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Objective To investigate the clinicopathologic features of Chinese patients with early gastric cancer (EGC) according to the World Health Organization(WHO) diagnostic criteria,and to explore the risk factors of lymph node metastasis (LNM) in EGC.Methods From 2002 to 2017,at the Second Affiliated Hospital of Nantong University,and from 2014 to 2017,at the People's Hospital of Qidong City,the People's Hospital of Haimen City and the People's Hospital of Rugao City,315 EGC patients with complete clinicopathological data were enrolled.The clinicopathologic features were analyzed including gender,age,tumor location,tumor size,macroscopic type,histological type (WHO),differentiation degree,depth of tumor invasion,Lauren subtype,infiltration pattern,ulceration,lymphoid follicles,lymphovascular invasion and perineural invasion.Chi-square test and Fisher's exact test were performed for univariate analysis and the logistic regression was used for multivariate analysis.Results The ratio of EGC was 10.0％ (315/3 140) of patients with gastric cancer and received surgery during the same period.Among the 315 EGC,the ratio of well-differentiated tubular adenocarcinoma was 11.7％ (37/315),which was lower than 24.8％(2 752/11 104) in Japan and 19.9％(41/206) in South Korea,and the differences were statistically significant (x2 =28.208,P＜0.01;x2 =6.51 0,P =0.011),however there was no statistically significant difference when compared with Western countries (11.9 ％,8/67;x2 =0.002,P=0.964).Among the 276 patients who underwent radical gastrectomy,49 (17.8 ％) patients had with LNM.The results of univariate analysis showed that tumor size,macroscopic type,differentiation degree,depth of invasion,infiltration pattern,ulceration and lymphovascular invasion were related with LNM(x2=9.327,6.038,6.381,34.983,19.309,52.297 and 5.058;all P＜0.05).The results of multivariate analysis revealed that lymphovascular invasion and ulceration were the independent risk factors of LNM (odd ratio (OR)=7.028 and 2.566,both P＜0.05).Conclusions There is obvious difference in pathological diagnostic standard of well-differentiated tubular adenocarcinoma between China,Japan and South Korea,which may influence the therapeutic strategy of EGC.Lymphovascular invasion and ulceration are independent risk factors of LNM in EGC.
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Blue laser imaging (BLI) is a new endoscopic system equipped with the laser beam emitting two different wavelengths.It produces bright and high resolution images for observation of microvascular and microsurface patterns of esophageal and gastric mucosa, helping the diagnosis of early upper gastrointestinal cancer.Compared with the existed endoscopic techniques, BLI shows its unique advantages.In this article, advances in application of BLI in diagnosis of early upper gastrointestinal cancer were reviewed.
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To conduct a meta-analysis of observational studies to explore the relationships between cholecystectomy and the risk of esophageal and gastric cancer [GC]. The study design was retrospective, and carried out in the First People's Hospital of Nantong, Jiangsu, China from January 2012 to April 2012. Studies were identified by a literature search of MEDLINE and EMBASE through March 31, 2012, and by manually searching the reference lists of pertinent articles. The summary relative risks [SRRs] with their 95% confidence intervals [CIs] were calculated with a random-effects model. A total of 12 estimates from 6 independent studies [including 1,622 esophageal cancer [EC] cases and 2,314 GC cases] were included in this meta-analysis. We found that cholecystectomy was not associated with risk of EC and GC [EC: SRRs - 1.03; 95% CI: 0.94-1.13; heterogeneity: p=0.496; I2=0; n=4 studies; [GC: SRRs - 1.03; 95% CI: 0.93-1.13; heterogeneity: p=0.652; I2=0; n=5 studies]]. Sub-grouped analyses revealed that these null associations were independent of geographic location and study design. Based on 2 studies, we found patients undergoing cholecystectomy at least 10 years before had an elevated risk of esophageal adenocarcinoma [EAC]. The results of this meta-analysis suggest that cholecystectomy does not increase the risk of esophageal squamous cell carcinoma and GC development, but may increase EAC risk. More epidemiological research of a prospective design is needed to further clarify these associations in the future
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Objective To evaluate the effectiveness and safety of minimal incision laparotomy assisted endoscopic resection for polyps in small intestine in patients with Peutz-Jeghers syndrome. Methods The clinical data of patients with Peutz-Jeghers syndrome, who underwent minimal incision laparotomy assisted endoscopic resection for polyps in small intestine, were retrospectively studied. The size and number of the endoscopically rosected polyps, and the procedure related complications were documented. Results A total of 812 polyps in small-bowel were resected in 8 patients, in which 384 were smaller than 10mm, 356 with diameter ranging from 11 mm to 30mm, and 72 were larger than 30mm in diameter. Procedure related complications included intestinal dysfunction in 1 patient and abdominal pain in another. No bleeding with a fall in Hb or other severe complications were observed. Conclusion Minimal incision laparotomy assisted endoscopic resectio is a safe and reliable procedure for the treatment of mid-small bowel polyps in patients with Peutz-Jeghers syndrome. It revolutionizes the therapeutic options for polyps in the region of the mid-small bowel and limits the indications for primary surgical management.
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Objective To investigate the relationship between the co-expression of CD105 and cyclin D1 and lymph node metastasis and prognosis of esophageal squamous cell carcinoma ( ESCC ). Methods Eighty cases of ESCC tissue were collected at The First People's Hospital of Nantong. The expression of CD105 and cyclin D1 of ESCC was detected by immunohistochemistry. The relationship between the co-expression of CD105 and cyclin D1 and lymph node metastasis and prognosis of ESCC was analysed. Eighty normal esophageal tissues were selected as controls. All data were analysed by t test, chi-square test, and Pearson correlation analysis. Survival was analysed by the Kaplan-Meier survival curve. Microvessel density (MVD) was used to indicate the expression of CD105 in the form of -x±s. Results The expression of CD105 in ESCC tissues was higher (36±8) than that in normal esophageal tissues ( 11±3) (t =25. 129, P＜0.05). The positive rate of cyclin D1 expression in ESCC tissues was 61% (49/80), which was significantly higher than 23% (18/80) in normal esophageal tissues ( x2 =4.972, P＜0.05). The MVD value of 44 patients was ≤36 (LCD105), and nine of them had lymph node metastasis. The MVD value of the remaining 36 patient was ＞ 36 ( HCD105 ), and 26 of them had lymph node metastasis. Twenty-eight patients with positive expression of cyclin D1 had lymph node metastasis, while seven patients with negative expression of cyclin D1 had lymph node metastasis. The results of Pearson correlation analysis revealed that a high expression of CD105 and a positive cyclin D1 expression were correlated with lymph node metastasis (x2 =21.562, 9.217, P＜0.05). The survival times of 28 patients with positive cyclin D1 and HCD105,21 patients with positive cyclin D1 and LCD105, eight patients with negative cyclin D1 and HCD105, and 23 patients with negative cyclin D1 and LCD105 were (31±6) months, (47±7) months, (51±9) months and (61±5) months, respectively, with a significant difference among the four groups (F = 11.76, P ＜ 0. 05 ).Conclusion Co-expression of CD105 and cyclin D1 may be used as a prognostic factor of ESCC.
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Objective To explore the clinical value of peripheral blood albumin gene and alpha-fetoprotein gene in early diagnosis and differential diagnosis ofhepatocellular carcinoma(HCC).Methods Two gene fragments were amplified by nested reverse transcription polymerase chain reaction(RT-PCR)with the samples from patients.Results The positive tales of peripheral blood gene fragments from patients with HCC were 53.7％in AFP and 59.7％in Alb.respectively.The former Wag signifieantly higher than that in liver cirrhosis(LC),chronic hepatitis(CH),acute hepatitis(AH)and extrahepatic tumor(ET).The latter Wag also significantly higher than that in LC,CH and ET(P<O.01),but there were no remarkably difference in the positive rate of Alb.mRNA between HCC and AH.The presenee of AFP-mRNA and AIb-mRNA were correlmed with the stage of HCC and intrahepatic metastasis.Conclusion The results suggest that gene fragments of peripheral blood AFP and Alb are useful marker8 for diagnosis of HCC,differentiating extrahepatic metastasis of HCC and monitoring recurrence after HCC operation.
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Objective To evaluate the value of miniprobe sonography (MPS) in diagnosing gastrointestinal submucosal protrusive lesions and selecting the indicated manual for treatment. Methods According to the sizes, properties, and depth of SMTs in the gastrointestinal tract detected by the MPS, different methods of resection were performed. Results Of 24 cases, 11 SMTs lying in submucosa under 2cm in diameter (2 benign gastrointestinal stromal tumors, 3 lipomas, 5 cysts, 1 granular cell tumor) were attempted with EMR or argon plasma coagulation (APC) ; there were no complications of hemorrhage or perforation. Thirteen SMTs lying in muscularis propria or with size of SMTs above 2 cm in diameter (4 malignant GISTs, 6 benign GISTs, 1 lipoma, 2 aberrant pancreas) were performed by surgical resection. Preoperative diagnoses of SMTs by MPS were consentient with their histological diagnoses. Conclusion MPS may detect the size, property, and depth of SMTs in the gastrointestinal tract and is helpful in selecting indicated cases for endoscopic resection. Endoscopic therapy of SMTs lying in mucosa or submucosa under 2cm in diameter is a safe and effective procedure.