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Gastrointestinal stromal tumor (GIST) is the most common gastrointestinal mesenchymal tumors, mainly due to the onset of the proto-oncogene receptor tyrosine kinase, or platelet-derived growth factor receptor gene activating mutations. Molecular targeted therapy drug of imatinib mesylate inhibit KIT, platelet-derived growth factor receptor aloha (PDGFRA) gene tyrosine kinase activity, which is effective in patients with advanced GIST. However, a growing number of studies have found the presence of imatinib mesylate in primary and secondary drug resistance in the treatment of GIST process. With the in-depth study of the physiological function and mechanism of action of non-coding RNA in recent years, making it gradually realized extensive regulation of non-coding RNA gene expression, which occurs in tumor development, invasion and metastasis, drug resistance and other processes plays an important role. Non-coding RNA has the potential to explore GIST pathogenesis and resistance mechanisms to provide new ideas and direction.
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<p><b>OBJECTIVE</b>To evaluate the efficacy and safety profile of XELOX (capecitabine/oxaliplatin) in patients with locally advanced gastric cancer who underwent curative D2 resection in China.</p><p><b>METHODS</b>This is a subgroup analysis of Chinese patients in the capecitabine and oxaliplatin adjuvant study in stomach cancer (CLASSIC study), which was a randomised, open-label, multicentre, parallel-group, phase III( study in the Asia-Pacific region. A total of 100 gastric cancer patients who received curative D2 gastrectomy were enrolled in this study and were randomly assigned to either XELOX group (oral capecitabine combined with intravenous oxaliplatin chemotherapy) or the control group (surgery alone). This study aims to compare the 3-year disease-free between the two groups.</p><p><b>RESULTS</b>Subgroup analysis showed that 3-year DFS rate were 78% and 56% in XELOX and control group, respectively. The risk of relapse in XELOX group was reduced by 59% (HR=0.41, 95%CI:0.20-0.85, P=0.013), compared with the control group. The 3-year overall survival rate were 78% and 66% in XELOX and control group, with no statistically significant difference (HR=0.55, 95%CI:0.26-1.16, P=0.110).</p><p><b>CONCLUSION</b>Adjuvant XELOX chemotherapy following D2 gastrectomy may improve the survival in patients with advanced gastric cancer in China.</p>
Subject(s)
Humans , Antineoplastic Combined Chemotherapy Protocols , Therapeutic Uses , Capecitabine , Chemotherapy, Adjuvant , Deoxycytidine , Disease-Free Survival , Fluorouracil , Gastrectomy , Neoplasm Recurrence, Local , Organoplatinum Compounds , Stomach Neoplasms , Drug Therapy , General Surgery , Survival RateABSTRACT
ObjectiveTo evaluate the factors implicated in the diagnosis and treatment of early gastric caner.Methods Fifty Patients early gastric caner with diagnosed from March 2004 to May 2006,were investigated in the study retrospectively.ResultsAll of the patients were diagnosed accurately by the gastroscopy,among which 2 had atrophic gastritis history for 6 or 10 years,respectively.Twenty-four masses were located in gastric pylorus,12 in gastic angular incisure,14 in gastric body.D2 radical mastectomy was performed in 41 cases,and D1 radical mastectomy in 9 cases.In 10 cases the diameter of tumors was ＜1 cm,17 cases 1 -2 cm,14 cases 2-3 cm,9 cases ＞3 cm.Lymph node involvements were observed in five cases ( 10％ ).Follow data were available in 48 cases.Among them,3 died from local recurrence and metastasis at postoperative 10,12,19 months respectively. Conclusions Although endosopic mucosal resection or limited surgical resection is a reasonable treatment for some early gastric caner patients,D2 radical mastectomy is necessary for most early gastric caner patients.
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Background and purpose: Currently endoscopic ultrasonography is clinically accepted for preoperative staging of gastric cancers. Endoscopic raucosai resection (EMR) and endoscopic subraucosal dissection (ESD) have been widely applied in the treatment of early gastric cancer. We need to improve the accuracy of pre-operative staging of gastric cancers, especially of early gastric cancers. This paper was to investigate the clinical significance of high frequency endoscopic ultrasound mini probe (UMP) in the preoperative T-staging of gastric cancer. Methods: Both UMP and MSCT were performed in 63 patients with pathologically proven gastric cancer frora Oct. 2008 to Apr.2009, and the results of UMP and MSCT were compared with surgical pathologic findings. Results: The accuracy of UMP and MSCT in T staging was 82.26% (51/62) and 88.71% (55/62) respectively, and there was no statistical difference (P>0.05). The accuracy of UMP and MSCT for early gastric cancer was 100.00% and 88.89% respectively.The accuracy of UMP and MSCT for advanced gastric cancer was 79.25% and 88.68% respectively. Conclusion: UMP appears to have a substantial diagnostic value for early stage gastric cancer. It is the approach of choice for superficial lesions.
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Gastrointestinal stromal tumor (GIST) may be defined as mesenchymal tumors of the gastrointestinal tract,and the application of the tyrosine kinase inhibitor imatinib mesylate has changed the treatment style of the tumor.The surgical treatment is the only choice for the GIST patients before imatinib era,but now the individualized treatment combined with target therapy,surgery and laparoscope surery becomes the mainstay.The paper focus on the new development of preoperative biopsy,laparoscope surery,imatinib neoadjuvant and imatinib therapeutic effect evaluation in recent years.
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Targeted therapy has gradually become the focus in the treatment of tumor, with the emerge of more and more targeted drugs which has brought the treatment of tumor into a new era. Imatinib, the tyrosine kinase inhibitor, is one of the important types of targeted therapy, has become the standard of care in adjuvant therapy of gastrointestinal stromal tumor(GIST) with extraordinary effects. However, the questions are still on debate incluing the optimal way to evaluate treatment results, the treatment duration, whether it can be intermitted or not, second line therapy for imatinib-intolerance or -resistance and the combination with surgery.
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Objective To evaluate the toxicity and efficacy of post-operative chemoradiotherapy for gastric cancer. Methods Forty-five gastric cancer patients treated with post-operative radiation ± concurrent chemotherapy were retrospectively analyzed. Among them, 14 were female and 31 were male. The median age was 54 (30-72) years. Pathology stages were IB-IV. Radiotherapy of doses from 45 Gy/25fx to 55 Gy/30fx was delivered to the tumor bed and regional lymph nodes with 3D conformal or IMRT technology.Concurrent chemotherapy agent was fluorouracil or capacitabine. Results All patients except 2 (4%)completed radiotherapy as planned. The most common acute toxicities were hematologic and gastrointestinal effects. The incidence of the patients was 56% with mild nausea/vomiting,71% and 7% with grade Ⅰ / Ⅱ and Ⅲ leucopenia, and 38% with grade Ⅰ/Ⅱ hypodynamia and anepithymia. The 1-year overall survival,relapse-free survival and local control rates were 87% ,82% and 95%, respectively. Conclusions Postoperative chemoradiation for patients with locally advanced gastric cancer is tolerable. Our study shows the advantage of post-operative chemoradiation for local control. However,further prospective randomized trial is needed to validate the efficacy.
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Sentinel lymph node(SLN) is prevalently studied in breast cancer and malignant melanoma as well as being applied in clinical practice.Currently,the study on sentinel lymph node of gastric cancer has gradually been a vital component in the study of diagnosis and treatment of gastric cancer.Sentinel lymph node examination is feasibly applied in clinical T1N0M0 stage gastric cancer or early gastric cancer because of its high accuracy and sensibility.However,the sentinel lymph node examination is not suitable for advanced gastric cancer due to low sensibility and high false negative rate.The article mainly reviewed the advances on SLN tracer,application,micrometastasis,imaging system and so on in gastric cancer.
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Synovial sarcoma(SS) is a common soft tissue tumor,which origin hasn’t been confirmed. With different morphology and various differentiation, SS is likely to be confused with other soft tissue tumors.Therefore,the rate of misdiagnosis is very high.It is very diffi cult to diagnose SS just relying on symptom,sign,imaging and so on. The article mainly reviews the advances on immunohistochemistry and genetical detection in diagnosis of SS.
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The treatment of gastrointestinal stromal tumors (GIST) has been revolutionized by the molecular targeted therapy, but we still emphasize the importance of how to use surgical principle and skill to treat GIST. In this review, we describe the experience in the treatment of GIST located in esophagus, gastrointestinalinal tract and colorectum. During operation, the surgeon shouldi resect the tumor completely. If the tumor can not to be resected completely, treatment should be managed by imatinib mesylate(Gleevec). Because GISTs seldom appear lymph metastases, it is not necessary to perform lymph node dissection.
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With the progress of gastrointestinal stromal tumor(GIST), to prevent GIST's recurrence and metastasis is still a hot topic. The pre-operative pathological diagnosis of GIST is difficult to be made, and the biopsy has the chance to cause metastasis. Standard operative procedure is the key point to prevent GIST's recurrence and metastasis, which includes en-bloc resection, enough margin and so on. For the recurrence/metastasis GIST, the reoperation can be performed, but the effective therapy is to use the molecular targeted drug:imatinib.
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Background and purpose:Blood vessel metastasis often occurs after the operation of rectal cancer of stage Ⅱ and Ⅲ,angiogenesis is an important step of the procedure.Cycloxygenase-2(COX-2) and vascular endothelial growth factor(VEGF-C) are correlated to angiogenesis. The purpose of this study is to investigate the expressions of Cycloxygenase 2(COX-2) and vascular endothelial growth factor(VEGF-C) in rectal cancer of stage Ⅱ and Ⅲ,to explore the relationships between them and the tumor biological characteristics,tumor angiogenesis.Methods:The expressions of COX-2,VEGF-C and the microvessel density(MVD) were detected by immunohistochemical staining.Results:①The positive rates of COX-2 and VEGF-C expression in rectal cancer were 72.5%,higher than those in peritumoral normal tissue(P
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Purpose:To investigate the possible causes, diagnosis, and treatment of functional delayed gastric emptying (FDGE) after colonic operation.Methods:The clinical data of 6 patients with coon cancer from 1995 to 2000 were retrospectively analysed.Results:FDGE occurred in all of the 6 patients 4 to 6 days after surgery and the clinical symptoms disppeared gradually with medical therapy.Conclusions:The causes of FDGE are due to many factors such as mental stress, asleep, inutration, low albumine, ertent of lymphadectomy and the combined organ resection. An upper gastrointestional radiography is the main method of diagnosis of FDGE and gastrointestinal motility can return spontaneously after a long period of medical therapy with some prokinetic drugs. [
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Objective Colonic short chain fatty acids(SCFA) may maintain colonocyte differentiation and oppose carcinogenesis, although its precise mechanisms remain unclear. The purpose of this study is to investigate SCFA regulation of intestinal epithelial phenotype by characterizing the effects of three kinds of SCFA on differentiation,proliferation,and migration of human colonic adenocarcinoma cell line Caco-2 and discuss its clinical value. Methods Differentiation was assessed by brush border enzyme expression, doubling time (proliferation) calculated directly from serial cell counts and logarithmic transformation method. Cell motility(migration) was quantitated by the expansion of a confluent Caco-2 monolayer(after release from a constraining fence) across bacteriologic plastic dishes precoated with saturating concentrations of type Ⅰ collagen. Results All three SCFA studied altered the Caco-2 phenotype. Treatment with 10 mmol/L SCFA significantly prolonged the cell doubling time, promoted brush border enzyme expression(cathepsin C), and inhibit the motility of the Caco-2 cells. Conclusion The SCFA butyrate, propionate, and acetate inhibit the proliferation and motility of a well-differentiated human colonic cancer cell line while promoting the expression of the differentiation marker cathepsin C. The SCFA produced by bacterial fermentation of dietary fiber may exert a protective effect against the development of colon cancer.
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Objective To summarize the clinical and pathological characteristics of gastrointestinal stromal tumors with hepatic metastasis, and to analyze its survival and explore its principles of diagnosis and treatment. Methods Among 99 patients diagnosed as gastrointestinal stromal tumors who had a completely case history in our hospital, we retrospectively analyzed the clinical data of 26 patients with hepatic metastatic and the factors influencing survival. Results The average age at diagnosis of primary and hepatic metastatic gastrointestinal stromal tumors was 50.8 and 51.8 years old respectively. Five cases were confirmed by pathological examination, 12 cases were diagnosed by the exploration during the operation and 14 patients had an imaging diagnosis only. Synchronous and metachronous hepatic metastasis happened in 8 and 18 patients respectively. The median interval between the primary tumor and the metachronous hepatic metastasis was 12 months. The primary sites of 12 cases were in stomach, 5 in colorectum, 6 in small intestine and 3 in extra-gastrointestinal tract.Four cases of the hepatic metastatic tumors were treated with surgical resections, 2 with injections of anhydrous alcohol, 3 with interven-tional therapies, 7 with systemic chemotherapies, 8 with imatinib and 2 without treatment. The median survival was 21 months after hepatic metastasis. The administration of imatinib was an important factor prolonging the survival after hepatic metastasis. Conclusions The most frequent primary site of hepatic metastatic stromal tumor is the stomach while small intestinal stromal tumors are most inclined to metastasize to the liver. Treatment with imatinib for more than 3 months can prolong the survival.
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Purpose:To investigate the association between the expression of vascular endothelial growth factor (VEGF) and p53, and their influence on clinicopathological characteristics and prognostic value in gastric cancer.Methods:A total of 108 paraffin embedded gastric cancer tissues were stained with the monoclonal antibodies VEGF and P53 protein by immunohistochemistry.Results:VEGF and P53 expression were observed in 53.7% and 57.4% of gastric tumors, respectively. A significant correlation was found between VEGF and p53 status ( P
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Purpose: The purpose of this study was to assess the method of compartment resection and evaluate its application to patients with extremity soft tissue sarcomas. Methods: From 1997 to 2002, 10 cases of thigh sarcoma underwent this operation (7 cases of posterior compartment and 3 anterior compartment) while 2 cases with upper limb disease received similar resection. Results: All the limbs of this group with such tumors were preserved. We followed up the 12 patients in the range of 10 to 60 months, 10(82%) were alive without tumor recurrence or metastases. One patient local with recurrent tumor is receiving radiotherapy now and another died from distance metastases. Conclusions: This improvement in the rate of limb -preserving resection in our series has been the result of compartment resection.
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ObjectiveTo assess the diagnostic value of preoperative lymphoscintigraphy for lateral lymph node metastasis in low rectal cancer. MethodsFrom May 1999 to March 2001, pelvic and lower abdominal lymphoscintigraphy with 99mTc sulfur colloid was performed on 32 patients with proven colorectal cancer one day prior to operation. Among these patients were 27 rectal cancers, 3 sigmoid cancers and 2 colon cancers. Fifteen cases of rectal cancer with the tumor located at or below the peritoneal reflection received extended lymphadenectomy with lateral dissection (D3 lymphadenectomy). The result of lymphoscintigrams was correlated with histologic lateral node examination. Results The image ratio of pararectal nodes, obturator nodes, and internal iliac aorti lymph trains was 69%, 91%, and 100% respectively. In 15 patients receiving D3 lymphadenectomy, 10 had negative lymphoscintigrams whereas 5 had positive image, and the lateral pathology positive rate was 13%(2/15). Analysis of these results revealed the sensitivity (100%), specificity (77%) and accuracy (80%) of this diagnostic method. ConclusionPelvic and lower abdominal lymphoscintigraphy with 99mTc sulfur colloid could demonstrate the lateral lymph node drainage of low rectal cancer, and the correlation with postoperative histologic lateral node examination was high enough to enable surgeons to adopt an individualized surgical approach.