Overall expression of beta-catenin outperforms its nuclear accumulation in predicting outcomes of colorectal cancers

AIM： To examine the expression of beta-catenin in colorectal cancer and look for association with other dinico-pathological parameters. METHODS;： Tumor samples from 163 cases of colorectal cancer （CRC） who had undergone primary colectomy between May, 1998 and November, 2002 with complete follow-up data for either 5 years or until death were recruited for a beta-catenin immunohistochemical study. The percentage of immunoreacted tumor cells was defined as overall staining density （OSD） and percentage of cells having nuclear localization was counted as nuclear staining density （NSD）. Univariate exploration used log-rank test and multivariate survival analysis used Cox＇s hazard regression model. RESULTS： Beta-catenin immunoreactivity was detected in 161 samples （98.8%）, of which 131 cases had nuclear staining. High OSD （≥ 75%）, detected in 123 cases （75.5%）, was significantly associated with earlier clinical staging （P 〈 0.01）, lower nodal status （P = 0.02）, non-metastatic status （P 〈 0.01） and better differentiation （P = 0.02）. Multivariate analysis found that high OSD was independently associated with better survival [Cox＇s hazard ratio 0.51, 95% confidence interval （CI） 0.31-0.83]. Although high NSD （≥ 75%） was correlated with high pre-operative serum CEA （P = 0.03）, well differentiation （P 〈 0.01）, and increased staining intensity（P 〈 0.01）, the parameter was not significantly associated with survival. CONCLI3SIOM： Unlike previous reports, the study did not find a predictive value of nuclear beta-catenin in CRC. Instead, the overall expression of beta-catenin in CRC showed an association with better differentiation and earlier staging. Moreover, the parameter also independently predicted superior survival.

Current management of pediatric soft tissue sarcomas

Pediatric soft tissue sarcomas are a group of malignant neoplasms arising within embryonic mesenchymal tissues during the process of differentiation into muscle, fascia and fat. The tumors have a biphasic peak for age of incidence. Rhabdomyosarcoma(RMS) is diagnosed more frequently in younger children, whereas adult-type non-RMS soft tissue sarcoma is predominately observed in adolescents. The latter group comprises a variety of rare tumors for which diagnosis can be difficult and typically requires special studies, including immunohistochemistry and molecular genetic analysis. Current management for the majority of pediatric sarcomas is based on the data from large multi-institutional trials, which has led to great improvements in outcomes over recent decades. Although surgery remains the mainstay of treatment, the curative aim cannot be achieved without adjuvant treatment. Pre-treatment staging and risk classification are of prime importance in selecting an effective treatment protocol. Tumor resectability, the response to induction chemotherapy, and radiation generally determine the risk-group, and these factors are functions of tumor site, size and biology. Surgery provides the best choice of local control of small resectable tumors in a favorable site. Radiation therapy is added when surgery leaves residual disease or there is evidence of regional spread. Chemotherapy aims to reduce the risk of relapse and improve overall survival. In addition, upfront chemotherapy reduces the aggressiveness of the required surgery and helps preserve organ function in a number of cases. Long-term survival in low-risk sarcomas is feasible, and the intensity of treatment can be reduced. In high-risk sarcoma, current research is allowing more effective disease control.

Clinical outcomes of gastrointestinal stromal tumor in southern Thailand

AIM: To review a single institutional experience in clinical management of gastrointestinal stromal tumors (GIST) and analyze for factors determining treatment outcome. METHODS: Clinicopathological data of patients with a diagnosis of GIST who were treated at our institute during November 2004 to September 2009 were retrospectively reviewed. RESULTS: Ninety-nine cases were included in the analysis. Primary tumor sites were at the stomach in and small bowel in 44% and 33%, respectively. Thirty-one cases already had metastasis at presentation and the most common metastatic site was the liver. Sixty-four cases (65%) were in the high-risk category. Surgical treatment was performed in 77 cases (78%), 3 of whom received upfront targeted therapy. Complete resection was achieved in 56 cases (73% of operative cases) and of whom 27 developed local recurrence or distant metastasis at a median duration of 2 years. Imatinib was given as a primary therapy in unresectable cases (25 cases) and as an adjuvant in cases with residual tumor (21 cases). Targeted therapy gave partial response in 7 cases (15%), stable disease in 27 cases (57%) and progressive disease in 13 cases (28%). Four-year overall survival was 74% (95% CI: 61%-83%). Univariate survival analysis found that low-risk tumor, gastric site, complete resection and response to imatinib were associated with better survival. CONCLUSION: The overall outcomes of GIST can be predicted by risk-categorization. Surgery alone may not be a curative treatment for GIST. Response to targeted therapy is a crucial survival determinant in these patients.

Population-based prevalence study of common congenital malformations of the alimentary tract and abdominal wall in Thailand:a study using data from the National Health Security Office

Background The study aimed to estimate the prevalence of major congenital anomalies of the alimentary system and the abdominal wall in Thailand using a nationwide hospital discharge database from the National Health Security Office(2017–2020).Methods The study extracted data from records with International Classification of Diseases-10(ICD-10)codes related to esophageal malformation(ESO),congenital duodenal obstruction(CDO),jejunoileal atresia(INTES),Hirschsprung’s disease(HSCR),anorectal malformation(ARM),abdominal wall defects(omphalocele(OMP)and gastroschisis(GAS)),and diaphragmatic hernia from the database with patient age selection set to less than 1year.Results A total of 2539 matched ICD-10 records were found in 2376 individuals over the 4-year study period.Concerning foregut anomalies,the prevalence of ESO was 0.88/10000 births,while that of CDO was 0.54/10000 births.The prevalence figures of INTES,HSCR,and ARM were 0.44,4.69,and 2.57 cases per 10000 births,respectively.For abdominal wall defects,the prevalences of OMP and GAS were 0.25 and 0.61 cases/10000 births,respectively.The mortality in our cases was 7.1%,and survival analysis found that associated cardiac defects had a statistically significant influence on survival in most anomalies studied.In HSCR,both Down syndrome(DS)(hazard ratio(HR)=7.57,95%confidence interval(CI)=4.12 to 13.91,p<0.001)and cardiac defects(HR=5.82,95%CI=2.85 to 11.92,p<0.001)were significantly associated with poorer survival outcomes.However,only DS(adjusted HR=5.55,95%CI=2.63 to 11.75,p<0.001)independently predicted worse outcomes by multivariable analysis.Conclusions Our analysis of the hospital discharge database found that the prevalence of gastrointestinal anomalies in Thailand was lower than that reported in other countries,except for HSCR and anorectal malformations.Associated Down syndrome and cardiac defects influence the survival outcomes of these anomalies.

Validation and modification of the‘Chiang Mai University Intussusception scoring system’used to predict failure of non-surgical treatment in infantile intussusception

background This study aimed to validate and modify the recently released Chiang Mai University Intussusception(CMUI)scoring system in predicting failure of non-surgical management of infantile intussusception.Methods A retrospective review was conducted in 151 cases of infantile intussusception who were primarily treated with pneumatic reduction in our institute during 2008-2018.The analysis focused on the validation of the CMUI scoring system.Following this analysis,the scoring system was modified to be more suitable for our clinical practice,in which we perform pneumatic reduction in all cases.results Pneumatic reduction was successfully performed in 120/151 cases(79.5%).A high CMUI score was significantly associated with increased likelihood of failure at the positive likelihood ratio of 1.49(sensitivity 25.8 and specificity 82.7).The area under the receiver operating characteristic curve(AUC)was 0.73.We modified the CMUI System in two ways,first by removing the item‘method of reduction’and replacing it with‘hyponatremia’,and by changing the definition of low body weight to less than 9 kg.The modified CMUI had an AUC of 0.76.A high score(>9 points)on the modified version gave a positive likelihood ratio of 4.77(sensitivity 53.0 and specificity 80.9).Conclusion In infantile intussusception primarily treated with pneumatic reduction,the modified CMUI scoring system gave a better prediction reliability than the original.