Background: Adolescents and young adults (AYA) with germline CDH1 variants are at risk of overtreatment when precancer lesions are detected with endoscopic screening. We characterize diffuse-type gastric cancer prevalence and survival in AYA managed with prophylactic total gastrectomy (PTG) or endoscopic surveillance.
Methods: Prospective cohort study of 188 individuals aged 39 and younger enrolled from January 27, 2017, to May 1, 2023. Clinicopathologic data, prevalence of early gastric signet ring cell (SRC) lesions, advanced gastric cancer diagnoses, and cancer-specific survival were measured.
Results: Among 188 AYA patients, 104 chose surveillance and 67 pursued PTG for management of elevated gastric cancer risk. AYA who enrolled early in the study period and had SRC lesions detected on preoperative endoscopy were more likely to elect for PTG compared to surveillance. SRC were detected on preoperative endoscopy in 48% of patients who subsequently had PTG, yet nearly all (93%, 62/67) had multifocal SRC (pT1aN0) on final pathology. Median age at enrollment (30 vs. 31 years, p = .21), biologic sex (p = .17), and median number of family members with gastric cancer (3 vs. 4, p = .14) were not different between groups. No patients under surveillance developed advanced cancer or developed cancer recurrence after PTG with a median follow-up of 2.5 years (IQR 1.6-4.0) from initial endoscopy.
Conclusions: Cancer-specific outcomes were not different in AYA who harbored SRC and were managed with surveillance or PTG. Lack of cancer-specific deaths and low prevalence of advanced gastric cancer underscore the risk of overtreatment of SRC lesions and suggest that active surveillance is warranted.
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http://dx.doi.org/10.1093/jnci/djaf002 | DOI Listing |
Int J Surg
January 2025
Department of Surgical Oncology, Fourth Affiliated Hospital of China Medical University.
Background: Several autoimmune diseases (ADs) are considered risk factors for gastrointestinal (GI) cancers. This study pooled and appraised the evidence associating ADs to GI cancer risks.
Methods: Three databases were examined from initiation through 26 January 2024.
Int J Surg
January 2025
Department of Upper Gastrointestinal Surgery, Royal Marsden NHS Foundation Trust, London, United Kingdom.
Background: The inclusion of clinical frailty in the assessment of patients planned for major surgery has proven to be an independent predictor of outcome. Since approximately half of all patients in the UK diagnosed with oesophagogastric (OG) cancer are over 75 years of age, assessment of frailty may be important in selection for surgery.
Materials And Methods: This retrospective cohort study applied the Hospital Frailty Risk Score to data obtained from the NHS Secondary Uses Service electronic database for patients aged 75 years or older undergoing oesophagectomy and gastrectomy between April 2017 and March 2020.
MedComm (2020)
January 2025
Department of Oncology Shanghai Medical College, Fudan University Shanghai China.
Cancer-associated fibroblasts (CAFs) are intrinsic components of the tumor microenvironment that promote cancer progression and metastasis. Through an unbiased integrated analysis of gastric tumor grade and stage, we identified a subset of proangiogenic CAFs characterized by high podoplanin (PDPN) expression, which are significantly enriched in metastatic lesions and secrete chemokine (CC-motif) ligand 2 (CCL2). Mechanistically, PDPN(+) CAFs enhance angiogenesis by activating the AKT/NF-κB signaling pathway.
View Article and Find Full Text PDFDiffuse gastric adenocarcinoma (DGAC) is an aggressive malignancy with limited therapeutic options, poor prognosis, and poorly understood biology. CRACD, an actin polymerization regulator, is often inactivated in gastric cancer, including DGAC. We found that genetic engineering of murine gastric organoids with ablation combined with mutation and loss induced aberrant cell plasticity, hyperproliferation, and hypermucinosis, the features that recapitulate DGAC transcriptional signatures.
View Article and Find Full Text PDFFront Immunol
January 2025
Department of Urology, Peking University People's Hospital, Beijing, China.
Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of systemic cancer therapy. During disinhibiting the antitumor responses of immune system, ICIs may also cause unique immune-related adverse events (irAEs) which could affect any organ. Here, we report a rare case of sintilimab-induced ureteritis/cystitis in a 55-year-old male undergoing neoadjuvant chemo-immunotherapy for gastric cancer.
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