Advances in recurrence risk assessment of gastrointestinal stromal tumor / 中华胃肠外科杂志

Identification of prognosis-related risk factors and accurate assessment of risk stratification in patients with gastrointestinal stromal tumor (GIST) is of great significance not only for establishing a reliable prognostic model and developing a follow-up plan but also for selecting potential populations benefiting from neoadjuvant therapies. Although several risk stratification models have been established, it is still challenging to accurately assess patients' risk of recurrence, and the performance of these prediction models still needs to be improved. This review focused on the latest studies in recurrence risk assessment for GIST patients, and summarized potential predictive markers and recurrence risk models related to tumor-related characteristic parameters, novel laboratory examinations, radiological imaging signatures and molecular pathological features, which could provide a reference for accurate risk stratification and individualized targeted therapies for GIST patients.

Importance of total radiation dose and overall treatment time in T1 early glottic cancer

Background: In this study, we retrospectively reviewed the treatment outcome of 63 patients with T1 early glottic cancer treated with RT alone to determine the treatment outcome and the prognostic factors affecting local control

Materials and Methods: All patients were treated by 6 MV photons with conventional bilateral fields up to a median dose of 66 Gy in 33 fractions

Results: The 5-year local control rate and overall survival were 77.7% and 93.1%, respectively. The total radiation dose with a cut-off value of 66 Gy was a significant prognostic factor for local control. The 5-year local control rate was 54.5% in patients treated with less than 66 Gy compared to 85.7% in patients treated with 66 Gy or higher dose [p = 0.014]. In subgroup analysis, in patients who received 66 Gy or higher doses, all recurrences developed in whose overall treatment time was 49 days or longer, although the statistical significance was marginal [p = 0.066]

Conclusion: This study showed that a total dose of 66 Gy or higher is required for the treatment of T1 glottic cancer, and delivering the total dose within 49 days seems important for local control

Down-Regulation of TGF-β Expression Sensitizes the Resistance of Hepatocellular Carcinoma Cells to Sorafenib

PURPOSE: Sorafenib, a multikinase inhibitor, is the standard therapy for patients with advanced-stage hepatocellular carcinoma (HCC). However, resistance develops to the treatment, therefore, we tried to unravel the underlying mechanism in the resistance of HCC cells to sorafenib via the development of more effective therapeutic strategies. MATERIALS AND METHODS: Various liver cancer cell lines were treated with either sorafenib only or with sorafenib after infection of adenovirus expressing short hairpin RNA (shRNA) against transforming growth factor-β (TGF-β) and p38 activity was examined using western blotting. RESULTS: p38 MAP kinase activity was inhibited by low concentrations of sorafenib, which could potentially lead to sorafenib resistance in HCC cell lines. Subsequently, we used constitutive form of MKK3/6 (MKK3/6E) to confirm that massive cell death was induced by the activation of p38, and demonstrated the ability to activate p38 without any stimulation. In addition, sorafenib resistance was reduced by the activation of p38. Subsequently, we confirmed that TGF-β shRNA effectively recovered the phosphorylation of p38 inhibited by sorafenib, and increased the sensitivity of HCC cells to sorafenib, thereby inducing cell death and overcoming the resistance of HCC cells to sorafenib. CONCLUSION: Our study provides a new therapeutic strategy for HCC that overcomes the resistance of HCC to sorafenib by down-regulation of TGF-β.

Pedicle screw-based dynamic stabilization of the lumbar spine

Although spinal fusion has been the definitive surgical management of symptomatic lumbar degenerative conditions, continued reports of adjacent level degeneration and suboptimal patient outcomes have prompted the advancement of motion-preserving technology. Posterior dynamic stabilization [PDS] devices are designed to maintain native motion while providing indirect foraminal decompression and off-loading of the facets and posterior anulus. Posterior dynamic stabilization systems relying on pedicle screws as vertebral anchors have the advantage of surgeon familiarity with screw placement technique and instrumentation. Interconnections between the screws serve as a tension band to resist posterior distractive forces during flexion and maintain foraminal height in extension. Short-term results of pedicle screw-based PDS systems show comparable pain relief to traditional fusion with the added advantage of retained motion and potential reduction of fusion-related morbidity and of the incidence of adjacent segment degeneration. As with most new technology, pedicle screw based PDS systems require further evaluation to determine their long-term clinical benefit