Clinicopathological features and survival analysis of gastroenteropancreatic neuroendocrine neoplasms: a retrospective study in a single center of China

Objective： To investigate the clinicopathological features, survival and prognostic factors for gastroenteropancreatic neuroendocrine neoplasms（GEP-NENs） in a Chinese population.Methods： We investigated 154 consecutive patients（88 males, 66 females; median age 56 years, age range 9-86 years） diagnosed with GEP-NENs between 2001 and 2013 at The Affiliated Hospital of Qingdao University. Demographic, clinical and pathological variables and survival data were retrieved.Results： The pancreas was the most common site of involvement（63/154, 40.9%）. Tumor size varied from 0.3 to 16.0 cm（median, 1.2 cm）. The patients were followed up for a median period of 22 months（range, 1-157 months）. The estimated 3- and 5-year overall survival（OS） rates for all patients were 84.0% and 81.9%, respectively. Multivariate analysis showed that larger tumor size, lymphatic metastases and distant metastases were significant predictors for poor survival outcome.Conclusions： Our data provide further information on the clinicopathological features of GEP-NENs in China. Additionally, we identified tumor size, lymphatic metastases and distant metastases as independent prognostic factors for long-term survival.

122例胃肠道间质瘤的临床病理及免疫组化分析(英文)

Objective:The aim of the study was to review the clinical records of 122 patients with gastrointestinal stromal tumors(GISTs) and analyze their clinicopathologic and immunohistochemical characteristics.Methods:The medic records of 122 patients with GISTs during the periods from January 2002 to May 2010 were reviewed.All tumors were confirmed by histological and immunohistochemical analyses.Results:The tumors occurred in 59 males and 63 females,ranging from 25 to 77 years.Of all cases,46 cases originated from stomach,42 from small intestine,17 from colon and rectum and 9 from retroperitoneal cavity and 4 cases from extra-gastrointestinal site.Liver was the most common organ that tumors metastases involved.Immunohistochemically,there were 114 tumors being positive for CD117 while 8 tumors negative for it.The frequencies of CD34 positive were higher in the stomach and rectum(89.1% and 86.7% respectively) than in the small intestine(64.3%,P < 0.05).Higher expression of SMA was in the tumors located in small intestine(54.8%) while the expressions of SMA in the gastric and rectal tumors were relatively low(21.7% and 20.0% respectively,P < 0.05).Conclusion:Gastrointestinal stromal tumors can occur in the gastrointestinal tract as well as in the extra-gastrointestinal sites.The frequencies of CD34 and SMA expression vary significantly with different locations.

十二指肠间质瘤:上消化道出血原因之一(英文)

Objective:The aim of the study was to report an anemia patient with melena for five years caused by duodenal gastrointestinal stromal tumor (GIST), who required surgical treatment. Methods: A 44-year old man present with anemia appearance was admitted to our center (Department of Hepatobiliary Surgery, Union Hospital, Huazhong University of Science and Technology, China) due to sustaining melena for five years. Endoscopy found no special mucosal abnormalities in the duodenal lumen. Computed Tomography showed a well-demarcated mass, 7.4 cm in diameter, located between the C loop of duodenum and pancreatic head. Pylorus-preserving pancreaticoduodenectomy and right hemicolectomy were performed when the patient's general conditions were improved. He recuperated successfully and was discharged on the 21st postoperative day. No complications happened during the period of hospital stay. Results: Histological and immunohistochemical study revealed a high risk invasive duodenal GIST which was positive for CD117, CD34, α-smooth muscle actin and negative for S-100. Conclusion: Duodenal GIST can be a source of upper gastrointestinal hemorrhage; surgical treatment is still a reasonable choice for the patients with invasive duodenal GIST.

Accuracy of preoperative serum CA19-9 levels in predicting the resectability of patients with pancreatic adenocarcinoma

Objective To assess the accuracy of preoperative serum CA19-9 levels in predicting the resectability of pancreatic adenocarcinoma.Methods Patients with biopsy-proven pancreatic adenocarcinoma who had preoperative serum CA19-9 level data were enrolled in the present retrospective analysis. Receiver operating characteristics(ROC) curve analysis was used to determine the optimal cut-off value of CA19-9. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated at this cut-off point.Results Seventy-six patients with pancreatic adenocarcinoma that was considered potentially resectable according to radiological imaging were included. Of all 76 patients, 44 received complete resection of the pancreatic adenocarcinoma. The preoperative serum CA19-9 level was significantly higher in the unresectable tumor group than in the resectable tumor group(P = 0.0036). The area under the ROC curve was 0.749(95% confidence interval [CI]: 0.637–0.842). When the cut-off value of CA19-9 was set to 359.1 U/m L, the sensitivity, specificity, positive and negative predictive values were 71.9%(95% CI: 53.3%–86.3%), 70.5%(95% CI: 54.8%–83.2%), 63.9%(95% CI: 46.0%–79.4%), and 77.5%(95% CI: 61.5%–89.2%), respectively.Conclusion The preoperative serum CA19-9 level is useful for predicting the resectability of pancreatic adenocarcinoma.

KCNH2 regulates the growth and metastasis of pancreatic cancer

Objective:Due to the characteristics of insidious onset and early metastasis of pancreatic cancer(PC),patients are often diag-nosed at an advanced stage and often delayed in completing surgical resection timely,resulting in poor prognosis.Therefore,this study aims to explore the expression of potassium voltage-gated channel subfamily H member 2(KCNH2)in PC and its relation-ship with clinicopathological parameters and the related mechanisms.Methods:GEPIA database and immunohistochemical staining were used to analyze the difference in KCNH2 expression be-tween PC and adjacent tissue in RNA and protein levels.Chi-squared test was used to evaluate the relationship between KCNH2 expression and clinicopathological features.The Cox regression model was used for multivariate analysis and univariate analysis.Histological diagnosis was performed according to World Health Organization(WHO)criteria to evaluate the relationship between KCNH2 expression and clinicopathological features.Results:KCNH2 expression was upregulated in PC compared with normal pancreatic tissue.In addition,the knockdown of KCNH2 inhibits PC cell proliferation,migration,invasion,and epithelial-mesenchymal transformation and promotes their apopto-sis.In addition,clinical data showed that the abnormal expression of KCNH2 in PC was related to the tumor stage.Patients with high expression of KCNH2 had a poor prognosis.Conclusions:KCNH2 is expected to be a novel targeted molecule in treating PC.

基于倾向性评分匹配的机器人与腹腔镜辅助根治性右半结肠切除术近远期疗效的比较

目的比较机器人与腹腔镜辅助根治性右半结肠切除术治疗结肠癌的近期及远期结局。方法回顾性分析2014年10月至2020年10月在青岛大学附属医院胃肠外科接受机器人辅助右半结肠切除术(n=57)或腹腔镜辅助右半结肠切除术(n=231)的288例右半结肠癌患者的临床资料。男性161例,女性127例,年龄(60.3±12.8)岁(范围:17~86岁)。采用倾向性评分匹配法对两组患者进行1∶4匹配,匹配后机器人组56例,腹腔镜组176例。采用t检验、秩和检验、χ^(2)检验、Fisher确切概率法及重复测量方差分析比较匹配后两组患者的手术情况及近期结局,应用Kaplan-Meier法绘制生存曲线,采用Log-rank检验进行比较。结果机器人组与腹腔镜组相比,总手术时间相近[(206.9±60.7)min比(219.9±56.3)min,t=-1.477,P=0.141],术中出血量更少[50(20)ml比50(50)ml,Z=-4.591,P<0.01],清扫淋巴结数目更多[(36.0±10.0)枚比(29.0±10.1)枚,t=4.491,P<0.01],术后住院时间、首次排气时间、排便时间明显缩短(t:-2.888、-2.946、-2.328,P值均<0.05)。机器人组和腹腔镜组围手术期并发症发生率的差异无统计学意义(P>0.05)。机器人组和腹腔镜组3年总体生存率分别为92.9%和87.9%,3年无病生存率分别为83.1%和82.6%(P值均>0.05)。结论机器人辅助右半结肠根治术较传统腹腔镜手术能够改善患者部分近期临床结局指标。两种术式患者远期预后相似。

Potential indicators predict progress after surgical resection of gastrointestinal stromal tumors

In order to find out the potential indicators predicting prognosis of malignant gastrointestinal stromal tumors(GISTs)after surgical resection,we collected clinical records of 80 patients with malignant GISTs.Tumor location,size,mitotic index,necrosis were compared with the prognosis of malignant GISTs by Kaplan-Meier method and log-rank test.After a median follow-up of 844 days(52–2145),we found that as National Institutes of Health suggested,tumors with intermediate risk had more favorable prognosis than that with high risk.Their 3-year survival rate were 65.3% and 41.3%,respectively(P<0.001).Moreover,tumor size and mitotic index were associated with free survival.The 3-year survival rate for patients with tumor size≤10 cm and>10 cm were 62.3% and 41.8%,respectively(P=0.002),Tumors with mitotic index≤5/50 HPF had a higher 3-year survival rate than tumors with mitotic index>5/50 HPF(67.1% versus 40.7%,P=0.005).The presence of necrosis was directly related to the malignant behavior.The 3-year survival rate for presence and absence necrosis were 50.8% and 64.8%(P=0.008).From the present study,we can conclude that besides tumors size and mitotic index,tumor location and necrosis also influence on the long-term survival of patient with malignant GISTs after surgical resection.

Mechanism of arterial remodeling in chronic allograft vasculopathy

Chronic allograft vasculopathy(CAV)remains a major obstacle for long-term survival of grafts even though therapeutic strategies have improved considerably in recent years.CAV is characterized by concentric and diffuse neointimal formation,medial apoptosis,infiltration of lymphocyte or inflammatory cells,and deposition of extracellular matrix both in arteries and veins.Recent studies have shown that stem cells derived from the recipient contribute to neointimal formation under the regulation of chemokines and cytokines.Arterial remodeling in allografts eventually causes ischemic graft failure.The pathogenesis is multi-factorial with both immunologic and non-immunological factors being involved.The immunological factors have been discussed extensively in other articles.This review focuses mainly on the arterial remodeling that occurs in 3 layers of vessel walls including intimal injury,accumulation of smooth muscle-like cells in the neointimal,medial smooth muscle cell apoptosis,adventitial fibrosis,and deposition of extracellular matrix.