BACKGROUND The tumor microenvironment(TME)plays an important role in the growth and expansion of gastric cancer(GC).Studies have identified that CD93 is involved in abnormal tumor angiogenesis,which may be related to ...BACKGROUND The tumor microenvironment(TME)plays an important role in the growth and expansion of gastric cancer(GC).Studies have identified that CD93 is involved in abnormal tumor angiogenesis,which may be related to the regulation of the TME.AIM To determine the role of CD93 in GC.METHODS Transcriptomic data of GC was investigated in a cohort from The Cancer Genome Atlas.Additionally,RNA-seq data sets from Gene Expression Omnibus(GSE118916,GSE52138,GSE79973,GSE19826,and GSE84433)were applied to validate the results.We performed the immune infiltration analyses using ESTIMATE,CIBERSORT,and ssGSEA.Furthermore,weighted gene co-expression network analysis(WGCNA)was conducted to identify the immunerelated genes.RESULTS Compared to normal tissues,CD93 significantly enriched in tumor tissues(t=4.669,95%CI:0.342-0.863,P<0.001).Higher expression of CD93 was significantly associated with shorter overall survival(hazard ratio=1.62,95%CI:1.09-2.4,P=0.017),less proportion of CD8 T and activated natural killer cells in the TME(P<0.05),and lower tumor mutation burden(t=4.131,95%CI:0.721-0.256,P<0.001).Genes co-expressed with CD93 were mainly enriched in angiogenesis.Moreover,11 genes were identified with a strong relationship between CD93 and the immune microenvironment using WGCNA.CONCLUSION CD93 is a novel prognostic and diagnostic biomarker for GC,that is closely related to the immune infiltration in the TME.Although this retrospective study was a comprehensive analysis,the prospective cohort studies are preferred to further confirm these conclusions.展开更多
BACKGROUND Growing evidence shows that pancreatic tumors in different anatomical locations have different characteristics,which have a significant impact on prognosis.However,no study has reported the differences betw...BACKGROUND Growing evidence shows that pancreatic tumors in different anatomical locations have different characteristics,which have a significant impact on prognosis.However,no study has reported the differences between pancreatic mucinous adenocarcinoma(PMAC)in the head vs the body/tail of the pancreas.AIM To investigate the differences in survival and clinicopathological characteristics between PMAC in the head and body/tail of pancreas.METHODS A total of 2058 PMAC patients from the Surveillance,Epidemiology,and End Results database diagnosed between 1992 and 2017 were retrospectively reviewed.We divided the patients who met the inclusion criteria into pancreatic head group(PHG)and pancreatic body/tail group(PBTG).The relationship between two groups and risk of invasive factors was identified using logistic regression analysis.Kaplan-Meier analysis and Cox regression analysis were conducted to compare the overall survival(OS)and cancer-specific survival(CSS)of two patient groups.RESULTS In total,271 PMAC patients were included in the study.The 1-year,3-year,and 5-year OS rates of these patients were 51.6%,23.5%,and 13.6%,respectively.The 1-year,3-year,and 5-year CSS rates were 53.2%,26.2%,and 17.4%,respectively.The median OS of PHG patients was longer than that of PBTG patients(18 vs 7.5 mo,P<0.001).Compared to PHG patients,PBTG patients had a greater risk of metastases[odds ratio(OR)=2.747,95%confidence interval(CI):1.628-4.636,P<0.001]and higher staging(OR=3.204,95%CI:1.895-5.415,P<0.001).Survival analysis revealed that age<65 years,male sex,low grade(G1-G2),low stage,systemic therapy,and PMAC located at the pancreatic head led to longer OS and CSS(all P<0.05).The location of PMAC was an independent prognostic factor for CSS[hazard ratio(HR)=0.7,95%CI:0.52-0.94,P=0.017].Further analysis demonstrated that OS and CSS of PHG were significantly better than PBTG in advanced stage(stage III-IV).CONCLUSION Compared to the pancreatic body/tail,PMAC located in the pancreatic head has better survival and favorable clinicopathological characteristics.展开更多
BACKGROUND Both hepatoid adenocarcinoma of the stomach(HAS)and neuroendocrine differentiation(NED)are rare histological subtypes of gastric cancer with unique clinicopathological features and unfavorable outcomes.HAS ...BACKGROUND Both hepatoid adenocarcinoma of the stomach(HAS)and neuroendocrine differentiation(NED)are rare histological subtypes of gastric cancer with unique clinicopathological features and unfavorable outcomes.HAS with NED is even rarer.CASE SUMMARY Here,we report a 61-year-old man with HAS with NED,as detected by gastric wall thickening by positron emission tomography/computed tomography for a pulmonary nodule.Distal gastrectomy was performed,and pathological examination led to the diagnosis of HAS with NED.However,liver metastases occurred 6 mo later despite adjuvant chemotherapy,and the patient died 27 mo postoperatively.CONCLUSION We treated a patient with HAS with NED who underwent adjuvant chemotherapy after radical surgery and still developed liver metastases.We first report the detailed processes of the treatment and development of HAS with NED,providing an important reference for the clinical diagnosis and treatment of this condition.展开更多
BACKGROUND The effect of perioperative blood transfusion(PBT)on the prognosis of ampullary carcinoma(AC)is still debated.AIM To explore the impact of PBT on short-term safety and long-term survival in AC patients who ...BACKGROUND The effect of perioperative blood transfusion(PBT)on the prognosis of ampullary carcinoma(AC)is still debated.AIM To explore the impact of PBT on short-term safety and long-term survival in AC patients who underwent pancreaticoduodenectomy.METHODS A total of 257 patients with AC who underwent pancreaticoduodenectomy between 1998 and 2020 in the Cancer Hospital,Chinese Academy of Medical Sciences,were retrospectively analyzed.We used Cox proportional hazard regression to identify prognostic factors of overall survival(OS)and recurrencefree survival(RFS)and the Kaplan-Meier method to analyze survival information.RESULTS A total of 144(56%)of 257 patients received PBT.The PBT group and nonperioperative blood transfusion group showed no significant differences in demographics.Patients who received transfusion had a comparable incidence of postoperative complications with patients who did not.Univariable and multivariable Cox proportional hazard regression analyses indicated that transfusion was not an independent predictor of OS or RFS.We performed Kaplan-Meier analysis according to subgroups of T stage,and subgroup analysis indicated that PBT might be associated with worse OS(P<0.05)but not RFS in AC of stage T1.CONCLUSION We found that PBT might be associated with decreased OS in early AC,but more validation is needed.The reasonable use of transfusion might be helpful to improve OS.展开更多
BACKGROUND Textbook outcomes(TOs)have been used to assess the quality of surgical treatment for many digestive tumours but not ampullary carcinoma(AC).AIM To discuss the factors associated with achieving a TO and furt...BACKGROUND Textbook outcomes(TOs)have been used to assess the quality of surgical treatment for many digestive tumours but not ampullary carcinoma(AC).AIM To discuss the factors associated with achieving a TO and further explore the prognostic value of a TO for AC patients undergoing curative pancreaticoduodenectomy(PD).METHODS Patients who underwent PD at the China National Cancer Center between 1998 and 2020 were identified.A TO was defined by R0 resection,examination of≥12 Lymph nodes,no prolonged hospitalization,no intensive care unit treatment,no postoperative complications,and no 30-day readmission or mortality.Cox regression analysis was used to identify the prognostic value of a TO for overall survival(OS)and recurrence-free survival(RFS).Logistic regression was used to identify predictors of a TO.The rate of a TO and of each indicator were compared in patients who underwent surgery before and after 2010.RESULTS Ultimately,only 24.3%of 272 AC patients achieved a TO.A TO was independently associated with improved OS[hazard ratio(HR):0.443,95%confidence interval(95%CI):0.276-0.711,P=0.001]and RFS(HR:0.379,95%CI:0.228-0.629,P<0.001)in the Cox regression analysis.Factors independently associated with a TO included a year of surgery between 2010 and 2020(OR:4.549,95%CI:2.064-10.028,P<0.001)and N1 stage disease(OR:2.251,95%CI:1.023-4.954,P=0.044).In addition,the TO rate was significantly higher in patients who underwent surgery after 2010(P<0.001)than in those who underwent surgery before 2010.CONCLUSION Only approximately a quarter(24.3%)of AC patients achieved a TO following PD.A TO was independently related to favourable oncological outcomes in AC and should be considered as an outcome measure for the quality of surgery.Further multicentre research is warranted to better elucidate its impact.展开更多
BACKGROUND Gastric neuroendocrine carcinoma(GNEC)is a rare histological subtype of gastric cancer,which is categorized into small cell and large cell neuroendocrine carcinomas.It is characterized by strong invasivenes...BACKGROUND Gastric neuroendocrine carcinoma(GNEC)is a rare histological subtype of gastric cancer,which is categorized into small cell and large cell neuroendocrine carcinomas.It is characterized by strong invasiveness and poor prognosis.Mixed large and small cell neuroendocrine carcinoma(L/SCNEC)is an extremely rare pathological type of gastric cancer,and there have been no reports on this situation until now.CASE SUMMARY Herein,we first present a 57-year-old patient diagnosed with L/SCNEC of the stomach.A 57-year-old Chinese male presented with epigastric discomfort.Outpatient gastroscopic biopsy was performed,and pathological examination revealed that the cardia was invaded by adenocarcinoma.The patient underwent laparoscopic-assisted radical proximal subtotal gastrectomy and was diagnosed with L/SCNEC.He refused adjuvant treatment and was followed up every 3 mo.Eight months after the operation,the patient showed no evidence of local recurrence or distant metastasis.CONCLUSION We advocate conducting further genomic studies to explore the origin of gastric large cell and small cell neuroendocrine carcinoma and using different chemotherapy schemes according to large or small cell neuroendocrine carcinoma of the stomach for clinical research to clarify the heterogeneity of GNEC and improve the prognosis of patients with GNEC.展开更多
BACKGROUND The preoperative total bilirubin-albumin ratio(TBAR)and fibrinogen-albumin ratio(FAR)have been proven to be valuable prognostic factors in various cancers.AIM To detect the prognostic value of TBAR and FAR ...BACKGROUND The preoperative total bilirubin-albumin ratio(TBAR)and fibrinogen-albumin ratio(FAR)have been proven to be valuable prognostic factors in various cancers.AIM To detect the prognostic value of TBAR and FAR in ampullary adenocarcinoma(AC)patients who underwent curative pancreaticoduodenectomy.METHODS AC patients who underwent curative pancreaticoduodenectomy in the National Cancer Center of China between 1998 and 2020 were retrospectively reviewed.The prognostic cutoff values of TBAR and FAR were determined through the best survival separation model.Then,a novel prognostic score combining TBAR and FAR was calculated and validated through the logistic regression analysis and Cox regression analysis.RESULTS A total of 188 AC patients were enrolled in the current study.The best cutoff values of TBAR and FAR for predicting overall survival were 1.7943 and 0.1329,respectively.AC patients were divided into a TBAR-low group(score=0)vs a TBAR-high group(score=1)and a FAR-low group(score=0)vs a FAR-high group(score=1).The total score was calculated as a novel prognostic factor.Multivariable logistic regression analysis revealed that a high score was an independent protective factor for recurrence[score=1 vs score=0:Odds ratio(OR)=0.517,P=0.046;score=2 vs score=0 OR=0.236,P=0.038].In addition,multivariable survival analysis also demonstrated that a high score was an independent protective factor in AC patients(score=2 vs score=0:Hazard ratio=0.230,P=0.046).CONCLUSION A novel prognostic score based on preoperative TBAR and FAR has been demonstrated to have good predictive power in AC patients who underwent curative pancreaticoduodenectomy.However,more studies with larger samples are needed to validate this conclusion.展开更多
文摘BACKGROUND The tumor microenvironment(TME)plays an important role in the growth and expansion of gastric cancer(GC).Studies have identified that CD93 is involved in abnormal tumor angiogenesis,which may be related to the regulation of the TME.AIM To determine the role of CD93 in GC.METHODS Transcriptomic data of GC was investigated in a cohort from The Cancer Genome Atlas.Additionally,RNA-seq data sets from Gene Expression Omnibus(GSE118916,GSE52138,GSE79973,GSE19826,and GSE84433)were applied to validate the results.We performed the immune infiltration analyses using ESTIMATE,CIBERSORT,and ssGSEA.Furthermore,weighted gene co-expression network analysis(WGCNA)was conducted to identify the immunerelated genes.RESULTS Compared to normal tissues,CD93 significantly enriched in tumor tissues(t=4.669,95%CI:0.342-0.863,P<0.001).Higher expression of CD93 was significantly associated with shorter overall survival(hazard ratio=1.62,95%CI:1.09-2.4,P=0.017),less proportion of CD8 T and activated natural killer cells in the TME(P<0.05),and lower tumor mutation burden(t=4.131,95%CI:0.721-0.256,P<0.001).Genes co-expressed with CD93 were mainly enriched in angiogenesis.Moreover,11 genes were identified with a strong relationship between CD93 and the immune microenvironment using WGCNA.CONCLUSION CD93 is a novel prognostic and diagnostic biomarker for GC,that is closely related to the immune infiltration in the TME.Although this retrospective study was a comprehensive analysis,the prospective cohort studies are preferred to further confirm these conclusions.
文摘BACKGROUND Growing evidence shows that pancreatic tumors in different anatomical locations have different characteristics,which have a significant impact on prognosis.However,no study has reported the differences between pancreatic mucinous adenocarcinoma(PMAC)in the head vs the body/tail of the pancreas.AIM To investigate the differences in survival and clinicopathological characteristics between PMAC in the head and body/tail of pancreas.METHODS A total of 2058 PMAC patients from the Surveillance,Epidemiology,and End Results database diagnosed between 1992 and 2017 were retrospectively reviewed.We divided the patients who met the inclusion criteria into pancreatic head group(PHG)and pancreatic body/tail group(PBTG).The relationship between two groups and risk of invasive factors was identified using logistic regression analysis.Kaplan-Meier analysis and Cox regression analysis were conducted to compare the overall survival(OS)and cancer-specific survival(CSS)of two patient groups.RESULTS In total,271 PMAC patients were included in the study.The 1-year,3-year,and 5-year OS rates of these patients were 51.6%,23.5%,and 13.6%,respectively.The 1-year,3-year,and 5-year CSS rates were 53.2%,26.2%,and 17.4%,respectively.The median OS of PHG patients was longer than that of PBTG patients(18 vs 7.5 mo,P<0.001).Compared to PHG patients,PBTG patients had a greater risk of metastases[odds ratio(OR)=2.747,95%confidence interval(CI):1.628-4.636,P<0.001]and higher staging(OR=3.204,95%CI:1.895-5.415,P<0.001).Survival analysis revealed that age<65 years,male sex,low grade(G1-G2),low stage,systemic therapy,and PMAC located at the pancreatic head led to longer OS and CSS(all P<0.05).The location of PMAC was an independent prognostic factor for CSS[hazard ratio(HR)=0.7,95%CI:0.52-0.94,P=0.017].Further analysis demonstrated that OS and CSS of PHG were significantly better than PBTG in advanced stage(stage III-IV).CONCLUSION Compared to the pancreatic body/tail,PMAC located in the pancreatic head has better survival and favorable clinicopathological characteristics.
文摘BACKGROUND Both hepatoid adenocarcinoma of the stomach(HAS)and neuroendocrine differentiation(NED)are rare histological subtypes of gastric cancer with unique clinicopathological features and unfavorable outcomes.HAS with NED is even rarer.CASE SUMMARY Here,we report a 61-year-old man with HAS with NED,as detected by gastric wall thickening by positron emission tomography/computed tomography for a pulmonary nodule.Distal gastrectomy was performed,and pathological examination led to the diagnosis of HAS with NED.However,liver metastases occurred 6 mo later despite adjuvant chemotherapy,and the patient died 27 mo postoperatively.CONCLUSION We treated a patient with HAS with NED who underwent adjuvant chemotherapy after radical surgery and still developed liver metastases.We first report the detailed processes of the treatment and development of HAS with NED,providing an important reference for the clinical diagnosis and treatment of this condition.
文摘BACKGROUND The effect of perioperative blood transfusion(PBT)on the prognosis of ampullary carcinoma(AC)is still debated.AIM To explore the impact of PBT on short-term safety and long-term survival in AC patients who underwent pancreaticoduodenectomy.METHODS A total of 257 patients with AC who underwent pancreaticoduodenectomy between 1998 and 2020 in the Cancer Hospital,Chinese Academy of Medical Sciences,were retrospectively analyzed.We used Cox proportional hazard regression to identify prognostic factors of overall survival(OS)and recurrencefree survival(RFS)and the Kaplan-Meier method to analyze survival information.RESULTS A total of 144(56%)of 257 patients received PBT.The PBT group and nonperioperative blood transfusion group showed no significant differences in demographics.Patients who received transfusion had a comparable incidence of postoperative complications with patients who did not.Univariable and multivariable Cox proportional hazard regression analyses indicated that transfusion was not an independent predictor of OS or RFS.We performed Kaplan-Meier analysis according to subgroups of T stage,and subgroup analysis indicated that PBT might be associated with worse OS(P<0.05)but not RFS in AC of stage T1.CONCLUSION We found that PBT might be associated with decreased OS in early AC,but more validation is needed.The reasonable use of transfusion might be helpful to improve OS.
文摘BACKGROUND Textbook outcomes(TOs)have been used to assess the quality of surgical treatment for many digestive tumours but not ampullary carcinoma(AC).AIM To discuss the factors associated with achieving a TO and further explore the prognostic value of a TO for AC patients undergoing curative pancreaticoduodenectomy(PD).METHODS Patients who underwent PD at the China National Cancer Center between 1998 and 2020 were identified.A TO was defined by R0 resection,examination of≥12 Lymph nodes,no prolonged hospitalization,no intensive care unit treatment,no postoperative complications,and no 30-day readmission or mortality.Cox regression analysis was used to identify the prognostic value of a TO for overall survival(OS)and recurrence-free survival(RFS).Logistic regression was used to identify predictors of a TO.The rate of a TO and of each indicator were compared in patients who underwent surgery before and after 2010.RESULTS Ultimately,only 24.3%of 272 AC patients achieved a TO.A TO was independently associated with improved OS[hazard ratio(HR):0.443,95%confidence interval(95%CI):0.276-0.711,P=0.001]and RFS(HR:0.379,95%CI:0.228-0.629,P<0.001)in the Cox regression analysis.Factors independently associated with a TO included a year of surgery between 2010 and 2020(OR:4.549,95%CI:2.064-10.028,P<0.001)and N1 stage disease(OR:2.251,95%CI:1.023-4.954,P=0.044).In addition,the TO rate was significantly higher in patients who underwent surgery after 2010(P<0.001)than in those who underwent surgery before 2010.CONCLUSION Only approximately a quarter(24.3%)of AC patients achieved a TO following PD.A TO was independently related to favourable oncological outcomes in AC and should be considered as an outcome measure for the quality of surgery.Further multicentre research is warranted to better elucidate its impact.
文摘BACKGROUND Gastric neuroendocrine carcinoma(GNEC)is a rare histological subtype of gastric cancer,which is categorized into small cell and large cell neuroendocrine carcinomas.It is characterized by strong invasiveness and poor prognosis.Mixed large and small cell neuroendocrine carcinoma(L/SCNEC)is an extremely rare pathological type of gastric cancer,and there have been no reports on this situation until now.CASE SUMMARY Herein,we first present a 57-year-old patient diagnosed with L/SCNEC of the stomach.A 57-year-old Chinese male presented with epigastric discomfort.Outpatient gastroscopic biopsy was performed,and pathological examination revealed that the cardia was invaded by adenocarcinoma.The patient underwent laparoscopic-assisted radical proximal subtotal gastrectomy and was diagnosed with L/SCNEC.He refused adjuvant treatment and was followed up every 3 mo.Eight months after the operation,the patient showed no evidence of local recurrence or distant metastasis.CONCLUSION We advocate conducting further genomic studies to explore the origin of gastric large cell and small cell neuroendocrine carcinoma and using different chemotherapy schemes according to large or small cell neuroendocrine carcinoma of the stomach for clinical research to clarify the heterogeneity of GNEC and improve the prognosis of patients with GNEC.
文摘BACKGROUND The preoperative total bilirubin-albumin ratio(TBAR)and fibrinogen-albumin ratio(FAR)have been proven to be valuable prognostic factors in various cancers.AIM To detect the prognostic value of TBAR and FAR in ampullary adenocarcinoma(AC)patients who underwent curative pancreaticoduodenectomy.METHODS AC patients who underwent curative pancreaticoduodenectomy in the National Cancer Center of China between 1998 and 2020 were retrospectively reviewed.The prognostic cutoff values of TBAR and FAR were determined through the best survival separation model.Then,a novel prognostic score combining TBAR and FAR was calculated and validated through the logistic regression analysis and Cox regression analysis.RESULTS A total of 188 AC patients were enrolled in the current study.The best cutoff values of TBAR and FAR for predicting overall survival were 1.7943 and 0.1329,respectively.AC patients were divided into a TBAR-low group(score=0)vs a TBAR-high group(score=1)and a FAR-low group(score=0)vs a FAR-high group(score=1).The total score was calculated as a novel prognostic factor.Multivariable logistic regression analysis revealed that a high score was an independent protective factor for recurrence[score=1 vs score=0:Odds ratio(OR)=0.517,P=0.046;score=2 vs score=0 OR=0.236,P=0.038].In addition,multivariable survival analysis also demonstrated that a high score was an independent protective factor in AC patients(score=2 vs score=0:Hazard ratio=0.230,P=0.046).CONCLUSION A novel prognostic score based on preoperative TBAR and FAR has been demonstrated to have good predictive power in AC patients who underwent curative pancreaticoduodenectomy.However,more studies with larger samples are needed to validate this conclusion.
