GATIS score for predicting the prognosis of rectal neuroendocrine neoplasms:A Chinese multicenter study of 12-year experience

BACKGROUND There is currently a shortage of accurate,efficient,and precise predictive instruments for rectal neuroendocrine neoplasms(NENs).AIM To develop a predictive model for individuals with rectal NENs(R-NENs)using data from a large cohort.METHODS Data from patients with primary R-NENs were retrospectively collected from 17 large-scale referral medical centers in China.Random forest and Cox proportional hazard models were used to identify the risk factors for overall survival and progression-free survival,and two nomograms were constructed.RESULTS A total of 1408 patients with R-NENs were included.Tumor grade,T stage,tumor size,age,and a prognostic nutritional index were important risk factors for prognosis.The GATIS score was calculated based on these five indicators.For overall survival prediction,the respective C-indexes in the training set were 0.915(95%confidence interval:0.866-0.964)for overall survival prediction and 0.908(95%confidence interval:0.872-0.944)for progression-free survival prediction.According to decision curve analysis,net benefit of the GATIS score was higher than that of a single factor.The time-dependent area under the receiver operating characteristic curve showed that the predictive power of the GATIS score was higher than that of the TNM stage and pathological grade at all time periods.CONCLUSION The GATIS score had a good predictive effect on the prognosis of patients with R-NENs,with efficacy superior to that of the World Health Organization grade and TNM stage.

Clinicopathological Characteristics and Prognosis of Hepatoid Adenocarcinoma of the Stomach:Evaluation of a Pooled Case Series

Hepatoid adenocarcinoma of the stomach (HAS)is an extremely rare and unique gastric malignancy.The present study aimed to examine the relevance of the clinicopathological characteristics of HAS with patient prognosis.We retrospectively reviewed clinical data of 34 HAS patients treated at our institution between January 2010 and December 2016,as well as 294 cases reported prior to 2017 in research databases.Among these patients,45.6%(115/252)had lesions in the gastric antrum and 77.0%(235/305)were male.Elevated levels of serum alpha-fetoprotein (AFP)were detected in most patients(75/93,80.6%).Vascular invasion(199/286,69.6%),lymph node metastasis (222/283,78.4%),and preoperative distant metastasis (121/328,36.9%)were commonly observed.The 5-year disease-free survival (DFS)and disease-specific survival (DSS) were 20.7%and 29.2%,respectively.DFS and DSS of patients receiving neoadjuvant therapy were significantly higher than those of patients receiving postoperative adjuvant therapy [DFS:P<0.001, hazard ratio (HR)=-1.831,95%confidence interval (CI):0.060-0.429;DSS:P<0.001,HR=-2.185, 95%CI:0.032-0.401].In conclusion,HAS exhibits distinct clinicopathological characteristics and a strikingly worse prognosis when compared with common gastric cancer.Complete surgery,early pTNM stage,and adjuvant therapy may predict a more favorable prognosis.Neoadjuvant therapy is strongly recommended for patients with lymph node metastasis or/and preoperative distant metastasis.

Enhanced Chemotherapy Sensitivity of Human Colon Cancer Cells to 5-Fluorouracil by siRNA Recombinant Expression Vector Targeting Survivin Gene

Objective To investigate the effects of small interfering RNA （siRNA） recombinant expression vector targeting survivin gene on chemotherapy sensitivity of human colon cancer cells to 5-fluorouracil. Methods siRNA recombinant expression vector targeting survivin gene was constructed and transfected into human colon cancer cell lines LOVO. After 48 hours of transfection, cells were harvested for analysis of survivin mRNA and protein expressions using RT-PCR and Western blot. In addition, after human colon cancer cell lines were treated with Survivin siRNA and/or 5-fluorouracil, MTT assay and flow cytometry were used to analyze cell proliferation and apoptosis. Results Restriction endonuclease analysis confirmed that siRNA recombinant expression vector targeting survivin gene was successfully constructed. Inhibitory ratios of survivin mRNA and protein expressions by Survivin siRNA were 36.33% and 44.65%, respectively. Survivin siRNA combined with 5-fluorouracil significantly increased the cell proliferation inhibitory ratio and apoptosis ratio compared with 5-fluorouracil treatin~ alone （P〈0.05）. Conclusion The siRNA recombinant expression vector targeting survivin gene can inhibit the expression of survivin gene, and enhance chemotherapy sensitivity of human colon cancer cells to 5- fluorouracil.

Performance of risk stratification systems for gastrointestinal stromal tumors: A multicenter study

BACKGROUND Gastrointestinal stromal tumors(GISTs) are the most common mesenchymal tumor type in the gastrointestinal system. Presently, various classification systems to prognosticate GISTs have been proposed.AIM To evaluate the application value of four different risk stratification systems for GISTs.METHODS Patients who were diagnosed with GISTs and underwent surgical resection at four hospitals from 1998 to 2015 were identified from a database. Risk of recurrence was stratified by the modified National Institute of Health(NIH)criteria, the Armed Forces Institute of Pathology(AFIP) criteria, the Memorial Sloan Kettering Cancer Center(MSKCC) prognostic nomogram, and the contour maps. Receiver operating characteristic(ROC) curves were established to compare the four abovementioned risk stratification systems based on the area under the curve(AUC).RESULTS A total of 1303 patients were included in the study. The mean age of the patients was 55.77 ± 13.70 yr; 52.3% of the patients were male. The mean follow-up period was 64.91 ± 35.79 mo. Approximately 67.0% the tumors were located in the stomach, and 59.5% were smaller than 5 cm; 67.3% of the patients had a mitotic count ≤ 5/50 high-power fields(HPFs). Thirty-four tumors ruptured before and during surgery. Univariate analysis demonstrated that tumor size > 5 cm(P <0.05), mitotic count > 5/50 HPFs(P < 0.05), non-gastric location(P < 0.05), and tumor rupture(P < 0.05) were significantly associated with increased recurrence rates. According to the ROC curve, the AFIP criteria showed the largest AUC(0.754).CONCLUSION According to our data, the AFIP criteria were associated with a larger AUC than the NIH modified criteria, the MSKCC nomogram, and the contour maps, which might indicate that the AFIP criteria have better accuracy to support therapeutic decision-making for patients with GISTs.

Application of laparoscopic total mesorectal excision combined with sphincter-preserving surgery in low or ultralow rectal cancer

This study aimed to investigate the influence of laparoscopic total mesorectal excision combined with sphincter-preserving surgery on the postoperative defecation function,urinary function and sexual function in low or ultralow rectal cancer.A retrospective study was undertaken on 107 patients(65 laparoscopic resection and 42 laparoctomic resection)with rectal cancer undergoing laparoscopic or open laparoscopic total mesorectal excision combined with sph incter-preserving surgery from April 2009 to April 2013.The quality of life outcomes of all patients,including defection,urinary and sexual function,were assessed at 6,12 and 24 months after operation.Gastrointestinal quality of life index(GQOLI)was used to evaluate the fecal incont inence and bowel dysfunction.Urinary and sexual functions were studied by means of questionnaires on the basis of the international prostatic symptom score(IPSS)and international index of erectile function(IEF),respectively.In laparoscopic surgery group,there were two cases of anastomotic leakage,three cases of anast omotic strict ure,seven cases of local recurrence,ten cases of hepatic metastasis and five cases of lung metastasis.The satisfaction rates of patients about their defe-cation function reached 60.3%(35/58,84.5%(49/58)and 913%(53/58)at6,12,and 24 months follow-up,respectively.The assessment after one year showed that the overall incidence of uri-nary dysfunction was 10.7%(7/65);Among male patients,18.4%(7/36)sufered from erectile dysfunction and 27.8%(10/36)sufered from ejaculatory dysfunction;65.5%(19/29)female patients investigated were satisfied with their postoperative sexual life.In open surgery group,there were two cases of anastomotic leakage,two cases of anastomotic stricture,nine cases of local recurrence,ten cases of hepatic metastasis and seven cases of kung metastasis.The satisfaction rates of patients about their defecation function were 56.4%(22/39),82.1%(32/39)and 94.8%(37/39)at 6,12,and 24 months follow-up,respectively.The assessment after one year showed that the overall incidence of urinary dysfunction was 11.9%(5/42);25%(4/16)male patients suffered from erectile dysfunction and 313%(5/16)sufered from ejaculatory dysfunction;69.2%(19/26)female patients investigated were satisfied of their postoperative sexual life.There was no statistic difference in the two groups.Laparoscopic total mesorectal excision combined with sphincter-preserving surgery in low or ultralow rectal carcinoma is safe and pract icable.It can be helpful for enhancing the probability of anus reservation,and obtains satisfactory defecation,sexual and urinary functions.

Risk Factors of Anastomotic Leakage After Anterior Resection for Rectal Cancer Patients

Objective Anastomotic leakage(AL)is one of the serious complications after anterior resection for rectal cancer.Defunctioning stoma(DS)is one of the most widely used approaches to prevent it;however,the effect of DS on the occurrence of AL remains controversial.This study aimed to investigate risk factors of AL and assess the effect of DS after anterior resection for rectal cancer patients.Methods A retrospective analysis was conducted for the data of 1840 patients who underwent anterior resection for rectal cancer from January 2014 to December 2019.Results The results showed the overall AL incidence was 7.5%.Multivariate analyses revealed that males[odds ratio(OR)1.562]and T3–T4 stage(OR 1.729)were independent risk factors for all patients.After propensity score matching analysis,the AL incidence was 14.1%in the group with no DS and 6.4%in the DS group(P<0.001).The clinical AL(grade B+grade C)incidence was 12.4%in no DS group and 4.6%in the DS group(P<0.001).Conclusion The study suggested that males and T3–T4 stage were independent risk factors of AL.In addition,DS could reduce the rate of symptomatic AL.

Development of a magnetite-gene complex for gene transfection

The key to successful gene therapy is tofind a suitable method and carrier for transfection to allow a gene to be transferred into a cell and integrated into the target gene.The aim of this study was to determine whether biomagnetic material could be combined with the nucleic acid for gene transfection.Dextran-coated iron oxide nanoparticles(DCIONPs)were prepared and mixed with the plasmid pGenesil-1 containing the test gene,which expresses enhanced greenfluorescent protein(eGFP).PGenesil-1 empty vector was used as a control.The binding ability was assessed by electrophoresis of the DNA on agarose gels and quantification using BANDS-CAN software.Using different gene carriers,Lipofecta-mine 2000,Sofast,and DCIONPs,the large intestine cancer(Lovo)cell line was transfected in vitro with or without a magneticfield.The expression of eGFP was observed byfluorescence microscopy,and the transfection efficiency was compared.The results showed there was a rapid increase in combining rate when the quality ratio of DCIONPs and pGenesil-1 ascended from 1∶1 to 5∶1.However,the combining rate increased less rapidly as the quality ratio continued ascending.The expression of eGFP showed that the early transfection rate could be improved by applying a magneticfield.In conclusion,the DCIONPs we synthesized are able to carry plasmid DNA and enhance the early transfection efficiency when using a magneticfield.

Strategies and recommendations for the management of gastrointestinal surgery during the COVID-19 pandemic:experience shared by Chinese surgeons

Novel coronavirus disease-2019(COVID-19),caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),is an ongoing public-health pandemic worldwide.Although SARS-CoV-2 has been known to spread primarily through respiratory droplets,recent evidence also supports fecal/oral as an additional route of transmission,raising concerns over gastrointestinal(GI)transmission of the infection.Herein,we,as the front-line Chinese GI surgeons,would like to share our experience and lessons in the combat against COVID-19.It is essential to create science-based,rational,and practical strategies during the outbreak of COVID-19.Here,we provide multi-institutional consensus on minimizing disease transmission while continuing to provide care from all aspects for patients in GI surgery,including outpatient clinics,inpatient units,gastrointestinal endoscopy centers,and adjustments in perioperative care.Our experiences and recommendations are worth sharing and may help to establish specific infection-control and outcome measures.