Prognostic impact and reasons for variability by tumor location in gastric cancer

BACKGROUND Gastric cancer(GC)is a highly prevalent gastrointestinal tract tumor.Several trials have demonstrated that the location of GC can affect patient prognosis.However,the factors determining tumor location remain unclear.AIM To investigate the tumor location of patients,we went on to study the influencing factors that lead to changes in the location of GC.METHODS A retrospective evaluation was carried out on 3287 patients who underwent gastrectomy for GC in Zhejiang Cancer Hospital.The patients were followed up post-diagnosis and post-gastrectomy.The clinicopathological variables and overall survival of the patients were recorded.By analyzing the location of GC,the tumor location was divided into four categories:“Upper”,“middle”,“lower”,and“total”.Statistical software was utilized to analyze the relationship of each variable with the location of GC.RESULTS A total of 3287 patients were included in this study.The clinicopathological indices of gender,age,serum levels of carcinoembryonic antigen(CEA),carbohydrate antigen(CA19-9)and CA72-4 levels,were significantly associated with tumor location in patients with GC.In addition,there was a strong correlation between GC location and the prognosis of postoperative patients.Specifically,patients with“lower”and“middle”GC demonstrated a better prognosis than those with tumors in other categories.CONCLUSION The five clinicopathological indices of gender,age,CEA,CA19-9 and CA72-4 levels exhibit varying degrees of influence on the tumor location.The tumor location correlates with patient prognosis following surgery.

Risk factors of gastric cancer specific for tumor location and histology in Cali,Colombia

AIM- To examine histology- and tumor-location specific risk factors of gastric cancer （GC）.METHODS： This was subjects were 216 GC the period 2000-2002 non-cancer patients hospital. We obtained habits, and others by a a case-control study. The study patients newly diagnosed during and 431 controls selected from matching in age, gender, and information on lifestyles, dietary questionnaire.RESULTS： The subjects who were not eldest among his/her siblings were at a slightly elevated GC risk （OR 1.3; 95% CI 0.8-2.0）. Salting meals before tasting was related to an increased GC risk （OR 3.5; 95% CI 1.6- 7.3）. Frequent consumptions of fruits （OR 0.3; 95% CI 0.1-1.0） and vegetables （OR 0.3; 95% CI 0.1-1.0） were related to decreased GC risks. On the other hand, frying foods （OR 1.9; 95% CI 1.0-3.6） and cooking with coal （OR 1.8; 95% CI 1.3-2.6） were related to increased GC risks. Neither Lauren＇s histological classification （intestinal and diffuse types） nor tumor location significantly affected those associations except birth order. The subjects who were not eldest among his/her siblings had an increased risk of GCs in the distal and middle thirds, and their ORs were 1.7 （95% CI 1.0-2.8） and 1.9 （95% CI 0.8-4.3）, respectively. The corresponding OR in the upper third stomach was 0.3 （95% CI 0.1-0.9）. The differences of those three ORs were statistically significant （P = 0.010）.CONCLUSION： The present study shows that birth order, salt intake, consumption of fruits and vegetables, the type of cooking, and cigarette smoking are related to GC risk. In histology and tumor-location specific analyses, non-eldest person among their siblings is related to an increased GC risk in the distal and middle thirds of the stomach, and is related to a decreased GC risk in the cardia.

Influence of primary tumor location and resection on survival in metastatic colorectal cancer

BACKGROUND Patients with right sided colorectal cancer are known to have a poorer prognosis than patients with left sided colorectal cancer, whatever the cancer stage. To this day, primary tumor resection(PTR) is still controversial in a metastatic, non resectable setting.AIM To explore the survival impact of PTR in patients with metastatic colorectal cancer(mCRC) depending on PTL.METHODS We retrospectively collected data from all consecutive patients treated for mCRC at the Centre Georges Francois Leclerc Hospital. Univariate and multivariate Cox proportional hazard regression models were used to assess the influence of PTR on survival. We then evaluated the association between PTL and overall survival among patients who previously underwent or did not undergo PTR. A propensity score was performed to match cohorts.RESULTS Four hundred and sixty-six patients were included. A total of 153(32.8%) patients had unresected synchronous mCRC and 313(67.2%) patients had resected synchronous mCRC. The number of patients with right colic cancer, left colic cancer and rectal cancer was respectively 174(37.3%), 203(43.6%) and 89(19.1%). In the multivariate analysis only PTL, PTR, resection of hepatic and or pulmonary metastases and the use of oxaliplatin, EGFR inhibitors or bevacizumab throughout treatment were associated to higher overall survival rates. Survival evaluation depending on PTR and PTL found that PTR improved the prognosis of both left and right sided mCRC. Results were confirmed by using a weighted propensity score.CONCLUSION In mCRC, PTR seems to confer a higher survival rate to patients whatever the PTL.

Rare synchronous colorectal carcinoma with three pathological subtypes: A case report and review of the literature

BACKGROUND Synchronous colorectal carcinomas(SCRC)are two or more primary colorectal carcinomas identified simultaneously or within 6 mo of the initial presentation in a single patient.Their incidence is low and the number of pathological types of SCRC is usually no more than two.It is very unusual that the pathological findings of a patient with SCRC show more than two different pathological subtypes.Here,we report a rare case of SCRC with three pathological subtypes.CASE SUMMARY A 75-year-old woman who had no previous medical history or family history was admitted to the hospital because of intermittent hematochezia for more than a month.Colonoscopy displayed an irregularly shaped neoplasm of the rectum,a tumor-like lesion causing intestinal stenosis in the descending colon,and a polypoidal neoplasm in the ileocecum.Subsequently,she underwent total colectomy,abdominoperineal resection for rectal cancer,and ileostomy.After operation,the pathological report showed three pathological subtypes including well-differentiated adenocarcinoma of the ascending colon,moderately differen-tiated adenocarcinoma of the descending colon,and mucinous adenocarcinoma of the rectum.She is now recovering well and continues to be closely monitored during follow-up.CONCLUSION Preoperative colonoscopy examination,imaging examination,and extensive intraoperative exploration play important roles in reducing the number of missed lesions.

Risk factors and surgical outcomes for spontaneous rupture of BCLC stages A and B hepatocellular carcinoma: A case-control study

AIM: To investigate the risk factors and surgical outcomes for spontaneous rupture of Barcelona Clinic Liver Cancer (BCLC) stages A and B hepatocellular carcinoma (HCC).

The diversity between pancreatic head and body/tail cancers:clinical parameters and in vitro models

BACKGROUND:Pancreatic ductal adenocarcinoma(PDAC) can be divided into head,body and tail cancers according to the anatomy.Distinctions in tissue composition,vascularization and innervations have been clearly identified between the head and body/tail of the pancreas both in embryological development and in histopathology.To understand the postulated genotype difference,we present comprehensive information on two PDAC cell lines as typical representatives originating from pancreatic head and body/tail cancers,respectively.DATA SOURCE:In the present review,we compare the difference between pancreatic head and body/tail cancers regarding clinical parameters and introducing an in vitro model.RESULTS:Increasing evidence has shown that tumors at different locations(head vs body/tail) display different clinical presentation(e.g.incidence,symptom),treatment efficiency(e.g.surgery,chemotherapy) and thus patient prognosis.However,the genetic or molecular diversity(e.g.mutations,microRNA) between the two subtypes of PDAC has not been elucidated so far.They present different chemo-and/or radio-resistance,extracellular matrix adhesion and invasiveness,as well as genetic profiles.CONCLUSION:Genetic and tumor biological diversity exists in PDAC according to the tumor localization.

Cone beam computed tomography-guided differences among registration methods for lung cancer and the effects of tumor position,treatment model,and tumor size on positioning errors

Objective To explore the differences in three different registration methods of cone beam computed tomography(CBCT)-guided down-regulated intense radiation therapy for lung cancer as well as the effects of tumor location,treatment mode,and tumor size on registration.Methods This retrospective analysis included 80 lung cancer patients undergoing radiotherapy in our hospital from November 2017 to October 2019 and compared automatic bone registration,automatic grayscale(t+r)registration,and automatic grayscale(t)positioning error on the X-,Y-,and Z-axes under three types of registration methods.The patients were also grouped according to tumor position,treatment mode,and tumor size to compare positioning errors.Results On the X-,Y-,and Z-axes,automatic grayscale(t+r)and automatic grayscale(t)registration showed a better trend.Analysis of the different treatment modes showed differences in the three registration methods;however,these were not statistically significant.Analysis according to tumor sizes showed significant differences between the three registration methods(P<0.05).Analysis according to tumor positions showed differences in the X-and Y-axes that were not significant(P>0.05),while the autopsy registration in the Z-axis showed the largest difference in the mediastinal and hilar lymph nodes(P<0.05).Conclusion The treatment mode was not the main factor affecting registration error in lung cancer.Three registration methods are available for tumors in the upper and lower lungs measuring<3 cm;among these,automatic gray registration is recommended,while any gray registration method is recommended for tumors located in the mediastinal hilar site measuring<3 cm and in the upper and lower lungs≥3 cm.

Pancreatic head vs pancreatic body/tail cancer:Are they different?

BACKGROUND The impact of pancreatic tumor location on patient survival has been studied in large national data-based analyses which yielded controversial results.AIM To explore if pancreatic head cancer(PHC)and pancreatic body/tail cancer(PBTC)have different overall survival(OS),molecular signature and response to chemotherapy.METHODS We retrospectively queried patient records from July 2016 to June 2020 in our institution.Patient demographics,cancer stage on diagnosis,tumor location,somatic mutations,treatment,and survival are recorded and analyzed.A test is considered statistically significant if the P value was<0.05.RESULTS We reviewed 101 patients with complete records,among which 67(66.34%)were PHC and 34(33.66%)were PBTC.More PHC were diagnosed at younger age[61.49 vs 68.97,P=0.010],earlier stages(P=0.006)and underwent surgical resection(P=0.025).There were no significant differences among all mutations and pathways studied except for TP53 mutations(37.0%in PHC vs 70.0%in PBTC,P=0.03).OS was not statistically different between PHC and PBTC(P=0.636)in the overall population and in subgroups according to surgical resection status or stages.In terms of response to chemotherapy,chemotherapy regimens(FOLFIRINOX-based vs gemcitabine-based)didn’t impact disease free interval in those who had surgical resection in either PHC(P=0.546)or PBTC(P=0.654),or the duration of response to first line palliative treatment in those with advanced disease in PHC(P=0.915)or PBTC(P=0.524).CONCLUSION Even though PHC and PBTC have similar poor OS and response to chemotherapy,the different presentations and molecular profiles indicate they are different diseases.Utilization of molecular profiling to develop targeted therapy for individualization of treatment is needed.

Right and Left Colon Cancer: Clinico-Pathological Features and Treatment Results (South Egypt Cancer Institute Experience)

Background: Colon cancer (CC) ranks as the third most common cancer worldwide and is considered the second leading cause of cancer death. Recently, many international studies have made the observation that right and left colon cancer have many significant differences regarding clinico-pathological characteristics and primary tumor location has a crucial impact on treatment outcomes and overall survival. Our study was conducted to verify the presence of significant differences between right and left colon cancer. Patients and Methods: This study is a retrospective cohort study which aimed at comparing right and left colon cancer as regards clinico-pathological data and treatment results among patients with colon cancer receiving treatment at South Egypt Cancer Institute (SECI) during the period from 1/2008 to 12/2018. A sample size of 160 cases of colon cancer patients (80 diagnosed as right colon cancer and 80 diagnosed as left colon cancer) was randomly selected from our South Egypt Cancer Institute (SECI)’s tumor registry. Statistical analysis was done using SPSS program version 20. Difference was considered statistically significant at P-value < 0.05. Survival curves were conducted using the Kaplan-Meier methods and were compared with the log-rank test. Results: Right colon cancer occurred at an older age and was more commonly presented with abdominal pain while left colon cancer was more commonly presented with bleeding manifestations. More cases of the right side underwent curative surgeries whereas more palliative surgeries were performed to left-sided cases. Left sided cases were associated with a more advanced stage at diagnosis while right-sided cases were associated with a better response to first-line chemotherapy. More cases of the left side died due to metastatic disease. On the other hand, our findings demonstrated no differences between both sides regarding gender predilection, risk factors, sites of metastases, number of metastatic organs, histo-pathological examination and grading, response to second- or third-line chemotherapy, chemotherapy toxicity (hematological or non-hematological), overall survival, progression-free survival, or disease-free survival. Conclusion: Primary tumor location of colon cancer has a significant effect on clinico-pathological characteristics and treatment outcomes.

Predictive factors for the success of “one-off” ablation in single hepatocellular carcinoma patients who underwent percutaneous radiofrequency ablation

Aim:To investigate the technique’s effectiveness and evaluate the risk factors affecting the success of“one-off”percutaneous ultrasound-guided radiofrequency ablation(RFA)for single hepatocellular carcinoma(HCC).Methods:A total of 462 consecutive patients who received RFA from February 2010 to December 2013 at a single center(Eastern Hepatobiliary Surgery Hospital,Shanghai,China)were enrolled in the study.The patients were followed up for at least 6 months.Herein,this study adopted a new terminology named“one-off”ablation which is defined as achieving complete necrosis and no local residual or recurrent tumor within 6 months after single-session RFA.The incidence of“one-off”RFA was observed and the attributing risk factors were analyzed.A multivariate analysis was conducted to determine the independent predictive factors for the success of“one-off”ablation.Results:The technique’s effectiveness was 90.0%(416/462).After 6 months,281 patients achieved“one-off”ablation,while 181 patients failed.On univariate analysis,tumor size≤3 cm and tumor further from organs were found to be significantly correlated with“one-off”complete ablation(P=0.003,and P=0.010,respectively).On multivariate analysis using a logistic regression,tumor size≤3 cm[odds ratio(OR),0.534;95%confidence interval(CI):0.346-0.825,P=0.005]and tumor further from organs(OR,0.593;95%CI:0.387-0.909,P=0.017)remained predictive.Conclusion:Tumor size and tumor location are the predictive factors for the success of“one-off”ablation in patients with single HCC.