Women health and microbiota:Different aspects of well-being

In this editorial,we comment on the article by Marano et al recently published in the World Journal of Gastroenterology 2023;29(45):5945-5952.We focus on the role of gut microbiota(GM)in women’s health,highlighting the need to thoroughly comprehend the sex differences in microbiota.Together,the host and GM support the host’s health.The microbiota components consist of viruses,bacteria,fungi,and archaea.This complex is an essential part of the host and is involved in neu-rological development,metabolic control,immune system dynamics,and host dynamic homeostasis.It has been shown that differences in the GM of males and females can contribute to chronic diseases,such as gastrointestinal,metabolic,neurological,cardiovascular,and respiratory illnesses.These differences can also result in some sex-specific changes in immunity.Every day,research on GM reveals new and more expansive frontiers,offering a wealth of innovative oppor-tunities for preventive and precision medicine.

Metadherin-driven promotion of cancer stem cell phenotypes and its effect on immunity in hepatocellular carcinoma

In this editorial we provide commentary on the article published by Wang et al,featured in the recent issue of the World Journal of Gastroenterology in 2024.We focus on the metadherin(MTDH),also known as astrocyte elevated gene-1 or lysine rich CEACAM1,and its effects on cancer stem cells(CSCs)and immunity in hepatocellular carcinoma(HCC).HCC is the most common primary liver cancer and one of the leading causes of cancer-related deaths worldwide.Most HCC cases develop in the context of liver cirrhosis.Among the pivotal mechanisms of carcinogenesis are gene mutations,dysregulation of diverse signaling pathways,epigenetic alterations,hepatitis B virus-induced hepatocarcinogenesis,chronic inflammation,impact of tumor microenvironment,oxidative stress.Over the years,extensive research has been conducted on the MTDH role in various tumor pathologies,such as lung,breast,ovarian,gastric,hepatocellular,colorectal,renal carcinoma,neuroblastoma,melanoma,and leukemias.Specifically,its involvement in tumor development processes including transformation,apoptosis evasion,angiogenesis,invasion,and metastasis via multiple signaling pathways.It has been demonstrated that knockdown or knockout of MTDH disrupt tumor development and metastasis.In addition,numerous reports have been carried out regarding the MTDH influence on HCC,demonstrating its role as a predictor of poor prognosis,aggressive tumor phenotypes prone to metastasis and recurrence,and exhibiting significant potential for therapy resistance.Finally,more studies finely investigated the influence of MTDH on CSCs.The CSCs are a small subpopulation of tumor cells that sharing traits with normal stem cells like self-renewal and differentiation abilities,alongside a high plasticity that alters their phenotype.Beyond their presumed role in tumor initiation,they can drive also disease relapse,metastasis,and resistance to chemo and radiotherapy.

Molecular methods for colorectal cancer screening:Progress with next-generation sequencing evolution

Currently,colorectal cancer(CRC)represents the third most common malignancy and the second most deadly cancer worldwide,with a higher incidence in developed countries.Like other solid tumors,CRC is a heterogeneous genomic disease in which various alterations,such as point mutations,genomic rearrangements,gene fusions or chromosomal copy number alterations,can contribute to the disease development.However,because of its orderly natural history,easily accessible onset location and high lifetime incidence,CRC is ideally suited for preventive intervention,but the many screening efforts of the last decades have been compromised by performance limitations and low penetrance of the standard screening tools.The advent of next-generation sequencing(NGS)has both facilitated the identification of previously unrecognized CRC features such as its relationship with gut microbial pathogens and revolutionized the speed and throughput of cataloguing CRC-related genomic alterations.Hence,in this review,we summarized the several diagnostic tools used for CRC screening in the past and the present,focusing on recent NGS approaches and their revolutionary role in the identification of novel genomic CRC characteristics,the advancement of understanding the CRC carcinogenesis and the screening of clinically actionable targets for personalized medicine.

Gastric cancer and the epoch of immunotherapy approaches

The incidence of gastric cancer(GC) fell dramatically over the last 50 years, but according to IARC-Globocan 2008, it is the third most frequent cause of cancerrelated deaths with a case fatality GC ratio higher than other common malignancies. Surgical resection is the primary curative treatment for GC though the overall 5-year survival rate remains poor(approximately 20%-25%). To improve the outcome of resectable gastric cancer, different treatment strategies have been evaluated such as adjuvant or perioperative chemotherapy. In resected gastric cancer, the addition of radiotherapy to chemotherapy does not appear to provide any additional benefit. Moreover, in metastatic patients, chemotherapy is the mainstay of palliative therapy with a median overall survival of 8-10 mo and objective response rates of merely 20%-40%. Therefore, the potential for making key beneficial progress is to investigate the GC molecular biology to realize innovative therapeutic strategies, such as specific immunotherapy. In this review, we provide a panoramic view of the different immune-based strategies used for gastric cancer treatment and the results obtained in the most significant clinical trials. In detail, firstly we describe the therapeutic approaches that utilize the monoclonal antibodies while in the second part we analyze the cell-based immunotherapies.

Role of diet and gut microbiota on colorectal cancer immunomodulation

Colorectal cancer(CRC) is one of the most commonly diagnosed cancers, and it is characterized by genetic and epigenetic alterations, as well as by inflammatory cell infiltration among malignant and stromal cells. However, this dynamic infiltration can be influenced by the microenvironment to promote tumor proliferation, survival and metastasis or cancer inhibition. In particular, the cancer microenvironment metabolites can regulate the inflammatory cells to induce a chronic inflammatory response that can be a predisposing condition for CRC retention. In addition, some nutritional components might contribute to a chronic inflammatory condition by regulating various immune and inflammatory pathways. Besides that, diet strongly modulates the gut microbiota composition,which has a key role in maintaining gut homeostasis and is associated with the modulation of host inflammatory and immune responses. Therefore, diet has a fundamental role in CRC initiation, progression and prevention. In particular,functional foods such as probiotics, prebiotics and symbiotics can have a potentially positive effect on health beyond basic nutrition and have antiinflammatory effects. In this review, we discuss the influence of diet on gut microbiota composition, focusing on its role on gut inflammation and immunity.Finally, we describe the potential benefits of using probiotics and prebiotics to modulate the host inflammatory response, as well as its application in CRC prevention and treatment.

Evaluation and comparison of short chain fatty acids composition in gut diseases

BACKGROUND An altered (dysbiosis) and unhealthy status of the gut microbiota is usually responsible for a reduction of short chain fatty acids (SCFAs) concentration. SCFAs obtained from the carbohydrate fermentation processes are crucial in maintaining gut homeostasis and their determination in stool samples could provide a faster, reliable and cheaper method to highlight the presence of an intestinal dysbiosis and a biomarker for various gut diseases. We hypothesize that different intestinal diseases, such as celiac disease (CD), adenomatous polyposis (AP) and colorectal cancer (CRC) could display a particular fecal SCFAs’ signature. AIM To compare the fecal SCFAs’ profiles of CD, AP, CRC patients and healthy controls, using the same analytical method. METHODS In this cross-sectional study, we defined and compared the SCFAs’ concentration in fecal samples of 9 AP, 16 CD, 19 CRC patients and 16 healthy controls (HC). The SCFAs’ analysis were performed using a gas-chromatography coupled with mass spectrometry method. Data analysis was carried out using Wilcoxon ranksum test to assess pairwise differences of SCFAs’ profiles, partial least squaresdiscriminate analysis (PLS-DA) to determine the status membership based on distinct SCFAs’ profiles, and Dirichlet regression to determine factors influencing concentration levels of SCFAs. RESULTS We have not observed any difference in the SCFAs’ amount and composition between CD and healthy control. On the contrary, the total amount of SCFAs was significantly lower in CRC patients compared to HC (P = 0.044) and CD (P = 0.005). Moreover, the SCFAs’ percentage composition was different in CRC and AP compared to HC. In detail, HC displayed higher percentage of acetic acid (P value = 1.3 × 10-6) and a lower amount of butyric (P value = 0.02192), isobutyric (P value = 7.4 × 10-5), isovaleric (P value = 0.00012) and valeric (P value = 0.00014) acids compared to CRC patients. AP showed a lower abundance of acetic acid (P value = 0.00062) and higher percentages of propionic (P value = 0.00433) and isovaleric (P value = 0.00433) acids compared to HC. Moreover, AP showed higher levels of propionic acid (P value = 0.03251) and a lower level of isobutyric acid (P value = 0.00427) in comparison to CRC. The PLS-DA model demonstrated a significant separation of CRC and AP groups from HC, although some degree of overlap was observed between CRC and AP. CONCLUSION Analysis of fecal SCFAs shows the potential to provide a non-invasive means of diagnosis to detect patients with CRC and AP, while CD patients cannot be discriminated from healthy subjects.

Metabolomics profile in gastrointestinal cancers:Update and future perspectives

Despite recent progress in diagnosis and therapy,gastrointestinal(GI)cancers remain one of the most important causes of death with a poor prognosis due to late diagnosis.Serum tumor markers and detection of occult blood in the stool are the current tests used in the clinic of GI cancers;however,these tests are not useful as diagnostic screening since they have low specificity and low sensitivity.Considering that one of the hallmarks of cancer is dysregulated metabolism and metabolomics is an optimal approach to illustrate the metabolic mechanisms that belong to living systems,is now clear that this-omics could open a new way to study cancer.In the last years,nuclear magnetic resonance(NMR)metabolomics has demonstrated to be an optimal approach for diseases’diagnosis nevertheless a few studies focus on the NMR capability to find new biomarkers for early diagnosis of GI cancers.For these reasons in this review,we will give an update on the status of NMR metabolomic studies for the diagnosis and development of GI cancers using biological fluids.

Role of gut microbiota-immunity axis in patients undergoing surgery for colorectal cancer:Focus on short and long-term outcomes

Human body is colonized by a huge amount of microorganisms mostly located in the gastrointestinal tract.These dynamic communities,the environment and their metabolites constitute the microbiota.Growing data suggests a causal role of a dysbiotic microbiota in several pathologies,such as metabolic and neurological disorders,immunity dysregulations and cancer,especially the well-studied colorectal cancer development.However,many were preclinical studies and a complete knowledge of the pathogenetic mechanisms in humans is still absent.The gut microbiota can exert direct or indirect effects in different phases of colorectal cancer genesis.For example,Fusobacterium nucleatum promotes cancer through cellular proliferation and some strains of Escherichia coli and Bacteroides fragilis produce genotoxins.However,dysbiosis may also cause a proinflammatory state and the stimulation of a Th17 response with IL-17 and IL-22 secretion that have a pro-oncogenic activity,as demonstrated for Fusobacterium nucleatum.Microbiota has a crucial role in several stages of postoperative course;dysbiosis in fact seems related with surgical site infections and Enterococcus faecalis(and other collagenase-producers microbes)are suggested as a cause of anastomotic leak.Consequently,unbalanced presence of some species,together with altered immune response may also have a prognostic role.Microbiota has also a substantial role in effectiveness of chemotherapy,chemoresistance and in the related side effects.In other words,a complete knowledge of the fine pathological mechanisms of gut microbiota may provide a wide range of new diagnostic tools other than therapeutic targets in the light of tailored medicine.

Gut microbiota and immune system in liver cancer:Promising therapeutic implication from development to treatment

Liver cancer is a leading cause of death worldwide,and hepatocellular carcinoma(HCC)is the most frequent primary liver tumour,followed by cholangiocarcinoma.Notably,secondary tumours represent up to 90% of liver tumours.Chronic liver disease is a recognised risk factor for liver cancer development.Up to 90% of the patients with HCC and about 20% of those with cholangiocarcinoma have an underlying liver alteration.The gut microbiota-liver axis represents the bidirectional relationship between gut microbiota,its metabolites and the liver through the portal flow.The interplay between the immune system and gut microbiota is also well-known.Although primarily resulting from experiments in animal models and on HCC,growing evidence suggests a causal role for the gut microbiota in the development and progression of chronic liver pathologies and liver tumours.Despite the curative intent of“traditional”treatments,tumour recurrence remains high.Therefore,microbiota modulation is an appealing therapeutic target for liver cancer prevention and treatment.Furthermore,microbiota could represent a non-invasive biomarker for early liver cancer diagnosis.This review summarises the potential role of the microbiota and immune system in primary and secondary liver cancer development,focusing on the potential therapeutic implications.

Microbiota shaping — the effects of probiotics, prebiotics, and fecal microbiota transplant on cognitive functions: A systematic review

BACKGROUND Dementia is a chronic progressive neurological disease affecting millions of people worldwide,and represents a relevant economic burden for healthcare systems.Although its pathogenesis is still unknown,recent findings have reported that a dysregulated gut-brain axis communication,a fundamental relationship mediated by several host and microbial molecules,is associated with cognitive disorders.In addition,gut microbiota manipulation reduces neuroinflammation,improving cognitive function by restoring the functional gut-brain axis.AIM To better define the effects of probiotics,prebiotics,synbiotics,and fecal microbiota transplant(FMT)on cognitive function.METHODS We performed a literature search of human randomized clinical trials to examine the effects of the administration of probiotics,prebiotics,synbiotics,or FMT on cognition outcomes in healthy or sick people of every age,sex,and nationality.We systematically searched Embase,Medline/PubMed,Cochrane Library,central and clinicaltrials.gov databases with a combination of comprehensive terms related to cognition and gut microbiota manipulation.Then we carefully reviewed and synthesized the data by type of study design and setting,characteristics of the studied population,kind of intervention(strain type or mixture type,dosage,and frequency of administration),control treatment,inclusion and exclusion criteria,follow-up duration,and cognitive or memory outcomes.RESULTS After examining the titles and abstracts,the initial literature screening identified 995 articles,but we added 23 papers in our systematic review.The analyses of these selected studies highlighted that both probiotic supplementation and FMT improved cognitive function regardless of the type and posology of administration and the adopted cognitive tests and questionnaires.We found that most of the studies conducted in healthy people showed a significant positive effect of the intervention on at least one of the performed cognitive tests.Regarding unhealthy subjects,while FMT and especially probiotic administration had multiple beneficial effects on different cognitive functions,supplementation with prebiotics did not provide any cognitive improvement.CONCLUSION Probiotic supplementation and FMT may represent a promising strategy to restore gut eubiosis and enhance the cognitive functions of healthy people and patients with neurological disorders.

Healthy axis: Towards an integrated view of the gut-brain health

Despite the lack of precise mechanisms of action, a growing number of studies suggests that gut microbiota is involved in a great number of physiological functions of the human organism. In fact, the composition and the relations of intestinal microbial populations play a role, either directly or indirectly, to both the onset and development of various pathologies. In particular, the gastrointestinal tract and nervous system are closely connected by the so-called gut–brain axis, a complex bidirectional system in which the central and enteric nervous system interact with each other, also engaging endocrine, immune and neuronal circuits. This allows us to put forward new working hypotheses on the origin of some multifactorial diseases: from eating to neuropsychiatric disorders (such as autism spectrum disorders and depression) up to diabetes and tumors (such as colorectal cancer). This scenario reinforces the idea that the microbiota and its composition represent a factor, which is no longer negligible, not only in preserving what we call “health” but also in defining and thus determining it. Therefore, we propose to consider the gut-brain axis as the focus of new scientific and clinical investigation as long as the locus of possible systemic therapeutic interventions.

Effect of ancient Khorasan wheat on gut microbiota,inflammation,and short-chain fatty acid production in patients with fibromyalgia

BACKGROUND Fibromyalgia(FM)syndrome is mainly characterized by widespread pain,sleeping disorders,fatigue,and cognitive dysfunction.In many cases,gastrointestinal distress is also reported,suggesting the potential pathogenic role of the gut microbiota(GM).The GM is deeply influenced by several environmental factors,especially the diet,and recent findings highlighted significant symptom improvement in FM patients following various nutritional interventions such as vegetarian diet,low-fermentable oligosaccharides,disaccharides,monosaccharides,and polyols based diets,gluten-free diet,and especially an ancient grain supplementation.In particular,a recent study reported that a replacement diet with ancient Khorasan wheat led to an overall improvement in symptom severity of FM patients.AIM To examine the effects of ancient Khorasan wheat on the GM,inflammation,and short-chain fatty acid production in FM patients.METHODS After a 2-wk run-in period,20 FM patients were enrolled in this randomized,double-blind crossover trial.In detail,they were assigned to consume either Khorasan or control wheat products for 8 wk and then,following an 8-wk washout period,crossed.Before and after treatments,GM characterization was performed by 16S rRNA sequencing while the fecal molecular inflammatory response and the short-chain fatty acids(SCFAs)were respectively determined with the Luminex MAGPIX detection system and a mass chromatography-mass spectrometry method.RESULTS The Khorasan wheat replacement diet,in comparison with the control wheat diet,had more positive effects on intestinal microbiota composition and on both the fecal immune and SCFAs profiles such as the significant increase of butyric acid levels(P=0.054),candidatus Saccharibacteria(P=9.95e-06)and Actinobacteria,and the reduction of Enterococcaceae(P=4.97e-04).Moreover,the improvement of various FM symptoms along with the variation of some gut bacteria after the Khorasan wheat diet have been documented;in fact we reported positive correlations between Actinobacteria and both Tiredness Symptoms Scale(P<0.001)and Functional Outcome of Sleep Questionnaire(P<0.05)scores,between Verrucomicrobiae and both Widespread Pain Index(WPI)+Symptom Severity scale(SS)(P<0.05)and WPI(P<0.05)scores,between candidatus Saccharibacteria and SS score(P<0.05),and between Bacteroidales and Sleep-Related and Safety Behaviour Questionnaire score(P<0.05).CONCLUSION The replacement diet based on ancient Khorasan wheat results in beneficial GM compositional and functional modifications that positively correlate with an improvement of FM symptomatology.

Immunomodulation by probiotics and prebiotics in hepatocellular carcinoma

Hepatocellular carcinoma(HCC)is the most prevalent primary malignancy in patients suffering from chronic liver diseases and cirrhosis.Recent attention has been paid to the involvement of the gut-liver axis(GLA)in HCC pathogenesis.This axis results from a bidirectional,anatomical and functional relationship between the gastrointestinal system and the liver.Moreover,the complex network of interactions between the intestinal microbiome and the liver plays a crucial role in modulation of the HCC-tumor microenvironment,contributing to the pathogenesis of HCC by exposing the liver to pathogen-associated molecular patterns,such as bacterial lipopolysaccharides,DNA,peptidoglycans and flagellin.Indeed,the alteration of gut microflora may disturb the intestinal barrier,bringing several toll-like receptor ligands to the liver thus activating the inflammatory response.This review explores the new therapeutic opportunities that may arise from novel insights into the mechanisms by which microbiota immunomodulation,represented by probiotics,and prebiotics,affects HCC through the GLA.

Effects of viremia and CD4 recovery on gut“microbiome-immunity”axis in treatment-na?ve HIV-1-infected patients undergoing antiretroviral therapy

BACKGROUND Human immunodeficiency virus type 1(HIV-1)infection is characterized by persistent systemic inflammation and immune activation,even in patients receiving effective antiretroviral therapy(ART).Converging data from many cross-sectional studies suggest that gut microbiota(GM)changes can occur throughout including human immunodeficiency virus(HIV)infection,treated by ART;however,the results are contrasting.For the first time,we compared the fecal microbial composition,serum and fecal microbial metabolites,and serum cytokine profile of treatment-na?ve patients before starting ART and after reaching virological suppression,after 24 wk of ART therapy.In addition,we compared the microbiota composition,microbial metabolites,and cytokine profile of patients with CD4/CD8 ratio<1(immunological non-responders[INRs])and CD4/CD8>1(immunological responders[IRs]),after 24 wk of ART therapy.AIM To compare for the first time the fecal microbial composition,serum and fecal microbial metabolites,and serum cytokine profile of treatment-na?ve patients before starting ART and after reaching virological suppression(HIV RNA<50 copies/m L)after 24 wk of ART.METHODS We enrolled 12 treatment-na?ve HIV-infected patients receiving ART(mainly based on integrase inhibitors).Fecal microbiota composition was assessed through next generation sequencing.In addition,a comprehensive analysis of a blood broad-spectrum cytokine panel was performed through a multiplex approach.At the same time,serum free fatty acid(FFA)and fecal short chain fatty acid levels were obtained through gas chromatography-mass spectrometry.RESULTS We first compared microbiota signatures,FFA levels,and cytokine profile before starting ART and after reaching virological suppression.Modest alterations were observed in microbiota composition,in particular in the viral suppression condition,we detected an increase of Ruminococcus and Succinivibrio and a decrease of Intestinibacter.Moreover,in the same condition,we also observed augmented levels of serum propionic and butyric acids.Contemporarily,a reduction of serum IP-10 and an increase of IL-8 levels were detected in the viral suppression condition.In addition,the same components were compared between IRs and INRs.Concerning the microflora population,we detected a reduction of Faecalibacterium and an increase of Alistipes in INRs.Simultaneously,fecal isobutyric,isovaleric,and 2-methylbutyric acids were also increased in INRs.CONCLUSION Our results provided an additional perspective about the impact of HIV infection,ART,and immune recovery on the"microbiome-immunity axis"at the metabolism level.These factors can act as indicators of the active processes occurring in the gastrointestinal tract.Individuals with HIV-1 infection,before ART and after reaching virological suppression with 24 wk of ART,displayed a microbiota with unchanged overall bacterial diversity;moreover,their systemic inflammatory status seems not to be completely restored.In addition,we confirmed the role of the GM metabolites in immune reconstitution.

Exploring the food-gut axis in immunotherapy response of cancer patients

Nowadays,immunotherapy is widely used to treat different cancer types as it boosts the body's natural defenses against the malignancy,with lower risk of adverse events compared to the traditional treatments.The immune system is able to control cancer growth but,unfortunately,many cancers take advantage of immune checkpoints pathways for the immune evasion.An intricate network of factors including tumor,host and environmental variables influence the individual response to immune checkpoints’inhibitors.Between them,the gut microbiota(GM)has recently gained increasing attention because of its emerging role as a modulator of the immune response.Several studies analyzed the diversities between immunotherapy-sensitive and immunotherapy-resistant cohorts,evidencing that particular GM profiles were closely associated to treatment effect.In addition,other data documented that interventional GM modulation could effectively enhance efficacy and relieve resistance during immunotherapy treatment.Diet represents one of the major GM determinants,and ongoing studies are examining the role of the food-gut axis in immunotherapy treatment.Here,we review recent studies that described how variations of the GM affects patient’s responsivity to anti-cancer immunotherapy and how diet-related factors impact on the GM modulation in cancer,outlining potential future clinical directions of these recent findings.

Microbiota and viral hepatitis:State of the art of a complex matter

Changes in gut microbiota influence both the gut and liver,which are strictly connected by the so-called“gut-liver axis”.The gut microbiota acts as a major determinant of this relationship in the onset and clinical course of liver diseases.According to the results of several studies,gut dysbiosis is linked to viral hepatitis,mainly hepatitis C virus and hepatitis B virus infection.Gut bacteriaderived metabolites and cellular components are key molecules that affect liver function and modulate the pathology of viral hepatitis.Recent studies showed that the gut microbiota produces various molecules,such as peptidoglycans,lipopolysaccharides,DNA,lipoteichoic acid,indole-derivatives,bile acids,and trimethylamine,which are translocated to the liver and interact with liver immune cells causing pathological effects.Therefore,the existence of crosstalk between the gut microbiota and the liver and its implications on host health and pathologic status are essential factors impacting the etiology and therapeutic approach.Concrete mechanisms behind the pathogenic role of gut-derived components on the pathogenesis of viral hepatitis remain unclear and not understood.In this review,we discuss the current findings of research on the bidirectional relationship of the components of gut microbiota and the progression of liver diseases and viral hepatitis and vice versa.Moreover,this paper highlights the current therapeutic and preventive strategies,such as fecal transplantation,used to restore the gut microbiota composition and so improve host health.

Evaluation of prognostic factors and clinicopathological patterns of recurrence after curative surgery for colorectal cancer

BACKGROUND Colorectal cancer is a common tumor with a quite high-related mortality.Despite the used curative treatments,patients will develop cancer recurrence in up to 50%of the cases and/or other primary neoplasms.Although most of the recurrences are discovered within 3 years from the first treatment,a small percentage is found after 5 years.The early detection of recurrence is crucial to allow further therapies improving patients’survival.Several follow-up programs have been developed but the optimal one is far from being established.AIM To evaluation of potential prognostic factors for timing and patterns of recurrence in order to plan tailored follow-up programs.METHODS Perioperative and long-term data of all consecutive patients surgically treated with curative intent,from January 2006 to June 2009,for colorectal adenocarcinoma,were retrospectively reviewed to find potential prognostic factors associated with:(1)Recurrence incidence;(2)Incidence of an early(within 3 years from surgery)or late recurrence;and(3)Different sites of recurrence.In addition,the incidence of other primary neoplasms has been evaluated in a cohort of patients with a minimum potential follow-up of 10 years.RESULTS Our study included 234 patients.The median follow-up period has been 119±46.2 mo.The recurrence rate has been 25.6%.Patients with a higher chance to develop recurrence had also the following characteristics:Higher levels of preoperative glycemia and carcinoembryonic antigen,highest anaesthesiologists Score score,occlusion,received a complex operation performed with an open technique,after a longer hospital stay,and showed advanced tumors.The independent prognostic factors for recurrence were the hospital stay,N stage 2,and M stage 1(multivariate analysis).Younger ages were significantly associated with an early recurrence onset.Patients that received intermediate colectomies or segmental resections,having an N stage 2 or American Joint Committee on Cancer stage 3 tumors were also associated with a higher risk of liver recurrence,while metastatic diseases at diagnosis were linked with local recurrence.Neoadjuvant treatments showed lung recurrence.Finally,bigger tumors and higher lymph node ratio were associated with peritoneal recurrence(marginally significant).Thirty patients developed a second malignancy during the follow-up time.CONCLUSION Several prognostic factors should be considered for tailored follow-up programs,eventually,beyond 5 years from the first treatment.

Impact of microbiota-immunity axis in pancreatic cancer management

The microbiota impact on human diseases is well-known,and a growing body of literature is providing evidence about the complex interplay between microbiotaimmune system-human physiology/pathology,including cancers.Together with the defined risk factors(e.g.,smoke habits,diet,diabetes,and obesity),the oral,gut,biliary,and intrapancreatic microbiota contribute to pancreatic cancer development through different pathways including the interaction with the immune system.Unfortunately,a great majority of the pancreatic cancer patients received a diagnosis in advanced stages not amenable to be radically treated and potentially cured.Given the poor pancreatic cancer prognosis,complete knowledge of these complicated relationships could help researchers better understand the disease pathogenesis and thus provide early potential noninvasive biomarkers,new therapeutic targets,and tools for risk stratification that might result in greater therapeutic possibilities and eventually in a better and longer patient survival.

Evaluating the best treatment for multifocal hepatocellular carcinoma:A propensity score-matched analysis

BACKGROUND Hepatocellular carcinoma(HCC)is a common tumour often diagnosed with a multifocal presentation.Patients with multifocal HCC represent a heterogeneous group.Although Trans-Arterial ChemoEmbolization(TACE)is the most frequently employed treatment for these patients,previous data suggested that liver resection(LR)could be a safe and effective procedure.AIM To compare LR and TACE in patients with multifocal HCC in terms of procedurerelated morbidity and oncologic outcomes.METHODS All patients with multifocal HCC who underwent LR or TACE as the first procedure between May 2011 and March 2021 were enrolled.The decision to perform surgery or TACE was made after a multidisciplinary team evaluation.Only patients in Child-Pugh class A or B7 and stage B(according to the Barcelona Clinic Liver Cancer staging system,without severe portal hypertension,vascular invasion,or extrahepatic spread)were included in the final analysis.Propensity score matching was used to adjust the baseline differences between patients undergoing LR and the TACE group[number and diameter of lesions,presence of cirrhosis,alpha-fetoprotein(AFP)levels,and Model for End-Stage Liver Disease score].The Kaplan-Meier method was used to estimate overall survival(OS)and disease-free survival(DFS).The outcomes of LR and TACE were compared using the log-rank test.RESULTS After matching,30 patients were eligible for the final analysis,15 in each group.Morbidity rates were 42.9% and 40% for LR and TACE,respectively(P=0.876).Median OS was not different in the LR and TACE groups(53 mo vs 18 mo,P=0.312),while DFS was significantly longer with LR(19 mo vs 0 mo,P=0.0001).Subgroup analysis showed that patients in the Italian Liver Cancer(ITA.LI.CA)B2 stage,with AFP levels lower than 400 ng/mL,less than 3 lesions,and lesions bigger than 41 mm,benefited more from LR in terms of DFS.Patients classified as ITA.LI.CA B3,with AFP levels higher than 400 ng/mL and with more than 3 lesions,appeared to receive more benefit from TACE in terms of OS.CONCLUSION In a small cohort of patients with multifocal HCC,LR confers longer DFS compared with TACE,with similar OS and post-procedural morbidity.

Fecal metabolomic profiles: A comparative study of patients with colorectal cancer vs adenomatous polyps

BACKGROUND Colorectal cancer(CRC),the third most common cause of death in both males and females worldwide,shows a positive response to therapy and usually a better prognosis when detected at an early stage.However,the survival rate declines when the diagnosis is late and the tumor spreads to other organs.Currently,the measures widely used in the clinic are fecal occult blood test and evaluation of serum tumor markers,but the lack of sensitivity and specificity of these markers restricts their use for CRC diagnosis.Due to its high sensitivity and precision,colonoscopy is currently the gold-standard screening technique for CRC,but it is a costly and invasive procedure.Therefore,the implementation of custom-made methodologies including those with minimal invasiveness,protection,and reproducibility is highly desirable.With regard to other screening methods,the screening of fecal samples has several benefits,and metabolomics is a successful method to classify the metabolite shift in living systems as a reaction to pathophysiological influences,genetic modifications,and environmental factors.AIM To characterize the variation groups and potentially recognize some diagnostic markers,we compared with healthy controls(HCs)the fecal nuclear magnetic resonance(NMR)metabolomic profiles of patients with CRC or adenomatous polyposis(AP).METHODS Proton nuclear magnetic resonance spectroscopy was used in combination with multivariate and univariate statistical approaches,to define the fecal metabolic profiles of 32 CRC patients,16 AP patients,and 38 HCs well matched in age,sex,and body mass index.RESULTS NMR metabolomic analyses revealed that fecal sample profiles differed among CRC patients,AP patients,and HCs,and some discriminatory metabolites including acetate,butyrate,propionate,3-hydroxyphenylacetic acid,valine,tyrosine and leucine were identified.CONCLUSION In conclusion,we are confident that our data can be a forerunner for future studies on CRC management,especially the diagnosis and evaluation of the effectiveness of treatments.