Preoperative Concurrent Chemoradiotherapy Versus Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer: Phase II Randomized Study.

Objective: We evaluated and compared the efficacy and safety of neoadjuvant chemoradiotherapy (NACRT) versus neoadjuvant chemotherapy (NACT) for locally advanced gastric cancer (LAGC) in a single-center randomized phase II trial. Methods: Patients with LAGC were enrolled and received either NACT or NACRT, followed by gastrectomy and adjuvant chemotherapy. The primary endpoint was an R0 resection rate. Results: We enrolled 75 patients: 75.7% (NACT, 28/37 patients) and 76.3% (NACRT, 29/38 patients) underwent surgery; R0 resection rates were 73.0% (27/37) and 73.7% (28/38), respectively. The NACRT group had significantly better major pathological response than the NACT group (37.9% vs 17.9%, p = 0.019). Between-group postoperative complications were not significantly different. The median follow-up was 59.6 months; 5-year overall survival (OS) rate was 50.1% (NACT) and 61.9% (NACRT); neither group reached the median OS; median progression-free survival was 37.3 and 63.4 months, respectively. Conclusions: S-1-based NACRT did not improve the R0 resection rate, although it presented better tumor regression with similar safety to NACT. Trial registration: ClinicalTrial.gov NCT02301481.

BCAT1 Activates PI3K/AKT/mTOR Pathway and Contributes to the Angiogenesis and Tumorigenicity of Gastric Cancer.

BACKGROUND: Focusing on antiangiogenesis may provide promising choices for treatment of gastric cancer (GC). This study aimed to investigate the mechanistic role of BCAT1 in the pathogenesis of GC, particularly in angiogenesis. METHODS: Bioinformatics and clinical samples analysis were used to investigate the expression and potential mechanism of BCAT1 in GC. BGC823 cells with BCAT1 overexpression or silencing were induced by lentiviral transduction. Cell phenotypes and angiogenesis were evaluated. The relevant proteins were quantized by Western blotting, immunohistochemistry, or immunofluorescence. Xenograft models were constructed to confirm the role of BCAT1 in vivo. RESULTS: BCAT1 was overexpressed in GC patients and associated with lower survival. BCAT1 expression was correlated with proliferation-, invasion-, or angiogenesis-related markers expression and pathways. Silencing BCAT1 expression suppressed cell viability, colony formation, cycle progression, invasion, and angiogenesis of BGC823 cells, as well as the tumor growth of xenograft models, whereas overexpressing BCAT1 had the opposite results both in vitro and in vivo. Bioinformatics analysis and Western blotting demonstrated that BCAT1 activated the PI3K/AKT/mTOR pathway. The addition of LY294002 reversed the tumor growth induced by BCAT1 overexpression, further verifying this mechanism. CONCLUSION: BCAT1 might act as an oncogene by facilitating proliferation, invasion, and angiogenesis through activation of the PI3K/AKT/mTOR pathway. This finding could aid the optimization of antiangiogenesis strategies.

Body mass index does not affect the survival of pancreatic cancer patients.

AIM: To evaluate the association of body mass index (BMI) with the overall survival of pancreatic ductal adenocarcinoma (PDAC) patients. METHODS: A retrospective analysis of PDAC patients diagnosed in the National Cancer Center of China between January 1999 and December 2014 was performed. These patients were categorized into four BMI groups (< 18.5, 18.5-22.9, 23-27.4 and ≥ 27.5 kg/m2). χ2 tests for comparison of the proportions of categorical variables, and Student's t-test or Mann-Whitney test for continuous variables were employed. Survival analysis was performed with the Kaplan-Meyer method. Their HRs of mortality and 95%CIs were estimated using the Cox proportional hazards model. RESULTS: With a median age of 59.6 years (range: 22.5-84.6 years), in total 1783 PDAC patients were enrolled in this study. Their mean usual BMI was 24.19 ± 3.53 for the whole cohort. More than half of the patients (59.3%) experienced weight loss during the disease onset and progression. Compared with healthy-weight individuals, newly diagnosed patients who were overweight or obese had more severe weight loss during their disease onset and progression (P < 0.001). Individuals who were overweight or obese were associated with positive smoking history (P < 0.001). A significant difference in comorbidity of diabetes (P = 0.044) and coronary artery disease (P < 0.001) was identified between high BMI and normal-weight patients. After a median follow-up of 8 mo, the survival analysis showed no association between BMI and the overall survival (P = 0.90, n = 1783). When we stratified the whole cohort by pancreatic cancer stage, no statistically significant association between BMI and overall survival was found for resectable (P = 0.99, n = 217), unresectable locally advanced (P = 0.90, n = 316) and metastatic patients (P = 0.88, n = 1250), respectively. The results did not change when we used the BMI at diagnosis. CONCLUSION: Our results showed no significance of BMI for the overall survival of PDAC patients.

Small Bowel Stromal Tumors: Different Clinicopathologic and Computed Tomography Features in Various Anatomic Sites.

Gastrointestinal stromal tumors (GISTs) can present with different clinical and immunohistochemical characteristics according to different anatomic sites. The aim of this study was to compare clinicopathologic and computed tomography (CT) features of small bowel stromal tumors located in the duodenum, jejunum, and ileum. In total, 197 patients (109 male, 88 female) with small bowel GISTs were retrospectively reviewed. All tumors had definite anatomic sites in the small bowel tract with surgical confirmation. The clinicopathologic variables included age, sex, onset of symptoms, and tumor risk category. CT variables included tumor size, degree enhancement, enhancement pattern (region of necrosis), adjacent tissue involvement, lymphadenopathy, and distant metastasis. We assessed any possible differences according to different GIST site of origin. Based on tumor size and mitotic count, the risk categories in different anatomic sites did not differ significantly between duodenal and jejunal GISTs. However, high risk ileum GISTs accounted for 66.0% of ileal cases, which was higher than duodenum cases (36.8%, P = 0.002) and jejunum cases (43.9%, P = 0.004). The mean size of GISTs in the ileum was 9.77 cm, which was significantly larger than in the duodenum (7.41 cm, P = 0.043), and in the jejunum (8.14 cm, P = 0.027). On CT images, enhancement degree appeared to gradually increase from the duodenum to the ileum in the portal phase, and the enhancement pattern presented a tendency for heterogeneity. In Conclusions, the clinicopathologic and CT features of small bowel GISTs can differ according to different primary anatomic sites.

Tumors of the angle of Treitz: a single-center experience.

AIM: To explore the feasibility and oncologic outcomes of segmental jejunal resection on the left side of the mesenteric vessels in patients with tumors of the angle of Treitz using data from a single center. METHODS: Thirteen patients with tumors of the angle of Treitz who underwent surgery at our institution were prospectively followed. A segmental jejunal resection on the left side of the mesenteric vessels was performed in all patients. Formalin-fixed and paraffin-embedded tumor samples were examined. The primary end point of this analysis was disease-free survival. RESULTS: In this study, there were 8 males and 5 females (mean age, 50.1 years; range, 36-74 years). The mean tumor size was 8.1 cm (range, 3.2-15 cm). Histologic examination showed 11 gastrointestinal stromal tumors (GISTs) and 2 adenocarcinomas. Five of the GIST patients presented with potential low risk, and 6 presented with intermediate and high risk, according to the National Institutes of Health criteria. One potentially high-risk patient showed tumor progression at 46 mo and died 52 mo after surgery. One patient with locally advanced adenocarcinoma received neoadjuvant chemotherapy and adjuvant radiotherapy, but the disease progressed, and the patient died 9 mo after surgery. One GIST patient without progression died 16 mo after surgery because of a postoperative intestinal obstruction. The median overall survival rate was 84.6 mo, and the median disease-free survival rate was 94.5 mo. CONCLUSION: The overall survival of patients with tumors of the angle of Treitz was encouraging even when the tumor size was relatively large. A segmental resection on the left side of the mesenteric vessels is considered to be a reliable and curative option for tumors of the angle of Treitz.

Risk factors associated with postoperative hospital stay after pancreaticoduodenectomy: a retrospective study.

BACKGROUND: Postoperative hospital stay after pancreaticoduodenectomy (PD) is relatively longer than after other gastrointestinal operations. The aim of the current study was to investigate the risk factors associated with prolonged hospital stay after PD. METHODS: Patients who had PD at the Cancer Hospital of Chinese Academy of Medical Sciences between December 2008 and November 2012 were selected for this retrospective study. Clinical and pathological data were collected and analyzed. The primary outcome was postoperative length of stay. Normal discharge or recovery was defined as a postoperative hospital stay of no more than 10 days; otherwise it was defined as delayed discharge or recovery (including hospital death). RESULTS: A total of 152 patients were enrolled in the present study. Postoperative hospital stay was (19.7 ± 7.7) days (range 7-57). Of the 152 patients, 67 were discharged within the normal time and 85 had delayed discharge. Postoperative complications occurred in 62.5% (95/152), and the mortality rate was 3.29% (5/152). Multiple regression analysis showed that delayed discharge was significantly associated with postoperative complications (adjusted odds ratio (OR) 10.40, 95% confidence interval (CI) 3.58-30.22), age (adjusted OR 4.09, 95% CI 1.16-14.39), body mass index (BMI) (adjusted OR 4.40, 95% CI 1.19-16.23), surgical procedure (adjusted OR 26.14, 95% CI 4.94-153.19), blood transfusion (adjusted OR 7.68, 95% CI 2.09-28.27), and fluid input (adjusted OR 3.47, 95% CI 1.24-11.57). CONCLUSIONS: Postoperative complications increase the time to postoperative hospital discharge. The length of hospital stay after PD is also associated with age, BMI, blood transfusion, surgical procedure, and fluid input. Further studies with more patients are needed in future.

[Status of glucose metabolism in Chinese essential hypertensive patients].

OBJECTIVE: To investigate glucose metabolism status and its relationship with blood pressure, obesity, renal function and cardio-cerebral vascular events in Chinese essential hypertensive patients. METHODS: Essential hypertensive patients without diabetic history were enrolled in this cross-sectional survey. All patients filled in questionnaires and received physical examination and laboratory tests. Oral glucose tolerance test (OGTT, fasting and 2 hours glucose level after drinking the 75 g glucose solution) was performed in patients who signed the informed consent. RESULTS: (1) The control rate of systolic BP was lower in patients with dysglycemia than in patients without dysglycemia (41.0% vs. 46.4%, P = 0.000). (2) The albuminuria detection rate and the abnormal rate of estimated glumerular filtration rate (eGFR) increased significantly with the deterioration of glucose metabolism. (3) Multifactor-analysis showed that abnormal waist circumference, decreased eGFR and presence of albuminuria were independent risk factors for abnormal glucose metabolism. Cardiovascular events was significantly higher in patients with abnormal glucose metabolism than patients with normal glucose metabolism. CONCLUSION: Abnormal glucose metabolism is common in Chinese essential hypertensive patients. When complicated with abnormal glucose metabolism, essential hypertensive patients had poor blood pressure control rate and were related to higher cardiovascular risk.

[Epidemiological characteristics of subclinical target organ damage in urban adult residents with hypertension in Tianjin and its relationships with renin-angiotensin-aldosterone system].

OBJECTIVE: To investigate the epidemiological characteristics of subclinical target organ damage (TOD) among urban adult residents with hypertension in Tianjin and evaluate its relationships with circulating renin-angiotensin-aldosterone system (RAAS). METHODS: An epidemiological survey was conducted on urban adult residents in Tianjin. The participants with uncomplicated hypertension were followed up to examine for target organ involvement, including left ventricular hypertrophy (LVH), carotid plaque or intima-media thickening (IMT), microalbuminuria (MAU) and estimated glomerular filtration rate (eGFR). Multivariate logistic regression was used to evaluate the relations between subclinical TOD and RAAS. RESULTS: A total of 1547 subjects with uncomplicated hypertension underwent further examinations for target organ involvement. The prevalence rates of LVH, carotid plaque, carotid IMT, MAU and eGFR < 60 ml×min(-1)×(1.73 m(2))(-1) were 37.7%, 38.2%, 35.4%, 33.7% and 4.4%, respectively. The prevalence rates were categorized according to the absence or presence of one marker, two or three markers of TOD at 20.5%, 34.7%, 33.7% and 11.1% respectively. According to the logistic regression analysis adjusting for age, gender, current smoking, current drinking, previous antihypertensive treatment, body mass index, mean systolic blood pressure, mean diastolic blood pressure, duration of hypertension and other risk factors, plasma renin activity (OR 0.870, 95%CI 0.791 - 0.958, P = 0.005) and plasma angiotensin II (OR 1.005, 95%CI 1.001 - 1.009, P = 0.021) levels were independently associated with LVH, serum aldosterone level was independently associated with carotid IMT or plaque (OR 1.025, 95%CI 1.000 - 1.050, P = 0.048) and MAU (OR 1.049, 95%CI 1.024 - 1.074, P < 0.001). CONCLUSION: Subclinical TOD is fairly common among urban adult residents with hypertension in Tianjin. And RAAS plays an important role in the pathogenesis of subclinical TOD.

[The role of slow-release 5-fluorouracil implantation in treatment of unresectable pancreatic cancer].

OBJECTIVE: To study the role of slow-release 5-fluorouracil implantation in treatment of unresectable pancreatic cancer. METHODS: 85 cases of untreated patients with locally advanced pancreatic cancer (LAPC) were randomized into two groups: Trial group: slow-release 5-fluorouracil implantation (50 patients) and control group (35 patients). Observing the objective tumor response, clinical benefit response, toxicity, complications and survival of patients of the two groups. RESULTS: In the trial group the overall response rate (PR + NC) was 76.0%, and the clinical benefit response rate was 52.0%. No toxicity was observed. Pancreatic fistula occurred in 2 patients. The median survival time of the two groups was 9.0 months and 4.0 months, respectively. The survival rates of 6- and 12-month were 56.8% vs. 31.4% and 22.9% vs. 2.9% in the two groups, respectively (P = 0.012). CONCLUSION: Slow-release 5-fluorouracil implantation is a simple, safe and effective method in treatment of LAPC.

[Role of 125I seed implantation in treatment of unresectable pancreatic cancer].

OBJECTIVE: To study the role of (125)I seed implantation in the treatment of unresectable pancreatic cancer. METHODS: From April 2004 to march 2006, 66 untreated patients with locally advanced pancreatic cancer (LAPC) were randomized into two groups: Group A: (125)I seeds implantation (n = 31) and Group B: control (n = 34). The objective tumor response, clinical benefit response, toxicity, complications and survival of two groups were observed. RESULTS: In Group A, the overall response rate (PR + NC) was 80.6%. Clinical benefit response rate was 54.8%. No toxicity was observed. Gastrointestinal hemorrhage and pancreatic fistula occurred in 1 patient respectively in Group A. The survival rates of 6 and 12 months were 56.0% vs 31.4% and 16.8% vs 2.9% respectively in two groups (P < 0.05). The median survival time of two groups was 8.0 months vs 4.0 months (P < 0.05). CONCLUSION: (125)I seed implantation is a simple, safe and effective method in the treatment of locally advanced pancreatic cancer.

[Application of tru-cut biopsy combined with fine needle aspiration biopsy in the intraoperative pathological diagnosis of pancreatic carcinoma].

OBJECTIVE: To investigate the method and value of tru-cut biopsy (TCB) combined with fine needle aspiration biopsy (FNAB) in the pathological diagnosis of pancreatic carcinoma during operation. METHODS: From April 2007 to October 2008, 22 cases who were suspected to suffer from pancreatic carcinoma were enrolled into this prospective study. All of them underwent a tru-cut biopsy combined with fine needle aspiration biopsy for the pathological diagnosis during operation. RESULTS: Of the 22 patients, 20 were finally diagnosed as having pancreatic carcinoma, while 2 having pancreatitis. The diagnosis of pancreatic carcinoma was confirmed in 19 by tru-cut biopsy combined with fine needle aspiration biopsy, while other 3 cases were not confirmed as pancreatic carcinoma. Among those 3 cases, one was diagnosed as having pancreatic carcinoma with hepatic metastasis by liver nodular biopsy, one as suffering from autoimmune pancreatitis, and another case as having chronic pancreatitis confirmed by follow-up for 9 months without any changes after the operation. The accuracy of FNA, TCB and FNA combined with TCB in the diagnosis for suspected pancreatic cancer were 86.4%, 90.9%, and 95.5%, respectively. No pancreatic fistula and bleeding developed after operation. CONCLUSION: Tru-cut biopsy is more accurate in diagnosis for the suspected pancreatic cancer than fine needle aspiration biopsy during operation. Tru-cut biopsy combined with fine needle aspiration biopsy can improve the accuracy of diagnosis, and is a safe and effective diagnostic method.

[Small pancreatic cancer diagnosis and prognosis].

OBJECTIVE: To investigate the clinicopathological characteristics, diagnostic methods and prognosis of small pancreatic cancer. METHODS: From May 2000 to January 2007, 89 patients with pancreatic cancer underwent surgery in our hospital. Of those, 14 had a tumor < or = 2 cm in diameter (small tumor group), and the other 75 had a tumor >2 cm in diameter (controlled group). The clinicopathological data of all the cases were retrospectively reviewed and analyzed. RESULTS: In the small pancreatic cancer group, CT and MRI detected 66.7% (8/12) and 77.8% (7/9) of the tumors, respectively. Serosal infiltration was found in 2 cases, lymph node involvement in 3 cases, and retroperitoneal infiltration in 3 cases. The follow-up duration of this group was 4-86 months. The overall 3- and 5-year survival rates were 42.8% and 31.7%, while in the control group, the overall 3- and 5-year survival rates were 29.7% and 22.5%, respectively. The multivariate analysis showed that the lymph node involvement, serosal infiltration and retroperitoneal infiltration were independent risk factors (P<0.05). However, the tumor size was not shown to be an independent risk factor (OR value = 1.45, P = 0.971). CONCLUSION: CT and MRI are valuable in detecting small pancreatic cancer. Small pancreatic cancers are likely to have a better prognosis when compared with larger ones. Lymph node metastasis and local infiltration are independent predictors of prognosis but not tumor size.

Secreted LOXL2 is a novel therapeutic target that promotes gastric cancer metastasis via the Src/FAK pathway.

The purpose of this study was to investigate invasion- and metastasis-related genes in gastric cancer. To this end, we used the transwell system to select a highly invasive subcell line from minimally invasive parent cells and compared gene expression in paired cell lines with high- and low-invasive potentials. Lysyl oxidase-like 2 (LOXL2) was overexpressed in the highly invasive subcell line. Immunohistochemical analysis revealed that LOXL2 expression was markedly increased in carcinoma relative to normal epithelia, and this overexpression in primary tumor was significantly associated with depth of tumor invasion, lymph node metastasis and poorer overall survival. Moreover, LOXL2 expression was further increased in lymph node metastases compared with primary cancer tissues. RNA interference-mediated knockdown and ectopic expression of LOXL2 showed that LOXL2 promoted tumor cell invasion in vitro and increased gastric carcinoma metastasis in vivo. Subsequent mechanistic studies showed that LOXL2 could activate both the Snail/E-cadherin and Src kinase/Focal adhesion kinase (Src/FAK) pathways. However, secreted LOXL2 induced gastric tumor cell invasion and metastasis exclusively via the Src/FAK pathway. Expression correlation analysis in gastric carcinoma tissues also revealed that LOXL2 promoted invasion via the Src/FAK pathway but not the Snail/E-cadherin pathway. We then evaluated secreted LOXL2 as a target for gastric carcinoma treatment and found that an antibody against LOXL2 significantly inhibited tumor growth and metastasis. Overall, our data revealed that LOXL2 overexpression, a frequent event in gastric carcinoma progression, contributes to tumor cell invasion and metastasis, and LOXL2 may be a therapeutic target for preventing and treating metastases.

[Surgical treatment and prognosis of primary duodenal carcinoma].

OBJECTIVE: To investigate the clinicopathological features, surgical treatment and prognosis of primary carcinoma of the duodenum. METHODS: The clinicopathological data of 86 patients with primary duodenal carcinoma from January 1996 to June 2007 were retrospectively reviewed and analyzed by SPSS 13.0. RESULTS: The clinical manifestation includes upper abdominal pain, jaundice, anemia, gastrointestinal obstruction, melena and weight loss. Four patients had a tumor located in the first portion of the duodenum, 66 in the second portion, 12 in the third portion and 4 in the fourth portion. The preoperative correct diagnostic rate by BUS was 41.7%, by CT 69.4%, by MRI 75.0%, by duodenal endoscopy 84.0%, and by air barium double radiography 80.9%. Complete resection of the tumors was achieved in 38 patients, palliative resection in 45 cases, and exploration alone in 3 cases. The median survival time of the group with complete resection was 42 months versus 13 months in the group with palliative resection, with a significant difference between the two groups (P < 0.05). CONCLUSION: Primary carcinoma of the duodenum has no specific symptoms. Early diagnosis and complete resection are effective to improve prognosis.

[Surgical treatment and prognosis of primary retroperitoneal malignant tumor].

OBJECTIVE: To investigate the surgical treatment and prognosis of primary retroperitoneal malignant tumor. METHODS: A total of 191 patients with primary retroperitoneal malignant tumor treated from January 1996 to December 2007 at our hospital were retrospectively analyzed. SPSS 13.0 was used to analyze the follow-up data. RESULTS: The clinical manifestations included abdominal mass [122 (63.9%)], abdominal pain [77 (40.3%)] and abdominal distension [48 (25.1%)]. Liposarcoma [75 (39.3%)] was more frequently encountered than other tumors. Among these patients, 142 underwent complete resection, 35 palliative resection and 14 exploratory operation. The median survival time of complete resection, palliative resection and exploratory operation were 56, 33 and 11 months respectively. The difference was of statistical significance. CONCLUSIONS: Surgical resection is an effective therapeutic method for primary retroperitoneal malignant tumor. Complete resection prolongs the survival time and it is effective in control of recurrent tumors.

[Value of combined therapy in pancreatic cancer with a poor prognosis: analysis of 233 clinical cases].

OBJECTIVE: To analyze the value of combined therapy in pancreatic cancer with a poor prognosis. METHODS: The prognostic factors of pancreatic cancer with different clinicopathological characteristics and treatment modalities were analyzed retrospectively and the cumulative curve was plotted using the Kaplan-Meier method. RESULTS: (1) From January 2001 to December 2005, 233 patients with pathological and cytological diagnosis of pancreatic cancer were analyzed. The median survival of all patients was 8.67 months, the 1-year survival rate 29.6% and the 5-year survival rate 4.5%. (2) Weightloss cases had a median survival of 7.7 months versus 10.0 months for cases without weightloss (P = 0.003). Back pain cases had a median survival of 6.5 months versus 9.0 months for cases without back pain (P = 0.015). Cases with normal CA19-9 levels (< or = 37 U/ml) had a median survival of 11.0 months versus 8.0 months for cases with CA19-9 > 37 U/ml levels (P = 0.000). Stages III and IV disease cases had a median survival of 8.7 and 6.3 months versus 16.0 months for cases of Stages I + II (P = 0.000). In the present study, patients suffering from weightloss or back pain or whose CA19-9 was above 37 U/ml or whose TNM stage was III/IV were defined as cases with a poor prognosis. (3) Patients were grouped as pancreatectomy group, cancer-directed treatment group (including intraoperative iodine-125 seed interstitial brachytherapy, 5-FU interstitial chemotherapy, radiotherapy, chemotherapy and transcatheter arterial infusion chemotherapy) and no cancer-directed treatment group (including cases receiving biopsies or bypass). Median survival of three groups were 14.0, 8.3 and 6.6 months respectively. And the 1-year survival rates were 53.5%, 22.5% and 11.8% respectively while the 5-year survival rate 5.8%, 0 and 0 respectively. (4) Median survival of poor prognostic cases (who suffered from weightloss or back pain or whose CA19-9 was above 37 U/ml or whose TNM stage was III/IV) treated with pancreatectomy were 12.0, 11.0, 12.0 and 7.0 months respectively. Median survival of poor prognostic cases treated with cancer-directed therapy were 7.7, 7.5, 8.6 and 8.0 months respectively. Median survival of poor prognostic cases treated with no cancer-directed therapy were 4.0, 3.0, 4.0 and 4.6 months respectively. CONCLUSION: Optimized combined therapy is recommended for pancreatic cancer patients with poor prognostic factors.

[Prospective evaluation of ultrasonography, multi-slice spiral CT, endoscopic ultrasonography, and magnetic resonance imaging in assessment of TNM staging and assessment of resectability in pancreatic carcinoma].

OBJECTIVE: To evaluate prospectively the efficacy and clinical significance of ultrasonography (US), multi-slice spiral CT (MSCT), magnetic resonance imaging (MRI), and endoscopic ultrasonography (EUS) in assessment of the TNM staging and resectability of pancreatic carcinoma. METHODS: Consecutive 68 patients with pancreatic carcinoma underwent US, MSCT, MRI, and EUS to assess their efficacies in assessment of the size of carcinoma, lymph node metastasis, and distant metastasis. The results of theses imaging techniques were compared with the surgical and pathological findings. RESULTS: EUS was the most precise technique in evaluating the T staging of pancreatic carcinoma with the coefficients of regression of maximum and minimum radii of 1.025 (P=0.043) and 0.987 (P<0.0001). In the assessment of lymph node metastasis, EUS had the highest sensitivity (75.0%), accuracy (87.5%), and negative predictive values (91.7%). Univariate logistic regression showed that EUS was significantly correlated with the surgical findings (OR: 33.00, 95%CI: 7.18-151.77 P<0.0001). Multivariate logistic regression analysis confirmed that EUS had an independent predictive value (OR: 34.50, 95%CI: 6.54-182.09, P<0.0001). MSCT had the highest sensibility (88.9%) in the assessment of distant metastasis and had the highest accuracy (61.8%) in preoperative TNM staging of pancreatic carcinoma. All 4 imaging techniques were correlated with surgical findings in assessment of the resectability. Multivariate logistic regression analysis confirmed that none of the imaging techniques had independent predictive value. CONCLUSION: MSCT is the best method in preoperative TNM staging of pancreatic carcinoma. EUS is the best methods in the assessment of tumor size and lymph node metastasis. Preoperative assessment of pancreatic carcinoma needs combination of at least two kinds of imaging techniques.

[Effects of hyperthermic chemotherapy on gastrointestinal cancer cells in vitro].

BACKGROUND & OBJECTIVE: Little evidence is known from experimental research for intraoperative hyperthermic intraperitoneal chemotherapy. This study was to investigate the effect of hyperthermic chemotherapy on gastrointestinal cancer cells in vitro and explore the possible factors which may affect this method. METHODS: Gastric cancer cell line MGC-803 and intestinal cancer cell line HCT-116 were chosen. Cells were treated with different drugs, temperatures and duration. Cell viability and growth were measured by MTS-PMS assay. The morphology of the cells was observed under a microscope. RESULTS: Significant synergistic effect was observed when the two cancer cell lines were treated with 5-FU, MMC, DDP and THP in combination with elevated hyperthermia from 41 degrees C to 45 degrees C compared with control group (P<0.01). The strongest effect was achieved at 45 degrees C, which the inhibitory effects of these four drugs were 61.7%, 79.2%, 88.7%, 94.7% on MGC-803 and 76.4%, 78.7%, 77.8%, 91.7 on HCT-1116, respectively. The inhibitory effect demonstrated a time and dose-dependent manner in HCT-116 cells within a certain period of time. The effect revealed a flat curve after 90 min when HCT-116 was treated with 43 centigrade. THP had the strongest effect at any conditions among all tested drugs (P<0.01). Either simple thermotherapy or chemohyperthermia displayed considerable killing effects on cancer cells which were confirmed by microscope observation. And a great deal of dead cells were observed when treated with chemohyperthermia. CONCLUSIONS: DDP or MMC reveals relatively satisfactory antitumor effects with the optimal temperature of 43-45 degrees C. Taken practical application into consideration, 60 min may be selected in clinical use. Synergistic antitumor effects of THP in combination with hyperthermia were prior to 5-FU, DDP or MMC, which deserve further clinical research.

[Diagnosis and management of metastatic pancreatic tumors].

OBJECTIVE: To study the clinicopathological features and prognostic factors of metastatic pancreatic tumor. METHODS: The clinical data of 18 metastatic pancreatic tumors were retrospectively analyzed. The primary foci of these 18 patients included: 8 lung cancer, 2 gastric cancer, and malignant histiocytoma, melanoma, rectal cancer, thyroid cancer, renal cell carcinoma, esophageal carcinoma, liver cancer and ovarian cancer each. RESULTS: All these 18 patients harboring metastatic pancreatic tumor did not show any specific symptoms but were frequently found to have a solitary (14 cases) or multiple (4 cases) homogeneous and hypodense nodules on CT scan without any enhancement except one metastatic renal cell carcinoma. The diagnosis was cytologically confirmed in 14 patients by fine needle aspiration biopsy guided by CT or ultrasonography, and diagnosed by postoperative pathology in the other 4 patients. After receiving combined modality treatment, their survival time was 8 to 38 months with an average of 19 months. CONCLUSION: Metastatic pancreatic tumors are rare and give no specific symptom or image finding. Selection of appropriate combined modality treatment according to the type of primary focus is very important for the management.

[Immediate cardioversion of atrial fibrillation and atrial flutter lasting less than 90 days by ibutilide versus propafenone: a multicenter study].

OBJECTIVE: To compare the efficacy and safety of ibutilide versus propafenone in immediate cardioversion of atrial fibrillation (AF) and atrial flutter (AFL) lasted less than 90 days. METHODS: 212 consecutive patients suffering from AF or AFL all lasting less than 90 days that were diagnosed and treated in 5 medical centers were randomly assigned into two groups: ibutilide group (n = 107, including 75 AF cases and 32 AFL cases, receiving intravenous injection of ibutilide 1mg over 10 minutes) and propafenone group as control group (n = 105, including 76 AF cases and 29 AFL cases, receiving intravenous injection of propafenone 70 mg over 10 minutes). If AF/AFL still persisted 10 minutes after treatment, the above dose was repeated. The conversion rate within 1.5 hours and adverse effects within 4 hours were observed. RESULTS: (1) The conversion rate on AFL of the ibutilide group was 78.1%, significantly higher than that of the propafenone group (48.3%, P < 0.01), while no significant difference was observed in the conversion rate on AF (54.7% vs. 39.5%, P > 0.05) and the mean conversion time (P > 0.05). However the overall conversion rate on AFL and AF of the ibutilide group was 61.7%, significantly higher than that of the propafenone group (41.9%, P < 0.05). (2) The conversion rate on AF/AFL lasting less than 48 h was 65.9% in the ibutilide group, not significantly different from that of the propafenone group (55.7%), the conversion rate on AF/AFL lasting 3 approximately 30 d in the ibutilide group was 66.7%, significantly higher than that of the propafenone group (26.3%, P < 0.05), and the conversion rate on AF/AFL lasting 31 - 88 d was 50%, significantly higher than that of the propafenone group (0, P < 0.01). (3) There was no difference in the times needed for conversion between these 2 groups. (4) The most severe adverse effect in the ibutilide group was short run of ventricular tachycardia occurring in 5 cases among which 4 cases recovered simultaneously and one case recovered after accepting a bolus dose of 100 mg lidocaine. The most severe adverse effects in propafenone group were RR interval longer than 1.5 s (4 cases) and transient hypotension. An acute coronary event was also seen in propafenone group, however, unrelated to the experimental drug. CONCLUSION: Intravenous administration of ibutilide in cardioversion of AF and AFL is safe and effective.