[Show abstract][Hide abstract] ABSTRACT: Multimodality therapy, including preoperative chemoradiotherapy (CRT) and total mesorectal excision (TME), has effectively reduced local recurrence rates of rectal cancer over the past decade. However, the benefits and risks of the addition of neoadjuvant CRT to surgery need to be evaluated. This study was to compare the efficacy of TME with versus without preoperative concurrent chemoradiotherapy (CCRT) involving XELOX regimen (oxaliplatin plus capecitabine) in Chinese patients with stages II and III mid/low rectal adenocarcinoma.
We randomly assigned patients to the TME group (TME without preoperative CCRT) or CCRT + TME group (TME with preoperative CCRT). The primary endpoint was disease-free survival (DFS); the secondary endpoints were overall survival (OS), local and distant recurrence, tumor response to CRT, toxicity, sphincter preservation, and surgical complications. An interim analysis of the potential inferiority of DFS in the CCRT + TME group was planned when the first 180 patients had been followed up for at least 6 months.
A total of 94 patients in the TME group and 90 patients in the CCRT + TME group were able to be evaluated. The 3-year DFS and OS rates were 86.3 % and 91.5 % in the whole cohort, respectively. The 3-year DFS rates of the TME and CCRT + TME groups were 85.7% and 87.9 % (P = 0.766), respectively, and the 3-year OS rates were 90.7 % and 92.3 % (P = 0.855), respectively. The functional sphincter preservation rates of the TME and CCRT + TME groups were 71.3 % and 70.0 % (P = 0.849), respectively. In the TME group, 16 (17.0 %) patients were proven to have pTNM stage I disease after surgery. In the CCRT + TME group, 32 (35.6 %) patients achieved a pathologic complete response (pCR).
Preliminary results indicated no significant differences in the DFS, OS, or functional sphincter preservation rates between the TME and CCRT + TME groups. However, preoperative CCRT with XELOX yielded a high pCR rate. Newer techniques are needed to improve the staging accuracy, and further investigation is warranted.
Preview · Article · Jun 2015 · Ai zheng = Aizheng = Chinese journal of cancer
[Show abstract][Hide abstract] ABSTRACT: Although numerous prognostic factors have been reported for colorectal cancer liver metastasis (CRLM), few studies have reported intraoperative blood loss (IBL) effects on clinical outcome after CRLM resection.
We retrospectively evaluated the clinical and histopathological characteristics of 139 patients who underwent liver resection for CRLM. The IBL cutoff volume was calculated using receiver operating characteristic curves. Overall survival (OS) and recurrence free survival (RFS) were assessed using the Kaplan-Meier and Cox regression methods.
All patients underwent curative resection. The median follow up period was 25.0 months (range, 2.1-88.8). Body mass index (BMI) and CRLM number and tumor size were associated with increased IBL. BMI (P=0.01; 95% CI = 1.3-8.5) and IBL (P<0.01; 95% CI = 1.6-12.5) were independent OSOs predictors. Five factors, including IBL (P=0.02; 95% CI = 1.1-4.1), were significantly related to RFS via multivariate Cox regression analysis. In addition, OSOs and RFS significantly decreased with increasing IBL volumes. The 5-year OSOs of patients with IBL≤250, 250-500, and >500mL were 71%, 33%, and 0%, respectively (P<0.01). RFS of patients within three IBL volumes at the end of the first year were 67%, 38%, and 18%, respectively (P<0.01).
IBL during CRLM resection is an independent predictor of long term survival and tumor recurrence, and its prognostic value was confirmed by a dose-response relationship.
[Show abstract][Hide abstract] ABSTRACT: Our aim is to explore the trend of association between the survival rates of colorectal cancer (CRC) and the different clinical characteristics in patients registered from 1960s to 2000s. We hypothesized that the survival rate of CRC increases over time and varies according to anatomic subsites.
Information from a total of 4558 stage T(1-4)N(1-2)M0 CRC patients registered from 1960s to 2008 were analyzed. The association of CRC overall survival with age, gender, tumor locations, time, histopathology types, pathology grades, no. of examined lymph nodes, the T stage, and the N stage was analyzed. The assessment of the influence of prognostic factors on patient survival was performed using Cox's proportional hazard regression models.
From 1960 to 2008, the studied CRC patients included 2625 (57.6%) and 1933 (42.4%) males and females, respectively. These included 1896 (41.6%) colon cancers, and 2662 (58.4%) rectum cancers. The 5-year survival rate was 49%, 58%, 58%, 70%, and 77% for the time duration of 1960s, 1970s, 1980s, 1990s and 2000s, respectively. An increased 5-year survival rate was observed in the colon cancer and rectum cancer patients. Patients older than 60 years of age were more likely to develop colonic cancer (sigmoid) than rectum cancer (49.2% vs. 39.9%). The Cox regression model showed that only rectum cancer survival was related to time duration.
The overall survival and 5-year survival rates showed an increase from the 1960s to 2000s. There is a trend of rightward shift of tumor location in CRC patients.
[Show abstract][Hide abstract] ABSTRACT: To study the molecular risk factors of lymph node metastasis in stage T1 and T2 colorectal cancers by tissue microarray and immunohistochemistry techniques.
Two hundred and three patients with stage T1 and T2 colorectal carcinoma who underwent radical surgery from 1999 to 2010 in our department were included in this study. Their clinicopathological data were retrospectively analyzed. Expression of the following 14 molecular markers were selected and assayed by tissue microarray and immunohistochemistry: VEGFR-3, HER2, CD44v6, CXCR4, TIMP-1, EGFR, IGF-1R, IGF-2, IGFBP-1, ECAD, MMP-9, RKIP, CD133, MSI. Chi-squared test and logistic regression were used to evaluate the variables as potential risk factors for lymph node metastasis.
The positive expression rates of biomarkers were as following: VEGFR-3 (44.3%), EGFR (30.5%), HER-2 (28.1%), IGF-1R (63.5%), IGF-2 (44.8%), IGFBP-1 (70.9%), ECAD (45.8%), CD44v6 (51.2%), MMP-9 (44.3%), TIMP-1 (41.4%), RKIP (45.3%), CXCR4 (40.9%), and CD133 (49.8%). The positive rate of MSI expression was 22.2%. Both univariate and multivariate analyses showed that VEGFR-3, HER-2, and TIMP-1 were significant predictors of lymph node metastasis. Univariate analysis showed that CD44v6 and CXCR4 were significant significant predictors of lymph node metastasis.
VEGFR-3, HER2 and TIMP-1 are independent factors for lymph node metastasis in stage T1 and T2 colorectal cancers.
No preview · Article · Apr 2013 · Zhonghua zhong liu za zhi [Chinese journal of oncology]
[Show abstract][Hide abstract] ABSTRACT: It is not clear if sentinel lymph node (SLN) mapping can improve outcomes in patients with colorectal cancers. The purpose of this study was to determine the prognostic values of ex vivo sentinel lymph node (SLN) mapping and immunohistochemical (IHC) detection of SLN micrometastasis in colorectal cancers.
Colorectal cancer specimens were obtained during radical resections and the SLN was identified by injecting a 1% isosulfan blue solution submucosally and circumferentially around the tumor within 30 min after surgery. The first node to stain blue was defined as the SLN. SLNs negative by hematoxylin and eosin (HE) staining were further examined for micrometastasis using cytokeratin IHC.
A total of 54 patients between 25 and 82 years of age were enrolled, including 32 males and 22 females. More than 70% of patients were T3 or above, about 86% of patients were stage II or III, and approximately 90% of patients had lesions grade II or above. Sentinel lymph nodes were detected in all 54 patients. There were 32 patients in whom no lymph node micrometastasis were detected by HE staining and 22 patients with positive lymph nodes micrometastasis detected by HE staining in non-SLNs. In contrast only 7 SLNs stained positive with HE. Using HE examination as the standard, the sensitivity, non-detection rate, and accuracy rate of SLN micrometastasis detection were 31.8% (7/22), 68.2% (15/22), and 72.2%, respectively. Micrometastasis were identified by ICH in 4 of the 32 patients with HE-negative stained lymph nodes, resulting in an upstaging rate 12.5% (4/32). The 4 patients who were upstaged consisted of 2 stage I patients and 2 stage II patients who were upstaged to stage III. Those without lymph node metastasis by HE staining who were upstaged by IHC detection of micrometastasis had a significantly poorer disease-free survival (p = 0.001) and overall survival (p = 0.004).
Ex vivo localization and immunohistochemical detection of sentinel lymph node micrometastasis in patients with colorectal cancer can upgrade tumor staging, and may become a factor affecting prognosis and guiding treatment. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1350200526694475.
Full-text · Article · Jun 2012 · Diagnostic Pathology
[Show abstract][Hide abstract] ABSTRACT: To determine the distal intramural spread (DIS) margin of rectal cancer.
Sixty-one p53-positive specimens of rectal cancer were used. After conventional hematoxylin and eosin (H&E) staining, the DIS margin of rectal cancer in large specimens was examined by immunohistochemistry. The patients were divided into A, B, C, and D groups. After a long-term follow-up, the survival curves of the four groups were estimated using the life table.
Fifty-one of the sixty-one cases (83.6%) had DIS. The extent of DIS ranged 0.11-3.5 cm; meanwhile the mean of DIS measured by H&E staining was 0.13 cm. The significant difference was found between the means (t=5.622, P<0.0001). Only 1 of 51 patients had DIS greater than 3 cm. The DIS was less than 1.0 cm in most rectal cancer patients. The long-term results indicated that the survival rate of the patients whose DIS was greater than 1.0 cm was lower than that of the patients whose DIS was less than 0.5 cm.
Rectal cancer patients with DIS greater than 1.0 cm have poor prognosis.
Full-text · Article · Mar 2006 · World Journal of Gastroenterology
[Show abstract][Hide abstract] ABSTRACT: To evaluate the feasibility and utility of an ex vivo sentinel lymph node (SLN) identification and ultrastaging for colorectal cancer (CRC).
CRC patients undergoing resection of a primary colorectal cancer were considered for inclusion. Following resection, SLN identification was performed. The SLN was dissected from the mesentery and submitted separately for pathologic analysis. All lymph nodes were stained with HE. Blue lymph nodes, when negative by routine HE staining, were further analyzed.
A total of 62 tumors from 60 patients with colorectal cancer were studied. 95.2% (59/62) specimens was successfully identified. In these 59 specimens, a total of 1114 (18.9 per specimens) lymph nodes were examined; of these, 157 (14.9%) were designated as SLNs. The number of blue-stained lymph nodes removed ranged from 1 to 9, with a mean of 2.7 blue nodes identified. The sensitivity of a blue-stained lymph node identifying metastatic disease was 39.1%. The false-negative was 23.7%. In 4 specimens micrometastases were detected only by immunohistochemistry with cytokeratin.
Ex vivo sentinel lymph nodes mapping in colorectal cancer is feasible and can identify the SLNs with a very high success rate. Ex vivo SLN mapping improves pathologic staging of patients with CRC. The SLN evaluation should not replace attempts to harvest large number of nodes for standard processing. SLN mapping can help improving the number of nodes for pathological examination.
No preview · Article · Sep 2005 · Zhonghua wai ke za zhi [Chinese journal of surgery]
[Show abstract][Hide abstract] ABSTRACT: The optimal distal molecular clearance margin of rectal cancer hasn't been confirmed. This study was designed to explore the molecular margin of distal intramural spread (DIS)in rectal cancer, and its prognostic value, and to further clarify the required distal margin of radical surgery for rectal cancer.
Sixty-one P53 positive specimens,resected from patients with rectal cancer from Aug.1996 to Oct. 1997, were collected. Microscopic DIS was examined by P53-immunohistochemistry (P53-IHC),comparing with conventional hematoxylineosin (HE)staining in consecutive large slice. Tissue shrinkage ratio,comparing the distal clearance margin measured in fresh specimens to that measured in large slice after fixed in each case,was used to convert macroscopically measured extent of distal spread to its actual extent. After long-term follow-up, the survival curves of 4 DIS groups were estimated by Life-table method.
With P53-IHC,DIS was observed in 50 cases (82.0%), DIS extents were 0.11-3.50 cm with the mean of 0.59 cm, DIS extent of > 3.00 cm was detected in 1 case only. Meanwhile,DIS was observed in 29 cases (47.5%)by HE staining, DIS extents were 0.10-1.39 cm with the mean of 0.13 cm. There was significant difference between the 2 means (P< 0.0001). The long-term result indicated that the survival rate of DIS extent of >1.00 cm group was lower than those of non-DIS group,and DIS extent of < 0.50 cm group (P< 0.05).
DIS was more exactly detected by P53-IHC than by HE. Most of DIS extents were less than 1 cm in rectal cancer. For over 95% cases, 3 cm distal to the rectal cancers was relatively safe in radical operations. The poor prognosis can be predicted in cases with DIS extent of >1 cm.
No preview · Article · Nov 2004 · Ai zheng = Aizheng = Chinese journal of cancer
[Show abstract][Hide abstract] ABSTRACT: To compare the effect of 5-fluorouracil (5-FU) portal vein infusion (PVI) for 7 days after radical resection, with intraluminal chemotherapy during operation for eliminating liver metastasis and elevating long-term prognosis in colorectal cancer.
162 colorectal cancer patients with radical resection were divided into portal vein chemotherapy group (group A, 82 cases) and intraluminal chemotherapy group (group B, 80 cases) randomly. In group A, 5-fluorouracil were infused with 1g per day constantly for 7 days after operation through portal vein catheters, which placed into greater omental vein and fixed on the abdominal wall. In group B, intraluminal chemotherapy was given and 5-fluorouracil 0.5 g was injected into the greater omental vein during operation.
The short-term complications and long-term effect in the two groups were compared by statistical software SPSS 8.0. Group A had more operative complications, and no statistical differences was found in hospital time and survival rate of the two groups. The 5-year survival rate is 76.7% (group A: 74.3%, group B: 79.2%), and the liver metastasis rate is 19.8%. There is no significant difference between the two group-survival curves. Multiple variable analysis suggested that Dukes' stage was the prognosis factor (P < 0.05).
The present study demonstrated that the two chemotherapy methods play an important role in preventing liver metastasis and improving the survival rate, and the intraluminal chemotherapy would be easier and simpler. The result should be further improved by using combined chemotherapy.
No preview · Article · Aug 2004 · Zhonghua wai ke za zhi [Chinese journal of surgery]