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In a portion of patients with DNA mismatch repair-deficient (dMMR)/microsatellite instability-high (MSI-H) rectal cancer, clinical complete response (cCR) could be achieved after anti-programmed cell death protein 1 (anti-PD-1) immunotherapy. However, no data are available concerning the safety of omitting surgery and adopting immunotherapy as a curative-intent treatment for these patients.We retrospectively collected a series of patients with dMMR/MSI-H rectal adenocarcinoma who had cCR after receiving anti-PD-1 immunotherapy and adopted immunotherapy as curative-intent treatment from six institutions. Survival outcomes were analysed using the Kaplan-Meier method.Nineteen patients were included with a median age of 48 (range 19-63). One patient was diagnosed with stage I disease, four with stage II disease and fourteen with stage III disease. Sixteen patients received anti-PD-1 immunotherapy as the first line of therapy, and eleven patients were treated with single-agent anti-PD-1 antibodies. The median time from the start of treatment to cCR was 3.8 (range 0.7-6.5) months. During a median follow-up of 17.1 (range 3.1-33.5) months since achieving cCR, no local or distant relapse was observed. Two-year local recurrence-free survival, distant metastasis-free survival, disease free-survival and overall survival for the whole cohort were 100%, 100%, 100% and 100%, respectively.For patients with dMMR/MSI-H locally advanced rectal cancer who achieved cCR during anti-PD-1 immunotherapy, adopting immunotherapy as curative-intent treatment might be an alternative option. Longer follow-up and larger cohorts are warranted to verify this innovative treatment approach. more...

Most patients with mid and low rectal cancer passively react to bowel symptoms after sphincter-preserving surgery (SPS), and their self-management behaviors are scarce in the Chinese patient population.The aim of this study was to evaluate the effect of a self-management program for bowel symptoms in patients with mid and low rectal cancer after SPS.A convenient sampling method was used to recruit patients with mid and low rectal cancer after SPS in gastric wards from 2 tertiary hospitals in Beijing, China. Ninety-five patients (intervention, n = 47; control, n = 48) were recruited. The intervention group received a predetermined self-management program plus routine postoperative care; the control group received only routine care in the ward. Data on patients' bowel symptoms, quality of life, and bowel symptom self-management behaviors were collected at baseline and at 3 and 6 months postoperatively using questionnaires. A generalized estimating equation was adopted to examine group effect and time effect.Bowel symptoms and quality of life in both the intervention and control groups of patients improved significantly 6 months after SPS compared with baseline (time effect, P.001). The total score of patients' bowel symptom self-management behaviors and the score of the therapeutic domain increased significantly in the intervention group compared with those in the control group (group effect, P = .009).Self-management programs could help prompt patients' self-management behaviors, but the extent to which they impact patients' bowel symptoms requires further investigation.The bowel dysfunction self-management program could alter the behavior of patients. It also effectively improves self-management strategies for bowel symptoms. more...

Background Induction chemotherapy combined with neoadjuvant chemoradiotherapy has been recommended for patients with high-risk, locally advanced rectal cancer. However, the benefit of more intensive total neoadjuvant treatment (TNT) is unknown. This study aimed to assess the safety and efficacy of induction chemotherapy combined with chemoradiotherapy and consolidation chemotherapy for magnetic resonance imaging-stratified high-risk rectal cancer. Methods This was a single-center, single-arm, prospective Phase II trial in Peking University Cancer Hospital (Beijing, China). Patients received three cycles of induction oxaliplatin and capecitabine (CapeOX) followed by chemoradiotherapy and two cycles of consolidation CapeOX. The primary end point was adverse event rate and the second primary end points were 3-year disease-free survival rate, completion of TNT, and pathological downstaging rate. Results Between August 2017 and August 2018, 68 rectal cancer patients with at least one high risk factor (cT3c/3d/T4a/T4b, cN2, mesorectal fascia involvement, or extramural venous invasion involvement) were enrolled. The overall compliance of receiving the entire treatment was 88.2% (60/68). All 68 patients received induction chemotherapy, 65 received chemoradiotherapy, and 61 received consolidation chemotherapy. The Grade 3–4 adverse event rate was 30.8% (21/68). Nine patients achieved clinical complete response and then watch and wait. Five patients (7.4%) developed distant metastasis during TNT and received palliative chemotherapy. Fifty patients underwent surgical resection. The complete response rate was 27.9%. After a median follow-up of 49.2 months, the overall 3-year disease-free survival rate was 69.7%. Conclusions For patients with high-risk rectal cancer, this TNT regimen can achieve favorable survival and complete response rates but with high toxicity. However, it is necessary to pay attention to the possibility of distant metastasis during the long treatment period. more...

With the advent of Kirsten rat sarcoma viral oncogene homologue G12C (KRAS G12C) inhibitors, RAS is no longer considered undruggable. For the suppression of RAS, new therapeutic approaches have been suggested. However, current clinical studies have indicated therapeutic resistance after short-lived tumour suppression. According to preclinical studies, this might be associated with acquired genetic alterations, reactivation of downstream pathways, and stimulation for upstream signalling. In this review, we aimed to summarize current approaches for combination therapy to alleviate resistance to KRAS G12C inhibitors in colorectal cancer with a focus on the mechanisms of therapeutic resistance. We also analysed the relationship between various mechanisms and therapeutic resistance. more...

The efficacy of laparoscopic vs open surgery for patients with low rectal cancer has not been established.To compare the short-term efficacy of laparoscopic surgery vs open surgery for treatment of low rectal cancer.This multicenter, noninferiority randomized clinical trial was conducted in 22 tertiary hospitals across China. Patients scheduled for curative-intent resection of low rectal cancer were randomized at a 2:1 ratio to undergo laparoscopic or open surgery. Between November 2013 and June 2018, 1070 patients were randomized to laparoscopic (n = 712) or open (n = 358) surgery. The planned follow-up was 5 years. Data analysis was performed from April 2021 to March 2022.Eligible patients were randomized to receive either laparoscopic or open surgery.The short-term outcomes included pathologic outcomes, surgical outcomes, postoperative recovery, and 30-day postoperative complications and mortality.A total of 1039 patients (685 in laparoscopic and 354 in open surgery) were included in the modified intention-to-treat analysis (median [range] age, 57 [20-75] years; 620 men [59.7%]; clinical TNM stage II/III disease in 659 patients). The rate of complete mesorectal excision was 85.3% (521 of 685) in the laparoscopic group vs 85.8% (266 of 354) in the open group (difference, -0.5%; 95% CI, -5.1% to 4.5%; P = .78). The rate of negative circumferential and distal resection margins was 98.2% (673 of 685) vs 99.7% (353 of 354) (difference, -1.5%; 95% CI, -2.8% to 0.0%; P = .09) and 99.4% (681 of 685) vs 100% (354 of 354) (difference, -0.6%; 95% CI, -1.5% to 0.5%; P = .36), respectively. The median number of retrieved lymph nodes was 13.0 vs 12.0 (difference, 1.0; 95% CI, 0.1-1.9; P = .39). The laparoscopic group had a higher rate of sphincter preservation (491 of 685 [71.7%] vs 230 of 354 [65.0%]; difference, 6.7%; 95% CI, 0.8%-12.8%; P = .03) and shorter duration of hospitalization (8.0 vs 9.0 days; difference, -1.0; 95% CI, -1.7 to -0.3; P = .008). There was no significant difference in postoperative complications rate between the 2 groups (89 of 685 [13.0%] vs 61 of 354 [17.2%]; difference, -4.2%; 95% CI, -9.1% to -0.3%; P = .07). No patient died within 30 days.In this randomized clinical trial of patients with low rectal cancer, laparoscopic surgery performed by experienced surgeons was shown to provide pathologic outcomes comparable to open surgery, with a higher sphincter preservation rate and favorable postoperative recovery.ClinicalTrials.gov Identifier: NCT01899547. more...

To assess the efficacy and safety of intentional watch-and-wait (WW) and organ preservation surgery following neoadjuvant chemoradiotherapy plus consolidation CAPEOX in MRI-defined low-risk rectal cancer.Clinical T2/early T3 rectal cancers can achieve high yield pathological response (ypCR) rates after chemoradiotherapy; thus, an intentional WW or organ-preservation strategy for good clinical responders in these subgroups can be further tested.This prospective, single-arm, phase 2 trial enrolled patients with low-risk MRI pre-staged rectal cancers, who concurrently received chemoradiation, followed by four 3-weekly cycles of CAPEOX regimen. Following reassessment, cCR or near-cCR patients underwent WW/organ-preservation surgery; the primary endpoint was 3-year organ-preservation rate.Of the 64 participants, 58 completed treatment, with 6.4% and 33.9% grade 3-4 toxicities in the radiotherapy and consolidation CAPEOX phases, respectively, during a median 39.5-month follow-up. Initial, near-, and non-cCR occurred in 33, 13, and 18 patients, respectively. Of the 31 cCR and 7 near-cCR cases managed by WW, local regrowth occurred in 7; of these, 6 received salvage surgery. The estimated 2-year local regrowth rates were 12.9%(95%[CI] 1.1-24.7%) in cCR and 42.9%(95%[CI] 6.2-79.6%) in near-cCR cases, respectively. Eight patients received local excision, including 2 with regrowth salvage. Lung metastases occurred in 3 patients and multiple metastasis occurred in 1 patient; no local recurrence occurred. The estimated 3-year organ-preservation rate was 67.2%(95%[CI] 55.6-78.8%). The estimated 3-year CSS, non-regrowth disease-free survival, and stoma-free survival were 96.6%(95%[CI] 92.1-100%), 92.2%(95%[CI] 85.5-98.9%) and 82.7%(95%[CI] 73.5-91.9%), respectively.Chemoradiotherapy plus consolidation CAPEOX for MRI-defined low-risk rectal cancer can lead to high rates of organ-preservation through intentional WW or local excision. The oncologic safety of this strategy should be further tested. more...

Purpose: Current low anterior resection syndrome (LARS) score is lagging behind and only based on clinical symptoms patient described. Whether there are preoperative imaging indicators can be used to predict LARS is unknown. We proposed to identify patients with high risk for major LARS by MRI measurements.Methods: Patients received curative restorative anterior resection (median 75.7 months since surgery) from Sept. 2007 to Sept. 2015 were collected to complete LARS score. MRI measurements associated with LARS were tested, and a multivariate logistic model was conducted for predicting LARS. Receiver operating characteristic curve was used to evaluate the model.Results: 255 patients (neoadjuvant chemoradiotherapy) and 72 patients (direct surgery) were enrolled. The incidence of major LARS in NCRT group was significantly higher (53.3% vs.34.7%) (P＝0.005).This study showed that the distance between the tumor’s lower edge and anal rectal joint (ARJ)(DTA) was an important factor for major LARS in both groups (PConclusions: Baseline MRI measurements have the potential to predict major LARS in rectal cancer, which will benefit the decision making and improve patients’ life quality. more...

To explore the association between CT-detected extramural vascular invasion (ctEMVI) and lymph-vascular invasion (LVI) in colon cancer, and analyze the prognostic value of ctEMVI in different conditions of LVI.This single-center, retrospective study included 448 colon cancer patients from January 2015 to December 2017. Preoperative CT features and clinical and pathological data were collected. Associations between ctEMVI and LVI were tested. Univariate and multivariate logistic regression was performed. Multivariate Cox regression was performed adjusted with propensity score(PS). Kaplan-Meier method was used to compare survival differences between the ctEMVI and LVI groups. A 1:1 patient pairing was conducted using PS matching to assess the prognostic effect of ctEMVI in LVI subgroups.Among the 448 patients, there were 261 men and 187 women, with an average age of 63 ± 12 years. The coincidence rate of ctEMVI and LVI was 73.9%. The k coefficient for identifying ctEMVI was 0.84. ctEMVI and LVI were both independent risk factors for overall survival (ctEMVI: HR 2.8, 95% CI 1.5-5.5; LVI: HR 2.2, 95% CI 1.2-4.1) and metastasis-free survival (ctEMVI: HR 3.3, 95% CI 1.7-6.4; LVI: HR 2.4, 95% CI 1.3-4.5) adjusted with PS. In the LVI(+) subgroup, the prognosis of ctEMVI(+) was significantly worse than that of ctEMVI(-); in the LVI(-) subgroup, the prognosis of different ctEMVI states was similar.ctEMVI is an independent prognostic risk factor and has different prognostic value in different LVI states. It is recommended to perform the evaluation in routine work, especially for patients with positive LVI. more...

BACKGROUND Human epidermal growth factor receptor 2 (HER2) is an oncogenic driver, and a well-established therapeutic target in breast and gastric cancers. While the role of HER2 as a prognostic biomarker in colorectal adenocarcinomas (CRCs) remains uncertain, its relevance as a therapeutic target has been established. We undertook the present study to evaluate the frequency of HER2 expression in CRC and to correlate it with various clinicopathological variables. AIM To correlate HER2 protein expression and HER2 gene amplification with clinicopathological features and survival in surgically resected CRC. METHODS About 1195 consecutive surgically resected CRCs were analyzed by immunohistochemical staining (IHC) to assess HER2 protein expression, and 141 selected tumors were further evaluated by fluorescence in situ hybridization (FISH) to assess HER2 gene amplification. Follow-up information was available for 1058 patients, and using this information we investigated the prevalence of HER2 protein overexpression and gene amplification in a large series of surgically resected CRCs, and evaluated the relationship between overexpression and clinicopathological parameters and prognosis. RESULTS HER2 IHC scores of 3+, 2+, 1+, and 0 were seen in 31 (2.6%), 105 (8.8%), 475 (39.7%), and 584 (48.9%) tumors, respectively. HER2 gene amplification was seen in 24/29 tumors with an IHC score of 3+ (82.8%; unreadable in 2/31), 12/102 tumors with an IHC score of 2+ (11.8%; unreadable in 2/104), and 0 tumors with IHC score of 1+ (0/10). HER2 gene amplification was seen in 36/1191 tumors (3.0%; unreadable in 4/1195). Among the tumors with HER2 IHC scores of 3+ and 2+, the mean percentage of tumor cells with positive IHC staining was 90% (median 100%, range 40%-100%) and 67% (median 75%, range 5%-95%), respectively (P < 0.05). Among tumors with IHC scores of 2+, those with HER2 gene amplification had a higher number of tumors cells with positive IHC staining (n = 12, mean 93%, median 95%, range 90%-95%) than those without (n = 90, mean 70%, median 50%, range 5%-95%) (P < 0.05). HER2 gene status was significantly associated with distant tumor metastasis and stage (P = 0.028 and 0.025). HER2 protein overexpression as measured by IHC or HER2 gene amplification as measured by FISH was not associated with overall survival (OS) or disease-specific survival for the overall group of 1058 patients. However, further stratification revealed that among patients with tubular adenocarcinomas who were 65 years old or younger (n = 601), those exhibiting HER2 gene amplification had a shorter OS than those without (mean: 47.9 mo vs 65.1 mo, P = 0.04). Among those patients with moderately to poorly differentiated tubular adenocarcinomas, those with positive HER2 tumor IHC scores (2+, 3+) had a shorter mean OS than those with negative HER2 IHC scores (0, 1+) (47.2 mo vs 64.8 mo, P = 0.033). Moreover, among patients with T2 to T4 stage tumors, those with positive HER2 IHC scores also had a shorter mean OS than those with negative HER2 IHC scores (47.1 mo vs 64.8 mo, P = 0.031). CONCLUSION HER2 protein levels are correlated with clinical outcomes, and positive HER2 expression as measured by IHC confers a worse prognosis in those patients 65 years old or younger with tubular adenocarcinomas. more...

To achieve uniform copper plating on the surface of the wafer consistently in a production lot, a particle-free plating solution must be presented to the wafer under uniform pressure, uniform flow and at the proper formulation. This is accomplished by recirculating large volumes of the plating solution past the surface of the wafer. It is important that the chemistry of the solution remains uniform during the copper plating process to ensure repeatable performance. To maintain a low particle level, the fluid is filtered in a recirculated mode at a high flow rate. The filter must have low pressure drop, good particle retention and high throughput to result in low wafer defects and high system uptime. In addition, the proper filter must be selected so that it doesn’t absorb or remove desirable components like additives as it removes contamination from the solution. more...

Surgeons often can contribute failure of sphincter-preserving procedure to a limitation of pelvis anatomy; however, they cannot determine definitely which anatomic diameter or spatial factor actually affected the success of the procedure. Colorectal surgeons, radiologists, and research fellows collaborated closely to establish a three-dimensional digital model of the pelvis with spiral computerized tomography scanning data of patients with rectal cancer. Retrospective analysis on data of 97 patients with low rectal cancer was performed with this model to identify geometric factors that might affect a successful sphincter preservation procedure for low rectal cancer. A digital pelvic model was established. Multivariate analysis demonstrated that distance from the anal verge, body mass index, and pelvic factors affected the success of sphincter preservation. Sphincter preservation was more likely to succeed when the distance from anal verge was ≥5 cm and body mass index was more...

To detect the expression of S100A6 in gastric cancer, and to investigate the regulation mechanism of S100A6 in invasion and metastasis of gastric cancer.Expression of S100A6 protein in gastric cancer specimens, tissue adjacent to cancer, liver and lymph node metastasis tissue specimens was detected by immunohistochemical staining in 166 patients with gastric cancer from January 1995 to December 2001. Their association with clinicopathological factors was analyzed. Chromatin Immunoprecipitation-chip was used to detect the downstream factors potentially regulated by S100A6 in gastric cancer cell lines KATO3. S100A6 gene was transfected into gastric cancer cell line AGS, and cell invasion experiment and real time Q-polymerase chain reaction(RT Q-PCR) were used to detect the cell invasive ability and the mRNA expression of invasion-related factors (CDK5 and FLJ12438) in transfection group, negative control group and blank control group, respectively.Low expression of S100A6 protein was found in cytoplasm of peritumoral tissues. In gastric cancer, liver and lymph node metastasis tissues, S100A6 protein expression was up-regulated in cytoplasm and (or) nuclei, especially in the tumor cells of invasive edge. The expression rates of gastric cancer, liver and lymph node metastasis tissues were 67.5%(112/166), 92.9%(26/28) and 100% (30/30) respectively. The high expression of S100A6 was associated with tumor local invasion, lymph node metastasis, cancer embolus, distant metastasis and TNM stages(all P0.05). The transmembrane cell number was 31.3±5.5 in the S100A6 transfection group, significantly higher than that in negative control group (7.7±1.5) and blank control group (9.3±2.1)(both P0.05), indicating an increase of cell invasion after S100A6 transfection. In transfection group, CDK5 mRNA expression was significantly higher than that in negative control group and blank control group(P0.05). While FLJ1243 mRNA expression was similar among the three groups(P0.05).S100A6 may affect the malignant biological behavior of gastric cancer cells by regulating the expressions of down-stream invasion-associated factors, such as CDK5. more...

To explore the risk factors for pulmonary metastasis after curative resection of colorectal cancer in order to improve the effectiveness of follow-up and the rate of early diagnosis for the high-risk patients.The clinicopathological and follow-up data of 268 patients with colorectal cancer undergoing radical resection from January 2004 to December 2006 in the Beijing Cancer Hospital were analyzed retrospectively. Patients were divided into study group including 16(6.0%) patients who developed lung metastasis and control group without lung metastasis. The high-risk variables associated with lung metastasis were reviewed by univariate analysis and multivariate analysis.Lung metastasis developed in 16 patients, including 10 cases with unilateral lung metastasis and 6 with bilateral. The median duration from colorectal surgery to identification of lung metastasis was 13.9 months. The diagnosis rate of pulmonary metastasis by enhanced chest CT was 81.3%(13/16). Univariate analysis identified the following associated with significant factors associated with pulmonary metastasis: primary tumor location(P=0.003), adjuvant chemotherapy(P=0.034), TNM stage(P=0.005) and preoperative serum carcinoembryonic antigen(CEA) level (P=0.001). Multivariate analysis revealed that primary tumor location(rectum) and preoperative serum CEA level(≥5 μg/L) were independent risk factors for pulmonary metastasis(both P0.05).Primary tumor location and elevated preoperative CEA level are independent risk factors for pulmonary metastasis. Strict postoperative follow-up and routine chest enhanced CT examination is necessary for this particular patient population. more...

To evaluate the effect of perioperative imatinib mesylate (IM) therapy for patients with initial resectable primary local advanced gastrointestinal stromal tumor (GIST) at intermediate or high risk on R0 resection rate and the prognosis.Forty-eight above GIST patients between December 2001 and February 2012 were divided into 2 groups: neoadjuvant group (15 cases, pre- and post-operation IM therapy) and adjuvant group (33 cases, post-operative IM therapy). R0 resection rate, complication rate, disease-free survival (DFS) and overall survival (OS) were analyzed and compared between the two groups.The maximal tumor diameter and average tumor diameter were larger in neoadjuvant group as compared to adjuvant group (11.2 cm vs. 7.7 cm, P=0.005; 9.1 cm vs. 6.2 cm, P=0.014). The response rate of preoperative IM therapy was 93.3% (14/15). The R0 resection rate was 86.7% and 84.8% (P=1.000), and the complication rate was 13.3% and 9.1% (P=0.642) in neoadjuvant and adjuvant group respectively. The 3-year DFS was 55% and 41% (P=0.935), and 5-year OS was 83% and 75% (P=0.766) in neoadjuvant and adjuvant group respectively.Resectable primary local advanced GIST at intermediate or high risk with larger tumor diameter receiving perioperative IM therapy can achieve the same R0 resection rate, complication rate, DFS and OS as the GIST with smaller diameter receiving operation first. Perioperative IM therapy has potential advantage. more...

Gastric remnant cancer (GRC) is defined as cancer in the remnant stomach after partial gastrectomy. The incidence of GRC is rising in recent years. The carcinogenesis, development, and metastasis of GRC are different from primary gastric cancer. The early detection of GRC should be based on rational surveillance of patients following gastrectomy. For early stage GRC, endoscopic resection is one of the safe and effective methods. For advanced GRC, the primary treatment alternative is surgical resection. Minimally invasive procedures such as laparoscopic exploration, laparoscopic-assisted resection of GRC are still safe choices for experienced surgeons. more...

Post-operative recurrence and metastasis remain the leading causes of death for patients with gastric cancer. The major determinants of recurrence and metastasis are the biological characteristics of cancer cells and the immunological status of the patients. In recent years, due to the target-specificity, biotherapy has yielded efficacious responses in diverse clinical applications for cancer treatment, partially for the treatment of recurrence and metastasis of gastric cancer. However, because of the high diversities in clinical manifestations, patients' condition, and tumor's characteristics, there is no ideal strategy of biotherapy established for the prevention and treatment of recurrence and metastasis in gastric cancer. Therefore, a lot of work need to be done in basic research and clinical trial to make the biotherapy effective in treatment of gastric cancer recurrence. more...

To study the status of splenic hilar lymph nodes(No.4sa, No.10 or No.11d lymph nodes) metastasis and to investigate the proper dissection technique in patients with advanced gastric cancer.A retrospective study was performed to investigate 590 patients who underwent D2 curative proximal or total gastrectomy for gastric carcinoma from January 2006 to December 2009. Clinicopathological factors such as sex, age, location of the primary tumor, tumor sizes, gross type, depth of invasion, microscopic classification, neoadjuvant chemotherapy and the metastasis of adjacent lymph node were analyzed with univariate and multivariate analysis. Influence of combined splenectomy or pancreatectomy on lymph node dissection was also investigated.The overall ratio of metastatic lymph node(positive lymph nodes/lymph nodes harvested) in the splenic hilum was 17.5%(99/565). The positive rates of No.4sa, No.10, No.11d lymph nodes were 17.8% (41/230), 13.9%(29/209), and 22.8%(29/127), respectively. A total of 7.1%(42/590) of the patients had lymph node metastasis in the splenic hilum. Multivariable logistic regression analysis showed that age, tumor size, depth of tumor invasion, positive metastasis of No.4sb lymph node were independent risk factors for lymph node metastasis in the splenic hilum region. When comparing patients undergoing combined splenectomy or pancreatectomy(n=23) and those who did not undergo combined organ resection (n=553), the ratios of metastatic lymph node in the splenic hilum were 14.8%(4/27) and 17.2%(91/527), respectively, and the difference was not statistically significant(P0.05). The postoperative complication rates were 26.1%(6/23) and 5.4%(30/553), respectively, and the difference was statistically significant(P0.05). The operative mortality rates were 4.3% and 0.9%, respectively, and the difference was not statistically significant(P0.05).Metastasis to lymph nodes in the splenic hilum region in patients with gastric cancer possesses a certain pattern, and it is associated with tumor location, size, depth of invasion, and metastasis in No.4sb. Combined resection of the spleen or pancreas does not result in increased number of harvested lymph nodes or positive lymph nodes, yet is associated with higher complication rate. Therefore, combined organ resection should be meticulous. more...

To observe the clinicopathological characteristics of gastric cancer with pathological complete response(pCR) following neoadjuvant chemotherapy.Data of gastric cancer patients who received neoadjuvant chemotherapy from 2002 to 2008 in the Beijing Cancer Hospital were reviewed. Five cases were found to have pCR. The slides were reviewed by two experienced pathologists independently. Histological structure, morphology of tumor cells, morphology and quantity of stromal cells were evaluated.Structure of the gastric wall was distinguishable in all the 5 cases, while distortion and rupture of muscular layer were found in 2 cases. Exudative inflammatory reaction was present in the whole gastric wall including the serosa layer. Three patients had ulcerative lesions with epithelial layer shedding, and atypical hyperplasia was found around the border of the ulcer, and vascular endothelial cells were swollen. Residual distorted necrotic tumor cells resided in 1 case only and no residual tumor cells was present in the other 4 patients. Significant hyperplasia of fibroblasts was present in 4 cases, large amount of lymphocytes infiltration in 3 cases including concurrent plasma cell infiltration in 1 case, multinucleated giant cell reaction in the muscular layer of 1 case, and foam cells aggregation in 1 case with mucinous adenocarcinoma. In addition, there were 2 cases with pCR had lymph node metastasis.For cases with pCR following neoadjuvant chemotherapy, heterogeneity of stromal cells reaction is found in previous tumor site. Furthermore, the response of primary tumor does not necessarily parallel to that of lymph nodes. more...

To compare the expression of human epidermal growth factor receptor 2 (HER2) under different scoring systems in gastroesophageal cancer and its relationship with clinicopathological features.Clinicopathological data were retrospectively reviewed of 127 patients with gastroesophageal cancer between January and December 2009 in the Department of Surgery at the Cancer Hospital of Peking University. Tumor specimens were collected. The expression of HER2 protein was detected by immunohistochemistry.HER2 positive rate(++/+++) in gastroesophageal cancer was 15.0%(19/127) with both new and traditional immunohistochemical scoring systems, while HER2 strong positive rate(+++) was 10.2%(13/127) and 6.3%(8/127), respectively(P=0.26). Univariate analysis showed that the expression rate of HER2 protein was associated with differentiation and Lauren classification of the tumor. Multivariable analysis showed that TNM staging and tumor differentiation were independently associated with the expression of HER2 protein(both P0.05).There is no change in HER2 positive rate in gastroesophageal cancer between the new and traditional immunohistochemical scoring systems. Expression of HER2 is associated with clinicopathological features in the gastroesophageal cancer. more...

To investigate the clinicopathological features, treatment, and prognosis of gastric neuroendocrine carcinoma and gastric carcinoma with neuroendocrine cell differentiation.A total of 19 patients were treated for gastric neuroendocrine cancer or gastric cancer with neuroendocrine differentiation in the Beijing Cancer Hospital from January 1997 to December 2008. Clinical data were retrospectively analyzed.Fourteen patients had neuroendocrine carcinoma in the gastric cardia (n=9) or gastric body(n=5), and 5 patients had gastric cancer with neuroendocrine differentiation in the gastric cardia(n=2), the antrum(n=2), and the entire stomach(n=1). According to the International Classification of Disease for Oncology(2000), patients were divided into gastric carcinoid type I((n=2, 10.5%), type III( sporadic gastric carcinoid (n=9, 47.4%), small cell carcinoma of the stomach(n=3,15.8%), and gastric cancer with neuroendocrine cell differentiation(n=5, 26.3%). Clinical manifestations were mostly non-specific. Diagnosis was based on pathological and immunohistochemical examination. Eighteen patients underwent surgery including radical subtotal gastrectomy and total gastrectomy, of whom 3 underwent simultaneous resection of the liver metastasis. The remaining one patient with small cell carcinoma of the gastric body received chemotherapy alone because of unresectable liver metastasis. The survival rate was 73.7% at 1 year and 38.6% at 3 years.Gastric neuroendocrine carcinoma usually develops in the cardia and body of the stomach. Gastric carcinoma with neuroendocrine cell differentiation can occur in any locations of the stomach. Immunohistochemistry is important to the diagnosis. Radical resection is the main treatment. more...

To clarify the important clinicopathological and therapeutical factors affecting the prognosis of patients with gastroesophageal junction carcinoma.Data of 514 cases with gastroesophageal junction carcinoma who underwent surgical treatment from September 1995 to January 2007 was retrospectively analyzed. Relevant prognostic factors were studied with univariate and multivariate analysis.For all 514 cases (424 men and 90 women), the median age was 63 years. The 1-, 3- and 5-year survival rates of this group were 74.8%, 42.1% and 29.1%, respectively. Gross type, TNM classification, histological type, vascular invasion and extent of surgical resection affected patients' survival remarkably. There was no significant difference in survival between operative approaches (via laparotomy or left thoracotomy) (P0.05). Long-term survival was similar between proximal subtotal gastrectomy and total gastrectomy in advanced cases (P0.05). For stage II and III tumors, patients with neoadjuvant chemotherapy had better prognosis than those without (P0.05). Cox multivariate regression analysis revealed TNM classification and vascular invasion were independent prognostic factors.TNM classification and vascular invasion are independent prognostic factors for gastroesophageal junction carcinoma. Neoadjuvant chemotherapy may improve prognosis of the patients with stage II and III tumors. Radical resection should be achieved with rational surgical procedures tailored by tumor position, size, staging and so on. more...

The role of perioperative chemotherapy for gastric cancer has been established for gastric cancers in their advanced stage. In most parts of the world, even in Japan and Korea, local recurrence of gastric cancer following curative resection remains a problem. Should radiation be added to chemotherapy to achieve better local and regional control? What is the current evidence? What are the concerns regarding neoadjuvant chemoradiation in terms of safety, efficacy and survival benefit? After a serious review of the literature, the authors conclude that it is still too early to get a definitive answer but radiation seems promising. It may bring a higher pathological response rate. Rationally, more high level clinical trials are needed to confirm the role of radiotherapy in the neoadjuvant setting or to ascertain subsets of patients who may benefit from it. It is of note that surgeons should pay attention to possible complicated circumstances following radiotherapy, maintain proper nutrition status and minimize the occurrence of postoperative complications. As few data are available in Japan and Korea, interpretation and implementation of neoadjuvant radiation or chemoradiation should be done with caution. more...

To study the diagnosis and treatment of persistent hyperinsulinemic hypoglycemia of infancy.The clinical data of 12 infants with persistent hyperinsulinemic hypoglycemia were retrospectively reviewed.Convulsion, cyanosis, lethargy, refusing milk sucking, irritability and sweating were common symptoms. The laboratory findings displayed persistent hypoglycemia and hyperinsulinism in all of the 12 infants. The glucagon test showed positive and no urine ketones were detected in all of the 12 infants. Seven infants were treated with oral diazoxide (5-15 mg/kg daily) and 4 infants showed effective to the therapy. One patient was given subtotal pancreatectomy and the blood glucose level was restored to normal after operation. Of the 12 infants, 6 presented psychomotor retardation in a follow-up of 2 months to 67 months, 3 had loss to follow-up and 3 were still in a follow-up.The measurement of blood glucose, blood insulin and urinary ketons is helpful in the diagnosis of persistent hyperinsulinemic hypoglycemia of infancy. Diazoxide therapy is effective in some of patients. more...

To explore the pattern of lymph node metastasis and its influence on the prognosis of early gastric cancer(EGC).The pattern of lymph node metastasis and the 3-,5-year survival rates in 157 EGC patients undergone surgery from October 1995 to October 2005 were analyzed retrospectively. The SPSS 11.5 statistics software was used to perform univariate and multivariate analysis.Twenty-two cases had lymph node metastasis among 157 EGC patients(14%). Two mucous cancers(2.4%) and 20 submucosal tumors(27.0%) had lymph node metastases (P0.01). Lymph node metastasis was not seen in minute gastric cancer(diameteror =0.5 cm). Lymph node metastasis rates were 6.4% in the cancers with diameter 1.1-2.0 cm and 21.5% in the cancers with the diameter2.0 cm(P0.01). Besides, lymph node metastasis rate of well-differentiated EGC was 0, of moderate differentiated EGC 11.1%, and poor-differentiated EGC 0.9%(P0.01). Of 9 cases with vascular cancer embolus, 4 had lymph node metastases. Logistic regression analysis showed that tumor size, vascular cancer embolus, histopathological type and depth of invasion were independent factors of lymph node metastasis in EGC. The 3- and 5-year survival rates of EGC patients with lymph node metastasis were 81.6 % and 79.5% respectively, which were much lower than those without lymph node metastasis(95.7% and 93.2%, P0.01).Lymph node metastasis in EGC is mainly correlated with depth of infiltration, tumor size, vascular cancer embolus and differentiation. For EGC treatment, choice should be made reasonably based on the risk of lymph node metastasis. more...

To examine the utility of the Ligasure vessel-sealing system in D(2) lymphadenectomy of gastric cancer, and compare with conventional hand tie method.One hundred and twenty-four consecutive patients undergone D(2) lymphadenectomy of gastric cancer from Jan. to Oct. 2005 were enrolled in this study. Operations of 62 patients were performed with Ligasure, whereas the other 62 patients with hand tie method. Operative duration, volume of intraoperative hemorrhage and postoperative course were analyzed.There was significant difference in operative duration (187.3 min vs 210.5 min, P0.05) and no significant differences in volume of intraoperative hemorrhage, postoperative course, or duration of postoperative drainage between Ligasure group and conventional method group. No significant difference was observed in the frequency of postoperative complications between the two groups.D(2) lymphadenectomy of gastric cancer using Ligasure instead of conventional hand tie method appears to be technically feasible and easy. more...