左亚叶酸钙联合5-氟尿嘧啶、奥沙利铂治疗晚期或复发胃、结直肠癌Ⅱ期的临床研究

目的:探究晚期或复发胃、结直肠癌Ⅱ期患者运用左亚叶酸钙和5-氟尿嘧啶、奥沙利铂联合治疗后的应用价值。方法:选取80例在2016年1月-2017年1月来笔者所在医院治疗的晚期或复发胃、结直肠癌Ⅱ期患者,根据患者治疗意愿分为观察组和对照组,每组40例。观察组患者采用左亚叶酸与5-氟尿嘧啶、奥沙利铂联合治疗,对照组采用5-氟尿嘧啶联合奥沙利铂治疗。结果:观察组癌肿病灶缓解率为82.5%,高于对照组的60.0%,差异有统计学意义(X^2=1.253,P<0.05);观察组不良反应发生率为7.5%,对照组为5.0%,差异无统计学意义(X^2=0.230,P>0.05);对照组生存质量各指标得分均低于观察组,差异均有统计学意义(t=4.976、4.235、4.573、4.346,P<0.05)。结论:左亚叶酸钙联合5-氟尿嘧啶、奥沙利铂治疗晚期或复发胃、结直肠癌Ⅱ期患者,能够有效缓解癌症病灶,改善患者生产质量状况,且不良反应发生率较低。

胃、结直肠癌术后良、恶性肠梗阻病因分析

目的进行胃、结直肠癌术后良、恶性肠梗阻病因分析。方法分析该院2008年1月—2009年6月胃、结直肠癌术后良、恶性肠梗阻病例68例,分为肿瘤组和良性组各34例,对他们原发病的手术间期、病理分期、分化类型及肠梗阻类型进行回顾性分析,并进行术后死亡及术后存活时间比较。结果两组间在原发肿瘤手术间期、病理分期、分化类型及肠梗阻类型、存活时间等方面均存在显著性差异(P<0.05)。结论原发肿瘤手术间期、病理分期、分化类型及肠梗阻类型、存活时间等方面可作为胃肠道恶性肿瘤术后良、恶性肠梗阻诊断的要点。

Detection of RASSF1A promoter hypermethylation in serum from gastric and colorectal adenocarcinoma patients

AIM：To evaluate the diagnostic role of serum RASSF1A promoter hypermethylation in gastric and colorectal adenocarcinoma. METHODS：Methylation-specific polymerase chain reaction （MSPCR） was used to examine the promoter methylation status of the serum RASSF1A gene in 47 gastric adenocarcinoma patients, 45 colorectal adenocarcinoma patients, 60 patients with benign gastrointestinal disease （30 with benign gastric disease and 30 with benign colorectal disease）, and 30 healthy donor controls. Apaired study of RASSF1A promoter methylation status in primary tumor, adjacent normal tissue, and postopertive serum were conducted in 25 gastric and colorectal adenocarcinoma patients who later were underwent surgical therapy. RESULTS：The frequencies of detection of serum RASSF1A promoter hypermethylation in gastric （34.0%） and colorectal （28.9%） adenocarcinoma patients were significantly higher than those in patients with benign gastric （3.3%） or colorectal （6.7%） disease or in healthy donors （0%） （P 〈 0.01）. The methylation status of RASSF1A promoter in serum samples was consistent with that in paired primary tumors, and the MSPCR results for RASSF1A promoter methylation status in paired preoperative samples were consistent with those in postoperative serum samples. The serum RASSF1A promoter hypermethylation did not correlate with patient sex, age, tumor differentiation grade, surgical therapy, or serum carcinoembryonic antigen level. Although the serum RASSF1A promoter hypermethylation frequency tended to be higher in patients with distant metastases, there was no correlation between methylation status and metastasis. CONCLUSION：Aberrant CpG island methylation within the promoter region of RASSF1A is a promising biomarker for gastric and colorectal cancer.

Endoscopic submucosal dissection for gastrointestinal neoplasms

Endoscopic submucosal dissection (ESD) is an advanced technique of therapeutic endoscopy for superficial gastrointestinal neoplasms. Three steps characterize it:injecting fluid into the submucosa to elevate the lesion, cutting the surrounding mucosa of the lesion, and dissecting the submucosa beneath the lesion. The ESD technique has rapidly permeated in Japan for treatment of early gastric cancer, due to its excellent results of en- bloc resection compared to endoscopic mucosal resection (EMR). Although there is still room for improvement to lessen its technical difficulty, ESD has recently been applied to esophageal and colorectal neoplasms. Favorable short-term results have been reported, but the application of ESD should be well considered by three aspects:(1) the possibility of nodal metastases of the lesion, (2) technical difficulty such as location, ulceration and operator’s skill, and (3) organ characteristics.

Circulating lymphangiogenic growth factors in gastrointestinal solid tumors, could they be of any clinical significance?

Metastasis is the principal cause of cancer mortality, with the lymphatic system being the first route of tumor dissemination. The glycoproteins VEGF-C and VEGF-D are members of the vascular endothelial growth factor (VEGF) family, whose role has been recently recognized as lymphatic system regulators during embryogenesis and in pathological processes such as inflammation, lymphatic system disorders and malignant tumor metastasis. They are ligands for the VEGFR-3 receptor on the membrane of the lymphatic endothelial cell, resulting in dilatation of existing lymphatic vessels as well as in vegetation of new ones (lymphangiogenesis). Their determination is feasible in the circulating blood by immunoabsorption and in the tissue specimen by immunohistochemistry and reverse transcription polymerase chain reaction (RT-PCR). Experimental and clinicopathological studies have linked the VEGF-C, VEGF-D/VEGFR3 axis to lymphatic spread as well as to the clinical outcome in several human solid tumors. The majority of these data are derived from surgical specimens and malignant cell series, rendering their clinical application questionable, due to subjectivity factors and post-treatment quantification. In an effort to overcome these drawbacks, an alternative method of immunodetection of the circulating levels of these molecules has been used in studies on gastric, esophageal and colorectal cancer. Their results denotethat quantification of VEGF-C and VEGF-D in blood samples could serve as lymph node metastasis predictive biomarkers and contribute to preoperative staging of gastrointestinal malignancies.

Gastric cancer patients at high-risk of having synchronous cancer

AIM： To identify patients with a high-risk of having a synchronous cancer among gastric cancer patients. METHODS： We retrospectively analyzed the prospective gastric cancer database at the National Cancer Center, Korea from December 2000 to December 2004. The clinicopathological characteristics of patients with synchronous cancers and those of patients without synchronous cancers were compared. Multivariate analysis was performed to identify the risk factors for the presence of a synchronous cancer in gastric cancer patients. RESULTS： 111 of 3291 gastric cancer patients （3.4%） registered in the database had a synchronous cancer. Among these 111 patients, 109 had a single synchronous cancer and 2 patients had two synchronous cancers. The most common form of synchronous cancer was colorectal cancer （42 patients, 37.2%） followed by lung cancer （21 patients, 18.6%）. Multivariate analyses revealed that elderly patients with differentiated early gastric cancer have a higher probability of a synchronous cancer. CONCLUSION： Synchronous cancers in gastric cancer patients are not infrequent. The physicians should try to find synchronous cancers in gastric cancer patients, especially in the elderly with a differentiated early gastric

Clinical analysis of 13 cases of synchronous gastric and colorectal cancer

Objective:To investigate the clinical characteristics and prognosis of patients with synchronous gastric and colorectal cancer.Methods:Clinical and pathological data of 3416 cases with gastric cancer and 3109 with colorectal cancer, from March 1985 to May 2005,were analyzed retrospectively.Results:Thirteen cases were confirmed as synchronous gastric and colorectal cancer and the incidences of the disease were 0.38%in gastric cancer cases and 0.42%in colorectal cancer.Of patients suffering from synchronous gastric and colorectal cancer,15.4%were diagnosed before the first operation and 33.3%were not diagnosed with the second cancer until it was radically dissected.The 3-year survival rate of the patients was 30.8%.Conclusion:The preoperative diagnosis rate of the synchronous gastric and colorectal cancer,the radical dis- section rate of the second cancer and the 3-year survival rate after surgical removal of the second cancer were rather low.The key for enhancing the radical dissection rate of the second cancer and the survival rate after surgery for the second cancer lies in the improvement of diagnosis rate before the first operation.