胰腺癌:经腹腔镜肿瘤分期

Objective： Accurate staging of patients with pancreatic cancer is crucial to clarify whether meaningful resection is indeed possible. Staging laparoscopy has been suggested as a tool for staging which may spare up to two-fifth of these patients from undergoing nontherapeutic laparotomy. A controversy exists, however, as to whether the procedure should be used routinely or selectively in these patients with no evidence of metastasis on noninvasive staging. This review aims to evaluate the available literature critically, identify its limitations and address the existing controversies. Methods： The current available English literature was reviewed on this topic. Results： A direct and conclusive comparison of the controversial literature is difficult because of inconsistent use of high-quality CT scans, different study designs and dissimilarity of judgment for non-resectability among patients staged by laparoscopy. However, recent studies reveal that not more than 14% of the patients benefit from diagnostic laparoscopy when a dual-contrast thin cut and 3-D digital reformatting CT scan has been performed previously. Conclusion： We conclude that routine use of diagnostic laparoscopy does not appear warranted in all patients with pancreatic cancer, especially for patients with early-staged pancreatic cancer or non-pancreatic periampullary cancers, because diagnostic laparoscopy is costly and ultrasonography is largely operator-dependent. Rather, selective use is appropriate, especially in patients with a large primary tumor, a tumor in the body or tail of the pancreas, equivocal findings of metastasis on CT, the presence of ascites, severe weight loss, hypoalbuminemia, and a markedly elevated CA 19-9.     

Depth of tumor invasion and tumor-occupied portions of stomach are predictive factors of intra-abdominal metastasis

Objective:Diagnostic laparoscopy is recommended for the pretherapeutic staging of gastric cancer to detect any unexpected or unconfirmed intra-abdominal metastasis.The aim of this study was to evaluate the role and indications of diagnostic laparoscopy in the detection of intra-abdominal metastasis.Methods:Standard diagnostic laparoscopy with peritoneal cytology examination was performed prospectively on patients who were clinically diagnosed with primary local advanced gastric cancer (cT≥2M0).We calculated the rate of intra-abdominal metastases identified by diagnostic laparoscopy,and examined the relationship between peritoneal dissemination (P) and cytology results (CY).Split-sample method was applied to find clinical risk factors for intra-abdominal metastasis.Multivariate logistic regression analysis and receiver-operator characteristic (ROC) analysis were performed in training set to find out risk factors of intra-abdominal metastasis,and then validate it in testing set.Results:Out of 249 eM0 patients,51 (20.5％) patients with intra-abdominal metastasis were identified by diagnostic laparoscopy,including 20 (8.0％) P1CY1,17 (6.8％) P0CY1 and 14 (5.6％) P1CY0 patients.In the training set,multivariate logistic regression analysis and ROC analysis showed that the depth of tumor invasion on computer tomography (CT) scan ≥21 mm and tumor-occupied ≥2 portions of stomach are predictive factors of metastasis.In the testing set,when diagnostic laparoscopy was performed on patients who had one or two of these risk factors,the sensitivity and positive predictive value for detecting intra-abdominal metastasis were 90.0％ and 32.1％,respectively.Conclusions:According to our results,depth of tumor invasion and tumor-occupied portions of stomach are predictive factors of intra-abdominal metastasis.     

微探头超声内镜和CT在胸段食管癌术前分期中的应用

Objective： To compare mini-probe endoscopic ultrasonography （MCUS） with computed tomography （CT） in preoperative T and N staging of esophageal cancer, and to find out the MCUS parameters to judge lymph nodes metastasis for esophageal cancer. Methods： Thirty-five patients received both MCUS and CT preoperatively, on both of which the T and N stages were determined. The accuracy, sensitivity, specificity, positive predicting value and negative predicting value were compared with the postoperative pathological results. Results： The accuracy of MCUS was 85.7% in T staging and 85.7% and 80.0% in N staging by two different methods, which were 45.7% and 74.3%, respectively, by CT. Conclusion： MCUS is better than CT in preoperative staging for esophageal cancer. The ratio of short to long axis （S/L） combined with short axis is a useful way to determine lymph nodes metastasis.     

Total Vertebral Body Breast Cancer Metastases: One Case Report and Literature Review

Breast cancer is one of the most commonly seen malignant tumors in the female population, and it ranks the first in the incidence of malignancies among women. The skeleton is a common metastatic site for advanced breast cancer and is where spinal metastasis is most frequently seen. The incidence rate of spinal metastasis in descending order is as follows: thoracic vertebrae, lumbar vertebrae, sacrococcy-geal vertebrae and cervical vertebrae. Although osseous metastasis of breast cancer is very common, cases with metastasis to all vertebral bodies is currently very rare. The diagnostic method of osseous metastasis of breast cancer typically includes radiograph, CT and MRI. Ordinary radiograph has a high specificity but a low sensitivity, so total vertebral body metastases can only be detected when the extent of osteoclasia exceeds 50%. Some diagnostic shortcomings remain, although the sensitivity of CT and MRI has been greatly improved compared to the radiograph. At present, the most advanced synchronous PET-CT visualization can presumably raise the sensitivity and specificity in the diagnosis of breast cancer, based on the features of 18F-FDG imaging, and combined with morphologic change and precise localization. The following case report is in regard to a patient with total vertebral body metastasis from breast cancer detected by PET-CT.     

Chromodomain-helicase-DNA binding protein 5, 7 and pronecrotic mixed lineage kinase domain-like protein serve as potential prognostic biomarkers in patients with resected pancreatic adenocarcinomas

Pancreatic cancer is one of the deadliest cancers with a very poor prognosis. Recently, there has been a significant increase in research directed towards identifying potential biomarkers that can be used to diagnose and provide prognostic information for pancreatic cancer. These markers can be used clinically to optimize and personalize therapy for individual patients. In this review, we focused on 3 biomarkers involved in the DNA damage response pathway and the necroptosis pathway: Chromodomainhelicase-DNA binding protein 5, chromodomain-helicaseDNA binding protein 7, and mixed lineage kinase domain-like protein. The aim of this article is to review present literature provided for these biomarkers and current studies in which their effectiveness as prognostic biomarkers are analyzed in order to determine their future use as biomarkers in clinical medicine. Based on the data presented, these biomarkers warrant further investigation,and should be validated in future studies.     

Therapy for non-small-cell lung cancer patients with brain metastasis

Brain metastasis is a major cause of poor prognosis and high mortality for non-small cell lung cancer patients. The prognosis of non-small-cell lung cancer（NSCLC） patients with brain metastasis is generally poor and more effective treatment is required to improve their prognosis. Whole-brain radiotherapy, surgery, stereotactic radiosurgery, chemotherapy and targeted therapy are the main treatment for brain metastasis. This review focuses on the five therapeutic strategy and in particular, on targeted therapy.     

HPV16感染与P21基因失活在胃癌发生及预后中的意义

Objective： To investigate whether there is a synergistic carcinogenesis between the infection of human papilloma virus （HPV） and the P21 gene mutation in gastric cancer tissue and their relationship with prognosis of the patients with gastric cancer. Methods： By using PCR technique, HPV16 infection in 46 gastric cancer tissue samples was measured and by using immunohistochemical S-P method, the P21 gene mutation in gastric cancer was detected. All patients were regularly followed up for 3 years by writing letter or clinics, to detect the infection of HPV16 by PCR and the p21 gene mutation by immunohistochemical method in 46 gastric cancer tissue specimens. Results： The positive rate of HPV16 was 41.3% and the gene mutation rate of p21 was 52.17% respectively. The recurrence or remote metastasis was observed in 21 of 46 patients. The recurrence rate was 73.68% in the patients positive for HPV16 and 66.6% in those positive for p21 gene mutation. In 8 cases positive for both HPV16 and P21, 6 had recurrence or remote metastasis. Conclusion： The HPV16 infection may be one factor causing gastric cancer and it has a synergistic carcinogenesis with the p21gene mutation. The latter may be one of the prognostic indices in gastric cancer.     

Stomach One-Point Cancer： One Case Report and Literature Review

Introduction
Gastric cancer is one of the most common cancers and one of the most frequent causes of cancer deaths worldwide. Early detection and accurate preoperative staging of gastric cancer is essential for planning optimal therapy such as endoscopic mucosal resection or gastric resection and offers the best prognosis. With advanced technology in diagnostic instruments and the mass screening, early gastric cancer has been detected easier. One-point cancer of gastric is a special type of early gastric cancer. Diagnosis of one-point cancer of gastric is important for both the immediate treatment and the prognosis. There is still no consensus on the operation extent and postoperative treatment for patients with one-point cancer of gastric. Learned from previous reports, we know that existed in the superficial layer of the gastric mucosa and the superficial ulcer is one of the important characteristics of one point cancer of gastric. Herein, we report a case of one point cancer of gastric with the appearance of a deep infiltrating ulcer. To the best of our knowledge, no such type of one point cancer of gastric has been reported.     

Status of colitis-associated cancer in ulcerative colitis

Surgical therapy for ulcerative colitis(UC) depends on the medical therapy administered for the patient’s condition. UC is a benign disease. However, it has been reported that the rare cases of cancer in UC patients are increasing, and such cases have a worse prognosis. Recently, surgical therapy has greatly changed, there has been quite an increase in the number of UC patients with high-grade dysplasia and/or cancer. These lesions are known as colitis-associated cancer(CAC). The relationship between inflammation and tumorigenesis is well-established, and in the last decade, a great deal of supporting evidence has been obtained from genetic, pharmacological, and epidemiological studies. Inflammatory bowel disease, especially UC, is an important risk factor for the development of colon cancer. We should determine the risk factors for UC patients with cancer based on a large body of data, and we should attempt to prevent the increase in the number of such patients using these newly identified risk factors in the near future. Actively introducing the surgical treatment in addition to medical treatment should be considered. Several physicians should analyze UC from their unique perspectives in order to establish new clinically relevant diagnostic and treatment methods in the future. This article discusses CAC, including its etiology, mechanism, diagnosis, and treatment in UC patients.     

Meta-analysis:prognostic value of survivin in patients with pancreatic cancer

Objective： The aim of the study was to conduct a systematic review of the literature evaluating survivin expres- sion in pancreatic carcinoma as a prognostic indicator. Methods： The relevant literatures were searched using PubMed, EMBASE, and Chinese Biomedicine Databases. A meta-analysis of the association between survivin expression and overall survival in patients with pancreatic cancer was performed. Studies were pooled and summary hazard ratios （HRs） were calculated. Subgroup analysis according to the location of survivin expression was also performed. Results： Seven eligible studies with a total of 448 patients were included in this study. Combined HR suggested that survivin expression had an unfavorable impact on survival of pancreatic cancer patients （HR = 1.65, 95% CI： 1.02-2.68）. When stratified according to the location of survivin expression, the combined HR showed that expression in the cytoplasm was significantly associated with poor prog- nosis of pancreatic cancer patients （HR = 2.09, 95% CI： 1.29-3.40）. In contrast, survivin expression in the nucleus was not significantly associated with poor prognosis （HR = 0.83, 95% CI： 0.24-2.81）, and the heterogeneity was highly significant （I2 = 87.2%, P = 0.005）. Conclusien： Survivin expression was associated with a poor prognosis in patients with pancreatic cancer. Cytoplasmic expression of survivin may be a prognostic factor for pancreatic cancer patients. Based on the current obtained data, there was no evidence that survivin expression in the nucleus had a significant impact on patients＇ overall survival.     

Pancreatic cancer–Laparoscopic resection

Objective: To assess current role of laparoscopic resection for pancreatic cancer, so as to improve the surgical management of pancreatic cancer. Methods: A comprehensive review of articles from PubMed was carried out. Results: Cur- rently, the advantages of a complete laparoscopic pancreatoduodenectomy (LPD) are still outweighed by the morbidity associ- ated with the procedure. However, laparoscopic distal pancreatectomy (LDP) offers patients benefits in terms of postoperative recovery and the length of hospital stay with similar morbidity and mortality to open surgery. Hand-assisted laparoscopic sur- gery can help to overcome the limitation of a complete laparoscopic surgery while maintaining a minimally invasive approach. Conclusion: Current literature suggests that laparoscopic resection of pancreatic cancer is feasible and safe in experienced hands. The hand-assisted laparoscopic surgery shows a promising future in pancreatic cancer surgery.     

Significance of the lymph nodes in the 7th station in rational dissection for metastasis of distal gastric cancer with different T categories

Objective： To determine the clinicopathological characteristics, and evaluate the appropriate extent of lymph node dissection in distal gastric cancer patients with comparable T category. Methods： A retrospective study was conducted on 570 distal gastric cancer patients, who underwent gastric resection with D2 nodal dissection, which was performed by the same surgical team from January 1997 to January 2011. We compared the differences in lymph node metastasis rates and metastatic lymph node ratios between different T categories. Additionally, we investigated the impact of lymph node metastasis in the 7th station on survival rate of distal gastric cancer patients with the same TNM staging. Results： Among the 570 patients, the overall lymph node metastasis rate of advanced distal gastric cancer was 78.1%, and the metastatic lymph node ratio was 27%. The lymph node metastasis rate in the 7th station was similar to that of perigastric lymph nodes. There was no statistical significance in patients with the same TNM stage （stage Ⅱ and Ⅲ）, irrespective of the metastatic status in the 7th station. Conclusions： Our results suggest that to a certain extent, it is reasonable to include lymph nodes in the 7th station in the D 1 lymph node dissection.     

胰腺癌:腹腔镜切除术

Objective： To assess current role of laparoscopic resection for pancreatic cancer, so as to improve the surgical management of pancreatic cancer. Methods： A comprehensive review of articles from PubMed was carried out. Results： Currently, the advantages of a complete laparoscopic pancreatoduodenectomy （LPD） are still outweighed by the morbidity associated with the procedure. However, laparoscopic distal pancreatectomy （LDP） offers patients benefits in terms of postoperative recovery and the length of hospital stay with similar morbidity and mortality to open surgery. Hand-assisted laparoscopic surgery can help to overcome the limitation of a complete laparoscopic surgery while maintaining a minimally invasive approach. Conclusion： Current literature suggests that laparoscopic resection of pancreatic cancer is feasible and safe in experienced hands. The hand-assisted laparoscopic surgery shows a promising future in pancreatic cancer surgery.     

Efficacy of minimally invasive therapies on unresectable pancreatic cancer

For patients with unresectable pancreatic cancer, current chemotherapies have negligible survival benefits. Thus, developing effective minimally invasive therapies is currently underway. This study was conducted to evaluate the efficacy of transarterial chemoembolization plus radiofrequency ablation and/or 125 I radioactive seed implantation on unresectable pancreatic cancer. We analyzed the outcome of 71 patients with unresectable pancreatic carcinoma who underwent chemoembolization plus radiofrequency ablation and/or radioactive seed implantation. Of the 71 patients, the median survival was 11 months, and the 1-, 2-, and 3-year overall survival rates were 32.4%, 9.9%, and 6.6%, respectively. Patients who had no metastasis, who had oligonodular liver metastases (≤3 lesions), and who had multinodular liver metastases (3 lesions) had median survival of 12, 18, and 8 months, respectively, and 1-year overall survival rates of 50.0%, 68.8% , and 5.7% , respectively. Although the survival of patients without liver metastases was worse than that of patients with oligonodular liver metastasis, the result was not significant (P = 0.239). In contrast, the metastasis-negative patients had significantly better survival than did patients with multinodular liver metastases (P0.001). Patients with oligonodular liver lesions had a significanthg longer median survival than did patients with multinodular lesions (P0.001). In conclusion, combined minimally invasive therapies had good efficacy on unresectable pancreatic cancer and resulted in a good control of liver metastases. In addition, the number of liver metastases was a significant factor in predicting prognosis and response to treatment.     

Clinicopathological Characteristics as Predictive Factrs for Lymph Node Metastasis in Submucosal Gastric Cancer

OBJECTIVE To identify clinicopathological characteristics as predictive factors for lymph node metastasis in submucosal gastric cancer, and in addi- tion to establish objective criteria as indications for endoscopic submucosal dissection (ESD). METHODS Data from 130 patients with submucosal gastric cancer were collected, and the relationship between their clinicopathological characteris- tics and the presence of lymph node metastasis was retrospectively analyzed by multivariate analysis. RESULTS In the multivariate logistic regression model, a tumor size of 2 cm or more and an undifferentiated histologic type were found to be inde- pendent risk clinicopathological characteristics for lymph node metastasis. Among 130 patients with submucosal carcinoma, no lymph node metastases were observed in 17 patients who showed neither of the two risk clinicopath- ological characteristics. Lymph node metastasis occurred in 61.1% (22/36) of the patients who had both risk clinicopathological characteristics. CONCLUSION A tumor size of 2 cm or more and an undifferentiated histologic type were significantly and independently related to lymph node metastasis in submucosal gastric cancer. It is rational for the paitients with neither of these two independent risk clinicopathological characteristics to undergo an ESD.     

The Efficacy of High-Intensity Focused Ultrasound （HIFU） in Advanced Pancreatic Cancer

OBJECTIVE To observe the efficacy of high-intensity focused ultrasound (HIFU) in the treatment of late-stage pancreatic cancer. METHODS Sixteen patients with advanced pancreatic cancer received HIFU therapy.Evaluation of efficacy was made on the basis of changes in clinical symptoms and variations in the tumor echo and size. RESULTS Clinical symptoms such as pain were significantly alleviated,echo of the tumor was enhanced with B-US and the quality of life such as eating,sleeping and mental status was markedly improved;no serious complications were observed. CONCLUSION The use of HIFU in the treatment of advanced pancreatic cancer is feasible and safe.It is effective in killing the carcinoma cells and alleviating pain.This technique may offer non-invasive therapy for the treatment of patients with late-stage pancreatic cancer.     

胰腺癌:PET诊断学

Important challenges for imaging of pancreatic cancer are the late presentation of the disease and the fact that therapeutic management is of limited success. Surgery continues to be the only treatment that offers potential cure. Therefore, defining whether the patient has an operable tumor remains the ultimate aim of imaging in pancreatic cancer. PET and PET/ CT with fluorodeoxyglucose （FDG） are of value in differential diagnosis between pancreatitis and carcinoma and for the detection of remote metastases, but relatively inefficient in the detection of nodal disease. The detection of recurrent disease is of little clinical consequence. FDG-PET may be considered as a prognostic marker for patient survival or therapy response, but evidence for these applications is lacking. Future applications will broaden the spectrum of tracers applied using molecules for the assessment of proliferation and detection of receptors.     

Pancreatic cancer–Diagnostics: PET

Important challenges for imaging of pancreatic cancer are the late presentation of the disease and the fact that therapeutic management is of limited success. Surgery continues to be the only treatment that offers potential cure. Therefore, defining whether the patient has an operable tumor remains the ultimate aim of imaging in pancreatic cancer. PET and PET/ CT with fluorodeoxyglucose (FDG) are of value in differential diagnosis between pancreatitis and carcinoma and for the detection of remote metastases, but relatively inefficient in the detection of nodal disease. The detection of recurrent disease is of little clinical consequence. FDG-PET may be considered as a prognostic marker for patient survival or therapy response, but evidence for these applications is lacking. Future applications will broaden the spectrum of tracers applied using molecules for the assessment of proliferation and detection of receptors.     

Prognostic value of metabolic tumor burden in lung cancer

Accurate prognosis in patients with lung cancer is important for clinical decision making and treatment selection. The TNM staging system is currently the main method for establishing prognosis. Using this system, patients are grouped into one of four stages based on primary tumor extent, nodal disease, and distant metastases. However, each stage represents a range of disease extent and may not on its own be the best reflection of individual patient prognosis. 18F-fluorodeoxyglucose_positron emission tomography （18F-FDG-PET） can be used to evaluate the metabolic tumor burden affecting the whole body with measures such as metabolic rumor volume （MTV） and total lesion glycolysis （TLG）. MTV and TLG have been shown to be significant prognostic factors in patients with lung cancer, independent of TNM stage. These metabolic tumor burden measures have the potential to make lung cancer staging and prognostication more accurate and quantitative, with the goal of optimizing treatment choices and outcome predictions.     

Maximum standardized uptake value on PET/CT in preoperative assessment of lymph node metastasis from thoracic esophageal squamous cell carcinoma

The presence of lymph node metastasis is an important prognostic factor for patients with esophageal cancer. Accurate assessment of lymph nodes in thoracic esophageal carcinoma is essential for selecting appropriate treatment and forecasting disease progression. Positron emission tomography combined with computed tomography （PET/CT） is becoming an important tool in the workup of esophageal carcinoma. Here, we evaluated the effectiveness of the maximum standardized uptake value （SUVmax） in assessing lymph node metastasis in esophageal squamous cell carcinoma （ESCC） prior to surgery. Fifty-nine surgical patients with pathologically confirmed thoracic ESCC were retrospectively studied. These patients underwent radical esophagectomy with pathologic evaluation of lymph nodes. They all had 18F-FDG PET/CT scans in their preoperative staging procedures. None had a prior history of cancer. The pathologic status and PET/CT SUVmax of lymph nodes were collected to calculate the receiver operating characteristic （ROC） curve and to determine the best cutoff value of the PET/CT SUVmax to distinguish benign from malignant lymph nodes. Lymph node data from 27 others were used for the validation. A total of 323 lymph nodes including 39 metastatic lymph nodes were evaluated in the training cohort, and 117 lymph nodes including 32 metastatic lymph nodes were evaluated in the validation cohort. The cutoff point of the SUVmax for lymph nodes was 4.1, as calculated by ROC curve （sensitivity, 80%; specificity, 92%; accuracy, 90%）. When this cutoff value was applied to the validation cohort, a sensitivity, a specificity, and an accuracy of 81%, 88%, and 86%, respectively, were obtained. These results suggest that the SUVmax of lymph nodes predicts malignancy. Indeed, when an SUVmax of 4.1 was used instead of 2.5, FDG-PET/ CT was more accurate in assessing nodal metastasis.