Artificial intelligence in gastric cancer: Application and future perspectives

Introduction: The extent of optimal gastric resection for proximal gastric cancer (PGC) continues to remain controversial, and a final consensus is yet to be met. The current study aimed to compare the perioperative outcomes, postoperative complications, and overall survival (OS) of proximal gastrectomy (PG) versus total gastrectomy (TG) in the treatment of PGC through a meta-analysis. Methods: We systematically searched PubMed, Embase, The Cochrane Library, and Web of Science for articles published in English since database establishment to October 2019. Evaluated endpoints were perioperative outcomes, postoperative complications, and long-term survival outcomes. Results: A total of 2,896 patients in 25 full-text articles were included, of which one was a prospective randomized study, one was a clinical phase III trial, and the rest were retrospective comparative studies. The PG group showed a higher incidence of anastomotic stenosis (OR = 2.21 [95% CI: 1.08–4.50]; p = 0.03) and reflux symptoms (OR = 3.33 [95% CI: 1.85–5.99]; p < 0.001) when compared with the TG group, while no difference was found in PG patients with double-tract reconstruction (DTR). The retrieved lymph nodes were clearly more in the TG group (WMD = −10.46 [95% CI: −12.76 to −8.17]; p < 0.001). The PG group was associated with a better 5-year OS relative to TG with 11 included studies (OR = 1.35 [95% CI: 1.03–1.77]; p = 0.03). After stratification for early gastric cancer and PG with DTR groups, however, there was no significant difference between the 2 groups (OR = 1.35 [95% CI: 0.59–2.45]; p = 0.62). Conclusion: In conclusion, PG was associated with a visible improved long-term survival outcome for all irrespective of tumor stage, while a similar 5-year OS for only early gastric cancer patients between the 2 groups. Future randomized clinical trials of esophagojejunostomy techniques, such as DTR following PG, are expected to prevent postoperative complications and assist surgeons in the choice of surgical approach for PGC patients.

Background: The aim of this study was to examine the differences in clinicopathological features, treatment strategies and prognosis between patients with proximal gastric cancer (PGC) and distal gastric cancer (DGC).

Objective. This systematic review and meta-analysis aimed to ascertain whether sex-based differences influence clinicopathological characteristics and survival outcomes of gastric cancer patients. Background. Gastric cancer in females has received less attention than in males. Clinicopathological features and survival outcomes of females with gastric cancer have been reported in several studies with controversial results. Methods. We systematically reviewed clinical studies from PubMed, Cochrane Library, Embase, and Web of Science published up to June 2022. The effect sizes of the included studies were estimated using odds ratios (ORs). Heterogeneity was investigated using the χ2 and I² tests, while sensitivity analyses were performed to identify the source of substantial heterogeneity. All data used in this study were obtained from previously published studies obviating the need for ethical approval and patient consent. Results. Seventy-six studies with 775,003 gastric cancer patients were included in the meta-analysis. Gastric cancer patients were less likely to be females ( < 0.00001). Female patients were younger in age ( < 0.00001) and showed a higher percentage of distal ( < 0.00001), non-cardia ( < 0.00001), undifferentiated ( < 0.00001), diffuse ( < 0.00001), and signet-ring cell carcinoma ( < 0.00001). Female patients showed better prognosis in both 3-year ( = 0.0003) and 5-year overall survival (OS) ( < 0.00001), especially White patients. However, females were associated with lower 5-year OS relative to males in the younger patients ( = 0.0001). Conclusions. In conclusion, gender differences were observed in clinicopathological characteristics and survival outcomes of gastric cancer. Different management of therapy will become necessary for different genders.

A nested case-control study was carried out using data from the US Department of Defense cohort between 2000 and 2013 to investigate the associations of papillary thyroid cancer (PTC) with serum concentrations of polybrominated diphenyl ethers and polybrominated biphenyls. This study included 742 histologically confirmed PTC cases (in 341 women and 401 men) and 742 matched controls with prediagnostic serum samples from the Department of Defense Serum Repository. Lipid-corrected serum concentrations of 8 congeners were measured. Multivariate conditional logistic regression analyses were performed for classical PTC and follicular variant of PTC, respectively. We also examined effect modification by sex. BDE-28, a polybrominated diphenyl ether congener, was associated with significantly increased risk of classical PTC (for the third tertile vs. below the limit of detection, odds ratio = 2.09, 95% confidence interval: 1.05, 4.15; P for trend = 0.02), adjusting for other congeners, body mass index, and branch of military service. This association was observed mainly for larger classical PTC (tumor size > 10 mm), with a significantly stronger association among women than men (P for interaction = 0.004). No consistent associations were observed for other congeners, including those at higher concentrations. This study found a significantly increased risk of classical PTC associated with increasing levels of BDE-28. The risk varied by sex and tumor size.

Collagen triple helix repeat containing-1 (CTHRC1), highly expressed in multiple human solid tumors, has been identified as a tumor associated protein. However, its specific role and mechanism with immune infiltrates in gastric cancer are still unclear. In this study, we systematically explored and validated the expression and prognostic value of CTHRC1 in gastric cancer by integrating the Cancer Genome Atlas (TCGA), Gene Expression Omnibus (GEO) and Genome Sequence Archive (GSA) datasets. Compared to adjacent normal tissues, we observed that CTHRC1 was highly overexpressed in tumor sample of multiple cancers. It was revealed that CTHRC1 overexpression was positively correlated with the T stage in gastric cancer but not lymph nodes metastasis from TCGA dataset. In addition, CTHRC1 expression may induce tumor associated macrophage infiltration though GRN/TNFRSF1A and AnxA1/FPR1 pathways and also tumor angiogenesis in gastric cancer. In this context, our results indicate that CTHRC1 plays a pivotal role in regulating the angiogenesis and macrophage infiltration in tumor microenvironment, and also can predict poor prognosis in gastric cancer, suggesting that CTHRC1 might be a promising novel immunotherapy and angiogenesis target for gastric cancer.