Journal of gastrointestinal oncology最新文献

{"title":"Erratum to Construction and validation of a predictive model for the risk of three-month-postoperative malnutrition in patients with gastric cancer: a retrospective case-control study.","authors":"","doi":"10.21037/jgo-2025-01","DOIUrl":"10.21037/jgo-2025-01","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.21037/jgo-22-1307.].</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"16 1","pages":"336-341"},"PeriodicalIF":2.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expression of Claudin18.2 in metastatic lesions in peritoneum of gastric cancer.","authors":"Akira Saito, Hideyuki Ohzawa, Rie Kawashima, Shiro Matsumoto, Kentaro Kurashina, Shin Saito, Hideyo Miyato, Yoshinori Hosoya, Naohiro Sata, Joji Kitayama, Hironori Yamaguchi","doi":"10.21037/jgo-24-743","DOIUrl":"10.21037/jgo-24-743","url":null,"abstract":"<p><strong>Background: </strong>Patients with advanced gastric cancer (GC) with peritoneal involvement have a dismal prognosis. Recent clinical trials have shown that anti-Claudin18.2 (CLDN18.2) antibody (zolbetuximab) enhances survival in patients with GC expressing high levels of CLDN18.2. However, the effectiveness of the zolbetuximab in patients with peritoneal metastases (PMs) remains unclear. In this study, we aimed to evaluate the expression of CLDN18.2 in disseminated lesions to assess the clinical utility of zolbetuximab in the treatment of GC with PM.</p><p><strong>Methods: </strong>In 42 patients diagnosed with stage IV GC with PM, biopsy samples from the primary tumors and peritoneal metastatic nodules were collected and immunostained using the specific antibody (43-14A, Ventana). The expression of CLDN18.2 was comparatively evaluated based on staining intensity and the proportion of positive cells.</p><p><strong>Results: </strong>Positive immunoreactivity of CLDN18.2 was observed in 37 (88%) of the primary tumors. Specifically, CLDN18.2 positivity was identified in 26 (62%) or 12 (29%) patients based on moderate to strong membrane staining in at least 40% or 75% of tumor cells, respectively. In comparison, the staining intensity in tumor cells was consistently reduced in PM across all patients. CLDN18.2 expression was absent in PM of 29 (69%) patients, while 3 (7.1%) cases were determined to be CLDN18.2-positive based on a cutoff value of 40% for high staining. This trend was particularly pronounced in cases with undifferentiated type and human epidermal growth factor receptor 2 (HER-2) negative primary tumors.</p><p><strong>Conclusions: </strong>Although CLDN18.2 expression in PM mirrored that in primary lesions, the levels were generally reduced. When zolbetuximab is used for GC patients with peritoneal involvement, it is preferable to assess the expression of CLDN18.2 in the disseminated lesions.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"16 1","pages":"67-76"},"PeriodicalIF":2.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperthermic intraperitoneal chemotherapy plus SOX chemotherapy versus SOX chemotherapy alone in patients with gastric cancer and peritoneal metastasis: a phase II randomized clinical trial.","authors":"Lijie Luo, Zijing Zhang, Haiping Zeng, Yuting Xu, Yaohui Peng, Haipeng Huang, Zeyu Lin, Wenjun Xiong, Wei Wang","doi":"10.21037/jgo-24-807","DOIUrl":"10.21037/jgo-24-807","url":null,"abstract":"<p><strong>Background: </strong>The prognosis of patients with gastric cancer with peritoneal metastasis (GCPM) is exceedingly poor. This study evaluated the efficacy and safety of hyperthermic intraperitoneal chemotherapy (HIPEC) with paclitaxel combined with S-1 and oxaliplatin (SOX) in the treatment of GCPM.</p><p><strong>Methods: </strong>Patients with pathologically confirmed primary gastric adenocarcinoma and laparoscopy-confirmed peritoneal metastasis were enrolled and randomized to receive either HIPEC plus SOX (HIPEC group) or SOX alone (SOX group). The primary endpoint was progression-free survival (PFS), and the secondary endpoints were 1-year survival rate, overall survival (OS), and safety.</p><p><strong>Results: </strong>Among the included patients, 30 were assigned to the HIPEC group and 29 to the SOX group. Compared to the HIPEC group, the SOX group had a significantly higher median PFS (SOX: median 8.5 months, IQR, 3.8-21.8 months; HIPEC: median 6.1 months, IQR, 3.3-10.8 months; P=0.004) and OS (SOX: median 13.0 months, IQR, 6.3-16.6 months; HIPEC: median 10.0 months, IQR, 5.2-24.0 months; P=0.02). The 1-year survival rate was 50.0% in the SOX group and 37.9% in HIPEC group, but the difference was not statistically significant. No serious adverse events related to the protocol treatment occurred in any patients.</p><p><strong>Conclusions: </strong>This trial failed to show the superiority of HIPEC with SOX over SOX alone. Further research into this regimen is needed.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT03604614.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"16 1","pages":"17-26"},"PeriodicalIF":2.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of <i>TMSB15A</i> in gastric cancer progression and its prognostic significance.","authors":"Xiaolei Zhang, Xiang Yu, Qicheng Shen, Xiaohui Jiang, Yuan Zhou, Qiu Xue, Guangxin Cao","doi":"10.21037/jgo-2025-64","DOIUrl":"10.21037/jgo-2025-64","url":null,"abstract":"<p><strong>Background: </strong>Human thymosin β15 (<i>TMSB15A</i>) has been found to have protumorigenic effects in various malignant tumors, yet its function in gastric cancer (GC) remains unclear. This study investigated the value and function of <i>TMSB15A</i> in the diagnosis and tumorigenesis of GC, respectively.</p><p><strong>Methods: </strong>Expression data for TMSB15A in GC tissues were analyzed using The Cancer Genome Atlas (TCGA). We evaluated the prognostic significance of TMSB15A through Kaplan-Meier survival analysis, time-dependent receiver operating characteristic (ROC) curves, and Cox regression models. Gene set enrichment analysis (GSEA) was performed to identify pathways associated with TMSB15A. <i>In vitro</i> assays assessed the effects of TMSB15A knockdown on GC cell proliferation, migration, and invasion.</p><p><strong>Results: </strong>TMSB15A was significantly overexpressed in GC tissues compared to normal tissues (P<0.05). ROC analysis showed high diagnostic accuracy for TMSB15A (area under the curve =0.851, 95% confidence interval: 0.786-0.905, P<0.05). Kaplan-Meier survival analysis revealed that high TMSB15A expression was associated with poor overall survival, disease-specific survival, and progression-free survival. TMSB15A levels were correlated with advanced tumor stages (P<0.05), lymph node metastasis (P<0.01), and perineural invasion (P<0.05). GSEA showed significant enrichment of TMSB15A in inflammatory and oncogenic pathways, including interleukin-6 (IL-6)/Janus kinase (JAK)/signal transducer and activator of transcription 3 (STAT3), transforming growth factor β (TGF-β), and Hedgehog. Functional assays demonstrated that TMSB15A knockdown significantly reduced GC cell proliferation, migration, and invasion, suggesting that TMSB15A contributes to GC tumorigenesis and metastasis.</p><p><strong>Conclusions: </strong><i>TMSB15A</i> could serve as a prospective therapeutic target for GC due to its involvement in disease progression and metastasis.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"16 1","pages":"27-40"},"PeriodicalIF":2.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determining the optimal number of examined lymph nodes for prognosis in colon cancer: a population-based study stratified by tumor location and T stage.","authors":"Jiahao Zhou, Tinghan Yang, Xiangbing Deng, Ziqiang Wang","doi":"10.21037/jgo-24-576","DOIUrl":"10.21037/jgo-24-576","url":null,"abstract":"<p><strong>Background: </strong>Clinical guidelines recommend ≥12 examined lymph nodes (ELNs) for colon cancer staging, but more may be necessary for accuracy. This study utilized nodal staging scores (NSS) to identity the optimal number of ELNs based on tumor location and T stage, and to assess its prognostic impact.</p><p><strong>Methods: </strong>Data from 80,792 patients in the Surveillance, Epidemiology, and End Results (SEER) database (2004-2014) and 2,300 patients from the West China Hospital (WCH) cohort (2008-2014) with stage I-III resected colon cancer were analyzed. Optimal ELNs was estimated using a β-binomial distribution model, stratified by tumor location (left-sided, LS; right-sided, RS) and T stage. The primary outcome was overall survival (OS). The association between sufficient nodal staging and OS in node-negative patients was validated by multivariate Cox models.</p><p><strong>Results: </strong>The mean number of ELN was 18.75 in the SEER and 14.58 in the WCH database. There were 57.8% and 48.8% patients who had RS colon cancer in the SEER and WCH database. Fewer T3-4 tumors were observed in the SEER cohort compared to the WCH cohort (68.4% <i>vs.</i> 87.2%). Sufficient nodal staging required ≥24 ELNs for T3 tumors, ≥34 nodes for T4 LS tumors, and ≥40 nodes for T4 RS tumors. For T3 lesions, examining 20-29 ELNs were more likely to have node-positive disease [odd ratio (OR) 1.07; 95% confidence interval (CI): 1.01-1.12] compared to patients with 12-15 ELNs. In the T3N0 group, ELN ≥24 was independently associated with better OS in the SEER database [hazard ratio (HR) 0.72; 95% CI: 0.68-0.75], which was validated in the WCH cohort (HR 0.54; 95% CI: 0.38-0.76).</p><p><strong>Conclusions: </strong>Optimal ELNs for adequate colon cancer staging is related to both T stage and tumor location. We recommend that ≥24 lymph nodes be examined for T3 tumors, ≥34 for LS T4 tumors and ≥40 for RS T4 tumors for sufficient staging.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"16 1","pages":"115-127"},"PeriodicalIF":2.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive models of lymph node metastasis in patients with gastrointestinal stromal tumors based on machine learning algorithms: a SEER-based retrospective study.","authors":"Zheng Lin, Jianping Xiong, Caixin Feng, Shaochun Pang, Liangxue Lin, Feiran Zhang, Xun Chen, Yuandong Yuan, Peijie Xie, Ting Wu, Yanchong Li, Peihong Zheng, Haijie Xu, Ziqun Liao","doi":"10.21037/jgo-24-777","DOIUrl":"10.21037/jgo-24-777","url":null,"abstract":"<p><strong>Background: </strong>Gastrointestinal stromal tumor (GIST) is one of the most prevalent tumors in the digestive system. Due to the rarity of lymph node metastasis in patients with GISTs, there is a scarcity of related studies, which leads to ongoing debates regarding its impact on patient prognosis. This study aimed to analyze the impact of lymph node metastasis on the overall survival of GISTs patients and further building predictive models with machine learning algorithms.</p><p><strong>Methods: </strong>This is a retrospective study based on the Surveillance, Epidemiology and End Results (SEER) database. The demographic and clinicopathological characteristics of GISTs patients who underwent surgical therapy were collected from database. Five different types of machine learning algorithms were used to build the models. The ensemble models were based on the three algorithms with the highest sensitivity in the validating cohort. At last, receiver operator characteristic (ROC) curve, precision-recall curve (PRC), calibration curve, decision curve analysis (DCA) and Kaplan-Meier survival curve (KMC) were used to evaluate our models.</p><p><strong>Results: </strong>A total of 1,404 patients with GISTs were included in our study after data cleaning. Artificial Neural Network model [area under the ROC curve (AUC): 0.951, 95% confidence interval (CI): 0.901-0.992, sensitivity: 0.752] achieved the best performance in the validating cohort and was chosen to be the final model. Calibration plots showed good consistency between prediction and actual observations. Although the AUC between the final model and the baseline model showed no significant difference, the area under the PRC (PRAUC) of the final model (PRAUC =0.765) was significantly higher than that of the baseline model (PRAUC =0.455). DCA showed that the final model had high net benefit. Survival analysis indicated that the final model could distinguish the prognosis of patients significantly (all P<0.001).</p><p><strong>Conclusions: </strong>We used machine learning algorithms to build models that can accurately predict lymph node metastasis in GISTs patients.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"16 1","pages":"53-66"},"PeriodicalIF":2.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geriatric Nutritional Risk Index is an effective prognostic predictor for metastatic/recurrent or unresectable esophageal cancer receiving immunotherapy.","authors":"Bei Wang, Zixuan Wang, Chuanhai Xu, Yueqin Wang, Honglan Gao, Haiping Liu, Mingyue Zheng, Zhenyuan Jiang, Zini Zhou, Gui Liu, Wei Geng","doi":"10.21037/jgo-24-722","DOIUrl":"10.21037/jgo-24-722","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitors (ICIs) have been extensively utilized in the treatment of esophageal squamous cell carcinoma (ESCC); however, patient responses to these therapies exhibit significant variability. This study aimed to investigate the prognostic value of Geriatric Nutritional Risk Index (GNRI) in patients with ESCC undergoing immunotherapy.</p><p><strong>Methods: </strong>A retrospective study was conducted on 677 patients with metastatic/recurrent or unresectable ESCC who received immunotherapy. Kaplan-Meier analysis and Log-rank test compared survival differences between high and low GNRI groups, while Cox proportional hazards models analyzed the impact of GNRI on survival in various subgroups and identified independent prognostic factors. Furthermore, immunohistochemistry (IHC) was performed on endoscopic biopsy tissues from 45 patients with unresectable disease who received immune ICIs as first-line treatments to investigate the predictive performance of GNRI combined with programmed cell death ligand 1 (PD-L1) for tumor response and overall survival (OS).</p><p><strong>Results: </strong>Regardless of metastatic/recurrent disease or unresectable status, patients with high GNRI levels had significantly longer OS time (P<0.001). Moreover, the protective role of GNRI was observed in various subgroups. Eastern Cooperative Oncology Group performance status (ECOG PS) score, distant organ metastasis, previous treatments, ICI modalities and GNRI were identified as independent prognostic factors for OS. Furthermore, the predictive performance of GNRI for OS may surpass that of PD-L1 expression (P=0.009 <i>vs.</i> P=0.38), while PD-L1 expression excelled in predicting tumor response (P=0.007 <i>vs.</i> P=0.08). The combination of these two indicators effectively predicted both tumor response (P=0.04) and OS (P=0.03) in immunotherapy.</p><p><strong>Conclusions: </strong>The GNRI serves as a robust prognostic indicator in patients with ESCC who are treated with ICIs. The integration of PD-L1 expression and GNRI demonstrates significant predictive value for tumor response and OS.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"16 1","pages":"1-16"},"PeriodicalIF":2.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PRMT5 attenuates regorafenib-induced DNA damage in hepatocellular carcinoma cells through symmetric dimethylation of RPL14.","authors":"Wendi Bi, Xiaojuan Sun, Qiuyun Yi, Xinyu Jiang, Huisi He, Lixuan Jiang, Zhecai Fan, Hailing Huang, Wen Wen, Xiaoqing Jiang","doi":"10.21037/jgo-24-737","DOIUrl":"10.21037/jgo-24-737","url":null,"abstract":"<p><strong>Background: </strong>Regorafenib has been approved for second-line treatment of hepatocellular carcinoma (HCC) following sorafenib failure, but resistance to targeted therapy remains a major challenge. Enhancing the therapeutic sensitivity of HCC cells to regorafenib is crucial for improving treatment outcomes. This study aims to elucidate the role of PRMT5 in HCC and its impact on regorafenib sensitivity. Specifically, it focuses on the regulatory relationship between PRMT5 and RPL14, investigating their influence on DNA damage repair and drug resistance mechanisms in HCC.</p><p><strong>Methods: </strong>A stable PRMT5-overexpressing HCC cell line was constructed via lentiviral infection. Immunoprecipitation was employed to examine whether PRMT5 catalyzes the symmetric dimethylation of RPL14 at arginine residues. Western blot (WB) was used to assess changes in DNA damage markers (γ-H2AX) and DNA repair markers (RAD51) after RPL14 knockdown. Huh7 cells with PRMT5 overexpression, RPL14 knockdown, and combined PRMT5 overexpression and RPL14 knockdown were treated with regorafenib. DNA damage repair-related factors were analyzed using WB and immunofluorescence.</p><p><strong>Results: </strong>Mass spectrometry and immunoprecipitation confirmed the interaction between PRMT5 and RPL14, with PRMT5 catalyzing symmetric dimethylation of RPL14. RPL14 knockdown inhibited HCC cell proliferation, increased sensitivity to regorafenib, and disrupted DNA damage repair, while overexpression had the opposite effect. Regorafenib-treated PRMT5-overexpressing cells showed reduced γ-H2AX expression and improved survival, whereas RPL14 knockdown enhanced γ-H2AX levels and decreased survival. Notably, simultaneous PRMT5 overexpression and RPL14 knockdown significantly elevated γ-H2AX expression compared to PRMT5 overexpression alone, leading to reduced cell viability. These results suggest that PRMT5 modulates DNA damage repair through RPL14, influencing the sensitivity of HCC cells to regorafenib.</p><p><strong>Conclusions: </strong>PRMT5-mediated symmetric dimethylation of RPL14 stabilizes the protein, promoting DNA damage repair and contributing to regorafenib resistance in HCC. RPL14 plays a key role in PRMT5-driven enhancement of DNA damage repair and reduced drug sensitivity, identifying RPL14 as a potential therapeutic target to overcome regorafenib resistance in HCC.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"16 1","pages":"191-208"},"PeriodicalIF":2.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to anti-EGFR therapy in chemo-refractory right-sided RAS wild-type metastatic colorectal cancer: a case report and literature review.","authors":"Annie Xiao, Marwan Fakih","doi":"10.21037/jgo-24-458","DOIUrl":"10.21037/jgo-24-458","url":null,"abstract":"<p><strong>Background: </strong>Anti-epidermal growth factor receptor (EGFR) therapies are important targeted agents in the treatment of metastatic colorectal cancer (CRC). However, clinical benefit is limited to patients with left-sided primary tumors and RAS wild-type (WT) disease. In right-sided chemo-refractory settings, response to anti-EGFR therapy has not been reported to date.</p><p><strong>Case description: </strong>We present a case of a 70-year-old man with metachronous metastatic ascending colon adenocarcinoma who experienced an exceptional response to FOLFIRI (fluorouracil, leucovorin, and irinotecan) plus panitumumab after failing multiple lines of therapy. He was initially diagnosed with stage IIIB (pT4aN1M0) disease and underwent hemicolectomy followed by adjuvant FOLFOX (fluorouracil, leucovorin, and oxaliplatin). Nine months after completion of adjuvant therapy, disease recurred in the liver, peritoneum, and mesenteric lymph nodes. Subsequent treatments included FOLFIRI plus bevacizumab and FOLFOX with eventual progression. Tumor genomic profiling revealed RAS/RAF WT disease, and in the absence of anti-EGFR therapy resistance mutations, the patient was offered treatment with FOLFIRI plus panitumumab. He achieved immediate palliation of his abdominal pain after one cycle, followed by normalization of his tumor markers and significant tumor regression of his hepatic, peritoneal, lung, and distant lymph node metastases within four cycles.</p><p><strong>Conclusions: </strong>Treatment options for right-sided RAS-WT metastatic CRC are limited, particularly after progression on standard chemotherapies. While anti-EGFR antibodies have demonstrated detrimental survival impact in the first-line setting for right-sided CRC, their performance in later lines is less well-characterized. This case challenges the notion of right-sided disease as uniformly resistant to EGFR inhibition and highlights the need for additional biomarker studies to identify the subset of right-sided CRC that may benefit from EGFR targeted strategies. Emerging evidence suggests that more stringent genomic criteria for EGFR resistance, beyond RAS mutation status alone, may refine patient selection for benefit from anti-EGFR therapies.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"16 1","pages":"292-300"},"PeriodicalIF":2.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Budding\"-an early MRI feature established in a case-control study of perianal fistula mucinous adenocarcinoma.","authors":"Lillian Reza, Alison Corr, Philip Tozer, John T Jenkins, Anthony Antoniou, Elaine M Burns, David Burling, Ailsa Hart, Sue K Clark, Phillip Lung","doi":"10.21037/jgo-24-562","DOIUrl":"10.21037/jgo-24-562","url":null,"abstract":"<p><strong>Background: </strong>Perianal fistula mucinous adenocarcinoma (FMA) usually presents at an advanced stage, necessitating extensive surgical resection. Symptoms of perianal pain and discharge are indistinguishable from fistula sepsis. Absence of defined features on magnetic resonance imaging (MRI) precludes early diagnosis. This study aims to validate MRI features that should increase suspicion of early mucinous transformation, prompting urgent examination and targeted biopsies.</p><p><strong>Methods: </strong>Retrospective review of MRI studies was conducted in 9 patients with FMA in Crohn's perianal and non-Crohn's ileoanal pouch fistula between 2015-2019. Radiological features were assessed. Fine T2-weighted high signal lobulation of the fistula tract on MRI, described as 'budding', was retrospectively noted on historic studies in all cases of FMA and was determined a feature distinct from expected T2-weighted high signal appearance of bland fistula sepsis. The significance of these features in early diagnosis of FMA was assessed using a case control study.</p><p><strong>Results: </strong>'Budding', mass-like expansion of the tract, and septation of T2-weighted high signal components of the fistula were significantly associated with FMA using Fisher's exact test (P<0.001). The presence of T2-weighted high signal \"budding\" predated the histological confirmation of FMA by a median 36 months (range, 12-156 months). One control patient was diagnosed with FMA during the study as 'budding' was retrospectively detected, triggering urgent targeted biopsy.</p><p><strong>Conclusions: </strong>Radiological awareness of early features of FMA may improve outcomes by reducing the morbidity of exenterative surgery with delayed diagnosis. The presence of T2-weighted high signal 'budding' on MRI should prompt urgent targeted biopsy.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"16 1","pages":"106-114"},"PeriodicalIF":2.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}