OBJECTIVETo analyze the risk factors of liver metastasis in patients after radical resection of pancreatic cancer.

METHODSOne hundred and twenty-four patients with non-metastatic, resectable pancreatic cancer treated in our department between 2006 and 2012 were included in this study. All of these patients underwent resection of the primary tumor combined with extensive lymph node dissection. The development of postoperative liver metastases was carefully followed up, and the clinicopathological factors and molecular characteristics were evaluated by univariate analysis and multivariate logistic regression using SPSS 16.0 software.

RESULTSForty-eight cases of liver metastases were found among the 124 cases of pancreatic cancer after radical surgery (38.7%). The rate of liver metastasis of pancreatic cancer after radical surgery in the age groups < 40, 40-60, and > 60 were 68.8%, 33.3% and 35.1%, respectively. The rate of liver metastasis in the body mass index (BMI) group < 20 kg/m2, 20-25 kg/m2, and > 25 kg/m2 were 21.6%, 44.1% and 52.6%, and the rate of liver metastasis in the time between the onset and diagnosis groups ≥ 3 months and < 3 months were 59.4% and 31.5%, respectively. The rate of liver metastasis in patients with preoperative fatty liver was 14.3% and it was 43.7% in patients without preoperative fatty liver. The rate of liver metastasis in patients of histological high, medium and low grade was 10.0%, 35.4% and 49.0%, respectively. The rate of liver metastasis in patients with venous tumor thrombus was 68.8% and it was 34.3% in patients without venous tumor embolus. The rate of liver metastasis in patients with postoperative chemotherapy was 31.2% and it was 51.1% in patients without postoperative chemotherapy. All those differences had statistical significance (P < 0.05). Univariate analysis revealed that age, body mass index (BMI), time between the onset and diagnosis, preoperative fatty liver, histological grading, tumor invasion depth, venous tumor embolus, and postoperative chemotherapy were significantly related to postoperative liver metastasis. Multivariate analysis revealed five statistically independent risk factors for postoperative liver metastasis: BMI, time between onset and diagnosis, preoperative fatty liver, histological grading, and venous tumor embolus.

CONCLUSIONSOur data suggest that patient's BMI, time between onset and diagnosis, histological grade, and venous tumor embolus are significantly correlated with postoperative liver metastases in patients with pancreatic cancer. Pancreatic cancer patients with preoperative fatty liver have less postoperative liver metastasis.

Adult ; Aged ; Body Mass Index ; Humans ; Liver Neoplasms ; secondary ; Lymph Node Excision ; Middle Aged ; Pancreatic Neoplasms ; pathology ; surgery ; Regression Analysis ; Risk Factors

Objective To analyse tratment strategies and to evaluate the relation between different therapies and survival rate of patients of with asynchronous liver metastases after pancreatic cancer surgery (PCLM).Methods From January 2006 to January 2012,48 patients with PCLM were included in this study,and their medical records were retrospectively analyzed.Results Among the 48 patients,27 cases of liver metastases were found within six months after surgery,and the survival rate for 1,3 and 5 years was 22.2％,3.7％ and 0％,respectively,with the median survival of 6 months,and 21 cases of liver metastases were found after six months,and the survival rate for 1,3 and 5 years was 85.7％,30.6％ and 9.2％,with the median survival of 15 months,and the difference between the two groups was statistically significant (P ＜ 0.01).After pancreatic cancer surgery and adjuvant gemcitabine chemotherapy,the probability of liver metastases was 33.3％ (8/24) within six months,the median disease-free survival time was 8 months and the disease-free survival rate for 1,3 and 5 years was 20.8％,4.3％ and 0％.For patients without adjuvant gemcitabine chemotherapy,the probability of liver metastases was 79.2％ (19/24),the median disease-free survival time was 3 months and the disease-free survival rate for 1,3 and 5 years was 4.2％,0％ and 0％,and the difference between the two groups was statistically significant (P ＜ 0.01).The overall survival for patients undergoing resection of liver metastases combined with gemcitabine treatment was better than the other groups (P ＜ 0.01).And the overall survival for patients undergoing transhepatic arterial embolization (TACE) combined with gemcitabine treatment was better than TACE group,gemcitabine group or the observation group (P ＜0.05).There were no difference in overall survival between TACE group,gemcitabine group and observation group.Conclusions Pancreatic cancer patients who develop liver metastasis within six months after surgery have poor prognosis,but postoperative chemotherapy can delay the development of liver metastasis.For patients with resectable lesion,resection of asynchronous liver metastasis is the treatment of choice,and TACE combined with gemcitabine has better efficacy than that of single treatment.

A rapid and simple method for the determination of cyanide in blood was developed based on pinhole shell-isolated nanoparticles (pinSHINs)-enhanced Raman spectroscopy and an online lysis-purging and trapping approach.In the online lysis-purging and trapping device, the bound cyanide in blood can be cleaved through sulfuric acid acidification, and transferred into HCN volatile gas, then purged into alkaline solution to form NaCN solution, thus high-efficient liberation and entrapment of cyanide from the methemoglobin-bound form can be achieved.The pinSHINs substrate is quite stable to weaken the gold-dissolution effect caused by cyanide under strong alkaline condition, and therefore the detection window can be prolonged to 1 h comparing with 5 min of AuNPs.A limit of detection down to 10 μg/L and a linear range from 100-2000 μg/L in blood were achieved in this method.This method was further applied to rapid measurement of blood samples of cyanide exposed rats and clinic poisoned patients, which provided a sensitive, selective and reliable way for rapid detection of cyanide poisoning.

Objective To analyze the risk factors of liver metastasis in patients after radical resection of pancreatic cancer.Methods One hundred and twenty-four patients with nonm-etastatic , resectable pancreatic cancer treated in our department between 2006 and 2012 were included in this study. All of these patients underwent resection of the primary tumor combined with extensive lymph node dissection.The development of postoperative liver metastases was carefully followed up, and the clinicopathological factors and molecular characteristics were evaluated by univariate analysis and multivariate logistic regression using SPSS 16.0 software.Results Forty-eight cases of liver metastases were found among the 124 cases of pancreatic cancer after radical surgery ( 38.7%) .The rate of liver metastasis of pancreatic cancer after radical surgery in the age groups <40, 40-60, and >60 were 68.8%, 33.3%and 35.1%, respectively.The rate of liver metastasis in the body mass index ( BMI) group <20 kg/m2 , 20-25 kg/m2 , and >25 kg/m2 were 21.6%, 44.1%and 52.6%, and the rate of liver metastasis in the time between the onset and diagnosis groups ≥3 months and <3 months were 59.4%and 31.5%, respectively. The rate of liver metastasis in patients with preoperative fatty liver was 14.3%and it was 43.7%in patients without preoperative fatty liver.The rate of liver metastasis in patients of histological high, medium and low grade was 10.0%, 35.4%and 49.0%, respectively.The rate of liver metastasis in patients with venous tumor thrombus was 68.8%and it was 34.3%in patients without venous tumor embolus.The rate of liver metastasis in patients with postoperative chemotherapy was 31.2%and it was 51.1%in patients without postoperative chemotherapy.All those differences had statistical significance ( P<0.05) .Univariate analysis revealed that age, body mass index ( BMI) , time between the onset and diagnosis, preoperative fatty liver, histological grading, tumor invasion depth, venous tumor embolus, and postoperative chemotherapy were significantly related to postoperative liver metastasis.Multivariate analysis revealed five statistically independent risk factors for postoperative liver metastasis: BMI, time between onset and diagnosis, preoperative fatty liver, histological grading, and venous tumor embolus.Conclusions Our data suggest that patient′s BMI, time between onset and diagnosis, histological grade, and venous tumor embolus are significantly correlated with postoperative liver metastases in patients with pancreatic cancer.Pancreatic cancer patients with preoperative fatty liver have less postoperative liver metastasis.

Objective To analyze the risk factors of liver metastasis in patients after radical resection of pancreatic cancer.Methods One hundred and twenty-four patients with nonm-etastatic , resectable pancreatic cancer treated in our department between 2006 and 2012 were included in this study. All of these patients underwent resection of the primary tumor combined with extensive lymph node dissection.The development of postoperative liver metastases was carefully followed up, and the clinicopathological factors and molecular characteristics were evaluated by univariate analysis and multivariate logistic regression using SPSS 16.0 software.Results Forty-eight cases of liver metastases were found among the 124 cases of pancreatic cancer after radical surgery ( 38.7%) .The rate of liver metastasis of pancreatic cancer after radical surgery in the age groups <40, 40-60, and >60 were 68.8%, 33.3%and 35.1%, respectively.The rate of liver metastasis in the body mass index ( BMI) group <20 kg/m2 , 20-25 kg/m2 , and >25 kg/m2 were 21.6%, 44.1%and 52.6%, and the rate of liver metastasis in the time between the onset and diagnosis groups ≥3 months and <3 months were 59.4%and 31.5%, respectively. The rate of liver metastasis in patients with preoperative fatty liver was 14.3%and it was 43.7%in patients without preoperative fatty liver.The rate of liver metastasis in patients of histological high, medium and low grade was 10.0%, 35.4%and 49.0%, respectively.The rate of liver metastasis in patients with venous tumor thrombus was 68.8%and it was 34.3%in patients without venous tumor embolus.The rate of liver metastasis in patients with postoperative chemotherapy was 31.2%and it was 51.1%in patients without postoperative chemotherapy.All those differences had statistical significance ( P<0.05) .Univariate analysis revealed that age, body mass index ( BMI) , time between the onset and diagnosis, preoperative fatty liver, histological grading, tumor invasion depth, venous tumor embolus, and postoperative chemotherapy were significantly related to postoperative liver metastasis.Multivariate analysis revealed five statistically independent risk factors for postoperative liver metastasis: BMI, time between onset and diagnosis, preoperative fatty liver, histological grading, and venous tumor embolus.Conclusions Our data suggest that patient′s BMI, time between onset and diagnosis, histological grade, and venous tumor embolus are significantly correlated with postoperative liver metastases in patients with pancreatic cancer.Pancreatic cancer patients with preoperative fatty liver have less postoperative liver metastasis.

Objective    To evaluate the efficacy and safety of neoadjuvant chemotherapy (a CRTS group) plus surgery versus surgery alone (a SA group) in the treatment of resectable esophageal neoplasms. Methods    PubMed, Ovid Technologies, SCI, CBM Database, CNKI Database, VIP Database and Wanfang Database were searched to identify all published or unpublished RCTs those compared neoadjuvant chemotherapy plus surgery with surgery alone for resectable esophageal neoplasms up to August 1, 2015. Meta-analysis was conducted by using Stata12.0 software. Results    Twenty-six RCTs included 3 252 patients (1 606 in the CRTS group, 1 646 in the SA group) were selected. There was a significant difference between the CRTS group and the SA group in 3-year survival rate, 5-year survival rate, R0 resection rate, local recurrence rate, local recurrence and distant metastasis rate with relative risk (RR) value and 95%CI at 1.24 (1.13–1.36, P<0.000 1), 1.29 (1.10–1.50, P=0.001), 1.13 (1.05–1.212, P=0.001), 0.67 (0.52–0.85, P=0.001), 0.60 (0.40–0.90, P=0.013). And there was no significant difference between the CRTS group and the SA group in 1-year survival rate and distant metastasis with RR (95%CI) of 1.05 (0.99–1.12, P=0.103) and 0.84 (0.70–1.00, P=0.053). There was no significant  difference in postoperative complications, 30-days mortality, pulmonary infections, anastomotic leakage, anastomotic stricture, cardiac complications, chylothorax between the two groups with RR (95%CI) at 1.09 (0.96–1.24, P=0.166), 1.32 (0.96–1.83, P=0.485), 1.45 (0.94–2.23, P=0.091), 0.89 (0.63–1.25, P=0.485), 0.93 (0.64–1.35, P=0.731), 1.24(0.84–1.87, P=0.283), and 1.62 (0.85–3.07, P=0.142). Conclusion    CRTS significantly benefits to survival rate, R0 rescetion rate, and local recurrence rate compared to SA. Additionally there is no increased postoperative complication for patients with resectable esophageal neoplasms.