Chinese consensus guidelines for diagnosis and management of gastrointestinal stromal tumor

In order to further promote the standardization of diagnosis and treatment of gastrointestinal stromal tumor （GIST） in China, the members of Chinese Society of Clinical Oncology （CSCO） Expert Committee on GIST thoroughly discussed the key contents of the consensus guidelines, and voted on the controversial issue. In final, the Chinese consensus guidelines for the diagnosis and management of GIST （2017 edition） was formed on the basis of 2013 edition consensus guidelines, which is hereby announced. The consensus included the pathological diagnosis, recurrence risk classification evaluation, targeted agent therapy, surgery and principles of surveillance of GIST.

Magnetostratigraphy and provenance of the Qingzhou loess in Shandong province

Loess deposits with varying thickness are widely distributed on the intermontane valleys and piedmont zones on the northern side of the central Shandong mountainous regions. However, the basal ages and material resources of the loess deposits are not clear. The paper studied the Qingzhou loess profile in Shandong with magnetostratigraphic and optical stimulated luminescence （OSL） methods and further investigated its main provenances with the mineralogical methods. The magnetostratigraphic results showed that the Brunhes/Matuyama （B/M） reversal boundary was not recognized, suggesting a basal age younger than 0.78 Ma. Extrapolations by sedimentation rates, based on the upper part depositional rate from the OSL age, the basal age of the Qingzhou loess is about 0.5 Ma. Until now, older loess deposits have not been reported on the northern side of the central Shandong mountainous regions. The results of the paper indicate that the loess deposits in this area might have strated from the Middle Pleistocene. The basal age of Qingzhou loess is approximately synchronous with the Xiashu loess in the middle-lower reaches of Yangtze River. Major components of clay minerals in the Qingzhou profile are dominated by illite. Other clay mineral compositions are mainly smectite, chlorite and kaolinite, which are similar with the Xifeng loess in the Loess Plateau. However, the contents of smectite and the ratios of illite and kaolinte in the Qingzhou loess samples are higher than those in the Xifeng loess samples of the Loess Plateau, indicating that the loess in the northern side of the central Shandong mountainous regions has different sources from that of the loess deposits in the Loess Plateau. The clay mineral analysis further reinforces the earlier conclu- sion that the marine strata exposed in the Laizhou Bay and the fluvial plain of the lower reaches of Yellow River during the glacier periods are the main material sources for the Qingzhou loess deposits, which is an indicator to the local aridification of the lower reaches of the Yellow River. Loess deposition in the central Shandong mountainous regions started at around 0.5 Ma. The age of Qingzhou loess is approximately synchronous with the ongoing high-latitude cold since the Middle Pleistocene, which indicates that strengthened East Asian winter monsoon was sufficiently energetic to bring substantial quantities of material from the marine strata exposed in the Laizhou Bay and the fluvial plain of the lower reaches of the Yellow River to the central Shandong mountainous regions. The results therefore suggest that both regional geological process and global changes were responsible for the formation of Qingzhou loess since Middle Pleistocene.

Examined lymph node numbers influence prognosis in rectal cancer treated with neoadjuvant therapy

Background:The number of lymph nodes examined(LNe)is often insufficient in patients with rectal cancer(RC)treated with neoadjuvant therapy;however,its prognostic value remains controversial.Thus,we retrospectively explored whether LNe had an influence on staging and prognosis and investigated whether there was a cut-off value for better prognosis in patients with RC treated with neoadjuvant therapy.Methods:Data were collected from seven prospective hospital databases in China from July 2002 to May 2018.Binary logistic regression models were used to predict lymph node metastasis.The cut-off value for LNe was determined using X-tile 3.6.1.Survival outcomes and risk factors were analyzed using the log-rank test and Cox regression model.Results:A total of 482 patients were included,of whom 459 had complete overall survival(OS)information.Using the percentile method,the total number of lymph nodes examined(TLNe)was 14-16(40th-60th percentile),and the proportion of patients with lymph node metastasis reached a maximum of 48.1%.Cox multivariate analysis showed that the odds ratio(OR)remained the highest when TLNe was 14-16(OR=3.379,P=0.003).The 3-year and 5-year OS were 85.4% and 77.8%,respectively.Negative lymph nodes examined(NLNe)of≤6 was an independent risk factor for 3-year and 5-year OS(3-year OS 71.1%vs.85.9%,P=0.004;5-year OS 66.3%vs.74.3%,P=0.035).Subgroup analysis for patients with ypN+showed that higher 3-year and 5-year OS were achieved when the TLNe was>10,78.8%vs.54.0%(P=0.005),and 60.8%vs.36.0%(P=0.012),respectively.Patients with ypN0M0 had a higher 5-year OS when the TLNe was>19(P=0.055).Conclusion:The TLNe and NLNe influenced the staging accuracy and demonstrated prognostic value in patients with RC treated with neoadjuvant therapy.