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??Updates and interpretations of the 8th edition of AJCC breast cancer staging system ZHOU Bin????JI Ke,XIN Ling,et al. ??Department of Surgery,Peking University First Hospital,Beijing100034,China
Corresponding author: LIU Yin-hua, E-mail: liuyinhua@
medmail.com.cn
Abstract It has been 40 years since the publication of 1st edition of AJCC cancer staging system, and there has been 8 editions. The consistent fundamental principle is insisting that the combination of primary tumor (T), regional lymph nodes (N) and metastases ??M?? is the cornerstone of cancer staging. Updates of 8th edition of breast cancer staging system include building up both Anatomic Stage Group and Prognostic Stage Group for the first time, redefining and detailing the definitions of T, N, M, and adding a large number of non-anatomical factors into prognostic evaluation, which is the highlight of this edition. The 8th edition staging system recommends that Oncotype Dx® MultiGene Panel should be used in appropriate patient population for the first time. The new staging system not only accelerates the progress of cancer staging system from level of macroanatomy to genomics, but also realizes the transformation of personalized medicine from theory to practice.     

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??Clinical value of serum CA19-9 in the diagnosis of suspected pancreatic cancer by imaging methods WANG Wei-lin*, WU Ze-hui, ZHU Feng, et al. Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou310003, China
Corresponding author: ZHENG Shu-sen, E-mail:shusenzheng@zju.edu.cn
Abstract Objective To explore the clinical value of the combination of serum tumor marker CA19-9 and imaging methods (computed tomography and magnetic resonance imaging) in the diagnosis of pancreatic cancer. Methods The clinical data of 267 patients with suspected pancreatic cancer by imaging methods admitted from January 2010 to February 2012 in Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital of Medical School of Zhejiang University were analyzed retrospectively. Results In all 267 patients, 225 (83.0%) and 42 (17.0%) patients were diagnosed as pancreatic cancer and non-pancreatic cancer respectively. In the pancreatic cancer group, serum CA19-9 was elevated in 173 (76.9%) patients. Eighty-five patients with suspected pancreatic cancer by imaging methods had normal CA19-9 value. Among them, 52 (61.2%) patients were finally diagnosed as pancreatic cancer on pathology, and 33 (38.8%) patients as non-pancreatic cancer. One hundred and eighty-two patients with suspected pancreatic cancer by imaging methods had elevated CA19-9 value. Among them, 173 patients were finally diagnosed as pancreatic cancer on pathology and 9 patients as non-pancreatic cancer. Conclusion Serum tumor marker CA19-9 may provide valuable clues for the diagnosis of pancreatic cancer which is suspected by imaging methods. As to CA19-9 negative patients, in whom pancreatic cancer is suspected by imaging methods, much more attention should be paid to the possibility of false positive results of imaging methods. Pancreas puncture before surgery is recommended to confirm the diagnosis and exclude the possibility of chronic pancreatitis, pancreatic neuroendocrine tumors and solid-pseudopapillary tumor, etc. As to patients with elevated CA19-9 and imaging methods suspected pancreatic cancer, operation is recommended.     

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??PredictIve value of EMVI detected by MDCT combined with CA19-9 for prognosis of stage III colon caner patients ZHOU Jing*,Yao Xun,ZHANG Hui, et al.*Department of Gastroenterological Surgery,Peking University People’s Hospital, Beijing 100044??China
Corresponding author: WANG Shan, E-mail??wangshan@pkuph.edu.cn
Abstract Objecetive To investigate the ability of extramural vascular invasion??EMVI?? in predicting 3-years disease-free survival ??3yr DFS?? of patients with colon cancer. Methods Between February 2009 and December 2013?? patients who had histologically proven primary colon cancer and underwent curative resection were included in this retrospective study. EMVI was defined as tumor tissue in adjacent vessels beyond colon wall on MDCT. DFS was defined as the time from the date of curative resection to the date of local recurrence?? and/or distant disease?? or tumor-related death. Univariate and multivariate analysis were conducted to identify prognostic factors associated with 3yr DFS. Kaplan-Meier analyses were used to compare 3yr DFS. Cox’s proportional hazards models were used to measure the impact of confounding variables on survival rates. Chi-square test was used to analyze the difference of recurrent/metastatic rate. Results In final?? 90 patients were included in this study that were identified as stage ?? patients by pathology based on American Joint Committee on Cancer ??AJCC??. Multivariate analysis showed that elevated serum CA19-9??HR=2.229??95%CI 1.040-4.776??P=0.039??and EMVI positive ??HR=3.266??95%CI 1.648-7.173??P=0.003?? were identified as independent predictors of 3yr DFS in stage ?? colon cancer. Cumulative 3-year DFS were 52.8% and 81.5%??95%CI 1.648-7.173?? for EMVI positive and negative patients?? and 55.6% and 76.6%??95%CI 1.040-4.776?? for elevated serum CA19-9 and normal serum CA19-9?? significances were seen ??P??0.05??. Compared with ctEMVI positive combined with elevated serum CA19-9?? 3yr recurrent/metastatic rate of ctEMVI negative combined with normal serum CA19-9 was lowerer significantly ??10.5% vs. 54.5%?? P??0.05?? .Conclusion EMVI detected with ceMDCT?? and elevated serum CA19-9 level could be used as independent predictors of 3yr DFS in patients with stage ?? colon cancer.     

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??Immediate breast reconstruction using prosthesis after nipple-sparing mastectomy for breast diseases??a report of 10 cases ZHANG Ya-nan*, QIAN Hong-mei, YOU Cheng-zhong, et al. *Department of General Surgery, Zhongda Hospital, Southeast University, Nanjing 210009, China
Corresponding author: ZHANG Ya-nan, E-mail: zhangyanan79@126.com
Abstract Objective To investigate the indications, surgical methods, effects and feasibility of immediate breast reconstruction after nipple-sparing mastectomy. Methods The immediate breast reconstruction after nipple-sparing mastectomy was performed in 10 cases of breast disease from January 2009 to October 2010 in Zhongda Hospital of Southeast University. The effects of reconstructed breast were evaluated according to objective and subjective criteria. Postoperative complications were observed and therapeutic effects were followed up. Results All operations were successful. Two cases had slight complications in early postoperative stage and were cured quickly. The aesthetic outcome and the satisfactory rate were all 100% during 6—18 months follow-up. No recurrence and metastasis were founded in 7 cases. Conclusion The operation method of immediate breast reconstruction after nipple-sparing mastectomy is maneuverable and has excellent effect of aesthetics with no influence of the therapy of breast diseases.     

MSKCC���ٰ�ǰ���ܰͽ�ת��Ԥ��ģ�͵���֤���о�

??Validation of MSKCC nomogram in predicting sentinel lymph node metastasis of breast cancer CHEN Jia-ying*, CHEN Jia-jian, YANG Ben-long, et al. *Department of Breast Surgery, Cancer Hospital/Cancer Institute, Breast Cancer Institute, Fudan University,Shanghai 200032, China
Corresponding author: WU Jiong, E-mail:wujiong1122@.vip.sina.com
Abstract Objective To validate the clinical value of the MSKCC nomogram that predicts the presence of sentinel lymph node (SLN) metastasis in Chinese early-stage breast cancer population. Methods Data were collected from 524 patients with successful SLN biopsy who were treated during 2005 March to 2009 October. Touch imprint cytology (TIC) and serial section with H&E staining were performed routinely on each sentinel node. MSKCC nomogram was used to estimate probability of SLN involvement and compared with actual probability after grouping into deciles. A ROC curve was drawn and predictive accuracy was assessed by calculating the area under the receiver-operating characteristic (ROC) curve. Results It was shown that age, tumor size, histological grade and lymphovascular invasion was correlated with the probability of SLN metastasis by univariate analysis. By Multivariate analysis, tumor size and lymphovascular invasion were identified as independent predictors of SLN metastasis. The odds ratio(OR )of the lymphovascular invasion was 9.462??95% CI 5.551-16.130??while OR of tumor size was 1.429??95% CI 1.142-1.788??. The trend of actual probability in various decile groups was comparable to the predicted probability. The area under the ROC curve was 0.757 as compared to 0.754 in the original population. Conclusion The MSKCC nomogram that predicts metastasis of breast cancer in the sentinel lymph node performed good in a Chinese breast cancer population. It could provide a clinical accessory in the preoperative discussion of the patients.     

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??A study of clinical characteristics and prognostic factors of 49 patients with gastric neuroendocrine neoplasm treated with radical surgery LI Jian-ang*, HAN Xu, FANG Yuan, et al. *Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Corresponding author: XU Xue-feng, E-mail: xuefengxu87@aliyun.com
Abstract Objective To study and explore the clinical characteristics and prognostic factors of patients with gastric neuroendocrine neoplasms (g-NENs) treated with radical surgeries. Methods The clinical and pathological data of 49 g-NENs patients who underwent surgery from January 2002 to December 2011 at the Zhongshan Hospital of Fudan University were analyzed retrospectively. The neoplasms were nominated and classified into different grades and stages according to the latest WHO classification of g-NENs. Follow-up was conducted by telephone, mail or returning visit survey. The overall survival rates were calculated and the survival curves were drawn using the Kaplan-Meier method. Univariate analysis was performed by the Log-rank test, and multivariate analysis was performed by the COX proportional hazards model. Results Among the 49 g-NENs patients, 37 were male and 12 were female, with an average age of 66 years. 6 neuroendocrine tumors (including G1 and G2) and 43 neuroendocrine carcinomas (G3). The tumor sizes ranged from 1.5cm×2.5cm×0.5cm~7cm×8cm×1.5cm. 15 NENs were localized, 33 had lymph node involvement and 1 had hepatic metastasis. At the end of the follow-up, the follow-up rate was 98.0% (48/49), and the median follow-up time was 22.2 months. The median overall survival rate of g-NENs patients was 43 months, and the overall 1-, 2-, and 5-year survival rates were 85.7%, 50.7%, 41.6% respectively. Sex (χ2=6.359??P<0.05) and lymph node involvement (χ2=4.036??P<0.05) were prognostic factors of postoperative g-NENs patients, among which sex was an independent prognostic factor (P<0.05). Conclusions Most of the patients with g-NENs had nonspecific symptoms. When diagnosed, lymph node or distant metastases were present in most patients. Female patients had a survival advantage.     

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??Objective    To explore the therapeutic effect of combined therapy of traditional Chinese medicine and western medicine on burning mouth syndrome. Methods    Eighty patients with burning mouth syndrome were randomly divided into observation group and control group??40 cases in each group. The observation group received traditional Chinese medicine and western medicine treatment combined with psychological therapy??while the control group was given traditional Chinese and western medicine treatment??two groups were compared before and after treatment. Results    In observation group 27 cases were markedly effective??11 cases effective??2 cases invalid??total effective rate 95.0%??in control group it was markedly effective in 4 cases??effective 13 cases??invalid 23 cases??total effective rate 42.5%. The clinical effect of the observation group was significantly better than that of the control group??P??0.05??. There were no significant differences in clinical symptoms in two groups before treatment??P??0.05????after treatment??tongue burning pain??numbness??irritability and insomnia symptoms of tongue in the observation group were significantly lower than those in the control group??P??0.05??. There was no significant difference between the two groups of patients before treatment concerning the Hamilton Anxiety Rating and Hamilton Depression??P??0.05????after treatment??Hamilton Anxiety Rating and Hamilton depression of the observation group were significantly lower than the control group??P??0.05??. Conclusion            Combination of traditional Chinese medicine and western medicine therapy along with psychological intervention in the treatment of burning mouth syndrome not only improves the clinical symptoms??but also can improve the quality of life of patients with good clinical efficacy.     

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??Objective??To investigate the current rate of Helicobacter pylori infection in asymptomatic children residing in Beijing urban area and to discuss the risk factors that predispose children to such infection. Methods??A total of 1196 asymptomatic children aged from 1 month to 18 years were selected from urban schools in Beijing areas. A face to face interview was conducted with a specially designed standard questionnaire. We performed enzyme-linked immunoadsorbent assay ??ELISA?? for H.pylori stool antigen test to determine H.pylori infection status. Results??The overall prevalance of H.pylori was 10.6%. On univariate analysis??risk factors for H.pylori infection included age??poor hygienic habits??lower socioeconomic status??and positive family history of gastrointestinal diseases. Multivariate logitstic regression identified that age??poor hygienic habits??economic status??number of people in the same house??house area??and positive family history of gastrointestinal diseases were the independent risk factors of H.pylori infection. Conclusion??H.pylori infection rate among these children is high??and increases with age. H.pylori infection clusters within families and is closely associated with personal and familial hygienic habits.     

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??Abstract??Objective To study the clinical effect on patients with generalized aggressive periodontitis who accepted periodontal systematic therapy for 5 years. Methods Ten patients with generalized aggressive periodontitis were selected in the Periodontology and Oral Mucosa Department??Stomatological Hospital of Dalian from January 2006 to January 2007. These patients accepted periodontal systematic therapy for 5 years??including??periodontal initial therapy??periodontal surgical therapy??and periodontal supportive therapy. Clinical parameters of probing depth(PD)??clinical attachment level(CAL)??tooth mobility(TM)and bleeding on probing(BOP)were recorded by Florida electronic probe at baseline and 1-5 years after therapy??then analysis was carried out. Panoramic tomogram and the first molar intraoral radiography were detected before and 5 years after therapy. Results PD and CAL were decreased 1-5 years after periodontal systematic therapy??the positive sites of BOP were reduced and TM was improved. The statistical differences were detected(P < 0.01). The positive sites of BOP were reduced in the 5th year than in 1-3years??and the statistical differences were detected(P < 0.05). Conclusion To generalized aggressive periodontitis??the effect of periodontal systematic therapy of 5 years is effective and stable.