Comparison of clinical features and prognostic factors among different histological subtypes of lung adenocarcinoma: An analysis of 370 cases

Objective To investigate the clinical efficacy of radical resection for stage T3 gallbladder cancer and prognostic factors. Methods The retrospective case-control study was conducted. The clinico-pathological data of 87 patients with T3 gallbladder cancer who were admitted to Tianjin Medical University Cancer Institute and Hospital from January 2005 to June 2016 were collected. There were 44 males and 43 females, aged 29-79 years, with a median age of 61 years. According to the different preoperative pathological classification and intraoperative exploration of gallbladder cancer, corresponding surgeries were performed. Observation indicators: (1) surgical and postoperative conditions; (2) clinical efficacy of stage T3 gallbladder cancer and prognostic factors analysis; (3) clinical efficacy of stage T3 gallbladder adenocarcinoma and prognostic factors analysis; (4) clinical efficacy of stage T3 gallbladder adenosquamous carcinoma and prognostic factors analysis. Follow-up by outpatient examination or telephone interview was performed to detect the postoperative survival of patients up to June 2018. Measurement data with skewed distribution were represented as M (range), and count data were described as absolute numbers. Survival curve, survival time and survival rate were drawn and calculated by the Kaplan-Meier method. Survival analysis was performed by the Log-rank test. Univariate analysis was performed using the Log-rank test and multivariate analysis using the COX proportional hazard model. Results (1) Surgical and postoperative conditions: all the 87 patients underwent radical resection of gallbladder cancer, including 29 cases of hepatic wedge resection and 58 cases of extended hepatectomy. Of the 87 patients, 42 underwent standard lymph node dissection and 45 underwent enlarged lymph node dissection. There were 27 cases receiving extrahepatic bile duct reconstruction. The postoperative pathological results of 87 patients showed that 64 were diagnosed with gallbladder adenocarcinoma and 23 were diagnosed with gallbladder adenosquamous carcinoma. There were 59 cases comorbid with liver invasion and 3 cases comorbid with vascular invasion. The marginal histopathological examination showed negative margin in 63 cases and positive margin in 24 cases. The degree of tumor differentiation: there were 23 patients with highly differentiated tumor and 64 with poorly differentiated tumor. Of the 87 patients, 43 received postoperative adjuvant therapy and 44 didn′t receive adjuvant therapy. (2) Clinical efficacy of stage T3 gallbladder cancer and prognostic factors analysis. ① All the 87 patients were followed up for 1.8-128.0 months, with a median follow-up time of 26.3 months. All the 87 patients had survived for 1.1-82.7 months, with a median time of 20.1 months. The 2-year overall survival rate of patients was 59.8%, and the 2-year disease-free survival rate was 49.4%. ② Univariate analysis showed that preoperative alkaline phosphatase (ALP) level, tumor diameter, pathological type of tumor, lymph node metastasis, and range of hepatectomy were associated factors for the postoperative 2-year overall survival rate of patients (χ2=5.451, 4.900, 8.256, 4.419, 5.858, P 0.05), but a significant difference in the postoperative 2-year disease-free survival rate between them (56.3% vs. 30.4%, χ2=5.828, P<0.05). (3) Clinical efficacy of stage T3 gallbladder adenocarcinoma and prognostic factors analysis. ① Sixty-four patients with gallbladder adenocarcinoma had the median survival time of 23.1 months, with a range from 3.2 to 82.7 months. The postoperative 2-year overall survival rate was 68.8%, and the postoperative 2-year disease-free survival rate was 56.3%. ② For the 64 patients with T3 stage gallbladder adenocarcinoma, univariate analysis showed that preoperative CA19-9 level and range of lymph node dissection were associated factors for the postoperative 2-year overall survival rate (χ2=4.012, 8.837, P<0.05). The range of lymph node dissection was an associated factor for the postoperative 2-year disease-free survival rate (χ2=6.361, P<0.05). Multivariate analysis showed that range of lymph node dissection was an independant factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate (HR=0.244, 0.382, 95%CI: 0.088-0.674, 0.176-0.831, P<0.05). ③ Survival analysis: range of lymph node dissection was an associated factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients. Of the 64 patients with T3 stage gallbladder adenocarcinoma, the postoperative 2-year overall survival rate and disease-free survival rate of patients undergoing enlarged lymph node dissection were 84.8% and 69.7%, versus 51.6% and 41.9% of the patients undergoing standard lymph node dissection (χ2=8.837, 6.361, P<0.05). (4)Clinical efficacy of stage T3 gallbladder adenosquamous carcinoma and prognostic factors analysis. ① Twenty-three patients with gallbladder adenosquamous carcinoma had the median survival time of 13.2 months, with a range from 1.1 to 70.3 months. The postoperative 2-year overall survival rate was 34.8%, and the postoperative 2-year disease-free survival rate was 30.4%. ② For the 23 patients with T3 stage gallbladder adenosquamous carcinoma, univariate analysis showed that preoperative ALP level, lymph node metastasis, range of hepatectomy, and extrahepatic bile duct reconstruction were associated factors for the postoperative 2-year overall survival rate of patients (χ2=5.288, 4.574, 12.960, 4.106, P<0.05). The lymph node metastasis and range of hepatectomy were associated factors for the postoperative 2-year disease-free survival rate of patients (χ2=7.364, 10.582, P<0.05). Multivariate analysis showed that range of hepatectomy was an independant factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate (HR=0.102, 0.153, 95%CI: 0.012-0.880, 0.033-0.718, P<0.05). ③ Survival analysis: range of hepatectomy was an independant factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients. Of the 23 patients with T3 stage gallbladder adenosquamous carcinoma, the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients undergoing extended hepatectomy were 87.5% and 75.0%, versus 6.7% and 6.7% of the patients undergoing hepatic wedge resection (χ2=12.960, 10.528, P<0.05). Conclusions Lymph node metastasis is an independent factor influencing the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients with T3 stage gallbladder cancer. The range of lymph node dissection is an independent factor for the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients with stage T3 gallbladder adenocarcinoma. Range of hepatectomy is an independent factor for the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients with stage T3 gallbladder adenosquamous carcinoma. Patients with gallbladder adenocarcinoma should undergo enlarged lymph node dissection, and patients with gallbladder adenosquamous carcinoma need to undergo extended hepatectomy. Key words: Biliary neoplasms; Gallbladder cancer, stage T3; Gallbladder adenocarcinoma; Gallbladder adenosquamous carcinoma; Lymph node dissection; Prognostic analysis

To investigate the clinicopathological features and prognosis of patients with gastrointestinal stromal tumor(GIST) after surgery in Shandong Province. Clinicopathological data of GIST patients undergoing surgery from January 2001 to June 2013 in four university teaching hospitals in Shandong Province were reviewed. Pathology results were rechecked. Patients were followed up. The prognostic factors were evaluated by univariate and multivariate analyses with Log-rank test and Cox proportional hazard model. A total of 1039 GIST cases were enrolled, including 509 males and 530 females, with age from 18 to 87 years(median, 58). Ninety-three patients died of GIST during follow-up. The 1-, 3-, 5-year survival rates were 94.6%, 91.7% and 87.8%, respectively. Patients undergoing R0 resection had a higher 5-year overall survival rate than those undergoing R1 resection(88.8% vs 69.0%, P<0.05). For patients with intermediate risk of recurrence after surgery, the 5-year overall survival rate was 94.4% and 89.2% respectively in imatinib and non-imatinib intervention groups(P>0.05). For patients with high risk of recurrence after surgery, the 5-year overall survival rate was 76.8% and 67.7% respectively(P<0.05). Multivariate analysis revealed that tumor size(P<0.01, RR=1.988, 95%CI:1.497-2.641), mitotic count(P<0.01, RR=2.326, 95%CI:1.686-3.208) and tumor rupture(P<0.01, RR=3.032, 95%CI:1.732-5.308) were independent prognostic factors. Tumor size, mitotic count and tumor rupture affect the prognosis of patients after resection of primary GIST independently. The standard treatment of localized GIST is R0 resection. Adjuvant imatinib therapy can improve overall survival of patients with high risk of recurrence after surgery. The efficacy of imatinib for patients with intermediate risk of recurrence remains to be verified.

Objective:The characteristics of male breast cancer (MBC),which is a rare disease,are different between Western and Eastern people.Up until now almost all the information about Chinese MBC has been based on small samples. The aim of this study is to explore the characteristics of Chinese MBC based on a relatively larger sample.Methods: Clinical data of 72 patients with MBC,who were histopathologically confirmed and treated at the Cancer Center of Sun Yat-sen University between January 1969 and March 2009,were collected.The clinicopathologic features,locoregional recurrence rate,metastatic rate,and 5-year survival rate were retrospectively analyzed.Results:Infiltrating ductal carcinoma was the predominant pathological subtype,accounting for 81.9%.The positive rates of ER,PR,and HER-2 were 90.9%, 84.8%,and 3.3%,respectively.Mass in the breast was the major initial sign in 98.5% patients and was mainly located in the areola area,accounting for 69.8%.About 67.6% patients received radical mastectomy,22.1% received modified radical mastectomy;50% received adjuvant chemotherapy,15.3% received neoadjuvant therapy;19.4% patients received adjuvant radiotherapy,and 44.4% received endocrine therapy.The 5-year overall survival rate of the whole group was 72.4%. The 5-year overall survival rates for stage Ⅰ,Ⅱ ,Ⅲ,and Ⅳ were 100%,74.2%,57.2%,and 0,respectively.About 12.5% of patients suffered locoregional recurrence at 12 months,and 12.5% of patients had distant metastasis at 14 months.Conclusion: The characteristics of Chinese MBC include a predominant pathological subtype of infiltrating ductal carcinoma, higher expression rate of ER and PR and lower expression rate of HER-2.Comprehensive treatment with primary surgery integrated with chemotherapy,radiotherapy or endocrine therapy provides a better prognosis.

Objective To investigate the long-term outcomes of splenic hilar lymphadenectomy (SPL) in patients with Siewert type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction (AEG) and a tumor diameter≥4 cm after radical total gastrectomy. Methods The retrospectively cohort study was conducted. The clinico-pathological data of 412 patients with Siewert type Ⅱ and Ⅲ AEG and a tumor diameter≥4 cm who were admitted to the Fujian Medical University Union Hospital from December 2007 to December 2013 were collected. Transabdominal and open or laparoscopic radical total gastrectomies were applied to 412 patients by surgeons in the same team. Of 412 patients, 154 receiving spleen-preserving SPL in situ were allocated into the SPL group and 258 who didn′t receive SPL were allocated into the non-SPL group. Observation indicators included: (1) surgical situations, (2) follow-up situations, (3) postoperative survival factors analysis in patients with Siewert type Ⅲ AEG and a tumor diameter≥4 cm. Follow-up using outpatient examination, door-to-door visit, correspondence and telephone interview was performed once every 3 months within 2 years postoperatively and once every 6 months within 3-5 years postoperatively up to June 2015. Follow-up included regular physical examination, laboratory examinations (levels of CA19-9, CA72-4 and CEA), chest X-ray, total abdomen color Doppler ultrasonography or computed tomography (CT) scan and annual gastroscopy. The overall survival was from operation to the last follow-up or death or deadline of follow-up database (loss to follow-up and dying of other diseases). Measurement data with normal distribution were represented as ±s and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were described as M (range) and comparison between groups was analyzed using the Mann-Whitney U test. Count data were analyzed using the chi-square test or Fisher exact probability. The survival rate and survival comparison were respectively done by the Kaplan-Meier method and the Log-rank test. The univariate analysis and multivariate analysis were done using the chi-square test and COX regression model. Results (1) Surgical situations: operation time, volume of intraoperative blood loss and number of lymph node dissected were (217±65)minutes, 50 mL (range, 10-1 000 mL), 38±13 in the SPL group and (204±54)minutes, 50 mL (range, 5-2 000 mL), 31±10 in the non-SPL group, respectively, with no statistically significant difference in volume of intraoperative blood loss between the 2 groups (Z=1.495, P>0.05) and with statistically significant differences in operation time and number of lymph node dissected between the 2 groups (t=2.140, 5.400, P 0.05). (2) Follow-up situations: 384 patients were followed up for 48 months (range, 17-89 months). The 3-year overall survival rate and disease-free survival rate were respectively 72.7%, 67.4% in the SPL group and 54.4%, 48.5% in the non-SPL group, with statistically significant differences between the 2 groups (χ2=7.580, 12.380, P 0.05). Among patients with Siewert type Ⅲ AEG, 3-year overall survival rate and disease-free survival rate which were 72.4% and 68.3% in the SPL group were significantly higher than that which were 48.3% and 42.2% in the non-SPL group (χ2=8.990, 14.030, P<0.05). (3) Postoperative survival factors analysis in patients with Siewert type Ⅲ AEG and a tumor diameter≥4 cm: results of univariate analysis showed that age, American Society of Anesthesiologists (ASA) score, tumor differentiation, splenic hilar dissection, T stage, N stage and TNM stage were factors affecting postoperative 3-year overall survival rate in patients with Siewert type Ⅲ AEG and a tumor diameter≥4 cm (χ2=8.825, 7.485, 6.766, 8.996, 14.024, 26.002, 19.461, P<0.05). There were correlations among age, splenic hilar dissection, N stage, TNM stage and postoperative 3-year disease-free survival rate in patients with Siewert type Ⅲ AEG and a tumor diameter≥4 cm (χ2=6.743, 14.038, 26.596, 21.285, P<0.05). Results of multivariate analysis showed that age≥65 years, without splenic hilar dissection, T stage and N stage were independent risk factors affecting postoperative 3-year overall survival rate in patients with Siewert type Ⅲ AEG and a tumor diameter≥4 cm [HR=1.817, 0.458, 1.613, 1.312, 95% confidence interval (CI): 1.117-2.955, 0.292-0.721, 1.129-2.304, 1.004-1.714, P<0.05]. Age≥65 years, without splenic hilar dissection and TNM stage were independent risk factors affecting postoperative 3-year disease-free survival rate in patients with Siewert type Ⅲ AEG and a tumor diameter≥4 cm (HR=1.807, 0.442, 1.799, 95%CI: 1.258-2.596, 0.228-0.679, 1.004-3.224, P<0.05). Conclusions SPL should be performed to patients with Siewert type Ⅲ AEG and a tumor diameter≥4 cm due to higher lymph node metastasis rate, and it will be beneficial to survival of patients. Key words: Esophagogastric junction neoplasms, adenocarcinoma; Siewert classification; Total gastectomy; Splenic hilar lymphadenectomy

To investigate the efficacy of intensity-modulated radiation therapy(IMRT) and the prognosis factors in advanced cervical cancer. A total of 218 cases of cervical cancer patients treated in Affiliated Tumor Hospital,Guangxi Medical University, between July 2007 and July 2012, were divided into IMRT group and routine radiotherapy group (conventional group, 94 vs 124 cases). To compare the short-term effects of two groups by Chi-square test, and the incidence rate of 1, 3, 5-year survival by rank sum test;to compare the acute and chronic toxicity of the two groups by rank sum test. And to analysis prognostic factors by log-rank test and Cox proportional hazard model and multiple linear regression analysis. (1) The effective rate in IMRT group was 95.7% (90/94), which in the conventional group was 86.3% (107/124; P < 0.01). The 1, 3, 5-year overall survival rates in IMRT group were not significant difference than those in conventional group (87.6% vs 90.1%, 73.4% vs 81.5%, and 72.3% vs 75.7%;all P > 0.05). The rate of acute gastrointestinal toxicity was 41.5% (39/94) in IMRT group , vs 42.7% (53/124) in conventional group(P < 0.01); and the incidence of acute hematopoietic toxicity in IMRT group was 76.6% (72/94), which was 78.2% (97/124) in conventional group(P < 0.01); the incidence of acute genitourinary toxicity was 12.8% (12/94 ) in IMRT and 8.1% (10/124) in conventional group(P = 0.248). The late gastrointestinal, genitourinary and hematopoietic toxicities were 18.1% (17/94), 16.0% (15/94) and 25.5% (24/94), which were lower than those in conventional group 91.9% (114/124), 47.6% (59/124) and 56.4% (70/124), respectively (all P < 0.01). (2) Univariate analysis showed that the International Federation of Gynecology and Obstetrics (FIGO) stage, histological grade and tumor size were closely associated with 5 years disease-free survival rates and overall survival rates (all P < 0.05) . Multivariate analysis showed that FIGO stage and histological grade were closely associated with 5 year overall survival rates ( all P < 0.01). FIGO stage and histological grade were independent factors to patients' 5-year overall survival rates in cervical cancer (P < 0.01). IMRT would be to reduce the acute and chronic toxicity, and to improve the quality of patients' life, but did not improve the 5 years survival rate in advanced cervical carcinoma.

Objective: Solid and micropapillary pattern are highly invasive histologic subtypes in lung adenocarcinoma and are associated with poor prognosis while the biopsy sample is not enough for the accurate histological diagnosis. This study aims to assess the correlation and predictive efficacy between metabolic parameters in (18)F-fluorodeoxy glucose positron emission tomography/computed tomography ((18)F-FDG PET-CT), including the maximum SUV (SUV(max)), metabolic tumor volume (MTV), total lesion glycolysis (TLG) and solid and micropapillary histological subtypes in lung adenocarcinoma. Methods: A total of 145 resected lung adenocarcinomas were included. The clinical data and preoperative (18)F-FDG PET-CT data were retrospectively analyzed. Mann-Whitney U test was used for the comparison of the metabolic parameters between solid and micropapillary subtype group and other subtypes group. Receiver operating characteristic (ROC) curve and areas under curve (AUC) were used for evaluating the prediction efficacy of metabolic parameters for solid or micropapillary patterns. Univariate and multivariate analyses were conducted to determine the prediction factors of the presence of solid or micropapillary subtypes. Results: Median SUV(max) and TLG in solid and papillary predominant subtypes group (15.07 and 34.98, respectively) were significantly higher than those in other subtypes predominant group (6.03 and 10.16, respectively, P<0.05). ROC curve revealed that SUV(max) and TLG had good efficacy for prediction of solid and micropapillary predominant subtypes [AUC=0.811(95% CI: 0.715~0.907) and 0.725(95% CI: 0.610~0.840), P<0.05]. Median SUV(max) and TLG in lung adenocarcinoma with the solid or micropapillary patterns (11.58 and 22.81, respectively) were significantly higher than those in tumors without solid and micropapillary patterns (4.27 and 6.33, respectively, P<0.05). ROC curve revealed that SUV(max) and TLG had good efficacy for predicting the presence of solid or micropapillary patterns [AUC=0.757(95% CI: 0.679~0.834) and 0.681(95% CI: 0.595~0.768), P<0.005]. Multivariate logistic analysis showed that the clinical stage (Stage Ⅲ-Ⅳ), SUV(max) ≥10.27 and TLG≥7.12 were the independent predictive factors of the presence of solid or micropapillary patterns (P<0.05). Conclusions: Preoperative SUV(max) and TLG of lung adenocarcinoma have good prediction efficacy for the presence of solid or micropapillary patterns, especially for the solid and micropapillary predominant subtypes and are independent factors of the presence of solid or micropapillary patterns.

To compare the clinicopathological features and prognosis between left-sided colon cancer (LC) and right-sided colon cancer (RC). Clinicopathological and follow-up data of 2 174 colon carcinoma cases undergoing resection at Shanghai Changhai Hospital of The Second Military Medical University from January 2000 to December 2010 were retrospectively analyzed. Patients with transverse colon cancer, overlapping position, unknown location, recurrent cancer, multiple primary cancer, concomitant malignant tumors, preoperative chemotherapy, local resection, incomplete clinical data and missed follow up were excluded. Finally, a total of 1 036 patients, whose primary tumors were radically removed, were enrolled, with 563 patients in LC group (including carcinoma in cecum, ascending colon and hepatic flexure) and 473 in RC group (including carcinoma in splenic flexure, descending colon and sigmoid colon). The clinicopathological features and survival, including median overall survival, 5-year overall survival rate, tumor specific median overall survival, cancer specific 5-year overall survival rate, were compared between LC and RC groups. Tumor specific overall survival was defined as the period between operation date to the date of death caused by cancer progression. Multivariate Cox regression analysis was used to analyze the influencing factors of survival. Propensity score matching was carried out to balance the clinicopathological factors between the two groups with the SAS 9.3, taking the following parameters into consideration (age, gender, gross appearance, tumor diameter, invasion depth, lymph node metastasis, distant metastasis, TNM stages, differentiation, CEA and CA199-9). Patients in RC group and LC group were matched according to the propensity scores and the clinicopathological characteristics and prognosis of two groups were compared again. No significant differences were identified between the two groups in age, distant metastasis and serum CEA level. Compared with RC group, LC group had more male patients [60.9%(343/563) vs. 51.0%(241/473), P=0.001], more ulcerative tumors [71.9% (405/563) vs. 65.3%(309/473), P=0.006], better differentiation [well/moderately differentiated: 87.5%(493/563) vs. 73.8%(349/473), P=0.000], lower infiltration depth [T1-2: 17.1%(96/563) vs. 10.1%(48/473), P=0.001], higher lymph node metastasis rate [N0: 53.3%(300/563) vs. 62.4%(295/473), P=0.013], lower TNM stage [stage I(: 13.3%(75/563) vs. 7.8%(37/473), P=0.000], lower serum CA199 level [<37 kU/L: 68.4% (385/563) vs. 62.6% (296/473), P=0.022] and smaller tumor diameter [<5.0 cm: 55.1%(310/563) vs. 38.3%(181/473), P=0.000]. The median overall survival was 82 months and 76 months in LC and RC groups, respectively, and the 5-year overall survival rate was 58.3% and 50.9%(P=0.038). The median tumor specific survival was 84 months and 78 months in LC and RC groups, respectively, and the 5-year tumor specific overall survival rate was 60.6% and 52.9% (P=0.031). Multivariate Cox regression analysis showed that tumor location (LC vs. RC) was not associated with overall survival (P=0.106) and tumor specific survival (P=0.091). After propensity score matching, no significant difference was found in clinicopathological factors and propensity score (0.458±0.129 vs. 0.459±0.129, P=0.622) between LC and RC group. After matching, there was no significant difference in overall survival rate (54.0% vs. 51.7%, P=0.982) and tumor specific overall survival rate(56.4% vs. 53.1%, P=0.819) between two groups. Significant difference exists between RC and LC in clinicopathological factors, but not in survival.

Objective To compare the efficacy and safety of surgical resection and thermal ablations in patients with hepatocellular carcinoma in China using a network Meta-analysis. Methods References related to eligible randomized controlled studies (RCTs) were searched from China Biology Medicine, China National Knowledge Infrastructure(CNKI), PubMed, Embase and Cochrane Library from 1st January 2010 to 1st December 2017, and were selected according to the criteria. The 1-year, 3-year, and 5-year survival rates and incidence of serious complications were compared among surgical resection (SR), radiofrequency ablation (RFA), and microwave ablation(MWA) by network Meta-analysis based frequency and Bayesian methods. Results A total of 24 RCTs were included in this study. The results of surface under the cumulative ranking probabilities (SUCRA) showed that when all RCTs were included, the frequency model supported MWA had the highest 5-year overall survival rate (66.1%), while the Bayesian model supported SR had the highest 5-year overall survival rate (64.7%). When the tumor diameter of hepatocellular carcinoma was less than 5 cm and the liver function was Child-Pugh A/B, the frequency and Bayesian model both supported SR had the highest 5-year overall survival rate (89.1% and 88.3%, respectively). When all RCTs or RCTs were included with the tumor diameter less than 5 cm and liver function was Child-Pugh A/B, both the frequency and the Bayesian model supported RFA had the best safety (serious complications rate) (16.4%, 18.7%, 12.6 and 12.8%, respectively). Conclusion SR should be the first choice for early and small hepatocellular carcinoma, while RFA and MWA have their own indications. Key words: Carcinoma, hepatocellular; Radiofrequency ablation; Microwave ablation; Surgical resection; Meta-analysis

To analyze the effects of number of positive lymph nodes and metastatic lymph node ratio (LNR) in evaluation of recurrence risk and overall survival in patients with adenocarcinoma of the esophagogastric junction (AEG) after curative resection. Clinical data of 337 AEG patients who underwent curative resection in our hospital were retrospectively reviewed. The pN stage was categorized based on the number of metastatic lymph nodes and LNR stage, and was determined by the best cutoff approach at log-rank test. Univariate Kaplan-Meier survival analysis and multivariate Cox proportional hazard model were used to analyze the effects of pN and LNR on recurrence-free survival and overall survival of these patients. Receiver operating characteristic (ROC) curves were plotted to compare the accuracy of prognosis prediction with pN and LNR. The 5-year recurrence-free survival rate and overall survival rate for all patients were 25.5% and 29.9%, respectively. The 5-year recurrence-free survival rates were 47.6%, 23.2%, 17.1% and 5.7% for pN0, pN1, pN2, and pN3, respectively, (P < 0.001) and the 5-year overall survival rates were 53.3%, 28.9%, 18.9% and 7.3%, respectively (P < 0.001). The 5-year recurrence-free survival rates were 47.6%, 24.3%, 11.4% and 2.0% for LNR0, LNR1, LNR2, and LNR3, respectively (P < 0.001), and the 5-year overall survival rates were 53.3%, 28.5%, 15.0%, 2.6%, respectively (P < 0.001). Univariate analysis showed that tumor size, macroscopic type, degree of differentiation, pT, pN, LNR and TNM stage were significantly associated with RFS and OS (P < 0.05). Cox multivariate analysis showed that either pN or LNR was independent risk factor for RFS and OS (P < 0.001). When pN and LNR were entered into the Cox hazard ratio model as covariates at the same time, LNR remained as an independent prognosis factor for RFS and OS (P < 0.001), but pN was not (P > 0.05). ROC curves showed that the area under the curve of LNR stage was larger than that of pN stage in prediction of both RFS and OS, however the differences were not statistically significant (P > 0.05). LNR is an independent risk factor associated with the prognosis of AEG patients. The value of LNR in prediction of recurrence hazard and overall survival was better than that of pN stage. It offers some helpful suggestions for AEG patients risk classification, allowing clinicians to develop a reasonable treatment.

Objective To investigate the clinical features and surgical indications of subtypes of intraductal papillary mucinous neoplasm (IPMN) of the pancreas, and analyze its malignant risk factors. Methods The retrospective case-control study was conducted. The clinicopathological data of 77 patients with IPMN of the pancreas who were admitted to the First Hospital of Peking University from January 2008 to December 2016 were collected. The subtypes of IPMN of the pancreas detected by preoperative imaging examination included main-duct type (MD-IPMN) in 46 patients, branch-duct type (BD-IPMN) in 12 patients, mixed type (MT-IPMN) in 19 patients. The surgical indications were consulted from the Guideline for the diagnosis and treatment of pancreatic cystic lesions composed by the Pancreatic Surgery Group of Surgery Branch of China Medical Association. Surgical procedure was selected according to the location and size of the IPMN. Four to 6 cycles of chemotherapy with S-1 and/or Gemcitabine were conducted for patients with malignant IPMN according to the tolerance and baseline characteristics. Observation indicators included: (1) comparison of the clinical features MD-IPMN, MT-IPMN and BD-IPMN; (2) surgical and postoperative conditions; (3) results of postoperative pathological examination and malignant risk factors analysis; (4) accuracy evaluation of Sendai and Fukuoka guidelines for the diagnosis of malignant IPMN of the pancreas; (5) follow-up results and survival. Patients were followed up by outpatient examination and telephone interview till December 2016. The postoperative adjuvant therapy, tumor recurrence and metastasis of malignant IPMN patients and postoperative survival condition of all the patients were collected. Measurement data with normal distribution were expressed as ±s or average (range), and pairwise comparison was analyzed by t test. Measurement data with skewed distribution were expressed by median (range). Comparison between count data and univariate analysis were done by chi-square test. Multiple factors analysis was done by Logistic regression model. The survival curve was drawn and the survival rate were calculated by Kaplan-Meier method. The comparison of survival was done by Log-rank test. Results (1) Comparison of clinical features between MD-IPMN, MT-IPMN and BD-IPMN: The numbers of patients with symptoms, jaundice, those complicated with diabetes and elevated CA19-9 were 55, 20, 43 and 28 in MD-IPMN and MT-IPMN, and 6 , 0, 3 and 1 in BD-IPMN, with statistically significant difference (χ2=5.421, 3.516, 5.525, 3.834, P 0.05), while significant difference in the specificity between the 2 guidelines were detected (χ2=12.500, P<0.05). (5) Follow-up and survival: Seventy of 77 patients were followed up, including 42 with benign IPMN and 28 with malignant IPMN. The median survival time was 35.0 months (range, 6.0-94.0 months). All the malignant IPMN patients received adjuvant therapy. The 1-, 3-, 5-year overall survival rates of 47 patient with benign IPMN were 100.0%, 96.2% and 96.2%, respectively, and 1 patient died of cardiac infarction. The 1-, 3-, 5-year overall survival rates of 30 patients with malignant IPMN were 96.6%, 81.8%, 38.6%, respectively, and 11 patients died of tumor recurrence or metastasis with median time of tumor recurrence or metastasis of 20.5 months (6.0-61.6 months). The 1-, 3-, 5-year overall survival rates of 17 patients with negative lymph node metastasis were 100.0%, 100.0% and 60.0%, respectively, and the 1-, 3-, 5-year overall survival rates of 13 patients with positive lymph node metastasis were 91.7%, 57.1% and 0, respectively. There was statistically significant difference between patients with benign and malignant IPMN (χ2=12.530, P<0.05). There was statistically significant difference between patients with negative lymph node metastasis and those with positive lymph node metastasis (χ2=16.977, P<0.05). Conclusions Patients with MD-IPMN or MT-IPMN are more vulnerable to be complicated with diabetes, jaundice, elevated CA19-9 and high malignancy, and thus surgery is recommended. Jaundice, elevated CEA and CA19-9, tumor diameter≥3.0 cm, MD-IPMN are the independent risk factors influencing the malignancy of IPMN. Key words: Intraductal papillary mucinous neoplasms of the pancreas; Classification; Surgical procedures, operative; Prognosis

Adenocarcinoma is the most common type of lung cancer, and pre-operative biopsy plays an important role to determine its major subtypes. As proposed by the International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS), and European Respiratory Society (ERS) in 2011, the predominant histological subtype of adenocarcinoma is an indicator of outcomes and recurrence rate. However, the value of CT-guided core biopsy in predicting the predominant subtype and detecting the presence of an aggressive subtype of adenocarcinoma, peripheral sub-solid nodule, has less been discussed. We retrospectively reviewed 318 consecutive peripheral sub-solid nodules that underwent percutaneous CT-guided lung biopsy and surgical resection, between October 2015 and December 2018 and were diagnosed as adenocarcinoma with histological subtype. The subtyping results from biopsy and surgical pathology were compared to evaluate the concordance rate. The overall concordance rate between biopsy and surgical pathology in determining the predominant histological subtype was 64%. Better concordance was found in small tumors (≤ 2cm), in predicting either predominant histology (χ2 = 7.091, P = 0.008) or high grade adenocarcinoma, micropapillary and/or solid subtype, MIP-SOL (χ2 = 22.301, P < 0.001). The analysis of ground glass opacity (GGO) component (C/T ratio) obtained significantly higher accuracy in the pure GGO group than in the other two groups in predicting predominant histology or high grade adenocarcinoma (χ2 = 17.560, P < 0.001 and χ2 = 61.938, P < 0.001, respectively). CT-guided core biopsies provide additional value in predicting the histological subtype of lung adenocarcinoma after surgical resection, especially in small tumors (≤ 2cm) or an initially pure GGO group.

The histologic heterogeneity of lung adenocarcinoma is well known. Many histologic subtypes have been described, and recently their prognostic and predictive value has emerged. Laser capture microdissection may aid in the isolation of cancer cells from distinct subtypes of lung adenocarcinoma, thus enabling the description of their specific molecular features. Characterization of epidermal growth factor receptor (EGFR) mutations in histologic subtypes of lung adenocarcinoma has become an important issue. The purpose of this study was to analyze EGFR mutations in exons 18-21 in single histologic subtypes of lung adenocarcinoma after laser capture microdissection. A revision and reclassification of a series of 208 non-small cell lung cancers was conducted, and 62 adenocarcinomas with a total of 119 histologic component subtypes were identified. Laser capture microdissection of each subtype was performed. EGFR mutations in exons 18-21 were detected using polymerase chain reaction single-strand conformation polymorphism and direct DNA sequencing. EGFR mutations were detected only in 3 out of the 62 adenocarcinomas analyzed. Two adenocarcinomas harbored EGFR mutations in exon 19 (the E746-T751 deletion VA insertion and the LREAT deletion) and one adenocarcinoma the EGFR exon 21 L858R missense point mutation. EGFR mutations were observed in all component subtypes. This suggests that, in a patient with lung adenocarcinoma, EGFR mutations are not associated with particular component histologic subtypes and probably occur at an early stage of tumorigenesis. Notably, 2 out of the 3 mutated adenocarcinomas had a bronchioloalveolar component, whereas the third mutated adenocarcinoma had a papillary subtype. Although we detected EGFR mutations only in 3 out of 62 adenocarcinomas and EGFR mutations were present in every subtype of each mutated adenocarcinoma, our research might represent a basis for further studies in characterizing molecular profiles of different component subtypes of lung adenocarcinoma.

Objective To investigate the application value of the anatomical location of positive nodes (N staging) from TNM staging systems published by American Joint Committee on Cancer (AJCC) (7th edition), number of metastatic lymph nodes(NMLN), lymph node ratio (LNR) and log odds of metastatic lymph nodes (LODDS) as prognostic predictors in advanced gallbladder carcinoma(GBC). Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 176 patients who underwent radical resection of advanced GBC in the First Affiliated Hospital of Xi′an Jiaotong University between January 2008 and December 2014 were collected. According to preoperative assessment, intraoperative exploration and frozen section biopsy, staging and surgical procedure were confirmed. Observation indicators and evaluation criteria: (1)surgical and postoperative situations; (2) follow-up and survival situations; (3) N staging related indicators based on TNM staging systems of AJCC (7th edition): LNR=NMLN / total number of lymph node dissection, LODDS=Log (NMLN+0.5) / (total number of lymph node dissection - NMLN+0.5); (4) lymph node staging based on NMLN, LNR and LODDS: LODDS <-1.0 as LODDS 1 staging, -1.0 ≤ LODDS < 0 as LODDS 2 staging, LODDS ≥0 as LODDS 3 staging; (5) prognostic comparisons of patients with different lymph node staging; (6) accuracy of 4 different types of lymph node staging predicting the prognosis of patients. Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to December 31, 2017. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were described as M(range), and comparisons were done using the nonparametric test.The survival rate was calculated by the Kaplan-Meier method, and the Log-rank test was used for survival comparison. Correlation analysis was done using the Spearman correlation analysis, r ≥ 0.800 as a high correlation, 0.500 ≤ r < 0.800 as a moderate correlation and 0.300 ≤ r < 0.500 as a low correlation. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were respectively drawn and calculated based on 4 kinds of binary logistic regression model. Akaike information criterion (AIC) and Harrell concordance index (Harrell c-index) were respectively calculated based on 4 kinds of COX proportional hazard regression model. The larger values of AUC and Harrell c-index caused a smaller value of AIC, but a lymph node staging standard correlated with greater prognostic accuracy. Harrell c-index < 0.50 was no prediction, and 0.50 ≤ Harrell c-index ≤ 1.00 was an obvious prediction. Results (1) Surgical and postoperative situations: 176 patients underwent successful radical resection of GBC, including 161 in R0 resection and 15 in R1 resection, 99 with D1 lymph node dissection and 77 with D2 lymph node dissection. Of 176 patients, 9 with postoperative complications were improved by symptomatic treatment, including 6 with bile leakage, 2 with hepatic dysfunction and 1 with intra-abdominal hemorrhage. Results of postoperative pathological examination: total number of lymph node dissection, NMLN and LNR were respectively 6.7±4.4, 0 (range, 0-12.0) and 0 (range, 0-1.00); high-differentiated, moderate-differentiated and low-differentiated tumors were respectively detected in 16, 81 and 79 patients; 162 and 14 patients were in T3 and T4 stages; 60 patients were combined with infiltration of the liver. (2) Follow-up and survival situations: 176 patients were followed up for 1-118 months, with a median time of 33 months. The 1-, 3- and 5-year overall survival rates were respectively 63.1%, 42.0% and 32.0%. (3) N staging related indicators based on TNM staging systems of AJCC (7th edition): 95, 45 and 36 patients were respectively detected in staging N0, N1 and N2. NMLN, LNR and LODDS were respectively 2.0 (range, 1.0-7.0), 0.40 (range, 0.08-1.00), -0.15 (range, -0.99-1.04)in staging N1 and 4.0 (range, 1.0-12.0), 0.57 (range, 0.13-1.00), 0.11 (range, -0.70-1.04) in staging N2, with a statistically significant difference in NMLN (Z=-3.888, P 0.05). (4) Lymph node staging based on NMLN, LNR and LODDS: NMLN and LNR as a cut-off point were respectively 4.0 and 0.70, NMLN 1 staging (NMLN=0) was detected in 95 patients, NMLN 2 staging (1.0 ≤ NMLN ≤ 4.0) in 61 patients and NMLN 3 staging (NMLN>4.0) in 20 patients; LNR 1 staging (LNR=0) was detected in 95 patients, LNR 2 staging (0 0.70) in 23 patients. LODDS 1, 2 and 3 stagings was detected in 61, 70 and 45 patients, respectively. The lymph node staging based on NMLN and LNR was significantly correlated with based on N staging of TNM staging systems of AJCC (7th edition) (r=0.949, 0.922, P<0.05); the lymph node staging based on LODDS was moderately correlated with based on N staging of TNM staging systems of AJCC (7th edition) (r=0.758, P<0.05). (5) Prognostic comparisons of patients with different lymph node staging: 1-, 3- and 5-year overall survival rates were respectively 86.3%, 65.3%, 52.2% in N0 staging patients and 44.4%, 22.2%, 13.3% in N1 staging patients and 25.0%, 5.6%, 2.8% in N2 staging patients, with a statistically significant difference (χ2=88.895, P<0.05). The 1-, 3- and 5-year overall survival rates were respectively 86.3%, 65.3%, 52.2% in NMLN 1 staging patients and 47.5%, 19.7%, 11.1% in NMLN 2 staging patients and 0, 0, 0 in NMLN 3 staging patients, with a statistically significant difference (χ2=121.086, P<0.05). The 1-, 3- and 5-year overall survival rates were respectively 86.3%, 65.3%, 52.2% in LNR 1 staging patients and 41.4%, 17.2%, 11.8% in LNR 2 staging patients and 17.4%, 8.7%, 0 in LNR 3 staging patients, with a statistically significant difference (χ2=86.503, P<0.05). The 1-, 3- and 5-year overall survival rates were respectively 85.2%, 65.5%, 51.8% in LODDS 1 staging patients and 65.7%, 40.0%, 31.3% in LODDS 2 staging patients and 28.9%, 13.3%, 5.9% in LODDS 3 staging patients, with a statistically significant difference (χ2=59.195, P<0.05). (6) Accuracy of 4 different types of lymph node staging predicting the prognosis of patients: according to N staging of TNM staging systems of AJCC (7th edition), NMLN, LNR and LODDS, AUC, AIC and Harrell c-index of lymph node staging were respectively 0.878, 0.881, 0.870, 0.864 and 1 047.5, 1 026.4, 1 044.2, 1 063.6 and 0.77, 0.78, 0.77, 0.76. AIC value was smaller with increased values of AUC and Harrell c-index based on NMLN, showing a greatest accuracy predicting the prognosis of patients. Conclusion Among N staging of TNM staging system of AJCC (7 edition), NMLN, LNR and LODDS as prognostic predictors, NMLN can more precisely predict radical resection of advanced GBC. Key words: Gallbladder neoplasms, advanced; Radical resection; N staging; Number of positive lymph nodes; Positive lymph node ratio; Log odds of metastatic lymph node; Prognosis

Lung adenocarcinoma is histologically diverse but has distinct histologic growth patterns. There is no consensus on the clinical benefit of this histologic model. We aimed to evaluate the differences in the distribution of the preoperative primary tumor positron emission tomography (PET)/computed tomography (CT) standardized uptake values (SUVs) and survival in the lung adenocarcinoma subtypes. We retrospectively evaluated the data of 107 patients with resected lung adenocarcinoma who had preoperative PET/CT between 2005 and 2017 in a single center. Patients had lepidic, acinar, papillary, micropapillary, and solid histologic subtypes. We compared fluorodeoxyglucose SUVs and survival data of histologic subtypes. The median age of the patients was 62 years (40-75), 76.4% were male, the median SUVmax was 9.4 (1-36.7), and the median follow-up time was 29 months (3-135 months). The median overall survival (OS) was 71 months and the median progression-free survival (PFS) was 33 months. SUVmax was significantly different in histologic subtypes: values for papillary, micropapillary, solid, acinar, and lepidic subtypes were 9.7, 8, 12, 9.1, and 3.9, respectively (p = 0.000). Solid predominant adenocarcinoma had significantly higher SUVmax than the other subtypes (p = 0.001). Lepidic predominant adenocarcinoma had significantly lower SUVmax than the other subtypes (p = 0.000). There was no significant difference in OS between histologic subtypes (p = 0.66), but PFS was significantly different between the groups (p = 0.017), and the solid subtype had a shorter PFS than the other histologic subtypes. Lung adenocarcinoma consists of a diverse group of diseases. Different SUVmax values are seen in different histologic subtypes of nonmetastatic lung adenocarcinoma. Solid predominant types have high SUVmax values while lepidic predominant types have lower SUVmax values. The solid subtype had a shorter PFS than the other histologic subtypes.

Objective To study the relationship between the number of examined lymph nodes and the prognosis of colorectal cancer by TNM stage. Methods According to the number of examined lymph nodes, 567 patients of colorectal carcinoma who underwent resection were divided into three groups: ≤ 6,7-11 and ≥ 12, the 5-year overall survival rates of three groups were compared. For each TNM stage ( stage Ⅰ -Ⅳ ) , patients were substratified into two groups basing on the number of examined lymph nodes: 0. 05 ) , however, the 5-year survival rates of stage Ⅱ and Ⅲ colorectal cancer in ≥12 group were significantly higher than<12 group(71. 1% vs. 32. 6% ,48. 8% vs. 30. 0% ,P<0. 05) , multivariable analysis revealed that the number of lymph nodes examined was an independent factor of prognosis of stage Ⅱ and Ⅲ colorectal cancer. Conclusions The number of examined lymph nodes significantly influenced the 5-year overall survival rate of TNM stage Ⅱ and Ⅲ colorectal cancer. Key words: Colorectal neoplasm; Neoplasm staging; Prognosis; Lymph node