Best treatment options for occult breast cancer: A meta-analysis.

Objectives: Occult breast cancer (OBC) is a rare malignant breast tumor. Because of the rare cases and limited clinical experience, a huge therapeutic difference has existed all over the world and standardized treatments have yet been established. Methods: A meta-analysis was conducted using MEDLINE and Embase databases to identify the choice of OBC surgical procedures in all studies: (1) patients undergoing axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB) only; (2) patients undergoing ALND with radiotherapy (RT); (3) patients undergoing ALND with breast surgery (BS); (4) patients undergoing ALND with RT and BS; and (5) patients undergoing observation or RT only. The primary endpoints were mortality rates, the second endpoints were distant metastasis and locoregional recurrence. Results: Among the 3,476 patients, 493 (14.2%) undergo ALND or SLNB only; 632 (18.2%) undergo ALND with RT; 1483 (42.7%) undergo ALND with BS; 467 (13.4%) undergo ALND RT and BS, and 401 (11.5%) undergo observation or RT only. After comparing the multiple groups, both groups 1 and 3 have higher mortality rates than group 4 (30.7% vs. 18.6%, p < 0.0001; 25.1% vs. 18.6%, p = 0.007), and group 1 has higher mortality rates than groups 2 and 3 (30.7% vs.14.7%, p < 0.00001; 30.7 vs. 19.4%, p < 0.0001). Group (1 + 3) had a prognosis advantage over group 5 (21.4% vs. 31.0%, p < 0.00001). There was no significant difference both in the distant recurrence rates and locoregional rates between group (1 + 3) and group (2 + 4) (21.0% vs. 9.7%, p = 0.06; 12.3% vs. 6.5%, p = 0.26). Conclusion: On the basis of this meta-analysis, our study indicates that BS including modified radical mastectomy (MRM) and breast-conserving surgery (BCS) combined RT may appear as the optimal surgical approach in patients with OBC. RT cannot prolong both the time of distant metastasis and the local recurrences.

[Quality of life of patients with gastric tube anastomosis after proximal gastrectomy in adenocarcinoma of esophagogastric junction].

OBJECTIVE: To compare postoperative quality of life (QOL) of patients receiving proximal gastrectomy (PG) for adenocarcinoma of gastroesophagealjunction (AEG) throughgastric tube anastomosis and traditional esophagogastrostomy. METHODS: Between January 2010 and February 2011, 112 patients were diagnosed as AEG in our hospital. All patients underwent curative operations. Two post-PG alimentary tract reconstruction methods were adopted: gastric tube anastomosis (n = 60) and traditional direct anastomosis (n = 52). The European Organization for Research and Treatment of Cancer (EORTC) Quality of life Questionnaire Core-30 (EORTC QLQ-C30) and QLQ-STO22 were used to assess QOL of those patients before and two years after operations. RESULTS: There were no statistically significant differences between the two groups of patients in clinical and pathologic characteristics, clinical pathological characteristics and preoperative QOL (P > 0.05). Two years after operations, the patients receiving traditional direct anastomosis showed higher scores in reflux, body image, and nausea and vomiting compared with those receiving gastric tube anastomosis. No statistical differences were found between the two groups of patients in general health, physical function, role function, fatigue and pain (P > 0.05). CONCLUSION: Gastric tube reconstruction could improve the postoperative QOL of AEG patients.

[Clinical analysis of efficacy and prognosis of intermediate risk gastric stromal tumor patients].

OBJECTIVE: To explore the clinical efficacy and prognosis of the patients with intermediate risk gastric stromal tumor (GST). METHODS: The data of intermediate risk GST patients confirmed by pathology and immunohistochemistry at Center of Gastrointestinal Surgery, West China Hospital, Sichuan University, between January 2007 and July 2011 were collected and retrospectively analyzed. And univariate and multivariate analyses were performed to assess the efficacy of imatinib mesylate (IM) according to recurrence-free survival (RFS). RESULTS: A total of 46 intermediate risk GST patients were enrolled with a median follow-up period of 31 (9-64) months. Among them, 20 patients received IM treatment and 1 had hepatic metastasis at 16 months after withdrawal. In contrast, 5 of 26 patients refusing IM treatment recurred or had a distant metastasis. The 1-, 2-, 3-year recurrence-free survival in IM treatment group and no IM treatment group were: 20/20 vs 25/26, 14/14 vs 17/20 and 6/7 vs 10/14, respectively. Cox proportion hazards regression: hazard ratio(HR) = 0.265, 95%CI: 0.025-2.761, P = 0.267. Among 6 patients with recurrence and(or) metastasis, 5 had mitotic count > 5/50 HPF. Cox proportion hazards regression (HR = 0.059, 95%CI: 0.004 - 0.976, P = 0.048) showed that IM can improve the progression free survival of mitotic count > 5/50 HPF group versus mitotic count < 5/50 HPF. The most common IM-related side effects were edema, nausea, abdominal discomfort, leukemia, etc. Most of them were Grade 1-2. CONCLUSIONS: Intermediate risk GST has a low rate of recurrence or metastasis. And 1-year IM treatment may improve the prognosis of the patients with mitotic counts > 5/50 HPF. Furthermore, IM treatment is safe in intermediate risk GST patients.

[Clinical research of the sentinel lymph node in patients with early gastric cancer].

OBJECTIVE: To assess the value of carbon nanoparticles which mapping sentinel lymph node (SLN) and predict the status of lymph node metastasis status in the early gastric cancer (EGC), and to explore the SLN distribution. METHODS: Forty five patients with EGC, who underwent surgical treatment, were enrolled. At the completion of exploratory laparotomy, 1 mL solution of carbon nanoparticles was injected subserosally in the gastric wall 4-6 sites around the primary tumor during surgery in all patients. The first stained lymph nodes were defined as the SLN. Postoperative SLN and dissection of the lymph node was sent for histopathological examination. RESULTS: Carbon nanoparticles were applied in 45 EGC patients for mapping SLN and 43 cases (95.6%) were observed with positive stain. 53 pieces of SLN were detected, average (1.23 +/- 0.53) pieces for one person. 11 of the 43 patients (25.6%) developed lymph node metastasis, through the SLN histopathological examination, 3 cases (7.0%) were false negative, the accuracy and sensitivity of the prediction of regional lymph node metastasis status was 93.0% and 72.7%, respectively. The false negative and negative predictive value was 27.3% and 91.4%. There were significant differences between the mucosal cancer group and submucous cancer group in the diameter of tumor (P = 0.042) and the rate of lymph node metastasis (P = 0.001). There were no significant differences between the two groups in the accuracy and sensitivity (P > 0.05). In 36 cases of gastric cancer patients, 23 SLN positive cases (63.9%) were detected in third group. CONCLUSIONS: The dyeing rate, accuracy and sensitivity of carbon nanoparticles mapping SLN for EGC were high. Carbon nanoparticles mapping SLN can more accurately predict perigastric lymph node metastasis status in patients with EGC.

[Prognostic analysis of 349 cases with gastrointestinal stromal tumor].

OBJECTIVE: To investigate the prognostic factors of gastrointestinal stromal tumor (GIST). METHODS: Clinical data of 349 cases of GIST patients in our hospital between January 2006 and September 2011 were analyzed retrospectively and the prognostic factors were evaluated. RESULTS: 335 patients underwent R0 resection and 14 with palliative resection. With a follow-up of 288 (82.5%) patients (median: 33 months, range 3-72 months), 61 patients with progressed were observed and 33 of them died. Unconditional logistic regression analysis showed that tumor location (P = 0.003, OR = 1.412, 95% CI: 1.125-1.772), risk classification (P = 0.011, OR = 2.930, 95% CI: 1.278-6.716) and use of imatinib treatment (P = 0.009, OR =0.291, 95 CI: 0.115-0.734) were independent factors for post-operative recurrence or metastasis. Survival analysis of 128 patients between January 2006 and December 2008, Cox regression analysis demonstrated diameter (P = 0.034, OR = 2.328, 95% CI: 1.065-5.089), risk classification (P = 0.015, OR = 3.031, 95% CI: 1.236-7.428) and use of imatinib treatment (P = 0.011, OR = 0.259, 95% CI: 0.091-0.734) were independent prognosis factors. CONCLUSIONS: No specific clinical manifestation was observed for GIST. Tumor location, diameter, risk classification and imatinib treatment could influence on prognosis. Radical resection combined with imatinib treatment could improve the prognosis.

[Clinicopathological characteristics and surgical treatment of duodenal gastrointestinal stromal tumor].

OBJECTIVE: To investigate the clinicopathological characteristics and surgical treatment of duodenal gastrointestinal stromal tumor (GIST). METHODS: Clinicopathological data of 25 cases with duodenal GIST from January 2007 to July 2011 in West China hospital were retrospectively analyzed. RESULTS: All the patients were identified by pathological examination without specific symptoms. Tumors were located in the bulb area in 2 cases, descending portion in 11 cases, transverse portion in 8 cases, and ascending portion in 4 cases. Two cases were at very low risk, 7 at low risk, 6 at intermediate risk, and 10 at high risk. All the patients received surgical resection, including 11 pancreaticoduodenectomies, 10 local tumor resections, 2 duodenal segmental resections, and 2 distal subtotal gastrectomies. Eighteen patients were followed up from 16 to 39 months and 3 patients recurred 18, 30, and 35 months after operation respectively. CONCLUSIONS: Duodenal GIST exhibits no distinct clinical characteristics. Complete removal of the tumor is the main choice of treatment.

[Clinical outcomes of surgical patients with types II and III adenocarcinoma of esophagogastric junction].

OBJECTIVE: To investigate the clinical pathological characteristics, choice of surgical therapy and postoprative complications of patients with types II and III adenocarcinoma of esophagogastric junction (AEG). METHODS: Clinical data of 112 patients with types II and III AEG who underwent intraperiteanal operations from January 2008 to July 2010 were reviewed. Amongst the patients, 77 suffered from type II AEG and 35 suffered from type III AEG; 72 underwent proximal gastrectomy and 40 underwent total gastrectomy. RESULTS: The patients with type II and type III AEG shared some common characteristics, such as advanced tumor TNM stage and lymphatic metastasis. There was a significant difference in choice of surgical approaches between the two groups of patients (P < 0.05), with 57 type II AEG patients (74.0%) and 15 type III AEG patients (42.9%) undergoing proximal gastrectomy respectively. Operational time and incidence of postoperative complications differed between proximal gastrectomy and total gastrectomy (P < 0.05). Total gastrectomy lasted longer [(304.12 +/- 23.12) min] than proximal gastrectomy [(275.76 +/- 27.02) min]. Proximal gastrectomy provoked 20.8% (15 patients) heartburn and/or acid regurgitation and 12.5% (9 cases) reflux esophagitis. Fifteen patients (37.5%) with total gastrectomy had more than 5 meals a day. CONCLUSION: Intraperiteanal operations are recommended for patients with types IT and Ili AEG. The choice of proximal gastrectomy or total gastrectomy depends on the location and size of the tumor, both being followed with some complications.

Gastric tube reconstruction reduces postoperative gastroesophageal reflux in adenocarcinoma of esophagogastric junction.

BACKGROUND: The anastomosis of gastric remnant to esophagus after proximal gastrectomy is the traditional surgical treatment procedure for patients with types II and III adenocarcinoma of esophagogastric junction. However, the postoperative complications such as gastroesophageal reflux are frequent. AIMS: To assess the outcome of the intraperitoneal anastomosis of the reconstructed gastric tube to esophagus after proximal gastrectomy for types II and III adenocarcinoma of esophagogastric junction. METHODS: Seventy-six consecutive patients with preoperative diagnosis of type II or type III adenocarcinoma of esophagogastric junction were recruited. Forty-one patients had the traditional anastomosis of gastric remnant to esophagus and 35 patients underwent an anastomosis of esophagus to a gastric tube that was constructed from the gastric remnant after proximal gastrectomy. RESULTS: Twenty-three (56.1%) versus 12 (28.6%) patients (p = 0.016) complained various discomforts and/or were diagnosed with complications in the traditional group and gastric tube group, respectively, although there were no significant differences between the two groups in demographic data and pathological characteristics. Fourteen (34.1%) versus five (14.3%) patients (p = 0.046) complained of heartburn or acid regurgitation and nine (22.0%) versus two (5.7%) patients (p = 0.045) were confirmed reflux esophagitis in the traditional group and the gastric tube group, respectively. CONCLUSIONS: The intraperitoneal anastomosis of the reconstructed gastric tube to esophagus demonstrates less complaints of gastroesophageal reflux and reflux esophagitis than the traditional anastomosis of gastric remnant to esophagus in the surgical treatment of types II and III adenocarcinoma of esophagogastric junction in 1-year follow-up.

[Identification of Streptococcus species and Haemophilus influenzae by direct sequencing of PCR products from 16S-23S rRNA itergenic sacer regions].

To facilitate species level identification of bacteria without the requirement of presumptive identification, the paper describes a rapid identification method of bacteria by amplification and direct sequencing 16S-23S rDNA intergenic spacer regions (ISR) of the pathogens which cause the upper respiratory tract infective disease by Streptococcus and Haemophilus. Three pairs of primer targeting conserved sequences flanking the 3' end of 16S and the 5' end of 23S rRNA were used to amplify 16S~23S rRNA ISR of 7 streptococcus strains and 8 Haemophilus strains. The PCR products were separated by 1% agarose gel electrophoresis and the polymorphisms fragments were purified with the Wizard PCR Min-Prep Kit (Promega) and Protocol-SK131(Sangon). The nucleotide sequences of ISR inserts were determined by using the XEQTM DTCS Kitjj Terminator Cycle Sequencing and a CEQTM 2000XL DNA Analysis system (Backman Coulter) automatic DAN sequencer. Then those sequences were compared with known sequences on the GenBank. The alignment of nucleotide sequence, evolutionary distances and phylogenetic trees were analyzed by software DANMAN version 4.0. The PCR products were showed polymorphism patterns with agarose gel. One band was contained in streptococcus genus. The significant variation was found among the spacer sequences of different species in Streptococcus with the lengths of the spacer varying from 269 to 446 bp. All the ISR of the streptococcal species had a tRNA Ala gene in the spacer and the sequence identities varied from 78 to 88% within genera. It was found that some spacer sequence blocks were highly conserved between operons of a genome, whereas the presence of others was variable, three regions showed significant spatial variation. Most of the differences between the sequences came from several bases insertions/deletions and substitutions. There are two major bands in the Haemophilus biotypes (515 and 884 bp), the small ISR amplicon contained one tDNA coding for tRNA(Glu). In contrast to the large one contained two tRNA genes coding for tRAN(Ala) and tRNA(Ile). Two regions of repeating motifs with only A or T were present in higher copy numbers between tRAN(Ala) and tRNA(Ile). The phylogenetic trees varied from 97.5 to 98.8%. The PCR and direct sequencing of 16S-23S rRAN ISR were successful in the pathogen species identification.