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Can patients with mild non-neoplastic lesions diagnosed at baseline screening be safely exempt from surveillance: evidence from multicenter community-based cohorts

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Science China Life Sciences 2025年第1期68卷 263-271页

作者： Siyi He Zhiyi Zhang Guohui Song Zhenhai Wang Chunyun Dai Shipeng Yan Kun Jiang Bingbing Song He Li Maomao Cao Dianqin Sun Fan Yang Xinxin Yan Shaoli Zhang Yi Teng Qianru Li Changfa Xia Wanqing Chen Office of Cancer Screening National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical College Department of Gastroenterology Gansu Wuwei Tumor Hospital Cixian Cancer Institute Linzhou Cancer Hospital Center for Disease Control and Prevention of Sheyang County Department of Cancer Prevention and Control Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of MedicineCentral South University Luoshan Center for Disease Control and Prevention Office for Cancer Control and Research Affiliated Cancer Hospital of Harbin Medical University

Surveillance recommendations for gastric cancer（GC） in current guidelines focused on advanced precancerous lesions and were based on precise diagnosis of severity/extent of baseline lesions. We aimed to develop a less endoscopy-related equipment-dependent risk-stratification tool, and assessed whether mild-precursor-lesion patients can be safely exempt from surveillance. In the multicenter communitybased cohort, 75,051 participants receiving baseline endoscopy were enrolled during 2015–2017 and followed-up until 2021. Cumulative incidence rates（CIRs） of GC for precancerous-conditions were calculated by Kaplan-Meier method and compared by Log-rank tests. Mixedeffects Cox regression models were used to detect potential factors for progression towards GC. A risk score was calculated as counts of selected factors. An independent cohort, including 26,586 participants was used for external validation. During a median follow-up of 6.25 years, CIRs of GC were 0.302%, 0.436%, and 4.756% for normal group, non-neoplastic（atrophic gastritis/intestinal metaplasia） and neoplastic lesions（low-grade/high-grade dysplasia）, respectively(Ptrend<0.001). Four predictors, including male, ≥60 years, smoking, and limited vegetable consumption, were selected for risk-stratification. High-risk patients（≥3 risk factors） with non-neoplastic lesions showed higher GC risks（adjusted HR=7.73, 95%CI: 4.29–13.92）, and their four-year CIR reached the one-year CIR of neoplastic lesions. Further categorizing non-neoplastic lesions by histological grade, both patients with moderate-to-severe lesions（aHR=3.07, 95%CI: 1.67–5.64） and high-risk patients with mild lesions（aHR=7.29, 95%CI: 3.58–14.86） showed higher risks. Consistent trends were observed in validation cohort. High-risk mild-precursor-lesion patients should receive surveillance within 3–5 years after baseline screening. Our study provides evidence on supplementing current guideline recommendations.

关键词： stomach neoplasms precancerous conditions cancer screening cumulative incidence risk stratification

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Extremely well-differentiated adenocarcinoma of the stomach: Clinicopathological and immunohistochemical features

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World Journal of Gastroenterology 2006年第16期12卷 2510-2516页

作者： Takashi Yao Takashi Utsunomiya Masafumi Oya Kenichi Nishiyama Masazumi Tsuneyoshi Department of Anatomic Pathology Graduate School of Medical SciencesKyushu UniversityFukuokaJapan Department of Clinical Radiology Graduate School of Medical SciencesKyushu UniversityFukuokaJapan Department of Pathology Aso-Izuka HospitalFukuokaJapan Department of Pathology National Kyushu Cancer CenterFukuokaJapan

AIM： Minimal deviation carcinoma of the uterine cervix, otherwise known as extremely well-differentiated adenocarcinoma （EWDA）, is characterized by its benign microscopic appearance in contrast to its aggressive behavior. In order to elucidate the clinicopathological features and biological behavior of the gastric counterpart of EWDA, we, using immunohistochemistry, analyzed nine lesions for the phenotypic expression, proliferative activity, and the expression of oncogene-associated products. METHODS： Clinicopathological features, including preoperative biopsy diagnosis, were reviewed. Using immunohitstochemistry, Ki-67 labeling index and expression of p53 and c-erbB-2 protein in the gastric lesions were ***： Locations in the middle or upper third of the stomach and polypoid macroscopic features are characteristic of EWDA of the stomach. Although 4 of the 9 lesions showed only focal lymphatic or venous invasion, lymph node metastasis was not present and none of the patients died of the lesions （mean follow-up period, 56 too）. All 9 cases of EWDA could be classified into gastric phenotype （5 lesions） and intestinal phenotype （4 lesions）. The former resembled gastric foveolar epithelium, mucous neck cells or pyloric glands, but their papillary structures were frequently elongated and the tumor cellsand their nuclei were slightly larger and more hyperchromatic compared to normal epithelium. The latter resembled intestinal metaplasia with minimal nulcear atypia and irregular glands; two of these lesions demonstrated complete intestinal phenotype, while two demonstrated incomplete intestinal phenotype. Ki-67 labeling index was low and none of the cases revealed over-expression of p53 and c-erbB-2 protein. CONCLUSION： Unlike minimal deviation carcinoma of the cervix, these findings suggest that EWDA of the stomach is a lesion of low-grade malignancy. This favorable biological behavior is supported by the data of a low Ki-67 labeling index and a lack of p53 or

关键词： stomach neoplasms Extremely well-differen-tiated adenocarcinoma Ki-67 p53 c-erbB-2

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Effect of lymphadenectomy extent on advanced gastric cancer located in the cardia and fundus

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World Journal of Gastroenterology 2008年第26期14卷 4216-4221页

作者： Chang-Ming Huang Bi-Juan Lin Hui-Shan Lu Xiang-Fu Zhang Ping Li Jian-Wei Xie Department of Oncology Affiliated-Union Hospital of Fujian Medical University Fuzh-ou350001 Fujian Province China

AIM： To analyze the prognostic impact of lymphade-nectomy extent in advanced gastric cancer located in the cardia and fundus. METHODS： Two hundred and thirty-six patients with advanced gastric cancer located in the cardia and fundus who underwent D2 curative resection were analyzed retrospectively. Relationships between the numbers of lymph nodes （LNs） dissected and survival was analyzed among different clinical stage subgroups. RESULTS： The 5-year overall survival rate of the entire cohort was 37.5%. Multivariate prognostic variables were total LNs dissected （P 〈 0.0001; or number of negative LNs examined, P 〈 0.0001）, number of positive LNs （P 〈 0.0001）, T category （P 〈 0.0001） and tumor size （P = 0.015）. The greatest survival differences were observed at cutoff values of 20 LNs resected for stage Ⅱ（p = 0.0136）, 25 for stage Ⅲ（P 〈 0.0001）, 30 for stage Ⅳ（P = 0.0002）, and 15 for all patients （P = 0.0024）. Based on the statistically assumed linearity as best fit, linear regression showed a significant survival enhancement based on increasing negative LNs for patients of stages Ⅲ （P = 0.013） and Ⅳ（P = 0.035）. CONCLUSION： To improve the long-term survival of patients with advanced gastric cancer located in the cardia and fundus, removing at least 20 LNs for stage Ⅱ,25 LNs for stage Ⅲ, and 30 LNs for stage N patients during D2 radical dissection is recommended.

关键词： stomach neoplasms Lymph node meta-stasis Surgery Lymphadenectomy Prognosis

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Clinicopathologic features of surgically resected primary gastric lymphoma

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World Journal of Gastroenterology 2004年第8期10卷 1103-1109页

作者： Seong-HoKong Do-JoongPark Hyuk-JoonLee Han-KwangYang Kuhn-UkLee Kuk-JinChoe Min-AKim Hye-SeungLee Chul-WooKim Dae-SeogHeo Chul-Woo Kim Dae-Seog Heo Department of Surgery Seoul National University College of MedicineSeoulKorea Cancer Research Institute Seoul National University College of MedicineSeoulKorea Department of Pathology Seoul National University College of MedicineSeoulKorea Tumor Immunity Medical Research Center and Cancer Research Institute Seoul National University College of MedicineSeoulKorea Department of Internal Medicine Seoul National University College of MedicineSeoulKorea

AIM:To analyze the clinicopathologic characteristics of surgically resected gastric lymphoma patients. METHODS:We retrospectively analyzed 57 surgically resected gastric lymphoma patients,dividing them into 2 subgroups:Low grade MALToma (the LG group),High grade MALToma and Diffuse large B cell lymphoma (the HG group). RESULTS:The numbers of patients were:20 in the LG group, 37 in the HG *** diagnostic rate of gastroscopy was 34.8% at primary diagnosis and 50% including differential *** positive rates of Hpyloriwere similar between the 2 groups (68% vs77%).Multiple lesions were found in 19.3%.The proportion of mucosal and submucosal lesions was 80.0%(16/20) in the LG group,and 24.3%(9/37) in the HG group (P<0.001).Lymph node invasion rates were 10.5%(2/19) in the LG group and 44.1%(15/34) in the HG group (P=0.031).The numbers of recurred patients were none in the LG group,and 8 in the HG *** univariant analysis,group (P=0.024) and TNM stage (stage Ⅰ,Ⅱ vs stages Ⅲ,Ⅳ,P=0.002) were found to be the significant risk *** was a tendency of higher recurrence rate in the subtotal gastrectomy group than in the total gastrectomy group (P=0.50). CONCLUSION:The HG groups had a more advanced stage and a higher recurrence rate than the LG *** there was no difference between subtotal and total gastrectomies,more careful assessments of multiplicities and radical resections with lymph node dissections seem to be needed because of multiplicity and LN invasion even in LG group.

关键词： Adenocarcinoma Adult Aged Disease-Free Survival Female Gastrectomy Helicobacter Infections Humans Lymphoma, B-Cell Lymphoma, Large-Cell, Diffuse Male Middle Aged Retrospective Studies stomach neoplasms Treatment Outcome

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Incidence and survival of stomach cancer in a high-risk population of Chile

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World Journal of Gastroenterology 2009年第15期15卷 1854-1862页

作者： Katy Heise Enriqueta Bertran Marcelo E Andia Catterina Ferreccio Regional Office of the Chilean Ministry of Health Region de Los Ríos Radiology Department School of MedicinePontificia Universidad Católica de Chile Public Health Department School of MedicinePontificia Universidad Católica de Chile

AIM:To study the incidence and survival rate of stomach cancer(SC)and its associated factors in a high risk population in Chile. METHODS:The population-based cancer registry of Valdivia,included in the International Agency for Research on Cancer system,covers 356 396 residents of Valdivia Province,Southern *** studied all SC cases entered in this Registry during 1998-2002 (529 cases).Population data came from the Chilean census(2002).Standardized incidence rates per 100 000 inhabitants(SIR)using the world population, cumulative risk of developing cancer before age 75, and rate ratios by sex,age,ethnicity and social factors were *** survival(EdererⅡmethod) and age-standardized estimates(Brenner method) were *** survival rates(Kaplan-Meier) were measured at 3 and 5 years and survival curves were analyzed with the Logrank and Breslow tests. Survival was studied in relation to demographics, clinical presentation,laboratory results and medical management of the *** variables significantly associated with survival were later included in a Cox multivariate model. RESULTS:Between 1998 and 2002,529 primary gastric cancers occurred in Valdivia(crude incidence rate 29.2 per 100000 inhabitants).Most cases were male(69.0%), residents of urban areas(57.5%)and Hispanic(83.2%), with a low education level(84.5%<8 school years). SC SIR was higher in men than women(40.8 and 14.8 respectively,P<0.001),risk factors were low education RR 4.4(95%CI:2.9-6.8)and 1.6,(95%CI:1.1-2.1) for women and men respectively and Mapuche ethnicity only significant for women(RR 2.2,95%CI:1.2-3.7).Of all cases,76.4%were histologically confirmed,11.5% had a death certificate only(DCO),56.1%were TNM stageⅣ;445 cases(84.1%)were eligible for survival analysis,all completed five years follow-up;42 remained alive,392 died of SC and 11 died from other causes. Specific 5-year survival,excluding cases with DCO,was 10.6%(95%CI:7.7-13.5);5-year relative survival rate was 12

关键词： Survival analysis stomach neoplasms Survival rate Incidence Risk factors Gastrectomy

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Relationship between phenotypes of cell-function differentiation and pathobiological behavior of gastric carcinomas

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World Journal of Gastroenterology 2001年第1期7卷 53-59页

作者： Yan Xin Xiao Ling Li Yan Ping Wang Su Min Zhang Hua Chuan Zheng Dong Ying Wu Yin Chang Zhang The Fourth Laboratory of Cancer Institute, China Medical University, Shenyang 110001, Liaoning Province, China The Fourth Laboratory of Cancer Institute China Medical University Shenyang 110001 Liaoning Province China.

AIM: To reveal the correlation between the functional differentiation phenotypes of gastric carcinoma cells and the invasion and metastasis by a new way of cell-function ***:Surgically resected specimens of 361 gastric carcinomas(GC) were investigated with enzyme-, mucin-, and tumor-related marker immunohistochemistry. According to the direction of cell-function differentiation, stomach carcinomas were divided into five functionally differentiated types. RESULTS: (1) Absorptive function differentiation type (AFDT): there were 82 (22.7%) patients including 76 (92.7%) aged 45 years. Sixty-nine (84.1%) cases belonged to the intestinal type. Thirty-eight (46.3%) expressed CD44v6 and 9 (13.6%) of 66 male patients developed liver *** 5-year survival rate of patients in this group (58.5%) was higher than those with the other types (P<0.01). (2) Mucin secreting function differentiation type (MSFDT): 54 (15%) cases. Fifty-three (98.1%) tumors had penetrated the serosa, 12 (22.2%) expressed ER and 22 (40.7%) expressed CD44v6. The postoperative 5-year survival rate was 28.6%. (3) Absorptive and mucin-producing function differentiation type (AMPFDT): there were 180 (49.9%) cases, including 31 (17.2%) aged younger than 45 years. The tumor was more common in women (62, 34.4%,) and expressed more frequently estrogen receptors (ER) (129, 81.7%) than other types (P<0.01). Ovary metastasis was found in 12 (19.4%) out of 62 female subjects. The patients with this type GC had the lowest 5-year survival rate (24.7%) among all types. (4) Specific function differentiation type (SFDT): 13 (3.6%) cases. Nine (69.2%) tumors of this type derived from APUD system, the other 4 (30.7%) were of different histological differentiation. Sixty per cent of the patients survived at least five years. (5) Non-function differentiation type (NFDT): 32 (8.9%) cases. Nineteen (59.4%) cases had lymph node metastases but no one with liver or ovary metastasis. The 5-year surv

关键词： Antigens, CD44 Cell Differentiation Female Glycoproteins Humans Immunohistochemistry Liver neoplasms Lymphatic Metastasis Male Middle Aged Neoplasm Invasiveness Ovarian neoplasms Phenotype Prognosis Receptors, Estrogen Research Support, Non-U.S. Gov't stomach neoplasms Survival Rate Tumor Markers, Biological

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Effect of cis-9,trans-11-conjugated linoleic acid on cell cycle of gastric adenocarcinoma cell line(SGC-7901)

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World Journal of Gastroenterology 2002年第2期8卷 224-229页

作者： Jia-Ren Liu Bai-Xiang Li Bing-Qing Chen Ying-ben Xue Yan-Mei Yang Yu-Mei Zheng,Department of Toxicological Health,Public Health College,Harbin Medical University,Harbin 150001,Heilongjiang Province,China Xiao-Hui Han ICU of Cardiological Surgery,The Second Hospital,Harbin Medical University,Harbin 150001,Heilongjiang Province,China Rui-Hai Liu,Food Science and Toxicology,Department of Food Science,Cornell University,Ithaca,NY 14853-7201,USA Department of Toxicological Health Public Health College Harbin Medical University 199 Dongdazhi Street Nangang District Harbin 150001 Heilongjiang Province China. jiarenliu@***

AIM: To determine the effect of cis -9, trans -11-conjugated linoleic acid (c9, t11-CLA) on the cell cycle of gastric cancer cells (SGC-7901) and its possible mechanism in inhibition cancer growth. METHODS: Using cell culture and immunocytochemical techniques, we examined the cell growth, DNA synthesis, expression of PCNA, cyclin A, B(1), D(1), p16(ink4a) and p21(cip/waf1) of SGC-7901 cells which were treated with various c9, t11-CLA concentrations (25, 50, 100 and 200 micromol.L(-1))of c 9, t 11-CLA for 24 and 48h, with a negative control (0.1% ethane). RESULTS: The cell growth and DNA synthesis of SGC-7901 cells were inhibited by c9, ***-7901 cells. Eight day after treatment with various concentrations of c9, t11-CLA mentioned above, the inhibition rates were 5.92%, 20.15%, 75.61% and 82.44%, respectively and inhibitory effect of c9, t11-CLA on DNA synthesis (except for 25 micromol.L, 24h) showed significantly less (3)H-TdR incorporation than that in the negative controls (P<0.05 and P<0.01). Immunocytochemical staining demonstrated that SGC-7901 cells preincubated in media supplemented with different c9, t11-CLA concentrations at various times significantly decreased the expressions of PCNA (the expression rates were 7.2-3.0%, 24h and 9.1-0.9% at 48h, respectively), Cyclin A (11.0-2.3%, 24h and 8.5-0.5%,48h), B(1) (4.8-1.8% at 24h and 5.5-0.6% at 48h)and D(1) (3.6-1.4% at 24h and 3.7%-0 at 48h) as compared with those in the negative controls(the expressions of PCNA, Cyclin A, B(1) and D(1) were 6.5% at 24h and 9.0% at 48h, 4.2% at 24h and 5.1% at 48h, 9.5% at 24h and 6.0% at 48h,respectively)(P<0.01), whereas the expressions of P16(ink4a) and P21(cip/waf1), cyclin-dependent kinases inhibitors(CDKI), were increased. CONCLUSION: The cell growth and proliferation of SGC-7901 cell is inhibited by c9, t11-CLA via blocking the cell cycle, with reduced expressions of cyclin A,B(1) and D(1) and enhanced expressions of CDKI(P16(ink4a) and p21(cip/waf1)).

关键词： Linoleic Acids, Conjugated Adenocarcinoma Animals Cell Cycle Cell Division Cyclin A Cyclin B Cyclin D1 Cyclin-Dependent Kinase Inhibitor p16 Cyclin-Dependent Kinase Inhibitor p21 Cyclins Enzyme Inhibitors Humans Immunohistochemistry Linoleic Acids Proliferating Cell Nuclear Antigen Research Support, Non-U.S. Gov't stomach neoplasms Tumor Cells, Cultured

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Efficacy of luteolin on the human gastric cancer cell line MKN45 and underlying mechanism

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Journal of Traditional Chinese Medicine 2023年第1期43卷 34-41页

作者： DING Yajie LIU Feng LI Zhaoyan Xu Yan CAO Nida ZHANG Guangao WANG Rui ZHAO Aiguang Department of Oncology Medicine Longhua Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghai 200032China

OBJECTIVE:To investigate the antitumour efficacy of luteolin on gastric cancer(GC)and study the mechanism underpinning the ***:Effects of luteolin on cell growth inhibition,apoptosis,and cell cycle arrest in MKN45 cells were investigated using the cell counting kit-8 *** in the mitochondrial membrane potential after luteolin treatment were assessed using 5,5′,6,6’-tetra-chloro-1,1’,3,3’-tetraethy lbenzimidazolcar bocyanineiodi-de(JC-1)*** investigate whether apoptotic effect by luteolin is related to the phosphoinositide 3-kinase/v-akt murine thymoma viral oncogene(PI3K/Akt)pathway,cells were additionally treated with LY294002,a PI3K/Akt pathway ***,the expressions of apoptosis-related proteins,namely B-cell lymphoma 2(Bcl-2),Bcl-2 associated X protein(Bax),Akt,p-Akt,caspase-3,and cytochrome C,were detected after luteolin ***:The study revealed that in MKN45 cells,luteolin could inhibit the cell proliferation in a time-and dose-dependent manner;block the cell cycle in the Sphase;induce apoptosis;reduce the mitochondrial membrane potential;increase the expression of Bax,caspase-3,and cytochrome C;and decrease the expression of Bcl-2 and *** might be involved in the PI3K/Akt signalling pathway,indicating that this pathway could be a therapeutic target for GC ***:Luteolin could inhibit the proliferation of GC cells and block the cell cycle in the *** mechanism of inducing apoptosis in these cells was related to the PI3K/Akt signalling pathway.

关键词： stomach neoplasms luteolin apoptosis phosphoinositide 3-kinase Akt signal transduction

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Effectiveness of Huachansu injection combined with chemotherapy for treatment of gastric cancer in China: a systematic review and Meta-analysis

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Journal of Traditional Chinese Medicine 2020年第5期40卷 749-757页

作者： Wu Jiarui Zhang Dan Ni Mengwei Xue Jiaping Wang Kaihuan Duan Xiaojiao Liu Shuyu Department of Clinical Pharmacology of Traditional Chinese Medicine School of Chinese Materia MedicaBeijing University of Chinese MedicineBeijing 100102China

OBJECTIVE:to evaluate the effectiveness and safety of Huachansu(HCS)injection plus chemotherapy in the treatment of gastric ***:A thorough and systematic retrieval of randomized controlled trials(RCTs)concerning HCS injection for treating gastric cancer was conducted in several electronic databases from inception to May 10,*** quality of the RCTs was assessed by the Cochrane risk of bias *** the data about objective remission rate,performance status,adverse drug reactions(ADRs)and other outcomes were extracted and analyzed by Review Manager 5.3 and Stata 13.0 ***:A total of 14 RCTs with 976 participants were involved in the current *** results suggested that HCS injection combined with chemotherapy was associated with better effects than receiving conventional chemotherapy alone in respect of improving the objective response rate[RR=1.18,95%CI(1.03,1.37),Z=2.32,P=0.02],and performance status[RR=1.84,95%CI(1.43,2.36),Z=4.74,P<0.00001].In addition,HCS injection combined with chemotherapy could relieve pain for patients with gastric ***:This Meta-analysis revealed that HCS injection plus chemotherapy might more effective than chemotherapy in treating gastric ***,more large-scale and rigorously designed RCTs should be performed to validate this finding.

关键词： stomach neoplasms Drug therapy Randomized controlled trial Meta-analysis Huachansu injection

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Primary gastric lymphoma

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World Journal of Gastroenterology 2004年第1期10卷 5-11页

作者： AhmadM.Al-Akwaa NeelamSiddiqui IbrahimA.Al-Mofleh Gastroenterology Division Neelam SiddiquiOncology DivisionDepartment of MedicineCollege of Medicine and King Khalid University HospitalKing Saud UniversityRiyadhSaudi Arabia

AIM:The purpose of this review is to describe the various aspects of primary gastric lymphoma and the treatment options currently available. METHODS:After a systematic search of Pubmed,Medscape and MDconsult,we reviewed and retrieved literature regarding gastric lymphoma. RESULTS:Primary gastric lymphoma is rare however,the incidence of this malignancy is *** gastritis secondary to Helicobacter pylori (H pylori) infection has been considered a major predisposing factor for MALT lymphoma. Immune histochemical marker studies and molecular biology utilizing polymerase chain reaction have facilitated appropriate diagnosis and abolished the need for diagnostic surgical *** in imaging techniques including Magnetic Resonance Imaging (MRI) and Endoscopic Ultrasonography (EUS) have helped evaluation of tumor extension and invasion. The clinical course and prognosis of this disease is dependent on histopathological sub-type and stage at the time of *** remains regarding the best treatment for early stages of this ***,surgery and combination have been studied and shared almost comparable results with survival rate of 70-90%.However,chemotherapy possesses the advantage of preserving gastric anatomy. Radiotherapy alone has been tried and showed good results. Stage IIIE,IVE disease treatment is solely by chemotherapy and surgical resection has been a remote consideration. CONCLUSION:We conclude that methods of diagnosis and staging of the primary gastric lymphoma have dramatically *** modalities of treatment are many and probably chemotherapy is superior because of high success rate, preservation of stomach and tolerable complications.

关键词： Humans Lymphoma stomach neoplasms

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