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Challenges and Opportunities in Gastric Cancer

Challenges and Opportunities in Gastric Cancer

Arantes, P. E., Fernandes, G., Silva, D., Coimbra, F. J. F., Calsavara, V. F., Tiengo, T., & Curado, M. P. (2023)


Background: Gastric cancer was the fourth cause of cancer-related deaths in 2020 in the worldThe aim of this study was to describe the characteristics of patients with gastric adenocarcinoma Stage I describing clinical, pathological, and neoadjuvant staging in a prospective cohort at A.C. Camargo Cancer Center (ACCCC).

Methods: Sixty-three patients with Stage I gastric adenocarcinoma treated at ACCCC were evaluated for clinical, pathological, and clinical Stages. For the comparison between the clinical staging and the post-treatment one (surgical and neoadjuvant): tumor (T) and lymph nodes (N) were evaluated.

Results: Of the 63 patients, 29/63 (46%) were clinical Stage I, and 34/63 (54%) were initially staged as clinical Stage II and III that migrated to Stage I after surgical and neoadjuvant treatment. As for the clinical aspects, 36/63 patients (57%) were men with an average age of 58.7 years, 63% patients were Caucasian and 83% (52) had private medical insurance. In the endoscopic reports, 68.3% (n=43) of the lesions were ulcerated and the histological type, 55.6% (n=35) were diffuse. Patients treated with neoadjuvant therapy had a 100% reduction of tumors T3/T4 to T1/T2 (p<0.001) and 78.5% of the regional lymph nodes, N+ to N0. (p=0.001).

Conclusion: The neoadjuvant therapy on patients with gastric adenocarcinoma led to significant tumor (T) and regional lymph nodes (N) regressions, thus, increasing the migration of cases from T3/T4 to T1 /T2 and N+ to N0 in this cohort.

Barukčić, I. (2023)


Background—Helicobacter pylori (HP) infection has been repeatedly reported to be associated with human gastric cancer (GC). However, Epstein Bar virus (EBV) has been found in gastric cancer tissues too. It is therefore not surprising that it proved difficult to establish a causal relationship between Helicobacter pylori and gastric cancer. A systematic review and meta-analysis of observational studies was performed to re-investigate the relationship between Helicobacter pylori and gastric cancer.

Material and methods—The electronic database PubMed was searched for titles and abstracts of studies which investigated the relationship between HP and GC. Four eligible Japanese studies were included in this meta-analysis (196 incident gastric cancers among a total of 14792 individuals). The data available were analysed by new statistical methods. This study considers 5% as a reasonable cut-off for statistical significance.

Results—The studies reviewed provided highly significant evidence that a HP infection is a necessary condition of GC. In everyday language, without a helicobacter pylori infection, no human gastric cancer (P Value < .004). In the same respect, the causal relationship between HP and GC was highly significant too.

Conclusion—In a systematic review and meta-analysis, it was possible to establish a causal relationship between HP and GC. Helicobacter pylori is the cause of human gastric cancer.

Yin, C., Nan, Y., & Yang, J. (2023)


Background: GLUT-1 expression is the crucial parameter affecting gastric cancer 18-FDG absorption is still controversial. This study is to explore the significance of GLUT-1 in gastric cancer 18-FDG SPECT.

Material/Methods: The gastric cancer samples of 134 patients with preoperative 18-FDG SPECT were assessed by GLUT-1 immunohistochemi­cal staining. The clinicopathological information of enrolled patients were analyzed with univariate and regression analyses.

Results: The SUVmax in positive GLUT-1 expression was significantly higher than that in negative expression (5.136±3.088 vs 4.003±3.604, p=0.004). Tumor diameter (OR 1.415, p=0.005) and GLUT-1 expression level(OR 1.683, p=0.041) were the factors associated with imaging results by visual assessment, independently. Tumor diameter was independent factor associated with SUVmax in positive imaging cases (p=0.029). Tumor diameter(p=0.003) and tumor differentiation(p=0.026) were independent factors related to SUVmax in differentiated carcinoma cases.

Conclusions: GLUT-1 expression level is major factor determining 18-FDG uptake of gastric cancer on SPECT. It is necessary to verify the result with PET/CT. Further investigation on analysis GLUT-1 expression in lesions of gastric cancer metastases and recurrences is required.

Hays, P. (2022)


Cancer stems cells are cells in tumors that have self-renewing capabilities and proliferation, and are partly responsible for tumor growth, metastasis and drug resistance, and have been associated with multidrug resistance and epithelial-mesenchymal transition. mRNA stemness index or mRNAsi is a machine learning tool that uses the application of algorithms to find associations between cancer stemness and tumor prognostic signatures. mRNAsi predicts gene mutation status and identifies tumor signaling pathways. Clinical tier grading is a common feature for stratifying the presenting features and symptoms of patients in several diseases. This study is a review article that summarizes studies in lung cancer, gastric cancer, hepatocellular carcinoma and glioblastoma that use mRNA stemness index machine learning tools to identify differentially expressed genes, characterize the tumor microenvironment and tumor mutational burden, and determine clinical endpoints. A prognostic signature is shown in this paper as determined by mRNAsi high and low values, and a clinical tier grading system is proposed that categorizes cancer stemness presenting characteristics. This clinical grading tier system demonstrates a relationship between cancer stemness and immune checkpoint inhibitor efficacy. This type of tiered system for cancer patients and the accompanying workflow proposed may prove useful to oncologists, and has not been performed before, and is unique in the literature.

Lam, K., & Lau, G. (2023)


Background and Aim: Gastric intestinal metaplasia (GIM) is precancerous with a worldwide prevalence of 25%. Eradicating Helicobacter pylori prevented about half of gastric cancers; failure to prevent the rest was attributed to GIM. GIM is irreversible and often extensive. There is no treatment. Existing endoscopic mucosal resection (EMR) is designed to treat early gastric cancer of usually <2 cm. A two‐endoscope technique of EMR for extensive GIM had been designed and successfully applied. Our aim is to describe the technique in detail.

Two-endoscope technique of endoscopic mucosal resection: Patients with histologically confirmed moderate to severe GIM (operative link on GIM [OLGIM] classification) received the treatment in a daycare center. Chromoendoscopy with methylene blue was first performed to disclose and mark the GIM. Submucosal saline injections were used to lift the stained mucosa to form multiple safety cushions, which were then transformed into artificial polyps by suction and ligation, using a cap for ligation of esophageal varices. EMRs were then achieved by snare polypectomy. By rotating two gastroscopes, one designated to perform lift and snare and the other to perform suction and ligation, cycles of lift–ligate–snare were carried out until all stained mucosa was removed. Assessment chromoendoscopy with ≥seven biopsies was performed at 6 months.

Results: A total of 227 EMRs were performed in 40 patients, with a median of 3.5 per patient. Bleeding was uncommon and minimal. Gastric perforation ascribable to loss of a safety cushion occurred in one patient. Chromoendoscopy at 6 months in 36 willing patients showed no recurrence of GIM.

Conclusion: The two‐endoscope technique of EMR for GIM was essentially safe and effective, with no recurrence at 6 months. It could be performed by endoscopists with standard skills.