Clinical analysis of multiple primary gastrointestinal malignant tumors:A 10-year case review of a single-center

BACKGROUND Multiple primary malignant tumors(MPMTs)was first described by Billroth as early as 1889,with the first report published by Warren and Gates in 1932.Since then,numerous cases have been reported.A literature review of 1104269 patients with cancer revealed that the incidence of MPMTs ranged from 0.73 to 11.7%.In recent years,however,there has been a significant upward trend in the incidence of this phenomenon,which may be associated with many different factors,including the advancement of modern diagnostic procedures facilitating the examination and diagnosis of more MPMTs,increased exposure to chemotherapy and radiotherapy that exacerbate the risk of new malignant tumors in patients with cancer,and prolonged survival of patients with cancer allowing sufficient time for the development of new primary cancers.AIM To analyze the incidence,clinical features,treatment factors,prevalence,and prognosis of patients with MPMTs in the gastrointestinal tract treated in a single center.Additionally,we analyzed the different tumor combinations,time interval between the occurrence of tumors,and staging.METHODS This retrospective cohort study analyzed 8059 patients with pathologically confirmed gastrointestinal malignant tumors treated at the Gansu Province Hospital in Lanzhou,Gansu,China between June 2011 and June 2020.Of these,85 patients had MPMTs.The clinical features,treatment factors,prevalence,and prognosis of this latter cohort were analyzed.RESULTS The incidence of MPMTs in patients with gastrointestinal malignant tumors was 1.05%(85/8059),including 83 double primary malignant tumors and two triple primary malignant tumors of which 57(67.06%)were synchronous MPMTs(SMPMTs)and 28(32.94%)were metachronous MPMTs(MMPMTs).The most frequent associations were found between the rectum colon cancers within the SMPMT category and the gastric-colon cancers within the MMPMT category.For the MMPMTs,the median interval was 53 months.The overall 1-,3-and 5-year survival rates from diagnosis of the first primary cancer were 91.36%,65.41%,and 45.97%,respectively;those from diagnosis of the second primary cancer were 67.90%,29.90%,and 17.37%,respectively.CONCLUSION MPMTs in the gastrointestinal tract have a high incidence and poor prognosis.Thus,it is necessary to perform both gastroscopy and colonoscopy in patients with gastrointestinal tumors.Multidisciplinary comprehensive diagnosis and treatment may improve the diagnosis rate and treatment efficiency of MPMTs.

Research progress on venous thrombosis development in patients with malignant tumors

The coexistence of venous thromboembolism(VTE)within patients with cancer,known as cancer-associated thrombosis(CAT),stands as a prominent cause of mortality in this population.Over recent years,the incidence of VTE has demonstrated a steady increase across diverse tumor types,influenced by several factors such as patient management,tumor-specific risks,and treatment-related aspects.Furthermore,mutations in specific genes have been identified as potential contributors to increased CAT occurrence in particular cancer subtypes.We conducted an extensive review encompassing pivotal historical and ongoing studies on CAT.This review elucidates the risks,mechanisms,reliable markers,and risk assessment methodologies that can significantly guide effective interventions in clinical practice.

Malignant triton tumor in the abdominal wall:A case report

BACKGROUND Malignant triton tumors(MTTs)comprise a subgroup of malignant peripheral nerve sheath tumors(MPNSTs)that exhibits rhabdomyosarcomatous differen-tiation and follow an aggressive course.MTTs are primarily located along peripheral nerves.Cases of MTTs in the abdominal wall have not been reported.MTT has a poorer prognosis than classic MPNSTs,and accurate diagnosis necessitates a keen understanding of the clinical history and knowledge of its differential diagnosis intricacies.Treatment for MTTs mirrors that for MPNSTs and is predominantly surgical.CASE SUMMARY A 49-year-old woman presented with a subcutaneous mass in her lower abdo-minal wall and a pre-existing surgical scar that had grown slowly over 3-4 months before the consultation.She had previously undergone radical hysterectomy and concurrent chemo-radiotherapy for cervical cancer approximately 5 years prior to the consultation.Abdominal computed tomography(CT)showed a 1.3 cm midline mass in the lower abdomen with infiltration into the rectus abdominis muscle.There was no sign of metastasis(T1N0M0).An incisional biopsy identified sporadic MTT of the lower abdomen.A comprehensive surgical excision with a 3 cm margin inclusive of the peritoneum was executed.Subse-quently,the general surgeon utilized an approach akin to the open peritoneal onlay mesh technique.The patient underwent additional treatment with an excision shaped as a mini-abdominoplasty for the skin defect.No complications arose,and annual follow-up CTs did not show signs of recurrence or metastasis.CONCLUSION An abdominal MTT was efficaciously treated with extensive excision and abdominal wall reconstruction,eliminating the need for postoperative radiotherapy.

Laparoscopic spleen-preserving total pancreatectomy for the treatment of low-grade malignant pancreatic tumors:Two case reports and review of literature

BACKGROUND Function-preserving pancreatectomy can improve the long-term quality of life of patients with benign or low-grade malignant tumors,such as intraductal papillary mucinous neoplasms(IPMNs)and mucinous cystic neoplasms.However,there is limited literature on laparoscopic spleen-preserving total pancreatectomy(LSpTP)due to technical difficulties.CASE SUMMARY Patient 1 was a 51-year-old male diagnosed with IPMN based on preoperative imaging,showing solid nodules in the pancreatic head and diffuse dilation of the main pancreatic duct with atrophy of the distal pancreas.We performed L-SpTP with preservation of the splenic vessels,and the postoperative pathology report revealed IPMN with invasive carcinoma.Patient 2 was a 60-year-old male with multiple cystic lesions in the pancreatic head and body.L-SpTP was performed,and intraoperatively,the splenic vein was injured and required ligation.Postoperative pathology revealed a mucinous cystic tumor of the pancreas with low-grade dysplasia.Both patients were discharged on postoperative day 7,and there were no major complications during the perioperative period.CONCLUSION We believe that L-SpTP is a safe and feasible treatment for low-grade malignant pancreatic tumors,but more case studies are needed to evaluate its safety,efficacy,and long-term outcomes.

Cost analysis of radical resection of malignant breast tumors under the China Healthcare Security Diagnosis Related Groups payment system

BACKGROUND Breast cancer is one of the most common malignant tumors in women worldwide and poses a severe threat to their health.Therefore,this study examined patients who underwent breast cancer surgery,analyzed hospitalization costs and structure,and explored the impact of China Healthcare Security Diagnosis Related Groups(CHS-DRG)management on patient costs.It aimed to provide medical institutions with ways to reduce costs,optimize cost structures,reduce patient burden,and improve service efficiency.AIM To study the CHS-DRG payment system’s impact on breast cancer surgery costs.METHODS Using the CHS-DRG(version 1.1)grouping criteria,4073 patients,who underwent the radical resection of breast malignant tumors from January to December 2023,were included in the JA29 group;1028 patients were part of the CHS-DRG payment system,unlike the rest.Through an independent sample t-test,the length of hospital stay as well as total hospitalization,medicine and consumables,medical,nursing,medical technology,and management expenses were compared.Pearson’s correlation coefficient was used to test the cost correlation.RESULTS In terms of hospitalization expenses,patients in the CHS-DRG payment group had lower medical,nursing,and management expenses than those in the diagnosis-related group(DRG)non-payment group.For patients in the DRG payment group,the factors affecting the total hospitalization cost,in descending order of relevance,were medicine and consumable costs,consumable costs,medicine costs,medical costs,medical technology costs,management costs,nursing costs,and length of hospital stay.For patients in the DRG nonpayment group,the factors affecting the total hospitalization expenses in descending order of relevance were medicines and consumable expenses,consumable expenses,medical technology expenses,the cost of medicines,medical expenses,nursing expenses,length of hospital stay,and management expenses.CONCLUSION The CHS-DRG system can help control and reduce unnecessary medical expenses by controlling medicine costs,medical consumable costs,and the length of hospital stay while ensuring medical safety.

Giant Tuberculomas Suggesting a Malignant Brain Tumor: About Two Cases

Tuberculoma is a common condition in developing countries. In some cases, it may mimic a glial lesion, making differential diagnosis challenging. The authors report two cases of giant tuberculoma in young patients aged 14 and 16. A literature review was conducted on these cases. Both patients underwent partial excision. Histology concluded tuberculoma. Anti-tubercular treatment was implemented. The evolution one year later was marked by the persistence of neurological disorders, although they had improved.

A study of current status of acceptance and influencing factors of advance care planning for patients with malignant tumors

Objective:To assess the ACP acceptance among patients with malignant tumor in China and factors affecting adoption and timing.Methods:Quantitative study:The convenience sampling method was adopted from October 2020 to October 2021 to investigate 200 oncology patients by a general information questionnaire,patient's advance care planning acceptance questionnaire(ACPQ).Multiple linear stepwise regression was used to analyze the influencing factors of ACP acceptance.Qualitative study:A purposive sampling method was used to select 31 oncology patients and 13 clinical nurses for semi-structured interviews.The data were analyzed using Colaizzi's seven steps.Results:The quantitative study revealed that patients with malignancy had an upper-middle acceptance score of(66.15±7.684)for ACP,with attitude(11.26±2.064),feelings(36.64±4.208),and intention(18.25±3.275)scores.Multiple linear regression analysis showed that religious beliefs,education,monthly income,bereavement experience and notification of condition were independent risk factors for acceptance of ACP(P<0.05).The qualitative study showed that(1)oncology patients have low awareness,high demand,and low acceptability of ACP intervention;(2)they preferred to discuss ACP when medical condition or treatment plan changes;(3)family members were usually involved in ACP discussions,followed by medical personnel;(4)economy,environment,companion,and doctor-patient relationship will all influence ACP implementation.As for nurses,they(1)were unsure about the dynamic changes of ACP content and its optimal timing;(2)had limited ACP knowledge;(3)were affected by environmental factors and nurse-patient relationships;(4)were prone to have disagreements due to inadequate organization department assistance.Conclusions:clinical practitioners should discuss ACP with patients in specific conditions to increase patient acceptance.ACP development requires updated legislation,professional training,and a standardized ACP system.

Research Progress on the Mental Toughness of Family Caregivers of Children with Malignant Solid Tumors

The physical,emotional,and caregiving quality of caregivers for children with malignant solid tumors is significantly influenced by mental toughness.The definition of mental toughness,study methods,primary influencing factors,and intervention strategies for the mental toughness of caregivers of children with malignant solid tumors will be examined in this paper.To improve the mental toughness of caregivers of children with malignant solid tumors,it is recommended that future studies enhance the number of intervention research methods and establish particular evaluation tools.

CLINICAL STUDY ON ACUPUNCTURE TREATMENT OF SIDE REACTIONS OF RADIOTHERAPY AND CHEMOTHERAPY FOR MALIGNANT TUMOR

Forty-two cancer patients were randomly divided into acupuncture plus radiotherapy chemotherapy (acupuncture) group and radiotherapy-chemotherapy (control) group. The indexes ob served were the counts of leukocytes and thrombocytes, and the activities of both natural killer (NK) cells and intCrleukin(IL) - 2. The findings showed that the counts of both leukocytes and thrombo cytes in acupuncture group had no significant changes while those of control group lowered consider ably, displaying a significant difference between the two groups (P< 0.01 ). The activities of NK cells and IL - 2 of acupuncture group raised apparently while that of NK cells and IL - 2 in control group lowered markedly. There was a significant difference between the two groups (P < 0.01 ). In acupuncture group, radiotherapy and chemotherapy induced symptoms of the d1gest1ve system and ner vous system were strikingly less than those of the control group, suggesting that acupuncture can pro nouncedly ameliorate radiotherapy and chemotherapy induced symptoms of arrest of bone marrow, im munosuppression, digestive system and nervous system.

The effect of Cordyceps Sinensis in the prognosis on patients receiving chemotherapy with malignant tumors:A systematic review and meta-analysis

Objective:The efficacy of Cordyceps Sinensis(CS)on malignant tumors remains controversial.We undertook a systematic meta-analysis of randomized controlled clinical studies on this issue.Method:A comprehensive literature search(by the end of Sep.31,2017)was conducted in following electronic databases:China National Knowledge Infrastructure(CNKI),VIP database,Wan fang database(VIP),PubMed,Medline,and EMBASE.Relevant studies were included according to inclusion criteria.Pooled relative risk was estimated by using the fixed effects model or random effects model according to heterogeneity.Data were extracted independently and the standardized mean deviation(SMD)of the calculated results was obtained.Result:After selection,8 of 729 studies were included.The result showed that CS combined with chemotherapeutic drugs was favorable for the treatment of malignant tumor.The amount of CD3^+T cells in the experimental group was signi行cantly higher than that in the control group(SMD=0.86;95%CI=0.02,1.70;P<0.01;I2=91%).The amount of CD4^+T cells in the experimental group was significantly higher than that in the control group(SMD=0.95;95%CI=0.22,1.68;P<0.01;I2=88%).The amount of CD8^+T cells in the experimental group was significantly higher than that in the control group(SMD=-0.07;95%CI=-0.30,0.17;P=0.32;I^2=14%).The rate of CD4^+/CD8^+T cells in the experimental group was higher than that in the control group(SMD=27.76;95%CI=25.25,30.28;P=0.39;I^2=0%).And CS may retard the declining trend of KPS functional status evaluation(RR=0.46,95%CI=0.2780,0.7350;P<0.01),thus improving the patients'life quality.Conclusion:The current evidence suggested that CS is favorable to improve the efficacy of chemotherapeutic drugs in patients with malignant tumors,probably by improving immune system function.

A clinical trial of cytokine induced killer cells treating patients with malignant tumor after radiochemotherapy

Objective: Our study investigated the immunity changes and life quality changes after the treatment of cytokine induced killer (CIK) cells for patients with malignant tumor after radiochemotherapy, and explored the therapeutic effects of CIK cells on these patients. Methods: Thirty-one patients with malignant tumor after radiochemotherapy were treated with CIK cells. Before and after CIK cells being transfused back, the immunity indexes of the peripheral blood of these cases were detected and the changes of life quality of these cases were compared. Results: After radiochemotherapy, the percentage of CD3+, CD4+ cells declined, the percentage of CD8+ cells rose; the ratio of CD4+/CD8+ declined, and the percentage of CD16+, CD56+ cells declined. As all the above indexes compared with that of normal people, the difference was significant (P < 0.05). After CIK cells therapy, the above indexes improved (P < 0.05). Life quality improved significantly after CIK cells therapy (P < 0.05). Conclusion: Radiochemotherapy can inhibit the immunity in patients with malignant tumor. CIK cells therapy is safe and effective. It may improve the recent immunity and life quality of the patients, which suggesting that it may be an alternative maintenance treatment for patients with malignant tumor after radiochemotherapy.

TREATMENT OF HICCUP BY ACUPUNCTURE IN 30 CASES OF MALIGNANT TUMOR PATIENTS AFTER CHEMOTHERAPIES

The curative effect of hiccup treated by acupuncture therapy was observed in 30 cases of malignant tumor patients after chemotherapies. The results show that hiccup disappeared completely in 28 cases after acupuncture at Zusanli (ST 36) and Neiguan (PC 6) on the both sides for 1 to 4 times, the total effective rate was 93. 3 %, it was very significant.

VARIOUS DOSES OF CISPLATIN (DDP) COMBINED WITH MULTI-DRUG CHEMOTHERAPY FOR ADVANCED MALIGNANT SOLID TUMOR

Two hundred and thirty-six patinets with various advanced malignant solid tumors treated by combined chemotherapy with routine doses of cisplatin (DDP) from 1980 to 1986 are presented. According to different doses of cisplatin everyday, the patients were divided into 4 groups: (1) 20 ing/day×4- 5, 80 cases; (2) 30 mg day × 3 - 5, 91 cases; (3) 40 mg/ day 3 -4, 37 cases; (4) 50 mg/day×2 - 3, 28 cases. Each group was repeated for 3 weeks. The effect and toxicity were analysed and compared with 22 cases treated by single DDP in 1975. The response (CR+PR) rate was 39.2% in 194 evaluated patients. The response rate was similar in group 20 mg and single DDP (29.2% and 27.3%). Ths response rate was lower than that of group 30 mg, 40 mg, and 50 mg 43.4% and 50%) (P<0.05). The remissions in various groups were not significantly different.The toxicity of combined chemotherapy was not severe. 91.1% of patients had nausea and vomiting. There was no statistical difference in the various groups. Bone marrow suppresion was less in single DDP group than that of combined chemotherapy group (P<0.05), DDP 30-50 mg 1/d×5-3 was better than HD-DDP in some patients.

Effects of VEP neoadjuvant chemotherapy before esophageal cancer surgery on the malignant biological behaviors of tumor cells

Objective: To study the effects of VEP neoadjuvant chemotherapy before esophageal cancer surgery on the malignant biological behaviors of tumor cells. Methods: Patients who were diagnosed with locally advanced esophageal cancer in Dangyang People's Hospital between March 2015 and March 2017 were selected as the research objects and randomly divided into the VEP group who received preoperative VEP (etoposide + 5-fluorouracil + cisplatin) chemotherapy and the control group who accepted routine preoperative preparation. The serum contents of tumor markers were determined at diagnosis and 1 d before surgery;the expression of proliferation genes and invasion genes in tumor tissue were determined after surgical resection. Results: One day before surgery, serum CEA, CA125, CYFRA21-1 and SCC-Ag levels of VEP group were significantly lower than those at diagnosis, and serum CEA, CA125, CYFRA21-1 and SCC-Ag levels of control group were not significantly different from those at diagnosis;after surgical resection, PTEN, Smac and PTPN14 mRNA expressions in the tumor tissue of VEP group were significantly higher than those of control group whereas CyclinB1, CDK1, Grp94, MMP2, β-catenin, Slug, Vimentin and N-cadherin mRNA expressions were significantly lower than those of control group. Conclusions: VEP neoadjuvant chemotherapy before esophageal cancer surgery can reduce the growth of tumor cells and inhibit the proliferation and invasion of tumor cells in the lesion.

Combined chemotherapy with Boning in the treatment of pain due to bone metasta ses from malignant tumors

Objective To investigate the effect of Boning o n pain due to bone metastases from mal ignant tumors.Method From De-cember,1998to December,2000,86pa tients with pathologically proved b one metastases from malignant tumors were randomly divided into two groups,study group(combined chemotherapy with boning),control group(simple chemotherapy).Boning(60mg )dissolved in saline solution(500ml )were given IV for consecutive 3days.Then 60mg Boning was given every half-month .Patients in control group accepted simple chemotherapy.Results Efficacy in study group was 88.37%which was significantly superior to th at in control group(66.47%).Boning could repair injured bone.Adverse r eaction associated with Boning was weak.Boning quickly relieved sympto ms for a long time.Conclusion Effect of large-dose Boning for reli eving pain due to bone metastases fro m malignant tumors is satisfying.At the same time,Boning play im-portant role in repair of destructed bone.

Psychological Intervention and Nursing Analysis of Gynecological Malignant Tumors during Chemotherapy

Objectives:To explore the clinical effect of psychological intervention and nursing during the chemotherapy of gynecological malignant tumor.Methods:120 patients with gynecologic malignancies were selected as subjects.According to the nursing method,these patients were divided into intervention group and control group,with 60 cases in each group.The patients in the control group were given routine care,and the patients in the observation group were given psychological intervention care on the basis of routine nursing.Before and after treatment,the anxiety and depression of the two groups were compared using the Self-rating Anxiety Scale(SAS)and the Self-rating Depression Scale(SDS).The satisfaction and adverse reactions of the two groups were compared.The results were statistically analyzed.Results:After nursing intervention,the anxiety and depression scores of the intervention group were lower than those of the control group(P<0.05).The incidence of nausea,vomiting and fatigue in the intervention group was significantly lower than that in the control group(P<0.01).There was no significant difference in the symptoms of diarrhea between the two groups(P>0.05).After the treatment,the satisfaction of the intervention group was significantly higher than that of the control group(P<0.05).Conclusions:During the chemotherapy of gynecological malignant tumor patients,psychological intervention nursing can alleviate the anxiety and depression of patients,improve the complications,and improve the satisfaction of patients.It is worthy of clinical application.

Effect of brucea javanica oil injection combined with neoadjuvant chemotherapy on malignant molecule expression and antitumor immune response in patients with gastric cancer

Objective:To study the effect of brucea javanica oil injection combined with neoadjuvant chemotherapy on malignant molecule expression and antitumor immune response in patients with gastric cancer.Methods: A total of 78 patients with gastric cancer undergoing preoperative neoadjuvant chemotherapy in our hospital between May 2013 and July 2016 were selected and randomly divided into two groups, intervention group received brucea javanica oil injection combined with neoadjuvant chemotherapy, and the control group accepted neoadjuvant chemotherapy. Serum tumor marker levels and peripheral blood regulatory molecule expression were determined before and after treatment, and the malignant molecule expression levels in gastric cancer lesions were determined after the operation.Results:2 cycles and 4 cycles after treatment, serum CEA, DKK1, exosc2 and ANXA2 levels of both groups of patients were significantly lower than those before treatment, PD-1, TIM-3 and Foxp3 mRNA expression in peripheral blood mononuclear cells of control group were significantly higher than those before treatment, PD-1, TIM-3 and Foxp3 mRNA expression in peripheral blood mononuclear cells of intervention group were significantly lower than those before treatment, serum CEA, DKK1, exosc2 and ANXA2 levels as well as PD-1, TIM-3 and Foxp3 mRNA expression in peripheral blood mononuclear cells of intervention group were significantly lower than those of control group, and the GKN1 and GKN2 mRNA expression in gastric cancer lesions were significantly higher than those of control group while GOLPH3 and PTP1B mRNA expression were significantly lower than those of control group.Conclusion:Brucea javanica oil injection combined with neoadjuvant chemotherapy can more effectively kill the gastric cancer cells and improve the antitumor immune response.

Pilot Study of Molecular Mechanism on Vasculogenic Mimicry in Bi-directional Differentiated Malignant Tumors

Objective: To investigate the role of collagen IV and PAS positive substancesecreted by tumor cells in vasculogenic mimicry (VM) and the effects of VM on tumor cells expressingVEGF. Methods: 158 cases of bi-direction differential malignant tumor specimens withparaffin-embedded were enrolled into our study and made tissue microarray which were dual-stainedwith CD31-PAS and stained with collagen IV. The difference of the areas and distribution withpattern surrounded by between CD31 and PAS positive respectively were identified via grid-counting,as well as the difference of VEGF expression with VE absent and present. Results: The basementmembrane of VM was both PAS and collagen IV positive. VEGF expression in the bi-directiondifferential malignant tumor was higher VM-absent than VM-present and the difference wasstatistically significance in malignant melanoma and alveolar rhabdomyosarcoma (P 【 0.05).Conclusion: PAS positive substance and collagen IV compose the wall of VE and VE could provide theoxygen and nutrition for tumor growth and progression.

Clinical Research on the Changes of Plasma TFPI and uPA System in Malignant Tumor

Objective: To investigate the expression levels and significance of TFPI, uPA, uPAR and PAI in malignant patients. Methods: The levels of TFPI, uPA and uPAR were measured by using ELISA and the level of PAI was determined by method of chromogenic substrates in 44 patients with malignant solid tumors (group A1) and 30 patients with acute leukemia (AL, group A2). Results: The levels of TFPI, uPA, and uPAR in group A1 were higher than those in normal control group (group B). TFPI, uPAR levels in group A2 were higher than those in group B, while the level of PAI in group A2 was lower than that in group B. Among the groups, TFPI was increased in the combined infection group; PAI decreased in the hemorrhage group; TFPI, uPA, uPAR and PAI increased in relapsing and metastasis group; TFPI decreased in one-week dead group, while uPA and uPAR increased. Conclusion: The patients with malignant solid tumor and AL had different anticoagulation or fibrinolysis states. TFPI, uPA, Upar and PAI can be used to evaluate the disease condition and the prognosis.