Efficacy and safety of sunitinib on patients with imatinib-resistant gastrointestinal stromal tumor / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy and safety of sunitinib on the management of gastrointestinal stromal tumors (GIST) patients with imatinib resistance.</p><p><b>METHODS</b>Clinical data of 48 patients with imatinib-resistant GIST received sunitinib therapy from May 2008 to April 2012 in the Union Hospital of Fujian Medical University were analyzed retrospectively. Eighteen patients received 50 mg/d of sunitinib in a protocol of 4/2 (4 weeks on and 2 weeks off) [50 mg/d (4/2)], and 30 patients received a protocol of 37.5 mg of sunitinib continuous daily dose (37.5 mg/d CDD).</p><p><b>RESULTS</b>The median duration of sunitinib administration of all the 48 patients was 56 weeks, and the short-term efficacy was evaluated at 24 weeks after the initial treatment according to the Choi criteria. The response rate was 27.1% (13/48), including 1 case with complete response (CR), 12 cases with partial response (PR), and 21 cases with stationary disease (SD). The disease control rate was 70.8% (34/48). The mean follow-up time of 48 patients was 89 weeks. The median progression-free survival (PFS) and overall survival (OS) were 48 weeks and 92 weeks respectively. Stratified analyses indicated that the median PFS of patients previously treated by imatinib 400 mg/d and >400 mg/d were 53 weeks and 35 weeks respectively (P=0.018), and the median OS of these two groups were 157 weeks and 71 weeks respectively (P=0.003). Patients with exon 11 mutations had a significantly shorter OS compared with those with exon 9 mutations (71 weeks vs 157 weeks, P=0.008). Hand-foot syndrome was the most common adverse effect (25/48, 52.1%), followed by nausea (24/48, 50.0%), fatigue (23/48, 47.9%), neutropenia(21/48, 41.7%). The sub-group analysis of two protocols of sunitinib administration showed that the incidence of diarrhea and hand-foot syndrome were higher in 50 mg/d (4/2) group than those in 37.5 mg/d CDD group (P=0.027, P=0.048).</p><p><b>CONCLUSIONS</b>Sunitinib is effective for the patients with imatinib-resistant GIST. After 400 mg/d imatinib treatment failure, sunitinib should be prescribed instead of increased dosage of imatinib. Patients with KIT exon 9 mutations present better prognosis than those with KIT exon 11 mutations. The protocol of sunitinib 37.5 mg/d CDD possesses better safety.</p>

Effect of number of resected lymph nodes on the prognosis of gastric cancer patients without lymphatic metastasis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the long-term correlation between the number of resected lymph nodes (LNs) and the prognosis of patients with node-negative gastric cancer.</p><p><b>METHODS</b>From January 1995 to December 2004, 221 patients with gastric cancer underwent D2 radical resection and were proved with no nodal involvement. The clinical records of the patients were analyzed retrospectively. The relationships of the dissected LNs number to 5-year survival rate and post-operative complication rate were analyzed respectively.</p><p><b>RESULTS</b>The overall 5-year survival rate of this group was 83.5%. The total number of dissected LNs was one independent prognostic factors in this group. Among patients with the same depth of tumor invasion, the more the number of dissected LNs, the better the survival would be (P < 0.05). The patients had better long-term survival outcomes with dissected LNs counts of more than 15 for cases with pT1-2 tumor, and more than 20 for cases with pT3 tumor. The post-operative complication rate was 10.8% and it was not significantly correlated with the number of dissected lymph nodes (P > 0.05).</p><p><b>CONCLUSIONS</b>The number of dissected LNs is an independent prognostic predicting factor for lymph node-negative gastric cancer. Sufficient dissection of LNs is recommended to improve the patients' long-term survival. Suitable increment of dissected LNs count would not increase the post-operative complication rate.</p>

Efficiency of laparoscopic D2 radical gastrectomy in gastric cancer: experiences of 218 patients / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility and efficacy of laparoscopic D2 radical gastrectomy in patients with gastric cancer.</p><p><b>METHODS</b>The clinical data of 529 patients with gastric cancer underwent D2 radical resection from January 2007 to March 2009 were analyzed retrospectively. Among the patients, 218 cases underwent laparoscopic D2 gastrectomy (LAG group) and 311 cases received open gastrectomy (OG group). The patients' operation, number of retrieved lymph nodes, recovery, postoperative morbidity and mortality were compared between the two groups.</p><p><b>RESULTS</b>The operative time in LAG group was (237 +/- 42) min, and was significantly longer than that in OG group [(229 +/- 42) min, P < 0.05]. However, the mean blood loss [(81 +/- 100) ml vs. (171 +/- 211) ml], number of patients needed blood transfusion (7 vs. 44 cases), first flatus time [(4.1 +/- 2.3) d vs. (5.0 +/- 1.4) d], time to resume soft diet [(4.5 +/- 2.2) d vs. (5.5 +/- 1.4) d] and postoperative hospital stay [(12 +/- 4) d vs. (14 +/- 4) d] in the two groups were all different statistically (P < 0.05), and all were better in LAG group. In LAG group, the operative time of patients with total gastrectomy was (250 +/- 46) min, and was significantly longer than that with distal gastrectomy (228 +/- 37) min (P < 0.05), but there was no significant differences in other aspects of patients' recovery between the two operation types. The postoperative morbidity of LAG group and OG group were 11.9% and 19.0%, respectively (P < 0.05). For all patients, the mean number of retrieved lymph nodes was (29 +/- 10) and the median number was 28. The mean number of retrieved lymph nodes was not significantly different between the two groups [(28 +/- 10) in LAG group vs. (29 +/- 9) in OG group, P > 0.05]. Thirteen patients (6.0%) converted to open surgery in LAG group.</p><p><b>CONCLUSION</b>Laparoscopic D2 radical gastrectomy is a safe and feasible procedure with quick recovery, and it is comparable with open gastrectomy in lymph node dissection.</p>

Association of microvessel density and blood vessel invasion with the prognosis in rectal carcinoma at stages I to II / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the possibility of microvessel density (MVD) and blood vessel invade (BVI) as the indexes in predicting prognosis of rectal carcinoma at stages I to II.</p><p><b>METHODS</b>Tumor tissues from 380 patients who underwent resection of stage I or II rectal cancer were analyzed for MVD and BVI by immunohistochemical S-P method with anti-CD105 and anti-CD 34 antibody. Binary and multivariable Cox regression was applied to indicate independent factors associated with overall survival.</p><p><b>RESULTS</b>CD105 was present in the neovascularity of the cancer tissue but not in the normal tissue, while CD34 was present in the tumor tissue and the normal tissue. BVI on CD34 staining was significantly higher than that on HE staining. Multivariable analysis revealed that TNM stage, CD34-BVI, histologic type, and CD105-MDV were independent risk factors to predict the possibility of poor prognosis of stage I or II rectal cancer. CD34-BVI or CD105-MVD positivity had a hazard ratio of 4.483 (95% confidence interval 2.861-7.026) for mortality.</p><p><b>CONCLUSION</b>The expressions of CD34-BVI and CD105-MVD are independent factors to predict the possibility of poor survival of stage I or II rectal carcinoma. Detection of CD105-MVD combined with CD34-BVI may help predict clinical outcome and design further individualized adjuvant treatment.</p>

Laparoscopic versus conventional open resection for early distal gastric cancer: a meta-analysis on the number of retrieved lymph nodes / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the number of retrieved lymph nodes (LN) between laparoscopic resection and conventional open resection for early distal gastric cancer with meta-analysis.</p><p><b>METHODS</b>Original articles published from January 2000 to December 2008 were searched in the MEDLINE, EMBASE and Cochrane Controlled Trials Register. According to the criterion, 14 articles were identified which compared the number of retrieved lymph nodes between laparoscopic resection and conventional open resection for early distal gastric cancer. Data were extracted from these trials by 3 reviewers independently and analyzed by Rev Man 5.0 software.</p><p><b>RESULTS</b>A total of 1454 patients with early gastric cancer were enrolled, including 815 patients in the laparoscopic group and 630 patients in the conventional group. The mean number of dissected lymph nodes per patient was 3.26 less in the laparoscopic group as compared to the conventional group (WMD -3.26,95% CI -6.24~-0.27,P=0.03). The differences were not statistically significant in the articles published during 2005-2008 years (WMD -2.84, 95% CI -6.79~1.11, P=0.16), in D(1)(+)alpha/beta lymph node dissection (WMD -2.80, 95% CI -7.57~1.97, P=0.25), and in retrospective non-randomized trials (WMD -2.89, 95% CI -6.48~0.70,P=0.11).</p><p><b>CONCLUSION</b>With the improvement in surgical skills, laparoscopic surgery and open surgery do not differ significantly in the number of retrieved lymph nodes for early distal gastric cancer with D(1)(+)alpha/beta lymph node dissection.</p>

Impact of solitary lymph node metastasis on the prognosis of gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the impact of solitary lymph node (LN) metastasis on the prognosis of gastric cancer.</p><p><b>METHODS</b>Clinical data of 280 patients with gastric cancer who underwent D(2) radical resection from January 1995 to December 2003 were analyzed retrospectively. Among them, solitary LN metastasis was proven pathologically in 83 cases(solitary LN metastasis group), while node-negative metastasis proven in 197 cases (node-negative group). The 5-year survival rate was compared between two groups and between patients with and without skipping LN metastasis. The prognostic factors were evaluated by uncaria and multivaria analyses.</p><p><b>RESULTS</b>The 5-year survival rates in the solitary LN metastasis group and the node-negative group were 62.3% and 83.5% respectively with significant difference (P<0.05). The solitary LN metastasis was one of the independent prognostic factors. Logistic regression revealed that the invasion depth was an independent covariate for solitary LN metastasis. The proportion of skip metastasis was 22.9% in gastric cancer patients with solitary LN metastasis. The 5-year survival rates of the patients with and without skipping LN metastasis were 50.0% and 66.1% respectively, which was not significantly different (P>0.05).</p><p><b>CONCLUSIONS</b>The prognosis of patients with solitary LN metastasis is significantly poorer than those without lymph node metastasis. Due to the high incidence of skip LN metastasis in gastric cancer, D(2) radical resection should be performed to ensure oncological clearance.</p>

Short-term efficacy of laparoscopic-assisted right hemicolectomy with D3 lymph node dissection in colon cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility and short-term efficacy of laparoscopic-assisted D3 lymph node dissection for right colon cancer with a medial-to-lateral approach.</p><p><b>METHODS</b>Clinical data of 61 patients with right colon cancer undergoing D3 lymph node dissection from March 2006 to June 2010 were analyzed retrospectively. Among them,29 underwent laparoscopic-assisted right hemicolectomy (LARH group) and 32 underwent open right hemicolectomy (ORH group). The number of lymph node harvest, operative details, and complication rate were compared between the two groups.</p><p><b>RESULTS</b>The mean number of lymph node harvest did not differ significantly between the two groups (16.9±3.8 vs. 15.4±3.6). As compared to ORH group, although the operative time was significantly longer [(214.4±37.9) min vs. (193.3±28.8) min] in LARH group, the mean blood loss [(83.4±38.0) ml vs. (192.7±43.6) ml], time to first flatus [(44.6±20.8) h vs. (70.4±80.0) h], time to resumption of soft diet[(32.5±10.6) h vs. (59.7±10.4) h], and postoperative hospital stay [(11.2±2.2) d vs. (13.8±2.8) d] were more favorable(all P<0.05). Complication rate was lower in LARH group(10.4% vs. 9.4%), however the difference was not statistically significant.</p><p><b>CONCLUSIONS</b>LARH with D3 lymph node dissection is oncologically comparable with ORH for right colon cancer. It is a safe and feasible procedure associated with rapid postoperative recovery.</p>

Analysis of the pattern of solitary lymph node metastasis in gastric cancer and its prognosis / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the pattern of solitary lymph node(LN) metastasis in gastric cancer and its prognosis.</p><p><b>METHODS</b>The clinical records of 83 patients with gastric cancer presenting solitary LN metastasis who underwent D2 radical resection from January 1995 to December 2003 were analyzed retrospectively. The precise stations of the metastasis of LN and their correlation with the location of primary tumor were studied. The 5-year survival rates were compared between patients with and without skipping LN metastasis. The prognostic factors were evaluated by using univariate and multivariate analyses.</p><p><b>RESULTS</b>Among the 83 patients with pathologically proven solitary LN metastasis, 64 cases (77%) presented with the perigastric nodes metastasis (N1 area), and 19 cases (23%) in N2 area without N1 involvement (skipping LN metastasis). For tumors in the upper and middle third stomach, the No. 3 station was the most common first metastasized LN station (40% and 42%, respectively). While for tumors in the lower third stomach, the No.6 station was the mostly affected LN (33%). Of the patients, 77 cases were followed up for 5-14 years, the median survival time was 77.0 months, and the overall 5-year survival rate was 63%. The 5-year survival rates of the patients with and without skipping LN metastasis was 52% and 67% respectively, there was no significant difference between the two groups (P>0.05). The serosal invasion and pathological types were influencing factors of the 5-year survival rate on univariate analysis. But with multivariate analysis, only the serosal invasion was an independent factor affecting the survival.</p><p><b>CONCLUSIONS</b>Perigastric nodes are the most common first sites of tumor metastasis, making them the main targets of operative sentinel lymphatic mapping procedures. The patients with serosal invasion have poorer prognosis.</p>

Efficacy of combined splenectomy in proximal gastric cancer with No.10 lymph node metastasis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the impact on prognosis of D(2) lymphadenectomy combined with splenectomy in patients of advanced proximal gastric cancer with No.10 lymph node metastasis.</p><p><b>METHODS</b>Clinical data of 216 patients of advanced proximal gastric cancer with No.10 lymph node metastasis undergone D(2) curative resection in our hospital from January 1980 to December 2002 were analyzed retrospectively. Among them, 73 underwent simultaneous splenectomy (splenectomy group), while 143 without splenectomy (spleen-preserving group). The 5-year survival rate, the mean numbers of dissected No.10 lymph nodes and metastatic No.10 lymph nodes, the complication morbidity and mortality were compared between the two groups.</p><p><b>RESULTS</b>The 5-year survival rates of splenectomy group and spleen-preserving group were 30.0% and 19.7% respectively, whose difference was significant(P<0.05). The mean numbers of dissected No.10 lymph nodes and metastatic No.10 lymph nodes in splenectomy group were significantly greater than those in spleen-preserving group(P<0.05). Splenectomy, invasion depth and gastrectomy type were independent prognostic factors. The survival rates of T(3) patients in splenectomy group and spleen-preserving group were 38.7% and 18.9% respectively, whose difference was significant (P<0.05). The survival rates of patients undergone total gastrectomy in splenectomy group and spleen-preserving group were 33.4% and 20.7% respectively, whose difference was significant (P<0.05). The complication morbidity and mortality in splenectomy group were 24.7% and 4.1%, while in spleen-preserving group were 17.5% and 3.5% respectively, whose differences were not significant(P>0.05).</p><p><b>CONCLUSIONS</b>Splenectomy is benefit for No.10 lymph node dissection in patients with advanced proximal gastric cancer. To improve the prognosis, total gastrectomy combined with splenectomy should be recommended for patients of T(3) proximal gastric cancer with No.10 lymph node metastasis. Simultaneous splenectomy dose not increase the complication morbidity and mortality.</p>

Prognostic analysis of splenectomy in patients with advanced proximal gastric cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluated the prognostic impact of splenectomy on patients with advanced proximal gastric cancer.</p><p><b>METHODS</b>The clinical records of 237 patients with advanced proximal gastric cancer who underwent D2 curative resection combined with splenectomy from January 1980 to June 2003 were analyzed retrospectively. Seventy-five patients presented with No.10 lymph nodes metastasis, while 162 patients did not. Potential patient prognostic factors were evaluated by univariate and multivariate analysis. The independent prognostic factors of patients were performed subgroup analysis.</p><p><b>RESULTS</b>The 5-year survival rate was 27.7% for patients with No.10 lymph nodes metastasis and 35.4% for patients without, the difference was statistically significant between the two groups (P < 0.05). On univariate analysis, lymph node metastasis, macroscopic appearance, depth of invasion, type of gastrectomy and No.10 lymph nodes metastasis were predictive factors of survival. The depth of invasion, type of gastrectomy and No.10 lymph nodes metastasis were independent prognostic factors. In the subgroup analysis, the survival rates of T3 patients with and without No.10 lymph nodes metastasis was 34.5% and 39.7%, respectively (P > 0.05). For patients undergoing total gastrectomy, survival rates were 31.2% and 36.7%, respectively (P > 0.05).</p><p><b>CONCLUSIONS</b>To improve patient prognosis, total gastrectomy with splenectomy should be recommended for patients with T3 proximal gastric cancer with No.10 lymph node metastasis.</p>

Prognostic impact of splenectomy on advanced proximal gastric cancer with No. 10 lymph node metastasis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>This study evaluated the prognostic impact of D2 lymphadenectomy combined with splenectomy in patients with advanced proximal gastric cancer and lymph node metastasis at the splenic hilum (No. 10 lymph nodes).</p><p><b>METHODS</b>The clinical records of 216 patients with advanced proximal gastric cancer and No. 10 lymph node metastasis who underwent D2 curative resection were retrospectively analyzed. Seventy-three patients underwent simultaneous splenectomy (splenectomy group), while 143 patients did not (spleen-preserving group). Five-year survival rates, mean numbers of dissected No. 10 lymph nodes and metastatic No. 10 lymph nodes, and operative morbidity and mortality were calculated and compared between the two groups. Potential prognostic factors were evaluated by univariate and multivariate analysis.</p><p><b>RESULTS</b>The 5-year survival rate was 30.0% for the splenectomy group and 19.7% for the spleen-preserving group (chi(2) = 14.73, P < 0.05). The mean numbers of dissected No. 10 lymph nodes and metastatic No. 10 lymph nodes in the splenectomy group were significantly greater than in the spleen-preserving group (P < 0.05). Multivariate analysis revealed that the depth of invasion, splenectomy, and type of gastrectomy were independent prognostic factors. The survival rate for T3 patients with and without splenectomy was 38.7% and 18.9%, respectively (chi(2) = 15.03, P < 0.05). For patients undergoing total gastrectomy, survival rates were 33.4% and 20.7%, respectively (chi(2) = 13.63, P < 0.05). Operative morbidity and mortality in splenectomy group was 24.7% and 4.1%, respectively, and in the spleen-preserving group was 17.5% and 3.5%, respectively. The differences were not statistically significant (P > 0.05).</p><p><b>CONCLUSIONS</b>Splenectomy is beneficial for No. 10 lymph node dissection in patients with advanced proximal gastric cancer. To improve patient prognosis, total gastrectomy with splenectomy is recommended for patients with T3 proximal gastric cancer who have No. 10 lymph node metastasis.</p>

Short-term efficacy of laparoscopy-assisted distal gastrectomy with lymph node dissection in distal gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility and short-term efficacy of laparoscopy-assisted distal gastrectomy with D(2) lymph node dissection.</p><p><b>METHODS</b>Clinical data of 241 patients of distal gastric cancer undergone D(2) lymph node dissection from January 2007 to December 2008 were analyzed retrospectively. Among them, 93 underwent laparoscopy-assisted distal gastrectomy (LADG group), while 148 underwent open distal gastrectomy (ODG group). The number of removal lymph node, recovery, complication rate and mortality were compared between two groups.</p><p><b>RESULTS</b>The mean number of removal lymph node were not significantly different between two groups (27.5+/-9.1 in the LADG group vs 27.3+/-8.5 in the ODG group, P>0.05), and there were also no significant difference between two groups in T(1), T(2), T(3) patients according to the subgroup analysis of depth invasion (P>0.05). As compared to ODG group, although the operative time was significantly longer,the mean blood loss and transfused patient number were less, ground activity time, first flatus time, resume soft diet time and postoperative hospital stay were shorter, and complication rate was significantly lower in LADG group (all P<0.05).</p><p><b>CONCLUSION</b>LADG with D(2) lymph node dissection is oncologically compatible with open gastrectomy, and it is a safe and feasible procedure which leads to quick postoperative recovery.</p>

Impact of dissected lymph node number on the prognosis of advanced cancer of cardiac and stomach fundus / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the impact of dissected lymph node number on the prognosis of patients with advanced cancer of cardia and stomach fundus.</p><p><b>METHODS</b>Clinical data of 236 patients with advanced cancer of cardia and stomach fundus undergone D(2) radical resection were reviewed retrospectively. Five-year survival rate and post-operative complication rate were followed up and their relationships with dissected lymph node number were analyzed respectively.</p><p><b>RESULTS</b>The 5-year survival rate of the entire cohort was 37.5%. Among those patients with the same stage, the more lymph nodes (LNs) resected, the better survival outcomes achieved(Log-rank trend test P=0.0013). A cut point analysis yielded the ability to detect the significant survival differences. The best long-term survival outcomes were observed with LN counts of more than 20 for stage II(P=0.0136), more than 25 for stage III(P<0.0001), more than 30 for stage IV(P=0.0002) or more than 15 for the entire cohort (P=0.0024), with greatest comparative discrepancies. The post-operative complication rate was 15.7% and was not significantly correlated with dissected lymph node number(P=0.101).</p><p><b>CONCLUSIONS</b>The prognosis of patients with advanced cancer of cardia and stomach fundus is associated with the number of resected LNs when D(2) lymphadenectomy is carried out. Suitable increment of dissected lymph node number would not increase the post-operative complication rate.</p>

Prognosis analysis of surgical treatment for cancer of stomach fundus and cardia with invasion to body and tail of the pancreas / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the prognostic factors of surgical treatment for the cancer of stomach fundus and cardia with invasion to body and tail of the pancreas.</p><p><b>METHODS</b>A total of 135 patients with cancer of stomach fundus and cardia invading body and tail of the pancreas undergone surgical treatment were enrolled in this study. Twenty of them underwent laparotomy, while 115 underwent gastrectomy with pancreaticosplenectomy, even combined with the resection of other organs for macroscopic invasion to adjacent organs during surgery. The 3-,5-year survival rates, morbidity of postoperative complications and mortality were followed up. The prognostic factors were evaluated by univariate and multivariate analyses.</p><p><b>RESULTS</b>The median survival time of the patients undergone laparotomy was 4.7 months, of patients treated by gastrectomy combined with pancreaticosplenectomy was 30.5 months,and the difference was significant (chi(2)=403.8, P<0.01). The cumulative 3- and 5-year survival rates of the patients treated by gastrectomy combined with pancreaticosplenectomy were 48.3% and 26.6% respectively. Univariate analysis revealed that significant differences in prognosis of 115 patients undergone combined resection were demonstrated for the following factors: maximal dimension of tumor, macroscopic type, extent of lymph node metastasis according to the Japanese classification, No.10 or No.11 lymph node metastasis,curability and number of invaded organs.And histological depth of invasion, extent of lymph node metastasis according to the Japanese classification, number of invaded organs and curability were significant prognostic factors, examined as variables by multivariate analysis (Cox's proportional hazard model, forward stepwise selection LR method). The postoperative complication rate and mortality of 135 patients were 20.0% and 3.5% respectively.</p><p><b>CONCLUSIONS</b>For cancer located in stomach fundus and cardia with limited invasion to distal pancreas, gastrectomy combined with pancreaticosplenectomy should be performed to improve long-term outcomes. Best long-term survival outcomes would be attained if there are no lymph node metastases, or no incurable factors, or no other organ invasions.</p>

Efficiency of D2 radical resection combined with splenectomy in T3 cancer of upper stomach / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the efficacy and influence of D2 radical resection combined with splenectomy in T3 cancer of upper stomach.</p><p><b>METHODS</b>From January 1980 to June 2002, 613 patients with T3 cancer of upper stomach received D2 radical resection. Of these cases, 102 underwent simultaneous splenectomy (splenectomy group), while 511 did not (spleen-preserved group). The metastatic rate of lymph nodes in splenic hilum and along the splenic artery (No. 10, No. 11), 5-year survival rates, recurrence rate, the postoperative complication rate and mortality rate were followed up and compared in the two groups.</p><p><b>RESULTS</b>The metastasis rate of No. 10 was 23.5% for splenectomy group and 14.9% for spleen-preserved group (P < 0.05). No significant difference was found in No. 11 metastasis between the two groups. The 5-year survival rate of splenectomy group was 39.8%, and was 32.3% in spleen-preserved group (P > 0.05). The recurrence rate of splenectomy group was 55.9%, and was 60.3% in spleen-preserved group (P > 0.05). In the splenectomy group, the 5-year survival rates were similar between patients with and without No. 10 metastasis (P > 0.05). The postoperative complication rate and mortality rate of the splenectomy group were 19.6% and 4.9%, and were 13.7% and 3.1% in the spleen-preserved group, respectively; and no significant difference was found between the two groups (P > 0.05).</p><p><b>CONCLUSIONS</b>D2 radical excision combined splenectomy should be recommended for stage T3 cancer of upper stomach when suspected with No. 10, No. 11 lymph nodes metastasis. Simultaneous splenectomy would not increase the postoperative complication rate and mortality rate.</p>

Measurement of soluble solids content in watermelon by Vis/NIR diffuse transmittance technique / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Watermelon is a popular fruit in the world with soluble solids content (SSC) being one of the major characteristics used for assessing its quality. This study was aimed at obtaining a method for nondestructive SSC detection of watermelons by means of visible/near infrared (Vis/NIR) diffuse transmittance technique. Vis/NIR transmittance spectra of intact watermelons were acquired using a low-cost commercially available spectrometer operating over the range 350~1000 nm. Spectra data were analyzed by two multivariate calibration techniques: partial least squares (PLS) and principal component regression (PCR) methods. Two experiments were designed for two varieties of watermelons [Qilin (QL), Zaochunhongyu (ZC)], which have different skin thickness range and shape dimensions. The influences of different data preprocessing and spectra treatments were also investigated. Performance of different models was assessed in terms of root mean square errors of calibration (RMSEC), root mean square errors of prediction (RMSEP) and correlation coefficient (r) between the predicted and measured parameter values. Results showed that spectra data preprocessing influenced the performance of the calibration models. The first derivative spectra showed the best results with high correlation coefficient of determination [r=0.918 (QL); r=0.954 (ZC)], low RMSEP [0.65 degrees Brix (QL); 0.58 degrees Brix (ZC)], low RMSEC [0.48 degrees Brix (QL); 0.34 degrees Brix (ZC)] and small difference between the RMSEP and the RMSEC by PLS method. The nondestructive Vis/NIR measurements provided good estimates of SSC index of watermelon, and the predicted values were highly correlated with destructively measured values for SSC. The models based on smoothing spectra (Savitzky-Golay filter smoothing method) did not enhance the performance of calibration models obviously. The results indicated the feasibility of Vis/NIR diffuse transmittance spectral analysis for predicting watermelon SSC in a nondestructive way.

Efficacy and safety of adjuvant post-surgical therapy with imatinib in gastrointestinal stromal tumor patients with high risk of recurrence: interim analysis from a multicenter prospective clinical trial / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of postoperative adjuvant chemotherapy with imatinib in gastrointestinal stromal tumor(GIST) patients who had high risk of recurrence.</p><p><b>METHODS</b>A prospective, open-label, multi-center trial conducted in sixteen teaching hospitals in China was carried out. The criteria of the enrolled patients included age more than 18 years old, CD117 positive GIST, tumor size more than 5 cm, pathological mitosis counts more than 5/50 HPF, and treatment beginning within 4 weeks after complete resection and with imatinib (400 mg, once a day) for at least 12 months. The 1, 3 year recurrence rates, disease free survival, overall survival rate and quality of life were evaluated.</p><p><b>RESULTS</b>From Aug. 16th 2004 to Sep. 13th 2005, there were totally 74 patients screened and 57 patients (34 men, 23 women) enrolled in the imatinib treatment group. The primary tumors were located in the stomach in 50.9%, the small intestine in 38.6% and the colorectum in 10.5% of the cases. All the patients received radical resection. Until the cut-off date of interim analysis, there was no evidence of tumor relapse or metastasis in all patients and no death was reported either. Among the 57 enrolled patients with intention to treat(ITT), twelve patients finished the protocol (per protocol, PP). The disease free survival was (268.3 +/-120.2) d in ITT analysis, and (396.7+/-38.2) d in the PP analysis. The incidence of adverse effect was 44.4% . The score in quality of life showed no statistically significant difference between the baseline visit and the follow-up visits.</p><p><b>CONCLUSION</b>Imatinib is a promising postoperative adjuvant chemotherapy in GISTs patients with high risk of recurrence, and the adverse effects are receivable.</p>

Application Fourier transform near infrared spectrometer in rapid estimation of soluble solids content of intact citrus fruits / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Nondestructive method of measuring soluble solids content (SSC) of citrus fruits was developed using Fourier transform near infrared reflectance (FT-NIR) measurements collected through optics fiber. The models describing the relationship between SSC and the NIR spectra of citrus fruits were developed and evaluated. Different spectra correction algorithms (standard normal variate (SNV), multiplicative signal correction (MSC)) were used in this study. The relationship between laboratory SSC and FT-NIR spectra of citrus fruits was analyzed via principle component regression (PCR) and partial least squares (PLS) regression method. Models based on the different spectral ranges were compared in this research. The first derivative and second derivative were applied to all spectra to reduce the effects of sample size, light scattering, instrument noise, etc. Different baseline correction methods were applied to improve the spectral data quality. Among them the second derivative method after baseline correction produced best noise removing capability and yielded optimal calibration models. A total of 170 NIR spectra were acquired; 135 NIR spectra were used to develop the calibration model; the remaining spectra were used to validate the model. The developed PLS model describing the relationship between SSC and NIR reflectance spectra could predict SSC of 35 samples with correlation coefficient of 0.995 and RMSEP of 0.79 degrees Brix.

Association of -160(C-->A) polymorphism in CDH1 gene with gastric cancer risk in Fujian Chinese population / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>CDH1, encoding E-cadherin, is an important tumor suppressor gene. The present study aims to investigate the association of -160(C-->A) polymorphism in CDH1 gene with susceptibility to gastric cancer in Fujian province.</p><p><b>METHODS</b>One hundred and two patients from independent families and 101 healthy control subjects were analyzed. Genotype analysis was performed through polymerase chain reaction-based denaturing high performance liquid chromatography. The odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by unconditional logistic regression model.</p><p><b>RESULTS</b>The frequencies of -160(C-->A) polymorphism CC, CA and AA genotype in case group and controls were 58(56.9%), 38(37.3%)ì6(5.9%) and 55(54.5%), 41(40.6%), 5(5%), respectively. AA genotype did not present a significantly increased risk for gastric cancer (OR=1.12; 95% CI:0.32-3.95). No association was found between A allele and clinicopathological characteristics of gastric cancer.</p><p><b>CONCLUSION</b>-160(C-->A) polymorphism in CDH1 gene promoter region may not be in association with genetic susceptibility to gastric cancer in Chinese population from Fujian.</p>

A prospective randomized study on the method of reconstruction after total gastrectomy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To find an ideal reconstruction method after total gastrectomy.</p><p><b>METHODS</b>With 12 healthy persons as control, a total of 120 gastric cancer patients received their digestive tract reconstruction after total gastrectomy were randomized into Roux-en-y esophagojejunostomy group (A), P pouch with Roux-en-y esophagojejunostomy group (B), Hunt-Lawrence esophagojejunostomy group (C), and jejunal interposition esophagojejunostomy group (D). After operation, quality of life, prognosis nutrition index (PNI), body weight, serum nutritional parameters, gastrointestinal hormone level and immunological state were evaluated.</p><p><b>RESULTS</b>The quality of life, PNI, body weight and serum nutritional parameters (SI, TS and Hb) were better in group D than those in groups A, B and C (P < 0.05). The cholecystokinin (CCK) level and NK cell, CD(4)(+) cell, CD(8)(+) cell and CD(4)/CD(8) ratio in group D, being similar to the control group, were significantly higher than groups A, B and C (P < 0.05).</p><p><b>CONCLUSION</b>Modified jejunal interposition esophagojejunostomy is a reasonable reconstruction method. The construction of "P" pouch, reserving foods as the stomach, can preserve the duodenal passage and secretion of the gastrointestinal hormones, which results in better digestion of the food and absorption of the nutrients. This method simplifies the operation and guarantee the blood supply of interpositioned jejunum without causing ischemia at the anastomotic orifice.</p>