Clinical significance and potential application of cuproptosis-related genes in gastric cancer

BACKGROUND

Worldwide, gastric cancer (GC) is a common lethal solid malignancy with a poor prognosis. Cuproptosis is a novel type of cell death mediated by protein lipoylation and may be related to GC prognosis.

AIM

To offer new insights to predict GC prognosis and provide multiple therapeutic targets related to cuproptosis-related genes (CRGs) for future therapy.

METHODS

We collected data from several public data portals, systematically estimated the expression level and prognostic values of CRGs in GC samples, and investigated related mechanisms using public databases and bioinformatics.

RESULTS

Our results revealed that FDX1, LIAS, and MTF1 were differentially expressed in GC samples and exhibited important prognostic significance in The Cancer Genome Atlas (TCGA) cohort. We constructed a nomogram model for overall survival and disease-specific survival prediction and validated it via calibration plots. Mecha-nistically, immune cell infiltration and DNA methylation prominently affected the survival time of GC patients. Moreover, protein-protein interaction network, KEGG pathway and gene ontology enrichment analyses demonstrated that FDX1, LIAS, MTF1 and related proteins play key roles in the tricarboxylic acid cycle and cuproptosis. Gene Expression Omnibus database validation showed that the expression levels of FDX1, LIAS, and MTF1 were consistent with those in the TCGA cohort. Top 10 perturbagens has been filtered by Connectivity Map.

CONCLUSION

In conclusion, FDX1, LIAS, and MTF1 could serve as potential prognostic biomarkers for GC patients and provide novel targets for immunotarget therapy.

[Effect of Circular RNA hsa_circ_0067582 on the Proliferation and Invasion Ability of Gastric Cancer Cells]

Objective To investigate the effects on cell proliferation and invasion of the circular RNA hsa_circ_0067582 in gastric cancer(GC). Methods After hsa_circ_0067582 overexpression (Oe-circ_0067582) plasmid was transfected into AGS and SGC-7901 cells,the cell viability,proliferation,invasion ability,and apoptosis were detected by CCK-8,colony formation and EdU assays,Transwell assay,and flow cytometry,respectively.Western blotting was employed to detect the expression levels of proteins related to the cell apoptosis and epithelial-mesenchymal transition(EMT).The effect of Oe-circ_0067582 on the growth of SGC-7901 cells in nude mice was observed.Bioinformatics tools were used to predict the binding target miRNA of hsa_circ_0067582,and the competing endogenous RNA(ceRNA)regulatory network was established.Finally,functional enrichment was performed to analyze the biological functions of the target genes of the predicted miRNA. Results Compared with the pLO-ciR(empty plasmid)group,the Oe-circ_0067582 group in AGS and SGC-7901 cells attenuated the cell viability(t=7.883,P=0.001;t=5.679,P=0.005),proliferation(t=6.709,P=0.003;t=5.857,P=0.003),and invasion ability(t=7.782,P=0.002;t=6.342,P=0.003)and induced cell apoptosis(t=7.225,P=0.002;t=11.509,P=0.001).Western blotting showed that the Oe-circ_0067582 group in AGS and SGC-7901 cells up-regulated the protein levels of cysteinyl aspartate specific proteinase (Caspase) 3(t=6.863,P=0.002;t=7.024,P=0.001),Caspase 7(t=3.295,P=0.04;t=6.008,P=0.004),Caspase 9(t=4.408,P=0.012;t=6.278,P=0.004),and E-cadherin(t=12.453,P=0.002;t=10.867,P=0.001),while down-regulated those of Vimentin(t=7.242,P=0.002;t=5.694,P=0.004)and N-cadherin(t=6.480,P=0.003;t=7.446,P=0.001).Furthermore,Oe-circ_0067582 significantly inhibited the growth of tumor in the SGC-7901 tumor-bearing nude mice(t=3.526,P=0.017).The prediction based on TargetScan and miRnada suggested that hsa_circ_0067582 can competitively bind to hsa-miR-181b-3p,hsa-miR-337-3p,hsa-miR-421,and hsa-miR-548d-3p.The functional enrichment indicated that the target genes of miRNA were involved in multiple cancer-related biological processes including negative regulation of apoptotic process,gene expression,transcriptional misregulation in cancer,transforming growth factor-β,and p53 signaling pathways. Conclusion Oe-circ_0067582 can inhibit the proliferation and attenuate EMT process to reduce the invasion ability of AGS and SGC-7901 cells,which provides a new target for the treatment of GC.

Signet ring cell carcinoma hidden beneath large pedunculated colorectal polyp: A case report

BACKGROUND

Large pedunculated colorectal polyps are not frequent among colonic polyps. We present a clinical case of a large pedunculated colorectal polyp with signet ring cell cancer infiltrating the submucosa and lymph node invasion in a patient who ultimately underwent additional surgery. Clinicians should attach importance to pedunculated colorectal polyps and choose the most appropriate therapy.

CASE SUMMARY

A 52-year-old female farmer underwent routine screening colonoscopy and denied constipation, diarrhea, hematochezia, or other gastrointestinal symptoms. Her past medical history and general biochemical examination results were unremarkable. During the colonoscopy, a 25-mm pedunculated polyp in the sigmoid colon was identified. The superficial epithelium was macroscopically congestive, rough, and granular, showing characteristic features of adenoma. We first ligated the root of the pedunculated polyp using nylon loops as well as a titanium clip. Histopathological examination revealed high-grade intraepithelial neoplasia of the tumor surface and a negative margin with signet ring cell adenocarcinoma infiltrating the submucosal layer. The deepest infiltration was approximately 0.9 cm from the tumor surface and 0.55 cm from the stratum basale. We performed radical resection of the left colon with lymph node dissection after two weeks. The lesion was completely resected, and pathological assessment revealed signet ring cell adenocarcinoma infiltrating the submucosal layer as well as lymph node invasion (stage PT1N1M0 and grade IIIA in pathological grading, NRAS-, BRAF V600E-, KRAS-).

CONCLUSION

This case highlights the importance of paying attention to the malignancy of large pedunculated polyps. Polyps or adenomas removed via endoscopy must be evaluated histologically. Even if adenomas may be fragile, endoscopy doctors should still remove polyps as completely as possible and choose perpendicular sections through the stalk and base to fix by formaldehyde solution.

[Jiangsu Province Coronary Artery Bypass Grafting Registry study: a report of 4 661 patients in 13 centers]

Objective: To examine the overall status of the Jiangsu Province Coronary Artery Bypass Grafting Registry database. Methods: The patients date of Jiangsu Province Coronary Artery Bypass Grafting Registry database from October 2017 to December 2019 was collected retrospectively.Risk factors, history, cardiac function (New York Heart Association class), extent of coronary artery lesion, European system for cardiac operative risk evaluation Ⅱ (EuroSCORE Ⅱ), cardiopulmonary bypss, arterial grafts, the numbers and flow of grafts and postoperative major adverse cardiac and cerebrovascular event(MACCE) information were analyzed. The clinical data of patients underwent on-pump CABG(ONCABG) or off-pump CABG (OPCAB) were compared by t test or χ(2) test. Results: Up till December 2019, the database enrolled 7 138 patients, in which 4 661 patients receiving primary isolated CABG. There were 3 486 males and 1 175 females with the age of (64.6±8.1) years (range:31 to 87 years). There were coronary left main disease in 960 patients, triple vessel disease in 3 934 patients, both left main and triple vessel disease in 837 patients, ejection fraction>50% in 3 841 patients, cardiac function class Ⅲ to Ⅳ in 1 664 patients. EuroSCORE Ⅱ was (2.3±0.7)% (range: 0.5% to 35.8%). There were 2 731 patients (58.59%) underwent ONCABG and 1 930 patients (41.41%) underwent OPCAB. There were 4 144 patients (88.91%) for whom the left internal thoracic artery was harvested. Seven centers (2 centers routinely) used left radial artery, 5 centers (3 centers routinely) used the transit time flow meter. The graft was 3.4±0.7 (range:1 to 7), the aortic crossclamp time was (65.0±20.4) minutes (range: 21 to 196 minutes), the cardiopulmonary bypass time was (90.0±24.2) minutes (range: 33 to 227 minutes). In-hospital death ocurred in 84 patients(1.80%), while re-operation in 93 patients (2.00%), myocardial infarction in 71 patients (1.52%), cerebral infarction in 33 patients (0.71%) and dialysis in 56 patients (1.20%). There were 2 936 patients prescribed with secondary prevention drugs(62.99%).Comparing with OPCAB group, ONCABG group had younger age, more female, more diabetes mellitus, more history of myocardial infarction and percutaneous transluminal coronary angioplasty, poorer cardiac function and coronary lesions, higher EuroSCORE Ⅱ, preoperatively (all P<0.05), and was associated with higher MACCE (135/2 731 vs. 71/1 930, χ(2)=4.280, P=0.039), and of more grafts, transfusion and intra-aortic balloon counterpulsation application (all P<0.05). Conclusions: Jiangsu Province Coronary Artery Bypass Grafting Registry database is generally in good operation, and some parameters still need to be improved. Comparing with OPCAB group, ONCABG has more severe preoperative general conditions, while the outcomes is acceptable.

Non-coding RNAs and gastric cancer

Non-coding RNAs (ncRNAs) play key roles in development, proliferation, differentiation and apoptosis. Altered ncRNA expression is associated with gastric cancer occurrence, invasion, and metastasis. Moreover, aberrant expression of microRNAs (miRNAs) is significantly related to gastric cancer tumor stage, size, differentiation and metastasis. MiRNAs interrupt cellular signaling pathways, inhibit the activity of tumor suppressor genes, and affect the cell cycle in gastric cancer cells. Some miRNAs, including miR-21, miR-106a and miR-421, could be potential markers for the diagnosis of gastric cancer. Long non-coding RNAs (lncRNAs), a new research hotspot among cancer-associated ncRNAs, play important roles in epigenetic, transcriptional and post-transcriptional regulation. Several gastric cancer-associated lncRNAs, such as CCAT1, GACAT1, H19, and SUMO1P3, have been explored. In addition, Piwi-interacting RNAs, another type of small ncRNA that is recognized by gastroenterologists, are involved in gastric carcinogenesis, and piR-651/823 represents an efficient diagnostic biomarker of gastric cancer that can be detected in the blood and gastric juice. Small interfering RNAs also function in post-transcriptional regulation in gastric cancer and might be useful in gastric cancer treatment.

Clinicopathological and prognostic features of hepatoid adenocarcinoma of the stomach

BACKGROUND

Hepatoid adenocarcinoma of the stomach (HAS) is a rare type of gastric carcinoma, which has its unique clinicopathological features and poorer prognosis than that of the ordinary gastric adenocarcinoma. At present, there is still a lack of understanding about this disease. The current study aimed to summarize and discuss the clinical, pathological, immunohistochemical, and prognostic features of this disease.

METHODS

A total of 20 patients of HAS were retrospectively studied. All the patients were treated in Cancer Hospital of Chinese Academy of Medical Sciences between March 1998 and October 2009. Statistical analysis, including the Kaplan-Meier method, log-rank test and Cox model, were performed by the SPSS 15.0 software.

RESULTS

Seventeen patients (85%) had at least 1 lymph node metastases; 17 patients (85%) received postoperative immunohistochemical examinations, with an alpha-fetoprotein (AFP) positive rate of 94.1% (16/17); 14 patients had distant metastases (including 12 liver metastases, 1 lung metastasis, and 1 celiac widespread metastases), and one simultaneously had anastomotic recurrence and liver metastases. The overall survival time was 2 - 99 months (median: 12.0 months). The 3-year survival rate of the 20 patients was 17.2%. The 3-year survival rate of patients with complete hepatocyte-like regions and those with both hepatocellular carcinoma and adenocarcinoma regions was 20.0% and 17.5%, respectively (P = 0.361). The survival difference among the radical surgery group, palliative surgery group and no surgery group was statistically significant (P = 0.022). The Kaplan-Meier method and log-rank test showed that surgery, pTNM stages, and adjuvant chemotherapy were associated with prognosis (P < 0.05). The Cox model only confirmed that the pTNM stages and adjuvant chemotherapy had statistical significance for the prognosis of HAS (P < 0.05) due to the limited cases.

CONCLUSIONS

HAS is a special type of gastric carcinoma and has a poor prognosis. The pTNM stage is an independent risk factor for HAS. Multidisciplinary therapy, including surgery and chemotherapy, may improve the prognosis of HAS.

Anorectal malignant melanomas: Retrospective experience with surgical management

AIM: To present the experience and outcomes of the surgical treatment for the patients with anorectal melanoma from the Cancer Hospital, Chinese Academy of Medical Sciences.

METHODS: Medical records of the diagnosis, surgery, and follow-up of 56 patients with anorectal melanoma who underwent surgery between 1975 and 2008 were retrospectively reviewed. The factors predictive for the survival rate of these patients were identified using multivariate analysis.

RESULTS: The 5-year survival rate of the 56 patients with anorectal melanoma was 20%, 36 patients underwent abdominoperineal resection (APR) and 20 patients underwent wide local excision (WLE). The rates of local recurrence of the APR and WLE groups were 16.13% (5/36) and 68.75% (13/20), (P = 0.001), and the median survival time was 22 mo and 21 mo, respectively (P = 0.481). Univariate survival analysis demonstrated that the number of tumor and the depth of invasion had significant effects on the survival (P < 0.05). Multivariate analysis showed that the number of tumor [P = 0.017, 95% confidence interval (CI) = 1.273-11.075] and the depth of invasion (P = 0.015, 95% CI = 1.249-7.591) were independent prognostic factors influencing the survival rate.

CONCLUSION: Complete or R0 resection is the first choice of treatment for anorectal melanoma, prognosis is poor regardless of surgical approach, and early diagnosis is the key to improved survival rate for patients with anorectal melanoma.

Prognostic factors for 5-year survival after local excision of rectal cancer

AIM: To evaluate the prognostic factors for 5-year survival after local excision of rectal cancer, and to examine the therapeutic efficacy and surgical indications for this procedure.

METHODS: Clinical data, obtained from 106 local rectal cancer excisions performed between January 1980 and December 2005, were retrospectively analyzed. Survival analysis was performed using the Kaplan-Meier method, statistical comparisons were performed using the log-rank test, and multivariate analysis was performed using the Cox proportional hazards model.

RESULTS: Transanal, transsacral, and transvaginal excisions were performed in 92, 12, and 2 cases, respectively. The rate of complication, local recurrence, and 5-year survival was 6.6%, 17.0%, and 86.7%, respectively. Univariate analysis showed that T stage, vascular invasion, and local recurrence were related to the prognosis of the cases (P < 0.05). Multivariate analysis showed that T stage [P = 0.011, 95% confidence interval (CI) = 1.194-3.878] and local recurrence (P = 0.022, 95% CI = 1.194-10.160) were the major prognostic factors for 5-year survival of cases after local excision of rectal cancer.

CONCLUSION: Local rectal cancer excision is associated with few complications, and suitable for stages Tis and T1 rectal cancer. Prevention of local recurrence, active postoperative follow-up, and administration of salvage therapy are the effective methods to increase the efficacy of local excision of rectal cancer.

[Prognostic factors for elderly patients with pancreaticoduodenectomy for periampullary tumor]

OBJECTIVES

To analyze the prognostic factors for elderly patients with pancreaticoduodenectomy for periampullary tumor.

METHODS

A retrospective analysis of the prognostic factors for the mortality rate was made in 127 elderly patients within 30 days of pancreaticoduodenectomy for periampullary tumor from January 1985 to November 2006 Chi-squared test, Fisher's exact test, t-test were used.

RESULTS

The prognostic factors for the first-month mortality rate in elderly patients with pancreaticoduodenectomy included time length of the operation, operative hemorrhage, postoperative hemorrhage, pulmonary infection, and postoperative TP.

CONCLUSIONS

An overall consideration should be paid to the factors that affect the prognosis of elderly patients with pancreaticoduodenectomy for periampullary tumor during the perioperative period. The security of the patients can be promoted by controlling these prognostic factors.

[Analysis of recurrence and prognosis after surgical resection for anorectal melanoma]

OBJECTIVE

To investigate the clinicopathologic factors related with recurrence and prognosis after surgical resection for anorectal melanoma.

METHODS

The clinicopathologic factors related to recurrence and prognosis of 50 patients with anorectal melanoma after surgical resection were retrospectively analyzed using univariate and multivariate methods.

RESULTS

Forty-seven patients underwent radical operation, including 31 abdominoperineal resection (APR) and 16 sphincter preserving operation. The local recurrence rates were 16.1%(5/31) and 68.8%(11/16) respectively. chi(2) analysis revealed that operation pattern was associated with local recurrence rate. The 5-year survival rate was 18.2%. Univariate analysis revealed that single tumor, intramural infiltration and operation pattern were related with prognosis. Multivariate analysis revealed that intramural infiltration was the most important prognostic factor for anorectal melanoma.

CONCLUSIONS

The prognosis of anorectal melanoma is poor. Early diagnosis and treatment are important for the improving of curative effect.

[Surgial treatment and prognosis of ovarian metastasis from colorectal cancer]

OBJECTIVE

To summarize the surgical treatment experiece and to investigate the prognosis of the patients with ovarian metastasis from colorectal cancer.

METHODS

The data of 67 patients with synchronous or asynchronous ovarian metastasis from colorectal cancer surgically treated between January 1989 and December 2005 were collected and analyzed retrospectively using Statistical Package for the Social Sciences (Release 11.5, SPSS, Inc). Prognostic factors were analyzed using chi2 test. Survival analysis was estimated by the Kaplan-Meier method and compared using the log-rank test. Multivariate analysis was carried out by Cox regression.

RESULTS

The overall 1-, 3- and 5-year survival of these 67 patients was 71.0%, 18.7% and 9.2%, respectively. Univariate analysis revealed that the metastasis was confined in the ovary or pelvis only, unilateral/double ovarian metastasis, and operation mode were all statistically significant prognostic factors (P <0.05). Cox regression analysis showed that the operation mode was the most important prognostic factor (OR = 3.531, P <0.001).

CONCLUSION

Surgical treatment is still the most effective mode in the treatment for the ovary metastasis from colorectal cancer.

[Clinical features and prognosis of alveolar soft part sarcoma]

OBJECTIVE

To investigate the clinical feature, suitable treatment and prognosis of alveolar soft part sarcoma.

METHODS

The clinical data of 58 such patients treated at our hospital from 1967 to 2006 were retrospectively analyzed. Fifty-three patients except 6 with distant metastasis underwent surgical resection including 33 extensive resection and 19 local resection. Furthermore, 19 patients received postoperative adjuvant radiotherapy or chemotherapy.

RESULTS

Eleven of 50 patients who underwent complete resection developed local recurrence. Thirty-One (53.4%) was found to have lung metastasis. The overall 3-, 5-, 10-year survival rate was 89.5%, 74.1% and 57.7%, respectively. The median survival time of the patients was 125 months. The 3-, 5-, 10-year survival rate was 100.0%, 81.6% and 65.3% for female patients, but it was 79.6%, 67.2% and 49.7% for male patients, respectively.

CONCLUSION

Alveolar soft part sarcoma usually grows slowly. Though local recurrence is rarely seen, distant metastasis is frequently observed. Lung is the most common organ of metastasis. However, survival can still be long even with lung metastasis. To achieve microscopically complete resection is quite critical to localized alveolar soft part sarcoma. No survival advantage was observed when adding adjuvant radiotherapy and/or chemotherapy. The phenomena of female patient or patient with X chromosome translocation showing better prognosis than the male or other patients needs further investigation.

[Clinical analysis of 14 cases of epithelioid sarcoma]

BACKGROUND & OBJECTIVE

Epithelioid sarcoma is a rare soft tissue sarcoma with a high propensity for aggressiveness, regional nodal spread, and distant metastases. This study was to investigate the clinical features, diagnosis, treatment, and prognosis of epithelioid sarcoma.

METHODS

The clinical data of 14 patients with epithelioid sarcoma, admitted to our hospital from 1990 to 2005, were analyzed. All of the 14 patients received initial operations at other hospitals. Eleven patients received extensive excision (9 patients) or amputation (2 patients), and 4 of them also received local lymph node dissection at our hospital; 3 patients received another local excision or extensive excision at other hospitals again. Nine patients received adjuvant radiotherapy and 3 of them also received adjuvant chemotherapy.

RESULTS

All diagnoses of epithelioid sarcoma were confirmed by pathology. Of the 14 patients, 12 (85.7%) had local recurrence and 4 (28.6%) had local lymph node metastasis, 9 (64.3%) died within 3 years after initial operation. The overall 1-, 2-, 5-, 10-year survival rates were 71.43%, 55.56%, 27.78%, 13.89%, respectively.

CONCLUSIONS

The prognosis of epithelioid sarcoma is poor because of a high propensity for local recurrence, node metastases, and distant metastases. Extensive excision or radical excision combined local lymph node dissection is effective for epithelioid sarcoma.

[Simultaneous liver and colorectal resection for synchronous colorectal liver metastasis]

OBJECTIVE

To investigate the safety and long term outcome of simultaneous liver and colorectal resection for synchronous colorectal liver metastasis.

METHODS

Forty-three synchronous colorectal liver metastasis patients who received simultaneous colectomy and hepatectomy between May 1981 and November 2005 were analyzed retrospectively.

RESULTS

The group included 21 male patients and 22 female patients, with the median age of 52 years. The overall median operative time was 180 minutes, 30 cases received blood transfusion, and the median volume was 800 ml. The median hospital stay was 15 days. The morbidity and mortality was 18.6% and 2.3%, respectively. The overall median survival time was 25 months, 5-year survival rate was 19.1%. The survival of patients underwent R0 resection were substantially better (median survival time 48 months, 5-year survival rate 33.8%) than that of the patients who did not undergo R0 resection (20 months, 7.6%) (P = 0.002).

CONCLUSIONS

Simultaneous liver and colorectal resection is safe and effective for synchronous colorectal liver metastasis. Furthermore, simultaneous R0 resection should be the optimal surgery for the resectable cases.

[Outcome of surgical therapy for liver metastasis of colorectal cancer: analysis of 75 cases]

OBJECTIVE

To explore the strategy to improve the long term survival of liver metastasis of colorectal cancer after surgical treatment.

METHODS

The clinical data of 75 patients with liver metastasis of colorectal cancer, 43 males and 32 females, aged 51.4, who received hepatectomy between January 1981 and November 2005, were analyzed.

RESULTS

The primary tumor site was colon in 39 cases, and rectum in 36 cases. Liver metastasis was synchronous in 59 patients, and metachronous in 16 patients. 45 patients received simultaneous liver and colorectal resection, 29 patients received metachronous resection, and 1 patient did not receive primary rectal cancer resection. The operative complication rate and the mortality were 16% (12/75) and 1.33% (1/75) respectively. The overall 1- 3-, and 5-year survival rates were 86.7%, 35.5%, and 22.2% respectively, and the median survival time was 25 months. There were residual tumors in 35 patients. The 1-, 3-, and 5-year survival rates of the residual tumor group were 80.6%, 5.4%, and 5.4% respectively, all significantly lower than those of the radical resection group (91.6%, 58.1%, and 34.9% respectively, and the median survival time of the residual tumor group was 18 months, significantly shorter than that of the radical resection group (38 months) (all P = 0.000).

CONCLUSION

Surgical resection of liver metastasis of colorectal cancer significantly prolongs the survival time, and resection of all liver deposits and the extrahepatic disease is the most important factor influencing survival.

[Intra-abdomen extragastrointestinal stromal tumors: a clinicopathologic study on 30 cases]

OBJECTIVE

To investigate the clinicopathological characteristics and prognostic factors in patients with intra-abdomen extragastrointestinal stromal tumors (EGISTs).

METHODS

The data of 47 patients of mesenchymal neoplasms that arose from the abdominal cavity and retroperitoneum, collected from July 1987 to June 2003 in our hospital with complete clinical and pathological data, were investigated retrospectively. EGISTs were diagnosed by reviewing the tumor slides stained with hematoxylin and eosin (H&E). Immunohistochemistry staining were performed on CD117, CD34, smooth muscle actin, Desmin and S-100 proteins. The relations of various clinicopathologic characteristics and outcomes were examined.

RESULTS

Among the 47 cases, 30 tumors were confirmed to be EGISTs. Twelve cases arose from the mesentery, six from small omentum, eight from retroperitoneum and four from the abdominal cavity. The size of tumors ranged from 4 to 30 cm (median 12.5 cm) in diameter and the tumor cell components mainly included spindle cells (23 cases), epithelioid cells (4 cases), and mixed cells (3 cases). The follow-up rate was 90% and the median follow up time was 44 months. The patient survival rates at 1, 5 and 10 years were 79.7%, 59.5% and 45.4% respectively. Univariate analysis showed that tumor size >10 cm, tumor necrosis, mitoses > or =5/50HPF, obvious nuclear atypia, moderate and poor differentiated tumor cells were predictors of poor prognosis.

CONCLUSIONS

EGISTs have specific clinical behaviors. The parameters used for predicting GISTs prognosis are not completely applicable for EGISTs. Tumor necrosis, obvious nuclear atypia and mitoses > or =5/50HPF help to predict aggressive behaviors in EGISTs.

[Analysis of prognostic and clinicopathologic factors in gastrointestinal stromal tumors of the stomach]

OBJECTIVE

To identify the clinical pathological characteristics and prognostic factors in patients with gastrointestinal stromal tumors of the stomach.

METHODS

The data of 98 patients of gastric stromal tumors, leiomyomas, leiomyosarcomas, leiomyoblastomas, schwannomas and neurofibromas, collected from Mar. 1983 to Dec. 2001 in our hospital with complete clinical and pathological data, were investigated retrospectively. Gastric stromal tumors were diagnosed by reviewing the tumor slides stained with hematoxylin and eosin (H&E). Two histomorphologically representative areas of each tumor slides were identified and arrayed on a tissue microarray. Immunohistochemistry staining were performed using antibodies to c-kit (CD117), CD34, smooth muscle actin (SMA), Desmin and S-100 proteins. The relations of various clinicopathologic characteristics and outcomes were tested by univariate analysis and multivariate analysis.

RESULTS

Ninety-one patients were clearly identified as gastric stromal tumors from the 98 patients, who were diagnosed as gastric stromal tumor, leiomyoma, leiomyosarcoma, leiomyoblastoma schwannoma and neurofibroma (92.9%). The follow-up rate was 91% and the median follow up time was 54 months. The patient survival rates at 1, 5 and 10 years were 88.8%, 79.6% and 63.7% respectively. Univariate analysis showed that tumor size, mitotic count, tumor necrosis, nuclear pleomorphism, cell type, cell density, surgical procedure, mucosal invasion, age and lable index of Ki-67 were associated with prognosis (P<0.05). Multivariate analysis showed that tumor size, mitotic count, mucosal invasion and tumor necrosis were predictors of prognosis (P<0.05).

CONCLUSION

Tumor size of >10 cm, mitotic count of >10 mitoses per 50 high power fields, necrosis and mucosal invasion are often associated with an aggressive clinical course in gastric stromal tumors.

[Value of intraoperative fine-needle aspiration cytology in the diagnosis of pancreatic cancer]

OBJECTIVE

To investigate the value of the intraoperative fine-needle aspiration cytology (IFNAC) in the diagnosis of pancreatic cancer.

METHODS

The IFNAC data of 70 pancreatic cancer patients were retrospectively reviewed. IFNAC had been done in our hospital only in a few patients before 2001, however, more and more patients have been examined by renovated method since 2002. But as the way of carrying out IFNAC improved by changing from the ordinary 10 ml syringe and 22 gauge needle (0.7 mm) before 2003 to 5 ml syringe and 25 gauge skin testing needle (0.5 mm), the panreas itself is properly exposed before IFNAC, the operator at frst fixes the suspected mass with his left hand and does the puncture with his right hand. Puncturing is done while the syringe is rotated, negative pressure is being kept at the same time. The needle is withdrawn under negative pressure, 6-8 syringe are used for each patient by puncturing at 6-8 points, then smears are made with the syringes. The whole process takes 20 min to accomplish.

RESULTS

The overall positive rate was 84.3%. The positive rate of the conventional IFNAC was 66.67%, while it was increased to 95.3% following the introduction of the renovated method (P = 0.002); No complication was observed in this series.

CONCLUSION

Intraoperative fine-needle aspiration cytology using 25 gauge skin testing needle and multi-point rotating maneuver during puncturing in the diagnosis of pancreatic cancer is safe and effective with few complications.

[Diagnosis and treatment of patients with cholangiocarcinoma]

OBJECTIVE

To explore the diagnosis and treatment of the cholangiocarcinoma.

METHODS

Forty one patients with cholangiocarcinoma who were enrolled in our hospital from January 1970 to January 2005 were retrospectively analyzed.

RESULTS

Among these 41 patients, the 1, 3, and 5-year survival rate was 82.3%, 45.8%, 45.8%, respectively, with radical operation, and was 11.0%, 0, 0 with non-radical operation (chi2 = 21.38, P < 0.01). The 1-year and 3-year survival rate was 11.0% and 0 in 9 patients treated with laparatomy, which was not significantly different from those treated with non-radical operation (chi2 = 0.02, P = 0.89). Four patients did not receive operation and all died within one year. Among 25 patients who did not experience lymph node metastasis, the 1, 3, and 5-year survival rate was 58.4%, 27.3%, and 27.3%. Among 16 patients who were found lymph node metastasis, the 1-year and 3-year survival rate was 61.8% and 0 (chi2 = 13.85, P < 0.01).

CONCLUSION

Operation is the most effective treatment for cholangiocarcinoma. Radical operation is the only curative treatment.

Safety and hemostatic effect of recombinant activated factor VII in cirrhotic patients undergoing partial hepatectomy: a multicenter, randomized, double-blind, placebo-controlled trial

BACKGROUND

Coagulopathy caused by cirrhosis may contribute to excessive bleeding during hepatectomy. We evaluated the hemostatic effect and safety of recombinant factor VIIa (rFVIIa) in cirrhotic patients undergoing partial hepatectomy.

METHODS

Patients were randomized to rFVIIa 50 or 100 mug/kg or placebo, administered intravenously 10 minutes before surgery and every second hour during surgery. The primary efficacy end points were the proportion of patients receiving red blood cell (RBC) transfusions and the amount of RBCs transfused. The RBC transfusion trigger was blood loss of 500 mL. Safety end points included thromboembolic and adverse events.

RESULTS

No statistically significant effect of rFVIIa treatment on efficacy end points was observed. Serious and thromboembolic adverse events occurred at similar incidences in the study groups.

CONCLUSIONS

Using blood loss as a transfusion trigger, the efficacy of rFVIIa in reducing the requirement for RBC transfusion was not established in this study. No safety concerns were identified.

The clinical value of serum CEA, CA19-9, and CA242 in the diagnosis and prognosis of pancreatic cancer

AIM

Serum tumour markers carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and CA242 were investigated to evaluate the values of single and combined test in the diagnosis and prognosis of pancreatic cancer.

METHODS

Pre-operative serum CEA, CA19-9 and CA242 were measured in 105 pancreatic cancers, 70 non-pancreatic malignancies and 30 benign pancreatic diseases.

RESULTS

The sensitivity of CA19-9 alone was the highest in pancreatic cancer patients (80%), but the specificity was significantly lower than that of CEA and CA242 (P<0.01). The combination of CEA and CA242 could increase the specificity to 92%. In serum CA242 positive patients, the survival time was remarkably shorter than that of patients with negative result (P<0.01). The survival time in patients with more than two markers positive expression of CEA, CA19-9 and CA242 was obviously shorter than that of only one or no marker positive expression (P<0.05).

CONCLUSION

The diagnostic rate of CA19-9 in pancreatic cancer is better than that of CEA and CA242. Combined detection of CEA and CA242 can improve the diagnostic specificity obviously. High levels of serum markers are associated with advanced stage of the disease. Patients with two or three markers positive expression of CEA, CA19-9, and CA242 simultaneously had a shorter survival time.

[Surgical treatment for liver metastasis of colorectal cancer: a report of 59 cases]

BACKGROUND & OBJECTIVE

Liver metastasis is the major cause of treatment failure of colorectal cancer. The median survival time of patients with untreated liver metastases is only about 6 months. Surgical resection is the major treatment to prolong survival time of the patients. This study was to assess surgical treatment efficacy on these patients and their prognosis.

METHODS

Records of 59 colorectal cancer patients with liver metastases, treated with hepatectomy (including 14 cases of anatomical segmentectomy and 45 cases of wedge resection) from Jan. 1987 to Dec. 1998 in Cancer Hospital of Chinese Academy of Medical Sciences were reviewed. Postoperative complications occurred in 4 (6.8%) patients, without surgical death. Survival rate was estimated by Kaplan-Meier method, and compared by log-rank test. Prognostic factors were analyzed by multivariate Cox regression model.

RESULTS

The overall 1-, 3-, and 5-year survival rates were 91.4%, 34.8%, and 21.9%. Survival rate was significantly lower in patients with heterochronia metastasis than in patients with synchronal metastasis (P < 0.05), and lower in patients with metastasis size of > 5 cm than in patients with metastasis size of < or = 5 cm. Univariate analysis showed that time of liver metastasis and metastasis size of > 5 cm were prognostic factors (P < 0.05); while node status of primary tumor, number of liver tumors, and carcinoembryonic antigen level had no significant relations with prognosis (P < 0.05).

CONCLUSIONS

Hepatectomy may prolong survival time of colorectal cancer patients with liver metastases. Early diagnosis with intensive follow-up is crucial to increase the resectability of liver metastasis.

Diagnosis and surgical treatment of primary hepatic cholangiocarcinoma

BACKGROUND/AIMS

To summarize the experience in the diagnosis and surgical treatment of primary hepatic cholangiocarcinoma (PHCC).

METHODOLOGY

Forty-seven PHCC patients, who had undergone surgical treatment in our hospital from 1970 to 1999, were retrospectively analyzed with their clinicopathological features, surgical treatments and prognoses.

RESULTS

1) PHCC patients lacked typical clinical manifestation, and some had an accompanying history of virus B hepatitis (36.2%, 17/47) and liver cirrhosis (46.8%, 23/47), and elevation of AFP (25.5%, 12/47). 2) The detection rates of BUS, CT, MRI and liver scintigraphy were 95.7% (45/47), 93.6% (44/47), 100% (23/23) and 100% (4/4), respectively. The lesions detected by those methods needed to differentiate with hepatocellular carcinoma. 3) The resection rate was 76.6% (36/47), the postoperative overall 1-, 3- and 5-year survival rates were 54.1% (24/47), 34.0% (16/47), and 29.8% (14/47) in all patients, respectively, including the 1-, 3- and 5-year survival rates were 83.3% (30/36), 50.0% (18/36), and 38.9% (14/36) in hepatectomy cases, respectively. 4) All of the four patients who survived more than 5 years, including small liver cancer (< or = 3 cm) three cases and encapsulated large nodular lesion one case, received curable resection and postoperative adjuvant therapies.

CONCLUSIONS

PHCC patients can obtain a better result by early detection and curative resection with adjuvant therapies.

Tight association of hepatocellular carcinoma with HBV infection in North China

BACKGROUND

Hepatocellular carcinoma (HCC) is the second most common cancer in China. Hepatitis B and C viruses (HBV and HCV) and aflatoxins are known risk factors for HCC, but the etiological status of these factors in HCC development is not clear. This study was undertaken to define the absolute importance of HBV in hepatocarcinogenesis of North China.

METHODS

A consecutive series of 119 patients with pathologically proven HCC were collected from North China during January 1998 to December 2000 by the Cancer Hospital of the Chinese Academy of Medical Sciences, Beijing. Serum HBsAg, anti-HBc and anti-HCV were negative HBV sero-markers. The HBV X gene was analyzed for its expression by PCR, DNA sequencing, and immunohistochemistry.

RESULTS

In the 119 HCC patients, 82.4% (98/119) were HBsAg seropositive. When a comprehensive set of HBV markers were detected, the HBV infection rate in these HCC patients was 99.2% (118/119). Of the patients, 11.8%(14/119) were found to be anti-HCV positive. But all the anti-HCV positive HCC patients were co-infected with HBV.

CONCLUSIONS

HBV infection is virtually ubiquitous in HCC patients in North China. The tight association of HBV with HCC strongly suggests the dominant role of HBV infection in causing hepatocellular carcinoma. About 11.8% of HCC patients being HCV-related are co-infected with HBV.

Overexpression of annexin 1 in pancreatic cancer and its clinical significance

AIM: To investigate the expression of annexin I in pancreatic cancer and its relationship with the clinicopathologic factors, and to evaluate its potential clinical significance.

METHODS: Annexin I expression was analyzed by Western blot and immunohistochemical staining in pancreatic adenocarcinoma and multi-tissue microarrays (MTAs).

RESULTS: Western blot analysis showed that annexin I was overexpressed in 84.6% (11/13) pancreatic ductal adenocarcinomas. Immunohistochemistry analysis of pancreatic cancer in MTAs showed that annexin I protein was 71.4% (30/42) positive which was markedly increased compared with that in the tumor matched normal pancreas tissues 18.4% (7/38) (P < 0.01). In the meantime, the high expression of annexin 1 was correlated with the poor differentiation of pancreatic adenocarcinoma.

CONCLUSION: Annexin 1 overexpression is a frequent biological marker and correlates with the differentiation of pancreatic cancer during tumorigenesis.

[Clinical analysis of surgery for rectal cancer in 122 elderly patients]

BACKGROUND & OBJECTIVE

Patients with rectal carcinoma in the elderly are usually complicated with coexisting diseases. For selection of operative procedure, it is necessary to consider the various factors. The aim of this study was to assess the treatment and prognosis of rectal carcinoma in patients over 65 years of age.

METHODS

The data of 122 such patients treated from January 1987 to December 1998 in Cancer Hospital of Chinese Academy of Medical Sciences was analyzed retrospectively. Curative resection was performed for all patients, including abdominoperineal resection (45), anterior resection (66), Hartmann's operation (7), and transanal local excision (4). Postoperative complication developed in 10 patients (8.2%). No death occurred within 30 days post operation. Survival analysis was estimated using the Kaplan-Meier method and compared using the log-rank test. Cox regression was used in multivariate analysis.

RESULTS

The overall 3- and 5- year survival rates were 76.4% and 61.0% for the whole group, 81.6% and 70.6% for the lymph node negative group (Dukes A, B), 60.9% and 40.4% for the lymph node positive group (Dukes C), respectively. The difference between the two groups was highly significant (Chi(2)=10.1, P< 0.01). However, histological type, coexisting disease, and tumor size had no significant association with prognosis (P< 0.05). Cox regression showed that lymph node metastasis was an important prognostic factor.

CONCLUSION

Suitable radical surgery are crucial for long-term survival of the elderly patients wtih rectal carcinoma. Lymph node metastasis is an important prognostic factor for rectal carcinoma in the elderly patients.

Surgical salvage therapy of anal canal cancer

AIM: To evaluate the results of salvage resection in the management of persistent or locally recurrent anal canal cancer.

METHODS: Details of all patients with anal canal cancer treated from 1978 to 1994 at Cancer Hospital of Chinese Academy of Medical Sciences (CAMS) were reviewed retrospectively. Sixteen patients who presented with persistent or locally recurrent anal canal cancer received salvage surgery. Before surgery all of the patients had received radiotherapy alone as their primary treatments.

RESULTS: Of the 16 patients, 14 received salvage abdominoperineal resection (APR) and two had transanal local excision. There were no deaths attributable to operation. Delayed healing of the perineal wound occurred in eight patients. Complications unrelated to the perineal wound were found in five patients. The median follow-up time was 120 (range 5 - 245) months after salvage surgery. Nine patients died of disease progression, with a median survival time of 16 (range 5 - 27) months. Six patients had a long-term survival.

CONCLUSION: Salvage resection after radiotherapy can yield a long-time survival in selected patients with anal canal cancer. However it offers little hope to patients with T₄ and/or N_2-3 tumors.

Local excision carcinoma in early stage

AIM: To assess the validity of local excision for the early stage low rectal cancer as an effective treatment alternative to radical resection.

METHODS: A retrospective medical chart review was done in 47 patients with early stage low rectal carcinoma who underwent local excision from November 1980 through November 1999 at Cancer Hospital of Chinese Academy of Medical Sciences (CAMS). The patients were treated by either transanal (40 cases), trans-sacral (5 cases), or trans-vaginal (2 cases) excision of tumors and no death was related to surgery. Sixteen patients received postoperative radiotherapy.

RESULTS: T1 and T2 lesion was found in 36 (76.6%) and 11 patients (23.4%) respectively. The overall local tumor recurrence rate was 14.9% (7/47), with an average recurrence time of 21 months. Among these 7 recurrent patients, there were 4 T1 and 3 T2 lesions. Microscopically, the surgical incisal margin was negative in 45 (95.7%) and positive in 2 patients (4.3%); Both of the later had developed local recurrence. The overall 5-year survival rate was 91.7%, in which there were 94.4% for T1 and 83.3% for T2 tumors. T stage, intravessel tumor thrombosis, lymphocytic infiltration and histological grade were not found to be significant by related to the local recurrence and survival (P > 0.05).

CONCLUSION: Local tumor excision was a safe procedure for the treatment of early stage low rectal carcinoma with minimal morbidity and mortality, which might serves as one of the primary surgical treatment methods for the disease of this kind.

Dietary variables and glucose tolerance in pregnancy

OBJECTIVE

To investigate relationships between dietary macronutrient intakes and glucose tolerance in pregnancy

RESEARCH DESIGN AND METHODS

Nulliparous pregnant Chinese women diagnosed with gestational diabetes mellitus (GDM) (n = 56) were compared to age-, gestational age-, height-, and parity-matched groups with normal glucose tolerance (n = 77) and glucose intolerance (IGT) (n = 38) based on the results of an oral glucose tolerance test (National Diabetes Data Group criteria), performed between 24 and 28 weeks of pregnancy. A 24-h recall dietary assessment was also obtained at the time of screening.

RESULTS

Subjects with IGT and GDM were significantly heavier (66.1 +/- 1.4 and 68.6 +/- 1.2 kg, respectively, mean +/- SEM) (P < 0.0001) than the normal group (61.2 +/- 1.8 kg) and had a higher BMI. Overall energy intake was similar between groups, as were the intakes of each macronutrient (%kcal). However, there was a highly significant reduction in polyunsaturated fat intake in the IGT and GDM groups whether expressed as %kcal, % of total fat, or fat kcal. This effect was independent of body weight or BMI whether assessed by ordinal logistic regression or by analysis of a weight- and BMI-matched subgroup of the subjects (P = 0.002 for %kcal; n = 47 normal, 26 IGT, and 43 GDM subjects). In logistic regression analysis of the complete data set, increased body weight (P < 0.0001) and decreased polyunsaturated fat intake (P = 0.0014) were both independent predictors of glucose intolerance (IGT and GDM), as were increased body weight and a low dietary polyunsaturated to saturated fat ratio.

CONCLUSIONS

Increased polyunsaturated fat intake is associated with a reduced incidence of glucose intolerance during pregnancy. This finding may have major implications for dietary management of women with or at risk of developing GDM.

[Occult breast cancer: 9 cases report and review]

From 1977 to 1994, 9 breast cancer were treated. All patients presented axillary node enlargement as first sign. Six patients were treated by radical or modified radical mastectomy and 3 by axillary node excision. All patients received postoperative adjuvant radiotherapy and chemotherapy. Among the 6 patients treated by radical or modified radical mastectomy, 4 survived over 10 years after surgery, 1 died of heart disease at 8 years, and 1 on chemotherapy is for 4 months. The three patients treated by axillary node excision, all died of the disease at 8-32 months. It is considered that radical or modified radical mastectomy with adjuvant radiotherapy and chemotherapy is a suitable treatment selection for occult breast cancer.

[Assay of DNA content and estrogen receptor status in human breast cancer]

Cellular DNA content of 72 samples was analyzed by flow cytometry. The results showed that 20 benign tumors and 10 normal breast tissue specimens were found to be DNA diploidy. 26 (62%) of 42 cases of breast cancer were DNA aneuploidy and the remainders were DNA diploidy. The median s-phase cell percentage was significantly higher in aneuploid tumors (28%) than diploid tumors (13%) and benign tumors (4%). Estrogen receptors were also investigated in 42 breast cancer specimens. There were 31 ER positive (74%) cases and 11 negative (26%) cases. The aneuploid DNA content was usually associated with lack of estrogen receptors. DNA content correlated significantly with age and ER status. The results suggest that flow cytometric analysis of cellular DNA content of breast cancer and status of estrogen receptors can provide an objective quantitative and reproducible new parameter for predicting prognosis of breast cancer.

[Case-control study on intrauterine growth retardation and vitamin nutritional status in late pregnancy]

Ninety-seven cases of pregnant women with intrauterine growth retardation (IUGR) and 133 controls were investigated on their dietary intake and blood vitamin levels in late pregnancy. Results showed insufficient calorie and protein intake, deficiency in calcium and vitamin B2, and low intake of vitamins A and B1 in pregnant women with IUGR. Their serum level of vitamin E was only half as that in controls (P < 0.01). Mothers' serum level of vitamin E correlated positively to several indicators reflecting infant growth with multiple stepwise regression analysis. There was no significant difference of activity of erythrocytic transketonas activity (TPP%) and activity coefficient (AC) of glutathione reductase between the two groups. It suggested pregnant women in both groups suffered from deficiency in thiamine and riboflavin (TPP% > 16%, AC > 1.2).

[Local excision of cancer of the rectum]

Conservative treatment of 35 patients with rectal cancer by local excision is reported. Limited surgery of rectal cancer can be a part of treatment of this tumor. Selection of the patient for limited surgical procedure should be strictly in accordance with the following criteria: tumor diameter less than 3 cm, clinical staging I and II, histologically well differentiated type, tumor invasion no deeper than the submucosa and patients with severe cardiopulmonary diseases who could not withstand radical surgery. A transanal local excision is the most straightforward approach. Local excision was by per anal full-thickness disc excision and trans-sphincteric disc excision. Prognosis and further treatment were based on the histopathologic results of operative specimen. The overall 5-year survival rate was 71.4% (18/21) and 10-year survival rate 33% (7/21).

[Treatment of proximal biliary duct carcinoma]

During the past 30 years, 21 patients suffering from proximal biliary duct carcinoma were treated by surgery. The resectability rate was 14%. Three patients had radical resection, 2 surgical bypass, 3 surgical catheterization for drainage, 4 PTCD, and 2 intraluminal radiotherapy with Iridium-192 delivered by a remote afterloading system through catheters introduced intraoperatively. The survivals ranged from 3 to 13 months. Due to the proximity of this portion of biliary duct to the hepatic hilus, invasion of the adjacent structures such as the portal vein and hepatic artery is common. Hence, complete resection is difficult and palliative surgical approach is usually adopted. Results of our treatment and review of relevant documents are presented.

[Multiple carcinomas of large bowel]

Thirty-eight patients with multiple carcinomas of large bowel were encountered during 32 years period in our hospital. The incidence of synchronous carcinomas (SC) was 1.5% (22/1430) and metachronous carcinomas (MC) 1.1% (16/1430). Thirty-one patients were found to have two primary carcinomas and seven patients have three primary malignancies. Among the 38 patients, six also had cancers in ether organs. The authors discussed the diagnosis, tumor distribution, the cancer association with familial colonic polyposis, and hereditary colon cancer. The 5 years survival rate with SC treated by surgery was 35.7% (5/14), and was 93% (15/16) with MC. It is the authors' opinion that surgical resection should always be attempted in patients with SC and MC.

[Hereditary site-specific colon cancer--report of two families]

Five cases of hereditary site-specific colon cancer (HSSCC or Lynch syndrome I) from two families are reported. The main features of HSSCC are: an autosomal dominant model of heredity, the absence of associated polyposis, the average age being younger, vulnerable site being the right colon (4/5 cases), multiple colon cancers (3/5 cases) and long survival. These 5 cases possessed the above mentioned features. Having no special detection method, the authors suggest that the members of these families be registered and the high risk members regularly checked.

[Extra-abdominal desmoid tumor--analysis of 26 patients]

Twenty-six patients with extra-abdominal desmoid tumor are reported. The tumor was located in the head and neck (6 cases), chest wall (3 cases), arm and leg (9 cases), paravertebral tissue (6 cases) and in the abdomen (2 cases). Of the 26 patients, 17 were treated for the first time and 9 had recurrent lesions. This tumor, showing aggressive growth, involved peripheral nerves (7 cases), blood vessels (4 cases), bones (11 cases) or viscera (2 cases). Surgery is the treatment of choice. The recurrence rate was 11% in those who received their first treatment. Wide dissection led to lower recurrence than simple excision (23% vs 72%). The authors stress the importance of excising at least 2-3 cm beyond the tumor margin and extra-abdominal desmoid tumor should be treated as a soft tissue tumor with low malignancy.

[Subungual malignant melanoma--30 year review of cases]

Twenty-five patients with subungual malignant melanoma confirmed by pathology from 1958 to 1987 were reported. There were 19 males and 6 females. 76% of the lesions occurred on the finger and 24% on the foot. The most common site was the thumb or great toe. 16/25 of the patients had history of subungual pigmented streaks. As trauma at the lesion site might initiate subungual melanoma (28%), doctors should pay close attention to the subungual black pigmented streaks or a mass below the nail with a history of trauma in order to avoid mis-diagnosis. In these 25 patients, the diagnosis was delayed in 19, and 10 of them already had regional lymph node metastasis. Surgical treatment still played a major role for subungual melanoma. According to the clinical staging, various degrees of amputation at different levels and regional lymph node dissection were recommended. The 5-year survival rate in this group was 28% (7/25).

[Eosinophilic granuloma of the stomach]

Two patients with eosinophilic granuloma of the stomach are reported with review of associated literatures. Neither of the patients had a history of allergy. The diagnosis of these two patients was not confirmed by barium-meal examination, endoscopy and biopsy before operation. One lesion was localized to the distal part and another to the near part of the stomach. The resected specimens were microscopically typical of eosinophilic granuloma of the stomach.

[Abdominal wall desmoid tumor--analysis of 42 patients]

Forty two patients with abdominal wall desmoid tumor, including one Gardner's syndrome, are reported. All patients were female except one. The tumor occurred in various sites in the abdominal wall, 66% in the lower abdominal wall. The fascia, sheath and muscle layer were chiefly involved and a very large tumor could invade peritoneum and viscera. This tumor shows aggressive growth and is prone to recurrence. Surgery is the treatment of choice. Local recurrence rate was 5.5%. Abdominal wall desmoid tumor associated colonic polyposis is named Gardner's syndrome. The authors emphasize that a local extended resection should be performed with a safety margin at least 2-3 cm beyond the tumor. Peritoneum, if involved, should be resected together with the primary focus.

[Occult blood detector for the upper G-I tract. I. A preliminary application in cancer screening]

The traditional chemical detection of small amount of blood in the stool can not tell whether the original bleeding site is in the upper or lower part of the G-I tract. The occult blood detector, designed by the authors, having a diameter of 8 mm, can easy be swallowed into the stomach with 30 to 50 ml of water. After remaining for 3 minutes in the stomach, it is pulled out by the patient himself and its coloration read to reveal the degree of bleeding. It can be used either by the medical personnel or the patient himself, at home, for the purpose of detecting minute bleeding in the upper G-I tract and for cancer screening in the high risk population. This detector gave a positive rate of 95% in patients with malignancies in the upper gastrointestinal tract. It is highly acceptable for its lack of discomfort during application. In cancer screening, it gave a positive rate of 5% to 10% in 10000 high risk persons. Those positive in this test showed a high incidence of gastric or esophageal cancers as proved by gastroscopy. This detector is being manufactured and sold by the Baiyunshan Pharmaceutical Factory, Guangzhou, Guangdong Province. Other papers concerning this topic are to be published.

[Squamous cell carcinoma of the ascending colon--a case report and review of literature]

One case of squamous cell carcinoma of the ascending colon is reported. The patient, a sixty two year old woman, was admitted because of right abdominal pain for three months. A mass, 6 X 5 cm in size, was palpated. 13 cm colonic mucosa destruction was shown by barium enema. Right hemicolectomy was done. A squamous cell carcinoma of the ascending colon was diagnosed by light and electron microscope. Squamous cell carcinoma of the colon is rare. Squamous cell carcinoma and adenoacanthoma, occurring in the colon and upper rectum, comprise 0.5% of all colonic malignancies. 18 cases have been collected in the literature and this case is the first one reported in China. Etiology of squamous cell carcinoma of the large bowel is reviewed.