Accuracy of endorectal ultrasonography in preoperative staging of rectal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the accuracy of endorectal ultrasonography in preoperative staging of rectal carcinoma.</p><p><b>METHODS</b>The 319 patients with rectal adenocarcinoma underwent endorectal ultrasonography evaluation from January 2007 to March 2010. There were 175 males and 144 females, and the age of patients were 22-82 year old (median 59 years). According their visiting time, 319 patients were divided into 3 groups (period A: January to December 2007; period B: January to December 2008; and period C: January 2009 to March 2010). All patients underwent endorectal ultrasonography, and the 3 doctors had finished evaluations with 272 cases (Doctor 1, 2, 3 had finished evaluations with 162, 64 and 46 cases respectively). The endorectal ultrasonography staging was compared with the pathology findings based on the surgical specimens in 319 patients who had surgery.</p><p><b>RESULTS</b>Overall accuracy in assessing the level of rectal wall invasion was 67%. The accuracy of uT2 and uT3 were 43% and 81% respectively, and the difference was statistically significant (χ(2) = 30.54, P < 0.01), and the accuracy of uT4a was 59%, which was lower than uT3 (81%,χ(2) = 13.77, P < 0.01). Overall accuracy in assessing nodal involvement in the 311 patients treated with radical surgery was 66%. Staging accuracy tends to improve with experience, the accuracy with Doctor 1 in period C(staging accuracy of T and N were 84% and 81% respectively) were higher than period A(staging accuracy of T and N were 55% and 41% respectively) (χ(2) = 6.65 and 13.27, P < 0.01).</p><p><b>CONCLUSIONS</b>Transrectal ultrasound for preoperative staging of rectal has higher accuracy with mastered ultrasound doctor.</p>

Standard of postoperative risk assessment for resectable gastrointestinal stromal tumor and its evaluation / 中华胃肠外科杂志

Surgery is the only possible cure protocol of gastrointestinal stromal tumor (GIST). But the risk of recurrence exists constantly. Risk assessment of relapse is very important to guide the targeted adjuvant therapy and predict the prognosis. Although the variables and grading in the risk assessment of recurrence after complete resection of primary local GIST have been identified, but either the F/NIH consensus, AFIP standards, modified NIH standards, or risk identification methods attempted to apply mathematical calculation model in recent years, including Jason S Gold risk nomogram, Rossi nomogram, Joensuu high Hotline Dengjun, are short of long-term, large-scale clinical trials without selection bias. Therefore, recurrence risk probability cannot be predicted accurately.

Relationship of c-kit and platelet-derived growth factor receptor alpha gene mutation features with prognosis of patients with gastrointestinal stromal tumor / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the relationship between c-kit and platelet-derived growth factor receptor alpha(PDGFRA) gene mutation features and the prognosis of gastrointestinal stromal tumor(GIST).</p><p><b>METHODS</b>Clinicopathological, genetic testing and follow-up informations of patients admitted to the Shanxi Tumor Hospital from June 2000 to January 2009 were collected. The survival was calculated and univariate analysis was conducted using the Kaplan-Meier method. Multivariate analysis was conducted by the Cox regression method.</p><p><b>RESULTS</b>The 5-year disease-free survival rate was 61.5% and the 5-year overall survival rate was 67.4%. The 5-year disease-free survival rates of patients without disease among those with c-kit exon 11 mutation (n=77), c-kit exon 9 mutation(n=4), and PDGFRA exon 18 mutation (n=2) were 63.4%, 14.3% and 100%, and the 5-year overall survival rates were 70.8%, 50.0% and 100%, respectively. In the patients with c-kit exon 11 mutation, the 5-year disease-free survival rates among those with point mutations(n=26), deletion mutations(n=44), and duplication mutations(n=7) were 87.1%, 44.9% and 80.0%, and the 5-year overall survival rates were 88.1%, 57.0% and 100%, respectively. There were significant differences in overall survival among different factors. Multivariate analysis showed that gene mutation was not the independent factor of prognosis(P=0.492).</p><p><b>CONCLUSIONS</b>In GIST patients undergoing surgery without imatinib treatment, mutated genotype is better than wild type in terms of prognosis. Gene mutation is not the independent factor of prognosis in GIST patients.</p>

Analysis of predictors of axillary node metastases in 787 breast cancer patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the predictors of axillary nodal metastass in patients with breast cancer.</p><p><b>METHODS</b>A retrospective study was performed using the clinicopathological data of breast cancer cases diagnosed and treated in our Hospital between Dec 2006 and Nov 2008. Logistic regression analysis was used to determine the predictors of axillary node positivity.</p><p><b>RESULTS</b>The total number of patients was 1133. 69.5% of them (787) had complete clinical and pathological data. The median age was 49 years old (range 20-85). The average number of lymph nodes removed was 14.6 per person. The average number of involved nodes was 3.5 per person. Increasing tumor size was associated with increased risk of lymph node metastases. Assessed by multivariate analysis, the tumor size, age, ER status, and pathological type were significantly associated with node metastasis.</p><p><b>CONCLUSIONS</b>Axillary nodal metastases are significantly affected by the tumor size, ER status, age, and pathological type in breast cancer patients.</p>

Irinotecan or oxaliplatin combined with 5-fluorouracil and leucovorin as first-line therapy for advanced colorectal cancer: a meta-analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>To compare clinical efficacy and toxicity of irinotecan combined with 5-fluorouracil and leucovorin with those of oxaliplatin combined with 5-fluorouracil and leucovorin as first-line therapy for advanced colorectal cancer.</p><p><b>METHODS</b>Literature search was performed by keywords "irinotecan", "oxaliplatin" and "colorectal cancer" on all randomized controlled trails reported on irinotecan versus oxaliplatin combined with 5-fluorouracil and leucovorin as first-line therapy for advanced colorectal cancer in MEDLINE, OVID, Springer, Cochrane Controlled Trials Register (CCTR) and CBMdisc (Chinese Biology and Medicine disc) before January 2010. Two authors drew the details of trial design, characteristics of patients, outcomes, and toxicity from the studies included. Data analysis was performed by RevMan 4.2.</p><p><b>RESULTS</b>According to the screening criteria, 7 clinical studies with 2095 participants of advanced colorectal cancer were included in this meta analysis. The baseline characteristics of irinotecan group were similar to those of oxaliplatin group. The response rate of oxaliplatin group was higher than that of irinotecan group (relative risk (RR) = 0.82, 95% confidence interval (95%CI) (0.70, 0.96), P = 0.01), and the median overall survival of oxaliplatin group was longer by 2.04 months than that of irinotecan group (95%CI (-3.54, -0.54), P = 0.008). In the comparison of grade 3 - 4 toxicity between the two groups, the incidences of nausea, emesis, diarrhoea and alopecia in irinotecan group were higher than those in oxaliplatin group (RR = 1.94, 95%CI (1.22, 3.09), P = 0.005; 1.71, 95%CI (1.34, 2.18), P < 0.001; 14.56, 95%CI (4.11, 51.66), P < 0.0001), respectively. However, the incidence of neurotoxicity, neutropenia and thrombocytopenia in irinotecan group were lower than those in oxaliplatin group (RR = 0.06, 95%CI (0.03, 0.14), P < 0.00001; 0.70, 95%CI (0.55, 0.91), P = 0.006; 0.18, 95%CI (0.05, 0.61), P = 0.006), respectively.</p><p><b>CONCLUSIONS</b>Both irinotecan and oxaliplatin combined with 5-fluorouracil and leucovorin were effective in the first-line therapy of advanced colorectal cancer. However, the combined regimen of oxaliplatin plus 5-fluorouracil and leucovorin is more excellent. Irinotecan tended to result in more gastrointestinal tract reactions than oxaliplatin did, but the myelosuppression and neurotoxicity were more frequent in oxaliplatin regimen than irinotecan regimen.</p>

Comparison of two-year efficacy between procedure for prolapse and hemorrhoids and Milligan-Morgan hemorrhoidectomy in treatment of III and IV degree internal hemorrhoids / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the long-term efficacy of procedure for prolapse and hemorrhoids (PPH) and Milligan-Morgan hemorrhoidectomy (MMH) in the treatment of III and IV degree internal hemorrhoids.</p><p><b>METHODS</b>One hundred patients were randomly divided into two groups and received PPH (n=42) and MMH (n=58) respectively. After two years, the efficacy, complications and function of defecation were compared.</p><p><b>RESULTS</b>Two years after operation, the morbidities of hydrorrhea (2.38% vs 20.69%, P=0.007), dermal neoplasm formation (9.52% vs 25.86%, P=0.040) and narrowing in the caliber of the stools (2.38% vs 18.97%, P=0.027) were significantly lower in PPH group than those in MMH group (P<0.05). The morbidities of overall complication (9.52% vs 25.86%, P=0.040) and overall abnormal function of defecation (9.52% vs 29.31%, P=0.017) were lower in PPH group than those in MMH group (P<0.05). However, there were no significant differences of the morbidity of relapse (14.29% vs 10.34%, P=0.549), patient satisfactory degree (92.86% vs 87.93%, P=0.636) and overall symptom recurrence rate (19.05% vs 25.86%, P=0.424) between the two groups.</p><p><b>CONCLUSIONS</b>Long-term efficacies of procedure for prolapse and hemorrhoids and Milligan-Morgan haemorrhoidectomy in the treatment of III and IV degree internal hemorrhoids are similar. PPH has better safety, less complications and less effect on abnormal function of defecation compared with MMH.</p>

Efficacy of intersphincteric resection in the sphincter-preserving operation for ultra-lower rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy of intersphincteric resection in the sphincter- preserving operation for ultra-lower rectum cancer.</p><p><b>METHODS</b>Thirty-one rectal cancer patients with the distal edge of the tumour less than 2 cm from the dentate line were evaluated. Eighteen advanced rectal cancer patients received preoperative chemo-radiation. Total mesorectal excision (TME) was performed with the rectum immobilized down, and the puborectal ligament and partial levator cut to the level of the dentate line. In some well-exposed patients, it was possible to further immobilize the rectum between the external sphincter ring and the rectum inner sphincter wall. In anal approach,good exposure was attained and the cut-line was made vertically to the anal canal 2 cm below the lower edge of the tumor, and further intersphincteric immobilization was made upright. Colon or colon pouch were anastomosed to the distal anal wall.</p><p><b>RESULTS</b>There was no peri-operative death. Thirty patients had good fecal control. Twenty-nine patients showed no evidence of recurrence or metastasis after follow-up for 12 months. Recurrence occurred in one case 1 year after operation. Another one had higher CEA 19.9 level, but without evidence of metastasis.</p><p><b>CONCLUSION</b>Radical resection can be attained and anal sphincter preserved by intersphincter resection which is an alternative sphincter-preserving operation.</p>

Study on the prognostic factors of colorectal cancer after radical resection and on suggested model for prediction / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the factors of colorectal cancer (CRC) after radical resection to provide data predicting the prognosis of the patients.</p><p><b>METHODS</b>120 cases of CRC were collected in this study. Medical clinical records and 5-year follow-up data were reviewed. Streptavidin-peroxidase immunohistochemical technique was used to detect the expression of p53, C-erbB-2, nm23-H(1) and Ras on formalin-fixed, paraffin embedded sections of CRC from the 120 patients.</p><p><b>RESULTS</b>Results showed that the rates of positive expression of p53, C-erbB-2, Ras and nm23-H(1) were 62.5% (75/120), 25.8% (31/120), 80.0% (96/120) and 60.8% (73/120) respectively in the CRC tissue. All pathological variables and biological markers were analyzed with Cox regression model (alpha = 0.05). Eight distinguished prognostic factors were identified in the univariate analysis as: macroscopic configuration, histology grade, depth of invasion of intestinal, lymph nodes metastasis, Dukes' classification, p53, Ras and nm23-H(1). The results of multivariate analysis (alpha = 0.05) indicated that the independent prognostic factors were Dukes' classification, p53 and nm23-H(1) (P = 0.000), with relative risk of 3.06, 6.02 and 0.40, respectively. A prognostic model: h(t, x) = h(0)(t)exp (-0.9269X(14) + 1.1197X(10) + 1.7948X(11)) was established. Sensitivity, specificity agreement and reliability of the model and Kappa were 79.1%, 83.0%, 80.8% and 0.62, respectively.</p><p><b>CONCLUSION</b>Dukes' classification, p53 and nm23-H(1)seemed to be independent and important prognostic factors. This prognostic model could be used to evaluate the prognosis of patients with CRC by clinicians.</p>

A clinical study on docetaxel plus capecitabine as front-line combination therapy for breast cancer with liver metastases / 肿瘤研究与临床

Objective To determine the efficacy and tolerability of docetaxel plus capecitabine as first-line treatment for breast cancer with liver metastases(BCLM).Methods Forty-two patients with BCLM received oral capecitabine 1900 mg/m~2/d(950 mg/m~2 twice daily)on days 1 through 14 and intravenous infu- sion of Docetaxel at 75 mg/m~2 on day 1 of each 21-day treatment cycle.Patients were evaluated for the re- sponse after two cycles.Results Among these 42 patients,the overall response rate was 54.76% with 4 CR, 19 PR, 9 SD and 6 PD.The clinical benefit rate was 64.28% and the median overall survival time was 17.5 months.The most common treatment-related adverse events were leukopenia(76.1%),neutropenia(71.4%), hand-foot syndrome(45.2%),nausea and vomiting(52.3%),which were mainly gradeⅠ～Ⅱ.Conclusion The combination of docetaxel plus capocitabine is a highly active and generally well-tolerated regimen for first-line treatment of BCLM.