Objective To review the relationship between histone modifications and gastrointestinal cancer. Methods Literatures on histone modifications and the relationship between histone modifications and gastrointestinal cancer were collected and reviewed. Results Histone modifications played an important role in the establishment of gene silencing during tumorgenesis. DNA methylation and histone modifications might interact with each other and form a complex network to establish and maintain gene silencing. Restoring gene function silenced by epigenetic changes in cancer had the potential of ‘normalizing’ cancer cells, which was named epigenetic therapy. Epigenetic therapy was very promising in prevention and treatment of gastrointestinal cancer, but many unsolved issues remain which need to be addressed in future studies. Conclusion Histone modifications are associated with the pathogenesis of gastrointestinal cancer. Restoring gene function silenced by epigenetic changes may have a great role in the prevention and treatment of gastrointestinal cancer.
Objective To discuss the clinicopathologic risk factors related to local recurrence of rectal cancer after radical surgery. Methods The complete clinicopathologic data of 368 patients with rectal cancer from January 2004 to April 2011 in this hospital were retrospectively analyzed by univariate and multivariate analysis methods. Results There were 73 cases suffered from local recurrence and accounted for 19.84% （73/368） of rectal cancer during the same period. Univariate analysis results showed that gender， tumor from anal margin， tumor circumference， TNM staging， histology type， vessel infiltration， tumor perforation， stomal leak， and chemoradiotherapy were associated with postoperative recurrence （P＜0.05）. Multivariate analysis results showed that tumor from anal margin， tumor circumference， TNM staging， histology type， vessel infiltration， tumor perforation， and chemoradiotherapy were prognostic factor for local recurrence of rectal cancer （P＜0.05）. Conclusions There are many factors related to postoperative local recurrence， but the most dangerous factor is vessel infiltration.
Objective To investigate the pathological features， diagnosis， treatment， and prognosis of multiple primary colorectal cancer （MPCC）. Methods Clinical data of 41 patients with MPCC treated in The Fourth Affiliated Hospital and The First Affiliated Hospital of China Medical University from Aug. 1993 to Mar. 2009 were retrospectively analyzed. Results Forty one patients with MPCC， including 29 patients with synchronous colorectal cancer （SCC） and 12 patients with metachronous colorectal cancer （MCC）， accounted for 1.8% （41/2 340） of colorectal cancer during the same period of time， and with adenomatous polyps in 19 cases and polyps canceration in 10 cases. Among 29 patients with SCC， 15 cases （51.7%） were diagnosed by preoperative fiberoptic colonoscopy， 9 cases （31.0%） were diagnosed by preoperative fiberoptic colonoscopy， abdomen CT， and barium enema， 5 cases （17.2%） were diagnosed by intraoperative exploration and intraoperative fiberoptic colonoscopy， respectively. All of the 12 patients with MCC were diagnosed by preoperative fiberoptic colonoscopy and abdomen CT. For 29 patients with SCC， tumor locations were from proximal appendix to distal rectum， but 12 patients with MCC were adverse. Sixty-five （77.4%） tumors were tubular or papillary adenocarcinoma， and 56 （66.7%） tumors were well and moderately differentiated adenocarcinoma. The TNM stage of most tumors （72） was stageⅡ or Ⅲ phase， account for 85.7%. Radical surgeries were performed in 37 patients and palliative surgeries in 4 patients， and there were no complications after operation. During the follow-up for 3-5 years （mear 3.6 years）， the overall survival rate of 3- and 5-year were 48.8% （20/41） and 34.1% （14/41）， respectively. In detail， 3-year survival rate of SCC group and MCC group were 48.3% （14/29） and 50.0% （6/12）， respectively；5-year survival rate were 31.0% （9/29） and 41.7% （5/12）， respectively. Conclusions Cause of MPCC has not been clear， but it has possible relationship with adenomatous polyps. Preoperative fiberoptic colonoscopy， abdomen CT， and barium enema are very important for patients with SCC， and intraoperative fiberoptic colonoscopy is also necessary. Patients with MCC should enhance postoperative follow-up with fiberoptic colonoscopy. Further more， radical resection should be performed as early as possible.
Objective To explore the perioperative management of the coexisting diseases for the elderly patients with gastric cancer. Methods The clinical data of perioperative management for coexisting diseases in 528 patients with gastric cancer over 70 years old treated in the First Affiliated Hospital of China Medical University from March 1980 to November 2008 were analyzed retrospectively. Results The main coexisting diseases included cardiovascuclar disease (259 cases, 49.05%), respiratory disease (161 cases, 30.49%), diabetes (72 cases, 13.64%). Adjusting blood pressure and blood glucose, improving cardiopulmonary function, and hepatic and renal function were mainly given. The common postoperative complications included intestinal obstruction (10 cases), pneumonia (10 cases), reflux esophagitis (9 cases), functional evacuation disorder of gastric remnant (7 cases), and anastomotic leakage (5 cases). Ten patients died during perioperative period: 6 died of heart and lung failure, 2 of acute myocardial infarction, 1 of anastomotic leakage, 1 of intestinal obstruction. Conclusions The common coexisting diseases in the elderly patients with gastric cancer are hypertension， bronchitis and diabetes. Complete assessment of the patient’s general health before operation and intensive perioperative management of the coexisting diseases not only can decrease the risk of surgical procedures， but also decrease the incidence of complication and perioperative mortality.
Objective To explore the perioperative management of the coexisting diseases for the elderly patients with gastric cancer. Methods The clinical data of perioperative management for coexisting diseases in 528 patients with gastric cancer over 70 years old treated in the First Affiliated Hospital of China Medical University from March 1980 to November 2008 were analyzed retrospectively. Results The main coexisting diseases included cardiovascuclar disease (259 cases, 49.05%), respiratory disease (161 cases, 30.49%), diabetes (72 cases, 13.64%). Adjusting blood pressure and blood glucose, improving cardiopulmonary function, and hepatic and renal function were mainly given. The common postoperative complications included intestinal obstruction (10 cases), pneumonia (10 cases), reflux esophagitis (9 cases), functional evacuation disorder of gastric remnant (7 cases), and anastomotic leakage (5 cases). Ten patients died during perioperative period: 6 died of heart and lung failure, 2 of acute myocardial infarction, 1 of anastomotic leakage, 1 of intestinal obstruction. Conclusions The common coexisting diseases in the elderly patients with gastric cancer are hypertension， bronchitis and diabetes. Complete assessment of the patient’s general health before operation and intensive perioperative management of the coexisting diseases not only can decrease the risk of surgical procedures， but also decrease the incidence of complication and perioperative mortality.
Objective To detect the expression of thromhospondin-1 （TSP-1） in gastric cancer and metastaticlymph node tissues， and to study its relationship of TSP-1 to clinicopathologic parameters or tumor angiogenesis. Methods The TSP-1 and vascular endothelial growth factor （VEGF） expressions and microvessel density （MVD） were evaluated by immunohistochemistry in 72 specimens obtained by gastric resection from patients with gastric cancer， including corres-ponding adjacent normal gastric mucosa tissues （distant from cancer ≥5 cm） and lymph nodes surrounding cancer. A semiquantitative scoring system was used for evaluating the staining. The relationship of TSP-1 to VEGF expression， MVD， or clinicopathologic parameters was analyzed. Results ① TSP-1 positive expression rate was 45.8% （33/72） in the primary gastric cancer tissues， 90.3% （65/72） in the corresponding adjacent normal gastric mucosa tissues， and 50.8% （30/59） in the metastatic lymph nodes tissues. The expressions of TSP-1 in the primary gastric cancer tissues and metastatic lymph nodes tissues were significantly lower than those in the adjacent normal gastric mucosa tissues （χ2=32.710，P=0.000；χ2=25.298， P=0.000）. The expression of TSP-1 had no statistical significance in the primary gastric cancer tissues as compared with in the metastatic lymph nodes tissues （χ2=0.327， P=0.568）. ② The expression of TSP-1 in the metastatic lymph nodes tissues was significantly lower than that in the non-metastatic lymph nodes tissues （Z=-2.573， P=0.010）. ③The expression of TSP-1 in the primary gastric cancer tissues and metastatic lymph nodes tissues suggested a negative correlation with VEGF （rs=-0.309， P=0.008；rs=-0.269， P=0.040） and MVD （rs=-0.348， P=0.003；rs=-0.272， P=0.037）. Conclusions TSP-1 expression is down-regulated and has a negative correlation with VEGF and MVD in the primary gastric cancer and the metastatic lymph nodes tissues. According to the present results， it seems likely that TSP-1 is a tumor angiogenesis inhibitor.
Objective To analyze the influencing factors on postoperative complications and mortality of gastric cancer after total gastrectomy. Methods The clinical data of 622 patients with gastric cancer received total gastrectomy were collected. According to the extent of lymph node dissection, the patients were divided into 2 groups: D0/D1 group (n=35) and D2/D3 group (n=587). The risk factors influencing postoperative morbidity and mortality were determined by logistic multiple regression analysis. Results The total postoperative complication morbidity and mortality for all patients were 9.81% (61/622) and 2.89% (18/622), respectively. The postoperative complication morbidity was 8.57% (3/35) and 9.88% (58/587) in the two groups, the postoperative mortality was 2.86% (1/35) and 2.90% (17/587) in the two groups, there were no significant differences between the two groups (Pgt;0.05). The most common postoperative complication was intestinal obstruction (18.03%, 11/61). Multivariate analysis revealed that risk factors on the postoperative complications and mortality were age ≥ 70 years, TNM stage Ⅳ, preoperative complication, palliative excision, merely manual or mechanical anastomosis, and multivisceral resection (Plt;0.05), however, the extent of lymph node was not influencing factor (Pgt;0.05). Conclusions Patients with advanced gastric cancer have a high risk of postoperative complications and mortality. Multiple organ resection should be avoided for patients with gastric cancer of TNM stage Ⅳ.
Objective The aim of this research was to explore the relationship between type D personality and symptom duration/emergency admissions/mental health status/quality of life (QOL) in Chinese rectal cancer patients. Methods Rectal cancer patients who were treated in our hospital form Oct. 2010 to Oct. 2012 were selected prospectively, and then their type D personality was measured with the 14-item Type D Personality Scale (DS14). Mental health status was measured with the Hospital Anxiety and Depression Scale (HADS). The QOL was assessed longitudinally by using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR38 questionnaires at the baseline and 6 months after diagnosis. Comparison between the type D personality group and non-type D personality group in social-demographic characteristics, clinicopathological features, mental health status, and QOL was performed. Results Of the 596 patients (92%) who responded, 131 patients (22%) had type D personality. ① Compared with non-type D personality group, the proportions of patients with duration of symptoms ≥1 month, without medical insurance, and emergency admissions in type D personality group were all higher, as well as the poor economic situation and more complication ( P<0.050). ② EORTC QLQ-C30. At the baseline, scores of role function, emotional function, cognitive function, social function, and overall health status in type D personality group were all lower than those of non-type D personality group ( P<0.050), but scores of fatigue, constipation, and financial difficulties in type D personality group were all higher than those of non-type D personality group ( P<0.050). In 6 months after diagnosis, scores of role function, emotional function, cognitive function, social function, and overall health status in type D personality group were all lower than those of non-type D personality group ( P<0.050), but scores of fatigue, insomnia, constipation, and financial difficulties in type D personality group were all higher than those of non-type D personality group ( P<0.050). ③ EORTC QLQ-CR38. At the baseline, score of expectation for the future in type D personality group was lower than that of non-type D personality group ( P<0.001), but score of urinary problems in type D personality group was higher in type D personality group than that of non-type D personality group ( P<0.001). In 6 months after diagnosis, scores of expectation for the future and sexual function in type D personality group were both lower than those of non-type D personality group ( P<0.050), but scores of urinary problems, gastrointestinal symptoms, male sexual dysfunction, and excretion difficulties in type D personality group were all higher than those of non-type D personality group ( P<0.050). ④ At the baseline and 6 months after diagnosis, the incidences of anxiety and depression in type D personality group were all higher than those of non-type D personality group at the same time point ( P<0.001). In type D personality group, the incidences of anxiety and depression in 6 months after diagnosis were both higher than baseline ( P<0.001). Conclusion Type D personality may be a general vulnerability factor to screen for subgroups at risk for longer SD and emergency admissions in clinical practice of rectal cancer patients, and it was associated with poor QOL and poor mental health status.