Peritoneal metastasis is the leading cause of death for gastrointestinal cancers. The native and therapy-induced ascites ecosystems are not fully understood. Here, we characterize single-cell transcriptomes of 191,987 ascites cancer/immune cells from 35 patients with/without gastric cancer peritoneal metastasis (GCPM). During GCPM progression, an increase is seen of monocyte-like dendritic cells (DCs) that are pro-angiogenic with reduced antigen-presenting capacity and correlate with poor gastric cancer (GC) prognosis. We also describe the evolution of monocyte-like DCs and regulatory and proliferative T cells following therapy. Moreover, we track GC evolution, identifying high-plasticity GC clusters that exhibit a propensity to shift to a high-proliferative phenotype. Transitions occur via the recently described, autophagy-dependent plasticity program, paligenosis. Two autophagy-related genes (MARCKS and TXNIP) mark high-plasticity GC with poorer prognosis, and autophagy inhibitors induce apoptosis in patient-derived organoids. Our findings provide insights into the developmental trajectories of cancer/immune cells underlying GCPM progression and therapy resistance.

Background: to discuss the diagnosis, treatment and mechanism of leukemoid reaction in bladder cancer. Methods: to present and analyze the clinical data of a patient who had urothelial carcinoma complicated with leukemoid reaction Result: The patient had years of smoking history. He underwent six TURBT operations during the time of 31st Aug 2015 to 26th Oct 2022. Pathological diagnosis deteriorated from low-grade papillary urothelial carcinoma to high-grade. The patient did not keep to regular bladder perforation or routine follow-up cystoscopy. He also refused radical resection intervention. Last CT results show the following: multiple tumors in the bladder, bilateral ureter bladder entrance invasion, bilateral renal pelvis and ureter dilatation , multiple lymphadenopathy in the pelvis and along the right iliac artery. After cystoscopy examination and urethral catheter was placed, creatinine level gradually decreased. However, body temperature raised from 38 oC to 40o C. White blood cell count increased from 67.83*109/L (neutrophils being 64.5*109/L) to 72.17*109/L (neutrophils being 70.27*109/L). The patient was considered to have leukemoid reaction complicated with bladder cancer. The patient refused to have bone marrow biopsy, palliative care was provided instead. The patient passed away on 28th Oct 2022. Conclusion: Bladder cancer patients complicated with leukemoid reactions are rarely reported clinically. Even after surgical resection, the outcome was poor. Monitoring of G-CSF level in blood can help to make predictions of the patient’s health condition. Blocking the G-CSF signaling pathway might work as a future therapeutic target for bladder cancer complicated with leukemia reaction.