MiR-449b表达对老年原发性肝细胞癌患者预后的影响

目的探讨miR-449b对老年原发性肝细胞癌(HCC)患者预后的影响。方法选取2013年1月-2015年1月于徐州医科大学附属医院肿瘤科接受肝癌根治性切除术治疗的老年HCC患者176例。应用实时荧光聚合酶链反应检测miR-449b在患者癌组织中的表达水平,随访患者的生存状况至2020年1月,评估miR-449b对HCC预后的预测值,分析影响老年HCC患者预后的因素。结果176例患者年龄66~82岁,平均(70.3±2.7)岁,其中男性141例、女性35例。截至2020年1月,随访的168例患者中,死亡97例。MiR-449b预测老年HCC患者死亡的临界值为0.36。当miR-449b为0.36时,miR-449b预测老年HCC患者死亡的敏感度为72.23%,特异度为70.38%,曲线下面积为0.712(P=0.001)。Kaplan-Meier和Log-rank检验显示,蔡尔德-皮尤改良(CTP)评分B级(HR=1.17,P<0.001)、肿瘤直径>5 cm(HR=1.13,P<0.001)、淋巴结转移(HR=1.09,P<0.001)和miR-449b低表达(HR=2.54,P<0.001)会增加老年HCC患者的死亡风险。Cox比例风险回归模型显示,CTP评分B级(HR=1.14,P<0.001)、肿瘤直径>5cm(HR=1.11,P<0.001)、淋巴结转移(HR=1.07,P<0.001)和miR-449b低表达(HR=2.48,P<0.001)是老年HCC患者死亡风险增加的独立危险因素。结论MiR-449b表达与老年HCC患者预后相关,miR-449b表达下调可能增加老年HCC患者的死亡风险。     

术前外周血中性粒细胞与淋巴细胞比值在评估肝细胞肝癌根治性切除术后预后中的临床价值

目的探讨术前外周血中性粒细胞/淋巴细胞比值(NLR)在评估肝细胞肝癌(HCC)根治性切除术预后中的临床价值。方法选取2007年1月至2016年1月我院收治的80例HCC患者作为研究对象,所有患者均行根治性切除术治疗,采用回顾性方法分析所有患者的临床及随访资料,记录所有患者术前其NLR值的大小及术后生存情况,采用Cox回归分析探讨NLR对HCC预后预测价值。结果(1)NLR升高组和NLR降低组5年OS分别为47.37%和71.43%(χ~2=4.812,P=0.028),NLR升高组和NLR降低组5年RFS分别为36.84%和59.52%(χ~2=7.020,P=0.008),差异均有统计学意义(P0.05);(2)不同年龄段、肿瘤浸润深度、肿瘤远处转移、肿瘤分期、肿瘤大小、肿瘤分级及肿瘤数目的HCC患者NLR升高比例存在显著差异(P0.05);(3)多因素Cox回归模型分析可得,NLR大于3(HR=1.81,95%CI:1.03~3.17)、肿瘤远处转移(HR=1.70,95%CI:1.09~2.66)、Ⅲ~Ⅳ期(HR=1.66,95%CI:1.05~2.61)及2~3级肿瘤(HR=1.68,95%CI:1.04~2.69)均为影响HCC患者根治治疗预后的独立危险因素(P0.05)。结论 NLR是影响HCC患者根治性手术治疗预后的独立危险因素,随着NLR升高其预后越差,可结合年龄及相关肿瘤情况作为评价临床HCC患者根治术治疗预后的重要指标。     

2q35 rs13387042基因多态性与老年胃癌患者预后的关系

目的研究探讨2q35rs13387042基因多态性与老年胃癌患者预后的关系。方法检测499例胃癌患者石蜡组织DNA上rs13387042基因多态性。采用Kaplan-Meier法、Log-rank检验及Cox回归分析2q35rs13387042基因多态性对胃癌患者预后的影响。结果在显性基因模型中,携带GA/AA基因型的老年胃癌患者比携带GG基因型者可以相对提高7%的死亡率(HR=1.07,95%CI:0.85～1.36,P=0.54)。在肿瘤>5cm患者中,携带GA/AA基因型患者的死亡危险系数是携带GG基因型者的1.15倍。在肿瘤≤5cm中,携带GA/AA基因型患者的死亡危险系数是携带GG基因型者的0.75倍(HR=0.75,95%CI:0.47～1.21,P=0.24)。进一步分层分析显示,无远处转移(HR=0.68,95%CI:0.41～0.93)和肠型胃癌(HR=0.61,95%CI:0.33～0.97)患者的死亡风险显著降低。结论检测肿瘤≤5cm老年胃癌患者的rs13387042基因多态性可能一定程度上有助于对患者预后的判断。     

胆碱激酶α与原发性肝细胞癌预后的关系研究

目的探讨胆碱激酶α(choline kinase alpha,CHKα)的表达对原发性肝细胞癌(hepatocellular carcinoma,HCC)患者预后的影响。方法选取2009年1月至2013年12月在河南科技大学第一附属医院接受根治性切除术治疗的HCC患者312例,应用实时荧光定量聚合酶链反应检测CHKα在HCC癌组织中的表达,并随访其生存状况。CHKα对HCC预后的预测价值采用受试者工作特征曲线(receiver operating characteristic,ROC)进行评估。单因素生存分析采用Kaplan-Meier并Log-rank检验,采用多因素分析Cox回归模型。结果截至2018年12月,312例HCC患者中,失访26例,随访率91.7%。在随访到的286例患者中,死亡177例。CHKα预测HCC死亡的最佳临界点为0.55,当CHKα为0.55时,CHKα预测HCC死亡的灵敏度为74.6%,特异度为83.5%;AUC曲线下面积为0.80。多因素Cox回归模型表明,较大肿瘤(HR=1.08,95%CI:1.03～1.14)、Child-Pugh B级(HR=1.14,95%CI:1.11～1.18)、CHKα低表达(HR=2.26,95%CI:1.92～2.39)是HCC患者死亡风险增加的独立危险因素。结论 CHKα表达是HCC患者预后独立危险因素,CHKα表达下调者预后更差。     

基于SEER数据的原发性小肝癌肝切除术后生存率列线图模型的构建及验证

目的基于SEER数据和中国数据建立并验证原发性小肝癌肝切除术后总生存率列线图模型。方法提取2004年—2015年美国国立癌症研究所SEER数据库所登记的原发性小肝癌接受肝切除术治疗的1809例患者资料作为建模组;收集2010年—2017年在川北医学院附属医院接受肝切除术治疗的小肝癌患者158例为验证组。采用单因素Cox风险回归、lasso回归、多因素Cox风险回归分析小肝癌患者肝切除术后OS的影响因素。根据OS的独立影响因素构建列线图模型,利用一致性指数(C-index)、绘制校准曲线及ROC曲线检验模型的预测能力。利用Kaplan-Meier生存分析和log-rank检验分析高、低风险组间的生存差异。结果多因素Cox风险回归分析发现性别(HR=1.22, 95%CI:1.05～1.41,P=0.010)、Seer分期(HR=1.51,95%CI:1.23～1.85,P<0.001;HR=10.31,95%CI:2.53～42.04,P=0.001)、肿瘤直径(HR=1.22,95%CI:1.06～1.39,P=0.004)、脉管侵犯或转移(HR=1.43,95%CI:1.24～...     

EGFR和K-ras基因表达突变与非小细胞肺癌预后的关联分析

目的探讨EGFR和K-ras基因表达突变与非小细胞肺癌(NSCLC)预后的关系。方法纳入126例NSCLC患者,使用免疫组织化学染色和基因测序检测其肿瘤组织EGFR和K-ras基因的表达突变情况,按NCCN指南对患者进行标准治疗和随访,采用Kaplan-Meier曲线、Log rank检验和Cox比例风险模型分析不同基因表达突变患者的中位生存期、5年总生存率和生存期的影响因素。结果 EGFR基因的阳性表达率为49.21%,突变率为28.57%,K-ras基因的阳性表达率为42.06%,突变率为2.38%;K-ras(+)的中位生存期和5年总生存率均显著低于K-ras(-)患者(χ2=4.348,Log-rank P=0.037),EGFR(突变)的中位生存期和5年总生存率均显著高于EGFR(野生)患者(χ2=11.518,Log-rank P=0.001);双基因阳性(P=0.027,HR=2.584,95%CI:1.113~6.002)和远处转移(P=0.046,HR=2.104,95%CI:1.013~4.369)是影响NSCLC患者生存期的危险因素,使用靶向药物治疗是生存期的保护因素(P0.001,HR=0.293,95%CI:0.149~0.574)。结论 EGFR和K-ras基因的表达突变与NSCLC患者的预后密切相关,双基因阳性可降低患者生存时间,它们是患者个体化用药和预后判断的重要指标。     

肝细胞癌患者肝移植术后复发的危险因素及预后分析

目的探讨肝细胞癌(HCC)患者肝移植术后肿瘤复发和死亡的危险因素,了解患者生存情况。方法选取2005年1月-2019年2月于解放军总医院第五医学中心行肝移植的391例HCC患者。根据肝移植术后HCC是否复发分为HCC复发组(n=78)和无复发组(n=313)。计量资料两组间比较采用t检验或Mann-Whitney U检验;计数资料两组间比较采用χ2检验。利用单因素和多因素Cox比例风险回归模型分析肝移植术后患者HCC复发和死亡的危险因素。应用Kaplan-Meier法分析生存情况,并通过受试者工作特征曲线(ROC曲线)分析肝移植术后肿瘤死亡相关危险因素的预测价值。结果 391例HCC肝移植患者的中位随访时间2年,其中78例(19.95%)患者出现HCC复发。肝移植术后患者肿瘤复发和死亡的独立危险因素包括术前AFP水平 200 ng/ml[风险比(HR)=2.52,95%可信区间(95%CI):1.58～4.03,P 0.001; HR=2.99,95%CI:1.59～5.62,P 0.001]、肿瘤直径总和(HR=1.20,95%CI:1.12～1.28,P 0.001; HR=1.10,95%CI:1.02～1.17,P=0.002)、血管侵犯(HR=1.15,95%CI:1.04～1.26,P=0.016; HR=1.10,95%CI:1.03～1.18,P=0.004)。HCC肝移植患者术后1、5和10年总生存率分别为94.8%、84.2%和83.5%; 1、5和10年无瘤生存率分别为84.0%、75.1%和75.1%。AFP、大血管侵犯、BMI与肿瘤直径总和联合因素对于HCC复发患者死亡有一定的预测价值(ROC曲线下面积为0.789,95%CI:0.719～0.858)。结论肝移植术前肿瘤生物学特征是肝移植术后肿瘤复发的关键因素。     

老年男性人群高血压合并糖耐量减低与全因死亡风险的相关性

目的 探讨高血压合并糖耐量减低(IGT)对老年男性人群全因死亡风险的影响。方法 纳入2005年5月至2007年5月在解放军总医院第二医学中心行口服葡萄糖耐量试验检出的老年男性IGT患者和正常糖耐量(NGT)人群,根据基线时是否存在高血压病史和IGT分为4组:非高血压(NH)+正常糖耐量(NGT)组、高血压(H)+NGT组、NH+IGT组、H+IGT组,每年至少随访1次。采用SPSS 13.0统计软件进行数据分析。采用Cox回归模型分析不同组别全因死亡风险的差异。结果 与NH+NGT组比较,H+IGT组(HR=2.55,95%CI 1.56-4.16; P<0.001)和NH+IGT组(HR=2.40,95%CI 1.35-4.25; P=0.003)2型糖尿病发病风险显著升高。单因素Cox比例风险回归分析提示,与NH+NGT组比较,H+IGT组(HR=2.59,95%CI 1.34-5.01; P=0.005)全因死亡风险明显升高,而H+NGT组和NH+IGT组无统计学差异(P>0.05)。在调整相关危险因素后多因素Cox比例风险回归分析显示,H+IGT组(HR=1.83,95%CI 0.90-3.70; P=0.095)全因死亡风险较NH+NGT组虽无统计学差异(P>0.05),但有升高的趋势。结论 老年男性人群高血压合并IGT与全因死亡风险密切相关,高血压与IGT并存可导致全因死亡风险增加。     

肌肉减少症对接受TACE治疗原发性肝癌患者生存期的影响

目的肌肉减少症(Src)对经导管动脉化疗栓塞术(TACE)预后的影响尚不十分明确,拟评估术前Src与TACE治疗后生存期的影响。方法回顾性分析2014年1月至2018年1月在成都市第六人民医院初次诊断和接受首次TACE治疗的155例原发性肝癌(HCC)患者的资料,依据纳入排除标准筛选其中98例纳入分析。依据术前CT影像计算第三腰椎骨骼肌质量指数,判断Src的存在,分为Src组(60例)和无Src组(38例)。采用Kaplan-Meier生存分析,Log-rank比较Src组和无Src组患者肿瘤无进展生存时间(TTP)和总生存时间(OS)。在Cox比例风险回归模型下进行单因素和多因素分析TACE预后不良的相关危险因子。结果随访观察期间95.92%(94例)患者出现肿瘤进展,88.78%(87例)患者死亡。Src组患者的TTP和OS显著低于无Src组(P<0.0001)。影响TACE预后的独立危险因素包括Src(HR:2.265,95%CI:1.350~3.800;P=0.002)、肿瘤BCLC分级≥C级(HR:1.627,95%CI:1.044~2.534;P=0.031)、ECOG-PS评分≥2分(HR:1.811,95%CI:1.050~3.125;P=0.033)和血AFP>400μg/L(HR:1.867,95%CI:1.198~2.911;P=0.006)。结论61.22%的HCC患者首次接受TACE治疗前已合并Src。Src是TACE治疗总体生存欠佳的独立危险因素,可以作为HCC患者接受TACE治疗预后的预测因子。     

肝动脉介入化疗栓塞术后甲胎蛋白的应答对进展期肝癌预后的影响

目的评价甲胎蛋白(AFP)应答对进展期肝细胞癌(HCC)患者行肝动脉介入化疗栓塞术(TACE)长期预后的影响。方法回顾性分析我院符合巴塞罗那分期B期的165例进展期HCC患者,根据TACE术后AFP是否下降50%分为两组:AFP应答组(n=80)和AFP未应答组(n=85)。采用Kaplan-Meier计算总体生存时间,Log-rank检验评估不同组别患者的生存差异,Cox比例风险模型分析影响总体生存的独立危险因素。结果一般临床资料两组比较差异无统计学意义。AFP应答组的1,3,5年总体生存率为68.9%,46.6%和40.8%,AFP未应答组为45.9%,20%和17.5%,经Log-rank检验,差异有统计学意义(P=0.001)。Cox多因素比例风险模型分析发现,AFP400ng/ml(HR:2.12,P=0.001)、肿瘤直径5cm(HR:3.33,P0.001)、肿瘤数目3(HR:2.06,P=0.001)、以及Child-Pugh B级(HR:1.93,P=0.004)是影响TACE预后独立的危险因素,AFP应答(HR:0.45,P0.001)是TACE术后生存的保护因素。结论连续AFP测量是TACE术后监测治疗反应的有效方法,AFP应答可提高进展期HCC行TACE后的长期生存。     

Cyberknife treatment for advanced or terminal stage hepatocellular carcinoma

AIM: To investigate the safety and efficacy of the Cyberknife treatment for patients with advanced or terminal stage hepatocellular carcinoma(HCC).METHODS: Patients with HCC with extrahepatic metastasis or vascular or bile duct invasion were enrolled between May 2011 and June 2015. The Cyberknife was used to treat each lesion. Treatment response scores were based on Response Evaluation Criteria in Solid Tumors v1.1. The trends of tumor markers,including alpha fetoprotein(AFP) and proteins induced by vitamin K absence Ⅱ(PIVKA Ⅱ) were assessed. Prognostic factors for tumor response and tumor markers were evaluated with Fisher's exact test and a logistic regression model. Survival was evaluated with the Kaplan-Meier method and multivariate analysis was performed using the Cox proportional hazards model.RESULTS: Sixty-five patients with 95 lesions were enrolled. Based on the Barcelona Clinic Liver Cancer classification,all patients were either in the advanced or terminal stage of the disease. The target lesions were as follows: 52 were bone metastasis; 9,lung metastasis; 7,brain metastasis; 9,portal vein invasion;4,hepatic vein invasion; 4,bile duct invasion; and 10 other lesion types. The response rate and disease control rate were 34% and 53%,respectively. None of the clinical factors correlated significantly with tumor response. Fiducial marker implantation was associated with better control of both AFP(HR = 0.152; 95%CI: 0.026-0.887; P = 0.036) and PIVKA Ⅱ(HR = 0.035; 95%CI: 0.003-0.342; P = 0.004). The median survival time was 9 mo(95%CI: 5-15 mo). Terminal stage disease(HR = 9.809; 95%CI: 2.589-37.17,P 0.001) and an AFP of more than 400 ng/m L(HR = 2.548; 95%CI: 1.070-6.068,P = 0.035) were associated with worse survival. A radiation dose higher than 30 Gy(HR = 0.274; 95%CI: 0.093-0.7541,P = 0.012) was associated with better survival. In the 52 cases of bone metastasis,36 patients(69%) achieved pain relief. One patient had cerebral bleeding and another patient had an esophageal ulcer after treatment.CONCLUSION: The Cyberknife can be safely administered to patients with advanced or terminal stage HCC. High AFP levels were associated with worse survival,but a higher radiation dose improved the survival.     

ALK gene copy number gain and its clinical significance in hepatocellular carcinoma

AIM:To examine the status and clinical significance of anaplastic lymphoma kinase(ALK)gene alterations in hepatocellular carcinoma(HCC)patients.METHODS:A total of 213 cases of HCC were examined by fluorescent in situ hybridization using dual color break-apart ALK probes for the detection of chromosomal translocation and gene copy number gain.HCC tissue microarrays were constructed,and the correlation between the ALK status and clinicopathological variables was assessed byχ2test or Fisher’s exact test.Survival analysis was estimated using the Kaplan-Meier approach with a Log-rank test.Univariate and multivariate analyses of clinical variables were performed using the Cox proportional hazards regression model.RESULTS:ALK gene translocation was not observed in any of the HCC cases included in the present study.ALK gene copy number gain(ALK/CNG)(≥4 copies/cell)was detected in 28(13.15%)of the 213 HCC patients.The 3-year progression-free-survival(PFS)rate for ALK/CNG-positive HCC patients was significantly poorer than ALK/CNG-negative patients(27.3%vs 42.5%,P=0.048),especially for patients with advanced stageⅢ/Ⅳ(0%vs 33.5%,P=0.007),and patients with gradeⅢdisease(24.8%vs 49.9%,P=0.023).ALK/CNG-positive HCC patients had a significantly poorer prognosis than ALK/CNG-negative patients in the subgroup that was negative for serum hepatitis B virus DNA,with significantly different 3-year overall survival rates(18.2%vs 63.6%,P=0.021)and PFS rates(18.2%vs 46.9%,P=0.019).Multivariate Cox proportional hazards regression analysis suggested that ALK/CNG prevalence can predict death in HCC(HR=1.596;95%CI:1.008-2.526,P=0.046).CONCLUSION:ALK/CNG,but not translocation of ALK,is present in HCC and may be an unfavorable prognostic predictor.     

High level of intercellular adhesion molecule-1 affects prognosis of patients with hepatocellular carcinoma

AIM: To determine the cut-off value of intercellular adhesion molecule-1 (ICAM-1) and assess the correlation of ICAM-1 with clinicopathological features and the prognosis of hepatocellular carcinoma (HCC) patients who underwent surgical resection.METHODS: We prospectively collected clinicopathological data from 236 HCC patients who had undergone successful hepatectomy. Receiver operating characteristic curve analysis was performed to determine the optimal cut-off value of ICAM-1. Enzyme-linked immunosorbent assay was used to measure the concentration of ICAM-1 in 236 serum samples isolated from HCC patients and the stratified analysis was used to compare the serum level of ICAM-1 in different HCC subgroups. Immunohistochemistry was performed to test the expression level of the ICAM-1 protein in 76 cases of HCC tissues and their adjacent normal liver tissues (ANLT). The survival probability of HCC patients was estimated using Kaplan-Meier plots and differences between the groups were obtained using the log-rank test. Furthermore, independent indicators of the prognosis were acquired using a stepwise Cox proportional hazard model to analyze a series of predictors that were associated with disease-free survival (DFS) and overall survival (OS) in HCC patients.RESULTS: Our findings suggested that ICAM-1 promotes HCC metastasis and high serum ICAM-1 is significantly associated with alpha-fetoprotein (AFP) (P = 0.022), clinical tumor-node-metastasis stage (P < 0.001), portal vein tumor thrombus (P = 0.005), distant metastasis (P = 0.016) and recurrence (P = 0.034). We further detected the ICAM-1 protein in HCC specimens and found that 56 of 76 (73.7%) HCC tissues had ICAM-1 positive staining while only 23 of 76 (30.3%) ANLT were positively stained (P < 0.0001). Survival analysis indicated that HCC patients with increased ICAM-1 concentrations had significantly shorter DFS and OS after resection. A multivariate analysis showed that ICAM-1 > 684 ng/mL was an independent factor for DFS (HR = 1.643; 95%CI: 1.125-2.401; P = 0.010) and OS (HR = 1.692; 95%CI: 1.152-2.486; P = 0.007).CONCLUSION: ICAM-1 may be a promising serological biomarker for HCC diagnosis and an independent predictor of DFS and OS after surgical resection and may provide a useful reference for the prediction of intra- and extrahepatic metastasis.     

Overexpression of lysine specific demethylase 1 predicts worse prognosis in primary hepatocellular carcinoma patients

AIM: To investigate the clinicopathological features and prognostic value of lysine specific demethylase 1 (LSD1) in hepatocellular carcinoma (HCC).METHODS: We examined LSD1 expression in 60 paired liver cancer tissues and adjacent noncancerous tissues by quantitative real time polymerase chain reaction (qRT-PCR) and Western blotting. In addition, we analyzed LSD1 expression in 198 HCC samples by immunohistochemistry. The relationship between LSD1 expression, clinicopathological features and patient survival was investigated.RESULTS: Immunohistochemistry, Western blotting, and qRT-PCR consistently confirmed LSD1 overexpression in HCC tissues compared to adjacent non-neoplastic tissues (P < 0.01). Additionally, immunostaining showed more LSD1-positive cells in the higher tumor stage (T3-4) and tumor grade (G3) than in the lower tumor stage (T1-2, P < 0.001) and tumor grade (G1-2, P < 0.001), respectively. Moreover, HCC patients with high LSD1 expression had significantly lower 5-year overall survival rates (P < 0.001) and lower 5-year disease-free survival rates (P < 0.001), respectively. A Cox proportional hazards model further demonstrated that LSD1 over-expression was an independent predictor of poor prognosis for both 5-year disease-free survival [hazards ratio (HR) = 1.426, 95%CI: 0.672-2.146, P < 0.001] and 5-year overall survival (HR = 2.456, 95%CI: 1.234-3.932, P < 0.001) in HCC.CONCLUSION: Our data suggest for the first time that the overexpression of LSD1 protein in HCC tissues indicates tumor progression and predicts poor prognosis.     

Prediction of hepatocellular carcinoma development by aminotransferase to platelet ratio index in primary biliary cholangitis

AIM To investigate the usefulness of aspartate aminotransferase to platelet ratio index(APRI) in predicting hepatocellular carcinoma(HCC) risk in primary biliary cholangitis(PBC).METHODS We identified PBC patients between 2000 and 2015 by searching the electronic medical database of a tertiary center. The hazard ratio(HR) of HCC with different risk factors was determined by Cox proportional hazards model. RESULTS One hundred and forty-four PBC patients were recru-ited. Patients were diagnosed at a median age of 57.8 years [interquartile range(IQR): 48.7-71.5 years), and 41(28.5%) patients had cirrhosis at baseline. The median follow-up duration was 6.9 years(range: 1.0-26.3 years). Twelve patients developed HCC, with an incidence rate of 10.6 cases per 1000 patient-years. The overall 5-, 10-and 15-year cumulative incidences of HCC were 2.3% 95%CI: 0%-4.8%), 8.4%(95%CI: 1.8%-14.5%) and 21.6%(6.8%-34.1%), respectively. Older age(HR = 1.07), cirrhosis(HR = 4.38) and APRI at 1 year after treatment(APRI-r1) 0.54(HR = 3.94) were independent factors for HCC development. APRI-r1, when combined with treatment response, further stratified HCC risk(log rank P 0.05). The area under receiver operating curve of APRI-r1 in predicting HCC was 0.77(95%CI: 0.64-0.88).CONCLUSION APRI-r1 can be used to predict the development of HCC in PBC patients. Combination of APRI-r1 with treatment response can further stratify the HCC risk.     

磷酸化STAT3蛋白与胃癌患者预后及临床病理特征关系的Meta分析

目的系统评价磷酸化STAT3蛋白(p-STAT3)与胃癌患者预后及临床病理特征的相关性。方法检索从建库至2019年6月在PubMed、Embase、The Cochrance Library、万方、中国知网、维普等数据库公开发表的关于胃癌中p-STAT3蛋白表达与临床意义的研究,根据纳入及排除标准筛选文献,提取相关数据,采用Revman 5.3和Stata 12.0软件进行Meta分析。结果共纳入13篇文献,共1307例胃癌患者。Meta分析结果显示:p-STAT3蛋白高表达与胃癌患者的不良预后有关(HR=2.38,95%CI:1.89~3.01,P<0.00001),其与胃癌分化程度(OR=3.08,95%CI:1.92~4.93,P<0.00001)、TNM分期(OR=2.87,95%CI:1.75~4.71,P<0.0001)、淋巴结转移(OR=2.53,95%CI:1.35~4.73,P=0.004)、远处转移(OR=0.17,95%CI:0.09~0.36,P<0.00001)、浸润深度(OR=2.74,95%CI:1.66~4.53,P<0.0001)具有相关性,而与性别(OR=0.97,95%CI:0.74~1.27,P=0.82)、年龄(OR=0.75,95%CI:0.53~1.06,P=0.10)、肿瘤大小(OR=0.76,95%CI:0.55~1.05,P=0.10)均无相关性。结论p-STAT3蛋白与胃癌患者不良预后及胃癌分化程度、TNM分期、淋巴结转移、远处转移及肿瘤浸润深度密切相关,提示其对胃癌的发展起调控作用,可能作为预测胃癌的一个分子标志物。     

Hepatocellular carcinoma treated by conventional transarterial chemoembolization in field-practice: Serum sodium predicts survival

AIM: To assess the prognostic role of baseline clinical, biochemical and radiological characteristics of patients with hepatocellular carcinoma (HCC) treated with the first transarterial chemoembolization (TACE) procedure.METHODS: Patients with HCC treated with conventional TACE in a tertiary care setting from 1997 to 2008 were retrospectively reviewed. Predictors of survival were identified using the Cox proportional regression model.RESULTS: Two hundred and seventy patients were included. Median age was 66 years, 81% were male, 58% were HCV-positive, 18% hepatitis B surface antigen-positive, 64% had a Child A status, 40% patients had a largest nodule diameter ≥ 5 cm and 32% had more than 3 tumor nodules. Median overall survival of the whole cohort was 25 mo (95%CI: 21.8-28.2) and the 1-, 2- and 3-year probability of survival was 80%, 50% and 31%, respectively. Non-tumor segmental portal vein thrombosis (HR = 1.76, 95%CI: 1.22-2.54), serum sodium (HR = 1.65, 95%CI: 1.25-2.18), diameter of largest nodule (HR = 1.59, 95%CI: 1.22-2.091), number of nodules (HR = 1.41, 95%CI: 1.06-1.88), alpha-fetoprotein (HR = 1.35, 95%CI: 1.03-1.76) and alkaline phosphatase (HR = 1.33, 95%CI: 1.01-1.74) were independent prognostic factors for overall survival on multivariate analysis.CONCLUSION: The inclusion of serum sodium alongside the already known prognostic factors may allow a better prognostic definition of patients with HCC as candidates for conventional TACE.     

超声引导下经皮射频消融治疗小肝癌患者疗效及预后分析*

目的 比较超声引导下经皮射频消融与肝切除术治疗小肝癌患者的疗效及分析影响生存的危险因素。方法 2011年1月~2015年4月在我院接受治疗的107例肝细胞癌（HCC）患者,接受超声引导下射频消融治疗58例,接受肝叶切除术治疗49例。术后随访3年,采用Cox单因素和多因素回归分析影响HCC患者生存的独立危险因素。结果 治疗后,射频消融患者血清ALT水平显著低于肝切除术组（P<0.05）,而血清ALB水平显著高于肝切除术组（P<0.05）;两组术后并发症发生率（10.3%对16.3%）比较,差异无统计学意义（P>0.05）;射频消融治疗患者1 a、2 a和3 a总生存率分别为84.5%（49/58）、65.5%（38/58）和44.8%（26/58）,而肝切除术组则分别为85.7%（42/49）、67.3%（33/49）和46.9%（23/49）,差异不具有统计学意义（x²=0.032,P=0.859;x²=0.040,P=0.842;x²=0.048,P=0.827）; Cox单因素分析结果显示肿瘤数目（HR=0.372,95%CI:0.105~0.876,P=0.033）与HCC患者无瘤生存时间有关,而血清AFP水平（HR=3.043,95%CI:1.007~5.248,P=0.035）、肿瘤数目（HR=0.871,95%CI:0.344~0.902,P=0.401）和肿瘤直径（HR=1.631,95%CI:1.273~3.045,P=0.005）与HCC患者总生存时间有关;Cox多因素回归分析结果显示肿瘤数目多（HR=0.087,95%CI:0.045~0.498,P=0.009）是影响HCC患者无瘤生存的独立危险因素,而肿瘤分化低（HR=2.974,95%CI:1.865~4.097,P=0.046）、肿瘤数目多（HR=0.062,95%CI:0.033~0.378,P=0.002）和肿瘤直径大（HR=2.216,95%CI:1.778~5.026,P=0.007）是影响HCC患者总生存时间的独立危险因素。结论 超声引导下经皮射频消融治疗与肝切除术治疗小肝癌患者的临床疗效相当,但射频消融治疗创伤小,术后恢复快,对肝功能的影响小。