1,388 results on '"Digestive System Neoplasms"'
Search Results
2. Patent Issued for Methods of treating gastrointestinal stromal tumors (USPTO 12059411).
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GASTROINTESTINAL stromal tumors ,INVENTORS ,DIGESTIVE system diseases ,SOFT tissue tumors ,PROTEIN kinase inhibitors ,C-kit protein - Abstract
The article focuses on the issuance of a patent to Deciphera Pharmaceuticals for new methods of treating gastrointestinal stromal tumors (GIST). Topics include the prevalence and genetic mutations associated with GIST, the evolution of targeted therapies such as imatinib, and the challenges posed by drug resistance due to secondary mutations.
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- 2024
3. Patent Issued for Methods of treating gastrointestinal stromal tumors (USPTO 12023326).
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GASTROINTESTINAL stromal tumors ,INVENTORS ,SOFT tissue tumors ,DIGESTIVE system diseases ,PROTEIN kinase inhibitors ,C-kit protein - Abstract
A patent has been issued for methods of treating gastrointestinal stromal tumors (GIST) by administering ripretinib or a pharmaceutically acceptable salt thereof. GISTs are rare tumors that occur in the gastrointestinal tract, with mutations in KIT and PDGFRA genes being common. Imatinib is a commonly used treatment, but resistance can develop. The patent describes various dosing regimens for ripretinib in patients whose tumors have progressed or who are intolerant to imatinib. The methods aim to provide effective treatment options for GIST patients. [Extracted from the article]
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- 2024
4. Patent Issued for Methods of treating gastrointestinal stromal tumors (USPTO 12023327).
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GASTROINTESTINAL stromal tumors ,INVENTORS ,SOFT tissue tumors ,DIGESTIVE system diseases ,PROTEIN kinase inhibitors ,C-kit protein - Abstract
A patent has been issued to Deciphera Pharmaceuticals LLC for methods of treating gastrointestinal stromal tumors (GIST). GISTs are rare tumors that occur in the gastrointestinal tract, with the majority of cases caused by mutations in the KIT or PDGFRA genes. The patent describes the use of ripretinib, a tyrosine kinase inhibitor, as a potential treatment for advanced GIST in patients who have progressed from or are intolerant to previous therapies such as imatinib. The patent outlines various dosing regimens for ripretinib and claims that the treatment can provide about 15 months of survival in patients who have received at least 4 lines of prior therapy. [Extracted from the article]
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- 2024
5. Patent Issued for Methods of treating gastrointestinal stromal tumors (USPTO 12023325).
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GASTROINTESTINAL stromal tumors ,INVENTORS ,SOFT tissue tumors ,DIGESTIVE system diseases ,PROTEIN kinase inhibitors ,C-kit protein - Abstract
A patent has been issued to Deciphera Pharmaceuticals LLC for methods of treating gastrointestinal stromal tumors (GIST). GISTs are rare tumors that occur in the gastrointestinal tract, with the majority of cases caused by mutations in the KIT or PDGFRA genes. The patent describes a method of treating advanced GIST by administering ripretinib, a tyrosine kinase inhibitor, to patients who have previously been treated with imatinib. The treatment aims to provide more than 3 months of progression-free survival in patients. The patent also includes various dosage regimens for ripretinib administration. [Extracted from the article]
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- 2024
6. Patent Issued for Combination therapy for the treatment of gastrointestinal stromal tumor (USPTO 11986463).
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A patent has been issued for a combination therapy for the treatment of gastrointestinal stromal tumor (GIST). The therapy involves the use of a c-KIT inhibitor in combination with an inhibitor of the MAPKAP kinase signaling pathway. The combination has been shown to lead to cell death, apoptosis, and prolonged cell stasis of GIST cells, as well as enhanced tumor regression in vivo. The therapy is particularly effective for GIST patients who are resistant to imatinib treatment. [Extracted from the article]
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- 2024
7. Correlation analysis between serum bile acid profiles and colonic neoplasms.
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COLON tumors ,BILE acids ,BLOOD serum analysis ,DIGESTIVE system diseases ,STATISTICAL correlation - Abstract
A recent study published in Cancer Screening and Prevention explores the relationship between serum bile acid (BA) profiles and colonic neoplasms. The study analyzed the serum BA profiles of 135 individuals with no abnormalities, 204 patients with colonic polyps, and 92 patients with colonic cancer. The findings suggest that there may be a correlation between serum BA levels and the incidence and progression of colonic neoplasms. However, further research is needed to fully understand the role of BA components in colonic neoplasms. [Extracted from the article]
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- 2024
8. Effect of lockdown on digestive system cancer care amongst older patients during the first wave of COVID-19: The CADIGCOVAGE multicentre cohort study
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Nathalie Ganne, François Hemery, Laurent Quero, Frédéric Prat, Thomas Aparicio, Nicola de Angelis, Gilles Galula, Richard Layese, Marc-Antoine Benderra, Atanas Pachev, Christophe Tournigand, Elena Paillaud, Florence Canouï-Poitrine, Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de santé publique [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), CHU Henri Mondor, Cooperator Multidisciplinary Oncology Group (GERCOR), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-IFR10, Département de Santé Publique [Avicenne], Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Cochin [AP-HP], Service d'Oncologie médicale [CHU Tenon], CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), IMRB - CEPIA/'Clinical Epidemiology And Ageing : Geriatrics, Primary Care and Public Health' [Créteil] (U955 Inserm - UPEC), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Gestionnaire, HAL Sorbonne Université 5
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Male ,Paris ,medicine.medical_specialty ,Digestive cancer ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,Disease ,Digestive System Neoplasms ,Health Services Accessibility ,03 medical and health sciences ,0302 clinical medicine ,[SDV.CAN] Life Sciences [q-bio]/Cancer ,Internal medicine ,Lockdown ,Older patients ,medicine ,Humans ,030212 general & internal medicine ,Pandemics ,Aged ,Retrospective Studies ,Aged, 80 and over ,Public health ,Hepatology ,SARS-CoV-2 ,business.industry ,Mortality rate ,Gastroenterology ,COVID-19 ,Cancer ,Emergency department ,medicine.disease ,3. Good health ,Oncology ,030220 oncology & carcinogenesis ,Communicable Disease Control ,Cohort ,Female ,Observational study ,business ,Cohort study - Abstract
International audience; Background: The coronavirus disease 2019 (COVID-19) pandemic has had a dramatic impact on cancer diagnosis and treatment. Most patients newly diagnosed with digestive system cancer are aged 65 and over. Methods: We performed a retrospective, observational, multicentre cohort study based on prospectively collected electronic health records. All adults aged 65 or over and having been newly treated for a digestive system cancer between January 2018 until August 2020 were enroled. Results: Data on 7882 patients were analysed. The first COVID-19 lockdown period led to a 42.4% decrease in newly treated digestive system cancers, and the post-lockdown period was associated with a 17% decrease. The decrease in newly treated digestive system cancer did not differ as a function of age, sex, comorbidities, primary tumour site, and disease stage. The proportion of patients admitted to an emergency department increased during the lockdown period. We do not observe a higher 3-month mortality rate in 2020, relative to the corresponding calendar periods in 2018 and 2019. Conclusion: To avoid a decrease in newly treated cancers during future lockdown periods, access to healthcare will have to be modified. Although 3-month mortality did not increase in any of the patient subgroups, the 2020 cohort must be followed up for long-term mortality.
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- 2022
9. Patent Issued for Methods of treating gastrointestinal stromal tumors (USPTO 11813251).
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GASTROINTESTINAL stromal tumors ,MEDICAL personnel ,PROTEIN-tyrosine kinase inhibitors ,C-kit protein ,PATENTS ,GENETIC counseling - Abstract
A patent has been issued to Deciphera Pharmaceuticals LLC for methods of treating gastrointestinal stromal tumors (GIST). GISTs are rare tumors that occur in the gastrointestinal tract, with the majority of cases caused by mutations in the KIT or PDGFRA genes. The patent describes a method of treating advanced GIST by administering ripretinib, a tyrosine kinase inhibitor, to patients who have previously been treated with imatinib. The treatment aims to provide more than 6 months of progression-free survival in patients. This patent provides valuable information for researchers and healthcare professionals studying and treating GIST. [Extracted from the article]
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- 2023
10. Effects of preoperative frailty on outcomes following surgery among patients with digestive system tumors: A systematic review and meta-analysis
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Li Chen, Lingyu Ding, Qin Xu, Xinyi Xu, Shuqin Zhu, Kang Zhao, Jinling Lu, Hongxia Hua, and Hanfei Zhu
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medicine.medical_specialty ,Frailty ,business.industry ,MEDLINE ,General Medicine ,Digestive System Neoplasms ,Severity of Illness Index ,Confidence interval ,Surgery ,Postoperative Complications ,Increased risk ,Oncology ,Quality of life ,Risk Factors ,Meta-analysis ,Relative risk ,Quality of Life ,Humans ,Medicine ,Functional status ,Risk factor ,business - Abstract
Background Frailty is common in patients who undergo digestive system tumor surgery. This review aimed to explore the effects of preoperative frailty on multiple outcomes following surgery among patients with digestive system tumors. Methods PubMed (Medline), Embase, Web of Science, and other databases were searched from the inception of each database to April 2021. Meta-analysis or qualitative synthesis was performed to examine the relationship between preoperative frailty and adverse postoperative outcomes. Results A total of 29 studies encompassing 122,548 patients were included. Through meta-analysis, frailty was associated with an increased risk of total complications (risk ratio [RR] 1.44; 95 % confidence interval [CI] 1.39 to 1.50), major complications (RR 1.72; 95 % CI 1.51 to 1.95), 30-d mortality (RR 2.40; 95 % CI 2.14 to 2.70), and 5-year mortality (RR 1.74; 95 % CI 1.35 to 2.24). Through qualitative synthesis, compared with non-frail patients, two studies found that frail patients had a worse quality of life, and three studies reported that frail patients experienced greater rates of non-home discharge. However, two studies demonstrated inconsistent conclusions regarding the relationship between frailty and functional status. Conclusions Preoperative frailty was an important risk factor for multiple adverse postoperative outcomes of patients with digestive system tumors, including objective clinical outcomes and patient-centered outcomes. Future studies focusing on the effects of frailty on patient-centered outcomes such as quality of life and functional status are needed.
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- 2021
11. Prognostic Value of ALP and LDH in Periampullary Carcinoma Patients Undergoing Surgery
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Chao Dang, Yun-Hua Deng, and Ren-Yi Qin
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Adult ,Male ,musculoskeletal diseases ,Prognostic factor ,medicine.medical_specialty ,Digestive System Neoplasms ,digestive system ,Biochemistry ,Gastroenterology ,Pancreaticoduodenectomy ,chemistry.chemical_compound ,stomatognathic system ,Predictive Value of Tests ,Lactate dehydrogenase ,Internal medicine ,Biomarkers, Tumor ,Genetics ,medicine ,Humans ,Statistical analysis ,Risk factor ,Aged ,Aged, 80 and over ,L-Lactate Dehydrogenase ,business.industry ,musculoskeletal, neural, and ocular physiology ,Carcinoma ,Cancer ,Middle Aged ,Alkaline Phosphatase ,Prognosis ,musculoskeletal system ,medicine.disease ,chemistry ,Preoperative Period ,Cancer cell ,Alkaline phosphatase ,Female ,Periampullary carcinoma ,business ,Follow-Up Studies - Abstract
OBJECTIVE Conversion of normal cells to cancer cells is often accompanied by abnormal synthesis of serum enzymes. Both alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) have been reported to have prognostic value in a variety of malignancies. The aim of this study was to investigate the effect of preoperative serum ALP and LDH levels on the prognosis of patients with periampullary carcinoma who underwent pancreatoduodenectomy (PD). METHODS According to the preoperative ALP or LDH values, 856 cancer patients receiving PD treatment from January 2001 to January 2019 were divided into high-ALP group and low-ALP group or high-LDH group and low-LDH group. Statistical analysis was carried out to study the differences between the high-ALP and low-ALP groups or the high-LDH and low-LDH groups. Furthermore, the possibility of preoperative ALP or LDH as prognostic factor of periampullary carcinoma was investigated. RESULTS In both the high-ALP and the high-LDH groups, the prognosis of patients with periampullary carcinoma who underwent PD was worse than that of the low-ALP and low- LDH group. Even through risk factor analysis, it was found that preoperative ALP and LDH could be independent prognostic factor for patients with periampullary carcinoma who underwent PD. CONCLUSION Preoperative ALP or LDH is an independent risk factor for periampullary carcinoma.
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- 2021
12. Comprehensive analysis of proton pump inhibitors and risk of digestive tract cancers
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Jinghua Wang, Kehang Guo, Dongling Luo, Weihong Sha, Felix W. Leung, Hao Chen, Jun Yang, Lei Jiang, Zewei Zhuo, Huihuan Wu, Yunjiu Cheng, and Ruijie Zeng
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Cancer Research ,medicine.medical_specialty ,Time Factors ,Colorectal cancer ,business.industry ,Cancer ,Proton Pump Inhibitors ,Esophageal cancer ,Digestive System Neoplasms ,medicine.disease ,Risk Assessment ,Confidence interval ,Defined daily dose ,Oncology ,Risk Factors ,Internal medicine ,Pancreatic cancer ,Relative risk ,medicine ,Humans ,Bradford Hill criteria ,business - Abstract
Background For the past two decades, dispute on whether proton pump inhibitor (PPI) leads to digestive tract cancer remains, and emerging studies in recent years still demonstrate inconsistent results, which continues to perpetuate concerns over the safety of PPI use. We performed a systematic review and meta-analysis, with comprehensive evaluation by Bradford Hill criteria of causation, to assess the effect of PPI use on digestive tract cancers. Methods Medline, Embase and Web of Science databases were searched for observational studies published up to 15th January 2021. Pooled relative risks (RRs) were estimated via random effects models. Cumulative defined daily dose- and duration-risk relationships using restricted cubic spline and fractional polynomial models were investigated. Bradford Hill criteria were applied to evaluate causation. PROSPERO Registration: CRD42020211103. Results Thirty-two publications containing 4,355,254 participants were included. PPI use is associated with an increased risk of overall digestive tract cancers (RR = 1.63, 95% confidence interval (CI) 1.33 to 2.00). PPI use is correlated with increased risks of gastric cancer (RR = 1.78, 95% CI 1.38 to 2.31), pancreatic cancer (RR = 1.72, 95% CI 1.05 to 2.82) and liver cancer (RR = 1.62, 95% CI 1.04 to 2.52), but not of esophageal cancer (RR = 2.06, 95% CI 0.65 to 6.57) and colorectal cancer (RR = 1.24, 95% CI 0.93 to 1.66). The association between PPI and digestive tract cancers is stronger in people with minimal exposure. When cumulative defined daily dose or duration increases, the risks decline and become non-significant. Evaluation by Bradford Hill criteria indicates weak evidence of causation. Conclusions A causal relationship between PPI use and digestive tract cancers is not supported by the evidence in the current review. Concerns over carcinogenic side-effects of PPI might be unfounded.
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- 2021
13. Characteristics of 1270 Chinese sibling pairs with cancer
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Kai Zhang, Ju Liu, Zhijian Xu, Jian Yin, and Yiwei Liu
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Oncology ,Adult ,Male ,Cancer Research ,medicine.medical_specialty ,China ,Lung Neoplasms ,Sibling ,Family history ,Breast Neoplasms ,Digestive System Neoplasms ,Breast cancer ,Age Distribution ,Sex Factors ,Internal medicine ,Neoplasms ,Endocrine Gland Neoplasms ,Genetics ,medicine ,Humans ,Sex Distribution ,Lung cancer ,Thyroid cancer ,Malignant disease ,Early Detection of Cancer ,RC254-282 ,Aged ,Cancer ,Cervical cancer ,Aged, 80 and over ,business.industry ,Research ,Siblings ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Middle Aged ,Genetic service ,medicine.disease ,Screening ,Female ,Liver cancer ,business ,Urogenital Neoplasms - Abstract
Background Previous research found that the cancer history of an individual’s sibling may be a better indicator than that of the parents. We aim to provide recommendations for opportunistic screening for individuals whose sibling had been diagnosed with cancer. Methods During the physical examination in Cancer Hospital, Chinese Academy of Medical Sciences, 43,300 people were asked if they have at least two siblings who developed cancer. Results A total of 1270 sibling-pairs from 766 families developed cancer, including 367 pairs of brothers (Bro-pairs), 368 pairs of sisters (Sis-pairs), and 535 pairs of brother-and-sister (BroSis-pairs). The mean ages at diagnosis of cancer for the three groups were from 58 to 62 years. More than half of Bro-pairs (55.3%) or Sis-pairs (51.1%) had cancer from the same systemic origin, and more than a quarter of Bro-pairs (28.1%) and Sis-pairs (37.2%) developed the same type of cancer. However, only 36.0% of BroSis-pairs developed cancers from the same systemic origin, and 18.9% developed the same type of cancer. In Bro-pairs and BroSis-pairs, lung cancer and digestive system cancer were the most common cancers, while in Sis-pairs, breast cancer, lung cancer, cervical cancer, liver cancer and thyroid cancer were the most common ones. Conclusions If an individual’s sibling is diagnosed with cancer, the individual should consider participating in opportunistic screening annually, especially for lung cancer and digestive system cancers for both sexes. For sisters, breast cancer, cervical cancer and thyroid cancer should be screened early. Additionally, genetic services are essential for individuals who have siblings with cancer.
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- 2021
14. Programmed cell death protein-1 inhibitors in the treatment of digestive system tumors in Chinese population: an observational study of effectiveness and safety
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Linlin Chang, Wei Yang, Weijiang Yu, Jinhua Chen, Qianqian Guo, and Wenzhou Zhang
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Male ,Advanced and Specialized Nursing ,China ,medicine.medical_specialty ,Proportional hazards model ,business.industry ,Incidence (epidemiology) ,Programmed Cell Death 1 Receptor ,Therapeutic effect ,Cancer ,Digestive System Neoplasms ,Malignancy ,medicine.disease ,Anesthesiology and Pain Medicine ,Internal medicine ,Pancreatic cancer ,medicine ,Humans ,Female ,Adverse effect ,Prospective cohort study ,business ,Immune Checkpoint Inhibitors ,Retrospective Studies - Abstract
BACKGROUND Tumor of the digestive system is a common malignancy with high morbidity and mortality. Although programmed cell death-1 (PD-1) inhibitors have become an effective treatment strategies for many kinds of tumors, there is still some uncertainty in digestive tumors, including: (I) therapeutic effects of PD-1 inhibitors are relatively limited; (II) responses of digestive system tumors to immunotherapies are highly heterogeneous. In the present study, we investigated the outcomes of PD-1 inhibitors for digestive system tumors in Chinese patients to analyze factors that may affect the effects of immunotherapies in digestive system tumors. METHODS Data were obtained from the Hospital Information System (HIS) of the Department of Digestive Oncology (Henan Cancer Hospital) between January 2019 and December 2019. Inclusion criteria included patients receiving the same PD-1 inhibitor continuously for advanced or recurrent/metastatic digestive system tumors. Indicators including age, sex, clinical diagnosis, height, weight, gene status, PD-1 inhibitors, treatment regimen, medication cycle, efficacy evaluation results, and adverse reactions were analyzed retrospectively. The clinical outcomes were progression-free survival (PFS) and safety. RESULTS A total of 2,767 patients were discharged from HIS, of which 64 (37 male/27 female) were included in this study. Thirty-eight (59.4%) of the patients were aged
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- 2021
15. Mixed adenoneuroendocrine carcinomas of stomach and ampulla of vater after curative-intent resection: a single center cases series
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Xian-Ze Xiong, Bei Li, Jiong Lu, Yu-Long Cai, and Sishu Yang
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Ampulla of Vater ,medicine.medical_specialty ,RC799-869 ,Adenocarcinoma ,Single Center ,Gastroenterology ,Metastasis ,Stomach Neoplasms ,Internal medicine ,medicine ,Humans ,Stage (cooking) ,Retrospective Studies ,business.industry ,Research ,Stomach ,General Medicine ,Hepatology ,Diseases of the digestive system. Gastroenterology ,medicine.disease ,Prognosis ,medicine.anatomical_structure ,Digestive system neoplasms ,Lymph ,business ,Mixed adenoneuroendocrine carcinomas - Abstract
Background Mixed adenoneuroendocrine carcinoma is a rare clinical manifestation, especially in the gastric and ampullary. The purpose of this study was to investigate the clinicopathological features and prognosis of mixed adenoneuroendocrine carcinoma in the gastric and ampullary and summarize related treatment suggestions. Methods In all, 32 cases of mixed adenoneuroendocrine carcinoma in the gastric and ampullary that were diagnosed from resected specimens were analyzed from 2009 to 2015. The corresponding demographic, clinicopathological and survival data were retrospectively reviewed. Results The 1-year, 3-year and 5-year survival rates were 78.1%, 28.1 and 9.4%, respectively, and the median overall survival was 28.0 months. In all, 75.0% (24/32) had lymph node metastasis at the time of initial diagnosis. A multivariate analysis revealed that TNM stage (HR 6.444 95%CI 1.477–28.121 P = 0.013), lymph nodes metastasis (HR10.617 95%CI 1.409–79.997 P = 0.022), vascular invasion (HR 5.855 95%CI 1.719–19.940 P = 0.005), grade of the adenocarcinoma component (HR 3.876 95%CI 1.451–10.357 P = 0.007) and CD56 positivity (HR 0.265 95%CI 0.100–0.705 P = 0.008) were independent predictors of overall survival. Conclusions Mixed adenoneuroendocrine carcinoma is an aggressive clinical entity with a poor prognosis. Taking both the neuroendocrine component and the adenocarcinoma component into consideration of optimal treatment is strongly recommended.
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- 2021
16. Clinicopathological features and lymph node and distant metastasis patterns in patients with gastroenteropancreatic mixed neuroendocrine‐non‐neuroendocrine neoplasm
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Lin Shen, Panpan Zhang, Yu Sun, Ming Lu, Xiaotian Zhang, Jian Li, Zhi Peng, Yan Li, Xicheng Wang, Jun Zhou, Zhihao Lu, Jie Li, and Zhongwu Li
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Male ,0301 basic medicine ,Cancer Research ,Esophageal Neoplasms ,Digestive System Neoplasms ,Gastroenterology ,Metastasis ,0302 clinical medicine ,distant metastasis ,Duodenal Neoplasms ,Lymph node ,lymph nodes metastasis ,RC254-282 ,Original Research ,Cancer Biology ,medicine.diagnostic_test ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Middle Aged ,mixed neuroendocrine‐non‐neuroendocrine neoplasm ,Primary tumor ,Neuroendocrine Tumors ,Biliary Tract Neoplasms ,medicine.anatomical_structure ,Oncology ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,gastroenteropancreatic ,Carcinoma, Squamous Cell ,Adenocarcinoma ,Female ,Lymph ,Colorectal Neoplasms ,medicine.medical_specialty ,mixed adenoneuroendocrine carcinoma ,03 medical and health sciences ,Stomach Neoplasms ,Internal medicine ,Biopsy ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Pathological ,Retrospective Studies ,business.industry ,medicine.disease ,Neoplasms, Complex and Mixed ,Squamous carcinoma ,Pancreatic Neoplasms ,030104 developmental biology ,Lymph Node Excision ,business - Abstract
Objective Owing to its rarity and heterogeneity, the biological behavior and optimal therapeutic management of mixed neuroendocrine‐non‐neuroendocrine neoplasm (MiNEN) have not been established. Herein, we aimed to evaluate the clinicopathological characteristics and metastatic patterns of MiNEN. Methods Continuous clinicopathological data of MiNEN patients treated at our hospital were retrospectively collected and analyzed. Results This study had enrolled 169 patients since January 2010 to January 2020. Pathological components were assessed in 129 patients with MiNEN (76.3%), and a focal (non‐)neuroendocrine component was observed in 40 patients (23.7%, Regional lymph nodes and distant metastases of MiNEN exhibited distinct metastatic patterns. We recommend that patients with MiNEN undergo aggressive multidisciplinary oncologic management, and an optimal modality should be established based on the NEC component.
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- 2021
17. A Most Unusual Polyposis
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Frederick Weber, Mahmoud Aryan, and Haider A. Mejbel
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medicine.medical_specialty ,Hepatology ,Genetic syndromes ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Colonic Polyps ,Ganglioneuroma ,Colonoscopy ,Multiple Endocrine Neoplasia Type 2b ,Digestive System Neoplasms ,Dermatology ,Abdominal Pain ,Endoscopy ,Young Adult ,medicine ,Humans ,Female ,Multiple Polyps ,business - Published
- 2022
18. Systematic analysis of molecular characterization and clinical relevance of m6A regulators in digestive system pan-cancers
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Lan Jin, Yongtian Zhao, Yun Yang, Tiankuo Kou, Ruizhi Chai, Yingchi Yang, Zhongtao Zhang, Dongfang Wu, and Zhigang Bai
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Adenosine ,business.industry ,Stomach ,Cancer ,Cell cycle ,Digestive System Neoplasms ,medicine.disease_cause ,medicine.disease ,General Biochemistry, Genetics and Molecular Biology ,Gene Expression Regulation, Neoplastic ,Pancreatic Neoplasms ,medicine.anatomical_structure ,Drug development ,Tumor progression ,Pancreatic cancer ,Biomarkers, Tumor ,Tumor Microenvironment ,Cancer research ,medicine ,Humans ,Pancreas ,Carcinogenesis ,business ,Digestive System ,Original Research - Abstract
Digestive system tumors, which mainly include esophagus, stomach, colorectum, liver, pancreas, bile duct, and some other tumors, often have a poor prognosis. N6-methyladenosine (m6A) has critical functions in development and tumorigenesis and may help improve the molecular mechanisms of digestive system tumors. However, current understanding of the reconstitution of m6A in digestive system tumors is far from comprehensive. Herein, this study systematically analyzed multi-layered genomic characteristics and clinical relevance of m6A regulators in 1906 patients involving seven digestive system tumor types. We discovered that m6A regulators showed extensive genetic changes and highly consistent expression regulation. The m6A expression was closely related to the activity of cancer pathways. At the same time, we also identified m6A regulators significantly related to the common cancer pathways of digestive system tumors and specific cancer pathways of digestive tract and digestive glands. These cancer pathways may explain the prognostic differences of patients with digestive tract tumors. In addition, m6A regulators demonstrated strong potential in prognostic stratification and drug development, especially in multiple research cohorts on pancreatic cancer, pointing to a strong prognostic stratification capability of m6A regulators. Finally, a m6A scoring model significantly related to highly active ubiquitin-mediated proteolysis, mismatch repair, cell cycle, ebasal transcription factors was constructed and had a strong prognostic stratification ability in digestive gland tumors. The score showed a significant negative correlation with the tumor immune microenvironment. This study demonstrated that the similarities and difference of the action mechanism m6A regulators in the digestive tract and digestive gland tumor progression could guide potential drug development.
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- 2021
19. Associations between hepatitis B virus exposure and the risk of extrahepatic digestive system cancers: A hospital‐based, case–control study (SIGES)
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Hui Wang, Xin‐Zu Chen, Xiao‐Long Chen, Wei‐Han Zhang, Kai Liu, You‐Juan Wang, Huai‐Rong Tang, Jian‐Kun Hu, and the SIGES research group
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Male ,0301 basic medicine ,Cancer Research ,HBsAg ,Epidemiologic Factors ,Digestive System Neoplasms ,medicine.disease_cause ,Gastroenterology ,digestive system cancer ,Serology ,0302 clinical medicine ,Risk Factors ,Medicine ,RC254-282 ,Original Research ,Medical record ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Middle Aged ,Anus Neoplasms ,Hepatitis B ,Biliary Tract Neoplasms ,Oncology ,030220 oncology & carcinogenesis ,Colonic Neoplasms ,Female ,Cancer Prevention ,China ,medicine.medical_specialty ,Protective factor ,03 medical and health sciences ,Stomach Neoplasms ,Internal medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Hepatitis B virus ,Hepatitis B Surface Antigens ,Rectal Neoplasms ,business.industry ,Case-control study ,Cancer ,case–control study ,medicine.disease ,oncovirus ,digestive system diseases ,infection ,Pancreatic Neoplasms ,030104 developmental biology ,Propensity score matching ,business ,hepatitis B virus - Abstract
Objectives This case–control study was aimed to investigate associations between HBV infection and extrahepatic digestive system cancers. Methods The patients of gastric, small intestinal, colonic, rectal, anal, biliary tract, and pancreatic cancers were retrospectively collected between 2016.5 and 2017.12. Simultaneously, the healthy controls were collected from the health check‐up registry, and cancer‐free status was confirmed based on medical records. Propensity score matching was performed to reduce bias. Multinomial logit model and conditional logistic regression model were used to assess the risk of individual cancer according to HBV serological markers and classifications. Results Totally, 4748 patients involving seven cancers, and 57,499 controls were included. After matching, HBsAg was associated with increased risk of gastric cancer (aOR = 1.39, 95% CI: 1.05–1.85), and anti‐HBs served as a protective factor for gastric (aOR = 0.72, 95% CI: 0.61–0.85), colonic (aOR = 0.73, 95% CI: 0.60–0.89), rectal (aOR = 0.73, 95% CI: 0.63–0.85), and pancreatic (aOR = 0.58, 95% CI: 0.42–0.82) cancers. Compared to subgroups with non‐infection and vaccination status, inactive HBsAg carriers and active HBV infection subgroup were correlated with gastric carcinogenesis (aOR = 1.41, 95% CI: 1.03–1.93). However, no clear association was found between HBV infection and other cancers. Conclusions HBV infection was potentially associated with an increased risk of gastric cancer. The development mechanism of HBV‐associated gastric cancer needs to investigate further., This case–control study was aimed to investigate associations between HBV infection and extrahepatic digestive system cancers. Our study revealed that HBV infection was potentially associated with an increased risk of gastric cancer. However, because of the limited ability to establish a causal relationship for case–control study, large‐scale prospective cohort studies are urgencies, and the latent mechanism about HBV extrahepatic carcinogenesis needs to be investigated as well.
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- 2021
20. MiRNA-145 and Its Direct Downstream Targets in Digestive System Cancers: A Promising Therapeutic Target
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Tianlu Shi, Guojuan Shi, Yini Ma, and Xiu Cao
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Pharmacology ,business.industry ,Apoptosis ,Digestive System Neoplasms ,Cancer treatment ,Gene Expression Regulation, Neoplastic ,MicroRNAs ,Drug Discovery ,microRNA ,Biomarkers, Tumor ,Cancer research ,Humans ,Diagnostic biomarker ,Biomarker (medicine) ,Medicine ,business ,Function (biology) - Abstract
MicroRNAs (miRNAs) play a vital role in the onset and development of many diseases, including cancers. Emerging evidence shows that numerous miRNAs have the potential to be used as diagnostic biomarkers for cancers, and miRNA-based therapy may be a promising therapy for the treatment of malignant neoplasm. MicroRNA-145 (miR-145) has been considered to play certain roles in various cellular processes, such as proliferation, differentiation and apoptosis, via modulating the expression of direct target genes. Recent reports show that miR-145 participates in the progression of digestive system cancers, and plays crucial and novel roles in cancer treatment. In this review, we summarize the recent knowledge concerning the function of miR-145 and its direct targets in digestive system cancers. We discuss the potential role of miR-145 as a valuable biomarker for digestive system cancers and how miR-145 regulates these digestive system cancers via different targets to explore the potential strategy of targeting miR-145.
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- 2021
21. Clinical Stage of Cancer Affects Perioperative Mortality for Gastrointestinal Cancer Surgeries
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Katia Papalezova, John Bliton, Haejin In, John C. McAuliffe, Peter Muscarella, and Michael K. Parides
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Adult ,Male ,Oncology ,medicine.medical_specialty ,Databases, Factual ,Rectum ,Disease ,Digestive System Neoplasms ,Article ,03 medical and health sciences ,0302 clinical medicine ,Clinical Decision Rules ,Internal medicine ,medicine ,Humans ,Gastrointestinal cancer ,Stage (cooking) ,Digestive System Surgical Procedures ,Aged ,Neoplasm Staging ,Aged, 80 and over ,business.industry ,Stomach ,Carcinoma ,Age Factors ,Cancer ,Perioperative ,Middle Aged ,Prognosis ,medicine.disease ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Cohort ,Linear Models ,Female ,030211 gastroenterology & hepatology ,Surgery ,business - Abstract
Background The impact of the stage of cancer on perioperative mortality remains obscure. The purpose of this study was to investigate whether cancer stage influences 30-d mortality for gastric, pancreatic, and colorectal cancers. Methods Data were collected from the National Cancer Database for patients undergoing resections for cancers of the stomach, pancreas, colon, or rectum between 2004 and 2015. The main analysis was conducted among patients with cancer stages 1-3. A sensitivity analysis also included cancer stage 4. Descriptive statistics were used to compare the patients’ baseline characteristics. Generalized linear mixed models were used to evaluate the relationship between stage and 30-d mortality, controlling for other disease-, patient- and hospital-level factors. Pseudo R2 statistics (%Δ pseudo R2) were used to quantify the relative explanatory capacity of the variables to the model for 30-d mortality. All analyses were performed using SAS 9.4. Results The cohort included 24,468, 28,078, 176,285, and 64,947 patients with stomach, pancreas, colon, and rectal cancers, respectively. After adjusting for other variables, 30-d mortality was different by stage for all cancer types examined. The factor most strongly associated with 30-d mortality was age (%Δ pseudo R2 range 14%-39%). The prognostic impact of cancer stage (Stages 1, 2, or 3) on 30-d mortality was comparable to that of the Charlson comorbidity index. Conclusions Cancer stage contributes to explaining differences observed in short-term mortality for gastrointestinal cancers. Short-term mortality models would benefit by including more granular cancer stage, beyond disseminated status alone.
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- 2021
22. Researchers Submit Patent Application, "Methods And Kits For Screening Colorectal Neoplasm", for Approval (USPTO 20230193395).
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PATENT applications ,PATENT offices ,MEDICAL screening ,TUMORS ,DIGESTIVE system diseases - Published
- 2023
23. Recommendations on intervention for hepatobiliary oncological surgery during the COVID-19 pandemic
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García Botella, Alejandra, Gómez Bravo, Miguel Angel, Di Martino, Marcello, Gastaca, Mikel, Martín-Pérez, Elena, Sánchez Cabús, Santiago, Sánchez Pérez, Belinda, López Ben, Santiago, Rodríguez Sanjuán, Juan Carlos, López-Andújar, Rafael, Barrera, Manuel, Grupo colaborativo Cirugía-AEC-COVID-19, Balibrea, Jose M, Rubio-Pérez, Inés, Badia, Josep M, Martin-Antona, Esteban, Álvarez Peña, Estibaliz, Garcia-Botella, A, Álvarez Gallego, Mario, Martínez Cortijo, Sagrario, Pascual Migueláñez, Isabel, Pérez Díaz, Lola, Ramos Rodríquez, José Luis, Espín-Basany, Eloy, Sánchez Santos, Raquel, Guirao Garriga, Xavier, Aranda Narváez, José Manuel, and Morales-Conde, Salvador
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Oncological surgery ,030230 surgery ,Digestive System Neoplasms ,Artículo Especial ,Special Article ,03 medical and health sciences ,0302 clinical medicine ,COVID-19 infection, Cancer, Cirugía oncológica, Cáncer, Infección COVID-19, Oncological surgery, Pandemia, Pandemic ,Intervention (counseling) ,Intensive care ,Pandemic ,Health care ,Humans ,Medicine ,Infección COVID-19 ,Intensive care medicine ,Cancer ,Pandemia ,Infection Control ,business.industry ,Patient Selection ,Risk of infection ,General Engineering ,COVID-19 ,Cáncer ,Cirugía oncológica ,COVID-19 infection ,Surgical Oncology ,Surgery ,business ,Humanities - Abstract
The SARS-CoV-2 (COVID-19) pandemic requires an analysis in the field of oncological surgery, both on the risk of infection, with very relevant clinical consequences, and on the need to generate plans to minimize the impact on possible restrictions on health resources. The AEC is making a proposal for the management of patients with hepatopancreatobiliary (HPB) malignancies in the different pandemic scenarios in order to offer the maximum benefit to patients, minimising the risks of COVID-19 infection, and optimising the healthcare resources available at any time. This requires the coordination of the different treatment options between the departments involved in the management of these patients: medical oncology, radiotherapy oncology, surgery, anaesthesia, radiology, endoscopy department and intensive care. The goal is offer effective treatments, adapted to the available resources, without compromising patients and healthcare professionals safety. (C) 2020 AEC. Published by Elsevier Espana, S.L.U. All rights reserved.
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- 2021
24. Effect of multiple comorbidities on mortality in chronic obstructive pulmonary disease among Korean population: a nationwide cohort study
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Won-Kyung Cho, Youngmee Kim, and Ye-Jee Kim
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Male ,Lung Neoplasms ,Kaplan-Meier Estimate ,Comorbidity ,Digestive System Neoplasms ,Cohort Studies ,Pulmonary Disease, Chronic Obstructive ,0302 clinical medicine ,Risk Factors ,Cause of Death ,030212 general & internal medicine ,education.field_of_study ,COPD ,Liver Diseases ,Middle Aged ,Bronchiectasis ,Cardiovascular Diseases ,Cohort ,Disease Progression ,Gastroesophageal Reflux ,Female ,Cohort study ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Population ,Article ,03 medical and health sciences ,Internal medicine ,Republic of Korea ,medicine ,Diabetes Mellitus ,Humans ,Thyroid Neoplasms ,Risk factor ,Renal Insufficiency, Chronic ,Mortality ,education ,Lung cancer ,Aged ,Dyslipidemias ,Proportional Hazards Models ,lcsh:RC705-779 ,business.industry ,Multimorbidity ,Pneumonia ,lcsh:Diseases of the respiratory system ,medicine.disease ,Asthma ,030228 respiratory system ,Osteoporosis ,business - Abstract
Background The effects of comorbidities on chronic obstructive pulmonary disease (COPD) have been usually studied individually in the past. In this study, we aimed to investigate the comorbidities associated with mortality, the effect of multimorbidity on mortality and other factors associated with mortality among Korean COPD population. Methods The Korean National Health Insurance Service-National Sample Cohort version 2.0, collected between 2002 and 2015, was used. Among COPD patients [entire cohort (EC), N = 12,779], 44% of the participants underwent additional health examination, and they were analysed separately [health-screening cohort (HSC), N = 5624]. Fifteen comorbidities previously reported as risk factors for mortality were studied using Cox proportional hazards regression models. Results Total mortality rates were 38.6 per 1000 person-years (95% CI 37.32–40.01) and 27.4 per 1000 person-years (95% CI 25.68–29.22) in EC and HSC, respectively. The most common causes of death were disease progression, lung cancer, and pneumonia. Only some of the comorbidities had a direct impact on mortality. Multimorbidity, assessed by the number of comorbid diseases, was an independent risk factor of all-cause mortality in both cohorts and was a risk factor of respiratory mortality only in HSC. The Kaplan–Meier analysis showed significant differences in survival trajectories according to the number of comorbidities in all-cause mortality but not in respiratory mortality. Low BMI, old age and male sex were independent risk factors for both mortalities in both cohorts. Conclusions The number of comorbidities might be an independent risk factor of COPD mortality. Multimorbidity contributes to all-cause mortality in COPD, but the effect of multimorbidity is less evident on respiratory mortality.
- Published
- 2021
25. Factors Affecting the Outcomes of Patients with Malignant Rhabdoid Tumors: A Population-Based Study
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Wen Cai, Junxi Xu, Rui Bai, Xue Liu, Hanguang Hu, Dehao Wu, and Weiting Ge
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Male ,Malignant rhabdoid tumor ,Epidemiology ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Digestive System Neoplasms ,Central Nervous System Neoplasms ,0302 clinical medicine ,Risk Factors ,Child ,Kidney ,Incidence (epidemiology) ,Incidence ,Age Factors ,Soft tissue ,General Medicine ,Middle Aged ,Kidney Neoplasms ,medicine.anatomical_structure ,Treatment Outcome ,Chemotherapy, Adjuvant ,Child, Preschool ,030211 gastroenterology & hepatology ,Female ,Research Paper ,Adult ,medicine.medical_specialty ,Adolescent ,Bone Neoplasms ,Malignancy ,Risk Assessment ,03 medical and health sciences ,Young Adult ,Internal medicine ,medicine ,Humans ,Survival analysis ,Rhabdoid Tumor ,Aged ,Retrospective Studies ,business.industry ,Infant ,medicine.disease ,Radiation therapy ,SEER ,Radiotherapy, Adjuvant ,business ,SEER Program - Abstract
Objective: Malignant rhabdoid tumor (MRT) is a rare but aggressive malignancy. It has been a long time since data on this tumor have been updated. Methods: We retrospectively reviewed patients from the SEER database who were pathologically diagnosed with MRT and analyzed incidence rates, clinical features and survival using Stata 12.0. Results: In total, 544 patients were included in the epidemiological analysis. There were two peak periods of MRT incidence: patients younger than 4 years and those older than 70 years. Further survival analysis showed that the survival of children (especially younger than 1 year) was markedly worse than that of adults (P
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- 2021
26. Efficacy of Exercise Rehabilitation Program in Relieving Oxaliplatin Induced Peripheral Neurotoxicity
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Dapeng Li, Yan Zhuge, Qi Gui, and Chengcheng Xu
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0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,Organoplatinum Compounds ,Oxaloacetates ,medicine.medical_treatment ,Leucovorin ,Antineoplastic Agents ,Gynecologic oncology ,Digestive System Neoplasms ,Irinotecan ,rehabilitation ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Brief Pain Inventory ,Capecitabine ,Chemotherapy ,peripheral neurotoxicity ,Rehabilitation ,exercise ,Dose-Response Relationship, Drug ,Cumulative dose ,business.industry ,Neurotoxicity ,Peripheral Nervous System Diseases ,General Medicine ,Middle Aged ,medicine.disease ,Oxaliplatin ,Exercise Therapy ,030104 developmental biology ,030220 oncology & carcinogenesis ,Female ,Neurotoxicity Syndromes ,Fluorouracil ,business ,Complication ,medicine.drug ,Research Article - Abstract
Background: Peripheral neurotoxicity is common in patients with digestive malignancies receiving chemotherapy containing oxaliplatin, and there is still no effective drug to prevent or treat this complication. Methods: Seventy-nine patients receiving chemotherapy containing oxaliplatin were included, and the relationship between chemotherapy regimens, cycles, and cumulative dose of oxaliplatin and peripheral neurotoxicity was analyzed. Patients were divided into two groups of control or intervention. Twenty-eight patients in the control group received routine chemotherapy care, and 51 patients in the intervention group underwent two-week exercise rehabilitation program. Patients’ Functional Assessment of Cancer Therapy/Gynecologic Oncology Group – Neurotoxicity (FACT/GOG-Ntx), functional tests, and Brief Pain Inventory(BPI) scores as well as interference life scores were assessed before intervention and two weeks after the intervention. Results: In the intervention group, 52.9% patients previously exercised regularly. The FOLFOX regimen was more common in peripheral neurotoxicity (73.4%), and the median oxaliplatin cycles for neurotoxicity was 9 (ranging from 1 to 16). The mean cumulative dose of oxaliplatin was 1080.02 ± 185.22 mg, both the cycles and cumulative dose were positively correlated with the occurrence of peripheral neurotoxicity. Compared with control, the scores of FACT/GOG-Ntx, functional tests, and BPI were significantly decreased in the intervention group (p < 0.05). Conclusion: Chemotherapy cycles and cumulative doses were in relation with OIN , and exercise rehabilitation program could effectively alleviate OIN.
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- 2021
27. Endoscopic placement of covered versus uncovered self-expandable metal stents for palliation of malignant gastric outlet obstruction
- Author
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Imakiire Kazuyuki, Shigeki Bamba, Keiji Hanada, Masanori Asada, Nobuaki Azemoto, Yoshitaka Nakai, Yoshifumi Fujimoto, Ichiro Moriyama, Takaaki Eguchi, Shinichi Hashimoto, Hiroko Nebiki, Hideyuki Shiomi, Hirofumi Kawamoto, Hidefumi Nishikiori, Yoshinobu Okabe, Noriyuki Hoki, Hideki Kamada, Motoyuki Yoshida, Daisuke Goto, Tetsuya Koga, Takahisa Kayahara, Hironari Kato, Yasutaka Chiba, Kazuya Matsumoto, Hiroshi Takihara, Kojiro Nakase, Shiro Hayashi, Ken Hirao, Masayuki Kitano, Chisio Noguchi, Yasushi Kudo, Takeshi Ogura, Toshiharu Ueki, Masahiro Serikawa, Yoshinori Kushiyama, Kentaro Yamao, Yukitaka Yamashita, Norimitsu Uza, Tsuyoshi Sanuki, Masaya Ohana, and Takao Kato
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Self Expandable Metallic Stents ,Subgroup analysis ,Digestive System Neoplasms ,Endoscopy, Gastrointestinal ,03 medical and health sciences ,0302 clinical medicine ,gastrointesinal endoscopy ,Risk Factors ,Stomach Neoplasms ,medicine ,Humans ,In patient ,Prospective Studies ,cardiovascular diseases ,Prospective cohort study ,Covered stent ,Aged ,Aged, 80 and over ,Gastric Outlet Obstruction ,business.industry ,Stomach ,Palliative Care ,Age Factors ,Gastroenterology ,Stent ,Patient survival ,Gastric outlet obstruction ,Middle Aged ,equipment and supplies ,medicine.disease ,Prosthesis Failure ,Surgery ,Self Expandable Metal Stents ,Pancreatic Neoplasms ,Survival Rate ,surgical procedures, operative ,stents ,030220 oncology & carcinogenesis ,Female ,Gallbladder Neoplasms ,030211 gastroenterology & hepatology ,business - Abstract
ObjectiveStenting is an established endoscopic therapy for malignant gastric outlet obstruction (mGOO). The choice of stent (covered vs uncovered) has been examined in prior randomised studies without clear results.DesignIn a multicentre randomised prospective study, we compared covered (CSEMS) with uncovered self-expandable metal stents (UCSEMS) in patients with mGOO; main outcomes were stent dysfunction and patient survival, with subgroup analyses of patients with extrinsic and intrinsic tumours.ResultsOverall survival was poor with no difference between groups (probability at 3 months 49.7% for covered vs 48.4% for uncovered stents; log-rank for overall survival p=0.26). Within that setting of short survival, the proportion of stent dysfunction was significantly higher for uncovered stents (35.2% vs 23.4%, p=0.01) with significantly shorter time to stent dysfunction. This was mainly relevant for patients with extrinsic tumours (stent dysfunction rates for uncovered stents 35.6% vs 17.5%, pConclusionsDue to poor patient survival, minor differences between covered and uncovered stents may be less relevant even if statistically significant; however, subgroup analysis would suggest to use covered stents for intrinsic and uncovered stents for extrinsic malignancies.
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- 2020
28. Nutritional assessment in surgical oncology
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Karol Polom, Dara Lundon, Florian Primavesi, Frederik J H Hoogwater, Laura Lorenzon, Santiago González-Moreno, Luigi Marano, Sergio Sandrucci, Andreas Brandl, Giacomo Montagna, Delia Cortes Guiral, Yvonne Schrage, Domenico D'Ugo, and Tibor Kovacs
- Subjects
0301 basic medicine ,surgical oncology ,mdt ,malnutrition ,nutritional assessment ,Colorectal cancer ,SURGERY ,Practice Patterns ,Digestive System Neoplasms ,MDT ,0302 clinical medicine ,Surgical oncology ,Weight loss ,Surgical ,Surveys and Questionnaires ,Medicine ,Practice Patterns, Physicians' ,ESPEN GUIDELINES ,Sarcoma ,General Medicine ,Middle Aged ,Nutritional assessment ,Oncology ,030220 oncology & carcinogenesis ,medicine.symptom ,Specialties ,Adult ,medicine.medical_specialty ,DIAGNOSTIC-CRITERIA ,PERIOPERATIVE NUTRITION ,Breast Neoplasms ,Specialties, Surgical ,03 medical and health sciences ,Internal medicine ,Weight Loss ,Humans ,Screening tool ,Nutritionists ,Serum Albumin ,Aged ,SCREENING TOOLS ,Patient Care Team ,Surgeons ,Malnutrition ,Colorectal Surgery ,Nutrition Assessment ,Surgical Oncology ,Physicians' ,030109 nutrition & dietetics ,business.industry ,Breast surgeons ,Cancer ,medicine.disease ,business - Abstract
Introduction: The majority of cancer patients report malnutrition, with a significant impact on patient's outcome. This study aimed to compare how nutritional assessment is conducted across different surgical oncology sub-specialties.Methods: Survey modules were designed for breast, hepato-pancreato-biliary (HPB), upper-gastrointestinal (UGI), sarcoma, peritoneal and surface malignancies (PSM) and colorectal cancer (CRC) surgeries to describe 4 domains: participants' setting, evaluation of clinical factors, use of screening tools and clinical practice. Results were compared among sub-specialties and according to human development index (HDI) in the largest cohorts.Results: Out of 457 answers from 377 global participants (62% European), 35.0% were from breast and 28.9% were from CRC surgeons. Although MDTs management is consistently reported (64-88%), the presence of a nutritionist/dietician ranges from 14.1% to 44.2%. Breast surgeons seldom evaluate albumin (25.6%) and weight loss (30.6%), opposite to HPB, PSM and UGI groups (>70%, p 0.044). Overall, responders declared that the use of screening tools is largely neglected, that nutritional status is often assessed by the surgeons and that nutrition is not consistently modified according to risk factors (range among groups respectively: 1.9%-25.6%, 33.1%-51.4%, 33.1%-60.5%). Less than 20% of breast surgeons assess patients before/after surgery, comparing to >60% of PSM surgeons. However, no statistical differences were documented comparing groups for the majority of the items of the 4 domains. Nutritional evaluation is more often conducted by breast surgeons in medium/low HDI countries comparing very high/high HDI (p 0.04).Conclusions: Nutritional assessment is largely neglected. These results identify target-issues for the implementation of clinical practice. (C) 2020 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
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- 2020
29. Metformin and everolimus in neuroendocrine tumours: A synergic effect?
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Julien Forestier, Philip Robinson, Catherine Lombard-Bohas, Gérald Raverot, Laurent Milot, Annie Lemelin, Françoise Borson-Chazot, Lucia Hue-Fontaine, Thomas Walter, Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Délégation à la recherche clinique et à l'innovation [CHU Dijon] (DRCI), and Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)
- Subjects
Male ,Oncology ,medicine.medical_specialty ,Lung Neoplasms ,endocrine system diseases ,[SDV]Life Sciences [q-bio] ,Population ,Antineoplastic Agents ,Neuroendocrine tumors ,Digestive System Neoplasms ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Diabetes mellitus ,Diabetes Mellitus ,medicine ,Clinical endpoint ,Humans ,Hypoglycemic Agents ,Everolimus ,Prospective cohort study ,education ,Aged ,education.field_of_study ,Univariate analysis ,Hepatology ,business.industry ,Gastroenterology ,Drug Synergism ,Middle Aged ,medicine.disease ,Metformin ,Progression-Free Survival ,3. Good health ,Neuroendocrine Tumors ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,business ,medicine.drug - Abstract
To explore potential synergy in effectiveness between metformin and everolimus, 2 inhibitors of the mTOR pathway, for neuroendocrine tumours (NET).A cohort of patients with advanced gastroenteropancreatic or lung NETs treated by everolimus were stratified in to those without diabetes, those with diabetes and without metformin, and those with diabetes with metformin. The primary endpoint was the median progression-free survival (PFS).A total of 213 patients were included, 165 of which were non-diabetic; among diabetic patients, 19 were treated with metformin and 29 with others anti-diabetic drugs. No significant difference in median PFS [95%CI] was found between the three groups: 10.05 months [8.27;11.83] for non-diabetic patients, 15.24 [19.88;49.43] for diabetic w/metformin, and 9.03 months [4.01;14.06] for diabetic w/o metformin group. In univariate analysis, factors significantly associated with longer PFS was a functioning NET, a number of metastatic sites3, the absence of lung metastasis, and an uptake on Octreoscan®, but not the absence of metformin use; only uptake on Octreoscan® remained significant in multivariate analysis.In contrast with the literature, we did not find a synergy between everolimus and metformin in NET. Prospective studies are underway to improve the comprehension of the potential synergy regarding population and tumour type.
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- 2020
30. Analysis of Non-Scheduled Consultations in Patients with Digestive Neoplasms
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Matilde Bolaños Naranjo, Francisco Javier Jiménez Ruiz, Juan Bayo Calero, and Victoria Aviñó Tarazona
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Adult ,Male ,medicine.medical_specialty ,Colorectal cancer ,Geography, Planning and Development ,Symptomatic treatment ,Management, Monitoring, Policy and Law ,Digestive System Neoplasms ,Very frequent ,Appointments and Schedules ,Internal medicine ,medicine ,Humans ,In patient ,Prospective Studies ,Aged ,business.industry ,Incidence (epidemiology) ,Advanced stage ,Cancer ,Middle Aged ,Patient Acceptance of Health Care ,medicine.disease ,Spain ,Female ,business ,Facilities and Services Utilization ,Information demand - Abstract
Non-scheduled consultation is very frequent among patients with cancer, creating alterations and delays in programmed visits. We describe the incidence of non-scheduled consultations in patients with digestive cancer in our hospital.Descriptive, prospective, non-interventional study. In a six-month period (May-December 2017), non-scheduled visits were chronologically recorded in the medical oncology consultation of digestive tumours of Hospital Juan Ramón Jiménez de Huelva. We performed a descriptive analysis of the variables collected through the statistical program G-STAT v.2.0.Patients with colon or rectal cancer generated most consultations (68.63%). followed by pancreatic (9.15%) and gastric (5.23%). Most patients had metastatic or advanced stage cancer (59.87%) and were under palliative or symptomatic treatment (58.82%). The most frequent reason for consultation was clinical symptoms (47.05%). followed by information demand (18.30 %).Non-scheduled consultations in cancer patients are frequent; they cause interference in scheduled consultations and not always resolved satisfactorily. We propose several measures to reduce the number of non-scheduled consultation in oncology.La demanda de asistencia no programada por parte de los pacientes oncológicos es muy frecuente (1,2) y conllevan alteraciones y retrasos en la actividad ya programada. Describimos la incidencia de consultas no programadas en pacientes con cáncer digestivo de nuestro centro.Estudio descriptivo, prospectivo y sin intervención. Se recogieron cronológicamente en un periodo de 6 meses (15 de mayo al 14 de diciembre de 2017) y utilizando como fuente la historia clínica de los pacientes, las visitas no programadas atendidas en la consulta de oncología médica de tumores digestivos del Hospital Juan Ramón Jiménez de Huelva. Realizamos un análisis descriptivo de las variables recogidas mediante el programa estadístico G-STAT v.2.0.El mayor número de consultas fue realizado por pacientes con cáncer de colon o recto (68,63%), seguidas por los de páncreas (9,15%) y los gástricos (5,23%). La mayoría de los pacientes tenían un cáncer en situación metastásica o avanzada (59,87%) y estaban recibiendo tratamiento paliativo (58,82%) con quimioterapia o sintomático. El motivo de consulta más frecuente fueron los síntomas clínicos (47,05%), seguido por la demanda de información (18,30 %).Se constata una alta demanda de asistencia no programada por parte de los pacientes con cáncer digestivo, que interfiere con la asistencia programada y no siempre se resuelve satisfactoriamente. Se proponen varias medidas para reducir el número de estas consultas.
- Published
- 2020
31. Feasibility of a fast-track randomized controlled trial of cell-free and concentrated ascites reinfusion therapy for patients with refractory malignant ascites
- Author
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Yuri Ichikawa, Masaki Sakamoto, Hidekazu Suzuki, Toshihiro Yamauchi, Toru Wada, Satoru Miwa, Tatsuya Morita, Masashi Horiki, Naosuke Yokomichi, Yu Uneno, Kengo Imai, and Satoshi Inoue
- Subjects
Male ,medicine.medical_specialty ,Cancer Research ,Cell- and Tissue-Based Therapy ,Cell free ,Digestive System Neoplasms ,law.invention ,Randomized controlled trial ,Refractory ,law ,Ascites ,medicine ,Genetics ,Humans ,Paracentesis ,Aged ,Aged, 80 and over ,business.industry ,Middle Aged ,Surgery ,Treatment Outcome ,Oncology ,Feasibility Studies ,Female ,medicine.symptom ,Fast track ,business ,Cell-Free Nucleic Acids - Abstract
Background Malignant ascites often causes discomfort in advanced cancer patients. Paracentesis is the most common treatment modality, but it requires frequently repeated treatment. Cell-free and concentrated ascites reinfusion therapy (CART) may prolong the paracentesis interval, but controlled trials are lacking. We assessed the feasibility of a randomized controlled trial of CART vs. paracentesis alone for patients with refractory malignant ascites. Methods This study was an open-label, fast-track, randomized controlled, feasibility trial. Patients admitted to four designated cancer hospitals who received no further anticancer treatments were eligible. Patients were randomly assigned 1:1 to a CART arm or control (simple paracentesis) arm. The feasibility endpoint was the percentage of patients who completed the study intervention. Secondary endpoints included paracentesis-free survival, patient’s request on the questionnaire for paracentesis (PRO-paracentesis)-free survival (the period until the patients first reported that they would want paracentesis if indicated), and adverse events. Results We screened 953 patients for eligibility. Of 61 patients with refractory malignant ascites, 21 patients were determined as eligible. Finally, 20 patients consented and were allocated; 18 patients (90%, 95% CI: 68.3–98.8) completed the study intervention. All patients had an ECOG performance status of 3 or 4. The median drained ascites volume was 3,200 mL in the CART arm and 2,500 mL in the control arm. In the CART arm, the median reinfused albumin volume was 12.6 g. Median paracentesis-free survivals were 5 days (95% CI: 2–6) in the CART arm, and 6 days (3–9) in the control arm. Median PRO-paracentesis-free survivals were 4 days (2–5) and 5 days (1–9), respectively. A total of 73% of patients received paracentesis within 2 days from their first request for the next paracentesis. One patient in the CART arm developed Grade 1 fever. Conclusions A fast-track randomized controlled trial of CART for patients with malignant ascites is feasible. The efficacy and safety of CART should be assessed in future trials. PRO-paracentesis-free survival may be a complementary outcome measure with paracentesis-free survival in future trials. Trial registration Registered at University Hospital Medical Information Network Clinical Trial Registry as UMIN000031029. Registered on 28/01/2018.
- Published
- 2022
32. Multiple endocrine neoplasia type 2:A review
- Author
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Jes Sloth Mathiesen, Grigoris Effraimidis, Peter Oturai, Ulla Feldt-Rasmussen, Christian Godballe, Lars Bastholt, Åse Krogh Rasmussen, Maria Rossing, and Lise Hoejberg
- Subjects
0301 basic medicine ,Oncology ,Prophylactic thyroidectomy ,Cancer Research ,medicine.medical_specialty ,Genotype ,endocrine system diseases ,Genetic counseling ,Genetic Counseling ,Multiple Endocrine Neoplasia Type 2a ,Multiple endocrine neoplasia type 2 ,Multiple Endocrine Neoplasia Type 2b ,Disease ,Genotype-phenotype ,Digestive System Neoplasms ,Germline ,Thyroid carcinoma ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,MEN 2 ,Internal medicine ,medicine ,Medullary thyroid carcinoma ,Humans ,Endocrine system ,Genetic Predisposition to Disease ,Genetic Testing ,Thyroid Neoplasms ,Germ-Line Mutation ,Risk stratification ,business.industry ,Hyperparathyroidism ,Proto-Oncogene Proteins c-ret ,Ganglioneuroma ,medicine.disease ,Prognosis ,Carcinoma, Neuroendocrine ,030104 developmental biology ,030220 oncology & carcinogenesis ,Thyroidectomy ,business ,Primary hyperparathyroidism - Abstract
Multiple endocrine neoplasias are rare hereditary syndromes some of them with malignant potential. Multiple endocrine neoplasia type 2 (MEN 2) is an autosomal dominant hereditary cancer syndrome due to germline variants in the REarranged during Transfection (RET) proto-oncogene. There are two distinct clinical entities: MEN 2A and MEN 2B. MEN 2A is associated with medullary thyroid carcinoma (MTC), phaeochromocytoma, primary hyperparathyroidism, cutaneous lichen amyloidosis and Hirschprung's disease and MEN 2B with MTC, phaeochromocytoma, ganglioneuromatosis of the aerodigestive tract, musculoskeletal and ophthalmologic abnormalities. Germline RET variants causing MEN 2 result in gain-of-function; since the discovery of the genetic variants a thorough search for genotype-phenotype associations began in order to understand the high variability both between families and within family members. These studies have successfully led to improved risk classification of prognosis in relation to the genotype, thus improving the management of the patients by thorough genetic counseling. The present review summarizes the recent developments in the knowledge of these hereditary syndromes as well as the impact on clinical management, including genetic counseling, of both individual patients and families. It furthermore points to future directions of research for better clarification of timing of treatments of the various manifestations of the syndromes in order to improve survival and morbidity in these patients.
- Published
- 2022
33. Dynapenia in digestive cancer outpatients: association with markers of functional and nutritional status (the FIGHTDIGO study)
- Author
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Marie-Amélie Ordan, Barbara Tailliere, Camille Mazza, Johanna Moreau, Marine Perrier, Olivier Bouché, Mathilde Brasseur, Philippe Regnault, Yohann Renard, Coralie Barbe, Damien Botsen, Eric Bertin, Université de Reims Champagne-Ardenne (URCA), and Centre Hospitalier Universitaire de Reims (CHU Reims)
- Subjects
Male ,medicine.medical_specialty ,Sarcopenia ,Multivariate analysis ,Population ,education ,Nutritional Status ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Outpatients ,medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,health care economics and organizations ,Aged ,Gastrointestinal Neoplasms ,2. Zero hunger ,education.field_of_study ,Univariate analysis ,Performance status ,Hand Strength ,business.industry ,Muscle strength ,Malnutrition ,Anthropometry ,medicine.disease ,3. Good health ,body regions ,Oncology ,030220 oncology & carcinogenesis ,Digestive system neoplasms ,Female ,business ,Dynapenia ,Body mass index ,human activities ,[SDV.AEN]Life Sciences [q-bio]/Food and Nutrition ,circulatory and respiratory physiology - Abstract
The FIGHTDIGO study determined the feasibility and acceptability of handgrip strength (HGS) measurement in digestive cancer outpatients. To assess the relationship between muscle strength and markers of functional and nutritional status in this population. In this prospective study, a total of 201 patients were followed during 6 months and were asked to perform HGS measurement at each hospitalization. Anthropometric measurements, laboratory tests, and performance status (PS) evaluation were collected. The modified Glasgow Prognostic Score (mGPS) was calculated using CRP and albumin levels. Severe malnutrition was defined as body mass index (BMI) 70 years old, and BMI
- Published
- 2022
34. Liquid biopsy as a perioperative biomarker of digestive tract cancers: review of the literature
- Author
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Daisuke Ichikawa, Hidenori Akaike, Hiromichi Kawaida, Yoshihiko Kawaguchi, Shinji Furuya, Makoto Sudo, Hidetake Amemiya, Suguru Maruyama, Shingo Inoue, Katsutoshi Shoda, Hiroshi Kono, and Ryo Saito
- Subjects
Oncology ,medicine.medical_specialty ,Digestive System Neoplasms ,03 medical and health sciences ,0302 clinical medicine ,Circulating tumor cell ,Internal medicine ,Biopsy ,Biomarkers, Tumor ,medicine ,Humans ,Sampling (medicine) ,Molecular Targeted Therapy ,Precision Medicine ,Liquid biopsy ,Perioperative Period ,Monitoring, Physiologic ,medicine.diagnostic_test ,business.industry ,Patient Selection ,Liquid Biopsy ,Cancer ,General Medicine ,Prognosis ,Precision medicine ,medicine.disease ,Body Fluids ,030220 oncology & carcinogenesis ,Biomarker (medicine) ,030211 gastroenterology & hepatology ,Surgery ,Personalized medicine ,Neoplasm Recurrence, Local ,business - Abstract
Tissue biopsies are the gold-standard for investigating the molecular characterization of tumors. However, a "solid" biopsy is an invasive procedure that cannot capture real-time tumor dynamics and may yield inaccurate information because of intratumoral heterogeneity. In this review, we summarize the current state of knowledge about surgical treatment-associated "liquid" biopsy for patients with digestive organ tumors. A liquid biopsy is a technique involving the sampling and testing of non-solid biological materials, including blood, urine, saliva, and ascites. Previous studies have reported the potential value of blood-based biomarkers, circulating tumor cells, and cell-free nucleic acids as facilitators of cancer treatment. The applications of a liquid biopsy in a cancer treatment setting include screening and early diagnosis, prognostication, and outcome and recurrence monitoring of cancer. This technique has also been suggested as a useful tool in personalized medicine. The transition to precision medicine is still in its early stages. Soon, however, liquid biopsy is likely to form the basis of patient selection for molecular targeted therapies, predictions regarding chemotherapy sensitivity, and real-time evaluations of therapeutic effects.
- Published
- 2020
35. Association between physical activity and digestive-system cancer: An updated systematic review and meta-analysis
- Author
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Jihan Huang, Jia Han, Ziji Chen, Fangfang Xie, Min Fang, Chong Guan, Fei Yao, and Yanli You
- Subjects
Oncology ,medicine.medical_specialty ,Colorectal cancer ,Physical Therapy, Sports Therapy and Rehabilitation ,Review ,Cochrane Library ,Digestive System Neoplasms ,lcsh:GV557-1198.995 ,03 medical and health sciences ,0302 clinical medicine ,Bias ,Risk Factors ,Internal medicine ,Confidence Intervals ,Medicine ,Humans ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Prospective Studies ,lcsh:Sports medicine ,Prospective cohort study ,Gastrointestinal Transit ,Exercise ,Life Style ,lcsh:Sports ,business.industry ,Physical activity ,Cancer ,030229 sport sciences ,medicine.disease ,Digestive-system cancer ,Confidence interval ,Meta-analysis ,Systematic review ,Relative risk ,Case-Control Studies ,Guideline Adherence ,Insulin Resistance ,lcsh:RC1200-1245 ,business ,Gastrointestinal Motility - Abstract
Highlights • The current systematic review analyzed the data from 161 risk estimates in 47 studies involving 5,797,768 participants and 55,162 cases. • Updated evidence suggests that a moderate to high physical activity level is a common protective factor that can significantly lower the overall risk of digestive-system cancer. • Limited evidence suggests that meeting the international physical activity guidelines might not significantly reduce the risk of digestive-system cancer., Background Physical activity (PA) may have an impact on digestive-system cancer (DSC) by improving insulin sensitivity and anticancer immune function and by reducing the exposure of the digestive tract to carcinogens by stimulating gastrointestinal motility, thus reducing transit time. The current study aimed to determine the effect of PA on different types of DSC via a systematic review and meta-analysis. Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched for relevant studies in PubMed, Embase, Web of Science, Cochrane Library, and China National Knowledge Infrastructure. Using a random effects model, the relationship between PA and different types of DSC was analyzed. Results The data used for meta-analysis were derived from 161 risk estimates in 47 studies involving 5,797,768 participants and 55,162 cases. We assessed the pooled associations between high vs. low PA levels and the risk of DSC (risk ratio (RR) = 0.82, 95% confidence interval (95%CI): 0.79–0.85), colon cancer (RR = 0.81, 95%CI: 0.76–0.87), rectal cancer (RR = 0.88, 95%CI: 0.80–0.98), colorectal cancer (RR = 0.77, 95%CI: 0.69–0.85), gallbladder cancer (RR = 0.79, 95%CI: 0.64–0.98), gastric cancer (RR = 0.83, 95%CI: 0.76–0.91), liver cancer (RR = 0.73, 0.60–0.89), oropharyngeal cancer (RR = 0.79, 95%CI: 0.72–0.87), and pancreatic cancer (RR = 0.85, 95%CI: 0.78–0.93). The findings were comparable between case-control studies (RR = 0.73, 95%CI: 0.68–0.78) and prospective cohort studies (RR = 0.88, 95%CI: 0.80–0.91). The meta-analysis of 9 studies reporting low, moderate, and high PA levels, with 17 risk estimates, showed that compared to low PA, moderate PA may also reduce the risk of DSC (RR = 0.89, 95%CI: 0.80–1.00), while compared to moderate PA, high PA seemed to slightly increase the risk of DSC, although the results were not statistically significant (RR = 1.11, 95%CI: 0.94–1.32). In addition, limited evidence from 5 studies suggested that meeting the international PA guidelines might not significantly reduce the risk of DSC (RR = 0.96, 95%CI: 0.91–1.02). Conclusion Compared to previous research, this systematic review has provided more comprehensive information about the inverse relationship between PA and DSC risk. The updated evidence from the current meta-analysis indicates that a moderate-to-high PA level is a common protective factor that can significantly lower the overall risk of DSC. However, the reduction rate for specific cancers may vary. In addition, limited evidence suggests that meeting the international PA guidelines might not significantly reduce the risk of DSC. Thus, future studies must be conducted to determine the optimal dosage, frequency, intensity, and duration of PA required to reduce DSC risk effectively., Graphical abstract Image, graphical abstract
- Published
- 2020
36. Surgical decision-making and prioritization for cancer patients at the onset of the COVID-19 pandemic: A multidisciplinary approach
- Author
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Brian K. Bednarski, Jeffrey E. Lee, Christina L. Roland, Matthew H.G. Katz, Naruhiko Ikoma, Emily Z. Keung, Hop S. Tran Cao, Christopher P. Scally, Jeffrey E. Gershenwald, Jean Nicolas Vauthey, Ching Wei D. Tzeng, Mediget Teshome, and Paul H. Graham
- Subjects
Coronavirus disease 2019 (COVID-19) ,Clinical Decision-Making ,Pneumonia, Viral ,MEDLINE ,Breast Neoplasms ,Digestive System Neoplasms ,Article ,Betacoronavirus ,03 medical and health sciences ,0302 clinical medicine ,Surgical oncology ,Multidisciplinary approach ,Neoplasms ,Endocrine Gland Neoplasms ,Health care ,Pandemic ,Humans ,Medicine ,Melanoma ,Pandemics ,Responsibility to protect ,Peritoneal Neoplasms ,Patient Care Team ,SARS-CoV-2 ,business.industry ,Patient Selection ,COVID-19 ,Cancer ,Sarcoma ,medicine.disease ,Neuroendocrine Tumors ,Surgical Oncology ,Oncology ,030220 oncology & carcinogenesis ,Practice Guidelines as Topic ,030211 gastroenterology & hepatology ,Surgery ,Medical emergency ,Coronavirus Infections ,business - Abstract
In the midst of the coronavirus disease 2019 (COVID-19) pandemic, governmental agencies, state medical boards, and healthcare organizations have called for restricting “elective” operations to mitigate the risk of transmission of the virus amongst patients and healthcare providers and to preserve essential resources for potential regional surges of COVID patients. While the fear of delaying surgical care for many of our patients is deeply challenging for us as cancer care providers, we must balance our personal commitment to providing timely and appropriate oncologic care to our cancer patients with our societal responsibility to protect our patients (including those on whom we are operating), co-workers, trainees, families, and community, from undue risks of contracting and propagating COVID-19. Herein, we present guidelines for surgical decision-making and case prioritization developed among all adult disease specialties in the MD Anderson Cancer Center Departments of Surgical Oncology and Breast Surgical Oncology in Houston, Texas.
- Published
- 2020
37. AHPBA Webinar about Covid-19: lessons learned responding to a pandemic
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Sean P. Cleary, Nicolas Demartines, Maria B. Doyle, Timothy M. Pawlik, Michael I. D’Angelica, and Tara S. Kent
- Subjects
2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,COVID19 ,Pneumonia, Viral ,MEDLINE ,Digestive System Neoplasms ,Global Health ,Article ,surgery ,Betacoronavirus ,Pandemic ,medicine ,Global health ,Humans ,Pandemics ,Digestive System Surgical Procedures ,Internet ,hepato-pancreato-biliary ,response ,Hepatology ,biology ,SARS-CoV-2 ,Viral Epidemiology ,business.industry ,pandemic ,Gastroenterology ,COVID-19 ,Congresses as Topic ,medicine.disease ,biology.organism_classification ,Virology ,Pneumonia ,Coronavirus Infections ,business ,Delivery of Health Care - Published
- 2020
38. MR Imaging Texture Analysis in the Abdomen and Pelvis
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Asser Abou Elkassem, Balaji Ganeshan, John V. Thomas, and Andrew D. Smith
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Male ,Digestive System Neoplasms ,Pelvis ,Qualitative analysis ,Radiomics ,Region of interest ,Histogram ,Abdomen ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Computer vision ,Pixel ,Rectal Neoplasms ,business.industry ,Prostatic Neoplasms ,Magnetic Resonance Imaging ,Mr imaging ,Kidney Neoplasms ,Endometrial Neoplasms ,medicine.anatomical_structure ,Female ,Artificial intelligence ,business - Abstract
Add "which is a" before "distribution"? Texture analysis (TA) is a form of radiomics that refers to quantitative measurements of the histogram, distribution and/or relationship of pixel intensities or gray scales within a region of interest on an image. TA can be applied to MR images of the abdomen and pelvis, with the main strength quantitative analysis of pixel intensities and heterogeneity rather than subjective/qualitative analysis. There are multiple limitations of MRTA. Despite these limitations, there is a growing body of literature supporting MRTA. This review discusses application of MRTA to the abdomen and pelvis.
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- 2020
39. Retrieval anchor-assisted endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction
- Author
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Sheng Wang, Xiang Liu, Kai Zhang, Jinlong Hu, Nan Ge, Guoxin Wang, Jintao Guo, and Siyu Sun
- Subjects
Male ,Endoscopic ultrasound ,medicine.medical_specialty ,medicine.medical_treatment ,Digestive System Neoplasms ,Endosonography ,Gastroscopy ,medicine ,Humans ,cardiovascular diseases ,Ultrasonography, Interventional ,Endoscopic stent ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,Gastric Outlet Obstruction ,business.industry ,digestive, oral, and skin physiology ,Gastroenterology ,Gastric outlet obstruction ,Middle Aged ,Gastroenterostomy ,medicine.disease ,digestive system diseases ,Endoscopy ,Surgery ,surgical procedures, operative ,medicine.anatomical_structure ,Duodenum ,Female ,business - Abstract
Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is an emerging procedure for gastric outlet obstruction (GOO) as an alternative to endoscopic stent placement in the duodenum or surgery; however, it is technically challenging. This study aimed to evaluate the safety, success rate, and adverse events rate associated with retrieval anchor-assisted EUS-GE.Data from patients who underwent retrieval anchor-assisted EUS-GE for malignant and benign GOO were retrospectively analyzed. Patients' clinical and demographic characteristics, procedure time, and success and adverse event rates were recorded.A total of 10 patients (6 females; mean age 63.2 ± 5.8 years) were included in our study. Nine cases were malignant and one case was benign GOO. Nine patients received retrievable anchor-assisted EUS-GE for GOO. One patient received retrievable anchor-assisted EUS-GE and concurrent EUS-guided hepatogastrostomy due to the biliary obstruction. There were no complications during any of the procedures. The rate of technical and clinical success was 100%.EUS-GE is a safe and effective procedure for GOO. The retrieval anchor can make EUS-GE easier to perform successfully.
- Published
- 2020
40. Image Quality Assessment of Abdominal CT by Use of New Deep Learning Image Reconstruction: Initial Experience
- Author
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Sanaz Javadi, Ajaykumar C. Morani, Nicolaus A. Wagner-Bartak, Jia Sun, Xinming Liu, Adam G. Chandler, Corey T. Jensen, and Eric P. Tamm
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Adult ,Male ,Radiography, Abdominal ,Image quality ,Iohexol ,Abdominal ct ,Contrast Media ,Iterative reconstruction ,Digestive System Neoplasms ,Radiation Dosage ,Deep Learning ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Computer vision ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Deep learning ,General Medicine ,Middle Aged ,Thoracic Neoplasms ,medicine.anatomical_structure ,Radiographic Image Interpretation, Computer-Assisted ,Abdomen ,Female ,Artificial intelligence ,Tomography, X-Ray Computed ,business - Abstract
OBJECTIVE. The purpose of this study was to perform quantitative and qualitative evaluation of a deep learning image reconstruction (DLIR) algorithm in contrast-enhanced oncologic CT of the abdomen...
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- 2020
41. Volatile versus Total Intravenous Anesthesia for Cancer Prognosis in Patients Having Digestive Cancer Surgery
- Author
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Kanako Makito, Hiroki Matsui, Kiyohide Fushimi, and Hideo Yasunaga
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Digestive System Neoplasms ,Sevoflurane ,03 medical and health sciences ,Desflurane ,0302 clinical medicine ,030202 anesthesiology ,medicine ,Humans ,Digestive System Surgical Procedures ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Hazard ratio ,Middle Aged ,Prognosis ,Surgery ,Anesthesiology and Pain Medicine ,Isoflurane ,Intravenous anesthesia ,Esophagectomy ,030220 oncology & carcinogenesis ,Anesthetic ,Anesthesia, Intravenous ,Female ,Anesthesia, Inhalation ,business ,Propofol ,Follow-Up Studies ,medicine.drug - Abstract
Background Previous experimental and clinical studies have shown that anesthetic agents have varying effects on cancer prognosis; however, the results were inconsistent among these studies. The authors compared overall and recurrence-free survival in patients given volatile or intravenous anesthesia for digestive tract cancer surgery. Methods The authors selected patients who had elective esophagectomy, gastrectomy, hepatectomy, cholecystectomy, pancreatectomy, colectomy, and rectal cancer surgery from July 2010 to March 2018 using the Japanese Diagnosis Procedure Combination database. Patients were divided into a volatile anesthesia group (desflurane, sevoflurane, or isoflurane with/without nitrous oxide) and a propofol-based total intravenous anesthesia group. The authors hypothesized that total intravenous anesthesia is associated with greater overall and recurrence-free survival than volatile anesthesia. Subgroup analyses were performed for each type of surgery. Results The authors identified 196,303 eligible patients (166,966 patients in the volatile anesthesia group and 29,337 patients in the propofol-based total intravenous anesthesia group). The numbers (proportions) of death in the volatile anesthesia and total intravenous anesthesia groups were 17,319 (10.4%) and 3,339 (11.4%), respectively. There were no significant differences between the two groups in overall survival (hazard ratio, 1.02; 95% CI, 0.98 to 1.07; P = 0.28) or recurrence-free survival (hazard ratio, 0.99; 95% CI, 0.96 to 1.03; P = 0.59), whereas instrumental variable analyses showed a slight difference in recurrence-free survival (hazard ratio, 0.92; 95% CI, 0.87 to 0.98; P = 0.01). Subgroup analyses showed no significant difference in overall or recurrence-free survival between the groups in any type of surgery. Conclusions Overall and recurrence-free survival were similar between volatile and intravenous anesthesia in patients having digestive tract surgery. Selection of the anesthetic approach for these patients should be based on other factors. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
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- 2020
42. Understanding the Lymphatics: Review of the N Category in the Updated TNM Staging of Cancers of the Digestive System
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Aparna Srinivasa Babu and Christian K. Pedersen
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Diagnostic Imaging ,medicine.medical_specialty ,Digestive System Neoplasms ,Medical Oncology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Esophagus ,Lymph node ,Neoplasm Staging ,N category ,business.industry ,Cancer ,General Medicine ,Anal canal ,Prognosis ,medicine.disease ,Lymphatic system ,medicine.anatomical_structure ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,TNM Staging ,Radiology ,Lymph ,business - Abstract
OBJECTIVE. The N category has been significantly updated in the 8th edition of the American Joint Committee on Cancer's TNM classification. To ensure correct tumor staging, prognosis, and management, it is critical to be aware of these changes. This article reviews the updated N category, organ-specific regional lymph nodes, and lymphatic drainage pathways for cancers of the digestive system from the esophagus to the anal canal. CONCLUSION. Detection of lymph node involvement may be challenging, and knowledge of nodal characteristics, lymphatic drainage pathways, and imaging modalities is essential to optimize detection rate to ensure accurate staging, prognosis estimation, and streamlined management.
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- 2020
43. Spine stereotactic radiosurgery for metastases from hepatobiliary malignancies: patient selection using PRISM scoring
- Author
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Debra Nana Yeboa, Laurence D. Rhines, David Boyce-Fappiano, Behrang Amini, Claudio E. Tatsui, Olsi Gjyshi, Andrew J. Bishop, Ahmed Kaseb, Ethan B. Ludmir, Todd A. Pezzi, Amol J. Ghia, Lianchun Xiao, Tina Marie Briere, and Jing Li
- Subjects
Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Systemic disease ,Multivariate analysis ,Neurology ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Stereotactic radiation therapy ,Digestive System Neoplasms ,Radiosurgery ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Deformity ,Humans ,Aged ,Retrospective Studies ,Spinal Neoplasms ,business.industry ,Proportional hazards model ,Patient Selection ,Middle Aged ,medicine.disease ,Spinal cord ,Treatment Outcome ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Female ,Neurology (clinical) ,Radiology ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Dose escalation via stereotactic radiation therapy techniques has been necessary for hepatobiliary malignancies in the primary and oligometastatic setting, but such dose escalation is challenging for spine metastases due to spinal cord proximity. Here, we investigate the role of spine stereotactic radiosurgery (SSRS) in the management of such metastases. We retrospectively reviewed patients treated with SSRS to spinal metastases from hepatobiliary malignancies between 2004 and 2017 at our Institution. We used the Kaplan–Meier method to calculate overall survival (OS) and local control (LC) and Cox regression analysis to identify factors associated with disease-related outcomes. We identified 28 patients treated to 43 spinal metastases with SSRS for either HCC or cholangiocarcinoma. The 1-year LC and OS were 85% and 23%, respectively. The median time to death was 6.2 months, while median time to local failure was not reached. Tumor volume > 60 cc (SHR 6.65, p = 0.03) and Bilsky ≥ 1c (SHR 4.73, p = 0.05) predicted for poorer LC, while BED10 > 81 Gy trended towards better local control (SHR 4.35, p = 0.08). Child–Pugh Class (HR 3.02, p = 0.003), higher PRISM Group (HR 3.49, p = 0.001), and systemic disease progression (HR 3.65, p = 0.001) were associated with worse mortality based on univariate modeling in patients treated with SSRS; on multivariate analysis, PRISM Group (HR 2.28, p = 0.03) and systemic disease progression (HR 2.67, p = 0.03) remained significant. Four patients (10%) developed compression deformity and one patient (2%) developed radiation neuritis. SSRS provides durable local control in patients with metastatic hepatobiliary malignancies, with higher BED necessary to ensure excellent LC. PRISM scoring is a promising prognostic tool to aid SSRS patient selection.
- Published
- 2020
44. Tumor Seeding along the Puncture Tract in CT-Guided Interstitial High-Dose-Rate Brachytherapy
- Author
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Bernhard Gebauer, Georg Böning, Willie M Lüdemann, Martin Jonczyk, Peter Wust, Gero Wieners, Laura Büttner, Timm Denecke, and Dirk Schnapauff
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Brachytherapy ,Local ablation ,Punctures ,Digestive System Neoplasms ,Radiation Dosage ,Radiography, Interventional ,Risk Assessment ,030218 nuclear medicine & medical imaging ,Tumor seeding ,03 medical and health sciences ,Neoplasm Seeding ,0302 clinical medicine ,Risk Factors ,Patient age ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Retrospective Studies ,business.industry ,Age Factors ,Odds ratio ,Middle Aged ,Radiation Exposure ,Iridium Radioisotopes ,Confidence interval ,High-Dose Rate Brachytherapy ,Catheter ,Treatment Outcome ,030220 oncology & carcinogenesis ,Female ,Radiology ,Radiopharmaceuticals ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose To quantify the occurrence of tumor seeding in computed tomography (CT)-guided high-dose-rate brachytherapy (HDRBT) and to identify potential risk factors. Materials and Methods CT-HDRBT is a minimally invasive therapeutic option for local ablation of unresectable tumors. The procedure involves CT-guided placement of an enclosed catheter and high-dose-rate brachytherapy using iridium-192. Transcutaneous puncture of a tumor with subsequent retraction of the applicator has the potential risk of tumor seeding along the puncture tract. A total of 1,765 consecutive CT-HDRBT procedures were performed at this center between 2006 and 2017 and were retrospectively analyzed. In addition, a distinction was made between whether the puncture tract was irradiated or not. Follow-up imaging datasets were evaluated for tumor seeding along the former puncture tracts. Descriptive and exploratory statistical analyses of the data were performed. Results Tumor seeding was observed in 25 cases (25 of 1,765 cases [1.5%]). A total of 0.008 cases occurred per person-age. Patient age was identified as a potential risk factor with an odds ratio of 1.046 (95% confidence interval, 1.003–1.091; P = .04). There were no differences between whether the puncture tract was irradiated or not (P = .552). Conclusions Tumor seeding along the puncture tract can occur in CT-HDRBT but is rare.
- Published
- 2020
45. Comparing textbook outcomes among patients undergoing surgery for cancer at U. S. News & World Report ranked hospitals
- Author
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Rittal Mehta, Mary Dillhoff, Diamantis I. Tsilimigras, Anghela Z. Paredes, Amika Moro, Kota Sahara, Allan Tsung, Ayesha Farooq, Susan White, Aslam Ejaz, Timothy M. Pawlik, and Jordan M. Cloyd
- Subjects
Male ,medicine.medical_specialty ,Lung Neoplasms ,Colorectal cancer ,030230 surgery ,Digestive System Neoplasms ,Odds ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Humans ,Medicine ,Esophagus ,Aged ,business.industry ,Cancer ,General Medicine ,Odds ratio ,medicine.disease ,Hospitals ,United States ,Confidence interval ,Surgery ,Surgical Oncology ,Treatment Outcome ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Cohort ,Female ,business ,Liver cancer - Abstract
Background The objective of the current study was to define and compare rates of textbook outcomes (TO) among patients undergoing colorectal, lung, esophagus, liver, and pancreatic surgery for cancer at U.S. News & World Report (USNWR) ranked hospitals. Methods Medicare Inpatient Standard Analytic Files 2013-2015 were utilized to examine the relationship of TO and USNWR hospital ratings following surgery for colorectal, lung, esophageal, pancreatic, and liver cancer. TO was defined as no postoperative surgical complications, no prolonged length of hospital stay, no readmission within 90 days after discharge, and no postoperative mortality within 90 days after surgery. Results Among the 35,352 Medicare patients included in the cohort, 16,820 (47.6%) underwent surgery at honor roll hospitals, whereas 18 532 (52.4%) underwent surgery at non-honor roll hospitals. The overall proportion of patients who achieved TO was 50.1%. In examining the clinical outcomes of patients who underwent surgery, there was no difference in the odds of achieving TO at honor roll vs non-honor roll hospitals (colorectal: odds ratio [OR], 0.87; 95% confidence interval [CI], 0.69-1.10; lung: OR, 1.07; 95% CI, 0.87-1.32; esophagus: OR, 1.44; 95% CI, 0.72-2.89; liver: OR, 1.27; 95% CI, 0.87-1.84; pancreas: OR, 1.04; 95% CI, 0.67-1.62). Conclusion and relevance Patients undergoing surgery for lung, esophageal, liver, pancreatic, and colorectal cancer had comparable rates of TO at honor roll vs non-honor roll hospitals. No linear association was observed between hospital position in the rank and postoperative outcomes such as TO indicating that patients should not overly focus on the exact position within USNWR ranked hospitals. These data highlight to patients and physicians that up to one-half of patients undergoing surgery for cancer should anticipate at least one adverse outcome.
- Published
- 2020
46. Digestive Neuroendocrine Neoplasms (NEN): French Intergroup clinical practice guidelines for diagnosis, treatment and follow-up (SNFGE, GTE, RENATEN, TENPATH, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, SFR)
- Author
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Sébastien Gaujoux, Pierre Goudet, Rodica Gincul, Christine Do Cao, Frédéric Courbon, Romain Coriat, Thomas Walter, Louis de Mestier, Catherine Lombard-Bohas, Eric Baudin, Olivier Bouché, Eric Frampas, Côme Lepage, Thierry Lecomte, Gilles Poncet, Anne Couvelard, Guillaume Cadiot, Philippe Ruszniewski, and Denis Smith
- Subjects
Diagnostic Imaging ,medicine.medical_specialty ,Disease ,Digestive System Neoplasms ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,medicine ,Carcinoma ,Humans ,Endoscopy, Digestive System ,Stage (cooking) ,Intensive care medicine ,Pathological ,Societies, Medical ,Neoplasm Staging ,Hepatology ,business.industry ,Gastroenterology ,Evidence-based medicine ,Prognosis ,medicine.disease ,Combined Modality Therapy ,Clinical Practice ,Neuroendocrine Tumors ,030220 oncology & carcinogenesis ,Radionuclide therapy ,Quality of Life ,Chromogranin A ,030211 gastroenterology & hepatology ,France ,business - Abstract
Introduction This document is a summary of the French Intergroup guidelines regarding the management of digestive neuroendocrine neoplasms (NEN) published in February 2020 ( www.tncd.org ). Methods All French medical societies involved in the management of NEN took part in this work. Recommendations were graded into four categories (A, B, C or D), according to the level of evidence found in the literature until May 2019. Results The management of NEN is challenging because of their heterogeneity and the increasing complexity of diagnostic and therapeutic procedures. Pathological analysis is required for their diagnostic and prognostic characterization, which mainly relies on differentiation, grade and stage. The two main emergency situations are functioning syndromes and poorly-differentiated carcinoma. Chromogranin A is the main biochemical marker of NET, although of limited clinical interest. Initial characterization relies on morphological and isotopic imaging. The treatment of localized NET relies on watchful follow-up and local or surgical resection depending on its supposed aggressiveness. Treatment options for metastatic disease include surgery, somatostatin analogues, chemotherapy, targeted therapies, organ-driven locoregional therapies and peptide-receptor radionuclide therapy. As specific predictive factors of treatment efficacy are yet to be identified and head-to-head comparisons have not or only rarely been performed, the therapeutic strategy currently depends on prognostic factors. Cumulative toxicity and the impact of treatment on quality of life must be considered since survival is relatively long in most patients with NET. Conclusion These guidelines are proposed to achieve the most beneficial therapeutic strategy in clinical practice as the therapeutic landscape of NEN is becoming ever more complex. These recommendations are permanently being reviewed.
- Published
- 2020
47. Select Epstein-Barr Virus–Associated Digestive Tract Lesions for the Practicing Pathologist
- Author
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Zainab I. Alruwaii and Elizabeth A. Montgomery
- Subjects
0301 basic medicine ,Epstein-Barr Virus Infections ,Herpesvirus 4, Human ,Pathology ,medicine.medical_specialty ,business.industry ,General Medicine ,Disease ,Digestive System Neoplasms ,medicine.disease_cause ,Epstein–Barr virus ,Virus ,Pathology and Forensic Medicine ,03 medical and health sciences ,Medical Laboratory Technology ,030104 developmental biology ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Humans ,Medicine ,Digestive tract ,business ,Oncovirus - Abstract
Context.— Epstein-Barr virus is a ubiquitous oncogenic virus. During the past 5 decades, the virus has been linked to several disease entities, both neoplastic and nonneoplastic. Several Epstein-Barr virus–associated conditions affect the digestive organs, ranging from mild transient inflammatory conditions to more debilitating and even fatal diseases. Objective.— To discuss the clinicopathologic aspects of some newly or recently recognized Epstein-Barr virus–related conditions encountered in the digestive system and their therapeutic implications. Data Sources.— Published peer-reviewed literature was reviewed. Conclusions.— This article highlights the importance of recognizing the discussed lesions because they influence the direct clinical management or serve as a potential predictive marker for therapy.
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- 2020
48. Efficacy of Second-Line Chemotherapy in Extrapulmonary Neuroendocrine Carcinoma
- Author
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Timothy J. Hobday, Thorvardur R. Halfdanarson, Patrick W. McGarrah, Gustavo Figueiredo Marcondes Westin, Julian R. Molina, Konstantinos Leventakos, and Heidi D. Finnes
- Subjects
Male ,Oncology ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Salvage therapy ,Kaplan-Meier Estimate ,Digestive System Neoplasms ,Carboplatin ,chemistry.chemical_compound ,0302 clinical medicine ,Endocrinology ,Antineoplastic Combined Chemotherapy Protocols ,Etoposide ,Aged, 80 and over ,Cell Differentiation ,Middle Aged ,Progression-Free Survival ,Treatment Outcome ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,medicine.drug ,Adult ,medicine.medical_specialty ,Small-cell carcinoma ,Article ,Young Adult ,03 medical and health sciences ,Internal medicine ,Internal Medicine ,medicine ,Humans ,Progression-free survival ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Salvage Therapy ,Chemotherapy ,Hepatology ,Performance status ,business.industry ,medicine.disease ,Carcinoma, Neuroendocrine ,Regimen ,chemistry ,Cisplatin ,business ,Urogenital Neoplasms - Abstract
Objectives A platinum/etoposide doublet is standard first-line therapy for poorly differentiated neuroendocrine carcinoma (PD NEC); however, evidence to guide treatment beyond first-line regimens is lacking. This study aimed to evaluate the efficacy of second-line regimens in PD NEC. Methods We performed a retrospective analysis of patients treated with second-line chemotherapy for PD NEC. Inclusion criteria were previous first-line therapy with platinum/etoposide, extrapulmonary PD NEC, and follow-up data. The primary end points were overall survival (OS) and progression-free survival (PFS) after second-line therapy. Secondary end points included OS and PFS from first-line therapy. Results Sixty-four patients were included. The median OS from initiation of second-line therapy was 6.2 months (95% confidence interval [CI], 4.9-8.9). The median PFS was 2.3 months (95% CI, 2.0-3.2). No second-line regimen showed a statistically significant difference in OS or PFS. There was a significant increase in OS for cisplatin first-line regimens compared with carboplatin (17.0 months [95% CI, 12.5-22.6] vs 11.7 months [95% CI, 8.0-14.0]). Conclusions The efficacy of current second-line therapy in PD NEC is poor. No second-line regimen showed statistically significant superiority. Cisplatin was associated with longer OS regardless of second-line regimen or age. However, unmeasured confounders such as performance status or comorbidities may explain this effect.
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- 2020
49. Surgical Outcomes in Patients With Malignant Small Bowel Obstruction
- Author
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Adrienne N. Bruce, Yun Song, Rachel R. Kelz, Robert S. Krouse, Giorgos C. Karakousis, Robert E. Roses, Daniel Aryeh Metzger, and Douglas L. Fraker
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Male ,medicine.medical_specialty ,Population ,Digestive System Neoplasms ,Rate ratio ,Postoperative Complications ,Internal medicine ,Intestine, Small ,medicine ,Humans ,Hypoalbuminemia ,Propensity Score ,education ,Aged ,Retrospective Studies ,education.field_of_study ,business.industry ,Mortality rate ,Area under the curve ,Odds ratio ,Length of Stay ,Middle Aged ,medicine.disease ,Quality Improvement ,United States ,Survival Rate ,Bowel obstruction ,Female ,Laparoscopy ,Surgery ,Morbidity ,Complication ,business ,Intestinal Obstruction ,Follow-Up Studies - Abstract
OBJECTIVE The study objectives were to characterize surgical outcomes for malignant small bowel obstruction (MaSBO) as compared to other small bowel obstructions (SBO) and to develop a prediction model for postoperative mortality for MaSBO. SUMMARY BACKGROUND DATA MaSBO is a morbid complication of advanced cancers for which the optimal management remains undefined. METHODS Patients who underwent surgery for MaSBO or SBO were identified from the National Surgical Quality Improvement Program (2005-2017). Outcomes [30-day morbidity, unplanned readmissions, mortality, postoperative length of stay (LOS)] were compared between propensity score-matched MaSBO and SBO patients. An internally validated prediction model for mortality in MaSBO patients was developed. RESULTS Of 46,706 patients, 1612 (3.5%) had MaSBO. Although MaSBO patients were younger than those with SBO (median 63 vs 65 years, P < 0.001), they were otherwise more clinically complex, including a higher proportion with recent weight loss (22.0% vs 4.0%, P < 0.001), severe hypoalbuminemia (18.6% vs 5.2%, P < 0.001), and cytopenias. After matching (N = 1609/group), MaSBO was associated with increased morbidity [odds ratio (OR) 1.2, P = 0.004], but not readmission (OR 1.1, P = 0.48) or LOS (incidence rate ratio 1.0, P = 0.14). The odds of mortality were significantly higher for MaSBO than SBO (OR 3.3, P < 0.001). A risk-score model predicted postoperative mortality for MaSBO with an optimism-adjusted Brier score of 0.114 and area under the curve of 0.735. Patients in the highest-risk category (11.5% of MaSBO population) had a predicted mortality rate of 39.4%. CONCLUSION Surgery for MaSBO is associated with substantial morbidity and mortality, necessitating careful patient evaluation before operative intervention.
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- 2020
50. Clinical impact of FDG PET/CT in alimentary tract malignancies: an updated review
- Author
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Murat Osman, Zain N. Qazi, Robert K. Zeman, and Esma A. Akin
- Subjects
medicine.medical_specialty ,Colorectal cancer ,Urology ,Digestive System Neoplasms ,Malignancy ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Fluorodeoxyglucose F18 ,Positron Emission Tomography Computed Tomography ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Neoplasm Staging ,PET-CT ,Radiological and Ultrasound Technology ,GiST ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Cancer ,Esophageal cancer ,Hepatology ,medicine.disease ,Positron emission tomography ,030220 oncology & carcinogenesis ,Radiology ,Radiopharmaceuticals ,business - Abstract
The use of 18F-fluorodeoxyglucose (FDG) positron emission tomography combined with computed tomography (PET/CT) is well established in the evaluation of alimentary tract malignancies. This review of the literature and demonstration of correlative images focuses on the current role of PET/CT in the diagnosis (including pathologic/clinical staging) and post-therapy follow-up of esophageal, gastric, and colorectal cancers. PET/CT provides utility in the management of esophageal cancer, including detection of distant disease prior to resection. In gastric cancer, PET/CT is useful in detecting solid organ metastases and in characterizing responders vs. non-responders after neoadjuvant chemotherapy, the latter of which have poorer overall survival. In patients with GIST tumors, PET/CT also determines response to imatinib therapy with greater expedience as compared to CECT. For colorectal cancer, PET/CT has proven helpful in detecting hepatic and other distant metastases, treatment response, and differentiating post-radiation changes from tumor recurrence. Our review also highlights several pitfalls in PET/CT interpretation of alimentary tract lesions.
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- 2020
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