肝内胆管细胞癌预后影响因素分析及生存列线图建立

目的探讨肝内胆管细胞癌(ICC)切除术后预后相关影响因素及建立有效的列线图生存预测模型。方法回顾性分析2010年1月—2018年12月在西安交通大学第一附属医院行手术切除的160例ICC患者的临床病理资料,其中男性89例,女性71例;年龄(57.41±10.35)岁,年龄范围29~81岁。观察指标:(1)患者随访的结果,术后生存情况;(2)影响患者术后预后的单因素及多因素分析;(3)列线图模型的建立及验证。采用门诊和电话方式进行常规随访,术后1年内每3个月复查肝功能、CA19-9、上腹部B超、CT或MRI检查。随后每3~6个月随访1次。观察终点为术后总体生存时间,即为手术日期到随访截止日期,或因肿瘤复发及转移致死亡的日期。随访截至2019年8月1日。将患者临床病理资料纳入预后影响因素分析,单因素分析采用Kaplan-Meier法和Log-rank检验,多因素分析采用Cox比例风险回归模型。基于Cox比例风险回归模型筛选的独立危险因素建立列线图生存预测模型。将160例患者按7∶3的比例分为模型组(n=112)及验证组(n=48),模型组用于生存列线图的建立,验证组用于其预测能力的评估,通过一致性指数(C-index)评估列线图模型对ICC患者术后生存预测的准确性。正态分布的计量资料以均数±标准差(Mean±SD)表示,偏态分布的计量资料以M(范围)表示。计数资料用例数和百分比(%)表示。结果160例ICC术后患者,随访期间死亡100例,死亡原因均为肿瘤复发转移致多器官功能衰竭,存活60例,生存时间20个月(2~111个月),1、3、5年总体生存率分别为63.3%、30.0%、19.6%。单因素分析结果显示,CA19-9、肝内胆管结石、肿瘤数目、肝脏切除范围、肿瘤分化程度、肿瘤细胞类型、肿瘤直径、脉管侵犯、TNM分期、淋巴结转移、卫星灶及切缘状态是ICC患者的预后影响因素(HR=1.78,1.97,2.91,1.89,3.06,2.86,2.07,1.94,2.24,1.95,2.68,2.00,95%CI:1.12~2.85,1.22~3.16,1.85~4.56,1.26~2.85,1.38~6.82,1.31~6.25,1.37~3.14,1.07~3.51,1.24~4.06,1.26~3.01,1.28~5.60,1.11~3.59,P<0.05)。多因素分析结果显示,肝内胆管结石、肿瘤数目、肝脏切除范围、肿瘤分化程度(低分化)及肿瘤细胞类型是影响ICC患者预后的独立危险因素(HR=2.47,2.37,2.06,5.52,5.72,95%CI:1.39~4.38,1.44~3.91,1.25~3.40,1.24~24.49,2.31~14.17,P<0.05)。列线图的建立基于5个独立危险因素,模型组的列线图预测术后生存的C-index值为0.71(95%CI:0.64~0.79),验证组C-index值为0.71(95%CI:0.61~0.81)。结论基于肝内胆管结石、肿瘤数目、肝脏切除范围、肿瘤分化程度和肿瘤细胞类型等影响ICC患者术后生存的独立危险因素构建的列线图生存预测模型具有较好的准确度。     

原发性肾脏恶性淋巴瘤的诊治及预后分析

目的:探讨原发性肾脏恶性淋巴瘤(PRL)的临床病理特征、治疗方法及影响预后的因素。方法:对2013年2月我院收治的1例PRL患者进行报道,同时查询国内2000~2014年正式发表的有关此病的文献报道,收集73例PRL患者资料进行分析。结果:男性略多于女性,高发年龄为50~70岁,中位年龄59岁,单侧多于双侧。最常见的症状为腰痛,其次为发热,血尿、腹痛常有发生。临床和影像学表现不典型,极易误诊为肾癌。病理检查以非霍奇金淋巴瘤常见,其中B细胞淋巴瘤占多数。74例(包括本例)患者中位生存时间为47个月,1、3、5年生存率分别为76.20%,59.90%,43.70%。Log-rank检验单因素分析结果显示:治疗方式、肿瘤病理类型与患者生存时间有关(P0.05);患者性别、年龄、左右侧、肿瘤大小与患者生存时间无关(P0.05)。Cox回归模型多因素分析结果显示,治疗方式是PRL患者生存时间的独立影响因素(P0.05)。治疗方式之间差异有统计学意义(P0.05),根治性切除后化疗预后最好,根治性切除后化疗+放疗其次。结论:PRL是罕见的疾病,临床和影像学表现不典型,极易误诊为肾癌,确诊依赖于组织病理学检查,预后与病理类型、治疗方式有关。以手术切除+化疗为主的综合治疗预后最好,最值得推荐。     

肿瘤细胞减灭术联合腹腔热灌注化疗治疗腹膜癌1384例疗效分析

目的腹膜癌是一类原发或继发于腹膜表面的恶性肿瘤,肿瘤细胞减灭术(CRS)加腹腔热灌注化疗(HIPEC)是针对腹膜癌发展的一套综合治疗策略。本文旨在分析CRS+HIPEC治疗腹膜癌的疗效和安全性,并探讨影响其生存的预后因素。方法采用描述性病例系列研究方法,回顾性收集2004年1月至2020年1月武汉大学中南医院(330例)和首都医科大学附属北京世纪坛医院(1054例)腹膜肿瘤外科连续治疗的1384例腹膜癌患者的临床病理资料。分析本组患者CRS+HIPEC治疗情况(手术时间、器官切除数量、腹膜切除数量、吻合口数量、HIPEC方案等)、安全性[术中出血量、术后严重不良事件(SAE)及发生时间、治疗情况]、生存情况及影响生存的预后因素。SAE依照国际腹膜癌联盟不良事件定义进行分级,将Ⅲ~Ⅳ级不良事件定义为SAE。围手术期定义为CRS+HIPEC治疗日至术后30 d。OS定义为CRS+HIPEC手术当日至死亡或末次随访时间,采用Kaplan-Meier法进行生存结果描述,组间比较采用Log-rank检验。影响生存的独立预后因素则采用Cox比例风险回归模型单因素和多因素分析。结果全组患者中男529例(38.2%),中位年龄55(10~87)岁,中位体质指数为22.6 kg/m²。1384例腹膜癌患者中来源于胃癌164例(11.8%),结直肠癌287例(20.7%),腹膜假黏液瘤356例(25.7%),腹膜恶性间皮瘤90例(6.5%),卵巢癌、宫颈癌、子宫内膜癌及原发性腹膜癌等共计300例(21.7%),腹膜后肉瘤、肺癌、乳腺癌等少见来源肿瘤187例(13.5%)。本组患者中位手术时间595(90~1170)min,中位脏器切除数2(0~10)个,中位腹膜切除区域数4(0~9)个,中位腹膜癌指数(PCI)评分21(1~39)分,细胞减灭程度(CC)评分0~1分达61.9%(857/1384)。HIPEC方案:顺铂+多西他赛917例(66.3%)、顺铂+丝裂霉素183例(13.2%)、阿霉素+异环磷酰胺43例(3.1%)及其他方案240例(17.3%)。331例(23.9%)腹膜癌患者发生围手术期严重不良事件500例次,其中21例(1.5%)患者因治疗无效于围手术期内死亡,其余患者经积极治疗后痊愈。全组患者中位随访时间为8.6(0.3~182.7)个月,414例(29.9%)死亡,mOS为38.2个月(95%CI:30.6~45.8),1、3、5年生存率分别为73.5%、50.4%、39.3%。其中,胃癌腹膜转移、结直肠癌腹膜转移、腹膜假黏液瘤、恶性腹膜间皮瘤和妇科肿瘤及原发性腹膜癌患者mOS分别为11.3个月(95%CI:8.9~13.8)、18.1个月(95%CI:13.5~22.6)、59.7个月(95%CI:48.0~71.4)、19.5个月(95%CI:6.0~33.0)和51.7个月(95%CI:14.6~88.8),组间比较差异有统计学意义(P<0.001)。Cox单因素和多因素分析显示,原发肿瘤为胃癌(HR=4.639,95%CI:1.692~12.724)、结直肠癌(HR=4.292,95%CI:1.957~9.420)和恶性腹膜间皮瘤(HR=2.741,95%CI:1.162~6.466);卡氏功能状态(KPS)评分为60分(HR=4.606,95%CI:2.144~9.895)、70分(HR=3.434,95%CI:1.977~5.965);CC评分为1分(HR=2.683,95%CI:1.440~4.999)、2~3分(HR=3.661,95%CI:1.956~6.852)以及围手术期发生SAE(HR=2.588,95%CI:1.846~3.629)均是影响本组腹膜癌患者生存的独立危险因素,差异均有统计学意义(均P<0.05)。结论CRS+HIPEC是针对腹膜癌有效的整合治疗技术,可延长生存,围手术期安全性可接受。术前需要严格筛选病例,KPS评分<80分者应慎重选择接受CRS+HIPEC治疗;术中应在保证安全的前提下,努力达到满意细胞减灭程度;另还要应积极预防围手术期SAE以降低腹膜癌患者死亡风险。     

骨肉瘤程序性死亡因子配体1的表达及临床意义

目的通过检测程序性死亡因子配体1(PD-L1)在骨肉瘤组织中的表达,探讨其与骨肉瘤患者临床特征及预后的相关性。方法选取2006年1月至2012年12月,福建医科大学附属第一医院初诊为骨肉瘤并接受手术切除术的72例患者为研究对象,收集经病理确诊的患者骨肉瘤石蜡标本,采用免疫组织化学(IHC)方法检测组织中PD-L1的表达,以PD-L1肿瘤细胞表达超过5%为阳性。同时收集患者的临床资料,进行统计学分析。结果在72例骨肉瘤组织样本中,22例(30.6%)呈PD-L1阳性。PD-L1的表达与患者年龄、性别、肿瘤位置以及肿瘤大小无相关性(P均0.05)。单因素分析结果表明,患者的年龄、性别、肿瘤位置和肿瘤大小均与无进展生存(PFS)和总生存(OS)中位时间无关(P均0.05);接受新辅助化疗患者的PFS中位时间(68.0个月,95%CI33.8~102.2个月)和OS中位时间(68.0个月,95%CI 34.6~101.4个月)均长于未接受新辅助化疗患者(22.0个月,95%CI 16.8~27.2个月;30.0个月,95%CI 20.6~39.4个月)(P均0.05);PD-L1阳性骨肉瘤患者PFS中位时间(10.0个月,95%CI0.0~20.7个月)和OS中位时间(28.0个月,95%CI 11.1~45.0个月)均短于PD-L1阴性患者(44.0个月,95%CI21.0~67.0个月;52.0个月,95%CI31.4~72.6个月)(P均0.05)。多因素分析结果显示:肿瘤大小是骨肉瘤患者PFS期的独立影响因子(P0.05);是否接受新辅助化疗以及肿瘤是否为PD-L1阳性均是骨肉瘤患者PFS期和OS期的独立影响因子(P均0.05)。结论骨肉瘤患者中部分肿瘤呈PD-L1阳性,是否接受新辅助化疗以及PD-L1是否阳性均是骨肉瘤患者预后不良的独立影响因子。阻断程序性死亡因子(PD-1)/PD-L1的免疫疗法可能是PD-L1阳性骨肉瘤患者可选择的新型治疗方式。     

围手术期化疗与术后化疗对行手术切除晚期胃癌病人预后影响对比研究

目的 研究围手术期化疗与术后化疗对行手术切除晚期胃癌病人的预后影响。 方法 回顾性分析2004年1月至2016年12月南方医科大学南方医院普通外科行胃切除手术治疗的Ⅳ期胃癌病人资料。其中,行手术切除联合术后辅助化疗228例（术后化疗组,A 组）,行术前化疗+手术切除+术后化疗49例（围手术期化疗组,B组）。采用倾向得分匹配法（PSM）均衡组间混杂因素的影响,选取8个协变量进行1∶1匹配 (性别、年龄、肿瘤生物学分类、化疗完成度、术后病理的肿瘤浸润深度分期、淋巴结转移分期、淋巴结清扫范围、胃切除范围),最终49例A组病人和49例B组病人成功进行匹配。采用Kaplan-Merier法进行生存分析,应用Cox比例风险回归模型对行手术切除的晚期胃癌病人进行独立生存危险因素的分析。 结果 匹配前,两组病人的肿瘤生物学分类（P<0.001）、化疗周期（P<0.001）、肿瘤浸润深度分期（P<0.001）、淋巴结转移分期（P=0.049）、淋巴结清扫范围（P=0.001）、胃切除范围（P=0.001）等差异有统计学意义,而匹配之后,仅有化疗完成度（P<0.001）在两组间差异有统计学意义,B组的化疗完成度优于A组。匹配之后,A组中位生存时间（MST）为16个月（95%CI 10.36～21.64）,与B组MST 29个月（95%CI 17.24～40.76）之间差异无统计学意义（P=0.191）。生存单因素分析显示,生物学分类、化疗周期、淋巴结转移情况和淋巴结清扫情况等四个因素可影响行手术切除晚期胃癌病人的生存预后,进一步多因素分析提示,化疗周期≤2次,淋巴结转移、淋巴结清扫范围不足D2等3个因素为独立预后不良因素。化疗与手术的先后次序（围手术期化疗相比术后化疗）并不影响病人生存预后（HR 0.986,95%CI 0.539～1.806,P=0.964）。 结论 相比术后化疗,围手术期化疗并不是改善行手术切除晚期胃癌病人生存预后的独立因素,但能够使病人有更好的化疗耐受性和依从性,从而使其生存显著优于术后开始化疗的病人。这可为后续晚期胃癌治疗的前瞻性研究设计提供参考和指导。     

髂内动脉化疗栓塞治疗肌层浸润性膀胱肿瘤远期效果分析

目的:探索最大限度TURBT+膀胱灌注化疗+髂内动脉栓塞化疗治疗肌层浸润性膀胱肿瘤的远期效果。方法:收集2003~2014年,福建省立医院收治确诊T2~3N0M0,但无上尿路梗阻的膀胱移行细胞癌患者。将行根治性全膀胱切除术的患者归积极组;将因各种原因改行姑息性治疗的患者归为保守组,姑息性治疗包括最大限度经尿道膀胱肿瘤电切、规律的表阿霉素膀胱灌注化疗,联合术后髂内动脉栓塞化疗。对比两组生存差异。结果:共入选患者90例,行根治性全膀胱切除术的患者66例,行姑息治疗的患者24例(26.7%)。中位随访时间50个月。生存分析结果显示,行根治性膀胱全术的积极组,中位无瘤生存时间为63个月(95%CI 40.3-85.6个月),中位总生存时间尚未到达;保守组的中位无瘤生存时间为21月(95%CI 6.7-35.3个月),中位总生存时间为54个月(95%CI 41.9-66.2个月);两组间对比,无瘤生存时间差异有统计学意义,63vs.21个月,P=0.002;中位总生存时间差异无统计学意义,NA vs.54个月,P=0.057。结论:最大限度TURBT+膀胱灌注化疗+髂内动脉栓塞化疗治疗肌层浸润性膀胱肿瘤尽管相比根治性治疗更容易复发或进展,但其远期疗效尚可,可以作为因各种原因不能接受根治手术患者保留膀胱的治疗方案之一。     

卵巢上皮癌术后激素补充治疗对肿瘤预后的影响

目的探讨上皮性卵巢癌患者术后行激素补充治疗(HRT)对肿瘤预后的影响。方法连续收集北京协和医院妇产科2000年1月至2010年12月收治的59岁的卵巢上皮癌患者756例,术后接受HRT者79例,为病例组。随机选取同期术后未行HRT者79例为对照组。详细记录该158例患者的临床资料,对相关因素进行回顾性分析。结果 (1)病例组术后总生存时间的中位时间45个月(术后6~264月),对照组42个月(术后6~189月),两组间差异无统计学意义(Z=-0.259,P=0.796)。(2)病例组术后19例复发(24.1%),对照组24例复发(30.3%),两组间差异无统计学意义(P=0.48)。(3)病例组术后2例死亡(3%),对照组术后2例死亡(3%),两组间无差异。(4)病例组术后无进展生存时间的中位时间34个月(术后3~181月),对照组28个月(术后2~189月),log-rank分析显示:两组间的差异无统计学意义(P=0.230)。(5)多因素Cox回归分析显示,HRT不是患者术后复发的独立预后因素(P=0.129),使用HRT复发的风险率(odds ratio,OR)为0.609(95%CI=0.321~1.155),病例组死亡的OR值为0.430(95%CI=0.040~4.682)。结论卵巢上皮癌患者术后的HRT不影响疾病的总体预后。     

原发性肝脏淋巴瘤19例临床病理学特点及预后分析

目的研究原发性肝脏淋巴瘤的临床病理学及预后特点。方法回顾性分析我院2006年1月1日至2014年12月31日期间收治的经病理学确诊的19例原发性肝脏淋巴瘤患者的临床资料,总结其临床病理学特点、诊断及治疗方案,根据随访结果进行预后分析。结果 19例患者病理检查前均误诊为其他肝脏疾病。19例患者中,男8例(42.1%),女11例(57.9%),年龄17~79岁,中位年龄47岁。10例(52.6%)患者合并乙肝病毒感染,9例(47.4%)出现LDH升高,12例(63.1%)出现A/G倒置。17例手术患者术后中位生存时间50.8个月,95%CI:32.0~69.5,术后化疗与否生存时间有明显差异(P=0.048,0.1)。结论原发性肝脏淋巴瘤临床误诊率高,确诊赖以病理学检查,发病可能与HBV感染有关,术后辅以化疗可延长患者生存时间。     

肾部分切除术与肾癌根治术治疗局限性肾癌的预后比较的Meta分析

目的系统评价局限性肾癌患者行肾部分切除术和根治性肾切除术的肿瘤预后。方法检索Cochrane图书馆、Medline、Embase、Web of Science和CNKI中国期刊全文数据库2014年5月前国内外公开发表的比较肾部分切除术(PN)与肾癌根治术(RN)治疗局限性肾癌的肿瘤预后的临床对照研究,进行系统评价。结果按照纳入与排除标准,最终纳入文献33篇,共33 520例,PN和RN手术分别为9 190例和24 340例。PN与RN的术后5年总的生存率(OS)、5年肿瘤特异性生存率(CSS)、并发症发生率和慢性肾脏病发生率的相对危险度分别为1.037(95%CI:1.023~1.050)、1.022(95%CI:1.006~1.038)、1.397(95%CI:1.078~1.811)、0.416(95%CI:0.295~0.587),差异均有统计学意义(P0.05)。术后10年总的生存率、10年肿瘤特异性生存率、肿瘤复发率和肿瘤转移率的相对危险度分别为:1.046(95%CI:1.020~1.073)、1.018(95%CI:0.992~1.043)、1.375(95%CI:0.920~2.057)、0.520(95%CI:0.260~1.039),差异均无统计学意义(P0.05)。结论对于局限性肾癌患者,PN的术后5年的生存预后优于RN,而两种手术方式的术后10年的生存预后相当,并且肿瘤复发情况与转移情况无明显差异。虽然PN的并发症发生率较RN高,但PN在慢性肾脏病发生率方面明显低于RN,所以PN是一种疗效显著并且有其自身优势的手术方法,值得在临床上推广。     

原发性胆总管非霍奇金淋巴瘤1例并文献复习

目的:探讨原发性胆总管非霍奇金淋巴瘤(NHL)的临床病理特征、诊治及预后。方法:报道广西医科大学附属肿瘤医院收治的1例原发性胆总管NHL患者,并结合1982—2017年间国内外文献报道的34例原发性胆总管NHL患者资料进行分析。结果:该患者为男性,81岁,行胰十二指肠切除术后病理结果证实原发性胆总管NHL(弥漫性大B细胞淋巴瘤),术后未行全身化疗及局部放疗等辅助抗肿瘤治疗,4个月后复查未见肿瘤复发。该例加上报道的34例患者中男21例(60.0%),女14例(40.0%);发病年龄4~81岁,中位年龄57岁;临床表现有黄疸(88.6%)和腹痛(40.0%),体表淋巴结肿大(11.4%),伴发热(11.4%);部分影像学表现为胆总管占位或者胆总管壁增厚狭窄;4例行全身化疗,10例行手术切除,16例行手术切除联合全身化疗,1例行手术切除联合局部放疗,3例行手术切除联合全身化疗及局部放疗,1例治疗方案未知。大部分患者治疗后预后较好,有1例生存期超过72个月;单纯手术切除患者与单独化疗或其他联合治疗患者的生存期差异无统计学意义(均P0.05)。结论:原发性胆总管NHL为临床罕见疾病,缺乏典型的临床表现,实验室及影像学检查无明显特异性,故其临床诊断困难,确诊依赖于术后病理学与免疫组织化学,选择合适的治疗方案是延长患者生存期的关键。     

Effect of surgical removal on survival and quality of life in patients with supratentorial glioblastoma

The relationship between the extent of tumor resection and the progression-free survival, overall survival, and quality of life was evaluated retrospectively in 105 consecutive adult patients with supratentorial hemispheric glioblastoma not primarily involving the basal ganglia, thalamus, or hypothalamus. All patients underwent multidisciplinary treatment including tumor removal and postoperative adjuvant therapy in prospective randomized trials designed to test several chemotherapy regimens. Magnetic resonance imaging with contrast medium was used to determine the extent of tumor resection. Gross total resection (GTR) was performed in 35 patients (33%), partial resection (PR) in 57 (54%), and biopsy in 13 (12%). Univariate and multivariate analysis was performed to assess the prognostic relevance of the extent of resection. The Karnofsky performance status (KPS) improved from 78% to 83% in the GTR group. The difference was not statistically significant. There was no significant change in the PR (from 70% to 72%) and the biopsy groups (from 64% to 62%). Progression- free survival was significantly longer in the GTR group (median survival time [MST] 10.3 months) than in the PR (MST 5.2 months) and the biopsy groups (MST 3.6 months). The overall survival was significantly longer in the GTR group (MST 20 months) than in the PR (MST 14.2 months) and the biopsy groups (MST 8.3 months). The difference in survival between the PR and the biopsy groups was not statistically significant. GTR prolongs the survival of patients with glioblastoma compared to PR or biopsy.     

放化疗在胆囊腺鳞癌治疗中的预后价值

目的 胆囊腺鳞癌的预后很差,本研究目的是寻找胆囊腺鳞癌预后的影响因素,评价放化疗对胆囊腺鳞癌预后的意义。方法 从SEER数据库中分析2004年1月至2015年12月214例胆囊腺鳞癌患者的临床病例资料,采用Kaplan-Meier法分析患者预后的影响因素,采用单因素和多因素Cox分析法探讨胆囊腺鳞癌的独立预后因素。结果 胆囊腺鳞癌患者中位生存时间为8个月,1年生存率为34.4%,3年生存率为17.1%。多因素分析结果表明,年龄（HR 1.407,95%CI 1.019~1.944,P=0.038）、M分期（HR 2.219,95%CI 1.595~3.086,P<0.001）、放疗（HR 1.609,95%CI 1.010~2.564,P=0.045）、化疗（HR 1.594,95%CI 1.101~2.307,P=0.013）是胆囊腺鳞癌患者预后的独立因素。42例患者同时接受了化疗和放疗,中位总生存期（OS）为16个月,明显优于未放化疗组（121例,中位OS为5个月）和仅化疗组（49例,中位OS为10个月）。放化疗可提高患者的生存时间（χ²=12.25,P<0.05）。在TNM分期II期和IV期亚组中,同时接受化疗和放疗的胆囊腺鳞癌患者OS比仅接受化疗的患者更长。结论 年龄、M分期、放疗、化疗是胆囊腺鳞癌患者的独立预后因素,放疗联合化疗可以有效改善胆囊腺鳞癌患者的预后。     

Independent association of extent of resection with survival in patients with malignant brain astrocytoma

OBJECT: With recent advances in the adjuvant treatment of malignant brain astrocytomas, it is increasingly debated whether extent of resection affects survival. In this study, the authors investigate this issue after primary and revision resection of these lesions. METHODS: The authors retrospectively reviewed the cases of 1215 patients who underwent surgery for malignant brain astrocytomas (World Health Organization [WHO] Grade III or IV) at a single institution from 1996 to 2006. Patients with deep-seated or unresectable lesions were excluded. Based on MR imaging results obtained < 48 hours after surgery, gross-total resection (GTR) was defined as no residual enhancement, near-total resection (NTR) as having thin rim enhancement of the resection cavity only, and subtotal resection (STR) as having residual nodular enhancement. The independent association of extent of resection and subsequent survival was assessed via a multivariate proportional hazards regression analysis. RESULTS: Magnetic resonance imaging studies were available for review in 949 cases. The mean age and mean Karnofsky Performance Scale (KPS) score at time of surgery were 51 +/- 16 years and 80 +/- 10, respectively. Surgery consisted of primary resection in 549 patients (58%) and revision resection for tumor recurrence in 400 patients (42%). The lesion was WHO Grade IV in 700 patients (74%) and Grade III in 249 (26%); there were 167 astrocytomas and 82 mixed oligoastrocytoma. Among patients who underwent resection, GTR, NTR, and STR were achieved in 330 (35%), 388 (41%), and 231 cases (24%), respectively. Adjusting for factors associated with survival (for example, age, KPS score, Gliadel and/or temozolomide use, and subsequent resection), GTR versus NTR (p < 0.05) and NTR versus STR (p < 0.05) were independently associated with improved survival after both primary and revision resection of glioblastoma multiforme (GBM). For primary GBM resection, the median survival after GTR, NTR, and STR was 13, 11, and 8 months, respectively. After revision resection, the median survival after GTR, NTR, and STR was 11, 9, and 5 months, respectively. Adjusting for factors associated with survival for WHO Grade III astrocytoma (age, KPS score, and revision resection), GTR versus STR (p < 0.05) was associated with improved survival. Gross-total resection versus NTR was not associated with an independent survival benefit in patients with WHO Grade III astrocytomas. The median survival after primary resection of WHO Grade III (mixed oligoastrocytomas excluded) for GTR, NTR, and STR was 58, 46, and 34 months, respectively. CONCLUSIONS: In the authors' experience with both primary and secondary resection of malignant brain astrocytomas, increasing extent of resection was associated with improved survival independent of age, degree of disability, WHO grade, or subsequent treatment modalities used. The maximum extent of resection should be safely attempted while minimizing the risk of surgically induced neurological injury.     

The role of surgery in intracranial PCNSL

This aimed to evaluate the effect of surgery for overall survival (OS) and progression-free survival (PFS) in intracranial primary CNS lymphoma (PCNSL) of all patients diagnosed at a single center. A prospective database at Oslo University Hospital of PCNSL was reviewed over a 12-year period (2003–2014). Seventy-nine patients with intracranial PCNSL were identified. Deep brain involvement was shown in 63 patients. Thirty-two patients underwent craniotomy with resection, while all other patients had a biopsy. Fifty-seven patients were given chemotherapy: 18 were treated with the MSKCC (Memorial Sloan-Kettering Cancer Center) with rituximab, 21 with the MSKCC without rituximab, and 14 within a Nordic prospective phase II protocol. Forty-four patients achieved complete response (CR) and had OS of 46.3 months. Patients who underwent resection had a median OS of 28.6 versus 11.7 months for those who had a biopsy performed. Resection showed an insignificant prolongation of OS. Multivariate analysis confirmed statistical significance of deep brain involvement only (p?<?0.005). Neither chemotherapy regimen, Karnofsky Performance Status (KPS), type of surgery, nor patient age was significant factors for OS or PFS. Resective surgery played no role in significantly improving either OS or PFS and therefore it is not recommended as treatment for PCNSL.     

The effect of histopathologic and clinical features on allograft survival in renal transplant patients with antibody-mediated rejection

Background: Antibody-mediated rejection is a frequent cause of graft failure; however, prognostic indications of this complication have not been well defined. The aim of this study was to evaluate the association of histopathological and clinical features and to determine the effect of these findings on allograft survival in patients with AMR.

Methods: Fifty-two patients suffered from AMR (30 male; mean age 39?±?11 years) were included in the study. Data were investigated retrospectively and graft survival was analyzed. All transplant biopsies were evaluated according to Banff 2009 classification.

Results: Of the 52 cases, 45 were transplanted from living-donors. Twenty-one patients were diagnosed in the first 3-months after transplantation. Graft survival was 65% at 12 months and 54% at 36 months. Mean serum creatinine at time of biopsy was 3.8?±?3.6?mg/dL. Thirty-five of the 52 cases showed diffuse C4d positivity, 12 cases showed focal and 5 remained C4d negative. One of the patients died, 13 experienced graft loss and 38 survived with functioning grafts. Serum creatinine levels at time of biopsy were correlated with graft survival (p?=?.021: OR?=?1.10: 95 % CI?=?1.015–1.199). In terms of the impact of pathological findings; tubulitis (p=.007: OR?=?2.62: 95 % CI?=?1.301–5.276), intimal arteritis (p=.017: OR?=?2.85: 95% CI?=?1.205–6.744) and interstitial infiltration (p=.004: OR?=?3.37: 95% CI?=?1.465–7.752) were associated with graft survival.

Conclusions: Serum creatinine at time of biopsy, tubulitis, intimal arteritis and interstitial infiltration were significantly associated with graft survival. Antibody-mediated rejection is associated with reduced long-term graft survival.     

Surgical volume influences survival in patients undergoing resections for stage II colon cancers

BACKGROUND: There is current interest in the correlation between surgical volume and outcomes. Survival in patients with rectal cancer appears to improve when carried out by surgeons who do high volumes of procedures. A similar correlation for patients with colon cancer has never been clearly established. The aim of this study was to determine whether surgical volume was an independent predictor for survival in patients undergoing surgery for stage II colon cancer. METHODS: Population-based findings were collected from all patients diagnosed with stage II colon cancer in Western Australia between 1993 and 2003. The Kaplan-Meier product limit estimate of survival was used to calculate overall and cancer-specific survival. The Cox proportional hazards model was used to define the correlation between a number of covariates and survival. The results are recorded as hazard ratio (HR) with 95% confidence intervals (CI). RESULTS: From 1993 to 2003, 1467 patients underwent resections for stage II colon cancers. Significant independent predictors for overall survival were surgeon carrying out more than 25 procedures (P = 0.0001, HR 0.657, 95%CI 0.532-0.811), surgery in a private hospital (P = 0.0001, HR 0.487, 95%CI 0.400-0.594), use of chemotherapy (P = 0.001, HR 0.664, 95%CI 0.496-0.837), age at diagnosis (P = 0.0001, HR 1.014, 95%CI 1.027-1.044) and T staging and vascular invasion (T4 and vascular positive P = 0.001, HR 1.850, 95%CI 1.294-2.645). CONCLUSIONS: Surgical volume was a significant independent predictor for survival in patients undergoing resections for stage II colon cancers. Surgeons carrying out only 25 procedures over a 10-year period outperformed surgeons doing fewer cases.     

Carcinoma urotelial de tracto urinario superior: 114 casos con largo seguimiento

PurposeUpper urinary tract urothelial carcinoma (UUTUC) represents 5% of all urothelial tumors and has uncertain prognostic. Exist few series which describes clinical-pathological parameters of tumor progression. The aim of this study is to evaluate clinical and pathological parameters and determine their value as prognostic factors of tumor progression and cancer-specific survival.Material and methodsRetrospective analysis of 114 cases of radical nephroureterectomy or partial ureterectomy collected between 1991 – 2004. Variables analyzed were age, sex, pathological tumor stage, histological tumor grade, CIS, tumor localization, multiplicity, bladder cancer history, pathological nodes and adjuvant chemotherapy. Spearman test was used for correlations. The probabilities of progression free survival and cancer-specific survival were calculated using Kaplan-Meier curves. In the multivariate analysis forward stepwise Cox regression was performed.ResultsPathological stage was: 15 pTa, 25 pT1, 26 pT2, 32 pT3 and 16 pT4. There were 10 G1 (9%), 52 G2 (45.5%) and 52 G3 (45.5%). Fifteen patients presented pathological nodes at the moment of diagnosis. Fourteen percent of 114 patients received adjuvant treatment (Platin-based regimen). Mean follow-up: 74.8 months; 30.7% of the patients developed tumor progression. Death from the disease: 24.6%. Five-years overall and cancer-specific survival: 59.3% and 72.9%, respectively. Five-year progression-free survival: 68%. Mean time of tumor progression: 12.2 months and 23.3 months for cancer-specific death. In the multivariate analysis the independent predictive variables of death and tumor progression were histological grade and pathological stage.ConclusionsWe demonstrated that histological grade and pathological stage constitute independent prognostic factors of tumor progression and cancer-specific survival in UUTUC.     

Prognostic factors for Korean patients with anaplastic thyroid carcinoma

BACKGROUND: Anaplastic thyroid carcinoma (ATC), although rare, is one of the most aggressive human cancers, and patients with ATC have extremely poor prognoses despite various therapeutic measures. We wished to determine the prognostic factors of survival and effect of treatment on survival rate in patients with ATC. METHODS: We retrospectively reviewed the medical records of the 121 patients (41 men and 80 women) diagnosed with ATC from January 1995 to June 2004 at 5 major referral centers in Korea. RESULTS: Mean patient age at diagnosis was 64 +/- 11 years (range, 17-84 years). Of the 121 patients, 11 (9%) had intrathyroidal tumors, 69 (57%) had extrathyroidal tumors or lymph node involvement, 29 (24%) had distant metastases, and 12 had no data about staging (9%). The mean tumor diameter was 5.5 +/- 2.5 cm (range, 0.5-17.0 cm). At a median follow-up of 41 months (range, 26-122 months), 8 patients were alive. Median survival time was 5.1 months. The disease-specific survival rates were 42% at 6 months, 16% at 12 months, and 9% at 24 months. Sixteen patients (13%) received only supportive care, 25 (21%) received surgery alone, 20 (16%) received radiation treatment or chemotherapy without surgery, and 60 (50%) received surgery plus radiation treatment or chemotherapy. Multivariate analysis showed that age less than 60 years, tumor size less than 7 cm, and lesser extent of disease were independent predictors of lower disease-specific mortality. CONCLUSIONS: Long-term survival is possible for ATC patients less than 60 years old and with small localized tumors. Although aggressive multimodal therapy, including surgery, radiation treatment, and chemotherapy, was not significantly associated with improved survival, we advocate aggressive multimodal therapy in selected ATC patients with good prognostic factors.     

局部进展期胃癌术前化疗的疗效分析

目的 探讨局部进展期胃癌术前化疗的疗效及安全性,以及影响术前化疗胃癌患者复发死亡的因素.方法 回顾性分析2007年7月至2011年6月间复旦大学附属中山医院肿瘤内科收治的49例局部进展期胃癌患者的临床资料.采用Cox比例风险模型来分析新辅助化疗患者复发死亡的危险因素.结果 其中48例患者化疗后在术前接受了影像学评估,术前化疗的有效率和疾病控制率分别为33.3％(16/48)和93.8％(45/48);另有1例因在化疗期间胃穿孔行急诊手术而未接受影像学评估.治疗后89.8％(44/49)的患者获得根治手术,其中90.9％的患者(40/44)接受了D2淋巴结清扫术.术后淋巴结转阴率为30.6％(15/49);术后病理有反应32例,其中2例获得完全病理缓解.术前化疗期间血液学毒性反应主要为白细胞下降,非血液学毒性反应主要为恶心呕吐,以1～2级为主.49例患者平均住院时间为11.6 d,其中2例(4.1％)分别因术后胰漏和胰周渗液而延长了住院时间.49例患者均接受了术后随访,中位随访时间为21.6个月,中位无复发生存期为29.6个月(95％CI:24.0～35.2),中位总生存期为34.6个月(95％CI:29.8～39.4).多因素预后分析显示,影像学疗效(P.=0.038,RR=0.168,95％CI:0.031～0.904)和病理反应(P=0.007,RR=0.203,95％CI:0.064～0.642)是影响本组患者术后复发死亡的独立因素.结论 术前化疗对于局部进展期胃癌具有较高的疾病控制率和R0切除率;影像学疗效和病理反应是影响局部进展期胃癌术前化疗患者最重要的预后指标.     

Oestrogen receptors revisited: long-term follow up of over five thousand breast cancer patients

BACKGROUND: The oestrogen receptor status of a breast tumour predicts the response to hormonal treatment and is an important prognostic marker; women with oestrogen receptor positive tumours having a better short-term survival outcome. METHODS: Kaplan-Meier estimates and Cox proportional hazard model were used to estimate the association between oestrogen receptor levels and long-term breast cancer-specific survival outcomes in 5735 women diagnosed with breast carcinoma from 1970 to 1997 in Western Australia. Further analysis was performed on a subset of women for whom biochemical and tumour characteristics were also available. RESULTS: Five-year breast cancer-specific survival estimates for women with oestrogen receptor positive tumours was 0.85 (95% CI 0.84-86) compared to 0.72 (95% CI 0.70-74) for women with oestrogen receptor negative tumours. The relative survival advantage of an oestrogen positive tumour over oestrogen negative tumours disappeared by the fourth year (0.8, 95% CI 0.6-1.0). Conditional upon surviving 5 years, long-term breast cancer-specific survival was better for women with oestrogen receptor and progesterone receptor negative tumours compared to other women (log rank test P-value <0.05). CONCLUSION: Despite an earlier survival advantage for women diagnosed with oestrogen receptor positive tumours, after 5 years of survival, women with oestrogen receptor negative and progesterone receptor negative tumours had better long-term survival outcomes from breast cancer compared to other women.