Tumor size is a major determinant of recurrence in patients with resectable gastrointestinal stromal tumor

BACKGROUND: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor of the gastrointestinal tract. Surgery remains the mainstay of curative treatment. Recurrence after surgery was frequent and was associated with poor prognosis. In this study, we tried to identify predictors of recurrence in resectable GISTs. METHODS: Between January 1995 and December 2005, 100 patients undergoing surgical resection for GISTs in 2 hospitals were studied. RESULTS: There were 67 gastric and 33 intestinal GISTs. Recurrence was noted in 11 patients (median follow-up of 43 months). Overall 5-year survival was 84%. Multivariate analysis demonstrated that tumor size > or = 10 cm was associated with higher recurrence rates (P = .032) and was the only independent poor prognostic factor for survival (P = .020). CONCLUSIONS: We concluded that tumor size > or = 10 cm carried both a higher risk of recurrence and worse survival in resectable GISTs and could be considered an indicator for adjuvant therapy.     

Prognosis of resected stage I bronchioloalveolar carcinoma of the lung

In this retrospective study, we investigated the prognosis of 25 patients with resected bronchioloalveolar carcinoma (BAC) of 3.0 cm or less in diameter. We assigned a diagnosis of BAC for non-invasive tumors as defined by the World Health Organization (WHO) classification. The patients ranged in age from 47 to 78 years with an average of 64.0 years. Eighteen patients (72%) were male and 7 patients (28%) were female. All the patients underwent complete resection. As the mode of surgical resection, at least lobectomy was performed in 84%. Sections of the resected tumor were stained by HE and Elastica, and then examined by light microscopy. The tumors ranged in size from 0.5 to 3.0 cm with an average of 1.9 cm. Neither pleural involvement nor vascular permeation was seen in BACs. There was also no lymph node involvement for BACs. The 5-year disease-free survival rate of all 25 patients with BAC was 100%. The unequivocally recognizing invasive features by morphology is important for a prospect of the prognosis of resected BACs.     

Predicting prognosis of resected hepatocellular carcinoma by radiomics analysis with random survival forest

Rationale and objectives

To investigate the impact of random survival forest (RSF) classifier trained by radiomics features over the prediction of the overall survival of patients with resectable hepatocellular carcinoma (HCC).

肿瘤大小与早期胃癌预后的关系

目的 探讨早期胃癌的预后因素,特别是肿瘤大小与早期胃癌预后的关系.方法 回顾性分析1998年1月至2002年2月119例在中国医学科学院肿瘤医院外科治疗的早期胃癌的临床病理特征,分析早期胃癌的预后因素.结果 本组早期胃癌病例5年生存率为90.9%,其预后主要与肿瘤大小相关,直径＜2 cm组、2 cm≤直径＜4 cm组与直径≥4 cm组5年生存率分别为100%、92.0%、80.8%,差异有统计学意义,P=0.024.同时比较淋巴结转移及浸润深度等因素,P值分别为0.816及0.371,差异无统计学意义.肿瘤大小与其他预后因素之间无明显相关性.结论 早期胃癌浸润深度及淋巴结转移与其预后关系不明确,而肿瘤大小很可能是早期胃癌独立的预后因素,对指导早期胃癌预后及手术选择有实用价值.     

Ki-67 expression and prognosis for smokers with resected stage I non-small cell lung cancer

BACKGROUND: The cigarette smoking status of patients before surgery is an important prognostic factor in evaluation of stage I non-small cell lung cancer, and the proliferative activity of lung tumors is also related to the patient's prognosis. This study evaluates relationships between various clinicopathologic factors, including tumor proliferative activity and smoking status, and the patient's prognosis in stage I non-small cell lung cancer. METHODS: One hundred eighty-seven stage I adenocarcinoma and squamous cell carcinoma cases were evaluated. The patients underwent complete resection between 1988 and 1993 at Chiba University Hospital. Expression levels of Ki-67 nuclear antigen, p53 protein, and retinoblastoma protein were determined immunohistochemically, and postoperative survival rates for patients in the categories of clinicopathologic factors were estimated. RESULTS: The mean Ki-67 labeling index (LI) for all cases was 19.3%. Labeling index values were significantly higher in squamous cell carcinoma than in adenocarcinoma (p < 0.0001). Postoperative survival of adenocarcinoma patients was significantly related to the LI values and to the patient's smoking status (p = 0.0164 and 0.0268, respectively). The LI values were also related to smoking status and the extent of histologic differentiation (p = 0.0112 and p < 0.0001, respectively). For non-smoking adenocarcinoma patients, higher LI values were associated with abnormalities in p53 expression (p = 0.0048). Retinoblastoma protein abnormalities were not related to LI values. CONCLUSIONS: In smokers with stage I pulmonary adenocarcinoma, tumor proliferative activity and smoking status before surgery were important prognostic determinants. The LI values were related to several clinicopathologic factors.     

肝癌中Transgelin表达与其预后相关

目的 研究肝癌中Transgelin表达水平与肝癌复发及预后的关系.方法 应用Western-blotting技术检测Transgelin在不同转移潜能肝癌细胞系中的表达,以及在临床肝癌手术标本中肝癌、癌旁组织及正常肝组织中的表达,并用免疫组织化学染色验证上述手术标本中Transgelin的表达水平.以Logrank检验及Kaplan-Meier分析其表达水平与肝癌病人总体生存和无瘤生存的关系.结果 Western-blot法显示Transgelin在肝癌高转移潜能细胞系中的表达明显高于低转移潜能细胞系,其在肝癌组织中的表达也明显高于癌旁及正常肝组织,免疫组化结果 与之相类似.Transgelin强阳性表达的病人术后生存率和无瘤生存率明显低于阴性表达者(P<0.01).结论 Transgelin与肝癌转移能力相关,可作为判断预后的指标.     

Comorbidity is a major determinant of severity in acute diverticulitis

BACKGROUND: Acute colonic diverticulitis may be simple or very complicated. Not much is understood about what factors determine severity. Answering this question may have therapeutic implications. METHODS: A retrospective review was performed consisting of teaching hospital admissions for simple or complicated acute diverticulitis. The intent was to identify characteristics of and differences between the 2 groups. The Charlson index was used to assess states of preexisting health (comorbidity). RESULTS: In multivariate analysis, the presence of a major degree of comorbidity (Charlson score 3 or greater) was strongly associated with complicated disease (P = 0.02) as was the use of nonsteroidal anti-inflammatory drugs (P = .01). Deaths were not seen below age 50, and high Charlson score also strongly predicted mortality (P < .0001). CONCLUSIONS: There are significant differences between patients presenting with simple and complicated diverticulitis, and the amount of associated comorbidity (as measured by Charlson score) appears to be a major one. Because of the high mortality seen in patients with Charlson scores 3 or greater and complicated diverticulitis, we believe that an early surgical approach should be considered for them, particularly if they are 50 or older.     

Mitotic index is the best predictive factor for survival of patients with resected hepatocellular carcinoma

BACKGROUND: In patients with hepatocellular carcinoma (HCC), tumor recurrence is not infrequent after resection. It is presumed that characteristics of the tumor such as cellular malignancy might influence the prognosis of the patients in association with tumor stage and radicality of the procedure. METHODS: Univariate and multivariate analyses were used to retrospectively determine the clinicopathologic factors potentially related to survival in 40 patients who underwent hepatectomy for HCC. RESULTS: In univariate analysis, tumor stage I or II, mitotic index of 4 or less/10 random high-power fields, solitary tumor, and curative resection were significantly correlated with better survival. In multivariate analysis, the mitotic index and surgical curability were independently significant variables influencing survival of patients, and the mitotic index was the best predictive factor. A highly significant correlation was found between the mitotic index and Ki-67 labeling index. Compared to tumors with a mitotic index of 4 or less, those with a mitotic index of 5 or more had a higher association with multiple tumors and advanced tumor stage, which preclude curative resection. CONCLUSION: Analysis of the mitotic index is quite simple, and the mitotic index could be a useful factor for predicting the long-term survival of patients with HCC following hepatic resection.     

Race is a major determinant of secondary hyperparathyroidism in uremic patients

In the general population, blacks have higher parathyroid gland mass and circulating parathyroid hormone (PTH) levels than whites. This may predispose black patients to more severe parathyroid disease when renal failure develops. Therefore, racial differences in the severity of uremic hyperparathyroidism were examined in a population of patients with end-stage renal disease (ESRD). Among ESRD patients receiving hemodialysis or peritoneal dialysis, two or more values of intact PTH (immunoradiometric assay, pg/ml) obtained at least 90 d apart were available in 1270 prevalent cases (61.1% blacks, 51% males, and 31.1% diabetic), including 466 incident cases with onset of ESRD after 1993. Maximum PTH levels were analyzed as a function of race, gender, age, diabetic status, and levels of serum calcium, phosphorus, alkaline phosphatase, and aluminum. Using a stepwise multiple regression model, the determinants of maximum PTH in the order of their importance were black race, serum phosphorus, absence of diabetes, younger age, serum calcium, and female gender. The maximum PTH levels averaged 641.7 in blacks and 346.0 in whites after adjusting for age, gender, diabetic status, serum calcium, and phosphorus (P < 0.0001). In blacks compared with whites, the odds ratio (95% confidence interval) for adynamic bone disease (maximum PTH <150 pg/ml) was 0.26 (0.17 to 0.41), whereas the odds ratio for hyperparathyroid bone disease (mean PTH >500 pg/ml) was 4.4 (2.10 to 9.25). Race is a major independent determinant of uremic secondary hyperparathyroidism. Among ESRD patients, blacks may be at an increased risk for hyperparathyroid bone disease and whites for adynamic bone disease.     

A resected case of a small hepatocellular carcinoma developing within the bile duct

We experienced a resected case of a small hepatocellular carcinoma, which required differential diagnosis from intrahepatic cholangiocellular carcinoma. The patient was a 76-year-old man. While his course had been being observed because of hepatitis C antibody-positive liver cirrhosis, ultrasonographic examination of the abdomen revealed dilation of biliary branches in the anterior segment of the liver and a hyperechoic mass 10mm in diameter at the origin of the branch. A dynamic computed tomography scan showed a high-density tumor in the early phase. After embolization of the right branch of the portal vein, resection of the right lobe of the liver and the extrahepatic bile duct was performed. A resected specimen showed a white-colored mass 8mm in diameter at the origin of the anterior segmental biliary branch. In the pathological findings, the diagnosis was a poorly differentiated hepatocellular carcinoma with strong nuclear atypia; the tumor filled the bile duct, forming a trabecular structure. The immunohistological stains of the tumor were positive for cytokeratin (CK) 8, CK18, and HepParl and negative for alpha-fetoprotein, carcinoembryonic antigen, CA19-9, CK7, CK19, and CK20. There was atypia in the biliary lining epithelium adjacent to the tumor, and the hepatocellular carcinoma may have developed from the biliary epithelium.     

术中出血对早期肝细胞癌病人围术期及预后的影响

目的 探讨早期肝细胞癌病人术中出血对病人围术期及预后的影响。方法 回顾性分析2008年1月至2013年12月天津医科大学肿瘤医院行手术切除的222例早期肝细胞癌病人。根据ROC曲线分析,术中出血量≤200 mL的185例为A组,而出血量>200 mL的37例为B组。比较两组有无腹水及感染等并发症发生、住院时间,以及生存时间。结果 两组间在性别、年龄、术前血小板计数、术前凝血酶原时间、术前血清总胆红素水平及肿瘤数和直径等方面无统计学差异（P>0.05）。与出血量>200 mL的B组病人作比较,出血量≤200 mL A组病人的中位生存时间较长,住院时间较短,腹水和感染的发生率较少,差异具有统计学意义（P<0.05）。结论 对于早期肝细胞癌病人,术中大出血可能对围术期并发症发生及远期预后产生不良影响。术中仔细操作,减少出血量非常必要。     

Prognostic significance of histologic findings in resected small hepatocellular carcinoma

Fifty-one patients with histologically proven small (less than 5 cm) hepatocellular carcinoma underwent hepatic resection. In ten cases (group A) the cancer cells were confined within the tumor capsule, in ten (group B) there was extracapsular extension of growth, in 23 (group C) there was also invasion of the portal vein from the main tumor or from satellite nodules, or both, and in eight cases (group D) the findings were the same as in group C but there was no tumor capsule. The mean follow-up period was 54 +/- 12 months, minimum 37 months. The estimated 7-year survival rates in groups A-D were, respectively 100, 47.5, 47.5 and 37.5%. The classification of gross tumor appearance as typical or atypical was fairly well correlated to the histologic pattern in groups A, C and D, but not in group B. Although safety margin at resection did not emerge as a prognostic factor, the group A patients with a good margin were free from tumour recurrence.     

Synchronously resected double primary hepatic cancers - hepatocellular carcinoma and cholangiolocellular carcinoma

The frequency of double primary cancers in the liver is very low. All reported cases are double cancers consisting of hepatocellular carcinoma (HCC) and intrahepatic cholangiocellular carcinoma (CCC). We herein report a surgical patient who had simultaneous double cancers consisting of HCC and cholangiolocellular carcinoma (CoCC). This is the first case report of such a patient. A 70-year-old Japanese man was admitted to our hospital for further examination of two hepatic nodules. He had a history of schistosomiasis japonica, idiopathic pulmonary fibrosis, and diabetes mellitus. Laboratory data revealed that hepatitis C virus (HCV) antibody was positive and hepatic enzymes were slightly elevated. The level of prothrombin induced by vitamin K absence or antagonist II was elevated. Computed tomography depicted two tumors; one, measuring 4.0 cm in diameter, was in the medial segment and the other, 2.2 cm in diameter, was in the posterior superior segment of the liver. The larger tumor showed contrast enhancement and the smaller one showed enhancement at the tumor periphery in the hepatic arterial phase. In the portal phase, the larger tumor became less dense than the liver parenchyma, but the periphery of the smaller one showed continuous enhancement. He underwent an operation under a diagnosis of double hepatic cancers, consisting of HCC and CCC. However, microscopic examination of the resected tumors revealed that the larger tumor was moderately differentiated HCC and the smaller one was CoCC.     

细胞外基质蛋白1在原发性肝癌中的表达与预后的关系

目的 探讨原发性肝癌中细胞外基质蛋白1(extracellular matrix protein 1,ECM1)表达水平与肝癌预后的关系.方法 选取77例原发性肝癌手术切除标本,采用免疫组织化学方法检测ECM1表达,并分析ECM1表达与肝癌临床病理特征及预后与复发的关系.结果 免疫组织化学染色显示ECM1主要表达在胞质中.肝癌组织中ECM1表达阳性率为74.0%(57/77),与肝癌血管侵犯(χ2=6.523,P=0.011)和TNM分级有关(χ2=6.989,P=0.030),而与患者性别、年龄、血清AFP水平、肿瘤大小、癌灶数、分化程度等指标无明显相关性(P＞0.05).ECM1阳性表达患者术后总生存率和无瘤生存率明显低于阴性表达者(P=0.016).多因素分析表明,ECM1表达是影响肝癌总生存和无瘤生存的独立危险因素(RR=3.721,P=0.002;PR=2.323,P=0.031).结论 EC M1的表达与肝癌侵袭转移特性有关,可作为判断肝癌术后预后、复发的指标之一.

Abstract：

Objective To examine the expression of extracellular matrix protein 1 ( ECM1 ) in hepatocellular carcinoma (HCC) and its correlation with prognosis and recurrence of HCC.Methods Immunohistochemistry was used to detect expression of ECM1 in cancerous tissues from 77 HCC patients. The correlation between ECM1 expression and clinicopathologic features and prognosis were analyzed. Results ECM1 is mainly expressed in the cytoplasm of liver cells. The positive rate of ECM1 expression in HCC tissues were 74. 0% (57/77), and the expression level was significantly correlated with vascular invasion (χ2 =6.523, P =0.011 ) and TNM stage (χ2 =6.989, P =0.030). No significant correlation was found between the expression of ECM1 and patient's gender, age, AFP level of plasm, tumor size, number of nodules, and tumor differentiation. Patients with positive ECM1 expression have significantly poorer overall survival (OS) and disease-free survival (DFS) after curative resection than those with negative ECM1 expression (P =0. 016). The Cox multivariate analysis demonstrated that among the factors analyzed, ECM1 expression is an independent prognostic factors for OS and DFS in HCC patients after a curative resection (RR=3.721, P=0.002; RR=2.323, P=0.031). Conclusions Positive ECM1 is correlated with postoperative metastasis and invasion of HCC and poor prognosis.     

低位Ⅰ期直肠癌患者的外科治疗与预后分析

目的探讨低位Ⅰ期直肠癌的外科治疗效果及影响复发和预后的因素。方法回顾性分析166例低位Ⅰ期直肠癌患者的临床资料。结果本组根治性手术138例，均按直肠全系膜切除（TME）手术原则进行；其中93例行腹会阴联合根治术，45例行保肛手术；肿瘤局部切除术28例。局部复发率根治性手术者为5．1％（7／138），其中腹会阴联合根治术组为6．5％（6／93），保肛术组为2．2％（1／45）；局部切除术组为17．9％（5／28）。X^2检验显示，肿瘤分化程度（P=0．009）和手术方式（P=0．039）与局部复发相关。腹会阴联合根治术组5年生存率为90．4％，保肛术组为95．5％。局部切除术组为82．6％。单因素分析显示，肿瘤分化程度（P=0．000）和局部复发（P=0．000）与预后相关；多因素分析显示，局部复发是影响预后的主要因素（P=0．000）。结论低位Ⅰ期直肠癌根治性手术切除复发率低、预后好。局部切除术的选择应严格把握指征。     

血管内皮细胞生长因子是预测肝细胞癌患者术后转移复发的潜在指标

目的　检测肝细胞癌（ＨＣＣ） 患者术前血清血管内皮细胞生长因子（ＶＥＧＦ）水平与ＨＣＣ切除术后转移复发的关系。方法　采用ＥＬＩＳＡ法检测ＨＣＣ患者血清ＶＥＧＦ水平,同时应用Ｗｅｓｔｅｒｎ Ｂｌｏｔ方法对２４ 例相应ＨＣＣ组织ＶＥＧＦ表达水平进行定量分析。结果　高转移复发倾向组ＨＣＣ 患者术前血清ＶＥＧＦ水平（２８３．３３±２６３ ．１５） ｎｇ／Ｌ显著高于低转移复发倾向组（１４７．０４ ±１３２ ．６８） ｎｇ／Ｌ（ Ｐ＜ ０ ．０５） 。Ｗｅｓｔｅｒｎ Ｂｌｏｔ 显示,ＨＣＣ患者血清ＶＥＧＦ水平变化与其对应肿瘤组织ＶＥＧＦ表达变化一致。结论　ＨＣＣ患者术前血清ＶＥＧＦ水平可作为预测ＨＣＣ切除术后转移复发的指标。ＨＣＣ患者血清ＶＥＧＦ水平升高是其对应肿瘤组织高表达的结果。     

Estimation of prognosis after hepatectomy for hepatocellular carcinoma

BACKGROUND: The preferred means of treatment for hepatocellular carcinoma is surgical resection. However, the tumour recurrence rate is high. Accurate estimation of the risk of tumour recurrence after hepatectomy may facilitate the administration of adjuvant therapy after hepatectomy to patients with a high likelihood of tumour recurrence. METHODS: The clinical and pathological profiles of 176 patients undergoing hepatectomy for hepatocellular carcinoma from March 1992 to August 1998 were reviewed. The Kaplan--Meier method and log rank test were used to analyse univariate prognostic factors. The Cox proportional hazard model was used for multivariate analysis. Disease-free and overall cumulative survival rates were estimated with respect to the number of prognostic factors. RESULTS: Independent factors associated with a lower disease-free survival included the presence of venous infiltration, presence of daughter tumours, absence of tumour encapsulation and tumour size exceeding 5 cm. Factors decreasing the overall survival rate included the presence of venous infiltration, absence of tumour encapsulation and surgical resection margin less than 1 cm. The 1-year disease-free survival rate decreased from 77.5(s.e. 5.6) to 14.0(8.5) per cent when the number of risk factors present increased from zero to three. The 5-year survival rate decreased from 60.2(11.7) per cent to zero when the number of risk factors increased from zero to three. CONCLUSION: The deterioration of disease-free or overall survival of patients with hepatocellular carcinoma after hepatectomy correlates with increasing number of risk factors. The number of risk factors can be employed to accurately estimate disease-free and overall survival.     

Tumor size as a simple prognostic indicator for gastric carcinoma

Background: Tumor size can be measured easily before or during operation with no special tools, but its prognostic use in patients with gastric carcinoma is still unclear. Methods: Clinicopathologic data of 479 patients who underwent curative operation for gastric carcinoma were studied. The relationship between tumor size and survival of patients was investigated. Results: The patients were divided into three groups: 182 with tumors measuring <4 cm (group I), 252 with tumors of 4–10 cm (group II), and 45 with tumors of 10 cm (group III). The 10-year survival rates for group I, II, and III patients were 92%, 66%, and 33%, respectively (p<0.01), and the three groups were significantly different with regard to depth of invasion (p<0.01), number and level of lymph node metastasis (p<0.01), and stage of disease (p<0.01). Multivariate analysis indicated that tumor size independently influenced the survival of patients. Conclusions: Tumor size clinically serves as a simple predictor of tumor progression and survival of patients in gastric carcinoma.