A comprehensive diagnosis and treatment system for borderline resectable pancreatic cancer based on portal vein reconstruction / 中华肝胆外科杂志

Borderline resectable pancreatic cancer is a special subtype between resectable and unresectable pancreatic cancer. Although the tumor is technically suitable for resection, there is increased risk of positive margin after surgery. At present, there is no optimal diagnostical criteria and treatment options for borderline resectable pancreatic cancer. With the popularization of the concept of multidisciplinary diagnosis and treatment, neoadjuvant therapy has been widely used in borderline resectable pancreatic cancer, and received good outcomes in some centers. However, for patients with borderline resectable pancreatic cancer who are not sensitive to radiotherapy and chemotherapy, long time of neoadjuvant therapy may delay the best time for surgery. This article summarized the definition, classification criteria and the latest diagnosis and treatment progress of borderline resectable pancreatic cancer, and discussed the comprehensive treatment mode suitable for this kind of patients combined with the clinical experience of our center.

Estadificación nodular linfática y supervivencia en pacientes operados por carcinoma pulmonar no microcítico / Lymphatic nodular staging and survival in patients operated due to non-small cell lung cancer

Introducción: En los pacientes con cáncer de pulmón resulta vital el tratamiento quirúrgico, pues posibilita una estadificación patológica minuciosa, así como un pronóstico y tratamiento acordes con la carga tumoral de cada paciente. Objetivo: Determinar la influencia del tipo de linfadenectomía mediastinal en la supervivencia de pacientes operados por cáncer pulmonar de células no pequeñas. Métodos: Se realizó un estudio descriptivo y longitudinal en el Servicio de Cirugía General del Hospital Provincial Clínico-Quirúrgico Docente Saturnino Lora de Santiago de Cuba, durante un período de 10 años (de 2009 a 2019), en 55 pacientes seleccionados aleatoriamente, quienes recibieron algún tipo de linfadenectomía del mediastino además de resección pulmonar. En el procesamiento estadístico, se utilizaron el número absoluto, el porcentaje y la media como medidas de resumen; también la prueba de independencia de la Χ2, para identificar la posible asociación entre variables, y el método de Kaplan-Meier, para precisar la supervivencia. Resultados: La técnica de linfadenectomía mediastínica más utilizada fue el muestreo ganglionar (47,3 %), con la cual también se obtuvo un mayor porcentaje (84,6) de resultados negativos en cuanto a invasión neoplásica, a diferencia de lo observado con la disección ganglionar sistemática, que reveló positividad de infiltración tumoral en un elevado número de pacientes (52,9 %). Asimismo, los pacientes operados mediante disección ganglionar sistemática mostraron mejor supervivencia a los 6 meses (100 %) y al año (87,5 %); a los 5 años las cifras de supervivencia con esta técnica fueron superiores a las obtenidas con todos los tipos de escisiones ganglionares practicadas. Conclusiones: Existió mayor probabilidad del diagnóstico de invasión linfática del mediastino y una mejor supervivencia en los pacientes tratados con disección ganglionar sistemática. Por ello, se recomienda protocolizar dicho tratamiento quirúrgico, lo cual pudiera estar avalado por un ensayo clínico que permita comparar grupos homogéneos que reciban cada tipo de linfadenectomía, respectivamente, a fin de recoger una evidencia científica relevante y concluyente.

Introduction: In the patients with lung cancer it is vital the surgical treatment, because it facilitates a meticulous pathological staging, as well as a prognosis and treatment according to each patient tumoral charge. Objective: To determine the influence of the mediastinal limphadenectomy type in the survival of patients operated due to non-small cells lung cancer. Methods: A descriptive and longitudinal study was carried out in the General Surgery Service of Saturnino Lora Teaching Clinical-Surgical Provincial Hospital in Santiago de Cuba, during 10 years (from 2009 to 2019), in 55 patients selected at random who received some type of mediastinum lymphadenectomy besides lung resection. In the statistical processing, the absolute number, percentage and the mean were used, as summary measures; also the chi-squared test to identify the possible association among variables, and the Kaplan-Meier method, to specify survival. Results: The most used medistinic lymphadenectomy technique was the ganglionar sampling (47.3 %), with which a higher percentage of negative results was also obtained (84.6) as regards neoplastic invasion, contrary to that is observed with the systematic ganglionar dissection that revealed metastasis positivity in a high number of the patients that received it (52.9 %). Likewise, patients operated by means of systematic ganglionar dissection showed a better survival 6 months later (100 %) and a year later (87.5 %); after 5 years the survival number with this technique was superior to all the types of ganglionar excisions practiced. Conclusions: There was a higher probability of the mediastinic lymphatic infiltration diagnosis and better survival in the patients treated with systematic ganglionar dissection. Reason why, it is recommended to protocolize this surgical treatment, which could be endorsed by a clinical trial that allows to compare homogeneous groups that receive each type of lymphadenectomy, respectively, in order to obtain an outstanding and conclusive scientific evidence.

Carcinoma vesicular de células en anillo de sello: diseminación poco frecuente: reporte de un caso con tomografía computada por emisión de positrones con fluor 18-deoxiglucosa / Bone metastases of a gallbladder carcinoma detected by positron emission tomography/computed tomography: case report

Signet ring gallbladder carcinoma is a rare aggressive variant of mucinous adenocarcinoma with poor prognosis. Positron emission tomography/computed tomography (PET/CT) with Fluor18 deoxyglucose (F18-FDG) is a useful tool in the staging of gallbladder cancer. We report a 68 years old man with a surgically resected acute cholecystitis, whose biopsy was positive for signet ring cell gallbladder carcinoma. During surgery, locoregional lymph nodes, liver or peritoneal involvement were not detected. A PET/CT was performed for staging, finding multiple hypermetabolic lytic bone lesions. Percutaneous biopsy of a pelvis bone lesion, confirmed a metastasis of the tumor. In this case, the staging with PET/CT allowed the diagnosis of unsuspected bone metastases and was a useful tool for deciding the best site of biopsy for histologic confirmation.

From traditional population-based approach to individualized precision medicine: the interpretation of update on The AJCC Colorectal Cancer Staging System, Eighth Edition / 中华外科杂志

The eighth edition of cancer staging system published by AJCC will be implemented all over the world in January 1, 2018. In addition to strengthening the traditional TNM staging system, the introduction of new molecular markers, is a major advance in the eighth edition, and is expected to play a more valuable role in the"individualized" clinical practice. The most important update in the eighth edition of AJCC colorectal cancer staging system is"non-anatomic" prognostic and predictive evaluation system based on the molecular detection. The system is useful for better understanding the pathogenesis of colorectal cancer, and guide clinicians to provide individualized treatment for the patients even in the same stage of colorectal cancer.

Interpretation of update on The AJCC Esophageal Cancer Staging System, Eighth Edition / 中华外科杂志

The recently published AJCC Esophageal Cancer Staging System, 8th Edition will be implemented on Januray 1, 2018, which was developed by Worldwide Esophageal Cancer Collaboration based on 22 654 esophageal cancer patients from 33 worldwide centers. The definition of T, N, M, G stage and regional lymph nodes were optimized in the 8th edition. And the new "2 cm" principle has simplified the definition for the cancer of esophagogastric junction. In addition to pathologic staging, the 8th edition also provided clinical staging and pathologic staging after neoadjuvant therapy, making the new esophageal cancer staging system more practicable and reasonable.

Overview of The AJCC Lung Cancer Staging System, Eighth Edition may give us more thought: opportunities and challenges / 中华外科杂志

The AJCC Lung Cancer Staging System, Eighth Edition has been officially published in January 2017. The implementation of the new stage classification will help clinicians to make right judgment about how well particular management strategies and associate results apply to new patient. This review briefly describes some important content change, compares the differences between old and new versions. It also shares author′s some new thoughts. The author expresses the hope that through our joint efforts, China thoracic surgeons can play more important roles and make greater contribution in the international field of lung cancer research.

Long-term outcomes and prognostic factors analysis of laparoscopic gastrectomy for stage T4a gastric cancer / 中华消化外科杂志

Objective To explore the long-term outcomes and prognostic factors of laparoscopic gastrectomy for stage T4a gastric cancer.Methods The retrospective case-control study was conducted.The clinicopathological data of 224 patients who underwent laparoscopic gastrectomy of gastric cancer and D2 lymph node dissection in the Ruijin Hospital of Shanghai Jiaotong University School of Medicine between February 2004 and December 2014 were collected.Lymph node dissection followed the Japanese Gastric Cancer Treatment Guidelines (13th edition).Anastomotic methods included Billroth Ⅰ,Billroth Ⅱ and Roux-en-Y gastrojejunostomy or esophagojejunostomy.Patients who were diagnosed in stage T4a by postoperative pathological examination underwent 5-fluorouracil chemotherapy.Observation indicators:(1) treatment;(2) postoperative pathological examination;(3) follow-up;(4) prognostic factors analysis.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative tumor recurrence or metastases up to death (end of follow-up) or July 31,2016.Measurement data with normal distribution were represented as x±s and comparison between groups was analyzed using Student-t test.Measurement data with skewed distribution were described as M (Q).Comparisons of count data were analyzed using the chi-square test.The overall and disease-free survival curves,overall and disease-free survival rates were respectively drawn and calculated using the Kaplan-Meier method.The survival analysis was done by the Log-rank method.The univariate analysis was done by the chisquare test,and COX regression model which included affecting factors (P＜0.10) in the univariate analysis was used for the multivariate analysis.Results (1) Treatment:all the 244 patients underwent successful operation,without conversion to open surgery.Surgical method:laparoscopic-assisted distal gastrectomy (4 combined with cholecystectomy,1 with splenectomy and 1 with transverse colectomy) were detected in 125 patients and laparoscopic-assisted total gastrectomy in 99 patients (3 combined with cholecystectomy and 2 with splenectomy).Anastomotic method:Billroth Ⅰ,Billroth Ⅱ and Roux-en-Y gastrojejunostomy or esophago-jejunostomy were respectively applied to 85,29 and 110 patients.Operation time and volume of intraoperative blood loss were (229±50)minutes and (229 ± 146)mL.All patients underwent 6 or 8 cycles 5-fluorouracil chemotherapy.(2)Postoperative pathological examination:numbers of lymph node dissected and positive lymph nodes were 25± 11 per case and 13 (8,25),with R0 resection.Tumor pathological diagnosis of 224 patients:tumor diameter was (4.5±2.3)cm.Tumors in 29,64,122 and 9 patients respectively located in 1/3 proximal stomach,1/3 middle segment of stomach,1/3 distal stomach and involving 2/3 or total stomach.Tumor differentiation:moderate-and high-differentiated tumors and low-and un-differentiated tumors were detected in 82 and 142 patients,respectively.Postoperative N staging:53,46,55 and 70 patients were detected in staging N0,N1,N2 and N3,respectively.Lymph node metastasis rates of 51,58,53 and 62 patients were 0,1％-15％,16％-40％ and ＞40％,respectively.Postoperative staging was T4a staging.(3) Follow-up:212 of 224 patients were followed up for 7-120 months,with a median time of 32 months.Of 212 follow-up patients,118 were survived and 94 died.Of 118 survived patients,13 and 105 were respectively survived with tumors and without tumor.Of 94 deaths,causes of 8 and 86 were respectively non-tumor and tumor-related deaths.The 5-year overall and disease-free survival rates of 224 patients were respectively 47.2％ and 43.6％.(4) Prognostic factors analysis:results of univariate analysis showed that tumor location,tumor diameter,N staging and lymph node metastasis rate were related factors affecting the postoperative 5-year overall and disease-free survival rates of patients undergoing laparoscopic gastrectomy of stage T4a gastric cancer (x2 =6.365,3.740,32.232,48.977,P＜0.10;x2 =9.919,8.818,34.277,45.612,P＜ 0.10).Results of multivariate analysis showed that lymph node metastasis rate was an independent factor affecting the postoperative 5-year overall and disease-free survival rates of patients undergoing laparoscopic gastrectomy of stage T4a gastric cancer (HR =1.828,1.197,95％ confidence interval:1.353-2.469,0.945-1.516,P＜0.05).Postoperative 5-year overall and disease-free survival rates were respectively 72.5％,57.0％,41.6％,23.3％ and 70.0％,53.9％,37.0％,32.4％in staging N0,N1,N2 and N3 patients,with statistically significant differences in different staging (x2 =32.232,34.277,P＜0.05).Conclusion There are good long-term outcomes in laparoscopic gastrectomy for stage T4a gastric cancer,and lymph node metastasis rate is an independent factor affecting postoperative overall and disease-free survival of patients.

Study on prelaryngeal node metastases in different glottic carcinoma / 中国耳鼻咽喉头颈外科

OBJECTIVE To study the rules of prelaryngeal node metastases in different glottic carcinoma in order to provide basic information for standard operation the laryngeal cancer. METHODS Prelaryngeal lymph node dissection was performed in 92 cases with glottic carcinoma.The differences of tumor staging, pathological typing, postoperative cervical or local recurrence, survival time were compared and analyzed between the groups of positive and negative prelaryngeal node. RESULTS There were 5 cases (5.4%) with positive prelaryngeal node among 92 cases. The prelaryngeal nodes in advanced laryngeal cancer (III, IV stage) was more easily to be metastasized than those in early stages (I, II), the difference was statistically significant. There was no significant difference in prelaryngeal node metastasis among different pathological types.The local and regional recurrence rates in positive prelaryngeal lymph node metastasis group were higher than those in the negative group, the difference was statistically significant. Compared with positive group, the negative group had a longer survival time,and the difference was statistically significant. CONCLUSION The rate of prelaryngeal node metastases is high in patients with advanced glottic carcinoma. Once the prelaryngeal node metastases occur, the recurrence rate will be increased and the prognosis is poor, that suggest the importance of standardized treatment.

Analysis on related factors of axillary lymph node metastasis in patients with cT1-2 N0 breast cancer / 吉林大学学报(医学版)

Objective To investigate the relationships between axillary lymph node metastasis and clinicopathologic features in the patients with cT1-2 N0 breast cancer and clarify the law of axillary lymph node metastasis,and to find the risk factor,and provide the theoretical basis for individuation therapy.Methods 687 patients with cT1-2 N0 breast cancer were divided into negative group and positive group according to the pathological results of axillary lymph node,and the clinicopathologic features were layered.The risk factors of axillary lymph node metastasis were screened out by Chi-square test and Logistic regression analysis.Results In 687 cases of cT1-2 N0 breast cancer,156 (22.7%)cases were observed with axillary lymph node metastasis. The age,cT stage,pT stage, pathological type,vascular invasion,perineural invasion estrogen receptor (ER),progesterone receptor (PR), and molecular subtyping were the factors that influenced axillary lymph node metastasis in univariate analyses.The age < 35 years, cT2 , invasive ductal carcinoma, vascular invasion positive and Luminal subtyping were the independent risk factors of axillary lymph nodes metastasis in multivariate analyses (r = 3.440,P = 0.010;r =1.770,P =0.007;r = 3.397,P = 0.001;r = 7.434,P = 0.000;r = 2.212,P = 0.015).Conclusion In the patients with cT1-2 N0 breast cancer,the age,cT,pathological type,vascular invasion and molecular subtyping are important predictors of axillary lymph node metastasis and vascular invasion was the most important predictor.The preoperative comprehensive analysis and evaluation of clinical data and preoperative pathological results obtained will help to select the right surgical operation.

Câncer de mama avançado como evento sentinela para avaliação do programa de detecção precoce do câncer de mama no Centro-Oeste do Brasil / Advanced Breast Cancer as a Sentinel Event for the Evaluation of the Breast Cancer Early Detection Program in the Midwest of Brazil / Cáncer de Mama Avanzado como un Evento Centinela para Evaluar el Programade Detección Precoz de Cáncer de Mama en el Centro-Oeste de Brasil

Introdução: O câncer de mama quando descoberto em sua fase inicial, há grande possibilidade de cura. Entretanto, o diagnóstico tardio da doença ainda é realidade em várias regiões do Brasil. Objetivo: Analisar os eventos relacionados ao diagnóstico em estádio avançado do câncer de mama e verificar a trajetória percorrida pelas mulheres nos serviços de saúde. Método: Foi realizado um estudo observacional, descritivo, transversal, por meio da técnica de investigaçãode eventos sentinela em mulheres com diagnóstico de câncer de mama avançado, residentes no Estado do MatoGrosso do Sul. Os dados foram analisados de forma descritiva e, na abordagem qualitativa, realizou-se a análise de conteúdo segundo as categorias temáticas. Resultados: Foram entrevistadas 12 mulheres com média de idade de 47,3 anos, 58,3% das mulheres fizeram a mamografia e a ultrassonografia mamária antes do diagnóstico de câncer e 75,0%afirmaram que o exame clínico das mamas era realizado na Unidade Básica de Saúde. Em 58,3%, as próprias mulheres perceberam o aparecimento do nódulo na mama e o sentimento de medo ou desconhecimento foram responsáveis pelo diagnóstico em estádio avançado; outro aspecto importante no atraso foi a baixa resolutividade do serviço de saúde. Conclusão: Observou-se a necessidade de desenvolver estratégias eficazes que priorizem o diagnóstico precoce do câncer de mama em tempo hábil, oferecendo às mulheres atendimento resolutivo e de fácil acesso

Comparison of endoscopic ultrasonography and CT scan for patients with esophageal carcinoma / 重庆医学

Objective To evaluate the guidance value of endoscopic ultrasonography (EUS) and CT scan in preoperative clinical staging for diagnosis and treatment of esophageal cancer .Methods 68 patients with esophageal cancer were randomly divided into EUS group and CT group using a random numbers table(34 cases in each group) .Patients in EUS group were examined by EUS , patients in CT group were examined by CT scan ,and staged according to the TNM (2003) staging system ,and were compared with surgical pathologic findings .Results The accuracy rates of T staging by EUS were 0(0/2) for Tis ,75 .0% (3/4) for T1 ,75 .0% (6/8) for T2 ,86 .7% (13/15) for T3 ,80 .0% (4/5) for T4 ,and the totle accuracy rate was 76 .5% (26/34) for T ;those of N staging were 71 .4% (5/7) for N0 ,75 .0% (9/12) for N1 ,0(0/11) for N2 ,0(0/4) for N3 ,and the totle accuracy rate was 41 .2% (14/34) for N .The accuracy rate of T staging by CT scan were 0(0/1) for Tis ,33 .3% (2/6) for T1 ,28 .6% (2/7) for T2 ,78 .6% (11/14) for T3 ,83 .3% (5/6) for T4 and the totle accuracy rate was 58 .8% (20/34) for T ,the difference was statistically significant com-pared with the EUS group(P<0 .05);those of N staging were 77 .8% (7/9) for N0 ,76 .9% (10/13) for N1 ,66 .7% (4/6) for N2 , 50 .0% (3/6) for N3 and the totle accuracy rate was 70 .6% (24/34) for N ,the difference was statistically significant compared with the EUS group (P<0 .05) .Conclusion The accuracy rate of EUS are higher for diagnosis in esophageal cancer and preoperative T staging .The accuracy rate of CT scan are higher for the preoperative N staging .EUS combined with CT scan has great significance for choosing ideal therapy plan for esophageal cancer ,and for estimating prognosis of esophageal cancer .

Effect of post bladder sparing operation intra-arterial chemotherapy combined with intravesical chemotheraoy for the treatment of T1G3 bladder urothelial carcinoma / 中华泌尿外科杂志

ObjectiveTo evaluate the clinical effect of post bladder sparing surgery intra-arterial chemotherapy combined with intravesical chemotherapy for the treatment of T1G3 bladder urothelial carcinoma.MethodsSeventy-four T1G3 bladder cancer patients were enrolled in this study.After bladder sparing surgery,22 patients received intra-arterial chemotherapy combined with intravesical chemotherapy,while the other 52 patients were treated with intravesical chemotherapy only.There was no significant difference between the 2 groups in sex,age,the size and number of bladder tumor and newly diagnosed cases (P ＞0.05).Twenty-two patients were treated with intra-arterial chemotherapy of piarubicin or epirubicin (40 -60 mg)+ cisplatin (60 -80 mg) 2 or 3 weeks after bladder sparing surgery,3 times as a cycle,repeat every 4 - 6 weeks.All the patients received the same protocol of intravesical chemotherapy.With a median follow-up of 32 months,effects of combination therapy group were compared with intravesical chemotherapy group in the aspects of tumor-specific death rates,recurrent rate,progressive rate,recurrent interval and the adverse reactions.ResultsThe tumor-specific death rates of combination therapy group and intravesical chemotherapy group were 0％ (0/22) and 13.5％ (7/52),respectively.There was no difference between the 2 groups (P =0.096).The recurrent rates were 13.6％ (3/22) and 46.2％ ( 24/52 ) ； The progressive rates were 0％ (0/22) and 21.2％ (11/52).There were significant differences between the 2 groups in recurrent rate (P =0.000) and progressive rate (P =0.048 ).The recurrent intervals of the 2 groups were 15 months and 6.5 months.During the interval of intra-arterial chemotherapy cycle,12 patients suffered 1 -2 degree nausea and vomit,2 patients suffered hypoleukemia,2 patients suffered neutropenia,4 patients'liver function was impaired and 1 patient's renal function was impaired.All the adverse reactions were minimal and reversible.ConclusionsIntra-arterial chemotherapy combined with intravesical chemotherapy is effective in preventing T1 G3 bladder cancer from recurrence and metastasis after bladder sparing surgery.The adverse reactions of this protocol were minimal and reversible.

Registro de evaluación de tratamiento de cáncer gástrico en Chile (REGATE): características clínicas básales de 523 pacientes / Registry of gastric cancer evaluation in Chile (REGATE): basal clinical features of 523 patients

Background: Gastric cancer is one of the leading causes of cancer-related deaths in Chile and worldwide. No consensus exists for therapeutic management. Aim: To assess clinical features and practice patterns of patients with newly diagnosed gastric cancer in Chile. Method: Chilean patients > 18 years old with newly diagnosed primary gastric adenocarcinoma enrolled by thirteen centers from different regions of Chile. Target sample size calculated according to gastric cancer prevalence in Chile. Data collected from two visits within a 10-month timeframe: baseline (patients and tumor features, treatment plan) and end of study (completion of initial treatment). Herein, baseline visit data is presented. Results: Between 2005 and 2008, 523 patients enrolled. Median age 61.3 years. Diagnosis by endoscopy in 98.5 percent patients. Location: body 35.8 percent, proximal 35.4 percent, and antral 23.9 percent. Most frequently used histopathological classification was WHO classification, with tubular adenocarcinoma being most frequent finding (53.1 percent). AJCC/UICC clinical staging (available in 31.1 percent of patients) was: 0 and I - 23.3 percent, II - 18.3 percent, III- 20.8 percent, IV - 37.6 percent. Therapeutic choice based mainly on clinical staging (49.9 percent) and included surgery in 440 patients (84.1 percent). Therapy planned by surgeon (54.9 percent) or multidisciplinary team (42.3 percent). Conclusions: REGATE is the largest prospective multicenter registry study performed in Chile. Basal visit data report that diagnosis is established frequently at advanced stages. Surgery is the most frequent therapeutic choice, (neo-) adjuvant therapies are only planned in one out of four patients. End of study visit data will provide the full scope of diagnosis and treatment of these patients.

Introducción: El cáncer gástrico es una de las principales causas de muerte por cáncer en Chile. No existe consenso acerca del tratamiento. Objetivos: Conocer características clínicas y patrón de tratamiento de pacientes con cáncer gástrico recién diagnosticado. Material y Método: Pacientes chilenos mayores de 18 años con diagnóstico reciente de adenocarcinoma gástrico primario, enrolados en 13 centros de diferentes regiones de Chile. Datos obtenidos en dos visitas dentro de período de 10 meses: basal (características del tumor y paciente, plan de tratamiento) y fin de estudio (tratamiento inicial completado). Se presentan datos de visita basal. Resultados: Entre 2005 y 2008, 523 pacientes enrolados. Mediana edad 61,3 años. Diagnóstico por endoscopia en 98,5 por ciento pacientes. Localización: corporal 35,8 por ciento, proximal 35,4 por ciento y antral 23,9 por ciento. Clasificación histopatológica más usada fue clasificación OMS, y tipo histopatológico más frecuente fue tubular 53,1 por ciento. Etapificación clínica AJCC/UICC (disponible en 37,6 por ciento de pacientes) distribuida en: 0 y I - 23,3 por ciento, II -18,3 por ciento, III - 20,8 por ciento, IV - 37,6 por ciento. Principal característica clínica para elección de terapia planeada fue etapificación clínica (49,9 por ciento). Plan de tratamiento consideró cirugía en 440 pacientes (84,1 por ciento). En mayoría de casos, plan terapéutico decidido por cirujano (54,9 por ciento) o equipo multidisciplinario (42,3 por ciento). Conclusiones: REGATE es el estudio de registro prospectivo multicéntrico más grande desarrollado en Chile. Datos visita basal informan que diagnóstico se establece frecuentemente en etapas avanzadas. Cirugía es alternativa terapéutica más frecuentemente indicada; terapias (neo-) adyuvantes sólo son ofrecidas a uno de cuatro pacientes. Datos visita fin de estudio proveerá visión completa del diagnóstico y tratamiento de estos pacientes.

Significance of transrectal ultrasound combined with carcinoembryonic antigen examination on accurate preoperative staging of rectal carcinoma / 肿瘤研究与临床

Objective To study the consistency of preoperative staging by transrectal ultrasonography (TRUS) combined with serum carcinoembryonic antigen (CEA) and the postoperative pathological TNM staging (PTNM).Methods 118 rectal cancer patients pathologically proven were divided into preoperative TRUS combined with CEA group (59 cases) and along TRUS group (59 cases).The consistency of preoperative stag in 2 groups and postoperative pathological stage was analyzed retrospectively.Results In TRUS combined with CEA group,the accuracy of T stage was 79.7 ％ (47/59),and the accuracy of N stage was 77.8 ％ (42/59),compared with the postoperative pTNM.While in along TRUS group,the accuracy of T stage was 86.4 ％ (51/59),and the accuracy of N stage was 57.7 ％ (30/59).The consistencies of T and N stage in TRUS combined with CEA group and postoperative pTNM were better (κ =0.685,P =0.000; κ =0.544,P =0.000).While the consistency of T stage in along TRUS and postoperative pTNM was better (κ =0.755,P =0.000),but that of N stage was poor (κ =0.154,P =0.229).Conclusion Preoperative evaluation by the TRUS combined with CEA can increase the accuracy of preoperative stage which can provide more reliable basis for decision-making and improve the rate of coincidence of operative procedures in line with forecasts.At the same time,it can provide the basis for the accurate preoperative diagnosis and individualized treatment.

Expanded radical resection for gallbladder cancer at different portions / 中华普通外科杂志

ObjectiveTo explore the value of expanded radical resection for gallbladder cancer located respectively at body and bottom of the gallbladder and at the neck.MethodsIn this study,91 cases of gallbladder cancer were macropathologically divided into two groups, one with the lesion at the body and bottom of the gallbladder and the other at the neck, survival analysis was made accordingly. Three different kinds of resection were performed: the expanded radical resection, the standard radical resection and palliative operation.ResultsThe overall median survival rate of patients undergoing expanded radical operation was significantly longer than that of the cases doing other two procedures, that was 27. 1 ± 2. 4,10. 7 ±2. 2,4. 7 ±2.2 (months) respectively for body and bottom cancer, and 8.5 ±2. 1,6. 7 ± 1.9,3.1 ± 1.1 (months) respectively for neck cancer. For cancer at the body and bottom RO was achieved by expanded radical resection in 16/18(88％ ) cases and by standard radical resection in 7/12(58％ ) cases, while for cancer at the neck it was in 6/16(38％ ) cases, and in 3/13 (23％)cases only.ConclusionsThe median survival time is longer and RO resection rate is higher in patients with the cancer at the body and bottom than these at the neck of the gallbladder.

Pilot study of acoustic radiation force impulse imaging for clinical pathological typing of advanced gastric cancer / 中华超声影像学杂志

ObjectiveTo explore the value of virtual touch tissue quantification (VTQ) in the evaluation of clinical pathological typing of advanced gastric cancer.MethodsFifty six patients who had been diagnosed as gastric cancer were examined using acoustic radiation force impulse.According to clinical pathological typing,all cases were divided into highly-moderately differentiated adenocarcinoma (14 cases) and non-highly-moderately differentiated adenocarcinoma (42 cases).A comparison with clinical pathologic results was made after surgery.The correlation of VTQ results and clinical pathological typing of gastric cancer was analyzed.ResultsThe VTQ value of highly-moderately differentiated adenocarcinoma was lower than that of non-highly-moderately differentiated adenocarcinoma [(1.49 ± 0.44) m/s vs (2.12 ± 0.45) m/s],with statistical significance( t =-4.53,P ＜0.05).According to the maximum area under the ROC curve,the cutoff value of VTQ was 1.795 m/s,the sensitivity and specificity were 78％ and 86％,respectively,the Youden's index was 0.64,and with high reproducibility(Kappa =0.81).ConclusionsVTQ could initial estimate the clinical pathological typing of advanced gastric cancer before operation.

Clinical characteristics of 1126 cases of malignant lymphoma / 白血病·淋巴瘤

Objective To analyze the clinical characteristics of 1126 cases of malignant lymphoma in our hospital from 2005 to 2009. Methods Age, sex, pathological classification, onset locus and clinical staging of the malignant lymphoma were analyzed and summed up, based on the data of the malignant lymphoma patient information in hospital case database from 2005 to 2009 and excluded the cases as pathology was not sure and the repeated cases. Results A male:female ratio of malignant lymphoma in inpatient was 1.94:1. The majority of Hodgkin lymphoma (HL) manifested in 20-40 years old, mixed cellularity (64.16 %) and nodular sclerosis (29.48%) was most common. The majority of non-Hodgkin lymphoma (NHL) manifested in 50-70 years old, the most common pathological classifications were diffuse large B-cell lymphoma (53.31 %), extranode nasal-type NK/T cell lymphoma (7.35 %), mantle cell lymphoma (6.40 %), B chronic lymphocytic leukemia/small B-cell lymphoma (4.30 %), anaplastic large cell lymphoma (4.09 %), precursor T cell lymphoblastic leukemia/lymphoma (3.88 %), peripheral T cell lymphoma but not otherwise specified (3.46 %), angioimmunoblastic lymphoma(3.04 %), follicular lymphoma(2.94 %), Burkitt lymphoma (2.52 %). The onset locus of both HL and NHL most often involved lymph nodes of the cervical region. Conclusion The gender, age, pathological classification, onset locus and clinical staging of malignant lymphoma were different between HL and NHL.

The revised TNM staging system and surgical strategies for non-small cell lung cancer / 肿瘤研究与临床

The International Association for the Study of Lung Cancer (IASLC) has presented the details of the IASLC/International Union Against Cancer (UICC)/American Joint Committee on Cancer (AJCC) Revised Staging Classification for Lung Cancer. The IASLC is the largest world-wide professional organization solely dedicated to reduce the worldwide burden of lung cancer. The IASLC recognizes that the staging classification will be most valuable and accurate if it is based on the evaluation of outcomes of large numbers of cases carefully collected and analyzed in an extensive worldwide database. The analyses of the T, N and M descriptors as well as the stage groupings were performed in 67,725 non-small cell lung cancer (NSCLC)patients. Survival was the primary outcome, measured from the date of diagnosis or date of protocol registration for clinical staging, or the date of surgery for pathologic staging. The remarkable efforts of the IASLC Staging Committee have resulted in an evidence-based, validated and robust revision of the international staging system for NSCLC. This landmark contribution will improve our care of patients and lays a strong foundation for future refinements based on an expanding knowledge of lung cancer behavior and biology. This review outlines the changes in the tumor, node, metastasis (TNM) descriptors and stage groupings anticipated in the official new stage classification system for NSCLC.

Clinical value of 3. 0 T MRI diagnosis and staging in early endometrial carcinoma / 中华放射学杂志

Objective To evaluate T2WI sequence and liver acquisition with volume acceleration (LAVA) technique in the diagnosis of early endometrial carcinoma on 3.0 T MR scanner. Methods Twenty-seven patients with endometrial carcinoma confirmed by pathology were retrospectively analyzed. MRI sequences included axial T1WI and sagittal T2WI with fat saturation, axial and sagittal LAVA scanning including four phases: early arterial phase, late arteral phase, parenchymal phase and delayed phase. The tumor location, signal features, and myometrial infiltration by tumor were recorded and preoperative staging was compared with pathologic results. The sensitivity, specificity, accuracy of T2WI and LAVA in diagnosing endometrial carcinoma was assessed. The accuracy of the evaluation of the deep myometrium infiltration was compared between the two sequences using Fisher's exact test. Results According to Federation International of Gynecologie and Obstetrigue (FIGO) standard, 27 patients with endometrial carcinoma were classified as: stage Ⅰ in 22 cases, stage Ⅱ in 5 cases. The sensitivity, specificity, positive and negative predictive values in assessing deep myometrium infiltration were 70.0% (7/10), 94. 1% (16/17), 87. 5% (7/8), 84. 2% (16/19) respectively for T2WI sequence. Its accuracy in assessing myometrium invasion was 85.2% (23/27). The sensitivity, specificity, positive and negative predictive values were 80. 0% (8/10), 94. 1% ( 16/17 ), 88. 9% (8/9), 88. 9% ( 16/18 ) respectively for LAVA sequence, and the accuracy was 88.9% (24/27). There was no statistical difference of accuracy between two techniques( P = 1.00). Conclusion 3.0 T MR T2WI sequence has important role in diagnosing early endometrial carcinoma, and LAVA technique is highly valued in preoperative diagnosis and staging in early endometrial carcinoma for myometrium infiltration.

Accuracy of preoperative tumor grading and intraoperative gross examination of myometrial invasion in clinical stage Ⅰ endometriod adenocarcinoma / 中华妇产科杂志

Objective To evaluate accuracy of preoperative tumor grade and intracperative gross examination of myometrial invasion in patients with clinical stage Ⅰ endometriod adenocarcinoma for lymphadenectomy. Methods Clinic-pathological data were retrospectively collected from 687 patients with clinical stage Ⅰ endometriod adenocarcinoma who underwent operation in Women's Hospital, Zhejiang University School of Medicine from January 1999 to December 2008. According to postoperative histology diagnosis, accuracy of preoperative tumor grade by curettage and depth of myometrial invasion by intraoperative gross examination was evaluated, and clinic-pathological factors associated with accuracy were analyzed. Results Sensitivity, specificity, accuracy, false negative rate, false positive rate, and positive and negative predictive value for the prediction of needing for intraoperative lymphadenectomy in patients with clinical stage Ⅰ endometriod adenocarcinoma were 70. 4% ,80. 2% ,77.6% ,12.0%, 43.0%, 57.0% and 88.0%, respectively. Analysis of mutil-factors shown that patient age, tumor size, lymph node metastasis and extrauterine spread lesions were independent factors affected the accuracy of prediction(P ＜ 0. 05 ). Conclusion Prediction of needing for lymphadenectomy by preoperative tumor grade and intraoperative gross examination of myometrial invasion is reliable in clinical stage Ⅰ endometriod adenocarcinoma patients, while there is a highly false negative rate in prediction of not needing for lymphadenectomy, while other prognostic factors such as patient age, tumor size, lymph node metastasis and extrauterine spread lesion should be together considered.