Background:Gastric cancer (GC) represents a considerable health risk, characterized by a poor 5-year survival rate of approximately 8%. Using data from The Cancer Genome Atlas (TCGA), this study investigated the function of calcium signaling-related genes in the context of GC. Methods:The RNA sequencing data and clinical characteristic data of GC patients were retrieved from TCGA database. A comprehensive analysis was conducted to identify the prognostic genes, and a significant correlation was found between these genes and the calcium signaling pathways related to GC. Results:The univariate Cox regression analysis identified 829 prognostic genes, primarily related to the calcium signaling pathway, focal adhesion, extracellular matrix (ECM)-receptor interaction, and cancer-associated pathways, all of which may significantly affect GC. Through consensus clustering, two distinct molecular subtypes of GC were identified [Cluster 1 (C1) and Cluster 2 (C2)] based on the genes associated with calcium signaling. Notably, C2 may serve as a prognostic indicator of risk, potentially reflecting the progression of clinical symptoms. The Gene Ontology (GO) analysis of biological processes revealed that these genes were significantly involved in cell-matrix adhesion, calcium ion homeostasis, and cell-substrate adhesion in the high-risk C1 cohort. Similarly, the Kyoto Encyclopedia of Genes and Genomes analysis indicated that the differentially expressed genes were largely associated with the pathways related to ECM-receptor interactions, focal adhesion, vascular smooth muscle contraction, cancer-related proteoglycans, and calcium signaling pathways in the high-risk C1 group. Further, there were significant differences in the immune activity of the two calcium signaling-related GC groups. The least absolute shrinkage and selection operator regression analysis identified 10 genes associated with calcium signaling in GC (i.e., PDE1B, NGF, FGF1, ADRA1B, TACR1, CXCR4, GNAS, EDNRB, EGF, and ERBB4). The accuracy of the prognostic model was assessed by a receiver operating characteristic curve analysis, yielding areas under the curve of 0.639 for 1 year, 0.707 for three years, and 0.674 for 5 years. Conclusions:We established an innovative signature associated with calcium signaling that serves as a reliable prognostic indicator for GC. Our findings may pave the way for enhanced diagnostic and therapeutic approaches in the context of GC.

BACKGROUND:Radical lymphadenectomy is essential for the long-term outcomes of colorectal cancer (CRC). However, the exact distribution and drainage patterns of central lymph nodes in left-sided colon cancer and rectal cancer remain unclear. This study aimed to map apical lymph node distribution using intraoperative Indocyanine green (ICG) fluorescence imaging and to evaluate the superiority of fluorescence-guided lymph node dissection in CRC surgery. METHODS:We conducted a prospective, propensity score-matched comparative study involving patients who underwent laparoscopic surgery for left-sided colon cancer and rectal cancer. The patients were assigned to either ICG fluorescence-guided or conventional laparoscopic surgery. Lymph node yield, short-term perioperative outcomes, and long-term survival were compared between groups. The central lymph node distribution patterns in the ICG group were analyzed. RESULTS:After propensity score matching, a total of 180 patients were enrolled, with 60 and 120 patients in the ICG and control groups, respectively. The ICG group had a significantly higher median number of retrieved lymph nodes [20.8 (7.9) vs 16.3 (7.1), P < 0.001] and a significantly lower postoperative complication rate (11.7% vs 17.5%, P = 0.01). Importantly, ICG-guided surgery was associated with a reduced risk of inadequate lymph nodes retrieval and was identified as an independent prognostic factor of overall survival (hazard ratio = 2.544, 95% CI: 1.088-5.948, P = 0.031). ICG imaging revealed that central lymphatic drainage patterns were highly personalized. Over 95% of apical lymph nodes located within 2.2 cm on the left side of the IMA, 1.3 cm on the right side and 0.9 cm from the root of the IMA, and additional atypical drainage pathways - including to the iliac region - were observed in select cases. CONCLUSIONS:ICG fluorescence-guided surgery improves the accuracy and extent of lymph node dissection in left-sided colon cancer and rectal cancer, reduces the risk of inadequate retrieval, and is independently associated with improved long-term survival. These findings support the integration of ICG-guided lymphadenectomy as a promising procedure for CRC.

803 Background: Ripretinib is a switch-control tyrosine kinase inhibitor approved for the fourth-line therapy for GIST. In the INTRIGUE study (NCT03673501), ripretinib as second-line (2L) treatment demonstrated similar progression-free survival (PFS) and fewer Grade 3/4 treatment-emergent adverse events (TEAEs) compared to sunitinib in the overall population. It showed a numerically longer PFS and a nominally higher objective response rate (ORR) than sunitinib in patients (pts) with KIT exon 11 mutations. This study aims to evaluate the efficacy and safety of ripretinib vs sunitinib as 2L treatment in GIST pts in China. Methods: This multicenter, randomized, open-label phase 2 study (NCT04633122) enrolled adults with GIST who progressed on or had intolerance to imatinib. Pts were randomized 1:1 to ripretinib 150 mg once daily (QD) or sunitinib 50 mg QD (4 weeks on/2 weeks off) in 42-day cycles. Randomization was stratified by KIT mutational status. The primary endpoint was PFS by independent radiologic review (IRR) using modified RECIST version 1.1. Secondary endpoints included ORR by IRR, overall survival (OS) and safety. Efficacy analysis was performed in all-patients intent-to-treat (AP ITT) and KIT exon 11 mutation intent-to-treat (Ex11 ITT) populations. This study was designed to bridge the global trial (INTRIGUE) to show consistency in the efficacy of ripretinib between the two studies. No statistical testing was pre-specified and nominal p-values were presented for descriptive purpose. Results: Overall, 108 pts were randomized to ripretinib (AP ITT n= 54; Ex11 ITT n=35) or sunitinib (AP ITT n= 54; Ex11 ITT n=35). Median age was 59.0 years (range 25–82); 63.9% of pts were male and 57.4% had ECOG PS≥1. By primary data cut-off (20 Jul 2022), PFS by IRR was similar between ripretinib and sunitinib in AP ITT population (HR 0.99, 95% CI 0.57, 1.69; p=0.92; median PFS [mPFS] 10.3 vs 8.3 months). ORR by IRR was numerically higher for ripretinib than sunitinib (29.6% vs 20.4%). Median OS was not reached in either arm. In Ex11 ITT population, a longer PFS by IRR (HR 0.46, 95% CI 0.23, 0.92; p=0.03; mPFS not reached for ripretinib and 4.9 months for sunitinib) and a numerically higher ORR by IRR (37.1% vs 22.9%) were observed for ripretinib vs sunitinib. Fewer Grade 3/4 treatment-related TEAEs were reported with ripretinib than with sunitinib (16.7% vs 55.6%), as were treatment-related TEAEs leading to dose interruption (7.4% vs 42.6%), dose reduction (20.4% vs 29.6%) and treatment discontinuation (1.9% vs 7.4%). Conclusions: Similar to the INTRIGUE trial, ripretinib demonstrated comparable overall efficacy and favorable safety vs sunitinib as 2L therapy in Chinese pts with advanced GIST. 2L GIST pts harboring a KIT exon 11 mutation may benefit from ripretinib vs sunitinib. Clinical trial information: NCT04633122 .

Background . Emerging evidence has shown that two common genetic polymorphisms within the pleckstrin domain-containing protein 5 (DEPDC5), rs1012068 and rs5998152, may be associated with the risk of hepatocellular carcinoma (HCC), especially in those individuals chronically infected with the hepatitis C virus (HCV) or the hepatitis B virus (HBV). However, these findings have not been consistently replicated in the literature due to limited sample sizes or different etiologies of HCC. Thus, the present systematic review and meta-analysis were performed to resolve this inconsistency. Methods . The databases PubMed, Embase, Web of Science, the China National Knowledge Infrastructure, and Scopus were searched up to December 12, 2022. Data from relevant studies were pooled, and odds ratios and 95% confidence intervals were calculated. Results . A total of 11 case-control studies encompassing 2,609 cases and 8,171 controls on rs1012068 and three encompassing 411 cases and 1,448 controls on rs5998152 were included. Results indicated that the DEPDC5 rs1012068 polymorphism did not significantly increase HCC risk in the total population (allelic model (OR = 1.32, 95% CI = 1.04–1.67, P  = 0.02); the recessive model (OR = 1.42, 95% CI = 0.96–2.10, P  = 0.08); the dominant model (OR = 1.43, 95% CI = 1.09–1.87, P  = 0.01); the homozygous model (OR = 1.61, 95% CI = 1.01–2.57, P  = 0.05); the heterozygous model (OR = 1.39, 95% CI = 1.09–1.79, P  = 0.009)). Subgroup analyses based on ethnicity and etiology revealed that the rs1012068 polymorphism, under all five genetic models, was associated with increased HCC risk in Asians or in individuals with chronic HBV infection but not in individuals with chronic HCV infection. A significant association was also observed between rs5998152 and HCV-related HCC risk in Asians chronically infected with HCV under allelic, dominant, and heterozygous models. Conclusion . Our study suggests that the DEPDC5 rs1012068 polymorphism increases HCC risk, especially in Asians with chronic HBV infection, while the rs5998152 polymorphism increases HCC risk in Asians with chronic HCV infection.

BACKGROUND Irreversible electroporation (IRE) is a local non-thermal ablative technique which has been suggested as a potential cancer therapy. However, the specific anatomic characteristics of the pancreatic head make it challenging to perform any local ablation in this region. Therefore, the safety and feasibility of IRE in the pancreatic head region should be further explored. AIM To evaluate the safety of IRE in pancreatic head region including its effects on pancreatic ducts, vessels, and adjacent gastrointestinal organs. METHODS Eight landrace miniature pigs underwent IRE of pancreatic head tissue successfully, with a total of 16 lesions created. Laboratory testing including white blood cell (WBC) count and serum amylase before IRE with follow-up laboratory analysis and pathological examination at 1, 7, 14, and 28 d postablation were performed. RESULTS All pigs tolerated the ablation procedure without serious perioperative complications. Transiently elevated WBC count and amylase were observed at 24 h post-IRE, suggesting an acute pancreatic tissue damage which was confirmed by pathological observations. Vascular endothelial cells and pancreatic duct epithelial cells in ablation zone were also positive in terminal deoxynucleotidyl transferase dUTP nick end labeling staining. There was extensive duodenum mucosa damage with local hemorrhage 24 h after ablation, while regeneration of new villous structures were observed at 7 and 28 d post-IRE. Masson’s trichromatic staining showed that the extracellular matrix was still intact in vessels and pancreatic ducts, and even in the duodenum. CONCLUSION IRE ablation to the pancreatic head may be safe and feasible without long-term damage to the surrounding vital structures. However, risks of stress injuries in acute phase should be taken into consideration to prevent severe perioperative complications.

Objective:To investigate clinicopathological characteristics and efficacy of conversion therapy in patients with metastatic gastric cancer.Methods:The clinicopathological and follow-up data of metastatic gastric cancer patients at the Department of Gastrointestinal Surgery of Peking University People's Hospital from Jan 2018 to Jun 2021 were retrospectively studied. Multivariate Logistic regression analysis was used to identify independent characteristics for pathological complete response (PCR). The influence of stage of metastatic gastric cancer and pathological response on prognosis were analyzed by Kaplan-Meier curve.Results:A total of 31 patients were enrolled, and 13 tumors located at the cardia or fundus, 8 at body, other 10 at pylorus or antrum . Baseline CT evaluation showed retroperitoneal lymph node metastasis in 10 cases, intraperitoneal metastasis in 10 cases, liver metastasis in 2 cases, adrenal and splenic metastasis in 1 case respectively, and multiple metastasis in 5 cases. After conversion therapy, 8 (26%) cases had pathological T0, 16 cases (52%) had pathological N0 and 7 cases (22%) had pathological complete response. Multivariate Logistic regression analysis showed retroperitoneal lymph node metastasis ( OR: 20.082, 95% CI: 2.141-188.315, P=0.009) was the only independent risk factor of PCR. Meanwhile, Kaplan-Meier curve showed pT0 improved disease-free survival significantly ( P=0.021). Conclusions:Metastatic gastric cancer patients with retroperitoneal lymph node metastasis alone had a tolerable conversion therapy effect. pT0 is a significant factor in improving prognosis.

Objective:To explore the effect of tumor deposit (TD) on the prognosis of patients with stage Ⅲ colon cancer after radical resection.Methods:The clinicopathological data of patients with stage Ⅲ colon cancer after radical surgery at the Department of Gastrointestinal Surgery, Peking University People's Hospital from Jan to Dec 2015 were analyzed collected. Clinicopathological characteristics such as tumor location, degree of differentiation, mismatch repair status, lymphatic and venous invasion, and preoperative CEA and CA19-9 levels were used to study the effect of TD on the postoperative survival of patients.Results:Among the 155 patients with stage Ⅲ colon cancer, 37 (23.9%) had tumor deposits. The incidence of tumor deposits was higher in patients with intravascular tumor thrombus and preoperative serum CA19-9 elevation ( χ2=9.567, P=0.002; χ2=11.561, P=0.003); Patients with tumor deposits had worse overall survival and disease-free survival than those without cancer nodules (OS: P=0.029, DFS: P=0.025). Multivariate COX analysis found that tumor deposit was an independent risk factor for postoperative overall survival and disease-free survival ( HR=1.990, 95% CI: 1.032-3.835, P=0.040; HR=2.416, 95% CI : 1.205-3.820, P=0.009). Conclusions:Tumor deposit is an independent risk factor affecting postoperative overall survival and disease-free survival in patients with stage Ⅲ colon cancer. For patients with lymph node metastasis, incorporating TD into TNM staging can more accurately predict the postoperative prognosis.

The conventional microwell-based platform for construction of organoid models exhibits limitations in precision oncology applications because of low-speed growth and high variability. Here, we established organoid models on a nested array chip for fast and reproducible drug testing using 50% matrigel. First, we constructed mouse small intestinal and colonic organoid models. Compared with the conventional microwell-based platform, the mouse organoids on the chip showed accelerated growth and improved reproducibility due to the nested design of the chip. The design of the chip provides miniaturized and uniform shaping of the matrigel that allows the organoid to grow in a concentrated and controlled manner. Next, a patient-derived organoid (PDO) model from colorectal cancer tissues was successfully generated and characterized on the chip. Finally, the PDO models on the chip, from three patients, were implemented for high-throughput drug screening using nine treatment regimens. The drug sensitivity testing on the PDO models showed good quality control with a coefficient of variation under 10% and a Z' factor of more than 0.7. More importantly, the drug responses on the chip recapitulate the heterogeneous response of individual patients, as well as showing a potential correlation with clinical outcomes. Therefore, the organoid model coupled with the nested array chip platform provides a fast and reproducible means for predicting drug responses to accelerate precise oncology.

BACKGROUND:Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer in humans after hepatocellular carcinoma and a rare epithelial malignancy that results in a poor prognosis. According to the Liver Cancer Study Group of Japan classification, ICC can be divided into three types: Mass-forming (MF) type, periductal-infiltrating (PI) type, and intraductal-growth type. The MF type is the most common, accounting for 57.1-83.6% of ICCs. Nevertheless, little is known about the epidemiology and treatment of MF ICC.AIM:To examine the prognostic factors for patients with MF ICC.METHODS:We carried out a retrospective analysis of consecutive patients with MF ICC treated at the Faculty of Hepato-Pancreato-Biliary Surgery of Chinese PLA General Hospital between January 2008 and December 2018. According to the treatment received, the patients were divided into either a resection group or an exploration group.RESULTS:The pooled 1-, 3-, and 5-year survival rates in the 68 patients with MF ICC were 66.5%, 36.3%, and 9.3%, respectively. Univariate analysis revealed that surgical resection (P < 0.001), nodal metastasis (P < 0.001), tumor location (P = 0.039), vascular invasion (P < 0.001), ascites (P < 0.001), and differentiation (P = 0.009) were significantly associated with the prognosis and survival of MF ICC. Multivariate analysis revealed that ascites (hazard ratio [HR] = 5.6, 95% confidence interval [CI]: 1.6-18.9, P = 0.006) and vascular invasion (HR = 2.5, 95%CI: 1.0-6.1, P = 0.045) were independent risk factors for MF ICC. The pooled 1-, 3-, and 5-year survival rates in the 19 patients of the exploration group were 5.3%, 5.3%, and 0, respectively. Among the 49 patients who underwent surgical resection, the pooled 1-, 3-, and 5-year survival rates were 93.5%, 49.7%, and 14.4%, respectively. Univariate and multivariate analyses revealed that vascular invasion (HR = 3.1, 95%CI: 1.2-8.5, P = 0.024) and nodal metastasis (HR = 3.2, 95%CI: 1.4-7.6, P = 0.008) were independent prognostic risk factors for surgical resection patients.CONCLUSION:The prognosis of MF ICC patients is dismal, especially those with ascites or vascular invasion. Surgical resection is a key factor in improving overall survival in patients with MF ICC, and vascular invasion and lymph node metastasis affect the efficacy of surgical resection.

Objective:To evaluate the surgical efficacy and to explore the prognostic factors of gallbladder cancer.Methods:Clinical data of 162 patients with gallbladder cancer admitted to the First Medical Center of Chinese PLA General Hospital from January 2013 to January 2015 were retrospectively analyzed. Among them, 77 patients were male and 85 female, aged (61±11) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. 9 cases were classified as stage T1a, 10 cases of stage T1b, 28 cases of stage T2, 103 cases of stage T3 and 12 cases of stage T4, respectively. Intraoperative and postoperative conditions of all patients were observed. The factors affecting survival and prognosis were analyzed. Survival analysis was performed by Kaplan-Meier method and Log-rank test. The independent prognostic factors were identified by Cox proportional hazards regression model.Results:Simple cholecystectomy was performed in 9 cases with stage T1a. Among the 153 cases with stage T1b and above, radical resection was conducted in 81 cases, palliative surgery in 45 cases and abdominal exploration in 27 cases. 140 patients were followed up after surgery. The median survival time was 12(9-15) months. The 1-, 3- and 5-year cumulative survival rates were 51.4%, 25.0% and 22.1%, respectively. The 5-year survival rates of patients with stage T2b undergoing wedge resection and patients receiving segment Ⅳb+Ⅴresection were 44.4% and 100.0%, where significant difference was observed between two groups (χ2=9.00, P<0.05). The 5-year survival rate of patients with stage T3 after radical resection and more than 6 lymph nodes dissection was 33.3%, significantly higher than 4.5% in their counterparts with less than 6 lymph nodes dissection (χ2=4.17, P<0.05). Cox proportional hazards regression model analysis showed that TNM staging and R0 resection were the independent influencing factors for the survival of patients with stage T1b and above gallbladder cancer after radical resection (HR=1.08, 3.23; P<0.05).Conclusions:Segment Ⅳb+Ⅴresection can bring clinical benefits to patients with stage T2b gallbladder cancer. Local dissection of more than 6 lymph nodes can benefit patients with stage T3 gallbladder cancer. TNM staging and R0 resection are the independent prognostic factors of patients with stage T1b and above gallbladder cancer after radical resection.

BACKGROUND:In recent years, we created and employed a new anastomosis method, "bridging" pancreaticogastrostomy, to treat patients with extremely severe pancreatic injury. This surgery has advantages such as short length of surgery, low secondary trauma, rapid construction of shunts for pancreatic fluid, preventing second surgeries, and achieving good treatment outcomes in clinical practice. However, due to the limited number of clinical cases, there is a lack of strong evidence to support the feasibility and safety of this surgical procedure. Therefore, we carried out animal experiments to examine this procedure, which is reported here.AIM:To examine the feasibility and safety of a new rapid method of pancreaticogastrostomy, "bridging" pancreaticogastrostomy.METHODS:Ten Landrace pigs were randomized into the experimental and control groups, with five pigs in each group. "Bridging" pancreaticogastrostomy was performed in the experimental group, while routine mucosa-to-mucosa pancreaticogastrostomy was performed in the control group. After surgery, the general condition, amylase levels in drainage fluid on Days 1, 3, 5, and 7, fasting and 2-h postprandial blood glucose 6 mo after surgery, fasting, 2-h postprandial peripheral blood insulin, and portal vein blood insulin 6 mo after surgery were assessed. Resurgery was carried out at 1 and 6 mo after the former one to examine the condition of the abdominal cavity and firmness and tightness of the pancreaticogastric anastomosis and pancreas.RESULTS:After surgery, the general condition of the animals was good. One in the control group did not gain weight 6 mo after surgery, whereas significant weight gain was present in the others. There were significant differences on Days 1 and 3 after surgery between the two groups but no differences on Days 5 and 7. There were no differences in fasting and 2-h postprandial blood glucose and fasting and 2-h insulin values of postprandial peripheral blood and portal vein blood 6 mo after surgery between the two groups. One month after surgery, the sinus tract orifice/anastomosis was patent in the two groups. Six months after surgery, the sinus tract orifice/anastomosis was sealed, and pancreases in both groups presented with chronic pancreatitis.CONCLUSION:"Bridging" pancreaticogastrostomy is a feasible and safe a means of damage control surgery during the early stage of pancreatic injury.

Objective:To observe the clinical characteristics of esophageal reflux after total gastrectomy (ERATG), and to explore the mechanism of occurrence.Methods:Fourteen gastric cancer patients who underwent total gastrectomy were prospectively enrolled in this study. The postoperative symptoms were observed and recorded and 24 h MII-pH with pH monitoring was performed to investigate the characteristics of postoperative reflux.Results:After total gastrectomy patients were with different degrees of ERATG as heartburn, appetite loss, chest tightness and belching. The overall nature of ERATG is mainly weak acid, with a pH between 4 and 7. ERATG involved esophageal-jejunal anastomosis and a length of esophagus 7 cm above the anastomosis. Patients with typical reflux symptoms had a lower pH minimum in the upright position than those without typical symptoms[(4.76±0.71) vs.(5.68±0.37), t=2.866, P<0.05]. Patients with typical reflux symptoms had a higher frequency of reflux of mixed liquid and liquid-air reflux than those without typical symptoms[liquid(31.25±29.76) vs.(4.50±9.14), t=0.011, P<0.05; liquid-air(19.50±12.99) vs.(2.00±2.61), t=0.004, P<0.05]. Conclusion:ERATG is mainly a upward reflux of weakly acidic gas, with typical symptoms of heartburn, appetite loss, chest tightness and belching. Patients with typical symptoms usually have lower pH in the upright position.

: Hemophagocytic lymphohistiocytosis (HLH) comprises a group of severe immune function disorders that can lead to immune-mediated organ damage. There are two subtypes of HLH: primary and secondary. Secondary HLH is associated with infectious, oncologic, chemotherapeutic, and other underlying causes, and studies on HLH triggered by tumors have mainly focused on hematological malignancies. Secondary HLH in patients with solid tumors is rare. Here, we present two cases of gastric cancer complicated with HLH. The patient 1 was diagnosed as gastric cancer at stage I and got intractable fever after a distal subtotal gastrectomy without any evidence of infections or other complications. The patient 2 suffered from unresectable gastric adenocarcinoma and got fever, hemorrhagic rashes, and petechiae in mouth after six cycles of neoadjuvant chemotherapy. After detailed and comprehensive examinations, HLH was diagnosed in the two patients according to 2004 HLH diagnostic criteria, and the patients received treatment including immunosuppressive agents immediately. After therapy, the two patients showed partial remission, but both eventually died due to HLH relapse or progression of the primary tumor. The treatment regimen for HLH is intricate, and only a few relevant studies have focused on the treatment of cancer patients with HLH. The high mortality associated with this disease calls for more attention and additional research to improve the prognosis for these patients.

Abstract INTRODUCTION Gastrointestinal stromal tumor (GIST) is the most common gastrointestinal soft tissue tumor. Clinical diagnosis mainly relies on enhanced CT, endoscopy and endoscopic ultrasound (EUS), but the misdiagnosis rate is still high without fine needle aspiration biopsy. We aim to develop a novel diagnostic model by analyzing the preoperative data of the patients. METHODS We used the data of patients who were initially diagnosed as gastric GIST and underwent partial gastrectomy. The patients were randomly divided into training dataset and test dataset at a ratio of 3 to 1. After pre-experimental screening, max depth = 2, eta = 0.1, gamma = 0.5, and nrounds = 200 were defined as the best parameters, and in this way we developed the initial extreme gradient-boosting (XGBoost) model. Based on the importance of the features in the initial model, we improved the model by excluding the hematological features. In this way we obtained the final XGBoost model and underwent validation using the test dataset. RESULTS In the initial XGBoost model, we found that the hematological indicators (including inflammation and nutritional indicators) examined before the surgery had little effect on the outcome, so we subsequently excluded the hematological indicators. Similarly, we also screened the features from enhanced CT and ultrasound gastroscopy, and finally determined the 6 most important predictors for GIST diagnosis, including the ratio of long and short diameter under CT, the CT value of the tumor, the enhancement of the tumor in arterial period and venous period, existence of liquid area and calcific area inside the tumor under EUS. Round or round-like tumors with a CT value of around 30 (25–37) and delayed enhancement, as well as liquid but not calcific area inside the tumor best indicate the diagnosis of GIST. CONCLUSIONS We developed a model to further differential diagnose GIST from other tumors in initially clinical diagnosed gastric GIST patients by analyzing the results of clinical examinations that most patients should have completed before surgical resection.

Objective:To determine the diagnostic value of tumor markers in peritoneal lavage fluid from colorectal cancer patients for tumor peritoneal metastasis.Methods:A total of 227 colorectal cancer patients who undergoing surgical treatment were included. 300 ml of peritoneal lavage fluid was irrigated immediately upon laparotomy for traditional cytology (PLC) testing, 134 patients were tested for tumor marker of peritoneal lavage fluid (pTM). Univariate analysis was performed to determine the risk factors for peritoneal metastasis; pTM ROC curve was used to determine the best cutoff value; paired chi-square test was used to compare the difference between PLC and pTM detection.Results:The positive rate of PLC was 12.3% (28/227). Age>65, stage T3 + , lymph node metastasis, mucinous adenocarcinoma and increased serum CA125, CA19-9 are related to peritoneal metastasis; The best cutoff value of pTM for peritoneal metastasis : pCEA 17.095 ng/dl, sensitivity 58.3%, specificity 93.9%; pCA19-9 4.515 U/ml, sensitivity 83.3%, specificity 80.0%; pCA125 303.2 U/ml, sensitivity 58.3%, specificity 95.7%; pCA-724 3.01 U/ml, sensitivity 66.7%, specificity 95.7%; The best cutoff value of pTM for peritoneal micrometastasis: pCA19-9 3.43 U/ml, sensitivity 100%, specificity 72.2%. The positive rate of pCA19-9 was 29.85%, which was higher than that of PLC (χ 2=2.00, P<0.05). Conclusion:Peritoneal metastasis of colorectal cancer is related to tumor T stage, lymph node metastasis, tumor pathological type, and increased serum CA125 and CA19-9; pTM has diagnostic value for peritoneal metastasis of colorectal cancer.

Objective: To investigate the clinicopathological features and prognostic factors in patients with presacral recurrent rectal cancer (PRRC). Methods: PRRC was defined as recurrence of rectal cancer after radical surgery involving posteriorly the presacral soft tissue, the sacrum/coccyx, and/or sacral nerve root. The diagnosis is confirmed with clinical symptoms (pain of pelvis/back/lower limb, bloody stools, increased frequency of defecation, and abnormal secretions), physical examination of perineal or pelvic masses, radiological findings, colonoscopy with histopathological biopsy, and the evaluation by multi-disciplinary team (MDT). Inclusion criteria: (1) primary rectal cancer undergoing radical surgery without distant metastasis; (2) PRRC was diagnosed; (3) complete inpatient, outpatient and follow-up data. According to the above criteria, clinical data of 72 patients with PRRC in Peking University People's Hospital from January 2008 to December 2017 were retrospectively analyzed. The clinicopathological features and follow-up data were summarized. Cox proportional hazard models was used to analyze the prognostic factors of PRRC. Results: Among 72 patients, 45 were male and 27 were female with a male-to-female ratio of 1.7:1.0. The median age at recurrence was 58 (34 to 83) years and the median interval from surgery to recurrence was 2.0 (0.2 to 17.0) years. The main symptom was pain in 48.6% (35/72) of patients. In addition, gastrointestinal symptoms were found in 25.0% (18/72) of patients. The presacral recurrent sites were presacral fascia in 36 (50.0%) patients, lower sacrum (S3~S5 or coccyx) in 25 (34.7%) patients, and higher sacrum (S1~S2) in 11 (15.3%) patients. Forty-seven (65.3%) patients underwent radical surgery (abdominal resection, abdominoperineal resection, sacrectomy, abdominosacral resection), 12 (16.7%) underwent non-radical surgery (colostomy, cytoreductive surgery), and 13 (18.1%) did not undergo any surgery but only receive palliative chemoradiotherapy and nutritional support treatment. Thirty-three (45.8%) patients received radiotherapy and/or chemotherapy (oxaliplatin, 5-fluorouracil, capecitabine, irinotecan, etc.). All the patients received follow-up, and the median follow-up time was 19 (2 to 72) months. The median overall survival time was 14 (1 to 65) months. The 1- and 3-year overall survival rates were 67.1% and 32.0%, respectively. Univariate analysis showed that age at recurrence (P=0.031) and radical resection (P<0.001) were associated with prognosis. Multivariate analysis demonstrated that radical resection was independent factor of good prognosis (RR=0.140, 95%CI: 0.061-0.322, P<0.001). Conclusions: Patients tend to develop presacral recurrent rectal cancer within 2 years after primary surgery. The main symptom is pain. Patients undergoing radical resection have a relatively good prognosis.

Objective:To investigate the role of indocyanine green(ICG) fluorescence imaging in laparoscopic anterior resection for rectal cancer.Methods:A retrospective analysis was performed on 7 patients who had undergone laparoscopic anterior resection with the use of ICG fluorescence imaging at Peking University People′s Hospital between Oct 2018 and Mar 2019. The clinicopathological variables, surgical factors, short-term outcome and complications were analyzed.Results:The median operation time was 185 min. The median estimated blood loss was 50 ml. The median time from ICG injection to anastomotic perfusion was 45 s. One patient received extended proximal resection of bowel due to poor perfusion as suggested by ICG imaging. The median time to soft diet was 4 days, and the median hospital stay was 8 days. The median number of lymph nodes harvested was 16. There were no major complications in all these patients. No adverse events related to ICG were recorded.Conclusions:ICG fluorescence imaging was safe and effective in detecting insufficient blood supply around newly established bowel anastomsis, hence potentially reducing the anastomotic leakage rate.

Objective:To investigate the expression of CD157 and its significance in colorectal cancer.Methods:The expression of CD157 was detected in 50 cases of colorectal cancer tissues and corresponding adjacent normal colorectal tissues by immunohistochemistry. The correlation between the expression of CD157 and clinicopathological parameters and prognosis was analyzed statistically.Results:Higher expression of CD157 protein was observed in colorectal cancer than that in normal colorectal tissues (72% vs. 20%, χ 2=25.09, P<0.01). Moreover, High expression of CD157 was correlated with the tumor size (χ 2=7.368, P=0.007), TNM stage (χ 2=9.223, P=0.002), the depth of tumor infiltration (χ 2=4.158, P=0.041), distant metastasis (χ 2=5.521, P=0.019), vascular invasion (χ 2=6.307, P=0.012) and microsatellite instability (χ 2=4.778, P=0.029), but not with gender, age, histology type, location, differentiation grade, lymph node metastasis, nerve infiltration or Kras mutation (all P>0.05 respectively). Patients with low expression of CD157 had longer survival (45±4 )months than those with high expression (30±3)months (χ 2=5.234, P=0.022). Conclusions:High expression of CD157 in colorectal cancer tissue is related to poor survival of postoperative patients.