Comprehensive Analysis of Cancer Incidence and Mortality Trends in Costa Rica: Implications for Public Health

This commentary delves into the evolving landscape of cancer incidence and mortality in Costa Rica, presenting a comprehensive analysis of the data. Key findings reveal a concerning upward trajectory in cancer incidence rates, placing Costa Rica at the forefront within Central America. While prostate cancer and breast cancer dominate, disparities emerge when scrutinizing gender-specific trends. Notably, stomach and cervical cancers show declines, potentially attributed to targeted interventions. However, colorectal and liver cancers witness mortality increases, necessitating strategic responses. Geographical disparities persist across provinces, highlighting the need for equitable healthcare access. In conclusion, this commentary underscores the urgency of addressing the burgeoning cancer burden in Costa Rica, calling for evidence-based interventions and collaborative efforts on a global scale.

Incidental gallbladder cancer during laparoscopic cholecystectomy:Managing an unexpected finding

AIM:To evaluate the impact of incidental gallbladder cancer on surgical experience.METHODS:Between 1998 and 2008 all cases of cholecystectomy at two divisions of general surgery,one university based and one at a public hospital,were retrospectively reviewed.Gallbladder pathology was diagnosed by history,physical examination,and laboratory and imaging studies [ultrasonography and computed tomography(CT)].Patients with gallbladder cancer(GBC) were further analyzed for demographic data,and type of operation,surgical morbidity and mortality,histopathological classification,and survival.Incidental GBC was compared with suspected or preoperatively diagnosed GBC.The primary endpoint was diseasefree survival(DFS).The secondary endpoint was the difference in DFS between patients previously treated with laparoscopic cholecystectomy and those who had oncological resection as first intervention.RESULTS:Nineteen patients(11 women and eight men) were found to have GBC.The male to female ratio was 1:1.4 and the mean age was 68 years(range:45-82 years).Preoperative diagnosis was made in 10 cases,and eight were diagnosed postoperatively.One was suspected intraoperatively and confirmed by frozen sections.The ratio between incidental and nonincidental cases was 9/19.The tumor node metastasis stage was:pTis(1),pT1a(2),pT1b(4),pT2(6),pT3(4),pT4(2);five cases with stageⅠa(T1 a-b);two with stageⅠb(T2 N0);one with stage Ⅱa(T3 N0);six with stage Ⅱb(T1-T3 N1);two with stage Ⅲ(T4 Nx Nx);and one with stage Ⅳ(Tx Nx Mx).Eighty-eight percent of the incidental cases were discovered at an early stage(≤Ⅱ).Preoperative diagnosis of the 19 patients with GBC was:GBC with liver invasion diagnosed by preoperative CT(nine cases),gallbladder abscess perforated into hepatic parenchyma and involving the transversal mesocolon and hepatic hilum(one case),porcelain gallbladder(one case),gallbladder adenoma(one case),and chronic cholelithiasis(eight cases).Every case,except one,with a T1b or more advanced invasion underwent Ⅳb + Ⅴ wedge liver resection and pericholedochic/hepatoduodenal lymphadenectomy.One patient with stage T1b GBC refused further surgery.Cases with Tis and T1a involvement were treated with cholecystectomy alone.One incidental case was diagnosed by intraoperative frozen section and treated with cholecystectomy alone.Six of the nine patients with incidental diagnosis reached 5-year DFS.One patient reached 38 mo survival despite a port-site recurrence 2 years after original surgery.Cases with non incidental diagnosis were more locally advanced and only two patients experienced 5-year DFS.CONCLUSION:Laparoscopic cholecystectomy does not affect survival if implemented properly.Reoperation should have two objectives:R0 resection and clearance of the lymph nodes.

Prevalence of incidental prostate cancer in patients undergoing radical cystoprostatectomy： data from China and other Asian countries

The purpose of this study is to investigate the frequency of prostate cancer （Pca） discovered incidentally in radical cystoprostatectomy specimens in Asia and to determine the feasibility of prostate-sparing cystectomy （PSC） for Asian patients. Ninety-two male bladder cancer patients who underwent radical cystoprostatectomy at our center between January 2003 and January 2008 were included in this study. The mean age of patients was 67.1 years （range： 32-75 years）. Prostate-specific antigen （PSA） levels and digital rectal examination （DRE） results before surgery were obtained retrospectively. Prostates of all patients were embedded and sectioned at 5-mm intervals. The same pathologist examined the prostatic tissues from radical cystoprostatectomy specimens. Finally, a structured literature review was performed using MEDLINE and PUBMED to estimate the occurrence of incidental Pca in Asia. Of the 92 patients, 3 （3.3%） were found to have Pca; in one out of three （33.3%） patients the disease was clinically significant due to a Gleason grade 4 carcinoma. Eight articles were included in our review. The overall incidence of Pca discovered incidentally in radical cystoprostatectomy specimens in Asia was 9.9% （64/642）. When age was restricted to 〈 60 years, only 7 out of 222 （3.2%） patients were found to have synchronous Pca, and none of the cases was clinically significant. The occurrence of Pca in radical cystoprostatectorny specimens in Asia is much lower than that in Western countries. PSC might be feasible for Asian patients under a strict preoperative selection.

Predictors of incidental gallbladder cancer in elderly patients

BACKGROUND： At the time of diagnosis, most patients with gallbladder cancer are in advanced stage and the cancer is unresectable. Long-term survivors are usually seen in a small number of patients with incidental gallbladder cancer. This study aimed to identify preoperative predictors of incidental gallbladder cancer in elderly patients.METHODS： A total of 4014 patients of more than 44 years old who had undergone cholecystectomy at our department from January 2000 to December 2010 were retrospectively reviewed Univariate and multivariate modalities were used to identify the predictive factors of incidental gallbladder cancer.RESULTS： Twenty-nine of the 4014 patients who had under gone cholecystectomy for benign gallbladder diseases were histologically diagnosed as having incidental gallbladder can cer. Multivariate analysis identified that elevated carbohydrate antigen 19-9 combined with carcinoembryonic antigen and/or carbohydrate antigen 125 （P=0.045）, a gallbladder polyp greater than or equal to 1.2 cm （P=0.043） and focal gallblad der wall thickening of more than or equal to 5 mm （P=0.002）were predictive factors of incidental gallbladder cancer.CONCLUSION： Cholecystectomy is suggested for patients with these predictive factors and intraoperative frozen section should be considered to rule out carcinoma.

Incidental gall bladder cancers:Are they truly incidental?

AIM: To seek and analyze features suggestive of gallbladder cancer(GBC) on preoperative imaging and intraoperative findings in patients diagnosed as having incidental GBC(IGBC). METHODS: The study was conducted on 79 patients of IGBC managed in our department over a 10-year period(2003-2012). Review of preoperative imaging and operative notes was done to ascertain any suspicion of malignancy-in-retrospect.RESULTS: Of the 79 patients, Ultrasound abdomen showed diffuse thickening, not suspicious of malignancy in 5 patients, and diffuse suspicious thickening was seen in 4 patients. Focal thickening suspicious of malignancy was present in 24 patients. Preoperative computed tomography/magnetic resonance imaging was done in 9 patients for suspicion of malignancy. In 5 patients, dif-ficult Cholecystectomy was encountered due to dense/inflammatory adhesions. Intraoperative findings showed focal thickening of the gallbladder and a gallbladder mass in 9 and 17 patients respectively. On overall analysis, 37 patients had preoperative imaging or intraoperative findings suggestive of malignancy, which was either a missed GBC or an unsuspected/unexpected GBC. In 42(53.2%) patients, there was no evidence suggestive of malignancy and was an unanticipated diagnosis.CONCLUSION: Our study highlights a potential and not-so-rare pitfall of Laparoscopic Cholecystectomy. A greater awareness of this clinical entity along with a high index of suspicion and a low threshold for conversion to open procedure, especially in endemic areas may avert avoidable patient morbidity and mortality.

Incidental prostate cancer in radical cystoprostatectomy specimens

Aim： To investigate the rates of prostate cancer （PCa） in radical cystoprostatectomy （RCP） specimens for bladder cancer in China's Mainland. To determine the follow-up outcome of patients with two concurrent cancers and identify whether prostate-specific antigen （PSA） is a useful tool for the detection of PCa prior to surgery. Methods： From January 2002 to January 2007, 264 male patients with bladder cancer underwent RCP at our center. All patients underwent digital rectal examination （DRE） and B ultrasound. Serum PSA levels were tested in 168 patients. None of the patients had any evidence of PCa before RCP. Entire prostates were embedded and sectioned at 5 mm intervals. Results： Incidental PCa was observed in 37 of 264 （14.0%） RCP specimens. Of these, 12 （32.4%） were clinically significant according to an accepted definition. The PSA levels were not significantly different between patients with PCa and those without PCa, nor between patients with significant PCa and those with insignificant PCa. Thirty-four patients with incidental PCa were followed up. During a mean follow-up period of 26 months, two patients with PSA 〉 4 ng/mL underwent castration. None of the patients died of PCa. Conclusion： The incidence of PCa in RCP specimens in China's Mainland is lower than that in most developed countries. PSA cannot identify asymptomatic PCa prior to RCP. In line with published reports, incidental PCa does not impact the prognosis of bladder cancer patients undergoing RCE

Incidental gallbladder cancer diagnosis confers survival advantage irrespective of tumour stage and characteristics

BACKGROUND Incidental gallbladder cancer(IGBC)represents 50%-60%of gallbladder cancer cases.Data are conflicting on the role of IGBC diagnosis in oncological outcomes.Some studies suggest that IGBC diagnosis does not affect outcomes,while others that overall survival(OS)is longer in these cases compared to non-incidental diagnosis(NIGBC).Furthermore,some studies reported early tumour stages and histopathologic characteristics as possible confounders,while others not.AIM To investigate the role of IGBC diagnosis on patients’overall survival,especially after surgical treatment with curative intent.METHODS Retrospective analysis of all patient referrals with gallbladder cancer between 2008 and 2020 in a tertiary hepatobiliary centre.Statistical comparison of patient and tumour characteristics between IGBC and NIGBC subgroups was performed.Survival analysis for the whole cohort,surgical and non-surgical subgroups was done with the Kaplan-Meier method and the use of log rank test.Risk analysis was performed with univariable and multivariable Cox regression analysis.RESULTS The cohort included 261 patients with gallbladder cancer.65%of cases had NIGBC and 35%had IGBC.A total of 90 patients received surgical treatment(66%of IGBC cases and 19%of NIGBC cases).NIGBC patients had more advanced T stage and required more extensive resections than IGBC ones.OS was longer in patients with IGBC in the whole cohort(29 vs 4 mo,P<0.001),as well as in the non-surgical(14 vs 2 mo,P<0.001)and surgical subgroups(29 vs 16.5 mo,P=0.001).Disease free survival(DFS)after surgery was longer in patients with IGBC(21.5 mo vs 8.5 mo,P=0.007).N stage and resection margin status were identified as independent predictors of OS and DFS.NIGBC diagnosis was identified as an independent predictor of OS.CONCLUSION IGBC diagnosis may confer a survival advantage independently of the pathological stage and tumour characteristics.Prospective studies are required to further investigate this,including detailed pathological analysis and molecular gene expression.

Clues to predict incidental gallbladder cancer

Background: Consequences of incidental gallbladder cancer(iGBC) following cholecystectomy may include repeat operation(depending on T stage) and worse survival(if bile spillage occurred), both avoidable if iGBC were suspected preoperatively.Methods: A retrospective single-institution review was done. Ultrasound images for cases and controls were blindly reviewed by a radiologist. Chi-square and Student’s t tests, as well as logistic regression and Kaplan–Meier analyses were used. A P ≤ 0.01 was considered significant.Results: Among 5796 cholecystectomies performed 2000–2013, 26(0.45%) were iGBC cases. These patients were older(75.61 versus 52.27 years), had more laparoscopic-to-open conversions(23.1% versus3.9%), underwent more imaging tests, had larger common bile duct diameter(7.13 versus 5.04 mm) and higher alkaline phosphatase. Ultrasound imaging showed that gallbladder wall thickening(GBWT) without pericholecystic fluid(PCCF), but not focal-versus-diffuse GBWT, was associated significantly with iGBC(73.9% versus 47.4%). On multivariable logistic regression analysis, GBWT without PCCF, and age were the strongest predictors of iGBC. The consequences iGBC depended significantly on intraoperative bile spillage, with nearly all such patients developing carcinomatosis and significantly worse survival.Conclusions: Besides age, GBWT, dilated common bile duct, and elevated alkaline phosphatase, number of preoperative imaging modalities and the presence of GBWT without PCCF are useful predictors of iGBC.Bile spillage causes poor survival in patients with iGBC.

膀胱癌患者根治术后合并前列腺偶发癌的临床病理特征分析

目的分析膀胱癌患者根治术后合并前列腺偶发癌的临床病理特征。方法回顾性分析行膀胱癌根治术75例患者的临床资料,所有患者术前均未被诊断为前列腺癌,统计术后前列腺偶发癌的发生率。另收集患者的年龄、膀胱癌分期等资料,统计对比合并前列腺偶发癌与未合并前列腺偶发癌患者各项临床资料的差异;同时统计分析合并前列腺偶发癌患者的病理特点;于术后进行随访,统计所有患者的生存率。结果75例患者中,合并前列腺偶发癌的共有18例,发生率为24.00%(18/75);合并前列腺偶发癌的患者年龄高于未合并前列腺偶发癌患者,有统计学差异(P<0.05);而两组术前的国际前列腺症状评分(IPSS)、生活质量综合评定问卷(GQOLI-74)、前列腺特异抗原(PSA)相比,无统计学差异(P>0.05);18例合并前列腺偶发癌的患者其临床分期大部分局限于pT_(2)内,其中pT_(1)有10例(55.56%),pT_(2)有5例(27.78%),pT 3有3例(16.67%);采用Gleason score评分对患者评估,其中<7分11例(61.11%)、=7分5例(27.78%)、>7分2例(11.11%);术后随访成功60例,生存率为80.00%(60/75),其中11例死于膀胱癌,4例死于其他疾病。结论膀胱癌根治术后前列腺偶发癌的发生率较高,大多局限于pT_(2)内,且Gleason score评分多数≤7分,前列腺偶发癌的发生对膀胱癌患者总体生存率无显著影响。

意外胆囊癌病人预后列线图模型的构建

目的:构建并验证可有效预测意外胆囊癌(incidental gallbladder cancer,IGBC)病人预后的列线图模型。方法:回顾性分析2011年5月至2022年10月西安交通大学第一附属医院收治的161例因IGBC而需根治手术病人的临床资料。使用COX比例风险回归模型筛选影响IGBC总体生存(OS)的影响因素。根据IGBC病人预后的独立影响因素构建列线图模型。利用一致性指数(concordance index,C-index)和校准曲线来验证模型的性能。利用受试者工作特征(receiver operating characteristic,ROC)曲线分析和决策曲线分析(decision curve analysis,DCA)来验证所绘制的列线图的预测精准度和净收益。结果:单因素COX回归分析提示,年龄、T分期、N分期、M分期、术前癌胚抗原(CEA)、术前糖类抗原(CA)19-9、术前红细胞体积分布宽度变异系数(RDW-CV)、治疗方式、复发转移是影响IGBC病人根治术后远期生存的危险因素。多因素COX回归分析提示,T分期、N分期、术前CA19-9、术前RDW-CV、术前天冬氨酸转氨酶(AST)、治疗方式、复发转移是影响IGBC病人预后的独立危险因素。所构建的列线图模型C-index为0.872。校准图显示列线图的良好性能。ROC曲线下面积为0.869,证实列线图的高精准度。DCA证实列线图模型的高净获益。结论:构建的列线图模型可准确、直观地预测IGBC病人根治术后生存概率。

Repeatedly elevatedγ-glutamyltransferase levels are associated with an increased incidence of digestive cancers:A population-based cohort study

BACKGROUND The association between elevatedγ-glutamyltransferase(GGT)at a certain point and incident cancer has been suggested;however,no study has evaluated the association between repeatedly elevated GGT and cancer incidence.AIM To investigate the effects of repeatedly elevated GGT on the incidence of digestive cancers.METHODS Participants who had undergone health screening from 2009 to 2012 and 4 consecutive previous examinations were enrolled.GGT points were calculated as the number of times participants met the criteria of quartile 4 of GGT in four serial measurements(0-4 points).Multivariable Cox proportional hazard regression models were applied.RESULTS In total,3559109 participants were included;among them,43574 digestive cancers developed during a median of 6.8 years of follow-up.The incidence of total digestive cancers increased in a dose-response manner in men[adjusted hazard ratio(aHR)compared with those with 0 GGT points=1.28 and 95%confidence interval(CI)=1.24-1.33 in those with 1 point;aHR=1.40 and 95%CI=1.35-1.46 in those with 2 points;aHR=1.52 and 95%CI=1.46-1.58 in those with 3 points;aHR=1.88 and 95%CI=1.83-1.94 in those with 4 points;P for trend<0.001].This trend was more prominent in men than in women and those with healthy habits(no smoking,no alcohol consumption,and a low body mass index)than in those with unhealthy habits.CONCLUSION Repeatedly elevated GGT levels were associated with an increased risk of incident digestive cancer in a dose-responsive manner,particularly in men and those with healthy habits.Repeated GGT measurements may be a good biomarker of incident digestive cancer and could help physicians identify high-risk populations.

意外胆囊癌的临床特征分析

目的系统评价胆囊切除术中或术后发现意外胆囊癌的临床特征。方法在Pubmed、Embase和Cochrane数据库中检索数据,最终选择了16篇文章进行荟萃分析,了解意外胆囊癌的发生率、T分期的分布以及根治性手术的比例。结果最终汇总1022例意外胆囊癌患者。在术前诊断为良性胆囊疾病的胆囊切除术中,意外胆囊癌的发生率为0.004(95%CI:0.003~0.004)。意外胆囊癌T_(2)期比例最高,为0.402(95%CI:0.372~0.433),其次T_(3)期为0.258(95%CI:0.230~0.285)。以治愈为目的再次手术的患者比例为0.411(95%CI:0.303~0.530)。在再次手术中无法切除的患者比例为0.089(95%CI:0.042~0.180)。结论大部分的意外胆囊癌处于T_(2)期和T_(3)期。对于T_(2)期及以上分期的胆囊癌,进行根治性胆囊癌切除是必要的。

Cancer incidence and mortality in China, 2014

Background： National Central Cancer Registry of China（NCCRC） updated nationwide cancer statistics using population-based cancer registry data in 2014 collected from all available cancer registries.Methods： In 2017, 449 cancer registries submitted cancer registry data in 2014, among which 339 registries＇ data met the criteria of quality control and were included in analysis. These cancer registries covered 288,243,347 population, accounting for about 21.07% of the national population in 2014. Numbers of nationwide new cancer cases and deaths were estimated using calculated incidence and mortality rates and corresponding national population stratified by area, sex, age group and cancer type. The world Segi＇s population was applied for agestandardized rates.Results： A total of 3,804,000 new cancer cases were diagnosed, the crude incidence rate was 278.07/100,000（301.67/100,000 in males, 253.29/100,000 in females） and the age-standardized incidence rate by world standard population（ASIRW） was 186.53/100,000. Calculated age-standardized incidence rate was higher in urban areas than in rural areas（191.6/100,000 vs. 179.2/100,000）. South China had the highest cancer incidence rate while Southwest China had the lowest incidence rate. Cancer incidence rate was higher in female for population between20 to 54 years but was higher in male for population younger than 20 years or over 54 years. A total of 2,296,000 cancer deaths were reported, the crude mortality rate was 167.89/100,000（207.24/100,000 in males,126.54/100,000 in females） and the age-standardized mortality rate by world standard population（ASMRW） was106.09/100,000. Calculated age-standardized mortality rate was higher in rural areas than in urban areas（110.3/100,000 vs. 102.5/100,000）. East China had the highest cancer mortality rate while North China had the lowest mortality rate. The mortality rate in male was higher than that in female. Common cancer types and major causes of cancer death differed between age group and sex.Conclusions： Heavy cancer burden and its disparities between area, sex and age group pose a major challenge to public health in China. Nationwide cancer registry plays a crucial role in cancer prevention and control.

Consumption of soybean,soy foods,soy isoflavones and breast cancer incidence:Differences between Chinese women and women in Western countries and possible mechanisms

Breast cancer is one of the most lethal diseases world-wide.However,there is a large difference in breast cancer incidence among Caucasian,Hispanic,African and Asian(e.g.Chinese)women with Caucasian women being the highest and Asian women being the lowest.It has been suggested that the dietary factors may account for approximately 50%of the breast cancer.One of such dietary components which are typical to Asian but not Caucasian diet is soy foods.A number of epidemiological studies have suggested that increasing soy consumption could be related to the decreased risk of occurrence and/or mortality of breast cancer.In this review,we first described briefly different types of soy products and their nutritional functions and consumption.Then,we described briefly soybean isoflavones,i.e.genistein(GEN),daidzein,glycitein,and presented several lines of evidence to demonstrate the possible association of soy flavone food consumption with incidence and prognosis of breast cancer;finally,we summarized several possible molecular mechanisms,including the effects of GEN as an agonist of ER,epigenetic and genome-wide effects,activation of peroxisome proliferator-activated receptors,induction of apoptosis and stimulation of autophagy,involved in the chemo-preventive effects of GEN on breast cancer.©2013 Beijing Academy of Food Sciences.Production and hosting by Elsevier B.V.All rights reserved.

Cancer incidence in Beijing, 2014

Objective： To analyze cancer incidence data in Beijing in 2014 and temporal trends for selected common cancers during 2005 and 2014.Methods： A total of 144 secondary and tertiary hospitals reported newly diagnosed cancer cases to Beijing Cancer Registry, which covers 13 million residents in Beijing. The cancer incidence rate was calculated in strata by cancer type, sex, age group and area. The population composition of China in 1982 and Segi＇s population structure were used to calculate age-standardized rates. Extensive procedures were used to assure the quality of the data.Results： The overall data quality indicators of the percentage of morphology verification（MV）（%）, the percentage of death certificate-only（DCO）（%） and the mortality to incidence ratio（M/I） were 72.15%, 0.94% and0.54 respectively. A total of 45,300 new cancer cases were diagnosed in Beijing in 2014. The incidence rate was341.92/100,000（343.50/100,000 in males, 340.33/100,000 in females）, and the age-standardized incidence rates by Chinese standard population（ASIRC） and by world standard population（ASIRW） were 143.48/100,000 and182.99/100,000, respectively. The cumulative incidence rate for cancer before 75 years was 20.61%. Cancers of lung, colorectum, liver, stomach and prostate were the top five common cancer types for males, while cancers of breast, lung, thyroid, colorectum and uterus were the top five common cancer types for females. The different patterns were also observed between rural and urban areas. Regarding temporal trends, the incidence of thyroid cancer has the fastest growth between 2005 and 2014. The incidence of liver cancer decreased, and stomach and esophageal cancer also decreased significantly for males in the last decade. Incidence rate for lung cancer was relatively stable during that period of time.Conclusions： With more than 45,000 new cases in Beijing in 2014, cancer remains an important public health problem. Actions should be taken to diminish total cancer incidence in Beijing.

Comparison of cancer incidence and mortality in three GDP per capita levels in China, 2013

Objective：In this research,the patterns of cancer incidence and mortality in areas with different gross domestic product per capita（GDPPC）levels in China were explored,using data from population-based cancer registries in 2013,collected by the National Central Cancer Registry（NCCR）.Methods：Data from 255 cancer registries were qualified and included in this analysis.Based on the GDPPC data of 2014,cities/counties were divided into 3 levels：high-,middle-and low-GDPPC areas,with 40,000 and 80,000 RMB per year as cut points.We calculated cancer incidences and mortalities in these three levels,stratified by gender and age group.The national population of the Fifth Census in 2000 and Segi’s population were applied for age-standardized rates.Results：The crude incidence and mortality rates as well as age-standardized incidence rate（ASIR）showed positive associations with GDPPC level.The age-standardized mortality rate（ASMR）nevertheless showed a negative association with GDPPC level.The ASMR in high-,middle-and low-GDPPC areas was 103.12/100,000,112.49/100,000 and 117.43/100,000,respectively.Lung cancer was by far the most common cancer in all three GDPPC levels.It was also the leading cause of cancer death,regardless of gender and GDPPC level.Negative associations with GDPPC level were found for the ASIRs of lung,stomach,esophageal and liver cancer,whereas colorectal and breast cancer showed positive associations.Except for breast cancer,the ASMRs of the other five cancers were always higher in middle-and low-GDPPC areas than in high-GDPPC areas.Conclusions：The economic development is one of the main factors of the heavy cancer burden on Chinese population.It would be reasonable to implement cancer control strategies referring to the local GDPPC level.

Unexpected gallbladder cancer:Surgical strategies and prognostic factors

Gallbladder cancer is the most common tumor of the biliary tract and it is associated with a poor prognosis.Unexpected gallbladder cancer is a cancer incidentally discovered,as a surprise,at the histological examination after cholecystectomy for gallstones or other indications.It is a potentially curable disease,with an intermediate or good prognosis in most cases.An adequate surgical strategy is mandatory to improve the prognosis and an adjunctive radical resection may be required depending on the depth of invasion.If the cancer discovered after cholecystectomy is a pTis or a pT1a,a second surgical procedure is not mandatory.In the other cases(pT1b,pT2 and pT3 cancer) a re-resection(4b + 5 liver segmentectomy,lymphadenectomy and port-sites excision in some cases) is required to obtain a radical excision of the tumor and an accurate disease staging.The operative specimens of re-resection should be examined by the pathologist to find any "residual" tumor.The "residual disease" is the most important prognostic factor,significantly reducing median disease-free survival and disease-specific survival.The other factors include depth of parietal invasion,metastatic nodal disease,surgical margin status,cholecystectomy for acute cholecystitis,histological differentiation,lymphatic,vascular and perineural invasion and overall TNM-stage.

CHEMOPREVENTION OF LUNG CANCER IN THE HIGH INCIDENCE AREA

Since 1984, mass screening for cancer and chemopreventive trials in the two high incidence areas of lung cancer have been carried out. Chemo preventive trials on the subjects having moderate or severe atypical hyperplasia cells in the sputum were done by treatment with R1 [N-(p-ethoxycarbophenyl) retinamide] and R2 [N-(p-carboxyphenyl) retina-mide]. Results showed that the general status of the patients had improved. IgA and IgM in the serum were increased and the arsenic skin lesions were relieved after the treatment with Rl and R2. The ratio of the incidence of lung cancer for the treated group and the control group was 1:4, and the mean degree of hyperplasia in the sputum had dropped. It is suggested that these drugs are both safe and effective in the chemoprevention of lung cancer.

Unexpected Intraoperative Resecting of Common Trunk of Pulmonary Vein Resulted in an Incidental Pneumonectomy from Left Upper Lobectomy

There is a wide range of anatomical variations in the pulmonary vessels. Some of these variations may cause surgical morbidity during general thoracic surgery. We intended to perform a left upper lobectomy for a 73-year-old male with suspected left lung cancer (lt.U, S3, 20 × 20 mm, P0, E0, D0, PM0, N0, T1aN0M0, c-stage IA). Preoperatively, we did not recognize the existence of the common trunk of the left pulmonary vein. After the open thoracotomy, due to a severe intrathoracic adhesion, we omitted releasing the adhesion of the lower lobe. We did not exactly confirm the location of the inferior pulmonary vein (IPV). After cutting the interlobular pulmonary arterial branchies, we resected the superior pulmonary vein (SPV) using auto sutures. After division of the lung parenchyma and incomplete fissures using auto sutures, we intended to resect the upper bronchus. However, we could not find an IPV at the normal IPV site. A thin IPV was found to be returned to the peripheral site of the resected SPV. The SPV and IPV formed a common trunk at the normal site of the SPV. Although we considered reconstructing the resected common trunk, we finally made a decision of performing an incidental pneumonectomy in order to prevent any postoperative complications on the reconstruction of the IPV such as thrombus occlusion at the anastomosis site and venous return congestion. Retrospectively, we confirmed the preoperative images of the computed tomographic scanning, which showed a narrow IPV that returned to the peripheral site of the SPV. It is important to confirm both accurate locations of the SPV and IPV when performing a lobectomy.

根治性膀胱切除术患者伴偶发前列腺癌的危险因素

目的分析根治性膀胱切除术(RCP)患者伴偶发前列腺癌的危险因素及其临床意义。方法回顾性分析2012年1月-2022年1月在新疆医科大学第一附属医院接受RCP治疗患者共260例的临床及病理资料,其中术后病理检出偶发前列腺癌共39例(有IPCa组),未检出偶发前列腺癌共221例(无IPCa组)。结果偶发前列腺癌的检出率为15%。单因素logistic回归分析结果显示年龄(P<0.001)、吸烟(P<0.05)、T分期(P<0.05)、肿瘤数目(P<0.05)、是否及膀胱三角(P<0.05)、前列腺体积(P<0.05)、术前总PSA(P<0.001)为膀胱癌发生前列腺癌的影响因素;多因素logistic回归分析表明年龄(OR=1.061,95%CI:1.021~1.107,P=0.004)、吸烟(OR=2.852,95%CI:1.296~6.677,P=0.012)、是否及膀胱三角(OR=2.967,95%CI:2.365~3.657,P=0.019)、术前总PSA(OR=1.109,95%CI:1.011~1.223,P=0.030)是偶发前列腺癌的独立危险因素。结论高龄、吸烟、膀胱肿瘤位于三角区及术前前列腺特异性抗原(PSA)异常是膀胱癌患者伴发偶发性前列腺癌的危险因素。