Relationship between plasma cell-free DNA (cfDNA) and prognosis of TACE for primary hepatocellular carcinoma

BackgroundOur study aims to investigate changes in cell-free DNA (cfDNA) concentration and integrity in primary hepatocellular carcinoma (PHC) patients before and after transcatheter arterial chemoembolization (TACE) treatment and their influence on the evaluation of prognosis of the disease.MethodsA total of 84 PHC patients admitted to the Affiliated Hospital of Nanjing University of Chinese Medicine from December 2016 to December 2017 were included as the study group, while 55 healthy people served as the control group. Plasma cfDNA concentration and integrity were determined using qRT-PCR. The correlation between cfDNA concentration/integrity and clinical characteristics of PHC patients were analyzed. A ROC curve was used to investigate the sensitivity and specificity of cfDNA as detection indices. Univariate and multivariate analyses were used to analyze factors affecting recurrence in PHC patients and compare recurrence-free survival (RFS) of PHC patients with high cfDNA expression and low cfDNA expression.ResultsPlasma cfDNA concentration and integrity were significantly higher in PHC patients before TACE treatment than in healthy people and significantly lower after treatment than before (P<0.05). The cfDNA concentration was significantly correlated with tumor size, lymph node metastasis, TNM stage, and BCLC stage, while cfDNA integrity was significantly correlated with tumor size, TNM stage, and BCLC stage (P<0.05). ROC results showed that the area under the curve (AUC) value of cfDNA concentration was the largest, with an optimal cut-off of 10.51 ng/mL. Multivariate regression analysis for COX showed that the TNM stage, cfDNA concentration, and AFP were independent risk factors that affected PHC patients’ survival.ConclusionsPlasma cfDNA concentration in PHC patients is more sensitive and specific than any other tumor marker. It is an independent risk factor for PHC patients treated with TACE. Therefore, it is hypothesized cfDNA is a potential biomarker for prognostic evaluation of PHC patients treated with TACE.     

NSCLC患者血清Ang2与VEGF动态变化的关系

目的 探讨非小细胞肺癌（NSCLC）患者病程中血管生成素2（Ang2）和血管内皮生长因子（VEGF）的变化情况,评价在肿瘤发生、进展、预后的临床意义。方法 对82例首诊未经治疗的NSCLC患者行ELISA法定量检测外周血Ang2与VEGF水平。结果 NSCLC患者外周血Ang2与VEGF水平较对照组明显升高［Ang2：（1326.8±942.9）pg/ml vs. （445.0±213.0） pg/ml, P<0.01;VEGF：（846.8±459.6）pg/ml vs. （691.3±369.6） pg/ml, P<0.05］。Ang2在早期NSCLC开始明显升高,但在各进展期之间比较差异无统计学意义,进入晚期后在越接近死亡的患者Ang2又再有上升趋势。VEGF在早期未见升高,进入进展期后逐渐升高,在未有远处转移的患者,原发灶直径越大,VEGF越高。COX回归分析显示临床分期与VEGF是NSCLC生存预后的独立危险因素(P<0.05）。结论 NSCLC患者血清Ang2与 VEGF均明显升高, 对早期NSCLC患者检测血清Ang2较VEGF有更好的辅助诊断价值,在NSCLC进展期检测血清VEGF较Ang2更有助于评价肿瘤进展情况,在NSCLC晚期检测血清Ang2升高较VEGF更能提示临终期。     

Roles of Salmonella typhi and Salmonella paratyphi in Gallbladder Cancer Development

Background: Typhoid (Salmonella typhi and paratyphi) carriers and gall bladder cancer (GBC) are endemic in northern India. Results of previous studies about association of typhoid carriers with GBC are inconsistent. We studied antibodies against Salmonella typhi and paratyphi in serum samples of patients with GBC. Methods: We performed modified Widal test for antibodies against Salmonella typhi (Vi and O) and Salmonella paratyphi (AO and BO) antigens in patients with GBC (n=100), xanthogranulomatous cholecystitis (XGC, n=24), chronic cholecystitis (CC, n=200) and healthy controls (HC, n=200). Results: Serum antibodies against Salmonella were more frequently positive in GBC (22%) and XGC (29%), particularly in males in age ≥50 years (GBC: 47% and XGC: 50%) vs. HC (0) (p <0.01). Vi antibody was more common in GBC (13%, OR:9.8) and XGC (8%, OR:5.9) than HC (2%). O antibody was more common in GBC (8%, OR: 8.6) and XGC (8%, OR: 9.0) than HC (1%). O antibody was also more common in males with GBC (12%) than CC (1%) and HC (1%) (P=0.02 and p <0.001, respectively). AO (6%) and BO (4%) antibodies were detected in GBC, particularly in males, than HC (0), (p <0.01). Salmonella antibodies were more frequent in GBC with GS than those without GS (50% vs. 20%, OR=3.94, P=0.01). Conclusions: Salmonella carrier state was more common in GBC and XGC, particularly in elderly males than HC. The Vi antibody was more common in GBC and XGC than HC. Salmonella infection was more common in GBC with GS than those without GS.     

CA 125: a potential tumor marker for gallbladder cancer

BACKGROUND: CA 125 is a glycoprotein and a commonly used tumor marker in ovarian carcinoma. Its use in gallbladder carcinoma (GBC) has not yet been reported. We have henceforth examined for the first time the diagnostic utility of CA 125 in patients with gallbladder diseases. PATIENTS AND METHODS: Serum CA 125 was measured in 64 patients with GBC, 47 Gallstone disease (GSD) and 23 healthy volunteers by ELISA. CA 125 level was compared between different cohorts by non-parametric test (Kruskal Wallis and Mann-Whitney test). Receiver operating characteristic curve (ROC) was constructed to see the diagnostic utility of CA 125. Its level was also correlated with age, sex and clinico-pathological parameters of the patients included in the study. RESULTS: Mean value of CA 125 in patients with GBC, GSD and healthy volunteers was 77.44 +/- 141.31 U/ml, 7.85 +/- 5.40 U/ml, and 8.08 +/- 3.26 U/ml respectively and showed a statistically significant difference (P < 0.001). CA 125 at cut off value of 11 U/ml yielded 64% sensitivity and 90% specificity in differentiating benign from malignant gallbladder disease. CA 125 level increased with stage and grade of the GBC though this was not statistically significant. A higher level of CA 125 was found in presence of gallbladder mass, weight loss, ascites and loss of appetite compared to patients with GSD. No association of CA 125 was apparent with either age or sex of the patients. CONCLUSION: CA 125 has a diagnostic potential for GBC and can differentiate GBC from GSD in light of other clinical details.     

糖类抗原15-3、癌胚抗原、环氧合酶-2联合检测在乳腺癌诊断中的应用

 目的　探讨糖类抗原15-3（CA15-3）、癌胚抗原（CEA）、环氧合酶-2（COX-2）联合检测对乳腺癌早期诊断的应用价值。方法　选择经影像学和病理学诊断为乳腺癌患者53例,同时选择同期良性乳腺病患者61例及同期健康体检者68名,采用电化学发光技术与酶联免疫吸附法（ELISA）分别检测血清CA15-3、CEA、COX-2水平。结果　乳腺癌组CA15-3、CEA、COX-2血清水平分别为（34.67±13.20）U／ml、（7.38±3.87）ng／ml、（43.25±10.87）ng／ml,与良性乳腺病组和健康对照组血清含量比较差异具有统计学意义（均P＜0.01）;CA15-3、CEA、COX-2联合检测将各项指标单独检测的阳性检出率提高至84.9 %（45／53）,其敏感度提高至84.9 %,准确度提高至91.2 %。结论　三项肿瘤标志物联合应用能弥补单项肿瘤标志物临床应用的不足,对提高乳腺癌阳性检出率具有一定意义。     

Preoperative serum leptin levels in patients with breast cancer

Leptin is an adipocyte-derived protein and plays an important role in the control of body weight by acting as a neurohormone regulating energy balance and food intake in the hypothalamus. The high serum leptin levels and the overexpression of leptin receptors have been documented in breast cancer patients, but the levels never checked preoperatively. In the present study, the relationship between preoperative serum leptin levels of the breast cancer patients and the healthy controls were evaluated. The serum leptin levels in 30 breast cancer patients were compared to 30 healthy female volunteers. In addition, the association of serum leptin levels and the various well-known risk factors were studied. Serum leptin levels of patients with breast cancer (28.55 + 19.7 ng/ml) were tended to be higher than those of controls (26.43 + 19.4 ng/ml), but it did not reach statistical difference (P = 0.712). There was significant correlation between the expression of ER, PR, and serum leptin levels (P = 0.018 and 0.037, respectively), but not with the HER-2/neu receptor expression (P = 0.067). Also association was not found between the tumor size, lymph node involvement, and the levels of serum leptin (P = 0.235, 0.34, and 0.86, respectively). The serum leptin level was also found to be similar in premenopausal (24.85 ± 18.14 ng/ml) and postmenopausal (30.49 ± 17.19 ng/ml) patients (P = 0.235). The preoperative serum leptin levels in breast cancer patients were similar to healthy controls. In subset analysis, the significant correlation between the leptin level and hormonal status was noted, but association with HER-2/neu was not detected. These findings should be confirmed with larger studies.     

胃癌血浆游离DNA检测的临床意义

目的探讨游离DNA(cfDNA)在胃癌术后辅助治疗和晚期胃癌患者血液中的浓度和临床意义。方法选择术后辅助化疗胃癌患者71例和晚期胃癌化疗患者106例为研究对象,同期招募40例健康志愿者作为对照组。每周期化疗前采用(SuperbDNATM)杂交技术检测血浆cfDNA浓度,连续检测3个周期,评价化疗过程中cfDNA浓度变化与疗效的关系。结果化疗前晚期胃癌患者cfDNA浓度为(22.75±12.22)ng/ml,术后辅助化疗患者cfDNA浓度为(22.50±13.86)ng/ml,均高于健康对照组的(12.28±7.72)ng/ml,差异具有统计学意义(P<0.05)。晚期胃癌患者CEA水平与cfDNA浓度有关(P=0.048)。在晚期胃癌中,PR患者的血浆cfDNA浓度呈下降趋势,差异具有统计学意义(P<0.05);SD患者的血浆cfDNA浓度变化趋势差异无统计学意义;PD患者的血浆cfDNA浓度呈现上升趋势,差异具有统计学意义(P<0.05)。术后辅助化疗患者的血浆cfDNA浓度呈下降趋势,差异具有统计学意义(P<0.05)。结论胃癌患者的血浆cfDNA浓度显著升高,与传统肿瘤生物标志物无显著相关性,与化疗疗效呈负相关。因此,血浆cfDNA浓度可作为胃癌诊断与疗效判断的一个潜在指标。     

Expression of survivin mRNA in gallbladder cancer: a diagnostic and prognostic marker?

Survivin, an inhibitor of apoptosis, has been shown to be expressed in various malignancies. However, its role in gallbladder cancer (GBC) has not been evaluated yet. We investigated its expression in peripheral blood of patients with gallbladder diseases (gallstone disease (GSD), n?=?30; GBC, n?=?39) and compared with healthy controls (n?=?25). Survivin expression was correlated with clinicopathological parameters, diagnosis, and prognosis of patients with GBC. Expression of survivin messenger RNA (mRNA) in blood was evaluated by real-time PCR. Significantly higher (P?mRNA was observed in GBC (2.2-fold) and GSD (1.52-fold) as compared to control. In GBC, increased survivin expression was significantly associated with higher tumor stage (stage III vs. stage II; P?P?mRNA relative quantification (RQ) was 1.08, with a sensitivity of 98.55 % and specificity of 100 % for the diseased group (GSD or GBC). RQ value of 1.71 differentiated GBC from GSD with a sensitivity of 89.74 % and specificity of 100 %. Increased expression of survivin was associated with a shorter median overall survival (12 vs. 18 months) in GBC patients. Differential expression of survivin in GBC suggests its possible role and association with poor prognosis. Expression of survivin in peripheral blood could be useful both in the diagnosis and prognosis of GBC.     

Model Based on Alkaline Phosphatase and Gamma- Glutamyltransferase for Gallbladder Cancer Prognosis

Purpose: To evaluate the prognostic value of alkaline phosphatase (ALP) and gamma-glutamyltransferase(GGT) in gallbladder cancer (GBC). Materials and Methods: Serum ALP and GGT levels and clinicopathologicalparameters were retrospectively evaluated in 199 GBC patients. Receiver operating characteristic (ROC) curveanalysis was performed to determine the cut-off values of ALP and GGT. Then, associations with overall survivalwere assessed by multivariate analysis. Based on the significant factors, a prognostic score model was established.Results: By ROC curve analysis, ALP ≥ 210 U/L and GGT ≥ 43 U/L were considered elevated. Overall survivalfor patients with elevated ALP and GGT was significantly worse than for patients within the normal range.Multivariate analysis showed that the elevated ALP, GGT and tumor stage were independent prognostic factors.Giving each positive factor a score of 1, we established a preoperative prognostic score model. Varied outcomeswould be significantly distinguished by the different score groups. By further ROC curve analysis, the simplescore showed great superiority compared with the widely used TNM staging, each of the ALP or GGT alone, ortraditional tumor markers such as CEA, AFP, CA125 and CA199. Conclusions: Elevated ALP and GGT levelswere risk predictors in GBC patients. Our prognostic model provides infomration on varied outcomes of patientsfrom different score groups.     

Clinical significance of serum MMP-2 and MMP-7 in patients with ovarian cancer

Matrix metalloproteinases (MMPs) are frequently expressed in malignant tumors and play an important role in tumor invasion and metastasis. The aim of this study was to evaluate role of serum MMP-2 and MMP-7 levels in patients with ovarian cancer. Serum levels of MMP-2 and MMP-7 were measured in 28 patients with ovarian carcinoma, 2 with borderline ovarian tumors, 10 with non-malignant gynecological disease and 30 healthy women by Enzyme-Linked Immunosorbent Assay (ELISA). Serum MMP-7 level was significantly (10.24 ± 1.35 ng/ml) higher in the patients with ovarian malign tumors than healthy controls (3.29 ± 1.64 ng/ml) (P < 0.05). Postoperative levels of MMP-7 (7.68 ± 1.17 ng/ml) were significantly lower in patients with malign ovarian tumors than those of preoperative level (10.24 ± 1.35 ng/ml) (P < 0.05). Serum MMP-2 levels were significantly lower in the patients with ovarian malign tumors (227.51 ± 9.91 ng/ml) than those in the healthy controls (279.12 ± 73 ng/ml) (P < 0.05). There was no significant difference in serum levels of MMP-2 and MMP-7 in patients with benign ovarian disease when compared to healthy controls and patients with malignant disease (P > 0.05). As a conclusion, MMP-7 can be a useful serum marker to show disease activity in malignant ovarian tumors.     

Evaluation of a Prospective Surgical Strategy of Extended Resection to Achieve R0 Status in Gall Bladder Cancer

Introduction

Radical resection to achieve R0 status remains the only potential curative option in patients with gall bladder cancer (GBC). This study was aimed to evaluate the efficacy of an extended criterion of radical resection to achieve R0 status in GBC.

Methods

A triple-phase CT with 3D reconstruction was done in all patients. A standard resectability criterion was followed in all patients. A minimum of liver segment 4B + 5 resection and radical lymphadenectomy including the para-aortic areas were undertaken in all patients. Adjacent organectomy was added as required.

Results

Between November 2008 and April 2011, 59 patients with GBC underwent operation and 40 (resectability, 68 %) underwent resection. The resectional procedures performed were segmentectomy 4B + 5 in 31 (78 %), median sectorectomy in 2 (5 %), extended right hepatectomy in 3 (8 %), and hepatopancreaticoduodenectomy in 4 (10 %) patients. Postoperative complications occurred in 24 (60 %) patients. Two patients died postoperatively. A total of 829 lymph nodes were harvested and the median lymph node count was 18 (4–77). Twenty-three (58 %) patients had lymph node metastases. Twenty-eight of 40 (70 %) had disease limited till N1 nodes. Metastases up to N2 lymph nodes were seen in 12 (30 %). American Joint Committee on Cancer seventh edition stages were I—2 (5 %) patients, II—5 (13 %), III—19 (48 %), and IV—14 (35 %). R0 resection was achieved in 33 (83 %) patients. Four patients had recurrence and one died of recurrence. All other patients are alive till the last follow-up.

Conclusions

Assessment with triple-phase CT with 3D reconstruction can produce high resectability rate in GBC. Extended criterion of radical resection results in R0 status in more than 80 % of patients with GBC.     

Serum VEGF and VEGF-C values before surgery and after postoperative treatment in gastric cancer

Introduction

Angiogenesis and lymphangiogenesis are essential processes for the formation of blood and lymphatic vessels that allow tumour growth and spread. The binding of VEGF and VEGF-C factors with their receptors (VEGFR2, VEGFR3) in endothelial cells triggers signals that regulate these processes. We compared preoperative serum VEGF and VEGF-C levels with samples obtained after completion of surgery and adjuvant treatment in patients with gastric cancer. In addition, we determined the prognostic value and relationship to survival of serum VEGF and VEGF-C levels.

Methods

We used a prospective cohort study of 59 gastric cancer patients who underwent surgery. Serum VEGF and VEGF-C were measured by enzyme-linked immunosorbent assay (ELISA) the day before surgery and 6 months later, after completion of adjuvant treatment.

Results

Serum VEGF values decreased after treatment in patients with resectable tumours (mean ± SD) (405.42 ± 298.38 vs. 306.38 ± 212.47 pg/ml; p < 0.01), poorly differentiated and undifferentiated tumours (G3, G4) (438 ± 339.71 vs. 322.47 ± 210.71 pg/ml; p = 0.01), locally advanced gastric tumours (T4 stage) (424.27 ± 323.08 vs. 333.62 ± 221.72 pg/ml; p = 0.03) and tumours with a greater number of involved regional lymph nodes (N3) (442.38 ± 311.52 vs. 337.4 ± 203.64 pg/ml; p = 0.04). Serum preoperative VEGF values over 761 pg/ml were associated with shorter patient survival. The mean overall survival time for patients with serum VEGF levels higher than 761 pg/ml was 7 ± 2.99 months (95 % CI 1.14–12.86) while for patients with serum VEGF levels of less than 761 pg/ml was 21.18 ± 2.88 (95 % CI 15.54–26.83) The mean disease-specific survival time for patients with serum VEGF levels higher than 761 pg/ml was 6.25 ± 2.53 months (95 % CI 1.29–11.21) while for patients with serum VEGF levels of less than 761 pg/ml was 27.57 ± 3.45 (95 % CI 20.80–34.35). Multivariate analysis identified preoperative serum VEGF levels as an independent prognostic factor (HR = 0.144; p = 0.03).

Conclusions

Serum VEGF levels decreased after the completion of treatment in patients with resected tumours, suggesting VEGF tracking may be useful in monitoring progression. Preoperative measurement of serum VEGF may help us identify patients with a poor prognosis.     

Negative feedback of miR-29 family TET1 involves in hepatocellular cancer

Circulating tumor cells (CTCs) are valuable for diagnosis, monitoring therapy and prognosis in primary lung cancer. Herein, we evaluated the clinical significance of lung cancer CTCs in this study. Detection of CTCs was performed using epithelial cell adhesion molecule-independent enrichment and CD45 fluorescence in situ hybridization detection. CTCs ≥2/3.2 mL were considered as positive. The positive rates in primary lung cancer, benign lung disease and healthy control groups were 84, 0 and 4.2 %. CTCs count was significantly higher in lung cancer patients than healthy controls and benign lung disease, with an area under ROC curve of 0.917 (95 % confidence interval 0.855–0.979; p = 0.000) between lung cancer and nonmalignant diseases. CTCs count significantly increased with an increase in pathological stage with mean count of 2.3 ± 2.6 (stage I–II), 3.5 ± 3.3 (stage III) and 4.5 ± 4.3 (stage IV), respectively. The positive detection rate of CTCs for primary lung cancer diagnosis was higher than serum tumor markers. In total, 25 metastasis lung cancer patients participated in the follow-up. Changes in CTCs count after two cycles of chemotherapy were consistent with radiographic appearance. Moreover, CTCs count was better than serum tumor markers for monitoring chemotherapy response. Median progression-free survival (PFS) was 2.05, 3.25 and 8.348 months (p < 0.05) in group in which post-treatment CTCs count was increased, unchanged and decreased, respectively. Furthermore, PFS in patients whose post-treatment CTCs count increased or were unchanged accompanied by a baseline CTCs count <3 was significantly shorter than those whose post-treatment CTCs count decreased or was unchanged accompanied with baseline value ≥3 (1.85 vs. 8.22 months, p = 0.000). Therefore, CTCs are a reproducible indicator of disease status that may be superior to imaging.     

A phase II study of gemcitabine and oxaliplatin (Oxigem) in unresectable gall bladder cancer

Purpose

There is a need for effective chemotherapy protocols for gall bladder cancer (GBC). Gemcitabine has antitumor activity in pancreatic cancer. Oxaliplatin is effective in GI cancers. Based on evidence of synergy between these two, we designed this study to evaluate efficacy of this combination in unresectable GBC.

Design

Unresectable GBC was enrolled for single center phase II study. Drugs gemcitabine 900 mg/m² and oxaliplatin 80 mg/m² IV infusion (Oxigem) on days 1 and 8 every 3 weeks for a maximum of six cycles or unacceptable toxicity which ever was earlier.

Materials and methods

Fifty patients were enrolled and analysis was restricted to 48 who were treated. Median age was 50 years and 31 patients were females.

Results

CR 3 (6.2%), PR 7 (15%), SD 17 (35.4%), and PD 18. One had complete pathological response. Median OS and PFS were 7.5 and 3 months, respectively. OS in responders was 10.5 versus 4 months in non-responders (p < 0.0000). Eleven patients (23%) survived for a year or more. There was no toxic death and grade III/IV toxicity seen in 10 (22%) patients: diarrhea 3, vomiting 2, neutropenia and thrombocytopenia 5 patients.

Conclusion

This combination of Oxigem effective in unresectable GBC. It may even induce complete pathological response. One-year survival was 20%. There is a need for controlled trial to assess efficacy of this combination.     

Spermidine radioimmunoassay in monitor of precancerous lesions of esophagus

Serum spermidine was assayed by radioimmunoassay in different stages of esophageal carcinogenesis in the population from high risk area of esophageal cancer, Linxian County. The serum spermidine values were 76.94±74.38 ng/ml in 36 normal individuals; 115.71±113.45 ng/ml in 35 patients with marked epithelial hyperplasia (MEH) and 294.48±135.36 ng/ml in 31 patients with early esophageal cancer. Patients with MEH were given intervention treatment by Aminoretinoic Ester or Anticancer B or placebo (starch) as controls. One year later, samples from the population were collected again for serum spermidine measurement. The values were 95.8+68.2 ng/ml in 27 normals; 125.1±72.9 ng/ml in 62 patients with MEH treated by Anticancer B; 125.6±117.2 ng/ml in 64 patients with MEH treated by Aminoretinoic Ester; 162.4±76.6 ng/ml in 62 controls and 210.5±182.9 ng/ml in 44 patients with early esophageal cancer. The results showed that spermidine radioimmunoassay could reflect the tendency of esophageal precancerous changes toward cancer or back to nromal. They can be taken as a mid-way monitor indicator for tumor-blocking drugs. Also, it could be of value in the early diagnosis of esophageal cancer.     

Primary carcinoma of gallbladder in Yazd, Iran: A 14-year study (1992–2006)

Aim: To investigate the clinico‐pathological profile and stage of disease at presentation of patients with carcinoma of the gallbladder diagnosed during 1992–2006 in Iran. Methods: During this study period 34 consecutive patients with gallbladder carcinoma were identified using a pathology‐based tumor database. The data extracted for each study patient included their gender, age at diagnosis, signs and symptoms, presence of gallstones and histopathological pattern of the gallbladder carcinoma and the UICC/AJCC TNM staging system was used for labeling the stages of the disease. Results: The median age of the 34 patients studied was 69.50 with most between 61 and 70 years of age. The age range of the men was between 53 and 80 years with a median age of 71.50 years and that of the women was between 33 and 79 years with a median age of 68.50 years. The most common symptom was pain in the right hypochondrium. More women had gallstones (15/34) than men (3/10). Adenocarcinoma was the most common histopathological type (91.18%) with the commonest subtype being papillary (47.06%). Eighteen patients had stage IB and stage IIA (52.94%) carcinomas whereas stages IIB and III were observed in six (17.6%) and seven cases (20.6%), respectively. Only three cases (8.82%) were seen in stage IV. The follow up of gall bladder carcinoma (GBC) patients in this study ranged from 6 to 60 months. However, there was a progressive reduction of patients attending follow‐up oncology clinic, particularly by those who had stages III and IV of the disease. Conclusion: Most patients (52.94%) presented with early disease (stage IB and IIA) which carries a good prognosis. Early detection of GBC and a national consensus for the evidence‐based management of GBC in Iran should be the major components of a strategy aimed at improving therapeutic outcome.     

Serum levels of osteopontin as a prognostic factor in patients with oral squamous cell carcinoma

Osteopontin (OPN) is a multifunctional glycophosphoprotein that was detected in many carcinomas, and it may have a prognostic role. The aim of this study was to determine osteopontin serum levels in patients with oral squamous cell carcinoma (OSCC) and investigated its correlation with clinicopathological features of tumor. Using an ELISA kit, we assessed and compared the circulating levels of OPN in blood serum of 45 oral squamous cell carcinoma patients with 45 healthy control samples. The serum osteopontin level in patients with OSCC was significantly higher (145.8?±?14.6 ng/ml, n?=?45) compared with the healthy controls (53.9?±?9.6 ng/ml, n?=?45, p?<?0.001). Mean serum osteopontin level was significantly higher in patients with nodal metastasis (p?=?0.03) and higher stage (p?=?0.02). Findings of the present study suggest that OPN may have a potential role in pathogenesis of OSCC and it may be used as a tool for monitoring tumor progression.     

cfDNA在胰腺癌中的诊断价值

目的 探讨cfDNA在胰腺癌中的诊断价值。方法 选取467例胰腺癌患者和129例健康对照受试者,采用QuantiDNA Direct cfDNA Test（DiaCarta）试剂盒检测cfDNA浓度。采用Mann-Whitney U检验比较不同组间cfDNA浓度差异,卡方检验分析cfDNA与胰腺癌病理资料的关系。ROC曲线评估诊断效能。结果 胰腺癌患者cfDNA水平显著高于健康对照组（20.85 vs. 15.15 ng/ml, P=0.0027）。cfDNA在胰腺癌中的阳性率高于健康对照组（77.73% vs. 59.68%）。 cfDNA、CEA和CA19-9作为诊断标志物的敏感度分别为62.65%、64.04%和60.32%,特异性分别为61.05%、70.53%和87.37%。cfDNA联合检测CEA和CA19-9敏感度为77.26%,特异性为53.58%。cfDNA、CEA、CA19-9和联合检测曲线下面积分别为0.62、0.67、0.74和0.67。结论 cfDNA在胰腺癌患者中水平升高,可作为胰腺癌潜在的辅助诊断标志物。     

Patterns of Presentation,Treatment, and Survival Rates of Gallbladder Cancer: a Prospective Study at a Tertiary Care Centre

Background

India has high incidence of gallbladder carcinoma with regional variation in incidence, the highest in Northern India. This study examines the patterns of presentation, treatment strategies, and survival rate of all patients with gallbladder cancer (GBC) evaluated at our tertiary academic hospital over a period of 2 years.

Methods

All patients presented to our institute with established tissue diagnosis of carcinoma gallbladder were accrued in our study over a time period of 2 years. Presentation, treatment modalities, and survival rates were analyzed.

Results

One hundred six patients were included: 80 females and 26 males (F: M = 3:1). Median age was 60 years. Eighty patients (75%) had gallstones and 20 patients (21%) had typical history of chronic cholecystitis. The common symptom and sign at presentation were pain in the right upper abdomen (81%) and lump abdomen (49%), respectively. Overall resectability rate was 19.8% (21/106). Eighty-five patients were unresectable or metastatic and treated with palliative intent. Stagewise distribution at diagnosis was stage I (0%), stage II (4%), stage IIIA (10%), stage IIIB (8%), stage IVA (17%), and stage IVB (61%). Estimated 1-year survival for stages II, IIIA, IIIB, IVA, and IVB was 100, 76, 47.4, 26, and 10.6%, respectively. Significant difference in OS was observed among different stages of GBC (p value <0.001).

Conclusion

If proper investigations are done, radical surgery including multi-organ resection can be curative with acceptable morbidity and mortality. Stage at presentation and ability to perform curative resection are the most important prognostic factors predicting survival. Palliative chemotherapy should be considered for metastatic GBC.