Clinical Edge Journal Scan

Interstitial lung disease (ILD) is a serious and not infrequent complication of rheumatoid arthritis (RA). Despite the use of several immunosuppressive medications for ILD as well as others for RA, the most effective treatment for both is yet unclear. Prior cross-sectional, retrospective, and open-label registry studies have suggested that abatacept can be used in patients with RA-ILD, with stability or improvement in pulmonary parameters in a majority of patients. Mena-Vazquez and colleagues present the results of a prospective, observational cohort study with 57 patients from multiple centers in Spain. Similar to previously published results, this study found stability or improvement in pulmonary function tests in 70% of patients as well as improvement in RA disease activity. A relatively high proportion of patients (25 in 57) experienced infections. The study lends further weight to the proposal that abatacept is a reasonable choice in patients with RA-ILD for treatment of both joint and pulmonary inflammation, given the lack of randomized controlled trials.

Lauper and colleagues published the results of a large cohort study of more than 30,000 treatment courses in patients with RA, looking at the efficacy of different biologics and a Janus kinase (JAK) inhibitor. Discontinuation of therapy was used as the primary efficacy outcome, and one secondary outcome was low disease activity based on Clinical Disease Activity Index (CDAI) at 12 months. Over 17,000 courses were anti–tumor necrosis factor (TNF) therapy, with about 7000 JAK-inhibitor therapy courses and the remainder an interleukin 6 (IL-6) inhibitor or abatacept therapy; individual data was only available from 13 to 17 registries (depending on the parameter of interest). Overall, IL-6 inhibitors and JAK inhibitors were less frequently stopped for ineffectiveness compared with anti-TNF agents, but were more frequently stopped owing to adverse events. Drug retention rates also varied between different countries, suggesting that prescription pattern differences may affect the primary outcome. In terms of CDAI, response rates at 1 year were similar between anti-TNF agents, JAK inhibitors, and IL-6 inhibitors and was slightly lower for abatacept. This real-world study does support similar efficacy between these classes of medications, though further conclusions are somewhat hampered by the lack of individual data.

A study in Japan by Mori and colleagues looked at biologic disease-modifying antirheumatic drugs (bDMARD) (TNF inhibitors and an IL-6 inhibitor) and tofacitinib discontinuation in a cohort of 97 patients with RA . Patients were required to initially be in a high or moderate disease activity state prior to treatment, then in remission or a low disease activity state with treatment for more than 48 weeks. Mean follow-up was 2.1 years and disease flare occurred in about 75% of patients at about 1.6 years after medication discontinuation. Though bDMARD- or targeted synthetic DMARD (tsDMARD)–free remission was not "durable" for most patients, the majority of those patients who experienced flares improved with resumption of their previous medication. Though it is reassuring that most study patients were able to discontinue their bDMARD or tsDMARD medication for a period of time, the fact that most experienced flares within 2 years suggests that discontinuation of these medications in patients with high disease activity is not a viable long-term approach.

Krekeler and colleagues performed a retrospective analysis of about 500 patients seen in a single rheumatology clinic to evaluate possible misdiagnosis of RA. The diagnosis of calcium pyrophosphate deposition disease (CPPD), as well as the presence of radiographic chondrocalcinosis, were more frequently found among patients diagnosed with seronegative RA vs those diagnosed with seropositive RA, particularly RA in the wrists. The CPPD diagnosis was made by rheumatologists on the basis of the presence of radiographic chondrocalcinosis along with typical joint swelling and signs of inflammation. Because chondrocalcinosis was part of the CPPD diagnosis, it is unsurprising that both followed similar patterns. Whether patients with CPPD were actually misdiagnosed as having seronegative RA is unclear from this retrospective study; as the authors note, chondrocalcinosis itself has been found to be associated with older age and osteoarthritis in prior studies, particularly in the knee. However, the study confirms that alternative diagnoses in seronegative RA should be considered.

Interstitial lung disease (ILD) is a serious and not infrequent complication of rheumatoid arthritis (RA). Despite the use of several immunosuppressive medications for ILD as well as others for RA, the most effective treatment for both is yet unclear. Prior cross-sectional, retrospective, and open-label registry studies have suggested that abatacept can be used in patients with RA-ILD, with stability or improvement in pulmonary parameters in a majority of patients. Mena-Vazquez and colleagues present the results of a prospective, observational cohort study with 57 patients from multiple centers in Spain. Similar to previously published results, this study found stability or improvement in pulmonary function tests in 70% of patients as well as improvement in RA disease activity. A relatively high proportion of patients (25 in 57) experienced infections. The study lends further weight to the proposal that abatacept is a reasonable choice in patients with RA-ILD for treatment of both joint and pulmonary inflammation, given the lack of randomized controlled trials.

Lauper and colleagues published the results of a large cohort study of more than 30,000 treatment courses in patients with RA, looking at the efficacy of different biologics and a Janus kinase (JAK) inhibitor. Discontinuation of therapy was used as the primary efficacy outcome, and one secondary outcome was low disease activity based on Clinical Disease Activity Index (CDAI) at 12 months. Over 17,000 courses were anti–tumor necrosis factor (TNF) therapy, with about 7000 JAK-inhibitor therapy courses and the remainder an interleukin 6 (IL-6) inhibitor or abatacept therapy; individual data was only available from 13 to 17 registries (depending on the parameter of interest). Overall, IL-6 inhibitors and JAK inhibitors were less frequently stopped for ineffectiveness compared with anti-TNF agents, but were more frequently stopped owing to adverse events. Drug retention rates also varied between different countries, suggesting that prescription pattern differences may affect the primary outcome. In terms of CDAI, response rates at 1 year were similar between anti-TNF agents, JAK inhibitors, and IL-6 inhibitors and was slightly lower for abatacept. This real-world study does support similar efficacy between these classes of medications, though further conclusions are somewhat hampered by the lack of individual data.

A study in Japan by Mori and colleagues looked at biologic disease-modifying antirheumatic drugs (bDMARD) (TNF inhibitors and an IL-6 inhibitor) and tofacitinib discontinuation in a cohort of 97 patients with RA . Patients were required to initially be in a high or moderate disease activity state prior to treatment, then in remission or a low disease activity state with treatment for more than 48 weeks. Mean follow-up was 2.1 years and disease flare occurred in about 75% of patients at about 1.6 years after medication discontinuation. Though bDMARD- or targeted synthetic DMARD (tsDMARD)–free remission was not "durable" for most patients, the majority of those patients who experienced flares improved with resumption of their previous medication. Though it is reassuring that most study patients were able to discontinue their bDMARD or tsDMARD medication for a period of time, the fact that most experienced flares within 2 years suggests that discontinuation of these medications in patients with high disease activity is not a viable long-term approach.

Krekeler and colleagues performed a retrospective analysis of about 500 patients seen in a single rheumatology clinic to evaluate possible misdiagnosis of RA. The diagnosis of calcium pyrophosphate deposition disease (CPPD), as well as the presence of radiographic chondrocalcinosis, were more frequently found among patients diagnosed with seronegative RA vs those diagnosed with seropositive RA, particularly RA in the wrists. The CPPD diagnosis was made by rheumatologists on the basis of the presence of radiographic chondrocalcinosis along with typical joint swelling and signs of inflammation. Because chondrocalcinosis was part of the CPPD diagnosis, it is unsurprising that both followed similar patterns. Whether patients with CPPD were actually misdiagnosed as having seronegative RA is unclear from this retrospective study; as the authors note, chondrocalcinosis itself has been found to be associated with older age and osteoarthritis in prior studies, particularly in the knee. However, the study confirms that alternative diagnoses in seronegative RA should be considered.

Interstitial lung disease (ILD) is a serious and not infrequent complication of rheumatoid arthritis (RA). Despite the use of several immunosuppressive medications for ILD as well as others for RA, the most effective treatment for both is yet unclear. Prior cross-sectional, retrospective, and open-label registry studies have suggested that abatacept can be used in patients with RA-ILD, with stability or improvement in pulmonary parameters in a majority of patients. Mena-Vazquez and colleagues present the results of a prospective, observational cohort study with 57 patients from multiple centers in Spain. Similar to previously published results, this study found stability or improvement in pulmonary function tests in 70% of patients as well as improvement in RA disease activity. A relatively high proportion of patients (25 in 57) experienced infections. The study lends further weight to the proposal that abatacept is a reasonable choice in patients with RA-ILD for treatment of both joint and pulmonary inflammation, given the lack of randomized controlled trials.

Lauper and colleagues published the results of a large cohort study of more than 30,000 treatment courses in patients with RA, looking at the efficacy of different biologics and a Janus kinase (JAK) inhibitor. Discontinuation of therapy was used as the primary efficacy outcome, and one secondary outcome was low disease activity based on Clinical Disease Activity Index (CDAI) at 12 months. Over 17,000 courses were anti–tumor necrosis factor (TNF) therapy, with about 7000 JAK-inhibitor therapy courses and the remainder an interleukin 6 (IL-6) inhibitor or abatacept therapy; individual data was only available from 13 to 17 registries (depending on the parameter of interest). Overall, IL-6 inhibitors and JAK inhibitors were less frequently stopped for ineffectiveness compared with anti-TNF agents, but were more frequently stopped owing to adverse events. Drug retention rates also varied between different countries, suggesting that prescription pattern differences may affect the primary outcome. In terms of CDAI, response rates at 1 year were similar between anti-TNF agents, JAK inhibitors, and IL-6 inhibitors and was slightly lower for abatacept. This real-world study does support similar efficacy between these classes of medications, though further conclusions are somewhat hampered by the lack of individual data.

A study in Japan by Mori and colleagues looked at biologic disease-modifying antirheumatic drugs (bDMARD) (TNF inhibitors and an IL-6 inhibitor) and tofacitinib discontinuation in a cohort of 97 patients with RA . Patients were required to initially be in a high or moderate disease activity state prior to treatment, then in remission or a low disease activity state with treatment for more than 48 weeks. Mean follow-up was 2.1 years and disease flare occurred in about 75% of patients at about 1.6 years after medication discontinuation. Though bDMARD- or targeted synthetic DMARD (tsDMARD)–free remission was not "durable" for most patients, the majority of those patients who experienced flares improved with resumption of their previous medication. Though it is reassuring that most study patients were able to discontinue their bDMARD or tsDMARD medication for a period of time, the fact that most experienced flares within 2 years suggests that discontinuation of these medications in patients with high disease activity is not a viable long-term approach.

Krekeler and colleagues performed a retrospective analysis of about 500 patients seen in a single rheumatology clinic to evaluate possible misdiagnosis of RA. The diagnosis of calcium pyrophosphate deposition disease (CPPD), as well as the presence of radiographic chondrocalcinosis, were more frequently found among patients diagnosed with seronegative RA vs those diagnosed with seropositive RA, particularly RA in the wrists. The CPPD diagnosis was made by rheumatologists on the basis of the presence of radiographic chondrocalcinosis along with typical joint swelling and signs of inflammation. Because chondrocalcinosis was part of the CPPD diagnosis, it is unsurprising that both followed similar patterns. Whether patients with CPPD were actually misdiagnosed as having seronegative RA is unclear from this retrospective study; as the authors note, chondrocalcinosis itself has been found to be associated with older age and osteoarthritis in prior studies, particularly in the knee. However, the study confirms that alternative diagnoses in seronegative RA should be considered.

This month brought us findings from DYNAMIC, a randomized trial of circulating tumor DNA (ctDNA), which aimed to provide guidance on the use of adjuvant chemotherapy in stage II colon cancer. This study has already been touted on oncology Twitter as a massive breakthrough for identifying patients with stage II colon cancer who would benefit from adjuvant chemotherapy. Does the reality live up to the hype? Let's break it down.

Patients with resected stage II colon cancer were eligible for enrollment. Two thirds of patients were randomly assigned to the ctDNA guidance arm, whereas the remaining third had chemotherapy guidance based on clinicopathologic high-risk features (T4, poor differentiation, < 12 lymph nodes in surgical sample, lymphovascular invasion, tumor perforation, or bowel obstruction). Chemotherapy choice was left up to the clinician and could be an oxaliplatin-based doublet or a single-agent fluoropyrimidine. The primary endpoint was recurrence-free survival at 2 years. A key secondary endpoint was chemotherapy treatment frequency by arm. A total of 459 patients were enrolled from 23 Australian centers over 4 years. Approximately 40% of patients were considered to be at high risk for recurrence on the basis of their tumors' clinicopathologic features. Approximately 20% of patients had tumors that were mismatch repair deficient.

There was no difference in 2-year recurrence-free survival between the two arms (93.5% vs 92.4%; 95% CI -4.1 to 6.2). This met criteria for noninferiority. However, chemotherapy administration in the two arms was markedly different. A significantly greater proportion of patients randomly assigned to the standard management arm received chemotherapy (28% vs 15%; relative risk [RR] 1.82; 95% CI 1.25-2.65). However, a significantly greater proportion of patients guided by ctDNA received an oxaliplatin-based doublet (62% vs 10%; RR 2.39; 95% CI 1.62-3.52). Clearly, when clinicians were presented with a positive ctDNA test, they overwhelmingly opted to give an oxaliplatin-based doublet rather than a single-agent fluoropyrimidine. Oxaliplatin's use in stage II colon cancer remains very controversial; it is oxaliplatin that causes most of the long-term toxicity associated with adjuvant chemotherapy for colorectal cancer. Although ctDNA testing might lower the total proportion of patients who received adjuvant treatment, it significantly raised the proportion who received oxaliplatin. I doubt this is a worthy trade-off.

Furthermore, clinicopathologic factors were still highly relevant in patients with ctDNA-negative results. Among ctDNA-negative patients, 3-year recurrence-free survival was higher in patients with clinicopathologic low-risk cancers than in those with high-risk cancers (96.7% vs 85.1%; hazard ratio 3.04; 95% CI 1.26-7.34). This strongly suggests that ctDNA testing is unlikely to replace clinicopathologic high-risk features in the real-world practice of clinical oncology. Rather, ctDNA testing will probably be added to the list of high-risk features, prompting use of more chemotherapy, not less, for stage II colon cancer.

A more useful study, in my opinion, should be performed in stage III colon cancer. Patients with stage III colon cancer receive chemotherapy without exception, although we know from MOSAIC that the absolute benefit of chemotherapy in stage III colon cancer is modest. What proportion of these patients who have a negative ctDNA test might be able to either forgo treatment completely or have treatment with a fluoropyrimidine only? That's something I would be very interested to find out.

This month brought us findings from DYNAMIC, a randomized trial of circulating tumor DNA (ctDNA), which aimed to provide guidance on the use of adjuvant chemotherapy in stage II colon cancer. This study has already been touted on oncology Twitter as a massive breakthrough for identifying patients with stage II colon cancer who would benefit from adjuvant chemotherapy. Does the reality live up to the hype? Let's break it down.

Patients with resected stage II colon cancer were eligible for enrollment. Two thirds of patients were randomly assigned to the ctDNA guidance arm, whereas the remaining third had chemotherapy guidance based on clinicopathologic high-risk features (T4, poor differentiation, < 12 lymph nodes in surgical sample, lymphovascular invasion, tumor perforation, or bowel obstruction). Chemotherapy choice was left up to the clinician and could be an oxaliplatin-based doublet or a single-agent fluoropyrimidine. The primary endpoint was recurrence-free survival at 2 years. A key secondary endpoint was chemotherapy treatment frequency by arm. A total of 459 patients were enrolled from 23 Australian centers over 4 years. Approximately 40% of patients were considered to be at high risk for recurrence on the basis of their tumors' clinicopathologic features. Approximately 20% of patients had tumors that were mismatch repair deficient.

There was no difference in 2-year recurrence-free survival between the two arms (93.5% vs 92.4%; 95% CI -4.1 to 6.2). This met criteria for noninferiority. However, chemotherapy administration in the two arms was markedly different. A significantly greater proportion of patients randomly assigned to the standard management arm received chemotherapy (28% vs 15%; relative risk [RR] 1.82; 95% CI 1.25-2.65). However, a significantly greater proportion of patients guided by ctDNA received an oxaliplatin-based doublet (62% vs 10%; RR 2.39; 95% CI 1.62-3.52). Clearly, when clinicians were presented with a positive ctDNA test, they overwhelmingly opted to give an oxaliplatin-based doublet rather than a single-agent fluoropyrimidine. Oxaliplatin's use in stage II colon cancer remains very controversial; it is oxaliplatin that causes most of the long-term toxicity associated with adjuvant chemotherapy for colorectal cancer. Although ctDNA testing might lower the total proportion of patients who received adjuvant treatment, it significantly raised the proportion who received oxaliplatin. I doubt this is a worthy trade-off.

Furthermore, clinicopathologic factors were still highly relevant in patients with ctDNA-negative results. Among ctDNA-negative patients, 3-year recurrence-free survival was higher in patients with clinicopathologic low-risk cancers than in those with high-risk cancers (96.7% vs 85.1%; hazard ratio 3.04; 95% CI 1.26-7.34). This strongly suggests that ctDNA testing is unlikely to replace clinicopathologic high-risk features in the real-world practice of clinical oncology. Rather, ctDNA testing will probably be added to the list of high-risk features, prompting use of more chemotherapy, not less, for stage II colon cancer.

A more useful study, in my opinion, should be performed in stage III colon cancer. Patients with stage III colon cancer receive chemotherapy without exception, although we know from MOSAIC that the absolute benefit of chemotherapy in stage III colon cancer is modest. What proportion of these patients who have a negative ctDNA test might be able to either forgo treatment completely or have treatment with a fluoropyrimidine only? That's something I would be very interested to find out.

This month brought us findings from DYNAMIC, a randomized trial of circulating tumor DNA (ctDNA), which aimed to provide guidance on the use of adjuvant chemotherapy in stage II colon cancer. This study has already been touted on oncology Twitter as a massive breakthrough for identifying patients with stage II colon cancer who would benefit from adjuvant chemotherapy. Does the reality live up to the hype? Let's break it down.

Patients with resected stage II colon cancer were eligible for enrollment. Two thirds of patients were randomly assigned to the ctDNA guidance arm, whereas the remaining third had chemotherapy guidance based on clinicopathologic high-risk features (T4, poor differentiation, < 12 lymph nodes in surgical sample, lymphovascular invasion, tumor perforation, or bowel obstruction). Chemotherapy choice was left up to the clinician and could be an oxaliplatin-based doublet or a single-agent fluoropyrimidine. The primary endpoint was recurrence-free survival at 2 years. A key secondary endpoint was chemotherapy treatment frequency by arm. A total of 459 patients were enrolled from 23 Australian centers over 4 years. Approximately 40% of patients were considered to be at high risk for recurrence on the basis of their tumors' clinicopathologic features. Approximately 20% of patients had tumors that were mismatch repair deficient.

There was no difference in 2-year recurrence-free survival between the two arms (93.5% vs 92.4%; 95% CI -4.1 to 6.2). This met criteria for noninferiority. However, chemotherapy administration in the two arms was markedly different. A significantly greater proportion of patients randomly assigned to the standard management arm received chemotherapy (28% vs 15%; relative risk [RR] 1.82; 95% CI 1.25-2.65). However, a significantly greater proportion of patients guided by ctDNA received an oxaliplatin-based doublet (62% vs 10%; RR 2.39; 95% CI 1.62-3.52). Clearly, when clinicians were presented with a positive ctDNA test, they overwhelmingly opted to give an oxaliplatin-based doublet rather than a single-agent fluoropyrimidine. Oxaliplatin's use in stage II colon cancer remains very controversial; it is oxaliplatin that causes most of the long-term toxicity associated with adjuvant chemotherapy for colorectal cancer. Although ctDNA testing might lower the total proportion of patients who received adjuvant treatment, it significantly raised the proportion who received oxaliplatin. I doubt this is a worthy trade-off.

Furthermore, clinicopathologic factors were still highly relevant in patients with ctDNA-negative results. Among ctDNA-negative patients, 3-year recurrence-free survival was higher in patients with clinicopathologic low-risk cancers than in those with high-risk cancers (96.7% vs 85.1%; hazard ratio 3.04; 95% CI 1.26-7.34). This strongly suggests that ctDNA testing is unlikely to replace clinicopathologic high-risk features in the real-world practice of clinical oncology. Rather, ctDNA testing will probably be added to the list of high-risk features, prompting use of more chemotherapy, not less, for stage II colon cancer.

A more useful study, in my opinion, should be performed in stage III colon cancer. Patients with stage III colon cancer receive chemotherapy without exception, although we know from MOSAIC that the absolute benefit of chemotherapy in stage III colon cancer is modest. What proportion of these patients who have a negative ctDNA test might be able to either forgo treatment completely or have treatment with a fluoropyrimidine only? That's something I would be very interested to find out.

Biomechanical stress and trauma are important factors driving the development and progression of psoriatic arthritis (PsA). On the other hand, physical exercise is beneficial for patients with arthritis. However, there is concern that high-intensity interval training (HIIT) may worsen PsA. Hypothesizing that bone marrow edema changes could occur in patients with PsA after HIIT despite no reported changes in disease activity by clinical examination, Chronaiou and colleagues aimed to assess whether HIIT in PsA patients led to MRI-detectable changes in the axial skeleton. Comparing 19 PsA patients who went through 11 weeks of HIIT with 20 patients who had no change in physical exercise habits, they found no significant changes in bone marrow edema on MRI images of the spine after HIIT. Thus, the 11-week HIIT regimen may be safe in PsA.

Mental health problems are often underestimated in psoriatic disease. Lada and colleagues aimed to estimate the prevalence of depression in patients with psoriatic disease and determine whether PsA is associated with higher depression and anxiety in patients with psoriasis. Analyzing data from British Association of Dermatologists Biologic and Immunomodulators Register (BADBIR) participants (540 with psoriasis and 167 with both psoriasis and PsA) who had completed the Hospital Anxiety and Depression Scale (HADS), they found that the prevalence of depression was higher in patients with PsA (32%) than in patients without PsA (22.7%) using a HADS cutoff of 8 (odds ratio 1.66; 95% CI 1.13--2.43). Pain mediated the effect of PsA on depression and anxiety.

Inhibitors of interleukin (IL)-23 are safe and efficacious in the treatment of psoriasis and PsA. However, changes in composite PsA indices have not been investigated in detail. Using pooled data from the phase 3 DISCOVER-1 (n = 381) and DISCOVER-2 (n = 739) studies, Coates and colleagues demonstrated that a significantly higher proportion of patients receiving guselkumab every 4 or 8 weeks vs placebo achieved low disease activity according to the Disease Activity Index for PsA (DAPSA) at week 8 (19.8%/17.3% vs 8.1%), DAPSA remission at week 12 (4.3%/4.3% vs 0.5%), minimal disease activity at week 16 (14.7%/16.5% vs 4.6%; all P < .001), and very low disease activity at week 24 (6.4%/4.3% vs 1.3%; P < .05), with improvements maintained until week 52. Thus, compared with placebo, treatment with guselkumab leads to early and sustained benefits for patients with PsA.

Similarly, Ostor and colleagues demonstrated in the phase 3 KEEPsAKE2 trial, which included 443 patients with PsA, that, at week 24, patients receiving risankizumab report a significantly greater improvement in the mean pain index score (-14.7 vs -6.5; P < .001), fatigue score (4.9 vs 2.6; P < .01), patient's global assessment of disease activity (-16.5 vs -7.7; P < .001), general health status (0.09 vs 0.01; P < .001), and physical functioning (5.1 vs 2.0; P < .001) compared with placebo.

In another study, treatment with bimekizumab, an inhibitor of IL-17A and IL-17F, was associated with sustained improvement in patient-reported outcomes. Mease and colleagues report that, at week 48, there was a substantial improvement in mean arthritis pain (29.9 points), fatigue (2.4 points), Health Assessment Questionnaire-Disability Index (0.43 points), and Physical Component Summary score (9.1 points), with improvements sustained till week 152. High proportions of patients achieved the Patient Acceptable Symptom State at weeks 48 (75.2%) and 152 (65.0%). Thus, inhibitors of IL-23 and IL-17 have established efficacy in the treatment of PsA.

Biomechanical stress and trauma are important factors driving the development and progression of psoriatic arthritis (PsA). On the other hand, physical exercise is beneficial for patients with arthritis. However, there is concern that high-intensity interval training (HIIT) may worsen PsA. Hypothesizing that bone marrow edema changes could occur in patients with PsA after HIIT despite no reported changes in disease activity by clinical examination, Chronaiou and colleagues aimed to assess whether HIIT in PsA patients led to MRI-detectable changes in the axial skeleton. Comparing 19 PsA patients who went through 11 weeks of HIIT with 20 patients who had no change in physical exercise habits, they found no significant changes in bone marrow edema on MRI images of the spine after HIIT. Thus, the 11-week HIIT regimen may be safe in PsA.

Mental health problems are often underestimated in psoriatic disease. Lada and colleagues aimed to estimate the prevalence of depression in patients with psoriatic disease and determine whether PsA is associated with higher depression and anxiety in patients with psoriasis. Analyzing data from British Association of Dermatologists Biologic and Immunomodulators Register (BADBIR) participants (540 with psoriasis and 167 with both psoriasis and PsA) who had completed the Hospital Anxiety and Depression Scale (HADS), they found that the prevalence of depression was higher in patients with PsA (32%) than in patients without PsA (22.7%) using a HADS cutoff of 8 (odds ratio 1.66; 95% CI 1.13--2.43). Pain mediated the effect of PsA on depression and anxiety.

Inhibitors of interleukin (IL)-23 are safe and efficacious in the treatment of psoriasis and PsA. However, changes in composite PsA indices have not been investigated in detail. Using pooled data from the phase 3 DISCOVER-1 (n = 381) and DISCOVER-2 (n = 739) studies, Coates and colleagues demonstrated that a significantly higher proportion of patients receiving guselkumab every 4 or 8 weeks vs placebo achieved low disease activity according to the Disease Activity Index for PsA (DAPSA) at week 8 (19.8%/17.3% vs 8.1%), DAPSA remission at week 12 (4.3%/4.3% vs 0.5%), minimal disease activity at week 16 (14.7%/16.5% vs 4.6%; all P < .001), and very low disease activity at week 24 (6.4%/4.3% vs 1.3%; P < .05), with improvements maintained until week 52. Thus, compared with placebo, treatment with guselkumab leads to early and sustained benefits for patients with PsA.

Similarly, Ostor and colleagues demonstrated in the phase 3 KEEPsAKE2 trial, which included 443 patients with PsA, that, at week 24, patients receiving risankizumab report a significantly greater improvement in the mean pain index score (-14.7 vs -6.5; P < .001), fatigue score (4.9 vs 2.6; P < .01), patient's global assessment of disease activity (-16.5 vs -7.7; P < .001), general health status (0.09 vs 0.01; P < .001), and physical functioning (5.1 vs 2.0; P < .001) compared with placebo.

In another study, treatment with bimekizumab, an inhibitor of IL-17A and IL-17F, was associated with sustained improvement in patient-reported outcomes. Mease and colleagues report that, at week 48, there was a substantial improvement in mean arthritis pain (29.9 points), fatigue (2.4 points), Health Assessment Questionnaire-Disability Index (0.43 points), and Physical Component Summary score (9.1 points), with improvements sustained till week 152. High proportions of patients achieved the Patient Acceptable Symptom State at weeks 48 (75.2%) and 152 (65.0%). Thus, inhibitors of IL-23 and IL-17 have established efficacy in the treatment of PsA.

Biomechanical stress and trauma are important factors driving the development and progression of psoriatic arthritis (PsA). On the other hand, physical exercise is beneficial for patients with arthritis. However, there is concern that high-intensity interval training (HIIT) may worsen PsA. Hypothesizing that bone marrow edema changes could occur in patients with PsA after HIIT despite no reported changes in disease activity by clinical examination, Chronaiou and colleagues aimed to assess whether HIIT in PsA patients led to MRI-detectable changes in the axial skeleton. Comparing 19 PsA patients who went through 11 weeks of HIIT with 20 patients who had no change in physical exercise habits, they found no significant changes in bone marrow edema on MRI images of the spine after HIIT. Thus, the 11-week HIIT regimen may be safe in PsA.

Mental health problems are often underestimated in psoriatic disease. Lada and colleagues aimed to estimate the prevalence of depression in patients with psoriatic disease and determine whether PsA is associated with higher depression and anxiety in patients with psoriasis. Analyzing data from British Association of Dermatologists Biologic and Immunomodulators Register (BADBIR) participants (540 with psoriasis and 167 with both psoriasis and PsA) who had completed the Hospital Anxiety and Depression Scale (HADS), they found that the prevalence of depression was higher in patients with PsA (32%) than in patients without PsA (22.7%) using a HADS cutoff of 8 (odds ratio 1.66; 95% CI 1.13--2.43). Pain mediated the effect of PsA on depression and anxiety.

Inhibitors of interleukin (IL)-23 are safe and efficacious in the treatment of psoriasis and PsA. However, changes in composite PsA indices have not been investigated in detail. Using pooled data from the phase 3 DISCOVER-1 (n = 381) and DISCOVER-2 (n = 739) studies, Coates and colleagues demonstrated that a significantly higher proportion of patients receiving guselkumab every 4 or 8 weeks vs placebo achieved low disease activity according to the Disease Activity Index for PsA (DAPSA) at week 8 (19.8%/17.3% vs 8.1%), DAPSA remission at week 12 (4.3%/4.3% vs 0.5%), minimal disease activity at week 16 (14.7%/16.5% vs 4.6%; all P < .001), and very low disease activity at week 24 (6.4%/4.3% vs 1.3%; P < .05), with improvements maintained until week 52. Thus, compared with placebo, treatment with guselkumab leads to early and sustained benefits for patients with PsA.

Similarly, Ostor and colleagues demonstrated in the phase 3 KEEPsAKE2 trial, which included 443 patients with PsA, that, at week 24, patients receiving risankizumab report a significantly greater improvement in the mean pain index score (-14.7 vs -6.5; P < .001), fatigue score (4.9 vs 2.6; P < .01), patient's global assessment of disease activity (-16.5 vs -7.7; P < .001), general health status (0.09 vs 0.01; P < .001), and physical functioning (5.1 vs 2.0; P < .001) compared with placebo.

In another study, treatment with bimekizumab, an inhibitor of IL-17A and IL-17F, was associated with sustained improvement in patient-reported outcomes. Mease and colleagues report that, at week 48, there was a substantial improvement in mean arthritis pain (29.9 points), fatigue (2.4 points), Health Assessment Questionnaire-Disability Index (0.43 points), and Physical Component Summary score (9.1 points), with improvements sustained till week 152. High proportions of patients achieved the Patient Acceptable Symptom State at weeks 48 (75.2%) and 152 (65.0%). Thus, inhibitors of IL-23 and IL-17 have established efficacy in the treatment of PsA.

Key clinical point: Compared with the open gastrectomy, laparoscopic gastrectomy is associated with less intraoperative blood loss, shorter hospitalization time, and early postoperative exhaust in patients with gastric cancer.

Major finding: Patients in the laparoscopic vs open gastrectomy group had less intraoperative bleeding (standardized mean difference [SMD] −1.11; P  =  .0006), early postoperative exhaust (SMD −0.45; P  =  .0004), first postoperative feeding (SMD −0.45; P  =  .0004), and shorter postoperative hospital stay (SMD­ −0.97; P  =  .008), but had a longer operation time (SMD­ 0.65; P < .00001). There was no significant difference in the number of lymph nodes dissected (P  =  .45) and the incidence of complications after 30 days of surgery (P  =  .23) between the 2 groups.

Study details: These results are from a meta-analysis 11 studies including 1027 patients with gastric cancer who underwent laparoscopic or open gastrectomy.

Disclosures: This study was supported by Key Clinical Subject construction Program of Chongqing Medical University, China. The authors declared no conflicts of interest.

Source: Huang K et al. Effects of laparoscopic versus open surgery for advanced gastric cancer after neoadjuvant chemotherapy: A meta-analysis. J Healthc Eng. 2022;3255403 (Jun 18). Doi: 10.1155/2022/3255403

Key clinical point: Compared with the open gastrectomy, laparoscopic gastrectomy is associated with less intraoperative blood loss, shorter hospitalization time, and early postoperative exhaust in patients with gastric cancer.

Major finding: Patients in the laparoscopic vs open gastrectomy group had less intraoperative bleeding (standardized mean difference [SMD] −1.11; P  =  .0006), early postoperative exhaust (SMD −0.45; P  =  .0004), first postoperative feeding (SMD −0.45; P  =  .0004), and shorter postoperative hospital stay (SMD­ −0.97; P  =  .008), but had a longer operation time (SMD­ 0.65; P < .00001). There was no significant difference in the number of lymph nodes dissected (P  =  .45) and the incidence of complications after 30 days of surgery (P  =  .23) between the 2 groups.

Study details: These results are from a meta-analysis 11 studies including 1027 patients with gastric cancer who underwent laparoscopic or open gastrectomy.

Disclosures: This study was supported by Key Clinical Subject construction Program of Chongqing Medical University, China. The authors declared no conflicts of interest.

Source: Huang K et al. Effects of laparoscopic versus open surgery for advanced gastric cancer after neoadjuvant chemotherapy: A meta-analysis. J Healthc Eng. 2022;3255403 (Jun 18). Doi: 10.1155/2022/3255403

Key clinical point: Compared with the open gastrectomy, laparoscopic gastrectomy is associated with less intraoperative blood loss, shorter hospitalization time, and early postoperative exhaust in patients with gastric cancer.

Major finding: Patients in the laparoscopic vs open gastrectomy group had less intraoperative bleeding (standardized mean difference [SMD] −1.11; P  =  .0006), early postoperative exhaust (SMD −0.45; P  =  .0004), first postoperative feeding (SMD −0.45; P  =  .0004), and shorter postoperative hospital stay (SMD­ −0.97; P  =  .008), but had a longer operation time (SMD­ 0.65; P < .00001). There was no significant difference in the number of lymph nodes dissected (P  =  .45) and the incidence of complications after 30 days of surgery (P  =  .23) between the 2 groups.

Study details: These results are from a meta-analysis 11 studies including 1027 patients with gastric cancer who underwent laparoscopic or open gastrectomy.

Disclosures: This study was supported by Key Clinical Subject construction Program of Chongqing Medical University, China. The authors declared no conflicts of interest.

Source: Huang K et al. Effects of laparoscopic versus open surgery for advanced gastric cancer after neoadjuvant chemotherapy: A meta-analysis. J Healthc Eng. 2022;3255403 (Jun 18). Doi: 10.1155/2022/3255403

Key clinical point: In patients with advanced gastric cancer, surgical vs nonsurgical palliation is associated with a significantly shorter overall survival (OS) and a significantly higher hazard of mortality.

Major finding: The use of surgical palliation declined significantly during 2004-2015 (P < .0001). The median OS was significantly longer in patients who received nonsurgical vs surgical palliation (6.0 vs 3.6 months; P < .001). Surgical vs nonsurgical palliation was associated with a significantly higher risk for mortality (adjusted hazard ratio 1.20; P < .001).

Study details: A retrospective study of 6829 patients with clinical stage IV gastric cancer from the National Cancer Database (2004-2015) who received surgical or nonsurgical palliation.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Nohria A et al. Outcomes after surgical palliation of patients with gastric cancer. J Surg Res. 2022;279:304-311 (Jul 6). Doi: 10.1016/j.jss.2022.06.018

Key clinical point: In patients with advanced gastric cancer, surgical vs nonsurgical palliation is associated with a significantly shorter overall survival (OS) and a significantly higher hazard of mortality.

Major finding: The use of surgical palliation declined significantly during 2004-2015 (P < .0001). The median OS was significantly longer in patients who received nonsurgical vs surgical palliation (6.0 vs 3.6 months; P < .001). Surgical vs nonsurgical palliation was associated with a significantly higher risk for mortality (adjusted hazard ratio 1.20; P < .001).

Study details: A retrospective study of 6829 patients with clinical stage IV gastric cancer from the National Cancer Database (2004-2015) who received surgical or nonsurgical palliation.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Nohria A et al. Outcomes after surgical palliation of patients with gastric cancer. J Surg Res. 2022;279:304-311 (Jul 6). Doi: 10.1016/j.jss.2022.06.018

Key clinical point: In patients with advanced gastric cancer, surgical vs nonsurgical palliation is associated with a significantly shorter overall survival (OS) and a significantly higher hazard of mortality.

Major finding: The use of surgical palliation declined significantly during 2004-2015 (P < .0001). The median OS was significantly longer in patients who received nonsurgical vs surgical palliation (6.0 vs 3.6 months; P < .001). Surgical vs nonsurgical palliation was associated with a significantly higher risk for mortality (adjusted hazard ratio 1.20; P < .001).

Study details: A retrospective study of 6829 patients with clinical stage IV gastric cancer from the National Cancer Database (2004-2015) who received surgical or nonsurgical palliation.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Nohria A et al. Outcomes after surgical palliation of patients with gastric cancer. J Surg Res. 2022;279:304-311 (Jul 6). Doi: 10.1016/j.jss.2022.06.018

Key clinical point: Mediterranean diet is associated with a lower risk of developing gastric cancer.

Major finding: The Mediterranean dietary pattern, which includes a diet rich in fresh fruits, vegetables, milk, yogurt, lentils, and olive oil, was associated with a significantly lower risk for gastric cancer in the third (adjusted odds ratio [aOR] 0.394; 95% CI 0.211-0.736) and fourth (aOR 0.212; 95% CI 0.107-0.419) quartiles. The Prudent, Unhealthy, and High-fruit diets did not show any association with the risk for gastric cancer.

Study details: A case-control study of 172 patients with incident gastric cancer and 314 controls. Four dietary patterns were identified and analyzed: Mediterranean, Prudent, Unhealthy, and High-fruit dietary patterns.

Disclosures: This study was funded by Hashemite University, Jordan. The authors declared no competing interests.

Source: Tayyem R et al. Mediterranean dietary pattern is associated with lower odds of gastric cancer: A case–control study. Cancer Manag Res. 2022;14:2017-2029 (Jun 17). Doi: 10.2147/CMAR.S360468

Key clinical point: Mediterranean diet is associated with a lower risk of developing gastric cancer.

Major finding: The Mediterranean dietary pattern, which includes a diet rich in fresh fruits, vegetables, milk, yogurt, lentils, and olive oil, was associated with a significantly lower risk for gastric cancer in the third (adjusted odds ratio [aOR] 0.394; 95% CI 0.211-0.736) and fourth (aOR 0.212; 95% CI 0.107-0.419) quartiles. The Prudent, Unhealthy, and High-fruit diets did not show any association with the risk for gastric cancer.

Study details: A case-control study of 172 patients with incident gastric cancer and 314 controls. Four dietary patterns were identified and analyzed: Mediterranean, Prudent, Unhealthy, and High-fruit dietary patterns.

Disclosures: This study was funded by Hashemite University, Jordan. The authors declared no competing interests.

Source: Tayyem R et al. Mediterranean dietary pattern is associated with lower odds of gastric cancer: A case–control study. Cancer Manag Res. 2022;14:2017-2029 (Jun 17). Doi: 10.2147/CMAR.S360468

Key clinical point: Mediterranean diet is associated with a lower risk of developing gastric cancer.

Major finding: The Mediterranean dietary pattern, which includes a diet rich in fresh fruits, vegetables, milk, yogurt, lentils, and olive oil, was associated with a significantly lower risk for gastric cancer in the third (adjusted odds ratio [aOR] 0.394; 95% CI 0.211-0.736) and fourth (aOR 0.212; 95% CI 0.107-0.419) quartiles. The Prudent, Unhealthy, and High-fruit diets did not show any association with the risk for gastric cancer.

Study details: A case-control study of 172 patients with incident gastric cancer and 314 controls. Four dietary patterns were identified and analyzed: Mediterranean, Prudent, Unhealthy, and High-fruit dietary patterns.

Disclosures: This study was funded by Hashemite University, Jordan. The authors declared no competing interests.

Source: Tayyem R et al. Mediterranean dietary pattern is associated with lower odds of gastric cancer: A case–control study. Cancer Manag Res. 2022;14:2017-2029 (Jun 17). Doi: 10.2147/CMAR.S360468

Key clinical point: Dietary iron shows an inverse association with the risk for gastric cancer irrespective of cancer subsite and histological type.

Major finding: Dietary iron intake was inversely associated with the risk for gastric cancer (per quartile odds ratio [OR] 0.88; 95% CI 0.83-0.93). The association (per quartile) was significant for cardia (OR 0.85; 95% CI 0.77-0.94) and noncardia (OR 0.87; 95% CI 0.81-0.94) gastric cancer and diffuse (OR,0.79; 95% CI 0.69-0.89) and intestinal (OR 0.88; 95% CI 0.79-0.98) type.

Study details: An analysis of pooled data from 11 case-control studies including 4658 participants with gastric cancer and 12,247 control participants from the Stomach Cancer Pooling Project.

Disclosures: This study was supported by AIRC Foundation for Cancer Research, Italy. The authors declared no conflicts of interest.

Source: Collatuzzo G et al. Inverse association between dietary iron intake and gastric cancer: A pooled analysis of case-control studies of the stop consortium. Nutrients. 2022;14(12):2555 (Jun 20). Doi: 10.3390/nu14122555

Key clinical point: Dietary iron shows an inverse association with the risk for gastric cancer irrespective of cancer subsite and histological type.

Major finding: Dietary iron intake was inversely associated with the risk for gastric cancer (per quartile odds ratio [OR] 0.88; 95% CI 0.83-0.93). The association (per quartile) was significant for cardia (OR 0.85; 95% CI 0.77-0.94) and noncardia (OR 0.87; 95% CI 0.81-0.94) gastric cancer and diffuse (OR,0.79; 95% CI 0.69-0.89) and intestinal (OR 0.88; 95% CI 0.79-0.98) type.

Study details: An analysis of pooled data from 11 case-control studies including 4658 participants with gastric cancer and 12,247 control participants from the Stomach Cancer Pooling Project.

Disclosures: This study was supported by AIRC Foundation for Cancer Research, Italy. The authors declared no conflicts of interest.

Source: Collatuzzo G et al. Inverse association between dietary iron intake and gastric cancer: A pooled analysis of case-control studies of the stop consortium. Nutrients. 2022;14(12):2555 (Jun 20). Doi: 10.3390/nu14122555

Key clinical point: Dietary iron shows an inverse association with the risk for gastric cancer irrespective of cancer subsite and histological type.

Major finding: Dietary iron intake was inversely associated with the risk for gastric cancer (per quartile odds ratio [OR] 0.88; 95% CI 0.83-0.93). The association (per quartile) was significant for cardia (OR 0.85; 95% CI 0.77-0.94) and noncardia (OR 0.87; 95% CI 0.81-0.94) gastric cancer and diffuse (OR,0.79; 95% CI 0.69-0.89) and intestinal (OR 0.88; 95% CI 0.79-0.98) type.

Study details: An analysis of pooled data from 11 case-control studies including 4658 participants with gastric cancer and 12,247 control participants from the Stomach Cancer Pooling Project.

Disclosures: This study was supported by AIRC Foundation for Cancer Research, Italy. The authors declared no conflicts of interest.

Source: Collatuzzo G et al. Inverse association between dietary iron intake and gastric cancer: A pooled analysis of case-control studies of the stop consortium. Nutrients. 2022;14(12):2555 (Jun 20). Doi: 10.3390/nu14122555

Key clinical point: Cisplatin and oxaliplatin are both suitable as a part of the systemic therapy for resectable gastric cancer.

Major finding: Patients receiving epirubicin+cisplatin+capecitabine (ECX) and those receiving epirubicin+oxaliplatin+capecitabine (EOX) had comparable 5-year overall survival (42% vs 47%; P  =  .303), preoperative (67% vs 60%; P  =  .105) and postoperative (60% vs 51%; P  =  .266) severe (grades 3-5) toxicity, and complete or near-complete pathological response (21% vs 15%; P  =  .126) rates.

Study details: This post hoc analysis included 781 adult patients with resectable gastric cancer from the CRITICS trial who received preoperative ECX (n = 632) or EOX (n = 149), of which 636 and 233 received potentially curative surgery and postoperative chemotherapy, respectively.

Disclosures: The CRITICS trial was sponsored by the Dutch Cancer Society, Dutch Colorectal Cancer Group, and Hoffmann-La Roche; this analysis required no additional funding. The authors declared no conflicts of interest.

Source: Slagter AE et al. Triplet chemotherapy with cisplatin versus oxaliplatin in the CRITICS trial: Treatment compliance, toxicity, outcomes and quality of life in patients with resectable gastric cancer. Cancers (Basel). 2022;14(12):2963 (Jun 15). Doi: 10.3390/cancers14122963

Key clinical point: Cisplatin and oxaliplatin are both suitable as a part of the systemic therapy for resectable gastric cancer.

Major finding: Patients receiving epirubicin+cisplatin+capecitabine (ECX) and those receiving epirubicin+oxaliplatin+capecitabine (EOX) had comparable 5-year overall survival (42% vs 47%; P  =  .303), preoperative (67% vs 60%; P  =  .105) and postoperative (60% vs 51%; P  =  .266) severe (grades 3-5) toxicity, and complete or near-complete pathological response (21% vs 15%; P  =  .126) rates.

Study details: This post hoc analysis included 781 adult patients with resectable gastric cancer from the CRITICS trial who received preoperative ECX (n = 632) or EOX (n = 149), of which 636 and 233 received potentially curative surgery and postoperative chemotherapy, respectively.

Disclosures: The CRITICS trial was sponsored by the Dutch Cancer Society, Dutch Colorectal Cancer Group, and Hoffmann-La Roche; this analysis required no additional funding. The authors declared no conflicts of interest.

Source: Slagter AE et al. Triplet chemotherapy with cisplatin versus oxaliplatin in the CRITICS trial: Treatment compliance, toxicity, outcomes and quality of life in patients with resectable gastric cancer. Cancers (Basel). 2022;14(12):2963 (Jun 15). Doi: 10.3390/cancers14122963

Key clinical point: Cisplatin and oxaliplatin are both suitable as a part of the systemic therapy for resectable gastric cancer.

Major finding: Patients receiving epirubicin+cisplatin+capecitabine (ECX) and those receiving epirubicin+oxaliplatin+capecitabine (EOX) had comparable 5-year overall survival (42% vs 47%; P  =  .303), preoperative (67% vs 60%; P  =  .105) and postoperative (60% vs 51%; P  =  .266) severe (grades 3-5) toxicity, and complete or near-complete pathological response (21% vs 15%; P  =  .126) rates.

Study details: This post hoc analysis included 781 adult patients with resectable gastric cancer from the CRITICS trial who received preoperative ECX (n = 632) or EOX (n = 149), of which 636 and 233 received potentially curative surgery and postoperative chemotherapy, respectively.

Disclosures: The CRITICS trial was sponsored by the Dutch Cancer Society, Dutch Colorectal Cancer Group, and Hoffmann-La Roche; this analysis required no additional funding. The authors declared no conflicts of interest.

Source: Slagter AE et al. Triplet chemotherapy with cisplatin versus oxaliplatin in the CRITICS trial: Treatment compliance, toxicity, outcomes and quality of life in patients with resectable gastric cancer. Cancers (Basel). 2022;14(12):2963 (Jun 15). Doi: 10.3390/cancers14122963

Key clinical point: In patients with locally advanced gastric cancer (LAGC), neoadjuvant chemotherapy (NACT) followed by laparoscopic gastrectomy (LG) vs upfront LG is associated with a lower rate of severe postoperative complications and improved survival.

Major finding: Grade ≥ 3 severe postoperative complication rate was significantly lower in the NACT-LG vs upfront LG group (0% vs 17.1%; P  =  .001). The postoperative complication-related death rate was 0% in the NACT-LG group vs 2.9% in the upfront LG group. NACT-LG vs upfront LG was associated with improved disease-free survival (14.4% vs 5.7%; P  =  .0299) and overall survival (34.1% vs 8.6%; P  =  .0061) at 3 years.

Study details: This was a retrospective study of 76 consecutive patients with LAGC who received either LG following NACT or upfront LG between March 2013 and October 2018.

Disclosures: This study did not receive any funding. The authors declare no competing interests.

Source: Liu L et al. The safety and efficacy of laparoscopic gastrectomy for patients with locally advanced gastric cancer following neoadjuvant chemotherapy. Sci Rep. 2022;12:10384 (Jun 20). Doi: 10.1038/s41598-022-14717-6

Key clinical point: In patients with locally advanced gastric cancer (LAGC), neoadjuvant chemotherapy (NACT) followed by laparoscopic gastrectomy (LG) vs upfront LG is associated with a lower rate of severe postoperative complications and improved survival.

Major finding: Grade ≥ 3 severe postoperative complication rate was significantly lower in the NACT-LG vs upfront LG group (0% vs 17.1%; P  =  .001). The postoperative complication-related death rate was 0% in the NACT-LG group vs 2.9% in the upfront LG group. NACT-LG vs upfront LG was associated with improved disease-free survival (14.4% vs 5.7%; P  =  .0299) and overall survival (34.1% vs 8.6%; P  =  .0061) at 3 years.

Study details: This was a retrospective study of 76 consecutive patients with LAGC who received either LG following NACT or upfront LG between March 2013 and October 2018.

Disclosures: This study did not receive any funding. The authors declare no competing interests.

Source: Liu L et al. The safety and efficacy of laparoscopic gastrectomy for patients with locally advanced gastric cancer following neoadjuvant chemotherapy. Sci Rep. 2022;12:10384 (Jun 20). Doi: 10.1038/s41598-022-14717-6

Key clinical point: In patients with locally advanced gastric cancer (LAGC), neoadjuvant chemotherapy (NACT) followed by laparoscopic gastrectomy (LG) vs upfront LG is associated with a lower rate of severe postoperative complications and improved survival.

Major finding: Grade ≥ 3 severe postoperative complication rate was significantly lower in the NACT-LG vs upfront LG group (0% vs 17.1%; P  =  .001). The postoperative complication-related death rate was 0% in the NACT-LG group vs 2.9% in the upfront LG group. NACT-LG vs upfront LG was associated with improved disease-free survival (14.4% vs 5.7%; P  =  .0299) and overall survival (34.1% vs 8.6%; P  =  .0061) at 3 years.

Study details: This was a retrospective study of 76 consecutive patients with LAGC who received either LG following NACT or upfront LG between March 2013 and October 2018.

Disclosures: This study did not receive any funding. The authors declare no competing interests.

Source: Liu L et al. The safety and efficacy of laparoscopic gastrectomy for patients with locally advanced gastric cancer following neoadjuvant chemotherapy. Sci Rep. 2022;12:10384 (Jun 20). Doi: 10.1038/s41598-022-14717-6

Key clinical point: Low body mass index (BMI) increased the risk for gastric cancer in men and women, whereas high fasting glucose levels slightly increased the risk in women but not in men.

Major finding: Low BMI (<18.5 kg/m²) increased the risk for gastric cancer in both men (adjusted odds ratio [aOR] 1.39; P < .001) and women (aOR 1.48; P < .001). High fasting glucose levels (≥126 mg/dL) slightly elevated gastric cancer risk in women (aOR 1.19; P < .001) but not in men.

Study details: This prospective, population-based cohort study included 5174 million individuals (men, 43.1%) who underwent national gastric cancer screening and were followed up for 9 years.

Disclosures: This study was funded by the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea; and others. The authors declared no conflicts of interest.

Source: Nam SY et al. Sex-specific effect of body mass index and fasting glucose on gastric cancer risk and all causes mortality; a cohort study of 5.17 million. Int J Obes. 2022 (Jun 10). Doi: 10.1038/s41366-022-01161-9

Key clinical point: Low body mass index (BMI) increased the risk for gastric cancer in men and women, whereas high fasting glucose levels slightly increased the risk in women but not in men.

Major finding: Low BMI (<18.5 kg/m²) increased the risk for gastric cancer in both men (adjusted odds ratio [aOR] 1.39; P < .001) and women (aOR 1.48; P < .001). High fasting glucose levels (≥126 mg/dL) slightly elevated gastric cancer risk in women (aOR 1.19; P < .001) but not in men.

Study details: This prospective, population-based cohort study included 5174 million individuals (men, 43.1%) who underwent national gastric cancer screening and were followed up for 9 years.

Disclosures: This study was funded by the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea; and others. The authors declared no conflicts of interest.

Source: Nam SY et al. Sex-specific effect of body mass index and fasting glucose on gastric cancer risk and all causes mortality; a cohort study of 5.17 million. Int J Obes. 2022 (Jun 10). Doi: 10.1038/s41366-022-01161-9

Key clinical point: Low body mass index (BMI) increased the risk for gastric cancer in men and women, whereas high fasting glucose levels slightly increased the risk in women but not in men.

Major finding: Low BMI (<18.5 kg/m²) increased the risk for gastric cancer in both men (adjusted odds ratio [aOR] 1.39; P < .001) and women (aOR 1.48; P < .001). High fasting glucose levels (≥126 mg/dL) slightly elevated gastric cancer risk in women (aOR 1.19; P < .001) but not in men.

Study details: This prospective, population-based cohort study included 5174 million individuals (men, 43.1%) who underwent national gastric cancer screening and were followed up for 9 years.

Disclosures: This study was funded by the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea; and others. The authors declared no conflicts of interest.

Source: Nam SY et al. Sex-specific effect of body mass index and fasting glucose on gastric cancer risk and all causes mortality; a cohort study of 5.17 million. Int J Obes. 2022 (Jun 10). Doi: 10.1038/s41366-022-01161-9