Interim report of prospective clinical study of two different digestive tract reconstruction after total gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare post-operative long-term complications and quality of life of two digestive reconstruction procedures after total gastrectomy.</p><p><b>METHODS</b>A total of 109 gastric cancer patients in Tianjin Medical University Cancer Hospital from March 2012 to February 2013 were prospectively enrolled and randomly divided into functional jejunal interposition (FJI) group (52 cases) and Roux-en-Y (R-Y) group (57 cases). The post-operative complications, nutritional status, and the quality of life were compared between two groups.</p><p><b>RESULTS</b>One, 3 and 6 months after operation, the incidence of R-S syndrome in FJI group was lower as compared to R-Y group[13% (6/45) vs. 37% (18/49), 3% (1/30) vs. 42% (14/33), 5% (1/21) vs. 48% (11/23), all P<0.01], while 3 months after operation, the incidence of reflux and heartburn in FJI group was higher[53% (16/30) vs. 21% (7/33), P<0.01; 37% (11/30) vs. 12% (4/33), P<0.05]. There were no significant differences in quality of life questionnaire QLQ-C30 between R-Y and FJI groups. QLQ-STO22 stomach module revealed in FJI group, the eating score was better, but reflux score was worse as compared to R-Y group 3 months after operation (all P<0.01).</p><p><b>CONCLUSIONS</b>Functional jejunal interposition keeps intestinal continuity preserving and food duodenal passing, which is a reasonable digestive reconstruction procedure.</p>

Mechanism study on intestinal motility of reconstruction procedures after total gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the mechanism of reconstruction procedures affecting intestinal motility after total gastrectomy.</p><p><b>METHODS</b>Beagle dogs were divided into 3 groups:3 dogs in sham operation group, 7 in functional jejunal interposition (FJI) group, and 3 in Roux-en Y(RY) group. These dogs were sacrificed 48 hours postoperatively. Dogs were gavaged with active carbon 1 h before sacrifice and the intestinal transit rate was evaluated. Intestinal tissues 5 cm away from the duodenojejunal anastomosis were collected for detecting inflammation, interstitial cells of Cajal (ICC), and apoptosis using HE staining, immunohistochemistry, and interference microscope respectively.</p><p><b>RESULTS</b>The intestinal transit rate in sham and FJI group (0.14 ± 0.03 and 0.32 ± 0.11) was lower than that in RY group (0.52 ± 0.21, P<0.05), which indicated FJI procedure had better food storage. More ICCs were found in submucosa of FJI group than those of RY group. Inflammation in serosal side of the intestine, including hemorrhage, fibrin deposition, and ulceration, neutrophil and macrophage infiltration, and intestinal epithelial cell apoptosis were significantly reduced in FJI group as compared to RY group, which indicated that amelioration of intestinal inflammation and damage might contribute to reducing ICC loss in FJI group.</p><p><b>CONCLUSIONS</b>As a reconstruction procedure with less traumatic and intestinal continuity preserving, FJI has better reservoir function and quicker recovery of intestinal motility.</p>

Efficacy and survival status of retuximab-NCE regimen treatment in patients with relapsed or refractory B cell non-Hodgkin's lymphoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The aim of this study was to analyze the efficacy and toxicity of RNCE regimen in the treatment of relapsed or refractory B cell non-Hodgkin's lymphoma (NHL).</p><p><b>METHODS</b>From January 2000 to December 2005, 46 patients with relapsed or refractory B cell NHL were treated by RNCE regimen with or without radiotherapy for the involved field. The clinical characteristics, response, toxicity and long-term survival results were analyzed retrospectively.</p><p><b>RESULTS</b>A total of 46 patients were eligible. The complete response rate of second-line therapy was 52.17% (24/46), and the overall response rate was 82.61% (38/46). The median follow-up duration in this series was 69 months (range:6 to 102 months). The overall 1, 3, 5-year survival rate was 74.8%, 48.3%, 40.1%, respectively, with a median survival time of 30.2 months (5 to 65 months), and median progression free survival time of 10.9 months (2 to 31 months). The major toxicities were myelosuppression, GI toxicity, fatigue, fever and alopecia.</p><p><b>CONCLUSION</b>Our data show that RNCE regimen treatment is effective and well tolerated in patients with relapsed or refractory B cell non-Hodgkin's lymphoma.</p>

Expression of Cdc7 and mcm2 as a marker for proliferation and prognosis in diffuse large B cell lymphoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The aim of this study was to assess the expression of cell division cycle 7 (Cdc7) kinase and minichromosome maintenance protein 2 (MCM2) in diffuse large B cell lymphoma (DLBCL) and explore their relationship with prognosis of DLBCL patients.</p><p><b>METHODS</b>Clinical data of 60 DLBCL patients treated in our hospital from 2008.1 to 2010.1 were collected. The expression levels of Cdc7 and MCM2 in peripheral blood and bone marrow were determined by real-time PCR. A statistical analysis was carried out to evaluate their association with prognosis in DLBCL patients.</p><p><b>RESULTS</b>The 2-year survival rate of patients with high expression of peripheral blood Cdc7 was 38.3% and those with low expression 65.4% (P = 0.001). The 2-year survival rate of patients with high expression of bone marrow Cdc7 was 37.2% and those with low expression was 75.5% (P = 0.032). The 2-year survival rate of patients with high expression of MCM2 in peripheral blood was 44.0% and those with low expression was 68.2% (P = 0.025). The 2-year survival rate of patients with high expression of MCM2 in bone marrow was 39.0% and those with low expression was 63.4% (P = 0.007). A poor disease specific survival was observed in DLBCL patients with high level expression of Cdc7 and MCM2.</p><p><b>CONCLUSIONS</b>Cdc7 and MCM2 expression can be used to assess tumor proliferation and may be useful as an additional marker in combination with conventional markers in prediction of the outcome of DLBCL patients. Moreover, the Cdc7 and MCM2 signal pathway might be useful as a new approach in the treatment of refractory DLBCL lymphoma patients.</p>

In vitro synergistic effect of bortezomib and pirarubicin on proliferation and apoptosis of T cell lymphoma cell line Hut-78 cells / 中华血液学杂志

<p><b>OBJECTIVE</b>To investigate the in vitro effect of bortezomib (BTZ) alone and in combination with pirarubicin (THP) on the growth inhibition of human cutaneous T-cell lymphoma cell line Hut-78.</p><p><b>METHODS</b>Hut-78 cells were cultured with different concentrations of BTZ or THP alone and the two drugs combination for 48 h. Cell proliferation, cell cycle and apoptosis were evaluated. The cell cycle inhibitor P21 was determined by Western blot.</p><p><b>RESULTS</b>BTZ or THP alone significantly inhibited the growth of Hut-78 cells in a time- and dose-dependent manner. In the combination groups, the inhibitory effect of BTZ followed by THP was the highest (P < 0.01). When the inhibition rate was more than 50%, the combination index analysis showed significant synergistic if treated with BTZ followed by THP or the two at the same time, but antagonistic if treated with THP followed by BTZ. With the inhibition rate increasing, only the synergistic effect of BTZ followed by THP was further increased. The apoptosis rate of BTZ followed by THP was higher than that of single agent each (P < 0.01). BTZ alone significantly increased the proportion of cells in G(2)/M phase (P < 0.01) in a dose-dependent manner and up-regulated the expression level of P21. Sequential THP notably enhanced BTZ-induced cell cycle arrest and apoptosis.</p><p><b>CONCLUSIONS</b>BTZ alone effectively induces growth inhibition and apoptosis of Hut-78 cells in vitro. BTZ followed by THP can synergistically enhance this cytotoxic effect. The mechanism may be that THP enhances BTZ-induced G(2)/M arrest and P21 up-regulation.</p>

Clinical characteristics and treatment analysis of primary breast lymphoma: 49 cases report / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the morbidity, clinical characteristics, diagnosis, metastasis, treatment and prognosis of primary breast lymphoma (PBL).</p><p><b>METHODS</b>From January 1960 to August 2007, 49 cases with PBL were treated among 22811 cases of breast malignancy and 7337 cases of malignant lymphoma. The clinical data of these 49 patients, included gender, age, pathologic type, breast X ray and B ultrasound examination results, involved lymph nodes and organs, treatment, survival time, were retrospectively analyzed.</p><p><b>RESULTS</b>From 1960 to 2007, the incidence rate of PBL in Tianjin Municipality was 59/10 millions; in details, the incidence rate of PBL for every 10 years was 2/10 millions, 3/10 millions, 0, 13/10 millions and 32/10 millions, respectively. According to circle graph of age, PBL occurred frequently in female aged 30 to 59 years. Most of this group of PBL was non-Hodgkin lymphoma (48 cases). No typical characteristics was found with the examination of breast X ray, B ultrasound and frozen section pathology. Bone marrow (9 cases), lung (7 cases), meninges (4 cases) and ovary (4 cases) were frequently involved organs. The overall 5-year survival rate was 6.1% for the group. The prognosis in patients with radical mastectomy combined chemotherapy was much better than that in patient received super to local mastectomy plus chemotherapy or simple tumor resection plus chemotherapy (5-year survival rates were 21.4%, 0, 0, respectively).</p><p><b>CONCLUSIONS</b>PBL is a kind of rare lymphoma with incidence increasing sharply in the past few decades. The clinical manifestation is atypical. Diagnosis of PBL should adopt histological examination. Radical mastectomy combined chemotherapy could bring better prognosis, but the prognosis is still poor.</p>

Capecitabine combined with weekly docetaxel in Chinese patients > 65 years with anthracycline-resistant metastatic breast cancer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There are no data on more tolerable capecitabine doses in elderly patients in Chinese population. The aim of this study was to evaluate the activity and safety of capecitabine combined with weekly docetaxel for the treatment of anthracycline-resistant metastatic breast cancer (MBC) in older Chinese patients.</p><p><b>METHODS</b>MBC patients aged > 65 years pretreated with 1 - 5 prior chemotherapy regimens, including an anthracycline, received oral capecitabine 825 mg/m(2) twice daily, days 1 - 14, plus docetaxel 30 mg/m(2) on days 1 and 8 every 21 days. All 41 enrolled patients received at least 1 dose of treatment and were evaluable for safety; 38 received at least 2 cycles (median 4, range 2 - 8) and were evaluable for efficacy.</p><p><b>RESULTS</b>The overall objective response rate was 47%, including complete responses in 8% of patients. Median time to progression was 8.9 months. Median overall survival was 17.6 months. The most common side effects were haematological and gastrointestinal toxicities and hand-foot syndrome. The only grade 3/4 adverse events were neutropenia (12%), alopecia (7%), grade 3 nausea and vomiting (2%) and grade 3 nail toxicity (2%).</p><p><b>CONCLUSIONS</b>Capecitabine 825 mg/m(2) twice daily plus weekly docetaxel is active with an acceptable safety profile in Chinese women > 65 years with anthracycline-resistant MBC. Efficacy and tolerability compare favourably with previously reported trials evaluating higher capecitabine doses in combination with 3-weekly or weekly docetaxel.</p>

Killing effect of interleukin-18-enhanced FasL-expressing colon cancer cells on human hepatocytes in vitro / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the influence of mutual interactions between FasL expressed by colon carcinoma cells and endogenous cytokines interleukin-18 on liver metastasis and invasion of human colon cancer cells.</p><p><b>METHODS</b>Using immunohistochemical streptavidin-biotin complex (SABC) method, the expressions of Fas receptor and Fas ligand in SW620 colon carcinoma cells and Chang liver cells were observed so as to provide morphological evidence for the functions of Fas receptor and Fas ligand. In an effort to examine the cytotoxicity of effector cells, CytoTox(96) Non-Radioactive Cytotoxicity Assay was adopted to measure the LDH releasing value after the SW620 cells were co-cultured with Chang liver cells.</p><p><b>RESULTS</b>It was shown that the Fas ligand of colon carcinoma SW620 cells was positive and the positive substances were distributed in the cell membrane and cytoplasm, and the Fas receptor of colon carcinoma SW620 cells was negative. The Fas receptor of Chang liver cells turned out to be positive and the positive substances were distributed in the cell membrane, and the Fas ligand of Chang liver cells was negative. At 6 hours after co-culture of IFN-γ-stimulated Chang liver cells with interleukin-18-stimulated (for 36 h) SW620 cells or unstimulated SW620 cells, the cytotoxicity of SW620 cells to IFN-stimulated Chang liver cells at effector-to-target ratios of 10:1, 5:1, 2.5:1 and 1.25:1 was 68.3%, 49.8%, 21.1%, 9.7% (F = 76.87, P < 0.05) and 32.7%, 21.8%, 11.1%, 6.7% (F = 7.27, P < 0.05), respectively. The non-radioactive cytotoxicity assay showed that the apoptotic rate of Chang liver cells was remarkably increased with the increase of planting concentration of SW620 after the SW620 cells were co-cultured with Chang liver cells. The cytotoxicity was significantly enhanced by interleukin-18.</p><p><b>CONCLUSION</b>The FasL expression of human colon cancer cells may be regulated by endogenous interleukin-18 in the host microenvironment and enhance the liver colonization competence of colon cancer cells through induction of apoptosis in the Fas-expressing hepatocytes.</p>

Analysis of the surgical outcome and prognostic factors for hilar cholangiocarcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the therapeutic strategies and prognostic factors which influence on clinical outcome of hilar cholangiocarcinoma.</p><p><b>METHODS</b>A total of 144 patients with hilar cholangiocarcinoma underwent operation between January 1990 and December 2005 were analyzed, including 102 males and 42 females with 36- 74-years-old. All patients underwent resection among which 86 cases (59.7%) had an R0 resection (negative histologic margins), 34 cases (23.6%) had an R1 resection (positive histologic margins), 24 cases (16.7%) had an R2 resection. The Bismuth-Corlette classification of group R0 and R1: 28 cases (23.3%) in type I , 49 cases (40.8%) in type II, 10 cases (8.3%) in type III A, 19 cases (15. 8%) in type III B and 14 cases (11.7%) in type IV. The TNM stages of group R0 and R1: 19 cases (15.8%) in stage I, 80 cases in stage II (66.7%), 16 cases in stage III (13.3%), 5 cases in stage IV (4.2%). In group R0 and R1, there were 41 cases with well differentiated and 79 cases with moderately and poorly differentiated, 62 cases (51.7%) with negative lymph nodes and 58 cases (48.3%) with positive lymph nodes, 42 cases in stage T1 and 78 cases in stage T2-3, 86 cases with negative blood vessel metastasis and 34 cases with positive blood vessel metastasis.</p><p><b>RESULTS</b>The median survival time was 46.8 months after R0 resection, 18.3 months after R1 resection, and 11.2 months after R2 resection. The 1-, 3- and 5-year cumulative survival rates of the patients were 60.2%, 36.1% and 29.4%. Survival rates after resection in patients with negative lymph nodes (n = 62) were significantly longer than that in those with positive lymph nodes (n = 58) (P < 0.01). The T stage system predicted respectability and the likelihood of an R0 resection and correlated with survival (P = 0.030). Patients requiring portal vein resection had a worse prognosis than those without vascular resection (P = 0.047) but still survived longer than patients who were unresectable (P < 0.01).</p><p><b>CONCLUSIONS</b>Negative histologic margins, concomitant partial hepatectomy, and well-differentiated tumor histology are associated with improved outcome after all hilar cholangiocarcinoma resections. In patients who underwent an R0 resection, concomitant partial hepatectomy is the only independent predictor of long-term survival.</p>

Cryoablation for prostate cancer induces tumor-specific immune response / 中华男科学杂志

<p><b>OBJECTIVE</b>To assess the anti-tumor immune response to percutaneous cryoablation in patients with local prostate cancer.</p><p><b>METHODS</b>We treated 10 patients with local prostate cancer by percutaneous cryoablation, collected the blood samples before and 2 weeks after the treatment and isolated peripheral blood mononuclear cells (PBMCs). Protein lysates were made by biopsy from autologous prostate cancer or non-cancer tissues. The levels of serum TNF-alpha, IFN-gamma, IL4 and IL-10 were determined by enzyme-linked immunosorbent assay (ELISA) and the Th1/Th2 ratio was calculated by the IFN-gamma/IL-4 ratio. The number of IFN-gamma + T cells under the stimulation of different protein lysates was counted by enzyme link immunol spot (ELISPOT). And the cytolytic activity of cytotoxic T lymphocytes (CTL) was detected by LDH assay.</p><p><b>RESULTS</b>Compared with pre-treatment, the levels of TNF-alpha and IFN-gamma, the Th1/ Th2 ratio and the number of IFN-gamma + T cells induced by tumor protein lysates in PBMCs were increased significantly after cryosurgery (P < 0.01), while the levels of IL4 and IL-10 decreased slightly, and the non-tumor protein lysates induced no obvious changes in the number of IFN-gamma T cells. The cytolytic activity of cytotoxic T lymphocytes against human prostate cancer cells LNCaP was markedly increased, but not that against renal cancer cells GRC-1. One case of recurrence was found during the 3-6 months follow-up.</p><p><b>CONCLUSION</b>Percutaneous cryoablation for prostate cancer could induce a tumor-specific immune response.</p>

Clinical impact of extracapsular extension of axillary lymph node metastases in breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the clinical significance of extracapsular extension (ECE) of axillary lymph node metastases in breast cancer.</p><p><b>METHODS</b>The clinicopathological data of 1230 cases of nodal positive breast cancer treated in our department from 1989 to 1995 were analyzed retrospectively.</p><p><b>RESULTS</b>486 (39.5%) from the 1230 cases were ECE positive. There was a higher incidence of ECE in postmenopausal women than premenopausal ones (47.5% versus 35.5%, respectively, P < 0.001). The patients in ECE positive group had a larger tumor size (5.11 +/- 2.53 cm versus 3.90 +/- 1.80 cm, P < 0.001). 18.3% of patients with stage T1 were ECE positive, stage T2 were 36.4%, and stage T3 were 54.4%, and the difference was significant (P < 0.001). ECE was correlated with the number of positive axillary lymph nodes. The ECE positive group had more positive nodes than ECE negative group (16.96 +/- 12.16 versus 5.24 +/- 6.60, P < 0.001). 6.1% of patients with 1 positive node were ECE positive, 13.5% with 2 - 3, 35.8% with 4 - 9, 62.3% with 10 - 19, and 84.0% with more than 20 positive axillary nodes, and there was a significant difference among those groups (P < 0.001). ECE had no association with ER/PR status (P = 0.706). ECE was a risk factor of local-regional recurrence, but the relapse time had no significant difference (P = 0.559). ECE was also a risk factor of distant metastasis, and the relapse time had a significant difference (P < 0.001). The median metastasis free time was 30.0 (2 approximately 172) months in ECE positive group, while 37.5 (2 approximately 170) months in ECE negative group (P = 0.006). CE occurred in 60.4% of the patients with firstly diagnosed bone, skin and distant lymph node metastasis, but in 42.0% of the patients with firstly diagnosed visceral metastasis (P = 0.001). The metastasis-free survival rate, locoregional recurrence-free survival rate and overall survival rate of the ECE positive group were much shorter than that of the ECE negative group. COX proportional hazard regression single factor analysis and multi-factor analysis suggested that ECE is an independent factor of metastasis-free survival, locoregional free recurrence and overall survival.</p><p><b>CONCLUSION</b>The presence of ECE in breast cancer is positively related with tumor size and the number of positive lymph nodes. It is also a risk factor of locoregional recurrence and distant metastasis. ECE positive group has a much shorter metastasis-free survival, locoregional recurrence-free survival and overall survival. ECE is a risk factor of those three indexes.</p>

Relationship between the expression of matrix metalloproteinase-13 protein and other biomarkers, prognosis in invasive breast cancer / 中华病理学杂志

<p><b>OBJECTIVE</b>The study was designed to investigate the expression patterns of metalloproteinase (MMP)-13 protein in invasive breast carcinoma and to determine the clinicopathological and prognostic values of its various localization and relation to the tumor phenotypes.</p><p><b>METHODS</b>Immunohistochemistry was performed on paraffin-embedded tissue array from 263 invasive breast carcinomas to investigate the protein expressions of MMP-13, estrogen receptor, progesterone receptor, HER2, MMP-2, MMP-9 and tissue inhibitor of matrix metalloproteinases (TIMP)-1, TIMP-2.</p><p><b>RESULTS</b>MMP-13 protein was detected in the cytoplasm of carcinoma cells and peritumoral fibroblasts. High level expression of MMP-13 protein in tumor cells was associated with more lymph node involvement and higher tumor grade (both P < 0.01), and positively correlated with HER2 (P = 0.015) and TIMP-1 protein (P < 0.01) expression in carcinoma cells. Moreover, high expression of MMP-13 was associated with shortened overall survival for the entire patient population and the patient group with positive lymph node. Tumor cell derived MMP-13 had different impact on patients with different HER2 status. Peritumoral fibroblasts derived MMP-13 protein, although correlated with tumor cell derived MMP-13 and associated with lymph node stage and HER2 expression, was found having less prognostic impact. Univariate survival analysis showed that the tumor size, grade, lymph node status, PR status, HER2 expression, tumors TIMP-1 and MMP-13 expression were prognostic factors. However, multivariate survival analysis showed that only tumor size, lymph node status, HER2 expression, tumors TIMP-1 and MMP-13 were independent prognostic factors.</p><p><b>CONCLUSION</b>MMP-13 protein expressed by tumor cells correlates with the invasion and metastasis of breast carcinoma, and therefore, may serve as a poor prognostic marker for the patient.</p>

Cox proportional hazard model analysis of prognosis in patients with carcinoma of esophagus and gastric cardia after radical resection / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the factors affecting the long-term survival of patients with carcinoma of esophagus and gastric cardia after curative resection.</p><p><b>METHODS</b>The clinical data of 906 patients with carcinoma of esophagus and gastric cardia treated by radical resection in 1996 - 2004 were analyzed retrospectively. Twelve clinicopathological factors possibly influencing survival were encoded and assessed by Cox regression analysis.</p><p><b>RESULTS</b>The 1-, 3- and 5-year cumulative survival rates were 89.8%, 75.4% and 71.7%, respectively. The univariate analysis showed that age, length of tumor, pathological differentiation, number of metastatic lymph nodes, depth of invasion, involvement of adjacent organs and the TNM stage influenced the prognosis significantly (P < 0.01). However, multivariate analysis showed that pathologic differentiation, number of metastatic lymph nodes, involvement of adjacent organs and TNM stage were independent prognostic factors (P < 0.05).</p><p><b>CONCLUSION</b>The independent prognostic factors of the patients with carcinoma of esophagus and gastric cardia are pathologic differentiation, TNM stage, number of metastatic lymph nodes, and involvement of adjacent organs. The other factors influencing survival are age, length of tumor and depth of invasion. Furthermore, invasion of adjacent organs suggests worse prognosis, and should be followed-up closely.</p>

Prognostic analysis of liver metastasis in gastric cancer patients with radical gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To elucidate the prognostic factors of liver metastasis in gastric cancer patients with radical gastrectomy.</p><p><b>METHODS</b>Clinicopathological data of 87 liver metastasis patients, undergone radical gastrectomy for gastric cancer from 1996 to 2001, were retrospectively analyzed.</p><p><b>RESULTS</b>Of these 87 patients, the 1-, 3- and 5-year survival rates were 28.8%, 3.6% and 0 respectively and the average survival time after gastrectomy was (11.3+/-1.1) months. By univariate analysis, tumor location, tumor size, histologic differentiation, invasive depth, Lauren classification, metastasis of lymph nodes from lymphadenectomy, vascular invasion, nervous invasion, peritoneal metastasis, number of liver metastasis, liver metastatic distribution and resection of liver metastasis were found to be significant factors associated with the prognosis of liver metastatic patients after radical gastrectomy. By multivariate analysis, location, the Lauren classification, liver metastatic distribution and resection of liver metastasis were found to be independent factors associated with hepatic metastasis after radical gastrectomy.</p><p><b>CONCLUSION</b>Location of gastric cancer, Lauren classification, liver metastatic distribution and resection of liver metastasis are important factors to evaluate the prognosis of liver metastasis in gastric cancer patients with radical gastrectomy.</p>

Expression change of apoptosis-associated genes after hyperthermia, chemotherapy and radiotherapy in human colon cancer-transplanted nude mice / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the expression change of apoptosis-associated genes in human colon cancer cells transplanted into nude mice after hyperthermia, chemotherapy and radiotherapy.</p><p><b>METHODS</b>Human colon cancer cell line HT29 was transplanted into the hind limbs of nude mice. Under the laboratory-simulated condition of hyperthermia(43 degree centigrade, 60 min), actual radiation doses and MMC doses were calculated in reference to the clinical practice. The mice were divided into 6 groups according to the treatment approaches: hyperthermia (group A), chemotherapy (group B), radiotherapy (group D), thermochemotherapy (group C), thermoradiotherapy (group E) and thermochemoradiotherapy (group F). The mice were sacrificed at different time points and the tumor tissues were taken for further procedures. The morphologic changes of P53, Bcl-2 and Bax expression in membrane, cytoplasm and nucleus of tumor cell after treatment were observed by immunohistochemistry stain (SP method).</p><p><b>RESULTS</b>All of the six approaches of treatment could down-regulate the expression of P53 and Bcl-2, and up-regulate the expression of Bax in different levels. There was no significant difference in the amount of reduction of P53 expression among group A, C and E. The extent of reduction in the above mentioned groups was significantly different as compared to group B and D. By comparing to group D, the extent of reduction of P53 expression was greater in group B. Down-regulation of Bcl-2 could be enhanced when hyperthermia was combined with chemotherapy (group C) or radiation (group E), but more obvious down-regulation was found in group E as compared to group C. Hyperthermia itself could not obviously up-regulate Bax expression, and it occurred at last. Bax expression increased more by chemotherapy treatment (group B) than that by radiation (group D). By comparing to group C, the greater increase occurred in group E.</p><p><b>CONCLUSIONS</b>Hyperthermia enhances the effects of radiosensitivity and chemosensitivity on tumors by changing the expression of apoptosis-associated genes P53, Bcl-2 and Bax. Hyperthermia combined with chemotherapy and/or radiation has a greater effect on down-regulation of P53 and Bcl-2 expression and up-regulation of Bax expression than any single therapy.</p>

DNCE regimen for treatment of refractory or relapsed aggressive and highly aggressive non-Hodgkin lymphoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of DNCE [DXM, navelbine (NVB), DDP and Vp-16] regimen and DICE [dexamethasone (DXM), ifosfamide (IFO), cisplatin (DDP) and etoposide (Vp-16)] regimen in the treatment of refractory or relapsed aggressive and highly aggressive non-Hodgkin lymphoma (NHL).</p><p><b>METHODS</b>A total of 69 patients with histopathologically proved advanced aggressive and highly aggressive NHL were randomized into trial group (32 patients treated with DNCE regimen) and control group (37 patients treated with DICE regimen). The control group was given DICE regimen: DXM 20 mg, iv d1 approximately d4; IFO 1 g/m2), iv d1 approximately d4; Mesna 400 mg, iv q8h, d1 approximately d4; DDP 25 mg/m2, iv d1 approximately d4; Vp-16 100 mg/m2, iv d1 approximately d4; one cycle for 21 approximately 28 days. The trial group was given DNCE regimen: DXM 20 mg, iv d1 approximately d4; NVB 25 mg/m2, iv d1 and d5; DDP 25 mg/m2, iv d1 approximately d4; Vp-16 100 mg/m2, iv d1 approximately d4; one cycle for 21 approximately 28 days. Each patient completed at least 2 cycles of treatment.</p><p><b>RESULTS</b>A better efficacy was shown in the complete response rate, partial response rate, and total response rate between DNCE and DICE groups (18.8% vs. 10.8%, 37.5% vs. 35.1%, and 56.3% vs. 45.9%, respectively), but the differences were statistically non-significant (P > 0.05). The 1-, 3-, and 5-year survival rates were not significantly increased in DNCE group compared with that in DICE group (86.5% vs. 87.5%, 58.3% vs. 63.2%, 42.9% vs.38.5%, respectively, P > 0.05). The major side effects were leucopenia, thrombocytopenia, and nausea in both groups. The bone marrow depression in DNCE group was significantly slighter than that in the DICE group (P < 0.05).</p><p><b>CONCLUSION</b>The efficacy of DNCE regimen is as good as DICE regimen, and the bone marrow toxicity is less severe in DNCE group than that in DICE regimen. Therefore, the DNCE regimen is an effective second-line salvage regimen for the treatment of refractory or relapsed aggressive and highly aggressive non-Hodgkin lymphoma.</p>

Diagnostic value of SYT-SSX fusion gene detection by fluorescence in-situ hybridization for synovial sarcoma / 中华病理学杂志

<p><b>OBJECTIVE</b>To establish a method of SYT-SSX fusion gene detection by FISH and to explore its diagnostic value for synovial sarcoma.</p><p><b>METHODS</b>The presence of SYT-SSX fusion gene was determined by FISH using a tissue microarray containing 62 known synovial sarcomas, 60 non-synovial sarcomas and 133 equivocal synovial sarcomas. FISH results were compared with those of RT-PCR published previously.</p><p><b>RESULTS</b>Overall, 96.9% (247/255) of the cases were successfully analyzed by FISH. The sensitivity of FISH for known synovial sarcomas was 96.7% (58/60), and the specificity for the non-synovial sarcoma was 100% (59/59). Moreover, SYT-SSX gene fusion was detected in 78.1% (100/128) of the equivocal synovial sarcomas. The concordance rate between FISH and RT-PCR was 83.6% (102/122) in those equivocal synovial sarcomas, and overall 79.7% (106/133) of these cases were confirmed as synovial sarcomas either by RT-PCR or by FISH.</p><p><b>CONCLUSIONS</b>The sensitivity and specificity of FISH detection of SYT-SSX fusion gene are high. FISH and RT-PCR are complementary to each other in the confirmation of synovial sarcomas, particularly those questionable cases.</p>

Number of lymph node metastases: a significant prognostic factor for patients with radical resection of carcinoma of the ampulla of Vater / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To identify prognostic factors predicting survival after radical resection of ampullary carcinoma.</p><p><b>METHODS</b>Clinical data of sixty- five patients with cancer of the ampulla of Vater underwent pancreaticoduodenectomy and regional lymphadenectomy were analyzed retrospectively.</p><p><b>RESULTS</b>A total of 1380 lymph nodes dissected from the resected specimens was examined to detect the presence of metastasis. The median follow- up period was 83 months. Univariate analysis revealed that factors associated with poor survival included the number and the location of positive nodes. Thirty- three of the 65 patients had a total of 116 positive lymph nodes, of whom 20 had 1- 3 positive regional nodes lymph and 13 had > or = 4 positive regional lymph nodes. Multivariate analysis revealed that the number of positive nodes lymph was an independent prognostic factor (P=0.007), while the locations of lymph nodes failed to remain as an independent variable. The survival rate in patients with > or = 4 positive lymph nodes was significantly lower than that in those with 1- 3 positive lymph nodes. The median survival time was 49 months with a 5- year survival rate of 43% in patients with 1- 3 positive lymph nodes, whereas all patients with > or = 4 positive nodes died of the disease within 23 months after resection (P=0.0001).</p><p><b>CONCLUSION</b>The number of positive regional lymph nodes is an independent prognostic factor in patients with ampullary carcinoma after resection.</p>

Construction of recombinant adenovirus vector expressing extracellular domain of TbetaR-II-RANTES fusion gene and its anti-tumor effects / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To construct a recombinant adenovirus vector expressing TbetaR-II extracellular domain-RANTES fusion gene and evaluate its anti-tumor effects.</p><p><b>METHODS</b>Mouse origin TbetaR-II extracellular domain and RANTES gene were amplified by RT-PCR. The TbetaR-II extracellular domain-RANTES fusion gene was amplified by overlapping PCR method. TbetaR-II extracellular domain-RANTES fusion gene was cloned into pDC316 vector. The recombinant adenovirus vector expressing the fusion gene was constructed by adMax adenovirus vector creation system. Recombinant adenovirus vector expressing the fusion gene was transfected into LA795 cells. The expression of recombinant adenovirus was checked by Westen blot. The levels of TGF-beta1, RANTES in supernatant were checked by ELISA. The transfected cells were counted and growth curve was obtained. Apoptosis of transfected cells was detected by Annexin V FITC method. The chemotactic activity of supernatant of transfected cells to splenic lymphocytes was assayed. Transfected cells (1 x 10(5)) were inoculated into T739 mice and to observe the tumor growth and survival time. Ad-TbetaR-II extracellular domain, Ad-RANTES and Ad-TbetaR-II extracellular domain-RANTES fusion gene(1 x 10(10) pfu) were injected into the tumor in T739 mice. The tumor size and tumor weight were recorded and tumor growth inhibition rate was counted and statistically analyzed.</p><p><b>RESULTS</b>TbetaR-II extracellular domain and RANTES gene were amplified by RT-PCR and TbetaR-II extracellular domain-RANTES fusion gene amplified by overlapping PCR, were identified by DNA sequence analysis. Restriction enzyme digestion analysis showed that the recombinant vector was constructed correctly. The recombinant adenovirus vector expressing the fusion gene was constructed successfully using the AdMax Adenovirus Vector Creation System. Its titer was 8 x 10(10) pfu/ml. Ad-TbetaR-II extracellular domain-RANTES fusion gene was transfected into LA795 cells and had specific protein fragment proved by Western Blot. The concentration of TGF-beta1 was decreased and RANTES was increased in supernatant of transfected cells. The growth curve showed that recombinant adenovirus vector expressing the fusion gene could delay tumor development and induce apoptosis, with an apoptosis rate in vitro of 16.9%. The supernant of infected cells showed chemotactic activity to splenic lymphocytes. Tumor growth and survival time were prolonged significantly in group tranfected with recombinant adenovirus vector expressing the fusion gene, and tumor growth was effectively inhibited after injecting recombinant adenovirus vector expressing the fusion gene, with a tumor growth inhibition rate of 37.6%.</p><p><b>CONCLUSION</b>A recombinant adenovirus vector expressing TbetaR-II extracellular domain-RANTES fusion gene has been constructed successfully. The recombinant adenovirus vector can bind TGF-beta1 effectively, counteract immune suppression mediated by TGF-beta, enhance immune function, induce significant antitumor immune respone, inhibit tumor growth, and prolong the survival time of tumor-bearing mice.</p>

Relationship between the dissected lymph node number and the prognosis in D(2) gastrectomy for gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To examine the relationship between the dissected lymph-node number and the prognosis in D(2) gastrectomy for gastric cancer.</p><p><b>METHODS</b>From January 1996 to January 2005, 457 patients with primary gastric cancer undergone gastrectomy with different extent of lymphadenectomy in our hospital were followed-up in term of prognostic benefit.</p><p><b>RESULTS</b>In lymph-node metastasis group, the 1-, 3-, 5-year survival rates were 82.4%, 49.0%, 33.4% with dissection of >20 nodes and 71.5%, 49.7%, 40.1% with dissection of 16-20 nodes. In the group without lymph-node metastasis, the 1-, 3-, 5-year survival rates were 98.2%, 92.7%, 84.7% with dissection of >20 nodes and 94.0%, 89.7%, 81.4% with dissection of 16-20 nodes. Whether or not it had lymph-node metastasis, the survival curve failed to show any significant difference with regard to the extent of lymph node dissection.</p><p><b>CONCLUSIONS</b>As to lymphadenectomy for gastric cancer, it is enough to excise the lymph node between 16 and 20. The number of excised lymph node should not be overemphasized unless it is metastasized.</p>