BACKGROUND Duodenal cancer is one of the most common subtypes of small intestinal cancer,and distant metastasis(DM)in this type of cancer still leads to poor prognosis.Although nomograms have recently been used in tum...BACKGROUND Duodenal cancer is one of the most common subtypes of small intestinal cancer,and distant metastasis(DM)in this type of cancer still leads to poor prognosis.Although nomograms have recently been used in tumor areas,no studies have focused on the diagnostic and prognostic evaluation of DM in patients with primary duodenal cancer.AIM To develop and evaluate nomograms for predicting the risk of DM and person-alized prognosis in patients with duodenal cancer.METHODS Data on duodenal cancer patients diagnosed between 2010 and 2019 were extracted from the Surveillance,Epidemiology,and End Results database.Univariate and multivariate logistic regression analyses were used to identify independent risk factors for DM in patients with duodenal cancer,and univariate and multivariate Cox proportional hazards regression analyses were used to determine independent prognostic factors in duodenal cancer patients with DM.Two novel nomograms were established,and the results were evaluated by receiver operating characteristic(ROC)curves,calibration curves,and decision curve analysis(DCA).RESULTS A total of 2603 patients with duodenal cancer were included,of whom 457 cases(17.56%)had DM at the time of diagnosis.Logistic analysis revealed independent risk factors for DM in duodenal cancer patients,including gender,grade,tumor size,T stage,and N stage(P<0.05).Univariate and multivariate COX analyses further identified independent prognostic factors for duodenal cancer patients with DM,including age,histological type,T stage,tumor grade,tumor size,bone metastasis,chemotherapy,and surgery(P<0.05).The accuracy of the nomograms was validated in the training set,validation set,and expanded testing set using ROC curves,calibration curves,and DCA curves.The results of Kaplan-Meier survival curves(P<0.001)indicated that both nomograms accurately predicted the occurrence and prognosis of DM in patients with duodenal cancer.CONCLUSION The two nomograms are expected as effective tools for predicting DM risk in duodenal cancer patients and offering personalized prognosis predictions for those with DM,potentially enhancing clinical decision-making.展开更多
BACKGROUND Development of distant metastasis(DM)is a major concern during treatment of nasopharyngeal carcinoma(NPC).However,studies have demonstrated im-proved distant control and survival in patients with advanced N...BACKGROUND Development of distant metastasis(DM)is a major concern during treatment of nasopharyngeal carcinoma(NPC).However,studies have demonstrated im-proved distant control and survival in patients with advanced NPC with the addition of chemotherapy to concomitant chemoradiotherapy.Therefore,precise prediction of metastasis in patients with NPC is crucial.AIM To develop a predictive model for metastasis in NPC using detailed magnetic resonance imaging(MRI)reports.METHODS This retrospective study included 792 patients with non-distant metastatic NPC.A total of 469 imaging variables were obtained from detailed MRI reports.Data were stratified and randomly split into training(50%)and testing sets.Gradient boosting tree(GBT)models were built and used to select variables for predicting DM.A full model comprising all variables and a reduced model with the top-five variables were built.Model performance was assessed by area under the curve(AUC).RESULTS Among the 792 patients,94 developed DM during follow-up.The number of metastatic cervical nodes(30.9%),tumor invasion in the posterior half of the nasal cavity(9.7%),two sides of the pharyngeal recess(6.2%),tubal torus(3.3%),and single side of the parapharyngeal space(2.7%)were the top-five contributors for predicting DM,based on their relative importance in GBT models.The testing AUC of the full model was 0.75(95%confidence interval[CI]:0.69-0.82).The testing AUC of the reduced model was 0.75(95%CI:0.68-0.82).For the whole dataset,the full(AUC=0.76,95%CI:0.72-0.82)and reduced models(AUC=0.76,95%CI:0.71-0.81)outperformed the tumor node-staging system(AUC=0.67,95%CI:0.61-0.73).CONCLUSION The GBT model outperformed the tumor node-staging system in predicting metastasis in NPC.The number of metastatic cervical nodes was identified as the principal contributing variable.展开更多
BACKGROUND Rectal cancer(RC)patient stratification by different factors may yield variable results.Therefore,more efficient prognostic biomarkers are needed for improved risk stratification,personalized treatment,and ...BACKGROUND Rectal cancer(RC)patient stratification by different factors may yield variable results.Therefore,more efficient prognostic biomarkers are needed for improved risk stratification,personalized treatment,and prognostication of RC patients.AIM To build a novel model for predicting the presence of distant metastases and 3-year overall survival(OS)in RC patients.METHODS This was a retrospective analysis of 148 patients(76 males and 72 females)with RC treated with curative resection,without neoadjuvant or postoperative chemoradiotherapy,between October 2012 and December 2015.These patients were allocated to a training or validation set,with a ratio of 7:3.Radiomic features were extracted from portal venous phase computed tomography(CT)images of RC.The least absolute shrinkage and selection operator regression analysis was used for feature selection.Multivariate logistic regression analysis was used to develop the radiomics signature(Rad-score)and the clinicoradiologic risk model(the combined model).Receiver operating characteristic curves were constructed to evaluate the diagnostic performance of the models for predicting distant metastasis of RC.The association of the combined model with 3-year OS was investigated by Kaplan-Meier survival analysis.RESULTS A total of 51(34.5%)patients had distant metastases,while 26(17.6%)patients died,and 122(82.4%)patients lived at least 3 years post-surgery.The values of both the Rad-score(consisted of three selected features)and the combined model were significantly different between the distant metastasis group and the nonmetastasis group(0.46±0.21 vs 0.32±0.24 for the Rad-score,and 0.60±0.23 vs 0.28±0.26 for the combined model;P<0.001 for both models).Predictors contained in the combined model included the Rad-score,pathological N-stage,and T-stage.The addition of histologic grade to the model failed to show incremental prognostic value.The combined model showed good discrimination,with areas under the curve of 0.842 and 0.802 for the training set and validation set,respectively.For the survival analysis,the combined model was associated with an improved OS in the whole cohort and the respective subgroups.CONCLUSION This study presents a clinicoradiologic risk model,visualized in a nomogram,that can be used to facilitate individualized prediction of distant metastasis and 3-year OS in patients with RC.展开更多
BACKGROUND Distant relapse is the leading cause of cancer-related death in locally advanced rectal cancer.Neoadjuvant chemoradiation(NACRT)followed by surgery inevitably delays delivery of systemic treatment.Some pati...BACKGROUND Distant relapse is the leading cause of cancer-related death in locally advanced rectal cancer.Neoadjuvant chemoradiation(NACRT)followed by surgery inevitably delays delivery of systemic treatment.Some patients show early distant metastasis before systemic treatment.AIM To identify the most effective treatments.We investigated prognostic factors for distant metastasis,especially early distant metastasis,using the standard treatment paradigm to identify the most effective treatments according to recurrence risk.METHODS From January 2015 through December 2019,rectal cancer patients who underwent NACRT for having clinical T 3-4 or clinical N 1-2 disease according to the 8th American Joint Committee on Cancer staging system were included.Radiotherapy was delivered to the whole pelvis with concomitant chemotherapy.Patients received surgery 6-8 wk after completion of NACRT.Adjuvant chemotherapy was administered at the physician’s discretion.RESULTS A total of 127 patients received NACRT.Ninety-three patients(73.2%)underwent surgery.The R0 resection rate was 89.2%in all patients.Pathologic tumor and node downstaging rates were 41.9%and 76.3%.Half the patients(n=69)received adjuvant chemotherapy after surgery.The 3-year distant metastasis-free survival(DMFS)and overall survival(OS)rates were 81.7%and 83.5%.On univariate analyses,poorly differentiated tumors,>5 cm,involvement of mesorectal fascia(MRF),or presence of extramural involvement(EMVI)were associated with worse DMFS and OS.Five patients showed distant metastasis at their first evaluation after NACRT.Patients with early distant metastasis were more likely to have poorly differentiated tumor(P=0.025),tumors with involved MRF(P=0.002),and EMVI(P=0.012)than those who did not.CONCLUSION EMVI,the involvement of MRF,and poor histologic grade were associated with early distant metastasis.In order to control distant metastasis and improve treatment outcome,selective use of neoadjuvant treatment according to individualized risk factors is necessary.Future studies are required to determine effective treatment strategies for patients at high risk for distant metastasis.展开更多
BACKGROUND Anaplastic thyroid carcinoma(ATC),also called undifferentiated thyroid cancer,is the least common but most aggressive and deadly thyroid gland malignancy of all thyroid cancers[1].It has poor prognosis,and ...BACKGROUND Anaplastic thyroid carcinoma(ATC),also called undifferentiated thyroid cancer,is the least common but most aggressive and deadly thyroid gland malignancy of all thyroid cancers[1].It has poor prognosis,and is the leading cause of death from malignant thyroid tumors.The one-year survival rate is 20%,with a median overall survival(OS)of only 5 mo[2].The aim of this report is to provide our experience in the diagnosis and treatment of ATC.CASE SUMMARY A patient with a thyroid mass underwent surgical treatment after developing symptoms of hoarseness.The resected tumor was pathologically diagnosed as ATC.Imaging examination revealed organ and lymph node metastasis.After multiple cycles of chemotherapy and local radiotherapy,the metastases were not relieved and gradually increased in size and new metastases appeared.The patient immediately received immunotherapy combined with targeted therapy.During treatment,immune-related adverse reactions occurred,which were improved after symptomatic treatment,and tolerated by the patient.The OS of the patient was more than 30 mo after immunotherapy combined with targeted therapy.CONCLUSION For metastatic ATC,surgical treatment,radiotherapy and chemotherapy have no significant effect on remission of the disease.However,immunotherapy has made a breakthrough in the treatment of ATC。展开更多
The aims of this study were to determine the prog no stic value of primary tumor surgery and identify optimal can didates for such surgery among patients with semi noma and dista nt metastasis at diag no sis.We ide nt...The aims of this study were to determine the prog no stic value of primary tumor surgery and identify optimal can didates for such surgery among patients with semi noma and dista nt metastasis at diag no sis.We ide ntified 521 patients with seminoma and distant metastasis at diagnosis between 2004 and 2014 from the Surveillanee,Epidemiology,and End Results database.Among these patients,434 had undergone surgery,whereas 87 had not.The prognostic value of primary tumor surgery was assessed by Kaplan-Meier methods,log-rank analyses,and multivariate Cox's proportional hazards model.Survival curves and forest plots were also plotted.Survival analysis indicated that patients who underwent surgery had a better 5-year overall survival and cancer-specific survival tha n those who did not.Multivariate analyses dem on strated that primary tumor surgery is an in depende nt prog no stic factor for overall survival and cancer-specific survival,along with age at diagnosis,Mstage,and marital status.In addition,primary tumor surgery still had con siderable prog no stic value in the subgroup of patie nts with lymph node metastasis.Further,forest plots demonstrated that patie nts with Mia stage,N1 or N2-3 stage,and a youn ger age at diagnosis(<60 years)may ben efit from primary tumor surgery.In con elusion,our findings indicate that primary tumor surgery is correlated with improved survival in patients with seminoma and distant metastasis.Furthermore,primary tumor surgery is an independent prognostic indicator for patients with seminoma and distant metastasis.展开更多
BACKGROUND The prognosis of many patients with distant metastatic hepatocellular carcinoma(HCC)improved after they survived for several months.Compared with tradi-tional survival analysis,conditional survival(CS)which...BACKGROUND The prognosis of many patients with distant metastatic hepatocellular carcinoma(HCC)improved after they survived for several months.Compared with tradi-tional survival analysis,conditional survival(CS)which takes into account changes in survival risk could be used to describe dynamic survival probabilities.AIM To evaluate CS of distant metastatic HCC patients.METHODS Patients diagnosed with distant metastatic HCC between 2010 and 2015 were extracted from the Surveillance,Epidemiology and End Results database.Univariate and multivariate Cox regression analysis were used to identify factors for overall survival(OS),while competing risk model was used to identify risk factors for cancer-specific survival(CSS).Six-month CS was used to calculate the probability of survival for an additional 6 mo at a specific time after initial diagnosis,and standardized difference(d)was used to evaluate the survival differences between subgroups.Nomograms were constructed to predict CS.Positiveα-fetoprotein expression,higher T stage(T3 and T4),N1 stage,non-primary site surgery,non-chemotherapy,non-radiotherapy,and lung metastasis were independent risk factors for actual OS and CSS through univariate and multivariate analysis.Actual survival rates decreased over time,while CS rates gradually increased.As for the 6-month CS,the survival difference caused by chemotherapy and radiotherapy gradually disappeared over time,and the survival difference caused by lung metastasis reversed.Moreover,the influence of age and gender on survival gradually appeared.Nomograms were fitted for patients who have lived for 2,4 and 6 mo to predict 6-month conditional OS and CSS,respectively.The area under the curve(AUC)of nomograms for conditional OS decreased as time passed,and the AUC for conditional CSS gradually increased.CONCLUSION CS for distant metastatic HCC patients substantially increased over time.With dynamic risk factors,nomograms constructed at a specific time could predict more accurate survival rates.展开更多
BACKGROUND Despite an expanding number of studies on intraductal papillary neoplasm of the bile duct(IPNB),distant metastasis remains unexplained especially in cases of carcinoma in situ.In the present study,we report...BACKGROUND Despite an expanding number of studies on intraductal papillary neoplasm of the bile duct(IPNB),distant metastasis remains unexplained especially in cases of carcinoma in situ.In the present study,we report a rare and interesting case of IPNB without invasive components that later metastasized to lungs and brain.CASE SUMMARY A 69-year-old male was referred to our hospital due to suspected cholangiocarcinoma.Laboratory tests on admission reported a mild elevation of alkaline phosphatase,γ-glutamyl transpeptidase,and total bilirubin in serum.Endoscopic retrograde cholangiography revealed a filling defect in the common bile duct(CBD)extending to the left hepatic duct.Peroral cholangioscopy delineated a tumor in the CBD that had a papillary pattern.Multidetector computed tomography and magnetic resonance cholangiopancreatography detected partial blockage ot interlude in the CBD leading to cholestasis without evidence of metastasis.Therefore,a diagnosis of IPNB cT1N0M0 was established.Left hepatectomy with bile duct reconstruction was performed.Pathological examination confirmed an intraepithelial neoplasia pattern without an invasive component and an R0 resection achievement.The patient was monitored carefully by regular examinations.However,at 32 mo after the operation,a 26 mm tumor in the lungs and a 12 mm lesion in the brain were detected following a suspicious elevated CA 19-9 level.Video-assisted thoracoscopic surgery of left upper lobectomy and stereotactic radiotherapy are indicated.In addition to histopathological results,a genomic profiling analysis using whole exome sequencing subsequently confirmed lung metastasis originating from bile duct cancer.CONCLUSION This case highlights the important role of genomic profiling analysis using whole exome sequencing in identifying the origin of metastasis in patients with IPNB.展开更多
Retrospective analysis of the progression of a case of metastatic castration-resistant prostate cancer with neuroendocrine differentiation:the patient was a 65 year old man with prostate adenocarcinoma on prostate bio...Retrospective analysis of the progression of a case of metastatic castration-resistant prostate cancer with neuroendocrine differentiation:the patient was a 65 year old man with prostate adenocarcinoma on prostate biopsy,Gleason 4+4 score=8,70%,ISUP4 group,localized invasion of nerves.Progressed to metastatic castration-resistant prostate cancer after 8 months of novel endocrine therapy,persistent elevated PSA after endocrine therapy,chemotherapy,and radiation,abdominal metastasis,brain metastasis,gastric metastasis,and staging as neuroendocrine differentiation after second prostate biopsy,which is a highly malignant subtype and has been concerned as a mechanism of resistance to targeted therapies.We discuss how to choose a more optimal treatment plan and outline the patient's diagnostic and therapeutic course.We provide a reflection for the clinical study of metastatic castration-resistant prostate cancer with neuroendocrine type.展开更多
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 incid...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.展开更多
BACKGROUND Multiple primary malignancies(MPM)are characterized by two or more primary malignancies in the same patient,excluding relapse or metastasis of prior cancer.We aimed to elucidate the clinical features and su...BACKGROUND Multiple primary malignancies(MPM)are characterized by two or more primary malignancies in the same patient,excluding relapse or metastasis of prior cancer.We aimed to elucidate the clinical features and survival of MPM patients.AIM To elucidate the clinical features and survival of MPM patients.METHODS A retrospective study of MPM patients was conducted in our hospital between June 2016 and June 2019.Overall survival(OS)was calculated using the Kaplan-Meier method.The log-rank test was used to compare the survival of different groups.RESULTS A total of 243 MPM patients were enrolled,including 222 patients with two malignancies and 21 patients with three malignancies.Of patients with two malignancies,51(23.0%)had synchronous MPM,and 171(77.7%)had metachronous MPM.The most common first cancers were breast cancer(33,14.9%)and colorectal cancer(31,14.0%).The most common second cancers were non-small cell lung cancer(NSCLC)(66,29.7%)and gastric cancer(24,10.8%).There was no survival difference between synchronous and metachronous MPM patients(36.4 vs 35.3 mo,P=0.809).Patients aged>65 years at diagnosis of the second cancer had a shorter survival than patients≤65 years(28.4 vs 36.4 mo,P=0.038).Patients with distant metastasis had worse survival than patients without metastasis(20.4 vs 86.9 mo,P=0.000).Following multivariate analyses,age>65 years and distant metastasis were independent adverse prognostic factors for OS.CONCLUSION During follow-up of a first cancer,the occurrence of a second or more cancers should receive greater attention,especially for common concomitant MPM,to ensure early detection and treatment of the subsequent cancer.展开更多
BACKGROUND Papillary thyroid carcinoma(PTC)is the most common endocrine malignancy.Papillary thyroid microcarcinoma(PTMC)accounts for the majority of PTC cases.However,concurrent pulmonary and hepatic metastases of PT...BACKGROUND Papillary thyroid carcinoma(PTC)is the most common endocrine malignancy.Papillary thyroid microcarcinoma(PTMC)accounts for the majority of PTC cases.However,concurrent pulmonary and hepatic metastases of PTMC are rarely seen.Here,we present a patient with coexisting liver and lung metastases from PTMC.CASE SUMMARY We describe a 26-year-old woman with PTMC with multiple concurrent metastases.After 3 d of unexplained fever,she was admitted to our hospital.Her thyroid functional tests were abnormal.Her positron emission tomography(PET)/magnetic resonance imaging(MRI)examination showed increased fluorodeoxyglucose(FDG)metabolism and space-occupying lesions in the left lobe of the thyroid.Additionally,PET/MRI images revealed multiple nodules in the lung and liver with increased FDG metabolism.Chest computer tomography(CT)showed multiple pulmonary metastases.Abdominal ultrasound and liver MRI showed multiple space-occupying lesions in the liver.The patient underwent total thyroidectomy and central lymph node dissection.Postoperative pathological analysis showed a papillary microcarcinoma multiplex in the left lobe of the thyroid.A diagnosis of hepatopulmonary metastases from papillary thyroid microcarcinoma was made.The patient was given iodine-131 treatment one year after the surgery.She recovered well after the operation,and the incision healed well.After discharge,she was treated with oral levothyroxine sodium tablets,and symptomatic and supportive treatments were also given to promote radioactive excretion and prevent bone marrow suppression by iodine-131 treatment.CONCLUSION Since patients with thyroid cancer concurrent with hepatopulmonary metastases have rarely been reported,our case will highlight the clinical and pathological profiles of these patients.展开更多
Objective: Stage N2-3 nasopharyngeal carcinoma(NPC) shows a high risk of distant metastasis, which will finally cause death. This study aimed to evaluate the impact of neoadjuvant chemotherapy(NACT) of various cy...Objective: Stage N2-3 nasopharyngeal carcinoma(NPC) shows a high risk of distant metastasis, which will finally cause death. This study aimed to evaluate the impact of neoadjuvant chemotherapy(NACT) of various cycles before radical radiotherapy on distant metastasis and survival of patients with stage N2-3 diseases.Methods: In this study, a total of 1,164 consecutive patients with non-metastatic N2-3 NPC were recruited and prospectively observed. Then 231 patients who received NACT of 4 cycles(NACT=4 group) were matched 1:2:1 to 462 patients treated with NACT of 2 cycles(NACT=2 group) and 231 patients treated without NACT(NACT=0 group), according to age, histological subtype, N stage and NACT regimen. Five candidate variables(sex, T stage, concurrent chemotherapy, intensity-modulated radiation therapy and cycle number of NACT) were analyzed for their association with patients' survival.Results: After matching, the overall survival(OS), disease-free survival(DFS), local-recurrence-free survival(RFS) and distant-metastasis-free survival(MFS) of the NACT=4 group(89.2%, 81.0%, 83.3% and 84.8%,respectively) were better than those of the NACT=2 group(83.3%, 72.5%, 81.2% and 77.9%, respectively) and the NACT=0 group(74.0%, 63.2%, 74.0% and 68.8%, respectively). In multivariate analysis, the cycle number of NACT maintained statistical significance on the OS, DFS, RFS and MFS(all P〈0.05).Conclusions: For N2-3 NPC, cycle number of NACT appeared to be an independent factor associated with an improvement of survival.展开更多
Localized malignant pleural mesothelioma (LMPM) is a rare occurrence, and gastrointestinal intra-luminal metastases have not previously been reported. Herein, we report a patient with LMPM who presented with a local r...Localized malignant pleural mesothelioma (LMPM) is a rare occurrence, and gastrointestinal intra-luminal metastases have not previously been reported. Herein, we report a patient with LMPM who presented with a local recurrence 10 mo after initial en bloc surgical resection. Abdominal computed tomography was performed for intractable, vague abdominal pain with episodic vomiting, which showed a "target sign" over the left lower quadrant. Laparotomy revealed several intra-luminal metastatic tumors in the small intestine and colon and a segmental resection of metastatic lesions was performed. Unfortunately, the patient died of sepsis despite successful surgical intervention. Though local recurrence is more frequent in LMPM, the possibility of distant metastasis should not be ignored in patients with non-specifi c abdominal pain.展开更多
BACKGROUND The role of HER2 overexpression in rectal cancer is controversial.AIM To assess the role of HER2 overexpression in the long-term prognosis of rectal cancer.METHODS Data from patients with locally advanced r...BACKGROUND The role of HER2 overexpression in rectal cancer is controversial.AIM To assess the role of HER2 overexpression in the long-term prognosis of rectal cancer.METHODS Data from patients with locally advanced rectal cancer who underwent total mesorectal excision after short-course radiotherapy at Beijing Cancer Hospital between May 2002 and October 2005 were collected.A total of 151 tissue samples of rectal cancer were obtained using rigid proctoscopy before neoadjuvant radiotherapy,followed by immunohistochemistry and fluorescence in situ hybridisation to determine the patients’HER2 expression status.Univariate and multivariate analyses of the associations between the clinicopathological factors and HER2 status were performed.Survival was estimated and compared using the Kaplan-Meier method based on HER2 expression status,and the differences between groups were verified using the log-rank test.RESULTS A total of 151 patients were enrolled in this study.A total of 27(17.9%)patients were ultimately confirmed to be HER2-positive.The follow-up duration ranged from 9 mo to 210 mo,with a median of 134 mo.Distant metastasis and local recurrence occurred in 60(39.7%)and 24(15.9%)patients,respectively.HER2 positivity was significantly associated with the pre-treatment lymph node stage(pre-N)(P=0.040),while there were no differences between HER2 status and age,sex,preoperative CEA levels(pre-CEA),T stage,and lympho-vascular invasion.In terms of prognosis,HER2 overexpression was correlated with distant meta stasis(P=0.002)rather than local recurrence(P>0.05).The multivariate analysis demonstrated that elevated pre-CEA[P=0.002,odds ratio(OR)=3.277,97.5%confidence interval(CI):1.543-7.163],post N(+)(P=0.022,OR=2.437,97.5%CI:1.143-5.308)and HER2(+)(P=0.003,OR=4.222,97.5%CI:1.667-11.409)were risk factors for distant metastasis.The survival analysis showed that there were significant differences between rectal cancer patients in terms of disease-free survival(DFS)[hazard ratio:1.69(95%CI:0.91-3.14);P=0.048]and overall survival(OS)[1.95(1.05-3.63);P=0.0077].CONCLUSION HER2 overexpression is a potential biomarker for predicting lymph node metastasis and distant metastasis,which are associated with worse long-term DFS and OS in rectal cancer patients with locally advanced disease.展开更多
BACKGROUND Surgical resection is regarded as the only potentially curative treatment option for patients with metastatic colorectal cancer(CRC).The National Comprehensive Cancer Network clinical practice guidelines do...BACKGROUND Surgical resection is regarded as the only potentially curative treatment option for patients with metastatic colorectal cancer(CRC).The National Comprehensive Cancer Network clinical practice guidelines do not recommend palliative surgery unless there is a risk of severe symptoms.However,accumulating evidence has shown that palliative surgery is associated with more favorable outcomes for patients with metastatic CRC.AIM To investigate the separate role of palliative primary tumor resection for patients with stage IVA(M1a diseases)and stage IVB(M1b diseases)colorectal adenocarcinoma(CRA).METHODS CRA patients diagnosed from 2010 to 2015 with definite M1a and M1b categories according to the 8th edition of American Joint Committee on Cancer staging system were selected from the Surveillance Epidemiology and End Results(SEER)database.To minimize potential selection bias,the data were adjusted by propensity score matching(PSM).Baseline characteristics,including gender,year of diagnosis,age,marital status,primary site,surgical information,race,grade,chemotherapy,and radiotherapy,were recorded and analyzed.Univariate and multivariate analyses were performed to explore the separate role of palliative surgery for patients with M1a and M1b diseases.RESULTS A total of 19680 patients with metastatic CRA were collected from the SEER database,including 10399 cases of M1a diseases and 9281 cases of M1b diseases.Common independent prognostic factors for both M1a and M1b patients included year of diagnosis,age,race,marital status,primary site,grade,surgery,and chemotherapy.After PSM adjustment,3732 and 3568 matched patients in the M1a and M1b groups were included,respectively.Patients receiving palliative primary tumor resection had longer survival time than those without surgery(P<0.001).For patients with M1a diseases,palliative resection could increase the median survival time by 9 mo;for patients with M1b diseases,palliative resection could prolong the median survival time by 7 mo.For M1a diseases,patients with lung metastasis had more clinical benefit from palliative resection than those with liver metastasis(15 mo for lung metastasis vs 8 mo for liver metastasis,P<0.001).CONCLUSION CRA patients with M1a diseases gain more clinical benefits from palliative primary tumor resection than those with M1b diseases.Those patients with M1a(lung metastasis)have superior long-term outcomes after palliative primary tumor resection.展开更多
<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> In India approximately 20% of the patients with brea...<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> In India approximately 20% of the patients with breast cancer are triple receptor negative. Owing to the aggressive nature and shorter disease-free survival judicious follow up and identification of failure pattern will benefit the patient. Similar studies have been conducted among non-Hispanic population and in China. This study aims to identify failure pattern in radically treated breast cancer patients who are triple receptor negative among Indian population. </span><b><span style="font-family:Verdana;">Methods</span></b><span style="font-family:Verdana;">: This prospective observational study was conducted in the Department of Radiation Oncology, a tertiary cancer centre in Kerala, India. The objective was to record the pattern of recurrence among triple negative breast cancer patients who completed their planned radical treatment. 171 patients with triple negative breast cancer were included in the study. Patients who completed the planned radical treatment were kept under regular follow up. Details of clinical examination and investigations during the follow up were recorded periodically. </span><b><span style="font-family:Verdana;">Results</span></b><span style="font-family:Verdana;">: Out of 171 patients 30 patients had </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">a </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">recurrence of disease. Median age of the population was 53 years. Among the 30 patients who had </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">a </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">recurrence, 16 patients (53%) had systemic relapse and 14 patients (47%) had locoregional relapse. Lung was found to be the most common site of distant metastasis (37%). Ipsilateral chest wall was found to be the most common site of locoregional relapse (50%). 6 months disease free survival was found to be 91.8%</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">and 1-year disease free survival was found to be 70.2%. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: Among radically treated triple negative breast cancers relapses, systemic recurrence was more than locoregional recurrences.</span></span></span></span>展开更多
Epidemiological studies have shown that human leukocyte antigen(HLA) allelic polymorphisms are closely correlated to susceptibility to nasopharyngeal carcinoma(NPC), and in a previous study, we showed that HLA-B*...Epidemiological studies have shown that human leukocyte antigen(HLA) allelic polymorphisms are closely correlated to susceptibility to nasopharyngeal carcinoma(NPC), and in a previous study, we showed that HLA-B*46 and HLA-A*02-B*46 haplotypes were strongly associated with NPC susceptibility. In this retrospective study, we investigated the phenotype of the HLA-A and HLA-B alleles and haplotypes and correlated these data to the clinical and pathological parameters of NPC to understand the role of HLA alleles and haplotypes in NPC prognosis. The cohort comprised 117 NPC patients from a Han population in Xinjiang. The local recurrence-free survival(LRFS), distant metastasis-free survival(DMFS), disease-free survival(DFS), and overall survival(OS) were analyzed. The 5-year DMFS of the HLA-A*02-B*46 haplotype carriers and non-carriers was 66.4% and 90.3%, respectively. In addition, age was found to be a prognostic factor for LRFS, DFS, and OS(P=0.032, 0.040, and 0.013, respectively). We found that the HLA-A*02-B*46 haplotype might be a prognostic marker in addition to the traditional TNM staging in patients with NPC.展开更多
Pulmonary and liver metastases are common sites of distant metastasis from the rectal carcinoma.Metastases to the head and neck region are uncommon from carcinoma of the rectum,and orbital metastases are extremely rar...Pulmonary and liver metastases are common sites of distant metastasis from the rectal carcinoma.Metastases to the head and neck region are uncommon from carcinoma of the rectum,and orbital metastases are extremely rare.Here,we describe a 27-year-old female,who was diagnosed as a case of anorectal carcinoma in April 2010.She underwent abdominoperineal resection followed by concurrent chemoradiotherapy and adjuvant chemotherapy with 5 fl uorouracil and leucovorin on follow-up.In January 2012,she presented with gradually increasing swelling over the left temporal region and left sided proptosis.Fine-needle aspiration and a cell block were performed.Metastasis was confi rmed histologically.Palliative radiotherapy to the left orbit at the dose of 3 Gy per fraction 10 fractions to a total dose of 30 Gy was given by cobalt-60.In patients with a history of rectal carcinoma,recent onset proptosis with temporal swelling,although rare,should raise suspicion of metastatic deposit.展开更多
Early stage carcinoma of the tonsil is curable,and the incidence of systemic metastasis is very low and central nervous system involvement is very rare.A patient diagnosed with early stage tonsillar carcinoma treated ...Early stage carcinoma of the tonsil is curable,and the incidence of systemic metastasis is very low and central nervous system involvement is very rare.A patient diagnosed with early stage tonsillar carcinoma treated with chemoradiation was followed by brachytherapy boost.One and half years after completion of treatment,the patient presented with disseminated metastasis to the skin,lung,liver,bone,and brain.He had all favorable prognostic parameters except being a young adult.展开更多
基金Supported by State Administration of Traditional Chinese Medicine Base Construction Stomach Cancer Special Fund,No.Y2020CX57Jiangsu Provincial Graduate Research and Practical Innovation Program Project,No.SJCX23-0799.
文摘BACKGROUND Duodenal cancer is one of the most common subtypes of small intestinal cancer,and distant metastasis(DM)in this type of cancer still leads to poor prognosis.Although nomograms have recently been used in tumor areas,no studies have focused on the diagnostic and prognostic evaluation of DM in patients with primary duodenal cancer.AIM To develop and evaluate nomograms for predicting the risk of DM and person-alized prognosis in patients with duodenal cancer.METHODS Data on duodenal cancer patients diagnosed between 2010 and 2019 were extracted from the Surveillance,Epidemiology,and End Results database.Univariate and multivariate logistic regression analyses were used to identify independent risk factors for DM in patients with duodenal cancer,and univariate and multivariate Cox proportional hazards regression analyses were used to determine independent prognostic factors in duodenal cancer patients with DM.Two novel nomograms were established,and the results were evaluated by receiver operating characteristic(ROC)curves,calibration curves,and decision curve analysis(DCA).RESULTS A total of 2603 patients with duodenal cancer were included,of whom 457 cases(17.56%)had DM at the time of diagnosis.Logistic analysis revealed independent risk factors for DM in duodenal cancer patients,including gender,grade,tumor size,T stage,and N stage(P<0.05).Univariate and multivariate COX analyses further identified independent prognostic factors for duodenal cancer patients with DM,including age,histological type,T stage,tumor grade,tumor size,bone metastasis,chemotherapy,and surgery(P<0.05).The accuracy of the nomograms was validated in the training set,validation set,and expanded testing set using ROC curves,calibration curves,and DCA curves.The results of Kaplan-Meier survival curves(P<0.001)indicated that both nomograms accurately predicted the occurrence and prognosis of DM in patients with duodenal cancer.CONCLUSION The two nomograms are expected as effective tools for predicting DM risk in duodenal cancer patients and offering personalized prognosis predictions for those with DM,potentially enhancing clinical decision-making.
文摘BACKGROUND Development of distant metastasis(DM)is a major concern during treatment of nasopharyngeal carcinoma(NPC).However,studies have demonstrated im-proved distant control and survival in patients with advanced NPC with the addition of chemotherapy to concomitant chemoradiotherapy.Therefore,precise prediction of metastasis in patients with NPC is crucial.AIM To develop a predictive model for metastasis in NPC using detailed magnetic resonance imaging(MRI)reports.METHODS This retrospective study included 792 patients with non-distant metastatic NPC.A total of 469 imaging variables were obtained from detailed MRI reports.Data were stratified and randomly split into training(50%)and testing sets.Gradient boosting tree(GBT)models were built and used to select variables for predicting DM.A full model comprising all variables and a reduced model with the top-five variables were built.Model performance was assessed by area under the curve(AUC).RESULTS Among the 792 patients,94 developed DM during follow-up.The number of metastatic cervical nodes(30.9%),tumor invasion in the posterior half of the nasal cavity(9.7%),two sides of the pharyngeal recess(6.2%),tubal torus(3.3%),and single side of the parapharyngeal space(2.7%)were the top-five contributors for predicting DM,based on their relative importance in GBT models.The testing AUC of the full model was 0.75(95%confidence interval[CI]:0.69-0.82).The testing AUC of the reduced model was 0.75(95%CI:0.68-0.82).For the whole dataset,the full(AUC=0.76,95%CI:0.72-0.82)and reduced models(AUC=0.76,95%CI:0.71-0.81)outperformed the tumor node-staging system(AUC=0.67,95%CI:0.61-0.73).CONCLUSION The GBT model outperformed the tumor node-staging system in predicting metastasis in NPC.The number of metastatic cervical nodes was identified as the principal contributing variable.
文摘BACKGROUND Rectal cancer(RC)patient stratification by different factors may yield variable results.Therefore,more efficient prognostic biomarkers are needed for improved risk stratification,personalized treatment,and prognostication of RC patients.AIM To build a novel model for predicting the presence of distant metastases and 3-year overall survival(OS)in RC patients.METHODS This was a retrospective analysis of 148 patients(76 males and 72 females)with RC treated with curative resection,without neoadjuvant or postoperative chemoradiotherapy,between October 2012 and December 2015.These patients were allocated to a training or validation set,with a ratio of 7:3.Radiomic features were extracted from portal venous phase computed tomography(CT)images of RC.The least absolute shrinkage and selection operator regression analysis was used for feature selection.Multivariate logistic regression analysis was used to develop the radiomics signature(Rad-score)and the clinicoradiologic risk model(the combined model).Receiver operating characteristic curves were constructed to evaluate the diagnostic performance of the models for predicting distant metastasis of RC.The association of the combined model with 3-year OS was investigated by Kaplan-Meier survival analysis.RESULTS A total of 51(34.5%)patients had distant metastases,while 26(17.6%)patients died,and 122(82.4%)patients lived at least 3 years post-surgery.The values of both the Rad-score(consisted of three selected features)and the combined model were significantly different between the distant metastasis group and the nonmetastasis group(0.46±0.21 vs 0.32±0.24 for the Rad-score,and 0.60±0.23 vs 0.28±0.26 for the combined model;P<0.001 for both models).Predictors contained in the combined model included the Rad-score,pathological N-stage,and T-stage.The addition of histologic grade to the model failed to show incremental prognostic value.The combined model showed good discrimination,with areas under the curve of 0.842 and 0.802 for the training set and validation set,respectively.For the survival analysis,the combined model was associated with an improved OS in the whole cohort and the respective subgroups.CONCLUSION This study presents a clinicoradiologic risk model,visualized in a nomogram,that can be used to facilitate individualized prediction of distant metastasis and 3-year OS in patients with RC.
文摘BACKGROUND Distant relapse is the leading cause of cancer-related death in locally advanced rectal cancer.Neoadjuvant chemoradiation(NACRT)followed by surgery inevitably delays delivery of systemic treatment.Some patients show early distant metastasis before systemic treatment.AIM To identify the most effective treatments.We investigated prognostic factors for distant metastasis,especially early distant metastasis,using the standard treatment paradigm to identify the most effective treatments according to recurrence risk.METHODS From January 2015 through December 2019,rectal cancer patients who underwent NACRT for having clinical T 3-4 or clinical N 1-2 disease according to the 8th American Joint Committee on Cancer staging system were included.Radiotherapy was delivered to the whole pelvis with concomitant chemotherapy.Patients received surgery 6-8 wk after completion of NACRT.Adjuvant chemotherapy was administered at the physician’s discretion.RESULTS A total of 127 patients received NACRT.Ninety-three patients(73.2%)underwent surgery.The R0 resection rate was 89.2%in all patients.Pathologic tumor and node downstaging rates were 41.9%and 76.3%.Half the patients(n=69)received adjuvant chemotherapy after surgery.The 3-year distant metastasis-free survival(DMFS)and overall survival(OS)rates were 81.7%and 83.5%.On univariate analyses,poorly differentiated tumors,>5 cm,involvement of mesorectal fascia(MRF),or presence of extramural involvement(EMVI)were associated with worse DMFS and OS.Five patients showed distant metastasis at their first evaluation after NACRT.Patients with early distant metastasis were more likely to have poorly differentiated tumor(P=0.025),tumors with involved MRF(P=0.002),and EMVI(P=0.012)than those who did not.CONCLUSION EMVI,the involvement of MRF,and poor histologic grade were associated with early distant metastasis.In order to control distant metastasis and improve treatment outcome,selective use of neoadjuvant treatment according to individualized risk factors is necessary.Future studies are required to determine effective treatment strategies for patients at high risk for distant metastasis.
文摘BACKGROUND Anaplastic thyroid carcinoma(ATC),also called undifferentiated thyroid cancer,is the least common but most aggressive and deadly thyroid gland malignancy of all thyroid cancers[1].It has poor prognosis,and is the leading cause of death from malignant thyroid tumors.The one-year survival rate is 20%,with a median overall survival(OS)of only 5 mo[2].The aim of this report is to provide our experience in the diagnosis and treatment of ATC.CASE SUMMARY A patient with a thyroid mass underwent surgical treatment after developing symptoms of hoarseness.The resected tumor was pathologically diagnosed as ATC.Imaging examination revealed organ and lymph node metastasis.After multiple cycles of chemotherapy and local radiotherapy,the metastases were not relieved and gradually increased in size and new metastases appeared.The patient immediately received immunotherapy combined with targeted therapy.During treatment,immune-related adverse reactions occurred,which were improved after symptomatic treatment,and tolerated by the patient.The OS of the patient was more than 30 mo after immunotherapy combined with targeted therapy.CONCLUSION For metastatic ATC,surgical treatment,radiotherapy and chemotherapy have no significant effect on remission of the disease.However,immunotherapy has made a breakthrough in the treatment of ATC。
基金The authors would like to thank all patients involved in this study.This work was funded by the National Natural Science Foundation of China(No.81572531).The funding source provided financial support for the study and did not have any other involvement in this study.
文摘The aims of this study were to determine the prog no stic value of primary tumor surgery and identify optimal can didates for such surgery among patients with semi noma and dista nt metastasis at diag no sis.We ide ntified 521 patients with seminoma and distant metastasis at diagnosis between 2004 and 2014 from the Surveillanee,Epidemiology,and End Results database.Among these patients,434 had undergone surgery,whereas 87 had not.The prognostic value of primary tumor surgery was assessed by Kaplan-Meier methods,log-rank analyses,and multivariate Cox's proportional hazards model.Survival curves and forest plots were also plotted.Survival analysis indicated that patients who underwent surgery had a better 5-year overall survival and cancer-specific survival tha n those who did not.Multivariate analyses dem on strated that primary tumor surgery is an in depende nt prog no stic factor for overall survival and cancer-specific survival,along with age at diagnosis,Mstage,and marital status.In addition,primary tumor surgery still had con siderable prog no stic value in the subgroup of patie nts with lymph node metastasis.Further,forest plots demonstrated that patie nts with Mia stage,N1 or N2-3 stage,and a youn ger age at diagnosis(<60 years)may ben efit from primary tumor surgery.In con elusion,our findings indicate that primary tumor surgery is correlated with improved survival in patients with seminoma and distant metastasis.Furthermore,primary tumor surgery is an independent prognostic indicator for patients with seminoma and distant metastasis.
文摘BACKGROUND The prognosis of many patients with distant metastatic hepatocellular carcinoma(HCC)improved after they survived for several months.Compared with tradi-tional survival analysis,conditional survival(CS)which takes into account changes in survival risk could be used to describe dynamic survival probabilities.AIM To evaluate CS of distant metastatic HCC patients.METHODS Patients diagnosed with distant metastatic HCC between 2010 and 2015 were extracted from the Surveillance,Epidemiology and End Results database.Univariate and multivariate Cox regression analysis were used to identify factors for overall survival(OS),while competing risk model was used to identify risk factors for cancer-specific survival(CSS).Six-month CS was used to calculate the probability of survival for an additional 6 mo at a specific time after initial diagnosis,and standardized difference(d)was used to evaluate the survival differences between subgroups.Nomograms were constructed to predict CS.Positiveα-fetoprotein expression,higher T stage(T3 and T4),N1 stage,non-primary site surgery,non-chemotherapy,non-radiotherapy,and lung metastasis were independent risk factors for actual OS and CSS through univariate and multivariate analysis.Actual survival rates decreased over time,while CS rates gradually increased.As for the 6-month CS,the survival difference caused by chemotherapy and radiotherapy gradually disappeared over time,and the survival difference caused by lung metastasis reversed.Moreover,the influence of age and gender on survival gradually appeared.Nomograms were fitted for patients who have lived for 2,4 and 6 mo to predict 6-month conditional OS and CSS,respectively.The area under the curve(AUC)of nomograms for conditional OS decreased as time passed,and the AUC for conditional CSS gradually increased.CONCLUSION CS for distant metastatic HCC patients substantially increased over time.With dynamic risk factors,nomograms constructed at a specific time could predict more accurate survival rates.
文摘BACKGROUND Despite an expanding number of studies on intraductal papillary neoplasm of the bile duct(IPNB),distant metastasis remains unexplained especially in cases of carcinoma in situ.In the present study,we report a rare and interesting case of IPNB without invasive components that later metastasized to lungs and brain.CASE SUMMARY A 69-year-old male was referred to our hospital due to suspected cholangiocarcinoma.Laboratory tests on admission reported a mild elevation of alkaline phosphatase,γ-glutamyl transpeptidase,and total bilirubin in serum.Endoscopic retrograde cholangiography revealed a filling defect in the common bile duct(CBD)extending to the left hepatic duct.Peroral cholangioscopy delineated a tumor in the CBD that had a papillary pattern.Multidetector computed tomography and magnetic resonance cholangiopancreatography detected partial blockage ot interlude in the CBD leading to cholestasis without evidence of metastasis.Therefore,a diagnosis of IPNB cT1N0M0 was established.Left hepatectomy with bile duct reconstruction was performed.Pathological examination confirmed an intraepithelial neoplasia pattern without an invasive component and an R0 resection achievement.The patient was monitored carefully by regular examinations.However,at 32 mo after the operation,a 26 mm tumor in the lungs and a 12 mm lesion in the brain were detected following a suspicious elevated CA 19-9 level.Video-assisted thoracoscopic surgery of left upper lobectomy and stereotactic radiotherapy are indicated.In addition to histopathological results,a genomic profiling analysis using whole exome sequencing subsequently confirmed lung metastasis originating from bile duct cancer.CONCLUSION This case highlights the important role of genomic profiling analysis using whole exome sequencing in identifying the origin of metastasis in patients with IPNB.
基金co-first authors:Zeng-Feng Hanco-first authors/Corresponding to:Bin-Xu Sun,Department of Oncology,The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion.No.88 Changling Road,Xiqing District,Tianjin 300381,China.E-mail:sunbinxu@126.comCorresponding to:Shan-Qi Guo,Department of Oncology,The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion.No.88 Changling Road,Xiqing District,Tianjin 300381,China.E-mail:15022476737@163.com.
文摘Retrospective analysis of the progression of a case of metastatic castration-resistant prostate cancer with neuroendocrine differentiation:the patient was a 65 year old man with prostate adenocarcinoma on prostate biopsy,Gleason 4+4 score=8,70%,ISUP4 group,localized invasion of nerves.Progressed to metastatic castration-resistant prostate cancer after 8 months of novel endocrine therapy,persistent elevated PSA after endocrine therapy,chemotherapy,and radiation,abdominal metastasis,brain metastasis,gastric metastasis,and staging as neuroendocrine differentiation after second prostate biopsy,which is a highly malignant subtype and has been concerned as a mechanism of resistance to targeted therapies.We discuss how to choose a more optimal treatment plan and outline the patient's diagnostic and therapeutic course.We provide a reflection for the clinical study of metastatic castration-resistant prostate cancer with neuroendocrine type.
基金National Key R&D Program of China,No.2019YFB1309704。
文摘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.
基金the institutional review board of our hospital(2020KY018-KS001).
文摘BACKGROUND Multiple primary malignancies(MPM)are characterized by two or more primary malignancies in the same patient,excluding relapse or metastasis of prior cancer.We aimed to elucidate the clinical features and survival of MPM patients.AIM To elucidate the clinical features and survival of MPM patients.METHODS A retrospective study of MPM patients was conducted in our hospital between June 2016 and June 2019.Overall survival(OS)was calculated using the Kaplan-Meier method.The log-rank test was used to compare the survival of different groups.RESULTS A total of 243 MPM patients were enrolled,including 222 patients with two malignancies and 21 patients with three malignancies.Of patients with two malignancies,51(23.0%)had synchronous MPM,and 171(77.7%)had metachronous MPM.The most common first cancers were breast cancer(33,14.9%)and colorectal cancer(31,14.0%).The most common second cancers were non-small cell lung cancer(NSCLC)(66,29.7%)and gastric cancer(24,10.8%).There was no survival difference between synchronous and metachronous MPM patients(36.4 vs 35.3 mo,P=0.809).Patients aged>65 years at diagnosis of the second cancer had a shorter survival than patients≤65 years(28.4 vs 36.4 mo,P=0.038).Patients with distant metastasis had worse survival than patients without metastasis(20.4 vs 86.9 mo,P=0.000).Following multivariate analyses,age>65 years and distant metastasis were independent adverse prognostic factors for OS.CONCLUSION During follow-up of a first cancer,the occurrence of a second or more cancers should receive greater attention,especially for common concomitant MPM,to ensure early detection and treatment of the subsequent cancer.
基金Supported by the Joint Funds of the Zhejiang Provincial Natural Science Foundation of China,No.LBY21H030001the Science and Technology Planning Project of Zhejiang Province,No.2020KY708.
文摘BACKGROUND Papillary thyroid carcinoma(PTC)is the most common endocrine malignancy.Papillary thyroid microcarcinoma(PTMC)accounts for the majority of PTC cases.However,concurrent pulmonary and hepatic metastases of PTMC are rarely seen.Here,we present a patient with coexisting liver and lung metastases from PTMC.CASE SUMMARY We describe a 26-year-old woman with PTMC with multiple concurrent metastases.After 3 d of unexplained fever,she was admitted to our hospital.Her thyroid functional tests were abnormal.Her positron emission tomography(PET)/magnetic resonance imaging(MRI)examination showed increased fluorodeoxyglucose(FDG)metabolism and space-occupying lesions in the left lobe of the thyroid.Additionally,PET/MRI images revealed multiple nodules in the lung and liver with increased FDG metabolism.Chest computer tomography(CT)showed multiple pulmonary metastases.Abdominal ultrasound and liver MRI showed multiple space-occupying lesions in the liver.The patient underwent total thyroidectomy and central lymph node dissection.Postoperative pathological analysis showed a papillary microcarcinoma multiplex in the left lobe of the thyroid.A diagnosis of hepatopulmonary metastases from papillary thyroid microcarcinoma was made.The patient was given iodine-131 treatment one year after the surgery.She recovered well after the operation,and the incision healed well.After discharge,she was treated with oral levothyroxine sodium tablets,and symptomatic and supportive treatments were also given to promote radioactive excretion and prevent bone marrow suppression by iodine-131 treatment.CONCLUSION Since patients with thyroid cancer concurrent with hepatopulmonary metastases have rarely been reported,our case will highlight the clinical and pathological profiles of these patients.
基金supported by the Science and Technology Planning Project of Guangdong Province, China (Grant No. 2017A020215157)
文摘Objective: Stage N2-3 nasopharyngeal carcinoma(NPC) shows a high risk of distant metastasis, which will finally cause death. This study aimed to evaluate the impact of neoadjuvant chemotherapy(NACT) of various cycles before radical radiotherapy on distant metastasis and survival of patients with stage N2-3 diseases.Methods: In this study, a total of 1,164 consecutive patients with non-metastatic N2-3 NPC were recruited and prospectively observed. Then 231 patients who received NACT of 4 cycles(NACT=4 group) were matched 1:2:1 to 462 patients treated with NACT of 2 cycles(NACT=2 group) and 231 patients treated without NACT(NACT=0 group), according to age, histological subtype, N stage and NACT regimen. Five candidate variables(sex, T stage, concurrent chemotherapy, intensity-modulated radiation therapy and cycle number of NACT) were analyzed for their association with patients' survival.Results: After matching, the overall survival(OS), disease-free survival(DFS), local-recurrence-free survival(RFS) and distant-metastasis-free survival(MFS) of the NACT=4 group(89.2%, 81.0%, 83.3% and 84.8%,respectively) were better than those of the NACT=2 group(83.3%, 72.5%, 81.2% and 77.9%, respectively) and the NACT=0 group(74.0%, 63.2%, 74.0% and 68.8%, respectively). In multivariate analysis, the cycle number of NACT maintained statistical significance on the OS, DFS, RFS and MFS(all P〈0.05).Conclusions: For N2-3 NPC, cycle number of NACT appeared to be an independent factor associated with an improvement of survival.
文摘Localized malignant pleural mesothelioma (LMPM) is a rare occurrence, and gastrointestinal intra-luminal metastases have not previously been reported. Herein, we report a patient with LMPM who presented with a local recurrence 10 mo after initial en bloc surgical resection. Abdominal computed tomography was performed for intractable, vague abdominal pain with episodic vomiting, which showed a "target sign" over the left lower quadrant. Laparotomy revealed several intra-luminal metastatic tumors in the small intestine and colon and a segmental resection of metastatic lesions was performed. Unfortunately, the patient died of sepsis despite successful surgical intervention. Though local recurrence is more frequent in LMPM, the possibility of distant metastasis should not be ignored in patients with non-specifi c abdominal pain.
基金Supported by Beijing Municipal Administration of Hospitals Incubating Program,No.PZ2020027Beijing Talent Incubating Funding,No.2019-4.
文摘BACKGROUND The role of HER2 overexpression in rectal cancer is controversial.AIM To assess the role of HER2 overexpression in the long-term prognosis of rectal cancer.METHODS Data from patients with locally advanced rectal cancer who underwent total mesorectal excision after short-course radiotherapy at Beijing Cancer Hospital between May 2002 and October 2005 were collected.A total of 151 tissue samples of rectal cancer were obtained using rigid proctoscopy before neoadjuvant radiotherapy,followed by immunohistochemistry and fluorescence in situ hybridisation to determine the patients’HER2 expression status.Univariate and multivariate analyses of the associations between the clinicopathological factors and HER2 status were performed.Survival was estimated and compared using the Kaplan-Meier method based on HER2 expression status,and the differences between groups were verified using the log-rank test.RESULTS A total of 151 patients were enrolled in this study.A total of 27(17.9%)patients were ultimately confirmed to be HER2-positive.The follow-up duration ranged from 9 mo to 210 mo,with a median of 134 mo.Distant metastasis and local recurrence occurred in 60(39.7%)and 24(15.9%)patients,respectively.HER2 positivity was significantly associated with the pre-treatment lymph node stage(pre-N)(P=0.040),while there were no differences between HER2 status and age,sex,preoperative CEA levels(pre-CEA),T stage,and lympho-vascular invasion.In terms of prognosis,HER2 overexpression was correlated with distant meta stasis(P=0.002)rather than local recurrence(P>0.05).The multivariate analysis demonstrated that elevated pre-CEA[P=0.002,odds ratio(OR)=3.277,97.5%confidence interval(CI):1.543-7.163],post N(+)(P=0.022,OR=2.437,97.5%CI:1.143-5.308)and HER2(+)(P=0.003,OR=4.222,97.5%CI:1.667-11.409)were risk factors for distant metastasis.The survival analysis showed that there were significant differences between rectal cancer patients in terms of disease-free survival(DFS)[hazard ratio:1.69(95%CI:0.91-3.14);P=0.048]and overall survival(OS)[1.95(1.05-3.63);P=0.0077].CONCLUSION HER2 overexpression is a potential biomarker for predicting lymph node metastasis and distant metastasis,which are associated with worse long-term DFS and OS in rectal cancer patients with locally advanced disease.
文摘BACKGROUND Surgical resection is regarded as the only potentially curative treatment option for patients with metastatic colorectal cancer(CRC).The National Comprehensive Cancer Network clinical practice guidelines do not recommend palliative surgery unless there is a risk of severe symptoms.However,accumulating evidence has shown that palliative surgery is associated with more favorable outcomes for patients with metastatic CRC.AIM To investigate the separate role of palliative primary tumor resection for patients with stage IVA(M1a diseases)and stage IVB(M1b diseases)colorectal adenocarcinoma(CRA).METHODS CRA patients diagnosed from 2010 to 2015 with definite M1a and M1b categories according to the 8th edition of American Joint Committee on Cancer staging system were selected from the Surveillance Epidemiology and End Results(SEER)database.To minimize potential selection bias,the data were adjusted by propensity score matching(PSM).Baseline characteristics,including gender,year of diagnosis,age,marital status,primary site,surgical information,race,grade,chemotherapy,and radiotherapy,were recorded and analyzed.Univariate and multivariate analyses were performed to explore the separate role of palliative surgery for patients with M1a and M1b diseases.RESULTS A total of 19680 patients with metastatic CRA were collected from the SEER database,including 10399 cases of M1a diseases and 9281 cases of M1b diseases.Common independent prognostic factors for both M1a and M1b patients included year of diagnosis,age,race,marital status,primary site,grade,surgery,and chemotherapy.After PSM adjustment,3732 and 3568 matched patients in the M1a and M1b groups were included,respectively.Patients receiving palliative primary tumor resection had longer survival time than those without surgery(P<0.001).For patients with M1a diseases,palliative resection could increase the median survival time by 9 mo;for patients with M1b diseases,palliative resection could prolong the median survival time by 7 mo.For M1a diseases,patients with lung metastasis had more clinical benefit from palliative resection than those with liver metastasis(15 mo for lung metastasis vs 8 mo for liver metastasis,P<0.001).CONCLUSION CRA patients with M1a diseases gain more clinical benefits from palliative primary tumor resection than those with M1b diseases.Those patients with M1a(lung metastasis)have superior long-term outcomes after palliative primary tumor resection.
文摘<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> In India approximately 20% of the patients with breast cancer are triple receptor negative. Owing to the aggressive nature and shorter disease-free survival judicious follow up and identification of failure pattern will benefit the patient. Similar studies have been conducted among non-Hispanic population and in China. This study aims to identify failure pattern in radically treated breast cancer patients who are triple receptor negative among Indian population. </span><b><span style="font-family:Verdana;">Methods</span></b><span style="font-family:Verdana;">: This prospective observational study was conducted in the Department of Radiation Oncology, a tertiary cancer centre in Kerala, India. The objective was to record the pattern of recurrence among triple negative breast cancer patients who completed their planned radical treatment. 171 patients with triple negative breast cancer were included in the study. Patients who completed the planned radical treatment were kept under regular follow up. Details of clinical examination and investigations during the follow up were recorded periodically. </span><b><span style="font-family:Verdana;">Results</span></b><span style="font-family:Verdana;">: Out of 171 patients 30 patients had </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">a </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">recurrence of disease. Median age of the population was 53 years. Among the 30 patients who had </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">a </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">recurrence, 16 patients (53%) had systemic relapse and 14 patients (47%) had locoregional relapse. Lung was found to be the most common site of distant metastasis (37%). Ipsilateral chest wall was found to be the most common site of locoregional relapse (50%). 6 months disease free survival was found to be 91.8%</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">and 1-year disease free survival was found to be 70.2%. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: Among radically treated triple negative breast cancers relapses, systemic recurrence was more than locoregional recurrences.</span></span></span></span>
基金supported by grants from the Chinese International Cooperation Project(No.2012DFA31560)Key Laboratory Projects of Xinjiang Uygur Autonomous Region(No.2015KL021)the Achievement Promotion Projects of the Autonomous Region(No.201554142)
文摘Epidemiological studies have shown that human leukocyte antigen(HLA) allelic polymorphisms are closely correlated to susceptibility to nasopharyngeal carcinoma(NPC), and in a previous study, we showed that HLA-B*46 and HLA-A*02-B*46 haplotypes were strongly associated with NPC susceptibility. In this retrospective study, we investigated the phenotype of the HLA-A and HLA-B alleles and haplotypes and correlated these data to the clinical and pathological parameters of NPC to understand the role of HLA alleles and haplotypes in NPC prognosis. The cohort comprised 117 NPC patients from a Han population in Xinjiang. The local recurrence-free survival(LRFS), distant metastasis-free survival(DMFS), disease-free survival(DFS), and overall survival(OS) were analyzed. The 5-year DMFS of the HLA-A*02-B*46 haplotype carriers and non-carriers was 66.4% and 90.3%, respectively. In addition, age was found to be a prognostic factor for LRFS, DFS, and OS(P=0.032, 0.040, and 0.013, respectively). We found that the HLA-A*02-B*46 haplotype might be a prognostic marker in addition to the traditional TNM staging in patients with NPC.
文摘Pulmonary and liver metastases are common sites of distant metastasis from the rectal carcinoma.Metastases to the head and neck region are uncommon from carcinoma of the rectum,and orbital metastases are extremely rare.Here,we describe a 27-year-old female,who was diagnosed as a case of anorectal carcinoma in April 2010.She underwent abdominoperineal resection followed by concurrent chemoradiotherapy and adjuvant chemotherapy with 5 fl uorouracil and leucovorin on follow-up.In January 2012,she presented with gradually increasing swelling over the left temporal region and left sided proptosis.Fine-needle aspiration and a cell block were performed.Metastasis was confi rmed histologically.Palliative radiotherapy to the left orbit at the dose of 3 Gy per fraction 10 fractions to a total dose of 30 Gy was given by cobalt-60.In patients with a history of rectal carcinoma,recent onset proptosis with temporal swelling,although rare,should raise suspicion of metastatic deposit.
文摘Early stage carcinoma of the tonsil is curable,and the incidence of systemic metastasis is very low and central nervous system involvement is very rare.A patient diagnosed with early stage tonsillar carcinoma treated with chemoradiation was followed by brachytherapy boost.One and half years after completion of treatment,the patient presented with disseminated metastasis to the skin,lung,liver,bone,and brain.He had all favorable prognostic parameters except being a young adult.