Low pretreatment serum globulin may predict favorable prognosis for gastric cancer patients.

An elevated serum albumin (ALB) and albumin/globulin ratio (AGR) have been reported to be associated with a favorable prognosis for several types of cancer. However, little is known about prognostic significance of globulin (GLB) in gastric cancer patients. The purpose of this study was to evaluate whether GLB, ALB, and AGR analysis could predict the prognosis of patients with gastric cancer. A retrospective cohort of 186 patients with gastric cancer followed by radical surgery was recruited between January 2007 and December 2010. Levels for preoperative GLB and ALB were obtained and used to calculate the AGR. Survival analysis was used to evaluate the predictive value of GLB, ALB, and AGR. X-tile program determined 37.6, 33.4, and 1.33 as the optimal cutoff value for ALB, GLB, and AGR in terms of survival. Univariate analysis revealed that low GLB levels were significantly associated with favorable survival (P = 0.045). Conversely, low ALB levels were associated with a significantly worse survival (P = 0.000). In conclusion, low preoperative GLB level may serve as a valuable marker to predict the prognosis of gastric cancer patients.

Long-term spatial distribution and implication of black and brown carbon in the Tibetan Plateau.

Black carbon (BC) and brown carbon (BrC) over the high-altitude Tibetan Plateau (TP) can significantly influence regional and global climate change as well as glacial melting. However, obtaining plateau-scale in situ observations is challenging due to its high altitude. By integrating reanalysis data with on-site measurements, the spatial distribution of BC and BrC can be accurately estimated using the random forest algorithm (RF). In our study, the on-site observations of BC and BrC were successively conducted at four sites from 2018 to 2021. Ground-level BC and BrC concentrations were then obtained at a spatial resolution of 0.25° × 0.25° for three periods (including Periods-1980, 2000, and 2020) using RF and multi-source data. The highest annual concentrations of BC (1363.9 ± 338.7 ng/m3) and BrC (372.1 ± 96.2 ng/m3) were observed during Period-2000. BC contributed a dominant proportion of carbonaceous aerosol, with concentrations 3-4 times higher than those of BrC across the three periods. The ratios of BrC to BC decreased from Period-1980 to Period-2020, indicating the increasing importance of BC over the TP. Spatial distributions of plateau-scale BC and BrC concentrations showed heightened levels in the southeastern TP, particularly during Period-2000. These findings significantly enhance our understanding of the spatio-temporal distribution of light-absorbing carbonaceous aerosol over the TP.

[Case Analysis of Heavy Air Pollution Process in Xi'an Using Multi-source Data].

Air pollution continues to be a serious problem in Xi'an. A heavy pollution process and formation mechanism were investigated in Xi'an in January 2019 using multi-source methods (such as material balance and sulfur/nitrogen oxidation rate (SOR/NOR)). The multi-source data included the concentrations of PM2.5, PM10, SO2, NO2, CO, and O3; the chemical components of PM2.5; the meteorological records of ground and vertical observations; the atmospheric reanalysis data. Three phases were obtained including the accumulation phase (P1), maintenance phase (P2), and dispersion phase (P3) during the pollution period. The pollution event was primarily attributed to the superposition of adverse weather conditions and feedback effects. During the periods of P1 and P2, the area of Xi'an was affected by blocking and zonal westerly airflow at 500 hPa (with flat westerly airflow) and uniform-distribution pressure at sea level with a limited pressure gradient and stable weather conditions, and the easterly wind was dominant at 925 hPa; not all of these factors were conducive to the pollutant diffusion. An interaction feedback mechanism between meteorological conditions and heavy pollution could be studied using the ground-based microwave radiometer. The correlations between PM2.5 and inversions of water vapor density, relative humidity, air temperature, and temperature inversion were significant with coefficients of 0.86, 0.62, 0.53, and 0.38, respectively. The feedback mechanism was primarily manifested as follows:with the pollutant accumulation, the radiative cooling effect could lead to or strengthen the occurrence and intensity of temperature inversion, decrease the mixed layer height, and cause moisture accumulation. High humidity could further maintain the pollution by accelerating the secondary formation and promoting the hygroscopic growth of aerosol particles. Therefore, the dominant chemical components to PM2.5were secondary inorganic ions (SO42-+NO3-+NH4+, SNA) and "other" components during the period of P2, with contributions of 43.2% and 23.1%, respectively. In addition, the peak values of PM2.5, SOR, NOR, and the light extinction coefficients all occurred on the same days (January 3 and 6), indicating that the effect of secondary formation was important for both heavy pollution events and visibility. The total contribution of NH4NO3, organic matter (OM), (NH4)2SO4, and EC to the light extinction coefficient was more than 85%. Limited variations in the proportion for components were observed in three phases. During the period of P3, the strong cold air in the mid-lower atmosphere was conducive to the dry and clean air sinking and the pressure gradient at sea level increasing. These were beneficial to the diffusion of air pollutants and water vapor.

Poor prognostic factors in patients with stage I gastric cancer according to the seventh edition TNM classification: a comparative analysis of three subgroups.

BACKGROUND AND OBJECTIVES: The purpose of this study was to investigate the prognosis of stage I gastric cancer and to compare clinicopathologic characteristics by subgroup. METHODS: Between January 2000 and December 2006, 384 patients with gastric cancer were reclassified as stage I according to the seventh edition classification. A comparative analysis was performed between three subgroups. Univariate and multivariate analyses were conducted. RESULTS: The 5-year overall survival rates in T1N0, T1N1, and T2N0 were 98.8%, 94.1%, 91.1%, respectively (P = 0.009). In patients with T2N0 gastric cancer, tumors in the upper third and larger tumors were more common than in patients with T1N0 and T1N1 gastric cancer (P < 0.001). In patients with T1N1 and T2N0 gastric cancer, the presence of lymphatic and/or blood vessel invasion (LBVI) and perineural invasion (PNI) were more common than in patients with T1N0 gastric cancer (P < 0.001). Univariate analysis showed tumor stage, depth of invasion, LBVI, and PNI were significant prognostic factors. However, multivariate analysis demonstrated that only tumor stage, LBVI, and PNI were significant variables. CONCLUSIONS: Survival data support the accuracy of new TNM classification for stage I gastric cancer. Tumor stage, the presence of LBVI and PNI are important independent prognostic factors in stage I gastric cancer.

[Expression of hypoxia-inducible factor 1α in osteosarcoma and its value in predicting chemosensitivity].

OBJECTIVE: To investigate the prognostic values of HIF-1α, APE1, VEGF, and COX-2 protein expressions and their predictive value of tumor necrosis rate and prognosis in osteosarcoma, as well as their interrelationships. METHODS: Formalin-fixed paraffin-embedded tissue samples were obtained from patients with osteosarcoma. Immunohistochemical assay was performed in pre-chemotherapy samples to determine the HIF-1α, VEGF, APE1, and COX-2 protein expression levels. Hematoxylin-eosin staining was used in post-operative samples to determine the tumor necrosis rate. Univariate and multivariate analyses were used to assess the impact of protein expression on prognosis. RESULTS: Tumor tissues were obtained from 49 patients. Their median follow up was 29 months. HIF-1α was significantly correlated to every protein we tested: VEGF (P = 0.032), APE1 (P < 0.001), and COX-2 (P < 0.001). HIF-1α protein expression had a significant impact on disease free survival (P = 0.006). Expression of HIF-1α had a sensitivity of 64.7% and a specificity of 71.9% for poor pathological response (< 90% of tumor necrosis) versus good pathological response to chemotherapy (≥ 90% necrosis). CONCLUSION: Expression of HIF-1α is a predictor of tumor response to neoadjuvant chemotherapy and outcome in osteosarcoma and is correlated with VEGF, APE1, and COX-2 expression.

Fibroblast growth factor receptor 4 regulates proliferation and antiapoptosis during gastric cancer progression.

BACKGROUND: Fibroblast growth factor receptor 4 (FGFR4) belongs to the tyrosine kinase receptor family. Little is known about the effect of FGFR4 on gastric cancer (GC). Therefore, the objective of the current study was to elucidate the role of FGFR4 in the tumorigenesis and progression of GC. METHODS: FGFR4 and some common prognosis markers, including p53, neu, and proliferating cell nuclear antigen (PCNA), were detected in 71 tissue samples from patients with GC using immunohistochemical analysis. In addition, a series of functional assays were carried out using small interfering RNA (siRNA) and included proliferation assays, clone assays, and apoptosis detection. RESULTS: Cytoplasmic FGFR4 expression in GC tissues was negative (7% of samples), low (14.1% of samples), intermediate (40.8%), and high (38% of samples). FGFR4 expression was associated with lymph node status and with PCNA and neu expression (P < .05). The 5-year relative survival rate was 61.5% in patients who had GC with low FGFR4 expression but was only 42% in patients who had high FGFR4 expression (P = .058). A subgroup analysis of the patients who had high FGFR4 expression revealed that those with stage III and IV disease had a worse prognosis (P = .044). Moreover, knockdown of FGFR4 expression led to decreased proliferation and an increased rate of apoptosis in the MKN45 and SGC7901 GC cell lines (P < .05). Western blot analysis demonstrated that the expression of caspase 3 increased, whereas the expression of extra-large B-cell lymphoma (Bcl-xL) decreased in MKN45 and SGC7901 cells after FGFR4-siRNA transfection. CONCLUSIONS: FGFR4 expression in GC tissue was extremely high. The current results indicated that FGFR4 may contribute to the progression of GC by regulating proliferation and antiapoptosis, indicating that FGFR4 may be a potential, novel drug target against GC.

Prognostic analysis of familial gastric cancer in Chinese population.

BACKGROUND: The aim of this study was firstly to elucidate the prognosis of familial gastric cancer (FGC) in Chinese population. METHODS: A total of 162 patients were recruited, including 81 patients with FGC and 81 patients with sporadic gastric cancer (SGC), who underwent gastrectomy between 1996 and 2007. Paraffin-embedded tumor specimens were obtained from tissue bank of Cancer Hospital, Fudan University. The expression of epidermal growth factor receptor (EGFR), P53, C-myc, and proliferating cell nuclear antigen (PCNA) were detected by immunohistochemical method. RESULTS: There were significant differences in tumor size, vessel invasion, EGFR, and P53 expression between FGC and SGC patients. The 5-year survival rates were 48% and 57% in FGC and SGC patients, respectively (P = 0.033). Subgroup analysis showed that the 5-year survival rates were worse in FGC patients with nerve invasion, high PCNA expression, negative expression of EGFR, and positive expression of P53 than those in SGC group. Multivariate analysis showed that AJCC stage, tumor size, and nerve invasion were independent prognostic factors in all patients. Furthermore, AJCC stage and P53 expression dramatically affected the prognosis of FGC patients. CONCLUSIONS: The prognosis of FGC patients might be worse than those of SGC patients. AJCC stage and P53 expression are independent prognostic factors in FGC patients.

Prognostic factors for extra-abdominal and abdominal wall desmoids: a 20-year experience at a single institution.

BACKGROUND AND OBJECTIVE: Previous reports even large studies discussing the prognosis of desmoids have included tumors from intra- and extra-abdominal sites as well as incomplete resection. The purpose of this study was to explore prognostic factors associated with the recurrence free survival (RFS) rate in surgically treated extra-abdominal and abdominal wall desmoids. PATIENTS AND METHODS: A total of 198 consecutive desmoid patients were treated with surgery over a 20-year period at a single institution. Of these, 151 patients with extra-abdominal and abdominal wall tumors were retrospectively reviewed. One hundred thirteen patients were referred for the primary tumor and the other 38 for recurrent disease initially treated elsewhere. All patients underwent a macroscopically complete resection. RESULTS: The median follow-up interval was 102 months. Thirty-one patients (20.5%) had a local recurrence (LR). No patients died of the disease. The 5- and 10-year RFS was 79.7% and 78.5%, respectively. Admission status, gender, tumor size, margin status, location, and number, were predictors of LR in univariate analysis. Tumor size and margin status were independent prognostic factors in multivariate analysis. Positive margins were predictive of recurrence of primary disease, and also showed a trend for recurrent disease, which was not statistically significant. The selective use of adjuvant radiation did not show significant benefit over local control. CONCLUSIONS: Regardless of primary or recurrent disease, microscopically negative margins should always be the goal for extra-abdominal desmoids surgery, if no cosmetic defects or function demolition is encountered. Extra-abdominal desmoids deserve more attention and should be treated more aggressively, especially when leaving positive margins.

Study on the different expression of molecular markers between cardiac cancer and distal gastric cancer and their correlations with clinicopathological features.

BACKGROUND AND AIM: Currently, few studies have reported the different expression of molecular markers between distal gastric cancer and cardiac cancer. Here, we sought to make an investigation about it by a retrospective analysis. METHODS: The expression of 8 proteins, including epidermal growth factor receptor, glutathione S-transferase pi (GST-pi), cyclin D1, Neu/Her-2, C-myc, p53, p27 and p21, were evaluated in 110 cases with cardiac cancer and 101 cases with distal gastric cancer who underwent curative surgery at the Cancer Hospital, Fudan University, in 2005 by immunohistochemistry method. RESULTS: The TNM stage, differentiation grade, invasion depth and lymph node metastasis were significantly different between cardiac cancer and distal gastric cancer. p21 (p = 0.034), Neu (p = 0.017), and GST-pi (p = 0.003) were expressed in relatively higher levels in cardiac cancer than in distal gastric cancer. Furthermore, the clinical pathological parameters were significantly correlated with the expression of molecules mentioned above. CONCLUSION: Different molecular mechanisms may be involved in the tumorigenesis and development of cardiac cancer and distal gastric cancer.

[Differential expression of immunohistochemical markers between cardiac carcinoma and carcinoma in antrum of stomach and correlation thereof with clinicopathological factors].

OBJECTIVE: To study the differences in expression of several common immunohistochemical markers: epidermal growth factor receptor (EGFR), topoisomerase II (TOPOII), glutathione S-transferase pi (GST-pi), proliferation cell nuclear antigen ( PCNA), Her-2/Neu, P27, P21, and P53, between cardiac carcinoma and carcinoma in antrum of stomach and the correlation thereof with clinicopathological factors. METHODS: 211 paraffin-embedded tissue samples of gastric cancer were randomly chosen from the patients of cardium and stomach operated in 2005, including 110 cases of cardiac carcinoma and 101 cases of carcinoma in antrum of stomach. Immunohistochemical Envision two step method was used to detect the expression of the above mentioned markers. RESULTS: Compared to the cardiac carcinoma, the carcinoma in antrum of stomach showed higher rate of clinicopathological staging was significantly higher, degree of differentiation lower, invasion deeper, and degree of lymph node metastasis higher (all P < 0.05). The expression rates of P21, Her-2/Neu, and GST-pi of the cardiac carcinoma group were 80.0% (88/110), 30.9% (34/110), and 92.7% (76/82) respectively, all significantly higher than those of the carcinoma in antrum of stomach group [67.0% (65/97), 16.7% (16/96), and 74.5% (41/55) respectively, P = 0.034, 0.017, and 0.003 respectively]. In the cardiac carcinoma, P21 expression was positively correlated with the expression of P27 and EGFR, the P27 expression was positively correlated with the expression of EGFR and TOPOII, and the GST-pi expression was positively correlated with the TOPOII expression (r = 0.255, P = 0.021). In the antrum of stomach carcinoma, GST-pi expression was positively correlated with the expression of EGFR, TOPOII, and Her-2/Neu, however, it was negatively correlated with the expression of PCNA, and the P27 expression was positively correlated with the P53 expression (r = 0.275, P = 0.042). CONCLUSION: Different molecular mechanisms may lead to the tumorigenesis and development of stomach carcinoma at different sites.

The analysis of status and clinical implication of KIT and PDGFRA mutations in gastrointestinal stromal tumor (GIST).

BACKGROUND AND OBJECTIVE: To analyze the frequency and spectrum of KIT and platelet-derived growth factor receptor-alpha (PDGFRA) gene in a large series of study and to explore the clinical implication of mutations in the gastrointestinal stromal tumors (GISTs) in China. METHOD: A total of 141 GISTs were subject to mutation analysis of KIT (exons 9, 11, 13, and 17) and PDGFRA (exons 12 and 18) using PCR amplification and direct sequencing. Clinicopathologic characteristics were correlated to gene mutations. RESULTS: Of the 141 tumors studied, approximately 76.6% had KIT gene mutations, 2.8% had PDGFRA gene mutations and 20.6% had a wild-type gene of KIT and PDGFRA. Among those with KIT gene mutations, 70.2% occurred in exon 11, 5.7% in exon 9, 0.7% in exon 13, and no mutation was detected in exons 17. The most frequent sites of mutation were in exon 11 and the mutations clustered in the classic "hot spot" at the 5'end of the exon mostly heterogeneous and the second "hot spot" were internal tandem duplications (ITD) at the 3'end of the exon. The overall mutation rate was significantly lower in GISTs originated from colorectum or extra-gastrointestinal tract (chi(2) = 6.728, P = 0.009; chi(2) = 4.059, P = 0.044), however, mutation rate on exon 11 was significantly increased in gastric stromal tumor (chi(2) = 5.713, P = 0.017; chi(2) = 4.341, P = 0.037). There were no significant differences in terms of age, gender, tumor size, mitotic counts, grade of malignant potential and liver metastasis in patients with or without gene mutations. CONCLUSION: KIT and PDGFRA gene were frequently found in patients with GISTs. Gene mutation rate varies in originated organ.

[Clinical analysis of 168 cases of multiple primary colorectal carcinoma].

OBJECTIVE: To study the incidence rate of multiple primary colorectal carcinomas (MPCC) in colorectal carcinoma and to evaluate its clinical and pathological characteristics. METHODS: One hundred and sixty-eight (4.6%) patients from 3663 cases with colorectal carcinoma were diagnosed with MPCC from January 1985 to December 2003. The clinical data of the patients were collected retrospectively to investigate the diagnosis and treatment of MPCC. RESULTS: Of the 168 patients, 81 were diagnosed as synchronous colorectal carcinoma (SC), 72 with metachronous colorectal carcinoma (MC), 15 with both SC and MC. The median age at time of diagnosis of colorectal carcinoma was 58 years old (range from 20 to 82 years old). Three hundred and ninety-three cancer lesions were detected in these 168 cases (mean, 2.3 lesions/case). The rectum and sigmoid colon were the most involved sites (61.6%). Eighteen cases (10.7%) were verified with hereditary non-polyposis colorectal cancer (HNPCC) while another 9 cases were highly suspected. Fourteen patients (8.3%) were found with other malignancies out of large intestine, 41 patients (24.4%) with colorectal adenomas, 72 (42.9%) with adenoma carcinogenesis. Among the 96 SC patients, 91 were given preoperative colonoscopy and 65 (71.4%) got the diagnosis. All the MC patients were diagnosed by postoperative colonoscopy. The overall 5-year survival rate of the 168 patients was 69.8%. CONCLUSIONS: MPCC should be paid more attention in colorectal cancer management. Colonoscopic surveillance is much more important in diagnosis and follow-up of MPCC for reducing the misdiagnosis of SC and detecting more MC in time. Prompt treatment of adenoma can reduce the occurrence of MPCC, and active and standard surgical treatment should be done for MPCC.

[Correlation between dissection of lymph nodes adjacent to mesenteric artery pedicle and prognosis in colorectal cancer patients].

OBJECTIVE: To analyze the impact of radical surgery with different extent of lymph nodes dissection on the prognosis of colorectal carcinoma patients and to see if lymph nodes adjacent to mesenteric artery root should be excised. METHODS: Data of 1409 cases with colorectal carcinoma treated in Shanghai Cancer Hospital during 1985-2000 were collected. These patients had primary colorectal carcinoma treated by radical surgery with different extent of lymph nodes excision. They were divided into two groups: in group D3 the lymph nodes adjacent to mesenteric artery root were excised (n = 857), while in group D2 (n = 552) were not. The time of follow-up was 6 approximately 289 months (median: 48 months). RESULTS: The 1-, 3-, 5-, 10-year total survival rates (TS) in group D3 patients were 90.3%, 81.4%, 77.0% and 73.0%, respectively. The 1-, 3-, 5-, 10-year tumor-free survival rates (TFS) in group D3 patients were 89.9%, 79.4%, 74.5% and 70.3%, respectively. In group D2 patients, the 1-, 3-, 5-, 10-year TS were 91.04%, 84.12%, 79.33% and 76.17%, and those of TFS were 90.0%, 82.7%, 76.0% and 71.8%, respectively. The differences in TS and TFS in the two groups of patients were not significant according to Kaplan-Meier analysis (P > 0.05). During the follow-up period, 42 patients in group D3 had local recurrence (4.9%), while in group D2 the rate of local recurrence was 5.4% (P > 0.05). Metastases developed in 79 cases in group D3 and in 60 cases in group D2 (P > 0.05). Multivariate analysis revealed that the excision of lymph nodes adjacent to mesenteric artery pedicle did not statistically correlate with recurrence, metastasis and survival time after radical operation of colorectal cancer. CONCLUSION: Excision of lymph nodes adjacent to the mesenteric artery root has no significant impact on prognosis and is unnecessary in the radical surgery for colorectal carcinoma.

Effect of short-chain fatty acids on the proliferation and differentiation of the human colonic adenocarcinoma cell line Caco-2.

OBJECTIVE: Short-chain fatty acids (SCFA) in the colon may maintain colonocyte differentiation and oppose carcinogenesis. The purpose of this study was to investigate the effects of three SCFA, butyrate, propionate and acetate, on the differentiation, proliferation, and matrix interactions of the Caco-2 human colonic adenocarcinoma cell line. METHODS: Differentiation was assessed by brush border enzyme expression and the doubling time (proliferation) was calculated directly from serial cell counts and by the logarithmic transformation method. Cell motility (migration) was quantitated by the expansion of a confluent Caco-2 monolayer (after release from a constraining fence) across bacteriologic plastic dishes precoated with saturating concentrations of type I collagen. Results were expressed as mean +/- SE and were analyzed by ANOVA and Bonferroni's modified t-test. RESULTS: All three SCFA studied altered the Caco-2 phenotype. Treatment with 10 mmol SCFA significantly prolonged the cell doubling time, promoted brush border enzyme expression (cathepsin C), and inhibited the motility of the Caco-2 cells. CONCLUSIONS: Butyrate, propionate and acetate inhibited the proliferation and motility of a well-differentiated human colonic cancer cell line while promoting the expression of the differentiation marker, cathepsin C. Thus the SCFA produced by bacterial fermentation of dietary fiber may exert a protective effect against the development of colon cancer.

[Experience and discussion on treatment of high-grade soft tissue sarcomas of crura in youth].

OBJECTIVE: To summarize the experience and investigate better method on treatment of high-grade soft tissue sarcomas of crura in youth. METHODS: Six young cases suffered from high-grade soft tissue sarcomas of crura were treated by interpolatory chemotherapy using vindesine 4mg or vincristine 2 mg combined with cisplatin 40 - 60 mg and 4'-Epidoxorubicin (4'-epi-ADM) 50 - 80 mg. There were 3 males and 3 females, and their ages rang from 12 to 23. The primary tumor locations were: calf in 4, thigh in 1, popliteal fossa in 1. The pathological type of these 6 cases were: 1 small round cell tumor from soft tissue, one rabdomyosarcoma, one alveoliar soft part sarcoma, one synovial sarcoma, one primitive neuroectodermal tumor and one without classification. All cases received interpolatory chemotherapy twice. Before their receiving interpolatory chemotherapy they had no tumor metastases. The maximum diameters of tumors rang from 4 - 15 cm. One patient's tumor disappeared after interpolatory chemotherapy and she received no further therapy. The other 5 cases received operations and one of them received additional pre-operational radiotherapy using Co(60) and pre-operational systemic chemotherapy using ifosfamide and dacarbazine. RESULTS: The tumors dwindled in size of 1 - 8 cm after interpolatory chemotherapy. All cases saved their crura and had normal functions. After interpolatory chemotherapy, all patients suffered from edema and ache of crura. One patient suffered from lymphatitis. All these patients were followed up for 6 - 20 months. All of them were alive and had pigmentations on their crura. A lung metastasis was found in 1 patient by CT 2 months after surgery, then he was in hospital and treated by chemotherapy. CONCLUSIONS: For treatment of high-grade soft tissue sarcomas of crura which are difficult to resect in youth, interpolatory chemotherapy is a good choice.

[Clinical analysis of 251 cases of soft tissue sarcomas].

OBJECTIVE: To explore the therapeutic principles and prognostic factors of soft tissue sarcoma. METHODS: Two hundred and fifty-one patients with soft tissue sarcoma (STS) treated at Shanghai Cancer Hospital during 1986 - 1990 were reviewed retrospectively. RESULTS: The 1-, 3-, 5-, 10-year tumor-free survival rates were 67.74%, 57.16%, 52.41%, 38.60%, respectively. The overall survival rates for 1, 3, 5 and 10 years were 81.01%, 67.75%, 60.79%, and 49.23% respectively. Log-rank test showed that the patients with different pathological findings, histological grades, mass location and size, anatomical depth, and surgical margin showed different outcomes. Whether the sarcomas invaded the vessels or metastasized would influence the survival rates. The patients who underwent different interventions or operations also had different outcomes. The prognosis of STS was associated with age, histological type, histological grade, tumor size, surgical margin and metastasis according to the Cox regression analysis. CONCLUSION: During the treatment of STS, wide-resection, especially 3-dimensional resection, comprehensive treatment and individualized treatment should be advocated.

[Realization of clinical diagnoses and treatment for dermatofibrosarcoma protuberans].

OBJECTIVE: To emphasize the importance of correct and standardized surgical treatment on dermatofibrosarcoma protuberans (DFSP), and discuss the suitable synthesized therapy on it. METHODS: 163 cases of DFSP, which were treated between January 1985 and September 2002,were submitted to a retrospective study. RESULTS: Among the 163 cases, 150 (92.0%) were treated with local excision as benign tumors before accepted to Cancer Hospital, Fudan University. 69 cases (46.0%) were approved by pathological examination to have tumor remnants after they were treated with wide excision, and 49 (71.0%) of them couldn't be found to have any tumor remnants by physical examination or B-ultrasonic examination before that operation. It was easy for the tumor to recur after excision, especially the local excision. The recurrent rate after it was 45.1%, which was much higher than the one after wide excision (5.6%). Among the 142 cases which wide excision were performed, 99 ones had excision margins >/= 3 cm and 5 of them (5.1%) developed local recurrence while 36 ones had excision margins 1 approximately 2 cm and 3 of them (8.3%) developed local failure. 46 cases (32.4%) were given skin graft, 11 cases were given flap, and 1 case had dacron mending in skin defection area. The main complications after these operations were necrosis of the skin flap (20 cases) and infection of the wound (6 cases). They could all be cured in 2 months. 17 cases were given complimentary radiotherapy with the dose range from 3275 cGy to 7000 cGy because of their recurrences for times or positive resection margins after wide excision. Only one case had wet molting after radiotherapy and 2 developed local recurrence. Among all the 163 cases, only 2 (1.2%) were dead, and 1 of them was died of metastasis of lung and liver. 2 cases got lymph node metastasis, then were given surgical treatment and still alive now. 13 cases (8.0%) were DFSP-FS with their malignancies increased. 11 of them were the recurrent ones after local excision or wide excision. CONCLUSIONS: In order to avoid misdiagnosis, it is necessary for the clinician to know much about DFSP. Once the tumor was diagnosed of DFSP after local excision, it is necessary to take wide excision. Because DFSP is a malignancy of a high recurrent rate after local excision, standardized wide excision is the key in reducing local failure. Adjuvant radiotherapy is an effective treatment for the patients with positive resection margin or the patients don't suit for surgical treatment. The DFSP-FS need to use more energetic treatment in curing it.

Prognostic factors influencing event-free survival and treatments in desmoid-type fibromatosis: analysis from a large institution.

BACKGROUND: Prognostic factors and optimal management of desmoid tumors have been discussed for decades. The authors present the results of a large series of patients with desmoid tumors treated at a single institution to investigate the prognostic factors influencing event-free survival (EFS) and suitable treatments for these rare tumors. METHODS: Two hundred fourteen patients with desmoid tumors admitted to the surgical department were included, of whom 20 were recommended for a policy of watchful waiting. The following clinical parameters were studied: admission status, age, sex, tumor site, tumor size, margin status, and therapeutic strategy. Univariate and multivariate analysis were performed for EFS. RESULTS: Forty-two patients had local recurrence. One patient died of intra-abdominal disease. The 5-year and 10-year EFS rates were 78.8% and 77.9%, respectively. In univariate analysis, admission status, tumor site, tumor size, and group (R0 vs R1 and R0 vs R2) had significant impacts on EFS. EFS discrepancy was not significant between R1 and R2 or biopsy groups. In multivariate analysis, tumor size and admission status had independent value. The median delay to progression for patients undergoing watchful waiting was comparable with that for the surgical group. CONCLUSIONS: This study demonstrates that tumor size and a history of recurrence are independent predictors of EFS. Surgery is warranted if it can be R0 and function sparing. Nonsurgical modalities or a policy of watchful waiting may be a better choice for unresectable disease.

Is there a role of surgery in patients with recurrent or metastatic gastrointestinal stromal tumours responding to imatinib: a prospective randomised trial in China.

OBJECTIVES: For advanced gastrointestinal stromal tumour (GIST) patients who are responding to imatinib mesylate, the role of surgery has not been formally demonstrated. This multicenter randomised controlled trial was designed to assess whether surgery to treat residual disease for patients with recurrent/metastatic GISTs responding to imatinib mesylate (IM) improved progression free survival (PFS) compared with IM treatment alone. METHODS: Between 3 and 12months after starting IM for recurrent/metastatic GISTs, eligible patients were randomised to two arms: Arm A (surgery for residual disease) and Arm B (IM treatment alone). In Arm A (19pts), surgery was performed to remove residual macroscopic lesions as completely as possible, and IM treatment continued after surgery. In Arm B (22pts), IM was given alone at a dose of 400mg per day until disease progression. The primary end-point was PFS measured from the date IM started. This study was registered in the ChiCTR registry with the ID number ChiCTR-TRC-00000244. RESULTS: This randomised trial was closed early due to poor accrual. Only 41 patients were enrolled as opposed to 210 patients planned. 2-year PFS was 88.4% in the surgery arm and 57.7% in the IM-alone arm (P=0.089). Median overall survival (mOS) was not reached in the surgery arm and 49months in patients with IM-alone arm (P=0.024). CONCLUSIONS: While no significant differences were observed in the two arms, this study suggests that surgical removal of the metastatic lesion may improve the outcome of advanced GIST patients and should stimulate additional research on this topic.