Gastric cancer is a leading cause of cancer deaths, but analysis of its molecular and clinical characteristics has been complicated by histological and aetiological heterogeneity. Stomach cancers are ...90% adenocarcinoma; lymphoma, carcinoid, and stromal tumours may occur. Adenocarcinoma can be subdivided into histological Lauren and the World Health Organization (WHO) classifications, but this information has not led to the development of histologic subtype-specific treatment options. One way to potentially improve treatment for gastric cancers is to better understand the pathogenesis of this disease, the contribution of Helicobacter pylori infection, and host immune response to lead to the development of integrated histological and molecular classification schemes for gastric cancer. The hope is that these studies may facilitate the development of clinical trials to explore therapies in defined sets of patients, ultimately improving survival from this deadly disease.
Background
Multimodal treatment strategies with surgery as its centerpiece have been accepted as the standard of care in nonmetastatic cardia gastric cancer (CGC). There remains a lack of consensus ...regarding the optimal multimodal treatment strategy.
Method
We queried National Cancer Database from 2004 to 2016 to identify patients with resected nonmetastatic CGC who received perioperative chemotherapy (PEC), postoperative chemoradiation therapy (POCR), or postoperative chemotherapy (POC). A subgroup analysis was performed in optimally treated patients defined as initial chemotherapy within 45 days of diagnosis, resection within 45 days of diagnosis, negative margins, adjuvant chemotherapy within 90 days of resection, and standard radiation dose (45 Gy). Kaplan–Meier, Univariate analysis (UVA), and Multivariable analysis (MVA) were performed.
Results
We identified 2387 patients. Median survival was 38.8 months in the PEC group, 36 months in the POCR group, and 32.3 months in the POC group (p = 0.1025). On UVA, patients treated with PEC had an association with improved survival (HR, 0.83; p = 0.037) when compared with POC. On MVA, no significant difference was noted in overall survival (OS) between PEC, POCR, and POC, similar to subgroup analysis of optimally treated cohort.
Conclusion
OS rate in nonmetastatic CGC is not significantly different between patients receiving PEC, POCR, or POC.
We previously estimated that 660,000 cases of cancer in the year 2008 were attributable to the bacterium Helicobacter pylori (H. pylori), corresponding to 5.2% of the 12.7 million total cancer cases ...that occurred worldwide. In recent years, evidence has accumulated that immunoblot (western blot) is more sensitive for detection of anti-H. pylori antibodies than ELISA, the detection method used in our previous analysis. The purpose of this short report is to update the attributable fraction (AF) estimate for H. pylori after briefly reviewing new evidence, and to reassess the global burden of cancer attributable to H. pylori. We therefore reviewed the literature for studies comparing the risk of developing non-cardia gastric cancer (NCGC) in cases and controls, using both ELISA and multiple antigen immunoblot for detection of H. pylori. The results from prospective studies were combined, and the new pooled estimates were applied to the calculation of the AF for H. pylori in NCGC, then to the burden of infection-related cancers worldwide. Using the immunoblot-based data, the worldwide AF for H. pylori in NCGC increased from 74.7% to 89.0%. This implies approximately 120,000 additional cases of NCGC attributable to H. pylori infection for a total of around 780,000 cases (6.2% instead of 5.2% of all cancers). These updated estimates reinforce the role of H. pylori as a major cause of cancer. What's new? Some 5.2 percent of the estimated 12.7 million new cancer cases in 2008, including 75% of non-cardia gastric cancer cases (NCGC), were attributed to the bacterium Helicobacter pylori. However, those percentages may be an underestimate, given the low sensitivity of detection of anti-H. pylori antibodies. Here, using improved estimates from prospective studies based on immunoblot, the fraction of all cancers and NCGC attributable to H. pylori was found to be 6.2 and 89% percent, respectively. Our findings reinforce the significance of the bacterium as a major cause of cancer.
There are three major hereditable syndromes that affect primarily the stomach: hereditary diffuse gastric cancer (HDGC), gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS) and ...familial intestinal gastric cancer (FIGC). HDGC is caused by germline mutations in CDH1 gene that occur in 10–40% of HDGC families and, in a minority of cases, by mutations in CTNNA1 gene. GAPPS is caused by germline mutations in the promoter 1B of APC gene, and the genetic cause of FIGC is not fully elucidated. Gastric cancer can also be observed as part of other inherited cancer disorders, namely in familial adenomatous polyposis, MUTYH-associated polyposis, Peutz-Jeghers syndrome, juvenile polyposis syndrome, Lynch syndrome, Li-Fraumeni syndrome, Cowden syndrome, and hereditary breast and ovarian cancer syndrome. In this article, the state of the art of familial gastric cancer regarding the clinical, molecular and pathology features is reviewed, as well as the practical aspects for a correct diagnosis and clinical management.
LINKED CONTENT
This article is linked to Gong et al papers. To view these articles, visit
https://doi.org/10.1111/apt.17676
and
https://doi.org/10.1111/apt.17741
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