The expression of cortactin in colorectal cancer and its relationship with clinicopathological and prognostic parameters / 中华肿瘤杂志

Objective: To investigate the expression of cortactin in colorectal cancer and its correlation with clinicopathological parameters and prognosis. Methods: The expressions of cortactin in normal colorectal mucosal tissue and colorectal cancer tissue in paraffin-embedded tissue microarray from 319 patients who were diagnosed as colorectal cancer and treated in Cancer Hospital of Chinese Academy of Medical Sciences from 2006 to 2009 was detected by immunohistochemistry. Kaplan-Meier method and Log rank test were used for survival analysis, and Cox proportional risk regression model was used for multivariate analysis. Results: The positive expression rates of cortactin in colorectal cancer tissue and normal colorectal mucosal tissue were 61.1% (195/319) and 5.6% (18/319, P<0.001), respectively. T-stage, N-stage, American Joint Committee on Cancer (AJCC) stage, degree of tumor differentiation, neural invasion and preoperative carcinoembryonic antigen (CEA) levels were associated with the expression of cortactin (P<0.05). The positive expression of cortactin was associated with poorer disease-free survival (P=0.036) and overall survival (P=0.043), and the effect was more significant in patients with stage Ⅱ to Ⅲ. For patients with stage Ⅱ-Ⅲ colorectal cancer, postoperative adjuvant therapy was associated with disease-free survival (P=0.007) and overall survival (P=0.015). The vascular tumor embolus, pathological type, preoperative CEA level and cortactin expression were independent influencing factors for disease-free survival (P<0.05). The age, AJCC stage, preoperative CEA level and cortactin expression were independent influencing factors for overall survival (P<0.05). Preoperative CEA level and cortactin expression were independent influencing factors for disease-free survival and overall survival (P<0.05). Conclusion: Cortactin is expressed in colorectal cancer and in stage Ⅱ-Ⅲ patients, it is a potential predictor of colorectal cancer prognosis.

Application and prospect of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal metastasis from colorectal cancer / 中华肿瘤杂志

Colorectal cancer is one of the common malignant tumors in China, and its incidence is increasing with years. As the second most common metastatic site of colorectal cancer, peritoneum is difficult to diagnose early and with a poor prognosis. Systemic intravenous chemotherapy was used as the main treatment strategy for peritoneal metastasis in the past, but its systemic toxic and side effects were obvious, and it could not effectively control tumor progression. In recent years, the continuous development of surgical techniques, concepts, and equipment, as well as the introduction of new chemotherapy drugs and targeted drugs have significantly improved the quality of life and prognosis of patients with peritoneal metastasis of colorectal cancer. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) can effectively eradicated the intraperitoneal free cancer cells and subclinical lesions, while reducing systemic side effects of chemotherapy drugs, and achieve the radical cure of the tumor at the macro and micro levels to the greatest extent. It has been used as the first-line treatment program for peritoneal metastasis of colorectal cancer at home and abroad. This article focuses on the analysis and summary of the survival efficacy, prognostic factor analysis, and chemotherapy safety of CRS+ HIPEC in the treatment of colorectal cancer peritoneal metastasis. The existing problems and controversies of HIPEC therapy are discussed simultaneously.

Comparison on efficacy between fascia-oriented versus vascular-oriented lateral lymph node dissection in patients with rectal cancer / 中华胃肠外科杂志

Objective: To compare the postoperative function, the short-term and long-term outcomes between fascia-oriented and vascular-oriented lateral lymph node dissection (LLND) in patients with rectal cancer. Methods: A retrospective cohort study was performed. Clinical data of patients who received total mesorectal excision (TME) with LLND at National Cancer Center, Cancer Hospital of Chinese Academy of Medical Science from January 2014 to December 2019 were retrospectively collected. Inclusion criteria were as follows: (1) rectal cancer was pathologically diagnosed, and the lower margin was below the peritoneal reflection. (2) resectable advanced rectal cancer with suspected lateral lymph node metastasis was evaluated based on rectal MRI assessment. (3) preoperative MRI showed lateral lymph node short diameter ≥5 mm and/or lymph node morphology (spike, blur, irregular) as well as heterogenous signal intensity. Lymph node shrinkage was less than 60% after receiving neoadjuvant therapy based on the reassessment of rectal MRI. (4) TME+LLND surgery was performed synchronously. Exclusion criteria were as follows: (1) previous history of pelvic surgery; (2) preoperative cystitis, urethritis, moderate and severe prostatic hyperplasia and other diseases resulting in abnormal urination function; (3) preoperative sexual dysfunction or loss of function; (4) patients receiving LLND due to lateral recurrence after TME; (5) distant metastasis of the tumor at initial diagnosis; (6) Incomplete collection of clinical data. A total of 73 consecutive patients were enrolled in this study. Based on the surgical approaches in performing LLND, patients were divided into fascia-oriented group (n=30) and vascular-oriented group (n=43). There were no significant differences in baseline data between the two groups (all P>0.05). The main outcome indicators of this study were the incidence of postoperative urinary and male sexual dysfunction, the efficacy, the number of lateral lymph nodes harvested and the detection rate of positive lymph nodes. Overall survival (OS) rates and progression free survival (PFS) rates were calculated by the Kaplan-Meier method and compared by log-rank test. Results: All patients in both groups completed surgery successfully. There were no significant differences in operation time, intraoperative blood loss, postoperative complications, and the length of hospital stay between the two groups (all P>0.05). In the whole group, the incidence of postoperative urinary dysfunction and male sexual dysfunction was 43.8% (32/73) and 62.5% (25/40), respectively. The median number of lateral lymph nodes harvested was 8.0(4.0,11.0) with a positive rate of 20.5%(15/73). Compared to the vascular-oriented group, the fascia-oriented group demonstrated a decreased rate of urinary dysfunction [26.7% (8/30) vs. 55.8% (24/43), χ(2)=6.098, P=0.014], lower rate of sexual dysfunction in males [6/15 vs. 76% (19/25), χ(2)=5.184, P=0.023], more harvested lateral lymph nodes [M (P25, P75): 9.5 (6.8, 15.3) vs. 6.0 (3.0, 9.0), Z=-2.849, P=0.004]. There was no significant difference in the positvie rate of lateral lymph nodes between the two groups [20% (6/30) versus 20.9% (9/43), χ(2)=0.009, P=0.923]. Three(4.1%) patients were lost during a median follow-up of 34 (1-66) months. The 3-year PFS and OS of the whole cohort were 69.5% and 88.3%, respectively. No significant difference in 3-year PFS rates (79.6% vs. 62.0%, P=0.172) and 3-year OS rates (91.2% vs. 85.9%, P=0.333) were observed between the fascia-oriented group and the vascular-oriented group (both P>0.05). Conclusion: Fascia-oriented LLND is associated with lower risk of postoperative urinary and male sexual dysfunction in patients with rectal carcinoma, and harvest of more lymph nodes, but no significant advantage in long-term survival.

Arthroscopic repair of partial articular supraspinatus tendon avulsion lesions by conversion to full-thickness tears through a small incision / 中华创伤杂志(英文版)

PURPOSE@#To assess the clinical efficacy of converting partial articular supraspinatus tendon avulsion (PASTA) lesions to full-thickness tears through a small local incision of the bursal-side supraspinatus tendon followed by repair.@*METHODS@#We retrospectively analyzed 41 patients with Ellman grade 3 PASTA lesions and an average age of (54.7 ± 11.4) years from March 2013 to July 2017. Patients without regular conservative treatment and concomitant with other shoulder pathologies or previous shoulder surgery were excluded from the study. The tears were confirmed via arthroscopy, and a polydioxanone suture was placed to indicate the position of each tear. A small incision of approximately 6 mm was made using a plasma scalpel on the bursal-side supraspinatus tendon around the positioned suture to convert the partial tear into a full-thickness tear. The torn rotator cuff was sutured through the full thickness using a suture passer after inserting a 4.5-mm double-loaded suture anchor. Data were analyzed using a paired Student's t-test with statistical significance defined as p <0.05.@*RESULTS@#At the final follow-up of 2 years, the pain-free shoulder joint range of motion and visual analog scale score were significantly improved compared to those before surgery (p < 0.001). The postoperative American Shoulder and Elbow Surgeons shoulder score was (90.6 ± 6.2), which was significantly higher than the preoperative score of (47.9 ± 8.3) (p < 0.001). The University of California at Los Angeles shoulder rating scale score increased from (14.7 ± 4.1) prior to surgery to (32.6 ± 3.4) points after surgery (p < 0.001). No patient had joint stiffness.@*CONCLUSION@#This modified tear completion repair, by conversion to full-thickness tears through a small incision, has less damage to the supraspinatus tendon on the side of the bursa compared to traditional tear completion repair in the treatment of PASTA lesions. This surgical method is a simple and effective treatment that can effectively alleviate pain and improve shoulder joint function.

Cytological study on aptamer selection for bladder cancer through CELL-SELEX / 医学研究生学报

ObjectiveThe methods based on bladder cancer markers which could be applied to early diagnosis and postoperative recurrence monitoring of bladder cancer were current research hotspots. This study aims to screen aptamers that specifically recognize human bladder cancer cell lines (EJ, T24, BIU87) through cell-based systematic evolution of ligand by exponential enrichment (CELL-SELEX).MethodsFor CELL-SELEX screening, bladder cancer cell lines EJ, T24, and BIU87 were used as positive control cells. HCV 29 (human normal urothelial cell line), 293T (human embryonic kidney cell line), huh7 (human hepatocellular carcinoma cell line) were used as negative control cells. PCR upstream primers were labeled with FITC, downstream primer was labeled with Biotin. ssDNA fragments collected from each round were amplified by PCR, and the amplified product was then purified using a DNA purification Kit. The biotin-streptavidin magnetic separation methods were used to isolate the PCR product to obtain secondary FITC-ssDNA for the next CELL-SELEX round. The screening process was monitored by flow cytometry. ssDNA pool with the highest binding rates to bladder cancer cell lines(EJ, T24, and BIU87) was selected to PCR amplification, product purification, molecular cloning, and sequencing. According to the sequencing results, the secondary structure of the aptamer was pre-simulated by Dnaman software. Aptamer labeled with FITC was synthesized in vitro, flow cytometry was used to detect the binding rate of the aptamer to bladder cancer cell lins (EJ, T24 and BIU87).ResultsWith the advance of the CELL-SELEX process, the binding rate of FITC-ssDNA to bladder cancer cell lins (EJ, T24, and BIU87) increased gradually. By the 15th round, the binding rate of FITC-ssDNA to EJ cells reached the highest level. The apt1 had the highest enrichment among the 15th round ssDNA pool. By the 18th round, the binding rate of FITC-ssDNA to T24 or BIU87 cells reached the highest level. The apt2 and apt3 had the highest enrichment among the 18th round ssDNA pool. DNA structure prediction showed that the secondary structure of apt1, apt2, and apt3 was mainly stem-loop structure. Flow cytometry showed that the highest binding rate was FITC-apt1 to EJ cells, FITC-apt2 to T24 cells, and FITC-apt3 to BIU87 cells, respectively. There is no significant combination between these aptamers with the negative cells.ConclusionIn this study, three kinds of aptamers with high specificity for bladder cancer cell lines were successfully screened by CELL-SELEX. The apt1 can specifically recognize EJ cells, apt2 can specifically recognize T24 cells and apt3 can specifically recognize BIU87 cells, all of which provide experimental evidence for early diagnosis and targeted therapy technology research of bladder cancer.

Clinical parameters predicting pathologic complete response following neoadjuvant chemoradiotherapy for rectal cancer / 癌症

<p><b>INTRODUCTION</b>Preoperative chemoradiotherapy (CRT), followed by total mesorectal excision, has become the standard of care for patients with clinical stages II and III rectal cancer. Patients with pathologic complete response (pCR) to preoperative CRT have been reported to have better outcomes than those without pCR. However, the factors that predict the response to neoadjuvant CRT have not been well defined. In this study, we aimed to investigate the impact of clinical parameters on the development of pCR after neoadjuvant chemoradiation for rectal cancer.</p><p><b>METHODS</b>A total of 323 consecutive patients from a single institution who had clinical stage II or III rectal cancer and underwent a long-course neoadjuvant CRT, followed by curative surgery, between 2005 and 2013 were included. Patients were divided into two groups according to their responses to neoadjuvant therapy: the pCR and non-pCR groups. The clinical parameters were analyzed by univariate and multivariate analyses, with pCR as the dependent variable.</p><p><b>RESULTS</b>Of the 323 patients, 75 (23.2%) achieved pCR. The two groups were comparable in terms of age, sex, body mass index, tumor stage, tumor location, tumor differentiation, radiation dose, and chemotherapy regimen. On multivariate analysis, a pretreatment carcinoembryonic antigen (CEA) level of ≤ 5 ng/mL [odds ratio (OR) = 2.170, 95% confidence interval (CI) = 1.195-3.939, P = 0.011] and an interval of >7 weeks between the completion of chemoradiation and surgical resection (OR = 2.588, 95% CI = 1.484-4.512, P = 0.001) were significantly associated with an increased rate of pCR.</p><p><b>CONCLUSIONS</b>The pretreatment CEA level and neoadjuvant chemoradiotherapy-surgery interval were independent clinical predictors for achieving pCR. These results may help clinicians predict the prognosis of patients and develop adaptive treatment strategies.</p>

Outcome analysis of simultaneous liver resection for synchronous liver metastases from colorectal cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the outcomes of simultaneous liver resection for patients who have primary colorectal cancer with synchronous hepatic metastases to see if there is any advantage for doing so.</p><p><b>METHODS</b>We retrospectively analyzed the medical records (1999 - 2009) of 53 consecutive patients with synchronously recognized primary colorectal carcinoma and hepatic metastases who underwent simultaneous (40 patients) or two-stage (13 patients) colonic and hepatic resections performed at our hospital.</p><p><b>RESULTS</b>There was no thirty-day mortality in both groups. The two groups had significant differences in mean operation duration [(212.9 ± 72.3) min vs. (326.5 ± 140.2) min, P = 0.014], mean blood loss [(337.5 ± 298.0) ml vs. (594.6 ± 430.5) ml, P = 0.020], post-operative hospital stay [(16.2 ± 8.1) day vs. (25.8 ± 8.5) day, P = 0.001]. The incidence rates of post-operative complications were 25.0% (10/40) and 53.8% (7/13), respectively, in the two groups (P = 0.053). The 1-, 3-, 5-year survival rates in the simultaneous resection group were 95.0%, 57.0% and 37.4%, respectively, with a median overall survival of 40.0 months and median disease-free survival of 14.0 months. The 1-, 3-, 5-year survival rates in the two-stage resection group were 92.3%, 58.7% and 36.7%, respectively, with a median overall survival of 38.0 months and median disease-free survival of 13.0 months. There were no significant differences between the two groups in respect of their survivals (P > 0.05).</p><p><b>CONCLUSIONS</b>Simultaneous colectomy and hepatectomy are safe and efficient for colorectal cancer patients who have synchronous colorectal liver metastases, with less complications and blood loss, and shorter hospital stay compared with the two-stage resection.</p>

Clinicopathological features and prognosis of primary appendiceal adenocarcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the clinicopathological characteristics and prognostic factors of primary appendiceal adenocarcinoma.</p><p><b>METHODS</b>The clinicopathological data of 42 patients with primary appendiceal adenocarcinoma treated in the Cancer Hospital of Chinese Academy of Medical Sciences between March 1994 and October 2009 were retrospectively analyzed. The survival analysis was conducted using Kaplan-Meier method. The factors influencing survival were analyzed using univariate (Log-rank) and multivariate (Cox) models.</p><p><b>RESULTS</b>A total of 42 patients (29 female and 13 males, median age 56 years) with appendiceal adenocarcinoma were included in this study. Of them, 26 (61.9%) were mucinous adenocarcinoma, 12 (28.6%) were intestinal-type adenocarcinoma and 4 (9.5%) were signet cell carcinoma. 18 patients underwent curative resection, 20 patients received cytoreductive surgery, and 4 patients underwent biopsy only. Thirty patients received systemic chemotherapy (5-Fu-based regimens). One patient who died of postoperative pulmonary embolism on day 8 was excluded from the survival analysis. The overall 1-, 3-, and 5-year survival rate was 80.3%, 46.0% and 38.3%, respectively. Univariate analysis revealed that presence of symptoms of acute appendicitis, curative resection, histological grade, histological subtype, preoperative CEA level, systematic chemotherapy, and stage were all significant factors affecting the survival. Multivariate analysis showed that the preoperative CEA level (P = 0.01), histological grade (P = 0.001), and stage (P = 0.001) were independent prognostic factors.</p><p><b>CONCLUSIONS</b>High level of CEA, G2/3 grade, and advanced stage are associated with poor prognosis in patients with primary appendiceal adenocarcinoma.</p>

Animal experimental study of compression anastomosis ring for low anterior resection / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and safety of nickel-titanium compression anastomosis ring (CAR27) in colorectal anastomosis after low anterior rectal resection in animal models.</p><p><b>METHODS</b>End-to-end colorectal anastomosis was performed using CAR27 in 6 experimental pigs after resection of the middle and lower third of the rectum. The animals were observed postoperatively for up to 56 days. Five pigs were sacrificed at day 14 and the other at day 56. Distance from anal verge to anastomosis and anastomotic circumference were measured. Histopathologic examination was performed.</p><p><b>RESULTS</b>The median distance from anal verge was 5.3(4-6) cm. No anastomotic leak or other complications were observed. All the pigs recovered and gained weight. In 5 animals sacrificed at day 14, the mean circumference of the anastomosis was 6.8(6.5-7.0) cm, and histopathological examination showed mild inflammatory reaction and fibrosis. In the one sacrificed at day 56, the circumference expanded to 9.3 cm, and no inflammation and fibrosis were observed. Minor adhesion was noticed in only one pig, while smooth and intact serosa in the anastomosis was seen in the rest of the animals.</p><p><b>CONCLUSION</b>CAR27 is a promising device for mid and low colorectal anastomosis.</p>

Association between the number of retrieved lymph nodes in stage II( colorectal cancer radical resection and its prognosis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the association between the number of retrieved lymph nodes and the prognosis of stage II colorectal cancer.</p><p><b>METHODS</b>Clinical data of 380 patients with stage II colorectal cancer were analyzed retrospectively. SPSS 13.0 was used for data processing. Survival rate was calculated by Kaplan-Meier method, and risk factors related to prognosis of stage II colorectal cancer were analyzed by Logistic regression analysis. Recurrence rate and survival rate were assessed with Chi-squared test.</p><p><b>RESULTS</b>The average number of lymph nodes retrieved from 56 patients who developed recurrence or metastasis in 5 year after surgery was 9.5, and 16.3 from patients who had no recurrence or no metastasis(P<0.01). The number retrieved from 97 patients who died in 5 years after surgery was 11.1, and 16.7 from survivors. Patients were divided into 2 groups:>or=12 group and <12 group. The 5-year survival rate was 83.9% in >or= 12 group and 62.0% in < 12 group, respectively(P<0.01), the recurrence rate was 6.4% in >or=12 group and 25.7% in < 12 group (P<0.01). The univariable analysis showed that the number of retrieved lymph nodes was significantly associated with the survival and recurrence in patients with stage II colorectal cancer (P<0.05).</p><p><b>CONCLUSIONS</b>The number of retrieved lymph nodes is associated with the prognosis of stage II colorectal cancer. Patients with more retrieved lymph nodes have a higher survival rate.</p>

Prognostic factors of resectable pulmonary metastases from colorectal cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the prognostic factors for patients who underwent curative resection of pulmonary metastases from colorectal cancer.</p><p><b>METHODS</b>The clinicopathological data of 60 patients with pulmonary metastases from colorectal carcinoma who underwent a radical pulmonary metastasectomy between February 1985 and December 2004 at the Cancer Hospital of Chinese Academy of Medical Sciences were retrospectively reviewed and analyzed.</p><p><b>RESULTS</b>The overall 5-year survival rate was 43.7% after pulmonary excision and 74.0% after colorectal resection. Three factors were identified as significant by univariate log-rank test for overall survival after pulmonary resection, they were preoperative carcinoembryonic antigen, number of pulmonary metastases (solitary vs. multiple), and hilar and/or mediastinal lymph node metastases (P < 0.05). Multivariate analysis showed that number of pulmonary metastases (solitary vs. multiple) and hilar and/or mediastinal lymph node metastasis were independent prognostic factors. However, shorter disease-free interval and more number of pulmonary metastases predicted poor prognosis after primary colorectal resection.</p><p><b>CONCLUSION</b>Pulmonary resection for metastases from colorectal cancer is safe and patients may get long-term survival in selected cases, especially in patients with a solitary pulmonary metastasis and without hilar and/or mediastinal lymph node metastasis.</p>

Significance of positive ductal margin and prognostic factors of surgical resection in middle and distal bile duct carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the significance of a positive ductal margin and evaluate the prognostic factors related to surgical resection for middle and distal bile duct carcinoma.</p><p><b>METHODS</b>A retrospective clinicopathological analysis of 79 patients who had undergone surgical resection for middle or distal bile ductal cancer between January 1990 and December 2006 was conducted. The surgical procedures consisted of pancreatoduodenectomy in 46 patients, bile duct resection in 25 patients, bile duct resection plus hepatectomy in 6 patients, and bile duct resection with partial resection of portal vein in 2 patients. In 74 patients, 5 patients were excluded because they died after surgery without being discharged from the hospital, 15 clinicopathologic factors were evaluated using univariate and multivariate analysis.</p><p><b>RESULTS</b>The overall 5-year survival rate and the median survival time was 30.7% and 36 months, respectively. Sixteen of 74 patients (20.3%) were determined to have positive ductal margins on the final pathological examination. As a result, hepatic-side ductal margin, duodenal-side ductal margin and both was found to be positive in 6, 3 and 2 patients, respectively. Five patients had positive radial margins. The 5-year survival rate was 34.4% in 58 patients without microscopic residual disease (R0), and 15.5% in 16 patients with microscopic residual tumor (R1). The ductal recurrence rate of 16 patients with R1 resection was higher than 58 patients with R0 resection (62.5% vs. 17.2%, chi(2) = 13.024, P < 0.01). The 1-, 3-, and 5-year survival rates were better in the patients with R0 (92.5%, 56.7%, and 34.4%, respectively) than those in the patients with R1 resection (75.0%, 23.2%, and 15.5%, respectively) (P < 0.05). Twelve patients received postoperative adjuvant therapy. The 5-year survival rate was not significantly different between patients with postoperative adjuvant therapy and those without (18.2% vs. 31.8%, P = 0.221). The preoperative serum level of hemoglobin, pathological differentiation grade, the depth of neoplastic invasion, lymph node metastasis, R1 resection, and TNM stage were significant prognostic factors on the univariate analysis. Multivariate analysis revealed that lymph node metastasis and R1 resection were the independent prognostic factors.</p><p><b>CONCLUSIONS</b>In the treatment of middle and distal bile duct cancer, radical resection should be made to obtain a tumor-free margin. An aggressive surgical approach may improve the survival for middle bile duct cancer. Adjuvant therapy needs to be further developed.</p>

Analysis of factors related to recurrence after local excision for low rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To discuss the factors predicting recurrence after local excision for low rectal cancer.</p><p><b>METHOD</b>Medical records and follow-up histories of 97 patients undergone local excision of adenocarcinoma of the rectum between April, 1975 and April, 2005 in Cancer Hospital of the Chinese Academy of Medical Sciences were reviewed retrospectively.</p><p><b>RESULTS</b>Postoperative pathologic examination revealed 28 pTis cases, 48 pT(1) cases, and 21 pT(2) cases. Eighty-nine patients underwent transanal excision, 7 transsacral excision, and 1 transvaginal excision. Twenty-two(45.8%) patients with T(1) tumors and 14(66.7%) patients with T(2) tumors were treated with postoperative radiotherapy with or without 5-fluorouracil. Seventeen(17.5%) patients presented recurrence, including 13 local recurrence, 2 local and distant recurrence, and 2 distant recurrence. The local recurrence rate was 15.5%. Median time to relapse was 27 months(range 4-73). The incidence of local recurrence were 7.1%, 12.5%, and 33.3% for patients with pTis, pT(1), and pT(2)(P=0.031) respectively. The local recurrence rate was 10.5%, 13.7%, and 3/5 for patients with pedunculated, sessile, and ulcerative carcinoma(P=0.017). The local recurrence of patients with T(2) tumors treated via local excision with or without chemoradiotherapy was 21.4%(3/14) and 4/7, but the difference was no significance(P=0.127). All the 15 patients with local recurrence underwent salvage resection, and the 5-year survival rate after salvage surgery was 59.6%.</p><p><b>CONCLUSIONS</b>Higher rates of recurrence are seen in patients with T(2) tumors and ulcerative carcinoma. Chemoradiotherapy or radical surgery should be chosen for T(2) tumors following local excision. Salvage resection should be considered after local recurrence.</p>

Surgical management for carcinoma of the gallbladder: a single-institution experience in 25 years / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Gallbladder carcinoma is rare and associated with dismal outcomes. Radical surgery is the only curative treatment, and options for adjuvant therapy remain limited. This study aimed to determine the factors influencing outcome of treatment in patients with gallbladder carcinoma, and to identify the patients who might benefit from radical surgery and adjuvant therapy.</p><p><b>METHODS</b>Medical records and follow-up histories of 150 patients with gallbladder carcinoma who had undergone surgery between April 1980 and December 2005 were retrospectively reviewed. The factors predictive for the survival of the patients were identified using multivariate analysis.</p><p><b>RESULTS</b>Surgery for gallbladder cancer was associated with an overall 5-year survival rate of 26.2%. After curative resection (40% of the patients), the 5-year survival rate was 60.3%. The patients who underwent R0 resection had a significantly longer median survival (97.3 months) than those who had R1/R2 resection (8.3 months) or only laparotomy (3.7 months) (P < 0.0001). Univariate analysis showed that resectability, American Joint Committee on Cancer staging, tumor grade, adjuvant therapy, jaundice at presentation, depth of tumor invasion, lymph node involvement, distant metastasis, and carcinoembryonic antigen level were statistically significant predictors for survival. Multivariate analysis revealed American Joint Committee on Cancer staging and resectability were independent prognostic factors for survival. The patients who underwent noncurative resection might benefit from adjuvant therapy (median survival, 12.4 months vs 7.2 months, P = 0.006).</p><p><b>CONCLUSIONS</b>Favorable survival rate can be achieved after curative resection, even for selected patients with advanced disease. Adjuvant therapy may improve the survival of patients with gallbladder carcinoma.</p>

Prognostic factors of colorectal cancer patients with synchronous liver metastasis treated with simultaneous liver and colorectal resection / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the prognostic factors of colorectal cancer patients with synchronous liver metastasis treated by simultaneous colorectal and liver resection.</p><p><b>METHODS</b>The clinical and follow-up data of 44 colorectal cancer patients with synchronous liver metastases who underwent simultaneous colorectal and liver resection from Jan. 1993 to Jan. 2003 were analyzed retrospectively. Survival rate was estimated by Kaplan-Meier method, and was compared using log-rank test. Prognostic factors were analyzed by multivariate Cox proportional hazards model.</p><p><b>RESULTS</b>The overall 1-, 3- and 5-year survival rates were 86.3%, 40.9% and 25.0%, respectively. The lymph node metastasis and vascular invasion by cancer cells from the primary tumour were found to affect prognosis significantly, while gender, age, tumor location, histopathological types, the number and distribution of liver metastases were not. Multivariate analysis revealed that the lymph node metastasis was the only independent prognostic factor.</p><p><b>CONCLUSION</b>Simultaneous liver and colorectal resection can be performed and may achieve good outcome in colorectal cancer patients with synchronous liver metastases, especially in those without lymph node metastasis.</p>

Clinicopathological features and prognosis of different gastric carcinoid subtypes / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the clinicopathological features and their relation to treatment and prognosis in different gastric carcinoid subtypes.</p><p><b>METHODS</b>The data of surgically treated 39 patients with gastric carcinoids (9 of type I and 30 of type III) were retrospectively analyzed. Univariate and multivariate analysis were performed using Chi square test (chi(2)) and Cox model, respectively. The survival rates were analyzed by Kaplan-Meier method, and the factors affecting survival by Log rank test.</p><p><b>RESULTS</b>Of the 9 patients with type I carcinoids, 5 underwent endoscopic or surgical resection, and extra antrectomy was performed in 2 patients simultaneously. 3 cases had a proximal gastrectomy, and 1 underwent total gastrectomy. Among the 30 patients with type III gastric carcinoids, 21 underwent radical resection, 6 had a palliative resection, and the remaining 3 underwent exploration and biopsy only due to invasion into adjacent organs and distant metastasis. Infiltration beyond the submucosa was found in all 30 type III gastric carcinoid patients, but in only 1 of 9 patients with type I gastric carcinoids. Regional lymph node metastases were found in 27 of 30 type III carcinoid cases, but in none of type I. Distant metastases occurred in 5 patients of type III carcinoid (4 in the liver and 1 in the ovary). There were statistically significant differences between type I and type III carcinoids in the sex, tumor number, location, size and infiltration depth of the tumors, the regional lymph node metastasis, distant metastasis and lymphatic emboli (P < 0.05 in all). The overall 5-year survival rate was 49.7% for the whole group, and 100.0% and 37.2% for type I and type III carcinoids, respectively. Univariate analysis revealed that the number of tumor, tumor size (> 2 cm), serosal invasion, regional lymph node metastasis and distant metastasis were all significant factors affecting the survival (P < 0.05 in all). However, by multivariate analysis, only distant metastasis was found to be a significant prognostic predictor.</p><p><b>CONCLUSION</b>The prognosis of type III carcinoids is much poorer than that of type I. Subtyping of gastric carcinoids is helpful in guiding clinical management, and also in prediction of malignant potential and prognosis.</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>

Bacteriological surveillance in a burn intensive care unit and the analysis of bacterial resistance to antibiotics / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the dynamic changes of the bacterial flora in our burn intensive care unit (ICU) in the past 6 years, and to analyze resistance of bacteria to various antibiotics.</p><p><b>METHODS</b>A retrospective analysis of bacterial culture and drug-sensitivity results from 209 patients in our burn intensive care unit during a period of 1998 to 2003 was carried out.</p><p><b>RESULTS</b>Eight hundred and forty-five strains of bacteria were isolated from 209 specimens, among which 486 strains were gram negative (G(-)) (57.51%), and 339 were gram positive (G(+)) (40.12%). Among all the G(+) bacteria, Enterococcus faecalis accounted for 34.51%, Staphylococcus aureus accounted for 31.27%, and 72.64% of Staphylococcus aureus strains were MRSA. Pseudomonas aeruginosa was predominant among all G(-) bacteria, and it accounted for 66.26% of the latter. All the bacteria isolated showed multiple resistance to antibiotics.</p><p><b>CONCLUSION</b>G(-) bacilli were still predominant in our burn intensive care unit. The isolated bacteria exhibited multiple resistance to antibiotics. The results imply that antibiotics should be administered rationally in the burn wards guided by the bacterial resistance test.</p>