卵巢颗粒-间质细胞恶性肿瘤的预后相关因素分析

目的分析卵巢颗粒-间质细胞恶性肿瘤的预后相关因素,并探讨其最佳治疗方案。方法回顾性研究41例卵巢颗粒-间质细胞恶性肿瘤患者的临床资料,其手术切除的标本由病理科医师测量肿瘤的大小,并经免疫组织化学染色计数肿瘤细胞的核分裂相及观察其分化程度。采用logrank单因素分析和Cox多因素比例风险模型分析各种发病因素与生存率的关系,采用Kaplan-Meier作出生存率曲线图。结果随访545～4791 d,中位数随访时间为2270．8 d。5年生存率为92．5％,10年生存率87．8％。核分裂指数和肿瘤体积与生存率呈正相关(P值均<0．05)。肿瘤分期、细胞分化程度、手术方式和术后化疗与生存率不相关(P值均>0．05)。结论核分裂指数和肿瘤体积是卵巢颗粒-间质细胞恶性肿瘤有价值的预后因素,而术后化疗并不改善患者的预后。     

儿童双表型白血病的临床特征及预后分析

目的分析儿童双免疫表型白血病的临床及生物学特征，评价儿童急性白血病双免疫表型与治疗相关因素及预后的临床重要性。方法自1998年1月1日至2003年5月31日进入XH 99治疗方案的所有新诊治的急性白血病(AL)患儿，诊断采用MICM分型诊断，治疗分别按AML XH 99、ALL XH 99危险度分类标准进行分层治疗。用流式细胞仪进行免疫表型分析，根据免疫表型结果将患儿分为4组，伴有/无髄系相关抗原表达的急性淋巴细胞白血病(My+ALL/My-ALL)以及伴有/无淋系相关抗原表达的急性髓系白血病(Ly+AML/Ly-AML)。生存分析采用Kaplan Meier方法；生存率之间的比较采用log rank检验；临床及生物学特征与治疗相关因素的分析采用χ2检验或Fisher精确概率法(双尾)。结果①174例提供免疫分型的ALL患儿中，My+ALL患儿34例，占19.54%，其与My-ALL组患儿除在B ALL组患儿达缓解时间有统计学差异外(P<0.05)，其它临床、生物学特征及治疗反应均无统计学差异(P>0.05)；两组患儿5年无事件生存(EFS)率分别为\[(61.76±8.33)%与(68.03±5.55)%\],log rank检验两组患儿5年EFS率无统计学差异(P=0.0526)。②74例提供免疫分型结果的AML患儿中，Ly+AML患儿18例，占24.32%，其与Ly-AML组患儿临床、生物学特征及治疗反应无统计学差异(P>0.05)；两组患儿5年EFS率分别为\[(39.82±13.59)%与(51.29±9.70)%\],log rank检验两组患儿5年EFS率无统计学差异(P=0.3164)。结论双免疫表型对儿童白血病预后无明显影响，可用同样现行的化疗方案治疗这部分患儿。     

Prognostic factors in maxillary sinus and nasal cavity carcinoma

AIMS: The aim of the present study is to define prognostic factors, particularly the impact of treatment on paranasal sinus and nasal cavity malignancies. MATERIAL AND METHODS: Retrospective study of patients with maxillary antrum and nasal fossae malignancies. A maxillectomy classification as performed to treat malignancies in our institution is described. Multivariate analysis of prognostic factors was done using the Cox's model. RESULTS: One hundred and nine patients were evaluated. Squamous cell carcinoma was found in 62 cases and in 95 patients the epicentre of the tumour was located in the maxillary antrum. Ten patients were treated with surgery only, 39 patients with surgery and adjuvant radiation therapy, 37 cases received only radiotherapy, and 18 received radiotherapy followed by surgery; in five cases a combination of chemo-radiotherapy was used. Multivariate analysis identified T classification, orbit invasion, N classification, site of origin of tumour in nasal fossae, and no surgical resection as independent prognostic factors (p=0.0001). CONCLUSION: T4 tumours with orbit invasion present bad prognosis as compared to other T4 tumours. Surgical resection should be included in the treatment strategy. Because of the high frequency of lymph-node metastasis, neck treatment should be considered in T4 tumours.     

Correlation of Pathologic Complete Response with Survival After Neoadjuvant Chemotherapy in Bladder Cancer Treated with Cystectomy: A Meta-analysis

ContextNeoadjuvant chemotherapy before radical cystectomy (RC) is the preferred initial option for muscle-invasive bladder cancer (BCa). As in rectal and breast cancer, pathologic downstaging is associated with increased overall survival (OS).ObjectiveWe conducted a meta-analysis to determine whether pathologic complete response (pCR) (pT0N0M0) after neoadjuvant chemotherapy is associated with a better outcome in muscle-invasive BCa.Evidence acquisitionA systematic search was conducted in PubMed, Web of Science, Cochrane Collaboration's Central register of controlled trials, and Embase for publications reporting outcomes of patients with and without pCR. All patients underwent neoadjuvant cisplatin-based polychemotherapy and RC. The primary outcome reported as relative risk (RR) was OS. Secondary end points were recurrence-free survival (RFS) and cancer-specific survival other than distant and locoregional RFS. A meta-analysis was performed using the fixed effects model or random effects model. Overall heterogeneity for RFS and OS was assessed with forest plots and the Q test.Evidence synthesisA total of 13 trials were included, for a total of 886 patients analysed after neoadjuvant chemotherapy and RC, without any postoperative treatment. The pCR rate was 28.6%. Patients who achieved pCR in the primary tumour and the lymph nodes presented an RR for OS of 0.45 (95% confidence interval [CI], 0.36–0.56; p < 0.00001). The number needed to treat to prevent 1 death was 3.7 (absolute risk difference: −26%). The summary RR for RFS was 0.19 (95% CI, 0.09–0.39; p < 0.00001).ConclusionsPatients with BCa who achieved pCR (pT0N0M0 stage) after neoadjuvant chemotherapy have a better OS and RFS than do patients without pCR.     

Recurrent retroperitoneal sarcomas: Clinical outcomes of surgical treatment and prognostic factors

Background and purposeLocoregional recurrence after resection of primary retroperitoneal sarcoma (RPS) is a challenging therapeutic issue. The objective of this study was to identify clinicopathological factors predictive of overall survival (OS) and disease specific survival (DSS) after reoperation for recurrent RPS.Patients and methodsWe retrospectively collected data from the medical records of 800 patients who underwent resection for sarcoma at our Institution, from 1983 to 2015. Among these patients, 120 were treated for retroperitoneal sarcoma and 55 had a locoregional recurrence (LR). Four of them did not undergo surgery and thus were excluded from this study leaving 51 cases available for data analysis. Univariate and multivariate survival analyses were performed to identify prognostic factors.ResultsMedian overall survival was 33 months. The 1-year, 3-year and 5-year OS rates were 75.5%, 47.1% and 31.6% respectively. Multivariate Cox regression analysis suggested that extension of surgery (P = 0.026), surgical margin status (P = 0.015) and histological grade of recurrent tumor (P = 0.047) were independent prognostic factors for OS. Median DSS was 48 months. The 1-year, 3-year and 5-year DSS rates were 79.2%, 53.1% and 40.9%, respectively. At multivariate analysis, predictors of DSS were extension of surgery (P = 0.004), margin status (P = 0.011), histological grade of recurrent tumor (P = 0.008), and disease free interval (DFI) (P = 0.020). As regards histological subtype of recurrent RPS, at univariate analysis, well-differentiated liposarcoma (WDLS) was associated with better OS and DSS (P = 0.052 and P = 0.016 respectively) compared to dedifferentiated liposarcoma (DDLS).ConclusionsAccording to our findings, surgery is more beneficial in patients with low-grade sarcoma, WDLS and long DFI. The achievement of clear resection margins, rather than performing a multivisceral resection, appears to be a key factor to improve OS and DSS.     

Monitoring of human cytomegalovirus DNAemia during primary infection in transmitter and non-transmitter mothers

Background and objectivesIt has been reported that maternal DNAemia is detectable in three quarters of pregnant women with acute/recent primary HCMV infections, with a higher median number of HCMV DNA copies/ml blood in transmitter as compared with non-transmitter mothers.Study designThe kinetics of HCMV DNA in blood of transmitter vs non-transmitter pregnant women with primary HCMV infection was retrospectively analyzed from their first blood sampling at referral up to amniocentesis strictly performed at 19–21 weeks’ gestation. Monthly monitoring of maternal HCMV DNAemia was performed up to prenatal diagnosis.ResultsHCMV DNAemia was determined in 154 pregnant women. At amniocentesis, HCMV DNA in blood was positive in 42/50 (84.0%) amniotic fluid (AF) −positive and 21/104 (20.2%) AF-negative mothers (p < 0.0001). The number of HCMV DNA copies/ml blood was not significantly different in AF-positive as compared with AF-negative mothers in the interval 0–30 days post-infection (p = 0.14). On the contrary, HCMV DNA load at 30–60 days (p = 0.03) and at 60–90 days (p < 0.001) after onset of infection was significantly different, as observed at amniocentesis (p < 0.001). Three patterns (clearance, delayed decrease, and increasing) in both transmitter and non-transmitter mothers were observed. However, 79.8% AF- negative mothers cleared HCMV DNA in blood, while in AF-positive mothers increasing (44.0%) or persisting (40.0%) levels of DNAemia were observed.ConclusionsThe presence of viral DNA in maternal blood at amniocentesis is statistically associated with fetal HCMV infection. Increasing or persisting levels of maternal DNAemia during primary HCMV infection in pregnancy correlate with HCMV transmission to the fetus.     

The increasing clinical relevance of human papillomavirus type 16 (HPV-16) infection in oropharyngeal cancer

Human papillomavirus type 16 (HPV-16) has been established beyond doubt as a causative agent in oropharyngeal squamous cell carcinoma (SCC). The incidence of oropharyngeal cancer has risen in recent decades, as has the proportion of patients who have a biologically relevant HPV-16 infection. Combined data from 14 recently published studies (2006-2010) show that 57% of 1316 reported cases of oropharyngeal SCC were HPV-16 positive. They had significantly better prognosis (hazard ratio (HR) for 5-year overall survival range 0.05-0.64), although smoking and higher T stage often appear as confounding factors to this favourable prognostic benefit. HPV-16 therefore has increasing importance as a clinically useful prognostic biomarker, but a benefit in survival has been seen in the use of surgery, radiotherapy, and chemotherapy, so specific changes in the preferred methods of treatment are hard to justify. Future trials that include oropharyngeal SCC will consider HPV-16 routinely as a stratification factor, and its use as a predictive biomarker awaits the development of effective targeted treatments. The undeniable and impressive prognostic significance of HPV-16 should hasten its addition to standard pathological reporting of oropharyngeal SCC, and ultimately to its inclusion in TNM staging systems of the American Joint Committee on Cancer (AJCC) and the International Union against Cancer (UICC).