Neoadjuvant Therapy for Rectal Cancer: Histologic Response of the Primary Tumor Predicts Nodal Status

PURPOSE: This study was designed to compare histologic T and N stages in patients with rectal adenocarcinoma undergoing various neoadjuvant radiotherapy regimens and proctectomy, in an attempt to determine if final histologic stage of the mural tumor predicts nodal status.METHODS: Data were collected from computerized databases at two institutions on 649 consecutive patients who underwent neoadjuvant radiotherapy or chemoradiotherapy and proctectomy for primary adenocarcinoma of the rectum from 1990 to 2002.RESULTS: Five patients were excluded because of incomplete pathology data sets, leaving a study population of 644. Patients underwent neoadjuvant radiotherapy alone (2,000 cGy in 5 fractions, n = 191; or 4,500 cGy in 25 fractions, n = 259) or chemoradiation (4,500 cGy in 25 fractions with concurrent 5-fluorouracil, n = 194). Histologic stage of the remaining mural tumor (ypT) correlated with nodal status (ypN). Lymph nodes harboring metastatic tumor were found in 1 of 42 (2 percent) ypT0 patients, 2 of 45 (4 percent) ypT1 patients, 43 of 186 (23 percent) ypT2 patients, 158 of 338 (47 percent) ypT3 patients, and 16 of 33 (48 percent) ypT4 patients (P < 0.001, chi-squared test). The probability of finding ypN+ disease was 3 of 87 (3 percent) in patients with ypT0-1 residual primary tumors vs. 220 of 557 (39 percent) in patients with ypT2-4 residual primary tumors (P < 0.0001; Fishers exact test).CONCLUSIONS: Nodal metastases are rare in patients whose mural tumor burden shrinks to ypT0-1 after neoadjuvant radiotherapy. If transanal excision is offered to select patients with distal rectal cancer, it is reasonable to select those who have an excellent clinical response to neoadjuvant therapy for transanal excision, and then reserve proctectomy for patients proven to have residual ypT2-4 disease.Read at the meeting of The American Society of Colon and Rectal Surgeons, New Orleans, Louisiana, June 21 to 26, 2003.     

Sentinel Lymph Node Mapping for Adenocarcinoma of the Colon Does Not Improve Staging Accuracy

PURPOSE This study was designed to: determine the efficacy of sentinel lymph node mapping in patients with intraperitoneal colon cancer; and create an algorithm to predict potential survival benefit by using best-case estimates in favor of sentinel node mapping and lymph node ultraprocessing techniques. METHODS Forty-one patients with intraperitoneal colon cancer undergoing colectomy with curative intent were studied prospectively. After mobilization of the colon and mesentery, 1 to 2 ml of isosulfan blue dye was injected subserosally around the tumor. The first several nodes highlighted with blue dye were identified as sentinel nodes. Additional nodes were identified by the pathologist in routine fashion by manual dissection of the mesentery. All nodes were processed in routine fashion by bivalving and hematoxylin and eosin staining. To create an algorithm to predict potential survival benefit of sentinel node mapping and lymph node ultraprocessing techniques, assumptions were made using data from the literature. All bias was directed toward success of the techniques. RESULTS Three of 41 patients (7 percent) did not undergo injection of dye and were excluded from further analysis. Stage of disease in the remaining 38 patients was: I, n = 10 (26 percent); II, n = 15 (39 percent); III, n = 11 (29 percent); IV, n = 2 (5 percent). At least one sentinel node was identified in 30 of 38 patients (79 percent). The median number of sentinel nodes identified was two (range, 1–3). Median total nodal retrieval was 14 (range, 7–45). All nodes were negative in 26 of 38 patients (68 percent). Sentinel nodes and nonsentinel nodes were positive in 2 of 38 patients (5 percent). Sentinel nodes were the only positive nodes in 1 of 38 patients (3 percent). Sentinel nodes were negative and nonsentinel nodes were positive in 9 of 38 patients (24 percent). Thus, sentinel node mapping would have potentially benefited only 3 percent, and failed to accurately identify nodal metastases in 24 percent of the patients in our study. To create a survival benefit algorithm, we assumed the following: combined fraction of Stage I and II disease (0.5); fraction understaged by bivalving and hematoxylin and eosin staining that would have occult positive nodes by more sophisticated analysis (0.15); fraction of occult positive nodes detected by sentinel node mapping (0.9); and survival benefit from chemotherapy (0.33). Thus, the fraction of patients benefiting from sentinel lymph node mapping and lymph node ultraprocessing techniques would be 0.02 (2 percent). CONCLUSIONS Sentinel node mapping with isosulfan blue dye and routine processing of retrieved nodes does not improve staging accuracy in patients with intraperitoneal colon cancer. Even using best-case assumptions, the percentage of patients who would potentially benefit from sentinel lymph node mapping is small. Read at the meeting of The American Society of Colon and Rectal Surgeons, Dallas, Texas, May 8 to 13, 2004.     

Identification of Patients with High-Risk Stage II Colon Cancer for Adjuvant Therapy

Purpose Adjuvant therapy for Stage II colon cancer remains controversial but may be considered for patients with high-risk features. The purpose of this study was to assess the prognostic significance of commonly reported clinicopathologic features of Stage II colon cancer to identify high-risk patients. Methods We analyzed a prospectively maintained database of patients with colon cancer who underwent surgical treatment from 1990 to 2001 at a single specialty center. We identified 448 patients with Stage II colon cancer who had been treated by curative resection alone, without postoperative chemotherapy. Results With median follow-up of 53 months, 5-year disease-specific survival for this cohort was 91 percent. Univariate and multivariate analyses identified three independent features that significantly affected disease-specific survival: tumor Stage T4 (hazard ratio (HR), 2.7; 95 percent confidence interval (CI), 1.1–6.2; P = 0.02), preoperative carcinoembryonic antigen >5 ng/ml (HR, 2.1; 95 percent CI, 1.1–4.1; P = 0.02), and presence of lymphovascular or perineural invasion (HR, 2.1; 95 percent CI, 1–4.4; P = 0.04). Five-year disease-specific survival for patients without any of the above poor prognostic features was 95 percent; five-year disease-specific survival for patients with one of these poor prognostic features was 85 percent; and five-year disease-specific survival for patients with ≥2 poor prognostic features was 57 percent. Conclusions Patients with Stage II colon cancer generally have an excellent prognosis. However, the presence of multiple adverse prognostic factors identifies a high-risk subgroup. Use of commonly reported clinicopathologic features accurately stratifies Stage II colon cancer by disease-specific survival. Those identified as high-risk patients can be considered for adjuvant chemotherapy and/or enrollment in investigational trials. Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6, 2007. Reprints are not avaliable.     

Limitations of Early Rectal Cancer Nodal Staging may Explain Failure after Local Excision

Successful selection of patients with rectal cancer for local excision requires accurate preoperative lymph node staging. Although endorectal ultrasound is capable of detecting locally advanced disease, its ability to correctly identify nodal metastases in early rectal lesions is less well described. This study examines the accuracy of endorectal ultrasound in determining nodal stage based on depth of penetration of the primary lesion (T stage). Between 1998 and 2003, endorectal ultrasound was performed on 938 consecutive patients; 134 had biopsy-proven rectal cancers and were treated with radical resection, without neoadjuvant therapy. Lymph node metastases were measured pathologically and correlated with endorectal ultrasound and clinicopathologic features. Accuracy and specificity of endorectal ultrasound nodal staging was determined. The overall accuracy of endorectal ultrasound nodal staging for the study cohort was 70 percent, with a 16 percent false-positive rate and 14 percent false-negative rate. Endorectal ultrasound was more likely to overlook small metastatic lymph node deposits. The size of lymph node metastasis and accuracy of endorectal ultrasound nodal staging was related to T stage. The specificity of endorectal ultrasound nodal staging, or the ability to identify patients who were node-negative, was dependent on T stage. Early rectal lesions are more likely to have lymph node micrometastases not detected by endorectal ultrasound. The ability of endorectal ultrasound to correctly identify patients without lymph node metastasis is dependent on the T stage of the primary lesion. The limitations of endorectal ultrasound in accurately staging nodal disease in early rectal lesions may, in part, explain the relatively high recurrence rates seen after local excision. Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Philadelphia, Pennsylvania, April 30 to May 5, 2005. Reprints are not available.     

Comparative Analysis of Nodal Upstaging Between Colon and Rectal Cancers by Sentinel Lymph Node Mapping: A Prospective Trial

PURPOSE Sentinel lymph node mapping accurately predicts nodal status in >90 percent of melanoma and breast and colorectal cancers. However, because of anatomic differences, sentinel lymph node mapping of rectal cancers has been considered inaccurate and difficult relative to colon. A prospective study was undertaken to identify differences in sentinel lymph node mapping between patients with colon cancer and those with rectal cancer.METHODS At operation 1 to 3 ml of 1 percent isosulfan blue dye was injected subserosally around colon cancers. The first to fourth blue-staining nodes seen within ten minutes of injection were marked as sentinel lymph nodes. For cancer of the mid-rectum to low rectum, the dye was injected submucosally via rigid scope and spinal needle. The mesorectum was dissected ex vivo to identify blue nodes nearest the tumor as sentinel lymph nodes. Multilevel microsections of sentinel lymph nodes were stained with hematoxylin and eosin and immunostained for cytokeratin, and standard examination of the entire specimen was performed.RESULTS There were 407 consecutive patients (336 with colon and 71 rectum). The sentinel lymph nodes were identified in 99.1 percent of colon and 91.5 percent of rectal patients (P < 0.0001). Skip metastases were found in 3.6 percent of colon vs. 2.8 percent of rectal patients (P = 0.16). Occult micrometastases were found in 13.4 percent of colon vs. 7.0 percent of rectal patients (P = 0.24). Except for success rates, no other parameters were statistically different between colon and rectum. Lower success in sentinel lymph node identification in rectal cancer may have been related to neoadjuvant chemoradiation received in all six of the patients with sentinel lymph node mapping failures.CONCLUSION Despite higher success rates in sentinel lymph node identification for colon patients, sentinel lymph node mapping was highly successful (91.5 percent) in rectal patients. Nodal upstaging, skip metastases, and occult metastases were similar.Read at the meeting of the American Society of Colon and Rectal Surgeons, New Orleans, Louisiana, June 21 to 26, 2003.     

Operative Salvage for Locoregional Recurrent Colon Cancer After Curative Resection: An Analysis of 100 Cases

PURPOSE Locoregional recurrence after resection of colon carcinoma is an uncommon and difficult clinical problem. Outcome data to guide surgical management are limited. This investigation was undertaken to review our experience with surgical resection for patients with locoregional recurrence colon cancer, determine predictors of respectability, and define prognostic factors associated with survival.PATIENTS AND METHODS A prospective database was queried for patients who had recurrent colon cancer between January 1991 and October 2002. Patients were selected for analysis if they had either isolated resectable locoregional recurrence or concomitant resectable distant disease. Disease-specific survival analysis was performed with the Kaplan-Meier actuarial method, and factors associated with outcome were determined by the log-rank test and Cox regression.RESULTS During this period of time, 744 patients with recurrent colon cancer were identified and 100 (13.4 percent) underwent exploration with curative intent for potentially resectable locoregional recurrence: 75 with isolated locoregional recurrence, and 25 with locoregional recurrence and resectable distant disease. The median follow-up for survivors was 27 months. Locoregional recurrence was classified into four categories: anastomotic; mesenteric/nodal; retroperitoneal; and peritoneal. Median survival for all patients was 30 months. Fifty-six patients had an R0 resection (including distant sites). Factors associated with prolonged disease-specific survival included R0 resection (P < 0.001); age <60 years (P < 0.01); early stage of primary disease (P = 0.05); and no associated distant disease (P = 0.03). Poor prognostic factors included more than one site of recurrence (P = 0.05) and involvement of the mesentery/nodal basin (P = 0.03). The ability to obtain an R0 resection was the strongest predictor of outcome, and these patients had a median survival of 66 months.CONCLUSION Salvage surgery for locoregional recurrence colon cancer is appropriate for select patients. Complete resection is critical to long-term survival and is associated with a single site of recurrence, perianastomotic disease, low presalvage carcinembryonic antigen level, and absence of distant disease.Read at the meeting of The American Society of Colon and Rectal Surgeons, Dallas, Texas, May 8 to 13, 2004.Reprints are not available.     

A Case of Isolated Invasive Aspergillus Colitis Presenting with Hematochezia in a Nonneutropenic Patient with Colon Cancer

Gastrointestinal invasive aspergillosis is often reported as part of a disseminated infection, and rarely as an isolated organ infection. Isolated invasive Aspergillus colitis is very rare, being observed only in patients with hematological malignancy and neutropenia. We encountered an unusual case of isolated invasive Aspergillus colitis presenting with hematochezia in a nonneutropenic patient with colon cancer. Fungal hyphae with surrounding inflammatory cells and mucosal necrosis were observed during the histological examination of a biopsy sample obtained at endoscopy. This case indicates that isolated invasive Aspergillus colitis may develop in a variable context of immunosuppression.     

High Frequency of Chromosome 14 Deletion in Early-Onset Colon Cancer

Purpose

Several genes have been recognized, when mutated in the germline, to highly predispose to colorectal cancer, impairing the DNA mismatch repair system in hereditary nonpolyposis colon cancer syndrome, or APC/MYH in adenomatous polyposis. However, 10 percent of microsatellite stable colorectal cancer is reported to develop in an unexplained context of genetic predisposition. This study was designed to depict the genetic mechanisms underlying early-onset microsatellite stable colon cancers.

Methods

Patients younger than aged 50 years undergoing primary surgical resection for colon carcinoma were collected prospectively between 1993 and 2003. A first series of 8 samples has been allelotyped using 361 poly–CA polymorphisms distributed on the 39 autosomal arms within a larger set of 166 sporadic tumors. Genotyping of 24 poly–CA polymorphisms distributed on the 8 chromosomes exhibiting allelic losses in more than 30 percent of the previous cases was then applied to an independent series of 40 tumors. A third series of 70 tumors has been genotyped on chromosome 14 only.

Results

Comparison of genomic profile from patients younger and older than aged 50 years at the 8 most frequently lost chromosomes allowed, identify chromosome 14 as showing a significant difference between the two groups. Dense chromosome 14 genotyping detected two partial deletions in a general background of 57 percent allelic loss, pointing at a region located between D14S63 and D14S292.

Conclusions

These observations suggest that a tumor-suppressor gene located on chromosome 14 might have an important role in microsatellite stable colon carcinogenesis. Because it seems to be more frequently involved in early-onset cases, it could be a good candidate in inherited conditions.

     

2008至2012年美国国立综合癌症网络结直肠癌临床实践指南变化历程解读

美国国立综合癌症网络(National Comprehensive Cancer Network,NCCN)指南对于规范结直肠癌的诊治具有重要意义,其内容每年均要进行更新,关注这些变化往往意味关注肠癌研究领域的热点、难点抑或疑点。为此,本文回顾2008至2012年指南更新的重点,回首肠癌诊治进步的点滴历程,希望能发现些许启迪,以飨同道。     

右半结肠癌全结肠系膜切除术47例分析

目的探讨右半结肠癌完整结肠系膜切除（complete mesocolic excision,CME）在临床手术治疗中的应用。 方法回顾性分析我科2012年7月至2014年9月间手术治疗的47例右半结肠癌行CME治疗患者的临床资料。 结果47例均行CME,手术顺利,无副损伤出现,中位淋巴结清扫数为18枚,Ⅲ期病人系膜根部淋巴结阳性率为25.53%（12/47）,手术时间、出血量及并发症与我院以往的传统手术相比并无明显增加。 结论CME能够使右半结肠癌根治更合理化,系膜和淋巴结切除的更彻底,尤其是系膜根部的淋巴结清扫的更彻底,使Ⅲ期病人获益更大,而手术风险及并发症并无增加。因此,CME值得在临床中推广。     

Optimizing the Outcome for Patients With Rectal Cancer

INTRODUCTION: Historically, rectal cancer with transmural spread and/or lymph node involvement has presented a major challenge to surgeons, with a variable and often high risk of local recurrence and poor survival outcomes. In recent years a large amount of literature has focused attention on the importance of surgical technique, tumor staging, and the optimal integration of CT and radiation therapy. METHODS: This article reviews the clinical trials that have defined the current approach to rectal cancer, the controversies regarding what should be considered the standard of care, and the ongoing clinical studies that will resolve some of these issues. RESULTS: The preoperative staging of rectal cancer can be improved with the use of endorectal ultrasound and (where available) magnetic resonance imaging. Careful pathologic analysis, particularly of the radial margin, provides important prognostic information that enables better allocation of postoperative care. Although both radiation therapy and CT have a proven role in adjuvant therapy, the interpretation of many studies is confounded by unacceptably poor outcomes in the control arm, and in older studies the use of inferior chemotherapy and radiation therapy techniques. Ongoing studies will better define the optimal combination and timing of chemotherapy and radiation therapy, with respect to both toxicity and survival endpoints. CONCLUSIONS: A combined modality approach to rectal cancer, integrating the colon and rectal surgeon, pathologist, medical oncologist, and radiation oncologist, is necessary to achieve optimal outcomes. The achievements to date and the ongoing vigorous debates regarding standard care continue to highlight the importance of quality ongoing research in a rapidly changing clinical environment.     

NK,NKT and Invariant-NKT Cells in Tumor Draining Lymph Nodes of Patients with Breast Cancer

Background: NK (natural killer) and NKT (natural killer T) cells, as components of innate immune system, play a crucial role in tumor progression and dissemination. Objective: To investigate the percentages of NK cells, NKT cells, iNKT (invariant natural killer T) cells, total T lymphocytes as well as activated T lymphocytes, in tumor draining lymph nodes (TDLNs) of patients with breast cancer (BC) and their association with different clinic-pathological features of the patients. Methods: Axillary lymph nodes were obtained from 30 Iranian women with breast cancer. After routine pathological evaluations, mononuclear cells were separated from their lymph nodes and incubated with appropriate fluorochrome conjugated monoclonal antibodies specific for CD3, HLA-DR, CD16/56, and Vα24Jα18-TCR. Data were collected on a four-color flow cytometer and analyzed by CellQuest software. Results: The mean percentages of NK (CD3-CD16/56+), NKT (CD3+CD16/56+) and iNKT (Vα24Jα18-TCR+) cells in TDLNs mononuclear cells of BC patients were 2.04%, 2.44% and 0.1%, respectively. A significant decrease in the percentages of NK and iNKT subsets in patients with grade I was observed compared to grade III (p=0.03 and p=0.01, respectively). Moreover, NK cells were increased in patients with grade III of BC compared to grade II (p= 0.003). Conclusion: The increase in the percentage of NK and iNKT cells in TDLNs of patients with higher grade of BC might suggest a suppressive phenotype for these cells in breast cancer, which merit more functional investigation.     

Influence of Lavage Timing on Tumor Cell Burden During Colonic Resection

INTRODUCTION: A subset of patients undergoing elective resection for an intra-abdominal malignancy may have viable tumor cells present within the peritoneal cavity at the start of the procedure. The presence of these cells may alter the pattern of tumor recurrence. METHODS: Six million human colorectal tumor cells were radiolabeled and injected into the pelvis of eight pigs before the undertaking of a standardized laparoscopic-assisted sigmoid colectomy. In four pigs, a 1-liter saline lavage was performed before resection, and in the four remaining pigs, a similar lavage was performed after construction of the anastomosis. After completion of the sigmoid colectomy, pigs were killed, and the anastomosis was excised. Counting the radioactivity present on each sample and correlating this with the radioactivity present within the initial cell inoculum enabled the number of cells on each anastomosis to be calculated. Additional measurements were made of the number of cells on the resected bowel specimen, the stapling device, the resected anastomotic donuts, the trocars and abdominal wounds, and the lavage fluid. RESULTS: Significantly fewer cells were detected on the anastomosis, the resected bowel specimen, and the donut of resected tissue in the pigs that received a preresection lavage (P = 0.01). Significantly greater numbers of cells were retrieved in the lavage fluid in this group (P = 0.01). No differences were detected in the number of cells that contaminated the stapling device (P = 0.1), trocars (P = 0.47), or trocar sites (P = 0.27). CONCLUSION: The simple strategy of lavage at the commencement of resection for an intra-abdominal resection may reduce contamination of the anastomosis and effect a reduction of the total number of viable cells present within the abdominal cavity in patients with free intra-abdominal tumor cells.     

表皮生长因子及其受体对结肠癌干细胞的增殖调控

背景：肿瘤干细胞是肿瘤组织中一小部分具有自我更新、多向分化以及高度增殖能力的肿瘤细胞。研究发现表皮生长因子（EGF）可促进肿瘤干细胞增殖。目的：探讨EGF及其受体（EGFR）在结肠癌干细胞增殖调控中的作用。方法：结肠癌细胞株HT29、HCTll6培养于无血清培养基中,以EGF、碱性成纤维细胞生长因子（bFGF）、胰岛素样生长因子（IGF）分别干预细胞。MTT11法检测EGFR抑制剂吉非替尼对结肠癌细胞球细胞的增殖抑制作用,体外实验检测EGFR抑制剂吉非替尼、PDl53035对细胞球形成的抑制作用,流式细胞术检测细胞凋亡。体内实验检测结肠癌细胞球和细胞株的成瘤能力,real、timePCR检测两者干细胞标记LGR5、Musashi-1和分化标记CK20表达。结果：EGF组HCT116细胞形成的细胞球数量显著高于空白对照、bFGF、IGF组（P〈0．05）。吉非替尼能抑制HCT116细胞球细胞增殖和细胞球形成,并诱导细胞凋亡,作用呈浓度依赖性。HCT116细胞球成瘤时间较细胞株显著缩短,移植瘤体积显著增大（P〈0．05）。LGR5、Musashi-1在细胞球中的表达显著高于细胞株,而CK20在细胞株中的表达显著高于细胞球（P〈0．05）。结论：EGF对结肠癌细胞株HCTll6、HT29形成细胞球具有促进作用。EGFR抑制剂可抑制结肠痛细胞球增殖并诱导细胞凋亡,相关作用可能与调控LGR5、Musashi-1和CK20表i大有关。     

Prognostic impact of dissected lymph node count on patients with node-negative gastric cancer

AIM： To investigate the long-term effect of the number of resected lymph nodes （LNs） on the prognosis of patients with node-negative gastric cancer. METHODS： Clinical data of 211 patients with gastric cancer, without nodal involvement, were analyzed retrospectively after D2 radical operation. We analyzed the relationship between the number of resected LNs with the 5-year survival, the recurrence rate and the post-operative complication rate. RESULTS： The 5-year survival of the entire cohort was 82.2%. The total number of dissected LNs was one of the independent prognostic factors. Among patients with comparable depth of invasion, the larger the number of resected LNs, the better the survival （P 〈 0.05）. A cut-point analysis provided the possibility to detect a significant survival difference among subgroups. Patients had a better long-term survival outcomes with LN counts ≥ 15 for pT1-2, ≥ 20 for pT3-4, and ≥ 15 for the entire cohort. The overall recurrence rate was 29.4% within 5 years after surgery. There was a statistically significant, negative correlation between the number of resected LNs and the recurrence rate （P 〈 0.01）. The post-operative complication rate was 10.9% and was not significantly correlated with the number of dissected LNs （P 〉 0.05）.CONCLUSION： For node-negative gastric cancer, sufficient number of dissected LNs is recommended during D2 lymphadenectomy, to improve the long-term survival and reduce the recurrence. Suitable increments of the dissected LN count would not increase the postoperative complication rate.     

Patient Satisfaction and Health-Related Quality of Life After Treatment for Colon Cancer

Purpose Health-related quality of life has become an important outcome in cancer treatment. Detailed health-related quality of life measures were taken as part of a trial of follow-up of patients with colon cancer by general practitioners and surgeons. This study was designed as a longitudinal assessment of health-related quality of life after treatment for carcinoma of the colon and patient satisfaction with two different settings of follow-up (general practitioners vs. surgeons). Methods A total of 338 patients were recruited into randomized (n = 203) and patient preference (n = 135) follow-up groups. Prospectively assessed physical and mental health-related quality of life measures and patient satisfaction are reported during two years. Results Elderly and less educated patients prefer follow-up by general practitioners over surgeons. Overall, physical health-related quality of life is reduced early after treatment; however, this returns to normal levels at one year. Mental quality of life, anxiety, and depression are at or above population levels throughout the two-year follow-up period. There were no differences in physical or psychologic health-related quality of life measures between general practitioner and surgeon groups at any time during follow-up. Overall, more advanced Dukes stage is associated with a trend to improved mental health-related quality of life. Patients’ ability to choose the setting of follow-up has no influence on health-related quality of life compared with random allocation to general practitioner or surgeon. Patients are equally highly satisfied with follow-up by general practitioner or surgeon. Conclusions After recovery from treatment for colon cancer, health-related quality of life is similar to the general population. Good health-related quality of life outcomes and high patient satisfaction are as well provided by general practitioners in the community setting as by surgeon review. Supported by the National Health and Medical Research Council of Australia, Cancer Council of South Australia. Reprints are not available.     

罗格列酮对人结肠癌裸鼠移植瘤生长作用研究

目的观察过氧化物酶体增殖物激活受体的配体罗格列酮（ROZ）对人结肠癌细胞系HT-29裸鼠移植瘤的作用,探讨ROZ活化PPARγ,下调NFκB,从而诱导人结肠癌细胞凋亡的作用机制。方法体外培养人结肠癌HT-29细胞,建立人结肠癌细胞HT-29裸鼠移植瘤模型,20只荷瘤裸鼠随机分组进行实验。Western Blot法分析PPARγ、NF-κB、Bcl-2、bax蛋白表达的影响及PPARγ活化依赖性。结果 ROZ能抑制裸鼠移植瘤的生长。结论 ROZ通过上调PPARγ蛋白表达,下调NF-κB蛋白表达,抑制人结肠癌裸鼠移植瘤生长。     

Strategies of follow-up for colorectal cancer: a survey of the American Society of Colon and Rectal Surgeons

Background The postoperative surveillance of patients who have undergone curative treatment for colorectal cancer (CRC) is controversial. The aim of this study was to investigate the follow-up practice of colorectal surgeons in the United States. Methods A postal survey was sent to 1641 active members of the American Society of Colon and Rectal Surgeons practicing in the United States to assess the frequency of follow-up and the methods used in the surveillance of asymptomatic patients following curative surgery for CRC. Results Only 582 (36%) of the questionnaires that were sent were returned fully completed. Of these, 173 surgeons (30%) followed their patients according to guidelines. Ninety-four percent of surgeons during the first year and 81% during the second year saw their patients regularly every 3 or 6 months. The most widely used tests were colonoscopy and carcinoembryonic antigen (CEA) testing. There was wide discrepancy in the frequency of follow-up and techniques employed, with only about 50% of surgeons following recommended practice. Conclusions Surveillance strategies mainly rely on clinical examination, CEA monitoring and colonoscopy. No clear consensus on surveillance programs for CRC patients exists. Poster presentation at the annual meeting of the Association of Coloproctology of Great Britain and Ireland, Harrogate, United Kingdom, 25–27 June 2001, and podium presentation at the International Society of University Colon and Rectal Surgeons biennial meeting, Osaka, Japan, 14–18 April 2002.