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Chen L.,Nanjing Southeast University | Ni C.-F.,Soochow University of China | Chen S.-X.,Cancer Institution of Jiangsu Province | Cao J.-M.,Nanjing University | And 8 more authors.
Journal of Vascular and Interventional Radiology | Year: 2016

Purpose: To develop a modified assessment for retreatment with transarterial chemoembolization (mART) score that may be more suitable for Chinese patients with hepatocellular carcinoma (HCC). Materials and Methods: Chinese patients with HCC who were treated with transarterial chemoembolization in four hospitals were included. A univariate analysis and a multivariate forward Cox regression analysis were used to identify significant prognostic factors of overall survival (OS). A point scoring model was subsequently developed from the training cohort, and the validation process was performed in the validation cohort. Results: The study included 259 patients (124 patients in the training cohort and 135 patients in the validation cohort). Increase in Child-Pugh scores relative to the baseline (P < .001), Barcelona Clinic Liver Cancer (BCLC) stage B before first transarterial chemoembolization (P = .001), and absence of radiologic tumor response (P < .001) were identified as negative prognostic factors for OS and were used to create the mART scores. BCLC staging was substituted for aspartate aminotransferase increase in the mART scores. The mART scores differentiated two groups with distinct prognosis by a cutoff score of 2.5 points (22.9 mo [95% confidence interval (CI), 17.4-28.4] vs 8.9 mo [95% CI, 7.5-10.3] in median survival; P < .001). In the validation cohort, the C index in assessment for retreatment with transarterial chemoembolization (ART) criteria was 0.64, whereas it was 0.82 in mART criteria. Conclusions: In Chinese patients with HCC, mART score of > 2.5 before second transarterial chemoembolization was associated with poor prognosis. The mART score was probably better validated compared with the ART score. © 2016 SIR.

Pan X.,Cancer Institution of Jiangsu Province | Wang R.,Nanjing University | Wang Z.-X.,Nanjing Medical University
Molecular Cancer Therapeutics | Year: 2013

MicroRNAs (miRNA) are small noncoding RNAs that converge to maintain an intrinsic balance of various processes, including cell proliferation, differentiation, and apoptosis. Recent research efforts have been devoted to translating these basic discoveries into applications that could improve the early diagnosis and therapeutic outcome of patients with cancer. Early studies have shown that miRNA-451 (miR-451) is widely dysregulated in human cancers and plays a critical role in tumorigenesis and tumor progression. In this review, we summarize the potential use of miR-451 for cancer diagnosis, prognosis, and treatment. In addition, we discuss the possible mechanisms of miR-451 dysregulation and future challenges in development of miR-451 as a noninvasive biomarker and a potential therapeutic target in human cancers. ©2013 AACR.

Hu Z.,Nanjing University | Hu Z.,Cancer Institution of Jiangsu Province | Yin R.,Cancer Institution of Jiangsu Province | Fan X.,University of Alberta | And 7 more authors.
Diseases of the Esophagus | Year: 2011

Esophageal anastomotic leak remains a lethal complication after esophagectomy for cancer. The aim of the present study is to describe an effective new management, nose fistula tube drainage (NFTD), to treat postoperative intrathoracic leaks. From July 2003 to August 2009, 41 of 4132 patients (0.99%) requiring transthoracic esophagectomy for esophageal and cardiac carcinoma had developed an intrathoracic esophageal anastomotic leak in our hospital as well as another three patients with similar conditions from other hospitals, excluding three patients with gastric necrosis (two) and tracheo-esophageal fistula (one); 23 patients were treated by NFTD, and the remaining 18 patients were treated by conventional chest tube drainage (CCTD). Clinical records of these patients were reviewed and analyzed, including the healing of the leak, mortality, and morbidity. In the NFTD group, 4 patients (17.4%) died, 1 patient (4.3%) required reoperation, and 18 patients (78.3%) healed. However, in the CCTD group, 3 patients (16.7%) died, 1 patient (5.5%) required reoperation, and 14 patients (77.8%) healed. As compared with the CCTD group, patients of the NFTD group had a shorter intensive care course (11.95 vs 33.62days, P= 0.01) and hospital stay (39.74 vs 77.54days, P= 0.02). Although this novel NFTD management did not significantly decrease mortality when compared with CCTD, it could gain more effective drainage than CCTD and eventually shorten hospital stay. © 2010 Copyright the Authors. Journal compilation © 2010, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

Yin R.,Cancer Institution of Jiangsu Province | Xu L.,Cancer Institution of Jiangsu Province | Ren B.,Cancer Institution of Jiangsu Province | Jiang F.,Cancer Institution of Jiangsu Province | And 4 more authors.
Clinical Lung Cancer | Year: 2010

Background: In patients with central lung cancer, lobectomy can be achieved without pneumonectomy by surgical reconstruction of the pulmonary artery (PA). Herein, we report our clinical experience of 34 patients who had lobectomy with PA reconstruction, including perioperative administration, morbidity, mortality, and long-term survival. Patients and Methods: The clinical records of 34 patients who received lobectomy with PA reconstruction in our department between August 2003 and September 2005 were reviewed. Results: In our series, PA reconstruction with endto- end anastomosis was performed in 18 patients (52.9%). Seven patients (20.6%) required partial PA reconstruction with autologous pericardium patch. Five patients (14.7%) with a lower lobe tumor required PA reconstruction with artery flap. The perioperative mortality was 2.9%, and 1 patient died on postoperative day 13 because of severe bronchopleural fistula. Another 2 patients had acute respiratory distress syndrome (ARDS) and required reintubation in our Intensive Care Unit. The overall Kaplan-Meier 3-year and 5-year survival rates were 46% and 37%, respectively. As compared with the stage III patients, stage I patients had significantly greater 5-year survival (80% vs. 11%; P = .005). Patients with pN0 disease also had greater 5-year survival than patients with pN2-3 disease (71% vs. 9%; P = .004). Conclusion: In our department, PA reconstruction has been more frequently and actively performed for patients with central lung cancer, especially for some patients with a lower lobe tumor. Although the morbidity and mortality is acceptable, surgeons should be more attentive to lethal postoperative complications such as ARDS induced by lung ischemia-reperfusion injury.

Jiang F.,Cancer Institution of Jiangsu Province | Huang J.,Cancer Institution of Jiangsu Province | You Q.,Peoples Hospital of Jiangsu Province | Yuan F.,Cancer Institution of Jiangsu Province | And 2 more authors.
Thoracic Cancer | Year: 2013

Background: Bronchopleural fistula is an especially severe complication with a high mortality rate. We investigated the efficiency of our surgical treatments for this severe complication. Methods: From January 2007 to December 2009, standard surgical resections and systematic lymph node dissections for non-small cell lung cancer (NSCLC) were performed on 1178 patients at our institution. Eight patients developed bronchopleural fistulas during the postoperative follow-up period, and received reoperations. Seven patients underwent additional pneumonectomies, and the omental flap, which was mobilized using a transdiaphragmatic harvesting technique through the usual thoracotomy, was used to cover postpneumonectomy bronchial stump. The other patient, who had received right side pneumonectomy and systemic lymph node dissection, received omental flap stuffing and covering without reclosure of the stump or carinal plasty. Results: Bronchopleural fistulas after standard surgical resections and systematic lymph node dissections for NSCLC were observed in eight patients (0.68%) in our study. The period between pulmonary resection and the appearance of bronchopleural fistula ranged from eight to 19 days (median 11 days). Repairing of the bronchial fistula was successful in all eight patients and no development of late fistula was found during the follow-up period. Postoperative hospital stay for undergoing omentoplasty to repair the bronchial fistula ranged between 11 and 23 days (median 15 days). There were no complications related to the omentoplasty procedure. Conclusion: Transdiaphragmatic harvesting technique of omental flap through a thoracotomy is safe and technically feasible. Surgical treatment for postoperative bronchopleural fistula with omental flap covering is effective. © 2012 Tianjin Lung Cancer Institute and Wiley Publishing Asia Pty Ltd.

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