Progress in diagnosis and treatment of gallbladder carcinoma in the past 60 years / 西安交通大学学报(医学版)

The First Affiliated Hospital of Xi’an Jiaotong University has experienced more than 60 years’ history in the diagnosis and treatment of gallbladder carcinoma (GBC). From 1956 to 2018, 3 430 cases of GBC were treated, including 1941 cases of surgical treatment and 703 cases of radical resection. The data comparison between 1956-2008 and 2009-2018 revealed that the radical resection rate increased from 19.9% to 48.3%. The mean survival time after regional radical resection and extended radical resection was (23.1±15.4) and (17.5±16.2) months, respectively, from 2004 to 2008. Compared with those between 2013 and 2017, the mean survival time after regional radical resection and extended radical resection was (31.5±2.0) and (18.6±3.9) months, respectively, and the median survival time was 31.0 and 11.0 months, respectively. By comparing the GBC data longitudinally, the mode of diagnosis and treatment of GBC in our hospital has changed significantly in the past 10 years, which is mainly reflected in the change of GBC staging system, the progress of imaging diagnosis mode, the standardization of surgery and the development of adjuvant treatment. All of these have significantly improved the prognosis of GBC.

Advances in surgical management of primary carcinoma of the gallbladder: Results from 10-year research at a single institution / 西安交通大学学报(医学版)

【Objective】 To analyze the clinical characteristics of patients with primary carcinoma of the gallbladder (PGC) who underwent radical intent resection in our center in the last decade and the therapeutic effects of the operation. 【Methods】 A single-institution database of The First Affiliated Hospital of Xi'an Jiaotong University from January 2008 to December 2017 was queried for patients with PGC who had received surgical treatment. The data were studied retrospectively to assess the trend of total admission, radical resection rate, prognosis and clinicopathological characteristics of PGC in the last decade. 【Results】 A total of 2 159 patients with PGC were treated in our institution from 2008 to 2017. Of them, 1072 were surgically treated and 503 underwent radical intent resection. In the past 5 years (2013-2017), the radical resection rate was 26.5% (319 cases of the operation), which was significantly higher than that in 2008-2012 (19.2%) (P<0.001). The overall survival time of the patients who underwent radical resection was 32 months, and the 1-, 3-, and 5-year survival rate was 68.9%, 48.4% and 41.6%, respectively. Compared with the data of 2008-2012, the proportion of the patients with preoperative jaundice decreased in the past 5 years (7.8% vs. 14.7%, P<0.05), that of the patients who underwent D2 lymphadenectomy (74.0% vs. 26.1%, P<0.001) increased significantly (P<0.001), the total number of lymph nodes obtained from the dissection (8.07±5.18 vs. 5.89±3.14, P<0.001) increased significantly (95.6% vs. 89.7%, P<0.05), and the proportion of R0 resection (95.6%) increased significantly (P<0.05). 【Conclusion】 The diagnosis and treatment of radical intent resection of PGC in our hospital have changed significantly in the last decade, mainly reflected in the extension of lymphadenectomy, increase in R0 resection rate and decrease in patients with preoperative jaundice.

Correction to: Projection from the Anterior Cingulate Cortex to the Lateral Part of Mediodorsal Thalamus Modulates Vicarious Freezing Behavior / 神经科学通报·英文版

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Clinical effects and prognostic analysis of radical surgery for primary gallbladder cancer / 中华消化外科杂志

Objective To investigate the clinical effects and prognostic factors of radical surgery for primary gallbladder cancer (GBC).Methods The retrospective case-control study was conducted.The clinicopathological data of 305 patients with primary GBC who underwent radical Ro resection in the First Affiliated Hospital of Xi'an Jiaotong University from 2013 to 2017 were collected,including 108 males and 197 females,aged from 30 to 88 years,with a median age of 62 years.According to the different tumor staging,patients underwent corresponding operation and adjuvant treatment based on the postoperative indication of chemotherapy.Observation indicators:(1) results of imaging and laboratory examinations;(2) treatment situations:① surgical situations,② postoperative adjuvant treatment;(3) results of postoperative pathological examination;(4) followup;(5) prognostic factors analysis.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to December 5,2018,and death was used as the end point.Measurement data with normal distribution were represented as Mean±SD.Measurement data with skewed distribution were described as M (range).Count data were represented as percentage.The survival curve and survival rate were respectively drawn and calculated using the Kaplan-Meier method.The univariate analysis and multivariate analysis were respectively done using the Log-rank test and COX regression model.Results (1) Results of imaging and laboratory examinations:results of imaging examination showed that diagnostic rates of ultrasound,CT and MRI examination were respectively 84.06％ (174/207),85.71％ (168/196) and 63.11％ (65/103).Results of laboratory examination showed that the positive rates of CA19-9,CA125 and carcinoembryonic antigen (CEA) were respectively 55.34％ (145/262),48.06％ (124/258) and 46.15％ (126/273).(2) Treatment situations:① surgical situations:305 patients underwent radical R0 resection for primary GBC,including 145 undergoing liver wedge resection + D2 lymph node dissection,61 undergoing liver wedge resection + D1 lymph node dissection,55 undergoing liver Ⅳ B and Ⅴ segmentectomy + D2 lymph node dissection,11 undergoing liver Ⅳ B and Ⅴ segrnentectomy + D1 lymph node dissection,9 undergoing right hepatectomy + D2 lymph node dissection,5 undergoing liver wedge resection + D2 lymph node dissection + partial colectomy,4 undergoing pancreaticoduodenectomy,3 undergoing simple cholecystectomy in Tis stage,3 undergoing right hepatectomy + D1 lymph node dissection,2 undergoing liver ⅣB and Ⅴ segmentectomy + D2 lymph node dissection + partial colectomy,1 undergoing liver Ⅳ B and Ⅴ segmentectomy + resection and reconstruction of portal vein + D2 lymph node dissection,1 undergoing liver ⅣB and Ⅴ segmentectomy + D2 lymph node dissection + partial resection of the stomach or duodenum,1 undergoing pancreaticoduodenectomy + resection and reconstruction of portal vein,1 undergoing right hepatectomy + pancreaticoduodenectomy,1 undergoing right hepatic lobectomy + partial gastrectomy + D2 lymph node dissection,1 undergoing right hepatic lobectomy + D1 lymph node dissection and 1 undergoing right hepatic trilobectomy + D2 lymph node dissection.Of 94 patients with unsuspected GBC,78 who were diagnosed in the other hospitals received salvage surgery in the authors' center.Twenty-one patients had postoperative surgery-related complications,including 11 with bile leakage,8 with pulmonary infection and 2 with abdominal bleeding.Two patients died in the perioperative period.② Postoperative adjuvant treatment:26 patients underwent postoperative adjuvant chemotherapy.Chemotherapy regimen:gemcitabine + oxaliplatin were used in 12 patients,gemcitabine + tegafur in 7 patients,gemcitabine + cisplatin in 6 patients,oxaliplatin + tegafur in 1 patient.(3) Results of postoperative pathological examination.The postoperative pathological type of 305 patients:257,23,6,5,4,3,3,2,1 and 1 patients were respectively confirmed as pure adenocarcinoma,adenocarcinoma combined with squamous cell carcinoma,adenocarcinoma combined with neuroendocrine carcinoma,mucinous adenocarcinoma,neuroendocrine carcinoma,adenocarcinoma combined with mucinous carcinoma,squamous cell carcinoma,sarcomatoid carcinoma,adenocarcinoma combined with sarcomatoid carcinoma,adenocarcinoma combined with signet-ring cell carcinoma.Degree of tumor differentiation:highdifferentiated,moderate-differentiated and low-differentiated tumors were detected in 37,130 and 121 patients,respectively,17 with unknown differentiated degree.Of 305 patients,16 and 32 patients had respectively vascular invasion and nerve invasion.The number of lymph node dissected of 305 patients was 8±5,with positive lymph node of 0 (range,0-9),including 121 with lymphatic metastasis (26 with jumping lymphatic metastasis).TNM staging of 305 patients:stage 0,Ⅰ,Ⅱ,ⅢA,ⅢB,ⅣA and ⅣB were detected in 7,18,13,137,57,11 and 62 patients,respectively.(4) Follow-up:245 of 305 patients were followed up for 18.0 months (range,6.0-70.0 months).The survival time,1-and 3-year survival rates were respectively 29.5 months (range,0.5-69.9 months),71.6％ and 45.8％.One hundred and twenty-two patients died during the follow-up.(5) Prognostic factors analysis:the results of univariate analysis showed that preoperative level of bilirubin,pathological type,degree of tumor differentiation,liver invasion,vascular invasion,nerve invasion,T staging,N staging and postoperative chemotherapy were factors affecting prognosis of patients with primary GBC (x2 =10.26,3.96,45.89,34.64,12.75,27.05,35.09,39.44,4.40,P＜0.05).The results of multivariate analysis showed that low-differentiated tumor,liver invasion and N2 staging were independent risk factors affecting prognosis of patients with primary GBC [odds ratio (OR)=1.90,1.71,1.46,95％ confidence interval (CI):1.34-2.70,1.15-2.52,1.17-1.82,P＜0.05],and postoperative chemotherapy was a protective factor affecting prognosis of patients with primary GBC (OR=0.35,95％ CI:0.15-0.82,P＜0.05).Conclusions For patients with primary GBC undergoing radical resection,D2 lymph node dissection should be performed routinely.The low-differentiated tumor,liver invasion and N2 staging are independent risk factors affecting prognosis of patients,and postoperative chemotherapy is a protective factor.

Surgical treatment of hilar cholangiocarcinoma / 中华普通外科杂志

Objective To investigate the clinical features and the prognosis after surgical treatment for hilar cholangiocarcinoma (HCC).Methods The surgical therapy and follow-up result were retrospectively analyzed on 98 cases of hilar cholangiocarcinoma admitted into our hospital from January 1995 to January 2005.Differences between groups were evaluated using Chi-square analysis or Student t-test according to the data type.Survival rate was calculated with Kaplan-Meier method,and using the log-rank test.Results Among 98 patients,83 patients underwent surgical treatment (radical resection in 33,palliative resection in 16,and nonresectional internal or external bile duct drainage in 34),15 patients underwent conservative therapy.The 1-,3-,5-year survival rates were 79％,42％,and 17％ in the resection group and 88％,54％,and 24％ in the radical resection group,respectively.The 1-,3-year survival rates were 55％,and 9％ in palliative resection group,respectively,and none of the patient survived for over 5 years.There were significant differences in the survival rate among the radical resection group and the palliative resection group (log-rank test,P ＜ 0.001).Conclusions Radical resection improves the prognosis of hilar cholangiocarcinoma.

Inhibitory effect of rapamycin on proliferation of H_(22) hepatic cancer in mice / 西安交通大学学报(医学版)

Objective To explore rapamycin's inhibitory effect on proliferation of H_(22) hepatic cancer in mice. Methods In vitro study: H_(22) hepatic cancer cell lines were cultured with rapamycin, CsA, FK506, and proliferation was determined through MTT. The influences of different agents on the H_(22) hepatic cancer cell cycle were observed by flow cytometry. The vascular endothelial growth factor (VEGF) concentration of the supernatant fluid of the cultured H_(22) hepatic cancer cell was detected by ELISA. In vivo study: C57BL/6 to Balb/c mice allogenic skin transplant was established, and the H_(22) hepatic cancer cell was implanted under skin. Rapamycin, CsA, FK506 and 5-FU were fed to the mice, respectively. The effect of different immunosuppressors on the survival of skin graft was observed while the proliferation of the transplant tumor was investigated. VEGF concentration of treated mice serum was examined by ELISA. The microvessel density of the transplanted tumor was observed through immunohistochemistry staining of CD34. Results The proliferation of the H_(22) hepatic cancer cells was inhibited by rapamycin at the concentration different dose of rapamycin, the VEGF concentration of the supernatant fluid decreased significantly (P<0.05). The number of S phase cells decreased significantly compared to that of other agents (P<0.05). When rapamycin, the lengthened survival time of the skin grafts was similar to that in CsA and FK506 groups. But the tumor volume was smaller than that in CsA and FK506 groups (P<0.05). Compared to that in the control group, the VEGF concentration of mice serum decreased in rapamycin group (P<0.05), and the microvessel density of the transplant tumor was reduced greatly (P<0.05). Conclusion Rapamycin, as an immunosuppressor, significantly resists immunologic rejection and inhibits the proliferation of H_(22) hepatic cancer, thus having its advantage in treating malignant hepatic cancer with liver transplantation.

Union examination of AFP, AFU, AFPL3 andγ-GT in early diagnosis of primary liver cancer / 药物分析学报

Objective To explore the significance of union examination of blood serum liver cancer tracers in the early diagnosis of liver cancer. Methods We observed and compared the level of blood serum liver cancer tracers armor embryo protein (AFP), crag algae glycosidase (AFU), armor embryo protein heteroplasmon (AFPL3) andγ-Gu Anxian transferase (γ-GT) in early time for primary liver cancer patients and hepatitis liver cirrhosis patients and those chronic hepatitis B patients who had liver cancer family history. Results Finally among the 30 patients in the early liver cancer group, 23 were positive with AFP, 20 with AFU, 15 with AFPL3 and 21 with γ-GT. Five were found positive with blood serum AFP, AFPL3, AFU and γ-GT at the same time; 5 with AFP, AFPL3 and γ-GT; 5 with AFP, AFU and AFPL3; 7 with AFP, AFU andγ-GT. By contrast, in the control group, among the 30 hepatitis liver cirrhosis patients and those chronic hepatitis B patients with liver cancer family history, 11 were found positive with AFP, 3 with AFPL3, 12 with AFU and 14 with γ-GT. None of the patients were found positive with union examination of AFP, AFPL3, AFU and γ-GT in the blood serum at the same time. Conclusion The union examination of AFP, AFU, AFPL3 and γ-GT is significant to the early diagnosis of primary liver cancer.

The effect and mechanism of ulinastatin application in abdominal surgery during perioperative period / 西安交通大学学报(医学版)

Objective To explore the effect a nd mechanism of ulinastatin application during perioperation in abdominal surger y. Methods Twenty patients administered with ulinastatin serve d as study group and twenty ones without ulinastatin treatment served as control group. Serum TNF-?, IL-6, IL-8, BUN and serum creatinine were detected in both groups before and after operation. The normalization time of body temper ature and leukocyte count were observed. All data analyses were performed using SPSS. Results ① Serum TNF-?, IL-6, and IL-8 concentratio ns in study group were significantly smaller than those in control group on the 1 st, 3 rd and 5 th day after operation (P

Effect of Bcl-2 and Bax protein expression on the apoptosis of renal tubular epithelia in rats with obstructive jaundice / 西安交通大学学报(医学版)

Objective To investigate the relationship of the expression of Bcl-2 and Bax protein with apoptosis of renal tubular epithelia in rats with obstructive jaundice(OJ).Methods A total of 60 adult Sprague-Dawley(SD) rats were divided into two groups: OJ rats by ligating bile duct(OJ group,n= 40) and the sham-operation rats(the control group,n=20).The two groups of rats were sacrificed at postoperative 1,2,3 and 4 week,respectively.Then serum BUN and Cr levels were tested and renal histopathological and ultrastructural changes were observed.Apoptosis of renal tissues was assayed by TUNEL method.The immunohistochemical Elivision~(TM) technique was adopted for detecting the Bcl-2 and Bax protein expression.Results With the time of OJ prolonging,the value of serum BUN and Cr increased;apoptotic cells of renal tubular epithelia increased.There were obvious differences in Bcl-2 and Bax protein expression of between OJ and control groups(P

Multivariate analysis by Cox Proportional Hazards Model on prognoses of patients with bile duct carcinoma after resection / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the influence of various clinicopathologic factors on the survival of patients with bile duct carcinoma after curative resection.</p><p><b>METHODS</b>A retrospective analysis was performed on 86 cases of bile duct carcinoma treated from January 1981 to September 1995. Fifteen clinicopathologic factors that could possibly influence survival were selected. A multivariate analysis of these individuals was performed using the Cox Proportional Hazards Model.</p><p><b>RESULTS</b>The overall cumulative survival rate was 73% for 1 year, 32% for 3 years and 19% for 5 years. The results of univariate analysis showed that the major significant prognostic factors for influencing survival of these patients were type of histological lesion, lymph node metastasis, pancreatic invasion, duodenal invasion, perineural invasion, macroscopic vessel involvement, resected surgical margin and depth of cancer invasion (P < 0.05). Pancreatic invasion, perineural invasion and lymph node metastases were the three most important prognostic factors determined by multivariate analysis using the Cox Proportional Hazards Model.</p><p><b>CONCLUSION</b>Pancreatic invasion, perineural invasion and lymph node metastases are the most important prognostic factors for bile duct carcinoma after curative resection.</p>

AN IMMUNOHISTOCHEMICAL STUDY ON EXPRESSION OF CD44v6 PROTEIN IN HUMAN GALLBLADDER CARCINOMA / 药物分析学报

Objective To investigate the clinical significances of CD44v6 protein expression in human gallbladder carcinoma(GBC).Methods The immunohistochemical technique was used to detect the CD44v6 protein expression in 40 cases of GBC,12 cases of chronic cholecystitis,6 cases of adenoma and 4 cases of adenomyomatous hyperplasia.Results The positive rate of CD44v6 expression in gallbladder carcinoma and benign lesions was 72.5% and 0%,respectively(P＜0.01),and it also correlated with the lymph node metastasis,pathologic differentiation and clinic staging,but there was no correlation among pathological types.Conclusion Detecting CD44v6 expression might be severed as an objective indicator for differential diagnosis,lymph node metastatic potency,tumor progress and prognosis in gallbladder carcinoma.

CT scan evaluation of tumor response to thermoradiation therapy / 中华放射肿瘤学杂志

80% of low density area in tumor), 10 PR(50%-80%) and 3 NC(0.05). Conclusion For tumor treated with hyperthermia plus radiotherapy, the response evaluation should be based on both the change in the mass size and the percentage of low density area in the tumor.

Observation on apoptosis of renal cell in the rat with obstructive jaundice and salvia miltiorrhiza's effect on apoptosis / 西安交通大学学报(医学版)

Objective To investigate the function of apoptosis in the renal injury by observing change of renal pathology and ultrastructure in the rat with obstructive jaundice(OJ) and if salvia miltiorrhiza(SM) can lighten the renal dysfunction of obstructive jaundice.Methods A total of 100 adult Sprague-Dawley rats were studied.Among them,the 80 models of obstructive jaundice were established by ligating bile duct(BDL),then divided into two groups: the OJ rats administered daily abdomen injections of SM(1.7g per rat) after operation of bile duct ligation(the SM group,n= 40);the OJ rats receiving only the same normal saline(the OJ group,n=40).The other rats with sham operation receiving only normal saline(the control group,n=20).Three groups of rats were sacrificed in groups at postoperation 1,2,3 and 4 week,respectively.Then serum BUN & Cr were tested and renal change of histopathology and ultrastructure were observed;Apoptosis of renal tissue were assayed by TUNEL method.Results With the time of BDL extending,the value of serum BUN & Cr increased;Apoptotic cells increased in renal tissue.After treatment with SM,the injury degree of renal function and histopathologic changes decreased.Conclusion Obstructive jaundice can lead to renal injury.Apoptosis had an important effect on renal function injury in the rat with obstructive jaundice.Salvia miltiorrhiza can ease the degree of renal function injury.

DIAGNOSIS AND TREATMENT OF GALLSTONE PANCREATITIS / 西安交通大学学报(医学版)

64 cases of gallstone pancreatitis were treatedin our hospital in recent eight years. Early biliaryoperations were performed in 36 cases and good re-sults were got. Gallstone pancreatitis has the char-acteristics of cholelithiasis, the temporary damageof liver and the manifestations of pancreatitis, aswell. The purpose of the paper is to analyse anddiscuss diagnostic methods and treatment of gall-stone pancreatitis. It is important to perform theexaminations of ultrasound scanning and liverfunction in differential diagnoses. The necessity ofoperation is emphasized. It is also proposed thatbiliary operation be performed early as soon as theinflammation of pancreas is controlled effectively.