喉癌组织淋巴管生成与其转移和患者预后的关系

目的：探讨喉癌组织的淋巴管生成与其肿瘤转移及患者临床预后间的可能联系。方法：采用免疫组织化学方法(IHC)对60例喉癌组织进行淋巴管内皮细胞透明质酸受体l(LYVE-1)特异性染色,并对淋巴管计数,进一步分析淋巴管密度(LVD)与患者临床病理及预后间的关系。结果：喉癌组织LYVE-l染色LVD为14.98±5.12,明显高于癌旁正常组织(6.76±3.01)(P<0.001);分层分析示喉癌组织LVD与患者年龄、性别、分化程度、临床分型和远隔转移无关(P>0.05),与淋巴结转移和肿瘤分期密切相关(P<0.05);高LVD组患者5年生存率为23.3%,低LVD组5年生存率为66.7%,两组5年生存率有统计学意义(P<0.001);进一步Cox生存风险模型分析示,肿瘤分期和LVD可能是影响喉癌患者5年临床预后的独立因素(均P<0.05)。结论：喉癌淋巴管生成可能参与淋巴结转移等过程,且LV D可能是影响患者临床预后的独立因素。     

治疗策略及治疗反应对小细胞肺癌预后影响的多因素分析

目的 探讨不同治疗策略及治疗反应对小细胞肺癌(SCLC)预后的影响.方法 收集2002年1月～2010年1月住院化疗的小细胞肺癌患者,回顾分析其治疗过程,并对其随访.对可能的危险因素进行单因素分析,P<0.1的因素进入Cox风险比例回归模型.结果 住院接受化疗的小细胞肺癌患者共76例,局限期43例,1、2和5年生存率分别为81%、56%和21%;广泛期33例,1和2年生存率分别为59%和24%.单因素分析放化疗联合治疗、一线化疗最佳疗效为有效(CR+PR)为生存相关因素;接受手术治疗为局限期患者生存相关因素.Cox风险比例回归模型多因素分析,上述因素均为独立相关因素.结论 放化疗联合治疗、提高一线方案疗效、局限期早期患者接受手术治疗可能会提高患者生存.     

404例结肠癌的临床病理及随访

目的通过对404例结肠癌患者的分析,探讨其临床病理特征及影响患者术后生存的因素。方法回顾性研究1993—2003年间在解放军总医院行手术治疗的404例结肠癌患者(其中209例获得完整的随访资料)的临床、病理资料,进行单因素及多因素分析。结果单因素分析显示,患者发病年龄、肿瘤的分化程度、淋巴结转移情况、腹腔及远处转移情况、肿瘤的病理分期及患者术后是否进行放化疗等均为影响预后的因素。(2)多因素回归分析表明腹腔及远处转移以及肿瘤的病理分期是影响患者术后生存的独立因素。结论影响结肠癌患者术后生存的独立因素仅为腹腔及远处转移情况以及肿瘤的病理分期     

颈管型宫颈癌预后的影响因素分析

目的 探讨颈管型宫颈癌的预后及影响预后的危险因素.方法 回顾性分析了2000年1月至2003年10月38例中山大学肿瘤防治中心经临床及病理证实为颈管型宫颈癌患者的预后.采用Kaplan-Meier法计算其生存率,Log-rank法检验组间差异,Cox比例风险模型分析预后因素.结果 单因素分析显示,年龄≤35岁或≥60岁、病理分化差、浸润宫颈深肌层、淋巴结转移、颈管直径＞4cm、宫体受累患者的预后不良(P＜0.05);Cox回归多因素分析结果显示:肿瘤淋巴结转移≥2个,临床分期≥ⅡB期,颈管直径＞4cm是影响预后的独立危险因素.结论 宫颈管直径、淋巴结转移、临床分期是影响颈管型宫颈癌患者预后的独立因素.     

早期宫颈腺癌的预后分析

目的探讨影响临床早期宫颈腺癌预后的相关因素,并分析不同辅助治疗方法对预后的影响。方法回顾性分析自1995年11月至2012年2月间于北京协和医院治疗的118例FIGOⅠa2期-Ⅱa2期宫颈腺癌患者的临床资料,记录人口统计学信息、诊断及治疗信息,并记录随访及生存资料,采用SPSS11.5软件Cox回归分析进行肿瘤复发相关因素分析。结果 118例患者的中位年龄为41岁(19～74岁),其中有102例(86.4%)初次治疗时采取了根治性子宫切除和/或双附件切除和/或盆腔腹主动脉旁淋巴结切除术。平均随诊29.8月(2～132月),19例患者在随访过程中肿瘤复发,7例患者死亡。与肿瘤复发相关的单因素分析显示,患者年龄大(P=0.008)、期别晚(P=0.008)、肿瘤≥4 cm(P=0.006)、淋巴结阳性(P=0.001)、宫颈有深肌层浸润(P=0.016)均是复发的高危因素,而淋巴血管间隙浸润及腺癌的病理类型与复发无明显相关性。多因素分析显示,仅淋巴结转移是肿瘤复发的独立高危因素(P=0.006)。淋巴结阴性和阳性患者的5年无瘤生存率分别为79.1%和12.7%,5年总生存率分别为94.0%和40.0%。淋巴结转移与肿瘤≥4 cm(P=0.018)、宫颈深肌层浸润(P=0.001)显著相关,而与年龄(P=0.746)、FIGO分期(P=0.155)、淋巴血管间隙浸润(P=0.802)不相关。对于高危患者,手术后辅助放化疗可延长患者无瘤生存期,但未达到统计学意义(P=0.201)。结论宫颈腺癌预后较差,早期患者的独立预后因素是盆腔淋巴结转移,对于高危患者于根治性子宫切除术后进行辅助放化疗可能延缓肿瘤复发。     

乳腺伴大汗腺分化的癌临床病理特征及预后分析

目的：探讨乳腺伴大汗腺分化的癌临床病理特点及影响其预后的因素。方法收集乳腺伴大汗腺分化的癌标本70例和同期诊断为非特殊型浸润性癌283例患者的临床病理资料,比较两组预后差异,并对患者年龄、肿瘤大小、淋巴结转移、组织学分级、分期、免疫组化等因素与预后的关系进行统计学分析。结果乳腺伴大汗腺分化的癌平均发病年龄(56．17±12．41岁)比非特殊型浸润性癌(52.77±11．07岁)高(P=0．039);与非特殊型浸润性癌相比,乳腺伴大汗腺分化的癌具有更低的腋窝淋巴结转移率,较低的ER、PR阳性率(P<0．05);乳腺伴大汗腺分化的癌患者与非特殊型浸润性癌患者相比,5年总生存率(P=0．221)和无病生存率(P=0．378)差异无统计学意义;单因素生存分析显示肿瘤大小、淋巴结转移、病理学分期、淋巴结外软组织浸润与乳腺伴大汗腺分化的癌患者预后有关(P<0．05),Cox多因素分析结果显示,淋巴结转移与乳腺伴大汗腺分化的癌患者不良预后有关(P<0．05)。结论乳腺伴大汗腺分化的癌与浸润性癌临床病理特征不同,但预后无统计学意义。淋巴结转移可作为乳腺伴大汗腺分化的癌患者预后不良的指标,早诊断、早治疗是改善其预后的关键。     

影响胃癌根治术后患者预后的多因素分析

目的探讨影响胃癌根治术患者远期复发及生存的相关因素,为临床判断患者预后、采用针对性治疗提供参考。方法对524例行胃癌根治术患者的临床资料进行回顾性分析,采用Kaplan-Meier法对患者的生存情况进行评价,采用Log-rank检验进行单因素分析,采用Cox比例风险模型进行多因素分析。结果单因素分析表明:性别、年龄对患者的生存率并无显著影响(P>0.05),病理分型、Borrmann分型、肿瘤生长部位、浸润情况、淋巴结转移程度、TNM分期、是否接受辅助放化疗为影响胃癌根治术患者预后的相关因素(P<0.05)。多因素分析表明:病理学分型、浸润情况、淋巴结转移程度为影响胃癌根治术患者预后的独立危险因素(P<0.05)。结论病理分型、浸润情况、淋巴结转移程度为影响胃癌根治术患者预后的独立危险因素,临床应根据上述因素判断患者预后,并给予合适的辅助治疗。     

胸腺肿瘤108例的病理组织学分型和预后相关性研究

目的 研究胸腺肿瘤组织学分型与预后多因素的相关性.方法 回顾性研究108例胸腺肿瘤患者的临床病理资料,按2004年WHO胸腺肿瘤分型标准重新对肿瘤分型,根据临床和随访结果,对其预后与Masaoka临床分期、胸腺肿瘤的组织学分型、肿瘤完整切除与否、患者年龄、性别、肿瘤大小及是否伴有重症肌无力多因素进行相关性研究.结果 组织学分型:A型7例(6.5%),AB型19例(17.6%),B1型23例(21.3%),B2型19例(17.6%),B3型27例(25.0%),C型13例(12.0%).临床分期:Ⅰ期36例(33.3%),Ⅱ期34例(31.5%),Ⅲ期27例(25.0%),Ⅳa期11例(10.2%).临床分期与组织学分型存在显著相关性(P=0.000).A型、AB型、B1型、B2型、B3型胸腺瘤的5年生存率分别为100%、100%、93%、83%、43%;10年生存率分别为100%、100%、81%、70%、33%.C型胸腺瘤中位生存时间62.5个月.B2、B3型胸腺瘤患者的预后介于C型胸腺瘤和A、AB、B1型胸腺瘤之间(P=0.000).临床Ⅰ、Ⅱ、Ⅲ期胸腺肿瘤切除术后5年生存率分别为100%、77%、54%;10年生存率分别为100%、70%、27%.Ⅳa期患者中位生存时间14.0个月.在多因素统计分析中,Masaoka临床分期足胸腺瘤患者最重要的独立预后指标(P=0.000).胸腺肿瘤组织学分型和肿瘤完整切除与否是影响预后的重要决定因素.结论 Masaoka临床分期是影响胸腺瘤患者生存的最重要的预后参数,WHO组织学分型和肿瘤是否完整切除是影响胸腺瘤患者术后生存的决定因素.WHO组织学分型能反映胸腺瘤各亚型的临床生物学行为,A、AB和B1型胸腺瘤为潜在恶性的肿瘤,而B2和B3型胸腺瘤为中度恶性肿瘤,C型胸腺瘤预后差,属于高度恶性肿瘤.     

肝细胞性肝癌中SOX9的表达及临床意义

目的：探讨蛋白质分子生物标志物SOX9在肝细胞性肝癌( hepatocellular carcinoma, HCC )组织中的表达及与HCC临床病理特征及预后的关系。方法采用免疫组化EnVision法检测65例原发性HCC组织及36例癌旁非肿瘤组织中SOX9蛋白的表达,分析SOX9蛋白表达与患者年龄、性别、肿瘤直径、肿瘤数目、分化程度、TNM分期、有无门静脉癌栓、有无肝硬化及生存率等临床病理学特征之间的关系。结果 SOX9在HCC中的阳性率明显高于癌旁正常组织,差异有统计学意义( P<0．01)。 HCC组织中SOX9表达与肿瘤分化程度( P<0．05)、门静脉有无癌栓( P<0．05)、TNM分期(P<0．01)有相关性,而与患者的年龄、性别、肿瘤大直径、肿瘤数目及有无肝硬化无相关性( P>0．05)。 Kap-lan-Meier生存分析显示：SOX9高表达患者5年生存率显著低于SOX9低表达者( P<0．05)。 Cox多因素回归分析证实SOX9高表达是影响HCC患者预后的独立因素( P<0．05)。结论 SOX9蛋白表达与HCC的分化程度、门静脉有无癌栓及临床分期有关,且是影响预后的独立因素。     

中晚期非霍奇金淋巴瘤并发肺炎患者预后的影响因素

目的:探讨中晚期非霍奇金淋巴瘤(NHL)化疗后并发肺炎患者预后情况及影响因素.方法:选取2016年3月-2019年8月我院收治的143例中晚期NHL化疗后并发肺炎患者作为研究对象,观察其治疗结局及预后,并根据患者的预后不同,将患者分为预后不良组和预后良好组.设计基线资料收集表,收集患者的临床资料.分析对比两组的基线资料;采用Cox比例风险回归模型分析预后的影响因素.结果:143例中晚期NHL化疗后并发肺炎患者1、2、3 y总生存率分别为80.42％(116/143)、48.25％(69/143)、30.06％(43/143).两组IPI、B症状、近期疗效、临床分期、β2-MG、LDH、NLRP3比较,差异有统计学意义(P<0.05).IPI、B症状、近期疗效、临床分期、NLRP3是NHL化疗后并发肺炎患者生存结局的影响因素,差异有统计学意义(P<0.05).结论:中晚期NHL化疗后并发肺炎患者预后较差,受IPI、B症状、近期疗效、临床分期、NLRP3等因素影响.     

ERCC1 expression and tumor regression predict survival in esophageal squamous cell carcinoma patients receiving combined trimodality therapy

Purpose

Combined trimodality therapy with neoadjuvant chemoradiation followed by surgery has shown promising results for locally advanced operable esophageal cancer. DNA repair proteins may affect treatment efficacy through repairing DNA damage induced by chemotherapy and radiation therapy. We evaluated the associations of XRCC1, ERCC1 and MGMT expression with histopathologic response and survival in patients with locally advanced operable esophageal squamous cell carcinoma (ESCC) who received neoadjuvant chemoradiation.

Methods

Paraffin-embedded pre-treatment tissue samples, collected by endoscopic biopsy from patients treated with cisplatin-based neoadjuvant chemoradiation followed by surgery, were immunohistochemically stained for XRCC1, ERCC1 and MGMT expression.

Results

Of the 44 patients, major histopathologic response was noted in 26 (59.1%) patients. 68.8% of patients with ERCC1-negative tumors had major histopathologic response, compared to 53.6% of those who expressed positive ERCC1, though the difference was not statistically significant (P = 0.361). The patients with ERCC1-negative tumor presented much better overall survival than those positive for ERCC1 expression (P = 0.018). Patients with major histopathologic response had a 3-year survival rate of 96.2% versus those with minor response, with a 3-year survival rate of 41.5% (P = 0.000). Multivariate analysis showed that ERCC1 expression and histopathologic response were independent predictive factors of overall survival in patients with locally advanced operable ESCC receiving neoadjuvant chemoradiation.

Conclusion

Patients with ERCC1-negative tumors show a benefit from neoadjuvant chemoradiation, ERCC1 expression and tumor regression are useful predictive markers in patients with locally advanced operable ESCC receiving neoadjuvant chemoradiation followed by surgery.     

D-Dimer与胰腺癌Ⅳ期患者生存期及预后的相关性研究

目的：探讨Ⅳ期胰腺癌患者血浆中D-二聚体(D-Dimer)水平与患者预后的相关性。方法：本研究回顾性分析了2001年1月至2015年12月在首都医科大学附属北京友谊医院治疗的胰腺癌住院患者90例,分析其入院时血浆D-Dimer、纤维蛋白原(fibrinogen,Fbg)含量与临床特征及总生存时间的关系。结果：Ⅳ期胰腺癌患者中D-Dimer水平升高、Fbg含量降低者生存期相对较短,体能状态评分相对较差。ECOG≥3分患者D-Dimer[(5.40±3.19) mg/L]显著高于ECOG≤2分患者[(2.42±2.33)mg/L](P<0.01)。D-Dimer水平正常者OS为9.82个月(95% CI,8.42~11.26个月),D-Dimer水平异常者OS为3.76个月(95% CI,3.11~4.40个月),二者差异有统计学意义(P<0.05)。D-Dimer水平为胰腺癌患者预后独立危险因素。结论：D-Dimer可作为Ⅳ期胰腺癌患者预后判断的实验室指标,其异常升高提示患者预后较差。     

Long-Term Survival after High-Dose Chemotherapy Followed by Peripheral Stem Cell Rescue for High-Risk,Locally Advanced/Inflammatory,and Metastatic Breast Cancer

Patients with high-risk locally advanced/inflammatory and oligometastatic (≤3 sites) breast cancer frequently relapse or experience early progression. High-dose chemotherapy combined with peripheral stem cell rescue may prolong progression-free survival/relapse-free survival (PFS/RFS) and overall survival (OS). In this study, patients initiated high-dose chemotherapy with STAMP-V (carboplatin, thiotepa, and cyclophosphamide), ACT (doxorubicin, paclitaxel, and cyclophosphamide), or tandem melphalan and STAMP-V. Eighty-six patients were diagnosed with locally advanced/inflammatory (17 inflammatory) breast cancer, and 12 were diagnosed with oligometastatic breast cancer. Median follow-up was 84 months (range, 6-136 months) for patients with locally advanced cancer and 40 months (range, 24-62 months) for those with metastatic cancer. In the patients with locally advanced cancer, 5-year RFS and OS were 53% (95% CI, 41%-63%) and 71% (95% CI, 60%-80%), respectively, hormone receptors were positive in 74%, and HER2 overexpression was seen in 23%. In multivariate analysis, hormone receptor-positive disease and lower stage were associated with better 5-year RFS (60% for ER [estrogen receptor]/PR [progesterone receptor]-positive versus 30% for ER/PR-negative; P < .01) and OS (83% for ER/PR-positive versus 38% for ER/PR-negative; P?相似文献   

Total Lesion Glycolysis Using 18F-FDG PET/CT as a Prognostic Factor for Locally Advanced Esophageal Cancer

Standardized uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) have been considered prognostic factors for survival in many cancers. However, their prognostic value for radiotherapy-treated squamous esophageal cancer has not been evaluated. In this study, SUV, MTV, and TLG were measured to predict their prognostic role in overall survival (OS) in 38 esophageal cancer patients who had undergone ¹⁸F-FDG PET/CT before radiotherapy. TLG demonstrated higher sensitivity and specificity for predicting OS than MTV and SUV; and a better OS was observed in patients with low TLG compared to those with high TLG in locally advanced disease (OS, 46.9 months; 95% confidence interval [CI], 33.50-60.26 vs. 25.3 months; 95% CI, 8.37-42.28; P=0.003). Multivariate analyses in these patients determined that TLG and the use of combination chemotherapy were the independent prognostic factors for OS (hazard ratio [HR], 7.12; 95% CI, 2.038-24.857; P=0.002 and HR, 6.76; 95% CI, 2.149-21.248; P=0.001, respectively). These results suggest that TLG is an independent prognostic factor for OS and a better predictor of survival than MTV and SUV in patients with locally advanced esophageal cancer treated with radiotherapy.     

Thymidine phosphorylase and hypoxia-inducible factor 1-α expression in clinical stage II/III rectal cancer: association with response to neoadjuvant chemoradiation therapy and prognosis

The aim of this study was to determine whether pretreatment status of thymidine phosphorylase (TP), and hypoxia-inducible factor alpha (HIF-1α) could predict pathologic response to neoadjuvant chemoradiation therapy with oxaliplatin and capecitabine (XELOXART) and outcomes for clinical stage II/III rectal cancer patients. A total of 180 patients diagnosed with clinical stage II/III rectal cancer received XELOXART. The status of TP, and HIF-1α were determined in pretreatment biopsies by immunohistochemistry (IHC). Tumor response was assessed in resected regimens using the tumor regression grade system and TNM staging system. 5-year disease free survival (DFS) and 5-year overall survival (OS) were evaluated with the Kaplan-Meier method and were compared by the log-rank test. Over expression of TP and low expression of HIF-1α were associated with pathologic response to XELOXART and better outcomes (DFS and OS) in clinical stage II/III rectal cancer patients (P < 0.05). Our result suggested that pretreatment status of TP and HIF-1α were found to predict pathologic response and outcomes in clinical stage II/III rectal cancer received XELOXART. Additional well-designed, large sample, multicenter, prospective studies are needed to confirm the result of this study.     

Modified Glasgow prognostic score is an independent prognostic factor in patients with cervical cancer undergoing chemoradiotherapy

Objectives: There is increasing evidence that the presence of an inflammation-based prognostic score (modified Glasgow prognostic score, mGPS) could predict survival in patients with advanced cancer. The aim of this study was to investigate the prognostic value of mGPS in patients with cervical cancer. Methods: We included 238 consecutive patients with cervical cancer in our study. The albumin and serum C-reactive protein (CRP) were measured before initiation of treatment. The relationships between the mGPS and other clinical parameters including body mass index (BMI), white blood cell count, lymphocyte, platelet, hemoglobin, total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) were analyzed. Overall survival (OS) and progression-free survival (PFS) were calculated. Significant prognostic factors were identified using univariate and multivariate analyses. Results: The 5-year OS rate for all patients was 52.1% and 5-year PFS rate was 42.3%. Patients with mGPS of 0, 1 and 2 were 138, 71, 29, respectively. Higher mGPS was related to more advanced disease, including higher FIGO stage, lymph node metastases and lower lymphocyte counts, BMI and hemoglobin level. Performance status (PS), FIGO stage, lymph nodal status and mGPS were independent prognostic indicators for OS and PFS in the multivariate analysis. Conclusions: Higher mGPS is associated with advanced cervical cancer. The mGPS is an easily measurable biomarker which can be used in combination with conventional FIGO stage to predict survival in patients with cervical cancer undergoing chemoradiotherapy.     

Anal canal carcinoma: experience from a single Korean institution

PURPOSE: The clinical features, treatment modality approaches in clinical practice, and prognostic factors for anal canal carcinoma patients were retrospectively analyzed. MATERIALS AND METHODS: Between October 1994 and December 2005, 50 patients with anal canal cancer were treated at Samsung Medical Center, Seoul, Korea. RESULTS: After a median follow up of 37.8 months (range, 6.6-136.1 months), the 5-year and 10-year survival rates for the 38 patients with early and locally advanced squamous and cloacogenic carcinoma (squamous cell carcinoma and cloacogenic carcinoma) were 74.8% and 66.5%, respectively. The 5-year survival and disease-free survival rates (DFS) of the 31 patients who received chemoradiation therapy (CRT) were 83.6% and 74.3%, respectively. The overall and DFS could not be determined for the adenocarcinoma group due to the small number of cases (n=8). Univariate analysis showed that tumor size (p=0.04) and inguinal node status (p=0.04) significantly influenced patient survival in patients with squamous cell and cloacogenic carcinomas. Furthermore, univariate analysis also showed that, inguinal node status influenced patient survival in the adenocarcinoma group. Multivariate analysis showed that inguinal node metastasis is a single independent prognostic variable for survival (p=0.04) in patients with squamous cell and cloacogenic carcinomas. CONCLUSION: Combined CRT has been adopted as standard treatment with outcomes that are comparable to those reported in randomized clinical trials. Due to the rarity and complexity of anal canal carcinoma, interdepartmental cooperation is required for disease treatment. Thus, proper treatment of patients should incorporate a team-approach and should be available to as many patients as possible.     

Predictive factors in locally advanced rectal cancer treated with preoperative hyperfractionated and accelerated radiotherapy

This study examines the prognostic significance of pathologic factors in patients with primary locally advanced rectal cancer treated prospectively with preoperative radiotherapy. From 1992 to 1998, 104 patients with rectal cancer of grades T3 or T4 and any N underwent preoperative radiotherapy followed by surgical resection. Survival curves were estimated according to the Kaplan-Meier method. Correlation of outcome with clinicopathologic variables (pathologic tumor and lymph node staging, histology, radial resection margin [RRM], clearance, vessel involvement, and tumor regression grade [TRG], quantitated in 5 grades) was evaluated using the Cox proportional hazards model. None of the patients achieved a histologically confirmed complete pathologic response, but 79% of the patients showed partial tumor regression (TRG2-4) and 21% did not show any tumor regression (TRG5). Among the tumors, 22% were of a mucinous type. The RRM was free of tumor in 76% of the surgical specimens. The median clearance was 2 mm. Vascular invasion was present in 37 cases (36%). In the univariate analysis, lymph node metastases, absence of tumor regression, positive RRM, and vascular invasion were correlated with adverse overall survival and disease-free survival; absence of tumor regression, positive RRM, and clearance <2 mm were correlated with local recurrences; and advanced pT stage was correlated only with disease-free survival. However, in the multivariate analysis, only lymph node metastases and RRM were independent prognostic factors for overall survival and disease-free survival, and clearance <2 mm was an independent prognostic factor for local control. Pathologic parameters remain strong determinants of local recurrence and survival in locally advanced rectal cancer, treated preoperatively with hyperfractionated and accelerated radiotherapy. We show that patients with advanced pT, positive lymph nodes, vascular invasion, positive RRM, clearance <2 mm, or absence of tumor regression are known to have poor clinical outcome.     

Prognostic Significance of Volume-Based FDG PET/CT Parameters in Patients with Locally Advanced Pancreatic Cancer Treated with Chemoradiation Therapy

Purpose

We investigated the prognostic role of volume-based parameters measured on ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) scans in patients with locally advanced pancreatic cancer (LAPC) treated with chemoradiation therapy (CRT).

Materials and Methods

We enrolled 60 patients with LAPC who underwent FDG PET/CT before CRT. Maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of primary pancreatic cancers were measured on FDG PET/CT scans. Treatment response was evaluated according to the Response Evaluation Criteria in Solid Tumors. Survival analysis was performed using the Kaplan-Meier method, and Cox proportional hazard models were used to determine independent prognostic factors.

Results

The progression-free survival (PFS), locoregional progression-free survival (LRFPS), and overall survival (OS) for this population were 6.2, 10.9, and 13.2 months, respectively. The overall treatment response rate was 16.7% at 4 weeks after CRT, and the disease control rate (DCR) was 80.0%. DCR was significantly higher in patients with low SUVmax, MTV, or TLG, and showed strong correlation with longer survival times. On univariate analysis, MTV and TLG were significant prognostic factors for PFS, LRPFS, and OS, together with pre-CRT and post-CRT CA19-9 levels. Multivariate analyses demonstrated that MTV together with the pre-CRT CA19-9 level were independent prognostic factors for PFS, LRPFS, and OS, as was TLG for LRPFS and OS.

Conclusion

MTV and the pre-CRT CA19-9 level provided independent prognostic information in patients with LAPC treated with CRT. Volume-based PET/CT parameters may be useful in identifying which subgroup of patients would benefit from radiation therapy as a part of CRT.     

Clinicopathologic characteristics and prognostic value of various histological types in advanced gastric cancer

The prognostic value of histological types in gastric cancer is not well defined. This study aims to clarify the clinicopathologic features of various WHO histological types and their prognostic significance in advanced gastric cancer (AGC). We retrospectively reviewed 741 patients with gastric cancer in our hospital from 1997 to 2007. The AGC (741 cases) were divided into five histological types: well-differentiated carcinoma (WD), moderately differentiated carcinoma (MD), poorly differentiated carcinoma (PD), mucinous carcinoma (MC), and signet ring cell carcinoma (SRC). The various AGC histological types presented significant differences in their clinical and tumor features. The five-year survival rates of patients with WD, MD, PD, MC, and SRC were 87.1%, 57.1%, 50.6%, 62.7%, and 43.4%, respectively (P=0.012). Multivariate analysis showed that cell differentiation, age, depth of invasion, and lymph node metastasis were independent prognostic factors in AGC, whereas MC and SRC were not. Cell differentiation is related to tumor aggression or patient stage. Advanced stage SRC carcinoma had more aggressive features and worse prognosis than the other types. MC carcinoma survival is correlated with the stage at diagnosis. The degree of cell differentiation is an important predictor of survival in AGC.