胃癌淋巴结转移相关危险因素及其临床预测价值分析

背景与目的:淋巴结转移与胃癌患者预后之间密切关联,且淋巴结转移与否及淋巴结转移程度对患者治疗方案的选择至关重要,但目前术前淋巴结转移预测方法仍有一定局限性。本研究旨在探讨胃癌患者淋巴结转移现象的相关危险因素,为术前预测淋巴结转移提供一定途径。方法:回顾2014年1月-2015年4月收治的380例胃癌患者的临床与随访资料,分析淋巴结转移与患者相关临床病理因素的关系,从中寻找出胃癌淋巴结转移危险因素,并进一步用ROC曲线分析危险因素对胃癌淋巴结转移的预测能力,用Kaplan-Meier法分析危险因素对患者预后的影响。结果:380例患者中,241例(63.42%)发生淋巴结转移。单因素分析结果显示,BMI、肿瘤浸润深度、分化程度、Lauren’s分型、肿瘤直径以及肿瘤标志物CA125与胃癌淋巴结转移明显有关(均P<0.05);多因素分析结果显示,BMI(OR=4.175,P=0.041)和肿瘤浸润深度(OR=16.444,P<0.000 1)是胃癌淋巴结转移的独立危险因素;相关性分析结果显示,淋巴结转移阳性率与BMI值呈明显正相关(r=1.95,P=0.007)。BMI(以24 kg/m^2为临界值)与肿瘤浸润深度分级(以T4期为标准)预测是否有淋巴结转移的敏感度均为63.16%,特异度分别为76.84%、53.68%;两者联合应用特异度增高至88.36%,ROC曲线下面积达75.76%。生存分析结果显示,高BMI值患者的3年总生存率明显低于低BMI值患者(51.09% vs.53.13%,P<0.05)。结论:BMI与肿瘤浸润深度是胃癌患者淋巴结转移的独立危险因素,患者BMI值越高淋巴结转移的可能性越大,结合肿瘤浸润深度情况分析,对术前预测淋巴结转移有一定的临床实用价值。     

The clinic factors in evaluating long-term outcomes of patients with stage I colorectal cancer

BackgroundThis study aimed to explore the survival and recurrences of stage I colorectal cancer (CRC) patients. Through the analysis of the results of preoperative serological values, we seek to find factors associated with the survival and recurrence of patients with stage I CRC.MethodsWe retrospectively enrolled patients from 2012 January to 2015 April. Survival rates were calculated with the Kaplan–Meier method and survival curves were compared using the log-rank test. The independent prognostic factors were assessed by the Cox proportional hazard regression analysis.ResultsA total of 476 patients with stage I disease were included to analysis. Median follow-up was 68 months (4–84 months) for OS. The OS rates were related to age,CEA, CHOL, LDL-C levels,HBDH, WBC, NLR, LMR, LWR, PNI, SII, NPS and CONUT at univariate analysis. At multivariate analysis, age, WBC and SII were confirmed to be independent prognostic factors for OS. The median DFS was 68 months (2–84 months). In this period, 38 (8.0%) experienced tumor relapse, and 17 (44.7%) died due to recurrence. The DFS rates were related to higher CEA, higher NLR values and lower LMR values at univariate analysis. At multivariate analysis, just elevated CEA levels was confirmed to be independent prognostic factors.ConclusionsPatients with stage I colorectal cancers still have a clinically significant risk of recurrence. We still need to expand the number of cases to validate our findings and better identify patients who are at high risk of relapse with less severe disease.     

Do clinicians convey what they intend? Lay interpretation of verbal risk labels used in decision encounters

ObjectiveTo assess the numerical probabilities that individuals associate with frequently-used verbal labels relating to treatment outcomes and their association with medical context, age, gender, educational level, health literacy, and numeracy.MethodsVerbal labels (N = 11) were extracted from N = 90 audiotaped decision encounters in oncology. Three hundred Dutch adults, as proxies for newly-diagnosed cancer patients, assigned numerical probabilities to the labels in the context of cancer recurrence or nausea, and completed questions on their socio-demographic characteristics, health literacy and numeracy.ResultsWe found considerable variation in how individuals interpreted the verbal labels. Participants’ probability estimates of verbal labels was lower in the context of (the more serious) cancer recurrence compared to (less serious) nausea. Lower numerate participants differentiated less between labels. There was no association between participants’ estimates and age, gender, educational level or health literacy.ConclusionThere is considerable variation in how individuals interpret verbal labels frequently-used in decision encounters. Individuals seem to take base rates and severity of outcomes into account. Verbal labels may be less helpful to lower numerate individuals.Practice implicationsTo minimize misinterpretation and to improve patient-clinician decision making about health and care, we recommend to avoid the use of verbal labels only.     

持续性非卧床腹膜透析患者腹膜炎发生的危险因素分析

目的探讨非卧床腹膜透析患者腹膜炎发生的危险因素。方法选取我院2017年1月至2018年12月收治的慢性肾衰竭持续性非卧床腹膜透析患者260例作为研究对象,采用一般情况调查问卷收集患者信息,统计记录腹膜炎发生情况,采用多因素logistic回归分析确定腹膜炎发生的影响因素。结果 260例患者中发生腹膜炎的73例,占28. 08%;多因素logistic回归分析显示腹膜炎发生的独立危险因素有高龄、低文化水平、合并糖尿病、透析时长、总蛋白(TP)水平下降、血钙(Ca)水平下降。结论我院慢性肾衰竭持续性非卧床腹膜透析患者相关性腹膜炎发生率为28. 08%,腹膜炎发生独立危险因素为高龄、低文化水平、伴有糖尿病、透析时间长、总蛋白水平下降、血钙水平下降,结合危险因素制定防范干预措施非常重要。