Analysis of results and indexes of quality in surgical treatment of gastric cancer

Anotācija Pētījumā tika analizēti kuņģa vēža pacientu dzīvildzi ietekmējoši riska faktori: komplikācijas, paaugstināts ķermeņa masas indekss, splenektomijas, asins pārliešanas un operācijas laikā izdalīto limfmezglu skaita atvasināts parametrs – N attiecība (metastātisko un izmeklēto limfmezglu attiecība), SIA Rīgas Austrumu klīniskās universitātes slimnīcas stacionāra Latvijas Onkoloģijas centrā radikāli operētiem kuņģa vēža pacientiem. Rezultāti: Nav nozīmīgas dzīvildzes atšķirības starp pN1 un pN2 pacientu grupām pēc TNM klasifikācijas. Izmantojot N attiecību (1–25% vs. 30 10,5% (p=0,195), sakarība starp ĶMI un komplikācijām nebija statistiski ticama (p=0,152). Kaplan-Meier līknes parāda, ka ir statistiski nozīmīgas dzīvildzes atšķirības dažādās ĶMI grupās (p=0,072). Pēcoperācijas komplikācijas novēroja 94 (16,3%) pacientiem, no kuriem nomira 14 (2,4%). 94 pacientiem, kuriem novēroja pēcoperāciju komplikācijas, biežāk tika veiktas splenektomijas un asins pārliešanas (87,5% vs. 12,1% p<0,0001 un 93,8% vs 9,2% p<0,0001). 5 gadu dzīvildze bija labāka pacientiem, kuriem netika veikta splenektomija (42,6% vs. 25% p=0,005) un asins pārliešanas (43,3% vs. 22,9% p=0,006). Piecu gadu dzīvildze ir labāka, ja pacientam netika novērotas pēcoperāciju komplikācijas (44,3% vs. 32,5% p=0,048) un pacientiem, kuriem netika veiktas perioperatīvas asins pārliešanas (43,8% vs. 27,5% p=0,045) Secinājumi: kad izmeklēto limfmezglu skaits ir mazāks par 15, N attiecības izmantošanai nav lielas klīniskas nozīmes. ĶMI neietekmē komplikāciju biežumu, pēcoperācijas mirstību un komplikāciju smagumu. Īstermiņā dzīvildze dažādās ĶMI grupās neatšķiras un nav saistīta ar ārstēšanas kvalitāti. Splenektomijas ar un bez perioperatīvām asins pārliešanām neietekmē pacientu 5 gadu dzīvildzi. Pēcoperāciju komplikācijas un perioperatīvās asins pārliešanas ietekmē pacientu 5 gadu dzīvildziThe study analyzed the factors having impact on the survival of gastric cancer patients: complicatons, increased Body Mass Index (BMI), splenectomies, blood transfusions and a parameter derived from the number of isolated lymph nodes during the surgery – N ratio (the ratio between metastatic and examinated lymph nodes) in radically operated gastric cancer patients of Riga East University Hospital Ltd., clinic „Latvia Oncology Centre". Results: There is no significant difference in survival between pN1 and pN2 groups by TNM classification. Using N ratio (1-25% vs. 30 the complication rate was 10.5% (p=0.195), the relationship between BMI and complications was not statistically significant (p= 0.152). The Kaplan-Meier curves show that statistically significant survival differences between BMI groups exist (p=0.072). Postoperative complications were observed in 94% (16.3%) of the patients 14 (2.4%) of which died. From 94 patients who experienced post-operative complications, most often underwent splenectomy and hemotransfusions (87.5% vs. 12.1% p<0.0001 and 93.8% vs. 9.2% p<0.0001). 5-year survival was better in patients who did not underwent splenectomy (42.6% vs. 25% p=0.005) and hemotransfusions (43.3% vs. 22.9% p = 0.006). Five-year survival rate was better when patients did not show postoperative complications (44.3% vs. 32.5% p = 0.048) and in patients who did not receive perioperative hemotransfusions (43.8% vs. 27.5%, p=0.045). Conclusions: In cases where the number of the examined lymph nodes is less than 15, N ratio has no great clinical significance. BMI affects neither the occurrence and severity of complications nor postoperative mortality. In a short-term time span, the survival of patients in different BMI groups did not differ different and apparently was unrelated to the quality of the treatment. Splenectomies and splenectomies with perioperative blood transfusions do not affect the 5-year patient survival

Breath Testing as Potential Colorectal Cancer Screening Tool

Although colorectal cancer (CRC) screening is included in organized programs of many countries worldwide, there is still a place for better screening tools. In this study, 418 breath samples were collected from 65 patients with CRC, 22 with advanced or nonadvanced adenomas, and 122 control cases. All patients, including the controls, had undergone colonoscopy. The samples were analysed with two different techniques. The first technique relied on gas chromatography coupled with mass spectrometry (GC-MS) for identification and quantification of volatile organic compounds (VOCs). The T-test was used to identify significant VOCs (p values < 0.017). The second technique relied on sensor analysis with a pattern recognition method for building a breath pattern to identify different groups. Blind analysis or leave-one-out cross validation was conducted for validation. The GC-MS analysis revealed four significant VOCs that identified the tested groups; these were acetone and ethyl acetate (higher in CRC), ethanol and 4-methyl octane (lower in CRC). The sensor-analysis distinguished CRC from the control group with 85% sensitivity, 94% specificity and 91% accuracy. The performance of the sensors in identifying the advanced adenoma group from the non-advanced adenomas was 88% sensitivity, 100% specificity, and 94% accuracy. The performance of the sensors in identifying the advanced adenoma group was distinguished from the control group was 100% sensitivity, 88% specificity, and 94% accuracy. For summary, volatile marker testing by using sensor analysis is a promising noninvasive approach for CRC screening

The Association of Circulating L-Carnitine, γ-Butyrobetaine and Trimethylamine N-Oxide Levels with Gastric Cancer

Our study aimed to evaluate the association between gastric cancer (GC) and higher concentrations of the metabolites L-carnitine, γ-butyrobetaine (GBB) and gut microbiota-mediated trimethylamine N-oxide (TMAO) in the circulation. There is evidence suggesting that higher levels of TMAO and its precursors in blood can be indicative of either a higher risk of malignancy or indeed its presence; however, GC has not been studied in this regard until now. Our study included 83 controls without high-risk stomach lesions and 105 GC cases. Blood serum L-carnitine, GBB and TMAO levels were measured by ultra-high-performance liquid chromatography–mass spectrometry (UPLC/MS/MS). Although there were no significant differences between female control and GC groups, we found a significant difference in circulating levels of metabolites between the male control group and the male GC group, with median levels of L-carnitine reaching 30.22 (25.78–37.57) nmol/mL vs. 37.38 (32.73–42.61) nmol/mL (p p p < 0.05). Thus, our study demonstrated the association between higher blood levels of L-carnitine, GBB, TMAO and GC in males, but not in females. Furthermore, correlations of any two investigated metabolites were stronger in the GC groups of both genders in comparison to the control groups. Our findings reveal the potential role of L-carnitine, GBB and TMAO in GC and suggest metabolic differences between genders. In addition, the logistic regression analysis revealed that the only significant factor in terms of predicting whether the patient belonged to the control or to the GC group was the blood level of L-carnitine in males only. Hence, carnitine might be important as a biomarker or a risk factor for GC, especially in males

Dissecting the genetic heterogeneity of gastric cancer

Background: Gastric cancer (GC) is clinically heterogenous according to location (cardia/non-cardia) and histopathology (diffuse/intestinal). We aimed to characterize the genetic risk architecture of GC according to its subtypes. Another aim was to examine whether cardia GC and oesophageal adenocarcinoma (OAC) and its precursor lesion Barrett's oesophagus (BO), which are all located at the gastro-oesophageal junction (GOJ), share polygenic risk architecture. Methods: We did a meta-analysis of ten European genome-wide association studies (GWAS) of GC and its subtypes. All patients had a histopathologically confirmed diagnosis of gastric adenocarcinoma. For the identification of risk genes among GWAS loci we did a transcriptome-wide association study (TWAS) and expression quantitative trait locus (eQTL) study from gastric corpus and antrum mucosa. To test whether cardia GC and OAC/BO share genetic aetiology we also used a European GWAS sample with OAC/BO. Findings: Our GWAS consisting of 5816 patients and 10,999 controls highlights the genetic heterogeneity of GC according to its subtypes. We newly identified two and replicated five GC risk loci, all of them with subtype-specific association. The gastric transcriptome data consisting of 361 corpus and 342 antrum mucosa samples revealed that an upregulated expression of MUC1, ANKRD50, PTGER4, and PSCA are plausible GC-pathomechanisms at four GWAS loci. At another risk locus, we found that the blood-group 0 exerts protective effects for non-cardia and diffuse GC, while blood-group A increases risk for both GC subtypes. Furthermore, our GWAS on cardia GC and OAC/BO (10,279 patients, 16,527 controls) showed that both cancer entities share genetic aetiology at the polygenic level and identified two new risk loci on the single-marker level. Interpretation: Our findings show that the pathophysiology of GC is genetically heterogenous according to location and histopathology. Moreover, our findings point to common molecular mechanisms underlying cardia GC and OAC/BO. Errata: Hess, T., Maj, C., Gehlen, J. et. al. Corrigendum to “Dissecting the genetic heterogeneity of gastric cancer”. eBioMedicine. 2023:94:104709. DOI: 10.1016/j.ebiom.2023.104709</p