Journal of Gastric Cancer最新文献

{"title":"Defect Size-Based Comparative Analysis of Treatment Modalities for Esophagojejunal Anastomotic Leakage Following Gastrectomy.","authors":"Ba Ool Seong, Ji Yong Ahn, Juno Yoo, Chang Seok Ko, Sa-Hong Min, Chung Sik Gong, Beom Su Kim, Moon-Won Yoo, Jeong Hwan Yook, Hee Jin Choi, In-Seob Lee","doi":"10.5230/jgc.2026.26.e20","DOIUrl":"10.5230/jgc.2026.26.e20","url":null,"abstract":"<p><strong>Purpose: </strong>Esophagojejunal anastomotic leakage (EJAL) represents a severe postoperative complication following total or proximal gastrectomy. Treatment strategies include conservative management, endoscopic interventions, and surgery; however, comparative data remain limited. This study aimed to compare clinical outcomes of different strategies to identify the optimal approach based on anastomotic defect size.</p><p><strong>Materials and methods: </strong>This retrospective study reviewed 100 patients diagnosed with EJAL between January 2015 and October 2024. Patients were categorized into four groups: conservative management, endoscopic vacuum-assisted closure (E-VAC), other endoscopic treatments, and surgery. The primary outcomes were leakage duration and length of hospital stay after EJAL diagnosis, whereas the secondary outcome was time to C-reactive protein normalization. Subgroup analyses were performed according to defect size.</p><p><strong>Results: </strong>Among the 100 patients, 76 were male and 24 were female, with a mean age of 65.7 years. Conservative treatment was the most common modality (53%), followed by other endoscopic treatments (19%), E-VAC (14%), and surgery (14%). In patients with a defect size <1 cm, conservative treatment was associated with significantly shorter leakage duration (P=0.035) and earlier resumption of diet (P=0.029) compared with endoscopic treatment. Among those with defects ≥2 cm, E-VAC demonstrated the most favorable median outcomes across all variables; however, statistical significance was not achieved because of the small sample size.</p><p><strong>Conclusions: </strong>Conservative treatment appears to be the most effective treatment strategy for EJAL with anastomotic defects <1 cm. For larger defects (≥2 cm), E-VAC may offer clinical benefit, although further studies are needed to confirm its efficacy. These findings highlight the importance of individualized treatment selection based on defect size.</p>","PeriodicalId":56072,"journal":{"name":"Journal of Gastric Cancer","volume":"26 2","pages":"295-306"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147628798","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":"Endoscopic Features of Background Gastritis Associated With Remnant Gastric Cancer: A Multicenter Retrospective Study.","authors":"Takuma Ohashi, Takeshi Kubota, Hayato Fukui, Osamu Dohi, Shuhei Komatsu, Yasuhiro Shioaki, Yasuhito Izumiya, Tetsuro Yamashita, Sachie Tanaka, Soujin Sai, Junki Yamajo, Nobuaki Fuji, Yosuke Ariyoshi, Sadao Kawakami, Kyoichi Harada, Toshiya Ochiai, Kenichi Aratani, Katsunori Nakano, Hidefumi Ueda, Takeshi Daido, Hiroyuki Inoue, Kazuya Takabatake, Keiji Nishibeppu, Hirotaka Konishi, Hitoshi Fujiwara, Yoshito Ito, Eigo Otsuji, Atsushi Shiozaki","doi":"10.5230/jgc.2026.26.e15","DOIUrl":"10.5230/jgc.2026.26.e15","url":null,"abstract":"<p><strong>Purpose: </strong>We identified the risk factors for remnant gastric cancer (RGC) based on remnant gastric mucosal characteristics and gastritis morphology in patients undergoing distal gastrectomy.</p><p><strong>Materials and methods: </strong>This multicenter retrospective study included 100 patients with RGC after distal gastrectomy and 550 patients without RGC treated between 2013 and 2020. Endoscopic findings, including anastomotic redness, red streaks, enlarged folds, bile reflux as anastomotic findings, as well as disappearance of the regular arrangement of collecting venules (RAC), atrophic gastritis, and intestinal metaplasia as background gastric mucosal findings, were evaluated. Disease risk score matching (1:1) was adjusted for baseline characteristics. Logistic regression analysis was used to develop a risk score model to stratify RGC risk into low, moderate, and high categories.</p><p><strong>Results: </strong>After matching, 96 patients with RGC and 96 controls were analyzed. Anastomotic redness and red streaks, as well as the disappearance of RAC and atrophic gastritis, were significantly more frequent in the RGC group than in the control group, whereas enlarged folds and bile reflux showed no significant differences. Risk scores were assigned as follows: anastomotic redness, 2; red streaks, 3; disappearance of RAC, 7; and atrophic gastritis, 3. The total score stratified patients into high (≥15), moderate (7-14), and low risk (≤6). The positive and negative predictive values were 67.7% and 83.3%, respectively.</p><p><strong>Conclusions: </strong>The endoscopic findings of anastomotic redness, red streaks, RAC disappearance, and atrophic gastritis were significantly associated with RGC development. The proposed risk-scoring model could serve as a stratification tool for RGC surveillance.</p><p><strong>Trial registration: </strong>University Hospital Medical Information Network Identifier: UMIN000055884.</p>","PeriodicalId":56072,"journal":{"name":"Journal of Gastric Cancer","volume":"26 2","pages":"232-246"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147629092","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":"Endoscopic Submucosal Dissection for Early Gastric Cancer: From Expanding Utilization to Lifelong Survivorship Care.","authors":"Han Hong Lee","doi":"10.5230/jgc.2026.26.e22","DOIUrl":"10.5230/jgc.2026.26.e22","url":null,"abstract":"","PeriodicalId":56072,"journal":{"name":"Journal of Gastric Cancer","volume":"26 2","pages":"161-164"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147629038","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":"Gastrointestinal Stromal Tumor: History, Molecular Subtypes, and Risk Stratification.","authors":"In Hye Song, Soomin Ahn, Hyung-Don Kim, Jeong-Hyeon Jo, Jinho Shin, Min-Hee Ryu, Young Soo Park","doi":"10.5230/jgc.2026.26.e7","DOIUrl":"10.5230/jgc.2026.26.e7","url":null,"abstract":"<p><p>The gastrointestinal stromal tumor (GIST) is one of the most common mesenchymal tumors of the gastrointestinal tract. Between the 1990s and early 2000s, GIST was identified as a tumor characterized by <i>KIT</i> or <i>PDGFRA</i> mutations, resulting in imatinib being established as an effective targeted therapy. However, with advances in molecular diagnostics, approximately 10%-15% of GISTs have been reported to harbor alternative mutations, such as those in the succinate dehydrogenase subunit genes and <i>BRAF</i>, leading to the development of additional targeted therapies. GISTs exhibit a wide spectrum of clinical behaviors, ranging from indolent to highly aggressive, prompting the development of diverse risk classification systems. However, multiple systems remain in use, leading to inconsistent pathologic reports. Moreover, the mitotic counting method-a key factor in risk stratification-has become a major source of confusion among pathologists owing to the adoption of digital pathology and discrepancies between updated international guidelines and outdated reimbursement requirements. These inconsistencies have hindered pathologic reporting and communication between pathologists and clinicians. This review comprehensively overviews the historical background, molecular subtypes, and risk classification systems of GIST, focusing on evolving issues in mitotic rate evaluation and the application of risk classification systems in clinical practice.</p>","PeriodicalId":56072,"journal":{"name":"Journal of Gastric Cancer","volume":"26 2","pages":"202-218"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147629261","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":"Tumor-Associated Macrophage Infiltration and PD-L1 Expression in Gastric Cancer According to a Modified TCGA-Based Classification.","authors":"Boram Song, Dong-Hoe Koo, Eo Jin Kim, In-Gu Do, Jinah Chu, Kyungeun Kim, Hyebin Lee, Min-Jung Kwon, Jung Ho Park, Byung Ho Son, Chang Hak Yoo, Seoung Wan Chae","doi":"10.5230/jgc.2026.26.e3","DOIUrl":"10.5230/jgc.2026.26.e3","url":null,"abstract":"<p><strong>Purpose: </strong>Although gastric cancer (GC) exhibits significant genomic heterogeneity, the clinical implications of its immune microenvironment remain poorly understood.</p><p><strong>Materials and methods: </strong>We retrospectively evaluated patients with GC who underwent gastrectomies between 2011 and 2014. The tumors were analyzed for Epstein-Barr virus (EBV), microsatellite instability-high (MSI-H), tumor-infiltrating lymphocytes (CD3), tumor-associated macrophages (CD68 and CD163), and programmed death-ligand 1 (PD-L1) expression. Tumors were classified using the modified The Cancer Genome Atlas scheme, and their clinical characteristics were compared.</p><p><strong>Results: </strong>A total of 567 patients were classified into EBV (6%), MSI-H (10%), chromosomal instability-like (36%), and genomically stable-like (48%) subtypes. EBV tumors exhibited the highest PD-L1 expression (85%) and immune infiltration by CD3+ T cells (86%), CD68+ macrophages (58%), and CD163+ macrophages (40%). High CD68+ macrophage tumors were associated with advanced stages and worse 5-year disease-free survival (83% vs. 95%; P<0.001); however, this association was not independently significant after adjusting for the tumor-node-metastasis stage. PD-L1 expression did not significantly affect the survival outcomes.</p><p><strong>Conclusions: </strong>GC subtypes have distinct immune microenvironments that influence prognosis. Our findings highlight the prognostic and therapeutic potential of immune profiling in GC.</p>","PeriodicalId":56072,"journal":{"name":"Journal of Gastric Cancer","volume":"26 2","pages":"247-259"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147629282","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":"Biological Characteristics and Therapeutic Strategies for Resectable Locally Advanced Esophagogastric Junction Cancer: A Comprehensive Update.","authors":"Koki Fujiwara, Satoru Matsuda, Yosuke Morimoto, Kazuaki Matsui, Masashi Takeuchi, Hirofumi Kawakubo, Yuko Kitagawa","doi":"10.5230/jgc.2026.26.e16","DOIUrl":"10.5230/jgc.2026.26.e16","url":null,"abstract":"<p><p>Although the clinical importance of esophagogastric junction (EGJ) cancer is being increasingly recognized, its definition and treatment strategies vary considerably across regions. Recently, new concepts such as the gastroesophageal junction zone have been proposed for classification of EGJ cancer. Moreover, EGJ adenocarcinoma has been shown to possess a heterogeneous molecular profile consisting of both esophageal- and gastric-like phenotypes, indicating the need for EGJ-specific therapeutic strategies. Although international clinical practice guidelines for EGJ cancer have been published, substantial regional differences remain. This review aimed to summarize recent updates on the biological characteristics and management of EGJ cancers. Trials such as TIME and MIRO have demonstrated that minimally invasive surgery (MIS) reduces postoperative complications and improves the early postoperative quality of life. More recently, the MONET trial showed that MIS is not inferior to open esophagectomy in terms of long-term oncological outcomes, and the REVATE trial demonstrated the advantages of robot-assisted surgery over thoracoscopic approaches. Perioperative treatment strategies also differ across regions. Western guidelines recommend 5-fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT)-based perioperative chemotherapy, as supported by the FLOT4 and ESOPEC trials, whereas Asian studies, such as RESOLVE and PRODIGY, have demonstrated the efficacy of docetaxel, oxaliplatin, and S-1 or S-1 plus oxaliplatin regimens. The application of immune checkpoint inhibitors is also evolving; although KEYNOTE-585 did not show a survival advantage, the MATTERHORN trial demonstrated that durvalumab plus FLOT significantly improved event-free survival, establishing a new emerging global standard. Future directions include redefining EGJ classification, implementing molecular-guided treatment selection, advancing organ-preserving strategies, and optimizing perioperative immunochemotherapy.</p>","PeriodicalId":56072,"journal":{"name":"Journal of Gastric Cancer","volume":"26 2","pages":"184-201"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147628608","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":"A Nomogram for Predicting Metachronous Gastric Cancer After Endoscopic Submucosal Dissection of Early Gastric Cancer Following Successful <i>Helicobacter pylori</i> Eradication.","authors":"Shangtao Mao, Miao Liu, Tao Zhao, Qiong Yan, Ying Xiang, Hai Wu, Wenjun Li, Hongji Tao, Duanming Zhuang, Lei Wang, Guifang Xu","doi":"10.5230/jgc.2026.26.e21","DOIUrl":"10.5230/jgc.2026.26.e21","url":null,"abstract":"<p><strong>Purpose: </strong>Due to the preservation of the entire stomach after endoscopic resection, the occurrence of metachronous gastric cancer (MGC) remains a possibility. In this study, we investigated the incidence and risk factors for MGC in patients with early gastric cancer who underwent endoscopic submucosal dissection (ESD) and successfully eradicated <i>Helicobacter pylori</i>.</p><p><strong>Materials and methods: </strong>A retrospective analysis was conducted of 1,191 patients who underwent ESD and successfully eradicated <i>H. pylori</i> at the Affiliated Drum Tower Hospital of Nanjing University. Endoscopic surveillance was performed at 3, 6, and 12 months post-resection, and annually thereafter. MGC was defined as the development of a new cancer at a site other than the primary gastric cancer site, at least 1 year after the initial endoscopic resection.</p><p><strong>Results: </strong>A total of 77 patients were diagnosed with MGC during a median follow-up of 41.5 months. Kaplan-Meier analysis showed a 5-year cumulative incidence of MGC of 9.4% after successful <i>H. pylori</i> eradication. Multivariate analysis of the training set using Cox proportional hazards models identified male sex, severe atrophic gastritis, multiple gastric cancers before <i>H. pylori</i> eradication, and smoking history as independent risk factors for MGC. The nomogram exhibited favorable discrimination, with area under the curves of 0.767 and 0.822 in the training set and 0.724 and 0.745 in the testing set at 3 and 5 years, respectively.</p><p><strong>Conclusions: </strong>Patients with gastric cancer who undergo endoscopic resection, even after successful <i>H. pylori</i> eradication, should undergo annual and continuous endoscopic surveillance for MGC.</p>","PeriodicalId":56072,"journal":{"name":"Journal of Gastric Cancer","volume":"26 2","pages":"279-294"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147628635","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":"Reply: Comment on Nutritional Counseling for Patients With Gastric Cancer After Subtotal Gastrectomy: A Randomized Clinical Trial.","authors":"Jae-Moon Bae","doi":"10.5230/jgc.2026.26.e18","DOIUrl":"10.5230/jgc.2026.26.e18","url":null,"abstract":"","PeriodicalId":56072,"journal":{"name":"Journal of Gastric Cancer","volume":"26 2","pages":"167-168"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147629255","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":"Comment on Nutritional Counseling for Patients With Gastric Cancer After Subtotal Gastrectomy: A Randomized Clinical Trial.","authors":"Pınar Peker","doi":"10.5230/jgc.2026.26.e17","DOIUrl":"10.5230/jgc.2026.26.e17","url":null,"abstract":"","PeriodicalId":56072,"journal":{"name":"Journal of Gastric Cancer","volume":"26 2","pages":"165-166"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147628886","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 Value of Insertion/Deletion Rate in Patients With Gastric Cancer Treated With Nivolumab Plus Chemotherapy.","authors":"Hyung-Don Kim, Hyungeun Lee, Sun Young Lee, Yuna Lee, Jaewon Hyung, Meesun Moon, Jinho Shin, Young Soo Park, Min-Hee Ryu","doi":"10.5230/jgc.2026.26.e14","DOIUrl":"10.5230/jgc.2026.26.e14","url":null,"abstract":"<p><strong>Purpose: </strong>Immune checkpoint inhibitor plus chemotherapy is the standard first-line treatment for advanced gastric cancer; however, predictive biomarkers for optimal patient selection remain unsatisfactory. This study was aimed at evaluating the predictive value of tumor mutational burden (TMB) and insertion/deletion (Indel) rate in patients with gastric cancer treated with nivolumab plus chemotherapy.</p><p><strong>Materials and methods: </strong>This retrospective study included 132 patients with gastric cancer treated with first-line nivolumab plus chemotherapy and 185 patients treated with chemotherapy alone, all of whom had next-generation sequencing data available. The TMB and Indel cut-offs were set at 15.63 mutations per megabase and 18.19%, respectively, as determined based on their ability to best distinguish progression-free survival (PFS) among the patients who received nivolumab plus chemotherapy.</p><p><strong>Results: </strong>PFS was favorable for nivolumab and chemotherapy than for chemotherapy alone in both the high and low TMB groups; nevertheless, survival benefits were observed only in the high Indel group. Among the subgroups defined based on both TMB and Indel rates, the high TMB and high Indel rate subgroup showed the greatest benefit from nivolumab plus chemotherapy compared with that from chemotherapy alone. The benefit of this subgroup remained significant in patients with proficient mismatch repair (MMR) tumors, whose survival outcomes were comparable to those of patients with deficient MMR tumors. Among patients treated with nivolumab plus chemotherapy, high TMB and Indel rate were independently associated with favorable survival outcomes.</p><p><strong>Conclusions: </strong>Thus, Indel rate, particularly in combination with TMB, may be a promising predictive biomarker for gastric cancer. However, further validation of their predictive value is warranted.</p>","PeriodicalId":56072,"journal":{"name":"Journal of Gastric Cancer","volume":"26 2","pages":"219-231"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147629292","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}