Contrast-enhanced ultrasonography assessment of gastric cancer response to neoadjuvant chemotherapy

AIM:To quantitatively assess the ability of double contrast-enhanced ultrasound(DCUS) to detect tumor early response to pre-operative chemotherapy.METHODS:Forty-three patients with gastric cancer treated with neoadjuvant chemotherapy followed by curative resection between September 2011 and February 2012 were analyzed.Pre-operative chemotherapy regimens of fluorouracil + oxaliplatin or S-1 + oxaliplatin were administered in 2-4 cycles over 6-12 wk periods.All patients underwent contrast-enhanced computed tomography(CT) scan and DCUS before and after two courses of pre-operative chemotherapy.The therapeutic response was assessed by CT using the response evaluation criteria in solid tumors(RECIST 1.1) criteria.Tumor area was assessed by DCUS as enhanced appearance of gastric carcinoma due to tumor vascularity during the contrast phase as compared to the normal gastric wall.Histopathologic analysis was carried out according to the Mandard tumor regression grade criteria and used as the reference standard.Receiver operating characteristic(ROC) analysis was used to evaluate the efficacy of DCUS parameters in differentiating histopathological responders from non-responders.RESULTS:The study population consisted of 32 men and 11 women,with mean age of 59.7 ± 11.4 years.Neither age,sex,histologic type,tumor site,T stage,nor N stage was associated with pathological response.The responders had significantly smaller mean tumor size than the non-responders(15.7 ± 7.4 cm vs 33.3 ± 14.1 cm,P < 0.01).According to Mandard's criteria,27 patients were classified as responders,with 11(40.7%) showing decreased tumor size by DCUS.In contrast,only three(18.8%) of the 16 non-responders showed decreased tumor size by DCUS(P < 0.01).The area under the ROC curve was 0.64,with a 95%CI of 0.46-0.81.The effects of several cut-off points on diagnostic parameters were calculated in the ROC curve analysis.By maximizing Youden's index(sensitivity + specificity-1),the best cut-off point for distinguishing responders from non-responders was determined,which had optimal sensitivity of 62.9% and specificity of 56.3%.Using this cut-off point,the positive and negative predictive values of DCUS for distinguishing responders from non-responders were 70.8% and 47.4%,respectively.The overall accuracy of DCUS for therapeutic response assessment was 60.5%,slightly higher than the 53.5% for CT response assessment with RECIST criteria(P = 0.663).Although the advantage was not statistically significant,likely due to the small number of cases assessed.DCUS was able to identify decreased perfusion in responders who showed no morphological change by CT imaging,which can be occluded by such treatment effects as fibrosis and edema.CONCLUSION:DCUS may represent an innovative tool for more accurately predicting histopathological response to neoadjuvant chemotherapy before surgical resection in patients with locally-advanced gastric cancer.

Effect of Fibulin-5 on cell proliferation and invasion in human gastric cancer patients

Objective:To explore the effect of Fibulin-5 expression on cell proliferation and invasion in human gastric cancer patients.Methods:Fibulin-5 expression was detected in 56 samples of surgically resected gastric cancer and paired noncancerous tissues using qRT-PCR and immunoblotting.Fibulin-5 was knocked dowu by Fibulin-5 shRNA in MGC-803 cells,then Brdu cell proliferation and transwell invasion assays were used to determine cell proliferation and invasion.Results:The level of Fibulin-5 mRNA in gastric cancer tissues was significantly higher as compared with that in normal tumor-adjacent tissues(P<0.05).Otherwise,the level of Fibulin-5 protein in cancer and noucancerous tissues was consistent with mRNA expression(P<0.05).Fibulin-5 protein expression in tumor tissues with poorly differentiated.lymph node metastasis and advanced TNM tumor stage was significantly higher(P<0.05.respectively).Fibulin-5 was obviously knocked down by Fibulin-5 shRNA(P<0.05).and Fibulin-5 knockdown significantly inhibited cell proliferation and invasion in MGC-803 cells(P<0.05.respectively).Conclusions:The high-expression of Fibulin-5 is associated with the malignant clinicopathologic parameters in gastric cancer and Fibuliu-5 knockdown inhibits cell proliferation and invasion in MGC-803 cells.suggesting Fibulin-5 may act as a key factor in the progression of gastric cancer.

Sister Mary Joseph's nodule as a first sign of pancreatic cancer

Sister Mary Joseph's nodule(SMJN) refers to a metastatic tumor of the umbilicus.It is a rare entity which arises from a malignancy in the intra-abdominal cavity.We herein describe a patient who presented with SMJN as his first sign of pancreatic cancer.It is an even more unusual case of SMJN.We therefore,suggest that pancreatic cancer should be included in the differential diagnosis when an umbilical mass is found.With the progress made in surgical procedures and other modalities,an early diagnosis will dramatically improve the prognosis of the patients.

Acute iatrogenic Budd-Chiari syndrome following hepatectomy for hepatolithiasis:A report of two cases

Budd-Chiari syndrome(BCS)is defined as hepatic venous outflow obstruction at any level from the small hepatic veins to the junction of the inferior vena cava(IVC)and the right atrium,regardless of the cause of obstruction.We present two cases of acute iatrogenic BCS and our clinical management of these cases.The first case was a 43-year-old woman who developed acute BCS following the implantation of an IVC stent for the correction of stenosis in the IVC after hepatectomy for hepatolithiasis.The second case was a61-year-old woman with complete obstruction of the outflow of hepatic veins during bilateral hepatectomy for hepatolithiasis.Acute iatrogenic BCS should be con-sidered a rare complication following hepatectomy for hepatolithiasis.Awareness of potential hepatic outflow obstructions and timely management are critical to avoid poor outcomes when performing hepatectomy for hepatolithiasis.