Current status and prospects of clinical research on diagnosis and treatment of gastric cancer in China / 中华胃肠外科杂志

As early as in the 1960s, China has begun to conduct exploratory clinical researches on gastric cancer. In the past 10 years, the research projects have increased significantly. Among them, the minimally invasive surgery represented by laparoscopy (CLASS Trial), the hot spot of the esophagogastric junction cancer (5010 Trial), the perioperative adjuvant treatment of advanced gastric cancer (CGOG1001 and RESOLVE Trials), the conversion treatment of late gastric cancer (DRAGON Trial) and high quality clinical research such as real-world research based on large database have made great progress. But there are still many deficiencies, such as few multi-center prospective research, limited research return, and the quality and innovation of scientific research data need to be further improved. However, it should also be noted that the clinical researches of gastric cancer in China have greater advantages and development space. The characteristics of large population base, rich cases and large proportion of advanced gastric cancer are conducive to real-world research. In the future, we should follow the international frontier and combine with national conditions to deepen clinical research, so that more "Chinese elements" can be introduced into the international guidelines for gastric cancer, and promote the overall level of diagnosis and treatment of gastric cancer in China.

Optimization of TNM staging and control of pathological quality in gastric cancer / 中华胃肠外科杂志

Comprehensive treatment of gastric cancer is mainly based on the pathological staging. The T stage mainly depends on the accurate determination of the depth of the tumor invasion. The accurate T stage should be standardized pathological examination and continuous sectioning. N stage may be influenced by the number of lymph node examined. Insufficient lymph node examined may lead to stage migration. Therefore, standardizing lymph node dissection and lymph node harvest after surgery is important. M stage is mainly to improve the detection rate of peritoneal lavage cytology (CY), identify high risk factors for peritoneal metastasis, and optimize the prediction of peritoneal metastasis molecular markers, as a complementary methods of clinical examination. Currently, the quality of standardized pathological diagnosis of gastric cancer in China still needs to be improved. This article mainly elucidates the related studies and clinical experience of our center on how to do better in the optimization of gastric cancer TNM staging and pathological quality control.

Problems for the conversion therapy in advanced gastric cancer / 中华肿瘤杂志

Patients with advanced gastric cancer have a poor prognosis, which remains the clinical concerned hot topic. The main previous treatments for advanced gastric cancer were adjuvant chemotherapy and palliative surgery, however, the application of conversion therapy has improved the survival in recent years. There are still many problems and challenges for conversion therapy because of its initial stage, such as the definition of advanced gastric cancer and conversion therapy, the selection of suitable population for conversion therapy, and the role of surgery in conversion therapy. Precision medicine will be applied to conversion therapy for advanced gastric cancer in the future, which would benefit more patients.

Prognostic factors of lymph node-negative metastasis gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the prognostic factors of patients with lymph node-negative metastasis gastric cancer (pN0).</p><p><b>METHODS</b>Clinicopathological data of patients with pN0 gastric cancer who underwent radical operation at the Department of Surgical Oncology, The First Hospital of China Medical University from May 1980 to August 2012 were collected and analyzed retrospectively.</p><p><b>INCLUSION CRITERIA</b>(1) Patients were diagnosed as gastric adenocarcinoma; (2) Postoperative pathology confirmed T1a to 4bN0M0 gastric cancer; (3) Total number of harvested lymph node was more than 15. The patients, who died within 1 month after the operation, died of other diseases, had remnant gastric cancer, or had incomplete follow-up data, were excluded. Univariate analysis was used to analyze the clinical factors that may influence the prognosis of patients with stage pN0 gastric cancer, then, those significant variables were entered into the Cox's proportional hazards regression model for multivariate analysis to obtain the independent prognostic factors for patients with pN0 gastric cancer finally. Furthermore, the prognosis of patients with pN0 advanced gastric cancer (invasive depth ≥ T2) were analyzed using the same method.</p><p><b>RESULTS</b>A total of 610 patients with pN0 gastric cancer were enrolled in the study, including 441 males and 169 females with age ranging from 19 to 83 (mean 56.4±11.0) years, D1 lymph node dissection in 45 cases, D2 lymph node dissection in 543 cases, D3 lymph node dissection in 22 cases, and 384 cases of advanced gastric cancer. The overall followed-up was 1 to 372 (median 32) months. Ninety cases (14.8%) were dead during the follow-up. The median survival was 277.7(95%CI: 257.6 to 297.8) months, and the 1-, 3-, 5-year survival rates were 96.5%, 87%, 83.2%. Univariate analysis showed that tumor diameter, depth of invasion, gross type, lymph node dissection and lymph vessel cancer embolus were related to the prognosis (all P<0.05). The 5-year survival rate of patients with tumor diameter >4 cm was significantly lower than those with tumor diameter ≤4 cm (75.6% vs. 87.8%, P=0.000). The 5-year survival rates of T1a, T1b, T2, T3 and T4 were 98.4%, 92.8%, 84.2%, 61.0% and 31.4% respectively, and the difference was statistically significant (P=0.000). In gross type, 5-year survival rate of early gastric cancer was 96.0%, and of Borrmann I( to IIII( type gastric cancer was 100%, 83.4%, 73.7% and 68.9% respectively, whose difference was statistically significant(P=0.000). The 5-year survival rates in patients undergoing lymph node dissection D1, D2 and D3 were 100%, 83.3% and 58.7%, and the difference was significant (P=0.005). The 5-year survival rate of patients with positive lymphatic cancer embolus was lower than those with negative ones (69.4% vs. 86.9%, P=0.000). Multivariate analysis showed that the gross type [Borrmann II(/early gastric cancer: HR(95% CI)=15.129(3.284 to 69.699), Borrmann III(/early gastric cancer: HR(95% CI)=14.613 (3.292 to 64.875), Borrmann IIII(/early gastric cancer: HR (95% CI)=15.430 (2.778 to 85.718),Borrmann IIIII(/early gastric cancer: HR(95%CI)=12.604 (1.055 to 150.642), P=0.025] and the positive lymphatic cancer embolus [HR(95% CI)=3.241 (2.056 to 5.108), P=0.000] were the independent prognostic factors of patients with pN0 gastric cancer. For pN0 patients with advanced gastric cancer, multivariate analysis showed that the depth of invasion [stage T3/stage T2: HR(95%CI)=1.520 (0.888 to 2.601), stage T4/stage T2: HR(95%CI)=2.235(1.227 to 4.070); P=0.031] and the positive lymphatic cancer embolus [HR(95%CI)=3.065 (1.930 to 4.868); P=0.000] were the independent risk factors influencing the prognosis.</p><p><b>CONCLUSIONS</b>Positive lymphatic cancer embolus and worse gross pattern indicate poorer prognosis of patients with pN0 gastric cancer, which may be used as effective markers in evaluating the prognosis. As for pN0 advanced gastric cancer, invasion depth and positive lymphatic cancer embolus can play a more important role in the prediction.</p>

Individualized treatment strategies for gastric cancer based on D2 dissection / 中华胃肠外科杂志

The Standard for Diagnosis and Treatment of Gastric Cancer published by China Ministry of Health in 2011 clearly advocates that individualized treatment strategy based on D2 standard radical surgery should be recommended, which is according to staging and biologic typing. The present review will comment on the strategy from the following aspects: clinical TNM staging, pathological TNM staging, biologic typing, occult lymph node metastasis and molecular typing.

Integration and analysis of associated data in surgical treatment of gastric cancer based on multicenter, high volume databases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To elucidate the current diagnosis and treatment status of gastric cancer in the Chinese population based on three high volume databases.</p><p><b>METHODS</b>Clinical and pathological data of patients who underwent gastric cancer resection with complete follow-up information between January 2000 and December 2012 from Sun Yat-sen University Cancer Center, The First Affiliated Hospital of China Medical University and Tianjin Medical University Cancer Hospital were retrospectively analyzed. The overall survival rate was calculated by Kaplan-Meier method. The prognostic risk factors were analyzed by using Cox proportional hazards model.</p><p><b>RESULTS</b>A total of 8 338 cases were enrolled into the study, including 2 977 cases (35.7%) from Sun Yat-sen University Cancer Center, 3 043 cases (36.5%) from The First Affiliated Hospital of China Medical University and 2 318 cases (27.8%) from Tianjin Medical University Cancer Hospital. There were 5 852 male cases and 2 486 female cases with a ratio of 2.4 to 1.0. The age of patients was from 15 to 89 years old (median 59 years old). The ratio of early gastric cancer (T1NanyM0) was 11.5% (956/8 338). There were 2 226 gastric cancer cases (26.7%) originating from the fundus and cardiac region, 1 637 cases (19.6%) from the body, 3739 (44.9%) cases from the antrum, and 736 cases (8.8%) from the whole stomach. The median maximal tumor diameter was (4.5 ± 2.8) cm. Based on the Lauren classification, 3 448 cases (41.4%) were intestinal type and 4 890 cases (58.6%) diffuse type. A total of 1 975 cases (23.7%) and 6 363 cases (76.3%) underwent complete and subtotal gastrectomy respectively. The majority of patients (7 707 cases, 92.4%) underwent radical gastric resection, while 631 cases (7.6%) palliative resection. According to AJCC/UICC seventh edition of gastric cancer TNM staging system, 802 patients (9.6%) were stage I(A, 735 patients (8.8%) stage I(B, 695 patients (8.3%) stage II(A, 1 507 patients (18.1%) stage II(B, 1 247 patients (15.0%) stage III(A, 1 342 patients (16.1%) stage III(B, 1 583 patients (19.0%) stage III (C and 427 patients (5.1%) stage IIII(. The average number of retrieved lymph node was 21.0 ± 13.1, in which 5 761 patients (69.1%) had more than 15 retrieved lymph nodes. The overall 1-, 3-, 5- and 10-year survival rates were 83.0%, 56.8%, 49.1% and 43.0% respectively. For patients receiving radical resection, the 1-, 3-, 5- and 10-year survival rates were 84.9%, 59.5%, 51.7% and 45.3% respectively. The overall 5-year survival rates for different stages were as follows: stage I(A 93.8%, stage I(B 80.8%, stage II(A 70.8%, stage II(B 59.6%, stage III(A 44.4%, stage III(B 32.9%, stage III(C 18.9% and stage IIII( 10.2%. Cox regression model showed that age, tumor site, tumor size, Lauren type, T staging, N staging, M staging and number of retrieved lymph nodes were independent factors affecting the prognosis of gastric cancer patients (P=0.000).</p><p><b>CONCLUSION</b>Retrospective study on these domestic three high volume databases demonstrates the clinical and pathological characteristics of gastric cancer based on Chinese population, which is expected to stand as a ground of basic data for future clinical research.</p>

Rationality of N3 classification and its sub-classification in TNM classification system for advanced gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the rationality of N3 classification and its sub-classification in the 7th UICC/AJCC TNM classification system.</p><p><b>METHODS</b>Clinicopathological data of 610 patients with stage N3 advanced gastric cancer who underwent standard D2 and D2+ radical surgery at the Department of Surgical Oncology, The First Hospital of China Medical University, from January 1980 to March 2010 were analyzed retrospectively. Patients were divided into N3a and N3b groups, and clinicopathological characteristics and prognosis were compared between N3a and N3b patients. Overall survival rate was determined using the Kaplan-Meier estimator. The log-rank test was used to identify differences between the survival curves of different groups. In multivariate analysis, Cox proportional hazard model was used to identify independent factors associated with prognosis.</p><p><b>RESULTS</b>Among 610 patients, 426 were men and 184 were women, 394 were N3a and 216 were N3b, with a mean age of(57±11) years old (range 23 to 83). A total of 19 842 lymph nodes were examined, in which 9 575 nodes were positive, with the metastatic ratio of 48.3%. The 5-year overall survival rate was 20.0%. Univariate analysis of prognostic factors suggested that tumor location (P=0.000), tumor size (P=0.003), Borrmann type (P=0.000), pathologic type (P=0.043), lymphatic vessel invasion (P=0.000), growth pattern (P=0.019), invasion depth (P=0.000), resection extent (P=0.000) and N3 sub-classification (P=0.000) were significantly associated with the prognosis of N3 patients. Further analysis showed that tumor size (P=0.028), invasion depth (P=0.000) and gastric resection extent (P=0.002) were significantly associated with the prognosis of N3a patients, while Borrmann type (P=0.034), lymphatic vessel invasion (P=0.002), invasion depth (P=0.008) and resection extent (P=0.003) were significantly associated with the prognosis of N3b patients. Multivariate analysis revealed that lymphatic vessel invasion (P=0.009), resection extent (P=0.001), invasion depth (P=0.000) and N3 sub-classification (P=0.000) were independent prognostic factors of N3 patients; resection extent (P=0.004) and invasion depth (P=0.001) were independent prognostic factors of N3a patients; lymphatic vessel invasion (P=0.006) and invasion depth (P=0.009) were independent prognostic factors of N3b patients. Comparison of 5-year survival rate revealed that there was significant difference between T2-4N3a and T2-4N3b patients (P=0.000), while there was no significant difference between T2N3a and T2N3b patients (P=0.140). On the contrary, there were significant differences between T3N3a and T3N3b patients, T4aN3a and T4aN3b patients, T4bN3a and T4bN3b patients, respectively (all P<0.05). Further comparison demonstrated that there were significant differences between T4aN3a and T4bN3a patients, T4aN3b and T4bN3b patients, respectively (P=0.000, P=0.041). Besides, there were no significant differences in 5-year survival rate between T2N3 (at present, staged as III(A), T3N3a (III(B) and T4aN3a (III(C) patients(P=0.506), and T3N3b (III(B), T4aN3b (III(C) and T4bN3a (III(C) patients(P=0.283), respectively.</p><p><b>CONCLUSIONS</b>N3 sub-classification should be included in the final TNM classification system. It is suggested that T2N3, T3N3a and T4aN3a may be categorized into III(A stage, T3N3b, T4aN3b and T4bN3a may be categorized into III(B stage,T4bN3b may be categorized into III(C stage or IIII( stage.</p>

Correlation Study of the Fascin Expression and Prognosis in Breast Cancer / 中国医科大学学报

Objective To investigate the relationship between the expression of Fascin and breast cancer prognosis. Methods Paraffin sections of breast cancer from 110 patients were investigated by immunohostochemistry with monoclonal anti-fascin antibody. Data of the Fascin expression and clinicopathological variables were analyzed for disease-free survival(DFS)and overall survival(OS)by Kaplan-miere and cox model. Results The expression of Fascin was significantly associated with ER negative,PR negative and lymph node metastasis,but not with age,HER2 status and tumor size. The patients with positive expression of Fascin had shorter disease free survival time than those without Fascin expression. Conclusion High expression of Fascin is associated with poor prognosis in breast cancer. Fascin is an independent prognostic indicator of disease-free survival time.

Role of transforming growth factor-β1 in epithelial-mesenchymal transition of mesothelial cells and its effect on peritoneal metastasis of gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To elucidate the role of transforming growth factor-beta1(TGF-β1) in epithelial-mesenchymal transition of mesothelial cells and peritoneal metastasis of gastric cancer.</p><p><b>METHODS</b>HMrSV5 cells, a human peritoneal mesothelial cell line, were incubated with TGF-β1, and their morphological changes were observed by phase contrast microscopy. Expressions of α-smooth muscle actin (α-SMA), vimentin, cytokeratin, E-cadherin, phosphorylated-Smad2 and Smad2 were examined by Western blotting. After fibroblastic-like mesothelial cells were co-incubate with HSC-39 cells(gastric cancer cell line), the adhesion and invasion potential of HSC-39 were evaluated by adhesion and invasion assay in vitro.</p><p><b>RESULTS</b>Few mesothelial cells converted to spindle fibroblast-like morphology for 24 h, and remarkable phenotypic changes were observed at 72 h of TGF-β1 activation. TGF-β1 could induce α-SMA and vimentin expression, and down-regulate cytokeratin and E-cadherin expression in mesothelial cells (P<0.05). TGF-β1 induced phosphorylation of Smad2 within 15 min of stimulation, reached a maximum at 30 min after treatment and remained high level during the experiment without affecting total Smad2 expression(P>0.05). The percentage of HSC-39 gastric cancer cells adhered were significantly increased as compared to the control. When the mesothelial cells were treated by TGF-β1 for 72 h, the increased adhesion percentage was(146±17)%(P<0.05). After fibroblastic-like mesothelial cells co-incubated with HSC-39 cells for 48 h, more cancer cells [(61.1±11.4) cells/view field] invaded the coated membrane as compared to the control group [(31.9±8.1) cells/view field] (P<0.05).</p><p><b>CONCLUSION</b>TGF-β1 can induce the transition of mesothelial cells into myofibroblasts and Smad2 signal pathway may play a role in this transition, which is associated with increased adhesion and invasiveness of gastric cancer cells, and provides favorable environment for the dissemination of gastric cancer.</p>

Clinical characteristics and prognosis of hepatoid adenocarcinoma of the stomach / 中华胃肠外科杂志

Hepatoid adenocarcinoma of the stomach (HAS) is a special type of gastric cancer characterized with hepatoid differentiation and the production of large amounts of α-fetoprotein (AFP). The pathogenesis of HAS is still not clear. Most of the relative studies are single case reports, and studies with large sample are absent. The prognosis of HAS is poor. HAS has a high rate of liver metastasis. The biology behaviors of HAS differ from common gastric cancers. Radical resection of the gastric cancer is considered to be the main treatment when no liver metastasis is found, while the treatment regimens of the metastasis lesions are still in debate. The serum AFP test is important for the early detection and diagnosis of HAS, and it is crucial for monitoring the therapeutic effect and the relapse and metastasis of the tumor.

Prognostic factors for patients after curative resection for proximal gastric cancer / 华中科技大学学报（医学）（英德文版）

The factors influencing the long-term survival of patients with proximal gastric cancer (PGC) after curative resection were investigated. Data from 171 patients who underwent curative resection for PGC were retrospectively analyzed. The patients were grouped according to the clinicopathological factors and operative procedures. The tumor depth (T stage) and lymph node metastasis (pN stage) were graded according to the fifth edition of TNM Staging System published by UICC in 1997. The metastatic lymph node ratio (MLR) was divided into four levels: 0%, 30%. The data of survival rate were analyzed by Kaplan-Meier method (log-rank test) and Cox regression model. The 5-year overall survival rate of 171 patients was 37.32%. The univariate analysis demonstrated that the survival time of the postoperative patients with PGC was related to tumor size (chi (2)=4.57, P=0.0325), gross type (chi (2)=21.38, P/=5 cm (chi (2)=6.31, P=0.0120), Borrmann III/IV (chi (2)=7.96, P=0.0050), T4 (chi (2)=4.57, P=0.0325), pN2 (chi (2)=5.52, P=0.0188), MLR 10%-30% (chi (2)=4.46, P=0.0347), MLR >30% (chi (2)=13.34, P=0.0003), TNM III (chi (2)=14.05, P=0.0002) or TNM IV stage (chi (2)=4.37, P=0.0366); and combining splenectomy was beneficial to the cases of T3 (chi (2)=5.68, P=0.0171) or MLR >30% (chi (2)=6.11, P=0.0134). It was concluded that MLR, pN stage, TNM stage, T stage, and gross type had advantages in providing a precise prognostic evaluation for patients undergoing curative resection for PGC, in which MLR was the most valuable index. TG and combining splenectomy were useful to improve the prognosis to patients with PGC of TNM III/IV stage, serosa invasion, or extensive regional lymph node metastasis.

Destruction of gastric cancer cells to mesothelial cells by apoptosis in the early peritoneal metastasis / 华中科技大学学报（医学）（英德文版）

This study examined the mechanism by which the gastric cancer cells lead to early peritoneal metastasis. HMrSV5 cells, a human peritoneal mesothelial cell line, were co-incubated with the supernatants of gastric cancer cells. Morphological changes of HMrSV5 cells were observed. The cell damage was quantitatively determined by MTT assay. The apoptosis of HMrSV5 cells was observed under transmission electron microscope. Acridine orange/ethidium bromide-stained condensed nuclei was detected by fluorescent microscopy and flow cytometry. The expressions of Bcl-2 and Bax was immunochemically evaluated. The results showed that conspicuous morphological changes of apoptosis were observed in HMrSV5 cells 24 h after treatment with the supernatants of gastric cancer cells. The supernatants could induce apoptosis of HMrSV5 cells in a time-dependent manner. The supernatants could up-regulate the expression of Bax and suppress that of Bcl-2 in HMrSV5 cells. These findings demonstrated that gastric cancer cells can induce the apoptosis of HPMCs through supernatants in the early peritoneal metastasis. The abnormal expressions of Bcl-2 and Bax may contribute to the apoptosis. Anti-apoptosis drugs promise to be adjuvant chemotherapeutic agents in the treatment of peritoneal metastasis of gastric cancer.

Paget's disease is associated with eleven cancerous regions: a case report and therapeutic strategy / 华中科技大学学报（医学）（英德文版）

Paget's disease of the breast is an uncommon disorder that accounts for 1% to 3% of all mammary tumors. The incidence of underlying carcinoma associated with Paget's disease has been reported in 82% to 100% of cases. The finding of underlying carcinoma reaches almost 100% when a palpable lump is also present. In this rare case, we described a patient presenting with Paget's disease but no palpable lump. However, we found 11 independent regions which were all invasive ductal carcinoma after the operation. Considering this patient, we should pay more attention to a multifocal and multicentric breast carcinoma associated with Paget's disease. Furthermore, we believe the mammography examination and a modified radical mastectomy are the most appropriate treatments for this population in clinical practice.

Evaluation on the use and results of computer-aided detection for full-field digital manunography / 中华放射学杂志

Objective To evaluate the using and results of computer-aided detection for full-field digital mammography in Chinese women. Methods 934 individuals more than 40 years old from a specific unit in Shenyang city were screened by full-field digital mammography ( Senographe 2000D, GE) . The examination images were diagnosed firstly by the experienced radiologists and then were analyzed by the computer-aided detection system ( R2' Image Checker ) , respectively. The results from these two assays were compared. Results The prompts were generated in 799 out of 1734 normal images, false-positive rate of computer-aided detection ( CAD) was 46. 1 % in the cases with normal breast image. The correct prompts rate was 70. 5 % in the cases with breast mass, 75. 0 % in the cases with breast microcalcification and 100. 0 % in the cases with breast cancer. Conclusion Although the CAD system has showed clinical values in practice, there are still some false-positive and false-negative results.

Diagnosis and treatment of gastric cancer with ovarian metastasis:a report of 17 cases / 中国普通外科杂志

Objective To investigate the clinical and pathological characteristics, diagnosis and treatment of gastric cancer with ovarian metastasis. Methods The clinical data of 17 cases of gastric cancer with ovarian metastasis, confirmed by surgery and pathology, were analyzed retrospectively. Results The average age of the patients was 48.41 years, and the first appearance of symptoms and signs often were of metastatic ovarian cancer. The main ultrasonographic findings were either a complex type of mass with both solid and cystic characteristics or only solid, and most of them were accompanied by intraperitoneal fluid accumulation. Bilateral metastatic ovarian cancer was more common(13 cases). The preoperative accurate diagnosis of this disease was difficult, so that the misdiagnostic rate was 64.7% in this series. Operation was done in all the patients, but prognosis was poor. The median survival time was only 11.6 months. Conclusions The prognosis of gastric cancer with ovarian metastasis is poor. It is of importance to inspect the stomach in cases of bilateral ovarian cancer. Radical resection of the primary disease focus together with hysterectomy and bilateral adnexectomy should be performed. Postoperative comprehensive therapy is conducive to improve the prognosis of gastric cancer with ovarian metastasis.

Caspase-3 in cellular apoptosis of bladder carcinoma induced by mitomycin C / 中华泌尿外科杂志

Objective To investigate caspase 3 in the apoptosis of EJ cells in bladder carcinoma induced by mitomycin C(MMC). Methods The apoptosis and changes in cell cycle were examined by means of TUNEL and flow cytometry. The ability of caspase 3 antibody to resist apoptosis induced by a low dose of mitomycin was also studied. Results The typical characteristics of apoptosis were observed in EJ cells treated with low dose of mitomycin and the apoptotic index (AI) was (62.9? 2.2 )%, being much higher than that in the group treated combinedly with caspase 3 antibody and MMC(4.9?0.3)% and in the controls (2.7?0.7)%, P

The expression and clinical significance of multi-genes in breast cancer / 中国普通外科杂志

0.05). Expression of MDR1 had a positive ~correlation with mutant p53 accumulation and HER2 expression(P0.05 ).In univariate analyses,TNM staging, axillary lymph node metastasis, mutant p53 accumulation, and HER2 over-expression were negatively correlated with DFS and OS, and MDR1 over-expression significantly reduced OS but not DFS. In multivariate analysis, axillary lymph node metastasis, over-expression of MDR1 and HER2 were independent risk factors for prognosis. Conclusions ~Induction of multidrug resistance and poor response to chemotherapy and endocrinotherapy may be the chief reasons for poor prognosis of breast cancer with mutant p53 accumulation, and HER2 and MDR1 over-expression. ~Determination of the above genes′expression in breast cancer tissue can be of use in deciding the degree of ~malignancy , metastasis phenotype and prognosis of brest cancer. Increasing anthracycline dose may increase the ~overall response rate to chemotherapy and improve prognosis in patients with mutant p53 accumulation, HER2 and MDR1 over-expression, especially HER2 over-expression.

Comparison of quality of life following three types of reconstruction procedures after gastrectomy for gastric cancer / 中国普通外科杂志

Objective To analyze the quality of life(QOL) of gastric cancer patients who underwent different types of gastrectomy and digestive tract reconstruction procedures.Methods Among the patients who(underwent) gastrectomy in our department over a period of 4 years,61 cases that survived for more than 2 years were analyzed for QOL using 14 parameters.The 61 cases included 13 cases of proximal subtotal(gastrectomy) and esophagogastrostomy,18 cases of total gastrectomy and jejunal P pouch reconstruction,and 30 cases of total gastrectomy and double Braun type of jejunal reconstruction.Pouch emptying function in 12 patients with different types of reconstruction was determined in by Isotope ~(99m)TC scintigraphy.Results At 6 months after operation,the parameters showed no significant differences between the 3 groups.At 12 months after operation,the QOL of patients with double Braun-type reconstruction was superior to that of patients with P jejunal pouch and patients with esophagogastrostomy in intake time(P