Retrospective cohort study on the postoperative survival rate enhancement of patients with colorectal cancer using three traditional Chinese medicine formulations:evidence from 1,361 cases

Background:Prior studies have affirmed the safety and effectiveness of traditional Chinese medicine in treating colorectal cancer patients.However,definitive evidence regarding whether traditional Chinese medicine can significantly enhance the survival of colorectal cancer patients remains elusive.This study seeks to provide conclusive insights by examining the postoperative administration of Xihuang capsules,Pingxiao capsules,and Zilongjin tablets and its impact on the 5-year overall survival(OS)and disease-free survival(DFS)rates among colorectal cancer patients.Methods:A retrospective study was conducted,involving 1,361 patients selected from the medical center.This retrospective study was carried out at a medical center in Tianjin,China.We assessed differences in postoperative OS and DFS between the control group and the medication group using Kaplan–Meier survival analysis and Cox proportional hazards modeling.Additionally,propensity score matching was used to mitigate imbalances in baseline characteristics among patients.Results:Before propensity score matching,Xihuang capsules could prolong the 5-year OS(79.9%vs.81.4%,P=0.0480)and 5-year DFS(74.9%vs.79.5%,P=0.0046)of patients after surgery.Similar conclusions were obtained after propensity score matching:OS(74.8%vs.78.3%,P=0.0084),DFS(72.7%vs.78.9%,P=0.008).Patients taking Pingxiao capsules showed improved 5-year OS(77.2%vs.84.0%,P=0.0383)and 5-year DFS(69.9%vs.80.0%,P=0.0157)after propensity score matching.Patients taking Zilongjin tablets showed improvement in the 2-year OS(84.2%vs.93.1%,P=0.0390)and 1-year DFS(88.2%vs.92.0%,P=0.0320)after propensity score matching.Conclusion:Xihuang capsules and Pingxiao capsules significantly improved the 5-year OS and DFS of patients with colorectal cancer after surgery.Zilongjin tablets showed improvement in the 2-year OS and 1-year DFS after surgery for patients.

Pattern of colorectal surgery and long-term survival:10-year experience from a single center

BACKGROUND The incidence of colorectal cancer(CRC)has increased in recent decades,and ranks fourth among males and third among females in China.Surgical resection remains the most important treatment modality for curative intent in CRC.Several studies found that surgeon volumes and specialization appeared to be associated with improved overall survival(OS).Moreover,numerous reports have suggested that specialization and minimally invasive surgery have gained increased popularity in CRC surgery.However,few studies have specifically examined the role and long-term survival of all stage CRC in a real-world study.AIM To evaluate the effect of surgeon specialization on survival changes and minimally invasive surgery utilization in a real world study.METHODS A retrospective analysis on the association between surgeon specialization and OS between 2008 and 2013 in Zhongshan Hospital CRC database was performed.Standard demographic,clinicopathologic,surgical and follow-up data were obtained from the CRC database.Surgeon specialty was categorized as colorectal surgeon(CS)and general surgeon(GS).CRC patients who underwent primary surgical resection were enrolled.RESULTS A total of 5141 CRC patients who underwent primary surgical resection between 2008 and 2013 were evaluated,1748(34.0%)of these by CS.The percentage of minimally invasive procedures in the CS group showed an increasing trend.There was no benefit associated with surgeon specialization for stage I,II and IV patients.Surgeon specialization exhibited a significant association with OS solely among stage III patients,with 5-year OS rates of 76%and 67%for the CS and GSgroups,respectively(P<0.01).Further analyses found that surgeon specialization was significantly associated with survival only in stage III rectal patients,and the 5-year OS rate in the CS group and GS group was 80%and 67%,respectively(P<0.01).CONCLUSION Surgeon specialization is associated with improved OS after primary surgery in stage III rectal patients.An appropriate surgical technique,perioperative program and adjuvant therapy may contribute to survival benefit in these patients.

Nomograms predicting long-term survival in patients with invasive intraductal papillary mucinous neoplasms of the pancreas: A population-based study

BACKGROUND There are few effective tools to predict survival in patients with invasive intraductal papillary mucinous neoplasms of the pancreas.AIM To develop comprehensive nomograms to individually estimate the survival outcome of patients with invasive intraductal papillary mucinous neoplasms of the pancreas.METHODS Data of 1219 patients with invasive intraductal papillary mucinous neoplasms after resection were extracted from the Surveillance,Epidemiology,and End Results database,and randomly divided into the training(n=853)and the validation(n=366)cohorts.Based on the Cox regression model,nomograms were constructed to predict overall survival and cancer-specific survival for an individual patient.The performance of the nomograms was measured according to discrimination,calibration,and clinical utility.Moreover,we compared the predictive accuracy of the nomograms with that of the traditional staging system.RESULTS In the training cohort,age,marital status,histological type,T stage,N stage,M stage,and chemotherapy were selected to construct nomograms.Compared with the American Joint Committee on Cancer 7th staging system,the nomograms were generally more discriminative.The nomograms passed the calibration steps by showing high consistency between actual probability and nomogram prediction.Categorial net classification improvements and integrated discrimination improvements suggested that the predictive accuracy of the nomograms exceeded that of the American Joint Committee on Cancer staging system.With respect to decision curve analyses,the nomograms exhibited more preferable net benefit gains than the staging system across a wide range of threshold probabilities.CONCLUSION The nomograms show improved predictive accuracy,discrimination capability,and clinical utility,which can be used as reliable tools for risk classification and treatment recommendations.

The effect of long-term traditional Chinese medicine treatment on disease-free survival of postoperative stage I-III lung cancer patients:a retrospective cohort study

Objective:Traditional Chinese medicine(TCM)has been extensively used as one of popular alternative therapies for several cancers.However,it remains unclear whether TCM treatment is associated with longer survival in lung cancer patients.In this study,we explored the effect of long-term TCM treatment on patients with different stages of lung cancer.Methods:All information of lung cancer patients with stage I-III disease from January 2007 to September 2015 was collected for this retrospective cohort study.Those who were treated with TCM after surgery were divided into TCM group and the others were into the non-TCM group(control group).All patients were regularly followed up by clinic appointment or phone,and all survival data were collected from databases after the last follow-up in October 2017.Results:A total of 575 patients were included in this study,with 299 patients in the TCM group and 276 in the control group.For all patients,5-year disease-free survival(DFS)was 62.2% in TCM group and 42.1% in the control group,and 6-year DFSs were 51.8% and 35.4%,respectively(HR=0.51,95% CI:0.40 to 0.66,log-rank P≤0.001).For patients with stage I,5-year DFSs were 83.7%(TCM group)and 57.5%(control group)and 6-year DFSs were 73.7% and 51.9%,respectively(HR=0.30,95% CI:0.18 to 0.50,log-rank P≤0.001).For patients with stage II in the TCM group and the control group,5-year DFSs were 59.4% and 17.6% and 6-year DFSs were 44.7% and 17.6%,respectively(HR=0.31,95% CI:0.19 to 0.52,log-rank P≤0.001),and for patients with stage III,5-year and 6-year DFSs in the TCM group were 18.7% and 12.5% compared with 28.4% and 20.3% in the control group(HR=1.06,95% CI:0.72 to 1.56,log-rank P=0.76).Conclusions:This study demonstrated that long-term TCM treatment as an adjuvant therapy is able to improve the DFS of postoperative stage I-III lung cancer patients,especially in patients with stage I and II disease.However,these observational findings need being validated by large sample randomized controlled trials.

Prognostic factors for disease-free survival in postoperative patients with hepatocellular carcinoma and construction of a nomogram model

BACKGROUND Hepatocellular carcinoma(HCC)is the most common type of liver cancer and has a high risk of invasion and metastasis along with a poor prognosis.AIM To investigate the independent predictive markers for disease-free survival(DFS)in patients with HCC and establish a trustworthy nomogram.METHODS In this study,445 patients who were hospitalized in The First Affiliated Hospital of Anhui Medical College between December 2009 and December 2014 were retrospectively examined.The survival curve was plotted using the Kaplan–Meier method and survival was determined using the log-rank test.To identify the prognostic variables,multivariate Cox regression analyses were carried out.To predict the DFS in patients with HCC,a nomogram was created.C-indices and receiver operator characteristic curves were used to evaluate the nomogram’s performance.Decision curve analysis(DCA)was used to evaluate the clinical application value of the nomogram.RESULTS Longer DFS was observed in patients with the following characteristics:elderly,I–II stage,and no history of hepatitis B.The calibration curve showed that this nomogram was reliable and had a higher area under the curve value than the tumor node metastasis(TNM)stage.Moreover,the DCA curve revealed that the nomogram had good clinical applicability in predicting 3-and 5-year DFS in HCC patients after surgery.CONCLUSION Age,TNM stage,and history of hepatitis B infection were independent factors for DFS in HCC patients,and a novel nomogram for DFS of HCC patients was created and validated.

Litter cover of the invasive tree <i>Melaleuca quinquenervia</i>influences seedling emergence and survival

Exotic tree Melaleuca quinquenervia (melaleuca) deposits large quantities of slowly decomposing litter biomass that accumulates over time and covers forest floors in its adventive habitats in Florida (USA). Herein, we assessed the influence of melaleuca litter cover, seed addition, and seeding date on seedling emergence and survival. The assessment was conducted by ma-nipulating litter cover and seed inputs of melaleuca and two native species at different dates in two soil types. Litter cover was either removed or left in place in organic and arenaceous soils within melaleuca stands. Each of the three treatment plots were seeded with melaleuca, wax myrtle or sawgrass, while the fourth plot was not seeded and served as the control. Seedlings were counted at 2-wk intervals to determine cumulative seedling emergence and survival during the experimental period. The experiment was repeated four times within a year. Soil type did not influence seedling emergence of all three species but influenced survival of wax myrtle. Litter removal increased the emergence of melaleuca, sawgrass, and wax myrtle and increased the survival of melaleuca. Seed addition increased the emergence and survival of sawgrass and wax myrtle but made no difference for melaleuca. Seeding during the periods of high soil moisture content had positive effects on the emergence and survival of melaleuca, wax myrtle, and sawgrass seedlings. These findings are deemed useful in planning active restoration for melaleuca invaded sites.

Deep learning-based multi-modal data integration enhancing breast cancer disease-free survival prediction

Background:The prognosis of breast cancer is often unfavorable,emphasizing the need for early metastasis risk detection and accurate treatment predictions.This study aimed to develop a novel multi-modal deep learning model using preoperative data to predict disease-free survival(DFS).Methods:We retrospectively collected pathology imaging,molecular and clinical data from The Cancer Genome Atlas and one independent institution in China.We developed a novel Deep Learning Clinical Medicine Based Pathological Gene Multi-modal(DeepClinMed-PGM)model for DFS prediction,integrating clinicopathological data with molecular insights.The patients included the training cohort(n=741),internal validation cohort(n=184),and external testing cohort(n=95).Result:Integrating multi-modal data into the DeepClinMed-PGM model significantly improved area under the receiver operating characteristic curve(AUC)values.In the training cohort,AUC values for 1-,3-,and 5-year DFS predictions increased to 0.979,0.957,and 0.871,while in the external testing cohort,the values reached 0.851,0.878,and 0.938 for 1-,2-,and 3-year DFS predictions,respectively.The DeepClinMed-PGM's robust discriminative capabilities were consistently evident across various cohorts,including the training cohort[hazard ratio(HR)0.027,95%confidence interval(CI)0.0016-0.046,P<0.0001],the internal validation cohort(HR 0.117,95%CI 0.041-0.334,P<0.0001),and the external cohort(HR 0.061,95%CI 0.017-0.218,P<0.0001).Additionally,the DeepClinMed-PGM model demonstrated C-index values of 0.925,0.823,and 0.864 within the three cohorts,respectively.Conclusion:This study introduces an approach to breast cancer prognosis,integrating imaging and molecular and clinical data for enhanced predictive accuracy,offering promise for personalized treatment strategies.

High level of preoperative carbohydrate antigen 19-9 is a poor survival predictor in gastric cancer

AIM:To assess the clinical significance and the prognostic value of preoperative serum carbohydrate antigen 19-9(CA 19-9)level in gastric cancer.METHODS:Between January 2005 and December2006,1960 patients underwent surgery for histologically confirmed gastric cancer.Of these,163 patients had elevated serum levels of CA 19-9 preoperatively,and1628 patients had normal serum levels of CA 19-9 preoperatively.For this study,325 patients were selected from the group of 1628 patients by age,sex,and cancer stage to serve as controls.Statistically significant differences in survival rates were calculated using the log-rank test.A P value less than 0.05 was considered statistically significant and was determined using SAS software.RESULTS:The baseline characteristics showed some differences between the two groups with regard to histology.Overall survival(OS)in the elevated and nonelevated group was 37.90 and 68.67 mo,respectively(P<0.001).N stage(P=0.001)was a significant predictor of disease-free survival by multivariate analysis.Also,N stage(P<0.001),and the presence of peritoneal metastasis(P<0.001)remained independent factors in predicting OS by multivariate analysis.Additionally,preoperative serum CA 19-9 levels were significantly associated with OS in univariate(P=0.009)and multivariate(P=0.021)analyses.CONCLUSION:Serum CA 19-9 can be considered an independent prognostic factor in predicting OS in patients anticipating surgery for gastric cancer.

Recurrence and survival after surgery for pancreatic cancer with or without acute pancreatitis

BACKGROUND In pancreatic cancer,acute pancreatitis(AP)is a serious morbidity,but its negative effect on long-term outcomes remains to be elucidated.AIM To investigate the effects of AP on the tumor recurrence pattern of pancreatic ductal adenocarcinoma(PDAC)and tumor-specific survival.METHODS The medical records of 219 patients with curative pancreatectomy for pancreatic cancer at the Pancreatic Surgery Center of West China Hospital from July 2012 to December 2016 were analyzed retrospectively.The severity of acute pancreatitis was classified according to the Atlanta classification of AP.The patient demographics and tumor characteristics were assessed.Early recurrence was defined as a relapse within 12 mo after surgery.Overall and disease-free survival and recurrence patterns were analyzed.Mild acute pancreatitis was excluded because its negative effects can be negligible.RESULTS Early recurrence in AP group was significantly higher than in non-AP group(71.4%vs 41.2%;P=0.009).Multivariate analysis of postoperative early recurrence showed that moderate or severe AP was an independent risk factor for an early recurrence[odds ratio(OR):4.13;95%confidence interval(CI):1.41-12.10;P=0.01].The median time to recurrence was shorter in patients with AP than in those without(8.4 vs 12.8 mo;P=0.003).Multivariate analysis identified AP as an independent prognostic factor for overall survival[relative risk(RR):2.35;95%CI:1.45-3.83]and disease-free survival(RR:2.24;95%CI:1.31-3.85)in patients with PDAC.CONCLUSION Patients with moderate or severe acute pancreatitis developed recurrences earlier than those without.Moderate or severe AP is associated with shorter overall and disease-free survival of patients with PDAC.

Lack of CD44 variant 6 expression in rectal cancer invasive front associates with early recurrence

AIM: To investigate the prognostic value of CD44 variant 6 (CD44v6), a membranous adhesion molecule, in rectal cancer. METHODS: Altogether, 210 rectal cancer samples from 214 patients treated with short-course radiotherapy (RT, n = 90), long-course (chemo) RT (n = 53) or surgery alone (n = 71) were studied with immunohistochemistry for CD44v6. The extent and intensity of membranous and cytoplasmic CD44v6 staining, and the intratumoral membranous staining pattern, were analyzed.RESULTS: Membranous CD44v6 expression was seen in 84% and cytoplasmic expression in 81% of the cases. In 59% of the tumors with membranous CD44v6 expression, the staining pattern in the invasive front was determined as "front-positive" and in 41% as "front-negative". The latter pattern was associated with narrower circumferential margin (P = 0.01), infiltrative growth pattern (P < 0.001), and shorter disease-free survival in univariate survival analysis (P = 0.022) when compared to the "front-positive" tumors. CONCLUSION: The lack of membranous CD44v6 in the rectal cancer invasive front could be used as a method to identify patients at increased risk for recurrent disease.

Breast Cancer Subtypes and Survival in Chinese Women with Operable Primary Breast Cancer

Objective： To investigate the associations between the different breast cancer subtypes and survival in Chinese women with operable primary breast cancer. Methods： A total of 1538 Chinese women with operable primary breast cancer were analyzed in this study, the median follow-up was 77 months. Estrogen receptor （ER）, progesterone receptor （PR）, and HER2 status were available for these patients. Results： Luminal A （ER＋ and/or PR＋, HER2-） had a favorable disease-free survival （DFS） and overall survival （OS） compared with other subtypes in the entire cohort. Using the luminal A as a reference, among the patients with lymph node positive disease, HER2＋ （ER-, PR-, HER2＋） had the worst DFS （hazard ratio, HR=1.80, 95% CI 1.11 to 2.91, P=0.017） and luminal B （ER＋ and/or PR＋, HER2＋） had the worst OS （HR=2.27, 95% CI 1.50 to 3.45, P0.001）; among the patients with lymph node negative disease, triple-negative （ER-, PR-, HER2-） had the worst DFS （HR=2.21, 95% CI 1.43 to 3.41, P0.001）, whereas no significant difference in DFS between HER2＋ and luminal B or luminal A was observed. Conclusion： As compared with luminal A, luminal B and HER2＋ have the worst survival in patients with lymph node positive disease, but this is not the case in patients with lymph node negative disease; triple-negative subtype has a worse survival in both lymph node positive and lymph node negative patients.

Grading severity of microscopic vascular invasion was independently associated with recurrence and survival following hepatectomy for solitary hepatocellular carcinoma

Background:Hepatectomy is the preferred treatment for solitary hepatocellular carcinoma(HCC)without macrovascular invasion and distant metastasis,but long-term survival remains unsatisfactory in certain patients.We sought to identify whether the grading severity of microscopic vascular invasion(MVI)was associated with recurrence and survival among patients with solitary HCC.Methods:Consecutive patients who underwent hepatectomy for solitary HCC were identified from a multicenter prospectively-collected database.Patients were categorized into three groups according to the MVI grading system proposed by the Liver Cancer Pathology Group of China:M0(no MVI),M1(1-5 sites of MVI occurring≤1.0 cm away from the tumor),and M2(>5 sites occurring≤1.0 cm or any site occurring>1 cm away from the tumor).Recurrence-free survival(RFS)and overall survival(OS)were compared among the groups.Results:Among 227 patients,97(42.7%),83(36.6%),and 47(20.7%)patients had M0,M1,and M2,respectively.Median RFS rates among patients with M0,M1,and M2 were 38.3,35.1,11.6 months,respectively,while OS rates were 66.8,62.3,30.6 months,respectively(both P<0.001).Multivariate Cox-regression analyses demonstrated that both M1 and M2 were independent risk factors for RFS(hazard ratio 1.20,95%CI:1.03-1.89,P=0.040;and hazard ratio 1.67,95%CI:1.06-2.64,P=0.027)and OS(hazard ratio 1.28,95%CI:1.05-2.07,P=0.035;and hazard ratio 1.97,95%CI:1.15-3.38,P=0.013).Conclusions:Grading severity of MVI was independently associated with RFS and OS after hepatectomy for solitary HCC.Enhanced surveillance for recurrence and potentially adjuvant therapy may be considered for patients with MVI,especially individuals with more severe MVI grading(M2).

Percutaneous radiofrequency ablation for early hepatocellular carcinoma: Risk factors for survival

AIM: To evaluate outcomes of radiofrequency ablation (RFA) therapy for early hepatocellular carcinoma (HCC) and identify survival- and recurrence-related factors.

Minimally invasive and open gallbladder cancer resections: 30-vs 90-day mortality

BACKGROUND:Minimally invasive surgery is increasingly used for gallbladder cancer resection.Postoperative mortality at 30 days is low,but 90-day mortality is underreported.METHODS:Using National Cancer Database(1998-2012),all resection patients were included.Thirty-and 90-day mortality rates were compared.RESULTS:A total of 36 067 patients were identified,19 139(53%) of whom underwent resection.Median age was 71 years and 70.7% were female.Ninety-day mortality following surgical resection was 2.3-fold higher than 30-mortality(17.1% vs 7.4%).There was a statistically significant increase in 30-and 90-day mortality with poorly differentiated tumors,presence of lymphovascular invasion,tumor stage,incomplete surgical resection and low-volume centers(P<0.001 for all).Even for the 1885 patients who underwent minimally invasive resection between 2010 and 2012,the 90-day mortality was 2.8-fold higher than the 30-day mortality(12.0% vs 4.3%).CONCLUSIONS:Ninety-day mortality following gallbladder cancer resection is significantly higher than 30-day mortality.Postoperative mortality is associated with tumor grade,lymphovascular invasion,tumor stage,type and completeness of surgical resection as well as type and volume of facility.

A comparison of survival and pathologic features of non-alcoholic steatohepatitis and hepatitis C virus patients with hepatocellular carcinoma

AIM： To compare the clinical outcome and pathologic features of non-alcoholic steatohepatitis （NASH） patients with hepatocellular carcinoma （HCC） and hepatitic C virus （HCV） patients with HCC （another group in which HCC is commonly seen） undergoing liver transplantation. METHODS： Patients transplanted for HCV and NASH at our institution from January 2000 to April 2011 were analyzed. All explanted liver histology and pre-trans- plant liver biopsies were examined by two specialist liver histopathologists. Patient demographics, disease free survival, explant liver characteristics and HCC features （tumour number, cumulative tumour size, vascular invasion and differentiation） were compared between HCV and NASH liver transplant recipients. RESULTS： A total of 102 patients with NA^SH and 283 patients with HCV were transplanted. The incidence of HCC in NASH transplant recipients was 16.7% （17/102）. The incidence of HCC in HCV transplant recipients was 22.6% （64/283）. Patients with NASH-HCC were statisti- cally older than HCV-HCC patients （P 〈 0.001）. A signif- icantly higher proportion of HCV-HCC patients had vas- cular invasion （23.4% vs 6.4%, P = 0.002） and poorly differentiated HCC （4.7% vs 0%, P 〈 0.001） compared to the NASH-HCC group. A trend of poorer recurrence free survival at 5 years was seen in HCV-HCC patients compared to NASH-HCC who underwent a Liver trans- plantation （P = 0.11）. CONCLUSION： Patients transplanted for NASH-HCC appear to have less aggressive turnout features com- pared to those with HCV-HCC, which likely in part ac- counts for their improved recurrence free survival.

Long-term survival outcome of laparoscopic liver resection for hepatocellular carcinoma

Long-term survival is the most important outcome measurement of a curative oncological treatment.For hepatocellular carcinoma(HCC),the long-term disease-free and overall survival of laparoscopic liver resection(LLR)is shown to be non-inferior to the current standard of open liver resection(OLR).Some studies have reported a superior long-term oncological outcome in LLR when compared to OLR.It has been argued that improvement of visualization and instrumentation and reduced operative blood loss and perioperative blood transfusion may contribute to reduced risk of postoperative tumor recurrence.On the other hand,since most of the comparative studies of the oncological outcomes of LLR and OLR for HCC are non-randomized,it remained inconclusive as to whether LLR confers additional survival benefit compared to OLR.Despite the paucity of level 1 evidence,the practice of LLR for HCC has gained wide-spread acceptance due to the reproducible improvements in the perioperative outcomes and non-inferior oncological outcomes demonstrated by large-scaled,matched comparative studies.Meta-analyses of the outcomes of these studies by multiple systematic reviews have also returned noncontradictory conclusions.On the basis of a theoretical advantage of LLR over OLR in preventing tumor recurrence,the current review aims to dissect from the current meta-analyses and comparative studies any evidence of such superiority.

Is there an optimal time to initiate adjuvant chemotherapy to predict benefit of survival in non-small cell lung cancer?

Objective: Adjuvant chemotherapy (AC) after curative resection is known to improve the survival of patients with non-small cell lung cancer (NSCLC); however, few studies have reported the correlation between the time to initiation of AC (TTAC) and survival in NSCLC patients. Methods: The clinical data of 925 NSCLC patients who received curative resection and post-operative AC at the Cancer Hospital of Chinese Academy of Medical Sciences between 2003 and 2013 were retrospectively analyzed. TTAC was measured from the date of surgery to the initiation of AC. Disease-free survival (DFS) was defined as the duration from surgery to the time of tumor recurrence or last follow-up evaluation. The optimal cut-off value of TTAC was determined by maximally selected log-rank statistics. The DFS curve was estimated using the Kaplan-Meier method, and the Cox proportional hazards regression model was used to identify risk factors independently associated with DFS. Propensity score matching (PSM) was performed for survival analysis using the match data. Results: The optimal discriminating cut-off value of TTAC was set at d 35 after curative resection based on which the patients were assigned into two groups: group A (<= 35 d) and group B (> 35 d). There was no significant difference in the DFS between the two groups (P=0.246), indicating that the TTAC is not an independent prognostic factor for DFS. A further comparison continued to show no significant difference in the DFS among 258 PSM pairs (P=0.283). Conclusions: There was no significant correlation between the TTAC and DFS in NSCLC patients. Studies with larger samples are needed to further verify this conclusion.

Efficacy of minimally invasive therapies on unresectable pancreatic cancer

For patients with unresectable pancreatic cancer, current chemotherapies have negligible survival benefits. Thus, developing effective minimally invasive therapies is currently underway. This study was conducted to evaluate the efficacy of transarterial chemoembolization plus radiofrequency ablation and/or 125 I radioactive seed implantation on unresectable pancreatic cancer. We analyzed the outcome of 71 patients with unresectable pancreatic carcinoma who underwent chemoembolization plus radiofrequency ablation and/or radioactive seed implantation. Of the 71 patients, the median survival was 11 months, and the 1-, 2-, and 3-year overall survival rates were 32.4%, 9.9%, and 6.6%, respectively. Patients who had no metastasis, who had oligonodular liver metastases (≤3 lesions), and who had multinodular liver metastases (>3 lesions) had median survival of 12, 18, and 8 months, respectively, and 1-year overall survival rates of 50.0%, 68.8% , and 5.7% , respectively. Although the survival of patients without liver metastases was worse than that of patients with oligonodular liver metastasis, the result was not significant (P = 0.239). In contrast, the metastasis-negative patients had significantly better survival than did patients with multinodular liver metastases (P<0.001). Patients with oligonodular liver lesions had a significanthg longer median survival than did patients with multinodular lesions (P<0.001). In conclusion, combined minimally invasive therapies had good efficacy on unresectable pancreatic cancer and resulted in a good control of liver metastases. In addition, the number of liver metastases was a significant factor in predicting prognosis and response to treatment.

Modified McKeown minimally invasive esophagectomy for esophageal cancer: A retrospective study of 376 patients at a single institution

Objective:Minimally invasive esophagectomy(MIE)was first implemented in 1992 and various MIEs have been performed subsequently.The modified McKeown MIE that includes thoracoscopic and laparoscopic procedures with left neck anastomosis has been implemented in our institution since 2006.We herein report our first 5-year experience in 376 consecutive patients undergone the modified McKeown MIE for esophageal cancer to evaluate perioperative outcomes and survival.Methods:A total of 376 patients underwent a modified McKeown MIE from March 2016 toMarch 2021 at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.Patient demographics and perioperative outcomes were collected and assessed,and overall survival and disease-free survival were analyzed.Results:All procedures were completed successfully with no conversions to open surgery.The median operative time was 240 min,and the median blood loss was 100 mL.The median number of harvested lymph nodes was 29,the median number of harvested thoracic lymph nodes was 18,and of harvested abdominal nodes was 10.The 30-day mortality rate was 0.27%and complications occurred in 133(35.4%)patients.The median follow-up period was 19(1-60)months,and 244 patients completed more than 1 year of follow-up.The 1-year overall survival and disease-free survival were 79.5%and 73.8%,respectively.Conclusion:The modified McKeown MIE is safe and feasible for esophageal cancer,offering satisfactory perioperative outcomes and acceptable oncologic survival.

Prognostic value of additional pathological variables for longterm survival after curative resection of rectal cancer

AIM： To evaluate the prognostic value of some pathological variables in rectal cancer survival. METHODS： 247 patients who underwent curative resection of rectal cancer were included in the study. The influence on survival of five pathological variables （histopathological tumor type, histopathological tumor grade differentiation, blood vessel invasion, perineural invasion and lymphatic invasion） was assessed using statistical analyses. RESULTS： Overall 5-year survival was 71.2%. Univariate analysis of all tested variables showed an effect on survival but only the effect of lymphatic invasion was statistically significant. At stages three and four it had a negative effect on survival （P = 0.0212）. Lymphatic invasion also significantly affected cancer related survival in multivariate analysis at stages three and four. At lower stages （stage 0, stage 1 and stage 2） multivariate analysis showed a negative effect of perineural invasion on cancer related survival. CONCLUSION： Patients with lymphatic and perineural invasion have a higher risk for rectal cancer related death after curative resection. Examination of these variables should be an important step in detecting patients with a poorer prognosis.