目的:探究结直肠间质瘤预后相关因素,并通过列线图预测该肿瘤生存概率,为指导临床评估预后提供依据。方法:通过监测流行病学和最终结果(surveillance,epidemiology,and end results,SEER)数据库获取1992年1月至2015年12月结直肠间质瘤临床病理及预后相关资料,对入组患者进行生存分析,将分析得到的独立预后因素绘制成列线图,之后采用校准曲线评估列线图预测生存准确性。结果:546例结直肠间质瘤患者被纳入研究。中位发病年龄64岁,区域淋巴结转移率9.4%。546例患者多因素生存分析显示发病年龄>64岁、未婚/离婚、结肠间质瘤(与直肠间质瘤相比)、非手术治疗、组织分化级别高、区域淋巴结转移及远处转移具有更差的肿瘤特异性生存和总生存(P均<0.05),美国东部地区诊治患者比西部地区患者具有更长的总生存时间(P=0.027),以上独立预后因素预测肿瘤特异性生存率和总生存率的C指数分别为0.76(95%CI:0.72-0.80)和0.75(95%CI:0.72-0.78)。在174例组织分化级别和肿瘤部位明确的患者中,影响肿瘤特异性生存和总生存的独立预后因素为年龄、组织分化级别和是否行手术治疗(P均<0.05),而肿瘤部位仅与肿瘤特异性生存显著相关(P=0.041),未证实与总生存显著相关(P=0.057),采用这4个预后影响因素预测546例患者肿瘤特异性生存率和总生存率的C指数分别是0.71(95%CI:0.66-0.75)和0.73(95%CI:0.70-0.77),能较准确预测结直肠间质瘤患者总生存率。结论:结直肠间质瘤预后受多个临床病理因素影响,列线图能为预测结直肠间质瘤患者生存率提供依据。
Relapse and metastasis are frequent in colon cancer and may be linked to stem cell characteristics.This study isolated side population（SP） cells from a colon cancer cell line（Colo-320） and examined their self-renewal and differentiation abilities.Compared to non-SP（NSP） cells,SP colon cancer cells were more tumorigenic in vivo and exhibited more invasive characteristics and a greater ability to form colonies.Additionally,more cells were in G0/G1 phase and more highly expressed the multidrug resistance protein BCRP/ABCG2.We achieved enhanced chemotherapy sensitivity by transfecting SP cells with a hairpin-like,small interfering RNA（si RNA） eukaryotic expression plasmid targeting BCRP/ABCG2.
Summary： Integrated resection of the pancreatic head is the most difficult step in radical pancreati- coduodenectomy （RPD） in patients with the portal vein （PV） and superior mesenteric vein （SMV） inva- sion or oppression by the tumor. This study introduced a new idea and skill named the ＂total arterial devascularization first＂ （TADF） technique and its applications in RPD. Three arterial blood supplies of pancreatic head were obstructed before dissection of veins. The critical steps included exposure of the anterior surface of the abdominal aorta （AA） by completely transecting neural and connective tissue between superior mesenteric artery （SMA） and pancreatic mesounsinate, and transection of the mesounsinate from the origin of SMA to the root of the celiac trunk. From January 2012 through May 2013, a total of 58 patients with PV/SMV invasion or oppression underwent RPD using this technique. The median operative time was 5.1 h （ranging 4.5-8.1 h）. The median intraoperative blood loss was 450 mL （ranging 200-900 mL）. No intraoperative and postoperative bleeding of pancreatic head region oc- curred. Among the 58 patients, 21 were subjected to vessel lateral wall angiectomy or angiorrhaphy, and 10 to angiectomy and end-to-end anastomosis. The incidence of postoperative bleeding, postoperative pancreatic fistula and biliary fistula was 5.2%, 6.8%, and 1.7%, respectively. No patients died 3 months after operation. The TADF technique is a new method for intricate RPD and could improve the security of surgery and reduce intraoperative bleeding, which is expected to become standardized surgical ap- proach for RPD.
