A robust method for simultaneous determination of eight B vitamins in human serum by liquid chromatography tandem mass spectrometry.

The level of vitamin B group in human serum is an important index of human health. Among B vitamins, cyanocobalamin in serum is unstable and its content is extremely low. Rapid and simultaneous detection of multiple B vitamins including cyanocobalamin is a challenge. Herein, we have developed a rapid and stable method that can realize the determination of thiamine, riboflavin, nicotinamide, pantothenic acid, pyridoxic acid, biotin, 5-methyltetrahydrofolate, and cyanocobalamin simultaneously in 6 min. The method was established based on protein precipitation with methanol and then chromatographic separation was achieved using Waters acquity ultra-high-performance liquid chromatography high strength silica T3 column, which was stable and sensitive especially for cyanocobalamin. Limit of quantification, precision, trueness, and matrix effect were validated according to the European Medicines Agency and United States Food and Drug guidelines and Clinical and Laboratory Standards Institute guidelines on bioanalytical method. The limit of quantification for thiamine, riboflavin, nicotinamide, pantothenic acid, pyridoxic acid, biotin, 5-methyltetrahydrofolate, and cyanocobalamin was 0.4, 0.4, 0.8, 2.0, 0.4, 0.1, 0.4, and 0.04 ng/mL separately, respectively. Intra- and interday precisions were 1.1%-12.4% and 2.0%-13.5%, respectively. The relative errors were between 0.3% and 13.3%, and the matrix effects were between 2.6% and 10.4%.

PFKFB4 Overexpression Facilitates Proliferation by Promoting the G1/S Transition and Is Associated with a Poor Prognosis in Triple-Negative Breast Cancer.

BACKGROUND: 6-Phosphofructo-2-kinase/fructose-2,6-biphosphate-4 (PFKFB4) is a key factor that plays an important role in tumorigenesis. However, its role in triple-negative breast cancer (TNBC) progression needs to be further validated. We investigated whether PFKFB4 is directly involved in the oncogenic signaling networks of TNBC. METHODS: First, we assessed the expression level of PFKFB4 in tumor tissue specimens by immunohistochemistry and evaluated its prognostic value. Next, the effect of PFKFB4 on TNBC cell growth and associated mechanisms were investigated. Finally, the results were further verified in vivo. RESULTS: We found that PFKFB4 overexpression was associated with an unfavorable prognosis in TNBC patients. PFKFB4 was overexpressed in TNBC cell lines in hypoxic environments, and its overexpression promoted tumor progression in vitro and in vivo. Further analyses demonstrated that the possible mechanism might be that PFKFB4 overexpression facilitates TNBC progression by enhancing the G1/S phase transition by increasing the protein level of CDK6 and phosphorylation of Rb. CONCLUSIONS: These data suggest that PFKFB4 plays significant roles in the tumorigenesis and development of TNBC.

Submucosal Saline Injection Followed by Endoscopic Ultrasound versus Endoscopic Ultrasound Only for Distinguishing between T1a and T1b Esophageal Cancer.

PURPOSE: To examine whether submucosal saline injection (SSI) can improve traditional endoscopic ultrasound (EUS) accuracy in distinguishing between T1a and T1b stage esophageal squamous cell carcinoma (ESCC). EXPERIMENTAL DESIGN: Patients with T1N0M0 stage ESCC (n = 180) ages 18 to 85 years were enrolled between February 14, 2012 to June 4, 2018 at Sun Yat-sen University Cancer Center (Guangdong, China). They were randomly assigned (1:1) to receive either EUS examination after 3-5 mL SSI or EUS only examination. All the patients were referred to thoracic surgeons to receive endoscopic resection (ER) or esophagectomy 5 to 10 days after EUS examination. Standard EUS criteria were used to preoperatively stage the ESCC cases, and surgical pathology reports after referral were used to postoperatively stage the cases. The primary endpoint was the diagnostic accuracy of T1b staging [defined as the sum of the true positive (T1b) and true negative (T1a) cases divided by the total number of cases]. RESULTS: Among the per-protocol population, the SSI+EUS group (n = 81) was superior to the EUS-only group (n = 85) in terms of the diagnostic accuracy for T1b staging [93.8% (95% confidence interval (CI), 88.6-99.1) vs. 65.9% (95% CI, 55.8-76.0); P < 0.001]. The positive predictive value of SSI+EUS for diagnosing T1b ESCC reached 90.9% (95% CI, 81.1-100), which was significantly superior to that of EUS only [0.576 (0.450-0.702), P = 0.001]. CONCLUSIONS: SSI significantly improves the diagnostic accuracy of EUS in distinguishing between T1a and T1b ESCC, which might help avoid unnecessary esophagectomy and diagnostic ER.

Ultrasound-guided fine needle aspiration of retropharyngeal lymph nodes after radiotherapy for nasopharyngeal carcinoma: a novel technique for accurate diagnosis.

BACKGROUND: Enlarged retropharyngeal lymph nodes (RLNs) are very common in patients with nasopharyngeal carcinoma (NPC) undergoing radiotherapy. The most suitable treatment option for enlarged RLNs depends on the pathological results. However, RLN sampling is difficult and imminent in the clinic setting. We recently developed a novel minimally invasive technique termed endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for sampling RLN tissues sufficient for pathological or cytological diagnosis. METHODS: We enrolled 30 post-radiotherapy patients with NPC with suspected RLN metastasis detected via magnetic resonance imaging (MRI). The EUS probe was introduced into the nasopharynx via the nostrils, and EUS was then used to scan the retropharyngeal space and locate the RLN in the anterior carotid sheath. EUS-FNA was subsequently performed. The safety and efficacy of using EUS-FNA to sample the RLN tissues were assessed. RESULTS: Strips of tissue were successfully sampled from all patients using EUS-FNA. Of the 30 patients, 23 were confirmed to have cancer cells in the biopsied tissues via pathology or cytology examinations with 1 EUS-FNA biopsy session. The seven cases without confirmed cancer cells were subsequently reanalyzed by using another EUS-FNA biopsy session, and two more cases were confirmed possessing cancer cells. The other five patients without confirmed cancer cells were closely followed with MRI every month for 3 months. After follow-up for 3 months, three patients were still considered cancer-free due to the presence of RLNs with stable or shrinking diameters. The rest two patients who showed progressive disease underwent a third EUS-FNA biopsy procedure and were further confirmed to be cancer cell-positive. In the whole cohort reported here, the EUS-FNA procedure was not associated with any severe complications. CONCLUSION: EUS-FNA is a safe and effective diagnostic approach for sampling tissues from the RLNs in patients with suspected recurrent NPC.

Contrast-Enhanced Ultrasound Improves the Pathological Outcomes of US-Guided Core Needle Biopsy That Targets the Viable Area of Anterior Mediastinal Masses.

Based on the option that ultrasound-guided core needle biopsy (US-CNB) of the enhanced portion of anterior mediastinal masses (AMMs) identified by contrast-enhanced ultrasound (CEUS) would harvest viable tissue and benefit the histological diagnoses, a retrospective study was performed to elucidate the correlation between the prebiopsy CEUS and diagnostic yield of AMMs and found that CEUS potentially improved the diagnostic yield of AMMs compared with conventional US with a significant increase in the cellularity of samples. Furthermore, the marginal blood flow signals and absence of necrosis can predict the diagnostic yield of AMM. It was concluded that US-CNB of the viable part of AMMs, as verified by CEUS, was able to harvest sufficient tissue with more cellularity that could be used for ancillary studies and improve the diagnostic yield. And CEUS was recommended to those patients with AMMs undergoing repeated US-CNB, with the absence of marginal blood signals or presence of necrosis.

Effects of omeprazole in improving concurrent chemoradiotherapy efficacy in rectal cancer.

AIM: To explore the effects of omeprazole on chemoradiotherapy efficacy and tumor recurrence in rectal cancer. METHODS: The medical data of 125 rectal cancer patients who received the same neoadjuvant chemoradiotherapy (CRT) followed by surgery were retrospectively collected. Patients who received omeprazole (OME) orally at a dose of 20 mg at least once daily for six days and/or intravenously at 40 mg a day were recognized as eligible OME users (EOU). Otherwise, patients were regarded as non-eligible OME users (non-EOU). Moreover, a preferred OME dose cut-off of 200 mg on tumor recurrence was obtained by receiver operating characteristic (ROC) curves. Patients were divided into two groups: the effective OME group (EOG, OME ≥ 200 mg) and the non-effective OME group (non-EOG, OME < 200 mg). RESULTS: The good response rate of CRT efficacy (50.8%) in EOU was significantly increased compared with non-EOU (30.6%) (P = 0.02). The recurrence rate in the EOG was 10.3%, which was significantly lower compared with 31.3% in non-EOG (P = 0.025). The good response rate of CRT efficacy in EOG was 55.2%, which was obviously higher compared with 36.5% in non-EOG, with a significant difference (P = 0.072). Multivariate Cox analysis demonstrated that OME (non-EOG and EOG) was an independent and significant impact factor for DFS (P = 0.048, HR = 0.30, 95%CI: 0.09-0.99). CONCLUSION: When applied as an adjuvant drug in cancer treatment for relieving common side effects of chemotherapy, omeprazole has a synergetic effect in improving CRT efficacy and decreasing rectal cancer recurrence.

Evaluation of preoperative staging for esophageal squamous cell carcinoma.

Esophageal squamous cell carcinoma (ESCC) is known for its rapid progression and poor outcomes. China has the highest incidence and mortality in the world. Diagnoses made at early stages and accurate staging are associated with better outcomes, all of which can play a significant role in the selection of treatment protocols. ESCC is staged according to the widely accepted TNM system. Common imaging modalities used in staging ESCC before treatment include endoscopy, computed tomography (CT), positron emission tomography (PET) and magnetic resonance imaging (MRI). Endoscopic ultrasound is useful for staging tumor depth and nodal status. Narrow band imaging is valuable for early stage disease assessment. CT and PET provide additional valuable information regarding node and metastasis staging. The ability of MRI to delineate ESCC is continuously being improved and adds information regarding locoregional status to routine examinations.

Endoscopic Ultrasound for Preoperative Esophageal Squamous Cell Carcinoma: a Meta-Analysis.

BACKGROUND: Treatment options and prognosis of esophageal squamous cell carcinoma (ESCC) depend on the primary tumor depth (T-staging) and regional lymph node status (N-staging). Endoscopic ultrasound (EUS) has emerged as a useful staging tool, but studies regarding its benefits have been variable. The objective of this study was to evaluate the diagnostic accuracy of EUS for detecting preoperative ESCC. METHODS: We included in our meta-analysis studies involving EUS-based staging of preoperative ESCC compared with pathological staging. Using a random-effects model, we performed a meta-analysis of the accuracy of EUS by calculating pooled estimates of sensitivity, specificity and the diagnostic odds ratio. In addition, we created a summary receiver operating characteristic (SROC) curve. RESULTS: Forty-four studies (n = 2880) met the inclusion criteria. The pooled sensitivity and specificity of T1 were 77% (95%CI: 73 to 80) and 95% (95%CI: 94 to 96). Among the T1 patients, EUS had a pooled sensitivity in differentiating T1a and T1b of 84% (95%CI: 80 to 88) and 83% (95%CI: 80 to 86), and a specificity of 91% (95%CI: 88 to 94) and 89% (95%CI: 86 to 92). To stage T4, EUS had a pooled sensitivity of 84% (95%CI: 79 to 89) and a specificity of 96% (95%CI: 95 to 97). The overall accuracy of EUS for T-staging was 79% (95%CI: 77 to 80), and for N-staging, 71% (95%CI: 69 to 73). CONCLUSIONS: EUS has good diagnostic accuracy for staging ESCC, which has better performance in T1 sub-staging (T1a and T1b) and advanced disease (T4).

Application of Endobronchial Ultrasonography for the Preoperative Detecting Recurrent Laryngeal Nerve Lymph Node Metastasis of Esophageal Cancer.

BACKGROUND: The preoperative detection of recurrent laryngeal nerve lymph node (RLN LN) metastasis provides important information for the treatment of esophageal cancer. We investigated the possibility of applying endobronchial ultrasonography (EBUS) with conventional preoperative endoscopic ultrasonography (EUS) and computerized tomography (CT) examination to evaluate RLN LN metastasis in patients with esophageal cancer. METHODS: A total of 115 patients with advanced thoracic esophageal cancer underwent EBUS examinations. Patients also underwent EUS and CT imaging as reference diagnostic methods. Positron emission tomography /computed tomography (PET/CT) was also introduced in partial patients as reference method. The preoperative evaluation of RLN LN metastasis was compared with the surgical and pathological staging in 94 patients who underwent radical surgery. RESULTS: The sensitivities of the preoperative evaluations of RLN LN metastasis by EBUS, EUS and CT were 67.6%, 32.4% and 29.4%, respectively. The sensitivity of EBUS was significantly different from that of EUS or CT, especially in the detection of right RLN LNs. In addition, according to the extra data from reference method, PET/CT was not superior to EBUS or EUS in detecting RLN LN metastasis. Among all 115 patients, 21 patients who were diagnosed with tracheal invasions by EUS or EBUS avoided radical surgery. Another 94 patients who were diagnosed as negative for tracheobronchial tree invasion by EUS and EBUS had no positive findings in radical surgery. CONCLUSIONS: EBUS can enhance the preoperative sensitivity of the detection of RLN LN metastasis in cases of thoracic esophageal cancer and is a useful complementary examination to conventional preoperative EUS and CT, which can alert thoracic surgeons to the possibility of a greater range of preoperative lymph node dissection. EBUS may also indicate tracheal invasion in cases of esophageal stricture.

Extraesophageal saline during endoscopic submucosal dissection in a patient with early esophageal squamous cell carcinoma.

Saline submucosal injection (SSI) is an indispensable procedure before endoscopic submucosal dissection (ESD) in patients with early esophageal squamous cell carcinoma. Successful SSI should create a saline cushion in the submucosa rather than elsewhere. However, saline outside the esophagus was detected incidentally by endoscopic ultrasonography during ESD in a patient with early esophageal cancer. In this case, saline separated the esophageal adventitia from adjacent tissues, and there were no complications during or after ESD. This finding indicates that it is possible to use interventional extraesophageal saline injection to help differentiate advanced esophageal cancer of Stage T3 from Stage T4 by endoscopic ultrasonography.

Extraesophageal saline enhances endoscopic ultrasonography to differentiate esophagus and adjacent organs.

AIM: To distinguish between the esophagus and adjacent organs using extraesophageal saline injection (ESI) in a canine model. METHODS: ESI was performed through the esophagus under the guidance of linear-array endoscopic ultrasonography (EUS). Approximately 15 mL of methylene blue saline (0.5%) was then injected through each of the extraesophageal puncture points using a 22 G needle. Radial EUS examinations were conducted before and after ESI. EUS images of the trachea, tracheal bifurcation, arcus aortae and thoracic aorta were recorded. Vital signs were monitored during the ESI procedure and EUS examination. The dogs were then sacrificed for exploratory thoracotomy. RESULTS: No obvious fluctuation in vital signs or serious adverse events occurred during the ESI procedure. On EUS imaging, an apparent hypoechoic area outside the esophagus, which separated the esophagus and adjacent organs, was visualized. The adventitious of the esophagus and adjacent organs were easily distinguished. The findings of subsequent exploratory thoracotomy confirmed the EUS findings: obvious accumulation of a blue liquid in the extraesophageal tissues, as well as in the esophageal-thoracic aorta space, esophageal-arcus aortae space and esophageal-tracheal space. CONCLUSION: The esophagus and adjacent organs were successfully separated by ESI, and extraesophageal saline acted as an effective ultrasonic contrast agent.

Endoscopic ultrasonography for staging of T1a and T1b esophageal squamous cell carcinoma.

AIM: To investigate the accuracy of Endoscopic ultrasound (EUS) in staging and sub-staging T1a and T1b esophageal squamous cell carcinoma (ESCC). METHODS: A retrospective analysis involving 72 patients with pathologically confirmed T1a or T1b ESCC, was undertaken between January 2005 and December 2011 in Sun Yat-sen University Cancer Center. The accuracy and efficiency of EUS for detecting stages T1a and T1b ESCC were examined. RESULTS: The overall accuracy of EUS for detecting stage T1a or T1b ESCC was 70.8% (51/72), and the sensitivity was 74.3%. 77.8% (7/9) of lesions originated in the upper thoracic region, 73.1% (38/52) in the mid-thoracic region and 72.7% (8/11) in the lower thoracic region. Multivariate analysis revealed that the diagnostic accuracy of EUS was closely related to lesion length (F = 4.984, P = 0.029). CONCLUSION: EUS demonstrated median degree of accuracy for distinguishing between stages T1a and T1b ESCC. Therefore, it is necessary to improve EUS for staging early ESCC.

Expression of Rac-1 related to tumor depth, lymph node metastasis and patient prognosis in esophageal squamous cell carcinoma.

Rac-1, which is a member of the Rho guanosine triphosphatase (GTPase) family, has been demonstrated to play an important role in cancer invasion and metastasis. In this study, we investigated the clinical and prognostic significance of Rac-1 in esophageal squamous cell carcinoma (ESCC). The protein and messenger ribonucleic acid (mRNA) levels of Rac-1 in normal esophageal epithelia cells and paired ESCC tissues were examined by Western blot and reverse transcription polymerase chain reaction. The results showed that Rac-1 was upregulated at the protein and mRNA levels in ESCC cancerous specimens compared with normal esophageal tissues. We then examined the correlation between Rac-1 expression and clinicopathological features using immunochemical analysis of 233 surgically resected ESCC. Rac-1 protein was expressed in 228 (97.85%) cancer tissues with cytoplasm staining, and there were significant correlations between Rac-1 expression and tumor location (P = 0.045), tumor stage (P = 0.020), tumor depth (P = 0.023) and lymph node metastasis (P = 0.009). The overall survival and disease-free rates of ESCC patients with high Rac-1 expression were much lower than those with low Rac-1 expression (P < 0.001; P < 0.001, respectively). Multivariate analysis showed that high Rac-1 expression and lymph node metastasis were two independent factors for poor survival (P < 0.001; P < 0.001, respectively). The results in this study indicate, for the first time, that Rac-1 is involved in the invasion and metastatic progression of ESCC and may be a potential marker for evaluating the prognosis of ESCC patients and a therapy target for ESCC.

Application of endobronchial ultrasound-guided transbronchial needle aspiration in the management of mediastinal and hilar lymphadenopathy without intrapulmonary mass: experience from the largest cancer center of southern China.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is useful for lung cancer diagnosis and lymph node staging. The purpose of this study was to investigate EBUS-TBNA for managing mediastinal and hilar lymphadenopathies without intrapulmonary masses. We retrospectively reviewed our EBUS-TBNA database that was obtained between August 2010 and October 2012. Mediastinal and hilar lymphadenopathies of unknown origin and in the absence of known pulmonary malignancies were included. Final diagnoses were determined by EBUS-TBNA, surgery, and/or clinical follow-up for at least 6 months. Sensitivity, specificity, accuracy, and positive and negative predictive values were determined using standard statistical methods. We identified 128 patients with mediastinal and hilar lymphadenopathies and without intrapulmonary masses. EBUS-TBNA was successfully performed to obtain samples from 161 lymph nodes and mediastinal masses. EBUS-TBNA was diagnostic for 119 of 128 patients (93.0%) for all disease categories. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of EBUS-TBNA were 89.8, 100, 100, 81.6, and 93.0%, respectively. The procedures were uneventful and there were no severe complications. EBUS-TBNA is a safe, minimally invasive approach for diagnosing mediastinal and hilar lymphadenopathies without intrapulmonary masses. It obviates the need for more invasive procedures for tissue sampling of the mediastinum and hilum.

The role of insulin-like growth factor 1 and its receptor in the formation and development of colorectal carcinoma.

OBJECTIVE: To investigate the role of insulin-like growth factor (IGF)-1 and its receptor (IGF1R) in the formation and development of colorectal carcinoma. METHODS: Colorectal tissue and matching serum samples were collected from patients with adenomatous polyps or carcinoma and healthy control subjects. IGF1R mRNA levels were determined via quantitative real-time reverse transcription-polymerase chain reaction. Serum IGF1 was quantified using enzyme-linked immunosorbent assay. RESULTS: Serum IGF1 concentrations and mucosal IGF1R mRNA levels were significantly higher in patients with adenomatous polyps (n = 24) or carcinoma (n = 13) compared with healthy control subjects (n = 13). There was a significant positive correlation between serum IGF1 and mucosal IGF1R mRNA in patients with adenomatous polyps. CONCLUSIONS: High circulating IGF1 concentrations and mucosal IGF1R expression may play important roles in both the formation and development of colorectal carcinoma. IGF1 and its receptor may be activated before carcinogenesis, and may promote the growth and malignant transformation of adenomatous polyps. IGF1 and IGF1R may be useful biomarkers for evaluating the stage and risk of carcinogenesis.

Value of transrectal ultrasonography for tumor node metastasis restaging in patients with locally advanced rectal cancer after neoadjuvant chemoradiotherapy.

OBJECTIVE: To explore the value of transrectal ultrasonography (TRUS) for tumor node metastasis (TNM) restaging for patients with locally advanced rectal cancer after neoadjuvant chemoradiotherapy (neo-CRT). METHODS: One hundred and forty-nine patients with locally advanced rectal cancer (cT3-4 or cN+) who underwent TRUS after neo-CRT were retrospectively reviewed. TRUS restaging was compared with the results of post-operative pathological TNM findings. RESULTS: After neo-CRT, the accuracy of TRUS for diagnosing T-staging was 30.9%, with 60.4% (90/149) of cases overestimated. The sensitivity of TRUS for T-staging (T0 vs T1 vs T2 vs T3 vs T4) were 16.3%, 0%, 12.5%, 42.6% and 75.0%, respectively. The accuracy of TRUS for diagnosing N-staging after neo-CRT was 81.2%, with the sensitivities of N0 and N+ were 93.3% and 31.0%, respectively. After neo-CRT, 27.5% (41/149) of patients achieved pathologically complete response (pCR). The sensitivity, specificity, positive predictive value and negative predictive values of TRUS for pCR were 17.1%, 99.1%, 87.5% and 75.9%, respectively. CONCLUSIONS: TRUS can be applied for restaging T4 and N0, and has potential for screening out patients with pCR in those with locally advanced rectal cancer after neo-CRT, although some stages are overestimated for T-staging and its sensitivity for predicting pCR is low.

Superficial esophageal lesions detected by endoscopic ultrasound enhanced with submucosal edema.

AIM: To determine if there is consistency between endoscopic ultrasound (EUS) findings and pathological results for detecting lesions of different depth in the esophageal mucosa. METHODS: A canine (Beagle) model was established in which lesions of different depths were created in the esophageal mucosa by thermal burning. Seventy-two hours later, these lesions and adjacent tissue in the esophagus were examined by EUS. EUS findings including infiltrating depth, strength of echogenicity and homogeneity were recorded. Dogs were sacrificed and tissue specimens were obtained. We then compared the EUS findings with the pathology reports. RESULTS: Thermal burns created at different power settings caused lesions of different depth in the esophageal mucosa. When the echo strength was shifted from high, medium, to low echogenicity, an increase in the infiltrating depth of the lesion was noted, which coincided with results of the pathology examination. Obvious submucosal edema visualized by EUS was also detected by pathology. Furthermore, because of the enhancement caused by the submucosal edema, the lesions invading into the submucosa were easily visualized by EUS. CONCLUSION: There is consistency between EUS findings and pathological results of esophageal lesions with different depths. Submucosal edema can serve as an ultrasonic contrast agent.

Managing esophageal fistulae by endoscopic transluminal drainage in esophageal cancer patients with superior mediastinal sepsis after esophagectomy.

The management of postoperative leaks into the mediastinum after esophagectomy remains a challenge. We describe our clinical management of this complication through endoscopic transluminal drainage. Between 2008 and 2011, 4 patients with esophageal squamous cell carcinoma (ESCC) who underwent McKeown-type esophagectomy with two-field lymphadenectomy experienced complicated anastomotic fistulae in the presence of superior mediastinal sepsis. All 4 patients underwent endoscopic transluminal drainage, and all survived. The mean healing period was 50 days (range, 31 to 58 days), the mean stay in the intensive care unit was 7.3 days (range, 1 to 18 days), and the mean hospital stay was 64.5 days (range, 49 to 70 days). Endoscopically guided transluminal drainage should be considered for ESCC patients with superior mediastinal fistulae after esophagectomy.

Primary intestinal non-Hodgkin's lymphoma: a clinicopathologic analysis of 81 patients.

AIM: To analyze the clinicopathologic features and the prognosis of primary intestinal lymphoma. METHODS: Patients were included in the study based on standard diagnostic criteria for primary gastrointestinal lymphoma, and were treated at Sun Yat-sen University Cancer Centre between 1993 and 2008. RESULTS: The study comprised 81 adults. The most common site was the ileocaecal region. Twenty-two point two percent patients had low-grade B-cell lymphoma. Fifty-one point nine percent patients had high-grade B-cell lymphoma and 25.9% patients had T-cell lymphoma. Most patients had localized disease. There were more patients and more early stage diseases in the latter period, and the origin sites changed. The majority of patients received the combined treatment, and about 20% patients only received nonsurgical therapy. The wverall survival and event-free survival rates after 5 years were 71.6% and 60.9% respectively. The multivariate analysis revealed that small intestine and ileocaecal region localization, B-cell phenotype, and normal lactate dehydrogenase were independent prognostic factors for better patient survival. Surgery based treatment did not improve the survival rate. CONCLUSION: Refined stratification of the patients according to the prognostic variables may allow individualized treatment. Conservative treatment may be an optimal therapeutic modality for selected patients.