Publications by authors named "Yingtai Chen"

71 Publications

Development and Validation of Machine Learning-based Model for the Prediction of Malignancy in Multiple Pulmonary Nodules: Analysis from Multicentric Cohorts.

Clin Cancer Res 2021 Apr 24;27(8):2255-2265. Epub 2021 Feb 24.

Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.

Purpose: Nodule evaluation is challenging and critical to diagnose multiple pulmonary nodules (MPNs). We aimed to develop and validate a machine learning-based model to estimate the malignant probability of MPNs to guide decision-making.

Experimental Design: A boosted ensemble algorithm (XGBoost) was used to predict malignancy using the clinicoradiologic variables of 1,739 nodules from 520 patients with MPNs at a Chinese center. The model (PKU-M model) was trained using 10-fold cross-validation in which hyperparameters were selected and fine-tuned. The model was validated and compared with solitary pulmonary nodule (SPN) models, clinicians, and a computer-aided diagnosis (CADx) system in an independent transnational cohort and a prospective multicentric cohort.

Results: The PKU-M model showed excellent discrimination [area under the curve; AUC (95% confidence interval (95% CI)), 0.909 (0.854-0.946)] and calibration (Brier score, 0.122) in the development cohort. External validation (583 nodules) revealed that the AUC of the PKU-M model was 0.890 (0.859-0.916), higher than those of the Brock model [0.806 (0.771-0.838)], PKU model [0.780 (0.743-0.817)], Mayo model [0.739 (0.697-0.776)], and VA model [0.682 (0.640-0.722)]. Prospective comparison (200 nodules) showed that the AUC of the PKU-M model [0.871 (0.815-0.915)] was higher than that of surgeons [0.790 (0.711-0.852), 0.741 (0.662-0.804), and 0.727 (0.650-0.788)], radiologist [0.748 (0.671-0.814)], and the CADx system [0.757 (0.682-0.818)]. Furthermore, the model outperformed the clinicians with an increase of 14.3% in sensitivity and 7.8% in specificity.

Conclusions: After its development using machine learning algorithms, validation using transnational multicentric cohorts, and prospective comparison with clinicians and the CADx system, this novel prediction model for MPNs presented solid performance as a convenient reference to help decision-making.
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http://dx.doi.org/10.1158/1078-0432.CCR-20-4007DOI Listing
April 2021

Development and validation of a novel competing risk model for predicting survival of esophagogastric junction adenocarcinoma: a SEER population-based study and external validation.

BMC Gastroenterol 2021 Jan 26;21(1):38. Epub 2021 Jan 26.

Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 PanjiayuanNanli, Chaoyang District, Beijing, 100021, China.

Background: Adenocarcinoma in Esophagogastric Junction (AEG) is a severe gastrointestinal malignancy with a unique clinicopathological feature. Hence, we aimed to develop a competing risk nomogram for predicting survival for AEG patients and compared it with new 8th traditional tumor-node-metastasis (TNM) staging system.

Methods: Based on data from the Surveillance, Epidemiology, and End Results (SEER) database of AEG patients between 2004 and 2010, we used univariate and multivariate analysis to filter clinical factors and then built a competing risk nomogram to predict AEG cause-specific survival. We then measured the clinical accuracy by comparing them to the 8th TNM stage with a Receiver Operating Characteristic (ROC) curve, Brier score, and Decision Curve Analysis (DCA). External validation was performed in 273 patients from China National Cancer Center.

Results: A total of 1755 patients were included in this study. The nomogram was based on five variables: Number of examined lymph nodes, grade, invasion, metastatic LNs, and age. The results of the nomogram was greater than traditional TNM staging with ROC curve (1-year AUC: 0.747 vs. 0.641, 3-year AUC: 0.761 vs. 0.679, 5-year AUC: 0.759 vs. 0.682, 7-year AUC: 0.749 vs. 0.673, P < 0.001), Brier score (3-year: 0.198 vs. 0.217, P = 0.012; 5-year: 0.198 vs. 0.216, P = 0.008; 7-year: 0.199 vs. 0.215, P = 0.014) and DCA. In external validation, the nomogram also showed better diagnostic value than traditional TNM staging and great prediction accuracy.

Conclusion: We developed and validated a novel nomogram and risk stratification system integrating clinicopathological characteristics for AEG patients. The model showed superior prediction ability for AEG patients than traditional TNM classification.
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http://dx.doi.org/10.1186/s12876-021-01618-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836166PMC
January 2021

The Effect of Neoadjuvant Therapies for Patients with Locally Advanced Gastric Cancer: A Propensity Score Matching Study.

J Cancer 2021 1;12(2):379-386. Epub 2021 Jan 1.

Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/ National Clinical Research for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

The aim of this study was to evaluate the effect of neoadjuvant therapies (NAT) on patients with locally advanced gastric cancer (LAGC). This study retrospectively analyzed LAGC patients treated at the China National Cancer Center between October 2006 and December 2018. All patients included were divided into two groups, NAT followed by surgery (NAT-Surgery) and adjuvant chemotherapy following surgery (Surgery-ACT). Subgroup analysis compared between patients underwent either neoadjuvant chemotherapy (nCT) or neoadjuvant chemoradiation (nCRT) was conducted. Propensity score matching (PSM) was implemented to reduce selection bias. In total, 2779 patients were included in this study (494 of NAT-Surgery group and 2285 of Surgery-ACT group). After PSM, the patients in NAT-Surgery group had a significantly longer overall survival (OS) than patients in Surgery-ACT group (<0.001). Subgroup analysis revealed that grade 3 or 4 adverse events were more frequently observed in nCRT group during neoadjuvant treatment (52.0% in nCRT group vs. 34.0% in nCT group, =0.010). Pathological complete response (pCR) being achieved in 17.0% after nCRT versus 4.0% after nCT (<0.001). Patients of the nCRT group obtained better disease-free survival (DFS, =0.024) and local-recurrence-free survival (LRFS, =0.014) than patients in nCT group, while there was no significant difference in OS between the two groups. In conclusion, NAT improved survival outcomes among LAGC patients over surgery followed by adjuvant chemotherapy. In comparison with nCT, nCRT resulted in higher pCR rate, better DFS and LRFS, without significantly affecting OS.
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http://dx.doi.org/10.7150/jca.46847DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738980PMC
January 2021

Clinical Outcomes of Proximal Gastrectomy versus Total Gastrectomy for Proximal Gastric Cancer: A Systematic Review and Meta-Analysis.

Dig Surg 2021 5;38(1):1-13. Epub 2020 Nov 5.

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

Introduction: The extent of optimal gastric resection for proximal gastric cancer (PGC) continues to remain controversial, and a final consensus is yet to be met. The current study aimed to compare the perioperative outcomes, postoperative complications, and overall survival (OS) of proximal gastrectomy (PG) versus total gastrectomy (TG) in the treatment of PGC through a meta-analysis.

Methods: We systematically searched PubMed, Embase, The Cochrane Library, and Web of Science for articles published in English since database establishment to October 2019. Evaluated endpoints were perioperative outcomes, postoperative complications, and long-term survival outcomes.

Results: A total of 2,896 patients in 25 full-text articles were included, of which one was a prospective randomized study, one was a clinical phase III trial, and the rest were retrospective comparative studies. The PG group showed a higher incidence of anastomotic stenosis (OR = 2.21 [95% CI: 1.08-4.50]; p = 0.03) and reflux symptoms (OR = 3.33 [95% CI: 1.85-5.99]; p < 0.001) when compared with the TG group, while no difference was found in PG patients with double-tract reconstruction (DTR). The retrieved lymph nodes were clearly more in the TG group (WMD = -10.46 [95% CI: -12.76 to -8.17]; p < 0.001). The PG group was associated with a better 5-year OS relative to TG with 11 included studies (OR = 1.35 [95% CI: 1.03-1.77]; p = 0.03). After stratification for early gastric cancer and PG with DTR groups, however, there was no significant difference between the 2 groups (OR = 1.35 [95% CI: 0.59-2.45]; p = 0.62).

Conclusion: In conclusion, PG was associated with a visible improved long-term survival outcome for all irrespective of tumor stage, while a similar 5-year OS for only early gastric cancer patients between the 2 groups. Future randomized clinical trials of esophagojejunostomy techniques, such as DTR following PG, are expected to prevent postoperative complications and assist surgeons in the choice of surgical approach for PGC patients.
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http://dx.doi.org/10.1159/000506104DOI Listing
November 2020

Association between air pollutants and atrial fibrillation in general population: A systematic review and meta-analysis.

Ecotoxicol Environ Saf 2021 Jan 1;208:111508. Epub 2020 Nov 1.

Department of Thoracic Surgery, Beijing Aerospace General Hospital, Wanyuan North Road, Beijing 100076, China. Electronic address:

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia with several risk factors. Recent studies have suggested that the exposure to air pollutants may increase the prevalence of AF, we evaluated those studies systematically to better elucidate the correlation between exposure to air pollution and AF.

Method: We conducted a systematic review of publications using PubMed, Embase, the Cochrane library and Web of Science to explore the association between air pollutants and AF within the general population. The chosen studies were published until 7 July 2020. According to different study designs, we divided the outcomes into "short-term-exposure group" and "long-term-exposure group" for each pollutant. We used I statistics and Q-test to examine statistical heterogeneity, and sensitivity analysis to exclude the heterogeneous study. Fixed or random-effect model was used to combine the effects. Final result was presented as the OR and 95% CI of AF prevalence for every 10 μg/m increase in the concentration of PM and PM;10 ppb increase in the concentration of SO ,NO ,O; and 1 ppm increase in the CO concentration.

Results: Our analysis contain 18 studies. Underlying short-term exposure effect, for each increment of 10 μg/m in the PM concentration, the combined OR of AF prevalence was 1.01(1.00-1.02), for PM was 1.03(1.01-1.05). For a 10 ppb increment in the concentration of SO, NO, and O was 1.05(1.01-1.09), 1.03(1.01-1.04), and 1.01(0.97-1.06), respectively, for a 1 ppm increase of CO concentration was 1.02(0.99-1.06). Underlying long-term-exposure effect for each increment of 10 μg/m in the PM concentration; the combined OR of AF prevalence was 1.07(1.04-1.10) and that for PM was 1.03(1.03-1.04) For a 10 ppb increment in the NO concentration was 1.02(1.00-1.04).

Conclusion: Our meta-analysis indicated that all air pollutants exposure had an adverse effect on AF prevalence in general population.
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http://dx.doi.org/10.1016/j.ecoenv.2020.111508DOI Listing
January 2021

Treatment Selection and Survival Outcomes in Locally Advanced Proximal Gastric Cancer: A National Cancer Data Base Analysis.

Front Oncol 2020 25;10:537051. Epub 2020 Sep 25.

Department of Surgery, Yale School of Medicine, New Haven, CT, United States.

We aimed to assess long-term survival between locally advanced proximal gastric cancer (LAPGC) patients who underwent proximal gastrectomy (PG) and those who underwent total gastrectomy (TG) to evaluate the optimal extent of resection and adjuvant therapy. Patients diagnosed with locally advanced proximal gastric adenocarcinoma were selected from the National Cancer Data Base (2004-2015) in America. Survival analysis was performed via Kaplan-Meier and Cox proportional hazards models. A total of 4,381 eligible patients were identified, 1,243 underwent PG and 3,138 underwent TG. Patients in TG group had a poor prognosis (hazard ratio [HR] = 1.13, 95% confidence interval [CI]: 1.03-1.25) compared with those in PG group. Moreover, postoperative chemoradiation therapy was associated with improved overall survival compared to surgery alone (HR = 0.71, 95% CI: 0.53-0.97) in LAPGC patients who had PG, while preoperative chemotherapy (HR = 0.74, 95% CI: 0.59-0.92) was associated with improved survival among patients who had TG. Our study suggested that LAPGC patients underwent PG experienced better long-term outcomes than those underwent TG. It also suggested that multimodality treatment of LAPGC, including preoperative chemotherapy followed by TG or postoperative chemotherapy followed by PG, should be considered to achieve better long-term outcomes.
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http://dx.doi.org/10.3389/fonc.2020.537051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7546198PMC
September 2020

Association between fine particulate matter and atrial fibrillation in implantable cardioverter defibrillator patients: a systematic review and meta-analysis.

J Interv Card Electrophysiol 2020 Dec 11;59(3):595-601. Epub 2020 Sep 11.

Department of Thoracic Surgery, Beijing Aerospace General Hospital, Wanyuan North Road, Beijing, 100076, China.

Purpose: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia with several risk factors. Recent studies have suggested that the exposure to fine particulate matter (PM) increased the incidence of AF, but there is no meta-analysis of AF occurrence due to the exposure to PM in implantable cardioverter defibrillator (ICD) patients.

Methods: We conducted a systematic review of publication using PubMed, Embase, the Cochrane library, and Web of Science to explore the association between PM and AF within ICD patients. The chosen studies were published until June 11, 2020. The I statistic and Q test were used to examine statistical heterogeneity across studies. Further sensitivity analyses were carried out to ascertain the reason for heterogeneity. Fixed or random-effect model was used to combine the effects. Final result was presented as the OR with 95% CI of increased incidence of AF for every 10 μg/m PM concentration increased.

Results: After screening our analysis contained four studies and involved 1689 AF events from 572 patients. After using the random-effect model to combine the included study result, the overall OR was 1.24 (95% CI 1.00-1.53).

Conclusion: Our meta-analysis indicated that PM exposure had an adverse effect on AF incidence in ICD patients.
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http://dx.doi.org/10.1007/s10840-020-00864-1DOI Listing
December 2020

Open vs. laparoscopic surgery for locally advanced gastric cancer after neoadjuvant therapy: Short-term and long-term survival outcomes.

Oncol Lett 2020 Jul 14;20(1):861-867. Epub 2020 May 14.

Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, P.R. China.

The aim of the present study was to compare the short-term and long-term survival outcomes of laparoscopic gastrectomy vs. open gastrectomy in treating locally advanced gastric cancer (LAGC) after neoadjuvant therapy. This study retrospectively reviewed the medical records of 270 patients with LAGC, who underwent laparoscopic (n=49) or conventional open (n=221) surgery following neoadjuvant therapy between January 2007 and December 2016 in China National Cancer Center. Postoperative parameters and survival outcomes including overall survival and disease-free survival were analyzed. Patients who underwent laparoscopic gastrectomy (LP) had significantly shorter postoperative stay and a decreased number of metastatic lymph nodes harvested compared to those who underwent open surgery. The 75% disease-free survival (DFS) time in the laparoscopic surgery group (25.7 months) was higher compared with the open surgery group (15.6 months). However, no significant difference was observed in 5-year overall survival and DFS between the two groups. In conclusion, LG provides non-inferior short- and long-term survival outcomes compared with open surgery, suggesting a laparoscopic approach may be justified for patients with LAGC receiving neoadjuvant therapy. More randomized controlled trials are required to investigate the positive effects of LG for LAGC following neoadjuvant therapy.
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http://dx.doi.org/10.3892/ol.2020.11626DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7285756PMC
July 2020

Is subtotal gastrectomy feasible for the treatment of gastric stump cancer located at the anastomotic site after distal gastrectomy for benign lesions?

World J Surg Oncol 2020 Feb 27;18(1):43. Epub 2020 Feb 27.

Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Beijing, 100021, China.

Background: Total gastrectomy (TG) is a widely accepted procedure for treating gastric stump cancer (GSC). However, subtotal gastrectomy (SG) would benefit elective patients with GSC. The aim of this study was to clarify the safety and long-term prognosis of SG in treating GSC after distal gastrectomy for benign lesions.

Methods: A total of 53 patients with GSC located at the anastomotic site or gastric body between May 1999 and December 2018 at our hospital were included. In total, 21 patients underwent SG, and the remaining 24 patients underwent TG. Clinicopathological data, operative data, and overall survival (OS) were compared.

Results: The operative duration, estimated blood loss volume, and length of hospital stay were similar between the SG and TG groups. The postoperative complications were similar between the two groups, but no cases of anastomotic leakage were noted in the SG group. TG was associated with significantly more retrieved lymph nodes than SG (18.5 ± 11.5 vs. 10.7 ± 9.2; p = 0.017), while the number of metastatic lymph nodes did not differ between the groups (2.9 ± 3.5 vs. 1.9 ± 3.6; p = 0.329). The median survival time in the SG group was 81.0 months (95% confidence interval (CI), 68.906 to 93.094 months), which was similar to the 45.0 months (95% CI, 15.920 to 74.080 months) observed in the TG group (p = 0.236). Both univariate and multivariate analyses showed that tumor location and histological type were prognostic factors, while surgery type was not a prognostic factor. Further stratified analyses according to tumor location revealed that OS was not significantly different between the two groups among patients with tumors located at the anastomotic site, while OS in the TG group was significantly better than that in the SG group among patients with tumors located in the gastric body (p = 0.046).

Conclusions: The results of the current study indicate that SG is a suitable alternative surgical procedure for GSC located at the anastomotic site after distal gastrectomy for benign lesions. The short-term outcomes and long-term prognoses of SG are comparable with those of TG.
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http://dx.doi.org/10.1186/s12957-020-01821-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047362PMC
February 2020

Long-term Results of Conversion Therapy for Initially Unresectable Gastric Cancer: Analysis of 122 Patients at the National Cancer Center in China.

J Cancer 2019 15;10(24):5975-5985. Epub 2019 Oct 15.

Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

To assess the long-term survival and prognostic factors of conversion therapy in patients with initially unresectable gastric cancer. We conducted a retrospective study of clinicopathological and survival data of 122 consecutive patients who were diagnosed with initially unresectable gastric cancer and underwent the conversion surgery after systemic chemotherapy at the China National Cancer Center between May 2006 and May 2017. For all the 122 patients, the 3- and 5-year overall survival (OS) rates from the date of chemotherapy initiation were 61.0% and 52.0%, respectively, with a median OS of 63.6 months. During follow-up, the recurrence was observed in 49 (40.1%) patients who underwent conversion surgery. According to the multivariate COX regression analysis, receipt of postoperative adjuvant chemotherapy (POAC) was the only significant independent predictor of a favorable OS (HR 0.40; 95% CI 0.18-0.85, =0.017). Log-rank analysis showed that POAC group experienced a survival advantage in terms of PFS when compared with observation group (HR 0.53, 95%CI 0.31-0.92, =0.009). Conversion therapy may provide long-term survival for patients with initially unresectable gastric cancer. Postoperative adjuvant chemotherapy might be recommended for patients who underwent conversion therapy.
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http://dx.doi.org/10.7150/jca.35527DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6856572PMC
October 2019

Polybrominated Diphenyl Ethers, Polybrominated Biphenyls, and Risk of Papillary Thyroid Cancer: A Nested Case-Control Study.

Am J Epidemiol 2020 02;189(2):120-132

Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut.

A nested case-control study was carried out using data from the US Department of Defense cohort between 2000 and 2013 to investigate the associations of papillary thyroid cancer (PTC) with serum concentrations of polybrominated diphenyl ethers and polybrominated biphenyls. This study included 742 histologically confirmed PTC cases (in 341 women and 401 men) and 742 matched controls with prediagnostic serum samples from the Department of Defense Serum Repository. Lipid-corrected serum concentrations of 8 congeners were measured. Multivariate conditional logistic regression analyses were performed for classical PTC and follicular variant of PTC, respectively. We also examined effect modification by sex. BDE-28, a polybrominated diphenyl ether congener, was associated with significantly increased risk of classical PTC (for the third tertile vs. below the limit of detection, odds ratio = 2.09, 95% confidence interval: 1.05, 4.15; P for trend = 0.02), adjusting for other congeners, body mass index, and branch of military service. This association was observed mainly for larger classical PTC (tumor size > 10 mm), with a significantly stronger association among women than men (P for interaction = 0.004). No consistent associations were observed for other congeners, including those at higher concentrations. This study found a significantly increased risk of classical PTC associated with increasing levels of BDE-28. The risk varied by sex and tumor size.
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http://dx.doi.org/10.1093/aje/kwz229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7156139PMC
February 2020

Clinicopathological Characteristics and Prognosis of Proximal and Distal Gastric Cancer during 1997-2017 in China National Cancer Center.

J Oncol 2019 13;2019:9784039. Epub 2019 Jun 13.

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: The prognostic relevance of gastric tumor location has been reported and debated. Our study was conducted to examine the differences in clinicopathological features, prognostic factors, and overall survival (OS) between patients with proximal gastric cancer (PGC) and distal gastric cancer (DGC).

Patients And Methods: Patients with PGC or DGC were identified from the China National Cancer Center Gastric Cancer Database (NCCGCDB) during 1997-2017. Survival analysis was performed via Kaplan-Meier estimates and Cox proportional hazards models.

Results: We reviewed 16,119 cases of gastric cancer patients, including 6,479 of PGC and 9,640 of DGC. PGC patients presented as older patients (61.5 versus 56.4 years, 0.001) and more males (82.9% versus 68.2%, <0.001). Compared with DGC, PGC was more likely to be in later pT stage (pT3 and pT4, 65.0% versus 52.8%, <0.001) and lymph node metastasis (54.8% versus 50.9%, <0.001). In univariate analysis, PGC patients had a worse survival outcome in stage I (Hazard ratio [HR] = 2.04, 95% CI: 1.42-2.94) but a better prognosis in stage IV (HR = 0.85, 95% CI: 0.73-0.98) when compared to DGC patients. However, multivariate analysis demonstrated that PGC was not an independent predictor for poor survival (HR = 1.07, 95% CI: 1.00-1.14). Results from multivariate analysis also revealed that pT4, lymph node metastasis, distant metastasis, no gastrectomy, and Borrmann IV were independent predictors associated with poor survival for both PGC and DGC patients. Additional prognostic factors for PGC patients included underweight (BMI < 18.5) (HR = 1.29, 95% CI: 1.06-1.58), linitis plastica (HR = 2.13, 95% CI: 1.25-3.65), and overweight (23 ≤ BMI <27.5) (HR = 0.80, 95% CI: 0.71-0.90). During the 20-year study period, the 5-year OS increased significantly for both PGC and DGC, with the increase rate of 91.7% and 67.7%, respectively.

Conclusion: In China, PGC significantly differed from DGC in clinicopathological characteristics and prognostic factors. However, there was no significant relationship between survival outcome and gastric tumor location.
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http://dx.doi.org/10.1155/2019/9784039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6595386PMC
June 2019

Comparison on Clinicopathological Features, Treatments and Prognosis between Proximal Gastric Cancer and Distal Gastric Cancer: A National Cancer Data Base Analysis.

J Cancer 2019 2;10(14):3145-3153. Epub 2019 Jun 2.

Department of Surgery, Yale School of Medicine, New Haven, CT 06520, United States.

: The aim of this study was to examine the differences in clinicopathological features, treatment strategies and prognosis between patients with proximal gastric cancer (PGC) and distal gastric cancer (DGC). : Patients with gastric adenocarcinoma were identified from the National Cancer Database during the years 2004-2015. Survival analysis was performed via Kaplan-Meier and Cox proportional hazards models. : A total of 97,060 patients were identified with gastric adenocarcinoma. DGC was associated with older age, more advanced tumor stage, and poorly differentiated tumors compared with PGC (all <0.01). In the multivariate analysis, patients with DGC had a worse prognosis compared with those with PGC. In early and locally advanced stage, the prognosis of DGC was better compared with PGC. In distant metastasis stage, the prognosis of DGC was worse compared with PGC. Compared with patients underwent gastrectomy who received adjuvant therapy (AT) in locally advanced stage, a survival benefit was seen for DGC patients who received neoadjuvant therapy (NAT) or NAT plus AT, whereas PGC patients with locally advanced disease did not share this result (>0.05). : PGC and DGC differed in their clinicopathologic characteristics and prognosis and heterogeneity may be due to differences in tumor biology. Tumor location should be taken into consideration when stratifying patients for optimal therapeutic strategies.
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http://dx.doi.org/10.7150/jca.30371DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6603385PMC
June 2019

[A Preliminary Study to Evaluate the Efficacy and Safety of A Optimized Computed Tomography-guided Pulmonary Nodule Microcoil Localization Technique].

Zhongguo Fei Ai Za Zhi 2019 Jun;22(6):349-354

Department of Thoracic Surgery, Beijing Aerospace General Hospital, Beijing 100076, China.

Background: Preoperative computed tomography (CT) guided microcoil localization is a common method for small lung nodules before video-assisted thoracoscopic surgery (VATS). However, this method still has some limitation such as complicated operation and slight complications. We have optimized the original method. The purpose of this study was to investigate the clinical value of this optimized method.

Methods: 35 pulmonary nodules from 31 patients between September 2018 and January 2019 were localized by the optimized method before VATS. The success rate, complications, pathological results and localization operations related data were statistically analyzed.

Results: The success rate of localization was 97.1%, and the success rate of VATS removal was 100%. The average operation time was 10.1 min (5 min-31 min), and the average time required for resection of lesions was 38.2 min (10 min-100 min). During the surgery, the microcoil of one patient was found to be dislocated and retracted into the chest wall. A puncture needle was inserted intolung tissue from the chest wall puncture point after the lung was inflated, and then the pulmonary nodule were successfully located and removed. A minor pneumothorax occurred in 3 patients, but no closed drainage was needed. Three patients developed intrapulmonary hematoma. The pathological results of 35 pulmonary nodules included 15 well-differentiated adenocarcinoma, 7 carcinoma in situ, 5 microinvasive adenocarcinoma, 4 atypical adenomatoid hyperplasia, 2 intrapulmonary lymph node hyperplasia, 2 inflammatory nodules.

Conclusions: For small pulmonary nodules requiring thoracoscopic surgery, the optimized computed tomography-guided pulmonary nodule microcoil localization technique is convenient, safe and effective, and worthy of promotion to use.
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http://dx.doi.org/10.3779/j.issn.1009-3419.2019.06.04DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6580085PMC
June 2019

Experts' consensus on intraoperative radiotherapy for pancreatic cancer.

Cancer Lett 2019 05 14;449:1-7. Epub 2019 Feb 14.

National Cancer Center, China and Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China. Electronic address:

Pancreatic cancer (PC), one of the most lethal malignancies, accounts for 8%-10% of digestive system cancers, and the incidence is increasing. Surgery, chemotherapy, and radiotherapy have been the main treatment methods but are not very effective. However, only 20% of patients have the opportunity to undergo surgical operation. Approximately 30-40% of patients present with locally advanced, unresectable pancreatic cancer because of invasion of mesenteric vessels or adjacent organs. The first patient with unresectable pancreatic cancer was treated with Intraoperative radiotherapy (IORT) in 1959 [1]. Since then, new surgical and radiotherapeutic techniques have been developed, clinical trials have provided new evidence, and intriguing long-term effects have emerged from global metadatabases. IORT has the advantages of more accurate target, better local control rate, less complications, longer survival time and better life quality. During the past decade, IORT has been applied in some hospitals in the world, but there is little agreement on technical details and standards. A guidelines of IORT in pancreatic cancer is therefore necessary and timely. To develop standardized criteria for the application of IORT in pancreatic cancer, the experts from China to discuss treatment methods and arrive at a consensus on the indications, contraindications, and preferred techniques of IORT in pancreatic cancer. This detailed and agreed technical description of IORT may have implications on training, assessment, quality control, and future research.
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http://dx.doi.org/10.1016/j.canlet.2019.01.038DOI Listing
May 2019

First-line chemotherapy regimens for locally advanced and metastatic pancreatic adenocarcinoma: a Bayesian analysis.

Cancer Manag Res 2018 20;10:5965-5978. Epub 2018 Nov 20.

Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College,

Background: Systemic chemotherapy is the standard treatment for locally advanced and metastatic pancreatic cancer, but there is no consensus on the optimum regimen. We aimed to compare and rank the locally advanced and metastatic pancreatic adenocarcinoma chemotherapy regimens evaluated in randomized controlled trials (RCTs) in the past 15 years.

Materials And Methods: PubMed, Embase, Cochrane Collaboration database, and ClinicalTrials.gov were searched for RCTs comparing chemotherapy regimens as first-line treatment for locally advanced and metastatic pancreatic adenocarcinomas. By using Bayesian network meta-analysis, we compared and ranked all included chemotherapy regimens in terms of overall survival, progression-free survival, response rate, and hematological toxicity.

Results: The analysis included 68 RCTs, with 14,908 patients and 63 treatment strategies. For overall survival, NSC-631570 (hazard ratio [HR] vs gemcitabine monotherapy 0.44, 95% credible interval: 0.24-0.76) and gemcitabine+NSC-631570 (HR 0.45, 0.24-0.86) were the two top-ranked chemotherapy regimens. For progression-free survival, PEFG (cisplatin + epirubicin + fluorouracil + gemcitabine) ranked first (HR 0.51, 0.34-0.77). PG (gemcitabine + pemetrexed) (odds ratio [OR] 4.68, 2.24-9.64) and FLEC (fluorouracil + leucovorin + epirubicin + carboplatin) (OR 4.52, 1.14-24.00) were ranked the most hematologically toxic, with gastrazole having the least toxicity (OR 0.03, 0.00-0.46).

Conclusion: The chemotherapy regimens NSC-631570 and gemcitabine+NSC-631570 were ranked the most efficacious for locally advanced and metastatic pancreatic adenocarcinomas in terms of overall survival, which warrants further confirmation in large-scale RCTs.
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http://dx.doi.org/10.2147/CMAR.S162980DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254987PMC
November 2018

[Preoperative Computed Tomography-guided Microcoil Localization for Multiple Small Lung Nodules before Video-assisted Thoracoscopic Surgery].

Zhongguo Fei Ai Za Zhi 2018 Nov;21(11):857-863

Department of Thoracic Surgery, Beijing Aerospace General Hospital, Beijing 100076, China.

Background: Localization of multiple small lung nodules is the technical difficulty of minimally invasive operation resection. However, there are few clinical studies on the preoperative localization of multiple small lung nodules. This study was designed to evaluate the clinical value of preoperative computed tomography (CT) guided microcoil localization for multiple small lung nodules compared with single small lung nodule before video-assisted thoracoscopic surgery (VATS).

Methods: A retrospective analysis of the clinical data of 235 patients with preoperative pulmonary nodules microcoil localization was performed. According to whether the nodules were single, they were divided into single nodule group (184 cases) and multiple nodules group (51 cases) (multiple nodules group). The single nodule group was positioned under CT-guided conventional methods. The multiple nodules group were CT guided localized by microcoil in batches according to priority before VATS. The success rate, complications, pathological results and localization operations related data were statistically analyzed.

Results: The success rate of localization in multiple nodule groups was 90.2%, there was no significant difference compared with the single nodule group (90.2% vs 94.6%, P=0.205). The occurrence rate of pneumothorax in multiple nodule group and single nodule group was no statistical difference (21.6% vs 14.1%, P=0.179), however, the operation time in the multiple nodule group was significantly longer than the single nodule group [(30.6±6.6) min vs (19.9±7.4) min, P=0.000]. There were no serious complications such as massive hemoptysis, air embolism or hemothorax. There was no conversion to thoracotomy due to failure of localizing the nodules during operation. Sub-lobectomy was the main method of operation. The majority of postoperative pathologies were non-invasive carcinomas.

Conclusions: For multiple small lung pulmonary nodules requiring thoracoscopic surgery, according to certain strategies, preoperative CT-guided localized by microcoil in batches according to priority before VATS is safe and effective, and worthy of promotion.
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http://dx.doi.org/10.3779/j.issn.1009-3419.2018.11.08DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6247003PMC
November 2018

Cell phone use and risk of thyroid cancer: a population-based case-control study in Connecticut.

Ann Epidemiol 2019 01 29;29:39-45. Epub 2018 Oct 29.

Department of Surgery, Yale School of Medicine, New Haven, CT; Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT. Electronic address:

Purpose: This study aims to investigate the association between cell phone use and thyroid cancer.

Methods: A population-based case-control study was conducted in Connecticut between 2010 and 2011 including 462 histologically confirmed thyroid cancer cases and 498 population-based controls. Multivariate unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for associations between cell phone use and thyroid cancer.

Results: Cell phone use was not associated with thyroid cancer (OR: 1.05, 95% CI: 0.74-1.48). A suggestive increase in risk of thyroid microcarcinoma (tumor size ≤10 mm) was observed for long-term and more frequent users. Compared with cell phone nonusers, several groups had nonstatistically significantly increased risk of thyroid microcarcinoma: individuals who had used a cell phone >15 years (OR: 1.29, 95% CI: 0.83-2.00), who had used a cell phone >2 hours per day (OR: 1.40, 95% CI: 0.83-2.35), who had the most cumulative use hours (OR: 1.58, 95% CI: 0.98-2.54), and who had the most cumulative calls (OR: 1.20, 95% CI: 0.78-1.84).

Conclusions: This study found no significant association between cell phone use and thyroid cancer. A suggestive elevated risk of thyroid microcarcinoma associated with long-term and more frequent uses warrants further investigation.
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http://dx.doi.org/10.1016/j.annepidem.2018.10.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6344271PMC
January 2019

Alcohol Consumption and Risk of Thyroid Cancer: A Population Based Case-Control Study in Connecticut.

Adv Exp Med Biol 2018;1032:1-14

Department of Surgery, Yale School of Medicine, New Haven, CT, USA.

Background: Studies examining the association between alcohol consumption and thyroid cancer risk have been inconsistent, in part due to varying types and amounts of alcohol consumption, incomplete information on confounders, and variations in genetic susceptibility in study populations.

Methods: The present study analyzed data from a population-based case-control study in Connecticut in 2010-2011 including 462 histologically confirmed incident thyroid cancer cases and 498 population-based controls. Unconditional logistic regression was used to estimate associations between alcohol consumption and risk of thyroid cancer. Potential confounding variables were age, gender, race, education, body mass index, family history of cancer among first-degree relatives, history of benign thyroid disease, smoking status, and physical activity.

Results: Ever consumption of alcohol was associated with a reduced risk of thyroid cancer (OR = 0.71, 95% CI: 0.54-0.95). The younger age at initiation and increasing duration of alcohol consumption were also associated with a reduced risk of thyroid cancer in a dose-dependent manner (P for trend = 0.041 and 0.0065, respectively). Compared to people who never drank alcohol, people who drank alcohol for >31 years were 50% less likely to develop thyroid cancer (OR = 0.50, 95% CI: 0.32-0.80). Alcohol consumption was associated with a reduced risk of papillary thyroid cancer (OR = 0.66, 95% CI: 0.49-0.88) and thyroid cancer with lager tumor size (>1 cm), but no significant association was found between alcohol consumption and non-papillary thyroid cancer or thyroid microcarcinoma. Analyses stratified by specific subtypes of alcohol demonstrated an inverse association for beer (OR = 0.69, 95% CI: 0.49-0.96) and wine consumption (OR = 0.71, 95% CI: 0.53-0.96) as compared to participants who never consumed alcohol, but no significant association was found for liquor consumption (OR = 0.75, 95% CI: 0.53-1.04).

Conclusions: The study findings suggest an inverse association between alcohol consumption and risk of thyroid cancer. Future mechanistic study is warranted to elucidate the underlying mechanisms.
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http://dx.doi.org/10.1007/978-3-319-98788-0_1DOI Listing
May 2019

Systemic Chemotherapy as First-line Treatment for Metastatic Pancreatic Adenocarcinoma: A Bayesian Analysis.

Intern Med 2018 Aug 24. Epub 2018 Aug 24.

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

Objective The preferred chemotherapy regimen for metastatic pancreatic cancer remains a matter of controversy. In the present study, we aimed to assess and rank the effectiveness and toxicity of all of the available chemotherapy regimens included in the last 15 years' randomized controlled trials (RCTs) for metastatic pancreatic adenocarcinomas objectively. Methods PubMed, Embase, Cochrane Collaboration database, and ClinicalTrials.gov were searched for RCTs comparing chemotherapy regimens as first-line treatment for metastatic pancreatic adenocarcinomas. Using a Bayesian network meta-analysis, we compared and ranked all included chemotherapy regimens in terms of the overall survival, progression-free survival, response rate, and hematological toxicity. Results We identified 2,206 articles and included in the analysis 46 eligible articles reporting 44 RCTs with a total of 9,133 patients and 48 first-line intravenous systemic chemotherapy regimens. The models showed a good fit to the data. The top-ranked chemotherapy regimen for the overall survival was FP (simplified leucovorin + fluorouracil + nab-paclitaxel), with a hazard ratio (HR) of 0.45 versus gemcitabine monotherapy (95% credible interval 0.28-0.71). The regimen ranked first for the progression-free survival was gemcitabine + erlotinib + bevacizumab (HR 0.39, 0.23-0.62). GS (gemcitabine + S-1) had the highest overall response rate [odds ratio (OR) versus gemcitabine monotherapy 7.06, 1.15-51.15]. GemCape (gemcitabine + capecitabine) + erlotinib was ranked the most hematologically toxic (OR 7.78, 0.75-95.60). Conclusion The available evidence suggests that FP ranked first for metastatic pancreatic cancer in terms of the overall survival. GemCape + erlotinib ranked the most toxic.
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http://dx.doi.org/10.2169/internalmedicine.1114-18DOI Listing
August 2018

Clinicopathologic characteristics, laboratory parameters, treatment protocols, and outcomes of pancreatic cancer: a retrospective cohort study of 1433 patients in China.

PeerJ 2018 28;6:e4893. Epub 2018 May 28.

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

Objectives: The prognosis of people with pancreatic cancer is extremely unfavorable. However, the prognostic factors remain largely undefined. We aimed to perform comprehensive analyses of clinicopathologic characteristics, laboratory parameters, and treatment protocols for exploring their role as prognostic factors of pancreatic cancer.

Methods: Patients diagnosed with pancreatic cancer and hospitalized at the China National Cancer Center between April 2006 and May 2016 were enrolled in this retrospective cohort study. Clinicopathologic characteristics, laboratory parameters, and treatment protocols were compared among patients at different stages of the disease. The association between these factors and overall survival (OS) was analyzed using the Kaplan-Meier method and Cox proportional hazards model.

Results: The present study included 1,433 consecutive patients with pancreatic cancer. Median OS was 10.6 months (95% confidence interval [CI] 9.8-11.3 months), with 1-, 3-, and 5-year survival rates of 43.7%, 14.8%, and 8.8%, respectively. Cox multivariate analysis findings identified the following factors as independent predictors of OS: gender (female vs male, hazard ratio 0.72, 95% CI [0.54-0.95]); elevated total bilirubin (TBil; 1.82, 1.34-2.47); elevated carbohydrate antigen 19-9 (CA19-9; 1.72, 1.17-2.54); tumor being located in pancreatic body and tail (1.52, 1.10-2.10); advanced T stage (T3-4 vs T1-2, 1.62, 1.15-2.27); lymph node metastasis (1.57, 1.20-2.07); distant metastasis (1.59, 1.12-2.27); the presence of surgical resection (0.53, 0.34-0.81); and the presence of systemic chemotherapy (0.62, 0.45-0.82).

Conclusions: Being male, elevated TBil and carcinoembryonic antigen, tumor being located in pancreatic body and tail, advanced T stage, lymph node and distant metastasis, the absence of surgical resection, and the absence of systematic chemotherapy were associated with worse OS in patients with pancreatic cancer.
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http://dx.doi.org/10.7717/peerj.4893DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5978392PMC
May 2018

Clinicopathological Characteristics, Surgical Treatments, and Survival Outcomes of Patients with Duodenal Gastrointestinal Stromal Tumor.

Dig Surg 2019 22;36(3):206-217. Epub 2018 Mar 22.

Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,

Background: Duodenal gastrointestinal stromal tumors (GISTs) are rare and their clinicopathological features have not been completely described. In this retrospective study, we examined the characteristics and long-term outcomes of patients who underwent surgical treatment for duodenal GISTs.

Methods: We examined patients surgically treated for duodenal GISTs from 1999 to 2016 at the China National Cancer Center. We analyzed patient characteristics, treatments, histological examinations, and survival outcomes.

Results: The 52 surgeries performed included 14 pancreaticoduodenectomies (26.9%), 37 limited resections (71.2%), and one palliative bypass procedure (1.9%). No surgery-related death occurred. The complication rate in patients who underwent pancreaticoduodenectomy was slightly higher than that in patients who underwent limited resection. The 5-year overall survival and progression-free survival rates for patients with duodenal adenocarcinoma were 89.1 and 72.9%, respectively. The overall survival and progression-free survival rates were not significantly related to surgical methods. Large tumor size and high mitotic rate were associated with poor overall survival outcomes. However, no independent factor was associated with prognosis, which may be due to the small sample size.

Conclusion: The prognosis of duodenal gastrointestinal stromal tumors was good. Limited resection seems to be oncologically feasible, with outcomes being less worse than those of pancreaticoduodenectomy.
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http://dx.doi.org/10.1159/000488008DOI Listing
October 2019

Effects of alcohol drinking and smoking on pancreatic ductal adenocarcinoma mortality: A retrospective cohort study consisting of 1783 patients.

Sci Rep 2017 08 29;7(1):9572. Epub 2017 Aug 29.

Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.

The effects of alcohol drinking and smoking on pancreatic ductal adenocarcinoma (PDAC) mortality are contradictory. Individuals who were diagnosed as PDAC and hospitalized at the China National Cancer Center between January 1999 and January 2016 were identified and included in the study. Ultimately, 1783 consecutive patients were included in the study. Patients were categorized as never, ex-drinkers/smokers or current drinkers/smokers. Hazard ratios (HRs) of all-cause mortality and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models. Compared with never drinkers, the HRs were 1.25 for ever drinkers, 1.24 for current drinkers, and 1.33 for ex-drinkers (trend P = 0.031). Heavy drinking and smoking period of 30 or more years were positive prognostic factors for PDAC. For different smoking and alcohol drinking status, only subjects who are both current smokers and current drinkers (HR, 1.45; 95% CI, 1.03-2.05) were associated with reduced survival after PDAC compared to those who were never smokers and never drinkers. Patients who are alcohol drinkers and long-term smokers before diagnosis have a significantly higher risk of PDAC mortality. Compared to those who neither smoker nor drink, only patients who both smokers and drinkers were associated with reduced survival from PDAC.
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http://dx.doi.org/10.1038/s41598-017-08794-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574975PMC
August 2017

Clinicopathological features, surgical treatments, and survival outcomes of patients with small bowel adenocarcinoma.

Medicine (Baltimore) 2017 Aug;96(31):e7713

Department of Pancreatic and Gastric Surgery State Key Laboratory of Molecular Oncology Department of Clinical Laboratory, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China Department of Biotherapy, Beijing Hospital, National Center of Gerontology, Beijing, China.

To date, because of their rarity, the clinicopathological features and surgical outcomes of small bowel adenocarcinomas (SBAs) have been insufficiently explored. We evaluated the clinicopathological features and long-term outcomes of patients who underwent surgery for SBA.This retrospective study (from 1999 to 2016) examined patients with SBA treated surgically at the China National Cancer Center/Cancer Hospital. Clinicopathological features, preoperative evaluation, surgical treatment, and outcome parameters were reviewed and analyzed.Among the 241 patients studied, pancreaticoduodenectomies were performed in 51.0%, partial resection in 24.5%, palliative bypass surgery in 23.7%, and abdominal exploration in 0.8% of the patients. Majority of the patients were diagnosed at an advanced disease stage, and the duodenum was the most common tumor site. Postoperative complications occurred in 44.4% of the patients. Median overall and progression-free survival rates were 22.0 and 13.0 months, respectively. The 5-year overall and progression-free survival rates for patients with duodenal adenocarcinoma were 30.2% and 21.7%, respectively. Duodenal adenocarcinomas, lymph node metastases, distant metastases, poor differentiation, and lymphovascular invasion were associated with poor overall survival outcomes. The 3 factors associated with progression-free survival were the degree of differentiation, lymph node metastases, and distant metastases.Surgery remains the mainstay of treatment for SBA. A poor prognosis could be owing to the site, metastasis, differentiation, and lymphovascular invasion; however, the prognosis may improve through early diagnosis and operation.
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http://dx.doi.org/10.1097/MD.0000000000007713DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5626164PMC
August 2017

Clinicopathologic features, surgical treatments, and outcomes of small bowel tumors: A retrospective study in China.

Int J Surg 2017 Jul 2;43:145-154. Epub 2017 Jun 2.

Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China. Electronic address:

Background: Small bowel tumors are relatively rare. Accumulation of data regarding their clinical presentation, pathologic features, prognostic factors, treatment modalities, and outcome has been an issue. We summarize the clinicopathologic features and evaluate the long-term outcome of patients with small bowel tumors who underwent surgery.

Methods: This is a retrospective study of medical records of 456 patients with small bowel tumors treated surgically at a Cancer Hospital between 1999 and 2016.

Results: The study included 275 males (60.3%) and 181 females (39.7%). Small bowel tumors were difficult to diagnose because of non-specific symptoms. The most common symptoms were alimentary symptoms (56.8%) and abdominal pain (37.3%). Final histopathology revealed 241 adenocarcinomas (52.9%), 153 gastrointestinal stromal tumors (GISTs; 33.6%), 16 neuroendocrine tumors (NETs; 3.5%), and 46 other types of tumors (10.1%). The 456 surgeries performed included 153 pancreaticoduodenectomies, 241 limited duodenum resections, 60 palliative bypass surgeries, and 2 abdominal explorations. The 5-year overall survival and progression-free survival rates for patients with small bowel tumor were 57.2% and 44.6%, respectively. Adenocarcinomas resulted in the worst overall survival compared to GISTs or NETs, and tumors with duodenal location resulted in a worse survival compared to those with non-duodenal location.

Conclusion: Surgery is the mainstay of treatment for small bowel tumors. Adenocarcinomas and duodenal involvement seem to contribute to poor outcomes.
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http://dx.doi.org/10.1016/j.ijsu.2017.05.076DOI Listing
July 2017

Perivascular epithelial cell tumor (PEComa) of the pancreas: A case report and review of literature.

Medicine (Baltimore) 2017 Jun;96(22):e7050

Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing Department of Oncology, Bozhou People's Hospital, Bozhou Department of Abdominal Surgery, Cancer Hospital of Chinese Academy of Medical Sciences, Shenzhen Center, Shenzhen Cancer Hospital, Shenzhen State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing Department of Medical Oncology, Affiliated Hospital of Qinghai University, Xining, China.

Rationale: Perivascular epithelial cell tumors (PEComas) of the pancreas are rare mesenchymal tumors and, to our knowledge, only 20 cases have been reported to date.

Patient Concerns: We report a 43-year-old female who presented with upper abdominal pain for 1 year. She underwent an exploratory laparotomy at a local hospital, which failed to resect the tumor. Five months later, she came to the Chinese National Cancer Center for surgery. Preoperative imaging revealed an 11.5-cm-sized mass located in the head of the pancreas. At the microscopic level, the tumor was composed of epithelioid and spindle cells possessing clear to focally granular eosinophilic cytoplasm, which grew in a nested and alveolar pattern around blood vessels. The tumor cells showed immunoreactivity for human melanoma black 45 (HMB-45), but did not express epithelial or endocrine markers.

Diagnoses: Pancreatic PEComa.

Interventions: Pancreaticoduodenectomy, partial hepatectomy, and vascular replacement were performed. After the surgery, the patient received 4 cycles of chemotherapy.

Outcomes: The patient is free of recurrence and metastasis 1.5 years after surgical resection.

Lessons: PEComa should be recognized as a preoperative differential diagnosis of pancreatic tumors. For treatment, removal of the tumor should be attempted, and in the case of tumors with malignant tendencies, the addition of chemotherapy should be considered.
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http://dx.doi.org/10.1097/MD.0000000000007050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5459730PMC
June 2017

Duct-to-mucosa versus invagination pancreaticojejunostomy after pancreaticoduodenectomy: a meta-analysis.

Oncotarget 2017 Jul;8(28):46449-46460

Department of abdominal surgery, Cancer hospital of Chinese Academy of Medical Sciences, Shenzhen center, Shenzhen cancer hospital, Shenzhen, 518116, China.

Objective: We aimed to compare the two most commonly used pancreatico-jejunostomy reconstruction techniques-duct-to-mucosa and invagination.

Methods: Databases, including MEDLINE, EMBASE, Cochrane Library, and several clinical trial registration centers were searched. Randomized controlled trials that compared duct-to-mucosa and invagination pancreaticojejunostomy techniques after pancreaticoduodenectomy were included and analyzed.

Results: In total, seven RCTs were included, involving 850 patients. The difference in postoperative pancreatic fistula rate between the duct-to-mucosa and invagination pancreaticojejunostomy was not significant (RR = 1.03, 95% CI = 0.76-1.39, P = 0.86). There was no significant difference in clinically relevant postoperative pancreatic fistula between the two groups (RR = 0.78, 95% CI = 0.15-3.96, P = 0.77). The overall morbidity, overall mortality, delayed gastric emptying, intra-abdominal collection, reoperation rate, and length of hospital stay between the two groups were not significantly different. Sensitivity analysis showed that the meta-analysis was stable. Further, no significant publication bias was seen.

Conclusions: Duct-to-mucosa and invagination pancreaticojejunostomy techniques after pancreaticoduodenectomy were comparable in terms of postoperative pancreatic fistula incidence and other parameters.
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http://dx.doi.org/10.18632/oncotarget.17503DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5542280PMC
July 2017

Are Internal or External Pancreatic Duct Stents the Preferred Choice for Patients Undergoing Pancreaticoduodenectomy? A Meta-Analysis.

Biomed Res Int 2017 30;2017:1367238. Epub 2017 Mar 30.

Department of Abdominal Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

The technique of pancreatic duct stenting during pancreatic anastomosis can markedly reduce the incidence of postoperative pancreatic fistula (PF) after pancreaticoduodenectomy (PD). The method of drainage includes using either an external or an internal stent; the meta-analysis result shows us that there were no differences in the rates of postoperative complications between PD using internal stents and PD using external stents; internal stents may be more favorable during postoperative management of drainage tube. What is more, internal stents could reduce the digestive fluid loss and benefit the digestive function.
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http://dx.doi.org/10.1155/2017/1367238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5390541PMC
February 2018

Use of Dietary Vitamin Supplements and Risk of Thyroid Cancer: A Population-Based Case-Control Study in Connecticut.

Int J Vitam Nutr Res 2016 Jun 24;86(3-4):189-197. Epub 2017 Apr 24.

2 Yale School of Public Health, Yale School of Medicine, New Haven, CT, USA.

Certain dietary supplements have been reported to increase the risk of some cancers. Over half of the US population regularly uses dietary supplements. Thyroid cancer incidence has increased over the past several decades. However, few studies have investigated the association between dietary supplements and thyroid cancer. Thus, it is essential to clarify any association between dietary supplements and risk of thyroid cancer.

Materials And Methods: A population-based case-control study in Connecticut was conducted during 2010-2011 among 462 histologically confi rmed incident thyroid cancer cases and 498 population-based controls. Dietary supplement intake was ascertained through in-person interviews and a food frequency questionnaire. Multivariate unconditional logistic regression models were used to estimate the risk of thyroid cancer and dietary supplement use.

Results: Overall, no statistically signifi cant associations were observed between dietary supplementation and thyroid cancer risk. Stratifi ed analyses revealed a suggestive protective effect on risk of papillary microcarcinoma among longterm (> 10 years) use of multivitamins (OR = 0.59, 95 % CI: 0.33, 1.04) and calcium supplementation (OR = 0.45, 95 % CI: 0.22, 0.93). An increased risk of large papillary thyroid cancers (tumor size > 1 cm) was observed among short-term (< 5 years) users of calcium supplements (OR = 2.24, 95 % CI: 1.30, 3.88).

Discussion: No signifi cant associations were observed between supplementation and overall thyroid cancer risk. The different associations between calcium supplements and risk of papillary thyroid cancer by tumor size warrant further investigation.
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http://dx.doi.org/10.1024/0300-9831/a000403DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5654698PMC
June 2016

Thyroid-Stimulating Hormone, Thyroid Hormones, and Risk of Papillary Thyroid Cancer: A Nested Case-Control Study.

Cancer Epidemiol Biomarkers Prev 2017 08 4;26(8):1209-1218. Epub 2017 Apr 4.

Department of Surgery, Yale School of Medicine, Yale Cancer Center, New Haven, Connecticut.

The effects of thyroid-stimulating hormone (TSH) and thyroid hormones on the development of human papillary thyroid cancer (PTC) remain poorly understood. The study population consisted of 741 (341 women, 400 men) histologically confirmed PTC cases and 741 matched controls with prediagnostic serum samples stored in the Department of Defense Serum Repository. Concentrations of TSH, total T3, total T4, and free T4 were measured in serum samples. Conditional logistic regression models were used to calculate ORs and 95% confidence intervals (CI). The median time between blood draw and PTC diagnosis was 1,454 days. Compared with the middle tertile of TSH levels within the normal range, serum TSH levels below the normal range were associated with an elevated risk of PTC among women (OR, 3.74; 95% CI, 1.53-9.19) but not men. TSH levels above the normal range were associated with an increased risk of PTC among men (OR, 1.96; 95% CI, 1.04-3.66) but not women. The risk of PTC decreased with increasing TSH levels within the normal range among both men and women ( = 0.0005 and 0.041, respectively). We found a significantly increased risk of PTC associated with TSH levels below the normal range among women and with TSH levels above the normal range among men. An inverse association between PTC and TSH levels within the normal range was observed among both men and women. These results could have significant clinical implications for physicians who are managing patients with abnormal thyroid functions and those with thyroidectomy. .
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http://dx.doi.org/10.1158/1055-9965.EPI-16-0845DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494475PMC
August 2017