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Objective:To explore the effect of different HER2 expression levels and gene amplification on the efficacy of immunotherapy in metastatic urothelial carcinoma (UC).Methods:The clinical data of 77 patients with metastatic UC who received immunotherapy from June 2017 to April 2021 after failure to the previous chemotherapy were analyzed retrospectively, including 49 males and 28 females with the median age of 62 years. The primary tumors located in bladder in 28 cases (36.4%), renal pelvis in 25 cases (32.5%) and ureter in 24 cases (31.2%). The common metastatic sites included: lymph nodes (n = 45, 58.4%), lung (n = 40, 51.9%), bone (n = 20, 26.0%) and liver (n = 16, 20.8%). 27 patients with bladder UC received surgery on the primary tumors including radical cystectomy (n = 18), partial cystectomy (n = 4) and transurethral resection (n = 5). 43 patients with renal pelvis or ureteral UC received surgery on the primary tumors including radical nephroureterectomy (n = 38), local resection (n = 3) and palliative resection (n = 2). Postoperative intravesical chemotherapy was performed in 15 cases, adjuvant radiotherapy was performed in 6 cases. 3 patients who emerged postoperative bladder recurrence received local radiotherapy. 7 patients received radiotherapy and 1 case received microwave ablation to their metastatic sites. All patients had received first-line chemotherapy and 30 patients (40.0%) had received at least second-line treatment including 70 cases (90.9%) with platinum containing chemotherapy. All 77 patients received anti-PD-1 treatment. 38 patients received sequential regimen after failed to the anti-PD-1 therapy, including antibody-drug conjugate (n = 17), chemotherapy (n = 18) and chemotherapy combined with anti-angiogenesis drugs (n = 12). Immunohistochemical (IHC) staining was used to detect the expression level of HER2 protein in the tumor tissues (74 cases from primary tumors and 3 cases from metastatic tumors) obtained from the initial diagnosis. For patients with HER2 IHC (+ + ), the copy number (CN) of HER2 gene was detected by next-generation sequencing (NGS). HER2 copy number amplification [CN (+ )] was defined as CN ≥ 4, and HER2 copy number non-amplification [CN(-)] was defined as CN < 4. HER2 IHC (0) was defined as HER2 negative, IHC (+ ) or IHC (+ + ) / CN (-)was defined as HER2 low expression, while IHC (+ + ) / CN(+ ) and IHC (+ + + ) were defined as HER2 high expression. Chi-square test or Fisher exact test were used to evaluate the correlation between HER2 expression and objective response rate (ORR) after anti-PD-1 treatment. Kaplan-Meier method and log-rank test were used to compare the differences of median progression free survival (PFS) and overall survival (OS) under different HER2 expression status.Results:All the 77 patients received a median of 11 (range: 2 - 45) doses of anti-PD-1 treatment with a median duration of treatment of 6.4 (range: 1.5 - 47.8) months and the ORR was 33.8% (26/77). The median follow-up time was 30.9 months. The overall median PFS time was 5.8 (95% CI: 3.0 - 8.6) months and the median OS time was 23.6 (95% CI: 8.5 - 38.7) months. HER2 IHC tests were performed in 77 patients. HER2 IHC levels of (0), (+ ), (+ + ) and (+ + + ) were found in 33 (42.9%), 19 (24.7%), 20 (26.0%) and 5 (6.5%) patients, respectively. HER2 copy number was detected in 20 patients with IHC (+ + ), while 1 CN(+ ) and 19 CN(-) were found. The ORR of HER2 negative, low expression and high expression patients were 42.4% (14/33) vs. 31.6% (12/38) vs. 0 (0/6) ( P = 0.08), respectively. The median PFS of the three groups were 11.0 months, 3.7 months and 1.8 months, respectively, with significant differences in overall and pairwise comparison( P=0.001). The median OS of patients with HER2 negative and low expression after anti-PD-1 treatment were 23.6 months and 22.7 months, respectively, while the median OS of patients with HER2 high expression had not been reached, with no significant difference in the overall comparison ( P=0.623). Conclusions:For patients with metastatic UC received anti-PD-1 treatment, the PFS of patients with high HER2 expression was significantly worse than that of patients with low or negative HER2 expression. HER2 expression may have potential value in predicting the efficacy of immunotherapy for metastatic UC who failed the previous chemotherapy, which needs further research.
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Objective:To investigate the diagnostic performance of repeat biopsy 68Ga-PSMA PET/CT to distinguish between benign and malignant prostate disease. Methods:The clinical data and medical imaging of thirty-nine patients underwent repeat prostate biopsy were analyzed respectively in this study. The median age of patients was 65 years (range 46-81 years), the median PSA level was 11.0ng/ml (range 5.4-49.8 ng/ml), f/tPSA was 0.15(0.01-16.50)ng/ml, prostate volume was 43.80(7.79-108.63)ml, and PSA density was 0.24(0.09-2.31)ng/ml 2. All patients underwent pre-biopsy 68Ga-PSMA PET/CT and the standard transrectal ultrasound-guided systematic prostate biopsy. Based on the biopsy results, 68Ga-PSMA PET/CT images of all patients were visually and semi-quantitatively analyzed. By visual analysis, 68Ga-PSMA uptake in prostate was defined as focal, multimodal and inhomogeneous, and then the detection rate of prostate cancer in each subgroup was analyzed. The value of the ROC curve in the diagnosis of prostate cancer was analyzed based on the SUV max of prostate cancer(SUV max), tumor-to-normal-prostate background(SUV T/BGp)as semi-quantitative parameters of 68Ga-PSMA PET/CT. Results:Prostate cancer was detected in 18 patients (46.2%) and 12 patients (30.8%) had clinically significant disease. There were 11, 5 and 2 patients with prostate cancer respectively in men with a focal (12 patients), multifocal(7 patients) and inhomogeneous (20 patients) 68Ga-PSMA uptake. The ROC analysis revealed a SUV max 5.3 and SUV T/BGp1.8 as an optimal cut-off level to distinguish between non-prostate cancer and prostate cancer in 68Ga-PSMA PET/CT, the sensitivity and specificity were 100.0% and 85.7% for SUV max (AUC=0.979), 83.3% and 90.5% for SUV T/BGp (AUC=0.915). Conclusions:Pre-biopsy 68Ga-PSMA PET/CT could help to distinguish between benign and malignant prostate disease before repeat prostate biopsy and detect the foci of prostate cancer.
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Objective:To explore the prognostic value of PD-L1 expression level in patients with metastatic renal cell carcinoma (mRCC).Methods:The clinicopathological and survival data of patients with mRCC in our hospital from Jan 2014 to Apr 2016 were retrospectively analyzed including 46 males and 15 females. The median age of these patients was 56 years(range: 29-75 years), with 41 patients ≤60 years and 20 patients >60 years. The baseline data before the systemic therapy showed 36 patients(59.0%)had 1 metastatic organ and 25 patients (41.0%) had equal or more than 2 organs to be metastasized. Among them, 17 patients(27.9%)had lung metastasis and 54 patients(88.5%)had liver metastasis. Abnormal baseline LDH occurred in 4 patients and 52 patients had normal LDH. Favorite and intermediate risk patients categorized by MSKCC risk stratification accounted for 59.6%(34 patients)and 40.4%(23 patients), respectively. Six patients(9.8%)experienced distant metastasis at initial diagnosis, with 4 of them undergoing primary site resection, and the other 55 patients undergoing radical nephrectomy. PD-L1 expression was detected by the immunohistochemical staining method. PD-L1 staining rate ≥1% detected on the tumor cell membrane was defined as positive expression. The correlation between PD-L1 expression and clinicopathological characteristics were compared. Kaplan-Meier method and log-rank test were used to compare the differences about DFS and OS under different factors. Cox proportional hazards regression model is used for multivariable analysis of survival data.Results:The detailed pathological types of the 61 patients with renal cell carcinoma were classified as 53 clear cell carcinomas, 3 papillary carcinomas, 1 collecting duct carcinoma, 2 translocation renal cell carcinomas and 2 being unclassified. There were 4, 20, 19 and 9 patients categorized as WHO/ISUP nuclear grade 1, 2, 3 and 4, and 26, 12, 20 and 2 patients were categorized as T 1, T 2, T 3 and T 4 stage, respectively. Five patients had regional lymph node metastasis(N+), and the other 56 patients had no regional lymph node metastasis(N-). The numbers of patients categorized as stage Ⅰ, Ⅱ, Ⅲ and Ⅳ diseases according to TNM staging system were 20, 11, 21 and 8, respectively. The total PD-L1 positive rate was 24.6%(15/61). The corresponding PD-L1 expression rate of patients with WHO/ISUP nuclear grade 1-4 were 0(0 patient), 5.0%(1 patient), 31.6%(6 patients)and 44.4%(4 patients), respectively; With the increasing WHO/ISUP nuclear grade, the positive rate of PD-L1 gradually escalated with a linear correlation ( P=0.006). The PD-L1 expression of the normal and abnormal LDH group were 19.2%(10 patients)and 75.0%(3 patients), respectively, with significant difference( P=0.035). Univariate analysis of disease-free survival time(DFS)showed that the prognostic factors include PD-L1( P=0.045), age group( P=0.014), WHO/ISUP nuclear grade( P<0.001), T stage( P=0.015), N stage( P=0.026)and TNM stage( P=0.005). However multivariate analysis only suggested WHO/ISUP nuclear grade as the independent prognostic factors for DFS( HR=1.8, 95% CI 1.1-2.9, P=0.018). Either in univariate or multivariate analysis, PD-L1 was not a prognostic factor for overall survival (OS)of mRCC patients(univariate analysis: P=0.154; multivariate analysis: P=0.902). The independent prognostic factors of OS include WHO/ISUP nuclear grade( HR=3.0, 95% CI 1.1-8.0, P=0.033)and MSKCC risk stratification( HR=5.9, 95% CI 1.2-29.7, P=0.03). Conclusions:This study showed that the higher the WHO/ISUP nuclear grade of patients with mRCC, the higher the positive rate of PD-L1. PD-L1 expression was not the independent prognostic factor for DFS or OS of mRCC.
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Objective To investigate the value of 68Ga-prostate specific membrane antigen (PSMA)-617 PET/CT in predicting high-risk prostate cancer.Methods From May 2016 to January 2017,30 patients (median age 67 years) with biopsy-proven prostate cancer were included.The 68Ga-PSMA-617 PET/CT images and clinical data of all patients were analyzed retrospectively.According to prostate cancer risk stratification criteria of National Comprehensive Cancer Network (NCCN) Guidelines (including Gleason scores,prostate specific antigen (PSA)),all patients were classified into low-moderate-risk group and high-riak group.PET images were analyzed semi-quantitatively and maximum standardized uptake value (SUVmax) of primary prostate cancer was measured.SUVmax of 68Ga-PSMA-617 PET/CT was used to establish logistic regression model for predicting high-risk prostate cancer,and the diagnostic efficiency of the model was evaluated by receiver operating characteristic (ROC) curve analysis.Results The median Gleason score of 30 patients was 7.5 (7,9),and the median PSA was 34.0 (19.4,119.1) μg/L,including 9 patients with PSA≤ 20 μg/L and 21 patients with PSA＞20 μg/L.According to the NCCN Guidelines,there were 24 patients with high-risk prostate cancer and 6 patients with low-moderate-risk prostate cancer.SUVmax was higher in high-risk group than that in low-moderate-risk group (14.2 (11.4,23.1) vs 7.9 (3.8,13.1);u =118,P＜ 0.05).Logistic regression model established with SUVmax could effectively predict high-risk prostate cancer with the area under ROC curve of 0.819.When the cut-off value was set as 0.73,the sensitivity and specificity of the model were 87.5％(21/24) and 4/6 respectively.Conclusion SUVmax of 68Ga-PSMA-617 PET/CT can be used as an imaging biomarker for predicting high-risk prostate cancer.
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Purpose To investigate the clinicopathologic features, diagnosis and differential diagnosis of primary gastric inflammatory myofibroblastic tumor ( IMT) . Methods Four cases of gastric IMTs were studied by clinicopathologic analysis, immunohistochemistry and in situ hybridization, and the related literature was reviewed. Results In four cases there are two males and two females, age range from 21 to 51 years old, and tumor size ranged from 1. 5 to 6. 5 cm in the greatest dimension. Histologically, these tumors were composed of varied spindle cells and chronic inflammatory cells, in a myxoid or hyalinized stroma. Occasionally, there were calcifica-tion and ossification areas. Most of the spindle cells had bland appearance and a minority of the tumor cells showed mild atypia. One to two mitotic figures were recognized in 10 high power fields ( HPFs) in 1 to 2 patients. Smooth muscle actin staining was observed in all tumors and ALK staining observed in two tumors. One tumor focally expressed CD34. S-100, desmin, CD68, CD117 and DOG1 was negative in all IMTs. The patients were followed up from 24 to 66 months, and none of them had tumor relapsed or metastasis. Conclu-sions Primary gastric IMTs have an intermediate behavior, and a few cases have malignant potential. It should be distinguished from other spindle cell lesions similar to IMT.
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Objective To investigate the possibility of increasing R0 resection rate in esophageal carcinoma after neoadjuvant chemotherapy. Methods 30 patients underwent operation after neoadjuvant chemotherapy mainly by paclitaxel combined with cis-platinum, including 18 squamous carcinoma cases. 10 adenocarcinoma cases and 2 small cell carcinoma cases.Results In these 30 patients,the overall effective rate of neoadjuvant chemotherapy is 56.7%(17/30)(CR+PR),R0 resection rate is 100%,and the incidence rate of anastomotic leakage is 3.3%(1/30),without perioperative death.Conclusion The neoadjuvant chemotherapv is significant in improving the R0 resection rate in esophageal carcinoma,and the impact of long-term survival after surgery needs further follow-up.
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Objective:To investigate the role of transforming growth factor β1 (TGFβ1) in the development of Helicobacter pylori ( H. pylori)-associated non-metaplastic atrophic gastritis. Methods:The expressions of TGFβ1, CD68 and smooth muscle actin(SMA) were detected immunohistochemically in 10 patients with mild non-atrophic gastritis, 30 patients with mild non-metaplastic atrophic gastritis, and 32 patients with severe non-metaplastic atrophic gastritis having H. pylori infecion. Meanwhile, three cases of mild non-atrophic gastritis and 4 cases of severe non-metaplastic atrophic gastritis were observed with electron microscope. Results: The count of TGFβ1 positive cells per high-power field (HPF) in severenon-metaplastic atrophic gastritis group (53±22 ) was significantly higher than that in mild non-atrophic gastritis group(22±/HPF) and mild non-atrophic gastritis group(0-3/HPF, P＜0.01). The count of CD68 positive cells in severe non-metaplastic atrophic gastritis group (23±7/HPF) was significantly higher than that in mild non-atrophic gastritis group (13±/HPF) and mild non-atrophic gastritis group (0-3/HPF, P＜0. 01). Correlation analysis showed that the expressions of TGFβ1 and CD68 had a moderate correlation in each group ( r = 0. 634, P＜ 0. 01; r = 0. 699, P＜ 0. 01). Compared with mild non-atrophic gastritis, SMA-positive myofibroblasts and smooth muscle cells in the lamina propria increased in mild and severe non-metaplastic atrophic gastritis. Ultrastructurally, the proliferation of fibroblasts in gastric lamina propria was observed in mild non-atrophic gastritis, while the proliferation of fibroblasts and presence of myofibroblasts could be observed in mild non-metaplastic atrophic gastritis, and there was a parallel phenomenon between myofibroblasts and fibroblasts, as well as smooth muscle cells.Conclusion: Our findings indicate that TGFβ1 expression increases with severity of H. pylori-associated non-metaplastic atrophic gastritis, suggesting that TGFβ1 might play an important role in the development of non-metaplastic atrophic gastritis.
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In order to implement the computerization of consumables management in hospital, the consumables management system is developed. The paper introduces the main functions, including treasury management, inventory management, bar,ode utilization, nurse station function intagration, financial reconciliation and management function. It points out that using this system could greatly re-duce the workload and enhance the efficiency.
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Objective To explore pathological characterization of the enlarged contrast enhanced area of hepatocellular carcinoma ( HCC) on contrast enhanced ultrasonography ( CEUS). Methods Thirty-five HCC patients underwent conventional ultrasonography and CEUS before hepatectomy. The tumor sizes were measured on conventional ultrasonography,CEUS and postoperative resected specimen at the largest section. The infiltration depth of the HCC was observed under microscope in the peripheral area of the tumors. HCC with the size of contrast enhancement area on CEUS 0. 3 cm larger than that on conventional ultrasonography was defined as group A, and the others as group B. The pathological character of the tumor and tissues surrounding the tumor were analyzed and compared between the two groups. Results Among 35 HCC, 40% (14/35) HCC increased in size on CEUS compared with ultrasonography. Of them,9 tumors with increased area on CEUS were confirmed to be invasive HCC on pathology. Using the enlarged contrast enhanced area on CEUS as the diagnostic criteria of invasive HCC, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 90%, 80%, 82.9%, 64.3%, 95. 2%, respectively. Conclusions The contrast enhanced area on CEUS can reflect the infiltrative tumor size more accurately compared with conventional ultrasonography.
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Objective To investigate the number, distribution and metastatic rule of lymph nodes in the mesorectum of rectal cancer specimen after processing the recta] cancer specimen with modified fat clearance technique. Methods Sixty patients with mid-low rectal cancer who had been admitted to Peking University School of Ontology from 2003 to 2008 were assigned to test group. All the 60 patients who denied neo-adjuvant therapy were treated with total mesorectal excision, and the rectums resected were processed with the modified fat clearance technique. Rectums from another 50 patients with mid-low rectal cancer in control group were fixed in formalin solution for 24 hours. The mesorectum was divided into anterior, posterior, left and right quadrants, and each quadrant was further divided into upper, middle and lower parts. The numbers of lymph nodes harvested and metastatic rate of lymph nodes between the 2 groups were analyzed by t test and chi-square test. Results (1) The numbers of lymph nodes harvested in the test and control groups were 1436 and 525, with statistical difference between the 2 groups (t =- 12. 153, P <0.05). The number of small lymph nodes(diameter≤5 mm) harvested in test group was 985. (2) The numbers of lymph nodes harvested in the anterior, posterior and bilateral mesorectum were 125,696 and 615, respectively. The numbers of lymph nodes harvested in the upper, middle and lower part of the mesorectum were 395,534 and 507, respectively. The metastatic rate of lymph nodes in the upper part of the mesorectum was 18.5% (37/200), which was significantly lower than in the middle [43.5% (87/200)] and lower [38.0% (76/200)] part of the mesoreetum (X2= 9. 414, 6.406, P < 0.05). Two hundred metastatic lymph nodes in 33 patients were harvested, 48.0% (96/200) of which with a diameter of ≤ 5 mm. Twenty percent patients had their TNM stage changed after the retrieval of metastatic small lymph nodes. Conclusions Modified fat clearance technique significandy improves the retrieval of lymph nodes, and more small lymph nodes retrieved can increase the accuracy of staging. Rectal cancer cells have strong tendency to disseminate to the distal mesorectum. Adequate excision of the distal mesorectum is key in controlling the local recurrence.
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Bases on the changing idea and management policy,the out-patient service process rebuilding focuses on the patient,makes use of the information technology,imports the theory of operation process reforming,reconsiders and redesigns the operation process of the out-patient department,and improves the medical quality and service.The digitizing procedure in out-patient service is the important base of process rebuilding.In the paper,we try to discuss how to improve the digitizing procedure in out-patient service and rebuild the service process.
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Objective To investigate the practical value of transcatheter hepatic arterial chemoembolization (TACE) in the treatment of spontaneously ruptured hepatocellular carcinoma. Methods Using Seldinger technique,we treated 14 patients with ruptured hepatocellular carcinoma by TACE, in which a suspension of gelatin sponge, iodide oil and chemotherapeutic agents was used as embolus. Results Of 12 patients with active bleeding, successful hemostasis was achieved in 10 patients, with an effective rate of 83 3% (10/12), and 2 patients died from hemorrhagic shock within 48 hours, with an in-hospital mortality of 14 3% (2/14). One patient succumbed to hepatic failure two months after the TACE, and 1 patient received a radical operation two months after the TACE. Follow-up in 10 patients revealed that 8 patients underwent TACE for 1 ～ 4 times (mean survival time, 7 8 months) and 5 patients existed for more than 1 year (35 7%, 5/14). Conclusions TACE is effective in the management of spontaneously ruptured hepatocellular carcinoma.
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Objective To evaluate the correlation between spiral CT ( SCT ) features and expression of cyclooxygenase-2 , nm23 in esophageal carcinoma.Methods Spiral CT scans were preformed in 44 patients with esophageal carcinoma before operation, and the results were compared with that of operation and pathology. Immunohistochemical streptavidin peroxidase conjugate method was used to analyze the expression of Cox-2 and nm23 in esophageal carcinoma. Statistical analysis was performed with SPSS 12.0 software. Results (1) The accuracy of spiral CT scan in judging adjacent- infiltration and lymph node metastasis in 44 patients was 88.6%(39 of 44) and 90.9% (40 of 44) respectively,there was significant coincidence with operation and pathology(P
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The authors hold that factors affecting the quality of hospital network data include ideologies of relevant personnel, state of the administrative organization, quality of the staff, standardization level of data, level of the software used, interdepartmental cooperation, feedback of test data, and mechanism of supervisory control. Only by taking corresponding measures can the quality of network data be constantly improved.
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The paper introduces our hospital as a former military hospital in the system conversion process.In order to adapt to administration of Guangdong Province,the first page of medical record program of hospital information systems is developed.