Are preoperative inflammatory and nutritional markers important for the prognosis of patients with peritoneal metastasis of colorectal cancer?

Colorectal cancer(CRC)is a type of cancer that grows from polypoid lesions developing over the years.It has a high incidence of about 1.8 million new cases annually.While screening and lifestyle modifications have stabilized the rate of CRC in high-income countries,the incidence of early-onset CRC is increasing globally.The worst prognosis for this cancer is linked to recurrence and metastasis,with peritoneal metastasis occurring in 8%to 20%of cases.In these cases,treatment with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is indicated.However,this approach is risky and requires careful selection of patients who will truly benefit from it.This article will discuss the correlation between nutrition and inflammation in patients with peritoneal metastasis and advanced CRC,emphasizing the importance of nutritional and inflammatory markers for assessing disease status.Finally,we will highlight the main biomarkers in the field.

Impact of preoperative inflammatory and nutritional markers on the prognosis of patients with peritoneal metastasis of colorectal cancer

BACKGROUND Identifying patients with peritoneal metastasis(PMs)of colorectal cancer(CRC)who will benefit from cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is crucial before surgery.Inflammatory and nutritional indicators play essential roles in cancer development and metastasis.AIM To investigate the association of preoperative inflammatory and nutritional markers with prognosis in patients with CRC-PM.METHODS We included 133 patients diagnosed with CRC-PM between July 2012 and July 2018.Patients’demographics,overall survival(OS),and preoperative inflammatory and nutritional markers were evaluated.The Kaplan-Meier method and log-rank test were used to estimate differences.RESULTS Of the 133 patients,94(70.6%)had normal hemoglobin(Hb)and 54(40.6%)had a high neutrophil-to-lymphocyte ratio(NLR).The median OS(mOS)was significantly lower for patients with high NLR(7.9 months)than for those with low NLR(25.4 months;P=0.002).Similarly,patients with normal Hb had a longer mOS(18.5 months)than those with low Hb(6.3 months;P<0.001).Multivariate analysis identified age,carbohydrate antigen 199 levels,NLR,Hb,and peritoneal cancer index as independent predictors of OS.Based on these findings,a nomogram was constructed,which demonstrated a good capacity for prediction,with a C-index of 0.715(95%confidence interval:0.684-0.740).Furthermore,the 1-and 2-year survival calibration plots showed good agreement between predicted and actual OS rates.The areas under the curve for the 1-and 2-year survival predictions of the nomogram were 0.6238 and 0.6234,respectively.CONCLUSION High NLR and low Hb were identified as independent predictive risk factors for poor prognosis in patients with CRC-PM.The established nomogram demonstrated high accuracy in predicting OS for patients with CRC-PM,indicating its potential as a valuable prognostic tool for this patient population.

Impact of hyperthermic intraperitoneal chemotherapy on gastric cancer survival: Peritoneal metastasis and cytology perspectives

BACKGROUND Gastric cancer presenting with peritoneal metastasis is notably associated with diminished survival prospects.The use of cytoreductive surgery in conjunction with hyperthermic intraperitoneal chemotherapy(HIPEC)has been shown to increase survival rates in these patients.Despite these advancements,debates persist regarding the magnitude of survival improvement attributed to this treatment modality.The present investigation examined survival outcomes following HIPEC in individuals diagnosed with gastric cancer and peritoneal metastasis,and it took a comparative analysis of patients exhibiting positive and negative cytological findings.Between April 2013 and March 2020,84 patients with advanced gastric cancer treated at our institution were categorized into three cohorts:HIPEC(20 patients with peritoneal metastasis),cytology-positive(23 patients without peritoneal nodules but with positive wash cytology),and cytology-negative(41 patients with advanced gastric cancer,no peritoneal nodules,and negative wash cytology).The HIPEC cohort underwent gastrectomy with HIPEC,while the cytology-positive and cytology-negative groups received gastrectomy alone.The demographic,pat-hological,and survival data of the groups were compared.RESULTS The HIPEC cohort-predominantly younger females-exhibited relatively extended surgical durations and high blood loss.Nevertheless,the complication rates were consistent across all three groups.Median survival in the HIPEC group was 20.00±4.89 months,with 1-year,2-year,and 3-year overall survival rates of 73.90%,28.70%,and 9.60%,respectively.These figures paralleled the survival rates of the cytology-positive group(52.20%at 1 year,28.50%at 2 years,and 19.00%at 3 years).Notably,47%of patients experienced peritoneal recurrence.CONCLUSION HIPEC may offer a modest improvement in short-term survival for patients with gastric cancer and peritoneal metastasis,mirroring the outcomes in cytology-positive patients.However,peritoneal recurrence remained high.

Development and validation of a nomogram for predicting metachronous peritoneal metastasis in colorectal cancer:A retrospective study

BACKGROUND Peritoneal metastasis(PM)after primary surgery for colorectal cancer(CRC)has the worst prognosis.Prediction and early detection of metachronous PM(m-PM)have an important role in improving postoperative prognosis of CRC.However,commonly used imaging methods have limited sensitivity to detect PM early.We aimed to establish a nomogram model to evaluate the individual probability of m-PM to facilitate early interventions for high-risk patients.AIM To establish and validate a nomogram model for predicting the occurrence of m-PM in CRC within 3 years after surgery.METHODS We used the clinical data of 878 patients at the Second Hospital of Jilin University,between January 1,2014 and January 31,2019.The patients were randomly divided into training and validation cohorts at a ratio of 2:1.The least absolute shrinkage and selection operator(LASSO)regression was performed to identify the variables with nonzero coefficients to predict the risk of m-PM.Multivariate logistic regression was used to verify the selected variables and to develop the predictive nomogram model.Harrell’s concordance index,receiver operating characteristic curve,Brier score,and decision curve analysis(DCA)were used to evaluate discrimination,distinctiveness,validity,and clinical utility of this nomogram model.The model was verified internally using bootstrapping method and verified externally using validation cohort.RESULTS LASSO regression analysis identified six potential risk factors with nonzero coefficients.Multivariate logistic regression confirmed the risk factors to be independent.Based on the results of two regression analyses,a nomogram model was established.The nomogram included six predictors:Tumor site,histological type,pathological T stage,carbohydrate antigen 125,v-raf murine sarcoma viral oncogene homolog B mutation and microsatellite instability status.The model achieved good predictive accuracy on both the training and validation datasets.The C-index,area under the curve,and Brier scores were 0.796,0.796[95%confidence interval(CI)0.735-0.856],and 0.081 for the training cohort and 0.782,0.782(95%CI 0.690-0.874),and 0.089 for the validation cohort,respectively.DCA showed that when the threshold probability was between 0.01 and 0.90,using this model to predict m-PM achieved a net clinical benefit.CONCLUSION We have established and validated a nomogram model to predict m-PM in patients undergoing curative surgery,which shows good discrimination and high accuracy.

Hyperthermic intraperitoneal chemotherapy for gastric cancer with peritoneal metastasis:A multicenter propensity scorematched cohort study

Objective:Systemic chemotherapy has limited efficacy in the treatment of peritoneal metastasis(PM)in gastric cancer(GC).Hyperthermic intraperitoneal chemotherapy(HIPEC)combined with complete cytoreductive surgery(CRS)has shown promising outcomes but remains controversial.The present study aimed to evaluate the safety and efficacy of HIPEC without CRS in GC patients with PM.Methods:This retrospective propensity score-matched multicenter cohort study included GC patients with PM treated with either chemotherapy alone(Cx group)or with HIPEC combined with chemotherapy(HIPEC-Cx group)in four Chinese high-volume gastric medical centers between 2010 and 2017.The primary outcomes were median survival time(MST)and 3-year overall survival(OS).Propensity score matching was performed to compensate for controlling potential confounding effects and selection bias.Results:Of 663 eligible patients,498 were matched.The MST in the Cx and HIPEC-Cx groups was 10.8 and 15.9 months,respectively[hazard ratio(HR)=0.71,95%confidence interval(95%CI),0.58-0.88;P=0.002].The 3-year OS rate was 10.1%(95%CI,5.4%-14.8%)and 18.4%(95%CI,12.3%-24.5%)in the Cx and HIPEC-Cx groups,respectively(P=0.017).The complication rates were comparable.The time to first flatus and length of hospital stay for patients undergoing HIPEC combined with chemotherapy was longer than that of chemotherapy alone(4.6±2.4 d vs.2.7±1.8 d,P<0.001;14.2±5.8 d vs.11.4±7.7 d,P<0.001),respectively.The median follow-up period was 33.2 months.Conclusions:Compared with standard systemic chemotherapy,HIPEC combined with chemotherapy revealed a statistically significant survival benefit for GC patients with PM,without compromising patient safety.

Nuclear heat shock protein 110 expression is associated with poor prognosis and hyperthermo-chemotherapy resistance in gastric cancer patients with peritoneal metastasis

AIM To investigate the significance of heat shock protein 110(HSP110) in gastric cancer(GC) patients with peritoneal metastasis undergoing hyperthermochemotherapy.METHODS Primary GC patients(n = 14) with peritoneal metastasis or positive peritoneal lavage cytology who underwent distal or total gastrectomy between April 2000 and December 2011 were enrolled in this study. The patients underwent postoperative intraperitoneal hyperthermo-chemotherapy using a Thermotron RF-8 heating device two weeks after surgery. We analyzed nuclear HSP110 expression in surgically resected tumors using immunohistochemistry. Additionally, the effect of HSP110 suppression on hyptherthermochemosensitivity was assessed in vitro in the MKN45 GC cell line using the HSP inhibitor KNK437. RESULTS HSP110 immnohistochemical staining in 14 GC patients showed that five(35.7%) samples belonged to the low expression group, and nine(64.3%) samples belonged to the high expression group. Progression-free survival was significantly shorter in the HSP110 high-expression group than in the low-expression group(P = 0.0313). However, no significant relationships were identified between HSP110 expression and the clinicopathological characteristics of patients. Furthermore, high HSP110 expression was not an independent prognostic factor in GC patients with peritoneal metastasis(P = 0.0625). HSP110 expression in MKN45 cells was suppressed by KNK437 at the hyperthermic temperature of 43 ℃ in vitro. Comparison of MKN45 cell proliferation in the presence and absence of KNK437 at 43 ℃, revealed that proliferation was significantly decreased when HSP110 was inhibited by KNK437. Additionally, HSP110 suppression via HSP inhibitor treatment increased cellular sensitivity to hyperthermo-chemotherapy in vitro.CONCLUSION The expression of nuclear HSP110 in GC patients might be a new marker of chemosensitivity and a therapeutic target for patients who are tolerant to existing hyperthermo-chemotherapies.

Complications and risk factors for complications of implanted subcutaneous ports for intraperitoneal chemotherapy in gastric cancer with peritoneal metastasis

Objective:Intraperitoneal(IP)chemotherapy through subcutaneous port is an effective treatment for gastric cancer(GC)patients with peritoneal metastasis(PM).The objective of this study is to assess the port complications and risk factors for complications in GC patients with PM.Methods:In retrospective screening of 301 patients with subcutaneous ports implantation,249 GC patients with PM who received IP chemotherapy were screened out for analysis.Port complications and risk factors for complications were analyzed.Results:Of the 249 analyzed patients,57(22.9%)experienced port complications.Subcutaneous liquid accumulation(42.1%)and infection(28.1%)were the main complications,and other complications included port rotation(14.1%),wound dehiscence(12.3%),inflow obstruction(1.7%)and subcutaneous metastasis(1.7%).The median interval between port implantation and occurrence of complications was 3.0 months.Eastern Cooperative Oncology Group(ECOG)performance status[odds ratio(OR),1.74;95%confidence interval(95%CI),1.12-2.69],albumin(OR,3.67;95%CI,1.96-6.86),implantation procedure optimization(OR,0.33;95%CI,0.18-0.61)and implantation groups(OR,0.37;95%CI,0.20-0.69)were independent risk factors for port complications(P<0.05).ECOG performance status was the only factor that related to the grades of port complications(P=0.016).Conclusions:Port complications in GC patients who received IP chemotherapy are manageable.ECOG performance status,albumin,implantation procedure and implantation group are independent risk factors for port complications in GC patients with PM.

Complete peritonectomy and intraperitoneal chemotherapy for recurrent rectal cancer with peritoneal metastasis

A 68-year-old man underwent laparoscopic low anterior resection for rectal carcinoma in December 2006.Nearly 19 mo after the operation,he developed recurrent rectal cancer with peritoneal metastasis. In September 2008,he subsequently underwent a laparotomy with a peritonectomy,omentectomy, splenectomy,and a Hartmann procedure.Hyperthermic intraperitoneal oxaliplatin 750 mg was administered. The patient was discharged with no postoperative complications and has been well with postoperative FOLFOX chemotherapy.

HAND2-AS1,PRKAA2 and VLDLR predict the risk of peritoneal metastasis in gastric cancer of different Lauren types based on STEPP analysis

The peritoneum is the most common site of recurrence of gastric cancer(GC).Early occult peritoneal metastasis is difficult to detect by imaging examination.Stratifying the risk of peritoneal metastasis in patients with different Lauren subtypes is of great clinical value.We performed a univariate Cox regression to identify those genes with prognostic value of overall survival(OS)and peritoneal-specified disease-free survival(psDFS)from the Gene Expression Omnibus database.The candidate genes were screened by the Subpopulation Treatment Effect Pattern Plot(STEPP)method.Propensity score matching(PSM)analysis was used to reduce the interference of confounders on the results.Based on the optimal cut-off values determined by the STEPP method,we found overexpression of three genes(HAND2-AS1,PRKAA2,and VLDLR)was correlated with shorter 1-year psDFS among patients with diffuse-type than that of patients with intestinal-type GC,and it is highly significant.Gene Set Enrichment Analysis(GSEA)potentially suggested that the three genes promote the early occurrence of peritoneal metastasis in patients with diffuse-type GC through glucose metabolism-related pathways.These three genes may be potential biomarkers.They can be used to assess the risk of peritoneal metastases to guide treatment decisions and follow-up strategies.

Intraperitoneal Chemotherapy as a Multimodal Treatment for Gastric Cancer Patients with Peritoneal Metastasis

Peritoneal metastasis of gastric cancer is mainly caused by the dispersion of free cancer cells from the serosal surface of the invaded stomach, from surgically transected lymphatic channels, and from tumor cell-containing blood from the primary lesion into the peritoneal cavity. Intraperitoneal chemotherapy (IPC) combined with surgery has performed for the prevention and treatment of peritoneal metastasis in gastric cancer. The efficacy of this technique is influenced by the pharmacokinetic advantage achievable with the anticancer drug, timing of administration, combination with hyperthermia, and tumor volume. The pharmacokinetic advantage for peritoneal cavity exposure relative to peripheral circulation by intraperitoneal delivery for drugs including cisplatin (10-fold advantage), mitomycin C (20- to 30-fold advantage), docetaxel (500-fold advantage), and paclitaxel (1000-fold advantage) has been confirmed. To avoid uneven drug distribution in the peritoneal cavity and the re-growth of residual tumor, it seems to be reasonable to perform IPC perioperatively;however, early perioperative intraperitoneal chemotherapy (EPIC) has a relatively high morbidity rate compared with intraoperative IPC. Hyperthermia has both cytotoxicity of itself and a synergistic effect with anticancer drugs, especially mitomycin C. In the adjuvant setting, patients with either hyperthermic intraperitoneal chemotherapy (HIPEC) or EPIC showed a significant improvement of survival compared to those with surgery alone. In addition, extensive intraoperative peritoneal lavage (EIPL) seems also to be a reasonable method to reduce free cancer cells in the peritoneal cavity. For the treatment of peritoneal metastasis, cytoreductive surgery which achieves R0 or R1 resection followed by IPC has demonstrated a survival benefit, whereas gross residual tumor (R2) treated by IPC has shown poor prognosis. Extensive cytoreductive surgery, such as peritonectomy, followed by IPC achieved long-term survival for selected patients, though this aggressive procedure led to high morbidity and mortality rates. It seems that combined chemotherapy (systemically and intraperitoneally) followed by conversion surgery can be expected to be a powerful procedure for the patients with gross peritoneal tumors.

Molecular targeting therapy using bevacizumab for peritoneal metastasis from gastric cancer

AIM: To clarify the significance of vascular endothelial growth factor(VEGF) in peritoneal metastasis from gastric cancer, using the gastric cancer cell line MKN-45 compared with the high potential peritoneal dissemination gastric cancer cell line MKN-45 P. METHODS: The supernatant of culture medium of MKN-45 cells or MKN-45 P cells was collected and the concentrations were measured of various cytokines, matrix metalloproteinases, growth factor and angiogenic factors, including VEGF. We performed an initial pilot study to explore whether bevacizumab, a humanized monoclonal antibody against VEGF, had any suppressive effect on the peritoneal dissemination from gastric cancer in an experimental nude mouse modelof peritoneal metastasis. RESULTS: The concentrations of interleukin-6(IL-6), IL-8, VEGF and matrix metalloproteinase-2 protein in the culture supernatant were each significantly higher than each of those for MKN-45. In the in vivo study, the volume of ascites and the mitotic index were significantly lower in the therapy group than in the nontherapy group. The survival curve of the therapy group was significantly higher than that of the non-therapy group. These results suggested that VEGF was correlated with peritoneal metastasis from gastric cancer. CONCLUSION: Findings suggested that bevacizumab for inhibiting VEGF could suppress peritoneal dissemination from gastric cancer.

Therapeutic options for peritoneal metastasis arising from colorectal cancer

Peritoneal metastasis is a common sign of advanced tumor stage, tumor progression or tumor recurrence in patients with colorectal cancer. Due to the improvement of systemic chemotherapy, the development of targeted therapy and the introduction of additive treatment options such as cytoreductive surgery(CRS) and hyperthermic intraperitoneal chemotherapy(HIPEC), the therapeutic approach to peritoneal metastatic colorectal cancer(pm CRC) has changed over recent decades, and patient survival has improved. Moreover, in contrast to palliative systemic chemotherapy or best supportive care, the inclusion of CRS and HIPEC as inherent components of a multidisciplinary treatment regimen provides a therapeutic approach with curative intent. Although CRS and HIPEC are increasingly accepted as the standard of care for selected patients and have become part of numerous national and international guidelines, the individual role, optimal timing and ideal sequence of the different systemic, local and surgical treatment options remains a matter of debate. Ongoing and future randomized controlled clinical trials may help clarify the impact of the different components, allow for further improvement of patient selection and support the standar-dization of oncologic treatment regimens for pm CRC. The addition of further therapeutic options such as neo-adjuvant intraperitoneal chemotherapy or pressurized intraperitoneal aerosol chemotherapy, should be investig-ated to optimize therapeutic regimens and further improve the oncological outcome.

Comprehensive treatment for the peritoneal metastasis from gastric cancer

Recently, a novel comprehensive treatment consisting of cytoreductive surgery(CRS) and perioperative chemotherapy(POC) was developed for the treatment of peritoneal metastasis(PM) with a curative intent. In the treatment, the macroscopic disease is completely removed by the peritonectomy techniques in combination with POC. This article reviews the results of the comprehensive treatment for PM from gastric cancer, and verifies the effects of CRS and POC, including neoadjuvant chemotherapy(NAC) and hyperthermic intraoperative intraperitoneal chemotherapy(HIPEC). Completeness of cytoreduction, peritoneal carcinomatosis index(PCI) less than the threshold levels after NAC,absence of ascites, cytologic status, pathologic response after NAC are the independent prognostic factors. Among these prognostic factors, PCI threshold level is the most valuable independent prognostic factor. After staging laparoscopy, patients with PM from gastric cancer are recommended to treat with NAC before CRS. After NAC, indication for CRS is determined by laparoscopy. The indications of the comprehensive treatment are patients with PCI less than the threshold levels, negative cytology, and responders after NAC. Patients satisfy these factors are the candidates for the CRS and HIPEC.

Deciphering metastatic route-specific signals and their microenvironment interactions in peritoneal metastasis of gastric cancer

Gastric cancer(GC)is a pervasive global malignancy with high mortality rates due to distant metastasis[1].GC metastasis can occur via hematogenous route,peri-toneal route,and specifically through ovarian spread in females[2].Among these,peritoneal metastasis is the most prevalent and challenging condition to treat[3].The Cancer Genome Atlas(TCGA)has uncovered four molec-ular subtypes of GC:microsatellite instability,Epstein-Barr virus-related,chromosomal instability,and genomically stable[4].

Effect of BRAF mutation on the prognosis for patients with colorectal cancer undergoing cytoreductive surgery for synchronous peritoneal metastasis

Background:KRAS/BRAF mutations(mutKRAS/mutBRAF)are unfavorable prognostic factors for colorectal cancer(CRC)metastases to the liver and lungs.However,their effects on the prognosis for patients with synchronous peritoneal metastasis(S-PM)of CRC after cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)are controversial.In the study,we aimed to determine the effects of mutKRAS/mutBRAF on the prognosis for patients with S-PM who received CRS.Methods:A total of 142 patients diagnosed with S-PM between July 2007 and July 2019 were included in this study.The demographics,mutKRAS/mutBRAF status,overall survival(OS),and progression-free survival(PFS)of the patients were evaluated.The Kaplan–Meier method and log-rank test were used to estimate the difference in survival between groups.Results:Among 142 patients,68(47.9%)showed mutKRAS and 42(29.5%)showed mutBRAF.The median OS values were 8.4 and 34.3 months for patients with mutBRAF and BRAF wild-type,respectively(P<0.01).However,KRAS status was not significantly associated with median OS(P=0.76).Multivariate analysis revealed carcinoembryonic antigen,CRS,HIPEC,and mutBRAF as independent predictors for OS.Based on these findings,a nomogram was constructed.The C-index was 0.789(95%confidence interval,0.742–0.836),indicating good predictive ability of the model.Furthermore,the 1-and 2-year survival calibration plots showed good agreement between the predicted and actual OS rates.The area under curves of the 1-and 2-year survival predictions based on the nomogram were 0.807 and 0.682,respectively.Additionally,mutBRAF was significantly associated with lower PFS(P<0.001).Conclusions:mutBRAF is an independent prognostic risk factor for S-PM.The established nomogram predicted the OS of patients with CRC having S-PM with high accuracy,indicating its usefulness as a valuable prognostic tool for the designated patient cohort.

Prolonged hyperthermic intraperitoneal chemotherapy duration with 90 minutes cisplatin might increase overall survival in gastric cancer patients with peritoneal metastases

BACKGROUND Advanced gastric cancer with synchronous peritoneal metastases(GC-PM)is associated with a poor prognosis.Although cytoreductive surgery with hyperthermic intraperitoneal chemotherapy(CRS-HIPEC)is a promising approach,only a limited number of Western studies exist.AIM To investigate the clinicopathological outcomes of patients who underwent CRSHIPEC for GC-PM.METHODS A retrospective analysis of patients with GC-PM was conducted.All patients were seen at the Department of General and Visceral Surgery,Hospital Barmherzige Brüder,Regensburg,Germany between January 2011 and July 2021 and underwent CRS-HIPEC.Preoperative laboratory results,the use of neoadjuvant trastuzumab,and the details of CRS-HIPEC,including peritoneal carcinomatosis index,completeness of cytoreduction,and surgical procedures were recorded.Disease-specific(DSS),and overall survival(OS)of patients were calculated.RESULTS A total of 73 patients were included in the study.Patients treated with neoadjuvant trastuzumab(n=5)showed longer DSS(P=0.0482).Higher white blood cell counts(DSS:P=0.0433)and carcinoembryonic antigen levels(OS and DSS:P<0.01),and lower hemoglobin(OS and DSS:P<0.05)and serum total protein(OS:P=0.0368)levels were associated with shorter survival.Longer HIPEC duration was associated with more advantageous median survival times[60-min(n=59):12.86 mo;90-min(n=14):27.30 mo],but without statistical difference.To obtain additional data from this observation,further separation of the study population was performed.First,propensity score-matched patient pairs(n=14 in each group)were created.Statistically different DSS was found between patient pairs(hazard ratio=0.2843;95%confidence interval:0.1119-0.7222;P=0.0082).Second,those patients who were treated with trastuzumab and/or had human epidermal growth factor receptor 2 positivity(median survival:12.68 mo vs 24.02 mo),or had to undergo the procedure before 2016(median survival:12.68 mo vs 27.30 mo;P=0.0493)were removed from the original study population.CONCLUSION Based on our experience,CRS-HIPEC is a safe and secure method to improve the survival of advanced GC-PM patients.Prolonged HIPEC duration may serve as a good therapy for these patients.

Inflammatory and nutritional markers in colorectal cancer: Implications for prognosis and treatment

The prognosis of colorectal cancer(CRC)patients with peritoneal metastasis remains poor despite advancements in detection and treatment.Preoperative inflammatory and nutritional markers have emerged as significant predictors of prognosis in CRC,potentially guiding treatment decisions and improving patient outcomes.This editorial explores the prognostic value of markers such as the neutrophil-to-lymphocyte ratio,hemoglobin,and serum albumin levels.By integrating these markers into prognostic models,clinicians can better stratify patients,personalize treatment strategies,and ultimately enhance clinical outcomes.This review highlights the importance of these markers in providing a comprehensive assessment of patient condition and underscores the need for further research to validate their clinical utility and uncover underlying mecha-nisms.

NIR-Ⅱ fluorescence/photoacoustic imaging of ovarian cancer and peritoneal metastasis

Ovarian cancer is a global problem,and is typically diagnosed in the middle or late stages,with a mysterious abdominal mass or atypical abdominal metastases due to the lack of specific initial diagnostic methods.Dual-modal near-infrared Ⅱ(NIR-Ⅱ,1,000–1,700 nm)fluorescence/photoacoustic imaging has great potential in early ovarian cancer diagnosis and image-guided surgery due to its high sensitivity and deep penetration.Herein,we report a novel organic NIR-Ⅱ dye(H10)with excellent aggregation-induced-emission(AIE)characteristics(I/I0>1.6)utilizing a selenadiazolo-[3,4-f]benzo[c][1,2,5]thiadiazole(ST)-based building block.Then,water-soluble and biocompatible H10@follicle-stimulating hormone(H10@FSH)dots with superior optical/photoacoustic properties and a tenfold increase in ovarian-specific targeting ability were synthesized.Finally,for the first time,in vivo dual-mode NIR-Ⅱ fluorescent/photoacoustic(PA)imaging and image-guided surgery of patient-derived tumor xenograft(PDTX)and micro-metastatic abdominal ovarian cancer lesions were investigated.This novel strategy will establish a new method for early detection of ovarian cancer and significantly improve the prognosis of ovarian cancer patients.

Standard Prophylactic Strategy against Peritoneal Dissemination Metastasis in Gastric Cancer

Peritoneal carcinomatosis is the most frequent pattern of metastasis and recurrence in patients with gastric cancer, and the prognosis of those patients with peritoneal metastasis is extremely poor. Once peritoneal metastasis is formed, it is extremely difficult to overcome. EIPL (extensive intraoperative peritoneal lavage) is a quite useful and practical adjuvant surgical technique for the gastric cancer patients who are likely to suffer from peritoneal recurrence. EIPL includes 10 times of an extensive shake and wash of abdominal cavity with saline followed by the complete aspiration of the fluid after potentially curative operation, which is supposed to have an amazing cyto-reduction power. The purpose of this article is to review the effect of EIPL on prevention of peritoneal recurrence in the patients with peritoneal free cancer cells and to evaluate its validity as a standard prophylactic strategy against peritoneal recurrence in gastric cancer.

Clinical significance of telomerase activity in peritoneal lavage fluid from patients with gastric cancer and its relationship with cellular proliferation

AIM： To evaluate the efficacy of telomerase activity assay and peritoneal lavage cytology （PLC） examination in peritoneal lavage fluid for the prediction of peritoneal metastasis in gastric cancer patients, and to explore the relationship between telomerase activity and proliferating cell nuclear antigen expression.METHODS： Telomeric repeated amplification protocol （TRAP）-enzyme-linked immunosorbent assay （ELISA） was performed to measure the telomerase activity in 60 patients with gastric cancer and 50 with peptic ulcer. PLC analysis of the 60 patients with gastric cancer was used for comparison. The proliferating cell nuclear antigen （PCNA） in gastric carcinoma was immunohistochemically examined.RESULTS： The telomerase activity and PLC positive rate in peritoneal lavage fluid from patients with gastric cancer was 41.7% （25/60）, and 25.0% （15/60）, respectively. The positive rate of telomerase activity was significantly higher than that Qf PLC in the group of pT, （15/16 vs 9/16, P 〈 0.05）, P1-3 （13/13 vs 9/13, P 〈 0.05） and diffuse type （22/42 vs 13/42, P 〈 0.05）. The patients with positive telomerase activity, peritoneal metastasis, and serosal invasion had significantly higher levels of average PCNA proliferation index （PI）, （55.00 ± 6.59 vs 27.43 ± 7.72, 57.26 ±10.18 vs 29.15 ±8.31, and 49.82 ± 6.74 vs 24.65 ±7.33, respectively, P 〈 0.05）.CONCLUSION： The TRAP assay for telomerase activity is a useful adjunct for cytologic method in the diagnosis of peritoneal micrometastasis and well related to higher proliferating activity of gastric cancer. The results of this study also suggest a promising future therapeutic strategy for treating peritoneal dissemination based on telomerase inhibition.