Prospects in the application of ultrasensitive chromosomal aneuploidy detection in precancerous lesions of gastric cancer

Gastric cancer(GC)is a prevalent malignant tumor within the digestive system,with over 40%of new cases and deaths related to GC globally occurring in China.Despite advancements in treatment modalities,such as surgery supplemented by adjuvant radiotherapy or chemotherapeutic agents,the prognosis for GC remains poor.New targeted therapies and immunotherapies are currently under invest-igation,but no significant breakthroughs have been achieved.Studies have indicated that GC is a heterogeneous disease,encompassing multiple subtypes with distinct biological characteristics and roles.Consequently,personalized treatment based on clinical features,pathologic typing,and molecular typing is crucial for the diagnosis and management of precancerous lesions of gastric cancer(PLGC).Current research has categorized GC into four subtypes:Epstein-Barr virus-positive,microsatellite instability,genome stability,and chromosome instability(CIN).Technologies such as multi-omics analysis and gene sequencing are being employed to identify more suitable novel testing methods in these areas.Among these,ultrasensitive chromosomal aneuploidy detection(UCAD)can detect CIN at a genome-wide level in subjects using low-depth whole genome sequencing technology,in conjunction with bioinformatics analysis,to achieve qualitative and quantitative detection of chromosomal stability.This editorial reviews recent research advancements in UCAD technology for the diagnosis and management of PLGC.

Epidemiological and Anatomo Path Ological Aspects of Stomach Cancers at the Koutiala District Hospital

Aim: This paper aims to evaluate the epidemiological and pathological aspects of stomach cancer at Koutiala District Hospital. Methods: This was a retrospective study carried out in the General Surgery Department of the Koutiala District Hospital Health Centre. The records of patients admitted for stomach cancer in the period from August 1, 2017 to December 31, 2022 were collected. Patients who underwent surgery for stomach cancer were included in the study. Patients who had not undergone surgery were excluded. Results: We collected records from 40 patients operated on for stomach cancer. The median age was 58.4 years ± 5.7. Men were in the majority with 72.5% The sex ratio was 2.6. The incidence rate of stomach cancer in the general population in the circle was 4.9 cases per 100,000 population. Patients had a history of gastric ulcer in 90%, Helicobacter pylori infection in 47.5% and a notion of excessive salt consumption in 47.5%. The median duration of disease progression was 5 years ± 2.3. The seat was antro-pyloric in 77.5%. The cancer was ulcerative budding in 23 patients. Adenocarcinoma was the histological type in all patients. The cancer was classified as stage III in 30 cases and stage IV in 10 cases. Palliative surgical treatment was the most performed (47.5%). Postoperative morbidity was 15% and mortality was 42.5% at one year. Conclusion: Stomach cancer is common in the ward. Most patients consult at the stage of metastasis. Palliative surgery remains the most practical. Postoperative morbidity and mortality is very high.

Cohort profile: design and methods of the Chinese colorectal, breast, lung, liver, and stomach cancer screening trial(C-BLAST)

Given the rapid changes in social structure(urbanization),economic structure(industrialization),and demographic structure(population aging)in China,cancer has become a major public health problem1.Extensive evidence has indicated that screening can decrease cancer mortality,particularly among high-risk groups,and several representative national and regional cancer screening programs have been launched in China to cope with the increasing burden of cancer.

Estimation of economic burden throughout course of cervical squamous intraepithelial lesion and cervical cancer in China:A nationwide multicenter cross-sectional study

Objective: Cervical squamous intraepithelial lesion(SIL) and cervical cancer are major threats to females' health and life in China, and we aimed to estimate the economic burden associated with their diagnosis and treatment.Methods: A nationwide multicenter, cross-sectional, hospital-based survey was conducted in 26 qualified hospitals across seven administrative regions of China. We investigated females who had been pathologically diagnosed with SIL and cervical cancer, and included five disease courses(“diagnosis”, “initial treatment”,“chemoradiotherapy”, “follow-up” and “recurrence/progression/metastasis”) to estimate the total costs. The median and interquartile range(IQR) of total costs(including direct medical, direct non-medical, and indirect costs), reimbursement rate by medical insurance, and catastrophic health expenditures in every clinical stage were calculated.Results: A total of 3,471 patients in different clinical stages were analyzed, including low-grade SIL(LSIL)(n=549), high-grade SIL(HSIL)(n=803), cervical cancer stage ⅠA(n=226), ⅠB(n=610), ⅡA(n=487), ⅡB(n=282), Ⅲ(n=452) and Ⅳ(n=62). In urban areas, the estimated total costs of LSIL and HSIL were $1,637.7(IQR:$956.4-$2,669.2) and $2,467.1(IQR:$1,579.1-$3,762.3), while in rural areas the costs were $459.0(IQR:$167.7-$1,330.3) and $1,230.5(IQR:$560.6-$2,104.5), respectively. For patients with cervical cancer stage ⅠA,ⅠB, ⅡA, ⅡB, and Ⅲ-Ⅳ, the total costs were $15,034.9(IQR:$11,083.4-$21,632.4), $19,438.6(IQR:$14,060.0-$26,505.9), $22,968.8(IQR:$16,068.8-$34,615.9), $26,936.0(IQR:$18,176.6-$41,386.0) and $27,332.6(IQR:$17,538.7-$44,897.0), respectively. Medical insurance covered 43%-55% of direct medical costs for cervical cancer patients, while the coverage for SIL patients was 19%-43%. For most cervical cancer patients, the expense was catastrophic, and the extent of catastrophic health expenditure was about twice large for rural patients than that for urban patients in each stage.Conclusions: The economic burden of SIL and cervical cancer in China is substantial, with a significant proportion of the costs being avoidable for patients with LSIL. Even for those with medical insurance, catastrophic health expenditures are also a major concern for patients with cervical cancer, particularly for those living in rural areas.

Breast cancer metastasizing to the upper gastrointestinal tract(the esophagus and the stomach):A comprehensive review of the literature

Breast cancer can infrequently metastasize to the upper gastrointestinal(GI)tract but the exact incidence is not well established-there is considerable variation between incidence reported from clinical studies and incidence noted in autopsy series.Clinical presentation can be very non-specific and often mimics primary gastrointestinal conditions.Endoscopy alone may not be sufficient to make a diagnosis and misdiagnosis is also common.A high degree of awareness and clinical suspicion is required to establish metastases to the upper GI tract.We undertook a comprehensive review of the available literature on breast cancer metastases to the esophagus and stomach including the clinical symptoms and presentation,endoscopic features,additional diagnostic imaging modalities,treatment and outcomes.

A NEWLY RECOGNIZED PRECANCEROUS LESION OF THE STOMACH (HISTOPATHOLOGIC FEATURES OF GLOBOID DYSPLASIA OF HUMAN GASTRIC EPITHELIUM)

The histopathological features of the globoid dysplasia of the human gastric epithelium were described in detail and in series by means of observation of serial sections of 61 cases with globoid dys-plasias. Three grades were divided according to the architectural and cellular atypia of the globoid dys-plasias. The penetration of outer layer globoid dys-plastic cells through the basement membrane of 'the structure of double layers' appeared in typical globoid dysplasia grade II and the infiltration of the globoid dysplastic cells into stroma as well as the formation of incipient focus of signet ring cell carcinoma were described. The twinkling scene of the infiltration of the globoid dysplastic cells into lamina propria through the basement membrane, and the destroying of the basement membrane by the globoid dysplastic cells were shown by means of Gordon Sweet's staining. Through the analysis as for the distribution characteristics of ages and sexes in 61 globoid dysplasia cases and 51 signet ring cell carcinomas, a fact was discovered that the mobility of female cases was ten years prior to that of male ones in average. A conclusion could be made that the globoid dysplasia might be an important precan-cerous lesion of the signet ring cell carcinoma of the stomach.

Traditional Chinese medicine for transformation of gastric precancerous lesions to gastric cancer:A critical review

Gastric cancer(GC)is a common gastrointestinal tumor.Gastric precancerous lesions(GPL)are the last pathological stage before normal gastric mucosa transforms into GC.However,preventing the transformation from GPL to GC remains a challenge.Traditional Chinese medicine(TCM)has been used to treat gastric disease for millennia.A series of TCM formulas and active compounds have shown therapeutic effects in both GC and GPL.This article reviews recent progress on the herbal drugs and pharmacological mechanisms of TCM in preventing the transformation from GPL to GC,especially focusing on antiinflammatory,anti-angiogenesis,proliferation,and apoptosis.This review may provide a meaningful reference for the prevention of the transformation from GPL to GC using TCM.

Gastric Cancer Disparities in the United States: Overcoming the Barriers

In this narrative review, we highlight the disparities in the incidence and mortality of gastric cancer across various racial and ethnic populations in the United States (US). Despite the low and decreasing trend in the incidence of gastric cancer in the US, the incidence remains significantly high among Asian and Hispanic Americans, showing a striking racial and ethnic disparity. The low survival rate of gastric cancer further accentuates the magnitude of this disparity. In addition, there is a marked funding disparity among different cancers in the US, reflecting the significantly lower level of support for cancers, such as gastric cancer, which are more prevalent in minority populations, compared to the cancers more prevalent among non-Hispanic Whites (NHW). Moreover, the economic burden from health disparities remains high. Although studies from the US and Asia suggest that screening for stomach cancer may be cost-effective, there is no currently available guideline for scree-ning high-risk populations in the US. A multidimensional framework involving the community, physicians, and policymakers is proposed to tackle these gastric cancer disparities and to develop population-based screening and surveillance programs to reduce the burden of gastric cancer.

Superficial Serrated Adenoma (SuSA): A New Subtype of Serrated Lesions

Superficial serrated adenoma (SuSA) is a new subtype of serrated lesions proposed in recent years, most of which are located in the sigmoid colon or rectum, with typical mixed adenoma and serrated pathological features, and its molecular features are high frequency of KRAS mutation and RSPO fusion or overexpression. At present, it is believed that SuSA has two subtypes: traditional serrated adenoma (TSA)-associated SuSA and isolated SuSA. Solitary SuSA showed faded pedicle-free protuberant lesions under endoscope and lobulated, pp (pit pattern) classification was type II and type IIIH, TSA-associated SuSA showed double-layer eminence, SuSA part showed white flat eminence, pp classification showed type II and IIIH, TSA part showed red tone high eminence, pp was IVH type. SuSA can develop into colorectal cancer through the evolution of TSA, and it can also directly develop into MSS colorectal cancer. In view of the superficial understanding of SuSA and the lack of a complete description of SuSA, this paper review the research progress of SuSA at home and abroad from the origin, endoscope features, histopathological features, molecular biology, differential diagnosis and treatment of SuSA, in order to better promote the understanding and clinical diagnosis of lesions.

Early detection of pancreatic cancer

The diagnosis of pancreatic cancer associates an appalling significance.Detection of preinvasive stage of pancreatic cancer will ameliorate the survival of this deadly disease.Premalignant lesions such as Intraductal Papillary Mucinous Neoplasms or Mucinous Cystic Neoplasms of the pancreas are detectable on imaging exams and this permits their management prior their invasive development.Pancreatic intraepithelial neoplasms(PanIN)are the most frequent precursors of pancreatic adenocarcinoma(PDAC),and its particular type PanIN high-grade represents the malignant non-invasive form of PDAC.Unfortunately,PanINs are not detectable on radiologic exams.Nevertheless,they can associate indirect imaging signs which would rise the diagnostic suspicion.When this suspicion is established,the patient will be enrolled in a follow-up strategy that includes performing of blood test and serial imaging test such as computed tomography or magnetic resonance imaging,which will cost in the best-case scenario a burden of healthcare systems,and potential mortality in the worst-case scenario when the patient underwent resection surgery,worthless when there is no moderate or high grade dysplasia in the final histopathology.This issue will be avoid having at its disposal a diagnostic technique capable of detecting high-grade PanIN lesions,such is the cytology of pancreatic juice obtained by nasopancreatic intubation.Herein,we review the possibility of detection of early malignant lesions before they become invasive PADC.

Prevalence, risk factors, and BRAF mutation of colorectal sessile serrated lesions among Vietnamese patients

BACKGROUND Sessile serrated lesions(SSLs)are considered precancerous colorectal lesions that should be detected and removed to prevent colorectal cancer.Previous studies in Vietnam mainly investigated the adenoma pathway,with limited data on the serrated pathway.AIM To evaluate the prevalence,risk factors,and BRAF mutations of SSLs in the Vietnamese population.METHODS This is a cross-sectional study conducted on patients with lower gastrointestinal symptoms who underwent colonoscopy at a tertiary hospital in Vietnam.SSLs were diagnosed on histopathology according to the 2019 World Health Organi-zation classification.BRAF mutation analysis was performed using the Sanger DNA sequencing method.The multivariate logistic regression model was used to determine SSL-associated factors.RESULTS There were 2489 patients,with a mean age of 52.1±13.1 and a female-to-male ratio of 1:1.1.The prevalence of SSLs was 4.2%[95%confidence interval(CI):3.5-5.1].In the multivariate analysis,factors significantly associated with SSLs were age≥40[odds ratio(OR):3.303;95%CI:1.607-6.790],male sex(OR:2.032;95%CI:1.204-3.429),diabetes mellitus(OR:2.721;95%CI:1.551-4.772),and hypertension(OR:1.650,95%CI:1.045-2.605).The rate of BRAF mutations in SSLs was 35.5%.CONCLUSION The prevalence of SSLs was 4.2%.BRAF mutations were present in one-third of SSLs.Significant risk factors for SSLs included age≥40,male sex,diabetes mellitus,and hypertension.

Clinical Application of Preliminary Breast Cancer Screening for Dense Breasts Using Real-Time AI-Powered Ultrasound with Deep-Learning Computer Vision

Objective:We propose a solution that is backed by cloud computing,combines a series of AI neural networks of computer vision;is capable of detecting,highlighting,and locating breast lesions from a live ultrasound video feed,provides BI-RADS categorizations;and has reliable sensitivity and specificity.Multiple deep-learning models were trained on more than 300,000 breast ultrasound images to achieve object detection and regions of interest classification.The main objective of this study was to determine whether the performance of our Al-powered solution was comparable to that of ultrasound radiologists.Methods:The noninferiority evaluation was conducted by comparing the examination results of the same screening women between our AI-powered solution and ultrasound radiologists with over 10 years of experience.The study lasted for one and a half years and was carried out in the Duanzhou District Women and Children's Hospital,Zhaoqing,China.1,133 females between 20 and 70 years old were selected through convenience sampling.Results:The accuracy,sensitivity,specificity,positive predictive value,and negative predictive value were 93.03%,94.90%,90.71%,92.68%,and 93.48%,respectively.The area under the curve(AUC)for all positives was 0.91569 and the AUC for all negatives was 0.90461.The comparison indicated that the overall performance of the AI system was comparable to that of ultrasound radiologists.Conclusion:This innovative AI-powered ultrasound solution is cost-effective and user-friendly,and could be applied to massive breast cancer screening.

Expression characteristics of peripheral lymphocyte programmed death 1 and FoxP3+ Tregs in gastric cancer during surgery and chemotherapy

BACKGROUND Programmed death 1(PD-1)and CD4^(+)CD25^(+)FoxP3^(+)expression in peripheral blood T-cells has been previously reported in various types of cancer.However,the specific variation tendency during surgery and chemotherapy,as well as their relationship in gastric cancer patients,still remain unclear.Understanding this aspect may provide some novel insights for future studies on tumor recurrence and tumor immune escape,and also serve as a reference for determining the optimal timing and dose of clinical anti-PD-1 antibodies.AIM To observe and analyze the expression characteristics of peripheral lymphocyte PD-1 and FoxP3^(+)regulatory T cells(FoxP3^(+)Tregs)before and after surgery or chemotherapy in gastric cancer patients.METHODS Twenty-nine stomach cancer patients undergoing chemotherapy after a D2 gastrectomy provided 10 mL peripheral blood samples at each phase of the perioperative period and during chemotherapy.This study also included 29 agematched healthy donors as a control group.PD-1 expression was detected on lymphocytes,including CD4^(+)CD8^(+)CD45RO^(+),CD4^(+)CD45RO^(+),and CD8^(+)CD45RO^(+)lymphocytes as well as regulatory T cells.RESULTS We observed a significant increase of PD-1 expression on immune subsets and a larger number of FoxP3^(+)Tregs in gastric cancer patients(P<0.05).Following D2 gastrectomy,peripheral lymphocytes PD-1 expression and the number of FoxP3^(+)Tregs notably decrease(P<0.05).However,during postoperative chemotherapy,we only observed a decrease in PD-1 expression on lymphocytes in the CD8^(+)CD45RO^(+)and CD8^(+)CD45RO^(+)populations.Additionally,linear correlation analysis indicated a positive correlation between PD-1 expression and the number of CD4^(+)CD45RO^(+)FoxP3high activated Tregs(aTregs)on the total peripheral lymphocytes(r=0.5622,P<0.0001).CONCLUSION The observed alterations in PD-1 expression and the activation of regulatory T cells during gastric cancer treatment may offer novel insights for future investigations into tumor immune evasion and the clinical application of anti-PD-1 antibodies in gastric cancer.

Profile of Radiotherapy Side Effects in Patients Treated for Cervical Cancer in Cameroon: Case of the Douala General Hospital

Background: Radiotherapy is one of the main therapeutic strategies used in cervical cancer. The first radiotherapy services in Cameroon have existed since 1987 and still treat by conventional radiation techniques. With the evolution of radiation techniques, acute, subacute, and late complications are minimized. Our study aimed to describe the profile of side effects in patients with uterine cervix cancer treated by conventional radiotherapy, still used in our services. Methods: This was a retrospective and descriptive study of the records of patients treated in the radiotherapy department of the Douala General Hospital from January 2015 to December 2019. Data concerning radiation-induced toxicities were collected using the CTCAE Version 4.0 classification. Data analysis was performed using SPSS version 20.0. Results: A total of 270 records were selected. The median age was 54 years. The mean total radiation dose was 55.9 ± 11.8 Gy and 71.1% of patients were treated for less than 8 weeks. We found a frequency of 66.7% of radio-induced lesions with 99% being acute. The main acute lesions encountered were radio dermatitis (40%), radiation cystitis (17.7%), and radiation proctitis (17.1%). As late lesions, we found one case of vaginal fibrosis (0.4%). Exclusive radiotherapy, classical fractionation, and total doses lower than 45 Gy seemed to decrease the toxicity linked to conventional radiotherapy. Conclusion: The frequency of side effects of radiotherapy for cervical cancer at the Douala General Hospital remains high. Early lesions are the most encountered but strategies should be put in place to better evaluate late lesions.

Detection of Human Papillomavirus DNA and E6/E7 mRNA from HPV Genotypes 16, 18, 31 and 33 in Histologically Confirmed Cases of Cervical Cancer and Precancerous Lesions in Burkina Faso

Introduction: Cervical cancer, caused by persistent high-risk human papillomavirus (HPV) infection, remains a global public health problem. The cellular transformation and maintenance of the malignant phenotype of these HPVs are attributed to the viral oncoproteins E6 and E7. Objective: This study aims to detect the presence of human papillomavirus DNA and E6/E7 oncoprotein mRNA of HPV genotypes 16, 18, 31 and 33 in cases of cervical cancer and precancerous lesions, histologically confirmed in Burkina Faso. Methods: This descriptive cross-sectional study focused on cases of cervical cancer and high-grade intraepithelial neoplasia (CIN) and was conducted from June to December 2022. One hundred (100) samples of fixed and paraffin-embedded tissues were collected from the pathological anatomy and cytology laboratories of hospitals in the capital of Burkina Faso. High-risk human papillomavirus (HR-HPV) DNA was detected using multiplex real-time PCR, while the presence of E6 and E7 mRNA in cervical cancer and high-grade CIN samples was determined using real-time Reverse Transcriptase-PCR (RT-PCR) with TaqMan probes. Results: The mean age of women diagnosed with cervical cancer and high-grade CIN was 50.81 ± 13.65 years, ranging from 22 to 82 years. Cervical cancer and high-grade CIN were positive for at least one high-risk human papillomavirus (HR-HPV) in 80% of cases. The most prevalent genotypes observed were HPV16, 18, 31, and 33, collectively accounting for 70.08% of cases. Of the 89 samples that tested positive for HR-HPV genotypes 16, 18, 31, and 33, 88 (98.88%;95% CI: [94.58 - 99.94]) were also positive for the presence of mRNA encoding the E6 and E7 oncoproteins of HPV16, 18, 31, and 33. Conclusion: In the presence of HPV DNA, testing for E6 and E7 oncoprotein mRNA could serve as a promising biomarker and valuable tool for improved assessment of the progression to cervical cancer.

Current progress on the endoscopic features of colorectal sessile serrated lesions

Along with the discovery and refinement of serrated pathways,the World Health Organization amended the classification of digestive system tumors in 2019,recommending the renaming of sessile serrated adenomas/polyps to sessile serrated lesions(SSLs).Given the particularity of the endoscopic appearance of SSLs,it could easily be overlooked and missed in colonoscopy screening,which is crucial for the occurrence of interval colorectal cancer.Existing literature has found that adequate bowel preparation,reasonable withdrawal time,and awareness of colorectal SSLs have improved the quality and accuracy of detection.More particularly,with the continuous advancement and development of endoscopy technology,equipment,and accessories,a potent auxiliary tool is provided for accurate observation and immediate diagnosis of SSLs.Highdefinition white light endoscopy,chromoendoscopy,and magnifying endoscopy have distinct roles in the detection of colorectal SSLs and are valuable in identifying the size,shape,character,risk degree,and potential malignant tendency.This article delves into the relevant factors influencing the detection rate of colorectal SSLs,reviews its characteristics under various endoscopic techniques,and expects to attract the attention of colonoscopists.

5’tiRNA-Pro-TGG,a novel tRNA halve,promotes oncogenesis in sessile serrated lesions and serrated pathway of colorectal cancer

BACKGROUND Transfer RNA(tRNA)-derived small RNAs(tsRNAs)are small fragments that form when tRNAs severe.tRNA halves(tiRNAs),a subcategory of tsRNA,are involved in the oncogenic processes of many tumors.However,their specific role in sessile serrated lesions(SSLs),a precancerous lesion often observed in the colon,has not yet been elucidated.AIM To identify SSL-related tiRNAs and their potential role in the development of SSLs and serrated pathway of colorectal cancer(CRC).METHODS Small-RNA sequencing was conducted in paired SSLs and their adjacent normal control(NC)tissues.The expression levels of five SSL-related tiRNAs were validated by q-polymerase chain reaction.Cell counting kit-8 and wound healing assays were performed to detect cell proliferation and migration.The target genes and sites of tiRNA-1:33-Pro-TGG-1(5′tiRNA-Pro-TGG)were predicted by TargetScan and miRanda algorithms.Metabolism-associated and immune-related pathways were analyzed by single-sample gene set enrichment analysis.Functional analyses were performed to establish the roles of 5′tiRNA-Pro-TGG based on the target genes.RESULTS In total,we found 52 upregulated tsRNAs and 28 downregulated tsRNAs in SSLs compared to NC.The expression levels of tiRNA-1:33-Gly-CCC-2,tiRNA-1:33-Pro-TGG-1,and tiRNA-1:34-Thr-TGT-4-M25′tiRNAs were higher in SSLs than those in NC,while that of 5′tiRNA-Pro-TGG was associated with the size of SSLs.It was demonstrated that 5′tiRNAPro-TGG promoted cell proliferation and migration of RKO cell in vitro.Then,heparanase 2(HPSE2)was identified as a potential target gene of 5′tiRNA-Pro-TGG.Its lower expression was associated with a worse prognosis in CRC.Further,lower expression of HPSE2 was observed in SSLs compared to normal controls or conventional adenomas and in BRAF-mutant CRC compared to BRAF-wild CRC.Bioinformatics analyses revealed that its low expression was associated with a low interferonγresponse and also with many metabolic pathways such as riboflavin,retinol,and cytochrome p450 drug metabolism pathways.CONCLUSION tiRNAs may profoundly impact the development of SSLs.5′tiRNA-Pro-TGG potentially promotes the progression of serrated pathway CRC through metabolic and immune pathways by interacting with HPSE2 and regulating its expression in SSLs and BRAF-mutant CRC.In the future,it may be possible to use tiRNAs as novel biomarkers for early diagnosis of SSLs and as potential therapeutic targets in serrated pathway of CRC.

Supply and quality of colonoscopy according to the characteristics of gastroenterologists in the French population-based colorectalcancer screening program

BACKGROUND Since its complete roll-out in 2009,the French colorectal cancer screening program(CRCSP)experienced 3 major constraints[use of a less efficient Guaiac-test(gFOBT),stopping the supply of Fecal-Immunochemical-Test kits(FIT),and suspension of the program due to the coronavirus disease 2019(COVID-19)]affecting its effectiveness.AIM To describe the impact of the constraints in terms of changes in the quality of screeningcolonoscopy(Quali-Colo).METHODS This retrospective cohort study included screening-colonoscopies performed by gastroenterologists between Jan-2010 and Dec-2020 in people aged 50-74 living in Ile-de-France(France).The changes in Quali-colo(Proportion of colonoscopies performed beyond 7 mo(Colo_7 mo),Frequency of serious adverse events(SAE)and Colonoscopy detection rate)were described in a cohort of Gastroenterologists who performed at least one colonoscopy over each of the four periods defined according to the chronology of the constraints[gFOBT:Normal progress of the CRCSP using gFOBT(2010-2014);FIT:Normal progress of the CRCSP using FIT(2015-2018);STOP-FIT:Year(2019)during which the CRCSP experienced the cessation of the supply of test kits;COVID:Program suspension due to the COVID-19 health crisis(2020)].The link between each dependent variable(Colo_7 mo;SAE occurrence,neoplasm detection rate)and the predictive factors was analyzed in a two-level multivariate hierarchical model.RESULTS The 533 gastroenterologists(cohort)achieved 21509 screening colonoscopies over gFOBT period,38352 over FIT,7342 over STOP-FIT and 7995 over COVID period.The frequency of SAE did not change between periods(gFOBT:0.3%;FIT:0.3%;STOP-FIT:0.3%;and COVID:0.2%;P=0.10).The risk of Colo_7 mo doubled between FIT[adjusted odds ratio(aOR):1.2(1.1;1.2)]and STOPFIT[aOR:2.4(2.1;2.6)];then,decreased by 40%between STOP-FIT and COVID[aOR:2.0(1.8;2.2)].Regardless of the period,this Colo_7 mo’s risk was twice as high for screening colonoscopy performed in a public hospital[aOR:2.1(1.3;3.6)]compared to screening-colonoscopy performed in a private clinic.The neoplasm detection,which increased by 60%between gFOBT and FIT[aOR:1.6(1.5;1.7)],decreased by 40%between FIT and COVID[aOR:1.1(1.0;1.3)].CONCLUSION The constraints likely affected the time-to-colonoscopy as well as the colonoscopy detection rate without impacting the SAE’s occurrence,highlighting the need for a respectable reference time-tocolonoscopy in CRCSP.

EPIDEMIC STRENGTH OF CARDIA AND DISTANT STOMACH CANCER IN THE HIGH RISK REGION OF ESOPHAGEAL CANCER AND THEIR IMPLICATION TO EDOSCOPIC SCREENING

Objective： To discuss the epidemic strength of cardia and distant stomach cancers in the high risk region of esophageal cancer along the south Taihang mountain such as in Shexian, Linxian, and Cixian Counties, and to clarify the tasks for the control of upper gastrointestinal tract cancer as a whole in the region. Methods： Comparisons of incidence and mortality rates of esophageal, cardia and stomach cancers were made between Cixian, Linxian and Shexian Counties with reference to detection rates of cancer in situ and precancerous lesions of the three upper gastrointestinal cancers by endoscopic screening. The screening was performed from 1999 through 2004 in the three adjacent counties including a total of 6233 local residents aged 40 to 69 years old. Results： The incidence rates for cardia cancer for the male and female from 2000 through 2004 were 69.9 and 41.5, and the mortality rates were 54.3 and 33.2 respectively in Shexian County. Esophageal, cardia, and stomach cancers constitute about 70～80 percent of all malignant disease by incidence or mortality rates. Endoscopic survey with iodine staining can effectively detect squamous cell precancerous lesions in the esophagus, but the method is inadequate for the detection of adeno precancerous lesions of the cardia and stomach. Conclusion： The south Taihang mountain region is a high risk area not only for esophagus cancer, but also for cardia and stomach cancers. To control upper gastrointestinal tract cancers as a whole in the region, special attention should be paid to the control of cardia and stomach cancers. Presently, to find effective screening methods for detecting cardia and stomach precancerous lesions is especially important.

Clinicopathological characteristics of clinical early gastric cancer in the upper-third stomach

AIM: To elucidate the clinicopathological characteristics of clinically early gastric cancer in the upper-third stomach and to clarify treatment precautions.METHODS: A total of 683 patients with clinical early gastric cancer were enrolled in this retrospective study, 128 of whom had gastric cancer in the upper-third stomach(U group). All patients underwent a double contrast barium examination, endoscopy, and computed tomography(CT), and were diagnosed preoperatively based on the findings obtained. The clinicopathological features of these patients were compared with those of patients with gastric cancer in the middle- and lower-third stomach(ML group). We also compared clinicopathological factors between accurate-diagnosis and under-diagnosis groups in order to identify factors affecting the accuracy of a preoperative diagnosis of tumor depth.RESULTS: Patients in the U group were older(P = 0.029), had a higher ratio of males to females(P = 0.015), and had more histologically differentiated tumors(P = 0.007) than patients in the ML group. A clinical under-diagnosis occurred in 57 out of 683 patients(8.3%), and was more frequent in the U group than in the ML group(16.4% vs 6.3%, P < 0.0001). Therefore, the rates of lymph node metastasis and lymphatic invasion were slightly higher in the U group than in the ML group(P = 0.071 and 0.082, respectively). An under-diagnosis was more frequent in histologically undifferentiated tumors(P = 0.094) and in those larger than 4 cm(P = 0.024). The medianfollow-up period after surgery was 56 mo(range, 1-186 mo). Overall, survival and disease-specific survival rates were significantly lower in the U group than in the ML group(P = 0.016 and 0.020, respectively). However, limited operation-related cancer recurrence was not detected in the U group in the present study.CONCLUSION: Clinical early gastric cancer in the upper-third stomach has distinguishable characteristics that increase the risk of a clinical under-diagnosis, especially in patients with larger or undifferentiated tumors.