TUBB3,TS,ERCCI mRNA表达对晚期胃癌化疗疗效和预后的影响

目的:探讨胃癌组织中3型β微管蛋白(β-tubulin-Ⅲ,TUBB3)、胸苷酸合成酶(thymidylate synthase,TS)、核苷酸切除修复交叉互补基因(excision repair cross complementation group 1,ERCC1)mRNA表达水平对接受多西他赛/顺铂/氟尿嘧啶(TXT/CDDP/FU,DCF)方案化疗的晚期胃癌患者化疗疗效和预后的影响.方法:共人组48例晚期胃癌患者,所有患者均接受DCF方案姑息化疗.采用分支DNA液相芯片技术对患者胃癌组织中TUBB3,TS,ERCC1 mRN表达情况进行检测.结果:TUBB3 mRNA低表达患者的化疗缓解率要显著高于高表达患者(P=0.011),而TS和ERCC1表达水平与缓解率无显著性相关.TUBB3 mRNA低表达患者的中位疾病进展时间(TTp)和中位总生存期(OS)均优于高表达患者(P=0.002; P＜0.001),TS和ERCC1表达水平与患者的TTP和OS无明显相关.TUBB3,TS,ERCC1中有0或1个基因高表达的患者在化疗缓解率、TTP和OS方面均要优于有2或3个基因高表达的患者(均P=0.001).Cox回归多因素分析显示:体力状态(Eastern Cooperative Oncology Group,ECOG)评分≥2分(HR=2.42,P=0.009)和TUBB3高表达(HR=2.34,P=0.036)是影响OS的独立不良预后因素.结论:TUBB3 mRNA高表达可能与DCF方案耐药相关,TUBB3可作为接受以TXT为基础化疗的晚期胃癌患者的疗效和预后预测指标.TUBB3,TS和ERCC1 mRN表达的联合检测有助于晚期胃癌患者的个体化治疗.     

Oncol2012: 术中全身性静脉化疗对可根治性切除的局部进展期胃癌患者预后的影响

背景: 尽管实行根治性切除术,局部进展期胃癌患者的预后仍然较差。 很少有研究报告关于术中全身性静脉化疗对胃癌的治疗作用。本研究目标是为了分析可切除的局部进展期胃癌患者的预后因素,重点是研究术中全身性静脉化疗对可切除的局部进展期胃癌患者预后的影响和其安全性。 方法: 收集2002-2007年中国医学科学院北京协和医院局部进展期胃癌根治手术患者264例,回顾性分析患者的临床病理及治疗资料。采用Kaplan-Meier法绘制患者的生存曲线。生存曲线差别比较采用log-rank法,单因素及多因素分析采用Cox 比例风险模型。 结果: 接受术中静脉全身性化疗的患者五年总生存时间较未进行术中静脉全身性化疗的患者明显升高(53.0% versus 37.3%, P=0.019), 同样接受术中静脉全身性化疗的患者五年无病生存时间较未进行术中静脉全身性化疗的患者也明显升高(48.3% versus 35.8%, P=0.010)。 在亚组分析中发现术中静脉化疗使pTNMIB-II期,pTNMIIIA-B期患者OS和DFS受益,但是对TNMIIIC期无明显作用。术中静脉化疗联合术后化疗患者较单纯术后静脉化疗患者的OS和DFS好（P=0.046 vs. P=0.021)。但是单纯术中静脉化疗组患者的OS和DFS较单纯手术组患者的改善作用未达到统计学差异(P=0.150 vs. P=0.170)。多因素分析显示术中全身性静脉化疗 是5年总生存时间和无病生存时间的独立的有益预后因素(P=0.048和P=0.023）。同时研究发现术后4周内没有与术中全身性静脉化疗相关的严重毒性发生。 结论: 术中全身性静脉化疗可使根治性切除的局部进展期胃癌患者(pTNM IB-IIIB)无病生存时间和总生存时间受益。     

首次疗效评估中肿瘤最长径之和变化对晚期肝内胆管癌化疗患者生存预后的预测价值

目的 探讨晚期肝内胆管癌患者接受一线化疗后首次疗效评估结果对生存预后价值。方法 回顾性纳入2018年10月—2022年12月在海军军医大学附属东方肝胆外科医院接受化疗方案治疗的107例晚期肝内胆管癌患者。基于实体瘤疗效评价标准1.1,对比化疗前后最长径之和(sum of the largest tumor diameters, SLD)变化将疗效分为3组,将肿瘤SLD缩小至少超过30%为SLD(1)组;SLD增加至少超过20%纳入SLD(3)组;介于两者之间的为SLD(2)组。Kaplan-Meier曲线分析3组患者的总生存期(overall survival, OS)。单因素和多因素Cox风险回归分析明确疗效与生存时间的预后价值。结果 Kaplan-Meier曲线分析结果表明SLD(1)组、SLD(2)组和SLD(3)组患者的中位OS分别为16.3、13.2、7.4个月(P<0.001),以及6、12和24个月OS率依次递减。SLD(1)组中6、12、24个月的生存率分别为100%、72.2%和16.7%;SLD(2)组中6、12、24个月的生存率分别为90.7%、53.7%和7.4%;SLD(3)组中6、12、24个月的生存率分别为57.1%、20%和0%。为进一步分析SLD增大或缩小的程度对患者预后的影响,我们在SLD(2)组中将SLD增大的患者纳入SLD(2+)组,将SLD减小的患者纳入到SLD(2-)组。SLD(2+)和SLD(3)组的中位OS分别为11.3个月和7.4个月,P=0.012。然而,SLD(2-)和SLD(1)组的中位OS分别为13.9个月和16.4个月,P=0.053。单因素和多因素Cox风险回归分析表明SLD缩小＞30%(HR=0.564,95%CI: 0.3210.991,P=0.046)、SLD增加＞20%(HR=3.012,95%CI: 1.8734.842,P<0.001)是晚期肝内胆管癌总体生存时间的独立预后因素。结论 晚期肝内胆管癌一线化疗患者,首次疗效结果对患者生存预后有重要的意义: 肿瘤SLD增长越大,生存预后越差,但在肿瘤SLD缩小部分中,SLD(1)与SDL(2-)对患者的生存预后没有明显差异性。     

预后营养指数与胃癌患者临床病理特征及预后相关性分析

目的 分析预后营养指数(prognostic nutritional index,PNI)与128例胃癌患者的临床特征及预后联系,探讨PNI作为胃癌患者预后指标的作用价值。 方法 回顾性分析2009年9月—2013年1月收治的128例胃癌患者的临床资料,分析PNI与患者临床病理特征联系,再根据随访生存情况,采用Kaplan-Meier法计算生存率并进行单因素分析、Cox比例风险回归模型多因素分析,评估患者临床病理特征、治疗方式、PNI等因素对胃癌患者生存期的影响。 结果 低PNI组与较晚临床分期有关(P=0.041),与年龄、性别、淋巴结转移、是否吸烟饮酒无关联(P＞0.05)。单因素分析发现淋巴结转移、较晚的临床分期、PNI较低、姑息治疗与患者较差的生存预后密切相关(P＜0.05)。PNI较低组患者总生存期(P=0.037)和无进展生存期(P=0.007)均差于PNI较高组。Cox多因素回归分析发现除了较晚的临床分期(风险比例:5.48,置信区间:0.23～21.95)、姑息治疗(风险比例:7.40,置信区间:1.03～16.25)外,PNI＜45(风险比例:0.41,置信区间:0.07～4.66)是胃癌患者不良预后的独立影响因素。 结论 PNI水平高低与胃癌患者肿瘤分期密切相关,除肿瘤分期和只接受姑息治疗外,低PNI是一个较新的胃癌患者预后独立危险因素,对临床预后转归判断有重要的价值。      

血清淀粉样蛋白A升高与局部晚期鼻咽癌预后的倾向匹配研究

目的 探讨血清淀粉样蛋白A(serum amyloid A,SAA)升高对局部晚期鼻咽癌患者预后的影响。 方法 分析2012年11月5日—2015年3月5日郑州大学第一附属医院收治的315例接受放化疗的Ⅲ~ⅣA/B期鼻咽癌患者临床及随访资料,SAA升高者53例(SAA-H),依据性别、年龄、KPS评分、T分期、N分期、临床分期采用倾向值匹配法,获得106例(1∶2匹配)SAA正常者(SAA-N)。Kaplan-Meier法计算生存率,Cox回归模型进行预后因素分析。主要研究终点:总生存率(OS);次要研究终点:无局部-区域进展生存率(loco-regional relapse-free survival,LRRFS)和无远处转移生存率(distant metastasis-free survival,DMFS)。 结果 315例局部晚期患者中,SAA升高与SAA正常组相比,4年OS为66.0%vs. 82.1%,P=0.007;4年LRRFS为86.8%vs. 90.1%,P=0.385;4年DMFS为58.5%vs. 77.5%,P=0.001。用倾向值匹配法纳入的159例患者中,SAA-H组预后明显差于SAA-N组,4年OS:66.0%vs. 80.2%,P=0.044;4年LRRFS为86.8%vs. 92.5%,P=0.198;4年DMFS为58.5%vs. 74.5%,P=0.023。Cox回归模型显示SAA升高是OS和DMFS的不良预后因素。 结论 SAA升高是局部晚期鼻咽癌患者死亡和转移的预后因素,治疗前SAA水平结合TNM分期可为局部晚期鼻咽癌患者危险度分级,指导临床治疗强度的选择。      

晚期结直肠癌患者一线应用FOLFOX方案化疗引起中性粒细胞减少的预后价值

目的：探讨一线应用奥沙利铂联合氟尿嘧啶、亚叶酸钙（FOLFOX）方案化疗的晚期结直肠癌患者中性粒细胞减少（chemotherapy-induced neutropenia,CIN）与预后的关系。方法： 回顾性分析一线应用FOLFOX方案化疗的晚期结直肠癌患者158例,根据患者化疗后3周期内最低中性粒细胞数与化疗前比较分为CIN程度大的组（较化疗前降低大于等于1.0×109）和程度小的组（较化疗前CIN降低小于1.0×109）以及无明显变化组,分析其与预后的关系。结果：CIN降低程度是患者预后指标无进展生存（progression free survival, PFS）和总生存（overall survival, OS）的独立影响因素。根据COX多因素回归分析,CIN程度大的组(large,L)较无明显变化组(absent,A)死亡风险降低31%(HR=0.687,95% CI: 0.381~0.812,P=0.016);CIN程度小的组(slight,S)较无明显变化组死亡风险降低18%(HR=0.817,95% CI: 0.527~0.939,P=0.027)。无明显变化组 (A)患者的中位OS为12.9个月,CIN程度少的组(S)患者的中位OS为17.3个月,CIN程度大的组(L)患者的中位OS为20.8个月(S vs. L, P=0.018; L vs. A, P=0.009; S vs. A, P=0.011)。结论：CIN程度是晚期结直肠癌化疗判断预后的独立影响因素,监测并根据CIN程度及时调整化疗药物剂量,或许有助于改善预后。     

健脾解毒通络方联合替加氟维持治疗晚期胃癌

目的:通过观察健脾解毒通络方联合替加氟维持治疗的晚期胃癌患者,分析该方案对晚期胃癌患者无进展生存时间(Progress Free Survival,PFS)、总体生存率(overall survival,OS)的影响并研究与晚期胃癌预后相关的临床因素。方法:搜集30例晚期胃癌患者,并对接受该方案维持治疗后的PFS、OS进行统计分析并研究影响预后的相关因素。结果:30例患者中位PFS是(15. 000±4. 674)个月;中位OS是(27. 000±5. 439)个月; 1年生存率约78. 94%; 2年生存率约36. 84%; 3年生存率约10. 52%,5年生存率约10%;手术治疗对能明显延长PFS但对OS无明显差异;淋巴结转移能明显减少PFS、OS;脏器转移情况是决定PFS、OS长短的相关因素。结论:健脾解毒通络方联合替加氟维持治疗可以提高晚期胃癌患者近期疗效,改善生存质量,延长无疾病进展时间,总生存期也有延长趋势,且不良反应低,耐受性好。     

MDR1基因多态性与胃癌顺铂化疗疗效的相关性

目的 研究多药耐药基因MDR1 C3435T基因多态性与胃癌患者对顺铂化疗疗效的关系。方法 选取102例经病理学确诊的胃癌患者进行顺铂方案的化疗,通过采集患者外周静脉血提取基因组DNA并测序分析,检测MDR1 C3435T基因多态性并分析基因多态性与患者化疗疗效及生存预后的关系。结果 102例胃癌患者中,MDR1 C3435T C/C基因型患者40例(39.2%),C/T基因型患者29例(28.4%),T/T基因型患者33例(32.4%),其中,C/C基因型患者的完全缓解率CR为3.9%,部分缓解率PR为23.6% ,有效治疗率CR+PR为27.6%,明显高于C/T(CR=1%, PR=2%, CR+PR=3%)和T/T(CR=0, PR=9.8%, CR+PR=9.8%)基因型患者。与MDR1 C3435T C/T和T/T基因型患者相比,C/C基因型患者的无进展生存时间(PFS)和总生存时间(OS)更长(PFS:P=0.046; OS:P=0.011)。Log-rank和COX多因素回归模型证实MDR1 C3435T基因多态性是影响顺铂化疗的胃癌患者生存的独立预后因素(PFS:HR=3.488, P=0.005; OS:HR=2.418, P=0.035)。结论MDR1基因 C3435T位点多态性与胃癌患者对顺铂化疗疗效和生存预后相关。     

以健脾为基础的复方辨证治疗对老年胃癌患者生存期的影响

背景：胃癌是最常见的恶性肿瘤之一,中医药已广泛用于胃癌的临床治疗,但尚未见到较大样本临床对照研究对其疗效进行评价。目的：通过对220例老年胃癌预后的分析,研究以健脾为基础的中药复方辨证治疗对老年胃癌预后的影响。设计、场所、受试者和干预措施：采用前瞻性同期病例对照研究方法,将65岁及以上老年胃癌病例（来自上海龙华医院肿瘤一科、瑞金医院消化外科和仁济医院普外科）分为接受中药复方辨证治疗的中药组和未接受中药治疗的非中药组。主要结局指标：依据临床病理分期,是否接受根治性手术和化疗进行分层。运用单因素及Cox多因素回归分析方法分析两组病例的临床病理因素及手术、化疗以及中药治疗对预后的影响。结果：共有220例病例纳入研究。中药组89例,非中药组131例。总体220例病例的Cox多因素回归分析表明,影响老年胃癌患者生存的独立的预后因素分别是临床病理分期、手术方式、化疗和中药治疗（P〈0．01）。服用中药的相对危险度为0．322,95％可信区间在0．212～0．489。中药组中位总生存期为41．129个月,1、3、5年生存率分别为85．2％、55．6％、45．7％;非中药组中位总生存期为17．195个月。1、3、5年生存率分别为63．9％、26．9％、21．9％。对未手术或术后复发转移的晚期胃癌分层研究,Cox多因素回归分析示,中药治疗和化疗是影响老年晚期胃癌患者总生存期独立的保护性因素（P〈0．01）,服用中药的相对危险度为0．421,95％可信区间在0．255～0．693;晚期中药组（36例）中位总生存期为17．819个月,晚期非中药组（60例）中位生存期为8．548个月。对临床病理分期为Ib—IV（T4N1-3M0、T1—3N3M0）接受根治性手术（R0）且接受3个及以上周期术后辅助化疗病例的分层研究结果显示,术后中药组和术后非中药组的无病生存期和总生存期均未达到中位数,故未作Cox多因素回归分析;术后中药组（33例）1、3、5年无病生存率分别为97．0％、59．9％、50．4％,1、3、5年生存率分别为100．0％、74．1％、61．49／6;术后非中药组（69例）1、3、5年无病生存率分别为82．6％、51．1％、51．1％,1、3、5年生存率分别为86．9％、55．6％、55．6％。结论：以健脾为基础的中药复方辨证治疗可改善老年胃癌的总体预后,是老年晚期胃癌预后的有效保护性因子,对老年根治性胃癌术后无病生存期和总生存期的影响需要继续随访评价。     

胃癌穿孔患者术后预后影响因素分析

目的了解胃癌穿孔患者术后的生存情况,探讨影响预后的相关因素。方法采用Cox模型回顾性分析2000年7月—2011年7月收治的61例胃癌穿孔术患者的临床资料。结果患者术后中位生存时间120 d。1、3、5年生存率分别是31.15%(19/61)、3.28%(2/61)和0。对单因素Cox回归分析筛选差异有统计学意义的变量进行多因素Cox回归分析显示,与Ⅱ期胃癌比较,Ⅲ期(OR=4.875,P=0.040)和Ⅳ期(OR=9.386,P=0.006)胃癌穿孔患者的预后差。与一期根治术相比,行单纯修补术(OR=3.937,P=0.008)和姑息性胃切除术(OR=2.347,P=0.031)患者的预后较差。此外,合并疾病也是预后的危险因素(OR=4.337,P=0.002)。结论胃癌穿孔患者术后的预后不良,与胃癌TNM分期的关系最密切,手术方式首选一期根治术;而是否患有合并疾病是机体能否耐受手术的参考指标。     

中医药治疗晚期非小细胞肺癌的回顾性研究

目的:评价中医药治疗对晚期非小细胞肺癌(NSCLC)生存率的疗效,探索影响晚期NSCLC预后的相关因素,为中西医结合个体化治疗晚期NSCLC的诊疗方案提供参考依据。方法:采用回顾性研究方法,整理连续性住院的609例晚期NSCLC患者的临床资料,分别从人口学资料、肿瘤特征、治疗方法三个方面进行影响因素的采集。运用寿命表法统计患者的1年、2年及3年生存率及中位生存期(MST);运用Kaplan-Meier计算进行单因素分析,经Log-rank法检验将有意义的因素纳入Cox回归模型进行多因素分析,筛选出晚期NSCLC的预后相关因素。结果:609例晚期NSCLC患者的中位生存期为25.1个月,1年、2年、3年生存率分别为71.7%、50.0%及32.8%。单因素分析结果显示,性别、年龄、吸烟指数、病理类型、中医辨证分型、PS评分、艾灸治疗、中药静脉疗程、靶向治疗时机、综合治疗方式为预后相关因素(P0.05);多因素分析结果显示,吸烟指数、病理类型、PS评分、中药静脉疗程、综合治疗方式是预后的独立因素。结论:长期辨证中医药治疗能有效延长晚期NSCLC的生存期;多疗程的中药静脉制剂、艾灸治疗能使患者获益,延长生存期;晚期NSCLC的最佳治疗模式是以中医药贯穿始终的多学科综合治疗;晚期NSCLC患者中不吸烟是预后的保护因素;晚期NSCLC病理类型中以腺癌预后较好。     

辨证颗粒剂配方联合化疗治疗老年晚期非小细胞肺癌生存质量分析

目的:观察中药辨证颗粒剂配方联合化疗治疗老年晚期肺癌对生存质量的改善作用,并评价其安全性。方法:年龄≥65岁的老年晚期非小细胞肺癌(NSCLC)患者共82例,随机分为化疗组、中药联合组。两组均接受标准方案的化疗,中药联合组经辨证后同时口服对证的中药颗粒剂,而化疗组则口服相应的中药颗粒剂安慰剂。化疗周期为21 d,2个周期为1个疗程,共完成2个疗程;中药由化疗后第1天开始服用,化疗当天停药。观察结束,评价无进展生存期(PFS)、总生存期(OS)、客观有效率(ORR)及生活质量量表(EORTC QLQ-L43)、中医证候评分与安全性指标。结果:中药联合组的中位无疾病进展期(m PFS)和中位总生存期(m OS)分别为255 d和533 d,化疗组m PFS和m OS分别为195 d和420 d,差异均具有统计学意义(P0.05);中医症状评分以及生存质量量表的数据显示,中药联合组的治疗积极有效,总健康状况明显优于化疗组(P0.05)。安全性方面均无治疗相关性死亡,且中药联合组可明显减轻化疗的副作用(P0.05)。结论:辨证使用中药颗粒剂配合化疗,对老年晚期NSCLC患者能一定程度延长疾病无进展时间和总生存时间,减轻化疗副反应,提高生存质量。     

中医药干预老年晚期非小细胞肺癌患者的生存研究

目的:探讨接受中医药干预的老年晚期非小细胞肺癌患者的生存状况及其预后的影响因素.方法:回顾性分析103例接受中医药干预持续3个月及以上的老年(年龄≥65岁)晚期(ⅢB或Ⅳ期)非小细胞肺癌患者的临床资料,利用SPSS 16.0统计软件COX回归模型分析年龄、性别、病理、临床分期、合并症、治疗方法、中医药干预持续时间等预后...     

Therapeutic evaluation on advanced pancreatic cancer Treated by Integrative Chinese and western medicine — Clinical analysis of 56 cases

Objective:In comparison with chemotherapy, to evaluate therapeutic effects on advanced pancreatic cancer treated by integrative Chinese and western medicine (ICWM) therapies.Methods: Based on the retrospective study of 56 patients with advanced pancreatic cancer, life table was applied to the analysis of patients’ survival rate and χ² test to the comparison of therapeutic response between ICWM and chemotherapy groups.Results: The results showed that 1-year survival rate in the ICWM group was 55. 37%±3.24%; 2-year survival rate 34. 61%±16. 31%; 3-year survival rate 25. 96%±24. 64%; 5-year survival rate 2596%±24.64%; and median survival period 16.3 months. However 1-year survival rate in the chemotherapy group was 21. 95%±27. 54%; 2-year survival rate 7. 31%±27. 54%; 3-year survival rate 0%; and median survival period 7. 5 months. The therapeutic effects between two groups were significantly different (P=0. 004). Further analysis suggested that the reduction of cancer mass in the ICWM group was more than that in chemotherapy group (P=0.049) and the improvement of advanced pancreatic cancer related-symptoms better than that of chemotherapy group (P = 0. 002).Conclusion: The ICWM comprehensive therapy is of important value in the treatment of advanced pancreatic cancer.     

Predictive Factors Improving Survival After Gastric and Hepatic Surgical Treatment in Gastric Cancer Patients with Synchronous Liver Metastasis

背景：胃癌肝转移患者预后较差,然而目前对于胃癌肝转移尚无规范化治疗体系。手术治疗的疗效及预后因素尚存在争议。 方法：回顾性分析解放军总医院自1995至2010年接受手术治疗的105例同时性胃癌肝转移且无肝外转移患者的病例资料。 结果：本组105例患者一、二、三年生存率分别为42.1%, 17.2%, 10.6%,中位生存期11个月。多因素分析表明淋巴结清扫范围(D) (P<0.001), N (P<0.001), 肝转移程度(H) (P=0.008), 脉管癌栓(P=0.002) 为生存期的独立预后因素。在对胃癌原发病灶给予D2淋巴结清扫的患者中,同时给予肝转移灶切除能够显著延长生存期（中位生存期分别为24个月和12个月,P<0.001）;然而在对胃原发病灶行D1或相似文献   

Predictive factors improving survival after gastric and hepatic surgical treatment in gastric cancer patients with synchronous liver metastases

Background  The prognosis for patients with gastric cancer and synchronous liver metastases is very poor. However, a standard therapeutic strategy has not been well established. The clinical benefit and prognostic factors after hepatic surgical treatment for liver metastases from gastric cancer remain controversial.

Methods  Records of 105 patients who underwent gastrectomy regardless of hepatic surgical treatment for gastric cancer with synchronous liver-only metastases in our center between 1995 and 2010 were retrospectively reviewed.

Results  The overall survival rate for the 105 patients was 42.1%, 17.2%, and 10.6% at 1, 2, and 3 years, respectively, with a median survival time of 11 months. Multivariate survival analysis revealed that the extent of lymphadenectomy (D) (P <0.001), lymph node metastases (P <0.001), extent of liver metastases (H) (P=0.008), and lymphovascular invasion (P=0.002) were significant independent prognostic factors for survival. Among patients who underwent D2 lymphadenectomy, those who underwent hepatic surgical treatment had a significantly improved survival compared with those who underwent gastrectomy alone (median survival, 24 vs. 12 months; P <0.001). However, hepatic surgical treatment was not a prognostic factor for patients who underwent D1 lymphadenectomy (median survival, 8 vs. 8 months; P=0.495). For the 35 patients who underwent gastrectomy plus hepatic surgical treatment, D2 lymphadenectomy (P <0.001), lymph node metastases (P=0.015), and extent of liver metastases (H1 vs. H2 and H3) (P=0.017) were independent significant prognostic factors for survival.

Conclusions  D2 lymphadenectomy plus hepatic surgical treatment may provide hope for long-term survival of judiciously selected patients with hepatic metastases from gastric cancer. Patients with a low degree of lymph node metastases and H1 liver metastases would make the most appropriate candidates. However, if D2 dissection cannot be achieved, hepatic surgical treatment is not recommended.

     

Prognostic impact of splenectomy on advanced proximal gastric cancer with No. 10 lymph node metastasis

Background This study evaluated the prognostic impact of D2 lymphadenectomy combined with splenectomy in patients with advanced proximal gastric cancer and lymph node metastasis at the splenic hilum （No. 10 lymph nodes）. Methods The clinical records of 216 patients with advanced proximal gastric cancer and No. 10 lymph node metastasis who underwent D2 curative resection were retrospectively analyzed. Seventy-three patients underwent simultaneous splenectomy （splenectomy group）, while 143 patients did not （spleen-preserving group）. Five-year survival rates, mean numbers of dissected No. 10 lymph nodes and metastatic No. 10 lymph nodes, and operative morbidity and mortality were calculated and compared between the two groups. Potential prognostic factors were evaluated by univariate and multivariate analysis.
Results The 5-year survival rate was 30.0% for the splenectomy group and 19.7% for the spleen-preserving group （χ^2=14.73, P 〈0.05）. The mean numbers of dissected No. 10 lymph nodes and metastatic No. 10 lymph nodes in the splenectomy group were significantly greater than in the spleen-preserving group （P 〈0.05）. Multivariate analysis revealed that the depth of invasion, splenectomy, and type of gastrectomy were independent prognostic factors. The survival rate for T3 patients with and without splenectomy was 38.7% and 18.9%, respectively （χ^2 =15.03, P 〈0.05）. For patients undergoing total gastrectomy, survival rates were 33.4% and 20.7%, respectively （χ^2 =13.63, P〈0.05）. Operative morbidity and mortality in splenectomy group was 24.7% and 4.1%, respectively, and in the spleen-preserving group was 17.5% and 3.5%, respectively. The differences were not statistically significant （P 〉0.05）. Conclusions Splenectomy is beneficial for No. 10 lymph node dissection in patients with advanced proximal gastric cancer. To improve patient prognosis, total gastrectomy with splenectomy is recommended for patients with T3 proximal gastric cancer who have No. 10 lymph node metastasis.     

Identifying prognostic factors for survival in advanced cancer patients: a prospective study.

OBJECTIVE: To identify potential prognostic factors affecting the survival in patients with advanced cancer in a local palliative care unit. DESIGN: Prospective cohort study. SETTING: Palliative Care Unit of a regional hospital in Hong Kong. PATIENTS: All advanced cancer in-patients and out-patients who were enrolled into the palliative care service of the United Christian Hospital between January and December 2002 were recruited. MAIN OUTCOME MEASURES: Potential prognostic factors including demographic data, tumour characteristics, blood parameters, functional status, co-morbidities, total symptom score, and psychosocial parameters were recorded upon enrollment. RESULTS: A total of 170 patients were eligible for analysis; their mean age was 69 (standard deviation, 12) years, of which 106 (62%) were male. Overall median survival was 77 (interquartile range, 31-160) days. The most frequent primary malignancy was lung (n=58, 34%), followed by liver (n= 24, 14%) and lower gastro-intestinal tract (n=24, 14%). By univariate analysis, 11 factors affected survival, including: age (P=0.040), number of metastatic sites involved (P=0.001), peritoneal metastases (P=0.009), skin metastases (P=0.011), tachycardia (P=0.009), serum albumin concentration (P<0.001), white cell count (P=0.002), Karnofsky Performance Status score (P<0.001), Hamilton Depression Scale score (P=0.004), Edmonton Symptom Assessment System score (P=0.003), and McGill Quality of Life (Hong Kong)-single item score (P=0.002). Multivariable Cox regression analysis revealed that only age (hazard ratio=0.84; 95% confidence interval, 0.73-0.96), number of metastatic sites involved (1.33; 1.13-1.56), serum albumin concentration (0.95; 0.92-0.98), Karnofsky Performance Status score (0.86; 0.78-0.96), and Edmonton Symptom Assessment System score (1.22; 1.05-1.41) were independent prognosticators. CONCLUSION: Age, number of involved metastatic sites, serum albumin, Karnofsky Performance Scale score, and Edmonton Symptom Assessment System score were independent prognosticators. Further studies are needed to provide a prognostic instrument applicable in local clinical settings.     

食道通结方对食管癌裸鼠移植瘤细胞增殖及凋亡的影响

目的:通过体内实验观察食道通结方对食管癌裸鼠移植瘤增殖、凋亡相关蛋白表达的影响,进一步明确该方治疗食管癌的作用机制。方法:裸鼠皮下接种食管癌TE-1瘤株,造模成功后随机分为模型组、中药组、顺铂组、中药+顺铂组,各组分别予0.9%Na Cl溶液、中药食道通结方、顺铂、中药食道通结方+顺铂干预,共28 d。观察各组裸鼠皮下移植瘤生长情况,检测肿瘤细胞增殖指数、凋亡指数的变化以及移植瘤细胞内增殖、凋亡相关蛋白Stat3、P53、Bcl-2、Bax、Caspase3表达情况。结果:与模型组比较,各药物组的平均移植瘤体积及瘤重均明显降低(P0.01),其中中药+顺铂组显著低于中药组及顺铂组(P0.01)。各药物组的皮下移植瘤细胞增殖指数均显著降低(P0.01),其中顺铂组明显低于中药组(P0.01),而中药+顺铂组降低更显著(P0.01);各药物组的皮下移植瘤细胞凋亡指数均明显升高(P0.01),其中中药+顺铂组显著高于中药组及顺铂组(P0.01)。各药物组的肿瘤组织中Stat3、Bcl-2表达均明显下降,P53、Bax、Caspase3表达均显著增加,其中中药+顺铂组变化更为明显。结论:食道通结方具有抑制食管癌细胞株TE-1皮下移植瘤细胞增殖、促进其凋亡的作用,并能增强顺铂抑制肿瘤细胞生长的作用,其可能与下调食管癌细胞株TE-1中Stat3、Bcl-2的表达,上调P53、Bax、Caspase3的表达相关。     

Intraoperative hyperthermic intraperitoneal chemotherapy as adjuvant chemotherapy for advanced gastric cancer patients with serosal invasion

BackgroundTo evaluate hyperthermic intraperitoneal chemotherapy (HIPEC) as an adjuvant chemotherapy in advanced gastric cancer (AGC) patients with serosal invasion.MethodsPatients who received radical surgery and palliative surgery between January 2002 and December 2010 were retrospectively examined. Patients were divided into two groups, namely, one group that underwent surgery and another group that underwent surgery with HIPEC. All patients who received HIPEC had suspected serosal invasion on an abdominal computed tomography or by the surgeon's assessment during the operation.ResultsThe prophylactic groups included 83 patients who underwent gastrectomy alone. A total of 29 patients underwent gastrectomy with HIPEC. The 5-year survival rates were 10.7% and 43.9%, respectively. The 5-year mean survival times were 22.66 (17.55–25.78) and 34.81 (24.97–44.66) months (p = 0.029), respectively. There were 52 patients who had a recurrence of carcinomatosis among 133 patients who had resections (52/133, 39.1%). The 3-year disease-free survival rate for carcinomatosis was 28.87% in the group that received surgery alone, whereas it was 66.03% in the group that received HIPEC. There was no significant difference in the rate of complication between the two groups in the prophylactic group (p = 0.542). Thus, curative surgery with HIPEC had a better prognosis for AGC with serosal invasion. The carcinomatosis recurrence time was longer in patients who underwent gastrectomy with HIPEC and received R0 resection.ConclusionThe survival benefit of HIPEC as an adjuvant therapy for gastric cancer patients with serosal invasion should be validated in a large cohort.