Predictors of lymph-node metastasis in surgically resected T1 colorectal cancer in Western populations.

BACKGROUND: The risk of lymph-node metastasis (LNM) in T1 colorectal cancer (CRC) has not been well documented in heterogeneous Western populations. This study investigated the predictors of LNM and the long-term outcomes of patients by analysing T1 CRC surgical specimens and patients' demographic data. METHODS: Patients with surgically resected T1 CRC between 2004 and 2014 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Patients with multiple primary cancers, with neoadjuvant therapy, or without a confirmed histopathological diagnosis were excluded. Multivariate logistic-regression analysis was used to identify the predictors of LNM. RESULTS: Of the 22,319 patients, 10.6% had a positive lymph-node status based on the final pathology (nodal category: N1 9.6%, N2 1.0%). Younger age, female sex, Asian or African-American ethnicity, poor differentiation, and tumor site outside the rectum were significantly associated with LNM. Subgroup analyses for patients stratified by tumor site suggested that the rate of positive lymph-node status was the lowest in the rectum (hazard ratio: 0.74; 95% confidence interval: 0.63-0.86). CONCLUSION: The risk of LNM was potentially lower in Caucasian patients than in API or African-American patients with surgically resected T1 CRC. Regarding the T1 CRC site, the rectum was associated with a lower risk of LNM.

Impact of Site-Specific Metastases on Surgical Value and Survival among Metastatic Colorectal Cancer Patients.

We aimed to explore the potential prognostic impact of the metastatic site on the management approach and prognosis of stage IV colorectal cancer patients with synchronous metastases. Synchronous metastatic colorectal cancer patients reported to the Surveillance, Epidemiology, and End Results Program database between 2010 and 2013 were included in this study. Overall survival (OS) was compared between patients with different treatment options using risk-adjusted Cox proportional hazard regression models. Overall, 17,776 patients with stage IV colorectal cancer were identified. Of these patients, 2,052 (11.5%) underwent surgical resection for tumors at both the primary and metastatic sites. Patients who underwent surgical resection of both primary and metastatic sites with liver, lung, and simultaneous liver and lung metastases had a longer median OS (P < 0.001) than patients who underwent nonsurgical treatments. Cox regression analysis revealed that surgical resection of both primary and metastatic sites was associated with a significantly enhanced OS (P < 0.001). Colorectal cancer patients with hepatic or pulmonary metastases, who underwent metastasectomy, even in selected patients with both hepatic and pulmonary metastases after multidisciplinary evaluation, could have a better survival benefit than patients who underwent nonsurgical treatments.

[Comparison of Polycaprolactone and Poly-3-hydroxybutyrate-co-3-hydroxyvalerate for Nitrogen Removal].

Two types of biodegradable polymers, polycaprolactone (PCL) and poly-3-hydroxybutyrate-co-3-hydroxyvalerate (PHBV), were used as a denitrification slow-release carbon source and a microbial carrier. By comprehensively comparing their performances in denitrification, carbon release, surface morphology, and material composition as well as their microbial community characteristics, the PHBV was determined as the better performer. It had a shorter denitrification start time, a higher denitrification rate, a lower residual organic matter concentration, and a more stable and sustained denitrification performance than PCL. This is because its surface was rough and contained large amounts of hydrophilic groups such as C-O and C=O, which is easily attached and degraded by microorganisms. As a result, the microorganisms on its surface were diverse. The dominant ones were identified with heterotrophic denitrification potentials, such as Thiothrix, Pseudomonas, Zoogloea, Flavobacterium, and Dechloromonas. Therefore, PHBV is suitable as a carbon source medium for tertiary nitrogen removal.

TNM Staging of Colorectal Cancer Should be Reconsidered According to Weighting of the T Stage: Verification Based on a 25-Year Follow-Up.

The gradient monotonicity of existing tumor, node, metastases staging systems for colorectal cancer is unsatisfactory. Our proposed T-plus staging system strengthens weighting of the T stage. In this study, applicability of the T-plus staging system was verified with data of a Chinese colorectal cancer center.Records of 2080 nonmetastatic, advanced cancer patients undergoing colorectal cancer surgery from 1985 to 2011 were reviewed for T, N stage pathology and follow-up information. Using overall and disease-specific survival data, the 7th edition tumor, node, metastases staging system and the T-plus staging system were compared for stage homogeneity and discrimination and gradient monotonicity.For gradient monotonicity, the T-plus staging system was superior for both colon and rectal cancer. With Kaplan-Meier survival curves, the T-plus staging system discriminated among different stages, and the corresponding survival was inversely associated with the stage. However, for the 7th edition tumor, node, metastases staging system, stage IIIa had a better prognosis than stage II for rectal cancer and stage I for colon cancer. For homogeneity within the same stage and discrimination between different stages, the 2 staging systems were similar for colorectal cancer, but the T-plus system was clearly better for colon cancer.The T-plus staging system provides good gradient monotonicity. For future colorectal cancer staging systems, we propose replacement of lymph node status as the criterion to discriminate colorectal cancer stage II and stage III with greater weighting of the T stage.

Feasibility and accuracy of sentinel lymph node biopsy in clinically node-positive breast cancer after neoadjuvant chemotherapy: a meta-analysis.

Sentinel lymph node biopsy (SLNB) has replaced conventional axillary lymph node dissection (ALND) in axillary node-negative breast cancer patients. However, the use of SLNB remains controversial in patients after neoadjuvant chemotherapy (NAC). The aim of this review is to evaluate the feasibility and accuracy of SLNB after NAC in clinically node-positive patients. Systematic searches were performed in the PubMed, Embase, and Cochrane Library databases from 1993 to December 2013 for studies on node-positive breast cancer patients who underwent SLNB after NAC followed by ALND. Of 436 identified studies, 15 were included in this review, with a total of 2,471 patients. The pooled identification rate (IR) of SLNB was 89% [95% confidence interval (CI) 85-93%], and the false negative rate (FNR) of SLNB was 14% (95% CI 10-17%). The heterogeneity of FNR was analyzed by meta-regression, and the results revealed that immunohistochemistry (IHC) staining may represent an independent factor (P = 0.04). FNR was lower in the IHC combined with hematoxylin and eosin (H&E) staining subgroup than in the H&E staining alone subgroup, with values of 8.7% versus 16.0%, respectively (P = 0.001). Thus, SLNB was feasible after NAC in node-positive breast cancer patients. In addition, the IR of SLNB was respectable, although the FNR of SLNB was poor and requires further improvement. These findings indicate that IHC may improve the accuracy of SLNB.

Clinical characteristics and prognosis of young patients with colorectal cancer in Eastern China.

AIM: To explore the clinical characteristics and prognosis of young patients with colorectal cancer patients in Eastern China. METHODS: A total of 1335 patients with colorectal cancer treated from December 1985 to December 2005 at the Second Affiliated Hospital of Zhejiang University School of Medicine were studied retrospectively. The patients were divided into two groups, a younger group (aged ≤ 30 years) and an older group (aged > 30 years), and comparison was made in the clinical characteristics and prognosis between the two groups. Chi-square test was used for data analysis of all categorical variables, and overall survival (OS) was calculated by the Kaplan-Meier method. A multivariate analysis was performed using the Cox model. RESULTS: There were 42 (3.1%) and 1293 (96.9%) cases in the younger group and older group, respectively. Univariate analysis showed that the 5- and 10-year OS in the younger group were 33.9% and 26.1%, respectively, and those in the older group were 60.1% and 52.2%, respectively. Younger group had poor survival (χ(2) = 14.146, P = 0.000). Multivariate analysis revealed that age was not a dependent factor for prognosis (OR = 0.866, 95%CI: 0.592-1.269, P = 0.461). Stratified analysis indicated that in stage III and IV disease, the 5- and 10-year OS were 24.6% and 14.8% in the younger group, and 40.4% and 33.3% in the older group, respectively, with a significant difference between the two groups (χ(2) = 5.101, P = 0.024). In the subgroup of radical surgery, the 5- and 10-year OS were 44.3% and 34.2% in the younger group, and 69.6% and 60.5% in the older group, with a difference being significant between the two groups (χ(2) = 7.830, P = 0.005). CONCLUSION: Compared with older patients, the younger patients have lower survival, especially in the subgroups of stage III and IV disease and radical surgery.