Is there an optimal time to initiate adjuvant chemotherapy to predict benefit of survival in non-small cell lung cancer?

Objective:Adjuvant chemotherapy (AC) after curative resection is known to improve the survival of patients with non-small cell lung cancer (NSCLC);however,few studies have reported the correlation between the time to initiation ofAC (TTAC) and survival in NSCLC patients.Methods:The clinical data of 925 NSCLC patients who received curative resection and post-operative AC at the Cancer Hospital of Chinese Academy of Medical Sciences between 2003 and 2013 were retrospectively analyzed.TTAC was measured from the date of surgery to the initiation of AC.Disease-free survival (DFS) was defined as the duration from surgery to the time of tumor recurrence or last follow-up evaluation.The optimal cut-off value of TTAC was determined by maximally selected log-rank statistics.The DFS curve was estimated using the Kaplan-Meier method,and the Cox proportional hazards regression model was used to identify risk factors independently associated with DFS.Propensity score matching (PSM) was performed for survival analysis using the match data.Results:The optimal discriminating cut-off value of TTAC was set at d 3 5 after curative resection based on which the patients were assigned into two groups:group A (≤35 d) and group B (＞35 d).There was no significant difference in the DFS between the two groups (P=0.246),indicating that the TTAC is not an independent prognostic factor for DFS.A further comparison continued to show no significant difference in the DFS among 258 PSM pairs (P=0.283).Conclusions:There was no significant correlation between the TTAC and DFS in NSCLC patents.Studies with larger samples are needed to further verify this conclusion.     

Prognostic factors of ampulla of vater carcinoma after radical surgery

OBJECTIVE Ampullary carcinoma is a rare disease with better prognosis than other periampullary neoplasms. This study investigated the association between clinicopathologic factors and prognosis after radical resection of ampulla of Vater carcinoma.
METHODS Clinical data from 105 patients who underwent radical pancreaticoduodenectomy from January 1990 to December 2005 were retrospectively analyzed by the Kaplan-Meier method, log-rank test, and the Cox proportional hazard model.
RESULTS The in-hospital mortality rate was 8.6%, the lymph node metastasis rate was 37.1%, and the five-year survival rate was 42.8%. Pancreatic involvement （P = 0.027）, tumor diameter （P = 0.008）, T stage （P = 0.003）, TNM stage （P 〈 0.001）, and number of metastatic lymph nodes （P 〈 0.001） were associated with prognosis when the univariate analysis was used. Multivariate analysis showed that the number of lymph node metastases （P 〈 0.001; OR： 1.923; CI： 1.367-2.705） and tumor diameter （P = 0.03; OR： 1.432; CI： 1.035-1.981） were the independent prognostic factors.
CONCLUSION The number of metastatic lymph nodes and tumor diameter are important pathologic factors predicting prognosis of ampulla of Vater carcinoma after radical resection, and lymph node dissection during the radical surgery effectively improves the survival rate.     

Analysis of liver metastasis after resection for pancreatic ductal adenocarcinoma

AIM:To investigate the risk factors affecting the liver metastasis(LM) of pancreatic ductal adenocarcinoma(PDAC) after resection.METHODS:We retrospectively analyzed 101 PDAC patients who underwent surgical resection at the Samsung Medical Center between January 2000 and December 2004.Forty one patients with LM were analyzed for the time of metastasis,prognostic factors affecting LM,and survival.RESULTS:LM was found in 40.6%.The median time of the LM(n = 41) was 6.0 ± 4.6 mo and most LM occurred within 1 year.In univariate analysis,tumor size,preoperative carbohydrate antigen 19-9,and perineural invasion were factors affecting LM after resection.In multivariate analysis,tumor size was the most important factor for LM.In univariate analysis,tumor cell differentiation was significant to LM in low-risk groups.CONCLUSION:LM after resection of PDAC occurs early and shows poor survival.Tumor size is the key indicator for LM after resection.     

Retrospective analysis of patients with rare-site and metastatic giant cell tumor

A giant cell tumor occurs mainly in the proximal tibia,humerus,distal radius bone and the pelvic bone.It is rarely observed in such sites as the ribs and the temporal bone.The condition is primarily treated with surgical excision and functional reconstruction.The effect of chemotherapy on lung metastases and locally advanced giant cell tumors has remained unknown.We collected and analyzed the data of six patients with rare giant cell tumors located in the head and neck patients.After an average follow-up of 42.6 months after surgery （14 to 90 months）,no local recurrence or metastasis was observed.We also collected and analyzed the data of five patients with metastatic giant cell tumors who were undergoing surgery for the primary tumor before; of three patients who had experienced multiple chemotherapy cycles,one had spontaneous regression,and one survived for long timer despite progression.The other two patients had their major metastatic lesions resected by surgery,and presented long-term survival during the follow up.In addition,this study reports one patient with locally advanced giant cell tumor of the rib,who has undergone successful surgical resection following two cycles of chemotherapy with ifosfamide and liposomal doxorubicin.Complete resection of the lesion at the head and neck is the key to relapse-free survival.The prognosis of lung metastases in patients with giant cell tumors is relatively satisfying.Neoadjuvant chemotherapy is also conducive to the surgery for locally advanced lesions and improvement of the quality of life.     

"Three-Grade Criteria" of Radical Resection for Primary Liver Cancer

OBJECTIVE The present study was designed to develop the "ThreeGrade Criteria" for radical resection of primary liver cancer (PLC) and to evaluate its clinical significance.METHODS Criteria for radical resection of PLC were summed up to 3 grades based on criterion development. Grade I: complete removal of all gross tumors with no residual tumor at the excision margin. Grade Ⅱ: on or the primary branches of the portal vein, the common hepatic duct or its dition to the above criteria, negative postoperative follow-up result including AFP dropping to a normal level (with positive AFP before surgery)within 2 months after operation, and no residual tumor upon diagnostic imaging.The clinical data from 354 patients with PLC who underwent hepatectomy were reviewed retrospectively. Based on the "Three-Grade Criteria" these patients were divided into 6 groups: Grade Ⅰ radical group,Grade Ⅰ palliative group, Grade Ⅱ radical group, Grade Ⅱ palliative group,Grade Ⅲ radical group, Grade Ⅲ palliative group. The survival rate of each group was calculated by the life-table method and the rates compared among the groups.RESULTS The survival rate of patients receiving radical treatment was better than those receiving palliative treatment (P＜0.01). Survival improved as more criteria were applied. The 5-year survival rate of the patients in Grade Ⅰ, Ⅱ and Ⅲ who underwent radical resection was 43.2%,51.2% and 64.4%, respectively (P＜0.01).CONCLUSION The "Three-Grade Criteria" may be applied for judging the curability of resection therapy for PLC. The stricter the criterion used,the better the survival would be. Adopting high-grade criteria to select cases and guide operations and strengthening postoperative follow-up would improve the results of hepatectomy for PLC.     

Survival analysis of children with stage II testicular malignant germ cell tumors treated with surgery or surgery combined with adjuvant chemotherapy

For children with stage II testicular malignant germ cell tumors(MGCT), the survival is good with surgery and adjuvant chemotherapy. However, there is limited data on surgical results for cases in which there was no imaging or pathologic evidence of residual tumor, but in which serum tumor markers either increased or failed to normalize after an appropriate period of half-life time post-surgery. To determine the use of chemotherapy for children with stage II germ cell tumors, we analyzed the outcomes(relapse rate and overall survival) of patients who were treated at the Sun Yat-sen University Cancer Center between January 1990 and May 2013. Twenty-four pediatric patients with a median age of 20 months(range, 4 months to 17 years) were enrolled in this study. In 20 cases(83.3%), the tumors had yolk sac histology. For definitive treatment, 21 patients underwent surgery alone, and 3 patients received surgery and adjuvant chemotherapy. No relapse was observed in the 3 patients who received adjuvant chemotherapy, whereas relapse occurred in 16 of the 21 patients(76.2%) treated with surgery alone. There were a total of 2 deaths. Treatment was stopped for 1 patient, who died 3 months later due to the tumor. The other patient achieved complete response after salvage treatment, but developed lung and pelvic metastases 7 months later and died of the tumor after stopping treatment. For children treated with surgery alone and surgery combined with adjuvant chemotherapy, the 3-year event-free survival rates were 23.8% and 100%, respectively(P = 0.042), and the 3-year overall survival rates were 90.5% and 100%, respectively(P = 0.588). These results suggest that adjuvant chemotherapy can help to reduce the recurrence rate and increase the survival rate for patients with stage II germ cell tumors.     

Radiation-induced osteosarcoma ofthe maxilla andmandible afterradiotherapy fornasopharyngeal carcinoma

Background: The increasing incidence of radiation?induced osteosarcoma of the maxilla and mandible (RIOSM) has become a signiifcant problem that can limit long?term survival. The purpose of this study was to analyze the associa?tion of clinicopathologic characteristics with treatment outcomes and prognostic factors of patients who developed RIOSM after undergoing radiotherapy for nasopharyngeal carcinoma (NPC). Methods: We reviewed the medical records of 53,760 NPC patients admitted to Sun Yat?sen University Cancer Center during the period August 1964 to August 2012. Of these patients, 47 who developed RISOM and met inclusion criteria were included in this study. Two of these 47 patients refused treatment and were then excluded. Results: For all patients treated for NPC at Sun Yat?sen University Cancer Center during the study period, the total incidence of RIOSM after radiotherapy was 0.084% (47/53,760). Two patients (4.4%) had metastases at the diagnosis of RIOSM. Thirty?nine of the 45 (86.7%) patients underwent surgery for RIOSM; most patients (24/39; 61.5%) who under?went resection had gross clear margins, with 15 patients (38.5%) having either a gross or microscopic positive margin. All patients died. The 1?, 2?, and 3?year overall survival (OS) rates for the entire cohort of 45 patients were 53.3%, 35.6% and 13.5%, respectively. The independent prognostic factors associated with high OS rate were tumor size and treat?ment type. Conclusions: RISOM after radiotherapy for NPC is aggressive and often eludes early detection and timely inter?vention. Surgery combined with postoperative chemotherapy might be an effective treatment to improve patient survival.     

Prognostic significance of ERCC1 expression in postoperative patients with gastric cancer

Aim： This study explored the correlation between the expression of excision repair cross-complementation group 1 （ERCC1） and the prognosis of gastric cancer patients. Methods： From January 2005 to December 2008, 605 patients who underwent radical surgery in The First Affiliated Hospital of Nanjing Medical University were enrolled. We conducted the follow-up every 6 months and its contents included a comprehensive medical history, tumor markers and abdominal ultrasound or CT and other imaging findings. Deadline was April 30, 2013 and follow-up time between 51 to 91 months. Survival time is calculated from the date of diagnosis to death or last follow-up date. Immunohistochemistry （IHC） was used to assess the expression of ERCCI in resected samples. The relationship between ERCCI expression and survival of patients was investigated. The comparison of count data were analyzed by Chi-square test. Median survival time （MST） and the 5-year survival rate were calculated by life table analysis. The Kaplan-Meier curves were used for survival analysis. Results： ERCC1 expression was positive in 412 patients （68.1%）. There is no significant difference between ERCCl-positive group and ERCCl-negative group in terms of the MST and 5-year survival rate （P=0.455）. The MST and 5-year survival rate have no significant difference （P=0.162） between group with chemotherapy and group with no chemotherapy in patients with ERCCl-positive expression. However, the MST and 5-year survival rate in patients with ERCCl-negative expression benefited more from with chemotherapy （P=0.019）. The ERCCl-positive patients survived longer than those ERCCl-negative patients （P=0.183） in subgroup with no adjuvant chemotherapy. In the subgroup analysis, ERCC 1 expression had no significant relationship with overall survival in patients with stage II or llI gastric cancer （P〉0.05）. Conclusions： ERCC1 might be a good prognostic factor for the patients of gastric cancer after radical resection. Patients with ERCC     

“Three-Grade Criteria” of Radical Resection for Primary Liver Cancer

OBJECTIVE The present study was designed to develop the “Three- Grade Criteria” for radical resection of primary liver cancer （PLC） and to evaluate its clinical significance. METHODS Criteria for radical resection of PLC were summed up to 3 grades based on criterion development. Grade Ⅰ： complete removal of all gross tumors with no residual tumor at the excision margin. Grade Ⅱ： on the basis of Grade Ⅰ, additional 4 requirements were added： （1） the tumor was not more than two in number; （2） no tumor thrombi in the main trunks or the primary branches of the portal vein, the common hepatic duct or its primary branches, the hepatic veins or the inferior vena cava; （3）no hilar lymph nodes metastases; （4）no extrahepatic metastases. Grade Ⅲ ： in addition to the above criteria, negative postoperative follow-up result including AFP dropping to a normal level （with positive AFP before surgery） within 2 months after operation, and no residual tumor upon diagnostic imaging.The clinical data from 354 patients with PLC who underwent hepatectomy were reviewed retrospectively. Based on the “Three-Grade Criteria” these patients were divided into 6 groups： Grade Ⅰ radical group, Grade Ⅰ palliative group, Grade Ⅱ radical group, Grade Ⅱ palliative group, Grade Ⅲ radical group, Grade Ⅲ palliative group. The survival rate of each group was calculated by the life-table method and the rates compared among the groups. RESULTS The survival rate of patients receiving radical treatment was better than those receiving palliative treatment （P〈0.01）. Survival improved as more criteria were applied. The 5-year survival rate of the patients in Grade Ⅰ, Ⅱ and Ⅲ who underwent radical resection was 43.2%, 51.2% and 64.4%, respectively （P〈0.01）. CONCLUSION The “Three-Grade Criteria” may be applied for judging the curability of resection therapy for PLC. The stricter the criterion used, the better the survival would be. Adopting high-grade criteria to select cases and guide operations and strengthening postoperative follow-up would improve the results of hepatectomy for PLC.     

Predictive Factors Relating to Tumor-Free Survival Rates and the Clinical Management of Small Cancer of the Liver after Hepatectomy

OBJECTIVE To investigate factors associated with tumor-free survival rates and methods of treatment for small cancer of the liver. METHODS A total 105 cases of small cancer of the liver (maximum diameter ≤5 cm in a solitary nodule or the sum of maximum diameters in double nodules ≤5 cm) were studied between 1983 and 2000. Patients were divided into an invasive group (primary tumor accompanied by any one or more of the following features: satellite nodules, venous invasion, adjacent organ involvement and double nodules) and a non-invasive group. RESULTS Three patients died from liver failure within 30 days after operation and 100 of the other patients were followed-up. The 1, 3, 5, 7 and 10-year survival rates after the first resection were 95.8%, 64.8%, 48.8%, 39.4% and 34.3% respectively. The main factors influencing tumor-free survival after radical resection were tumor size, presence or absence of satellite nodules or vascular invasion, the incisal edge, the UICC TNM stage, and the number of tumor nodules. The survival rate of the invasive group was significantly lower than that of the non-invasive group. Tumors of fifty-one cases recurred after radical resection. For the recurrent patients, treatments included a repeated resection for 17 cases, transcatheter artery chemotherapy and embolization (TACE) for 18 cases and no treatment or chemotherapy for 18 cases. The 1,3 and 5-year survival rates after repeated hepatectomy for recurrent patients were 82.4% , 51.3% and 34.2% respectively, which were higher than those in the non-resected group.CONCLUSIONS Factors that influence postoperative tumor-free survival rate were concluded to be early stage detection, tumor invasive or noninvasive traits and the incisal edge. For the recurrent patients, active treatment especially a second hepatectomy, is safe and feasible, and can improve the 5-year survival rate by 10 percent. The categorization of invasive and non-invasive groups for small cancer of the liver is useful in clinical work. For patients with invasive small cancer of the liver, postoperative close surveillance and follow-up is the key to improve the prognosis.     

Prognosis of rectal neuroendocrine tumors after endoscopic resection: a single-center retrospective study

BackgroundThe efficacy of endoscopic resection in patients with rectal neuroendocrine tumors (NETs) which are less than 20 mm in diameter remains unclear. This study aimed to investigate the efficacy and outcomes of different types of endoscopic resection in patients with NETs.MethodsWe performed a retrospective analysis and follow-up on 98 patients who underwent endoscopic resection for rectal NETs between August 2010 and October 2019 at Guangdong Provincial People’s Hospital, China. The lesions were preoperatively classified according to their endoscopic morphology and measured by endoscopic ultrasound. Patients were divided into modified endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) groups depending on the endoscopic treatment they received. The en bloc resection rate, histopathological complete resection rate, and the complication rate of the 2 groups were evaluated after the operation. The risk factors for incomplete resection were also analyzed.ResultsThe average diameter of the 98 NETs was 6.29±2.90 mm (range, 2–15 mm). The en bloc resection rate of the modified EMR and ESD treatment groups was 97.2% (35/36) and 100% (62/62), respectively. The histopathological complete resection rate was 86.1% (31/36) and 87.1% (54/62), respectively. No tumor recurrence or tumor-related death occurred. There were no statistically significant differences in the rate of histopathological complete resection, perforation, or delayed hemorrhage between the 2 groups (P>0.05). Multivariate analysis demonstrated that the depth of tumor invasion (P=0.007) and tumor diameter (P<0.001) were independent risk factors for histopathological complete resection.ConclusionsModified EMR and ESD are safe and effective endoscopic approaches for the resection of rectal NETs ≤15 mm in diameter. Endoscopic resection requires a comprehensive preoperative evaluation of risk factors including the depth of tumor invasion and tumor diameter.     

Safety, efficacy, and long-term outcomes for endoscopic submucosal dissection of early esophagogastric junction cancer

Background

Early esophagogastric junction (EGJ) cancer is currently being treated in the same way as early gastric cancer, by endoscopic submucosal dissection (ESD), but long-term outcomes are still unknown. Our aim was to retrospectively evaluate the safety and efficacy of ESD in treating early EGJ cancer and compare risk factors in curative and non-curative resection cases.

Methods

Forty-four cases of early EGJ cancer, defined as a Siewert’s type II tumor, in 44 patients with a mean age of 70.0 years and a male/female ratio of 90.9:9.1 % were treated by ESD between January 2004 and June 2010. There were 30 standard indication cases; the remaining 14 cases were expanded indication cases.

Results

Mean resected specimen and tumor sizes were 35 and 17 mm, respectively, and median procedure time was 121 min, with no bleeding or perforation complications. All cases were resected en bloc with an 84.1 % curative resection rate (37/44). The curative resection rates in the standard and expanded indication cases were 90.0 % (27/30) and 71.4 % (10/14), respectively. There were no significant differences in tumor location, tumor morphology, tumor size, histology of biopsy specimens, or standard versus expanded indication cases with regard to risk factors for curative and non-curative resections. However, submucosal invasion, positive tumor margins, lymphovascular invasion, and some components of poorly differentiated adenocarcinomas in just the submucosal layer were significantly more common in the non-curative resection cases.

Conclusions

ESD was a safe, effective, and minimally invasive treatment for early EGJ cancer. For tumors without any submucosal invasion findings, therefore, ESD is an acceptable treatment option, in addition to also being suitable for diagnostic purposes in evaluating the need for surgery.     

内镜黏膜下剥离术治疗不同浸润深度早期胃癌的安全性及相关因素分析

目的:探讨内镜黏膜下剥离术(endoscopic submucosal dissection, ESD)治疗不同浸润深度早期胃癌的临床安全性及其相关影响因素。方法:收集2012年01月01日至2018年12月31日在我院行ESD术的早期胃癌患者的临床相关资料,根据ESD术后病理,比较黏膜内癌组(M)与浅层黏膜下癌组(浸润深度≤500μm, SM1)患者的临床特征及临床预后,运用Logistic回归模型分析影响ESD术治愈性切除的相关因素。结果:276例患者中,M组247例,SM1组29例。M组与SM1组在病变大小、病变部位、术后病理类型方面差异有统计学意义(P<0.05);M组治愈性切除率远高于SM1组(94.74%vs 65.52%,χ²=29.007,P<0.05);M组与SM1组3年生存率(96.21%vs 86.67%),差异无统计学意义(χ²=0.540,P=0.463),术后并发症的发生差异也无统计学意义(P=0.572);有溃疡和浸润深度SM1是影响ESD术治愈性切除的相关因素。结论:ESD治疗不同浸润深度早期胃癌,...     

Prognostic factors in gastric cancer with serosal invasion--importance of the extent of cancer infiltration in the subserosal layer

The extent of cancer infiltration in the subserosal layer has been examined in 214 stomachs resected for cancer with a serosal invasion. The extent was 4 cm or less in 109 patients (Group A) and 5 cm or more in 105 patients (Group B). The resection was estimated as being non-curative in 26% of Group A and in 52% of Group B (p less than 0.001). Peritoneal dissemination was the outstanding non-curative factor in the latter. The five-year survival rate was 39% in Group A and 14% in Group B (p less than 0.001). The survival rate after the curative resection was 49% and 26%, respectively (p less than 0.01). In Group B, peritoneal dissemination was the main mode of recurrence after the curative resection.     

经内镜黏膜下剥离术治疗直肠神经内分泌肿瘤的疗效及安全性CSCD

目的探讨经内镜黏膜下剥离术(ESD)治疗直肠神经内分泌肿瘤(RNET)的疗效,并评估其安全性。方法回顾性分析2011年1月—2017年12月在江苏省人民医院行直肠ESD治疗、经病理及免疫组织化学确诊为RNET的80例患者(91处病变)的临床资料,并对患者进行随访。结果所有病变均为完整切除病灶。有症状的患者术后3天~2月症状均有不同程度缓解,无严重术后并发症,标本切缘阳性率20.88%(19/91),切缘可疑阳性率35.16%(32/91)。切除标本最大长径20 mm。单因素分析中,肿瘤长径≥10 mm、肿瘤处于G2级与切缘可疑阳性及阳性相关(P<0.05)。肿瘤处于G2级为切缘可疑阳性及阳性的独立危险因素。仅有1例患者术前证实为RNET。中位随访时间34月,复发率4.40%(4/91)。结论ESD在治疗直径<20 mm的G1级和G2级的RNET患者中具有良好疗效。对于ESD术后显示切缘阳性及可疑阳性的RNET患者,可密切随访暂不实施其他治疗。     

Clinicopathological features of Siewert type II adenocarcinoma: comparison of gastric cardia adenocarcinoma and Barrett’s esophageal adenocarcinoma following endoscopic submucosal dissection

Objectives

Siewert type II esophagogastric junction adenocarcinoma encompasses both gastric cardia adenocarcinoma (GCA) and Barrett’s esophageal adenocarcinoma (BEA) due to short-segment Barrett’s esophagus. We compared these two types of Siewert type II esophagogastric junction adenocarcinoma in terms of background factors and clinical outcomes of endoscopic submucosal dissection (ESD).

Methods

We enrolled 139 patients (142 lesions) who underwent ESD from 2006 to 2014 at our institution. Background factors evaluated were age, sex, body mass index, hypertension, hyperlipidemia, hyperuricemia, diabetes mellitus, smoking, drinking, double cancer, and endoscopic findings. Clinical outcomes evaluated were procedure time, en bloc resection rate, curative resection rate, and adverse events.

Results

There were 87 GCA lesions (61.2%) and 55 BEA lesions. Features of BEA [55 lesions (38.8%)] included a younger age, small diameter, and a protruding type, along with a high frequency of esophageal hiatal hernia and less mucosal atrophy. There were no significant differences in lifestyle-related background factors between the GCA and BEA groups. Curative resection rate was greater for GCA (81%) than for BEA (66%) (P = 0.01). There were no serious adverse events in either group. Among the factors for noncurative resection, lymphovascular invasion and depth of invasion were greater for BEA (33.3 vs. 7 and 20.7 vs. 8.2%, respectively (P < 0.01). Of the noncured patients, 70% underwent additional surgery and none had postoperative lymph node metastasis.

Conclusions

Siewert type II adenocarcinoma encompasses two types of cancers with different etiologies: GCA and BEA. Although there are no significant differences in lifestyle-related background factors between GCA and BEA, BEA is a risk factor for noncurative resection via ESD.

     

A multicenter retrospective study of endoscopic resection for early gastric cancer

Background The reported outcomes of endoscopic resection (ER) for early gastric cancer (EGC) remain limited to several single-institution studies. Methods A multicenter retrospective study was conducted at 11 Japanese institutions concerning their results for ER, including conventional endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). Results A total of 714 EGCs (EMR, 411; ESD, 303) in 655 consecutive patients were treated from January to December 2001. Technically, 511 of the 714 (71.6%) lesions were resected in one piece. The rate of one-piece resection with ESD (92.7%; 281/303) was significantly higher compared with that for EMR (56.0%; 230/411). Histologically, curative resection was found in 474 (66.3%) lesions. The rate of curative resection with ESD (73.6%; 223/303) was significantly higher compared with that for EMR (61.1%; 251/411). Blood transfusion because of bleeding was required in only 1 patient (0.1%) with EMR of 714 lesions. Perforation was found in 16 (2.2%). The incidence of perforation with ESD (3.6%; 11/303) was significantly higher than that with EMR (1.2%; 5/411). All complications were managed endoscopically, and there was no procedure-related mortality. The median follow-up period was 3.2 years (range, 0.5–5.0 years). In total, the 3-year cumulative residual-free/recurrence-free rate and the 3-year overall survival rate were 94.4% and 99.2%, respectively. The 3-year cumulative residual-free/recurrence-free rate in the ESD group (97.6%) was significantly higher than that in the EMR group (92.5%). Conclusion ER leads to an excellent 3-year survival in clinical practice and could be a possible standard treatment for EGC. ESD has the advantage of achieving one-piece resection and reducing local residual or recurrent tumor.     

EMR和ESD治疗早期结直肠癌的临床疗效分析

目的：探讨内镜下黏膜切除术（endoscopic mucosal resection,EMR）和内镜黏膜下剥离术（endoscopic submucosal dissection,ESD）治疗早期结直肠癌的临床效果及安全性。方法：回顾性分析2015年5月至2021年12月在福建省立医院南院行内镜治疗的早期结直肠癌患者的资料。根据治疗方法不同,分为EMR和ESD两组,比较两组患者手术时间、整块切除率、完全切除率、并发症发生率及复发率。结果：共纳入167例患者,其中EMR组74例,ESD组93例。ESD组的手术时间均长于EMR组（P<0.05）。病变直径≥20 mm时,ESD组病灶整块切除率、完全切除率高于EMR组（P<0.05）;病变直径<20 mm时,EMR组和ESD组病灶整块切除率及完全切除率差异无统计学意义（P>0.05）。在EMR组中,病变直径≥20 mm的整块切除率和完全切除率均低于病变直径<20 mm(P<0.05)。ESD组术后并发症发生率高于EMR组（P<0.05）。ESD组术后复发率低于EMR组,差异无统计学意义（P>0....     

直肠神经内分泌肿瘤淋巴结转移的危险因素分析及内镜切除方式比较

背景与目的： 直肠神经内分泌肿瘤（rectal neuroendocrine neoplasm,R-NEN）的发病率呈上升趋势,但其治疗仍存在争议,特别是10 ~ 20 mm之间的肿瘤。本研究通过分析R-NEN的临床病理学特征,探讨其淋巴结转移的危险因素,并比较不同内镜切除效果的差异,探索内镜治疗R-NEN的适应证及方式。方法： 回顾性分析2007年2月—2020年12月河北医科大学第四医院收治的R-NEN患者的相关临床信息,分析淋巴结转移的危险因素,比较不同内镜切除方式的安全性和有效性。结果： 共分析了190例R-NEN患者的临床病理学特征,结果显示,肿瘤大小≥12.5 mm（OR = 69.081,95% CI：11.385 ~ 419.155,P<0.001）和淋巴管血管侵犯（OR = 11.732,95% CI：1.028 ~ 84.567,P = 0.015）是淋巴结转移的独立危险因素。比较内镜下套帽辅助黏膜切除术（endoscopic mucosal resection with cap,EMR-c）和内镜下黏膜下剥离术（endoscopic submucosal dissection,ESD）治疗114例R-NEN患者的临床资料,结果显示,EMR-c组的手术时间明显短于ESD组[（10.23±1.99）min vs （24.78±8.09）min,P<0.001]。两组的内镜整块切除率、病理学完全切除率和并发症发生率差异无统计学意义（P>0.05）。结论： 肿瘤大小≥12.5 mm和淋巴管血管侵犯是R-NEN患者淋巴结转移的独立危险因素。对于<12.5 mm且无淋巴结转移的R-NEN来说,EMR-c和ESD均是安全有效的治疗方法。     

Neoadjuvant chemotherapy in advanced gastric cancer with non-curative factors: a Phase II study with 5-fluorouracil, leucovorin, and cisplatin

Background. Neoadjuvant chemotherapy (NAC) has recently received increasing attention in an attempt to increase the rate of complete tumor resections, reduce systemic metastases, and prolong survival in patients with advanced gastric cancer. Methods. Since 1993, 21 patients with unresectable or non-curative resectable gastric cancer received NAC, consisting of 5-fluorouracil, leucovorin, and cisplatin (FLP) with at least two cycles before surgery. Results. All except 2 patients underwent surgical treatment, and resection was performed in 18 (85.7%). There were no deaths and no major morbidity following operation. There was no complete response (CR), but 12 patients (57.1%) had a partial response (PR), the response rate was 47.6% for the primary region, 64.7% for abdominal para-aortic (No.16) lymph node metastasis, 40.0% for liver metastasis, and 11.1% for peritoneal dissemination. One-year survival of the 21 patients was 40.5%, and median survival time (MST) was 322 days. MST in the responders was 571 days, and that in non-responders was 199 days (P < 0.01). MST was 835 days in patients who underwent curative resection and 310 days in those who underwent non-curative surgery (P < 0.01). There was no grade 4 toxicity, but grade 3 leukopenia occurred in 4 patients (19.0%), grade 3 anemia occurred in 3 patients (14.3%), and grade 3 stomatitis in 2 patients (9.5%). There were no serious renal disorders and no treatment-related death. Conclusions. The combination of FLP for NAC was feasible and useful for tumor reduction, especially for No.16 lymph node metastasis. There was a survival benefit in patients whose tumor had PR or who had had curative resection. We should confirm the effect and survival benefit of FLP for NAC by a prospectively randomized clinical controlled study. Received for publication on Jan. 19, 1999; accepted on March 15, 1999