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The PIK3CA gene codes p100α,the catalytic subunit of phosphatidylinositol 3-kinase (PI3K) and is involved in the initiating the PI3K/AKT pathway.PIK3CA plays its biological roles through.downstream PI3K pathway. PIK3CA gene mutants can be detected in many kinds of tumors. The mutant PIK3CA gene can abnormally activate PI3K pathway,leading to the abnormal cell cycle,decreased cell adhesion,down regulated apoptosis and neovascularization,and then promotes tumor genesis and development.Recent researches have found that mutant PIK3CA gene is closely correlated with the genesis,development,differentiation,metastasis and drug resistance of colorectal cancer.Research of PIK3CA in colorectal cancer may provide significant evidence for the early diagnosis,gene screen,therapeutic regimen making,recurrence and follow up.
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Objective To evaluate the efficacy of discriminant function analysis for pericolic infiltration in colorectal cancer on enhanced 64-slice spiral CT and to improve the diagnostic accuracy and specificity of pericolic infiltration. Methods Dynamic enhanced 64-slice spiral CT was performed in 49 colorectal cancer patients (49 masses in total) before surgery. One or two slices were selected for each mass, with a total of 96 slices. The 96 slices were classified into two groups (pericolic infiltration or nonpericolic infiltration group) according to pathological data. Discriminant analysis was performed on the CT values between the mass and the corresponding pericolic tissue 5 mm from the mass at different time points as follows; 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, and 75 s. The discriminant function was calculated, and the pericolic infiltration determined by discriminant function and CT morphology were compared with the pathological results. The CT values in pericolic and non-pericolic infiltration groups at different enhancement time points were assessed using analysis of variance. Results The mean CT values ranged from (43. 6 ±7. 8) HU to (52. 3 ±0. 8) HU in the pericolic infiltration group, and ranged from (100.4±20.3)HU to(116.2±21.4)HU in the non.perieolic infiltration group.At 20 s and 40 s,the mean CT vshle8 were(43.6±27.8)HU and(50.9±27.8)HU in the perleolic infiltration group, (102.0±16.9)HU and(116.2 ±21.4)HU in the non-perieolic infiltration group,respectively.The mean CT value in the pericolic infiltration group was significantly lower than that in the non-pericolic infiltration group at all contrast enhancement time points(F=6.278,P<0.01).A diseriminant function Was obtained as follows:D=-3.450+0.023Xl±0.017X2-0.00lX12-0.001X22+0.002X1×X2. Based on the CT morphology of colorectal cancer,69 slices were identified correctly and 27 slices were fulsely interpreted.the sensitivity.speeificity and accuracy for perieolic infiltration determination were 82.5%,64.3%and 71.9%.respectively.Based on diseriminant function,85 slices were identified correctly and 11 slices were falsely interpreted.the sensitivity,specificity and accuracy were 85.0%.91.1%and 88.5%,respectively.Conclusion The discriminant function with dynamic enhanced 64-slice spiral CT can improve the diagnostic accuracy and specificity of perieolic infiltration in eolorectal cancer patients.
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Objective To evaluate the feasibility and short-term outcome of laparoscopic operation for colorectal neoplasm in comparison with open operation procedure for colorectal neoplasm, laparoscopic operation for colorectal neoplasm may be critical in the evolving practice of medieine. Methods 234 cases of colorectal neoplasm were divided into two groups and was analyzed. 103 patients with colorectal neoplasm underwent laparoscopic operation (LCS), while 131 cases received open operation (OCS). Results The mean operating time in laparoscopic operation group was significantly longer than in open operation group (P <0.05). The blood loss was less. Time to pass flatus, time to ambulate and return of bowel function were restored earlier in laparoscopic operation group than that in open operation group (P <0.05). Duration of hospital stay were longer in open operation group than that in laparoscopic operation group (P <0.05). There was not significant difference in the length, distal margin, size of tumors and number of removed lymphatic nodes(P > 0.05) between the two groups. Laparoscopic colorectal resection is better in pathologic sample compared with the traditional open operation procedure. Conclusion Laparoscopic colorectal resection is secure and effective for colorectal neoplasm, and it is with lower blood loss during operation,earlier return of bowel function and shorter hospitalization, and provide better short-term outcome compared with the traditional open procedure.
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Objective To study the surgical treatment strategy for elderly(aged at 80 years or over)colorectal cancer patients.Methods There were 65 cases of colorectal cancer undergoing Surgical treatment in Beijing Cancer Hospital from 1999 to 2006,and results were analyzed retrospectively.Results In this group of patients.the postoperative morbidity was 53.8%,but anastomotic leakage rate was only 3.9%,operative mortality was 1.5%.Postoperative 1-,3-and 5-year survival rate was 78.92%,27.79%,and 16.32%respectively.Kaplan-meier analysis and Cox regression analysis showed that:the TNM stage of the tumor and preoperative hemoglobin and WBC level were independent prognostic factors,but patients' age,gender,preoperative serum level of CEA and albumin,tumor differentiation,tumor size were not independent prognosis factors.Conclusion Elderly CRC patients have a higher risk of surgical treatment.But with the improvement of perioperative management,the anastomotic fistula and mortality rate were not increased significantly and the result is satisfactory.
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Objective To evaluate the effect of various methods of fecal exfoliated cell testing for screening of colorectal cancer.Methods The stool samples from 814 patients who underwent colonoscopy were collected for fecal exfoliated cell testing using diarrhea feces,twice naturally evacuated feces,magnetic separation or naturally evacuated combined with diarrhea feces.The fecal exfoliated cells were isolated and examined cytologically.The DNA quantitative analysis and gene detection were carried out.Fecal occult blood test was simultaneously performed in twice naturally evacuated feces and naturally evacuated combined with diarrhea feces.Results The sensitivity and specificity of exfoliated cells testing for colorectal Cancer was 66.27%(112 of 169 cases of colorectal cancer)and 99.56%(225 of 226 normal subjects),respectively.There was no correlation of positive rate with differentiations of colorectal cells or Duke's stages(P＞0.05).The nuclear DNA quantitative analysis showed that the sensitivity for detecting cancer was 76.09%for twice naturally evacuated feces and 68.29%for naturally evacuated combined with diarrhea feces,which was superior than diarrhea feces(26.31%)and magnetic separation (43.24%).The positive rate of genes detected in carcinoma tissues concordant with fecal exfoliated cells testing were 83.33%(25/30)for p53,9/10 for APC and 9/10 for K-ras.The sensitivity of cytology was higher than gene detection.The sensitivity of cancer detection was higher in combining exfoliated cells test with fecal occult blood test(93.10%)than exfoliated cells test(73.56%)or fecal occult blood test (80.46%)alone(P＜0.05).Conclusions Fecal exfoliated cells test is an effective method for screening of colorectal cancer.It is the best option for detecting cancer by twice tests of fecal exfoliated cells with liquid-based thin-layer cytological test,and combined with fecal occult blood test.
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Objective To evaluate the impact of pathologic parameters and lymphatic mierometastasis on 5-year disease-frtee survival in patients with stages Ⅰ and Ⅱ colorectal cancer.Methods Surgical operation was performed in 126 patients with stage Ⅰ and Ⅱ colorectal cancer.Sixteen (range,10-28)lymph nodes were harvested in each specimen and immunohistochemical staning was performed. Theimpact of pathologic parameters and lymphatic micrometastases in survival was estimated by KaplanMeier.Results The mean follow up time was 64.11 (range,64-106) months. Multivariate analysisrevealed that lymphatic vessel invasion and depth of tumor invasion were correlated with positive CEA in lymph node,and unrelated with clinical pathologic factors.There was no significant difference between pathologic parameters and five year disease-free survival rates. The five-year diseasse-free survival rates was 75.4 percent in CEA negative patients,68.2 percent in patients with isolated tumor cells,and 46.2 percent in patients positive for micrometastasis.There was no significant difference in 5 year disease-free survival between CEA negative patients and patients with isolated tumor cells (P=0.245).However,the5-year disease-free survival was lower in patients positive for micrometastases compared to CEA negativepatients (P=0.003).Conclusions The presence of micrometastases in patients with stages Ⅰ and Ⅱ colorectal cancer may result in poor prognosis and high recurrence,and adjuvant chemotherapy will bejustified and effective.
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Objective To quantify the benefit of primary Pdmor removal in patients with differently presenting incurable coloreetal cancer,while no other therapy combined.Methods One hundred and forty-three consecutive patients were operated for incurable colorectal cancer(91 undergoing resective and 52 non-resective procedures),with the purpose of comparing homogenous populations and of identifying whether the patients got benefit from primary tumor resection.Results In patients with resectable primary tumors,resective procedures were associated with longer median survival than non-resective procedures(10 months vs 3 months),patients with distant spread without neoplastic ascites/implanting metastasis got benefit from primary tumor removal(P＜0.01).The complication of resective procedures was not significantly differ-ent from that of non-resective procedares(P＞0.05).Conclusion Palliative resection of primary colorectal cancer should be pursued in patients with unresectable distant metastasis whenever the primary tumor is technically resectable.