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Nomogram based on tumor-associated neutrophil-tolymphocyte ratio to predict survival of patients with gastric neuroendocrine neoplasms

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World Journal of Gastroenterology 2017年第47期23卷 8376-8386页

作者： long-long cao jun lu jian-xian lin chao-hui zheng ping li jian-wei xie jia-bin wang qi-yue chen mi lin ru-hong tu chang-ming huang department of gastricsurgery fujian medical university union hospital

AIM To assess the predictive value of the tumor-associated neutrophil-to-lymphocyte ratio in terms of the clinical outcomes of patients with gastric neuroendocrine neoplasms after radical *** Data were retrospectively collected from 142 patients who were diagnosed with gastric neuroendocrine neoplasms and who underwent radical gastrectomy at our department from March 2006 to March 2015. These data were retrospectively analyzed, and a receiver operating characteristic curve analysis was used to identify the optimal value of the tumorassociated neutrophil-to-lymphocyte ratio. Univariate and multivariate survival analyses were used to identify prognostic factors. A nomogram was then applied to predict clinical outcomes after *** The tumor-associated neutrophil-to-lymphocyte ratio was significantly associated with tumor recurrence, especially with liver metastasis and lymph node metastasis(P 0.05 for all). A multivariate Cox regression analysis identified the tumor-associatedneutrophil-to-lymphocyte ratio as an independent prognostic factor for recurrence-free survival and overall survival(P < 0.05 for both). The concordance index of the nomograms, which included the tumorassociated neutrophil-to-lymphocyte ratio, Ki-67 index, and lymph node ratio, was 0.788(0.759) for recurrence-free survival(overall survival) and was higher than the concordance index of the traditional TNM staging system [0.672(0.663)].CONCLUSION The tumor-associated neutrophil-to-lymphocyte ratio is an independent prognostic factor in patients with gastric neuroendocrine neoplasms. Nomograms that include the tumor-associated neutrophil-to-lymphocyte ratio, Ki-67 index, and lymph node ratio have a superior ability to predict clinical outcomes of postoperative patients.

关键词： Gastric neuroendocrine neoplasms Tumorassociated neutrophil-to-lymphocyte ratio Tumor recurrence Prognosis

Digestive tract reconstruction using isoperistaltic jejunumlater-cut overlap method after totally laparoscopic total gastrectomy for gastric cancer: Short-term outcomes and impact on quality of life

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World Journal of Gastroenterology 2017年第39期23卷 7129-7138页

作者： Ze-Ning Huang Chang-Ming Huang Chao-Hui Zheng Ping Li Jian-Wei Xie Jia-Bin Wang Jian-Xian Lin Jun Lu Qi-Yue Chen Long-Long Cao Mi Lin Ru-Hong Tu Ju-Li Lin Department of Gastric Surgery Fujian Medical University Union Hospital

AIM To evaluate the short-term outcomes and quality of life(Qo L) in gastric cancer patients undergoing digestive tract construction using the isoperistaltic jejunum-latercut overlap method(IJOM) after totally laparoscopic total gastrectomy(TLTG).METHODS A total of 507 patients who underwent laparoscopic gastrectomy(D2) from January 2014 to March 2016 were originally included in the study. The patients were divided into two groups to undergo digestive tract construction using either IJOM after TLTG(group T, n = 51) or Roux-en-Y anastomosis after laparoscopic-assisted total gastrectomy(LATG)(group A, n = 456). The short-term outcomes and Qo L were compared between the two groups after 1:2 propensity-score matching(PSM). We used a questionnaire to assess Qo *** Before matching, age, sex, tumor size, tumor location, preoperative albumin and blood loss were significantly different between the two groups(P < 0.05). After PSM, the patients were well balanced in terms of their clinicopathological characteristics, although both blood loss and in-hospital postoperative days in group T were significantly lower than those in group A(P < 0.05). After matching, group T reported better Qo L in the domains of pain and dysphagia. Among the items evaluating pain and dysphagia, group T tended to report better Qo L("Have you felt pain" and "Have you had difficulty eating solid food")(P < 0.05).CONCLUSION The IJOM for digestive tract reconstruction after TLTG is associated with reduced blood loss and less pain and dysphagia, thus improving Qo L after laparoscopic gastrectomy.

关键词： Esophagojejunostomy Overlap Later-cut Totally laparoscopic total gastrectomy Quality of life

Notch4 Inhibition Suppresses Invasion and Vasculogenic Mimicry Formation of Hepatocellular Carcinoma Cells

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2017年第5期37卷 719-725页

作者：程锐蔡欣然柯坤陈燕凌 Department of Hepatobiliary Surgery Union Hospital Fujian Medical University Department of Interventional Radiology Union Hospital Fujian Medical University

Vasculogenic mimicry（VM） is a process by which aggressive tumor cells generate non-endothelial cell-lined channels in malignant tumors including hepatocellular carcinoma（HCC）. It has provided new insights into tumor behavior and has surfaced as a potential target for drug therapy. The molecular events underlying the process of VM formation are still poorly understood. In this study, we attempted to elucidate the relationship between Notch4 and VM formation in HCC. An effective si RNA lentiviral vector targeting Notch4 was constructed and transfected into Bel7402, a HCC cell line. VM networks were observed with a microscope in a 3 dimensional cell culture system. Cell migration and invasion were evaluated using wound healing and transwell assays. Matrix metalloproteinases（MMPs） activity was detected by gelatin zymography. Furthermore, the role of Notch4 inhibition in Bel7402 cells in vivo was examined in subcutaneous xenograft tumor model of mice. The results showed that downregulation of Notch4 destroyed VM network formation and inhibited migration and invasion of tumor cells in vitro（P〈0.05）. In vivo, tumor growth was also inhibited in subcutaneous xenograft model（P〈0.05）. The potential mechanisms might be related with down-regulation of MT1-MMP, MMP-2, MMP-9 expression and inhibition of the activation of MMP2 and MMP9. These results indicated that Notch4 may play an important role in VM formation and tumor invasion in HCC. Related molecular pathways may be used as novel therapeutic targets for HCC antiangiogenesis therapy.

关键词： vasculogenic mimicry hepatocellular carcinoma invasion Notch4 matrix metalloproteinase

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合理把握直肠癌侧方淋巴结清扫适应证

中国实用外科杂志 2018年第10期38卷 1119-1123页

作者：兰平陈钰锋吴现瑞中山大学附属第六医院结直肠外科广东省结直肠盆底疾病研究重点实验室广东广州510655

直肠癌侧方淋巴结清扫手术难度高,术后排尿和性功能障碍等并发症发生率较高,在我国尚未常规开展。术前新辅助治疗、影像学评估和术式选择等均对侧方淋巴结清扫的效果具有重要影响。为直肠癌病人制定手术方案时,应合理把握侧方淋巴结清... 详细信息

直肠癌侧方淋巴结清扫手术难度高,术后排尿和性功能障碍等并发症发生率较高,在我国尚未常规开展。术前新辅助治疗、影像学评估和术式选择等均对侧方淋巴结清扫的效果具有重要影响。为直肠癌病人制定手术方案时,应合理把握侧方淋巴结清扫的适应证。对于腹膜返折以下的局部进展期(Ⅱ~Ⅲ期)直肠癌病人实施侧方淋巴结清扫可遵循以下原则:(1)术前应结合MRI检查进行综合判断。对于可根治性切除者,如术前检查提示侧方淋巴结短径≥5 mm,建议进行清扫,否则可不必进行清扫;而对于无法根治性切除者(如盆壁侵犯等),建议先行新辅助放化疗,治疗后如仍有侧方淋巴结短径≥5 mm者,须进行清扫,否则可不必进行清扫。(2)由于侧方淋巴结清扫易损伤盆腔神经丛,导致术后排尿和性功能障碍,一般建议对淋巴结肿大的一侧进行清扫,仅两侧均出现侧方淋巴结肿大时才考虑进行双侧清扫,清扫过程应注意保留盆腔自主神经。(3)对于有腹腔镜和机器人手术操作经验的医生,可采用微创技术。

关键词：直肠癌侧方淋巴结清扫适应证

Small-volume chylous ascites after laparoscopic radical gastrectomy for gastric cancer:Results from a large population-based sample

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World Journal of Gastroenterology 2015年第8期21卷 2425-2432页

作者： Jun Lu Zhen-Quan Wei Chang-Ming Huang Chao-Hui Zheng Ping Li Jian-Wei Xie Jia-Bin Wang Jian-Xian Lin Qi-Yue Chen Long-Long Cao Mi Lin Department of Gastric Surgery Fujian Medical University Union Hospital Department of General Surgery Sanming No. 2 Hospital

AIM:To report the incidence and potential risk factors of small-volume chylous ascites(SVCA)following laparoscopic radical gastrectomy(LAG).METHODS:A total of 1366 consecutive gastric cancer patients who underwent LAG from January 2008 to June 2011 were enrolled in this *** analyzed the patients based on the presence or absence of ***:SVCA was detected in 57(4.17%)patients,as determined by the small-volume drainage(range,30-100 m L/24 h)of triglyceride-rich *** univariate and multivariate analyses revealed that the total number of resected lymph nodes(LNs),No.8 or No.9 LN metastasis and N stage were independent risk factors for SVCA following LAG(P0.05).CONCLUSION:SVCA following LAG developed significantly more frequently in the patients with≥32harvested LNs,≥3 metastatic LNs,or No.8 or No.9LN ***,which was successfully treated with conservative management,was associated with a prolonged hospital stay but was not associated with the prognosis.

关键词： Gastric cancer Laparoscopic gastrectomy Small volu

Expression of CRM1 and CDK5 shows high prognostic accuracy for gastric cancer

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World Journal of Gastroenterology 2017年第11期23卷 2012-2022页

作者： Yu-Qin Sun Jian-Wei Xie Hong-Teng Xie Peng-Chen Chen Xiu-Li Zhang Chao-Hui Zheng Ping Li Jia-Bin Wang Jian-Xian Lin Long-Long Cao Chang-Ming Huang Yao Lin College of Life Sciences Fujian Normal University Department of Gastric Surgery Fujian Medical University Union Hospital

AIM To evaluate the predictive value of the expression of chromosomal maintenance(CRM)1 and cyclindependent kinase(CDK)5 in gastric cancer(GC) patients after *** A total of 240 GC patients who received standard gastrectomy were enrolled in the study. The expression level of CRM1 and CDK5 was detected by immunohistochemistry. The correlations between CRM1 and CDK5 expression and clinicopathological factors were explored. Univariate and multivariate survival analyses were used to identify prognostic factors for GC. Receiver operating characteristic analysis was used to compare the accuracy of the prediction of clinical outcome by the parameters. RESULTS The expression of CRM1 was significantly related to size of primary tumor(P = 0.005), Borrmann type(P = 0.006), degree of differentiation(P = 0.004), depth of invasion(P = 0.008), lymph node metastasis(P = 0.013), TNM stage(P = 0.002) and distant metastasis(P = 0.015). The expression of CDK5 was significantly related to sex(P = 0.048) and Lauren's classification(P = 0.011). Multivariate Cox regression analysis identified that CRM1 and CDK5 co-expression status was an independent prognostic factor for overall survival(OS) of patients with GC. Integration of CRM1 and CDK5 expression could provide additional prognostic value for OS compared with CRM1 or CDK5 expression alone(P = 0.001).CONCLUSION CRM1 and CDK5 co-expression was an independent prognostic factors for GC. Combined CRM1 and CDK5 expression could provide a prognostic model for OS of GC.

关键词： Gastric cancer CRM1 CDK5 Prognosis

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克罗恩病吻合口并发症防治策略

中国实用外科杂志 2017年第3期37卷 236-239页

作者：吴小剑陈钰锋柯嘉中山大学附属第六医院结直肠外科广东省结直肠盆底疾病研究重点实验室广东广州510655

克罗恩病(CD)病人因长期肠道炎症和营养不良,肠切除术后吻合口并发症发生率远高于其他肠道疾病,显著影响病人生活质量。因此,应高度重视CD术后吻合口并发症的防治方法。

关键词：克罗恩病吻合口并发症危险因素预防

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放疗相关直肠吻合口并发症的外科预防及治疗

中国实用外科杂志 2023年第10期43卷 1122-1125页

作者：黄斌杰秦启元马腾辉中山大学附属第六医院普通外科(结直肠外科、放射性肠损伤中心) 广东省结直肠盆底疾病研究重点实验室广州市黄埔区中六生物医学创新研究院广东广州510655 中山大学附属第六医院临床营养与微生态科广东广州510655

术前放疗是局部进展期直肠癌的重要治疗手段之一,能有效提高病人保肛率并改善其肿瘤学预后。但术前放疗会增加术后吻合口漏、吻合口狭窄等并发症的发生风险,这可能与吻合口两端肠管均存在放射性损伤有关。出现放疗相关吻合口并发症的病... 详细信息

术前放疗是局部进展期直肠癌的重要治疗手段之一,能有效提高病人保肛率并改善其肿瘤学预后。但术前放疗会增加术后吻合口漏、吻合口狭窄等并发症的发生风险,这可能与吻合口两端肠管均存在放射性损伤有关。出现放疗相关吻合口并发症的病人术后长期造口及不良肛门功能事件发生率较高,严重影响病人生活质量。扩大切除吻合口近端肠管,保障至少一侧肠管无放射性损伤能显著降低放疗后吻合口并发症的发生风险;对于已经发生放疗相关吻合口并发症且保守治疗无效的病人,可以在谨慎评估病人手术风险的前提下,使用腹腔镜直肠乙状结肠扩大切除结肠拖出术对病人进行代直肠切除重建。

关键词：放疗直肠癌吻合口并发症代直肠切除重建手术

Anatomy and influence of the splenic artery in laparoscopic spleen-preserving splenic lymphadenectomy

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World Journal of Gastroenterology 2015年第27期21卷 8389-8397页

作者： Chao-Hui Zheng Mu Xu Chang-Ming Huang Ping Li Jian-Wei Xie Jia-Bin Wang Jian-Xian Lin Jun Lu Qi-Yue Chen Long-Long Cao Mi Lin Department of Gastric Surgery Fujian Medical University Union Hospital

AIM: To investigate the splenic hilar vascular anatomy and the influence of splenic artery(Sp A) type in laparoscopic total gastrectomy with spleen-preserving splenic lymphadenectomy(LTGSPL).METHODS:The clinical anatomy data of 317 patients with upper- or middle-third gastric cancer who underwent LTGSPL in our hospital from January 2011 to December 2013 were collected. The patients were divided into two groups(concentrated group vs distributed group) according to the distance between the splenic artery's furcation and the splenic hilar region. Then, the anatomical layout, clinicopathologic characteristics, intraoperative variables, and postoperative variables were compared between the two ***: There were 205 patients with a concentrated type(64.7%) and 112 patients with a distributed type(35.3%) Sp A. There were 22 patients(6.9%) with a single branch of the splenic lobar vessels, 250(78.9%) with 2 branches, 43(13.6%) with 3 branches, and 2 patients(0.6%) with multiple branches. Eighty sevenpatients(27.4%) had type?Ⅰ?splenic artery trunk, 211(66.6%) had type Ⅱ, 13(4.1%) had type Ⅲ, and 6(1.9%) had type Ⅳ. The mean splenic hilar lymphadenectomy time(23.15 ± 8.02 vs 26.21 ± 8.84 min; P = 0.002), mean blood loss resulting from splenic hilar lymphadenectomy(14.78 ± 11.09 vs 17.37 ± 10.62 m L; P = 0.044), and number of vascular clamps used at the splenic hilum(9.64 ± 2.88 vs 10.40 ± 3.57; P = 0.040) were significantly lower in the concentrated group than in the distributed group. However, the mean total surgical time, mean total blood loss, and the mean number of harvested splenic hilar lymph nodes were similar in both groups(P > 0.05 for each comparison). There were also no significant differences in clinicopathological and postoperative characteristics between the groups(P > 0.05).CONCLUSION: It is of value for surgeons to know the splenic hilar vascular anatomy when performing LTGSPL. Patients with concentrated type Sp A may be optimal patients for training

关键词： Stomach neoplasms Spleen-preservation Laparoscopy Lymphadenectomy Vascular anatomy