Prognostic significance of preoperative fibrinogen in patients with colon cancer

AIM: To investigate the prognostic significance of preoperative fibrinogen levels in colon cancer patients.METHODS: A total of 255 colon cancer patients treated at the Affiliated Tumor Hospital of Xinjiang Medical University from June 1^st 2005 to June 1^st 2008 were enrolled in the study. All patients received radical surgery as their primary treatment method. Preoperative fibrinogen was detected by the Clauss method, and all patients were followed up after surgery. Preoperative fibrinogen measurements were correlated with a number of clinicopathological parameters using the Student t test and analysis of variance. Survival analyses were performed by the Kaplan-Meier method and Cox regression modeling to measure 5-year disease-free survival (DFS) and overall survival (OS).RESULTS: The mean preoperative fibrinogen concentration of all colon cancer patients was 3.17 ± 0.88 g/L. Statistically significant differences were found between preoperative fibrinogen levels and the clinicopathological parameters of age, smoking status, tumor size, tumor location, tumor-node-metastasis (TNM) stage, modified Glasgow prognostic scores (mGPS), white blood cell (WBC) count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and carcinoembryonic antigen (CEA) levels. Univariate survival analysis showed that TNM stage, tumor cell differentiation grade, vascular invasion, mGPS score, preoperative fibrinogen, WBC, NLR, PLR and CEA all correlated with both OS and DFS. Alpha-fetoprotein (AFP) and body mass index correlated only with OS. Kaplan-Meier analysis revealed that both OS and DFS of the total cohort, as well as of the stage II and III patients, were higher in the hypofibrinogen group compared to the hyperfibrinogen group (all P < 0.05). In contrast, there was no significant difference between OS and DFS in stage I patients with low or high fibrinogen levels. Cox regression analysis indicated preoperative fibrinogen levels, TNM stage, mGPS score, CEA, and AFP levels correlated with both OS and DFS.CONCLUSION: Preoperative fibrinogen levels can serve as an independent prognostic marker to evaluate patient response to colon cancer treatment.     

Prognostic analysis and comparison of colon cancer in Han and Hui patients

AIM:To investigate the relevant prognostic factors and their differences between colorectal cancer(CRC)patients of Chinese Han and Hui ethnicities in the Beijing region.METHODS:A retrospective analysis of 880 patients diagnosed with CRC at Xuanwu Hospital,Capital Medical University between September 2001 and September2011 was performed.Among the 880 patients,398 and482 were Hui and Han,respectively.Characteristics including sex,age,diet,tumor size,primary tumor site,Dukes’stage and degree of differentiation were analyzed for their influence on prognosis.Data on dietary structures were recorded through a questionnaire survey conducted during the patient’s first visit,return visit or follow-up checkups.RESULTS:Among patients with colon cancer,the5-year survival rate for patients of Hui ethnicity was lower than that for Han patients(P=0.025).Six risk factors(age of onset,dietary structure,tumor size,Dukes’stage,location of cancer and degree of differentiation)in both Han and Hui patients were identified as prognostic factors(P<0.05).Multivariate analysis showed that age of onset(P=0.002),diet(P=0.000),Dukes’stage(P=0.000)and degree of differentiation(P=0.000)are prognostic factors affecting both ethnic groups.Comparison of prognostic factors between Han and Hui patients with CRC showed that dietary structure was a statistically significant factor,and diet varied significantly between the two ethnic groups.CONCLUSION:Dietary structure has a significant influence on colon cancer prognosis among Han and Hui patients with colon cancer in Beijing,which may cause a difference in their survival rates.     

Prognostic factors in esophageal cancer treated with curative intent

The overall prognosis of patients with esophageal cancer has improved in recent decades due to surgical and medical progress, but overall survival remains poor. Better patient selection and tailored treatment are needed. Different prognostic factors linked with the patient, tumoral characteristics and treatment with curative intent have been identified and are the purpose of this review. Tumor detection at an earlier stage, the advent of new molecules and therapeutic combinations, and the centralization of management in high-volume centers should help to improve the prognosis of esophageal cancer. Improved imaging techniques and a better prediction strategy should guide future treatments.     

Prognostic factors for 5-year survival after local excision of rectal cancer

AIM: To evaluate the prognostic factors for 5-year survival after local excision of rectal cancer, and to examine the therapeutic efficacy and surgical indications for this procedure.METHODS: Clinical data, obtained from 106 local rectal cancer excisions performed between January 1980 and December 2005, were retrospectively analyzed. Survival analysis was performed using the Kaplan-Meier method, statistical comparisons were performed using the log-rank test, and multivariate analysis was performed using the Cox proportional hazards model.RESULTS: Transanal, transsacral, and transvaginal excisions were performed in 92, 12, and 2 cases,respectively. The rate of complication, local recurrence,and 5-year survival was 6.6%, 17.0%, and 86.7%,respectively. Univariate analysis showed that T stage,vascular invasion, and local recurrence were related to the prognosis of the cases ( P < 0.05). Multivariate analysis showed that T stage [ P = 0.011, 95% confidence interval (CI) = 1.194-3.878] and local recurrence ( P = 0.022, 95% CI = 1.194-10.160) were the major prognostic factors for 5-year survival of cases after local excision of rectal cancer.CONCLUSION: Local rectal cancer excision is associated with few complications, and suitable for stages Tis and T1 rectal cancer. Prevention of local recurrence, active postoperative follow-up, and administration of salvage therapy are the effective methods to increase the efficacy of local excision of rectal cancer.     

老年结直肠癌术后长期生存的预后因素分析

目的:探索影响老年结直肠癌术后长期生存的相关因素。方法:回顾性分析SEER数据库中2004年登记注册诊断为(CRC)术后(年龄≥60岁)的病例,有随访10年以上存活记录。采用 Cox比例风险模型评估年龄,性别,种族,婚姻状况,肿瘤部位和大小,临床分期,TNM分期,淋巴结清除范围等对生存死亡的预后风险。 ...     

Clinical significance of rectal cancer in young patients

Thirty-nine patients (age 40 years and younger) with rectal cancer treated at the Mount Sinai Hospital between 1967 and 1985 were studied. Their mean age was 34 years (range, 21 to 40). A positive family history for colorectal cancer was found in six patients (15 percent). Fifty percent of patients under age 30 had metastatic disease at diagnosis. Twenty-seven patients (69 percent) had potentially curative resections. Of these, 17 (63 percent) had lymph-node metastasis. This rate is twice as high as in a group of 315 patients with rectal cancer over age 40 (31 percent). The overall five-year survival for young patients having curative resection was 53 percent. Noncolorectal cancer occurred in three patients in this series and six patients also had first-degree relatives with noncolorectal cancer. Young patients with rectal cancer appear to belong to a high-risk cancer group which often seems to have a genetic pattern of predisposition.     

Prognostic factors and survival in patients with gastric stump cancer

AIM:To elucidate the clinicopathological characteristics and prognostic factors of gastric stump cancer(GSC).METHODS:The clinical data for 92 patients with GSC were collected at Fudan University Shanghai Cancer Center.The prognostic factors were analyzed with Cox proportional hazard models.RESULTS:GSC tended to occur within 25 years following the primary surgery,when the initial disease is benign,whereas it primarily occurred within the first15 years post-operation for gastric cancer.Patients with regular follow-up after primary surgery had a better survival rate.The multivariate Cox regression analysis revealed that Borrmann type?Ⅰ/Ⅱ(HR=3.165,95%CI:1.055-9.500,P=0.040)and radical resection(HR=1.780,95%CI:1.061-2.987,P=0.029)were independent prognostic factors for GSC.The overall 1-,3-,and 5-year survival rates of the 92 patients were78.3%,45.6%and 27.6%,respectively.The 1-,3-,and 5-year survival rates of those undergoing radical resection were 79.3%,52.2%,and 37.8%,respectively.The 5-year survival rates for stages?Ⅰ,Ⅱ,Ⅲ,andⅣwere 85.7%,47.4%,16.0%,and 13.3%,respectively(P=0.005).CONCLUSION:The appearance of GSC occurs sooner in patients with primary malignant cancer than in patients with a primary benign disease.Therefore,close follow-up is necessary.The overall survival of patients with GSC is poor,and curative resection can improve their prognosis.     

快速康复护理在腹腔镜结肠癌术后康复中的应用

目的探讨快速康复护理在腹腔镜结肠癌术后康复的应用价值。 方法招募2018年1月至2019年1月行全身麻醉腹腔镜下结肠癌手术的128例患者,完全随机分为快速康复护理组和常规护理组。统计手术时间、出血量、卧床时间、首次排气、排便时间、医疗费用、住院时间及术后疼痛等级、术后并发症发病率;分析两组间的差异。 结果两组间年龄、性别、手术时间、出血量等无明显差异(P>0.05)。快速康复组卧床时间、首次排气、排便时间少于常规护理组(P<0.05);快速康复组医疗费用、住院时间均少于对照组(P<0.05);快速康复护理组患者术后6 h、24 h、48 h疼痛程度均小于常规护理组患者(P<0.05);快速康复护理组术后不良反应及并发症发生率少于常规护理组。 结论快速康复护理可有效减低腹腔镜结肠癌术后并发症发生率,加速患者康复,减少住院时间,提高患者满意度。     

Heparanase expression correlates with malignant potential in human colon cancer

Purpose Heparanase cleaves carbohydrate chains of heparan sulphate proteoglycans and is an important component of the extracellular matrix. This study was designed to determine the relation between heparanase expression and prognosis of patients with colon cancer.Methods The study included 54 patients (35 males and 19 females) who underwent colorectal resection for colorectal cancer between January 1992 and December 1994. Expression of heparanase protein and mRNA were determined and correlated with various clinicopathological parameters. In vitro studies were also performed to examine tumor invasion and to test the effects of heparanase inhibition, and in vivo studies were performed to examine tumor metastasis and prognosis.Results Heparanase expression was detected in the invasion front of the tumor in 37 of 54 (69%) colon cancer samples, whereas 17 of 54 (31%) tumors were negative. Expression of heparanase was significantly more frequent in tumors of higher TNM stage (P=0.0481), higher Dukes stage (P=0.0411), higher vascular infiltration (P=0.0146), and higher lymph vessel infiltration (P=0.0010). Heparanase expression in colon cancers correlated significantly with poor survival (P=0.0361). Heparanase-transfected colon cancer cells exhibited significant invasion compared with control-transfected colon cancer cells (P=0.001), and the peritoneal dissemination model also showed the malignant potential of heparanase-transfected cells, as assayed by number of nodules (P=0.017) and survival (P=0.0062). Inhibition of heparanase significantly reduced the invasive capacity of cancer cells (P=0.003).Conclusions Heparanase is a marker for poor prognosis of patients with colon cancer and could be a suitable target for antitumor therapy in colon cancer.     

Expression of aldehyde dehydrogenase 1 in colon cancer

ObjectiveTo study the expression of ALDH1 in colon cancer and its clinical significance.MethodsThe expression of ALDH1 was examined in 98 surgical specimens of primary colonic carcinoma and 15 normal colon tissues with immunohistochemistry method. The correlations of the expression with clinicopathological parameters and prognosis of colon cancer were analyzed.ResultsThe positive rate of expression of ALDH1 was 76.5% (75/98) in the cancer tissues and 13.3% (2/15) in normal colon tissues. There were an obvious statistical difference (P<0.05) between the two groups. The ALDH1 expression was significantly correlated with the histological grade, TNM stages and lymph node metastasis in colon cancer (P<0.05). It was also related with patients' survival time, those with positive expressions had a poor prognosis (P<0.05).ConclusionsThe results suggeste that the overexpression of ALDH1 plays important roles in proliferation and progression in colon cancer, the ALDH1 may be a valuable marker to predict the biological behavior and trend of metastasis of colon cancer.     

Clinical characteristics and prognosis of young patients with colorectal cancer in Eastern China

AIM:To explore the clinical characteristics and prognosis of young patients with colorectal cancer patients in Eastern China.METHODS:A total of 1335 patients with colorectal cancer treated from December 1985 to December 2005at the Second Affiliated Hospital of Zhejiang University School of Medicine were studied retrospectively.The patients were divided into two groups,a younger group(aged≤30 years)and an older group(aged>30 years),and comparison was made in the clinical characteristics and prognosis between the two groups.Chisquare test was used for data analysis of all categorical variables,and overall survival(OS)was calculated by the Kaplan-Meier method.A multivariate analysis was performed using the Cox model.RESULTS:There were 42(3.1%)and 1293(96.9%)cases in the younger group and older group,respectively.Univariate analysis showed that the 5-and10-year OS in the younger group were 33.9%and26.1%,respectively,and those in the older group were60.1%and 52.2%,respectively.Younger group had poor survival(χ2=14.146,P=0.000).Multivariate analysis revealed that age was not a dependent factor for prognosis(OR=0.866,95%CI:0.592-1.269,P=0.461).Stratified analysis indicated that in stageⅢandⅣdisease,the 5-and 10-year OS were 24.6%and14.8%in the younger group,and 40.4%and 33.3%in the older group,respectively,with a significant difference between the two groups(χ2=5.101,P=0.024).In the subgroup of radical surgery,the 5-and 10-year OS were 44.3%and 34.2%in the younger group,and69.6%and 60.5%in the older group,with a difference being significant between the two groups(χ2=7.830,P=0.005).CONCLUSION:Compared with older patients,the younger patients have lower survival,especially in the subgroups of stageⅢandⅣdisease and radical surgery.     

老年胃癌术后患者118例的预后分析

目的:研究老年胃癌患者的临床因素以及术后化疗对预后产生的影响.方法:对1997-01/2006-01我院收治的老年胃癌术后患者118例进行回顾性分析,采用Kaplan-Meier和Cox回归分析评价性别、临床分期、组织学分化、浸润深度、淋巴结转移、远处转移、脉管癌栓、手术切除淋巴结数量、术后肿瘤残留及术后化疗等因素对预后的影响.结果:单因素分析显示临床分期、浸润深度、淋巴结转移、远处转移、术后化疗和肿瘤残留情况与预后明显相关(P<0.05).多因素分析证实,术后化疗、肿瘤残留情况及临床分期为预后的独立因素(P=0.000,P=0.000和P=0.002).结论:术后化疗、肿瘤残留情况及临床分期是老年胃癌术后患者预后的独立危险因素,Ⅲ期及Ⅳ期老年患者接受术后化疗具有明显的生存优势,但是,术后化疗并未改善Ⅰ期及Ⅱ期老年患者的生存期.     

青年人胰腺恶性肿瘤46例临床分析

目的 探讨40岁以下青年胰腺恶性肿瘤患者的临床特点,以提高青年人胰腺恶性肿瘤早期诊断水平和治疗效果.方法 回顾性分析46例40岁以下青年胰腺恶性肿瘤的临床表现、临床病理参数、血清CA19-9和CEA水平、误诊情况、治疗与生存时间.结果 青年胰腺恶性肿瘤患者首发症状主要为:上腹部饱胀(78.26%)、上腹部不适(73.91%)、消瘦(73.91%)、食欲不振(69.57%)、腹痛(60.87%);肿瘤多位于胰头部(52.17%);病理证实30例(65.22%)发生转移,其中13例累及多器官;胰腺外分泌肿瘤占72.73%(24/33),胰腺内分泌肿瘤占27.27%(9/33);CA19-9和CEA阳性率分别为73.91%(34/46)、32.61%(15/46);误诊率为80.43%(37/46),主要误诊为急、慢性胃炎(36.96%);根治性手术率为23.91%;平均生存期12.6个月.结论 40岁以下青年人胰腺恶性肿瘤早期无特异性临床表现、误诊率高、预后差,应重视早期诊断.     

Reversal of defective lymphoproliferation in postoperative patients with colon cancer

Summary To establish a method for evaluation of immunological parameters in small blood samples, a whole blood technique was developed for the estimation of mitogen- or antigen-induced proliferation. Studies regarding cellular immunity in patients with colon cancer were done with 108 patients in all tumor stages, aged 32 to 80 years. They were studied before surgery and 10 days after operation. A group of 35 patients were further tested 3 months after surgical treatment. In patients with colon cancer the proliferative responses of peripheral blood lymphocytes to mitogens were significantly lower in comparison to healthy controls. These results were found when the response to concanavalin A, phytohemagglutinin, OKT 3, and pokeweed mitogen were analyzed preoperatively and 10 days postoperatively. There was no relation to the stage of disease. The marked reduction of mitogen responses was followed by a gradual return toward normal values 3 months after surgical resection of neoplastic growth in 80% of the patients. Our studies indicate that the defects were largely restored when testing was performed 3 months after operation. Using this result, it will be possible to perform longterm studies in order to establish if there is a correlation between the return to normal immune reactivity and the survival of individual patients.Dedicated to Professor Dr. E. Hecker on the occasion of his 60th birthday     

A long adult intussusception secondary to transverse colon cancer

The occurrence of adult intussusception arising from colorectal cancer is quite rare. We present the case of a 76-year-old man with sudden abdominal pain and vomiting. Clinical symptoms included severe abdominal distension and tenderness. Computed tomography scan of the abdomen revealed left-sided colocolic intussusception with a lead point. The patient underwent a left hemicolectomy with right transverse colostomy. Pathologic evaluation revealed moderately differentiated adenocarcinoma invading the muscularis propria; the regional lymph nodes were negative for cancer cells. The postoperative course was uneventful.     

阑尾肿瘤急诊手术后追加外科手术的价值评估

目的探讨以阑尾炎起病的阑尾肿瘤行急诊手术后追加右半结肠切除术的临床意义以及对预后的影响。 方法收集32例阑尾肿瘤急诊手术后再行补救性右半结肠切除术患者的病例资料,分析其临床病理特征,并对预后进行评价。 结果32例患者均以阑尾炎起病,其中30例于外院行单纯阑尾切除术,2例行阑尾及回盲部切除术。术后中国医学科学院肿瘤医院病理会诊15例为类癌（类癌组）,17例为腺癌、黏液腺癌或者印戒细胞癌（非类癌组）,均在本院接受补救性右半结肠切除术。术后类癌组均未发现有癌残留及淋巴结转移,非类癌组有11例（64.7%）发现癌残留或者淋巴结转移。全组患者中位随访时间为60.5（12~156）月,其中类癌组均无复发、转移或死亡;非类癌组有6例出现疾病进展,4例因肿瘤死亡,其5年无病生存率（DFS）及总生存率（OS）分别为67.6%和68.6%。 结论对于以阑尾炎起病的阑尾肿瘤行急诊手术后病理结果提示类癌者,追加右半结肠根治术后可获得良好的长期预后。而对于腺癌、黏液腺癌或者印戒细胞癌者,有较高的肿瘤残存或淋巴结转移率,应及早追加右半结肠根治术,以决定最终的病理分期,指导后续辅助治疗,进而提高预后。     

结肠癌血行转移患者的凝血功能变化

目的探讨结肠癌血行转移患者凝血功能的变化。方法收集武汉大学人民医院2011年11月-2013年10月确诊的139例结肠癌患者(包括结肠癌远处转移患者28例,其中19例为血行转移)与同期住院的30例结肠良性疾病患者病例资料,回顾性分析治疗前凝血常规指标。结果与对照组比较,结肠癌组血小板(PLT)水平、纤维蛋白原(Fbg)水平升高,凝血酶原时间(PT)延长,差异均有统计学意义(P0.05);各组间血浆凝血酶时间(TT)水平相比,差异无统计学意义(P0.05);血行转移组活化部分凝血活酶时间(APTT)、D-二聚体(D-Dimer)水平升高,与对照组及无转移组相比,差异有统计学意义(P0.05)。结论凝血指标的异常可能是血行转移的重要影响因素。积极改善患者血液高凝状态不仅可以减少血栓形成,还可以影响结肠肿瘤的生长和转移,从而延长患者的生存期。     

Colorectal cancer prognosis twenty years later

AIM:To evaluate changes in colorectal cancer(CRC) survival over the last 20 years.METHODS:We compared two groups of consecutive CRC patients that were prospectively recruited:Group Ⅰincluded 1990 patients diagnosed between 1980 and 1994.GroupⅡincluded 871 patients diagnosed in 2001.RESULTS:The average follow up time was 21 mo(1-229)for GroupⅠand 50 mo(1-73.4)for GroupⅡ.Overall median survival was significantly longer in Group Ⅱthan in GroupⅠ(73 mo vs 25 mo,P&lt;0.001)and the difference was significant for all ...     

Local recurrence after curative resection in patients with colon and rectal cancers

Background and aims  There are a range of rates and a number of prognostic factors associated with the local recurrence of colorectal cancer after curative resection. The aim of this study was to identify the potential prognostic factors of local recurrence in patients with colon and rectal cancers. Materials and methods  A retrospective review of 1,838 patients who underwent curative resection of non-metastatic colorectal cancer was conducted. The patients were treated between 1994 and 2004, and had a minimum follow-up of 3 years. Results  There were 994 patients with colon cancer and 844 patients with rectal cancer. The median duration of follow-up was 60.9 ± 24.5 months. With respect to colon cancer, the local recurrence rate was 6.1% (61 patients). With respect to rectal cancer, 95 patients had a local recurrence (11.3%), the rate of which was statistically greater than the local recurrence rate for colon cancer (p < 0.001). The overall recurrence rate was 16.4% (301 patients), and the local recurrence rate, with or without systemic metastases, was 8.5% (156 patients). Local recurrences occurred within 2 and 3 years in 59.9% and 82.4% of the patients, respectively. In patients with colon and rectal cancer, the pathologic T stage (p = 0.044 and p = 0.034, respectively), pathologic N stage (p = 0.001 and p < 0.001, respectively), and lymphovascular invasion (p = 0.013 and p = 0.004, respectively) were adverse risk factors for local recurrence. The level of the anastomosis from the anal verge was an additional prognostic factor (p = 0.007) in patients with rectal cancer. Conclusion  Compulsive follow-up care of patients with colon and rectal cancers is needed for 3 years after curative resection, especially in patients who have adverse risk factors for local recurrence.