[Prognostic values of stromal tumor-infiltrating lymphocytes and lymphocyte-activation gene-3 in advanced gastric adenocarcinoma].

Objective: To analyze density of stromal tumor-infiltrating lymphocytes (sTIL) and expression of lymphocyte-activation gene-3 (LAG-3) protein in advanced gastric adenocarcinomas, and to investigate the correlation of sTIL and LAG-3 with the prognosis in patients with advanced gastric adenocarcinoma. Methods: The clinicopathological characteristics and follow-up data of 260 patients with advanced gastric adenocarcinoma were collected at Fujian Cancer Hospital, from January 2011 to December 2014. The percentage of sTILs was reported semi-quantitatively using histological section evaluation, the LAG-3 protein was detected using immunohistochemistry, and the expression was correlated with the clinicopathological features and patient outcomes. Results: Among the 260 cases, high density of sTIL was detected in 173 cases (66.5%) while LAG-3 high expression was observed in 160 cases (61.5%). These cases were divided into four groups. Group Ⅰ: 48 cases (18.5%) were sTIL low/LAG-3 low; group Ⅱ: 52 cases (20.0%) were sTIL high/LAG-3 low; group Ⅲ: 39 cases (15.0%) were sTIL low/LAG-3 high; group Ⅳ: 121 cases (46.5%) were sTIL high/LAG-3 high. Kaplan-Meier survival analyses showed that patient prognoses were related to age, tumor size, tumor location, Lauren classification, perineural invasion, vascular invasion, TNM staging, postoperative adjuvant chemotherapy and molecular classification (P<0.05). Meanwhile, higher densities of sTIL and higher expression of LAG-3 were associated with better prognosis. Multivariate survival analysis showed age, tumor size, Lauren classification and postoperative adjuvant chemotherapy were independent prognostic factors for patient survival. The results showed a poor prognosis in low-sTIL/low-LAG-3 patients. Conclusions: Compared with low density of sTIL and low expression of LAG-3, high density of sTIL and high expression of LAG-3 are associated with better outcomes in patients with advanced gastric adenocarcinoma, respectively. Combined detecton of sTIL and LAG-3 may be more useful in gastric cancer than using either alone. Age, tumor size, Lauren classification and postoperative adjuvant chemotherapy are independent prognostic factors for patients with advanced gastric adenocarcinoma.

[Giant cell reparative granuloma originating from the paranasal sinus: a case report].

A 40-year-old man presented with a 10-year history of nasal obstruction of his left nose, a 1-year history of headache and orbital pain. Radiologically, an extensive paranasal sinus mass was seen. Superiorly ,the cribriform plate was demineralized, and the lesion had intracranial extension with mild mass effect over the basal frontal lobes. Histologic examination revealed a central giant cell reparative granuloma. After endoscopic removal, the patient was symptom free at the 2-month follow-up.

Long-term outcome of resection of large hepatocellular carcinoma.

BACKGROUND: The role of hepatectomy in the treatment of large hepatocellular carcinoma (HCC) is still controversial. This retrospective study evaluated whether the long-term outcome of hepatectomy for large HCC improved over 14 years in one centre. METHODS: Data from 2102 patients who underwent hepatectomy for large HCC were collected prospectively and divided into two time intervals for analysis: before end of December 1996 (group 1) and after December 1996 (group 2). Clinicopathological data for the two groups were compared, and factors associated with long-term prognosis were further analysed. RESULTS: Cumulative 1-, 3- and 5-year overall survival rates were 71.2, 58.8 and 38.7 per cent respectively in group 2, and were significantly better than respective rates of 67.8, 50.7 and 27.9 per cent in group 1. Cumulative 1-, 3- and 5-year disease-free survival rates were 61.5, 38.6 and 23.8 per cent respectively in group 2, and 56.5, 34.7 and 18.9 per cent in group 1. There was a significant difference in median survival time after recurrence between groups 2 and 1 (17 and 10 months respectively; P = 0.043). CONCLUSION: Hepatic resection in patients with large HCC has improved overall and disease-free survival during the past decade at this institute. Long-term survival can be improved significantly by aggressive treatment of recurrent tumours.

Use of hepatectomy and splenectomy to treat hepatocellular carcinoma with cirrhotic hypersplenism.

BACKGROUND: The aim of this study was to compare the outcome after simultaneous hepatectomy and splenectomy with that after hepatectomy alone for hepatocellular carcinoma with associated hypersplenism. METHODS: Two hundred and four patients with hepatocellular carcinoma and cirrhotic hypersplenism were divided non-randomly into two groups. Ninety-four underwent simultaneous hepatectomy and splenectomy and 110 underwent hepatectomy alone. White blood cell (WBC) and platelet counts, total serum bilirubin levels, immune function, incidence of complications and 5-year survival rates in the two groups were compared. RESULTS: WBC and platelet counts, distribution of T cell subsets, and levels of bilirubin, interferon gamma and interleukin 2 were different between the two groups after operation. All patients who underwent hepatectomy and splenectomy but only 15.5 per cent of those who had hepatectomy alone completed adjuvant chemotherapy. The 5-year tumour-free survival rate was significantly higher after hepatectomy and splenectomy than after hepatectomy alone (37 versus 27.3 per cent; P = 0.003), although overall survival rates were similar. CONCLUSION: Simultaneous hepatectomy and splenectomy was associated with improved 5-year tumour-free survival in patients with hepatocellular carcinoma and hypersplenism.

Chinese experience with hepatectomy for huge hepatocellular carcinoma.

BACKGROUND: The risks and outcome of hepatic resection for huge hepatocellular carcinoma (HCC) are controversial. METHODS: The clinical records of 525 patients who underwent resection of HCC greater than 10 cm in diameter were studied retrospectively. Prognostic factors for long-term survival were evaluated by univariate and multivariate analyses. RESULTS: Postoperative complications were common (26.8 per cent) and five patients (0.9 per cent) required relaparotomy. The 30-day mortality rate was 2.7 per cent. The main causes of postoperative death were liver failure (nine patients) and bleeding (four). The 3-, 5- and 10-year crude survival rates after liver resection were 34.3, 16.8 and 2.9 per cent respectively. CONCLUSION: Prognostic factors for long-term survival mainly reflected the biological behaviour of the tumour. They can be used only as a guide in balancing the risks of operation against the potential benefits of resection in a patient in poor general condition or with poor liver function. They cannot be used alone to exclude patients from liver resection with curative intent. Liver resection for huge HCC was safe and efficacious. It should be used to treat patients with acceptable surgical risks and resectable tumours.

Construction of retroviral vector carrying HSV-tk gene under control of human AFP enhancer core sequence and human pgk promotor.

AIM: To construct retroviral vector bringing HSV-tk gene under control of human AFP enhancer core sequence and human pgk promoter. METHODS: Internal SV40 promoter was deleted by SalI from retroviral vector pMNSM to construct pMNM. HSV-tk gene driven by pgk promoter was released by BamH I from an eukaryotic expression vector pBPGK-tk, and inserted into polylinker site of pMNM to construct pMNP-tk retroviral vector. Human α-fetoprotein gene enhancer core sequence was released by EcoR I from pGEM. 7Z-AFPe plasmid was inserted into the immediate upstream of pgk promoter of pMNP-tk vector. Construction of hepatoma specific retroviral vector pMNAP-tk was completed. RESULTS: The structure of pMNP-tk and pMNAP-tk vector was confirmed by restriction analysis. CONCLUSION: The vector is of great significance for hepatoma specific prodrug transformation gene therapy.

The retrospective study on high risk factors of subphrenic infection after hepatectomy.

In order to identify the high risk factors that determine subphrenic infection after hepatectomy, 187 liver resections performed during January, 1985 to December, 1990 in Department of Surgery of Tongji Hospital were reviewed. Thirteen patients developed subphrenic infection with the incidence of subphrenic infection being 6.95%. The results of retrospective study on 187 liver resections demonstrated that the high risk factors related to subphrenic infection after hepatectomy were as follows: (1) The extent of liver resection was associated with subphrenic infection. (2) The incidence of subphrenic infection after liver resection of primary liver cancer patients with hepatic cirrhosis was higher than that of non-cirrhotic patients. (3) Intraoperative estimated blood loss greater than 1500 ml was found to be a significant risk factor in the development of postoperative subphrenic infection. (4) Adequate postoperative drainage of subdiaphragm and the raw surface of the liver was one of critical factors of decreasing subphrenic infection after liver resection.

[Surgical management of hepatic trauma].

In the past 37 years, 207 patients with hepatic injuries were managed in our hospital. Of them, 5 patients died during the preparation for emergency laparotomy. 191 patients were surgically treated, with 11 (5.8%) postoperative deaths, while all 11 patients treated nonsurgically were cured. Finally, we discussed operative methods of hepatic injuries and indications for conservative therapy.

Pharmacokinetics of mitomycin C following hepatic arterial chemoembolization with gelfoam.

Twelve mongrel dogs were randomly allocated into two groups using matched paired-design. Catheters were inserted into the hepatic artery, hepatic vein and the femoral vein, respectively. In the first group, gelfoam supplemented with mitomycin C (MMC) was injected into the hepatic artery, whereas the second group received a hepatic arterial injection of MMC solution alone. Simultaneous blood sampling from the hepatic and femoral vein at regular intervals was performed. MMC concentrations in plasma was determined using high performance liquid chromatography (HPLC) and the pharmacokinetics of MMC were determined. MMC concentrations in hepatic and femoral veins did not differ and no significant difference in pharmacokinetics was found when comparing MMC administration into the hepatic artery with or without gelfoam supplementation. Thus, our results revealed that gelfoam could not delay the clearance of MMC from the liver.

[Hepatectomy with Nd:YAG laser: an experimental and clinical study].

We conducted an experimental and clinical study of hepatectomy with Nd:YAG laser. The results showed that cutting effect artificial sapphire contact Nd:YAG laser scalpel was better than that of quartz fiber contact and noncontact Nd:YAG laser. The tissue damage was minimal in the former group whereas, the blood loss was similar in both groups. Seven patients were operated on, with quartz fiber and 12 with artificial sapphire laser scalpel. No complications were related to the use of laser. We consider that partial liver resection can be performed effectively with artificial sapphire contact Nd:YAG laser scalpel because of its better cutting, coagulation effects, and less tissue damage.