This study examined the long-term outcomes of undifferentiated-type early gastric cancer (UD EGC) with positive horizontal margins (HMs) after endoscopic resection (ER) and compared them between ...additional surgery and nonsurgical management.
From 2005 to 2015, a total of 1,124 patients with UD EGC underwent ER at 18 tertiary hospitals in Korea. Of them, 92 patients with positive HMs as the only noncurative factor (n=25) or with both positive HMs and tumor size >2 cm (n=67) were included. These patients underwent additional surgery (n=40), underwent additional endoscopic treatment (n=6), or were followed up without further treatment (n=46).
No lymph node (LN) metastasis was found in patients who underwent additional surgery. During a median follow-up of 57.7 months (interquartile range, 27.6 to 68.8 months), no LN or distant metastases or gastric cancer-related deaths occurred in the overall cohort. At baseline, the residual cancer rate was 57.8% (26/45) after additional surgery or ER. The 5-year local recurrence rate was 33.6% among patients who were followed up without additional treatment. The 5-year overall survival rates were 95.0% and 87.8% after additional surgery and nonsurgical management (endoscopic treatment or close follow-up), respectively (log-rank p=0.224). In the multivariate Cox regression analysis, nonsurgical management was not associated with an increased risk of mortality.
UD EGC with positive HMs after ER may have favorable long-term outcomes and a very low risk of LN metastasis. Nonsurgical management may be suggested as an alternative, particularly for patients with old age or chronic illness.
Purpose
Foods such as grains and vegetables are the dominant sources of exposure to cadmium, which has been classified as a carcinogen by various public health agencies. Cadmium exposure is a growing ...concern due to its associations with numerous harmful health effects, including gastric cancer risk. The objective of this study was to investigate the association of dietary cadmium intake and the consumption of cadmium-contributing foods with early gastric cancer risk.
Methods
A case–control study including 1245 subjects (cases, 415; controls, 830) was conducted in Korea. The dietary cadmium intake and the consumption of cadmium-contributing foods were assessed using a semi-quantitative food frequency questionnaire.
Results
After adjustment for covariates, the gastric cancer risk was increased for participants in the highest tertile of cadmium intake odds ratios (ORs) 1.33, 95% confidence intervals (95% CIs) 0.94–1.88, but there was no significance. Both female (ORs 2.71, 95% CIs 1.37–5.36) and male (ORs 1.63, 95% CIs 1.07–2.50) participants in the highest tertile of rice consumption had a higher gastric cancer risk than did those in the lowest tertile. Men in the highest tertile of crab consumption had a gastric cancer risk 2.23 times greater than that of men in the lowest tertile (ORs 2.23, 95% CIs 1.21–4.13), but a difference was not seen in women.
Conclusions
Future studies examining the causal effects of dietary cadmium intake and the consumption of cadmium-contributing foods on early gastric cancer risk in large-scale prospective cohorts are recommended.
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DOBA, EMUNI, FIS, FSPLJ, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, SIK, UILJ, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
AIM: To investigate the effects of dietary vitamin C and foods containing vitamin C on gastric cancer risk.METHODS: Our study included 830 control subjects and 415 patients. Data regarding ...demographics, medical history, and lifestyle, including dietary and nutrient intake, were collected using reliable selfadministered questionnaires. Dietary intake information was collected from the participants using a food frequency questionnaire that has been previously reported as reliable and valid. A rapid urease test and a histological evaluation were used to determine the presence of Helicobacter pylori(H. pylori) infection. Twenty-three vitamin C-contributing foods were selected, representing over 80% of the cumulative vitamin C contribution. RESULTS: In analyses adjusted for first-degree family history of gastric cancer, education level, job, household income, smoking status, and regular exercise, an inverseassociation between vitamin C intake and gastric cancer risk was observed for the highest(≥ 120.67 mg/d) vs the lowest(< 80.14 mg/d) intake category OR(95%CI): 0.64(0.46-0.88), with a significant trend across the three intake categories(P = 0.007). No protective effect of vitamin C was detected after stratification by gender. No effect of vitamin C intake on the gastric cancer incidence was found in either men or women infected with H. pylori. Vitamin C-contributing foods, including cabbage 0.45(0.32-0.63), 0.50(0.34-0.75), 0.45(0.25-0.81), strawberries 0.56(0.40-0.78), 0.49(0.32-0.74), 0.52(0.29-0.93), and bananas 0.40(0.29-0.57), 0.41(0.27-0.62), 0.34(0.19-0.63), were protective factors against the risk of gastric cancer based on the results of the overall adjusted analyses and the results for men and women, respectively.CONCLUSION: A protective effect of vitamin C and vitamin C-contributing foods against gastric cancer was observed. Further studies using larger sample sizes are required to replicate our results.
Gastric carcinogenesis is linked to oxidative stress from both exogenous and endogenous exposures. This study aimed to determine the association between the risk of gastric cancer and the oxidative ...balance score (OBS), which comprises antioxidant and pro-oxidant factors, including diet and lifestyle.
For this hospital-based case-control study, 808 controls and 404 patients with gastric cancer who had clinical records indicating Helicobacter pylori infection and the histological subtype of cancer were recruited. The OBS was determined based on diet and lifestyle factors obtained from a 106-item semiquantitative food frequency questionnaire and a constructed questionnaire. Logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).
A higher OBS was associated with a reduced gastric cancer risk (OR, 0.49; 95% CI <sub.T3 vs. T1, 0.33 to 0.71; p for trend <0.001). In a subgroup analysis, antioxidant factors showed inverse associations with gastric cancer risk (OR, 0.53; 95% CI T3 vs. T1, 0.35 to 0.79; p for trend=0.003). A stronger association with antioxidant factors was observed in patients with intestinal gastric cancer (OR, 0.34; 95% CI T3 vs. T1, 0.19 to 0.62; p for trend<0.001) and those with H. pylori infection (OR, 0.57; 95% CI T3 vs. T1, 0.37 to 0.88; p for trend=0.014).
A predominance of antioxidant factors compared to pro-oxidant factors from diet and lifestyle reduced the risk of gastric cancer. The combined effect of oxidative stress, which involves an altered balance between antioxidants and pro-oxidants, is important for modulating the risk of gastric cancer.
Background and Aims Excellent long-term outcome is expected for early gastric cancers (EGCs) after endoscopic submucosal dissection (ESD). However, if ESD is considered noncurative at the pathologic ...evaluation, additional surgery is recommended. We evaluated whether long-term outcome is compromised if additional surgery is not performed for EGCs that are out-of-indication. Methods We retrospectively analyzed a cohort of patients with EGC not meeting ESD indications whose initial treatment was either ESD (n = 219) or surgery (n = 1799). Among them, 127 patients who underwent additional surgery after initial ESD and 67 patients who did not were matched using propensity scores to patients who initially underwent standard surgery, at a 1:1 ratio. Overall mortality and gastric cancer recurrence were compared. Results The overall mortality and gastric cancer recurrence rates were not significantly different between the 127 patients who underwent initial ESD with additional surgery and the corresponding initial standard surgery patients. However, the overall mortality of the 67 patients who underwent ESD without additional surgery (5-year mortality, 26.0%; 95% CI, 13.5%-49.9%) was higher than that of the matched initial standard surgery patients (5-year mortality, 14.5%; 95% CI, 6.3%-33.6%; P = .04). Gastric cancer recurrence was also higher in ESD patients without additional surgery (5-year recurrence, 17.0%; 95% CI, 7.6%-37.8%) than in the matched initial surgery group (0%; P = .002). In multivariate analyses, ESD without additional surgery was a significant risk factor for overall mortality and gastric cancer recurrence. Conclusions Additional surgery should be encouraged after non-curative ESD to obtain long-term outcomes comparable with those of initial standard surgery. (Clinical trial registration number: NCC2015-0093.)
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Gastric cancer is the most common cancer among men in Korea, and dietary factors are closely associated with gastric cancer risk. We performed a case-control study using 334 cases and 334 matched ...controls aged 35-75 years. Significant associations were observed in total dietary flavonoids and their subclasses, with the exception of anthocyanidins and isoflavones (OR (95% CI): 0.49 (0.31-0.76), p trend = 0.007 for total flavonoids). However, these associations were not significant after further adjustment for fruits and vegetable consumption (OR (95% CI): 0.62 (0.36-1.09), p trend = 0.458 for total flavonoids). Total flavonoids and their subclasses, except for isoflavones, were significantly associated with a reduced risk gastric cancer in women (OR (95% CI): 0.33 (0.15-0.73), p trend = 0.001 for total flavonoids) but not in men (OR (95% CI): 0.70 (0.39-1.24), p trend = 0.393 for total flavonoids). A significant inverse association with gastric cancer risk was observed in flavones, even after additional adjustment for fruits and vegetable consumption in women. No significantly different effects of flavonoids were observed between H. pylori-positive and negative subjects. In conclusion, dietary flavonoids were inversely associated with gastric cancer risk, and these protective effects of dietary flavonoids were prominent in women. No clear differences were observed in the subgroup analysis of H. pylori and smoking status.
Eus-guided ethanol with paclitaxel ablation for the pancreatic cyst Choi, Jung Sik; Yang, Ju Il
Pancreatology : official journal of the International Association of Pancreatology (IAP) ... et al.,
September 2017, 2017-09-00, 20170901, Volume:
17, Issue:
4
Journal Article
Peer reviewed
Introduction: Pancreas cystic lesions are frequently detected incidentally but surgical resection of the pancreas still carries substantial morbidity, and sometimes mortality, especially when the ...cystic lesion is located in the head portion. A curvilinear-array echoendoscope (GF-UCT 240-AL-5; Olympus) and a 22-gauge needle (Boston Scientific Corp.) were used for cystic fluid aspiration, 99% ethanol lavage for 5 minutes, and then 3 mg/mL paclitaxel.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Background Self-expandable metallic stents (SEMSs) provide effective palliation of malignant pyloric obstruction in patients with inoperable gastric cancer. Objective To compare the effectiveness and ...side effects of covered and uncovered SEMSs for the palliation of malignant pyloric obstruction. Design Prospective, randomized, single-center study. Setting Tertiary-care cancer center hospital. Patients This study involved 80 patients with pyloric obstruction related to inoperable gastric cancer. Intervention Covered or uncovered SEMS placement. Main Outcome Measurements Technical and clinical success rates as well as the patency rate at 8 weeks after placement. Results Both groups had a technical success rate of 100% with no immediate complications. Both groups also had comparable clinical success rates (covered SEMS, 95% 38 of 40 and uncovered SEMS, 90% 36 of 40, P = .68) and 8-week patency rates (covered SEMS, 61.3% 19 of 31 and uncovered SEMS, 61.1% 22 of 36, P > .99). Stent migration within 8 weeks was more common in the covered SEMS group (25.8% 8 of 31) than in the uncovered SEMS group (2.8% 1 of 36, P = .009), whereas re-stenosis because of tumor ingrowth was more common in the uncovered SEMS group (25.0% 9 of 36 vs 0% 0 of 31 in the covered SEMS group, P = .003). Overall patient survival and stent patency did not differ between groups ( P = .27 and 0.61 by log-rank test, respectively). Limitations The study population was limited to gastric cancer patients, and stent designs were changed in the midst of the study period. Conclusion Both the covered and uncovered SEMSs are effective and have comparable 8-week patency in patients with malignant pyloric obstruction, despite different patterns of late stent failure.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
There exists no coherent national strategy for the early detection or prevention of gastric cancer in the United States (US), even among identified high-risk groups such as Asian Americans, African ...Americans, Hispanic Americans, and Alaska Native/American Indian peoples. As a result, patients with gastric cancer in the US are diagnosed at later stages and demonstrate worse overall survival compared to nations of East Asia with established screening programs (
Table 1
). The under-recognition of gastric cancer risk within minority communities is a significant unaddressed healthcare disparity.
To address this disparity, the Division of Gastroenterology and Hepatology and the Center for Asian Health Research and Education at Stanford University hosted the inaugural Gastric Cancer Summit on March 5–6, 2020. This Summit brought together academic physicians, researchers, policy leaders, and patient advocates to identify strategies to combat gastric cancer in high-risk US populations through prevention and early detection. The first day of the Summit consisted of health policy- and advocacy-oriented presentations, and the second day consisted of scientific presentations on advances in early detection and prevention.
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