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Prognostic value of preoperative prognostic nutritional index and its associations with systemic inflammatory response markers in patients with stage Ⅲ colon cancer

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Chinese Journal of Cancer 2017年第11期36卷 635-646页

作者： Jianhong Peng Rongxin Zhang Yixin Zhao Xiaojun Wu Gong Chen desen wan Zhenhai Lu Zhizhong Pan Department of Colorectal Surgery State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Sun Yat-sen University Cancer Center 651 Dongfeng Road East GuangzhouGuangdong 510060 P. R. China

Background: The prognostic nutritional index(PNI) has been widely applied for predicting survival outcomes of patients with various malignant tumors. Although a low PNI predicts poor prognosis in patients with colorectal cancer after tumor resection, the prognostic value remains unknown in patients with stage Ⅲ colon cancer undergoing curative tumor resection followed by adjuvant chemotherapy. This study aimed to investigate the prognostic value of PNI in patients with stage III colon cancer.Methods: Medical records of 274 consecutive patients with stage Ⅲ colon cancer undergoing curative tumor resection followed by adjuvant chemotherapy with oxaliplatin and capecitabine between December 2007 and December2013 were reviewed. The optimal PNI cutoff value was determined using receiver operating characteristic(ROC) curve analysis. The associations of PNI with systemic inflammatory response markers, including lymphocyte-to-monocyte ratio(LMR), neutrophil-to-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio(PLR), and C-reactive protein(CRP)level, and clinicopathologic characteristics were assessed using the Chi square or Fisher's exact test. Correlation analysis was performed using Spearman's correlation coefficient. Disease-free survival(DFS) and overall survival(OS)stratified by PNI were analyzed using Kaplan-Meier method and log-rank test, and prognostic factors were identified by Cox regression analyses.Results: The preoperative PNI was positively correlated with LMR(r= 0.483, P < 0.001) and negatively correlated with NLR(r =-0.441, P < 0.001), PLR(r =-0.607, P < 0.001), and CRP level(r =-0.333, P < 0.001). A low PNI(≤49.22)was significantly associated with short OS and DFS in patients with stage ⅢC colon cancer but not in patients with stage ⅢA/ⅢB colon cancer.In addition, patients with a low PNI achieved a longer OS and DFS after being treated with6-8 cycles of adjuvant chemotherapy than did those with < 6 cycles. Multivariate analyses revealed that PNI was independently associated with DFS(hazard ratios 2.001;

关键词： Prognostic nutritional index Colon cancer Systemic inflammatory response marker Prognosis

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Expression of voltage.gated sodium channel Nav1.5 in non.metastatic colon cancer and its associations with estrogen receptor(ER)-βexpression and clinical outcomes

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Chinese Journal of Cancer 2017年第12期36卷 694-703页

作者： Jianhong Peng Qingjian Ou Xiaojun Wu Rongxin Zhang Qian Zhao Wu Jiang Zhenhai Lu desen wan Zhizhong Pan Yujing Fang Department of Colorectal Surgery State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yatsen University Cancer Center651 Dongfeng Road EastGuangzhou 510060GuangdongP.R.China Department of Experimental Research Sun Yat-sen University Cancer CenterGuangzhou 510060GuangdongP.R.China Department of Statistics School of Public HealthGuangzhou Medical UniversityGuangzhou 510182GuangdongP.R.China

Background: Voltage-gated sodium channel 1.5(Nav1.5) potentially promotes the migratory and invasive behaviors of colon cancer cells. Hitherto, the prognostic significance of Nav1.5 expression remains undetermined. The present study aimed to explore the associations of Nav1.5 expression with clinical outcomes and estrogen receptor-β(ER-β)expression in non-metastatic colon cancer patients receiving radical resection.Methods: A total of 269 consecutive patients with pathologically confirmed stages Ⅰ-Ⅲ colon cancer who underwent radical resection were selected. Nav1.5 and ER-β expression was detected by using immunohistochemistry(IHC)on tissue microarray constructed from paraffin-embedded specimens. IHC score was determined according to the percentage and intensity of positively stained cells. Statistical analysis was performed with the X-tile method, k coefficient, Chi square test or Fisher's exact test, logistic regression, log-rank test, and Cox proportional hazards models.Results: We found that Nav1.5 was commonly expressed in tumor tissues with higher mean IHC score as compared with matched tumor-adjacent normal tissues(5.1 ± 3.5 vs. 3.5 ± 2.7, P < 0.001).The high expression of Nav1.5 in colon cancer tissues was associated with high preoperative carcinoembryonic antigen level [odds ratio(OR) = 2.980;95% confidential interval(CI)1.163-7.632; P = 0.023] and high ER-β expression(OR = 2.808; 95% CI 1.243-6.343;p = 0.00 3). Log-rank test results showed that high Nav1.5 expression contributed to a low 5-year disease-free survival(DFS) rate in colon cancer patients(77.2% vs. 92.1%, P = 0.048), especially in patients with high ER-β expression tumor(76.2% vs. 91.3%, P = 0.032). Analysis with Cox proportional hazards model demonstrated that high Nav1.5 expression[hazard ratio(HR) = 2.738; 95% CI 1.100-6.819;P = 0.030] and lymph node metastasis(HR = 2.633; 95% CI 1.632-4.248; P < 0.001) were prognostic factors for unfavorable DFS in colon cancer patients.Conclusions: High expression of Nav1.5 was associated with high expr

关键词： Nav1.5 Estrogen receptor-β Colon cancer Clinical outcome

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Is there a survival benefit from adjuvant chemotherapy for patients with liver oligometastases from colorectal cancer after curative resection?

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Cancer Communications 2018年第1期38卷 319-328页

作者： Zhizhong Pan Jianhong Peng Junzhong Lin Gong Chen Xiaojun Wu Zhenhai Lu Yuxiang Deng Yujie Zhao Qiaoqi Sui desen wan Department of Colorectal Surgery Sun Yat-sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer Medicine651 Dongfeng Road EastGuangzhou 510060GuangdongP.R.China

Background:Although colorectal oligometastases to the liver can potentially be cured with aggressive local abla-tion,the efficacy of adjuvant chemotherapy(ACT)for such metastasis remains unclear.The present study explored the effects of ACT on patients with colorectal liver oligometastases(CLO)after curative resections and aimed to iden-tify patients who could benefit from ACT.Methods:We retrospectively analyzed 264 eligible patients with CLO who underwent curative resection between September 1999 and June 2015.Recurrence-free survival(RFS)and overall survival(OS)were analyzed using the Kaplan-Meier method and log-rank test;prognostic factors were a by Cox regression modeling.Results:Among 264 patients,200(75.8%)patients received ACT and 64(24.2%)did not receive ACT.These two groups did not significantly differ in clinicopathologic characteristics,and had comparable 3-year OS and RFS rates(RFS:42.1%vs.45.7%,P=0.588;OS:69.7%vs.62.7%,P=0.446)over a median follow-up duration of 35.5 months,irrespective of preoperative chemotherapy.ACT markedly improved 3-year OS in high-risk patients with Memorial Sloan-Kettering Cancer Center clinical risk scores(MSKCC-CRS)of 3-5(68.2%vs.33.8%,P=0.015),but presented no additional benefit in patients with MSKCC-CRS of 0-2(72.2%vs.78.6%,P=0.834).In multivariate analysis,ACT was independently associated with improved OS in patients with MSKCC-CRS of 3-5.Conclusions:ACT might offer a prognostic benefit in high-risk patients with CLOs after curative liver resection,but not in low-risk patients.Therefore,patients’risk status should be determined before ACT administration to optimize postoperative therapeutic strategies.

关键词： Colorectal cancer Oligometastases Adjuvant chemotherapy Liver resection Benefit

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Total mesorectal excision with or without preoperative chemoradiotherapy for resectable mid/low rectal cancer: a long-term analysis of a prospective, single-center, randomized trial

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Cancer Communications 2018年第1期38卷 773-782页

作者： Fulong wang Wenhua Fan Jianhong Peng Zhenhai Lu Zhizhong Pan Liren Li Yuanhong Gao Hui Li Gong Chen Xiaojun Wu Peirong Ding Zhifan Zeng desen wan Sun Yat-sen University Cancer Center State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou 510060GuangdongP.R.China Department of Colorectal Surgery Sun Yat-sen University Cancer Center651 Dongfeng Road EastGuangzhou 510060GuangdongP.R.China Department of Radiation Oncology Sun Yat-sen University Cancer CenterGuangzhou 510060GuangdongP.R.China Department of Gynecological Oncology Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhou 510060GuangdongP.R.China

Background:The preliminary results of our phase II randomized trial reported comparable functional sphincter pres-ervation rates and short-term survival outcomes between patients undergoing total mesorectal excision(TME)with or without preoperative concurrent chemoradiotherapy(CCRT).We now report the long-term results after a median follow-up of 71 months.Methods:Between March 23,2008 and August 2,2012,192 patients with T3-T4 or node-positive,resectable,mid/low rectal adenocarcinoma were randomly assigned to receive TME with or without preoperative CCRT.The following endpoints were assessed:cumulative rates of local recurrence and distant metastasis,disease-free survival(DFS),and overall survival(OS).Results:The data of 184 eligible patients were analyzed:94 patients in the TME group and 90 patients in the CCRT+TME group.In the whole cohort,the 5-year DFS and OS rates were 84.8%and 85.1%,respectively.The 5-year DFS rates were 85.2%in the CCRT+TME group and 84.3%in the TME group(P=0.969),and the 5-year OS rates were 83.5%in the CCRT+TME group and 86.5%in the TME group(P=0.719).The 5-year cumulative rates of local recur-rence were 6.3%and 5.0%(P=0.681),and the 5-year cumulative rates of distant metastasis were 15.0%and 15.7%(P=0.881)in the CCRT+TME and TME groups,respectively.No significant improvements in 5-year DFS and OS were observed with CCRT by subgroup analyses.Conclusions:Both treatment strategies yielded similar long-term outcomes.A selective policy towards preoperative CCRT is thus recommended for rectal cancer patients if high-quality TME surgery and enhanced chemotherapy can be performed.

关键词： Rectal cancer Total mesorectal excision Chemoradiotherapy Long-term outcomes Phase II randomized trial

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Ⅲ期结肠癌患者术前预后营养指数的预后价值及其与全身炎症反应标志物的相关性

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癌症 2019年第1期38卷 10-22页

作者： Jianhong Peng Rongxin Zhang Yixin Zhao Xiaojun Wu Gong Chen desen wan Zhenhai Lu Zhizhong Pan 结直肠外科华南肿瘤学国家重点实验室肿瘤医学协同创新中心中山大学肿瘤防治中心

背景与目的预后营养指数(prognostic nutritional index,PNI)已广泛应用于预测各种恶性肿瘤患者的生存结局。虽然低PNI预测肿瘤切除后的结直肠癌患者的预后不良,但对接受根治性肿瘤切除术后辅助化疗的Ⅲ期结肠癌患者的预后价值仍未知。... 详细信息

背景与目的预后营养指数(prognostic nutritional index,PNI)已广泛应用于预测各种恶性肿瘤患者的生存结局。虽然低PNI预测肿瘤切除后的结直肠癌患者的预后不良,但对接受根治性肿瘤切除术后辅助化疗的Ⅲ期结肠癌患者的预后价值仍未知。本研究旨在探讨PNI对Ⅲ期结肠癌患者的预后价值。方法本文回顾了2007年12月至2013年12月期间,274例接受根治性肿瘤切除术后接受奥沙利铂和卡培他滨辅助化疗的Ⅲ期结肠癌的连续患者的医疗记录。采用受试者工作特征(receiver operating characteristic,ROC)曲线分析确定最佳PNI临界值。采用卡方检验或Fisher’s精确检验评估PNI与全身炎症反应标志物[包括淋巴细胞与单核细胞比值(lymphocyte-to-monocyte ratio,LMR)、中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、血小板与淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)、C反应蛋白(C-reactive protein,CRP)水平]和临床病理特征的相关性。采用Spearman’s相关系数进行相关分析。采用Kaplan-Meier法和log-rank检验分析PNI分层的无病生存期(disease-free survival,DFS)和总生存期(overall survival,OS),并通过Cox回归分析确定预后因子。结果术前PNI与LMR呈正相关(r=0.483,P <0.001),与NLR(r=-0.441,P <0.001)、PLR(r=-0.607,P <0.001)和CRP水平(r=-0.333,P <0.001)呈负相关。在ⅢC期结肠癌患者中,低PNI(≤49.22)与短OS和DFS显著相关,而在ⅢA/ⅢB期结肠癌患者中则不相关。此外,在PNI低的患者中,接受6–8个疗程辅助化疗的患者比接受<6个疗程治疗的患者获得了更长的OS和DFS。多变量分析显示PNI与DFS独立相关(风险比=2.001;95%置信区间:1.157–3.462;P=0.013)。结论术前PNI是接受根治性肿瘤切除术后辅助化疗的Ⅲ期结肠癌患者生存结局的重要预测指标。

关键词：预后营养指数结肠癌全身炎症反应标志物预后

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对可切除的中/低位直肠癌是/否进行术前放化疗的全直肠系膜切除术研究:一项前瞻性、单中心、随机试验的长期分析

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癌症 2019年第5期38卷 207-216页

作者： Fulong wang Wenhua Fan Jianhong Peng Zhenhai Lu Zhizhong Pan Liren Li Yuanhong Gao Hui Li Gong Chen Xiaojun Wu Peirong Ding Zhifan Zeng desen wan 中山大学肿瘤防治中心华南肿瘤学国家重点实验室肿瘤医学协同创新中心广东广州510060 中山大学肿瘤防治中心结直肠科广东广州510060 中山大学肿瘤防治中心放疗科广东广州510060 中山大学孙逸仙纪念医院妇科肿瘤科广东广州510060

背景与目的我们的Ⅱ期随机试验的初步研究结果显示,对进行全直肠系膜切除术(total mesorectal excision,TME)的患者是/否进行术前同步放化疗(concurrent chemoradiotherapy,CCRT),二者的功能性括约肌保留率和短期生存结局相近。在经过中... 详细信息

背景与目的我们的Ⅱ期随机试验的初步研究结果显示,对进行全直肠系膜切除术(total mesorectal excision,TME)的患者是/否进行术前同步放化疗(concurrent chemoradiotherapy,CCRT),二者的功能性括约肌保留率和短期生存结局相近。在经过中位71个月的随访后,现报告这一长期试验的结果。方法在2008年3月23日至2012年8月2日期间,192例患有T3–T4或淋巴结阳性、可切除的中/低直肠腺癌患者被随机分为接受或不接受术前CCRT组,之后均进行TME。评估以下终点:局部复发和远处转移的累积率、无病生存(disease?free survival,DFS)和总生存(overall survival,OS)。结果对入组的184例患者资料进行分析,其中TME组有94例,CCRT+TME组有90例。在整个队列中,5年DFS和OS率分别为84.8%和85.1%。CCRT+TME组的5年DFS率为85.2%,TME组为84.3%(P=0.969);CCRT+TME组的5年OS率为83.5%,TME组为86.5%(P=0.719)。在CCRT+TME和TME组中,局部复发的5年累积率分别为6.3%和5.0%(P=0.681),远处转移的5年累积率分别为15.0%和15.7%(P=0.881)。通过亚组分析,接受CCRT未观察到5年DFS和OS的显著改善。结论两种治疗方案的长期结局相近。因此,如果可以进行高质量的TME手术和强化化疗,建议选择性地对直肠癌患者进行术前CCRT。

关键词： Ⅱ直肠癌全直肠系膜切除术放化疗长期结局 Ⅱ期随机试验

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Bevacizumab with preoperative chemotherapy versus preoperative chemotherapy alone for colorectal cancer liver-only metastases: the clinical outcome of an open-label cohort study

Bevacizumab with preoperative chemotherapy versus preoperati...

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第八届中国肿瘤学术大会暨第十三届海峡两岸肿瘤学术会议

作者： Zhenhai Lu Fulong wang Jianhong Peng Yunfei Yuan Wu Jiang Yuhong Li Xiaojun Wu Gong Chen Peirong Ding Liren Li Lingheng Kong Junzhong Lin Rongxin Zhang desen wan Zhizhong Pan Department of Colorectal Surgery Sun Yat-sen University Cancer Center Department of Hepatobiliary Surgery Sun Yat-sen University Cancer Center Department of Medical Oncology Sun Yat-sen University Cancer Center

＜正＞Objective Bevacizumab as a humanized monoclonal antibody increases survival when combined with chemotherapy in first-line treatment of metastatic colorectal cancer（mCRC）.This study was conducted to assess the ...

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低位直肠类癌的外科治疗

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中国实用外科杂志 2005年第3期25卷 143-144页

作者：万德森中山大学附属肿瘤医院腹科广州510060

类癌源于肠黏膜的Kulchitsky细胞,其胞浆含有能沉积银盐的颗粒,故又称为嗜银细胞,为此,类癌也称为嗜银细胞癌.其细胞形态似癌,但发展缓慢,表现为良性肿瘤,与癌不同,因此称之为"类癌".首先由Oberndorfer(1907)命名,以区别一般的腺癌和腺... 详细信息

类癌源于肠黏膜的Kulchitsky细胞,其胞浆含有能沉积银盐的颗粒,故又称为嗜银细胞,为此,类癌也称为嗜银细胞癌.其细胞形态似癌,但发展缓慢,表现为良性肿瘤,与癌不同,因此称之为"类癌".首先由Oberndorfer(1907)命名,以区别一般的腺癌和腺瘤.由于部分类癌分泌5-羟色胺,并引起类癌综合征(皮肤潮红、哮喘、腹泻、瓣膜性心脏病等系列症候群),故有学者将其归入胺前体摄取及脱羧酶细胞瘤(APUD瘤)一类,属胃肠神经内分泌肿瘤.类癌最常发生在胃肠道,但是消化道外的器官如支气管、卵巢、肺、甲状腺等也可发生[1,2].……

关键词：直肠类癌低位外科治疗胞浆瓣膜性心脏病类癌综合征细胞瘤区别一般学者

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全系膜切除术在直肠癌根治术中的应用

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中国普通外科杂志 2009年第4期18卷 389-391页

作者：李辰生万德森山东大学附属省立医院胃肠外科山东济南250021 中山大学肿瘤医院腹部外科广东广州510060

全直肠系膜切除术(total mesorectal excision,TME)可明显降低局部复发率,正作为一种标准的直肠癌根治术被越来越多的外科医生所接受。笔者就全直肠系膜切除术(TME)的临床、解剖、病理因素及其并发症作一综述。

关键词：直肠肿瘤/外科学全系膜切除术病理解剖综述文献

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同时性结直肠癌肝转移的外科治疗策略

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临床肿瘤学杂志 2018年第12期23卷 1135-1139页

作者：胡丹旦万德森中山大学附属肿瘤防治中心肝胆胰外科广州510060 中山大学附属肿瘤防治中心结直肠外科 510060

结直肠癌的发病率高居不下,其中20%以上的患者在诊断时即发现肝转移灶。同时性结直肠癌肝转移患者的肿瘤生物学行为较差,以外科为主的综合治疗可改善患者预后。但手术时机的选择、术前术后辅助性放化疗方案的制定等问题均无高级别证据... 详细信息

结直肠癌的发病率高居不下,其中20%以上的患者在诊断时即发现肝转移灶。同时性结直肠癌肝转移患者的肿瘤生物学行为较差,以外科为主的综合治疗可改善患者预后。但手术时机的选择、术前术后辅助性放化疗方案的制定等问题均无高级别证据给予定论,我们提倡多学科团队对患者进行全面评估,根据原发部位和肝内病灶的严重程度、是否引起症状及患者一般情况等因素综合制定个体化诊疗方案。

关键词：结直肠癌肝转移外科治疗辅助放化疗个体化治疗

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