BACKGROUND Current tumor regression grade(TRG)evaluations are based on various systems which brings confusion for oncologists and pathologists when interpreting results.The recent six-tier system(JGCA2017-TRG)recommen...BACKGROUND Current tumor regression grade(TRG)evaluations are based on various systems which brings confusion for oncologists and pathologists when interpreting results.The recent six-tier system(JGCA2017-TRG)recommended by the Japanese Gastric Cancer Association(JGCA)is worth investigating,as four-tier TRG systems are favored in various parts of the world.AIM To compare the predictive accuracies of five published TRG systems.METHODS Data were retrospectively collected from patients with locally advanced gastric cancer(LAGC)who underwent neoadjuvant chemotherapy followed by D2 Lymphadenectomy between January 2005 and January 2014 at our institution.Outcomes were overall survival(OS)and disease-free survival(DFS),which were evaluated separately using the following TRG systems:JGCA2017,JGCA,Becker,AJCC/CAP,and Mandard.RESULTS All five published TRG systems were independent predictors for OS and DFS.Concordance indices of the JGCA2017,JGCA,Becker,AJCC/CAP-TRG,and Mandard systems were 0.651/0.6480.652/0.649,0.693/0.695,0.688/0.685,and 0.674/0.675 for OS and DFS,respectively.The four-tier Becker system showed the highest c-index,which was significantly greater than that of the six-tier JGCA2017 and five-tier JGCA systems(P<0.05 in OS and DFS).When residual tumor percentages were reset as:“no residual tumor”,<10%,<100%,and“no response”,the rearranged cutoff values achieved a maximum c-index with 0.728 for OS and 0.737 for DFS,which was superior to the other five systems.CONCLUSION The newly introduced six-tier JGCA-TRG system cannot increase prognostic stratification.The four-tier Becker system is more suitable for LAGC patients.A population-based study is warranted to define the optimal criterion for TRG in LAGC patients.展开更多
Objective The present study attempted to evaluate the value of neoadjuvant chemotherapy in limiteddisease small cell lung cancer(LD-SCLC),and to identify the predictive value of the tumor regression grading(TRG) syste...Objective The present study attempted to evaluate the value of neoadjuvant chemotherapy in limiteddisease small cell lung cancer(LD-SCLC),and to identify the predictive value of the tumor regression grading(TRG) system in LD-SCLC treatment-response and prognosis.Methods The records of patients with LD-SCLC(p-Stage I–IIIa) who underwent definitive radical resection at Shaanxi Provincial People's Hospital between March 1,2000 and March 31,2014 were retrospectively analyzed.We compared the disease-free survival(DFS) and overall survival(OS) rates between Group A patients(patients who underwent surgery combined with pre-and post-operative chemotherapy) and Group B patients(patients who underwent surgery combined with adjuvant chemotherapy only) using the Kaplan-Meier method and the Mantel-Cox test.The specimens of patients who received neoadjuvant chemotherapy were reassessed according to the TRG system.Results The median DFS for 27 patients was 16.267 months and the median OS was 81.167 months(1-year OS,74.07%;3-year OS,22.22%;5-year OS,14.81%).Thirteen patients received neoadjuvant chemotherapy,and their specimens were reassessed by TRG(pathological complete remission,3/13,23.08%).Patients in group A had a longer OS than those in group B(mean,93.782 months versus 42.322 months,P = 0.025),although there was no significant difference in DFS between the two groups(median 20.100 months versus 14.667 months,P = 0.551).Statistical analysis revealed that TRG Grade(G) 0(mean,61.222 months) was associated with better OS than G1-2(mean,31.213 months)(P = 0.311).Conclusion Our study indicated that neoadjuvant chemotherapy combined with surgical resection may represent a feasible treatment method for patients with LD-SCLC.The TRG system may be a valuable prediction tool to assess neoadjuvant chemotherapeutic efficacy,especially in patients with G0 disease as determined by TRG;these patients may attain an improved survival benefit with neoadjuvant chemotherapy.展开更多
BACKGROUND Oral squamous cell carcinoma(OSCC)poses a major health burden,with frequent late-stage diagnoses and limited prognostic tools.Palmitoyl-protein thioesterase(PPT)1,a lysosomal enzyme,has been implicated in t...BACKGROUND Oral squamous cell carcinoma(OSCC)poses a major health burden,with frequent late-stage diagnoses and limited prognostic tools.Palmitoyl-protein thioesterase(PPT)1,a lysosomal enzyme,has been implicated in tumor biology.This study investigates PPT1 expression in OSCC and its association with clinicopathological features.AIM To evaluate the immunohistochemical expression of PPT1 in OSCC and assess its correlation with patient age,gender,tumor grade,and TNM staging using Hscore quantification.METHODS Immunohistochemistry for PPT1 was performed on 43 histopathologically confirmed OSCC samples.PPT1 expression was quantified using the H-score method(range:0-300).Correlation with clinical parameters was assessed using Spearman’s rank correlation and Kruskal-Wallis test.RESULTS PPT1 expression showed a significant positive correlation with tumor grade(ρ=0.48,P=0.0015),while a weak,nonsignificant negative correlation was noted with patient age(ρ=-0.27,P=0.083).No significant differences were found by gender or tumor stage.Given the small sample size,these findings should be interpreted as preliminary.CONCLUSION PPT1 expression is associated with histological tumor grade in OSCC and may reflect tumor aggressiveness.These initial results highlight the potential of PPT1 as a prognostic biomarker,warranting further validation in larger,multicenter studies.展开更多
BACKGROUND Human epidermal growth factor receptor 2(HER2)plays pivotal roles in cellular proliferation,survival,and differentiation of several malignancies.Upper tract urothelial carcinoma(UTUC)is a relatively rare ma...BACKGROUND Human epidermal growth factor receptor 2(HER2)plays pivotal roles in cellular proliferation,survival,and differentiation of several malignancies.Upper tract urothelial carcinoma(UTUC)is a relatively rare malignancy.The clinical and molecular significance of HER2 expression level in UTUC remains poorly characterized vs bladder cancer.AIM To comprehensively evaluate HER2 expression patterns and their association with UTUC patients’clinicopathological features.METHODS Data were retrospectively collected from patients diagnosed with UTUC at The First Affiliated Hospital of Guangxi Medical University between January 2023 and December 2024.HER2 status was evaluated by immunohistochemistry in 145 UTUC patients who met the inclusion criteria.Its associations with tumor grade,tumor stage,and other clinicopathological parameters were assessed.Theχ2 test or Fisher’s exact test,along with univariate and multivariate logistic regression analyses,were performed to determine the influences of clinicopathological factors on HER2 expression.RESULTS HER2 positivity was significantly associated with high tumor grade(P=0.003),while other variables,including sex,anatomical tumor location,pathological T stage,Ki-67 proliferation index,nodal metastasis status,lymphovascular invasion,and tumor laterality failed to demonstrate statistically significant correlations.These findings were further substantiated through univariate logistic regression modeling,yielding an odds ratio of 3.56[95%confidence interval(CI):1.30-9.75;P=0.013]for the association between high tumor grade and HER2 positivity.Importantly,this relationship remained robust(hazard ratio=3.42,95%CI:1.22-9.60;P=0.019)even after implementing multivariate logistic regression analysis.With a median follow-up time of 8 months(interquartile range,4-14)months,14 patients experienced intravesical recurrence after radical nephroureterectomy.Certain patient characteristics,such as HER2-negative,male sex,high-grade tumors,and luminal phenotype,were associated with a higher risk of intravesical recurrence.CONCLUSION In UTUC,HER2 overexpression is closely associated with tumor dedifferentiation(high grade),while it does not correlate with conventional indicators of disease progression,indicating that HER2 may serve a distinct biological function in this cancer type.展开更多
Objective: To investigate histo-pathological distribution and clinico-pathological significance in a large Chinese triple-negative breast cancer(TNBC) patients serials based on the latest understanding of its clinico-...Objective: To investigate histo-pathological distribution and clinico-pathological significance in a large Chinese triple-negative breast cancer(TNBC) patients serials based on the latest understanding of its clinico-pathological diversity, and to provide more information to clinicians to improve precision of individualized treatment of TNBC.Methods: A retrospective analysis was performed on patients with TNBC at Breast Disease Center, Peking University First Hospital between January 2010 and December 2019. Histo-and clinico-pathological characteristics were analyzed by Chi-square test and Student's t-test, and prognoses were calculated using KaplanMeier method and a Cox proportionate hazards model. Bonferroni correction was used to correct for multiple comparison.Results: Conventional type of TNBC(c TNBC) were identified in 73.7% of 582 TNBC, while special type of TNBC(s TNBC) were 26.3%, including 71 apocrine carcinoma, 20 medullary carcinoma, 31 metaplastic carcinoma, 18 invasive lobular carcinoma, 7 invasive micropapillary carcinoma, 5 adenoid cystic carcinoma and 1 acinic cell carcinoma. Compared to s TNBC, c TNBC was associated with high histologic grade(P<0.001) and lower androgen receptor(AR) expression(P<0.001). TNM stage of low-grade c TNBC was significantly lower than that of high-grade c TNBC(P=0.002). Although no significant difference, there was a trend that the rate of 5-year disease-free survival(DFS) and 5-year overall survival(OS) were longer in high-grade c TNBC than in high-grade s TNBC(P=0.091 and 0.518), and were longer in low-grade s TNBC than in high-grade s TNBC(P=0.051 and0.350). Metaplastic carcinomas showed larger tumor size(P=0.008) and higher proliferative Ki67 index(P=0.004)than c TNBCs.Conclusions: Results from our cohort imply that sub-categorization or subtyping and histological grading could be meaningful in pathological evaluation of TNBC, and need to be clarified in more large collections of TNBC.展开更多
BACKGROUND Primary hepatic neuroendocrine tumors(PHNETs),a group of neuroendocrine neoplasms,are extremely rare.There are only few case reports about PHNETs in the literature.The lack of large samples and multicenter ...BACKGROUND Primary hepatic neuroendocrine tumors(PHNETs),a group of neuroendocrine neoplasms,are extremely rare.There are only few case reports about PHNETs in the literature.The lack of large samples and multicenter research results in poor diagnostic and therapeutic approaches.AIM To discuss the clinical characteristics,diagnosis,and treatment of PHNETs and risk factors related to survival.METHODS We retrospectively analyzed the clinical data,imaging features,immunohistochemistry data,and treatment efficacy of 40 patients who were pathologically diagnosed with PHNETs and admitted to The First Affiliated Hospital of Zhengzhou University from January 1,2014 to November 15,2019.Finally,survival analysis was performed to identify the risk factors for survival.RESULTS The main symptoms and signs included intermittent abdominal pain(19 patients,47.5%)and bloating(8 patients,20.0%).The positive rates of tested tumor markers were recorded as follows:Carbohydrate antigen 19-9(CA19-9)(6 patients,15.0%),CA72-4(3 patients,7.5%),carcinoembryonic antigen(7 patients,17.5%),and alpha-fetoprotein(6 patients,15.0%).Immunohistochemical staining results showed positivity for Syn in 38(97.4%)of 39 patients,for chromogranin A in 17(65.4%)of 26 patients,for CD56 in 35(94.6%)of 37 patients,for AE1/AE3 in 28(87.5%)of 32 patients,and for Ki-67 in all 40(100.0%)patients.The overall survival rate was significantly related to the tumor grade,AE1/AE3,and Ki-67.tumor number,tumor size,metastasis,and treatment)and overall survival.CONCLUSION Higher grade,negative AE1/AE3,and higher Ki-67 are associated with a worse survival rate.Kinds of treatment and other parameters have no significant influence on overall survival.展开更多
BACKGROUND Neuroendocrine tumors(NETs)frequently occur in the gastrointestinal tract,lung,and pancreas,and the rectum and appendix are the sites with the highest incidence.Epidemiology statistics show that an estimate...BACKGROUND Neuroendocrine tumors(NETs)frequently occur in the gastrointestinal tract,lung,and pancreas,and the rectum and appendix are the sites with the highest incidence.Epidemiology statistics show that an estimated 8000 people every year in the United States are diagnosed with NETs occurring in the gastrointestinal tract,including the stomach,intestine,appendix,colon,and rectum.The pathological changes and clinical symptoms of NETs are not specific,and therefore they are frequently misdiagnosed.AIM To investigate the clinical symptoms,pathological characteristics,treatment,and prognosis of rectal neuroendocrine tumors(RNETs)by analyzing the clinical and pathological data of 132 RNET cases at our hospital.METHODS All RNETs were graded according to Ki-67 positivity and mitotic events.The tumors were staged as clinical stages I,II,III,and IV according to infiltrative depth and tumor size.COX proportional hazard model was used to assess the main risk factors for survival.RESULTS These 132 RNETs included 83 cases of G1,21 cases of G2,and 28 cases of G3(neuroendocrine carcinoma)disease.Immunohistochemical staining showed that 89.4%of RNETs were positive for synaptophysin and 39.4%positive for chromogranin A.There were 19,85,23,and 5 cases of clinical stages I,II,III,and IV,respectively.The median patient age was 52.96 years.The diameter of tumor,depth of invasion,and pathological grade were the main reference factors for the treatment of RNETs.The survival rates at 6,12,36,and 60 mo after operation were 98.5%,94.6%,90.2%,and 85.6%,respectively.Gender,tumor size,tumor grade,lymph node or distant organ metastasis,and radical resection were the main factors associated with prognosis of RNETs.Multivariate analysis showed that tumor size and grade were independent prognostic factors.CONCLUSION The clinical symptoms of RNETs are not specific,and they are easy to misdiagnose.Surgery is the main treatment method.The grade and stage of RNETs are the main indices to evaluate prognosis.展开更多
Contrast-enhanced computed tomography(CT)contributes to the increasing detection of pancreatic neuroendocrine neoplasms(PNENs).Nevertheless,its value for differentiating pathological tumor grades is not well recognize...Contrast-enhanced computed tomography(CT)contributes to the increasing detection of pancreatic neuroendocrine neoplasms(PNENs).Nevertheless,its value for differentiating pathological tumor grades is not well recognized.In this report,we have conducted a retrospective study on the relationship between the 2017 World Health Organization(WHO)classification and CT imaging features in 94 patients.Most of the investigated features eventually provided statistically significant indicators for discerning PNENs G3 from PNENs G1/G2,including tumor size,shape,margin,heterogeneity,intratumoral blood vessels,vascular invasion,enhancement pattern in both contrast phases,enhancement degree in both phases,tumor-to-pancreas contrast ratio in both phases,common bile duct dilatation,lymph node metastases,and liver metastases.Ill-defined tumor margin was an independent predictor for PNENs G3 with the highest area under the curve(AUC)of 0.906 in the multivariable logistic regression and receiver operating characteristic curve analysis.The portal enhancement ratio(PER)was shown the highest AUC of 0.855 in terms of quantitative features.Our data suggest that the traditional contrastenhanced CT still plays a vital role in differentiation of tumor grades and heterogeneity analysis prior to treatment.展开更多
BACKGROUND Duodenal gastrointestinal stromal tumor(DGIST)is a rare tumor with a specific anatomic site and biological characteristics.As the incidence of lymph node metastasis is very low,the main treatment method is ...BACKGROUND Duodenal gastrointestinal stromal tumor(DGIST)is a rare tumor with a specific anatomic site and biological characteristics.As the incidence of lymph node metastasis is very low,the main treatment method is surgery.Two main surgical techniques(local resection and Whipple)are performed in patients with DGISTs.The critical question is which surgical technique to choose.AIM To identify factors influencing the choice of surgery for DGISTs.METHODS The clinicopathological data of patients with DGISTs who underwent surgery between January 1999 and January 2021 were analyzed.We used the Student’s ttest or Mann-Whitney U-test and theχ2 test or Fisher’s exact test to determine the differences between the two groups of patients.Furthermore,we used logistic analysis to identify the relevant factors and independent factors related to the type of surgery.The Kaplan-Meier method was used to analyze the patient’s survival information and Cox regression analysis was performed to determine prognostic risk factors.RESULTS Overall,86 patients were analyzed,including 43 men(50%)and 43 women(50%).We divided the patients into two groups based on surgical technique(local resection or Whipple surgery).There were no differences in the age,mitotic figures,and complications between the two groups;however,the tumor size,tumor location,risk grade,postoperative hospital stay,and abdominal drainage time were significantly different.Based on univariate logistic analysis,the Whipple procedure was chosen if the tumor size was≥5.0 cm,the tumor was located in the descending part of the duodenum,or the risk grade was medium or high.In our research,the five-year overall survival rate of patients was more than 90%.We also describe two DGIST patients with liver metastases at first diagnosis and analyzed their management in order to provide advice on complicated cases.CONCLUSION The Whipple procedure was performed if the primary tumor was in the descending part of the duodenum,tumor size was≥5.0 cm,or the tumor risk grade was medium or high.展开更多
The relation between morphometric grades (M grading) of 84 cases of bladder tumor and prognoses was evaluated. The results shown that the higher the M grading, the lower the survival rate and the higher the recurrence...The relation between morphometric grades (M grading) of 84 cases of bladder tumor and prognoses was evaluated. The results shown that the higher the M grading, the lower the survival rate and the higher the recurrence rate. As the M grade increases, the tumor has partial of total absence of ABO(H) antigens of tumor cell surface and could be accompanied with muscular invasion. When recurring, the tumor has a poor prognosis if M grading increases from lower to higher grades. The morphometric grading system is able to make a quantitative pathologic diagnosis and can predict the biological behavior of bladder tumors.展开更多
BACKGROUND Pancreatic mixed neuroendocrine-non-neuroendocrine neoplasms(MiNENs)are rare malignancies affecting the pancreas.The World Health Organization defines MiNENs as neoplasms composed of morphologically recogni...BACKGROUND Pancreatic mixed neuroendocrine-non-neuroendocrine neoplasms(MiNENs)are rare malignancies affecting the pancreas.The World Health Organization defines MiNENs as neoplasms composed of morphologically recognizable neuroendocrine and non-neuroendocrine components,each constituting 30%or more of the tumor volume.Adenocarcinoma-neuroendocrine carcinoma is the most frequent MiNEN combination.A well-differentiated neuroendocrine tumor(NET)component is rarely reported in MiNENs.CASE SUMMARY Here we report a rare case with intermingled components of ductal adenocarcinoma and grade 1 well-differentiated NET in the pancreas.The two tumors show distinct histology and significant differentiation discrepancy(poorly differentiated high grade adenocarcinoma and well-differentiated low grade NET),and also present as metastases in separate lymph nodes.Next generation sequencing of the two components demonstrates KRAS and TP53 mutations in the ductal adenocarcinoma,but no genetic alterations in the NET,suggesting divergent origins for these two components.Although tumors like this meet the diagnostic criteria for MiNEN,clinicians often find the diagnosis and staging confusing and impractical for clinical management.CONCLUSION Mixed NET/non-NET tumors with distinct histology and molecular profiles might be better classified as collision tumors rather than MiNENs.展开更多
BACKGROUND Breast cancer is a prominent contributor to female cancer-related mortality.Early detection and accurate diagnosis are essential for effective management.AIM To evaluate the diagnostic relevance of a panel ...BACKGROUND Breast cancer is a prominent contributor to female cancer-related mortality.Early detection and accurate diagnosis are essential for effective management.AIM To evaluate the diagnostic relevance of a panel of circulating microRNAs(miRNAs)independently or in combination with other tumor biomarkers and evaluate their sensitivity and specificity in classifying breast cancer patients by grade.METHODS In the present study,we analyzed the aberrant expression of miR-21,miR-221,miR-1246,miR-145,and miR-382,in addition to the tumor biomarkers cancer antigen 15-3(CA15-3)and 8-hydroxy-2′-deoxyguanosine(8-OHdG)in breast cancer patients with varying grades.RESULTS Our results revealed distinct expression patterns of these miRNAs between grade II and III patients.Specifically,miR-21,miR-221,and miR-1246 were significantly elevated, while miR-145 and miR-382 were downregulated. Elevated serum levels of CA15-3 and 8-OHdG wereobserved in breast cancer patients compared to healthy controls, with CA15-3 showing greater diagnostic efficacyin differentiating between grades. Our study revealed strong correlations among evaluated miRNAs, suggestingtheir interconnected roles in breast cancer progression. Receiver operating characteristic curve analysisdemonstrated high diagnostic accuracy for all investigated miRNAs, with miR-21 and miR-1246 showing thehighest diagnostic power for differentiating patients from healthy individuals and distinguishing breast cancergrades. Moreover, the combination of multiple miRNAs and conventional tumor biomarkers revealed enhanceddiagnostic accuracy and sensitivity.CONCLUSIONThese findings suggest that circulating miRNAs may play a significant role in distinguishing breast cancer patientsbased on tumor grade, with superior diagnostic performance over some tumor biomarkers, supporting thedevelopment of multi-analyte liquid biopsy approaches in the diagnostic process and personalized management ofbreast cancer patients.展开更多
Rectal cancer poses a major global health challenge,with neoadjuvant chemoradiotherapy improving outcomes in locally advanced cases by reducing tumor burden and recurrence risk.However,response variability,including o...Rectal cancer poses a major global health challenge,with neoadjuvant chemoradiotherapy improving outcomes in locally advanced cases by reducing tumor burden and recurrence risk.However,response variability,including only 15%-20%of patients achieving pathological complete response,underscores the urgent need for accurate predictive tools.This review explored current and emerging biomarkers to enhance neoadjuvant chemoradiotherapy response prediction and inform clinical practice.展开更多
To study the morphology of the enteric nervous system and the expression of beta-2 adrenergic (B2A) receptors in primary colorectal cancer.METHODSIn this study, we included forty-eight patients with primary colorectal...To study the morphology of the enteric nervous system and the expression of beta-2 adrenergic (B2A) receptors in primary colorectal cancer.METHODSIn this study, we included forty-eight patients with primary colorectal cancer and nine patients for control tissue from the excision of a colonic segment for benign conditions. We determined the clinicopathological features and evaluated the immunohistochemical expression pattern of B2A receptors as well as the morphological changes of the enteric nervous system (ENS). In order to assess statistical differences, we used the student t-test for comparing the means of two groups and one-way analysis of variance with Bonferroni’s post hoc analysis for comparing the means of more than two groups. Correlations were assessed using the Pearson’s correlation coefficient.RESULTSB2A receptors were significantly associated with tumor grading, tumor size, tumor invasion, lymph node metastasis (P < 0.05), while there were no statistically significant associations with gender, CRC location and gross appearance (P > 0.05). We observed, on one hand, a decrease of the relative area for both Auerbach and Meissner plexuses with the increase of the tumor grading, and on the other hand, an increase of the relative area of other nervous elements not in the Meissner plexus or in the Auerbach plexus with the tumor grading. For G1 tumors we found that epithelial B2A area showed an inverse correlation with the Auerbach plexus areas [r(14) = -0.531, P < 0.05], while for G2 tumors, epithelial B2A areas showed an indirect variation with both the Auerbach plexus areas [r(14) = -0.453, P < 0.05] and the Meissner areas [r(14) = -0.825, P < 0.01]. For G3 tumors, the inverse dependence increased for both Auerbach [r(14) = -0.587, P < 0.05] and Meissner [r(14) = -0.934, P < 0.05] plexuses.CONCLUSIONB2A receptors play an important role in colorectal carcinogenesis and can be utilized as prognostic factors. Furthermore, study of the ENS in colorectal cancer may lead to targeted molecular therapies.展开更多
AIM: To examine the correlation of phosphatidylinositol 3-kinase (PIK3) CB expression with preoperative radiotherapy response in patients with stage II/III rectal adenocarcinoma.
BACKGROUND T1b gallbladder carcinoma(GBC)is defined as a tumor that invades the perimuscular connective tissue without extension beyond the serosa or into the liver.However,controversy still exists over whether patien...BACKGROUND T1b gallbladder carcinoma(GBC)is defined as a tumor that invades the perimuscular connective tissue without extension beyond the serosa or into the liver.However,controversy still exists over whether patients with T1b GBC should undergo cholecystectomy alone or radical GBC resection.AIM To explore the optimal surgical approach in patients with T1b gallbladder cancer of different pathological grades.METHODS Patients with T1bN0M0 GBC who underwent surgical treatment between 2000 and 2017 were included in the Surveillance,Epidemiology,and End Results database.The Kaplan-Meier method and log-rank test were used to analyze the overall survival(OS)and disease-specific survival(DSS)of patients with T1b GBC of different pathological grades.Cox regression analysis was used to identify independent predictors of mortality and explore the selection of surgical methods in patients with T1b GBC of different pathological grades and their relationship with prognosis.RESULTS Of the 528 patients diagnosed with T1bN0M0 GBC,346 underwent simple cholecystectomy(SC)(65.5%),131 underwent SC with lymph node resection(SC+LN)(24.8%),and 51 underwent radical cholecystectomy(RC)(9.7%).Without considering the pathological grade,both the OS(P<0.001)and DSS(P=0.003)of T1b GBC patients who underwent SC(10-year OS:27.8%,10-year DSS:55.1%)alone were significantly lower than those of patients who underwent SC+LN(10-year OS:35.5%,10-year DSS:66.3%)or RC(10-year OS:50.3%,10-year DSS:75.9%).Analysis of T1b GBC according to pathological classification revealed no significant difference in OS and DSS between different types of procedures in patients with grade Ⅰ T1b GBC.In patients with grade Ⅱ T1b GBC,obvious survival improvement was observed in the OS(P=0.002)and DSS(P=0.039)of those who underwent SC+LN(10-year OS:34.6%,10-year DSS:61.3%)or RC(10-year OS:50.5%,10-year DSS:78.8%)compared with those who received SC(10-year OS:28.1%,10-year DSS:58.3%).Among patients with grade Ⅲ or Ⅳ T1b GBC,SC+LN(10-year OS:48.5%,10-year DSS:72.2%),and RC(10-year OS:80%,10-year DSS:80%)benefited OS(P=0.005)and DSS(P=0.009)far more than SC(10-year OS:20.1%,10-year DSS:38.1%)alone.CONCLUSION Simple cholecystectomy may be an adequate treatment for grade Ⅰ T1b GBC,whereas more extensive surgery is optimal for grades Ⅱ-Ⅳ T1b GBC.展开更多
Objective:The accurate prediction of tumor response to neoadjuvant chemoradiotherapy(nCRT)remains challenging.Few studies have investigated pathologic complete response(ypCR)prediction in patients with residual flat m...Objective:The accurate prediction of tumor response to neoadjuvant chemoradiotherapy(nCRT)remains challenging.Few studies have investigated pathologic complete response(ypCR)prediction in patients with residual flat mucosal lesions after treatment.This study aimed to identify variables for predicting ypCR in patients with residual flat mucosal lesions after nCRT for locally advanced rectal cancer(LARC).Methods:Data of patients with residual flat mucosal lesions after nCRT who underwent radical resection between 2009 and 2015 were retrospectively collected from the LARC database at Peking University Cancer Hospital.Univariate and multivariate analyses of the association between clinicopathological factors and ypCR were performed,and a nomogram was constructed by incorporating the significant predictors.Results:Of the 246 patients with residual flat mucosal lesions included in the final analysis,56(22.8%)had ypCR.Univariate and multivariate analyses showed that pretreatment cT stage(pre-cT)≤T2(P=0.016),magnetic resonance tumor regression grade(MR-TRG)1-3(P=0.001)and residual mucosal lesion depth=0 mm(P<0.001)were associated with a higher rate of ypCR.A nomogram was developed with a concordance index(C-index)of0.759 and the calibration curve showed that the nomogram model had good predictive consistency.The follow-up time ranged from 3.0 to 113.3 months,with a median follow-up time of 63.77 months.The multivariate Cox regression model showed that the four variables in the nomogram model were not risk factors for disease-free survival(DFS)or overall survival(OS).Conclusions:Completely flat mucosa,early cT stage and good MR-TRG were predictive factors for ypCR instead of DFS or OS in patients with LARC with residual flat mucosal lesions after nCRT.Endoscopic mucosal re-evaluation before surgery is important,as it may contribute to decision-making and facilitate nonoperative management or organ preservation.展开更多
BACKGROUND Perioperative fluorouracil plus leucovorin,oxaliplatin,and docetaxel(FLOT)improves prognosis in locally advanced gastric cancer(LAGC).Neutrophil-to-lymphocyte(NLR),lymphocyte-tomonocyte(LMR),and platelet-to...BACKGROUND Perioperative fluorouracil plus leucovorin,oxaliplatin,and docetaxel(FLOT)improves prognosis in locally advanced gastric cancer(LAGC).Neutrophil-to-lymphocyte(NLR),lymphocyte-tomonocyte(LMR),and platelet-to-lymphocyte(PLR)ratios are prognostic biomarkers but not predictive factors.AIM To assess blood ratios’(NLR,LMR and PLR)potential predictive response to FLOT and survival outcomes in resectable LAGC patients.METHODS This was a multicentric retrospective study investigating the clinical potential of NLR,LMR,and PLR in resectable LAGC patients,treated with at least one preoperative FLOT cycle,from 12 Portuguese hospitals.Means were compared through non-parametric Mann-Whitney tests.Receiver operating characteristic curve analysis defined the cut-off values as:High PLR>141 for progression and>144 for mortality;high LMR>3.56 for T stage regression(TSR).Poisson and Cox regression models the calculated relative risks/hazard ratios,using NLR,pathologic complete response,TSR,and tumor regression grade(TRG)as independent variables,and overall survival(OS)as the dependent variable.RESULTS This study included 295 patients(mean age,63.7 years;59.7% males).NLR was correlated with survival time(r=0.143,P=0.014).PLR was associated with systemic progression during FLOT(P=0.022)and mortality(P=0.013),with high PLR patients having a 2.2-times higher risk of progression[95% confidence interval(CI):0.89-5.26]and 1.5-times higher risk of mortality(95%CI:0.92-2.55).LMR was associated with TSR,and high LMR patients had a 1.4-times higher risk of achieving TSR(95%CI:1.01-1.99).OS benefit was found with TSR(P=0.015)and partial/complete TRG(P<0.001).Patients without TSR and with no evidence of pathological response had 2.1-times(95%CI:1.14-3.96)and 2.8-times(95%CI:1.6-5)higher risk of death.CONCLUSION Higher NLR is correlated with longer survival time.High LMR patients have a higher risk of decreasing T stage,whereas high PLR patients have higher odds of progressing under FLOT and dying.Patients with TSR and a pathological response have better OS and lower risk of dying.展开更多
BACKGROUND Gastric cancer(GC)is the fifth most common and the fourth most lethal malignant tumour in the world.Most patients are already in the advanced stage when they are diagnosed,which also leads to poor overall s...BACKGROUND Gastric cancer(GC)is the fifth most common and the fourth most lethal malignant tumour in the world.Most patients are already in the advanced stage when they are diagnosed,which also leads to poor overall survival.The effect of posto-perative adjuvant chemotherapy for advanced GC is unsatisfactory with a high rate of distant metastasis and local recurrence.AIM To investigate the safety and efficacy of a programmed cell death 1(PD-1)inhibitor combined with oxaliplatin and S-1(SOX)in the treatment of Borrmann large type III and IV GCs.METHODS A retrospective analysis(IRB-2022-371)was performed on 89 patients with Borrmann large type III and IV GCs who received neoadjuvant therapy(NAT)from January 2020 to December 2021.According to the different neoadjuvant treatment regimens,the patients were divided into the SOX group(61 patients)and the PD-1+SOX(P-SOX)group(28 patients).RESULTS The pathological response(tumor regression grade 0/1)in the P-SOX group was significantly higher than that in the SOX group(42.86%vs 18.03%,P=0.013).The incidence of ypN0 in the P-SOX group was higher than that in the SOX group(39.29%vs 19.67%,P=0.05).The use of PD-1 inhibitors was an independent factor affecting tumor regression grade.Meanwhile,the use of PD-1 did not increase postoperative complications or the adverse effects of NAT.CONCLUSION A PD-1 inhibitor combined with SOX could significantly improve the rate of tumour regression during NAT for patients with Borrmann large type III and IV GCs.展开更多
Objective： XIAP-associated factor 1 （XAF1） expression has been shown to be related with apoptosis in hepatocellular carcinoma （HCC）. However, the correlation of XAF1 expression with HCC tumor grade has not been i...Objective： XIAP-associated factor 1 （XAF1） expression has been shown to be related with apoptosis in hepatocellular carcinoma （HCC）. However, the correlation of XAF1 expression with HCC tumor grade has not been intensively assessed. XIAP-associated factor-1 （XAF1） is an important apoptosis inducer in human HCC. The aim of this study is to determine the correlation between XAF1 expression and HCC histopathological grades. Methods： The mRNA levels of XAF1 in 24 paired HCC-nonneoplastic specimens were quantified by real-time reverse transcription PCR （RT-PCR）. Protein levels of XAF1 in 110 paired HCC-noncancer tissues were investigated by immunostaining specimens on a tissue microarray （TMA）. Correlations between XAF1 mRNA levels or protein expression and clinicopathological features were assessed by statistical analysis. Results： Both XAF1 mRNA and protein were significantly under-expressed in HCC tissues compared to their non-neoplastic counterparts. No significant relationship was found between XAF1 mRNA or protein expression and histological tumor grade. Conclusion： All these data suggest that XAF1 is a potential biomarker for differentiating HCC with noncancerous tissues.展开更多
基金the Beijing Municipal Health Commission,No.DFL20181103 and No.ZYLX201701.
文摘BACKGROUND Current tumor regression grade(TRG)evaluations are based on various systems which brings confusion for oncologists and pathologists when interpreting results.The recent six-tier system(JGCA2017-TRG)recommended by the Japanese Gastric Cancer Association(JGCA)is worth investigating,as four-tier TRG systems are favored in various parts of the world.AIM To compare the predictive accuracies of five published TRG systems.METHODS Data were retrospectively collected from patients with locally advanced gastric cancer(LAGC)who underwent neoadjuvant chemotherapy followed by D2 Lymphadenectomy between January 2005 and January 2014 at our institution.Outcomes were overall survival(OS)and disease-free survival(DFS),which were evaluated separately using the following TRG systems:JGCA2017,JGCA,Becker,AJCC/CAP,and Mandard.RESULTS All five published TRG systems were independent predictors for OS and DFS.Concordance indices of the JGCA2017,JGCA,Becker,AJCC/CAP-TRG,and Mandard systems were 0.651/0.6480.652/0.649,0.693/0.695,0.688/0.685,and 0.674/0.675 for OS and DFS,respectively.The four-tier Becker system showed the highest c-index,which was significantly greater than that of the six-tier JGCA2017 and five-tier JGCA systems(P<0.05 in OS and DFS).When residual tumor percentages were reset as:“no residual tumor”,<10%,<100%,and“no response”,the rearranged cutoff values achieved a maximum c-index with 0.728 for OS and 0.737 for DFS,which was superior to the other five systems.CONCLUSION The newly introduced six-tier JGCA-TRG system cannot increase prognostic stratification.The four-tier Becker system is more suitable for LAGC patients.A population-based study is warranted to define the optimal criterion for TRG in LAGC patients.
文摘Objective The present study attempted to evaluate the value of neoadjuvant chemotherapy in limiteddisease small cell lung cancer(LD-SCLC),and to identify the predictive value of the tumor regression grading(TRG) system in LD-SCLC treatment-response and prognosis.Methods The records of patients with LD-SCLC(p-Stage I–IIIa) who underwent definitive radical resection at Shaanxi Provincial People's Hospital between March 1,2000 and March 31,2014 were retrospectively analyzed.We compared the disease-free survival(DFS) and overall survival(OS) rates between Group A patients(patients who underwent surgery combined with pre-and post-operative chemotherapy) and Group B patients(patients who underwent surgery combined with adjuvant chemotherapy only) using the Kaplan-Meier method and the Mantel-Cox test.The specimens of patients who received neoadjuvant chemotherapy were reassessed according to the TRG system.Results The median DFS for 27 patients was 16.267 months and the median OS was 81.167 months(1-year OS,74.07%;3-year OS,22.22%;5-year OS,14.81%).Thirteen patients received neoadjuvant chemotherapy,and their specimens were reassessed by TRG(pathological complete remission,3/13,23.08%).Patients in group A had a longer OS than those in group B(mean,93.782 months versus 42.322 months,P = 0.025),although there was no significant difference in DFS between the two groups(median 20.100 months versus 14.667 months,P = 0.551).Statistical analysis revealed that TRG Grade(G) 0(mean,61.222 months) was associated with better OS than G1-2(mean,31.213 months)(P = 0.311).Conclusion Our study indicated that neoadjuvant chemotherapy combined with surgical resection may represent a feasible treatment method for patients with LD-SCLC.The TRG system may be a valuable prediction tool to assess neoadjuvant chemotherapeutic efficacy,especially in patients with G0 disease as determined by TRG;these patients may attain an improved survival benefit with neoadjuvant chemotherapy.
文摘BACKGROUND Oral squamous cell carcinoma(OSCC)poses a major health burden,with frequent late-stage diagnoses and limited prognostic tools.Palmitoyl-protein thioesterase(PPT)1,a lysosomal enzyme,has been implicated in tumor biology.This study investigates PPT1 expression in OSCC and its association with clinicopathological features.AIM To evaluate the immunohistochemical expression of PPT1 in OSCC and assess its correlation with patient age,gender,tumor grade,and TNM staging using Hscore quantification.METHODS Immunohistochemistry for PPT1 was performed on 43 histopathologically confirmed OSCC samples.PPT1 expression was quantified using the H-score method(range:0-300).Correlation with clinical parameters was assessed using Spearman’s rank correlation and Kruskal-Wallis test.RESULTS PPT1 expression showed a significant positive correlation with tumor grade(ρ=0.48,P=0.0015),while a weak,nonsignificant negative correlation was noted with patient age(ρ=-0.27,P=0.083).No significant differences were found by gender or tumor stage.Given the small sample size,these findings should be interpreted as preliminary.CONCLUSION PPT1 expression is associated with histological tumor grade in OSCC and may reflect tumor aggressiveness.These initial results highlight the potential of PPT1 as a prognostic biomarker,warranting further validation in larger,multicenter studies.
基金Supported by Scientific Research Project of Health Commission of Guangxi Zhuang Autonomous Region,No.Z-A20240546Undergraduate Education and Teaching Reform Project of Guangxi Medical University,No.2025XJGYC38and Key Textbook Construction Project of Guangxi Medical University,No.Gxmuzdjc2417。
文摘BACKGROUND Human epidermal growth factor receptor 2(HER2)plays pivotal roles in cellular proliferation,survival,and differentiation of several malignancies.Upper tract urothelial carcinoma(UTUC)is a relatively rare malignancy.The clinical and molecular significance of HER2 expression level in UTUC remains poorly characterized vs bladder cancer.AIM To comprehensively evaluate HER2 expression patterns and their association with UTUC patients’clinicopathological features.METHODS Data were retrospectively collected from patients diagnosed with UTUC at The First Affiliated Hospital of Guangxi Medical University between January 2023 and December 2024.HER2 status was evaluated by immunohistochemistry in 145 UTUC patients who met the inclusion criteria.Its associations with tumor grade,tumor stage,and other clinicopathological parameters were assessed.Theχ2 test or Fisher’s exact test,along with univariate and multivariate logistic regression analyses,were performed to determine the influences of clinicopathological factors on HER2 expression.RESULTS HER2 positivity was significantly associated with high tumor grade(P=0.003),while other variables,including sex,anatomical tumor location,pathological T stage,Ki-67 proliferation index,nodal metastasis status,lymphovascular invasion,and tumor laterality failed to demonstrate statistically significant correlations.These findings were further substantiated through univariate logistic regression modeling,yielding an odds ratio of 3.56[95%confidence interval(CI):1.30-9.75;P=0.013]for the association between high tumor grade and HER2 positivity.Importantly,this relationship remained robust(hazard ratio=3.42,95%CI:1.22-9.60;P=0.019)even after implementing multivariate logistic regression analysis.With a median follow-up time of 8 months(interquartile range,4-14)months,14 patients experienced intravesical recurrence after radical nephroureterectomy.Certain patient characteristics,such as HER2-negative,male sex,high-grade tumors,and luminal phenotype,were associated with a higher risk of intravesical recurrence.CONCLUSION In UTUC,HER2 overexpression is closely associated with tumor dedifferentiation(high grade),while it does not correlate with conventional indicators of disease progression,indicating that HER2 may serve a distinct biological function in this cancer type.
基金supported by the National Key R&D Program of China (No.2016YFC0901302)。
文摘Objective: To investigate histo-pathological distribution and clinico-pathological significance in a large Chinese triple-negative breast cancer(TNBC) patients serials based on the latest understanding of its clinico-pathological diversity, and to provide more information to clinicians to improve precision of individualized treatment of TNBC.Methods: A retrospective analysis was performed on patients with TNBC at Breast Disease Center, Peking University First Hospital between January 2010 and December 2019. Histo-and clinico-pathological characteristics were analyzed by Chi-square test and Student's t-test, and prognoses were calculated using KaplanMeier method and a Cox proportionate hazards model. Bonferroni correction was used to correct for multiple comparison.Results: Conventional type of TNBC(c TNBC) were identified in 73.7% of 582 TNBC, while special type of TNBC(s TNBC) were 26.3%, including 71 apocrine carcinoma, 20 medullary carcinoma, 31 metaplastic carcinoma, 18 invasive lobular carcinoma, 7 invasive micropapillary carcinoma, 5 adenoid cystic carcinoma and 1 acinic cell carcinoma. Compared to s TNBC, c TNBC was associated with high histologic grade(P<0.001) and lower androgen receptor(AR) expression(P<0.001). TNM stage of low-grade c TNBC was significantly lower than that of high-grade c TNBC(P=0.002). Although no significant difference, there was a trend that the rate of 5-year disease-free survival(DFS) and 5-year overall survival(OS) were longer in high-grade c TNBC than in high-grade s TNBC(P=0.091 and 0.518), and were longer in low-grade s TNBC than in high-grade s TNBC(P=0.051 and0.350). Metaplastic carcinomas showed larger tumor size(P=0.008) and higher proliferative Ki67 index(P=0.004)than c TNBCs.Conclusions: Results from our cohort imply that sub-categorization or subtyping and histological grading could be meaningful in pathological evaluation of TNBC, and need to be clarified in more large collections of TNBC.
文摘BACKGROUND Primary hepatic neuroendocrine tumors(PHNETs),a group of neuroendocrine neoplasms,are extremely rare.There are only few case reports about PHNETs in the literature.The lack of large samples and multicenter research results in poor diagnostic and therapeutic approaches.AIM To discuss the clinical characteristics,diagnosis,and treatment of PHNETs and risk factors related to survival.METHODS We retrospectively analyzed the clinical data,imaging features,immunohistochemistry data,and treatment efficacy of 40 patients who were pathologically diagnosed with PHNETs and admitted to The First Affiliated Hospital of Zhengzhou University from January 1,2014 to November 15,2019.Finally,survival analysis was performed to identify the risk factors for survival.RESULTS The main symptoms and signs included intermittent abdominal pain(19 patients,47.5%)and bloating(8 patients,20.0%).The positive rates of tested tumor markers were recorded as follows:Carbohydrate antigen 19-9(CA19-9)(6 patients,15.0%),CA72-4(3 patients,7.5%),carcinoembryonic antigen(7 patients,17.5%),and alpha-fetoprotein(6 patients,15.0%).Immunohistochemical staining results showed positivity for Syn in 38(97.4%)of 39 patients,for chromogranin A in 17(65.4%)of 26 patients,for CD56 in 35(94.6%)of 37 patients,for AE1/AE3 in 28(87.5%)of 32 patients,and for Ki-67 in all 40(100.0%)patients.The overall survival rate was significantly related to the tumor grade,AE1/AE3,and Ki-67.tumor number,tumor size,metastasis,and treatment)and overall survival.CONCLUSION Higher grade,negative AE1/AE3,and higher Ki-67 are associated with a worse survival rate.Kinds of treatment and other parameters have no significant influence on overall survival.
文摘BACKGROUND Neuroendocrine tumors(NETs)frequently occur in the gastrointestinal tract,lung,and pancreas,and the rectum and appendix are the sites with the highest incidence.Epidemiology statistics show that an estimated 8000 people every year in the United States are diagnosed with NETs occurring in the gastrointestinal tract,including the stomach,intestine,appendix,colon,and rectum.The pathological changes and clinical symptoms of NETs are not specific,and therefore they are frequently misdiagnosed.AIM To investigate the clinical symptoms,pathological characteristics,treatment,and prognosis of rectal neuroendocrine tumors(RNETs)by analyzing the clinical and pathological data of 132 RNET cases at our hospital.METHODS All RNETs were graded according to Ki-67 positivity and mitotic events.The tumors were staged as clinical stages I,II,III,and IV according to infiltrative depth and tumor size.COX proportional hazard model was used to assess the main risk factors for survival.RESULTS These 132 RNETs included 83 cases of G1,21 cases of G2,and 28 cases of G3(neuroendocrine carcinoma)disease.Immunohistochemical staining showed that 89.4%of RNETs were positive for synaptophysin and 39.4%positive for chromogranin A.There were 19,85,23,and 5 cases of clinical stages I,II,III,and IV,respectively.The median patient age was 52.96 years.The diameter of tumor,depth of invasion,and pathological grade were the main reference factors for the treatment of RNETs.The survival rates at 6,12,36,and 60 mo after operation were 98.5%,94.6%,90.2%,and 85.6%,respectively.Gender,tumor size,tumor grade,lymph node or distant organ metastasis,and radical resection were the main factors associated with prognosis of RNETs.Multivariate analysis showed that tumor size and grade were independent prognostic factors.CONCLUSION The clinical symptoms of RNETs are not specific,and they are easy to misdiagnose.Surgery is the main treatment method.The grade and stage of RNETs are the main indices to evaluate prognosis.
基金This study was supported by a grant from the Innovation Capability Development Project of Jiangsu Province(No.BM2015004).
文摘Contrast-enhanced computed tomography(CT)contributes to the increasing detection of pancreatic neuroendocrine neoplasms(PNENs).Nevertheless,its value for differentiating pathological tumor grades is not well recognized.In this report,we have conducted a retrospective study on the relationship between the 2017 World Health Organization(WHO)classification and CT imaging features in 94 patients.Most of the investigated features eventually provided statistically significant indicators for discerning PNENs G3 from PNENs G1/G2,including tumor size,shape,margin,heterogeneity,intratumoral blood vessels,vascular invasion,enhancement pattern in both contrast phases,enhancement degree in both phases,tumor-to-pancreas contrast ratio in both phases,common bile duct dilatation,lymph node metastases,and liver metastases.Ill-defined tumor margin was an independent predictor for PNENs G3 with the highest area under the curve(AUC)of 0.906 in the multivariable logistic regression and receiver operating characteristic curve analysis.The portal enhancement ratio(PER)was shown the highest AUC of 0.855 in terms of quantitative features.Our data suggest that the traditional contrastenhanced CT still plays a vital role in differentiation of tumor grades and heterogeneity analysis prior to treatment.
基金Supported by CAMS Initiative for Innovative Medicine,No.2016-I2M-1-007.
文摘BACKGROUND Duodenal gastrointestinal stromal tumor(DGIST)is a rare tumor with a specific anatomic site and biological characteristics.As the incidence of lymph node metastasis is very low,the main treatment method is surgery.Two main surgical techniques(local resection and Whipple)are performed in patients with DGISTs.The critical question is which surgical technique to choose.AIM To identify factors influencing the choice of surgery for DGISTs.METHODS The clinicopathological data of patients with DGISTs who underwent surgery between January 1999 and January 2021 were analyzed.We used the Student’s ttest or Mann-Whitney U-test and theχ2 test or Fisher’s exact test to determine the differences between the two groups of patients.Furthermore,we used logistic analysis to identify the relevant factors and independent factors related to the type of surgery.The Kaplan-Meier method was used to analyze the patient’s survival information and Cox regression analysis was performed to determine prognostic risk factors.RESULTS Overall,86 patients were analyzed,including 43 men(50%)and 43 women(50%).We divided the patients into two groups based on surgical technique(local resection or Whipple surgery).There were no differences in the age,mitotic figures,and complications between the two groups;however,the tumor size,tumor location,risk grade,postoperative hospital stay,and abdominal drainage time were significantly different.Based on univariate logistic analysis,the Whipple procedure was chosen if the tumor size was≥5.0 cm,the tumor was located in the descending part of the duodenum,or the risk grade was medium or high.In our research,the five-year overall survival rate of patients was more than 90%.We also describe two DGIST patients with liver metastases at first diagnosis and analyzed their management in order to provide advice on complicated cases.CONCLUSION The Whipple procedure was performed if the primary tumor was in the descending part of the duodenum,tumor size was≥5.0 cm,or the tumor risk grade was medium or high.
文摘The relation between morphometric grades (M grading) of 84 cases of bladder tumor and prognoses was evaluated. The results shown that the higher the M grading, the lower the survival rate and the higher the recurrence rate. As the M grade increases, the tumor has partial of total absence of ABO(H) antigens of tumor cell surface and could be accompanied with muscular invasion. When recurring, the tumor has a poor prognosis if M grading increases from lower to higher grades. The morphometric grading system is able to make a quantitative pathologic diagnosis and can predict the biological behavior of bladder tumors.
文摘BACKGROUND Pancreatic mixed neuroendocrine-non-neuroendocrine neoplasms(MiNENs)are rare malignancies affecting the pancreas.The World Health Organization defines MiNENs as neoplasms composed of morphologically recognizable neuroendocrine and non-neuroendocrine components,each constituting 30%or more of the tumor volume.Adenocarcinoma-neuroendocrine carcinoma is the most frequent MiNEN combination.A well-differentiated neuroendocrine tumor(NET)component is rarely reported in MiNENs.CASE SUMMARY Here we report a rare case with intermingled components of ductal adenocarcinoma and grade 1 well-differentiated NET in the pancreas.The two tumors show distinct histology and significant differentiation discrepancy(poorly differentiated high grade adenocarcinoma and well-differentiated low grade NET),and also present as metastases in separate lymph nodes.Next generation sequencing of the two components demonstrates KRAS and TP53 mutations in the ductal adenocarcinoma,but no genetic alterations in the NET,suggesting divergent origins for these two components.Although tumors like this meet the diagnostic criteria for MiNEN,clinicians often find the diagnosis and staging confusing and impractical for clinical management.CONCLUSION Mixed NET/non-NET tumors with distinct histology and molecular profiles might be better classified as collision tumors rather than MiNENs.
基金Supported by National Research Centre,Egypt,No.E120504.
文摘BACKGROUND Breast cancer is a prominent contributor to female cancer-related mortality.Early detection and accurate diagnosis are essential for effective management.AIM To evaluate the diagnostic relevance of a panel of circulating microRNAs(miRNAs)independently or in combination with other tumor biomarkers and evaluate their sensitivity and specificity in classifying breast cancer patients by grade.METHODS In the present study,we analyzed the aberrant expression of miR-21,miR-221,miR-1246,miR-145,and miR-382,in addition to the tumor biomarkers cancer antigen 15-3(CA15-3)and 8-hydroxy-2′-deoxyguanosine(8-OHdG)in breast cancer patients with varying grades.RESULTS Our results revealed distinct expression patterns of these miRNAs between grade II and III patients.Specifically,miR-21,miR-221,and miR-1246 were significantly elevated, while miR-145 and miR-382 were downregulated. Elevated serum levels of CA15-3 and 8-OHdG wereobserved in breast cancer patients compared to healthy controls, with CA15-3 showing greater diagnostic efficacyin differentiating between grades. Our study revealed strong correlations among evaluated miRNAs, suggestingtheir interconnected roles in breast cancer progression. Receiver operating characteristic curve analysisdemonstrated high diagnostic accuracy for all investigated miRNAs, with miR-21 and miR-1246 showing thehighest diagnostic power for differentiating patients from healthy individuals and distinguishing breast cancergrades. Moreover, the combination of multiple miRNAs and conventional tumor biomarkers revealed enhanceddiagnostic accuracy and sensitivity.CONCLUSIONThese findings suggest that circulating miRNAs may play a significant role in distinguishing breast cancer patientsbased on tumor grade, with superior diagnostic performance over some tumor biomarkers, supporting thedevelopment of multi-analyte liquid biopsy approaches in the diagnostic process and personalized management ofbreast cancer patients.
文摘Rectal cancer poses a major global health challenge,with neoadjuvant chemoradiotherapy improving outcomes in locally advanced cases by reducing tumor burden and recurrence risk.However,response variability,including only 15%-20%of patients achieving pathological complete response,underscores the urgent need for accurate predictive tools.This review explored current and emerging biomarkers to enhance neoadjuvant chemoradiotherapy response prediction and inform clinical practice.
基金Supported by the Romanian National Authority for Scientific Research and Innovation,CNCS-UEFISCDI,project No.PN-IIRU-TE-2014-4-0582,contract No.160/01.10.2015
文摘To study the morphology of the enteric nervous system and the expression of beta-2 adrenergic (B2A) receptors in primary colorectal cancer.METHODSIn this study, we included forty-eight patients with primary colorectal cancer and nine patients for control tissue from the excision of a colonic segment for benign conditions. We determined the clinicopathological features and evaluated the immunohistochemical expression pattern of B2A receptors as well as the morphological changes of the enteric nervous system (ENS). In order to assess statistical differences, we used the student t-test for comparing the means of two groups and one-way analysis of variance with Bonferroni’s post hoc analysis for comparing the means of more than two groups. Correlations were assessed using the Pearson’s correlation coefficient.RESULTSB2A receptors were significantly associated with tumor grading, tumor size, tumor invasion, lymph node metastasis (P < 0.05), while there were no statistically significant associations with gender, CRC location and gross appearance (P > 0.05). We observed, on one hand, a decrease of the relative area for both Auerbach and Meissner plexuses with the increase of the tumor grading, and on the other hand, an increase of the relative area of other nervous elements not in the Meissner plexus or in the Auerbach plexus with the tumor grading. For G1 tumors we found that epithelial B2A area showed an inverse correlation with the Auerbach plexus areas [r(14) = -0.531, P < 0.05], while for G2 tumors, epithelial B2A areas showed an indirect variation with both the Auerbach plexus areas [r(14) = -0.453, P < 0.05] and the Meissner areas [r(14) = -0.825, P < 0.01]. For G3 tumors, the inverse dependence increased for both Auerbach [r(14) = -0.587, P < 0.05] and Meissner [r(14) = -0.934, P < 0.05] plexuses.CONCLUSIONB2A receptors play an important role in colorectal carcinogenesis and can be utilized as prognostic factors. Furthermore, study of the ENS in colorectal cancer may lead to targeted molecular therapies.
基金Supported by Grants from the National Natural Science Foundation of China No.30872923the Peking University People’s Hospital Research and Development Fund No.RDB2007-47,No.RDK2008-01 and No.RDB2011-25
文摘AIM: To examine the correlation of phosphatidylinositol 3-kinase (PIK3) CB expression with preoperative radiotherapy response in patients with stage II/III rectal adenocarcinoma.
基金Supported by the National Natural Science Foundation of China,No.81773126,No.81560475,and No.82160486.
文摘BACKGROUND T1b gallbladder carcinoma(GBC)is defined as a tumor that invades the perimuscular connective tissue without extension beyond the serosa or into the liver.However,controversy still exists over whether patients with T1b GBC should undergo cholecystectomy alone or radical GBC resection.AIM To explore the optimal surgical approach in patients with T1b gallbladder cancer of different pathological grades.METHODS Patients with T1bN0M0 GBC who underwent surgical treatment between 2000 and 2017 were included in the Surveillance,Epidemiology,and End Results database.The Kaplan-Meier method and log-rank test were used to analyze the overall survival(OS)and disease-specific survival(DSS)of patients with T1b GBC of different pathological grades.Cox regression analysis was used to identify independent predictors of mortality and explore the selection of surgical methods in patients with T1b GBC of different pathological grades and their relationship with prognosis.RESULTS Of the 528 patients diagnosed with T1bN0M0 GBC,346 underwent simple cholecystectomy(SC)(65.5%),131 underwent SC with lymph node resection(SC+LN)(24.8%),and 51 underwent radical cholecystectomy(RC)(9.7%).Without considering the pathological grade,both the OS(P<0.001)and DSS(P=0.003)of T1b GBC patients who underwent SC(10-year OS:27.8%,10-year DSS:55.1%)alone were significantly lower than those of patients who underwent SC+LN(10-year OS:35.5%,10-year DSS:66.3%)or RC(10-year OS:50.3%,10-year DSS:75.9%).Analysis of T1b GBC according to pathological classification revealed no significant difference in OS and DSS between different types of procedures in patients with grade Ⅰ T1b GBC.In patients with grade Ⅱ T1b GBC,obvious survival improvement was observed in the OS(P=0.002)and DSS(P=0.039)of those who underwent SC+LN(10-year OS:34.6%,10-year DSS:61.3%)or RC(10-year OS:50.5%,10-year DSS:78.8%)compared with those who received SC(10-year OS:28.1%,10-year DSS:58.3%).Among patients with grade Ⅲ or Ⅳ T1b GBC,SC+LN(10-year OS:48.5%,10-year DSS:72.2%),and RC(10-year OS:80%,10-year DSS:80%)benefited OS(P=0.005)and DSS(P=0.009)far more than SC(10-year OS:20.1%,10-year DSS:38.1%)alone.CONCLUSION Simple cholecystectomy may be an adequate treatment for grade Ⅰ T1b GBC,whereas more extensive surgery is optimal for grades Ⅱ-Ⅳ T1b GBC.
基金supported by grants from the National Natural Science Foundation of China(No.82173156)Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support(No.ZYLX202116)。
文摘Objective:The accurate prediction of tumor response to neoadjuvant chemoradiotherapy(nCRT)remains challenging.Few studies have investigated pathologic complete response(ypCR)prediction in patients with residual flat mucosal lesions after treatment.This study aimed to identify variables for predicting ypCR in patients with residual flat mucosal lesions after nCRT for locally advanced rectal cancer(LARC).Methods:Data of patients with residual flat mucosal lesions after nCRT who underwent radical resection between 2009 and 2015 were retrospectively collected from the LARC database at Peking University Cancer Hospital.Univariate and multivariate analyses of the association between clinicopathological factors and ypCR were performed,and a nomogram was constructed by incorporating the significant predictors.Results:Of the 246 patients with residual flat mucosal lesions included in the final analysis,56(22.8%)had ypCR.Univariate and multivariate analyses showed that pretreatment cT stage(pre-cT)≤T2(P=0.016),magnetic resonance tumor regression grade(MR-TRG)1-3(P=0.001)and residual mucosal lesion depth=0 mm(P<0.001)were associated with a higher rate of ypCR.A nomogram was developed with a concordance index(C-index)of0.759 and the calibration curve showed that the nomogram model had good predictive consistency.The follow-up time ranged from 3.0 to 113.3 months,with a median follow-up time of 63.77 months.The multivariate Cox regression model showed that the four variables in the nomogram model were not risk factors for disease-free survival(DFS)or overall survival(OS).Conclusions:Completely flat mucosa,early cT stage and good MR-TRG were predictive factors for ypCR instead of DFS or OS in patients with LARC with residual flat mucosal lesions after nCRT.Endoscopic mucosal re-evaluation before surgery is important,as it may contribute to decision-making and facilitate nonoperative management or organ preservation.
文摘BACKGROUND Perioperative fluorouracil plus leucovorin,oxaliplatin,and docetaxel(FLOT)improves prognosis in locally advanced gastric cancer(LAGC).Neutrophil-to-lymphocyte(NLR),lymphocyte-tomonocyte(LMR),and platelet-to-lymphocyte(PLR)ratios are prognostic biomarkers but not predictive factors.AIM To assess blood ratios’(NLR,LMR and PLR)potential predictive response to FLOT and survival outcomes in resectable LAGC patients.METHODS This was a multicentric retrospective study investigating the clinical potential of NLR,LMR,and PLR in resectable LAGC patients,treated with at least one preoperative FLOT cycle,from 12 Portuguese hospitals.Means were compared through non-parametric Mann-Whitney tests.Receiver operating characteristic curve analysis defined the cut-off values as:High PLR>141 for progression and>144 for mortality;high LMR>3.56 for T stage regression(TSR).Poisson and Cox regression models the calculated relative risks/hazard ratios,using NLR,pathologic complete response,TSR,and tumor regression grade(TRG)as independent variables,and overall survival(OS)as the dependent variable.RESULTS This study included 295 patients(mean age,63.7 years;59.7% males).NLR was correlated with survival time(r=0.143,P=0.014).PLR was associated with systemic progression during FLOT(P=0.022)and mortality(P=0.013),with high PLR patients having a 2.2-times higher risk of progression[95% confidence interval(CI):0.89-5.26]and 1.5-times higher risk of mortality(95%CI:0.92-2.55).LMR was associated with TSR,and high LMR patients had a 1.4-times higher risk of achieving TSR(95%CI:1.01-1.99).OS benefit was found with TSR(P=0.015)and partial/complete TRG(P<0.001).Patients without TSR and with no evidence of pathological response had 2.1-times(95%CI:1.14-3.96)and 2.8-times(95%CI:1.6-5)higher risk of death.CONCLUSION Higher NLR is correlated with longer survival time.High LMR patients have a higher risk of decreasing T stage,whereas high PLR patients have higher odds of progressing under FLOT and dying.Patients with TSR and a pathological response have better OS and lower risk of dying.
基金Supported by Medical Science and Technology Project of Zhejiang Province(2022KY085).
文摘BACKGROUND Gastric cancer(GC)is the fifth most common and the fourth most lethal malignant tumour in the world.Most patients are already in the advanced stage when they are diagnosed,which also leads to poor overall survival.The effect of posto-perative adjuvant chemotherapy for advanced GC is unsatisfactory with a high rate of distant metastasis and local recurrence.AIM To investigate the safety and efficacy of a programmed cell death 1(PD-1)inhibitor combined with oxaliplatin and S-1(SOX)in the treatment of Borrmann large type III and IV GCs.METHODS A retrospective analysis(IRB-2022-371)was performed on 89 patients with Borrmann large type III and IV GCs who received neoadjuvant therapy(NAT)from January 2020 to December 2021.According to the different neoadjuvant treatment regimens,the patients were divided into the SOX group(61 patients)and the PD-1+SOX(P-SOX)group(28 patients).RESULTS The pathological response(tumor regression grade 0/1)in the P-SOX group was significantly higher than that in the SOX group(42.86%vs 18.03%,P=0.013).The incidence of ypN0 in the P-SOX group was higher than that in the SOX group(39.29%vs 19.67%,P=0.05).The use of PD-1 inhibitors was an independent factor affecting tumor regression grade.Meanwhile,the use of PD-1 did not increase postoperative complications or the adverse effects of NAT.CONCLUSION A PD-1 inhibitor combined with SOX could significantly improve the rate of tumour regression during NAT for patients with Borrmann large type III and IV GCs.
基金supported by grants from the National Natural Science Foundation of China (No. 30800186)Shanghai Natural Science Fundation (No. 11ZR1416800)
文摘Objective： XIAP-associated factor 1 （XAF1） expression has been shown to be related with apoptosis in hepatocellular carcinoma （HCC）. However, the correlation of XAF1 expression with HCC tumor grade has not been intensively assessed. XIAP-associated factor-1 （XAF1） is an important apoptosis inducer in human HCC. The aim of this study is to determine the correlation between XAF1 expression and HCC histopathological grades. Methods： The mRNA levels of XAF1 in 24 paired HCC-nonneoplastic specimens were quantified by real-time reverse transcription PCR （RT-PCR）. Protein levels of XAF1 in 110 paired HCC-noncancer tissues were investigated by immunostaining specimens on a tissue microarray （TMA）. Correlations between XAF1 mRNA levels or protein expression and clinicopathological features were assessed by statistical analysis. Results： Both XAF1 mRNA and protein were significantly under-expressed in HCC tissues compared to their non-neoplastic counterparts. No significant relationship was found between XAF1 mRNA or protein expression and histological tumor grade. Conclusion： All these data suggest that XAF1 is a potential biomarker for differentiating HCC with noncancerous tissues.
