Combining pathological risk factors and T, N staging to optimize the assessment for risk stratification and prognostication in low-risk stage III colon cancer.

BACKGROUND: This study aimed to investigate the combined pathological risk factors (PRFs) to stratify low-risk (pT1-3N1) stage III colon cancer (CC), providing a basis for individualized treatment in the future. PATIENTS AND METHODS: PRFs for low-risk stage III CC were identified using COX model. Low-risk stage III CC was risk-grouped combining with PRFs, and survival analysis were performed using Kaplan-Meier. The Surveillance, Epidemiology, and End Results (SEER) databases was used for external validation. RESULTS: Nine hundred sixty-two stage III CC patients were included with 634 (65.9%) as low risk and 328 (34.1%) as high risk. Poor differentiation (OS: P = 0.048; DFS: P = 0.011), perineural invasion (OS: P = 0.003; DFS: P < 0.001) and tumor deposits (OS: P = 0.012; DFS: P = 0.003) were identified as PRFs. The prognosis of low-risk CC combined with 2 PRFs (OS: HR = 3.871, 95%CI, 2.004-7.479, P < 0.001; DFS: HR = 3.479, 95%CI, 2.158-5.610, P < 0.001) or 3 PRFs (OS: HR = 5.915, 95%CI, 1.953-17.420, P = 0.002; DFS: HR = 5.915, 95%CI, 2.623-13.335, P < 0.001) was similar to that of high-risk CC (OS: HR = 3.927, 95%CI, 2.317-6.656, P < 0.001; DFS: HR = 4.132, 95%CI, 2.858-5.974, P < 0.001). In the SEER database, 18,547 CC patients were enrolled with 10,023 (54.0%) as low risk and 8524 (46.0%) as high risk. Low-risk CC combined with 2 PRFs (OS: HR = 1.857, 95%CI, 1.613-2.139, P < 0.001) was similar to that of high-risk CC without PRFs (HR = 1.876, 95%CI, 1.731-2.033, P < 0.001). CONCLUSION: Combined PRFs improved the risk stratification of low-risk stage III CC, which could reduce the incidence of undertreatment and guide adjuvant chemotherapy.

Anatomical characteristics of the inferior epigastric artery in Uygur and it's implication in the management of bleeding.

OBJECTIVES: This study aimed to determine the locations of the inferior epigastric arteries in a group of Uygur by ultrasound and explore the anatomical characteristics of vessels in the management of inferior epigastric bleeding. METHODS: The study included 61 patients. The locations of inferior epigastric arteries through ultrasound were determined at three levels, and the distance from the midline was correlated with patients' demographics by Pearson correlation coefficient. RESULTS: This study included 52 males and nine females, with a mean age of 37.56 years (± SD 3.16) and a mean BMI of 24.34 kg/m2 (± SD 3.71). At the symphysis pubis level, the average distance from the inferior epigastric artery to the midline was 5.98 ± 0.13 cm on the right and 7.32 ± 0.15 cm on the left. At the anterior superior iliac spine level, the average distance of the inferior epigastric artery on the right was 4.12 ± 0.15 cm and 5.2 ± 0.15 cm on the left. The inferior epigastric arteries were 3.86 ± 0.17 cm on the right and 5.06 ± 0.16 cm on the left of the midline at the level midway between the umbilicus and anterior superior iliac spine. CONCLUSION: Inferior epigastric arteries were located between 3.5 and 8 cm from the midline, with the right vessel being closer to the midline than the left. The invasive operations through the abdominal wall should avoid these areas to reduce vascular injury. The anatomical characteristics of inferior epigastric arteries may potentially manage inferior epigastric bleeding.