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Severity of diabetes tied to lung cancer prognosis
Key clinical point: Patients with squamous cell lung carcinoma (SqCLC) and moderate-to-severe diabetes may have a higher risk for all-cause mortality than those with SqCLC and mild diabetes.
Major finding: Patients with SqCLC and moderate to severe diabetes had a 17% higher risk for all-cause death than those with SqCLC and mild diabetes (adjusted hazard ratio 1.17; P = .0005).
Study details: The data come from a retrospective cohort study including patients with both SqCLC and diabetes (n = 5742) from the Taiwan Cancer Registry database.
Disclosures: The study was funded by grants from Lo-Hsu Medical Foundation, LotungPoh-Ai Hospital, and Fu Jen Catholic University. The authors declared no conflicts of interest.
Source: Su C-H et al. Association of diabetes severity and mortality with lung squamous cell carcinoma. Cancers (Basel). 2022;14(10):2553 (May 22). Doi: 10.3390/cancers14102553
Key clinical point: Patients with squamous cell lung carcinoma (SqCLC) and moderate-to-severe diabetes may have a higher risk for all-cause mortality than those with SqCLC and mild diabetes.
Major finding: Patients with SqCLC and moderate to severe diabetes had a 17% higher risk for all-cause death than those with SqCLC and mild diabetes (adjusted hazard ratio 1.17; P = .0005).
Study details: The data come from a retrospective cohort study including patients with both SqCLC and diabetes (n = 5742) from the Taiwan Cancer Registry database.
Disclosures: The study was funded by grants from Lo-Hsu Medical Foundation, LotungPoh-Ai Hospital, and Fu Jen Catholic University. The authors declared no conflicts of interest.
Source: Su C-H et al. Association of diabetes severity and mortality with lung squamous cell carcinoma. Cancers (Basel). 2022;14(10):2553 (May 22). Doi: 10.3390/cancers14102553
Key clinical point: Patients with squamous cell lung carcinoma (SqCLC) and moderate-to-severe diabetes may have a higher risk for all-cause mortality than those with SqCLC and mild diabetes.
Major finding: Patients with SqCLC and moderate to severe diabetes had a 17% higher risk for all-cause death than those with SqCLC and mild diabetes (adjusted hazard ratio 1.17; P = .0005).
Study details: The data come from a retrospective cohort study including patients with both SqCLC and diabetes (n = 5742) from the Taiwan Cancer Registry database.
Disclosures: The study was funded by grants from Lo-Hsu Medical Foundation, LotungPoh-Ai Hospital, and Fu Jen Catholic University. The authors declared no conflicts of interest.
Source: Su C-H et al. Association of diabetes severity and mortality with lung squamous cell carcinoma. Cancers (Basel). 2022;14(10):2553 (May 22). Doi: 10.3390/cancers14102553
Advance directives for psychiatric care reduce compulsory admissions
, new research shows.
Results of a randomized trial showed the peer worker PAD group had a 42% reduction in compulsory admission over the following 12 months. This study group also had lower symptom scores, greater rates of recovery, and increased empowerment, compared with patients assigned to usual care.
In addition to proving that PADs are effective in reducing compulsory admission, the results show that facilitation by peer workers is relevant, study investigator Aurélie Tinland, MD, PhD, Faculté de Médecine Timone, Aix-Marseille University, Marseille, France, told delegates attending the virtual European Psychiatric Association (EPA) 2022 Congress. The study was simultaneously published online in JAMA Psychiatry.
However, Dr. Tinland noted that more research that includes “harder to reach” populations is needed. In addition, greater use of PADs is also key to reducing compulsory admissions.
‘Most coercive’ country
The researchers note that respect for patient autonomy is a strong pillar of health care, such that “involuntary treatment should be unusual.” However, they point out that “compulsory psychiatric admissions are far too common in countries of all income levels.”
In France, said Dr. Tinland, 24% of psychiatric hospitalizations are compulsory. The country is ranked the sixth “most coercive” country in the world, and there are concerns about human rights in French psychiatric facilities.
She added that advance care statements are the most efficient tool for reducing coercion, with one study suggesting they could cut rates by 25%, compared with usual care.
However, she noted there is an “asymmetry” between medical professionals and patients and a risk of “undue influence” when clinicians facilitate the completion of care statements.
To examine the impact on clinical outcomes of peer-worker facilitated PADs, the researchers studied adults with a diagnosis of schizophrenia, bipolar I disorder, or schizoaffective disorder who were admitted to a psychiatric hospital within the previous 12 months. Peer workers are individuals who have lived experience with mental illness and help inform and guide current patients about care options in the event of a mental health crisis.
Study participants were randomly assigned 1:1 to an intervention group or a usual care control group. The intervention group received a PAD document and were assigned a peer worker while the usual care group received comprehensive information about the PAD concept at study entry and were free to complete it, but they were not connected with a peer worker.
The PAD document included information about future treatment and support preferences, early signs of relapse, and coping strategies. Participants could meet the peer worker in a place of their choice and be supported in drafting the document and in sharing it with health care professionals.
In all, 394 individuals completed the study. The majority (61%) of participants were male and 66% had completed post-secondary education. Schizophrenia was diagnosed in 45%, bipolar I disorder in 36%, and schizoaffective disorder in 19%.
Participants in the intervention group were significantly younger than those in the control group, with a mean of 37.4 years versus 41 years (P = .003) and were less likely to have one or more somatic comorbidities, at 61.2% versus 69.2%.
A PAD was completed by 54.6% of individuals in the intervention group versus 7.1% of controls (P < .001). The PAD was written with peer worker support by 41.3% of those in the intervention and by 2% of controls. Of those who completed a PAD, 75.7% met care facilitators, and 27.1% used it during a crisis over the following 12 months.
Results showed that the rate of compulsory admissions was significantly lower in the peer worker PAD group, at 27% versus 39.9% in control participants, at an odds ratio of 0.58 (P = .007).
Participants in the intervention group had lower symptoms on the modified Colorado Symptom Score than usual care patients with an effect size of -0.20 (P = .03) and higher scores on the Empowerment Scale (effect size 0.30, P = .003).
Scores on the Recovery Assessment Scale were also significantly higher in the peer worker PAD group versus controls with an effect size of 0.44 (P < .001). There were no significant differences, however, in overall admission rates, the quality of the therapeutic alliance, or quality of life.
Putting patients in the driver’s seat
Commenting on the findings, Robert Dabney Jr., MA, MDiv, peer apprentice program manager at the Depression and Bipolar Support Alliance, Chicago, said the study “tells us there are many benefits to completing a psychiatric advance directive, but perhaps the most powerful one is putting the person receiving mental health care in the driver’s seat of their own recovery.”
However, he noted that “many people living with mental health conditions don’t know the option exists to decide on their treatment plan in advance of a crisis.”
“This is where peer support specialists can come in. Having a peer who has been through similar experiences and can guide you through the process is as comforting as it is empowering. I have witnessed and experienced firsthand the power of peer support,” he said.
“It’s my personal hope and the goal of the Depression and Bipolar Support Alliance to empower more people to either become peer support specialists or seek out peer support services, because we know it improves and even saves lives,” Mr. Dabney added.
Virginia A. Brown, PhD, department of psychiatry & behavioral sciences, University of Texas at Austin Dell Medical School, noted there are huge differences between the health care systems in France and the United States.
She explained that two of the greatest barriers to PADs in the United States is that until 2016, filling one out was not billable and that “practitioners don’t know anything about advanced care plans.”
Dr. Brown said her own work shows that individuals who support patients during a crisis believe it would be “really helpful if we had some kind of document that we could share with the health care system that says: ‘Hey, look, I’m the designated person to speak for this patient, they’ve identified me through a document.’ So, people were actually describing a need for this document but didn’t know that it existed.”
Another problem is that in the United States, hospitals operate in a “closed system” and cannot talk to an unrelated hospital or to the police department “to get information to those first responders during an emergency about who to talk to about their wishes and preferences.”
“There are a lot of hurdles that we’ve got to get over to make a more robust system that protects the autonomy of people who live with serious mental illness,” Dr. Brown said, as “losing capacity during a crisis is time-limited, and it requires us to respond to it as a medical emergency.”
The study was supported by an institutional grant from the French 2017 National Program of Health Services Research. The Clinical Research Direction of Assistance Publique Hôpitaux de Marseille sponsored the trial. Dr. Tinland declares grants from the French Ministry of Health Directorate General of Health Care Services during the conduct of the study.
A version of this article first appeared on Medscape.com.
, new research shows.
Results of a randomized trial showed the peer worker PAD group had a 42% reduction in compulsory admission over the following 12 months. This study group also had lower symptom scores, greater rates of recovery, and increased empowerment, compared with patients assigned to usual care.
In addition to proving that PADs are effective in reducing compulsory admission, the results show that facilitation by peer workers is relevant, study investigator Aurélie Tinland, MD, PhD, Faculté de Médecine Timone, Aix-Marseille University, Marseille, France, told delegates attending the virtual European Psychiatric Association (EPA) 2022 Congress. The study was simultaneously published online in JAMA Psychiatry.
However, Dr. Tinland noted that more research that includes “harder to reach” populations is needed. In addition, greater use of PADs is also key to reducing compulsory admissions.
‘Most coercive’ country
The researchers note that respect for patient autonomy is a strong pillar of health care, such that “involuntary treatment should be unusual.” However, they point out that “compulsory psychiatric admissions are far too common in countries of all income levels.”
In France, said Dr. Tinland, 24% of psychiatric hospitalizations are compulsory. The country is ranked the sixth “most coercive” country in the world, and there are concerns about human rights in French psychiatric facilities.
She added that advance care statements are the most efficient tool for reducing coercion, with one study suggesting they could cut rates by 25%, compared with usual care.
However, she noted there is an “asymmetry” between medical professionals and patients and a risk of “undue influence” when clinicians facilitate the completion of care statements.
To examine the impact on clinical outcomes of peer-worker facilitated PADs, the researchers studied adults with a diagnosis of schizophrenia, bipolar I disorder, or schizoaffective disorder who were admitted to a psychiatric hospital within the previous 12 months. Peer workers are individuals who have lived experience with mental illness and help inform and guide current patients about care options in the event of a mental health crisis.
Study participants were randomly assigned 1:1 to an intervention group or a usual care control group. The intervention group received a PAD document and were assigned a peer worker while the usual care group received comprehensive information about the PAD concept at study entry and were free to complete it, but they were not connected with a peer worker.
The PAD document included information about future treatment and support preferences, early signs of relapse, and coping strategies. Participants could meet the peer worker in a place of their choice and be supported in drafting the document and in sharing it with health care professionals.
In all, 394 individuals completed the study. The majority (61%) of participants were male and 66% had completed post-secondary education. Schizophrenia was diagnosed in 45%, bipolar I disorder in 36%, and schizoaffective disorder in 19%.
Participants in the intervention group were significantly younger than those in the control group, with a mean of 37.4 years versus 41 years (P = .003) and were less likely to have one or more somatic comorbidities, at 61.2% versus 69.2%.
A PAD was completed by 54.6% of individuals in the intervention group versus 7.1% of controls (P < .001). The PAD was written with peer worker support by 41.3% of those in the intervention and by 2% of controls. Of those who completed a PAD, 75.7% met care facilitators, and 27.1% used it during a crisis over the following 12 months.
Results showed that the rate of compulsory admissions was significantly lower in the peer worker PAD group, at 27% versus 39.9% in control participants, at an odds ratio of 0.58 (P = .007).
Participants in the intervention group had lower symptoms on the modified Colorado Symptom Score than usual care patients with an effect size of -0.20 (P = .03) and higher scores on the Empowerment Scale (effect size 0.30, P = .003).
Scores on the Recovery Assessment Scale were also significantly higher in the peer worker PAD group versus controls with an effect size of 0.44 (P < .001). There were no significant differences, however, in overall admission rates, the quality of the therapeutic alliance, or quality of life.
Putting patients in the driver’s seat
Commenting on the findings, Robert Dabney Jr., MA, MDiv, peer apprentice program manager at the Depression and Bipolar Support Alliance, Chicago, said the study “tells us there are many benefits to completing a psychiatric advance directive, but perhaps the most powerful one is putting the person receiving mental health care in the driver’s seat of their own recovery.”
However, he noted that “many people living with mental health conditions don’t know the option exists to decide on their treatment plan in advance of a crisis.”
“This is where peer support specialists can come in. Having a peer who has been through similar experiences and can guide you through the process is as comforting as it is empowering. I have witnessed and experienced firsthand the power of peer support,” he said.
“It’s my personal hope and the goal of the Depression and Bipolar Support Alliance to empower more people to either become peer support specialists or seek out peer support services, because we know it improves and even saves lives,” Mr. Dabney added.
Virginia A. Brown, PhD, department of psychiatry & behavioral sciences, University of Texas at Austin Dell Medical School, noted there are huge differences between the health care systems in France and the United States.
She explained that two of the greatest barriers to PADs in the United States is that until 2016, filling one out was not billable and that “practitioners don’t know anything about advanced care plans.”
Dr. Brown said her own work shows that individuals who support patients during a crisis believe it would be “really helpful if we had some kind of document that we could share with the health care system that says: ‘Hey, look, I’m the designated person to speak for this patient, they’ve identified me through a document.’ So, people were actually describing a need for this document but didn’t know that it existed.”
Another problem is that in the United States, hospitals operate in a “closed system” and cannot talk to an unrelated hospital or to the police department “to get information to those first responders during an emergency about who to talk to about their wishes and preferences.”
“There are a lot of hurdles that we’ve got to get over to make a more robust system that protects the autonomy of people who live with serious mental illness,” Dr. Brown said, as “losing capacity during a crisis is time-limited, and it requires us to respond to it as a medical emergency.”
The study was supported by an institutional grant from the French 2017 National Program of Health Services Research. The Clinical Research Direction of Assistance Publique Hôpitaux de Marseille sponsored the trial. Dr. Tinland declares grants from the French Ministry of Health Directorate General of Health Care Services during the conduct of the study.
A version of this article first appeared on Medscape.com.
, new research shows.
Results of a randomized trial showed the peer worker PAD group had a 42% reduction in compulsory admission over the following 12 months. This study group also had lower symptom scores, greater rates of recovery, and increased empowerment, compared with patients assigned to usual care.
In addition to proving that PADs are effective in reducing compulsory admission, the results show that facilitation by peer workers is relevant, study investigator Aurélie Tinland, MD, PhD, Faculté de Médecine Timone, Aix-Marseille University, Marseille, France, told delegates attending the virtual European Psychiatric Association (EPA) 2022 Congress. The study was simultaneously published online in JAMA Psychiatry.
However, Dr. Tinland noted that more research that includes “harder to reach” populations is needed. In addition, greater use of PADs is also key to reducing compulsory admissions.
‘Most coercive’ country
The researchers note that respect for patient autonomy is a strong pillar of health care, such that “involuntary treatment should be unusual.” However, they point out that “compulsory psychiatric admissions are far too common in countries of all income levels.”
In France, said Dr. Tinland, 24% of psychiatric hospitalizations are compulsory. The country is ranked the sixth “most coercive” country in the world, and there are concerns about human rights in French psychiatric facilities.
She added that advance care statements are the most efficient tool for reducing coercion, with one study suggesting they could cut rates by 25%, compared with usual care.
However, she noted there is an “asymmetry” between medical professionals and patients and a risk of “undue influence” when clinicians facilitate the completion of care statements.
To examine the impact on clinical outcomes of peer-worker facilitated PADs, the researchers studied adults with a diagnosis of schizophrenia, bipolar I disorder, or schizoaffective disorder who were admitted to a psychiatric hospital within the previous 12 months. Peer workers are individuals who have lived experience with mental illness and help inform and guide current patients about care options in the event of a mental health crisis.
Study participants were randomly assigned 1:1 to an intervention group or a usual care control group. The intervention group received a PAD document and were assigned a peer worker while the usual care group received comprehensive information about the PAD concept at study entry and were free to complete it, but they were not connected with a peer worker.
The PAD document included information about future treatment and support preferences, early signs of relapse, and coping strategies. Participants could meet the peer worker in a place of their choice and be supported in drafting the document and in sharing it with health care professionals.
In all, 394 individuals completed the study. The majority (61%) of participants were male and 66% had completed post-secondary education. Schizophrenia was diagnosed in 45%, bipolar I disorder in 36%, and schizoaffective disorder in 19%.
Participants in the intervention group were significantly younger than those in the control group, with a mean of 37.4 years versus 41 years (P = .003) and were less likely to have one or more somatic comorbidities, at 61.2% versus 69.2%.
A PAD was completed by 54.6% of individuals in the intervention group versus 7.1% of controls (P < .001). The PAD was written with peer worker support by 41.3% of those in the intervention and by 2% of controls. Of those who completed a PAD, 75.7% met care facilitators, and 27.1% used it during a crisis over the following 12 months.
Results showed that the rate of compulsory admissions was significantly lower in the peer worker PAD group, at 27% versus 39.9% in control participants, at an odds ratio of 0.58 (P = .007).
Participants in the intervention group had lower symptoms on the modified Colorado Symptom Score than usual care patients with an effect size of -0.20 (P = .03) and higher scores on the Empowerment Scale (effect size 0.30, P = .003).
Scores on the Recovery Assessment Scale were also significantly higher in the peer worker PAD group versus controls with an effect size of 0.44 (P < .001). There were no significant differences, however, in overall admission rates, the quality of the therapeutic alliance, or quality of life.
Putting patients in the driver’s seat
Commenting on the findings, Robert Dabney Jr., MA, MDiv, peer apprentice program manager at the Depression and Bipolar Support Alliance, Chicago, said the study “tells us there are many benefits to completing a psychiatric advance directive, but perhaps the most powerful one is putting the person receiving mental health care in the driver’s seat of their own recovery.”
However, he noted that “many people living with mental health conditions don’t know the option exists to decide on their treatment plan in advance of a crisis.”
“This is where peer support specialists can come in. Having a peer who has been through similar experiences and can guide you through the process is as comforting as it is empowering. I have witnessed and experienced firsthand the power of peer support,” he said.
“It’s my personal hope and the goal of the Depression and Bipolar Support Alliance to empower more people to either become peer support specialists or seek out peer support services, because we know it improves and even saves lives,” Mr. Dabney added.
Virginia A. Brown, PhD, department of psychiatry & behavioral sciences, University of Texas at Austin Dell Medical School, noted there are huge differences between the health care systems in France and the United States.
She explained that two of the greatest barriers to PADs in the United States is that until 2016, filling one out was not billable and that “practitioners don’t know anything about advanced care plans.”
Dr. Brown said her own work shows that individuals who support patients during a crisis believe it would be “really helpful if we had some kind of document that we could share with the health care system that says: ‘Hey, look, I’m the designated person to speak for this patient, they’ve identified me through a document.’ So, people were actually describing a need for this document but didn’t know that it existed.”
Another problem is that in the United States, hospitals operate in a “closed system” and cannot talk to an unrelated hospital or to the police department “to get information to those first responders during an emergency about who to talk to about their wishes and preferences.”
“There are a lot of hurdles that we’ve got to get over to make a more robust system that protects the autonomy of people who live with serious mental illness,” Dr. Brown said, as “losing capacity during a crisis is time-limited, and it requires us to respond to it as a medical emergency.”
The study was supported by an institutional grant from the French 2017 National Program of Health Services Research. The Clinical Research Direction of Assistance Publique Hôpitaux de Marseille sponsored the trial. Dr. Tinland declares grants from the French Ministry of Health Directorate General of Health Care Services during the conduct of the study.
A version of this article first appeared on Medscape.com.
FROM EPA 2022
Gastric cancer: Epstein-Barr virus and H. pylori coinfection is not prognostic
Key clinical point: Epstein-Barr virus (EBV) and Helicobacter pylori coinfection is not an independent prognostic factor for gastric cancer. EBV infection was associated with survival, but not in patients with non-gastric carcinoma with lymphoid stroma (non-GCLS).
Major finding: EBV infection alone (hazard ratio 0.362; P = .049) showed an inverse correlation with overall survival (OS). The 5-year OS rate was not significantly different between the EBV and H. pylori coinfection vs. other groups (97.6% vs. 86.8%; P = .144). In patients with non-GCLS, the OS rate was not significantly different between the EBV-positive vs. other groups (96.9% vs. 86.4%; P = .126).
Study details: This retrospective study included 956 patients with gastric cancer who underwent surgery between September 2014 and August 2015 and were subdivided into groups according to the GCLS morphology and EBV and H. pylori infection statuses.
Disclosures: No funding source was identified for this study. Dr. JY Ahn is an editorial board member of the journal. The other authors reported no conflicts of interest.
Source: Noh JH et al. Clinical significance of Epstein-Barr virus and Helicobacter pylori infection in gastric carcinoma. Gut Liver. 2022 (May 25). Doi: 10.5009/gnl210593
Key clinical point: Epstein-Barr virus (EBV) and Helicobacter pylori coinfection is not an independent prognostic factor for gastric cancer. EBV infection was associated with survival, but not in patients with non-gastric carcinoma with lymphoid stroma (non-GCLS).
Major finding: EBV infection alone (hazard ratio 0.362; P = .049) showed an inverse correlation with overall survival (OS). The 5-year OS rate was not significantly different between the EBV and H. pylori coinfection vs. other groups (97.6% vs. 86.8%; P = .144). In patients with non-GCLS, the OS rate was not significantly different between the EBV-positive vs. other groups (96.9% vs. 86.4%; P = .126).
Study details: This retrospective study included 956 patients with gastric cancer who underwent surgery between September 2014 and August 2015 and were subdivided into groups according to the GCLS morphology and EBV and H. pylori infection statuses.
Disclosures: No funding source was identified for this study. Dr. JY Ahn is an editorial board member of the journal. The other authors reported no conflicts of interest.
Source: Noh JH et al. Clinical significance of Epstein-Barr virus and Helicobacter pylori infection in gastric carcinoma. Gut Liver. 2022 (May 25). Doi: 10.5009/gnl210593
Key clinical point: Epstein-Barr virus (EBV) and Helicobacter pylori coinfection is not an independent prognostic factor for gastric cancer. EBV infection was associated with survival, but not in patients with non-gastric carcinoma with lymphoid stroma (non-GCLS).
Major finding: EBV infection alone (hazard ratio 0.362; P = .049) showed an inverse correlation with overall survival (OS). The 5-year OS rate was not significantly different between the EBV and H. pylori coinfection vs. other groups (97.6% vs. 86.8%; P = .144). In patients with non-GCLS, the OS rate was not significantly different between the EBV-positive vs. other groups (96.9% vs. 86.4%; P = .126).
Study details: This retrospective study included 956 patients with gastric cancer who underwent surgery between September 2014 and August 2015 and were subdivided into groups according to the GCLS morphology and EBV and H. pylori infection statuses.
Disclosures: No funding source was identified for this study. Dr. JY Ahn is an editorial board member of the journal. The other authors reported no conflicts of interest.
Source: Noh JH et al. Clinical significance of Epstein-Barr virus and Helicobacter pylori infection in gastric carcinoma. Gut Liver. 2022 (May 25). Doi: 10.5009/gnl210593
Artificial intelligence may support the diagnosis of early gastric cancer
Key clinical point: Artificial intelligence (AI) shows high sensitivity, specificity, and accuracy for the diagnosis of early gastric cancer.
Major finding: The pooled sensitivity and specificity of AI for early gastric cancer diagnosis were 0.86 and 0.90, respectively. The accuracy of AI was 0.94. The pooled sensitivity and specificity of deep learning methods were 0.84 and 0.88, respectively, and those of nondeep learning methods were 0.91 and 0.90, respectively. The accuracy of the nondeep learning methods was higher compared with the deep learning methods (0.96 vs. 0.93).
Study details: This meta-analysis of 12 retrospective case-control studies (n = 11,685) assessed the performance of AI in the endoscopic diagnosis of early gastric cancer.
Disclosures: No funding source was identified for this study. The authors declared no conflicts of interest.
Source: Chen P-C et al. The accuracy of artificial intelligence in the endoscopic diagnosis of early gastric cancer: Pooled Analysis Study. J Med Internet Res. 2022;24(5):e27694 (May 16). Doi: 10.2196/27694
Key clinical point: Artificial intelligence (AI) shows high sensitivity, specificity, and accuracy for the diagnosis of early gastric cancer.
Major finding: The pooled sensitivity and specificity of AI for early gastric cancer diagnosis were 0.86 and 0.90, respectively. The accuracy of AI was 0.94. The pooled sensitivity and specificity of deep learning methods were 0.84 and 0.88, respectively, and those of nondeep learning methods were 0.91 and 0.90, respectively. The accuracy of the nondeep learning methods was higher compared with the deep learning methods (0.96 vs. 0.93).
Study details: This meta-analysis of 12 retrospective case-control studies (n = 11,685) assessed the performance of AI in the endoscopic diagnosis of early gastric cancer.
Disclosures: No funding source was identified for this study. The authors declared no conflicts of interest.
Source: Chen P-C et al. The accuracy of artificial intelligence in the endoscopic diagnosis of early gastric cancer: Pooled Analysis Study. J Med Internet Res. 2022;24(5):e27694 (May 16). Doi: 10.2196/27694
Key clinical point: Artificial intelligence (AI) shows high sensitivity, specificity, and accuracy for the diagnosis of early gastric cancer.
Major finding: The pooled sensitivity and specificity of AI for early gastric cancer diagnosis were 0.86 and 0.90, respectively. The accuracy of AI was 0.94. The pooled sensitivity and specificity of deep learning methods were 0.84 and 0.88, respectively, and those of nondeep learning methods were 0.91 and 0.90, respectively. The accuracy of the nondeep learning methods was higher compared with the deep learning methods (0.96 vs. 0.93).
Study details: This meta-analysis of 12 retrospective case-control studies (n = 11,685) assessed the performance of AI in the endoscopic diagnosis of early gastric cancer.
Disclosures: No funding source was identified for this study. The authors declared no conflicts of interest.
Source: Chen P-C et al. The accuracy of artificial intelligence in the endoscopic diagnosis of early gastric cancer: Pooled Analysis Study. J Med Internet Res. 2022;24(5):e27694 (May 16). Doi: 10.2196/27694
Artificial intelligence may support the diagnosis of early gastric cancer
Key clinical point: Artificial intelligence (AI) shows high sensitivity, specificity, and accuracy for the diagnosis of early gastric cancer.
Major finding: The pooled sensitivity and specificity of AI for early gastric cancer diagnosis were 0.86 and 0.90, respectively. The accuracy of AI was 0.94. The pooled sensitivity and specificity of deep learning methods were 0.84 and 0.88, respectively, and those of nondeep learning methods were 0.91 and 0.90, respectively. The accuracy of the nondeep learning methods was higher compared with the deep learning methods (0.96 vs. 0.93).
Study details: This meta-analysis of 12 retrospective case-control studies (n = 11,685) assessed the performance of AI in the endoscopic diagnosis of early gastric cancer.
Disclosures: No funding source was identified for this study. The authors declared no conflicts of interest.
Source: Chen P-C et al. The accuracy of artificial intelligence in the endoscopic diagnosis of early gastric cancer: Pooled Analysis Study. J Med Internet Res. 2022;24(5):e27694 (May 16). Doi: 10.2196/27694
Key clinical point: Artificial intelligence (AI) shows high sensitivity, specificity, and accuracy for the diagnosis of early gastric cancer.
Major finding: The pooled sensitivity and specificity of AI for early gastric cancer diagnosis were 0.86 and 0.90, respectively. The accuracy of AI was 0.94. The pooled sensitivity and specificity of deep learning methods were 0.84 and 0.88, respectively, and those of nondeep learning methods were 0.91 and 0.90, respectively. The accuracy of the nondeep learning methods was higher compared with the deep learning methods (0.96 vs. 0.93).
Study details: This meta-analysis of 12 retrospective case-control studies (n = 11,685) assessed the performance of AI in the endoscopic diagnosis of early gastric cancer.
Disclosures: No funding source was identified for this study. The authors declared no conflicts of interest.
Source: Chen P-C et al. The accuracy of artificial intelligence in the endoscopic diagnosis of early gastric cancer: Pooled Analysis Study. J Med Internet Res. 2022;24(5):e27694 (May 16). Doi: 10.2196/27694
Key clinical point: Artificial intelligence (AI) shows high sensitivity, specificity, and accuracy for the diagnosis of early gastric cancer.
Major finding: The pooled sensitivity and specificity of AI for early gastric cancer diagnosis were 0.86 and 0.90, respectively. The accuracy of AI was 0.94. The pooled sensitivity and specificity of deep learning methods were 0.84 and 0.88, respectively, and those of nondeep learning methods were 0.91 and 0.90, respectively. The accuracy of the nondeep learning methods was higher compared with the deep learning methods (0.96 vs. 0.93).
Study details: This meta-analysis of 12 retrospective case-control studies (n = 11,685) assessed the performance of AI in the endoscopic diagnosis of early gastric cancer.
Disclosures: No funding source was identified for this study. The authors declared no conflicts of interest.
Source: Chen P-C et al. The accuracy of artificial intelligence in the endoscopic diagnosis of early gastric cancer: Pooled Analysis Study. J Med Internet Res. 2022;24(5):e27694 (May 16). Doi: 10.2196/27694
Nonmetastatic gastric cancer survival trends in the United States and Europe
Key clinical point: There is no improvement in survival of patients with nonmetastatic gastric adenocarcinoma in selected European countries. The survival has slightly improved in the US and worsened in Sweden.
Major finding: The overall survival (OS) trend improved in the US (hazard ratio [HR] per year 0.99) and worsened in Sweden (HR per year 1.03). There was no improvement in OS trend in the Netherlands, Belgium, Norway, and Slovenia. After adjusting for resection, the OS trend became insignificant in Sweden and improved in the US, Slovenia, and Norway.
Study details: A real-world observational study of individual-level data of 66,398 patients diagnosed with nonmetastatic gastric adenocarcinoma during 2003-2016 in the US and 5 European countries.
Disclosures: This study was supported by Deutsche Krebshilfe. The authors declared no competing interests.
Source: Huang L et al. Survival trends of patients with non-metastatic gastric adenocarcinoma in the US and European countries: The impact of decreasing resection rates. Cancer Commun (Lond). 2022 (Jun 6). Doi: 10.1002/cac2.12318
Key clinical point: There is no improvement in survival of patients with nonmetastatic gastric adenocarcinoma in selected European countries. The survival has slightly improved in the US and worsened in Sweden.
Major finding: The overall survival (OS) trend improved in the US (hazard ratio [HR] per year 0.99) and worsened in Sweden (HR per year 1.03). There was no improvement in OS trend in the Netherlands, Belgium, Norway, and Slovenia. After adjusting for resection, the OS trend became insignificant in Sweden and improved in the US, Slovenia, and Norway.
Study details: A real-world observational study of individual-level data of 66,398 patients diagnosed with nonmetastatic gastric adenocarcinoma during 2003-2016 in the US and 5 European countries.
Disclosures: This study was supported by Deutsche Krebshilfe. The authors declared no competing interests.
Source: Huang L et al. Survival trends of patients with non-metastatic gastric adenocarcinoma in the US and European countries: The impact of decreasing resection rates. Cancer Commun (Lond). 2022 (Jun 6). Doi: 10.1002/cac2.12318
Key clinical point: There is no improvement in survival of patients with nonmetastatic gastric adenocarcinoma in selected European countries. The survival has slightly improved in the US and worsened in Sweden.
Major finding: The overall survival (OS) trend improved in the US (hazard ratio [HR] per year 0.99) and worsened in Sweden (HR per year 1.03). There was no improvement in OS trend in the Netherlands, Belgium, Norway, and Slovenia. After adjusting for resection, the OS trend became insignificant in Sweden and improved in the US, Slovenia, and Norway.
Study details: A real-world observational study of individual-level data of 66,398 patients diagnosed with nonmetastatic gastric adenocarcinoma during 2003-2016 in the US and 5 European countries.
Disclosures: This study was supported by Deutsche Krebshilfe. The authors declared no competing interests.
Source: Huang L et al. Survival trends of patients with non-metastatic gastric adenocarcinoma in the US and European countries: The impact of decreasing resection rates. Cancer Commun (Lond). 2022 (Jun 6). Doi: 10.1002/cac2.12318
Laparoscopic gastrectomy is safe in the elderly
Takeaway: Laparoscopic vs. open gastrectomy (LG vs. OG) is associated with a lower complication rate and higher survival in elderly patients (age ≥ 80 years) with gastric cancer.
Major finding: Elderly patients who received LG vs. OG had lower blood loss (40 vs. 240 g; P < .01) and incidence of overall postoperative complications (29% vs. 53%; P < .05). The 5-year disease-specific survival rate was significantly higher in the LG vs. OG elderly group (93% vs. 78%; P < .05). Elderly vs. nonelderly patients who received LG had a significantly lower 5-year overall survival rate (67% vs. 87%; P < .01).
Study details: This retrospective study included patients with gastric cancer who received curative gastrectomy between 2003 and 2015 and were divided into three groups, elderly patients who received LG (n = 45) and OG (n = 43) and nonelderly patients who received LG (n = 329).
Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.
Source: Ueda Y et al. Technical and oncological safety of laparoscopic gastrectomy for gastric cancer in elderly patients ≥ 80 years old. BMC Geriatr. 2022;22:475 (Jun 2). Doi: 10.1186/s12877-022-03180-7
Takeaway: Laparoscopic vs. open gastrectomy (LG vs. OG) is associated with a lower complication rate and higher survival in elderly patients (age ≥ 80 years) with gastric cancer.
Major finding: Elderly patients who received LG vs. OG had lower blood loss (40 vs. 240 g; P < .01) and incidence of overall postoperative complications (29% vs. 53%; P < .05). The 5-year disease-specific survival rate was significantly higher in the LG vs. OG elderly group (93% vs. 78%; P < .05). Elderly vs. nonelderly patients who received LG had a significantly lower 5-year overall survival rate (67% vs. 87%; P < .01).
Study details: This retrospective study included patients with gastric cancer who received curative gastrectomy between 2003 and 2015 and were divided into three groups, elderly patients who received LG (n = 45) and OG (n = 43) and nonelderly patients who received LG (n = 329).
Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.
Source: Ueda Y et al. Technical and oncological safety of laparoscopic gastrectomy for gastric cancer in elderly patients ≥ 80 years old. BMC Geriatr. 2022;22:475 (Jun 2). Doi: 10.1186/s12877-022-03180-7
Takeaway: Laparoscopic vs. open gastrectomy (LG vs. OG) is associated with a lower complication rate and higher survival in elderly patients (age ≥ 80 years) with gastric cancer.
Major finding: Elderly patients who received LG vs. OG had lower blood loss (40 vs. 240 g; P < .01) and incidence of overall postoperative complications (29% vs. 53%; P < .05). The 5-year disease-specific survival rate was significantly higher in the LG vs. OG elderly group (93% vs. 78%; P < .05). Elderly vs. nonelderly patients who received LG had a significantly lower 5-year overall survival rate (67% vs. 87%; P < .01).
Study details: This retrospective study included patients with gastric cancer who received curative gastrectomy between 2003 and 2015 and were divided into three groups, elderly patients who received LG (n = 45) and OG (n = 43) and nonelderly patients who received LG (n = 329).
Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.
Source: Ueda Y et al. Technical and oncological safety of laparoscopic gastrectomy for gastric cancer in elderly patients ≥ 80 years old. BMC Geriatr. 2022;22:475 (Jun 2). Doi: 10.1186/s12877-022-03180-7
Gastric cancer: Epstein-Barr virus and H. pylori coinfection is not prognostic
Key clinical point: Epstein-Barr virus (EBV) and Helicobacter pylori coinfection is not an independent prognostic factor for gastric cancer. EBV infection was associated with survival, but not in patients with non-gastric carcinoma with lymphoid stroma (non-GCLS).
Major finding: EBV infection alone (hazard ratio 0.362; P = .049) showed an inverse correlation with overall survival (OS). The 5-year OS rate was not significantly different between the EBV and H. pylori coinfection vs. other groups (97.6% vs. 86.8%; P = .144). In patients with non-GCLS, the OS rate was not significantly different between the EBV-positive vs. other groups (96.9% vs. 86.4%; P = .126).
Study details: This retrospective study included 956 patients with gastric cancer who underwent surgery between September 2014 and August 2015 and were subdivided into groups according to the GCLS morphology and EBV and H. pylori infection statuses.
Disclosures: No funding source was identified for this study. Dr. JY Ahn is an editorial board member of the journal. The other authors reported no conflicts of interest.
Source: Noh JH et al. Clinical significance of Epstein-Barr virus and Helicobacter pylori infection in gastric carcinoma. Gut Liver. 2022 (May 25). Doi: 10.5009/gnl210593
Key clinical point: Epstein-Barr virus (EBV) and Helicobacter pylori coinfection is not an independent prognostic factor for gastric cancer. EBV infection was associated with survival, but not in patients with non-gastric carcinoma with lymphoid stroma (non-GCLS).
Major finding: EBV infection alone (hazard ratio 0.362; P = .049) showed an inverse correlation with overall survival (OS). The 5-year OS rate was not significantly different between the EBV and H. pylori coinfection vs. other groups (97.6% vs. 86.8%; P = .144). In patients with non-GCLS, the OS rate was not significantly different between the EBV-positive vs. other groups (96.9% vs. 86.4%; P = .126).
Study details: This retrospective study included 956 patients with gastric cancer who underwent surgery between September 2014 and August 2015 and were subdivided into groups according to the GCLS morphology and EBV and H. pylori infection statuses.
Disclosures: No funding source was identified for this study. Dr. JY Ahn is an editorial board member of the journal. The other authors reported no conflicts of interest.
Source: Noh JH et al. Clinical significance of Epstein-Barr virus and Helicobacter pylori infection in gastric carcinoma. Gut Liver. 2022 (May 25). Doi: 10.5009/gnl210593
Key clinical point: Epstein-Barr virus (EBV) and Helicobacter pylori coinfection is not an independent prognostic factor for gastric cancer. EBV infection was associated with survival, but not in patients with non-gastric carcinoma with lymphoid stroma (non-GCLS).
Major finding: EBV infection alone (hazard ratio 0.362; P = .049) showed an inverse correlation with overall survival (OS). The 5-year OS rate was not significantly different between the EBV and H. pylori coinfection vs. other groups (97.6% vs. 86.8%; P = .144). In patients with non-GCLS, the OS rate was not significantly different between the EBV-positive vs. other groups (96.9% vs. 86.4%; P = .126).
Study details: This retrospective study included 956 patients with gastric cancer who underwent surgery between September 2014 and August 2015 and were subdivided into groups according to the GCLS morphology and EBV and H. pylori infection statuses.
Disclosures: No funding source was identified for this study. Dr. JY Ahn is an editorial board member of the journal. The other authors reported no conflicts of interest.
Source: Noh JH et al. Clinical significance of Epstein-Barr virus and Helicobacter pylori infection in gastric carcinoma. Gut Liver. 2022 (May 25). Doi: 10.5009/gnl210593
Gastric cancer: What is the optimal surgical strategy in the elderly?
Key clinical point: In older patients with potentially resectable gastric cancer, gastrectomy vs. conservative treatment may improve survival. The minimally invasive approach has fewer complications and extended lymphadenectomy may have survival benefit.
Major finding: Gastrectomy vs. conservative treatment improved overall survival in all six studies included in the analysis, but study quality was low and meta-analysis was not feasible. Minimally invasive vs. open gastrectomy was associated with fewer complications (pooled risk ratio 0.71; P = .005) and similar OS (P = .58). Extended vs. limited lymphadenectomy prolonged OS or cancer-specific survival in two cohort studies, with similar complication rates.
Study details: This systematic review of 31 studies included patients aged ≥ 70 years with potentially resectable stage I-III gastric cancer.
Disclosures: This study had no sponsors. The authors declared no conflicts of interest.
Source: Argillander TE et al. Outcomes of surgical treatment of non-metastatic gastric cancer in patients aged 70 and older: A systematic review and meta-analysis. Eur J Surg Oncol. 2022 (May 16). Doi: 10.1016/j.ejso.2022.05.003
Key clinical point: In older patients with potentially resectable gastric cancer, gastrectomy vs. conservative treatment may improve survival. The minimally invasive approach has fewer complications and extended lymphadenectomy may have survival benefit.
Major finding: Gastrectomy vs. conservative treatment improved overall survival in all six studies included in the analysis, but study quality was low and meta-analysis was not feasible. Minimally invasive vs. open gastrectomy was associated with fewer complications (pooled risk ratio 0.71; P = .005) and similar OS (P = .58). Extended vs. limited lymphadenectomy prolonged OS or cancer-specific survival in two cohort studies, with similar complication rates.
Study details: This systematic review of 31 studies included patients aged ≥ 70 years with potentially resectable stage I-III gastric cancer.
Disclosures: This study had no sponsors. The authors declared no conflicts of interest.
Source: Argillander TE et al. Outcomes of surgical treatment of non-metastatic gastric cancer in patients aged 70 and older: A systematic review and meta-analysis. Eur J Surg Oncol. 2022 (May 16). Doi: 10.1016/j.ejso.2022.05.003
Key clinical point: In older patients with potentially resectable gastric cancer, gastrectomy vs. conservative treatment may improve survival. The minimally invasive approach has fewer complications and extended lymphadenectomy may have survival benefit.
Major finding: Gastrectomy vs. conservative treatment improved overall survival in all six studies included in the analysis, but study quality was low and meta-analysis was not feasible. Minimally invasive vs. open gastrectomy was associated with fewer complications (pooled risk ratio 0.71; P = .005) and similar OS (P = .58). Extended vs. limited lymphadenectomy prolonged OS or cancer-specific survival in two cohort studies, with similar complication rates.
Study details: This systematic review of 31 studies included patients aged ≥ 70 years with potentially resectable stage I-III gastric cancer.
Disclosures: This study had no sponsors. The authors declared no conflicts of interest.
Source: Argillander TE et al. Outcomes of surgical treatment of non-metastatic gastric cancer in patients aged 70 and older: A systematic review and meta-analysis. Eur J Surg Oncol. 2022 (May 16). Doi: 10.1016/j.ejso.2022.05.003
Metastatic gastric cancer: CD163+ macrophage infiltration is a prognostic biomarker
Key clinical point: Pretreatment CD163+ macrophage infiltration is a prognostic biomarker in patients with metastatic gastric cancer.
Major finding: The median overall survival (OS) was significantly longer in patients who underwent vs. did not undergo conversion surgery after induction chemotherapy (33.3 vs. 9.0 months; P < .0001). Overall, the median OS in the CD163-low vs. -high group was not reached vs. 16.8 months, respectively (P < .001). In patients who underwent conversion surgery, the median OS in the CD163-low vs. -high group was not reached vs. 24.8 months, respectively (P = .020).
Study details: This retrospective study evaluated the numbers of tumor-infiltrating CD4+, CD8+, and Foxp3+ lymphocytes and CD68+ and CD163+ macrophages in pretreatment endoscopic biopsy samples of 68 patients with metastatic gastric cancer who received induction chemotherapy (docetaxel plus cisplatin plus S-1) with or without conversion surgery between April 2006 and March 2019.
Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.
Source: Kinoshita J et al. Prognostic value of tumor-infiltrating CD163+macrophage in patients with metastatic gastric cancer undergoing multidisciplinary treatment. BMC Cancer. 2022;22:608 (Jun 3). Doi: 10.1186/s12885-022-09713-y
Key clinical point: Pretreatment CD163+ macrophage infiltration is a prognostic biomarker in patients with metastatic gastric cancer.
Major finding: The median overall survival (OS) was significantly longer in patients who underwent vs. did not undergo conversion surgery after induction chemotherapy (33.3 vs. 9.0 months; P < .0001). Overall, the median OS in the CD163-low vs. -high group was not reached vs. 16.8 months, respectively (P < .001). In patients who underwent conversion surgery, the median OS in the CD163-low vs. -high group was not reached vs. 24.8 months, respectively (P = .020).
Study details: This retrospective study evaluated the numbers of tumor-infiltrating CD4+, CD8+, and Foxp3+ lymphocytes and CD68+ and CD163+ macrophages in pretreatment endoscopic biopsy samples of 68 patients with metastatic gastric cancer who received induction chemotherapy (docetaxel plus cisplatin plus S-1) with or without conversion surgery between April 2006 and March 2019.
Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.
Source: Kinoshita J et al. Prognostic value of tumor-infiltrating CD163+macrophage in patients with metastatic gastric cancer undergoing multidisciplinary treatment. BMC Cancer. 2022;22:608 (Jun 3). Doi: 10.1186/s12885-022-09713-y
Key clinical point: Pretreatment CD163+ macrophage infiltration is a prognostic biomarker in patients with metastatic gastric cancer.
Major finding: The median overall survival (OS) was significantly longer in patients who underwent vs. did not undergo conversion surgery after induction chemotherapy (33.3 vs. 9.0 months; P < .0001). Overall, the median OS in the CD163-low vs. -high group was not reached vs. 16.8 months, respectively (P < .001). In patients who underwent conversion surgery, the median OS in the CD163-low vs. -high group was not reached vs. 24.8 months, respectively (P = .020).
Study details: This retrospective study evaluated the numbers of tumor-infiltrating CD4+, CD8+, and Foxp3+ lymphocytes and CD68+ and CD163+ macrophages in pretreatment endoscopic biopsy samples of 68 patients with metastatic gastric cancer who received induction chemotherapy (docetaxel plus cisplatin plus S-1) with or without conversion surgery between April 2006 and March 2019.
Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.
Source: Kinoshita J et al. Prognostic value of tumor-infiltrating CD163+macrophage in patients with metastatic gastric cancer undergoing multidisciplinary treatment. BMC Cancer. 2022;22:608 (Jun 3). Doi: 10.1186/s12885-022-09713-y