Prognostic value of lateral lymph node metastasis for advanced low rectal cancer

AIM： To evaluate the risk factors for lateral lymph node metastasis in patients with advanced low rectal cancer, in order to make the effective selection of patients who could benefit from lateral lymph node dissection, as well as the relationship of lateral lymph node metastasis with local recurrence and survival of patients with advanced low rectal cancer. METHODS： A total of 96 consecutive patients who underwent curative surgery with lateral pelvic lymphadenectomy for advanced lower rectal cancer were retrospectively analyzed. The relation of lateral lymph node metastasis with clinicopathologic characteristics, local recurrence and survival of patients was identified. RESULTS： Lateral lymph node metastasis was observed in 14.6% （14/96） of patients with advanced low rectal cancer. Lateral lymph node metastasis was detected in 10 （25.0%） of 40 patients with tumor diameter ≥ 5 cm and in 4 （7.1%） of 56 patients with tumor diameter 〈 5 cm. The difference between the significant （X^2 = 5.973, P = two groups was statistically 0.015）. Lateral lymph node metastasis was more frequent in patients with 4/4 diameter of tumor infiltration （7 of 10 cases, 70.0%）, compared with patients with 3/4, 2/4 and 1/4 diameter of tumor infiltration （3 of 25 cases, 12.0%; 3 of 45 cases, 6.7%; 1 of 16 cases, 6.3%） （X^2 = 27.944, P = 0.0001）. The lateral lymph node metastasis rate was 30.0% （9 of 30 cases）, 9.1% （4 of 44 cases） and 4.5% （1 of 22cases） for poorly, moderately and well-differentiated carcinoma, respectively. The difference between the three groups was statistically significant （X^2 = 8.569, P = 0.014）. Local recurrence was 18.8% （18 of 96 cases）, 64.3% （9 of 14 cases）, and 11.0% （9 of 82 cases） in patients with advanced low rectal cancer, in those with and without lateral lymph node metastasis, respectively. The difference between the two groups was statistically significant （X^2 = 22.308, P = 0.0001）. Kaplan-Meier survival analysis showed significant improvements in median survival （80.9 ± 2.1 m, 95% CI： 76.7-85.1 m vs 38 ± 6.7 m, 95% CI： 24.8-51.2 m） of patients without lateral lymph node metastasis compared with those with lateral lymph node metastasis （log-rank, P = 0.0001）. CONCLUSION： Tumor diameter, infiltration and differentiation are significant risk factors for lateral lymph node metastasis. Lateral pelvic lymphadenectomy should be performed following surgery for patients with tumor diameter ≥ 5 cm. Lateral lymph node metastasis is an important predictor for local recurrence and survival in patients with advanced low rectal cancer.

Photodynamic Therapy for Gynecological Diseases and Breast Cancer

Photodynamic therapy （PDT） is a minimally invasive and promising new method in cancer treatment. Cytotoxic reactive oxygen species （ROS） are generated by the tissueqocalized non-toxic sensitizer upon illumination and in the presence of oxygen. Thus, selective destruction of a targeted tumor may be achieved. Compared with traditional cancer treatment, PDI has advantages including higher selectivity and lower rate of toxicity. The high degree of selectivity of the proposed method was applied to cancer diagnosis using fluorescence. This article reviews previous studies done on PDT treatment and photodetection of cervical intraepithelial neoplasia, vulvar intraepithelial neoplasia, ovarian and breast cancer, and PDT application in treating non-cancer lesions. The article also highlights the clinical responses to PDT, and discusses the possibility of enhancing treatment efficacy by combination with immunotherapy and targeted therapy.

A Preliminary Study of The Value of Quantitative Testing of TP-DNA In The Treatment of Patients with Syphilis

Objectives: To explore the relationship betweenquantitative Treponema pallidum DNA (TP-DNA) PCR testingand the Toludine Red Unheated Serum Test (TRUST) inpatients with syphilis before and after treatment, and evaluatethe clinical value of quantitative TP-DNA testing in thediagnosis and treatment evaluation of syphilis. Methods: 29 patients with primary (12 cases) or secondary(17 cases) syphilis, who met the criteria set for this study wererecruited as subjects. All patients were treated with 2.4 millionunits benzathine penicillin IM weekly for 3 weeks.Quantitative tests of TP-DNA in the patients' plasma wereperformed using FQ-PCR before and after the treatment.Serologic tests including TRUST and TPPA were alsoperformed. Results: Before the treatment, 9 out of 12 primary syphilispatients (75%) and all secondary syphilis patients (17/17)tested positive for Treponema pallidum (TP) by TP-DNAtesting. The average quantitative test values of TP-DNA inprimary and secondary syphilis patients were (3.38±2.34)×10~4and (5.73±1.33)×10~6 copies/ml, respectively. After threemonths of treatment, 1 of the 9 primary and 5 out of 17secondary syphilis patients were positive upon TP-DNAtesting, respectively. The average quantities of TP-DNA were2.01×10~2 copies/ml in primary and 5.87×10~2 copies/ml insecondary syphilis patients with positive TRUST and TP-DNAtests, and 3.09×10~2 copies/ml for those with negative TRUSTrespectively. After nine months of treatment, all the primaryand secondary syphilis patients were negative upon TP-DNAtesting, while all primary and 14 of 17 (82.35%) secondarysyphilis patients showed negative TRUST results. Conclusion: That the results of TP-DNA tests are notconsistent with those or TRUST before and after treatmentindicates that quantitative TP-DNA testing may have valuableclinical significance in the early diagnosis and evaluation oftreatment regimens for syphilis.

Clinical,serological and genetic predictors of inflammatory bowel disease course

Patients with extensive or complicated Crohn's disease(CD) at diagnosis should be treated straightaway with immunosuppressive therapy according to the most recent guidelines.In patients with localized and uncomplicated CD at diagnosis,early use of immunosuppressive therapy is debated for preventing disease progression and limiting the disabling clinical impact.In this context,there is a need for predictors of benign or unfavourable subsequent clinical course,in order to avoid over-treating with risky drugs those patients who would have experienced spontaneous mid-term asymptomatic disease without progression towards irreversible intestinal lesions.At diagnosis,an age below 40 years,the presence of perianal lesions and the need for treating the first flare with steroids have been consistently associated with an unfavourable subsequent 5-year or 10-year clinical course.The positive predictive value of unfavourable course in patients with 2 or 3 predictors ranges between 0.75 and 0.95 in population-based and referral centre cohorts.Consequently,the use of these predictors can be integrated into the elements that influence individual decisions.In the CD postoperative context,keeping smoking and history of prior resection are the stron-gest predictors of disease symptomatic recurrence.However,these clinical predictors alone are not as reliable as severity of early postoperative endoscopic recurrence in clinical practice.In ulcerative colitis(UC),extensive colitis at diagnosis is associated with unfavourable clinical course in the first 5 to 10 years of the disease,and also with long-term colectomy and colorectal inflammation-associated colorectal cancer.In patients with extensive UC at diagnosis,a rapid step-up strategy aiming to achieve sustained deep remission should therefore be considered.At the moment,no reliable serological or genetic predictor of inflammatory bowel disease clinical course has been identified.