Pancreatic cancer remains one of the most lethal diseases worldwide owing to its late diagnosis, early metastasis, and poor prognosis. Because current therapeutic options are limited, there is an urgent need to investigate novel targeted treatment strategies. Pancreatic cancer faces significant metabolic challenges, principally hypoxia and nutrient deprivation, due to specific microenvironmental constraints, including an extensive desmoplastic stromal reaction. Pancreatic cancer cells have been shown to rewire their metabolism and energy production networks to support rapid survival and proliferation. Increased glucose uptake and glycolytic pathway activity during this process have been extensively described. However, growing evidence suggests that pancreatic cancer cells are glutamine addicted. As a nitrogen source, glutamine directly (or indirectly via glutamate conversion) contributes to many anabolic processes in pancreatic cancer, including amino acids, nucleobases, and hexosamine biosynthesis. It also plays an important role in redox homeostasis, and when converted to α-ketoglutarate, glutamine serves as an energy and anaplerotic carbon source, replenishing the tricarboxylic acid cycle intermediates. The present study aims to provide a comprehensive overview of glutamine metabolic reprogramming in pancreatic cancer, focusing on potential therapeutic approaches targeting glutamine metabolism in pancreatic cancer.

Update on diagnosis and treatment of early signet-ring cell gastric carcinoma: A literature review

Purpose Endoscopic procedures and surgery are common treatments for early colorectal cancer (CRC). However, only approximately 10% of patients who undergo surgery have lymph node metastases (LNM) detected on postoperative pathology, which often leads to overtreatment. This study aims to comprehensively analyze the risk factors for LNM in early CRC patients, establishing a predictive model to aid in treatment decisions. Methods This study reviewed the clinicopathologic data of patients with early CRC who underwent surgery from January 2015 to June 2023. Univariate and multivariate logistic regression analyses were employed to identify LNM risk factors. The receiver operating characteristic (ROC) analysis and calibration curves were also constructed to verify the model’s discrimination and calibration. A simplified scale was calculated to promote the risk stratification for LNM. Results The study analyzed medical records of 375 patients. Of these, 37 (9.9%) cases had LNM. Univariate analysis identified age, nerve invasion, depth of submucosal invasion, histologic grade, LVI, and tumor budding as risk factors. The multivariate analysis confirmed histologic grade (OR, 13.403; 95% CI, 1.415–126.979; P = 0.024), LVI (OR, 6.703; 95% CI, 2.600–17.284; P < 0.001), and tumor budding (OR, 3.090; 95% CI, 1.082–8.820; P = 0.035) as independent predictors. The optimal nomogram, incorporating six risk factors, demonstrated strong predictability with an area under the ROC curve (AUC) of 0.837 (95% CI, 0.762–0.912). A simplified risk assessment scale with a total score of 19 points was developed. Conclusion The study developed a nomogram and a simplified risk assessment scale to predict LNM risk, potentially optimizing the management of early CRC patients.

Background: Colonoscopy is considered the most effective screening method for colorectal polyps. However, the longevity and complexity of the procedure makes it less desirable to screen for colorectal polyps in the general population. Therefore, it is essential to identify other independent risk factors. In this study, we explored the link between Hp infection, atrophic gastritis, and colorectal polyps to identify a new potential risk factors of colorectal polyps. Methods: In this study, atrophic gastritis and intestinal polyps were diagnosed by endoscopy and pathology. All the 792 patients in this retrospective study were divided into sub-groups based on the presence of colorectal polyps. The correlation between polyps and atrophic gastritis was analyzed using the chi-square test and Kruskal-Wallis test. The receiver operating characteristic (ROC) curve was used to compare the predictive value for colorectal polyps between Hp infection and atrophic gastritis. Binary logistic regression was utilized to identify independent risk factors for colorectal polyps. Results: Patients with colorectal polyps were primarily male with advanced age, and the number of patients with colorectal polyps had a higher association with smoking, alcohol drinking, and Hp infection than the control group. A positive correlation between the number of colorectal polyps and the severity of atrophic gastritis was observed. ROC analysis showed that atrophic gastritis was a better risk factors for colorectal polyps. Multivariate analysis identified atrophic gastritis as an independent risk factor for colorectal polyps (OR 2.294; 95% CI 1.597–3.296). Conclusions: Atrophic gastritis confirmed could be an independent risk factors for colorectal polyps.

Background and purpose: Although endoscopic submucosal dissection (ESD) is considered standard treatment for early gastric cancer (EGC), patients with non-curative resection (NCR) of ESD may still require gastrectomy. The systemic immune-inflammation index (SII) showed great potential in predicting the prognosis of gastric cancer patients. This study aims to investigate the predictive validity of SII of NCR in EGC patients. Methods: We reviewed data from EGC patients who underwent ESD in the past. The relationship between SII and clinicopathologic features was investigated. We used Receiver operating characteristic curves to compare the predictive values of NCR between SII and other inflammation indices. Binary logistic analysis was used to identify independent risk factors for NCR. These factors were then used to construct a predictive nomogram. Results: SII was associated with larger tumor size, male gender, older age, submucosal invasion, and a greater risk of NCR. SII showed better predictivity of NCR than platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR). SII [odds ratio (OR) = 1.003, P = 0.001], NLR (OR = 1.520, P = 0.029), PLR (OR = 1.009, P = 0.010), upper stomach tumors (OR = 16.393, P < 0.001), poorly differentiated type (OR = 29.754, P < 0.001), ulceration (OR = 4.814, P = 0.001), and submucosal invasion (OR = 48.91, P < 0.001) were independent risk factors for NCR. The nomogram model based on these factors exhibited superior concordance and accuracy. Conclusion: SII could be considered a simple and effective predictor of NCR of ESD in EGC patients.