Reconstruction of extensive thoracic wall defect using the external oblique myocutaneous flap: An analysis on 20 Chinese patients with locally advanced soft tissue sarcoma.

BACKGROUND: Soft tissue sarcomas are rare neoplasms that can occur in the thoracic wall, abdominal wall, extremities, and inguinal region. Wide local resection, with precise histological margin control, results in large skin defects that are challenging to close. Various repair procedures, such as vertical rectus abdominis flaps (VRAM), latissimus dorsi flaps, and tensor fascia lata (TFL) flaps are used to cover broad thoracic wall defects. Although the cosmetic reconstruction results of using these flaps are often excellent, each has significant drawbacks. The external oblique musculocutaneous flap is a simple and safe surgical procedure for covering thoracic wall defects. OBJECTIVE: This study aimed to retrospectively assess the safety and technique of using the external oblique musculocutaneous flap to cover large thoracic wall defects after radical excision of locally advanced sarcomas in 20 patients at a single institution. METHOD: From January 2006 to December 2016, 20 Chinese patients with large advanced sarcomas on their trunks received wide local resection, with precise histological negative margins. The external oblique musculocutaneous flap, mobilized from the ipsilateral abdominal wall, was harvested to cover broad thoracic wall defects. RESULTS: Among the 20 sarcoma patients (12 females and 8 males, ranging in age from 25 to 73 years), there were five patients with primary tumors and 15 patients with recurrent tumors. The median tumor diameter was approximately 15.3 cm. After excising the lesion, the median time to cover the defect with the external oblique myocutaneous flap was 66 min. The average blood loss when harvesting the flap was approximately 48 mL. For the 20 patients in our cohort, the external oblique flap achieved closure of defects measuring an average area of 256 cm2 . No other flaps or reconstruction techniques were used to cover the large defects in this study. There were no deaths directly related to the flap reconstruction procedures. CONCLUSION: The external oblique musculocutaneous flap was a safe and reliable method of covering broad thoracic wall defects after radical tumor excision.

Chinese consensus guidelines for diagnosis and management of gastrointestinal stromal tumor.

In order to further promote the standardization of diagnosis and treatment of gastrointestinal stromal tumor (GIST) in China, the members of Chinese Society of Clinical Oncology (CSCO) Expert Committee on GIST thoroughly discussed the key contents of the consensus guidelines, and voted on the controversial issue. In final, the Chinese consensus guidelines for the diagnosis and management of GIST (2017 edition) was formed on the basis of 2013 edition consensus guidelines, which is hereby announced. The consensus included the pathological diagnosis, recurrence risk classification evaluation, targeted agent therapy, surgery and principles of surveillance of GIST.

Low pretreatment serum globulin may predict favorable prognosis for gastric cancer patients.

An elevated serum albumin (ALB) and albumin/globulin ratio (AGR) have been reported to be associated with a favorable prognosis for several types of cancer. However, little is known about prognostic significance of globulin (GLB) in gastric cancer patients. The purpose of this study was to evaluate whether GLB, ALB, and AGR analysis could predict the prognosis of patients with gastric cancer. A retrospective cohort of 186 patients with gastric cancer followed by radical surgery was recruited between January 2007 and December 2010. Levels for preoperative GLB and ALB were obtained and used to calculate the AGR. Survival analysis was used to evaluate the predictive value of GLB, ALB, and AGR. X-tile program determined 37.6, 33.4, and 1.33 as the optimal cutoff value for ALB, GLB, and AGR in terms of survival. Univariate analysis revealed that low GLB levels were significantly associated with favorable survival (P = 0.045). Conversely, low ALB levels were associated with a significantly worse survival (P = 0.000). In conclusion, low preoperative GLB level may serve as a valuable marker to predict the prognosis of gastric cancer patients.

The multicenter, phase II prospective study of paclitaxel plus capecitabine as first-line chemotherapy in advanced gastric carcinoma.

BACKGROUND: The efficacy and toxicity of paclitaxel plus capecitabine (PX) as first-line treatment in advanced gastric cancer (AGC) was evaluated. METHODS: Patients with previously untreated AGC were included. PX was given every 3 weeks until a maximum of six cycles or progression. Capecitabine monotherapy was continued for patients without disease progression. The primary endpoint was progression-free survival, and secondary endpoints were objective response rate, overall survival (OS), and safety. RESULTS: Overall, 194 patients were treated per protocol and one patient was excluded because of allergy to paclitaxel. Response was evaluated in 175 patients, with an objective response rate of 34.8%. After a median follow-up of 33.2 months, disease progression was observed in 141 patients, 137 died, and 16 were lost to follow-up, with progression-free survival of 188 days and OS of 354 days. In multivariate Cox regression analysis, no factor remained an independent predictor of OS. Forty-five patients who received capecitabine monotherapy after PX had longer OS (531 days). Adverse events were mild (Fig. 1), and the most common grade 3-4 toxicities were leucopenia and neutropenia. CONCLUSION: PX as a first-line treatment has promising efficacy in AGC. Based on these data, a phase III study has been launched for further investigation.

Prognostic role of microRNA-100 in various carcinomas: evidence from six studies.

Recent studies have shown that microRNAs (miRNA) exhibit altered expression levels in cancers, and they may be considered as valuable prognostic biomarkers for patients with cancers. We performed this meta-analysis to provide a comprehensive evaluation of the role of miRNA-100 expression on the overall survival rate by calculating the pooled hazard ratio (HR) for overall survival (OS), which compared the high and low expression levels of miR-100 in patients of the available studies. Finally, a total of six studies dealing with various carcinomas were involved for this meta-analysis. The results indicated that lower expression of miR-100 in cancerous tissue could significantly predict poorer survival in various carcinomas with the pooled HR of 2.19 (95% CI 1.49-3.24, P = 0.0007). In conclusion, the findings from this present meta-analysis suggest that miR-100 expression is associated with OS in cancer patients and could be a useful clinical prognostic factor for those patients.

Hypoxia-inducible factor-1α C1772T polymorphism and cancer risk: a meta-analysis including 18,334 subjects.

Studies on HIF 1α C1772T (P582S) polymorphism revealed a genetic susceptibility to malignant tumors, however, the results were conflicting. We conducted a meta-analysis utilizing 29 eligible case-control studies to analyze the data concerning the association between the HIF-1α C1772T polymorphism and cancer risks. There was statistical association between the HIF-1α CT/TT genotype and cancer risk (OR = 1.28, 95% CI = 1.06-1.54, P(heterogeneity) < .00001). The stability of these observations was confirmed by a one-way sensitivity analysis. Our findings suggested that CT/TT genotype was associated with increased risks of prostate cancer. Besides, the HIF-1α C1772T polymorphism most likely contributes to susceptibility to malignant tumors, especially in American population.

The use of unilateral or bilateral external oblique myocutaneous flap in the reconstruction of lower abdominal wall or groin defects after malignant tumor resection.

BACKGROUND: External oblique myocutaneous flap (EOMF) has been used successfully for many years in reconstructive plastic surgery, its function is mainly concentrated in the restoration of chest wall defects following breast cancer resection. However, for the lower abdominal wall or groin defects after malignant tumor resection, reconstruction with EOMF is little reported. In this study, we report our experience with EOMF downward transposition to repair the defects. METHODS: 12 patients with malignant diseases in the lower abdominal wall or groin underwent aggressive tumor resection, the defects were reconstructed immediately with EOMF. Patient characteristics, details of operation and postoperative complications were described. RESULTS: 12 patients received radical resection, the defect size ranged from 140 to 588 cm(2) . Ipsilateral or bilateral EOMF was utilized to repair the defects. The EOMF had good quality skin and soft tissue to cover the defects, postoperatively, four patients developed seroma, two patients had distal tip necrosis, but no serious complications occurred, the wound of donor site healed well, no abdominal hernia was found. CONCLUSION: Our study provides a new and alternative approach to reconstruct large defects with EOMF downward transposition after malignant tumor resection in the lower abdominal wall or groin.

Long-term spatial distribution and implication of black and brown carbon in the Tibetan Plateau.

Black carbon (BC) and brown carbon (BrC) over the high-altitude Tibetan Plateau (TP) can significantly influence regional and global climate change as well as glacial melting. However, obtaining plateau-scale in situ observations is challenging due to its high altitude. By integrating reanalysis data with on-site measurements, the spatial distribution of BC and BrC can be accurately estimated using the random forest algorithm (RF). In our study, the on-site observations of BC and BrC were successively conducted at four sites from 2018 to 2021. Ground-level BC and BrC concentrations were then obtained at a spatial resolution of 0.25° × 0.25° for three periods (including Periods-1980, 2000, and 2020) using RF and multi-source data. The highest annual concentrations of BC (1363.9 ± 338.7 ng/m3) and BrC (372.1 ± 96.2 ng/m3) were observed during Period-2000. BC contributed a dominant proportion of carbonaceous aerosol, with concentrations 3-4 times higher than those of BrC across the three periods. The ratios of BrC to BC decreased from Period-1980 to Period-2020, indicating the increasing importance of BC over the TP. Spatial distributions of plateau-scale BC and BrC concentrations showed heightened levels in the southeastern TP, particularly during Period-2000. These findings significantly enhance our understanding of the spatio-temporal distribution of light-absorbing carbonaceous aerosol over the TP.

Radiographic response to neoadjuvant therapy and its impact on scope of surgery and prognosis in stage IIB/III soft tissue sarcomas.

BACKGROUND: Neoadjuvant chemoradiotherapy has been newly included in the NCCN guidelines as a treatment option for stage IIB/III soft tissue sarcomas. Whether radiographic response to neoadjuvant therapy correlates with improved quality of resection and prognosis remains unproven. METHODS: Data from 120 consecutive patients who were treated with neoadjuvant chemoradiotherapy followed by surgical resection for their locally aggressive limb sarcomas were retrospectively reviewed. Radiographic response was evaluated after neoadjuvant therapy according to Response Evaluation Criteria In Solid Tumors, and data was analyzed for overall survival (OS), local recurrence free survival (LRFS) and metastasis free survival (MFS). Surgical complications and toxicities, as well as functional outcomes, were also analysed. RESULTS: After neoadjuvant chemoradiotherapy, 25 patients (20.8%) had a partial response, 75 patients (62.5%) had stable disease, and 20 patients (16.7%) showed disease progression. Radiographic response to neoadjuvant therapy correlated significantly with improved OS (P = 0.002) and MFS (P < 0.001). Patients with partial response (PR) had a significantly decreased rate of R2 resection as compared with stable disease (SD) and progressive disease (PD) patients (4.0% Vs 21.4%, P < 0.001). CONCLUSIONS: Radiographic response to neoadjuvant chemoradiotherapy correlates with improved quality of resection and prognosis in extremity STS patients.

Imatinib as preoperative therapy in Chinese patients with recurrent or metastatic GISTs.

OBJECTIVE: Imatinib has dramatically altered the options for management of patients with gastrointestinal stromal tumours. However, it has become clear that secondary resistance to the drug develops during long-term therapy. The purpose of our study was to retrospectively analyze safety and long-term outcomes in Chinese patients with recurrent or metastatic GISTs treated with imatinib preoperatively. METHODS: Between June 2003 and June 2011, 22 patients underwent surgery for recurrent or metastatic GISTs after preoperative treatment with imatinib. RESULTS: Complete resection was accomplished in 8 of the 10 responsive disease (RD) patients (80%), and in 3 of the 12 patients (25%) who had progression disease (PD). The amount of blood loss during the operation in PD patients was higher than in RD patients. There was 1 hospital death in PD group related to surgery, while the other patients recovered with conservative therapy because complications were mild. The difference in median PFS between patients with RD and those with PD was significant (24.8 vs. 2.81 months, P<0.001). The difference in 2-year OS rate between patients with RD and those with PD was not significant (100% vs. 87.5%, P>0.05). CONCLUSIONS: Our study indicates that surgical intervention can improve the PFS of Chinese patients with recurrent or metastatic GISTs responsive to imatinib, but does not prolong OS as well as in patients who develop imatinib resistance. Surgical resection following imatinib treatment is feasible and can be considered for patients with advanced GISTs responsive to imatinib.

[Case Analysis of Heavy Air Pollution Process in Xi'an Using Multi-source Data].

Air pollution continues to be a serious problem in Xi'an. A heavy pollution process and formation mechanism were investigated in Xi'an in January 2019 using multi-source methods (such as material balance and sulfur/nitrogen oxidation rate (SOR/NOR)). The multi-source data included the concentrations of PM2.5, PM10, SO2, NO2, CO, and O3; the chemical components of PM2.5; the meteorological records of ground and vertical observations; the atmospheric reanalysis data. Three phases were obtained including the accumulation phase (P1), maintenance phase (P2), and dispersion phase (P3) during the pollution period. The pollution event was primarily attributed to the superposition of adverse weather conditions and feedback effects. During the periods of P1 and P2, the area of Xi'an was affected by blocking and zonal westerly airflow at 500 hPa (with flat westerly airflow) and uniform-distribution pressure at sea level with a limited pressure gradient and stable weather conditions, and the easterly wind was dominant at 925 hPa; not all of these factors were conducive to the pollutant diffusion. An interaction feedback mechanism between meteorological conditions and heavy pollution could be studied using the ground-based microwave radiometer. The correlations between PM2.5 and inversions of water vapor density, relative humidity, air temperature, and temperature inversion were significant with coefficients of 0.86, 0.62, 0.53, and 0.38, respectively. The feedback mechanism was primarily manifested as follows:with the pollutant accumulation, the radiative cooling effect could lead to or strengthen the occurrence and intensity of temperature inversion, decrease the mixed layer height, and cause moisture accumulation. High humidity could further maintain the pollution by accelerating the secondary formation and promoting the hygroscopic growth of aerosol particles. Therefore, the dominant chemical components to PM2.5were secondary inorganic ions (SO42-+NO3-+NH4+, SNA) and "other" components during the period of P2, with contributions of 43.2% and 23.1%, respectively. In addition, the peak values of PM2.5, SOR, NOR, and the light extinction coefficients all occurred on the same days (January 3 and 6), indicating that the effect of secondary formation was important for both heavy pollution events and visibility. The total contribution of NH4NO3, organic matter (OM), (NH4)2SO4, and EC to the light extinction coefficient was more than 85%. Limited variations in the proportion for components were observed in three phases. During the period of P3, the strong cold air in the mid-lower atmosphere was conducive to the dry and clean air sinking and the pressure gradient at sea level increasing. These were beneficial to the diffusion of air pollutants and water vapor.

Dermatofibrosarcoma protuberans: clinical diagnoses and treatment results of 260 cases in China.

BACKGROUND AND OBJECTIVES: Dermatofibrosarcoma protuberans (DFSP) is a low-grade malignant tumor but has high local recurrence rate. The objectives of this study were to analyze their clinicopathologic factors and review the experience of multidisciplinary treatments. METHODS: A total of 260 patients who were treated between 1985 and 2006 in Fudan University Shanghai Cancer Center were evaluated. Outcomes were compared focusing on recurrence and survival. Classical DFSP and transformed DFSP were the two subtypes. RESULTS: After local excision, 50.2% of the patients were found to have residual tumors. The recurrence rate after local excision was significantly higher than that after wide excision (45.0% vs. 8.5%, P < 0.0001). Patients undergoing wide excision with margins ≥3 cm were found to have lower recurrence rate compared with those margins 1.5-2.5 cm (5.7% vs. 13.6%, P = 0.043). Compared with classical DFSPs, transformed DFSPs had significantly higher recurrence rate (34.5% vs. 6.3%, P < 0.0001), higher metastatic rate (23.5% vs. 0.4%, P < 0.0001), and worse prognosis (10-year survival rate 66.0% vs. 98.6%, P < 0.0001). CONCLUSIONS: Performing adequate initial resection is important for patients with DFSP. Once DFSP was diagnosed, wide excision with a best margin of ≥3 cm is necessary. Transformed DFSPs are more aggressive tumors which need more energetic treatments.

Adjuvant chemotherapy decreases and postpones distant metastasis in extremity stage IIB/III synovial sarcoma patients.

BACKGROUND AND OBJECTIVES: The role of adjuvant chemotherapy (AC) in treatment of synovial sarcoma remains controversial. Aim of our study is to investigate the influence of AC on disease-specific survival and metastasis free survival, the difference in time to metastasis (TTM) was also analyzed. MATERIALS AND METHODS: Seventy-six cases of stage IIB/III synovial sarcoma from January 1993 to December 2008 were retrospectively analyzed. All the 76 patients were treated with surgical resection. AC regimen included first line MAID or AIM, second line Gemcitabine + Docetaxel with sufficient dose intensity. The clinical, pathologic, and treatment variables were analyzed for disease specific survival (DSS), metastasis free survival (MFS) and TTM. RESULTS: Median follow up period was 68 months. 51 patients received AC (51/76, 67%), 25 received no adjuvant chemotherapy (NAC, 25/76, 33%). The 5-year DSS of the AC patients was 73%(58-87%) compared with 31%(19-52%) for the NAC patients (P = 0.001). AC was also independently associated with improved MFS (P = 0.008) and prolonged TTM (P = 0.001). CONCLUSIONS: Patients with stage IIB/III synovial sarcoma might benefit in DSS, MFS, and a prolonged TTM from AC.

Poor prognostic factors in patients with stage I gastric cancer according to the seventh edition TNM classification: a comparative analysis of three subgroups.

BACKGROUND AND OBJECTIVES: The purpose of this study was to investigate the prognosis of stage I gastric cancer and to compare clinicopathologic characteristics by subgroup. METHODS: Between January 2000 and December 2006, 384 patients with gastric cancer were reclassified as stage I according to the seventh edition classification. A comparative analysis was performed between three subgroups. Univariate and multivariate analyses were conducted. RESULTS: The 5-year overall survival rates in T1N0, T1N1, and T2N0 were 98.8%, 94.1%, 91.1%, respectively (P = 0.009). In patients with T2N0 gastric cancer, tumors in the upper third and larger tumors were more common than in patients with T1N0 and T1N1 gastric cancer (P < 0.001). In patients with T1N1 and T2N0 gastric cancer, the presence of lymphatic and/or blood vessel invasion (LBVI) and perineural invasion (PNI) were more common than in patients with T1N0 gastric cancer (P < 0.001). Univariate analysis showed tumor stage, depth of invasion, LBVI, and PNI were significant prognostic factors. However, multivariate analysis demonstrated that only tumor stage, LBVI, and PNI were significant variables. CONCLUSIONS: Survival data support the accuracy of new TNM classification for stage I gastric cancer. Tumor stage, the presence of LBVI and PNI are important independent prognostic factors in stage I gastric cancer.

The correlations between the expression of FGFR4 protein and clinicopathological parameters as well as prognosis of gastric cancer patients.

BACKGROUND: Fibroblast growth factor receptor 4 (FGFR4) was seldom investigated in gastric cancer (GC). The purpose of the study was to elucidate the expression of FGFR4 protein in GC and related clinical significance. METHODS: Ninety-four paraffin-embedded tumor specimens were obtained from Cancer Hospital, Fudan University. The expression of FGFR4 as well as p53, p21, EGFR, neu, c-myc, and PCNA were detected by immunohistochemical method. Then, correlation analysis and survival analysis were performed. RESULTS: The expression rate of FGFR4 protein in GC tissues and normal stomach tissues was 93.6% and 30.8%, respectively (P = 0.000). The expression of FGFR4 was positively correlated with the expression of p21, neu and PCNA (P-value was 0.009, 0.012, and 0.018, respectively). Subgroup analysis showed that compared to low expression group, the prognosis of patients with III/IV stage and negative expression of p21 in high expression group of FGFR4 were worse (P = 0.048, 0.041, respectively). Multivariate analysis showed that TNM stage was the independent prognostic factor in high expression group (HR, 11.593; 95% CI, 3.532-18.058; P = 0.000). CONCLUSIONS: High expression of FGFR4 protein, accelerating the progression of advanced GC, might be associated with a poor prognosis in patients with advanced FC.

[Expression of hypoxia-inducible factor 1α in osteosarcoma and its value in predicting chemosensitivity].

OBJECTIVE: To investigate the prognostic values of HIF-1α, APE1, VEGF, and COX-2 protein expressions and their predictive value of tumor necrosis rate and prognosis in osteosarcoma, as well as their interrelationships. METHODS: Formalin-fixed paraffin-embedded tissue samples were obtained from patients with osteosarcoma. Immunohistochemical assay was performed in pre-chemotherapy samples to determine the HIF-1α, VEGF, APE1, and COX-2 protein expression levels. Hematoxylin-eosin staining was used in post-operative samples to determine the tumor necrosis rate. Univariate and multivariate analyses were used to assess the impact of protein expression on prognosis. RESULTS: Tumor tissues were obtained from 49 patients. Their median follow up was 29 months. HIF-1α was significantly correlated to every protein we tested: VEGF (P = 0.032), APE1 (P < 0.001), and COX-2 (P < 0.001). HIF-1α protein expression had a significant impact on disease free survival (P = 0.006). Expression of HIF-1α had a sensitivity of 64.7% and a specificity of 71.9% for poor pathological response (< 90% of tumor necrosis) versus good pathological response to chemotherapy (≥ 90% necrosis). CONCLUSION: Expression of HIF-1α is a predictor of tumor response to neoadjuvant chemotherapy and outcome in osteosarcoma and is correlated with VEGF, APE1, and COX-2 expression.

Prognostic analysis of familial gastric cancer in Chinese population.

BACKGROUND: The aim of this study was firstly to elucidate the prognosis of familial gastric cancer (FGC) in Chinese population. METHODS: A total of 162 patients were recruited, including 81 patients with FGC and 81 patients with sporadic gastric cancer (SGC), who underwent gastrectomy between 1996 and 2007. Paraffin-embedded tumor specimens were obtained from tissue bank of Cancer Hospital, Fudan University. The expression of epidermal growth factor receptor (EGFR), P53, C-myc, and proliferating cell nuclear antigen (PCNA) were detected by immunohistochemical method. RESULTS: There were significant differences in tumor size, vessel invasion, EGFR, and P53 expression between FGC and SGC patients. The 5-year survival rates were 48% and 57% in FGC and SGC patients, respectively (P = 0.033). Subgroup analysis showed that the 5-year survival rates were worse in FGC patients with nerve invasion, high PCNA expression, negative expression of EGFR, and positive expression of P53 than those in SGC group. Multivariate analysis showed that AJCC stage, tumor size, and nerve invasion were independent prognostic factors in all patients. Furthermore, AJCC stage and P53 expression dramatically affected the prognosis of FGC patients. CONCLUSIONS: The prognosis of FGC patients might be worse than those of SGC patients. AJCC stage and P53 expression are independent prognostic factors in FGC patients.

Simultaneous vs. staged resection for synchronous colorectal liver metastases: a metaanalysis.

PURPOSE: The optimal timing of surgical resection for synchronous colorectal liver metastases (SCLMs) remains controversial. The aim of this metaanalysis was to compare outcomes between simultaneous resection and staged resection from all published comparative studies in the literature. MATERIALS AND METHODS: Databases, including PubMed, Embase, Cochrane Library, Ovid, and Web of Science, were searched to identify studies comparing outcomes following simultaneous resection with staged resection for SCLM. The metaanalysis was performed by RevMan 4.2. RESULTS: Fourteen comparative studies comprising 2,204 patients were identified. Patients undergoing simultaneous resection were found to have similar operative time (weighted mean difference [WMD], -34.19; 95% confidence interval [CI], -81.32-12.95, P = .16) and intraoperative blood loss (WMD, -161.33; 95% CI, -351.45-28.79, P = .10). Shorter hospital stay (WMD, -4.77; 95% CI, -7.26-2.28, P < .01) and lower morbidity rate (odds ratio [OR], 0.71; 95% CI, 0.57-0.88, P = .002) were observed in simultaneous resection group. The survival rate in the simultaneous resection group did not statistically differ with that in the staged resection group at 1 year (OR, 0.77; 95% CI, 0.51-1.16, P = .21), 3 years (OR, 1.12; 95% CI, 0.85-1.47, P = .43), and 5 years (OR, 1.14; 95% CI, 0.86-1.50, P = .37) postresection, respectively. CONCLUSIONS: Simultaneous resection is safe and efficient in the treatment of patients with SCLM while avoiding a second major operation. In appropriately selected patients, simultaneous resection might be considered as the preferred treatment. Since heterogeneity was detected, caution is needed in interpretation of the results. Better designed, adequately powered studies are required for addressing this issue.

Survival after anatomic resection versus nonanatomic resection for hepatocellular carcinoma: a meta-analysis.

BACKGROUND AND OBJECTIVES: To compare the effect on survival of anatomic resection (AR) versus nonanatomic resection (NAR) in patients with hepatocellular carcinoma (HCC) from all published comparative studies in the literature. METHODS: Databases, including Pubmed, Embase, the Cochrane Library, Ovid, and Web of Science, were searched to identify studies comparing AR with NAR for HCC. In this meta-analysis, primary end points were the overall survival and disease-free survival; the secondary end point was local recurrence rate. The meta-analysis was performed by use of RevMan 4.2. RESULTS: Nine comparative studies comprising 1,503 patients (833 AR and 670 NAR) were identified. In the combined results, disease-free survival was significantly higher in the AR group than in the NAR group (OR 1.78, 95% CI 1.22-2.59, P = 0.003; heterogeneity P = 0.08). Overall survival (OR 1.31, 95% CI 0.92-1.85, P = 0.13; heterogeneity P = 0.04) did not suggest any significant difference between AR and NAR. No statistically significant difference was found for local recurrence rate between the two resection methods (OR 0.55, 95% CI 0.25-1.23, P = 0.15; heterogeneity P = 0.010). CONCLUSIONS: Anatomic resection is associated with better disease-free survival than nonanatomic resection. Because heterogeneity was detected, caution is needed in interpretation of the results. Better designed, adequately powered studies are required to address this issue.

The fibroblast growth factor receptor-4 Arg388 allele is associated with gastric cancer progression.

BACKGROUND: Fibroblast growth factor receptor 4 (FGFR4) Gly388Arg polymorphism, located in the FGFR4 gene exon 9, was reported to be associated with malignant tumors prognosis; however, there has been no relevant research for gastric cancer. The purpose of this study was to investigate the clinical significance of FGFR4 Gly388Arg polymorphism as well as the mRNA expression of FGFR4 in patients with gastric cancer. METHODS: The mRNA expression of FGFR4 in 103 gastric cancer tissues and corresponding normal tissues were measured by reverse transcription polymerase chain reaction (PCR) and real-time quantitative PCR. PCR-restriction fragment length polymorphism analysis was performed to detect the FGFR4 Gly388Arg in 103 gastric cancer tissues. RESULTS: In 57.3% of patients, homozygous or heterozygous Arg388 allele was present. FGFR4 expressions in mRNA levels were higher in gastric cancer tissues compared with those in relevant normal tissues. However, there is no significantly statistical difference compared with mRNA expression of FGFR4 in different genotypes. Associations between FGFR4 Gly388Arg polymorphism and overall survival exist in patients with gastric cancer (P = 0.046).The FGFR4 Arg allele (hazard risk (HR), 2.324; 95% confidence interval (CI), 1.054-4.125; P = 0.037) and TNM stage (HR, 5.516; 95% CI 3.658-7.409; P = 0.005) were independent prognostic factors in patients with gastric cancer. CONCLUSIONS: Based on this study, FGFR4 Arg388 genotype-a marker for gastric cancer progression-may predict prognosis of gastric cancer.