2013 Vol.25(3)

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Editorial
Controversies in the diagnosis and management of early gastric cancer
Zhaode Bu, Jiafu Ji
2013, 25(3): 263-266. doi: 10.3978/j.issn.1000-9604.2013.06.15
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Surgical organ displacement: what is the best “materials and methods” for proton radiotherapy?
Takashi Ogino
2013, 25(3): 267-268. doi: 10.3978/j.issn.1000-9604.2013.04.03
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Pharmacological blockage of CYP2E1 and alcohol-mediated liver cancer: is the time ready?
Sebastian Mueller
2013, 25(3): 269-271. doi: 10.3978/j.issn.1000-9604.2013.05.01
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New frontiers in peritoneal malignancies
Emel Canbay
2013, 25(3): 272-273. doi: 10.3978/j.issn.1000-9604.2013.06.10
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Original Article
Impact of comorbidity in elderly prostate cancer patients treated with brachytherapy
Costanza Chiumento, Alba Fiorentino, Mariella Cozzolino, Rocchina Caivano, Stefania Clemente, Piernicola Pedicini, Vincenzo Fusco
2013, 25(3): 274-280. doi: 10.3978/j.issn.1000-9604.2013.06.06
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ObjectiveTo analyze the correlations among comorbidity and overall survival (OS), biochemical progression-free survival (b-PFS) and toxicity in elderly patients with localized prostate cancer treated with 125I brachytherapy.MethodsElderly men, aged ≥65 years, with low-intermediate risk prostate cancer, were treated with permanent 125I brachytherapy as monotherapy. Comorbidity data were obtained from medical reports using age-adjusted Charlson comorbidity index (a-CCI). The patients were categorized into two age groups (<75 and ≥75 years old), and two comorbidity score groups (a-CCI ≤3 and >3). Toxicity was scored with Radiation Therapy Oncology Group (RTOG) scale.ResultsFrom June 2003 to October 2009, a total of 92 elderly patients underwent prostate brachytherapy, including 57 men (62%) with low-risk prostate cancer, and 35 men (38%) with intermediate-risk prostate cancer. The median age of patients was 75 years (range, 65-87 years). Forty-seven patients (51%) had a-CCI ≤3 and 45 patients (49%) a-CCI >3. With a median follow-up period of 56 months (range, 24-103 months), the 5-year actuarial OS and b-PFS were 91.3% and 92.4% respectively, without statistical significance between two Charlson score groups. Toxicity was mild. None of the patients experienced gastrointestinal (GI) toxicity, and only 4 patiens (4%) experienced late genitourinary (GU) grade-3 (G3) toxicity. No correlation between acute GU and GI toxicity and comorbidity was showed (P=0.50 and P=0.70, respectively).ConclusionsOur data suggest that elderly men with low-intermediate risk prostate cancer and comorbidity can be considered for a radical treatment as 125I low-dose rate brachytherapy.
Establishment of NOD/SCID mouse models of human hepatocellular carcinoma via subcutaneous transplantation of histologically intact tumor tissue
Mingxia Yan, Hong Li, Fangyu Zhao, Lixing Zhang, Chao Ge, Ming Yao, Jinjun Li
2013, 25(3): 289-298. doi: 10.3978/j.issn.1000-9604.2013.05.02
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Hepatocellular carcinoma (HCC) is one of the most deadly human cancers, but it is very difficult to establish an animal model by using surgical specimens. In the present experiment, histologically intact fresh surgical specimens of HCC were subcutaneously transplanted in non-obese diabetic/severe combined immunodeficienccy (NOD/SCID) mice. The biological characteristics of the original and the corresponding transplanted tumors and cell lines were investigated. The results showed that 5 new animal models and 2 primary cell lines were successfully established from surgical specimens. Hematoxylin-eosin staining showed that xenografts retained major histological features of the original surgical specimens. The two new cell lines had been cultivated for 3 years and successively passaged for more than 100 passages in vitro. The morphological characteristics and biologic features of the two cell lines were genetically similar to the original tumor. The subcutaneous transplant animal models with histologically intact tumor tissue and primary cell lines could be useful for in vivo and in vitro testing of anti-cancer drugs and be ideal models to study various biologic features of HCC.
Effect of early enteral nutrition on postoperative nutritional status and immune function in elderly patients with esophageal cancer or cardiac cancer
Guiping Yu, Guoqiang Chen, Bin Huang, Wenlong Shao, Guangqiao Zeng
2013, 25(3): 299-305. doi: 10.3978/j.issn.1000-9604.2013.06.01
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ObjectiveTo explore the effect of early enteral nutrition (EN) on postoperative nutritional status, intestinal permeability, and immune function in elderly patients with esophageal cancer or cardiac cancer.MethodsA total of 96 patients with esophageal cancer or cardiac cancer who underwent surgical treatment in our hospital from June 2007 to December 2010 were enrolled in this study. They were divided into EN group (n=50) and parenteral nutrition (PN) group (n=46) based on the nutrition support modes. The body weight, time to first flatus/defecation, average hospital stay, complications and mortality after the surgery as well as the liver function indicators were recorded and analyzed. Peripheral blood samples were collected on the days 1, 4 and 7 after surgery. The plasma diamine oxidase (DAO) activity and D-lactate level were determined to assess the intestinal permeability. The plasma endotoxin levels were determined using dynamic turbidimetric assay to assess the protective effect of EN on intestinal mucosal barrier. The postoperative blood levels of inflammatory cytokines and immunoglobulins were determined using enzyme-linked immunosorbent assay (ELISA).ResultsAfter the surgery, the time to first flatus/defecation, average hospital stay, and complications were significantly less in the EN group than those in the PN group (P<0.05), whereas the EN group had significantly higher albumin levels than the PN group (P<0.05). On the 7th postoperative day, the DAO activity, D-lactate level and endotoxin contents were significantly lower in the EN group than those in the PN group (all P<0.05). In addition, the EN group had significantly higher IgA, IgG, IgM, and CD4 levels than the PN group (P<0.05) but significantly lower IL-2, IL-6, and TNF-α levels (P<0.05).ConclusionsIn elderly patients with esophageal cancer or cardiac cancer, early EN after surgery can effectively improve the nutritional status, protect intestinal mucosal barrier (by reducing plasma endoxins), and enhance the immune function
A novel PTEN gene promoter mutation and untypical Cowden syndrome
Chen Liu, Guangbing Li, Rongrong Chen, Xiaobo Yang, Xue Zhao, Haitao Zhao
2013, 25(3): 306-311. doi: 10.3978/j.issn.1000-9604.2013.06.02
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Cowden syndrome (CS), an autosomal dominant disorder, is one of a spectrum of clinical disorders that have been linked to germline mutations in the phosphatase and tensin homolog (PTEN) gene. Although 70-80% of patients with CS have an identifiable germline PTEN mutation, the clinical diagnosis presents many challenges because of the phenotypic and genotypic variations. In the present study, we sequenced the exons and the promoter of PTEN gene, mutations and variations in the promoter and exons were identified, and a PTEN protein expression negative region was determined by immunohistochemistry (IHC). In conclusion, a novel promoter mutation we found in PTEN gene may turn off PTEN protein expression occasionally, leading to the disorder of PTEN and untypical CS manifestations.
Intrinsic apoptotic pathway and G2/M cell cycle arrest involved in tubeimoside I-induced EC109 cell death
Yang Xu, Guanghui Wang, Quancheng Chen, Ting Lin, Zhiping Zeng, Qiang Luo, Jie Liu, Cuiling Sun
2013, 25(3): 312-321. doi: 10.3978/j.issn.1000-9604.2013.06.03
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ObjectiveSquamous esophageal carcinoma is highly prevalent in developing countries, especially in China. Tu Bei Mu (TBM), a traditional folk medicine, has been used to treat esophageal squamous cell carcinoma (ESCC) for a long term. tubeimoside I (TBMS1) is the main component of TBM, exhibiting great anticancer potential. In this study, we investigated the mechanism of TBMS1 cytotoxic effect on EC109 cells.MethodsComparative nuclear proteomic approach was applied in the current study and we identified several altered protein spots. Further biochemical studies were carried out to detect the mitochondrial membrane potential, cell cycle and corresponding proteins’ expression and location.ResultsSubcellular proteomic study in the nucleus from EC109 cells revealed that altered proteins were associated with mitochondrial function and cell proliferation. Further biochemical studies showed that TBMS1-induced molecular events were related to mitochondria-induced intrinsic apoptosis and P21-cyclin B1/cdc2 complex-related G2/M cell cycle arrest.ConclusionsConsidering the conventional application of TBM in esophageal cancer, TBMS1 therefore may have a great potential as a chemotherapeutic drug candidate for ESCC.
Matrix metalloproteinase gene expressions might be oxidative stress targets in gastric cancer cell lines
Salih Gencer, Anil Cebeci, Meliha Burcu Irmak-Yazicioglu
2013, 25(3): 322-333. doi: 10.3978/j.issn.1000-9604.2013.06.05
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ObjectiveOxidative stress is linked to increased risk of gastric cancer and matrix metalloproteinases (MMPs) are important in the invasion and metastasis of gastric cancer. We aimed to analyze the effect of the accumulation of oxidative stress in the gastric cancer MKN-45 and 23132/87 cells following hydrogen peroxide (H2O2) exposure on the expression patterns of MMP-1, MMP-3, MMP-7, MMP-9, MMP-10, MMP-11, MMP-12, MMP-14, MMP-15, MMP-17, MMP-23, MMP-28, and β-catenin genes.MethodsThe mRNA transcripts in the cells were determined by RT-PCR. Following H2O2 exposure, oxidative stress in the viable cells was analyzed by 2',7'-dichlorofluorescein diacetate (DCFH-DA). Caffeic acid phenethyl ester (CAPE) was used to eliminate oxidative stress and the consequence of H2O2 exposure and its removal on the expressions of the genes were evaluated by quantitative real-time PCR.ResultsThe expressions of MMP-1, MMP-7, MMP-14, MMP-15, MMP-17 and β-catenin in MKN-45 cells and only the expression of MMP-15 in 23132/87 cells were increased. Removal of the oxidative stress resulted in decrease in the expressions of MMP genes of which the expressions were increased after H2O2 exposure. β-catenin, a transcription factor for many genes including MMPs, also displayed decreased levels of expression in both of the cell lines following CAPE treatment.ConclusionsOur data suggest that there is a remarkable link between the accumulation of oxidative stress and the increased expressions of MMP genes in the gastric cancer cells and MMPs should be considered as potential targets of therapy in gastric cancers due to its continuous exposure to oxidative stress.
Risk factors associated with early recurrence of adenocarcinoma of gastroesophageal junction after curative resection
Guodong Wang, Aiwen Wu, Xiaojing Cheng, Jiafu Ji
2013, 25(3): 334-338. doi: 10.3978/j.issn.1000-9604.2013.06.11
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ObjectiveTo clarify the important clinicopathological factors affecting the early recurrence of adenocarcinoma of esophagogastric junction (AEG).MethodsWe retrospectively reviewed the clinical data of 147 AEG patients who underwent R0 resection during the period from December 1995 to December 2007. Risk factors asssociated with the early recurrence were analyzed by χ2 test and logistic regression test.ResultsThe mean time to tumor recurrence was 16.3 months after R0 resection, and the 1-year recurrence rate was 48.3%. Univariate analysis showed that the histological grade (poorly and moderately differentiated), number of positive lymph nodes, and vascular invasion were significantly related with the early recurrence (P<0.05). Logistic multivariate regression analysis showed that only histological grade and vascular invasion were independently related with early tumor recurrence (P<0.05).ConclusionsHistological grade and vascular invasion are independent factors for predicting the early tumor recurrence after R0 resection for AEG.
Intraoperative ultrasound assistance in resection of intracranial meningiomas
Hailiang Tang, Huaping Sun, Liqian Xie, Qisheng Tang, Ye Gong, Ying Mao, Qing Xie, Mingzhe Zheng, Daijun Wang, Hongda Zhu, Jianhong Zhu, Xiaoyuan Feng, Zhenwei Yao, Xiancheng Chen, Liangfu Zhou
2013, 25(3): 339-345. doi: 10.3978/j.issn.1000-9604.2013.06.13
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ObjectiveIntracranial meningiomas, especially those located at anterior and middle skull base, are difficult to be completely resected due to their complicated anatomy structures and adjacent vessels. It’s essential to locate the tumor and its vessels precisely during operation to reduce the risk of neurological deficits. The purpose of this study was to evaluate intraoperative ultrasonography in displaying intracranial meningioma and its surrounding arteries, and evaluate its potential to improve surgical precision and minimize surgical trauma.MethodsBetween December 2011 and January 2013, 20 patients with anterior and middle skull base meningioma underwent surgery with the assistance of intraoperative ultrasonography in the Neurosurgery Department of Shanghai Huashan Hospital. There were 7 male and 13 female patients, aged from 31 to 66 years old. Their sonographic features were analyzed and the advantages of intraoperative ultrasonography were discussed.ResultsThe border of the meningioma and its adjacent vessels could be exhibited on intraoperative ultrasonography. The sonographic visualization allowed the neurosurgeon to choose an appropriate approach before the operation. In addition, intraoperative ultrasonography could inform neurosurgeons about the location of the tumor, its relation to the surrounding arteries during the operation, thus these essential arteries could be protected carefully.ConclusionsIntraoperative ultrasonography is a useful intraoperative technique. When appropriately applied to assist surgical procedures for intracranial meningioma, it could offer very important intraoperative information (such as the tumor supplying vessels) that helps to improve surgical resection and therefore might reduce the postoperative morbidity.
Review Article
Hedgehog signaling pathway and ovarian cancer
Qi Chen, Guolan Gao, Shiwen Luo
2013, 25(3): 346-353. doi: 10.3978/j.issn.1000-9604.2013.06.04
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Epithelial ovarian carcinoma (EOC) is the most common form of ovarian malignancies and the most lethal gynecologic malignancy in the United States. To date, in spite of treatment to it with the extensive surgical debulking and chemotherapy, the prognosis of EOC remains dismal. Recently, it has become increasingly clear that in many instances, the signaling and molecular players that control development are the same, and when inappropriately regulated, drive tumorigenesis and cancer development. Here, we discuss the possible involvement of Hedgehog (Hh) pathway in the cellular regulation and development of cancer in the ovaries. Using the in vitro and in vivo assays developed has facilitated the dissection of the mechanisms behind Hh-driven ovarian cancers formation and growth. Based on recent studies, we propose that the inhibition of Hh signaling may interfere with spheroid-like structures in ovarian cancers. The components of the Hh signaling may provide novel drug targets, which could be explored as crucial combinatorial strategies for the treatment of ovarian cancers.
Case Report
Primary thymic mucosa-associated lymphoid tissue lymphoma with multiple thin walled lung cysts: case report and literature review
Lung-Yun Kang, Szu-Pei Ho, Yi-Pin Chou
2013, 25(3): 354-357. doi: 10.3978/j.issn.1000-9604.2013.06.07
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Mucosa-associated lymphoid tissue (MALT) lymphoma of the thymus is rare. We reported a case of a 37-year-old Chinese female with Sjögren’s syndrome and hyperglobulinemia. She suffered from chronic cough for 3 weeks. Chest computed tomography (CT) demonstrated a multiloculated cystic mass in mediastinum prevascular space and multiple lung cysts. Laboratory exam of autoimmune markers showed positive of antinuclear antibody (ANA), Sjögren’s syndrome A (SSA), Sjögren’s syndrome B (SSB), and rheumatoid factors (RF). Thymectomy with lymph node dissection was performed. The pathology report revealed thymic extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue. Under immunohistochemical stains, CD20 and Bcl-2 were positive. No evidence of recurrence of disease was found.
Combination therapy for scalp angiosarcoma using bevacizumab and chemotherapy: a case report and review of literature
Ping Yang, Qi Zhu, Fuqiang Jiang
2013, 25(3): 358-361. doi: 10.3978/j.issn.1000-9604.2013.06.09
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Bevacizumab, an angiogenesis inhibitor, is a recombined humanized monoclonal antibody against vascular endothelial growth factor and a promising therapeutic option for angiosarcoma management. This is a case report and review of the literature using bevacizumab and combination chemotherapy for angiosarcoma. The understanding of the effectiveness of combined therapy of bevacizumab and chemotherapy agents is still limited. The benefits of bevacizumab treatment for angiosarcoma will need to be weighed against the risks of venous thromboembolism in this population.
Unusual presentation of cutaneous metastasis from bladder urothelial carcinoma
Chin-Pao Chang, Yen Lee, Hung-Jen Shih
2013, 25(3): 362-365. doi: 10.3978/j.issn.1000-9604.2013.06.08
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Cutaneous metastases from urothelial carcinoma of the bladder are a rare disease. In previous reports, the most common metastatic cutaneous lesions were non-tender nodules on the abdominal skin. We report a patient with bladder urothelial carcinoma with cutaneous metastases initially presenting as right leg and suprapubic lymphedema. Bladder tumor was the incidental finding by magnetic resonance venography. Urothelial carcinoma (clinical stage IV) was diagnosed, and chemotherapy was performed. Extensive painful erythematous plaques with an erysipelas-like appearance located on the suprapubic area, chest and abdomen were noted, and cutaneous metastases were confirmed by histopathology. Subsequently, extensive scrotal and prepuce ulcerative changes developed. This paper reports a rare case of extensive cutaneous metastasis of bladder urothelial carcinoma who presented an interesting clinical course.
Letter to the Editor
Being an oncologist in China: my notes about cancer treatment in China
Aiwen Wu
2013, 25(3): 366-367. doi: 10.3978/j.issn.1000-9604.2013.06.12
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Meeting Report
The 8th National Gastric Cancer Academic Conference: focus on specification, translational research, and plan
Ni Dai
2013, 25(3): 368-372. doi: 10.3978/j.issn.1000-9604.2013.06.14
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