Early gastric cancer recurrence after endoscopic submucosal dissection:Not to be ignored!

This editorial comments on the article“Efficacy of multi-slice spiral computed tomography in evaluating gastric cancer recurrence after endoscopic submucosal dissection”.We focus on the importance of paying more attention to postendoscopic submucosal dissection(ESD)gastric cancer recurrence in patients with early gastric cancer(EGC)and how to manage it effectively.ESD has been a wellknown treatment and the mainstay for EGC,with the advantages of less invasion and fewer complications when compared with traditional surgical procedures.Despite a lower local recurrence rate after ESD,the problem of postoperative recurrence in patients with EGC has become increasingly non-ignorable with the global popularization of ESD technology and the increasing number of post-ESD patients.

Development and validation of a circulating tumor DNA-based optimization-prediction model for short-term postoperative recurrence of endometrial cancer

BACKGROUND Endometrial cancer(EC)is a common gynecological malignancy that typically requires prompt surgical intervention;however,the advantage of surgical management is limited by the high postoperative recurrence rates and adverse outcomes.Previous studies have highlighted the prognostic potential of circulating tumor DNA(ctDNA)monitoring for minimal residual disease in patients with EC.AIM To develop and validate an optimized ctDNA-based model for predicting shortterm postoperative EC recurrence.METHODS We retrospectively analyzed 294 EC patients treated surgically from 2015-2019 to devise a short-term recurrence prediction model,which was validated on 143 EC patients operated between 2020 and 2021.Prognostic factors were identified using univariate Cox,Lasso,and multivariate Cox regressions.A nomogram was created to predict the 1,1.5,and 2-year recurrence-free survival(RFS).Model performance was assessed via receiver operating characteristic(ROC),calibration,and decision curve analyses(DCA),leading to a recurrence risk stratification system.RESULTS Based on the regression analysis and the nomogram created,patients with postoperative ctDNA-negativity,postoperative carcinoembryonic antigen 125(CA125)levels of<19 U/mL,and grade G1 tumors had improved RFS after surgery.The nomogram’s efficacy for recurrence prediction was confirmed through ROC analysis,calibration curves,and DCA methods,highlighting its high accuracy and clinical utility.Furthermore,using the nomogram,the patients were successfully classified into three risk subgroups.CONCLUSION The nomogram accurately predicted RFS after EC surgery at 1,1.5,and 2 years.This model will help clinicians personalize treatments,stratify risks,and enhance clinical outcomes for patients with EC.

Association between tobacco exposure and bladder cancer recurrence:A systematic review and meta-analysis

BACKGROUND However,the connection between smoking and the prognosis of patients with bladder cancer remains unclear.AIM To determine whether smoking is linked to the recurrence and progression of bladder cancer.METHODS As of July 20,2022,relevant English-language research was identified by searching PubMed,the Web of Science,and the Cochrane Library.We pooled the available data from the included studies using a random effects model.Subgroup analysis and sensitivity analysis were also conducted.RESULTS A total of 12 studies were included in this meta-analysis.The combined analysis revealed that tobacco exposure was associated with a significantly greater recurrence rate than nonsmoking status[odd ratios(OR)=1.76,95%CI:1.84-2.93],and the progression of bladder cancer was significantly greater in smokers than in nonsmokers(OR=1.21,95%CI:1.02-1.44).Stratified analysis further revealed that current smokers were more likely to experience relapse than never-smokers were(OR=1.85,95%CI:1.11-3.07).Former smokers also had a greater risk of relapse than did never-smokers(OR=1.73,95%CI:1.09-2.73).Subgroup analysis indicated that non-Caucasians may be more susceptible to bladder cancer recurrence than Caucasians are(OR=2.13,95%CI:1.74-2.61).CONCLUSION This meta-analysis revealed that tobacco exposure may be a significant risk factor for both the recurrence and progression of bladder cancer.

Predictors of disease recurrence after radical resection and adjuvant chemotherapy in patients with stage IIb-IIIa squamous cell lung cancer:A retrospective analysis

BACKGROUND Lung cancer(LC)is a global medical,social and economic problem and is one of the most common cancers and the leading cause of mortality from malignant neoplasms.LC is characterized by an aggressive course,and in the presence of disease recurrence risk factors,patients,even at an early stage,may be indicated for adjuvant therapy to improve survival.However,combined treatment does not always guarantee a favorable prognosis.In this regard,establishing predictors of LC recurrence is highly important both for determining the optimal treatment plan for the patients and for evaluating its effectiveness.AIM To establish predictors of disease recurrence after radical resection and adjuvant chemotherapy in patients with stage IIb-IIIa lung squamous cell carcinoma(LSCC).METHODS A retrospective case-control cohort study included 69 patients with LSCC who underwent radical surgery at the Orenburg Regional Clinical Oncology Center from 2009 to 2018.Postoperatively,all patients received adjuvant chemotherapy.Histological samples of the resected lung were stained with Mayer's hematoxylin and eosin and examined under a light microscope.Univariate and multivariate analyses were used to identify predictors associated with the risk of disease recurrence.Receiver operating characteristic curves were constructed to discriminate between patients with a high risk of disease recurrence and those with a low risk of disease recurrence.Survival was analyzed using the Kaplan-Meier method.The log-rank test was used to compare survival curves between patient subgroups.Differences were considered to be significant at P<0.05.RESULTS The following predictors of a high risk of disease recurrence in patients with stage IIb-IIa LSCC were established:a low degree of tumor differentiation[odds ratio(OR)=7.94,95%CI=1.08-135.81,P=0.049];metastases in regional lymph nodes(OR=5.67,95%CI=1.09-36.54,P=0.048);the presence of loose,fine-fiber connective tissue in the tumor stroma(OR=21.70,95%CI=4.27-110.38,P=0.0002);and fragmentation of the tumor solid component(OR=2.53,95%CI=1.01-12.23,P=0.049).The area under the curve of the predictive model was 0.846(95%CI=0.73-0.96,P<0.0001).The sensitivity,accuracy and specificity of the method were 91.8%,86.9%and 75.0%,respectively.In the group of patients with a low risk of LSCC recurrence,the 1-,2-and 5-year disease-free survival(DFS)rates were 84.2%,84.2%and 75.8%,respectively,while in the group with a high risk of LSCC recurrence the DFS rates were 71.7%,40.1%and 8.2%,respectively(P<0.00001).Accordingly,in the first group of patients,the 1-,2-and 5-year overall survival(OS)rates were 94.7%,82.5%and 82.5%,respectively,while in the second group of patients,the OS rates were 89.8%,80.1%and 10.3%,respectively(P<0.00001).CONCLUSION The developed method allows us to identify a group of patients at high risk of disease recurrence and to adjust to ongoing treatment.

Stenting as a bridge to surgery in obstructing colon cancer:Longterm recurrence pattern and competing risk of mortality

BACKGROUND Stenting as a bridge to curative surgery(SBTS)for obstructing colon cancer(OCC)has been associated with possibly worse oncological outcomes.AIM To evaluate the recurrence patterns,survival outcomes,and colorectal cancer(CRC)-specific death in patients undergoing SBTS for OCC.METHODS Data from 62 patients undergoing SBTS at a single tertiary centre over ten years between 2007 and 2016 were retrospectively examined.Primary outcomes were recurrence patterns,overall survival(OS),cancer-specific survival(CSS),and CRC-specific death.OS and CSS were estimated using the Kaplan-Meier curves.Competing risk analysis with cumulative incidence function(CIF)was used to estimate CRC-specific mortality with other cause-specific death as a competing event.Fine-Gray regressions were performed to determine prognostic factors of CRC-specific death.Univariate and multivariate subdistribution hazard ratios and their corresponding Wald test P values were calculated.RESULTS 28 patients(45.2%)developed metastases after a median period of 16 mo.Among the 18 patients with single-site metastases:Four had lung-only metastases(14.3%),four had liver-only metastases(14.3%),and 10 had peritoneum-only metastases(35.7%),while 10 patients had two or more sites of metastatic disease(35.7%).The peritoneum was the most prevalent(60.7%)site of metastatic involvement(17/28).The median follow-up duration was 46 mo.26(41.9%)of the 62 patients died,of which 16(61.5%)were CRC-specific deaths and 10(38.5%)were deaths owing to other causes. The 1-, 3-, and 5-year OS probabilities were 88%, 74%, and 59%;1-, 3-, and5-year CSS probabilities were 97%, 83%, and 67%. The highest CIF for CRC-specific death at 60 mowas liver-only recurrence (0.69). Liver-only recurrence, peritoneum-only recurrence, and two ormore recurrence sites were predictive of CRC-specific death.CONCLUSIONThe peritoneum was the most common metastatic site among patients undergoing SBTS. Liveronlyrecurrence, peritoneum-only recurrence, and two or more recurrence sites were predictors ofCRC-specific death.

Molecular signaling in cancer stem cells of tongue squamous cell carcinoma:Therapeutic implications and challenges

Head and neck squamous cell carcinoma is the seventh most common cancer worldwide with high mortality rates.Amongst oral cavity cancers,tongue carcinoma is a very common and aggressive oral cavity carcinoma.Despite the implementation of a multimodality treatment regime including surgical intervention,chemo-radiation as well as targeted therapy,tongue carcinoma shows a poor overall 5-year survival pattern,which is attributed to therapy resistance and recurrence of the disease.The presence of a rare population,i.e.,cancer stem cells(CSCs)within the tumor,are involved in therapy resistance,recurrence,and distant metastasis that results in poor survival patterns.Therapeutic agents targeting CSCs have been in clinical trials,although they are unable to reach into therapy stage which is due to their failure in trials.A more detailed understanding of the CSCs is essential for identifying efficient targets.Molecular signaling pathways,which are differentially regulated in the CSCs,are one of the promising targets to manipulate the CSCs that would provide an improved outcome.In this review,we summarize the current understanding of molecular signaling associated with the maintenance and regulation of CSCs in tongue squamous cell carcinoma in order to emphasize the need of the hour to get a deeper understanding to unravel novel targets.

Relationship between anal cancer recurrence and cigarette smoking

BACKGROUND The incidence of anal cancer has been increasing in the United States.Smoking is a well-established risk factor;however,the impact of smoking on disease recurrence and outcome has not been well studied.The aim of this study was to assess the association between anal cancer recurrence and cigarette smoking.AIM To investigate the relationship between cigarette smoking status and anal cancer treatment outcome.METHODS The cancer registry from a single,community hospital was screened for patients with anal cancer between 2010 and 2021.The following characteristics were gathered from the database:Age;sex;cigarette smoking history;American Joint Committee on Cancer Clinical Stage Group;response to therapy;recurrence;time to recurrence;mortality;time to death;and length of follow-up.Patients were divided into the following groups:Current smokers;former smokers;and never smokers.SPSSv25.0 software(IBM Corp.,Armonk,NY,United States)was used for statistical analysis.RESULTS A total of 95 patients from the database met the screening criteria.There were 37 never smokers,22 former smokers,and 36 current smokers.There was no difference between groups in regards to race or sex.There was no difference in the American Joint Committee on Cancer Clinical Stage Group between groups.The former smokers were significantly older when compared to never smokers and current smokers(66.5±13.17 vs 57.4±7.82 vs 63.7±13.80,P=0.011).Former smokers and current smokers had a higher recurrence rate compared to never smokers(30.8%and 20.8%compared to zero,P=0.009).There was not a significant difference in recurrence between former smokers and current smokers.There was no difference in the mortality,non-response rate,or time to death between the groups.CONCLUSION Our data contributes evidence that cigarette smoking status is associated with increased recurrence for patients with anal cancer.

Recurrence of Poorly Differenciated Cervical Cancer by Single Splenic Metastasis: Case Report and Literature Review

Background: The incidence of cervical cancer in Belgium is 11.1 per 100,000. With the introduction of cervical cytology screening and more recently anti-HPV vaccination, this rate has been decreasing for almost 20 years. Despite this, some patients are missed by the screening and prevention system and cervical cancer is still diagnosed at an advanced stage. Recurrences by splenic metastases are rare and are most often found at autopsy. Case Study: We describe the case of a 41-year-old caucasian patient with a single splenic recurrence after radiotherapy, chemotherapy, brachytherapy, and surgery for a poorly differentiated adenocarcinoma of the cervix grade 3 at an initial stage IIB according to FIGO. This recurrence happens 3 years after the initial treatment. After monitoring this asymptomatic lesion, the size increase results in laparoscopic splenectomy. Histology demonstrates a splenic metastasis recurrence of adenocarcinoma of endocervical origin. Conclusion: The spleen is a rare metastatic site in cervical cancer. Splenectomy followed by chemotherapy is the therapy most often found in the literature, which is however poor in this regard.

MAPK9 as a therapeutic target:unveiling ferroptosis in localized prostate cancer progression

Background:Ferroptosis,a lipid peroxidation-mediated programmed cell death,is closely linked to tumor development,including prostate cancer(PCa).Despite established connections between ferroptosis and PCa,a comprehensive investigation is essential for understanding its impact on patient prognosis.Methods:A risk model incorporating four ferroptosis-related genes was developed and validated.Elevated risk scores correlated with an increased likelihood of biochemical recurrence(BCR),diminished immune infiltration,and adverse clinicopathological characteristics.To corroborate these results,we performed validation analyses utilizing datasets from both the Cancer Genome Atlas Cohort(TCGA)and the Gene Expression Synthesis Cohort(GEO).Moreover,we conducted further investigations into the pivotal gene identified in our model to explore its impact on tumor characteristics through cell proliferation and invasion assays,as well as animal studies conducted in vivo.Additionally,we conducted further experiments involving ferroptosis-related analysis to validate its association with ferroptosis.Results:The risk model demonstrated exceptional predictive capabilities for prognosis and therapeutic outcomes in PCa patients.Mitogen-activated protein kinase 9(MAPK9)emerged as a crucial gene within the model.In vivo and in vitro experiments explored MAPK9’s role in ferroptosis and its influence on tumor migration and proliferation.Conclusion:The findings provide a novel perspective for advancing ferroptosis exploration in PCa,bridging basic research and clinical applications.

Survival benefit of concurrent chemoradiotherapy for advanced ampulla of Vater cancer

BACKGROUND Currently,there is no standard adjuvant therapy for patients with resected ampulla of Vater(AoV)cancer.AIM To evaluate the effectiveness of adjuvant concurrent chemoradiotherapy(CCRT)in patients with advanced AoV cancer who underwent curative resection.METHODS This single-centered,retrospective study included 29 patients with advanced AoV cancer who underwent pancreaticoduodenectomy between 2006 and 2018.The impact of CCRT on advanced AoV cancer was analyzed.RESULTS The 1-,3-,and 5-yr recurrence-free survival(RFS)rates for patients with advanced AoV cancer were 82.8%,48.3%,and 40.8%,respectively,and the overall survival(OS)rates were 89.7%,62.1%,and 51.7%,respectively.Lymphovas-cular invasion was found to be a significant risk factor for RFS and OS in patients with advanced AoV cancer in the univariate analysis,whereas T stage and lymph node metastasis were significantly associated with OS in the multivariate analysis.Compared to the patients who did not receive adjuvant CCRT,those who received adjuvant CCRT did not show statistically significant improvements in the RFS and OS,although they had a significantly lower average age and significantly higher platelet-to-lymphocyte ratio.CONCLUSION Adjuvant CCRT did not improve survival outcomes in patients with advanced AoV cancer.These findings contribute to existing knowledge on the effectiveness of CCRT in this patient population and provide important insights for clinical decision-making.

Laparoscopic vs open surgery for gastric cancer: Assessing time, recovery, complications, and markers

BACKGROUND Gastric cancer(GC)is one of the most common cancers worldwide.Morbidity and mortality have increased in recent years,making it an urgent issue to address.La-paroscopic radical surgery(LRS)is a crucial method for treating patients with GC;However,its influence on tumor markers is still under investigation.The data of 194 patients treated at Chongqing University Cancer Hospital bet-ween January 2018 and January 2019 were retrospectively analyzed.Patients who underwent traditional open surgery and LRS were assigned to the control(n=90)and observation groups(n=104),respectively.Independent sample t-tests andχ2 tests were used to compare the two groups based on clinical efficacy,changes in tumor marker levels after treatment,clinical data,and the incidence of posto-perative complications.To investigate the association between tumor marker levels and clinical efficacy in patients with GC,three-year recurrence rates in the two groups were compared.RESULTS Patients in the observation group had a shorter duration of operation,less in-traoperative blood loss,an earlier postoperative eating time,and a shorter hospital stay than those in the control group(P<0.05).No significant difference was observed between the two groups regarding the number of lymph node dissections(P>0.05).After treatment,the overall response rate in the control group was significantly lower than that in the observation group(P=0.001).Furthermore,after treatment,the levels of carbohydrate antigen 19-9,cancer antigen 72-4,carcinoembryonic antigen,and cancer antigen 125 decreased significantly.The observation group also exhibited a significantly lower incidence rate of postoperative complications compared to the control group(P<0.001).Additionally,the two groups did not significantly differ in terms of three-year survival and recurrence rates(P>0.05).CONCLUSION LRS effectively treats early gastric cancer by reducing intraoperative bleeding,length of hospital stays,and postoperative complications.It also significantly lowers tumor marker levels,thus improving the short-term prognosis of the disease.

Evaluation of bacterial contamination and medium-term oncological outcomes of intracorporeal anastomosis for colon cancer:A propensity score matching analysis

BACKGROUND Although intracorporeal anastomosis(IA)for colon cancer requires longer operative time than extracorporeal anastomosis(EA),its short-term postoperative results,such as early recovery of bowel movement,have been reported to be equal or better.As IA requires opening the intestinal tract in the abdominal cavity under pneumoperitoneum,there are concerns about intraperitoneal bacterial infection and recurrence of peritoneal dissemination due to the spread of bacteria and tumor cells.However,intraperitoneal bacterial contamination and medium-term oncological outcomes have not been clarified.abdominal cavity in IA.METHODS Of 127 patients who underwent laparoscopic colon resection for colon cancer from April 2015 to December 2020,75 underwent EA(EA group),and 52 underwent IA(IA group).After propensity score matching,the primary endpoint was 3-year disease-free survival rates,and secondary endpoints were 3-year overall survival rates,type of recurrence,surgical site infection(SSI)incidence,number of days on antibiotics,and postoperative biological responses.RESULTS Three-year disease-free survival rates did not significantly differ between the IA and EA groups(87.2%and 82.7%,respectively,P=0.4473).The 3-year overall survival rates also did not significantly differ between the IA and EA groups(94.7%and 94.7%,respectively;P=0.9891).There was no difference in the type of recurrence between the two groups.In addition,there were no significant differences in SSI incidence or the number of days on antibiotics;however,postoperative biological responses,such as the white blood cell count(10200 vs 8650/mm^(3),P=0.0068),C-reactive protein(6.8 vs 4.5 mg/dL,P=0.0011),and body temperature(37.7 vs 37.5℃,P=0.0079),were significantly higher in the IA group.CONCLUSION IA is an anastomotic technique that should be widely performed because its risk of intraperitoneal bacterial contamination and medium-term oncological outcomes are comparable to those of EA.

Advanced cervix cancer patient with chemotherapy-induced grade IV myelosuppression achieved complete remission with cadonilimab:A case report

BACKGROUND The prognosis for patients with advanced metastatic cervix cancer(MCC)is poor,and this disease continues to pose a considerable therapeutic challenge.Despite the administration of first-line regimens consisting of cisplatin,paclitaxel,and bevacizumab,survival rates for patients with metastasis remain poor.The emergence of bispecific antibodies(BsAbs)offers a novel treatment option for patients diagnosed with MCC.CASE SUMMARY In this report,we present a patient with MCC who was treated with cadonilimab monotherapy at a dose of 6 mg/kg every two weeks after chemotherapy was proven to be intolerable.The patient exhibited a sustained complete response for a duration of 6 months,demonstrating an optimistic outlook.CONCLUSION This case illustrates the considerable efficacy of cadonilimab for treating advanced MCC.Therefore,BsAb therapy is a promising strategy for effectively treating patients with advanced MCC and should be considered as an option when patients are intolerant to standard chemotherapy.

Different types of tumor microvessels in stageⅠ-ⅢA squamous cell lung cancer and their clinical significance

BACKGROUND Lung cancer(LC)is the leading cause of morbidity and mortality among malignant neoplasms.Improving the diagnosis and treatment of LC remains an urgent task of modern oncology.Previously,we established that in gastric,breast and cervical cancer,tumor microvessels(MVs)differ in morphology and have different prognostic significance.The connection between different types of tumor MVs and the progression of LC is not well understood.AIM To evaluate the morphological features and clinical significance of tumor MVs in lung squamous cell carcinoma(LUSC).METHODS A single-center retrospective cohort study examined medical records and archival paraffin blocks of 62 and 180 patients with stage I-IIIA LUSC in the training and main cohorts,respectively.All patients underwent radical surgery(R0)at the Orenburg Regional Cancer Clinic from May/20/2009 to December/14/2021.Tumor sections were routinely processed,and routine Mayer's hematoxylin and eosin staining and immunohistochemical staining for cluster of differentiation 34(CD34),podoplanin,Snail and hypoxia-inducible factor-1 alpha were performed.The morphological features of different types of tumor MVs,tumor parenchyma and stroma were studied according to clinicopathological characteristics and LUSC prognosis.Statistical analysis was performed using Statistica 10.0 software.Univariate and multivariate logistic regression analyses were performed to identify potential risk factors for LUSC metastasis to regional lymph nodes(RLNs)and disease recurrence.Receiver operating characteristic curves were constructed to discriminate between patients with and without metastases in RLNs and those with and without disease recurrence.The effectiveness of the predictive models was assessed by the area under the curve.Survival was analyzed using the Kaplan-Meier method.The log-rank test was used to compare survival curves between patient subgroups.A value of P<0.05 was considered to indicate statistical significance.RESULTS Depending on the morphology,we classified tumor vessels into the following types:normal MVs,dilated capillaries(DCs),atypical DCs,DCs with weak expression of CD34,"contact-type"DCs,structures with partial endothelial linings,capillaries in the tumor solid component and lymphatic vessels in lymphoid and polymorphocellular infiltrates.We also evaluated the presence of loose,fine fibrous connective tissue(LFFCT)and retraction clefts in the tumor stroma,tumor spread into the alveolar air spaces(AASs)and fragmentation of the tumor solid component.According to multivariate analysis,the independent predictors of LUSC metastasis in RLNs were central tumor location(P<0.00001),the presence of retraction clefts(P=0.003),capillaries in the tumor solid component(P=0.023)and fragmentation in the tumor solid component(P=0.009),whereas the independent predictors of LUSC recurrence were tumor grade 3(G3)(P=0.001),stage N2(P=0.016),the presence of LFFCT in the tumor stroma(P<0.00001),fragmentation of the tumor solid component(P=0.0001),and the absence of tumor spread through the AASs(P=0.0083).CONCLUSION The results obtained confirm the correctness of our previously proposed classification of different types of tumor vessels and may contribute to improving the diagnosis and treatment of LUSC.

Characteristics of gastric cancer recurrence five or more years after curative gastrectomy

Objective： To investigate the characteristics of recurrences that occurred 5 or more years after curative resection for gastric cancer.Methods： We analyzed recurrences among 1,299 patients with gastric cancer who underwent curative operations at the Department of Surgery, Inje University Seoul Paik Hospital between September 1998 and December 2002. Recurrences were classified as within 2 years （early）, 2-5 years （intermediate）, and more than 5 years （late） after gastrectomy. The clinicopathologic findings of the patients with late recurrence were compared with those of patients in the other two recurrence groups, with special reference to the patterns of recurrence. Both univariate and multivariate analyses were performed, incorporating factors such as operation type, T-stage, N-stage, stage, lymphatic invasion, neural invasion, histology, tumor size, and recurrence site.Results： At the time of last follow-up, recurrence occurred in 266 （20.5%） patients. Recurrence times were classified as 〈2 years （182 patients）, 2-5 years （61 patients）, or 〉5 years （23 patients）. The late recurrence rate was 8.6%. The occurrence of recurrence 〉5 years after gastrectomy was significantly correlated with age, operation type, T-stage, N-stage, stage, lymphatic invasion, neural invasion, histology, tumor size, location and recurrence site （P〈0.05）. The main recurrence patterns in the 23 patients with late recurrence were locoregional metastasis （10 patients, 43.5%）, peritoneal seeding （8 patients, 34.8%）, hematogenous metastasis （2 patients, 8.7%）, and multiple metastasis （3 patients, 13.0%）. A multivariate analysis showed that larger tumor size and younger age were independent prognostic factors for late recurrence. Additionally, locoregional and peritoneal recurrences were significantly more common than hematogenous recurrences. Conclusions： Although late recurrence was uncommon, younger age and larger tumor size were associated with high risk. Follow-up surveillance is recommended for locoregional and peritoneal metastasis.

Recurrence risk model for esophageal cancer after radical surgery

Objective：The aim of the present study was to construct a risk assessment model which was tested by disease-free survival （DFS） of esophageal cancer after radical surgery.Methods：A total of 164 consecutive esophageal cancer patients who had undergone radical surgery between January 2005 and December 2006 were retrospectively analyzed.The cutpoint of value at risk （VaR） was inferred by stem-and-leaf plot,as well as by independent-samples t-test for recurrence-free time,further confirmed by crosstab chi-square test,univariate analysis and Cox regression analysis for DFS.Results：The cutpoint of VaR was 0.3 on the basis of our model.The rate of recurrence was 30.3 ％ （30/99）and 52.3％ （34/65） in VaR ＜0.3 and VaR ＞0.3 （chi-square test,x2 =7.984,P=0.005）,respectively.The 1-,3-,and 5-year DFS of esophageal cancer after radical surgery was 70.4％,48.7％,and 45.3％,respectively in VaR ＞≥0.3,whereas 91.5％,75.8％,and 67.3％,respectively in VaR ＜0.3 （Log-rank test,x2 =9.59,P=0.0020）,and further confirmed by Cox regression analysis [hazard ratio =2.10,95 ％ confidence interval （CI）：1.2649-3.4751; P=0.0041].Conclusions：The model could be applied for integrated assessment of recurrence risk after radical surgery for esophageal cancer.

Therapeutic strategy for postoperative recurrence in patients with non-small cell lung cancer

Postoperative recurrence occurs in approximately half of patients with non-small cell lung cancer(NSCLC), even after complete resection. Disease recurrence after surgical resection reduces the patient's life expectancy sharply. The prognosis after postoperative recurrence is considered to largely depend on both the mode of first recurrence(distant, locoregional or combined) and the treatment modality:(1) The majority of cases of postoperative recurrence involve distant metastasis with or without locoregional recurrence. Platinum-based systemic chemotherapy is practically accepted as the treatment for these diseases on the basis of evidence for original stage Ⅳ disease. The advent of both pemetrexed and molecular-targeted drugs has improved the survival of nonsquamous NSCLC and changed the chemotherapeutic algorithm for NSCLC;(2) Among patients with distant metastatic recurrence without locoregional recurrence at the primary tumor site, the metastasis is often limited in both organ and number. Such metastases are referred to as oligometastases. Local therapy, such as surgical resection and radiotherapy, has been suggested to be the first-line treatment of choice foroligometastatic recurrence; and(3) While locoregional recurrence is likely to cause troublesome symptoms, it is a potentially limited disease. Therefore, providing local control is important, and radiation is usually beneficial for treating local recurrence. In order to obtain better control of the disease and provide treatment with curative intent in patients with limited disease, the administration of concurrent platinum-based chemoradiotherapy is recommended according to the results of originally nonresectable stage ⅢA and ⅢB disease.

High Expression of p300 in Human Breast Cancer Correlates with Tumor Recurrence and Predicts Adverse Prognosis

Objective：Transcriptional coactivator p300 has been shown to play a variety of roles in the transcription process and mutation of p300 has been found in certain types of human cancers.However,the expression dynamics of p300 in breast cancer （BC） and its effect on BC patients＇ prognosis are poorly understood.Methods：In the present study,the methods of tissue microarray and immunohistochemistry （IHC） were used to investigate the protein expression of p300 in BCs.Receiver operating characteristic （ROC） curve analysis,Spearman＇s rank correlation,Kaplan-Meier plots and Cox proportional hazards regression model were utilized to analyze the data.Results：Based on the ROC curve analysis,the cutoff value for p300 high expression was defined when the H score for p300 was more than 105.High expression of p300 could be observed in 105/193 （54.4%） of BCs,in 6/25 （24.0%） of non-malignant breast tissues,respectively （P=0.004）.Further correlation analysis showed that high expression of p300 was positively correlated with higher histological grade,advanced clinical stage and tumor recurrence （P0.05）.In univariate survival analysis,a significant association between high expression of p300 and shortened patients＇ survival and poor progression-free survival was found （P0.05）.Importantly,p300 expression was evaluated as an independent prognostic factor in multivariate analysis （P0.05）.Conclusion：Our findings provide a basis for the concept that high expression of p300 in BC may be important in the acquisition of a recurrence phenotype,suggesting that p300 high expression,as examined by IHC,is an independent biomarker for poor prognosis of patients with BC.

Survival and prognostic factors of non-small cell lung cancer patients with postoperative locoregional recurrence treated with radical radiotherapy

Background: Locoregional recurrence remains the challenge for long-term survival of non-small cell lung cancer(NSCLC) patients after radical surgery, and curative-intent radiotherapy could be a treatment choice. This study aimed to assess the survival and prognostic factors of patients with postoperative locoregionally recurrent NSCLC treated with radical radiotherapy.Methods: We reviewed medical records of 74 NSCLC patients with postoperative locoregional recurrence who received radical radiotherapy between April 2012 and February 2016 at Sun Yat-sen University Cancer Center(Guangzhou, China). The efficacy and safety of radical radiotherapy were analyzed. The probability of survival was estimated using the Kaplan-Meier method and compared using the log-rank test. The Cox proportional hazards model was used to identify prognostic factors.Results: Grade 3/4 adverse events included neutropenia(8 cases, 10.8%), esophagitis(7 cases, 9.5%), pneumonitis(1 case, 1.4%), and vomiting(1 case, 1.4%).The 2-year overall survival, progression-free survival, local recurrencefree survival(LRFS), and distant metastasis-free survival(DMFS) rates of all patients were 84.2,42.5,70.0, and 50.9%,respectively. Univariate and multivariate analyses showed that a higher biological effective dose(BED) of radiation was associated with longer LRFS [hazard ratios(HR)=0.317,95% confidence interval(CI) = 0.112-0.899, P = 0.016] and that wild-type epidermal growth factor receptor(EGFR) was associated with longer DMFS compared with EGFR mutation(HR = 0.383,95% CI=0.171-0.855, P = 0.019).Conclusions: Radical radiotherapy is effective and well-tolerated in NSCLC patients with postoperative locoregional recurrence. High BED is a predictor for long LRFS, and the presence of wild-type EGFR is a predictor for long DMFS.

Risk factors for local recurrence after en bloc endoscopic submucosal dissection for early gastric cancer

AIM: To investigate factors related to recurrence following en bloc resection using endoscopic submucosal dissection(ESD) in patients with early gastric cancer(EGC). METHODS: A total of 1121 patients(1215 lesions) who had undergone ESD for gastric neoplasia between April 2003 and May 2010 were retrospectively reviewed. Data from 401 patients(415 lesions) were analyzed, following the exclusion of those who underwent piecemeal resection, with deep resection margin invasion or lateral margin infiltration, and diagnosed with benign lesions. RESULTS: Local recurrence after en bloc ESD was found in 36 cases(8.7%). Unclear resection margins, long procedure times, and narrow safety margins were identified as risk factors for recurrence. Lesions located in the upper third of the stomach showed a higher rate of recurrence than those located in the lower third of the stomach(OR = 2.9, P = 0.03). The probability of no recurrence for up to 24 mo was 79.9% in those with a safety resection margin ≤ 1 mm and 89.5% in those with a margin > 1 mm(log-rank test, P = 0.03). CONCLUSION: Even in cases in which en bloc ESD is performed for EGC, local recurrence still occurs. To reduce local recurrences, more careful assessment will be needed prior to the implementation of ESD in casesin which the tumor is located in the upper third of the stomach. In addition, clear identification of tumor boundaries as well as the securing of sufficient safety resection margins will be important.