Zuzanna Pelc

Colorectal cancer (CRC) remains one of the leading causes of cancer-related morbidity and mortality worldwide. Despite significant advances in screening and treatment, the prognosis for advanced-stage disease continues to be poor. One thriving area of research focuses on the use of epigenetic alterations for the diagnosis, prediction of treatment response, and prognosis of CRC. In this study, we evaluated original studies and meta-analyses published within the past five years to identify the most clinically relevant epigenetic biomarkers. DNA methylation-based assays, particularly those targeting SDC2 and SEPT9 in stool and plasma, exhibit superior diagnostic accuracy compared to other epigenetic modalities. Circulating microRNAs (miRNAs), including miR-211, miR-197, and miR-21, as well as specific long non-coding RNAs (lncRNAs) such as SNHG14, LINC01485, and ASB16-AS1, also show promising diagnostic potential. Furthermore, panels combining multiple epigenetic markers, especially those incorporating DNA methylation targets, have demonstrated improved sensitivity and specificity for early-stage CRC detection. In the context of therapeutic prediction, microRNAs such as miR-140, miR-21, and miR-4442 have been associated with chemotherapy resistance and recurrence risk. DNA methylation markers like LINE-1, mSEPT9 and ERCC1 have also shown predictive value, while lncRNAs including MALAT1 and GAS6-AS1 remain less validated. Regarding prognosis, miRNAs appear to be the most promising biomarkers, with miR-675-5p and miR-150 being associated with poor survival, while miR-767-5p and miR-215 predict favorable outcomes. Methylation of NKX6.1, IGFBP3, and LMX1A has been identified as an independent negative prognostic factor, while SFRP2 hypermethylation is linked to better prognosis. Selected lncRNAs, including THOR and LINC01094, have also demonstrated significant prognostic value. Despite these advances, challenges persist, including inconsistent reporting, limited external validation, and a lack of replication by independent research groups.

While Prognostic Nutritional Index (PNI) is an established predictor of outcomes in Asian gastric cancer (GC) patients, data among Western populations are limited. This study assessed the predictive value of PNI in European GC patients undergoing multimodal treatment. Data from GASTRODATA, the largest European repository of GC patients undergoing gastrectomy, were collected between 2017 and 2022. The primary outcome was textbook outcome (TO) achievement, and the secondary was 90‐day mortality. PNI was calculated one day before surgery, with a cut‐off of 45.5 based on ROC analysis. Among 721 patients included 60.7% were men. Most patients had advanced tumors (cT3‐4 = 75.2%) and metastatic lymph nodes (57.7%). Neoadjuvant chemotherapy (NAC) was administered to 46.7% of patients, and 32.9% received adjuvant chemotherapy. Median PNI was 49.5 (IQR 45.0–56.4). Low PNI was present among 30% of patients and was associated with decreased odds of TO achievement (OR = 0.57, 95% CI 0.37–0.89), higher 90‐day mortality (OR = 4.99, 95% CI 2.32–10.73). NAC administration was associated with lower morbidity risk (OR = 0.56, p = 0.0408), and low PNI was a predictor of receiving AC (p = 0.0005). PNI was a valuable predictor for oncological outcomes and morbidity among European GC patients undergoing multimodal. While low PNI was associated with decreased odds of TO achievement and increased risk of 90‐day mortality, further prospective and nutritional intervention studies are warranted to standardize the PNI threshold and improve its clinical applicability.

Although malignancies during pregnancy are relatively rare, breast cancer emerges as the most common neoplasm affecting pregnant women. Diagnostic workup and multimodal treatment of breast cancer during pregnancy must be weighed against the potential risk to the fetus. With the increasing number of breast cancer diagnoses during pregnancy, this narrative review aimed to outline the epidemiological and molecular background, followed by presenting available therapeutic options. Surgery remains the treatment of choice among patients with breast cancer during pregnancy. However, systemic therapy based on anthracyclines, fluoropyrimidines, taxanes and platinum derivatives is possible after 12 weeks gestation and can be administered in both neoadjuvant and adjuvant settings. Novel diagnostic and therapeutic directions are investigated. Due to its complexity, the treatment process should be managed by multidisciplinary team.

Purpose The purpose of this study was to evaluate the feasibility and safety of indocyanine green (ICG) fluorescence as an alternative to traditional sentinel lymph node biopsy (SLNB) techniques in breast cancer (BC) patients undergoing neoadjuvant chemotherapy (NAC). Specifically, the study aimed to assess sentinel node identification rates and the effectiveness of ICG in axillary staging without the use of radioactive tracers. Methods This retrospective study included 71 BC patients treated with NAC, who underwent SLNB using ICG fluorescence between 2020 and 2024. ICG was injected intradermally around the nipple–areolar complex, and the lymphatic pathways were visualized with a fluorescence camera. SN identification rate (IR) and retrieval of three or more SNs were the primary and secondary endpoints, respectively. Statistical analyses were performed using the Mann–Whitney U test for continuous variables and Fisher’s exact test for categorical variables. Results ICG-guided SNs were identified in 91.5% of patients, with a median retrieval time of 25 min (range: 10–50). Three or more SNs were successfully collected among 66.2% of cases and 38% of patients achieved a complete pathological response to NAC, while 53.5% had partial responses. Metastatic SNs were found in 21.1% of patients, and no serious intraoperative or postoperative complications were observed. Conclusion ICG fluorescence-guided SLNB proved to be a feasible and promising method for SNs identification among BC patients after NAC. While ICG shows potential as an alternative to traditional techniques, further studies are required to confirm these findings and to establish ICG role in post-NAC axillary staging.

Background: There is an upward shift in the incidence and localization of gastric cancer (GC). Proximal gastrectomy (PG) has been advocated as an alternative operation for upper-third GC. An uneventful postoperative course is currently measured using a well-defined textbook outcome (TO), which represents a composite of surgical quality metrics. The aim of this study was to compare TO after two reconstruction methods following PG: double-tract reconstruction (DTR) and posterior esophagogastrostomy with partial neo-fundoplication (EGF). Materials and Methods: Primary proximal gastric adenocarcinoma patients who had undergone PG with DTR or EGF were included in this study. In a prospectively collected database, DTR and EGF were identified in 30 and 30 patients, respectively. Results: Patients with DTR had a 5.5-fold higher chance of achieving TO compared to those with EGF (OR = 5.67; p = 0.0266). No statistically significant differences in overall survival were noted when both reconstruction methods were compared. Conclusion: In patients with proximal GC undergoing PG, TO is more likely to be achieved using DTR compared to EGF, with similar overall survival. Randomized controlled trials are warranted to indicate the preferred reconstruction technique after PG.

In 2022, colorectal cancer (CRC) was the third most prevalent malignancy worldwide. The therapeutic approach for CRC typically involves a multimodal regimen. The human gut microbiota comprises over 35,000 bacterial species. The composition of the gut microbiota is influenced by dietary intake, which plays a crucial role in food absorption, nutrient extraction, and the development of low-grade inflammation. Dysbiosis in the gut microbiota is a key driver of inflammation and is strongly associated with CRC development. While the gut microbiome influences CRC initiation and progression, emerging evidence suggests a role for the gut microbiome in modulating the efficacy and toxicity of cancer treatments. Therapeutic strategies targeting the gut microbiome, such as probiotics, hold promise as effective interventions in the modern therapeutical approach to CRC. For example, Microbiota Implementation to Reduce Anastomotic Colorectal Leaks (MIRACLe) implementation has resulted in improvements in clinical outcomes, including reduced incidence of anastomotic leakage (AL), surgical site infections (SSIs), reoperation, as well as shorter recovery times and hospital stays compared with the control group. Therefore, this review aims to describe the current state of knowledge regarding the involvement of the gut microbiota in CRC pathogenesis and its potential therapeutic implications to treat CRC.

The incidence of gastric cancer (GC) is expected to increase to 1.77 million cases by 2040. To improve treatment outcomes, GC patients are increasingly treated with neoadjuvant chemotherapy (NAC) prior to curative-intent resection. Although NAC enhances locoregional control and comprehensive patient care, survival rates remain poor, and further investigations should establish outcomes assessment of current clinical pathways. Individually assessed parameters have served as benchmarks for treatment quality in the past decades. The Outcome4Medicine Consensus Conference underscores the inadequacy of isolated metrics, leading to increased recognition and adoption of composite measures. One of the most simple and comprehensive is the “All or None” method, which refers to an approach where a specific set of criteria must be fulfilled for an individual to achieve the overall measure. This narrative review aims to present the rationale for the implementation of a novel composite measure, Textbook Neoadjuvant Outcome (TNO). TNO integrates five objective and well-established components: Treatment Toxicity, Laboratory Tests, Imaging, Time to Surgery, and Nutrition. It represents a desired, multidisciplinary care and hospitalization of GC patients undergoing NAC to identify the treatment- and patient-related data required to establish high-quality oncological care further. A key strength of this narrative review is the clinical feasibility and research background supporting the implementation of the first and novel composite measure representing the “ideal” and holistic care among patients with locally advanced esophago-gastric junction (EGJ) and GC in the preoperative period after NAC. Further analysis will correlate clinical outcomes with the prognostic factors evaluated within the TNO framework.

The 5th edition of the World Health Organization (WHO) classification of tumors of the digestive system distinguishes four categories of appendiceal tumors (ATs): serrated lesions and polyps, mucinous neoplasms, adenocarcinomas, and neuroendocrine neoplasms (NENs). The differential diagnosis of ATs can be challenging in medical practice, due to their rarity and lack of data from randomized controlled trials on a large, diverse group of patients. ATs are usually noted in specimens obtained during appendectomies due to clinical acute appendicitis. In the European population, most ATs (65%) occur over the age of 50 and among women (56.8%). According to histological type, 54.6% are neuroendocrine tumors (NETs); 26.8% cystic, mucinous, and serous neoplasms; and 18.6% adenocarcinoma not otherwise specified (NOS). On pathologic analysis, most AT findings are benign lesions or small NENs that do not require further therapeutic measures. The presence of appendiceal mucinous neoplasm (AMN) can lead to pseudomyxoma peritonei (PMP). While the multimodal treatment for abdominal malignancies has evolved over the past several decades, the clinical workup and treatment of ATs remain a challenge. Therefore, this review aims to describe the diagnostic possibilities, molecular-based diagnosis, staging, differences in the treatment process, and prognostic factors associated with ATs.