Analysis of influencing factors to metastasis in sentinel lymph nodes and non-sentinel lymph nodes in breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the relevant factors influencing sentinel and non-sentinel lymph node (SLNM, NSLNM) metastases in breast cancer.</p><p><b>METHODS</b>The clinicopathological data of 283 women with breast cancer who underwent sentinel lymph node biopsy from July 2010 to August 2011 in the Cancer Institute and Hospital at Chinese Academy of Medical Sciences were reviewed retrospectively, and the relevant factors affecting sentinel and non-sentinel lymph node metastases were analyzed.</p><p><b>RESULTS</b>Univariate analysis showed that age, menopause status, tumor size, pathological type and intravascular tumor thrombus were associated with SLNM metastasis (all P < 0.05). Multivariate analysis showed that age, tumor size and intravascular tumor thrombus were associated with SLNM (all P < 0.05) . No risk factors were found in either univariate or multivariate analysis of NSLNM.</p><p><b>CONCLUSIONS</b>Age, tumor size and intravascular tumor thrombus are independent influencing factors associated with SLNM, and age is a protective factor. Whether ER, pathological type and pathological grade are associated with SLNM or not is still controversial.</p>

Characterization of hormone receptor status in 5758 Chinese females with breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the characteristics of hormone receptor status in Chinese females with breast cancer.</p><p><b>METHODS</b>The clinicopathological data of 5758 female breast cancer patients surgically treated in our breast cancer center from Jan. 1997 to Oct. 2008 were retrospectively analyzed.</p><p><b>RESULTS</b>The positive rates of estrogen receptor (ER) and progesterone receptor (PR) were 64.1% and 70.2%, respectively. The ER positive rate was significantly higher in elderly, post-menopausal females with a smaller tumor and well-differentiated histology (P < 0.05), while the PR positive rate was significantly correlated with only histological differentiation and tumor size (P < 0.05). The ER and PR positive rates were significantly higher in the patients with lymph node metastasis than that in those without (P < 0.05). Multivariate analysis showed that the histological differentiation, T stage, N stage and menopause status were significantly correlated with ER positive rate, while histological differentiation, T stage and N stage were significantly correlated with PR positive rate.</p><p><b>CONCLUSION</b>Our results show that the ER positive rate of breast cancer in Chinese women is lower than that in western high incidence areas. The ER positive rate is significantly correlated with age, histological differentiation, tumor size, and menopause status. The PR positive rate is correlated only with histological differentiation and tumor size. Interestingly, the ER and PR positive rates are significantly higher in the patients with axillary lymph node metastases than that in those without. However, further study is needed to verify this special phenomenon.</p>

Analysis of the treatment and prognosis of recurrent breast phyllodes tumor / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the methods of diagnosis, treatment and prognosis for patients with recurrent breast phyllodes tumor.</p><p><b>METHODS</b>Clinicopathological data of 26 patients with pathologically proven recurrent phyllodes tumors treated from March 1972 to June 2006 were retrospectively analyzed.</p><p><b>RESULTS</b>The mean age of the 26 cases was 45 years, and the median follow-up duration was 83 months. The mean overall survival time of this series was 96 months. The primary breast phyllodes tumor was > or = 5 cm in 10 cases with a recurrence rate of 60.0% (6/10 cases); < 5 cm in 16 cases with a recurrence rate of 31.3% 5/16 cases). After surgical removal of the breast primary tumor, the recurrent tumor was > or = 5 cm in 14 cases with a re-recurrence rate of 35.7% (5/14 cases); < 5 cm was in 12 cases with are-recurrence rate of 50.0% (6/12 cases). There was no statistically significant relationship between the (primary and reccurent) tumor size and recurrence rate (P = 0.094, P = 0.383) or prognosis (P = 0.142, P = 0.486). The benign or malignant nature of the breast phyllodes tumor was significantly correlated with the rate of local re-recurrence (P = 0.046) and prognosis (P = 0.028).</p><p><b>CONCLUSION</b>The benign or malignant nature of the breast phyllodes tumor is significantly correlated with the local re-recurrence and prognosis, while the size of the primary breast phyllodes tumor has no significant effect on either re-recrruence or prognosis. The first rescue operation is most important in the treatment of recurrent breast phyllodes tumor. The resection margin should be wide enough. Active surgical treatment can still effectively save the life of the patients with a local re-recurrent tumor.</p>

Clinical characteristics comparison between triple-negative and non-triple-negative breast cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the clinical characteristics of triple-negative (TN) breast cancer and non-triple-negative (NTN) breast cancer, enrich the information of TN patients, and provide evidences for individualized combined treatment.</p><p><b>METHODS</b>The data of 408 cases received operation in the year of 2002 was enrolled in this study. TN patients were confirmed according to the immunohistochemical (IHC) test of estrogen receptor (ER), progesterone receptor (PR) and HER-2/neu. The clinical characteristics, recurrence, metastasis and survival were compared between the two groups.</p><p><b>RESULTS</b>Seventy-seven patients (18.9%) were confirmed TN cases. The median follow-up was 64 months (range, 3-79 months). Of all the cases, 58 occurred local recurrence or metastasis and 51 died, it was 19 and 12 in TN group. Compared with the NTN group, the TN patient tended to be younger and the tumor mass larger (P=0.015 and 0.011). However, axillary lymph nodes metastasis occurred more often in NTN patients than in TN patients (P=0.001). The rate of local recurrence and metastasis in TN group was significantly higher than in NTN group (P=0.005 and 0.025), and TN cases were more likely to develop lung metastasis than NTN patients (P<0.01). The 3-year and 5-year overall survival rate in TN group were significantly lower than in NTN group (86.4% vs. 93.4%, P=0.0205; 77.7% vs. 87.9%, P=0.0215). The 3-year and 5-year disease-free survival rate in TN group were also significantly lower than in NTN group (78.4% vs. 92.4%, P=0.0038; 72.8% vs. 85.8%, P=0.0041). Tumor size, lymph node status and triple-negative were the most important factors influencing the prognosis on multivariate Cox regression analysis.</p><p><b>CONCLUSIONS</b>TN breast cancer haa some specific clinical characteristics. The prognosis of TN patients is worse than that of NTN patients. Further study is needed to find individualized treatment for TN breast cancer patients.</p>

Clinicopathological comparison between young and old patients with rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the clinicopathological features and prognosis between patients under 40 years old (young group) and patients over 65 years old (old group) with rectal carcinoma.</p><p><b>METHODS</b>The data of 138 young rectal cancer patients and 163 old patients, treated in our hospital from January 1990 to January 2000, were analyzed retrospectively by SPSS 11.5 software. Survival was estimated by the Kaplan-Meier method and comparison by the log-rank test. Cox regression was used in multivariate analysis.</p><p><b>RESULTS</b>Stage III patients accounted for 53.6% (74/138) in young group, which was significantly higher as compared with 34.3% (55/163) in old group (P=0.001). The young group had significantly worse histologic grade with 28.2% of poorly differentiated tumors compared with 10.4% in the old group (P<0.001). The overall 5-year survival rates were 50.4% and 64.1% in young and old group respectively (P<0.05). However, the 5-year survival rates of the young group and old group with same TNM stage were similar. Cox regression showed that lymph node metastasis and T stage were independent prognostic factors.</p><p><b>CONCLUSIONS</b>As compared to the old patients, advanced stage and poorly differentiated carcinoma are more common in young patients with rectal cancer. However, no significant difference of survival rate is found between the young and the old patients with same stage. Early examination and treatment are crucial to improve the survival rate of rectal cancer.</p>

Expression of annexin I in human pancreatic cancer and the influence of its down-regulation on biology of this cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the expression of annexin in human pancreatic cancer and to elucidate its role in oncogenesis of pancreatic cancer.</p><p><b>METHODS</b>A pancreatic carcinoma cell line Suit-II with high-expression of annexin I gene was adopted. Three subtypes of annexin I -siRNA sequences and a non-related fragment were combined, and the eukaryotic expression vectors bearing siRNA fragments were constructed. Then they were transfected into pancreatic carcinoma cells to knock down the expression of annexin I by RNAi. After knocking down the expression of annexin I , the growth speed, cell cycling, morphological features and apoptosis of pancreatic carcinoma cells were examined by RT-PCR and MTT test.</p><p><b>RESULTS</b>When the expression of annexin I was blocked, the growth speed of pancreatic carcinoma cells was significantly decreased, the morphological features were changed and pronounced apoptosis occurred.</p><p><b>CONCLUSION</b>Annexin I can modulate pancreatic carcinoma cell cycle, promote the cell proliferation, increasingly stimulate the cell growth, and suppress the process of apoptosis in pancreatic carcinoma cells.</p>

Risk features of HBV in human hepatocarcinogenesis: a nested case-controlled study / 中华外科杂志

<p><b>OBJECTIVE</b>To identify the association strength of the prevalence of HBeAg, covalently closed circular DNA (cccDNA) and 1762/1764 nucleotide mutations of hepatitis B virus (HBV) with the occurrence of hepatocellular carcinoma (HCC) in Qidong high risk male cohort.</p><p><b>METHODS</b>A cohort of 377 middle aged HBV infected men in Qidong was followed from January 1989 to December 2002. Incident HCC cases were carefully registered. A matched case-controlled study was conducted on 32 pairs of inherent HCC cases with their matched non-HCC controls. Serum HBeAg was measured by ELISA. cccDNA was detected by primer selected PCR. 1762/1764 nucleotide mutations of HBV was identified by PCR of X gene segment spanning the mutation region. Standard statistical comparison between the prevalence of each HBV marker in HCC versus in control group provided the odds ratio with P value to evaluate its association strength with HCC occurrence.</p><p><b>RESULTS</b>Serum HBeAg prevalence was 53.1% (17/32) in HCC group versus and 15.6% (5/32) in controls (OR = 6.12, P < 0.01). Prevalence of serum cccDNA was detected in 62.5% (21/32) of HCC cases but in 25.0% (8/32) of controls (OR = 5.73, P < 0.01). Sequence of detected cccDNA was repeatedly found to be over 90% homologous with HBV. However, the mutation rate of nucleotide 1762/1764 was not found to be statistically higher in the HCC group versus its controls (OR = 1.54, P = 0.425).</p><p><b>CONCLUSIONS</b>The Qidong male case-controlled cohort had shown that serum HBeAg and cccDNA prevalence were tightly associated with hepatocellular carcinoma occurrence in HBV infected men. These biomarkers may have predictive value in earlier diagnosis and therapeutic effect monitoring.</p>

Clinical application of localized biopsy on breast microcalcification / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate fine needle localized biopsy under mammography-guiding and skin incision selection by hookwire under ultrasound-guiding for patients with breast microcalcification.</p><p><b>METHODS</b>Breast microcalcification of 178 patients treated from May 2000 to November 2006 were resected after localized with fine needle under X-ray mammography-guiding. Among them, 62 patients received the selection of hookwire under ultrasound-guiding.</p><p><b>RESULTS</b>Breast cancer was detected in 58 patients (32.6%). Among them, 32 (55.1%) cases were carcinoma in situ, 11 (19.0%) intraductal carcinoma with early infiltration, 15 (25.9%) infiltrative ductal carcinoma, and 4 infiltrative ductal carcinoma with lymph node metastasis. The overall 5-year survival rate was 100%. Compared with that in needle guided group, the acceptable rate of cosmetic results was higher in hookwire group (P = 0.022).</p><p><b>CONCLUSIONS</b>For breast microcalcification, mammography guided needle biopsy with ultrasound selected skin incision is an effective and accurate diagnostic method.</p>

Analysis of recurrence and prognosis after surgical resection for I stage lower rectal carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathologic factors related with recurrence and prognosis after surgical resection for I stage lower rectal carcinoma.</p><p><b>METHODS</b>The related clinicopathologic factors for recurrence and prognosis of 166 patients with I stage lower rectal carcinoma after surgical resection were retrospectively analyzed using univariate and multivariate methods.</p><p><b>RESULTS</b>A total of 138 patients with I stage lower rectal carcinoma received radical resection according to the operative rules of total mesorectal excision (TME). Ninety-three patients received abdominoperineal resection (APR) operation, 45 patients received sphincter preserving operation, and 28 patients received local excision. The local recurrence rates were 6.5% (6/93), 2.2% (1/45), 17.9% (5/28), respectively . Histological differentiation and operative procedures were associated with local recurrence. The 5-year survival rates were 91.1% in APR group, 95.5% in sphincter preservation group and 82.6% in local resection group. Univariate analysis revealed that histological differentiation and local recurrence were correlated with prognosis. Multivariate analysis revealed that local recurrence was the most important prognostic factor for I stage lower rectal carcinoma.</p><p><b>CONCLUSIONS</b>Radical resection of I stage lower rectal carcinoma has low recurrence rate and better prognosis. Sphincter preserving operation and local excision must be strictly selected in proper patients.</p>

Characteristics of metastasis and recurrence following curative resection for colonic carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the characteristics of metastasis and recurrence following curative resection for colonic carcinoma,and analyze the prognosis.</p><p><b>METHODS</b>The clinicopathological and follow-up data of 310 patients with colon carcinoma undergoing curative resection were analyzed retrospectively.</p><p><b>RESULTS</b>The recurrence rate after curative resection was 23.2% (72/310). The 5-year survival rate was 64.6%. Hepatic metastasis accounted for 38.9% of the cases. Gross classification,histological type, differentiation, lymph node metastasis were correlated with metastasis/recurrence. Univariate analysis revealed that gross classification, histological type, differentiation, lymph node metastasis, blood vessel invasion, TNM Stage, postoperative chemotherapy, portal chemotherapy were prognostic factors. Cox regression analysis revealed that only gross classification, lymph node metastasis, postoperative chemotherapy, portal chemotherapy were independent prognostic factors.</p><p><b>CONCLUSIONS</b>Liver is the most common metastatic site after curative resection for colonic carcinoma. Gross classification, lymph node metastasis, postoperative chemotherapy, and portal chemotherapy are independent prognostic factors.</p>

Lymph node metastasis and prognosis in T1 and T2 rectal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the characteristics of lymph node metastasis and prognosis of T1/T2 rectal carcinoma.</p><p><b>METHODS</b>The clinical data of 241 patients with T1 or T2 rectal carcinoma were retrospectively analyzed. The factors relative to lymph node metastasis were analyzed using Chi-square test. The survival data were analyzed using Kaplan-Meier method. The factors influencing survival were analyzed using univariate (Long-rank) and multivariate (Cox model) methods.</p><p><b>RESULTS</b>Of the 241 patients, 132 received Mile's operation and 109 underwent sphincter preserving operation. The over-all lymph node metastasis rate was 22.0% (53/241). The lymph node metastasis was significantly correlated with histological differentiation as revealed by Chi-square test. The over-all 5-year survival rate for the whole series group was 91.5%. Univariate analysis revealed that tumor histological type, intramural infiltration, differentiation, lymph node metastasis, radiation therapy were significant predictors of survival; however, only intramural infiltration was the most important prognostic predictor by multivariate analysis.</p><p><b>CONCLUSION</b>Even though lymph node metastasis can be observed either in T1 or T2 rectal carcinoma, histological differentiation is significantly related to the lymph node metastasis. As radical resection achieve better survival than local resection, it should be suggested as the chief treatment for T1/T2 rectal carcinoma.</p>

Suppression of c-myc expression by interference RNA in HepG2 hepatocellular carcinoma cells / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the inhibitory effect of RNA interference (RNAi) on c-myc expression in hepatocellular carcinoma cell line, HepG2.</p><p><b>METHODS</b>Expression vector of c-myc gene-targeting small interference RNA (siRNA) was constructed (psilencer-c-myc) and transfected into HepG2 cells by lipofectamine, and the unloaded vector was used as control (mock). The expression of c-myc mRNA and protein was identified by quantitive PCR and Western blot. Apoptosis of the transfected cells was examined by flow cytometry and immunofluorescent microscopy.</p><p><b>RESULTS</b>After HepG2 cells were transfected with psilencer-c-myc, the expression of c-myc mRNA and protein was suppressed with an inhibition rate of 67% compared with the mock-transfected cells. Apoptosis was identified in the transfected HepG2 cells.</p><p><b>CONCLUSION</b>The expression of c-myc at transcriptional and translational levels in HepG2 cells transfected with siRNA is markedly inhibited, which may be associated with the induction of apoptosis.</p>

Diagnosis and surgical treatment of primary duodenal carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the early diagnosis of primary duodenal carcinoma and its outcome after surgical procedure.</p><p><b>METHODS</b>Twenty-two patients with primary duodenal carcinoma treated operatively between 1983 and 1997 were analyzed retrospectively. Eleven patients complained of epigastric pain and discomfort, 5 jaundice, 4 nausea and vomiting and 2 epigastric fullness. The correct diagnosis rate for endoscopy was 90.0% (9/10), for duodenography 86.7% (13/15), for ultrasound examination 33.3% (4/12) and for computerized tomography (CT) scanning 58.3% (7/12), respectively. All of the 22 patients received surgery including pancreaticoduodenectomy (12 patients), segmental resection (4) and bypass operation (gastrojejunostomy and cholecystojejunostomy or cholangiojejunostomy) (6).</p><p><b>RESULTS</b>Primary duodenal carcinoma was characterized nonspecifically, and the correct diagnosis was based on endoscopy and duodenography. The follow-up rate of this group was 86.4% (19/22). The 1-, 3-, 5-year survival rates of patients receiving radical resection (n = 16, 1 patient lost follow-up) were 86.7% (13/15), 46.7% (7/15), and 26.7% (4/15), respectively. The 5-year survival rate of patients receiving pancreaticoduodenectomy was 27.3% (3/11), and the 5-year survival rate of patients having segmental resection was 1/4. No patient (n = 6, 2 lost follow-up) with primary duodenal carcinoma treated by bypass procedure survived more than one year. There was a significant difference between patients receiving radical procedure and bypass operation (chi(2) = 6.84, P < 0.01).</p><p><b>CONCLUSION</b>Radical resection might improve the survival of patients with primary duodenal carcinoma.</p>