Objective:To reveal the molecular characteristics of gene fusions in gastric cancer and their potential targeted therapeutic value, and to develop new targeted treatment strategies for advanced gastric cancer.Methods:Tumor tissue samples from 50 fusion-positive gastric cancer patients admitted to the Zhejiang Provincial People′s Hospital from January 2018 to December 2024 were retrospectively included. Next-generation sequencing (NGS) technologies for DNA and RNA were used to analyze gene fusion events in these 50 patients.Results:A total of 53 gene fusion events were detected in the 50 gastric cancer samples, among which 73.6%(39) were druggable fusion types. The main types included FGFR (25.6%, 10/39), NTRK (15.4%, 6/39), MET (12.8%, 5/39), and ROS1 (12.8%, 5/39). Further verification by RNA NGS showed that some gene fusion events could not be confirmed at the transcript level, indicating that there was a certain false positive rate in DNA-level detection. Conclusions:This study provides new molecular targets for personalized targeted therapy of gastric cancer, especially new clinical application prospects for targeted therapy of genes such as FGFR, NTRK, MET, and ROS1. It also emphasizes the importance of RNA NGS in the detection of gene fusions in gastric cancer, which can effectively supplement and correct the false positive signals of DNA NGS and further improve the detection accuracy.

Gastric cancer is one of the most common digestive system malignancies in China. Most patients are diagnosed at an advanced stage (Stage Ⅲ-Ⅳ), with poor prognosis and great difficulty in treatment. This article systematically summarizes the epidemiological characteristics, diagnostic methods, and comprehensive treatment strategies for advanced gastric cancer. In terms of diagnosis: although serum tumor markers have value in dynamic monitoring, their specificity is limited; molecular markers have gradually become the core basis for precision treatment; imaging, gastroscopy, and laparoscopy form a complementary diagnostic chain, which can improve the accuracy of staging. In terms of treatment: radical surgery remains the main treatment method, emphasizing R0 resection and standardized D2 lymph node dissection; palliative surgery aims to relieve symptoms and improve quality of life. In recent years, the development of conversion therapy has provided surgical opportunities for some initially unresectable patients; local treatments such as proton radiotherapy, hyperthermic intraperitoneal chemotherapy (HIPEC), and radiofrequency ablation also have value in specific populations. The multidisciplinary team (MDT) model and individualized treatment guided by molecular typing have become future development trends. Although problems such as drug resistance and low detection rate of peritoneal metastasis still exist, the application of cytological examination, multi-omics integration, artificial intelligence-assisted diagnosis and treatment, and new targeted and immunotherapies is expected to break through the current bottlenecks in the treatment of advanced gastric cancer and improve patients′ survival and quality of life.

Objective:To explore the correlation between serum carbohydrate antigen 72-4 (CA72-4) level and pathological differentiation degree of gastric cancer, and to provide reference for early diagnosis, prognosis evaluation and efficacy monitoring of gastric cancer.Methods:A retrospective study was conducted on 136 patients with gastric cancer admitted to Zhejiang Provincial People′s Hospital from April 2022 to December 2024. According to postoperative pathological diagnosis, patients were divided into well-differentiated group ( n=9), moderately differentiated group ( n=36) and poorly/undifferentiated group ( n=91). Preoperative CA72-4 levels and clinical characteristics of patients were collected to analyze the relationship between differentiation degree and CA72-4 level, and to compare the changes of CA72-4 before and after surgery in gastric cancer patients with different differentiation degrees. Results:The preoperative CA72-4 level in the poorly/undifferentiated group was significantly higher than that in the well-differentiated group and moderately differentiated group (all P<0.001). Preoperative CA72-4 level in gastric cancer patients was weakly negatively correlated with differentiation degree ( R=-0.341). After surgery, the CA72-4 level in the poorly/undifferentiated group decreased significantly compared with that before surgery ( P=0.043), while the changes in the well-differentiated group and moderately differentiated group were not significant. Conclusions:There are significant differences in CA72-4 levels among gastric cancer groups with different differentiation degrees. Preoperative CA72-4, as a tumor marker, is of great significance for early diagnosis, prognosis evaluation and postoperative monitoring of gastric cancer. Especially in patients with poorly/undifferentiated gastric cancer, the CA72-4 level is relatively high, which can be used for auxiliary diagnosis and formulation of treatment plans.

Objective:To compare the clinical efficacy of laparoscopic-assisted, totally laparoscopic, and robotic radical gastrectomy (for total or distal gastrectomy) in real-world practice, clarify the advantages and disadvantages of each approach, and provide evidence for clinical surgical selection.Methods:A retrospective analysis was conducted on 225 patients who underwent radical gastrectomy for gastric cancer at the Zhejiang Provincial People′s Hospital from January 2022 to September 2023, including 100 cases of total gastrectomy and 125 cases of distal gastrectomy. Patients were divided into three groups based on the surgical approach: laparoscopic-assisted group, totally laparoscopic group, and robotic group. Perioperative indicators (operation time, intraoperative blood loss, number of lymph nodes dissected, etc.), inflammatory and nutritional indicators (C-reactive protein, white blood cell count, albumin, etc.), and postoperative recovery indicators (time to oral feeding, time to first flatus, length of hospital stay, etc.) were compared among the three groups.Results:In total gastrectomy, there were statistically significant differences among the three groups in C-reactive protein ( P<0.001), operation time ( P=0.002), time to oral feeding ( P<0.001), and intraoperative blood loss ( P<0.001). In distal gastrectomy, significant differences were observed in C-reactive protein ( P<0.001), operation time ( P<0.001), time to oral feeding ( P=0.002), and length of hospital stay ( P<0.001). No statistically significant differences were found in the incidence of postoperative complications or the number of lymph nodes dissected among the three groups (all P>0.05). Conclusions:Each of the three surgical approaches has its own advantages and disadvantages. The laparoscopic-assisted approach has low hardware requirements and shorter hospital stay after distal gastrectomy, making it suitable for widespread application. The robotic approach causes less trauma and milder inflammatory response but has high equipment and maintenance costs, requiring selection based on actual clinical conditions.

Objective:To reveal the molecular characteristics of gene fusions in gastric cancer and their potential targeted therapeutic value, and to develop new targeted treatment strategies for advanced gastric cancer.Methods:Tumor tissue samples from 50 fusion-positive gastric cancer patients admitted to the Zhejiang Provincial People′s Hospital from January 2018 to December 2024 were retrospectively included. Next-generation sequencing (NGS) technologies for DNA and RNA were used to analyze gene fusion events in these 50 patients.Results:A total of 53 gene fusion events were detected in the 50 gastric cancer samples, among which 73.6%(39) were druggable fusion types. The main types included FGFR (25.6%, 10/39), NTRK (15.4%, 6/39), MET (12.8%, 5/39), and ROS1 (12.8%, 5/39). Further verification by RNA NGS showed that some gene fusion events could not be confirmed at the transcript level, indicating that there was a certain false positive rate in DNA-level detection. Conclusions:This study provides new molecular targets for personalized targeted therapy of gastric cancer, especially new clinical application prospects for targeted therapy of genes such as FGFR, NTRK, MET, and ROS1. It also emphasizes the importance of RNA NGS in the detection of gene fusions in gastric cancer, which can effectively supplement and correct the false positive signals of DNA NGS and further improve the detection accuracy.

Gastric cancer is one of the most common digestive system malignancies in China. Most patients are diagnosed at an advanced stage (Stage Ⅲ-Ⅳ), with poor prognosis and great difficulty in treatment. This article systematically summarizes the epidemiological characteristics, diagnostic methods, and comprehensive treatment strategies for advanced gastric cancer. In terms of diagnosis: although serum tumor markers have value in dynamic monitoring, their specificity is limited; molecular markers have gradually become the core basis for precision treatment; imaging, gastroscopy, and laparoscopy form a complementary diagnostic chain, which can improve the accuracy of staging. In terms of treatment: radical surgery remains the main treatment method, emphasizing R0 resection and standardized D2 lymph node dissection; palliative surgery aims to relieve symptoms and improve quality of life. In recent years, the development of conversion therapy has provided surgical opportunities for some initially unresectable patients; local treatments such as proton radiotherapy, hyperthermic intraperitoneal chemotherapy (HIPEC), and radiofrequency ablation also have value in specific populations. The multidisciplinary team (MDT) model and individualized treatment guided by molecular typing have become future development trends. Although problems such as drug resistance and low detection rate of peritoneal metastasis still exist, the application of cytological examination, multi-omics integration, artificial intelligence-assisted diagnosis and treatment, and new targeted and immunotherapies is expected to break through the current bottlenecks in the treatment of advanced gastric cancer and improve patients′ survival and quality of life.

Objective:To explore the correlation between serum carbohydrate antigen 72-4 (CA72-4) level and pathological differentiation degree of gastric cancer, and to provide reference for early diagnosis, prognosis evaluation and efficacy monitoring of gastric cancer.Methods:A retrospective study was conducted on 136 patients with gastric cancer admitted to Zhejiang Provincial People′s Hospital from April 2022 to December 2024. According to postoperative pathological diagnosis, patients were divided into well-differentiated group ( n=9), moderately differentiated group ( n=36) and poorly/undifferentiated group ( n=91). Preoperative CA72-4 levels and clinical characteristics of patients were collected to analyze the relationship between differentiation degree and CA72-4 level, and to compare the changes of CA72-4 before and after surgery in gastric cancer patients with different differentiation degrees. Results:The preoperative CA72-4 level in the poorly/undifferentiated group was significantly higher than that in the well-differentiated group and moderately differentiated group (all P<0.001). Preoperative CA72-4 level in gastric cancer patients was weakly negatively correlated with differentiation degree ( R=-0.341). After surgery, the CA72-4 level in the poorly/undifferentiated group decreased significantly compared with that before surgery ( P=0.043), while the changes in the well-differentiated group and moderately differentiated group were not significant. Conclusions:There are significant differences in CA72-4 levels among gastric cancer groups with different differentiation degrees. Preoperative CA72-4, as a tumor marker, is of great significance for early diagnosis, prognosis evaluation and postoperative monitoring of gastric cancer. Especially in patients with poorly/undifferentiated gastric cancer, the CA72-4 level is relatively high, which can be used for auxiliary diagnosis and formulation of treatment plans.

Objective:To compare the clinical efficacy of laparoscopic-assisted, totally laparoscopic, and robotic radical gastrectomy (for total or distal gastrectomy) in real-world practice, clarify the advantages and disadvantages of each approach, and provide evidence for clinical surgical selection.Methods:A retrospective analysis was conducted on 225 patients who underwent radical gastrectomy for gastric cancer at the Zhejiang Provincial People′s Hospital from January 2022 to September 2023, including 100 cases of total gastrectomy and 125 cases of distal gastrectomy. Patients were divided into three groups based on the surgical approach: laparoscopic-assisted group, totally laparoscopic group, and robotic group. Perioperative indicators (operation time, intraoperative blood loss, number of lymph nodes dissected, etc.), inflammatory and nutritional indicators (C-reactive protein, white blood cell count, albumin, etc.), and postoperative recovery indicators (time to oral feeding, time to first flatus, length of hospital stay, etc.) were compared among the three groups.Results:In total gastrectomy, there were statistically significant differences among the three groups in C-reactive protein ( P<0.001), operation time ( P=0.002), time to oral feeding ( P<0.001), and intraoperative blood loss ( P<0.001). In distal gastrectomy, significant differences were observed in C-reactive protein ( P<0.001), operation time ( P<0.001), time to oral feeding ( P=0.002), and length of hospital stay ( P<0.001). No statistically significant differences were found in the incidence of postoperative complications or the number of lymph nodes dissected among the three groups (all P>0.05). Conclusions:Each of the three surgical approaches has its own advantages and disadvantages. The laparoscopic-assisted approach has low hardware requirements and shorter hospital stay after distal gastrectomy, making it suitable for widespread application. The robotic approach causes less trauma and milder inflammatory response but has high equipment and maintenance costs, requiring selection based on actual clinical conditions.

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor originating from the gastrointestinal tract, mainly associated with KIT and PDGFRA gene mutations, and related to factors such as patient age, gender, and pathological differentiation level. The clinical manifestations of GIST include abdominal pain, indigestion, gastrointestinal bleeding, etc. The diagnostic methods involve endoscopy, imaging examination, and pathological evaluation. The treatment strategy for GIST is customized based on tumor characteristics and individual circumstances, including surgery, drug therapy, and targeted therapy. With the development of molecular biology, the understanding of GIST has become increasingly profound, and various diagnostic techniques and treatments for GIST have made new progress, especially in individualization, precision medicine, and targeted therapy.

Objective:To analyze the clinical efficacy of endoscopic submucosal dissection (ESD) in the treatment of gastrointestinal submucosal tumors (SMT).Methods:A retrospective analysis was conducted on the clinical data of 114 SMT patients who underwent ESD treatment at the Endoscopy Center of the Shulan (Hangzhou) Hospital from January 1, 2023 to December 31, 2023. The use of mucosal incision during surgery, surgical related indicators, and postoperative recovery were observed.Results:The age of the patients in this group ranged from 22-84(61.0±12.0)years old, with 62 males and 52 females. Tumors were located in 5 cases of esophagus, 2 cases of cardia, 11 cases of gastric fundus, 7 cases of gastric body, 3 cases of gastric angle, 13 cases of gastric antrum, 38 cases of colon, 11 cases of sigmoid colon, and 24 cases of rectum. All tumors were located in the submucosal layer, with 55 cases of benign lesions, 44 cases of precancerous lesions, and 15 cases of malignant tumor lesions. All patients successfully completed the surgery without any serious complications or deaths. During the operation, 59 cases used Dual knives, the surgical cost was 5 082.44-12 515.51(8 657.34±1 471.23)yuan, the total hospitalization cost was 10 878.02-32 310.74(18 934.47±4 404.21)yuan; 55 cases used snare devices, the surgical cost was 3 159.87-9 970.71(5 597.37±1 587.78)yuan, the total hospitalization cost was 6 985.92-40 309.26(13 807.12±5 213.76)yuan, the surgical time was 18-204(63.07±35.48)minutes; there were 22 cases of intraoperative bleeding, 8 cases of intraoperative perforation, 36 cases of fasting for 48 hours after surgery, 78 cases of fasting for 72 hours after surgery, and the postoperative hospitalization time was 3-16(6.91±2.38)days. Postoperative complications such as abdominal pain, bloating, and fever occurred in 14 cases. After surgery, 5 patients underwent surgical salvage surgery due to pathological indications of malignant tumors with infiltration depth>500 μm (>1 000 μm in the colon).Conclusions:ESD treatment for SMT is safe and feasible. For different sizes of gastrointestinal SMT, each endoscopic center and surgeon should comprehensively consider factors such as tumor characteristics, treatment effectiveness, and cost-effectiveness balance when selecting the corresponding surgical type and consumables.