China special issue on gastrointestinal tumors-Radiological features of pathological complete response in mismatch repair deficient colorectal cancer after neoadjuvant PD-1 blockade: A post hoc analysis of the PICC phase II trial

Neoadjuvant programmed cell death protein 1 (PD-1) blockade exhibits promising efficacy in patients with mismatch repair deficient (dMMR) colorectal cancer (CRC). However, discrepancies between radiological and histological findings have been reported in the PICC phase II trial (NCT 03926338). Therefore, we strived to discern radiological features associated with pathological complete response (pCR) based on computed tomography (CT) images. Data were obtained from the PICC trial that included 36 tumors from 34 locally advanced dMMR CRC patients, who received neoadjuvant PD-1 blockade for 3 months. Among the 36 tumors, 28 (77.8%) tumors achieved pCR. There were no statistically significant differences in tumor longitudinal diameter, the percentage change in tumor longitudinal diameter from baseline, primary tumor sidedness, clinical stage, extramural venous invasion status, intratumoral calcification, peritumoral fat infiltration, intestinal fistula and tumor necrosis between the pCR and non-pCR tumors. Otherwise, tumors with pCR had smaller posttreatment tumor maximum thickness (median: 10 mm vs 13 mm, P = .004) and higher percentage decrease in tumor maximum thickness from baseline (52.9% vs 21.6%, P = .005) compared to non-pCR tumors. Additionally, a higher proportion of the absence of vascular sign (P = .003, odds ratio [OR] = 25.870 [95% CI, 1.357-493.110]), nodular sign (P < .001, OR = 189.000 [95% CI, 10.464-3413.803]) and extramural enhancement sign (P = .003, OR = 21.667 [2.848-164.830]) was observed in tumors with pCR. In conclusion, these CT-defined radiological features may have the potential to serve as valuable tools for clinicians in identifying patients who have achieved pCR after neoadjuvant PD-1 blockade, particularly in individuals who are willing to adopt a watch-and-wait strategy.     

Complete pathological response in rectal cancer utilising novel treatment strategies for neo-adjuvant therapy: A systematic review

BackgroundLocally advanced rectal cancer is routinely treated with neo-adjuvant long course chemoradiotherapy or short course radiotherapy, followed by total mesorectal excision. Not all patients respond to this treatment and there has been an emergence of novel treatment strategies designed to improve outcomes for these patients. This systematic review aims to assess the current novel neo-adjuvant treatment strategies being utilised in the treatment of patients with rectal cancer and how these impact pathological complete response (pCR) rates.MethodsA systematic review of the literature was performed to evaluate pathological response in patients with rectal cancer receiving novel neo-adjuvant therapy. EMBASE and Medline electronic databases were searched for relevant articles. Articles published between January 2008 and February 2019 were retrieved. Included studies underwent critical appraisal and complete pathological response rates were recorded.ResultsOf the initial 1074 articles identified, 217 articles fulfilled the inclusion criteria, of these 60 articles (4359 patients) were included. Neo-adjuvant therapy delivered included novel long course chemoradiation therapy, neoadjuvant chemotherapy alone, addition of a biological agent, total neo-adjuvant therapy, novel short course radiation therapy and studies utilising biomarkers to select patients for therapy. Complete pathological response rates ranged from 0 to 60%.ConclusionA validated novel neo-adjuvant therapy that significantly increases pCR rates in patients with rectal cancer has not been identified.     

Comparing bone resorption after anatomical shoulder arthroplasty between various surgical procedures using a single-stem model

BackgroundIn shoulder arthroplasty, bone resorption around the stem can lead to stem loosening and makes surgery difficult at the time of revision. Proximal bone resorption after reverse shoulder arthroplasty can cause instability because of a decrease of deltoid wrapping effect. As factors of the stem itself, such as stem coating, shape, length, and use of bone cement, may also affect bone resorption, a single-stem model should be used to compare bone resorptions between different pathologies and surgical procedures. However, to date, a few reports have compared these differences in detail using a single-stem model. Therefore, we investigated the prevalence and location of humeral bone resorption in a single-stem model.MethodsThe study included 100 shoulders that underwent anatomical total shoulder arthroplasty (TSA) or humeral head replacement (HHR) with a single uncemented humeral stem from 2008 to 2018. The patients were 31 men and 69 women. The mean age at surgery was 72.9 years (range, 41-86 years). The patients were divided into three groups: especially, 25, 61, and 14 shoulders received TSA for primary osteoarthritis without rotator cuff tears (TSA group), HHR using an anatomical head with rotator cuff repair for cuff tear arthropathy (CTA) (HHR group), and HHR using a CTA head without rotator cuff repair (CTA group), respectively. Patients were monitored for a mean of 56 months (range, 12-98 months). The location of bone resorption was divided into seven zones as follows: zone 1, greater tuberosity; zone 2, lateral diaphysis; zone 3, lateral diaphysis beyond the deltoid tuberosity; zone 4, tip of the stem; zone 5, medial diaphysis beyond the deltoid tuberosity; zone 6, medial diaphysis; and zone 7, calcar region. The degree of bone resorption was classified from grade 0 to 4.ResultsBone resorption of grade 3 or higher was significantly more frequent at the greater tuberosity in the HHR and CTA groups (P < .001 and P < .001, respectively) than that in the TSA group. Grade 4 bone resorption was significantly more frequent in the CTA than that in the TSA and HHR groups in zone 1 (P = .016 and P = .041, respectively).ConclusionThe state of attachment of the rotator cuff to the greater tuberosity might affect bone resorption at the greater tuberosity, such as the greater tuberosity after shoulder arthroplasty. In cases of shoulder arthroplasty for arthropathy with rotator cuff tear, performing rotator cuff repair might prevent bone resorption.Level of evidenceLevel IV; Prognosis Study     

加拿大问题赌博指数中文版的效度和信度

目的:评估加拿大问题赌博指数中文版(CPGI-C)的效度和信度。方法:选取43例匿名戒赌会成员和202例正常成人为研究对象,将其随机分为两半,分别进行探索性因子分析和验证性因子分析;以赌博相关认知量表(GRCS-C)、Barratt冲动性人格问卷(BIS-11)、抑郁自评量表(SDS)、网络成瘾量表修订版(CIAS-R)和DSM-IV多重反应问卷(DSM-IV-MR)作为效标工具;以受试者工作特征曲线(ROC)评估量表区分问题赌博者的特异度与灵敏度。2周后有5例匿名戒赌会成员和31例正常成人完成重测。结果:CPGI-C的问题赌博指数(PGSI)分量表共9个条目,探索性因子分析得出1个主成分因子,可解释总方差的74.3%;验证性因子分析显示,单因子结构模型的拟合指标良好(χ~2=2.087,CFI=0.926,TLI=0.963,GFI=0.926,IFI=0.978,NFI=0.958, RMSEA=0.094,SRMR=0.032);CPGI总分与各效标量表的总分均呈正相关(r=0.48～0.82,均P<0.001);ROC曲线下面积为0.962,划界分为9.5。CPGI-C的...     

乳腺浸润性微乳头状癌的研究现状

乳腺浸润性微乳头状癌（invasive micropapillary carcinom，IMPC）是乳腺癌一种特殊类型，具有独特的微乳头状结构及生长方式，发病率较低，约占所有乳腺癌的3%～6%。相比较于其他类型浸润性乳腺癌，IMPC具有更高的淋巴结转移率和更强的淋巴管侵袭性的特征，其恶性程度高、预后差，近年来引起国内外病理以及临床医师的高度关注。     

左、右半结肠癌骨转移病理特征及预后分析

目的:比较左半结肠癌（LSCC）和右半结肠癌（RSCC）骨转移的病理特征和临床预后差异。方法:对漯河市中心医院2007年1月至2015年12月收治的103例结肠癌骨转移病例资料进行回顾性分析，据解剖位置将64例纳入LSCC组，39例纳入RSCC组，对比分析其病理学特征,绘制并分析生存曲线,筛选预后因素。结果:RSCC骨转移相对LSCC表现为:CA199 阳性率高、年龄大、分化程度更差、分期更晚、预后更差。单因素分析结果示原发肿瘤位置、TNM分期、LDH水平、ALP水平是影响结肠癌骨转移3年生存的相关因素。Logistic多因素回归分析显示原发肿瘤位置、TNM分期、ALP水平是结肠癌骨转移的独立危险因素。结论:左、右半结肠癌在病理特点、临床表现、生物学行为、生存预后等方面存在差异，本文为区分左、右半结肠癌骨转移的不同病理特征及预后评价提供了依据。     

胰腺神经内分泌肿瘤病理学分级诊断

胰腺神经内分泌肿瘤的病理学诊断是临床治疗和判断预后的重要基础。不同阶段的诊断标准存在不同临床意义，日趋完善。总的分级原则，由以往关注肿瘤大小等分期要素，发展为以肿瘤增殖程度作为主要标准，到以分化程度作为先决条件，结合增殖指数进行分级。首先依据形态分为神经内分泌瘤和神经内分泌癌，然后根据核分裂像和Ki67增殖指数把前者分为G1，G2，G3三级。     

内镜活检胃癌组织中MUC3A,MUC13表达及与病理参数和预后的关系

目的:探讨内镜活检胃癌组织中黏蛋白3A(MUC3A)、黏蛋白13(MUC13)表达及与病理参数和预后的关系。方法:选取2013年1月至2014年12月南阳市中心医院肿瘤科收治的接受内镜活检的116例患者胃癌组织和癌旁正常组织进行分析,采用免疫组织化学法检测所有组织样本中MUC3A,MUC13表达,观察二者表达情况,并分析二者与临床病理参数及预后的关系。结果:胃癌患者组织MUC3A,MUC13阳性率分别为68.97%和66.38%,高于正常组织的32.76%和7.76%(P<0.05);胃癌组织中MUC3A,MUC13表达与年龄、性别、肿瘤大小无关(P>0.05),与组织分化、浸润深度、TNM分期、淋巴结转移有关(P<0.05);随访5年结果显示:胃癌组织中MUC3A阳性患者中位生存时间为(40.50±1.95)个月,低于阴性患者的(48.67±2.51)个月(P<0.05),MUC3A阳性患者预后5年生存率为32.50%,低于阴性患者的55.56%(P<0.05);MUC13阳性患者中位生存时间为(38.52±1.92)个月,低于阴性患者的(49.06±2.71)个月(P<0.05),MUC13阳性患者预后5年生存率为30.00%,低于阴性患者的61.11%(P<0.05);COX多因素回归分析显示:TNM分期,淋巴结转移,MUC3A,MUC13是影响胃癌预后的独立危险因素(P<0.05)。结论:MUC3A,MUC13在胃癌组织中呈高表达,且与临床病理参数及预后密切相关,二者均有望作为判定胃癌发生发展及预后评估的参考指标。