Analysis of gastric gastrointestinal stromal tumors in Shandong Province: a midterm report of multicenter GISSG1201 study / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the treatment status of gastric gastrointestinal stromal tumor (GIST) in Shandong province,by analyzing the clinicopathological features and prognostic factors.</p><p><b>METHODS</b>Clinicopathological and follow-up data of 1 165 patients with gastric GIST between January 2000 and December 2013 from 23 tertiary referral hospitals in Shandong Province were collected to establish a database. The risk stratification of all cases was performed according to the National Institutes of Health(NIH) criteria proposed in 2008. Kaplan-Meier method was used to calculate the survival rate. Log-rank test and Cox regression model were used for univariate and multivariate prognostic analyses.</p><p><b>RESULTS</b>Among 1 165 cases of gastric GIST, 557 were male and 608 were female. The median age of onset was 60 (range 15-89) years. Primary tumors were located in the gastric fundus and cardia in 623 cases(53.5%), gastric body in 346 cases(29.7%), gastric antrum in 196 cases(16.8%). All the cases underwent resection of tumors, including endoscopic resection (n=106), local resection (n=589), subtotal gastrectomy(n=399), and total gastrectomy(n=72). Based on the NIH risk stratification, there were 256 cases (22.0%) at very low risk, 435 (37.3%) at low risk, 251 cases (21.5%) at intermediate risk, and 223 cases (19.1%) at high risk. A total of 1 116 cases(95.8%) were followed up and the median follow-up period was 40 (range, 1-60) months. During the period, 337 patients relapsed and the median time to recurrence was 34 (range 1-60) months. The 1-, 3-, and 5-year survival rates were 98.6%, 86.1% and 73.4%, respectively. The 5-year survival rates of patients at very low, low, intermediate, and high risk were 93.1%, 85.8%, 63.0% and 42.3% respectively, with a statistically significant difference (P=0.000). Multivariate analysis showed that primary tumor site (RR=0.580, 95%CI:0.402-0.835), tumor size (RR=0.450, 95%CI:0.266-0.760), intraoperative tumor rupture(RR=0.557, 95%CI:0.336-0.924), risk classification (RR=0.309, 95%CI:0.164-0.580) and the use of imatinib after surgery (RR=1.993, 95%CI:1.350-2.922) were independent prognostic factors.</p><p><b>CONCLUSIONS</b>The choice of surgical procedure for gastric GIST patients should be based on tumor size. All the routine procedures including endoscopic resection, local excision, subtotal gastrectomy and total gastrectomy can obtain satisfactory curative outcomes. NIH classification has a high value for the prediction of prognosis. Primary tumor site, tumor size, intraoperative tumor rupture, risk stratification and postoperative use of imatinib are independent prognostic factors in gastric GIST patients.</p>

A multicentre retrospective cohort study of patients with gastrointestinal stromal tumors in Shandong Province / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological features and prognosis of patients with gastrointestinal stromal tumor(GIST) after surgery in Shandong Province.</p><p><b>METHODS</b>Clinicopathological data of GIST patients undergoing surgery from January 2001 to June 2013 in four university teaching hospitals in Shandong Province were reviewed. Pathology results were rechecked. Patients were followed up. The prognostic factors were evaluated by univariate and multivariate analyses with Log-rank test and Cox proportional hazard model.</p><p><b>RESULTS</b>A total of 1039 GIST cases were enrolled, including 509 males and 530 females, with age from 18 to 87 years(median, 58). Ninety-three patients died of GIST during follow-up. The 1-, 3-, 5-year survival rates were 94.6%, 91.7% and 87.8%, respectively. Patients undergoing R0 resection had a higher 5-year overall survival rate than those undergoing R1 resection(88.8% vs 69.0%, P<0.05). For patients with intermediate risk of recurrence after surgery, the 5-year overall survival rate was 94.4% and 89.2% respectively in imatinib and non-imatinib intervention groups(P>0.05). For patients with high risk of recurrence after surgery, the 5-year overall survival rate was 76.8% and 67.7% respectively(P<0.05). Multivariate analysis revealed that tumor size(P<0.01, RR=1.988, 95%CI:1.497-2.641), mitotic count(P<0.01, RR=2.326, 95%CI:1.686-3.208) and tumor rupture(P<0.01, RR=3.032, 95%CI:1.732-5.308) were independent prognostic factors.</p><p><b>CONCLUSIONS</b>Tumor size, mitotic count and tumor rupture affect the prognosis of patients after resection of primary GIST independently. The standard treatment of localized GIST is R0 resection. Adjuvant imatinib therapy can improve overall survival of patients with high risk of recurrence after surgery. The efficacy of imatinib for patients with intermediate risk of recurrence remains to be verified.</p>

Changes of MDR gene expression in patietns of gastric cancer undergoing neoadjuvant chemotherapy / 中华普通外科杂志

Objective To investigate the expression and sensitivity of 6 muhidmg resistance gene products(MDR) : GST-π、LRP、MRP、Topo Ⅱ、P-gp、TS in gastric cancer during neoadjuvant chemotherapy. Methods Expression of the 6 muhidrug resistance gene was detected by immunohistoehemistry in 35 cases of stomach cancer tissues before and after neoadjuvant chemotherapy. The relationship between muhidrug resistance gene and neoadjuvant chemotherapy was analyzed. All patients were given FOLFOX4, and the effects were evaluated according to World Health Organization criteria. Results The overall response rates to chemotherapy was 46%, expression of the 6 mtdtidrug resistance gene in 35 cases of stomach cancer tissues were as follows:GST-π was 40% ,LRP was 69% ,MRP was 34% ,Topo Ⅱ was 37% ,P-gp was 86%, TS was 40%, expression of the 6 muhidrug resistance gene did not change during neoadjuvant chemotherapy; GST-π、LRP、MRP、Topo Ⅱ、P-gp were not correlated with chemotherapy sensitivity(P > 0.05), while TS was significantly correlated with chemotherapy sensitivity (P = 0.0048). Conclusion FOLFOX4 does not effect a change in the expression of the 6 muhidrug resistance gene: GST-π、LRP、MRP、Topo Ⅱ、P-gp and TS, while TS is significantly correlated with gastric cancer chemotherapy sensitivity.

Relationship of gene polymorphisms of angiotensin convertion enzyme, aldosterone synthase and α-adducin with subclinical renal lesion / 中华老年医学杂志

Objective To investigate the relationship of gene polymorphisms of angiotensin eonvertion enzyme (ACE), aldosterone synthase (CYP11B2)and α-adducin with subclinical renal lesion. Methods I/D polymorphism of ACE gene, -344T/C polymorphism of CYP11B2 gene and 460G/T polymorphism of α-adduein gene were detected by polymerase chain reaction (PCR) and restrictive fragment length polymorphism(RFLP) in 604 normotensive subjects and 1081 primary hypertensive patients whose creatinine (Cr) were less than 2mg/L. The primary hypertensive and normotensive subjects were divided respectively into normal group (Ccr≥60ml/min) and subclinical renal lesion (Ccr＜60 ml/min) group, according to creatinine clearance rate (Ccr) calculated by Cockcroft-Gault equation. Results ANOVA, contingency X2 and partition of chi-square were selected. The frequencies of different genotypes of ACE, CYP11B2, and α-adducin were in agreement with Hardy-Weinberg equilibrium in our study. Normal renal function group (A group, n=512) and subclinical renal lesion group (B group, n=92) in normotensive subjects, and normal renal function group (C group, n=828) and subclinical renal lesion group (D group, n=252) in hypertensive patients were compared. The patients in B and D groups were older than those in A and C groups (P<0.01). But there were no significant differences in the age between B and D groups, and between A and C groups. The frequency of ACE-DD genotype in D group was the highest (22.6%) among four groups and the frequency of α-adducin-TT genotype in A group was the lowest (13.3%) among four groups (all P<0.01). The differences of genotype frequencies of ACE and α-adducin genes among other three groups were not significant. No significant difference was found in frequencies of genotypes of CYP11B2 among four groups. Conclusions Subclinical renal lesion is increased with the aging. ACE-DD genotype is related with hypertension and subclinical renal lesion, while α-adducin-TT genotype is related with hypertension and subclinical renal lesion. Association between the genotypes of CYP11B2 and subclinical renal lesion is not found.

Study on the prediction of early liver metastasis of colorectal tumor by detection of CK20mRNA、CD44v6 and PCNA / 中国现代普通外科进展

Objective:To obtain some effective objective markers used to predict the early liver metastasis of colorectal tumor,the relationship of liver metastasis of colorectal tumor with associate detection three markers such as CK20mRNA、CD44V6 and PCNA was studied. Methods:The expression of CK20mRNA in portal venous blood from 30 colorectal cancer patients was detected by fluorescent quarto RT-PCR,and the results of CD44V6 and PCNA in colorectal cancer tissue were determined by means of immunohistochemistry, and then compared with control groups through statistics analysis. Results:The rate of positive expression of CK20mRNA in colorectal cancer patients' portal venous blood was obviously superior to the level of benign pathological changes controls(P