Postoperative 3-year Survival Rate Research Articles

Tumor budding as an indicator for lymph node metastasis and prognosis of early gastric cancer.

Tumor budding, considered as an independent risk factor reflecting prognosis of some malignant tumors, has been recognized as an important clinicopathological indicator of colorectal carcinoma. However, the evaluation of tumor budding and its clinicopathological significance in gastric cancer remain controversial. To investigate the relationship between tumor budding and clinical biological behavior of early gastric cancer (EGC) and assess the predictive value of tumor budding for lymph node metastasis as well as its impact on prognosis of EGC patients. Tissue specimens of 164 EGC patients who underwent radical gastrectomy between June 2011 and January 2017 from a single center were selected to carry out HE and CK staining respectively, so as to evaluate tumor budding under light microscopy. Clinicopathological data and follow-up results of all EGC patients were collected for statistical analysis among tumor budding, EGC clinicopathological factors and prognosis. Of all 164 EGC patients, there were 84 (51.2%) cases with mucosal invasion and 80 (48.8%) cases with submucosal invasion. Meanwhile, 32 cases (19.5%) had lymph node metastasis, 19 (11.6%) had lympho-vascular invasion and 4 (2.4%) had early recurrence. Tumor budding were observed in 90 (54.9%) patients, with low-grade budding 68 (41.5%) cases and high-grade budding 22 (13.4%) cases. Tumor budding was closely correlated with tumor size (c2 = 6.609, P = 0.037), tumor histologic differentiation (c2 = 10.522, P = 0.032), depth of invasion (c2 = 8.787, P = 0.012), lymph node metastasis (c2 = 24.226, P < 0.01), TNM stage (c2 = 24.226, P < 0.01), lympho-vascular invasion (c2 = 8.225, P = 0.016) and early recurrence (c2 = 6.462, P = 0.040). Additionally, tumor budding was correlated with postoperative survival rate as well. Multiple regression analysis revealed that tumor budding was an independent influencing factor of postoperative 3-year survival rate, 5-year survival rate, OS, DFS and DSS (P < 0.05). Furthermore, tumor budding was an independent risk factor of lymph node metastasis of EGC patients, and high-grade budding was a high-risk indicator of lymph node metastasis. Tumor budding is related to tumor size, tumor histologic differentiation, depth of invasion, lymph node metastasis, lympho-vascular invasion and early recurrence of EGC. Tumor budding, especially high-grade budding can serve as an indicator for predicting lymph node metastasis of EGC, and high-grade budding could be an important parameter for evaluating prognosis of EGC patients.

The efficacy of function-preservation in treating paranasal sinus and nasal cavity neoplasms.

Craniofacial resection (CFR) has been regarded as the gold standard for paranasal sinus and nasal cavity (PNSNC) neoplasms. The improvement of surgical procedures has been ongoing in recent years. We analyzed the clinical curative effects of the function-preservation therapy that was mainly using nasal endoscopic surgery along with appropriate radiotherapy and chemotherapy as applicable. We performed a retrospective analysis of factors that influence the survival time of the 28 patients with PNSNC neoplasms who underwent nasal endoscopic surgery. All patients with tumor lesions underwent a complete resection in en bloc or piecemeal resection. Five cases did not undergo radiotherapy or chemotherapy; the remaining 23 patients had multimodality therapy. The median follow-up time was 41.5 (range = 14-97) months. The overall 3-year survival rate was 78.57% for T3 cancer and 50% for those with T4. T classification (P = 0.031) and multimodality therapy (P = 0.038) were independent prognostic factors for postoperative 3-year survival rate of patients with PNSNC neoplasms. Function-preservation therapy based on the minimally invasive endoscopic resection (MIER) with appropriate adjuvant therapy not only prolonged the overall survival time but also provided an opportunity to preserve organ function at the same time, which helped to improve the patients' quality of life.

Application value of vessel-guided lymph node dissection in the laparoscopic radical gastrectomy (D2) of distal gastric cancer

Objective To investigate the application value of vessel-guided lymph node dissection (LND) in the laparoscopic distal gastrectomy (D2) of distal gastric cancer. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 157 patients who underwent laparoscopic distal gastrectomy (D2) of distal gastric cancer in the Affiliated Tumor Hospital of Shanxi Medical University from October 2012 to July 2015 were collected. Patients used vessel-guided LND that was divided into 4 steps: middle colic vessel-guided LND in the upper pyloric region, gastroduodenal artery-guided LND in the lower pyloric region, common hepatic artery-guided LND in the right upper margin of pancreas and splenic artery-guided LND in the left upper margin of pancreas. Observation indicators: (1) surgical and intraoperative situations, (2) postoperative pathological results, (3) follow-up situations. Follow-up using outpatient examination and telephone interview was performed to detect the postoperative 3-year survival rate up to June 2017. Measurement data with normal distribution were represented as ±s. The survival rate was calculated using the Kaplan-Meier method. Results (1) Surgical and intraoperative situations: 157 patients underwent successful laparoscopic distal gastrectomy (D2) of distal gastric cancer. Operation time, LND time, volume of intraoperative blood loss, time for initial out-of-bed activity, time to initial anal exsufflation and time of postoperative abdominal drainage-tube removal were (178±38)minutes, (61±27)minutes, (87±40)mL, (1.2±0.4)days, (2.8±1.3)days and (7.5±2.6)days, respectively. Of 157 patients, 10 with postoperative complications were improved by conservative treatment, including 5 with intestinal obstruction, 3 with anastomotic fistula and 2 dying of pulmonary infection; other patients didn′t have complications. Duration of hospital stay of 157 patients was (9±3)days. (2) Postoperative pathological results: total number of LND, numbers of LND in the lower pyloric region and in the upper margin of pancreas were 34.6±11.0, 4.8±2.1 and 12.3±4.7, respectively. TNM staging: 26, 33, 18, 24, 37 and 19 patients were respectively detected in stageⅠa, Ⅰb, Ⅱa, Ⅱb, Ⅲa and Ⅲb. (3) Follow-up situations: 142 of 157 patients were followed up for 6-56 months, with a median time of 27 months, and postoperative 3-year survival rate was 67.6%. Conclusion The vessel-guided LND is safe and effective in the laparoscopic distal gastrectomy (D2) of distal gastric cancer, and the operation steps can be simplified. Key words: Gastric neoplasms; Gastrectomy; Lymph node dissection; Vessel-guided; Laparoscopy

Role of patient-, tumor- and systemic inflammatory response-related factors in predicting survival of patients with node-negative gastric cancer.

It is currently unclear as to which patients with node-negative gastric cancer can benefit from adjuvant chemotherapy. This study aimed to develop a prognostic model based on patient-, tumor-, and host-related factors to stratify high-risk patients eligible for adjuvant therapy. Correlations of clinicopathological and hematological features with overall survival were analyzed using a Cox model. A score to identify risk classes was derived from hazard ratios in multivariate analysis. In all, 436 patients with node-negative gastric cancer (stage pT1-4aN0M0) were analyzed in this study. Multivariate analysis showed that age, depth of invasion, and neutrophil-lymphocyte ratio were independent prognostic indicators of overall survival, and a prognostic model was developed using these significant factors. Patients were stratified into three risk groups with significant differences in the 3-year survival rates (98.5%, 91.6%, and 70.7%, respectively; p < 0.001) according to their scores. The prognostic model improved the predictive accuracy of postoperative 3-year survival rate by 7% when compared with the pathological T stage. A model based on age, depth of invasion, and neutrophil-lymphocyte ratio is more effective than traditional staging systems in predicting the prognosis of node-negative gastric cancer. High-risk patients could be considered for adjuvant therapy.

Clinicopathological characteristics of EGFR mutated adenosquamous carcinoma of the lung

Adenosquamous carcinoma of the lung (Ad-Sq) is an uncommon subtype with poor prognosis. We analyzed the clinicopathological characteristics of Ad-Sq, focusing the correlation between Epidermal Growth Factor Receptor (EGFR) mutation and clinicopathological factors. A total of 67 cases were selected from September 1992 to May 2011. EGFR mutational analysis (n = 59) was performed by direct sequence. We also performed immunohistochemical staining for EGFR mutated cases using the two mutation-specific antibodies for deletion and L858R. Postoperative 3-year survival rate of Ad-Sq was 58.7%, statistically worse in comparison with adenocarcinoma (58.7% vs. 78.1%, P = 0.038). Twenty-four percent (14/59) were positive for EGFR mutations. Patients who had never been smokers and who were lymphatic permeation positive were seen more frequently in the mutation positive group (P = 0.035, 0.027, respectively). Moreover, the EGFR mutated group tended to have a more positive prognosis than negative. Focusing on the pathological features, the lepidic growth pattern was more frequently seen in the positive group (P = 0.018). Immunoreactivity for the DEL-specific and L858-specific antibody were observed in both adenocarcinoma and squamous cell carcinoma components. Our study demonstrated that EGFR mutated Ad-Sq had similar clinicopathological features as EGFR mutated adenocarcinoma.