Nutritional status of patients undergoing upper gastrointestinal cancer surgery: A cross-sectional study at a single centre

Malnutrition is closely related to the outcome of disease treatment, especially in digestive cancer surgery. The aim of this study was to assess the nutritional condition of pre-operative patients with upper digestive cancers (including stomach and oesophagus) at the Department of General Surgery, Bach Mai Hospital in 2016. We conducted a cross-sectional descriptive analysis of 76 malignancies of the upper gastrointestinal tract with surgical treatments. The results revealed that the weight loss rate of hospitalized patients with gastric cancer and esophageal cancer was 76.6% and 66.7%, respectively. The rate of weight loss above 10% of body weight was 19.7%. The prevalence of chronic energy deficit was 29.9%. The risk of malnutrition according to SGA was 77.6%, of which mild to moderate and severe was 67.2% and 10.4%, respectively. The rate of low blood albumin level (less than 35 g/L) was 36.5%. The average net nutritional value was 1146.3 ± 592.7 Kcal (range 246.7 – 3653.5), which equals to 55.7% of the necessary daily intake. Protein, lipid, and glucid contents reached 73.4%, 57.8%, and 52.1% of the recommended levels, respectively. Conclusion: malnutrition was still prevalent among patients undergoing upper gastrointestinal cancer surgery, and pre-operative nutritional status does not achieve recommended levels.

Oral Bacterial Microbiota in Digestive Cancer Patients: A Systematic Review

The relation between the gut microbiota and human health is increasingly recognized. Recently, some evidence suggested that dysbiosis of the oral microbiota may be involved in the development of digestive cancers. A systematic review was conducted according to the PRISMA guidelines to investigate the association between the oral microbiota and digestive cancers. Several databases including Medline, Scopus, and Embase were searched by three independent reviewers, without date restriction. Over a total of 1654 records initially identified, 28 studies (2 prospective cohort studies and 26 case-controls) were selected. They investigated oral microbiota composition in patients with esophageal squamous cell carcinoma (n = 5), gastric cancer (n = 5), colorectal cancer (n = 9), liver carcinoma (n = 2), and pancreatic cancer (n = 7). In most of the studies, oral microbiota composition was found to be different between digestive cancer patients and controls. Particularly, oral microbiota dysbiosis and specific bacteria, such as Fusobacterium nucleatum and Porphyromonas gingivalis, appeared to be associated with colorectal cancers. Current evidence suggests that differences exist in oral microbiota composition between patients with and without digestive cancers. Further studies are required to investigate and validate oral–gut microbial transmission patterns and their role in digestive cancer carcinogenesis.

Neutrophil Extracellular Traps in Digestive Cancers: Warrior or Accomplice

Characterized as a complex of extracellular DNA fibers and granule proteins, neutrophil extracellular traps (NETs) are generated specifically by neutrophils which play a critical role in host defense and immune regulation. NETs have been initially found crucial for neutrophil anti-microbial function. Recent studies suggest that NETs are involved in tumorigenesis and cancer progression. However, the function of NETs in cancer remains unclear, which might be due to the variation of research models and the heterogeneity of cancers. Although most of malignant tumors have similar biological behaviors, significant differences indeed exist in various systems. Malignant tumors of the digestive system cause the most incidence and mortality of cancer worldwide. In this review, we would focus on research developments on NETs in digestive cancers to provide insights on their role in digestive cancer progression and future research directions.

Socioeconomic Environment and Survival in Patients with Digestive Cancers: A French Population-Based Study

Social inequalities are an important prognostic factor in cancer survival, but little is known regarding digestive cancers specifically. We aimed to provide in-depth analysis of the contextual social disparities in net survival of patients with digestive cancer in France, using population-based data and relevant modeling. Digestive cancers (n = 54,507) diagnosed between 2006–2009, collected through the French network of cancer registries, were included (end of follow-up 06/30/2013). Social environment was assessed by the European Deprivation Index. Multidimensional penalized splines were used to model excess mortality hazard. We found that net survival was significantly worse for individuals living in a more deprived environment as compared to those living in a less deprived one for esophageal, liver, pancreatic, colon and rectal cancers, and for stomach and bile duct cancers among females. Excess mortality hazard was up to 57% higher among females living in the most deprived areas (vs. least deprived) at 1 year of follow-up for bile duct cancer, and up to 21% higher among males living in the most deprived areas (vs. least deprived) regarding colon cancer. To conclude, we provide a better understanding of how the (contextual) social gradient in survival is constructed, offering new perspectives for tackling social inequalities in digestive cancer survival.

OncomiRs miR-106a and miR-17 negatively regulate the nucleoside-derived drug transporter hCNT1

High-affinity uptake of natural nucleosides as well as nucleoside derivatives used in anticancer therapies is mediated by human concentrative nucleoside transporters (hCNTs). hCNT1, the hCNT family member that specifically transports pyrimidines, is also a transceptor involved in tumor progression. In particular, oncogenesis appears to be associated with hCNT1 downregulation in some cancers, although the underlying mechanisms are largely unknown. Here, we sought to address changes in colorectal and pancreatic ductal adenocarcinoma—both of which are important digestive cancers—in the context of treatment with fluoropyrimidine derivatives. An analysis of cancer samples and matching non-tumoral adjacent tissues revealed downregulation of hCNT1 protein in both types of tumor. Further exploration of the putative regulation of hCNT1 by microRNAs (miRNAs), which are highly deregulated in these cancers, revealed a direct relationship between the oncomiRs miR-106a and miR-17 and the loss of hCNT1. Collectively, our findings provide the first demonstration that hCNT1 inhibition by these oncomiRs could contribute to chemoresistance to fluoropyrimidine-based treatments in colorectal and pancreatic cancer. Graphic abstract

Peritoneal Metastases: Their Associated Imaging Features

Peritoneal Metastases (PM) detection remains a challenge even with modern imaging. Knowing imaging features of abnormal findings frequently associated with PM is of interest to improve PM detection. Although ascites is a common imaging finding of PM, the presence of ascites alone, even in patients with known cancer, is not enough to diagnose PM. The peritoneum should be read as an own organ with careful analysis of the ligament (e.g. falciform and hepatoduodenal ligament), the mesos and the omenta. Indirect manifestations of visceral peritoneal involvement is a segment of small bowel fixed to the parietal peritoneum, the appearance of blockage of free circulation of ascites, plurisegmental bowel obstruction and clumped bowel that is a strong predictor of diffuse involvement of the visceral peritoneum by a high grade tumor. Ovarian and umbilical metastases are frequently associated with PM in particular in digestive cancers. Moreover, ovarian metastases has been shown to be less responsive to chemotherapy than other metastases and should not be chosen as a target lesion for RECIST assessment. The presence of cardiophrenic angle lymph nodes also increases the possibility of metastatic spread in peritoneum. Finally, the most common PM mimickers include colonic diverticulum, mesenteric lymph nodes, splenosis implants, fat necrosis and postoperative changes after cytoreductive surgery and HIPEC.

Incidence rates of digestive cancers among U.S. military servicemen: Comparison with the rates in the general U.S. population

Background Digestive cancers greatly contribute to the cancer burden in the United States. These cancers are more common among men and some are increasing among adults under age 50. Military population, which is dominantly male and young, and general populations differ in exposure to risk factors for these cancers. However, no studies have systematically investigated whether the incidence rates of these cancers differ between the two populations. This study aimed to compare incidence rates and trends of select digestive cancers between active-duty military and general populations in men aged 20–59 years. Methods Data were from the Department of Defenses’ Automated Central Tumor Registry (ACTUR) and the National Cancer Institute’s Surveillance, Epidemiology, and End Results 9 (SEER-9) registries. Age-adjusted incidence rates of colorectal, stomach, liver, and pancreatic cancers among men aged 20–59 years during 1990–2013 were compared between the two populations. Stratified analyses by age were done for colorectal and stomach cancers. The joinpoint regression analysis was conducted to examine temporal trends for colorectal cancer. Results The age-adjusted incidence rates of colorectal, stomach, liver, and pancreatic cancers were overall lower among active-duty than SEER (IRR = 0.86, 95% CI = 0.81–0.92; IRR = 0.65, 95% CI = 0.55–0.76; IRR = 0.39, 95% CI = 0.30–0.49; IRR = 0.51, 95% CI = 0.41–0.62, respectively). This was observed in the groups of both ages 20–39 and 40–59 years for stomach cancer, and in the group of ages 40–59 years for colorectal cancer. The incidence rates of colorectal cancer tended to decrease since 2008 in ACTUR. Conclusion The incidence rates for selected digestive cancers overall were lower in the active-duty military population than the U.S. general population. This study highlights the need for more research enhancing our understanding of variations in these cancers between the two populations.

Anxiety and depression prevalence in digestive cancers: a systematic review and meta-analysis

BackgroundCancers of the digestive system can be associated with disturbing and disabling symptoms, which can contribute to a negative psychological pressure on patients.AimTo investigate the reported prevalence of symptoms of anxiety and depression in patients with major digestive cancers, including oesophageal, gastric, colorectal, pancreatic or hepatic cancers.MethodsWe searched Embase, PubMed, Scopus and Web of Science for articles published from inception to December 2020. We included studies reporting the prevalence of anxiety or depression symptoms using validated questionnaires in adult patients (≥18 years).ResultsIn total, 51 eligible papers were finally included. Overall, the pooled prevalence of anxiety symptoms was 20.4% (95% CI 17% to 23.8%). The estimate in patients with gastrointestinal (GI) cancers was 19.1% and in patients with hepatic cancer was 29.1%. Among GI cancers, the highest pooled prevalence of anxiety symptoms related to oesophageal cancer (20.6%), while the lowest pooled prevalence pertained to gastric cancer (18.7%). Regarding depression symptoms, the overall pooled prevalence was 30.2% (95% CI 24.3% to 36.1%). The estimate in patients with GI cancers was 31% and in patients with hepatic cancer was 21.5%. Among GI cancers, the highest pooled prevalence of depression symptoms related to oesophageal cancer (45.2%), while the lowest pooled prevalence pertained to colorectal cancer (22.9%).ConclusionA considerable prevalence of anxiety and depression symptoms is observed in patients with digestive cancers. Screening and preventive measures with early management of these psychological problems by clinicians could possibly improve outcomes for these patients.PROSPERO registration numberCRD42020210079.