OBJECTIVETo explore clinicopathologic characteristics, surgical features and prognostic factors in patients with primary gastrointestinal lymphoma(PGIL) in order to provide evidence for optimizing surgical treatment.

METHODSClinicopathological data of 57 PGIL patients undergoing abdominal surgery in Sun Yat-sen University Cancer Center between October 1990 and January 2015 were retrospectively collected. The survival rates were compared among patients with different clinicopathologic characteristics by Kaplan-Meier method, while Cox regression model was employed to analyze the prognostic factors.

RESULTSAmong 57 patients, 43 were male and 14 were female, with a median age of 48 (range 16 to 80) years. Seventeen (29.8%) cases were classified as Musshoff I( stage, 19 (33.3%) cases as II( stage, 9 (15.8%) cases as III( stage, and 12(21.1%) cases as IIII( stage. Forty-four (77.2%) cases underwent selective operation, 13(22.8%) cases underwent emergent operation due to acute abdomen. Thirty-two(56.1%) cases had radical resection, 18 (31.6%) cases had partial resection and the rest 7(12.3%) cases failed to perform resection. Four (7.0%) cases received simple surgical operation, and 53 (93.0%) cases received comprehensive treatment, including 5(8.8%) cases with preoperative chemotherapy and surgery, 40 (70.2%) cases with surgery and postoperative chemotherapy, and 8 (14.0%) cases with surgery and perioperative chemotherapy. Stage III( and IIII( accounted for 76.9%(10/13) in patients undergoing emergent operation and accounted for 25.0%(11/44) in patients undergoing selective operation, whose difference was statistically significant (χ=9.503, P=0.002). Univariate prognostic analysis showed that T lymphocyte source pathological cell phenotype (P=0.000), clinical Musshoff stage III( and IIII((P=0.001), emergent operation (P=0.000) and incomplete tumor resection(P=0.007) had worse 5-year overall survival. Multivariate Cox regression analysis indicated that tumor pathological cell phenotype (HR=13.75, 95%CI:3.546-53.308, P=0.000) and surgical timing (HR=7.497, 95%CI:1.163-48.313, P=0.034) were independent prognostic risk factors of patients with stage I( and II(.

CONCLUSIONSSurgical operation is an important part of comprehensive treatment for PGIL. T lymphocyte source and ulcerative lymphoma indicates poorer prognosis.

Neoadjuvant immunotherapy has achieved exciting efficacy with high clinical complete response (cCR) and pathologic complete response (pCR) rates and durable long-term effects. PD-1 checkpoint blockade-based immunotherapy has been highly successful in microsatellite instability high (MSI-H)/mismatch repair deficiency (dMMR) colorectal cancer and has been recommended as the first-line treatment for metastatic colorectal cancer by domestic and international guidelines. Several studies have shown that immunotherapy can be a potentially curable treatment for MSI-H rectal cancer and has even shown promise in organ preservation in colon cancer. In this study, we first clarified the feasibility of the watch-and-wait strategy after PD-1 checkpoint blockade treatment by indirect and direct evidence. Then from the assessment tools (including digital rectal examination, endoscopy, radiology, and lymph node assessment), the viable assessment methods of cCR for immunotherapy and related difficulties are proposed. Finally, the medication choices of immunotherapy, the treatment regimen, and the follow-up strategy are further discussed. We hope that neoadjuvant immunotherapy could be appropriately applied in MSI-H/dMMR colorectal cancer so that more patients can achieve organ preservation.

Neoadjuvant immunotherapy has achieved exciting efficacy with high clinical complete response (cCR) and pathologic complete response (pCR) rates and durable long-term effects. PD-1 checkpoint blockade-based immunotherapy has been highly successful in microsatellite instability high (MSI-H)/mismatch repair deficiency (dMMR) colorectal cancer and has been recommended as the first-line treatment for metastatic colorectal cancer by domestic and international guidelines. Several studies have shown that immunotherapy can be a potentially curable treatment for MSI-H rectal cancer and has even shown promise in organ preservation in colon cancer. In this study, we first clarified the feasibility of the watch-and-wait strategy after PD-1 checkpoint blockade treatment by indirect and direct evidence. Then from the assessment tools (including digital rectal examination, endoscopy, radiology, and lymph node assessment), the viable assessment methods of cCR for immunotherapy and related difficulties are proposed. Finally, the medication choices of immunotherapy, the treatment regimen, and the follow-up strategy are further discussed. We hope that neoadjuvant immunotherapy could be appropriately applied in MSI-H/dMMR colorectal cancer so that more patients can achieve organ preservation.

ObjectiveTo investigate the clinical characteristics and prognosis of cryptogenic hepatocellular carcinoma (HCC).MethodsClinical data of 177 patients who were diagnosed with cryptogenic HCC in the Third Afifliated Hospital of Sun Yat-sen University from January 2001 to December 2012 were analyzed retrospectively. The informed consents of all patients were obtained and the ethical committee approval was received. There were 138 males and 39 females with age ranging from 30 to 82 years old and median age of 56 years old. Data of clinical characteristics were collected and hepatitis B virus (HBV) serological markers were investigated. According to the different treatments, the patients were divided into surgical resection group (n=24), comprehensive treatment group (n=88), and conservative treatment group (n=65). Impacts of these 3 treatments on the survival of patients were compared.ResultsOf the 177 patients, the ratio of male to female was about 4:1. Patients with age over 60 accounted for 48.0% (85/177), liver cirrhosis 90.4% (160/177), non-alcoholic fatty liver disease (NAFLD) 19.2% (34/177), diabetes mellitus (DM) 21.5% (38/177). Patients with positive hepatitis B virus core antibody (HBcAb) accounted for 70.6% (125/177), alpha fetal protein (AFP) >400 μg/L 31.6% (56/177), liver function Child-Pugh grade A 62.7% (111/177), tumor diameter≤5 cm 35.6% (63/177), single tumor 54.2% (96/177), Barcelona Clinic Liver Cancer (BCLC) stage A 9.6% (17/177), stage B-D 90.4% (160/177). The 1-year survival rate was 92% in surgical resection group, 65% in comprehensive treatment group, but only 8% in conservative group.ConclusionsOccult HBV infection may be the main cause of cryptogenic HCC, though NAFLD and DM may also play an important role in its occurrence. Cryptogenic HCC most occurs on the basis of liver cirrhosis and is usually found at an middle or advanced stage during the initial diagnosis. The treatment outcomes and prognosis are poor so regular follow-up, early diagnosis are the key to improve the prognosis.