Gastric cancer remains a significant health burden, especially in Asia. Potassium-competitive acid blockers (P-CABs) provide stronger acid suppression than proton pump inhibitors (PPIs), but their long-term impact on metachronous gastric cancer (MGC) remains unclear. This study evaluated the incidence and duration-dependent risk of MGC in P-CAB/PPI users. This multicenter retrospective cohort study included patients from 15 institutions in Japan who underwent endoscopic or surgical resection for gastric cancer between 2014 and 2022. After exclusions, 7172 patients who had received H. pylori eradication were analyzed. Chronic use of P-CAB/PPI was defined as administration for more than 3 months. The primary outcome was the incidence of MGC. Cox regression models were used, along with subgroup analyses based on duration and initial treatment type (endoscopy versus surgery). During a median follow-up of 5.8 years, MGC developed in 342 patients. The incidence was highest among P-CAB users (20.9 per 1,000 person-years), followed by PPI users (13.5) and non-users (7.1). Both P-CAB and PPI use were independently associated with increased MGC risk (hazard ratio 3.89 and 1.75, respectively). The association between P-CAB use and MGC was stronger with longer durations of use (hazard ratio 3.44 for < 1 year, 3.95 for 1–3 years, and 9.36 for > 3 years) and was particularly evident in the post-endoscopic group (hazard ratio 4.22) in subgroup analyses. Chronic use of P-CAB/PPI were associated with MGC. Longer duration may be associated with increased risk of MGC. Further studies are warranted to validate these findings.
Purpose Provisional stenting is recommended in percutaneous coronary intervention (PCI) for non-true left main bifurcation lesions (LMBLs); however, unexpected severe stent-jailed left circumflex coronary artery (LCX) narrowing is a clinical concern, and its prediction remains challenging. This study aimed to investigate anatomical features associated with LCX narrowing following provisional stenting for non-true LMBLs without significant LCX lesions and to derive an exploratory risk score using coronary computed tomography angiography (CCTA). Methods This was a multicenter retrospective observational study that enrolled patients who underwent CCTA before PCI for non-true LMBLs with provisional stenting from December 2019 to May 2024. Quantitative CCTA analysis of LMBL was performed, and severe stent-jailed LCX narrowing, defined as angiographic stenosis ≥ 90%, was assessed. Anatomical features associated with LCX narrowing were identified using multivariable analysis, and a CCTA-derived exploratory risk score was derived. Results Overall, 109 patients were recruited, 16 (14.7%) of whom had severe stent-jailed LCX narrowing. Multivariable analysis identified the following parameters as associated with LCX narrowing: left anterior descending artery–LCX vessel angle ≤ 86°, area stenosis (AS) of the distal LM (LMd) ≥ 54%, AS of the ostial LCX ≥ 63%, and calcium thickness of the LMd ≥ 0.5 mm. An exploratory risk score based on these four features showed a stepwise increase in the incidence of severe LCX narrowing, with a C-statistic of 0.877. Conclusion CCTA identified anatomical features associated with severe stent-jailed LCX narrowing following provisional stenting. An exploratory risk score was derived from these features.
To evaluate whether AI can substitute for the first reader in a double-reading workflow for lung-cancer detection on screening chest radiographs. A retrospective analysis was conducted in a screening cohort at Ishikawa Health Service Association that included 155,503 participants undergoing 320,329 examinations between January 2018 and September 2020. From examinations initially identified as suspected lung cancer by the conventional double-reading system (n = 2,882), prespecified exclusions were applied, yielding 1,847 examinations for detection-performance analysis. AI-based lesion detection was retrospectively performed using three AI models, and the localization accuracy of the AI outputs was evaluated. Detection performance (AI vs. first readers) was compared using McNemar’s test with a non-inferiority margin of − 0.05 (AI deemed non-inferior if the lower bound of the 95
BACKGROUND:We aimed at estimating trends in 5-year net survival for myeloid and lymphoid malignancies, by age group and morphological subtype, using data on patients diagnosed during 2000-2014 and registered by 16 Japanese population-based cancer registries participating in the CONCORD-3 study. METHODS:We analyzed data on adult patients (15-99 years) diagnosed with a myeloid or lymphoid malignancy during 2000-2014 and followed up to December 31, 2014. We estimated 5-year net survival by age group and morphological subtype with the Pohar Perme estimator, and age-standardized the estimates using International Cancer Survival Standard weights. RESULTS:Significant improvements were observed in five-year net survival for myeloid malignancies among patients aged 15-44 years (from 57.3% in 2000-2004 to 72.3% in 2010-2014) and 45-54 years (from 41.9% to 61.3% over the same period). For lymphoid malignancies, 5-year net survival improved for all ages, but the improvement was less pronounced for older patients. Five-year net survival improved by 10% or more for myeloproliferative neoplasms, classic Hodgkin's lymphoma, and follicular lymphoma. Moderate improvement was observed for diffuse B-cell lymphoma and acute myeloid leukemia. CONCLUSIONS:Five-year net survival for patients with hematological malignancies improved throughout 2000-2014 in Japan. The improvement was more pronounced in younger than older patients. Continuous and detailed monitoring of cancer survival trends is crucial for devising effective control strategies for hematological malignancies. [221/250 words].
