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Li D, Morgan DR, Corral JE, Montgomery EA, Riquelme A, Shah SC. Gastric Cancer Screening in the United States: A Review of Current Evidence, Challenges, and Future Perspectives. Am J Gastroenterol 2025; 120:765-777. [PMID: 40072512 DOI: 10.14309/ajg.0000000000003301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Accepted: 12/18/2024] [Indexed: 03/14/2025]
Abstract
Gastric cancer remains a leading cause of cancer-related mortality worldwide. In the United States, gastric cancer incidence and mortality are substantially higher among non-White racial and ethnic groups and new immigrants from high-incidence countries. This is in large part related to the higher prevalence of Helicobacter pylori -associated gastric premalignant changes in these populations. Apart from primary prevention, early detection of gastric cancer is the principal strategy to reduce gastric cancer mortality and improve survival. Extensive evidence in Asian countries has demonstrated the benefits of endoscopic screening in detecting early-stage gastric cancer and reducing gastric cancer-related mortality. By contrast, direct, high-quality US-based data, such as from large clinical trials or observational studies, on important outcomes of gastric cancer screening are still lacking. In this review, we evaluate and summarize the latest global evidence on the epidemiology and predisposing factors of gastric cancer as well as the efficacy, benefits vs. risks, and cost-effectiveness of gastric cancer screening. We further discuss the critical knowledge gaps and challenges in promoting gastric cancer screening in the United States. Dedicated research is urgently needed to enrich the US-based data on gastric cancer primary and secondary prevention to inform clinical practice and reduce gastric cancer-related morbidity and mortality in a cost and resource efficient manner.
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Affiliation(s)
- Dan Li
- Department of Gastroenterology, Kaiser Permanente Medical Center, Santa Clara, California, USA
- Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Douglas R Morgan
- Division of Gastroenterology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Juan E Corral
- Division of Gastroenterology, Prisma Health, Greenville, South Carolina, USA
| | - Elizabeth A Montgomery
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Arnoldo Riquelme
- Department of Gastroenterology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Center for Control and Prevention of Cancer (CECAN), Santiago, Chile
| | - Shailja C Shah
- Division of Gastroenterology, University of California, San Diego, La Jolla, California, USA
- Gastroenterology Section, Jennifer Moreno Department of Veterans Affairs Medical Center, La Jolla, California, USA
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2
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Che PY, Zuo CJ, Tian J. Global trends in esophageal cancer and metabolic syndrome research: bibliometric analysis and visualization from 1995 to 2024. Discov Oncol 2025; 16:398. [PMID: 40138022 PMCID: PMC11947393 DOI: 10.1007/s12672-025-02181-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2025] [Accepted: 03/18/2025] [Indexed: 03/29/2025] Open
Abstract
PURPOSE Metabolic syndrome (MetS) plays a key role in the progression of esophageal cancer (EC), yet few studies have comprehensively explored research trends on this topic. To fill this gap, this study analyzes global research developments, hotspots, and collaborations related to MetS and EC. METHODS A total of 1008 publications from 1995 to 2024 were analyzed using bibliometric tools like VOSviewer, CiteSpace, and the R package 'bibliometrix', drawing from the Web of Science Core Collection. RESULTS The analysis includes contributions from 5,183 researchers at 1500 institutions across 85 countries, with publications appearing in 411 journals. The United States, China, and the United Kingdom are leading in both publication volume and research impact. Karolinska Institutet emerged as a prominent contributor to this body of work. Key journals include the Diseases of the Esophagus and Gastroenterology. Main areas cover metabolic factors, metabolic surgery, adipokines, lifestyle risk factors, cirrhosis & portal hypertension. Emerging trends focus on "metabolic syndrome and EC risk", "inflammation and adipokines", "bariatric surgery and EC prevention", "post-surgical outcomes", "early detection strategies". CONCLUSION As the first comprehensive bibliometric study on MetS and EC, this research highlights metabolism-related factors driving EC progression. Future research should focus on clarifying MetS-EC mechanisms and developing prevention and treatment strategies.
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Affiliation(s)
- Peng-Yu Che
- Department of Cardiothoracic Surgery, The People's Hospital of Chongqing Hechuan, Chongqing, 401520, China.
| | - Chun-Jian Zuo
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Jie Tian
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China.
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Hardvik Åkerström J, Santoni G, von Euler Chelpin M, Chidambaram S, Markar SR, Maret-Ouda J, Ness-Jensen E, Kauppila JH, Holmberg D, Lagergren J. Decreased Risk of Esophageal Adenocarcinoma After Gastric Bypass Surgery in a Cohort Study From 3 Nordic Countries. Ann Surg 2023; 278:904-909. [PMID: 37450697 DOI: 10.1097/sla.0000000000006003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
OBJECTIVE The objective of this study was to test the hypothesis that bariatric surgery decreases the risk of esophageal and cardia adenocarcinoma. BACKGROUND Obesity is strongly associated with esophageal adenocarcinoma and moderately with cardia adenocarcinoma, but whether weight loss prevents these tumors is unknown. METHODS This population-based cohort study included patients with an obesity diagnosis in Sweden, Finland, or Denmark. Participants were divided into a bariatric surgery group and a nonoperated group. The incidence of esophageal and cardia adenocarcinoma (ECA) was first compared with the corresponding background population by calculating standardized incidence ratios (SIR) with 95% CIs. Second, the bariatric surgery group and the nonoperated group were compared using multivariable Cox regression, providing hazard ratios (HR) with 95% CI, adjusted for sex, age, comorbidity, calendar year, and country. RESULTS Among 748,932 participants with an obesity diagnosis, 91,731 underwent bariatric surgery, predominantly gastric bypass (n=70,176; 76.5%). The SIRs of ECA decreased over time after gastric bypass, from SIR=2.2 (95% CI, 0.9-4.3) after 2 to 5 years to SIR=0.6 (95% CI, <0.1-3.6) after 10 to 40 years. Gastric bypass patients were also at a decreased risk of ECA compared with nonoperated patients with obesity [adjusted HR=0.6, 95% CI, 0.4-1.0 (0.98)], with decreasing point estimates over time. Gastric bypass was followed by a strongly decreased adjusted risk of esophageal adenocarcinoma (HR=0.3, 95% CI, 0.1-0.8) but not of cardia adenocarcinoma (HR=0.9, 95% CI, 0.5-1.6), when analyzed separately. There were no consistent associations between other bariatric procedures (mainly gastroplasty, gastric banding, sleeve gastrectomy, and biliopancreatic diversion) and ECA. CONCLUSIONS Gastric bypass surgery may counteract the development of esophageal adenocarcinoma in morbidly obese individuals.
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Affiliation(s)
- Johan Hardvik Åkerström
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, and Karolinska University Hospital, Sweden
| | - Giola Santoni
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, and Karolinska University Hospital, Sweden
| | | | - Swathikan Chidambaram
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, and Karolinska University Hospital, Sweden
| | - Sheraz R Markar
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, and Karolinska University Hospital, Sweden
- Nuffield Department of Surgery, University of Oxford, United Kingdom
| | - John Maret-Ouda
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Eivind Ness-Jensen
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, and Karolinska University Hospital, Sweden
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim/Levanger, Norway
- Medical Department, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Joonas H Kauppila
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, and Karolinska University Hospital, Sweden
- Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Dag Holmberg
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, and Karolinska University Hospital, Sweden
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, and Karolinska University Hospital, Sweden
- School of Cancer and Pharmaceutical Sciences, King's College London, United Kingdom
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Gao X, Wang Z, Liu B, Cheng Y. Causal association of gut microbiota and esophageal cancer: a Mendelian randomization study. Front Microbiol 2023; 14:1286598. [PMID: 38107856 PMCID: PMC10722290 DOI: 10.3389/fmicb.2023.1286598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/07/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Despite the growing body of evidence, the link between the gut microbiota and different types of tumors, such as colorectal, gastric, and liver cancer, is becoming more apparent. The gut microbiota can be used as a reference for evaluating various diseases, including cancer, and can also act as risk factors or preventive factors. However, the specific connection between the gut microbiota and the advancement of esophageal cancer has yet to be investigated. Therefore, the aim of this research is to clarify the possible causal influence of intestinal microorganisms on the vulnerability to esophageal cancer through the utilization of Mendelian randomization (MR) studies. Methods In this study, we employed a two-sample Mendelian randomization approach to evaluate the unbiased causal association between 150 different gut microbiota types and the occurrence of esophageal cancer. Following the selection from the IEU GWAS database and SNP filtration, we utilized various MR statistical techniques on the suitable instrumental variables. These included IVW methods, employing inverse variance weighting. Additionally, we performed a range of sensitivity analyses to confirm the heterogeneity and pleiotropy of the instrumental variables, thus ensuring the reliability of the outcomes. Results The increased likelihood of developing esophageal cancer is linked to the genetically predicted high levels of Gordonibacter, Oxalobacter, Coprobacter, Veillonella, Ruminiclostridium 5, Ruminococcus 1, and Senegalimasilia genera. Conversely, a decreased risk of esophageal cancer is associated with the high abundance of Turicibacter, Eubacterium oxidoreducens group, Romboutsia, and Prevotella 9 genera. No heterogeneity and pleiotropy were detected in the sensitivity analysis. Discussion We found that 11 types of gut microbial communities are associated with esophageal cancer, thereby confirming that the gut microbiota plays a significant role in the path.
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Affiliation(s)
- Xiangyu Gao
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhiguo Wang
- The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Bowen Liu
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, China
| | - Yufeng Cheng
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, China
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Li D, Jiang SF, Lei NY, Shah SC, Corley DA. Effect of Helicobacter pylori Eradication Therapy on the Incidence of Noncardia Gastric Adenocarcinoma in a Large Diverse Population in the United States. Gastroenterology 2023; 165:391-401.e2. [PMID: 37142201 DOI: 10.1053/j.gastro.2023.04.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 03/24/2023] [Accepted: 04/11/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND & AIMS High-quality data regarding the effect of Helicobacter pylori eradication on the risk of noncardia gastric adenocarcinoma (NCGA) remain limited in the United States. We investigated the incidence of NCGA after H pylori eradication therapy in a large, community-based US population. METHODS We performed a retrospective cohort study of Kaiser Permanente Northern California members who underwent testing and/or treatment for H pylori between 1997 and 2015 and were followed through December 31, 2018. The risk of NCGA was evaluated using the Fine-Gray subdistribution hazard model and standardized incidence ratios. RESULTS Among 716,567 individuals with a history of H pylori testing and/or treatment, the adjusted subdistribution hazard ratios and 95% confidence intervals of NCGA for H pylori-positive/untreated and H pylori-positive/treated individuals were 6.07 (4.20-8.76) and 2.68 (1.86-3.86), respectively, compared with H pylori-negative individuals. When compared directly with H pylori-positive/untreated individuals, subdistribution hazard ratios for NCGA in H pylori-positive/treated were 0.95 (0.47-1.92) at <8 years and 0.37 (0.14-0.97) ≥8 years of follow-up. Compared with the Kaiser Permanente Northern California general population, standardized incidence ratios (95% confidence interval) of NCGA steadily decreased after H pylori treatment: 2.00 (1.79-2.24) ≥1 year, 1.01 (0.85-1.19) ≥4 years, 0.68 (0.54-0.85) ≥7 years, and 0.51 (0.38-0.68) ≥10 years. CONCLUSION In a large, diverse, community-based population, H pylori eradication therapy was associated with a significantly reduced incidence of NCGA after 8 years compared with no treatment. The risk among treated individuals became lower than the general population after 7 to 10 years of follow-up. The findings support the potential for substantial gastric cancer prevention in the United States through H pylori eradication.
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Affiliation(s)
- Dan Li
- Department of Gastroenterology, Kaiser Permanente Northern California, Santa Clara, California; Division of Research, Kaiser Permanente Northern California, Oakland, California.
| | - Sheng-Fang Jiang
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Nan Ye Lei
- Department of Internal Medicine, Kaiser Permanente Northern California, Santa Clara, California
| | - Shailja C Shah
- Division of Gastroenterology, University of California San Diego, San Diego, California; Gastroenterology Section, VA San Diego Healthcare System, San Diego, California
| | - Douglas A Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Gastroenterology, Kaiser Permanente Northern California, San Francisco, California
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Uchima H, Da Fieno A, Bonilla A, Melo-Borges J, Sánchez-Montes C, Cuatrecasas M, Córdova H, Elizalde I, Rakislova N, Gratacós-Ginès J, Bayarri C, Casanova G, Ginès À, Llach J, Balaguer F, Fernández-Esparrach G. Serological levels of IGF-1 and IGFBP-3 in patients with Barrett's esophagus and esophageal adenocarcinoma: Longitudinal study. GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:360-368. [PMID: 36179948 DOI: 10.1016/j.gastrohep.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 05/09/2023]
Abstract
BACKGROUND Barrett's esophagus (BE) is an entity with a known histological progression to malignancy. The insulin-like growth factor (IGF) system is involved in the carcinogenesis through obesity-related mechanisms that include IGF and it has been associated with several types of cancer. OBJECTIVES To evaluate the serological levels of IGF-1 and IGFBP-3 in patients with BE and esophageal adenocarcinoma. PATIENTS AND METHODS Prospective study of patients with BE and esophageal adenocarcinoma who underwent upper endoscopy between September 2012 and December 2015. A baseline determination of IGF-1 and IGFBP-3 was performed. We included a control group of patients without BE. RESULTS One hundred sixteen patients were included: 36 controls, 62 with BE (42 without dysplasia and 20 with dysplasia) and 18 with adenocarcinoma. IGF-1 and IGF-1/IGFBP-3 molar ratio showed a progression to high levels in BE and adenocarcinoma than in controls (IGF-1: 135.55±66.07ng/ml, 148.33±81.5ng/ml, 108.19±46.69ng/ml, respectively; P=.049) (molar ratio: 0.23±0.91, 0.29±0.11, 0.19±0.06, respectively; P=.001), without differences between the histological types of BE. Fifty-four out of the 65 patients with BE were followed up (median of 58.50 months, range 12-113) and 11 of them (20.4%) presented progression to low-grade dysplasia (n=8) or high-grade dysplasia/adenocarcinoma (n=3), without differences in the IGF system compared with patients without progression. CONCLUSIONS Patients with BE and esophageal adenocarcinoma have changes in the IGF system although the serological levels of IGF-1 and IGFBP-3 do not correlate with histological progression of BE.
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Affiliation(s)
- Hugo Uchima
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Angella Da Fieno
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Araceli Bonilla
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Jordana Melo-Borges
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Cristina Sánchez-Montes
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Míriam Cuatrecasas
- Servicio de Anatomía Patológica, Hospital Clinic de Barcelona, Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España
| | - Henry Córdova
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España
| | - Ignasi Elizalde
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España
| | - Natalia Rakislova
- Servicio de Anatomía Patológica, Hospital Clinic de Barcelona, Barcelona, España
| | - Jordi Gratacós-Ginès
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Carolina Bayarri
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Gherzon Casanova
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Àngels Ginès
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España
| | - Josep Llach
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España
| | - Francesc Balaguer
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España
| | - Glòria Fernández-Esparrach
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España.
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Jove AG, Holmes HM, Tan MC, El-Serag HB, Thrift AP. Inverse Association Between Gluteofemoral Obesity and Risk of Non-Cardia Gastric Intestinal Metaplasia. Clin Gastroenterol Hepatol 2023; 21:64-71. [PMID: 35569739 PMCID: PMC9653509 DOI: 10.1016/j.cgh.2022.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/25/2022] [Accepted: 04/26/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS It is unclear whether obesity confers increased risk of non-cardia gastric adenocarcinoma and its precursor, gastric intestinal metaplasia. Here, we examined whether various dimensions of adiposity independently predispose to the development of non-cardia gastric intestinal metaplasia. METHODS We compared data from 409 non-cardia gastric intestinal metaplasia cases and 1748 controls without any gastric intestinal metaplasia from a cross-sectional study at the VA Medical Center in Houston, Texas. Participants completed standardized questionnaires, underwent anthropometric measurements, and underwent a study endoscopy with gastric mapping biopsies. Non-cardia gastric intestinal metaplasia cases included participants with intestinal metaplasia on any non-cardia gastric biopsy. We calculated odds ratios (ORs) and 95% confidence intervals (95% CIs) using logistic regression models. RESULTS Increasing body mass index (BMI) was not associated with risk of non-cardia gastric intestinal metaplasia (per unit BMI adjusted OR, 0.98; 95% CI, 0.96-1.00). Similarly, we found no associations with increase in waist circumference (per 10-cm increase adjusted OR, 0.94; 95% CI, 0.87-1.03) and waist-to-hip ratio (WHR) (per unit WHR adjusted OR, 2.34; 95% CI, 0.37-14.7). However, there was a significant inverse association with gastric intestinal metaplasia and increasing hip circumference, reflecting gluteofemoral obesity (per 10-cm increase adjusted OR, 0.89; 95% CI, 0.80-0.98). The inverse association was observed for both extensive and focal gastric intestinal metaplasia. CONCLUSIONS The independent dimensions of adiposity (BMI, waist circumference) are not associated with increased risk of non-cardia gastric intestinal metaplasia. The inverse association between gluteofemoral obesity and risk of gastric intestinal metaplasia warrants additional study.
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Affiliation(s)
- Andre G Jove
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Hudson M Holmes
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Mimi C Tan
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Hashem B El-Serag
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Aaron P Thrift
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas; Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas.
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Abstract
BACKGROUND This study aimed to systematically analyze the association between long-term use of proton pump inhibitors (PPIs) and the risk of gastric cancer (GC). METHODS We performed a systematic search of articles on the relationship between long-term use of PPIs and the risk of GC from PubMed and EMBASE. We calculated the pooled odds ratio of GC in PPI users compared to non-PPI users using random-effects models. RESULTS This meta-analysis included 18 studies from 20 different databases with 4348,905 patients enrolled. In the random effects model, we found that an increased risk of GC among PPI users (OR = 1.94; 95% CI [1.43, 2.64]). The long-term use of PPIs compared with histamine-2 receptor antagonist users did not increase the risk of GC (OR = 1.65; 95% CI [0.92, 2.97]). Stratified analysis showed that PPI users had a significantly increased risk of noncardia GC (OR = 2.53; 95% CI [2.03, 3.15]), but had a relatively small relationship with the risk of gastric cardia cancer. (OR = 1.79; 95% CI [1.06, 3.03]). With the extension of PPI use time, the estimated risk value decreases (<1 year: OR = 6.33, 95% CI [3.76, 10.65]; 1-3 years: OR = 1.82, 95% CI [1.30, 2.55]; >3 years: OR = 1.25, 95% CI [1.00, 1.56]). Despite Helicobacter pylori eradication, the long-term use of PPIs did not alter the increased risk of GC (OR = 2.29; 95% CI [1.57, 3.33]). CONCLUSION Our meta-analysis found that PPI use may be associated with an increased risk of GC. Further research on the causal relationship between these factors is necessary.
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Affiliation(s)
- Huiqin Gao
- Department of Gastroenterology, Guoyang County People’s Hospital, Guoyang Branch of Anhui Provincial Hospital, Guoyang, Anhui, China
| | - Lunan Li
- Department of Gastroenterology, NO.2 People’s Hospital of Fuyang City, Fuyang, Anhui, China
| | - Ke Geng
- Department of Gastroenterology, Guoyang County People’s Hospital, Guoyang Branch of Anhui Provincial Hospital, Guoyang, Anhui, China
| | - Changzheng Teng
- Department of Gastroenterology, Guoyang County People’s Hospital, Guoyang Branch of Anhui Provincial Hospital, Guoyang, Anhui, China
| | - Yuanyuan Chen
- Department of Gastroenterology, Guoyang County People’s Hospital, Guoyang Branch of Anhui Provincial Hospital, Guoyang, Anhui, China
| | - Fei Chu
- Department of Gastroenterology, Guoyang County People’s Hospital, Guoyang Branch of Anhui Provincial Hospital, Guoyang, Anhui, China
| | - Yi Zhao
- Department of Gastroenterology, Guoyang County People’s Hospital, Guoyang Branch of Anhui Provincial Hospital, Guoyang, Anhui, China
- *Correspondence: Yi Zhao, Department of Gastroenterology, Guoyang County People’s Hospital, Guoyang Branch of Anhui Provincial Hospital, No. 189 Xiangyang Road, Guoyang 233600, Anhui, China (e-mail: )
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Watanabe K, Koizumi S, Shirane K, Tsuda H, Watanabe H, Tsuji T, Onochi K, Yamai K, Kusano C, Dohmen T, Horikawa Y, Ajimine T, Shimodaira Y, Matsuhashi T, Iijima K. Diverse contributions of the visceral fat area to the etiology of two distinct subtypes of esophago-gastric junctional adenocarcinoma. Scand J Gastroenterol 2022; 57:1463-1469. [PMID: 35737566 DOI: 10.1080/00365521.2022.2089859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND There are two distinct etiologies of esophago-gastric junctional adenocarcinomas (EGJACs): one associated with extensive gastric mucosal atrophy (GA), resembling non-cardiac gastric cancers; and the other related to gastro-esophageal reflux disease, resembling esophageal adenocarcinoma. In this study, we investigated the associations between the visceral fat area (VFA) and EGJACs separately in the two subtypes of EGJACs, depending on the extent of background GA. METHODS Sixty-four consecutive patients with EGJACs (Siewert type 2) were enrolled from a population-based database in Akita Prefecture, Japan, between 2014 and 2019. Two age- and sex-matched healthy controls were randomly assigned to each EGJAC case. The extents of GA were evaluated endoscopically, and the VFA values were measured based on computed tomography images. Logistic regression analyses were performed to investigate the associations between EGJACs and the VFA. RESULTS Study subjects were classified into 2 subgroups depending on the extent of endoscopic GA: 29 (45.3%) without and 35 (54.7%) with extensive GA. Multivariable regression analyses revealed that a VFA of ≥100 cm2 was significantly associated with EGJACs in subjects without extensive GA [odds ratio (95% confidence interval): 2.65 (1.08-6.54)], while there was no such association in subjects with extensive GA [odds ratio (95% confidence interval): 1.52 (0.60-3.83)]. CONCLUSIONS The contribution of the VFA to the etiology of EGJACs seems to differ depending on the extent of background GA, with the VFA more prominently associated with EGJACs in subjects without extensive GA than in those with it, providing further rationale concerning the heterogeneous nature of EGJAC etiology.
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Affiliation(s)
- Kenta Watanabe
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita City, Japan
| | - Shigeto Koizumi
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita City, Japan
| | - Kenji Shirane
- Department of Internal Medicine, Shirane Hospital, Akita City, Japan
| | - Hidehiko Tsuda
- Department of Gastroenterology, Akita Kosei Medical Center, Akita City, Japan
| | - Hiroyuki Watanabe
- Department of Gastroenterology, Akita Kosei Medical Center, Akita City, Japan
| | - Tsuyotoshi Tsuji
- Department of Gastroenterology, Akita City Hospital, Akita City, Japan
| | - Kengo Onochi
- Department of Gastroenterology, Omagari Kosei Medical Center, Daisen City, Japan
| | - Kiyonori Yamai
- Department of Gastroenterology, Odate Municipal General Hospital, Odate City, Japan
| | - Chika Kusano
- Department of Gastroenterology, Yuri Kumiai General Hospital, Yurihonjo City, Japan.,Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara City, Japan
| | - Takahiro Dohmen
- Department of Gastroenterology, Yuri Kumiai General Hospital, Yurihonjo City, Japan
| | - Yohei Horikawa
- Department of Gastroenterology, Hiraka General Hospital, Yokote City, Japan
| | - Takuma Ajimine
- Department of Gastroenterology, Northern Akita Municipal Hospital, Kitaakita City, Japan
| | - Yosuke Shimodaira
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita City, Japan
| | - Tamotsu Matsuhashi
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita City, Japan
| | - Katsunori Iijima
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita City, Japan
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10
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Eser S, Özgür S, Shayan NA, Abdianwall MH. Risk Factors Related to Esophageal Cancer, a Case-Control Study in Herat Province of Afghanistan. ARCHIVES OF IRANIAN MEDICINE 2022; 25:682-690. [PMID: 37542400 PMCID: PMC10685874 DOI: 10.34172/aim.2022.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/27/2022] [Indexed: 08/06/2023]
Abstract
BACKGROUND The Herat province of Afghanistan is located on the Asian Esophageal Cancer Belt (AECB), a wide area in Central and Eastern Asia where very high rates of esophageal cancer (EC) have been observed. Several risk factors have been reported in the AECB Region by previous studies. Considering lack of information in Afghanistan on this issue, a study was conducted to determine the major risk factors related to EC in order to guide protective measures. METHODS A population-based case-control study was performed from July 2015 to August 2016 among 657 EC patients in the Herat Province and 180 histopathological confirmed cases and 189 controls were interviewed. A structured questionnaire was used and face-to-face interviews were conducted. RESULTS Low body mass index (BMI), low socio-economic status, family history of EC, consumption of dark tea, very hot beverage and qulurtoroosh were found to be statistically significant for EC and esophageal squamous cell carcinoma (ESCC) in univariate analyses. According to multivariate analyses, sex (OR=2.268; 95% CI=1.238-4.153), very hot beverages (OR=2.253; 95% CI=1.271- 3.996), qulurtoroosh (OR=5.679; 95% CI=1.787-18.815), dark tea (OR=2.757; 95% CI=1.531-4.967), high previous BMI (OR=0.215; 95% CI=0.117-0.431) and low socio-economic status (OR=1.783; 95% CI=1.007-3.177) were associated with ESCC. Being male was found to increase the risk of ESCC with OR=2.268 (95% CI=1.238-4.153). CONCLUSION Consuming very hot beverages dark tea and a local food, qulurtoroosh, were found as important risk factors for EC. Our findings warrant further studies and necessitate the implementation of protective measures for EC which is one of the leading cancers in the region.
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Affiliation(s)
- Sultan Eser
- Balıkesir University, Faculty of Medicine, Department of Public Health, 10145, Balıkesir, Turkey
| | - Su Özgür
- Ege University Faculty of Medicine Department of Biostatistics and Medical Informatics, 35040 Bornova, İzmir, Turkey
| | - Nasar Ahmad Shayan
- Western University, Faculty of Medicine, Department of Epidemiology and Biostatistics, London- On, Canada
| | - Mohammed Haris Abdianwall
- Nangarhar University, Faculty of Medicine, Department of Clinical Ophthalmology, Celalabad, Afghanistan
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Waters JK, Reznik SI. Update on Management of Squamous Cell Esophageal Cancer. Curr Oncol Rep 2022; 24:375-385. [PMID: 35142974 DOI: 10.1007/s11912-021-01153-4] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE OF THE REVIEW Esophageal cancer is the sixth most common cause of cancer death globally. Squamous cell carcinoma of the esophagus (ESCC) is the predominant histologic type in the world. Treatment strategies have evolved in the last decade and new paradigms are replacing traditional approaches at all stages of cancer. This review will summarize the epidemiology, diagnosis, staging, and treatment of esophageal squamous cell carcinoma. RECENT FINDINGS Novel approaches to screening may be cost-effective in regions with a high incidence of ESCC. Multi-disciplinary evaluation and treatment has become the standard of care. Endoscopic resection may be an option for early stage ESCC. Minimally invasive esophagectomy can be performed safely as a primary therapy or after-induction chemoradiation. Several recent studies have found a survival benefit to immunotherapy for patients with metastatic or persistent disease. Multi-disciplinary evaluation and multi-modal therapy including cytotoxic chemotherapy, radiation, surgery, and immunotherapy have improved survival compared to surgery alone.
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Affiliation(s)
- John K Waters
- Division of Thoracic Surgery, Department of Cardiovascular and Thoracic Surgery, 5323 Harry Hines Boulevard, MC 8879, Dallas, TX, 75390-8879, USA
| | - Scott I Reznik
- Division of Thoracic Surgery, Department of Cardiovascular and Thoracic Surgery, 5323 Harry Hines Boulevard, MC 8879, Dallas, TX, 75390-8879, USA.
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12
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Lee HW, Huang D, Shin WK, de la Torre K, Yang JJ, Song M, Shin A, Lee JK, Kang D. Obesity at early adulthood increases risk of gastric cancer from the Health Examinees-Gem (HEXA-G) study. PLoS One 2022; 17:e0260826. [PMID: 35120118 PMCID: PMC8815964 DOI: 10.1371/journal.pone.0260826] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 11/17/2021] [Indexed: 12/13/2022] Open
Abstract
Emerging evidence has indicated a possible link between obesity in early life with subsequent cancer risks, but its association with gastric cancer remains unknown. This study aimed to investigate the association of obesity at ages 18-20 and 35 with the later risk of gastric cancer among the Korean population. Included were 122,724 individuals who participated in the large-scale prospective cohort study, the Health Examinees-Gem (HEXA-G) study, during 2004-2017. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for gastric cancer risk associated with body mass index (BMI) at ages 18-20 and 35 years. During a mean follow-up period of 8.6±2.1 years, a total 927 gastric cancer cases (531 men and 396 women) were identified. When compared to normal BMI (18.5-23.0 kg/m2), obesity (BMI ≥30 kg/m2) at age 35 was significantly associated with increased risk of gastric cancer later in life among total participants (HR 1.94, 95% CI 1.26-2.97, p 0.01). When analyzed separately by sex, obesity at 35 years of age was significantly associated with increased risk of gastric cancer among both men (HR 1.79, 95% CI 1.02-3.13, p 0.05) and women (HR 2.35, 95% CI 1.21-4.60, p 0.02). No significant associations were found for obesity at late adolescence in both men and women. Our findings suggest that obesity in early adulthood may be associated with an increased risk of gastric cancer. The results may aid in understanding the etiology of GC in a population with a divergent trend of gastric cancer.
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Affiliation(s)
- Hwi-Won Lee
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dan Huang
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Korea
| | - Woo-Kyoung Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Korea
| | - Katherine de la Torre
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Jeong Yang
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Minkyo Song
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jong-koo Lee
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Daehee Kang
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Korea
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13
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Nucci D, Marino A, Realdon S, Nardi M, Fatigoni C, Gianfredi V. Lifestyle, WCRF/AICR Recommendations, and Esophageal Adenocarcinoma Risk: A Systematic Review of the Literature. Nutrients 2021; 13:3525. [PMID: 34684526 PMCID: PMC8538904 DOI: 10.3390/nu13103525] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 12/12/2022] Open
Abstract
One of the most notable changes in the epidemiology of esophageal cancer (EC) is the rising incidence and prevalence of esophageal adenocarcinoma (EAC) in developed countries. The aim of this systematic review was to collect and summarize all the available evidence regarding lifestyle, diet, and EAC risk. We searched the PubMed and Scopus databases in January 2021 for studies providing information about lifestyle, diet, WCRF/AICR recommendations, and EAC risk; published in English; without a time filter. The Newcastle-Ottawa Scale was used to assess risk of bias. The results are stratified by risk factor. A total of 106 publications were included. Half of the case-control studies were judged as high quality, whilst practically all cohort studies were judged as high quality. Body mass index and waist circumference were associated with increased EAC risk. Physical activity did not appear to have a significant direct role in EAC risk. A diet rich in fruit, vegetables, and whole grains appeared to be more protective than a Western diet. Alcohol does not seem to be related to EAC, whereas smokers, particularly heavy smokers, have an increased risk of EAC. Prevention remains the best option to avert EAC. Comprehensible and easy to follow recommendations should be provided to all subjects. Protocol ID number: CRD-42021228762, no funds received.
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Affiliation(s)
- Daniele Nucci
- Nutritional Support Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy
| | - Alessio Marino
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina, 60, 20132 Milan, Italy
| | - Stefano Realdon
- Digestive Endoscopy Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy
| | - Mariateresa Nardi
- Nutritional Support Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy
| | - Cristina Fatigoni
- Department of Pharmaceutical Science, University of Perugia, Via del Giochetto 2, 06123 Perugia, Italy
| | - Vincenza Gianfredi
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina, 60, 20132 Milan, Italy
- CAPHRI Care and Public Health Research Institute, Maastricht University, 6211 Maastricht, The Netherlands
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Clinical and Lifestyle-Related Prognostic Indicators among Esophageal Adenocarcinoma Patients Receiving Treatment at a Comprehensive Cancer Center. Cancers (Basel) 2021; 13:cancers13184653. [PMID: 34572881 PMCID: PMC8465866 DOI: 10.3390/cancers13184653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Esophageal adenocarcinoma (EAC) is a highly lethal cancer with rising incidence in Western countries. Despite diagnostic and therapeutic advances, average 5-year EAC survival remains poor (~20%), with tumor stage and treatment the strongest prognostic factors. The role of lifestyle-related exposures remains uncertain. To address this gap, we analyzed survival associations among EAC patients treated at a tertiary cancer center. Importantly, this study is among the first to assess survival relationships by disease stage for several key lifestyle-related exposures (e.g., physical activity, medications, and diet), enabling us to identify associations which may have been obscured in past analyses. Our findings suggest that lifestyle interventions such as smoking cessation, exercise regimens, and use of cholesterol-lowering (statin) or anti-inflammatory (NSAID) medications may represent promising avenues to improve outcomes in this deadly cancer. Abstract Purpose: The incidence of esophageal adenocarcinoma (EAC) has risen substantially in recent decades, while the average 5-year survival remains only ~20%. Disease stage and treatment are the strongest prognostic factors. The role of lifestyle factors in relation to survival remains uncertain, with a handful of studies to date investigating associations with obesity, smoking, physical activity, diet, or medications. Methods: This study included patients diagnosed with primary adenocarcinoma of the esophagus, gastroesophageal junction, or cardia (N = 371) at Roswell Park Comprehensive Cancer Center between 2003 and 2019. Leveraging extensive data abstracted from electronic medical records, epidemiologic questionnaires, and a tumor registry, we analyzed clinical, behavioral, and environmental exposures and evaluated stage-specific associations with survival. Survival distributions were visualized using Kaplan–Meier curves. Cox proportional hazards regression models adjusted for age, sex, stage, treatment, and comorbidities were used to estimate the association between each exposure and all-cause or cancer-specific mortality. Results: Among patients presenting with localized/regional tumors (stages I–III), current smoking was associated with increased overall mortality risk (HR = 2.5 [1.42–4.53], p = 0.002), while current physical activity was linked to reduced risk (HR = 0.58 [0.35–0.96], p = 0.035). Among patients with stage IV disease, individuals reporting pre-diagnostic use of statins (HR = 0.62 [0.42–0.92], p = 0.018) or NSAIDs (HR = 0.61 [0.42–0.91], p = 0.016) had improved overall survival. Exploratory analyses suggested that high pre-diagnostic dietary consumption of broccoli, carrots, and fiber correlated with prolonged overall survival in patients with localized/regional disease. Conclusion: Our data suggest that lifestyle exposures may be differentially associated with EAC survival based on disease stage. Future investigation of larger, diverse patient cohorts is essential to validate these findings. Our results may help inform the development of lifestyle-based interventions to improve EAC prognosis and quality of life.
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15
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Guo Q, Peng Y, Yang H, Guo J. Prognostic Nomogram for Postoperative Patients With Gastroesophageal Junction Cancer of No Distant Metastasis. Front Oncol 2021; 11:643261. [PMID: 33937047 PMCID: PMC8085428 DOI: 10.3389/fonc.2021.643261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background Gastroesophageal junction (GEJ) was one of the most common malignant tumors. However, the value of clinicopathological features in predicting the prognosis of postoperative patients with GEJ cancer and without distant metastasis was still unclear. Methods The 3425 GEJ patients diagnosed and underwent surgical resection without distant metastasis in the Surveillance, Epidemiology and End Results (SEER) database from 2010 to 2015 were enrolled,and they were randomly divided into training and validation cohorts with 7:3 ratio. Univariate and multivariate Cox regression analysis were used to determine the predictive factors that constituted the nomogram. The predictive accuracy and discriminability of Nomogram were determined by the area under the curve (AUC), C index, and calibration curve, and the influence of various factors on prognosis was explored. Results 2,400 patients were designed as training cohort and 1025 patients were designed as validation cohort. The percentages of the distribution of demographic and clinicopathological characteristics in the training and validation cohorts tended to be the same. In the training cohort, multivariate Cox regression analysis revealed that the age, tumor grade, T stage and N stage were independent prognostic risk factors for patients with GEJ cancer without distant metastasis. The C index of nomogram model was 0.667. The AUC of the receiver operating characteristic (ROC) analysis for 3- and 5-year overall survival (OS) were 0.704 and 0.71, respectively. The calibration curve of 3- and 5-year OS after operation showed that there was the best consistency between nomogram prediction and actual observation. In the validation cohort, the C index of nomogram model, the AUC of 3- and 5-year OS, and the calibration curve were similar to the training cohort. Conclusions Nomogram could evaluate the prognosis of patients with GEJ cancer who underwent surgical resection without distant metastasis.
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Affiliation(s)
- Qiang Guo
- Department of Thoracic Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - YuanYuan Peng
- Department of Gastroenterology, The Affiliated Xinchang Hospital of Wenzhou Medical University, Wenzhou, China
| | - Heng Yang
- Department of Thoracic Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - JiaLong Guo
- Department of Thoracic Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
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16
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Standardization of esophageal adenocarcinoma in vitro model and its applicability for model drug testing. Sci Rep 2021; 11:6664. [PMID: 33758229 PMCID: PMC7988140 DOI: 10.1038/s41598-021-85530-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/25/2021] [Indexed: 01/11/2023] Open
Abstract
FLO-1 cell line represents an important tool in esophageal adenocarcinoma (EAC) research as a verified and authentic cell line to study the disease pathophysiology and antitumor drug screenings. Since in vitro characteristics of cells depend on the microenvironment and culturing conditions, we performed a thorough characterization of the FLO-1 cell line under different culturing conditions with the aim of (1) examining the effect of serum-free growth medium and air–liquid interface (A–L) culturing, which better reflect physiological conditions in vivo and (2) investigating the differentiation potential of FLO-1 cells to mimic the properties of the in vivo esophageal epithelium. Our study shows that the composition of the media influenced the morphological, ultrastructural and molecular characteristics of FLO-1 cells, such as the expression of junctional proteins. Importantly, FLO-1 cells formed spheres at the A–L interface, recapitulating key elements of tumors in the esophageal tube, i.e., direct contact with the gas phase and three-dimensional architecture. On the other hand, FLO-1 models exhibited high permeability to model drugs and zero permeability markers, and low transepithelial resistance, and therefore poorly mimicked normal esophageal epithelium. In conclusion, the identified effect of culture conditions on the characteristics of FLO-1 cells should be considered for standardization, data reproducibility and validity of the in vitro EAC model. Moreover, the sphere-forming ability of FLO-1 cells at the A–L interface should be considered in EAC tumor biology and anticancer drug studies as a reliable and straightforward model with the potential to increase the predictive efficiency of the current in vitro approaches.
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17
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Gastric Cancer After Laparoscopic Sleeve Gastrectomy: a Case Report and Literature Review. Obes Surg 2021; 31:2797-2800. [PMID: 33641035 DOI: 10.1007/s11695-021-05307-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 12/21/2022]
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18
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Moodi M, Tavakoli T, Tahergorabi Z. Crossroad between Obesity and Gastrointestinal Cancers: A Review of Molecular Mechanisms and Interventions. Int J Prev Med 2021; 12:18. [PMID: 34084315 PMCID: PMC8106288 DOI: 10.4103/ijpvm.ijpvm_266_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 09/12/2020] [Indexed: 12/28/2022] Open
Abstract
The burden of gastrointestinal (GI) cancer is increasing worldwide, and in the past decade, cancer had entered the list of chronic debilitating diseases whose risk is substantially increased by hypernutrition. Obesity may increase the risk of cancer by the imbalance of various mechanisms including insulin and insulin-like growth factor1 (IGF-I) signaling, systemic inflammation, immune dysregulation, tumor angiogenesis, adipokines secretion, and intestinal microbiota that usually act interdependently. An increased understanding of the mechanisms underlying obesity-GI cancer link can provide multiple opportunities for cancer prevention. This review discusses various mechanisms involved molecular mechanisms linking obesity with GI cancers including esophagus, stomach, colorectal and hepatocellular. Furthermore, an optional intervention such as diet restriction and exercise is described, which may be preventive or therapeutic in GI cancer.
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Affiliation(s)
- Mitra Moodi
- Social Determinants of Health Research Center, Department of Health Education and Health Promotion, School of Health, Birjand University of Medical Sciences, Birjand, Iran
| | - Tahmineh Tavakoli
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Gasteroenterology Section, Department of Internal Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Zoya Tahergorabi
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Department of Physiology, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
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Klair JS, Zafar Y, Nagra N, Murali AR, Jayaraj M, Singh D, Rustagi T, Krishnamoorthi R. Outcomes of Radiofrequency Ablation versus Endoscopic Surveillance for Barrett's Esophagus with Low-Grade Dysplasia: A Systematic Review and Meta-Analysis. Dig Dis 2021; 39:561-568. [PMID: 33503615 DOI: 10.1159/000514786] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/22/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Endoscopic therapy using radiofrequency ablation (RFA) is a recommended treatment for Barrett's esophagus with high-grade dysplasia (BE-HGD) without a visible lesion which is managed by resection. However, currently, there is no consensus on the management of BE with low-grade dysplasia (BE-LGD) - RFA versus endoscopic surveillance. Hence, we performed a systematic review and meta-analysis of these comparative studies to compare the risk of progression to HGD or esophageal adenocarcinoma (EAC) among patients with BE-LGD treated with RFA versus endoscopic surveillance. METHODS The primary outcome was to compare the risk of progression to HGD or EAC among patients with BE-LGD treated with RFA versus endoscopic surveillance. RESULTS Four comparative studies reporting a total of 543 patients with BE-LGD were included in the meta-analysis (234 in RFA and 309 in endoscopic surveillance). The progression of BE-LGD to either HGD or EAC was significantly lower in patients treated with RFA compared to endoscopic surveillance (OR: 0.17, 95% confidence interval [CI]: 0.04-0.65, p = 0.01). The progression to HGD alone was significantly lower in patients treated with RFA versus endoscopic surveillance (OR: 0.23, 95% CI: 0.08-0.61, p = 0.003). The progression to EAC alone was numerically lower in RFA than endoscopic surveillance without statistical significance (OR: 0.44, 95% CI: 0.17-1.16, p = 0.09). Moderate heterogeneity was noted in the analysis. CONCLUSIONS Based on our meta-analysis, there was a significant reduction in the risk of progression to HGD or EAC among patients with BE-LGD treated with RFA compared with those undergoing endoscopic surveillance. Endoscopic eradication therapy with RFA should be the preferred management approach for BE-LGD.
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Affiliation(s)
- Jagpal Singh Klair
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Yousaf Zafar
- Department of Internal Medicine, Naples Community Healthcare, University of Central Florida, Orlando, Florida, USA
| | - Navroop Nagra
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Arvind R Murali
- Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Mahendran Jayaraj
- Division of Gastroenterology and Hepatology, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Dhruv Singh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Tarun Rustagi
- Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Rajesh Krishnamoorthi
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
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20
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Chang C, Worrell SG. Viruses and esophageal cancer. Dis Esophagus 2020; 33:5847897. [PMID: 32462190 DOI: 10.1093/dote/doaa036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/14/2020] [Accepted: 04/18/2020] [Indexed: 12/11/2022]
Abstract
Esophageal adenocarcinoma (EAC) has had the fastest increasing incidence of any solid tumor in the United States in the last 30 years. Long standing gastroesophageal reflux disease is a well-established risk factor with strong associations with obesity, alcohol and tobacco. However, there are likely additional contributing factors. Viruses such as human papillomavirus, ebstein-barr virus and herpes simplex virus have been implicated in the pathogenesis of esophageal cancer. This review will discuss the known literature linking viruses to esophageal adenocarcinoma and consider future relationships such as identifying prognostic and predictive molecular biomarkers to guide therapies.
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Affiliation(s)
- Carolyn Chang
- Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Stephanie G Worrell
- Case Western Reserve School of Medicine, Cleveland, OH, USA.,University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Pflüger MJ, Felsenstein M, Schmocker R, Wood LD, Hruban R, Fujikura K, Rozich N, van Oosten F, Weiss M, Burns W, Yu J, Cameron J, Pratschke J, Wolfgang CL, He J, Burkhart RA. Gastric cancer following pancreaticoduodenectomy: Experience from a high-volume center and review of existing literature. Surg Open Sci 2020; 2:32-40. [PMID: 32954246 PMCID: PMC7486455 DOI: 10.1016/j.sopen.2020.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/11/2020] [Accepted: 06/21/2020] [Indexed: 01/02/2023] Open
Abstract
Background Prolonged survival of patients after pancreaticoduodenectomy can be associated with late complications due to altered gastrointestinal anatomy. The incidence of gastric cancer is increasingly reported. We set out to examine our experience with gastric cancer as a late complication after pancreaticoduodenectomy with a focus on incidence, risk factors, and outcomes. Methods We queried our prospectively collected institutional database for patients that developed gastric cancer after pancreaticoduodenectomy and conducted a systematic review of the literature. Results Our database revealed 6 patients who developed gastric cancer following pancreaticoduodenectomy, presenting with a mean age of 62.2 years and an even sex distribution. All of those patients underwent pancreaticoduodenectomy for malignant indications with an average time to development of metachronous gastric cancer of 8.3 years. Four patients complained of gastrointestinal discomfort prior to diagnosis of secondary malignancy. All of these cancers were poorly differentiated and were discovered at an advanced T stage (≥ 3). Only half developed at the gastrointestinal anastomosis. Four underwent surgery with a curative intent, and 2 patients are currently alive (mean postgastrectomy survival = 25.5 months). In accordance with previous literature, biliopancreatic reflux from pancreaticoduodenectomy reconstruction, underlying genetic susceptibility, and adjuvant therapy may play a causative role in later development of gastric cancer. Conclusion Long-term survivors after pancreaticoduodenectomy who develop nonspecific gastrointestinal complaints should be evaluated carefully for complications including gastric malignancy. This may serve as an opportunity to intervene on tumors that typically present at an advanced stage and with aggressive histology.
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Affiliation(s)
- Michael Johannes Pflüger
- Johns Hopkins School of Medicine, Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Baltimore, MD, USA.,Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Surgery (CCM/CVK), Berlin, Germany
| | - Matthäus Felsenstein
- Johns Hopkins School of Medicine, Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Baltimore, MD, USA.,Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Surgery (CCM/CVK), Berlin, Germany
| | - Ryan Schmocker
- Johns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USA
| | - Laura DeLong Wood
- Johns Hopkins School of Medicine, Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Baltimore, MD, USA
| | - Ralph Hruban
- Johns Hopkins School of Medicine, Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Baltimore, MD, USA
| | - Kohei Fujikura
- Johns Hopkins School of Medicine, Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Baltimore, MD, USA
| | - Noah Rozich
- Johns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USA
| | - Floortje van Oosten
- Johns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USA
| | - Matthew Weiss
- Johns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USA
| | - William Burns
- Johns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USA
| | - Jun Yu
- Johns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USA
| | - John Cameron
- Johns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USA
| | - Johann Pratschke
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Surgery (CCM/CVK), Berlin, Germany
| | - Christopher Lee Wolfgang
- Johns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USA
| | - Jin He
- Johns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USA
| | - Richard Andrew Burkhart
- Johns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USA
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22
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Schlottmann F, Dreifuss NH, Patti MG. Obesity and esophageal cancer: GERD, Barrett´s esophagus, and molecular carcinogenic pathways. Expert Rev Gastroenterol Hepatol 2020; 14:425-433. [PMID: 32441160 DOI: 10.1080/17474124.2020.1764348] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/30/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Increases in the rates of esophageal adenocarcinoma (EAC) have paralleled rises in the prevalence of overweight and obesity. Despite not being fully understood, obesity-related EAC seems to have different carcinogenic pathways. AREAS COVERED This comprehensive review will thoroughly evaluate the current literature, describing the underlying mechanisms that help understanding the strong association between obesity and esophageal cancer. EXPERT COMMENTARY The risk of esophageal cancer among obese individuals could be partially explained by several factors: high prevalence of GERD; linear association between central adiposity and Barrett´s esophagus development; low levels of adiponectin and high levels of leptin that alter cell proliferation processes; insulin-resistant state that creates a tumorigenesis environment; and changes in the esophageal microbiota due to unhealthy dietary habits that promote carcinogenesis. In addition, a large proportion of obese patients are undergoing sleeve gastrectomy which can worsen GERD or cause de novo reflux, esophagitis, and Barrett´s metaplasia.
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Affiliation(s)
| | - Nicolás H Dreifuss
- Department of Surgery, Hospital Alemán of Buenos Aires , Buenos Aires, Argentina
| | - Marco G Patti
- Department of Medicine and Surgery, University of North Carolina , Chapel Hill, NC, USA
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23
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Wang BY, Huang JY, Chen HC, Lin CH, Lin SH, Hung WH, Cheng YF. The comparison between adenocarcinoma and squamous cell carcinoma in lung cancer patients. J Cancer Res Clin Oncol 2020; 146:43-52. [PMID: 31705294 DOI: 10.1007/s00432-019-03079-8] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/03/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are several studies comparing the difference between adenocarcinoma (AC) and squamous cell carcinoma (SqCC) of lung cancer. However, seldom studies compare the different overall survival (OS) between AC and SqCC at same clinical or pathological stage. The aim of the study was to investigate the 5-year OS between AC and SqCC groups. METHODS Data were obtained from the Taiwan Society of Cancer Registry. There were 48,296 non-small cell lung cancer (NSCLC) patients analyzed between 2009 and 2014 in this retrospective study. We analyzed both the AC and SqCC groups by age, gender, smoking status, Charlson co-morbidity index (CCI) score, clinical TNM stage, pathological stage, tumor location, histologic grade, pleura invasion, performance status, treatment, stage-specific 5-year OS rate in each clinical stage I-IV and causes of death. We used propensity score matching to reduce the bias. RESULTS The AC and SqCC groups are significantly different in age, gender, smoking status, CCI score, clinical TNM stage, pathological stage, tumor location, histologic grade, pleura invasion, performance status, treatment, stage-specific 5-year OS rate in each clinical stage and causes of death (p < 0.0001). The stage-specific 5-year OS rates between AC and SqCC were 79% vs. 47% in stage I; 50% vs. 32% in stage II; 27% vs. 13% in stage III; 6% vs. 2% in stage IV, respectively (all p values < 0.0001). CONCLUSIONS AC and SqCC have significantly different outcomes in lung cancer. We suggest that these two different cancers should be analyzed separately to provide more precise outcomes in the future.
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Affiliation(s)
- Bing-Yen Wang
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua County 500, Changhua City, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Heng-Chung Chen
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua County 500, Changhua City, Taiwan
| | - Ching-Hsiung Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Taiwan
| | - Sheng-Hao Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Taiwan
| | - Wei-Heng Hung
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua County 500, Changhua City, Taiwan
| | - Ya-Fu Cheng
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua County 500, Changhua City, Taiwan.
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24
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Jiang K, Jiang X, Wen Y, Liao L, Liu FB. Relationship between long-term use of proton pump inhibitors and risk of gastric cancer: A systematic analysis. J Gastroenterol Hepatol 2019; 34:1898-1905. [PMID: 31206764 DOI: 10.1111/jgh.14759] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/25/2019] [Accepted: 05/29/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM This study aims to systematically analyze the effect of long-term therapy with proton pump inhibitors (PPIs) on the risk of gastric cancer. METHODS PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), and China biomedical literature database (CBM) were searched for studies before February 2019. We evaluated the quality of the included articles through the Newcastle-Ottawa Scale and gathered relevant data to calculate the pooled odds ratio (OR) through Stata14.0. RESULTS Seven relevant articles conformed to the inclusion criteria; 943 070 patients were included. The pooled OR was 2.50; 95% CI (1.74, 3.85); the subgroup analysis results showed that patients who had used PPIs for more than 36 months were most likely to develop gastric cancer, and an increased risk was observed among patients after Helicobacter pylori eradication. Noncardia gastric cancer was more likely to develop. CONCLUSIONS Long-term use of PPIs can possibly increase the risk of gastric cancer even among patients after H. pylori eradication; in particular, for noncardia gastric cancer, the risk increases with longer durations of PPI use. Due to the limited number of studies, more high-quality studies are required to be designed.
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Affiliation(s)
- Kailin Jiang
- First College of Clinic Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaotao Jiang
- First College of Clinic Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yi Wen
- First College of Clinic Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Liu Liao
- First College of Clinic Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Feng-Bin Liu
- Department of Gastroenterology, First Affiliation Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
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25
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Petrick JL, Jensen BW, Sørensen TI, Cook MB, Baker JL. Overweight Patterns Between Childhood and Early Adulthood and Esophageal and Gastric Cardia Adenocarcinoma Risk. Obesity (Silver Spring) 2019; 27:1520-1526. [PMID: 31380608 PMCID: PMC6707875 DOI: 10.1002/oby.22570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/23/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Esophageal adenocarcinoma (EA) and gastric cardia adenocarcinoma (GCA) are among the most rapidly increasing cancers in Western countries. Elevated BMI in adulthood is a known risk factor, but associations in early life are unclear. METHODS This study assessed weight change between childhood and early adulthood in relation to EA/GCA. Measured weights and heights during childhood (7-13 years) and early adulthood (17-26 years) were available for 64,695 young men from the Copenhagen School Health Records Register and the Danish Conscription Database. Individuals were categorized as having normal weight or overweight. Linkage with the Danish Cancer Registry identified 275 EA/GCA cases. Hazard ratios (HR) and 95% CI were estimated using Cox proportional hazards regression. RESULTS The risk of EA/GCA was 2.5 times higher in men who were first classified as having overweight at age 7 (HR = 2.49; 95% CI: 1.50-4.14) compared with men who were never classified as having overweight. Men who had persistent overweight at ages 7 and 13 and in early adulthood had an EA/GCA risk that was 3.2 times higher (HR = 3.18; 95% CI: 1.57-6.44). However, there was little evidence of increased EA/GCA risk for men with overweight during childhood and subsequent remittance by early adulthood. CONCLUSIONS Persistent overweight in early life is associated with increased EA/GCA risk, which declines if body weight is reduced.
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Affiliation(s)
- Jessica L. Petrick
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Britt Wang Jensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Thorkild I.A. Sørensen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Public Health, Section of Epidemiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael B. Cook
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Jennifer L. Baker
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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26
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Yang X, Zhang T, Yin X, Yuan Z, Chen H, Plymoth A, Jin L, Chen X, Lu M, Ye W. Adult height, body mass index change, and body shape change in relation to esophageal squamous cell carcinoma risk: A population-based case-control study in China. Cancer Med 2019; 8:5769-5778. [PMID: 31369212 PMCID: PMC6746109 DOI: 10.1002/cam4.2444] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 12/24/2022] Open
Abstract
The relationship between risk of esophageal squamous cell carcinoma (ESCC) and adult height, changes in individual body mass index (BMI) and body shape is not established. We performed a large population‐based case‐control study, which enrolled a total of 1414 ESCC cases and 1989 controls in a high‐incidence area in China. Using face‐to‐face interview with a structured questionnaire, information on participants' heights, weights, and perceived body shapes at 20 years of age was collected. Additionally, data on weight and perceived body shape among the same participants 10 years prior to ascertainment were collected using the same method. Odd ratios (ORs) of ESCC risk in relation to BMI and body shape were estimated using unconditional logistic regression models. The adjusted results indicated that ESCC risk in adults rapidly rose as height increased, plateauing at 170 cm among men and 157 cm among women. Among participants who were underweight, normal weight, or thinner than body shape 4, body weight loss was associated with increased risk of ESCC, and body weight gain was associated with decreased incidence of ESCC (ORs ranging from 0.40 to 0.76). Notably, however, changes in body weight did not significantly affect ESCC risk among participants who were overweight, obese, or larger than body shape 3. Maintaining a fit body shape and a reasonable BMI is advisable and of vital importance to reduce the risk of ESCC, especially in high‐risk areas.
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Affiliation(s)
- Xiaorong Yang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China
| | - Tongchao Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, China
| | - Xiaolin Yin
- Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, China
| | - Ziyu Yuan
- Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Hui Chen
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China
| | - Amelie Plymoth
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Li Jin
- Fudan University Taizhou Institute of Health Sciences, Taizhou, China.,State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai, China
| | - Xingdong Chen
- Fudan University Taizhou Institute of Health Sciences, Taizhou, China.,State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai, China
| | - Ming Lu
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China.,Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Weimin Ye
- Fudan University Taizhou Institute of Health Sciences, Taizhou, China.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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27
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Hua RX, Zhuo Z, Zhu J, Zhang SD, Xue WQ, Li XZ, He J, Jia WH. LIG3 gene polymorphisms and risk of gastric cancer in a Southern Chinese population. Gene 2019; 705:90-94. [PMID: 31034940 DOI: 10.1016/j.gene.2019.04.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 04/07/2019] [Accepted: 04/25/2019] [Indexed: 02/07/2023]
Abstract
DNA ligase III (LIG3) has been implicated in the etiology of cancer. However, few studies have accessed the association of LIG3 single nucleotide polymorphisms (SNPs) with gastric cancer risk, especially in Chinese population. The current study was undertaken to investigate contribution of LIG3 gene polymorphisms to gastric cancer risk. We first applied TaqMan assay to genotype three LIG3 gene SNPs (rs1052536 C > T, rs3744356 C > T, rs4796030 A > C) in 1142 patients with gastric cancer and 1173 healthy controls. And then, we adopted unconditional multivariate logistic regression analysis to estimate the association between LIG3 SNP genotypes and gastric cancer risk. In all, no positive association was found between the three LIG3 SNPs and gastric cancer risk in single locus analysis or combined risk genotypes analysis. However, compared with participants with rs4796030 AA genotype, participants with the AC/CC had a decreased risk of developing tumors from cardia at an adjusted OR of 0.68 (95% CI = 0.48-0.96, P = 0.026). In addition, we found that participants harboring 2-3 risk genotypes were at a significantly increased risk of developing tumor from cardia (adjusted OR = 1.63, 95% CI = 1.16-2.28, P = 0.005). These results suggest that genetic variations in LIG3 gene may play a weak role in modifying the risk of gastric cancer. Future functional studies should be performed to elucidate the biological role of LIG3 polymorphisms in gastric cancer carcinogenesis.
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Affiliation(s)
- Rui-Xi Hua
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Experimental Research, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, China; Department of Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Zhenjian Zhuo
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Jinhong Zhu
- Department of Clinical Laboratory, Molecular Epidemiology Laboratory, Harbin Medical University Cancer Hospital, Harbin 150040, Heilongjiang, China
| | - Shao-Dan Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Experimental Research, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, China
| | - Wen-Qiong Xue
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Experimental Research, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, China
| | - Xi-Zhao Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Experimental Research, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, China
| | - Jing He
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Experimental Research, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, China; Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China.
| | - Wei-Hua Jia
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Experimental Research, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, China.
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28
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Affiliation(s)
- Sri G Thrumurthy
- Department of Surgery, Epsom and St Helier University Hospitals, Sutton SM5 1AA, UK
- Department of Surgery, Royal Marsden Hospital, London SW3 6JJ, UK
| | - M Asif Chaudry
- Department of Surgery, Royal Marsden Hospital, London SW3 6JJ, UK
| | | | - Muntzer Mughal
- Department of Surgery, University College Hospital London, London, UK
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29
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Maev IV, Yurenev GL, Mironova EM, Yureneva-Thorzhevskaya TV. Phenotype of obesity and gastroesophageal reflux disease in the context of comorbidity in patients with cardiovascular diseases. TERAPEVT ARKH 2019; 91:126-133. [PMID: 31094183 DOI: 10.26442/00403660.2019.02.000099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The relevance of studying such problems as gastroesophageal reflux disease (GERD) and obesity is caused by their high prevalence in the developed countries of the world. Epidemiological data indicate that obesity is a significant risk factor for developing GERD due to increased intra-abdominal pressure and gastroesophageal gradient, slowing of gastric evacuation and formation of hiatal hernia. Abdominal obesity increases the likelihood of complications of GERD: erosive esophagitis, Barrett's esophagus and adenocarcinoma. This fact is connected with humoral influences: increased production of pro-inflammatory cytokines and leptin, and decreased secretion of adiponectin. Treatment of comorbid patients requires higher dosages and longer courses of antisecretory medicines, and an additional prescription of ursodeoxycholic acid.
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Affiliation(s)
- I V Maev
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - G L Yurenev
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - E M Mironova
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - T V Yureneva-Thorzhevskaya
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of the Russian Federation, Moscow, Russia
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30
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Zhang FX, Miao Y, Ruan JG, Meng SP, Dong JD, Yin H, Huang Y, Chen FR, Wang ZC, Lai YF. Association Between Nitrite and Nitrate Intake and Risk of Gastric Cancer: A Systematic Review and Meta-Analysis. Med Sci Monit 2019; 25:1788-1799. [PMID: 30850575 PMCID: PMC6420797 DOI: 10.12659/msm.914621] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 01/22/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Studies have shown inconsistent associations of nitrite and nitrate intake with the risk of gastric cancer or its associated mortality. We performed a meta-analysis of observational studies to evaluate the correlation of nitrite and nitrate intake with the risk of gastric cancer. MATERIAL AND METHODS We searched for studies reporting effect estimates and 95% confidence intervals (CIs) of gastric cancer in PubMed, EMBASE, and the Cochrane Library through November 2018. The summary results of the included studies were pooled using a random-effects model. RESULTS Eighteen case-control and 6 prospective cohort studies recruiting 800 321 participants were included in this study. The summary results indicated that the highest (odds ratio [OR], 1.27; 95%CI, 1.03-1.55; P=0.022) or moderate (OR: 1.12; 95%CI, 1.01-1.26; P=0.037) nitrite intake were associated with a higher risk of gastric cancer. However, we noted that high (OR, 0.81; 95%CI, 0.68-0.97; P=0.021) or moderate (OR, 0.86; 95%CI, 0.75-0.99; P=0.036) nitrate intakes were associated with a reduced risk of gastric cancer. These associations differed when stratified by publication year, study design, country, the percentage of male participants, assessment of exposure, adjusted model, and study quality. CONCLUSIONS High or moderate nitrite intake was associated with higher risk of gastric cancer, whereas high or moderate nitrate intake was correlated with lower risk of gastric cancer.
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Affiliation(s)
- Fei-Xiong Zhang
- Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, P.R. China
| | - Yu Miao
- Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, P.R. China
| | - Ji-Gang Ruan
- Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, P.R. China
| | - Shu-Ping Meng
- Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, P.R. China
| | - Jian-Da Dong
- Department of Pathology, Ningxia Medical University, Yinchuan, Ningxia, P.R. China
| | - Hua Yin
- Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, P.R. China
| | - Ying Huang
- Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, P.R. China
| | - Fu-Rong Chen
- Ningxia Medical University, Yinchuan, Ningxia, P.R. China
| | | | - Ya-Fang Lai
- Department of Gastroenterology, Ordos Center Hospital, Ordos, Inner Mongolia, P.R. China
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31
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Liu F, Zhou R, Jiang F, Liu G, Li K, Zhu G. Proposal of a Nomogram for Predicting Survival in Patients with Siewert Type II Adenocarcinoma of the Esophagogastric Junction After Preoperative Radiation. Ann Surg Oncol 2019; 26:1292-1300. [PMID: 30805805 PMCID: PMC6456486 DOI: 10.1245/s10434-019-07237-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Indexed: 12/12/2022]
Abstract
Background Preoperative radiotherapy tends to be more frequently used for patients with adenocarcinoma of the esophagogastric junction (AEG); however, the prognostic values of postoperative pathologic characteristics in these patients remain unclear. This study aimed to examine the outcomes in Siewert type II AEG patients receiving preoperative radiotherapy to identify the predictive factors for overall survival (OS). Methods and Results A total of 1818 AEG patients undergoing preoperative radiotherapy were reviewed. Univariate analyses showed that age, sex, histology, tumor grade, positive lymph node (PLN), lymph node ratio, and log odds of positive lymph nodes (LODDS) were significantly correlated with OS; however, only age, grade, PLN, and LODDS were identified as independent risk factors in a multivariate regression model. Subsequently, patients were randomly grouped into training and validation cohorts (1:1 ratio), and the beta coefficients of these variables in the training set were used to generate the nomogram. The composite nomogram showed improved prognostic accuracy in the training, validation, and entire cohorts compared with that of TNM stage alone. Conclusions In conclusion, our proposed nomogram represents a promising tool for estimating OS in Siewert type II AEG patients after preoperative radiotherapy. Electronic supplementary material The online version of this article (10.1245/s10434-019-07237-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Feng Liu
- Department of Geriatrics, National Clinical Key Specialty, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, Guangdong, China
| | - Rui Zhou
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Funeng Jiang
- Department of Geriatrics, National Clinical Key Specialty, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, Guangdong, China
| | - Guolong Liu
- Department of Geriatrics, National Clinical Key Specialty, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, Guangdong, China
| | - Kangbao Li
- Department of Geriatrics, National Clinical Key Specialty, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, Guangdong, China
| | - Guodong Zhu
- Department of Geriatrics, National Clinical Key Specialty, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, Guangdong, China.
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Qumseya B. Barrett esophagus: Current standards and future directions. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2018. [DOI: 10.1016/j.tgie.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Li N, Petrick JL, Steck SE, Bradshaw PT, McClain KM, Niehoff NM, Engel LS, Shaheen NJ, Risch HA, Vaughan TL, Wu AH, Gammon MD. A pooled analysis of dietary sugar/carbohydrate intake and esophageal and gastric cardia adenocarcinoma incidence and survival in the USA. Int J Epidemiol 2017; 46:1836-1846. [PMID: 29040685 PMCID: PMC5837717 DOI: 10.1093/ije/dyx203] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/17/2017] [Accepted: 08/29/2017] [Indexed: 02/06/2023] Open
Abstract
Background During the past 40 years, esophageal/gastric cardia adenocarcinoma (EA/GCA) incidence increased in Westernized countries, but survival remained low. A parallel increase in sugar intake, which may facilitate carcinogenesis by promoting hyperglycaemia, led us to examine sugar/carbohydrate intake in association with EA/GCA incidence and survival. Methods We pooled 500 EA cases, 529 GCA cases and 2027 controls from two US population-based case-control studies with cases followed for vital status. Dietary intake, assessed by study-specific food frequency questionnaires, was harmonized and pooled to estimate 12 measures of sugar/carbohydrate intake. Multivariable-adjusted odds ratios (ORs) and hazard ratios [95% confidence intervals (CIs)] were calculated using multinomial logistic regression and Cox proportional hazards regression, respectively. Results EA incidence was increased by 51-58% in association with sucrose (ORQ5vs.Q1 = 1.51, 95% CI = 1.01-2.27), sweetened desserts/beverages (ORQ5vs.Q1 = 1.55, 95% CI = 1.06-2.27) and the dietary glycaemic index (ORQ5vs.Q1 = 1.58, 95% CI = 1.13-2.21). Body mass index (BMI) and gastro-esophageal reflux disease (GERD) modified these associations (Pmultiplicative-interaction ≤ 0.05). For associations with sucrose and sweetened desserts/beverages, respectively, the OR was elevated for BMI < 25 (ORQ4-5vs.Q1-3 = 1.79, 95% CI = 1.26-2.56 and ORQ4-5vs.Q1-3 = 1.45, 95% CI = 1.03-2.06), but not BMI ≥ 25 (ORQ4-5vs.Q1-3 = 1.05, 95% CI = 0.76-1.44 and ORQ4-5vs.Q1-3 = 0.85, 95% CI = 0.62-1.16). The EA-glycaemic index association was elevated for BMI ≥ 25 (ORQ4-5vs.Q1-3 = 1.38, 95% CI = 1.03-1.85), but not BMI < 25 (ORQ4-5vs.Q1-3 = 0.88, 95% CI = 0.62-1.24). The sucrose-EA association OR for GERD < weekly was 1.58 (95% CI = 1.16-2.14), but for GERD ≥ weekly was 1.01 (95% CI = 0.70-1.47). Sugar/carbohydrate measures were not associated with GCA incidence or EA/GCA survival. Conclusions If confirmed, limiting intake of sucrose (e.g. table sugar), sweetened desserts/beverages, and foods that contribute to a high glycaemic index, may be plausible EA risk reduction strategies.
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Affiliation(s)
- Nan Li
- Department of Epidemiology, University of North Carolina at Chapel Hill, NC, USA
| | - Jessica L Petrick
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Susan E Steck
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Patrick T Bradshaw
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Kathleen M McClain
- Department of Epidemiology, University of North Carolina at Chapel Hill, NC, USA
| | - Nicole M Niehoff
- Department of Epidemiology, University of North Carolina at Chapel Hill, NC, USA
| | - Lawrence S Engel
- Department of Epidemiology, University of North Carolina at Chapel Hill, NC, USA
| | - Nicholas J Shaheen
- Department of Epidemiology, University of North Carolina at Chapel Hill, NC, USA
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, NC, USA
| | - Harvey A Risch
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Newhaven, CT, USA
| | - Thomas L Vaughan
- Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA and
| | - Anna H Wu
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Marilie D Gammon
- Department of Epidemiology, University of North Carolina at Chapel Hill, NC, USA
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Abstract
Obesity is now epidemic worldwide, and an increasing number of patients have undergone a weight-loss procedure. Although obesity is a risk factor for esophageal cancer, there are few reports on esophagectomy after bariatric procedures. Careful understanding of the patient's gastroesophageal anatomy as a result of the bariatric procedure and attention to the creation of the esophageal replacement conduit are fundamental for the success of esophagectomy after bariatric surgery.
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Affiliation(s)
- Katy A Marino
- Division of Thoracic Surgery, University of Tennessee Health Science Center, 1325 Eastmoreland Avenue, Suite #460, Memphis, TN 38104, USA
| | - Benny Weksler
- Division of Thoracic Surgery, University of Tennessee Health Science Center, 1325 Eastmoreland Avenue, Suite #460, Memphis, TN 38104, USA.
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Hollis AC, Quinn LM, Hodson J, Evans E, Plowright J, Begum R, Mitchell H, Hallissey MT, Whiting JL, Griffiths EA. Prognostic significance of tumor length in patients receiving esophagectomy for esophageal cancer. J Surg Oncol 2017; 116:1114-1122. [PMID: 28767142 DOI: 10.1002/jso.24789] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 07/05/2017] [Indexed: 12/15/2022]
Abstract
AIMS We investigated the prognostic value of tumor length measurements acquired both from pre-operative imaging and post-operative pathology in esophageal cancer. METHODS Tumor lengths were examined retrospectively for 389 esophagectomy patients with respect to Endoscopy, EUS (Endoscopic Ultrasound), CT and PET-CT, and pathology. Correlations between the measurements on the different approaches were assessed, and associations between tumor length and survival were analyzed. RESULTS Only the tumor lengths assessed on pathology were found to be significantly associated with overall (P = 0.001) and recurrence free (P < 0.001) survival on univariable analysis. The median overall survival was 47.1 months in those patients with tumor lengths <3.0 cm, falling to 19.6 and 18.0 months in those with 3.0-4.4 and 4.5+ cm tumors, respectively, demonstrating a reduction in patient survival at a tumor length of around 3 cm. Tumor length on pathology was significantly correlated with tumor differentiation and both T- and N-categories. After accounting for these factors, tumor length on pathology was a significant independent predictor of recurrence-free (P = 0.016), but not overall (P = 0.128) survival. CONCLUSIONS Tumor lengths on pathology were found to be the most predictive of patient outcome. However, after accounting for other tumor-related factors, tumor length only resulted in a marginal improvement in predictive accuracy.
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Affiliation(s)
- Alexander C Hollis
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Lauren M Quinn
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - James Hodson
- Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Emily Evans
- Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - James Plowright
- Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ruksana Begum
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Harriet Mitchell
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mike T Hallissey
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - John L Whiting
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Hirata Y, Sezaki T, Tamura-Nakano M, Oyama C, Hagiwara T, Ishikawa T, Fukuda S, Yamada K, Higuchi K, Dohi T, Kawamura YI. Fatty acids in a high-fat diet potentially induce gastric parietal-cell damage and metaplasia in mice. J Gastroenterol 2017; 52:889-903. [PMID: 27873093 DOI: 10.1007/s00535-016-1291-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/14/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Obesity is associated with risk of adenocarcinoma in the proximal stomach. We aimed to identify the links between dietary fat and gastric premalignant lesions. METHODS C57BL/6 mice were fed high fat diet (HFD), and gastric mucosa was histologically analysed. Morphological changes were also analysed using an electron microscope. Transcriptome analysis of purified parietal cells was performed, and non-parietal gastric corpus epithelial cells were subjected to single-cell gene-expression profiling. Composition of gastric contents of HFD-fed mice was compared with that of the HFD itself. Lipotoxicity of free fatty acids (FFA) was examined in primary culture and organoid culture of mouse gastric epithelial cells in vitro, as well as in vivo, feeding FFA-rich diets. RESULTS During ~8-20 weeks of HFD feeding, the parietal cells of the stomach displayed mitochondrial damage, and a total of 23% of the mice developed macroscopically distinct metaplastic lesions in the gastric corpus mucosa. Transcriptome analysis of parietal cells indicated that feeding HFD enhanced pathways related to cell death. Histological analysis and gene-expression profiling indicated that the lesions were similar to previously reported precancerous lesions identified as spasmolytic polypeptide-expressing metaplasia. FFAs, including linoleic acid with refluxed bile acids were detected in the stomachs of the HFD-fed mice. In vitro, FFAs impaired mitochondrial function and decreased the viability of parietal cells. In vivo, linoleic acid-rich diet, but not stearic acid-rich diet induced parietal-cell loss and metaplastic changes in mice. CONCLUSIONS Dietary lipids induce parietal-cell damage and may lead to the development of precancerous metaplasia.
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Affiliation(s)
- Yuki Hirata
- Department of Gastroenterology, The Research Center for Hepatitis and Immunology, Research Institute, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan.,2nd Department of Internal Medicine, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Takuhito Sezaki
- Department of Gastroenterology, The Research Center for Hepatitis and Immunology, Research Institute, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan
| | - Miwa Tamura-Nakano
- Communal Laboratory, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Chinatsu Oyama
- Communal Laboratory, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Teruki Hagiwara
- Department of Gastroenterology, The Research Center for Hepatitis and Immunology, Research Institute, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan
| | - Takamasa Ishikawa
- Institute for Advanced Biosciences, Keio University, 246-2 Mizukami, Kakuganji, Tsuruoka, Yamagata, 997-0052, Japan
| | - Shinji Fukuda
- Institute for Advanced Biosciences, Keio University, 246-2 Mizukami, Kakuganji, Tsuruoka, Yamagata, 997-0052, Japan
| | - Kazuhiko Yamada
- Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Taeko Dohi
- Department of Gastroenterology, The Research Center for Hepatitis and Immunology, Research Institute, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan.
| | - Yuki I Kawamura
- Department of Gastroenterology, The Research Center for Hepatitis and Immunology, Research Institute, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan.
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Fan J, Wang J, Wang S, Abnet CC, Qiao Y, Taylor PR. Body mass index and risk of gastric cancer: A 30-year follow-up study in the Linxian general population trial cohort. Cancer Sci 2017; 108:1667-1672. [PMID: 28594442 PMCID: PMC5543512 DOI: 10.1111/cas.13292] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/24/2017] [Accepted: 05/31/2017] [Indexed: 01/15/2023] Open
Abstract
Although a number of previous studies have noted either positive or no association for body mass index (BMI) and gastric cancer risk, little evidence exists in the Chinese population. We prospectively examined the associations of BMI with risk of gastric cancer in the Linxian General Population Trial cohort, with 29 584 healthy adults enrolled in 1985 and followed through to the end of 2014. Body weight and height were measured during physical examination at baseline and BMI was calculated as weight in kilograms divided by height in meters squared. Body mass index from 138 subjects was missing, and a total of 29 446 participants were included in the final analysis. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals. During 30 years of follow-up, we confirmed 1716 newly diagnosed gastric cardia adenocarcinoma (GCA) cases and 626 new gastric non-cardia adenocarcinoma (GNCA) cases. Overall, compared to the lowest quartile (BMI <20.32 kg/m2 ), subjects in the fourth quartile (BMI ≥23.31 kg/m2 ) subjects had lower risk of developing GNCA (hazard ratio, 0.65; 95% confidence interval, 0.51-0.83). Age- and sex-specific analyses showed that this protective effect was only observed in men and older (52 + years) persons. No associations were observed for BMI with GCA incidence. Higher BMI was associated with decreased risk of GNCA in this population, particularly in men and older persons. Future studies are needed to confirm these findings. The trial is registered with ClinicalTrials.gov: NCT00342654.
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Affiliation(s)
- Jin‐hu Fan
- Department of Cancer EpidemiologyCancer Institute/HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jian‐bing Wang
- Department of Epidemiology and Health StatisticsSchool of Public HealthZhejiang UniversityHangzhouChina
| | - Shao‐ming Wang
- Department of Cancer EpidemiologyCancer Institute/HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Christian C. Abnet
- Nutritional Epidemiology BranchDivision of Cancer Epidemiology and GeneticsNational Cancer InstituteRockvilleMarylandUSA
| | - You‐lin Qiao
- Department of Cancer EpidemiologyCancer Institute/HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Philip R. Taylor
- Genetic Epidemiology BranchDivision of Cancer Epidemiology and GeneticsNational Cancer InstituteRockvilleMarylandUSA
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Manfredelli S, Delhorme JB, Venkatasamy A, Gaiddon C, Brigand C, Rohr S, Romain B. Could a Feeding Jejunostomy be Integrated into a Standardized Preoperative Management of Oeso-gastric Junction Adenocarcinoma? Ann Surg Oncol 2017; 24:3324-3330. [DOI: 10.1245/s10434-017-5945-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Indexed: 12/13/2022]
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39
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Qumseya BJ, Wani S, Gendy S, Harnke B, Bergman JJ, Wolfsen H. Disease Progression in Barrett's Low-Grade Dysplasia With Radiofrequency Ablation Compared With Surveillance: Systematic Review and Meta-Analysis. Am J Gastroenterol 2017; 112:849-865. [PMID: 28374819 DOI: 10.1038/ajg.2017.70] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 01/28/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Barrett's esophagus (BE) is the only identifiable premalignant condition for esophageal adenocarcinoma (EAC). Management of BE with low-grade dysplasia continues to be controversial. We aimed to conduct a systematic review and meta-analysis comparing the risk of progression to high-grade dysplasia or EAC among patients with BE with low-grade dysplasia treated with radiofrequency ablation (RFA) compared with surveillance endoscopy. METHODS Our search included Medline, Embase, and Cochrane Central, was limited to English language articles, and was last searched on 31 December 2015. Studies were reviewed by title and abstract, and then full text by two independent reviewers. Two independent reviewers extracted data. Differences were resolved by consensus. The primary outcome of interest was the relative risk of disease progression among patients with BE with low-grade dysplasia treated with RFAcompared with surveillance. RESULTS Our search resulted in 2,029 citations, 19 studies were included in the final analysis, totaling 2,746 patients. Relative risk of disease progression in RFA compared with surveillance was 0.14% (95% confidence interval: 0.04-0.45), P=0.001. This measure was stable when only all studies were included. Absolute risk reduction was 10.9% and the number needed to treat was 9.2. Results were stable over several quality measures, overtime, and when excluding randomized trials. The cumulative rate of progression to high-grade dysplasia/EAC was lower in RFA compared with surveillance (1.7% vs. 12.6%, P<0.001). CONCLUSIONS Similarly, the incidence rate of progression among patients with surveillance was significantly higher from those treated with RFA (0.022 vs. 0.005, P<0.001). RFA results in a significant reduction risk of disease progression to high-grade dysplasia/EAC among patients with BE with low-grade dysplasia.
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Affiliation(s)
- Bashar J Qumseya
- Division of Gastroenterology and Hepatology, Archbold Medical Group/Florida State University, Thomasville, Georgia, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado, Aurora, Colorado, USA
| | - Sherif Gendy
- Florida A &M University, Tallahassee, Florida, USA
| | - Ben Harnke
- Division of Gastroenterology and Hepatology, University of Colorado, Aurora, Colorado, USA
| | - Jacques J Bergman
- Department of Gastroenterology and Hepatology, Academic Medical Centre Amsterdam, Amsterdam, Netherlands
| | - Herbert Wolfsen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
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40
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Zheng J, Zhao M, Li J, Lou G, Yuan Y, Bu S, Xi Y. Obesity-associated digestive cancers: A review of mechanisms and interventions. Tumour Biol 2017; 39:1010428317695020. [PMID: 28351315 DOI: 10.1177/1010428317695020] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The prevalence of obesity has steadily increased over the past few decades. Previous studies suggest that obesity is an oncogenic factor and that over 20% of all cancers are obesity-related. Among such cancers, digestive system malignancies (including esophageal adenocarcinomas, colorectal cancers, and cancers of the gastric cardia, liver, and pancreas) are reported most frequently. While the 5-year survival rates of cancers of the breast and prostate are 90%, that rate is only 45% for digestive cancers. In this review, the mechanisms of obesity-associated digestive cancers are discussed, with an emphasis on obesity-related gene mutations, insulin and insulin-like growth factor signaling pathways, chronic inflammation, and altered adipokine levels. Evidence that these factors often function interdependently rather than independently in carcinogenesis is presented. Recommended interventions that may reduce the burden of obesity-associated digestive cancers, such as participation in physical activity, diet modulation, and calorie restriction, are also described.
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Affiliation(s)
- Jiachen Zheng
- Diabetes Center, Zhejiang Provincial Key Laboratory of Pathophysiology, Institute of Biochemistry and Molecular Biology, School of Medicine, Ningbo University, Ningbo, China
| | - Ming Zhao
- Diabetes Center, Zhejiang Provincial Key Laboratory of Pathophysiology, Institute of Biochemistry and Molecular Biology, School of Medicine, Ningbo University, Ningbo, China
| | - Jiahui Li
- Diabetes Center, Zhejiang Provincial Key Laboratory of Pathophysiology, Institute of Biochemistry and Molecular Biology, School of Medicine, Ningbo University, Ningbo, China
| | - Guoying Lou
- Diabetes Center, Zhejiang Provincial Key Laboratory of Pathophysiology, Institute of Biochemistry and Molecular Biology, School of Medicine, Ningbo University, Ningbo, China
| | - Yanyan Yuan
- Diabetes Center, Zhejiang Provincial Key Laboratory of Pathophysiology, Institute of Biochemistry and Molecular Biology, School of Medicine, Ningbo University, Ningbo, China
| | - Shizhong Bu
- Diabetes Center, Zhejiang Provincial Key Laboratory of Pathophysiology, Institute of Biochemistry and Molecular Biology, School of Medicine, Ningbo University, Ningbo, China
| | - Yang Xi
- Diabetes Center, Zhejiang Provincial Key Laboratory of Pathophysiology, Institute of Biochemistry and Molecular Biology, School of Medicine, Ningbo University, Ningbo, China
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41
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Powell AGMT, Hughes DL, Brown J, Larsen M, Witherspoon J, Lewis WG. Esophageal cancer's 100 most influential manuscripts: a bibliometric analysis. Dis Esophagus 2017; 30:1-8. [PMID: 28375483 DOI: 10.1093/dote/dow039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Indexed: 12/11/2022]
Abstract
Bibliometric analysis highlights key topics and publications that have shaped the understanding and management of esophageal cancer (EC). Here, the 100 most cited manuscripts in the field of EC are analyzed. The Thomson Reuters Web of Science database with the search terms 'esophageal cancer' or 'esophageal carcinoma' or 'oesophageal cancer' or 'oesophageal carcinoma' or 'gastroscopy' was used to identify all English language full manuscripts for the study. The 100 most cited papers were further analyzed by topic, journal, author, year, and institution. A total of 121,556 eligible papers were returned and the median (range) citation number was 406.5 (1833 to 293). The most cited paper focused on the role of perioperative chemotherpy in EC (1833 citations). Gastroenterology published the highest number of papers (n = 15, 6362 citations) and The New England Journal of Medicine received the most citations (n = 12, 12125 citations). The country and year with the greatest number of publications were the USA (n = 50), and 1998, 1999, and 2000 (n = 7). The most ubiquitous topic was the pathology of EC (n = 66) followed by management of EC (n = 54), and studies related to EC prognosis (n = 44). The most cited manuscripts highlighted the pathology, management, and prognosis of EC and this bibliometirc review provides the most influential references serving as a guide to popular research themes.
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Affiliation(s)
- A G M T Powell
- Division of Cancer and Genetics, Cardiff University, University Hospital of Wales, Cardiff, UK.,Department of Surgery, University Hospital of Wales, Cardiff, UK
| | - D L Hughes
- Department of Surgery, University Hospital of Wales, Cardiff, UK
| | - J Brown
- Department of Surgery, University Hospital of Wales, Cardiff, UK
| | - M Larsen
- Department of Surgery, University Hospital of Wales, Cardiff, UK
| | - J Witherspoon
- Department of Surgery, University Hospital of Wales, Cardiff, UK
| | - W G Lewis
- Department of Surgery, University Hospital of Wales, Cardiff, UK
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Spreafico A, Coate L, Zhai R, Xu W, Chen ZF, Chen Z, Patel D, Tse B, Brown MC, Heist RS, Dodbiba L, Teichman J, Kulke M, Su L, Eng L, Knox J, Wong R, Darling GE, Christiani DC, Liu G. Early adulthood body mass index, cumulative smoking, and esophageal adenocarcinoma survival. Cancer Epidemiol 2017; 47:28-34. [DOI: 10.1016/j.canep.2016.11.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/21/2016] [Accepted: 11/26/2016] [Indexed: 01/16/2023]
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43
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Ichihara S, Uedo N, Gotoda T. Considering the esophagogastric junction as a 'zone'. Dig Endosc 2017; 29 Suppl 2:3-10. [PMID: 28425656 DOI: 10.1111/den.12792] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 12/21/2016] [Indexed: 02/08/2023]
Abstract
Siewert's classification of adenocarcinoma of the esophagogastric junction (EGJ) classifies tumors anatomically for determining the appropriate surgical technique. According to this classification, a type II tumor, true carcinoma of the cardia, is defined as a cancer within 1 cm proximal to 2 cm distal of the EGJ. Histological analysis indicates that the cardiac gland is present with a high degree of frequency between 1-2 cm to the gastric side and 1-2 cm to the esophageal side of the EGJ, which means that this zone can be considered as neither the stomach nor the esophagus but rather as a third zone known as the 'EGJ zone'. It has been suggested that there are multiple causes for development of adenocarcinoma in the EGJ zone. The TNM Classification of Malignant Tumours 7th Edition considers EGJ adenocarcinoma (EGJAC) occurring in the EGJ zone to be a part of esophageal adenocarcinoma (EAC). However, recent studies have indicated that EGJAC behaves differently from EAC and gastric carcinoma. Barrett's esophagus is now considered an important factor in the etiology of EGJAC, but, as yet, no studies have elucidated the differences between cancer arising from short-segment Barrett's esophagus and cancer of the gastric cardia. Thus, there is currently no clinical relevance to subdivision of adenocarcinoma in the EGJ zone into above or below the EGJ line.
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Affiliation(s)
- Shin Ichihara
- Department of Surgical Pathology, Sapporo Kosei General Hospital, Sapporo, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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Murphy CC, Claire Yang Y, Shaheen NJ, Hofstetter WL, Sandler RS. An age-period-cohort analysis of obesity and incident esophageal adenocarcinoma among white males. Dis Esophagus 2017; 30:1-8. [PMID: 27862652 PMCID: PMC5386785 DOI: 10.1111/dote.12526] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The incidence of esophageal adenocarcinoma (EAC) has increased in recent decades. Increases in incidence have been attributed to changes in the prevalence of risk factors for EAC; however, the extent to which these changes explain increases in EAC incidence has not been studied in detail. We used age-period-cohort analysis to estimate changes in the incidence of EAC among white males by age, time period, and birth cohort. Incidence rates per 100,000 individuals were analyzed from 1973 to 2012. Hierarchical Poisson models were used to estimate age, period, and cohort effects, whereby age-specific incidence rates were nested within periods and cohorts. The prevalence of obesity for each time period and birth cohort was included in the model as a fixed-effect. Incidence increased with advancing age (β = 0.12, P < 0.01). There were significant period and birth cohort effects, although the period effect was much larger than the cohort effect. The period effect decreased dramatically when obesity was included as a fixed effect, while the small cohort effect remained unchanged. Results suggest much of the increase in the incidence of EAC can be attributed to a period effect, which may be due to changes in the prevalence of obesity over time.
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Affiliation(s)
- Caitlin C. Murphy
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Y. Claire Yang
- Department of Sociology, University of North Carolina, Chapel Hill, North Carolina, USA,Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Nicholas J. Shaheen
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA,Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Wayne L. Hofstetter
- Department of Thoracic and Cardiovascular Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Robert S. Sandler
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA,Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, North Carolina, USA
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Petrick JL, Kelly SP, Liao LM, Freedman ND, Graubard BI, Cook MB. Body weight trajectories and risk of oesophageal and gastric cardia adenocarcinomas: a pooled analysis of NIH-AARP and PLCO Studies. Br J Cancer 2017; 116:951-959. [PMID: 28196067 PMCID: PMC5379141 DOI: 10.1038/bjc.2017.29] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/10/2017] [Accepted: 01/15/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Elevated body mass index (BMI, kg m-2) has been consistently associated with oesophageal adenocarcinoma (EA) and gastric cardia adenocarcinoma (GCA) incidence. However, effects of adiposity over the life course in relation to EA/GCA have not been thoroughly explored. METHODS We pooled two prospective cohort studies: NIH-AARP Diet and Health Study and Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, with data on 409 796 individuals (633 EA, 415 GCA). At baseline, participants reported their height and weight at ages 20 and 50 years, and current. Body mass index trajectories were determined using latent class analysis. Hazard ratios (HRs) and 95% confidence intervals (CI) were estimated using proportional hazards regression. RESULTS Compared with individuals with a BMI<25 kg m-2 at all time points, exceeding a BMI of 25 kg m-2 at age 20 was associated with increased risks of EA (HR=1.76, 95% CI: 1.35-2.29) and GCA (HR=1.62, 95% CI: 1.16-2.25). Similarly, a BMI trajectory of overweight (⩾25-<30 kg m-2) at age 20 progressing to obesity (⩾30 kg m-2) by age 50 was associated with increased risks of EA (HR=2.90, 95% CI: 1.67-5.04) and GCA (HR=4.07, 95% CI: 2.32-7.15), compared with individuals with a normal weight (⩾18.5-<25 kg m-2) trajectory. Weight gain of ⩾20 kg between age 20 and baseline was also associated with a two times increased risk of EA (HR=1.97, 95% CI: 1.43-2.73) and more modestly with GCA (HR=1.40, 95% CI: 0.96-2.05). CONCLUSIONS Being overweight in early adulthood and weight gain later in life were each associated with increased risks of EA and GCA. This underscores the potential of weight control programs for reducing EA and GCA risk.
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Affiliation(s)
- Jessica L Petrick
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Scott P Kelly
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Linda M Liao
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Barry I Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Michael B Cook
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
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Dixon JL, Copeland LA, Zeber JE, MacCarthy AA, Reznik SI, Smythe WR, Rascoe PA. Association between diabetes and esophageal cancer, independent of obesity, in the United States Veterans Affairs population. Dis Esophagus 2016; 29:747-751. [PMID: 26455587 DOI: 10.1111/dote.12402] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In the past 30 years, the incidence of esophageal adenocarcinoma (EAC) has increased more rapidly than any other cancer in the United States. The prevalence of obesity and diabetes mellitus has drastically increased as well. We explored the potential association between obesity, diabetes mellitus, and EAC. By means of retrospective interrogation of an administrative database from fiscal year 2005-2009, we identified two cohorts. The cancer cohort was defined as patients with adenocarcinoma of the distal esophagus or gastric cardia. The comparison cohort contained patients with gastroesophageal reflux disorder (GERD; diagnosis coupled with a procedure code for fundoplication). Patient data, including demographic measures, diagnoses of obesity, diabetes mellitus, dyslipidemia, alcohol abuse, and nicotine dependence were examined. A logistic regression model identified risk factors for development of EAC. The sample included 2,836 patients identified as having either EAC (1,704) or fundoplication with GERD (1,132). Although slightly higher percentages of the benign cohort were obese, the cancer cohort had more diabetics (30.8% vs. 14.8%; chi-square = 94.5; P < 0.0001). In a logistic regression analysis adjusting for comorbidity and lifestyle factors, diagnosis of diabetes mellitus was significantly associated with esophageal cancer as opposed to GERD without cancer (OR = 2.2; 95% confidence interval [CI] 1.7-2.8). Nicotine dependence was also identified as a risk factor (OR = 1.7; 95% CI 1.4-2.0). We identified a potential association between diabetes mellitus and adenocarcinoma of the esophagus or gastric cardia. This association appears to be independent of obesity. Additionally, nicotine dependence was identified as a risk factor for EAC.
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Affiliation(s)
- J L Dixon
- Surgery Service, Central Texas Veterans Health Care System, Temple, TX, USA.,Department of Surgery, Scott & White Healthcare, Temple, TX, USA
| | - L A Copeland
- Center for Applied Health Research, jointly sponsored by Central Texas Veterans Health Care System and by Scott & White Healthcare, Temple, TX, USA.,Texas A&M Health Science Center, College Station, TX, USA
| | - J E Zeber
- Center for Applied Health Research, jointly sponsored by Central Texas Veterans Health Care System and by Scott & White Healthcare, Temple, TX, USA.,Texas A&M Health Science Center, College Station, TX, USA
| | - A A MacCarthy
- Health Services Research & Development, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - S I Reznik
- Surgery Service, Central Texas Veterans Health Care System, Temple, TX, USA.,Department of Surgery, Scott & White Healthcare, Temple, TX, USA
| | - W R Smythe
- Surgery Service, Central Texas Veterans Health Care System, Temple, TX, USA.,Department of Surgery, Scott & White Healthcare, Temple, TX, USA
| | - P A Rascoe
- Surgery Service, Central Texas Veterans Health Care System, Temple, TX, USA. .,Department of Surgery, Scott & White Healthcare, Temple, TX, USA.
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Hua RX, Zhuo ZJ, Shen GP, Zhu J, Zhang SD, Xue WQ, Li XZ, Zhang PF, He J, Jia WH. Polymorphisms in the XPC gene and gastric cancer susceptibility in a Southern Chinese population. Onco Targets Ther 2016; 9:5513-5519. [PMID: 27660469 PMCID: PMC5019428 DOI: 10.2147/ott.s113055] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Previous studies have reported that XPC gene polymorphisms may modify the individual susceptibility to gastric cancer. In this case-control study with a total of 1,142 cases and 1,173 controls, four potentially functional polymorphisms were genotyped in the XPC gene (rs2228001 A>C, rs2228000 C>T, rs2607775 C>G, and rs1870134 G>C) by Taqman assays and their associations were analyzed with the risk of gastric cancer in a Southern Chinese population. No significant association between any of XPC polymorphisms and gastric cancer risk was detected except for a borderline association with the rs2228000 CT/TT genotype (crude odds ratio =0.86, 95% confidence interval =0.73-1.02, P=0.088) when compared to the rs2228000 CC genotype. Further stratified analysis revealed that the protective effect of rs2228000 CT/TT on the risk of gastric cancer was only significant among subjects older than 58 years. In summary, results indicated that genetic variations in XPC gene may play a weak effect on gastric cancer susceptibility in Southern Chinese population, which warrants further confirmation in larger prospective studies with different ethnic populations.
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Affiliation(s)
- Rui-Xi Hua
- Department of Experimental Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
- Department of Oncology, The First Affiliated Hospital of Sun Yat-sen University
| | - Zhen-Jian Zhuo
- Department of Traditional Chinese Medicine Research, Guangdong Province Key Laboratory of Pharmacodynamic Constituents of TCM and New Drugs Research, College of Pharmacy, Jinan University, Guangdong
| | - Guo-Ping Shen
- Department of Experimental Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
| | - Jinhong Zhu
- Department of Laboratory Medicine and Molecular Epidemiology Laboratory, Harbin Medical University Cancer Hospital, Heilongjiang
| | - Shao-Dan Zhang
- Department of Experimental Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
| | - Wen-Qiong Xue
- Department of Experimental Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
| | - Xi-Zhao Li
- Department of Experimental Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
| | - Pei-Fen Zhang
- Department of Experimental Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
| | - Jing He
- Department of Experimental Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong, People’s Republic of China
| | - Wei-Hua Jia
- Department of Experimental Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
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Li L, Gan Y, Li W, Wu C, Lu Z. Overweight, obesity and the risk of gallbladder and extrahepatic bile duct cancers: A meta-analysis of observational studies. Obesity (Silver Spring) 2016; 24:1786-802. [PMID: 27392541 DOI: 10.1002/oby.21505] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/25/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Epidemiological studies have repeatedly investigated the association between excess body weight and the risk of biliary tract cancer with inconsistent results. The objective of this study was to quantitatively assess the associations between overweight and obesity and the risk of biliary tract cancer. METHODS A comprehensive search of PubMed, Embase, Web of Science, and China National Knowledge Infrastructure databases up to August 2015 was conducted, and the reference lists of retrieved articles for additional relevant studies were manually searched. RESULTS Fourteen prospective cohort studies and 15 case-control studies were included in this meta-analysis. These studies included 11,448,397 participants (6,733 patients with gallbladder cancer [GBC] and 5,798 patients with extrahepatic bile duct cancer [EBDC]) with follow-up durations ranging from 5 to 23 years. Among overweight adults, the pooled RR was 1.17 (95% CI, 1.07-1.28) for GBC and 1.26 (95% CI, 1.14-1.39) for EBDC, and among people with obesity, the pooled RR was 1.62 (95% CI, 1.49-1.75) for GBC and 1.48 (95% CI, 1.21-1.81) for EBDC. Visual inspection of the funnel plots and the Begg's and the Egger's tests did not show enough evidence of publication bias. CONCLUSIONS Integrated evidence from this meta-analysis suggests that excess body weight is associated with a significantly increased risk of GBC and EBDC.
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Affiliation(s)
- Liqing Li
- Department of Management, School of Economics and Management, Jiangxi Science and Technology Normal University, Nanchang, Jiangxi, China
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenzheng Li
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chunmei Wu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Risks and Predictors of Gastric Adenocarcinoma in Patients with Gastric Intestinal Metaplasia and Dysplasia: A Population-Based Study. Am J Gastroenterol 2016; 111:1104-13. [PMID: 27185078 DOI: 10.1038/ajg.2016.188] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/18/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Gastric intestinal metaplasia and dysplasia are precursor lesions for adenocarcinoma. The risks of progression to malignancy from these lesions are not well characterized, particularly in the US populations. METHODS We identified 4,331 Kaiser Permanente Northern California members who were diagnosed with gastric intestinal metaplasia or dysplasia between 1997 and 2006 and followed them through December 2013. The incident rates of gastric adenocarcinoma, relative risks in comparison with the Kaiser Permanente general population, and predictors of progression to malignancy were investigated. RESULTS Among 4,146 individuals with gastric intestinal metaplasia and 141 with low-grade dysplasia with 24,440 person-years follow-up, 17 and 6 cases of gastric adenocarcinoma were diagnosed, respectively, after 1 year from the index endoscopy. The incidence rate of gastric adenocarcinoma was 0.72/1,000 person-years in patients with intestinal metaplasia, with a relative risk of 2.56 (95% confidence interval (CI) 1.49-4.10) compared with the Kaiser Permanente member population, and 7.7/1,000 person-years for low-grade dysplasia, with a relative risk of 25.6 (95% CI, 9.4-55.7). The median time for gastric intestinal metaplasia to progress to adenocarcinoma was 6.1 years, and for low-grade dysplasia, 2.6 years. Hispanic race/ethnicity and history of dysplasia were associated with significantly higher risk of progression to gastric adenocarcinoma. CONCLUSIONS Gastric intestinal metaplasia and dysplasia are significant predictors for gastric adenocarcinoma. The low risk for malignancy associated with intestinal metaplasia does not support routine endoscopic surveillance. However, surveillance should be considered in patients at higher risks, including those with suspicious endoscopic features, presence of dysplasia, and Hispanic race/ethnicity.
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50
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Zero-Inflated Models for Identifying Relationships Between Body Mass Index and Gastroesophageal Reflux Symptoms: A Nationwide Population-Based Study in China. Dig Dis Sci 2016; 61:1986-95. [PMID: 26993823 DOI: 10.1007/s10620-016-4113-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 03/04/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIM That obesity leads to gastroesophageal reflux is a widespread notion. However, scientific evidence for this association is limited, with no rigorous epidemiological approach conducted to address this question. This study examined the relationship between body mass index (BMI) and gastroesophageal reflux symptoms in a large population-representative sample from China. METHODS We performed a cross-sectional study in an age- and gender-stratified random sample of the population of five central regions in China. Participants aged 18-80 years completed a general information questionnaire and a Chinese version of the Reflux Disease Questionnaire. The zero-inflated Poisson regression model estimated the relationship between body mass index and gastroesophageal reflux symptoms. RESULTS Overall, 16,091 (89.4 %) of the 18,000 eligible participants responded. 638 (3.97 %) and 1738 (10.81 %) experienced at least weekly heartburn and weekly acid regurgitation, respectively. After adjusting for potential risk factors in the zero-inflated part, the frequency [odds ratio (OR) 0.66, 95 % confidence interval (95 % CI) 0.50-0.86, p = 0.002] and severity (OR 0.66, 95 % CI 0.50-088, p = 0.004) of heartburn in obese participants were statistically significant compared to those in normal participants. In the Poisson part, the frequency of acid regurgitation, overweight (OR 1.10, 95 % CI 1.01-1.21, p = 0.038) and obesity (OR 1.19, 95 % CI 1.04-1.37, p = 0.013) were statistically significant. BMI was strongly and positively related to the frequency and severity of gastroesophageal reflux symptoms. Additionally, gender exerted strong specific effects on the relationship between BMI and gastroesophageal reflux symptoms. CONCLUSIONS The severity and frequency of heartburn were positively correlated with obesity. This relationship was presented distinct in male participants only.
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