Effects of exercise by type and duration on quality of life in patients with digestive system cancers:A systematic review and network meta-analysis

Background:There is scant evidence regarding the effects of exercise type and duration on quality of life(QoL)in digestive system cancer(DSC)survivors.We aim to investigate the optimal type and duration of exercise to improve QoL for DSC survivors through a systematic review and network meta-analysis.Methods:A systematic literature search of PubMed,Embase,and Web of Science was performed.Eligibility for study inclusion was limited to studies that were randomized controlled trials involving all kinds of exercise in adult patients with DSCs,and the comparator was in standard care or other types of exercise.The primary outcome was QoL,including general health,physical health,mental health,and role function.Secondary outcomes included cancer-related symptoms such as fatigue,insomnia,depression,anxiety,and duration of hospital stay.The network meta-analyses were performed using a random-effect model.Results:The analysis included 32 eligible articles and a total of 2558 participants.Our primary outcome indicated that short-term aerobic exercise significantly enhanced general health(standardized mean difference(SMD)=0.66,95%credible intervals(Crls):0.05 to 1.30),and also contributed to a better mental health(SMD=0.38,95%CrI:-0.05 to 0.81)and role function(SMD=0.48,95%CrI:-0.27 to 1.20).Although without significant changes,short-term resistance exercise tended to increase the physical health of patients with DSCs(SM=0.69,95%CrI:-0.07 to 1.50)and effective in alleviating fatigue(SMD=-0.77,95%CrI:-1.50 to 0.01).Short-term aerobic exercise was related to a lower score of insomnia(SMD=-1.20,95%CrI:-2.40 to 0.06),depression(SMD=-0.51,95%CrI:-1.50 to 0.45),and anxiety(SMD=-0.45,95%CrI:-1.30 to 0.34).All types of exercise related to a trend of declined hospital stays(-0.87 to-5.00 day).Long-term resistance exercise,however,was negatively associated with general health(SMD=-0.33,95%CrI:-1.70 to 1.00),physical health(SMD=-0.18,95%CrI:-1.30to 0.90),and role function(SMD=-1.20,95%CrI:-2.50 to 0.11).Conclusion:This study suggests that short-term aerobic exercise,with or without resistance exercise programs,enhances QoL(especially for general health)as well as relieves cancer-related symptoms for DSC survivors,while long-term resistance exercise may have negative effects,and thus should be adopted cautiously.These results provide important evidence for the management of DSCs.

Suicide in Digestive System Cancers: A Scoping Review

Digestive system cancers are important causes of morbidity and mortality worldwide.Cancer patients are more likely to commit suicide.The objective of this scoping review is to provide a comprehensive and updated summary of the existing literature on suicide among patients with digestive system cancers to identify the incidence and risk factors relevant to suicide in these populations.The PRISMA-Scr(Preferred Reporting Items for Systematic reviews and Meta-Analyses extension protocol for scoping reviews)protocol was used.The review was based on relevant articles published prior to January 2022 in databases of Web of Science and PubMed.The authors identified 21 records that met the criteria for inclusion.Among the 21 articles,18(n=85.7%)reported suicide risk factors,21(n=100%)evaluated the incidence of suicide and 16(n=76.2%)involved the variation in suicide rates.Only one study comprehensively reported that the suicide rate for this population was 32.8 per 100,000 years and the standardized mortality ratio(SMR)was 1.91.Most suicides occurred in patients with pancreatic,esophageal,and gastric cancers.The factors associated with suicide in digestive system cancers included male gender,older age,the white race,single status,advanced stage of disease,and cancer metastasis.The most critical time for suicide was in the early post-diagnostic period.It is indispensable to identify suicide in these cancer patients,especially those with high-risk factors.In the future,more prospective research may be needed to provide more reliable support and care to prevent suicide.

XPC Polymorphism Increases Risk of Digestive System Cancers:Current Evidence from A Meta-Analysis

Objective： Xeroderma pigmentosum complementation group C （XPC） participates in the initial recognition of DNA damage during nucleotide excision repair process in global genomic repair. Our meta-analysis was performed to evaluate the association between three polymorphisms （Lys939Gln, PAT＋/- and Ala499Val） of XPC gene and risk of digestive system cancers. Methods： All the relevant case-control studies published to April 2011 were identified through searching PubMed. Digestive system cancer risk with the three polymorphisms was estimated for each study by odds ratio （OR） with its 95% confidence interval （95% CI）. Results： We found an increased overall risk for digestive system cancers in all three models of Lys939Gln AC （AC/CC vs. AA： OR, 1.20; 95% CI, 1.11-1.30; CC vs. AC/AA： OR, 1.24; 95% CI, 1.11-1.39; CC vs. AA： OR, 1.36; 95% CI, 1.21-1.53）. When strati？ed by ethnicity, results remained significant in Asian population （AC/CC vs. AA： OR, 1.18; 95% CI, 1.02-1.37; CC vs. AC/AA： OR, 1.32; 95% CI, 1.1-1.51; CC vs. AA： OR, 1.35; 95% CI, 1.08-1.70）, but not for Caucasians. However for Ala499Val CT, a significant protective effect of T allele was only observed in the dominant model. Otherwise, no significant results were observed for PAT＋/-. Conclusion： XPC Lys939Gln AC polymorphism may play an important role in digestive system cancer susceptibility.

Organoid Technology and Clinical Applications in Digestive System Cancer

Cancers of the digestive system(DS),including esophageal,gastric,colorectal,liver,and pancreatic can-cers,have a high incidence and mortality worldwide.Current cancer models cannot faithfully recapitu-late the critical features of the original tumor,resulting in the failure of translation from basic research into clinical practice.More advanced cancer models are in urgent need of pathogenesis exploration and anticancer medicine development.Organoids are in vitro cultured three dimensional(3D)self-organizing organotypic structures derived from tissues and pluripotent stem cells,which faithfully mimic the histological features and preserve the genetic heterogeneity of the original tissues.Both normal and malignant organoids can now be efficiently established from the DS tissues of patients.In this review,we summarize the general methods to generate human DS organoids and their applications as a novel model in basic cancer research,preclinical medical practice,and precision medicine.