lncRNA-FTX与脑胶质瘤病人预后的相关性分析

目的 探讨长链非编码RNA（lncRNA）FTX表达水平与脑胶质瘤病人预后的相关性。方法 前瞻性收集2016年1月~2018年1月手术切除的脑胶质瘤88例（46例获得瘤旁组织），采用实时逆转录PCR检测lncRNA FTX表达水平，以脑胶质瘤组织lncRNA FTX表达水平均值为界分为高表达组（n=57）和低表达组（n=31）。术后随访3年，主要观察指标为无进展生存期、总生存期。结果 脑胶质瘤组织lncRNA FTX表达水平[（7.54±2.15）]明显高于瘤旁组织[（2.65±0.69）；P<0.001]。多因素Cox比例回归风险模型分析显示，lncRNA FTX高表达是脑胶质瘤生存预后不良的独立危险因素（RR=1.589；95% CI 1.004~2.515；P=0.048）。生存曲线分析显示，高表达组无进展生存期（15.10个月）和总生存期（20.24个月）较低表达组（分别为18.96和25.53个月）明显缩短（P<0.05）。结论 脑胶质瘤lncRNA FTX呈高表达，与病人不良生存预后有关。     

Predictors of survival following surgical resection of limited-stage small cell lung cancer

BackgroundAdjuvant chemotherapy, postoperative radiation (PORT), and prophylactic cranial irradiation (PCI) have been individually examined in limited-stage small cell lung cancer (SCLC). There is a paucity of data on the effectiveness of each adjuvant treatment modality when used in combination after surgical resection of SCLC.MethodsData were collected from 5 cancer centers on all patients with limited-stage SCLC who underwent surgical resection between 1986 and 2019. Univariate and multivariable models were conducted to identify predictors of long-term outcomes, focusing on freedom from recurrence and survival benefit of adjuvant chemotherapy, PORT, and PCI.ResultsA total of 164 patients were analyzed. Multivariable Cox regression analysis did not identify any adjuvant therapies to significantly influence recurrence in this cohort. Specifically, PORT was not associated with a significant influence on locoregional recurrence and PCI was not significantly associated with intracranial outcomes. Adjuvant chemotherapy improved survival in all stage I through III disease (hazard ratio, 0.49; 95% confidence interval, 0.29-0.81; P = .005) and even in pathologically node negative patients (hazard ratio, 0.49; 95% confidence interval, 0.27-0.91; P = .024). Although PCI was found to improve survival in univariate analysis, it was not significant in a multivariable model. PORT was not found to affect survival on either univariate or multivariable analysis.ConclusionsThis is among the largest multi-institutional studies on surgically resected limited-stage SCLC. Our results highlight survival benefit of adjuvant chemotherapy, but did not identify a statistically significant influence from mediastinal PORT or PCI in our cohort. Larger prospective studies are needed to determine the benefit of PORT or PCI in a surgically resected limited-stage SCLC population.     

A propensity score–matched analysis indicates screening for asymptomatic coronary artery disease does not predict cardiac events in kidney transplant recipients

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复发性肝癌再次手术方式的选择:一项基于倾向评分匹配的研究

目的本研究基于倾向评分匹配(PSM)比较挽救性肝移植(sLT)及再次肝切除(RR)的疗效,同时探讨影响复发性肝癌患者预后的危险因素。方法回顾分析2012年1月至2018年8月宁波大学附属李惠利医院124例肝癌切除术后肝内复发再手术的患者,按照再次所行手术方式的不同,分成sLT组(46例)和RR组(78例),通过1∶1倾向评分匹配(PSM),筛选出34例患者用于数据分析,比较匹配前后两组的临床基本资料、总生存期(OS)及无瘤生存期(DFS)来探讨两种手术方式的优劣以及影响患者预后的因素。结果匹配前sLT组的术前血清总胆红素、多发肿瘤的比例、术前行经导管动脉化疗栓塞术(TACE)的比例及符合米兰标准的比例均要高于RR组(P<0.05),最大肿瘤直径sLT组要小于RR组(P<0.05);手术时间、术中出血量、微血管侵犯(MVI)阳性率及术后ClavienⅢ级以上的并发症的比例均要高于RR组(P<0.05)。匹配后sLT组的手术时间、术中出血量、术后并发症ClavienⅢ以上的比例均高于RR组(P<0.05);sLT组的1、3、5年OS与RR组相比差异无统计学意义(P>0.05),sLT组的1、3、5年DFS与RR组相比较优(P<0.05);甲胎蛋白(AFP)≥100μg/L是OS的独立危险因素,手术方式、AFP≥100μg/L是DFS的独立危险因素。结论sLT组术前病情更重,手术时间、术中出血量及术后严重并发症率高于RR组;sLT组较RR组可取得更长的DFS,但对OS来说,两组之间差异无统计学意义。     

Variabilidad del uso intraoperatorio de cristaloides y asociación con los resultados postoperatorios: análisis post hoc de dos estudios prospectivos y multicéntricos de cohortes

BackgroundThe optimal regimen for intravenous administration of intraoperative fluids remains unclear. Our goal was to analyze intraoperative crystalloid volume administration practices and their association with postoperative outcomes.MethodsWe extracted clinical data from two multicenter observational studies including adult patients undergoing colorectal surgery and total hip (THA) and knee arthroplasty (TKA). We analyzed the distribution of intraoperative fluid administration. Regression was performed using a general linear model to determine factors predictive of fluid administration. Patient outcomes and intraoperative crystalloid utilization were summarized for each surgical cohort. Regression models were developed to evaluate associations of high or low intraoperative crystalloid with the likelihood of increased postoperative complications, mainly acute kidney injury (AKI) and hospital length of stay (LOS).Results7,580 patients were included. The average adjusted intraoperative crystalloid infusion rate across all surgeries was to 7.9 (SD 4) mL/kg/h. The regression model strongly favored the type of surgery over other patient predictors. We found that high fluid volume was associated with 40% greater odds ratio (OR 1.40; 95% confidence interval1.01-1.95, p = 0.044) of postoperative complications in patients undergoing THA, while we found no associations for the other types of surgeries, AKI and LOSConclusionsA wide variability was observed in intraoperative crystalloid volume administration; however, this did not affect postoperative outcomes.