Adenocarcinoma of gastric cardia in the elderly： Surgical problems and prognostic factors

AIM: To analyze retrospectively, our results about patients who underwent surgical treatment for adenocarcinoma of the cardia in relation to age, in order to evaluate surgical problems and prognostic factors. METHODS: From January 1987 to March 2003, 140 patients with adenocarcinoma of the cardia underwent resection in the authors' institution. They were divided into three groups with regard to age. Patients <70 and > 60 year old (31) were excluded; we also excluded 18 out of 109 patients with poor general status or systemic metastases. So, we compared 51 elderly (≥ 70 year old) and 58 younger patients (≤ 60 year old). The treatment was esophagectomy for type Ⅰ tumors, and extended gastrectomy and distal esophagectomy for type Ⅱ and Ⅲ lesions. RESULTS: Laparotomy was carried out in 91 patients (83.4%), 38 in the elderly (74.5%) and 53 in younger patients (91.3%, P<0.05). Primary resection was performed in 81 cases (89%) without significant differences between the two groups. Postoperative death was higher in the elderly (12.1%) than the other group (4.1%, P<0.05), while morbidity was similar in both groups. A curative resection (RO) was performed in 59 patients (72.8%), 69.6% in the elderly and 75% in the younger group (P>0.05). The overall 3- and 5-year survival rates were 26.7% and 17.8% respectively for the elderly and 40.7% and 35.1% respectively for younger patients (P= 0.1544). Survival rates were significantly associated with RO resection, pathological node-positive category and tumor differentiation in both groups. CONCLUSION: As the age of the general population increases, more elderly patients with gastric cardia cancer will be candidates for surgical resection. Age alone should not preclude surgical treatment in elderly patients with gastric cardia cancer and a tumor resection can be carried out safely. Certainly, we should take care in defining the surgical treatment in elderly patients, particularly as regarding the surgical approach; although the surgical approach does not influence the survival rate, the transhiatal way still remains the best one due, to the lower incidence of respiratory morbidity and thoracic pain.     

Characteristics of patients with columnar-lined Barrett＇s esophagus and risk factors for progression to esophageal adenocarcinoma

AIM: To determine the risk factors for the development of esophageal adenocarcinoma in these patients with columnar-lined esophagus (CLE). METHODS: Data collected retrospectively on 597 consecutive patients diagnosed at endoscopy and histology to have CLE at Leeds General Infirmary between 1984 and 1995 were analyzed. Factors evaluated included age, sex, length of columnar segment, smoking, and drinking habits, history of non-steroidal ingestion, presence of endoscopic esophagitis, ulceration or benign strictures and presence of Helicobacter pylori in esophageal biopsies. Univariate and multivariate analyses were performed to identify risk factors for the development of adenocarcinoma. RESULTS: Forty-four patients presented or developed esophageal adenocarcinoma during follow-up. Independent risk factors for the development of adenocarcinoma in patients with CLE were males (OR 5.12, 95%CI 2.04-12.84, P = 0.0005), and benign esophageal stricture (OR 4.37, 95%CI 2.02-9.45, P = 0.0002). Male subjects and patients who developed benign esophageal stricture constituted 86% (n = 38) of all patients who presented or developed esophageal adenocarcinoma. The presence of esophagitis was associated with a significant reduction in the development of esophageal carcinoma (OR 0.28, 95%CI 0.13-0.57, P = 0.0006). No other clinical characteristics differentiate between the non-malignant and malignant group. CONCLUSION: In patients with CLE, endoscopic surveillance for the early detection of adenocarcinoma may be restricted to male subjects, as well as patients who develop benign esophageal strictures.     

Bile duct hamartomas （von Mayenburg complexes） mimicking liver metastases from bile duct cancer： MRC findings

We present a case of a 72-year-old man with a common bile duct cancer, who was initially believed to have multiple liver metastases based on computed tomography findings, and in whom magnetic resonance cholangiography (MRC) revealed a diagnosis of bile duct hamartomas. At exploration for pancreaticoduodenectomy, liver palpation revealed disseminated nodules at the surface of the liver. These nodules showed gray-white nodular lesions of about 0.5 cm in diameter scattered on the surface of both liver lobes, which were looked like multiple liver metastases from bile duct cancer. Frozen section of the liver biopsy disclosed multiple bile ducts with slightly dilated lumens embedded in the collagenous stroma characteristics of multiple bile duct hamartomas (BDHs). Only two reports have described the MRC features of bile duct hamartomas. Of all imaging procedures, MRC provides the most relevant features for the imaging diagnosis of bile duct hamartomas.     

Living-related liver transplantation for multiple liver metastases from rectal carcinoid tumor： A case report

A 42-year-old woman was admitted to our hospital because of multiple liver tumors detected by ultrasono-graphy. Colonoscopy revealed submucosal tumor in the rectum, which was considered the primary lesion. Endo-scopic mucosal resection followed by histopathological examination revealed that the tumor was carcinoid. The resected margin of the tumor was positive for malignant cells. Two courses to transcatheter arterial chemotherapy for liver metastasis were ineffective. Accordingly, the rectal tumor and metastatic lymph nodes were surgically resected. One month after the operation, she received liver transplantation (left lateral segment and caudate lobe) from her son. No recurrent lesion has been observed at two years after the liver transplantation. Liver transplantation should be considered as a treatment option even in advanced case of carcinoid metastasis to the liver. We also discuss the literature on liver transplantation for metastatic carcinoid tumor.     

Metastatic breast cancer to the gastrointestinal tract： A case series and review of the literature

INTRODUCTION Breast cancer is the most common neoplasm in women, accounting for approximately 32% of cancers in women, with a lifetime risk of 1 in 10[1]. Prognosis is related to the presence of hormonal receptors, the size and grade of the primary tumour…     

Risk factors for Barrett＇s oesophagus and oesophageal adenocarcinoma： Results from the FINBAR study

AIM:To investigate risk factors associated with Barrett's oesophagus and oesophageal adenocarcinoma.METHODS:This all-Ireland population-based case-control study recruited 224 Barrett's oesophagus patients,227 oesophageal adenocarcinoma patients and 260 controls.All participants underwent a structured interview with information obtained about potential lifestyle and environmental risk factors.RESULTS:Gastro-oesophageal reflux was associated with Barrett's [OR 12.0(95% CI 7.64-18.7)] and oesophageal adenocarcinoma [OR 3.48(95% CI 2.25-5.41)].Oesophageal adenocarcinoma patients were more likely than controls to be ex-or current smokers [OR 1.72(95% CI 1.06-2.81)and OR 4.84(95% CI 2.72-8.61)respectively] and to have a high body mass index [OR 2.69(95% CI 1.62-4.46)].No significant associations were observed between these risk factors and Barrett's oesophagus.Fruit but not vegetables were negatively associated with oesophageal adenocarcinoma [OR 0.50(95% CI 0.30-0.86)].CONCLUSION:A high body mass index,a diet low in fruit and cigarette smoking may be involved in the progression from Barrett's oesophagus to oesophageal adenocarcinoma.     

Metastatic liver cancer： A rare case

Hemangiopericytoma is a rare tumor especially when it rises in the peritoneal cavity. We present a case of a 60-year-old woman with an isolated recurrent hemangiopericytoma of the liver. The patient presented with a palpable right upper quadrant abdominal mass, which occurred 7 years after undergoing resection of a malignant hemangiopericytoma arising from the greater omentum. She had not followed up 6 mo after surgery. Various imaging studies showed a single large, well-capsulated liver tumor with central necrosis, accompanied by hypervascularity typical of a vascular tumor. Preoperative laboratory HBsAg and anti-HCV workup were both negative. Under the impression of recurrent malignant hemangiopericytoma, right triseg-mentectomy was performed to completely resect the tumor. Pathological examination confirmed the diagnosis of recurrent hemangiopericytoma. Even though the incidence of the hemangiopericytoma is relatively low, malignant hemangiopericytoma has a tendency to recur frequently after a long-term disease-free interval. Also, the recurrent hemangiopericytoma is not easily detected early during follow-up until it becomes symptomatic because there are no specific tumor markers, and because of the diversity with regard to site of recurrence. The authors suggest that Positron Emission Tomogram (PET) may be a useful tool for the detection of recurrent hemangiopericytoma. We describe herein some characteristics and behaviors of malignant hemangiopericytoma, particularly after surgical resection.     

Proposal of criteria to select candidates with colorectal liver metastases for hepatic resection： Comparison of our scoring system to the positive number of risk factors

INTRODUCTION It is well accepted that hepatic resection for colorectal liver metastases is beneficial; it has been reported survival rates improve to as high as almost 30% to 50% at 5 years after curative hepatic resection recently[1-10]. However, the fea…     

Atrial fibrillation after surgery for esophageal carcinoma： Clinical and prognostic significance

AIM:To retrospectively evaluate the clinical relevance,perioperative risk factors,outcome of differentpharmacological prophylaxis,and short-term prognosticvalue of atrial fibrillation(AF)after surgery foresophageal carcinoma.METHODS:We retrospectively studied 63 patients withAF after surgery for esophageal carcinoma in comparisonwith 126 patients without AF after esophagectomyduring the same time.Postoperative AF incidence wasrelated to different clinical factors possibly involved in itsoccurrence and short-term survival.RESULTS:A strong relationship was observed betweenAF and postoperative hypoxia,history of chronicobstructive pulmonary disease(COPD),postoperativethoracic-gastric dilatation,age older than 65 years,malesex and history of cardiac disease.No difference wasobserved between the two groups with regard to short-term mortality and length of hospital stay.CONCLUSIONS:AF occurs more frequently afteresophagectomy in aged and male patients.Other factorscontributing to postoperative AF are history of COPD andcardiac disease,postoperative hypoxia and thoracic-gastric dilatation.     

Prognostic factors in patients with node-negative gastric carcinoma： A comparison with node-positive gastric carcinoma

AIM: To identify the clinicopathological characteristics of lymph node-negative gastric carcinoma, and also to evaluate outcome indicators in the lymph node-negative patients. METHODS: Of 2848 gastric carcinoma patients, 1524 (53.5%) were lymph node-negative. A statistical analysis was performed using the Cox model to estimate outcome indicators. RESULTS: There was a significant difference in the recurrence rate between lymph node-negative and lymph node-positive patients (14.4% vs 41.0%, P<0.001). The 5-year survival rate was significantly lower in lymph node-positive than in lymph node-negative patients (31.1% vs 77.4%, P<0.001). Univariate analysis revealed that the following factors influenced the 5-year survival rate: patient age, tumor size, depth of invasion, tumor location, operative type, and tumor stage at initial diagnosis. The Cox proportional hazard regression model revealed that tumor size, serosal invasion, and curability were independent, statistically significant, prognostic indicators of lymph node-negative gastric carcinoma. CONCLUSION: Lymph node-negative patients have a favorable outcome attributable to high curability, but the patients with relatively large tumors and serosal invasion have a poor prognosis. Curability is one of the most reliable predictors of long-term survival for lymph node-negative gastric carcinoma patients.     

结直肠癌肝转移的预后因素

目的:评价结直肠癌肝转移的临床预后因素及治疗方案对预后的影响.方法:收集71例结直肠癌肝转移患者的临床资料及预后情况,用Kaplan-Meier生存分析及Log-rank检验进行单因素分析,将有统计学意义的预后因素纳入Cox回归模型进行多因素分析.结果:Kaplan-Meier单因素分析及Log-rank检验显示,肝转移灶最大直径、有无区域淋巴结转移及诊断肝转移时碱性磷酸酶(ALP)最高值3个因素对其预后影响有显著意义;将这3个预后因素纳入Cox回归多因素分析显示,有无区域淋巴结转移、诊断肝转移时ALP最高值是结直肠癌肝转移的独立预后因素.全组3种治疗方式比较差别无统计学意义,但对手术切除组和化疗组两组进行比较,差异有统计学意义(P<0.05),而局部治疗组和手术组之间,局部治疗组和化疗组之间差别无统计学意义.结论:肝转移灶最大直径、原发病灶有无区域淋巴结转移、诊断肝转移时最高ALP值是结直肠癌肝转移患者的预后因素;肝转移灶最大直径越小、无区域淋巴结转移、诊断肝转移时最高ALP值正常的患者预后越好;手术切除联合化疗目前是结直肠癌肝转移的首选治疗方案,可获得较好的远期生存.     

Surgery for liver metastases from breast cancer

Liver metastases develop in approximately half of women with metastatic breast cancer, and are typically associated with metastases at other sites, indicating advanced disease and poor prognosis. Whenever possible, hormonal therapy should be administered, until resistance develops. Several series in the literature have reported a poor effect of chemotherapy alone in patients with metastatic breast cancer, therefore liver surgery could be considered as an adjuvant treatment to systemic therapy in highly selected patients. This study looked at recent case series in the literature, and analysed prognostic factors and indications for surgery.     

结直肠癌同时性肝转移患者原发灶切除的预后分析

目的 原发灶切除能否使结直肠癌肝转移患者生存获益,目前仍有争议.本研究探讨接受原发灶切除结直肠癌肝转移患者的生存状况及预后的影响因素.方法 回顾性分析2010年1月～2018年2月在国家癌症中心/中国医学科学院肿瘤医院治疗的371例结直肠癌同时性肝转移患者的病例资料.根据治疗方式分为单纯化疗组和原发灶切除组,分析两组患...     

Predictive model for acute abdominal pain after transarterial chemoembolization for liver cancer

BACKGROUND Transarterial chemoembolization(TACE) is the first-line treatment for patients with unresectable liver cancer;however,TACE is associated with postembolization pain.AIM To analyze the risk factors for acute abdominal pain after TACE and establish a predictive model for postembolization pain.METHODS From January 2018 to September 2018,all patients with liver cancer who underwent TACE at our hospital were included.General characteristics;clinical,imaging,and procedural data;and postembolization pain were analyzed.Postembolization pain was defined as acute moderate-to-severe abdominal pain within 24 h after TACE.Logistic regression and a classification and regression tree were used to develop a predictive model.Receiver operating characteristic curve analysis was used to examine the efficacy of the predictive model.RESULTS We analyzed 522 patients who underwent a total of 582 TACE procedures.Ninety-seven(16.70%) episodes of severe pain occurred.A predictive model built based on the dataset from classification and regression tree analysis identified known invasion of blood vessels as the strongest predictor of subsequent performance,followed by history of TACE,method of TACE,and history of abdominal pain after TACE.The area under the receiver operating characteristic curve was 0.736 [95% confidence interval(CI):0.682-0.789],the sensitivity was 73.2%,the specificity was 65.6%,and the negative predictive value was 92.4%.Logistic regression produced similar results by identifying age [odds ratio(OR) = 0.971;95%CI:0.951-0.992;P = 0.007),history of TACE(OR = 0.378;95%CI:0.189-0.757;P = 0.007),history of abdominal pain after TACE(OR = 6.288;95%CI:2.963-13.342;P 0.001),tumor size(OR = 1.978;95%CI:1.175-3.330;P = 0.01),multiple tumors(OR = 2.164;95%CI:1.243-3.769;P = 0.006),invasion of blood vessels(OR = 1.756;95%CI:1.045-2.950;P = 0.034),and TACE with drug-eluting beads(DEBTACE)(OR = 2.05;95%CI:1.260-3.334;P = 0.004) as independent predictive factors for postembolization pain.CONCLUSION Blood vessel invasion,TACE history,TACE with drug-eluting beads,and history of abdominal pain after TACE are predictors of acute moderate-to-severe pain.The predictive model may help medical staff to manage pain.     

Preliminary experience with transarterial chemoembolization (TACE) in liver metastases of uveal malignant melanoma: local tumor control and survival

Purpose To evaluate results in the palliative treatment of patients with liver metastases of uveal malignant melanoma using transarterial chemoembolization (TACE). Materials and methods Superselective TACE was repeatedly performed in 12 patients with liver metastases of uveal malignant melanoma. Six patients presented with solitary liver metastases (6–12 cm in size) and six patients with oligonodular metastases (n ≤ 6). The embolization suspension consisted of a maximum of 10 mg/m² Mitomycin C, 10 ml Lipiodol, and an injection of 200–450 mg resorbable microspheres for vascular occlusion. In the follow-up, magnetic resonance imaging was performed in 3-month intervals. Results The TACE procedure was well tolerated in all patients without any relevant side effects. Three patients responded to TACE with a size reduction of more than 50% (partial response), five patients with stable disease, and four patients with progressive disease with an increase in volume of more than 25%. Mean survival following primary tumor treatment was 32.9 months, and after first embolization 19.5 months. Lower survival rates were recorded for the progressive group (16.5 months). Conclusion Repeated TACE offers a palliative treatment option in patients with oligonodular liver metastases of uveal malignant melanoma.     

结直肠癌肝转移的危险因素分析138例

目的:探讨影响结直肠癌肝转移的危险因素.方法:采用Kaplan-Meier和多因素回归分析方法,分析138例有完整随访资料的结直肠癌肝转移患者的生存情况及影响预后的相关因素.结果:138例患者的中位生存时间为18.3mo.单因素分析显示,患者年龄(P=0.460)、原发肿瘤部位(P=0.568)、原发肿瘤最大直径(P=0.250)、原发肿瘤组织学分级(P=0.589)与患者的总生存时间无关,而性别(P=0.048)、治疗前血清CEA水平(P=0.023)、肝转移灶数目(P=0.000)、肝转移灶最大直径(P=0.001)、区域淋巴结转移情况(P=0.001)、肝转移灶手术与否(P=0.002)与患者的预后有关.多因素回归分析显示,治疗前血清CEA水平(P=0.028)、肝转移灶数目(P=0.001)、肝转移灶最大直径(P=0.001)、区域淋巴结转移情况(P=0.049)、肝转移灶手术与否(P=0.003)是影响结直肠癌肝转移患者预后的主要因素.结论:治疗前血清CEA水平、肝转移灶数目、肝转移灶最大直径、区域淋巴结转移情况、肝转移灶手术与否是结直肠癌肝转移患者预后的影响因素;治疗前血清CEA水平越低、肝转移灶数目越少、肝转移灶最大直径越小、无区域淋巴结转移、肝转移灶通过手术治疗的患者预后越好.     

Chemotherapy and resection for gastric cancer with synchronous liver metastases

AIM: To investigate the effect of surgery and chemotherapy for gastric cancer with multiple synchronous liver metastases (GCLM). METHODS: A total of 114 patients were entered in this study, and 20 patients with multiple synchronous liver metastases were eligible. After screening with preoperative chemotherapy, 20 patients underwent curative gastrectomy and hepatectomy for GCLM; 14 underwent major hepatectomy, and the remaining six underwent minor hepatectomy. There were 94 patients without aggressive treatment, and they were in the non-operative group. Two regimens of perioperative chemotherapy were used: S-1 and cisplatin (SP) in 12 patients, and docetaxel, cisplatin and 5-fluorouracil (DCF) in eight patients. These GCLM patients were given preoperative chemotherapy consisting of two courses chemotherapy of SP or DCF regimens. After chemotherapy, gastrectomy and hepatectomy were preformed. Evaluation of patient survival was by follow-up contact using telephone and outpatient records. All patients were assessed every 3 mo during the first year and every 6 mo thereafter. RESULTS: Twenty patients underwent gastrectomy and hepatectomy and completed their perioperative chemotherapy and hepatic arterial infusion before and after surgery. Ninety-four patients had no aggressive treatment of liver metastases because of technical difficulties with resection and severe cardiopulmonary dysfunction. In the surgery group, there was no toxicity greater than grade 3 during the course of chemotherapy. The response rate was 100% according to the Response Evaluation Criteria in Solid Tumors Criteria. For all 114 patients, the overall survival rate was 8.0%, 4.0%, 4.0% and 4.0% at 1, 2, 3 and 4 years, respectively, with a median survival time (MST) of 8.5 mo (range: 0.5-48 mo). For the 20 patients in the surgery group, MST was 22.3 mo (range: 4-48 mo). In the 94 patients without aggressive treatment, MST was 5.5 mo (range: 0.5-21 mo). There was a significant difference between the surgery and unresectable patients (P = 0.000). Thr     

Role of surgery in colorectal cancer liver metastases

Colorectal carcinoma (CRC) is the third most common cancer, and approximately 35%-55% of patients with CRC will develop hepatic metastases during the course of their disease. Surgical resection represents the only chance of long-term survival. The goal of surgery should be to resect all metastases with negative histological margins while preserving sufficient functional hepatic parenchyma. Although resection remains the only chance of long-term survival, management strategies should be tailored for each case. For patients with extensive metastatic disease who would otherwise be unresectable, the combination of advances in medical therapy, such as systemic chemotherapy (CTX), and the improvement in surgical techniques for metastatic disease, have enhanced prognosis with prolongation of the median survival rate and cure. The use of portal vein embolization and preoperative CTX may also increase the number of patients suitable for surgical treatment. Despite current treatment options, many patients still experience a recurrence after hepatic resection. More active systemic CTX agents are being used increasingly as adjuvant therapy either before or after surgery. Local tumor ablative therapies, such as microwave coagulation therapy and radiofrequency ablation therapy, should be considered as an adjunct to hepatic resection, in which resection cannot deal with all of the tumor lesions. Formulation of an individualized plan, which combines surgery with systemic CTX, is a necessary task of the multidisciplinary team. The aim of this paper is to discuss different approaches for patients that are treated due to CRC liver metastasis.     

乳腺癌患者接受术后辅助化疗的影响因素分析

目的 探讨65岁以上乳腺癌患者接受术后辅助化疗的影响因素. 方法 采用χ2检验和Logistic回归分析方法对590例65岁以上浸润性乳腺癌患者术后辅助化疗的影响因素进行分析. 结果 全组接受术后辅助化疗者231例,占39.15%.结果表明,并存糖尿病、年龄、手术方式及肿瘤的病理生物学特征对患者接受术后辅助化疗有影响(χ2值分别为4.49、88.27、23.49及9.40,均为P<0.05).Logistic回归分析结果显示.年龄、术后病理肿瘤最大径(pT)、术后病理淋巴结状况(pN)、雌激素受体(ER)对接受术后辅助化疗有影响(χ2值分别为68.857、15.284、43.540、7.009,均为P<0.01).淋巴结阳性激素受体阴性的患者中44例(66.7%)接受了术后辅助化疗. 结论 肿瘤大小、淋巴结状况、激素受体状况和年龄是老年乳腺癌患者接受术后辅助化疗的独立预测因素.     

New prognostic model for patients with advanced gastric cancer: Fluoropyrimidine/platinum doublet for first-line chemotherapy

BACKGROUNDNew prognostic factors have been reported in patients with metastatic or recurrent gastric cancer (MRGC), necessitating modifications to the previous prognostic model.AIMTo develop a new model, MRGC patients who received fluoropyrimidines/ platinum doublet chemotherapy between 2008 and 2015 were analyzed.METHODSA total of 1883 patients was divided into a training set (n = 937) and an independent validation set (n = 946).RESULTSMultivariate analysis showed that the following six factors were associated with poor overall survival (OS) in the training set: Eastern Cooperative Oncology Group performance score ≥ 2 and bone metastasis (2 points each), peritoneal metastasis, high alkaline phosphatase level, low albumin level, and high neutrophil-lymphocyte ratio (1 point each). A prognostic model was developed by stratifying patients into good (0-1 point), moderate (2-3 points), and poor (≥ 4 points) risk groups. In the validation set, the median OS of the three risk groups was 15.8, 10.1, and 5.7 mo, respectively, and those differences were significant (P < 0.001).CONCLUSIONWe identified six factors readily measured in clinical practice that are predictive of poor prognosis in patients with MRGC. The new model is simpler than the old and more easily predicts OS.