OBJECTIVETo assess the value of detecting peripheral blood circulating tumor cells (CTCs) in the diagnosis and treatment of hepatocellular carcinoma (HCC).

METHODSA total of 296 patients diagnosed with HCC admitted in our department from July 2013 to January 2015 were analyzed, with 39 patients with benign liver disease serving as the control group. The distribution of CTCs in the peripheral blood of HCC patients were detected by CanPatrol(TM) CTCs, and its relationship with the clinical features and prognosis of the patients were analyzed.

RESULTSs CTCs were detected in 64.5% (191/296) of the HCC patients but in none of the control group (P<0.05). Positive CTCs in peripheral blood of HCC patients were significantly correlated with serum AFP level, tumor number, TNM stage, BCLC stage, portal vein tumor thrombus and metastasis (P<0.05). In 127 HCC patients receiving radical surgery, the patients positive for CTCs showed significantly shorter relapse-free survival time (P<0.05).

CONCLUSIONPositive CTCs in the peripheral blood may indicate a poor prognosis in HCC patients. CTCs may serve as a indicator for monitoring the prognosis of HCC.

Carcinoma, Hepatocellular ; blood ; diagnosis ; Case-Control Studies ; Humans ; Liver Neoplasms ; blood ; diagnosis ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Neoplastic Cells, Circulating ; Portal Vein ; pathology ; Prognosis

OBJECTIVETo assess the effects of platelet and fibrinogen on progressive ovarian cancer.

METHODSThe platelet counts and fibrinogen levels were measured in 180 initially treated ovarian cancer patients within 2 weeks before and 1 week after operation and 6 months after chemotherapy. The results were compared with those of 40 patients with epithelial ovarian neoplasms.

RESULTSThe platelet counts and fibrinogen levels were significantly higher in ovarian cancer patients than in patients with epithelial ovarian neoplasms (P < 0.05), significantly higher in late stage than in early stage (P < 0.05), and significantly lower after operation than before operation (P < 0.05). The platelet counts and fibrinogen levels were also significantly lower 6 months after operation in patients who responded well to the therapies than the levels before operation (P < 0.05); however, such difference did not exist between patients who were refractory to the therapies 6 months after treatment and the post-operation levels (P > 0.05).

CONCLUSIONSPlatelet and fibrinogen may be closely correlated with progressive ovarian cancer. Monitoring platelet counts and fibrinogen levels are instrumental for the early diagnosis of cancer and metastasis.

Adult ; Aged ; Cystadenocarcinoma, Serous ; blood ; Female ; Fibrinogen ; analysis ; Humans ; Middle Aged ; Neoplasm Recurrence, Local ; blood ; diagnosis ; Ovarian Neoplasms ; blood ; pathology ; Platelet Count ; Young Adult

Precision medicine is becoming the goal of translational research on colorectal cancer. Accurate molecular subtyping contributes to better guidance of clinical practice. The current TNM staging system of colorectal cancer is inadequate in terms of guiding clinical practice, such as the underestimation of prognosis of with stage II( and III( colorectal cancer TNM staging, and identification of high-risk and low-risk patients with stage II( colorectal cancer. Researchers from Europe and US have proposed a number of molecular subtypings with clinicopathological phenotypes and molecular phenotypes, which has certain practical significance and is beneficial to the choice of treatment regimen and targeted drugs. But the current results of subtyping research require further validations by clinical large scale multi-center trials. Based on precision medicine, molecular subtyping gradually reveals its clinical significance and is optimized through combining genomics with various clinical phenotypes, indicating its guidance for clinical practice, which is the inevitable course of precision medicine accomplishment. In recent years, there have been many new advances in colorectal cancer liver metastasis treatment. The prognosis of colorectal cancer patients undergoing resection of liver metastasis lesion is similar to those with stage III(. Early recurrence within 6 months after translational treatment and resection occurred in about one third of the patients with initially unresectable liver metastasis, and the overall survival was poor. Thus, an evaluation system should be established in order to avoid the strong therapy and strive for better quality of life in some patients. Individualized treatment for colorectal cancer is emphasized increasingly. Body fluid (peripheral blood and urine) marker detection is a recent research hotspot, including serum protein(polypeptide), plasma miRNA, circulating tumor cells and circulating nucleic acid.
Biomarkers, Tumor ; blood ; urine ; Colorectal Neoplasms ; diagnosis ; pathology ; therapy ; Humans ; Liver Neoplasms ; secondary ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Precision Medicine ; Prognosis ; Quality of Life ; Translational Medical Research

To tailor the subsequent treatment and follow-up strategy,this study dynamically assessed the response to initial therapy in non-distant metastatic differentiated thyroid cancer (DTC) patients with intermediate and high risk. A total of 184 non-distant metastatic DTC patients (intermediate-risk 111 cases and high-risk 73 cases) were retrospectively enrolled in this study. Based on the results of initial response assessment (6-12 months after initial therapy),patients were divided into two groups:excellent response (ER) group (=113) and non-excellent response (non-ER) group (=71). We compared the differences in clinicopathological features between these 2 groups and evaluated the changes of dynamic response to therapy at the initial and final assessments after initial therapy in all patients. Compared with the ER group,the non-ER group showed a larger tumor size (=2771.500,=0.000),higher proportion of extrathyroidal invasion (=4.070,=0.044),and higher preablative-stimulated thyroglobulin levels (=1367.500,=0.000). ER was achieved in 31% of patients in the initial non-ER group [including indeterminate response (IDR) and biochemical incomplete response (BIR)] at the final follow-up only by thyroid stimulating hormone (TSH) suppression therapy,among which 63.6% were with intermediate risk (especially the patients with IDR) and 36.4% at high risk. In addition,5.2%(6/113) of patients in the initial ER group were reassessed as IDR,BIR,or even structural incomplete response at the end of the follow-up (among which one patient developed into cervical lymph node recurrence,as confirmed by pathology);the TSH level in these patients fluctuated at 0.56-10.35 μIU/ml and was not corrected in time during the follow-up after initial therapy. Some of non-distant metastatic DTC patients with intermediate and high risks who presented initial non-ER may achieve ER only by TSH suppression therapy over time;in contrast,the patients presented initial ER may develop into non-ER without normalized TSH suppression therapy. The dynamic risk assessment system may provide a real-time assessment of recurrence risk and tailor the subsequent treatment and follow-up strategies.
Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Retrospective Studies ; Risk Assessment ; Thyroglobulin ; blood ; Thyroid Neoplasms ; diagnosis ; therapy ; Thyrotropin ; antagonists & inhibitors

OBJECTIVETo study the treatment strategy and survival of patients with primary leiomyosarcoma of inferior vena cava (PIVCLMS).

METHODSClinical data of 12 cases with PIVCLMS admitted in Peking University People's Hospital from January 2006 to September 2014 were reviewed retrospectively. All cases were confirmed by pathology examination. Among them, there were 4 male and 8 female patients with a mean age of (54 ± 9) years old. Tumors arose from the inferior vena cava (IVC) upper segment in 5 patients, from the middle in other 7 patients. Cardiac extension was observed in 4 cases. Tumor resection was undertaken in 8 patients, the other 4 patients were inoperable. The series was analyzed to identify clinical outcome of surgical strategy and protective factors for patient survival.

RESULTSIn tumor resection group, 6 patients had radical resection and 2 underwent palliative resection. As for IVC reconstruction, caval wall resection with a direct suture was carried out in 6 patients or with prosthetic patch in 1 patient. The other 1 patient underwent a segment caval resection and prosthetic graft replacement in situ. In 4 cases of suprahepatic PIVCLMS cardiopulmonary bypass or perfusion by right atrial intubation was performed to assist bleeding control and maintain circulation stabilization, among them 1 patient survived for more than 101 months with no tumor recurrence or metastasis. Among the patients submitted to tumor resection 2 early postoperative deaths occurred, and another 2 patients had complications. All 4 patients submitted to non-resective operation (only neoplasm biopsy) died of PIVCLMS within 8 months. Except for 2 cases of early death, mean survival after tumor resection was (54 ± 40) months. Two patients presented local recurrence and hepatic metastasis at follow-up of 16 months and 68 months.

CONCLUSIONSTumor resection is the only therapy for PIVCLMS with an expectation for long-term survival. The applicant of cardiopulmonary bypass makes some inoperable indicated to tumor resection.

Adult ; Blood Vessel Prosthesis Implantation ; Cardiopulmonary Bypass ; Female ; Humans ; Leiomyosarcoma ; diagnosis ; surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Retrospective Studies ; Vascular Neoplasms ; diagnosis ; surgery ; Vena Cava, Inferior ; pathology

OBJECTIVE: To investigate the clinical manifestation, diagnosis, treatment of parathyroid occupying lesions. METHOD: The clinical data of 26 patients with parathyroid occupying lesions between January 2003 and October 2012 at Dalian Central Hospital were retrospectively analyzed. RESULT: There were 2 cases of parathyroid cancer, 11 cases of parathyroid adenoma, 13 cases of parathyroid cysts in this study. All the cases,except 13 cases of cysts, are accompanied by symptoms of hyperparathyroidism. The symptoms were as follows:26 cases of neck lump, 11 cases of osteoporosis/osteitis fibrosa cystica,9 cases of urinary symptom, 8 cases of digestive symptom. Serum calciumion level and serum parathyroid hormone(PTH) level were examined qualitatively before operation. Ultrasonography, CT, MRI were used in diagnosing and locating parathyroid occupying lesion before operation. 2 cases of parathyroid cancer, 11 cases of parathyroid adenoma and 13 cases of parathyroid cysts with preoperative and postoperative diagnosis coincidence rate was 0 (0/2), 91% (10/11), 69% (9/13). All patients were treated with operation. 2 cases of parathyroid cancer survived with out recurrence during follow up for 17 months and 27 months after operation. 11 cases of parathyroid adenoma and 13 cases of parathyroid cysts were treated with operation,achieved complete remission and the outcome was no recurrence. CONCLUSION There lack of specific clinical symptoms of parathyroid occupying lesions,neck lump are common manifestations. Examination of serum calcium and PTH level together with ultrasonography, CT, MRI, 99mTc-MIBI is helpful to diagnose parathyroid occupying lesions. Parathyroid cancer preoperative diagnosis is difficult . Parathyroid occupying lesions determine the diagnosis depends on pathology. Surgery should be done as primary treatment.
Adenoma ; blood ; complications ; diagnosis ; surgery ; Adult ; Aged ; Biomarkers, Tumor ; Cysts ; blood ; diagnosis ; surgery ; Female ; Humans ; Hyperparathyroidism ; etiology ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Parathyroid Hormone ; blood ; Parathyroid Neoplasms ; blood ; complications ; diagnosis ; surgery ; Retrospective Studies

BACKGROUND/AIMS: Primary non-ampullary duodenal adenocarcinomas (PNADAs) comprise <0.3% of gastrointestinal malignancies. The rarity of PNADA and poorly defined natural history often leads to a delayed correct diagnosis. This study was conducted to evaluate the clinical characteristics of PNADA and to identify its prognostic factors. METHODS: Data were collected by retrospectively reviewing the medical records of patients with PNADA managed at Gyeongsang National University Hospital from January 2000 to December 2014. Demographic, clinical, endoscopic, and pathological variables were investigated, and factors related to survival were analyzed. RESULTS: Twenty-seven patients with PNADA were identified, and their median age was 64.9+/-13.6 years with 16 (59.3%) being male. The majority of patients (25/27, 92.6%) were initially diagnosed during upper endoscopy with biopsies. The tumor was located on the 1st or 2nd portion of duodenum in 92.6% (25/27) of patients. At the time of diagnosis, 85.2% (23/27) had advanced diseases (stage III or IV); 48.2% (13/27) had distant metastasis. Median survival time was 12 months (1-93 months). One and 3-year survival rates were 48.1% and 33.3%, respectively. On multivariable analysis, total bilirubin > or =2 mg/dL (OR, 85.28; 95% CI, 3.77-1,938.79; p=0.005) and distant metastasis (OR, 26.74; 95% CI, 3.13-2,328.14; p=0.003) at the time of diagnosis were independent poor prognostic factors. CONCLUSIONS: The majority of patients were diagnosed at an advanced stage. Presence of distant metastasis was independent prognostic factor of PNADA together with elevated total bilirubin.
Adenocarcinoma/*diagnosis/mortality/pathology ; Adult ; Aged ; Aged, 80 and over ; Bilirubin/blood ; Demography ; Duodenal Neoplasms/*diagnosis/mortality/pathology ; Female ; Gastroscopy ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Prognosis ; Retrospective Studies

Gastric cancer (GC) is one of the most common tumor in the world, and remains a major public health problem and one of the leading causes of death. Recently many researches have demonstrated that systemic inflammatory response is associated with prognosis and response to therapy in gastric cancer, and the peripheral blood count test can partly reflect the systemic inflammatory response. Based on the peripheral blood count test, there are a lot of research regarding the relation between the platelet count (PLT), neutrophil, lymphocyte, white blood cell (WBC), neutrophil to lymphocyte ratio(NLR), platelet to lymphocyte ratio (PLR) with their prognostic role in gastric cancer. A high PLT and preoperative lymphocytopenia are both associated with increased lymph node metastasis, stage (III(+IIII(), serosal invasion (T3+T4) risk and poorer overall survival. Besides above, platelet monitoring following surgery can be applied to predict the recurrence for patients with GC that suffer preoperative high PLT but have restored PLT levels following resection. Moreover systemic inflammatory factors based on blood parameters, such as PLR, NLR and so on, have relation with the poor prognosis of patients with GC. Among them, high NLR is a negative predictor of prognosis in GC patients. However PLR remains inconsistent, while most researches demonstrated high PLR may be useful prognostic factor rather than independent prognostic factor. There are still some limitations which include various cut-off values, little of clinician attention, the uncertain mechanism, etc. Here we review the research progress in the prognostic role of the blood count test in gastric cancer.
Blood Cell Count ; methods ; statistics & numerical data ; Blood Platelets ; physiology ; Humans ; Inflammation ; blood ; diagnosis ; immunology ; Leukocyte Count ; statistics & numerical data ; Lymphatic Metastasis ; diagnosis ; immunology ; Lymphocyte Count ; statistics & numerical data ; Lymphopenia ; blood ; physiopathology ; Neoplasm Invasiveness ; immunology ; Neoplasm Recurrence, Local ; blood ; diagnosis ; Neoplasm Staging ; statistics & numerical data ; Neutrophils ; immunology ; Platelet Count ; statistics & numerical data ; Prognosis ; Stomach Neoplasms ; blood ; diagnosis ; immunology ; mortality ; Treatment Outcome

BACKGROUND/AIMS: The prognosis of pancreatic adenocarcinoma (PAC) is poor. The serum carbohydrate antigen 19-9 (CA 19-9) level has been identified as a prognostic indicator of recurrence and reduced overall survival. The aim of this study was to identify preoperative prognostic factors and to create a prognostic model able to assess the early recurrence risk for patients with resectable PAC. METHODS: A series of 177 patients with PAC treated surgically at the St. Andrea Hospital of Rome between January 2003 and December 2011 were reviewed retrospectively. Univariate and multivariate analyses were utilized to identify preoperative prognostic indicators. RESULTS: A preoperative CA 19-9 level >228 U/mL, tumor size >3.1 cm, and the presence of pathological preoperative lymph nodes statistically correlated with early recurrence. Together, these three factors predicted the possibility of an early recurrence with 90.4% accuracy. The combination of these three preoperative conditions was identified as an independent parameter for early recurrence based on multivariate analysis (p=0.0314; hazard ratio, 3.9811; 95% confidence interval, 1.1745 to 15.3245). CONCLUSIONS: PAC patient candidates for surgical resection should undergo an assessment of early recurrence risk to avoid unnecessary and ineffective resection and to identify patients for whom palliative or alternative treatment may be the treatment of choice.
Adenocarcinoma/*diagnosis/surgery ; Aged ; CA-19-9 Antigen/blood ; Feasibility Studies ; Female ; Humans ; Male ; *Models, Biological ; Neoplasm Recurrence, Local/*diagnosis ; Pancreatic Neoplasms/*diagnosis/surgery ; Prognosis ; Retrospective Studies ; Tumor Markers, Biological/*blood

OBJECTIVETo explore clinical and pathological factors correlating with early recurrence of resected non small cell lung cancer (NSCLC), and to further understand the function of serum carcinoembryonic antigen (CEA) on NSCLC.

METHODS93 patients of NSCLC were selected. All of them received resection and were followed up for more than one year. The first time of recurrence was recorded. Logistic univariate and multivariable analysis were used to find the factors that affect the early recurrence of NSLSC, including age, sex, serum CEA level, tumor size, tumor location, tumor differentiation, histological type and clinical staging, and the ability of factors predicting the recurrence were compared by receiver operating characteristic (ROC) curve.

RESULTSOf all the clinical and pathological factors that are correlated with early recurrence of NSCLC, the serum carcinoembryonic antigen (CEA) value, clinical staging, and tumor difference are of statistical significance. The preoperative serum CEA value is the most valuable factor to predict early recurrence of NSCLC (ROC area: 0.843, 95% CI: 0.723 approximately 0.963, P = 0.000). When preoperative serum CEA value > 10 micro g/L, patients of NSCLC will have an early recurrence rate of 88%; and when preoperative serum CEA value recurrence is 92%.

CONCLUSIONFor the patients with respectable NSCLC, it is very important to know the precise clinical stage and pathological difference, and so is the preoperative serum CEA value. When preoperative serum CEA value > 10 micro g/L, even if the lesion is of early stage and well differenced, the general situation of patients should be carefully examined for the prompt and accurate treatment to them and close follow up is needed to treat these patients.

Biomarkers, Tumor ; blood ; Carcinoembryonic Antigen ; blood ; Carcinoma, Non-Small-Cell Lung ; blood ; pathology ; surgery ; Female ; Humans ; Logistic Models ; Lung Neoplasms ; blood ; pathology ; surgery ; Male ; Neoplasm Recurrence, Local ; diagnosis ; ROC Curve ; Risk Factors