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BACKGROUND@#The effect of intra-operative chemotherapy (IOC) on the long-term survival of patients with colorectal cancer (CRC) remains unclear. In this study, we evaluated the independent effect of intra-operative infusion of 5-fluorouracil in combination with calcium folinate on the survival of CRC patients following radical resection.@*METHODS@#1820 patients were recruited, and 1263 received IOC and 557 did not. Clinical and demographic data were collected, including overall survival (OS), clinicopathological features, and treatment strategies. Risk factors for IOC-related deaths were identified using multivariate Cox proportional hazards models. A regression model was developed to analyze the independent effects of IOC.@*RESULTS@#Proportional hazard regression analysis showed that IOC (hazard ratio [HR]=0.53, 95% confidence intervals [CI] [0.43, 0.65], P < 0.001) was a protective factor for the survival of patients. The mean overall survival time in IOC group was 82.50 (95% CI [80.52, 84.49]) months, and 71.21 (95% CI [67.92, 74.50]) months in non-IOC group. The OS in IOC-treated patients were significantly higher than non-IOC-treated patients ( P < 0.001, log-rank test). Further analysis revealed that IOC decreased the risk of death in patients with CRC in a non-adjusted model (HR=0.53, 95% CI [0.43, 0.65], P < 0.001), model 2 (adjusted for age and gender, HR=0.52, 95% CI [0.43, 0.64], P < 0.001), and model 3 (adjusted for all factors, 95% CI 0.71 [0.55, 0.90], P = 0.006). The subgroup analysis showed that the HR for the effect of IOC on survival was lower in patients with stage II (HR = 0.46, 95% CI [0.31, 0.67]) or III disease (HR=0.59, 95% CI [0.45, 0.76]), regardless of pre-operative radiotherapy (HR=0.55, 95% CI [0.45, 0.68]) or pre-operative chemotherapy (HR=0.54, 95% CI [0.44, 0.66]).@*CONCLUSIONS@#IOC is an independent factor that influences the survival of CRC patients. It improved the OS of patients with stages II and III CRC after radical surgery.@*TRIAL REGISTRATION@#chictr.org.cn, ChiCTR 2100043775.
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Humans , Fluorouracil/therapeutic use , Leucovorin/therapeutic use , Colorectal Neoplasms/pathology , Retrospective Studies , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Proportional Hazards Models , PrognosisABSTRACT
Objective:To investigate the impact of the clinicopathological characteristics of anorectal malignant melanoma (ARMM) on the prognosis.Methods:The clinicopathological data of 40 ARMM patients undergoing surgery at the Department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences from Apr 2012 to Apr 2022 were collected, and the impact of different clinicopathological factors and treatment modalities on the overall survival of ARMM patients was investigated using Kaplan-Meier survival analysis and multifactorial Cox proportional risk model analysis.Results:Among 40 ARMM patients , 16 were male and 24 were female. The median age of onset was 61 yr. The median follow-up period for all patients was 47 (25-69) months, with a median survival of 19 (15-23) months and 1-year and 3-year survival rates of 74.3% and 21.7%, respectively. There was no statistically significant difference in survival time between the two groups of patients receiving wide local excision and abdominoperineal resection( χ2=1.281, P=0.258). Univariate analysis showed that overall survival in patients with ARMM was related to tumour diameter, depth of infiltration, specimen margin and lymph node metastasis ( χ2=1.281, P=0.039; χ2=3.760, P=0.042; χ2=6.581, P=0.010; χ2=21.683, P<0.001), and multivariate analysis suggested that lymph node metastasis was an independent risk factor for overall survival in patients with ARMM. Conclusion:Tumour diameter, depth of infiltration, specimen margin and lymph node metastasis were important prognostic influences in ARMM, and lymph node metastasis was an independent risk factor for overall survival in ARMM patients.
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Objective:To evaluate the safety and feasibility of radical surgery and explore prognostic factors affecting cancer-specific survival (CSS) in elderly patients with colorectal cancer (CRC).Methods:From Jan 2010 to Dec 2020, a total of 372 elderly (aged over 80 years) CRC patients who underwent curative resection at the National Cancer Center were enrolled. Preoperative clinical features, perioperative outcomes and postoperative pathological characteristics were collected.Results:In the multivariable COX regression analysis, BMI ≥30 kg/m 2 ( HR:2.30, 95% CI: 1.27-4.17, P=0.006) and N1-N2 stage ( HR: 2.97,95% CI:1.48-5.97, P=0.002) correlated with worse CCS. Conclusions:The results of this study demonstrated that radical resection for CRC is safe and feasible for patients over 80 years of age. BMI and N stage were independent prognostic factors for elderly CRC patients after radical resection.
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Objective:To explore the safety of transanal re-excision (TAR) after positive-margin local resection for early rectal cancer.Methods:A retrospective analysis was made data of 44 patients with rectal cancer after local excision from Mar 2006 to Oct 2018 at the Department of Colorectal Surgery, Cancer Hospital of Chinese Academy of Medical Sciences. All patients had positive margin or suspicious tumor remains after local excision, and subsequently salvage TAR surgery was performed after informed consent was given.Results:Forty-four patients after local excision were with pathologically showed residual condition, including 26 cases of positive margin and 18 cases of suspicious tumor remaining. The pathological types were all adenocarcinoma. Forty-one (93%) patients with pT1 and 3 (7%) patients with pT2. The median follow-up time after salvage TAR was 100 (11-164) months. During follow-up, 3 patients (7%) developed mild anal incontinence. One patient (2%) had local recurrence, 3 (7%) patients had distant metastases, and 3 patients (7%) died of non-tumor specific deaths. The overall 5-year survival rate and disease-free survival rate were 98% and 93 %, respectively.Conclusions:Transannal full thickness tumor re-excision is safe and reliable for the salvage treatment after non-complete local resection of early rectal cancer. The long-term follow-up results show that the 5-year survival rate is comparable to that of radical surgical resection, and with a good anal function.
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Objective To investigate the safety and efficacy of enhanced recovery after surgery (ERAS) used in laparoscopic colorectal cancer surgery.Methods We conducted a retrospective analysis of the medical records of 99 cases treated with ERAS programed laparoscopic colorectal cancer surgery (ERAS group) and 103 cases treated with traditional perioperative care and laparoscopic colorectal cancer surgery (controlled group) from Mar 2017 to Sep 2017 in our center.Results There was no significant difference in age,gender,BMI,ASA classification,tumor location,operation time,pathological stage and the incidence of postoperative complications between ERAS group and controlled group (all P ＞ 0.05).Compared to control group,ERAS had less blood loss,shorter time to pass first flatus,stool and start diet and shorter hospitalization day,with all the difference statistically significant [(60 ± 63)ml vs.(112 ± 245)ml,(3.0±0.8)dvs.(4.3 ±1.2)d,(3.5 ±1.0)dvs.(4.6±1.3)d,(4.1 ±1.2)dvs.(5.4± 2.0)d,(5.8±2.1)dvs.(7.8±2.5)d,t=-2.021、-9.216、-6.887、-5.252、-6.163,allP＜ 0.05].No patients in both groups suffered from readmission or death within 30 days after surgery.Conclusion Patients treated with ERAS programed laparoscopic colorectal cancer surgery is safe and effective,with rapid recovery and reduced hospital stay.
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Objective@#To investigate the safety and feasibility of laparoscopic remedial surgery in patients who didn′t reach the cure criterion of early colorectal cancer after endoscopic resection.@*Methods@#The clinical and follow-up data of 12 patients who didn′t reach the cure criterion of early colorectal cancer and then underwent endoscopic resection was collected. The clinicalpathological features and remedial indications were analyzed to evaluate the effects of laparoscopic remedial surgery.@*Results@#The average number of lymph nodes in the lymph node dissection was 15 during remedial surgery, and 3 of them had lymph node metastasis. Among the 3 patients with residual cancer, two cases were poorly differentiated, 1 case was moderately differentiated, 1 case was positive for basal margin, and 1 case had vascular invasion. No lymph node metastasis occurred in the 9 patients who had no residual cancer. Among these, 8 cases were moderately differentiated, 1 case was poorly differentiated and 2 cases had positive basal margin. The average follow-up duration was 40 months and all 12 patients were in a state of survival at the last follow-up. During the follow-up of the 3 patients with residual cancer, 1 patient received adjuvant chemotherapy with unknown prognosis; 1 patient received postoperative adjuvant radiochemotherapy, and lung metastasis occurred; 1 patient did not receive any treatment after surgery and survived for 33 months.@*Conclusions@#Laparoscopic remedial surgery is a safe and feasible remedy for patients who didn′t reach the cure criterion of early colorectal cancer after endoscopic resection. However, the choice of remedial strategy for colorectal carcinoma needs further investigation for patients with no vascular invasion, high degree of differentiation, and negative basal margin.
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Objective@#To evaluate the compliance rate of screening colonoscopy and associated factors in high-risk populations of colorectal cancer (CRC) in urban China.@*Methods@#CRC screening data from the Program of Cancer Screening in Urban China conducted in 12 provinces in 2012-2014 was used in the present study. All 97 445 participants were asked to take epidemiological questionnaire survey to evaluate their cancer risk. Participants who were evaluated as "high risk for CRC" were recommended to receive colonoscopy at designated hospitals. Chi-square tests were used to compare the differences of participation rates between groups. Multivariate logistic regression models were applied to explore the potential factors associated withthe compliance rate of screening colonoscopy.@*Results@#Overall, 97 445 participants of CRC high-risk were included in this analysis, and 14 949 of them took screening colonoscopy, yielding a participation rate of 15.3%. The participation rate varied greatly across provinces, ranging from 25.2% (2 785/11 071) in Heilongjiang to 9.7% (1 698/17 515) in Liaoning. Moreover, the participation rate in 2013-2014 was significantly higher than that in 2012-2013 (17.1%(9 766/57 280) vs 12.9% (5 183/40 165), χ2=57.67, P<0.001) . The multivariate logistic regression analyses showed that: compared with individuals of 40-49 years old, individuals of 50-59 or 60-69 years old were more willing to accept screening colonoscopy, with OR of 1.17 (95% CI: 1.12-1.22) and 1.13 (95% CI: 1.08-1.19), respectively; compared with uneducated individuals, individuals with good educational background of equivalent to high school or higher (OR=1.29, 95% CI:1.10-1.50) were more willing to accept screening colonoscopy; compared with individuals who never took fecal occult blood tests (FOBT) before, individuals with previous positive FOBT results (OR=1.40, 95% CI:1.31-1.50) were more willing to accept screening colonoscopy; compared with individuals with no inflammatory bowel diseases (IBD), individuals with IBD (OR=1.63, 95%CI:1.56-1.69) were more willing to accept screening colonoscopy; Compared with individuals without polyp history, individuals having history of previous polyp detection (OR=1.43, 95% CI:1.37-1.50) were more willing to accept screening colonoscopy; compared to individuals with no family history of CRC, individuals with history of CRC (OR=1.60, 95% CI:1.53-1.66) were more willing to accept screening colonoscopy.@*Conclusion@#The overall participation rate of screening colonoscopy among high-risk population of CRC in the 12 participating sites was 15.3%. The study findings indicated that age, education level, history of past fecal occult blood test, IBD, history of polyp, family history of CRC were associated with the compliance rate of colonoscopy in this population-based CRC screening program.
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Objective:To confirm the potential of growth-related gene productβ(GROβ) as a biomarker for colorectal cancer. Methods:Serum GROβlevels in 123 subjects with colorectal cancer, 88 healthy controls, and 125 subjects with other diseases were measured using enzyme-linked immunosorbent assay. Serum levels of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) in all subjects were measured using immunoluminometric assay. Statistical analyses were conducted to determine the associa-tions between serum GROβlevels and clinical parameters for colorectal cancer. The receiver operating characteristic (ROC) curves of GROβ, CEA, and CA19-9 were analyzed. Results:The serum GROβlevels were higher in patients with colorectal cancer (median=96.15 pg/mL) than in the healthy controls (median=43.28 pg/mL, P<0.01) and in patients with other diseases (median=57.30 pg/mL, P<0.01). The serum GROβlevels in patients with colorectal cancer were positively correlated with the tumor-node-metastasis staging (P<0.01) and depth of infiltration (P<0.05), but not with the histological grade, tumor embolus, lymph node metastasis, gross pathologic tu-mor type, or gender of the patients. The sensitivity and specificity of the assay for serum GROβwere 56.1%(69/123) and 95.31%(203/213), respectively. The diagnostic sensitivity was 22.2%(4/18) for stage I and 66.7%(26/39) for stage II when the data of GROβwere combined with the data of CEA and CA19-9. The ROC curve constructed with the data of GROβ(0.834) was larger than that construct-ed with the data of CEA (0.739) or CA19-9 (0.676) for discriminating colorectal cancer from the matched controls. Conclusion:These preliminary results indicated that the serum GROβlevel could be a useful biomarker for colorectal cancer diagnoses.
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Objective To summarize and analyze the clinical feature,therapeutic mnethods and prognosis of colorectal small cell carcinoma.Methods From January 2000 to January 2012,15 patients of colorectal small cell carcinoma were analyzed retrospectively.Results There were 12 male cases,3 females.The age at diagnosis was between 39-71 years,with median age of 60.SCC located in the rectum in 12 cases,in the colon in 3 cases.The time from the onset of symptoms to final diagnosis was from 1 to 12 months.The diameter of tumors varied from 2.5 to 8.0 cm.13 cases received up-front surgery,including radical tumor resection in 6 cases,palliative resection in 7 cases,and neoadjuvant-chemotherapy followed by palliative resection in one case.The initial Ⅰ,Ⅲ B,Ⅳ B stage were 1 case,6 cases and 8 cases,respectively.The overall median survival time is 11 months,1,2 year's survival rate is 40.0％ and 20.0％,respectively.Conclusions Colorectal SCC is less common and the prognosis is poor.Multimodality management,with radical surgical resection of the primary lesion followed by standard adjuvantchemotherapy,affords good local disease control and a fair survival.
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Objective To study the clinical features of gallbladder small cell carcinoma (GSCC),to improve the diagnosis and treatment of GSCC.Methods We retrospectively analyzed the clinical data of GSCC patients at our hospital from January 2000 to January 2012,and made a collective review of the literature.Results In this series,there were four female cases,one male case,the age at the first diagnosis was between 42-67,with the median age of 57.The main complain was pain and dis-comfort on the up and right abdomen.Tumor located in the bottom of gallbladder in 3 cases,and in the body in 2.Cholelithiasis was complicated in 4 cases.2 patients received radical resection of GSCC,followed by adjuvant chemotherapy of VP-16 and cisplatin,radioactive therapy in one.Postoperatively,these two were followed up for 45 and 32 mons with tumor free survival.3 cases received palliative resection,followed by adjuvant chemoradioactive therapy or intervention treatment,these three were followed up to 8,11,30 months respectively to their death for tumor recurrence.Conclusions GSCC is a rare disease,the initial symptoms are not often specific and easily misdiagnosed.The prognosis of GSCC is poor.
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Objective To investigate the effects on the condition of nutrition and immunologic function of gastric cancer treated with the insertion of jejunal nutrient canal after total gastrectomy.Methods In this study 113 gastric cancer patients were randomly divided into enteral nutrition group (the group of the fine-needle/catheter jejunostomy during operation,FCJ group) and parenteral nutrition group (PN group) after total gastrectomy.Evacuating time and postoperative complications were observed and relative laboratory parameters were measured prior to surgery (preoperative) and on days 3 and 7 postoperatively.Results The evacuating time in enteral nutrition group was shorter than that in parenteral nutrition group significantly[(4.1±2.2) d vs.(5.1 ±2.0) d,t =2.156,P =0.037];Serum level of prealbumin[( 18 ± 7 ) mg/dl vs.( 14 ± 7 ) mg/dl,t =2.370,P =0.022]and transferring[(205 ±45 ) mg/dl vs.( 186 ± 39 ) mg/dl,t =3.665,P =0.001]in enteral nutrition group on postoperative day 7 was higher than that in parenteral nutrition group;Serum IgA[( 2.3 ± 1.0 ) g/L vs.( 1.9 + 0.7 ) g/L,t =2.178,P=0.034],lgM[(1.4 ±0.4) g/L vs.(1.0 ±0.4) g/L,t=2.124,P=0.039]and IgG[(9.5 ±1.9) g/L vs.(9.0 ± 2.3 ) g/L,t =2.189,P =0.033]were higher in enteral nutrition group than that in parenteral nutrition group;The incidence of postoperative alimentary dysfunction in enteral nutrition group was lower than that in parenteral nutrition group( 3％ vs.13％,x2 =3.962,P =0.048).Conclusions It is safe and convenient to use early postoperative enteral nutrition support by fine-needle/catheter jejunostomy (FCJ) in gastric cancer patients immediately after total gastrectomy.
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ObjectiveTo evaluate the safety and effects of pseudomonas aerug PA-MSHA vaccine on cytoimmunity in advanced gastric cancer patients. MethodsSeventy two patients with advanced gastric cancer were randomly divided into experimental group and control group. Tumor bed was treated intraoperatively by pseudomonas vaccine injection in experimental group.The venous bloods were sampled prior to surgery (preoperative) and on days 10,20,and 30 postoperatively.The total lymphocyte count and lymphocyte subpopulations were detected while the postoperative complications and adverse drug reaction were observed,prognosis was evaluated. ResultsThe total lymphocyte count(P =0.042) and the counts ofCD3+ lymphocyte(P =0.027) and NK cell increased (P =0.012) obviously in experimental group.CD8+ lymphocyte decreased(P =0.037),but the counts of CI4+ lymphocyte and CD4+/CD8+ were not significantly different.Complications were not significantly different in the two groups.One year survival rate was longer ( 94.9％ ) in experimental group than that in the control group ( 83.3％ ) ( P =0.022 ).ConclusionsPeritoneal cavity administration with pseudomonas aerug vaccine was safe,and effectively helps regulate cytoimmunity in postoperative patients of advanced gastric carcinoma.
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Objective To investigate the prognostic factors of EGC patients,especially the relationship between prognosis and tumor size.Methods Clinical data of 119 EGC cases from 1998 to 2002 were analyzed retrospectively.Results The overall 5-year survival rate was 90.9%.and the survival rate of patients with tumor D＜2 cm.2 cm≤D＜4 cm and D≥4 cm respectively was 100%,92.0%and 80.8%(P=0.024).In this group,tumor stage,lymph node metastasis and tumor invasion depth did not affect the survival statistically.There was no correlation between tumor size and other prognostic factors.Conclusion Tumor size is an independent prognostic factor of patients with EGC,which may have some relevance to the surgical approach of EGC.
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OBJECTIVE To understand and use reasonably the strategy of prevention and management of overwhelming postsplenectomy infection(OPSI). METHODS According to intervention to patients with postsplenectomy by means of education,vaccination,antibotic prophylaxis after April 1998,clinical and follow-up data were reviewed and analyzed from 337 cases patients with traumatic splenectomy from Jan 1992 to Jan 2004,and correlative factors of four OPSI cases were further analyzed. RESULTS Incidence of OPSI descended obviously after intervention(P
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<p><b>OBJECTIVE</b>To evaluate the result of laparoscopic colorectomy in treatment of colorectal cancer.</p><p><b>METHODS</b>Laparoscopic colorectal surgery was performed in 78 patients with colorectal cancer. Operative procedures, complications and postoperative recovery were studied.</p><p><b>RESULT</b>None of the 78 patients died of laparoscopic colorectal surgery or complications. Eleven patients died from tumor metastasis and 2 from other causes. Twenty-one, 17, 8 patients for 1, 3, 5 years survived respectively. In nine patients who had received operation less than 1 year, no tumor recurrence or metastasis was found except in 1 patient 11 months after operation.</p><p><b>CONCLUSION</b>Laparoscopic colorectal cancer resection is essential to colectomy for colon and rectum cancer when indicated.</p>