Objective To detect human papillomavirus (HPV) infection and HRAS,PIK3CA mutations in early laungeal squamous cell carcinoma (LSCC),and prognostic analysis regarding the clinicopathological teatures,including HPV status,was conducted.Methods A total of 186 patients with T2N0-1M0 LSCC were included in this study.HPV infection,p16INK4A expression,and PIK3CA,HRAS hot spot mutations were detected.Results 9.8 ％ (16/163) cases of high-risk HPV infection and 3.8 ％ (7/186) cases of p16INK4A overexpression were found in the cohort.Three cases of PIK3CA mutation and no HRAS mutation were found.HPV-positive cases had a significantly longer overall survival (OS) (P =0.019).N1 stage had a significantly reduced RFS (P =0.021).In multivariate analysis,HPV status was the only significantly prognostic factor for OS (RR =0.30,95 ％ CI 0.09-0.96,P =0.043).Conclusions p16 cannot be used as a surrogate biomarker of HPV status in early LSCC patients.HRAS or PIK3CA mutation is not a common event in early LSCC,and no mutation is found in HPV-positive cases.HPV status is an independent prognostic factor for survival.

Objective To explore the spread patterns of retropharyngeal lymph node (RLN) metastasis of nasopharyngeal carcinoma. Methods From July 2003 to March 2005, three hundred and three patients with nasopharyngeal carcinoma in initial treatment were enrolled in this study. All patients underwent magnetic resonance imaging (MRI) before treatment, meanwhile measured the minimal and maximal axial diameters, the longitudinal diameter and the central and craniocaudad locations of each positive RLN. Results A total number of 264 positive RLN were found in 177 patients. The minimal and maximal axial diameters and longitudinal diameter of positive RLN were 9.9, 12.9 and 22.4 mm, respectively. Ipsilateral metastatic RLN were noted as follows: two nodes in 21 patients, three nodes in 3 patients and four nodes in 1 patient. According to the longitudinal central location of 263 positive lateral RLN, the numbers of nodes at occipital bone, C1, C1/C2, C2, C2/C3 and C3 were 27, 166, 40, 23, 5 and 2, respectively; the mean minimal axial diameters of nodes were 6.8, 9.9, 12.5, 10.4, 9.3 and 8.0 mm, respectively. Conclusion Multiple metastatic ipsilateral RLN are not common in NPC. The rate of RLN metastasis shows the trend of decreasing from vertebral C1 to C3.The maximal diameters of RLN are in the C1/C2 intervertebral space, and reveal a decreasing frequency along the craniocaudal directions of occipital and vertebral C1.

Objective To analyze clinical features and treatment results of primary non-Hodgkin lymphoma of bone (PLB) and further to investigate the rational treatment. Methods Clinical data of 26 patients with PLB were analyzed. Twenty-three (88.5 %) patients received radiotherapy in combination with chemotherapy, three received chemotherapy alone, and three patients also received surgical resection. Results The pathological types of lymphoma in the patients were diffused large B-cell iymphoma (DLBCL) in 15 patients (57.7 %), small B-cell lymphoma in 1 patient(3.8 %), B-cell lymphoma with unclassified subtypes in 4 patients (15.5 %), T-cell lymphoma in 5 patients (19.3 %,among which anaplastic large cell lymphoma in 3 patients), and unclassified lymphoma in one patient (3.8 %). Of the 26 cases of PLB, 15 were at stage Ⅰ, 3 at stage Ⅱ, 3 at stage Ⅲ and 5 at stage Ⅵ. The 3- and 5-year overall survival rates were 59.16 % and 31.37 %respectively. In the eleven patients who died of lymphoma, three had Iocol-regional relapse, and nine had systemically involved lymphoma. The radiation-induced bone fracture had not been observed after local radiotherapy with median dose of 50 Gy. Conclusion Pelvis maybe a common primary site of PLB, and DLBCL type are the most observed histological subtype. The optimal treatment for PLB is radiotherapy combined with chemotherapy. Local regional radiotherapy with median dose of 50 Gy can be safe and feasible.

Objective To investigate the clinical features, effective treatment, survival and prognostic factors of second primary tongue squamous cell carcinoma (SPTSCC) after nasopharyngeal carcinoma (NPC) radiotherapy. Methods The clinical data of 35 cases with SPTSCC after NPC radiotherapy were analyzed retrospectively. Kaplan-Meier method, Log-Rank test and COX proportional hazard mode was performed for statistical analysis. Results 3-year and 5-year overall survival rates were 55 % and 47 %, respectively, lymph node metastasis rate was 5.71 %. Univariate analysis indicated that gender (χ2 = 8.89, P = 0.00), T classification (χ2= 5.58, P= 0.02), clinical stage (χ2 = 8.51, P= 0.04) and treatment methods (χ2 = 29.37, P = 0.00) were important factors of prognosis. Multivariate analysis showed that treatment methods (P = 0.00) and T classification (P = 0.03) were independent prognostic factors. Operative treatment group had better prognosis than the non-operative treatment group, the difference was statistically significant (P <0.05), male patients in the risk of SPTSCC was higher than the female patients, and the incidence of SPTSCC was increased along with extension of the time after NPC radiotherapy. Conclusion The rate of the lymph node metastasis is lower for SPTSCC after NPC radiotherapy and treatment patterns and T stage are independent prognostic factors. Long-term follow-up after NPC radiotherapy is necessary to the early diagnosis of SPTSCC, so that to give surgery or combined therapy with surgery in order to achieve a good effect.

Objective To explore the clinical significance of PET-CT in evaluating distant metastasis and M staging of nasopharyngeal carcinoma(NPC). Methods 257 NPC patients with no prior treatment were investigated with PET-CT and conventional imaging (chest X-ray, abdominal ultrasound, and bone scan). The findings of PET-CT in diagnosing distant metastasis and M staging were compared with those of conventional imaging according to the results of biopsy and follow-up. Results PET-CT disclosed 34 of 39 patients with distant malignancy compared with 22 patients disclosed by conventional imaging. The false positive rate of PET-CT was 12.8 %. On region-based analyses, PET-CT was more effective than bone scan and chest X-ray for detecting mediastinum metastasis (x2=4.063, P =0.041) and bone metastasis (x2=5.939, P=0.015), respectively. Compared with conventional imaging, PET-CT had an impact on the M staging of 19 patients (7.4 %), of which 15 patients were truly staged and 4 patients incorrectly staged. Conclusion PET-CT is superior to MRI in evaluating distant metastasis and M staging of NPC.

ObjectiveTo examine the relationship between HIF-1αt and VEGF expression and the clinicopathological characteristics in hypopharyngeal squamous cell carcinoma. Methods The expression status of HIF-1α and VEGF were examined by immunohistochemistric method (IHC) in 62 tumor tissue and 19 paracancerous normal tissue.The relationships between the expression of HIF-1α and VEGF and clinicopathological characteristic were analyzed. Results HIF-1αt and VEGF expression were higher in hypopharyngeal carcinoma tissues than those in paracancerous normal tissues (66. 1％:26. 3％ ;x2 =18. 02,P ＜0. 05 ;67. 7％ : 31.6％ ; x2 =19.22, P ＜ 0. 05 ). The expression intensity of HIF-1 α was related to T stage, N stage and TNM stage ( x2 =4. 23,5.83,9.94,all P ＜0. 05). The expression intensity of VEGF was related to metastasis, T stage, N stage and TNM stage (x2 =5.62,7. 38,15.75,4. 29 ,all P ＜0. 05 ). There was minus relationship between overall survival and expression level of HIF-1 α and/or VEGF (x2 =29. 25, P＜0.01; x2 =24.88, P＜ 0.01 ).On multivariate analysis,HIF-1α expression and T stage were independent prognostic factors for overall survival (x2 =4.80,5.74, all P＜0. 05).ConclusionsHIF-1α and VEGF may be considered as a parameter in evaluation of progression, metastasis and prognosis of hypopharyngeal carcinoma and also may be a direction of molecular target therapy.

The most common metastasis modality of gastric cancer is the perigastric lymph node metastasis. Complete dissection of regional lymph nodes of the stomach is the core surgical treatment strategy of gastric cancer, and is closely related to the prognosis of gastric cancer patients. Infrapyloric lymph node metastasis is common in gastric cancer,and its incomplete dissection is associated with tumor recurrence. Meanwhile, anatomical variations of vessels and complex mesentery layers of infrapyloric area increase the difficulty of lymphadenectomy during the operation. So, infrapyloric lymph node (No. 6) is an important station. Based on the theory of embryonic development and complete mesogastrium excision, operation across the anatomical space among mesentery layers can ensure en bloc resection of the infrapyloric lymph nodes.

OBJECTIVETo investigate the feasibility and safety of Da Vinci surgical robot in the dissection of splenic hilar lymph nodes for gastric cancer patients with total gastrectomy.

METHODSClinical data of two cases who underwent total gastrectomy for cardia cancer at our department in January 2016 were analyzed retrospectively.

RESULTSTwo male patients were 62 and 55 years old respectively, with preoperative diagnosis as cT2-3N0M0 and cT1-2N0M0 gastric cancer by gastroscope and biopsy, and both received robotic total gastrectomy spleen-preserving splenic hilar lymph node dissection successfully. The operative time for splenic hilar lymph node dissection was 30 min and 25 min respectively. The intraoperative estimated blood loss was both 100 ml, while the number of total harvested lymph node was 38 and 33 respectively. One dissected splenic hilar lymph node and fatty tissues in two patients were proven by pathological examinations. There were no anastomotic leakage, pancreatic fistula, splenic infarction, intraluminal bleeding, digestive tract bleeding, aneurysm of splenic artery, and other operation-associated complications. Both patients suffered from postoperative pneumonia, and were cured by conservative therapy.

CONCLUSIONThe robotic spleen-preserving splenic hilar lymph node dissection is feasible and safe, but its superiority needs further evaluation.

Blood Loss, Surgical ; Dissection ; Female ; Gastrectomy ; methods ; Humans ; Laparoscopy ; Lymph Node Excision ; methods ; Lymph Nodes ; Male ; Middle Aged ; Operative Time ; Retrospective Studies ; Robotic Surgical Procedures ; Spleen ; Stomach Neoplasms ; surgery

Objective To analyse the prognosis of 117 newly diagnosed nasopharyngeal carcinoma (NPC) patients underwent intensity modulated radiotherapy (IMRT). Methods From Jan to Nov 2005, 117 NPC patients who were treated by IMRT were enrolled. There were 81 males and 36 females with a median age of 42 years (range 18-76 years). According to Chinese Fuzhou Staging system(1992), 11 cases were Stage I , 15 Stage Ⅱ, 54 Stage Ⅲ and 37 Stage ⅣA. IMRT was carried out with Peacock plan. The prescription dose to the gross target volume(GTVnx) of nasopharyngeal tumor was 68 Gy, that of positive neck lymph nodes (GTVnd) was 60-66 Gy, clinical target volume 1 (CTV1) was 60 Gy, and CTV2 was 54 Gy. Results After a median follow-up time of 48 months (range 10.5-59.5 months), the 3-and 5-year overall survival (OS) rates were 95.7 % and 89.7 %, the disease-free survival (DFS) rates were 91.5 % and 87.2%, and the local-regional control rates were 94.0 % and 91.5 %. Univariate analysis showed the KPS, stage, Fuzhou clinical stage, status of blood platelet before treatment and uric acid after treatment were correlated with OS rate. T stage was the only independent factor of prognosis in the COX stepwise regression model. Conclusion Radical IMRT significantly prolongs the survival of NPC patients. T stage is the only independent prognostic factor for NPC patients.

Objective To analyze the effect of quality of life (QOL) on the prognosis of long-term survivors with nasopharyngeal carcinoma (NPC). Methods A total of 192 NPC patients treated between 1999 and 2000 and with tumor-free survival before July 2003 were enrolled in this study. All patients received QOL measurement between July and August in 2003. Measurement scales included Chinese SF-36 questionnaire and a checklist consisting of fourteen items about self-rating symptoms. The median follow-up time was 7.9S years (range 2.67-9.55 years). The effects of QOL, social demographic and clinical factors on prognosis were analyzed. Results Univariate analysis showed that QOL affected the tumor-free survival and overall survival. Multivariate analysis showed that hypomnesia was an independent prognostic factor of tumor-free survival, while trismus, headache and age were independent prognostic factors of overall survival. The younger and the better QOL had better prognosis. The other sociodemographic and clinical factors had no prognostic value. Conclusion QOL is an important factor affecting the prognosis of long-term survivors with NPC, and it should be routinely evaluated during the follow-up.