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It remains controversial whether adjuvant therapy should be delivered to pathological T3N0M0 rectal cancer without neoadjuvant chemoradiotherapy. Thus identification of patients at high risk is of particular importance. Herein, we aimed to evaluate whether the absolute peripheral blood monocyte count can stratify the pathological T3N0M0M0 rectal cancer patients in survival. A total of 270 pathological T3N0M0 rectal cancer patients with total mesorectal excision-principle radical resection were included. The optimal cut-off value of preoperative monocyte count was determined by receiver operating characteristic curve analysis. Overall survival and disease-free survival between low- and high-monocyte were estimated by Kaplan-Meier method and Cox regression model. The optimal cut-off value for monocyte count was 595 mm(3). In univariate analysis, patients with monocyte counts higher than 595/mm(3) had significantly inferior 5-year overall survival (79.2 vs 94.2 %, P = 0.006) and disease-free survival (67.8 vs 86.0 %, P < 0.001). With adjustment for the known covariates, monocyte count remained to be associated with poor overall survival (HR = 2.55, 95 % CI 1.27-5.10; P = 0.008) and disease-free survival (HR = 2.63, 95 % CI 1.48-4.69; P = 0.001). Additionally, the significant association of monocyte count with disease-free survival was hardly influenced in the subgroup analysis, whereas this correlation was restricted to the males and patients with normal carcinoembryonic antigen (CEA) level (<5 μg/L), tumor grade II, and with adjuvant therapy. High preoperative monocyte count is independently predictive of worse survival of pathological T3N0M0 rectal cancer patients without neoadjuvant chemoradiotherapy. Postoperative adjuvant therapy might be considered for patients with high-monocyte count.

Background: The optimal interval between neoadjuvant chemoradiotherapy (CRT) and surgery has yet to be established. Additionally, it is unknown whether patients with different pathologic stages or chemoradiation responses should undergo different intervals between CRT and surgery. Therefore, the purpose of this study was to evaluate whether this interval has a differential effect on the oncologic outcome of patients with different chemoradiation responses or pathologic stages., Methods: We performed a retrospective study of 291 rectal cancer patients who were treated with preoperative chemoradiation and surgery between March 2004 and November 2012. All patients were separated into two groups according to a 7-week treatment interval. Overall survival (OS) and disease-free survival (DFS) were compared between patients undergoing intervals that were shorter and longer than 7 weeks in the entire group and in subgroups of ypT0-2N0, ypT3-4N0 and ypT0-4N+. The recurrence patterns were also analysed in all of the subgroups. Multivariate analysis was performed to explore the clinical factors that were significantly associated with DFS, local recurrence-free survival (LRFS) and distant metastasis-free survival among patients exhibiting ypT3-4N0 and ypT0-4N+., Results: For the ypT0-2N0 patients, the 5-year OS and DFS and the rates of local and distant recurrence were similar between the short and long interval groups. For the patients exhibiting ypT3-4N0, although no significant difference was found in OS or DFS between the short and long interval groups, the rate of local recurrence was higher in the long interval group, which was further confirmed by multivariate analysis. In the patients exhibiting ypT0-4N+, both OS and DFS were lower in the long interval group than in the short interval group. Furthermore, multivariate analysis indicated that the interval was significantly associated with DFS, especially LRFS., Conclusions: The interval between CRT and surgery may exert a differential effect on the prognosis of patients exhibiting different pathologic stages or chemoradiation responses. Therefore, we strongly suggest tailoring the interval between CRT and surgery in locally advanced rectal cancer.

Purpose: Systemic failure remains the major challenge in management of locally advanced rectal cancer (LARC). To optimize the timing of neoadjuvant treatment and enhance systemic control, we initiated a phase 2 trial to evaluate a new strategy of neoadjuvant sandwich treatment, integrating induction chemotherapy, concurrent chemoradiation therapy, and consolidation chemotherapy. Here, we present preliminary results of this trial, reporting the tumor response, toxicities, and surgical complications., Methods and Materials: Fifty-one patients with LARC were enrolled, among which were two patients who were ineligible because of distant metastases before treatment. Patients were treated first with one cycle of induction chemotherapy consisting of oxaliplatin, 130 mg/m² on day 1, with capecitabine, 1000 mg/m² twice daily for 14 days every 3 weeks (the XELOX regimen), followed by chemoradiation therapy, 50 Gy over 5 weeks, with the modified XELOX regimen (oxaliplatin 100 mg/m²), and then with another cycle of consolidation chemotherapy with the XELOX regimen. Surgery was performed 6 to 8 weeks after completion of radiation therapy. Tumor responses, toxicities, and surgical complications were recorded., Results: All but one patent completed the planned schedule of neoadjuvant sandwich treatment. Neither life-threatening blood count decrease nor febrile neutropenia were observed. Forty-five patents underwent optimal surgery with total mesorectal excision (TME). Four patients refused surgery because of clinically complete response. There was no perioperative mortality in this cohort. Five patients (11.1%) developed postoperative complications. Among the 45 patients who underwent TME, pathologic complete response (pCR), pCR or major regression, and at least moderate regression were achieved in 19 (42.2%), 37 (82.2%), and 44 patients (97.8%), respectively., Conclusions: Preliminary results suggest that the strategy of neoadjuvant sandwich treatment using XELOX regimen as induction, concomitant, and consolidation chemotherapy to the conventional radiation is well tolerated. The strategy is highly effective in terms of pCR and major regression, which warrants further investigation., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Purpose: To determine diagnostic performance of simple measurements on diffusion-weighted MR imaging (DWI) for assessment of complete tumour response (CR) after neoadjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC) by signal intensity (SI) and apparent diffusion coefficient (ADC) measurements., Materials and Methods: Sixty-five patients with LARC who underwent neoadjuvant CRT and subsequent surgery were included. Patients underwent pre-CRT and post-CRT 3.0 T MRI. Regions of interest of the highest brightness SI were included in the tumour volume on post-CRT DWI to calculate the SIlesion, rSI, ADClesion and rADC; diagnostic performance was compared by using the receiver operating characteristic (ROC) curves. In order to validate the accuracy and reproducibility of the current strategy, the same procedure was reproduced in 80 patients with LARC at 1.5 T MRI., Results: Areas under the ROC curve for identification of a CR, based on SIlesion, rSI, ADClesion, and rADC, respectively, were 0.86, 0.94, 0.66, and 0.71 at 3.0 T MRI, and 0.92, 0.91, 0.64, and 0.61 at 1.5 T MRI., Conclusion: Post-CRT DWI SIlesion and rSI provided high diagnostic performance in assessing CR and were significantly more accurate than ADClesion, and rADC at 3.0 T MRI and 1.5 T MRI., Key Points: • Signal intensity (SI lesion ) and rSI are accurate for assessment of complete response. • rSI seems to be superior to SI lesion at 3.0 T MRI. • ADC or rADC measurements are not accurate for assessment of complete response.

Background: The administration of adjuvant chemotherapy for rectal cancer patients with ypN0 is controversial. The purposes of this study were to evaluate the role of adjuvant chemotherapy in ypN0 patients and to optimize its use for these patients., Methods: We performed a retrospective study of 160 rectal cancer patients who had the final pathology of ypN0 between March 2003 and November 2010. Overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were compared between patients who did and did not receive adjuvant chemotherapy. Multivariate analysis was performed to explore clinical factors significantly associated with DFS, LRFS, and DMFS., Results: For ypT0-2N0 patients, the 5-year OS, DFS, LRFS, and DMFS were similar between patients who did and did not receive adjuvant chemotherapy (P > 0.05). For patients with ypT3-4N0, those who were given adjuvant chemotherapy exhibited a higher 5-year OS than those who were not (P = 0.026), with also an extended 5-year DFS (P = 0.050). Further analysis indicated that adjuvant chemotherapy could decrease the rates of distant metastases for ypT3-4N0 patients with no impact on local control. In multivariable analysis, both the final pathological stage and adjuvant chemotherapy were independent predictors of DMFS for the whole group. When stratified by pathological stage, adjuvant chemotherapy was still significantly associated with DMFS in the ypT3-4 stratum., Conclusions: Adjuvant chemotherapy may not improve survival for ypT0-2N0 patients. However, it may be clinically meaningful for ypT3-4N0 patients by decreasing rates of distant metastases. Further randomized controlled clinical trials are needed to address this problem.

Objective: To study the molecular risk factors of lymph node metastasis in stage T1 and T2 colorectal cancers by tissue microarray and immunohistochemistry techniques., Methods: Two hundred and three patients with stage T1 and T2 colorectal carcinoma who underwent radical surgery from 1999 to 2010 in our department were included in this study. Their clinicopathological data were retrospectively analyzed. Expression of the following 14 molecular markers were selected and assayed by tissue microarray and immunohistochemistry: VEGFR-3, HER2, CD44v6, CXCR4, TIMP-1, EGFR, IGF-1R, IGF-2, IGFBP-1, ECAD, MMP-9, RKIP, CD133, MSI. Chi-squared test and logistic regression were used to evaluate the variables as potential risk factors for lymph node metastasis., Results: The positive expression rates of biomarkers were as following: VEGFR-3 (44.3%), EGFR (30.5%), HER-2 (28.1%), IGF-1R (63.5%), IGF-2 (44.8%), IGFBP-1 (70.9%), ECAD (45.8%), CD44v6 (51.2%), MMP-9 (44.3%), TIMP-1 (41.4%), RKIP (45.3%), CXCR4 (40.9%), and CD133 (49.8%). The positive rate of MSI expression was 22.2%. Both univariate and multivariate analyses showed that VEGFR-3, HER-2, and TIMP-1 were significant predictors of lymph node metastasis. Univariate analysis showed that CD44v6 and CXCR4 were significant significant predictors of lymph node metastasis., Conclusions: VEGFR-3, HER2 and TIMP-1 are independent factors for lymph node metastasis in stage T1 and T2 colorectal cancers.

Estrogen receptor beta (ERβ) and TROP2 expressed in colon carcinoma and might play an important role there. We explored the relationship of ERβ and TROP2 expression with the prognosis of early-stage colon cancer. ERβ and TROP2 levels were assessed by immunohistochemistry in normal mucosa and tumoral tissues from 220 Chinese patients with T(3)N(0)M(0) (stage IIa) and T(4)N(0)M(0) (stage IIb) colon cancer in the Cancer Center, Sun Yat-sen University, who underwent curative surgical resection between 1995 and 2003. The Cox proportional hazards regression model was applied to analyze the overall survival (OS) data, and the ROC curve, Kaplan-Meier estimate, log rank test, and Jackknife method were used to show the effect of ERβ and TROP2 expression at different stages of cancer. The 5-year survival rates were not significantly different between the patients with stage IIa and stage IIb colon cancer (83 vs. 80 %, respectively). The high expression of ERβ was related to decreasing OS in stage IIa and stage IIb colon cancer, while the high expression of TROP2 was related to decreasing OS in stage IIb colon cancer. The expression of ERβ and TROP2 has tumor-suppressive and tumor-promoting effect in stage IIa and stage IIb colon cancer, respectively.

The correlation of ERβ/CD44 expression and progression of patients with stage II of colon cancer were explored in this work. A total of 220 paraffin-embedded specimens with stage II colon cancer from 1995 to 2003 were included for assessing ERβ and CD44 by immunohistochemistry in normal mucosa and tumor tissues. Kaplen-Meier method, log-rank test, and the Cox proportional hazards regression model were used to analyze the overall survival data. ROC curve was used to describe the capacity of variables in prognosis prediction. Jackknife method was used to perform cross validation of predictions. The survival rates were significantly different between the patients with high expression and low expression of CD44-tumor tissues (61 % vs. 90 %, p < 0.0001) and between the patients with high expression and low expression of ERβ-tumor tissue (99 % vs. 36 %, p < 0.0001), respectively. In addition, the interaction between expression of ERβ and CD44 was found that the impact of CD44 to the overall survive appeared only when expression of ERβ was low; and the high expression of ERβ-tumor could be regarded as a protective factor for overall survival. This study suggest that low expression of ERβ-tumor and high expression of CD44-tumor are risk factors for overall survival in patients with stage II colon cancer.

Objective: To investigate the compliance and associated factors of postoperative chemotherapy for elderly patients with colorectal cancer., Methods: A total of 386 elderly patients (>70 years old) with stage II(-IIII( colorectal cancer underwent surgery between January 2000 and January 2010. The clinicopathological data were retrospectively reviewed. There were 226 patients received postoperative chemotherapy and 160(41.4%) refused. Logistic regression model was used to analyze factors associated with patients compliance to chemotherapy. Patients were followed up by phone call regarding the reason for refusal., Results: Multivariate analysis showed that gender, body mass index (BMI), body surface area (BSA), age, and complication were independent risk factors associated with chemotherapy compliance(All P<0.05). Follow-up phone questionnaire showed that 63.8%(51/80) of patients with stage II( cancer did not received chemotherapy because of the doctor's uncertainty of chemotherapy benefit. For stage III( patients, fear of chemotherapy (31.2%, 15/48), feeling uncomfortable (18.8%, 9/48), and financial issues(18.8%, 9/48) were the main factors. The desperate feeling was the predominant reason for stage IIII( patients(56.2%, 18/32)., Conclusions: Gender, BSA, age, and postoperative complication are the main factors associated with compliance to postoperative chemotherapy. Doctors' recommendation should be emphasized for stage II( patients. For stage III( patients, treatment recommendation should be enthusiastic.

Chronic Myeloid Leukemia (CML) is a clonal disease characterized by the presence of the Philadelphia (Ph+) chromosome and its oncogenic product, BCR-ABL, a constitutively active tyrosine kinase, that is present in >90% of the patients. Epidemiologic data indicates that almost 5000 new cases are reported every year and 10% of these patients eventually succumb to the disease. The treatment of CML was revolutionized by the introduction of imatinib mesylate (IM, Gleevec), a BCR-ABL tyrosine kinase inhibitor (TKI). The clinical use of specific BCR-ABL inhibitors has resulted in a significantly improved prognosis, response rate, overall survival, and patient outcome in CML patients compared to previous therapeutic regimens. However, the complete eradication of CML in patients receiving imatinib was limited by the emergence of resistance mostly due to mutations in the ABL kinase domain and to a lesser extent by molecular residual disease after treatment. The second-generation BCR-ABL TKIs nilotinib (Tasigna) and dasatinib (Sprycel), showed significant activity in clinical trials in patients intolerant or resistant to imatinib therapy, except in those patients with the T315I BCR-ABL mutation. Identifying key components involved in the CML pathogenesis may lead to the exploration of new approaches that might eventually overcome resistance mediated to the BCR-ABL TKIs. Here, we present an overview about the current treatment of Ph+ CML patients with the TKIs and the obstacles to successful treatment with these drugs., (Copyright (c) 2010 Elsevier Ltd. All rights reserved.)

Objective: To analyze the outcome of the patients with gastric gastrointestinal stromal tumor(GIST) after surgical treatment and identify the associated risk factors., Methods: Clinical data and the tissue slices including immunohistochemistry staining of 140 patients with gastric GIST from January 1990 to December 2008 were retrospectively reviewed. SPSS 16.0 for Windows software package was used for statistical analysis., Results: The overall survival rates of 1-, 3-, 5-year were 96.8%, 86.7% and 79.3%, respectively. The survival rates of 1-, 3-, 5-year were 98.1%, 90.0% and 85.4% in patients who underwent complete tumor resection. But the survival rates of 1-, 3-, 5-year were 38.1%, 0 and 0 in patients with incomplete tumor resection. The differences were statistically significant (P<0.05). Gender, preoperative metastasis, tumor size,pathology type,karyokinesis, recurrence and metastasis were associated with survival rates in patients with complete tumor resection by univariate analysis. However, only tumor size, karyokinesis, recurrence and metastasis were associated with survival rates by Cox regression multivariable analysis(P<0.05)., Conclusion: Surgery remains the main treatment for gastric GIST. Local complete resection is the principal treatment.

Background and Objective: Total mesorectal excision (TME) can reduce local recurrence and improve prognosis of rectal cancer. This study was to analyze the clinicopathologic characteristics of rectal cancer, and explore the prognosis factors of rectal cancer after radical TME., Methods: From 1990 to 2003, 1056 rectal cancer patients had received radical TME. The impacts of 20 clinicopathologic factors on the prognosis were analyzed with univariate and multivariate method., Results: The 3-, 5-, and 10-year overall survival rates were 84.9% (95% CI, 83.8%-86.0%), 73.8% (95% CI, 72.4%-75.2%), and 65.1% (95% CI, 63.4%-66.8%), respectively. Univariate analysis showed that preoperative serum carcinoembryonic antigen (CEA) and CA19-9 levels, tumor gross type, pathologic type, pathologic grade, preoperative bowel obstruction or bowel perforation, T stage, N stage, and first treatment era were associated with the prognosis of rectal cancer. Multivariate analysis showed that N stage, histological type, surgical procedures, and T stage were independent prognostic factors., Conclusion: N stage, histological type, surgical procedures, and T stage are independent prognostic factors for rectal cancer patients who received radical TME.

Background and Objective: Patients with locally advanced rectal cancer undergoing preoperative radiotherapy have disparity in pathological tumor regression. This study was to investigate clinicopathologic factors correlated with pathological complete response (pCR) following preoperative radiotherapy in rectal adenocarcinoma., Methods: In total 132 patients with rectal adenocarcinoma received preoperative radiation from January 2002 to June 2008 at Sun Yat-sen University Cancer Center. Pathological tumor response after radiation was evaluated, and correlations of pCR to 12 clinicopathologic factors were analyzed using logistic regression method., Results: A total of 18 patients achieved pCR after preoperative radiation, with a pCR rate of 13.6%. Univariate analysis showed that pretreatment T stage with or without concomitant chemotherapy, pretreatment serum CEA level, and CA199 level were correlated with pCR after preoperative radiation in rectal adenocarcinoma. Multivariate analysis revealed that pretreatment serum CEA level and with or without concomitant chemotherapy were independent factors for pCR after radiotherapy in rectal adenocarcinoma., Conclusion: Patients undergoing preoperative radiochemotherapy with a low pretreatment serum CEA level were more likely to achieve pCR.

Background and Objective: Neoadjuvant therapy (radiotherapy, RT or chemoradiotherapy, CRT) could change status of the invasion and lymph node metastasis of rectal cancer. The risk factors of lymph node metastasis in rectal cancers without neoadjuvant therapy have been well known, but those in rectal cancers treated with preoperative RT or CRT remain unclear. This study was to investigate the risk factors of lymph node metastasis in patients who underwent preoperative RT or CRT for rectal cancers., Methods: Clinical data of 93 patients underwent preoperative RT or CRT followed by total mesorectal exesion (TME) for locally advanced rectal adenocarcinoma from August, 2003 to February, 2008 were reviewed. Twelve clinicopathologic factors and treatment-related factors were studied with univariate and multivariate analyses., Results: Univariate analysis showed that post-RT or post-CRT serum carcinoembryonic antigen (CEA) level, radiation dose, time interval from RT or CRT to TME, concurrent chemotherapy with oxaliplatin-containing regimens, and infiltration extent to bowel wall after RT or CRT (ypT stage) were significantly associated with lymph node status after RT or CRT (ypN stage). Multivariate analysis showed that concurrent chemotherapy with oxaliplatin-containing regimens (r=-0.481, P<0.01) and ypT stage (r=0.503, P<0.01) were independent risk factors of ypN stage., Conclusions: Pathologic T stage is the most reliable predictor of lymph node stage in rectal cancer patients received preoperative RT or CRT. Oxaliplatin-containing regimens could significantly reduce the risks of lymph node metastases and potentially improve the prognosis.

Background and Objective: Prognosis of stage II colorectal cancer varies. Whether or not to perform adjuvant chemotherapy on patients with stage II colorectal cancer is controversial. This study was to explore the prognostic factors for the patients with stage II colorectal cancer and evaluate the effect and the necessity of adjuvant chemotherapy., Methods: Between January 2000 and January 2005, 443 patients with stage II colorectal cancer receiving radical surgery at Sun Yat-sen University Cancer Center were retrospectively analyzed. The overall survival rate and survival curve were analyzed using the Kaplan-Meier method and the log-rank test. The univariate and multivariate prognostic analyses were performed by the Cox regression model. Patients with or without chemotherapy (Xelox/Folfox regimen) with high-risk factors were analyzed respectively., Results: The median follow-up time was 59 months, and the 3-and 5-year survival rates were 88.4% and 82.5%, respectively. Univariate analysis showed that intestinal obstruction or perforation, diabetes mellitus, inadequate surgical margin, and the number of sampled nodes < 9 were poor prognostic factors. Patients with intestinal obstruction or perforation, the number of sampled nodes < 9 achieved higher 5-year survival (80% and 86%) undergoing adjuvant chemotherapy than those receiving surgery alone (67% and 64%)., Conclusions: The prognosis of colorectal cancer patients with intestinal obstruction or perforation, diabetes mellitus, inadequate surgical margin, and the number of sampled nodes < 9 are relatively poor. Adjuvant chemotherapy is recommended to patients with intestinal obstruction, perforation or sampled nodes < 9.

Background and Objective: Besides current clinicopathologic staging system extensively used in clinic, more information of molecular staging is need for more accurate staging of colorectal cancer (CRC). This study was to evaluate the prognostic value of metastasis-related tumor markers in CRC., Methods: The expression of CD44v6, matrix matalloproteinase-2 (MMP-2), cyclooxygenase-2 (COX-2), epidermal growth factor (EGF), epidermal growth factor receptor (EGFR) and vascular epidermal growth factor (VEGF) in a tissue microarray containing 95 specimens of CRC were detected by immunohistochemistry (IHC). The correlations of these tumor markers to the prognosis of CRC patients were analyzed., Results: In patients with Dukes' A/B disease, the 5-year recurrence rates were significantly higher in CD44v6-, EGF-and EGFR-positive groups than in negative groups (30.9% vs. 8.3%,P=0.045; 38.1% vs. 8.8%, P=0.022; 27.5% vs. 11.8%, P=0.047, respectively). In patients with Dukes' C disease, the 5-year recurrence rates were significantly higher in MMP-2-, COX-2-and VEGF-positive group than in negative groups (73.3% vs. 37.5%, P=0.045; 69.2% vs. 25.0%, P=0.017; 62.5% vs. 25.0%, P=0.03, respectively). In patients with Dukes' A/B disease, there were a significantly higher 5-year recurrence rate and a lower 5-year survival rate in those with more than three positive markers than in those with 1-3 positive markers (P=0.019, P=0.03). However, there was no significant difference in patients with Dukes' C disease in such condition., Conclusions: Over-expression of CD44v6, EGF and EGFR are related to poor prognosis of Dukes' A/B CRC, while over-expression of MMP-2, COX-2 and VEGF are related to poor prognosis of Dukes' C CRC. For patients with Dukes' A/B CRC, the more positive markers, the higher 5-year recurrence rate and the poorer 5-year survival.

Background and Objective: Whether selective defunctioning stoma could reduce the rate of anastomotic leak and lessen adverse effects in low anterior resection (LAR) remains controversial. This study was to evaluate the necessity of selective defunctioning stoma after LAR., Methods: Medline databases were searched and English-language articles regarding to selective defunctioning stoma in LAR published from January 1, 1990 to October 1, 2007 were acquired. Seven literatures from seven different studies were included in this study, with total enrollment of 5040 patient. The rate of anastomotic leakage and re-operation rate in different surgical procedures (with or without selective defunctioning stoma) were pooled to compare using meta-analysis., Results: Selective defunctioning stoma did not significantly reduce the rate of anastomotic leakage after LAR. The pooled odds ratio (OR) was 0.68 (95%CI=0.45-1.02, P>0.05). Selective defunctioning stoma significantly reduced the rate of surgery-required anastomotic leakage following LAR. The pooled OR was 0.33(95% CI=0.25-0.44, P<0.01)., Conclusion: Although selective defunctioning stoma does not reduce the rate of anastomotic leakage, it reduces the rate of surgery-required anastomotic leakage.

Background & Objective: Previously, we identified frequent loss of heterozygosity (LOH) at D7S486 of chromosome 7q31 in gastric carcinoma. The TESTIN (TES) gene is a candidate tumor suppressor gene at 7q31.2. This study aimed to investigate the expression of TES in gastric carcinomas, and explore its correlations to clinicopathologic features and prognosis of gastric cancer., Methods: Semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry were used to investigate the expression of TES in 140 specimens of primary gastric carcinomas and corresponding adjacent normal tissues; Western blot was performed to evaluate the expression of TES protein in 50 specimens of gastric carcinomas and adjacent normal tissues. The correlations of TES to clinicopathologic features and prognosis of gastric carcinoma were analyzed., Results: The mRNA level of TES was down-regulated in 96 (68.6%) of the 140 carcinomas as compared with that in matched normal tissues. The positive rate of TES protein was significantly lower in gastric cancer than in normal tissues (22.9% vs. 85.7%, P<0.001). The protein level of TES was down-regulated in 36 (72.0%) of 50 carcinomas as compared with corresponding normal tissues. TES expression was positively correlated with the differentiation of gastric carcinoma (r=0.178, P=0.035). The median survival was significantly shorter in TES-negative patients than in TES-positive patients (P=0.035)., Conclusions: The expression level of TES is significantly down-regulated in primary gastric cancer. TES may be a valuable marker for assessing the prognosis of gastric carcinoma.

Background & Objective: Multiple primary colorectal carcinoma (MPCC) is not rarely seen, but it possesses a unique biological characters. This study was to investigate the clinical characteristics, diagnosis, therapeutic principle and prognosis of MPCC., Methods: Data of 70 MPCC patients, treated by operation from 1997 to 2003, were analyzed. Of the 70 patients, 61 had synchronous carcinoma (SC) and 9 had metachronous carcinoma (MC)., Results: Fifty-five patients were diagnosed by colonoscopy, barium enema or CT scan pre-operationally, while 15 were diagnosed intra-operationally due to the oversized tumor at the distal end of the colon. Thirty-three patients had colorectal carcinoma accompanying with adenoma and multiple polyps. All the patients underwent surgical resection except 3, who received short-circuit operation because of unresectable lesions. Fifty-two patients received radical resection, while 15 received palliative resection due to hepatic or peritoneal metastasis. The overall 3-and 5-year survival rates were 65.7% and 45.7%. In the patients who received radical resection, the 3-and 5-year survival rates were 78.1% and 59.3%., Conclusions: The occurrence of MPCC is largely related with adenomas and polyps. The extent of resection should be individually determined by the lesion location, range, the distance of lesions as well as the general condition of the patients. Prognosis of MPCC is relatively good. The patients accompanying with adenoma and multiple polyps should be followed up intensively.

Objective: To analyze the effects of surgical treatment for gastrointestinal stromal tumors (GISTs) and influential factors of survival., Methods: The clinical data and the tissue slices including immunohistochemical staining of 153 cases of GISTs from January 1990 to March 2006 were rechecked retrospectively. All patients were followed up carefully. More attention was paid to the surgical effects and the influential factors of survival., Results: The overall survival rates at 1-, 2-, 3-, 4- and 5-year were 94.9%, 83.3%, 73.3%, 70.5% and 64.3%, respectively. The median survival time for patients with tumor resected completely was 66.0 months, and the 2- and 5-year survival rate were 89.4% and 70.9% respectively. The median survival time was 23.8 months for the patients with tumor resected partly, and only two of these patients survived over 2 years. Gender, tumor sites, preoperative metastasis, tumor size, pathological type, karyokinesis and recurrence and metastasis were related with survival rates for the patients with tumor resected completely on univariate analysis, but tumor size, pathology type, recurrence and metastasis were related with survival rates on Cox regression multivariate analysis (P < 0.05)., Conclusions: Surgery should still be the main therapy for GISTs. Local complete resection is the principal treatment. The survival cannot be improved by extensive resection and lymph nodes clearance.

Background & Objective: FOLFOX6 regimen has been used in treating advanced colorectal cancer for a period, but there is no systemic study on FOLFOX6 regimen in treating Chinese colorectal cancer patients with liver metastasis. This study was to evaluate the efficacy of FOLFOX6 regimen on Chinese colorectal cancer patients with liver metastasis, and observe the adverse events., Methods: Ninety-one colorectal cancer patients with liver metastasis were treated by FOLFOX6 regimen. FOLFOX6 regimen consisted of 2-hour infusion of oxaliplatin (100 mg/m(2)) and 2-hour infusion of leucovorin (CF) (400 mg/m(2)) on Day l, followed by 5-fluorouracil (5-FU) bolus (400 mg/m(2)) on Day 1 and 46-hour infusion (2.4 g/m(2)). FOLFOX6 regimen was repeated at 2-week intervals. The clinical efficacy and adverse events were evaluated., Results: The objective response rate for all patients was 40.7%, with 4 cases of complete remission (CR), 33 partial remission (PR), 19 stable disease (SD), and 35 progressive disease (PD). There was no significant difference in objective response rate between the patients with and without previous treatment (P>0.05). The median survival time was 17.0 months for all patients, 20.0 months for the patients without previous treatment, and 12.0 months for the patients with previous treatment. The time to progress (TTP) was 7.0 months for all patients, 9.0 months for the patients without previous treatment, and 6.0 months for the patients with previous treatment. Peripheral neuritis, gastrointestinal reaction, and myelosuppression were major adverse events. All patients with 5-FU-associated adverse events recovered after treatment., Conclusion: FOLFOX6 regimen can be used in treating colorectal cancer with liver metastasis for its efficacy and less toxicity.

Objective: To evaluate the efficacy and safety of imatinib mesylate in the treatment of patients as preoperative supplement, or used alone for unresectable and/or metastatic gastrointestinal stromal tumors (GIST)., Methods: A total of 51 cases with advanced GIST were proved pathologically. Among them, CD117 was detected positive in 47 patients and negative in 4 patients; 4 patients received imatinib mesylate before operation and 47 patients with unresectable and (or) metastatic GIST received oral imatinib mesylate daily at dose of 300-800 mg. One patient was lost in follow-up and the objective effect was evaluated in 50 patients., Results: 3 of the 50 patients (6.0%) achieved complete response (CR), 34 (68%) had partial response (PR), 5 (10.0%) had stable disease (SD) and 8 (20.0%) had progression disease (PD). The median time to progression (mTTP) was 16 months during which most of the patients experienced benefit. 32 patients had been followed up for more then 1 year. The 1-year and 2-year survival rate were 95.3%, 89% respectively. 50 patients were valuable for the toxicity assessment according to the WHO standard. The main toxicity included grade I-II edema of periorbital area and lower limb in 72.0% (36/50) patients, leukopenia was present in 46% (23/50) and intratumoral bleeding in 4.0% (2/50). Other toxicities included mild fatigue (28.0%), abdominal pain (14.0%), efflorescence (18.0%), nausea and vomiting (18.0%)., Conclusions: As an inhibitor of tyrosine kinase, imatinib mesylate is generally well tolerated and has been proved to be effective and safe during prolonged treatment of patients with advanced gastrointestinal stromal tumors. Its toxicity is acceptable.

Background & Objective: The incidence of colorectal cancer is increasing in China, of which rectal cancer accounts for over 50%. Because of the limitation of pelvic cavity, the selection of surgical procedures, the proportion of sphincter saving and prognosis of male patients are different from those of female patients. This study was to analyze the correlations of clinicopathologic features of rectal cancer in 384 male patients to their prognosis., Methods: Correlations of 12 clinicopathologic factors of 384 male patients with rectal cancer to the prognosis were studied with univariate and multivariate analysis., Results: Univariate analysis revealed that tumor site, gross type, histologic type, infiltrative extent to bowel wall, site of lymphatic metastasis and Dukes' stage were prognostic factors of male patients with rectal cancer. Multivariate analysis revealed that histologic type and site of lymphatic metastasis were independent prognostic factors., Conclusion: Histologic type and site of lymphatic metastasis are independent prognostic factors of male patients with rectal cancer.

Background & Objective: It is not very clear about the factors that affect the prognosis of liver metastases from colorectal cancer. This study was to investigate the clinicopathologic factors related to the prognosis of liver metastases from colorectal cancer., Methods: The clinicopathologic factors and follow-up data of 197 patients with liver metastases from colorectal cancer, treated from Jan. 1996 to Dec. 2000, were analyzed retrospectively. The prognostic index (PI) of patients was calculated based on the results of multivariate analysis and patients were classified into different hazard groups accordingly., Results: The overall 1-, 3-, and 5-year survival rates were 59.04%, 17.73%, and 11.48%. Univariate analysis revealed that extrahepatic invasion, primary tumor resection, liver metastasis resection, type of primary tumor, serum CEA concentration, number and size of liver metastases, and distribution of liver metastases were associated with prognosis. Multivariate analysis identified that the resection of liver metastases, serum CEA concentration, number and size of liver metastases were prognostic factors. The patients were classified into high risk, moderate risk, and low risk groups according to the PI value, and there was significant difference in survival rates between each two groups., Conclusions: Liver metastasis resection, serum CEA concentration, number and size of liver metastases are important prognostic factors for liver metastases from colorectal cancer. In order to improve the survival rate, liver metastases should be resected for suitable patients. Moreover, PI value could be used to predict the prognosis of patients with liver metastases from colorectal cancer.

Objective: To investigate the clinical features and treatment of anal canal adenocarcinoma., Methods: Clinical data of 49 patients with anal canal adenocarcinoma treated in our hospital from January 1965 to March 2002 were analyzed retrospectively., Results: The ratio of male to female was 1.3. The median age was 56 years old. Anal bleeding, tapering stool and anal lump were the most common symptoms. Chronic perianal diseases were complicated in 36.7% of the cases. The median follow-up was 66 months. Local recurrence and inguinal lymph node metastasis were found in 7 cases respectively, lung metastasis in 2, supraclavicular and mediastinal metastasis in 1 respectively. The 3-year survival rates in the patients with resection alone, radiochemotherapy alone, resection combined with radiochemotherapy, and without any treatment were 41.3%, 20.0%, 56.3% and 15.0%, respectively, and the 5-year survival rates were 34.4%, 0, 37.5%, 0, respectively., Conclusions: Anal canal adenocarcinoma is a rare and fatal malignancy. Abdomino-perineal resection combined with postoperative radiochemotherapy is the principal treatment.

Background & Objective: The incidence of low and middle rectal cancer is high in China. Researches on improving treatment efficacy of this disease have constantly been concerned. This study was to evaluate the correlation of clinicopathologic features to the prognosis in low and middle rectal cancer., Methods: The clinicopathologic data of 599 patients with low and middle rectal cancer, treated from 1990 to 1999 in Cancer Center of Sun Yat-sen University, were analyzed retrospectively. Curative resection was performed for all patients, including abdominoperineal resection (ARP, 355 cases) and low anterior resection (LAR, 244 cases). Survival rate was calculated using life table method, and differences between survival curves were tested by log-rank test. Cox regression model was used for multivariate prognostic analysis., Results: The overall 5-year survival rate was 70.7%; it was significantly lower in APR group than in LAR group (67.5% vs. 75.2%, P=0.026). Univariate analysis showed that local recurrence, perioperative blood transfusion, lymph node metastasis, T stage, histology, macropathology, operation pattern, and distance from anal margin were correlated to prognosis (P<0.05). Multivariate analysis showed that local recurrence, perioperative blood transfusion, lymph node metastasis, and T stage were independent prognostic factors (P<0.01)., Conclusions: Local recurrence, perioperative blood transfusion, lymph node metastasis, and T stage are important prognostic factors of low and middle rectal cancer. LAR has become the preferred option in curative surgery for low and middle rectal cancer.

Objective: To analyze the long- term results of radical resection for rectal cancer and the factors influencing the operative results., Methods: From January 1990 to December 1999, clinical data of 689 patients who underwent radical resection for rectal cancer were analyzed retrospectively., Results: The overall operative mortality was 0.7%, the follow- up rate was 96.7%, the median survival rate was 67.4 months. The 1-, 3-, 5- and 10-year survival rate after operation was 89.9%, 77.3%, 69.6% and 63.3% respectively. Univariate analysis showed that the survival rate was related with the first onset symptom, tumor location, infiltrated circumference of intestine, T staging, Dukes staging, histological type, extent of lymph node metastasis and operative approaches. Multivariate analysis showed that tumor location, histological type, invasive depth and Dukes staging were independent prognostic factors., Conclusions: The long-term efficacy after radical resection for rectal cancer is correlated with tumor location, histological type, invasive depth and Dukes staging.

Background & Objective: Currently, to preserve the anal function and improve the patients' quality of life, low anterior resection has become the preferred option in curative rectal cancer surgery. As the use of stapling instruments provides more reliable anastomoses in low anterior resection for rectal cancer, it enlarges the indication of this procedure. The aim of this study was to review the operation results and their outcomes of 449 rectal cancer patients who recieved of curative low anterior resections with stapling devices, and intent to find some measures that can reduce complications and improve long-term effects of this procedure., Methods: The study included 449 patients who had a potentially curative anterior resection with stapled anastomosis in rectal cancer between Jan.1990 and Sept. 2002 at Sun Yat-sen University Cancer Center. All patients had complete follow-up data. All data were analyzed by SPSS8.0 software, risk factors for anastomotic leakage and recurrence were analyzed by Logistic regression, survival was analyzed by life table, and prognostic factors were screened by multivariate COX model., Results: There were 11 cases of anastomotic leakage and 23 cases of anastomotic recurrence after operation. The 5-year survival rate was 78.4%. Age of >/= 65 years, and tumor involvement of more than half circumference were risk factors for anastomotic leakage, blood transfusion during operation was the risk factor for anastomotic recurrence. The independent factors for poor survival were stage of disease and tumor differentiation., Conclusions: Stapling devices can improve the anal reservation rate in low rectal cancer surgery, and stapled anastomoses is safe and feasible. Adequate preparation of bowel ends, a tension-free anastomosis with excellent blood supply and skilled stapled anastomoses were key measures to reduce anastomotic leakage, While TME, multidisciplinary therapy and the principle of avoiding medical spread, were key measures to improve treatment effect of rectal cancer.

Objective: To compare the effect of 5-fluorouracil (5-FU) portal vein infusion (PVI) for 7 days after radical resection, with intraluminal chemotherapy during operation for eliminating liver metastasis and elevating long-term prognosis in colorectal cancer., Methods: 162 colorectal cancer patients with radical resection were divided into portal vein chemotherapy group (group A, 82 cases) and intraluminal chemotherapy group (group B, 80 cases) randomly. In group A, 5-fluorouracil were infused with 1g per day constantly for 7 days after operation through portal vein catheters, which placed into greater omental vein and fixed on the abdominal wall. In group B, intraluminal chemotherapy was given and 5-fluorouracil 0.5 g was injected into the greater omental vein during operation., Results: The short-term complications and long-term effect in the two groups were compared by statistical software SPSS 8.0. Group A had more operative complications, and no statistical differences was found in hospital time and survival rate of the two groups. The 5-year survival rate is 76.7% (group A: 74.3%, group B: 79.2%), and the liver metastasis rate is 19.8%. There is no significant difference between the two group-survival curves. Multiple variable analysis suggested that Dukes' stage was the prognosis factor (P < 0.05)., Conclusions: The present study demonstrated that the two chemotherapy methods play an important role in preventing liver metastasis and improving the survival rate, and the intraluminal chemotherapy would be easier and simpler. The result should be further improved by using combined chemotherapy.

Background & Objective: It was indicated that there was relationship between estrogen and colorectal cancer. Estrogen receptor (ER) and progesterone receptor (PR) were expressed in colorectal cancer tissue. They were measured using immunohistochemistry with various results,but there was little quantitative study. This study was designed to quantitatively measure the expression of ER and PR in tumor tissues and normal mucosas and analyze its relationship with clinicopathological parameters in colorectal cancer., Methods: ER and PR expression in cytoplasm and nucleus of tumor tissues and normal mucosas from 45 colorectal cancer patients were quantitatively measured using radioligand binding assay (RBA)., Results: ER and PR were expressed in all tumor tissues and normal mucosas. In cytoplasm, the ER expression level of tumor tissues was higher than that of normal mucosas; they were 7.96+/-3.69 fmol/mg protein and 4.34+/-2.84 fmol/mg protein (P< 0.01) respectively. And that was the same for PR expression; they were 3.89+/-2.64 fmol/mg protein and 2.50+/-1.73 fmol/mg protein(P< 0.01)respectively. In nucleus, the ER expression level of tumor tissues was higher than that of normal mucosas; they were 18.42+/-8.30 fmol/mg protein and 11.24+/-5.44 fmol/mg protein (P< 0.01)respectively. And that was the same for PR expression, they were 9.36+/-5.90 fmol/mg protein and 7.84+/-7.41 fmol/mg protein (P< 0.05) respectively. There was positive correlation between ER and PR expression in cytoplasm and nucleus of tumor tissues (P< 0.01) respectively,so was in cytoplasm in normal mucosas (P< 0.01) respectively, but not in nucleus (P >0.05). There was correlation between ER expression in tumor tissues and patients' age,and the expression in these people over 45 years old was higher than those less 45 years old (P< 0.05), but no correlation between tumor tissues PR expression and age (P >0.05). There was no correlation between tumor tissues ER, PR expression and sex, staging, tumor location, size, gross and histological type, invasive depth, lymph nodes metastasis, or tumor tissue CEA expression (P >0.05)., Conclusions: ER and PR expression in colorectal tumor tissues were higher than those in normal mucosas, and there was positive correlation between ER and PR expression in tumor tissues. All these indicate that ER in colorectal cancer tissues has some activity. The level of the ER, PR expression in tumor tissue could not predict the malignant biological behaviors of colorectal cancer.