Lymph nodes distribution and metastatic pattern of ultra-low rectal cancer after neoadjuvant therapy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the lymph nodes distribution and metastatic pattern of the ultra-low rectal cancer after neoadjuvant therapy.</p><p><b>METHODS</b>A total of 21 rectal cancer gross specimen after neoadjuvant therapy and 23 rectal cancer gross specimen without neoadjuvant therapy were investigated by whole mount section and tissue microarray techniques with CK20. All the patients were treated by abdominoperineal resection.</p><p><b>RESULTS</b>There were 138 lymph nodes retrieved from the mesorectum in the neoadjuvant group including 39 metastatic lymph nodes and 12 micro-metastatic lymph nodes. Among these nodes, there were 7 rectal cancer cases with lymph nodes and 2 cases with micro-metastatic lymph nodes, and 6 cases had pathological complete remission. There were 415 lymph nodes retrieved from the mesorectum in the group without neoadjuvant therapy including 169 metastatic lymph nodes and 59 micro-metastatic lymph nodes. Among these nodes, there were 12 rectal cancer cases with lymph nodes and 4 cases with micro-metastatic lymph nodes. The proportions of metastatic lymph nodes in outer zone between the two groups were 21.5% and 29.0%, and those in pre-zone were 17.6% and 17.2% respectively. The ratio of metastatic lymph nodes in ischiorectal fossa between the two groups were 25.0% vs. 22.2% respectively. The rate of metastatic or micro-metastatic lymph nodes cases between the two groups were 4.8% vs. 13.0% respectively.</p><p><b>CONCLUSIONS</b>The lymph nodes distribution and metastatic pattern of the ultra-low rectal cancer are affected by neoadjuvant therapy. The proportions of the anal sphincter invasion and metastatic or micro-metastatic lymph nodes in ischiorectal fossa are lower after neoadjuvant therapy. Abdominoperineal resection as the standard treatment of the ultra-low rectal cancer after neoadjuvant therapy should be re-evaluated.</p>

Meta-analysis of efficacy and safety on neoadjuvant therapy for rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To assess the value of neoadjuvant therapy for resectable rectal cancer and the impact on postoperative complications.</p><p><b>METHODS</b>Literature search was performed in PubMed, Ovid, Web of Science, Springer-Link and Elsevier ScienceDirect for randomized controlled trials published before May 2010 that compared neoadjuvant therapy with surgery alone or postoperative adjuvant therapy. The computer search was supplemented with hand search of reference lists for available primary studies. Inclusion criteria and quality assessment were performed.</p><p><b>RESULTS</b>Eleven studies including 7407 patients were enrolled for analysis. Neoadjuvant therapy group had significant advantages in local recurrence (OR=0.43, 95%CI:0.37-0.50, P<0.01), distant recurrence (OR=0.85, 95%CI:0.76-0.95, P<0.01), 5-year overall survival (RR=1.15, 95%CI:1.04-1.28, P<0.01), and sphincter-saving surgery (RR=1.48, 95%CI:1.17-1.87, P<0.01). There were no significant difference in postoperative mortality rate(OR=1.20, 95%CI:0.68-2.13, P=0.53) and anastomotic complications (OR=1.04, 95%CI:0.73-1.48, P=0.84).</p><p><b>CONCLUSION</b>Neoadjuvant therapy improves local control, distant recurrence and long-term survival without increasing postoperative complications.</p>

Metabolic disorders of fatty acids and fatty acid amides associated with human gastric cancer morbidity / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Gastric cancer (GC) is one of the most common types of cancer in the world. A change in the metabolism of lipids in tumor cells could lead to the pathogenesis of cancer. In this study, we investigated fatty acid and fatty acid amide metabolic perturbations associated with GC morbidity.</p><p><b>METHODS</b>Gas chromatography/mass spectrometry (GC/MS) was utilized to analyze fatty acids (FAs) and fatty acid amides (FAAs) of GC tissues and matched normal mucosae from 30 GC patients. Acquired lipid data was analyzed using non parametric Wilcoxon rank sum test to find the differential biomarkers for GC and diagnostic models for GC were established by using orthogonal partial least squares discriminant analysis (OPLS-DA).</p><p><b>RESULTS</b>A total of 13 FAs and 4 FAAs were detected using GC/MS and 5 differential FAs as well as oleamide were identified with significant difference (P<0.05). The OPLS-DA model generated from lipid profile showed adequate discrimination of GC tissues from normal mucosae while the OPLS-DA model failed to separate GC specimens of different TNM stages. A total of 8 variables were obtained for their most contribution in the discriminating model (Variable importance in the projection (VIP) value>1.0), five of which were detected with significant difference (P<0.05).</p><p><b>CONCLUSIONS</b>FA and FAA metabolic profiles have great potential in detecting GC and helping understand perturbations of lipid metabolism associated with GC morbidity.</p>

Meta-analysis of laparoscopy-assisted distal gastrectomy and conventional open distal gastrectomy for early gastric cancer / 癌症

<p><b>BACKGROUND AND OBJECTIVE</b>With the application of laparoscopy, laparoscopic gastrectomy for the treatment of patients with early gastric cancer has been performed, but the safety and effectiveness of this method need to be explored. This study evaluated the safety and effectiveness of laparoscopy-assisted and conventional open distal gastrectomy for patients with early gastric cancer.</p><p><b>METHODS</b>A search of MEDLINE, EMBASE, the Chinese Biomedical Database (CBM), and Cochrane Central Register of Controlled Trials (CENTRAL) identified all the randomized clinical trials that compared laparoscopy-assisted gastrectomy with open distal gastrectomy for patients with early gastric cancer published in the last 10 years. Quality assessment was done on each trial and relevant data were extracted from qualified trials. Meta-analysis was performed using RevMan 4.2.2 software (Cochrane).</p><p><b>RESULTS</b>Six randomized controlled trials (RCTs) involving 218 patients were included. Comparing laparoscopic resection with open resection, results showed less estimated blood loss (WMD (weighted mean difference): -121.86; 95% CI (confidence interval): -145.61, -98.11; P < 0.001), earlier postoperative first flatus (WMD: -0.95; 95% CI: -1.09, -0.81; P < 0.001), and shorter durations of hospital stays (WMD: -2.27; 95%CI: -3.47, -1.06; P = 0.0002), but longer surgery times (WMD: 58.71; 95% CI: 52.69, 64.74; P < 0.001) and fewer lymph nodes dissected (WMD: -3.64; 95% CI: -5.80,-1.47; P = 0.001). There was no significant difference between the two groups in postoperative complications (OR (odds ratio): 0.57; 95% CI: 0.31,1.03; P = 0.06).</p><p><b>CONCLUSIONS</b>The short-term outcome of laparoscopy-assisted distal gastrectomy for patients with early gastric cancer is superior to the open procedure, but its long-term outcome should be proven by further outcomes of RCTs.</p>

Systematic review on safety and efficacy of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of laparoscopy- assisted distal gastrectomy (LADG) with D2 lymph node dissection for gastric cancer.</p><p><b>METHODS</b>Literature search was performed in Pubmed, Medline, EMBASE, the Chinese Biomedical Database (CBM) to identify controlled trials comparing LADG and open distal gastrectomy (ODG) for gastric cancer published between January 2005 and February 2010. A meta-analysis was performed using RevMan 5.0 software.</p><p><b>RESULTS</b>Seven controlled trials were included. One trail was randomized controlled trial. Compared to ODG, LADG had less blood loss[WMD: -132.04, 95% confidence interval (CI): -207.32 to -56.77], earlier postoperative first flatus (WMD: -0.82, 95% CI: -1.20 to -0.45], less complications [odds ratio (OR): 0.45, 95% CI: 0.26 to 0.78], shorter postoperative hospital stay (WMD: -3.63, 95% CI: -4.19 to -3.07), more harvested lymph nodes (WMD: 1.93, 95%CI: 0.36 to 3.50). There were no significant differences between the two groups in recurrence rate, metastasis rate, mortality and survival rate.</p><p><b>CONCLUSION</b>Short-term outcome of LADG with D2 lymph node dissection for gastric cancer is superior to ODG.</p>

Impact of width of hepatectomy margin on survival after simultaneous liver and colorectal resection for colorectal cancer liver metastasis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To elucidate an adequate hepatectomy margin for simultaneous liver and colorectal resection in colorectal cancer liver metastasis.</p><p><b>METHODS</b>Clinical data of 39 patients, undergone simultaneous liver and colorectal resection for colorectal cancer liver metastasis from August 1994 to December 2004, were analyzed retrospectively. Two groups were divided according to the width of hepatectomy margin:less than 1 cm in group A, and equal or more than 1 cm in group B. The data were analyzed and compared between the 2 groups using Kaplan-Meier survival analysis and Log-rank test.</p><p><b>RESULTS</b>There were 14 patients in group A and 25 patients in group B. No significant differences in gender, age, primary tumor invasion, lymph node metastasis, the number, distribution and size of liver metastasis, duration and blood lose of surgery were found between two groups. The median survival time was 17 months in group A, and 37 months in group B, and the overall 5-year survival rate in group B was much better than that in group A (19.8% vs 0, P<0.01).</p><p><b>CONCLUSION</b>Simultaneous liver and colorectal resection in colorectal cancer liver metastasis should be performed with a hepatectomy margin equal or more than 1 cm.</p>

Expression of CD45 in the serum of patients with Crohn's disease / 南方医科大学学报

<p><b>OBJECTIVE</b>To search for differentially expressed proteins in the serum of patients with Crohn's disease.</p><p><b>METHODS</b>Serum protein samples obtained from 4 patients with Crohn's disease and 4 normal adults were cross-labeled with different CyDyes and underwent two-dimensional differential in-gel electrophoresis (2-D DIGE) and imaging analysis. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) was used to identify the differentially expressed proteins.</p><p><b>RESULTS</b>2-D DIGE revealed that the protein on spot 973 was overexpressed by 2.55 folds in the serum of patients with Crohn's disease compared with that in normal adults (P<0.05). The protein was identified as CD45 using mass spectrometry.</p><p><b>CONCLUSION</b>CD45 overexpression in the serum of patients with Crohn's disease may play a role in the disequilibrium of the immune system.</p>

Serum proteomic variation study in patients with Crohn disease / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To search differentially expressed proteins in serum of patients with Crohn disease.</p><p><b>METHODS</b>Serum protein samples from 4 patients with Crohn disease and 8 healthy adults were recruited cross-labeled with variant CyDye, and then followed by two-dimensional differential in-gel electrophoresis (2-D DIGE), image analysis, and identified by matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS).</p><p><b>RESULTS</b>The 2-D electrophoresis results were compared between the Crohn disease patients and the healthy adults. The spot 1058 expression in serum of Crohn disease patients increased by 1.68 folds as compared with healthy adults (P<0.05). The protein was identified as haptoglobin by mass spectrometry.</p><p><b>CONCLUSION</b>Up-regulating expression of haptoglobin in serum of Crohn disease patients may play a role in disequilibrium of immunity system.</p>

Association between hypermethylation of Syk gene and clinicopathological characteristics in colorectal cancer patients / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the association of the methylation status and expression level of Syk gene with the clinicopathological characteristics in colorectal cancer (CRC) patients.</p><p><b>METHODS</b>Methylation-specific PCR(MSP) and RT-PCR techniques were used to analyze the methylation status and expression level of Syk gene in cancer and normal tissues of 120 CRC patients, meanwhile, association of the methylation status and expression level of Syk gene with the clinicopathological characteristics and the prognosis were studied.</p><p><b>RESULTS</b>(1) Syk gene expression was not found in 48 cancer tissues out of 120 patients and was found in all the normal tissues.The difference was significant. (2) Loss of Syk expression was found in 37 patients with Syk hypermethylation, and in 11 out of 83 patients with Syk nonmethylation. (3) The methylation status of Syk gene was correlated with the lymph node status and the Dukes stage, but not with other clinicopathological parameters. (4) The follow-up data revealed that the 3-year survival of patients with Syk hypermethylation was lower than that of patients without Syk hypermethylation(73.5% vs.95.7%,P=0.007),and postoperative recurrence rate significantly increased in the Syk hypermethylation group (32.4% vs. 8.4%,P=0.02).</p><p><b>CONCLUSION</b>Hypermethylation leads to silence of Syk gene involved in the initiation of colorectal cancer, which increases the infiltration of colorectal cancer cells, postoperative relapse and decreases the postoperative 3-year survival time.</p>

Clinicopathological characteristics and prognosis of patients with recurrent colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological characteristics and prognosis of patients with recurrent colorectal cancer.</p><p><b>METHODS</b>Clinicopathological characteristics and postoperative survival of 235 patients with recurrent colorectal cancer after radical resection were retrospectively analyzed, and was compared with that of 993 patients with radical resection.</p><p><b>RESULTS</b>The overall 5- and 10-year survival rates after radical resection were 67.7% and 55.8%, respectively. The 5- and 10-year survival rates in patients with recurrent colorectal cancer was 43.9% and 28.1% (P=0.000), respectively. Among patients with recurrent colorectal cancer, the 5- and 10-year survival rates of the patients underwent second radical resection were 50.2% and 32.7%, while the 5- and 10-year survival rates of the patients without second surgery were 25.8% and 0, respectively (P=0.000). On univariate analysis, postoperative recurrence was associated with age at diagnosis, cancerous ileus, ascites, lymphs nodes involvement, gross types, infiltration of tumor and Duke's stage. Multivariate analysis revealed that cancerous ileus, ascites, gross types and Duke's stage were independent predictive factors for postoperative recurrence.</p><p><b>CONCLUSION</b>Cancerous ileus, ascites, gross types and Duke's stage were independent predictive factors for recurrence and metastasis of colorectal cancer after radical resection. The 5- and 10-year survival rates and quality of life could be improved by second radical resection.</p>

Adenovirus mediated double suicide gene under controlling by KDR promoter selectively kills vascular endothelial cells and colorectal tumor cells / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the selectively killing effect of adenovirus (Ad) mediated double suicide gene under the regulation of KDR promoter on vascular endothelial cells and colorectal tumor cells.</p><p><b>METHODS</b>293 packaging cells were transfected with the plasmids of pAdEasy- KDR- CDglyTK and pAdEasy- CMV- CDglyTK and the infectious viruses were generated. The KDR expressive cells of ECV304,SW620 and the KDR inexpressive cells of LS174T were infected by two Ads. The infection rate was observed and the expression of CDglyTK was detected by RT- PCR. After treatment with different concentrations of 5- FC and GCV,the killing effect and bystander effect on ECV304,SW620 and LS174T were examined.</p><p><b>RESULTS</b>The titers of these two purified Ads were 2.0 x 10(12 ) pfu/ml. There was no significant difference in infection rate between two recombinant Ads infecting various cells,and the infection rate increased in accordance with the enhancing titers of Ads. RT- PCR demonstrated that there existed the product of CDglyTK gene in all the cells infected by Ad- CMV- CDglyTK and the cells infected by Ad- KDR- CDglyTK except in the SL174T. The curative effect in this system on various cells was shown as follows: (1) All cells infected with Ad- CMV- CDglyTK and some cells of ECV304 and SW620 infected with Ad- KDR- CDglyTK were highly sensitive to the prodrugs,but there was no significant differences among them (P > 0.05); compared with ECV304 and SW620 cells,LS174T cells were not sensitive to the two prodrugs (P< 0.001). (2) The efficacy of double suicide gene was better than that of single suicide gene (P< 0.001). (3) The system had considerable bystander effect.</p><p><b>CONCLUSION</b>The double suicide gene under the regulation of KDR promoter has specific killing effect on the KDR- expressing endothelial cells and colorectal tumor cells.</p>

Multi-variate regression analysis of clinicopathological characteristics and prognosis of colorectal cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the relationship between clinicopathologic features and prognosis of colorectal cancer after surgical treatment.</p><p><b>METHODS</b>The clinical characteristics, pathologic features and survival rate of 761 patients with colorectal cancer after surgical treatment were univariately and multivariately analyzed.</p><p><b>RESULTS</b>The overall 3- and 5-year survival rates of patients with colorectal cancer after surgical treatment were 62.9% and 60.7% with a median survival of 1,825 days. The factors of gross findings, degree of differentiation, infiltration, nodal and distant metastasis and neoplastic intestinal obstruction influenced the survival rate by univariate analysis. The factors of Dukes stage, gross tumor configuration, intramural spread and differentiation degree were available independent prognostic factors through multivariate analysis.</p><p><b>CONCLUSION</b>Dukes stage, as the most important available independent prognostic factor (P < 0.0005), is able to assess the postoperative survival.</p>