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ABSTRACT: PURPOSE: The primary objective of this study was to evaluate the dose-limiting toxicities (DLTs) and identify the maximum-tolerated dose (MTD) and recommended dose of nab-paclitaxel plus gemcitabine as a first-line treatment in Chinese patients with advanced pancreatic ductal adenocarcinoma (PDA). METHODS: Patients with previously untreated advanced PDA were treated with nab-paclitaxel followed by gemcitabine (1,000 mg/m2) administered intravenously for 30 min on days 1 and 8 and repeated every 21 days. RESULTS: Patients received nab-paclitaxel at the following dose levels: 80 mg/m2 (n = 3), 100 mg/m2 (n = 6), and 120 mg/m2 (n = 12). The DLTs evaluated were elevated alanine aminotransferase and febrile neutropenia. However, there had no two out of three to six patients experienced DLTs, the MTD was not met. A total of 93 cycles were administered. The most common grade 3/4 toxicities were neutropenia (9.52 %), thrombocytopenia (4.76 %), and sensory neuropathy (4.76 %). For 12 patients receiving 120 mg/m2, the overall response rate and disease control rate were 41.67 and 83.33 %, respectively, and the median progression-free survival and overall survival were 5.23 and 12.17 months, respectively. CONCLUSIONS: Treatment with albumin-bound nab-paclitaxel (120 mg/m2) plus gemcitabine has a favorable safety profile with an encouraging antitumor effect in Chinese patients.
Cancer Chemotherapy and Pharmacology 03/2013; · 2.83 Impact Factor
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Ying Jin,
Miao-Zhen Qiu,
De-Shen Wang,
Dong-Sheng Zhang,
Chao Ren,
Long Bai,
Hui-Yan Luo,
Zhi-Qiang Wang, Feng-Hua Wang,
Yu-Hong Li,
Rui-Hua Xu
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ABSTRACT: A phase III clinical trial has already shown the survival benefits of postoperative chemotherapy in gastric cancer. However, there are limited published data concerning the elderly. This study aims to investigate the use of adjuvant chemotherapy for gastric cancer after D2 gastrectomy among the elderly and identify its impact on survival.
We retrospectively reviewed 360 patients who had undergone D2 gastrectomy, aged 65 years or older, with non-metastatic gastric cancer in a single institution. We analyzed the predictors and survival benefits of adjuvant chemotherapy use in the elderly. Further, we analyzed the survival benefits of adjuvant chemotherapy by dividing the patients into groups according to disease stages and chemotherapeutic regimens.
Among the 360 patients, only 34.7% of patients received adjuvant chemotherapy. Age, tumor location, lymph node involvement and tumor invasion were associated with the receipt of adjuvant chemotherapy. Adjuvant chemotherapy improved the overall survival for non-metastatic elderly patients (HR 0.60, 95%CI 0.42-0.83, P = 0.003). Significant survival benefits were found with adjuvant chemotherapy in stage III patients (HR 0.67, 95%CI 0.47-0.97, P = 0.033), but not in stage I patients or in stage II patients (HR 0.52, 95%CI 0.21-1.30 P = 0.161). Compared to adjuvant chemotherapy without platinum, no significant survival benefits were observed with platinum-containing chemotherapy (HR 0.84, 95%CI 0.49-1.45, P = 0.530). Besides adjuvant chemotherapy, other independent prognostic factors of survival included tumor location, tumor size, histologic grade, depth of tumor invasion, and lymph node status.
This study demonstrated the survival benefits of adjuvant fluoropyrimidine-based chemotherapy among the elderly patients with non-metastatic gastric cancer after D2 gastrectomy. However, due to the limitations of this study, further well-designed prospective studies with large populations are needed to confirm these findings and identify the patients that can tolerate and benefit from adjuvant chemotherapy.
PLoS ONE 01/2013; 8(1):e53149. · 4.09 Impact Factor
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Dong-Liang Chen,
De-Shen Wang,
Wen-Jing Wu,
Zhao-Lei Zeng,
Hui-Yan Luo,
Miao-Zhen Qiu,
Chao Ren,
Dong-Sheng Zhang,
Zhi-Qiang Wang, Feng-Hua Wang,
Yu-Hong Li,
Tie-Bang Kang,
Rui-Hua Xu
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ABSTRACT: The deregulation of paxillin (PXN) has been involved in the progression and metastasis of different malignancies including colorectal cancer (CRC). MiR-137 is frequently supressed in CRC. PXN is predicted to be a direct target of miR-137 in CRC cells. On this basis, we hypothesized that overexpression of PXN induced by suppression of miR-137 may promote tumor progression and metastasis and predicts poor prognosis. We detected the expression of PXN and miR-137 in clinical tumor tissues by immunohistochemical analysis and real-time PCR, positive PXN staining was observed in 198 of the 247 (80.1%) cases whereas no or weak PXN staining was observed in the adjacent noncancerous area. Higher level of PXN mRNA and lower level of miR-137 was observed in cancer tissues than adjacent non-cancerous tissues. High expression of PXN and low expression of miR-137 was associated with aggressive tumor phenotype and adverse prognosis. Moreover, the expression of PXN was negatively correlated with miR-137 expression. A dual-luciferase reporter gene assay validated that PXN was a direct target of miR-137. The use of miR-137 mimics or inhibitor could decrease or increase PXN mRNA and protein levels in CRC cell lines. Knockdown of PXN or ectopic expression of miR-137 could markedly inhibit cell proliferation, migration and invasion in vitro and repress tumor growth and metastasis in vivo. Taken together, these results demonstrated overexpression of PXN induced by suppression of miR-137 promotes tumor progression and metastasis and could serve as an independent prognostic indicator in CRC patients.
Carcinogenesis 12/2012; · 5.70 Impact Factor
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ABSTRACT: PURPOSE: Platinum-based chemotherapy is the recognized first-line treatment for metastatic nasopharyngeal carcinoma (NPC). However, no standard treatment regimens have been established. This phase II study was designed to evaluate the efficacy and safety of a paclitaxel, cisplatin and 5-FU combination in metastatic and/or recurrent NPC. METHODS: Patients with evaluable metastatic and/or recurrent NPC were entered into this study. Treatment consisted of paclitaxel at a dose of 135 mg/m(2) on day 1, cisplatin 25 mg/m(2)/day from day 1 to day 3 and 5-FU-continuous infusion for 120 h at a variable dosage from 600 to 1,000 mg/m(2)/day according to prior radiation. This regimen was repeated every 3 weeks. RESULTS: A total of 95 patients were enrolled; 92 patients were evaluable for response. The overall response and disease control rates were 78.9 and 93.6 %, respectively. At a median follow-up of 24.8 months, the respective median overall survival (OS) and progression-free survival were 22.7 months (95 % CI 18.6-26.9 months) and 8.6 months (95 % CI 7.7-9.5 months). Toxicities were moderate and manageable. Grade 3/4 toxicities included leucopenia (14.7 %), neutropenia (17.9 %), anemia (3.2 %), thrombocytopenia (6.4 %), nausea (4.2 %), vomiting (9.5 %), stomatitis (9.5 %), diarrhea (3.2 %), aminotransferase (2.2 %) and sensory neuropathy (3.2 %). CONCLUSION: Triplet combination chemotherapy with paclitaxel, cisplatin and 5-FU is an effective and safe option in the front-line treatment for recurrent and/or metastatic NPC. The encouraging results with high response rate and long OS suggest that this regimen might be especially considered where tumor shrinkage is required.
Cancer Chemotherapy and Pharmacology 11/2012; · 2.83 Impact Factor
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Xin An,
Xi Lin, Feng-Hua Wang,
Karyn Goodman,
Pei-Qiang Cai,
Ling-Heng Kong,
Yu-Jing Fang,
Yuan-Hong Gao,
Jun-Zhong Lin,
De-Sen Wan,
Zhi-Zhong Pan,
Pei-Rong Ding
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ABSTRACT: BACKGROUND: Oxaliplatin (OX), in combination with fluoropyrimidine (5-fluorouracil or Capecitabine, FU)-based regimens and radiation, has been expected to both enhance primary tumour shrinkage and reduce micrometastases at distant sites in the neoadjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC). However, results in terms of pathologic complete response (pCR) and toxicities were inconsistent. The aim of this meta analysis was to evaluate the short term efficacy and toxicities of adding OX to FU in CRT for LARC. METHODS: We searched PubMed, EMBASE, ISI databases, Chinese Biomedical Literature Database and the Cochrane library before December, 2011. Additionally, abstracts presented at American Society of Clinical Oncology conferences held between January, 2000, and July, 2011, were searched to identify relevant clinical trials. Only randomised studies with an analysis by an intention-to-treat principle were included, and searches were restricted to those databases citing articles in English. Summary incidence rates and 95% confidence intervals (CIs) were calculated using a fixed-effects or random-effects model, depending on the heterogeneity of the included studies. Four randomised clinical trials comparing OX/FU versus FU alone regimens in CRT for LARC met our search criteria and were assessed. A total of 3863 patients (FU, n=1937; OX/FU, n=1926) were included in the analysis. FINDINGS: The addition of OX to FU significantly improved pathologic complete response (pCR), and reduced peri-operative metastases (including intra-abdominal metastases) with an odd ratios (OR) for OX/FU compared with FU of 1.20 (95% CI, 1.01-1.42; P=0.04) and 0.51 (95% CI, 0.34-0.77; P=0.001), respectively. The grade 3/4 toxicity rate was significantly higher for OX/FU versus FU alone with an OR of 2.29 (95% CI, 1.31-4.00; P=0.004). There was no difference in the rates of positive circumferential resection margin, permanent stoma, surgical complication and death within 60d between the OX/FU and FU alone patients. The OR for the proportion of patients completing full-dose radiotherapy and completing full-dose chemotherapy were 0.32 (95% CI, 0.15-0.69; P=0.004), and 0.71 (95% CI, 0.35-1.42; P=0.33), respectively. INTERPRETATION: Adding weekly OX to FU in neoadjuvant CRT of LARC appeared to modestly increase the pCR rate and reduced the rate of intra-abdominal or peri-operative metastases in this meta analysis. Although OX/FU significantly increased grade 3/4 toxicity, it did not result in more surgical complications or postoperative deaths within 60d. The concept of combination of OX and FU in the pre-operative setting for LARC still seems promising, either with a modified schedule, or as induction therapy prior to CRT or after CRT, prior to surgery.
European journal of cancer (Oxford, England: 1990) 10/2012; · 4.12 Impact Factor
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ABSTRACT: Platinum-based chemotherapy is the recognized first-line treatment for metastatic nasopharyngeal carcinoma (NPC). However there is no standard second-line treatment. This study was designed to evaluate the efficacy and safety of a gemcitabine and vinorelbine combination (GV) in patients with metastatic NPC previously treated with platinum-based chemotherapy.
A total of 61 patients with metastatic NPC after prior platinum-based chemotherapy were enrolled. Gemcitabine (1000mg/m(2)) and vinorelbine (25mg/m(2)) were administered intravenously on Day 1 and Day 8 every 3weeks.
In this study, the overall response rate was 37.7% (95% CI, 25.5-49.9%) one complete response (1.6%) and 22 partial responses (36.1%). The median progression-free survival was 5.2months (95% CI, 3.4-7.0months) and the median overall survival was 14.1months (95% CI, 11.1-17.1months). Grade 3/4 toxicity including leucopenia (19.7%), neutropenia (18%), anemia (4.9%) and thrombocytopenia (6.5%) were tolerable. Univariate and multivariate analyses indicated age and salvage treatment after failure of GV treatment were independently significant prognostic factors.
Our preliminary result shows gemcitabine and vinorelbine combination is effective and safe for the patients with advanced NPC pretreated with platinum-based chemotherapy. Further clinical study is warranted.
Oral Oncology 06/2012; 48(11):1146-51. · 2.86 Impact Factor
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ABSTRACT: PurposeThe aim of this study is to evaluate the safety and efficacy of the combination of capecitabine and oxaliplatin (XELOX) as
first-line treatment in Chinese patients with metastatic colorectal carcinoma (mCRC). Furthermore, we aimed to explore whether
a maintenance therapy with oral capecitabine in patients who were non-progression to the XELOX regimen was able to improve
the duration of disease control (DDC).
Patients and methodsOne hundred twenty-four patients with mCRC received a 3-weekly regimen of oxaliplatin plus capecitabine (XELOX) as first-line
treatment. Patients without progressive disease after six cycles of XELOX could stop treatment or continue to receive oral
capecitabine until disease progression or unacceptable toxicity.
ResultsA total of 637 cycles (median 6 cycles) of XELOX were given to 124 patients (males 58.1%, median age 52years). The response
rate was 49.1% (complete response in 11 patients and partial response in 50 patients). The median overall survival and progression-free
survival were 20.0 and 8.0months, respectively. Main drug-related grade 3–4 toxicities included neutrapenia (5.6%), nausea/vomiting
(4%), thrombocytopenia (2.4%), diarrhea (2.4%) and hand–foot syndrome (2.4%). Among 62 patients achieving objective response
or stable disease after at least 6 cycles of XELOX, there were 22 patients received oral capecitabine as maintenance therapy.
The median DDC was significantly longer for maintenance therapy group than those of no maintenance group (14 vs. 9months;
P=0.041).
ConclusionsXELOX is a highly effective first-line treatment for Chinese mCRC patients. The response rate, TTP, and overall survival of
patients treated with this regimen are similar to those treated with FU/leucovorin/oxaliplatin. Furthermore, our preliminary
data show maintenance therapy with capecitabine for those patients without progressive disease after at least six cycles of
XELOX can significantly improve DDC; and further prospective randomized control trial is warranted.
KeywordsMetastatic colorectal cancer-Oxaliplatin-Capecitabine-Maintenance therapy
Journal of Cancer Research and Clinical Oncology 04/2012; 136(4):503-510. · 2.56 Impact Factor
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ABSTRACT: The aim of the present study was to determine whether C-reactive protein (CRP)-based systemic inflammatory response scores (modified Glasgow prognostic score, mGPS; prognostic index, PI) have prognostic value superior to that of scores based on circulating white cells (neutrophil/lymphocyte ratio, NLR; platelet/lymphocyte ratio, PLR) or in combination with albumin (prognostic nutritional index, PNI) in patients with pancreatic cancer. The medical records of 177 patients with pancreatic adenocarcinoma were reviewed. Kaplan-Meier methodology and a multivariable Cox proportional hazards model were used to evaluate the potential prognostic factors. NLR > 5 was associated with higher white cell count, higher PLR, elevated CRP, hypoalbuminemia, increased mGPS, PI and PNI, poorer performance status (PS), greater weight loss and poorer tumor differentiation. On multivariate analysis, only NLR (HR, 2.537; 95 % CI, 1.313-4.902; p = 0.006), PS, tumor-node-metastasis (TNM) staging, type of surgery and palliative chemotherapy were associated independently with survival, whereas PLR, mGPS, PI and PNI were not. NLR > 5 predicted poorer overall survival (OS) compared with NLR ≤ 5 (median OS, 4.133 and 9.300, respectively; p = 0.006). On the subgroup analysis, the median OS of patients with NLR > 5 was 5.767 months, whereas patients with NLR ≤ 5 who had received palliative chemotherapy had a median OS of 10.200 months (p < 0.001). Our study demonstrates that elevated NLR is superior to the mGPS, PI, PLR and PNI for prognostication in patients with pancreatic cancer.
Medical Oncology 04/2012; · 2.14 Impact Factor
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ABSTRACT: The development of pancreatic cancer is a process in which genes interact with environmental factors. We performed this study to determine the effects of the ABO blood group, obesity, diabetes mellitus, metabolic syndrome (MetS), smoking, alcohol consumption and hepatitis B viral (HBV) infection on patient survival.
A total of 488 patients with pancreatic cancer were evaluated.
Patients who presented as chronic carriers of HBV infection were younger at disease onset (p = 0.001) and more predominantly male (p = 0.020) than those never exposed to HBV. Patients with MetS had later disease staging (p = 0.000) and a lower degree of pathological differentiation (p = 0.008) than those without MetS. In a univariate analysis, the ABO blood group, smoking and alcohol consumption were not associated with overall survival. HBsAg-positivity and elevated fasting plasma glucose were significantly associated with unfavorable survival though not in the multivariate analysis. The presence of MetS (HR: 1.541, 95% CI: 1.095-2.169, p = 0.013), age ≥65, an elevated CA19-9 baseline level, TNM staging, the type of surgery, the degree of differentiation and chemotherapy were independently associated with overall survival.
We report, for the first time, that patients with chronic HBV infection may represent a special subtype of pancreatic cancer, who have a younger age of disease onset and male dominancy. Patients with MetS had later disease staging and a poorer histological grade. Patients with MetS demonstrated significantly poorer survival.
PLoS ONE 01/2012; 7(7):e41984. · 4.09 Impact Factor
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ABSTRACT: Results from large epidemiologic studies on the association between vitamin D and gastric cancer are controversial. Vitamin D significantly promotes apoptosis in the undifferentiated gastric cancer cell, but the prognostic effects of its levels are unknown.
197 gastric carcinoma patients who received treatment in the cancer centre of Sun Yat-sen University from January 2002 to January 2006 were involved in the study. The stored blood drawn before any treatment was assayed for 25-hydroxyvitamin D levels. The clinicopathologic data were collected to examine the prognostic effects of vitamin D.
The mean vitamin D levels of the 197 gastric patients was 49.85 ± 23.68 nmol/L, among whom 114(57.9%) were deficient in Vitamin D(< 50 nmol/L), 67(34%) were insufficient (50-75 nmol/L) and 16(8.1%) were sufficient (> 75 nmol/L). Clinical stage (P = 0.004) and lymph node metastasis classification (P = 0.009) were inversely associated with vitamin D levels. The patients with high vitamin D levels group (≥ 50 nmol/L) had a higher overall survival compared with the low vitamin D levels group (< 50 nmol/L)(P = 0.018). Multivariate analysis indicated that vitamin D levels were an independent prognostic factor of gastric cancer (P = 0.019).
Vitamin D deficiency may be associated with poor prognosis in gastric cancer.
Journal of Translational Medicine 01/2012; 10:16. · 3.41 Impact Factor
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ABSTRACT: The aim of present study was to examine whether the C-reactive protein (CRP)-based systemic inflammatory response such as the Glasgow Prognostic Score (GPS; a combination of CRP and albumin) offers prognostic value that is superior to the circulating white cellular components as neutrophil/lymphocyte ratio (NLR) or platelet/lymphocyte ratio (PLR) in patients undergoing resection for stage III gastric cancer. The medical records of 324 patients with stage III gastric adenocarcinoma were reviewed. Potential prognosis factors were evaluated with the Kaplan-Meier methodology and multivariable Cox hazards model. An increase of GPS was associated with an increase weight loss, higher NLR, higher PLR, and larger tumor size. On multivariate analysis, only the GPS, tumor-nodes-metastasis staging, and adjuvant chemotherapy were associated independently with disease-free and overall survival. However, the NLR and PLR were not. In subgroup analysis, patients with a GPS of 2 had a significantly poorer median survival (13.70 months) when compared with patients with a GPS of 1 (27.4 months) or 0 (median survival had not been reached) in patients who had received adjuvant chemotherapy. Our study demonstrated that elevated preoperative GPS is superior to circulating white cellular components and was associated with reduced overall and disease-free survival for patients with stage III gastric cancer.
Tumor Biology 12/2011; 33(3):749-56. · 1.94 Impact Factor
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ABSTRACT: The prognosis of patients with advanced gastric cancer (AGC) remains poor, and no single chemotherapy regimen is recognized as a global standard. A phase 2 trial was conducted to determine the efficacy and tolerability of the modified combination regimen of capecitabine and irinotecan (mXELIRI) in patients with AGC.
Patients with earlier untreated AGC received intravenous irinotecan (125 mg/m) over 90 minutes on days 1 and 8, and oral capecitabine (850 mg/m) twice daily on days 2 to 15, every 3 weeks. Treatment was continued for at most 8 cycles or until disease progression or intolerable toxicity.
Thirty-two patients were enrolled. In total, 141 cycles of mXELIRI were administered. The overall response rate was 43.7%, with 1 complete response and 13 partial responses. At a median follow-up of 16.2 months, median time to progression and overall survival were 5.6 months (95% confidence interval, 4.27-6.93 mo) and 11.0 months (95% confidence interval, 8.71-13.29 mo), respectively. The most common hematological adverse event was neutropenia (n=18, 56.3%); grade 3 neutropenia was observed in 5 patients, with neutropenic fever in only 2 patients. The most common grade 3/4 nonhematological toxicities were anorexia (n=3, 9.4%), nausea (n=3, 9.4%), vomiting (n=2, 6.3%), and diarrhea (n=2, 6.3%). There was no treatment-related death.
mXELIRI is a safe and effective first-line treatment for unresectable and metastatic gastric cancer with a manageable tolerability profile. It can be used as one of the first-line treatment options for patients with AGC.
American journal of clinical oncology 12/2011; 34(6):555-60. · 2.21 Impact Factor
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ABSTRACT: To explore the diagnostic significance of glypican-3 (GPC3) immunohistochemistry in hepatocellular carcinoma (HCC).
Fourteen tissue microarray paraffin blocks were constructed, which comprised 731 samples from hepatic tumors and paratumor tissues, including 357 cases of HCC, 26 cholangiocarcinoma, 171 HCC adjacent hepatic tissue including cirrhosis, 93 hemangioma adjacent hepatic tissues, and 84 carcinomas metastatic to liver. GPC3 (Clone 1G12) protein was detected immunohistochemically in all of cases with positive controls.
GPC3 protein was positive in 72.0% HCC (257/357), but negative in the rest 374 of non-HCC cases, including cholangiocarcinoma, HCC adjacent hepatic tissue including cirrhosis, hemangioma adjacent hepatic tissues and metastatic carcinomas. GPC3 positive percentage was significantly correlated with histological grading of HCC (P < 0.01), highest in grade 3 (77.1%, 64/83) followed by grade 2 (73.3%, 187/255), grade 1 (6/12) and grade 4 (0).
GPC3 is a valuable diagnostic marker for hepatocellular carcinoma with sensitivity of 72.0%, and a differential diagnostic marker from tumor adjacent hepatic tissue and carcinomas metastatic to liver with specificity of 100%.
Zhonghua bing li xue za zhi Chinese journal of pathology 09/2011; 40(9):626-9.
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ABSTRACT: Little is known about the role of association between ABO blood type and risk of pancreatic cancer develops through effects on hepatitis B viral (HBV) infection. Our study aimed to determine whether joint ABO blood type and HBV infection could increase the risk for pancreatic cancer. A total of 645 patients with pancreatic adenocarcinoma and 711 age- and sex-matched individuals who had nonmalignant diseases treated at the Sun Yat-sen University Cancer Center in China were retrospectively analyzed. Blood samples were tested for ABO blood type and hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), hepatitis B e antigen (HBeAg), hepatitis B e antibody (anti-HBe) and hepatitis B core antibody (anti-HBc). Multivariable unconditional logistic regression analysis was used to estimate adjusted odds ratios [AORs] and 95% confidence interval [CI]. Multivariable analysis with adjustment for risk factors showed that A blood type, HBsAg-positive/anti-HBc-positive, anti-HBs-positive/anti-HBc-positive were significantly associated with pancreatic cancer. The estimated AORs (95% CI) were as follows: A blood type, 1.425 (1.071-1.894), HBsAg-positive/anti-HBc-positive, 1.610 (1.125-2.304), anti-HBs-positive/anti-HBc-positive, 1.526 (1.159-2.011). The effect of A blood type significantly modified the risk of pancreatic cancer among subjects with anti-HBc-positive (AORs = 1.882, 95% CI, 1.284-2.760). In our study, we reported an association between A blood type, infection with HBV and pancreatic cancer risk. Moreover, we found a synergism between A blood type and HBV infection in the development of pancreatic cancer.
International Journal of Cancer 08/2011; 131(2):461-8. · 5.44 Impact Factor
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ABSTRACT: Pancreatic neuroendocrine tumors (PNETs) are uncommon malignancies. The purpose of this study was to identify the prognostic factors of pancreatic neuroendocrine tumors at a single center in China. Clinical data of 27 patients with PNETs treated at the Sun Yat-sen University Cancer Center between January 1995 and December 2010 were retrospectively reviewed. Survival was estimated with the Kaplan-Meier methodology. Twenty-three patients (85.2%) had nonfunctional tumors and four patients (14.8%) had functional tumors. The majority of PNETs located in the body and/or tail of the pancreas in 20 patients (74.1%). All Patients with functional tumors cause syndromes related to hormone overproduction. Anorexia, nausea, vomiting, obstructive jaundice, weight loss, and incidental mass were more common in patients with nonfunctional tumors. The median follow-up time was 40 months. The overall 1-, 2-, and 5-year accumulative survival rates were 91%, 81%, and 81%, respectively. In univariate analysis, factors associating with significantly better survival included macroscopically radical resection of the primary tumor, tumor-node-metastasis (TNM) staging, World Health Organization (WHO) classification, and palliative chemotherapy. Macroscopically radical resection of the primary tumor, TNM staging, WHO classification, and palliative chemotherapy were prognostic variables which may emerge as a practical clinical tool to predict survival.
Tumor Biology 04/2011; 32(4):697-705. · 1.94 Impact Factor
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ABSTRACT: Plasma Epstein-Barr virus (EBV) DNA is widely used in screening, monitoring, and prediction of relapse in nonmetastatic nasopharyngeal carcinoma (NPC). However, data regarding utility of plasma EBV DNA in metastatic NPC are rare. The current study was to test the prognostic implication of plasma EBV DNA level in metastatic/recurrent NPC patients treated with palliative chemotherapy.
Plasma EBV DNA level was measured at baseline and thereafter at the start of each treatment cycle in 127 histologically proven metastatic/recurrent NPC patients treated with palliative chemotherapy. Correlations of pre-treatment and post-treatment plasma EBV DNA levels to survival and response were analyzed.
Patients with a low pre-treatment plasma EBV DNA level (<median) had significantly better survival than those with a high pre-treatment plasma EBV DNA level (≥median). Patients with a post-treatment plasma EBV DNA decline to an undetectable level had better survival and better tumor response compared with those with a sustained detectable post-treatment plasma EBV DNA level. The early decrease of post-treatment plasma EBV DNA to an undetectable level after 1 cycle of chemotherapy was associated with significantly increased survival. Patients with low pre-treatment plasma EBV DNA level and undetectable post-treatment plasma EBV DNA showed a favorable prognosis (5-year overall and progression-free survival of 50.6% and 21.7%, respectively).
Plasma EBV DNA is of predictive value for prognosis in metastatic/recurrent NPC patients undergoing palliative chemotherapy. The pre-treatment plasma EBV DNA level as well as the early decrease of plasma EBV DNA after chemotherapy enabled easy and early discrimination between patients who will and those who will not benefit from continued treatment.
Cancer 02/2011; 117(16):3750-7. · 4.77 Impact Factor
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ABSTRACT: The impact of hypoxia-inducible factor (HIF)-1α and hexokinase-II (HK-II) expression on prognosis of gastric adenocarcinoma patients has not been clearly established. We identified all patients in Cancer Center of Sun Yat-Sen University who were diagnosed as gastric adenocarcinoma and underwent radical gastrectomy between January 1999 and December 2001. We used immunohistochemistry to determine the expressions of HIF-1α protein and HK-II in the surgical sections. We identified 188 patients with gastric adenocarcinoma for the final analysis. The positive rate of HIF-1α and HK-II were 110/188 (54.6%) and 40/188 (21.3%), respectively. Both HIF-1α and HK-II were all positively correlated with tumor size, lower differentiation, and tumor stage. Univariate analysis showed that advanced tumor stages (P < 0.001), tumor size (P = 0.003), HIF-1α expression (P < 0.001), and HK-II expression (P < 0.001) were all significantly associated with shorter survival. The multivariate Cox analysis revealed that tumor stage (P < 0.001), HIF-1α expression (P < 0.001), and HK-II expression (P = 0.002) remained independent prognostic variables for survival. In addition, there was a positive correlation of HIF-1α protein expression and HK-II (P = 0.022). Both HIF-1α and HK-II were overexpressed in gastric adenocarcinoma. The multivariate Cox analysis revealed that both of them were independent factors on survival of gastric adenocarcinoma patients.
Tumor Biology 02/2011; 32(1):159-66. · 1.94 Impact Factor
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ABSTRACT: The incidence of gastric cancer in young has increased steadily in the last decades. Little is known about the clinicopathologic features and prognostic factors of young adult gastric cancer patients. The clinicopathological characteristics of 294 young adult gastric cancer patients between 20 and 50 years old were reviewed retrospectively from hospital records in Sun Yat-Sen University Cancer Center between 1996 and 2006. They were compared with 706 elder patients 51 years of age or over. A steady increasing in the proportion of female in the gastric carcinoma patients as the age decreasing was found. The distinguishing histological features of young adult patients were higher percentage of poorly differentiated grade and distant metastasis. The distribution of tumor-nodes-metastasis (TNM) stage was similar between these two groups. The 5-year disease-specific survival rate in the young adult group was significantly higher than in the elderly group. More patients receiving adjuvant chemotherapy were found in the young adult group. Multivariable analysis demonstrated that TNM stage and presence of angiolymphatic invasion were the independent negative predictors of survival for young patients with gastric cancer. Gastric cancer in young patients differs from that in elderly patients including a lack of male predilection, more aggressive histologic features, and better survival rate.
Tumor Biology 12/2010; 32(3):509-14. · 1.94 Impact Factor
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ABSTRACT: Little is known about the relationship between ABO blood groups and the clinicopathologic features in gastric adenocarcinoma patients of China. Whether the distribution of ABO blood groups in patients with gastric adenocarcinoma differs from that with benign diseases is also unknown. A total of 474 gastric adenocarcinoma patients and 404 with benign diseases were enrolled for the study. The relationship between patients' ABO blood groups and the clinicopathologic features was analyzed. The percentage of blood group AB was more common in men of gastric cancer than in benign diseases. The proportion of angiolymphatic invasion among patients with blood group O was significantly lower than those with other blood groups (P = 0.034). Proportion of tumors associated with estrogen receptor (ER), progestogen receptor (PR) and carcinoembryonic antigen (CEA) expression in blood type A was significantly higher than in other blood types (P = 0.002 for ER expression, 0.009 for PR expression, 0.003 for CEA expression). Proportion of tumors associated with serum CEA and CA19-9 elevation in blood type AB was significantly lower than in other blood types (P < 0.001 for serum CEA elevation, 0.005 for CA19-9 elevation). Though there was no significant difference between ABO blood groups and survival of the patients, patients with blood group B had a trend to show superiority in the survival. The significance of ABO blood group distribution might be associated with biological behavior of gastric adenocarcinoma patients. However, it was found not to be a prognosis factor for patients with gastric adenocarcinoma.
Medical Oncology 11/2010; 28 Suppl 1:S268-73. · 2.14 Impact Factor
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ABSTRACT: Elevated neutrophil to lymphocyte ratio (NLR) has been reported to be associated with worse survival in many malignancies, whereas its role in nasopharyngeal carcinoma (NPC) remains unclear. We retrospectively reviewed 363 consecutively, newly diagnosed, non-disseminated, and biopsy-proven NPC patients. Disease-specific survival (DSS), distant metastasis-free survival (DMFS), and locoregional recurrence-free survival (LRFS) rates were compared according to NLR level. Multivariate analysis was performed to assess the prognostic value of NLR. The 5-year DSS, DMFS, and LRFS rates for patients with elevated or non-elevated NLR (> or ≤3.73) were 59.6% vs. 76.6% (p = 0.03), 69.7% vs. 86.6% (p = 0.002), and 78.5% vs. 87.3% (p = 0.105), respectively. For patients with locoregionally advanced disease, NLR was not only an independent prognostic factor, but also a predictor of response to chemoradiotherapy. The 5-year DSS, DMFS, and LRFS rates for patients with elevated or non-elevated NLR were 47.2% vs. 73.7% (p < 0.001), 59.2% vs. 85.1% (p < 0.001), and 72.3% vs. 84.6% (p = 0.041), respectively. Compared with radiation alone, chemoradiotherapy significantly improved DSS and LRFS for patients with non-elevated NLR, but not for those with elevated NLR. Pre-treatment NLR is a strong prognostic factor for NPC patients. For patients with locoregionally advanced disease, NLR might also be a useful indicator for selection of treatment strategies.
Tumor Biology 10/2010; 32(2):317-24. · 1.94 Impact Factor
