Objective To evaluate the effect of tumor infiltrating lymphocyte(TIL) on prognosis of rectal cancer treated with preoperative radiotherapy. Methods From Jan. 1999 to Oct. 2007,107 patients with rectal cancer were treated with preoperative radiotherapy of 30 Gy/10f/12 days. The relationships a-mong TIL,pathologic regression and prognosis were analyzed. Results Before radiotherapy,TIL in rectal cancer was 75 patients (70.1%) in grade 1,16 (15.0%) in grade 2 and 16 (15.0%) in grade 3; While after radiotherapy,it changed to 19 (17.7 %) in grade 1,43 (40.2%) in grade 2,35 (32.7 %) in grade 3 and 10 (9.3%) in grade 4. After radiotherapy,pathologic regression was 36 (33.6%) in grade 1,57 (53.3%) in grade 2 and 14 (13.1%) in grade 3. Univariate analysis showed that TIL both before and after radiotherapy was the significant prognostic factor for local pathologic regression (X2= 36.80, P < 0.01; X<'2>= 14.00, P<0.01). Kaplan Meier survival analysis showed that TIL and pathologic regression after radiother-apy were significant associated with the survival(X2=24.00, P < 0.01; X2=12.17, P<0.01 ). Logistic re-gression showed that TIL after radiotherapy had a significant effect on local pathologic regression(X2=8.05, P<0.01). Conclusions For rectal cancer treated with preoperative radiotherapy,TIL before and after ra-diotherapy is significantly related with local pathologic regression, and TIL after radiotherapy is a prognostic factor.

Objective To evaluate the effect of concomitantdifferent regimens chemotherapy and radiotherapy for inoperable stage Ⅲ non small cell lung cancer (NSCLC). Methods From September 1995 to December 1998, 62 patients with inoperable stage Ⅲ NSCLC were randomized into two groups. Twenty nine patients received paclitaxel 30 mg and cisplatin 30 mg weekly for 5～6 weeks (paclitaxel group), and 33 patients received etoposide (Vp 16) 100 mg and cisplatin 30 mg weekly for 5～6 weeks (VP 16 group). All patients received concomitant radiotherapy as well. Radiotherapy was given with conventional fraction in 2Gy per fraction and five fractions per week. The total tumor doses were 60～70 Gy. Treatment fields covered clinical tumor and lymph node involved. Results The overall response (CR+PR) rate in paclitaxel group was 82.8% with a complete response (CR) rate of 10.3%. The overall response rate in the VP 16 group was 54.6% with a CR rate of 18%. The difference of overall response rate between the two groups was statistically significant (P0.05). The major toxic effects of chemotherapy were gastrointestinal tract reaction and myelosuppression. Conclusions Concomitant chemotherapy of paclitaxel plus cisplatin and radiotherapy for inoperable stage Ⅲ NSCLC is acceptable, and its efficacy is superior to cisplatin plus etoposide combined with radiotherapy.

Objective:To investigate the effects of Adp53 and F56 on the growth and lung metastasis of breast cancer.Methods:The BICR-H1 cells were inoculated into the mammary fatty pad of BALB/C nude mice and NOD/SCID mice to establish breast cancer model.Then the nude mice with xenograft tumor were randomized into group Adp53+F56,Adp53,F56 and control.The NOD/SCID mice with xenograft tumor were randomized into group Adp53+F56,Adp53,F56,Adlacz and control.They were theated for 3 weeks according to the plan,diversity of the volume and histopathology of xenograft tumor of nude mice was observed and the expressions of p53 and VEGF gene,and microvessel density(MVD)were detected by immunohistochemistry.Lung metastasis of breast cancer in NOD/SCID mice was observed.Results:(1)Intratumoral injections of Adp53,F56,and their combination resulted in an inhibition on the growth of xenograft tumor of BICR-H1 cells.The ultimate relative growth volumes of groups Adp53+F56,Adp53,F56 and control were 2.47,4.37,4.69 and 12.49 respectively.(2)After treatment,P53 positive rate of group Adp53+F56,Adp53 increased 9.4%,6.3% than before respectively,but compared with control group,the difference is not significant(P=0.693);VEGF protein of group Adp53+F56,Adp53 and F56 decreased 21.9%,9.4% and 3.1% than before respectively,but compared with control group,the difference was not significant(P=0.284).Necrosis and decrease of vessel in the tumor and morphological change of endothelium were observed under light microscope in the groups Adp53+F56,Adp53 and F56.MVD estimated by FⅧ-RA staining of group Adp53+F56,Adp53 and F56 were 14.50?2.54,16.28?3.44 and 18.06?7.66,compared with control group(24.93?6.53),the difference is significant(P=0.000).(3)The average number of lung metastasis of NOD/SCID mice in group Adp53+F56,Adp53 and F56 were 1.143?0.378,2.750?0.886 and 3.375?0.518 respectively,lower than Adlacz group(5.000?0.816)and control group(5.670?0.817)obviously(P=0.000).Conclusion:Adp53 combined with F56 can greatly inhibit growth and matastasis of breast cancer in vivo.The mechanism of anti-tumor effects of Adp53 and F56 may be related to the anti-angiogenesis effect on malignant tumor through inhibiting the expression and activity of VEGF.

Objective To evaluate the effect of radiochemotherapy for unresectable extra-hepatic bile duct cancinoma. Methods Form June 1993 to August 2003, 28 unresectable extra-hepatic bile duct carcinoma treated by radiochemotherapy were analyzed. There were 13 gallbladder carcinoma and 15 bile duct carcinoma. The radiotherapy regimen consisted of conventional radiation therapy group(15 patients,with a median dose of 45Gy, range 30-60Gy) and three-dimensional conformal radiation therapy group(13 patients, with a median dose of 55Gy , range 50-70Gy). Among these patients, 12 patients were treated by radiotherapy alone( RT), 16 patients treated by radiochemotherapy(CRT), with a chemotherapy regimen consisting of 5-Fu 500mg twice weekly or 5-Fu 500mg + DDP 30mg once weekly for 3-6 cycles. Results The CR+PR, SD and PD rate was 14%, 64%, and 21%, respectively. The overall 1-,2-year survival rate was 38% and 15%, with a median survival time of 9.4 months. The 1-year survival of gallbladder cancer and extra-hepatic bile duct cancer was 46% and 27%;of 3DCRT and conventional radiotherapy was 42% and 33%;of those radiation dose less than 50Gy and more than 50Gy was 29% and 45%;of RT alone and radiochemotherapy was 37% and 31%, respectively. There was significance difference in overall survival between those RT dose less than 50Gy and more than 50Gy,(P=0.023). Grade 1-2 and Grade 3 acute gastrointestinal toxicity was 57% and 18%, respectively. Only 25% patients suffered grade 1-2 hematology toxicity. Conclusion Radiochemotherapy shows moderate effect for unresectable extra-hepatic bile duct cancer with acceptable side effects.

Objective To analyze the dosimetfic benefits, clinical effect and side-respond of whole breast using intensity modulated radiotherapy for early breast cancer after conservative surgery. Methods From Oct.2004 to Aug. 2005,103 patients received the whole breast intensity modulated radiation therapy (IMRT). A dosimetric comparison of IMRT with conventional radiotherapy (CR) was performed on each patient. The cosmetic results, clinical effect and side-respond were observed. Results The average volume proportion of 95% and 107% prescribed dose was 95.8% ± 4.90% and 84.0% ± 20.7% (t = 9.60, P < 0.01) with IMRT and CR in clinical target volume, respectively. The V20 (lung volume of aceepted> 20 Gy/all lung volume × 100%) of the ipsilateral lung were 15.70% ± 4.64% and 23. 11% ± 7.88% (t = - 13.3, P < 0.01). The V30of the heart were 4.44% ±3.93% and 15.55% ± 10.89%(t = - 11.3, P< 0.01) with IMRT and CR respectively for sixty-three left side breast cancer patients. The 1- and 2-year excellent rate of good cosmetic outcome was both 100%. The 1-, 2- and 3-year local control rate was 99% ,99% and 98% ,respectively. The 1-, 2- and 3-year disease-free survival rate was 99% ,99% and 96% ,respectively. The Grade 1 and 2 acute radiation skin reaction rate was 95.1% and 4.9%, respectively. Conclusion Compared with conventional radiotherapy, IMRT improves dose distribution of CTV and reduce the dose of normal tissue around CTV;but with better clinical effects and lower side-respond for early breast cancer patients after breast conservative surgery.

Objective To summarize our experience in robotic-assisted laparoscopic surgery for adrenal diseases Methods The clinical data of 243 patients with adrenal tumor treated by robotic-assisted laparoscopic surgery from March 2010 to February 2017 were retrospectively reviewed.There were 99 men and 144 women.The mean age was 51.6 years (range, 19-84).Tumors located at left adrenal in 140 cases, right in 97 cases,and both sides in 6 cases.The average diameter was 3.32 cm (range, 0.8-12 cm).However, there were 41 cases whose tumor diameter were greater than 5 cm.Results There were 2 cases of conversion during operation, 1 case converted to open surgery and the other to the traditional laparoscope surgery.The mean operative time was 35 min (range, 20-130 min).Estimated blood loss was 80 ml (range,20-1 200 ml).Blood transfusion was needed in 6 cases.The mean postoperative hospital stay was 5d (range, 3-20 d).The pathological diagnosis included 37 cases of pheochromocytoma, 149 cases of cortical adenoma, 3 cases of cortical carcinoma, 5 cases of metastatic tumor, 9 cases of adrenal myelolipoma, 3 cases of adrenal cyst, 2 cases of bronchogenic cyst, 25 cases of adrenal nodular hyperplasia,2 cases of angiomyolipomas, 1 case of mature teratoma, 1 case of diffuse large B-Cell lymphoma, 1 case of angioma, and 4 cases of neurofibromatosis.Conclusions Robotic-assisted laparoscopic adrenalectomy was safe and effective.Robotic-assisted laparoscopic surgery has the advantages over laparoscopic surgery in treatment of complicated adrenal tumor, such as large adrenal tumors, pheochromocytoma, bilateral adrenal diseases, overweight and obese patients with adrenal diseases.

Objective To explore the effect and mechanism of anti-mesangial cell-proliferation-peptide 2(AMPP2)on mesangial cell proliferation induced by transforming growth factor β1(TGF-β1).Methods Mesangial cells were cultured in vitro and treated with TGF-β1(10 μg/L)and AMPP2(10 ng/L).According to different intervention factors,mesangial cells were divided into four groups:the control group,the AMPP2 group,the TGF-β1 group and the TGF-β1+AMPP2 group.The proliferation activity of mesangial cells was detected by CCK-8.The relative protein expression of cyclin dependent kinase 4(CDK-4),cyclin dependent kinase 6(CDK-6),proliferating cell nuclear antigen(PCNA),α-smooth muscle actin(α-SMA),collagen-Ⅰ(COL-Ⅰ)and fibronectin(FN)were examined by Western blot assay.The relative mRNA expression of α-SMA,COL-Ⅰ and FN were detected by qPCR.Results Compared with the control group,proliferation activity of mesangial cells was significantly increased in the TGF-β1 group(P＜0.05).The proliferation activity of mesangial cells was markedly decreased in the TGF-β1+AMPP2 group compared with that of the TGF-β1 group(P＜0.05).Compared with the control group,protein levels of CDK-4,CDK-6,PCNA,α-SMA,COL-Ⅰand FN in cells were significantly increased in the TGF-β1 group(P＜0.05),as well as the mRNA levels of α-SMA,COL-Ⅰand FN(P＜0.05).In the TGF-β1+AMPP2 group,the protein and mRNA levels of α-SMA,COL-Ⅰand FN and the protein levels of CDK-4,CDK-6 and PCNA were markedly decreased compared with those of the TGF-β1 group(P＜0.05).Compared with the control group,levels of p-SMAD3/SMAD3 was remarkably upregulated in the TGF-β1 group(P＜0.05),while levels of p-SMAD3/SMAD3 was remarkably downregulated in the TGF-β1+AMPP2 group compared with those of the TGF-β1 group(P＜0.05).Conclusion AMPP2 may inhibit mesangial cell proliferation by regulating TGF-β1/SMAD3 pathway.

Objective To evaluate the efficacy and safety of recombinant adenovirus-p53(rAdp53) injection combined with radiotherapy and hyperthermia in the treatment of unresectable advanced soft tissue sarcoma.Methods In this retrospective study, we evaluated 76 patients with unresectable advanced primary or recurrent soft tissue sarcoma treated in our hospital from November 2005 to November 2012.These patients received radiotherapy and hyperthermia with rAdp53(p53 group, n=41) or without rAdp53(control group, n=35).rAdp53((1-2)×1012viral particles each time, once a week, 8 times on average) was injected into the tumor or infused into the pelvic cavity.Radiotherapy (2 Gy each time, 5 times a week) was performed for the planning target volume at 56.3±5.3 Gy in the p53 group and 58.1±4.2 Gy in the control group, with no significant difference between the two groups (P>0.05).Superficial or deep thermotherapy was employed 8 times on average (twice a week).Clinical features, response rate, time to progression (TTP), overall survival (OS), and adverse events were compared between the two groups (P>0.05).The Kaplan-Meier method was used to calculate OS;the log-rank test was used for survival difference analysis and univariate prognostic analysis;the chi-square test was used for comparison of categorical data.Results At 2 months after treatment, the p53 group had significantly increased response rate (partial response+ complete response+ stable disease)(85% vs.54%, P=0.003) and local control rate (49% vs.23%, P=0.020) as well as prolonged TTP (12 months vs.5 months, P=0.010) and OS (48 months vs.31 months, P=0.049), as compared with the control group.No adverse events caused by radiotherapy and hyperthermia except transient fever were seen in the two groups.Conclusions Concurrent radiotherapy and hyperthermia combined with rAdp53 injection is effective and safe for patients with advanced soft tissue sarcoma.

Objective To explore the clinical feasibility of robot-assisted laparoscopic radical cystectomy (RARC) with total intracorporeal othotopic ileal neobladder (TIOIN).Methods A consecutive series of 4 patients (2 male,2 female),who underwent RARC with TIOIN by a single surgeon,were included in the retrospective study,between March 2017 and June 2017.Their age ranged from 59 to 71 years,which the mean age was (65.7 ± 4.9) years.Preoperative urinary CT scan,cystoscopic examination and transurethral resection of bladder tumor were performed for diagnosis.Among these,2 patients underwent side-to-side bowel anastomosis using a linear stapler,while hand-sewn anastomosis was performed in the other 2 patients.The detubularized bowel segment was arranged in a U shape,and then the two medial borders were closed to create the posterior wall of the neobladder,which completed a partial U shape and anastomosed with the end of urethra.After placing the single J stents into the ureter,the uretero-neobladder was anastomosed.To close the urine reservoir,each border of the U-shaped segment was folded again and sutured to form a sealed pouch.Results All operations were performed successfully.The average operation time for RARC was 93.2 min (ranging 79-117 min).The average operation time for urinary diversion was 214.2 min (ranging 163-251 min).The mean estimated blood loss was 304.5 ml (ranging 200-400 ml).The mean hospital stay was 20.5 d (ranging 13-32 day).The number of dissected lymph node ranged from 11 to 16 (mean 3.7 ± 2.6).All the surgical margins were negative.The time for postoperative out-of-bed activity and bowel function recovery was 2-3 days and 3-4 days,respectively.The single-J stents were removed 1 months after operation,generally.No urine leakage was noticed after removing the drainage tube and catheter.The lymph leakage was observed in one case,which was resolved 15 days post-operatively after given nutrient therapy.The performance of urinary continence was satisfactory,except one patient complained about the nocturnal incontinence.After the regular pelvic exercise,the symptom improved two months after the operation.Hydronephrosis and intestinal leakage were not observed.Conclusions Our initial experience showed that RARC with TIOIN is feasible and alterative for experienced surgeon.

Objective To explore the clinical efficacy and safety of off-clamping in robotic-assisted partial nephrectomy (RAPN) for the treatment of renal tumors.Methods From January 2015 to March 2017,the data of 48 patients who underwent off-clamping RAPN were reviewed retrospectively.There were 31 males and 17 females,and the mean age was 57 years (range:23-84 years).The mean tumor size was 3.1 cm (range:1.2-6.4 cm),with the upper,middle,and lower polar tumors account for 35.4％,27.1％,and 37.5％,respectively.The clinical tumor stage was T1N0M0 in all 48 cases,according to the AJCC tumor staging system for renal cancer.Results RAPNs were performed successfully in all 48 cases,without conversion to open surgery.In those patients,the application of off-clamping in robotic-assisted partial nephrectomy was performed in 44 cases.The renal artery and vein was exposed,dissected,isolated and then clamped in 4 cases due to bleeding.The mean surgical time was 85 min (range:75-185 min).The mean estimated blood loss was 134 ml (range:60-270 ml),and no blood transfusion was needed.The wound surface was closed using interrupted suture with Hem-o-lok clips securing each needle point.The mean time for renorrhaphy was 22 min (rang:11-31 min).No intraoperative severe complications such as vascular injury,trauma of abdominal organ occurred.There were 5 complications,including 2 cases of hematuria,2 cases of delayed healing of incision,and 1 case of pneumohypoderma.The pathological diagnosis included 40 cases of renal clear cell carcinoma,3 cases of papillary renal cell carcinoma,and 5 cases of angiomyolipomas.No tumor recurrence or distant metastasis was observed during the average follow-up of 17 months (range 3-27 months).Conclusions Off-clamping RAPN is safe and feasible approach to excise certain kidney tumors.It carries the benefits of less complication,quick recovery,and less ischemia reperfusion renal injury.Off-clamping RAPN would be suitable for those patients with solitary kidneys,renal insufficiency,and bilateral tumors.