| Objectives The incidence of gastric neuroendocrine neoplasms(g-NENs)is increasing annually,among which gastrin-independent g-NENs own a high potential of malignancy,poor prognosis,and high heterogeneity.But there is few studies about genomic characteristics of g-NENs.The purpose of this study was to make a gene mutation map of gastrin-independent g-NENs by means of whole genome sequencing(WGS)and whole exome sequencing(WES),and further explore the molecular features among different subtypes of gastrin-independent g-NENs.Methods Fresh cryopreserved tissue specimens from 8 patients with g-NENs who were surgically treated at Fujian Medical University Union Hospital from January 2012 to December 2017 were analyzed by WGS;formalin-fixed paraffin-embedded tissue specimens from 20 patients with g-NENs that were surgically treated at Cancer Hospital Chinese Academy of Medical Sciences from January 2012 to December 2015 were analyzed by WES.The data were used for drawing mutation maps,looking for high-frequency mutations,analyzing patterns of tumor mutations,and further comparing molecular features among subtypes.Results Two cases of fresh frozen tissue specimens of g-NENs were excluded due to severe DNA degradation.Overall,twenty-six cases of g-NENs were included for genomic analysis,including 8 cases of mixed adenoneuroendocrine carcinoma(MANEC),10 cases of typical poorly differentiated NEC(including 9 cases of large cell NEC and 1 case of small cell NEC),and atypical poorly differentiated NECs were 8 cases.In 26 cases of gastric NEC,TP53 was the most common mutation gene with a frequency of 57.7%(15/26),followed by TTN gene(42.3%,11/26)and AHNAK2 gene(34.6%,9/26);TTN gene(50%,4/8)mutation was most common in MANEC;the frequency of TP53 gene mutation in atypical poorly differentiated NEC was 71.4%(5/7).The most common mutation pattern was C>T(57.19%).Conclusions Through the WGS of 6 cases of gastric NEC and the WES of 20 cases of gastric NEC,we found that TP53 gene,TTN gene and AHNAK2 gene are the most common mutations.MANEC mainly owned mutation in the TTN gene.The most common mutant gene for large cell NEC was TP53.The atypical poorly differentiated NECs were predominantly mutated by TP53 gene.The mutation pattern of gastrin-independent g-NENs was dominated by CST.Objective The rationality and feasibility of simultaneous resection of primary colorectal cancer and liver metastases for treating synchronous colorectal and liver metastases(SCRLMs)have been well recognized.Traditionally,hepatectomy was performed before primary colorectal resection during the simultaneous operation for SCRLMs in the background of aseptic principle.On this occasion,colorectal surgery can hardly be conducted laparoscopically in a minimally invasive way.This study aimed at comparing the short-term and long-term outcomes of the two surgical approaches.Methods 235 patients diagnosed with SCRLMs from January 2009 to December 2016 at our institution were enrolled in this study.The patients included in this study were divided as "liver first" group and "colorectum first" group according to surgical sequence,and 32 patients were selected for further research by the means of propensity score matching(PSM).The short-term and long-term outcomes were evaluated among the patients before and after PSM.Results Finally,152 patients with SCRLMs were admitted in this study.Before PSM,the 152 patients included in this study were divided into two groups,liver first group(n=64)and colorectum first group(n=88).There were more patients with primary colon cancer in liver first group than colorectum first group(70.3%vs.44.3%,P=0.001).The patients in coloretum first group owned a larger number of liver metastases than liver first group(3.0 vs.1.0,P<0.001).More patients were conducted with major hepatectomy in coloretum first group than that in liver first group(44.5%vs.22.6%,P=0.001).Comparing to the liver first group,the operation time(370.0min vs.295.0min,P<0.001)was longer,and the intra-operative blood loss(300.0ml vs.200ml,P<0.001)was more in coloretum first group.But the two groups did not differ greatly in the length of postoperative hospital stay and the incidence of postoperative complications(such as abdominal infection,pulmonary infection,abdominal hemorrhage,bile leakage and so on).In multivariate analysis,intra-operative blood loss was identified as the unfavorable independent factor for postoperative complications(HR=1.002,95%CI=1.000-1.004,P=0.029).There were no significantly statistical differences in both overall survival(OS,P=0.550)and disease-free survival(DFS,P=0.083)between the two groups.After PSM for the patients with major hepatectomy,each group embraced 16 patients with SCLMs.The duration of operation(P=0.193),the intra-operative blood loss(P=0.329),the duration of postoperative hospital stay(P=0.606),and the postoperative complication rate(P=0.198)were comparable between the two groups.In addition,there were also no significant differences in OS(P=0.677)and DFS(P=0.904)between the two groups.Conclusions The operative approach of initial vessel rupture and primary colorectum mobilization followed by hepatectomy in the procedure of simultaneous resection of primary colorectal cancer and livers metastases is practicable and safe,without increasing operative morbidity and worsening OS and DFS.Objectives The approach of simultaneous resection for patients with colorectal cancer liver metastases has launched universally,while the operation procedures have differences.In general,the colorectal lesions are removed laparoscopically.However,many of liver metastases cannot be radically resected under laparoscopy.For these patients,the traditional way was simultaneous resection utilizing right subcostal incision and inferior abdominal midline incision.In this study,we assessed the safety and feasibility of the single incision approach(right subcostal incision)for patients with sigmoid colon or rectal cancer and liver metastasis who underwent simultaneous resection.Methods A total of 85 patients with sigmoid colon or rectal cancer and liver metastasis who underwent simultaneous resection was identified from January 2012 to December 2016 at Cancer Hospital Chinese Academy of Medical Sciences.Clinicopathologic data,operative and perioperative outcomes were collected and analyzed prospectively.Results Overall,42patients were admitted in this study.26(61.9%)patients underwent simultaneous resection with single surgical incision(right subcostal incision),and 16(38.1%)were submitted to simultaneous resection with dual surgical incision(inferior abdominal midline incision and right subcostal incision).The single-incision approach had a shorter operation time(328.0min vs.420.0min,P=0.006),and had no significant difference compared to the dual-incision approach in total hospitalization time,postoperative hospitalization time,intro-operative blood loss,time of postoperative drainage tube extraction,time of defecation and postoperative complications(P>0.05).Conclusions The single-incision approach(right subcostal incision)is feasible and safe for patients with sigmoid colon or rectal cancer and liver metastases undergoing simultaneous resection. |
PDF Full Text Request