This study aimed to assess the benefit of postoperative adjuvant chemotherapy in stage II-III colorectal signet ring cell carcinoma (SRCC). Qualified postoperative patients were extracted from Surveillance, Epidemiology, and End Results (SEER) database from 2004 until 2015. We collected 1675 patients in the research, and 936 patients were subjected to adjuvant chemotherapy group. the proportions of married status, male, rectal cancer, grade iii/iV, AJcc stage iii and radiotherapy were higher; While, the rates of white race, ≥ 65 years old and located in cecum-transverse colon were lower in patients of chemotherapy group compared to no chemotherapy group (all P < 0.05). K-M plots revealed significantly better OS of adjuvant chemotherapy group than no chemotherapy group (P < 0.001). Meanwhile, there was no significantly different in CSS between the two groups (P = 0.93). However, after adjusting for confounding factors by multivariable Cox regression analysis, receipt of postoperative chemotherapy was still associated with better cSS and oS (cSS: hazard ratio [HR] = 0.719, 95% CI 0.612-0.844, P < 0.001) ; (OS: HR = 0.618, 95% CI 0.537-0.713, P < 0.001). Patients with stage II/III colorectal SRCC could receive survival benefit from postoperative adjuvant chemotherapy. Colorectal cancer (CRC) ranks the third of cancer-associated death, causing great health burden globally 1. The diverse pathological types of CRC have been uncovered to be having correlation with various clinical parameters and patient survival, with adenocarcinoma being most prevalent type 2,3. Signet-ring cell carcinoma (SRCC) is a relatively rare histological subtype, consisting of 0.1-2.6% of CRC patients 4,5 , defined as the abundant presence of intracellular mucin in over 50% cells according to WHO 6,7. SRCC is considered as a distinct pathological subtype in CRCs. A series of differences among colorectal SRCC, mucinous adenocarcinoma (MC) and non-mucinous adenocarcinoma (NMC) have been consistently reported. To be specific, SRCC has been reported to be associated with younger age at diagnosis, more advanced stage and poorer clinical outcomes than MC and NMC 7-9. In addition, massive lymphatic involvement, higher frequency of multiple metastatic organs and greater risks of peritoneal metastases are more commonly seen in SRCC 9. Because SRCC is relatively rare, there is a lack of consensus on therapeutic guidelines due to the difficulty in conducting large randomized controlled trials 5. At present, surgical intervention is still the optimal option for colorectal SRCC patients. Moreover, the combined application of other therapeutics has been increasing, especially chemotherapy 10. Hugen et al. have assessed the efficacy of adjuvant chemotherapy in colorectal SRCC, who further indicated the benefit of adjuvant chemotherapy in stage III SRCC patients 11. Meanwhile, by analyzing the distinct metastatic patterns of colorectal SRCC toward different sites, Tao et al. have demonstrated better survival of received chemotherapy in metastatic colorectal SR...
Minimally invasive therapy for upper tract urothelial cell cancer has assumed an important role in the management of this relatively uncommon genitourinary malignancy. In this review, current standards for patient selection, surgical approach, as well as overall outcomes will be discussed. Moreover, the use of intraluminal agents in upper tract disease is examined along with its efficacy and associated complications.
This study aimed to explore the association of tumor sidedness with the prognosis of patients with colon signet ring cell carcinoma (SRCC). Eligible patients were retrieved from the Surveillance, Epidemiology, and End Results database between 2004 and 2015. Cancer-specific survival (CSS) and overall survival (OS) were compared between patients with left-sided colon SRCC and those with right-sided lesions. A total of 2660 patients were included, among them, 1983 (74.5%) had right-sided colon SRCC. Compared to patients with left-sided colon SRCC, those who had the right-sided colon SRCC showed higher proportion of white race, female, aged ≥ 65 years, receiving total colectomy and ≥ 4 regional lymph node dissection; while had lower proportion of advanced AJCC stage. Besides, right-sided patients exhibited superior 5-year CSS (32.74% vs. 25.89%, P = 0.001) and OS (27.38% vs. 23.02%, P = 0.024) rates compared with left-sided ones. Multivariate analysis revealed that tumor sidedness was an independent prognostic factor. To be specific, patients with right-sided colon SRCC showed better CSS (HR: 0.873; 95% CI 0.777–0.981; P = 0.023) and OS (HR: 0.838; 95% CI 0.753–0.965; P = 0.002). Moreover, subgroup analysis demonstrated superior CSS and OS for right-sided patients in most subgroups. Tumor sidedness was an independent prognostic indicator for colon SRCC. Besides, patients with right-sided colon SRCC have superior prognosis than those with left-sided lesions.
In order to evaluate the effect of different doses of penehyclidine hydrochloride (penehyclidine) on heart rate (HR) and HR variability (HRV) in hysteroscopy, 180 patients (American Society of Anesthesiologists grade I-II) were randomized equally to three groups: 0.5 mg penehyclidine and intravenous anesthesia (group I), 1.0 mg penehyclidine and intravenous anesthesia (group II) and saddle anesthesia combined with intravenous anesthesia (control group). HR and HRV, including total power (TP), low-frequency power (LF), high-frequency power (HF) and the LF to HF ratio (LF/HF), were recorded prior and subsequent to the induction of anesthesia (T and T, respectively), following the start of surgery (T) and following completion of surgery (T). HR was lower at T than at T in the control patients, but no differences were observed in groups I and II. The HR at T was increased in group II compared with that in group I. TP in group II was significantly higher compared with that in group I at T. At T and at T, the LF and HF values were lower in group I than those in the controls. Patients in group II also had higher LF and HF at T than patients in group I. The HF was higher at T than that at T in the controls; however, the HF and LF did not change significantly within groups I and II. No significant differences were observed in the LF/HF ratio among the three groups. At a dose of 0.5 mg, penehyclidine stabilized HRV and did not alter the autonomic nervous modulation of HR. A penehyclidine dose of 1.0 mg may be superior to a dose of 0.5 mg in maintaining HR, but is less effective at balancing sympathetic and parasympathetic activity.
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