Difference between type 2 gastroesophageal varices and isolated fundic varices in clinical profiles and portosystemic collaterals

BACKGROUND There is significant heterogeneity between gastroesophageal varices(GOV2)and isolated gastric varices(IGV1).The data on the difference between GOV2 and IGV1 are limited.AIM To determine the etiology,clinical profiles,endoscopic findings,imaging signs,portosystemic collaterals in patients with GOV2 and IGV1.METHODS Medical records of 252 patients with gastric fundal varices were retrospectively collected,and computed tomography images were analyzed.RESULTS Significant differences in routine blood examination,Child-Pugh classification and MELD scores were found between GOV2 and IGV1.The incidence of peptic ulcers in patients with IGV1(26.55%)was higher than that of GOV2(11.01%),while portal hypertensive gastropathy was more commonly found in patients with GOV2(22.02%)than in those with IGV1(3.54%).Typical radiological signs of cirrhotic liver were more commonly observed in patients with GOV2 than in those with IGV1.In patients with GOV2,the main afferent vessels were via the left gastric vein(LGV)(97.94%)and short gastric vein(SGV)(39.18%).In patients with IGV1,the main afferent vessels were via the LGV(75.61%),SGV(63.41%)and posterior gastric vein(PGV)(43.90%).In IGV1 patients with pancreatic diseases,spleno-gastromental-superior mesenteric shunt(48.15%)was a major collateral vessel.In patients with fundic varices,the sizes of gastric/esophageal varices were positively correlated with afferent vessels(LGVs and PGVs)and efferent vessels(gastrorenal shunts).The size of the esophageal varices was negatively correlated with gastrorenal shunts in GOV2 patients.CONCLUSION Significant heterogeneity in the etiology and vascular changes between GOV2 and IGV1 is useful in making therapeutic decisions.

Retrospective analysis of sentinel lymph node biopsy using methylene blue dye for early breast cancer

Background:Methylene blue is the most commonly used tracer for sentinel lymph node(SLN)biopsy(SLNB)in China.This study aimed to investigate the feasibility of clinical application of SLNB using methylene blue dye(MBD)for early breast cancer and the prognosis of patients with different SLN and non-SLN statuses.Methods:We retrospectively analyzed the clinicopathological data of patients with early breast cancer treated at the Peking University First Hospital between 2013 and 2018.We calculated the SLN identification rate(IR)in SLNB with MBD and the false-negative rate(FNR),and analyzed the prognosis of patients with different SLN and non-SLN statuses using Kaplan-Meier curves.Results:Between January 2013 and December 2018,1603 patients with early breast cancer underwent SLNB with MBD.The SLN IR was 95.8%(1536/1603).Two SLNs(median)were detected per patient.There were significant differences in FNR between patients with SLN micrometastasis and macrometastasis(19.0%vs.4.5%,χ^(2)=12.771,P<0.001).Chi-square test showed that there were significant differences in SLN successful detection rates among patients with different vascular tumor embolism status(96.3%vs.90.8%,χ^(2)=9.013,P=0.003)and tumor(T)stages(96.6%vs.94.1%,χ^(2)=5.189,P=0.023).Multivariate analysis showed that vascular tumor embolism was the only independent factor for SLN successful detection(odds ratio:0.440,95%confidence interval:0.224-0.862,P=0.017).Survival analysis showed a significant difference in disease-free survival(DFS)between patients with non-SLN metastasis and patients without non-SLN metastasis(P=0.006).Conclusion:Our single-center data show that,as a commonly used tracer in SLNB in China,MBD has an acceptable SLN IR and a low FNR in frozen sections.This finding is consistent with reports of dual tracer-guided SLNB.Positive SLNs with non-SLN metastasis are associated with DFS.

Clinicopathologic analysis of 722 breast cancer patients who met the inclusion criteria of the TAILORx trial

Background:The results of the Trial Assigning IndividuaLized Options for Treatment(TAILORx)suggested that approximately 70%of T1-2N0M0,hormone receptor-positive,human epidermal growth factor receptor 2(HER2)-negative breast cancer patients can avoid chemotherapy and receive only adjuvant endocrine therapy.We conducted a retrospective analysis of the clinicopathologic features and prognostic factors of patients with breast cancer who met the inclusion criteria of the TAILORx trial.Methods:According to the enrollment criteria of the TAILORx trial,a retrospective analysis was performed on patients with breast cancer who were treated from January 2008 to December 2015 at Peking University First Hospital.The clinicopathologic characteristics of all patients were analyzed,and prognoses were calculated using the Kaplan-Meier method and a Cox proportionate hazards model.Results:A total of 2430 patients with early stage breast cancer who were admitted at our hospital had complete clinicopathologic data and follow-up information.Of these patients,722 met the inclusion criteria and were enrolled in the present study,accounting for 29.7%of all patients.Among them,417(57.8%)patients received only adjuvant endocrine therapy(the non-chemo group),and 305(42.2%)patients received adjuvant chemotherapy followed by adjuvant endocrine therapy(the chemo group).No statistically significant difference was observed in overall survival(OS)between the two groups(non-chemo vs.chemo:5-year OS:97.9%vs.97.9%,χ^2=1.00,P=0.995;hazard ratio[HR]=1.00,95%confidence interval[CI]:0.46–2.21).A significant difference was observed in disease-free survival(DFS)between the two groups(non-chemo vs.chemo:5-year DFS:97.9%vs.94.7%,χ^2=8.65,P=0.003;HR=3.05,95%CI:1.40–6.67).The choice of adjuvant therapy was associated with clinicopathologic factors,such as the age at diagnosis,T stage,histologic grade,the Ki67 index,the presence of intravascular tumor thrombus(P<0.001),pathologic type,and menstrual status(P=0.014).Conclusions:In the absence of internationally recognized multigene testing methods,for patients with early hormone receptorpositive,HER2-negative breast cancer,clinicians can develop a treatment plan based on clinicopathologic features only,which can effectively screen some patients who do not need adjuvant chemotherapy.However,nearly half of patients still receive adjuvant chemotherapy,and whether these patients can be exempted from chemotherapy warrants further exploration.