Background
The aim of this trial was to compare the Enhanced Recovery After Surgery (ERAS) program with conventional perioperative management in patients who underwent radical resection for ...colorectal cancer.
Methods
A combination of evidence-based and consensus methodology was used to develop the ERAS protocol. Five hundred ninety-seven consecutive patients who underwent elective colorectal resection were randomized to either the ERAS (
n
= 299) or the control group (
n
= 298). Outcomes relating to nutrition and metabolism index, stress index, and recovery index were measured and recorded.
Results
Demographic and operative data were similar between the two groups. Patients in the ERAS group showed improved nutritional status when compared with those of the control group. On postoperative day (POD) 1, the HOMA-IR (insulin resistance index) of the ERAS group was lower than that of the control group (
p
< 0.001). The cortisol level of the control group was elevated on both POD 1 (
p
= 0.007) and POD 5 (
p
= 0.002) compared to the preoperative level. However, the cortisol level of the ERAS group was not increased until POD 5 (
p
= 0.001). Reduced levels of TNF-α, IL-1β, IL-6, and IFN-γ in the ERAS group indicated less postoperative stress responses. In addition, ERAS was associated with accelerated recovery of gastrointestinal function. The postoperative length of stay (
p
< 0.001) and expense (
p
< 0.001) for the ERAS group were reduced in comparison to the controls. Twenty-eight cases in the control group and twenty-nine in the ERAS group suffered complications, which was not significantly different.
Conclusion
The ERAS protocol attenuates the surgical stress response and accelerates postoperative recovery without compromising patient safety.
Objective
This study was designed to evaluate the long-time outcome of patients with colorectal liver metastasis (CRLM) undergoing different types of therapy and identify prognosis factors.
Methods
...From 2000 to 2010, 1,613 consecutive patients with CRLM were identified. Clinicopathological and outcome data were collected and analyzed by univariate and multivariate analyses.
Results
Synchronous liver metastasis (SLM), female, grade III-IV, T4 and N positive of primary tumor, bilobar disease, number of liver metastases ≥4, size of largest liver metastases ≥5 cm, serum CEA level ≥5 ng/ml, and CA19-9 level ≥37 u/ml were the predictors of adverse outcome using univariate analysis. The median survival and 5-year survival rate for patients after resection of liver metastases was 49.8 months and 47%, better than that for those after other therapy. In addition, patients without treatment had the poorest survival. Sixty-four initially unresectable patients underwent surgery after conversion therapy with a median survival of 36.9 months and a 5-year survival of 30%. By multivariate analysis, SLM, poorly differentiated primary tumor, number of liver metastases ≥4, size of largest liver metastases ≥5 cm, and no surgical treatment of liver metastases were found to be independent predictors of poor survival.
Conclusions
Patients with CRLM could get long-term survival benefit from different types of therapy, and resection of liver metastases was the optimal strategy. A predictive model using these above five factors may be of use in stratifying patients who may benefit from intensive surveillance and adjuvant therapy.
Many genes and mutations have been reported for colorectal cancer (CRC); however, very few have been associated with colorectal cancer liver metastasis (CRLM). We performed gene expression profiling ...experiments to identify genetic markers for CRLM and elucidate the molecular mechanisms. Microarray experiments were performed on CRC primary tumor samples with or without liver metastasis (LM) using the Affymetrix U133 plus 2.0 GeneChip Array. A new identified gene-scinderin (
SCIN
) was overexpressed with synchronous LM at both the RNA level evaluated with quantitative real-time PCR and protein level evaluated with immunohistochemistry and also with short overall survival analyzed with Kaplan-Meier method. With multivariate analysis indicated that
SCIN
served as an independent poor prognostic predictor for CRC patients. Disease-free survival was also significantly lower in
SCIN
overexpressing CRC patients with metachronous LM. In addition,
SCIN
knockdown significantly reduced cell proliferation, induced cell cycle arrest, and promoted the expression of some cell cycle apoptosis-related protein. Moreover, the
DIAPH1
,
STAT3
,
CDK2
,
CDK4
, and
EGFR
levels were downregulated, whereas
CDKN2B
and
COL4A1
were upregulated in DLD-1-shSCIN cells by microarray analysis compared with DLD-1 shCon cells. These findings revealed that
SCIN
may serve as an important predictor of CRLM and poor outcome for CRC patients.
SCIN
may be a potential therapeutic target in human CRC. However, translation of its roles into clinical practice will require further investigation and additional experimental validation.
Objective: To investigate the effect of preoperative radiotherapy in the patients with primary retroperitoneal soft tissue sarcoma difficult to resect or unresectable and recognize the results of ...radiotherapy associated with resection and the effect of treatment on prognosis. Methods: It was analyzed retrospectively with 44 cases of primary retroperitoneal soft tissue sarcoma difficult to resect or unresectable in Department of Radiation Oncology, Zhongshan Hospital from May 2017 to February 2022. Intensity modulated radiation therapy (IMRT) and helical tomotherapy (TOMO) were used to treat the patients, and the effects of conversion to resection treatment for patients with the prognosis and complications were analyzed. Results: A total of 44 cases received radiotherapy including 30 cases with IMRT and 14 cases with TOMO. The adverse events of radiotherapy were grade 1 to 2. After preoperative radiotherapy, 12 cases achieved partial response, 26 cases remained in stable condition and 6 cases progressed. There
Definitive radiotherapy has become a more common treatment for cervical esophageal squamous cell carcinoma (CESCC), but data about long-term clinical outcomes is still relatively sparse. The purpose ...of this study was to describe long-term clinical outcomes after definitive radiotherapy for CESCC, and identify the prognostic factors influencing these outcomes.
We retrospectively analyzed all patients who received definitive radiotherapy for CESCC at our institution between 2006 and 2014. The overall survival (OS) rate, locoregional failure-free survival (LRFFS) rate, and toxicities were retrospectively evaluated during long-term follow-up. Univariate and multivariate analyses were performed to identify prognostic factors.
A total of 120 patients were included for analysis. The median prescribed radiation dose for the gross tumor and metastatic lymph nodes was 60 Gy. Elective nodal irradiation (ENI) was performed on 99 patients (83%); 90 patients (75%) received concurrent chemotherapy. The OS rates were 22.7% at 5 years and 14.9% at 8 years. The LRFFS rates at 3, 5, and 8 years were 27.5%, 21.7%, and 15.0%, respectively. The univariate analysis suggested that N classification and non-regional lymph node metastasis (M1Lym) status were independent risk factors for overall survival (P<0.01). A dose of more than 60 Gy didn't have a statistically significant influence in the multivariate analysis, although a total dose of more than 60 Gy was associated with improved survival in the univariate analysis. Concurrent chemotherapy was not associated with OS or LRFFS time in the univariate or multivariate analysis. A total of 74 patients (61.7%) experienced locoregional treatment failure. The most commonly documented acute toxicities were grade 1 and grade 2 toxicities in 61 patients (50.8%). There were 2 patients diagnosed with hypothyroidism as a late toxicity event.
Definitive radiotherapy is a reasonable curative treatment option with laryngopharyngeal preservation for CESCC patients. Radical treatments for lymph node metastases may improve the OS and LRFFS times. Monitoring for thyroid function may be warranted during long-term follow-up.
Breast cancer remains a great threat to females worldwide. As a recently defined programmed cell death pathway that associates with immune activation, RIP1/RIP3/MLKL necroptosis signaling has been ...implicated in a variety of diseases. The present study aimed to investigate the role of RIP1/RIP3/MLKL signaling in breast cancer cell proliferation and metastasis in vivo and in vitro.
Western blot and quantitative real-time PCR were performed to evaluate the activation of necroptosis signaling in clinical human breast cancer tissues. Correlation of necroptosis signaling markers with clinicopathological parameters was statistically assessed. Cell viability assay, colony formation assay, wound healing assay, and transwell migration and invasion assays were performed to investigate the effects of necroptosis inhibition on breast cancer cell proliferation and metastasis.
Clinical breast cancer tissues showed significantly higher levels of tumor necrosis factor alpha (TNFα), RIP1, RIP3 and MLKL at both mRNA and protein levels as compared with their paired non-cancerous tissues. Phosphorylation of RIP3 and MLKL was also remarkably provoked. Statistics showed that both RIP1 and MLKL positively correlated with cancer parameters such as N-cadherin (
=0.002 for RIP1 and
=0.021 for MLKL) and Ki67 (
=0.031 for RIP1 and
=0.05 for MLKL). The MLKL expression level significantly correlated with tumor size (
=0.001) and the proliferation indicator Ki67 (
=0.018). In addition, pharmacological inhibition of the necroptosis signaling using necrostatin-1 promoted breast cancer cell proliferation and colony formation by approximately 50%. Blockade of necroptosis signaling also accelerated wound healing process and cell transmigration in breast cancer cells.
Our results suggested that pharmacological inhibition of necroptosis promoted breast cancer cell proliferation and metastasis. Modulation of tumor cell necroptosis might represent a novel strategy as to breast cancer treatment.
External beam radiotherapy (EBRT) has been reported to be effective in palliating painful bone metastases, but the optimal fractions and doses for treating bone metastases from hepatocelluar ...carcinoma (HCC) are not established. This study aimed to compare toxicity and efficacy for conventional fraction versus hypofraction schedules. From January 2009 through December 2014, 183 patients with HCC bone metastases were randomly assigned to conventional fraction EBRT (Group A) or hypofraction radiotherapy (Group B). Study outcomes were pain relief, response rate and duration, overall survival, and toxicity incidence. Median follow-up time was 9.3 months. Response times were 6.7 ± 3.3 fractions in Group A and 4.1 ± 1.2 fractions in Group B (p <0.001). Pain relief rates were 96.7% and 91.2% in Group A and B, respectively (p=0.116). Time to treatment failure for Group A was significantly longer than Group B (p=0.025). Median overall survival was similar between two groups (p=0.628). Toxicity incidence in both groups was minimal, with no significant differences observed. In conclusion, hypofractionated radiotherapy is safe for patients with HCC bone metastases and may achieve earlier pain relief compared to conventional radiotherapy. This protocol should be considered for patients with shorter predicted survival times.
Identification and quantification of sesame oil products are crucial due to the existing problems of adulteration with lower-priced oils and false labeling of sesame proportions. In this study, 1D ...CNN models were established to achieve discrimination of oil types and multiple quantification of adulteration using portable Raman spectrometer. An improved data augmentation method involving discarding transformations that alter peak positions was proposed, and synchronously injecting noise during geometric transformations. Furthermore, a novel neural network structure was introduced incorporating vector regression to accurately predict each component simultaneously. The proposed method has achieved higher accuracy in detecting multi-component adulteration compared with chemometrics (100 % accuracy in classifying different oils; R2 over 0.99 and RMSE within 2 % in predicting unknown adulterated samples). Finally, commercially available sesame oil products were tested and compared with gas chromatography and colorimetric methods, demonstrating the effectiveness of our proposed model in achieving higher detection accuracy at low-concentration adulteration.
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