No long-term survival benefit with sustained-release 5-fluorouracil implants in patients with stages Ⅱ and Ⅲ gastric cancer

BACKGROUND The prognosis of gastric cancer in an advanced stage remains poor. The exact efficacy of the use of intraoperative sustained-release chemotherapy with 5-fluorouracil(5-FU) in advanced-stage gastric cancer is still unelucidated.AIM To explore the long-term survival benefit of using sustained-release 5-FU implants in stage Ⅱ and stage Ⅲ gastric cancer patients.METHODS Patients with gastric cancer in a locally advanced stage and who underwent an R0 radical resection between Jan 2014, to Dec 2016, in this single institution were included. Patients with pathological diagnoses other than adenocarcinoma were excluded. All included patients were grouped according to whether intraoperative sustained-release(SR) chemotherapy with 5-FU was used or not(NSR). The primary end-point was 5-year overall survival. Kaplan–Meier method with logrank test was used to analyze the overall survival of patients and Cox analysis was used to analyze prognosis factors of these patients.RESULTS In total, there were 563 patients with gastric cancer with locally advanced stage, who underwent an R0 radical resection. 309 patients were included in the final analysis. 219(70.9%) were men, with an average age of 58.25 years. Furthermore, 56(18.1%) received neoadjuvant chemotherapy, and 191(61.8%) were in TNM stage Ⅲ. In addition, 158 patients received intraoperative sustainedrelease chemotherapy with 5-FU and were included in the SR group, while the other 161 patients were included in the NSR group. The overall complication rate was 12.94% in the whole group and 10.81%, 16.46% in SR and NSR groups, respectively. There were no significant differences between the two groups in overall survival and complication rate(P > 0.05). The multivariate cox analysis indicated that only N Stage and neoadjuvant therapy were independent influencing factors of survival.CONCLUSION Intraoperative sustained-release chemotherapy usage with 5-FU, did not improve the survival of patients who underwent an R0 radical resection in locally advanced stage of gastric cancer.

Thirty-one patients with primary hepatocellular carcinoma survived for more than 5 years after hepatectomy

Objective: To investigate the factors affecting progno- sis of patients with primary hepatocellular carcinoma (PHC) after resection. Methods: From 1976 to 1992, 213 patients with PHC treated with hepatectomy were followed up for more than 5 years. Thirty-one of the patients who had sur- vived for more than 5 years were compared with 56 patients who had survived for less than 5 years. Results: Early detection of tumor, radical resection, number of tumors, capsule formation, operation safe distance, presence of portal tumor embolus, pre- sence of cirrhosis and tumor size were important fac- tors affecting the prognosis of patients with PHC. The proportion of small liver cancer in the patients who had survived for more than 5 years was greatly larger than that in the control group. Conclusions: Early detection of tumor and radical re- section are of value in raising the 5-year survival rate. Much remains to be investigated about the rela- tionship between safe margin distance and prognosis of patients with PHC.

Chronic disease and its therapeutic drugs may effect on the postoperative 5-year survival rate of lung cancer patients

In this study, we aimed to investigate the influencing factors of postoperative 5-year survival rate in non small-cell lung cancer（NSCLC） patients with stage I–III. We enrolled 220 patients who underwent surgical operation and survived longer than 3 months, with histologically confirmed adenocarcinoma or squamous cell carcinoma from Jan. 2009 to Dec. 2009. Multiple variables, like age, gender, smoking, alcohol, obesity, family history of cancer, diabetes, hypertension, antidiabetic drugs, tumor staging, pathology, treatments, surgical side as well as lipid levels, were selected. We found that tumor staging was associated with 5-year survival rate of stage I–III NSCLC patients by univariate analysis. Furthermore, diabetes mellitus, hypertension and surgical side were associated with the overall survival of NSCLC patients with stage I, stageⅡand stage III, respectively. In conclusion, the status of chronic disease had potential effect on the postoperative 5-year survival rate of lung cancer patients.

CDX2、SOX2在浆液性卵巢癌组织中的表达及其临床意义

目的:探究卵巢浆液性肿瘤组织中尾型同源盒转录因子2(CDX2)、Y染色体性别决定区相关的高迁移率族盒蛋白2(SOX2)表达水平及其与预后关系。方法:选取2012年6月-2015年6月本院收治的卵巢浆液性癌患者84例、卵巢交界性浆液性肿瘤患者52例、卵巢良性浆液性肿瘤(卵巢浆液性囊腺瘤)患者63例,收集术中卵巢浆液性癌患者癌组织及癌旁正常组织(距病灶>5 cm),卵巢交界性浆液性肿瘤组织及卵巢良性浆液性肿瘤组织,免疫组织化学染色法检测组织中CDX2、SOX2蛋白表达;Kaplan-Meier生存曲线分析卵巢浆液性癌组织中CDX2、SOX2蛋白表达与患者预后关系;Cox回归模型分析浆液性卵巢癌患者预后影响因素。结果:癌旁正常组织、卵巢良性浆液性肿瘤组织、卵巢交界性浆液性肿瘤组织、卵巢浆液性癌组织中CDX2蛋白高表达率依次降低,SOX2蛋白高表达率依次升高(P<0.05)。与FIGO分期Ⅰ-Ⅱ期、组织学分级G1、无淋巴结转移、无远处转移、未复发患者比较,FIGO分期Ⅲ-Ⅳ期、组织学分级G2-G3、淋巴结转移、远处转移、复发患者癌组织中CDX2蛋白高表达率降低、SOX2蛋白高表达率升高(P<0.05)。卵巢浆液性癌组织中CDX2与SOX2蛋白表达呈负相关(P<0.05)。5年累积生存率,CDX2低表达患者(32.9%)低于高表达患者(71.4%),SOX2低表达患者(68.8%)高于SOX2高表达患者(21.2%)(P<0.05)。Ⅲ-Ⅳ期FIGO分期、淋巴结转移、远处转移及CDX2低表达、SOX2高表达是影响卵巢浆液性癌患者不良预后发生的独立危险因素(P<0.05)。结论:卵巢浆液性癌组织中CDX2蛋白低表达、SOX2蛋白高表达,二者可能在肿瘤进展中存在相互作用,与患者FIGO分期、组织学分级升高及复发、死亡等预后不良发生密切相关。

胃癌血管侵犯的临床病理分析

目的探讨胃癌血管侵犯与患者临床病理因素及预后的关系，分析影响胃癌患者预后的相关因素。方法回顾性分析2007年1月至2010年12月南京医科大学附属南京医院收治的206例胃癌患者的临床病理资料。收集胃癌患者手术切除的肿瘤标本，采用免疫组织化学染色检测肿瘤标的本血管侵犯情况。采用门诊和电话方式进行随访，随访时间截至2014年3月。计数资料比较采用r检验。采用Kaplan-Meier法绘制生存曲线，Log-rank检验进行生存分析和单因素分析。采用COX模型逐步后退法进行多因素分析。结果206例患者中，血管侵犯率为27．67％（57／206）。胃癌患者的不同肿瘤分化程度、神经侵犯、T分期、N分期、TNM分期胃癌组织中血管侵犯率比较，差异有统计学意义（χ^2=14．396，9．569，15．579，43．453，30．732，P〈0．05）。188例患者获得术后随访，随访率为91．26％（188／206），随访时间为6．0～60．0个月，中位随访时间为34．0个月。188例获得随访患者中，血管侵犯患者中位生存时间为32．4个月，5年累积生存率为19．6％；血管未侵犯患者中位生存时间为40．7个月，5年累积生存率为42．0％，两者生存情况比较，差异有统计学意义（χ^2=9．364，P〈0．05）。单因素分析结果显示：肿瘤直径、肿瘤分化程度、神经侵犯、血管侵犯、T分期、N分期、TNM分期是影响胃癌患者预后的相关因素（χ^2=9．241，17．486，11．243，9．364，27．666，216．745，49．887，P〈0．05）。多因素分析结果显示：肿瘤直径≥5cm、血管侵犯、T分期为T4期、N分期为N3期、TNM分期为Ⅲ期是影响胃癌患者预后的独立危险因素（HR=0．502，0．456，0．052，0．001，0．735，95％可信区间：0．334—0．754，0．289～0．720，0．004—0．664，0．000～0．006，0．159～3．398，P〈0．05）。结论胃癌患者血管侵犯可能与肿瘤进展有关。肿瘤直径≥5cm、血管侵犯、T分期为T4期、N分期为N3期、TNM分期为Ⅲ期是影响胃癌患者预后的独立危险因素。血管侵犯可作为判断胃癌患者预后不良的指标。