Low muscle mass and Charlson comorbidity index are risk factors for short-term postoperative prognosis of elderly patients with gastrointestinal tumor: a cross-sectional study

Background Sarcopenia is one of the most frequent syndromes in older adults and one of its main characteristics is low muscle mass. Gastrointestinal tumor is a malignant disease with high incidence. This study aimed to investigate the risk factors of low muscle mass in older adults with gastrointestinal tumor, the prognostic indicators of and short-term outcomes after resection for gastrointestinal tumor, and to explore the relationship between low muscle mass and short-term postoperative prognosis. Method A total of 247 older patients with gastrointestinal tumors who underwent radical resection in 2019 were included in this study. Relevant indexes were calculated using L3 slice image of computed tomography (CT) to evaluate low muscle mass. Short-term postoperative complications and length of stay were considered as short-term outcomes of this study. Results Advanced age, lower higher body mass index (BMI), lower hemoglobin, having history of abdominal surgery and higher visceral fat index (VFI) were risk factors of low muscle mass, while higher BMI and lower subcutaneous fat index (SFI) were protective factors of low muscle mass. Further multivariate logistic regression analysis showed that having history of abdominal surgery, advanced age and lower BMI were independent risk factors. Low muscle mass and higher Charlson comorbidity index were independent risk factors of short-term postoperative complications in older adults with gastrointestinal tumor. Higher Charlson comorbidity index gave rise to longer length of stay. Conclusions Low muscle mass and higher Charlson comorbidity index predict poor short-term prognosis of older patients undergoing gastrointestinal tumor resection.

Non-immune Cell Components in the Gastrointestinal Tumor Microenvironment Influencing Tumor Immunotherapy

Interactions of genetic susceptibility factors, immune microenvironment, and microbial factors contribute to gastrointestinal tumorigenesis. The suppressive immune microenvironment reshaped by the tumors during gastrointestinal tumorigenesis directly contributes to T-cell depletion in tumor immunotherapy. Soluble factors secreted by tumor cells or stromal cells collectively shape the suppressive immune environment. Here, we reviewed the key factors in the gastrointestinal tumor microenvironment that influence tumor immunotherapy, focusing on the effects of fibroblasts, neuronal cells, soluble cytokines, exosomes, and the microbiome in tumor microenvironment. Research in this field has helped to identify more precise and effective biomarkers and therapeutic targets in the era of tumor immunotherapy.

Rationale for MYC imaging and targeting in pancreatic cancer

The incidence and lethality of pancreatic ductal adenocarcinoma (PDAC) will continue to increase in the next decade. For most patients, chemotherapeutic combination therapies remain the standard of care. The development and successful implementation of precision oncology in other gastrointestinal tumor entities point to opportunities also for PDAC. Therefore, markers linked to specific therapeutic responses and important subgroups of the disease are needed. The MYC oncogene is a relevant driver in PDAC and is linked to drug resistance and sensitivity. Here, we update recent insights into MYC biology in PDAC, summarize the connections between MYC and drug responses, and point to an opportunity to image MYC non-invasively. In sum, we propose MYC-associated biology as a basis for the development of concepts for precision oncology in PDAC.

Clinicopathological Analysis and Prognostic Assessment of TCN1 in Patients with Gastric Cancer

Background Stomach cancer is the fourth most common type of cancer worldwide. TCN1 mainly encodes the vitamin B12 transporter, transcobalamin. TCN1 is a marker of gastrointestinal tumor progression, but the impact of TCN1 on survival is unclear. Material/Methods Gastrointestinal tumor records were reviewed and analyzed, clinicopathological data were summarized, immunohistochemical detection of TCN1 was performed again, and the protein expression in tumor tissue, non-tumor tissue, and lymph nodes was semi-quantitatively analyzed. Patients were followed up for 5 years to determine the 5-year survival rates. Results The strong immune reactivity of the TCN1 protein was significantly correlated with tumor invasion depth, regional lymph nodes, and a tumor diameter of >5 cm (Z = −2.531 and P = .016; Z = 3.785 and P < .001; Z = 2.541 and P = .049). Kaplan–Meier survival analysis showed that the total survival time of patients in the low-expression TCN1 group was significantly longer than that in the high-expression TCN1 group (P = .001; Table 2 and Figure 5 ). The mean survival time of all patients was 49.774 months (95% CI: 47.871–51.676; Table 4 ) and the 5-year overall survival rates were 73.3, 50.8, and 34.0%, respectively. Multivariate analysis revealed that regional lymph nodes (HR = 1.253; 95% CI: 1.031–1.747, P = .012), TCN1 immune expression status (HR = 2.707; 95% CI: 1.068–1.886, P = .016), and pTNM staging (HR = 2.293; 95% CI: 1.583–3.321; P = .001) were independent risk factors for poor survival. Conclusion The high expression of TCN1 in gastric tumor tissues was found to be associated with the clinicopathological factors of patients, and the high expression of TCN1 was shown to indicate a poor clinical prognosis.

Synchronous Fibromatosis Indistinguishable from Suspected Synchronous Gastrointestinal Stromal Tumor: A Case Report

Desmoid tumors most commonly occur in the anterior abdominal wall in approximately 50% of cases and are locally aggressive. We describe a case of a 38-year-old lady who was investigated as a case of gastrointestinal tumor. Post-operative immunohistochemistry staining showed the presence of a synchronous desmoid in the abdominal wall and proximal ileum. Wide local excision remains the gold-standard of treatment with pharmacotherapeutics and radiotherapy serving as adjuvant or palliative treatment options.

A Prospective Comparison of TL-400 and NICOM for Goal-Directed Fluid Therapy in Gastrointestinal Tumors Surgery

Objective: Goal-directed fluid therapy (GDFT) based on NICOM(CheetahMedical, Vancouver, Washington) was highly associated with improved postoperative prognosis, but has several limitations. T-Line-400(TL-400, TensysMedical, San Diego, California) which is an emerging non-invasive hemodynamic monitor may be applicable for GDFT. Thus, the trial was to determine whether GDFT based on TL-400, when compared to GDFT based on NICOM, would lead to similar outcomes on patients undergoing gastrointestinal tumor resection.Methods: 100 patients who underwent laparoscopic resection of gastrointestinal tumors in Yongchuan Hospital of Chongqing Medical University from October 2020 to May 2021 were randomized into either TL-400 GDFT group (group T) or NICOM GDFT group (group N). The intraoperative fluid volume and the postoperative complications within 30 days were recorded.Results: There were no significantly statistical differences between groups with respect to the total fluid volume (2360 ±282ml vs 2295 ±223ml), the colloid volume (1167±153ml vs 1126±109ml), the crystalloid volume(1193 ±156ml vs 1173±157ml). Both GDFT based on TL-400 and NICOM strategies were equivalent for the first flatus(57.3±7.9 vs 58.5±8.5hours), wound healing time(11.2 ±1.2days vs 10.9±1.1days) and LOS(hospital length of stay) (13.3±1.4days vs 13.1±1.2days). In addition, the TL-400 had less data missing than the NICOM.Conclusion: TL-400 performs similarly to NICOM in guiding GDFT, with no significant differences in perioperative fluid infusion and postoperative prognosis in patients undergoing gastrointestinal tumor resection. Compared with NICOM, TL-400 can avoid the interference of electrocoagulation and can capture more data.Trial registration: This study has been registered on the Chinese Clinical Trial Registry (ChiCTR2100046350) (http://www.chictr.org.cn/index.aspx).