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Objective To observe the clinical effect of intensity modulated radiation therapy (IMRT) combined with apapatinib mesylate in the treatment of elderly patients with locally advanced cardia adenocarcinoma and its effect on vascular endothelial growth factor receptor (VEGFR). Methods Forty-six elderly patients with locally advanced cardia cancer who were unwilling to accept surgery or couldn't get complete removal of cancers in Xuzhou Hospital Affiliated to Jiangsu University between January 2015 and April 2016 were collected. All the patients were randomly divided into the control group (23 cases) and the observation group (23 cases) according to the random number table method. The control group received radiotherapy alone. In the observation group, oral apatinib (500 mg/d) was taken in the first day of radiotherapy after breakfast until the disease progress or death occurred. Results The total effective rate was 92 % (19/23) in the observation group and 60 % (10/23) in the control group. There was a significant difference between the two groups(χ2=5.86,P <0.05). After treatment, the average level of VEGFR in both groups was decreased[(76.3±4.9)vs.(55.0±2.3)pg/ml],and there was a significant difference between the two groups (t = 3.93, P < 0.05). The common adverse reactions were blood adverse reactions and gastrointestinal reactions. The incidence rate of gastrointestinal reaction was both 83 %, and the blood adverse reaction was 100 %, and there was no significant difference between the two groups (both P > 0.05). Hypertension, proteinuria and rash response in the observation group were increased compared with the control group,but noⅣ grade of adverse reactions occurred. The median progression-free survival time was 10 months in the observation group and 8 months in the control group respectively (P = 0.01). Conclusion IMRT combined with apatinib in the treatment of elderly patients with locally advanced gastric cardia has a favorable efficacy and tolerance.
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Objective To analyze the prognostic factors of patients with adenocarcinoma of gastroesophageal junction (AGEJ) after radical resection. Methods In this retrospective study, 269 patients with AGEJ who underwent curative resection from March 2004 to June 2007 were enrolled.The survival curve was drawn by Kaplan-Meier method and the survival analysis was done by Log-rank test. Univariate and multivariate analyses of the prognostic factors of AGEJ were made by Cox model. Results The overall 5-year survival rate of 269 patients was 25.0 % with the median survival time of 22 months.The Siewert type and the number of positive lymph nodes could influence the survival rate (both P < 0.05). Among the 269 patients, 216 (80.3 %) were Siewert Ⅱ type, their median survival time was 30 and 12 months in the thoracic surgery group and the laparotomy group when the tumor diameter was 3-7 cm, the difference was statistically significant (χ2= 5.036, P= 0.025). Univariate analysis showed that tumor diameter, pT, pN, operation time, age and sex were significantly associated with survival rate (all P < 0.05). Cox multivariate analysis showed that patients with a more advanced tumor size suffered from a poorer prognosis (P< 0.05). The risk of postoperative death in patients with lymph node metastasis was 1.854 times that of patients without lymph node metastasis. Conclusions Patients with AGEJ are predominantly Siewert Ⅱ type, the transthoracic approach or thoracoabdominal approach are reasonable selections for these patients. Tumor diameter and pN are independent prognostic factors of AGEJ patients.
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Objective To explore the relations among the promoter methylation of tissue inhibitor of metalloproteinase-3 (TIMP-3) gene and its protein expression, and the clinicopathological features in the gastric cardia carcinoma. Methods The tumor tissues and the adjacent normal mucosal tissues were collected from 65 patients with cardia carcinoma. The promoter methylation levels and the protein expression of TIMP-3 gene were detected by methylation-specific PCR (MSP) and immunohistochemistry respectively. Results The TIMP-3 methylation rates was 78.5 % (51/65) in the tumor tissues and 13.8 % (9/65) in the incisal edge of normal tissues, the methylation rates of TIMP-3 had positive correlation with the size of tumor, invasion depth, lymphatic metastasis and the stage of tumor. The protein expression of TIMP-3 was 26.2 %(17/65) in the tumor tissues and 95.4 % (62/65) in the incisal edge of normal tissues (P = 0.016), the protein expression of TIMP-3 was negatively correlated with the size of tumor, invasion depth, lymphatic metastasis and the stage of tumor. Conclusion The methylation of promoter region in CpG islands is a main mechanism of reduced and loss expression of TIMP-3 gene, which may play an important role in the invasion and metastasis of cardia carcinoma.
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Objective To investigate the diagnostic value of combined examination of homocysteine (Hcy) and CEA for male patients with gastric cardia cancer.Methods Serum concentration of Hcy,CEA,CA199,CA724,CA242 and TPS in 54 male patients with gastric cardia cancer and in 30 healthy men were measured.The diagnostic efficacy was analyzed between the combination of Hcy,CEA and the combination of Hcy,CEA,CA199,CA724,CA242,TPS.Results Total Hcy,CEA levels were significantly increased in patients group compared with control group ((20.3±9.2) μmol/L vs (13.7±3.1) μmol/L,(7.8±3.5) μg/L vs (1.6±1.2) μg/L,P ＜ 0.05).The sensitivity,specificity and accuracy of the combination of CEA,CA199,CA724,CA242 and TPS were 73.6 ％,64.5 ％ and 70.2 ％ respectively,while those of the combination of Hcy,CEA were 92.5 ％,64.5 ％ and 82.1％,respectively.There was significant difference between the combination of Hcy,CEA and the combination of CEA,CA199,CA724,CA242 and TPS (P ＜ 0.05).Conclusion Combined detection of Hcy and CEA is helpful for diagnosis in male patients with gastric cardia cancer.
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Objective To evaluate the changes and clinical significance ot the serum levels of homocysteine (Hcy) in gastric cardia cancer patients before and after surgery.Methods Serum Hcy concentrations of 102 patients with gastric cardia cancer (including 69 case of males) and 50 healthy human were measured by enzymatic cycling assay.Results Total Hcy levels were significantly increased in male patient group compared with the levels in control group (t =5.143,P =0.001).Hcy levels were significantly lower in postoperative group compared with preoperative group [(17.08±5.31) μmol/L vs (20.34±9.26) μmol/L,(14.07±4.87) μmol/L vs (20.34±9.26) μmol/L,P ＜ 0.05].Compared with Ⅳ stage group and other TNM stage groups,significantly lower levels of Hcy were detected in patients with gastric cardia cancer (t =2.306,3.285,P =0.030,0.002).Hcy levels in patients with gastric cardia cancer were also significantly higher than those in the tumor length ＜ 3 cm,3-5 cm and ＞ 5 cm groups (t =2.461,2.147,P =0.017,0.038).Multiple logistic regression analysis indicated a statistically significant association between serum Hcy concentration and gastric cardia cancer incidence (OR =1.136,95 ％ CI 1.010-1.278,P =0.033).Increasing serum Hcy levels were significantly associated with a decreasing risk of metastatic lymph node (OR =0.865,P =0.010).Conclusion Serum Hcy levels are directly associated with risk of male patients with gastric cardia cancer,and play important roles in the development of gastric cardia cancer.
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Objective To investigate diagnosis and treatment of concealed thoracic cavity fistula in the postoperative patients of esophagus or cardia carcinoma.Methods The clinical data of 40 patients were analyzed who presented with unexplained sepsis (elevated white blood cell count and temperature＞38 ℃) after esophagectomy and intrathoracic anastomosis from January 2010 to September 2013.All patients underwent oral meglumine diatrizoate esophageal imaging and computerized tomography scan of the chest.None of the patients had any sign of contrast leak in the early in these diagnostic examinations,but their chest CT scan all showed peri-anastomotic or the gastric remnant diffuse bubble and bit encapsulated effusion.Twenty patients were treated as concealed intrathoracic anastomotic or the gastric remnant leak including fasting,broad spectrum antibiotic treatment,kept the gastrointestinal decompression and enteral nutrition via naso-intestinal feeding tube.The other twenty patients were not treated only received broad spectrum antibiotic treatment.Results Two of the 20 patients in group of who were treated as concealed intrathoracic leak finally developed intrathoracic leak proved by oral meglumine diatrizoate esophageal imaging and CT scan (10 ％,2/20).Among the twenty patients who were not treated as intrathoracic leak,seventeen patients developed intrathoracic leak (85 ％,7/20),six patients died of multiple organ dysfunction syndrome.Conclusions Perianastomotic or the gastric remnant diffuse bubble and irregular encapsulated effusion in oral meglumine diatrizoate esophageal imaging and CT scan of the chest should be considered as specific signs of concealed intrathoracic anastomotic or the gastric remnant leak after esophagectomy and intrathoracic anastomosis.Patients with such signs should be treated as intrathoracic leak.
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Objective To analyze the different risks of cardia neoplasms in the immediate relatives of the cardia cancer patients,through a case-control study.Methods A case-control study was adopted on 772 cases and 772 controls,and relative risk (RR) were measured to compare the results from patemal or matrilineal groups.Results (1)Risk of the 1st grade kinship to the male cardia-cancer-patient group was obviously higher than that of the control group with RR=2.61 (95％CI:1.44-4.73,P＜0.01).(2) The risks of both paternal (P＜0.05) and matrilineal (P＜0.05) in the male cardia-cancer-patients were obviously higher than that of the control groups while the risk of those male cardia-cancer-patients in the paternal was higher than that of the control group (P＜0.05),so as the case for female patients in the matrilineal group (P＜0.05).(3) Data from the 1st grade kinship of cardia-cancer-patient group showed that parents and siblings had a higher risk than the control group (P＜0.05).(4) No significant genetic differences were found between the patemal of either the cancer group or the control group (P＞ 0.05),but statistical difference was observed that the risk of someone being the matrilineal of the cancer group was higher than that of the control group (P＜0.05).Conclusion The risks of cardia-cancer were higher in the 1st grade kinship,which including parents,brothers,sisters,maternal grandmother,mother,and maternal aunt.It was suggested that prevention programs should be focused on both earlier detection and treatment of the patients.New strategy for cancer prevention also need to be further developed.
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Objective Studies on cardia-cancer caused by hereditary factors. Methods Case-control method was adopted,with information including name,sex,date of birth,date of death of all the Ⅰ,Ⅱ,Ⅲ relatives of the patients,diagnosis and the treatment collected. The hereditary probability of cardia cancer and the separation degree were calculated by Falconer and Li-Mentel-Gart. Results (1) Prevalence rates of cardia-cancer on relative Ⅰ,relative Ⅱ,relative Ⅲ of cardia-cancer patients appeared to be 0.54%,0.04%,and 0.05% respectively. Prevalence rates of upper-digestive-tract-cancer of relative Ⅰ,relative Ⅱ,relative Ⅲ of cardia-cancer patients showed as: 2.50%,0.36% and 0.13% respectively. Data showed that relative Ⅰ> relative Ⅱ> relative Ⅲ and family cluster existed in both males and females. (2) Cardia-cancer hereditary probability of the relative Ⅰ cardia-cancer probands was 11.71%,with males as 14.01% and females as 14.72%. The upper-digestive-tract-cancer hereditary probability of the relative Ⅰ cardia-cancer probands was 13.87%,with males as 11.49% and females as 23.08%,both below 25%,indicating this was a low hereditary cancer. (3) The upper-digestive-tract-cancer separation of the blood compatriots of cardia-cancer patients was 0.0452,with males as 0.0441 and females as 0.0507,both below 0.25,indicating the nature of a multi-gene but not single-gene hereditary way. Conclusion Hereditary factor is recognized as one of the high risk cardia cancer,but not the most risky factor causing the high morbidity of cardia cancer in Shanxi province.
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Purpose To characterize the alterations and significance of Rb in concurrent esophageal and gastric cardia precancerous lesions (dysplasia) from the same patients in Henan,a high-incidence area of esophageal carcinoma.Methods Rb protein expression was detected by the immunohistochemical staining (ABC method) in 30 patients with both esophageal and gastric cardia dysplasia in Henan area.Results Rb positive rates in esophageal epithelial dysplasia (EDYS) and gastric cardia dysplasia (GDYS) were 70% (21/30) and 80% (24/30), respectively, and the difference was not significant,(χ~2=0.800,P>0.05).However, there were 25 patients with Rb coincident changes in EDYS and GDYS from the same patient in 30 cases of esophageal and gastric cardia dysplasia (83%,25/30). The positive coincidence rate for Rb positive expression in EDYS and GDYS from the same patient accounted for 67% (20/30) and the negative coincidence rate was 17% (5/30) (Kappa=0.561,P<0.01).The significant relationship between Rb coincidence expression in EDYS and GDYS was found (P<0.01).Conclusions The high coincident alterations of Rb in EDYS and GDYS from the same patient indicate the possibility of similar molecular basis, which provides an important etiological clue for the similar geographic distribution and risk factors involved in esophageal squmaous cell carcinoma and gastric cardia adenocarcinoma.
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Objective: To study early diagnosis and treatment of multi-primary esophageal cancer and esophageal and cardiac double primary cancer. Methods: The data of 71 cases patients of multi-primary esophageal, double primary esophageal and cardiac cancer were collected. The diagnosis was made by dye staining through gastroscopy and X-ray. Pathological examination after operation was analyzed. Results: 14 patients were diagnosed by X-ray(14/71), 69 by endoscopy (69/71), 54 early foci and 6 early stage patients were found. All of them were operated. The resection rate is 100% with no operative death. 3-year survival rate was 40 5%. Conclusion: Routine X-ray examination of esophagus or stomach, and esophageal dye-staining and/or biopsy through endoscopy are important measures for early diagnosis of multi-primary cancer or esophageal and double primary cardiac cancer prompt surgery is advised.