ABSTRACT
Objective:To analyze the association between thyroglobulin antibody (TgAb) and differentiated thyroid cancer (DTC) metastases detected by post-radioactive iodine (RAI) therapy scan, when stimulated thyroglobulin (sTg) <1 μg/L.Methods:A total of 314 (68 males, 246 females, age (44.5±12.5) years) post-thyroidectomy DTC patients whose sTg <1 μg/L between March 2013 and May 2017 in Henan Cancer Hospital were enrolled retrospectively. Patients underwent 131I whole-body planar imaging ( 131I-WBS) and SPECT/CT imaging 5 d after 131I administration. Iodine avid metastases were compared between TgAb-positive group and TgAb-negative (TgAb<4 kU/L) group. Logistic regression analysis was conducted to assess odds ratio ( OR) for iodine avid metastases in each subgroup (Q1: 4 kU/L≤TgAb≤9.27 kU/L; Q2: 9.27 kU/L<TgAb≤26.75 kU/L; Q3: 26.75 kU/L<TgAb≤101.43 kU/L; Q4: TgAb>101.43 kU/L) of TgAb-positive patients, with the TgAb-negative patients as the reference. χ2 test was used to analyze the data. Results:Iodine avid metastases were found in 16.9% (53/314) of DTC patients and were more frequently in TgAb-positive group with TgAb>26.75 kU/L than TgAb-negative group (26.0%(19/73) vs 13.7%(23/168); χ2=5.382, P=0.02). Most metastases (92.5%, 49/53) occurred in cervical and mediastinal lymph nodes. The OR for iodine avid metastases was obviously high in TgAb-positive patients with 26.75 kU/L<TgAb≤101.43 kU/L ( OR(95% CI): 3.687(1.397-9.733), P=0.008) and with intermediate-high risk of recurrence ( OR(95% CI): 2.489(1.169-5.301), P=0.018), with the TgAb-negative group as the reference. Conclusion:The possibility of functional metastasis should be fully considered during 131I therapy in TgAb-positive DTC patients after surgery who have higher TgAb level and risk stratification, even if sTg<1 μg/L.
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Objective:To investigate the clinical value of 125I seeds implantation in the treatment of primary liver cancer with portal vein tumor thrombus. Methods:A total of 218 patients (184 males and 34 females, age: (53.8±9.2) years) with primary liver cancer with portal vein tumor thrombus between January 2015 and June 2018 were retrospectively analyzed. All patients underwent 125I seeds implantation under CT guidance. CT examination and liver function test were repeated 2-3 months after the implantation, and the portal vein tumor thrombus diameter, liver function parameters and ascites before and after treatment were compared. All patients were followed up for 2-26 months and the survival time were calculated. Paired t test was used for data analysis. Results:Among 218 patients, 8 patients (3.7%) had complete remission of tumor thrombus, 111 patients (50.9%) had partial remission, 80 patients (36.7%) had no change, and 19 patients (8.7%) had disease progression 2-3 months after the implantation. The total effective rate was 91.3%(199/218). The diameter of tumor thrombus after treatment was (12.63±4.64) mm, which was significantly smaller than that before treatment ((26.65±10.88) mm; t=18.74, P<0.01); serum bilirubin, the direct bilirubin after treatment were different compared with those before treatment: (20.59±10.29) vs (24.27±12.65) pg/L ( t=5.37, P<0.05), (11.40±8.37) vs (15.64±7.99) pg/L ( t=8.44, P<0.05); the indirect bilirubin after treatment was not significantly different from that before treatment ( t=0.85, P>0.05). Ascites in 86/142 patients were better after the implantation. No serious complications associated with treatment were seen. There were 162 patients died and 56 patients survived till the end of follow-up. The survival time of all patients was (9.23±0.59) months. Conclusion:125I seeds implantation can safely and effectively treat the portal vein tumor thrombus in patients with primary liver cancer, and improve the clinical symptoms such as ascites.
ABSTRACT
Objective To investigate the application value of the modified Overlap method in digestive tract reconstruction of totally laparoscopic total gastrectomy (TLTG).Methods The retrospective cohort study was conducted.The clinicopathological data of 50 patients with gastric cancer who underwent TLTG with Overlap anastomosis between January 2016 and December 2016 in the Tangdu Hospital of the Fourth Military Medical University were collected.Twenty-six patients using classic Overlap method and 24 patients using modified Overlap method were respectively allocated into the classic Overlap group and modified Overlap group.All the patients underwent D2 lymph node dissection.Patients in the classic Overlap group underwent totally laparoscopic catastalsis side-to-side esophagojejunostomy.During digestive tract reconstruction in the modified Overlap group,there was no esophageal transection before anastomosis,and gastric fundus traction fully exposed to the lower esophagus.Esophagus was spun anticlockwise,and a hole was opened at the left posterior esophageal wall.Transection of jejunum was 25 cm away from Treitz ligment,and opening a hole at mesenteric margin was 6 cm away from distal jejunum to transected end of jejunum.Esophagus-distal jejunum side-to-side anastomosis was done using 60 mm linear stapler,and then laterally closing openings and transecting esophagus.Observation indicators:(1) intra-and post-operative recovery:total operation time,time of esophagus-jejunum anastomosis,volume of intraoperative blood loss,number of lymph node dissected,time to anal exsufflation,cases with complications and duration of postoperative hospital stay;(2) follow-up and survival.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative tumor-free survival and tumor recurrence or metastasis up to March 2017.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using the independent-sample t test.Comparison of count data was analyzed using the chi-square test or Fisher exact probability.Results (1) Intra-and post-operative recovery:all the 50 patients underwent successful TLTG using Overlap method,without conversion to open surgery.Total operation time and time of esophagus-jejunum anastomosis were respectively (278.6± 14.9) minutes,(46.5 ± 4.4) minutes in the classic Overlap group and (253.3 ± 12.8) minutes,(20.4 ± 2.3) minutes in the modified Overlap group,with statistically significant differences between the 2 groups (t =5.459,22.482,P＜0.05).Volume of intraoperative blood loss,number of lymph node dissected,time to anal exsufflation,cases with complications and duration of postoperative hospital stay were respectively (73±25) mL,34±6,(2.7± 1.0) days,2,(9.7± 1.6) days in the classic Overlap group and (71 ± 22) mL,35± 5,(2.6± 1.3) days,2,(9.8± 1.5) days in the modified Overlap group,with no statistically significant difference between the 2 groups (t =0.175,-0.616,0.293,-0.217,P＞ 0.05).Two patients in the classic Overlap group were respectively complicated with esophagus-jejunum anastomotic fistula and pancreatic leakage,2 patients in the modified Overlap group were respectively complicated with pulmonary infection and subcutaneous emphysema,and they were improved by symptomatic treatment.(2) Follow-up and survival:41 of 50 patients were followed up for 3-15 months,with a median time of 7 months,including 20 in the classic Overlap group and 21 in the modified Overlap group.During follow-up,patients had tumor-free survival,without tumor recurrence and metastasis.Conclusion Compared with classic Overlap method,the modified Overlap method can simplify the anastomotic procedures,shorten operation time and achieve similar efficacy,and it is also a simple and effective method for digestive tract reconstruction after TLTG.