Impact of Cytoreductive Nephrectomy on Survival in Patients with Metastatic Renal Cell Carcinoma Treated by Targeted Therapy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The metastatic renal cell carcinoma (mRCC) patients treated with upfront cytoreductive nephrectomy combined with α-interferon yields additional overall survival (OS) benefits. It is unclear whether mRCC patients treated with vascular endothelial growth factor receptor-tyrosine kinase inhibitor (VEGFR-TKI) will benefit from such cytoreductive nephrectomy either. The aim of the study was to identify variables for selection of patients who would benefit from upfront cytoreductive nephrectomy for mRCC treated with VEGFR-TKI.</p><p><b>METHODS</b>Clinical data on 74 patients enrolled in 5 clinical trials conducted in Cancer Hospital (Institute), Chinese Academy of Medical Sciences from January 2006 to January 2014 were reviewed retrospectively. The survival analysis was performed by the Kaplan-Meier method. Comparisons between patient groups were performed by Chi-square test. A Cox regression model was adopted for analysis of multiple factors affecting survival, with a significance level of α = 0.05.</p><p><b>RESULTS</b>Fifty-one patients underwent cytoreductive nephrectomy followed by targeted therapy (cytoreductive nephrectomy group) and 23 patients were treated with targeted therapy alone (noncytoreductive nephrectomy group). The median OS was 32.2 months and 23.0 months in cytoreductive nephrectomy and noncytoreductive nephrectomy groups, respectively (P = 0.041). Age ≤45 years (P = 0.002), a low or high body mass index (BMI <19 or >30 kg/m2) (P = 0.008), a serum lactate dehydrogenase (LDH) concentration >1.5 × upper limit of normal (P = 0.025), a serum calcium concentration >10 mg/ml (P = 0.034), and 3 or more metastatic sites (P = 0.023) were independent preoperative risk factors for survival. The patients only with 0-2 risk factors benefited from upfront cytoreductive nephrectomy in terms of OS when compared with the patients treated with targeted therapy alone (40.0 months vs. 23.2 months, P = 0.042), while those with more than 2 risk factors did not.</p><p><b>CONCLUSIONS</b>Five risk factors (age, BMI, LDH, serum calcium, and number of metastatic sites) seemed to be helpful for selecting patients who would benefit from undergoing upfront cytoreductive nephrectomy.</p>

Clinicopathological Characteristics and Prognosis of Colorectal Cancer in Chinese Adolescent Patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Colorectal adenocarcinoma rarely occurred in adolescent. Clinical feature and prognosis of this population are not clear until now. In addition, DNA mismatch repair (MMR) status may relate to the early disease occurrence. The present study aimed to perform a retrospective analysis of adolescent patients with colorectal cancer, including clinicopathological characteristics and prognosis.</p><p><b>METHODS</b>The medical records of 11,503 patients diagnosed as colorectal cancer in Cancer Hospital, Chinese Academy of Medical Sciences from January 1999 to December 2009 were retrospectively reviewed. Finally, 19 patients who were between 10 and 20 years old were selected as the study group. We summarized the clinicopathological characteristics, analyzed the association with prognosis and assessed the expression of MMR protein by immunohistochemical method.</p><p><b>RESULTS</b>The most common primary site was the right colon in 7 patients. Ten patients had Stage III colorectal cancer, 5 patients had Stage IV disease. Signet ring cell carcinoma was the most frequent pathological type (7/19). Deficient MMR was identified in 2 patients. The 5-year survival rate and median survival time were 23.2% and 26 months. Distant metastasis was identified as an independent prognostic factor (P = 0.02).</p><p><b>CONCLUSIONS</b>Colorectal cancer in Chinese adolescents was very rare. The chinese adolecents with colorectal cancer were frequently diagnosed in the right colon, as Stage III/IV disease with signet ring cell carcinoma. The prognosis was relatively poor.</p>

An open-labeled, randomized, multicenter phase IIa study of gambogic acid injection for advanced malignant tumors / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Gambogic acid is a pure active compound isolated from the traditional Chinese medicinal plant gamboge (Garcinia morella Desv.). Based on the preliminary results of a phase I study, this phase IIa study compared the efficacy and safety of different dosage schedules of gambogic acid in patients with advanced malignant tumors.</p><p><b>METHODS</b>Patients with advanced or metastases cancer who had not received any effective routine conventional treatment or who had failed to respond to the existing conventional treatment were randomly assigned to receive either 45 mg/m(2) gambogic acid intravenously from Days 1 to 5 of a 2-week cycle (Group A), or 45 mg/m(2) every other day for a total of five times during a 2-week cycle (Group B). The primary endpoint was objective response rate (ORR).</p><p><b>RESULTS</b>Twenty-one patients assigned to Group A and 26 to Group B were included in the final analysis. The ORRs were 14.3% in Group A and 0% in Group B. It was not possible to analyze the significant difference because one of the values was zero. The disease control rates (DCRs) were 76.2% in Group A and 61.5% in Group B (P = 0.0456). The observed adverse reactions were mostly Grades I and II, and occurred in most patients after administration of the trial drug. There was no significant difference in the incidence of adverse reactions between the two arms.</p><p><b>CONCLUSIONS</b>The preliminary results of this phase IIa exploratory study suggest that gambogic acid has a favorable safety profile when administered at 45 mg/m(2). The DCR was greater in patients receiving gambogic acid on Days 1 - 5 of a 2-week cycle, but the incidence of adverse reactions was similar irrespective of the administration schedule.</p>

Famitinib in metastatic renal cell carcinoma: a single center study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Famitinib is a novel and potent multitargeting receptor tyrosine kinase inhibitor. The phase I clinical study showed that famitinib was well tolerated and had a broad anti-tumor spectrum. The purpose of this study was to examine the efficacy and safety of famitinib for the treatment of metastatic renal cell carcinoma (mRCC).</p><p><b>METHODS</b>The data of famitinib in treating patients with mRCC from the single-center phases I and II clinical trials were analyzed. Famitinib was administered orally at the dose of 13-30 mg once daily until tumor progression, occurrence of intolerable adverse reactions or withdrawal of the informed consent.</p><p><b>RESULTS</b>A total of 24 patients with mRCC were treated including 17 patients at a dose of 25 mg once daily, 4 patients at a dose of 27 mg and 1 patient each at a dose of 13 mg, 20 mg and 30 mg, respectively. Twelve (50.0%) patients achieved partial response (PR) and 9 patients achieved stable disease (SD). Progressive disease was found in 3 (12.5%) patients. The disease control rate was 87.5%. The median follow-up time was 17.6 months; the median progression free survival (PFS) was 10.7 (95% CI 7.0-14.4) months; and the estimated median overall survival (OS) time was 33.0 (95% CI 8.7-57.3) months. The adverse drug reactions mainly included hypertension (54.1%), hand-foot skin reactions (45.8%), diarrhea (33.3%), mucositis (29.2%), neutropenia (45.8%), thrombocytopenia (29.2%), hyperlipidemia (41.7%) and proteinuria (41.7%). The incidence rate of grades 3 and 4 adverse events was low, mainly including hypertension 12.5%, hand-foot skin reactions 4.2%, neutropenia 4.2%, thrombocytopenia 4.2%, hyperlipidemia 4.2% and proteinuria 12.5%.</p><p><b>CONCLUSIONS</b>Famitinib has significant anti-tumor activity in mRCC. The common adverse reactions are generally manageable.</p>

Neuroendocrine tumors: analysis of 252 cases / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the epidemiology, diagnosis, and treatment status of neuroendocrine tumors (NETs) in our hospital.</p><p><b>METHODS</b>Medical records of 252 patients with neuroendocrine tumors diagnosed and treated in our hospital from January 1, 2004 to December 31, 2009 were collected and retrospectively reviewed in this study. The clinicopathological data including age of onset, initial symptoms, primary site, pathological conditions (Sny, CgA, Ki-67), disease stage at diagnosis, treatment, and follow up were analyzed.</p><p><b>RESULTS</b>The gender ratio M/F of the 252 cases was 1.9:1, with mean age of 55.2 years, and the high incidence was in age of 60-69 years. The tumors were located in the gastrointestinal tract (117 cases, 46.4%), broncho-pulmonary system (74 cases, 29.4%), other sites (61 cases, 24.2%) and unknown primary site (2 cases, 0.8%). Their first clinical symptoms vary, depending on the primary site. The common symptoms of primary rectal NETs were changes in bowel habits (29.3%) and diarrhea or constipation (17.5%), and most gastric NETs presented epigastric discomfort (86.4%). Most patients (71.4%) were diagnosed with stage I, II, III disease. Among the 252 cases, there were 110 carcinoids (43.7%), 108 neuroendocrine carcinomas (42.9%), 23 atypical carcinoids (9.1%), five neuroendocrine tumors (2.0%), four Merkel cell tumors (1.6%), and two composite carcinoids (0.8%). 206 patients (81.7%) received surgery, 39 (15.5%) received chemotherapy, and 31 cases (12.3%) were treated by palliative radiotherapy.</p><p><b>CONCLUSIONS</b>This single-center retrospective analysis of data demonstrated that males have a higher incidence rate than females. The most common primary sites of NETs are the digestive tract and lungs. The initial symptoms of NETs are different depending on their primary sites. Good prognosis can be achieved in the majority of patients after surgery, chemotherapy and palliative radiotherapy.</p>

Analysis of prognostic factors after radical resection in 628 patients with stage II or III colon cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the clinicopathologic factors related to recurrence and metastasis of stage II or III colon cancer after radical resection.</p><p><b>METHODS</b>The clinical and pathological data of 628 patients with stage II or III colon cancer after radical resection from Jan. 2005 to Dec. 2008 in our hospital were retrospectively reviewed and analyzed.</p><p><b>RESULTS</b>The overall recurrence and metastasis rate was 28.5% (179/628). The 5-year disease-free survival (DFS) rate was 70.3% and 5-year overall survival (OS) rate was 78.5%. Univariate analysis showed that age, smoking intensity, depth of tumor invasion, lymph node metastasis, TNM stage, gross classification, histological differentiation, blood vessel tumor embolus, tumor gross pathology, multiple primary tumors, preoperative and postoperative serum concentration of CEA and CA19-9, and the regimen of adjuvant chemotherapy were correlated to recurrence and metastasis of colon cancer after radical resection. Multivariate analysis showed that regional lymph node metastasis, TNM stage, the regimen of postoperative adjuvant chemotherapy, and preoperative serum concentration of CEA and CA19-9 were independent factors affecting the prognosis of colon cancer patients.</p><p><b>CONCLUSION</b>Regional lymph node metastasis, TNM stage, elevated preoperative serum concentration of CEA and CA19-9, the regimen of postoperative adjuvant chemotherapy with single fluorouracil type drug are independent risk factors of recurrence and metastasis in patients with stage II-III colon cancer after radical resection.</p>

A phase II trial of oxaliplatin plus S-1 as a first-line chemotherapy for patients with advanced gastric cancer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Palliative chemotherapy has been shown to have a survival benefit for patients with recurrent or metastatic gastric cancer. We conducted a Phase II trial to determine the efficacy and safety of S-1 plus oxaliplatin (SOX regimen) as first-line chemotherapy for patients with unresectable locally advanced or metastatic gastric cancer.</p><p><b>METHODS</b>Eligible patients had measurable lesions and no previous history of chemotherapy (except adjuvant chemotherapy). Oxaliplatin was administered intravenously at a dose of 130 mg/m(2) on day 1. S-1 was administered orally in doses of 80, 100, or 120 mg/d according to body surface areas of <1.25 m(2), 1.25-1.5 m(2), or >1.5 m(2) respectively; the total dose was divided into two daily doses on days 1-14. Treatments were repeated every 3 weeks until disease progression or intolerable toxicity occurred.</p><p><b>RESULTS</b>Forty-three patients were enrolled in the study. All were assessable for efficacy and adverse events. The objective response and disease control rates were 55.8% and 76.7% respectively. The median follow-up time was 16.5 months. The median progression-free survival time was 7 months (95% CI, 5.8-8.2 months) and the median overall survival time was 16.5 months (95% CI, 9.7-23.3 months). The one-year survival rate was 54.2%. Major adverse reactions were grade 3/4 neutropenia (9.3%) and thrombocytopenia (20.9%).</p><p><b>CONCLUSION</b>The SOX regimen with oxaliplatin at a dose of 130 mg/m(2) was found to be effective and safe as a first-line chemotherapy in Chinese patients with advanced gastric cancer.</p>

A safety analysis in patients treated with oxaliplatin plus S-1 as adjuvant therapy for gastric cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The combination of oxaliplatin and S-1 is effective in patients with advanced gastric cancer. The purpose of this study was to analyze the safety and compliance of this combination regimen as adjuvant chemotherapy in patients with gastric cancer.</p><p><b>METHODS</b>Clinical data of 71 patients with gastric cancer treated with oxaliplatin plus S-1 as adjuvant chemotherapy in the Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) from Jan 1(st), 2010 to Jan 1(st), 2012 were retrospectively reviewed. The types and incidence rate of adverse events related to chemotherapy and the results of follow up of the patients were analyzed.</p><p><b>RESULTS</b>Among the 71 cases, 17 were treated with oxaliplatin biweekly, while 54 with oxaliplatin triweekly. The most common adverse events were neutropenia (n = 49, 69.0%), nausea/vomiting (n = 51, 71.8%), and anorexia (n = 49, 69.0%). The most frequent grade 3-4 toxicities were neutropenia (n = 13, 18.3%), thrombocytopenia (n = 10, 14.1%), anorexia (n = 5, 7.0%) and nausea/vomiting (n = 4, 5.6%). Seven (87.5%) of the 8 patients previously treated with neoadjuvant chemotherapy experienced thrombocytopenia in the postoperative adjuvant chemotherapy, and four (50%) of the 8 patients experienced grade 3-4 thrombocytopenia. The rates of grade 3-4 adverse events in patients aged 65-years or older were similar to that in younger patients.</p><p><b>CONCLUSIONS</b>The combination of oxaliplatin and S-1 used as adjuvant chemotherapy is well tolerated by patients with gastric cancer. Neutropenia, thrombocytopenia, nausea/vomiting and anorexia are the major treatment-related adverse events. Patients who received neoadjuvant chemotherapy do not well tolerate this regimen as postoperative adjuvant chemotherapy. This combination regimen has a manageable tolerability profile in adjuvant setting in patients ≥ 65 years old.</p>

Phase II clinical study on the modified DCF regimen for treatment of advanced gastric carcinoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>A phase III trial involving docetaxel, cisplatin, and fluorouracil (DCF) in the treatment of advanced gastric cancer was shown to have superior efficacy compared to cisplatin and fluorouracil alone, but with a high rate of hematologic toxicity. To reduce toxicity while maintaining the efficacy of DCF, we reduced the doses of docetaxel (D) and cis-platinum (CDDP), and administered 5-fluorouracil (5-FU) via a continuous intravenous (CIV) infusion.</p><p><b>METHODS</b>Chemotherapy-naive patients with gastric adenocarcinomas received D (60 mg/m(2) 1 hour on day 1), CDDP (30 mg/m(2) on days 1 and 2), and 5-FU (1500 mg×m(-2)×24 h(-1) CIV on days 1 and 8 every 3 weeks). The primary endpoint was the response rate.</p><p><b>RESULTS</b>Fourteen patients were enrolled. Based on the efficacy evaluation following at least 2 cycles of treatment, there was 7.1% complete remission (CR), 71% partial remission (PR), 14% stable disease (NC/SD), and 7.1% progressive disease (PD). The median survival time was 13 months. Nine patients (64%) had grade III-IV neutropenia, and 4 patients (29%) had grade IV neutropenia, among whom 1 had grade IV neutropenia with grade III nausea and vomiting.</p><p><b>CONCLUSION</b>The modified DCF regimen is highly active and has a favorable toxicity profile in Chinese patients with gastric cancer.</p>

Long-term outcomes of gemcitabine and cisplatin in patients with recurrent or metastatic esophageal squamous cell carcinoma: a phase II trial / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Esophageal cancer is the sixth most common cause of cancer-related death worldwide. Prior studies had demonstrated potential synergistic antitumor activity of gemcitabine in combination with cisplatin. Therefore, we studied the efficacy and tolerability of such combination for esophageal cancer.</p><p><b>METHODS</b>Between October 2003 and October 2006, thirty-eight patients with metastatic or recurrent advanced squamous cell carcinoma of the esophagus were enrolled. The median number of treatment cycles per patient was 4 (range 1 - 7). Gemcitabine was given at 1000 mg/m(2) over 30 minutes on days 1, 8 and cisplatin 40 mg/m2 was given on days 1, 2 in an every 21-day cycle.</p><p><b>RESULTS</b>The median follow-up for all 38 patients was 76 months (range 11 - 88 months). The overall response rate was 42.1% (95%CI, 25.5% - 56.5%). Median progression-free survival and median survival for all patients were 4.1 months (95%CI, 3.0 - 5.7 months) and 10 months (95%CI, 7 - 12 months), respectively. Patients with a response had significantly longer median survival compared with the patients without a response (11 months vs. 7.5 months, P = 0.0069). Overall survival at 1 year was 36.8%, at 2 years was 10.5%, and at 5 years was 5.3%. The most common grade 3 - 4 toxicity for all patients was leucopenia (44.7%).</p><p><b>CONCLUSIONS</b>This cisplatin-gemcitabine regimen was manageable and had significant efficacy in patients with esophageal squamous cell carcinoma. Patients with a response had improved survival time. Furthermore, a small number of the patients with metastatic esophageal cancer were still alive in 5 years with this regimen.</p>

Relationship between HER2/neu gene amplification and protein expression and prognosis in patients with advanced gastric carcinoma / 癌症

<p><b>BACKGROUND AND OBJECTIVE</b>There is a mounting evidence of the role of HER2 overexpression inpatients with gastric cancer, and it has been solidly correlated with poor outcomes and more aggressive diseases. This study was to investigate the relationship between the expression of HER2/neu and the clinical characteristics of advanced gastric carcinomas, including survival.</p><p><b>METHODS</b>The clinical data of 83 patients admitted in Cancer Hospital, Chinese Academy of Science, from 2006 to 2008 were reviewed. The HER2/neu status in 83 advanced gastric carcinomas was evaluated using immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). The survival rate was calculated by Kaplan-Meier method and the log-rank test using SPSS13.0 software.</p><p><b>RESULTS</b>The median age of the patients was 60 years and the male-to-female ratio was 2.95:1. HER2/neu overexpression (2+ and 3+) and amplification were found in 25 (30.1%) and 29 (34.9%) advanced gastric carcinomas, respectively. HER2/neu amplification/overexpression was associated with worse survival in patients with advanced gastric carcinoma. The median survival of the patients without HER2/neu amplification was 12.6 months and that of those with HER2 amplification was 5.5 months.</p><p><b>CONCLUSIONS</b>HER2/neu status may be a clinical predictor of prognosis in advanced gastric cancer patients.</p>

Prognostic analysis of patients with liver metastases from colorectal cancer treated with different modes of therapy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the potential prognostic factors for patients with liver metastases from colorectal cancer treated with different modes of therapy.</p><p><b>METHODS</b>The clinicopathological data of 300 patients with liver metastases from colorectal cancers were retrospectively reviewed and analyzed.</p><p><b>RESULTS</b>The median survival of patients with recurrence (MSR) treated with complete and palliative resection of liver metastases and unresectable patients was 48, 19 and 18 months, respectively (P = 0.000). In patients with unresectable liver metastases, systemic chemotherapy plus regional therapy demonstrated a median survival time of 23 months, significantly longer than the 6 months in untreated patients (P = 0.000). Patients who showed response to the first-line therapy demonstrated an improved survival versus the patients who had no response, with a median survival time of 24 vs. 16 months (P = 0.000). Univariate analysis revealed that resection modes of primary diseases and liver metastases, treatment modality for liver metastases, and response to first-line therapy were prognostic factors. Multivariate analysis showed that resection modes of liver metastases, multimodality treatment after liver metastases, and the response to first-line therapy were all independent prognostic factors for patients with liver metastases from colorectal cancer.</p><p><b>CONCLUSION</b>Resection of liver metastases, multimodality treatment after liver metastases, and response to first-line chemotherapy are all independent prognostic factors for patients with liver metastasis from colorectal cancer.</p>

Treatment and prognosis of extrapulmonary small cell carcinoma of 243 cases / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The extrapulmonary small cell carcinoma (EPSCC), a uncommon malignant tumor, has seldom been reported. The aim of this study was to analyze the clinical characteristics, treatment and prognosis of EPSCC.</p><p><b>METHODS</b>The clinical data of 243 patients admitted in our hospital from 1977 to 2007 were reviewed. The survival rate was calculated by the Kaplan-Meier method and log-rank test.</p><p><b>RESULTS</b>The median age of the patients was 58 years and the male-to-female ratio was 2.47:1. According to VALSG criteria, 209 patients had limited disease (LD) and 34 had extensive disease (ED). 170 patients received chemotherapy-based multimodal therapy, 73 received surgery, and/or radiotherapy. The 6, 12, 24, 36 and 60-month survival rates of these patients were 88.9%, 67.2%, 36.8%, 27.3% and 18.3%, respectively. The clinical stage, vessel involvement and regional lymph node metastases were independent prognostic factors of EPSCC. Patients with LD had a median overall survival of 18.6 months compared with 14.0 months in patients with ED (P = 0.030). The median survival was 19.2 months for the patients without vessel involvement and 14.4 months with vessel involvement (P = 0.026). The median survival of the patients with regional lymph node metastases was 13.9 months, while 39.5 months without regional lymph node metastases (P = 0.000). Among different primary sites, patients with gynecologic small cell cancer had a median survival of 28.0 months, head and neck 20.1 months and gastrointestinal tract 14.3 months. Brain metastasis was observed in a lower number of patients with EPSCC compared with that in patients with SCLC. There were no statistically significant differences in overall survival between patients with pure and mixed EPSCC (P = 0.396).</p><p><b>CONCLUSION</b>EPSCC is an uncommon malignant tumor with early metastasis and poor prognosis. The clinical characteristics of EPSCC and SCLC were similar in some aspects, however, there are some differences in etiology, clinic course, survival and frequency of brain metastases. These differences may influence the choice of therapeutic strategy. Multimodal therapy, combination of chemo- and radio-therapy after surgical resection may improve the outcome of EPSCC.</p>

Clinical analysis of 126 patients with primary small cell carcinoma of the esophagus / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the prognostic factors and the principles of treatment of primary esophageal small cell carcinoma (SCEC) retrospectively.</p><p><b>METHODS</b>The data of 126 patients with histologically confirmed SCEC treated in our department between May 1985 and June 2005 were retrospectively analyzed. 85 patients were in limited disease stage (LD) and 41 patients as extensive disease stage (ED) according to the Veterans Administration Lung Study Group staging system. Among the 84 patients treated with esophagectomy, 8 cases were in stage I, 16 in stage IIa, 10 in stage IIb, 40 in stage III, 4 in stage IVa and 6 in stage IVb, according to the TNM system (6(th) edition, AJCC). Cox's hazard regression model was used to identify the prognostic factors, and Chi-square test to detect the difference of frequencies among different groups. Kaplan-Meier and log-rank methods were used to estimate and compare the survival rates.</p><p><b>RESULTS</b>The median follow-up duration of this series was 13 months. One hundred and eight patients died of the disease during the follow-up, 10 were still alive and 8 were lost to follow-up. The 1-, 3-, and 5-year overall survival rates (OS) were 52.2%, 15.9%, and 12.2%, respectively, with a median survival time (MST) of 12.5 months. The 1-, 2-, and 3-year OS were 62.1%, 30.8%, and 22.4% with a MST of 14.0 months for LD, and 29.3%, 13.6% and 2.7% with a MST of 7.0 months for ED, respectively. There was a statistically significant difference in OS between LD and ED (P = 0.0001). The MST of the patients treated with chemotherapy was 14.5 months, significantly longer than the 5.2 months of the patients without (P = 0.0001). Multivariate analysis showed that stage (HR 1.91, 95% CI 1.26 approximately 2.91, P = 0.002), length of the primary lesion (HR 1.75, 95% CI 1.17 approximately 2.63, P = 0.007), and chemotherapy (HR 0.42, 95% CI 0.28 approximately 0.65, P = 0.000) were independent prognostic factors.</p><p><b>CONCLUSION</b>Esophageal small cell carcinoma is a systemic disease. The tumor stage (LD or ED), length of the primary lesion and chemotherapy are independent prognostic factors. Therefore, a systemic therapy based on chemotherapy should be recommended.</p>

Analysis of prognostic factors in 300 colorectal cancer patients with liver metastases / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyse the clinical characteristics and potential prognostic factors of colorectal cancer patients with liver metastases.</p><p><b>METHODS</b>The clinical and pathological data of 300 colorectal cancer patients with liver metastases were retrospectively reviewed and analyzed.</p><p><b>RESULTS</b>The median survival time of these patients was 19.0 months. The 1-, 2- and 5-year survival rates after liver metastases were 79.0%, 29.0% and 3.0%, respectively. Univariate analysis revealed that performance status (KPS), histological grading, primary tumor, N status, lymphatic and vascular invasion, stage at diagnosis, the number, size and distribution of liver metastases and other accompanied metastases were prognostic factors. Multivariate analysis showed that KPS, lymphatic and vascular invasion, the number and size of liver metastases were independent prognostic factors of colorectal cancer with liver metastases.</p><p><b>CONCLUSION</b>Performance status, lymphatic and vascular invasion, the number and size of liver metastases are independent prognostic factors of colorectal cancer with liver metastases.</p>

Comparison of the efficiency of CHOP-based regimen with or without high dose consolidation treatment combined with hematopoietic stem cell transplantation in 63 lymphoblastic lymphoma patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To retrospectively analyze and compare the treatment efficiency of CHOP-based regimens with or without high-dose consolidation treatment combined with hematopoietic stem cell transplantation (HDT-HSCT) in the patients with lymphoblastic lymphoma (LBL).</p><p><b>METHODS</b>From 1989 to 2004, totally 63 patients with LBL were initially treated with a standard CHOP-based regimen. Forty-two of the 63 patients achieved complete response (CR), 26 of those subsequently received consolidation HDT-HSCT, while the other 16 had 6-8 cycles of standard CHOP-based treatment only.</p><p><b>RESULTS</b>Of the 63 patients, 57 had a T-LBL and 6 B-LBL, with a median age of 20 years, 19 (30.2%) had a stage I-II diseases and 44 (69.8%) stage III-IV diseases, 61.9% presented with a mediastinal mass. Bone marrow involvement presented in 28.6% of the patients. Fourteen percent had central nervous system involvement. The median follow-up period was 24 months, and the estimated 5-year overall survival and disease-free survival of this series was 31.2% and 29.3%, respectively. Of the 42 patients who achieved CR, the 5-year OS rate of the patients who received HDT-HSCT as a consolidation therapy was 59.8% versus 14.6% of the patients treated by CHOP-based regimens alone (P=0.004). Bone marrow involvement, age > or =20 years, short response duration and primary refractory disease were factors significantly associated with poor outcome. Among the 18 patients with bone marrow involvement, 3 received allogeneic HSCT and were all still alive at the follow up time of 22, 32 and 37 months, respectively, while another 4 received auto-HSCT and all died of the disease within 14 months.</p><p><b>CONCLUSION</b>Short term treatment with a CHOP-based regimen is not sufficient for the patients with lymphoblastic lymphoma. High-dose consolidation treatment and hematopoietic stem cell transplantation may improve overall survival and disease free survival. Bone marrow involvement, age >20 years, and short response duration and primary refractory disease are all the factors significantly associated with poor outcome. For the patients with bone marrow involvement, allohematopoietic stem cell transplantation is superior to auto-hematopoietic stem cell transplantation.</p>

Sorafenib in combination with interferon-α-2b for the treatment of metastatic renal cell carcinoma: pre-liminary results / 中华泌尿外科杂志

Objective To explore the efficacy and tolerability of sorafenib in combination with interferon-α-2b for Chinese patients with metastatic renal cell carcinoma. Methods Seventeen pa-tients with unreseetable metastatic renal cell carcinoma were enrolled and received sorafenib in combi-nation with interferon-α-2b. Sorafenib was continuously given at the dose of 400 mg twice per day, in-terferon-α-2b 300 MIU subscutaneously once per day for 5 d each week, until disease progression or intolerable toxieities occurred. Tumor responses were evaluated every two months by response evalua-tion criteria in solid tumor. Results The median treatment duration was 120(51-442)d. All 17 pa-tients were evaluable for efficacy and safety. Five patients achieved partial responses (PR), 1 uncon-firmed PR,9 stable diseases. Two patients had progressed diseases. The overall response rate was 29%(5/17)with the disease control rate of 88%(15/17). Due to short-time follow up, the median progression free and overall survival time were not yet available. The common side effects included: fever 82%(14/17), diarrhea 82%(14/17), hand-foot syndrome 71%(12/17), asthenia 65%(11/17), rash 53%(9/17), alopecia 41% (7/17), mucosities 41% (7/17), hypertension 29% (5/17), anorexia 24% (4/17), hoarseness 24% (4/17), myalgia 24 % (4/17), nausea/vomiting 12 % (2/17) and headach/ dizzle 12%(2/17). Eleven (65%) out of 17 patients developed neutropenia, 5(29%) thrombocytope-nia and 5 (29%)anemia. Four(24%) out of 17 patients had abnormally elevated ALT/AST. Conclu-sion Sorafenib in combination with interferon-α-2b for metastatic renal cell carcinoma improves re-sponse rate with manageable toxicity.

Clinical analysis of 81 cases with primary small cell carcinoma of the esophagus / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the clinical characteristics, treatment and prognostic factors in patients with primary small cell carcinoma (SmCC) of the esophagus.</p><p><b>METHODS</b>Eighty-one esophageal SmCC patients were treated from 1999 to 2007 in our department, and their clinical data were retrospectively reviewed.</p><p><b>RESULTS</b>Of the 81 patients, 52 (64.2%) were in limited stage (LS) and 23 (28.4%) in extensive stage (ES). The 1-, 3- and 5-year survival rates were 55.6%, 6.2% and 2.5%, respectively, with a median survival time of 13.5 months for the whole group; 69.2%, 7.3% and 3.6%, respectively, with a median survival time of 15 months for the LS group; while only 25.2%, 0 and 0, respectively, with a median survival time of 6 months for the ES group. Multivariate analysis showed that disease stage, performance status, multidisciplinary comprehensive therapy and mode of treatment were independent prognostic factors.</p><p><b>CONCLUSION</b>Esophageal small cell carcinoma is a rare but highly aggressive malignant tumor. Disease stage and performance status are important prognostic factors. Appropriate treatment may play a key role in improving the survival of the patients.</p>

Long-term outcome of testicular seminoma in 294 patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the correlation of long-term survival with the treatment strategies in patients with testicular seminoma.</p><p><b>METHODS</b>Clinical data of 294 patients with testicular seminoma treated in our hospital between 1959 and 2004 were collected and analyzed. The median age of the patients was 37 years (range 13 - 70 years). Among them, 260 were in stage I disease, 16 in stage II, and 18 in stage III. The patients were treated by surgical resection plus chemotherapy and/or radiotherapy. The survival rate was calculated using Kaplan-Meier method and log-rank test using SPSS 13.0 software.</p><p><b>RESULTS</b>The overall 5-, 10-, 20- and 30-year survival rates in this series were 92.1%, 91.8%, 85.5% and 71.4%, respectively. The major prognostic factor was found to be clinical stage. The patients with adjuvant chemotherapy after orchiectomy had better 10-year survival than the patients without (97.5% vs. 79.2%, P = 0.001). For stage II/III patients, the patients with chemotherapy and the patients with chemotherapy plus radiotherapy had a similar progression-free survival (PFS) and overall survival (OS) (P > 0.05).</p><p><b>CONCLUSION</b>Testicular seminoma is sensitive to chemotherapy and radiotherapy, and a good cure rate can still be achieved in the relapsed patients with a salvage treatment. Therefore, wide excision and long-term chemotherapy should be avoided in order to maintain the quality of life in those patients.</p>

Polymorphisms of UGT1A gene and irinotecan toxicity in Chinese colorectal cancer patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To assess the polymorphism of UGT1A gene in Chinese, and to investigate the correlation between UGT1A polymorphism and irinotecan toxicity in colorectal cancer patients.</p><p><b>METHODS</b>70 patients with advanced colorectal cancer were treated with irinotecan and 5-fluorouracil. Polymorphism analysis was performed in all those patients and 100 healthy subjects. Genomic DNA was extracted from peripheral blood and genotyped using polymerase chain reaction and direct sequencing.</p><p><b>RESULTS</b>14 patients exhibiting grade 3 - 4 neutropenia (20.0%), 16 patients experienced grade 2 - 4 diarrhea (22.9%), including only 4 patients with grade 3 - 4 diarrhea (5.7%). Compared with TA6/7 and TA7/7, UGT1 A1 * 28 wild genotype TA6/6 was significantly associated with reduced toxicity (42.1% vs. 15.7%, P = 0.027). There was no significant difference in the distribution of UGT1A genotypes between colorectal cancer patients and healthy subjects.</p><p><b>CONCLUSION</b>Chinese patients exhibit less irinotecan-related diarrhea due to higher frequence of UGT1A A1 * 28 wild genotype TA6/6.</p>