Objective To investigate the clinical characteristics, therapeutic methods, and prognostic factors of patients with rectal stromal tumor. Methods The clinicopathological data of 33 patients with rectal stromal tumor who treated in the Affiliated Hospital of Xuzhou Medical University from January 2008 to November 2014 were retrospectively reviewed, and the therapeutic methods and prognostic factors of these patients were further analyzed. Results The major clinical manifestations of 33 patients included abdominal discomfort in 21 patients, changes of defecation habit and fecal property in 15 patients, bloody stool in 13 patients, and anal pain in 9 patients. CT and MRI examination showed a mass in the pelvic with the clear boundary, growed through the wall of rectum, with the heterogeneous density and signal, sometimes with necrosis, calcification, and haemorrhage. The results of immunohistochemical staining showed that, 31 patients were strongly positive for CD117, 28 patients were strongly positive for CD34, 15 patients were positive for smooth muscle actin (SMA), 13 patients were positive for vimentin, and 3 patients were positive for soluble acid protein (S-100). The therapeutic methods of 33 patients included local excision in 13 patients, low anterior resection in 11 patients, abdominal pelvic resection in 5 patients, and conservative treatment in 4 patients. A total of 26 patients underwent surgery combiend with imatinib therapy. The follow-up time was 10–102 months and the median time was 58 months. During follow-up period, there were 8 patients suffered from recurrence or metastasis, and 15 patients died. The results of Cox proportional hazards regression model showed that, postoperative relapse and metastasis were prognostic factors for survival〔RR=19.338, 95% CI was (2.821, 132.568), P=0.003〕. The survival situation of the patients suffered from postoperative relapse and metastasis was poor. Conclusions CD117 and CD34 could serve as valuable diagnostic indexes for rectal stromal tumor. Surgery is an effective treatment for rectal stromal tumor.
Objective Establishing Nomogram to predict the overall survival (OS) rate of patients with gastric adenocarcinoma by utilizing the database of the Surveillance, Epidemiology, and End Results (SEER) Program. Methods Obtained the data of 3 272 gastric adenocarcinoma patients who were diagnosed between 2004 and 2014 from the SEER database. These patients were randomly divided into training (n=2 182) and validation (n=1 090) cohorts. The Cox proportional hazards regression model was performed to evaluate the prognostic effects of multiple clinicopathologic factors on OS. Significant prognostic factors were combined to build Nomogram. The predictive performance of Nomogram was evaluated via internal (training cohort data) and external validation (validation cohort data) by calculating index of concordance (C-index) and plotting calibration curves. Results In the training cohort, the results of Cox proportional hazards regression model showed that, age at diagnosis, race, grade, 6th American Joint Committee on Cancer (AJCC) stage, histologic type, and surgery were significantly associated with the survival prognosis (P<0.05). These factors were used to establish Nomogram. The Nomograms showed good accuracy in predicting OS rate, with C-index of 0.751 ［95%CI was (0.738, 0.764)］ in internal validation and C-index of 0.753 ［95% CI was (0.734, 0.772)］ in external validation. All calibration curves showed excellent consistency between prediction by Nomogram and actual observation. Conclusion Novel Nomogram for patients with gastric adenocarcinoma was established to predict OS in our study has good prognostic significance, it can provide clinicians with more accurate and practical predictive tools which can quickly and accurately assess the patients’ survival prognosis individually, and can better guiding clinicians in the follow-up treatment of patients.
Objective To investigate the clinical features, treatment, and influence factors of prognosis in patients with gastric neuroendocrine neoplasms (GNENs). Methods From March 2011 to January 2016, the clinicopathological data of 44 patients with GNENs who treated in The Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed to summarize the choice of treatment plan and analyze influence factors of prognosis. Results A total of 44 patients enrolled in this study. The major clinical manifestation included abdominal pain in 18 patients (40.9%), abdominal distension in 16 patients (36.4%), loss of appetite in 4 patients (9.1%), acid regurgitation and belching in 4 patients (9.1%), nausea and vomiting in 1 patient (2.3%), eating after choking sense in 3 patients (6.8%), gastrointestinal bleeding in 2 patients (4.5%), diarrhea in 1 patient (2.3%), and palpitations with weakness in 3 patients (6.8%). The treatment of 44 patients included radical resection in 26 patients (59.1%), endoscopic resection in 13 patients (29.6%), local excision in 1 patient (2.3%), and 4 patients had distant metastasis before operation were conducted of palliative treatment〔palliative resection in 2 patients (4.5%) and conservative treatment in 2 patients (4.5%)〕. Univariate analysis showed that the gender, the age, the tumor size, and the N staging (lymph node metastasis) were not associated with prognosis (P>0.050), but the tumor location and the depth of tumor invasion were related to the prognosis (P<0.050). The tumors located in the upper part of the stomach and the serosal infiltration indicated poor prognosis. However, neither of them can be used as independent factor to evaluate the poor prognosis of GNENs patients (P>0.050). Conclusions GNENs has nonspecific clinical manifestation. Radical surgery and endoscopic resection are the main treatment methods, but the influence factors of prognosis in GNENs patients need further study.
ObjectiveTo investigate the application of ascending aorta cannulation and brachiocephalic trunk cannulation in acute type A aortic dissection.MethodsWe screened 183 patients with acute type A aortic dissection from January 2017 to January 2020 in our hospital. They were divided into 2 groups according to the cannulation strategy: ascending aorta cannulation and brachiocephalic trunk cannulation (a DAC group, n=42, 33 males and 9 females with a median age of 50 years) and the single axillary artery cannulation (an AAC group, n=141, 116 males and 25 females with a median age of 51 years). The general clinical data, intraoperative data and early postoperative results of the two groups before and after matching with propensity scores were compared.ResultsBefore propensity-score matching, the operation time, cardiopulmonary bypass time, aortic occlusion time and ICU stay in the DAC group were all shorter than those in the AAC group (P<0.05). The early postoperative mortality, and rates of brain complications, renal failure and pulmonary complications in the DAC group were significantly lower than those in the AAC group. After propensity-score matching, the operation time in the DAC group was significantly shorter than that in the AAC group (P<0.05). The early postoperative mortality, and rates of brain complications and pulmonary complications in the DAC group were significantly lower than those in the AAC group.ConclusionAscending aorta cannulation and brachiocephalic trunk cannulation can provide a safe, fast and effective method of establishing cardiopulmonary bypass for some acute type A aortic dissection patients, and significantly shorten the operation time without increasing surgical complications.
ObjectiveTo investigate the effect of Yttrium-90 selective internal radiotherapy (90Y-SIRT) on tumor control and compensatory hyperplasia of left hepatic lobe in the treatment of right hepatic malignant tumor. MethodsThe clinical data of 134 patients with liver malignant tumor (primary or secondary) who were treated with 90Y-SIRT in the Department of Hepatobiliary and Pancreatic Surgery, Beijing Tsinghua Changgung Hospital from September 2022 to November 2023 were collected, and 29 patients who met the inclusion and exclusion criteria were analyzed retrospectively. The liver volume, tumor volume, postoperative future liver remnant (FLR) and the percentage of FLR proliferation before and after treatment were measured by CT or MRI, and the surgical resection rate and pathological necrosis rate of tumor focus after 90Y-SIRT treatment were analyzed. The liver volume, tumor volume, postoperative future liver remnant (FLR) and the percentage of FLR hyperplasia were measured by CT or MRI before and 1 and 3 months after 90Y-SIRT, and the surgical resection rate and pathological necrosis rate of tumor lesions after 90Y-SIRT treatment were analyzed. ResultsOf the 29 patients, 22 patients with hepatocellular carcinoma, 2 patients with cholangiocarcinoma and 5 patients with liver metastases from colorectal cancer received 90Y-SIRT of the right liver. At 1 and 3 months after treatment, the tumor volume average decreased by 149.2 mL (P=0.124) and 228.2 mL (P=0.012), the right liver volume was average reduced by 197.4 mL (P=0.026) and 318.6 mL (P=0.023), the left liver volume average increased by 64.9 mL (P=0.261) and 144.7 mL (P=0.124), and the percentage of FLR increased by 6.6% (P=0.018) and 13.4% (P＜0.001) of 29 patients, respectively. Three months after operation, mRECIST standard was used to evaluate the curative effect of tumor imaging. The results showed that the objective response rate of tumor was 79.3% and the disease control rate was 93.1%. Conclusions90Y-SIRT can effectively control the growth of malignant tumors in the right lobe of the liver and induce compensatory hyperplasia of the left liver. At the same time, high objective response rate and pathological necrosis rate of tumor lesions can be obtained.