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This study used artificial intelligence techniques to identify clinical cancer biomarkers for recurrent gastric cancer survivors. From a hospital-based cancer registry database in Taiwan, the datasets of the incidence of recurrence and clinical risk features were included in 2476 gastric cancer survivors. We benchmarked Random Forest using MLP, C4.5, AdaBoost, and Bagging algorithms on metrics and leveraged the synthetic minority oversampling technique (SMOTE) for imbalanced dataset issues, cost-sensitive learning for risk assessment, and SHapley Additive exPlanations (SHAPs) for feature importance analysis in this study. Our proposed Random Forest outperformed the other models with an accuracy of 87.9%, a recall rate of 90.5%, an accuracy rate of 86%, and an F1 of 88.2% on the recurrent category by a 10-fold cross-validation in a balanced dataset. We identified clinical features of recurrent gastric cancer, which are the top five features, stage, number of regional lymph node involvement, Helicobacter pylori, BMI (body mass index), and gender; these features significantly affect the prediction model's output and are worth paying attention to in the following causal effect analysis. Using an artificial intelligence model, the risk factors for recurrent gastric cancer could be identified and cost-effectively ranked according to their feature importance. In addition, they should be crucial clinical features to provide physicians with the knowledge to screen high-risk patients in gastric cancer survivors as well. [ABSTRACT FROM AUTHOR]

Background: The accuracy of histopathology diagnosis largely depends on the pathologist's experience. It usually takes over 10 years to cultivate a senior pathologist, and small numbers of them lead to a high workload for those available. Meanwhile, inconsistent diagnostic results may arise among different pathologists, especially in complex cases, because diagnosis based on morphology is subjective. Computerized analysis based on deep learning has shown potential benefits as a diagnostic strategy.Methods: This research aims to automatically determine the location of gastric cancer (GC) in the images of GC slices through artificial intelligence. We use image data from a regional teaching hospital in Taiwan for training. We collect images of patients diagnosed with GC from January 1, 2019 to December 31, 2020. In this study, scanned images are used to dissect 13,600 images from 50 different patients with GC sections whose GC sections are stained with hematoxylin and eosin (H&E stained) through a whole slide scanner, the scanned images from 50 different GC slice patients are divided into 80% training combinations, 2200 images of 40 patients are trained. The remaining 20%, totaling 10 people, are validated from a test set of 550 images.Results: The validation results show that 91% of the correct rates are interpreted as GC images through deep learning. The sensitivity, specificity, PPV, and NPV were 84.9%, 94%, 87.7%, and 92.5%, respectively. After creating a 3D model through the grayscale value, the position of the GC is completely marked by the 3D model. The purpose of this research is to use artificial intelligence (AI) to determine the location of the GC in the image of GC slice.Conclusion: In patients undergoing pancreatectomy for pancreatic cancer, intraoperative infusion of lidocaine did not improve overall or disease-free survival. Reduced formation of circulating NETs was absent in pancreatic tumour tissue.Conclusion: For AI to assist pathologists in daily practice, to help a pathologist making a definite diagnosis is not the prime purpose at present time. The benefits could come from cancer screening and double-check quality control in a heavy workload which could distract the attention of pathologist during the time constraint examination process. We propose a two-steps method to identify cancerous areas in endoscopic gastric biopsy slices via deep learning. Then a 3D model is used to further mark all the positions of GC in the picture, and the model overcomes the problem that deep learning can't catch all GC. [ABSTRACT FROM AUTHOR]

Background: We aimed to assess the latest prevalence and secular trend of Helicobacter pylori infection and its association with the incidence and mortality of gastric cancer in Taiwan. Materials and Methods: Adults naive to H. pylori eradication received 13C‐urea breath test (13C‐UBT), H. pylori stool antigen test, and serology test during 2019–2020 in this prospective screening program. Children and adolescent aged between 7 and 19 years received 13C‐UBT for H. pylori screening. We also conducted a systematic review and meta‐analysis to assess the secular trend of prevalence of H. pylori from 1990 to 2020 in Taiwan. The secular trends of age‐standardized incidence and mortality of gastric cancer were obtained from the Taiwan Cancer Registry. Results: A total of 1494 participants were enrolled, including 294 children or adolescents and 1200 adults. The overall prevalence of active H. pylori infection by 13C‐UBT was 26.6% (397/1494), which was 30.8% in adults and 9.5% in adolescents/children. The age‐standardized prevalence of active H. pylori infection was 32.3% in adults after adjustment of the population structure in Taiwan. Of the 29 studies including 38,597 subjects eligible for the meta‐analysis, the pooled prevalence of H. pylori infection decreased from 63.8% (95% CI: 55.9%–71%) in 1990–2000 to 28.2% (95% CI:21.8%–35.6%) in 2016–2020. The age‐standardized incidence and mortality of gastric cancer have also declined from 15.2 to 10.75 per 100,000, respectively, in 1999 to 9.29 and 5.4 per 100,000, respectively, in 2019. Conclusions: The prevalence of H. pylori infection has declined in Taiwan, which correlates with the declining trends of age‐standardized incidence and mortality of gastric cancer in Taiwan. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown elevated cancer risk in anorexia nervosa but the literature on other eating disorders (EDs) is scarce. This study aimed to investigate the association between all EDs and esophageal, stomach, and other cancers. Methods: We used a retrospective cohort design, based on a two‐million randomized longitudinal health insurance dataset, a sub‐dataset of Taiwan's National Health Insurance Research Database. From all the potential participants aged 20 years or more, a total of 6,628 participants were enrolled, including 1,657 patients with EDs, with sex‐, age‐, and indexed date‐matched (1:3) 4,971 controls. Each participant was individually tracked from 2000 to 2015 to identify incident cases of cancers, including esophageal cancer (EC), stomach cancer (SC), and all other cancers (AOC). The multivariate Cox proportional hazards model was employed to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between EDs and cancer. Results: Of the total 6,628 enrollees, 222 in 1,657 individuals with EDs and 810 in the 4,971 non‐ED control individuals developed cancer (1,262.40 vs. 1,472.15 per 100,000 person‐years), and the Kaplan–Meier survival analysis was not statistically significant (log‐rank, p =.324). However, after adjusting for covariates, the risk of EC and SC among the individuals with an ED was significantly higher, with adjusted HRs of 5.32 (95% CI: 1.07–26.49, p <.001) and 4.61 (95% CI: 1.91–11.14, p <.001), respectively. EDs were not associated with other cancers. Conclusions: This study provides evidence for the association between EDs and the risk for EC and SC. Further research on mechanisms and prevention is therefore needed. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic gastrectomy is an acceptable procedure for early-stage gastric cancer; however, most patients are diagnosed at an advanced stage and older age in Taiwan. The feasibility and safety of applying laparoscopic gastrectomy in daily practice remain unclear. This study aimed to examine the short- and long-term outcomes of laparoscopic gastrectomy versus open procedures. Methods: From 2007 to 2015, 192 patients who underwent open gastrectomy and 189 patients who underwent laparoscopic gastrectomy for gastric cancer at a single center were included. Propensity score matching analysis was used to adjust selection biases associated with age, preoperative hemoglobin, the extent of resection, tumor size, and stage of the disease. The demographics, perioperative parameters, short-term postoperative results, and 5-year survival data were analyzed. Results: Open gastrectomy was more frequently performed in the elderly, larger tumor size, advanced stage of the disease, and disease requiring total gastrectomy or combined organ resection. After propensity score matching, 108 patients with laparoscopic gastrectomy were compared to 108 patients with open gastrectomy. The morbidity rates were not different in both groups (25.9%), while hospital stay was shorter in the laparoscopic group (16.0 vs. 18.8 days, p = 0.04). The 5-year overall survival and disease-free survival were superior in the laparoscopic group (p = 0.03 and p = 0.01, respectively); however, the survival differences were not significant in the subgroup analysis by stage. Laparoscopic gastrectomy had fewer recurrences than open gastrectomy. The pattern of recurrence was not different between the groups. Conclusions: Laparoscopic gastrectomy can be safely applied in both early and locally advanced gastric cancer without compromising oncologic outcomes. Trial registration: Retrospective registration. [ABSTRACT FROM AUTHOR]

In Japan, South Korea, and Taiwan, nivolumab might provide overall survival benefits for patients with advanced gastric cancer. However, it is effective only in a limited number of patients. The Glasgow prognostic score is an indicator of the systematic inflammatory response and nutritional status. This study aimed to investigate the ability of the Glasgow prognostic score and other markers to predict the outcomes of patients treated with nivolumab. We reviewed the medical records of patients treated for advanced gastric cancer and who received nivolumab between February 2015 and June 2019 at Hyogo Cancer Center. The patients were categorized into two groups according to their Glasgow prognostic scores. Overall, 53.3% and 46.7% of the patients were assigned to groups with Glasgow prognostic scores of 0 and 1/2, respectively. The median durations of progression-free and overall survival of the participants were 2.3 and 5.7 months, respectively. The patients with a Glasgow prognostic score of 0 had significantly higher median overall survival than those with scores of 1 or 2 (16.4 vs. 4.2 months; p = 0.0006). This observation suggests that a pretreatment Glasgow prognostic score of 0 is associated with better outcomes, and this scoring system may be used as a predictor of outcomes in patients with advanced gastric cancer treated with nivolumab. [ABSTRACT FROM AUTHOR]

Currently, consensus reports on the nutritional management for gastric cancer patients receiving gastric resection are lacking. The Gastroenterological Society of Taiwan therefore organized the Taiwan Gastric Cancer Nutritional Consensus Team to provide an overview of evidence and recommendations on nutritional support for gastric cancer patients undergoing gastrectomy. This consensus statement on the nutritional support for gastric cancer patients has two major sections:(1)perioperative nutritional support; and (2)long-term postoperative nutritional care. Thirty Taiwan medical experts conducted a consensus conference, by a modified Delphi process, to modify the draft statements. The key statements included that preoperative nutritional status affects the incidence of operative complications and disease-specific survival in gastric cancer patients undergoing gastrectomy. Following gastrectomy, both early oral and enteral tube feeding can result in a shorter stay than total parenteral nutrition. Compared to late oral feeding, early oral feeding can reduce hospital stay in gastric cancer patients receiving gastrectomy without an increase in complication rate. Routine supplementation with vitamin B12 is indicated for gastric cancer patients undergoing a total gastrectomy. Both high-dose oral vitamin B12 supplementation and intramuscular administration of vitamin B12 are equally effective in the treatment of vitamin B12 deficiency. [ABSTRACT FROM AUTHOR]

Background/purpose: The choice of endoscopic submucosal dissection (ESD) as first line treatment for selected early gastric cancer (EGC) patients was proved as effective as surgical treatment in studies over many countries. Yet there is no such cohort comparison in Taiwan. This study is aimed to describe our experience in ESD treated EGC and to compare the outcomes with those underwent surgical treatment.Methods: This was a retrospective cohort study reviewing the patients with EGC underwent ESD and surgical treatments in a single tertiary referral center in Taiwan. The primary endpoint was disease specific survival. Recurrence free survival and length of hospital stay were also compared.Results: The disease specific survival between indicated ESD and surgery showed no significant difference (cumulative survival 100% vs. 97.03%, p = 0.39), so as the recurrence free survival (cumulative survival 92.31% vs. 94.06%, p = 0.60). In subgroup analyses of ESD treated patients, a non-significant recurrence rate difference between indicated and non-indicated ESD was found (cumulative recurrence 7.69% vs. 20%, p = 0.39) and a higher recurrence rate in patients with non-R0 resection compared with R0 resection (cumulative recurrence 0% vs. 40%, p < 0.01). However, the shorter duration of hospital stay in ESD group was noted in comparison to surgery (mean 5.67 days vs. 15.75 days, p < 0.01). The ESD patients have minor complications including bleeding, perforation and fever than surgery.Conclusion: ESD is a reasonable first line treatment in selected early gastric cancer in additional to surgery. Pre-treatment evaluation and post-ESD review of curability is crucial to further surveillance program or definite therapy including surgery. [ABSTRACT FROM AUTHOR]

Background: The updated prevalence of Helicobacter pylori (H. pylori) is lacking in Taiwan. We aimed to assess the accuracy of Vstrip® H. pylori Stool Antigen Rapid Test (Vstrip®HpSA) in the detection and surveillance of the updated prevalence of H. pylori in Taiwan.Methods: A total of 347 adult subjects including 152 volunteers and 195 symptomatic patients were recruited. Stool samples were collected for detection of H. pylori using Vstrip® HpSA, ImmunoCard STAT!® HpSA and Premier Platinum HpSA® PLUS. All subjects who have completed the stool sample collections were included in the ITT analysis. The sensitivity, specificity, and accuracy of Vstrip® HpSA were calculated compared to gold standard test with 13C-Urea breath test.Results: The un-adjusted prevalence of H. pylori infection was 22.5% (95% CI: 18.3-27%) in 2018. The age-standardized prevalence of H. pylori was 21.8% in asymptomatic adults in Taiwan. The sensitivity, specificity, and accuracy of the Vstrip® HpSA, and ImmunoCard STAT!® HpSA tests were 91% (95% CI: 82-96%) versus 76.9% (95% CI: 66-86%), 97% (95% CI: 94.1-98.6%) versus 97% (95% CI: 94.1-98.6%), and 95.7% (95% CI: 92-97%) versus 92.5% (95% CI: 89-95%), respectively.Conclusion: The age-standardized prevalence of H. pylori infection in Taiwan was 21.8% in asymptomatic adults in 2018. The Vstrip® HpSA had equivalent performance as the ImmunoCard STAT!® HpSA, and can be used in future mass screening of H. pylori infection for gastric cancer prevention. [ABSTRACT FROM AUTHOR]

Background Gastric stump ("remnant") cancer is the development of a malignancy related to previous gastric surgery. Prognosis in gastric stump cancer, compared with that in primary gastric cancer, is still controversial. Methods From January 1988 to December 2012 at a single medical centre in Taiwan, 105 patients with gastric stump cancer, including 85 with previous peptic ulcer disease and 20 with previous gastric cancer, were analyzed for clinicopathologic characteristics and overall survival (os). Results The 5-year os rates for patients with gastric stump cancer and with primary gastric cancer were 51.2% and 54.5% respectively (p = 0.035). Analysis of clinicopathologic characteristics indicated that, compared with patients having primary gastric cancer, those with gastric stump cancer had more lymph node metastasis (p < 0.001) and had been diagnosed at a more advanced stage (p = 0.047). Multivariate analysis with os as an endpoint showed that age [p = 0.015; hazard ratio (hr): 2.300; 95% confidence interval (ci): 1.173 to 4.509], tumour size (p = 0.037; hr: 1.700; 95% ci: 1.031 to 2.801), stromal reaction (p = 0.021; hr: 1.802; 95% ci: 1.094 to 2.969), and pathologic N category (p = 0.001; hr: 1.449; 95% ci: 1.161 to 1.807) were independent predictors in gastric stump cancer. The os rates for patients with gastric stump cancer who previously had gastric cancer or peptic ulcer disease were 72.9% and 50.0% respectively (p = 0.019). The Borrmann classification was more superficial (p = 0.005), lymph node metastases were fewer (p = 0.004), and staging was less advanced (p = 0.025) in patients with gastric stump cancer who previously had gastric cancer than in their counterparts who previously had peptic ulcer disease. Conclusions Survival is poorer in patients with gastric stump cancer who previously had peptic ulcer disease than in those who previously had primary gastric cancer. Patients with gastric stump cancer who previously had gastric cancer and could receive curative gastrectomy tended to have a better prognosis because of a more superficial Borrmann classification. Regular follow-up in patients who have undergone gastric surgery is recommended for the early detection of gastric stump cancer. [ABSTRACT FROM AUTHOR]

Background: International guidelines on clinical staging of gastric cancer recommend the use of chest CT for the detection of pulmonary metastases. This study assessed the clinical value of routine chest CT in the staging of gastric cancer. Methods: This retrospective study included patients identified from the gastric cancer registry of Chang Gung Memorial Hospital, Linkou, Taiwan. All patients who underwent clinical staging between 2008 and 2014 were included. The pattern, site and number of metastases at initial presentation and after surgery with curative intent were evaluated. Pulmonary metastases were defined as multiple small round pulmonary nodules with a random distribution or of variable size. Results: Some 1669 patients were included, of whom 478 (28·6 per cent) had metastatic disease at clinical presentation. The majority of metastases were to the peritoneum (75·7 per cent of patients) or liver (30·5 per cent), and only 27 patients (5·6 per cent) had pulmonary metastases at presentation, none of which were isolated to the lung. Of these 27 patients, 11 had primary lesions located at the cardia/fundus. In 19 patients the lung metastases were also detected on the staging chest X‐ray. After surgery there were 196 cancer recurrences. Some 15 patients (7·6 per cent) had lung metastasis and this was not the only site of metastases in any patient. The prevalence of lung metastasis at presentation of the disease and after surgery was 1·6 and 1·5 per cent respectively. Conclusion: This study does not support the routine use of chest CT for staging of gastric cancer as isolated pulmonary metastasis in the absence of other metastatic sites could not be detected. [ABSTRACT FROM AUTHOR]

Objective: The association between antipsychotic use and gastric cancer risk remains unclear. Therefore, this study aimed to determine the association between antipsychotic exposure and the incidence of gastric cancer. Methods: Using a nested case‐control design, a total of 34 470 gastric cancer patients and 163 430 nongastric cancer controls were identified from Taiwan's National Health Insurance Research Database between 1 January 1997 and 31 December 2013. We analyzed the data using a conditional logistic regression model to adjust for possible confounding variables. Results: Antipsychotic use was independently inversely associated with gastric cancer risk after controlling for potential confounding factors including income, urbanization, medications, physical and medical illness, aspirin use, nonsteroidal anti‐inflammatory drug use and triple therapy. In addition, dose‐dependent trends against gastric cancer risk were also shown with individual antipsychotic compounds including thioridazine, haloperidol, sulpiride, clozapine, olanzapine, quetiapine, amisulpride, and risperidone. A sensitivity analysis showed that second‐generation antipsychotics had significant dose‐dependent effects in reducing the risk of gastric cancer risk in patients with and without peptic ulcer disease. Conclusions: Antipsychotic use was inversely associated with gastric cancer risk, and dose‐dependent effects against gastric cancer were also seen with several individual antipsychotic compounds. [ABSTRACT FROM AUTHOR]

Aim To describe treatment patterns, outcomes and healthcare resource use in patients with metastatic and/or locally recurrent, unresectable gastric cancer (MGC) in Taiwan. Methods Patients who had received first-line therapy (platinum and/or fluoropyrimidine) followed by second-line therapy or best supportive care (BSC) only were eligible. Participating physicians provided de-identified information from patient charts. Data were summarized descriptively and Kaplan-Meier analysis was used to describe time to events. Results Overall, 37 physicians contributed 122 patient charts. Of the 122 patients (median age, 61 years; 62% male), 43 (35%) received BSC only following first-line therapy, whereas 79 (65%) received second-line therapy. There was heterogeneity in second-line treatment, although fluoropyrimidine with or without a platinum agent was most frequently used. Median survival was 12.5 (interquartile range [IQR], 8.2-20.8) months from MGC diagnosis for patients receiving second-line therapy and 8.0 (IQR, 5.6-not reached) months for patients receiving BSC only. The most common treatment-related symptoms were nausea/vomiting (58%); the most common cancer-related symptoms were pain (61%), ascites (35%) and nausea/vomiting (33%). Inpatient and outpatient hospitalizations were numerically more common for patients receiving second-line therapy than for those receiving BSC only; the prevalence of hospice and skilled nursing facility stays were numerically more common for patients receiving BSC only. Conclusions In this Taiwanese MGC population, 65% received active second-line therapy with heterogeneity seen in the regimen used. Clinical outcomes suggest an unmet medical need in this population. This study may help inform clinical practice and future research to ultimately improve patient outcomes in Taiwan. [ABSTRACT FROM AUTHOR]

Background: Epidemiological data concerning the association between diabetes and the subsequent development of gastric cancer are controversial. This population-based retrospective cohort study investigated the subsequent risk of gastric cancer for diabetic patients. Methods: From claims data of the universal health insurance of Taiwan, we identified 19,625 persons aged ≥20 years newly diagnosed with diabetes during 2000-2005. A comparison group ( n = 78,500), frequency matched by age, sex, and calendar year, was randomly selected from people without diabetes. Incidence and hazard ratios (HR) of gastric cancer were ascertained during the follow-up period until 2008. We also explored associations of antidiabetic medicines with the incidence of gastric cancer. Results: During the follow-up period, 47 subjects in the diabetic group and 216 subjects in the comparison group suffered gastric cancer, with the incidence rates of 4.34 and 4.86 per 10,000 person-years, respectively. During the first 4 years after diabetes diagnosis, the incidence of gastric cancer was relatively low in diabetic patients [adjusted HR = 0.63; 95 % confidence interval (CI) = 0.42-0.97]. However, after that time, the diabetic group had a 76 % (95 % CI = 1.06-2.91) higher risk of developing gastric cancer than the comparison group. In diabetic patients, alpha-glucosidase inhibitors were associated with a significantly decreased risk of gastric cancer (adjusted HR = 0.38; 95 % CI = 0.15-0.96). Conclusions: Our findings suggested that the association between diabetes and subsequent risk of gastric cancer may vary over time. Increased risk of gastric cancer was observed in patients with longer duration of diabetes. [ABSTRACT FROM AUTHOR]

Objective To evaluate the benefit of mass eradication of Helicobacter pylori infection in reducing premalignant gastric lesions. Design Mass eradication of H pylori infection was started from 2004 for a Taiwanese population with prevalent H pylori infection, who were >30 years of age. Participants positive for the 13C-urea breath test underwent endoscopic screening and 1-week clarithromycin-based triple therapy. For subjects whose initial treatment failed, 10-day levofloxacin-based triple therapy was administered. The main outcome measures were changes in the prevalence of H pylori infection and premalignant gastric lesions, and changes in the incidence of premalignant gastric lesions and gastric cancer before (1995e2003) and after (2004e2008) chemoprevention using various comparators. Results The reduction in H pylori infection was 78.7% (95% CI 76.8% to 80.7%), and the estimated incidence of re-infection/recrudescence was 1% (95% CI 0.6% to 1.4%) per person-year. The effectiveness of reducing the incidence of gastric atrophy resulting from chemoprevention was significant at 77.2% (95% CI 72.3% to 81.2%), while the reduction in intestinal metaplasia was not significant. Compared with the 5-year period before chemoprevention and in the absence of endoscopic screening, the effectiveness in reducing gastric cancer incidence during the chemoprevention period was 25% (rate ratio 0.753, 95% CI 0.372 to 1.524). The reduction in peptic ulcer disease was 67.4% (95% CI 52.2% to 77.8%), while the incidence of oesophagitis was 6% (95% CI 5.1% to 6.9%) after treatment. Conclusions Population-based eradication of H pylori infection has led to a significant reduction in gastric atrophy at the expense of increased oesophagitis. The ultimate benefit in reducing gastric cancer incidence and its mortality should be validated by a further long-term follow-up [ABSTRACT FROM AUTHOR]

To investigate the relationship between air pollution and risk of death attributed to gastric cancer, a matched cancer case-control study was conducted using deaths that occurred in Taiwan from 2004 through 2008. Data for all eligible gastric cancer deaths were obtained and compared to a control group consisting of individuals who died from causes other than neoplasms and diseases that were associated with gastrointestinal (GIT) disorders. The controls were pair-matched to the cancer cases by gender, year of birth, and year of death. Each matched control was randomly selected from the set of possible controls for each cancer case. Data for the number of petrol stations in study municipalities were collected from two major petroleum supply companies. The petrol station density (per square kilometer) (PSD) for study municipalities was used as an indicator of a subject's exposure to benzene and other hydrocarbons present in ambient evaporative losses of petrol or to air emissions from motor vehicles. The exposed individuals were subdivided into three categories (≤25th percentile; 25th-75th percentile; >75th percentile) according to PSD in the residential municipality. Results showed that individuals who resided in municipalities with the highest PSD were at an increased risk of death attributed to gastric cancer compared to those subjects living in municipalities with the lowest PSD. The findings of this study warrant further investigation of the role of traffic air pollution exposure in the etiology of gastric cancer. [ABSTRACT FROM AUTHOR]

BACKGROUND: The association between diabetes and gastric cancer has been rarely studied. OBJECTIVE: To investigate gastric cancer mortality trends, the mortality rate ratios between patients with diabetes and the general population, and the risk factors for gastric cancer mortality in diabetic patients. METHODS: In the Taiwanese general population from 1995 to 2006, age-standardised trends of gastric cancer mortality were evaluated, followed by calculation of age–sex-specific mortality rates. A total of 113 347 men with diabetes and 131 573 women with diabetes, aged ≥25 years and recruited in 1995–1998, were followed to 2006 for gastric cancer mortality. Age–sex-specific mortality rate ratios for diabetic patients versus the general population were calculated. Cox''s regression was used to evaluate the risk factors among diabetic patients. RESULTS: A decreasing trend of age-standardised gastric cancer mortality in the general population (p<0.0001) was observed from 1995 to 2006 for both sexes. A total of 627 diabetic men and 422 diabetic women died of gastric cancer, with a calculated mortality rate of 72.8 and 40.0 per 100 000 person-years, respectively. Mortality rate ratios showed a significantly higher risk in diabetic patients with a magnitude most remarkable at the youngest age: 1.52 (1.31–1.77), 1.58 (1.40–1.78) and 4.49 (3.93–5.12) for ≥75, 65–74 and 25–64 years old, respectively, for men; and 1.58 (1.32–1.90), 1.95 (1.67–2.27) and 3.65 (3.11–4.28), respectively, for women. In the diabetic patients, age and male sex were associated with gastric cancer mortality, but diabetes type, insulin use, and smoking were not. Body mass index and area of residence did not show consistent association. Diabetes duration was significantly predictive when those who died of gastric cancer within 5 years of diabetes diagnosis were excluded from analysis. CONCLUSIONS: Despite a decreasing age-standardised mortality trend in the general population, diabetic patients have a higher risk of gastric cancer mortality and this was most remarkable in the youngest age group of 25–64 years. [ABSTRACT FROM AUTHOR]

Background/purpose: Endoscopic submucosal dissection (ESD) is an advanced endoscopic procedure to resect early gastric cancer (EGC). The purpose of this study was to determine the effectiveness and complications of ESD for gastric epithelial tumors in Taiwan.Methods: We retrospectively analyzed the efficacy and outcome of ESD in patients who received ESD for gastric epithelial tumors between June 2004 and August 2007.Results: A total of 70 patients with gastric epithelial tumors were treated by ESD. The mean age was 66.5 +/- 12.9 years (range, 35-84 years). The mean size of the gastric epithelial tumors was 1.85 +/- 0.81 cm. The mean size of resected specimens was 3.26 +/- 1.39 cm. The one-piece resection rate was 91.4% (64/70). The median operation time was 92.4 minutes. The complicating bleeding and perforation rates were 5.7% (4/70) and 4.3% (3/70), respectively. Emergency surgery was performed for three patients with perforations. The local recurrence rate of gastric cancer was 2.8%. Except for one patient who died of congestive heart failure and another who died of stroke, the remaining 68 patients (97.1%) survived.Conclusion: ESD is a promising local curative treatment option for EGC in Taiwan but it still carries risks of perforation and bleeding. The education and learning curve of endoscopists will improve the outcome of this procedure. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This prospective cohort study investigated the impact of Helicobacter pylori infection on the development of various gastric malignancies. METHODS: We prospectively followed up 1,225 dyspeptic Taiwanese who had nonulcer dyspepsia, gastric ulcers, or duodenal ulcers at enrollment. Among them, 618 (50.4%) had H. pylori infection and 607 (49.6%) did not. Patients underwent endoscopy at enrollment and at 1- to 3-yr intervals thereafter. RESULTS: During a mean follow-up of 6.3 yr, gastric adenocarcinoma developed in 7 of the 618 H. pylori-infected patients, but in none of the 607 uninfected patients (1.1% vs 0.0%, P= 0.015). The incidence of gastric lymphoma was 0.2% (1/618) and 0% in H. pylori-infected and uninfected patients. Taken together, the development rate of gastric malignancy in H. pylori-infected patients was significantly higher than that in uninfected patients (1.3% vs 0%, P= 0.007). Among H. pylori-infected subjects, the incidence of gastric malignancy was similar between those receiving and not receiving eradication therapy (1.4% vs 1.2%). Multivariate analysis showed that intestinal metaplasia was the only independent factor predicting subsequent development of gastric malignancy in H. pylori-infected subjects with an odds ratio of 4.5 (95% CI 1.1–19.1). CONCLUSIONS: In this prospective cohort study, all gastric malignancies, including adenocarcinoma and lymphoma, developed in H. pylori-infected patients. The finding implies that H. pylori is a necessary cause of most gastric malignancies. Follow-up for H. pylori-infected patients who have intestinal metaplasia is indicated. [ABSTRACT FROM AUTHOR]

The stomach is an uncommon site for metastasis, and most of the reported examples would appear to have been caused by direct invasion from primary malignancies. Metastases to the stomach are extremely rare, and few cases have been reported in the literature. This study was intended to evaluate the character of and the prognosis for metastasized tumors of the stomach. We evaluated the medical records of patients who had presented at the National Taiwan University Hospital over a period of 10 years prior to writing who had malignancies and had developed metastasis to the stomach. We evaluated the histology, initial presentations, imaging findings, lesion locations, treatment courses, and overall patient survival. From October 1995 to October 2004 inclusively, only 18 patients featuring known malignancies with metastases to the stomach were found. The male to female ratio was 10:8. The initial symptom for 13 study patients was bleeding from the metastasis tumors, and the remaining 5 experienced a variety of other symptoms. The site of the metastasis was the gastric body for 9 patients, the gastric antrum for 6, the cardia or fundus for 2, and the entire stomach for 1. The time period elapsing between the emergence of the primary malignancy and the gastric metastasis was less than 2 years for 3 patients and about 5–6 years for another 2 patients. The mean time elapsing from the diagnosis of gastric metastasis to patient death was quite short, namely, about 6 months. Carcinomas featuring gastric metastasis are typically very rare and reveal a rather poor prognosis. The results of this preliminary study suggest that most treatment for these patients seemed to provide only symptomatic relief but did not prove helpful for long-term survival. [ABSTRACT FROM AUTHOR]

Randomized controlled trials and cohort studies have confirmed that Helicobacter pylori eradication can effectively reduce the incidence of gastric cancer in H. pylori-infected persons.[[1]] Consensus meetings also emphasized that gastric cancer is a preventable disease and that populations with high prevalence of H. pylori infection and high incidence of gastric cancer should be considered for eradication treatments.[3] However, in face of the global decreasing trend of gastric cancer, whether and how to initiate such a mass eradication program remain unclear. Therefore, to disseminate the knowledge about gastric cancer caused by H. pylori and treatment with antibiotics, the screening service should be integrated into their social activities to engage more subjects in health promotion. [Extracted from the article]

Pyruvate kinase M2 (PKM2) is a key enzyme responsible for the final step of glycolysis. Whether and how the pyruvate kinase M2 is involved in reactive oxygen species (ROS)-mediated cytotoxicity of gastrointestinal cancer is unknown. One duodenal cancer cell line AZ521, and two gastric cancer cell lines NUGC and SCM-1 and were treated with OSU-A9 which is known to induce cytotoxicity of acute myeloid leukemia through ROS generation. The in vitro cytotoxic and proapoptotic activities of OSU-A9 was evaluated by the 3-(4,5-dimethylthiazol-2yl)-2,5-diphenyltetrazolium bromide (MTT) assay and annexin V – propidium iodide staining, respectively. Overexpression experiment was performed by transfection with indicated plasmid using Lipofectamine 2000 according to the manufacturer's protocol. OSU-A9 induced a dose- and time-dependent cytotoxicity and apoptosis in duodenal cancer and gastric cancer cells through ROS generation. The IC50 of OSU-A9 at 24 and 48 h for AZ-521, NUGC and SCM-1 were 2.68 and 1.83, 3.34 and 2.81, and 2.71 and 2.36 mM, respectively. Pretreatment with ROS scavenger rescued the cancer cells from apoptosis and concomitant PARP cleavage, implicating a key role of ROS in OSU-A9-induced cell death. Furthermore, OSU-A9-mediated ROS down-regulated pTyr105-PKM2 which occurred in cell nucleus rather than in cytoplasm. Ectopic overexpression of PKM-2 partially overcame the cytotoxicity of OSU-A9, which implied a role of phosphorylated PKM2 beyond glycolysis in survival of duodenal cancer and gastric cancer cells. This study shows that ROS-mediated intranuclear PKM2 dephosphorylation, in part, contributes to the anticancer activity of OSU-A9 in duodenal cancer and gastric cancer. Differential down-regulation of phosphorylated PKM2 between nucleus and cytoplasm suggests a non-glycolytic role of PKM2 in cell survival response to ROS stress. The authors. The Ministry of Health and Welfare, Taiwan. All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

Incomplete intestinal metaplasia (IM) is a precursor of stomach cancer. To identify risk factors of incomplete IM, a 2-stage survey was carried out in 1995 among 1,485 residents in Matzu, an area with highest mortality from stomach cancer in Taiwan. There were 312 study subjects including 174 men and 138 women sampled for the gastroendoscopic examination of IM. Information on personal and familial history of stomach cancer, cigarette smoking, alcohol consumption and intake frequency of various salted food items were obtained by personal interview based on a structured questionnaire. Blood samples were collected from each participant. Four biopsies per subject were taken from all subjects at gastroendoscopic examination to diagnose the status of IM pathologically. The Helicobacter pylori in biopsies was detected by the histomorphological or immunochemistry method, and antibodies against H. pylori in serum by the enzyme-linked immunosorbent assay. Plasma level of selenium was determined by atomic absorption spectrometry, plasma level of retinol, α-tocopherol, α-carotene, and β-carotene by high performance liquid chromatography, genotypes of glutathione S-transferase (GST) M1 and T1 and cytochrome P450 (CYP) 2E1 by polymerase chain reaction. The significant association between history of stomach cancer among first-degree relatives and incomplete IM was found (odds ratio [OR] = 2.50; 95% confidence interval [CI] = 1.15–5.43). There was no association between H. pylori infection and incomplete IM. Alcohol drinkers for >20 years had an elevated risk compared to non-drinkers (OR = 3.34; 95% CI = 1.19–9.39). No associations between incomplete IM and plasma levels of selenium, retinol, α-tocopherol, α-carotene and β-carotene were found. Salted food including salted meat, dehydrated salted vegetables and raw salted seafood consumed at ages of ≤15 and 16–30 years old was associated with an increased IM risk with OR ranging from 2–3. More striking associations between incomplete IM and salted food intake were observed among subjects with genotypes of GSTM1 null, GSTT1 non-null and CYP2E1 c1/c1. Our study suggests the importance of gene–environment interaction on the development of incomplete IM. © 2003 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

• This is a large cohort study consisting of 385,650 adults aged ≥18 years in Taiwan. • PM 2.5 was associated with higher risk of gastrointestinal cancer mortality. • PM 2.5 was associated with higher risk of liver and colorectal cancers mortality. Information on the association between long-term exposure to PM 2.5 and gastrointestinal cancer mortality is scarce. This study investigated the association between long-term exposure to PM 2.5 and deaths from gastrointestinal cancer and its subtypes in adults in Taiwan. A total of 385,650 Taiwanese adults (≥18 years old) jointed a standard medical examination program between 2001 and 2014 and were followed up until 2016. Their vital data were obtained from the National Death Registry maintained by the Ministry of Health and Welfare in Taiwan. We estimated the ambient PM 2.5 concentration at individual's address utilising a satellite-based spatiotemporal model at a resolution of 1 km2. Cox proportional hazard regression model was used to investigate the associations between ambient PM 2.5 and deaths from gastrointestinal, stomach, colorectal and liver cancers. We found that each 10 µg/m3 increase in PM 2.5 was associated with an increased hazard risk (HR) of 1.09 (95% confidence interval (CI): 1.03–1.16) and 1.13 (95%CI: 1.02–1.24) in deaths from gastrointestinal and liver cancers, respectively. The association between PM 2.5 and death from colorectal cancer was marginally statistically significant [HR: 1.13 (95%CI: 1.00–1.26)]. We did not find significant associations between PM 2.5 and mortality from stomach cancer. Long-term exposure to ambient PM 2.5 was associated with an increased risk of deaths from gastrointestinal cancers, liver cancer and also potentially colorectal cancer. Air pollution control strategies are necessary to reduce the burden of gastrointestinal cancer. [ABSTRACT FROM AUTHOR]

Background & Aims: Patients with gastric ulcers have significantly higher risk of gastric cancer, especially within 2 years after diagnosis. We used data from a national database to develop a personalized risk prediction model for patients with peptic ulcer diseases., Methods: We collected data from Taiwan's National Health Insurance Research Database on 278,898 patients admitted for the first time with a primary diagnosis of peptic ulcer disease. We used the data to develop a nomogram, which we validated by discrimination and calibration, and in a test cohort. Cumulative incidences of study subjects predicted by the nomogram were examined., Results: In total, 1269 subjects developed gastric cancer. Age, sex, peptic ulcer sites, peptic ulcer complications, Helicobacter pylori eradication, nonsteroidal anti-inflammatory drug use, and surveillance endoscopy were independent factors associated with risk of gastric cancer (all P < .001). The concordance index for the nomogram developed on the basis of these factors was 0.78. Study subjects were divided into quartiles of predicted risk scores; from lowest score quartile to highest, cumulative incidences at 1 year were 7.4/10,000 people, 14.2/10,000 people, 25.5/10,000 people, and 86.6/10,000 people. The cumulative incidences at 2 years were 9.3/10,000 people, 20.9/10,000 people, 38.0/10,000 people, and 135.7/10,000 people for the same quartiles of risk scores. The nomogram was validated in an independent cohort, and similar incidence values were determined., Conclusions: We developed and validated a nomogram to predict risk for gastric cancer 1 and 2 years after diagnosis of peptic ulcer disease. The nomogram provides a prognostic tool that can be easily used for individuals and can help physicians explain risk levels to patients., (Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Aim: To evaluate the genetic associations of IL-IB and IL-1RN polymorphisms with gastric cancer in Taiwan. Methods: Genomic DNA from 98 unrelated Taiwanese patients with gastric adenocarcinoma and 100 ethically matched healthy controls was typed for polymorphisms at positions -31, -511, and +3954 in the IL-IB gene, and the variable number of tandem repeats polymorphisms in intron 2 of the IL-1RN gene. Results: The allele frequencies of IL-1RN*2 in gastric cancer cases were significantly higher than those in healthy controls (9% vs. 4%, p = 0.024). The allele frequencies of IL-IB -31, IL-1B -511 and IL-1B +3954 did not differ. A significant association was found between IL-1RN*2 carriers and the risk of developing intestinal type gastric carcinoma, with an odds ratio (OR) of 2.8 (95%CI: 1.0-7.6; p = 0.014). A trend towards an increased risk for the development of diffuse type gastric carcinoma in IL-1 RN*2 carriers was also observed (OR= 2.4; 95% CI: 0.8-7.1; p = 0.130). No significant relationship was noted in patients with atypical carcinoma. Additionally, a synergistic interaction between blood type A and IL-1 RN*2 carriers existed (OR= 4.8; 95% CI: 1.0-23.5). Conclusions: Genetic polymorphism of IL-1RN*2 and blood type A is associated with the development of gastric cancer, especially intestinal type gastric cancer in Taiwan. [ABSTRACT FROM AUTHOR]

Background & Aims: We used a new, semi-parametric method to estimate life expectancy and expected years of life lost (EYLL) after diagnosis of gastric cancer and assess whether patients' sex or tumor type or location had any effects., Methods: We performed a nationwide retrospective cohort study of 35,576 patients with gastric cancer who were registered in the Taiwan Cancer Registry from 1998 through 2007; data were collected until the end of 2010. The Monte Carlo method and tables in Taiwan National Vital Statistics database were matched to the cohort reference populations on the basis of age and sex. The estimated regression line and the survival curve of reference populations were used to extrapolate the survival curve beyond 2010. We compared patients' age at diagnosis, life expectancy, and EYLL based on sex, tumor type, and location., Results: In Taiwan, gastric cancer is more prevalent among men, and 88.6% of tumors are adenocarcinomas. Patients with adenocarcinoma of the gastric cardia have shorter life expectancies and greater EYLL than those with noncardia tumors (P < .05). Women with gastric adenocarcinoma are diagnosed at a younger age and have longer life expectancies but more EYLL than men with such tumors (P < .05). The estimated years of life saved if gastric adenocarcinoma is diagnosed at an early stage and cured are 22,827 years (2.62 years/case) for women and 33,700 years (1.97 years/case) for men., Conclusion: Among patients with gastric cancer, men and patients with adenocarcinomas of the cardia have shorter life expectancies and more EYLL. Early detection of gastric adenocarcinoma can increase life expectancy., (Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.)