OBJECTIVETo explore the risk factors for early recurrence (recurrence within 2 years) of proximal gastric cancer after radical resection.

METHODSThe clinical data of 367 proximal gastric cancer patients who underwent radical resection in the Cancer Institute and Hospital of Tianjin Medical University between January 2000 and May 2006 were reviewed. Among them, there are 71 patients (19.3%) with early recurrence. Univariate analysis and multivariate analysis were applied to investigate risk factors for early recurrence.

RESULTSUnivariate analysis showed that Borrmann type (P<0.01), histology type (P<0.01), depth of invasion (P<0.05), negative lymph nodes count (P<0.05) were risk factors for early recurrence of proximal gastric. On multivariate analysis, histology type (P<0.05), depth of invasion (P<0.05), negative lymph nodes counts (P<0.05) were independent risk factors for early recurrence of proximal gastric cancer. Negative lymph nodes in early recurrence patients were 8.4 ± 7.2, which were significantly less as compared to patients without early recurrence (10.7 ± 8.7) (P<0.05).

CONCLUSIONFor T3 proximal gastric adenosquamous cancer, extended resection and lymphadenectomy should be considered. Intraoperative or postoperative adjuvant treatment should be administered as routine.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; pathology ; Postoperative Period ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; pathology ; surgery

OBJECTIVETo explore the clinicopathological characteristics and prognostic factors of primary gastric lymphoma (PGL).

METHODSThe clinical data of 204 patients with PGL was reviewed and analyzed. There were 106 males and 98 females, their age were 19 to 85 years (average age was 53.7 years). The Focal areas included gastric fundus lesions 41 cases (20.1%), stomach body lesions 127 cases (62.3%), distal gastric lesions 105 cases (51.5%), cardia lesions 13 cases (6.4%), duodenal bulb lesion 1 cases (0.5%). The clinical characteristics and the outcomes in patients with influence were analysed.

RESULTSIn 204 PGL patients, the most common complaints were abdominal pain (62.3%) and weight loss (52.9%). Most of the PGL patients appeared ulcerative (76.0%) and results showed that 62.7% patients involved single location. As to the factors of cellulate grading and pathological characteristics, most patients (87.7%) show low-grade or intermediate-grade lymphoma, Musshoff stages I and II (74.0%). In 186 patients with complete follow-up data, survival rates of 1-, 3- and 5-year were 75.8%, 63.4% and 60.2% respectively. The median overall survival time was 50.0 months. In univariate survival analysis, age (χ(2) = 5.030), level of LDH (χ(2) = 40.084), cellulate grading (χ(2) = 35.238), Musshoff stage (χ(2) = 71.601), tumor diameter (χ(2) = 12.018) and option of managements (χ(2) = 14.140) were obviously correlated with the prognosis (all P < 0.05). Musshoff stage (RR = 2.230, 95%CI: 1.372 - 3.625) and cellulate grading (RR = 1.892, 95%CI: 1.010 - 3.543) were independent prognostic factors in multivariable analysis (both P < 0.05). There was no prognostic difference between surgery and chemotherapy in stage I and II (χ(2) = 1.223, P = 0.542).

CONCLUSIONSMusshoff stage and grade malignancy are independent prognostic factors. For patients with stage I and II, surgical resection is not the first-choice for clinical therapy.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lymphoma, Non-Hodgkin ; diagnosis ; pathology ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; diagnosis ; pathology ; Young Adult

OBJECTIVETo explore the prognostic factors and to compare chemotherapy alone versus surgical resection plus chemotherapy for early stage primary gastric diffuse large B-cell lymphomas (DLBCL).

METHODSClinical data of 75 patients who were diagnosed as primary gastric DLBCL between January 1993 and August 2008 in Cancer Institute and Hospital of Tianjin Medical University were reviewed retrospectively.

RESULTSAmong these 75 patients, 20 patients received chemotherapy alone and 55 underwent surgical resection plus chemotherapy. Complete remission rates were 65.0% (13/20) and 83.6% (46/55), effective rates were 75.0% (15/20) and 92.7% (51/55), and 5-year survival rates were 86.9% and 78.7% respectively in chemotherapy alone group and resection plus chemotherapy group, while the differences were not statistically significant (all P>0.05). Multivariate Cox regression model showed that international prognosis index (IPI) was the only independent prognostic factor (P<0.05, HR=11.350, 95%CI:1.011-127.371).

CONCLUSIONSIn early stage of DLBCL, IPI is the only independent prognostic factor. The clinical outcomes are comparable between chemotherapy alone and surgical resection plus chemotherapy.

Female ; Humans ; Lymphoma, Large B-Cell, Diffuse ; therapy ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; therapy ; Treatment Outcome

Objective To study the achievements and safety of Transcatheter arterial chemoembolization (TACE) associated Portal Vein Chemo-therapy (PVC) per-drug delivery system (DDS) program in preventing the recurrence of hepatic cell cancer (HCC) and Portal Vein Tumor Thrombus (PVTT).Methods 97 cases with HCC and PVTT were treated from Januay 2009 to January 2011.Patients with tumor or tumor thrombus were resected on all the cases and randomly divided into 3 groups.TACE,PVC per-DDS TACE and PVC per-DDS were given to group A,group B,and group C,respectively.Patients in the 3 groups were followed and compared on the Disease Free Survivals (DFS) and the accumulative survival rates,at 6 months,1 year and 2 years after the operation.Results After the surgery was completed in June,the 1-year,2-year,3-year survival rates and cummulative survival rate in group C was higher than in group A or group.Significant differences did no appeare in June but did show in 1 year after the surgery (P＞0.05) as well as in both 2 and 3 years,after the surgery (P＜0.01).Conclusion Patients with HCC and PVTT,the TACE chemotherapy in association with PVC per-DDS could increase both the DFSs and accumulative survival rates,when compared to the either single TACE or PVC per-DDS,after the tumor or tumor thrombus were resected.

Objective To investigate the common reasons for the misdiagnosis of rectal cancer. Methods A retrospective study was performed in 568 cases of rectal cancer in the Changhai Hospital from January 2007 to December 2008. Age at diagnosis, gender distribution, symptom, delay in diagnosis, TNM stage, and grade of differentiation were recorded and analyzed. The importance of digital examination and colonoscopy were addressed. Results Two hundred and seventy-one(47.7%) out of 568 patients were misdiagnosed for iatrogenic reasons. Rectal cancer patients who presented hematochezia were more likely to be misdiagnosed. There were 110 cases of stage Ⅲ(40.6%) and 68 cases of stage Ⅳ(12.5%) in patients who were misdiagnosed, which was significantly higher than those who were diagnosed correctly(P＜0.05). Patients under 40 years old were more likely to be misdiagnosed, and their correct diagnosis was often delayed longer and the tumors were in more advanced stage as compared to the older groups(P＜0.05). Conclusions The misdiagnosis rate of rectal cancer is high. Tumor stage of patients misdiagnosed is significantly more advanced than those who are correctly diagnosed. Digital examination and colonoscopy should be emphasized, especially for patients under the age of 40.

Objective To investigate the common reasons for the misdiagnosis of rectal cancer. Methods A retrospective study was performed in 568 cases of rectal cancer in the Changhai Hospital from January 2007 to December 2008. Age at diagnosis, gender distribution, symptom, delay in diagnosis, TNM stage, and grade of differentiation were recorded and analyzed. The importance of digital examination and colonoscopy were addressed. Results Two hundred and seventy-one(47.7%) out of 568 patients were misdiagnosed for iatrogenic reasons. Rectal cancer patients who presented hematochezia were more likely to be misdiagnosed. There were 110 cases of stage Ⅲ(40.6%) and 68 cases of stage Ⅳ(12.5%) in patients who were misdiagnosed, which was significantly higher than those who were diagnosed correctly(P＜0.05). Patients under 40 years old were more likely to be misdiagnosed, and their correct diagnosis was often delayed longer and the tumors were in more advanced stage as compared to the older groups(P＜0.05). Conclusions The misdiagnosis rate of rectal cancer is high. Tumor stage of patients misdiagnosed is significantly more advanced than those who are correctly diagnosed. Digital examination and colonoscopy should be emphasized, especially for patients under the age of 40.

BACKGROUNDKCNJ11, ABCC8, PPARG, and HNF4A have been found to be associated with type 2 diabetes in populations with different genetic backgrounds. The aim of this study was to test, in a Chinese Han population from Beijing, whether the genetic variants in these four genes were associated with genetic predisposition to type 2 diabetes.

METHODSWe studied the association of four representative SNPs in KCNJ11, ABCC8, PPARG, and HNF4A by genotyping them using ABI SNaPshot Multiplex System in 400 unrelated type 2 diabetic patients and 400 unrelated normoglycaemic subjects.

RESULTSrs5219 (E23K) in KCNJ11 was associated with genetic susceptibility to type 2 diabetes (OR = 1.400 with 95% CI 1.117 1.755, P = 0.004 under an additive model, OR = 1.652 with 95% CI 1.086 2.513, P = 0.019 under a recessive model, and OR = 1.521 with 95% CI 1.089 2.123, P = 0.014 under a dominant model) after adjusting for sex and body mass index (BMI). We did not find evidence of association for ABCC8 rs1799854, PPARG rs1801282 (Pro12Ala) and HNF4A rs2144908. Genotype-phenotype correlation analysis revealed that rs1799854 in ABCC8 was associated with 2-hour postprandial insulin secretion (P = 0.005) after adjusting for sex, age and BMI. Although no interactions between the four variants on the risk of type 2 diabetes were detected, the multiplicative interaction between PPARG Pro12Ala and HNF4A rs2144908 was found to be associated with 2-hour postprandial insulin (P = 0.004 under an additive model for rs2144908; and P = 0.001 under a dominant model for rs2144908) after adjusting for age, sex and BMI, assuming a dominant model for PPARG Pro12Ala.

CONCLUSIONSOur study replicated the association of rs5219 in KCNJ11 with type 2 diabetes in Chinese Han population in Beijing. And we also observed that ABCC8 as well as the interaction between PPARG and HNF4A may contribute to post-challenge insulin secretion.

ATP-Binding Cassette Transporters ; genetics ; Adult ; Body Mass Index ; Diabetes Mellitus, Type 2 ; genetics ; Female ; Genetic Predisposition to Disease ; genetics ; Genotype ; Hepatocyte Nuclear Factor 4 ; genetics ; Humans ; Male ; Middle Aged ; PPAR gamma ; genetics ; Polymorphism, Single Nucleotide ; genetics ; Potassium Channels, Inwardly Rectifying ; genetics ; Receptors, Drug ; genetics ; Sulfonylurea Receptors

BACKGROUND AND OBJECTIVERadiotherapy is effective in treating nasopharyngeal carcinoma (NPC). This study evaluated the treatment efficacy, toxicity, and prognostic factors of intensity-modulated radiotherapy (IMRT) in the treatment NPC.

METHODSBetween September 2003 and September 2006, 305 patients with NPC were treated with IMRT in Fujian Provincial Cancer Hospital. IMRT was delivered as follows: gross tumor volume (GTV) received 66.0-69.8 Gy in 30-33 fractions, high-risk clinical target volume (CTV-1) received 60.0-66.65 Gy, low-risk clinical target volume (CTV-2) and clinical target volume of cervical lymph node regions (CTV-N) received 54.0-55.8 Gy. Patients with stages III or IV disease also received cisplatin-based chemotherapy. All patients were assessed for local-regional control, survival, and toxicity.

RESULTSWith a median follow-up of 35 months (range, 5-61 months), there were 16, 8, and 39 patients who had developed local, regional, and distant recurrence, respectively. The 3-year rates of local control, regional control, metastasis-free survival, disease-free survival, and overall survival were 94.3%, 97.7%, 86.1%, 80.3%, and 89.1%, respectively. Multivariate analyses revealed that T-classification had no predictive value for local control and survival, whereas N-classification was a significant prognostic factor for overall survival (P < 0.001), metastasis-free survival (P < 0.001), and disease-free survival (P = 0.003). For stages III-IV disease, concurrent and adjuvant chemotherapy did not influence prognosis. The most severe acute toxicities included Grade III mucositis in 14 patients (4.6%), Grade III skin desquamation in 90 (29.5%), and Grades III-IV leucocytopenia in 20 (6.5%). There were 7% patients with Grade II xerostomia after 2 years of IMRT, no Grades 3 or 4 xerostomia was detected.

CONCLUSIONSIMRT provided favorable locoregional control and survival rates for patients with NPC, even in those with locally advanced disease. The acute and late toxicities were acceptable. N-classification was the main factor of prognosis. Further study is needed on chemotherapy for patients with NPC.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Child ; Cisplatin ; administration & dosage ; Combined Modality Therapy ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Leukopenia ; etiology ; Lymphatic Metastasis ; Male ; Middle Aged ; Mucositis ; etiology ; Nasopharyngeal Neoplasms ; drug therapy ; pathology ; radiotherapy ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Radiotherapy Dosage ; Radiotherapy, Intensity-Modulated ; adverse effects ; methods ; Retrospective Studies ; Survival Rate ; Xerostomia ; etiology ; Young Adult

OBJECTIVETo investigate the clinicopathological characteristics and prognostic factors of bone metastasis in gastric cancer patients.

METHODSClinicopathological data of 66 gastric cancer patients with bone metastasis, who were treated at the Tianjin Medical University Cancer Institute and Hospital from October 1997 to September 2011, were analyzed retrospectively. The clinicopathological characteristics of the primary cancer and bone metastasis were summarized and the prognosis was analyzed.

RESULTSOf 66 patients, 4 underwent operation, 28 chemotherapy, 32 inhibitors of bone resorption,8 local treatment and 23 symptomatic treatment alone. The median survival time of these 66 patients was 5 months (95%CI:3.3-6.7 months). The 1-, 2- and 3-year survival rates were 9.1%, 3.0% and 1.5%, respectively. Univariate Log-rank test indicated that gender, bone metastasis combined with other distant metastasis and chemotherapy were significant prognostic factors (all P<0.05). Multivariate analysis revealed bone metastasis combined with other distant metastasis was an independent prognostic factor (P=0.011, RR=2.067, 95%CI:1.178-3.626).

CONCLUSIONSPrognosis of patients with bone metastasis from gastric cancer is poor. Chemotherapy-based comprehensive treatment may improve the prognosis of these patients.

Adult ; Aged ; Aged, 80 and over ; Bone Neoplasms ; secondary ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; pathology

Objective On July 6, 2010, the parents of a patient with confirmed measles reported several suspected measles patients with fever and rash in their village. An investigation was carried out to verify and understand the cause of the outbreak. Methods Several suspected cases had an onset of fever and rash in this and other neighboring villages during June 1 to August 3,2010. A confirmed case was a suspected case with measles-specific IgM identified in the serum. We conducted door-to-door visits and searched the Chinese Center for Disease Control and Prevention Information System to identify cases, also conducted a retrospective cohort study among migrant children aged 8 months-14 years to identify risk factors related to measles. Results We identified 19 measles cases (17 confirmed case, 2 suspected cases)in the village, and all of them were migrants. Children aged 1-2 years had the highest attack rate(13%). The primary case-patient had onset on the day she arrived in this village(June 4,2010). Caretakers from an unlicensed private clinic were providing service in the village but did not report the outbreak to the public health authority. The outbreak was identified only after receiving a report from the parents of one of the patients, by that time the outbreak had lasted for one month. The measles vaccine coverage rate was 81% among the 315 migrant children aged 8 months-14 years. Among the 61 unvaccinated children, those who reportedly being contacted a measles patient had a higher attack rate(14/16, 88%)than those who did not(2/45, 4.4%)(Relative risk=20, Fisher' s exact 95% confidence interval: 5.7-94). Conclusion The low measles vaccine coverage among migrant children and lack of measures taken on the incident, timely isolation diagnosis/reporting by the caretakers from the unlicensed private clinic etc. had contributed to this prolonged outbreak. Measures need to be taken to improve the immunization services for migrant populations and to enhance measles surveillance programs in the area.