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Objective@#To acknowledge the availability and rates of annual transition of outcomes during the progression and regression stages of colorectal cancer (CRC) and related diseases, by pooling global follow-up studies on the natural history of CRC.@*Methods@#Till March, 2017, data was collected through systematic literature review over multiple databases, including PubMed, Embase, Cochrane and Chinese Biology Medicine (CBM) disc. Information regarding the characteristics, classification system of health states, related outcomes and incidence rates on CRC or high-risk adenoma for the surveillance cohorts of the studies, were extracted and summarized. Both Meta and sensitivity analyses were performed on those outcomes if they appeared in more than 3 studies, using the random effects model. Annual transition rate with 95%CI was used to estimate each of the outcomes, Quality of the studies was assessed, using the Newcastle-Ottawa Scale.@*Results@#A total of 29 cohort studies were included, with the mean follow-up period as 5.7 years. All studies except one, focused on adenoma-carcinoma pathway and reported the outcome parameters of adenomas by different risk, and some reported the findings on different sizes (n=6) of adenomas. These cohorts were divided into three groups (normal status, with low-risk or high-risk adenoma) according to the status of baseline endoscopic pathologic findings. Their available outcome parameters, corresponding number of involved articles, aggregated sample size and pooled annual transition rates were presented. Six parameters were obtained in the normal cohorts, including those from normal to low-risk adenoma (16 articles, 58 235, 0.030: 0.024-0.037), to high-risk adenoma (17 articles, 62 089, 0.003: 0.002-0.004), to diminutive adenoma (<5 mm, 4 articles, 1 277, 0.021: 0.013-0.029), to small adenoma (6-9 mm, 4 articles, 1 277, 0.006: 0.001-0.010), to large adenoma (≥10 mm, 7 articles, 3 531, 0.002: 0.000-0.003) and to CRC (19 articles, 104 836, 0.000 3: 0.000 2-0.000 5). Three parameters were obtained in low-risk adenoma in cohorts with polypectomy findings, including recurrence (9 articles, 4 788, 0.109: 0.062-0.157) from low-risk adenoma after polypectomy to high-risk adenoma (10 articles, 5 736, 0.009: 0.004-0.013) and to CRC (12 articles, 11 347, 0.000 6: 0.000 4-0.000 8). Three parameters were obtained on high-risk adenoma from cohorts with polypectomy findings, including recurrence (12 articles, 7 030, 0.038: 0.028-0.048) from high-risk adenoma after polypectomy to low-risk adenoma (8 articles, 2 489, 0.133: 0.081-0.185) and CRC (14 articles, 14 899, 0.002: 0.001-0.003). Except for normal to low-risk adenomas, results from the sensitivity analysis for the other parameters showed stable. Of the included studies, two presented incidence rates of CRC in different clinical stages and the another two were focusing on the parameters related to serrated pathway.@*Conclusions@#Globally, follow-up studies reported data on natural history of colorectal cancer is of paucity. Compared to the "adenoma-carcinoma" pathway, transition parameters of the serrated lesion pathway are more limited. This Meta-analysis provided convincing evidence for optimizing the strategies regarding follow-up program on the disease, using the baseline endoscopic findings from global CRC Screening Program. These results also offered strong data-related support for Chinese population- specific interventional model on colorectal cancer.
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Objective@#To investigate the associations between genetic variations in DNA mismatch repair genes and sensitivity as well as prognosis to preoperative chemoradiotherapy in patients with locally advanced rectal cancer.@*Methods@#Fourteen haplotype-tagging single nucleotide polymorphisms (htSNPs) of MLH1, MLH3 and MSH2 genes were genotyped by Sequenom MassARRAY method in 146 patients with locally advanced rectal cancer who received preoperative chemoradiotherapy. The associations between genotypes and response to capecitabine-based neoadjuvant chemoradiotherapy (nCRT) were measured by odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for sex, age, clinical stages and karnofsky performance score (KPS) by unconditional logistic regression model. The survival analyses were performed by the hazard ratios (HRs) and 95% CIs by Cox proportional regression model.@*Results@#Among 146 cases, 64 patients were nCRT responders with a response rate of 43.8%. MLH3 rs175057 C>T and MSH2 rs13019654 G>T loci were associated with the sensitivity to preoperative chemoradiotherapy. Compared with the rs175057 CC genotype, the adjusted OR for patients with CT and TT genotypes was 0.42 (95% CI: 0.19-0.91; P=0.029). Moreover, for rs13019654, the adjusted OR for patients with the GT or TT genotypes was 0.49 (95% CI: 0.24-0.98; P=0.047) than those with GG genotype. The remaining 12 SNPs, including rs1540354, rs4026175, rs1981929, rs2042649, rs2303428, rs3771273, rs4608577, rs4952887, rs6544991, rs6544997, rs10188090 and rs10191478, were not significantly associated with therapeutic response to preoperative chemoradiotherapy. Meanwhile, MLH3 rs175057 C>T locus was also associated with longer overall survival time in locally advanced rectal cancer (HR=0.44, 95% CI: 0.20-0.96, P=0.038), whereas MSH2 rs3771273 T>A, rs10188090 A>G and rs10191478 T>G loci were associated with shorter overall survival time (HR=1.74, 95% CI: 1.06-2.84, P=0.028; HR=1.64, 95% CI: 1.01-2.66, P=0.046; HR=1.71, 95% CI: 1.01-2.91, P=0.047, respectively). The remaining 10 SNPs, including rs1540354, rs4026175, rs1981929, rs2042649, rs2303428, rs4608577, rs4952887, rs6544991, rs6544997 and rs13019654, were not significantly associated with prognosis.@*Conclusions@#Genetic polymorphisms of MLH3 rs175057 and MSH2 rs13019654 loci can predict the nCRT response, while MLH3 rs175057 as well as MSH2 rs3771273, rs10188090 and rs10191478 may predict prognosis in patients with locally advanced rectal cancer who received preoperative chemoradiotherapy. Therefore, these SNPs could be used as potential genetic markers in the personalized therapy of rectal cancer.
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Objective@#To evaluate the compliance rate of screening colonoscopy and associated factors in high-risk populations of colorectal cancer (CRC) in urban China.@*Methods@#CRC screening data from the Program of Cancer Screening in Urban China conducted in 12 provinces in 2012-2014 was used in the present study. All 97 445 participants were asked to take epidemiological questionnaire survey to evaluate their cancer risk. Participants who were evaluated as "high risk for CRC" were recommended to receive colonoscopy at designated hospitals. Chi-square tests were used to compare the differences of participation rates between groups. Multivariate logistic regression models were applied to explore the potential factors associated withthe compliance rate of screening colonoscopy.@*Results@#Overall, 97 445 participants of CRC high-risk were included in this analysis, and 14 949 of them took screening colonoscopy, yielding a participation rate of 15.3%. The participation rate varied greatly across provinces, ranging from 25.2% (2 785/11 071) in Heilongjiang to 9.7% (1 698/17 515) in Liaoning. Moreover, the participation rate in 2013-2014 was significantly higher than that in 2012-2013 (17.1%(9 766/57 280) vs 12.9% (5 183/40 165), χ2=57.67, P<0.001) . The multivariate logistic regression analyses showed that: compared with individuals of 40-49 years old, individuals of 50-59 or 60-69 years old were more willing to accept screening colonoscopy, with OR of 1.17 (95% CI: 1.12-1.22) and 1.13 (95% CI: 1.08-1.19), respectively; compared with uneducated individuals, individuals with good educational background of equivalent to high school or higher (OR=1.29, 95% CI:1.10-1.50) were more willing to accept screening colonoscopy; compared with individuals who never took fecal occult blood tests (FOBT) before, individuals with previous positive FOBT results (OR=1.40, 95% CI:1.31-1.50) were more willing to accept screening colonoscopy; compared with individuals with no inflammatory bowel diseases (IBD), individuals with IBD (OR=1.63, 95%CI:1.56-1.69) were more willing to accept screening colonoscopy; Compared with individuals without polyp history, individuals having history of previous polyp detection (OR=1.43, 95% CI:1.37-1.50) were more willing to accept screening colonoscopy; compared to individuals with no family history of CRC, individuals with history of CRC (OR=1.60, 95% CI:1.53-1.66) were more willing to accept screening colonoscopy.@*Conclusion@#The overall participation rate of screening colonoscopy among high-risk population of CRC in the 12 participating sites was 15.3%. The study findings indicated that age, education level, history of past fecal occult blood test, IBD, history of polyp, family history of CRC were associated with the compliance rate of colonoscopy in this population-based CRC screening program.
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Objective To investigate the pattern of nodal recurrence after curative resection in adenocarcinoma of the gastroesophageal junction ( AGE ) , and to provide a basis for delineation of the radiation range in the high-risk lymphatic drainage area.Methods A retrospective analysis was performed in 78 patients with locally advanced AGE who were newly treated in our hospital from January 2009 to December 2013 and had complete clinical data.All patients received curative resection and were pathologically diagnosed with stage T3/T4 or N (+) AGE.Those patients were also diagnosed with SiewertⅡor Ⅲ AGE by endoscopy, upper gastroenterography, macroscopic examination during operation, and pathological specimens.None of the patients received preoperative or postoperative radiotherapy.All patients were diagnosed by imaging with postoperative nodal recurrence.The computed tomography images of those patients were accessible and had all the recurrence sites clearly and fully displayed.Results The median time to recurrence was 10 months ( 1-48 months) , and 90%of the recurrence occurred within 2 years after surgery.The lymph nodes with the highest risk of recurrence were No.16b1( 39%) , No.16a2( 37%) , No.9 (30%), and No.11p (26%), respectively.There was no significant difference in the recurrence rate within each lymphatic drainage area between patients with SiewertⅡandⅢAGE ( P=0.090-1.000) .The lymph nodes with the most frequent recurrence were No.16b1, No.16a2, No.9, No.16b2, No.11p, and No.7 in patients with stage N3 AGE and No.11p, No.16b1, No.16a2, No.9, No.8, and No.7 in patients with stage non-N3 AGE.Patients with stage N3 AGE had a significantly higher recurrence rate in the para-aortic regions (No.16a2-b2) than those with stage non-N3 AGE (67%vs.33%, P=0.004, OR=4.00, 95% CI=1.54-10.37) .Conclusions The lymph nodes with the highest risk of recurrence are located in the celiac artery, proximal splenic artery, and retroperitoneal areas ( No.16a2 and No.16b1) in patients with SiewertⅡorⅢlocally advanced AEG.Moreover, patients with stage N3 AGE have a higher risk of retroperitoneal recurrence.The above areas should be involved in target volume delineation for postoperative radiotherapy.
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<p><b>BACKGROUND</b>The incidence of thyroid cancer has been increasing. Our aim was to evaluate the efficacy of low-dose dual-phase helical computed tomography (CT) in the characterization of thyroid lesions, and to discuss the relationship between image characteristics and their pathology.</p><p><b>METHODS</b>One hundred and six patients with thyroid lesions underwent low-dose dual-phase helical CT after the injection of contrast material. CT scans were obtained at arterial and venous phase with delays of 25 and 65 seconds, and tube current of 60 and 120 mA, respectively. The attenuation change in the lesion between the arterial and venous phase was analyzed and categorized as "increased," "decreased," "mixed" or "no change."</p><p><b>RESULTS</b>Histopathologic diagnosis was obtained by surgery in 106 patients (115 lesions). Of the 106 patients, 45 had nodular goiter, 5 thyroid adenoma, 6 thyroiditis, and 50 papillary thyroid carcinoma (PTC) (59 lesions). The attenuation value showed a significant difference (P < 0.05) between the arterial and venous phase for the high attenuation area. There was statistical significant difference in terms of attenuation value in high attenuation areas at both phases and in low attenuation areas on arterial phase between nodular goiter and PTC (P < 0.05). However, there was no significant difference in attenuation value between adenoma and PTC. Twenty-nine cases (76.3%) of goiter manifested mixed type, 3 cases (3/5) of adenoma showed decreased type, 6 cases (6/6) of thyroiditis showed increased type, and 55 cases (93.2%) of PTC showed decreased type attenuation. The sensitivity, specificity for thyroid carcinoma by dual-phase CT were 94.9% and 80.4% respectively. The overall diagnostic accuracy for thyroid lesions by dual-phase CT was 87.8%.</p><p><b>CONCLUSIONS</b>The performance of dual-phase helical CT is related to the pathological structure of the lesions. The analysis of enhancement patterns by using dual-phase helical CT will be helpful in the differential diagnosis of thyroid lesions.</p>
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Carcinoma , Diagnostic Imaging , Pathology , Carcinoma, Papillary , Goiter, Nodular , Diagnostic Imaging , Pathology , Thyroid Gland , Diagnostic Imaging , Pathology , Thyroid Neoplasms , Diagnostic Imaging , Pathology , Thyroiditis , Diagnostic Imaging , Pathology , Tomography, X-Ray ComputedABSTRACT
Objective To analyze and summarize the CT features of medullary thyroid carcinoma (MTC).Methods 30 patients with MTC proved by surgery and pathology were scanned by CT.And the CT manifestations were analyzed retrospectively.Results In a total of 30 patients,a single lesion in 25 (83.3%)patients and multiple ones in 5 (16.7%)were found with irregular shape in 27 (90.0%),unclear border in 26 (86.7%),heterogenous enhancement with irregular internal hypodensity in 27 (90.0%),cal-cifications in 4 (13.3%)and invasion of trachea in 4 (13.3%).As for the 29 patients underwent the neck surgery ,26 (89.7%) were pathologically confirmed with lymph nodes metastasis.CT showed the metastatic lymph nodes with well-defined border in 1 2 (46.2%)and ill-defined one in 14 (53.8%),calcifications in 5 (19.2%)and heterogenous enhancement with irregular internal hy-podensity in all (100.0%).Conclusion CT features of MTC and metastatic lymph nodes appeared as heterogenous enhancement with irregular internal low attenuation area,which can improve the accuracy of preoperative diagnosis.
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Objective To investigate the optimal methods of detecting micrometastasis of sentinel lymph node(SLN) in papillary thyroid carcinoma(PTC).Methods Data of 51 consecutive PTC patients without clinical evidence of cervical lymph node metastasis were analyzed.They were conducted with SLN localization with blue dye,technetium-labeled sulfur colloid or the combination of them from Aug.2007 to Sep.2010.55 SLNs from 18 cases were selected.No metastasis was found to these 55 SLNs by routine pathological section.The 55 SLNs were serially sectioned at a 50 μm interval and stained by both HE and immunohistochemistry for detecting micrometastasis.Results SLN was successfully identified in all the 51 cases,with SLN identification rate of 100％.Among the 18 cases without metastasis to SLN by routine pathological section,5 cases were found micrometastasis by step sectioning plus immunohistochemically stains.The false negative rate was reduced from 15.4％ by routine pathological section to 2.6％ by step sectioning plus immunohistochemically stains.Conclusion Cytokeratin immunohistochemistry on series sections is a reliable method in detecting SLN micrometastasis in PTC.
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Objective To evaluate the efficiency of BIOMED-2 system in detecting IGH gene clonal rearrangement and application in diagnosis of extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) lymphoma. Methods Forty-five cases were collected, including 36 MALT lymphomas from different organs, 3 extranodal lymphoid tissue proliferative lesions and 6 severe gastritis associated with H pylori. DNA was extracted from the formalin fixed paraffin embedded blocks of these cases and the quality of DNA was assessed using the BIOMED-2 specimen mixed control primers. IGH gene clonal rearrangement was detected using IGH VH-JH primers. The sensitivity and specificity of BIOMED-2 PCR were analyzed.Results Adequate DNA (≥ 300 bp) was obtained in 31 of 45 samples (including 22 MALT lymphomas, 3 lymphoid tissue proliferative lesions and 6 severe gastritis), and the DNA from the other 14 samples was degraded seriously. 16 of 22 MALT lymphomas were positive of IGH clonal rearrangement with the sensitivity of 72.7 ％.In contrast,none of 6 severe gastritis was positive with the specificity of 100 ％ IGH and clonal rearrangement were detected in one of 3 lymphoid tissue proliferative lesions. Conclusion BIOMED-2 assay is an effient and reliable method for diagnosis and differential diagnosis of MALT lymphoma which is important for clinical practical value.
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ObjectiveTo evaluate combined radioisotope and methylene blue dye method for identifying sentinel lymph node (SLN) for modified radical neck dissection of papillary thyroid carcinoma (PTC). MethodFifty-one consecutive PTC patients without clinical evidence of locoregional lymph node involvement were enrolled in the study between August 2007 and September 2010.5 h ( rangel.5 - 8 h) before the surgery,one single intratumoral injection of 74 MBq in a volume of 0.4 ml 99mTc -Dextran was administered under ultrasound guidance and 1％ methylene blue dye was injected into the parenchyma surrounding the primary tumor intraoperatively.Preoperative lymphoscintigraphy,intra-operative hand-held gamma probe detecting and blue dyed lymph node were used to identify the SLN.All SLNs were sent for frozen-section and the specimens of routine selective neck dissection were stained with haematoxylin and eosin (H&E). ResultsSLNs were identified in 48 of 51 cases (94.1％ ) with combination method.SLN identification rate were 66.7％by methylene blue dye method and 90.2％by radioisotope method respectively.Final pathologic examination revealed that 30 cases ( 58.8％ ),including 3 cases who had negative SLNs,had lateral neck occult lymph node metastasis.The rate of occult lymph node metastasis in level Ⅱ,level Ⅲ,level Ⅳ and level Ⅴ were 17.6％,52.9％,29.4％ and 0％.Thus,the sensitivity,specificity,accuracy, and positive and negative predictive values of SLN biopsy were 90％, 100％,94.1％,100％ and 87.5％,respectively. ConclusionsSLNB is feasible and safe,the findings correlate with lateral lymph node status.Therefore,SLN biopsy is a good method for estimating the status of lateral lymph node in patients with clinical negative lymph node papillary thyroid carcinoma.
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Objective To identify the expression of DLK1 protein in different types of renal cell carcinomas and its correlations with pathological characteristics and metastasis. Methods Immunohistochemistry analysis was performed to evaluate the expression of DLK1 protein in 94 cases of primary clear cell renal cell carcinoma, 76 cases of papillary renal cell carcinoma, 45 cases of chromophobe renal cell carcinoma, 71 cases of distal metastatic and 24 cases of lymph node metastatic clear cell renal cell carcinoma, as well as 18 cases of normal renal tissue. The correlations of DLK1 protein expression with pathological characteristics were analyzed. Results DLK1 protein was expressed in proximal and distal renal tubular epithelial cells in all the normal renal cases. In contrast, DLK1 protein expression was lower in different types of renal cell carcinoma. The low or negative expression of DLK1 protein in clear cell renal cell carcinoma, papillary renal cell carcinoma and chromophobe renal cell carcinoma was 33.0% (31/94), 27.6% (21/76) and 33.3% (15/45), respectively. Compared to normal renal tissue, DLK1 protein expression was significantly down-regulated in renal cell carcinomas (P＞0.05), whereas there was no significant difference on DLK1 protein expressions among the different types (P＞0.05) of renal cell carcinomas. DLK1 protein expression was not correlated with sex (60 male and 34 female cases), age (≥55, 50 cases and 55, 44 cases), grade (41 cases in grade I, 9 cases in grade II, 21 cases in grade III and 23 cases in grade Ⅳ respectively) and lymph node metastasis (76 cases with and 18 cases without lymph node metastasis) in clear cell renal cell carcinoma (P＞0.05). There was also no significant difference among primary, lymph node and distal metastatic lesions of clear cell carcinoma (P＞0.05). Conclusions DLK1 protein expression is commonly down-regulated in different types of renal cell carcinomas. Down-regulation of DLK1 protein expression is not associated with pathological characteristics and metastasis in clear cell renal cell carcinoma.
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Objective To clarify the MUM1/IRF4 expression in follicular lymphoma (FL) and its clinical and pathological significance. Methods Ninety-six cases FL were immunostained with MUM1,CD10,bcl-2,bcl-6 and Ki-67 antibodies. The results were compared with their clinical and pathological features. Results The overall MUM1 expression rate in FL was 59.2 % (58/96),including 36.2 % (19/51) grade 1 or 2 and 86.4 %(39/45) grade 3 cases (x2 =24.406,P <0.001). 68.9 % cases with diffuse area were MUM1 positive (x2 =8.161,P =0.004). MUM 1 and CD10 expression had inverse correlation,83.3 % CD10 negative cases were MUM1 positive (x2= 12.649,P<0.001). The mitosis rate and Ki-67 label index were statistically higher in MUM1 positive cases than in negative cases (t = -3.852 & -4.610,respectively,P <0.001). Conclusion MUM1 can be used as a biomarker to divide FL into different malignancies. The MUM1 positive FL may be the feature of high grade non germinal center B cell malignant lymphoma.
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<p><b>OBJECTIVE</b>To investigate the significance of thyroid transcription factor-1 (TTF-1) in the histogenesis of pulmonary sclerosing hemangioma (PSH).</p><p><b>METHODS</b>With clinicopathologic data of 36 PSH patients obtained, all specimens were stained by immunohistochemical method with a panel of antibodies including TTF-1, SpA, CK, EMA, F-VIII, CD34, Claretinin, HBME, synaptophsin, chromogranin, actin and S-100.</p><p><b>RESULTS</b>The patients were mostly women with a mean age of 46.7 years and a median age of 48 years. All lesions were solitary and well circumscribed with a mean size of 3.3 cm and a median size of 3 cm. No multiple or metastasis was found. Surface cells (SC) and round cells (RC) were showed in PSH, with more than 90% showing TTF-1 and EMA by immunohistochemical method. CK and SpA were showed in SC, which were not showed in RC. Neuroendocrine cells scattered within RC of PSH were detected in a few cases. Mesothelial, vascular endothelial, neuroendocrine, and myoepithelial markers by immunohistochemical method were negative.</p><p><b>CONCLUSION</b>Pulmonary sclerosing hemangioma, a benign tumor, originates from the alveolar pneumocytes. Its surface cells are more mature, while the round cells, being primitive respiratory epithelia, may undergo phenotypic differentiation and evolve into mucinous glands or neuroendocrine structure among other components.</p>