Is ypTNM staging a comparable predictor as pTNM staging for survival in non-metastatic rectal cancer after preoperative chemoradiation therapy?

Abstract:Background:The pTNM staging system is widely recognized as the most effective prognostic indicator for cancer.The latest update of this staging system introduced a new pathological staging system(ypTNM)for patients receiving neoadjuvant chemoradiotherapy(NACRT).However,whether the prognostic value of the ypTNM staging system for rectal cancer is similar to that of the pTNM staging system remains unclear.This study was conducted to compare the ypTNM and pTNM staging systems in terms of their prognostic value for patients with nonmetastatic rectal cancer undergoing proctectomy.Material and Methods:This study was conducted at a large teaching hospital.Between January 2014 and December 2022,542 patients with rectal cancer were analyzed(median follow-up period,60 months;range,6–105 months).Of them,258 and 284 were included in the pTNM and ypTNM groups,respectively.Inverse probability of treatment weighting(IPTW)was performed to account for the effects of confounders.Cox proportional-hazards regression was performed for the between-group comparison of overall survival(OS).Results:The crude model revealed that OS was similar between the two groups(p=0.607).After performing IPTW,we found that patients with the same ypTNM-and pTNM-classified stages had similar overall survival(hazard ratio=1.15;95%CI=0.76–1.73;p=0.5074).Conclusions:For patients with rectal cancer who have received preoperative NACRT,the prognostic value of ypTNM staging appears to be similar to that of pTNM staging,mostly because of the downstaging effect of neoadjuvant chemoradiotherapy。

Dual specimens increase the diagnostic accuracy and reduce the reaction duration of rapid urease test

AIM:To evaluate the influence of multiple samplings during esophagogastr oduodenoscopy(EGD) on the accuracy of the rapid urease test,and the validity of newly developed rapid urease tests,HelicotecUT plus test and HelicotecUT test,CLO test and ProntoDry test.METHODS:A total of 355 patients undergoing EGD for dyspepsia were included.Their Helicobacter pylori(H.pylori) treatment status was either nave or eradicated.Six biopsy specimens from antrum and gastric body,respectively,were obtained during EGD.Single antral specimens and dual(antrum+body) specimens were compared.Infection status of H.pylori was evaluated by three different tests:culture,histology,and four different commercially available rapid urease tests(RUTs)-including the newly developed HelicotecUT plus test and HelicotecUT test,and established CLO test and ProntoDry test.H.pylori status was defined as positive when the culture was positive or if there were concordant positive results among histology,CLO test and ProntoDry test.RESULTS:When dual specimens were applied,sensitivity was enhanced and RUT reaction time was signif icantly reduced,regardless of their treatment status.Thirty minutes were enough to achieve an agreeable positive rate in all the RUTs.Both newly developed RUTs showed comparable sensitivity,specif icity and accuracy to the established RUTs,regardless of patient treatment status,RUT reaction duration,and EGD biopsy sites.CONCLUSION:Combination of antrum and body biopsy specimens greatly enhances the sensitivity of rapid urease test and reduces the reaction duration to 30 min.

Short-term Celecoxib intervention is a safe and effective chemopreventive for gastric carcinogenesis based on a Mongolian gerbil model

AIM： To evaluate the optimal intervention point of a selective cyclooxygenase-2 （COX-2） inhibitor, Celecoxib, for inhibiting Helicobacter pylori （H pylori-associated gastric carcinogenesis in Mongolian gerbils （MGs）.METHODS： One hundred and twelve MGs were divided into six groups （A-F）. One hundred gerbils were inoculated with H pylor/（groups A-E）. Twelve gerbils were inoculated with vehicle broth only （group F）. After 4 wk, they were given N＇-methyl-N＇ -nitro-N-nitroso-guanidine （MNNG） （50 μg/mL） in the drinking water for 20 wk. in groups B-E, the animals were given the stock Celecoxib （10 mg/kg per day） diet from the 21st, 31st, 21st and 41st week respectively. The periods of administering Celecoxib were 30, 20, 20, and 15 wk respectively. On the 51st week, the animals were sacrificed for histological examination. Local PCNA expression was examined by the immunohistochemistry method. The expression of COX-2 protein was assessed by Western Blot. Analysis used the 2 test. The difference was regarded as significant when P value was less than 0.05. RESULTS： Seventeen percent （17/100） of H pyloriinfected MGs developed gastric cancer. All of these lesions were well-differentiated adenocarcinoma. The incidence rates of adenocarcinoma in groups A-F were 40%, 0%, 0%, 20%, 25%, and 0% respectively. The inflammatory scores were higher in group B than in other groups. There was no inflammatory response noted in group F. Celecoxib treatment resulted in a significant reduction in the proliferation of H pyloriinfected mucosal cells （groups B, C and D） （P 〈 0.01）. The expression of COX-2 protein was significantly attenuated in the groups which were Celecoxib-treated for more than 20 wk （groups B, C, D）. The groups treated with Celecoxib had a significantly lower rate of advanced gastric cancer （34% vs 75%, P 〈 0.001） There were no sudden deaths in any of the groups. CONCLUSION： Short-term treatment with Celecoxib has an anti-carcinogenic effect, and resulted in less severe inflammation and inhibited the invasive degree of gastric cancer.

Association between Helicobacter pylori seropositivity and digestive tract cancers

AIM： To explore the role of Helicobacter pylori （Hpylori） infection on the risk of digestive tract cancers. METHODS： In total, 199 oral squamous-cell carcinoma （SCC）, 317 esophagea! SCC, 196 gastric cardia and non-cardia adenocarcinoma and 240 colon adenocarcinoma patients were recruited for serum tests of Hpylori infection. Two hospital- and one community-based control groups were used for the comparisons. Hpylori seropositivity was determined by an enzyme linked immunosorbent assay method against Hpylori IgG. RESULTS： Presence of H pylori infection was significantly inversely associated with esophageal SCC [adjusted odds ratio （AOR）： 0.315-0.472, all P-value 〈 0.05] but positively associated with gastric adenocarcinoma （both cardia and non-cardia） （AOR： 1.636-3.060, all P-value 〈 0.05） in comparison to the three control groups. Similar results were not found in cancers of the oral cavity and colon. CONCLUSION： Our findings support the finding that H pylori seropositivity is inversely associated with esophageal SCC risk, but increases the risk of gastric cardia adenocarcinoma.

Hypocaloric peripheral parenteral nutrition with lipid emulsion in postoperative gastrointestinal cancer patients

AIM:To investigate the use of lipid emulsion substitutingfor glucose in postoperative hypocaloric peripheral parenteral nutrition (HPPN).METHODS:This prospective, randomized study was conducted on 20 postoperative gastrointestinal cancer patients. They were randomized and equally divided into interventional group and control group, and both were administered isocaloric and isonitrogenous diets with for lipid emulsion substituting for partial glucose loads in the interventional group.RESULTS: Nutritional parameters and biochemical data were compared between the two groups before and after 6-d of HPPN. Most investigated variables showed no significant changes after administration of HPPN with lipid emulsion. However, the postoperative triglyceride level was significantly lower in the interventional group than in the control group (P < 0.05). In comparison with lipid emulsion, glucose administration resulted in less decrease in postoperative prealbumin level (P < 0.05).CONCLUSION: In addition to supplementing with essential fatty acid, it seems that HPPN with lipid emulsion is well-tolerated and beneficial to postoperative gastrointestinal cancer patients.

Effects of the number of neoadjuvant therapy cycles on clinical outcomes, safety, and survival in patients with metastatic colorectal cancer undergoing metastasectomy

The controversial outcomes in patients with metastatic colorectal cancer(mCRC)highlight the need for developing effective systemic neoadjuvant treatment strategies to improve clinical results.The optimal treatment cycles in patients with mCRC for metastasectomy remain undefined.This retrospective study compared the efficacy,safety,and survival of cycles of neoadjuvant chemotherapy/targeted therapy for such patients.Sixty-four patients with mCRC who received neoadjuvant chemotherapy/targeted therapy following metastasectomy were enrolled between January 2018 and April 2022.Twenty-eight patients received 6 cycles of chemotherapy/targeted therapy,whereas 36 patients received≥7 cycles(median,13;range,7–20).Clinical outcomes,including response,progression-free survival(PFS),overall survival(OS),and adverse events,were compared between these two groups.Of the 64 patients,47(73.4%)were included in the response group,and 17(26.6%)were included in the nonresponse group.The analysis revealed chemotherapy/targeted therapy cycle and pretreatment serum carcinoembryonic antigen(CEA)level as independent predictors of the response as well as overall survival and chemotherapy/targeted therapy cycle as an independent predictor of progression(all p<0.05).Furthermore,our results revealed shorter operation time,lower estimated operative blood loss,higher response rate,lower progression rate,and higher survival rate in≥7 cycles of chemotherapy/targeted therapy group(all p<0.05),but no statistical differences in adverse events were observed between the two groups(all p>0.05).The median OS and PFS were 48 months(95%CI,40.855–55.145)and 28 months(95%CI,18.952–37.48)in the≥7-cycle group and 24 months(95%CI,22.038–25.962)and 13 months(95%CI,11.674–14.326)in the 6-cycle group,respectively(both p<0.001).The oncological outcomes in the≥7-cycle group were significantly better than those in the 6-cycle group,without significant increases in adverse events.However,prospective randomized trials are mandatory to confirm the potential advantages of cycle numbers of neoadjuvant chemotherapy/targeted therapy.