Clinicopathologic analysis of primary gastroenteropancreatic poorly differentiated neuroendocrine carcinoma; A ten year retrospective study of 68 cases at Moffit Cancer Center

Chemotherapy combined with Shenmai injection alleviates inflammatory response and side effects in the patients with advanced colorectal cancer: A retrospective analysis

Objective

To assess the inflammatory response and side effects of chemotherapy combined with Shenmai injection (SMI) in the treatment of patients with advanced colorectal cancer (CRC).

Methods

This retrospective cohort study included the clinical data of 152 patients with advanced CRC admitted to the First Affiliated Hospital of Huzhou University from April 2020 to April 2023. The patients were divided into control group (patients received chemotherapy treatment, n=75) and observation group (patients received chemotherapy combined with SMI, n=77) based on the treatment received. Tumor control rate, levels of immune function indicators before and after treatment, levels of inflammatory factor indicators, and incidence of toxic side effects in two groups were analyzed.

Results

Tumor control rate in the observation group (89.61%) was higher than that in the control group (77.33%) (P<0.05). After the treatment, the levels of CD3+, CD4+, CD4+/CD8+in both groups were significantly higher than before the treatment, and significantly higher in the observation group compared to the control group (P<0.05). After the treatment, serum levels of interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-α), and interleukin-8 (IL-8) in both groups decreased compared to pretreatment levels, and was significantly lower in the observation group (P<0.05). The incidence of adverse reactions in the observation group was significantly lower than that in the control group (P<0.05).

Conclusions

Compared with chemotherapy alone, chemotherapy combined with SMI better alleviates inflammatory response in patients with advanced CRC, enhance immune function, and improve tumor control rate, with a lower incidence of toxic side effects.

Deep learning radiomics analysis based on computed tomography for survival prediction in gastric neuroendocrine neoplasm: a multicenter study

Background

Survival prediction is crucial for patients with gastric neuroendocrine neoplasms (gNENs) to assess the treatment programs and may guide personalized medicine. This study aimed to develop and evaluate a deep learning (DL) radiomics model to predict the overall survival (OS) in patients with gNENs.

Methods

The retrospective analysis included 162 consecutive patients with gNENs from two hospitals, who were divided into a training cohort, internal validation cohort (The First Affiliated Hospital of Zhengzhou University; n=108), and an external validation cohort (The Henan Cancer Hospital; n=54). DL radiomics analysis was applied to computed tomography (CT) images of the arterial phase and venous phase, respectively. Based on pretreatment CT images, two DL radiomics signatures were developed to predict OS. The combined model incorporating the radiomics signatures and clinical factors was built through the multivariable Cox proportional hazards (CPH) method. The combined model was visualized into a radiomics nomogram for individualized OS estimation. Prediction performance was assessed with the concordance index (C-index) and the Kaplan-Meier (KM) estimator.

Results

The DL-based radiomics signatures based on two phases were significantly correlated with OS in the training (C-index: 0.79-0.92; P<0.01), internal validation (C-index: 0.61-0.86; P<0.01), and external validation (C-index: 0.56-0.75; P<0.01) cohorts. The combined model integrating radiomics signatures with clinical factors showed a significant improvement in predictive performance compared to the clinical model in the training (C-index: 0.86 vs. 0.80; P<0.01), internal validation (C-index: 0.77 vs. 0.71; P<0.01), and external validation (C-index: 0.71 vs. 0.66; P<0.01) cohorts. Moreover, the combined model classified patients into high-risk and low-risk groups, and the high-risk group had a shorter OS compared to the low-risk group in the training cohort [hazard ratio (HR) 3.12, 95% confidence interval (CI): 2.34-3.93; P<0.01], which was validated in the internal (HR 2.51, 95% CI: 1.57-3.99; P<0.01) and external validation cohort (HR 1.77, 95% CI: 1.21-2.59; P<0.01).

Conclusions

DL radiomics analysis could serve as a potential and noninvasive tool for prognostic prediction and risk stratification in patients with gNENs.

Analysis of risk factors and construction of predictive model for post-endoscopic retrograde cholangiopancreatography pancreatitis

Objective

To explore the risk factors of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and to establish a predictive model.

Methods

This was a retrospective observational study. Patients diagnosed with calculous cholangitis and treated with ERCP (n=998) in The First People's Hospital of Linping District from January 2014 to September 2022 were included. Risk factors of PEP were identified using univariate and multivariate logistic regression, and a nomograph prediction model was established based on the identified independent risk factors.

Results

PEP occurred in 52 patients (5.2%). Logistic regression analysis showed that common bile duct diameter, history of PEP, operation time, intubation frequency, pancreatic ducts visualization, and Sphincter of Oddi dysfunction (SOD) were independent risk factors for inducing PEP (P<0.05). The calibration curve showed that the predicted probability of occurrence of the nomograph model was consistent with the actual probability of occurrence. The C-index value calculated by the Bootstrap method was 0.966, suggesting the nomograph prediction model has a good discrimination ability. The AUC of the nomograph prediction model ROC curve was 0.966 (95% CI: 0.857-0.941), suggesting good prediction efficiency, and the decision analysis curve shows a high value.

Conclusions

Independent risk factors for PEP are large diameter of common bile duct, history of pancreatitis, long operation time, high intubation frequency, pancreatic ducts visualization, and SOD. The nomogram prediction model based on the above independent risk factors has good prediction ability.

Effect of laparoscopic complete mesocolic excision combined with immunotherapy and its impact on immune function and tumor markers in elderly patients with colon cancer

Objective

To determine the effect of laparoscopic complete mesocolic excision combined with immunotherapy and its impact on immune function and tumor markers in elderly patients with colon cancer.

Methods

This is a clinical comparative study. Eighty elderly patients with colon cancer hospitalized in the No.2 Hospital of Baoding from May 2020 to May 2022 were randomly divided into two groups, with 40 cases in each group. Patients in the study group received laparoscopic complete mesocolic resection combined with ubenimex orally. While patients in the control group received routine open surgery. The surgical indexes, surgical complications, and the changes of immune molecules and tumor markers before and after treatment were compared between the two groups.

Results

The amount of intraoperative bleeding, retention time of drainage tube and postoperative length of stay in the hospital in the study group were significantly better than those in the control group (p=0.000). The incision length of the study group was significantly shorter than that of the control group, the number of lymph nodes removed during the operation was significantly higher than that of the control group, and the incidence of surgical complications was significantly lower than that of the control group (p<0.05). After treatment, the levels of immune molecules in the study group were remarkably higher than those in the control group (p<0.05), while the levels of tumor markers were much lower than those in the latter group (p=0.000).

Conclusion

Laparoscopic complete mesocolic excision combined with immunotherapy exhibits a superior therapeutic effect to traditional open surgery in elderly patients with colon cancer, and is worthy of clinical promotion.

Clinical effect and safety of targeted therapy combined with chemotherapy in the treatment of patients with advanced colon cancer

Objective

To evaluate the clinical effect and safety of immunotherapy combined with chemotherapy in patients with advanced colon cancer.

Methods

This is a retrospective study. The subjects of this study were 120 patients with advanced colon cancer who were admitted to The No.2 Hospital of Baoding from November 30, 2019 to November 30, 2021. The enrolled patients were randomly divided into two groups, with 60 cases in each group. Patients in the control group were given F0LF0X4 regimen, while those in the study group were provided with Bevacizumab therapy on the basis of the method in the control group. All patients were evaluated after two cycles of treatment. The comparison of outcome measures included the curative effects, adverse drug reactions, improvement of quality-of-life scores and changes in tumor markers between the two groups.

Results

The total effective rate of the study group was significantly better than that of the control group. There was no significant difference in the incidence of adverse drug reactions between the two groups. After treatment, the study group had a significantly higher rate of improved quality of life score, while the obviously lower rate of the aggravated score than those in the control group. The levels of CEA, CA19-9 and CA125 in the study group were significantly lower than those in the control group after treatment.

Conclusion

Targeted therapy combined with chemotherapy is a safe and effective therapeutic option that has a definite curative effect in the treatment of patients with advanced colon cancer.

Significance of tumor markers combined with neutrophil to lymphocyte ratio, D-dimer and T-lymphocyte in the diagnosis of colon cancer

Objective

To analyze the value of combined detection of tumor markers, neutrophil to lymphocyte ratio (NLR), D-dimer and T lymphocyte in the diagnosis of colon cancer.

Methods

This is a retrospective study. A total of 80 patients with colon cancer and 80 patients with benign colon mass admitted to Baoding NO.1 Central Hospital from June 10, 2021 to December 10, 2022 were divided into the study group and the control group. Further comparison was performed on the tumor markers, NLR, D-dimer and T-lymphocyte levels between the two groups, associated with the comparison of corresponding levels of colon cancer at different stages. In addition, correlation analysis was carried out focusing on the above indicators with colon cancer.

Results

Carcinoembryonic antigen (CEA), CA199, NLR, D-dimer and CD8+ cell count levels in the study group were significantly higher than those in the control group, while CD4+ cell count and CD4+/CD8+ ratio were obviously lower (P<0.05). Among I-IV colon cancer, the highest levels of CEA, CA199, NLR, D-dimer, CD4+ and CD4+/CD8+ ratio were found in patients with Stage-IV colon cancer, while the level of CD8+ was the lowest (P<0.05). Correlation analysis indicated that CEA, CA199, NLR, D-dimer and CD8+ were positively correlated with whether the patient had colon cancer (r=0.841, 747,991,889,565, all P<0.05), but negative correlations with CD4+ and CD4+/CD8+ ratio (r=-0.999, -0.994, all P<0.05).

Conclusion

The detection of tumor markers combined with NLR, D-dimer and T-lymphocytes has reference value in the diagnosis of colon cancer.

Analysis of pathological characteristics and nursing intervention of patients with gastric polyps based on image stitching algorithm and endoscopy

Objectives:

The paper uses image stitching algorithm to understand the clinical and pathological characteristics of gastric polyps under gastroscope, and provides objective basis for the clinical diagnosis and treatment of gastric polyps and nursing intervention.

Methods:

The endoscopic, pathological data and surgical conditions of 111 patients with gastric polyps detected in the hospital from January 2017 to August 2019 were retrospectively analyzed.

Results:

The elderly patients (≥60 years old) in this group were those with high incidence of gastric polyps (56.8%); 80 patients with single polyps (72.1%), 31 patients with multiple polyps (27.9%); polyps were mainly located in the stomach (53.2%); polyps diameter ≤0.5cm are more common (69.4%); polyps are mainly hyperplastic polyps (40.5%) and inflammatory polyps in 37 cases (33.3%). Polyps were removed by biopsy forceps in 30 cases, endoscopic submucosal injection of 0.9% NaCl solution combined with high-frequency electrosurgical removal of 54 cases, endoscopic mucosal resection (EMR) in 6 cases, and endoscopic submucosal dissection (ESD) in treatment of the 4 cases, the remaining 17 cases were treated with surgery, and 12 patients were followed up, 2 of whom relapsed.

Conclusion:

Gastric polyps are small in diameter and mostly single; polyps are mainly located in the stomach body, mainly hyperplastic polyps; treatment methods are mostly endoscopic resection, and there is a possibility of recurrence after polypectomy, and follow-up should be strengthened. Full preparation before the operation, close cooperation during the operation, and careful postoperative care are important links to ensure the safety of the operation and reduce complications such as upper gastrointestinal bleeding.

Clinicopathological characteristics and prognosis of 232 patients with poorly differentiated gastric neuroendocrine neoplasms

BACKGROUND

Poorly differentiated gastric neuroendocrine neoplasms (PDGNENs) include gastric neuroendocrine carcinoma (NEC) and mixed adenoneuroendocrine carcinoma, which are highly malignant and rare tumors, and their incidence has increased over the past few decades. However, the clinicopathological features and outcomes of patients with PDGNENs have not been completely elucidated.

AIM

To investigate the clinicopathological characteristics and prognostic factors of patients with PDGNENs.

METHODS

The data from seven centers in China from March 2007 to November 2019 were analyzed retrospectively.

RESULTS

Among the 232 patients with PDGNENs, 191 (82.3%) were male, with an average age of 62.83 ± 9.11 years. One hundred and thirteen (49.34%) of 229 patients had a stage III disease and 86 (37.55%) had stage IV disease. Three (1.58%) of 190 patients had no clinical symptoms, while 187 (98.42%) patients presented clinical symptoms. The tumors were mainly (89.17%) solitary and located in the upper third of the stomach (cardia and fundus of stomach: 115/215, 53.49%). Most lesions were ulcers (157/232, 67.67%), with an average diameter of 4.66 ± 2.77 cm. In terms of tumor invasion, the majority of tumors invaded the serosa (116/198, 58.58%). The median survival time of the 232 patients was 13.50 mo (7, 31 mo), and the overall 1-year, 3-year, and 5-year survival rates were 49%, 19%, and 5%, respectively. According to univariate analysis, tumor number, tumor diameter, gastric invasion status, American Joint Committee on Cancer (AJCC) stage, and distant metastasis status were prognostic factors for patients with PDGNENs. Multivariate analysis showed that tumor number, tumor diameter, AJCC stage, and distant metastasis status were independent prognostic factors for patients with PDGNENs.

CONCLUSION

The overall prognosis of patients with PDGNENs is poor. The outcomes of patients with a tumor diameter > 5 cm, multiple tumors, and stage IV tumors are worse than those of other patients.

Pancreatic neuroendocrine neoplasms: Clinicopathological features and pathological staging

The nomenclature and classification of pancreatic neuroendocrine neoplasms has evolved in the last 15 years based on the advances in knowledge of the genomics, clinical behaviour and response to therapies. The current 2019 World Health Organization classification of pancreatic neuroendocrine neoplasms categorises them into three groups; pancreatic neuroendocrine tumours (PanNETs)(grade 1 grade 2, grade 3), pancreatic neuroendocrine carcinomas and mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) based on the mitotic rate, Ki-67 index, morphological differentiation and/or co-existing tissue subtype. PanNETs are also classified into non-functional NET, insulinoma, gastrinoma, VIPoma, glucagonoma, somatostatinoma, ACTH-producing NET and serotonin producing NET based on hormone production and clinical manifestations. A portion of the cases were associated with genetic syndromes such as multiple neuroendocrine neoplasia 1 (MEN 1), neurofibromatosis and Von Hippel-Lindau syndrome. In view of the distinctive pathology and clinical behaviour of PanNENs, the current 8th AJCC/UICC staging system has separated prognostic staging grouping for PanNETs from the pancreatic neuroendocrine carcinomas or MiNENs. Pancreatic neuroendocrine carcinomas and MiNENs are staged according to the prognostic stage grouping for exocrine pancreatic carcinoma. The new stage grouping of PanNETs was validated to have survival curves separated between different prognostic groups. This refined histological and staging would lead to appropriate selections of treatment strategies for the patients with pancreatic neuroendocrine neoplasms.