Patterns of local recurrence in rectal cancer after a multidisciplinary approach

Improvements in surgery and the application of combined approaches to fight rectal cancer have succeeded in reducing the local recurrence (LR) rate and when there is LR it tends to appear later and less often in isolation. Moreover, a subtle change in the distribution of LRs with respect to the pelvis has been observed. In general terms, prior to total mesorectal excision the most common LRs were central types (perianastomotic and anterior) while lateral and posterior forms (presa-cral) have become more common since the growth in the use of combined treatments. No differences have been reported in the current pattern of LRs as a function of the type of approach used, that is, neo-adjuvant therapies (short-term or long-course radiotherapy, orchemoradiotherapy versus extended lymphadenectomy, though there is a trend towards posterior or presacral LR in patients in the Western world and lateral LR in Asia. Nevertheless, both may arise from the same mechanism. Moreover, as well as the mode of treatment, the type of LR is related to the height of the initial tumor. Nowadays most LRs are related to the advanced nature of the disease. Involvement of the circumferential radial margin and spillage of residual tumor cells from lymphatic leakage in the pelvic side wall are two plausible mechanisms for the genesis of LR. The patterns of pelvic recurrence itself (pelvic subsites) also have important implications for prognosis and are related to the potential success of salvage curative approach. The re-operability for cure and prognosis are generally better for anastomotic and anterior types than for presacral and lateral recurrences. Overall survival after LR diagnosis is lower with radio or chemoradiotherapy plus optimal surgery approaches, compared to optimal surgery alone.

Do the expressions of gap junction gene connexin messenger RNA in noncancerous liver remnants of patients with hepatocellular carcinoma correlate with postoperative recurrences?

AIM: To investigate whether the changes of gap junction gene connexin messenger RNA in the noncancerous liver tissue of patients with hepatocellular carcinoma (HCC) could play a significant role in its postresection recurrence.METHODS: Seventy-nine consecutive patients having undergone curative resection for HCC entered this study.Using a reverse-transcription polymerase chain reaction (RT-PCR)-based assay, connexin (Cx) 26, connexin (Cx)32 and connexin (Cx) 43 mRNAs were determined prospectively in noncancerous liver tissues from these 79 patients and in the liver tissues from 15 controls. The correlations between connexin mRNA expression and the clinicopathological variables and outcomes (tumor recurrence and recurrence related mortality) were studied.RESULTS: Compared with liver tissues of control patients,the expression of Cx 32 mRNA in noncancerous liver tissues was significantly lower (mean: 0.715 vscontrol 1.225,P＜0.01), whereas the decreased Cx 26 mRNA (mean:0.700 vs of control 1.205,P＞0.05) and increased Cx 43 mRNA (mean: 0.241 vscontrol 0.100, P＞0.05) had no statistical significance. We defined the value of Cx 32 mRNA or Cx 26mRNA below 0.800 as a lower value. By multivariate analysis for noncancerous livers, a lower value of Cx 32 mRNA correlated significantly with a risk of HCC recurrence and recurrence-related mortality. The lower value of Cx 26 mRNA did not correlate with recurrence and mortality. The increased value of Cx43 mRNA also did not correlate with postoperative recurrence and recurrence-related mortality. By multivariate analysis, other significant predictors of HCC recurrence included vascular permeation, cellular dedifferentiation, and less encaps-ulation. The other significant parameter of recurrence related mortality was vascular permeation.CONCLUSION: The decreased expression of Cx 32 mRNA in noncancerous liver tissues plays a significant role in the prediction of postoperative recurrence of HCC.

Prediction of recurrence and prognosis in patients with hepatocellular carcinoma after resection by use of CLIP score

AIM: The survival time of patients with hepatocellular carcinoma (HCC) after resection is hard to predict. Both residual liver function and tumor extension factors should be considered. A new scoring system has recently been proposed by the Cancer of the Liver Italian Program (CLIP). CLIP score was confirmed to be one of the best ways to stage patients with HCC. To our knowledge, however, the literature concerning the correlation between CLIP score and prognosis for patients with HCC after resection was not published. The aim of this study is to evaluate the recurrence and prognostic value of CLIP score for the patients with HCC after resection. METHODS: A retrospective survey was carried out in 174 patients undergoing resection of HCC from January 1986 to June 1998. Six patients who died in the hospital after operation and 11 patients with the recurrence of the disease were excluded at 1 month after hepatectomy. By the end of June 2001, 4 patients were lost and 153 patients with curative resection have been followed up for at least three years. Among 153 patients, 115 developed intrahepatic recurrence and 10 developed extrahepatic recurrence, whereas the other 28 remained free of recurrence. Recurrences were classified into early (【 or =3 year) and late (】3 year) recurrence. The CLIP score included the parameters involved in the Child-Pugh stage (0-2), plus macroscopic tumor morphology (0-2), AFP levels (0-1), and the presence or absence of portal thrombosis (0-1). By contrast, portal vein thrombosis was defined as the presence of tumor emboli within vascular channel analyzed by microscopic examination in this study. Risk factors for recurrence and prognostic factors for survival in each group were analyzed by the chi-square test, the Kaplan-Meier estimation and the COX proportional hazards model respectively. RESULTS: The 1-, 3-, 5-, 7-,and 10-year disease-free survival rates after curative resection of HCC were 57.2%, 28.3%, 23.5%, 18.8%, and 17.8%, respectively. Median survival time was 28, 10, 4, and 5 mo for CLIP score 0, 1, 2, 3, and 4 to 5, respectively. Early and late recurrence developed in 109 patients and 16 patients respectively. By the chi-square test, tumor size, microsatellite, venous invasion, tumor type (uninodular, multinodular, massive), tumor extension (【 or = or 】50% of liver parenchyma replaced by tumor), TNM stage, CLIP score, and resection margin were the risk factors for early recurrence, whereas CLIP score and Child-Pugh stage were significant risk factors for late recurrence. In univariate survival analysis, Child-Pugh stages, resection margin, tumor size, microsatellite, venous invasion, tumor type, tumor extension, TNM stages, and CLIP score were associated with prognosis. The multivariate analysis by COX proportional hazards model showed that the independent predictive factors of survival were resection margins and TNM stages. CONCLUSION: CLIP score has displayed a unique superiority in predicting the tumor early and late recurrence and prognosis in the patients with HCC after resection.

Recurrence of hepatocellular carcinoma with rapid growth after spontaneous regression

We report an 80-year-old man who presented with sponta- neous regression of hepatocellular carcinoma(HCC).He complained of sudden right flank pain and low-grade fever. The level of protein induced by vitamin K antagonist(PIVKA)- II was 1 137 mAU/mL.A computed tomography scan in November 2000 demonstrated a low-density mass located in liver S4 with marginal enhancement and a cystic mass of 68 mm×55 mm in liver S6,with slightly high density content and without marginal enhancement.Angiography revealed that the tumor in S4 with a size of 25 mm×20 mm was a typical hypervascular HCC,and transarterial chemoembolization was performed.However,the tumor in S6 was hypovascular and atypical of HCC,and thus no therapy was given.In December 2000,the cystic mass regressed spontaneously to 57 min×44 mm,and aspiration cytology revealed bloody fluid,and the mass was diagnosed cytologically as class I. The tumor in S4 was treated successfully with a 5 mm margin of safety around it.The PIVKA-II level normalized in February 2001.In July 2001,the tumor regressed further but presented with an enhanced area at the posterior margin.In November 2001,the enhanced area extended,and a biopsy revealed well-differentiated HCC,although the previous tumor in S4 disappeared.Angiography demonstrated two tumor stains,one was in S6,which was previously hypovascular, and the other was in S8.Subsequently,the PIVKA-II level started to rise with the doubling time of 2-3 wk,and the tumor grew rapidly despite repeated transarterial embolization with gel foam.In February 2003,the patient died of bleeding into the peritoneal cavity from the tumor that occupied almost the entire right lobe.Considering the acute onset of the symptoms,we speculate that local ischemia possibly due to rapid tumor growth,resulted in intratumoral bleeding and/or hemorrhagic necrosis,and finally spontaneous regression of the initial tumor in S6.

Successful treatment of solitary bladder plasmacytoma:A case report

BACKGROUND Plasmacytoma is a rare neoplastic disorder that arises from B-lymphocytes.Solitary bladder plasmacytoma,a type of solitary extramedullary plasmacytoma,is even rarer.Treatments for solitary extramedullary plasmacytoma include surgery,chemotherapy,and radiation.However,there are no clinical trials or guidelines specifying which treatment might represent the gold standard.CASE SUMMARY We herein report a case of a 51-year-old woman with solitary bladder plasmacytoma(SBP).There remains no consensus regarding the optimal treatment for SBP.However,we successfully treated her with transurethral resection of bladder tumor followed by postoperative radiotherapy(50 Gy/25 F).The patient remained free of tumor recurrence at a 7-mo follow-up.CONCLUSION Radiation is the potential main treatment for SBP.However,surgery is also necessary.

Oncologic Outcomes of Breast Cancer Patients Treated with Oncoplastic Surgery

Background: The impact of breast appearance after breast cancer surgical treatment on patients’ quality of life led to the development of the oncoplastic approach. However, studies reporting oncologic results associated with this treatment strategy are scarce. This cross-sectional study was designed to assess oncologic outcomes among patients who underwent oncoplastic surgery. Methods: A total of 190 breast cancer patients who underwent breast-conserving surgery were enrolled. Fifty of them underwent oncoplastic surgery and 140 had none breast reconstruction procedure (control group). All surgeries were performed by the same surgical team. Results: Groups were similar with regard to staging, histological type, grade of the tumor, presence of intraductal component, hormone receptors and nodal commitment. Patients in oncoplastic surgery group had larger tumors (ρ = 0.001) and more lymphovascular invasion (ρ = 0.047). Further, a higher proportion of them underwent chemotherapy (ρ = 0.030). Follow-up time of control group was longer (ρ = 0.05), and these patients also had a longer relapse-free survival time (ρ = 0.001). Local recurrence rate was 5.8% (11/190) and it was significantly greater in the oncoplastic surgery group (8/11, ρ = 0.001). Time to local recurrence after surgery was longer in oncoplastic surgery group (ρ = 0.002). Overall, patients in oncoplastic surgery group were younger (ρ = 0.001), but at the time of local recurrence, patients in oncoplastic surgery group were older than those in control group (ρ = 0.0002). Conclusions: Among the studied patients, local recurrence rate was greater in those who underwent oncoplastic surgery.

Rapid progression of hepatocellular carcinoma after Radiofrequency Ablation

AIM:To report the results of radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) in cirrhotic patients and to describe the treatment related complications (mainly the rapid intrahepatic neoplastic progression). METHODS:Eighty-seven consecutive cirrhotic patients with 104 HCC (mean diameter 3.9 cm,1.3 SD) were submitted to RFA between January 1998 and June 2003.In all cases RFA was performed with percutaneous approach under ultrasound guidance using expandable electrode needles. Treatment efficacy (necrosis and recurrence) was estimated with dual phase computed tomography (CT) and alpha- fetoprotein (AFP)level. RESULTS:Complete necrosis rate after single or multiple treatment was 100%,87.7% and 57.1% in HCC smaller than 3 cm,between 3 and 5 cm and larger than 5 cm respectively (P=0.02).Seventeen lesions of 88(19.3%) developed local recurrence after complete necrosis during a mean follow up of 19.2 mo.There were no treatment-related deaths in 130 procedures and major complications occurred in 8 patients (6.1%).In 4 patients,although complete local necrosis was achieved,we observed rapid intrahepatic neoplastic progression after treatment.Risk factors for rapid neoplastic progression were high preoperative AFP values and location of the tumor near segmental portal branches. CONCLUSION:RFA is an effective treatment for hepatocellular carcinoma smaller than 5 cm with complete necrosis in more than 80% of lesions.Patients with elevated AFP levels and tumors located near the main portal branch are at risk for rapid neoplastic progression after RFA.Further studies are necessary to evaluate the incidence and pathogenesis of this underestimated complication.

Detection of BCL2-IGHrearrangement on paraffin-embedded tissue sections obtained from a small submucosal tumor of the rectum in a patient with recurrent follicular lymphoma

A 59-year-old woman was admitted to our hospital because of recurrent follicular lymphoma(FL).Colonoscopic examination revealed a rectal submucosal tumor(SMT)without any erosions and ulcers.In this patient,it was difficult to distinguish non-Hodgkin's lymphoma(NHL)invasion from other disorders of the colon including carcinoid tumor merely based on endoscopic findings.Histopathologic and immunohistochemical studies on biopsy specimens showed an infiltration of atypical lymphocytes that were positive for CD20 and BCL2 but negative for UCHL-1.Fluorescence in situ hybridization on paraffin-embedded tissue sections (T-FISH)identified a translocation of BCL2 with IGHgene. Based on these findings,the tumor was defined as an invasion of FL.T-FISH method is useful for the detection of a monoclonality of atypical lymphocytes in an SMT of the gastrointestinal tract,and particularly for the detection of chromosomal translocations specific to lymphoma subtypes.

Analysis of 30 patients with persistent or recurrent squamous cell carcinoma of the cervix within one year after concurrent chemoradiotherapy

Objective： To investigate the recurrence sites, risk factors, and prognosis of＇patients with persistent or recurrent squamous cell carcinoma （SCC） of the cervix within one year after undergoing concurrent chemoradiotherapy （CCRT）. Methods： Clinical data of 30 patients with persistent or recurrent SCC of the cervix within one year after CCRT between July 2006 and July 2011 were analyzed retrospectively： These data were compared with those of 35 SCC cases with no signs of recurrence after complete remission. These 35 patients were treated during the same period （between 2,006 and Z011） and selected randomly. Results： Among these 30 patients, 25 exhibited distant metastases of which 14 were observed within 6 months after CCRT. Univariate analysis showed higher incidence of pelvic or para-aortic lymphadenectasis and SCC-ag 〉 10 ng/mL in the group with persistent or recurrent disease before treatment （P〈0.01）. Multivariate analysis by logistic regression revealed that the pre-therapeutic pelvic or para-aortic lymph node enlargement and SCC-ag 〉 10 ng/mL were the independent risk factors. Palliative chemotherapy was the main treatment option for patients with persistent or recurrent disease. The 2-year survival rate was 21.7%, and the median survival time was 17 months. Conclusion： Patients with persistent or recurrent SCC of the cervix after CCRT exhibited a high rate of distant metastasis with poor prognosis. The pre-therapeutic pelvic or para-aortic lymph node enlargement and SCC-ag 〉10 ng/mL were identified as the independent risk factors for persistent or recurrent SCC within i year after CCRT.

复发性咽部原发滑膜肉瘤1例

1 临床资料 患者,女,37岁,因“确诊口咽滑膜肉瘤5年,吞咽异物感4个月余”于2021-11-14日入院。患者5年前于海军军医大学第二附属医院耳鼻咽喉科在全麻下行“左侧扁桃体新生物切除术”,术后病理:梭形细胞滑膜肉瘤。后在我院肿瘤科行“吡柔比星+异环磷酰胺”方案化疗共6次,定期复查无明显异常。2021年7月患者开始出现吞咽异物感,伴咽部不适,无发热、声嘶、咽痛、咳血、呼吸困难等症状,就诊我科。

CLINICAL STUDY ON ACUPUNCTURE TREATMENT OF STOMACH CARCINOMA PAIN

Clinical observation on 48 cases of stomach carcinoma pain indicated that acupuncture including filiform needle group and point-injection group had better therapeutic effects in treatment of stomach carcinoma pain when patient's mind was concentrated at the site of disease. After treatment for 2 months, the long-term effective rates of analgesia in both the filiform needle group and the point-injection group were similar to that in the western medicine group, all being about 81%. While the long-term markedly effective rates in the two groups were superior to that in the western medicine group. Life quality of the patients in all the groups were improved. The toxic action and side effects caused by chemotherapy were prevented, the high viscous state showed by indexes of blood rheology was improved, and the lowered Cu-Zu-SOD activity in erythrocytes in patients of stomach carcinoma was increased in the filiform needle group and the point-injection group. Based on the results of clinical study, we consider that acupuncture analgesic effect on stomach carcinoma is related to the increase of PLEK, improvement of cellular immune function and the elevation of life quality after acupuncture.

THE EFFECTS OF CHINESE DRUGS FOR SUPPORTING HEALTHY ENERGY AND REMOVING BLOOD STASIS ON POSTOPERATIVE METASTASIS OF GASTRIC CARCINOMA AND ORNITHINE DECARBOXYLASE

32 postoperative cases of gastric carcinoma were treated by traditional Chinese medicine (TCM) drugs for supporting healthy energy and removing blood stasis, and their therapeutic results were compared with those in the control group treated by western medicine. After 6 months of treatment, in the TCM group, the rate of metastatic recurrence was significantly reduced, and the level of ornithine decarboxylase was also markedly lowered. Therefore, it is considered that the action of anti-metastatic recurrence of TCM drugs in postoperative cases of gastric carcinoma is probably related to the lowered activity of ornithine decarboxylase.

Telomerase activity in urine in diagnosis and recurrence surveillance of urothelial carcinoma

OBJECTIVE: To investigate the significance of telomerase activity in urine in the diagnosis and recurrence surveillance of urothelial carcinoma. METHODS: Telomerase activity in urine of 54 cases of urothelial carcinoma (urothelial carcinoma group) was estimated by polymerase chain reaction-enzyme-linked immunosorbent assay, and monitored continuously in 23 cases after tumor removal. 46 patients with benign urological diseases were also included as the control group. RESULTS: The telomerase activity in urine of patients with urothelial carcinoma increased significantly as compared with the control group (P

Serum α-fetoprotein level as a biomarker for early recurrence after R0 resection in primary hepatocellular carcinoma

Objectives:To investigate the impact of serumα-fetoprotein(AFP)levels on survival and early recurrence after R0 resection in primary hepatocellular carcinoma(HCC).Methods:We retrospectively analyzed clinical data of 582 patients with primary HCC(male:488,female:94;mean age:51 years[age range,31-73 years])who underwent R0 resection between January 1997 and December 2009.The 1-,3-,and 5-year overall survival(OS)rates and the clinico-pathological factors between the AFP-negative and AFP-positive groups were compared.Risk fac-tors of early recurrence in the AFP-positive group were further analyzed.Results:Age and histological differentiation were significantly lower in the AFP-positive group than in AFP-negative group(χ^(2)=11.004,32.293;P=0.000).In the AFP-positive group,serumγ-glutamyl transferase levels,tumor diameters,TNM stage,and early recurrence rate were higher(χ^(2)=9.814 to 14.009,P<0.05),whereas the proportion of solitary HCC was lower(χ^(2)=8.509,P=0.004).The 1-,3-,and 5-year OS rates in the AFP-positive group were 80.5%,66.9%,and 40.2%,respectively,and those in the AFP-negative group were 89.2%,79.9%,and 50.3%,respec-tively(χ^(2)=11.884,P=0.001).The 1-,3-,and 5-year disease-free survival rates were 65.6%,48.5%,29.6%in the AFP-positive group and 81.7%,63.9%,42.1%in the AFP-negative group respectively(χ^(2)=15.574,P=0.000).The median OS times of early recurrence and non-early recurrence were 10 and 62 months,respectively(χ^(2)=45.013,P=0.000),and their median survival times from recurrence to death were 6 and 14 months,respectively(χ^(2)=40.581,P=0.000).Multiple-factor analysis suggested non-solitary HCC and low histological differentiation are independent risk factors influencing early recurrence of HCC.Conclusion:Elevated preoperative serum AFP levels were indicative of early HCC recurrence.

Combined modality therapy following bladder conservation surgery for bladder cancers

OBJECTIVE: To analyze the efficacy of recurrence prophylaxis using radiation and chemotherapy following bladder conservation surgery for muscle invasive bladder cancer. METHODS: 23 patients with muscle invasive bladder cancer were treated with radiotherapy combined with bladder mitomycin infusion after bladder conservation surgery (study group). Radiotherapy was given using an external beam at an average dose of 5148 +/- 462 cGy with conventional fractionation. For comparison, 29 similar patients treated with postoperative bladder mitomycin infusion without radiation served as control (control group). All patients were followed up for more than 3 years, an average of 41.6 months (36 - 60 months). RESULTS: The 3-year pelvic recurrent rate of muscle invasive bladder cancer was 17.4% in the study group and 44.8% (P = 0.036) in the control group. The 3-year distant metastasis rates were 17.4% and 24.1%, respectively (P = 0.554). The 3-year overall survival rates were 81.8% and 86.2%, respectively (P = 0.670). Two patients from the study group had their treatment interrupted, one for 3 days and the other for one week due to acute cystitis, while the rest of the patients were able to complete the treatment according to schedule. CONCLUSION: Radiotherapy plus chemotherapy after bladder conservation surgery for muscle invasive bladder cancer can decrease the rate of pelvic recurrence effectively and be used as a realistic adjuvant treatment.

The role of nuclear matrix protein 22 combined with bladder tumor antigen stat test in surveillance of recurring bladder cancer

OBJECTIVE: To investigate a non-invasive, effective and rapid mode of detecting the recurrence of bladder cancer during follow-up. METHODS: Ninety patients following transurethral resection of bladder tumor (TURBt) surgery were recruited from January 1998 to March 2000. Standard ELISA was used to determine the quantity of nuclear matrix protein (NMP-22) in urine of all bladder cancer patients during their follow-up periods. Urine bladder tumor antigen (BTA) stat test was simultaneously performed and followed by cystoscopy. RESULTS: The total positive rates of urinary NMP-22 and BTA stat test were 76.7% (33/43) and 67.4% (29/43), respectively. Comparatively, this positive rate would increase to 93.0% (40/43) when the combination of both urine NMP-22 and BTA test were adopted. CONCLUSION: Examination of NMP-22 in urine is a rapid and effective way to detect the recurrence of bladder cancer. If combined with BTA test, NMP-22 may be used as a non-invasive method in surveillance of recurring of bladder cancer, which may reduce the frequency of patients needing to undergo conventional invasive cystoscopy.

Post-radiation CT changes and recurrent nasopharyngeal carcinoma

Background Nasopharyngeal carcinoma （NPC） is endemic in Southern Asia. Radiation therapy remains the mainstay of treatment strategies for NPC. Although approximately 19%-56% of patients develop a recurrent disease 5 years after their primary treatment, recognition of post-radiation changes and early detection of relapse are important in improving the outcome of NPC. Our aim was to analyze the post-radiation changes and recurrent diseases related to NPC using computed tomography （CT） scans and to investigate their relationship. Methods CT scans of 510 pathologically proven NPC patients who have been followed up for more than 2 years after radiation were reviewed. The tumor＇s response to the radiation therapy and its relevance to recurrence were evaluated. Results For patients who were followed up for more than 2 years, their CT scans-obtained within 3 months, during the 4th to the 6th month, and beyond 7 months after radiation therapy, showed a normal nasopharyngeal cavity with a slight thickening in the wall in 93.5%, 95.0% and 84.8% of the patients respectively. The degree of tumor regression had no significant relevance to the risk of recurrence within the initial 3 months （P=0.094）. During this term, the relapse rates in the cases in which the nasopharyngeal walls were displayed as normal, slightly or moderately thickening, or with obvious residual masses on CT scans were 7.1%, 11.7%, 23.5% and 23.1% respectively. The degree of tumor regression beyond 3 months after radiation therapy had a considerable reverse relevance to the risk of recurrence （P=-0.000）. The relapse rates were 13.2%, 14.1%, 10.2% and 2.1%, respectively, in the cases with a normal and a slightly thickening nasopharyngeal wall during the 4th to the 6th month, the 7th to the 12th month, the 13th to the 24th month, and beyond 25 months after radiation. In contrast, the percents in cases with moderate or more aggressive thickening walls in the corresponding periods were 62.5%, 88.9%, 100% and 100%. Within 6 months after radiation therapy, shown by CT scans the metastatic lymph nodes disappeared, markedly decreased, slightly decreased, or enlarged in 37.4%, 51.8%, 4.7%, and 0.4%, respectively, of the patients. During 6 to 12 months after radiation therapy, the proportions were 78.5%, 19.2%, 0.6% and 1.7% correspondingly. Beyond 12 months, the proportions were 83.7%, 7.9%, 0%, and 8.4%. The regression degree of the malignant nodes after radiation therapy showed a remarkable reverse relevance to the risk of recurrence in lymph nodes （P=0.000）. In the cases with disappearing, markedly decreased, slightly decreased, or enlarged malignant nodes within six months after radiation, the relapse rates were 2.9%, 4.5%, 12.5% and 100%, respectively. Conclusions If the nasopharyngeal walls are shown to remain moderately thick on a CT scan beyond 6 months after radiotherapy, the risk of relapse will increase. The baseline images taken within 3 months after radiotherapy and regular follow-uo studies are the kev to pick up the tumor recurrences in an earlier stage.