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Neoadjuvant chemotherapy without radiation as a potential alternative treatment for locally advanced rectal cancer:A metaanalysis

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World Journal of Gastrointestinal Oncology 2021年第9期13卷 1196-1209页

作者： Pei Wu hui-mian xu Zhi Zhu Department of Gastrointestinal Surgery Yongchuan Hospital of Chongqing Medical UniversityChongqing 402160China Department of Surgical Oncology The First Hospital of China Medical UniversityShenyang 110001Liaoning ProvinceChina

BACKGROUND Neoadjuvant chemoradiotherapy(Neo-CRT)is the current standard strategy for treating locally advanced rectal ***,it delays the administration of optimal chemotherapy and increases *** To compare the feasibility and efficacy of neoadjuvant chemotherapy(Neo-CT)and Neo-CRT for patients with locally advanced rectal *** The Cochrane,EMBASE,and PubMed databases were searched for relevant articles using MESH terms and free *** hazard ratio of overall survival and the risk ratio(RR)for the pathological complete response,the sphincter preservation rate,and treatment-related adverse events were *** A total of 19 studies of 60870 patients were included in the *** was no significant difference in overall survival[hazard ratio=1.09,95%confidence interval(CI)=0.93–1.24;P=0.19]or the pathological complete response(RR=0.79,95%CI=0.61–1.03;P=0.086)between the Neo-CT and Neo-CRT *** compared to the Neo-CRT group,the incidences of anastomotic fistula(RR=0.49,95%CI=0.35–0.68;P=0.000)and temporary colostomy(RR=0.69,95%CI=0.58–0.83;P=0.000)were significantly lower in the Neo-CT group,with a simultaneous increase in the sphincter preservation rate(RR=1.07,95%CI=1.01–1.13;P=0.029).However,there was no significant difference in the tumor downstaging rate,overall complications,and urinary *** Neo-CT administration can lower the incidences of anastomotic fistula and temporary colostomy and increase the sphincter preservation rate as to compared to Neo-CRT and could provide an alternative to chemoradiotherapy for locally advanced rectal cancer.

关键词： Rectal cancer Neoadjuvant chemotherapy Chemoradiation Prognosis

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Astragalus extract inhibits destruction of gastric cancer cells to mesothelial cells by anti-apoptosis

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World Journal of Gastroenterology 2009年第5期15卷 570-577页

作者： Di Na Fu-Nan Liu Zhi-Feng Miao Zong-Min Du hui-mian xu Department of Oncology The First Affiliated Hospital China Medical University Shenyang 110001 Liaoning Province China

AIM： To determine the inhibitory effect of Astragalus memebranaceushas on gastric cancer cell supernatant- induced apoptosis of human peritoneal mesothelial cells. METHODS： Human peritoneal mesothelial cell （HPMC） line HMrSV5 was co-incubated with gastric cancer cell supernatant （MKN45） and/or Astragalus memebranaceushas. Morphological changes in gastric cancer cells were observed under phase-contrast microscope. Quantitative cell damage was determined by MTT assay. Apoptosis was determined under transmission electron microscope and quantified by detectinr, acridine orange/ethidium bromide-stained （AO/EB） condensed nuclei under fluorescent microscope or by flow cytometry. Expressions of Bcl-2 and Bax were evaluated with immunostaining.

关键词： Peritoneal carcinomatosis Stomachneoplasm Astragalus plant Mesothelial cell Apoptosis

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Improved quality of life in patients with gastric cancer after esophagogastrostomy reconstruction

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World Journal of Gastroenterology 2009年第25期15卷 3183-3190页

作者： Hao Zhang Zhe Sun hui-mian xu Ji-Xian Shan Shu-Bao Wang Jun-Qing Chen State Key Department of General Surgery Department of Surgical Oncology First Affiliated Hospital of China Medical University Shenyang 110001 Liaoning Province China

AIM:To compare postoperative quality of life (QOL) in patients with gastric cancer treated by esophagogastrostomy reconstruction after proximal ***: QOL assessments that included functional outcomes (a 24-item survey about treatment-specific symptoms) and health perception (Spitzer QOL Index) were performed in 149 patients with gastric cancer in the upper third of the stomach, who had received proximal gastrectomy with additional ***: Fifty-four patients underwent reconstruction by esophagogastric anterior wall end-to-side anastomosis combined with pyloroplasty (EA group); 45 patients had reconstruction by esophagogastric posterior wall end-to-side anastomosis (EP group); and 50 patients had reconstruction by esophagogastric end-to-end anastomosis (EE group). The EA group showed the best postoperative QOL, such as recovery of body weight, less discomfort after meals, and less heart burn or belching at 6 and 24 mo postoperatively. However, the survival rates, surgical results and Spitzer QOL index were similar among the three ***: Postoperative QOL was better in the EA than EP or EE group. To improve QOL after proximal gastrectomy for upper third gastric cancer, the EA procedure using a stapler is safe and feasible for esophagogastrostomy.

关键词： Gastric cancer Proximal gastrectomy Esophagogastrostomy Quality of life

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Neoadjuvant therapy strategies for advanced gastric cancer:Current innovations and future challenges

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Chronic Diseases and Translational Medicine 2020年第3期6卷 147-157页

作者： Zhi Zhu Ying-Bo Gong hui-mian xu Department of Surgical Oncology The First Hospital of China Medical UniversityShenyangLiaoning 110001China

Gastric cancer,which has a high incidence and poor prognosis,remains a therapeutic ***,neoadjuvant therapy has attracted increasing attention due to high recurrence rate and low survival rate after resection in most patients with advanced *** trials show that neoadjuvant approaches confer a significant survival advantage for resectable locally advanced gastric *** specific advantages of chemoradiotherapy compared with chemotherapy have not been clarified;optimal regimens and cycles,particularly in the preoperative setting,should be studied further;and trials aimed at determining the role of targeted and immunological therapies should be conducted.

关键词： Gastric cancer Neoadjuvant therapy Chemotherapy Radiotherapy

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Standardizing the classification of gastric cancer patients with limited and adequate number of retrieved lymph nodes:an externally validated approach using real-world data

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Military Medical Research 2022年第5期9卷 565-575页

作者： Wei Wang Yu-Jie Yang Ri-Hong Zhang Jing-Yu Deng Zhe Sun Sharvesh Raj Seeruttun Zhen-Ning Wang hui-mian xu Han Liang Zhi-Wei Zhou Department of Gastric Surgery Sun Yat-sen University Cancer CenterGuangzhou 510060China State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer MedicineGuangzhou 510060China Department of Gastric Cancer Surgery Tianjin Medical University Cancer Institute and HospitalTianjin 300000China Department of Surgical Oncology the First Hospital of China Medical UniversityShenyang 110000China

Background:Currently,there is no formal consensus regarding a standard classification for gastric cancer(GC)patients with<16 retrieved lymph nodes(rLNs).Here,this study aimed to validate a practical lymph node(LN)staging strategy to homogenize the nodal classification of GC cohorts comprising of both<16(Limited set)and≥16(Adequate set)***:All patients in this study underwent R0 *** overall survival(OS)difference between the Limited and Adequate set from a large Chinese multicenter dataset was *** the 8th American Joint Committee on Cancer(AJCC)pathological nodal classification(pN)for GC as base,a modified nodal classification(N’)resembling similar analogy as the 8th AJCC pN classification was *** performance of the proposed and 8th AJCC GC subgroups was compared and validated using the Surveillance,Epidemiology,and End Results(SEER)dataset comprising of 10,208 multi-ethnic GC ***:Significant difference in OS between the Limited and Adequate set(corresponding N0–N3a)using the 8th AJCC system was observed but the OS of N0_(limited)vs.N1_(adequate),N1_(limited)vs.N2_(adequate),N2_(limited)vs.N3_(aadequate),and N3_(alimited)vs.N3_(badequate)subgroups was almost similar in the Chinese ***,we formulated an N’classification whereby only the nodal subgroups of the Limited set,except for pT1N0M0 cases as they underwent less extensive surgeries(D1 or D1+gastrectomy),were re-classified to one higher nodal subgroup,while those of the Adequate set remained unchanged(N’0=N0_(adequate)+pT1N0M0_(limited),N’1=N1_(adequate)+N0_(limited)(excluding pT1N0M0_(limited)),N’2=N2_(adequate)+N1_(limited),N’3a=N3_(aadequate)+N2_(limited),and N’3b=N3_(badequate)+N3_(alimited)).This N’classification demonstrated less heterogeneity in OS between the Limited and Adequate *** analyses demonstrated superior statistical performance of the pTN’M system over the 8th AJCC edition and was successfully validated using the SEER

关键词： Lymph nodes Limited Adequate Gastric cancer American Joint Committee on Cancer Tumor-node-metastasis Staging system Overall survival

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Proposal and validation of a modified staging system to improve the prognosis predictive performance of the 8th AJCC/ UICC pTNM staging system for gastric adenocarcinoma: a multicenter study with external validation

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Cancer Communications 2018年第1期38卷 714-725页

作者： Cheng Fang Wei Wang Jing-Yu Deng Zhe Sun Sharvesh Raj Seeruttun Zhen-Ning Wang hui-mian xu Han Liang Zhi-Wei Zhou Department of Gastric Surgery Sun Yat-sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer Medicine651 Dongfeng Road EastGuangzhouGuangdong 510060P.R.China Department of Gastric Cancer Surgery Tianjin Medical University Cancer Institute&HospitalTianjin 300000P.R.China Department of Surgical Oncology The First Hospital of China Medical UniversityShenyang 110000P.R.China

Background:The 8th edition of the American Joint Committee on Cancer/Union for International Cancer Control(AJCC/UICC)pathological tumor-node-metastasis(pTNM)staging system may have increased accuracy in predicting prognosis of gastric cancer due to its important modifications from previous ***,the homogeneity in prognosis within each subgroup classified according to the 8th edition may still *** study aimed to compare and analyze the prognosis prediction abilities of the 8th and 7th editions of AJCC/UICC pTNM staging system for gastric cancer and propose a modified pTNM staging system with external ***:In total,clinical data of 7911 patients from three high-capacity institutions in China and 10,208 cases from the Surveillance,Epidemiology,and End Results(SEER)Program Registry were *** homogeneity,discrimina-tory ability,and monotonicity of the gradient assessments of the 8th and 7th editions of AJCC/UICC pTNM staging system were compared using log-rank χ^(2),linear-trend χ^(2),likelihood-ratioχ2 statistics and Akaike information criterion(AIC)calculations,on which a modified pTNM classification with external validation using the SEER database was ***:Considerable stage migration,mainly for stage III,between the 8th and 7th editions was observed in both *** survival rates of subgroups of patients within stage IIIA,IIIB,or IIIC classified according to both editions were significantly different,demonstrating poor homogeneity for patient stratification.A modified pTNM staging system using data from the Chinese cohort was then formulated and demonstrated an improved homogeneity in these abovementioned *** staging system was further validated using data from the SEER cohort,and similar promising results were *** with the 8th and 7th editions,the modified pTNM staging system displayed the highest log-rank χ^(2),linear-trend χ^(2),likelihood-ratio χ^(2),and lowest AIC values,indicatin

关键词： Pathological TNM staging system Gastric cancer Akaike information criterion(AIC) Prognosis prediction SEER Chinese

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Relationship between collagen Ⅳ expression and biological behavior of gastric cancer

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World Journal of Gastroenterology 2000年第3期6卷 438-439页

作者： Zhen Ning Wang hui mian xu Oncology Department,China Medical University,Shenyang 110001,Liaoning Province,China

INTRODUCTION Conceivably the presence of basement membrane(BM)in a neoplasm might be a result of interactionof tumor cells with the extracellular *** Ⅳ is one of the major intrinsic componentsof *** study has shown that collagen Ⅳhas cell adhesion function and is involved in theprocess of tumor invasion and metastasis,includingcolorectal cancer and breast *** there arefew systematic studies on gastric cancer and theresults are *** this study we evaluated

关键词： stomach neoplasms collagen IV biological behavior immunohistochemisty

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A novel nomogram individually predicting disease-specific survival after D2 gastrectomy for advanced gastric cancer

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Cancer Communications 2018年第1期38卷 254-262页

作者： Wei Wang Zhe Sun Jing-Yu Deng Xiao-Long Qi Xing-Yu Feng Cheng Fang Xing-Hua Ma Zhen-Ning Wang Han Liang hui-mian xu Zhi-Wei Zhou Department of Gastric Surgery Sun Yat-sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer Medicine651 Dongfeng East RoadGuangzhou 510060GuangdongP.R.China Department of Surgical Oncology The First Affiliated Hospital of China Medical UniversityShenyang 110000LiaoningP.R.China Department of Gastric Cancer Surgery Tianjin Medical University Cancer HospitalTianjin 300000P.R.China Department of General Surgery Nanfang HospitalSouthern Medical UniversityGuangzhou 510515GuangdongP.R.China Department of Gastroenterology Surgery Guangdong General HospitalGuangzhou 510030GuangdongP.R.China Department of Preventive Medicine School of Public HealthSun Yat-sen UniversityGuangzhou 510275GuangdongP.R.China

Background:Few studies have shown nomograms that may predict disease-specific survival(DSS)probability after curative D2 gastrectomy for advanced gastric cancer(AGC),particularly among Chinese *** study sought to develop an elaborative nomogram that predicts long-term DSS for AGC in Chinese ***:A retrospective study was conducted on 6753 AGC patients undergoing D2 gastrectomy between January 1,2000 and December 31,2012 from three large medical hospitals in *** assigned patients from Sun Yat-sen University Cancer Center to the training set,and patients from the First Affiliated Hospital of China Medical University and Tianjin Medical University Cancer Hospital to two separate external validation sets.A multivariate survival analysis was performed using Cox proportional hazards regression model in a training set,and a nomogram was ***’s C-index was used to evaluate discrimination and calibration plots were used to validate similarities between survival probabilities predicted by the nomogram model and actual survival rates in two validation ***:The multivariate Cox regression model identified age,tumor size,location,Lauren classification,lymphatic/venous invasion,depth of invasion,and metastatic lymph node ratio as covariates associated with *** the training set,the nomogram exhibited superior discrimination power compared with the 8th American Joint Com-mittee on Cancer TNM classification(Harrell’s C-index,0.82 vs.0.74;P<0.001).In two validation sets,the nomogram’s discrimination power was also excellent relative to TNM classification(C-index,0.83 vs.0.75 and 0.81 vs.0.74,respec-tively;P<0.001 for both).After calibration,the nomogram produced survival predictions that corresponded closely with actual survival ***:The established nomogram was able to predict 3-,5-,and 10-year DSS probabilities for AGC *** revealed that this nomogram exhibited excellent discrimination and calibrat

关键词： Advanced gastric cancer Disease-specific survival Prognostic nomogram

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Distribution of solitary Iymph nodes in primary gastric cancer:A retrospective study and clinical implications

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World Journal of Gastroenterology 2007年第35期13卷 4776-4780页

作者： Cai-Gang Liu Ping Lu Yang Lu Feng Jin hui-mian xu Shu-Bao Wang Jun-Qing Chen Department of Surgical Oncology First Affiliated Hospital of China Medial University Heping Shenyang110001 Liaoning Province China

AIM： To investigate the distribution pathway of metastatic lymph nodes in gastric carcinoma as a foundation for rational lymphadenectomy. METHODS： We investigated 173 cases with solitary or single station metastatic lymph nodes （LN） from among 2476 gastric carcinoma patients. The location of metastatic LN, histological type and growth patterns were analyzed retrospectively. RESULTS： Of 88 solitary node metastases cases, 65 were limited to perigastric nodes （N1）, while 23 showed skipping metastasis. Among 8 tumors in the upper third stomach, 3 involved right paracardial LN （station number： No.1）, and one in the greater curvature was found in No.1. In the 28 middle third stomach tumors, 10 were found in LN of the lesser curvature （No.3） and 6 in LN of the left gastric artery （No.7）; 5 of the 20 cases on the lesser curvature spread to No.7, while 2 of the 8 on the greater curvature metastasized to LN of the spleen hilum （No.10）. Of 52 lower third stomach tumors, 13 involved in No.3 and 19 were detected in inferior pyloric LN （No.6）; 9 of the 29 cases along the lesser curvature were involved in No.6. CONCLUSION： Transversal and skipping metastases of sentinel lymph nodes （SLN） are notable, and rational lymphadenectomy should, therefore, be performed.

关键词： Gastric cancer Metastatic lymph node,Lymph node dissection Rational lymphadenectomy Sentinel lymph node

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Clinicopathological Characteristics of Synchronous Multiple Gastric Cancers in Chinese:An Analysis of 44 Cases

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Chinese Journal of Cancer Research 2009年第2期21卷 130-134页

作者： Rui-shan Zhang Cai-gang Liu Yang Lu Feng Jin hui-mian xu Ping Lu Department of Surgical Oncology First Hospital China Medical University Shenyang 110001 China

Objective： To investigate the clinicopathologic characteristics of the primary synchronous multiple gastric cancers （SMGC） in Chinese. Methods： Clinicopathologic data of patients with histologically confirmed gastric cancer who received surgical operations in our department between 1993 and 2002 were retrospectively collected and analyzed. Clinicopathologic characteristics including gender, age, tumor location, differentiation and staging between patients with SMGC and those with solitary gastric cancer （SGC） were compared. Synchronous multiple and solitary gastric cancers were diagnosed and classified based on radiography upper endoscopy and histology. All the cases were followed up after the operation and 5-year survival rate between the two groups was compared. Results： A total of 871 patients with gastric cancer were included. Synchronous multiple gastric cancers were found in 44 （5.1%） of these cases. More of the diagnose in the early stage to SMGC than to SGC. SMGC were more likely to be located at the lower third stomach and of a low grade differentiation, compared to SGC. However, there were no significant differences in the rates of lymph node metastasis and lymphatic vessel invasion between multiple and solitary gastric cancers. In addition, the 5-year survival rate did not difference between the two groups. Conclusion： The whole stomach should be detected carefully to avoid missing out the multiple gastric cancers. Concerning the treatment of multiple gastric cancer, the sufficient extent of the stomach wall resection was necessary, and the extent of lymphadenectomy was supposed to follow the operation for the solitary gastric cancer according to the staging of the cancer lesions.

关键词： Multiple gastric cancer Solitary gastric cancer Radical gastrectomy Ciinicopathologic characteristics

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