Kun Yang

Sichuan University, Hua-yang, Sichuan, China

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Publications (37)95.63 Total impact

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    ABSTRACT: Gastric cancer is one of the leading causes of cancer-related deaths worldwide. We report our experience with surgery-related parameters and survival outcomes at a single Chinese center. This study analyzed patients following gastric resection between 2000 and 2010, and overall survival was the primary end point. In this study, 1,936 patients who underwent gastrectomy were collected from 2000 to 2010. Curative gastrectomy (R0 resection) was performed in 86.6 % of patients. D1/D1+ lymphadenectomy was frequently performed from 2000 to 2005, and the proportion of D2/D2+ lymphadenectomy increased after 2006. The number of harvested lymph nodes was 10.1 ± 6.0 in 2000 and increased to 28.0 ± 10.5 in 2010. Serosa-invasive lesions (pT4) accounted for 67.9 % of all cases. The 1-year overall survival (OS), 2-year OS, and 3-year OS rates were 89, 74, and 63 %, respectively. Multivariate analysis identified R status, tumor location, macroscopic type, and tumor stage (pT stage and pN stage) as the independent risk factors for overall survival. The prognosis of gastric cancer patients in China remains dismal. To improve the survival outcomes, further efforts toward early detection and multi-disciplinary treatment are needed.
    Medical oncology (Northwood, London, England). 09/2014; 31(9):150.
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    ABSTRACT: To study the safety and survival outcome of surgical management for elderly gastric cancer patients. Methods: Patients proven of gastric cancer who aged ≥80 years during November 2002 to July 2011 were retrospectively analyzed. The detailed information of patients’ characteristics and surgical management was retrieved. Follow-up of overall survival status was performed to analyze the surgical effectiveness. Totally, 92 (48 in surgery and 44 in non-surgery group) out of 187 eligible patients recorded adequate information and analyzed finally. There were 34 patients undergone radical gastrectomy, 6 palliative gastrectomy, 1 gastrojejunostomy and 7 exploratory laparotomy. Median follow-up durations were 25 (9-111) and 28 (8-114) months in surgery and non-surgery groups, respectively (p=0.797). Clinical-pathological T stage and node status were comparable. Clinical-pathological distal metastasis status was 15 and 26 M1 cases for surgery and nonsurgery, respectively (p=0.006). Incidence of postoperative complications and hospital mortality were 25.0% and 2.1%, respectively. The 2-year survival rates of M0 subgroups were 35.7% and 0% for surgery and nonesurgery, respectively (HR=3.98, p=0.022). The safety of surgery for well-selected ≥ 80-year elderly gastric cancer patients was potentially acceptable and the patients of early or locally advanced diseases could obtain survival benefits by surgery.
    Hepato-gastroenterology 09/2014; 61(134):1801-5. · 0.77 Impact Factor
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    ABSTRACT: The aim of the study was to analyze the clinicopathological characteristics and survival outcomes in Siewert type II and Siewert type III tumors. The clinicopathological characteristics and survival outcomes were analyzed in patients diagnosed with Siewert II/III tumors, who underwent transabdominal gastrectomy from Jan 2006 to Dec 2010. A total of 321 patients diagnosed with Siewert II/III tumors who underwent gastrectomy were enrolled in this study. Siewert III tumors are larger and have a higher proportion of Borrmann 3-4 types than Siewert II tumors (p < 0.05). For Siewert II and the Siewert III tumors, the 3-year overall survival rate was 59.1 versus 57.1 %, respectively, and the median survival time was 46.0 (31.5-60.5) months versus 46.0 (31.3-60.7) months, respectively. Positive proximal resection margin, large tumor size, Borrmann 3-4 types, poor or undifferentiated degree and advanced T stages and N stages were found to be poor prognostic risk factors for the overall survival outcomes by univariate analysis. Multivariate analysis revealed that the differentiation degree (poor and undifferentiated) and advanced T and N stages were independent prognostic factors for poor overall survival. Siewert III tumors were larger and had a lower differentiation degree than Siewert II tumors, whereas there was no difference in the survival outcomes.
    Medical oncology (Northwood, London, England). 08/2014; 31(8):116.
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    ABSTRACT: To investigate the metastatic status of lymph nodes numbers (no.) 1, 3a, and 3b groups in radical distal gastrectomy with upper lesser curvature skeletonization and the risk factors for lesser curvature regional node (LCRN) metastasis.
    Journal of Surgical Research 07/2014; · 2.02 Impact Factor
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    ABSTRACT: The objective of this study is to quantitatively analyze the predictive strength among the conventional serological tumor biomarkers for gastric cancer in Chinese population. Thirty-three hospital-based case-control studies were searched out through Chinese databases and PubMed during 1999-2009. Gastric cancer cases and healthy volunteers or benign gastric diseases controls were detected of any of serological CA724, CA242, CEA, CA199, CA125, or CA153. Areas under the curve (AUC) and optimal Q indexes of summary receiver operating characteristics (sROC) curves were quantitatively compared. The summary positive and negative likelihood ratios (sLR + and sLR-) were pooled. Totally, 2,390 gastric cancer cases and 2,893 controls were analyzed. CA724 and CA242 both had the greatest AUCs (0.88), respectively, followed by the combination CA724 + CEA + CA199 (0.85), CA125 (0.82), CEA (0.80), and CA199 (0.76), but all of them had no statistical significance to CA153 (negative control) by Z tests, possibly due to relatively great standard errors. The results of Q index analyses were similar to those of AUCs, that CA724 and CA242 had the optimal strength. The sLR + of CA724 (16.08, 95 % confidence interval (CI) 7.86-32.86) or CA242 (11.03, 95 % CI 7.12-17.08) was strong to judge the gastric cancer status based on its positive result. The combination of CA724 + CEA + CA199 had the prior sLR- (0.33, 95 % CI 0.25-0.43) to the others. Serological CA724 or CA242 has predictive effect for screening gastric cancer and can be recommended into the screening program of population-based or symptomatic cases. However, prospective epidemiological studies are required before confirmative conclusion.
    Tumor Biology 06/2014; · 2.52 Impact Factor
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    ABSTRACT: Postgastrectomy quality of life (QoL) is affected by various symptoms, and compared with the preoperative baseline QoL, is typically impaired for the first 6 mo after surgery. Thereafter, improvement to a stable QoL is observed at approximately 12 mo postoperatively. We consider the digestive tract reconstruction pattern to be a determining factor in postgastrectomy QoL among gastric cancer patients, and believe it requires further discussion. Proximal gastrectomy is associated with the worst postoperative QoL among gastrectomy procedures and should be performed cautiously. The trend of better QoL provided by the pouch procedure of total gastrectomy requires further robust support. Whether the use of Billroth-I gastroduodenostomy or Roux-en-Y gastrojejunostomy for distal gastrectomy is optimal remains controversial, but Roux-en-Y gastrojejunostomy is likely to be preferable.
    World Journal of Gastroenterology 01/2014; 20(1):330-2. · 2.55 Impact Factor
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    ABSTRACT: To compare surgical efficacy and postoperative recovery of ultrasonic scalpel (USS) with conventional techniques for the resection of gastric carcinoma.
    PLoS ONE 01/2014; 9(7):e103330. · 3.53 Impact Factor
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    ABSTRACT: The metastatic rate and risk factors of splenic hilar (No.10) lymph nodes (LNs) in gastric adenocarcinoma were still variable and uncertain, and the prognostic significance of No.10 LNs was also controversial. The aim of this retrospective study was to analyze the metastatic rate, risk factors and prognostic significance of No.10 LNs in gastric adenocarcinoma.
    PLoS ONE 01/2014; 9(6):e99650. · 3.53 Impact Factor
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    ABSTRACT: Background/Aims: The incidence of acute pancreatitis has been increasing recently. This study aims to elucidatethe role of TRAIL signal pathway in the process of acute pancreatitis. Methodology: Pancreatitis models were constructed by cerulein or cerulein plus lipopolysaccharide. Amylase and lipidase were measured in different groups. The mRNA expression of TRAIL, DR5, DcR1 and DcR2 were studied by means of relative Quantitative-Real-Time PCR. In addition, the expression of TUNEL and Caspase 3 was studied by immunohistochemistry. Results: The establishment of pancreatitis model was successful. There were significant differences of amylase and lipidase in the three groups (p<0.05), with highest in MAP group. The mRNA expression of TRAIL was upregulated in SAP group and downregulated in MAP group. The expressions of DcR1 were detected to be statistically upregulated in MAP group and SAP group. The expressions of DR5 and DcR2 were not significant different from each other among the three groups (p>0.05). There were no siginificant differences among the three groups for the expression of Caspase 3 which indicated the apoptosis of acinar cell. The correlation coefficient between the expression of TUNEL and Caspase 3 was 0.383 (p=0.037). Conclusions: TRAIL signal pathway might play a role in the process of acute pancreatitis which needs to be explored further.
    Hepato-gastroenterology 01/2013; 60(126). · 0.77 Impact Factor
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    ABSTRACT: Gastric carcinoma (GC) is one of the highest cancer-mortality diseases with a high incidence rate in Asia. For surgically unfit but medically fit patients, palliative chemotherapy is the main treatment. The chemotherapy regimen of docetaxel, cisplatin and 5-fluorouracil (DCF) has been used to treat the advanced stage or metastatic GC. It is necessary to compare effectiveness and toxicities of DCF regimen with non-taxane-containing palliative chemotherapy for GC. PubMed, EmBase, Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure databases were searched to select relative randomized controlled trials (RCTs) comparing DCF to non-taxane-containing chemotherapy for patients with palliatively resected, unresectable, recurrent or metastatic GC. Primary outcome measures were 1-year and 2-year overall survival (OS) rates. Secondary outcome measures were median survival time (MST), median time to progression (TTP), response rate and toxicities. Twelve RCTs were eligible and 1089 patients were analyzed totally (549 in DCF and 540 in control). DCF regimen increased partial response rate (38.8% vs 27.9%, p = 0.0003) and reduced progressive disease rate (18.9% vs 33.3%, p = 0.0005) compared to control regimen. Significant improvement of 2-year OS rate was found in DCF regimen (RR = 2.03, p = 0.006), but not of 1-year OS rate (RR = 1.22, p = 0.08). MST was significantly prolonged by DCF regimen (p = 0.039), but not median TTP (p = 0.054). Both 1-year OS rate and median TTP had a trend of prolongation by DCF regimen. Chemotherapy-related mortality was comparable (RR = 1.23, p = 0.49) in both regimens. In grade I-IV toxicities, DCF regimen showed a major raise of febrile neutropenia (RR = 2.33, p<0.0001) and minor raises of leucopenia (RR = 1.25, p<0.00001), neutropenia (RR = 1.19, p<0.00001), and diarrhea (RR = 1.59, p<0.00001), while in other toxicities there were no significant differences. DCF regimen has better response than non-taxane containing regimen and could potentially improve the survival outcomes. The chemotherapy-related toxicity of DCF regimen is acceptable to some extent.
    PLoS ONE 01/2013; 8(4):e60320. · 3.53 Impact Factor
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    ABSTRACT: To investigate the correlation between CD133-positive gastric cancer and clinicopathological features and its impact on survival. A search in the Medline and Chinese CNKI (up to 1 Dec 2011) was performed using the following keywords gastric cancer, CD133, AC133, prominin-1 etc. Electronic searches were supplemented by hand searching reference lists, abstracts and proceedings from meetings. Outcomes included overall survival and various clinicopathological features. A total of 773 gastric cancer patients from 7 studies were included. The median rate of CD133 expression by immunohistochemistry (IHC) was 44.8% (15.2%-57.4%) from 5 studies, and that by reverse transcription polymerase chain reaction (RT-PCR) was 91.3% (66.7%-100%) from 4 studies. The accumulative 5-year overall survival rates of CD133-positive and CD133-negative patients were 21.4% and 55.7%, respectively. Meta-analysis showed that CD133-positive patients had a significant worse 5-year overall survival compared to the negative ones (OR = 0.20, 95% CI 0.14-0.29, P<0.00001). With respect to clinicopathological features, CD133 overexpression by IHC method was closely correlated with tumor size, N stage, lymphatic/vascular infiltration, as well as TNM stage. CD133-positive gastric cancer patients had worse prognosis, and was associated with common clinicopathological poor prognostic factors.
    PLoS ONE 01/2013; 8(3):e59154. · 3.53 Impact Factor
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    ABSTRACT: Serum tumor biomarker carbohydrate antigen 724 (CA724) is noticeable for gastric cancer. Correlation between CA724 and gastric cancer was investigated based on Chinese population. Chinese Biomedical Database, Chinese Journal Full-text Database and PubMed were searched. Gastric cancer patients were proven by biopsy, and control included health volunteers or benign gastric diseases. Participants received at least one test of CA724, CA125, CA153, CA199, CA242 or CEA. Meta-analysis, summary ROC (SROC) and post hoc analysis were performed by RevMan 5.0 and SPSS 11.5. Totally, 33 eligible studies were analyzed. Meta-analysis showed CA724 had the highest odds ratio 32.86 compared to control, orderly followed by CA242, CA199, CEA, CA125 and CA153. Accumulated accuracy rate of CA724 was 77 %, superior to others. In SROC analysis, specificity of all studies was above 0.70, but sensitivity of few studies was above 0.70; CA724 was selected as the preferable single test, followed by CA242, CA199, CEA, CA125 and CA153. If threshold of both specificity and sensitivity up to 0.70, CA153 was unacceptable; if up to 0.80, only CA724 and CA242 were considerable. In CA724-combined patterns, CA724+CEA+CA199 combination performed best by increasing sensitivity to 0.74 without impairing specificity, while CA724 + CA199 pattern was not a proper combination. CA724 was the most correlative serum tumor biomarker for gastric cancer in Chinese population. Sensitivity of serum CA724 is limited, but CA724+CEA+CA199 combination is considerable to improve sensitivity without impairing specificity.
    Molecular Biology Reports 06/2012; 39(9):9031-9. · 2.51 Impact Factor
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    ABSTRACT: Background/Aims: This study investigated quality of life (QoL) of patients 6 months after surgery for early or advanced gastric cancer. Methodology: Between June, 2006 and December, 2009, 39 patients undergoing laparoscopic assisted distal gastrectomy (LADG) and 35 patients undergoing open distal gastrectomy (ODG) were enrolled. All the patients completed a validated questionnaire (EORTC QLQ-C30) and site specific module (QLQ-STO22) after surgery. Clinicopathological characteristics were compared and the patients' QoL were emphasized. Results: There were no significant differences between the two groups in age, comorbidities, curative degree, tumor stage, etc. In terms of QLQ-C30 items, significantly better role, cognitive, emotional and social functioning in the LADG group were identified as well as a significant lower incidence rate of constipation. Physical functioning, dyspnea, pain, fatigue, insomnia, diarrhea, financial difficulties and global health status, were not significantly different between the two groups. With respect to QLQ-STO22 items, LADG associated with lower incidence of reflux symptoms and better body image. However, there were no significant differences on symptoms of dysphagia, pain, eating restrictions, dry mouth, change of taste, anxiety and hair loss. QoL stratified by Billroth II reconstruction procedure gave similar results except for role functioning and body image, LADG had higher score compared with ODG. Conclusions: Long-term follow-up results suggest that LADG might help improve the QoL in patients with gastric cancer. Well-designed large scale randomized controlled trials are needed.
    Hepato-gastroenterology 01/2012; 59(119). · 0.77 Impact Factor
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    ABSTRACT: Background/Aims: To evaluate short-term versus long-term single prophylactic antibiotic for elective gastric tumor surgery. Methodology: Patients in a single surgical team undergoing elective gastric tumor surgery were enrolled from November 2009 to December 2010. The included patients were aged from 18 to 70 years without conditions as severe comorbidity, preoperative infectious diseases, antibiotic administration 48h before surgery, exploratory laparotomy only or combined colorectal resection, neoadjuvant chemotherapy, or steroid administration before surgery. The overall and infection-related postoperative complications and also economic outcomes were analyzed. The software SPSS 17.0 and TreeAge Pro 2007 were used for statistics. Results: Patients (n=158 (45 vs. 113)) were enrolled in short-term and long-term groups. No death cases occurred. Overall postoperative complication rates were 8.9% and 8.0%, respectively (p=1.000). The rates of infection related complications were 8.9% and 4.4%, respectively (p=0.231). No surgical site infection (SSI) occurred in the short-term group, whereas SSI was 1.8% in the long-term group. Total hospitalization cost (THC) of short-term branch was 36,557RMB per patients and preferable against 39,523RMB of long-term branch. Incremental cost-effectiveness analysis showed there was a 10 times interval between the extra healthcare expenditure of benefit and harm. Conclusions: Short-term administration did not increase the risk of postoperative complications and was more cost-effective.
    Hepato-gastroenterology 01/2012; 59(118):1784-8. · 0.77 Impact Factor
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    ABSTRACT: Background/Aims: To compare effectiveness between total gastrectomy (TG) and proximal gastrectomy (PG) for proximal gastric cancer. Methodology: PubMed, Embase, Cochrane library and Chinese CNKI databases were searched to select eligible studies comparing TG to PG for proximal gastric cancer. Outcome measures included overall survival, recurrence, mortality and morbidity rates, as well as nutritional states. Meta-analyses were performed by RevMan 5.0. Results: One randomized controlled trial and 7 retrospective studies involving 1077 patients were included. Meta-analysis showed no significant difference of 5-year overall survival rate (OR=0.89, p=0.53). However, TG achieved a lower recurrence rate (Peto OR=0.53, p=0.004). PG experienced higher morbidity risk (OR=0.11, p<0.00001), concerning higher risks of reflux esophagitis (OR=0.04, p<0.00001) and anastomotic stenosis (OR=0.14, p<0.00001) in a short period. TG performed longer operation time (p=0.002) and more blood loss (p<0.00001). Operative mortality and nutritional states were comparable without significant differences. Conclusions: Based on current retrospective evidences, TG and PG had similar overall survival outcome for proximal gastric cancer, but TG showed lower recurrence rate. PG with gastroesophagostomy had higher incidence of reflux esophagitis and anastomotic stenosis. TG can be recommendation for proximal gastric cancer, although more high-quality trials are still expected.
    Hepato-gastroenterology 01/2012; 59(114):633-40. · 0.77 Impact Factor
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    ABSTRACT: The aim of this meta-analysis is to evaluate the impact of transthoracic resection on long-term survival of patients with GEJ cancer and to compare the postoperative morbidity and mortality of patients undergoing transthoracic resection with those of patients who were not undergoing transthoracic resection. Searches of electronic databases identifying studies from Medline, Cochrane Library trials register, and WHO Trial Registration etc were performed. Outcome measures were survival, postoperative morbidity and mortality, and operation related events. Twelve studies (including 5 RCTs and 7 non-RCTs) comprising 1105 patients were included in this meta-analysis, with 591 patients assigned treatment with transthoracic resection. Transthoracic resection did not increase the 5-y overall survival rate for RCTs and non-RCTs (HR = 1.01, 95% CI 0.80- 1.29 and HR = 0.89, 95% CI 0.70- 1.14, respectively). Stratified by the Siewert classification, our result showed no obvious differences were observed between the group with transthoracic resection and group without transthoracic resection (P>0.05). The postoperative morbidity (RR = 0.69, 95% CI 0.48- 1.00 and OR = 0.55, 95% CI 0.25- 1.22) and mortality (RD = -0.03, 95% CI -0.06- 0.00 and RD = 0.00, 95% CI -0.05- 0.05) of RCTs and non-RCTs did not suggest any significant differences between the two groups. Hospital stay was long with thransthoracic resection (WMD = -5.80, 95% CI -10.38- -1.23) but did not seem to differ in number of harvested lymph nodes, operation time, blood loss, numbers of patients needing transfusion, and reoperation rate. The results of sensitivity analyses were similar to the primary analyses. There were no significant differences of survival rate and postoperative morbidity and mortality between transthoracic resection group and non-transthoracic resection group. Both surgical approaches are acceptable, and that one offers no clear advantage over the other. However, the results should be interpreted cautiously since the qualities of included studies were suboptimal.
    PLoS ONE 01/2012; 7(6):e37698. · 3.53 Impact Factor
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    ABSTRACT: Objective: To compare the perioperative systemic immunity of laparoscopy-assisted and open radical gastrectomy for gastric cancer. Methods: Patients with gastric adenocarcinoma proven by endoscopy and biopsy were eligible, while patients with preoperative staging of T4, N2-3, or M1 were excluded. Eligible patients willing to undertake laparoscopic surgery in the consecutive cohort were assigned to the laparoscopy-assisted gastrectomy (LAG) group, while concurrent patients were assigned to the conventional open gastrectomy (OG) group. All operations were performed with the intention of radical resection. Various immunological parameters were tested in peripheral venous blood collected at preoperative 1(st) day and postoperative 2(nd) day (POD2) and 7(th) day (POD7). SPSS 13.0 software was used for statistical analysis. Results: Thirty patients were included, 15 each in the LAG and OG groups. The general characteristics and short-term outcomes (harvested lymph nodes number, hospital stay, complications, and mortality rate) of the two groups were comparable, but the operation time was significantly longer in LAG (P = 0.001). Moreover, intergroup comparisons indicated no significant differences between the groups in levels of neutrophils, T-lymphocytes, natural killer cells, IgG, IgM, IgA, C3, C4, interleukin-6, or interleukin-10 at any time point (P > 0.05). However, there was a gradual decrease in natural killer cell count in the LAG group up to POD7 (P = 0.008). Conclusion: The changes in systemic immunity markers were comparable between laparoscopy-assisted and open gastrectomy for gastric cancer. However, there was a trend of suppression of natural killer cells in the laparoscopy-assisted gastrectomy group.
    Journal of Evidence-Based Medicine 11/2011; 4(4):225-231.
  • Annals of surgery 11/2011; 254(5):834-5; author reply 835. · 7.90 Impact Factor
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    ABSTRACT: Neoadjuvant chemotherapy (NAC) has drawn more attention to the treatment of locally advanced gastric cancer (AGC) in the current multidisciplinary treatment model. EORTC trial 40954 has recently reported that NAC plus surgery without postoperative adjuvant chemotherapy could not benefit the locally AGC patients in their overall survival. We performed a meta-analysis of 10 studies including 1518 gastric cancer patients. Stratified subgroups were NAC plus surgery and NAC plus both surgery and adjuvant chemotherapy (AC), while control was surgery alone. The results showed that NAC plus surgery did not benefit the patients with locally AGC in their overall survival [odds ratio (OR) = 1.20, 95% CI 0.80-1.80, P = 0.37] and the number needed to treat (NNT) was 74. However, the NAC plus both surgery and AC had a slight overall survival benefit (OR = 1.33, 95% CI 1.03-1.71, P = 0.03) and NNT was 14, which is superior to the NAC plus surgery. Therefore, we recommend that combined NAC and AC should be used to improve the overall survival of the locally AGC patients.
    World Journal of Gastroenterology 10/2011; 17(40):4542-4. · 2.55 Impact Factor
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    ABSTRACT: Background: CD133 has been used to identify normal and cancer stem cells from several different tissues. Nowadays some researchers have reported that CD133 expression was not restricted to cancer stem cells (CSCs) of colorectal cancer and brain tumors, and CD133-negative subsets could also initiate tumors. We therefore performed a meta-analysis to assess the value of CD133 as a biomarker of CSCs for colorectal cancer and brain tumors. Methods: A Medline search was performed to identify relevant studies for the analysis. The meta-analysis was done using RevMan 5.0 software. Outcome measures were colony formation rate and xenotransplanted tumor formation rate. Results: Fifteen identified studies were available for analysis. For in vitro tests, there were no significant differences in the colony formation rates between CD133-positive and CD133-negative cells for colorectal cancer and brain tumors. For in vivo tests, the xenotransplanted tumor formation rate showed a significant difference between CD133-positive cells and CD133-negative cells in colorectal cancer only, corresponding to a risk difference of 0.40 (95%CI: 0.07, 0.73). Samples (cell lines versus tissues), applied biomarkers (combined versus single), and injection site were included as factors in sensitivity analyses, but the results were very inconsistent. Conclusions: CD133 may not be suitable as a universe biomarker in identifying CSCs of colorectal cancer and brain tumors. Additional studies are necessary to further delineate its role.
    The International journal of biological markers 07/2011; 26(3):173-180. · 1.59 Impact Factor

Publication Stats

224 Citations
95.63 Total Impact Points

Institutions

  • 2008–2014
    • Sichuan University
      • Department of General Surgery
      Hua-yang, Sichuan, China