To characterize the salivary microbiota in patients at different progressive histological stages of gastric carcinogenesis and identify microbial markers for detecting gastric cancer, two hundred and ...ninety-three patients were grouped into superficial gastritis (SG; n = 101), atrophic gastritis (AG; n = 93), and gastric cancer (GC; n = 99) according to their histology. 16S rRNA gene sequencing was used to access the salivary microbiota profile. A random forest model was constructed to classify gastric histological types based on the salivary microbiota compositions. A distinct salivary microbiota was observed in patients with GC when comparing with SG and AG, which was featured by an enrichment of putative proinflammatory taxa including
and
. Among the significantly decreased oral bacteria in GC patients including
,
,
,
,
, and
,
, and
are known to reduce nitrite, which may consequently result in an accumulation of carcinogenic N-nitroso compounds. We found that GC can be distinguished accurately from patients with AG and SG (AUC = 0.91) by the random forest model based on the salivary microbiota profiles, and taxa belonging to
and
have potential as diagnostic biomarkers for GC. Remarkable changes in the salivary microbiota functions were also detected across three histological types, and the upregulation in the isoleucine and valine is in line with a higher level of these amino acids in the gastric tumor tissues that reported by other independent studies. Conclusively, bacteria in the oral cavity may contribute gastric cancer and become new diagnostic biomarkers for GC, but further evaluation against independent clinical cohorts is required. The potential mechanisms of salivary microbiota in participating the pathogenesis of GC may include an accumulation of proinflammatory bacteria and a decline in those reducing carcinogenic N-nitroso compounds.
Background: The World Health Organization (WHO) has recently endorsed thermal coagulation as an alternative to cryotherapy for cervical precancerous lesions. However, the comparative efficacy and ...safety of these two treatments lack robust support from large-sample data. This systematic review and meta-analysis aim to evaluate the effectiveness and safety of thermocoagulation compared to cryotherapy in the treatment of cervical precancerous lesions. Methods: A comprehensive search of PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov was conducted from inception. Additional trials were identified through the reference lists of published reviews. Inclusion criteria encompassed original data studies with colposcopically, biopsied, cytologically, or visually inspected (VIA/VILI) identified patients. Studies were required to have a follow-up duration of at least 6 months, a sample size exceeding 20 patients, a follow-up attendance rate exceeding 50%, and involve cryotherapy or thermocoagulation treatments. Results: Inclusive of all patients, thermocoagulation demonstrated a significantly higher pooled cure proportion compared to cryotherapy (85% vs. 81%, z = 2.245, p = 0.025). However, for VIA-positive patients alone, the difference was not statistically significant (80.0% vs. 79%, z = 1.932, p = 0.053). The incidence of pain was comparable between the two treatment arms, while both exhibited a high incidence of vaginal discharge. Thermocoagulation displayed a lower complication rate for intraoperative pain and postoperative vaginal discharge than cryotherapy, providing a higher level of patient comfort. Conclusions: Thermal coagulation proves to be more effective for patients with cervical precancerous lesions, but the effectiveness of the two regimens is similar if only for VIA-positive patients. In terms of complications, thermocoagulation exhibits a similar rate of intraoperative pain and a lower rate of postoperative vaginal discharge than cryotherapy, enhancing patient comfort.
To identify risk factors for precancerous cervical lesions and factors associated with treatment delay among women in the rural Busoga Region, Uganda.
A retrospective cross-sectional study from a ...regional cervical cancer screening program and from cervical cancer patients enrolled in a region-wide palliative care program.
Logistic regression analysis was conducted to assess risk factors for screening positive for precancerous lesions. In a separate analysis, factors associated with treatment delay were assessed among women enrolled in the palliative care program.
Three thousand nine hundred forty-six women were included from the screening program and 334 from the palliative care program. In total, 7.6% of screening participants had precancerous lesions. Within Busoga Region, the highest positivity rate was found in Bugweri and Namayingo Districts. Abnormal vaginal bleeding (adjusted odds ratio aOR 1.60; 95% confidence interval CI 1.15–2.21; p = 0.005) and older age at first menstrual period (aOR 1.08; 95% CI 1.01–1.16; p = 0.03) were associated with having a precancerous lesion. Among palliative care patients, a history of previous contact with the health care system was associated with a delay in enrolment (≥12 months from first symptom presentation until commencement in palliative care; aOR 5.23; 95% CI 1.16–36.54; p = 0.047).
The results underline an unmet need for broad-scale cervical cancer screening focusing on all women in the reproductive age. Abnormal bleeding was the only substantial risk factor for precancerous lesions, indicating that specific algorithms to identify high-risk populations may not be applicable in this population. Increased awareness, resources, and funding are still necessary to achieve global cervical cancer elimination.
The incidence of anal cancer is elevated in human immunodeficiency virus (HIV)‐infected men‐who‐have‐sex‐with‐men (MSM) compared to the general population. Anal high‐grade squamous intraepithelial ...lesions (HSIL) are common in HIV‐infected MSM and the presumed precursors to anal squamous cell cancer; however, direct progression of HSIL to anal cancer has not been previously demonstrated. The medical records were reviewed of 138 HIV‐infected MSM followed up at the University of California, San Francisco, who developed anal canal or perianal squamous cancer between 1997 and 2011. Men were followed up regularly with digital anorectal examination (DARE), high‐resolution anoscopy (HRA) and HRA‐guided biopsy. Although treatment for HSIL and follow‐up were recommended, not all were treated and some were lost to follow‐up. Prevalent cancer was found in 66 men. Seventy‐two HIV‐infected MSM developed anal cancer while under observation. In 27 men, anal cancer developed at a previously biopsied site of HSIL. An additional 45 men were not analyzed in this analysis due to inadequate documentation of HSIL in relation to cancer location. Of the 27 men with documented progression to cancer at the site of biopsy‐proven HSIL, 20 men progressed from prevalent HSIL identified when first examined and seven men from incident HSIL. Prevalent HSIL progressed to cancer over an average of 57 months compared to 64 months for incident HSIL. Most men were asymptomatic, and cancers were detected by DARE. Anal HSIL has clear potential to progress to anal cancer in HIV‐infected MSM. Early diagnosis is facilitated by careful follow‐up. Carefully controlled studies evaluating efficacy of screening for and treatment of HSIL to prevent anal cancer are needed.
What's new?
The elevated incidence of anal cancer seen among HIV‐infected men‐who‐have‐sex‐with‐men (MSM) is presumably linked to the common occurrence of anal high‐grade squamous intraepithelial lesions (HSIL) in this population. This study provides some of the first evidence for direct progression of the postulated HSIL precursors to anal cancer. MSM were followed for a period of more than 20 years with high‐resolution anoscopy and biopsy. The data provide conclusive evidence of the malignant potential of anal HSIL and underscore the potential to reduce anal cancer through targeted removal of anal HSIL.
The endoscopic diagnosis of Helicobacter-pylori(H.pylori) infection and gastric precancerous lesions(GPL), namely atrophic-gastritis and intestinal-metaplasia, still remains challenging. Artificial ...intelligence(AI) may represent a powerful resource for the endoscopic recognition of these conditions.
To explore the diagnostic performance(DP) of AI in the diagnosis of GPL and H.pylori infection.
A systematic-review was performed by two independent authors up to September 2021. Inclusion criteria were studies focusing on the DP of AI-system in the diagnosis of GPL and H.pylori infection. The pooled accuracy of studies included was reported.
Overall, 128 studies were found (PubMed-Embase-Cochrane Library) and four and nine studies were finally included regarding GPL and H.pylori infection, respectively. The pooled-accuracy(random effects model) was 90.3%(95%CI 84.3–94.9) and 79.6%(95%CI 66.7–90.0) with a significant heterogeneityI2=90.4%(95%CI 78.5–95.7);I2=97.9%(97.2–98.6) for GPL and H.pylori infection, respectively. The Begg's-test showed a significant publication-bias(p = 0.0371) only among studies regarding H.pylori infection. The pooled-accuracy(random-effects-model) was similar considering only studies using CNN-model for the diagnosis of H.pylori infection: 74.1%(95%CI 51.6–91.3);I2=98.9%(95%CI 98.5–99.3), Begg's-test(p = 0.1416) did not show publication-bias.
AI-system seems to be a good resource for an easier diagnosis of GPL and H.pylori infection, showing a pooled-diagnostic-accuracy of 90% and 80%, respectively. However, considering the high heterogeneity, these promising data need an external validation by randomized control trials and prospective real-time studies.
Background and Aims:
Precancerous lesions of gastric cancer (PLGC) are the most important pathological phase with increased risk of gastric cancer (GC) and encompass the key stage in which the ...occurrence of GC can be prevented. In this study, we found that the gut microbiome changed significantly during the process of malignant transformation from chronic gastritis to GC in N-methyl-N′-nitro-N-nitrosoguanidine (MNNG) multiple factors-induced rat model. Accumulating evidence has shown that alterations in gut microbiota and metabolism are potentially linked to chronic inflammation and cancer of the gastrointestinal tract. However, the correlation of gut microbiota and metabolites, inflammatory factors, and the potential mechanism in the formation of PLGC have not yet been revealed.
Methods:
In this study, multiple factors including MNNG, sodium salicylate drinking, ranitidine feed, and irregular diet were used to establish a PLGC rat model. The pathological state of the gastric mucosa of rats was identified through HE staining and the main inflammatory cytokine levels in the serum were detected by the Luminex liquid suspension chip (Wayen Biotechnologies, Shanghai, China). The microbial composition and metabolites in the stool samples were tested by using
16S ribosomal RNA
(
rRNA
) gene sequencing and non-targeted metabolomics. The correlation analysis of gut microbiota and inflammatory cytokines in the serum and gut microbiota and differential metabolites in feces was performed to clarify their biological function.
Results:
The results showed that compared to the control group, the gastric mucosa of the model rats had obvious morphological and pathological malignant changes and the serum levels of inflammatory cytokines including interleukin-1β (IL-1β), interleukin-4 (IL-4), interleukin-6 (IL-6), interleukin-10 (IL-10), interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), and macrophage colony-stimulating factor (M-CSF) increased significantly, while the level of chemokine (C-X-C motif) ligand 1 (CXCL1) in serum reduced significantly. There were significant differences in the composition of the gut microbiota and fecal metabolic profiles between the model and control rats. Among them,
Lactobacillus
and
Bifidobacterium
increased significantly, while
Turicibacter
,
Romboutsia
,
Ruminococcaceae_UCG-014
,
Ruminococcaceae_UCG-005
, and
Ruminococcus_1
reduced significantly in the model rats compared to the control rats. The metabolites related to the lipid metabolism and peroxisome proliferator-activated receptor (PPAR) signaling pathway have also undergone significant changes. In addition, there was a significant correlation between the changes of the differential inflammatory cytokines in the serum, fecal metabolic phenotypes, and gut microbial dysbiosis in model rats.
Conclusion:
The activation of the inflammatory response, disturbance of the gut microbiota, and changes in the fecal metabolic phenotype could be closely related to the occurrence of PLGC. This study provides a new idea to reveal the mechanism of risk factors of chronic gastritis and GC from the perspective of inflammation-immune homeostasis, gut microbiota, and metabolic function balance.
Cervical cancer is the most common gynecological malignancy and screening for risk factors with early detection has been shown to reduce the mortality. In this study, we aimed to analyze the ...characteristics and risk factors of human papillomavirus (HPV) infection and precancerous lesions in women and provide clinical evidence for developing strategies to prevent cervical precancerous lesions and cancer in women. Furthermore, we evaluated the influencing factors for high-risk HPV infection. From April 2018 to December 2021, 10,628 women were recruited for cervical cancer screening at Liaoning Cancer Hospital, Shenyang Sujiatun District Women’s and Infants Hospital, Benxi Manchu Autonomous County People’s Hospital, and Shandong Affiliated Hospital of Qingdao University. The study participants were tested to determine if they were HPV-positive (HPV +) or underwent thinprep cytology test (TCT) for atypical squamous cells of undetermined significance (ASCUS) and above. Furthermore, colposcopies and biopsies were performed for the histopathological examination. Finally, 9991 cases were included in the statistical analysis, and the factors influencing HPV infection and those related to cervical cancer and precancerous lesions were analyzed. HPV + infection, high-grade squamous intraepithelial lesion-positive (CINII +) in cervical high-grade intraepithelial neoplasia, and early cervical cancer diagnosis rates were 12.45, 1.09, and 95.41%, respectively. The potential risk factors for HPV were education ≤ high school odds ratio (OR) = 1.279 (1.129–1.449),
P
< 0.001, age at initial sexual activity ≤ 19 years OR = 1.517 (1.080–2.129),
P
= 0.016, sexual partners > 1 OR = 1.310 (1.044–1.644),
P
= 0.020, ASCUS and above OR = 11.891 (10.105–13.993),
P
< 0.001, non-condom contraception OR = 1.255 (1.059–1.487),
P
= 0.009, and HSIL and above OR = 1.541 (1.430–1.662),
P
< 0.001. Compared with women aged 56–65 and 35–45 years OR = 0.810 (0.690–0.950),
P
= 0.010 the HPV infection rate was significantly lower in those aged 46–55 years OR = 0.79 (0.683–0.915),
P
= 0.002. Furthermore, ≤ high school age OR = 1.577 (1.042–2.387),
P
= 0.031, not breastfeeding OR = 1.763 (1.109–2.804),
P
= 0.017, ASCUS and above OR = 42.396 (28.042–64.098),
P
< 0.001 were potential risk factors for cervical cancer and precancerous lesions. In women with HPV infection, ≤ high school education level, initial sexual activity at ≤ 19 years of age, number of sexual partners > 1, ASCUS and above, non-condom contraception, HSIL and above were risk factors for HPV infection. Compared with women aged 56–65 years, those aged 35–45 and 46–55 years had significantly lower HPV infection rates, and high school age and below, non-breastfeeding, and ASCUS and above were all potential risk factors for cervical cancer and precancerous lesions.
Background
The effect of Helicobacter pylori (
H. pylori
) eradication on gastric cancer (GC) prevention is controversial. Intestinal metaplasia (IM) seems to be a “point of no return” in the ...precancerous cascade. We performed a meta-analysis of randomized controlled trials (RCTs) to illustrate this issue.
Materials and Methods
The MEDLINE, EMBASE, Cochrane Library were searched for relevant RCTs that were published in any language up to March 2014. By dividing participants into subgroups based on their baseline diagnoses as group <IM (normal, non-atrophic gastritis, atrophic gastritis) and group ≥IM(intestinal metaplasia, dysplasia), the relative risk (RR) of GC in each study compared treatment group with control group were pooled using Mantel–Haenszel fixed-effect model and publication bias analyses were performed.
Results
Ten studies from eight RCTs were included in this analysis, for a total of 7,955 participants.
H. pylori
treatment compared with control significantly reduced the risk of GC, with a pooled RR of 0.64 (95 % CI, 0.48–0.85). Subgroup analysis for patients with non-atrophic gastritis, atrophic gastritis (<IM) yielded a similar results (RR = 0.25, 95 % CI, 0.08–0.81). But this difference was not observed in patients with intestinal metaplasia, dysplasia (≥IM) (RR = 0.88; 95 % CI, 0.59–1.31).
Conclusions
Our results suggested that patients with Intestinal metaplasia or dysplasia could not benefit from the
H. pylori
treatment on the risk of GC.
Gastric precancerous lesions (GPL) are a major health concern worldwide due to their potential to progress to gastric cancer (GC). Understanding the mechanism underlying the transformation from GPL ...to GC can provide a fresh insight for the early detection of GC. Although chronic inflammation is prevalent in the GPL, how the inflammatory microenvironment monitored the progression of GPL-to-GC are still elusive. Inflammation has been recognized as a key player in the progression of GPL. This review aims to provide an overview of the inflammatory microenvironment in GPL and its implications for disease progression and potential therapeutic applications. We discuss the involvement of inflammation in the progression of GPL, highlighting
(
) as a mediator for inflammatory microenvironment and a key driver to GC progression. We explore the role of immune cells in mediating the progression of GPL, and focus on the regulation of inflammatory molecules in this disease. Furthermore, we discuss the potential of targeting inflammatory pathways for GPL. There are currently no specific drugs for GPL treatment, but traditional Chinese Medicine (TCM) and natural antioxidants, known as antioxidant and anti-inflammatory properties, exhibit promising effects in suppressing or reversing the progression of GPL. Finally, the challenges and future perspectives in the field are proposed. Overall, this review highlights the central role of the inflammatory microenvironment in the progression of GPL, paving the way for innovative therapeutic approaches in the future.
The influence of the gastric microbiota in gastric cancer development Pereira-Marques, Joana; Ferreira, Rui M.; Machado, Jose C. ...
Baillière's best practice & research. Clinical gastroenterology,
March-April 2021, 2021 Mar-Apr, 2021-03-00, 20210301, Letnik:
50-51
Journal Article
Recenzirano
Colonization of the stomach by Helicobacter pylori is the trigger for a series of gastric mucosal changes that culminate in gastric cancer. Infection with this bacterium is considered the major risk ...factor for this malignancy. The introduction of high-throughput sequencing technologies coupled to advanced computational pipelines offered an improved understanding of the microbiome, and it is now currently accepted that, besides H. pylori, the stomach harbours a complex microbial community. While it is well established that H. pylori plays a central role in gastric carcinogenesis, the significance of the non-H. pylori microbiota is yet to be clarified. This review will address the state of the art on the relationship between the gastric microbiota and gastric cancer development, and identify areas where additional research is needed before translating microbiome research into preventive and therapeutic strategies to reduce gastric cancer burden.
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