肝癌原位肝移植术后肿瘤复发的多层螺旋CT和MRI影像学诊断

Objective To investigate the manifestation and diagnostic value of multislice spiral CT (MSCT)and MRI imaging in detection of tumor recurrence after liver transplantation for bepatocellular carcinoma(HCC).Methods The clinical data of 161 consecutive HCC patients who underwent orthotopic liver transplantation were retrospectively reviewed.Twenty-nine HCC patients were classified by pTNM according to the "Pittsburgh criteria".MSCT and MRI findings of tumor recurrence after liver transplantation were evaluated retrospectively in 29 stage Ⅱ-Ⅳ b HCC patients.The recurrence site and relapse interval between liver transplantation and recurrence were analyzed.Results Lung tumor recurrence were found in 21 cases,presented as cotton-like lesions in a diameter of 2-3 cm,with a clear margin and homogeneous density.Pleural tumor recurrence was detected in 4 cases.Liver tumor recurrence were found in 9 cases,which can be divided into four subtypes:multinodular in 4 cases,diffuse lesion in 2 cases,huge mass in 2 cases,and uninodular in 1 case.Two cases showed tumor thrombus in the inferior vena cava and portal vein.Lymph node tumor recurrence was found in 9 cases,presented as multiple nodules at hepatic hilum,lesser peritoneal sac,posterior mediastinum,retroperitoneum,or around pancreatic head,and accompanied with merging and necrosis in one case.Bone tumor recurrence were found as osteolytie destruction in 4 cases,and accompanied with adjacent soft-tissue mass in 2 cases.The recurrence sites of the 29 cases were as following:lung(21 cases,72.4%),liver(9 cases,31.0%),lymph nodes(9 cases,31.0%),bone (4 cases,13.8%)and other sites(3 cases,10.3%).Lung tumor recurrence was found in all the 10 stage Ⅳb patients with tumor recurrence after liver transplantation,significantly more frequent than that in stage Ⅳ a patients(P = 0.023).After liver transplantation,all 25 patients with stage Ⅲ～Ⅳ b HCC developed recurrence within one year,but in the 4 cases with stage Ⅱ HCC at one year later(P = 0.009).Conclusion The results of our study show that in hepatoceUular carcinoma patients after liver transplantation,the lung and pleura are the most fequent site of recurrence,followed by liver,lymph node and bone as the second and third sites.The Stage Ⅳ b hapatocellular carcinoma should be regarded as a contradiction for liver transplantation due to rapid recurrence.Tumor recurrence occurs later in stage Ⅱ HCC than in stage Ⅲ～Ⅳb patients.MSCT and MRI are of significant importance in diagnosis and formulating operation plan in HCC patients with recurrence after liver transplantation.     

TREATMENT OF LOCAL RECURRENCE OF NASOPHARYN-GEAL CARCINOMA WITH REIRRADIATION

From 1975 to 1987, 112 patients with loco-regional recurrence of nasopharyngeal carcinoma (N P C) were treated again with radiation at our hospital. All cases were proven histologically by biopsy. Of these patients, 92 had their recurrence in the nasopharynx only, 13 had additional involvement of the base of the skull, and 7 had tumor recurrences simultaneously in the nasopharynx as well as the cervical lymph nodes. Radiotherapy adopted in this series was 60Co external irradiation (X R Te) and/ or betatron in 96 patients, X R Te plus intracavitary 60Co irradiation (X R Ti) in 12 patients and X R Ti alone in the other 4 patients. The 1-, 3-, and 5-year survival rates were 86.3%, 45.8% and 30.2% respectively after the start of recurrence retreatment. The 63 patients who survived for 5 years or more were analyzed. The prognosis of the patient was related to the histological type, clinical stage, modality of treatment, and disease interval to recurrence and site of recurrence. No serious complications occur     

The recurrence and survival of oral squamous cell carcinoma: a report of 275 cases

Oral squamous cell carcinoma （OSCC） is a common malignant tumor of the head and neck, and recurrence is an important prognostic factor in patients with OSCC. We explored the factors associated with recurrence of OSCC and analyzed the survival of patients after recurrence. Clinicopathologic and follow-up data of 275 patients with OSCC treated by surgery in the Cancer Institute and Hospital of Tianjin Medical University between 2002 and 2006 were analyzed. Recurrence factors were analyzed with Chi- square or Fisher＇s exact test and multivariate analysis. The prognosis of patients after recurrence was analyzed with the Kaplan-Meier method and log-rank test. The recurrence rate was 32.7%. The recurrence time ranged from 2 to 96 months, with a median of 14 months. Univariate analysis showed that T stage, degree of differentiation, pN stage, flap application, resection margin, and lymphovascular invasion were factors of recurrence （P 〈 0.05）. Multivariate analysis showed that T stage, degree of differentiation, and pN stage were independent factors of recurrence （P 〈 0.001）. The differences in gender, age, tumor site, region of lymph node metastasis, and perineural invasion between the recurrence and non-recurrence groups were not significant （P 〉 0.05）. Kaplan-Meier and log-rank tests showed that the 2- and 5-year survival rates were significantly lower in the recurrence group than in non-recurrence group （67.6% vs. 88.0%, 31.8% vs. 79.9%, P 〈 0.001）. Therefore, to improve prognosis, we recommend extended local excision, flap, radical neck dissection, and adjuvant chemoradiotherapy for patients more likely to undergo recurrence.     

Analysis of 6 cases of stromal sarcoma of the breast

OBJECTIVE To investigate the clinical and pathological characteristics, diagnosis and treatment of stromal sarcoma of the breast （SSB）. Methods： The clinical and pathological data of 6 patients with SSB treated between 1954 and 2007 were retrospectively analyzed.
METHODS The clinical and pathological data of 6 patients with SSB treated between 1954 and 2007 were retrospectively analyzed.
RESULTS All patients were female and one was menopausal. The median age of the patients was 39 years old （range, 20-55）. All cases had a history of a palpable mass. The tumor rapidly augmented in a short time period in 3 patients. One patient had discontinuous pain and 3 patients had masses located in the upper outer quadrant of the breast. The median tumor radius was 6.0 cm （range, 3-15 cm）. According to the AJCC breast cancer staging standard （6th edition）, 1 case was of stage ⅡA, 2 cases were of stage ⅡB, 2 cases were of stage ⅢB and one case couldn＇t be staged. Four patients were initially treated by excising the tumor and then undergoing mastectomy or modified radical mastectomy after recurrence. Radical mastectomy was suitable for those with pectoralis major muscle involvement. Two patients received simple mastectom）~ 2 patients underwent radical mastectomy and another 2 patients received modified radical mastectomy. After surgery, all patients were identified as SSB through pathology, with focal ossification in one case and mucinous degeneration in another one case. Four patients who underwent axillary lymph node dissection did not have lymph node metastases. Three patients received chemotherapy after surgery. After a median follow-up time of 36.5 months （8-204 months）, 4 patients had recurrence after local excision and 3 patients had recurrence more than 2 times with a median time to recurrence of 2.5 months （1 to 4 months） after surgery. One patient had lung metastases at 7 months after the initial surgery and the other 5 patients were alive without disease at the end of the follow-up period.
CONCLUSION SSB is difficult to diagnose preoperatively and is characterized by its tendency to .recur locally. To obtain negative margins, wide local excision or mastectomy must be performed. Axillary lymph node dissection is not mandatory. The roles of adjuvant chemotherapy and radiotherapy have still been controversial.     

肝癌术后复发

Objective:To analyze pest-surgical recurrence of hepatocellular carcinoma (HHC) according to pathologic findings, primary tumor and angiographic features of the recurrent tumor. Methods:In this series, 100 cases of recurrent HCC were analyzed in following aspects: (1) size, tumor nodular numbers, gross and histologic findings of the primary tumor; (2) post-surgical recurrent time; (3) size, tumor nodular numbers, blood supply, staining property, and accumulation of lipiodol oil in the recurrent tumor. Following angiography, arterial chemoembolization was performed. Results:In the primary tumor, single nodules were seen in 80 cases, multiple nodules in 16 cases and multiple fused nodules in 4 cases. All tumors were classified as: trabecular type, 65 eases; compact type, 12; sclerotic type, 2 cases; mixed type, 15 cases and cholangiocareinoma type, 6 cases. 38 cases had incomplete or no capsule. Satellite tumor nodules were grossly identified during operation in 33 cases, but were proven microscopically in 66 cases. Tumor thrombi of portal vein was noted in 18 cases during oeration, but 85 cases in histopathological sections. The recurrent tumors were diagnosed post surgically within 6 months in 67 cases, 6-12 months in 15 cases and after 12 months in 18 cases respectively. On angiography, 67% recurrent tumors was rich in blood supply and with abundant accumulation of lipiodol after embolization. Conclusion:The post-surgical recurrence rate of the HCC patients with massive size, incomplete or no capsule, satellite tumor nodules and portal vein tumor thrombus was high. The patients shoud receive angiography in 1-2 months after surgery in order to detect early recurrence and, if confirmed, the patients may be treated by transcatheter arterial chemoembolization     

Significance of ipsilateral breast tumor recurrence after breast conserving treatment: role of surgical removal

Objective: To analyze the pattern over time (dynamics) of further recurrence and death after ipsilateral breast tumor recurrence (IBTR) in breast cancer patients undergoing breast conserving treatment (BCT). Methods: A total of 338 evaluable patients experiencing IBTR were extracted from a database of 3,293 patients undergoing BCT. The hazard rates for recurrence and mortality throughout 10 years of follow-up after IBTR were assessed and were compared to the analogous estimates associated to the primary treatment. Results: In a time frame with the time origin at the surgical treatment for IBTR, the hazard rate for further recurrence displays a bimodal pattern (peaks at the second and at the sixth year). Patients receiving mastectomy for IBTR reveal recurrence and mortality dynamics similar to that of node positive (N+) patients receiving mastectomy as primary surgery, apart from the first two-three years, when IBTR patients do worse. If the patients with time to IBTR longer than 2.5 years are considered, differences disappear. Conclusions: The recurrence and mortality dynamics following IBTR surgical removal is similar to the corresponding dynamics following primary tumor removal. In particular, patients with time to IBTR in excess of 2.5 years behave like N+ patients following primary tumor removal. Findings may be suitably explained by assuming that the surgical manoeuvre required by IBTR treatment is able to activate a sudden growing phase for tumor foci most of which, as suggested by the systemic model of breast cancer, would have reached the clinical level according to their own dynamics.     

Recurrence and cancerization of ameloblastoma: multivariate analysis of 87 recurrent craniofacial ameloblastoma to assess risk factors associated with early recurrence and secondary ameloblastic carcinoma

Objective:The recurrence and progression of ameloblastoma are unpredictable.Therefore,we examined the influence of clinical factors on recurrence time and analyzed the clinical factors associated with early recurrence and cancerization.We then developed a staging system to predict early recurrence and cancerization.Methods:All of the primary craniofacial ameloblastoma patients treated in Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine were recorded.There were 87 recurrent cases used to create a staging system and tested in a Cox regression analysis for risk factors associated with early recurrence or cancerization following surgery.Results:There were 890 craniofacial ameloblastoma patients,and 72 cases had recurrence.There were also 15 cases with cancerous recurrence.The overall recurrence rate was 9.78％,and the cancer rate was 1.69％.The primary cases were classified into the following 3 stages based on clinicopathological features:stage Ⅰ,the maximum tumor diameter ≤6 cm;stage Ⅱ,the maximum diameter of tumor ＞6 cm or tumor invasion to the maxilla sinus/orbital floor/soft tissue;and stage Ⅲ,tumor invasion of the skull base or metastasis into regional lymph nodes.When the method of surgery was controlled by partial correlation,the staging had significance with recurrence time (P=0.004).The Cox analysis showed the tumor stage was correlated with recurrence time (P=0.027) and cancerization time (P=0.002).However,the surgical method did not influence the recurrence rime when adjusted for cofounding variables.Conclusions:Tumor larger than 6 cm and invasion to soft tissues or adjacent anatomical structures are associated with early recurrence.This staging system can be used to predict the risk factors of early recurrence and cancerization in ameloblastoma patients.     

Implantation of 125Ⅰ seeds for recurrence cervical node of head and neck tumor after external beam radiotherapy

Objective To summarize the efficacy and the feasibility of 125I seed implantation for recurrence cervical lymph node of head and neck tumor after radiotherapy or radiotherapy plus neck dissection. Methods Thirty-six patients with the recurrence cervical lymphnode of head and neck tumor after radiotherapy (17 patients) or radiotherapy plus neck dissection (19 patients) were treated with 125I seed implantation guided by ultrasound or CT under local anesthesia. The median number of seeds was 27( range from 3 to 78 ). Postoperative quality evaluation were routinely obtained for all patients. The actuarial D90 ranged from 90-160 Gy (median, 130 Gy). Results The follow-up rate was 100%. The number of the patients who were followed up over 1-and 2-year were 11 and 3. The overall response rate was 81%. The 1-and 2-year over local control rates, over survival rates were 69% and 35%, 50% and 22%, respectively.The 1-and 2-year local control rates in patients with recurrence node after radiotherapy plus neck dissection were 72% and 54%, while those were 67% and 50% in patients with recurrence node after radiotherapy,respectively (χ2=00,P=0.965). The 1-and 2-year survival rates in two groups were 48%, 13% , and 51%, 39%, respectively (χ2=0.17, P=0.676). Conclusions 125I seed implantation is a safe,minimal invasive with low morbidity and high efficacy salvage treatment method for cervical lymph node recurrence of head and neck tumor after radiotherapy with or without neck dissection.     

THE FACTORS AND TREATMENT OF LOCAL RECURRENCE AFTER RADICAL RESECTION RESERVING THE ANUS IN THE PATIENTS WITH RECTAL CANCER

Of seventy-one patients with rectal cancer after radical resection retaining the anus, 15 developed local recurrence with a recurrence rate of 21.1%. Local recurrence was correlated with improper safety margin from the lower edge of cancer to the anal end. There was statistical significant difference between 3 cm or more and 2 cm or less. The local recurrence was also related to the pathologic stage, histologic differentiation and implant of free cancer cells. It is suggested that the surgical indication of saving the anus be strict and without stretching, the safety margin from the lower edge of cancer to the anal end should not be less than 2 cm in early rectal cancer and not less than 4 cm in advanced lesions. During the operation, no touching tumor technique, thorough rinsing of the peritoneal cavity and pre- or post-operative radiotherapy are important for prevention of local recurrence. Early local recurrent rectal cancer can be detected by periodic examinations.     

Hypertrophic adenoids in patients with nasopharyngeal carcinoma:appearance at magnetic resonance imaging before and after treatment

Introduction: Patients with nasopharyngeal carcinoma (NPC) sporadically develop abnormal adenoids. Nasopharyngeal adenoids are usually included in the gross tumor volume (GTV) but may have different therapeutic responses than tumor tissue. Therefore, distinguishing adenoids from tumor tissue may be required for precise and efficient chemoradiotherapy and radiotherapy. We characterized nasopharyngeal adenoids and investigated the therapeutic responses of NPC and nasopharyngeal adenoids using magnetic resonance imaging (MRI). Methods: MRI data from 40 NPC patients with a coexisting adenoid mass before and after treatment were analyzed. The features of the adenoid masses, including location, striped appearance, size, interface, symmetry/ asymmetry, and cysts, were evaluated. Treatment response were scored according to the World Health Organization guidelines. Results: A striped appearance was observed in 36 cases before treatment and in all cases after treatment. In these 36 cases, the average GTVs including and excluding the uninvolved adenoids were 19.8 cm 3 and 14.8 cm 3 , respectively. The average percentage change after excluding the uninvolved adenoids from the GTV was 31.0%. Stable disease in the adenoids was identified in 27 (96.4%) of 28 patients after neoadjuvant chemotherapy, while NPC clearly regressed. Partial adenoid responses were identified in 33 (82.5%) of 40 patients at 3 months after chemoradiotherapy or radiotherapy, whereas complete tumor responses were achieved in all patients. Six months after treatment, the adenoids continued to atrophy but did not disappear, and tumor recurrence was not found. Conclusions: Nasopharyngeal adenoids and carcinoma tissue in NPC patients can be distinguished by using MRI and have different responses to chemoradiotherapy and radiotherapy. These findings contribute to better delineating the GTV of NPC, based on which spatially optimized strategies can be developed to render precise and efficient chemoradiotherapy and radiotherapy. Additionally, we observed a clear difference in the responses of these two tissue types to current therapies. This finding may reduce or avoid unnecessary biopsies or overtreatment.     

骨的硬纤维瘤及其治疗

PurposeDesmoplastic fibroma of bone is a rare benign tumor of bone．Its histopathologic feature is similar to desmoid fibroma of soft tissue,and it has strong invasiveness and easy to recur．MethodsThe authors report on 8 cases treated by wide excision from 1986 to 1998 including 5 males and 3 females,with an average age of 28 years．The common site of the tumor was at the epiphyseal end of the long bone.All the patients experienced local pain or a mass for a relatively long time．ResultsSurgery was not performed in one case with a huge mass and multiple lesions．Seven patients were treated by operation including 3 intracapsular excision and four wide excision．One of the three patients with tumor intracapsularly excised tumor recurred 3 times and finally turned into osteosarcoma and died of lung metastasis.There was no recurrence observed in four cases of wide excision and prosthesis．ConclusionWide excision is the treatment of choice．Although desmoplastic fibroma of bone is considered as benign tumor but its recurrence rate is about 50％ after intracapsular excision．If wide excision is not feasible,thorough curettage of the tumor followed by alcohol or liquid nitrogen deactivation of tumor cavity is recommended．     

Risk Factors for Fatal Recurrence of Liver Transplant Recipients with Hepatocellular Carcinoma in the First Year

Objective： To investigate the clinicopathological risk factors for fatal recurrence of hepatocellular carcinoma （HCC） in orthotopic liver transplant recipients in the first year. Methods： From April 2002 to October 2005, 303 recipients who received orthotopic liver transplantation for HCC were reviewed. Of These patients, those who demonstrated diffuse intra-hepatic or multiple systemic recurrent lesions and died within 1 y after surgery were investigated （fatal recurrence group, 48 cases）. The remaining patients were designated as the control group, and the two groups were compared for clinicopathologic risk factors by logistic regression analysis. Results： Among the 303 patients reviewed, 48 patients were enrolled in the fatal recurrence group （15.84%）. Multivariate analysis between the fatal recurrence group and control group showed that the presence of vascular invasion, tumor size greater than 6.5 cm, and pre-operative serum alpha-fetoprotein （AFP） level greater than 1000 ptg/L were the risk factors in the fatal recurrence group. 85.71% of the patients who had all the three risk factors, 37.84% of those who had two risk factors, 13.64% of those who had one risk factors, and 6.71% of those who had none risk factors died because of recurrence within 1 y after transplantation. Conclusion： Three distinct risk factors attributed to fatal recurrence of liver transplant recipients for HCC are vascular invasion, tumor size ≥6.5 cm, and pre-operative serum AFP level ≥1000 μg/L. The high risk HCC patients with two or more risk factors should not to be the candidates for liver transplantation.     

活检组织端粒酶活性检测评价肝癌合并肝硬化腹腔镜射频消融治疗的疗效

Objective： To explore the role of telomerase activity detected in biopsy samples for evaluating the efficacy of laparoscopic radiofrequency ablation （RFA） therapy in patients with hepatocellular carcinoma （HCC） and liver cirrhosis. Methods： From August 2001 to October 2004, 34 cirrhotic patients with HCC were treated by laparoscopic RFA under general anesthesia. A total of 34 tumors, with a mean maximum tumor diameter of 4.0 ＋ 1.0 cm, were all located on the liver surface or adjacent to the gallbladder. Laparoscopic ultrasound-guided core biopsy for liver lesions was performed before and immediately after RFA therapy. In these biopsy samples, telomerase activity was detected by the ELISA-based telomeric repeat amplification protocol （ELISA-TRAP） assay, and pathological examination was routinely performed. Results： Laparoscopic RFA was successfully performed in all the 34 patients. A complete tumor necrosis was achieved in all patients on the contrast-enhanced helical CT scanning one month after laparoscopic RFA. The positive rates of telomerase activity and histopathologic diagnosis in biopsy samples were 91.2% （31/34） and 100% （34/34） respectively before RFA, and 26.5% （9/34） and 0% respectively after RFA. During a median follow-up period of 35 months （range, 18-51 months）, the rates of local tumor recurrence at the ablation sites in post-RFA telomerase-positive and negative patients were 88.9% （8/9） and 4% （1/25） respectively （P 〈 0.01）, and the rates of distant recurrence within the livers were 0% （0/9） and 12% （3/25） respectively （P 〉 0.05）. Conclusion： For cirrhotic patients with HCC treated by laparoscopic RFA, detection of telomerase activity in biopsy samples may be useful for evaluating the therapeutic efficacy of RFA and predicting postoperative local tumor recurrence.     

免疫组化检测Survivin和Livin表达可预测Dukes'''' B期结直肠癌术后的复发和生存

Objective： To detect the expressions of Survivin and Livin in Dukes＇ B colorectal cancer tissues and analyze the prognosis after curative resection. Methods： The expressions of Survivin and Livin were evaluated immunohistochemically in Dukes＇ B colorectal cancer specimens from 81 patients after curative resection of the tumor. Their correlations to clinical characters and survival were also explored. Results： The positive rates of Survivin and Livin in colorectal cancer tissues were significantly higher than those in normal colorectal tissues （58.0% vs. 16.7% and 45.7% vs. 8.3% respectively, P 〈 0.05）. The expressions of Survivin and Livin were not related to gender, tumor site, primary size, T stage, pathologic category, and degree of differentiation （P 〉 0.05）, and no relationship was found between the expressions of Survivin and Livin （P 〉 0.05）. The expression rate of Survivin in patients older than 50 years was higher than that in patients younger than 50 years （70.6% vs. 36.7%, P 〈 0.05）. Both Survivin and Livin were related to recurrence and/or metastasis （P = 0.02 and P = 0.001, respectively）, and shorter survival （P = 0.039 and P = 0.001, respectively）. Cox multivariate analysis showed T4 and positive Livin expression were independent prognostic factors （P = 0.002 and P = 0.047, respectively）. Conclusion： Survivin and Livin are over-expressed in Dukes＇ B colorectal cancer tissues and are positively related to recurrence and/or metastasis and poor prognosis after curative resection of the tumor.     

Prognostic role of lymph node metastasis in early gastric cancer

Objective： To clarify the relationship between clinicopathological features and lymph node metastasis and to propose the potential indications of lymph node metastasis for prognosis in early gaswic cancer （EGC） patients. Methods： We retrospectively observed 226 EGC patients with lymph node resection, and analyzed the associations between lymph node metastasis and clinicopathological parameters using the chi-square test in univariate analysis and logistic regression analysis in multivariate analysis. Overall survival analysis was determined using the Kaplan-Meier and log-rank test. We conducted multivariate prognosis analysis using the Cox proportional hazards model. Results： Of all the EGC patients, 7.5% （17/226） were histologically shown to have lymph node metastasis. The differentiation, lymphovascular invasion and depth of invasion were independent risk factors for lymph node metastasis in EGC. The 5- and 10-year survival rates were significantly lower in patients with lymph node metastasis than in those without and the patients also had shorter progress-free survival time. Lymph node metastasis and tumor size were independent prognostic factors for EGC. The status of the lymph nodes was a significant factor in predicting recurrence or metastasis after surgery. Conclusions： The undifferentiated carcinoma and lymphovascular and/or submucosal invasion were associated with a higher incidence of lymph node metastasis in EGC patients, whom need to perform subsequent D2 lymphadenectomy or laparoscopic lymph node dissection and more rigorous follow-up or additional chemotherapy/radiation after D2 gastrectomy for poor prognosis and high recurrence/metastasis rate.     

冷冻异体骨移植治疗骨肿瘤切除后骨缺损

Objective： To evaluate the functional outcome and complications of allograft replacement in management of bone tumors. Methods： Between March 1992 and September 2002, 164 patients underwent bone tumor resection and massive allograft reconstruction of bone defects. The length of the resected part ranged from 5-35 cm. The resections were classified as marginal or wide resections of the tumor on the basis of the Musculoskeletal Tumor Society staging system. Fresh-frozen allografts were employed as osteoarticular grafts （n = 95）, hemi-condylar （n = 15）, massive （n = 23）, allograft-prosthesis composite （n = 12）, intercalary grafts （n = 15） or hemi-pelvic grafts （n = 4）. Most of the lesions were osteosarcoma and giant cell tumor of bone and located in proximal and distal femur, proximal tibia and humerus. Results： At a median follow-up of 47 months （range, 12 to 168 months） after the operation, 154 of the patients in the study were free of disease and 10 died of disease. Twenty-one （12.8%） patients had local recurrence and 38 （23.2%） nonunion. Late complications included 11 （6.7%） fractures of the allograft and 18 （11.0%） infections of the graft, instability of the joint in the form of subluxation was noted in 13 （7.9%） patients. Ten extremities were amputated due to local recurrence or severe infection. Conclusion： AIIografts can be used for reconstruction of bony defects after tumor resection. AIIograft has nearly similar shape, strength, osteo-inductivity and osteo-conductivity with host bone. AIIograft implantation is a high complication reconstruction method, and the dsk of recurrence increases when less surgical margin achieves.     

Pancreatic cancer–Surgery for recurrent disease

Recurrence of pancreatic ductal adenocarcinoma (PDAC) after a resection with curative intent is inevitable in the majority of cases. Approximately three-quarters of patients ultimately die from metastatic, local, or combined tumor recurrence [1–3]. This may be due to the insuf     

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.     

The Value of Interferon Combined with Hepatic Artery Chemoembolization and Portal Vein Chemotherapy in Preventing a Recurrence after Radical Resection for Hepatocellular Carcinoma

OBJECTIVE The change of cell immune function after hepatectomy of patients suffering from hepatocellular carcinoma (HCC) is usually neglected. The aim of this study was to explore the change of T cell subsets in HCC patients after hepatectomy, and to study the value of treatment with interferon (INF)combined with hepatic artery chemoembolization (HACE) and portal vein chemotherapy (PVC) to prevent recurrence after radical resection of HCC.METHODS Seventy-five HCC patients were treated with PVC and HACE at the 2nd week and 4th week after radical tumor resection. In the 2nd week after surgery, 33 pationts received INF treatment for one week. Seventy-two patients were followed up over three years. The effect of INF combined with HACE and PVC on the postoperative recurrence rate was compared with that of HACE and PVC treatment. Changes of T cell subsets in the peripheral blood were examined with labeled monoclonal antibodies before and after hepatectomy or with use of interferon. Forty cholecystolithiasis patients who received a cholecystectomy were used as controls.RESULTS CD3^ and CD4^ cells in the peripheral blood were reduced in patients with HCC. After hepatectomy, they declined further with a decrease in the CD4^ /CD8^ ratio. The values returned to pre-operative level at the 4th week after surgery. The CD3^ and CD4^ cells and the CD4^ /CD8^ ratio increased remarkably following the use of INF. The 1-, 2- and 3-year recurrent rates of patients treated with HACE, PVC and INF in combination were 0%, 6.2% and 15.6%, respectively, while those treated only with HACE and PVC were 5.0%, 12.5% and 27.5%, respectively.CONCLUSION Patients with HCC suffer from a marked immunosuppression, which become ever more severe after hepatectomy. The combined use of HACE, PVC and INF is superior in decreasing the recurrent rate to the combination of only HACE and PVC.     

Diagnosis and Surgical Treatment of 105 Cases with a Tumor of the Chest Wall

OBJECTIVE To summarize the experience in diagnosis and surgical treatment of 105 cases with a tumor of the chest wall,and to investigate re-construction of a large chest-wall defect after resection of a chest wall tumor.METHODS Clinical data from 105 patients with a tumor of the chest wall were retrospectively analyzed.There were 78 males and 27 females with ages ranging from 6 to 70 years.Of the 105 cases,94 had a primary tumor,among which 75 were benign,19 malignant and the other 11 metastatic.After a resection of a chest-wall tumor in 19 patients,reconstruction of the large chest-wall defect was conducted.RESULTS All surgical operations were smoothly performed,without an intraoperative death.The results of postoperative follow-up were as follows:48 patients with a benign tumor were still living and well,16 patients with a benign tumor died of other diseases,13 with a malignant tumor survived for a period from 21 months to 8 years,and the others with a malignancy died of local recurrence or distant metastasis.All of the 11 patients with a metastatic tumor died of carcinomatous deseases during a period from 10 to 76 months.CONCLUSION With regard to a primary costal tumor without a patho-logical diagnosis,a restricted radical excision should be conducted first.Use of suitable repairing materials is very important for reconstruction of a mas-sive chest-wall defect.