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The low resection and high recurrence rates in hepatocellular carcinoma (HCC) are the major challenges to improving prognosis. Neoadjuvant and conversion therapies are underlying strategies to overcome these challenges. To date, no guideline or consensus has been published on the neoadjuvant and conversion therapies in HCC. Recent studies showed that neoadjuvant therapy for resectable HCC and conversion therapy for unresectable HCC are safe, feasible, and effective. Neoadjuvant and conversion therapies have the following advantages in treating HCC: R0 resection with sufficient volume of future liver remnant, relatively simple operation, and wide applicability. Therefore, it was necessary to conduct a widely accepted consensus among the experts in China who have extensive expertise and experience in treating HCC using neoadjuvant and conversion therapies, which is important to standardize the application of neoadjuvant and conversion therapies for the management of HCC. The strategies of neoadjuvant therapy include the selection of the eligible patients, therapy regimen, cycles, effect evaluations, and multidisciplinary treatment. The management of patients with insufficient volume of future liver remnant and patients who cannot achieve R0 resection is the key to the strategies of conversion therapy. Here, we present the resultant evidence- and experience-based consensus to guide the application of neoadjuvant and conversion therapies in clinical practice.

PurposeTo explore the feasibility and safety of centrally located hepatocellular carcinoma (CL-HCC) treated by narrow-margin resection combined with intraoperative electron radiotherapy (IOERT).Methods and MaterialsFrom November 2009 to November 2016, 37 consecutive patients were treated with IOERT as adjuvant treatment during narrow-margin resection for CL-HCC. Long-term outcomes, adverse events for surgery, and acute and chronic toxicities were analyzed.ResultsThe median follow-up was 57.82 months (range, 3.75-111.41 months). A total dose of 15 Gy (range 12 to 17Gy) (prescribed at the 90% isodose) was delivered with a 0.9cm (range 0.8-1.2 cm) median treatment depth targeting the narrow-margin. The 1-year, 3-year and 5-year OS rates were 91.39%, 88.34% and 88.34%, respectively. The 1-year, 3-year and 5-year DFS rates were 80.81%, 68.59% and 54.17%, respectively. In the univariate analysis, none of the treatment characteristics were predictive of overall survival. Fifteen (40.5%) patients suffered from a recurrence event. No patient had marginal recurrence. The 1-year, 3-year and 5-year intrahepatic recurrence rates were 19.75%, 25.92% and 39.58%, respectively. The 1-year, 3-year and 5-year extrahepatic recurrence rates were 2.7%, 5.95% and 9.87%, respectively. There was no 30-day surgical-related death. Three patients had grade 4, and 28 patients had grade 3 alanine aminotransferase (ALT) levels, and seven patients had grade 4, and 30 patients had grade 3 aspartate transaminase (AST) levels. All of them returned to normal within four months. There was no acute radiation-induced liver injury during follow-up. There were no acute or chronic toxicities associated with IOERT.ConclusionIOERT for narrow-margin CL-HCC may achieve good long-term survival outcomes, without significantly increasing acute and chronic toxicities. An IOERT dose of 15Gy may be the safest and most feasible. IOERT might be considered as an adjuvant therapy for CL-HCC patients with a narrow-margin.

OBJECTIVE The aim of this study was to determine whether adjuvant chemotherapy (AC) provides a survival benefit in patients with nonmetastatic poorly differentiated colorectal neuroendocrine carcinomas (CRNECs) following resection. BACKGROUND There is little evidence to support the association between use of AC and improved overall survival (OS) in patients with CRNECs. METHODS Patients with resected non-metastatic CRNECs were identified in the National Cancer Database (2004-2014). Inverse probability of treatment weighting (IPTW) method was used to reduce the selection bias. IPTW-adjusted Kaplan-Meier curves and Cox proportional hazards models were used to compare OS of patients in different treatment groups. RESULTS A total of 806 patients diagnosed between 2004 and 2014 met the study entry criteria. Of these, 394 patients (48.9%) received AC. IPTW-adjusted Kaplan-Meier curves showed that median OS was significantly longer for AC versus observation [57.4 (interquartile range, IQR, 14.8-153.8) vs 38.2 (IQR, 10.4-125.4) months; P = 0.007]. In IPTW-adjusted Cox proportional hazards regression analysis, AC was associated with a significant OS benefit [hazard ratio (HR) = 0.73, 95% confidence interval (CI) 0.64-0.84; P < 0.001]. The results were consistent across subgroups stratified by pathologic T stage, pathologic N stage, and surgical margin status. Subgroup analysis according to tumor location demonstrated improved OS in the adjuvant therapy cohort among patients with left-sided neuroendocrine carcinomas (HR, 0.55; 95% CI, 0.44-0.68), but not in those with right-sided disease (HR, 0.89; 95% CI, 0.74-1.07). CONCLUSIONS Patients with nonmetastatic CRNECs may derive survival benefit from AC. These findings support current guidelines recommending AC in patients with poorly differentiated neuroendocrine carcinomas in the colon and rectum. Efforts in education and adherence to national guidelines for NECs are needed.

ObjectiveThere is little evidence that adjuvant therapy after radical surgical resection of hepatocellular carcinoma (HCC) improves recurrence-free survival (RFS) or overall survival (OS). We conducted a multicentre, randomised, controlled, phase IV trial evaluating the benefit of an aqueous extract of Trametes robinophila Murr (Huaier granule) to address this unmet need.Design and resultsA total of 1044 patients were randomised in 2:1 ratio to receive either Huaier or no further treatment (controls) for a maximum of 96 weeks. The primary endpoint was RFS. Secondary endpoints included OS and tumour extrahepatic recurrence rate (ERR). The Huaier (n=686) and control groups (n=316) had a mean RFS of 75.5 weeks and 68.5 weeks, respectively (HR 0.67; 95% CI 0.55 to 0.81). The difference in the RFS rate between Huaier and control groups was 62.39% and 49.05% (95% CI 6.74 to 19.94; p=0.0001); this led to an OS rate in the Huaier and control groups of 95.19% and 91.46%, respectively (95% CI 0.26 to 7.21; p=0.0207). The tumour ERR between Huaier and control groups was 8.60% and 13.61% (95% CI −12.59 to −2.50; p=0.0018), respectively.ConclusionsThis is the first nationwide multicentre study, involving 39 centres and 1044 patients, to prove the effectiveness of Huaier granule as adjuvant therapy for HCC after curative liver resection. It demonstrated a significant prolongation of RFS and reduced extrahepatic recurrence in Huaier group.Trial registrationNCT01770431; Post-results.

Background: Hepatocellular carcinoma (HCC) (about 85–90% of primary liver cancer) is particularly prevalent in China because of the high prevalence of chronic hepatitis B infection. HCC is the fourth most common malignancy and the third leading cause of tumor-related deaths in China. It poses a significant threat to the life and health of Chinese people. Summary: This guideline presents official recommendations of the National Health and Family Planning Commission of the People’s Republic of China on the surveillance, diagnosis, staging, and treatment of HCC occurring in China. The guideline was written by more than 50 experts in the field of HCC in China (including liver surgeons, medical oncologists, hepatologists, interventional radiologists, and diagnostic radiologists) on the basis of recent evidence and expert opinions, balance of benefits and harms, cost-benefit strategies, and other clinical considerations. Key Messages: The guideline presents the Chinese staging system, and recommendations regarding patients with HCC in China to ensure optimum patient outcomes.

// Chun Guang Guo 1 , Dong Bing Zhao 1 , Qian Liu 1 , Zhi Xiang Zhou 1 , Ping Zhao 1 , Gui Qi Wang 2 , Jian Qiang Cai 1 1 Department of Abdominal Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China 2 Department of Endoscopy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China Correspondence to: Dong Bing Zhao, email: dbzhao2003@sina.com Gui Qi Wang, email: wangguiq@126.com Keywords: gastric cancer, lymph node metastasis, nomogram, endoscopic resection, decision analysis Received: April 05, 2016 Accepted: December 25, 2016 Published: January 14, 2017 ABSTRACT Background: Lymph node status is crucial to determining treatment for early gastric cancer (EGC). We aim to establish a nomogram to predict the possibility of lymph node metastasis (LNM) in EGC patients. Methods: Medical records of 952 EGC patients with curative resection, from 2002 to 2014, were retrospectively retrieved. Univariate and multivariate analysis were performed to examine risk factors associated with LNM. A nomogram for predicting LNM was established and internally validated. Results: Five variables significantly associated with LNM were included in our model, these are sex (Odd ratio [OR] = 1.961, 95% confidence index [CI], 1.334 to 2.883; P = 0.001), depth of tumor (OR = 2.875, 95% CI, 1.872 to 4.414; P = 0.000), tumor size (OR = 1.986, 95% CI, 1.265 to 3.118; P = 0.003), histology type (OR = 2.926, 95% CI, 1.854 to 4.617; P = 0.000) and lymphovascular invasion (OR = 4.967, 95% CI, 2.996 to 8.235; P = 0.000). The discrimination of the prediction model was 0.786. Conclusions: A nomogram for predicting lymph node metastasis in patients with early gastric cancer was successfully established, which was superior to the absolute endoscopic submucosal dissection (ESD) indication in terms of the clinical performance.

// Mu-xing Li 1 , Hong Zhao 1 , Xin-yu Bi 1 , Zhi-yu Li 1 , Xue-song Yao 2 , Huai Li 2 , Zhen Huang 1 , Yue Han 2 , Jian-guo Zhou 1 , Jian-jun Zhao 1 , Ye-fan Zhang 1 , Dong-bin Zhao 1 , Jian-qiang Cai 1 1 Department of Abdominal Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing 100021, P. R. China 2 Department of Interventional Therapies, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing 100021, P. R. China Correspondence to: Jian-qiang Cai, email: caijianqiang@cicams.ac.cn Hong Zhao, email: zhaohong9@sina.com Keywords: LDH, hepatocellular carcinoma, sorafenib, prognosis, HBV endemic area Received: April 07, 2016 Accepted: October 31, 2016 Published: November 17, 2016 ABSTRACT Purpose: Lactate dehydrogenase (LDH), which was an indirect marker of hypoxia, was a potentially prognostic factor in several malignancies. There is a lack of evidence about the prognostic value of serum LDH level in patients with hepatocellular carcinoma (HCC) receiving sorafenib treatment from hepatitis B virus endemic areas. Materials and Methods: A total of 119 HBV-related HCC patients treated by sorafenib from a Chinese center were included into the study. They were categorized into 2 groups according to the cut-off value of pre-treatment LDH, which was determined by the time dependent receiver operating characteristics (ROC) curve for the overall survival. The prognostic value of LDH was evaluated. The relationships between LDH and other clinicopathological factors were also assessed. Results: The cut-off value was 221 U/L. With a median follow up of 15 (range, 3-73) months, 91 patients reached the endpoint. Multivariate analysis proved that pre-treatment serum LDH level was an independent prognostic factor for both overall survival (OS) and progression-free survival (PFS). For patients whose pre-treatment LDH ≥ 221 U/L, increased LDH value after 3 months of sorafenib treatment predicted inferior OS and PFS. And patients with elevated pre-treatment LDH level predisposed to be featured with lower serum albumin, presence of macroscopic vascular invasion, advanced Child-Pugh class, advanced T category, higher AFP, and higher serum total bilirubin. Conclusions: Serum LDH level was a potentially prognostic factor in HCC patients treated by sorafenib in HBV endemic area. More relevant studies with reasonable study design are needed to further strengthen its prognostic value.

Aim The prognostic value of the newly raised objective liver function assessment tool, the albumin-bilirubin (ALBI) grade, in patients with hepatocellular carcinoma (HCC) has not been fully validated. We aimed to compare the performance of ALBI grade with the specific Child-Pugh score in predicting the prognosis in this study. Methods The clinical data of 491 Child-Pugh class A patients who underwent liver resection as the initial therapy from January 2000 to December 2007 in Cancer Hospital, Chinese Academy of Medical Sciences were retrospectively analyzed. The prognostic performance of ALBI and C-P score in predicting the short and long term clinical outcomes was compared. Results ALBI score gained a significantly larger area under the receiver operating characteristic (ROC) curve for predicting the occurrence of severe postoperative complications than that of C-P score. With a median follow-up of 57 months,the 1-year, 3-year and 5-year overall survival (OS) rates of the patients were 92.1%, 65.8% and 45.2%, respectively. Multiple tumors, tumor size and ALBI grade were proved to be the independent prognostic factors for the overall survival in the multivariate analysis. Prognostic performance was shown to be better for ALBI when it was compared to C-P score in terms of both the AIC value and χ2 value of likelihood ratio test. Conclusions ALBI, which is featured by the simplicity and objectivity, gained a superior prognostic value than that of C-P grade in patients with HCC who underwent liver resection. Future well-designed studies with larger sample size were warranted.

Although the National Comprehensive Cancer Network (NCCN) guidelines recommend use of lymph node dissection (LND) in patients with pancreatic neuroendocrine tumors (pNETs) > 2 cm, there is limited evidence to support the association between use of LND and overall survival (OS). Patients with resected pNETs were identified in the National Cancer Database (2004–2014). The inverse probability of treatment weighting (IPTW) method was used to reduce the selection bias. IPTW-adjusted Kaplan–Meier curves and Cox proportional hazards models were used to compare OS of patients in different treatment groups. A total of 2664 patients diagnosed met the study entry criteria. Of these, 2132 patients (80.6%) received LND, with a median of nine nodes removed. Positive nodes were identified in 28.0% of patients who underwent LND. IPTW-adjusted Kaplan–Meier analysis showed that median OS was similar between the LND and LND-omitted groups (152.8 vs. 147.3 months; p = 0.61). In IPTW-adjusted Cox proportional hazards regression analysis, LND was not associated with an OS benefit (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.94–1.42; p = 0.18). The results were consistent across subgroups stratified by clinical T and N stages. Among patients with lymph node metastasis, the number of removed nodes (NRN) above the median was not associated with an improved OS (HR 0.82, 95% CI 0.60–1.13; p = 0.22). LND had no additional therapeutic benefit among patients undergoing resection for pNETs. The present findings should be considered when managing patients with resectable pNETs.

Background: Conflicting results about the association between expression level of excision repair cross-complementation group 1 (ERCC1) and clinical outcome in patients with colorectal cancer (CRC) receiving chemotherapy have been reported. Thus, we searched the available articles and performed the meta-analysis to elucidate the prognostic role of ERCC1 expression in patients with CRC. Methods: A thorough literature search using PubMed (Medline), Embase, Cochrane Library, Web of Science databases, and Chinese Science Citation Database was conducted to obtain the relevant studies. Pooled hazard ratios (HR s) or odds ratios (OR s) with 95% confidence intervals (CI s) were calculated to estimate the results. Results: A total of 11 studies were finally enrolled in this meta-analysis. Compared with patients with lower ERCC1 expression, patients with higher ERCC1 expression tended to have unfavorable overall survival (OS) (HR = 2.325, 95% CI: 1.720–3.143, P < 0.001), progression-free survival (PFS) (HR = 1.917, 95% CI: 1.366–2.691, P < 0.001) and poor response to chemotherapy (OR = 0.491, 95% CI: 0.243–0.990, P = 0.047). Subgroup analyses by treatment setting, ethnicity, HR extraction, detection methods, survival analysis, and study design demonstrated that our results were robust. Conclusions: ERCC1 expression may be taken as an effective prognostic factor predicting the response to chemotherapy, OS, and PFS. Further studies with better study design and longer follow-up are warranted in order to gain a deeper understanding of ERCC1's prognostic value.

Background: Hepatocellular carcinoma (HCC) is a common cancer in China, an area of high hepatitis B virus (HBV) infection. Although several staging systems are available, there is no consensus on the best classification to use because multiple factors, such as etiology, clinical treatment and populations could affect the survival of HCC patients. Methods: This study analyzed 743 HBV-related Chinese HCC patients who received surgery first and evaluated the predictive values of eight different commonly used staging systems in the clinic. Results: The overall 1-, 3-, 5-year survival rates and a median survival were 91.5%, 70.3%, 55.3% and 72 months respectively. Barcelona Clinic Liver Cancer (BCLC) staging systems had the best stratification ability and showed the lowest Akaike information criterion (AIC) values (2896.577), followed by tumor-node-metastasis 7 th (TNM 7 th ) (AIC = 2899.980), TNM 6 th (AIC = 2902.17), Japan integrated staging score (AIC = 2918.085), Tokyo (AIC = 2938.822), Cancer of the Liver Italian Program score (AIC = 2941.950), Chinese University Prognostic Index grade (AIC = 2962.027), and Okuda (AIC = 2979.389). Conclusions: BCLC staging system is a better staging model for HBV infection patients with HCC in Chinese population among the eight currently used staging systems. These identifications afford a large group of Chinese HCC patients with HBV infection and could be helpful to design a new staging system for a certain population.

Background: The liver is the most common site for colorectal cancer (CRC) metastases. Their removal is a critical and challenging aspect of CRC treatment. We investigated the prognosis and risk factors of patients with CRC and liver metastases (CRCLM) who underwent simultaneous resections for both lesions. Methods: From January 2009 to August 2016, 102 patients with CRCLM received simultaneous resections of CRCLM at our hospital. We retrospectively analyzed their clinical data and analyzed their outcomes. Overall survival (OS) and disease-free survival (DFS) were examined by Kaplan-Meier and log-rank methods. Results: Median follow-up time was 22.7 months; no perioperative death or serious complications were observed. Median OS was 55.5 months; postoperative OS rates were 1-year: 93.8%, 3-year: 60.7%, and 5-year: 46.4%. Median DFS was 9.0 months; postoperative DFS rates were 1-year: 43.1%, 3-year: 23.0%, and 5-year 21.1%. Independent risk factors found in multivariate analysis included carcinoembryonic antigen ≥100 ng/ml, no adjuvant chemotherapy, tumor thrombus in liver metastases, and bilobar liver metastases for OS; age ≥60 years, no adjuvant chemotherapy, multiple metastases, and largest diameter ≥3 cm for DFS. Conclusions: Simultaneous surgical resection is a safe and effective treatment for patients with synchronous CRCLM. The main prognostic factors are pathological characteristics of liver metastases and whether standard adjuvant chemotherapy is performed. Key words: Colorectal Cancer; Liver Metastases; Prognosis; Simultaneous Resection

The purpose of this study was to evaluate the prognostic value of lymph node ratio (LNR) in patients with gastric cancer liver metastasis (GCLM) who received combined surgical resection. A retrospective analysis of 46 patients from two hospitals was conducted. Patients were dichotomized into two groups (high LNR and low LNR) by the median value of LNR. The overall survival (OS) and recurrence-free survival (RFS) were analyzed by the Kaplan–Meier method with the log-rank test. The Cox proportional hazard model was used to carry out the subsequent multivariate analyses. And the relationship between LNR and clinicopathological characteristics was assessed. The cut-off value defining elevated LNR was 0.347. With a median follow-up of 67.5 months, the median OS and RFS of the patients were 17 and 9.5 months, respectively. Six patients survived for >5 years after surgery. Patients with higher LNR had significantly shorter OS and RFS than those with lower LNR. In the multivariate analyses, higher LNR and multiple liver metastatic tumors were identified as the independent prognostic factors for both OS and RFS. Elevated LNR was significantly associated with advanced pN stage (P

Assessing the prognosis of patients with hepatocellular carcinoma (HCC) by the number and size of tumors is sometimes difficult. The main purpose of the study was to evaluate the prognostic value of total tumor volume (TTV), which combines the two factors, in patients with HCC who underwent liver resection. We retrospectively reviewed 521 HCC patients from January 2001 to December 2008 in our center. Patients were categorized using the tertiles of TTV. The prognostic value of TTV was assessed. With a median follow-up of 116 months, the 1-, 3-, and 5-year overall survival (OS) rates of the patients were 93.1 , 69.9, and 46.3 %, respectively. OS was significantly differed by TTV tertile groups, and higher TTV was associated with shorter OS (P

Background Little is known about the prognosis of intrahepatic cholangiocarcinoma (ICC) patients with hepatitis B virus (HBV) infection following surgical resection. Methods The clinico-pathological data of 40 consecutive ICC patients including 29 patients with HBV infection were analyzed after surgical resection. Results Of all 40 ICC patients, the overall 1-, 3-, 5-year survival rates and a median survival for 29 (74.4%) patients with current or previous HBV infection were 78.9%, 42.8%, 35.7%, and 32.0 months, respectively. Twenty-nine (74.4%) patients with HBV infection, represented by HBsAg+ or anti-HBc+, had a better prognosis than 10(25%) patients without HBV infection represented by all markers-negative. Compared with 10 (25%) patients without HBV infection, 11 (27.5%) ICC patients with HBsAg+ had a better prognosis as well. Additionally, lymph node metastasis were identified as an independent predictors of poor overall survival on multivariate analysis in the study of all the 40 patients and 29 patients with HBV infection. Conclusions Patients with current or previous HBV infection, represented by HBsAg+ or anti-HBc+, had significantly better prognosis than patients without HBV infection. Patients with HBV infection should be distinguished from other ICC patients, because of their favorable outcome after surgery. J. Surg. Oncol. 2010; 101:233–238. © 2010 Wiley-Liss, Inc.

Background Conflicting results about the prognostic value of surgical margin status in patients with intrahepatic cholangiocarcinoma (ICC) have been reported. We aimed to assess the association between surgical margin status and prognosis in ICC through a meta-analysis. Materials and methods We conducted a literature search of the articles evaluating the prognostic value of surgical margin status in patients with ICC. The pooled estimation of the hazard ratio (HR) with the 95% confidence interval (CI) was performed to determine the influence of surgical margin status on the survival outcome. Results A total of 21 studies involving 3201 patients were finally included into the meta-analysis. The percentage of patients with positive surgical margin ranged from 7.2% to 75.9% in the enrolled studies. The pooled estimates showed that patients with positive surgical margin had inferior overall survival (HR: 1.864; 95% CI: 1.542–2.252; P P = 0.041) than patients with negative ones. The subgroup analyses and sensitivity analyses were consistent with the overall results. Conclusions Patients with negative surgical margin had significantly favorable overall survival and progression-free survival after surgical resection for ICC. The notion of achieving the R0 resection should be emphasized.

The prognostic value of the newly raised objective liver function assessment tool, the albumin-bilirubin (ALBI) grade, in patients with hepatocellular carcinoma has not been fully validated. We aimed to compare the performance of ALBI grade with the specific Child-Pugh (C-P) score in predicting prognosis in this study.The clinical data of 491 C-P class A patients who underwent liver resection as initial therapy from January 2000 to December 2007 in Cancer Hospital, Chinese Academy of Medical Sciences (Beijing, China) were retrospectively analyzed. The prognostic performances of ALBI and C-P score in predicting the short- and long-term clinical outcomes were compared.The ALBI score gained a significantly larger area under the receiver operating characteristic curve for predicting the occurrence of severe postoperative complications than that of C-P score. With a median follow-up of 57 months, the 1-year, 3-year, and 5-year overall survival rates of the patients were 92.1%, 65.8%, and 45.2%, respectively. Tumor number, tumor size, and ALBI grade were proved to be the independent prognostic factors for overall survival in the multivariate analysis. Prognostic performance was shown to be better for ALBI grade when it was compared to C-P score in terms of both the Akaike information criterion value and χThe ALBI grade, which was featured by simplicity and objectivity, gained a superior prognostic value than that of C-P grade in patients with hepatocellular carcinoma who underwent liver resection. Future well-designed studies with larger sample sizes are warranted.

Gastrectomy was reported to be an excessive approach for early gastric cancer with signet ring cell carcinoma. This study was conducted to explore the feasibility of endoscopic submucosal dissection for early gastric with signet ring cell carcinoma. Data from 1067 patients who underwent gastrectomy for early gastric cancer were collected retrospectively. The association between the clinicopathological factors and the lymph node metastasis was analyzed by univariate and multivariate logistic regression analyses. Lymph node metastasis was confirmed in 17.2 % (184/1067) of patients. Meanwhile, the incidence of lymph node metastasis with each histology type was 13.1 % (26/198), 9.8 % (34/347), and 23.8 % (124/522) for signet ring cell carcinoma, differentiated carcinomas, and undifferentiated carcinomas, respectively. Signet ring cell carcinoma occurs more in women and young patients, with a higher predominance for mucosa. Various factors—including sex, tumor size, depth of tumor, and lymphovascular invasion—were found to be associated with lymph node metastasis for signet ring cell carcinoma (P

AIM: To analyze the clinicopathologic characteristics and prognostic factors of rectal neuroendocrine tumors. METHODS: The records of 48 patients with rectal neuroendocrine tumors who were treated at the Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, from March 2004 to September 2009 were retrospectively reviewed. The clinicopathological data were extracted and analyzed, and patients were followed-up by telephone or follow-up letter to determine their survival status. Follow-up data were available for all 48 patients. Uni- and multivariate Cox regression analyses were performed to determine the prognostic factors significantly associated with overall survival. RESULTS: The tumors occurred mostly in the middle and lower rectum, and the most prominent symptoms experienced by patients were hematochezia and diarrhea. The median distance between the tumors and the anal edges was 5.0 ± 2.257 cm, and the median diameter of the tumors was 0.8 ± 1.413 cm. The major pathological type was a typical carcinoid tumor, which accounted for 93.8% (45/48) of patients. Tumor-node-metastasis (TNM) stages I, II, III and IV tumors accounted for 78.8%, 3.9%, 9.6% and 7.7% of patients, respectively. The main treatment method, in 72.9% (35/48) of patients, was transanal extended excision. The 1-, 3- and 5-year survival rates of the whole group of patients were 100%, 93.7%, and 91.3%, respectively. Univariate analysis showed that age (P = 0.032), tumor diameter (P < 0.001), histological type (P < 0.001), TNM stage (P < 0.001), and surgical approach (P = 0.002) were all prognostic factors. On multivariate analysis, only the pathological type was shown to be an independent prognostic factor (HR = 2.797, 95%CI: 1.676-4.668, P = 0.004). CONCLUSION: In patients with rectal neuroendocrine tumors, TNM stage I is the most common stage found, and lymph node or distant metastases are rarely seen. The pathological type of the tumor is an independent prognostic factor.

To explore the clinicopathological characteristics of rectal gastrointestinal stromal tumors (GISTs) and elucidate their associated prognostic factors.The clinicopathological data were collected for 27 patients with rectal gastrointestinal stromal tumors at our hospital from January 2000 to December 2011. Univariate analyses were performed to evaluate the prognostic factors.Changed habit of discharge and hematochezia were the most common symptoms. Most GISTs were localized in lower rectum. The 1, 3 and 5-year progression-free survival (PFS) rates were 85.19%, 65.04% and 52.04% respectively. Overall survival (OS) and PFS rates were significantly correlated with incisional margin and invasion of surrounding organs. There was no significant difference in PFS and OS between different resection procedures.Due to the limitation of cases multivariate survival analysis can not be performed.Incisional margin and invasion of surrounding organs are two important prognostic factors. And transanal excision is both safe and effective for those properly indicated patients.

To investigate the clinicopathological features and prognostic factors of primary clear cell carcinoma of the liver (PCCCL).The clinical data of 41 PCCCL patients who underwent hepatic resection for PCCCL from October 1998 to June 2012 in our department were retrospectively analyzed. There were 31 male and 10 female patients. The median age was 56 years (range, 25 to 80 years), and the diagnosis was confirmed by postoperative pathological examination. The data of 106 well or moderately differentiated non-clear cell hepatocellular carcinoma (HCC) patients and 86 poorly differentiated non-clear cell HCC patients who underwent hepatic resection in the same period in our hospital in the same period were compared. The χ(2) test or Fischer's exact test, as appropriate, was used to compare group frequencies. Survival analysis was estimated by Kaplan-Meier method. Cox proportional hazards model was used in multivariate analysis.The proportion of fibrous capsule formation in the PCCCL tumors (46%, 19/41) was significantly higher than that of the other two groups (P0.05), whereas the PCCCL group had a lower rate of intravascular tumor embolus (2/41) and vascular invasion (1/41) (P0.05). The median survival time of PCCCL group was 65 months, the 1-, 3-, 5-year survival rates for PCCCL patients were 90.2%, 67.4% and 42.0%, significantly better than that of poor differentiated NCCHCC group's (82.9%, 33.3%, 7.2%, P0.01). However, there were no statistic significant differences between PCCCL group and well or moderately differentiated NCCHCC group (84.7%, 55.7%, 34.4%, P0.05). Tumor capsule formation was an independent favorable prognostic factor. In contrast, preoperative serum α-fetoprotein (AFP) level and hepatitis B virus infection were independent unfavorable prognostic factors for PCCCL.PCCCL is a rare, low degree malignant pathological subtype of HCC. Surgical resection may achieve favorable prognosis and even long-term survival.

To assess the value of application of percutaneous radiofrequency ablation (RFA) with artificial hydrothorax for liver cancer in the hepatic dome.Thirty-two patients with 43 lesions of hepatic malignant tumors in the hepatic dome underwent ultrasound-guided percutaneous radiofrequency ablation (RFA) with artificial hydrothorax. Artificial hydrothorax was created by infusion of saline via an intrathoracically placed 14-G central venous catheter, which was ultrasound-guided percutaneously inserted before RFA, separating the right lung from the hepatic dome. The adverse reaction and therapeutic efficacy were also analyzed.In the 32 patients with 43 lesions in the hepatic dome (4 tumors in segment IV 21 tumors in segment VII and 18 tumors in segment VIII), 18 lesions of 14 patients were not observed by ultrasound before the operation. Thirty-two patients received the ultrasound-guided placement of intrathoracical catheter, and (1606.3 ± 485.9) ml (1000 - 2500 ml) saline solution was infused successfully. After obtaining an image of the whole tumor, 31 patients received percutaneous RFA therapy on schedule, and 22 patients received percutaneous transdiaphragmatic RFA therapy. One patient with 2 lesions gave up the treatment, because one of his tumors was not detectable by ultrasound. Diaphragmatic muscle hemorrhage was seen in two patients, subcutaneous edema in two patients, and pneumothorax in one patient. All the complications were cured, and no serious complications or related death occurred. 1-month follow-up with contrast-enhanced CT/MRI images showed that 29 patients had complete ablation, and the effective rate of this technique was 93.5% (29/31).Artificial hydrothorax helps us not only to visualize the whole tumor in the hepatic dome, but also offers a transdiaphragmatic route for therapy. Ultrasound-guided percutaneous RFA with artificial hydrothorax is a feasible, safe, and effective technique for treating liver cancer in the hepatic dome and worthy of being promoted.

To assess the value of an infusion-based separation technique to assist in ultrasound (US)-guided percutaneous radiofrequency ablation (RFA) of liver cancers abutting the liver edge.Twenty-four cases of malignant liver tumors abutting the hepatic edge were treated with US-guided puncture accompanied by the assistant infusion technique. The US-guided puncture was made with a 22-G needle through the hepatic tissue and into the abdominal cavity near the target tumor. Infusion of a saline solution was used to separate the liver from any surrounding structures so that percutaneous RFA could be safely performed. Complications, including gastrointestinal injury, hemorrhage and death, were recorded. Technical efficacy and safety were evaluated.Among the 24 patients, the target tumors were adjacent to the right kidney (n=6), colon (n=6), stomach (n=5), pericardium (n=4), and gall bladder (n=3). Twenty-three patients received a successful radical percutaneous RFA with assistant infusion. The assistant infusion volumes ranged from 80-390 ml and created spaces ranging from 0.8-2.5 cm between the liver and surrounding structures. Five of the cases with tumors adjacent to the stomach or colon received the largest volume infusions. The infusion failed to create a separation space in only one case, due to the presence of an adhesion; as a result, this patient was treated with palliative RFA. The mean hospital stay for all 24 patients was four days after surgery. No severe complications or deaths occurred. At 1-month follow-up, computed tomography images showed that 22 cases had complete ablation, yielding a technical success rate of 95.7% (22/23). No needle track implantation was observed.Assistant infusion for percutaneous radiofrequency ablation creates a protective space between the liver and surrounding structures in patients with liver tumors abutting the liver edge. This safe and effective assistant technique broadens the range of patients available for percutaneous RFA treatment.

To evaluate the clinical characteristics and survival factors of patients with duodenal gastrointestinal stromal tumors (GIST).The clinical data of 41 patients with duodenal GIST were analyzed retrospectively at Cancer Hospital and Institute, Chinese Academy of Medical Sciences from June 1996 to August 2011. Kaplan-Meier method was used to calculate the recurrence-free survival rate and the Cox proportional hazard regression model employed for the recurrence-free survival analysis.The lesions of duodenal GIST were predominantly located in the descending (n = 26, 63.4%) and transverse portions (n = 10, 24.4%). Most duodenal GIST presented commonly with upper gastrointestinal bleeding (n = 18, 43.9%) and 12 cases (29.3%) were incidentally detected by physical examinations. Eight patients underwent pancreatoduodenectomy and 27 limited resection. The tumor size varied from 0.6 cm to 30.0 cm (mean: 8.4 cm). The recurrence-free survival rates analyzed by Kaplan-Meier method at 1, 2 and 5-year were 94.1%, 77.5% and 65.0% respectively. The results of Cox proportional hazards regression model indicated that the patients with10/50 HP mitotic count showed a worse recurrence-free survival than those with ≤ 10/50 HP (HR = 3.7, 95%CI 1.0 - 13.7, P = 0.049). After adjusting other confounding factors, mitotic activity was one significant prognostic factor of recurrence (P = 0.024). There was no significant association between the risk of recurrence and other prognostic factors, including diagnostic age, tumor size, type of operation and the risk of aggressive behaviors (all P0.05).Mitotic activity is one prognostic factor of duodenal GIST. And R(0) resection should be regarded as an optional treatment for duodenal GIST.

To explore and improve the diagnosis and treatment of benign hyperplasia tumor-like hepatic lesion.The clinical data of 72 patients who had undergone hepatic resection for benign non-cystic hepatic lesions between January 1987 and December 2010 were analyzed retrospectively. There were 46 male and 26 female patients. The median age was 49 years (ranging 15 to 72 years), and diagnosis were confirmed by postoperative pathological examination. Thirty-four cases had symptoms, such as abdominal discomfort in right upper quadrant, fever, fatigue. All the cases had undergone hepatic resection; totally 78 lesions were removed. The surgical procedure including hepatic lobectomy for 13 cases, hepatic segmentectomy for 19 cases and non-anatomy resection for 39 cases.The finally diagnosis included focal nodular hyperplasia in 47 cases, adenomatous hyperplasia in 3 cases, hepatic dysplastic nodule in 3 cases, inflammatory pseudotumor in 3 cases, hepatic granuloma in 4 cases, nodular cirrhosis in 3 cases, hepatitis nodule in 6 cases, nodular regenerative hyperplasia in 1 case, lymphoid hyperplasia in 1 case. The postoperative complication rate was low (19.4%, 14/72). The follow-up period was 6 to 96 months. There was no mortality caused by lesion. One patient developed recurrence after 3 years.It is suggested that symptomatic lesions, lesions when malignancy cannot be excluded, and lesions which have canceration tendency, just like adenomatous hyperplasia, dysplastic nodule, and nodular cirrhosis regenerative hyperplasia need surgical resection. Operation is not necessary for other nodular hyperplasia lesions if the diagnoses are identified.

Conflicting results about the prognostic value of Glasgow Prognostic Score (GPS) in hepatocellular carcinoma (HCC) patients have been reported. We searched the available articles and performed the meta-analysis to clarify the predictive value of GPS in HCC patients' outcome.A systematic literature search was conducted using PubMed (Medline), Embase, Cochrane Library, Web of Science, ChinaInfo, and Chinese National Knowledge Infrastructure for all years up to September 2015. Studies analyzing the relationship of GPS and survival outcome were identified. Hazard ratio (HR) with 95% confidence interval (CI) was calculated to assess the risk.A total of 10 studies were finally enrolled in the meta-analysis. The pooled estimates demonstrated a significant relationship between elevated GPS and inferior overall survival in patients with HCC (HR = 2.156, 95% CI: 1.696-2.740, P < 0.001). Patients with increased GPS had a tendency toward shorter progression-free survival (HR = 1.755, 95% CI: 0.943-3.265, P = 0.076). And elevated GPS was found to be significantly associated with advanced Child-Pugh class (odds ratio = 25.979, 95% CI: 6.159-109.573, P < 0.001). The publication bias analysis revealed that there was publication bias in the meta-analysis.Glasgow Prognostic Score may be an independent prognostic factor in patients with HCC. More well-designed studies with adequate follow-up duration are warranted.

To investigate the influence of combined hepatectomy with splenectomy on safety of operation for hepatocellular carcinoma patients complied with cirrhosis and hypersplenism and the best peri-operative treatment of these patients.Clinical data of 177 hepatocellular carcinoma patients complied with cirrhosis and hypersplenism admitted from January 1999 to December 2009 were analyzed retrospectively. Among which, 71 patients received concomitant splenectomy with hepatectomy (splenectomy group), 106 patients only receive a hepatectomy (non-splenectomy group). The safety of operation, complications, liver function and WBC and PLT counts were compared between the two groups.There was no significant difference of general conditions, counts of WBC and PLT between the two groups before operation. The counts of PLT at 1, 10, 30 day after operation were (88.4 ± 23.6) × 10⁹/L, (345.3 ± 98.2) × 10⁹/L and (210.8 ± 92.2) × 10⁹/L respectively in splenectomy group, which were significantly higher than that of non-splenectomy group (P0.05). The operation time of splenectomy group was (216 ± 105) min, which was longer than that of non splenectomy group (P0.05), but the blood loss and transfusion rate had not significantly difference between the two groups. The complication rates of splenectomy group and non-splenectomy group were 11.3% and 6.6% respectively, there was no significant difference between the two groups.Combined hepatectomy with splenectomy will be safe for hepatocellular carcinoma patients complied with cirrhosis and hypersplenism as if the operative indication and increase the ability of peri-operative treatment are strictly obeyed.

Little is known about the prognosis of intrahepatic cholangiocarcinoma (ICC) patients with hepatitis B virus (HBV) infection following surgical resection.The clinico-pathological data of 40 consecutive ICC patients including 29 patients with HBV infection were analyzed after surgical resection.Of all 40 ICC patients, the overall 1-, 3-, 5-year survival rates and a median survival for 29 (74.4%) patients with current or previous HBV infection were 78.9%, 42.8%, 35.7%, and 32.0 months, respectively. Twenty-nine (74.4%) patients with HBV infection, represented by HBsAg(+) or anti-HBc(+), had a better prognosis than 10(25%) patients without HBV infection represented by all markers-negative. Compared with 10 (25%) patients without HBV infection, 11 (27.5%) ICC patients with HBsAg(+) had a better prognosis as well. Additionally, lymph node metastasis were identified as an independent predictors of poor overall survival on multivariate analysis in the study of all the 40 patients and 29 patients with HBV infection.Patients with current or previous HBV infection, represented by HBsAg+ or anti-HBc+, had significantly better prognosis than patients without HBV infection. Patients with HBV infection should be distinguished from other ICC patients, because of their favorable outcome after surgery.

To analyze the clinicopathologic factors influencing the outcome of surgically treated intrahepatic cholangiocarcinoma (ICC) and to explore the proper treatment choice of ICC.The clinicopathological data of 43 surgically treated ICC patients in our hospital were retrospectively analyzed. Of the 43 patients, hepatic resection was performed in 40 patients, ethanol injection in 2, and laparoscopic exploration alone in 1. Kaplan-Meier method and Cox regression model were used for the analysis of factors influencing survival after operation.The accumulative 1-, 3- and 5-year survival rates were 64.4%, 30.9%, 25.8% for the whole group, and 74.7%, 33.3%, 27.8% for the 40 patients with hepatic resection, respectively. Univariate analysis revealed that tumor size, carcinoembryonic antigen (CEA) level, lymph node involvement and TNM stage were factors significantly affecting the survival (P0.05). Cox multivariate analysis demonstrated that only tumor size and lymph node involvement were the independent factors significantly affecting the survival (P0.05).Our results show that tumor size and lymph node involvement are independent factors affecting the survival. CEA level and TNM stage are important prognostic factors for surgical management. Radical resection is still the optimal treatment for patient with intrahepatic cholangiocarcinoma.

To investigate the clinicopathological factors affecting lymph node metastasis in early gastric cancer(EGC).Clinicopathological data of 369 patients with EGC from Jan. 1999 to Jun. 2008 were analyzed retrospectively. Multivariate analysis was performed to find the risk factors affecting lymph node metastasis.The age, gender, tumor size, invasion depth, histological classification and vascular cancer thrombosis were associated with lymph node metastasis. Multivariate analysis showed that tumor size and depth of invasion were main independent risk factors.The main independent risk factors affecting lymph node metastasis in EGC are tumor size and invasion depth. The gender, vascular cancer thrombosis, tumor size, invasion depth and histological classification should be considered to establish the surgical program.

To explore the diagnosis, treatment, and prognostic factors of liver sarcoma.The clinical data of 16 liver sarcoma patients, 9 males and 7 females, aged 46.7 (12-73), treated 1980-2005, were analyzed retrospectively.The most common symptoms were right upper quadrant pain (56.3%) and mass in the right upper abdomen (56.3%). Alpha fetoprotein (AFP) was negative in all the patients. None was correctly diagnosed by imaging examination preoperatively. Fifteen patients underwent surgical treatment, including radical operation in 7 patients (46.7%) and palliative resection/biopsy in 8 patients. 1 patient took transcatheter hepatic arterial chemo-embolization rather than operation because of multifocal tumor. Pathological analysis diagnosed 6 patients (37.5%) as with leiomyosarcoma, 5 patients (31.25%) with angiosarcoma, 2 patients (12.5%) with fibrosarcoma, 1 patient (12.5%) with epithelioid hemangioendothelioma, 1 patient (12.5%) with myxoid liposarcoma, and 1 patient (12.5%) with undifferentiated embryonal sarcoma. The 1-year, 3-year, and 5-year survival rates were 71.4%, 41.7%, and 33.3% respectively. The 1-year, 3-year, and 5-year survival rates of the patients who received R0 were 100.0%, 83.3%, and 66.7% respectively, all significantly higher than those of the patients who did not receive R0 (all P = 0.011). The 1-year, 3-year, and 5-year survival rates of the patients with the tumor size5 cm were 100%, 100%, and 75% respectively, all higher than those of the patients with the tumor size5 cm, however, not significantly (all P = 0.084).Liver sarcoma is difficult to be diagnosed preoperatively. Surgical resection is the mainstay of the treatment of liver sarcoma. R0 and tumor size are of prognostic values.

To investigate the diagnosis and treatments of malignant melanoma in gastrointestinal tract.The clinical data of 70 cases of malignant melanoma in gastrointestinal tract treated between July 1965 and June 2007 were collected and analyzed.There were 27 male and 43 female patients in this group with a median age of 53 years. The melanoma arose from rectum in 50 cases, from anus in 10 cases and from esophagus in 10 cases. The overall 1, 3, 5 years survival rate were 48.3%, 14.6% and 6.5%, respectively, the median survival time was 379 days. Sixty-three cases received operations with or without adjuvant therapy after the operation. There was no significant differences in overall survival rate between the 25 cases received operation only (Group 1) and 38 cases supplemented by adjuvant therapy after operation (Group 2); whereas, the cases with clinical stage III tumor in Group 2 had significantly better survival than their counterparts in Group 1. It was found that the depth of tumor invasion was the risk factor of patient's prognosis on multivariate Cox regression analysis.Operation combined with adjuvant therapy can improve the survival of the patient with stage III melanoma in gastrointestinal tract. The depth of tumor invasion is a risk factor of survival in these patients.

To investigate the effectiveness of anatomic method of separation in hepatectomy methods of decreasing postoperative complication and mortality for liver cancer patients.The clinical data of 398 patients with liver malignant tumors, admitted in our hospital during 2001 to 2007, were retrospectively analyzed. The anatomic method group (group A) included 243 contiguous patients of liver cancer who received hepatectomy by anatomical method of separation, while the traditional method group (group B) included 155 patients of liver cancer who received hepatectomy by traditional method of separation during the same period. Blood loss and transfusion during operation, postoperative liver function, complication and mortality of operation, and postoperative hospital stay were compared between these two groups.In group A, the tumor diameters ranged (6.02 +/- 3.24) cm, the operative blood loss was (445 +/- 240) ml, and 52 patients (24.3%) underwent blood transfusion [range: (520 +/- 280) ml]. No mortality and intraabdominal hemorrhage, liver function failure, or other severe complications were noted. Only 12 patients (4.9%) suffered mild complications. The postoperative hospital stay was (13.4 +/- 4.9) days. In group B, the tumor diameters ranged (5.84 +/- 2.93 cm, the operative blood loss was (1200 +/- 320) ml, and 53 patients (34.2%) underwent transfusion [range: (1400 +/- 623) ml]. Five patients (3.23%) died within 30 days after operation. The total complication morbidity was 16.1% (25/155). Five patients suffered intraabdominal hemorrhage and 5 experienced liver function failure. Postoperative hospital stay was (18.9 +/- 10.3) days. The volume of blood loss and transfusion in group A were significantly less than in group B (P0.05). Mortality, severe complications, and total complication morbidity were significantly lower in group A than in group B (P0.05, P0.01). The postoperative stay was also significantly shorter in group A than in group B (P0.05).Anatomical method of separation is an effective method of hepatectomy with relatively low complication and mortality.

To investigate the surgical treatment and prognosis for recurrent colon cancer after curative resection.The clinical data of 102 recurrent colon cancer cases from January 1997 to December 2005 were analyzed retrospectively. Obtained data were analyzed by Statistical Package for the Social Sciences (Release 11.5, SPSS, Inc). The related factors were underwent chi2 analysis,survival analysis were estimated using the Kaplan-Meier method and compared using the Log-rank test. COX regression was used in multivariate analysis.Univariate analysis revealed that obstruction of primary tumors, CEA level before reoperation, number of recurrence, time of recurrence, and reoperation type were significant statistically. COX regression analysis revealed that number of recurrence, reoperation type was the most important prognostic factor.The recurrent colon cancer still need active surgical treatment in order to prolong the survival time.

Objective The definite prognostic role of p-STAT3 has not been well defined. We performed a meta-analysis evaluating the prognostic role of p-STAT3 expression in patients with digestive system cancers. Methods We searched the available articles reporting the prognostic value of p-STAT3 in patients with cancers of the digestive system, mainly including colorectal cancer, gastric cancer, hepatocellular carcinoma, esophagus cancer and pancreatic cancer. The pooled hazard ratios (HRs) with 95 % confidence intervals (95 % CIs) of overall survival (OS) and disease-free survival (DFS) were used to assess the prognostic role of p-STAT3 expression level in cancer tissues. And the association between p-STAT3 expression and clinicopathological characteristics was evaluated. Results A total of 22 studies with 3585 patients were finally enrolled in the meta-analysis. The results showed that elevated p-STAT3 expression level predicted inferior OS (HR=1.809, 95% CI: 1.442-2.270, P