Systematic review of prognostic importance of extramuralvenous invasion in rectal cancer

AIM: To systematically review the survival outcomes relating to extramural venous invasion in rectal cancer.METHODS: A systematic review was conducted using PRISMA guidelines. An electronic search was carried out using MEDLINE, EMBASE, CINAHL, Cochrane library databases, Google scholar and Pub Med until October 2014. Search terms were used in combination to yield articles on extramural venous invasion in rectal cancer. Outcome measures included prevalence and 5-year survival rates. These were graphically displayed using Forest plots. Statistical analysis of the data was carried out.RESULTS: Fourteen studies reported the prevalence of extramural venous invasion(EMVI) positive patients. Prevalence ranged from 9%-61%. The pooled prevalence of EMVI positivity was 26% [Random effects: Event rate 0.26(0.18, 0.36)]. Most studies showed that EMVI related to worse oncological outcomes. The pooled overall survival was 39.5% [Random effects: Event rate 0.395(0.29, 0.51)].CONCLUSION: Historically, there has been huge variation in the prevalence of EMVI through inconsistent reporting. However the presence of EMVI clearly leads to worse survival outcomes. As detection rates become more consistent, EMVI may be considered as part of risk-stratification in rectal cancer. Standardised histopathological definitions and the use of magnetic resonance imaging to identify EMVI will improve detection rates in the future.

Prognostic significance of computed tomography-detected extramural vascular invasion in colon cancer

AIM: To compare disease-free survival(DFS) between extramural vascular invasion(EMVI)-positive and-negative colon cancer patients evaluated by computed tomography(CT).METHODS: Colon cancer patients(n = 194) undergoing curative surgery between January 2009 and December 2013 were included. Each patient's demographics, cancer characteristics, EMVI status, pathological status and survival outcomes were recorded. All included patients had been routinely monitored until December 2015. EMVI was defined as tumor tissue within adjacent vessels beyond the colon wall as seen on enhanced CT. Disease recurrence was defined as metachronous metastases, local recurrence, or death due to colon cancer. Kaplan-Meier analyses were used to compare DFS between the EMVI-positive and-negative groups. Cox's proportional hazards models were used to measure the impact of confounding variables on survival rates.RESULTS: EMVI was observed on CT(ct EMVI) in 60 patients(30.9%, 60/194). One year after surgery, there was no statistically significant difference regarding the rates of progressive events between EMVI-positive and-negative patients [11.7%(7/60) and 6.7%(9/134), respectively; P = 0.266]. At the study endpoint, the EMVI-positive patients had significantly more progressive events than the EMVI-negative patients [43.3%(26/60) and 14.9%(20/134), respectively; oddsratio = 4.4, P < 0.001]. Based on the Kaplan-Meier method, the cumulative 1-year DFS rates were 86.7%(95%CI: 82.3-91.1) and 92.4%(95%CI: 90.1-94.7) for EMVI-positive and EMVI-negative patients, respectively. The cumulative 3-year DFS rates were 49.5%(95%CI: 42.1-56.9) and 85.8%(95%CI: 82.6-89.0), respectively. Cox proportional hazards regression analysis revealed that ctE MVI was an independent predictor of DFS with a hazard ratio of 2.15(95%CI: 1.12-4.14, P = 0.023). CONCLUSION: ctE MVI may be helpful when evaluating disease progression in colon cancer patients.

Combination of three-gene immunohistochemical panel and magnetic resonance imaging-detected extramural vascular invasion to assess prognosis in non-advanced rectal cancer patients

AIM To identify a small, clinically applicable immunohistochemistry(IHC) panel that could be combined with magnetic resonance imaging(MRI)-detected extramural vascular invasion(EMVI) for assessment of prognosis concerning the non-advanced rectal cancer patients prior to operation.METHODS About 329 patients with pathologically confirmed rectal carcinoma(RC) were screened in this research, all of whom had been examined via an MRI and were treatment-na?ve from July 2011 to July 2014. The candidate proteins that were reported to be altered by RC were examined in tissues by IHC. All chosen samples were adopted from the fundamental cores of histopathologically confirmed carcinomas during the initial surgeries.RESULTS Of the three proteins that were tested, c-MYC, PCNA and TIMP1 were detected with relatively significant expression in tumors, 35.9%, 23.7% and 58.7% respectively. The expression of the three proteins were closely connected with prognosis(P = 0.032, 0.003, 0.021). The patients could be classified into different outcome groups according to an IHC panel(P < 0.01) via these three proteins. Taking into consideration known survival covariates, especially EMVI, the IHC panel served as an independent prognostic factor. The EMVI combined with the IHC panel could categorize patients into different prognostic groups with distinction(P < 0.01).CONCLUSION These studies argue that this three-protein panel of c-MYC, PCNA, coupled with TIMP1 combined with MRIdetected EMVI could offer extra prognostic details for preoperative treatment of RC.

Principles of extramural hl ealth care for chronic wounds in China

Development of extramural health care for chronic wounds is still in its infancy in China,and thus it is urgent and vital to establish a correct concept and practicable principles.The authors reviewed recent domestic and international literature and summarized the following treatment procedures and principles for extramural health care of chronic wounds.(1)The patient needs to do self-assessment of the wound by using available simple methods;(2)The patient consults with professional physicians or nurses on wound care to define the severity and etiology of the non-healing wound;(3)Professionals evaluate the existing treatment strategies;(4)Etiological treatments are given by professionals;(5)Patients buy needed dressings via the more convenient ways from pharmacies,e-commerce platform or others;(6)Professionals provide a standardized and reasonable therapeutic plan based on the patient's wound conditions;(7)Both professionals and the patient pay attention to complications to prevent adverse outcomes;(8)Professionals strengthen the public education on wound care and integrated rehabilitation.This review expected to provide new perspectives on the therapeutic strategies for chronic wounds in an extramural setting.

Predictive factors for early distant metastasis after neoadjuvant chemoradiotherapy in locally advanced rectal cancer

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.