Predictive value of Barcelona clinic liver cancer staging system combined with albumin-indocyanine green score in hepatectomy for hepatocellular carcinoma / 中华肝胆外科杂志

Objective:To study the predictive value of Barcelona clinic liver cancer (BCLC) staging system combined with albumin-indocyanine green (ALICE) score (ALICE-BCLC) in hepatectomy for hepatocellular carcinoma, and compare it with BCLC staging system combined with Child-Pugh score (CP-BCLC).Methods:The clinical data of 311 patients with hepatocellular carcinoma who underwent hepatectomy at Jinhua Hospital Affiliated to Zhejiang University from April 2012 to June 2021 were analyzed retrospectively. There were 271 males and 40 females, with a median age of 59 years old (range 26 to 92 years old). These patients were divided into two groups based on the ALICE-BCLC: the ALICE-BCLC grade 0 group ( n=63) and the ALICE-BCLC grade A group ( n=248); and another two groups based on the CP-BCLC: the CP-BCLC grade 0 group ( n=58) and the CP-BCLC grade A group ( n=253). The clinical data, including indocyanine green retention rate at 15 min, and albumin were collected and the scores were calculated. Follow-up was conducted by combining outpatient visits with telephone calls. The survival rate was calculated by the life method, and survival curves were drawn by the Kaplan-Meier method. The multivariate Cox regression model was used to determine the main factors affecting prognosis. Weighted Kappa was used to compare consistency of the two staging systems. Results:Multivariate analysis showed that a maximum tumor diameter >5 cm, total bilirubin >18 μmol/L, major hepatectomy, CP-BCLC grade A and ALICE-BCLC grade A to be independent risk factors affecting overall survival of patients with hepatocellular carcinoma after liver resection with curative intent (all P<0.05). The median survival of patients in the CP-BCLC grade 0 group and the CP-BCLC grade A group were 43.0 and 28.0 months, respectively. There was a significant difference between the two groups ( P=0.017). The median survival of patients in the ALICE-BCLC grade 0 group and the ALICE-BCLC grade A group were 41.4 and 28.1 months, respectively. There was a significant difference between the two groups ( P=0.035). The weighted Kappa coefficient of ALICE-BCLC and CP-BCLC was 0.949, showing a strong consistency ( P<0.001). Conclusion:ALICE-BCLC showed a good predictive value for prognosis of hepatocellular carcinoma after liver resection, and it had a similar overall prognostic discrimination ability as CP-BCLC.

Effect of surgical resection on the survival of patients with CNLC stage Ⅱ hepatocellular carcinoma / 中华肝胆外科杂志

Objective:To evaluate the effect of surgical resection on the prognosis of patients with China Liver Cancer Staging (CNLC)-Ⅱ hepatocellular carcinoma.Methods:Patients with CNLC-Ⅱ hepatocellular carcinoma between 2004 and 2015 from the SEER database were included. A total of 3 764 patients were enrolled, with the age (64±11)(18-93) years, including 2 935 males and 829 females. Among them, 2 825 patients underwent non-surgery treatment (NST), 510 patients underwent liver resection (LR), and 429 patients underwent local ablation (LA). The effects of different treatment modalities on overall survival (OS) and cancer-specific survival (CSS) were evaluated by using Kaplan-Meier analysis, propensity score matching analysis, and subgroup analysis. Cox regression were used to analyze the prognosis.Results:The 1-, 3- and 5-year overall survival rates of LR group were 76.3%, 51.9% and 34.0% respectively, which were significantly higher than those in LA group (71.7%, 34.8% and 24.9%, χ 2=18.50, P<0.001), and those in NST group (46.8%, 16.1% and 8.4%, χ 2=276.00, P<0.001). Similarly, the 1-, 3-, and 5-year cancer-related survival rates of LR group were 80.2%, 58.9%, and 41.8% respectively, which were significantly higher than those in LA group (75.9%, 42.8%, and 32.6%, χ 2=15.20, P<0.001), and those in NST group (52.3%, 21.5% and 12.7%, χ 2=245.00, P<0.001). Cox regression analysis showed that age, tumor size, chemotherapy, pathological grade, AFP levels, and surgical modalities were independent prognostic factors (all P<0.05). Propensity score matching analysis further showed that the prognosis of LR patients was significantly better than NST group [median OS: 52 months (95% CI: 38-60) vs. 10 months (95% CI: 7-16), P<0.001; median CSS: 59 months (95% CI: 44-77) vs. 11 months (95% CI: 8-18), P<0.001]. However, subgroup analysis showed no clinical benefit from surgical resection when the tumor size exceeded 10.0 cm. Conclusions:It was suggested that surgical resection could improve the OS and CSS of patients with CNLC-Ⅱ hepatocellular carcinoma.

Time between Diagnosis and Treatment of Hypopharynx and Larynx Cancer: Are Longer Delays Associated with Higher Discrepancy between Clinical and Pathological Staging?

Abstract Introduction At the time of diagnosis, treatment strategies for cancer are largely based upon clinical staging. However, discrepancy between clinical and pathological staging has been reported. Objective To assess the rate of staging discrepancy in Laryngeal and Hypopharyngeal Squamous Cell Carcinoma (LHSCC), the potential influence of higher interval of time from diagnosis to primary surgical treatment, and whether this has any impact on survival outcomes. Methods Retrospective study of patients with LHSCC proposed for primary surgical treatment. Results The study population included 125 Caucasian patients with LHSCC. The level of agreement between clinical and pathological tumor staging was moderate (Cohen's Kappa: 0.400; p < 0.001) and similar result was found for node staging (Cohen' Kappa: 0.520; p < 0.001). The mean time between diagnosis and surgical treatment was 26.66 days and no statistically significant influence was found with staging discrepancy. The sample presented a 5-year Overall Survival (OS) of 58.2% and a Disease-specific survival (DSS) of 72.6%. No statistically significant impact of staging discrepancy on survival was found. Conclusion For advanced LHSCC, based on the findings of physical examination, endoscopy and imaging, is possible to achieve a moderate accuracy between clinical and pathological staging which allows a reliable counselling and treatment planning. Interval of time under 3-4 weeks between diagnosis and surgical treatment does not influence the rate of discrepancy. However, almost 30% of staging discrepancy is expected due to false negatives of imaging and limitations of physical exams.

Aspectos tomográficos e histológicos en pacientes con neoplasia exocrina de páncreas / Tomographic and histologic aspects in patients with pancreas exocrine neoplasm

Introducción: El cáncer de páncreas se origina en la glándula pancreática y es una de las neoplasias más invasivas debido a su rápida diseminación, la falta de síntomas específicos en sus inicios y su diagnóstico tardío. Objetivo: Caracterizar a pacientes con cáncer de páncreas según variables de interés. Métodos: Se efectuó un estudio observacional, descriptivo y transversal en el Servicio de Imagenología del Hospital Provincial Clinicoquirúrgico Docente Saturnino Lora de la provincia de Santiago de Cuba, desde enero de 2013 hasta diciembre de 2017, de 70 pacientes con diagnóstico tomográfico sugestivo de dicha neoplasia maligna. Resultados: En la serie el tumor exocrino pancreático primó en pacientes mayores de 60 años de edad (37,1 %), del sexo masculino (54,2 %) y de la raza mestiza (61,4 %). El diagnóstico histológico predominante fue el de adenocarcinoma ductal poco diferenciado (47,2 %), en tanto, los factores de riesgo mayormente asociados al proceso neoplásico fueron las comidas grasas (68,6 %), el tabaquismo (61,4 %) y el alcoholismo (50,0 %), y el antecedente patológico personal más frecuente, la diabetes mellitus (37,1 %). Conclusiones: La tomografía axial computarizada proporciona una descripción detallada de las neoplasias pancreáticas y su extensión, lo cual es de gran utilidad para la estadificación de estas y, además, determina la conducta terapéutica a seguir.

Introduction: The pancreas cancer originates in the pancreatic gland and it is one of the more invasive neoplasms due to its quick dissemination, lack of specific symptoms in its beginnings and its late diagnosis. Objective: To characterize patients with pancreas cancer according to variables of interest. Methods: An observational, descriptive and cross-sectional study was carried out in the Imaging Service of Saturnino Lora Teaching Provincial Clinical Surgical Hospital in Santiago de Cuba, from January, 2013 to December, 2017 to 70 patients with suggestive tomographic diagnosis of this malignancy. Results: In the series the pancreatic exocrine tumor prevailed in patients older than 60 years (37.1 %), the male sex (54.2 %) and mixed race (61.4 %). The predominant histologic diagnosis was the ductal adenocarcinoma hardly differentiated (47.2 %), as long as, the risk factors mostly associated with the neoplasm were fatty foods (68.6 %), nicotine addiction (61.4 %) and alcoholism (50.0 %), and the most frequent personal pathological history was diabetes mellitus (37.1 %). Conclusions: The computerized axial tomography provides a detailed description of the pancreatic neoplasms and their extension, which is very useful for the staging of these malignancies and, also, it determines the therapeutic behavior we should follow.

Preoperative Serum CA 125 is Associated With Myometrial and Cervical Invasion in Endometrial Carcinoma

@#Introduction: Endometrial carcinoma is the most common gynaecological malignancy in developed countries and the sixth most common cancer among women worldwide. Cancer staging is vital in treatment decisions and the prediction of prognoses, and is based on imaging studies, histological results and surgery. Therefore, a simple and fast preoperative tool to predict the precise cancer stage of patients is needed. CA 125, a cancer antigen, is used in assessing therapeutic response and cancer surveillance in endometrial carcinoma. However, this tumour marker is not routinely performed in the mentioned circumstances. Studies have shown that preoperative CA 125 was significantly high in patients in a higher stage of endometrial cancer. Thus, this study aims to assess the primary role of CA 125 in predicting the stage of endometrial carcinoma, by correlating preoperative serum CA 125 with clinicopathological parameters. Method: The retrospective data of endometrial carcinoma cases consisting of demographic and clinicopathological parameters as well as preoperative serum CA 125 levels were retrieved from Laboratories Information System (LIS) at Hospital Selayang, Selangor, Malaysia, from January 2000 until June 2016. Only 20 cases fulfilled the inclusion and exclusion criteria. Preoperative serum CA 125 was correlated with demographic and clinicopathological parameters, and was analysed using a Kruskal-Wallis test. Results: There was a significant association between elevated serum CA 125 with myometrial and cervical stroma invasion in endometrial carcinoma (p<0.05). Conclusion: Preoperative serum CA 125 is a useful marker in predicting early stages of endometrial carcinoma, and plays a role in pre-operative cancer staging in endometrial carcinoma.

BREAST CANCER SURVIVAL IN A BRAZILIAN CANCER CENTER: A COHORT STUDY OF 5, 095 PATIENTS / Sobrevida do câncer de mama em um centro de câncer brasileiro: um estudo de coorte de 5. 095 pacientes

Objectives: To describe the age group, clinical stage at diagnosis, treatment, and survival rates of breast cancer patients treated in a Brazilian specialized Cancer Center. Method: A hospital-based retrospective cohort study is presented herein, on women with breast cancer diagnosed between January 1, 2000 and December 31, 2012. Data were extracted from the Hospital Cancer Registry of the A.C.Camargo Cancer Center. Data on age group, histology of the tumor, TNM classification, clinical stage and treatments were described in absolute and relative frequencies for three periods. Survival curves were estimated with the Kaplan-Meier estimator. Hazard ratio (HR) and 95% confidence interval (95%CI) were calculated for all variables. Results: A total of 5,095 female breast cancer patients were identified, with most stages classified as I and II (60%). The overall survival was 82.7% for the period of 2000­2004, and 89.9% for 2010­2012 (p<0.001). Patients with invasive ductal carcinoma, who were treated with surgery and hormonal therapy, showed a reduction in the risk of death in the most recent period HRadj=0.42 (95%CI 0.34­0.53) (2010­2012). Conclusions: Early stage diagnosis and combined treatment (including HT) are predictive prognostic factors for high survival rates in patients with invasive breast cancer. Specialized cancer centers can provide valuable indications regarding cancer control policies, evaluating overall survival for breast cancer and its associated prognosis.

Objetivos: Descrever as faixas etárias, estadiamento clínico ao diagnóstico, tratamento e sobrevida global das pacientes com câncer de mama tratadas em um centro de câncer brasileiro. Método: Estudo de uma coorte retrospectiva de base hospitalar, com mulheres diagnosticadas de câncer de mama entre 1º de janeiro de 2000 e 31 de dezembro de 2012. Os dados foram extraídos do Registro Hospitalar de Câncer do A. C. Camargo Cancer Center. Faixa etária, tipo histológico, classificação TNM, estadiamento clínico e tratamento foram descritos em frequência absoluta e relativa estratificados em três períodos. As curvas de sobrevida global foram estimadas pelo método de Kaplan-Meier. A Hazard ratio (HR) com intervalo de confiança de 95% foram calculados para todas as variáveis. Resultados: O total de 5.095 pacientes mulheres com câncer de mama foi identificado, a maioria era estágio inicial 60% (I e II). A sobrevida global foi de 82,7% para o período de 2000­2004 e 89,9% para 2010­2012 (p<0,001). Pacientes com carcinoma ductal invasivo que foram tratadas com cirurgia e hormonioterapia, mostraram redução do risco de morte no período mais recente HRaj=0,42 (0,34­0,53 em 2010­2012). Conclusões: Diagnóstico precoce e tratamento combinado (incluindo hormonioterapia) são fatores prognósticos preditivos para altas taxas de sobrevida em pacientes com câncer de mama invasivo. Centros especializados em câncer podem prover informações valiosas sobre as políticas de controle do câncer, avaliando a sobrevida global do câncer de mama e fatores associados ao prognóstico.

A Proposal for Modification of the Barcelona Clinic Liver Cancer Staging System Considering the Prognostic Implication of Performance Status

BACKGROUND/AIMS: Barcelona Clinic Liver Cancer (BCLC) C stage demonstrates considerable heterogeneity because it includes patients with either symptomatic tumors (performance status [PS], 1–2) or with an invasive tumoral pattern reflected by the presence of vascular invasion (VI) or extrahepatic spread (EHS). This study aimed to derive a more relevant staging system by modification of the BCLC system considering the prognostic implication of PS. METHODS: A total of 7,501 subjects who were registered in the Korean multicenter hepatocellular carcinoma (HCC) registry database from 2008 to 2013 were analyzed. The relative goodness-of-fit between staging systems was compared using the Akaike information criterion (AIC) and integrated area under the curve (IAUC). Three modified BCLC (m-BCLC) systems (#1, #2, and #3) were devised by reducing the role of PS. RESULTS: As a result, the BCLC C stage, which includes patients with PS 1–2 without VI/EHS, was reassigned to stage 0, A, or B according to their tumor burden in the m-BCLC #2 model. This model was identified as the most explanatory and desirable model for HCC staging by demonstrating the smallest AIC (AIC=70,088.01) and the largest IAUC (IAUC=0.722), while the original BCLC showed the largest AIC (AIC=70,697.17) and the smallest IAUC (IAUC=0.705). The m-BCLC #2 stage C was further subclassified into C1, C2, C3, and C4 according to the Child-Pugh score, PS, presence of EHS, and tumor extent. The C1 to C4 subgroups showed significantly different overall survival distribution between groups (p<0.001). CONCLUSIONS: An accurate and relevant staging system for patients with HCC was derived though modification of the BCLC system based on PS.

The predicting value of the 8th edition of American Joint Committee on Cancer staging manual in mucinous breast cancer / 中华肿瘤杂志

Objective@#The current study aimed to evaluate the predictive performances of anatomic staging system (AS) and prognostic staging system (PS) proposed in the 8th edition American Joint Committee on Cancer (AJCC) staging manual in patients with pure mucinous breast cancer (PMBC).@*Methods@#Clinicopathologic features and follow-up information were collected from a total of 3628 patients with PMBC. Breast cancer-specific survival (BCSS) were compared among patients in different stage groups. Likelihood ratio (LR) χ2, Akaike information criterion (AIC) and Harrell′s concordance index (C-index) were used to evaluate the predictive performances of AS and PS in PMBC.@*Results@#In PMBC, BCSS was associated with tumor size (P=0.002), lymph node status (P=0.002), grade(P=0.003), PR status(P=0.017)and the receipt of radiation. Compared to AS, 1326 patients (37.54%) underwent stage change after applying PS, with 6.50% upstaged and 37.04% downstaged. There were significant differences in BCSS among patients of different stages under the AS and PS (P<0.001). However, PS was not superior to AS in predicting prognosis (AS vs PS, LR χ2: 16.41 vs 17.5; AIC: 357.44 vs 358.35; C-index, 0.72 vs 0.73, P=0.667).@*Conclusions@#Both of AS and PS proposed in the 8th edition American Joint Committee on Cancer (AJCC) staging manual were predictive factors in patients with PMBC. Compared with AS, the PS did not show superiority in prognosis prediction among patients with PMBC.

Paranasal Sinus Invasion in Nasopharyngeal Carcinoma after Intensity-Modulated Radiotherapy / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The aim of this study is to evaluate the prognostic significance of paranasal sinus invasion for nasopharyngeal carcinoma (NPC) and its suitable position in the T classification. MATERIALS AND METHODS: The magnetic resonance imaging (MRI) scans of 695 patients with previously untreated, biopsy-proven, non-metastatic NPC that was treated with intensity-modulated radiotherapy (IMRT) were reviewed retrospectively. RESULTS: The incidence of paranasal sinus invasion was 39.4% (274 of 695 patients). Multivariate analysis showed that paranasal sinus invasion was an independent negative prognostic factor for local failure-free survival (LFFS) (p < 0.05). According to the eighth American Joint Committee on Cancer (AJCC) staging system, 275 patients were classified as T3 classification. Of these, 78 patients (28.4%) developed paranasal sinus invasion (T3b) and 197 (71.6%) didn't (T3a). The estimated 5-year LFFS and overall survival (OS) rates for the patients with T3b and T3a classification were 88.6% versus 95.0% (p=0.047), and 84.5% versus 93.3% (p=0.183), respectively. The estimated 5-year LFFS and OS rates for the patientswith T4 classificationwere 89.5% and 83.2%,whichwere similarwith the outcomes of patients with T3b classification. CONCLUSION: MRI-determined paranasal sinus invasion is an independent prognostic factor of NPC treated by IMRT. Paranasal sinus invasion is recommended to classify as T4 classification in the 8th AJCC staging system for NPC.

Linfadenectomía paraaórtica extraperitoneal por laparoscopia como método clasificatorio en pacientes con diagnóstico de carcinoma de cérvix localmente avanzado: reporte de casos / Laparoscopic extraperitoneal para-aortic lymphadenectomy as a classification method in locally advanced cervical cancer: Report of a series of cases

Resumen Describimos la experiencia quirúrgica de diez pacientes sometidas a linfadenectomía paraaórtica extraperitoneal laparoscópica (LPEL) para clasificación en carcinoma de cérvix localmente avanzado (CCLA) y revisión de la literatura. Métodos: Búsqueda de literatura en MEDLINE y EMBASE usando palabras clave: "Uterine Cervical Neoplasms; Neoplasm Staging; Lymph Nodes; Lymph Node Excision; Laparoscopy; extraperitoneal''. Describimos la técnica quirúrgica para LPEL y resultados obtenidos en 10 pacientes intervenidas. Resultados: Diez pacientes con CCLA fueron sometidas a LPEL, rango de edad entre 29 y 65 años, sangrado operatorio entre 5 y 30cc, recuento ganglionar entre 2 y 11 ganglios; no complicaciones intraoperatorias y estancia hospitalaria entre uno y tres días. Conclusión: Es la primera experiencia reportada de LPEL para el CCLA en Colombia, siendo un procedimiento factible, seguro y útil para identificar compromiso paraaórtico adaptando el tratamiento.

Abstract A description is presented on the surgical experience of 10 patients who underwent laparoscopic extraperitoneal para-aortic lymphadenectomy (LEPL) in order to classify locally advanced cervical carcinoma (LACC), as well as a literature review. Methods: A literature search was performed in MEDLINE and EMBASE using the following keywords:''Uterine Cervical Cancer; Cancer Staging; Lymph Nodes; Lymph Node Excision; Laparoscopy; extraperitoneal''. The surgical technique for LEPL is described, as well as the outcomes of the 10 patients who underwent surgery. Results: A total of 10 patients, with ages between 29 and 65 years and with LACC underwent LPEL. There were surgical blood losses between 5 to 30 cc, a lymph node count between 2 and 11, no surgical complications, and a hospital stay of between 1 and 3 days. Conclusion: This is the first experience reported for LPEL for LACC in Colombia. It is a safe, feasible, and useful procedure to identify para-aortic involvement.

Observaciones críticas en torno al ganglio centinela en el cáncer colorrectal / Critical observations about the sentinel lymph node in colorectal cancer

Introducción: La identificación del ganglio centinela durante el tratamiento quirúrgico del cáncer colorrectal puede ayudar a la correcta estadificación posoperatoria y trascender a la quimioterapia adyuvante en el seguimiento a fin de mejorar la supervivencia de estos enfermos. Objetivo: Identificar las técnicas utilizadas para detectar el ganglio centinela mediante acceso convencional o laparoscópico: tinción o radiotrazador, ex vivo o in vivo así como su influencia en la estadificación posoperatoria y en el tratamiento adyuvante correlacionado con la evolución del cáncer de colon. Material y Métodos: Revisión documental en formato electrónico e impreso de publicaciones actualizadas sobre el tema. Desarrollo: El estudio de los linfáticos supone el factor pronóstico más importante en el cáncer colorrectal sin metástasis. La detección del ganglio centinela es la técnica que mejor predice el estado ganglionar de un paciente y permite realizar estudios intensivos que mejoran la estadificación. Conclusiones: El estudio del ganglio centinela es una práctica reproducible sin aumento significativo del tiempo y costos. En el seguimiento de los enfermos clasificados N0 con ganglio centinela positivo parece haber tendencia a un porcentaje mayor de recidivas, lo que podría trascender a cambios en las pautas de tratamiento adyuvante en aras de mejorar la supervivencia(AU)

Introduction: The identification of the sentinel lymph node during surgical treatment of colorectal cancer can help the correct postoperative staging and go beyond adjuvant chemotherapy in the follow-up of patients with the aim to improve survival of these sick people. Objective: To identify the techniques used to detect the sentinel lymph node through either conventional or laparoscopic approach: staining or radiotracer ex vivo or in vivo, as well as its influence in postoperative staging and the adjuvant treatment correlated with the evolution of colon cancer. Material and Methods: Document review of up-to-date publications about the topic in both electronic and printed formats. Development:The study of lymphatics is considered the most important prognostic factor in the colorectal cancer without metastases. The detection of the sentinel node is the technique that best predicts the lymph node status in a patient, and allows to conduct intensive studies to improve staging. Conclusions:The study of the sentinel lymph node is a reproducible practice without a significant increase in time and costs. The follow-up of patients classified as NO with a positive sentinel lymph node seems to have a tendency to a higher percentage of relapses, which could go beyond changes in the adjuvant treatment guidelines aimed at improving survival(AU)

Early Detection is Important to Reduce the Economic Burden of Gastric Cancer

PURPOSE: Early detection of gastric cancer is important to improve prognosis. Early detection enables local treatment, such as endoscopic submucosal dissection (ESD). Therefore, we investigated whether early detection of gastric cancer could reduce healthcare costs by comparison according to stage and treatment modalities. MATERIALS AND METHODS: Medical care costs were investigated according to tumor stage and initial treatment modality in 1,188 patients newly diagnosed with gastric cancer at 7 medical institutions from December 2011 to June 2012. Total medical care costs during the first-year after diagnosis (total first-year costs) were examined, including the costs of initial treatment, post-initial treatment, and inpatient and outpatient visits. RESULTS: Stage I (75.3%) was the most common cancer stage. ESD was the second most common treatment following surgery. Total first-year costs increased significantly from stages I to IV. The costs of initial treatment and post-initial treatment were lowest in patients with stage I cancer. Among patients with stage I cancer, total first-year costs were significantly lower when treated by ESD; in particular, initial ESD treatment costs were much lower than others. CONCLUSIONS: The cost of healthcare has increased significantly with increasing cancer stages. ESD can greatly reduce medical care costs of gastric cancer. Thus, early detection of gastric cancer is important to reduce healthcare costs.

Utilidad de la resonancia magnética en la estadificación pre operatoria del cáncer de endometrio / Utility of magnetic resonance in preoperative staging of endometrial cancer

Objetivo: Evaluar la utilidad de la Resonancia Magnética (RM) para valorar la infiltración tumoral miometrial y del cérvix en el carcinoma de endometrio. Pacientes y métodos: Se evaluaron retrospectivamente los estudios de RM de 26 pacientes con diagnóstico histológico por biopsia de cáncer de endometrio. Se realizó estadificación prequirúrgica y correlación con la estadificación histológica de la pieza operatoria. Se estudió la concordancia, sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y valor predictivo negativo (VPN) del método, para la profundización del tumor en el espesor miometrial y la invasión del cérvix. Se analizaron las posibles causas de sobrestimación e infraestimación. Resultados: En la evaluación por RM para la infiltración miometrial por estadío e invasión del cérvix se obtuvieron: S de 72,2%, 75%, 66,7%, E de 75%, 72,2%, 95,7%, VPP de 86,7%, 54,5%, 66,7%, VPN de 54,5%, 86,7%, 95,7% (para estadios IA, IB y II respectivamente). Se sobrestimaron 5 casos para infiltración miometrial y 1 para el cérvix, se infraestimaron 2 casos para infiltración miometrial y 1 caso para el cérvix. Se encontró una concordancia moderada para estadio I y buena para estadio II. Conclusión: La RM es una herramienta útil para la estadificación prequirúrgica del carcinoma de endometrio con una fiabilidad moderada a buena, lo que sumado al tipo y grado histológico ayuda a determinar la estrategia terapéutica.

Objective: Evaluate the usefulness of Magnetic Resonance Imaging (MRI) in order to assess myometrial and cervical tumor infiltration in endometrial carcinoma. Patients and Methods: A retrospective review of 26 patient's MRI studies with histological confirmation of endometrial cancer was conducted (diagnosis by endometrial cancer biopsy). Pre-surgical staging and correlation with the histological staging of the operative piece was performed. Concordance, sensitivity (S), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) of the method for the deepening of the tumor in the myometrial thickness and the invasion of the cervix were studied. The possible causes of overestimation and underestimation were analyzed. Results: MRI evaluation for the myometrial infiltration by stage and cervix invasion generated these results: S of 72.2%, 75%, 66.7%, SP of 75%, 72.2%, 95.7%, PPV of 86.7%, 54.5%, 66.7%, NPV of 54.5%, 86.7%, 95.7% (for stages IA, IB and II respectively). Five cases were overestimated for myometrial infiltration and 1 for the cervix; 2 cases were underestimated for myometrial infiltration and 1 case for the cervix. A moderate concordance was found for stage I and a good concordance for stage II. Conclusion: MRI is a useful tool for pre-surgical staging of endometrial carcinoma with a moderate to good reliability, which added to the type and histological grade, helps to determine the most appropriate therapeutic strategy.

Accuracy of detection rate and intraoperative sentinel lymph node assessment in early-stage cervical carcinoma

Objective: This study was aimed at evaluating the usefulness of paired box-2 gene (PAX-2) in the diagnosis of renal tumors. Materials and Methods: This study included 60 renal tumors. The newly prepared hematoxylin and eosin stained slides of all cases were evaluated and the diagnoses were confirmed or revised for each tumor according to the 2004 World Health Organization classification of renal tumors. Representative and consecutive sections of each tumor were submitted for anti-PAX-2 antibody immunohistochemistry. The pattern of staining (nuclear or cytoplasmic) was also noted. PAX-2 expression in tumors was correlated with low- and high-nuclear grades (Fuhrman nuclear grades). Results: The 45/60 (75%) cases showed PAX-2 nuclear immunoexpression. The frequency of positivity in renal tumors was seen in 29/34 (85.5%) and 12/15 (80%) cases of clear cell RC, papillary RCC, respectively. The PAX-2 was positive in 20/45 cases for score 1+. The 16/45 cases were categorized into score 2+, and 9/45 cases were categorized into score 3+. Conclusion: PAX-2 is a diagnostically useful marker for primary renal tumors and is inversely proportion to the grades of the renal tumor.

Hepatectomy combined with splenectomy in patients with hepatocellular carcinoma with Barcelona Clinic Liver Cancer Stage A and portal hypertension / 中华肝胆外科杂志

Objective To evaluate the peri-operative and survival outcomes of hepatectomy combined with splenectomy in patients with hepatocellular carcinoma with Barcelona Clinic Liver Cancer Stage A and portal hypertension.Methods We retrospectively analyzed the data on patients with hepatocellular carcinoma with Barcelona Clinic Liver Cancer Stage A and portal hypertension who underwent surgery at the Shengli Oilfield Central Hospital between July 2008 and June 2015.According to the operative method,the patients were classified as the experimental group (hepatectomy combined with splenectomy) and the control group (hepatectomy).We compared and analyzed the clinical data between these two groups,which included the operation time,blood loss,duration of hepatic portal occlusion,width of surgical resection margin,liver function,PLT,HBV reactivation,time to remove drainage tube,complications,upper gastrointestinal hemorrhage rate and survival outcomes.Results (1) The operation time,blood loss,PLT at 1 week and 1 month after surgery in the experimental group were all significantly higher than the control group [(161.4 ± 38.3) min vs.(119.2±36.4) min,(268.7±72.1) vs.(201.3±61.3) ml,(189.2±51.3) ×109/L vs.(81.9±32.2) ×109/L,(327.4±69.1) ×109/L vs.(84.5±28.5) × 109/L (all P＜0.05),respectively].The time to remove drainage tube,duration of hepatic portal occlusion,width of resection surgical margin,TBil,complications and upper gastrointestinal hemorrhage rates of the two groups were not significantly different (all P ＞ 0.05).The HBV reactivation rate,ALT and AST in the experimental group were significantly lower than the control group [3.9％ (2/51) vs.18.2％ (12/66),(45.7 ± 11.4) U/L vs.(58.3±14.7) U/L,(48.1±12.4) U/Lvs.(61.3±15.1) U/L (allP＜0.05),respectively].(2) The 1,3 and 5-year recurrence free survival rates were not significantly different between the experimental and control groups [84.3 ％,34.1％,27.3 ％ vs.78.8 ％,42.1％,9.7 ％ (all P ＞ 0.05),respectively].The 1,3 and 5-year overall survival rates in the experimental Group were significantly higher than the control group [94.1％,66.3 ％,33.5 ％ vs.90.9％,46.7％,16.1％ (all P ＜ 0.05),respectively].Conclusion Combined liver and spleen resection was a safe and efficacious modality to treat patients with BCLC A hepatocellular carcinoma,which reduced the incidence of HBV reactivation and improved the overall survival.

Analysis of stage and clinical pathological characteristics of invasive lobular carcinoma with the 8th AJCC Cancer Staging system / 国际外科学杂志

Objective To study the meaning of breast cancer staging system by AJCC eighth edition to invasive lobular carcinoma and analysis the clinical pathological characteristics.Methods According to the eighth edition of the AJCC staging to evaluate the TNM stage and prognosis evaluation of invasive lobular carcinoma cancer patient in Peking University Shenzhen Hospital from 2011 to 2016,and compared with others in clinical pathological data.Results There were 21 cases of invasive lobular carcinoma,accounting for 2.7％ of all invasive breast cancer.We found that invasive lobular carcinoma shows no significant difference (P ＞ 0.05) in ages,menstrual status,molecular features and anatomic staging and prognosis staging with others;histological grade were significantly different (P ＜ 0.05).There were significant differences in the prognosis and staging of invasive lobular carcinoma.Conclusions Eighth AJCC staging systemn provides a new reference for the clinical treatment of breast cancer,should be evaluated with anatomic stage.Histological grade is relatively good in invasive lobular carcinoma and the prognosis is good,needs more research to the individualized treatment of invasive lobular carcinoma.

Correlation between serum homocysteine and the staging of gastric cancer / 中国现代普通外科进展

Objective:To study the correlation between serum homocysteine (Hcy) and the staging of gastric cancer,by comparing the concentrations of patients with gastric cancer at different pathological staging.Methods:90 patients with benign gastric diseases and 138 patients with gastric cancer were selected and admitted by Shandong University Qilu Hospital during the date from Mar 2014 to Jun 2015.The patients with gastric cancer were divided into 4 groups,according to the 7th AJCC Cancer Staging.To compare the difference of the concentration levels of Hcy and Tumor marks in different groups and analyze the relationship between benign disease and gastric cancer,and analyze it correlation with different pathological stagings of gastric cancer.Enzymatic cycling assay was used for detecting serum Hcy.Results:The serum Hcy concentration level in benign disease was (1 2.31 ± 3.22) μ mol/L,and significantly lower than cancer group(1 6.19 ± 4.84) μ mol/L,the difference was statistically significant (P＜0.05):The serum Hcy concentration levels increased gradually from staging I to staging Ⅳ,and the concentration level in staging Ⅰ was (13.94 ± 4.07) μ mol/L,in staging Ⅱ was (15.49 ± 4.09) μ mol/L,in staging Ⅲ was (17.10 ± 4.79) μ mol/L,in stagingⅣ was (19.81 ± 5.77) μ mol/L,the differences among the four groups were statistically significant(P＜0.05).Spearman Rank Correlation analysis confirmed that,the Hcy concentration level was positively related with pathological staging(r=0.503,P＜ 0.001).Logistic regression analysis showed that,the serum Hcy concentration level is significantly correlated with gastric cancer,after the adjustment of other risk factors (OR=1.208,P=0.003).Conclusions:The serum Hcy concentration level is closely correlated with gastric cancer staging,and increase significantly with the cancer staging (from staging Ⅰ to staging Ⅳ),so itcan be used to evaluate the severity of gastric cancer.

Clinical value of liver cancer staging in predicting the survival time in Chinese patients after receiving TACE: comparison of Hong Kong liver cancer staging system with Barcelona clinic liver cancer staging system / 介入放射学杂志

Objective To compare the prognostic ability of Hong Kong Liver Cancer (HKLC) staging system with that of Barcelona Clinic Liver Cancer (BCLC) staging system for Chinese patients with hepatocellular carcinoma (HCC) after receiving transarterial chemoembolization (TACE).Methods The clinical data of 180 Chinese patients with primary HCC,who were treated with TACE during the period from August 2008 to December 2015,were retrospectively analyzed.HCC staging of each patient was scored by two staging methods separately.Kaplan-Meier analysis was adopted to separately calculate the median survival time of each stage that was judged by the two staging methods.The likelihood ratio (LR) x2 values,the Akaike information criterion (AIC) value and Harrell's C value of the two staging methods were calculated.Results Statistically significant differences in the survival time of each period existed between the two staging systems.AIC value,LRx2 value and Harrell's C value of HKLC staging system were 1360,66.6,and 0.813 respectively,while those of BCLC staging system were 1365,61.8,and 0.772 respectively.Conclusion Compared with BCLC staging,HKLC staging is more suitable for predicting the survival time of Chinese patients with primary liver cancer treated with TACE.

Differences in clinical features between hepatitis B virus positive and negative patients with primary liver cancer / 中华肝胆外科杂志

Objective To investigate the differences in clinical features between primary liver cancer (PLC) patients with positive and negative hepatitis B virus (HBV) and discuss the correlation of positive HBV and TNM staging.Methods Clinicopathological data of 430 patients with primary liver cancer who underwent partial hepatectomy in Henan Cancer Hospital from November 2012 to December 2015 were retrospectively reviewed.The cases were divided into HBV-positive PLC group (n =362) and HBV-negative PLC group (n =68) in according to the HBV infection status.x2 test was performed to analyze the clinical feature differences of the two groups.Spearman rank correlation was used to assess the differential clinical features and TNM staging of HBV-positive PLC.Results There were statistic differences in gender,age,AFP level,tumor numbers,tumor size,histopathological types and TNM staging between two groups (P ＜0.05).Furthermore,AFP level,tumor numbers,tumor size and histopathological types showed positive correlation with TNM staging (all P ＜ 0.05).Conclusions A number of remarked differences in clinical feature of gender,age,AFP level,tumor numbers,tumor size,histopathological types and TNM staging could be observed in HBV-positive PLC patients compared with HBV-negative patients.HBV-positive PLC patients may have positive correlations of AFP level,tumor numbers,tumor size,histopathological types and TNM staging.

Extensive Lymph Node Dissection Improves Survival among American Patients with Gastric Adenocarcinoma Treated Surgically: Analysis of the National Cancer Database

INTRODUCTION: The extent of lymphadenectomy in the surgical treatment of gastric cancer is a topic of controversy among surgeons. This study was conducted to analyze the American National Cancer Database (NCDB) and conclude the optimal extent of lymphadenectomy for gastric adenocarcinoma. METHODS: The NCDB for gastric cancer was utilized. Patients who received at least a partial gastrectomy were included. Patients with metastatic disease, unknown TNM stages, R1/R2 resection, or treated with a palliative intent were excluded. Joinpoint regression was used to identify the extent of lymphadenectomy that reflects the optimal survival. Cox regression analysis and Bayesian information criterion were used to identify significant survival predictors. Kaplan-Meier was applied to study overall survival and stage migration. RESULTS: 40,281 patients of 168,377 met the inclusion criteria. Joinpoint analysis showed that dissection of 29 nodes provides the optimal median survival for the overall population. Regression analysis reported the cutoff ≥29 to have a better fit in the prognostic model than that of ≥15. Dissection of ≥29 nodes in the higher stages provides a comparable overall survival to the immediately lower stage. Nonetheless, the retrieval of ≥15 nodes proved to be adequate for staging without a significant stage migration compared to ≥29 nodes. CONCLUSION: The extent of lymphadenectomy in gastric adenocarcinoma is a marker of improved resection which reflects in a longer overall survival. Our analysis concludes that the dissection of ≥15 nodes is adequate for staging. However, the dissection of 29 nodes might be needed to provide a significantly improved survival.