Clinicopathological Characteristics and Prognosis of Hepatoid Adenocarcinoma of the Stomach:Evaluation of a Pooled Case Series

Hepatoid adenocarcinoma of the stomach (HAS)is an extremely rare and unique gastric malignancy.The present study aimed to examine the relevance of the clinicopathological characteristics of HAS with patient prognosis.We retrospectively reviewed clinical data of 34 HAS patients treated at our institution between January 2010 and December 2016,as well as 294 cases reported prior to 2017 in research databases.Among these patients,45.6%(115/252)had lesions in the gastric antrum and 77.0%(235/305)were male.Elevated levels of serum alpha-fetoprotein (AFP)were detected in most patients(75/93,80.6%).Vascular invasion(199/286,69.6%),lymph node metastasis (222/283,78.4%),and preoperative distant metastasis (121/328,36.9%)were commonly observed.The 5-year disease-free survival (DFS)and disease-specific survival (DSS) were 20.7%and 29.2%,respectively.DFS and DSS of patients receiving neoadjuvant therapy were significantly higher than those of patients receiving postoperative adjuvant therapy [DFS:P<0.001, hazard ratio (HR)=-1.831,95%confidence interval (CI):0.060-0.429;DSS:P<0.001,HR=-2.185, 95%CI:0.032-0.401].In conclusion,HAS exhibits distinct clinicopathological characteristics and a strikingly worse prognosis when compared with common gastric cancer.Complete surgery,early pTNM stage,and adjuvant therapy may predict a more favorable prognosis.Neoadjuvant therapy is strongly recommended for patients with lymph node metastasis or/and preoperative distant metastasis.

Clinicopathological characteristics and prognosis of 232 patients with poorly differentiated gastric neuroendocrine neoplasms

BACKGROUND Poorly differentiated gastric neuroendocrine neoplasms(PDGNENs)include gastric neuroendocrine carcinoma(NEC)and mixed adenoneuroendocrine carcinoma,which are highly malignant and rare tumors,and their incidence has increased over the past few decades.However,the clinicopathological features and outcomes of patients with PDGNENs have not been completely elucidated.AIM To investigate the clinicopathological characteristics and prognostic factors of patients with PDGNENs.METHODS The data from seven centers in China from March 2007 to November 2019 were analyzed retrospectively.RESULTS Among the 232 patients with PDGNENs,191(82.3%)were male,with an average age of 62.83±9.11 years.One hundred and thirteen(49.34%)of 229 patients had a stage III disease and 86(37.55%)had stage IV disease.Three(1.58%)of 190 patients had no clinical symptoms,while 187(98.42%)patients presented clinical symptoms.The tumors were mainly(89.17%)solitary and located in the upper third of the stomach(cardia and fundus of stomach:115/215,53.49%).Most lesions were ulcers(157/232,67.67%),with an average diameter of 4.66±2.77 cm.In terms of tumor invasion,the majority of tumors invaded the serosa(116/198,58.58%).The median survival time of the 232 patients was 13.50 mo(7,31 mo),and the overall 1-year,3-year,and 5-year survival rates were 49%,19%,and 5%,respectively.According to univariate analysis,tumor number,tumor diameter,gastric invasion status,American Joint Committee on Cancer(AJCC)stage,and distant metastasis status were prognostic factors for patients with PDGNENs.Multivariate analysis showed that tumor number,tumor diameter,AJCC stage,and distant metastasis status were independent prognostic factors for patients with PDGNENs.CONCLUSION The overall prognosis of patients with PDGNENs is poor.The outcomes of patients with a tumor diameter>5 cm,multiple tumors,and stage IV tumors are worse than those of other patients.

Clinicopathological characteristics and prognosis of 77 cases with type 3 gastric neuroendocrine tumours

BACKGROUND For the rarity of type 3 gastric neuroendocrine tumours(g-NETs),their clinicopathological characteristics and prognosis are not well illustrated.AIM To describe the clinicopathological features and outcome of type 3 g-NETs in the Chinese population.METHODS Based on the 2019 WHO pathological classification,the clinicopathological characteristics and prognosis of patients with type 3 g-NETs in China were retrospectively analysed.RESULTS A total of 77 patients(55.8%of females)with type 3 g-NETs were analysed,with a median age of 48 years(range:28-79 years).The tumours were mainly located in the gastric fundus/body(83.1%)and were mostly solitary(83.1%),with a median size of 1.5 cm(0.8-3.5 cm).Of these,there were 37 G1 tumours(48.1%),31 G2(40.3%),and 9 G3(11.7%).Ten(13.0%)and 24(31.2%)patients had lymph node and distant metastasis,respectively.In addition,type 3 g-NETs were heterogeneous.Compared with G1 NETs,G2 NETs had a higher lymph node metastasis rate,and G3 NETs had a higher distant metastasis rate.G1 and G2 NETs with stage I/II disease(33/68)received endoscopic treatment,and no tumour recurrence or tumour-related death was observed within a median follow-up time of 36 mo.Grade and distant metastasis were identified to be independent risk factors for prognosis in multivariable analysis.CONCLUSION Type 3 g-NETs are obviously heterogeneous,and the updated WHO 2019 pathological classification may be used to effectively evaluate their biological behaviors and prognosis.Also,endoscopic treatment should be considered for small(<2 cm),low grade,superficial tumours.

Hepatic epithelioid hemangioendothelioma:Clinical characteristics,diagnosis,treatment,and prognosis

BACKGROUND Hepatic epithelioid hemangioendothelioma(HEHE)is a rare hepatic vascular tumor with unpredictable malignant potential.The etiology,characteristics,diagnosis,treatment,and prognosis of HEHE are not well-understood,and largescale retrospective studies are required to understand better this disease.AIM To determine the characteristics of HEHE and identify its optimal treatments and prognostic factors.METHODS The clinical data of two patients diagnosed with HEHE at the Fourth Hospital of Hebei Medical University and 258 previously reported cases retrieved from the China National Knowledge Infrastructure and PubMed databases between 1996 and 2021 were combined and summarized.All cases were pathologically identified as HEHE.Information such as clinical features,laboratory examination findings,imaging findings,pathological characteristics,treatment,and survival periods was reviewed.Kaplan-Meir curves were used for survival analysis.Prognostic factors were identified by Cox regression analysis.RESULTS HEHE primarily affected middle-aged women.The typical manifestations included epigastric pain,hepatosplenomegaly,inappetence,distension,weight loss,and fatigue.Tumor markers were expressed normally.The incidence of extrahepatic metastasis was 34.5% at the time of diagnosis.The most common sites of extrahepatic involvement were the lungs(22.3%),lymph nodes(5.6%),peritoneum(3.6%),bones(6.6%),and spleen(5.1%).Furthermore,“capsular retraction”,“target sign”,and“lollipop sign”were the characteristic features of HEHE on imaging.The immunohistochemical profile for HEHE(expression of vascular markers,such as factor VIII-related antigen,CD31,and CD34;expression levels of D2-40)can facilitate and ensure an accurate diagnosis.The management options for patients with HEHE include liver resection(29.7%),liver transplantation(16.1%),palliative treatments(12.7%),transhepatic arterial chemotherapy and embolization(TACE,10.2%),chemotherapy(11.0%),antiangiogenic therapy(15.3%),and other treatments(5.1%);the mean survival time was 158.6,147.3,4.2,90.8,71.4,83.1,and 55.0 mo,respectively.The survival time of patients who underwent surgical treatment was longer than that of patients who did not.TACE and antiangiogenic therapy tended to prolong survival compared with other nonsurgical treatments.The 1-,5-,and 10-year survival rates were 82%,71%,and 64%,respectively.Multivariate analysis showed that liver function(P=0.045),intrahepatic metastasis(P=0.029),and treatment(P=0.045)were independent prognostic factors.The presence of extrahepatic metastases was not an independent risk factor for poor prognosis(P=0.558).CONCLUSION The clinical course of HEHE is rare and variable,and patients with intrahepatic metastases and liver dysfunction may have a poorer prognosis than those without.Surgical intervention,whether liver resection or transplantation,might be warranted regardless of extrahepatic metastasis.For patients without the option for surgery,clinicians should consider the use of TACE with antiangiogenic drugs in the treatment of HEHE.

The clinicopathological characteristics and surgical treatment of retroperitoneal angiomyolipoma:a case report and literature review of both English and Chinese

Angiomyolipoma usually present as incidental findings on routine imaging or laparotomy, but rarely they may give rise to massive hemorrhage. If bleeding occurs, the treatment of choice is to save life either by angiography with selective embolisation or surgery. Herein, we reported a case of a 32-year-old man who came to our hospital complaining of sudden colicky pain in the right hypochondria region, associated with nausea and vomiting. On physical examination, the patient was in a state of shock; blood pressure of 60/36 mmHg, heart rate of 160 beats/min, high abdominal distention, and non-coagulated blood was extracted from abdominal puncture. The abdominal computed tomography (CT) and arteriography showed a 20 × 15 × 15 cm mass suggestive of spontaneous rupture of liver neoplasm and intraperitoneal hemorrhage. On laparotomy, 1500 mL of non-coagulated blood was found, and the tumor located at right upper abdomen, which originated from retroperitoneum. The tumor was resected totally with hematoma and sutured the bleeding vessels. The histological study of the resected mass revealed the presence of angiomyolipoma.

Unveiling the clinicopathological enigma of crawling-type gastric adenocarcinoma

In this editorial we comment on the article by Xu et al.Gastric adenocarcinoma(GA)is a malignancy which arises from the gastric mucosa and encompasses heterogenous tumors with varying characteristics.There are two main classifications:Lauren’s and the World Health Organization distinguishing the diverse types of GA depending on clinical,genetic,morphological and epidemiological features.“Crawling-type”adenocarcinoma(CRA)is a subtype characterized by irregularly fused glands with low-grade cellular atypia.Moreover,CRA represents differentiated tumor cells resembling intestinal metaplasia which results in misdiagnosis.The diagnosis is of utmost importance,as well as the subclassification and thorough pathological assessment.With regard to the symptoms of GA,these depend on the stage of the disease.Diagnostic methods play a crucial role in assessing the extent of the tumor and the stage of the disease.Nevertheless,early detection of CRA remains challenging due to its histological features.In summary,CRA is a distinct type of GA with particular clinicopathological and histological characteristics.Despite its significance,it not distinguished as a subtype,resulting in diagnostic challenges.Diagnosis is based on careful observation and thorough biopsy analysis,indicating the importance of comprehensive pathological assessment.

Clinical and pathological characteristics and expression of related molecules in patients with airway disseminated lung adenocarcinoma

Objective:Lung adenocarcinoma exhibits diverse genetic and morphological backgrounds,in addition to considerable differences in clinical pathology and molecular biological characteristics.Among these,the phenomenon of spread through air space(STAS),a distinct mode of lung cancer infiltration,has rarely been reported.Therefore,this study aimed to explore the relationship between STAS tumor cells and the clinical and molecular characteristics of patients with lung adenocarcinoma,as well as their impact on prognosis.Methods:This study included 147 patients who were diagnosed with lung adenocarcinoma at the Inner Mongolia Autonomous Region Cancer Institute between January 2014 and December 2017.Surgical resection specimens were retrospectively analyzed.Using univariate and multivariate Cox analyses,we assessed the association between STAS and the clinicopathological features and molecular characteristics of patients with lung adenocarcinoma.Furthermore,we investigated the effects on patient prognosis.In addition,we developed a column–line plot prediction model and performed internal validation.Results:Patients with positive STAS had a significantly higher proportion of tumors with a diameter≥2 cm,with infiltration around the pleura,blood vessels,and nerves,and a pathological stage>IIB than in STAS-negative patients(P<0.05).Cox multivariate survival analysis revealed that clinical stage,STAS status,tumor size,and visceral pleural invasion were independent prognostic factors influencing the 5-year progression-free survival in patients with lung adenocarcinoma.The predictive values and P values from the Hosmer-Lemeshow test were 0.8 and 0.2,respectively,indicating no statistical difference.Receiver operating characteristic curve analysis demonstrated areas under the curve of 0.884 and 0.872 for the training and validation groups,respectively.The nomogram model exhibited the best fit with a value of 192.09.Conclusions:Clinical stage,pleural invasion,vascular invasion,peripheral nerve invasion,tumor size,and necrosis are independent prognostic factors for patients with STAS-positive lung adenocarcinoma.The nomogrambased on the clinical stage,pleural invasion,vascular invasion,peripheral nerve invasion,tumor size,and necrosis showed good accuracy,differentiation,and clinical practicality.

Classification,clinicopathologic features and treatment of gastric neuroendocrine tumors

Gastric neuroendocrine tumors (GNETs) are rare lesions characterized by hypergastrinemia that arise from enterochromaffin-like cells of the stomach. GNETs consist of a heterogeneous group of neoplasms comprising tumor types of varying pathogenesis, histomorphologic characteristics, and biological behavior. A classification system has been proposed that distinguishes four types of GNETs; the clinicopathological features of the tumor, its prognosis, and the patient&#x02019;s survival strictly depend on this classification. Thus, correct management of patients with GNETs can only be proposed when the tumor has been classified by an accurate pathological and clinical evaluation of the patient. Recently developed cancer therapies such as inhibition of angiogenesis or molecular targeting of growth factor receptors have been used to treat GNETs, but the only definitive therapy is the complete resection of the tumor. Here we review the literature on GNETs, and summarize the classification, clinicopathological features (especially prognosis), clinical presentations and current practice of management of GNETs. We also present the latest findings on new gene markers for GNETs, and discuss the effective drugs developed for the diagnosis, prognosis and treatment of GNETs.

Undifferentiated embryonal sarcoma of the liver:Clinical characteristics and outcomes

BACKGROUND Undifferentiated embryonal sarcoma of the liver(UESL)is a rare liver malignancy originating from primary mesenchymal tissue.The clinical manifestations,laboratory tests,and imaging examinations of the disease lack specificity and the preoperative misdiagnosis rate is high.The overall prognosis is poor and survival rate is low.AIM To investigate the diagnosis,treatment,and prognosis of UESL.METHODS We performed a retrospective,single-center cohort study in Shengjing Hospital of China Medical University,which is a central hospital in northeast China.From 2005 to 2017,we recruited 14 patients with pathologically confirmed UESL.We analyzed the clinical manifestations,laboratory tests,imaging examinations,pathological examinations,therapy,and prognosis of these patients.RESULTS There were nine males and five females aged 2-60 years old included in the study.The major initial symptoms were abdominal pain(71.43%)and fever(57.14%).Preoperative laboratory tests revealed that seven patients had increased leukocyte levels,four showed a decrease in hemoglobin levels,seven patients had increased glutamyl transpeptidase levels,nine had increased lactate dehydrogenase levels,and three showed an increase in carbohydrate antigen 199.There was no difference in the rate of misdiagnosis in preoperative imaging examinations of UESL between adults and children(6/6 vs 5/8,P=0.091).The survival rate after complete resection was 6/10,while that after incomplete resection was 0/4(P=0.040),suggesting that complete resection is important to improve survival rate.In total,five out of the eight children achieved survival.During the follow-up,the maximum survival time was shown to be 11 years and minimum survival time was 6 mo.Six adult patients relapsed late after surgery and all of them died.CONCLUSION Preoperative imaging examination for UESL has a high misdiagnosis rate.Multidisciplinary collaboration can improve the diagnostic accuracy of UESL.Complete surgical resection is the first choice for treatment of UESL.

Clinicopathological and prognostic significance of aberrant Arpin expression in gastric cancer

AIM To detect the expression of Arpin, and determine its correlation with clinicopathological characteristics and the prognosis of gastric cancer (GC) patients. METHODS A total of 176 GC patients were enrolled as study subjects and classified into groups according to different clinicopathological variables. GC mucosal tissues were obtained via surgery. Another 43 paraffin-embedded tissue blocks of normal gastric epithelium (> 5 cm away from the edge of the tumor) were included in the control group. Immunohistochemistry (IHC) for the Arpin and Arp3 proteins was performed on the formalin-fixed, paraffin-embedded GC tissues. Additionally, expression of the Arpin protein in 43 normal gastric tissues was also determined using IHC. RESULTS Expression of the Arpin protein in GC was lower than that in normal gastric mucosa (30.68% vs 60.47%, P < 0.001). A chi(2) test of the 176 GC samples used for IHC showed that decreased Arpin expression was associated with advanced TNM stage (P < 0.01) and the presence or absence of lymph node metastasis (80.92% vs 35.56%, P < 0.001). Additionally, a significant correlation was observed between the expression of Arpin and the presence of the Arp2/3 complex in GC tissues (chi(2) = 30.535, P < 0.001). Moreover, a multivariate Cox regression analysis revealed that Arpin expression [hazard ratio (HR) = 0.551, P = 0.029] and TNM stage (HR = 5.344, P = 0.001) were independent prognostic markers for overall survival of GC patients. Regarding the 3-year disease-free survival (DFS), the recurrence rate of GC patients with low Arpin expression levels (median DFS 19 mo) was higher than that in the high-Arpin-expression group (median DFS 34 mo, P = 0.022). CONCLUSION Low Arpin levels are associated with clinicopathological variables and a poor prognosis in GC patients. Arpin may be regarded as a potential prognostic indicator in GC.

Characteristics of Chinese male patients with breast cancer:summary of the published papers

Objective:The extremely low incidence of male breast cancer (MBC) leads to lack of prospective randomized phase III studies worldwide. Especially in China,all studies on Chinese patients with MBC were based on small sample size and single institute experience. The aim of this study was to provide overall view of characteristics of Chinese patients with MBC by means of summarizing all related papers published in Chinese journals. Methods: An online search was made in CBM,VIP,CNKI,and CBA databases to find all published articles of interest on Chinese patients with MBC. And eight subjects including the proportion of MBC in all breast cancer,age,tumor location,clinical stages,pathological subtypes,treatment modalities,ER/PR expression,and 5-year survival rate were selected to calculate the proportion and their 95% interval confidence. Results: There were 122 papers with 2584 patients enrolled. The basic features of Chinese patients with MBC included:(1) MBC only with a proportion of 1.06% of all the breast cancer; (2) The mean age at diagnosis was 57.6 years old; (3) Tumor mainly located in the areolar region (74.83%) with obvious nipple and/or skin involvement; (4) Nearly 62.62% patients were in early stage before accepting treatment; (5) Infiltrating ductal carcinoma accounted for 79.05% of all pathological subtypes; (6) ER/PR expression rate was 65.86%; (7) Radical resection was up to 86.06% in all surgical modalities; (8) The 5-year survival rate was 57.33%. Conclusion: The results showed in this study were an overall view of Chinese patients with MBC whose characteristics were similar to that reported in the West. Though this study provided a little bit stronger confidence than a single study collected in this paper,studies with more powerful evidence are urgently demanding in China.

Clinicopathological characterization of ten patients with primary malignant melanoma of the esophagus and literature review

BACKGROUND Primary malignant melanoma of the esophagus(PMME) is a rare malignant disease and has not been well characterized in terms of clinicopathology and survival.AIM To investigate the clinical features and survival factors in Chinese patients with PMME.METHODS The clinicopathological findings of ten cases with PMME treated at Henan Provincial People’s Hospital were summarized. Moreover, the English-and Chinese-language literature that focused on Chinese patients with PMME from 1980 to September 2021 was reviewed and analyzed. Univariate and multivariate analyses were employed to investigate the clinicopathologic factors that might be associated with survival.RESULTS A total of 290 Chinese patients with PMME, including ten from our hospital and 280 from the literature were enrolled in the present study. Only about half of the patients(55.8%) were accurately diagnosed before surgery. Additionally, 91.1% of the patients received esophagectomy, and 88 patients(36.5%) received adjuvant therapy after surgery. The frequency of lymph node metastasis(LNM) was 51.2%(107/209), and LNM had a positive rate of 45.3% even when the tumor was confined to the submucosal layer. The risk of LNM increased significantly with the p T stage [P < 0.001, odds ratio(OR): 2.47, 95% confidence interval(CI): 1.72-3.56] and larger tumor size(P = 0.006, OR: 1.21, 95%CI: 1.05-1.38). The median overall survival(OS) was 11.0 mo(range: 1-204 mo). The multivariate Cox analysis showed both the p T stage [P = 0.005, hazard ratio(HR): 1.70, 95%CI: 1.17-2.47] and LNM(P = 0.009, HR: 1.78, 95%CI: 1.15-2.74) were independent prognostic factors for OS. The median disease-free survival(DFS) was 5.3 mo(range: 0.8-114.1 mo). The multivariate analysis indicated that only the advanced p T stage(P = 0.02, HR: 1.93, 95%CI: 1.09-3.42) was a significant independent indicator of poor RFS in patients with PMME.CONCLUSION The correct diagnosis of PMME before surgery is low, and physicians should pay more attention to avoid a misdiagnosis or missed diagnosis. Extended lymph node dissection should be emphasized in surgery for PMME even though the tumor is confined to the submucosal layer. Both the LNM and p T stage are independent prognosis factors for OS, and the p T stage is the prognosis factor for DFS in patients with PMME.

Clinicopathological and Prognostic Significance of Circulating Tumor Cells in Patients with Head and Neck Cancer: A Meta-Analysis

Purpose: The aim of the study was to evaluate the association between clinicopathological and prognostic significance and circulating tumor cells (CTCs) in patients with head and neck cancer. Methods: We searched PubMed, MEDLINE, BioMed, and EMbase databases for studies that assessed the association between clinicopathological and prognostic significance and CTCs in patients with head and neck cancer. Studies obtained from search strategy were screened using pre-specified criteria, and necessary data were retrieved for meta-analysis. Results: Seventeen studies with 816 patients were eligible for combined analysis. Presence of CTCs in peripheral blood was significantly associated with N stage (OR 0.50, 95%CI [0.30, 0.81], n = 10, P = 0.005). Patients in the high-CTC group were significantly associated with poorer disease-free survival (DFS;HR = 1.73, 95%CI [1.01 - 2.96], P = 0.050) and poorer overall survival (OS;HR = 2.53, 95%CI [1.37 - 4.69] P = 0.003). Further analyses indicated strong prognostic powers of CTCs in non-RT-PCR group and pre-treatment group. Conclusion: Our meta-analysis indicates that presence of CTCs is associated with higher N stage and poorer prognosis in patients with head and neck cancer. The potential for further clinical application may be needed for further investigation.Purpose: The aim of the study was to evaluate the association between clinicopathological and prognostic significance and circulating tumor cells (CTCs) in patients with head and neck cancer. Methods: We searched PubMed, MEDLINE, BioMed, and EMbase databases for studies that assessed the association between clinicopathological and prognostic significance and CTCs in patients with head and neck cancer. Studies obtained from search strategy were screened using pre-specified criteria, and necessary data were retrieved for meta-analysis. Results: Seventeen studies with 816 patients were eligible for combined analysis. Presence of CTCs in peripheral blood was significantly associated with N stage (OR 0.50, 95%CI [0.30, 0.81], n = 10, P = 0.005). Patients in the high-CTC group were significantly associated with poorer disease-free survival (DFS;HR = 1.73, 95%CI [1.01 - 2.96], P = 0.050) and poorer overall survival (OS;HR = 2.53, 95%CI [1.37 - 4.69] P = 0.003). Further analyses indicated strong prognostic powers of CTCs in non-RT-PCR group and pre-treatment group. Conclusion: Our meta-analysis indicates that presence of CTCs is associated with higher N stage and poorer prognosis in patients with head and neck cancer. The potential for further clinical application may be needed for further investigation.

Clinicopathological significance and prognostic value of claudin10 expression in primary malignant tumors of digestive system:A metaanalysis

Objective:To investigate the correlation between claudin10 expression and clinicopathological characteristics and prognosis of primary malignant tumors of digestive system.Methods:We searched the PubMed,Web of Science,Ovid MEDLINE,CNKI,CQVIP,and WanFang Data databases.The data between claudin10 expression and clinical characteristics as well as survival outcome were extracted.RevMan 5.3 and Stata 15.1 software were employed for metaanalysis.Results:A total of 6 studies containing 512 patients with primary malignant tumors of digestive system were analyzed.The analysis showed that high expression of claudin10 was more common in cancer tissue than in normal tissue[OR=3.22,95%CI(2.26,4.60),P<0.01],and was associated with increasing tumor size[OR=6.21,95%CI(2.44,15.83),P<0.01],high differentiation[OR=0.56,95%CI(0.32,0.99),P=0.05],positive lymph node metastasis[OR=3.41,95%CI(1.09,10.65),P=0.03].The expression of claudin10 was not associated with sex[OR=1.62,95%CI(0.91,2.90),P=0.10],age[OR=1.72,95%CI(0.97,3.07),P=0.06],distant metastasis[OR=4.51,95%CI(0.55,36.70),P=0.16],or prognosis[HR=1.99,95%CI(0.93,4.23),P=0.08].Conclusion:The expression of claudin10 is correlated with the clinicopathological features of primary malignant tumors of digestive system and is a potential tumor marker.

Clinicopathologic and prognostic relevance of ARID1A protein loss in colorectal cancer

AIM: To explore the association between AT-rich interactive domain 1A (ARID1A) protein loss by immunohistochemistry and both clinicopathologic characteristics and prognosis in patients with colorectal cancer.

同源异型盒基因A5、三结构域蛋白14与结直肠癌的关系

目的探讨结直肠癌组织同源异型盒基因A5(HOXA5)、三结构域蛋白14(TRIM14)蛋白表达水平与临床病理特征及患者预后的关系。方法回顾性收集整理2016年5月至2018年5月期间于河南中医药大学郑州人民医院确诊的120例结直肠癌患者癌组织及癌旁组织标本及相关临床资料,采用免疫组化法检测组织HOXA5、TRIM14蛋白表达水平;分析HOXA5、TRIM14水平与结直肠癌患者临床病理特征及预后的关系;采用Kaplan-Meier法分析组织中HOXA5、TRIM14表达与结直肠癌5年生存率的关系;采用Cox比例风险回归模型分析结直肠癌5年预后影响因素。结果结直肠癌组织中TRIM14蛋白阳性率为73.33%,明显高于癌旁组织的10.00%,HOXA5蛋白阳性率为27.50%,明显低于癌旁组织的81.67%,差异均有统计学意义(P<0.05)。TRIM1蛋白阳性表达患者肿瘤低分化比例为42.05%,浸润深度T_(3)~T_(4)比例为72.73%,有淋巴结转移比例为47.73%,有远处转移比例为29.55%,明显高于TRIM1蛋白阴性表达的12.50%、37.50%、12.50%、6.25%,差异均有统计学意义(P<0.05);HOXA5蛋白阴性表达患者肿瘤低分化比例为41.38%,浸润深度T3~T4比例为77.01%,有淋巴结转移比例为48.28%,有远处转移比例为29.89%,明显高于HOXA5蛋白阳性表达的15.15%、27.27%、12.12%、6.06%,差异均有统计学意义(P<0.05)。结直肠癌组织中HOXA5阴性表达和TRIM14阳性表达患者的5年生存率分别为57.47%、59.09%,明显低于HOXA5阳性表达患者的90.91%和TRIM14阴性表达患者的87.50%,差异均有统计学意义(P<0.05)。死亡组患者有淋巴结转移比例为85.00%,有远处转移比例为55.00%,明显高于生存组的15.00%、7.50%,差异均有统计学意义(P<0.05)。经Cox比例风险回归模型分析结果显示,TRIM14是结直肠癌患者5年内死亡的独立危险因素,HOXA5是结直肠癌患者5年内死亡的保护因素(P<0.05)。结论结直肠癌组织中TRIM14呈高表达状态,HOXA5呈低表达状态,两者均与TNM分期、肿瘤分化程度、浸润深度等临床病理特征及预后相关,有作为预后标志物及治疗靶点的潜力。

188例侧向发育型肿瘤内镜及临床病理学分析

目的总结并评价结直肠侧向发育型肿瘤(laterally spreading tumor,LST)的内镜及临床病理特征。方法回顾性分析2010年12月至2019年12月首都医科大学附属北京世纪坛医院消化内科经内镜下治疗并诊断为LST的患者,根据LST病变内镜下特点,分为颗粒型LST(granular LST,LST-G)及非颗粒型LST(non-granular LST,LST-NG)两个亚组和四个亚型,总结并分析患者的临床一般资料、内镜下特征、组织病理特征、治疗方法等相关资料。结果(1)内镜下特征:共收集176例LST患者(188处病变),LST-NG亚组病变最多,LST病变直径为(22.48±12.26)mm(10~65 mm),LST-G组病变直径大于LST-NG组(P<0.001);LST-G及LST-NG好发于升结肠,LST-G较LST-NG更好发于直肠(χ^(2)=42.360,P<0.001);NICE分类对非肿瘤性息肉及癌和癌前病变诊断的敏感性为97.9%,特异性为82.6%,Kappa值为0.820(P<0.001),NICE分型与病理金标准具有很高的一致性。(2)病理特征:LST亚组均以管状腺瘤为主,LST-NG的癌变率包括HGIN为41.9%,高于LST-G的16.7%(χ^(2)=14.63,P<0.01);LST亚组间微卫星不稳定状态、p53的表达和Ki-67增殖指数差异均无统计学意义(P>0.05)。(3)治疗方式:结肠病变多选择使用EMR及ESD治疗,直肠病变多选择ESD及手术治疗(χ^(2)=19.596,P<0.01),<20 mm的病变多选用EMR治疗,20~<30 mm的病变多选用ESD治疗,≥30 mm的病变,手术治疗的比例逐渐升高(χ^(2)=102.725,P<0.01)。结论LST的临床特性及内镜下表现存在一定的特殊性,临床应重视识别LST病变,提高LST的检出,并对于不同病变采取合适的治疗方案。

外周血循环肿瘤细胞与胃癌患者临床病理特征及新辅助化疗疗效的关系

目的探讨外周血循环肿瘤细胞(CTC)与胃癌患者临床病理特征及新辅助化疗疗效的关系。方法选择2015年3月至2016年2月新乡医学院第三附属医院收治的112例胃癌患者为研究对象。所有患者均于治疗前1 d抽取空腹外周静脉血4 mL,采用阴性富集联合免疫荧光法检测外周血CTC,根据CTC检测结果将患者分为CTC阳性组和CTC阴性组。2组患者均给予新辅助化疗,奥沙利铂130 mg·m^(-2),静脉滴注,第1天;卡培他滨1000 mg·m^(-2),口服,每日2次,第1~14天;21 d为1个疗程,共治疗3个疗程。比较2组患者临床病例特征。采用Kappa检验分析实体瘤疗效评价标准(RECIST)和CTC数目评价标准的一致性,应用Kaplan-Meier生存分析计算患者3、5 a累积生存率,log-rank检验比较CTC阳性组和CTC阴性组患者治疗后3、5 a累积生存率。结果112例胃癌患者中,64例(57.14%)外周血CTC阳性,48例(42.86%)外周血CTC阴性。经新辅助化疗后,完全缓解、部分缓解、疾病稳定、疾病进展者分别为0例、76例、21例、15例,治疗总有效率为67.86%(76/112)。CTC阳性组患者肿瘤浸润深度、TNM分期与CTC阴性组比较差异有统计学意义(P<0.05);CTC阳性组与CTC阴性组患者的性别、年龄、病理分型、肿瘤大小、肿瘤位置、肿瘤分化程度、脉管癌栓比较差异均无统计学意义(P>0.05)。CTC阳性组患者治疗总有效率为59.38%(38/64),CTC阴性组患者治疗总有效率为79.17%(38/48);CTC阳性组患者治疗总有效率显著低于CTC阴性组(χ^(2)=4.926,P<0.05)。RECIST评价标准与CTC数目评价标准具有中度一致性(Kappa=0.546)。CTC阳性组患者3、5 a累积生存率分别为75.6%、26.7%,CTC阴性组患者3、5 a累积生存率分别为85.2%、46.6%。CTC阳性组患者3 a累积生存率与CTC阴性组比较差异无统计学意义(P>0.05);CTC阳性组患者5 a累积生存率显著低于CTC阴性组(P<0.05)。结论检测CTC有助于评估胃癌患者肿瘤浸润程度、临床分期,且能够评估新辅助化疗效果,并对患者的远期生存情况有一定预测价值。

多功能蛋白聚糖与子宫内膜样腺癌的相关性研究

目的 研究子宫内膜样腺癌组织中多功能蛋白聚糖的表达水平,探讨其与临床病理特征及患者预后生存的相关性。方法 选2016年1月-2019年1月在广西壮族自治区人民医院因子宫内膜样腺癌入院患者120例,收集临床及病理数据,对各病例多功能蛋白聚糖表达水平进行评分,采用统计学方法分析多功能蛋白聚糖与临床病理特征及患者预后生存的相关性。结果 多功能蛋白聚糖表达水平与肿瘤组织学分级、分期有显著相关性;与患者总生存期呈负相关。年龄、分级、分期、多功能蛋白聚糖表达水平与患者总生存期密切相关。多因素Cox回归分析显示,多功能蛋白聚糖是子宫内膜癌患者预后的独立危险因素。结论 多功能蛋白聚糖对子宫内膜样腺癌的发生、发展有一定影响,它可能是子宫内膜样腺癌潜在的预后预测指标。

PABPC1在肝细胞癌患者癌组织中的表达及其与预后的关系

目的 分析多聚腺苷酸结合蛋白胞质1(PABPC1)在肝细胞癌(HCC)患者癌组织中的表达情况及其对患者预后的影响。方法 采用癌症基因组图谱计划(TCGA)中的数据分析369例HCC患者癌组织及50例正常肝组织的PABPC1 mRNA表达水平。回顾性分析、比较2018年1月至2019年2月在该院就诊的166例HCC患者癌组织和癌旁正常组织PABPC1 mRNA表达水平及不同临床病理特征的HCC患者癌组织中PABPC蛋白表达情况。绘制受试者工作特征(ROC)曲线分析采用PABPC1 mRNA表达水平区分癌组织和癌旁正常组织的效能,根据随访结果采用多因素COX回归模型分析影响HCC患者预后的因素。结果 TCGA数据结果显示,369例HCC患者癌组织中PABPC1 mRNA表达量显著高于50例正常肝组织中的表达量(P<0.05)。在临床病例分析中,166例HCC患者癌组织中PABPC1 mRNA表达水平及PABPC1蛋白阳性率均显著高于癌旁组织(P<0.05),且PABPC1蛋白阳性表达患者PABPC1 mRNA表达水平为2.76±0.79,显著高于阴性表达患者的1.52±0.84(P<0.001)。ROC曲线结果显示,PABPC1 mRNA区分癌组织和癌旁正常组织的曲线下面积为0.913。UICC分期Ⅲ~Ⅳ期、伴有淋巴结转移以及多发肿瘤灶HCC患者的PABPC1蛋白阳性表达率分别高于UICC分期Ⅰ~Ⅱ期、无淋巴结转移及单发肿瘤灶的患者,差异均有统计学意义(P<0.05)。随访期间,50例(30.12%)患者在术后1年内死亡,95例(57.23%)患者在术后3年内死亡,101例(60.84%)患者在术后5年内死亡;多因素COX回归分析结果显示,癌组织PABPC1蛋白表达情况是影响HCC患者1年、3年、5年生存情况的独立因素(P<0.05)。癌组织PABPC1蛋白阳性表达及阴性表达HCC患者的1年、3年和5年总生存期比较,差异均有统计学意义(P<0.001)。结论 PABPC1 mRNA和蛋白在HCC患者癌组织中均呈高表达,且PABPC1蛋白高表达预示HCC患者生存预后不良。