Chapter 219 - 152: Subversion
As Jiang He stepped out of the taxi, he immediately saw the crowd gathered in front of Affiliated Hospital No. 1.
Back in '08, the doctor-patient relationship was rather tense. Protests with banners at hospital entrances weren't uncommon, but today's situation was clearly out of control.
"Give me back my father's life!"
"Killer doctors!"
A white banner was pulled taut. Several family members sat on the steps, wailing dramatically, surrounded by a circle of gawking onlookers.
Two police cars were parked on the side of the road, and officers were reasoning with the family, trying to maintain order.
Jiang He frowned slightly, walked around the crowd, and headed for a side entrance.
He'd only taken a couple of steps when he saw Yang Xu smoking next to a flowerbed.
He rarely ever smoked here—only when something was troubling him.
"Professor," Jiang He said, walking over to him.
Yang Xu, a cigarette pinched between his fingers, paused. When he turned and saw it was Jiang He, he stubbed it out.
He remembered that his student didn't like smoking.
Then, letting out a weary breath, he asked, "Here for the samples?"
"Yes. Did the approval from the ethics committee come through?"
"It's been approved. I'll give it to you in a minute." Yang Xu's gaze drifted past Jiang He's shoulder, settling once more on the crowd in front of the outpatient building.
Jiang He followed his gaze. "What's going on?"
"A colon cancer patient from the second general surgery department... we lost him in the ICU this morning. The family couldn't accept it and started making a scene."
Jiang He didn't respond, waiting for Yang Xu to continue.
Surgeons are used to matters of life and death. If it were simply a case of a critical patient who couldn't be saved, Yang Xu wouldn't have that look on his face.
"Three months ago, the attending surgeon performed a radical colectomy on this patient. During the lymph node dissection, he only removed five."
Jiang He's brow furrowed.
The standard for a curative resection is to remove at least 12 lymph nodes. Removing only five is severely substandard.
Yang Xu continued, "The pathology report came back: out of the five lymph nodes, two showed metastasis. According to our current TNM staging standards, any metastasis, regardless of the primary tumor's size, automatically makes it Stage III. The problem is, whether it's one, two, or three positive nodes, it's all classified as N1. And for N1, the recommended adjuvant chemotherapy regimen is exactly the same."
"The family saw the pathology report and felt relieved. Even though it was Stage III, only two nodes were positive. They assumed standard chemotherapy would be enough to control it and everything would be fine."
Jiang He understood.
This was a limitation of the times, and a fatal flaw in the current guidelines.
A complex look crossed Yang Xu's face.
"But in reality? The dissection was severely inadequate, leaving a huge number of cancerous cells behind. In just three short months, the tumors flared up aggressively, metastasizing throughout his abdominal cavity. This morning, he suffered a massive hemorrhage. No one could have saved him. Jiang He, according to your LNR—Lymph Node Ratio—theory, how would you classify this case?"
Jiang He replied, "Two positive nodes out of five makes for a ratio of 40%. That's far above the 20% high-risk threshold, placing him in the extremely high-risk category. According to my standards, standard adjuvant chemo would have been completely useless. He should have immediately started on the most intensive combination chemotherapy."
Yang Xu let out a long sigh.
The sigh was heavy with a sense of helplessness at the slow pace of medical progress.
"If we had been able to rewrite the guidelines sooner, maybe this never would have happened. The family wouldn't have been misled by the false hope that 'standard chemo is enough for N1' and lost their final opportunity."
Yang Xu patted Jiang He's shoulder.
"Keep pushing. Let's get this done as soon as we can."
"Yeah."
Jiang He took the approval form from Yang Xu and turned towards the administration building.
His steps were quicker now than when he had arrived.
'Rewrite the guidelines.'
Those three words sounded thrilling, but in the world of medicine, they represented an incredibly long journey.
Even though the LNR paper had been published in a top-tier journal, it was only the beginning.
The medical community is arguably one of the most conservative fields in the world.
When lives are at stake, no one is going to change decades of surgical habits and assessment standards over a single paper.
Once the paper was published, the immediate reaction from the world's top oncologists and surgeons would be, without a doubt, skepticism.
Over the next year or two, major top-tier hospitals would quietly pull their own past patient records to verify the accuracy of the LNR theory.
Only after their own results showed a perfect match would they begin to publish corroborating studies.
During this phase, only a rare few who trusted him, like Yang Xu, would dare to adopt the new standard in their clinical practice.
Only after the theory was validated with data from tens of thousands of patients worldwide would leading statisticians produce a [meta-analysis].
Then, Jiang He would have to attend the world's top medical conferences and go head-to-head with the old guard who stubbornly clung to the existing standards.
Finally, an authoritative organization would convene dozens of the field's leading experts for a vote.
Only if a majority agreed would LNR be formally written into the *Clinical Practice Guidelines*.
After the guidelines were published, the theory would finally be printed in the new editions of Medical School textbooks.
This entire process, from introduction to implementation, would take three to five years at the very least.
Jiang He took a deep breath and pushed open the doors to the biobank.
'I can't afford to wait that long.'
The incident in front of the outpatient building today was a reminder.
Even though he was rapidly advancing his early prediction model for pancreatic cancer, that was just the first step.
Diagnosing cancer was just the alarm bell.
What truly saved lives were the follow-up: curative surgery and the development of effective targeted drugs.
And that was an even longer and more complicated undertaking.
If he pursued the surgical route, he would have to refine the curative resection procedure and quickly gain privileges to act as a lead surgeon.
If he pursued the targeted drug route, the advantage was that it didn't involve surgery. But succeeding down that path was next to impossible.
So, he had to compress and accelerate the entire process.