
6.
Medicine (Baltimore) ; 99(41): e22556, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031301

RESUMO

Sedation esophagogastroduodenoscopy (EGD) has become more prevalent in many countries. However, owing to the limitation of health insurance payment for sedation EGD in Taiwan, non-sedation EGD still accounts for the majority of cases. This study was aimed to explore the differences between the sedation and non-sedation groups in terms of endoscopic findings, such as detection rate of gastric polyp of any size, number of detected gastric polyps, and location of the gastric polyps detected.We enrolled 10,940 patients who underwent EGD between January 1, 2016 and December 31, 2016 at the Tri-Service General Hospital; among the patients, 1900 received intravenous sedation (IVS) and 9040 did not. The data reviewed included demographics, parameters of the polyp (number, size, and location), and pathology.Compared with the non-sedation group, the sedation group had a higher overall polyp detection rate (P < .001); a greater number of detected polyps (Odds ratio 1.50, P = .007); and a higher detection rate of smaller polyps, such as fundic gland polyp, and hyperplastic polyp (P < .001). Among the pathological findings, gastric neuroendocrine tumor (NET) was detected using EGD in 2 cases and manifested as small polyps (<0.05 cm), and it showed significantly better detection rates in the sedation EGD group than in the non-sedation EGD group (P = .002).Sedation EGD could enhance a patients willingness and cooperation during EGD. Furthermore, sedation EGD increased the detection rates of small gastric polyps and was more likely to enable identification of unusual findings, such as gastric NET.


Assuntos
Pólipos Adenomatosos/diagnóstico , Endoscopia do Sistema Digestório , Neoplasias Gástricas/diagnóstico , Pólipos Adenomatosos/patologia , Criança , Sedação Consciente , Feminino , Humanos , Masculino , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Taiwan
7.
Anticancer Res ; 40(11): 6387-6398, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33109577

RESUMO

BACKGROUND/AIM: Helicobacter pylori (Hp) infection affects a substantial proportion of the world population and is a major risk factor of gastric cancer (GC). The caveats of common Hp-tests can be evaded by a serological biomarker test (GastroPanel®, Biohit Oyj, Helsinki), the most comprehensive Hp-test on the market. The clinical validation of Helicobacter pylori IgG ELISA of the new-generation GastroPanel® test is reported. The aim of the study is to validate the clinical performance of the Helicobacter pylori IgG ELISA test in diagnosis of biopsy-confirmed Hp-infection in gastroscopy referral patients. PATIENTS AND METHODS: A cohort of 101 patients (mean age=50.1 years) referred for gastroscopy at the outpatient Department of Gastroenterology (SM Clinic, St. Petersburg) were examined by two test versions to validate the new-generation GastroPanel®. All patients were examined by gastroscopy and biopsies, which were stained with Giemsa for specific identification of Hp in the antrum (A) and corpus (C). RESULTS: Biopsy-confirmed Hp-infection was found in 64% of patients, most often confined to antrum. The overall agreement between Hp IgG ELISA and gastric biopsies in Hp-detection was 91% (95%CI=84.1-95.8%). Hp IgG ELISA diagnosed biopsy-confirmed Hp (A&C) with sensitivity (SE) of 92.3%, specificity (SP) of 88.6%, positive predictive value (PPV) of 93.8% and negative predictive value (NPV) of 86.1%, with AUC=0.904 (95%CI=0.842-0.967). In ROC analysis for Hp detection (A&C), Hp IgG ELISA shows AUC=0.978 (95%CI=0.956-1.000). CONCLUSION: The Hp IgG ELISA test successfully concludes the clinical validation process of the new-generation GastroPanel® test, which retains the unrivalled diagnostic performance of all its four biomarkers, extensively documented for the first-generation test in different clinical settings.


Assuntos
Anticorpos Antibacterianos/isolamento & purificação , Infecções por Helicobacter/diagnóstico , Helicobacter pylori/isolamento & purificação , Imunoglobulina G/isolamento & purificação , Adolescente , Adulto , Anticorpos Antibacterianos/genética , Anticorpos Antibacterianos/imunologia , Biópsia , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Gastrinas/genética , Gastrinas/isolamento & purificação , Gastrite Atrófica/diagnóstico , Gastrite Atrófica/genética , Gastrite Atrófica/microbiologia , Gastrite Atrófica/patologia , Gastroscopia/métodos , Infecções por Helicobacter/genética , Infecções por Helicobacter/microbiologia , Infecções por Helicobacter/patologia , Helicobacter pylori/genética , Helicobacter pylori/patogenicidade , Humanos , Imunoglobulina G/imunologia , Masculino , Pessoa de Meia-Idade , Pepsinogênio A/genética , Pepsinogênio A/isolamento & purificação , Pepsinogênio C/genética , Pepsinogênio C/isolamento & purificação , Encaminhamento e Consulta , Estômago/microbiologia , Estômago/patologia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/genética , Neoplasias Gástricas/microbiologia , Neoplasias Gástricas/patologia , Adulto Jovem
8.
BMC Med Genet ; 21(1): 207, 2020 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-33076854

RESUMO

BACKGROUND: Apoptosis is a type of cell death involved in different pathways inherent to the cell and the evasion from this mechanism has been related to cancer, although this process remains not very well comprehended. Gastric cancer (GC) is one of the most incident and aggressive types of cancer worldwide. In this study, we analyzed the distribution of INDEL variants in GC patients (Case) and individuals from the general population (Control) from the Amazon region, in which GC is remarkably frequent. METHODS: A panel of nine INDEL markers in apoptosis-related genes (BCL2 rs11269260, CASP3 rs4647655, CASP8 rs3834129 and rs59308963, CASP9 rs4645982 and rs61079693, FADD rs4197, FAS rs10562972 and TP53 rs17880560) was developed and genotyped by multiplex PCR in both groups. RESULTS: In our analyses, only marker rs4197 (FADD gene) was associated to GC development as follows: INS/DEL genotype of rs4197 increasing in about 2-fold the chances of developing this type of cancer (P = 0.046; OR = 1.940; 95%CI = 1.011-3.725). CONCLUSION: Our results suggest that rs4197 (FADD gene) might play a role in gastric carcinogenesis in the investigated population. More studies are needed to clarify this relation. Here, we highlight the importance of investigating INDEL variants in genes involved in apoptosis.


Assuntos
Apoptose/genética , Predisposição Genética para Doença/genética , Mutação INDEL , Polimorfismo de Nucleotídeo Único , Neoplasias Gástricas/genética , Biomarcadores Tumorais/genética , Caspase 3/genética , Caspase 8/genética , Caspase 9/genética , Proteína de Domínio de Morte Associada a Fas/genética , Genótipo , Proteínas Proto-Oncogênicas c-bcl-2/genética , Neoplasias Gástricas/diagnóstico , Proteína Supressora de Tumor p53/genética , Receptor fas/genética
9.
Life Sci ; 261: 118402, 2020 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-32926930

RESUMO

AIMS: The prognoses of patients with gastric cancer(GC) vary in different stages, which is mainly due to the great differences in tumor and tumor microenvironment. This study is aimed to explore the specific differences. MAIN METHODS: Based on RNAseq-based expression data from The Cancer Genome Atlas database and GSE15459 and the latest biological process genelist, stage-related biological processes in gastric cancer were screened out. GSVA, LASSO-COX, univariate and multivariate Cox regression analysis, Kaplan-Meier survival analysis, and pearson correlation analysis were performed for prediction model construction, verification and functional annotation. KEY FINDINGS: The immune system process was enriched at advanced stages of gastric cancer. The tumor immune microenvironment-based prognostic risk score could be used to predict the overall survival and disease-free survival of patients with gastric cancer. The prognostic risk score was significantly associated with gastric cancer subtypes, inflammatory factors, and immune processes and a higher risk score indicated stronger tumor immunosuppression. SIGNIFICANCE: We found immune system processes were significantly elevated in advanced gastric cancer and established an immune-based prognostic predictive risk model for gastric cancer, which could reflect the degree of tumor immunosuppression and might be beneficial for clinical decision-making.


Assuntos
Tolerância Imunológica , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/imunologia , Microambiente Tumoral , Regulação Neoplásica da Expressão Gênica , Humanos , Estimativa de Kaplan-Meier , Análise Multivariada , Prognóstico , Modelos de Riscos Proporcionais , Neoplasias Gástricas/genética , Transcriptoma
10.
Medicine (Baltimore) ; 99(33): e21085, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871979

RESUMO

The lymph nodal invasion diagnosis is critical for therapeutic-decision and follows up in gastric cancer. However, the number of nodes to be examined for nodal invasion diagnosis is still under controversy, and the model for quantifying risk of missing positive node is currently not reported yet. We analyzed the nodal invasion status of 13,857 gastric cancer samples with records of primary tumor stage, the number of examined and positive lymph nodes in the surveillance, epidemiology, and end results (SEER) database, fitting a beta-binomial model. The nodes need to be examined with different primary tumor stage were determined based on the model. Overall, examining 11 lymph nodes reduces the probability of missing positive nodes to <10%, and the currently median nodes dissected is adequate (12 nodes). While the number of nodes demands to be dissected for T1, T2, T3, and T4 subgroups are 6, 19, 40, and 66, respectively. The currently implemented median value for these samples was 12, 12, 13, and 16, separately. It implies that the number of nodes to be examined is sufficient for early gastric cancer (T1), but it is inadequate for middle and advanced gastric cancer (T2-T3). The clinical significance of nodal staging score was validated with survival information. In summary, we first quantified the lymph nodes to be examined during surgery using a beta-binomial model, and validated with survival information.


Assuntos
Linfonodos/patologia , Metástase Linfática/diagnóstico , Metástase Linfática/patologia , Estadiamento de Neoplasias/métodos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologia , Reações Falso-Negativas , Feminino , Humanos , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Probabilidade , Estudos Retrospectivos , Programa de SEER , Sensibilidade e Especificidade , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/cirurgia , Análise de Sobrevida
11.
Medicine (Baltimore) ; 99(37): e21963, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925730

RESUMO

This study aims to identify differentially expressed microRNAs (miRNAs) in gastric cancer by comparing gastric cancerous tissues with normal tissues, explore the potential roles.The miRNA expression microarray was employed on gastric cancer tissues, and apparently normal para-cancerous tissues from 3 patients undergoing radical surgery were matched. Quantitative RT-PCR was performed on the other 7 patients to validate the findings of the microarray. Furthermore, Gene Ontology (GO) analysis and enrichment analysis of KEGG Pathway were performed for 5 dysregulated candidate miRNAs, including 3 upregulated (miR-31-3p, miR-6736-3p, and miR-147b) and 2 downregulated (miR-3065-5p and miR-3921) miRNAs, in order to determine the role of miRNAs in tumorigenesis and development.Among these miRNAs, 17 miRNAs were found to be upregulated, and 19 miRNAs were found to be downregulated. The dysregulated expression of 5 candidate miRNAs, including miR-31-3p, miR-147b, miR-6736-3p, miR-3065-5p, and miR-3921, were verified by quantitative RT-PCR in the validation set. Among these miRNAs, miR-31-3p, miR-6736-3p, miR-3065-5p, and miR-3921 had 551 target gene intersections. The GO and KEGG Pathway analyses Revealed that miR-31-3p, miR-6736-3p, miR-3065-5p, and miR-3921 may participate in multiple pathophysiological processes, such as foreign substance metabolism and chemical carcinogenesis.The profile of differentially expressed miRNAs was successfully screened, and 4 miRNAs (i.e., miR-31-3p, miR-6736-3p, miR-3065-5p, and miR-3921) appeared to be involved in gastric carcinogenesis. These might serve as promising biomarkers for gastric cancer.


Assuntos
Perfilação da Expressão Gênica , MicroRNAs/genética , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/genética , Regulação para Baixo , Regulação Neoplásica da Expressão Gênica , Humanos , Reação em Cadeia da Polimerase em Tempo Real , Regulação para Cima
12.
Medicine (Baltimore) ; 99(38): e22306, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957392

RESUMO

RATIONALE: Gastric mixed adenoneuroendocrine carcinoma (gMANEC) is a rare malignant tumor. Most gMANECs are diagnosed at an advanced stage and have a worse prognosis than gastric adenocarcinoma. In order to improve the prognosis, it is necessary to diagnose gMANEC at an early stage. However, the endoscopic features of early gMANECs are unclear. We, herein, report a case of early gMANEC that showed characteristic magnifying endoscopic findings. PATIENT CONCERNS: A 78-year-old man was referred to our institution for endoscopic resection of a gastric lesion. He had a medical history of distal gastrectomy due to early gastric cancer with negative surgical margins 9 years previously. DIAGNOSIS: Esophagogastroduodenoscopy showed a reddish depressed lesion on the suture line of the gastric remnant, which was classified as type 0-IIc according to the Paris classification. ME-NBI at the oral side of the lesion revealed the absence of the microsurface pattern (MSP) and scattered microvessels with dilation and caliber variation, while ME-NBI at the anal side showed an irregularly tubular MSP. An endoscopic forceps biopsy showed a well- to moderately differentiated adenocarcinoma. INTERVENTIONS: We performed endoscopic submucosal dissection, and en bloc resection of the tumor was successfully achieved. OUTCOMES: The histological findings showed two distinct components: neuroendocrine carcinoma (NEC) and well-differentiated adenocarcinoma, which comprised ∼60% and 40% of the tumor, respectively. The NEC component corresponded to the site with the absence of an MSP and scattered microvessels on ME-NBI, while the well-differentiated adenocarcinoma component corresponded to the site with an irregularly tubular MSP. The pathological diagnosis was mixed adenoneuroendocrine carcinoma, infiltrating into the deep submucosal layer. LESSONS: We propose that the absence of an MSP plus an irregular MSP is characteristics of gMANEC, which was useful for the diagnosis of gMANEC before treatment.


Assuntos
Carcinoma Neuroendócrino/patologia , Neoplasias Gástricas/patologia , Idoso , Carcinoma Neuroendócrino/diagnóstico , Carcinoma Neuroendócrino/cirurgia , Endoscopia do Sistema Digestório , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgia
13.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(9): 835-839, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32927505

RESUMO

The actual incidence of small gastrointestinal stromal tumors (GIST) increases gradually. Although the biological behavior of most of small GIST is benign or indolent, a few small GIST can develope to recurrence and metastasis with biological invasive behavior. Identification of biological behavior and malignant potential is the cornerstone of treatment. For non-gastric small GIST, surgery is always the treatment of choice. Regarding gastric small GIST, close follow-up is acceptable for patients without risk factors detected by endoscopic ultrasonography. Surgery should be suggested for those with high risks, or significant growth of tumor during follow-up. Complete resection with function preservation is the principle of surgery. Besides, individualized treatment should also be taken into consideration.


Assuntos
Neoplasias Gastrointestinais/diagnóstico , Neoplasias Gastrointestinais/terapia , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/terapia , Neoplasias Gastrointestinais/cirurgia , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Assistência ao Paciente/normas , Guias de Prática Clínica como Assunto/normas , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgia
14.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(9): 880-887, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32927513

RESUMO

Objective: Platelet-derived growth factor α (PDGFRA)-mutant gastrointestinal stromal tumor (GIST) is a relatively rare disease, whose clinicopathological characteristics and prognosis have been poorly studied. In this paper, the clinicopathological features and prognostic factors of PDGFRA-mutant GIST are investigated to provide more data for its understanding and treatment. Methods: A retrospective case-control study was used to collect the medical records of patients with GIST who underwent surgical resection in Zhongshan Hospital of Fudan University from January 2015 to August 2019. Patients with PDGFRA-mutant GIST were enrolled, and those with synonymous PDGFRA mutations, non-tumor-related deaths, and lack of clinicopathological data were excluded. The clinicopathological data were collected and the risk factors associated with prognosis were analyzed. Results: Among the enrolled 59 patients, there were 41 males (69.5%) and 18 females (30.5%) with the median age of 60 (25-79) years. All tumors originated from the stomach. The tumor size was 5 (3-7) cm, and the mitotic count was 2 (1-4)/50 high-power fields (HPF). According to the modified NIH risk stratification, 8 cases were classified as very low risk (13.6%), 25 cases as low risk (42.4%), 14 cases as moderate risk (23.7%), and 12 cases as high risk (20.3%). There were 7 cases of exon 12 mutation and 52 cases of exon 18 mutation (including 36 cases of D842V mutation). A comparison of clinicopathological features between the D842V mutation group and the non-D842V mutation group showed no statistically significant difference (all P>0.05). During a median follow-up of 21 (0-59) months, the 1- and 3-year relapse-free survival (RFS) rates of all the patients were 96.6% and 91.5%, respectively. There were 8 cases of recurrence and 3 cases of death. Six GIST patients with D842V mutation had tumor recurrence after operation, of whom 4 cases achieved varying degrees of tumor remission after being treated with dasatinib or avapritinib. Log-rank analysis showed that the overall survival (OS) of male was better than that of female (100% vs. 83.3%, P=0.046), but there was no significant difference in OS among patients with different risk grades (P=0.057). The RFS and OS of patients with D842V mutation and non-D842V mutation, exon 12 and exon 18 mutation were similar (all P>0.05). Univariate Cox analysis showed that RFS was associated with gender (P=0.010), tumor size (P=0.042), mitotic count (P=0.003), and the modified NIH risk stratification (P=0.042), while multivariate analysis revealed that higher risk grade was an independent risk factor for recurrence of PDGFRA-mutant GIST (HR=12.796, 95%CI: 1.326-123.501, P=0.028). Gender was an independent factor for recurrence, and the risk of recurrence in males was lower than that in females (HR=0.154, 95%CI: 0.028-0.841, P=0.031). Conclusions: Gender and the modified NIH risk stratification are independent risk factors for recurrence of PDGFRA-mutant GIST, while patients with D842V and non-D842V mutation, and exon 12 and exon 18 mutation have a similar risk of recurrence and death.


Assuntos
Tumores do Estroma Gastrointestinal/genética , Recidiva Local de Neoplasia , Receptor alfa de Fator de Crescimento Derivado de Plaquetas/genética , Neoplasias Gástricas/genética , Adulto , Idoso , Estudos de Casos e Controles , Éxons , Feminino , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/mortalidade , Tumores do Estroma Gastrointestinal/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/terapia
15.
Medicine (Baltimore) ; 99(36): e22078, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899079

RESUMO

INTRODUCTION: Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory disorder characterized by specific pathologic findings and often, but not in all cases, elevated serum IgG4 concentration. Although it can virtually involve every organ system, cases involving the gastrointestinal tract and especially gastric mass lesions have rarely been reported. PATIENT CONCERNS: A 45-year-old man, who was incidentally discovered asymptomatic subepithelial tumor (SET), by endoscopy, on the greater curvature of the upper gastric body, was referred to our hospital for further evaluation. DIAGNOSIS: The patient was postoperatively diagnosed with IgG4-RD by histopathologic results. INTERVENTIONS: The patient underwent laparoscopic wedge resection. OUTCOMES: The patient is presently followed up annually in our clinic and had no problems and showed no signs of recurrence in examination. CONCLUSION: We reported a rare case of IgG4-RD presenting as a gastric SET. The first line treatment of IgG4-RD is glucocorticoid administration. However, because pathologic examination is challenging owing to the lesion location, preoperative diagnosis is difficult and may lead to unnecessary gastric resection. Thus, using alternative preoperative diagnostic methods such as endoscopic ultrasound-guided fine-needle biopsy or the biopsy unroofing technique could spare the patient from unnecessary surgical treatment.


Assuntos
Doença Relacionada a Imunoglobulina G4/diagnóstico , Doença Relacionada a Imunoglobulina G4/patologia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologia
16.
Medicine (Baltimore) ; 99(36): e22125, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899097

RESUMO

RATIONALE: Primary gastric squamous cell carcinoma (SCC) is rarely encountered clinically. SCC, which presents as a submucosal tumor, is even rarer. Without the support of pathological evidence, it is difficult to make a correct preoperative diagnosis. Due to limited clinical data, the pathogenesis and treatment of gastric SCC remain unclear. PATIENT CONCERNS: A 69-year-old man was admitted to our hospital with unexplained weight loss. Endoscopy revealed a submucosal mass without any ulcer on its surface located on the body of the stomach. The results of 2 gastroscopic mucosal biopsies were chronic inflammation. DIAGNOSES: The clinical diagnosis by computed tomography (CT) and gastroscopy was gastrointestinal stromal tumor (GIST) preoperatively. The postoperative pathological examination demonstrated this tumor as moderately differentiated SCC. INTERVENTIONS: Total gastrectomy, distal pancreatectomy, and splenectomy were performed. OUTCOMES: The patient was discharged 7 days after the surgery without any complications. The follow-up CT scan showed no evidence of metastatic disease 6 months after surgery. LESSONS: Large primary gastric SCC could present as a submucosal mass. Gastroscopic mucosal biopsy may not be able to get tumor tissue due to inflammatory reaction.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologia , Idoso , Carcinoma de Células Escamosas/cirurgia , Diagnóstico Diferencial , Tumores do Estroma Gastrointestinal/diagnóstico , Humanos , Masculino , Neoplasias Gástricas/cirurgia
17.
Value Health ; 23(9): 1171-1179, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32940235

RESUMO

OBJECTIVES: To evaluate cost-effectiveness of a novel screening strategy using a microRNA (miRNA) blood test as a screen, followed by endoscopy for diagnosis confirmation in a 3-yearly population screening program for gastric cancer. METHODS: A Markov cohort model has been developed in Microsoft Excel 2016 for the population identified to be at intermediate risk (Singaporean men, aged 50-75 years with Chinese ethnicity). The interventions compared were (1) initial screening using miRNA test followed by endoscopy for test-positive individuals and a 3-yearly follow-up screening for test-negative individuals (proposed strategy), and (2) no screening with gastric cancer being diagnosed clinically (current practice). The model was evaluated for 25 years with a healthcare perspective and accounted for test characteristics, compliance, disease progression, cancer recurrence, costs, utilities, and mortality. The outcomes measured included incremental cost-effectiveness ratios, cancer stage at diagnosis, and thresholds for significant variables. RESULTS: The miRNA-based screening was found to be cost-effective with an incremental cost-effectiveness ratio of $40 971/quality-adjusted life-year. Key drivers included test costs, test accuracy, cancer incidence, and recurrence risk. Threshold analysis highlights the need for high accuracy of miRNA tests (threshold sensitivity: 68%; threshold specificity: 77%). A perfect compliance to screening would double the cancer diagnosis in early stages compared to the current practice. Probabilistic sensitivity analysis reported the miRNA-based screening to be cost-effective in >95% of iterations for a willingness to pay of $70 000/quality-adjusted life-year (approximately equivalent to 1 gross domestic product/capita) CONCLUSIONS: The miRNA-based screening intervention was found to be cost-effective and is expected to contribute immensely in early diagnosis of cancer by improving screening compliance.


Assuntos
Detecção Precoce de Câncer/economia , Endoscopia/economia , Programas de Rastreamento/economia , MicroRNAs/economia , Neoplasias Gástricas/diagnóstico , Idoso , Grupo com Ancestrais do Continente Asiático , Análise Custo-Benefício , Detecção Precoce de Câncer/métodos , Humanos , Estudos Longitudinais , Masculino , Programas de Rastreamento/estatística & dados numéricos , MicroRNAs/sangue , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Medição de Risco , Sensibilidade e Especificidade , Singapura/epidemiologia , Neoplasias Gástricas/epidemiologia
18.
Anticancer Res ; 40(10): 5593-5600, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988883

RESUMO

BACKGROUND: Despite improved treatment for gastric cancer (GC), the prognosis of advanced disease remains poor. Further investigation of the oncogenic sequence for GC is needed. MATERIALS AND METHODS: The expression of TYRO3 protein tyrosine kinase in five GC cell lines was confirmed using western blotting. TYRO3 knockdown in GC cells, and bromodeoxyuridine and Transwell assays were used to examine the functions of TYRO3 in tumor proliferation and invasion. Finally, TYRO3 expression in 138 patients who underwent curative gastric resection for advanced GC (Union for International Cancer Control stage II/III) was tested by immunohistochemistry, and the association between prognosis and TYRO3 expression was analyzed. RESULTS: TYRO3 was detected at various levels in all the tested GC cell lines. Deleting TYRO3 significantly suppressed proliferation and invasion. Immunohistochemistry revealed TYRO3 expression was an independent prognostic factor for overall survival in patients with GC. CONCLUSION: TYRO3 appears to mediate tumor progression and predict prognosis of patients with GC.


Assuntos
Biomarcadores Tumorais/genética , Prognóstico , Receptores Proteína Tirosina Quinases/genética , Neoplasias Gástricas/genética , Idoso , Carcinogênese/genética , Linhagem Celular Tumoral , Movimento Celular/genética , Proliferação de Células/genética , Progressão da Doença , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica/genética , Invasividade Neoplásica/patologia , Proteínas Proto-Oncogênicas c-akt/genética , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologia
19.
Anticancer Res ; 40(10): 5807-5813, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988909

RESUMO

BACKGROUND/AIM: The survival benefit of negative resection margins in patients who undergo gastrectomy with positive peritoneal lavage cytology (CY1) is unknown. PATIENTS AND METHODS: We reviewed the medical records of 128 patients with CY1 but no other distant metastases who had undergone R1 gastrectomy, 21 of whom had positive margins. We compared overall survival (OS) according to margin status. RESULTS: The positive-margin group had poorer performance status scores (p=0.02), higher number of patients had undergone limited lymphadenectomy (p=0.01), had type 4 tumors (p=0.01), and undifferentiated type (p=0.02). Median OS was 19.0 and 16.9 months in the groups with negative and positive margins, respectively (HR=1.26, 95%CI=0.75-2.12, p=0.39). An inverse probability of treatment weighted analysis showed an OS of 13.1 and 11.9 months for the groups with negative and positive margins, respectively (HR=0.83, 95%CI=0.43-1.63, p=0.59). CONCLUSION: The prognoses of patients with CY1 and negative or positive margins may be equivalent.


Assuntos
Citodiagnóstico , Gastrectomia , Prognóstico , Neoplasias Gástricas/cirurgia , Feminino , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Lavagem Peritoneal/métodos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologia , Taxa de Sobrevida
20.
Z Gastroenterol ; 58(8): 754-760, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32785912

RESUMO

AIM: White globe appearance (WGA), a small white lesion with a globular shape that can be clearly visualized by magnifying endoscopy with narrow-band imaging (ME-NBI), was reported to be a reliable marker of early gastric cancer (EGC). However, we found that this endoscopic presentation could also be seen in non-cancerous tissues, especially in ulcerative lesions. This study aimed to further investigate the diagnostic value of WGA in differentiating non-cancerous lesions from EGC in ulcer-type cases. MATERIALS AND METHODS: We retrospectively reviewed 54 cases of EGC and 155 cases of non-cancerous lesions in this study, all of which had endoscopic imaging data of ME-NBI scanning and pathological data of biopsy or resected specimens. The correlation of the prevalence of WGA and ulcerative lesions, as well as the characteristics of WGA between the 2 groups were analyzed in this study. RESULTS: WGA was more common in ulcerative lesions (27.6 %, 21/76) than in non-ulcerative lesions (3.8 %, 5/133) (p < 0.001) in our study. In the ulcerative cases, no significant difference in prevalence of WGA was observed between EGC and non-cancerous lesions (p = 0.532). Compared with WGA in EGC, WGA in non-cancerous lesions tended to show the characteristic of tree-branch-like vessels on globular shape (p < 0.001). CONCLUSIONS: WGA is more likely to occur in ulcerative lesions, and the presence of WGA alone cannot distinguish EGC from non-cancerous lesions in ulcer-type cases. In WGA-positive tissue, tree-branch-like vessels of globular shape may provide a certain clinical value in diagnosis of non-cancerous lesions or EGC.


Assuntos
Gastroscopia/métodos , Neoplasias Gástricas/diagnóstico , Úlcera/diagnóstico , Humanos , Imagem de Banda Estreita/métodos , Estudos Retrospectivos , Úlcera/epidemiologia
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