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1.
Neuroendocrinology ; 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31940636

RESUMO

PURPOSE: To evaluate whether the European Neuroendocrine Tumor Society (ENETS) system or the 8th American Joint Committee on Cancer (AJCC) staging manual are suitable for gastric neuroendocrine carcinomas and/or mixed adenoneuroendocrine carcinomas (G-NECs/MANECs). METHODS: Patients in the a multicentric series with G-NEC/MANEC who underwent curative-intent surgical resection for a primary tumor were included. An optimal staging system was proposed base on analysis of the T and N status and validated by the SEER database. RESULTS: Compared with the ENETS system, the survival curves of the T category and N category in the 8th AJCC system were better separated and distributed in a more balanced way, but the survival curves of T2 vs T3, N0 vs N1, and N3a vs N3b overlapped. For the T category, the 8th AJCC T category was modified by combining T2 and T3, which was consistent with the T category in the 6th AJCC manual for GC. For the N category, the optimal cut-off values of metastatic lymph nodes using X-tile were also similar to those of the N category in the 6th AJCC system. The Kaplan-Meier plots of the 6th AJCC system showed statistically significant differences between individual substages. Compared with the other two classifications, the 6th AJCC system also showed superior prognostic stratification. Similar results were obtained in both multicentric and SEER validation sets. CONCLUSIONS: Compared to the 8th AJCC and ENETS systems, the 6th AJCC staging system for GC is more suitable for G-NEC/MANEC and can be adopted in clinical practice.

2.
Med Dosim ; 2019 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-31822373

RESUMO

The same fractionation scheme of accelerated partial breast irradiation (APBI) with brachytherapy is usually applied to APBI patients without considering the radiaton effect on the planning target and organs at risk (OARs) for an individual patient. The purpose of this study is to report the results of optimization of the fractionation scheme by evaluating the radiation effect on target and OARs with a modified linear-quadratic model, universal survival curve (USC), based on dose-volume histograms (DVHs). Ten breast patients treated with multilumen balloon brachytherapy were selected. The minimum skin and chest wall/rib (CW/rib) spacing ranged from 2.5 to 14.3 mm and from 0.5 to 25.0 mm, respectively. The USC model parameters were set as: (1) breast:α = 0.3, ß = 0.05; (2) skin: acute reaction α = 0.101, ß = 0.009; late reaction α = 0.064, ß = 0.029; (3) CW/rib: α = 0.3, ß = 0.12. Boundary dose Dt was 6 Gy for both target and OARs. The relation between radiation effects on the target (ET) and OARs (EOAR) were plotted for fraction numbers (N) from 1 to 20. If ET is set at a certain value, the fractionation that results in a minimum EOAR value corresponds to the optimal fractionation. The results show that the optimal fractionation is different for different OAR damage effects. For most of the patients, N = 2 is best for minimizing skin acute reactions while N = 20 is best for minimizing skin late reactions. N varies from 3 to 20 among patients for minimizing CW/rib toxicity. The determined unique optimal N for treatment delivery was found to vary from 1 to 20 among these 10 patients resulted from balancing the different damage effects considering the spatial dose for a given patient geometry. Optimal fractionation can be achieved for an individual patient by evaluating the radiation effect on tumor and OARs with the USC model based on the patient specific DVHs with APBI brachytherapy.

3.
Onco Targets Ther ; 12: 7623-7636, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31571913

RESUMO

Purpose: Cisplatin (DDP) based chemotherapy regimens are widely used in advanced gastric cancer (GC). Drug resistance often limited the clinical benefits of cisplatin regimen. The mechanisms of cisplatin resistance have not been fully revealed. Therefore, further exploration of the relevant molecular mechanisms is urgently needed. Patients and methods: DDP resistance associated miRNA of GC microarray dataset GSE86195 was obtained from the National Center for Biotechnology Information (NCBI) GEO database, GEO2R was applied to compare the samples in two different groups under the same experimental conditions. |log2(Fold Change) | (log2(FC)) was selected as the criteria to screen the statistically significant DE-miRNAs. StarBaseV3.0 was used to predict the target genes of the DE-miRNAs. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses of target genes of DE-miRNAs were carried out using DAVID. The STRING database was applied to estimate the correlations between target genes. Analysis of hubgenes by coremine and The Human Protein Atlas (THPA). Initial expression validations of miR-424 and miR-491-5p, SMURF1 and BCL2L1 were carried out using clinical pathological specimens by RT-PCR. Results: A total of 13 Differential expression-miRNAs (DE-miRNAs) were identified in DDP chemoresistant cells, including 9 upregulated miRNAs and 4 downregulated miRNAs. SMURF1 and BCL2L1 were screened as the critical genes in DDP-resistant GC, which were regulated by miR-424 and miR-491-5p respectively. The results of validation of hub genes expression in GC tissues indicated that in DFS<1-year group, the expression of miR-424 decreased significantly, notably upregulated expression of SMURF1 was also detected. Conclusion: Our results implied that miR-424, as a tumor suppressor, could deregulate SMURF1 in DDP-resistant GC cells.

4.
J Comp Eff Res ; 8(10): 753-766, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31361160

RESUMO

Aim: To compare efficacy between total gastrectomy (TG) and proximal gastrectomy (PG) for upper-third gastric cancer. Materials & methods: PubMed, Embase and Cochrane library were searched to select suitable researches. Stata was used for meta-analysis including 5-year overall survival rate, recurrence rate, complication morbidities and serum nutritional levels. Results: Ten retrospective English researches were contained. Our study showed no significant difference of 5-year overall survival rate, recurrence rate, reflux symptoms and anastomotic leakage. TG experienced longer operation time, more lymph nodes-retrieved number, more estimated blood loss and higher ileus, but less anastomotic stricture. PG showed advantages over TG in terms of serum nutritional levels. Conclusion: PG is more preferable to TG for treatment of upper-third gastric cancer.

5.
Onco Targets Ther ; 12: 4713-4719, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31354302

RESUMO

Background: Surgical resection is the standard treatment for localized and potentially resectable gastrointestinal stromal tumors (GISTs), If the postoperative pathology diagnosis indicates that patients are at high risk of recurrence, they should be treated with imatinib. Even though the introduction of imatinib substantially improved the outcome of GIST patients, it is unclear whether different imatinib treatment regimens affect patients' survival. Methods: This retrospective study included 120 patients who underwent tumor resection for high-risk GISTs between January 2009 and October 2018. The patients were divided into three groups: one group of patients received postoperative imatinib adjuvant therapy regularly (regular treatment group); the second group was not treated with imatinib until they were found to have disease progression (observation group); the third group was treated with postoperative imatinib adjuvant therapy irregularly (irregularly treatment group). The progression-free survival (PFS) and overall survival (OS) were compared between the three groups, and the prognostic risk factors were analysed by the Cox regression model. Results: The median PFS was 45 months (range: 25-59). The 3- and 5-year PFS values were 71.3% and 49.9%, respectively. The PFS in the regular group was longer than in the observation group and irregular group (P<0.001). The median OS was 59 months (range:47-78). The 3- and 5-year OS values were 91.6% and 84.2%, respectively. There were no differences in OS among the three groups (P=0.150). The extent of radical resection (P<0.001) and intraoperative tumor rupture (P=0.005) were independent prognostic factors influencing OS. Conclusions: Irregular administration of imatinib was associated with a worse PFS, but it did not affect the OS of patients with high-risk GISTs. Avoiding intraoperative tumor rupture and R0 resection were associated with better survival.

6.
J Cell Physiol ; 234(12): 22635-22647, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31102300

RESUMO

Calcium-activated nucleotidase 1 (CANT1, belongs to the apyrase family, is widely expressed in various organs. However, the biological function of CANT1 remains poorly explored. In this study, we aimed to investigate the expression profile and functions of CANT1 in clear cell renal cell carcinoma (ccRCC). Our data show that the protein level of CANT1 was significantly higher in tumor tissues than in adjacent normal tissues. CANT1 silencing suppressed cell proliferation, migration, and invasion obviously in 769-P and 786-O cells, arrested cell cycle in S phase and promoted apoptosis in 769-P cells. In conclusion, the present study shows the different expression mode of CANT1 in human ccRCC tumor tissue and adjacent normal tissue, denotes the function of CANT1 in ccRCC cells and provides potential molecular mechanisms and pathways of CANT1 antitumor function in ccRCC.

7.
Int Immunopharmacol ; 71: 224-232, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30925323

RESUMO

Immune escape is the final phase of the cancer immunoediting process. Researchers have found that cancer induces immune escape by inhibiting the expression of CD40L. The purpose of the present study was to select a high affinity CD40 single chain variable fragment (ScFv) and to evaluate its effect on tumor-specific immune activation. One Wistar rat was immunized with mouse CD40 antigen. CD40 ScFv with high affinity was constructed by overlap extension-polymerase chain reaction (SOE-PCR) and screened by three rounds of phage display. CD40 ScFv protein was expressed by the pET28a (+)-Rosetta prokaryotic expression system and purified using a nickel-nitrilotriacetic acid (Ni-NTA) column. CD40 ScFv significantly upregulated CD80, CD86, and MHC-II in vitro expression in dendritic cells (DCs) and upregulated the expression of IL-12 (p70) based on ELISA results. Cell counting kit-8 (CCK-8) results indicated that T lymphocytes were stimulated by DCs in an Ag + CD40 ScFv group, which also inhibited the proliferation of immortalized T6-17 cells. In an in vivo assay, 1 × 106 T6-17 cells were subcutaneously injected into BALB/c mice in the hind flank. Tumor volume curves showed that CD40 ScFv exhibited a remarkable inhibition of tumor proliferation after 15 days of treatment. Hematoxylin-eosin (H&E) staining of tumor tissues indicated that CD40 ScFv enhanced lymphocyte infiltration, which remarkably inhibited the proliferation of T6-17 cells. Furthermore, immunohistochemistry (IHC) staining revealed that caspase-3 was abundantly expressed in the T6-17 cytoplasm after CD40 ScFv treatment. In conclusion, this study revealed that high affinity CD40 ScFv could be screened by phage display and had a significant stimulating effect on DCs and inhibited the proliferation of T6-17 cells in vivo and in vitro.


Assuntos
Antígenos CD40/imunologia , Técnicas de Visualização da Superfície Celular/métodos , Células Dendríticas/imunologia , Imunoterapia/métodos , Neoplasias Experimentais/terapia , Anticorpos de Cadeia Única/metabolismo , Linfócitos T/imunologia , Animais , Antígenos CD40/metabolismo , Diferenciação Celular , Linhagem Celular Tumoral , Proliferação de Células , Feminino , Humanos , Ativação Linfocitária , Camundongos , Camundongos Endogâmicos BALB C , Neoplasias Experimentais/imunologia , Ratos , Ratos Wistar , Anticorpos de Cadeia Única/genética , Carga Tumoral , Evasão Tumoral
8.
World J Urol ; 37(7): 1441-1447, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30361956

RESUMO

PURPOSE: To compare the perioperative and long-term outcomes of retroperitoneal laparoscopic pyelolithotomy (RLP) and percutaneous nephrolithotomy (PCNL) for the treatment of staghorn calculi. METHODS: From May 2011 to March 2017, eligible patients with staghorn calculi were randomly assigned to two groups: RLP and PCNL. Patients underwent the operations prospectively. Subsequently, a follow-up protocol was performed. Perioperative data related to the efficacy, safety and long-term outcomes (stone recurrence and functional changes in the affected kidney) were comparatively analyzed between the two groups. RESULTS: Overall, 105 patients underwent surgical treatment, including 51 in the RLP group and 54 in the PCNL group. There was no difference in demographics or stone characteristics between the two groups. The single-session stone-free rate (SFR) was higher (88.2% vs. 64.8%), the mean hemoglobin drop was lower (0.4 ± 0.3 vs. 1.7 ± 0.9 g/dL), the rate of postoperative fever was lower (5.9% vs. 20.4%), but operative time was longer (135.7 ± 35.5 vs. 101.9 ± 41.2 min) and the total cost was more expensive (5546 ± 772 vs. 3861 ± 402 USD)in the RLP group than in the PCNL group (all p < 0.05). The mean increase in the split function (8.3 ± 3.1 vs. 4.2 ± 2.4 mL/min) and the rate of improvement of the affected kidney (56.3% vs. 35.3%) were significantly higher in the RLP group than in the PCNL group at 1 year after surgery (both p < 0.05). However, the rate of stone recurrence was similar between the groups at a mean follow-up of 47.3 ± 18.6 months. CONCLUSIONS: PCNL remains the first-line treatment for most cases of staghorn calculi. Nevertheless, in some selected cases with the extrarenal and dilated pelvis, RLP can be considered as an alternative management of staghorn calculi, which was associated with a high single-session SFR, low rates of complications, and better functional preservation of the affected kidney.


Assuntos
Pelve Renal/cirurgia , Laparoscopia/métodos , Nefrolitotomia Percutânea/métodos , Cálculos Coraliformes/cirurgia , Adulto , Idoso , Feminino , Humanos , Cálculos Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrotomia/métodos , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Espaço Retroperitoneal/cirurgia , Resultado do Tratamento
9.
Zhonghua Wei Chang Wai Ke Za Zhi ; 21(12): 1366-1373, 2018 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-30588587

RESUMO

OBJECTIVE: To determine the incidence of surgical site infection (SSI) after abdominal surgery and to further evaluate the related risk factors of SSI in China. METHODS: The multicenter cross-sectional study collected clinical data of all adult patients who underwent abdominal surgery from May 1, 2018 to May 31, 2018 in 30 domestic hospitals, including basic information, perioperative parameters, and incisional microbial culture results. The primary outcome was the incidence of SSI within postoperative 30 days. SSI was classified into superficial incision infection, deep incision infection, and organ/gap infection according to the US Centers for Disease Control and Prevention (CDC) criteria. The secondary outcome variables were ICU stay, postoperative hospital stay, total hospital stay, 30-day mortality and treatment costs. Multivariate logistic regression was used to analyze the risk factors of SSI. RESULTS: A total of 1666 patients were enrolled in the study, including 263 cases of East War Zone Hospital of PLA, 140 cases of Affiliated Hospital of Qingdao University, 108 cases of The First Affiliated Hospital of Nanchang University, 87 cases of Central War Zone Hospital of PLA, 77 cases of West China Hospital, 74 cases of Guangdong General Hospital, 71 cases of Chenzhou First People's Hospital, 71 cases of Zigong First People's Hospital, 64 cases of Zhangjiagang First People's Hospital, 56 cases of Nanyang City Central Hospital, 56 cases of Lanzhou General Hospital of Lanzhou Military Command, 56 cases of Shandong Provincial Hospital, 52 cases of Shangqiu First People's Hospital, 52 cases of People's Hospital of Xinjiang Uygur Autonomous Region, 48 cases of The Second Xiangya Hospital of Central South University, 48 cases of Chinese PLA General Hospital, 44 cases of Affiliated Hospital of Xuzhou Medical University, 38 cases of Hunan Province People's Hospital, 36 cases of Dongguan Kanghua Hospital, 30 cases of Shaoxing Central Hospital, 30 cases of Northern Jiangsu People's Hospital, 29 vases of The First Affiliated Hospital of Zhengzhou University, 27 cases of General Hospital of Tianjin Medical University, 22 cases of Zigong Fourth People's Hospital, 21 cases of The Second Hospital of University of South China, 18 cases of Tongji Hospital, 15 cases of Nanchong Central Hospital, 12 cases of The 901th Hospital of PLA, 11 cases of Hunan Cancer Hospital, 10 cases of Lanzhou University Second Hospital. There were 1019 males and 647 females with mean age of (56.5±15.3) years old. SSI occurred in 80 patients (4.8%) after operation, including 39 cases of superficial incision infection, 16 cases of deep incision infection, and 25 cases of organ/interstitial infection. Escherichia coli was the main pathogen of SSI, and the positive rate was 32.5% (26/80). Compared with patients without SSI, those with SSI had significantly higher ICU occupancy rate [38.8%(31/80) vs. 13.9%(220/1586), P<0.001], postoperative hospital stay (median 17 days vs. 7 days, P<0.001) and total hospital stay (median 22 days vs. 13 days, P<0.001), and significantly higher cost of treatment (median 75 000 yuan vs. 44 000 yuan, P<0.001). Multivariate analysis showed that male rise(OR=2.110, 95%CI:1.175-3.791, P=0.012), preoperative blood glucose level rise(OR=1.100, 95%CI: 1.012-1.197, P=0.026), operative time (OR=1.006, 95%CI:1.003-1.009, P<0.001) and surgical incision grade (clean-contaminated incision:OR=10.207, 95%CI:1.369-76.120, P=0.023; contaminated incision: OR=10.617, 95%CI:1.298-86.865, P=0.028; infection incision: OR=20.173, 95%CI:1.768-230.121, P=0.016) were risk factors for SSI; and laparoscopic surgery (OR=0.348, 95%CI:0.192-0.631, P=0.001) and mechanical bowel preparation(OR=0.441,95%CI:0.221-0.879, P=0.020) were protective factors for SSI. CONCLUSIONS: The incidence of postoperative SSI in patients with abdominal surgery in China is 4.8%. SSI can significantly increase the medical burden of patients. Preoperative control of blood glucose and mechanical bowel preparation are important measures to prevent SSI.


Assuntos
Infecção da Ferida Cirúrgica , Abdome/cirurgia , Adulto , Idoso , China , Estudos Transversais , Feminino , Cirurgia Geral/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/prevenção & controle , Período Pré-Operatório , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/prevenção & controle
10.
Chin J Cancer Res ; 30(5): 500-507, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30510361

RESUMO

Objective: Infra-pyloric artery (IPA) is an important anatomical landmark in treatment of gastric cancer and is the key vessel for pylorus-preserving gastrectomy and subgroup of infra-pyloric lymph nodes. However, its anatomical variation is not thoroughly understood. Our study aimed to clarify the origination of the IPA. Methods: We did this prospective, multicenter, open-label, observational study at gastric surgery departments of 34 hospitals in China. Gastric cancer patients aged 18 years or older and scheduled to undergo elective total or distal gastrectomy were assigned. During the surgery, IPA dissecting and exposing the origination point with photographs or video clips were required. The primary outcome was the origination of the IPA. Analysis of variance, χ2 tests and Fisher's tests were used to analyze the differences between groups. The study is registered at Clinicaltrials.gov (No. NCT03071237). Results: Between May 8 and July 31, 2017, 429 patients were assigned for the study, and 419 (97.7%) patients had the IPA dissected and recorded through photograph or video and were included in the primary outcome analysis. The median age was 62 years old, and 73.7% were male. Among the patients, 78.5% received laparoscopic surgery. Single IPA origination was identified in 398 (95.0%) patients, including gastroduodenal artery (GDA) in 154 (36.8%) patients, anterior superior pancreaticoduodenal artery (ASPDA) in 130 (31.0%) patients, and right gastroepiploic artery (RGEA) in 114 (27.2%) patients. Fifteen (3.6%) patients were identified with multiple IPA and 6 (1.4%) patients were identified as IPA absence. The differences in the distribution of surgical approach (P=0.003) and geographic area (P=0.030) were statistically significant. No difference was shown in sex, age, gastrectomy type, tumor location, and clinical T, N and M stage. Conclusions: Our study found that the IPA originates from GDA, ASPDA and RGEA in similar proportions. Laparoscopic surgery may be more helpful in dissection of the IPA than open surgery.

11.
Medicine (Baltimore) ; 97(41): e12784, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30313101

RESUMO

Retrospective studies have suggested that capecitabine combined with temozolomide (CAPTEM) is effective for treating patients with advanced neuroendocrine neoplasms (NENs); however, the efficacy and safety of this regimen needs to be verified by high-quality evidence or results of randomized controlled trials.We carried out a meta-analysis to evaluate the safety and effectiveness of a CAPTEM protocol for patients with advanced NENs. Systematic electronic literature searches were conducted using PubMed, EMBASE, and the Cochrane Library, and among meeting abstracts of the American Society of Clinical Oncology, European Society for Medical Oncology, European Neuroendocrine Tumor Society, and North American Neuroendocrine Tumor Society, up to June 30, 2017. We selected studies describing CAPTEM regimens for treating advanced NENs and reported on tumor response and/or toxicities according to clear World Health Organization (WHO) grading of patients. Three reviewers independently and repeatedly identified studies, extracted data, and assessed the quality of the literature. A single-proportion meta-analysis was applied to included articles.Fifteen studies with a total of 384 individuals were included. Medium overall survival in most studies was more than 12 months, whereas medium progression-free survival was similar or slightly higher than that in studies using other treatment regimes. Disease control rate of CAPTEM administration for patients with NENs was 72.89% (95% confidence interval, 64.04-81.73%; I = 82.4%; P < .01). WHO grade 3 to 4 toxicities, such as thrombocytopenia (3.36%), neutropenia (0.69%), lymphopenia (0.65%), anemia (0.59%), mucositis (0.57%), fatigue (0.54%), diarrhea (0.49%), nausea (0.39%), and transaminase elevation (0.13%) were reported in the trials included.CAPTEM is effective and relatively safe for treating patients with advanced NENs.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Capecitabina/uso terapêutico , Dacarbazina/análogos & derivados , Tumores Neuroendócrinos/tratamento farmacológico , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Capecitabina/administração & dosagem , Capecitabina/efeitos adversos , Dacarbazina/administração & dosagem , Dacarbazina/efeitos adversos , Dacarbazina/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Observacionais como Assunto , Análise de Sobrevida , Temozolomida
12.
Oncotarget ; 8(31): 51963-51969, 2017 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-28881703

RESUMO

Lymph node metastasis is one of the most important prognostic factors in patients with gastric cancer. An inadequate number of dissected lymph nodes is an independent risk factor affecting recurrence, even in patients who are node negative. Oddly, certain early-stage patients still experience recurrence or metastasis within a short time, even if they have undergone standard radical mastectomy. Many researchers have attributed these adverse events to lymph node micrometastasis (LNM), which is defined as a microscopic deposit of malignant cells of less than 2 mm in diameter. With the development of diagnostic tools such as immunohistochemistry and reverse transcription-polymerase chain reaction, the rate of detection of LNM has been constantly increasing. Although there is no clear consensus about risk factors for or the definitive clinical significance of LNM, the clinical impact of LNM is remarkable in gastric cancer. For minimally invasive treatment in particular, such as endoscopic submucosal dissection and laparoscopic surgery, accurate diagnosis of LNM is regarded as the potential key to maintaining the balance between curability and safety. This review provides an overview of the definition, detection and significance of LNM in gastric cancer. We also summarize several attention-drawing controversies regarding the treatment of patients who may have LNM.

13.
Medicine (Baltimore) ; 96(33): e7772, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28816959

RESUMO

Laparoscopic colorectal surgery had been widely used for colorectal cancer patient and showed a favorable outcome on the postoperative morbidity rate. We attempted to evaluate physiological status of patients by mean of Estimation of physiologic ability and surgical stress (E-PASS) system and to analyze the difference variation of postoperative morbidity rate of open and laparoscopic colorectal cancer surgery in patients with different physiological status.In total 550 colorectal cancer patients who underwent surgery treatment were included. E-PASS and some conventional scoring systems were reviewed to examine their mortality prediction ability. The preoperative risk score (PRS) in the E-PASS system was used to evaluate the physiological status of patients. The difference of postoperative morbidity rate between open and laparoscopic colorectal cancer surgeries was analyzed respectively in patients with different physiological status.E-PASS had better prediction ability than other conventional scoring systems in colorectal cancer surgeries. Postoperative morbidities were developed in 143 patients. The parameters in the E-PASS system had positive correlations with postoperative morbidity. The overall postoperative morbidity rate of laparoscopic surgeries was lower than open surgeries (19.61% and 28.46%), but the postoperative morbidity rate of laparoscopic surgeries increased more significantly than in open surgery as PRS increased. When PRS was more than 0.7, the postoperative morbidity rate of laparoscopic surgeries would exceed the postoperative morbidity rate of open surgeries.The E-PASS system was capable to evaluate the physiological and surgical risk of colorectal cancer surgery. PRS could assist preoperative decision-making on the surgical method. Colorectal cancer patients who were assessed with a low physiological risk by PRS would be safe to undergo laparoscopic surgery. On the contrary, surgeons should make decisions prudently on the operation method for patient with a high physiological risk.


Assuntos
Neoplasias Colorretais/cirurgia , Laparoscopia/efeitos adversos , Estresse Fisiológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco
14.
J Appl Clin Med Phys ; 18(2): 50-61, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28300367

RESUMO

We developed a four-dimensional volumetric modulated arc therapy (4D VMAT) planning technique for moving targets using a direct aperture deformation (DAD) method and investigated its feasibility for clinical use. A 3D VMAT plan was generated on a reference phase of a 4D CT dataset. The plan was composed of a set of control points including the beam angle, MLC apertures and weights. To generate the 4D VMAT plan, these control points were assigned to the closest respiratory phases using the temporal information of the gantry angle and respiratory curve. Then, a DAD algorithm was used to deform the beam apertures at each control point to the corresponding phase to compensate for the tumor motion and shape changes. Plans for a phantom and five lung cases were included in this study to evaluate the proposed technique. Dosimetric comparisons were performed between 4D and 3D VMAT plans. Plan verification was implemented by delivering the 4D VMAT plans on a moving QUASAR™ phantom driven with patient-specific respiratory curves. The phantom study showed that the 4D VMAT plan generated with the DAD method was comparable to the ideal 3D VMAT plan. DVH comparisons indicated that the planning target volume (PTV) coverages and minimum doses were nearly invariant, and no significant difference in lung dosimetry was observed. Patient studies revealed that the GTV coverage was nearly the same; although the PTV coverage dropped from 98.8% to 94.7%, and the mean dose decreased from 64.3 to 63.8 Gy on average. For the verification measurements, the average gamma index pass rate was 98.6% and 96.5% for phantom 3D and 4D VMAT plans with 3%/3 mm criteria. For patient plans, the average gamma pass rate was 96.5% (range 94.5-98.5%) and 95.2% (range 94.1-96.1%) for 3D and 4D VMAT plans. The proposed 4D VMAT planning technique using the DAD method is feasible to incorporate the intra-fraction organ motion and shape change into a 4D VMAT planning. It has great potential to provide high plan quality and delivery efficiency for moving targets.


Assuntos
Tomografia Computadorizada Quadridimensional/métodos , Processamento de Imagem Assistida por Computador/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/radioterapia , Imagens de Fantasmas , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada/métodos , Estudos de Viabilidade , Humanos , Órgãos em Risco/efeitos da radiação , Dosagem Radioterapêutica , Tomografia Computadorizada por Raios X/métodos , Carga Tumoral
15.
Medicine (Baltimore) ; 95(50): e5603, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27977599

RESUMO

BACKGROUND: The diagnostic and prognostic value of CD44v6 in patients with gastric cancer remains unclear. Therefore, a quantitative meta-analysis was conducted to determine the clinical value of CD44v6 in patients with gastric cancer. METHODS: Sixteen studies with 2177 patients were included. Pooled odds ratios (ORs) and hazard ratio (HR) with 95% confidence intervals (CIs) were calculated to estimate the impact of CD44v6 in patients with gastric cancer on clinicopathological features and 5-year overall survival (OS). Sensitivity analysis, subgroup analysis, and regression analysis were introduced to evaluate the heterogeneity across the studies. Publication bias was also explored among the studies. RESULTS: The meta-analysis showed that the upregulated CD44v6 was associated with lymph node metastasis (OR 1.91, 95% CI 1.19-3.08; P = 0.007), distant metastasis (OR 3.41, 95% CI 2.01-5.78; P = 0.000), high TNM stage (OR 2.29, 95% CI 1.10-4.75; P = 0.026), lymphatic vessel invasion (OR 1.59, 95% CI 1.21-2.09; P = 0.001), and vascular invasion (OR 1.57, 95% CI 1.19-2.07; P = 0.001). When excluded 1 study based on sensitivity analysis, pooled HR indicated that CD44v6 positive expression was correlated poor 5-year OS (OR 1.76, 95% CI 1.30-2.39; P = 0.000), meanwhile, heterogeneity was eliminated. The heterogeneity of Lauren type mainly existed in the big sample size subgroup. Different region and publication year might contribute to the heterogeneity of differentiation type. While the heterogeneity of lymph node mainly existed in Asian and big sample size group. Publication bias was observed among 12 studies on lymph node metastasis (Ppublication bias = 0.041), and 5 studies on TNM stage (Ppublication bias = 0.026). CONCLUSION: Taken together, CD44v6 overexpression might be correlated to the characteristics of tumor metastasis in gastric cancer, consisting with many mechanism studies. Therefore, CD44v6 might present a metastasis-associated biomarker in patients with gastric cancer.


Assuntos
Receptores de Hialuronatos/análise , Neoplasias Gástricas/diagnóstico , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/metabolismo , Humanos , Receptores de Hialuronatos/metabolismo , Prognóstico , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Análise de Sobrevida
16.
Medicine (Baltimore) ; 95(42): e5163, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27759647

RESUMO

BACKGROUND: In recent years, CD44 and CD133 have been identified as 2 common used cancer stem cell (CSC) markers in gastric cancer. However, the clinicopathological and prognostic value of these markers in gastric cancer remains controversial; moreover, there is lack of comparison of these 2 markers' roles in clinical applications. A systematic review and meta-analysis was conducted to elucidate these markers' clinicopathological features and association with prognosis in patients with gastric cancer. METHODS: Eligible studies were identified and odds ratios (ORs), hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated. Heterogeneity and sensitivity were analyzed as well. Publication bias was assessed using funnel plots and Egger tests. RESULTS: The meta-analysis included 26 studies involving 4729 patients. High expression of CD44 was associated with Lauren type (intestinal type) (OR, 1.53 [95% CI, 1.02-2.30]; P = 0.038) and lymphatic vessel invasion (OR, 1.36 [95% CI, 1.06-1.76]; P = 0.021). CD133 overexpression was related to high TNM stage (III/IV) (OR, 3.18 [95% CI, 2.48-4.07]; P = 0.000), high depth of invasion (T3/T4) (OR, 2.97 [95% CI, 2.20-4.03]; P = 0.000), lymph node metastasis (OR, 2.82 [95% CI, 2.16-3.69]; P = 0.000), vascular invasion (OR, 6.71 [95% CI, 1.63-27.63]; P = 0.008), and distant metastasis (OR, 2.32 [95% CI, 1.64-3.29]; P = 0.000). In addition, survival analysis demonstrated a significant association between CD44, as well as CD133 and poor 5-year overall survival (HR, 1.87 [95% CI, 1.55-2.26]; P = 0.000; HR, 2.07 [95% CI, 1.76-2.44]; P = 0.000, respectively). CONCLUSION: These data suggest that upregulated expression of CD44 and CD133 correlates with several clinicopathological features and poor prognosis. Since the related features do not overlap, combined detection of CD44 and CD133 expression can be an especially effective tool for pathological diagnosis and prognostic prediction of gastric cancer patients in clinical applications.


Assuntos
Antígeno AC133/metabolismo , Receptores de Hialuronatos/metabolismo , Células-Tronco Neoplásicas/patologia , Neoplasias Gástricas , Biomarcadores Tumorais/metabolismo , Saúde Global , Humanos , Células-Tronco Neoplásicas/metabolismo , Prognóstico , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/metabolismo , Neoplasias Gástricas/mortalidade , Taxa de Sobrevida/tendências
17.
Oncotarget ; 7(42): 69087-69096, 2016 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-27634907

RESUMO

Glioma associated oncogene-1 (Gli-1) is considered as a strong positive activator of downstream target genes of hedgehog signal pathway in mammalians. However, its diagnostic and prognostic value in gastric cancer remains unclear and controversial. Therefore, a quantitative meta-analysis was conducted to determine the clinical value of Gli-1 in gastric cancer patients. Twelve eligible articles with 886 gastric cancer patients were included in this meta-analysis. The relationship between Gli-1 expression in gastric cancer patients and clinicopathological features and 5-year overall survival (OS) was evaluated using pooled odds ratios (ORs) and hazard ratio (HR) with 95% confidence intervals (CIs). The meta-analysis showed that the upregulated Gli-1 was associated with sample type (gastric cancer tissues) (OR 10.31, 95%CI 7.14-14.88; P = 0.000), differentiation type (OR 3.76, 95%CI 2.55-5.53; P = 0.000), depth of invasion (OR 8.17, 95%CI 3.60-18.55; P = 0.000), lymph node metastasis (OR 3.97, 95%CI 2.73-5.78; P = 0.000) and high TNM stage (OR 3.65, 95%CI 1.89-7.04; P = 0.000). Three studies including 316 patients were assessed for the correlation between Gli-1 and 5-year OS, which indicated that positive Gli-1 expression was associated with poor prognosis in gastric cancer patients (HR 2.14, 95%CI 1.35-3.40; P = 0.001). Little publication bias was identified by funnel plots and Egger's tests. The sensitivity analysis indicated that no study substantially influenced pooled OR/HR. Taken together, Gli-1 is a credible indicator for highly aggressive tumor with poor prognosis in gastric cancer patients.


Assuntos
Regulação Neoplásica da Expressão Gênica , Neoplasias Gástricas/metabolismo , Proteína GLI1 em Dedos de Zinco/metabolismo , Biomarcadores Tumorais/genética , Feminino , Humanos , Masculino , Razão de Chances , Prognóstico , Modelos de Riscos Proporcionais , Transdução de Sinais , Neoplasias Gástricas/genética , Neoplasias Gástricas/mortalidade , Resultado do Tratamento , Proteína GLI1 em Dedos de Zinco/genética
18.
ACS Appl Mater Interfaces ; 8(35): 22963-70, 2016 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-27547984

RESUMO

Ultrasensitive and quantitative fast screening of cancer biomarkers by immunochromatography test strip (ICTS) is still challenging in clinic. The gold nanoparticles (NPs) based ICTS with colorimetric readout enables a quick spectrum screening but suffers from nonquantitative performance; although ICTS with fluorescence readout (FICTS) allows quantitative detection, its sensitivity still deserves more efforts and attentions. In this work, by taking advantages of colorimetric ICTS and FICTS, we described a reverse fluorescence enhancement ICTS (rFICTS) with bimodal signal readout for ultrasensitive and quantitative fast screening of carcinoembryonic antigen (CEA). In the presence of target, gold NPs aggregation in T line induced colorimetric readout, allowing on-the-spot spectrum screening in 10 min by naked eye. Meanwhile, the reverse fluorescence enhancement signal enabled more accurately quantitative detection with better sensitivity (5.89 pg/mL for CEA), which is more than 2 orders of magnitude lower than that of the conventional FICTS. The accuracy and stability of the rFICTS were investigated with more than 100 clinical serum samples for large-scale screening. Furthermore, this rFICTS also realized postoperative monitoring by detecting CEA in a patient with colon cancer and comparing with CT imaging diagnosis. These results indicated this rFICTS is particularly suitable for point-of-care (POC) diagnostics in both resource-rich and resource-limited settings.


Assuntos
Cromatografia de Afinidade , Antígeno Carcinoembrionário , Colorimetria , Ouro , Humanos , Nanopartículas Metálicas
19.
Int J Cancer ; 139(12): 2827-2837, 2016 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-27542841

RESUMO

Human renal cancer is extremely resistant to chemotherapy and radiation therapy. This clinical characteristic reduces the efficacy of chemotherapeutic agents in the treatment of recurrence or metastasis following surgical resection. Understanding the mechanism of chemotherapy resistance in renal cell carcinoma remains a significant challenge. In this study, we have shown that varied level of XPF expression was organ-tissue specific by comparing human renal cancer, bladder cancer, testicular cancer and their normal tissue counterparts, respectively. The expression of XPF was significantly higher in renal cancer than in bladder cancer and testicular cancer and correlated with the clinical characteristic of their chemotherapeutics sensitivity. These novel findings proposed that the intrinsic chemoresistance of human renal cell carcinomas might be derived from the high level of XPF expression. In a panel of five cancer cell lines, decreasing cisplatin sensitivity correlated with increasing levels of XPF expression. Knockdown of XPF expression not only increased sensitivity of renal carcinoma cells to cisplatin treatment by affecting the DNA damage response, including DNA repair, cell cycle regulation and apoptosis, but also increased senescence of renal cancer cell. Furthermore, experiment in vivo confirmed that silenced XPF significantly increased the sensitivity and survival following treatment with cisplatin in xenograft mice bearing renal cell tumor. These findings firstly uncover a partial mechanism of intrinsic chemoresistance in renal cancer and may provide a new approach to break through the obstacle of intrinsic chemoresistance by targeting the XPF protein with a potential new inhibitor.


Assuntos
Antineoplásicos/farmacologia , Carcinoma de Células Renais/genética , Proteínas de Ligação a DNA/genética , Resistencia a Medicamentos Antineoplásicos/genética , Expressão Gênica , Neoplasias Renais/genética , Animais , Antineoplásicos/uso terapêutico , Apoptose/efeitos dos fármacos , Carcinoma de Células Renais/tratamento farmacológico , Carcinoma de Células Renais/patologia , Ciclo Celular/efeitos dos fármacos , Linhagem Celular Tumoral , Senescência Celular/efeitos dos fármacos , Senescência Celular/genética , Cisplatino/farmacologia , Reparo do DNA/efeitos dos fármacos , Proteínas de Ligação a DNA/metabolismo , Modelos Animais de Doenças , Técnicas de Silenciamento de Genes , Humanos , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/patologia , Camundongos , Carga Tumoral/efeitos dos fármacos , Ensaios Antitumorais Modelo de Xenoenxerto
20.
Exp Ther Med ; 12(6): 3972-3978, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28101175

RESUMO

The aim of the present study was to investigate the expression levels of miR-146a and miR-155 in a cardiac xenograft model treated with the immunosuppressant FK506, and to construct lentiviral vectors to further study the roles of miR-146a and miR-155 in cardiac xenotransplantation. Expression levels of miR-146a and miR-155 were examined by quantitative polymerase chain reaction analysis and protein expression of RelA, which is a member of the nuclear factor-κB family, was examined by western blot analysis. Pre-miR-146a and pre-miR-155 fragments were designed and synthesized according to MiRBase and were cloned into the plasmid pCDH1-MCS1-EF1-copGFP. Recombinant plasmids were identified by enzyme digestion and sequencing. Survival time of cardiac grafts in the FK506 treatment group was significantly increased in comparison with the control group (P<0.05). In addition, the histopathological grading results were significantly decreased in the treatment group (P<0.05). A significant decrease in RelA protein expression levels was observed in the treatment group (P<0.05), along with a significant increase in miR-146a expression levels (P<0.05) and a significant decrease in miR-155 expression levels (P<0.05). Digestion and sequencing findings demonstrated that the insertion of miRNA into the plasmid pCDH1-MCS1-EF1-copGFP conformed with the pre-miRNAs, and the lentiviral vectors were concentrated to a titer of 5×107 IFU/ml. These findings demonstrated that FK506 is able to inhibit the rejection effect in a mouse-to-rat cardiac xenotransplantation model. FK506 treatment altered the expression levels of miR-146a and miR-155, indicating that they may have an important role in regulating the immune response to the rejection effect. miR-146a and miR-155 lentiviral vectors were successfully constructed for further experiments both in vitro and in vivo.

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