BACKGROUND The 8^th edition of the American Joint Committee on Cancer(AJCC)staging system for pancreatic ductal adenocarcinoma(PDAC)excludes extrapancreatic extension from the assessment of T stage and restages tumors...BACKGROUND The 8^th edition of the American Joint Committee on Cancer(AJCC)staging system for pancreatic ductal adenocarcinoma(PDAC)excludes extrapancreatic extension from the assessment of T stage and restages tumors with mesenterico-portal vein(MPV)invasion into T1-3 diseases according to tumor size.However,MPV invasion is believed to be correlated with a poor prognosis.AIM To analyze whether the inclusion of MPV invasion can further improve the 8th edition of the AJCC staging system for PDAC.METHODS This study retrospectively included 8th edition AJCC T1-3N0-2M0 patients undergoing pancreaticoduodenectomy/total pancreatectomy from two cohorts and analyzed survival outcomes.In the first cohort,a total of 7539 patients in the surveillance,epidemiology,and end results database was included,and in the second cohort,689 patients from the West China Hospital database were enrolled.RESULTS Cox regression analysis showed that MPV invasion is an independent prognostic factor in both databases.In the MPV-group,all pairwise comparisons between the survival functions of patients with different stages were significant except for the comparison between patients with stage IIA and those with stage IIB.However,in the MPV+group,pairwise comparisons between the survival functions of patients with stage IA,stage IB,stage IIA,stage IIB,and stage III were not significant.T1-3N0 patients in the MPV+group were compared with the T1N0,T2N0,and T3N0 subgroups of the MPV-group;only the survival of MPV-T3N0 and MPV+T1-3N0 patients had no significant difference.Further comparisons of patients with stage IIA and subgroups of stage IIB showed(1)no significant difference between the survival of T2N1 and T3N0 patients;(2)a longer survival of T1N1 patients that was shorter than the survival of T2N0 patients;and(3)and a shorter survival of T3N1 patients that was similar to that of T1-3N2 patients.CONCLUSION The modified 8th edition of the AJCC staging system for PDAC proposed in this study,which includes the factor of MPV invasion,provides improvements in predicting prognosis,especially in MPV+patients.展开更多
Purpose: The study of the sentinel lymph node is the best technique to stage, have a prognosis and decide the adequate treatment in breast cancer. The usual technique implies studding the axillary lymph node. Our work...Purpose: The study of the sentinel lymph node is the best technique to stage, have a prognosis and decide the adequate treatment in breast cancer. The usual technique implies studding the axillary lymph node. Our work tries to identify affected nodes in other regions apart from the axilla and its possible impact in staging and treatment. Methods: The sentinel lymph node technique was performed on 1660 patients included in an observational and multicentric study designed to observe the presence of metastatic cells in axillary and non-axillary lymph nodes. Results: In 19% of the patients the sentinel lymph node was detected in non-axillary regions. In these cases metastatic cells were more frequent which could suppose a change in the stage and/or treatment. As protective factor against non-axillary nodes involvement we found the localization of the cancer in external quadrants while youth and injecting the tracer inside the tumor were found to be risk factors. Conclusions: Detecting and studding non-axillary lymph nodes in breast cancer leads to a more precise staging of the disease which could imply a change in the optimal treatment.展开更多
China faces a disproportionate cancer burden to the population size and is undergoing a transition in the cancer spectrum.We extracted data in five aspects of cancer incidence,mortality,survival,staging distributions,...China faces a disproportionate cancer burden to the population size and is undergoing a transition in the cancer spectrum.We extracted data in five aspects of cancer incidence,mortality,survival,staging distributions,and attribution to risk factors in China,the USA and worldwide from open-source databases.We conducted a comprehensive secondary analysis of cancer profiles in China in the above aspects,and compared cancer statistics between China and the USA.A total of 4,546,400 new cancer cases and 2,992,600 deaths occurred in China in 2020,accounting for 25.1%and 30.2%of global cases,respectively.Lifestyle-related cancers including lung cancer,colorectal cancer,and breast cancer showed an upward trend and have been the leading cancer types in China.41.6%of new cancer cases and 49.3%of cancer deaths occurred in digestive-system cancers in China,and the cancers of esophagus,nasopharynx,liver,and stomach in China accounted for over 40%of global cases.Infection-related cancers showed the highest population-attributable fractions among Chinese adults,and most cancers could be attributed to behavioral and metabolic factors.The proportions of stage I for most cancer types were much higher in the USA than in China,except for esophageal cancer(78.2%vs.41.1%).The 5-year relative survival rates in China have improved substantially during 2000–2014,whereas survival for most cancer types in the USA was significantly higher than in China,except for upper gastrointestinal cancers.Our findings suggest that although substantial progress has been made in cancer control,especially in digestive system cancers in China,there was still a considerable disparity in cancer burden between China and the USA.More robust policies on risk factors and standardized screening practices are urgently warranted to curb the cancer growth and improve the prognosis for cancer patients.展开更多
Objective:To evaluate the use of Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography(^(68)Ga-PSMA PET/CT),compared with conventional CT abdomen/pelvis(CTAP)and whole body sin...Objective:To evaluate the use of Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography(^(68)Ga-PSMA PET/CT),compared with conventional CT abdomen/pelvis(CTAP)and whole body single photon emission CT bone scan(BS),for detection of local or distant metastasis following biochemical failure/recurrence in post-prostatectomy patients.Methods:We conducted a review of our prospectively maintained,institutional database to identify 384 patients with post-prostatectomy biochemical failure/recurrence who underwent PSMA PET/CT,CTAP and BS from February 2015 to August 2017 in Nepean Hospital,tertiary referral centre.The results of the three imaging modalities were analysed for their ability to detect local recurrence and distant metastases.PSMA PET/CT and CTAP imaging were separately performed on the same day and the BS was performed within several days(mostly in 24 h).Difference in detection rates was determined between the modalities and the Chi square test was used to determine significance.Results:A total of 384 patients were identified with a median prostate-specific antigen(PSA)of 0.465 ng/mL(interquartile range =0.19-2.00 ng/mL).Overall,PSMA PET/CT was positive for 245(63.8%)patients whereas CTAP and BS were positive in 174 patients(45.3%).A total of 98 patients(25.5%)had local or distant metastasis detected on PSMA only,while 20 patients(5.2%)had recurrences detected on CTAP but not on PSMA PET/CT.Conclusion:The use of PSMA PET/CT has a higher detection rate of predicted local or distant metastasis compared to CTAP and BS in the staging of patients with biochemical recurrences after radical prostatectomy.展开更多
Mediastinal or N2 disease is the most important factor in selecting the optimal treatment strategy in patients without distant metastasis.A direct surgical resection has not generally been accepted as a treatment moda...Mediastinal or N2 disease is the most important factor in selecting the optimal treatment strategy in patients without distant metastasis.A direct surgical resection has not generally been accepted as a treatment modality in whom mediastinal nodal involvement is demonstrated.Patients with lung cancer can be diagnosed as clinical N2 disease based on CT and PET-CT characteristics of the mediastinum and the clinical presentation.Invasive diagnostic modalities used in the detection of N2 disease are:mediastinoscopy,endoesophageal ultrasound guided biopsy(EUS),transbronchial needle aspiration(TBNA),endobronchial ultrasound guided biopsy(EBUS),video-assisted thoracoscopic surgery(VATS),and mediastinotomy/extended mediastinoscopy.In this article,the author discusses about invasive and noninvasive techniques on the evaluation of mediastinal disease and presents his experience on this topic.展开更多
BACKGROUND Pancreatic neuroendocrine neoplasms(pNENs)that produce hormones leading to symptoms are classified as functional tumors,while others are classified as nonfunctional tumors.The traditional view is that funct...BACKGROUND Pancreatic neuroendocrine neoplasms(pNENs)that produce hormones leading to symptoms are classified as functional tumors,while others are classified as nonfunctional tumors.The traditional view is that functionality is a factor that affects the prognosis of pNEN patients.However,as the sample sizes of studies have increased,researches in recent years have proposed new viewpoints.AIM To assess whether functionality is an independent factor for predicting the prognosis of pNEN patients.METHODS From January 2004 to December 2016,data of patients who underwent surgery at the primary site for the treatment of pNENs from the Surveillance,Epidemiology,and End Results(SEER)database and West China Hospital database were retrospectively analyzed.RESULTS Contemporaneous data from the two databases were analyzed separately as two cohorts and then merged as the third cohort to create a large sample that was suitable for multivariate analysis.From the SEER database,age(P=0.006)and T stage(P<0.001)were independent risk factors affecting the survival.From the West China Hospital database,independent prognostic factors were age(P=0.034),sex(P=0.032),and grade(P=0.039).The result of the cohort consisting of the combined populations from the two databases showed that race(P=0.015),age(P=0.002),sex(P=0.032)and T stage(P<0.001)were independent prognostic factors.In the West China Hospital database and in the total population,nonfunctional pNETs and other functional pNETs tended to have poorer prognoses than insulinoma.However,functionality was not associated with the survival time of patients with pNETs in the multivariate analysis.CONCLUSION Functionality is not associated with prognosis.Race,age,sex,and T stage are independent factors for predicting the survival of patients with pNETs.展开更多
BACKGROUND In colorectal cancer, tumor deposits(TDs) are considered to be a prognostic factor in the current staging system, and are only considered in the absence of lymph node metastases(LNMs). However, this definit...BACKGROUND In colorectal cancer, tumor deposits(TDs) are considered to be a prognostic factor in the current staging system, and are only considered in the absence of lymph node metastases(LNMs). However, this definition and the subsequent prognostic value based on it is controversial, with various hypotheses. TDs may play an independent role when it comes to survival and addition of TDs to LNM count may predict the prognosis of patients more accurately.AIM To assess the prognostic impact of TDs and evaluate the effect of their addition to the LNM count.METHODS The patients are derived from the Surveillance, Epidemiology, and End Results database. A prognostic analysis regarding impact of TDs on overall survival(OS) was performed using Cox regression model, and other covariates associating with OS were adjusted. The effect of addition of TDs to LNM count on N restaging was also evaluated. The subgroup analysis was performed to explore the different profile of risk factors between patients with and without TDs.RESULTS Overall, 103755 patients were enrolled with 14131(13.6%) TD-positive and 89624(86.4%) TD-negative tumors. TD-positive patients had worse prognosis compared with TD-negative patients, with 3-year OS rates of 47.3%(95%CI, 46.5%-48.1%) and 77.5%(95%CI, 77.2%-77.8%, P < 0.0001), respectively. On multivariable analysis, TDs were associated poorer OS(hazard ratio, 1.35;95%CI, 1.31-1.38;P < 0.0001). Among TD-positive patients, the number of TDs had a linear negative effect on disease-free survival and OS. After reclassifying patients by adding TDs to the LNM count, 885 of 19 965(4.4%) N1 patients were restaged as p N2, with worse outcomes than patients restaged as p N1(3-year OS rate: 78.5%, 95%CI, 77.9%-79.1% vs 63.2%, 95%CI, 60.1%-66.5%, respectively;P < 0.0001).CONCLUSION TDs are an independent prognostic factor for OS in colorectal cancer. The addition of TDs to LNM count improved the prognostic accuracy of tumor, node and metastasis staging.展开更多
Objective:To study the manifestation,pathohistologic type,stage of disease,treatment andoutcome of epithelial ovarian carcinoma in women under the age of 30 years.Methods:The 21 cases of epithelial ovarian carcinoma i...Objective:To study the manifestation,pathohistologic type,stage of disease,treatment andoutcome of epithelial ovarian carcinoma in women under the age of 30 years.Methods:The 21 cases of epithelial ovarian carcinoma in women aged below 30 years betweenJan,1986 and Mar,2002 were analyzed retrospectively.Results:The median age at the time of diagnosis was 24 years(range,16-29 years).All car-cinomas occurred after menarche.The most common symptoms were abdominal pain(50%),fol-lowed by tympanites(25%)and menstrual disorders(19%).The initial diagnosis was usuallymade by physical examination,ultrasonography and serum CA125.The mean maximal tumor di-ameter was 17.6 cm.Ten patients had Stage Ⅰ disease(5 Ⅰa,5 Ⅰc),five had Stage Ⅲ disease,andthe other six were unknown during staging operation.There were nine mucinous tumors,six se-rous tumors.Most tumors were well-differentiated and classified as Grade1 in 11 cases,Grade2 in2 cases,Grade3 in 2 cases,unknown in 6 cases.Optimal and suboptimal cytoreduction wasachieved in 14 patients in primary treatment and 5 in recurrent treatment.8 patients were treatedwith conservative surgery.18 patients were treated with chemotherapy and 7 patients had experi-enced six or more than six courses of chemotherapy.The median follow-up was 50 months(range,2-192 months).There were 6 deaths,2 alive with tumor,11 alive without the disease,2losing follow-up.The 3-year survival rate was 89%,and 5-year survival rate was 76%.Conclusion:Young patients with epithelial ovarian carcinoma appeared to have a less aggres-sive form of the disease and a more favorable prognosis.展开更多
Background and objective Sleeve resections were introduced to preserve lung function in patients with limited pulmonary reserve.Increasing experience with sleeve resection has reduced the rate of pneumonectomy below 1...Background and objective Sleeve resections were introduced to preserve lung function in patients with limited pulmonary reserve.Increasing experience with sleeve resection has reduced the rate of pneumonectomy below 10%.The aim of the study was to assess the outcome after neoadjuvant chemo-or chemoradiotherapy and sleeve resection in patients with N2 non-small cell lung cancer.Methods Retrospective analysis of 41 patient records between 01.01.2005 and 31.12.2007 underwent induction therapy in N2-disease followed by tracheobronchial sleeve resection.These patients were compared to the overall results after sleeve resection in our institution.Data analysed were;length of chest tube drainage in days,length of hospital stay,complications,morbidity and hospital mortality.Results In 178 patients,an anatomical bronchoplastic resection was performed.Preoperative chemotherapy in N2-disease(n=42) was given in 30 patients and radiochemotherapy in 11 patients.The length of the operation was between 94 min-493 min(average 143 min).Chest tubes were removed on average after 5 days.Patients were discharged after 10 days.R0-resection was possible in 90%.The overall complication rate was 27%(11/41).The rate of bronchial anastomotic leakage was 9.7%(4/41).Two patients with postoperative respiratory insufficiency and mechanical ventilation,1 patient with technical failure required early correction of the suture and one patient with a necrosis of the anastomosis.30-day hospital mortality rate was 2.4%(1/41).Conclusion Sleeve resection after neoadjuvant therapy has a higher local morbidity(anastomotic insufficiency 9.7% vs 2.8%).This may be explained by the quality of the surrounding tissue after neoadjuvant therapy,which compromises healing of the anastomosis.However,the results are comparable to those without induction therapy in terms of radicality,and 30-d mortality rate(P>0.05).We therefore believe that sleeve resection after neoadjuvant therapy should be performed whenever possible to preserve functioning lung tissue.展开更多
China has the highest incidence of esophageal squamous cell carcinoma(ESCC).Unlike esophageal adenocarcinoma in western countries,90%of esophageal cancer in China is squamous cell carcinoma,and there are distinct regi...China has the highest incidence of esophageal squamous cell carcinoma(ESCC).Unlike esophageal adenocarcinoma in western countries,90%of esophageal cancer in China is squamous cell carcinoma,and there are distinct regional differences.Cancer stem cells,microecology,and epigenetics are closely related to esophageal cancer occurrence and development.The application of endoscopic ultrasonography,PET-CT,and MRI are conducive to the accurate staging of esophageal cancer.Advanced technologies such as neoadjuvant/definitive concurrent chemoradiotherapy,minimally invasive surgery,and photodynamic therapy have improved the overall survival and quality.The application of immunotherapy in advanced esophageal cancer has achieved remarkable results.展开更多
基金Supported by the 1.3.5 Project for Disciplines of Excellence,West China Hospital,Sichuan University,No.ZY2017302 1-3-5the Key Research and Development Projects of Sichuan Province,No.2017SZ0132 and No.2019YFS0042
文摘BACKGROUND The 8^th edition of the American Joint Committee on Cancer(AJCC)staging system for pancreatic ductal adenocarcinoma(PDAC)excludes extrapancreatic extension from the assessment of T stage and restages tumors with mesenterico-portal vein(MPV)invasion into T1-3 diseases according to tumor size.However,MPV invasion is believed to be correlated with a poor prognosis.AIM To analyze whether the inclusion of MPV invasion can further improve the 8th edition of the AJCC staging system for PDAC.METHODS This study retrospectively included 8th edition AJCC T1-3N0-2M0 patients undergoing pancreaticoduodenectomy/total pancreatectomy from two cohorts and analyzed survival outcomes.In the first cohort,a total of 7539 patients in the surveillance,epidemiology,and end results database was included,and in the second cohort,689 patients from the West China Hospital database were enrolled.RESULTS Cox regression analysis showed that MPV invasion is an independent prognostic factor in both databases.In the MPV-group,all pairwise comparisons between the survival functions of patients with different stages were significant except for the comparison between patients with stage IIA and those with stage IIB.However,in the MPV+group,pairwise comparisons between the survival functions of patients with stage IA,stage IB,stage IIA,stage IIB,and stage III were not significant.T1-3N0 patients in the MPV+group were compared with the T1N0,T2N0,and T3N0 subgroups of the MPV-group;only the survival of MPV-T3N0 and MPV+T1-3N0 patients had no significant difference.Further comparisons of patients with stage IIA and subgroups of stage IIB showed(1)no significant difference between the survival of T2N1 and T3N0 patients;(2)a longer survival of T1N1 patients that was shorter than the survival of T2N0 patients;and(3)and a shorter survival of T3N1 patients that was similar to that of T1-3N2 patients.CONCLUSION The modified 8th edition of the AJCC staging system for PDAC proposed in this study,which includes the factor of MPV invasion,provides improvements in predicting prognosis,especially in MPV+patients.
文摘Purpose: The study of the sentinel lymph node is the best technique to stage, have a prognosis and decide the adequate treatment in breast cancer. The usual technique implies studding the axillary lymph node. Our work tries to identify affected nodes in other regions apart from the axilla and its possible impact in staging and treatment. Methods: The sentinel lymph node technique was performed on 1660 patients included in an observational and multicentric study designed to observe the presence of metastatic cells in axillary and non-axillary lymph nodes. Results: In 19% of the patients the sentinel lymph node was detected in non-axillary regions. In these cases metastatic cells were more frequent which could suppose a change in the stage and/or treatment. As protective factor against non-axillary nodes involvement we found the localization of the cancer in external quadrants while youth and injecting the tracer inside the tumor were found to be risk factors. Conclusions: Detecting and studding non-axillary lymph nodes in breast cancer leads to a more precise staging of the disease which could imply a change in the optimal treatment.
基金This work was supported by the National Natural Science Foundation of China(82273721)the Jing-jin-ji Special Projects for Basic Research Cooperation(J200017)the Sanming Project of the Medicine in Shenzhen(SZSM201911015).
文摘China faces a disproportionate cancer burden to the population size and is undergoing a transition in the cancer spectrum.We extracted data in five aspects of cancer incidence,mortality,survival,staging distributions,and attribution to risk factors in China,the USA and worldwide from open-source databases.We conducted a comprehensive secondary analysis of cancer profiles in China in the above aspects,and compared cancer statistics between China and the USA.A total of 4,546,400 new cancer cases and 2,992,600 deaths occurred in China in 2020,accounting for 25.1%and 30.2%of global cases,respectively.Lifestyle-related cancers including lung cancer,colorectal cancer,and breast cancer showed an upward trend and have been the leading cancer types in China.41.6%of new cancer cases and 49.3%of cancer deaths occurred in digestive-system cancers in China,and the cancers of esophagus,nasopharynx,liver,and stomach in China accounted for over 40%of global cases.Infection-related cancers showed the highest population-attributable fractions among Chinese adults,and most cancers could be attributed to behavioral and metabolic factors.The proportions of stage I for most cancer types were much higher in the USA than in China,except for esophageal cancer(78.2%vs.41.1%).The 5-year relative survival rates in China have improved substantially during 2000–2014,whereas survival for most cancer types in the USA was significantly higher than in China,except for upper gastrointestinal cancers.Our findings suggest that although substantial progress has been made in cancer control,especially in digestive system cancers in China,there was still a considerable disparity in cancer burden between China and the USA.More robust policies on risk factors and standardized screening practices are urgently warranted to curb the cancer growth and improve the prognosis for cancer patients.
文摘Objective:To evaluate the use of Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography(^(68)Ga-PSMA PET/CT),compared with conventional CT abdomen/pelvis(CTAP)and whole body single photon emission CT bone scan(BS),for detection of local or distant metastasis following biochemical failure/recurrence in post-prostatectomy patients.Methods:We conducted a review of our prospectively maintained,institutional database to identify 384 patients with post-prostatectomy biochemical failure/recurrence who underwent PSMA PET/CT,CTAP and BS from February 2015 to August 2017 in Nepean Hospital,tertiary referral centre.The results of the three imaging modalities were analysed for their ability to detect local recurrence and distant metastases.PSMA PET/CT and CTAP imaging were separately performed on the same day and the BS was performed within several days(mostly in 24 h).Difference in detection rates was determined between the modalities and the Chi square test was used to determine significance.Results:A total of 384 patients were identified with a median prostate-specific antigen(PSA)of 0.465 ng/mL(interquartile range =0.19-2.00 ng/mL).Overall,PSMA PET/CT was positive for 245(63.8%)patients whereas CTAP and BS were positive in 174 patients(45.3%).A total of 98 patients(25.5%)had local or distant metastasis detected on PSMA only,while 20 patients(5.2%)had recurrences detected on CTAP but not on PSMA PET/CT.Conclusion:The use of PSMA PET/CT has a higher detection rate of predicted local or distant metastasis compared to CTAP and BS in the staging of patients with biochemical recurrences after radical prostatectomy.
文摘Mediastinal or N2 disease is the most important factor in selecting the optimal treatment strategy in patients without distant metastasis.A direct surgical resection has not generally been accepted as a treatment modality in whom mediastinal nodal involvement is demonstrated.Patients with lung cancer can be diagnosed as clinical N2 disease based on CT and PET-CT characteristics of the mediastinum and the clinical presentation.Invasive diagnostic modalities used in the detection of N2 disease are:mediastinoscopy,endoesophageal ultrasound guided biopsy(EUS),transbronchial needle aspiration(TBNA),endobronchial ultrasound guided biopsy(EBUS),video-assisted thoracoscopic surgery(VATS),and mediastinotomy/extended mediastinoscopy.In this article,the author discusses about invasive and noninvasive techniques on the evaluation of mediastinal disease and presents his experience on this topic.
基金Supported by 1.3.5 Project for Disciplines of Excellence,West China Hospital,Sichuan University,China,No.ZY20173021-3-5the Key Research and Development Projects of Sichuan Province,China,No.2017SZ0132 and No.2019YFS0042.
文摘BACKGROUND Pancreatic neuroendocrine neoplasms(pNENs)that produce hormones leading to symptoms are classified as functional tumors,while others are classified as nonfunctional tumors.The traditional view is that functionality is a factor that affects the prognosis of pNEN patients.However,as the sample sizes of studies have increased,researches in recent years have proposed new viewpoints.AIM To assess whether functionality is an independent factor for predicting the prognosis of pNEN patients.METHODS From January 2004 to December 2016,data of patients who underwent surgery at the primary site for the treatment of pNENs from the Surveillance,Epidemiology,and End Results(SEER)database and West China Hospital database were retrospectively analyzed.RESULTS Contemporaneous data from the two databases were analyzed separately as two cohorts and then merged as the third cohort to create a large sample that was suitable for multivariate analysis.From the SEER database,age(P=0.006)and T stage(P<0.001)were independent risk factors affecting the survival.From the West China Hospital database,independent prognostic factors were age(P=0.034),sex(P=0.032),and grade(P=0.039).The result of the cohort consisting of the combined populations from the two databases showed that race(P=0.015),age(P=0.002),sex(P=0.032)and T stage(P<0.001)were independent prognostic factors.In the West China Hospital database and in the total population,nonfunctional pNETs and other functional pNETs tended to have poorer prognoses than insulinoma.However,functionality was not associated with the survival time of patients with pNETs in the multivariate analysis.CONCLUSION Functionality is not associated with prognosis.Race,age,sex,and T stage are independent factors for predicting the survival of patients with pNETs.
基金Supported by the Scientific and Technological Project of Qinghai Province,China,No. 2015-ZJ-742。
文摘BACKGROUND In colorectal cancer, tumor deposits(TDs) are considered to be a prognostic factor in the current staging system, and are only considered in the absence of lymph node metastases(LNMs). However, this definition and the subsequent prognostic value based on it is controversial, with various hypotheses. TDs may play an independent role when it comes to survival and addition of TDs to LNM count may predict the prognosis of patients more accurately.AIM To assess the prognostic impact of TDs and evaluate the effect of their addition to the LNM count.METHODS The patients are derived from the Surveillance, Epidemiology, and End Results database. A prognostic analysis regarding impact of TDs on overall survival(OS) was performed using Cox regression model, and other covariates associating with OS were adjusted. The effect of addition of TDs to LNM count on N restaging was also evaluated. The subgroup analysis was performed to explore the different profile of risk factors between patients with and without TDs.RESULTS Overall, 103755 patients were enrolled with 14131(13.6%) TD-positive and 89624(86.4%) TD-negative tumors. TD-positive patients had worse prognosis compared with TD-negative patients, with 3-year OS rates of 47.3%(95%CI, 46.5%-48.1%) and 77.5%(95%CI, 77.2%-77.8%, P < 0.0001), respectively. On multivariable analysis, TDs were associated poorer OS(hazard ratio, 1.35;95%CI, 1.31-1.38;P < 0.0001). Among TD-positive patients, the number of TDs had a linear negative effect on disease-free survival and OS. After reclassifying patients by adding TDs to the LNM count, 885 of 19 965(4.4%) N1 patients were restaged as p N2, with worse outcomes than patients restaged as p N1(3-year OS rate: 78.5%, 95%CI, 77.9%-79.1% vs 63.2%, 95%CI, 60.1%-66.5%, respectively;P < 0.0001).CONCLUSION TDs are an independent prognostic factor for OS in colorectal cancer. The addition of TDs to LNM count improved the prognostic accuracy of tumor, node and metastasis staging.
文摘Objective:To study the manifestation,pathohistologic type,stage of disease,treatment andoutcome of epithelial ovarian carcinoma in women under the age of 30 years.Methods:The 21 cases of epithelial ovarian carcinoma in women aged below 30 years betweenJan,1986 and Mar,2002 were analyzed retrospectively.Results:The median age at the time of diagnosis was 24 years(range,16-29 years).All car-cinomas occurred after menarche.The most common symptoms were abdominal pain(50%),fol-lowed by tympanites(25%)and menstrual disorders(19%).The initial diagnosis was usuallymade by physical examination,ultrasonography and serum CA125.The mean maximal tumor di-ameter was 17.6 cm.Ten patients had Stage Ⅰ disease(5 Ⅰa,5 Ⅰc),five had Stage Ⅲ disease,andthe other six were unknown during staging operation.There were nine mucinous tumors,six se-rous tumors.Most tumors were well-differentiated and classified as Grade1 in 11 cases,Grade2 in2 cases,Grade3 in 2 cases,unknown in 6 cases.Optimal and suboptimal cytoreduction wasachieved in 14 patients in primary treatment and 5 in recurrent treatment.8 patients were treatedwith conservative surgery.18 patients were treated with chemotherapy and 7 patients had experi-enced six or more than six courses of chemotherapy.The median follow-up was 50 months(range,2-192 months).There were 6 deaths,2 alive with tumor,11 alive without the disease,2losing follow-up.The 3-year survival rate was 89%,and 5-year survival rate was 76%.Conclusion:Young patients with epithelial ovarian carcinoma appeared to have a less aggres-sive form of the disease and a more favorable prognosis.
文摘Background and objective Sleeve resections were introduced to preserve lung function in patients with limited pulmonary reserve.Increasing experience with sleeve resection has reduced the rate of pneumonectomy below 10%.The aim of the study was to assess the outcome after neoadjuvant chemo-or chemoradiotherapy and sleeve resection in patients with N2 non-small cell lung cancer.Methods Retrospective analysis of 41 patient records between 01.01.2005 and 31.12.2007 underwent induction therapy in N2-disease followed by tracheobronchial sleeve resection.These patients were compared to the overall results after sleeve resection in our institution.Data analysed were;length of chest tube drainage in days,length of hospital stay,complications,morbidity and hospital mortality.Results In 178 patients,an anatomical bronchoplastic resection was performed.Preoperative chemotherapy in N2-disease(n=42) was given in 30 patients and radiochemotherapy in 11 patients.The length of the operation was between 94 min-493 min(average 143 min).Chest tubes were removed on average after 5 days.Patients were discharged after 10 days.R0-resection was possible in 90%.The overall complication rate was 27%(11/41).The rate of bronchial anastomotic leakage was 9.7%(4/41).Two patients with postoperative respiratory insufficiency and mechanical ventilation,1 patient with technical failure required early correction of the suture and one patient with a necrosis of the anastomosis.30-day hospital mortality rate was 2.4%(1/41).Conclusion Sleeve resection after neoadjuvant therapy has a higher local morbidity(anastomotic insufficiency 9.7% vs 2.8%).This may be explained by the quality of the surrounding tissue after neoadjuvant therapy,which compromises healing of the anastomosis.However,the results are comparable to those without induction therapy in terms of radicality,and 30-d mortality rate(P>0.05).We therefore believe that sleeve resection after neoadjuvant therapy should be performed whenever possible to preserve functioning lung tissue.
文摘China has the highest incidence of esophageal squamous cell carcinoma(ESCC).Unlike esophageal adenocarcinoma in western countries,90%of esophageal cancer in China is squamous cell carcinoma,and there are distinct regional differences.Cancer stem cells,microecology,and epigenetics are closely related to esophageal cancer occurrence and development.The application of endoscopic ultrasonography,PET-CT,and MRI are conducive to the accurate staging of esophageal cancer.Advanced technologies such as neoadjuvant/definitive concurrent chemoradiotherapy,minimally invasive surgery,and photodynamic therapy have improved the overall survival and quality.The application of immunotherapy in advanced esophageal cancer has achieved remarkable results.
