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Nomograms for predicting pathological response to neoadjuvant treatments in patients with rectal cancer

World Journal of Gastroenterology 2019年第1期25卷 118-137页

作者： Dong-Lin Ren Juan Li Hui-Chuan Yu Shao-Yong Peng Wei-Da Lin Xiao-Lin Wang Roshan Ara Ghoorun Yan-Xin Luo Department of colorectal and Anal Surgery Guangdong Institute of Gastroenterology Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases The Sixth Affiliated Hospital Sun Yat-sen University guangdong Institute of Gastroenterology Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases The Sixth Affiliated Hospital Sun Yat-sen University Department of colorectal Surgery Guangdong Institute of Gastroenterology Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases The Sixth Affiliated Hospital Sun Yat-sen University

BACKGROUND In recent decades, neoadjuvant therapy(NT) has been the standardized treatment for locally advanced rectal cancer(LARC). Approximately 8%-35% of patients with LARC who received NT were reported to have achieved a complete pathological response(pCR). If the pathological response(PR) can be accurately predicted, these patients may not need surgery. In addition, no response after NT implies that the tumor is destructive, resistant to both chemotherapy and radiotherapy, and prone to having a high metastatic potential. Therefore,developing accurate models to predict PR has great clinical significance and can help achieve individualized treatment in LARC patients.AIM To establish nomograms for predicting PR to different NT regimens based on pretreatment parameters for patients with LARC.METHODS Rectal cancer patients were identified from the database of The Sixth Affiliated Hospital, Sun Yat-sen University from January 2012 to December 2016. Logistic regression and nomograms were developed to predict the probability of pCR and good downstaging to ypT0-2N0M0(ypTNM 0-I), respectively, based on pretreatment parameters for all LARC patients. Nomograms were also developed for three NT regimens(capecitabine/deGramont-RT, mFOLFOX6, and m FOLFOX6-RT) to predict pCR probability.RESULTS Four hundred and three patients were included in this study; 72(17.9%) had pCR at the final pathology report, and 177(43.9%) achieved good downstaging to ypT0-2N0M0(ypTNM 0-I). The nomogram for predicting pCR probability showed that NT regimens, tumor differentiation, mesorectal fascia(MRF) status,and tumor length significantly influenced pCR probability. When predicting the probability of good downstaging, tumor differentiation, MRF status, and clinical T stage were the significant factors. Nomograms were developed based on NT regimens. For the capecitabine/de Gramont-RT group, the multivariate analysis showed that the neutrophil-lymphocyte ratio(NLR) was the only significant factor, thus we could not develop a nomogram for this regim

关键词： Neoadjuvant therapy Locally advanced rectal cancer Nomogram Prediction of pathological response Complete pathological response Good downstaging

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男性直肠癌患者全直肠系膜切除术后吻合口漏风险增高

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Gastroenterology Report 2018年第2期6卷 137-143,I0003页

作者： Jian-ping Wang and Ping Lan Chi Zhou Xian-rui Wu Xuan-hui Liu Yu-feng Chen Jia Ke Xiao-wen He Xiao-sheng He Tuo Hu Yi-feng Zou Xiao-bin Zheng Hua-shan Liu Jian-cong Hu Xiao-jian Wu Jian-ping Wang Ping Lan Department of colorectal Surgery the Sixth Affiliated Hospital of Sun Yat-sen UniversityGuangdong Provincial Key Laboratory of Colorectal and Pelvic Floor DiseasesGuangzhouGuangdong 510065China

背景:患者性别对于直肠癌全直肠系膜切除术(TME)后吻合口漏形成的影响目前仍存在争议。本研究旨在评估性别与吻合口漏的相关性。方法:回顾性分析2010-2014年间在我院接受TME手术且行一期吻合的直肠癌患者的临床资料。比较男性与女性患... 详细信息

背景:患者性别对于直肠癌全直肠系膜切除术(TME)后吻合口漏形成的影响目前仍存在争议。本研究旨在评估性别与吻合口漏的相关性。方法:回顾性分析2010-2014年间在我院接受TME手术且行一期吻合的直肠癌患者的临床资料。比较男性与女性患者术后吻合口漏发生率。结果:入组的956例直肠癌患者中,男性587例(61.4%),女性369例(38.6%)。相较于女性患者,男性患者中吸烟和饮酒的比例更高,但有腹部手术史者较少;术前肠梗阻的比例更高,肿瘤本身也相对较大。全组病例中出现术后吻合口漏81例(8.5%),其中男性患者发生率高于女性患者(10.6%vs.5.1%,P¼0.003)。多因素逻辑回归分析证实,男性是术后吻合口漏发生的独立危险因素(OR¼2.41,95%CI:1.37-4.23,P¼0.002);对于腹腔镜TME手术的亚组分析也得到了相同的结果(OR¼2.11,95%CI:1.15-3.89,P¼0.016)。结论:男性直肠癌患者TME手术后吻合口漏的发生风险相对较高。保护性肠造口或可为吻合口提供保护,降低吻合口漏的发生风险,尤其是对于男性患者。

关键词：直肠癌吻合口漏性别危险因素全直肠系膜切除术一期吻合

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The microbiome in inflammatory bowel diseases:from pathogenesis to therapy

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Protein & Cell 2021年第5期12卷 331-345页

作者： Sheng Liu Wenjing Zhao Ping Lan Xiangyu Mou Guangdong Provincial Key laboratory of Colorectal and Pelvic Floor Diseases The Sixth Affiliated HospitalSchool of MedicineSun Yat-sen UniversityGuangzhou 510275China

Inflammatory bowel disease(IBD)has become a global disease with accelerating incidence worldwide in the 21st century while its accurate etiology remains unclear.In the past decade,gut microbiota dysbiosis has consistently been associated with IBD.Although many IBDassociated dysbiosis have not been proven to be a cause or an effect of IBD,it is often hypothesized that at least some of alteration in microbiome is protective or causative.In this article,we selectively reviewed the hypothesis supported by both association studies in human and pathogenesis studies in biological models.Specifically,we reviewed the potential protective bacterial pathways and species against IBD,as well as the potential causative bacterial pathways and species of IBD.We also reviewed the potential roles of some members of mycobiome and virome in IBD.Lastly,we covered the current status of therapeutic approaches targeting microbiome,which is a promising strategy to alleviate and cure this inflammatory disease.

关键词： inflammatory bowel disease pathogenesis etiology microbiome dysbiosis therapy

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Transanal total mesorectal excision combined with intersphincteric resection has similar long-term oncological outcomes to laparoscopic abdominoperineal resection in low rectal cancer:a propensity score-matched cohort study

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Gastroenterology Report 2022年第1期10卷 377-385页

作者： Zhi-Hang Liu Zi-Wei Zeng Hai-Qing Jie Liang Huang Shuang-Ling Luo Wen-Feng Liang Xing-Wei Zhang Liang Kang Department of colorectal Surgery The Sixth Affiliated HospitalSun Yat-sen UniversityGuangzhouGuangdongP.R.China Guangdong Provincial Key laboratory of Colorectal and Pelvic Floor Diseases The Sixth Affiliated HospitalSun Yat-sen UniversityGuangzhouGuangdongP.R.China

Background Transanal total mesorectal excision(taTME)or intersphincteric resection(ISR)has recently proven to be a valid and safe surgical procedure for low rectal cancer.However,studies focusing on the combination of these two technologies are limited.This study aimed to evaluate perioperative results,long-termoncologic outcomes,and anorectal functions of patients with low rectal cancer undergoing taTME combined with ISR,by comparing with those of patients undergoing laparoscopic abdominoperineal resection(laAPR).Methods After 1:1 propensity score matching,200 patients with low rectal cancer who underwent laAPR(n=100)or taTME combined with ISR(n=100)between September 2013 and November 2019 were included.Patient demographics,clinicopathological characteristics,oncological outcomes,and anal functional results were analysed.Results Patients in the taTME-combined-with-ISR group had less intraoperative blood loss(79.6672.6 vs 107.3665.1 mL,P=0.005)and a lower rate of post-operative complications(22.0%vs 44.0%,Pdisease-free survival rates were 86.3%in the taTME-combined-with-ISR group and 75.1%in the laAPR group(P=0.056),while the 3-year overall survival rates were 96.7%and 94.2%,respectively(P=0.319).There were 39 patients(45.3%)in the taTME-combined-with-ISR group who developed major low anterior resection syndrome,whereas 61 patients(70.9%)had good post-operative anal function(Wexner incontinence score≤10).Conclusion We found similar long-term oncological outcomes for patients with low rectal cancer undergoing laAPR and those undergoing taTME combined with ISR.Patients receiving taTME combined with ISR had acceptable post-operative anorectal function.

关键词： rectal cancer transanal totalmesorectal excision laparoscopic abdominoperineal resection oncological outcomes

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Risk factors for recurrence of colorectal conventional adenoma and serrated polyp

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Gastroenterology Report 2022年第1期10卷 291-297页

作者： Zengjie Chi Yanyun Lin Juanni Huang Min-Yi Lv Junguo Chen Xijie Chen Bin Zhang Yufeng Chen Jiancong Hu Xiaosheng He Ping Lan Department of colorectal Surgery Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor DiseasesGuangdong Institute of Gastroenterologythe Sixth Affiliated Hospital of Sun Yat-sen UniversityGuangzhouGuangdongP.R.China Department of Geriatrics The First Affiliated HospitalGuangzhou Medical UniversityGuangzhouGuangdongP.R.China

Background Removal of colorectal polyps during screening could reduce the incidence of colorectal cancer(CRC).However,there is a lack of data on risk factors associated with recurrence of polyps,including conventional adenomas and serrated polyps(SPs).This study aimed to determine risk factors for recurrence of colorectal polyps and their subtypes based on the characteristics of the patients and polyps.Methods A total of 1,165 patients diagnosed with conventional adenoma or SP in the Sixth Affiliated Hospital of Sun Yat-sen University between January 2013 and December 2019 were enrolled in this study,including 668 cases with conventional adenomas,385 with SPs,and 112 with coexistence of adenomas and SPs.Univariate analysis and multivariate logistic regression were used to identify potential risk factors for polyp recurrence.A nomogram was established according to risk factors and the performance was evaluated using calibration plots.Results During a median follow-up of 24 months,recurrent polyps were observed in 531(45.6%)cases.Male,age≥50 years,body mass index(BMI)≥24 kg/m^(2),at least three polyps,smoking,alcohol consumption,family history of polyps,and family history of CRC were independent risk factors for polyp recurrence.The Harrell’s C-index of the nomogram developed with these parameters was 0.69 and the calibration plots showed good agreement between actual polyp recurrence and nomogram-predicted recurrence probability.In the subtype analyses,conventional adenomas had the same risk factors for recurrence as all polyps,while smoking,alcohol consumption,family history of polyps,and family history of CRC were not risk factors for SP recurrence.Conclusions We identified several risk factors for recurrence of colorectal polyps and found that some of them could increase the risk of adenoma recurrence but not SP recurrence,including smoking,alcohol consumption,and family history of polyps/CRC,which might help us to understand different etiology and biology between conventional adenomas and SPs.

关键词： colorectal polyps recurrence conventional adenomas serrated polyps risk factors

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Easily-injectable shear-thinning hydrogel provides long-lasting submucosal barrier for gastrointestinal endoscopic surgery

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Bioactive Materials 2022年第9期7卷 44-52页

作者： Yinxiang Tang Minhui Hu Fuxin Tang Rongkang Huang Hui Wang Dingcai Wu Ping Lan Materials Science Institute Key Laboratory for Polymeric Composite and Functional Materials of Ministry of EducationSchool of ChemistrySun Yat-sen UniversityGuangzhou510275China Department of Gastrointestinal Endoscopy Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor DiseasesThe Sixth Affiliated Hospital of Sun Yat-sen UniversityGuangzhou510655China Department of colorectal Surgery Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor DiseasesThe Sixth Affiliated Hospital of Sun Yat-sen UniversityGuangzhou510655China Institute of Biomedical Innovation and laboratory of Regenerative Medicine and Biomaterials Biomedical Material Conversion and Evaluation Engineering Technology Research Center of Guangdong ProvinceGuangzhou510655China

Submucosal injection material has shown protective effect against gastrointestinal injury during endoscopic surgery in clinic.However,the protective ability of existing submucosal injection material is strictly limited by their difficult injectability and short barrier time.Herein,we report a shear-thinning gellan gum hydrogel that simultaneously has easy injectability and long-lasting barrier function,together with good hemostatic property and biocompatibility.Shear-thinning property endows our gellan gum hydrogel with excellent endoscopic injection performance,and the injection pressure of our gellan gum hydrogel is much lower than that of the small molecule solution(50 wt%dextrose)when injected through the endoscopic needle.More importantly,our gellan gum hydrogel shows much stronger barrier retention ability than normal saline and sodium hyaluronate solution in the ex vivo and in vivo models.Furthermore,our epinephrine-containing gellan gum hydrogel has a satisfactory hemostatic effect in the mucosal lesion resection model of pig.These results indicate an appealing application prospect for gellan gum hydrogel utilizing as a submucosal injection material in endoscopic surgery.

关键词： Shear-thinning Injectable hydrogel Gellan gum Long-lasting barrier Endoscopic surgery

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肠道菌群失调促进结直肠癌的发生

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Gastroenterology Report 2018年第1期6卷 1-12,I0001页

作者： Shaomin Zou Lekun Fang Mong-Hong Lee Research Institute of Gastroenterology Sun Yat-sen UniversityGuangzhou 510020China Guangdong Provincial Key laboratory of Colorectal and Pelvic Floor Disease The Sixth Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510020China

肠道菌群包含至少100万亿的细菌,定居在人类的肠道黏膜表面。最近研究显示,肠道微生态的改变会影响正常生理,与许多疾病相关,包括结直肠肿瘤的发生。结直肠癌是第三常见的恶性肿瘤,呈现多基因、多步骤的演进,但肠道微生态在结直肠癌发... 详细信息

肠道菌群包含至少100万亿的细菌,定居在人类的肠道黏膜表面。最近研究显示,肠道微生态的改变会影响正常生理,与许多疾病相关,包括结直肠肿瘤的发生。结直肠癌是第三常见的恶性肿瘤,呈现多基因、多步骤的演进,但肠道微生态在结直肠癌发生中的具体机制尚知之甚少。随着宏基因组学等新技术的出现,使针对肠道菌群的大样本基因全貌和代谢模式分析成为可能,从而使我们可以深入了解肠道菌群组成、分类变化及其与宿主的相互作用。不同菌属及其代谢产物在结直肠癌的发生中至关重要。同时,肠道菌群对于结直肠癌发生发展过程中的炎性反应和免疫逃逸也有重要影响。本文就目前针对肠道菌群与结直肠癌关系的研究进行了综述,从而为结直肠癌的治疗策略提供了新的视角。

关键词：肠道菌群菌群失调结直肠癌肿瘤发生

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肠道菌群在功能性便秘中的作用

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Gastroenterology Report 2021年第5期9卷 392-401,I0001页

作者： Shengsheng Zhang Ruixin Wang Danyan Li Luqing Zhao Lixin Zhu Digestive disease Center Beijing Hospital of Traditional Chinese MedicineCapital Medical UniversityBeijingP.R.China Department of colorectal Surgery Guangdong Institute of GastroenterologyGuangdong Provincial Key Laboratory of Colorectal and Pelvic Floor DiseasesThe Sixth Affiliated Hospital of Sun Yat-sen UniversityGuangzhouGuangdongP.R.China

功能性便秘非常常见,但其发病机制尚不明了。越来越多的证据显示,功能性便秘与肠道微生态失调有关,而肠道微生态与肠道转运之间很可能存在相互影响。本文对功能性便秘发生过程中肠道微生态所发挥作用的证据进行了总结。肠道微生态通过... 详细信息

功能性便秘非常常见,但其发病机制尚不明了。越来越多的证据显示,功能性便秘与肠道微生态失调有关,而肠道微生态与肠道转运之间很可能存在相互影响。本文对功能性便秘发生过程中肠道微生态所发挥作用的证据进行了总结。肠道微生态通过胆酸、短链脂肪酸、5-羟色胺和甲烷等相关微生物代谢活动调控结肠动力、结肠黏膜分泌和吸收,进而促使功能性便秘的发生。作为肠道微生态影响功能性便秘的证据支持,用益生菌、益生元、合生元和中药治疗功能性便秘时,常可观察到患者肠道微生态在菌种组成和功能上的改变。深入研究功能性便秘的病理发生,阐明微生态制剂治疗功能性便秘的药理机制,将为功能性便秘的新型治疗方法提供理论基础。

关键词： gut microbiota functional constipation bile acids SCFA serotonin traditional Chinese medicine

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Endoscopic management of delayed bleeding after polypectomy of small colorectal polyps:two or more clips may be safe

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Gastroenterology Report 2022年第1期10卷 284-290页

作者： Xue-Feng Guo Xiang-An Yu Jian-Cong Hu De-Zheng Lin Jia-Xin Deng Ming-Li Su Juan Li Wei Liu Jia-Wei Zhang Qing-Hua Zhong Department of Endoscopic Surgery The Sixth Affiliated HospitalSun Yat-sen UniversityGuangzhouGuangdongP.R.China Guangdong Provincial Key laboratory of Colorectal and Pelvic Floor Diseases The Sixth Affiliated HospitalSun Yat-sen UniversityGuangzhouGuangdongP.R.China

Background:The resection of small colorectal polyps(≤10mm)is routine for endoscopists.However,the management of one of its main complications,namely delayed(within 14 days)postpolypectomy bleeding(DPPB),has not been clearly demonstrated.We aimed to assess the role of coloscopy in the management of DPPB from small colorectal polyps and identify the associated factors for initial hemostatic success.Methods:We conducted a retrospective study of 69 patients who developed DPPB after the removal of colorectal polyps of≤10mmand underwent hemostatic colonoscopy at the Sixth Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between April 2013 and June 2021.Demographics,clinical variables,and colonoscopic features were collected independently.We applied univariate and multivariate analyses to assess factors associated with initial hemostatic success.Results:General colonoscopy without oral bowel preparation was successfully performed in all the patients,with a median duration of 23.9(12.5–37.9)minutes.Among 69 patients,62(89.9%)achieved hemostasis after initial hemostatic colonoscopy and 7(10.1%)rebled 2.761.1 days after initial colonoscopic hemostasis and had rebleeding successfully controlled by one additional colonoscopy.No colonoscopy-related adverse events occurred.Multivariate analysis showed that management with at least two clips was the only independent prognostic factor for initial hemostatic success(odds ratio,0.17;95%confidence interval,0.03–0.91;P=0.04).All the patients who had at least two clips placed at the initial hemostatic colonoscopy required no further hemostatic intervention.Conclusions:Colonoscopy is a safe,effective,and not too time-consuming approach for the management of patients with DPPB of small colorectal polyps and management with the placement of at least two hemoclips may be beneficial.

关键词： colonoscopy gastrointestinal bleeding polypectomy clip complication

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胃肠道癌:中国、美国和欧洲

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Gastroenterology Report 2021年第2期9卷 91-104,I0001页

作者： Yumo Xie Lishuo Shi Xiaosheng He Yanxin Luo Department of colorectal Surgery The Sixth Affiliated HospitalSun Yat-sen UniversityGuangzhouGuangdongChina guangdong Institute of Gastroenterology Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor DiseaseThe Sixth Affiliated HospitalSun Yat-sen UniversityGuangzhouGuangdongChina Center for Clinical Research The Sixth Affiliated HospitalSun Yat-sen UniversityGuangzhouGuangdongChina

胃肠道癌包括结直肠癌、胃癌和食管癌,给全球带来了沉重的医疗和经济负担,无论是每年新发病例数还是死亡例数,均居癌症首位。食管癌和胃癌多见于发展中国家,而结直肠癌则是西方国家的主要胃肠道恶性肿瘤。然而,一些经济转型的发展中国家... 详细信息

胃肠道癌包括结直肠癌、胃癌和食管癌,给全球带来了沉重的医疗和经济负担,无论是每年新发病例数还是死亡例数,均居癌症首位。食管癌和胃癌多见于发展中国家,而结直肠癌则是西方国家的主要胃肠道恶性肿瘤。然而,一些经济转型的发展中国家,其胃肠道癌谱正在发生巨大转变,同时,在西方国家,由于某些危险因素的暴露增加,食管癌和胃癌也有抬头的趋势。所有胃肠道癌的发生发展均与生活习惯密切相关,而且都能通过癌前病变予以识别。因此,这些胃肠道癌都非常适宜早期筛查。本文中,我们综述了胃肠道癌在中国、美国、欧洲的流行病学特点,总结其主要危险因素以及这些危险因素在上述地区的分布情况,并对当前的筛查策略进行了探讨。

关键词： colorectal cancer gastric cancer esophageal cancer epidemiology cancer screening

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