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   2017|   | Volume 13 | Issue 5  
    Online since December 13, 2017

 
 
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ORIGINAL ARTICLES
Clinicopathological features and prognostic evaluation of bone metastasis in triple-negative breast cancer
Anqi Luo, Fang Wu, Rui Han, Shangke Huang, Yujiao Zhang, Xin Jing, Xinhan Zhao
2017, 13(5):778-784
DOI:10.4103/jcrt.JCRT_543_17  PMID:29237903
Background: Bone metastases (BMs) are common for breast cancer patients. However, triple-negative breast cancer (TNBC) with BM is relatively rare and few data on it are available. In this study, we aim to investigate the incidence and clinicopathological features and to evaluate the prognosis of TNBC patients with BM. Materials and Methods: A total of 616 patients with TNBC (120 out of them had BM) between 2007 and 2011 were involved in the study. Clinicopathological characteristics were statistically analyzed. Results: A total of 120 (19.5%) patients developed BM with a median age of 53.1 years. The median overall survival (OS) was 40 months, and the 5-year OS rate was 37.3% in TNBC patients with BM. Patients without BM had longer survival time than those with BM (P < 0.001). In the univariate analysis, lymph nodes metastasis, tumor Stage III-IV, multiple BMs, and coexistence of visceral metastasis were correlated to a poor prognosis (P = 0.020; P < 0.001; P < 0.001; P < 0.001). Moreover, multivariate analysis demonstrated that tumor stage, number of BM, and visceral metastasis were significantly independent factors for OS (P < 0.001; P < 0.001; P < 0.001). Conclusions: Tumor Stage III-IV, multiple BMs, or coexistence of visceral metastasis were associated with poor prognosis for OS in TNBC patients with BM. These associations may contribute to prevention, early detection, and goal-directed treatment of bone metastatic TNBC.
  2,634 72 -
Meta-analysis of diagnostic accuracy of magnetic resonance imaging and mammography for breast cancer
Yueqiao Zhang, Hong Ren
2017, 13(5):862-868
DOI:10.4103/jcrt.JCRT_678_17  PMID:29237918
Objective: The aim of this study was to compare the performance of mammography (MG) and magnetic resonance imaging (MRI) in the diagnosis of breast cancer. Methods: Searching in the databases including PubMed, Embase, and Google Scholar about comparative study of MG and MRI in the diagnosis of breast cancer during 2000–2017. After we screened further, the extracted effective data were calculated by Meta-Disc 1.4 software. Results: we obtained 11 articles. The pooled estimates for sensitivity of MG and MRI were 0.75 (95% confidence interval [CI], [0.72, 0.78]) and 0.92 (95% CI, [0.89, 0.94]) respectively, and for specificity were 0.71 (95% CI, [0.67, 0.74]) and 0.70 (95% CI, [0.66, 0.73]), respectively. Their weighted area under the summary receiver operating characteristic curve was 0.79 and 0.93, respectively. Conclusion: MRI remains to be a satisfactory method for the diagnosis of breast cancer and should first be considered for patients.
  2,107 169 -
Influence of risk factors on stomal recurrence after total laryngectomy for laryngeal carcinomas: A meta-analysis
Zhi-Yi Wang, Ze-Qin Li, Han Ji, Wei Chen, Kun-Min Wu, Min-Hui Zhu, Hong-Liang Zheng
2017, 13(5):856-861
DOI:10.4103/jcrt.JCRT_90_17  PMID:29237917
Background: Total laryngectomy is preserved for those the most advanced larynx cancer and nonsurgical cases. However, stomal recurrence is frequently occurred and leads to high mortality. Herein, we aimed to determine the risk factors for the stomal recurrence after total laryngectomy (SRAL). Methods: Databases such as PubMed and EMBASE were comprehensively searched using the keywords “stomal recurrence” and “total laryngectomy.” Based on the inclusion and exclusion criteria, qualified studies would be incorporated in this meta-analysis, followed by quality evaluation and data extraction. Risk ratios (RRs) were used. Results: A total of six studies were included in the meta-analysis, and the pooled RRs showed that subglottic location increased the incidence of stomal recurrence most among the four primary locations. Expectedly, advanced tumor stage before the laryngectomy was the risk factor for stomal recurrence, while lymph node metastases showed no difference in this meta-analysis. Further, preoperative tracheostomy increased two times more risk in the stomal recurrence compared with nonpreoperative surgery. Conclusions: In this study, we proved that subglottic location, advanced tumor stage, especially T4 stage, and preoperative tracheostomy were risk factors for SRAL for larynx cancer. However, many other potential risk factors, such as surgical margins, could not be determined for inadequate records. Hence, more prospective trials should be designed to determine the risk factors for SRAL for larynx cancer.
  1,827 102 -
Effect of auricular points treatment combined with acupoints application in patients with constipation after lung cancer surgery
Yan Li, Daliang Qi, Lei Gong, Huiping Qu, Bin Xu, Xiaoyan Wen, Jing Li, Jie Xu
2017, 13(5):844-848
DOI:10.4103/jcrt.JCRT_709_17  PMID:29237915
Object: To assess the effect of auricular points treatment combined with acupoints application on patient with constipation after lung cancer surgery. Methods: Design and participants: This is a single-center randomized controlled trial. Totally 341 after lung cancer surgery patients were randomly assigned into the experimental group (n = 174) and the control group (n = 167). The control group received routine nursing care, which was included psychological support, diet instruction, and post-operative activities guidance. The experimental group received auricular points treatment combined with acupoints application therapy in addition to the routine nursing care. All the patients had defecation within 3 days after operation. The characteristics of the stool were recorded, and the progress and performance of the incidence of constipation was recorded in two groups. Results: The incidence of constipation in the control group was higher than that in the experimental group (P < 0.001). Moreover, the stool characteristics of experimental group were better than it in the control group by rank-sum test (P = 0.047). Conclusion: On the basis of routine measures to prevent constipation after lung cancer surgery, auricular point sticking combined with acupoint application therapy can effectively decrease the incidence of postoperative constipation.
  1,572 70 -
Lymphoepithelioma is a nonkeratinizing squamous cell carcinoma with Epstein–Barr virus infection in China
Qiuyan He, Yangying Zhou, Chunyan Fu, Wei Zhu, Jianhua Zhou, Shuang Liu, Yongguang Tao, Desheng Xiao
2017, 13(5):807-812
DOI:10.4103/jcrt.JCRT_280_17  PMID:29237908
Objective: The objective of this study is to investigate the histogenesis of lymphoepithelial carcinoma (LEC) and its relationship with Epstein–Barr virus (EBV). Materials and Methods: The expression of EBV was detected using in situ hybridization, and the CK5/6, p63, and p40 expression levels were detected using immunohistochemistry in 45 paraffin-embedded tissues from LEC. Results: In 45 paraffin-embedded LEC tissues from 10 different samples, the positive CK5/6 signals were located in the cell membrane. The positive signals for p63 and p40 were located in the cell nucleus. In all LEC cases, the positive rates of CK5/6, p63, and p40 were 93.3% (42/45), 95.6% (43/45), and 93.3% (42/45), respectively. The positive EBV-encoded RNA (EBER) signals were located in the cell nucleus. In the 45 LEC cases, the expression of EBER was strongly positive with a positive rate of 100% (45/45). Conclusions: LEC is closely related to EBV, and EBV plays an important role in the development of LEC. LEC showed positive squamous cell markers, indicating that the samples contain squamous cell carcinoma (SQCC). LEC is EBV (+) with nonkeratinizing SQCC, and this name better reflects the nature of this disease.
  1,547 66 -
A clinical study of polyethylene glycol recombinant human granulocyte colony-stimulating factor prevention neutropenia syndrome in patients with esophageal carcinoma and lung cancer after concurrent chemoradiotherapy
Fang Liu, Yu Du, Boning Cai, Maohui Yan, Wei Yang, Qianqian Wang
2017, 13(5):790-795
DOI:10.4103/jcrt.JCRT_320_17  PMID:29237905
Objective: To compare the efficacy and safety of PEG-rhG-CSF and recombinant human G-CSF (rhG-CSF) for the prevention and delayed application in febrile neutropenia, hospitalization rate in concurrent chemoradiotherapy of tumors. Methods: A total of 163 patients, who received concurrent chemoradiotherapy for solid tumors. There were 75 patients in the PEG-rhG-CSF group (PEG group), who received 146 cycles of concurrent chemoradiotherapy, of which 132 cycles (90.42%) were prophylactic therapy, while 9 cycles (6.16%) were delayed therapy. There were 88 patients in the rhG-CSF group (rhG group), who received 164 cycles of concurrent chemoradiotherapy, of which 48 cycles (29.3%) were prophylactic, while 116 cycles (70.7%) were delayed therapy. G-CSF was used for prophylaxis in 180 cycles of chemotherapy, with delayed use in 130 cycles. Results: Comparison between the prevention group and the delayed group showed that the incidence of neutropenia-related hospitalization was 4.44% and 14.62%, respectively (OR = 0.272, 95% CI, 0.115-0.642) (P = 0.002). Intravenous antibiotics usage was 2.78% vs. 11.54%, (OR = 0.004, 95% CI, 0.077-0.619) (P = 0.004). Dose reduction of chemotherapy or delay was 5% vs. 17.69% (OR = 0.245, 95% CI, 0.109-0.549) (P = 0.001). The prevention group had protective effects from all factors as compared to the delayed group (all P < 0.05, and all OR < 1). Moreover, the protective role of intravenous antibiotics was the strongest in the prevention group. Conclusion: Prophylactic use of GSF reduced hospitalization rate and the rate of intravenous application of antibiotics.
  1,561 50 -
Efficacy and safety of bevacizumab in elderly patients with advanced colorectal cancer: A meta-analysis
Xiuxing Chen, Yanfeng Chen, Xiuyu Cai, Dongsheng Zhang, Lei Fan, Huijuan Qiu, Bei Zhang, Guifang Guo
2017, 13(5):869-877
DOI:10.4103/jcrt.JCRT_833_17  PMID:29237919
Aims: Bevacizumab plus chemotherapy (CT) has been the standard treatment for advanced colorectal cancer (ACRC) in the last decade. However, whether geriatric patients treated with this combination achieved more benefits or suffered severer toxicities than CT alone remained controversial. This meta-analysis was aimed to provide more convincing evidence. Subjects and Methods: Randomized control trials (RCTs) and retrospective comparative studies on the comparison between bevacizumab plus CT and CT for geriatric ACRC patients were retrieved in PubMed, Web of Science, EMBASE, and Ovid until June 2016. One RCT, five subgroup analyses of RCTs, and two retrospective studies with efficacy and safety data were identified, involving a total of 2813 cases. The included primary outcomes were overall survival (OS), progression-free survival (PFS), and adverse events (AEs). Results: For geriatric ACRC, both OS (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.74–0.94, P = 0.003) and PFS (HR 0.55, 95% CI 0.48–0.63, P < 0.001) have been improved after the addition of bevacizumab to CT. The odds ratios (ORs) for total grade and grade 3–5 AEs were 1.85 (95% CI 1.12–3.04, P = 0.02) and 2.09 (95% CI 1.69–2.58, P < 0.001), respectively. For overall grade toxicities, proteinuria (OR 10.89, 95% CI 1.37–86.28, P = 0.02), hypertension (OR 4.44, 95% CI 1.85–10.62, P < 0.05), and fistulae/abscess (OR 12.07, 95% CI 1.54–94.88, P < 0.05) were significantly higher in the bevacizumab arm. For grades 3–5, increased risk of hypertension (OR 3.91, 95% CI 2.48–6.16, P < 0.001), arterial thromboembolism (OR 3.25, 95% CI 1.70–6.19, P < 0.001), and venous thromboembolism (OR 2.17, 95% CI 1.11–4.25, P = 0.02) was observed in the bevacizumab group. Conclusions: After the addition of bevacizumab to CT in geriatric ACRC, both PFS and OS could be significantly improved, while it would also lead to some high-grade AEs, hypertension, and arterial and venous thromboembolism.
  1,521 71 -
Brachytherapy with iodine 125 seeds for bone metastases
Wei Wang, Zhonghao Liu, Jingrun Zhu, Chuanwang Wu, Mingyang Liu, Yongzheng Wang, Wujie Wang, Bin Liu, Yuliang Li
2017, 13(5):742-747
DOI:10.4103/jcrt.JCRT_399_17  PMID:29237897
Objective: To evaluate the treatment safety and efficacy of iodine 125 (I125) seeds implantation in patients with bone metastases and assess the availability of quality of life (QOL) as an index for efficacy evaluation. Patients and Methods: The study enrolled 98 patients with 133 bone metastases from July 2010 to January 2016, who had undergone computed tomography-guided brachytherapy with I125 seeds. Brief pain inventory was administered to assess the degree of pain at the preoperative (W0) and postoperative 2 weeks, 4 weeks, 8 weeks, 12 weeks, and 24 weeks (W2, W4, W8, W12, and W24). Drug use, QOL score, and complications were also assessed. Results: Postoperative pain scores were significantly decreased and maintained for a long term. Numerical rating scale score at W0 was 7.3 ± 1.6, which was decreased to 4.5 ± 1.7 (P < 0.01), 3.7 ± 1.3 (P < 0.01), 2.5 ± 1.1 (P < 0.01), 1.9 ± 0.9 (P < 0.01), and 1.3 ± 0.5 (P < 0.01) at W2, W4, W8, W12, and W24, respectively. After standardized transformation, the dose of morphine for patients at W0 was 175.2 ± 24.5 mg, which was decreased to 91.2 ± 21.7 mg (P < 0.01), 89.4 ± 24.6 mg (P < 0.01), 89.4 ± 24.6 mg (P < 0.01), 72.8 ± 14.8 mg (P < 0.01), and 56.7 ± 11.3 mg (P < 0.01) at W2, W4, W8, W12, and W24, respectively. The efficiency reached 65.3%, 85.1%, 91.2%, 95.2%, and 92.7% at postoperative W2, W4, W8, W12, and W24, respectively. QOL score at W0 was 17.4 ± 3.3, which increased to 23.2 ± 4.5 (P < 0.01), 28.6 ± 7.6 (P < 0.01), 43.2 ± 9.1 (P < 0.01), 45.6 ± 10.3 (P < 0.01), and 47.6 ± 9.8 (P < 0.01) at W2, W4, W8, W12, and W24, respectively. Conclusion: Brachytherapy with I125 seeds was safe and effective for treating bone metastases, offering a potential alternative to external-beam radiotherapy. QOL could be applied to evaluate the efficacy of I125 seeds implantation for treating bone metastases.
  1,417 60 -
Functional analysis of RET with multiple endocrine neoplasia type 2
Meihua Zhang, Yao Liu, Jie Fu, Ying Hu, Zheng Sun
2017, 13(5):823-828
DOI:10.4103/jcrt.JCRT_274_17  PMID:29237911
Background: Multiple endocrine neoplastic type 2 (MEN2) is an endocrine carcinoma syndrome which is caused by a germline activation mutation that occurs during transfection (RET) proto-oncogene transmission. MEN2A patients are affected by RET (C634Y, C634R) mutation; MEN2B patients are affected by RET (M918T) mutation. Aims: We aim to identify RET mutations' (C634R and M918T) expression, location, and signaling activation during the disease's progression, which providing a theoretical basis for the study on etiology of multiple endocrine neoplasia. Settings and Design: This study was conducted to determine whether RET dysfunction involves an induced mutation into SK-N-MC cells. Materials and Methods: Wildtype RET and mutant RET plasmids (M918T and C634R) were constructed and transfected into SK-N-MC cells, the protein level was detected by Western blot, the efficiency of the transfected cells was detected by real time PCR, and the location of RET protein in cells as-determined by immunofluorescence. SK-N-MC cells with different RET plasmids treated/untreated by GDNF, AKT and ERK1/2 phosphorylation detected by specific antibodies. Results: We found that C634R mutation could enhance RET protein expression and change the location of the mutated protein and forced it into the nucleus, GDNF treatment alone can only enhance M918T RET phosphorylation level and not impact WT or C614R mutation, and AKT/ERK1/2 pathway can be affected by GDNF treatment. Conclusion: RET dysfunction involves an induced mutation into SK-N-MC cells.
  1,356 68 -
Efficacy and safety of temozolomide plus whole-brain radiotherapy in the treatment of intracranial metastases
Hai-Peng Liu, Ke-Bin Zheng, Ji-Wei Wang
2017, 13(5):785-789
DOI:10.4103/jcrt.JCRT_323_17  PMID:29237904
Objective: This study aimed to explore the clinical efficacy and safety of temozolomide (TMZ) plus whole-brain radiotherapy (WBRT) in the treatment of intracranial metastases. Subjects and Methods: A total of 72 patients with intracranial metastases were randomly divided into observation group and control group (each n = 36). The patients of observation group received WBRT plus TMZ, while the patients of control group received WBRT. The observation index of both groups included the short- and long-term clinical efficacies, improvement of symptoms and signs, quality of life (QOL), and adverse responses. Results: After treatment, the objective remission rate in observation group (77.78%, 28/36) was evidently higher than that of in control group (47.22%, 17/36), with significant difference (P = 0.0074). However, the disease control rate in observation group (94.44%, 34/36) was only slightly higher than that of in control group (86.11%, 31/36) (P = 0.4263). Moreover, after treatment, compared to control group, observation group showed markedly better improvement in symptoms and signs, as well as QOL (P < 0.001), with significantly longer overall survival and progression-free survival (P < 0.001). Conclusion: TMZ concomitant with WBRT can increase the local control, prolong the survival time and improve the QOL of patients with intracranial metastases.
  1,290 82 -
Role of surgical treatment for hepatolithiasis-associated intrahepatic cholangiocarcinoma: A retrospective study in a single institution
Jian Xiao, Jisheng Zhu, Zhanying Liu, Renhua Wan, Yong Li, Weidong Xiao
2017, 13(5):756-760
DOI:10.4103/jcrt.JCRT_356_17  PMID:29237899
Context: The extent of hepatectomy and lymph node dissection (LND) in the treatment of hepatolithiasis-associated intrahepatic cholangiocarcinoma (HL-iCCA) is still controversial. Aims: The aim of this retrospective study was to evaluate the role of surgical treatment for HL-iCCA. Methods: The clinical data of 63 patients with HL-iCCA who undergoing surgery between January 2005 and December 2015 were analyzed retrospectively. Statistical Analysis Used: All data were analyzed by the SPSS 17.0 software program (IMB Inc., Chicago, IL, USA). Survival curves were analyzed by the Kaplan–Meier method and compared by the Log-rank test. A P < 0.05 was considered statistically significant. Results: Forty-nine patients (77.8%) underwent surgical resection including 35 with LND and 14 without LND. The overall 1-, 3-, and 5-year survival rates were 58.1%, 28.2%, and 10.6%, respectively, and the median survival time was 19 months. The 1-, 3-, and 5-year survival rates of resection group were 78.9%, 36.3%, and 13.5%, respectively, while the 1-year survival rate of exploratory laparotomy group was 0 (P < 0.0001). The 1-, 3-, and 5-year survival rates of patients with LND were significantly superior to those of without LND (75.9%, 39.4%, and 20.2% vs. 71.4%, 17.9%, and 0, P = 0.043). According to the N status, the 1-, 3-, and 5-year survival rates of pN0 subgroup were 81.8%, 49.2%, and 28.1%; pN1 subgroup were 65.3%, 18.6%, and 0%; and pNx subgroup were 71.4%, 17.9%, and 0%, respectively (pN0 vs. pN1, P = 0.005; pN0 vs. pNx, P = 0.004; pN1 vs. pNx, P = 0.653). The 1-, 3-, and 5-year survival rates of R0 resection (n = 42) were 80.2%, 36.7%, and 14.9%, respectively, and those of R1 resection (n = 7) were 71.4%, 0%, and 0%, respectively (P = 0.028). Conclusions: Radical resection is the most effective therapy for HL-iCCA. Regional lymphadenectomy is strongly recommended in resectable HL-iCCA, which is helpful in tumor staging and long-term survival.
  1,309 62 -
Clinical efficacy of preoperative vaginal intracavitary irradiation for Stage Ib2 and IIa cervical cancer
Fengshuang Li, Yumei Wu, Weimin Kong, Jiandong Wang, Xia Hao, Juwei Niu, Laifu Bai
2017, 13(5):796-800
DOI:10.4103/jcrt.JCRT_398_17  PMID:29237906
Objective: The purpose of this study was to evaluate the clinical efficacy of preoperative vaginal intracavitary irradiation for Stage Ib2 and IIa cervical cancer. Materials and Methods: From June 2008 to June 2014, data from 78 Stage Ib2 and IIa cervical cancer patients (age ≤75 years) with a diameter of local lesions >4 cm were collected in our hospital. Before treatment, all cases were confirmed by biopsy. The patients' general state was good, Karnofsky Performance Score ≥90, heart and lung functioning was normal, and patients were able to tolerate the surgery. The 78 patients were randomly divided into two groups: neoadjuvant radiotherapy group (NRG) (n = 38) and radical surgery group (n = 40). Patients in NRG received 2000~3000 cGy192 Ir irradiation of preoperatively intracavitary brachytherapy (radioactive source at 1 cm distance). After a rest of 10–14 days, radical hysterectomy with pelvic lymphadenectomy was performed. Surgery alone group (SAG) (n = 40) underwent radical surgery directly. The treatment outcomes between these two groups were compared, and the effect of preoperative intracavitary brachytherapy and presence of postoperative complications were evaluated. Results: The total clinical efficacy for intracavitary brachytherapy was 94.7% (36/38) with complete response 13 (34.2%), partial response 23 (60.5%), and stable disease 2 (5.3%). Moreover, no patients developed progression disease; for SAG patients, 32 cases successfully finished the extensive hysterectomy and pelvic lymphadenectomy. Operation time <240 min was found in 19 patients. Moreover, the positive complication for lymphatic cyst and urinary retention was 20.0% and 15.0%, respectively. For NAG group, 36 patients successfully finished the extensive hysterectomy and pelvic lymphadenectomy. Operation time <240 min was found in 22 patients. Moreover, the positive complication for lymphatic cyst and urinary retention was 15.8% and 13.2%, respectively. The median follow-up time for NRG and SAG was 28 and 30 months, respectively. Three cases lost to follow-up in the SAG with the follow-up rate of 92.5% (37/40). In the NRG group, 3 cases lost to follow-up with the follow-up rate of 92.1% (35/38). The locoregional control rate for 1, 3, and 5 years was 80.0%, 61.3%, and 52.6%, respectively, for SAG group and 89.5%, 82.9%, and 76.9%, respectively, for NRG group with significant statistical difference for 3 and 5 years. Conclusion: Preoperative intracavitary brachytherapy is an effective procedure for the treatment for Stage Ib2 and IIa cervical cancer and can significantly improve the locoregional control rate.
  1,282 70 -
The prognostic value of preoperative serum albumin-globulin ratio for high-grade bladder urothelial carcinoma treated with radical cystectomy: A propensity score-matched analysis
Zhenhua Liu, Haichao Huang, Shaobo Li, Wei Yu, Wei Li, Jie Jin, Xin Li, Jinchun Xing
2017, 13(5):837-843
DOI:10.4103/jcrt.JCRT_237_17  PMID:29237914
Objectives: Albumin-globulin ratio (AGR) has been reported as an independent risk factor for survival outcomes of a variety of malignancies. We aimed to further examine the prognostic value of AGR for urothelial carcinoma of bladder (UCB) using a propensity score-matched (PSM) analysis. Materials and Methods: The medical data of 189 high-grade UCB patients undergoing radical cystectomy were retrospectively reviewed. AGR was defined as the ratio of serum albumin to nonalbumins (serum total protein–albumin). The association of preoperative AGR with clinicopathologic characteristics and prognosis were assessed. Multivariate analyses using Cox regression models were applied to evaluate the independent prognostic factors. Results: The receiver operating curve analysis indicated 1.55 as the optimal cutoff value to define low or high AGR. In prematched cohorts, Kaplan–Meier analysis indicated that AGR lower than 1.55 was associated with poorer overall survival (OS), progression-free survival (PFS), and tumor-specific survival (TSS) (P < 0.001 for all). Multivariable cox analyses also showed that AGR lower than 1.55 were an independent risk factor for survival outcomes, including OS, PFS, and TSS (P < 0.01 for all). In particular, AGR lower than 1.55 remained its prognostic value after PSM analysis. Conclusion: Low AGR was a significant unfavorable factor for UCB patients treated with radical cystectomy. This viable parameter should be enrolled in the pretreatment risk stratification for UCB.
  1,287 52 -
Optimization of b-values in diffusion-weighted imaging for esophageal cancer: Measuring the longitudinal length of gross tumor volume and evaluating chemoradiotherapeutic efficacy
Gang Liu, Zhijie Yang, Tianran Li, Li Yang, Xiangdong Zheng, Lijie Cai
2017, 13(5):748-755
DOI:10.4103/jcrt.JCRT_630_17  PMID:29237898
Purpose: To study the optimization of b-values of magnetic resonance-diffusion-weighted (MR-DWI) in evaluating the chemoradiotherapeutic efficacy for esophageal squamous cell carcinoma (ESCC) and measuring the longitudinal length of gross tumor volume (GTV) of ESCC. Materials and Methods: Eighteen patients with biopsy-proven ESCC were undergoing concurrent chemoradiotherapy (CCRT). Conventional magnetic resonance imaging (MRI) combined with DWI using b-values of 600 s/mm2, 800 s/mm2, and 1000 s/mm2 was performed before CCRT and after the 1st, 3rd, 5th, and 10th weeks. The apparent diffusion coefficient (ADC) values of ESCC were derived from DWI using multiple b-values. The correlations between ADC values and apoptosis positive rates of ESCC cells obtained from the endoscope biopsy were statistically analyzed. Thirty-eight patients with confirmed ESCC who underwent radical surgery were analyzed. Longitudinal length of GTV of ESCC was measured using endoscopy, esophageal barium fluoroscopy, computed tomography (CT), and T2-weighted MRI and DWI using different b-values (b = 400, 600, and 800 s/mm2) before surgery and were compared with pathologic lesion length. Results: The ADC values of DWI images with different b-values are positively correlated with ESCC cell apoptosis positive ratios, the relation is significant, especially in the group of b = 1000 s/mm2 (P < 0.01). The measured length of esophageal lesions from short to long was MR-DWI b = 800 s/mm2, endoscopy, real tumor, MR-DWI b = 600 s/mm2, esophageal barium fluoroscopy, CT, and MR-DWI b = 400 s/mm2. Conclusion: MR-DWI b = 800 s/mm2 and b = 1000 s/mm2 are in favor of observing the chemoradiotherapeutic efficacy with time variation and evaluating the chemoradiotherapeutic efficacy, respectively. MR-DWI b = 600 s/mm2 could be used as a supplementary means in measuring the length of ESCC.
  1,269 51 -
Microwave ablation: Results with three different diameters of antennas in ex vivo bovine and in vivo porcine liver
Ze Song, Han Qi, Hao Zhang, Lin Xie, Fei Cao, Weijun Fan, Chao Wan
2017, 13(5):737-741
DOI:10.4103/jcrt.JCRT_755_17  PMID:29237896
Purpose: To evaluate the ablation ranges and temperature rising rates of three microwave antenna with different diameters in vitro bovine and in vivo porcine livers. Materials and Methods: In vitro and in vivo study, microwave ablations (MWA) were induced at a power output of 70 W for 5, 8, and 10 min; a total of 54 and 36 ablations were performed, respectively. Temperature measurements were performed in the 70 W/10 min group with 3 different microwave antennas. Results: In vitro study, the long axis diameter for the 16G microwave antenna was longer than the 15G (P < 0.05) and 14G microwave antennae (P < 0.05). The sphericity index for the 14G and 15G microwave antennae was higher than the 16G microwave antenna (P < 0.05 for both). In the in vivo study, the short- and long-axis diameters, and sphericity index were not statistically different between the 14G, 15G, and 16G groups. The temperature data were not statistically different in both studies. Conclusions: Although the thin microwave antenna had a longer long-axis diameter and a lower sphericity index in vitro study, the thin microwave antenna achieved the same ablation effect in vivo application. MWA has several advantages, and the thin microwave antenna decreases the puncture risk and complication rate. Thus, a thin microwave antenna (15G and 16G) is beneficial in clinical applications and will have a significant influence in the development of MWA.
  1,244 67 -
CORRESPONDENCE
Adenocarcinoma located at a Meckel's Diverticulum: A case report and literature review
Yiguo Zhao, Xiaodong Yang, Yingjiang Ye
2017, 13(5):878-881
DOI:10.4103/jcrt.JCRT_124_17  PMID:29237920
Tumors arising from Meckel's diverticulum (MD) reported in the literature are mainly carcinoid and gastrointestinal stromal tumors. We herein report a rare case of adenocarcinoma arising from intestinal mucosa in an MD with multiple liver metastases at the onset of symptoms. A 57-year-old female complaining of bloody stool for 2 weeks was admitted to our hospital. Colonoscopy revealed massive bloody fluids but did not find any neoplasm. Computed tomography (CT) found a heterogeneous mass at the distal ileum and multiple liver metastases. A segmental ileal resection with local mesentery excision was performed to control the bleeding. During surgery, a tumor arising from a diverticulum in the antimesenteric border of ileum was observed. Histologic examination revealed moderate to poorly differentiated adenocarcinoma. Majority of the MD remain asymptomatic and are diagnosed incidentally during small bowel contrast study, laparoscopy or laparotomy done for unrelated conditions, or until complications arise from the diverticulum. Malignancies are reported to account for only 0.5%–3.2% of the complications. The occurrence of adenocarcinoma in an MD is exceedingly rare. In the few cases described so far, the prognosis of adenocarcinoma within an MD has been poor due to the advanced stage as seen at the time of surgery. Despite the availability of many publications, there is a little consensus concerning the management of an incidental finding of MD. Adenocarcinoma in an MD is extremely sporadic and prognosis has been reported as very poor. However, early diagnosis is challenging. When found incidentally during laparotomy, MD should be carefully examined and best treated with prophylactic resection.
  1,231 59 -
ORIGINAL ARTICLES
Long noncoding RNA activated by transforming growth factor-β promotes cancer development and is a prognostic marker in cervical cancer
Weichun Cao, Tianfang Peng, Yi Zhou
2017, 13(5):801-806
DOI:10.4103/jcrt.JCRT_256_17  PMID:29237907
Background: Long noncoding RNAs (lncRNAs) have been highlighted as crucial elements in cancer biology. LncRNA activated by transforming growth factor-β (ATB) was identified to promote the development of multiple cancers and may serve as a potential therapeutic target in human cancers. However, to the best of our knowledge, the functional role of ATB in cervical cancer has not been verified yet. Materials and Methods: The expression of lncRNA ATB was evaluated by quantitative reverse transcriptase-polymerase chain reaction assay in cervical cancer cell lines and clinical specimens. The clinical significance of ATB was statistically evaluated by analyzing the relationship between ATB overexpression and the clinicopathological characteristics of cervical cancer patients. Moreover, Kaplan–Meier analysis and log-rank test were conducted to investigate the role of ATB in the overall survival (OS) and progression-free survival (PFS) of cervical cancer patients or subgroup patients. Furthermore, univariate and multivariate analyses were adopted to identify the risk factors of OS and PFS of cervical cancer patients. Results: LncRNA ATB was upregulated in cervical cancer cell lines and tissues (P < 0.05). Statistical analysis revealed that ATB overexpression was correlated with higher squamous cell carcinoma antigen level, larger tumor size, lymph node metastasis, and more advanced International Federation of Gynecology and Obstetrics (FIGO) stage of cervical cancer patients (P < 0.05). In addition, survival analysis showed that ATB upregulation was associated with poorer OS in cervical cancer patients and in subgroup patients without/with lymph node metastasis and with FIGO Stage I/II (P < 0.05). Furthermore, high ATB expression was defined as an independent risk factor of poorer OS and early recurrence of cervical cancer patients (P < 0.05). Conclusion: LncRNA ATB correlates with the malignant phenotypes and poor prognosis of cervical cancer. ATB may serve as a promising prognostic marker and therapeutic target of cervical cancer patients.
  1,225 60 -
Effects of exogenous hydrogen sulfide on the proliferation and invasion of human Bladder cancer cells
Hui Liu, Junkai Chang, Zhenhua Zhao, Yang Li, Junqing Hou
2017, 13(5):829-832
DOI:10.4103/jcrt.JCRT_423_17  PMID:29237912
Objective: The objective of this study is to evaluate the effects of exogenous hydrogen sulfide (H2S) on the proliferation and invasion of human bladder cancer cells. Methods: Human bladder cancer EJ cells were cultured and then treated with sodium bisulfide (NaHS) (100 μmol/L for low dosage, 200 μmol/L for moderate dosage, 400 μmol/L for high dosage). The differences on proliferation and invasion of EJ cells were detected among different groups with MTT and transwell invasion assays. The differences in the expression levels of matrix metalloproteinase 2 (MMP2) and MMP9 among the groups were detected with Western blot. Results: Cell proliferation activity was elevated by exogenous NaHS, with significantly statistical difference compared to the blank control group (P < 0.05). With the increased NaHS concentration, the EJ cell proliferation activity presented a statistically significant trend of increase, showing comparative differences among different groups (P < 0.05). Exogenous NaHS could also improve the invasion ability of bladder cancer EJ cells, which was significantly enhanced with increased NaHS dose (P < 0.001). The levels of MMP2 and MMP9 in EJ cells were significantly upregulated with the increased NaHS dose (P < 0.001). Conclusion: Exogenous H2S may promote cell proliferation and invasion by upregulating the expression level of MMP2 and MMP9 in human bladder cancer EJ cells.
  1,231 43 -
Clinical significance of Twist, E-cadherin, and N-cadherin protein expression in endometrioid adenocarcinoma
Xinping Xie, Xiu Zheng, Jinhua Wang, Lihong Chen
2017, 13(5):817-822
DOI:10.4103/jcrt.JCRT_405_17  PMID:29237910
Objective: The aim of the study was to investigate the expression of Twist, E-cadherin, and N-cadherin both in normal endometrium and in endometrioid adenocarcinoma tissues (NET and EAT), and further discuss the relationship between the proteins expression and the clinical parameters. Methods: Seventy-six EAT and 50 NET were collected from endometrioid adenocarcinoma patients and patients who received hysterectomy. We used immunohistochemistry (two steps methods) to detect the expression of Twist, E-cadherin, and N-cadherin proteins in EAT and NET. The Twist, E-cadherin, and N-cadherin protein positive expression rate in EAT and NET were compared by Chi-square test. Moreover, the correlation between patients' clincial characteristics and Twist, E-cadherin, and N-cadherin protein expression was evaluated. Results: The positive expression of Twist and N-cadherin proteins in EAT was significantly higher than those in NET (u = 14.8, 9.04, P < 0.05), the positive expression of E-cadherin protein in ENT was significantly lower than those in NET (u = 4.14, P < 0.05). The Twist, E-cadherin, and N-cadherin expressions were related with endometrioid adenocarcinoma under different International Federation of Gynecology and Obstetrics (FIGO) clinical stages (P < 0.05), depths of tumor invasion (P < 0.05), and tumor differentiation degrees (P < 0.05). However, these proteins exerted no influence on vessel and lymph metastases (P > 0.05). The Spearman rank correlation analysis showed that the expression of the Twist protein and that of the E-cadherin (r = –0.584, P < 0.05), N-cadherin protein (r = 0.460, P < 0.05) in endometrioid adenocarcinoma was significant correlated with statistical difference. Conclusion: Twist, E-cadherin, and N-cadherin protein were different expressed in EAT and NET which indicating their potential function for endometrioid adenocarcinoma development. Twist may participate in the occurrence of epithelial–mesenchymal transition, affect the expression of E-cadherin and N-cadherin and may be related to metastasis and progression of endometrioid adenocarcinoma.
  1,018 52 -
Transarterial chemoembolization with gelatin sponge microparticles for barcelona clinic liver cancer Stage C and large hepatocellular carcinoma: Initial clinical experience
Jun Zhou, Ying Liu, Zhizhong Ren, Yuewei Zhang, Ming Zhang
2017, 13(5):767-772
DOI:10.4103/jcrt.JCRT_297_17  PMID:29237901
Objective: The purpose of this investigation is to present a preliminary clinical experience in transarterial chemoembolization (TACE) with gelatin sponge microparticles (GSMs) for barcelona clinic liver cancer (BCLC) Stage C and large hepatocellular carcinoma (HCC) patients in China. Materials and Methods: Between August 2009 and August 2012, 20 BCLC Stage C HCC patients with tumor size ≥5 cm undergoing GSMs-TACE were retrospectively analyzed. Tumor response was evaluated using modified response evaluation criteria in solid tumors (mRECIST) with enhanced magnetic resonance/computed tomography imaging performed 4–6 weeks after each GSMs-TACE procedure. Kaplan–Meier curves were used to assess overall survival (OS). Complications postprocedure was also analyzed. Results: In this cohort of 20 HCC patients, vascular invasion was present in 8 patients (40%), extrahepatic metastases in 6 patients (30%), and both in 6 individuals (30%). Median tumor size was 9.9 ± 3.2 cm. All procedures were successfully performed with minimal complications. The mean number of TACE per patient was 2.6 sessions (range 1–5). Median OS (mOS) was 14 months for the entire study population. Survival rates at 6 and 12 months were 85% and 73.7%, respectively. According to mRECIST criteria, follow-up images were obtained 6 months after initial GSMs-TACE. Five patients (25.0%) achieved complete response, 8 patients (40.0%) had partial response, 4 (20.0%) had stable disease, and 3 (15.0%) had progressive disease. The objective response rate for TACE was 65%. Conclusions: From our preliminary clinical experience, GSMs-TACE in the treatment of BCLC Stage C and large HCC appears to offer favorable survival and tumor response with low morbidity. However, further prospective studies are required to assess its safety and efficacy.
  982 61 -
Meta-analysis of efficacy of laparoscopic hepatectomy versus open hepatectomy for hepatocarcinoma
Hongyu Liu, Dan Wang, Yang Yu, Hui Ren, Tao Jiang
2017, 13(5):849-855
DOI:10.4103/jcrt.JCRT_533_17  PMID:29237916
Objective: The aim of this study was to summarize the current evidence to evaluate the effects of laparoscopic hepatectomy (LH) and open hepatectomy (OH) in the treatment of hepatocarcinoma. Methods: A comprehensive literature search was performed using PubMed, Embase, and Google Scholar to identify all relevant studies. After we screened further, 22 published studies were included in this meta-analysis. We pooled the odds ratios (ORs), standardized mean difference (SMD) and conducted heterogeneity, quality assessment. Results: The outcomes of treatment effects included surgical blood loss, surgical time, postoperative complications, perioperative mortality, 3-year survival rate, and 5-year survival rate. Comparing OH for liver cancer patients, the pooled SMD of surgical blood loss was −0.65 (95% confidential index [confidence interval (CI)] = [−0.80, −0.50]), the pooled SMD of surgical time was −0.12 (95% CI = [−0.25, −0.00]), the pooled OR of postoperative complications was 0.48 (95% CI = [0.38, 0.62]), the pooled OR of perioperative mortality was 0.34 (95% CI = [0.14, 0.84]), the pooled OR of 3-year survival rate was 1.03 (95% CI = [0.76, 1.39]), and the pooled OR of 5-year survival rate was 0.99 (95% CI = [0.75, 1.30]). Conclusion: LH was found to significantly decrease patients' blood loss. LH slightly decreases surgical time. In addition, LH appears not to affect 3- and 5-year survival rate, but it offers less postoperative complications and perioperative mortality.
  987 40 -
The clinical significance of secreted protein acidic and rich in cysteine expression in breast cancer tissue and its association with prognosis
Wei Guo, Mingliang Zhang, Yong Chen, Suyang Guo
2017, 13(5):833-836
DOI:10.4103/jcrt.JCRT_424_17  PMID:29237913
Objective: The aim of this study was to evaluate the secreted protein acidic and rich in cysteine (SPARC) expression in breast cancer tissue and its association with patients' clinical pathology characteristics and prognosis. Materials and Methods: Eight-eight cases with confirmed diagnosis of breast cancer who received operation from January 2010 to February 2016 were included in this study. The SPARC expression in cancer tissue was examined by immunohistochemical method. The SPARC expression status, clinical pathology characteristics, and prognosis of included patients were recorded and evaluated. Results: SPARC protein was mainly expressed in cytoplasm and stroma of tumor tissue with dark brown and purple stain. The SPARC protein-positive expression rate was 69.3% (61/88) in cancer tissue. The positive expression of SPARC in breast tissues was not significantly correlated with age, menstruation status, tumor, node, and metastasis stage, tumor size, progesterone level, and HER-2 status (P > 0.05). However, SPARC protein-positive expression was correlated with tumor differentiation (P < 0.05), estrogen receptor expression (P < 0.05), and lymph node metastasis (P < 0.05). The 3-year disease-free survival (DFS) was 60.8% and 71.2% for SPARC-positive and -negative groups with no statistical difference (P > 0.05); there was no statistical difference of disease progression risk between the SPARC-positive and -negative groups (hazard ratio = 1.78, 95% confidence interval: 0.80–3.57, P > 0.05). However, SPARC-positive and -negative patients have shown a trend of DFS difference. Conclusion: SPARC is closely related to the development of breast cancer and can be used as a tumor marker for breast cancer recurrence.
  858 48 -
Laparoscopic surgery for endometrial cancer in aged patients: Experience from a tertiary referral center in Eastern China
Song-Ping Liu, Xiao-Wei Cheng, Xin Tian, Qiong Zhang, Hong-Yan Cui, Ke-Qin Hua
2017, 13(5):761-766
DOI:10.4103/jcrt.JCRT_417_17  PMID:29237900
Objective: The aim of the present study was to evaluate the feasibility and safety of laparoscopic surgery for endometrial cancer in aged patients and show the experiences of laparoscopic surgery for elderly endometrial cancer patients in Eastern China. Materials and Methods: A total of 211 patients (≥60 years) with endometrial carcinoma treated with surgery were retrospectively analyzed, including 104 patients who underwent laparoscopic surgery, and 107 who underwent laparotomy. Results: The operation time was similar in both groups (192.9 vs. 185.5 min, P = 0.722). For all cases, the estimated blood loss was less in the laparoscopic group relative to that of in the open group (227.5 vs. 382.6 ml, P = 0.000). There was no difference in the complication rate between the two groups (21.2% vs. 29.0%, P = 0.191). Overall, right pelvic and periaortic lymph node dissections were similar for the laparoscopic and laparotomy groups, but the former procedure dissected more left pelvic lymph nodes than that of in laparotomy (13.3 vs. 7.2 nodes, P = 0.038). The hospital stay was shorter after laparoscopic surgery than that of after laparotomy (7 vs. 10.5 days, P = 0.000). The recurrence rate was similar in the two groups (7.7% vs. 10.3%, P = 0.511). Conclusions: Laparoscopy could be a safe alternative to laparotomy for endometrial cancer in aged patients.
  847 42 -
Change of circulating antibodies against CD25-derived peptide antigen in hepatocellular carcinoma
Jiaxin Wang, Yangchun Xu, Huan Zhao, Xuan Zhang
2017, 13(5):813-816
DOI:10.4103/jcrt.JCRT_823_17  PMID:29237909
Aims: Several studies have shown altered levels of plasma anti-CD25 antibodies in patients with malignancy in lung, esophagus and breast. The present study was thus designed to test whether circulating anti-CD25 antibody levels were changed in hepatocellular carcinoma (HCC). Methods: An enzyme-linked immunosorbent assay (ELISA) was developed in-house to detect plasma IgG antibodies to CD25-derived linear peptide antigens in 122 patients with HCC and 121 control subjects. Results: Student's t-test showed that plasma anti-CD25 IgG levels were significantly higher in HCC patients than control subjects (t = 4.96, P < 0.001), in which male patients mainly contributed to the increased IgG levels (t = 5.11, P < 0.001). Further analysis showed that plasma anti-CD25 IgG levels were dependent on the stages of HCC although there was no significant correlation between plasma anti-CD25 IgG levels and BCLC stages (r = 0.145, P = 0.110, N = 122); a significant increase in anti-CD25 IgG levels was observed in HCC patients with stages B (t = 4.43, P < 0.001) and C+D (t = 4.89, P < 0.001) as compared with control subjects. Receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve (AUC) was 0.66 (SE = 0.035, 95% CI 0.60-0.73). The sensitivity of anti-CD25 IgG assay was 12.3% against a specificity of 99.2%. Conclusions: The present study suggests that circulating anti-CD25 IgG antibodies may have prognostic rather than early diagnostic values for HCC.
  826 27 -
The significance of prophylactic transarterial chemoembolization after radical resection of small hepatocellular carcinoma: A retrospective analysis
Sunfu Fan, Bingqi Yu, Xinbao Wang
2017, 13(5):773-777
DOI:10.4103/jcrt.JCRT_662_17  PMID:29237902
Purpose: To clarify the necessity of prophylactic transarterial chemoembolization (pTACE) after radical resection for small hepatocellular carcinoma (sHCC) (<3.0 cm) and identify prognostic determinants. Materials and Methods: Consecutive 161 patients with sHCC in Zhejiang Cancer Hospital from May 2009 to May 2014 were retrospectively studied. In these patients, 87 patients only received radical resection alone (control group), while other 74 patients received pTACE after radical resection (pTACE group). The overall survival (OS) and recurrence-free survival (RFS) were evaluated by Kaplan–Meier method and the related factors on OS and RFS were analyzed by Cox regression analysis. Results: The median OS for all patients was 33.6 months. The median OS in the pTACE and control group was 34.1 and 33.4 months, respectively (P = 0.508). The 1-, 3-, and 5-year survival rates were 91.9%, 73.4%, and 42.7% in the pTACE group and 93.1%, 77.9%, and 51.4% in the control group, respectively. The median RFS in pTACE and control group was 21.6 and 31.3 months (P = 0.002), respectively. The 1-, 3-, and 5-year RFS rate in pTACE group and control group was 81.0%, 47.4%, and 27.6% and 86.9%, 71.7%, and 49.9%, respectively. Preoperative gamma-glutamyl transferase (GGT) serum level ≥60 U/L (hazard ratio [HR] = 2.603, 95% confidence interval [CI] =1.506–4.501, P = 0.001) and recurrence (HR = 6.034, 95% CI = 2.931–12.421, P = 0.003) were independent prognostic determinants associated with poor prognosis in multivariate analysis. Resection followed by pTACE (HR = 2.046, 95% CI = 1.262–3.319, P = 0.004) and preoperative GGT serum level ≥60 U/L (HR = 1.864, 95% CI = 1.152–3.017, P = 0.011) were independent prognostic factors associated with higher rate of recurrence. Conclusions: Instead of improving the survival time, postoperative pTACE increased the rate of recurrence in sHCC patients. Preoperative GGT serum level ≥60 U/L and recurrence were independent prognostic determinants associated with poor prognosis.
  786 29 -