Gastric carcinoma

胃癌
  • 文章类型: Published Erratum
    在上述论文发表后,一位感兴趣的读者提请作者注意,图中显示的MMP-9实验的蛋白质印迹数据。第1493页的第4页与图中总-Akt实验的蛋白质印迹非常相似。第6页1494页。在重新检查了他们的原始数据文件之后,作者意识到,无花果。6个无意中组装不正确。图的修订版。6,包含total-Akt实验的正确数据,如下所示。请注意,对该数字进行的更正不会影响本文报告的总体结论。作者感谢《肿瘤学报告》编辑允许他们有机会发表本更正,并对造成的不便向读者道歉。[肿瘤学报告31:1489-1497,2014;DOI:10.3892/or.2013.2961]。
    Subsequently to the publication of the above paper, an interested reader drew to the authors\' attention that the western blot data shown for the MMP‑9 experiment in Fig. 4 on p. 1493 were strikingly similar to the western blots shown for the total‑Akt experiments in Fig. 6 on p. 1494. After having re‑examined their original data files, the authors realized that Fig. 6 had been inadvertently assembled incorrectly. The revised version of Fig. 6, containing the correct data for the total‑Akt experiments, is shown below. Note that the corrections made to this figure do not affect the overall conclusions reported in the paper. The authors are grateful to the Editor of Oncology Reports for allowing them the opportunity to publish this Corrigendum, and apologize to the readership for any inconvenience caused. [Oncology Reports 31: 1489‑1497, 2014; DOI: 10.3892/or.2013.2961].
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  • 文章类型: Journal Article
    尽管KRAS和PI3K通路的异常激活以及TP53突变导致人类胃癌的频繁畸变,这些突变的序列和个体贡献均未得到澄清.这里,我们建立了等位基因系列小鼠,以在KrasG12D的腺上皮中提供条件表达;Pik3caH1047R或Trp53R172H和/或Pten或Trp53的消融。我们发现KrasG12D;Pik3caH1047R足以诱导腺瘤,并且当还带有Pten缺失时,病变会进展为癌。对Trp53功能缺失或获得等位基因的额外挑战进一步加速了肿瘤进展并引发了转移性疾病。虽然响应gp130家族细胞因子的肿瘤固有STAT3信号仍然是肿瘤发展所有阶段的看门人,转移性进展需要突变型Trp53诱导的白细胞介素(IL)-11向IL-6依赖性转换.与IL-6高表达患者的生存率较差一致,我们确定IL-6/STAT3信号传导是TP53突变型胃癌的治疗脆弱性.
    Although aberrant activation of the KRAS and PI3K pathway alongside TP53 mutations account for frequent aberrations in human gastric cancers, neither the sequence nor the individual contributions of these mutations have been clarified. Here, we establish an allelic series of mice to afford conditional expression in the glandular epithelium of KrasG12D;Pik3caH1047R or Trp53R172H and/or ablation of Pten or Trp53. We find that KrasG12D;Pik3caH1047R is sufficient to induce adenomas and that lesions progress to carcinoma when also harboring Pten deletions. An additional challenge with either Trp53 loss- or gain-of-function alleles further accelerated tumor progression and triggered metastatic disease. While tumor-intrinsic STAT3 signaling in response to gp130 family cytokines remained as a gatekeeper for all stages of tumor development, metastatic progression required a mutant Trp53-induced interleukin (IL)-11 to IL-6 dependency switch. Consistent with the poorer survival of patients with high IL-6 expression, we identify IL-6/STAT3 signaling as a therapeutic vulnerability for TP53-mutant gastric cancer.
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  • 文章类型: Journal Article
    目标:在过去的十年中,胃肠上皮化生(GIM)的治疗已由几个不同的国际循证指南解决.在这次审查中,我们旨在综合这些指南,并为临床医生提供当前GIM患者管理建议的全球视角,以及强调未来研究需要解决的证据差距。
    方法:我们对2010年1月至2023年2月期间发表的针对GIM诊断和管理的指南和共识声明的文献进行了系统回顾。
    结果:从确定的426份手稿中,评估了15条准则。关于GIM内镜监测的目的,指南之间存在一致性,这是确定普遍的肿瘤病变和阶段胃肿瘤前的条件。指南还同意只有具有高风险GIM表型的患者(例如,语料库扩展的GIM,OLGIMIII/IV阶段,不完整GIM亚型),持续性难治性幽门螺杆菌感染或胃癌一级家族史应定期进行内镜监测.相比之下,低风险表型,其中包括大多数GIM患者,不需要监视。并非所有指南都在组织学分期系统上保持一致。如果指示监视,大多数指南建议间隔3年,但是有一些可变性。所有指南都推荐根除幽门螺杆菌作为预防胃癌的唯一非内镜干预措施。而一些人提供了关于生活方式改变的额外建议。虽然大多数指南都提到高质量内窥镜检查对内窥镜监测的重要性,除了说明应遵循系统的胃活检方案外,几乎没有详细的重要指标。值得注意的是,大多数指南都评论了内镜在胃癌筛查和胃癌前病变检测中的作用,但是高度异质性,关于实施的指导有限,缺乏有力的证据。
    结论:尽管人群和实践具有异质性,国际指南在GIM作为癌前病变的重要性以及对内镜监测的风险分层方法的必要性方面总体上是一致的,以及根除幽门螺杆菌。关于(1)哪些人群值得进行胃癌的内窥镜筛查和GIM检测/分期的指标;(2)高质量内窥镜检查的客观指标;(3)对组织学分期的需求达成共识;(4)除了单独根除幽门螺杆菌外,非内镜干预措施用于预防胃癌的指南仍有协调的空间。健壮的研究,理想情况下,以随机试验的形式,需要弥合存在的充足证据差距。
    OBJECTIVE: During the last decade, the management of gastric intestinal metaplasia (GIM) has been addressed by several distinct international evidence-based guidelines. In this review, we aimed to synthesise these guidelines and provide clinicians with a global perspective of the current recommendations for managing patients with GIM, as well as highlight evidence gaps that need to be addressed with future research.
    METHODS: We conducted a systematic review of the literature for guidelines and consensus statements published between January 2010 and February 2023 that address the diagnosis and management of GIM.
    RESULTS: From 426 manuscripts identified, 15 guidelines were assessed. There was consistency across guidelines regarding the purpose of endoscopic surveillance of GIM, which is to identify prevalent neoplastic lesions and stage gastric preneoplastic conditions. The guidelines also agreed that only patients with high-risk GIM phenotypes (eg, corpus-extended GIM, OLGIM stages III/IV, incomplete GIM subtype), persistent refractory Helicobacter pylori infection or first-degree family history of gastric cancer should undergo regular-interval endoscopic surveillance. In contrast, low-risk phenotypes, which comprise most patients with GIM, do not require surveillance. Not all guidelines are aligned on histological staging systems. If surveillance is indicated, most guidelines recommend a 3-year interval, but there is some variability. All guidelines recommend H. pylori eradication as the only non-endoscopic intervention for gastric cancer prevention, while some offer additional recommendations regarding lifestyle modifications. While most guidelines allude to the importance of high-quality endoscopy for endoscopic surveillance, few detail important metrics apart from stating that a systematic gastric biopsy protocol should be followed. Notably, most guidelines comment on the role of endoscopy for gastric cancer screening and detection of gastric precancerous conditions, but with high heterogeneity, limited guidance regarding implementation, and lack of robust evidence.
    CONCLUSIONS: Despite heterogeneous populations and practices, international guidelines are generally aligned on the importance of GIM as a precancerous condition and the need for a risk-stratified approach to endoscopic surveillance, as well as H. pylori eradication when present. There is room for harmonisation of guidelines regarding (1) which populations merit index endoscopic screening for gastric cancer and GIM detection/staging; (2) objective metrics for high-quality endoscopy; (3) consensus on the need for histological staging and (4) non-endoscopic interventions for gastric cancer prevention apart from H. pylori eradication alone. Robust studies, ideally in the form of randomised trials, are needed to bridge the ample evidence gaps that exist.
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  • 文章类型: Journal Article
    背景:胰腺上淋巴结转移是胃癌的常见途径之一。然而,胰腺上转移性淋巴结切除数年后才发现原发灶是罕见的。这是转移性淋巴结切除10年后诊断为微卫星不稳定的隐匿性胃癌的报告。
    方法:一名55岁女性在体检时表现为胰腺上淋巴结肿大。胃镜检查未发现恶性肿瘤。我们通过剖腹手术进行了切除活检,在组织学上怀疑是未知来源的转移性癌症。九年半之后,我们通过胃镜检查发现早期胃癌,并进行了远端胃切除术。胃肿瘤在病理上与先前的胰腺上肿瘤相似。免疫组织化学检查显示胃和胰腺上淋巴结均显示微卫星不稳定,这表明这两个病变的起源相同。
    结论:该病例被认为是有价值的,因为以前没有关于胃癌具有高微卫星不稳定性特征的报道,在转移灶切除后很长时间内就确定了原发肿瘤。
    BACKGROUND: Suprapancreatic lymph node metastasis is one of the usual routes for gastric cancer. However, it is rare for the primary lesion to be found several years after resection of the suprapancreatic metastatic lymph node. This is a report of occult gastric carcinoma with microsatellite instability diagnosed 10 years after excision of a metastatic lymph node.
    METHODS: A 55-year-old female presented with suprapancreatic lymph node swelling during a medical examination. Gastroscopy revealed no malignancy. We performed an excisional biopsy via laparotomy and histologically suspected metastatic cancer of unknown origin. After nine and a half years, we detected early gastric cancer by gastroscopy and performed a distal gastrectomy. The gastric tumor was pathologically similar to the previous suprapancreatic tumor. Immunohistochemical examination revealed that both the stomach and suprapancreatic lymph node exhibited microsatellite instability, suggesting that the two lesions were of the same origin.
    CONCLUSIONS: This case is considered valuable because there have been no previous reports of gastric cancer with characteristics of high microsatellite instability in which the primary tumor was identified a long time after resection of metastatic lesions.
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  • 文章类型: Journal Article
    这项回顾性研究分析了2010年至2015年期间接受治疗的大量胃癌(GC)患者,以调查发展为继发性原发性恶性肿瘤(SPM)的临床特征和预测风险因素。使用Kaplan-Meier分析评估SPM的累积发生率。使用分层Cox比例风险回归模型和多变量分析进行针对死亡率进行校正的竞争风险分析,以确定SPM的独立预测因子。167747例GC患者中共有3289例纳入分析队列,155例患者诊断为SPM。在多变量Cox回归分析中,除腺癌(AC)和印戒细胞癌(SRCC)以外的组织学类型的患者成为发生SPM的独立危险因素(风险比[HR]2.262,95%置信区间[CI]1.146-4.465,P=0.019)。手术方法,包括活检/局部切除(HR2.3,[CI]1.291-4.095,P=0.005)和次全切除/全切除([HR]1.947,[CI]1.028-3.687,P=0.041),化疗([HR]1.527,[CI]1.006-2.316,P=0.047),和组织学类型([HR]2.318,[CI]1.193-4.504,P=0.013)),在竞争风险模型中被确定为独立的风险因素。亚组分析,通过化疗分层,显示老年患者SPM的风险增加。此外,我们制作了列线图,并对其进行了内部验证,以预测GC患者中SPM的累积发生率(72个月C指数=0.73).这些发现表明,在特定的GC组织学类型中,局部手术切除后淋巴结浸润区漏诊,同时化疗会增加癌症幸存者的SPM风险.
    This retrospective study analyzed a large population of gastric cancer (GC) patients treated between 2010 and 2015 to investigate the clinical features and predictive risk factors for developing secondary primary malignancies (SPMs). The cumulative incidence of SPM was assessed using Kaplan-Meier analysis. Competing risk analyses adjusted for mortality were conducted using stratified Cox proportional hazard regression models and multivariate analyses to identify independent predictors of SPM. A total of 3289 out of 167,747 GC patients were included in the analytic cohort, with 155 patients diagnosed with SPM. Patients whose histologic type other than adenocarcinomas (AC) and signet ring cell carcinoma (SRCC) emerged as an independent risk factor for developing SPM (hazard ratio [HR] 2.262, 95% confidence interval [CI] 1.146-4.465, P = 0.019) in multivariate Cox regression analysis. The surgical method, including biopsy/local excision (HR 2.3, [CI] 1.291-4.095, P = 0.005) and subtotal/total resection ([HR] 1.947, [CI] 1.028-3.687, P = 0.041), chemotherapy ([HR] 1.527, [CI] 1.006-2.316, P = 0.047), and histologic type ([HR] 2.318, [CI] 1.193-4.504, P = 0.013)), were identified as independent risk factors in the competitive risk model. Subgroup analyses, stratified by chemotherapy, revealed an increased risk of SPM among older patients. Furthermore, a nomogram was developed and internally validated to predict the cumulative incidence of SPM in GC patients (C-index = 0.73 for 72 months). These findings suggested that in specific histologic types of GC, the lymph node infiltration region missed after local surgical resection, and concomitant chemotherapy would have an increased risk of SPM for cancer survivors.
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  • 文章类型: Journal Article
    背景:作为几种癌症的可行治疗选择,免疫治疗的最新进展引起了相当多的关注。本研究旨在探索免疫治疗相关基因(IRGs),并基于这些基因建立胃癌(GC)的预后风险特征.
    方法:通过比较GC中的免疫治疗应答者和非应答者来鉴定IRG。然后,通过基于IRGs的无监督聚类方法将GC患者分为不同的亚型,并分析了这些亚型之间的免疫特征和预后分层的差异。基于癌症基因组图谱(TCGA)和基因表达综合(GEO)队列,开发并验证了免疫疗法相关风险评分(IRRS)标签,用于风险分类和预后预测。此外,还确定了IRRS在免疫治疗反应中的预测能力.
    结果:总共确定了63个IRG,将371例GC患者分为两个分子亚组,预后和免疫特征明显不同。然后,我们构建了由3个IRGs(CENP8,NRP1和SERPINE1)组成的IRRS特征,以预测TCGA队列中GC患者的预后.重要的是,多个GEO队列的外部验证进一步证实了IRRS在不同人群中的普遍适用性.此外,我们发现IRRS与患者对免疫治疗的反应性显着相关,低IRRS的GC患者更有可能从现有的免疫治疗中获益。
    结论:风险评分可以作为一个强有力的预后生物标志物,为免疫治疗提供治疗益处,可能有助于GC患者的临床决策。
    BACKGROUND: Recent advances in immunotherapy have elicited a considerable amount of attention as viable therapeutic options for several cancer types, the present study aimed to explore the immunotherapy-related genes (IRGs) and develop a prognostic risk signature in gastric carcinoma (GC) based on these genes.
    METHODS: IRGs were identified by comparing immunotherapy responders and non-responders in GC. Then, GC patients were divided into distinct subtypes by unsupervised clustering method based on IRGs, and the differences in immune characteristics and prognostic stratification between these subtypes were analyzed. An immunotherapy-related risk score (IRRS) signature was developed and validated for risk classification and prognosis prediction based on The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) cohorts. Besides, the predictive ability of the IRRS in immunotherapy response was also determined.
    RESULTS: A total of 63 IRGs were identified, and 371 GC patients were stratified into two molecular subgroups with significantly different prognosis and immune characteristics. Then, an IRRS signature comprised of three IRGs (CENP8, NRP1, and SERPINE1) was constructed to predict the prognosis of GC patients in TCGA cohort. Importantly, external validation in multiple GEO cohorts further confirmed the universal applicability of the IRRS in distinct populations. Furthermore, we found that the IRRS was significantly correlated with patient\'s responsiveness to immunotherapy, GC patients with low IRRS are more likely to benefit from existing immunotherapy.
    CONCLUSIONS: The risk score could serve as a robust prognostic biomarker, provide therapeutic benefits for immunotherapy and may be helpful for clinical decision making in GC patients.
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  • 文章类型: Journal Article
    本研究旨在对胃神经内分泌癌(NEC)和混合腺神经内分泌癌(MANEC)的基因表达和微环境特征进行深入检查。使用数字空间谱分析(GeoMx®DSP)分析了55例胃MANEC(N=32)或NEC(N=23)患者的组织微阵列。感兴趣的代表性区域(ROI)选自MANEC核心的腺癌部分(ADC-MANEC)和神经内分泌癌部分(NEC-MANEC)。和纯NEC(PNEC)内核。通过GeoMx®平台中的掩蔽程序将所有ROI分离成上皮成分和基质成分,其次是转录组分析。ADC-MANEC和NEC-MANEC/pNEC之间的基因表达的比较确定了上皮中的几个差异表达基因(包括PEG10,MAP1B,STMN3和AKT3)和基质(FN1,COL1A1,SPARC,和BGN)组件。基因集富集分析显示,与E2F靶标和G2M检查点相关的途径在NEC-MANEC和pNEC中比在ADC-MANEC中更富集。去卷积分析表明,微环境特征随组织学分化而变化。在ADC-MANEC中,上皮内浸润免疫细胞相对较多,而NEC-MANEC和PNEC基质中的成纤维细胞更丰富。该研究使用DSP平台根据MANEC的肿瘤相对于基质区室证实了MANEC的每个组织学组分的不同表达谱。尽管MANEC的每个组成部分具有相同的遗传起源,在管理MANEC患者时不应忽视独特的表型.这项研究为未来的研究提供了一个有用的验证数据集。
    This study aimed to conduct an in-depth examination of gene expression and microenvironmental profiles of gastric neuroendocrine carcinoma (NEC) and mixed adeno-NEC (MANEC). Tissue microarrays from 55 patients with gastric MANEC (N = 32) or NEC (N = 23) were analyzed using digital spatial profiling (GeoMx DSP, NanoString Technologies). Representative regions of interest were selected from the adenocarcinoma (ADC) portion (ADC-MANEC) and the NEC portion (NEC-MANEC) of the MANEC cores, and pure NEC (pNEC) cores. All regions of interest were separated into epithelial components and stromal components using the masking procedure in the GeoMx platform, followed by transcriptome analysis. Comparison of gene expression between ADC-MANEC and NEC-MANEC/pNEC identified several differentially expressed genes in the epithelial (including PEG10, MAP1B, STMN3, and AKT3) and stromal (FN1, COL1A1, SPARC, and BGN) components. Gene set enrichment analysis revealed that pathways related to the E2F target and G2M checkpoint were more enriched in NEC-MANEC and pNEC than in ADC-MANEC. Deconvolution analysis showed that the microenvironmental profile varied according to histologic differentiation. In ADC-MANEC, intraepithelial infiltrating immune cells were relatively more numerous, whereas fibroblasts in the stroma were more abundant in NEC-MANEC and pNEC. This study confirmed the distinct expression profile of each histologic component of MANEC according to its tumor vs stromal compartment using the DSP platform. Although each component of MANEC shares the same genetic origin, distinctive phenotypes should not be overlooked when managing patients with MANEC. This study provides a useful validation data set for future studies.
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  • 文章类型: Journal Article
    胃癌是一种侵袭性和多因素疾病。幽门螺杆菌(H.pylori)被确定为胃癌的重要病因。尽管只有一小部分感染幽门螺杆菌的患者进展为胃癌,细菌感染在这种恶性肿瘤的病理和发展中至关重要。该细菌的致病机制涉及胃上皮屏障的破坏和慢性炎症的诱导,氧化应激,血管生成和转移。粘附分子,毒力(CagA和VacA)和定植(脲酶)因子是其致病性的重要因子。另一方面,白藜芦醇是一种具有抗炎和抗氧化特性的天然多酚。白藜芦醇还抑制癌细胞增殖和血管生成,提示作为一种潜在的癌症治疗剂的作用。这篇综述探讨了白藜芦醇作为一种替代癌症治疗方法。特别是针对幽门螺杆菌诱导的胃癌,由于其减轻细菌感染引起的致病作用的能力。白藜芦醇已在体外和体内显示出降低胃癌细胞增殖的功效。此外,白藜芦醇与化疗和放疗的协同作用强调了其治疗潜力。然而,需要进一步的研究来全面描述其治疗胃癌的有效性和安全性。
    Gastric cancer is an aggressive and multifactorial disease. Helicobacter pylori (H. pylori) is identified as a significant etiological factor in gastric cancer. Although only a fraction of patients infected with H. pylori progresses to gastric cancer, bacterial infection is critical in the pathology and development of this malignancy. The pathogenic mechanisms of this bacterium involve the disruption of the gastric epithelial barrier and the induction of chronic inflammation, oxidative stress, angiogenesis and metastasis. Adherence molecules, virulence (CagA and VacA) and colonization (urease) factors are important in its pathogenicity. On the other hand, resveratrol is a natural polyphenol with anti-inflammatory and antioxidant properties. Resveratrol also inhibits cancer cell proliferation and angiogenesis, suggesting a role as a potential therapeutic agent against cancer. This review explores resveratrol as an alternative cancer treatment, particularly against H. pylori-induced gastric cancer, due to its ability to mitigate the pathogenic effects induced by bacterial infection. Resveratrol has shown efficacy in reducing the proliferation of gastric cancer cells in vitro and in vivo. Moreover, the synergistic effects of resveratrol with chemotherapy and radiotherapy underline its therapeutic potential. However, further research is needed to fully describe its efficacy and safety in treating gastric cancer.
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  • 文章类型: Journal Article
    背景:2019年,胃切除术并发症共识小组(GCCG)发布了一套标准化的并发症,旨在统一报告胃切除术后并发症。本研究旨在根据GCCG定义报告荷兰胃切除术后的结果,并将其与先前报告的国家结果和GCCG报告的欧洲数据库进行比较。
    方法:全国范围内,以人群为基础的队列研究纳入了2020-2021年在DUCA注册的所有因胃癌而接受胃切除术的患者.根据GCCG定义分析术后发病率和30天/院内死亡率。对于所有患者来说,将基线特征和结局与由27个欧洲专家中心组成的GCCG队列进行了比较(GASTRODATA;2017-2018).
    结果:在2020-2021年,荷兰有782例患者接受了胃切除术。荷兰和GCCG队列之间的基线特征存在差异(N=1349),最值得注意的是微创手术(80.6%和19.6%,p<0.001)。在荷兰,223例(28.5%)患者共发生407例并发症,最常见的是非手术感染(28.5%)和吻合口漏(13.4%)。荷兰和GCCG队列的总体并发症和30天死亡率相似(28.5%vs29.8%,p=0.563;3.7%对3.6%,p=0.953)。与GCCG队列相比,荷兰的手术和内窥镜/放射学再介入率更高(10.7%vs7.8%,p=0.025;10.9%对2.9%,p<0.001)。
    结论:根据标准化GCCG定义报告结果允许进行国际基准测试。荷兰和GCCG队列之间的术后结局具有可比性,但两者都超过了胃切除术专家护理的国际基准,突出国家和国际质量改进的目标。
    BACKGROUND: In 2019, the Gastrectomy Complications Consensus Group (GCCG) published a standardized set of complications aiming toward uniform reporting of post-gastrectomy complications. This study aimed to report outcomes after gastrectomy in the Netherlands according to GCCG definitions and compare them to previously reported national results and the European database reported by the GCCG.
    METHODS: This nationwide, population-based cohort study included all patients undergoing gastrectomy for gastric cancer registered in the DUCA in 2020-2021. Postoperative morbidity and 30-day/in-hospital mortality were analyzed according to the GCCG definitions. For all patients, baseline characteristics and outcomes were compared with the GCCG cohort consisting of 27 European expert centers (GASTRODATA; 2017-2018).
    RESULTS: In 2020-2021, 782 patients underwent gastrectomy in the Netherlands. Variation was seen in baseline characteristics between the Dutch and the GCCG cohort (N = 1349), most notably in minimally invasive surgery (80.6% vs 19.6%, p < 0.001). In the Netherlands, 223 (28.5%) patients developed a total of 407 complications, the most frequent being non-surgical infections (28.5%) and anastomotic leakage (13.4%). The overall complication and 30-day mortality rates were similar between the Dutch and GCCG cohort (28.5% vs 29.8%, p = 0.563; 3.7% vs 3.6%, p = 0.953). Higher surgical and endoscopic/radiologic reintervention rates were observed in the Netherlands compared to the GCCG cohort (10.7% vs 7.8%, p = 0.025; 10.9% vs 2.9%, p < 0.001).
    CONCLUSIONS: Reporting outcomes according to the standardized GCCG definitions allows for international benchmarking. Postoperative outcomes were comparable between Dutch and GCCG cohorts, but both exceed the international benchmark for expert gastrectomy care, highlighting targets for national and international quality improvement.
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  • 文章类型: Journal Article
    背景胃腺癌(GCA)由于其患病率和高发病率和死亡率而造成了巨大的全球健康负担。GCA分为三种主要的组织学类型:高分化(肠型),分化差(弥漫型),和混合或不确定的形式。这些类型的原因各不相同,流行病学,和遗传学,弥漫型通常与最差预后相关。内窥镜活检是表征的主要方法,但它有其局限性。有可能使用对比增强计算机断层扫描(CT)来区分胃腺癌的组织学亚型,这可以帮助亚型分化。在这个基础上,我们的研究旨在评估CT在基于增强模式区分胃腺癌的广泛组织学组中的有效性,有助于提高诊断准确性目的我们的研究重点是评估多相对比增强计算机断层扫描(CECT)在区分胃肠道肿瘤的三种广泛的组织病理学亚型中的有效性。方法本研究是一项前瞻性研究,在我们的机构三级护理医院批准并进行的分析观察性研究。连续接受内窥镜引导活检并显示GCA组织学证据的个体被考虑参与研究。为了完成临床分期过程,对50例患者中的每一例进行了进一步的多相CT扫描,并根据组织病理学结果进行了相应分类.结果在分化型中,节段分布为:上节段5.5%,16.7%中段,细分市场较低66.7%,和11.1%扩散型。食管受累为5.6%,十二指肠受累相似,淋巴结受累约为38.8%。TNM分期:38.8%IIIB,22.2%III,27.8%IVA,和11.1%IVB。在未分化类型中,节段分布:6.2%上段,31.2%中段,下段50.0%,和12.5%扩散型。食管受累约为6.25%,十二指肠受累为18.75%,淋巴结受累约为71.8%。TNM分期:34.4%IIIB,21.8%III,28.1%IVA,和15.6%IVB。结论多相CT评估通过评估峰值增强为胃癌的预后方面提供了有价值的见解。分化肿瘤通常表现出动脉期增强,而未分化肿瘤显示静脉期增强,反映了它们的微血管结构。最近的研究强调了解胃癌特征对诊断和预后的重要性。我们的研究与此相符,揭示了分化和未分化类型之间不同的对比增强模式。然而,不同研究中组织学分类和对比增强模式的差异值得进一步研究.整合组织病理学和放射学见解对于准确的诊断和治疗计划至关重要。
    Background Gastric adenocarcinoma (GCA) poses a significant global health burden due to its prevalence and high morbidity and mortality rates. GCA is classified into three main histological types: well-differentiated (intestinal type), poorly differentiated (diffuse type), and mixed or indeterminate forms. These types vary in causes, epidemiology, and genetics, with the diffuse type often associated with the worst prognosis. Endoscopic biopsy is the primary method for characterization, but it has its limitations. There is potential in using contrast-enhanced computed tomography (CT) to differentiate between histological subtypes of gastric adenocarcinoma, which could aid subtype differentiation. Building on this, our study aims to assess CT\'s effectiveness in distinguishing between broad histological groups of gastric adenocarcinoma based on enhancement patterns, contributing to improved diagnostic accuracy Objective Our research focuses on evaluating the effectiveness of multiphasic contrast-enhanced computed tomography (CECT) in distinguishing between the three broad histopathological subtypes of gastrointestinal cancers. Methods This study was a prospective, analytical observational study that was approved and carried out in our institutional tertiary care hospital. Consecutive individuals who had undergone endoscopic-guided biopsy and demonstrated histological evidence of GCA were taken into consideration for participation in the study. In order to complete the clinical staging process, further multiphasic CT scans were carried out on each of the fifty patients and were categorised accordingly based on the findings of histopathology. Results In the differentiated type, segmental distribution was: 5.5% upper segment, 16.7% middle segment, 66.7% lower segment, and 11.1% diffuse type. Esophageal involvement was 5.6%, duodenal involvement was similar, and lymph node involvement was approximately 38.8%. TNM staging: 38.8% IIIB, 22.2% III, 27.8% IVA, and 11.1% IVB. In the undifferentiated type, segmental distribution: 6.2% upper segment, 31.2% middle segment, 50.0% lower segment, and 12.5% diffuse type. Esophageal involvement was around 6.25%, duodenal involvement was 18.75%, and lymph node involvement was about 71.8%. TNM staging: 34.4% IIIB, 21.8% III, 28.1% IVA, and 15.6% IVB. Conclusion Multiphasic CT evaluations provide valuable insights into the prognostic aspects of gastric carcinomas by assessing peak enhancement. Differentiated tumors typically exhibit arterial phase enhancement, while undifferentiated tumors show venous phase enhancement, reflecting their microvascular architecture. Recent studies emphasize the importance of understanding gastric carcinoma characteristics for diagnosis and prognosis. Our research aligns with this, revealing distinct contrast enhancement patterns between differentiated and undifferentiated types. However, discrepancies in histological classifications and contrast enhancement patterns across studies warrant further investigation. Integrating histopathological and radiological insights is essential for accurate diagnosis and treatment planning.
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