Gastrointestinal Malignancies

Screening for GI cancer and payment mechanisms

Objective To investigate the survey status of and people’s willingness to cancer screening, including cervical cancer, breast, gastric, colon cancer, lung cancer. Methods Survey on cancer screening status was performed, with the residents in Liaoning Province as research subjects, so as to investigate people’s satisfactory, willingness to cancer screening in primary hospitals, and causes of rejection to cancer screening. Results Questionnaires were successfully collected from 8 142 residents, totally. Of them, 1 034 female (22.3%) residents had participated in cervical cancer screening, and 862 female (18.6%) residents in breast cancer screening. Moreover, 576 of 8 142 individuals (7.1%) had experienced gastric cancer screening, 516 individuals (6.3%) had experienced colon cancer screening, and 614 individuals (7.5%) had joined in lung cancer screening. A total of 1 391 peoples (65.2%) voted organization and management as very satisfied item, 1 364 peoples (64.2%) voted skills and ability of doctors, 1 336 persons (62.8%) voted medical device, 1 383 persons (65.8%) voted examination results and follow-up service, and 1 388 persons (66.5%) voted examination expense. A total of 1 334 urban female residents (69.5%) would like to undergo cervical cancer screening in the next 1 to 3 years, and 1 348 urban women (70.2%) were willing to undergo breast cancer screening. In countryside, 1 989 women (73.3%) and 1 982 women(73.1%)were willing to participate cervical cancer screening and breast cancer screening respectively. In urban area, 2 265 peoples (62.9%) would like to join in gastric cancer screening, 2 247 peoples (62.4%) in colon cancer screening, 2 282 peoples (63.3%) in lung cancer screening in the next 1 to 3 years. In countryside, 2 945 peoples (64.9%) showed intention to undergo gastric cancer screening, 2 868 peoples (63.2%) had intention to have colon cancer screening and 2 929 peoples (64.5%) were willing to had examination for lung cancer. However, 3 712 individuals (45.6%) rejected to cancer screening for skills and ability of medical staff, 3 908 individuals (48.0%) for specificity of medical device in primary hospital, 1 760 persons (21.6%) for normativity of screening technology, 2 904 persons (35.7%) for reliability of examination results, 803 persons (9.9%) for follow-up diagnosis and treatment, 1 296 peoples (15.9%) for examination coast. Conclusions At present, screening rate of 5 kinds of cancer are low, and people show mediocre satisfactory to the participated screening items. Most of residents are willing to have cancer screening in the next 1 to 3 years, but they are doubting the accuracy of examination and skills and ability of medical staff. Therefore, intervention measures should be performed to promote screening rate of the 5 kinds of cancer according to the survey results, so as to improve prevention and control level of cancers. Key words: Cancer; Screening; Satisfaction; Willingness survey

The methyltransferase gene family is known for its diverse biological functions and critical role in tumorigenesis. This study aimed to identify these family genes in common gastrointestinal (GI) cancers using comprehensive methodologies. Gene identification involved analysis of scientific literature and insights from The Cancer Genome Atlas (TCGA) database. RNA sequencing (RNA-seq) data for colon, gastric, pancreatic, esophageal, and liver cancers were collected, processed, and normalized. Differential expression analysis was conducted using R software with the Limma package. Additionally, real-time PCR analysis was performed on 30 tumor and 30 normal tissue samples from patients with colon and gastric cancer. Pathway analysis was conducted via the EnrichR web tool, while survival analysis used Cox regression methods, and biomarker potential was assessed with the pROC package. Prognostic significance was evaluated by examining associations between gene expression, patient survival, and recurrence rates. The study also investigated diagnostic potential through receiver operating characteristic (ROC) analysis, and assessed how small molecules affect gene expression, with implications for drug resistance and sensitivity, analyzed via CCLE and GDSC datasets. Findings revealed METTL5 overexpression in colon, liver, esophagus, and pancreas cancers, while METTL7A was underexpressed in gastric, esophagus, liver, and colon cancers. METTL7B expression varied, being higher in gastric and esophagus cancers but lower in liver and colon cancers. Enrichment analysis identified pathways related to these genes, and survival analysis associated altered METTL7A and METTL5 expressions with poor prognosis and higher recurrence rates. These findings suggest that METTL genes could serve as predictive biomarkers in GI cancers, offering potential implications for patient prognosis and treatment response.

Background: Previous studies have extensively explored the correlation between preoperative skeletal muscle mass and long-term survival in gastrointestinal cancers. However, investigations into postoperative skeletal muscle mass alterations are limited. In gastrointestinal cancers, factors such as the tumor and surgical interventions can significantly impact dietary intake, nutritional status, and skeletal muscle mass, affecting postoperative body composition. This study aimed to examine these postoperative changes in skeletal muscle mass across different gastrointestinal cancers, including esophageal, gastric, and colorectum. Methods: This study encompassed 969 patients with Stage I-III esophageal (307 cases), gastric (278 cases), and colorectal (384 cases) cancers who underwent radical resection between 2005 and 2019. Skeletal muscle mass was quantified as the total psoas volume (TPV), measured using Ziostation2® imaging software from preoperative and postoperative CT scans at 1, 2, and 3 years. The study compared postoperative TPV trends across the different cancer types. Results: The study cohort comprised patients with esophageal (median age 66 years, 85% male), gastric (65 years, 60%), and colorectal cancers (67 years, 55%). Median BMIs were 21.5, 19.4, and 22.6 kg/m2, and median TPVs were 352.0, 305.8, and 309.5 cm3 for esophageal, gastric, and colorectal cancers, respectively. Esophageal cancer patients had significantly higher TPV and male predominance, while gastric cancer patients had notably lower BMI. Relative to preoperative TPV, the postoperative TPV at three years was 0.92, 0.91, and 0.96 for esophageal, gastric, and colorectal cancers, respectively. A year-by-year decrease in TPV was observed for each cancer type, with colorectal cancer demonstrating a less pronounced decrease compared to esophageal and gastric cancers (p<0.01). Stage-wise analysis revealed no significant differences among the cancer types. Regarding gender, no significant differences were noted between gastric and colorectal cancers, but esophageal cancer showed a more marked decrease in TPV in males compared to females. In recurrent cases, no significant TPV differences were observed in esophageal cancer, while recurrent gastric and colorectal cancers exhibited significant TPV decreases. Conclusions: The study indicates a general decline in TPV following gastrointestinal cancer surgery, with the extent of reduction varying according to the type of tumor and treatment. Citation Format: Yuto Maeda, Yuji Miyamoto, Mayuko Ohuchi, Yukiharu Hiyoshi, Naoya Yoshida, Hideo Baba. Changes in skeletal muscle mass after gastrointestinal cancer surgery by body composition [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2401.

BackgroundThe spatiotemporal epidemiological evidence supporting joint endoscopic screening for esophageal cancer (EC) and gastric cancer (GC) remains limited. This study aims to identify combined high-risk regions for EC and GC and determine optimal areas for joint and separate endoscopic screening.MethodsWe analyzed the association of incidence trends between EC and GC in cancer registry areas across China from 2006 to 2016 using spatiotemporal statistical methods. Based on these analyses, we divided different combined risk regions for EC and GC to implement joint endoscopic screening.ResultsFrom 2006 to 2016, national incidence trends for both EC and GC showed a decline, with an average annual percentage change of -3.15 (95% confidence interval [CI]: -5.33 to -0.92) for EC and -3.78 (95% CI: -4.98 to -2.56) for GC. A grey comprehensive correlation analysis revealed a strong temporal association between the incidence trends of EC and GC, with correlations of 79.00% (95% CI: 77.85 to 80.14) in males and 77.62% (95% CI: 76.50 to 78.73) in females. Geographic patterns of EC and GC varied, demonstrating both homogeneity and heterogeneity across different regions. The cancer registry areas were classified into seven distinct combined risk regions, with 33 areas identified as high-risk for both EC and GC, highlighting these regions as priorities for joint endoscopic screening.ConclusionThis study demonstrates a significant spatiotemporal association between EC and GC. The identified combined risk regions provide a valuable basis for optimizing joint endoscopic screening strategies for these cancers.

A Functional Polymorphism of Toll-Like Receptor 4 Gene Increases Risk of Gastric Carcinoma and Its Precursors

Background/Objectives: Cancer screening programs are effective in the early detection of several cancers. This study aimed to identify the findings of cancer screenings that were conducted in 2016 and 2017.Methods/Statistical analysis: Sample were obtained from the National Health Insurance Service, and the cancer screening findings among both people with disabilities and those without were compared. Gastric, breast, colon, liver, and cervical cancer were analyze the findings of the screening programs. The findings were categorized as benign, suspicious of malignancy, or other categories (depending on type of cancer). Descriptive statistics and the X2-test were used to analyze the findings among the groups.Findings: The findings were as follows: For gastric cancer screenings, 0.30% in 2016 and 0.35% in 2017 of those screened who had brain injury were found to have gastric cancer, whereas 0.16% in 2016 and 0.15% in 2017 of those screened who were non-disabled where found to have gastric cancer (p<.001). For breast cancer screenings, 0.90% in 2016 and 0.54% in 2017 of those screened who had brain injury had findings that were suspicious of malignancy. For colon cancer screenings, 4.48% in 2016 of those screened who had brain injury were found to have colon cancer, whereas 3.70% in 2016 of those who were non-disabled were found to have colon cancer (p<.001). For liver cancer screenings, people with brain injury had the most findings that were suspicious of liver cancer in 2016 (p<.001), whereas people with physical impairment had the most findings that were suspicious of liver cancer in 2017 (p<.001). The non-disabled group had the highest incidence of carcinoma in situ among groups in 2016 (p<.001) and 2017 (p<.001).Improvements/Applications: Rigorous cancer screening programs should be implemented and expanded to include brain injury and physical impairment disabilities for the early detection of gastric, breast, colon, and liver cancer.

Cancer is among the fatal diseases caused by abnormal cell growth from one organ that can invade and destroy adjacent organs. These abnormally growing cells are caused by defects in the gene sequence of the living organisms. These unregulated, proliferating cells exceed their normal boundaries to infiltrate adjacent bodily tissues and/or move to other organs. Cancer is the second leading cause of death globally, responsible for more than 10 million deaths in 2020 alone. Cancer is the second most common non-communicable disease to cause death. Currently, the health systems around the world are facing a huge challenge in finding a proper cure for cancer. Lung cancer is the leading cause of cancer deaths in China, followed by liver cancer, stomach cancer, esophageal cancer, and cardiovascular disorders, which together account for 43% of all deaths. Currently; the health system is facing huge challenge on the proper cure for cancer. This is because cancer is not one disease but many disorders that share a profound growth dysregulation of cells. The peculiar traits of cancer, including altered cellular metabolism, unlimited capacity for replication, sustained angiogenesis, the ability to invade and metastasize, the ability to evade apoptosis, self-sufficiency in growth signals, evasion of immune surveillance, and insensitivity to growth-inhibitory signals, are to chastise for this growth dysregulation. Due to their poor general health, concurrent illnesses, a systemic immunosuppressive condition brought on by cancer itself, and some drugs as conventional immune checkpoint inhibitors (ICIs) used to treat cancer, cancer patients are more vulnerable to different infectious diseases. Hence, cancer patients are more vulnerable to coronavirus infection. The main goal of this study was to conduct a meta-analysis of COVID-19 incidence, risk factors, and mortality among diverse cancer patients. We narrowed our attention to both inpatients and outpatients with Covid-19 symptoms du

PCN209 - ASSOCIATION BETWEEN AGE FACTORS AND STRATEGIES FOR PROMOTING PARTICIPATION IN GASTRIC AND COLORECTAL CANCER SCREENINGS

29 Background: Gastric cancer is a major cause of death and a substantial socioeconomic burden in Korea. The National Cancer Screening Program for Medicaid recipients was initiated in 1999 and has contributed to reduction of cancer-related mortality in Korea. Endoscopy may be cost-effective screening tool in Korea, where the cost of endoscopy and UGIS are similar and the incidence of gastric cancer is high. Most of Japanese studies on the efficiency of mass screening for gastric cancer have dealt with photoflurography as a screening tool. Although biennial gastric cancer screening by endoscopy has been increasing in Korea as part of the National Cancer Screening Program, few studies have evaluated its efficiency. Therefore, we analyzed the outcomes and efficiency of the National Gastric Cancer Screening Program using endoscopy in Korea. Methods: We reviewed medical records from the National Gastric Cancer Screening Program at Chung-Ang University hospital in Korea from January 2007 to December 2010. The study population was comprised of Medicaid recipients ≥ 40 years of age who were taken from the National Health Insurance Corporation. Results: A total of 41,150 asymptomatic subjects underwent endoscopy for gastric cancer screening. The mean age of the screened subjects was 56.3 years for men and 48.9 years for women. The male to female ratio of the screened subjects was 1.57:1. Gastric cancer was diagnosed in 102 (0.24%) of 41,150 subjects (60 men and 42 women). Their mean age was 54.4 years. Of these, 76 subjects (0.18%) were diagnosed as early gastric cancer and 26 subjects (0.06%) as advanced gastric cancer. The proportion of early gastric cancer among total gastric cancers was 74.5%. During the period, only 6,586 (16.0%) subjects participated in the biennial gastric cancer screening (59% for men and 49% for women). Conclusions: Despite accomplishments of the National Gastric Cancer Screening Program in Korea, low compliance to the screening program remains an issue. Furthermore, its cost-effectiveness analysis will be needed for successful progression.

IntroductionEsophageal cancer and stomach cancer occupy the leading places in the structure of morbidity and mortality not only in Kazakhstan but also around the world.MethodsMorbidity prognosis for esophageal and stomach cancers within the regions of Kazakhstan was conducted on the basis of on the level of morbidity from 1999 to 2013. Correlation analysis was used for estimation. Morbidity prognosis was conducted by fitting time‐series models, constructed on the basis of&lt;a name=“_GoBack”&gt; &lt;/a&gt;dynamic series for the observation period and its extrapolation to 2015‐2016. The length of the prognosis period was determined by the quantity of data.ResultsA strong association was found between the level of morbidity with cancer of esophagus and stomach (r=0.76‐0.78), predominantly in southern regions of the country. A moderate positive association was found in western regions; in other regions there was weak/no association of the level of morbidity with cancer of stomach and esophagus (r&lt;0.33). In general the trend of reduction of morbidity with cancer of esophagus and stomach has been noted in in Kazakhstan; however, the nature of reduction of oncological morbidity is different. In the coming years, comparatively high levels of morbidity are expected in northern and eastern regions of the country (with a downward trend), and also in the central region.ConclusionsThe pattern in the level of morbidity of cancer of the esophagus and stomach in general is subject to common social processes law of development – reduction of morbidity level with decrease of reduction rate. The most common function for reflection of dynamics law of oncological morbidity is a logarithmic function.

Liquid biopsy has become a research focus and a hotspot of product development in cancer screening. With the rapid development of molecular biology technology, many new markers have been identified and developed in cancer screening tests in recent years. This article reviews the development of novel liquid biopsy-based markers in cancer screening, including methylation, hydroxymethylation, mutation, copy number variation, and microRNA (miRNA), with specific focuses on clinical trials and studies from approved cancer screening assays or tests under development in China. Studies on screening of lung cancer, hepatocellular carcinoma (HCC), colorectal cancer, gastric cancer, esophageal cancer, and multiple cancers (pan-cancer screening) are reviewed and summarized. Liquid biopsy techniques detecting novel markers show great potential in the early screening of cancers, but still face challenges in sensitivity, specificity, productization, standardization, and cost-effectiveness. The emerging pan-cancer screening represents a direction of high-throughput and multiple cancer simultaneous screening, while it still needs optimization in detection performance and organ-specific recognition. Multi-omics integration analysis, artificial intelligence (AI)-assisted diagnosis, and large-scale prospective clinical studies will become important development steps in this field. Through a systematic review of the relevant literature, this paper describes in detail the development of new liquid biopsy technology, new progress in the field of cancer early screening, clinical application status, and future research direction. The review provides some useful insights into the future selection of early screening technology, the formulation of clinical research or trial protocols, and the balance between performance and cost.

Survival in patients with metastatic esophageal and gastric cancer is dismal. No standard treatment has been established. Carboplatin/paclitaxel is active in both advanced gastric and esophageal cancer. Here we retrospectively present our single center experience. Between 1998 and 2013, a total of 134 patients with metastatic esophageal and gastric adenocarcinoma treated with carboplatin/paclitaxel (carboplatin predominantly area under the curve 5 and paclitaxel predominantly 175 mg/m(2)) every 3 weeks as first-line therapy were identified. Baseline characteristics, response to therapy, toxicities, and survival in this patient population were evaluated. Overall survival was defined as date from diagnosis to death or last follow up, and progression-free survival was defined at time from cycle 1 to, progression or last follow up. Kaplan-Meier curves were fit to estimate overall and progression-free survival. Of the 134 patients evaluated, the median age at diagnosis was 65 years. Disease control rate was 62.6% (complete response: 11%, partial response: 28%, stable disease: 33%). Median overall survival from date of initial diagnosis was 15.5 months (95% confidence interval [CI] 1.06-1.5). Median progression-free survival from date of initiation of carboplatin and paclitaxel was 5.3 months (95% CI 0.34-0.5). Grade III or greater toxicity occurred in 26.1% of patients. The most common grade III toxicities were neutropenia and neuropathy, present in 14.2% and 3.7% of the total study population, respectively. In patients with metastatic or unresectable esophageal or gastric cancer, the combination of carboplatin and paclitaxel is well tolerated with comparable overall survival and progression-free survival to existing regimens in this population.

Iran has variations in the incidence of cancer in its different provinces. Moreover, it is one of the countries with a high incidence of gastrointestinal cancers in the world. The aim of this study was to investigate the relation between the incidence of esophageal, stomach, and colon cancers with ultraviolet radiation. This is an ecological study. The age-standardized incidence of cancer from 2004 to 2008 was obtained from the National Cancer Registry of Iran for all provinces. UV index data was taken from the world weather site. The altitude and latitude of cities were obtained from the National Topography Organization. Demographic variables were taken from the STEPS report of the Ministry of Health. In this study, lung cancer were used as the index of the effects of smoking. Data were analyzed using the SPSS22 software and through linear regression. UV emission levels showed a strong negative correlation with the incidence of esophageal and gastric cancers, in both genders, in all years. However, this correlation was stronger in men. UV radiation showed a significant correlation with colon cancer among both genders as well. There was no relation between altitude and incidence of cancer. Linear regression results showed that with a unit increase in UV, the incidence of gastric and esophagus cancers in males decreases by β = -4.99 and β = - 3.16 significant coefficients, respectively. Cities with higher levels of UV index have a relatively lower incidence of gastrointestinal cancers. Ultraviolet radiation may act as a protective factor against these cancers.

IntroductionEsophageal and gastric cancers are among the most common cancers in Iran. Usually survival of these cases is poor despite of treatment. Here we studied outcome of these cases in our center to have an estimation of general prognosis of patients.MethodsIn this retrospective study, we reviewed the data of patient's files before treatment, including cancer stage at diagnosis, types of treatments and outcomes. We studied 368 patients treated between 1995 and 2011.ResultsThe study included 368 patients (248 [67.4%] males and 120 [32.6%] females) with a median age of 58 (range: 23 - 94). Sixty nine patients (18.8%) had esophageal cancer with a median age of 58.5 years (range: 33 – 84), and 47.8% (33/69) of whom were male. Sixty five (17.7%) were reported to have gastro-esophageal junction (GEJ) with a median age of 62.0 (range: 32 – 94), among them 72.3% (47/65) of whom were male and finally Two hundred thirty four (63.6%) had gastric cancer with a median age of 57.0 (range: 23 – 82), which 71.8% (168/234) of whom were male. The Median follow-up was 10 months. The majority of patients were diagnosed at an advanced stage of disease. Stage III or IV was observed in 65.0% (39/60) of patients with esophageal cancer, 75.0% (33/44) with GEJ cancer and 65.4% (121/185) with gastric cancer. In this study, 58% of patients with esophageal cancer, 50.8% with GEJ and gastric cancers had unresectable disease or metastases at presentation. One-year EFS was 51.8% (95% CI: 39.8 – 67.3%), 32.8% (95% CI: 22.1 – 48.7%), and 56.7% (95% CI: 50.1 – 64.3%) in patients with esophageal, GEJ and gastric cancers, respectively (p = 0.002). The 1-year OS was 54.5% (95% CI: 42.6 – 69.8%), 39.5% (95 CI: 28.1 – 55.5%), and 68.2% (95% CI: 61.8 – 75.3%), respectively (p < 0.001).ConclusionCancers of the upper gastrointestinal (GI) tract contribute to the high mortality and morbidity rates because they are more likely to be diagnosed at late or advanced stages of disease. Cancer of the GEJ has a poor prognosis compared to esophageal and gastric cancers. Moreover, treatment protocols may need improvement to achieve better results.