保留乳头乳晕复合体的乳腺癌改良根治术预后的相关因素分析

目的探究影响保留乳头乳晕复合体(NAC)的乳腺癌改良根治术(NSM)预后的相关因素。 方法回顾性分析2011年1月至2014年12月84例早期原发性乳腺癌并接受NAC的NSM患者临床病理资料。使用统计软件SPSS 20.0进行数据分析,采用K-M生存曲线评估术后无病生存(DFS)及总生存(OS),采用单因素分析和Cox多因素分析影响NSM术后患者DFS和OPS的影响因素。P<0.05差异有统计学意义。 结果术后局部复发8例,远处转移6例,术后5年DFS为83.3%,OS为91.7%。多因素分析显示,肿瘤最大径、肿瘤距乳头乳晕距离(TND)、腋窝淋巴结状态、组织学类型及Her-2阳性是影响DFS的独立危险因素(P<0.05);而腋窝淋巴结状态是影响术后OS的独立危险因素(P<0.05)。 结论肿瘤最大径、TND、腋窝淋巴结状态、组织学类型及Her-2阳性是DFS的独立危险因素,腋窝淋巴结状态是OS的独立危险因素;腋窝淋巴结情况同时影响患者术后DFS和OS,术前系统、精准地评估并妥善处理特殊腋窝淋巴结可提高乳腺癌患者预后。     

术前中性粒细胞与淋巴细胞比值对淋巴结转移的胸段食管鳞癌病人预后的预测价值

目的探讨术前中性粒细胞与淋巴细胞比值(NLR)对淋巴结转移的胸段食管鳞癌病人预后的预测价值。方法 2014年4月～2016年4月我院行手术治疗的胸段食管鳞癌病人313例,以病人NLR中位值3.2为界值,将所有病人分为高NLR值(≥3.2)组和低NLR值(3.2)组。比较两组的一般临床病理特征,绘制两组的总生存期(OS)与无病生存期(DFS)生存曲线并进行比较。使用Cox比例风险模型进行多因素分析以确定预后相关的因素。结果高NLR组与低NLR组病人的1年、3年OS率分别为86.5%、56.2%和88.9%、61.0%(P0.05),高NLR组与低NLR组病人的1年、3年DFS率分别为71.1%、35.3%和83.1%、47.1%(P0.05)。多因素分析显示,病理分期是OS的独立预后因素(P0.05),而手术入路、肿瘤分化程度、病理分期及NLR是DFS的独立预后因素(P0.05)。结论对于已存在淋巴结转移的食管胸段鳞癌病人, NLR值对于病人复发预测具有价值,但是对于其总生存期来说,并不能作为预测指标。     

肺癌根治术对肺大细胞神经内分泌肿瘤患者生存期的影响

目的探讨肺大细胞神经内分泌肿瘤(LCNEC)的临床特点及对患者术后生存的影响。 方法回顾性分析2008年1月至2014年12月在上海交通大学附属胸科医院治疗的90例LCNEC患者的临床资料,均经肺癌根治性切除及系统性淋巴结清扫。根据术后化疗与否将90例患者分为辅助化疗组(64例)和未化疗组(26例)。随访1～100个月,观察患者的总生存期(OS)和无复发生存期(DFS)。 结果90例LCNEC患者中,男性80例,女性10例;平均年龄62.2(36～79)岁,中位生存时间35个月。总生存率和无复发生存率分别为36.2%和32.2%。单因素分析表明：辅助化疗、外科手术方式、吸烟史和肿瘤病理分期为OS和DFS的影响因素(P<0.05或P<0.01)。COX多因素分析表明：吸烟史、术后病理分期、辅助化疗分别为OS和DFS独立的预后影响因素(P<0.01)。 结论LCNEC是一类稀少、恶性程度高和术前难以明确诊断的恶性肿瘤,术后化疗可以明显提高患者的预后。     

中性粒细胞与淋巴细胞比值和血小板与淋巴细胞比值评价TACE后肝细胞癌患者预后

目的探讨中性粒细胞与淋巴细胞比值(NLR)和血小板与淋巴细胞比值(PLR)预测TACE后肝细胞癌(HCC)患者预后的价值。方法分析95例接受TACE治疗的BCLC分期B期的HCC患者资料,根据NLR、PLR值预测患者预后ROC曲线的界值,将其分成高值组和低值组。观察TACE术前、术后3天、术后1个月NLR和PLR变化及NLR、PLR值与术后生存期的相关性。结果术后3天NLR高于术前(P0.05),术后3天PLR低于术前(P0.05)。术后1个月,NLR回落至接近术前水平(P0.05),PLR上升至接近术前水平(P0.05)。术前NLR≥2.51组中位总生存期(OS)短于NLR2.51组(13.40个月vs 26.83个月;Z=5.24,P0.05);术前PLR≥96.84组中位OS短于PLR96.84组(17.27个月vs 28.83个月;Z=3.06,P0.05)。术后3天NRL≥5.17组中位OS短于NLR5.17组(15.20个月vs 25.07个月;Z=3.32,P0.05);术后3天PLR≥100.65组中位OS短于PLR100.65组(14.87个月vs 25.07个月;Z=3.54,P0.05)。术前NLR水平、肿瘤最大径、AFP水平、AST水平、ALB水平是影响HCC患者TACE治疗预后的独立危险因素。结论 TACE治疗HCC前后NLR、PLR值与TACE后患者预后有关,可作为评估HCC患者预后的指标。     

经皮微波消融治疗较大原发性肝癌的可行性及疗效研究

目的:评估经皮微波消融(PMWA)治疗较大原发肝癌(HCC)的可行性和疗效。方法:回顾性收集2007年1月—2010年1月49例接受了超声引导下PMWA手术不可行的较大HCC(5~6 cm)患者的临床与随访资料。分析患者肿瘤完全消融率、严重并发症发生率,治疗后的总体生存(OS)和无瘤生存(DFS)情况,以及OS影响因素。结果:49例患者中首次肿瘤完全消融率为85.7%,二次消融后所有患者均达到完全消融率。严重并发症发生率为8.1%。截至随访结束(中位随访时间48个月),41例(87.5%)出现了肝内复发;平均生存时间(54.4±32.0)个月;1、3、5年OS分别为87.8%、63.3%、39.1%。平均DFS时间为(35.8±30.6)个月,1、3、5年DFS率分别为69.4%、40.9%、21.8%。单因素分析显示术前乙肝病毒定量阳性和甲胎蛋白(AFP)高水平是影响OS的不良因素(均P0.05),多因素分析显示术前AFP高水平是OS的独立影响因素(HR=1.730,95%CI=1.135~2.635,P=0.011)。结论:PMWA是较大肝癌安全可行且有效的治疗方式,但术后复发的治疗仍需探索。术前AFP高水平是PMWA术后OS的独立影响因素。     

pT1b期食管鳞状细胞癌开放手术与微创食管切除术后预后分析

目的比较微创食管切除术与传统开放食管切除术对pT1b期食管鳞状细胞癌(ESCC)患者近远期疗效之间的差异。方法回顾性分析2015~2018年于苏北人民医院胸外科行手术治疗并且术后病理确诊为pT1b期ESCC 162例患者的临床病理资料。根据手术方式分为微创手术(MIE)组和开放手术(OE)组。其中OE组共76例,男55例、女21例,平均年龄(63.3±5.6)岁;MIE组共86例,男60例、女26例,平均年龄(64.7±6.1)岁。比较两组患者的围术期资料并进行随访。采用Kaplan-Meier和log-rank检验对两组生存曲线进行比较,并利用Cox比例风险回归模型分析预后因素。结果与OE组相比,MIE组的术中出血量更少[(119.8±70.0)mL vs.(210.5±136.2)mL,P<0.001]、术中清扫淋巴结数量更多[(19.1±7.4)枚vs.(13.8±5.9)枚,P<0.001]、术后肺部感染发生率更低(9.3%vs.21.1%,P=0.036),但MIE组的手术时间[(240.0±52.4)min vs.(179.5±35.7)min,P<0.001]更长。162例患者中21例出现淋巴结转移,淋巴结转移率13.0%。至随访结束时共有19例患者死亡,术后1年、3年、5年总生存率(OS)分别为97.5%、88.8%和82.9%;31例患者出现复发转移,术后1年、3年、5年无病生存率(DFS)分别为95.1%、80.9%和75.6%;两组的OS和DFS差异无统计学意义。OS的多因素Cox回归分析结果发现淋巴结转移、吻合口瘘和乳糜胸是影响患者OS的独立危险因素。DFS的多因素Cox回归分析结果发现淋巴结转移、吻合口瘘、乳糜胸和脉管癌栓是影响患者DFS的独立危险因素。结论MIE可以达到与OE相同的远期疗效,并且术中出血量更少、清扫的淋巴结数目更多、术后肺部感染发生率更低,但手术时间更长。     

血清HBeAg状态对肝细胞癌患者术后生存的影响

目的研究肝癌患者血清HBeAg状态对肝癌切除术后复发及生存的影响。方法收集1999~2005年在我科行根治性切除的223例肿瘤直径≤3cm的肝癌患者的资料。根据患者术前血清HBeAg状态,分为HBeAg阳性组(n=73)和HBeAg阴性组(n=150),比较2组患者无瘤生存率(DFS)和总体生存率(OS),并分析影响DFS和OS的危险因素。结果HBeAg阳性和HBeAg阴性患者的1、3、5年的OS分别为91.5%、76.8%、60.1%和95.2%、85.3%、73.2%(P=0.053);1、3、5年DFS分别为73.3%、53.7%、40.3%和86.6%、65.5%、54.5%(P=0.002)。与HBeAg阴性组比较,HBeAg阳性组患者年龄较轻(P=0.004),肝硬变较重(P=0.008),而在肿瘤因素及手术相关因素方面2组间的差异无统计学意义(P>0.05)。对DFS和OS的多因素分析显示,年龄>50岁、HBeAg阳性和大结节肝硬变是影响OS的独立危险因素,而HBeAg阳性和多发肿瘤是影响DFS的独立危险因素。结论小肝癌患者术后HBeAg阳性患者较HBeAg阴性者更易早期复发,而且总体生存较差。     

结直肠癌肝转移病人原发灶切除的临床意义及其预后影响因素分析——基于SEER数据库的倾向得分匹配分析

目的基于SEER数据库探讨不可切除转移灶的结直肠癌肝转移病人(CRLM)原发灶的切除对生存预后的影响并进一步分析其预后相关危险因素。方法获取SEER数据库中2010～2015年结直肠癌肝转移病人的临床及预后资料。根据标准筛选病例,最终获得高价值临床资料3920例,其中化疗联合原发灶切除组(联合组)3232例,单纯化疗组(化疗组)688例。采用倾向得分匹配(PSM)方法平衡两组病人的临床病理基线特征,比较两组病人的总体生存率(OS)和肿瘤特异性生存率(CSS)差异,通过COX比例风险回归模型对联合组中影响病人预后的危险因素进行分析。结果 PSM前,联合组病人OS和CSS均明显高于化疗组(P0.05),但两组中包括性别、肿瘤分级、肿瘤部位、肿瘤大小、种族、婚姻状态、T分期、N分期、CEA等临床病理特征具有显著的不均衡性(P0.05)。通过1∶1 PSM匹配后,最终有效地筛选出1168例病人,联合组和化疗组分别584例,两组病人的临床病理特征差异明显缩小,其中性别、肿瘤分级、肿瘤大小、种族、婚姻状态、CEA等经过匹配后基线分布特征获得显著改善(P0.05),而联合组病人的OS和CSS依旧显著高于化疗组(P0.05)。采用COX等比例风险回归模型分析显示,年龄、肿瘤部位、肿瘤N分期、放疗、婚姻状态等是影响联合组病人预后的独立危险因素。结论对能够耐受手术的不可切除转移灶的CRLM病人应采取在全身化疗基础上联合原发灶切除的治疗策略。     

营养状态和肥胖与根治性膀胱切除术后的早期并发症和死亡风险的相关性

目的探讨营养状态和肥胖对根治性膀胱切除术后早期并发症的发生及预后的影响。方法回顾性分析2014年1月至2017年3月上海交通大学医学院附属同仁医院泌尿外科因膀胱癌行根治性膀胱切除术的84例患者的一般营养状况及手术资料。分析营养因素与术后90 d内并发症发生的关系,应用多因素Cox回归分析随访1年不良预后的危险因素。结果并发症组在美国麻醉医师协会分级、术后住院时间、手术时间方面与无并发症组比较差异有统计学意义(P<0.05),并发症组术前血红蛋白、白蛋白均低于无并发症组(P<0.05),术前6个月体重下降情况较无并发症组更严重(P<0.05),术前体质指数(BMI)高于无并发症组(P<0.05)。多因素Cox回归分析发现低白蛋白、BMI以及手术时间是术后1年死亡的独立危险因素(P<0.05)。结论低白蛋白和BMI是根治性膀胱切除术后死亡的独立危险因素,应重视患者术前营养状态,积极改善预后。     

腹腔镜结直肠癌手术对应激细胞因子ET、IL-6及CRP的影响

目的:探讨腹腔镜结直肠癌手术对机体应激反应的影响。方法:选择2006年6月~2007年3月结直肠癌患者35例,分为腹腔镜组15例,开腹组20例。比较两组围手术期内皮素(ET)、白细胞介素-6(IL-6)、C-反应蛋白质(CRP)及相关临床指标的变化。结果:两组患者的性别、年龄、身高、体重、术后病理分期及手术方式差异无统计学意义(P>0.05),平均手术时间腹腔镜组长于开腹组(P<0.05);术中平均出血量开腹组多于腹腔镜组(P<0.05)。腹腔镜组术后第1天ET显著下降(P<0.05),术后第3天恢复至术前水平;开腹组手术前后ET无显著变化。两组术后未出现显著差异。两组患者术后IL-6和CRP均明显升高(P<0.01),且开腹组明显高于腹腔镜组(P<0.01),术后第5天腹腔镜组IL-6恢复至术前水平,但开腹组仍明显高于腹腔镜组(P<0.05)。术后第5天两组CRP仍显著高于术前水平(P<0.05;P<0.01),且开腹组高于腹腔镜组(P<0.05)。结论:腹腔镜结直肠癌手术对ET、IL-6和CRP的影响小,应激反应比开腹手术轻、强度低、持续时间短。     

Peri-Operative Blood Transfusion Does Not Influence Overall and Disease-Free Survival After Radical Gastrectomy for Stage II/III Gastric Cancer: a Propensity Score Matching Analysis

Objective

Whether peri-operative blood transfusions (BTF) negatively impact long-term survival after gastrectomy for gastric cancer (GC) remains controversial. The aim of this retrospective study was to investigate independent predictive factors of BTF and the potential impact of BTF on overall survival (OS) and disease-free survival (DFS) in patients who underwent radical gastrectomy for stage II/III GC.

Methods

Of 1020 patients who underwent gastrectomy for stage II/III GC from November 2010 to December 2015, 231 (22.6%) patients received BTF. The independent predictive factors of BTF were identified using univariate and multivariate analyses. Cox regression and propensity score matching (PSM) analyses of OS and DFS in patients who received BTF or not were compared.

Results

Multivariate analysis revealed that age, pre-operative hemoglobin levels, tumor size, operation time, combined multi-organ resection, and intra-operative blood loss were independent predictive factors for BTF. PSM analysis created 205 pairs of patients. BTF was significantly associated with decreased OS (P?=?0.025) and DFS (P?=?0.034) in the entire cohort before PSM. After PSM, there was no longer a significant association between BTF and OS (P?=?0.850) or DFS (P?=?0.880). BTF was not identified as an independent risk factor for OS or DFS by multivariate Cox regression analysis.

Conclusions

The present study revealed that BTF did not influence OS and DFS after radical gastrectomy for stage II/III GC. Worse oncological outcomes were caused by clinical circumstances requiring blood transfusions, including longer operation time and advanced tumor stage, not due to BTF itself.

     

肝切除术与TACE治疗原发性肝癌破裂出血疗效的倾向评分匹配分析

背景与目的:肝切除术(LR)和经导管动脉栓塞化疗术(TACE)都广泛应用于原发性肝癌(PLC)破裂出血的治疗,但相关疗效结果报道仍有较大差异.目前,在选择最合适的治疗策略以降低院内病死率和改善长期生存方面仍未达成共识.因此,本研究通过回顾性分析比较LR和TACE治疗PLC破裂出血的临床疗效和预后,以期为该病提供合理的治...     

Gamma-Glutamyl Transpeptidase to Platelet Ratio Is a Novel and Independent Prognostic Marker for Resectable Lung Cancer: A Propensity Score Matching Study

Background: We report this propensity score matching (PSM) analysis to assess prognostic roles of preoperative gamma-glutamyl transpeptidase to platelet ratio (GPR) in video-assisted thoracoscopic (VATS) lobectomy for stage I-II non-small-cell lung cancer (NSCLC).Methods: The PSM-based study conducted on our single-center prospectively collected database from January 2014 to August 2015 provided Kaplan–Meier survival analyses using the log-rank test to discriminate differences in overall survival (OS) and disease-free survival (DFS) between patients stratified by preoperative GPR.Results: Our study includes 379 patients diagnosed with operable primary stage I-II NSCLC. A GPR value at 0.16 was recognized as the optimal cutoff point for prognostic prediction. Both OS and DFS of patients with GPR ≥0.16 were significantly shortened when compared to those of patients with GPR <0.16. Patients with GPR ≥0.16 had significantly lower 5-year rates of OS and DFS than those of patients with GPR <0.16 (P <0.001). Significant associations between GPR and unfavorable survival still are validated in the PSM analysis. Multivariable Cox regression models on both the entire cohort and the PSM cohort consistently demonstrated that an elevated preoperative GPR could be an independent prognostic marker for both OS and DFS of resectable NSCLC.Conclusions: GPR may be an effective and noninvasive prognostic biomarker in VATS lobectomy for surgically resectable NSCLC.     

Benefits of neoadjuvant therapy compared with adjuvant chemotherapy for the survival of patients with HER2-positive breast cancer: A retrospective cohort study at FUSCC

PurposeNeoadjuvant therapy (NAT) is considered the standard of care for patients with HER2-positive breast cancer (BC). However, there is no proven survival benefit of NAT compared to adjuvant therapy for the survival of patients with early-stage HER2-positive BC. This study aimed to compare the prognosis of HER2-positive BC patients treated with NAT to that of patients treated with adjuvant therapy.MethodsThis was a single-center real-world retrospective study. This study analyzed the disease-free survival (DFS) and overall survival (OS) of 538 HER2-positive BC patients treated with neoadjuvant therapy and 2684 patients treated with adjuvant therapy at Fudan University Shanghai Cancer Center (FUSCC) between 2012 and 2016. Patients with a clinical tumor size (cT) ≤5 cm or >5 cm were matched using the propensity score matching (PSM) method to prevent selection bias.ResultsAfter PSM, among patients with cT ≤ 5 cm, there was no significant difference in DFS (P = 0.08) or OS (P = 0.11) between the two groups. The analysis of survival outcomes of patients treated with neoadjuvant and adjuvant therapy in the different chemotherapy subgroups yielded consistent results. According to multivariate analysis, lymph node status and response to NAT showed independent prognostic value for OS and DFS. Among patients with cT > 5 cm, the DFS (P = 0.25) and OS (P = 0.57) of patients treated with NAT were similar to those of patients treated with adjuvant therapy after PSM.ConclusionWe confirmed the equivalent effects of adjuvant therapy and NAT in HER2-positive BC patients. Neoadjuvant therapy should be used for patients with HER2-positive BC.     

Impact of positive surgical margins on overall survival after partial nephrectomy—A matched comparison based on the National Cancer Database

Introduction

The impact of positive surgical margins (PSM) in partial nephrectomy (PN) has been a controversy. Previous studies on the relationship between PSM and overall survival (OS) were either underpowered or had highly dissimilar groups. We used the National Cancer Database with propensity score matching to determine the association between PSM and OS after PN.

局部进展期胃癌根治性手术联合腹腔热灌注化疗的安全性及近期疗效

背景与目的：胃癌治疗过程中加入腹腔热灌注化疗（HIPEC）的临床应用日渐增多,但是HIPEC治疗胃癌尚缺乏统一的标准,其安全性和有效性至今尚未明确。本研究旨在探讨局部进展期胃癌根治性手术联合术中雷替曲塞HIPEC的安全性及近期疗效。 方法：调阅安徽医科大学附属安庆医院肿瘤外科胃癌云端数据库,回顾性分析2017年12月—2019年12月连续性收治行D2根治性胃切除术的155例局部进展期胃癌患者的临床病例资料。其中52例行手术加HIPEC（观察组）,103例行单纯手术（对照组）。通过采用倾向性评分匹配（PSM）均衡组间协变量,比较两组患者的术后资料、术后并发症及血液学毒性不良事件发生情况。 结果：PSM匹配前,观察组在肿瘤部位、病理TNM分期与对照组比较差异均有统计学意义（均P<0.05）,两组患者的基线数据不平衡。PSM 1:1匹配后,100例患者（观察组和对照组各50例）配对成功,观察组患者临床及病理分期资料与对照组比较,差异均无统计学意义（均P>0.05）,基线数据均衡。匹配前、后观察组的手术时间均长于对照组的手术时间（P<0.001）。匹配前观察组术后第1天复查实验室检查指标中天门冬氨酸氨基转移酶（AST）、白蛋白（ALB）水平低于对照组（P<0.05）,匹配后两组患者术后第1天复查实验室检查指标差异均无统计学意义（均P>0.05）;两组匹配前、后的术中出血量、术后首次通气时间、术后住院日、术后前3 d疼痛评分差异均无统计学意义（均P>0.05）;两组匹配前、后的围手术期病死率、非计划再次手术率、术后并发症发生率、术后并发症Clavien-Dindo分级及血液学毒性不良事件与对照组差异均无统计学意义（均P>0.05）。 结论：局部进展期胃癌行根治性手术术中即刻行雷替曲塞HIPEC治疗虽延长了患者手术麻醉时间,但并不影响患者术后恢复和增加术后并发症的发生率,安全可靠,远期疗效需进一步研究,可能为患者带来生存获益。     

微血管侵犯对肝内胆管癌根治性切除病人预后影响研究：基于多中心的倾向评分匹配分析

目的 分析微血管侵犯（MVI）对肝内胆管癌（ICC）根治性切除病人预后的影响。方法 采用倾向评分匹配（PSM）及回顾性队列研究方法。搜集自2011年12月至2017年12月国内13家医疗中心（海军军医大学东方肝胆外科医院、浙江大学医学院附属第二医院、福建医科大学孟超肝胆医院、陆军军医大学西南医院、中国医学科学院北京协和医学院肿瘤医院、华中科技大学同济医学院附属同济医院、首都医科大学附属北京友谊医院、四川大学华西医院、上海交通大学医学院附属仁济医院、首都医科大学宣武医院、川北医学院附属医院、首都医科大学附属天坛医院、东南大学附属中大医院）收治的初诊为ICC病人的临床病理资料。其中男性202例,女性299例;中位年龄为57（49～64）岁,年龄范围为23～88岁。根据术后病理学诊断是否合并MVI分为MVI组和Non-MVI组,其中MVI组61例、Non-MVI组440例。观察指标：（1）PSM前后两组病人基线资料比较。（2）生存分析：采用Kaplan-Meier法进行总体生存（OS）及无瘤生存（DFS）分析,COX回归分析影响ICC预后的独立危险因素。（3）MVI影响因素分析：Logistic回归分析MVI发生的独立危险因素。结果 （1）共纳入501例ICC根治性切除术后病人,MVI发生率为12.2%。经1∶1 PSM后,MVI组和Non-MVI组分别获得61例,两组之间基线资料差异无统计学意义（所有P＞0.05）。（2）PSM前COX多因素分析结果显示：性别、肿瘤最大径、MVI、术后辅助治疗为OS的独立危险因素（HR=0.74,95％CI 0.58~0.94,P=0.013;HR=1.43,95％CI 1.11~1.83,P=0.006;HR=1.87,95％CI 1.35~2.58,P＜0.01;HR=0.69,95％CI 0.50~0.97,P=0.031）。性别、切缘距离、病理学分型、肿瘤最大径、卫星灶、微血管侵犯为DFS的独立危险因素（HR=0.80,95％CI 0.64~1.01,P=0.061;HR=1.40,95％CI 1.10~1.77,P=0.005;HR=1.51,95％CI 1.08~2.12,P=0.017;HR=1.35,95％CI 1.07~1.71,P=0.013;HR=1.74,95％CI 1.21~2.52,P=0.003;HR=2.36,95％CI 1.73~3.21,P＜0.01）。经1∶1 PSM,COX多因素分析结果显示：Child-Pugh分级、MVI为OS的独立危险因素（HR=1.75,95％CI 1.03~2.99,P=0.039;HR=1.84,95％CI 1.17~2.90,P=0.008）。病理学分型、MVI为DFS的独立危险因素（HR=1.93,95％CI 1.08~3.44,P=0.027;HR=2.64,95％CI 1.64~4.24,P＜0.01）。（3）Kaplan-Meier分析显示,PSM前后MVI组总存活率和无瘤存活率显著低于Non-MVI组（所有P＜0.05）。（4）PSM前,MVI组与Non-MVI组病人的复发率分别为88.5%、62.5％（P＜0.01）。PSM后,MVI组与Non-MVI组病人的复发率分别为88.5%和50.8%（P＜0.01）。（5）Logistic多因素分析结果显示,ECOG评分＜2分（OR=0.49,95％CI 0.27~0.87,P=0.014）,Child-Pugh 分级（OR=0.49,95％CI 0.25~0.97,P=0.041）,肿瘤分化程度（OR=1.85,95％CI 1.01~3.39,P=0.046）,肿瘤最大径（OR=2.19,95％CI 1.18~4.08,P=0.014）及神经侵犯（OR=2.18,95％CI 1.03~4.59,P=0.41）是MVI的独立影响因素。结论 MVI与ICC侵袭性特征及肿瘤复发相关,MVI是ICC根治术后预后不良的独立危险因素。     

肝内胆管癌根治性切除术中淋巴结清扫价值研究

目的 通过分析海军军医大学东方肝胆外科医院7年间诊断肝内胆管癌（ICC）并接受手术治疗病人的治疗及预后情况,探讨术中淋巴结清扫的意义。方法 回顾性分析2010年1月至2017年12月于海军军医大学东方肝胆外科医院经手术治疗的265例ICC病人资料。结果 共纳入265例病人,男性175例,女性90例。年龄22~86岁,中位年龄56.5岁。中位随访时间33.5个月。全部病人1、2、3年无瘤存活率分别为50%、29%、20%,中位无瘤生存时间11.9个月;1、2、3年总存活率分别为 77%、47%、36%,总中位生存时间22.8个月。COX多因素分析结果显示病人无瘤生存的影响因素包括糖尿病史、术前CA19-9高水平、肿瘤直径≥5 cm、肿瘤周边子灶、淋巴结是否清扫;病人总体生存的影响因素包括术前CA19-9高水平、肿瘤直径≥5 cm、血管侵犯、淋巴结是否清扫。分组对比经倾向评分匹配（PSM）后,淋巴结清扫组及未清扫组各77例。1、2、3年无瘤存活率:清扫组68%、47%、36% vs.未清扫组31%、13%、6%（P＜0.05）,中位无瘤生存时间：清扫组22.2个月 vs.未清扫组9.2个月。1、2、3年总存活率：清扫组91%、75%、56% vs.未清扫组71%、30%、21%（P＜0.05）,中位总生存时间：清扫组46.8个月vs.未清扫组17.0个月。剔除清扫组淋巴结阳性病人,比较清扫组中淋巴结病理学诊断阴性与未清扫病人生存情况,PSM后：清扫淋巴结阴性组及未清扫组各50例。1、2、3年无瘤存活率：清扫淋巴结阴性组77%、60%、52% vs.未清扫组32%、22%、15%（P＜0.05）,中位无瘤生存时间：清扫淋巴结阴性组38.1个月vs.未清扫组9.0个月。1、2、3年总存活率：清扫淋巴结阴性组94%、82%、74% vs.未清扫组68%、40%、28%,（P＜0.05）,中位总生存时间：清扫淋巴结阴性组54.0个月vs.未清扫组18.9个月。病人发生淋巴结转移的影响因素分析显示,肿瘤直径≥5 cm、术前CA19-9高水平是影响病人淋巴结转移的独立危险因素。结论 术中淋巴结清扫可改善ICC病人预后。术前无法明确淋巴结转移,但评估肿瘤可行根治性切除的ICC病人,伴随术前CA19-9水平较高、肿瘤直径较大时,术中应积极常规进行淋巴结清扫。     

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??Analysis of prognostic predictors affecting hepatectomy combined with postoperative adjuvant TACE in patients with hepatocellular carcinoma??A double-centered propensity-score matching study QU Kai*??GU Jing-xian??CUI Rui-xia??et al. *Department of Hepatobiliary Surgery??the First Affiliated Hospital of Xi'an Jiaotong University??Xi'an 710061??China
Corresponding author??LIU Chang??E-mail??eyrechang@126.com??FAN Hai-ning??E-mail??1486713174@qq.com
Abstract Objective To confirm the clinical effectiveness of postoperative adjuvant transcatheter arterial chemoembolization??TACE?? in HCC patients after liver resection??and further identify the patients who could benefit most from postoperative adjuvant TACE. Methods The clinical data of 593 consecutive patients were retrospectively collected from the First Affiliated Hospital of Xi’an Jiaotong University from January 2005 to December 2016 and the Affiliated Hospital of Qinghai University between January 2011 and June 2017. Propensity score matching (PSM) was used between hepatectomy patients with and without receiving postoperative adjuvant TACE and finally a total of 348 patients were matched. Kaplan-Meier analysis was performed to compare overall survival (OS) and recurrence-free survival (RFS) between the two groups??univariate COX regression and stratified survival analysis were performed to screen and identify survival predictors for postoperative adjuvant TACE patients. Results The Log-rank tests showed both OS and RFS of the patients in postoperative adjuvant TACE group were significantly longer than those in the control group (P<0.05). The identified prognostic predictors by Cox regression and stratified survival analysis included hepatitis B infection??spleen diameter??preoperative serum alpha-fetoprotein (AFP)??TNM stage??tumor size??tumor number. Conclusion Postoperative adjuvant TACE could improve prognosis markedly in HCC patients??particularly in late-stage ones with hepatitis B??portal hypertension??or higher level of preoperative AFP.     

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??Middle hepatic vein-guidedhepatectomy for treatment of hepatocellular carcinoma: A preliminary clinical study JI Gu-wei??WANG Ke??LI Chang-xian??et al. Liver Transplantation Center??the First Affiliated Hospital of Nanjing Medical University??Nanjing 210029??China
Corresponding author??LI Xiang-cheng??E-mail??drxcli@njmu.edu.cn
Abstract Objective To explore the clinical efficacy of middle hepatic vein (MHV)-oriented hepatectomy for treatment of hepatocellular carcinoma (HCC). Methods A retrospective analysis of the clinical and follow-up data of 91 patients??who received radical treatment by hemihepatectomy at Liver Transplantation Center??the First Affiliated Hospital of Nanjing Medical University between June 2006 and June 2015 was conducted. Surgical approaches were divided into MHV-oriented group and conventional group according to full exposure of the MHV on the dissection plane. Early recurrence was defined as tumor recurrence within the first year after surgery. One-to-one propensity score matching (PSM) analysis of the two groups was performed to investigate the clinical efficacy of different surgical approaches. Results Among the 91 patients??left and right hemihepatectomy was performed in 30 and 61 patients. Mean tumor size was 9.9 cm (1.5 to 20.0 cm). Median survival time was 48 months (2 to 127 months). The 1-??3- and 5-year overall survival (OS) rates were 80.1%??58.0%??and 41.8%??respectively. Corresponding disease-free survival (DFS) rates were 57.7%??37.4%??and 30.3%. There was no statistic difference between MHV-oriented group and conventional group in terms of OS and DFS; However??early recurrence rate in conventional group was significantly higher than that in MHV-oriented group. The result was further confirmed by PSM. Multivariate analysis of all patients showed that macrovascular invasion and satellite focus were independent prognostic factors for OS??macrovascular invasion was the independent prognostic factor for DFS??and surgical approach was an independent risk factor for early recurrence after surgery. Conclusion MHV-oriented hepatectomy is associated with decreased early recurrence after radical resection of HCC??However??tumor biology remains the main determinant of overall prognosis.