Clinical analysis of multiple primary gastrointestinal malignant tumors:A 10-year case review of a single-center

BACKGROUND Multiple primary malignant tumors(MPMTs)was first described by Billroth as early as 1889,with the first report published by Warren and Gates in 1932.Since then,numerous cases have been reported.A literature review of 1104269 patients with cancer revealed that the incidence of MPMTs ranged from 0.73 to 11.7%.In recent years,however,there has been a significant upward trend in the incidence of this phenomenon,which may be associated with many different factors,including the advancement of modern diagnostic procedures facilitating the examination and diagnosis of more MPMTs,increased exposure to chemotherapy and radiotherapy that exacerbate the risk of new malignant tumors in patients with cancer,and prolonged survival of patients with cancer allowing sufficient time for the development of new primary cancers.AIM To analyze the incidence,clinical features,treatment factors,prevalence,and prognosis of patients with MPMTs in the gastrointestinal tract treated in a single center.Additionally,we analyzed the different tumor combinations,time interval between the occurrence of tumors,and staging.METHODS This retrospective cohort study analyzed 8059 patients with pathologically confirmed gastrointestinal malignant tumors treated at the Gansu Province Hospital in Lanzhou,Gansu,China between June 2011 and June 2020.Of these,85 patients had MPMTs.The clinical features,treatment factors,prevalence,and prognosis of this latter cohort were analyzed.RESULTS The incidence of MPMTs in patients with gastrointestinal malignant tumors was 1.05%(85/8059),including 83 double primary malignant tumors and two triple primary malignant tumors of which 57(67.06%)were synchronous MPMTs(SMPMTs)and 28(32.94%)were metachronous MPMTs(MMPMTs).The most frequent associations were found between the rectum colon cancers within the SMPMT category and the gastric-colon cancers within the MMPMT category.For the MMPMTs,the median interval was 53 months.The overall 1-,3-and 5-year survival rates from diagnosis of the first primary cancer were 91.36%,65.41%,and 45.97%,respectively;those from diagnosis of the second primary cancer were 67.90%,29.90%,and 17.37%,respectively.CONCLUSION MPMTs in the gastrointestinal tract have a high incidence and poor prognosis.Thus,it is necessary to perform both gastroscopy and colonoscopy in patients with gastrointestinal tumors.Multidisciplinary comprehensive diagnosis and treatment may improve the diagnosis rate and treatment efficiency of MPMTs.

Treatment trends of muscle invasive bladder cancer: Evidence from the Surveillance, Epidemiology, and End Results database, 1988 to 2013

Objective:Guidelines for muscle-invasive bladder cancer(MIBC)recommend that patients receive neoadjuvant chemotherapy with radical cystectomy as treatment over radical cystectomy alone.Though trends and practice patterns of MIBC have been defined using the National Cancer Database,data using the Surveillance,Epidemiology,and End Results(SEER)program have been poorly described.Methods:Using the SEER database,we collected data of MIBC according to the American Joint Commission on Cancer.We considered differences in patient demographics and tumor charac-teristics based on three treatment groups:chemotherapy(both adjuvant and neoadjuvant)with radical cystectomy,radical cystectomy,and chemoradiotherapy.Multinomial logistic regression was performed to compare likelihood ratios.Temporal trends were included for each treatment group.Kaplan-Meier curves were performed to compare cause-specific sur-vival.A Cox proportional-hazards model was utilized to describe predictors of survival.Results:Of 16728 patients,10468 patients received radical cystectomy alone,3236 received chemotherapy with radical cystectomy,and 3024 received chemoradiotherapy.Patients who received chemoradiotherapy over radical cystectomy were older and more likely to be African American;stage III patients tended to be divorced.Patients who received chemotherapy with radical cystectomy tended to be males;stage II patients were less likely to be Asian than Caucasian.Stage III patients were less likely to receive chemoradiotherapy as a treatment op-tion than stage II.Chemotherapy with radical cystectomy and chemoradiotherapy are both un-derutilized treatment options,though increasingly utilized.Kaplan-Meier survival curves showed significant differences between stage II and III tumors at each interval.A Cox proportional-hazards model showed differences in gender,tumor stage,treatment modality,age,andmarital status.Conclusion:Radical cystectomy alone is still the most commonly used treatment for muscle-invasive bladder cancer based on temporal trends.Significant disparities exist in those who receive radical cystectomy over chemoradiotherapy for treatment.

Colorectal adenocarcinoma patients with M1a diseases gain more clinical benefits from palliative primary tumor resection than those with M1b diseases: A propensity score matching analysis

BACKGROUND Surgical resection is regarded as the only potentially curative treatment option for patients with metastatic colorectal cancer(CRC).The National Comprehensive Cancer Network clinical practice guidelines do not recommend palliative surgery unless there is a risk of severe symptoms.However,accumulating evidence has shown that palliative surgery is associated with more favorable outcomes for patients with metastatic CRC.AIM To investigate the separate role of palliative primary tumor resection for patients with stage IVA(M1a diseases)and stage IVB(M1b diseases)colorectal adenocarcinoma(CRA).METHODS CRA patients diagnosed from 2010 to 2015 with definite M1a and M1b categories according to the 8th edition of American Joint Committee on Cancer staging system were selected from the Surveillance Epidemiology and End Results(SEER)database.To minimize potential selection bias,the data were adjusted by propensity score matching(PSM).Baseline characteristics,including gender,year of diagnosis,age,marital status,primary site,surgical information,race,grade,chemotherapy,and radiotherapy,were recorded and analyzed.Univariate and multivariate analyses were performed to explore the separate role of palliative surgery for patients with M1a and M1b diseases.RESULTS A total of 19680 patients with metastatic CRA were collected from the SEER database,including 10399 cases of M1a diseases and 9281 cases of M1b diseases.Common independent prognostic factors for both M1a and M1b patients included year of diagnosis,age,race,marital status,primary site,grade,surgery,and chemotherapy.After PSM adjustment,3732 and 3568 matched patients in the M1a and M1b groups were included,respectively.Patients receiving palliative primary tumor resection had longer survival time than those without surgery(P<0.001).For patients with M1a diseases,palliative resection could increase the median survival time by 9 mo;for patients with M1b diseases,palliative resection could prolong the median survival time by 7 mo.For M1a diseases,patients with lung metastasis had more clinical benefit from palliative resection than those with liver metastasis(15 mo for lung metastasis vs 8 mo for liver metastasis,P<0.001).CONCLUSION CRA patients with M1a diseases gain more clinical benefits from palliative primary tumor resection than those with M1b diseases.Those patients with M1a(lung metastasis)have superior long-term outcomes after palliative primary tumor resection.

Clinically detected gastroenteropancreatic neuroendocrine tumors are on the rise: Epidemiological changes in Germany

AIM:To study the epidemiologic changes of gastroenteropancreatic neuroendocrine tumors(GEP-NET)in Germany,we analyzed two time periods 1976-1988 and1998-2006.METHODS:We evaluated epidemiological data of GEP-NET from the former East German National Cancer Registry(DDR Krebsregister,1976-1988)and its successor,the Joint Cancer Registry(GKR,1998-2006),which was founded after German reunification.Due to a particularly substantial database the epidemiological data from the federal states of Mecklenburg-Western Pomerania,Saxony,Brandenburg and Thuringia,covering a population of more than 10.8 million people,were analyzed.Survival probabilities were calculated using life table analysis.In addition,GEP-NET patients were evaluated for one or more second(non-GEP-NET)primary malignancies.RESULTS:A total of 2821 GEP neuroendocrine neoplasms were identified in the two registries.The overall incidence increased significantly between 1976 and2006 from 0.31(per 100.000 inhabitants per year)to2.27 for men and from 0.57 to 2.38 for women.In the later period studied(2004-2006),the small intestine was the most common site.Neuroendocrine(NE)neoplasms of the small intestine showed the largest absolute increase in incidence,while rectal NE neoplasms exhibited the greatest relative increase.Only the incidence of appendiceal NET in women showed little change between 1976 and 2006.Overall survival of patients varied for sex,tumor site and the two periods studied but improved significantly over time.Interestingly,about 20%of the GEP-NET patients developed one or more second malignancies.Their most common location was the gastrointestinal tract.GEP-NET patients without second malignancies fared better than those with one or more of them.CONCLUSION:The number of detected GEP-NET increased about 5-fold in Germany between 1976 and2006.At the same time,their anatomic distribution changed,and the survival of GEP-NET patients improved significantly.Second malignancies are common and influence the overall survival of GEP-NET patients.Thus,GEP-NET warrant our attention as well as intensive research on their tumorigenesis.

Critical prognostic value of the log odds of negative lymph nodes/tumor size in rectal cancer patients

BACKGROUND The number of negative lymph nodes(NLNs)and tumor size are associated with prognosis in rectal cancer patients undergoing surgical resection.However,little is known about the prognostic significance of the NLN count after adjusting for tumor size.AIM To assess the prognostic impact of the log odds of NLN/tumor size(LONS)in rectal cancer patients.METHODS Data of patients with stage I–III rectal cancer were extracted from the Surveillance,Epidemiology,and End Results Program database.These patients were randomly divided into a training cohort and a validation cohort.Univariate and multivariate Cox regression analyses were used to determine the prognostic value of the LONS.The optimal cutoff values of LONS were calculated using the"X-tile"program.Stratified analysis of the effect of LONS on cancer-specific survival(CSS)and overall survival(OS)were performed.The Kaplan-Meier method with the log-rank test was used to plot the survival curve and compare the survival data among the different groups.RESULTS In all,41080 patients who met the inclusion criteria were randomly divided into a training cohort(n=28775,70%)and a validation cohort(n=12325,30%).Univariate and multivariate analyses identified the continuous variable LONS as an independent prognostic factor for CSS[training cohort:Hazard ratio(HR)=0.47,95%confidence interval(CI):0.44–0.51,P<0.001;validation cohort:HR=0.46,95%CI:0.41-0.52,P<0.001]and OS(training cohort:HR=0.53,95%CI:0.49-0.56,P<0.001;validation cohort:HR=0.52,95%CI:0.42-0.52,P<0.001).The Xtile program indicated that the difference in CSS was the most significant for LONS of-0.8,and the cutoff value of-0.4 can further distinguish patients with a better prognosis in the high LONS group.Stratified analysis of the effect of the categorical variable LONS on CSS and OS revealed that LONS was also an independent predictor,independent of pN stage,pT stage,tumor-node-metastasis stage,site,age,sex,the number of examined lymph nodes,race,preoperative radiotherapy and carcinoembryonic antigen level.CONCLUSION LONS is associated with improved survival of rectal cancer patients independent of other clinicopathological factors.

Mesenchymal Tumors in Gastrointestinal Tract

Mesenchymal neoplasms arising in the digestive tract are rare compared to adenomas and carcinomas [1]. They include several entities with histomorphological similarity and immunohistochemistry helps to confirm the diagnosis [2]. Our goals are to study the epidemiological aspect of mesenchymal tumors, and to compare the histological diagnoses before and after the use of immunochemistry. This is a retrospective, descriptive, single-center study performed on all cases of mesenchymal tumors in gastrointestinal tract, diagnosed at the laboratory of Pathological Anatomy Unit of Joseph Ravoahangy Andrianavalona University Hospital from January 1, 2007 to December 31, 2018. We included 29 cases. The mean age was 43.28 years. The sex ratio was 1.07. After immunohistochemical examination, 24.14% of tumors changed diagnosis to GISTs which are the most common mesenchymal tumor involving the gastrointestinal tract. In all cases of mesenchymal tumors of the gastrointestinal tract GIST should first be ruled out before making other diagnoses. Histologic and immunophenotypic features are thereby essential. According to the literature review, if c-Kit and DOG-1 are negative, molecular biology must be used.

Long-term assessment of risk factors for canine tumors registered in Xi’an, China

Tumors are one of the leading causes to death in pet dogs among diseases. The tumor incidence of pet dogs has been increasing, raising widespread concern. In this study, retrospective analysis was performed with 246 tumor cases registered in Xi’an Animal Hospital, Northwest A&F University from 2009 to 2018. Correlations of sex, age and breed with tumor incidences were evaluated. The results showed that reproductive system tumors occupied the highest proportion (39.84%), followed by cutaneous tumors (28.05%), digestive tumors (18.70%) and ocular tumor (4.47%). Among the reproductive system tumors, breast tumors are the most common tumor in female pet dogs, especially for Pekingese (11.43%). Female dogs with high susceptibility to breast tumors were at the ages of 6–18 years old. As far as cutaneous tumors were concerned, the male pet dogs at all ages, particularly Golden Retrievers (17.39%), showed a high incidence. By contrast, male Samoyed aged from 4 to 13 years had the highest incidence (15.22%) of digestive tumors. In addition, pet dogs with ocular tumors mainly happened at the ages of 0–1 years and 6–13 years. Collectively, our findings are significant to develop effective measures of medical surveillance for pet dogs’ health and will provide insights for comparative oncology.

Reflections on the New Classification of Tumors by the WHO and Changes in Esophageal Cancer in a High-risk Area

In year 2000, a book entitled the Pathology and Genetics of Tumors of the Digestive System was published by the WHO, presenting some new diagnostic criteria and treatment principles. I have analyzed the epidemiologic change of tumors in over 30 years in the high-risk area with esophageal cancer. The following phenomenon was found: accompanied by the sharp decrease in the incidence and mortality of esophageal cancer, there was an increase in the incidence and death rate of stomach cancer involving cardiac cancer. This fact should be considered when analyzing the sharp decrease in esophageal cancer incidence and mortality rate. More attention was given to diagnosis of cardiac cancer; at the same time it is more practical to improve the early screening of cancers. To observe the development of high and low -grade intraepithelial neoplasms will be an urgent task for esophageal cancer research in the high risk area, according to WHO'S new classification.

Population-based affective-disorder-related biomedical/biophysical multi-hyper-morbidity across the lifespan:A 16-year population study

BACKGROUND There are few if any life-span population-based studies of psychiatric disorderassociated biomedical and biophysical disorders and diseases(morbidity).AIM To scope the present state of research regarding the biomedical and biophysical morbidity associated with affective and mental disorder in epidemiological samples,and to examine the life-span relationship between affective disorders and biomedical/biophysical disorders to illustrate a novel approach employing the odds ratio to represent the intensity of biomedical and biophysical morbidity associated in time in a population.METHODS A repeatable systematic literature search of PubMed was represented in summary.Additionally,a regional population-based dataset was constructed and analyzed to represent the age-and sex-specific diagnoses(International Classification of Diseases Version 9,ICD-9)for those with and without affective disorder.The analysis presents a novel index of the relative age-specific frequency of life-span biomedical and biophysical diagnoses associated with affective disorder.RESULTS The volume of biomedical and biophysical morbidity associated with mental disorder literature has increased,yet few studies measure comprehensive temporal hyper-morbidity(over-representation of diseases over time,either before or after the index diagnostic event)in populations.Further,there have been only a few population-based studies examining the morbidity associated with affective disorder and only one that examines the full diagnostic range of lifespan morbidity.Substantial differences arose between males and females with more females than males having greater frequencies of diagnoses.The age-specific distributions of the maximum proportional diagnosis frequency ratios for each sex illustrate the greatest diagnosis-specific differences when comparing the biomedical and biophysical diagnoses of those with and without affective disorder when the same diagnosis was represented in each grouping at the same age.CONCLUSION Clinical research needs to focus on more than one or two comorbid biomedical or biophysical disorders at a time.Comprehensive population-based examination of the lifespan biomedical and biophysical multi-morbidity associated with affective disorder has the potential to directly inform clinical practice.Representing the proportional ratios of age-specific frequency of diagnoses for the full range of ICD-9 diagnoses is a novel analytical model.Diagnostic frequency appears a viable representation of a given disease state,such as affective disorder.Fortunately,the WPA has developed a global education section to better understand the biomedical and biophysical morbidity associated with all psychiatric disorders.This has been identified by the WPA as the psychiatric practice challenge of the 21st century.

陕西省渭南市麻疹流行病学特征调查研究

目的:调查分析渭南市麻疹流行病学特征,为麻疹防控提供科学依据。方法:采用描述流行病学方法分析2009—2022年渭南市麻疹疫情监测资料。结果:2009—2022年渭南市累计报告麻疹病例274例,年均发病率0.37/10万。发病呈明显季节性,主要集中在4~6月,占总病例数的61.31%。年平均发病率前三位的区县依次为韩城市(0.78/10万)、潼关县(0.64/10万)和华州区(0.53/10万)。发病年龄主要为0~1岁,占全部病例数的50.73%。发病人群以散居儿童为主(57.30%)。含麻疹成分疫苗(MCV)接种0剂次、1剂次、≥2剂次以及免疫史不详占比依次为34.31%、8.76%、1.82%、55.11%。结论:渭南市近年来麻疹发病率显著降低,2022年发病率达到历史最低水平,但MCV首针及时率及2剂次覆盖率仍需进一步提升。

Colon and rectal cancer:An emergent public health problem

Colorectal cancer ranks third globally,with a high mortality rate.In the United States,and different countries in Europe,organized population screenings exist and include people between 50 and 74 years of age.These screenings have allowed an early diagnosis and consequently an improvement in health indicators.Colon and rectal cancer(CRC)is a disease of particular interest due to the high global burden associated with it and the role attributed to prevention and early diagnosis in reducing morbidity and mortality.This study is a review of CRC pathology and includes the most recent scientific evidence regarding this pathology,as well as a diagnosis of the epidemiological situation of CRC.Finally,the recommendation from a public health perspective will be discussed in detail taking into account the context and the most current recommendations.

2016-2020年新疆生产建设兵团第四师恶性肿瘤流行病学特征分析

目的:分析新疆生产建设兵团第四师2016-2020年恶性肿瘤流行特征,为恶性肿瘤的防控策略提供科学依据。方法:收集2016-2020年就诊于新疆第四师各级医疗卫生机构的兵团恶性肿瘤患者的病案资料,对患者的性别、年龄和病理类型等临床资料进行分析,计算第四师恶性肿瘤发病率、中标率等指标。结果:2016-2020年在第四师各级医疗卫生机构就诊的兵团新发恶性肿瘤患者共计2612例,年平均粗发病率为244.0/10万,中标率209.5/10万,大体呈上升趋势。女性年均发病率较男性高(246.4/10万vs 241.7/10万),汉族年均发病率较少数民族高(279.9/10万vs 109.7/10万)。全体人群发病年龄存在2个高峰,分别位于50岁和77岁。前10位恶性肿瘤依次为:气管/支气管/肺恶性肿瘤、结直肠恶性肿瘤、乳腺恶性肿瘤、宫颈恶性肿瘤、前列腺恶性肿瘤、胃恶性肿瘤、原发性肝癌、子宫内膜恶性肿瘤、食管恶性肿瘤、甲状腺恶性肿瘤,约占全部病例的73.4%。第四师下辖各单位中发病率前四位的单位有:69团、72团、73团、77团,年均发病率分别为332.4/10万、326.4/10万、307.5/10万、302.7/10万。结论:第四师恶性肿瘤发病率接近全国水平,各辖区流行特征不同,应针对不同性别、年龄、辖区开展早诊早治等综合防控措施。

2011—2020年盐城市居民恶性肿瘤死亡流行病学特征及趋势分析

目的:了解2011—2020年盐城市居民恶性肿瘤死亡流行病学特征及所致过早死亡情况,为防控恶性肿瘤、降低早死概率提供依据。方法:收集2011—2020年盐城市户籍居民恶性肿瘤死亡资料,计算死亡率、年龄别率、标化死亡率、年度变化百分比(APC)、死因构成、减寿年数、早死概率等指标。结果:2011—2020年,盐城市恶性肿瘤累计死亡人数177716例,占总死亡人数的31.96%,是盐城市居民的首要死因。恶性肿瘤年均粗死亡率为217.07/10万,标化死亡率为150.73/10万,APC为-2.84%。恶性肿瘤死亡数及死亡率随年龄增长呈逐年增长趋势,各年龄组男女死亡数构成有差异(CMH趋势性检验χ^(2)=151.39,P<0.001),男性死亡率高于女性(χ^(2)=30.91,P<0.001)。盐城市居民死亡数排名前10的恶性肿瘤依次为肺癌、食管癌、胃癌、肝癌、胰腺癌、直肠癌、脑癌、乳腺癌、宫颈癌、结肠癌,占所有恶性肿瘤死亡总数的86.00%。盐城市居民因恶性肿瘤死亡累计减寿966839.0人年,减寿率13.41%,标化减寿人年数847247.23人年,标化减寿率11.75%,平均减寿年数11.33年。盐城市居民恶性肿瘤所致平均早死率为7.73%,恶性肿瘤总早死率由2011年的8.91%,下降到2020年的6.15%(APC=-4.02%,t=7.92,P<0.001)。结论:恶性肿瘤死亡率、早死概率呈下降趋势,死亡率随年龄增长而上升,男性死亡率高于女性,肺癌位居恶性肿瘤死亡排名首位。不同性别、年龄人群恶性肿瘤死亡分布情况存在差异,对男女不同年龄段人群应采取不同的预防控制措施,减少恶性肿瘤的死亡。

漳州市诏安县2017-2022年法定传染病流行特征分析

目的分析2017—2022年漳州市诏安县法定传染病的流行特征,为制定传染病防控策略提供参考依据。方法通过中国疾病预防控制信息管理系统收集2017—2022年漳州市诏安县法定传染病监测报告数据,采用Excel 2010和描述性流行病学方法分析其流行病学特征。结果诏安县2017—2022年共报告法定传染病13862例,年均发病率为384.42/105,报告发病率呈波动下降趋势(趋势χ2=484.488,P<0.05)。居发病前5位的病种依次为手足口病、流行性感冒、乙肝、肺结核、其它感染性腹泻。2020—2022年的年均发病率与2017—2019年比较,肠道传染病、呼吸道传染病的下降幅度大。5至9月为传染病的发病高峰期,12月至次年1月出现发病次高峰。男性的年均发病率显著高于女性(χ2=809.77,P<0.05);5岁以下年龄组的报告病例数最多;发病人群以散居儿童为主。结论诏安县2017—2022年法定传染病发病率有所下降,但仍应强化传染病监测,加强健康教育宣传,提高公众的防病意识,推广疫苗接种,切实把漳州市诏安县的传染病控制在更低水平。

某院45-59岁住院恶性肿瘤病例统计分析

目的:分析某三甲医院2018年至2022年中年恶性肿瘤住院患者病种构成、年龄及变化趋势,为预防干预该年龄段恶性肿瘤提供依据。方法:通过病案管理系统和SQL语句,采集该医院2018年至2022年45岁至59岁恶性肿瘤住院患者共20097例,依据ICD-10类目分类汇总病种构成,分析年龄、性别分布及疾病变化趋势。结果:45岁至59岁年龄段恶性肿瘤住院患者占恶性肿瘤总住院患者比重呈上升趋势,排名前三位的恶性肿瘤病种为肺癌(17.41%)、甲状腺癌(10.75%)和胃癌(9.33%),前十位病种占比合计达69.62%,女性占比高于男性。多发恶性肿瘤病种随年龄变化有明显差异。结论:2018年至2022年45-59岁年龄段恶性肿瘤发病呈逐年上升趋势,进一步提高对该年龄段恶性肿瘤发病特征的认识,做好预防和诊治工作,是实施健康中国战略的重要环节之一。

重庆市忠县恶性肿瘤流行特征及生存率分析

目的:分析2016年重庆市忠县恶性肿瘤发病、死亡特征及生存率,为开展恶性肿瘤防治提供依据。方法:根据重庆市肿瘤随访登记信息系统报告的忠县新发恶性肿瘤患者随访信息,采用SPSS 25.0统计分析发病率、标化发病率、死亡率、标化死亡率等指标。采用生存分析寿命表法和乘积极限法(Kaplan-Meier)计算观察生存率和平均生存时间,生存率的比较采用logrank of Mantel-Cox进行统计检验。结果:2016年重庆市忠县恶性肿瘤发病率和标化发病率分别为367.63/10万和238.57/10万,恶性肿瘤死亡率和标化死亡率分别为252.90/10万和150.83/10万。对2900例恶性肿瘤患者进行5年随访,随访5年平均生存时间为2.68年,1年、2年、3年、4年、5年生存率分别为50.34%、40.62%、36.21%、33.07%、31.59%,女性恶性肿瘤生存率均高于男性,差异有统计学意义(P<0.001)。结论:重庆市忠县恶性肿瘤的发病率和死亡率较高,生存率较低,应该重视恶性肿瘤的预防、筛查和诊断治疗,加强危险因素和高危人群的控制和干预。

Epidemiological characteristics of central nervous system tumors in children: a 5-year review of 3180 cases from Beijing Tiantan Hospital

Background:To describe the epidemiological characteristics of central nervous system(CNS)tumors in children,based on the neurosurgery department of Beijing Tiantan Hospital.Methods:From January 2015 to December 2019,3180 children were histopathologically diagnosed with CNS tumors based on the 2016 World Health Organization(WHO)classification of tumors.Patients were 0 to 15 years old.We analyzed age-related gender preferences,tumor locations,and the histological grades of the tumors.In addition,the epidemiological characteristics of the five most common intracranial tumors were compared to the previous studies.Results:In this study,intracranial and spinal tumors account for 96.4%(3066)and 3.6%(114)of all tumors,with a preponderance of supratentorial tumors(57.9%).Among all pediatric patients,low-grade tumors comprise 67.1%(2135).The integral gender ratio of males to females is 1.47:1 and the average age of patients is 7.59 years old.The five most common intracranial tumors are craniopharyngioma(15.4%),medulloblastoma(14.3%),pilocytic astrocytoma(11.8%),diffuse astrocytoma(9.8%),and anaplastic ependymoma(4.8%).Conclusions:Due to the lack of national data on childhood brain tumors,we used a large nationally representative population sample based on the largest pediatric neurosurgery center in China.We analyzed the data of the past 5 years,reflecting the incidence of CNS tumors in Chinese children to a certain extent,and laying a data foundation for subsequent clinical studies.

Evaluation of quality of clinical management of neuroendocrine tumors

Background:Neuroendocrine tumors(NETs)are a group of biologically and clinically heterogeneous neoplasms predominantly found in the gastrointestinal and bronchopulmonary tractus.Despite a rising incidence,implementation of evidence-based standardized care for this heterogenous group remains challenging.The European Neuroendocrine Tumor Society regularly reviews guidelines regarding diagnostic and treatment strategies for NETs.The aim of this study is to shed light on the care of patients with a NET in Belgian Limburg,to provide data as a basis for future studies and to check whether data and results are according to consensus guidelines and outcomes described in literature.Methods:Our study concerned a detailed observational data collection of two large Belgian hospitals(Jessa Hospital Hasselt and Hospital Oost-Limburg Genk)with special interest in patient profile,quality of pathology reports,use of diagnostic imaging,and overall survival.Data on 188 patients were assembled between January 2010 and December 2014 with follow-up until June 2016(median follow-up:33.6 months).Results:Fifty percent of patients were male.NETs were located mainly in the digestive tract(63.8%)and lung(20.2%).Appendiceal NETs were diagnosed at a significantly younger age than other tumors(41.3 vs.64.0 years).Overall,a mean pathology report quality score of 3.0/5 was observed with the highest scores for small bowel NETs.Diagnostic and nuclear imaging was performed in 74.5%and 29.8%of cases,respectively.Seventy-four percent of the population survived until the end of the observation period with highest survival rates for appendiceal and small bowel NETs.Conclusion:Overall,epidemiological results were comparable with findings in the literature.Gastrointestinal NETs met most of the requirements of qualitative pathology reporting and diagnostic imaging as listed in the European Neuroendocrine Tumor Society consensus guidelines.However,consensus with regard to bronchopulmonary NETs is still scarce and remains an objective for future research.Moreover,discussing treatment strategies in specialized multidisciplinary tumor boards would facilitate regional care.

Lymph node involvement in pancreatic neuroendocrine tumors: significance as a predictor of survival

Whether regional lymph node involvement exerts significant effect on the prognosis still remains obscure for pancreatic neuroendocrine tumors.To clarify this association and identify predictors for lymph node involvement,we studied the data of patients aged>18 years with regional lymph node involvement histologically confirmed pancreatic neuroendocrine tumors from 2004 to 2014 in the Surveillance,Epidemiology,and End Results database(http://seer.cancer.gov/about).We evaluated Lymph node involvement as a prognostic factor by Cox regression.We reduced 9 variables of demographic and tumor characteristics to 5 potential predictors using least absolute shrinkage and selection operator(LASSO)regression model.We further constructed a lymph node involvement model by logistic regression.The model was verified by the verification set,and the visual expression of the model was realized by a nomogram.A total of 1545 cases of pancreatic neuroendocrine tumors were included in our study.Lymph node positivity was significantly associated with disease-specific survival(P<0.001).Younger patients(P<0.05),patients with tumors in the pancreatic head(P<0.05),patients at high American Joint Committee on Cancer T stage(P<0.001),and patients of an undifferentiated status(P<0.05)showed a significantly higher possibility of developing lymph node involvement.The reliability of this model was verified by cross-validation between the training and testing set,and we obtained good discrimination and calibration power.This model also showed great performance in C-index and area under receiver operating characteristic curve.Lymph node positivity was an important negative prognostic predictor for pancreatic neuroendocrine tumor.We developed a lymph node involvement model based on the predictors including age,marital status,primary site,T status,and tumor grade.

1022例椎管内肿瘤的流行病学分析

目的 分析椎管内肿瘤的流行病学特点,并与既往文献进行对比。方法 回顾性分析2015年1月—2019年12月在南京大学医学院附属鼓楼医院神经外科接受手术治疗并获得病理学诊断的1 022例椎管内肿瘤患者,分析患者年龄、性别、肿瘤部位以及组织学类型之间的相关性。结果 1 022例患者中,男507例(49.6%),女515例(50.4%),男女比例1∶1.02;接受手术治疗时平均年龄(47.19±16.98)岁。常见的七类椎管内肿瘤中,神经鞘瘤557例(54.51%),脊膜瘤145例(14.19%),脂肪瘤34例(3.33%),神经纤维瘤32例(3.13%),海绵状血管瘤32例(3.13%),室管膜瘤31例(3.03%)和星形细胞瘤29例(2.84%);男女比例分别为神经鞘瘤1.15,脊膜瘤0.21,脂肪瘤0.89,神经纤维瘤2.56,海绵状血管瘤1.67,室管膜瘤1.07和星形细胞瘤2.63。结论 既往国内外报道椎管内肿瘤男性较女性多发不同,本研究发现椎管内肿瘤发病总体无明显性别差异,但脊膜瘤女性占明显优势。与西方人群中脊膜瘤占优势不同,本研究结果显示前四位最常见的椎管内肿瘤类型依次为神经鞘瘤、脊膜瘤、脂肪瘤和神经纤维瘤。本研究的临床数据反映了国内椎管内肿瘤的流行病学特点。