AIM To assess clinical outcomes for submucosal (T1b) oesophageal adenocarcinoma (OAC) patients managed with either surgery or endoscopic eradication therapy.METHODS Patients found to have T1b OAC following endoscopic ...AIM To assess clinical outcomes for submucosal (T1b) oesophageal adenocarcinoma (OAC) patients managed with either surgery or endoscopic eradication therapy.METHODS Patients found to have T1b OAC following endoscopic resection between January 2008 to February 2016 at University College London Hospital were retrospectively analysed. Patients were split into low-risk and high-risk groups according to established histopathological criteria and were then further categorised according to whether they underwent surgical resection or conservative management. Study outcomes include the presence of lymphnode metastases, disease-specific mortality and overall survival. RESULTS A total of 60 patients were included; 22 patients were surgically managed (1 low-risk and 21 high-risk patients) whilst 38 patients were treated conservatively (12 low-risk and 26 high-risk). Overall, lymph node metastases (LNM) were detected in 10 patients (17%); six of these patients had undergone conservative management and LNM were detected at a median of 4 mo after endoscopic mucosal resection (EMR). All LNM occurred in patients with highrisk lesions and this represented 21% of the total high-risk lesions. Importantly, there was no statistically significant difference in tumor-related deaths between those treated surgically or conservatively (P = 0.636) and disease-specific survival time was also comparable between the two treatment strategies (P = 0.376).CONCLUSION T1b tumours without histopathological high-risk markers of LNM can be treated endoscopically with good outcomes. In selected patients, endoscopic therapy may be appropriate for high-risk lesions.展开更多
AIM: To investigate if azathioprine could reduce adenoma formation in ApcMin/+, a mouse model of sporadic intestinal tumorigenesis.METHODS:Azathioprine was administered via drinking water(estimated 6-20 mg/kg body wei...AIM: To investigate if azathioprine could reduce adenoma formation in ApcMin/+, a mouse model of sporadic intestinal tumorigenesis.METHODS:Azathioprine was administered via drinking water(estimated 6-20 mg/kg body weight per day)to ApcMin/+and wildtype mice.Control animals received vehicle only(DMSO)dissolved in drinking water.At 15wk of age all mice were sacrificed and intestines of ApcMin/+were harvested for evaluation of polyp number.Azathioprine induced toxicity was investigated by immunohistochemical analysis on spleens.RESULTS:All azathioprine treated mice showed signs of drug-associated toxicity such as weight loss and development of splenic T-cell lymphomas.Although this suggests that the thiopurine concentration was clearly in the therapeutic range,it did not reduce tumor formation(48±3.1 adenomas vs 59±5.7 adenomas,P=0.148).CONCLUSION:We conclude that in the absence of inflammation,azathioprine does not affect intestinal tumorigenesis.展开更多
文摘AIM To assess clinical outcomes for submucosal (T1b) oesophageal adenocarcinoma (OAC) patients managed with either surgery or endoscopic eradication therapy.METHODS Patients found to have T1b OAC following endoscopic resection between January 2008 to February 2016 at University College London Hospital were retrospectively analysed. Patients were split into low-risk and high-risk groups according to established histopathological criteria and were then further categorised according to whether they underwent surgical resection or conservative management. Study outcomes include the presence of lymphnode metastases, disease-specific mortality and overall survival. RESULTS A total of 60 patients were included; 22 patients were surgically managed (1 low-risk and 21 high-risk patients) whilst 38 patients were treated conservatively (12 low-risk and 26 high-risk). Overall, lymph node metastases (LNM) were detected in 10 patients (17%); six of these patients had undergone conservative management and LNM were detected at a median of 4 mo after endoscopic mucosal resection (EMR). All LNM occurred in patients with highrisk lesions and this represented 21% of the total high-risk lesions. Importantly, there was no statistically significant difference in tumor-related deaths between those treated surgically or conservatively (P = 0.636) and disease-specific survival time was also comparable between the two treatment strategies (P = 0.376).CONCLUSION T1b tumours without histopathological high-risk markers of LNM can be treated endoscopically with good outcomes. In selected patients, endoscopic therapy may be appropriate for high-risk lesions.
文摘AIM: To investigate if azathioprine could reduce adenoma formation in ApcMin/+, a mouse model of sporadic intestinal tumorigenesis.METHODS:Azathioprine was administered via drinking water(estimated 6-20 mg/kg body weight per day)to ApcMin/+and wildtype mice.Control animals received vehicle only(DMSO)dissolved in drinking water.At 15wk of age all mice were sacrificed and intestines of ApcMin/+were harvested for evaluation of polyp number.Azathioprine induced toxicity was investigated by immunohistochemical analysis on spleens.RESULTS:All azathioprine treated mice showed signs of drug-associated toxicity such as weight loss and development of splenic T-cell lymphomas.Although this suggests that the thiopurine concentration was clearly in the therapeutic range,it did not reduce tumor formation(48±3.1 adenomas vs 59±5.7 adenomas,P=0.148).CONCLUSION:We conclude that in the absence of inflammation,azathioprine does not affect intestinal tumorigenesis.
