Comparison of Total and Nontotal Endoscopic Transaxillary Breast Augmentation Techniques: A Retrospective Study.

BACKGROUND: The aim of this retrospective study was to compare the clinical outcomes of total endoscopic transaxillary (TET) breast augmentation with those of non-TET (NTET) breast augmentation. For the purposes of this study, the term NTET refers to the combination of blunt dissection and endoscopic techniques, whereas TET did not involve blunt dissection. METHODS: We conducted a retrospective review of 119 consecutive cases of primary breast augmentation from May 1, 2020, to August 31, 2020. The primary outcomes were the number of drainage days and pain scores as assessed using the visual analog scale on the first postoperative day. The secondary outcomes were the daily drainage volume recorded during the postoperative drainage days, the presence of postoperative daily pain that required the administration of tramadol for relief, reoperation rate, and operative time. RESULTS: The number of drainage days was significantly lower in the TET group than in the NTET group (TET vs NTET: 2.56 ± 0.57 vs 3.78 ± 1.30 days, P = 0.000). The visual analog scale score on the first postoperative day was significantly lower in the TET group than in the NTET group (TET vs NTET: 4.96 ± 0.63 vs 5.93 ± 0.93, P = 0.000). CONCLUSIONS: We observed that the major outcomes of the TET group were more favorable than those of the NTET group. Based on our results, we recommend the avoidance of blunt dissection during endoscopic transaxillary breast augmentation. LEVEL OF EVIDENCE: III.

Evaluation of a beneficial effect of adjuvant chemotherapy in patients with stage I triple-negative breast cancer: a population-based study using the SEER 18 database.

PURPOSE: To evaluate the effect of adjuvant chemotherapy on improving the prognosis of patients with stage I triple-negative breast cancer (TNBC). METHODS: TNBC patients diagnosed in the SEER 18 database from 2010 to 2015 were included. Kaplan-Meier plots and log-rank tests were used to compare the differences in breast cancer-specific survival (BCSS) and overall survival (OS) between subgroups of variables. A Cox proportional hazard model was used to determine the prognostic factors affecting BCSS and OS. RESULTS: A total of 9256 patients were enrolled in this study. Among these patients, 380 died from breast cancer, and 703 died from all causes. Patients who received chemotherapy had significantly better BCSS and OS than those who did not receive chemotherapy for stage T1cN0M0 (BCSS, hazard ratio (HR) = 0.68, 95% confidence interval (CI) 0.51-0.90; OS, HR = 0.54, 95% CI 0.44-0.67) and stage IB (BCSS, HR = 0.39, 95% CI 0.16-0.95; OS, HR = 0.41, 95% CI 0.19-0.87) disease. Patients who received chemotherapy did not have significantly better BCSS or OS than those who did not receive chemotherapy for stage T1aN0M0 or T1bN0M0 disease. The patients who received chemotherapy in the poorly differentiated and undifferentiated groups had better BCSS (HR = 0.68, 95% CI 0.52-0.88) and OS (HR = 0.54, 95% CI 0.44-0.66) than the patients who did not receive chemotherapy. CONCLUSION: According to current clinical guidelines, patients with stage T1bN0M0 TNBC are probably overtreated. The prognosis of these patients with stage T1aN0M0 or T1bN0M0 disease is good enough that adjuvant chemotherapy cannot improve it further.

Trends in Radical Surgical Treatment Methods for Breast Malignancies in China: A Multicenter 10-Year Retrospective Study.

BACKGROUND: Incidence rates of breast cancer continue to rise in the People's Republic of China. The purpose of this study was to describe Chinese trends in radical surgical modalities and influential imaging and demographic factors for breast malignancies. MATERIALS AND METHODS: This study was a hospital-based, multicenter, 10-year (1999-2008), retrospective study. Descriptive statistical tests were used to illustrate information regarding radical surgical trends for the treatment of breast malignancies. Chi-square tests were used to assess effect of demographic factors in addition to imaging and pathological data on the specific surgical method. RESULTS: A total of 4,211 patients were enrolled in the survey. Among them, 3,335 patients with stage 0 to stage III disease undergoing mastectomy or breast-conserving surgery (BCS) were included in the final analysis. The rate of BCS increased from 1.53% in 1999 to 11.88% in 2008. The rate of mastectomy declined over this time period, from 98.47% in 1999 to 88.12% in 2008, with increasing use of diagnostic imaging methods and pathological biopsies. A significantly greater percentage of patients with office work, high education levels, unmarried status, younger age, and early pathological stages preferred BCS compared with mastectomy. CONCLUSION: Rates of mastectomy in China remain elevated due to diagnosis at higher stages; however, because of increased use of diagnostic imaging, improvement of biopsy methods, and patient education, rates of less invasive lumpectomy are increasing and rates of mastectomy have decreased in China. IMPLICATIONS FOR PRACTICE: In this study, 4,211 cases were collected from 1999 to 2008 through a multicenter retrospective study of varying geographic and socioeconomic areas to illustrate trends of surgeries in the People's Republic of China. The correlations between demographic and tumor characteristics and among methods of surgical treatment were explored. This study shows that the rate of breast-conserving surgery (BCS) increased and the rate of mastectomy declined over this time period with increasing use of diagnostic imaging methods and pathological biopsies. Patients with office work, high education levels, unmarried status, younger age, and early pathological stages preferred BCS compared with mastectomy in China.

Prognosis prediction and risk stratification of breast cancer patients based on a mitochondria-related gene signature.

As the malignancy with the highest global incidence, breast cancer represents a significant threat to women's health. Recent advances have shed light on the importance of mitochondrial function in cancer, particularly in metabolic reprogramming within tumors. Recognizing this, we developed a novel risk signature based on mitochondrial-related genes to improve prognosis prediction and risk stratification in breast cancer patients. In this study, transcriptome data and clinical features of breast cancer samples were extracted from two sources: the TCGA, serving as the training set, and the METABRIC, used as the independent validation set. We developed the signature using LASSO-Cox regression and assessed its prognostic efficacy via ROC curves. Furthermore, the signature was integrated with clinical features to create a Nomogram model, whose accuracy was validated through clinical calibration curves and decision curve analysis. To further elucidate prognostic variations between high and low-risk groups, we conducted functional enrichment and immune infiltration analyses. Additionally, the study encompassed a comparison of mutation landscapes and drug sensitivity, providing a comprehensive understanding of the differing characteristics in these groups. Conclusively, we established a risk signature comprising 8 mitochondrial-related genes-ACSL1, ALDH2, MTHFD2, MRPL13, TP53AIP1, SLC1A1, ME3, and BCL2A1. This signature was identified as an independent risk predictor for breast cancer patient survival, exhibiting a significant high hazard ratio (HR = 3.028, 95%CI 2.038-4.499, P < 0.001). Patients in the low-risk group showed a more favorable prognosis, with enhanced immune infiltration, distinct mutation landscapes, and greater sensitivity to anti-tumor drugs. In contrast, the high-risk group exhibited an adverse trend in these aspects. This risk signature represents a novel and effective prognostic indicator, suggesting valuable insights for patient stratification in breast cancer.

[Analysis of influencing factors to metastasis in sentinel lymph nodes and non-sentinel lymph nodes in breast cancer].

OBJECTIVE: To explore the relevant factors influencing sentinel and non-sentinel lymph node (SLNM, NSLNM) metastases in breast cancer. METHODS: The clinicopathological data of 283 women with breast cancer who underwent sentinel lymph node biopsy from July 2010 to August 2011 in the Cancer Institute and Hospital at Chinese Academy of Medical Sciences were reviewed retrospectively, and the relevant factors affecting sentinel and non-sentinel lymph node metastases were analyzed. RESULTS: Univariate analysis showed that age, menopause status, tumor size, pathological type and intravascular tumor thrombus were associated with SLNM metastasis (all P < 0.05). Multivariate analysis showed that age, tumor size and intravascular tumor thrombus were associated with SLNM (all P < 0.05) . No risk factors were found in either univariate or multivariate analysis of NSLNM. CONCLUSIONS: Age, tumor size and intravascular tumor thrombus are independent influencing factors associated with SLNM, and age is a protective factor. Whether ER, pathological type and pathological grade are associated with SLNM or not is still controversial.

[Clinical analysis of intraoperative radiotherapy in breast-conserving surgery of early breast cancer].

OBJECTIVE: To evaluate the safety and feasibility of intraoperative radiotherapy during breast-conserving surgery instead of whole breast radiotherapy in early breast cancer patients. METHODS: From July 2008 to December 2012, 36 early breast cancer patients underwent breast-conserving surgery plus interoperative radiotherapy on a Mobetron 1000 mobile electron accelerator. Postoperative recurrence and metastases, complications and cosmetic outcomes were recorded and analyzed. RESULTS: During a median follow-up period of 27.9 months, 2 patients (5.56%) underwent mastectomy after local relapses. There was no occurrence of distant metastasis or mortality. Their average wound healing time was 17 days and 2 of them (5.56%) developed infection while another 2 (5.56%) had delayed wound healing. And 1 patient (2.78%) showed wound edema and neither necrosis nor hematoma was found. The evaluation of cosmetic outcome shows 32 patients (88.89%) were graded as excellent or good while another 4 (11.11%) fair or poor. None had radiotherapy-related acute hemotological toxicity and 2 patients (5.56%) developed skin pigmentation. CONCLUSION: Intraoperative radiotherapy during breast-conserving surgery instead of whole breast radiotherapy in early breast cancer patients is both safe and reliable with better cosmetic outcomes.

[Comparison of clinicopathological characteristics between colorectal signet-ring cell carcinoma and mucinous adenocarcinoma].

OBJECTIVE: To compare the difference of clinicopathological characteristics between colorectal signet-ring cell carcinoma and mucinous adenocarcinoma. METHODS: The clinicopathological and survival data of 65 patients with colorectal signet-ring carcinoma and 166 with mucinous adenocarcinoma were retrospectively analyzed. RESULTS: Such clinical characteristics as gender, gross anatomical classification, preoperative carcinoembryonic antigen level and hepatic metastasis or not had no significant difference between two groups (P > 0.05) while the difference of such characteristics as age, location of tumor, vascular tumor embolus, N stage, T stage, AJCC stage, preoperative obstruction and the ratio of radical resection between them was significant (P < 0.05). The overall 3, 5-year survival of the whole group was 56.7% and 31.6% respectively. The 3, 5-year survival and median survival time (MST) in the signet-ring cell carcinoma and the mucinous adenocarcinoma groups were 33.1%, 14.8%, 24.0 months and 64.1%, 36.6%, 41.5 months respectively. The pathological type of signet-ring cell carcinoma was an independent risk factor of survival in the whole group. CONCLUSION: Compared to colorectal mucinous adenocarcinoma, signet-ring cell carcinoma has a higher degree of malignancy and the patients have a worse survival.

[Analysis of the treatment and prognosis of recurrent breast phyllodes tumor].

OBJECTIVE: To explore the methods of diagnosis, treatment and prognosis for patients with recurrent breast phyllodes tumor. METHODS: Clinicopathological data of 26 patients with pathologically proven recurrent phyllodes tumors treated from March 1972 to June 2006 were retrospectively analyzed. RESULTS: The mean age of the 26 cases was 45 years, and the median follow-up duration was 83 months. The mean overall survival time of this series was 96 months. The primary breast phyllodes tumor was > or = 5 cm in 10 cases with a recurrence rate of 60.0% (6/10 cases); < 5 cm in 16 cases with a recurrence rate of 31.3% 5/16 cases). After surgical removal of the breast primary tumor, the recurrent tumor was > or = 5 cm in 14 cases with a re-recurrence rate of 35.7% (5/14 cases); < 5 cm was in 12 cases with are-recurrence rate of 50.0% (6/12 cases). There was no statistically significant relationship between the (primary and reccurent) tumor size and recurrence rate (P = 0.094, P = 0.383) or prognosis (P = 0.142, P = 0.486). The benign or malignant nature of the breast phyllodes tumor was significantly correlated with the rate of local re-recurrence (P = 0.046) and prognosis (P = 0.028). CONCLUSION: The benign or malignant nature of the breast phyllodes tumor is significantly correlated with the local re-recurrence and prognosis, while the size of the primary breast phyllodes tumor has no significant effect on either re-recrruence or prognosis. The first rescue operation is most important in the treatment of recurrent breast phyllodes tumor. The resection margin should be wide enough. Active surgical treatment can still effectively save the life of the patients with a local re-recurrent tumor.

[Characterization of hormone receptor status in 5758 Chinese females with breast cancer].

OBJECTIVE: To analyze the characteristics of hormone receptor status in Chinese females with breast cancer. METHODS: The clinicopathological data of 5758 female breast cancer patients surgically treated in our breast cancer center from Jan. 1997 to Oct. 2008 were retrospectively analyzed. RESULTS: The positive rates of estrogen receptor (ER) and progesterone receptor (PR) were 64.1% and 70.2%, respectively. The ER positive rate was significantly higher in elderly, post-menopausal females with a smaller tumor and well-differentiated histology (P < 0.05), while the PR positive rate was significantly correlated with only histological differentiation and tumor size (P < 0.05). The ER and PR positive rates were significantly higher in the patients with lymph node metastasis than that in those without (P < 0.05). Multivariate analysis showed that the histological differentiation, T stage, N stage and menopause status were significantly correlated with ER positive rate, while histological differentiation, T stage and N stage were significantly correlated with PR positive rate. CONCLUSION: Our results show that the ER positive rate of breast cancer in Chinese women is lower than that in western high incidence areas. The ER positive rate is significantly correlated with age, histological differentiation, tumor size, and menopause status. The PR positive rate is correlated only with histological differentiation and tumor size. Interestingly, the ER and PR positive rates are significantly higher in the patients with axillary lymph node metastases than that in those without. However, further study is needed to verify this special phenomenon.

[Clinicopathological characteristics and prognosis of patients with breast cancer over 65 years of age].

OBJECTIVE: To study clinicopathological characteristics and prognosis of elderly women with breast cancer. METHODS: The data of 399 patients with breast cancer over 65 years of age was analyzed retrospectively in the Cancer Hospital of Chinese Academy of Medical Sciences from January 1989 to December 2003. RESULTS: Curative resection was performed for all patients, including modified radical mastectomy 277 (69.4%), radical mastectomy 12 (3.0%), breast-conserving therapy 59 (15.8%), mammectomy 24 (6.0%), breast segmentectomy 25 (6.3%) and breast segmentectomy with sentinel node biopsy 2 (0.5%). Major pathological type was invasive ductal carcinoma (337/399, 85.5%). The positive rates of estrogen receptor (ER) and progesterone receptor (PR) were 71.4% and 69.6%, respectively. The overall 5-and 10- year survival rates were 78.9% and 56.3%, respectively. Univariate analysis showed that ER status, PR status, T stage, lymph node status and histological grade were significant statistically (P < 0.05). The multivariate analysis showed ER status, lymph node status and histological grade were the independent prognostic factors. CONCLUSION: Elderly women with breast cancer should be given multimodality therapy. Surgery and endocrine therapy are crucial, but the surgical style should be individuation. ER status, lymph node status and histological grade were the independent prognostic factors.

[Clinical characteristics comparison between triple-negative and non-triple-negative breast cancer].

OBJECTIVE: To compare the clinical characteristics of triple-negative (TN) breast cancer and non-triple-negative (NTN) breast cancer, enrich the information of TN patients, and provide evidences for individualized combined treatment. METHODS: The data of 408 cases received operation in the year of 2002 was enrolled in this study. TN patients were confirmed according to the immunohistochemical (IHC) test of estrogen receptor (ER), progesterone receptor (PR) and HER-2/neu. The clinical characteristics, recurrence, metastasis and survival were compared between the two groups. RESULTS: Seventy-seven patients (18.9%) were confirmed TN cases. The median follow-up was 64 months (range, 3-79 months). Of all the cases, 58 occurred local recurrence or metastasis and 51 died, it was 19 and 12 in TN group. Compared with the NTN group, the TN patient tended to be younger and the tumor mass larger (P=0.015 and 0.011). However, axillary lymph nodes metastasis occurred more often in NTN patients than in TN patients (P=0.001). The rate of local recurrence and metastasis in TN group was significantly higher than in NTN group (P=0.005 and 0.025), and TN cases were more likely to develop lung metastasis than NTN patients (P<0.01). The 3-year and 5-year overall survival rate in TN group were significantly lower than in NTN group (86.4% vs. 93.4%, P=0.0205; 77.7% vs. 87.9%, P=0.0215). The 3-year and 5-year disease-free survival rate in TN group were also significantly lower than in NTN group (78.4% vs. 92.4%, P=0.0038; 72.8% vs. 85.8%, P=0.0041). Tumor size, lymph node status and triple-negative were the most important factors influencing the prognosis on multivariate Cox regression analysis. CONCLUSIONS: TN breast cancer haa some specific clinical characteristics. The prognosis of TN patients is worse than that of NTN patients. Further study is needed to find individualized treatment for TN breast cancer patients.

[Expression of annexin I in human pancreatic cancer and the influence of its down-regulation on biology of this cancer].

OBJECTIVE: To investigate the expression of annexin in human pancreatic cancer and to elucidate its role in oncogenesis of pancreatic cancer. METHODS: A pancreatic carcinoma cell line Suit-II with high-expression of annexin I gene was adopted. Three subtypes of annexin I -siRNA sequences and a non-related fragment were combined, and the eukaryotic expression vectors bearing siRNA fragments were constructed. Then they were transfected into pancreatic carcinoma cells to knock down the expression of annexin I by RNAi. After knocking down the expression of annexin I , the growth speed, cell cycling, morphological features and apoptosis of pancreatic carcinoma cells were examined by RT-PCR and MTT test. RESULTS: When the expression of annexin I was blocked, the growth speed of pancreatic carcinoma cells was significantly decreased, the morphological features were changed and pronounced apoptosis occurred. CONCLUSION: Annexin I can modulate pancreatic carcinoma cell cycle, promote the cell proliferation, increasingly stimulate the cell growth, and suppress the process of apoptosis in pancreatic carcinoma cells.

[Clinical application of localized biopsy on breast microcalcification].

OBJECTIVE: To evaluate fine needle localized biopsy under mammography-guiding and skin incision selection by hookwire under ultrasound-guiding for patients with breast microcalcification. METHODS: Breast microcalcification of 178 patients treated from May 2000 to November 2006 were resected after localized with fine needle under X-ray mammography-guiding. Among them, 62 patients received the selection of hookwire under ultrasound-guiding. RESULTS: Breast cancer was detected in 58 patients (32.6%). Among them, 32 (55.1%) cases were carcinoma in situ, 11 (19.0%) intraductal carcinoma with early infiltration, 15 (25.9%) infiltrative ductal carcinoma, and 4 infiltrative ductal carcinoma with lymph node metastasis. The overall 5-year survival rate was 100%. Compared with that in needle guided group, the acceptable rate of cosmetic results was higher in hookwire group (P = 0.022). CONCLUSIONS: For breast microcalcification, mammography guided needle biopsy with ultrasound selected skin incision is an effective and accurate diagnostic method.

[Risk features of HBV in human hepatocarcinogenesis: a nested case-controlled study].

OBJECTIVE: To identify the association strength of the prevalence of HBeAg, covalently closed circular DNA (cccDNA) and 1762/1764 nucleotide mutations of hepatitis B virus (HBV) with the occurrence of hepatocellular carcinoma (HCC) in Qidong high risk male cohort. METHODS: A cohort of 377 middle aged HBV infected men in Qidong was followed from January 1989 to December 2002. Incident HCC cases were carefully registered. A matched case-controlled study was conducted on 32 pairs of inherent HCC cases with their matched non-HCC controls. Serum HBeAg was measured by ELISA. cccDNA was detected by primer selected PCR. 1762/1764 nucleotide mutations of HBV was identified by PCR of X gene segment spanning the mutation region. Standard statistical comparison between the prevalence of each HBV marker in HCC versus in control group provided the odds ratio with P value to evaluate its association strength with HCC occurrence. RESULTS: Serum HBeAg prevalence was 53.1% (17/32) in HCC group versus and 15.6% (5/32) in controls (OR = 6.12, P < 0.01). Prevalence of serum cccDNA was detected in 62.5% (21/32) of HCC cases but in 25.0% (8/32) of controls (OR = 5.73, P < 0.01). Sequence of detected cccDNA was repeatedly found to be over 90% homologous with HBV. However, the mutation rate of nucleotide 1762/1764 was not found to be statistically higher in the HCC group versus its controls (OR = 1.54, P = 0.425). CONCLUSIONS: The Qidong male case-controlled cohort had shown that serum HBeAg and cccDNA prevalence were tightly associated with hepatocellular carcinoma occurrence in HBV infected men. These biomarkers may have predictive value in earlier diagnosis and therapeutic effect monitoring.

[Lymph node metastasis and prognosis in T1 and T2 rectal carcinoma].

OBJECTIVE: To investigate the characteristics of lymph node metastasis and prognosis of T1/T2 rectal carcinoma. METHODS: The clinical data of 241 patients with T1 or T2 rectal carcinoma were retrospectively analyzed. The factors relative to lymph node metastasis were analyzed using Chi-square test. The survival data were analyzed using Kaplan-Meier method. The factors influencing survival were analyzed using univariate (Long-rank) and multivariate (Cox model) methods. RESULTS: Of the 241 patients, 132 received Mile's operation and 109 underwent sphincter preserving operation. The over-all lymph node metastasis rate was 22.0% (53/241). The lymph node metastasis was significantly correlated with histological differentiation as revealed by Chi-square test. The over-all 5-year survival rate for the whole series group was 91.5%. Univariate analysis revealed that tumor histological type, intramural infiltration, differentiation, lymph node metastasis, radiation therapy were significant predictors of survival; however, only intramural infiltration was the most important prognostic predictor by multivariate analysis. CONCLUSION: Even though lymph node metastasis can be observed either in T1 or T2 rectal carcinoma, histological differentiation is significantly related to the lymph node metastasis. As radical resection achieve better survival than local resection, it should be suggested as the chief treatment for T1/T2 rectal carcinoma.

Tight association of hepatocellular carcinoma with HBV infection in North China.

BACKGROUND: Hepatocellular carcinoma (HCC) is the second most common cancer in China. Hepatitis B and C viruses (HBV and HCV) and aflatoxins are known risk factors for HCC, but the etiological status of these factors in HCC development is not clear. This study was undertaken to define the absolute importance of HBV in hepatocarcinogenesis of North China. METHODS: A consecutive series of 119 patients with pathologically proven HCC were collected from North China during January 1998 to December 2000 by the Cancer Hospital of the Chinese Academy of Medical Sciences, Beijing. Serum HBsAg, anti-HBc and anti-HCV were negative HBV sero-markers. The HBV X gene was analyzed for its expression by PCR, DNA sequencing, and immunohistochemistry. RESULTS: In the 119 HCC patients, 82.4% (98/119) were HBsAg seropositive. When a comprehensive set of HBV markers were detected, the HBV infection rate in these HCC patients was 99.2% (118/119). Of the patients, 11.8%(14/119) were found to be anti-HCV positive. But all the anti-HCV positive HCC patients were co-infected with HBV. CONCLUSIONS: HBV infection is virtually ubiquitous in HCC patients in North China. The tight association of HBV with HCC strongly suggests the dominant role of HBV infection in causing hepatocellular carcinoma. About 11.8% of HCC patients being HCV-related are co-infected with HBV.

Surgical salvage therapy of anal cancer.

AIM: To evaluate the results of salvage resection in the management of persistent or locally recurrent anal canal cancer. METHODS: Details of all patients with anal canal cancer treated from 1978 to 1994 at Cancer Hospital of Chinese Academy of Medical Sciences (CAMS) were reviewed retrospectively. Sixteen patients who presented with persistent or locally recurrent anal canal cancer received salvage surgery. Before surgery all of the patients had received radiotherapy alone as their primary treatments. RESULTS: Of the 16 patients, 14 received salvage abdominoperineal resection (APR) and two had transanal local excision. There were no deaths attributable to operation. Delayed healing of the perineal wound occurred in eight patients. Complications unrelated to the perineal wound were found in five patients. The median follow-up time was 120 (range 5-245) months after salvage surgery. Nine patients died of disease progression, with a median survival time of 16 (range 5-27) months. Six patients had a long-term survival. CONCLUSION: Salvage resection after radiotherapy can yield a long-time survival in selected patients with anal canal cancer. However it offers little hope to patients with T4 and/or N(2-3) tumors.

Local excision carcinoma in early stage.

AIM: To assess the validity of local excision for the early stage low rectal cancer as an effective treatment alternative to radical resection. METHODS: A retrospective medical chart review was done in 47 patients with early stage low rectal carcinoma who underwent local excision from November 1980 through November 1999 at Cancer Hospital of Chinese Academy of Medical Sciences (CAMS). The patients were treated by either transanal (40 cases), trans-sacral (5 cases), or trans-vaginal (2 cases) excision of tumors and no death was related to surgery. Sixteen patients received postoperative radiotherapy. RESULTS: T1 and T2 lesion was found in 36 (76.6 %) and 11 patients (23.4 %) respectively. The overall local tumor recurrence rate was 14.9 % (7/47), with an average recurrence time of 21 months. Among these 7 recurrent patients, there were 4 T1 and 3 T2 lesions. Microscopically, the surgical incisal margin was negative in 45 (95.7 %) and positive in 2 patients (4.3 %); Both of the later had developed local recurrence. The overall 5-year survival rate was 91.7 %, in which there were 94.4 % for T1 and 83.3 % for T2 tumors. T stage, intravessel tumor thrombosis, lymphocytic infiltration and histological grade were not found to be significant by related to the local recurrence and survival (P>0.05). CONCLUSION: Local tumor excision was a safe procedure for the treatment of early stage low rectal carcinoma with minimal morbidity and mortality, which might serves as one of the primary surgical treatment methods for the disease of this kind.

[Suppression of c-myc expression by interference RNA in HepG2 hepatocellular carcinoma cells].

OBJECTIVE: To study the inhibitory effect of RNA interference (RNAi) on c-myc expression in hepatocellular carcinoma cell line, HepG2. METHODS: Expression vector of c-myc gene-targeting small interference RNA (siRNA) was constructed (psilencer-c-myc) and transfected into HepG2 cells by lipofectamine, and the unloaded vector was used as control (mock). The expression of c-myc mRNA and protein was identified by quantitive PCR and Western blot. Apoptosis of the transfected cells was examined by flow cytometry and immunofluorescent microscopy. RESULTS: After HepG2 cells were transfected with psilencer-c-myc, the expression of c-myc mRNA and protein was suppressed with an inhibition rate of 67% compared with the mock-transfected cells. Apoptosis was identified in the transfected HepG2 cells. CONCLUSION: The expression of c-myc at transcriptional and translational levels in HepG2 cells transfected with siRNA is markedly inhibited, which may be associated with the induction of apoptosis.

[Diagnosis and surgical treatment of primary duodenal carcinoma].

OBJECTIVE: To investigate the early diagnosis of primary duodenal carcinoma and its outcome after surgical procedure. METHODS: Twenty-two patients with primary duodenal carcinoma treated operatively between 1983 and 1997 were analyzed retrospectively. Eleven patients complained of epigastric pain and discomfort, 5 jaundice, 4 nausea and vomiting and 2 epigastric fullness. The correct diagnosis rate for endoscopy was 90.0% (9/10), for duodenography 86.7% (13/15), for ultrasound examination 33.3% (4/12) and for computerized tomography (CT) scanning 58.3% (7/12), respectively. All of the 22 patients received surgery including pancreaticoduodenectomy (12 patients), segmental resection (4) and bypass operation (gastrojejunostomy and cholecystojejunostomy or cholangiojejunostomy) (6). RESULTS: Primary duodenal carcinoma was characterized nonspecifically, and the correct diagnosis was based on endoscopy and duodenography. The follow-up rate of this group was 86.4% (19/22). The 1-, 3-, 5-year survival rates of patients receiving radical resection (n = 16, 1 patient lost follow-up) were 86.7% (13/15), 46.7% (7/15), and 26.7% (4/15), respectively. The 5-year survival rate of patients receiving pancreaticoduodenectomy was 27.3% (3/11), and the 5-year survival rate of patients having segmental resection was 1/4. No patient (n = 6, 2 lost follow-up) with primary duodenal carcinoma treated by bypass procedure survived more than one year. There was a significant difference between patients receiving radical procedure and bypass operation (chi(2) = 6.84, P < 0.01). CONCLUSION: Radical resection might improve the survival of patients with primary duodenal carcinoma.