阳性淋巴结对数比分期对Ⅲ期直肠癌患者预后的评估价值

目的探讨阳性淋巴结对数比(LODDS)分期对Ⅲ期直肠癌患者术后3年无疾病生存(DFS)的评估价值。方法收集我院2010年1月至2014年12月就诊的Ⅲ期直肠癌根治术后患者的临床病理资料及随访数据,受试者工作特性(ROC)曲线计算LODDS的最佳截点值并分组,单因素和多因素分析患者的预后影响因素,ROC曲线下面积(AUC)比较pN分期、LODDS分期对3年DFS的预后评估能力。结果 LODDS分期最佳截点值为-0.3552,单因素分析结果显示:年龄(P=0.015)、癌结节(P=0.000)、神经侵犯/脉管癌栓(P=0.004)、术前CEA水平(P=0.012)、pN分期(P=0.000)和LODDS分期(P=0.001)均与本组患者3年DFS相关,不同分组间生存差异有统计学意义。多因素分析结果显示:pN分期(HR:2.258,95%CI:1.175-4.338,P=0.015)和LODDS分期(HR:2.638,95%CI:1.318-5.281,P=0.006)、癌结节(HR:1.860,95%CI:1.017-3.402,P=0.044)是本组患者3年DFS的独立预后因素。LODDS分期的AUC=0.730,pN分期的AUC=0.725,两者差异无统计学意义(P=0.857)。结论LODDS分期是Ⅲ期直肠癌患者术后3年无疾病生存的独立预后因素,对于预后评估具有重要意义。     

术前中性粒细胞/淋巴细胞比值对术后胃癌患者预后的影响

目的:探讨胃癌患者术前中性粒细胞/淋巴细胞比值(neutrophil lymphocyte ratio,NLR)对术后预后的影响。方法:术后病理确诊胃癌患者根据术前NLR分为低NLR组(2.8,n=165)和高NLR组(≥2.8,n=66),比较两组患者临床病理因素和术后总生存期(overall survival,OS)及无病生存期(disease free survival,DFS),分析预后影响因素。结果:高NLR组淋巴结转移数多、TNM分期晚、清蛋白低(P0.05)。高NLR组1年、2年及5年OS低于低NLR组(75.8%、60.6%、48.5%vs 87.9%、77.6%、61.2%,P=0.039);高NLR组中位DFS短于低NLR组(16个月vs 49个月,P=0.000)。Cox单因素分析显示:高NLR、浸润深度深、淋巴结转移数多、TNM分期晚、年龄大、低清蛋白是影响OS及DFS的不良预后因素(P0.05);Cox多因素分析显示:TNM分期是影响OS的独立预后因素(P=0.000),TNM分期、NLR是影响DFS的独立预后因素(P=0.000,P=0.024)结论:术前NLR是影响胃癌DFS的独立预后因素,对OS的预后意义有待进一步探讨。     

乳腺癌真空辅助旋切术后保乳手术的可行性

目的：探讨胃癌患者术前中性粒细胞/淋巴细胞比值（neutrophillymphocyteratio,NLR）对术后预后的影响。方法：术后病理确诊胃癌患者根据术前NLR分为低NLR组（＜2.8,n=165）和高NLR组（≥2.8,n=66）,比较两组患者临床病理因素和术后总生存期（overallsurvival,OS）及无病生存期（diseasefreesurvival,DFS）,分析预后影响因素。结果：高NLR组淋巴结转移数多、TNM分期晚、清蛋白低（P＜0.05）。高NLR组1年、2年及5年OS低于低NLR组（75.8%、60.6%、48.5%vs87.9%、77.6%、61.2%,P=0.039）;高NLR组中位DFS短于低NLR组（16个月vs49个月,P=0.000）。Cox单因素分析显示：高NLR、浸润深度深、淋巴结转移数多、TNM分期晚、年龄大、低清蛋白是影响OS及DFS的不良预后因素（P＜0.05）;Cox多因素分析显示：TNM分期是影响OS的独立预后因素（P=0.000）,TNM分期、NLR是影响DFS的独立预后因素（P=0.000,P=0.024）。结论：术前NLR是影响胃癌DFS的独立预后因素,对OS的预后意义有待进一步探讨。     

错配修复功能缺陷的结直肠癌术后患者预后影响因素的分析

目的 探讨错配修复功能缺陷（dMMR）的结直肠癌术后患者错配修复（MMR）蛋白表达情况和预后影响因素,分析辅助化学治疗（化疗）对Ⅱ、Ⅲ期dMMR结直肠癌预后的影响。方法 回顾性分析dMMR结直肠癌根治性手术病例106例,分析其MMR蛋白（包括MLH1、MSH2、MSH6、PMS2）缺失的情况。单因素和多因素Cox分析dMMR结直肠癌术后患者的无病生存期（DFS）和总生存期（OS）预后影响因素,Kaplan-Meier法分析Ⅱ、Ⅲ期dMMR结直肠癌化疗组与无化疗组的差异。结果 MLH1/PMS2蛋白缺失率为45%,MSH2/MSH6蛋白缺失率为18%,单个MLH1蛋白的缺失率为11％,单个MSH6蛋白的缺失率为9％,单个PMS2蛋白的缺失率为12％。单因素Cox分析显示,术前癌胚抗原（CEA）≥5 ng/ml、直肠、T4、N1、N2、神经侵犯、脉管侵犯和淋巴结获取数量< 12枚是dMMR结直肠癌患者DFS的危险因素;术前CEA≥5 ng/ml、术前糖链抗原199（CA199）≥34 U/ml、直肠、T4、N1、N2和淋巴结获取数量< 12枚是dMMR结直肠癌患者OS的危险因素。多因素Cox分析显示术前CEA≥5 ng/ml[HR = 2.68（1.08 ~ 6.63）,P = 0.034]、 N1[HR = 2.94（1.12 ~ 7.73）,P = 0.028]、 N2[HR = 9.31（2.49 ~ 34.77）,P = 0.001]和淋巴结获取数量< 12枚[HR = 3.97（1.66 ~ 9.50）,P = 0.002]是dMMR结直肠癌患者DFS的独立危险因素;N1[HR = 6.64（2.25 ~ 19.64）,P = 0.001]、 N2[HR = 9.68（1.92 ~ 48.96,P = 0.006）]和淋巴结获取数量< 12枚[HR = 6.36（2.28 ~ 17.73）,P < 0.001]是dMMR结直肠癌患者OS的独立危险因素。Ⅱ、Ⅲ期dMMR结直肠癌化疗组与无化疗组的DFS和OS比较差异无统计学意义（P均> 0.05）。结论 术前CEA≥5 ng/ml是dMMR结直肠癌患者DFS的独立危险因素;N1、N2和淋巴结获取数量< 12枚是dMMR结直肠癌患者DFS和OS的独立危险因素。辅助化疗不影响Ⅱ、Ⅲ期dMMR结直肠癌的预后。     

结直肠黏液腺癌术后患者的预后影响因素分析

目的 探讨结直肠黏液腺癌（MA）术后患者的预后影响因素。方法 收集结直肠MA根治性手术病例81例。使用Kaplan-Meier法分析无病生存期（DFS）和总生存期（OS）,单因素和多因素Cox分析结直肠MA术后患者的预后影响因素。结果 结直肠MA、结肠MA、直肠MA的5年无瘤生存率分别是55%、57%和47%;5年总生存率分别为60%、62%和51%。单因素Cox分析发现T4（HR = 2.174）、N2（HR = 3.592）、TNM Ⅲ期（HR = 2.435）、糖类抗原199（CA199） ≥34 U/ml（HR = 3.330）为结直肠MA患者DFS的危险因素;手术时间> 200 min（HR = 2.594）、T4（HR = 2.465）、N2（HR = 5.413）、TNM Ⅲ期（HR = 3.275）、CA199≥34 U/ml（HR = 4.150）和癌胚抗原（CEA）≥5 ng/ml（HR = 2.636）为结直肠MA患者OS的危险因素。多因素Cox分析显示,N2和CA199 ≥34 U/ml是结直肠MA预后的危险因素,N2的DFS和OS的HR分别为2.763和4.113,CA199≥34 U/ml的DFS和OS的HR值分别为2.560和2.948。分层分析发现,N2（HR = 5.628）是结肠MA患者DFS的危险因素,N2（HR = 7.547）和CA199 ≥ 34 U/ml （HR = 2.947）是结肠MA患者OS的危险因素;行辅助化学治疗是直肠MA预后的保护因素,DFS和OS的HR值分别为0.063和0.182（P均< 0.05）。结论 N2分期、CA199≥34 U/ml是结直肠MA术后预后的独立危险因素,辅助化学治疗是直肠MA术后患者预后的保护因素。     

围术期癌胚抗原联合术后糖类抗原19-9及糖类抗原125预测Ⅰ～Ⅲ期结直肠癌预后的价值

目的探讨Ⅰ～Ⅲ期结直肠癌(CRC)患者围术期癌胚抗原(CEA)水平变化与临床病理特征、疾病进展的关系,分析术后糖类抗原125(CA125)、糖类抗原19-9(CA19-9)对评估术后CEA阴性患者预后的价值。方法选取2013年1月—2016年12月苏州大学附属第一医院接受根治性手术的结直肠癌患者287例。应用χ2检验、Kaplan-Meier法、Log-rank检验、Cox风险回归模型分析患者围术期CEA、术后CA125联合CA19-9与临床病理特征及预后的关系。结果所有患者中位随访时间为49个月。术后CEA阳性与不良T分期(T_3、T_4)、N分期(N_1、N_2)和TNM分期均显著相关(P 0.01),与癌结节和神经侵犯显著相关(P 0.05)。单因素分析发现,N分期、TNM分期、肿瘤分化程度、癌结节、脉管癌栓、神经侵犯、CA19-9和CA125是影响无病生存期(DFS)的相关因素(P 0.05),N分期、肿瘤分化程度、癌结节、CA19-9和CA724是影响总生存期(OS)的相关因素(P 0.05)。多因素分析显示,术后CA125阳性(P 0.001)和癌结节(P 0.05)是术后CEA阴性患者DFS的独立预后危险因素,癌结节(P 0.05)和肿瘤分化程度(P 0.05)是影响OS的重要因素。术前和术后CEA均阴性组患者的DFS和OS高于术前或术后CEA阳性组,术后CEA降至正常组的DFS、OS高于术后CEA未降至正常组,术后CA19-9和CA125均阴性者DFS、OS高于术后CA19-9或CA125阳性者,差异均有统计学意义(P 0.05或P 0.01)。结论围术期血清CEA水平变化直接影响CRC患者的预后,术前及术后CEA阴性或者术后早期CEA降至正常的患者预后较好。对于术后CEA阴性患者,术后CA125或CA19-9表达阳性提示术后复发、转移风险增高,预后不佳。     

乳腺癌骨转移骨相关事件对患者生存期的影响

目的:探讨乳腺癌骨转移骨相关事件(skeletal-related events,SREs)的发生及SREs对患者生存期的影响。方法:选择复旦大学附属中山医院和上海市黄浦区中心医院收治的乳腺癌骨转移患者。将患者分为不伴SREs组和伴SREs组,比较两组患者的基本临床特征、骨转移特征,分析SREs的特点及SREs对乳腺癌骨转移患者的骨转移生存期(BS)和总生存期(OS)的影响。结果:乳腺癌骨转移患者共104例,不伴SREs组和伴SREs组分别为46例、58例。两组间年龄、手术方式、肿瘤组织类型、美国癌症联合会(American Joint Committee on Cancer,AJCC)分期、骨转移间歇期、骨转移部位等差异无统计学意义,骨转移数目差异有统计学意义(P=0.006)。骨相关事件间歇期0~48个月,中位时间为5.5(1.0,20.5)个月。SREs以骨痛最多,占70.6%。不伴SREs组和伴SREs组间BS(HR=1.043,95%CI 0.608~1.790,P=0.878)和OS(HR=0.927,95%CI0.543~1.581,P=0.781)差异无统计学意义。结论:SREs不增加乳腺癌骨转移患者的死亡风险。     

电视辅助胸腔镜下解剖性肺叶切除术与亚肺叶切除术分别联合纵隔淋巴结清扫术治疗早期非小细胞肺癌对比研究

目的 对比电视辅助胸腔镜(VATS)下解剖性肺叶切除术与亚肺叶切除术分别联合纵隔淋巴结清扫术在早期非小细胞肺癌(NSCLC)中的应用效果.方法 选取我院早期NSCLC患者78例,依照治疗方案不同分为肺叶切除组(n=39)、亚肺叶切除组(n=39).肺叶切除组采用VATS下解剖性肺叶切除术+纵隔淋巴结清扫术,亚肺叶切除组采用VATS下解剖性亚肺叶切除术+纵隔淋巴结清扫术,统计比较两组围术期相关指标、肺功能变化情况[最大呼气流速峰值(PEF)、每分钟最大通气量(MVV)、第1s用力呼气容积/用力肺活量(FEV1/FVC)]、并发症发生率、术后1年、3年生存率[无病生存期(DFS)、总生存期(OS)].结果 亚肺叶切除组术中出血量、术后胸腔引流量低于肺叶切除组(P＜0.05);术后6个月亚肺叶切除组PEF、MVV、FEV1/FVC水平高于肺叶切除组(P＜0.05);亚肺叶切除组并发症发生率10.26％与肺叶切除组15.38％比较无显著差异(P＞0.05);亚肺叶切除组1年DFS率94.44％、OS率97.22％与肺叶切除组97.30％、100.00％比较无显著差异(P＞0.05);亚肺叶切除组3年DFS率80.56％、OS率88.89％与肺叶切除组83.78％、94.59％比较无显著差异(P＞0.05).结论 VATS下解剖性肺叶切除术与亚肺叶切除术分别联合纵隔淋巴结清扫术治疗早期NSCLC近远期生存率基本一致,两种术式均安全可行,但亚肺叶切除术对机体创伤较小,可更好保留肺功能,有助于患者术后恢复.     

局部进展期食管癌患者围术期化疗后复发转移临床分析

目的探讨局部进展期食管癌患者围术期化疗后的复发转移模式及生存分析。方法回顾性分析73例行围术期化疗的cT_3/4N_0～2M_0期食管癌患者的临床资料。结果 73例患者均获随访,随访时间6～72个月,49例复发转移(67.12%),其中16例(21.91%)颈部和锁骨上淋巴结转移,12例(16.44%)血行转移,8例(10.96%)混合转移,6例(8.22%)纵隔淋巴结转移,5例(6.85%)吻合口复发,2例(2.74%)腹腔淋巴结转移;中位无病生存期为17个月,中位总生存期为36个月,5年总生存率为40.4%。ypT分期(HR=1.439,95%CI:1.128～1.836,P=0.003)、ypN分期(HR=1.584,95%CI:1.073～2.340,P=0.021)、神经脉管侵犯(HR=2.788,95%CI:1.401～5.548,P=0.004)、切缘病理阳性R_1(HR=2.130,95%CI:1.094～4.148,P=0.026)是围术期化疗后复发转移的危险因素;新辅助化疗术后病理ypT分期是总生存期的独立危险因素(HR=1.537,95%CI:1.165～2.029,P=0.002)。ypN_0中有神经脉管侵犯者无病生存期(7.2个月)少于无神经脉管侵犯者(35.8个月)(P0.05),ypN~+中有神经脉管侵犯者无病生存期(11.1个月)与无神经脉管侵犯者(25.4个月)比较差异无统计学意义(P0.05)。结论局部进展期食管癌患者围术期化疗后复发转移以颈部和锁骨上淋巴结、血行转移和混合转移为主,神经脉管侵犯为影响复发转移的独立危险因素。     

局限期小细胞肺癌并发抗利尿激素分泌不当综合征的临床研究

目的：探讨合并抗利尿激素分泌不当综合征(SIADH)的局限期小细胞肺癌(SCLC)患者的临床特点及预后情况。方法回顾性分析经吉林大学第一医院确诊的63例局限期 SCLC 患者,比较正常血钠组患者及合并SIADH 组患者无进展生存期(PFS)、总生存期(OS)、1年生存率、2年及3年生存率的异同。结果局限期 SCLC 合并SIADH 的发生率为12.7%(8/63),SIADH 组与正常血钠组 PFS 分别为(239.4±143.9)天 vs (403.4±166.7)天(P <0.05);两组 OS 分别为(337.8±237.7)天 vs (683.8±343.3)天(P <0.05),差异有统计学意义;两组1年生存率为37.5%(3/8)vs 85.5%(47/55),P <0.05,差异有统计学意义;2年及3年生存率分别为12.5%(1/8)vs 47.3%(26/55)、0 vs 25.5%(14/55)(P >0.05),差异无统计学意义。结论局限期 SCLC 合并 SIADH 的发生率并不低,并发SIADH 的局限期 SCLC 预后更差,临床上应高度警惕局限期 SCLC 合并 SIADH 并及时治疗。     

Patient and Technique Survival of Older Adults with ESRD Treated with Peritoneal Dialysis

The number of older adults worldwide is increasing as societies gain success in improving the health and lifespan of their citizens. As a result, increasing numbers of older adults are presenting to the medical community with advanced kidney failure. Historically, dialysis treatments were withheld from older adults particularly those with severe co-existing illnesses. This has changed in most parts of the world, and there is now an increasing emphasis on shared decision-making to determine whether dialysis is appropriate and to determine which modality meets the needs, expectations, and desire of patients. Evidence examining the difference in risk for death of older adults treated with hemodialysis (HD) or peritoneal dialysis (PD), and the probability of those treated with PD to transfer to HD among older compared to younger adults, is largely derived from prospective cohort studies or analyses of data from national registries. In such studies, it is difficult to distinguish whether differences in outcomes reflect the effect of dialysis modality or differences in health status of different groups of patients. Longevity and technique survival are important, albeit not the only or most important consideration in such decision-making. Given the risk for bias in observational studies and the profound effect of dialysis modality on patients'' lifestyle, the selection of dialysis modality should remain a decision made by the patient, caregivers, and his/her physician after thorough education and review of the available data.     

儿童T系急性淋巴细胞白血病的临床研究

目的 研究T系急性淋巴细胞白血病(ALL)患儿的临床与预后特征.方法 对1999年1月至2005年4月采用ALL-XH-99方案治疗的305例ALL患儿进行细胞形态学、免疫学、细胞遗传学和分子遗传学分型,并按型分层治疗.结果 在305例ALL患儿中T系ALL患儿43例,其中男34例(79.1%),平均年龄7.8(2.2～16.4)岁,大于10岁的患儿29例(67.4%),中危和高危组患儿分别为11例和32例,WBC≥50×109/L 27例(62.8%),骨髓形态学分型L2 32例,22例患儿出现纵隔增宽.与B系ALL患儿比较,T系ALL患儿在骨髓形态学分型L2比例、大于10岁患儿的比例和WBC≥50×109/L的比例差异均有统计学意义(P<0.05).在诱导缓解治疗中,T系ALL患儿泼尼松窗口试验反应好和第19天骨髓未达缓解的比例分别为62.9%和57.9%,与B系ALL患儿比较,差异均有统计学意义(P值均<0.01).有14例T系ALL患儿复发,完全缓解至复发时间为(1.2±1.5)年.T系ALL患儿的8年无事件生存(EFS)率、无复发生存(RFS)率和总生存(OS)率分别为(40.2±10.1)%、(51.4±11.6)%和(49.8±9.9)%,而B系ALL患儿的8年EFS率、RFS率和OS率分别为(72.1±3.0)%、(83.2±2.7)%和(76.6±2.9)%(P值均<0.01).结论 T系ALL患儿在年龄、白细胞计数和骨髓形态学分型上和B系ALL患儿存在差异,早期治疗反应以及远期疗效较B系ALL患儿差.     

急性髓细胞白血病患儿miR-126表达水平与预后的关系研究

目的研究急性髓细胞白血病(AML)患儿miR-126表达水平与预后的相关性。方法选取2014年5月至2016年12月本院收治的AML患儿58例为研究对象,纳入研究组(高危、中危、低危分别16、20、22例),均接受AML标准治疗,同时以本院同期入院的30例非恶性病儿童作为对照组,采用TagMan RT-PCR法检测2组骨髓标本中miR-126表达量,依据出院时miR-126表达量相对水平将AML患儿分为高表达组、低表达组各29例,比较2组miR-126表达量、中位生存时间、无事件生存时间、中位生存率,并根据1年内随访结果将其分为完全缓解组、难治复发组、死亡组,对比3组miR-126表达量,同时分析AML患儿miR-126表达水平与预后的关系。结果研究组miR-126表达量明显高于对照组(P<0.05),且研究组中miR-126表达量依次为高危患儿>中危患儿>低危患儿(P<0.05);miR-126高表达组miR-126表达量(1.52±0.27)高于低表达组,而其中位生存时间(6.21个月)、无事件生存时间(5.34个月)短于低表达组(8.24个月、7.12个月),中位生存率96.55%低于低表达组(P<0.05);完全缓解组出院时、末次随访时miR-126明显低于难治复发组、死亡组,难治复发组、死亡组miR-126表达水平差异也有统计学意义(P<0.05);相关性分析结果显示AML患儿miR-126表达水平与中位生存时间、无事件生存时间、中位生存率呈负相关(P<0.05)。结论AML患儿中miR-126呈高表达状态,且miR-126表达水平与患儿预后关系密切,因而临床可结合miR-126基因检测以提高初治AML患儿的预测准确性。     

Effect of a δ Receptor Agonist on Duration of Survival during Hemorrhagic Shock

OBJECTIVES: Selective delta receptor agonists have been shown to stabilize membrane physiologic processes, reduce metabolic rates, and provide protection against ischemic insults through K(ATP) channel opening in a variety of organ beds. However, their potential for affecting outcomes in states of generalized ischemia has not been explored. The authors examined the effect of the nonselective delta receptor agonist, DADLE (D-Ala2-Leu5-enkephalin), on hemodynamic stability and duration of survival in an animal model of severe hemorrhagic shock. METHODS: Conscious Sprague Dawley rats with indwelling catheters were hemorrhaged at a rate of 3.25 mL/100 grams over 20 minutes after half of the group received 1% DADLE (1 mg/kg IV). Following the hemorrhage, all rats were continuously monitored for heart rate (HR), mean arterial pressure (MAP), and life signs for up to three hours (death defined as apnea, systolic blood pressure < 30 mm Hg without pulsations, and electroencephalographic silence). Survival rates and hemodynamic trends were compared between the control and DADLE-treated groups. RESULTS: In the 14 rats studied (8 DADLE; 6 controls), initial hemorrhage resulted in similar hemodynamic shock (average MAP fall: 118 to 59 vs 119 to 55 mm Hg). Analysis of survival at 3.5 hours revealed statistically significant differences between the control and DADLE groups. While 50% of the DADLE group survived past the three hours, no control animals were still alive at the end of the experimental period. The MAP trended downward and the HR increased for the control group, but all hemodynamic parameters stabilized in the rats treated with DADLE. CONCLUSIONS: Most current strategies for treating shock focus on the supply side of resuscitation. The coordinated various actions of DADLE have the potential to work in concert in the intact organism to improve overall survival during severe hemorrhagic shock. In an animal model of severe hemorrhagic shock, there was improvement in hemodynamic stability and a prolonged survival with DADLE treatment. Physiologic manipulation with DADLE appears to be a way to improve survival during shock with possible clinical implications.     

Effect of Body Mass Index on Outcomes of Peritoneal Dialysis Patients in India

♦ Objectives: We studied the effect of body mass index (BMI) at peritoneal dialysis (PD) initiation on patient and technique survival and on peritonitis during follow-up.♦ Methods: We followed 328 incident patients on PD (176 with diabetes; 242 men; mean age: 52.6 ± 12.6 years; mean BMI: 21.9 ± 3.8 kg/m²) for 20.0 ± 14.3 months. Patients were categorized into four BMI groups: obese, ≥25 kg/m²; overweight, 23 - 24.9 kg/m²; normal, 18.5 - 22.9 kg/m² (reference category); and underweight, <18.5 kg/m². The outcomes of interest were compared between the groups.♦ Results: Of the 328 patients, 47 (14.3%) were underweight, 171 (52.1%) were normal weight, 53 (16.2%) were overweight, and 57 (17.4%) were obese at commencement of PD therapy. The crude hazard ratio (HR) for mortality (p = 0.004) and the HR adjusted for age, subjective global assessment, comorbidities, albumin, diabetes, and residual glomerular filtration rate (p = 0.02) were both significantly greater in the underweight group than in the normal-weight group. In comparison with the reference category, the HR for mortality was significantly greater for underweight PD patients with diabetes [2.7; 95% confidence interval (CI): 1.5 to 5.0; p = 0.002], but similar for all BMI categories of nondiabetic PD patients.Median patient survival was statistically inferior in underweight patients than in patients having a normal BMI. Median patient survival in underweight, normal, overweight, and obese patients was, respectively, 26 patient-months (95% CI: 20.9 to 31.0 patient-months), 50 patient-months (95% CI: 33.6 to 66.4 patient-months), 57.7 patient-months (95% CI: 33.2 to 82.2 patient-months), and 49 patient-months (95% CI: 18.4 to 79.6 patient-months; p = 0.015). Death-censored technique survival was statistically similar in all BMI categories. In comparison with the reference category, the odds ratio for peritonitis occurrence was 1.8 (95% CI: 0.9 to 3.4; p = 0.086) for underweight patients; 1.7 (95% CI: 0.9 to 3.2; p = 0.091) for overweight patients; and 3.4 (95% CI: 1.8 to 6.4; p < 0.001) for obese patients.♦ Conclusions: In our PD patients, mean BMI was within the normal range. The HR for mortality was significantly greater for underweight diabetic PD patients than for patients in the reference category. Death-censored technique survival was similar in all BMI categories. Obese patients had a greater risk of peritonitis.     

中药加味一贯煎提高原发性肝癌晚期患者生存率的临床研究

目的:探讨中药加味一贯煎在提高晚期肝癌患者生存期及改善生活质量方面的疗效.方法:将复旦大学附属中山医院的原发性肝癌患者100例(男性84例,女性16例)随机分成中药组和对照组,2组均进行常规保肝及对症治疗,中药组加用加味一贯煎,比较2组患者的半年生存率、中位生存期、生活质量评分(Karnofsky)、体力状况美国东部肿瘤协作组(ECOG)评分、中医症候评分.结果:(1)中药组半年生存率为35.80％,中位生存期为114 d;对照组半年生存率为21.21％,中位生存期为71 d,中药组的生存时间显著长于对照组(P=0.041).(2)2组中医症状评分、生活质量评分(Karnofsky标准)、体力状况ECOG评分比较,差异均有统计学意义,中药组在改善症状、提高生活质量、改善体力方面优于对照组.晚期原发性肝癌患者病死危险性与ECOG评分和Child-Pugh分期密切相关.ECOG评分越高,病死的危险越大,即ECOG每增加一个单位,相应病死的危险性增加1.8倍;Child-Pugh评分越高,病死的危险越大,即Child-Pugh每增加一个单位,相应病死的危险性增加1.24倍.结论:加味一贯煎能显著提高晚期原发性肝癌患者半年生存率和中位生存期,改善晚期原发性肝癌患者生活质量和体力状况,降低中医症候评分.     

Evaluation of the Palliative Prognostic Score (PaP) and routinely collected clinical data in prognostication of survival for patients referred to a palliative care consultation service in an acute care hospital

Context

Patients, caregivers, and clinicians require high levels of information regarding prognosis when conditions are incurable.

Objectives

1) To validate the Palliative Prognostic Score (PaP) and 2) to evaluate prognostic capacity of used clinical tools and the diagnosis of delirium, in a population referred to a palliative care consultation service at a Canadian acute care hospital.

Methods

This was a prospective observational cohort study on survival prediction based on the PaP and routinely collected clinical data, including the Palliative Performance Scale (PPS) and the Folstein Mini-Mental State Examination (MMSE). Kaplan-Meier survival curves, log-rank tests for significant differences between survival curves, and the Cox proportional hazards model were used to identify the relationship between the hazard ratio for death and the above variables.

Results

Nine hundred fifty-eight cases underwent final analysis, of which 181 (19%) had a noncancer diagnosis. Median and mean survival were 35 and 131 days, respectively. The three groups, divided based on different ranges of PaP, had significantly different survival curves, with 30-day-survival rates of 78%, 55%, and 11%. Age, PPS, and PaP remained significantly associated with survival, whereas diagnosis group, MMSE, and delirium became insignificant, despite lower hazard of death for cancer vs. noncancer and higher hazard for abnormal vs. normal MMSE and presence vs. absence of delirium.

Conclusion

The PaP was successfully validated in a population with characteristics that extend beyond those of the population in which it was originally developed. This is the largest sample in which the PaP has been validated to date.