Publications by authors named "Xu Guan"

120 Publications

A novel risk stratification for predicting prognosis of colorectal cancer patients with bone metastasis.

J Gastrointest Oncol 2021 Jun;12(3):933-943

Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Background: Our understanding in prognosis of bone metastasis (BM) from colorectal cancer (CRC) is limited. We aimed to establish a clinical risk stratification for individually predicting the survival of CRC patients with BM.

Methods: A total of 200 CRC patients with BM were included in this study. Survival time from BM diagnosis was estimated using the Kaplan-Meier method. The multivariable COX regression model identified the risk factors on cancer specific survival (CSS). Based on weighted scoring system, the stratification model was constructed to classify patients with BM according to prognostic risk. Discrimination power and calibration ability of risk stratification were measured.

Results: The median CSS time was 11 months after BM diagnosis. Lymph node metastasis, Carbohydrate antigen 199 (CA199) levels, bone involvement, Karnofsky Performance Status (KPS) scores, primary tumor resection, bisphosphonates therapy and radiotherapy were identified as predictors of CSS. Four risk groups were stratified according to weighted scoring system, including low risk, medium risk, medium-high risk and high risk group, with 35, 16, 9 and 5 months of median CSS, respectively (P=0.000). The risk stratification displayed good accuracy in predicting CSS, with acceptable discrimination and calibration.

Conclusions: This novel risk stratification predicts CSS in CRC patient with BM using easily accessible clinicopathologic factors, which is recommended for use in individualized clinical decision making in patient with BM.
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http://dx.doi.org/10.21037/jgo-20-586DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8261323PMC
June 2021

Laparoscopic radical right hemicolectomy with transrectal-specimen extraction: a novel natural-orifice specimen-extraction procedure.

Gastroenterol Rep (Oxf) 2021 Apr 10;9(2):182-184. Epub 2020 Sep 10.

Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China.

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http://dx.doi.org/10.1093/gastro/goaa047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8128022PMC
April 2021

Upregulated insulin receptor tyrosine kinase substrate promotes the proliferation of colorectal cancer cells via the bFGF/AKT signaling pathway.

Gastroenterol Rep (Oxf) 2021 Apr 25;9(2):166-175. Epub 2020 Jul 25.

Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China.

Background: Some recent studies on insulin receptor tyrosine kinase substrate (IRTKS) have focused more on its functions in diseases. However, there is a lack of research on the role of IRTKS in carcinomas and its mechanism remains ambiguous. In this study, we aimed to clarify the role and mechanism of IRTKS in the carcinogenesis of colorectal cancer (CRC).

Methods: We analysed the expression of IRTKS in CRC tissues and normal tissues by researching public databases. Cancer tissues and adjacent tissues of 67 CRC patients who had undergone radical resection were collected from our center. Quantitative real-time polymerase chain reaction and immunohistochemistry were performed in 52 and 15 pairs of samples, respectively. and experiments were conducted to observe the effect of IRTKS on CRC cells. Gene Set Enrichment Analysis and Metascape platforms were used for functional annotation and enrichment analysis. We detected the protein kinase B (AKT) phosphorylation and cell viability of SW480 transfected with small interfering RNAs (siRNAs) with or without basic fibroblast growth factor (bFGF) through immunoblotting and proliferation assays.

Results: The expression of IRTKS in CRC tissues was higher than that in adjacent tissues and normal tissues (all <0.05). Disease-free survival of patients with high expression was shorter. Overexpression of IRTKS significantly increased the proliferation rate of CRC cells and the number of tumor xenografts . The phosphorylation level of AKT in CRC cells transfected with pLVX-IRTKS was higher than that in the control group. Furthermore, siRNA-IRTKS significantly decreased the proliferation rate of tumor cells and the phosphorylation level of AKT induced by bFGF.

Conclusion: IRTKS mediated the bFGF-induced cell proliferation through the phosphorylation of AKT in CRC cells, which may contribute to tumorigenicity .
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http://dx.doi.org/10.1093/gastro/goaa032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8128016PMC
April 2021

Detecting joint inflammation by an LED-based photoacoustic imaging system: a feasibility study (Erratum).

J Biomed Opt 2021 May;26(5)

University of Michigan, Department of Biomedical Engineering, Ann Arbor, Michigan, United States.

An error in the first author's name is corrected.
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http://dx.doi.org/10.1117/1.JBO.26.5.059802DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8130859PMC
May 2021

Imaging of enthesitis by an LED-based photoacoustic system (Erratum).

J Biomed Opt 2021 May;26(5)

University of Michigan, Department of Biomedical Engineering, Ann Arbor, Michigan, United States.

An error in the first author's name is corrected.
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http://dx.doi.org/10.1117/1.JBO.26.5.059801DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8126520PMC
May 2021

LncRNA EGOT/miR-211-5p Affected Radiosensitivity of Rectal Cancer by Competitively Regulating ErbB4.

Onco Targets Ther 2021 28;14:2867-2878. Epub 2021 Apr 28.

Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.

Background/aims: Long non-coding ribonucleic acids (lncRNAs) are involved in the progression of cancers and affect the response to radiation therapy. This study was to investigate the mechanism of lncRNA EGOT in the radiosensitivity of rectal cancer.

Methods: The mRNA expression of EGOT, miR-211-5p and ErbB4 in rectal cancer tissues and cells was detected by qRT-PCR. The protein expression of ErbB4 was detected by Western blot. Dual-luciferase reporter assay and ribonucleic acid immunoprecipitation (RIP) were used to confirm the interaction between EGOT and miR-211-5p or miR-211-5p and ErbB4. Transfection technology was used to down-regulate and up-regulate the expression of EGOT and miR-211-5p in rectal cancer cells, respectively. MTT, colony formation and flow cytometry were used to detect the effect of EGOT and miR-211-5p on proliferation, invasion, migration and apoptosis of rectal cancer cells.

Results: The expression of EGOT was up-regulated in rectal cancer tissues and cells, and the expression of EGOT was related to the late stage of pathology. EGOT knockdown inhibited the proliferation and colony formation of rectal cancer cells and induced the apoptosis of rectal cancer cells. Moreover, EGOT knockdown was significantly enhanced the effects of radiotherapy on rectal cancer in vivo and in vitro. Furthermore, EGOT was found to serve as a sponge of miR-211-5p, and ErbB4 was a downstream target of miR-211-5p. EGOT enhanced the expression of ErbB4 by regulating miR-211-5p. MiR-211-5p inhibitor restored the effect of EGOT knockdown on the radiosensitivity of rectal cancer.

Conclusion: Down-regulation of EGOT could inhibit the growth of rectal cancer cells by regulating the miR-211-5p/ErbB4 axis and improve the radiosensitivity of rectal cancer cells. EGOT may be a new therapeutic target for rectal cancer.
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http://dx.doi.org/10.2147/OTT.S256989DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8091867PMC
April 2021

Precision analysis model and experimentation of vision reconstruction with two cameras and 3D orientation reference.

Sci Rep 2021 Feb 16;11(1):3875. Epub 2021 Feb 16.

Transportation College, Nanling Campus, Jilin University, Renmin Str. 5988#, Changchun, China.

Active vision reconstruction is widely used in industrial manufacturing and three-dimensional inspection. The reconstruction accuracy is an important problem to be investigated for the inspection process. The paper conducts an analysis study of the reconstruction error for the vision reconstruction with a planar laser, two cameras and a 3D orientation board. The variation principles of the spatial coordinates caused by the variations of the extrinsic parameters of the cameras, intrinsic parameters of the internal camera, and image coordinate points of the internal camera, are modeled and analyzed in this paper. The analysis is also proved by the verification experiments, which provides the application potential for other active-vision-based reconstructions.
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http://dx.doi.org/10.1038/s41598-021-83390-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887214PMC
February 2021

Risk and Prognosis of Secondary Bladder Cancer After Radiation Therapy for Rectal Cancer: A Large Population-Based Cohort Study.

Front Oncol 2020 25;10:586401. Epub 2021 Jan 25.

Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Background: Although radiation therapy (RT) improves local control for rectal cancer (RC), the long-term risks from RT, including development of a secondary malignancy, are controversial. The risk and prognosis of secondary bladder cancer (SBC) in RC patients undergoing RT have not been adequately studied. Our goal is to investigate the impact of RT on the risk of developing SBC and assess their survival outcomes.

Methods: This large population-based study included RC patients as their initial primary cancer from nine registries of the Surveillance, Epidemiology and End Results (SEER) database between 1973 and 2015. The cumulative incidence of SBC was assessed by using Fine and Gray's competing risk regression. The standardized incidence ratio (SIR) was used to compare the incidence of SBC in RC survivors to the US general population. The Kaplan-Meier method was used to evaluate the 10-year overall survival (OS) and 10-year cancer specific survival (CSS) for patients with SBC.

Results: Of 74,646 RC patients, 24,522 patients were treated with surgery and RT and 50,124 patients were treated with surgery alone. The incidence of SBC was 1.85% among patients who received RT and 1.24% among patients who did not. The incidence of SBC in RC patients who received RT was higher than the US general population (SIR, 1.35; 95% CI, 1.19-1.53, P<0.05), and decreased with increasing age at diagnosis, and increased with time since diagnosis. In competing risk regression analysis, undergoing RT was associated with a higher risk of SBC (hazard ratio [HR], 1.443, 95% confidence interval [CI], 1.209-1.720; P<0.001). The results of the dynamic SIR for SBC revealed that a slightly increased risk of SBC was observed after RT in the early latency, and was significantly related to the variations of age at RC diagnosis and decreased with time progress. The 10-year OS and CSS among SBC patients after RT were comparable to SBC patients after NRT.

Conclusion: Radiation was associated with an increased risk of developing SBC in RC patients, and special attention should be paid to the surveillance of these patients.
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http://dx.doi.org/10.3389/fonc.2020.586401DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868538PMC
January 2021

Biomedical Photoacoustic Imaging with Unknown Spatially Distributed Ultrasound Sensor Array.

IEEE Trans Biomed Eng 2021 Feb 3;PP. Epub 2021 Feb 3.

Objective: With the growth of interest in different medical study on biological function, non-invasive photoacoustic imaging of biological tissue attracts the interests for researchers. To eliminate the limited angle effect of photoacoustic imaging based on ultrasound linear array, spatially distributed ultrasound sensor array is applied. The accurate sensor array position determines the quality of the imaging results. In this study, we proposed three methods based on photoacoustic and ultrasound signals to enhance the imaging quality using a 256-element full-ring array.

Methods: Groups of photoacoustic and ultrasound signals are used to regress the position of each element sensor.

Result: In phantom study and mouse brain study, photoacoustic imaging results can both yield details clearly with average error rate of less than 1% (50 μm).

Conclusion: The performance of our three methods have proved that they can be potentially applied to other ultrasound-based medical imaging studies with unknown distributed positions of sensor array to enhance the imaging quality.

Significance: The proposed methods can contribute to precise biomedical imaging with unknown distributed positions of sensor array in different application scenarios.
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http://dx.doi.org/10.1109/TBME.2021.3056715DOI Listing
February 2021

Association of Radiotherapy for Rectal Cancer and Second Gynecological Malignant Neoplasms.

JAMA Netw Open 2021 01 4;4(1):e2031661. Epub 2021 Jan 4.

National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.

Importance: Radiotherapy is a common treatment for rectal cancer, yet the risk of second gynecological malignant neoplasms (SGMNs) in patients with rectal cancer undergoing radiotherapy have not been adequately studied.

Objective: To investigate the association between radiotherapy and the risk of individual types of SGMN in patients with rectal cancer and assess survival outcomes.

Design, Setting, And Participants: A large population-based cohort study was designed to identify the risk of SGMNs in patients with rectal cancer diagnosed from January 1973 to December 2015. The statistical analysis was conducted from September 2019 to April 2020. The study was based on the 9 cancer registries of Surveillance, Epidemiology, and End Results database. A total of 20 142 female patients with rectal cancer in localized and regional stage were included.

Exposure: Receipt of neoadjuvant radiotherapy for rectal cancer.

Main Outcomes And Measures: The development of an SGMN defined as any type of GMN occurring more than 5 years after the diagnosis of rectal cancer. The cumulative incidence of SGMNs was estimated by Fine-Gray competing risk regression. Poisson regression was used to evaluate the radiotherapy-associated risk for SGMNs in patients undergoing radiotherapy vs patients not undergoing radiotherapy. The Kaplan-Meier method was used to assess the survival outcomes of patients with SGMNs.

Results: Of 20 142 patients, 16 802 patients (83.4%) were White and the median age was 65 years (interquartile range, 54-74 years). A total of 5310 (34.3%) patients were treated with surgery and radiotherapy, and 14 832 (65.7%) patients were treated with surgery alone. The cumulative incidence of SGMNs during 30 years of follow-up was 4.53% among patients who received radiotherapy and 1.53% among patients who did not. In competing risk regression analysis, undergoing radiotherapy was associated with a higher risk of developing cancer of the uterine corpus (adjusted hazard ratio, 3.06; 95% CI, 2.14-4.37; P < .001) and ovarian cancer (adjusted hazard ratio, 2.08; 95% CI, 1.22-3.56; P = .007) compared with those who did not receive radiotherapy. The dynamic radiotherapy-associated risks (RR) for cancer of the uterine corpus significantly increased with increasing age at rectal cancer diagnosis (aged 20-49 years: adjusted RR, 0.79; 95% CI, 0.35-1.79; P = .57; aged 50-69 years: adjusted RR, 3.74; 95% CI, 2.63-5.32; P < .001; aged ≥70 years: adjusted RR, 5.13; 95% CI, 2.64-9.97; P < .001) and decreased with increasing latency since rectal cancer diagnosis (60-119 months: adjusted RR, 3.22; 95% CI, 2.12-4.87; P < .001; 120-239 months: adjusted RR, 2.72; 95% CI, 1.75-4.24; P < .001; 240-360 months: adjusted RR, 1.95; 95% CI, 0.67-5.66; P = .22), but the dynamic RR for ovarian cancer increased with increasing latency since rectal cancer diagnosis (60-119 months: adjusted RR, 0.70; 95% CI, 0.26-1.89; P = .48; 120-239 months: adjusted RR, 2.26; 95% CI, 1.09-4.70; P = .03; 240-360 months: adjusted RR, 11.84; 95% CI, 2.18-64.33; P = .004). The 10-year overall survival among patients with radiotherapy-associated cancer of the uterine corpus was significantly lower than that among matched patients with primary cancer of the uterine corpus (21.5% vs 33.6%; P = .01).

Conclusions And Relevance: Radiotherapy for rectal cancer was associated with an increased risk of cancer of the uterine corpus and ovarian cancer. Special attention should be paid to reduce radiotherapy-associated SGMNs and improve their prognosis.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.31661DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794669PMC
January 2021

Imaging of enthesitis by an LED-based photoacoustic system.

J Biomed Opt 2020 12;25(12)

University of Michigan, Department of Biomedical Engineering, Ann Arbor, Michigan, United States.

Significance: One key pathological characteristic of seronegative spondyloarthropathy (SpA) is inflammation at the insertion of tendons and ligaments into the bone (enthesitis).

Aim: We explore the potential of the emerging photoacoustic (PA) imaging in diagnosis of SpA and review its feasibility in detecting SpA-associated Achilles tendon enthesitis.

Approach: A light-emitting diode (LED)-based PA and ultrasound combined system was employed. The PA images, both along the long and the short axes of each Achilles tendon insertion region, were acquired at 850-nm wavelength, which is sensitive in depicting increased blood volume (i.e., hyperemia). To assess the hyperemia indicating enthesis inflammation, two parameters were quantified in the imaged tendons, including the average intensity and the density of the color pixels in the pseudo-color PA images. Ten SpA patients, all of which met Assessment of SpA International Society (ASAS) criteria for SpA and were found to have Achilles enthesitis by clinical exam according to a board-certified rheumatologist, were included in the study.

Results: The PA and Doppler ultrasound imaging of Achilles enthesitis resulting from these 10 SpA patients were compared to those from 10 healthy volunteers, leading to statistically significant differences (p  <  0.05) in the applied t-tests.

Conclusions: This preliminary clinical study suggests that the LED-based PA imaging holds a promise for sensitive and objective assessment of SpA enthesitis in an outpatient setting of the rheumatology clinic.
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http://dx.doi.org/10.1117/1.JBO.25.12.126005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744251PMC
December 2020

Safety and survival outcomes of transanal natural orifice specimen extraction using prolapsing technique for patients with middle- to low-rectal cancer.

Chin J Cancer Res 2020 Oct;32(5):654-664

Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

Objective: The transanal approach to specimen collection, combined with the prolapsing technique, is a well-established and minimally invasive surgery for treating rectal cancer. However, reports on outcomes for this approach are sparse. We compared short- and long-term outcomes of conventional laparoscopic surgery (CLS) transanal natural orifice specimen extraction (NOSE) using the prolapsing technique for patients with middle- to low-rectal cancer.

Methods: From January 2013 to December 2017, we enrolled consecutive patients with middle- to low-rectal cancer undergoing laparoscopic anterior resection. Totally, 50 patients who underwent transanal NOSE using the prolapsing technique were matched with 50 patients who received CLS. Clinical parameters and survival outcomes between the two groups were compared.

Results: Estimated blood loss (29.70±29.28 . 52.80±45.09 mL, P=0.003), time to first flatus (2.50±0.79 . 2.86±0.76, P=0.022), time to liquid diet (3.62±0.64 . 4.20±0.76 d, P<0.001), and the need for analgesics (22%. 48%, P=0.006) were significantly lower for the NOSE group compared to the CLS group. The incidences of overall complications and fecal incontinence were comparable in both groups. After a median follow-up of 44.52 months, the overall local recurrence rate (6% . 5%, P=0.670), 3-year disease-free survival (86.7% . 88.0%, P=0.945) and 3-year overall survival (95.6% . 96.0%, P=0.708), were not significantly different.

Conclusions: For total laparoscopic rectal resection, transanal NOSE using the prolapsing technique is effective and safe, and associated with less trauma and pain, a faster recovery, and similar survival outcomes compared to CLS.
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http://dx.doi.org/10.21147/j.issn.1000-9604.2020.05.10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7666784PMC
October 2020

Risk and Prognosis of Secondary Rectal Cancer After Radiation Therapy for Pelvic Cancer.

Front Oncol 2020 29;10:584072. Epub 2020 Oct 29.

Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.

Background: The relationship between pelvic radiation therapy (RT) and second primary rectal cancer (SPRC) is unclear. The aim of this study was to assess the risk and prognosis of SPRC after pelvic RT.

Materials And Methods: Data for patients who had primary pelvic cancer (PPC) between 1973 and 2016 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Multiple primary standardized incidence ratios (SIRs) were used to assess the risk of SPRC. Five-year overall survival (OS) and rectal cancer-specific survival (RCSS) were calculated using Kaplan-Meier curves.

Results: A total of 573,306 PPC patients were included, 141,225 of whom had been treated with RT. Primary cancers were located in the prostate (50.83%), bladder (24.18%), corpus uterus (16.26%), cervix (5.83%), and ovary (2.91%). A total of 1,491 patients developed SPRC. Overall, the patients who received RT were at increased risk of developing SPRC (SIR = 1.39, 95% confidence interval [CI]: 1.27-1.52). The risk of SPRC decreased in patients who did not undergo RT (SIR = 0.85, 95% CI: 0.80-0.91). The SIR for SPRC in patients who underwent external beam radiation therapy (EBRT) was 1.22 (95% CI: 1.09-1.36). The SIR for SPRC in patients who underwent a combination of EBRT and brachytherapy (EBRT-BRT) was 1.85 (95% CI: 1.60-2.14). For patients who received RT, the SIR for SPRC increased with time after a 5-year latency period from PPC diagnosis. The survival of RT-treated SPRC patients was significantly worse than that of patients with primary rectal cancer only (PRCO).

Conclusions: Patients receiving pelvic RT were at an increased risk of developing SPRC. Different pelvic RT treatment modalities had different effects on the risk of SPRC. We suggest that long-term surveillance of SPRC risk is required for patients who have undergone pelvic RT, especially young patients.
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http://dx.doi.org/10.3389/fonc.2020.584072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7658675PMC
October 2020

Safety and Long-Term Effect Assessment of Neoadjuvant Chemoradiotherapy for Elderly Patients With Locally Advanced Rectal Cancer: A CHN Single-Center Retrospective Study.

Technol Cancer Res Treat 2020 Jan-Dec;19:1533033820970339

Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Introduction: Neoadjuvant chemoradiotherapy (nCRT) followed by operation has become the standard treatment for locally advanced rectal cancer (LARC). However, considering the possible toxicity and complications of radiochemotherapy, nCRT is seldom used for the elderly. The purpose of this study was to assess the safety and long-term effect of nCRT combined with TME in elderly patients with LARC.

Method: Four-hundred-fourteen LARC patients were divided into 2 groups: 108 patients were in the elderly group (≥ 65 years old) and 306 patients were in the non-elderly group (<65 years old). The side effects, toxicity, complications, disease-free survival (DFS), and overall survival (OS) of all of the patients were assessed.

Results: The data comprised 103 patients in the elderly group and 292 patients in the non-elderly group who completed nCRT sessions following operation. The treatment-completion rates of the elderly and non-elderly groups were 95.37% and 95.42%, respectively. Twenty-two patients developed radiotherapy complications (grade III) in the elderly group and 37 such cases developed in the non-elderly group. Diarrhea, skinulcer, and perianal pain were ranked as the top 3 most common complications. The incidence of infection, anastomotic leakage, and intestinal obstruction was 0.97% in the elderly group. The 5-year DFS and 5-year OS rate were 70.7% and 80.8% in the elderly group, 67.3% and 81.6% in the non-elderly group respectively.

Conclusions: nCRT are safe and effective for elderly patients, and it does not increase the risk of postoperative complications for the elderly. Hence, nCRT should not be withheld based on age alone.
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http://dx.doi.org/10.1177/1533033820970339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7658521PMC
November 2020

Photoacoustic spectral analysis at ultraviolet wavelengths for characterizing the Gleason grades of prostate cancer.

Opt Lett 2020 Nov;45(21):6042-6045

The diagnosis of aggressive prostate cancer (PCa) has relied on microscopic architectures, namely Gleason patterns, of tissues extracted through core biopsies. Technology capable of assessing the tissue architecture without tissue extraction will reduce the invasiveness of PCa diagnosis and improve diagnostic accuracy by allowing for more sampling locations. Our recently developed photoacoustic spectral analysis (PASA) has achieved quantification of tissue architectural heterogeneity interstitially. Taking advantage of the unique optical absorption of cell nuclei at ultraviolet (UV) wavelengths, this study investigated PASA at 266 nm for quantifying the tissue architecture heterogeneity in prostates. The results have shown significant differences among the normal, early cancer, and late cancer stages in mouse prostates ex vivo and in vivo (=20, <0.05). The study with human samples ex vivo has shown a correlation of 0.80 (=11, <0.05) between PASA quantification and pathologic diagnosis.
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http://dx.doi.org/10.1364/OL.409249DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7687867PMC
November 2020

BMI May Be a Prognostic Factor for Local Advanced Rectal Cancer Patients Treated with Long-Term Neoadjuvant Chemoradiotherapy.

Cancer Manag Res 2020 20;12:10321-10332. Epub 2020 Oct 20.

Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China.

Objective: This study aims to develop feasible nomograms to predict the overall survival (OS) and cancer-specific survival (CSS) of the local advanced rectal cancer (LARC) patients who were treated with neoadjuvant chemoradiotherapy (nCRT) and operation.

Methods: A total of 243 LARC patients undergoing nCRT followed by total mesorectal excision (TME) were enrolled. Preoperative clinical features and postoperative pathological characteristics were collected. A Cox regression analysis was performed, and Cox-based nomograms were developed to predict the OS and CSS. We assessed the predictive performance of the nomogram with concordance index and calibration plots.

Results: A total of 243 patients were included with a median follow-up period of 46 months (range from 9 to 86 months). Cox regression analysis showed that low BMI (BMI < 18.5, HR= 21.739, < 0.05), high level of preoperative CA19-9 (HR = 3.369, = 0.036), high ypStage (HR = 19.768, < 0.001), positive neural invasion (HR = 4.218, = 0.026) and no adjuvant chemotherapy (HR = 5.495, < 0.001) were independent predictors of poor OS. Age ≥70 (HR = 2.284, <0.001), low BMI (BMI < 18.5, HR = 3.906, < 0.05), positive preoperative CA19-9 (HR = 1.920, = 0.012), high ypStage (HR = 5.147, <0.001) and positive neural invasion (HR = 2.873, = 0.022) were independent predictors of poor CSS. The predictive nomograms were developed to predict the OS and CSS with a C-index of 0.837 and 0.760. Good statistical performance on internal validation was shown by calibration plots.

Conclusion: In conclusion, this study demonstrated that BMI was an independent prognostic factor for OS and CSS in LARC patients treated with nCRT followed TME. A nomogram incorporating BMI, neural invasion, pre-CA19-9, ypStage, age, and adjuvant chemotherapy could be helpful to predict the OS and CSS.
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http://dx.doi.org/10.2147/CMAR.S268928DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7586017PMC
October 2020

Comparative short- and long-term outcomes of three techniques of natural orifice specimen extraction surgery for rectal cancer.

Eur J Surg Oncol 2020 10 14;46(10 Pt B):e55-e61. Epub 2020 Jul 14.

Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China. Electronic address:

Background: The aim of this study was to evaluate the safety of natural orifice specimen extraction surgery (NOSES) and to compare the short- and long-term outcomes of three techniques of NOSES for rectal cancer (RC).

Materials And Methods: A consecutive series of RC patients in stage I-III who underwent laparoscopic NOSES were enrolled. Three main techniques of NOSES included specimen eversion and extra-abdominal resection (EVER), specimen extraction and extra-abdominal resection (EXER) and intra-abdominal resection and specimen extraction (IREX). The postoperative complications, 5-year disease free survival (DFS), 5-year local recurrence rate (LRR) and 5-year distant metastasis rate (DMR) were compared in three techniques.

Results: 268 RC patients met inclusion criteria, including 83 patients treated with EVER, 75 patients treated with EXER and 110 patients treated with IREX. Tumor location was the most critical factor associated with technique selection, with P < 0.001. Postoperative complication rate was 12.3% for all patients, and it was 18.1% for EVER, 13.3% for EXER and 7.3% for IREX. There were no significant differences for anastomotic leakage, anastomotic bleeding and intraabdominal abscess among three technique groups, with P > 0.05. For long-term outcomes, the 5-year DFS, 5-year LRR and 5-year DMR were 85.03%, 4.22% and 11.00% for all patients. Patients in advanced tumor stage have worse long-term survival compared with patients in early stage, but no significant survival differences were observed among three technique groups.

Conclusion: Three techniques of NOSES for RC had acceptable short- and long-term outcomes, and tumor location was a determinant of technique selection.
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http://dx.doi.org/10.1016/j.ejso.2020.06.023DOI Listing
October 2020

Vision-based reconstruction of laser projection with invariant composed of points and circle on 2D reference.

Sci Rep 2020 Jul 17;10(1):11866. Epub 2020 Jul 17.

School of Mechanical and Aerospace Engineering, Nanling Campus, Jilin University, Renmin Str. 5988#, Changchun, China.

A vision-based reconstruction method is conducted by the point-circle invariant and the planar laser. The planar laser is coplanar to the two-dimensional (2D) reference. The combination of a circle on the 2D reference, a point on the 2D reference and a random point on the laser stripe is considered as the invariant, which is impervious to the projection from the laser plane to the image. Therefore, the reconstruction model is achieved by the invariant, which is generated from the projections of the above geometric features. The experiments are performed to verify the performance and reconstruction error of the method. The minimum error is 0.473 mm for the camera-reference distance of 600 mm, the scaleplate-projector distance of 100 mm and the reference length of 30 mm. Besides, the maximum error is 4.960 mm, for the camera-reference distance of 900 mm, the scaleplate-projector distance of 400 mm and the reference length of 120 mm. The reconstruction error means of 0.891 mm, 1.365 mm, 2.578 mm and 3.767 mm are observed with respect to the test conditions of 600-900 mm, which proves the applicability of the reconstruction method with the point-circle invariant.
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http://dx.doi.org/10.1038/s41598-020-68901-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368060PMC
July 2020

The Distinction of Clinicopathological Characteristics, Treatment Strategy and Outcome in Colorectal Cancer Patients With Synchronous vs. Metachronous Bone Metastasis.

Front Oncol 2020 19;10:974. Epub 2020 Jun 19.

Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China.

The impact of the timing of bone metastasis (BM) diagnosis on colorectal cancer (CRC) patients is unclear. Our study aimed to explore the differences in clinicopathological characteristics, treatments and prognosis between synchronous BM (SBM) and metachronous BM (MBM) from CRC. We retrospectively investigated clinical data of CRC patients with SBM or MBM from 2008 to 2017 at Chinese National Cancer Center. Cancer specific survival (CSS) after BM diagnosis was estimated using the Kaplan-Meier method. The multivariable COX regression model identified the prognostic factors of CSS. Finally, 63 CRC patients with SBM and 138 CRC patients with MBM were identified. Compared to SBM from CRC, MBM significantly was more involving multiple bone lesions (63.0 vs. 7.9%; < 0.001), and more frequently originated from rectal cancer (60.9 vs. 41.3%; = 0.033). The therapeutic strategies in SBM and MBM group were contrasted including systemic treatment, bisphosphonates, radiotherapy and metastasectomy for BM. 85.5% of patients in MBM group and 25.4% of patients in SBM group underwent primary tumor resection at initial diagnosis ( < 0.001). The median CSS was 11 months in both SBM and MBM group ( = 0.556), yet MBM patients developed from CRC in early AJCC stage presented obviously longer survival than those from advanced stage. Furthermore, patients could have improved CSS from primary tumor resection while there might be no survival benefit from targeted therapy in both SBM and MBM groups. Bisphosphonates was associated with a better CSS for patients with SBM, while radiotherapy for BM was related to a better CSS for patients with MBM. The CRC patients in SBM and MBM group represented different clinicopathological characteristics and treatment modalities, which affected the prognosis in different ways. Distinct consideration for CRC patients with SBM and MBM in clinical decision making is required.
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http://dx.doi.org/10.3389/fonc.2020.00974DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7318073PMC
June 2020

Leptin Overexpression as a Poor Prognostic Factor for Colorectal Cancer.

Biomed Res Int 2020 3;2020:7532514. Epub 2020 Jun 3.

Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, China.

Leptin acts as an adipocytokine functions via the leptin receptor, which stimulates growth, migration, and invasion of cancer cells. This study is aimed at identifying leptin as a prognostic factor in colorectal cancer (CRC). The differentially expressed genes with prognostic value in CRC tissues either with or without liver metastasis were assessed based on The Cancer Genomic Atlas (TCGA). Leptin was considered a candidate gene for further analysis. Its expression features of 206 CRC patients without liver metastasis and 201 patients with metastasis on tissue microarrays were assessed by immunochemical staining, and the effect of leptin on survival was assessed by Kaplan-Meier analyses. Overexpressed leptin indicated a poorer prognosis for CRC patients in overall survival ( < 0.05, log-rank test) based on the TCGA database. The leptin expression significantly correlated with metastasis stage ( < .010) and lymph node involvement ( < .010). Multivariate analysis also indicated that strong leptin expression was an independent adverse prognosticator in CRC ( = .017). Leptin may be valued as a prognostic marker could contribute to predicting a clinical outcome for patients with CRC.
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http://dx.doi.org/10.1155/2020/7532514DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292990PMC
March 2021

Geometry-invariant-based reconstruction generated from planar laser and metrical rectification with conic dual to circular points in the similarity space.

Opt Express 2020 May;28(11):17086-17101

3D point reconstruction is a crucial component in optical inspection. A direct reconstruction process is proposed by combining two similarity invariants in active vision. A planar reference with an isosceles-right-angle pattern and a coplanar laser are adopted to generate the laser projective point on the measured object. The first invariant is the image of the conic dual to the circular points (ICDCP), which is derived from the lines in two pairs of perpendicular directions on the reference pattern. The invariant provides the transform from the projection space to the similarity space. Then, the ratio of the line segments consisting of the laser projection points and reference points is constructed as the other similarity invariant, by which the laser projection point in the similarity space is converted to Euclidean space. The solution of the laser point is modeled by the ratio invariant of the line segments and improved by a special point selection to avoid nonlinear equations. Finally, the benchmark-camera distance, the benchmark-generator distance, the benchmark length, image noise, and the number of orthogonal lines are experimentally investigated to explore the effectiveness and reconstruction error of the method. The reconstruction error averages of 0.94, 1.22, 1.77, and 2.15 mm are observed from the experiment results with the benchmark-camera distances from 600 mm to 750 mm with a 50 mm interval. This proves the validity and practicability of the reconstruction method.
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http://dx.doi.org/10.1364/OE.393981DOI Listing
May 2020

Evaluation of clinical significance of claudin 7 and construction of prognostic grading system for stage II colorectal cancer.

World J Clin Cases 2020 Jun;8(11):2190-2200

Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

Background: Claudin 7 is often abnormally expressed in cancers and promotes the progression of some malignancies. However, the role of claudin 7 in stage II colorectal cancer (CRC) has not been studied.

Aim: To assess the expression and prognostic value of claudin 7 in stage II CRC.

Methods: We retrospectively studied 231 stage II CRC patients who underwent radical surgery at our hospital from 2013 to 2014. The protein expression level of claudin 7 was assessed and its relationship with clinicopathological features and prognosis was statistically analyzed. The independent prognostic factors were identified by Cox proportional hazards models. A prognostic grading system was constructed to stratify the survival of CRC patients.

Results: The expression of claudin 7 was significantly reduced in cancer tissues compared with normal tissues ( < 0.001), and its low expression was closely related to recurrence of the disease ( = 0.017). Multivariate analysis confirmed that claudin 7 low expression (claudin 7-low) ( = 0.028) and perineural invasion positivity (PNI+) ( = 0.026) were independent predictors of poor disease-free survival (DFS). A prognostic grading system based on the status of claudin 7 and PNI classified the patients into three prognostic grades: grade A (claudin 7-high and PNI-), grade B (claudin 7-low and PNI-, claudin 7-high and PNI+), and grade C (claudin 7-low and PNI+). The DFS was significantly different among the three grades (grade B grade A, = 0.032; grade C grade A, < 0.001; grade C grade B, = 0.040).

Conclusion: Claudin 7 can be used as a new prognostic marker to predict the DFS of patients with stage II CRC. The prognostic grading system with the addition of claudin 7 can further improve prognosis stratification of patients.
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http://dx.doi.org/10.12998/wjcc.v8.i11.2190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7281043PMC
June 2020

B7-H3 immune checkpoint expression is a poor prognostic factor in colorectal carcinoma.

Mod Pathol 2020 11 8;33(11):2330-2340. Epub 2020 Jun 8.

Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Although PD-1/PD-L1 immunotherapy has been used successfully in treating many cancers, metastatic colorectal cancer (CRC) patients are not as responsive. B7-H3 is a promising target for immunotherapy and we found it to have the highest expression among B7-CD28 family members in CRC. Thus, the aim of the present study was to investigate B7-H3 expression in a large CRC cohort. B7-H3, B7-H4, and PD-L1 protein levels and differential lymphocyte infiltration were evaluated in tissue microarrays from 805 primary tumors and matched metastases. The relationships between immune markers, patient characteristics, and survival outcomes were determined. B7-H3 (50.9%) was detected in more primary tumors than B7-H4 (29.1%) or PD-L1 (29.2%), and elevated B7-H3 expression was associated with advanced overall stage. Co-expression of B7-H3 only with B7-H4 or PD-L1 was infrequent in primary tumors (6.3%, 5.7%, respectively). Moreover, B7-H3 in primary tumors was positively correlated with their respective expression at metastatic sites (ρ = 0.631; p < 0.001). No significant relationships between B7-H4 and PD-L1 and survival were observed; however, B7-H3 overexpression in primary tumors was significantly related to decreased disease-free survival. A positive relationship between B7-H3 expression and high density CD45RO T cell was observed in primary tumors, whereas B7-H4 and PD-L1 overexpression were related to CD3 T-cell infiltration. In conclusion, compared with B7-H4 and PD-L1, B7-H3 expression exhibited a higher prevalence and was significantly related to aggressiveness, worse prognosis and CD45RO T-cell infiltration in primary tumors. Further exploration of this potential target of immunotherapy in CRC patients is warranted.
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http://dx.doi.org/10.1038/s41379-020-0587-zDOI Listing
November 2020

A prognostic index model to individually predict clinical outcomes for colorectal cancer with synchronous bone metastasis.

J Cancer 2020 11;11(15):4366-4372. Epub 2020 May 11.

Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China.

The prognosis of synchronous bone metastasis (BM) in colorectal cancer (CRC) is poor and rarely concerned. A clinical tool to evaluate the prognosis and clinical outcomes for BM would be attractive in current clinical practice. A total of 342 CRC patients with synchronous BM were identified from Surveillance, Epidemiology, and End Results (SEER) database. The cancer specific survival (CSS) was estimated with the Kaplan-Meier method. Prognostic factors were identified from multivariate Cox model, and the final clinical nomogram was developed to predict the CSS. The concordance index (C-index) was used to assess the discriminative ability. Calibration curves were provided to internally validate the performance of the nomogram. The nomogram finally consisted of 6 prognostic factors including age, tumor grade, AJCC N stage, carcinoembryonic antigen (CEA) levels, primary tumor resection and chemotherapy, which translated the effects of prognostic factors into certain scores to predict the 1-, 2- and 3-year CSS for the synchronous BM in CRC patients. The nomogram presented a good accuracy for predicting the CSS with the C-index of 0.742. The calibration of the nomogram predictions was also accurate. This nomogram was accurate enough to predict the CSS of CRC patients with synchronous BM using readily available clinicopathologic factors and could provide individualized clinical decisions for both physicians and patients.
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http://dx.doi.org/10.7150/jca.40921DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255384PMC
May 2020

Optimizing response in surgical systems during and after COVID-19 pandemic: Lessons from China and the UK - Perspective.

Int J Surg 2020 06 4;78:156-159. Epub 2020 May 4.

Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK; School of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, CB1 1PT, UK. Electronic address:

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http://dx.doi.org/10.1016/j.ijsu.2020.04.062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7196555PMC
June 2020

A Preoperative Risk Prediction Model for Lymph Node Examination of Stage I-III Colon Cancer Patients: A Population-Based Study.

J Cancer 2020 5;11(11):3303-3309. Epub 2020 Mar 5.

Department of Colorectal Surgery, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

: Lymph node examination is a prognostic indicator for colon cancer (CC) patients. The aim of this study was to develop and validate a preoperative risk prediction model for inadequate lymph node examination. : 24284 patients diagnosed as stage I-III CC between 2010-2014 were extracted from SEER database and randomly divided into development cohort (N=12142) and internal validation cohort (N=12142). 680 patients diagnosed as stage I-III CC between 2012-2014 were extracted from our hospital as external validation cohort. Logistic regression analysis was performed and risk score of each factor was calculated according to model formula. Model discrimination was assessed using C-statistics. : Preoperative risk factors were identified as gender, age, tumor site and tumor size. Patients with total risk score of 0-6 were considered as low risk group while patients scored ≥13 were considered as high risk group. The model had good discrimination and calibration in all cohorts and could apply to patients in the SEER database (American population) and patients in our hospital (Chinese population). : The model could accurately predict the risk of inadequate lymph node examination before surgery and might provide useful reference for surgeons and pathologists.
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http://dx.doi.org/10.7150/jca.41056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7097944PMC
March 2020

International consensus on natural orifice specimen extraction surgery (NOSES) for gastric cancer (2019).

Gastroenterol Rep (Oxf) 2020 Feb 24;8(1):5-10. Epub 2020 Jan 24.

Department of Gastric Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, P. R. China.

At present, natural orifice specimen extraction surgery (NOSES) has attracted more and more attention worldwide, because of its great advantages including minimal cutaneous trauma and post-operative pain, fast post-operative recovery, short hospital stay, and positive psychological impact. However, NOSES for the treatment of gastric cancer (GC) is still in its infancy, and there is great potential to improve its theoretical system and clinical practice. Especially, several key points including oncological outcomes, bacteriological concerns, indication selection, and standardized surgical procedures are raised with this innovative technique. Therefore, it is necessary to achieve an international consensus to regulate the implementation of GC-NOSES, which is of great significance for healthy and orderly development of NOSES worldwide.
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http://dx.doi.org/10.1093/gastro/goz067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7034234PMC
February 2020

Prognostic scoring system for synchronous brain metastasis at diagnosis of colorectal cancer: A population-based study.

World J Gastrointest Oncol 2020 Feb;12(2):195-204

Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

Background: Brain metastasis (BM) from colorectal cancer (CRC) is rarely encountered clinically, and its prognosis has not been fully evaluated.

Aim: To construct a scoring system and accurately predict the survival of patients with synchronous BM at diagnosis of CRC.

Methods: A retrospective study of 371 patients with synchronous BM from CRC was performed, using the data from 2010 to 2014 from the Surveillance, Epidemiology, and End Results database. Survival time and prognostic factors were statistically analyzed by the Kaplan-Meier method and Cox proportional hazards models, respectively. A scoring system was developed using the independent prognostic factors, and was used to measure the survival difference among different patients.

Results: For the 371 patients, the median overall survival was 5 mo, survival rates were 27% at 1 year and 11.2% at 2 years. Prognostic analysis showed that age, carcinoembryonic antigen level and extracranial metastasis to the liver, lung or bone were independent prognostic factors. A scoring system based on these three prognostic factors classified the patients into three prognostic subgroups (scores of 0-1, 2-3, and 4). The median survival of patients with scores of 0-1, 2-3 and 4 was 14, 5 and 2 mo, respectively ( < 0.001). Subgroup analysis showed that there were significant differences in prognosis among the groups. Score 2-3 0-1: hazard ratio (HR) = 2.050, 95%CI: 1.363-3.083; 0.001; score 4 0-1: HR = 3.721, 95%CI: 2.225-6.225; < 0.001; score 2-3 4: HR = 0.551, 95%CI: 0.374-0.812; = 0.003.

Conclusion: The scoring system effectively distinguishes long-term and short-term survivors with synchronous BM from CRC. These results are helpful in providing a reference for guiding therapy.
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http://dx.doi.org/10.4251/wjgo.v12.i2.195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7031150PMC
February 2020

One-Step Synthesis of N, P-Codoped Carbon Nanosheets Encapsulated CoP Particles for Highly Efficient Oxygen Evolution Reaction.

Front Chem 2019 9;7:805. Epub 2020 Jan 9.

Fujian Provincial Key Laboratory of Electrochemical Energy Storage Materials, College of Chemistry, Fuzhou University, Fuzhou, China.

Oxygen electrocatalysis, especially oxygen evolution reaction (OER), is a central process during the actual application of rechargeable metal-air battery. It is still challenging to develop ideal electrocatalysts to substitute the commercial noble metal-based materials. In this work, we have constructed a new material, CoP nanoparticles, which are encapsulated by a biomolecule-derived N, P-codoped carbon nanosheets via a simple and facile one-step strategy. The as-prepared material releases a high electrocatalytic activity and stability for OER, with an overpotential of 310 mV to achieve 10 mA/cm in 1 M KOH. Importantly, we found that the phosphoric acid can not only introduce phosphorus dopant into 2D N-doped carbon nanosheets and play a role of pore-forming agent, but also participate in the formation of active center (cobalt phosphide). Moreover, the coverage of N, P-doped carbon can prevent the CoP nanoparticles from corrosion under the harsh reaction medium to achieve high and stable activity. We believe that our strategy can offer a novel pathway to synthesize new transition metal-based catalysts for electrocatalysis or other heterogeneous catalysis.
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http://dx.doi.org/10.3389/fchem.2019.00805DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6962193PMC
January 2020

Reconsidering the prognostic significance of tumour deposit count in the TNM staging system for colorectal cancer.

Sci Rep 2020 01 9;10(1):89. Epub 2020 Jan 9.

Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150081, China.

Although the occurrence of tumour deposits (TDs) without metastatic lymph nodes (mLNs) is classified as "N1c" in the 8 TNM staging system for colorectal cancer (CRC), the prognostic significance of the TD count is still controversial. A total of 39155 CRC patients were collected from the Surveillance, Epidemiology, and End Results (SEER) database. The potential associations between baseline characteristics and TD status were evaluated using the χ test. Cancer-specific survival (CSS) rates were calculated by using the Kaplan-Meier method, and CSS comparisons were performed by using the log-rank test. The results showed that TD count was an important prognostic factor and that the number of TDs was negatively correlated with the prognosis of CRC patients. We found that the prognostic value of one TD is equivalent to that of two mLNs based on the comparison of CSS rates. Accordingly, we proposed a novel N staging system by integrating the TD count into the N category with the ratio of TDs to mLNs being 1:2. There were no prognostic differences in patients with or without TDs in each novel N category. Weighing one TD as two mLNs in this novel TNM staging system is superior to the "N1c" classification in the 8 TNM staging system in evaluating the prognosis of CRC patients.
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http://dx.doi.org/10.1038/s41598-019-57041-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6952424PMC
January 2020
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