Metastatic lymph node size and colorectal cancer prognosis

BACKGROUND: Colorectal cancer patients with lymph node metastasis constitute a heterogeneous population with variable prognoses. In this study, my colleagues and I propose a simpler lymph node (LN) staging system for colorectal cancer. STUDY DESIGN: Four-hundred and twenty-three consecutive colorectal cancer patients were studied. Of these, 36 were excluded because another carcinoma was present. The remaining 387 patients entered the TNM staging analysis. In the survival analysis, 76 patients with distant metastasis were excluded and the remaining 311 patients (LN(-) = 204 and LN(+) = 107) were studied. The diameter of the largest metastatic LN (MLN) was measured on histopathological slides. After examination of various cutpoints and survival outcomes, patients with MLNs were classified into n1 (< or = 9 mm) and n2 (> or = 10 mm) groups, according to size of MLNs (n-stage). RESULTS: Using disease-free survival (DFS) and overall survival (OS) as outcomes, patients were separated into significant prognostic groups by MLN size (univariate, p < 0.0001) (5-year survival, DFS: n0 = 91.5%, n1 = 62.2%, and n2 = 34.4%; OS: n0 = 85.1%, n1 = 63.5%, and n2 = 42.5%) and International Union Against Cancer/American Joint Committee on Cancer (UICC/AJCC) (N-stage) (univariate, p < 0.0001) (5-year survival, DFS: N0 = 91.5%, N1 = 60.5%, and N2 = 36.8%; OS: N0 = 85.1%, N1 = 65.3%, and N2 = 38.0%). But in patients with fewer than 15 LNs examined (n = 31), only the new nodal stage stratified patients into significant groups (OS: p = 0.003 and DFS: p = 0.001). Only the UICC/AJCC N-stage subcategories were further split into significant prognostic groups by MLN size (UICC/AJCC N1: DFS, p = 0.048 and OS, p = 0.11; N2: DFS, p = 0.04 and OS, p = 0.04). n-stage was an independent important factor both in the DFS and OS in multivariable analysis. CONCLUSIONS: MLN size is a strong prognostic variable in colorectal carcinoma. This new metric may help clinicians treating colorectal cancer patients, but additional studies are required before clinical application.     

Clinical node-negative thick melanoma

BACKGROUND: Patients with T4 N0 M0 melanoma are considered at high risk for having occult metastases, and adjuvant therapy is usually recommended. HYPOTHESIS: Long-term survival in patients with thick melanoma is not universally poor. DESIGN: A retrospective study. SETTING: University teaching hospital. PATIENTS: We evaluated clinical node-negative thick (> or = l4.0 mm) melanoma in 151 patients who received their primary definitive surgical treatment in our department. None of these patients received any adjuvant therapy. RESULTS: Median follow-up was 44 months; median thickness, 5.5 mm. Median overall (OS) and disease-free survivals (DFS) were 70 (5-year survival, 52%) and 51 months (5-year survival, 47%), respectively. Patients with node-positive disease faired significantly worse than did those with node-negative disease. Median OS and DFS for patients with node-positive disease were 49 and 32 months (5-year survival, 35%), respectively, compared with 209 (5-year survival, 61%) and 165 months (5-year survival, 56%), respectively, for patients with node-negative disease. Similarly, OS and DFS were significantly lower when the primary tumor had at least 5 mitoses/mm(2) or was located in the head and neck region. After multivariate analysis, status of the lymph nodes was the most predictive variable for OS and DFS. CONCLUSIONS: The thickness of melanoma, by itself, should not be used as a criterion for adjuvant therapy. Other prognostic factors should be considered.     

Does Postoperative Complication Have a Negative Impact on Long-Term Outcomes Following Hepatic Resection for Colorectal Liver Metastasis?: A Meta-Analysis

Background

The negative impact of postoperative complications (POCs) on long-term outcomes is well documented for several cancer surgeries, but conclusive evidence has yet to be provided on the influence of POCs on long-term oncological outcomes after hepatic resection for colorectal liver metastasis (CRLM).

Methods

Studies published through February 2012 evaluating the oncological impact of POCs after hepatectomy for CRLM were identified by an electronic literature search. Finally, 4 studies were identified and included in the meta-analysis. The main outcome measures were 5-year disease-free survival (DFS) and overall survival (OS). A meta-analysis was performed using the DerSimonian-Laird random-effects models to compute odds ratio (OR) along with 95 % confidence intervals (95 % CI).

Results

The outcomes of 2,280 patients were studied. Meta-analysis of 5-year DFS data extracted from three studies demonstrated a significant reduction in 5-year DFS after POCs, with an OR of 1.98 (95 % CI = 1.33–2.96; P = .0008). Meta-analysis of 5-year OS data extracted from four studies demonstrated a significant reduction in 5-year OS after POCs, with an OR of 1.68 (95 % CI = 1.25–2.27; P = .0006). No differences between study heterogeneity were observed in either the DFS or the OS analyses.

Conclusions

This study provides persuasive evidence that POCs following hepatic resection for CRLM have significant adverse oncological outcomes. These findings emphasize the need for meticulous surgical technique and careful perioperative management to minimize POCs.     

Prognostic Comparison Between Number and Distribution of Lymph Node Metastases in Patients with Right-Sided Colon Cancer

Background

Lymph node metastasis is the most important prognostic indicator for colon cancer patients. We compared the prognostic significance of the number of lymph node metastases (LNN) and the distribution of lymph node metastases (LND).

Methods

A total of 187 patients underwent curative resection for stage III right-sided colon cancer between 2000 and 2010. We evaluated the oncologic outcomes according to LNN (N1 1–3, N2 4–6, N3 >6) and LND (LND1 metastases in pericolic nodes, LND2 metastases along the major vessels, N3 metastases around the origin of a main artery). A Cox proportional hazards model, with backward stepwise analysis was used to determine the effects of covariates on 5-year, disease-free survival (DFS) and 5-year overall survival (OS). Akaike’s information criterion (AIC), and Harrell’s concordance index (C-index) were compared for each developed model.

Results

During the median follow-up of 42.2 months, 5-year DFS and OS were 68 and 79.3 %, respectively. Multivariate analysis showed that both LNN and LND3 were independent prognostic factor for both 5-year DFS and OS. However, the prognostic model incorporating number of LNM was more precise than that of LND, with a lower AIC (5-year DFS, 554.2 vs. 566.9; 5-year OS, 318.1 vs. 337.9) and higher C-index (5-year DFS, 0.706 vs. 0.667; 5-year OS, 0.778 vs. 0.743).

Conclusions

Our results show that the staging system incorporating LNN predicted prognosis better than LND.     

Predictive value of renal tumor contour irregularity score in pathological T3a upstaging of clinical T1 renal cell carcinoma: A multi-institutional study

PurposeTo explore the predictive value of renal tumor contour irregular degree (CID) in pathological T3a upstaging of clinical T1 renal cell carcinoma (RCC).Materials and methodsWe performed a retrospective multi-institutional review of 1,487 patients with clinical T1N0M0 RCC between January 2009 and June 2019. Kaplan-Meier survival curve and Cox regressions were used to analyze the prognostic factors of disease-free survival (DFS). Logistic regressions were performed to determine predictors of pathological T3a upstaging in clinical T1 RCC.ResultsAmong 1,487 patients with cT1 RCC, 96 (6.5%) were pathological T3a upstaging. Multivariable logistic regression analysis showed that age (odds ratio [OR] = 1.022, 95% confidence interval [CI] = 1.001–1.042, P = 0.036), tumor maximum diameter(OR = 1.242, 95% CI = 1.042-–1.480, P = 0.015) and CID (OR = 1.067, 95% CI = 1.051–1.083, P < 0.001) were independent predictors of pathological T3a upstaging. The area under the curve (AUC) of the prediction model that included the CID was 0.846, while the AUC of the prediction model that did not include CID was only 0.741, the difference was statistically significant (P < 0.001). Kaplan-Meier survival curve showed that patients with pathological T3a upstaging had significantly worse DFS than patients without pathological T3a upstaging (P < 0.001). Multivariable Cox analysis showed that pathological T3a upstaging (HR = 1.836, 95% CI = 1.013–3.329, P = 0.002) is an independent prognostic factor for DFS in patients with cT1N0M0 RCC.ConclusionsThe predictive model of CID combined with tumor maximum diameter and age significantly improved the ability to predict pathological T3a upstaging in clinical T1 RCC, compared with the prediction model of tumor maximum diameter combined with age. The predictive model of CID combined with tumor maximum diameter and age may be applicable to patients considering partial vs. radical nephrectomy.     

Relationship between insulin-like growth factor II and prognosis of colorectal cancer

OBJECTIVE: To investigate the relationship between insulin-like growth factor II (IGF-II) and prognosis of colorectal cancer. METHODS: One hundred and forty-two colorectal cancer patients were enrolled. In colonoscopic biopsy specimens, the expression of IGF-II and PCNA were detected immunohistochemically, while TUNEL technique was used to detect apoptosis. All patients were followed up, and disease-free survival (DFS) and overall survival (OS) rate were calculated. RESULTS: The expression level of IGF-II was significantly higher in colorectal cancer than in normal colorectal mucosa. A correlation was observed between more IGF-II expression, high PCNA labeling index, and apoptotic index was demonstrated. Patients with lower expression level of IGF-II had higher DFS and OS. Multivariate analysis by means of the Cox proportional-hazards model revealed that the expression level of IGF-II was an independent prognostic predictor in colorectal cancer patients. CONCLUSION: The expression level of IGF-II is a new prognostic predictor for colorectal cancer.     

The metastatic/examined lymph node ratio is an important prognostic factor after pancreaticoduodenectomy for pancreatic adenocarcinoma

Survival after curative resection for pancreatic adenocarcinoma remains poor; an important prognostic factor is lymph node (LN) status. Recent reports have established the number of LN examined as a separate prognostic factor in many malignancies. We retrospectively reviewed the charts of 128 patients undergoing pancreaticoduodenectomy (PD) for pancreatic cancer and obtained information such as overall survival (OS), disease-free survival (DFS), tumor characteristics, preoperative carbohydrate antigen (CA) 19-9, sex, and age. The ratio of metastatic to examined LN (LNR) was determined, and OS and DFS were analyzed in relation to the three groups: LNR = 0, LNR < 0.15, and LNR > 0.15. The median number of LN collected was 17. There were 46 N0 patients (median = 12) and 83 N1 patients (median = 19). The number of LN harvested had no impact on OS or DFS in the N0 or N1 patient populations. When LNR was examined as a continuous variable, it had a borderline impact on OS (P = 0.068). Examination of LNR by three groups showed an impact on OS (P = 0.037) and DFS (P = 0.013). After curative PD for pancreatic cancer, the ratio of metastatic to examined lymph nodes is an important prognostic factor and should be evaluated in stratification schemes for future clinical trials investigating adjuvant treatments.     

Long-term follow-up in the treatment of peritoneal carcinomatosis

Background

The objective of this study was to report a long-term survival analysis of a phase II protocol of cytoreductive surgery (CS) and heated intraperitoneal chemotherapy (HIPEC) in the treatment of peritoneal carcinomatosis (PCs).

Methods

Between 2000 and 2008, 101 consecutive patients were treated with CS, HIPEC and early postoperative intraperitoneal chemotherapy using a standardized protocol. Disease recurrence and mortality data were collected prospectively. Primary outcomes were median, 3-year, and 5-year disease-free survival (DFS) and overall survival (OS).

Results

The median age was 49 years (range, 18–77 years), and the majority (82%) had complete CS with no gross residual cancer. Tumor types included appendiceal (n = 58), colorectal (n = 31), and other (n = 12). Median follow-up was 28 months (range, 0–119 months), with minimum of 24 months among survivors. For appendiceal tumors, median DFS was 34 months (range, 0–119 months) and OS has not yet been defined. Three-year and 5-year DFS was 48% and 42%, respectively, and 3-year and 5-year OS was 76% and 62%, respectively. For colorectal carcinomatosis, median disease-free and OS was 9 months (range, 0–87 months) and 27 months (range, 0–87 months), respectively. Three-year and 5-year DFS was 34% and 26%, respectively, and 3-year and 5-year OS was 38% and 34%, respectively.

Conclusions

Long-term survival with regional treatment of PC from appendiceal or colorectal primary tumors with CS and HIPEC is achievable.     

Is hepatic resection justified for non-colorectal non-neuroendocrine liver metastases? A systematic review and meta-analysis

BackgroundHepatic resection (HR) is effective for colorectal or neuroendocrine liver metastases. However, the role of HR for non-colorectal non-neuroendocrine liver metastases (NCNNLM) is unknown. This study aims to perform a systematic review and meta-analysis on long-term clinical outcomes after HR for NCNNLM.Methodselectronic search was performed to identify relevant publications using PRISMA and MOOSE guidelines. Primary outcomes were 3- and 5-year overall survival (OS) and disease-free survival (DFS). Secondary outcomes were post-operative morbidity and 30-day mortality.ResultsThere were 40 selected studies involving 5696 patients with NCNNLM undergone HR. Pooled data analyses showed that the 3- and 5-year OS were 40% (95% CI 0.35–0.46) and 32% (95% CI 0.29–0.36), whereas the 3- and 5-year DFS were 28% (95% CI 0.21–0.36) and 24% (95% CI 0.20–0.30), respectively. The postoperative morbidity rate was 28%, while the 30-day mortality was 2%. Subgroup analysis on HR for gastric cancer liver metastasis revealed the 3-year and 5-year OS of 39% and 25%, respectively.ConclusionsHR for NCNNLM may achieve satisfactory survival outcome in selected patients with low morbidities and mortalities. However, more concrete evidence from prospective study is warrant in future.     

The prognostic importance of immunohistochemically detected node metastases in resected esophageal adenocarcinoma

Background

The number or ratio of lymph node metastases detected by hematoxylin & eosin (H&E) staining is the most important predictor of survival in esophageal cancer. The survival effect of lymph node metastases detected on immunohistochemistry (IHC) is controversial. My colleagues and I hypothesized that the extent of nodal disease determined by both H&E and IHC examination would more accurately predict survival than either technique alone.

Methods

The study population consisted of 37 patients who underwent en bloc esophagectomy as primary therapy for esophageal adenocarcinoma 5 or more years ago. All had mediastinal and upper abdominal lymphadenectomy. No patient received neoadjuvant or adjuvant therapy. Tissue blocks were sectioned for H&E staining to confirm the initial histology, and a second slide was stained with monoclonal antibodies AE1 and CAM 5.2, which are directed at a number of cytokeratin antigens. The slides were reviewed by an investigator blinded to clinical outcome. The effect of IHC staining on prognosis was assessed by comparing 5-year survival based on H&E and IHC findings.

Results

A total of 1,970 nodes were examined in the 37 patients. Routine H&E staining detected metastases in 29 patients (78%); the remaining 8 with N0 disease all survived at least 5 years after operation (median not reached). In the 29 patients with N1 disease, survival was 41% at 5 years. In 20 of the 29 N1 patients, metastases were detected by H&E in less than 10% of the nodes removed; 55% of the patients survived 5 years, and 39% survived 8 years. Nine of the 29 patients had metastases detected in more than 10% of the nodes removed, and all died at a median of 17 months. IHC staining was performed on the nodes from the 8 N0 patients and the 20 patients with less than 10% nodal involvement (a total of 28 patients). Additional nodal metastases, not identified on H&E examination, were found in 51 nodes from 17 patients (60.7%). Of the 8 patients who were node negative on H&E examination, 3 had metastases detected by IHC, and all survived 5 years or more free of disease. Of the 20 patients with less than 10% nodal metastases on H&E, 14 (70%) had additional metastases detected by IHC (median, 2 nodes per patient). When combined with the results of H&E staining, the node ratio remained less than 10% in 13 patients and exceeded 10% in 7. Survival in patients whose ratio remained less than 10% was significantly better than in those whose ratio exceeded 10% (actual 5-year survival, 77% vs 14%; χ² = 4.662; p = 0.03).

Conclusions

IHC staining techniques can identify nodal metastases missed by routine H&E examination in a large number of patients. The combination of H&E and IHC examination is useful in patients with less than 10% nodal involvement by H&E examination in that IHC detection of micrometastases allows classification into low-risk (> 75% survival) and high-risk (< 15% survival) groups. IHC-detected micrometastases are not of prognostic importance in N0 patients or those with greater than 10% nodal metastases on H&E.     

Impact and Outcomes of Routine Microstaging of Sentinel Lymph Nodes in Breast Cancer: Significance of the pN0(i+) and pN1mi Categories

Background  In 2003, the American Joint Committee on Cancer (AJCC) initiated the 6th edition staging criteria, including pN0(i+) and pN1mi categories for breast cancer. However, the clinical significance of these categories is debated in the literature. Methods  A prospective registry was used to identify patients staged with sentinel lymph node (SLN) biopsy. SLN evaluation included routine serial sectioning and immunohistochemical stains. SLN biopsies performed before January 2003 were restaged according to the AJCC’s 6th edition criteria. Results  Of 954 SLN biopsies identified, on review, 491 N0i-, 86 N0i+, 73 N1mi, 146 N1a, 29 N2a, and 11 N3a patients were available for analysis with a median follow-up of 45.4 months. Significant prognostic and therapeutic differences existed between the groups. Differences in overall survival (OS) and recurrence-free survival (RFS) were only noted when the size of the metastases reached the N1a level. There were no statistically significant differences in OS or RFS between N0(i−) and N0(i+) or N1mi disease. Cases that were N0(i+) or N1mi were more likely to have other poor prognostic factors and to receive more aggressive therapy. Conclusion  SLN biopsy allows a more sensitive evaluation of lymph nodes for metastatic cells. This has led to the increased identification of very small axillary metastases. While the new microstaging categories are not yet clearly associated with a significantly decreased OS or DFS in this series, they are associated with other poor prognostic factors and more local/regional and systemic therapy. Further analysis of the microstaging categories is needed.     

Clinicopathological Characteristics and Survival Analysis of 87 Male Breast Cancer Cases

BACKGROUND: The aim of this study was to investigate the clinicopathologic characteristics, therapy methods, and prognosis of male breast cancer. PATIENTS AND METHODS: We retrospectively analyzed the clinicopathological characteristics, recurrence or metastasis, and survival information of 87 male breast cancer patients. Statistical analysis included the Kaplan-Meier method to analyze survivals, log-rank to compare curves between groups, and Cox regression for multivariate prognostic analysis. A p value of <0.05 was considered statistically significant. RESULTS: 5-year disease free survival (DFS) and 5-year overall survival (OS) were 66.3 and 77.0%, respectively. Monofactorial analysis showed tumor size, stage, lymph node involvement, and adjuvant chemotherapy to be prognostic factors with regard to 5-year DFS and 5-year OS. Multivariate Cox regression analysis showed tumor size, stage, and adjuvant chemotherapy to be independent prognostic factors with regard to 5-year DFS and 5-year OS. CONCLUSION: Male breast cancer has a lower incidence rate and poor prognosis. Invasive ductal carcinoma is the main pathologic type. Operation-based combined therapy is the standard care for these patients. Tumor size, stage, and adjuvant chemotherapy are independent prognostic factors. More emphasis should be placed on early diagnosis and early therapy, and adjuvant chemotherapy may improve survival.     

IHC和RT-PCR法对检测胃癌区域淋巴结微转移的价值及其意义

目的 探讨免疫组织化学方法(IHC)和逆转录聚合酶链反应(RT-PCR)两种方法对检测胃癌区域淋巴结微转移的临床价值及意义.方法 对85例胃癌根治性手术切除的淋巴结转移患者的临床资料进行了回顾性分析.共切取淋巴结1835枚,每例平均切除21.7枚.采用IHC和RT-PCR法检测细胞角蛋白20(CK20)的表达,研究淋巴结微转移与临床病理参数和预后的关系.结果 患者的淋巴结转移率经IHC法和RT-PCR法检测从HE染色的75.3%分别上升为83.5%和90.6%.经IHC和RT-PCR法检测重新分期率分别为18.8%和37.6%.淋巴结微转移的发生与肿瘤大小、部位无关·与肿瘤Lauren分型和浸润深度密切相关.82例完成随访,平均随访时间为21.2个月.微转移与预后无明显关系.结论 IHC和RT-PCR法是检测胃癌淋巴结微转移的有效手段,能准确判断临未分期,可为制定治疗方案提供依据.     

Prognostic nutritional index and prognosis in renal cell carcinoma: A systematic review and meta-analysis

PurposeTo perform a systematic review and meta-analysis of the Prognostic Nutritional Index (PNI) as a prognostic factor for renal cell carcinoma (RCC).Materials and methodsEligible studies that evaluated the prognostic impact of pretreatment PNI in RCC patients were identified by comprehensive searching the electronic databases PubMed, Cochrane Central Search library, and EMBASE. The end points were overall/cancer-specific survival (OS/CSS) and recurrence-free/disease-free survival (RFS/DFS). Meta-analysis using random-effects models was performed to calculate hazard ratios (HRs) with 95 % confidence intervals (CIs).ResultsIn total, 9 retrospective, observational, case-control studies involving 5,976 patients were included for final analysis. Eight studies evaluated OS/CSS, and 5 evaluated RFS/DFS. Our results showed that lower PNI was significantly associated with unfavorable OS/CSS (HR = 1.68, 95% CI 1.44-1.96, P < 0.001, I² = 9.2%, P = 0.359) and RFS/DFS (HR = 1.98, 95% CI 1.57-2.50, P < 0.001, I² = 18.2%, P = 0.299) in patients with RCC. Subgroup and meta-regression analysis based on ethnicity, study sample size, presence of metastasis, PNI cut-off value, Newcastle–Ottawa quality assessment scale (NOS) score, and gender ratio all showed that lower PNI was associated with poorer OS/CSS and RFS/DFS. Funnel plots and Egger's tests indicated significant publication bias in OS/CSS (P = 0.001), but not in RFS/DFS (P = 0.757).ConclusionThis meta-analysis indicated that lower PNI was a negative prognostic factor and associated with tumor progression and poorer survival of patients with RCC. Therefore, PNI could be a potential prognostic predictor of treatment outcomes for patients with RCC.     

癌结节对结直肠癌肝转移同期切除术预后的影响

目的探讨癌结节对初始可切除同时性结直肠癌肝转移患者同期切除术预后的影响。 方法回顾性分析2003年7月至2015年7月复旦大学附属中山医院行同期切除的212例同时性结直肠癌肝转移患者资料,分析癌结节和临床病理因素的相关性,采用Kaplan-Meier生存分析和Cox回归模型分析癌结节对预后的影响。 结果癌结节的阳性率为43.9%（93/212）,癌结节和肿瘤分化、淋巴结转移、血管浸润和神经浸润显著相关（P=0.044、0.001、0.035、<0.001）,是低DFS的独立预后因素。癌结节阳性患者的OS和DFS明显低于癌结节阴性患者,差异有统计学意义（P=0.003、<0.001）。淋巴结阳性的135例患者中,癌结节阳性和阴性患者的OS比较,差异无统计学意义（P=0.608）,癌结节阳性患者DFS更低（P=0.003）;在淋巴结阴性的77例患者中,癌结节阳性患者的OS和DFS均显著低于癌结节阴性患者（P<0.001、0.010）。 结论对于结直肠癌肝转移同期切除术后患者,癌结节和肿瘤分化、淋巴结转移以及神经浸润显著相关,且预示不良预后。     

Value of Preoperative Inflammation-Based Prognostic Scores in Predicting Overall Survival and Disease-Free Survival in Patients with Gastric Cancer

Background

This study was designed to identify which are the best preoperative inflammation-based prognostic scores in terms of overall survival (OS) and disease-free survival (DFS) in patients with gastric cancer.

Methods

Between January 2004 and January 2013, 102 consecutive patients underwent resection for gastric cancer at S. Andrea Hospital, "La Sapienza", University of Rome. Their records were retrospectively reviewed.

Results

After a median follow up of 40.8 months (8–107 months), patients’ 1-, 3-, and 5-year OS rates were 88, 72, and 59 %, respectively. After R0 resection, the 1-, 3-, and 5-year DFS rates were 93, 74, and 56 %, respectively. A multivariate analysis of the significant variables showed that only the modified Glasgow prognostic scores (p < 0.001) and PI (p < 0.001) were independently associated with OS. Regarding DFS, multivariate analysis of the significant variables showed that the modified Glasgow prognostic score (p = 0.002) and prognostic index (p < 0.001) were independently associated with DFS.

Conclusions

The results of this study show that modified Glasgow prognostic score and prognostic index are independent predictors of OS and DFS in patients with gastric cancer.     

HER2/neu表达对乳腺癌术后应用CMF化疗病人预后的影响

目的：研究HER2/neu癌基因在乳腺癌组织中的表达，探讨其对接受手术及CMF（环磷酰胺、氨甲碟呤和氟脲嘧啶）辅助化疗病人预后的影响。方法：选择1995年至2001年间112例接受手术和术后行CMF化疗的乳腺癌病人的组织标本，用免疫组织化学方法检测原发肿瘤HER2/neu蛋白及雌孕激素受体的表达，结合临床病理资料并分析其与5年生存率的关系。结果：本组乳腺癌组织中HER2/neu的过度表达率为21．4％（n=24）。经随访13～104月，整体病人的5年无病生存率为85．3％，5年总体生存率为91．1％。HER2／neu过度表达者的5年无病生存率为43．2％，而HER2/neu表达缺失者为71％（P=0．01）。HER2/neu过度表达者的5年总体生存率为49．2％，而HER2/neu表达缺失者为83.3％（P=0．02）。同时，生存率亦与肿瘤大小和孕激素受体密切相关。结论：乳腺癌组织中HER2/neu蛋白的过度表达与接受手术及术后CMF化疗病人的预后密切相关，可以作为预测其复发及转移的重要指标。     

The role of postoperative radiotherapy in non-small cell lung cancer; a retrospective analysis of our experience

Sixty-one patients with completely resected non-small cell lung cancer followed by postoperative radiotherapy were retrospectively reviewed. Forty-six patients were male and 15 were female. Ages ranged 34-79 (median 64) years. Squamous cell carcinoma (scc) in 28, adenoca. in 31, large cell ca in 1 and adenoid cystic ca. in 1. Pathological stage was IIA in 1, IIB in 9, IIIA in 41 and IIIB in 10. Over-all 5-year survival rate (OS) was 56.0%, and 5-year disease-free survival rate (DFS) was 39.7%. For IIB, IIIA, IIIB patients, OS were 77.8%, 55.4%, 24.0% respectively. According to purpose of radiotherapy, patients divided into 3 types as local invasion (LI) group (T3-4N0-1, n = 12), lymphnode metastases (LN) group (T1-2N2-3, n = 38) and both advanced (BA) group (T3-4N2-3, n = 8). OS were 71.6%, 50.7%, 46.9% and DFS were 68.6%, 31.0%, 42.9% respectively. In LN group, half of patients with scc had no relapse, but about half of non-scc had distant metastases. All N2 patients divided 2 types as single-station N2 and multi-station N2. OS were 71.8%, 40.0% and DFS were 53.5%, 21.1% respectively. DFS was significantly different (p = 0.04). The advantage was remarkable in patients with scc-single-station N2 (OS was 88.9%, DFS was 77.8%). The effectiveness of postoperative radiotherapy is not showed, but our results suggest the possibility for existence of subgroup benefited from postoperative radiotherapy.     

Disease-free survival as a surrogate for overall survival in upper tract urothelial carcinoma

Objectives

The primary endpoint in trials of perioperative systemic therapy for urothelial carcinoma is 5-year overall survival (OS). A shorter-term endpoint could significantly speed the translation of advances into practice. We hypothesized that disease-free survival (DFS) could be a surrogate endpoint for OS in upper tract urothelial carcinoma (UTUC) patients treated with radical nephroureterectomy (RNU).

Patients and methods

The study included 2,492 patients treated with RNU with curative intent for UTUC.

Results

2/3-year DFS estimates were 78/73 %, and the 5-year OS estimate was 64 %. The overall agreements between 2- and 3-year DFS with 5-year OS were 85 and 87 %, respectively. Agreements were similar when analyzed in subgroups stratified by pathological stages, lymph node status, and adjuvant chemotherapy. The kappa statistic was 0.59 (95 % CI 0.55–0.63) for 2-year DFS/5-year OS and 0.64 (95 % CI 0.61–0.68) for 3-year DFS/5-year OS, indicating moderate reliability. The hazard ratio for DFS as a time-dependent variable for predicting OS was 11.5 (95 % CI 9.1–14.4), indicating a strong relationship between DFS and OS.

Conclusions

In patients treated with RNU for UTUC, DFS and OS are highly correlated, regardless of tumor stage and adjuvant chemotherapy. While significant differences in DFS, assessed at 2 and 3 years, are highly likely to persist in OS at 5 years, marginal DFS advantages may not translate into OS benefit. External validation is necessary before accepting DFS as an appropriate surrogate endpoint for clinical trials investigating advanced UTUC patients.     

不同中国肝癌分期肝癌根治性切除术后的临床效果及预后因素分析

目的探讨不同中国肝癌分期(CNLC)肝癌接受根治性切除术后的临床效果及长期生存的预后因素。方法回顾性分析2010年1月至2019年12月南京医科大学第一附属医院肝胆中心单一治疗组收治的行肝癌根治术的549例肝细胞癌(HCC)患者的临床病理学资料。男性462例(84.2%),女性87例(15.8%);中位年龄57岁(范围:21~84岁)。观察患者的术前变量、术中及术后情况、术后病理学检查结果等。采用门诊与电话相结合的方式进行随访。采用寿命表法进行生存率的估计,采用Kaplan-Meier法绘制总体生存和无瘤生存曲线,采用Log-rank检验比较不同组别生存过程的差异,采用多因素Cox回归模型分析影响预后的主要因素。结果 549例HCC患者中,CNLC Ⅰa期200例(36.4%),CNLC Ⅰb 期148例(27.0%),CNLC Ⅱa期49例(8.9%),CNLC Ⅱb期32 例(5.8%),CNLC Ⅲa期101例(18.4%),CNLC Ⅲb期19例(3.5%)。患者1、3、5、10年总体生存率分别为83.8%、69.0%、54.2%、37.7%,1、3、5年无瘤生存率分别为61.0%、44.2%、36.0%。CNLC Ⅰa期患者的1、3、5年总体生存率和无瘤生存率分别为97.3%、90.6%、80.5%和83.9%、65.0%、54.0%;CNLC Ⅰb期患者的1、3、5年总体生存率和无瘤生存率分别为87.9%、71.0%、47.7%和58.4%、42.3%、33.4%;CNLC Ⅱa和Ⅱb期患者的5年总体生存率(Ⅱa期:37.2%,Ⅱb期:44.3%)与CNLC Ⅰb期类似。CNLC Ⅲb期患者 1、3、5年总体生存率和无瘤生存率分别为35.3%、13.2%、0和23.5%、0、0。单因素分析结果显示,术前合并症状、术前甲胎蛋白水平、术前总蛋白水平、术前AST水平、术前总胆红素水平、术中出血量、术中或术后输血、术后并发症、肿瘤最大径和数目、微血管侵犯、大血管侵犯、肿瘤分化程度是HCC患者长期生存(≥5年)的预后因素(P值均<0.05)。多因素分析结果显示,术前AST水平、术中出血量、肿瘤数目、肿瘤最大径、大血管侵犯和肿瘤分级是HCC患者长期生存的独立预后因素(P值均<0.05)。结论不同CNLC的HCC患者具有不同的复发模式及预后。经过严格术前评估的CNLC Ⅱa~Ⅲb期HCC患者可从外科根治切除术中获得生存获益。术前AST水平、术中出血量、肿瘤数目、肿瘤最大径、大血管侵犯和肿瘤分化程度是影响HCC患者长期生存的独立预后因素。