Progress in evaluating the risk of lymph node metastasis in early colorectal cancer / 中华胃肠外科杂志

Early colorectal cancers refer to invasive cancers that have infiltrated into the submucosa without invading muscularis propria, and approximately 10% of these patients have lymph node metastases that cannot be detected by conventional imaging. According to the guidelines of Chinese Society of Clinical Oncology (CSCO) Colorectal Cancer, early colorectal cancer cases with risk factors for lymph node metastasis (poor tumor differentiation, lymphovascular invasion, deep submucosal invasion and high-grade tumor budding) should receive salvage radical surgical resection; however, the specificity of this risk-stratification is inadequate, making most patients undergo unnecessary surgery. Firstly, this review focuses on the definition, oncological impact importance and controversy of the above "risk factors". Then, we introduce the progress of the risk stratification system for lymph node metastasis in early colorectal cancer, including the identification of new pathological risk factors, the construction of new risk quantitative models based on pathological risk factors, artificial intelligence and machine learning technology and the discovery of novel molecular markers associated with lymph node metastasis based on gene test or liquid biopsy. Aim to enhance clinicians' understanding of the risk assessment of lymph node metastasis in early colorectal cancer; we suggest to take the patient's personal situation, tumor location, anti-cancer intention and other factors into account to make individualized treatment strategies.

From rural practice to national strategy for colorectal cancer screening in China--Mr. Zheng Shu who is a pioneer and practitioner / 中华胃肠外科杂志

Haining City and Jiashan County in Zhejiang Province are the first areas to carry out colorectal cancer screening in China, which started in the early 1970s and has been going on for more than 40 years. Meanwhile, Haining and Jiashan have also become the first batch of National Demonstration Bases for Early Diagnosis and Treatment of Colorectal Cancer. In the past 40 years, owing to Professor Zheng Shu who is brave and innovative, with an indomitable spirit, as well as the unremitting efforts and active exploration of all the team members, colorectal cancer screening which was unknown by the public and implemented with difficulties, has gradually been widely accepted and benefited the population. Today, remarkable achievements have been fulfilled in the colorectal cancer screening of Haining and Jiashan which has become the pioneer power in promoting the progress of colorectal cancer prevention and control in China and has certain influence both on China and the world. Meanwhile, a set of colorectal cancer screening strategies suitable for China has been explored and further promoted to be used nationwide, which is of great significance to the prevention and control of colorectal cancer in China. Looking forward to the future, the prevention and control of colorectal cancer in China is still difficult. We will continue to give full play to our existing advantages, not forget our original intention, move forward, explore innovation, and create greater glories!

Clinical value of radial endorectal ultrasound in the assessment of preoperative staging of rectal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the clinical value of radial endorectal ultrasound (ERUS) in the assessment of preoperative staging of rectal carcinoma.</p><p><b>METHODS</b>One hundred and ten patients with rectal cancer underwent preoperative endorectal ultrasound (ERUS) examination in our hospital from February 2010 to September 2011. ERUS was performed using a Hitachi 900, Hitachi HI Vision Preirus US scanner, with a 5 - 10 MHz rigid rotating radial transducer and a focal length of 2 - 5 cm. The size, shape, echo pattern, infiltration depth, degree of circumferential involvement, extra-rectal invasion of the lesions and lymph node involvement were observed. The results of ERUS staging were compared with histopathological findings of the surgical specimens.</p><p><b>RESULTS</b>The accuracy of ERUS for T staging was 91.4%. The accuracy of ERUS in diagnosing stage T1, T2, T3, T4 cancers was 92.7%, 88.2%, 88.2% and 96.4%, respectively. The sensitivity of ERUS in diagnosing stage T1, T2, T3, T4 cancers was 92.3%, 72.7%, 85.4% and 71.4%, respectively. The specificity of ERUS in diagnosing stage T1, T2, T3, T4 cancer was 92.9%, 92.0%, 90.3% and 100.0%, respectively. Comparing the consistency of preoperative T-staging and postoperative pathological results, the Kappa value was 0.75, with a considerable consistency. The sensitivity, specificity, and accuracy of ERUS in the assessment of lymph node metastasis were 74.2%, 89.9% and 85.5%, respectively. Comparing the consistency of preoperative N-staging and postoperative pathological results, the Kappa value was 0.64, with a considerable consistency.</p><p><b>CONCLUSIONS</b>ERUS is a practical and accurate tool in assessment of preoperative staging of rectal tumors in regard to tumor invasion depth (T) and regional lymph node status (N), with advantages of simple operation, less pain, and high accuracy.</p>

A meta-analysis of the safety of simultaneous versus staged resection for synchronous liver metastasis from colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety of simultaneous and staged resection for synchronous liver metastasis from colorectal cancer.</p><p><b>METHODS</b>PubMed/Medline, ISI Web of Knowledge, Springer link, ebscohost, Elsevier Wiley Interscience, Google Scholar were searched for case-control studies concerning simultaneous versus staged resection of synchronous liver metastasis from colorectal cancer between January 1989 and March 2009. A meta-analysis was performed to analyze the morbidity and perioperative mortality.</p><p><b>RESULTS</b>Seven case-control studies, with a total of 1390 patients of liver metastasis from colorectal cancer undergone curative hepatic resection, were reviewed. There were 495 simultaneous and 895 staged resections. Perioperative mortality was 1.1% in the staged resection group and 2.4% in the the simultaneous group, the difference was statistically significant[Peto OR 3.39, 95% CI 1.29-8.93, P=0.01]. No significant difference was found in morbidity between two groups[OR(random)0.88, 95% CI 0.51-1.51, P=0.64].</p><p><b>CONCLUSION</b>Selective staged resection is safe for synchronous liver metastasis from colorectal cancer.</p>

Quality of life in patients with rectal cancer after laparoscopic colectomy / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To assess the quality of life in patients with rectal cancer after laparoscopic colectomy.</p><p><b>METHODS</b>From Sep.2004 to Dec. 2005, 51 patients with rectal cancer were recruited in this prospective, non-randomized study.Twenty-three patients underwent laparoscopic colectomy (LC), 28 patients had open colectomy (OC). EORTC QLQ-C30 and QLQ-CR38 questionnaire were applied to evaluate quality of life baseline, discharging and 3 months after operation.</p><p><b>RESULTS</b>Before operation,the median score of role functioning in LC group was lower. However, LC group patients complained less financial difficulties. The differences were of statistical significance (P<0.05), but not of clinical significance. The median scores of other function domains and symptom domains were similar between two groups (P>0.05). Postoperatively, the most median scores of function domains and symptom domains between two groups were similar (P>0.05). The only score with statistically significant difference was the pain when patients left hospital (U=218.5, P=0.042). However, the difference was not of clinical significance, too.</p><p><b>CONCLUSION</b>Only minimal benefits in short-term postoperative quality of life are found with laparoscopic colectomy in patients with rectal cancer compared with open colectomy.</p>

Efficacy and safety of adjuvant post-surgical therapy with imatinib in gastrointestinal stromal tumor patients with high risk of recurrence: interim analysis from a multicenter prospective clinical trial / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of postoperative adjuvant chemotherapy with imatinib in gastrointestinal stromal tumor(GIST) patients who had high risk of recurrence.</p><p><b>METHODS</b>A prospective, open-label, multi-center trial conducted in sixteen teaching hospitals in China was carried out. The criteria of the enrolled patients included age more than 18 years old, CD117 positive GIST, tumor size more than 5 cm, pathological mitosis counts more than 5/50 HPF, and treatment beginning within 4 weeks after complete resection and with imatinib (400 mg, once a day) for at least 12 months. The 1, 3 year recurrence rates, disease free survival, overall survival rate and quality of life were evaluated.</p><p><b>RESULTS</b>From Aug. 16th 2004 to Sep. 13th 2005, there were totally 74 patients screened and 57 patients (34 men, 23 women) enrolled in the imatinib treatment group. The primary tumors were located in the stomach in 50.9%, the small intestine in 38.6% and the colorectum in 10.5% of the cases. All the patients received radical resection. Until the cut-off date of interim analysis, there was no evidence of tumor relapse or metastasis in all patients and no death was reported either. Among the 57 enrolled patients with intention to treat(ITT), twelve patients finished the protocol (per protocol, PP). The disease free survival was (268.3 +/-120.2) d in ITT analysis, and (396.7+/-38.2) d in the PP analysis. The incidence of adverse effect was 44.4% . The score in quality of life showed no statistically significant difference between the baseline visit and the follow-up visits.</p><p><b>CONCLUSION</b>Imatinib is a promising postoperative adjuvant chemotherapy in GISTs patients with high risk of recurrence, and the adverse effects are receivable.</p>

Study on relationship of fucosyltransferase gene types in breast cancer with metastasis and prognosis / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the association of five types of fucosyltransferase gene (Fuc-T), the important biosynthesis gene of sialylated carbohydrate antigens (Sialyl Lewis A, Sialyl Lewis X), with metastasis and prognosis of breast cancer.</p><p><b>METHODS</b>The real-time quantitative PCR of five-type Fuc-T III, IV, V, VI, VII genes was performed in 80 patients with breast cancer.</p><p><b>RESULTS</b>The result showed that Fuc-TVII gene had higher gene copy compared to other type of Fuc-T in breast cancer. The grading of Fuc-TVII gene was related to lymph node metastasis and poor disease-free survival. Statistically difference was significant (P < 0.01). Fuc-T III, IV, V, VI gene were not significant relation to the metastasis and prognosis in 80 cases.</p><p><b>CONCLUSIONS</b>These findings suggest that Fuc-TVII gene is a prognostic indicator of breast cancer, and it may be play an important role in the biosynthesis of sialylated carbohydrate antigens in breast cancer.</p>

Expression of sialylated carbohydrate antigens and nm23-H1 gene in prognosis of breast cancer / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To assess the significance of expression of sialylated carbohydrate antigens and nm23-H1 gene in metastasis and prognosis of breast cancer.</p><p><b>METHODS</b>Tissue specimens from 102 cases of primary breast cancer were stained with antibodies against sialyl Lewis A (SleA) and salyl Lewis X (SleX), and nm23-H1 proteins by immunohistochemical methods.</p><p><b>RESULT</b>Of the 102 cases, the positive cases of SleA and SleX were 24.5% (25/102) and 59.89% (61/102),respectively; the reduced expression of nm23-H1 was showed in 37.3% (38/102) of the cases. The positive expression of SleX and the reduced expression of nm23-H1 gene were significantly associated with lymph node involvement. Among the 100 patients who underwent curative surgery, the disease-free survival rate was significantly correlated with nm23-H1 and SleX expression, respectively,but not with SleA expression. In multivariate analysis using Cox regression model, combination assay of nm23 H1 and SleX expression emerged as independent prognostic factors.</p><p><b>CONCLUSION</b>These results suggest that nm23-H1 gene and SleX may be involved in the metastatic process in human breast cancer, and immunohistochemical detection of SleX and nm23-H1 may be used as a biologic marker of prognosis.</p>

Improvement of wound treatment in modified radical mastectomy of breast cancer / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To evaluate the efficacy of Dexon continuous intracutaneous sewing (DCIS) and Redon negative pressure absorbing drainage (RNPAD) in modified radical mastectomy of breast cancer.</p><p><b>METHODS</b>The clinical data of 128 patients treated with DCIS and RNPAD, and 123 cases treated with traditional sewing and negative pressure absorbing ball were analyzed retrospectively.</p><p><b>RESULTS</b>There were 16 cases (12.5%) of seroma formation,1 (0.8%) of skin flay necrosis among 128 cases treated by DCIS and RNPAD, and 47 cases (38%) of seroma formation, 16 (13%) of skin flay necrosis among 123 cases treated by traditional method. The statistically significant difference was found (P <0.001). The average length of post-operation hospital stay in DCIS and RNPAD group was 8.8 days compared with 14.7 days in traditional treatment group.</p><p><b>CONCLUSION</b>The use of DCIS and TNPAD could decrease the complication rate of breast cancer operation.</p>