Publications by authors named "Jun-Te Hsu"

127 Publications

The optimal timing of interval laparoscopic cholecystectomy following percutaneous cholecystostomy based on pathological findings and the incidence of biliary events.

J Hepatobiliary Pancreat Sci 2021 Jun 15. Epub 2021 Jun 15.

Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.

Background: The incidence of biliary events (BE) following percutaneous cholecystostomy (PC) in acute cholecystitis (AC) patients is high. Therefore, definitive laparoscopic cholecystectomy (LC) is recommended. We aimed to investigate the optimal timing of LC following PC with regard to the clinical course and pathological findings.

Methods: All 744 AC patients with PC were included. The incidence and median number of BE were investigated with the concept of competing risks. The 344 patients with interval LC were divided into two groups based on the pathological findings of resected gallbladders: the acute/acute-and-chronic group (AANC group) (n=221) and the chronic group (n=123). A comparative analysis of the demographic data and perioperative outcomes was performed.

Results: Among the 744 AC patients with PC, 142 patients experienced recurrent BE. The cumulative incidence of BE was 26.6%, and the median time to recurrence was 67.5 days. The PC-to-LC days of the chronic group were longer than those of the AANC group (73.51 vs. 63.00, p<0.001). The multivariate analysis indicated that the operation time was longer in the AANC group than in the chronic group (p=0.040).

Conclusion: In terms of the clinical course and sequential pathological changes in the gallbladder, a 9- to 10-week interval after PC is the optimal timing for LC.
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http://dx.doi.org/10.1002/jhbp.1012DOI Listing
June 2021

Metabolism of Proteins and Amino Acids in Critical Illness: From Physiological Alterations to Relevant Clinical Practice.

J Multidiscip Healthc 2021 14;14:1107-1117. Epub 2021 May 14.

Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan.

The clinical impact of nutrition therapy in critically ill patients has been known for years, and relevant guidelines regarding nutrition therapy have emphasized the importance of proteins. During critical illness, such as sepsis or the state following major surgery, major trauma, or major burn injury, patients suffer from a high degree of stress/inflammation, and during this time, metabolism deviates from homeostasis. The increased degradation of endogenous proteins in response to stress hormones is among the most important events in the acute phase of critical illness. Currently published evidence suggests that adequate protein supplementation might improve the clinical outcomes of critically ill patients. The role of sufficient protein supplementation may even surpass that of caloric supplementation. In this review, we focus on relevant physiological alterations in critical illness, the effects of critical illness on protein metabolism, nutrition therapy in clinical practice, and the function of specific amino acids.
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http://dx.doi.org/10.2147/JMDH.S306350DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8131070PMC
May 2021

Cytoreductive Surgery may be beneficial for highly selected patients with Metastatic Gastrointestinal Stromal Tumors receiving Regorafenib facing Local Progression: A Case Controlled Study.

J Cancer 2021 12;12(11):3335-3343. Epub 2021 Apr 12.

GIST Team, Department of Surgery, Chang Gung Memorial Hospital, Linkou; Chang Gung University, Taiwan.

Current evidence have shown surgery may provide progression-free survival (PFS) benefit for selected patients with metastatic gastrointestinal stromal tumor (GIST) who received first line imatinib and second line sunitinib. However, impact of cytoreductive surgery for GIST patients receiving third line regorafenib facing progression is not yet reported. Between 2014 and 2019, 41 patients with metastatic GIST received regorafenib and 37 of them facing progression. 37 of 41 (90.2%) pre-treated GIST patients receiving regorafenib who experienced progression of disease after a median follow-up of 12.42 months after regorafenib use and 15 out of 37 (40.5%) patients with local progression underwent cytoreductive surgery (local progression and operation, LPOP). All the patients facing local progression (LP) were significantly younger with more exon 17 mutation than diffuse progression (DP). The complication rate for cytoreductive surgery was 33.3% (5/15). Cytoreductive surgery provided PFS prolongation of 5.52 months. Patients underwent cytoreductive surgery, compared with control group (local progression and no operation (LPNOP) and DP), may gain a significant PFS (12.91 versus 2.33 versus 5.29 months, = 0.0001) and overall survival (OS) benefit (32.33 versus 5.26 versus 12.42 months, = 0.004). Cytoreductive surgery might be feasible in highly selected patients with pre-treated GIST who are being treated with regorafenib experiencing LP.
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http://dx.doi.org/10.7150/jca.50324DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8100794PMC
April 2021

Alpha-fetoprotein for Gastric Cancer Staging: An Essential or Redundant Tumor Marker?

Anticancer Res 2021 May;41(5):2711-2718

Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan, R.O.C.;

Background/aim: This study was designed to clarify the value of routine alpha-fetoprotein (AFP) testing for patients with gastric cancer (GC).

Patients And Methods: A total of 905 patients with newly diagnosed GC and available pretreatment carcinoembryonic antigen (CEA), cancer-related antigen 19-9 (CA19-9), and AFP data from 2010 to 2016 were collected for comparison of tumor stage and survival.

Results: In total, 139 patients (15.4%), 155 patients (17.1%), and 27 patients (3.0%) had elevated CEA, CA19-9, and AFP levels, respectively. The c-index values of elevated AFP levels in predicting stage IV disease and the 1-year mortality rate were 0.564 (95%CI=0.520-0.608) and 0.594 (95%CI=0.553-0.635), respectively, which were significantly lower than those of CEA (0.673 and 0.665) and CA19-9 (0.619 and 0.618).

Conclusion: Elevated AFP is rare in patients with newly diagnosed GC. Routine AFP sampling would not provide a higher survival prediction in GC patients than CEA or CA19-9.
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http://dx.doi.org/10.21873/anticanres.15052DOI Listing
May 2021

Management of Patients With Acute Cholecystitis After Percutaneous Cholecystostomy: From the Acute Stage to Definitive Surgical Treatment.

Front Surg 2021 15;8:616320. Epub 2021 Apr 15.

Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.

Percutaneous cholecystostomy (PC) has become an important procedure for the treatment of acute cholecystitis (AC). PC is currently applied for patients who cannot undergo immediate laparoscopic cholecystectomy. However, the management following PC has not been well-reviewed. The efficacy of PC tubes has already been indicated, and compared to complications of other invasive biliary procedures, complications related to PC are rare. Following the resolution of AC, patients who can tolerate anesthesia and the surgical risk should undergo interval cholecystectomy to reduce the recurrence of biliary events. For patients unfit for surgery, whether owing to comorbidities, anesthesia risks, or surgical risks, expectant management may be applied; however, a high incidence of recurrence has been noted. In addition, several interesting issues, such as the indications for cholangiography via the PC tube, removal or maintenance of the PC catheter before definitive treatment, and timing of elective surgery, are all discussed in this review, and a relevant decision-making flowchart is proposed. PC is an effective and safe intervention, whether as expectant treatment or bridge therapy to definitive surgery. High-level evidence of post-PC care is still necessary to modify current practices.
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http://dx.doi.org/10.3389/fsurg.2021.616320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8083985PMC
April 2021

Everolimus Related Fulminant Hepatitis in Pancreatic Neuroendocrine Tumor With Liver Metastases: A Case Report and Literature Review.

Front Endocrinol (Lausanne) 2021 1;12:639967. Epub 2021 Apr 1.

Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.

Background: Everolimus, an immunosuppressant, is approved for the treatment of advanced renal cell carcinoma, metastatic hormone receptor-positive breast cancer, and pancreatic neuroendocrine tumors (P-NETs) but has been reported to be related to hepatitis B reactivation. Here, we present the first case of fatal fulminant hepatitis B reactivation in a man with P-NET accompanied by multiple liver metastases who received everolimus and octreotide long-acting repeatable (LAR).

Case Presentation: A 45-year-old male had a history of chronic hepatitis B infection. He was found to have a complicated liver cyst incidentally, and then he underwent biopsy, which disclosed a grade 2 neuroendocrine tumor (NET). Subsequent MRI of the abdomen and PET revealed a solid mass at the pancreatic tail with numerous liver tumors favoring metastases and peripancreatic lymph node metastases. Transarterial chemoembolization (TACE) of the right lobe of the liver was performed, and he started to take 5 mg everolimus twice a day and 20 mg octreotide LAR every month 8 days after the 1 TACE. No hepatitis B virus (HBV) prophylaxis treatment was administered. He then underwent laparoscopic distal pancreatectomy and splenectomy three and half months after the initial treatment of everolimus. He continued everolimus 5 mg twice a day and octreotide 20 mg every month after the operation. Three months later, hepatic failure occurred due to acute hepatitis B flare-up-related fulminant hepatic failure since other possible causes of hepatic failure were excluded. Five days after hepatic failure presented, hepatic failure was apparent, and pulseless ventricular tachycardia occurred. The patient expired after failed resuscitation.

Conclusion: A literature review of everolimus-related hepatitis B reactivation was conducted. In P-NET patients with chronic hepatitis B who will undergo everolimus treatment, HBV prophylaxis should be considered since fatal hepatitis B reactivation might occur under rare conditions.
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http://dx.doi.org/10.3389/fendo.2021.639967DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8047461PMC
April 2021

Impact of Pancreatic Resection on Survival in Locally Advanced Resectable Gastric Cancer.

Cancers (Basel) 2021 Mar 14;13(6). Epub 2021 Mar 14.

Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 333, Taiwan.

Whether gastric adenocarcinoma (GC) patients with adjacent organ invasion (T4b) benefit from aggressive surgery involving pancreatic resection (PR) remains unclear. This study aimed to clarify the impact of PR on survival in patients with locally advanced resectable GC. Between 1995 and 2017, patients with locally advanced GC undergoing radical-intent gastrectomy with and without PR were enrolled and stratified into four groups: group 1 (G1), pT4b without pancreatic resection (PR); group 2 (G2), pT4b with PR; group 3 (G3), positive duodenal margins without Whipple's operation; and group 4 (G4), cT4b with Whipple's operation. Demographics, clinicopathological features, and outcomes were compared between G1 and G2 and G3 and G4. G2 patients were more likely to have perineural invasion than G1 patients (80.6% vs. 50%, < 0.001). G4 patients had higher lymph node yield (40.8 vs. 31.3, = 0.002), lower nodal status ( = 0.029), lower lymph node ratios (0.20 vs. 0.48, < 0.0001) and higher complication rates (45.2% vs. 26.3%, = 0.047) than G3 patients. The 5-year disease-free survival (DFS) and overall survival (OS) rates were significantly longer in G1 than in G2 (28.1% vs. 9.3%, = 0.003; 32% vs. 13%, = 0.004, respectively). The 5-year survival rates did not differ between G4 and G3 (DFS: 14% vs. 14.4%, = 0.384; OS: 12.6% vs. 16.4%, = 0.321, respectively). In conclusion, patients with T4b lesion who underwent PR had poorer survival than those who underwent resection of other adjacent organs. Further Whipple's operation did not improve survival in pT3-pT4 GC with positive duodenal margins.
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http://dx.doi.org/10.3390/cancers13061289DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001184PMC
March 2021

Impact of highest drain fluid amylase levels on surgical outcomes and postoperative interventions in patients undergoing pancreaticoduodenectomy.

Asian J Surg 2021 Mar 2. Epub 2021 Mar 2.

Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.

Objectives: The clinical significance of the highest drain fluid amylase (DFA) level beyond pancreaticoduodenectomy (PD) postoperative day three (POD 3) remains unclear. This study investigated the impact of highest DFA level beyond POD 3 on postoperative pancreatic fistula (POPF) severity and outcomes of patients undergoing PD with POPF.

Methods: Patient demographics of biochemical POPF and clinically relevant POPF (CR-POPF) were compared. Predictive factors were assessed using binary logistic regression. Receiver operating characteristic curve analysis was performed to determine the optimal cutoff value of highest DFA (beyond POD 3). We compared length of hospital stay, surgical mortality rates, and need for postoperative interventions by highest DFA level.

Results: Patients with CR-POPF had an older age (p = 0.039), required intraoperative blood transfusion (p = 0.006), and had greater highest DFA levels (p = 0.001) than those with biochemical POPF. The optimal highest DFA cutoff was 2014.5 U/L. Multivariate analysis showed that percentage of patients with intraoperative blood transfusion (p = 0.011; odds ratio, 3.716) and a highest DFA > 2014.5 U/L beyond POD 3 (p = 0.001; odds ratio, 5.722) was predictive of CR-POPF.

Conclusion: Highest DFA > 2014.5 U/L beyond POD 3 is an independent predictor for CR-POPF. At a highest DFA >2014.5 U/L, 30-day surgical mortality rate, length of stay, and need for postoperative interventions did not differ.
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http://dx.doi.org/10.1016/j.asjsur.2021.01.041DOI Listing
March 2021

Cytomegalovirus gastritis: Clinicopathological profile.

Dig Liver Dis 2021 Jun 11;53(6):722-728. Epub 2021 Jan 11.

Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch5, Fu-Hsin Street, Guei-Shan District, Taoyuan City, Taoyuan, Taiwan; Taiwan Association of the Study of Small Intestinal Disease, Taiwan; Liver Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taiwan. Electronic address:

Background: Cytomegalovirus (CMV) gastritis is occasionally reported in case reports and limited case series. Up to now, it is the largest and most comprehensive retrospective study of CMV gastritis.

Methods: All patients who were histologically diagnosed with CMV gastritis at Linkou Chang Gung Memorial Hospital between January 2000 and April 2020 were included. Patients were divided into two groups according to immunity. Between-group differences in characteristics, manifestations, endoscopic features, prognostic factors, and outcomes were analyzed. The main endpoint was 3-month mortality.

Results: A total of 54 patients (34 immunocompromised, 20 immunocompetent) were enrolled. Common presentations included gastrointestinal bleeding (35.2%), abdominal pain (33.3%) and fever (31.5%). The endoscopic features included ulcer (88.9%) and inflammation (11.1%). The 3-month mortality rate was 20.4% and overall mortality rate was 40.7%. Acute kidney injury was the only independent risk factor for 3-month mortality (OR 53.89, 95%CI 1.56-1861.73, p = 0.027). Anti-viral therapy and host immune status did not affect 3-month mortality.

Conclusion: Both immunocompromised and immunocompetent patients with CMV gastritis have high mortality rates, without significant between-group differences. Acute kidney injury is the only independent predictive factor for 3-month mortality. Prevention of acute kidney injury may possibly improve the 3-month mortality rate.
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http://dx.doi.org/10.1016/j.dld.2020.12.002DOI Listing
June 2021

Non-small cell lung cancer with gastric metastasis and repeated gastrointestinal bleeding: A rare case report and literature review.

Thorac Cancer 2021 02 5;12(4):560-563. Epub 2021 Jan 5.

Departments of General Surgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan.

The occurrence of gastrointestinal metastasis from lung carcinoma is rare. Compared with non-small cell lung cancer (NSCLC), small cell lung cancer more commonly results in this sort of metastasis. Here, we report an unusual case of NSCLC initially without evidence of distant metastasis that developed into gastric metastasis five months after the initial diagnosis, despite the primary lung cancer having a partial response to radiotherapy and chemotherapy. Serial radiological examinations and endoscopic biopsies of the gastric tumor confirmed that it was a metastatic carcinoma originating from the lung. The patient received a total gastrectomy for gastric metastasis due to repeated gastrointestinal bleeding.
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http://dx.doi.org/10.1111/1759-7714.13815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7882379PMC
February 2021

Alternative application of percutaneous cholecystostomy in patients with biliary obstruction.

Abdom Radiol (NY) 2021 06 2;46(6):2891-2899. Epub 2021 Jan 2.

Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan.

Purpose: Percutaneous cholecystostomy (PC) is an important modality for acute cholecystitis and has been applied for other clinical scenarios as well. In the present study, we aimed to investigate an alternative use of PC for obstructive jaundice.

Methods: From January 2012 to December 2018, eligible subjects were selected from patients undergoing PC in our institute. The characteristics, spectrum of underlying disease, indication for PC performance, details of the procedure, and treatment effect were all investigated.

Results: During the study period, 1364 patients underwent PC. Seventy patients fulfilled the defined inclusion criteria. While 47 patients were diagnosed with malignant biliary obstruction with or without cholangitis, 23 patients were diagnosed with nonmalignant biliary obstruction and acute cholangitis. There were 63 patients (90%) diagnosed with acute cholangitis. Pancreatic cancer (n = 24, 51%) and advanced malignancy (n = 28, 59%) were noted mostly in the group with malignant biliary obstruction. Treatment effects were proven by laboratory data, including the white blood cell count, C-reactive protein level, and hepatic function.

Conclusion: PC can temporize definitive therapies and serve as an alternative treatment for patients with nonmalignant conditions. For patients with advanced malignancy, PC can serve as a palliative procedure that has a high success rate and low complication rate and effectively relieves biliary obstruction.
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http://dx.doi.org/10.1007/s00261-020-02898-5DOI Listing
June 2021

Predicting Postoperative Events in Patients With Gastric Cancer: A Comparison of Five Nutrition Assessment Tools.

In Vivo 2020 Sep-Oct;34(5):2803-2809

Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan, R.O.C.

Background/aim: We compared the adequacy of five nutrition assessment tools with respect to their predictive value in patients with locally advanced gastric cancer (GC) receiving radical surgery.

Patients And Methods: Five nutrition assessment tools-Glasgow prognostic score (GPS), malnutritional universal screening tool (MUST), nutritional risk screening, patient generated subjective global assessment (PG-SGA), and prognostic nutritional index (PNI)-were assessed preoperatively for stage III GC patients. The correlation between postoperative events and nutritional status was further analyzed.

Results: Most of the nutritional tools accurately predicted length of hospital stay and grade 3 or higher surgical complications, while only the GPS correlated with 30-day readmission and surgical complications. The PG-SGA performed the poorest among the five tools and failed to predict any postoperative event.

Conclusion: The application of GPS is recommended as a prognostic index for patients with locally advanced GC prior to radical surgery.
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http://dx.doi.org/10.21873/invivo.12106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652472PMC
May 2021

Impact of Metformin Use on Survival in Patients with Gastric Cancer and Diabetes Mellitus Following Gastrectomy.

Cancers (Basel) 2020 Jul 23;12(8). Epub 2020 Jul 23.

Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan.

Studies have shown the anticancer effects of metformin in vitro. However, whether metformin can prevent cancer recurrence or prolong survival in patients with gastric cancer (GC) and diabetes mellitus (DM) post-gastrectomy remains unknown. We evaluated the beneficial effects of metformin in patients with GC and DM post-gastrectomy. We recruited 2400 patients with GC (1749 without DM, 651 with DM) who underwent surgery between 1997 and 2010. Patients with DM were stratified into metformin (group 1) and non-metformin (group 2) users. Their clinicopathological data were recorded prospectively, and demographics, recurrence-free survival (RFS), and cancer-specific survival (CSS) were compared. Tumour recurrence risk and cause of death were analysed between groups 1 and 2 among patients with DM stratified by tumour stage. We also compared RFS and overall survival among patients with and without DM. Tumour recurrence occurred in 201 patients with GC: 57 (25%) in group 1 and 144 (37%) in group 2. After adjusting for confounders, metformin significantly prolonged CSS (hazard ratio (HR) = 0.54, 95% confidence interval (CI) = 0.38-0.77) in patients with stage I-III GC and DM. In subgroup analysis, metformin users with stage III GC and DM had significantly prolonged CSS compared to non-metformin users (HR = 0.45, 95% CI = 0.30-0.68), with an insignificant difference in patients with stage I-II GC. Adjusted HRs for RFS and CSS were significantly lower in patients with stage I-III GC and DM than those in patients without DM (0.67 (95% CI = 0.54-0.92) and 0.62 (95% CI = 0.50-0.77), respectively), with an insignificant difference in patients with stage I GC. Metformin significantly reduces tumour recurrence risk and improves CSS in patients with stage III GC and DM post-gastrectomy. Further prospective studies may confirm the efficacy of metformin as an adjunctive treatment for advanced GC postoperatively.
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http://dx.doi.org/10.3390/cancers12082013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7465508PMC
July 2020

Rescue therapy with rifabutin regimen for refractory Helicobacter pylori infection with dual drug-resistant strains.

BMC Gastroenterol 2020 Jul 10;20(1):218. Epub 2020 Jul 10.

Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou, 5, Fushin Street, Kweishan, Taoyuan, Taiwan, Republic of China, 333.

Background: There is no current standard rescue treatment for dual drug-resistant strains of Helicobacter pylori (H. pylori). This aim of this study was to investigate the efficacy of rifabutin-based triple therapy for patients infected with dual drug-resistant strains to clarithromycin and levofloxacin.

Methods: After 2 or 3 H. pylori treatment failures, patients underwent upper endoscopy with tissue biopsies. Phenotypic and genotypic resistances were determined using agar dilution test and polymerase chain reaction with direct sequencing, respectively. Patients infected with dual drug-resistant (clarithromycin and levofloxacin) strains and receiving rifabutin-based triple therapy (rifabutin 150 mg bid, amoxicillin 1 g bid and esomeprazole 40 mg bid for 10 days) were enrolled. Eradication status was determined by 13C-urea breath test 4 weeks after treatment completion.

Results: A total of 39 patients infected with dual drug-resistant strains were enrolled in this study, with a mean age of 55.9 years. The eradication rate was 79.5% (31/39) (95% confidence intervals: 54.96% ~ 111.40%). Adverse event was reported in 23.1% (9/39) of patients but they were mild and tolerable. In univariate analysis, no factor was identified as an independent predictor of eradication failure.

Conclusions: Our current study demonstrated that rifabutin-based triple therapy was well tolerated and yielded an acceptable eradication rate for patients infected with dual drug-resistant strains of H. pylori.
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http://dx.doi.org/10.1186/s12876-020-01370-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350721PMC
July 2020

Surgical outcomes of patients with maintained or removed percutaneous cholecystostomy before intended laparoscopic cholecystectomy.

J Hepatobiliary Pancreat Sci 2020 Aug 1;27(8):461-469. Epub 2020 May 1.

Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.

Background: Percutaneous cholecystostomy (PC) followed by definitive cholecystectomy is an alternative treatment for acute cholecystitis (AC). We retrospectively investigated the impact of PC tube removal before definitive cholecystectomy on surgical outcomes.

Methods: From 2012 to 2017, 942 AC patients underwent PC at a single institute. Eligible patients were selected according to inclusion criteria. Demographic data, clinical and laboratory parameters, and treatment outcomes were extracted from medical records. Categorization of patients and subsequent subgroup analysis were based on cholangiography.

Results: The rate of emergent cholecystectomy in the PC tube removal group was higher than that in the PC tube preserved group (OR = 2.969, 95% CI 1.334-6.612, P = 0.008). In subgroup analysis of patients with patent bile flow under cholangiography, the rate of emergent cholecystectomy was higher in the PC tube removal group (OR = 3.173, 95% CI 1.182-8.523, P = 0.022), though the incidence of complications was higher in the PC tube preserved group (P = 0.012). In addition, routine preoperative cholangiography had no clinical impact on surgical outcome.

Conclusion: Percutaneous cholecystostomy tube can be removed before subsequent LC to avoid postoperative complications, though removal of the PC tube is associated with an increased likelihood of emergent cholecystectomy.
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http://dx.doi.org/10.1002/jhbp.740DOI Listing
August 2020

Is Adjuvant Chemotherapy Necessary for Patients with Deficient Mismatch Repair Gastric Cancer?-Autophagy Inhibition Matches the Mismatched.

Oncologist 2020 07 14;25(7):e1021-e1030. Epub 2020 Feb 14.

Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.

Purpose: The use of microsatellite instability (MSI) and mismatch repair (MMR) as predictive biomarkers for fluorouracil-based adjuvant chemotherapy in colorectal cancer has been a paradigm shift. However, whether this applies to gastric cancer is questionable. Furthermore, we herein investigated whether and how autophagy plays a role in MSI-relevant chemoresistance.

Materials And Methods: A total of 929 patients with deficient MMR (dMMR) and proficient MMR (pMMR) gastric cancers who underwent curative-intent gastrectomy were enrolled. We compared clinicopathological variables and survival among dMMR and pMMR cohorts and tested the responses of MSI-high and microsatellite stable (MSS) gastric cancer cell lines to 5-fluorouracil (5-FU) with or without chloroquine, an autophagy inhibitor.

Results: We identified an 8.9% prevalence of dMMR cases (83 out of 929) in our cohort. This was associated with old age, tumor site at the distal stomach, an intestinal phenotype, fewer nodal metastasis, and early pathological stages. MMR was an independent prognostic factor after multivariate adjustment. Overall survival (OS) of dMMR patients was better than that of the pMMR patients but was only applicable to stage III patients. There was no difference in OS between dMMR patients treated with or without adjuvant chemotherapy, although the latter showed more medical morbidities. The MSI-high gastric cancer cell lines, versus the MSS counterparts, displayed increased resistance to 5-FU and increased autophagy. Interestingly, autophagy inhibition abrogated the chemoresistance.

Conclusion: Our data show that fluorouracil-based adjuvant chemotherapy does not work for dMMR cases, if not worse. Autophagy inhibition and/or immune checkpoint inhibition might be promising alternative strategies for gastric cancer treatment.

Implications For Practice: The use of microsatellite instability (MSI) and mismatch repair (MMR) as predictive biomarkers for adjuvant chemotherapy in colorectal cancer has caused a paradigm shift in cancer therapy, although its implications in gastric cancer are still questionable. The data obtained in the current study indicate that MSI-MMR is an independent prognostic factor for gastric cancer. Standard fluorouracil-based adjuvant chemotherapy did not work for deficient MMR cases, and was likely worse. Instead, strategies like autophagy inhibition and/or immune checkpoint inhibition should be taken into consideration in the future.
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http://dx.doi.org/10.1634/theoncologist.2019-0419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356708PMC
July 2020

Adverse birth outcomes in adolescent and young adult female cancer survivors: a nationwide population-based study.

Br J Cancer 2020 03 13;122(6):918-924. Epub 2020 Jan 13.

Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.

Background: For female adolescent and young adult (AYA), cancer with treatments may affect their children's health. Our aim was to determine reliable risk estimates of adverse birth outcomes in AYA cancer survivors and the differential effects of treatments.

Methods: The study population of 4547 births in the AYA cancer survivor group and 45,463 in the comparison group were identified from two national databases between 2004 and 2014. Detailed maternal health conditions, such as maternal comorbidities, medication use during pregnancy and lifestyles, were adjusted in the statistical analyses. The outcomes included low birth weight, preterm labour, stillbirth, small or large for gestational age, a 5-min Apgar score <7, congenital malformation and foetal distress.

Results: The AYA cancer survivor group had a 9% higher risk of overall adverse birth outcomes (adjusted odds ratio, 1.09; 95% confidence interval, 1.02-1.16), especially low birth weight and preterm labour than the comparison group. The radiotherapy-only group additionally had a higher risk of foetal distress, and a 5-min Apgar score <7.

Conclusion: AYA cancer survivors, especially those who have received radiotherapy, still have higher risks of adverse birth outcomes after adjusting for detailed maternal health conditions. Preconception counselling and additional surveillance may be warranted in this population.
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http://dx.doi.org/10.1038/s41416-019-0712-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7078184PMC
March 2020

Significance of the Glasgow Prognostic Score in Predicting the Postoperative Outcome of Patients with Stage III Gastric Cancer.

J Clin Med 2019 Sep 12;8(9). Epub 2019 Sep 12.

College of Medicine, Chang Gung University, Taoyaun 333, Taiwan.

This study aimed at investigating the ability of a preoperative Glasgow prognostic score (GPS) to predict postoperative complications and survival outcomes in patients with stage III gastric cancer undergoing D2 gastrectomy. We retrospectively reviewed data from 272 such patients, treated between 2010 and 2016, at a Taiwanese medical center. The patients were categorized according to their GPS. In total, 36.8%, 48.5%, and 14.7% of the patients were assigned to groups with a GPS of 0, 1, and 2, respectively. Overall surgical complication rates in these groups were 30%, 45.5%, and 52.5% ( = 0.016); postoperative intensive care unit admission rates were 10%, 14.4%, and 22.5% ( = 0.15); postoperative 30-day re-admission rates were 6%, 15.2%, and 20% ( = 0.034); and the in-hospital mortality rates were 1.0%, 1.5%, and 10.0%, respectively ( = 0.006). The median survival times of the patients were 42.9 months (95% confidence interval [CI], 29.1-56.6), 22.6 months (95% CI, 19.3-25.8), and 16.6 months (95% CI, 7.8-25.4), respectively (< 0.001). A significant correlation was observed between the preoperative GPS, short-term postoperative complications, and long-term survival outcomes in patients with gastric cancer undergoing D2 gastrectomy. These findings recommend the usage of the GPS as a predictive and prognostic factor in patients with gastric cancer considering surgical resection.
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http://dx.doi.org/10.3390/jcm8091448DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780196PMC
September 2019

Efficacy of dexlansoprazole-based triple therapy for infections.

Therap Adv Gastroenterol 2019 5;12:1756284819870960. Epub 2019 Sep 5.

Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5, Fuxing Street, Guishan Dist., Taoyuan City.

Background: Dexlansoprazole has been shown to be efficacious for the treatment of gastroesophageal reflux disease. However, there is a paucity of data about its efficacy for eradication. The aim of this study was to evaluate the efficacy of dexlansoprazole for eradication as triple therapy in real-world practice.

Methods: Adult patients with endoscopically proven related peptic ulcer diseases or gastritis were recruited for this study. The eradication status was assessed based on the results of the C-urea breath test performed 4 weeks after treatment. According to the different treatment regimens, the patients were allocated to group A: Esomeprazole 40 mg b.i.d. + amoxicillin 1 g b.i.d. + clarithromycin 500 mg b.i.d. for 7 days; group B: Esomeprazole 40 mg q.d. + amoxicillin 1 g b.i.d. + clarithromycin 500 mg b.i.d. for 7 days, or group C: Dexlansoprazole 60 mg q.d. + amoxicillin 1 g b.i.d. + clarithromycin 500 mg b.i.d. for 7 days.

Results: A total of 215 patients (49% males) were enrolled in this study, with a mean age of 55 years. The eradication rates in group A, B, and C were 94.7% (71/75), 89.6% (69/77), and 93.7% (59/63) ( = 0.457), respectively. The adverse events were similar between the three groups ( = 0.068).

Conclusions: This study suggests that dexlansoprazole-based triple therapy has an acceptable eradication rate for infection.
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http://dx.doi.org/10.1177/1756284819870960DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732863PMC
September 2019

Interferon α-inducible protein 27 is an oncogene and highly expressed in cholangiocarcinoma patients with poor survival.

Cancer Manag Res 2019 28;11:1893-1905. Epub 2019 Feb 28.

Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan, Taiwan, ROC,

Objective: Cholangiocarcinoma (CCA) is a devastating disease. Interferon α-inducible protein 27 (IFI27), originally known to involve in innate immunity, is later found to intervene in cell proliferation, leading to inventive studies regarding the role of IFI27 in cancer treatment. We aimed to investigate the role of IFI27 in CCA.

Materials And Methods: Cell proliferation, migration, and invasion assays, Western blot, gene transfection and knockdown, immunofluorescent and immunohistochemical stains, and xenograft animal model were applied.

Results: IFI27 knockdown in CCA cells induced cell cycle arrest in S phase, resulting in lower cell proliferative rate in vitro and in vivo. IFI27 knockdown attenuated CCA cell migration and invasion through inhibition of epithelial-mesenchymal transition, which was supported by increased E-cadherin and decreased N-cadherin and fibronectin. Filamentous actin level was also reduced. IFI27 knockdown further repressed expression and secretion of vascular endothelial growth factor (VEGF-A), a strong stimulator of angiogenesis, through downregulation of c-jun and c-fos, which was supported in vitro by the finding that human vascular endothelial cells grew more slowly in conditioned medium of IFI27 knockdown on CCA cells and in vivo by the lower erythropoietin concentration found in the xenografted tumors derived from IFI27 knockdown on CCA cells. In addition, anti-VEGF-A antibody treatment was able to repress CCA cell growth. To the contrary, IFI27 overexpression could increase CCA cell proliferation, migration, and invasion. Clinically, higher IFI27 expression was linked to inferior overall survival of CCA patients.

Conclusion: Our data strongly suggest that IFI27 could be deemed as a potential target for CCA treatment.
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http://dx.doi.org/10.2147/CMAR.S196485DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6400119PMC
February 2019

Melatonin Attenuates Acute Pancreatitis-Induced Liver Damage Through Akt-Dependent PPAR-γ Pathway.

J Surg Res 2019 04 28;236:311-318. Epub 2018 Dec 28.

Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan. Electronic address:

Background: Despite melatonin treatment diminishes inflammatory mediator production and improves organ injury after acute pancreatitis (AP), the mechanisms remain unknown. This study explores whether melatonin improves liver damage after AP through protein kinase B (Akt)-dependent peroxisome proliferator activated receptor (PPAR)-γ pathway.

Methods: Male Sprague-Dawley rats were subjected to cerulein-induced AP. Animals were treated with vehicle, melatonin, and melatonin plus phosphoinositide 3-kinase (PI3K)/Akt inhibitor wortmannin 1 h following the onset of AP. Various indicators and targeted proteins were checked at 8 h in the sham and AP groups.

Results: At 8 h after AP, serum alanine aminotransferase/aspartate aminotransferase levels, histopathology score of hepatic injury, liver myeloperoxidase activity, and proinflammatory cytokine production were significantly increased and liver tissue adenosine triphosphate concentration was lower compared with shams. AP resulted in a marked decrease in liver Akt phosphorylation and PPAR-γ expression in comparison with the shams (relative density, 0.442 ± 0.037 versus. 1.098 ± 0.069 and 0.390 ± 0.041 versus ± 1.080 0.063, respectively). Melatonin normalized AP-induced reduction in liver tissue Akt activation (1.098 ± 0.054) and PPAR-γ expression (1.145 ± 0.083) as well as attenuated the increase in liver injury markers and proinflammatory mediator levels, which was abolished by coadministration of wortmannin.

Conclusions: Collectively, our findings suggest that melatonin improves AP-induced liver damage in rats, at least in part, via Akt-dependent PPAR-γ pathway.
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http://dx.doi.org/10.1016/j.jss.2018.11.056DOI Listing
April 2019

Surgical Margin Status of Patients with Pancreatic Ductal Adenocarcinoma Undergoing Surgery with Radical Intent: Risk Factors for the Survival Impact of Positive Margins.

In Vivo 2018 Nov-Dec;32(6):1591-1597

Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan, R.O.C.

Background: For pancreatic ductal adenocarcinoma (PDAC), surgical margin status is an important pathological factor for evaluating surgical adequacy. In this study, we attempted to investigate predictive factors for the survival impact of positive surgical margins.

Materials And Methods: From February 2004 to December 2013, 204 patients were diagnosed with PDAC and underwent surgery with radical intent; 189 patients fulfilled our selection criteria and were enrolled for analysis.

Results: For the 189 enrolled patients with PDAC, we found male predominance (112/189, 59%) and a median age of 64 years; most patients were diagnosed with stage IIB disease (n=115, 61%). The positive surgical margin rate was 21% (n=40). Carbohydrate antigen 19-9 (CA19-9) level higher than 246 U/ml (odds ratio (OR)=2.318; 95% confidence interval (CI)=1.037-5.181 p=0.040) and lesion location in the uncinate process (OR=2.996; 95% CI=1.232-7.284 p=0.015) were the only two independent risk factors for positive surgical margins. Positive retroperitoneal soft-tissue margins were the most frequently observed (24/40, 60%). Overall, positive surgical margins had no survival impact in the 189 patients with PDAC who underwent surgery; however, positive surgical margins had an unfavorable survival impact on patients with stage IIA PDAC who underwent surgery.

Conclusion: Retroperitoneal soft-tissue was the most common site for positive surgical margins. Additionally, surgical margin positivity was more likely for tumors located in the uncinate process than for other tumors. Positive surgical margins had an unfavorable survival impact on patients with stage IIA PDAC who underwent surgery.
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http://dx.doi.org/10.21873/invivo.11419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365746PMC
January 2019

CD44 Predicts Early Recurrence in Pancreatic Cancer Patients Undergoing Radical Surgery.

In Vivo 2018 Nov-Dec;32(6):1533-1540

Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan, R.O.C.

Background/aim: Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive types of digestive cancer. Recurrence within one year after surgery is inevitable in most PDAC patients. Recently, cluster of differentiation 44 (CD44) has been shown to be associated with tumor initiation, metastasis and prognosis. This study aimed to explore the correlation of CD44 expression with clinicopathological factors and the role of CD44 in predicting early recurrence (ER) in PDAC patients after radical surgery.

Materials And Methods: PDAC patients who underwent radical resection between January 1999 and March 2015 were enrolled in this study. Tumor recurrence within 6 months after surgery was defined as ER. Immunohistochemical staining was performed with anti-CD44 antibodies. The association between clinicopathological parameters and CD44 expression was analyzed. Predictors for ER were also assessed with univariate and multivariate analyses.

Results: Overall, 155 patients were included in this study. Univariate analysis revealed CA19-9 levels (p=0.014), CD44 histoscores (H-scores; p=0.002), differentiation (p=0.010), nodal status (p=0.005), stage (p=0.003), vascular invasion (p=0.007), lymphatic invasion (p<0.001) and perineural invasion (p=0.042) as risk factors for ER. In multivariate analysis, high CA19-9 levels and CD44 H-scores and poor differentiation independently predicted ER.

Conclusion: High CA19-9 levels, CD44 H-scores and poor differentiation are independent predictors for ER in PDAC patients undergoing radical resection. Therefore, the determination of CD44 expression might help in identifying patients at a high risk of ER for more aggressive treatment after radical surgery.
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http://dx.doi.org/10.21873/invivo.11411DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365743PMC
January 2019

Prognostic Stratification of Advanced Gastric Signet Ring Cell Carcinoma by Clinicopathological Factors and Genotype.

J Cancer 2018 8;9(19):3540-3547. Epub 2018 Sep 8.

Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.

Gastric signet ring cell carcinoma (SRCC) is a histologic variant characterized by abundant intracytoplasmic mucin. Although it has been recognized that gastric adenocarcinoma harboring this feature has poorer prognosis, prognostic stratification within gastric SRCCs themselves has not been clearly defined. genotype has been associated to poorer treatment outcome in mucinous type colorectal cancer. Here we incorporated clinicopathological factors and genotype to stratify prognosis of advanced gastric SRCC. Totally 347 gastric SRCC patients were retrospectively enrolled for genotyping. Clinicopathological factors were included for prognosis stratification. Of the 347 patients, 341 underwent radical-intent gastrectomy and 6 received palliative gastrectomy. Kaplan-Meier analysis for overall survival indicated that Tumor-Node-Metastasis staging could only stratify the patients into three prognosis-distinguishable groups: group-1 (stage IA); group-2 (stage IB/IIA) and group-3 (the remaining Tumor-Node-Metastasis stages combined). Multivariate Cox-proportional hazard models for group-3 patients revealed genotype (P = 0.0482). Tumor size (P = 0.0009), node status (P <0.0001), metastasis status (P = 0.0096), and perineural invasion (P = 0.037) independently associated with unfavorable OS. Exploratory subgroup analysis showed that genotype was associated with unfavorable OS in SRCCs with more aggressive phenotypes: node status >0 (P = 0.0013), lymphatic invasion (P = 0.021), vascular invasion (P = 0.0076) and perineural invasion (P = 0.0161). Accordingly, a scoring system was established capable of stratifying advanced gastric SRCC patients into three distinguishable prognostic subgroups. Gastric SRCC could be stratified into different prognostic subgroups by combining clinicopathological factors and genotype
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http://dx.doi.org/10.7150/jca.26293DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6171017PMC
September 2018

Factors related to patient propensity to receive adjuvant chemotherapy and outcomes in stage III gastric cancer cases after D2 surgery.

Asian J Surg 2019 May 22;42(5):604-612. Epub 2018 Sep 22.

Division of Hematology-Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan. Electronic address:

Background: Radical gastrectomy and extended lymph node (D2) dissection followed by adjuvant chemotherapy is the optimal treatment for patients with stage III gastric cancer in Asian population. The clinical factors associated with patient propensity to receive adjuvant chemotherapy and outcomes were analyzed.

Methods: In total, 509 patients with stage III gastric cancer who had undergone D2 surgery between 2007 and 2017 at a single medical center in Taiwan were analyzed. The patients' preoperative clinical characteristics relevant to adjuvant chemotherapy adherence were analyzed using multivariate regression. Significant variables were analyzed using recursive partitioning analysis (RPA) for identifying specific patient groups with the lowest and highest probabilities of adjuvant chemotherapy adherence.

Results: After surgery, 361 (70.9%) patients in the cohort had received adjuvant chemotherapy. All patients were categorized into five probability groups with adherence to adjuvant chemotherapy according to age, Eastern Cooperative Oncology Group (ECOG) performance status grade, and American Society of Anesthesiologists (ASA) class, which were discovered to be independent factors in the RPA-based probability prediction. In general, adjuvant chemotherapy improved survival across broad categories of stage III gastric cancer patients (overall survival hazard ratio: 0.53-0.75 and disease-free survival hazard ratio: 0.47-0.76).

Conclusions: Our study identified that age, ECOG grade, and ASA class were independent clinical factors associated with patient propensity to receive adjuvant chemotherapy in stage III gastric cancer. Knowledge of the clinical factors of patients may help clinicians identify and encourage specific patients to receive the adjuvant chemotherapy.
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http://dx.doi.org/10.1016/j.asjsur.2018.08.001DOI Listing
May 2019

Pancolitis associated with higher mortality risk of cytomegalovirus colitis in patients without inflammatory bowel disease.

Ther Clin Risk Manag 2018 20;14:1445-1451. Epub 2018 Aug 20.

Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan,

Background: Cytomegalovirus (CMV) colitis typically presents in immunocompromised and inflammatory bowel disease (IBD) patients. Several studies have been conducted on the endoscopic characteristics of CMV colitis in IBD patients.

Objectives: The endoscopic findings of CMV colitis in non-IBD patients and their relationship with inhospital mortality are unclear. We aimed to describe the endoscopic presentation in these patients and to determine the endoscopic predictors of inhospital mortality.

Patients And Methods: Patients with CMV colitis diagnosed using histology between April 2002 and December 2016 at the Linkou Chang Gung Memorial Hospital, Taiwan, were retrospectively enrolled. Patients diagnosed with IBD during follow-up were excluded. Patient data, including underlying diseases, endoscopic presentation, laboratory data, clinical course, complications, and clinical outcomes, were collected. The independent risk factors for inhospital mortality were analyzed with logistic regression. The difference of overall survival was compared using Kaplan-Meier survival curve and log rank test. All statistical calculations were performed using SPSS software, version 21.

Results: Sixty-nine patients were enrolled, and 8 IBD patients were excluded. Within the 61 non-IBD patients, 31 were diagnosed by colonoscopy and others by sigmoidoscopy. Ulceration (77%) was the most common endoscopic finding, followed by a cobblestone appearance (19.7%), colitis with/without erosions (9.8%), pseudomembrane (9.8%), and tumor/polyp-like lesions (8.2%). Among the patients who underwent full-length colonoscopy, 35.3% presented with right-sided colitis, 23.5% with left-sided colitis, and 32.4% with pancolitis. Pancolitis was identified as a negative predictor of inhospital mortality (odds ratio, 6.8; 95% confidence interval, 1.233-37.497; =0.028) and overall survival (log rank =0.018).

Conclusion: Colonoscopy is recommended for precise CMV colitis diagnosis and outcome prediction in non-IBD patients.
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http://dx.doi.org/10.2147/TCRM.S172071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6108329PMC
August 2018

The 8th edition American Joint Committee on gastric cancer pathological staging classification performs well in a population with high proportion of locally advanced disease.

Eur J Surg Oncol 2018 10 11;44(10):1634-1639. Epub 2018 Jun 11.

Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan. Electronic address:

Background: The 8th edition of AJCC gastric cancer pathological staging system (AJCC8) derived from the IGCA database needs an external validated in cohorts with higher proportion of advanced disease.

Patients And Methods: A total of 5386 gastric cancer patients treated at Chang Gung Memorial Hospital (CGMH) and Veteran General Hospital in Taipei (TVGH) were enrolled. Clinicopathological data of the IGCA series and the CGMH/TVGH cohort were compared. Cumulative survival curves of the CGMH/TVGH cohort as stratified by the AJCC7 and the AJCC8 were compared. Lymph node ratio (LNR) was analyzed in patients with N3b disease.

Results: Patients in the CGMH/TVGH cohort were older and had more advanced tumor stage (stage III, 49% versus 26%, p < 0.001) than those in the IGCA cohort. The median survival of stages IIIA, IIIB, and IIIC as defined by the AJCC 8 were 49, 27 and 15 months, respectively, with narrower 95% confidence intervals, in comparison with 62, 30 and 18 months, respectively, as defined by the AJCC7. The AJCC8 exhibited better homogeneity within stages and discriminatory ability between stages, compared to the AJCC7. Six hundred and four patients with N3b disease were stratified by LNR into three subgroups, and their median survival were 31, 17, and 11 months, respectively (p < 0.001). LNR further appeared as a powerful outcome predictor of N3b disease (HR, 3.1).

Conclusion: The AJCC8 performs well in patients with high proportion of advanced gastric cancer. We recommend that LNR is a supplementary prognostic indicator for N3b disease.
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http://dx.doi.org/10.1016/j.ejso.2018.05.036DOI Listing
October 2018

Linked color imaging can help gastric Helicobacter pylori infection diagnosis during endoscopy.

J Chin Med Assoc 2018 Dec 31;81(12):1033-1037. Epub 2018 May 31.

Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital- Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC. Electronic address:

Background: Esophagogastroduodenoscopy (EGD) is a standard tool for detection of mucosal and submucosal lesions. However, identification of Helicobacter pylori (H. P) infection using EGD alone is limited in accuracy. Linked color imaging (LCI) is a novel tool to capture real-time image with sufficient contrast to observe mucosal microstructure.

Methods: This study aims to evaluate the applicability of LCI in the identification of H. pylori infection. Consecutive 122 patients scheduled for EGD were included. They were examined with LCI and magnifying endoscopy. The classification of H. pylori was based on pathology results of biopsy and rapid urease test or urea breath test.

Results: We compared the results based on LCI or magnifying endoscopy to reference classification. Of 122 patients, 36 had H. pylori infection (29.51%). The level of accuracy of diagnosis of H. pylori infections by LCI, magnifying endoscopy, and both LCI and magnifying endoscopy was 78.38%, 81.98%, and 78.38%, respectively. The sensitivity and specificity of each group were 70.97%, 81.25%, and 80.65% and 82.5%, 83.87%, and 76.25%, respectively. The positive predictive values were 59.46%, 64.10%, and 57.78%, respectively, and the negative predictive values were 87.84%, 91.67%, and 92.42%, respectively.

Conclusion: LCI could be playing a valuable initial screen tool for real-time diagnosis of H. pylori infections. It has a high accuracy of diagnosis of H. pylori infections. Therefore, in patients suspected to have H. pylori infections using LCI, the infections need to be carefully diagnosed using appropriate methods because, as per the consensus, they should be eradicated as soon as possible before precancerous lesions develop.
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http://dx.doi.org/10.1016/j.jcma.2018.03.006DOI Listing
December 2018

Circulating microRNA-22-3p Predicts the Malignant Progression of Precancerous Gastric Lesions from Intestinal Metaplasia to Early Adenocarcinoma.

Dig Dis Sci 2018 09 7;63(9):2301-2308. Epub 2018 May 7.

Graduate Institute of Biomedical Sciences, School of Medicine, Chang Gung University, Taoyuan, Taiwan.

Background: Gastric cancer has a poor outcome and identifying useful biomarkers from peripheral blood or tissue could allow its early detection, or potentially precancerous changes, thus improving the curative rates. MicroRNAs (miRNAs) have been shown to offer great potential in cancer diagnosis and prediction.

Aim: Here, we investigated the role of plasma miRNAs in the natural course of gastric cancer, from intestinal metaplasia to early cancer. The findings were used to understand whether patients at a high risk of malignancy could be given appropriate interventions in the early disease process, such as using endoscopic submucosal dissection to treat gastric dysplasia or early gastric cancer.

Methods: Participants were divided into healthy control, intestinal metaplasia (IM), and dysplasia/early cancer (pT1a/b) groups. Microarray was used to select potential markers in tissue.

Results: Quantitative real-time polymerase chain reaction data showed circulating miRNA-22-3p had significantly different expression in patients with precancerous lesions or gastric adenocarcinoma. The areas under the curve of incomplete IM versus healthy control, low-grade/high-grade dysplasia, early gastric cancer, and GED were 0.8080, 0.8040, 0.8494, and 0.8095, respectively (all P values < 0.05).

Conclusions: Circulating miRNA-22-3p could be a potential biomarker for gastric precancerous dysplasia and early cancer detection.
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http://dx.doi.org/10.1007/s10620-018-5106-4DOI Listing
September 2018

Circulating microRNA-196a is an early gastric cancer biomarker.

Oncotarget 2018 Feb 7;9(12):10317-10323. Epub 2017 Dec 7.

Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan.

MicroRNA-196a (miRNA-196a) is associated with the development of gastric cancer and metastasis. Intestinal metaplasia and low- or high-grade dysplasia are considered to be precursors of intestinal type gastric cancer. Accordingly, we investigated the expression of plasma miRNA-196a as an early detection biomarker in precancerous gastric lesions and early cancer (pT1a/b), which is otherwise treated with endoscopic submucosal dissection. Our data showed that levels of circulating (plasma) miRNA-196a were higher in patients with precancerous lesions/early gastric adenocarcinoma than in healthy controls. The area under the receiver operating characteristic curve (AUC) for healthy controls vs. intestinal metaplasia was 0.9736; healthy controls vs. low-grade/high-grade dysplasia 0.9495; and healthy controls vs. early gastric cancer 0.9318. These results indicate that circulating miRNA-196a is a novel biomarker for detection of early gastric cancer and its precursor.
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http://dx.doi.org/10.18632/oncotarget.23126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5828184PMC
February 2018