Clinicopathological features and prognosis of colorectal cancer with extranodal tumor deposits.

e15005 Background: The study discusses clinicopathological features of colorectal cancer with extranodal tumor deposits(ENTDs) and investigates whether ENTDs is a poor prognostic factor. Methods: 1. Clinicopathological data and follow-up of colorectal cancer with ENTDs who underwent surgery between June 2007 and June 2010 in seven hospitals in North China were collected retrospectively. Kaplan-Meier method was used for survival analysis. Cox proportional hazards model was used for multivariate analysis of prognostic factors. 2. The literatures on ENTDs and postoperative survival rate in colorectal cancer published from 1990 to 2016 were retrieved in English literature databases such as MEDLINE/PubMed, Web of Science and Chinese literature databases such as CNKI. Meta-analysis was conducted by Review Manager 5.3 software. Results: 1. A total of 253 cases of colorectal cancer with ENTDs were collected. The 5-year survival with only one ENTD was 49.2% (87/177), with median survival time 60 months. The 5-year survival with more than one ENTD was 17.1% (13/76), with median survival time 44 months. Cox regression analysis revealed that age, tumor size, number of ENTDs, N, m stage, surgical approach and adjuvant treatment were independent risk factors of prognosis of colorectal cancer with ENTDs. 2. The total sample size of the studies was 4731 cases with ENTDs (+) 917 cases. Meta analysis showed that: 5-year overall survival and 5-year relapse-free survival rate were significantly lower in ENTDs (+) group than ENTDs (-) group for colorectal cancer (OR:respectively 0.25,0.30; 95% CI:respectively 0.17-0.37,0.22-0.41; both P < 0.00001); 5-year overall survival rates were both significantly lower in ENTDs (+) group than ENTDs (-) group for patients with N0 and N+ colorectal cancer (N0 group: P = 0.003; N+ group: P = 0.0008; both P < 0.05). Conclusions: 1.Age, tumor size, number of ENTDs, N, m stage, surgical approach and adjuvant treatment were independent risk factors of prognosis of colorectal cancer with ENTDs. 2. ENTDs was a poor prognostic factor in colorectal cancer. The effect of ENTDs on postoperative survival rate might resemble that of between lymph node metastasis and distant metastasis.

ROLE OF CYTOKINES IN THE PATHOGENESIS OF DIFFUSE BACTERIAL PERITONITIS

We analyzed present-day data in Russian and foreign literature on development of cytokine cascade in diffuse bacterial peritonitis having studied the role of cytokines in forming systemic inflammation response syndrome. It has been showed that cytokines primary regulate local protective response by forming typical inflammatory reaction with its classic local manifestations and natural anti-microbial resistance mechanisms. The main stage in the development of diffuse bacterial peritonitis is a disbalance in the system of proinflammatory cytokines and anti-inflammatory mediators; and this disbal-ance defines the severity of extraabdominal complications and multisystem organ failure. In the article, the markers of inflammation severity are described assisting in evaluation of the course of inflammation process and postoperative survival rate. Due to changes in immune system of the patients, it is necessary to assess complexly their immune status including cytokine profile, which in this group of patients is of diagnostic and prognostic value and needs to be further studied.

D-Dimer and Carcinoembryonic Antigen Levels: Useful Indicators for Predicting the Tumor Stage and Postoperative Survival

The purpose of this prospective study is to determine the preoperative plasma D-dimer and serum Carcinoembryonic Antigen (CEA) levels of patients scheduled for curative surgical resection for colorectal cancer and to evaluate the significance of these levels on the prognosis and postoperative survival rate. One hundred sixty-five patients with colorectal cancer, who were scheduled to have elective resection between January 2008 and January 2011, were included in the study. A significant increase was observed in the D-dimer levels, particularly in poorly differentiated tumors. The distance covered by the tumor inside the walls of the colon and rectum (T-stage) was significant for both D-dimer and CEA levels. As the T-stage increased, there was also a significant increase in the D-dimer and CEA levels. A high significance and correlation level was detected between the TNM staging and both D-dimer and CEA. A significant relationship was found between the advanced tumor stage and short postoperative survival rate of patients with colorectal cancer. Therefore, the analysis of preoperative D-dimer and CEA levels can be useful in predicting the stage and differentiation of the tumor and the postoperative survival rate.

The impact of bevacizumab on liver regeneration following hepatectomy in rats.

228 Background: In our clinical data, we had the interesting findings that the pathologic sinusoidal obstruction syndrome and serum hyaluronic acid after neoadjuvant oxaliplatin-associated chemotherapy for liver metastatic colorectal cancer with bevacitumab (Bev) was ameliorated compared to those without Bev. The purpose of this study was to investigate the influence of bevacizumab administration on regenerating liver in rat 70% and 90% hepatectomy (Hx) model as a surrogate model of human massive hepatectomy for liver metastatic colorectal cancer. Methods: Male Wister rats weighing 180-230g were divided into the following four groups: 70%Hx, 70%Hx + Bev, 90%Hx and 90%Hx+Bev group. The rats were pretreated with intraperitoneal administration of bevacizumab (5mg/kg) 7 days before hepatectomy. The remnant liver and blood samples were taken one day after hepatectomy, and the following parameters were evaluated: blood analysis (AST, ALT, LDH, T- Bil, and hyaluronic acid), liver weight to body weight (Lw/Bw) ratio, and postoperative survival rate for three days. Results: In the 70%Hx model, there was no significant difference between the 70%Hx group and 70%Hx + Bev group in blood analysis one day after hepatectomy; AST (1928 vs. 923 IU/L), ALT (1282 vs. 670 IU/L), T-Bil (0.17 vs. 0.19 mg/dl), LDH (3822 vs. 2967 U/L) and hyaluronic acid (995.7 vs. 1026.6 ng/ml) and in Lw/Bw ratio (1.78 vs. 1.84). In 90%Hx model, AST and ALT of blood analysis in 90%Hx+Bev group significantly decreased compared to those in 90%Hx group; AST (3428 vs. 4995 IU/L, P<0.05), ALT (1471 vs. 2287 IU/L, P<0.05), T-Bil (1.94 vs. 2.57 mg/dl), LDH (3229 vs. 5351 U/L) and hyaluronic acid (3865.7 vs. 7862.2 ng/ml). The Lw/Bw ratio in 90%Hx+Bev group significantly increased compared to that in 90%Hx group (0.80 vs. 0.67, P<0.05). The postoperative survival rate in 90%Hx+Bev group showed tendency to improve compared to that in 90%Hx group (75% vs. 50%, P=0.19). Conclusions: The administration of bevacizumab seven days before hepatectomy did not significantly affect the liver functions and liver regeneration rate. These findings suggest that hepatectomy might be safe and feasible after the use of bevacizumab. No significant financial relationships to disclose.

Chronologic changes in the clinicopathologic findings and survival of gastric cancer patients.

PURPOSE To determine the chronologic changes in the clinicopathologic features of gastric cancer patients. PATIENTS AND METHODS The clinicopathologic findings of 1,795 patients with gastric cancer were examined retrospectively from hospital records obtained between 1969 and 1995. The patients were divided into three generations on the basis of chronologic order. The first generation included patients treated over the period 1969 to 1977; the second generation, 1978 to 1986; and the third generation, 1987 to 1995. RESULTS The chronologic changes in the clinicopathologic findings for all gastric cancers included increases in the superficial type based on macroscopic appearance (P < .005), small-sized tumor (P < .025), superficial depth of invasion (P < .005), and earlier histologic stages (P < .005), in addition to a decrease in lymph node metastasis (P < .005). Overall, the postoperative survival rate has improved over time in gastric cancer patients, with 5-year survival rates of 36.0%, 53.3%, and 68.6% in the first, second, and third generations, respectively. In stages 1,2, and 3, the survival rate in the third generation was the highest of the three generations, whereas in stage 4, the survival rate did not differ between the three generations. Patients who underwent a D2 dissection showed a higher survival rate than those with D1 or D3 dissections, but there was no statistical difference in the survival of patients with D1, D2, and D3 dissections when stage 4 patients were excluded. CONCLUSION The chronologic changes in gastric cancer patients over the past 27 years have included an increase in the incidence of earlier-staged gastric cancers, which has had a significant impact on the improved postoperative survival rate.