Treatment of gallbladder carcinoma invading porta hepatis with the conventional surgery approach and the transhepatic hilar approach: A retrospective comparative study / 中国实用外科杂志

OBJECTIVE: To evaluate the clinical efficacy of transhepatic hilar approach exposing porta hepatis for the treatment of gallbladder carcinoma invading porta hepatis. METHODS: The clinicopathological data of patients with gallbladder carcinoma invading porta hepatis who underwent surgical treatment at Department of General Surgery and Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University from January 2007 to December 2017 was collected. There were 39 patients enrolled in the study, including 19 patients in the conventional surgical approach group and 20 patients in the transhepatic hilar approach group. The R0 resection, intraoperative bleeding, postoperative complications and overall survival time were compared between the conventional approach group and the transhepatic hilar approach group. RESULTS: CT and/or MRI were used for preoperative evaluation in the conventional approach group, and CT + MRI + 3 D reconstruction were used in the transhepatic hilar approach group.The accuracy rate of preoperative resectable evaluation was 57.9%(11/19) in the conventional approach group, and 90.0%(18/20) in the transhepatic hilar approach group(P=0.031). The R0 resection rate of the conventional approach group was 26.3%(5/19), while the R0 resection rate of transhepatic hilar approach group was 85.0%(17/20)(P=0.000). The operations of the conventional approach group and the transhepatic hilar approach group were shown as follow: S4 b,5 + extrahepatic bile duct (7/8), S4 b,5,6,7,8 + extrahepatic bile duct (3/6), S4 a,4 b,5,6,7,8 +extrahepatic bile duct (0/1), extended resection(1/3) and others (8/2)(P= 0.156). The number of death within 30 days after surgery in the conventional approach group and the transhepatic hilar approach group was 4 and 0 respectively (P=0.047). Among the hepatectomy patients, the blood loss in the conventional approach group was significantly higher than that in the transhepatic hilar approach group [(660 ± 219.1)mL vs.(358.8 ± 184.8)m L,P=0.006]. The postoperative complication rate of Clavien Ⅲ to Clavien Ⅴwas significantly higher in the conventional approach group [Clavien Ⅲ was72.7% vs. 27.8% (P=0.027), Clavien Ⅳ was 45.5% vs. 0 (P=0.004), and Clavien Ⅴ was 27.3% vs. 0(P=0.045)]. The 1-year survival rate of the conventional approach group and the transhepatic hilar approach group was 21.1%(4/19) and61.1%(11/18)(P=0.020), respectively. The overall survival time of the transhepatic hilar approach group was significantly better than that of the conventional approach group(16.0 months vs. 8.4 months, P=0.0005). CONCLUSION: The transhepatic hilar approach can improve the R0 resection rate, reduce intraoperative blood loss, perioperative mortality and serious complication rate, and improve the overall survival time. CT+MRI+3 D reconstruction can improve the accuracy of preoperative resectable evaluation and reduce unnecessary surgical exploration.

Effect of pantoprazole in tumor bleeding prevention in patients with unresectable gastric cancer: a randomized,double-blind, placebo-controlled clinical trial / 中国综合临床

Objective To investigate the effects of pantoprazole treatment in the prevention of gastric tumor bleeding in patients with unresectable gastric cancer. Methods This study was a prospective double-blind,randomized,placebo-controlled trial. From January 2014 to July 2015,patients with gastric tumor bleeding in Xuzhou Cancer Hospital were included in this study. 131 cases of unresectable gastric cancer were randomly divided into two groups. In the experimental group,66 cases were taken pantoprazole 40 mg,1 time / d,and 65 cases in the control group were given placebo 40 mg and 1 time/ d. The course of treatment was 8 weeks. The differences in tumor bleeding,blood transfusion requirements and overall survival time between the two groups were observed during the follow-up period. Results The median follow-up time was 6. 5 ( 3. 3, 13. 2 ) months. Seven cases ( 10. 61%) in pantoprazole group had tumor bleeding, and 13 ( 20%) in the placebo group. There was no significant difference in cumulative risk of tumor bleeding between the two groups (Gray's test: P = 0. 426) . However,in the first 5 months of follow-up,the cumulative incidence of tumor bleeding in pantoprazole group was 0,lower than that in placebo group (9. 23%) (6/ 65) (Gray's test: P = 0. 039). There was no significant difference in blood transfusion requirement and overall survival between the two groups. No drug-related adverse reactions and bleeding related deaths occurred during the follow-up period. Conclusion Pantoprazole can not significantly reduce tumor bleeding in patients with unresectable gastric cancer.

Risk factors for the prognosis of pediatric medulloblastoma: a retrospective analysis of 40 cases

OBJECTIVES: In this study, we evaluated the association of molecular subtypes, clinical characteristics and pathological types with the prognosis of patients with medulloblastoma. METHODS: We analyzed forty patients with medulloblastoma who underwent surgical resection at our center between January 2004 and June 2014. Risk factors associated with survival, disease progression and recurrence were analyzed with a univariate Cox regression analysis, and the identified significant risk factors were further analyzed by Kaplan-Meier survival curves. RESULTS: Factors associated with overall survival included M stage (p=0.014), calcification (p=0.012), postoperative treatment, postoperative Karnofsky Performance Scale (KPS) score (p=0.015), and molecular subtype (p=0.005 for WNT and p=0.008 for SHH). Number of symptoms (p=0.029), M stage (p<0.001), and postoperative radiotherapy (p=0.033) were associated with disease progression. Patients with the WNT or SHH subtype had better survival outcomes than patients with non-WNT/SHH subtypes. Risk factors for disease progression-free survival were symptoms >2 and ≥M1 stage without postoperative radiotherapy. The risk of recurrence increased with advanced M stage. Protective factors for recurrence included M0 stage and a combination of chemotherapy and radiotherapy. CONCLUSION: We identified the risk factors associated with survival, disease progression and recurrence of medulloblastoma patients. This information is helpful for understanding the prognostic factors related to medulloblastoma.

Prognostic value of CEA and CA19-9 expression in peripheral blood of patients with advanced gastric cancer / 实用肿瘤学杂志

Objective The aims of this study were to investigate the prognostic value of CEA and CA19-9 expression in advanced gastric cancer and the prognostic factors of advanced gastric cancer.Methods A total of 255 patients with advanced gastric cancer who underwent radical R0 radical surgery were enrolled in the Department of Gastrointestinal Surgery,Harbin Medical University Cancer Hospital from January 2010 to December 2010,and were divided into group A(CEA0.05).The 1-year,3-year and 5-year survival rates of group A were higher than those of group B and group C(P>0.05).The factors affecting the prognosis of gastric cancer included the degree of tumor differentiation,pathological T staging,pathological TNM staging,the total number of lymph nodes,the number of positive lymph nodes and lymph node metastasis.Conclusion Combined detection of CEA and CA19-9 expression indicates a certain reference value for prognosis of gastric cancer.

Effects of prophylactic cranial irradiation and its different optional times on prognosis of limited-stage small cell lung cancer / 天津医药

Objective To observe the impact of the prophylactic cranial irradiation (PCI) and its different interventional times on the prognosis of patients with limited-stage small cell lung cancer (LSCLC) who received comprehensive therapy of complete response (CR). Methods A total of 184 LSCLC patients who received radiotherapy and chemotherapy based on comprehensive treatment were retrospectively analyzed. Patients were divided into two groups based on with or without PCI intervention. There were 50 patients (27.2%) in the PCI group and 134 patients (72.8%) in the non PCI group. The PCI group was subdivided into two groups, PCI1 group (n=20) and PCI2 group (n=30), according to whether patients completed 4 cycles of chemotherapy. Chemotherapy regimen, irradiation method and dose were identical for two groups. Results The brain metastasis rates were 14.0%and 30.6%for PCI group and non PCI group. There was significant difference in brain metastasis rate between the two groups (P<0.05). The median survival times were 25 months (95%CI:21.487-28.513) and 17 months (95%CI:15.175-18.825) for PCI group and non PCI group (P<0.05). The 1, 2 and 3-year survival rates were 54%, 36%, 15% and 37%, 18%, 13% for the two groups. There were no significant differences in brain metastasis rates between PCI1 group and PCI2 group (10.0% and 16.7%). There was no significant difference in median survival time between the two subgroups. Conclusion PCI can reduce the incidence of SCLC brain metastases, and prolong the overall survival time. However, different intervention times of PCI have no significant influence on the prognosis of LSCLC.

Analysis of prognostic factors and the effect of adjuvant radiother-apy and chemotherapy for liposarcoma of the extremities / 中国肿瘤临床

Objective:To analyze the clinical prognostic factors of liposarcoma on the extremities and trunk, as well as to retrospectively analyze the effect of adjuvant radiotherapy and chemotherapy on liposarcoma of the extremities. Methods:Patients with liposarcoma of the extremities treated in our hospital from July 1, 2007 to December 31, 2012 were followed up. The relationship of clinical prognostic factors with gender, age, location, depth, and size of the tumors, as well as the histological grade and admission status, were statistically analyzed. The effects of adjuvant radiotherapy or chemotherapy on overall survival (OS) and disease free survival (DFS) were evaluated. Results:A total of 82 patients with extremity liposarcoma received surgery-based comprehensive treatment in our hospital. Of the total patients, 73 received a 24-month to 88-month satisfied follow-up;the median follow-up time was 47 months. The OS rate was 83.6%(61/73), and the DFS rate was 68.5%(50/73). Multivariate Cox regression analysis showed that the tumor location, histological grade, and admission status were the independent correlative factors influencing DFS, and the age and pathologic grading were the independent correlative factors influencing the OS. Kaplan-Meier survival analysis showed that radiation therapy can significantly improve the DFS and OS of the G2 and G3-grade liposarcoma (DFS:59.1 months vs. 28.4 months, P<0.01;OS:70.8 months vs. 55.1 months, P<0.05). Significant difference was not found in the effect of chemotherapy on OS and DFS. Conclusion:The prognosis of liposarcoma was significantly associated with the pathologic grades and subtypes. Auxiliary radiotherapy could improve the survival and prognosis of G2 and G3 liposarcoma of the extremities, but the role of chemotherapy in treating liposarcoma remained unclear.

Relationship between RAD51 135G ＞ C polymorphism and prognosis in triple-negative breast cancer patients / 中华内分泌外科杂志

Objective To investigate the relationship between RAD51 135G ＞ C polymorphism and prognosis in triple-negative breast cancer patients by retrospective analysis.Methods The clinical data of 62 triplenegative breast cancer patients were collected.The 62 cases underwent standard chemotherapy and radiotherapy after tumor resection from Jan.2004 to Dec.2010 in Affiliated Cancer Hospital of Zhengzhou University.RAD51 135G ＞ C polymorphism was detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RELP) technology.The survival curve about progress free and overall survival time were then made.Results The median progress free and overall survival time in triple-negative breast cancer patients with or with-out RAD51 135G ＞ C polymorphism were(77.00 ±5.55)and(89.00 ± 10.40) months vs(99.00 ±4.26)and (103.00 ±4.30) months.The difference had statistical significance(P =0.039 and 0.015 respectively).Conclusion RAD51 135G ＞ C polymorphism is related with prognosis of triple-negative breast cancer patients,which might be a prognostic factor for breast cancer.

Liver microvessel density in evaluating therapeutic effect of sorafenib combined with argon-helium cryoablation in treatment of advanced hepatocellular carcinoma / 第二军医大学学报

Objective To investigate the therapeutic effect of argon-helium cryoablation combined with sorafenib on hepatitis B-related advanced hepatocellular carcinoma (HCC) and to evaluate the role of microvessel density (MVD) in prognostic evaluation. Methods A total of 102 patients with advanced HCC were randomly divided into two groups, with 50 receiving sorafenib plus cryoablation(group S&-C) and 52 receiving only cryoablation (group C). The endpoint of the treatment was tumor progression or untolerable adverse reaction. Tumor tissues were obtained before treatment. MVD was evaluated by immunohistochemical analysis using CD34 antibody. The therapeutic effects were evaluated according to RECIST criterion every 4-6 weeks. The adverse events were observed in both groups; the therapeutic effect, overall survival time (OS), and time to progression(TTP) were compared between two groups. Results In group ScV-C, complete response (CR) was achieved in 2 patients(4%), partial response (PR) in 9 (18%), and stable disease(SD) in 22(44%), with the disease control rate(DCR) being 66%; in group C. no CR, PR in 4(7. 6%), and SD in 19(36. 5%), with the DCR being 44. 2% (P<0. 05). The overall survival (OS) and the time to progression (TTP) were significantly longer in group S&-C than in group C (12. 5 months vs 8. 6 months, 9. 6 months vs 5. 3 months; P<0.01). The mean MVD in group CR&.PR (111/0.74 mm2) was significantly lower than that in group PD( 339/0. 74 mm2, P<0.01). Patients with lower MVD receiving sorafenib plus cryoablation had longer OS and TTP than those only receiving cryoablation. The OS and TTP in patients with higher MVD had no significant difference between different groups. Conclusion Sorafenib plus cryoablation is a safe and effective therapy for patients with advanced HCC; it can improve the OS and TTP of patients. Patients with higher MVD have a lower response to therapy and poor prognosis.