The most common histological type of gastric cancer(GC)is gastric adenocarcinoma arising from the gastric epithelium.Less common variants include mesenchymal,lymphoproliferative and neuroendocrine neoplasms.The Lauren...The most common histological type of gastric cancer(GC)is gastric adenocarcinoma arising from the gastric epithelium.Less common variants include mesenchymal,lymphoproliferative and neuroendocrine neoplasms.The Lauren scheme classifies GC into intestinal type,diffuse type and mixed type.The WHO classification includes papillary,tubular,mucinous,poorly cohesive and mixed GC.Chronic atrophic gastritis(CAG)and intestinal metaplasia are recommended as common precancerous conditions.No definite precancerous condition of diffuse/poorly/undifferentiated type is recommended.Chronic superficial inflammation and hyperplasia of foveolar cells may be the focus.Presently,the management of early GC and precancerous conditions mainly relies on endoscopy including diagnosis,treatment and surveillance.Management of precancerous conditions promotes the early detection and treatment of early GC,and even prevent the occurrence of GC.In the review,precancerous conditions including CAG,metaplasia,foveolar hyperplasia and gastric hyperplastic polyps derived from the gastric epithelium have been concluded,based on the overview of gastric epithelial histological organization and its renewal.展开更多
Objective Gastric precancerous conditions such as atrophic gastritis(AG)and intestinal metaplasia(IM)are considered independent risk factors for gastric cancer(GC).The suitable endoscopic monitoring interval is unclea...Objective Gastric precancerous conditions such as atrophic gastritis(AG)and intestinal metaplasia(IM)are considered independent risk factors for gastric cancer(GC).The suitable endoscopic monitoring interval is unclear when we attempt to prevent GC development.This study investigated the appropriate monitoring interval for AG/IM patients.Methods Totally,957 AG/IM patients who satisfied the criteria for evaluation between 2010 and 2020 were included in the study.Univariate and multivariate analyses were used to determine the risk factors for progression to high-grade intraepithelial neoplasia(HGIN)/GC in AG/IM patients,and to determine an appropriate endoscopic monitoring scheme.Results During follow-up,28 AG/IM patients developed gastric neoplasia lesions including gastric low-grade intraepithelial neoplasia(LGIN)(0.7%),HGIN(0.9%),and GC(1.3%).Multivariate analysis identified H.pylori infection(P=0.022)and extensive AG/IM lesions(P=0.002)as risk factors for HGIN/GC progression(P=0.025).Conclusion In our study,HGIN/GC was present in 2.2%of AG/IM patients.In AG/IM patients with extensive lesions,a 1–2-year surveillance interval is recommended for early detection of HIGN/GC in AG/IM patients with extensive lesions.展开更多
Background Oral cancer is the most common head and neck malignancy and may develop from oral leukoplakia(OL)and oral lichenoid disease(OLD).Machine learning classifiers using structured(tabular)data have been employed...Background Oral cancer is the most common head and neck malignancy and may develop from oral leukoplakia(OL)and oral lichenoid disease(OLD).Machine learning classifiers using structured(tabular)data have been employed to predict malignant transformation in OL and OLD.However,current models require improved discrimination,and their frameworks may limit feature fusion and multimodal risk prediction.Therefore,this study investigates whether tabular-to-image data conversion and deep learning(DL)based on convolutional neural networks(CNNs)can improve malignant transformation prediction compared to traditional classifiers.Methods This study used retrospective data of 1,010 patients with OL and OLD treated at Queen Mary Hospital,Hong Kong,from January 2003 to December 2023,to construct artificial intelligence-based models for oral cancer risk stratification in OL/OLD.Twenty-five input features and information on oral cancer development in OL/OLD were retrieved from electronic health records.Tabular-to-2D image data transformation was achieved by creating a feature matrix from encoded labels of the input variables arranged according to their correlation coefficient.Then,2D images were used to populate five pre-trained DL models(VGG16,VGG19,MobileNetV2,ResNet50,and EfficientNet-B0).Area under the receiver operating characteristic curve(AUC),Brier scores,and net benefit of the DL models were calculated and compared to five traditional classifiers based on structured data and the binary epithelial dysplasia grading system(current method).Results This study found that the DL models had better AUC values(0.893-0.955)and Brier scores(0.072-0.106)compared to the traditional classifiers(AUC:0.887-0.941 and Brier score:0.074-0.136)during validation.During internal testing,VGG16 and VGG19 had better AUC values and Brier scores than other CNNs(AUC:0.998-1.00;Brier score:0.036-0.044)and the best traditional classifier(random forest)(AUC:0.906;Brier score:0.153).Additionally,VGG16 and VGG19 models outperformed random forest in discrimination and calibration during external testing(AUC:1.00 vs.0.976;Brier score:0.022-0.034 vs.0.129).The best CNNs also had better discriminatory performance and calibration than binary dysplasia grading at internal and external testing.Overall,decision curve analysis showed that the optimal DL models with transformed data had a higher net benefit than random forest and binary dysplasia grading.Conclusion Tabular-to-2D image data transformation may improve the use of structured input features for developing optimal intelligent models for oral cancer risk prediction in OL and OLD using convolutional networks.This approach may have the potential to robustly handle structured data in multimodal DL frameworks for oncological outcome prediction.展开更多
BACKGROUND Detecting gastric precancerous lesions(GPLs)is critical for the early diagnosis and treatment of gastric cancer.Endoscopy combined with tissue examination is an important method for detecting GPLs.However,n...BACKGROUND Detecting gastric precancerous lesions(GPLs)is critical for the early diagnosis and treatment of gastric cancer.Endoscopy combined with tissue examination is an important method for detecting GPLs.However,negative biopsy results often increase patients’risks,economic burdens,and lead to additional healthcare costs.Improving the detection rate of GPLs and reducing the rate of negative biopsies is currently a key focus in endoscopic quality control.AIM To explore the relationships between the endoscopist biopsy rate(EBR),qualifications of endoscopists and endoscopic assistants,and detection rate of GPLs.METHODS EBR,endoscopists,and endoscopic assistants were divided into four groups:Low,moderate,high,and very high levels.Multivariable logistic regression analysis was used to analyze the relationships between EBR and the qualifications of endoscopists with respect to the detection rate of positive lesions.Pearson and Spearman correlation analyses were used to evaluate the correlation between EBR,endoscopist or endoscopic assistant qualifications,and the detection rate of positive lesions.RESULTS Compared with those in the low EBR group,the odds ratio(OR)values for detecting positive lesions in the moderate,high,and very high EBR groups were 1.12[95%confidence interval(CI):1.06-1.19,P<0.001],1.22(95%CI:1.14-1.31,P<0.001),and 1.38(95%CI:1.29-1.47,P<0.001),respectively.EBR was positively correlated with the detection rate of gastric precancerous conditions(atrophic gastritis/intestinal metaplasia)(ρ=0.465,P=0.004).In contrast,the qualifications of the endoscopists were positively correlated with GPLs detection(ρ=0.448,P=0.005).Compared to endoscopists with low qualification levels,those with moderate,high,and very high qualification levels endoscopists demonstrated increased detection rates of GPLs by 13%(OR=1.13,95%CI:0.98-1.31),20%(OR=1.20,95%CI:1.03-1.39),and 32%(OR=1.32,95%CI:1.15-1.52),respectively.Further analysis revealed that the qualifications of endoscopists were positively correlated with the detection rates of GPLs in the cardia(ρ=0.350,P=0.034),angularis(ρ=0.396,P=0.015)and gastric body(ρ=0.453,P=0.005)but not in the antrum(ρ=0.292,P=0.079).Moreover,the experience of endoscopic assistants was positively correlated with the detection rate of precancerous lesions by endoscopists with low or moderate qualifications(ρ=0.427,P=0.015).CONCLUSION Endoscopists and endoscopic assistants with high/very high qualifications,but not EBR,can improve the detection rate of GPLs.These results provide reliable evidence for the development of gastroscopic quality control indicators.展开更多
AIM:To further understand the molecular basis for gastric cardia carcinogenesis and to provide etiological clues. METHODS: Endoscopic mucosa biopsy and histopathological examinations were made on 37 subjects from a hi...AIM:To further understand the molecular basis for gastric cardia carcinogenesis and to provide etiological clues. METHODS: Endoscopic mucosa biopsy and histopathological examinations were made on 37 subjects from a high incidence area for both esophageal and gastric cardia carcinomas in northern China. All the biopsy samples were fixed in 850 ml. (-1)L alcohol and embedded in paraffin. Each block contained one piece of tissue and was serially section at 5 microm. Immunohistochemistry (ABC) was carried out on these gastric cardia samples to determine the alterations of p16 and Rb. RESULTS: Based on the histopathlogical examination there were 11 cases of chronic superficial gastritis, 12 cases of chronic atrophic gastritis and 14 cases of dysplasia. The immunostaining demonstrated different levels of unclear immunostaining of p16 and Rb in normal gastric cardia tissue and the tissues with different severity of lesions. With the lesions progressing, the positive immunostaining rates for p16 protein had a decreasing tendency. In contrast, the positive immunostaining rate for Rb protein had an increasing tendency. There was a significant negative relationship between the two parameters. Changes of p16 was CSG 11(100%), CAG 7(58%), DYS 4(29%) and changes of Rb was CSG 2(18%), CAG 8(67%) and DYS 12(86%), (P【0.05). CONCLUSION: The alterations of p16 and Rb protein may play a role in the early stages of gastric cardia carcinogenesis.展开更多
AIM: To assess the possibility of non-invasive screening of atrophic chronic gastritis for preventing further development of gastric cancer.METHODS: One hundred and seventy-eight consecutive Helicobacter pylori ( H py...AIM: To assess the possibility of non-invasive screening of atrophic chronic gastritis for preventing further development of gastric cancer.METHODS: One hundred and seventy-eight consecutive Helicobacter pylori ( H pylori)-positive dyspeptic patients after detection of serum levels of pepsinogen-1 (PG-1) and gastrin-17 (G-17) by enzyme immunoassay were proposed for endoscopy and histology. The serologic and morphologic results were compared with estimating the sensitivity, specificity and prognostic values of the tests.RESULTS: There was statistically significant reverse dependence between the grade of stomach mucosal antral or corpus atrophy and the proper decreasing of serum G17 or PG1 levels. The serologic method was quite sensitive in the diagnosis of non-atrophic and severe antral and corpus gastritis. Also, it was characterized by the high positive and negative prognostic values.CONCLUSION: Detection of serum G-17 and PG1 levels can be offered as the screening tool for atrophic gastritis. The positive serologic results require further chromoendoscopy with mucosal biopsy, for revealing probable progressing of atrophic process with development of intestinal metaplasia, dysplasia or gastric cancer.展开更多
In the model rat with precancerous lesion of stomach induced by the combined method of insertion of a spring into the pylorus and high salt hot paste,effects of San Qi (三七 Radix Notoginseng) on gastric secretion and...In the model rat with precancerous lesion of stomach induced by the combined method of insertion of a spring into the pylorus and high salt hot paste,effects of San Qi (三七 Radix Notoginseng) on gastric secretion and protective factors of stomach were investigated.The results indicated that gastric secretion,gastric mucosal blood flow (GMBF) and aminohexose content lowered significantly,and malondialdehyde (MDA) increased significantly (P<0.01) in the model group as compared with the normal group;after treatment with San Qi Powder for 12 weeks,both gastric secresion and GMBF increased,and MDA content decreased as compared with the negative control group (P<0.01),with no significant increase of aminohexose content.It is suggested that San Qi (三七 Radix Notoginseng) may improve gastric secretion,and that increase of GMBF and antagonism against the lesion of oxygen free radicals are possibly one of its mechanisms.展开更多
AIM: To observe the protein and mRNA expression of bcl-2 oncogene in gastric precancerous lesions (GPL) and to analyze its correlation with syndromes in traditional Chinese medicine (TCM). METHODS: Sixty-seven patient...AIM: To observe the protein and mRNA expression of bcl-2 oncogene in gastric precancerous lesions (GPL) and to analyze its correlation with syndromes in traditional Chinese medicine (TCM). METHODS: Sixty-seven patients with GPL confirmed by gastroscopy and pathology were studied,including 39 cases of moderate gastric mucosal dysplasia,19 cases of severe gastric mucosa dysplasia, 9 cases of incomplete colon metaplasia. In syndrome differentiation of TCM,17 cases belonged to the syndrome of qi and yin deficiency of the spleen and stomach complicated by qi stagnation, 21 cases belonged to the syndrome of qi and yin deficiency of the spleen and stomach complicated by stomach heat, 29 cases belonged to the syndrome of qi and yin deficiency of the spleen and stomach complicated by blood stasis. Protein and mRNA expression of bcl-2 oncogene were detected by labeled streptavidin biotin (LSAB) immunohist-ochemistry and in situ hybridization respectively. RESULTS: Abnormal expression of protein and mRNA on bcl-2 oncogene was found in GPL,which increased gradually with the course of lesions. In moderate and severe gastric mucosal dysplasia and incomplete colon metaplasia,there was no difference in the expression of bcl-2 oncogene (P>0.05).In different accompanying syndromes, the expression of protein and mRNA on bcl-2 oncogene increased gradually in the following order: deficiency of both qi and yin of the spleen and stomach accompanying qi stagnation→stomach heat→blood stasis. In GPL, compared with accompanying blood stasis, there was an obvious difference in the expression of bcl-2 oncogene between the syndrome of qi and yin deficiency of the spleen and stomach and accompanying stomach heat, so did accompanying qi stagnation (the level of protein: X2=8.45, P<0.05;the level of mRNA: X2=7.35, P<0.05). CONCLUSION: Apoptosis-associated bcl-2 oncogene is abnormally expressed in GPL,which correlates with different accompanying syndromes in TCM.展开更多
BACKGROUND The diagnosis of gastric carcinoma(GC)is essential for improving clinical outcomes.However,the biomarkers currently used for GC screening are not ideal.AIM To explore the diagnostic implications of the neut...BACKGROUND The diagnosis of gastric carcinoma(GC)is essential for improving clinical outcomes.However,the biomarkers currently used for GC screening are not ideal.AIM To explore the diagnostic implications of the neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),and systemic immune-inflammatory index(SII)for GC.METHODS The baseline data of 133 patients with GC and 134 patients with precancerous gastric conditions admitted between January 2022 and December 2023 were retrospectively analyzed.The information on peripheral blood platelet,neutrophil,and lymphocyte counts in each patient was collected,and the NLR,PLR,and SII levels of both groups were calculated.Additionally,multivariate logistic regression analysis was conducted,and the diagnostic implications of NLR,PLR,and SII in differentiating patients with precancerous gastric conditions,compared with those with GC,were analyzed through receiver operating characteristic(ROC)curves.RESULTS The data indicated that NLR,PLR,and SII had abnormally increased levels in the patients with GC.Gender and body mass index were risk factors for the occurrence of GC.ROC data revealed that the areas under the curve of three patients with precancerous gastric conditions,who were differentiated from those with GC,were 0.824,0.787,and 0.842,respectively.CONCLUSION NLR,PLR,and SII are all abnormally expressed in GC and have diagnostic implications,especially when used as joint indicators,in distinguishing patients with precancerous gastric conditions from those with GC.展开更多
INTRODUCTIONIn China ,the incidence and mortality of gastric cancer rank the second among all cancers. Recent development of cancer [1-20].The aim of this study was investigat the insight of apoptosis and bcl-2, p53 a...INTRODUCTIONIn China ,the incidence and mortality of gastric cancer rank the second among all cancers. Recent development of cancer [1-20].The aim of this study was investigat the insight of apoptosis and bcl-2, p53 and C-myc protein expression in the development of gastric cancer .展开更多
AIM:To investigate the macroscopic and clinicopathologic features of gastric cancer in patients with biopsy-suggested high grade intraepithelial neoplasia. METHODS:Patients with biopsy-confirmed gastric high grade int...AIM:To investigate the macroscopic and clinicopathologic features of gastric cancer in patients with biopsy-suggested high grade intraepithelial neoplasia. METHODS:Patients with biopsy-confirmed gastric high grade intraepithelial neoplasia were reviewed from January 2001 to March 2008.Pathologic sections were re-evaluated by two senior pathologists. Patients with an en-bloc resection of the lesion within two months after the diagnosis of high grade intraepithelial neoplasia were enrolled in the study. Clinical manifestations,endoscopic features,biopsy and surgical pathology of all patients were collected and analyzed.The data acquired were subjected to univariate and multivariate analysis. RESULTS:Seventy-two superficial gastric lesions with a pathologic diagnosis of high grade intraepithelial neoplasia based on biopsy specimens were enrolled. True high grade intraepithelial neoplasia was finally proved in 16 lesions and gastric cancer in the rest 56 lesions,most of which(96.4%)were differentiated carcinomas.The result of univariate analysis indicatedthat the size and the presence of marked ulcer plaque or scar in a superficial lesion were independently associated with gastric cancer(P<0.05),when high grade intraepithelial neoplasia was diagnosed by biopsy pathology.The results of multivariate analysis revealed the size greater than 1.5 cm[odds ratio(OR)18.400,P<0.001]and the presence of 5-odd mm ulcer plaque or scar(OR 10.000,P=0.044)were associated with gastric cancer.Accordingly,the sensitivity,specificity and negative predictive value of multivariate analysis for predicting"true high grade intraepithelial neoplasia" was 87.5%,89.3%and 96.2%,respectively. CONCLUSION:Macroscopic findings are of value in differentiation between high grade intraepithelial neoplasia and superficial gastric cancer.This may simplify patient work-up and save costs for patients and healthcare system.展开更多
Recent technological advances in miniaturization have allowed for a confocal scanning microscope to be integrated into a conventional flexible endoscope,or into trans-endoscopic probes,a technique now known as confoca...Recent technological advances in miniaturization have allowed for a confocal scanning microscope to be integrated into a conventional flexible endoscope,or into trans-endoscopic probes,a technique now known as confocal endomicroscopy or confocal laser endomicroscopy.This newly-developed technology has enabled endoscopists to collect real-time in vivo histological images or "virtual biopsies" of the gastrointestinal mucosa during endoscopy,and has stimulated significant interest in the application of this technique in clinical gastroenterology.This review aims to evaluate the current data on the technical aspects and the utility of this new technology in clinical gastroenterology and its potential impact in the future,particularly in the screening or surveillance of gastrointestinal neoplasia.展开更多
IM To detect glutathione Stransferase placental (GSTP) mRNA expression in hepatic preneoplastic lesions in rats.METHODS Using SolitFarber model, the GSTP mRNA expression was observed in hepatic preneoplastic lesio...IM To detect glutathione Stransferase placental (GSTP) mRNA expression in hepatic preneoplastic lesions in rats.METHODS Using SolitFarber model, the GSTP mRNA expression was observed in hepatic preneoplastic lesions induced by diethylnitrosamine (DEN) in rats and normal and regenerated hepatic tissues in the control group by in situ hybridization.RESULTS GSTP mRNA was mainly expressed in altered hepatic foci (AHF) and some of the oval cells in hepatic preneoplastic lesions and the extent of its expression was different among various foci or/and positive cells in the same focus whereas no expression was observed in normal and regenerated hepatic tissues.CONCLUSION Cells in AHF and oval cells may be the preneoplastic cells in the experimental hepatocellular carcinoma at the molecular level and heterogeneity exists in GSTP transcription levels..展开更多
Malignant tumors are caused by multiple carcinogenic factors undergoing several stages. The occurrence and development of tumors may be prevented and blocked if some effective interference factors are brought into pla...Malignant tumors are caused by multiple carcinogenic factors undergoing several stages. The occurrence and development of tumors may be prevented and blocked if some effective interference factors are brought into play.1 At present, there are two main subjects for the researches, that is, blocking the precancerous lesions and blocking the develop-ment of tumors. The former focuses on the removing of carcinogenic factors and on the chemoprophylaxis of cancer, while the latter on the inhibition of cancer cell infiltration and cancerometastasis. These are summarized as follows.展开更多
Objective: To investigate cyclooxygenase- 2(Cox-2) protein expression in esophageal cancer and precancerous lesions. Methods: One hundred twenty biopsy specimens from esophageal carcinoma and 113 from patients with es...Objective: To investigate cyclooxygenase- 2(Cox-2) protein expression in esophageal cancer and precancerous lesions. Methods: One hundred twenty biopsy specimens from esophageal carcinoma and 113 from patients with esophageal premalingnant lesions, 27 from individuals with normal esophageal mucosa and 3 from Barrett’s esophagus were examined for Cox-2 protein expression by immunohistochemistry. Results: Cox-2 protein was not observed in normal esophageal squamous and glandular epithelium, hyperplasia from mild to severe dysplasia lesions and carcinoma in situ. Positive Cox-2 protein expression was found in 4 of 60 specimens of invasive squamous-cell carcinomas, 21 of 30 specimens of esophageal adenocarcinomas and in 3 of 3 Barret’s esophageal tissues. Conclusion: The Cox-2 protein expression may be associated with the development of the esophageal adenocarcinomas but not esophageal squamous-cell carcinomas.展开更多
Surveillance recommendations for gastric cancer(GC)in current guidelines focused on advanced precancerous lesions and were based on precise diagnosis of severity/extent of baseline lesions.We aimed to develop a less e...Surveillance recommendations for gastric cancer(GC)in current guidelines focused on advanced precancerous lesions and were based on precise diagnosis of severity/extent of baseline lesions.We aimed to develop a less endoscopy-related equipment-dependent risk-stratification tool,and assessed whether mild-precursor-lesion patients can be safely exempt from surveillance.In the multicenter communitybased cohort,75,051 participants receiving baseline endoscopy were enrolled during 2015–2017 and followed-up until 2021.Cumulative incidence rates(CIRs)of GC for precancerous-conditions were calculated by Kaplan-Meier method and compared by Log-rank tests.Mixedeffects Cox regression models were used to detect potential factors for progression towards GC.A risk score was calculated as counts of selected factors.An independent cohort,including 26,586 participants was used for external validation.During a median follow-up of 6.25 years,CIRs of GC were 0.302%,0.436%,and 4.756%for normal group,non-neoplastic(atrophic gastritis/intestinal metaplasia)and neoplastic lesions(low-grade/high-grade dysplasia),respectively(Ptrend<0.001).Four predictors,including male,≥60 years,smoking,and limited vegetable consumption,were selected for risk-stratification.High-risk patients(≥3 risk factors)with non-neoplastic lesions showed higher GC risks(adjusted HR=7.73,95%CI:4.29–13.92),and their four-year CIR reached the one-year CIR of neoplastic lesions.Further categorizing non-neoplastic lesions by histological grade,both patients with moderate-to-severe lesions(aHR=3.07,95%CI:1.67–5.64)and high-risk patients with mild lesions(aHR=7.29,95%CI:3.58–14.86)showed higher risks.Consistent trends were observed in validation cohort.High-risk mild-precursor-lesion patients should receive surveillance within 3–5 years after baseline screening.Our study provides evidence on supplementing current guideline recommendations.展开更多
OBJECTIVE: To investigate telomerase gene expression in precancerous mammary lesion, such as atypical ductal hyperplasia and breast cancer and to study the relationship between expression and malignant transformation....OBJECTIVE: To investigate telomerase gene expression in precancerous mammary lesion, such as atypical ductal hyperplasia and breast cancer and to study the relationship between expression and malignant transformation. METHODS: Expression of human telomerase genes (hTR) and human reverse transcriptase gene (hTRT) in 76 cases of mammary tissue was evaluated using in situ hybridization and included 50 cases of mammary hyperplasia, 6 of which were benign hyperplasia, 9 were mild atypical hyperplasia, 12 were moderate atypical hyperplasia, 23 were severe atypical hyperplasia and 26 were mammary cancer. RESULTS: The expressions of hTR and hTRT mRNA were much weaker or negative in benign hyperplasia (16.6%, 0), weak to mild moderate in atypical hyperplasia (22.2%, 11.1%, 33.3%, 25.0%), strong in severe atypical hyperplasia (60.9%, 52.1%), and significantly strong in mammary cancer (88.5%, 80.8%).The difference between mild-moderate atypical hyperplasia, invasive ductal carcinoma and severe atypical hyperplasia was significant (P 0.05). CONCLUSION: Telomerase genes (hTR and hTRT) expressions are related to the transformation of atypical hyperplasia. Activated telomerase may play a role in mammary cancer development.展开更多
OBJECTIVES: To investigate telomerase activity in esophageal squamous cell carcinoma (SCC) and its preneoplasia lesions, and to study the relationships between telomerase activity and cancer differentiation, cancer in...OBJECTIVES: To investigate telomerase activity in esophageal squamous cell carcinoma (SCC) and its preneoplasia lesions, and to study the relationships between telomerase activity and cancer differentiation, cancer invasiveness, and lymphatic metastasis. METHODS: Telomerase activity in esophageal SCC tissues, adjacent dysplasia tissues and normal epithelia from the surgical edge were assessed by microdissection-TRAP (telomeric repeat amplification protocol)-silver staining assay. RESULTS: Telomerase activity was detected in 37 (82.2%) of 45 esophageal tumors, 23 (79.3%) of 29 dysplasias, and 2 (5%) of 40 normal epithelia. There was a significant difference in activity between dysplasia and normal epithelium, as well as between tumor and normal epithelium. Twenty-six (92.9%) of 28 tumors with lymphatic metastasis had detectable telomerase activity compared to 11 (64.7%) of 17 non-lymphatic metastasis tumors. These relationships were statistically significant (P展开更多
文摘The most common histological type of gastric cancer(GC)is gastric adenocarcinoma arising from the gastric epithelium.Less common variants include mesenchymal,lymphoproliferative and neuroendocrine neoplasms.The Lauren scheme classifies GC into intestinal type,diffuse type and mixed type.The WHO classification includes papillary,tubular,mucinous,poorly cohesive and mixed GC.Chronic atrophic gastritis(CAG)and intestinal metaplasia are recommended as common precancerous conditions.No definite precancerous condition of diffuse/poorly/undifferentiated type is recommended.Chronic superficial inflammation and hyperplasia of foveolar cells may be the focus.Presently,the management of early GC and precancerous conditions mainly relies on endoscopy including diagnosis,treatment and surveillance.Management of precancerous conditions promotes the early detection and treatment of early GC,and even prevent the occurrence of GC.In the review,precancerous conditions including CAG,metaplasia,foveolar hyperplasia and gastric hyperplastic polyps derived from the gastric epithelium have been concluded,based on the overview of gastric epithelial histological organization and its renewal.
文摘Objective Gastric precancerous conditions such as atrophic gastritis(AG)and intestinal metaplasia(IM)are considered independent risk factors for gastric cancer(GC).The suitable endoscopic monitoring interval is unclear when we attempt to prevent GC development.This study investigated the appropriate monitoring interval for AG/IM patients.Methods Totally,957 AG/IM patients who satisfied the criteria for evaluation between 2010 and 2020 were included in the study.Univariate and multivariate analyses were used to determine the risk factors for progression to high-grade intraepithelial neoplasia(HGIN)/GC in AG/IM patients,and to determine an appropriate endoscopic monitoring scheme.Results During follow-up,28 AG/IM patients developed gastric neoplasia lesions including gastric low-grade intraepithelial neoplasia(LGIN)(0.7%),HGIN(0.9%),and GC(1.3%).Multivariate analysis identified H.pylori infection(P=0.022)and extensive AG/IM lesions(P=0.002)as risk factors for HGIN/GC progression(P=0.025).Conclusion In our study,HGIN/GC was present in 2.2%of AG/IM patients.In AG/IM patients with extensive lesions,a 1–2-year surveillance interval is recommended for early detection of HIGN/GC in AG/IM patients with extensive lesions.
基金funded by the Hong Kong Research Grants Council General Research Fund(Grant Nos.17117523 and 17114722)HKU Seed Funding for Collaborative Research(Grant No.23017102377)。
文摘Background Oral cancer is the most common head and neck malignancy and may develop from oral leukoplakia(OL)and oral lichenoid disease(OLD).Machine learning classifiers using structured(tabular)data have been employed to predict malignant transformation in OL and OLD.However,current models require improved discrimination,and their frameworks may limit feature fusion and multimodal risk prediction.Therefore,this study investigates whether tabular-to-image data conversion and deep learning(DL)based on convolutional neural networks(CNNs)can improve malignant transformation prediction compared to traditional classifiers.Methods This study used retrospective data of 1,010 patients with OL and OLD treated at Queen Mary Hospital,Hong Kong,from January 2003 to December 2023,to construct artificial intelligence-based models for oral cancer risk stratification in OL/OLD.Twenty-five input features and information on oral cancer development in OL/OLD were retrieved from electronic health records.Tabular-to-2D image data transformation was achieved by creating a feature matrix from encoded labels of the input variables arranged according to their correlation coefficient.Then,2D images were used to populate five pre-trained DL models(VGG16,VGG19,MobileNetV2,ResNet50,and EfficientNet-B0).Area under the receiver operating characteristic curve(AUC),Brier scores,and net benefit of the DL models were calculated and compared to five traditional classifiers based on structured data and the binary epithelial dysplasia grading system(current method).Results This study found that the DL models had better AUC values(0.893-0.955)and Brier scores(0.072-0.106)compared to the traditional classifiers(AUC:0.887-0.941 and Brier score:0.074-0.136)during validation.During internal testing,VGG16 and VGG19 had better AUC values and Brier scores than other CNNs(AUC:0.998-1.00;Brier score:0.036-0.044)and the best traditional classifier(random forest)(AUC:0.906;Brier score:0.153).Additionally,VGG16 and VGG19 models outperformed random forest in discrimination and calibration during external testing(AUC:1.00 vs.0.976;Brier score:0.022-0.034 vs.0.129).The best CNNs also had better discriminatory performance and calibration than binary dysplasia grading at internal and external testing.Overall,decision curve analysis showed that the optimal DL models with transformed data had a higher net benefit than random forest and binary dysplasia grading.Conclusion Tabular-to-2D image data transformation may improve the use of structured input features for developing optimal intelligent models for oral cancer risk prediction in OL and OLD using convolutional networks.This approach may have the potential to robustly handle structured data in multimodal DL frameworks for oncological outcome prediction.
基金Supported by Jiangsu Science and Technology Project,No.BK20211039the Top Talent Support Program for Young and Middle-Aged People of the Wuxi Health Committee,No.BJ2023008+3 种基金the Major Program of Wuxi Medical Center,Nanjing Medical University,No.WMCM202305the Cohort and Clinical Research Program of Wuxi Medical Center,Nanjing Medical University,No.WMCC202302the Scientific Research Program of Wuxi Health Commission,No.Z202208Wuxi Municipal Health and Health Commission Precision Medicine Project,No.J202104.
文摘BACKGROUND Detecting gastric precancerous lesions(GPLs)is critical for the early diagnosis and treatment of gastric cancer.Endoscopy combined with tissue examination is an important method for detecting GPLs.However,negative biopsy results often increase patients’risks,economic burdens,and lead to additional healthcare costs.Improving the detection rate of GPLs and reducing the rate of negative biopsies is currently a key focus in endoscopic quality control.AIM To explore the relationships between the endoscopist biopsy rate(EBR),qualifications of endoscopists and endoscopic assistants,and detection rate of GPLs.METHODS EBR,endoscopists,and endoscopic assistants were divided into four groups:Low,moderate,high,and very high levels.Multivariable logistic regression analysis was used to analyze the relationships between EBR and the qualifications of endoscopists with respect to the detection rate of positive lesions.Pearson and Spearman correlation analyses were used to evaluate the correlation between EBR,endoscopist or endoscopic assistant qualifications,and the detection rate of positive lesions.RESULTS Compared with those in the low EBR group,the odds ratio(OR)values for detecting positive lesions in the moderate,high,and very high EBR groups were 1.12[95%confidence interval(CI):1.06-1.19,P<0.001],1.22(95%CI:1.14-1.31,P<0.001),and 1.38(95%CI:1.29-1.47,P<0.001),respectively.EBR was positively correlated with the detection rate of gastric precancerous conditions(atrophic gastritis/intestinal metaplasia)(ρ=0.465,P=0.004).In contrast,the qualifications of the endoscopists were positively correlated with GPLs detection(ρ=0.448,P=0.005).Compared to endoscopists with low qualification levels,those with moderate,high,and very high qualification levels endoscopists demonstrated increased detection rates of GPLs by 13%(OR=1.13,95%CI:0.98-1.31),20%(OR=1.20,95%CI:1.03-1.39),and 32%(OR=1.32,95%CI:1.15-1.52),respectively.Further analysis revealed that the qualifications of endoscopists were positively correlated with the detection rates of GPLs in the cardia(ρ=0.350,P=0.034),angularis(ρ=0.396,P=0.015)and gastric body(ρ=0.453,P=0.005)but not in the antrum(ρ=0.292,P=0.079).Moreover,the experience of endoscopic assistants was positively correlated with the detection rate of precancerous lesions by endoscopists with low or moderate qualifications(ρ=0.427,P=0.015).CONCLUSION Endoscopists and endoscopic assistants with high/very high qualifications,but not EBR,can improve the detection rate of GPLs.These results provide reliable evidence for the development of gastroscopic quality control indicators.
基金the National Natural Science Foundation of China,No,39770296
文摘AIM:To further understand the molecular basis for gastric cardia carcinogenesis and to provide etiological clues. METHODS: Endoscopic mucosa biopsy and histopathological examinations were made on 37 subjects from a high incidence area for both esophageal and gastric cardia carcinomas in northern China. All the biopsy samples were fixed in 850 ml. (-1)L alcohol and embedded in paraffin. Each block contained one piece of tissue and was serially section at 5 microm. Immunohistochemistry (ABC) was carried out on these gastric cardia samples to determine the alterations of p16 and Rb. RESULTS: Based on the histopathlogical examination there were 11 cases of chronic superficial gastritis, 12 cases of chronic atrophic gastritis and 14 cases of dysplasia. The immunostaining demonstrated different levels of unclear immunostaining of p16 and Rb in normal gastric cardia tissue and the tissues with different severity of lesions. With the lesions progressing, the positive immunostaining rates for p16 protein had a decreasing tendency. In contrast, the positive immunostaining rate for Rb protein had an increasing tendency. There was a significant negative relationship between the two parameters. Changes of p16 was CSG 11(100%), CAG 7(58%), DYS 4(29%) and changes of Rb was CSG 2(18%), CAG 8(67%) and DYS 12(86%), (P【0.05). CONCLUSION: The alterations of p16 and Rb protein may play a role in the early stages of gastric cardia carcinogenesis.
文摘AIM: To assess the possibility of non-invasive screening of atrophic chronic gastritis for preventing further development of gastric cancer.METHODS: One hundred and seventy-eight consecutive Helicobacter pylori ( H pylori)-positive dyspeptic patients after detection of serum levels of pepsinogen-1 (PG-1) and gastrin-17 (G-17) by enzyme immunoassay were proposed for endoscopy and histology. The serologic and morphologic results were compared with estimating the sensitivity, specificity and prognostic values of the tests.RESULTS: There was statistically significant reverse dependence between the grade of stomach mucosal antral or corpus atrophy and the proper decreasing of serum G17 or PG1 levels. The serologic method was quite sensitive in the diagnosis of non-atrophic and severe antral and corpus gastritis. Also, it was characterized by the high positive and negative prognostic values.CONCLUSION: Detection of serum G-17 and PG1 levels can be offered as the screening tool for atrophic gastritis. The positive serologic results require further chromoendoscopy with mucosal biopsy, for revealing probable progressing of atrophic process with development of intestinal metaplasia, dysplasia or gastric cancer.
文摘In the model rat with precancerous lesion of stomach induced by the combined method of insertion of a spring into the pylorus and high salt hot paste,effects of San Qi (三七 Radix Notoginseng) on gastric secretion and protective factors of stomach were investigated.The results indicated that gastric secretion,gastric mucosal blood flow (GMBF) and aminohexose content lowered significantly,and malondialdehyde (MDA) increased significantly (P<0.01) in the model group as compared with the normal group;after treatment with San Qi Powder for 12 weeks,both gastric secresion and GMBF increased,and MDA content decreased as compared with the negative control group (P<0.01),with no significant increase of aminohexose content.It is suggested that San Qi (三七 Radix Notoginseng) may improve gastric secretion,and that increase of GMBF and antagonism against the lesion of oxygen free radicals are possibly one of its mechanisms.
基金Supported by the Major Programs of Guangzhou University of TCM and the National Key Technologies Research and Development Program of China during the 8th Five-Year Plan Period, No. GH0016 and 85-919-01-01
文摘AIM: To observe the protein and mRNA expression of bcl-2 oncogene in gastric precancerous lesions (GPL) and to analyze its correlation with syndromes in traditional Chinese medicine (TCM). METHODS: Sixty-seven patients with GPL confirmed by gastroscopy and pathology were studied,including 39 cases of moderate gastric mucosal dysplasia,19 cases of severe gastric mucosa dysplasia, 9 cases of incomplete colon metaplasia. In syndrome differentiation of TCM,17 cases belonged to the syndrome of qi and yin deficiency of the spleen and stomach complicated by qi stagnation, 21 cases belonged to the syndrome of qi and yin deficiency of the spleen and stomach complicated by stomach heat, 29 cases belonged to the syndrome of qi and yin deficiency of the spleen and stomach complicated by blood stasis. Protein and mRNA expression of bcl-2 oncogene were detected by labeled streptavidin biotin (LSAB) immunohist-ochemistry and in situ hybridization respectively. RESULTS: Abnormal expression of protein and mRNA on bcl-2 oncogene was found in GPL,which increased gradually with the course of lesions. In moderate and severe gastric mucosal dysplasia and incomplete colon metaplasia,there was no difference in the expression of bcl-2 oncogene (P>0.05).In different accompanying syndromes, the expression of protein and mRNA on bcl-2 oncogene increased gradually in the following order: deficiency of both qi and yin of the spleen and stomach accompanying qi stagnation→stomach heat→blood stasis. In GPL, compared with accompanying blood stasis, there was an obvious difference in the expression of bcl-2 oncogene between the syndrome of qi and yin deficiency of the spleen and stomach and accompanying stomach heat, so did accompanying qi stagnation (the level of protein: X2=8.45, P<0.05;the level of mRNA: X2=7.35, P<0.05). CONCLUSION: Apoptosis-associated bcl-2 oncogene is abnormally expressed in GPL,which correlates with different accompanying syndromes in TCM.
文摘BACKGROUND The diagnosis of gastric carcinoma(GC)is essential for improving clinical outcomes.However,the biomarkers currently used for GC screening are not ideal.AIM To explore the diagnostic implications of the neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),and systemic immune-inflammatory index(SII)for GC.METHODS The baseline data of 133 patients with GC and 134 patients with precancerous gastric conditions admitted between January 2022 and December 2023 were retrospectively analyzed.The information on peripheral blood platelet,neutrophil,and lymphocyte counts in each patient was collected,and the NLR,PLR,and SII levels of both groups were calculated.Additionally,multivariate logistic regression analysis was conducted,and the diagnostic implications of NLR,PLR,and SII in differentiating patients with precancerous gastric conditions,compared with those with GC,were analyzed through receiver operating characteristic(ROC)curves.RESULTS The data indicated that NLR,PLR,and SII had abnormally increased levels in the patients with GC.Gender and body mass index were risk factors for the occurrence of GC.ROC data revealed that the areas under the curve of three patients with precancerous gastric conditions,who were differentiated from those with GC,were 0.824,0.787,and 0.842,respectively.CONCLUSION NLR,PLR,and SII are all abnormally expressed in GC and have diagnostic implications,especially when used as joint indicators,in distinguishing patients with precancerous gastric conditions from those with GC.
基金Supported by the Medical Research Foundation of Guangdong Province,No.1997423
文摘INTRODUCTIONIn China ,the incidence and mortality of gastric cancer rank the second among all cancers. Recent development of cancer [1-20].The aim of this study was investigat the insight of apoptosis and bcl-2, p53 and C-myc protein expression in the development of gastric cancer .
文摘AIM:To investigate the macroscopic and clinicopathologic features of gastric cancer in patients with biopsy-suggested high grade intraepithelial neoplasia. METHODS:Patients with biopsy-confirmed gastric high grade intraepithelial neoplasia were reviewed from January 2001 to March 2008.Pathologic sections were re-evaluated by two senior pathologists. Patients with an en-bloc resection of the lesion within two months after the diagnosis of high grade intraepithelial neoplasia were enrolled in the study. Clinical manifestations,endoscopic features,biopsy and surgical pathology of all patients were collected and analyzed.The data acquired were subjected to univariate and multivariate analysis. RESULTS:Seventy-two superficial gastric lesions with a pathologic diagnosis of high grade intraepithelial neoplasia based on biopsy specimens were enrolled. True high grade intraepithelial neoplasia was finally proved in 16 lesions and gastric cancer in the rest 56 lesions,most of which(96.4%)were differentiated carcinomas.The result of univariate analysis indicatedthat the size and the presence of marked ulcer plaque or scar in a superficial lesion were independently associated with gastric cancer(P<0.05),when high grade intraepithelial neoplasia was diagnosed by biopsy pathology.The results of multivariate analysis revealed the size greater than 1.5 cm[odds ratio(OR)18.400,P<0.001]and the presence of 5-odd mm ulcer plaque or scar(OR 10.000,P=0.044)were associated with gastric cancer.Accordingly,the sensitivity,specificity and negative predictive value of multivariate analysis for predicting"true high grade intraepithelial neoplasia" was 87.5%,89.3%and 96.2%,respectively. CONCLUSION:Macroscopic findings are of value in differentiation between high grade intraepithelial neoplasia and superficial gastric cancer.This may simplify patient work-up and save costs for patients and healthcare system.
文摘Recent technological advances in miniaturization have allowed for a confocal scanning microscope to be integrated into a conventional flexible endoscope,or into trans-endoscopic probes,a technique now known as confocal endomicroscopy or confocal laser endomicroscopy.This newly-developed technology has enabled endoscopists to collect real-time in vivo histological images or "virtual biopsies" of the gastrointestinal mucosa during endoscopy,and has stimulated significant interest in the application of this technique in clinical gastroenterology.This review aims to evaluate the current data on the technical aspects and the utility of this new technology in clinical gastroenterology and its potential impact in the future,particularly in the screening or surveillance of gastrointestinal neoplasia.
文摘IM To detect glutathione Stransferase placental (GSTP) mRNA expression in hepatic preneoplastic lesions in rats.METHODS Using SolitFarber model, the GSTP mRNA expression was observed in hepatic preneoplastic lesions induced by diethylnitrosamine (DEN) in rats and normal and regenerated hepatic tissues in the control group by in situ hybridization.RESULTS GSTP mRNA was mainly expressed in altered hepatic foci (AHF) and some of the oval cells in hepatic preneoplastic lesions and the extent of its expression was different among various foci or/and positive cells in the same focus whereas no expression was observed in normal and regenerated hepatic tissues.CONCLUSION Cells in AHF and oval cells may be the preneoplastic cells in the experimental hepatocellular carcinoma at the molecular level and heterogeneity exists in GSTP transcription levels..
文摘Malignant tumors are caused by multiple carcinogenic factors undergoing several stages. The occurrence and development of tumors may be prevented and blocked if some effective interference factors are brought into play.1 At present, there are two main subjects for the researches, that is, blocking the precancerous lesions and blocking the develop-ment of tumors. The former focuses on the removing of carcinogenic factors and on the chemoprophylaxis of cancer, while the latter on the inhibition of cancer cell infiltration and cancerometastasis. These are summarized as follows.
基金This work was supported by a grant from the National 9th Five-Year Program of China (No. 96-906-01-02) and the National Natural Science Foundation of China (No. 39870838).
文摘Objective: To investigate cyclooxygenase- 2(Cox-2) protein expression in esophageal cancer and precancerous lesions. Methods: One hundred twenty biopsy specimens from esophageal carcinoma and 113 from patients with esophageal premalingnant lesions, 27 from individuals with normal esophageal mucosa and 3 from Barrett’s esophagus were examined for Cox-2 protein expression by immunohistochemistry. Results: Cox-2 protein was not observed in normal esophageal squamous and glandular epithelium, hyperplasia from mild to severe dysplasia lesions and carcinoma in situ. Positive Cox-2 protein expression was found in 4 of 60 specimens of invasive squamous-cell carcinomas, 21 of 30 specimens of esophageal adenocarcinomas and in 3 of 3 Barret’s esophageal tissues. Conclusion: The Cox-2 protein expression may be associated with the development of the esophageal adenocarcinomas but not esophageal squamous-cell carcinomas.
基金supported by the National Natural Science Foundation of China(82273721)Special Project of Beijing-Tianjin-Hebei Basic Research Cooperation(J200017)Sanming Project of Medicine in Shenzhen(SZSM201911015).
文摘Surveillance recommendations for gastric cancer(GC)in current guidelines focused on advanced precancerous lesions and were based on precise diagnosis of severity/extent of baseline lesions.We aimed to develop a less endoscopy-related equipment-dependent risk-stratification tool,and assessed whether mild-precursor-lesion patients can be safely exempt from surveillance.In the multicenter communitybased cohort,75,051 participants receiving baseline endoscopy were enrolled during 2015–2017 and followed-up until 2021.Cumulative incidence rates(CIRs)of GC for precancerous-conditions were calculated by Kaplan-Meier method and compared by Log-rank tests.Mixedeffects Cox regression models were used to detect potential factors for progression towards GC.A risk score was calculated as counts of selected factors.An independent cohort,including 26,586 participants was used for external validation.During a median follow-up of 6.25 years,CIRs of GC were 0.302%,0.436%,and 4.756%for normal group,non-neoplastic(atrophic gastritis/intestinal metaplasia)and neoplastic lesions(low-grade/high-grade dysplasia),respectively(Ptrend<0.001).Four predictors,including male,≥60 years,smoking,and limited vegetable consumption,were selected for risk-stratification.High-risk patients(≥3 risk factors)with non-neoplastic lesions showed higher GC risks(adjusted HR=7.73,95%CI:4.29–13.92),and their four-year CIR reached the one-year CIR of neoplastic lesions.Further categorizing non-neoplastic lesions by histological grade,both patients with moderate-to-severe lesions(aHR=3.07,95%CI:1.67–5.64)and high-risk patients with mild lesions(aHR=7.29,95%CI:3.58–14.86)showed higher risks.Consistent trends were observed in validation cohort.High-risk mild-precursor-lesion patients should receive surveillance within 3–5 years after baseline screening.Our study provides evidence on supplementing current guideline recommendations.
文摘OBJECTIVE: To investigate telomerase gene expression in precancerous mammary lesion, such as atypical ductal hyperplasia and breast cancer and to study the relationship between expression and malignant transformation. METHODS: Expression of human telomerase genes (hTR) and human reverse transcriptase gene (hTRT) in 76 cases of mammary tissue was evaluated using in situ hybridization and included 50 cases of mammary hyperplasia, 6 of which were benign hyperplasia, 9 were mild atypical hyperplasia, 12 were moderate atypical hyperplasia, 23 were severe atypical hyperplasia and 26 were mammary cancer. RESULTS: The expressions of hTR and hTRT mRNA were much weaker or negative in benign hyperplasia (16.6%, 0), weak to mild moderate in atypical hyperplasia (22.2%, 11.1%, 33.3%, 25.0%), strong in severe atypical hyperplasia (60.9%, 52.1%), and significantly strong in mammary cancer (88.5%, 80.8%).The difference between mild-moderate atypical hyperplasia, invasive ductal carcinoma and severe atypical hyperplasia was significant (P 0.05). CONCLUSION: Telomerase genes (hTR and hTRT) expressions are related to the transformation of atypical hyperplasia. Activated telomerase may play a role in mammary cancer development.
文摘OBJECTIVES: To investigate telomerase activity in esophageal squamous cell carcinoma (SCC) and its preneoplasia lesions, and to study the relationships between telomerase activity and cancer differentiation, cancer invasiveness, and lymphatic metastasis. METHODS: Telomerase activity in esophageal SCC tissues, adjacent dysplasia tissues and normal epithelia from the surgical edge were assessed by microdissection-TRAP (telomeric repeat amplification protocol)-silver staining assay. RESULTS: Telomerase activity was detected in 37 (82.2%) of 45 esophageal tumors, 23 (79.3%) of 29 dysplasias, and 2 (5%) of 40 normal epithelia. There was a significant difference in activity between dysplasia and normal epithelium, as well as between tumor and normal epithelium. Twenty-six (92.9%) of 28 tumors with lymphatic metastasis had detectable telomerase activity compared to 11 (64.7%) of 17 non-lymphatic metastasis tumors. These relationships were statistically significant (P
