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Current opinion on lymphadenectomy in pancreatic cancer surgery

Hepatobiliary & Pancreatic Diseases International 2011年第1期10卷 21-25页

作者： Theodoros E Pavlidis Efstathios T Pavlidis Athanasios K Sakantamis Second surgical Propedeutical Department Medical SchoolAristotle University of ThessalonikiHippocration Hospital

BACKGROUND:Adenocarcinoma of the pancreas exhibits aggressive behavior in growth,inducing an extremely poor prognosis with an overall median 5-year survival rate of only 1%-4%.Curative resection is the only potential therapeutic opportunity. DATA SOURCES:A PubMed search of relevant articles published up to 2009 was performed to identify information about the value of lymphadenectomy and its extent in curative resection of pancreatic adenocarcinoma. RESULTS:Despite recent advances in chemotherapy,radio-therapy or even immunotherapy,surgery still remains the major factor that affects the *** initial promising performance in japan gave conflicting results in Western countries for the extended and more radical pancreatectomy; it has failed to prove *** prospective,randomized trials on extended versus standard lymphadenectomy during pancreatic cancer surgery have shown no improvement in long-term survival by the extended *** exact lymph node status,including malignant spread and the total number retrieved as well as the lymph node ratio,is the most important prognostic *** lymph nodes after pancreatectomy are present in 70%.Paraaortic lymph node spread indicates poor prognosis. CONCLUSIONS:Undoubtedly,a standard lymphadenectomy including>15 lymph nodes must be no longer preferred in patients with the usual head *** extended lymphadenectomy does not have any place,unless in randomized *** cases with body or tail location,the radical antegrade modular pancreatosplenectomy gives promising ***,accurate localization and detailed examination of the resected specimen are required for better staging.

关键词： pancreatic carcinoma lymphadenectomy pancreatectomy curative resection pancreatoduodenectomy distal pancreatosplenectomy

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Are the SNPs of NKX2-1 associated with papillary thyroid carcinoma in the Han population of Northern China？

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Frontiers of Medicine 2014年第1期8卷 113-117页

作者： Lizhe Ai Yaqin Yu Xiaoli Liu Chong Wang Jieping Shi Hui Sun Qiong Yu Department of Epidemiology and Biostatistics School of Public Health Jilin University Changchun 130021 China Jilin Provincial Key Laboratory of surgical Translational Medicine Department of Thyroid and Parathyroid Surgery China-Japan Union Hospital Jilin University Changchun 130033 China

Papillary thyroid carcinoma （PTC） is one of the most common tumors of the thyroid gland. The common risk factors of PTC include ionizing radiation, positive family history, and thyroid nodular disease. PTC was identified in Europeans by conducting a genome-wide association study, and a strong association signal with PTC was observed in rs944289 and NKX2-1 （located at the 14q13.3 locus）, which was probably the genetic risk factor of PTC. This study aimed to examine the association of this gene with PTC in Chinese. A total of 354 patients with PTC and 360 healthy control subjects from the Han population of Northern China were recruited in the study. These individuals were genotyped to determine rs12589672, rs12894724, rs2076751, and rs944289. The association of rs944289 with PTC was obtained （C vs. T, P= 0.027, OR= 1.264, 95% CI = 1.026-1.557; and C/C-C/T vs. T/T, P= 0.034, OR= 1.474, 95% CI = 1.028-2.112）. Conducting a subgroup analysis, we found a marginal difference in the allele frequency distribution of rs944289 （adjusted P = 0.062） between the patients with PTC and multi-nodular goiter and the control subjects. We also observed an interaction （P= 0.029; OR = 2.578, 95% CI=1.104-6.023） between rs944289 and diabetes in patients with PTC. In conclusion, rs944289 was associated with an increased risk of PTC in the Han population of Northern China, but no clear association was observed in either of the tag single nucleotide polymorphisms of NKX2-1.

关键词： NKX2-1 papillary thyroid carcinoma the Han population of Northern China association

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A specific gene-expression signature quantifies the degree of hepatic fibrosis in patients with chronic liver disease

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World Journal of Gastroenterology 2007年第3期13卷 383-390页

作者： Tohru Utsunomiya Masahiro Okamoto Shigeki Wakiyama Masaji Hashimoto Kengo Fukuzawa Takahiro Ezaki Shinichi Aishima Yasuji Yoshikawa Taizo Hanai Hiroshi Inoue Graham F Barnard Masaki Mori Department of Molecular and surgical Oncology Medical Institute of Bioregulation Kyushu University Beppu Japan Department of Surgery Iizuka Hospital Iizuka Japan Department of Digestive Surgery Toranomon Hospital and Okinaka Memorial Institute for Medical Research Tokyo Japan Department of Surgery Oita Red Cross Hos-pital Oita Japan Department of Surgery Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital Hiroshima Japan Department of Anatomic pathology Graduate School of Medical Sciences Kyushu University Fukuoka Japan Department of Pathology Medical Institute of Bioregulation Kyushu University Beppu Japan Laboratory for Bioinformatics Graduate School of Systems Life Sciences Kyushu University Fukuoka Japan Division of Gastroenterology University of Massachusetts Medical School Worcester MA United States

AIM： To study a more accurate quantification of hepatic fibrosis which would provide dinically useful information for monitoring the progression of chronic liver disease. METHODS： Using a cDNA microarray containing over 22000 clones, we analyzed the gene-expression profiles of non-cancerous liver in 74 patients who underwent hepatic resection. We calculated the ratio of azanstained： total area, and determined the morphologic fibrosis index （MFI）, as a mean of 9 section-images. We used the MFI as a reference standard to evaluate our method for assessing liver fibrosis. RESULTS： We identified 39 genes that collectively showed a good correlation （r 〉 0.50） between geneexpression and the severity of liver fibrosis. Many of the identified genes were involved in immune responses and cell signaling. To quantify the extent of liver fibrosis, we developed a new genetic fibrosis index （GFI） based on gene-expression profiling of 4 clones using a linear support vector regression analysis. This technique, based on a supervised learning analysis, correctly quantified the various degrees of fibrosis in both 74 training samples （r = 0.76, 2.2% vs 2.8%, P 〈 0.0001） and 12 independent additional test samples （r = 0.75, 9.8% vs 8.6%, P 〈 0.005）. It was far better in assessing liver fibrosis than blood markers such as prothrombin time （r = -0.53）, type IV collagen 7s （r = 0.48）, hyaluronic acid （r = 0.41）, and aspartate aminotransferase to platelets ratio index （APRI）（r = 0.38）. CONCLUSION： Our cDNA microarray-based strategy may help clinicians to precisely and objectively monitor the severity of liver fibrosis.

关键词： Uver fibrosis Hepatitis virus DNA microarray Supervised learning analysis Scoring system

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Evaluation of rational extent lymphadenectomy for local advanced gastric cancer

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Chinese Journal of Cancer Research 2016年第4期28卷 397-403页

作者： Han Liang Jingyu Deng Gastric Cancer surgical Department Tianjin Medical University Cancer Institute & HospitalNational Clinic Research Center for Cancer

Based upon studies from randomized clinical trials, the extended （D2） lymph node dissection is now recommended as a standard procedure for local advanced gastric cancer worldwide. However, the rational extent lymphadenectomy for local advanced gastric cancer has remained a topic of debate in the past decades. Due to the limitation of low metastatic rate in para-aortic nodes （PAN） in JCOG9501, the clinical benefit of D2＋ para-aortic nodal dissection （PAND） for patients with stage T4 and/or stage N3 disease, which is very common in China and other countries except japan and Korea, cannot be determined. Furthermore, the role of splenectomy for complete resection of No.10 and No.l I nodes has been controversial, and however, the final results from the randomized trial ofJCOG0110 have yet to be completed. Gastric cancer with the No.14 and No.13 lymph node metastasis is defined as MI stage in the current version of the japanese classification. We propose that D2~No.14v and ＋No.13 lymphadenectomy may be an option in a potentially curative gastrectomy for tumors with apparent metastasis to the No.6 nodes or infiltrate to duodenum. The examined lymph node and extranodal metastasis are significantly associated with the survival of gastric cancer patients.

关键词： Re-evaluation extended (D2) lymphadenectomy D2+No.14v lymphadenectomy para-aortic nodal dissection (PAND)

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Trend in gastric cancer:35 years of surgical experience in japan

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World Journal of Gastroenterology 2011年第29期17卷 3390-3397页

作者： Keishi Yamashita Shinichi Sakuramoto Masayuki Nemoto Tomotaka Shibata Hiroaki Mieno Natsuya Katada Shiroh Kikuchi Masahiko Watanabe Department of Surgery Kitasato University School of MedicineKitasato 1-15-1Minami-kuSagamiharaKanagawa 252-0374Japan

AIM:To investigate the trend in gastric cancer surgery in the context of rapid therapeutic advancement in japan and East ***:A retrospective analysis was performed on 4163 patients who underwent gastric resection for gastric cancer with histological confirmation between 1971 and 2007 at the surgical unit in Kitasato University Hospital,to determine the trend in gastric cancer requiring ***:Gastric cancer requiring surgical resection increased in our hospital,but the incidence adjusted for population was constant during the observed ***,the ratio of diffuse type/intestinal type gastric cancer was unexpectedly unchanged,and that of advanced/early gastric cancer(EGC)was,however,markedly reduced,while the actual incidence of potentially curative advanced gastric cancer tended to *** incidence of EGC requiring surgery tended to increase as a whole,which is consistent with increased prevalence of endoscopic *** a result,overall survival and mortality of gastric cancer requiring gastric resection has recently markedly ***:In japan,planned interventions may improve surgical gastric cancer mortality,but an unexpected trend of persistent existence of intestinal type cancer suggests the need for more robust medical intervention.

关键词： Histology Age factors Clinical classification Prognosis Disease progression Gastric cancer

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Intestinal Behçet's disease: A review of clinical diagnosis and treatment

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World Journal of Gastrointestinal Surgery 2024年第6期16卷 1493-1500页

作者： Ying Liu Feng Gao Ding-Quan Yang Yan Jiao Department of General Surgery The Affiliated Hospital to Changchun University of Chinese MedicineChangchun 130021Jilin ProvinceChina Department of Gastrointestinal and Colorectal Surgery China-Japan Union Hospital of Jilin UniversityChangchun 130033Jilin ProvinceChina Department of Hepatobiliary and Pancreatic Surgery General Surgery CenterThe First Hospital of Jilin UniversityChangchun 130021Jilin ProvinceChina

Behçet's disease(BD)is a chronic inflammatory disorder prone to frequent re-currences,with a high predilection for intestinal ***,the ef-ficacy and long-term effects of surgical treatment for intestinal BD are *** the current issue of World J Gastrointest Surg,Park et al conducted a retrospec-tive analysis of 31 patients with intestinal BD who received surgical *** found that elevated C-reactive protein levels and emergency surgery were poor prognostic factors for postoperative recurrence,emphasizing the adverse impact of severe inflammation on the prognosis of patients with intestinal *** work has clinical significance for evaluating the postoperative condition of intestinal *** editorial attempts to summarize the clinical diagnosis and treatment of intestinal BD,focusing on the impact of adverse factors on surgical *** hope this review will facilitate more precise postoperative management of patients with intestinal BD by clinicians.

关键词： Intestinal Behçet's disease Diagnosis Treatment Surgery Recurrence

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Clinical significance of subcellular localization of KL-6 mucin in primary colorectal adenocarcinoma and metastatic tissues

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World Journal of Gastroenterology 2006年第1期12卷 54-59页

作者： Qian Guo Wei Tang Yoshinori Inagaki Yutaka Midorikawa Norihiro Kokudo Yasuhiko Sugawara MunehiroNakata Toshiro Konishi Hirokazu Nagawa Masatoshi Makuuchi Hepatobiliary-Pancreatic Surgery Division Department of Surgery GraduateSchool of Medicine the University of Tokyo 7-3-1 HongoBunkyo-ku Tokyo 113-8655 Japan Department of Applied Biochemistry and Institute of Glycotechnology Tokai University Hiratsuka Kanagawa 259-1292 Japan Kanto Medical Center NTT EC 5-9-22 Higashigotanda Shinagawa-ku Tokyo 141-8625 Japan surgical Oncology Division Department of Surgery Graduate School of Medicine the University of Tokyo 7-3-1 Hongo Bunkyo-ku Tokyo 113-8655 Japan

AIM： To assess subcellular localization of KL-6 mucin and its clinicopathological significance in colorectal carcinoma as well as metastatic lymph node and liver tissues. METHODS： Colorectal carcinoma tissues as well as metastatic lymph node and liver tissues were collected from 82 patients who underwent colorectomy or hepatectomy. Tissues were subjected to immunohistochemical analysis using KL-6 antibody. RESULTS： Of the 82 colorectal carcinoma patients, 6 showed no staining, 29 showed positive staining only in the apical membrane, and 47 showed positive staining in the circumferential membrane and/or cytoplasm. Positive staining was not observed in non-cancerous colorectal epithelial cells surrounding the tumor tissues. The five-year survival rate was significantly lower in cases showing positive staining in the circumferential membrane and/or cytoplasm （63.0%） than those showing positive staining only in the apical membrane （85.7%） and those showing no staining （100%）. Statistical analysis between clinicopathological factors and subcellular localization of KL-6 mucin showed that KL-6 localization in the circumferential membrane and/or cytoplasm was significantly associated with the presence of venous invasion （P = 0.0003）, lymphatic invasion （P 〈 0.0001）, lymph node metastasis （P〈0.0001）, liver metastasis （P = 0.058）, and advanced histological stage （P〈 0.0001）. Positive staining was observed in all metastatic lesions tested as well as in the primary colorectal carcinoma tissues. CONCLUSION： The subcellular staining pattern of KL-6 in colorectal adenocarcinoma may be an important indicator for unfavorable behaviors such as lymph node and liver metastasis, as well as for the prognosis of patients.

关键词： KL-6 mucin Colorectal carcinoma Metasta-sis Prognosis Immunohistochemistry

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Efficacy of the revised Vienna Classification for diagnosing colorectal epithelial neoplasias

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World Journal of Gastroenterology 2009年第19期15卷 2351-2356页

作者： Kenji Tominaga Sumio Fujinuma Takuro Endo Yoshihisa Saida Kei Takahashi Iruru Maetani Division of Gastroenterology Department of Internal MedicineToho University Ohashi Medical Center2-17-6 OhashiMeguro-kuTokyo 153-8515Japan Third Department of Surgery Toho University Ohashi Medical Center2-17-6 OhashiMeguro-kuTokyo 153-8515Japan Department of surgical Pathology Toho University Ohashi Medical Center2-17-6 OhashiMeguro-kuTokyo 153-8515Japan

AIM： To prospectively investigate the efficacy of the revised Vienna Classification for diagnosing colorectal epithelial neoplastic lesions in cold biopsy ***： Patients were selected for inclusion if they had colorectal epithelial lesions that were not considered suitable for direct endoscopic resection,These included colorectal polyps ≥ 10 mm and lesions suspected of being carcinomas capable of invading the colorectal submucosa or beyond, including strictures, based on the cold biopsies obtained from each lesion prior to resection. We investigated the relationship between diagnoses based on cold biopsy samples using the revised Vienna Classification and resected specimens of the same lesions, and the therapeutic implications of diagnoses made using the revised Vienna Classification. The same cold biopsy specimens were also examined using the japanese Group Classification guidelines, and compared with the resected specimens of the same lesions for ***： A total of 179 lesions were identified. The sensitivity, specificity, positive and negativepredictive values of the revised Vienna Classification for distinguishing between intramucosal lesions and submucosal invasive carcinomas in cold biopsy specimens was 22.2%, 100%, 100%, and 71.4%,respectively, and for distinguishing between intramucosal lesions and those invading the submucosa or beyond was 59.7%, 100%, 100%, and 37.6%,respectively. The sensitivity, specificity, positive and negative predictive values of the japanese Group Classification for distinguishing between intramucosal lesions and submucosal invasive carcinomas in cold biopsy specimens was 83.3%, 91.4%, 83.3%. and 91.4%, respectively, and for distinguishing between intramucosal lesions and those invading the submucosa or beyond was 95.1%, 91.4%, 97.9%, and 82.1%, respectively. A total of 137 of 144 carcinomas that had invaded the submucosa or beyond and three high-grade intraepithelial neoplasias were diagnosed as ＂carcinoma＂

关键词： Biopsy Cancer Colonoscopy Colorectalepithelial neoplasia Revised Vienna Classification

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lmmunotherapy utilization for hepatobiliary cancer in the United States: disparities among patients with different socioeconomic status

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Hepatobiliary Surgery and Nutrition 2020年第1期9卷 13-24,中插2页

作者： Kota Sahara S.Ayesha Farooq Diamantis I.Tsilimigras Katiuscha Merath Anghela Z.Paredes Lu Wu Rittal Mehta J.Madison Hyer Itaru Endo Timothy M.Pawlik Department of Surgery Division of Surgical OncologyThe Ohio State University Wexner Medical Center and James Comprehensive Cancer CenterColumbusOHUSA Gastroenterological Surgery Division Yokohama City University School of MedicineYokohamaJapan

Background: Patients with advanced hepatobiliary cancer (HBC) have a dismal prognosis and limited treatment options. Immunotherapy has been considered as a promising treatment, especially for cancers not amenable to surgery. Methods: Between 2004, and 2015, patients diagnosed with hepatocellular carcinoma (HCC), intra- and extrahepatic cholangiocarcinoma and gallbladder cancer (GBC) were identified in the National Cancer Database. Results: Among 249,913 patients with HBC, only 585 (0.2%) patients received immunotherapy. Among patients who received immunotherapy, most patients were diagnosed between 2012 and 2015, had private insurance, as well as an income ≥$46,000 and were treated at an academic facility. The use of immunotherapy among HBC patients varied by diagnosis (HCC, 67.7%;bile duct cancer, 14%). On multivariable analysis, a more recent period of diagnosis (OR 1.80, 95% CI: 1.44-2.25), median income >$46,000 (OR 1.43, 95% CI: 1.11-1.87), and higher tumor stage (stage III, OR 2.22, 95% CI: 1.65-3.01;stage IV, OR 3.24, 95% CI:2.41-4.34) were associated with greater odds of receiving immunotherapy. Conclusions: Overall utilization of immunotherapy in the US among patients with HBC was very low, yet has increased over time. Certain socioeconomic factors were associated with an increased likely of receiving immunotherapy, suggesting disparities in access of patients with lower socioeconomic status.

关键词： Immunotherapy hepatobiliary cancer (HBC) trends socioeconomic status

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Hepatocellular carcinoma in extremely elderly patients:An analysis of clinical characteristics,prognosis and patient survival

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World Journal of Gastroenterology 2006年第1期12卷 48-53页

作者： Gengo Tsukioka Satoru Kakizaki Naondo Sohara Ken Sato Hitoshi Takagi Hirotaka Arai Takehiko Abe Mitsuo Toyoda Kenji Katakai Akira Kojima Yuichi Yamazaki Toshiyuki Otsuka Yutaka Matsuzaki Fujio Makita Daisuke Kanda Katsuhiko Horiuchi Tetsuya Hamada Mieko Kaneko Hideyuki Suzuki Masatomo Mori Department of Medicine and Molecular Science Gunma University Graduate School of MedicineMaebashiGunma 371-8511Japan Department of Gastroenterology Maebashi Red Cross HospitalMaebashiGunma 371-0014Japan Department of Internal Medicine Isesaki Municipal HospitalIsesakiGunma 372-0817Japan Department of Internal Medicine Kiryu Kousei General HospitalKiryuGunma 376-0024Japan Department of Internal Medicine Tone Chuo HospitalNuraataGunma 378-0053Japan Department of Gastroenterology National Nishigunma HospitalShibukawaGumna 377-0027Japan Department of Gastroenterology Saiseikai Maebashi HospitalMaebashiGunma 371-0821Japan Department of Gastroenterology Public Tomioka General HospitalTomiokaGunma 370-2361Japan Department of Internal Medicine Fuji Heavy Industries Ltd.Health Insurance Society General Ota HospitalOtaGunma 373-0056Japan Department of Gastroenterology Shimada Memorial HospitalFujiokaGunma 375-0024Japan

AIM： To identify the clinical and prognostic features of patients with hepatocellular carcinoma （HCC） aged 80 years or more. METHODS： A total of 1310 patients with HCC were included in this study. Ninety-one patients aged 80 years or more at the time of diagnosis of HCC were defined as the extremely elderly group. Two hundred and thirty-four patients aged 〉/ 50 years but less than 60 years were regarded as the non-elderly group. RESULTS： The sex ratio （male to female） was significantly lower in the extremely elderly group （0.90：1） than in the non-elderly group （3.9：1, P〈 0.001）. The positive rate for HBsAg was significantly lower in the extremely elderly group and the proportion of patients negative for HBsAg and HCVAb obviously increased in the extremely elderly group （P〈 0.001）. There were no significant differences in the following parameters： diameter and number of tumors, Child-Pugh grading, tumor staging, presence of portal thrombosis or ascites, and positive rate for HCVAb. Extremely elderly patients did not often receive surgical treatment （P 〈 0.001） and they were more likely to receive conservative treatment （P〈 0.01）. There were no significant differences in survival curves based on the Kaplan-Meier methods in comparison with the overall patients between the two groups. However, the survival curves were significantly worse in the extremely elderly patients with stage Ⅰ/Ⅱ, stage Ⅰ/Ⅱ and Child-Pugh grade A cirrhosis in comparison with the non-elderly group. The causes of death did not differ among the patients, and most cases died of liverrelated diseases even in the extremely elderly patients. CONCLUSION： In the patients with good liver functions and good performance status, aggressive treatment for HCC might improve the survival rate, even in extremely elderly patients.

关键词： Hepatocellular carcinoma Extremely elderly patients Survival analysis Cause of death

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