Immune evasion mechanisms and therapeutic strategies in gastric cancer

Gastric cancer (GC) is a malignancy with a high incidence and mortality. The tumor immune microenvironment plays an important role in promoting cancer development and supports GC progression. Accumulating evidence shows that GC cells can exert versatile mechanisms to remodel the tumor immune microenvironment and induce immune evasion. In this review, we systematically summarize the intricate crosstalk between GC cells and immune cells, including tumor-associated macrophages, neutrophils, myeloid-derived suppressor cells, natural killer cells, effector T cells, regulatory T cells, and B cells. We focus on how GC cells alter these immune cells to create an immunosuppressive microenvironment that protects GC cells from immune attack. We conclude by compiling the latest progression of immune checkpoint inhibitor-based immunotherapies, both alone and in combination with conventional therapies. Anti-cytotoxic T-lymphocyte-associated protein 4 and anti-programmed cell death protein 1/programmed death-ligand 1 therapy alone does not provide substantial clinical benefit for GC treatment. However, the combination of immune checkpoint inhibitors with chemotherapy or targeted therapy has promising survival advantages in refractory and advanced GC patients. This review provides a comprehensive understanding of the immune evasion mechanisms of GC, and highlights promising immunotherapeutic strategies.     

Perioperative,short-, and long-term outcomes of gastric cancer surgery: Propensity score-matched analysis of patients with or without prior solid organ transplantation

BackgroundDetails of perioperative outcomes and survival after gastric cancer surgery in prior transplant recipients have received minimal research attention.MethodsWe performed an observational cohort study using the database of 20,147 gastric cancer patients who underwent gastrectomy at a single gastric cancer center in Korea. Forty-one solid organ recipients [kidney (n = 35), liver (n = 5), or heart (n = 1)] were matched with 205 controls using propensity score matching.ResultsOperation time, blood loss, and postoperative pain were similar between groups. Short-term complication rates were similar between transplantation and control groups (22.0% vs. 20.1%, P = 0.777). Transplantation group patients with stage 1 gastric cancer experienced no recurrence, while those with stage 2/3 cancer had significantly higher recurrence risk compared to the controls (P = 0.049). For patients with stage 1 cancer, the transplantation group had a significantly higher rate of non-gastric cancer-related deaths compared to the controls (19.2% vs. 1.4%, P = 0.001). For those with stage 2/3 cancer, significantly lower proportion of the transplantation group received adjuvant chemotherapy compared to the control group (26.7% vs. 80.3%, P < 0.001). The transplantation group had a higher (albeit not statistically significant) rate of gastric cancer-related deaths compared to the controls (40.0% vs. 18.0%, P = 0.087).ConclusionTransplant recipients and non-transplant recipients exhibited similar perioperative and short-term outcomes after gastric cancer surgery. From long-term outcome analyses, we suggest active surveillance for non-gastric cancer-related deaths in patients with early gastric cancer, as well as strict oncologic care in patients with advanced cancer, as effective strategies for transplant recipients.     

双歧杆菌三联活菌胶囊联合四联疗法治疗幽门螺杆菌所致胃溃疡的效果

目的观察双歧杆菌三联活菌胶囊联合四联疗法治疗幽门螺杆菌(Hp)所致胃溃疡的效果。方法选取2016年1月至2019年12月在郑州大学附属郑州中心医院治疗的112例Hp所致胃溃疡患者为研究对象。按照随机数字表法分为对照组与观察组,每组56例。对照组采取四联疗法(雷贝拉唑钠+胶体果胶铋+克拉霉素+阿莫西林)治疗;观察组在对照组基础上,联合双歧杆菌三联活菌胶囊治疗。比较两组患者的临床疗效、Hp根除率、不良反应及复发率。结果观察组患者的治疗总有效率(98.21%,55/56)高于对照组(85.71%,48/56),差异有统计学意义(P<0.05)。观察组患者的Hp根除率(92.96%,52/56)高于对照组(76.79%,43/56),观察组复发率(3.57%,2/56)低于对照组(16.07%,9/56),差异均有统计学意义(P<0.05)。结论联合应用双歧杆菌三联活菌胶囊、四联疗法可提高治疗效果及Hp根除率,减少病情复发,且安全性良好。     

胃肠超声造影的临床应用价值

目的对比胃肠超声造影的优缺点,探讨对胃十二指肠良恶性病变的诊断符合率,评估胃肠超声造影的临床应用价值。方法选取200例有胃肠道症状患者的胃肠超声造影检查结果,与胃镜检查结果对比分析。结果胃肠超声造影对胃肠道疾病的诊断符合率为94.34%,特异度为100%,敏感度为94.12%,与胃镜对比,在胃十二指肠良恶性病变的检出率的差异无统计学意义(P>0.05)。结论口服胃肠超声造影剂对胃十二指肠结构性病变的诊断符合率高,且能有助于提高胰腺等腹膜后病变的检出率,有较好的诊断价值。应熟练掌握胃肠超声检查的适应证,规范扫查流程。     

Validity and reliability of the Turkish version of the pressure injury knowledge assessment tool 2.0

AimThe aim of this study was to develop a Turkish version of the Pressure Ulcer Knowledge Assessment Tool 2.0 (PUKAT 2.0) and determine its validity and reliability.Materials and MethodsThis was a cross-cultural adaptation and validation study. The study sample included a total of 451 participants (232 nurses and 219 nursing students). The validity of the Turkish version of the PUKAT 2.0 was evaluated with linguistic validity, content validity, item validity (item difficulty, discriminating index), and construct validity (known-groups technique) analyses. The reliability of the tool was evaluated by conducting a test–retest analysis.ResultsContent validity index (CVI) for the items (Item-CVI) ranged from 0.83 to 1.00 and the CVI for the scale (Scale-CVI) was 0.95. The difficulty index for 21 items ranged from 0.10 to 0.63. Four items were found to be too difficult. Item discriminating index values ranged from 0.00 to 0.61. The overall intraclass correlation coefficient (ICC) was found to be 0.80.ConclusionThe Turkish version of the Pressure Injury Knowledge Assessment Tool 2.0 (PIKAT 2.0-Tr) is supported by acceptable psychometric properties and can be used to evaluate the knowledge of nurses and nursing students in Turkey about the prevention of PI.     

Tumor Response and Symptom Palliation from RAINBOW,a Phase III Trial of Ramucirumab Plus Paclitaxel in Previously Treated Advanced Gastric Cancer

BackgroundIn the intent‐to‐treat (ITT) population of the RAINBOW study, objective response rate (ORR) was 28% and 16% in the ramucirumab and control arms, respectively. To further characterize tumor response, we present details on timing and extent of tumor shrinkage, as well as associations with symptom palliation.Materials and MethodsTumor response was assessed with RECIST v1.1, and quality of life (QoL) was assessed with the European Organization for Research and Treatment of Cancer Quality‐of‐Life Questionnaire‐Core 30 (EORTC QLQ‐C30) v3.0. Prespecified and post hoc analyses were conducted in the ITT population, patients with measurable disease, or responders, and included best overall response (BOR), ORR, disease control rate (DCR), duration of response, time to response (TtR), change in tumor size, and associations of QoL with tumor shrinkage and BOR.ResultsIn both treatment arms, median TtR was 1.5 months. Responses were more durable in the ramucirumab versus control arm (median 4.4 vs. 2.8 months). In patients with measurable disease (78% of ITT), ORR was 36% versus 20%; DCR was 81% versus 61% in the ramucirumab versus control arms. Waterfall plots demonstrated more tumor shrinkage in the ramucirumab versus control arm. Regardless of treatment, tumor response and stable disease were associated with improved or stable QoL, with more tumor shrinkage associated with greater symptom palliation.ConclusionTreatment with ramucirumab plus paclitaxel yielded the highest ORR reported to date for patients with previously treated advanced gastric or gastroesophageal junction adenocarcinoma. Additional details demonstrate robustness of tumor response results. The extent of tumor shrinkage is directly associated with symptom palliation and should be considered when evaluating patient needs and treatment selection. Clinical trial identification number. {"type":"clinical-trial","attrs":{"text":"NCT01170663","term_id":"NCT01170663"}}NCT01170663.Implications for PracticeRamucirumab plus paclitaxel is a recognized standard of care as it improves survival for patients with advanced gastric or gastroesophageal junction adenocarcinoma who have been previously treated with recommended first‐line therapy. These additional data on tumor response demonstrate a positive association between tumor shrinkage and symptom palliation in a patient population that is often symptomatic. These observations included patients with nonmeasurable disease, a group of patients often underrepresented in clinical trials. This knowledge can inform treatment decisions, which align individual patient characteristics and needs with demonstrated benefits.     

胃癌患者免疫功能及炎症水平的变化与腹腔镜术后发生医院感染的关系

目的探讨胃癌患者免疫功能及炎症水平的变化与腹腔镜手术后发生医院感染的关系。方法选取腹腔镜手术治疗胃癌并发术后感染患者70例,同期未感染患者70例。检测感染患者血清中免疫细胞及炎症相关因子水平变化情况。结果感染组患者血清中CD3+、CD4+、CD8+、CD4+/CD8+水平明显低于未感染组(P<0.05);感染组患者血清中CRP和IL-6水平明显高于未感染组(P<0.05)。同时对感染组患者进行分析发现,感染率随CD4+水平下降呈显著上升趋势(P<0.05)。ROC分析显示:血清CRP、IL-6及CD4+对腹腔镜手术治疗胃癌后发生医院感染具有较高的预测诊断价值,ROC-AUC均在0.72以上,敏感度和特异度均高于0.7。结论胃癌患者免疫功能及炎症因子水平的变化与腹腔镜手术后发生医院感染有密切关系,对手术后发生医院感染有一定的预测诊断价值,因此,术后应密切关注患者免疫功能及炎症水平的变化,降低感染率。