5-year Tumor-free Survival Rates Research Articles

Efficacy and safety of B-ultrasound-guided radiofrequency ablation in the treatment of primary liver cancer: Systematic review and meta-analysis.

Primary liver cancer is one of the most lethal malignancies in the world. Traditional treatment methods have limitations in terms of efficacy and safety. Radiofrequency ablation (RFA) guided by B-ultrasound, as a minimally invasive treatment, has attracted increasing attention in the treatment of primary liver cancer in recent years. To study the efficacy and safety of RFA were compared with those of traditional surgery (TS) for treating small liver cancer. At least 2 people were required to search domestic and foreign public databases, including foreign databases such as EMBASE, PubMed and the Cochrane Library, and Chinese databases such as the China National Knowledge Infrastructure database, China Biomedical Literature database, Wanfang database and VIP database. Controlled trials of RFA vs conventional surgery for small liver cancer were retrieved from January 2008 to January 2023. They were screened and evaluated according to the quality evaluation criteria in the Cochrane Handbook of Systematic Reviews. The meta-analysis was performed using RevMan 5.3 software. A total of 10 studies were included in this study, including 1503 patients in the RFA group and 1657 patients in the surgery group. The results of the meta-analysis showed that there was no significant difference in 1-year overall survival between the two groups (P > 0.05), while the 3-year and 5-year overall survival rates and 1-year, 3-year and 5-year tumor-free survival rates in the surgery group were greater than those in the RFA group (P < 0.05). In terms of complications, the incidence of complications in the RFA group was lower than that in the surgery group (P < 0.05). In terms of long-term survival, TS is better than RFA for small liver cancer patients. However, RFA has fewer complications and is safer.

Study on the mechanism of liver cancer immune escape mediated by MINDY1 through regulation of PD-L1 ubiquitination level.

The novel deubiquitinase enzyme, motif interacting with ubiquitin-containing novel DUB family-1 (MINDY1), is highly expressed in liver cancer tissues and plays a crucial role in maintaining the stemness of liver cancer cells. Programmed death ligand-1 (PD-L1) is an immunosuppressive molecule overexpressed by tumour cells. The potential role of MINDY1 in inhibiting the stemness of liver cancer cells by deubiquitinating PD-L1 has not yet been reported. To investigate the mechanism by which MINDY1 mediates immune escape in liver cancer through the regulation of PD-L1 ubiquitination, we examined the expression levels of MINDY1 and PD-L1 in liver cancer and adjacent tissues from 50 hepatocellular carcinoma (HCC) patients using protein imprinting and immunohistochemistry. We analyzed the relationship between the expression levels of MINDY1 and PD-L1 in liver cancer tissues and their correlation with the 5-year tumor-free survival rates of patients. Subsequently, MINDY1 expression was knocked down in Huh7 cells using small interfering RNA (siRNA) interference or upregulated through transfection with a MINDY1 overexpression plasmid. The effects of MINDY1 knockdown or overexpression on the proliferation, apoptosis, migration, and invasion of HCC cells, as well as the regulation of PD-L1 binding and ubiquitination, were assessed. The 5-year tumor-free survival rates were significantly lower in both the high MINDY1 expression group and the high PD-L1 expression group (χ2 = 4.919 and 13.158, respectively).A significant difference in survival was observed between the high and low MINDY1 expression groups (χ2= 27.415). MINDY1 was found to directly interact with PD-L1, with MINDY1 gene knockdown promoting PD-L1 ubiquitination and MINDY1 overexpression inhibiting PD-L1 ubiquitination. All comparisons yielded statistically significant results (P < 0.05). In conclusion, MINDY1 inhibits the malignant progression of liver cancer by inhibiting PD-L1 ubiquitination and mediating immune escape.

Sorafenib as adjuvant therapy following radiofrequency ablation for recurrent hepatocellular carcinoma within Milan criteria: a multicenter analysis

BackgroundRadiofrequency ablation (RFA) is considered as a convenient treatment with mild damage in treating recurrent hepatocellular carcinoma (RHCC). However, for patients with high risk of progression after RFA still needs new strategies to decrease the repeat recurrence.MethodsA total of 460 patients with RHCC within Milan criteria in four institutions were enrolled. 174 pairs were enrolled after propensity score matching (PSM). Overall survival (OS) and tumor-free survival (TFS) were compared between the two groups. A quantitative score system was established to screen out the beneficial population from RFA–sorafenib treatment.ResultsThe 1-, 3-, and 5-year OS rates were 97.7%, 83.7%, 54.7% for RFA–sorafenib group, and 93.1%, 61.3%, 30.9% for RFA group after PSM, respectively. Compared with the RFA group, the RFA–sorafenib group had significantly better OS (P < 0.001). The 1-, 3-, and 5-year TFS rates were 90.8%, 49.0%, 20.4% for RFA–sorafenib group, and 67.8%, 28.0%, 14.5% for RFA group after PSM. The difference was observed significantly between RFA–sorafenib group and RFA group (P < 0.001). A quantitative risk score system was established to precisely screen out the beneficial population from RFA–sorafenib treatment.ConclusionsAdjuvant sorafenib after RFA was superior to RFA alone in improving survival outcomes in patients with recurrent HCC within Milan criteria after initial hepatectomy. Subgroup analyses concluded that patients with high risk score had significantly longer survival from sorafenib administration.

Long-Term Efficacy of Photodynamic Therapy with Fractionated 5-Aminolevulinic Acid 20% versus Conventional Two-Stage Topical Methyl Aminolevulinate for Superficial Basal-Cell Carcinoma

Background: Photodynamic therapy (PDT) is a noninvasive treatment for patients with superficial basal-cell carcinoma (sBCC). The efficacy of PDT may vary with different photosensitizers and treatment schedules. Objective: Our objective was to evaluate whether fractionated 5-aminolevulinic acid 20% (ALA)-PDT is superior to conventional two-stage methyl aminolevulinate (MAL)-PDT for sBCC. Methods: We present the 5 years results of a single-blind, randomized, multicenter trial. 162 patients with a histologically confirmed primary sBCC were randomized to fractionated ALA-PDT or MAL-PDT. Results: The 5-year tumor-free survival rate was 70.7% (95% CI 58.2–80.1%) for ALA-PDT and 76.5% (95% CI 64.4–85.0%) for MAL-PDT. In the first 3 years, there was no significant difference in risk of treatment failure (HR = 1.53, p = 0.283), but in the long-term, the risk of recurrence was significantly lower following MAL-PDT compared to ALA-PDT (HR = 0.125, p = 0.049). As judged by patients, the esthetic result was good-excellent in 96.8% (61/63) and 94.4% (56/59) of patients treated with ALA-PDT and MAL-PDT, respectively (p = 0.631). Conclusion: The long-term efficacy is significantly higher for conventional two-stage MAL-PDT than for fractionated ALA-PDT, whereas there was no significant difference in esthetic outcome between the treatments at 5 years after treatment. These results indicate that fractionated ALA-PDT offers no benefit over conventional two-stage MAL-PDT.

Validation of Risk Estimation of Tumor Recurrence After Transplant Score in Patients With Hepatocellular Carcinoma Treated by Liver Transplant.

Recurrent hepatocellular carcinoma can occur after liver transplant in up to 15% of cases. Recurrent hepatocellular carcinoma is associated with a dismal prognosis and subsequently a futile liver transplant in most instances. A validated prognostic scoring system forrecurrent hepatocellular carcinoma that combines both pretransplant factors and explant characteristics has not been available until lately. The Risk Estimation of Tumor Recurrence After Transplant ("RETREAT") score was recently validated. In this study, we analyzed this score for patients treated by liver transplant at our institution. Between August 2006 and December 2019, 73 adult patients within Milan criteria underwentlivertransplantfor hepatocellular carcinoma at our center. Follow-up ranged from 24.3 to 149.9 months with a mean of 45.98 ± 33.3 months. The overall 5-year patient survival, graft survival, and tumor-free survival rates were 78.6%, 90.1%, and 86.3%, respectively. Recurrent hepatocellular carcinoma cases exclusively occurred in patients with score of 3 or more points, with incidence increasing from 0% in those who had scores of ≤2 points to 30.8% in those who had scores of 3 to 5 points and to 66.7% in those who had >5 points (P < .001). The Risk Estimation of Tumor Recurrence After Transplant ("RETREAT") score predicted the occurrence of recurrent hepatocellular carcinoma in our patients and correlated significantly with its incidence. Patients with scores of >5 points were at a very high risk for recurrent hepatocellular carcinoma and should be closely monitored using laboratory and magnetic resonance imaging.

Comparison of long-term outcomes between Lynch sydrome and sporadic colorectal cancer: a propensity score matching analysis

BackgroundLynch syndrome (LS) is the most common hereditary colorectal cancer (CRC) syndrome. Comparison of prognosis between LS and sporadic CRC (SCRC) were rare, with conflicting results. This study aimed to compare the long-term outcomes between patients with LS and SCRC.MethodsBetween June 2008 and September 2018, a total of 47 patients were diagnosed with LS by genetic testing at Fudan University Shanghai Cancer Center. A 1:2 propensity score matching was performed to obtain homogeneous cohorts from SCRC group. Thereafter, 94 SCRC patients were enrolled as control group. All of enrolled patients received curative surgeries and standardized postoperative monitoring. The long-term survival rates between the two groups were compared, and the prognostic factors were also analyzed.ResultsThe 5-year overall survival rate of LS group was 97.6%, which was significantly higher than of 82.6% for SCRC group (χ2 = 4.745, p = 0.029). The 5-year recurrence free survival rate showed no significant differences between the two groups (78.0% for LS group vs. 70.6% for SCRC patients; χ2 = 1.260, p = 0.262). The 5-year tumor free survival rates in LS group was 62.1% for LS patients, which were significantly lower than of 70.6% for SCRC group (χ2 = 4.258, p = 0.039). Subgroup analysis of recurrent patients show that the LS group had longer overall survival than the SCRC group after combined chemotherapy. By multivariate analysis, we found that tumor recurrence of primary CRC [Risk ratio (95% (confidence interval): 48.917(9.866–242.539); p < 0.001] and late TNM staging [Risk ratio (95% (confidence interval): 2.968(1.478–5.964); p = 0.002] were independent risk factors for OS.ConclusionLS patients have better long-term survival prognosis than SCRC patients, even though the two groups have statistically comparable recurrence free survival. Combined chemotherapy is an effective treatment for LS patients who developed primary CRC recurrence. Standardized postoperative monitoring for LS patients may enable detection of metachronous tumors at earlier stages, which was a guarantee of a favorable prognosis despite lower tumor free survival.

Comparative analysis of the prognosis of patients with locally advanced cervical cancer undergoing laparoscopic or abdominal surgery

Objective: To compare the prognosis of patients with cervical cancer in stage Ⅰb2-Ⅱa2 undergoing laparoscopic radical hysterectomy or abdominal radical hysterectomy. Methods: From January 1, 2009 to December 31, 2018, patients with stage Ⅰb2-Ⅱa2 who underwent laparoscopic or abdominal radical hysterectomy (laparoscopic group and abdominal group) in Peking University People's Hospital were collected. The clinicopathological data were retrospectively analyzed. There were 237 cases in this study, including 115 cases in laparoscopic group and 122 cases in abdominal group. The clinicopathological characteristics, surgery-related complications, recurrence and death were analyzed between the two groups. The related factors of recurrence and death were also analyzed.During laparoscopic surgery, the pressure of the carbon dioxide pneumoperitoneum were controlled, to try avoid the tumor tissue in the vagina from being exposed to the abdominal cavity when taking out the uterine specimen through the vagina, and fully flushed the abdominal cavity with sterile water after the specimen was taken out. Results: (1) Clinicopathological characteristics: there was no significant differences between the two groups among age, pathological type, pathological grade, clinical stage, depth of interstitial infiltration, lymph node metastasis,parametrial infiltration, vaginal stump infiltration, lymph-vascular space invasion (LVSI), neoadjuvant chemotherapy, and postoperative adjuvant treatments (all P>0.05). (2) Surgery-related complications: the incidence of surgery-related complications in the laparoscopic group and the abdominal group were 32.2% (37/115) and 25.4% (31/122), respectively. There was no statistically significant difference between the two groups (P>0.05). (3) Recurrence and death: during the follow-up period, the recurrence rates of the laparoscopic group and the abdominal group were respectively 15.7% (18/115) and 12.3% (15/122). There was no statistically significant difference between the two groups (P=0.456). The 5-year overall survival rates of the laparoscopic group and the open group were 86.8% and 87.8%, and the 5-year tumor-free survival rates were 81.7% and 84.6%, respectively. There were no statistically significant differences between the two groups (P=0.405, P=0.429). (4) Analysis of related factors of recurrence and death: univariate analysis showed that neoadjuvant chemotherapy, lymph node metastasis, vaginal stump infiltration, LVSI and interstitial infiltration depth were risk factors for postoperative recurrence of cervical cancer patients (all P<0.05); neoadjuvant chemotherapy, lymph node metastasis, parametrial infiltration, vaginal stump infiltration, LVSI and interstitial infiltration depth were risk factors for postoperative death in patients with cervical cancer (all P<0.05). Multivariate analysis showed that neoadjuvant chemotherapy and lymph node metastasis were independent risk factors for postoperative recurrence and death of cervical cancer patients (P<0.05). Conclusion: There is no significant difference in the prognosis of patients with cervical cancer in stage Ⅰb2-Ⅱa2 undergoing laparoscopic radical hysterectomy with non-touch operative technique and abdominal radical hysterectomy.

Mate Analysis of Comprehensive Treatmentstrategy for Advanced Rectal Cancer

AIM: Objective to evaluate the clinical value of therapeutic lateral lymph node dissection in advanced rectal cancer after neoadjuvant radio-chemotherapy in patients with peritoneal retroperitoneum under MR suggesting perivascular iliac lymph node enlargement (lymph node diameter > 8mm). Methods: Because of this study is a retrospective study, the propensity to evaluate matching group is adopted to one group to Fujian Medical University Union Hospital, Fujian province hospital from January 2009 to June 2014 treated 103 cases of rectum MR images after neoadjuvant chemoradiation weeks iliac blood vessels have the progress of the lymph node enlargement period under peritoneal fold return rectal cancer line TME + therapeutic cases of lateral lymph node cleaning; In the group 2, 192 cases with the same tumor site, stage, type, gender and age as group 1 or similar were matched for the same period by propensity assessment, while the group 2 received TME only. The incidence of pelvic autonomic nerve injury after surgery, the 3-year local recurrence rate of pelvic cavity, and the 5-year tumor-free survival rate were compared between the two groups, so as to explore the clinical value of therapeutic periiliac dissection for advanced rectal cancer under peritoneal reflux. Results: The local recurrence rate of pelvic cavity in group 1 and group 2 was 2.91% (3/103) and 9.90% (19/192), respectively, 3 years after operation (P<0.05). Postoperative dysuria in group 1 and group 2 was 14.56% (15/103) and 5.21% (10/192), respectively, with significant difference (P<0.05). Postoperative sexual dysfunction in group 1 and group 2 was 12.50% (7/56) and 2.15% (2/93), respectively, with significant difference (P<0.05). The 5-year survival rates of group 1 and group 2 were 54.37% (56/103) and 51.56% (99/192), respectively, with no significant difference (P›0.05). The liver metastasis rates of group 1 and group 2 were 26.21% (27/103) and 29.17% (56/192), respectively. Lung metastasis rates in group 1 and group 2 were 19.41% (20/103) and 19.27% (37/192), respectively. Conclusion: After neoadjuvant chemoradiotherapy for advanced rectal cancer, selective lymphatic dissection along the iliac vessels guided by rectal magnetic resonance can reduce the local pelvic recurrence of patients for 3 years, but increase the probability of pelvic autonomic nerve injury, and periiliac lymph node dissection will not increase the 5-year survival rate of patients.

HER2 decreases drug sensitivity of ovarian cancer cells via inducing stem cell-like property in an NFκB-dependent way.

Increasing evidence shows that cancer stem cells are responsible for drug resistance and relapse of tumors. In breast cancer, human epidermal growth factor receptor 2 (HER2) induces Herceptin resistance by inducing cancer stem cells. In the present study, we explored the effect of HER2 on cancer stem cells induction and drug sensitivity of ovarian cancer cell lines. First, we found that HER2 overexpression (HER2 OE) induced, while HER2 knockdown (HER2 KD) decreased CD44+/CD24− population. Consistently, HER2 expression was closely correlated with the sphere formation efficiency (SFE) of ovarian cancer cells. Second, we found that NFκB inhibition by specific inhibitor JSH23 or siRNA targetting subunit p65 dramatically impaired the induction of ovarian cancer stem cells by HER2, indicating that NFκB mediated HER2-induced ovarian cancer stem cells. Third, we found that HER2 KD significantly attenuated the tumorigenicity of ovarian cancer cells. Further, we found that HER2 inhibition increased drastically the sensitivity of ovarian cancer cells to doxorubicin (DOX) or paclitaxel (PTX). Finally, we examined the correlation between HER2 status and stem cell-related genes expression in human ovarian tumor tissues, and found that expressions of OCT4, COX2, and Nanog were higher in HER2 positive tumors than in HER2 negative tumors. Consistently, the 5-year tumor-free survival rate of HER2 positive patients was dramatically lower than HER2 negative patients. Taken together, our data indicate that HER2 decreases drug sensitivity of ovarian cancer cells via inducing stem cell-like property.

Expressions of PTEN and E-cadherin in breast cancer tissues and their clinical significance

Objective To investigate the expressions of phosphatase and tensin homologue deleted on chromosome ten (PTEN) and epithelial cadherin (E-cadherin) in breast cancer tissues and explore their clinical significance. Methods We retrospectively analyzed the clinical data of 263 breast cancer patients admitted to the First Affiliated Hospital of Harbin Medical University from November 2012 to December 2014. The expressions of PTEN and E-cadherin were detected by immunohistochemistry. The relationship of protein expression with clinicopathological characteristics was analyzed by χ2 test or Fisher exact test. Contingency correlation analysis was used to analyze the correlation between PTEN and E-cadherin, and Kaplan-Meier was used to evaluate the relationship between their expressions and patients′ survival. COX regression model was used to analyze risk factors. Results The positive expression rates of PTEN and E-cadherin in breast cancer tissues were 68.4% (180/263) and 95.4% (251/263) respectively, lower than those in para-tumor breast tissues 77.9% (205/263) and 98.5% (259/263), with statistically significant differences (χ2=6.056, P=0.014; χ2=4.125, P=0.042). PTEN expression was associated with lymph node metastasis (χ2=8.443, P=0.015) and clinical stage (χ2=9.253, P=0.010). E-cadherin expression was not correlated with age, menopausal status, tumor maximum diameter, lymph node metastasis and clinical stage (all P>0.05). Contingency correlation analysis showed a positive correlation between PTEN and E-cadherin expressions in breast cancer tissues (C=0.125, P=0.041). Survival analysis showed that the 5-year tumor-free survival rate was 81.9% in the PTEN negative group, lower than 95.0% in the positive group (χ2=12.040, P=0.001). The 5-year tumor-free survival rate in the E-cadherin negative group was 66.7%, lower than 92.0% in the positive group (χ2=13.313, P<0.001). COX multivariate analysis showed that negative expressions of PTEN and E-cadherin and lymph node metastasis were independent risk factors for the prognosis of breast cancer patients (HR=2.554, 95%CI: 1.016-6.420, P=0.046; HR=3.573, 95%CI: 1.136-11.239, P=0.029; HR=3.622, 95%CI: 2.026-6.476, P<0.001). Conclusion PTEN is related to E-cadherin expression and low expressions of both may be one of the mechanisms of breast cancer development, invasion and metastasis. Combined detection can be used as an indicator to determine the prognosis of breast cancer. Key words: Breast neoplasms; PTEN phosphohydrolase; Cadherins; Prognosis

A propensity score matching analysis of hepatectomy and radiofrequency ablation for patients with solitary hepatocellular carcinoma less than or equal to 5 cm and portal hypertension

Objective To compare the clinical efficacy of hepatectomy and radiofrequency ablation (RFA) for patients with solitary hepatocellular carcinoma (HCC) less than or equal to 5 cm (≤5 cm) and portal hypertension (PHT). Methods The propensity score matching and retrospective case-control study was conducted. The clinicopathological data of 154 patients with solitary HCC ≤ 5 cm and PHT who were admitted to the Qingdao University between January 2011 and July 2016 were collected. Of 154 patients, 61 and 93 underwent R0 hepatectomy and RFA, respectively. Observation indicators: (1) the propensity score matching conditions and comparison of general data between groups after the propensity score matching: patients′ data were matched by the propensity score matching, patients undergoing hepatectomy and RFA were respectively allocated into the hepatectomy group and RFA group; (2) follow-up and survival. Follow-up using outpatient examination and telephone interview was performed to detect postoperative tumor-free and overall survival up to July 31, 2018. Patients received enhanced scans of computed tomography (CT) or magnetic resonance imaging (MRI) in 1 month postoperatively, and then reexaminations of liver function, level of alpha-fetoprotein (AFP), B ultrasound and pulmonary CT within 3 months postoperatively, once every 3 months from 3 months postoperatively to 2 years and once every 6 months after 2 years postoperatively. Measurement data with skewed distribution were described as M (range). Comparisons of count data were analyzed using chi-square test. The Logistic regression model was used for the propensity score matching. The survival curve and rate were respectively drawn and calculated by the Kaplan-Meier method, and Log-rank test was used for survival analysis. Results (1) The propensity score matching conditions and comparison of general data between groups after the propensity score matching: 118 of 154 patients had successful matching, including 59 in each group. There were statistically significant differences in the tumor diameter and level of preoperative albumin (Alb) before the propensity score matching between groups (χ2=11.050, 6.687, P 0.05). (2) Follow-up and survival: all the 154 patients were followed up for 4.5-91.4 months before the propensity score matching, with a median time of 44.4 months. The postoperative 1-, 2-, 3- and 5-year tumor-free survival rates were respectively 88.1%, 79.5%, 64.1%, 40.3% in patients of hepatectomy group and 84.9%, 68.6%, 52.8%, 43.4% in patients of RFA group, with no statistically significant difference in the tumor-free survival between groups (χ2=0.997, P>0.05). The postoperative 1-, 2-, 3- and 5-year overall survival rates were respectively 95.1%, 88.5%, 85.0%, 70.1% in patients of hepatectomy group and 100.0%, 95.7%, 85.6%, 73.7% in patients of RFA group, with no statistically significant difference in the overall survival between groups (χ2=0.053, P>0.05). One hundred and eighteen patients were followed up for 4.5-91.4 months after the propensity score matching, with a median time of 49.4 months. The postoperative 1-, 2-, 3- and 5-year tumor-free survival rates were respectively 89.4%, 82.3%, 66.4%, 41.7% in patients of hepatectomy group and 83.1%, 64.2%, 47.4%, 38.5% in patients of RFA group, with no statistically significant difference in the tumor-free survival between groups (χ2=2.612, P>0.05). The postoperative 1-, 2-, 3- and 5-year overall survival rates were respectively 94.9%, 89.8%, 86.1%, 70.8% in patients of hepatectomy group and 100.0%, 91.5%, 79.4%, 67.6% in patients of RFA group, with no statistically significant difference in the overall survival between groups (χ2=0.383, P>0.05). Conclusion The both hepatectomy and RFA are reliable radical treatments for solitary HCC ≤ 5 cm and PHT. Key words: Hepatocellular carcinoma; Portal hypertension; Hepatectomy; Radiofrequency ablation; Prognosis; Propensity score matching

Efficacy analysis of endoscopic therapy for early colorectal carcinoma: a retrospective study of 113 cases

To analyze the clinical efficacy of endoscopic therapy for early colorectal cancer. Clinical data of 113 early colorectal mucosal carcinoma or submucosal carcinoma receiving endoscopic therapy were retrospectively analyzed and compared with 39 early colorectal cancer cases receiving surgery during the same time. All the cases were well-moderately differentiated adenocarcinoma. Size of tumors in endoscopic group was (26.2±21.5) mm, and that was (30.9±24.3) mm in surgery group (P=0.257). Baseline data between the two groups were not significantly different (all P>0.05). Significantly shorter median operating time [15.0 minutes vs. 203.0 minutes, χ2=69.322, P=0.000] and median hospital stay [3.0 days vs. 17.0 days, χ2=76.180, P=0.000] were observed in endoscopic group compared with surgery group. The en bloc resection rate, curative resection rate, lymph node metastatic rate and complication rate were not significantly different between two groups (all P>0.05). Ten patients in endoscopic group were referred to additional surgery for deep invasion and/or incomplete resection, of whom 7 received radical surgery, and the other 3 cases without radical surgery did not develop recurrence during follow-up of (20.5±0.9) months. After follow-up for (17.5±15.8) months, the local recurrence rate was 5.3% (6/113) in endoscopic group and 0 (0/39) in surgery group without significant difference (χ2=0.983, P=0.321). There was no significant difference in 5-year tumor-free survival rate between two groups (91.8% vs. 97.0%, χ2=1.533, P=0.216). Endoscopic therapy possesses shorter operating time, shorter hospital stay and similar efficacy as compared to surgery in the treatment of early colorectal cancer.

Management decision based on lymphovascular involvement leads to favorable outcomes after endoscopic treatment of esophageal squamous cell carcinoma.

Esophageal squamous cell carcinoma (ESCC) invading the muscularis mucosae (MM) and submucosa up to 200 µm (SM1) has a risk of metastasis. The aims of this study were to investigate the long-term outcome of endoscopic submucosal dissection (ESD) for MM/SM1 ESCC and to assess the management after ESD in our hospital. This was a retrospective cohort study conducted at a single institution. Patients with MM or SM1 ESCC who were treated with ESD were included. Additional prophylactic therapy was added if lymphovascular involvement (LVI) was noted in the ESD specimens. A total of 102 patients were analyzed. The median length of follow-up was 71.5months (range 9 - 144months) and the median number of CTs was 6 (range 0 - 24). LVI was found in 21 patients (20.6 %), and 12 patients underwent additional prophylactic therapy. The 5-year overall survival, disease-specific survival, and tumor-free survival rates were 84.1 %, 97.5 %, and 82.1 %, respectively. A total of 26 patients died, but only 2 of them died from ESCC. The cumulative metastasis rate was 11.8 %, and LVI was a significant predictor of metastasis (hazard ratio 5.42, 95 % confidence interval1.39 - 21.18; P = 0.02). There were no differences between patients with MM ESCC and those with SM1 ESCC. The long-term outcome after ESD for MM/SM1 ESCC was favorable with additional prophylactic therapy and strict adherence to follow-up. These results indicate that our management decision based on LVI is a valid approach and that ESD can be offered as a therapeutic option to MM/SM1 ESCCs.

Clinicopathological features and prognosis of malignant peripheral nerve sheath tumor: a retrospective study of 159 cases from 1999 to 2016.

ObjectiveTo investigate the clinicopathological features and prognosis of malignant peripheral nerve sheath tumors (MPNST).ResultsA total of 159 patients with MPNST were enrolled in the study. The ratio of male to female was 1.04 to 1. The median age was 40 (range: 5–76) years at the time of diagnosis. The 3- and 5-year overall survival rates were 50.0% and 43.0%, respectively. The median follow-up period was 31.0 (range: 2.0–199.0) months. Multivariate analysis showed that AJCC stage and S-100 were independent factors affecting overall survival (p < 0.05 for both). 3- and 5-year tumor-free survival rates for 140 completely resected patients were 40.0% and 34.0%, respectively. Multivariate analysis showed that AJCC stage, S-100 and Ki67 staining were independent factors of tumor-free survival (p < 0.05 for all).Materials and MethodsThe clinical data of MPNST patients who were treated at Cancer Institute and Hospital, Chinese Academy of Medical Science from January 1999 to January 2016 was retrospectively reviewed.ConclusionsMPSNT is a highly aggressive tumor with poor prognosis and this study may be useful for prognostic assessment and management decisions. This had been largest documented retrospective study of MPSNT among Chinese populations. Some characteristics were different from those of foreign populations which may suggest the specificity of Chinese patients.

Clinical efficacy of total caudate lobectomy via anterior hepatic transaction in treatment of hepatic tumor involving paracaval portion of caudate lobe

Objective To explore the clinical efficacy of total caudate lobectomy via anterior hepatic transaction in treatment of hepatic tumor involving paracaval portion of caudate lobe. Methods The retrospective cross-sectional study was conducted. The clinical data of 72 patients with hepatic tumor involving paracaval portion of caudate lobe who were admitted to the Eastern Hepatobiliary Hospital of Second Military Medical University from August 2004 to May 2014 were collected. Of 72 patients, 49 had malignant hepatic tumors and 23 had benign hepatic tumors. Tumors of 43 patients exceeded caudate lobe of the liver and tumors of 29 patients didn′t exceed caudate lobe of the liver. According to hepatic tumor involving range, total caudate lobectomy via anterior hepatic transaction or mesohepatectomy with total caudate lobectomy were selected. Observation indicators: (1) operation situations: surgical procedures, hepatic vascular occlusion, time of the first hepatic hilum occlusion, operation time, volume of intraoperative blood loss, number of patient with blood transfusion; (2) postoperative recovery situations: duration of hospital stay, postoperative complications; (3) postoperative pathological examinations: surgical margin of malignant hepatic tumor; (4) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival of patients up to August 2016. Measurement data with skewed distribution were described as M (range). Survival rate was calculated by the Kaplan-Meier method. Results (1) Operation situations: all 72 patients received successful total caudate lobectomy via anterior hepatic transaction, without perioperative death. Of 17 patients undergoing single total caudate lobectomy, 2 underwent the first hepatic hilum occlusion, 13 underwent the first hepatic hilum occlusion combined with hepatic veins occlusion and 2 underwent total hepatic vascular occlusion. Of 42 patients undergoing hepatic segment Ⅳresection combined with total caudate lobectomy, 12 received the first hepatic hilum occlusion, 27 received the first hepatic hilum occlusion combined with selective hepatic veins occlusion and 3 received total hepatic vascular occlusion. Of 13 patients undergoing hepatic segment Ⅳ, Ⅴ and Ⅷ resection combined with total caudate lobectomy, 2 received the first hepatic hilum occlusion and 11 received the first hepatic hilum occlusion combined with selective hepatic veins occlusion. Operation time, time of the first hepatic hilum occlusion, volume of intraoperative blood loss and number of patients with blood transfusion were 205 minutes (range, 120-445 minutes), 49 minutes (range, 24-139 minutes), 800 mL (range, 200-5 000 mL), 41 in all the 72 patients and 245 minutes (range, 140-345 minutes), 52 minutes (range, 29-75 minutes), 700 mL (range, 200-3 000 mL), 10 in 17 patients undergoing single total caudate lobectomy and 200 minutes (range, 120-370 minutes), 48 minutes (range, 24-120 minutes), 675 mL (range, 200-36 00 mL), 21 in 42 patients undergoing hepatic segment Ⅳ resection combined with total caudate lobectomy and 210 minutes (range, 145-300 minutes), 50 minutes (range, 26-139 minutes), 1 000 mL (range, 300-5 000 mL), 10 in 13 patients undergoing hepatic segment Ⅳ, Ⅴ and Ⅷ resection combined with total caudate lobectomy, respectively. (2) Postoperative recovery situations: duration of hospital stay was 9 days (range, 7-18 days) in 72 patients. Twenty-five patients had postoperative complications, including 7 with effusion at surgical area, 5 with intra-abdominal effusion, 4 with bleeding, 4 with bile leakage, 4 with pleural effusion and 1 with pulmonary infection. Four patients with bleeding received reoperation haemostasis. Other patients with complications were improved by symptomatic treatment. (3) Postoperative pathological examinations: of 49 patients with malignant hepatic tumors, surgical margin >5 mm was detected in 9 patients and 1 mm< surgical margin <5 mm was detected in 11 patients. Twenty-seven patients without surgical margin had complete excision of tumors, and 2 patients had tumor rupture during the operation. (4) Follow-up: all the 72 patients were followed up for 6-141 months, with a median time of 46 months. The 1-, 3-, 5-year overall survival rates and 1-, 3-, 5-year tumor-free survival rates were 83.5%, 61.1%, 36.4%, 66.3%, 40.7%, 27.1% in 49 patients with malignant tumor, respectively. Twenty-three patients with benign hepatic tumor had healthy living. Conclusion Total caudate lobectomy via anterior hepatic transaction is safe and feasible in treatment of hepatic tumor involving paracaval portion of caudate lobe and middle lobe. Key words: Liver neoplasms; Hepatic caudate lobectomy; Paracaval portion; Anterior approach

Preoperative adjuvant transarterial chemoembolization cannot improve the long term outcome of radical therapies for hepatocellular carcinoma

Combinations of transarterial chemoembolization (TACE) and radical therapies (pretransplantation, resection and radiofrequency ablation) for hepatocellular carcinoma (HCC) have been reported as controversial issues in recent years. A consecutive sample of 1560 patients with Barcelona Clinic Liver Cancer (BCLC) stage A/B HCC who underwent solitary Radiofrequency ablation (RFA), resection or liver transplantation (LT) or adjuvant pre-operative TACE were included. The 1-, 3- and 5-year overall survival rates and tumor-free survival rates were comparable between the solitary radical therapy group and TACE combined group in the whole group and in each of the subgroups (RFA, resection and LT) (P > 0.05). In the subgroup analysis, according to BCLC stage A or B, the advantages of adjuvant TACE were also not observed (P > 0.05). A Neutrophil-lymphocyte ratio (NLR) more than 4, multiple tumor targets, BCLC stage B, and poor histological grade were significant contributors to the overall and tumor-free survival rates. In conclusions, our results indicated that preoperative adjuvant TACE did not prolong long-term overall or tumor-free survival, but LT should nevertheless be considered the first choice for BCLC stage A or B HCC patients. Radical therapies should be performed very carefully in BCLC stage B HCC patients.

Clinicopathological characteristics and prognostic factors analysis of combined hepatocellular-cholangiocarcinoma

Objective To analyze the clinicopathological characteristics and prognostic factors of combined hepatocellular-cholangiocarcinoma (cHCC-CC). Methods The retrospective cohort study was conducted. The clinicopathological data of 72 patients with primary hepatocellular carcinoma (HCC) who were admitted to the Xiangya Hospital of Central South University between January 2005 and December 2014 were collected. Thirty-two patients who were diagnosed with cHCC-CC by postoperative pathological examination were allocated into the cHCC-CC group and 40 patients who were diagnosed with HCC by postoperative pathological examination were allocated into the HCC group. Observation indicators: (1) clinicopathological characteristics: male, age>60 years, positive hepatitis B surface antigen (HBsAg), positive alpha-fetoprotein (AFP), positive CA19-9, positive carcinoembryonic antigen (CEA), liver cirrhosis, Child-Pugh grade A, tumor diameter>5 cm, tumor with capsule, solitary tumor, portal vein tumor thrombus (PVTT), cancer thrombus of the bile duct, positive lymph node metastasis, stage Ⅰ-Ⅱ of TNM stage, Edmondson-Steiner stageⅠ-Ⅱ; (2) pathological features of surgical incision specimens; (3) follow-up situations: median survival time, 1-, 3-, 5-year survival rates and tumor-free survival rate; (4) prognostic factors analysis of patients with cHCC-CC: AFP, CA19-9, liver cirrhosis, tumor diameter, tumor capsule, number of tumor, PVTT, cancer thrombus of the bile duct, lymph node metastasis, Edmondson-Steiner stage, volume of intraoperative blood loss, intraoperative blood transfusion, distant from surgical margin. Follow-up using outpatient examination and telephone interview was performed to detect survival of patients and tumor recurrence or metastasis up to October 2015. Comparison of count data was analyzed using the chi-square test. The survival curve was drawn by the Kaplan-Meier method, and the survival analysis was done using the Log-rank test. The prognostic analysis was done using the COX regression model. Results (1) Clinicopathological characteristics: positive CA19-9, tumor with capsule, cancer thrombus of the bile duct and positive lymph node metastasis were detected in 16, 4, 12, 6 patients in the cHCC-CC group and 5, 17, 1, 1 patients in the HCC group, respectively, with statistically significant differences between the 2 groups (χ2=10.471, 9.723, 13.005, 4.009, P<0.05). (2) Pathological features of surgical incision specimens: pathological results showed that surgical incision specimens in the cHCC-CC group had characteristics of HCC tissues and cholangiocarcinoma tissues. The antigenic activity of hepatic cells in paraffin sections, Cytokeratin 7, Cytokeratin 19 and progenitor cell markers were positive by immunohistochemical staining detection. Patients in the HCC group had characteristics of HCC tissues, with positive AFP using immunohistochemical staining detection. (3) Follow-up situations: all the 72 patients were followed up for 5.0-74.0 months with a median time of 41.0 months. The median survival time, 1-, 3-, 5-year survival rates, 1-, 3-, 5-year tumor-free survival rates were 14.5 months, 62.3%, 38.9%, 19.1%, 50.0%, 23.9%, 4.0% in the cHCC-CC group and 46.8 months, 82.3%, 57.4%, 38.6%, 72.9%, 35.6%, 17.6% in the HCC group, respectively, with statistically significant differences in overall survival and tumor-free survival between the 2 groups (χ2=4.231, 3.881, P<0.05). (4) Prognostic factors analysis of patients with cHCC-CC: results of univariate analysis showed that CA19-9, tumor capsule, number of tumor, cancer thrombus of the bile duct, lymph node metastasis and Edmondson-Steiner stage were related factors affecting prognosis of patients with cHCC-CC [HR=1.824, 0.227, 0.441, 1.421, 1.887, 2.745, 95% confidence interval (CI): 1.126-2.172, 0.118-0.654, 0.318- 0.764, 1.071-4.231, 1.017-5.643, 1.223-6.421, P<0.05]. Results of multivariate analysis showed that lymph node metastasis and stage Ⅲ-Ⅳ of Edmondson-Steiner stage were independent risk factors affecting prognosis of patients with cHCC-CC (RR=1.658, 2.912, 95% CI: 1.027-7.542, 1.143 - 6.582, P<0.05). Conclusions The positive CA19-9, tumor without capsule, cancer thrombus of the bile duct and positive lymph node metastasis can partly predict cHCC-CC. The prognosis of patients with cHCC-CC is worse than that with HCC. The positive lymph node metastasis and stage Ⅲ-Ⅳof Edmondson-Steiner stage are independent risk factors affecting prognosis of patients with cHCC-CC. Key words: Hepatic neoplasms; Biliary neoplasms; Mixed type; Hepatectomy; Prognosis

Clinical value of Fluorine-18-fluorodeoxyglucose PET/CT examination to predict the prognosis of patients after colorectal cancer operation

Objective To investigate the clinical value of Fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT examination to predict the prognosis of patients after colorectal cancer operation. Methods The retrospective cross-sectional study was adopted. The clinicopathological data of 80 patients with colorectal cancer who were admitted to the First Hospital of Nanjing Medical University from March 2007 to October 2015 were collected. Eighty patients received first preoperative 18F-FDG PET/CT examination and underwent operations under decisions of patients and their families, and then adjuvant chemotherapy were performed according to the patients′ condition. Observation indicators included: (1) preoperative imaging examination, (2) situations of treatment and follow-up, (3) analysis of prognostic factors. The patients were followed up by outpatient examination and telephone interview once every 3 months within postoperative 1 year, once every half a year within postoperative 2 years and then once a year up to May 2016. The follow-up included tumor recurrence or progression and survival of patients. Tumor-free survival time was from postoperative day 1 to tumor recurrence or progression and death or end of follow-up. Overall survival time was from postoperative day 1 to death or end of follow-up. Measurement data with skewed distribution were represented as M (Qn) and M (range). The optimal cutoff point of tumor-free survival of maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolism of volume (MTV) and total lesion of glycolysis (TLG) were investigated using the ROC curve analysis, and calculating area under the curve (AUC). The median was used as a cutoff point if there was smaller AUC. The Kaplan-Meier method and Log-rank test were respectively used for survival analysis and univariate analysis, and COX proportional hazards model for multivariate analysis. Results (1) Results of preoperative imaging examination: results of PET/CT in patients with colorectal cancer showed there were circumscribed thickening of bowel wall, intestinal cavity strictures, fuzzy fat space around the some lesions, enlarged lymph node and 18F-FDG uptake increased abnormally. The SUVmax, SUVmean, MTV and TLG of 80 patients were 11.83(4.26, 35.42), 7.06(2.38, 20.92), 20.47 cm3(1.29 cm3, 161.50 cm3) and 138.58(14.17, 857.89), respectively. ROC curve showed that the AUC of SUVmax , SUVmean, MTV and TLG were 0.453, 0.448, 0.815 and 0.749 [95% confidence interval (CI): 0.307-0.600, P>0.05; 0.303-0.594, P>0.05; 0.717- 0.913, P<0.05; 0.635- 0.863, P<0.05], respectively. The median SUVmax (11.83) and SUVmean(7.06) were used as the cutoff points due to smaller AUC of SUVmax and SUVmean. The cutoff point of MTV was 18.79 cm3 (sensitivity=86.2% and specificity=68.3%), and the cutoff point of TLG was 142.05 (sensitivity=75.9% and specificity=70.7%). (2) Situations of treatment and follow-up: among 80 patients, 13 underwent the radical resection of colorectal cancer and resection of liver metastasis and 67 underwent radical resection of colorectal cancer. Sixty-two patients received postoperative chemotherapy, including 45 with chemotherapy regimens of capecitabine and 17 with fluorouracil. Eighty patients were followed up for 41.8 months (range, 6.5-109.1 months ). During the follow-up, 29 patients had tumor recurrence or progression, and 19 patients were dead. The median tumor-free survival time, 1-, 3- and 5-year tumor-free survival rates in 80 patients were 19.5 months (range, 2.0-109.1 months), 73.7%, 36.3% and 18.8%, respectively. The median overall survival time, 1-, 3- and 5-year overall survival rates were 31.8 months (range, 3.3-109.1 months), 76.3%, 37.5% and 20.0%, respectively. (3) Analysis of prognostic factors: results of univariate analysis showed that tumor location, N staging, M staging, clinical staging, postoperative chemotherapy, MTV and TLG were relative factors affecting postoperative tumor-free survival rate (HR=3.469, 5.325, 5.295, 8.605, 2.630, 7.388, 5.155, 95% CI: 1.522-7.906, 2.256-12.568, 2.405-11.657, 2.969-24.937, 1.063-6.504, 2.550-21.403, 2.178-12.204, P<0.05). The tumor location, tumor differentiation, N staging, M staging, clinical staging, MTV and TLG were relative factors affecting postoperative overall survival rate (HR=2.697, 2.814, 3.083, 2.916, 4.193, 5.450, 4.876, 95% CI: 1.011-7.197, 1.121-7.062, 1.166-8.149, 1.140-7.454, 1.386-12.678, 1.581-18.786, 1.727-13.766, P<0.05). In multivariate analysis, stage Ⅲ-Ⅳ of clinical staging and TLG≥142.05 were independent risk factors affecting postoperative tumor-free survival rate (HR=9.879, 3.569, 95% CI: 1.854-22.836, 1.127-11.306, P<0.05). The stage M1, stage Ⅲ-Ⅳ of clinical staging and TLG≥142.05 were independent risk factors affecting postoperative overall survival rate (HR=4.522, 9.315, 10.120, 95% CI: 1.223-16.717, 1.338-24.864, 2.385-12.947, P<0.05). Conclusion TLG through 18F-FDG PET/CT examination is an independent prognostic factor affecting postoperative tumor-free survival rate and overall survival rate in patients with colorectal cancer after curative resection, and it has certainly reference value for prognosis. Key words: Colorectal neoplasms; Prognosis; Tomography, emission-computed; Tomography, X-ray computed; Deoxyglucose

Poster

Poster

Effect of abdominal lymphadenectomy on prognosis of intrahepatic cholangiocarcinoma: a systematic review and Meta analysis

Objective To systematically review the prognostic factors of cholangiocarcinoma (ICC) and clinical significance of abdominal lymphadenectomy. Methods PubMed was queried with the terms of intrahepatic cholangiocarcinoma, survival, surgery, lymph or vascular to find all studies published from January 2005 to December 2015. Authors were contacted by letters for the publications that were initially ineligible due to insufficient information for data extraction, responses were received, so these publications were included. Data were analyzed and evaluated by 2 independent researchers. Prognostic factors of ICC (vascular invasion, bile duct invasion, lymphatic vessel invasion, lymph node metastasis and peripheral nerve invasion) and related-factors of surgical method (R0 resection and lymph node dissected) were analyzed. The 3-, 5-year survival rate, tumor-free survival rate and effect of lymph node dissected for prognosis of patients were extracted. Heterogeneity was analyzed by the chi-squared test and I2 test. The hazard ratio (HR) and 95% confidence interval (CI) were transformed to Log (HR) and standard errors (SE) Log (HR). HR and 95% CI of clinical factors associated with outcomes were done using univariate COX regression models. Publication bias was evaluated by the Egger's method, visualizing with funnel plot. Results A total of 48 publications including 7 868 patients with ICC were eligible to be included in this analysis, 12 of 48 publications were included in the Mata analysis. Of 7 868 patients with ICC, vascular invasion, bile duct invasion, lymphatic vessel invasion, lymph node metastasis, peripheral nerve invasion, R0 resection and lymph node dissected were detected in 30%(5%-98%), 40%(11%-59%), 45%(35%-65%), 28%(9%-100%), 25%(7%-55%), 79%(35%-100%) and 64%(9%-100%), respectively. The 3-, 5-year survival rate and 3-, 5-year tumor-free survival rate were 39%(16%-65%), 29%(5%-60%) and 34%(3%-60%), 23%(0-52%), respectively. The results of meta-analysis showed that lymph node metastasis and vascular invasion were factors affecting the prognosis of patients with ICC (HR=2.30, 1.92, 95%CI: 1.94-2.73, 1.64-2.25, P 0.05). Among the patients with lymph node metastasis, 5-year survival rate in patients with and without lymphadenectomy was 48% and 11%, respectively, showing a statistically significant difference (P<0.05). Conclusions Lymph node metastasis and vascular invasion are the risk factors affecting the prognosis of patients with ICC. Routine lymphadenectomy for ICC cannot show survival benefit, while routine lymphadenectomy should be applied to patients with ICC and uncertain lymph node metastasis. Key words: Biliary neoplasms; Lymphadenectomy; Prognosis; Systematic Review; Meta-analysis