Journal of gastrointestinal oncology最新文献

{"title":"The role of negative hyperselection in metastatic colorectal cancer.","authors":"Jingran Ji, Marwan Fakih","doi":"10.21037/jgo-24-376","DOIUrl":"10.21037/jgo-24-376","url":null,"abstract":"","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"15 5","pages":"2353-2357"},"PeriodicalIF":2.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11565117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647809","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":"Development and validation of a prognostic nomogram for elderly-onset pancreatic neuroendocrine carcinoma: a prospective cohort study from the SEER database.","authors":"Haoxi Liu, Qian Zhang, Yitian Chen, Jie Xing, Xue Li, Haiyi Hu, Shutian Zhang, Rui Cheng","doi":"10.21037/jgo-24-344","DOIUrl":"10.21037/jgo-24-344","url":null,"abstract":"<p><strong>Background: </strong>The incidence of elderly-onset pancreatic neuroendocrine carcinoma (PanNEC) is increasing. This study investigated independent risk factors affecting cancer-specific survival (CSS) and constructed a nomogram to predict CSS in patients with elderly-onset PanNEC.</p><p><strong>Methods: </strong>PanNEC patients older than 50 years from the Surveillance, Epidemiology, and End Results database were retrospectively selected from 2010 to 2021 and were randomly divided into a training set and a validation set. Independent factors affecting CSS were selected by univariate and multivariate analyses. The nomogram was built using significant variables. The discrimination and calibration of the nomogram were evaluated by the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis.</p><p><strong>Results: </strong>A total of 407 patients were selected and randomly assigned to a training set or a validation set at a 6:4 ratio. In the selected population, 227 individuals (55.8%) were male, 313 (76.9%) were white, with a mean age of 69.4 years. Among them, 318 individuals (78.1%) died due to the tumor, with a CSS time of 6 months. Multivariate Cox analysis showed that age [hazard ratio (HR): 1.56, 95% confidence interval (CI): 1.10-2.22, P=0.01], surgery (HR: 2.32, 95% CI: 1.27-4.23, P=0.006), chemotherapy (HR: 2.39, 95% CI: 1.68-3.38, P<0.001), tumor, nodes, and metastasis (TNM) stage (HR: 3.96, 95% CI: 1.19-13.19, P=0.03), and liver metastasis (HR: 1.75, 95% CI: 1.16-2.65, P=0.008) were independent risk factors that shortened CSS. The AUCs of the nomogram for the 6-month, 1-year, and 2-year CSS were 0.826, 0.791, and 0.8 in the training set and 0.848, 0.775, and 0.781 in the validation set, respectively. Calibration curves showed that the nomogram could accurately predict the 6-month, 1-year, and 2-year CSS in both datasets. Furthermore, decision curve analysis indicated that the nomogram had clinical benefits.</p><p><strong>Conclusions: </strong>The nomogram for CSS in patients with elderly-onset PanNEC showed good predictive power, enabling clinicians to understand patient's prognosis and make appropriate decisions.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"15 5","pages":"2265-2276"},"PeriodicalIF":2.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11565105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647440","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":"Rare germline chromosome 1 duplication identified in young male with colon cancer: a case report investigating causality.","authors":"Anna Byrjalsen, Sara L Garcia, Line Borgwardt, Karin Wadt, Anne Marie Gerdes, Thomas van Overeem Hansen","doi":"10.21037/jgo-24-148","DOIUrl":"10.21037/jgo-24-148","url":null,"abstract":"<p><strong>Background: </strong>The occurrence of colorectal cancer (CRC) is increasing among young adults, but the etiology is still largely unknown. In addition to germline monogenetic variants also polygenic risk scores (PRS) have been proven to correctly estimate the risk of CRC.</p><p><strong>Case description: </strong>We present a 24-year-old male with disseminated colon cancer who carried a germline duplication on chromosome 1 spanning 200 kb and covering <i>CD101, TTF2, MIR942, TRIM45,</i> and parts of <i>PTGFRN</i> and <i>VTCN1</i>. The duplication was located in tandem. A similar duplication was previously reported in a family with CRC among two brothers aged 52 and 61 years old at diagnosis. Particularly, <i>MIR942</i> was an interesting finding as it is involved in the regulation of the Wnt signaling pathway. Disruption of the Wnt pathway is known to cause CRC. However, in our case the duplication did not segregate with disease in the family. Calculation of a PRS in our patient found an average PRS for CRC.</p><p><strong>Conclusions: </strong>Our findings do not support that this duplication is a monogenetic cause of CRC, nor did a PRS point towards an increased risk in this 24-year-old male. Whether the duplication is a risk factor in combination with other genetic and non-genetic risk factors requires further studies.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"15 5","pages":"2316-2322"},"PeriodicalIF":2.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11565109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647789","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":"Is the transverse colon the new right?-similarities in EGFR drug response and prognosis.","authors":"Soledad Cameselle-García, Ana Fernández Montes","doi":"10.21037/jgo-24-272","DOIUrl":"10.21037/jgo-24-272","url":null,"abstract":"","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"15 5","pages":"2363-2366"},"PeriodicalIF":2.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11565101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647381","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":"Machine learning-based analysis identifies a 13-gene prognostic signature to improve the clinical outcomes of colorectal cancer.","authors":"Dexu Xun, Xue Li, Lan Huang, Yuanchun Zhao, Jiajia Chen, Xin Qi","doi":"10.21037/jgo-24-325","DOIUrl":"10.21037/jgo-24-325","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer (CRC) is a common intestinal malignancy worldwide, posing a serious threat to public health. Due to its high heterogeneity, prognosis and drug response of different CRC patients vary widely, limiting the effectiveness of traditional treatment. Therefore, this study aims to construct a novel CRC prognostic signature using machine learning algorithms to assist in making informed clinical decisions and improving treatment outcomes.</p><p><strong>Methods: </strong>Gene expression matrix and clinical information of CRC patients were obtained from the The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases. Then, genes with prognostic value were identified through univariate Cox regression analysis. Next, nine machine learning algorithms, including least absolute shrinkage and selection operator (LASSO), gradient boosting machine (GBM), CoxBoost, plsRcox, Ridge, Enet, StepCox, SuperPC and survivalSVM were integrated to form 97 combinations, which was employed to screen the best strategy for building a prognostic model based on the average C-index in the three CRC cohorts. Kaplan Meier survival analysis, receiver operating curve (ROC) analysis and multivariate regression analysis were conducted to assess the predictive performance of the constructed signature. Furthermore, the CIBERSORT and ESTIMATE algorithms were utilized to quantify the infiltration level of immune cells. Besides, a nomogram were developed to predict 1-, 2-, and 3-year overall survival (OS) probabilities for individual patient.</p><p><strong>Results: </strong>A prognostic signature consisting of 13 genes was developed utilizing LASSO Cox regression and GBM methods. Across both the training and validation datasets, the performance evaluation consistently indicated the signature's capacity to accurately predict the prognosis of CRC patients. Especially, compared with 30 published signatures, the 13-gene model exhibited dramatically superior predictive power. Even within clinical subgroups, it could still precisely stratify the prognosis. Functional analysis revealed a robust association between the signature and the immune status as well as chemotherapy response in CRC patients. Furthermore, a nomogram was created based on the signature-derived risk score, which demonstrated a strong predictive ability for OS in CRC patients.</p><p><strong>Conclusions: </strong>The 13-gene prognostic signature is expected to be a valuable tool for risk stratification, survival prediction, and treatment evaluation of patients with CRC.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"15 5","pages":"2100-2116"},"PeriodicalIF":2.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11565104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647400","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":"Clinical characteristics, survival and prognostic nomogram for patients with esophageal mucinous adenocarcinoma: a SEER population-based analysis.","authors":"Zhikang Liu, Yuhang Yuan, Xiong Cao, Minjie Ma, Biao Han","doi":"10.21037/jgo-24-244","DOIUrl":"10.21037/jgo-24-244","url":null,"abstract":"<p><strong>Background: </strong>Esophageal mucinous adenocarcinoma (MAC) is a rare adenocarcinoma (AC) subtype. Limited research exists on its incidence, survival rates, and treatment responses. This study utilized the Surveillance, Epidemiology, and End Results (SEER) database to compare the clinical characteristics and prognoses of patients with esophageal MAC, AC, and signet-ring cell carcinoma (SRC), and developed nomograms to predict outcomes.</p><p><strong>Methods: </strong>Patient information was retrieved from the SEER database from 2004 to 2015. The baseline characteristics were balanced using propensity score matching (PSM). Prognostic factors for esophageal MAC patients were identified by univariate and multivariate Cox analyses.</p><p><strong>Results: </strong>A total of 497 esophageal MAC, 21,109 esophageal AC and 1,144 esophageal SRC patients were selected. MAC patients were more likely to have a higher pathological grade (P<0.001), and later T stage (P<0.001) and American Joint Committee on Cancer (AJCC) stage (P=0.003) than AC patients. The proportion of grade I-II MAC patients was higher than that of SRC patients. The overall survival (OS) and cancer-specific survival (CSS) of MAC patients were similar to those of AC patients. However, MAC patients had significantly better OS and CSS than SRC patients. After PSM analysis, the OS and CSS of MAC patients were similar to those of AC and SRC patients (all P>0.05). In MAC patients, N stage, M stage, and surgery were independent predictive factors for both OS and CSS. The area under the curve (AUC) and calibration curves demonstrated high precision and discrimination. Decision curve analysis (DCA) demonstrated that the CSS and OS nomograms have high potential clinical value.</p><p><strong>Conclusions: </strong>Esophageal MAC patients had similar survival compared with esophageal AC and esophageal SRC patients. The nomograms provide OS and CSS predictions for MAC patients, to aid clinicians in predicting patients' prognoses.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"15 5","pages":"2028-2040"},"PeriodicalIF":2.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11565096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647354","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":"Initial adjustments in the dosage and rest period of gemcitabine plus cisplatin therapy for patients with incurable biliary tract cancer based on baseline estimated glomerular filtration rate (eGFR) values may be crucial for treatment outcomes and the preservation of renal function.","authors":"Takanori Masumoto, Takuo Yamai, Kazuki Nakamura, Kohei Kamizono, Hiroki Sugioka, Tetsuro Miyazaki, Ryosuke Kiyota, Yuki Maegawa, Takeshi Shimizu, Shoichiro Kawai, Seiichi Tawara, Takuya Inoue, Takayuki Yakushijin","doi":"10.21037/jgo-24-330","DOIUrl":"10.21037/jgo-24-330","url":null,"abstract":"<p><strong>Background: </strong>Gemcitabine (GEM) and cisplatin (CDDP) combination therapy (GC therapy) is the standard 1st-line regimen for incurable biliary tract cancers (BTCs). However, the correlation between dynamic changes in renal function and the outcomes of GC therapy remains unclear. This study aimed to clarify the association between renal function alterations and treatment outcomes after GC therapy.</p><p><strong>Methods: </strong>We retrospectively examined 44 patients with incurable BTC who underwent GC therapy (January 2015 to December 2022). The patients were stratified according to their baseline estimated glomerular filtration rate (eGFR). Changes in eGFR, overall survival (OS), and progression-free survival (PFS).</p><p><strong>Results: </strong>The median baseline eGFRs were 65.0 mL/min/1.73 m² (low group, n=22) and 90.7 mL/min/1.73 m² (high group, n=22). No significant background differences were observed between the groups. During the 1st course, 86.4% and 54.5% of patients in the low and high groups underwent dose adjustments and/or administration postponement, which was found to be significantly greater in the low group. In the high group, eGFR decreased with an increase in the CDDP dose (100 mg =-12.0, 200 mg =-12.7, 300 mg =-25.9, and 400 mg =-25.7 mL/min/1.73 m²). In the low group, eGFR remained stable (100 mg =0.8, 200 mg =7.5, 300 mg =4.5, and 400 mg =-0.3 mL/min/1.73 m²). The decrease in the eGFR in the high group was significantly greater at each CDDP dose. However, the median OS and PFS were longer in the low group (OS: 16.3 <i>vs.</i> 9.2 months, P=0.02; PFS: 5.4 <i>vs.</i> 3.6 months, P=0.02). No significant differences in adverse events were observed between the groups.</p><p><strong>Conclusions: </strong>Adjusting GC therapy based on baseline estimated glomerular eGFR may be pivotal for therapeutic benefits and renal function protection in patients with incurable BTC.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"15 5","pages":"2277-2285"},"PeriodicalIF":2.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11565106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647450","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":"Development of a streamlined NGS-based TCGA classification scheme for gastric cancer and its implications for personalized therapy.","authors":"Pengda Guo, Yang Yang, Lu Wang, Yu Zhang, Bei Zhang, Jinping Cai, Fabrício Freire de Melo, Matthew R Strickland, Min Huang, Biao Liu","doi":"10.21037/jgo-24-345","DOIUrl":"10.21037/jgo-24-345","url":null,"abstract":"<p><strong>Background: </strong>The Cancer Genome Atlas (TCGA) has identified four distinct molecular subtypes of gastric cancer (GC) with prognostic significance: Epstein-Barr virus (EBV)-positive, microsatellite instability (MSI)-high, genomically stable (GS), and chromosomal instability (CIN). Unfortunately, the complex analysis required for TCGA classification limits its practical use in clinical settings. Our study sought to devise a next-generation sequencing (NGS)-based method to classify GC more efficiently, serving as a promising biomarker for prognosis and immunotherapy efficacy.</p><p><strong>Methods: </strong>This study was a retrospective observation study, and we employed 2 independent GC cohorts. The 3DMed cohort (n=765), comprising data on 733 cancer-related genes along with 4 EBV-encoded genes, was utilized to develop the new NGS classification. Additionally, the secondary Korean cohort (n=55), which includes both genomic data and information on immune checkpoint inhibitor (ICI) treatment, was employed to establish a correlation between NGS subtypes and ICI responsiveness.</p><p><strong>Results: </strong>In the 3DMed cohort, we identified 5.2% EBV, 4.6% MSI, 30.6% GS, and 59.6% CIN subtypes. The MSI subtype exhibited the highest number of mutation events, along with the highest tumor mutational burden (TMB) and strong programmed cell death ligand 1 (PD-L1) expression. CIN tumors showed extensive copy number variations (CNVs) and genomic heterogeneity. The EBV subtype presented recurrent <i>ARID1A</i> and <i>PIK3CA</i> mutations and fewer <i>TP53</i> mutations. GS tumors exhibited specific mutations in <i>CDH1</i> and <i>ARID1A</i>. In the Korean cohort, ICIs were most effective in MSI and EBV cases, showing disease control rates of 100%, compared to 62.9% in GS and 12.5% in CIN subtypes.</p><p><strong>Conclusions: </strong>The NGS method successfully maps the mutational landscape of GC, providing a practical TCGA classification surrogate to optimize patient-specific treatment strategies.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"15 5","pages":"2053-2066"},"PeriodicalIF":2.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11565108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647441","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":"Evaluating the mitochondrial structure and gene expression profile of regenerated liver tissues in mice after 85% partial hepatectomy.","authors":"Yongquan Shi, Yu Lei, Yanping Zhao, Shuaishuai Zhang, Hongxin Xu, Li Huo, Wei Liu, Qinlong Liu","doi":"10.21037/jgo-24-243","DOIUrl":"10.21037/jgo-24-243","url":null,"abstract":"<p><strong>Background: </strong>Partial hepatectomy (PH) is the primary method used for treating liver injury and transplantation. The regeneration process after hepatectomy requires an adequate energy supply, and mitochondria serve as the primary source of energy. Alterations in genes related to the respiratory chain complex may impact the liver regeneration process. The aim of this study was the changes in mitochondrial structure and mitochondrial function in 85% PH.</p><p><strong>Methods: </strong>A PH (up to 85%) model was developed using male C57BL/6 mice, and the regenerated liver tissue was harvested after 24 hours. Hematoxylin and eosin staining and transmission electron microscopy were used for morphological studies. In terms of proliferation, a positive proliferating cell nuclear antigen (PCNA) rate was detected via immunohistochemistry. Real-time polymerase chain reaction was performed to identify differentially expressed genes (DEGs), which were screened using a P value of <0.05 and a |fold change| of ≥1.5. The Hiplot online tool was used for generating a volcano plot and conducting correlation analyses. R software was employed for Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses for the DEGs. A combined Search Tool for the Retrieval of Interacting Genes/Proteins (STRING)-Cytoscape method was used for protein-protein interaction (PPI) network analyses, whereas cytoHubba was used to the screen core DEGs.</p><p><strong>Results: </strong>After 85% PH, we observed steatosis, an increased PCNA positivity rate, mitochondrial swelling, and a reduced number of cristae due to cristae disintegration. We screened 30 DEGs that were associated with different processes, including oxidation-reduction, oxidoreductase activity, electron transfer activity, organelle envelope, inner mitochondrial membrane processes, and oxidative phosphorylation as well as those involved in nonalcoholic fatty liver disease (NAFLD). We identified a total of six hub genes: <i>COX4I1</i>, <i>ATP5B</i>, <i>UQCRC2</i>, <i>CYC1</i>, <i>ATP5O</i>, and <i>ATP5A1</i>.</p><p><strong>Conclusions: </strong>The 85% PH model promotes mitochondrial complex protein expression, thereby providing energy for liver regeneration. The enriched genes were associated with oxidation-reduction, electron transfer activity, and inner mitochondrial membrane processes.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"15 5","pages":"2252-2264"},"PeriodicalIF":2.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11565125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647446","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":"Unexpected peritoneal metastases diagnosed at the time of primary colon cancer resection: controversies regarding options for management.","authors":"Ramakrishnan Ayloor Seshadri, Paul H Sugarbaker, Avanish Saklani, Steven D Wexner","doi":"10.21037/jgo-24-258","DOIUrl":"10.21037/jgo-24-258","url":null,"abstract":"<p><p>Peritoneal metastases synchronously occurring in the patient with primary colon cancer causes that patient to be at high risk for subsequent disease progression within the abdomen and pelvis. If peritoneal metastases are preoperatively diagnosed, patients are likely to be treated with neoadjuvant chemotherapy with or without biological therapy prior to cytoreductive surgery (CRS). However, if one only considers patients with peritoneal metastases unexpectedly identified at the time of primary colon cancer resection, the optimal management strategy is neither standardized nor evidence based. These authors present an opinion regarding treatment options in unexpectedly (incidentally) detected peritoneal metastases. The primary colon cancer may be asymptomatic (elective list) or may present as an emergency with obstruction or with perforation. The fitness of the patient, the condition of the colon, availability of a colonic stent, consent of the patient and capabilities of the institution for management of peritoneal metastases by CRS and intraperitoneal chemotherapy cannot be ignored and must all be considered. These patients with known peritoneal metastases should not be allowed to return for further treatment with advanced disease after multiple regimens of systemic chemotherapy. Delay in definitive management will cause peritoneal metastases to be unresectable and not amenable to cure. It is time to debate optimal management strategies for unexpectedly detected peritoneal metastases. The authors find the data compelling that the modifications presented in the management of unexpected peritoneal metastases documented at the time of colon cancer resection changes a palliative approach to treatment to a plan that has curative intent.</p>","PeriodicalId":15841,"journal":{"name":"Journal of gastrointestinal oncology","volume":"15 5","pages":"2305-2315"},"PeriodicalIF":2.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11565119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647815","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}