系统免疫炎症指数与胃癌患者预后关系的Meta分析

背景与目的 系统性免疫炎症指数（SII）一种新的炎症和预后标志物,但其与胃癌患者预后之间的关系仍有争议。因此,本研究通过系统评价和Meta分析评估SII与胃癌患者预后的关系,以为临床决策提供循证医学证据。方法 检索PubMed、EMBASE、Web of Science、Cochrane Library数据库,收集SII与胃癌患者预后关系的队列研究,检索时间均为建库至2020年7月28日。由2名研究者独立筛选文献、提取资料并评价纳入文献的偏倚风险,采用Stata 12.0件进行数据分析。结果 共纳入12项回顾性队列研究,包括7 244例患者。Meta分析结果显示,较高水平SII的胃癌患者总生存期（OS）与无病生存期（DFS）/无复发生存期（RFS）均缩短（HR=1.28,95% CI=1.16~1.41,P<0.001;HR=1.34,95% CI=1.06~1.70,P=0.013）。根据国家、治疗方案、样本量进行的亚组分析结果显示,较高水平SII均与OS缩短有关（均P<0.05）。SII达临界值600或以上时,较高水平SII与OS缩短有关（HR=1.56,95% CI=1.34~1.80,P<0.001）,但SII在临界值600以下时,SII与OS无明显关系（P>0.05）。研究时间≥6年时,较高水平SII与OS缩短有关（HR=1.65,95% CI=1.21~2.25,P<0.001）,但研究时间<6年时,SII与OS无明显关系（P>0.05）。此外,较高水平SII患者的TNM分期晚（OR=2.45,95% CI=1.75~3.44,P<0.001）、淋巴结转移风险高（OR=1.72,95% CI=1.27~2.32,P<0.001）、肿瘤体积大（OR=2.45,95% CI=1.75~3.44,P<0.001）、分化程度较差（OR=2.45,95% CI=1.75~3.44,P<0.001）。结论 SII可作为胃癌患者的预后标志物,较高水平SII的胃癌患者可能预后不良。受所纳入的研究数量与质量限制,上述结论尚待更多高质量研究予以验证。     

胃癌根治术联合SOX方案辅助化疗治疗进展期胃癌的疗效与安全性

背景与目的 胃癌根治术后辅助化疗对延长患者术后生存时间方面具有一定的效果,但采用常用的化疗方案仍有相当一部分患者疗效欠佳,且毒副反应明显。有研究认为奥沙利铂+替吉奥组成的SOX方案可明显降低化疗毒副作用,故本研究探讨进展期胃癌患者根治性手术后采用SOX方案行辅助性化疗的效果与安全性。方法 选择2015年1月—2017年12月马鞍山市人民医院收治的72例进展期胃癌患者为观察对象,采用前瞻性随机研究方法,依据随机数字表法分为对照组与试验组,每组36例,均接受根治性手术治疗;对照组患者采用多西他赛、顺铂、5-氟尿嘧啶（DCF方案辅助化疗）,试验组给予SOX辅助化疗方案（奥沙利铂+替吉奥）辅助性化疗。对比两组患者血清肿瘤标记物水平、毒副反应、无进展生存率、总生存率及生存时间。结果 在化疗前,试验组和对照组的血清CA125、CA19-9、CA72-4水平差异无统计学意义（均P>0.05）;化疗后,两组患者的血清CA125、CA19-9、CA72-4水平较化疗前均降低（均P<0.05）,且试验组的血清CA125、CA19-9、CA72-4水平低于对照组（均P<0.05）;在化疗前,试验组和对照组的KPS评分差异无统计学意义（P>0.05）;化疗后,两组患者的KPS评分较化疗前均升高（均P<0.05）,且试验组的KPS评分高于对照组（P<0.05）;试验组和对照组在化疗中的白细胞减少、血小板减少、腹泻、外周神经毒性、肝肾功能损害程度差异无统计学意义（均P>0.05）;试验组的恶心呕吐程度低于对照组（P<0.05）;试验组和对照组的3年无进展生存率、3年总生存率差异无统计学意义（均P>0.05）;试验组的无进展生存时间（18.0个月）高于对照组（12.0个月）（P<0.05）;试验组的总生存时间（21.0个月）与对照组（17.0个月）比较,差异无统计学意义（P>0.05）。结论 进展期胃癌患者根治性手术后采用SOX方案行辅助性化疗较DCF方案更有利于改善患者的肿瘤标记物水平及KPS评分,并能延长无进展时间。     

机器人辅助胃癌根治术后腹腔感染的危险因素及预后分析

背景与目的 腹腔感染是胃癌根治术后常见的并发症,但目前有关机器人辅助胃癌根治术后发生腹腔感染的影响因素及相关预后研究报道较少。本研究旨在分析和探讨机器人辅助胃癌根治术后发生腹腔感染的危险因素及预后,以期为临床提供参考。方法 回顾甘肃省人民医院普外一科2017年1月—2021年3月行机器人辅助胃癌根治术的262例胃癌患者临床资料,分析患者术后腹腔感染的发生情况及其影响因素,以及术后腹腔感染对患者治疗结局与预后的影响。结果 在262例患者中,14例（5.34%）术后发生腹腔感染,感染原因分别为腹腔脓肿12例（4.58%）、横结肠瘘1例（0.38%）、胰瘘1例（0.38%）;Clavien-Dindo分级包括II级9例（3.44%）,IIIa级4例（1.53%）,IIIb级1例（0.38%）。单因素分析结果显示,体质量指数（BMI）、术前白蛋白、术前贫血、肿瘤直径、术中联合脏器切除、术中出血量、pTNM分期、N分期、肿瘤淋巴血管侵犯、神经侵犯和术后第3天中性粒细胞百分比（NEUT%）与机器人辅助胃癌根治术后发生腹腔感染有关（均P<0.05）;多因素Logistic回归分析结果表明,BMI<18.5 kg/m²（OR=11.160,95% CI=2.289~54.410,P=0.003）、术前白蛋白<30 g/L（OR=6.612,95% CI=1.630~26.820,P=0.008）、术中联合脏器切除（OR=5.236,95% CI=1.068~25.661,P=0.041）、肿瘤淋巴血管侵犯（OR=8.151,95% CI=1.771~37.52,P=0.007）和术后第3天NEUT%（OR=1.208,95% CI=1.069~1.366,P=0.003）是机器人辅助胃癌根治术后患者发生腹腔感染的独立危险因素。对术后第1、3、7天NEUT%行ROC曲线分析,结果表明,术后第3天NEUT%诊断术后腹腔感染的AUC（0.805）最大,其最佳截断值为82.65%,敏感度为71.4%,特异度为84.7%。与无术后腹腔感染的患者比较,有感染患者术后首次通气时间、首次进流食时间、术后1~7 d腹腔引流量、腹腔引流管拔除时间、术后住院时间及住院总费用均明显增加（均P<0.05）。生存分析结果显示,术后腹腔感染患者的总生存率低于无腹腔感染患者（45.4% vs. 67.8%,P=0.046）。结论 对于有以上危险因素的患者,在行机器人辅助胃癌根治术后要积极预防腹腔感染的发生,从而促进患者术后恢复、改善患者术后生存。术后第3天NEUT%对于预测机器人辅助胃癌根治术后腹腔感染有一定的价值。     

肝切除联合血管切除重建治疗肝内胆管癌并血管侵犯疗效与安全性的多中心回顾性研究

背景与目的 在过去,大血管（门静脉、下腔静脉等）侵犯被认为是肝内胆管癌（ICC）根治性切除的禁忌证,随着手术技术的进步,目前肝切除联合血管切除重建的安全性逐渐被认可,但其疗效如何尚无定论。因此,本研究通过国内多中心数据探讨ICC并血管侵犯患者肝切除联合血管切除重建的安全性和疗效,以及术后辅助治疗的价值。方法 回顾性收集2010年1月—2021年6月国内12家三甲医院收治的1 040例行根治性切除术的ICC患者临床病理资料,包括未发生血管侵犯872例,血管侵犯168例（其中行联合血管切除重建35例,行常规ICC根治术未行血管切除133例）。分析全组及不同类型患者的总生存（OS）时间;在血管侵犯的患者中,分析血管切除重建对患者的主要临床指标与OS时间的影响,以及术后辅助治疗对患者OS时间的影响。结果 全组患者中位OS时间为18（9.4~30.6）个月,无血管侵犯患者中位OS时间为18.51（10~32）个月,血管侵犯患者中,未血管切除患者中位OS时间为16.3（9.4~28）个月,血管切除患者中位OS时间为10（5.5~21.6）个月。生存分析结果显示,血管侵犯患者无论是否行血管切除,OS时间均低于无血管侵犯患者（均P<0.05）,血管切除重建对血管侵犯患者的OS无明显改善作用（P=0.662）;两两1∶1倾向评分匹配后分析显示,血管侵犯患者无论是否行血管切除,中位OS时间均低于无血管侵犯患者,但差异无统计学意义（无血管侵犯vs.血管切除：26个月vs. 21.8个月,P=0.087;无血管侵犯vs.未血管切除：27个月vs. 16个月,P=0.068）,血管切除重建对血管侵犯患者的OS无明显改善作用（P=0.293）。在血管侵犯的患者中,血管切除重建患者手术时间及术后住院时间均长于未血管切除患者（均P<0.05）,而术后并发症等其他临床指标均无明显差异（均P>0.05）;同种类型血管侵犯患者的亚组分析结果显示,血管切除重建对不同类型的血管侵犯患者的OS均无改善作用（均P>0.05）;无论是否行血管切除重建,术后辅助治疗对患者的OS均有一定的改善作用,但差异均无统计学意义（均P>0.05）。结论 血管侵犯是ICC患者预后的危险因素,血管切除重建不能明显改善患者预后,且可能增加患者手术时间及术后住院时间。对血管侵犯是ICC患者术后进行辅助治疗可能有助于改善预后。     

意外胆囊癌二次术后早期复发的危险因素及辅助化疗疗效分析

背景与目的 术后早期复发是胆囊癌预后不良的重要危险因素，越来越多的证据表明辅助化疗可以改善患者的预后。但目前有关意外胆囊癌（IGBC）二次术后早期复发及辅助化疗对患者预后的影响尚未见报道。因此，本文探讨IGBC二次术后早期复发的危险因素及分析辅助化疗对于早期复发和非早期复发患者的疗效，以为临床提供决策支持。方法 回顾性收集2011年1月—2021年12月于西安交通大学第一附属医院肝胆外科因IGBC行意向性根治术的170例患者的临床病理资料，分析患者术后早期复发的影响因素（早期复发定义为二次意向根治术后12个月内），以及患者术后无复发生存（RFS）与总体生存（OS）的影响因素。结果 170例行IGBC意向性根治术后患者，随访期间复发者73例（42.94%）、早期复发者41例（24.12%）。IGBC术后早期复发患者中位OS时间明显短于非早期复发患者（χ²=192.910，P<0.001）。病理分化程度（OR=20.758，95% CI=5.557~80.239）、CA19-9水平（OR=7.920，95% CI=1.557~39.771）及病灶残留（OR=8.050，95% CI=3.062~21.160）是IGBC术后早期复发的独立危险因素（均P<0.05）。病理分化程度（HR=6.160，95% CI=2.877~13.193）、CA19-9水平（HR=2.538，95% CI=1.297~4.965）、手术切除范围（HR=2.111，95% CI=1.154~3.860）、病灶残留（HR=2.571，95% CI=1.547~4.273）是IGBC术后RFS时间的独立危险因素（均P<0.05）。病理分化程度（HR=3.225，95% CI=1.461~7.121）、早期复发（HR=29.558，95% CI=14.250~61.311）、病灶残留（HR=2.416，95% CI=1.361~4.287）是IGBC术后OS时间的独立危险因素（均P<0.05），辅助化疗是术后OS时间的独立保护性因素（HR=0.260，95% CI=0.123~0.551，P<0.05）。按有无病灶残留及是否早期复发分层分析的结果显示，辅助化疗可延长病灶残留患者术后RFS时间及OS时间，亦可延长早期复发患者术后OS时间（均P<0.05）。结论 病灶残留是IGBC二次术后早期复发及预后的独立危险因素，术后辅助化疗可以有效改善病灶残留及早期复发患者的预后。     

胃癌患者预后相关影响因素的列线图模型构建及验证

背景与目的 中国胃癌疾病负担较重且预后影响因素较多,有关量化和综合评估预后风险的研究较少。因此,本研究基于列线图探究炎症指标中性粒细胞/淋巴细胞比率（NLR）和血小板/淋巴细胞比率（PLR）对胃癌患者预后生存的意义,并将其纳入列线图与传统TNM分期进行预后评估效能比较。方法 回顾性纳入2013年6月—2018年6月在中国科学技术大学第一附属医院胃肠外科接受胃癌根治切除术的胃癌患者作为训练组（n=300）,同时从胃肠外科另一病区纳入接受相同手术处理的胃癌患者作为验证组（n=100）。通过医院电子病历系统采集患者的年龄、性别、肿瘤类型、肿瘤部位、侵袭深度和淋巴结转移（LNM）等信息;术前3 d收集外周静脉血数据,并计算NLR和PLR,通过ROC曲线确定NLR（1.98）和PLR（134.87）的最佳临界点。术后2年内每3个月随访1次,2年后每6个月随访1次。采用Cox比例风险模型计算暴露与结局指标的关联,根据多因素分析结果识别影响胃癌预后的独立风险因素,纳入列线图后通过C-指数在训练组和验证组评估列线图的稳定性。最后,基于ROC曲线下面积（AUC）比较列线图和传统TNM分期的预测效能。结果 训练组男性患者220例（73.3%）,验证组男性患者69例（69.0%）,训练组平均年龄（62.52±10.61）岁,验证组平均年龄（63.67±10.21）岁。两组除肿瘤类型、分化程度和侵袭深度外,其他基线特征差异无统计学意义;训练组中位生存时间（OS）为28个月,1、3、5年OS率分别为63.5%、43.0%和35.1%;验证组中位OS为32个月,1、3、5年OS率分别为58.9%、41.6%和31.7%。单因素Cox回归分析显示,年龄、病理分型、肿瘤分化程度、侵袭深度、存在LNM、NLR、PLR和CEA水平均与OS有关（均P<0.05）。经过多因素调整后,存在LNM、术前NLR>1.98、PLR>134.87和癌胚抗原（CEA）≥5 μg/L的患者OS显著缩短（均P<0.01）。校准曲线结果显示列线图模型在训练组（C-指数=0.81）和验证组（C-指数=0.75）的拟合度良好。此外,列线图模型预测训练组1、3、5年OS率的AUC值（0.865,0.855,0.827）高于TNM分期（0.677,0.690,0.683）;验证组1、3、5年OS率的AUC值（0.856,0.788,0.725）高于TNM分期（0.781,0.691,0.605）。结论 NLR和PLR是预测胃癌患者术后生存的独立风险因素,基于两者构建的列线图可以较为准确地预测行胃切除术胃癌患者的1、3、5年OS率,为临床医师提供更精确的治疗、护理决策证据。     

胆囊神经内分泌癌临床特征及诊治分析：附3例报告并文献回顾

背景与目的 胆囊原发性神经内分泌癌（GB-NEC）极为罕见且预后差,由于GB-NEC病例非常少见,目前少有系统总结其临床特征的研究。因此,本研究对扬州大学附属兴化市人民医院收治的GB-NEC病例及近20年中文献报道的GB-NEC病例进行总结分析,以期提高对该病的认识。方法 回顾收治的3例GB-NEC患者资料,并收集2000年1月—2020年12月间文献报道的121例GB-NEC病例的相关资料,分析患者的基本临床特征、预后因素及治疗结局。结果 收治的3例患者均因腹痛等非特异性症状就诊,3例均行手术治疗,术后病理与免疫组化证实均为GB-NEC（1例意外胆囊癌）。3例均行术后辅助化疗,中短期随访期间2例死亡,1例存活。124例GB-NEC患者的中位年龄为58岁,其中女性占62.9%（78/124）;72.1%（44/61）为小细胞癌,32.5%（29/84）为混合型神经内分泌癌。中位生存时间在全组患者中为11个月,在不同临床分期患者中随着临床分期增加而缩短。将49例有完整资料的患者纳入分析,结果显示,年龄>80岁（HR=1.364,95% CI=1.026~1.860,P=0.049）、TNM分期（II期vs. I期：HR=10.408,95% CI=2.554~42.404,P=0.001;III期vs. I期：HR=13.167,95% CI=3.288~52.732,P<0.001;IV期vs. I期：HR=38.022,95% CI=9.738~148.459,P<0.001）、手术（非根治术vs.未手术：HR=0.122,95% CI=0.022~0.786,P=0.027;根治术vs.未手术：HR=0.088,95% CI=0.019~0.481,P=0.006）、化疗与否（HR=0.517,95% CI=0.305~0.983,P=0.042）是生存结局的独立影响因素。糖类抗原125（CA125）水平的升高与更晚的临床分期相关（r=0.727,P<0.05）。亚组分析中,术式（胆囊切除术vs.根治术：HR=2.889,95% CI=0.908~9.168,P=0.072）、化疗与否（HR=3.120,95% CI=0.768~12.676,P=0.112）对于I、II期患者的结局影响差异无统计学意义。术式（胆囊+转移灶切除术vs.根治术：HR=0.675,95% CI=0.113~4.023,P=0.667）和化疗与否（HR=2.109,95% CI=0.808~5.994,P=0.127）对III期患者结局的影响无统计学意义。IV期患者行化疗有生存优势（HR=2.785,95% CI=1.376~5.636,P=0.004）,主要体现在小细胞癌患者（中位值生存时间：9个月vs. 3个月,P<0.001）,而对大细胞癌患者效果不显著（中位值生存时间：5个月vs. 2个月,P=0.247）;手术不能改善IV期患者预后（根治术vs.未手术：HR=0.533,95% CI=0.232~1.233,P=0.138;非根治术vs.未手术：HR=0.932,95% CI=0.434~2.000,P=0.856）。结论 提高早期诊断率是改善GB-NEC患者预后的关键。I~III期患者可行手术切除,但胆囊癌根治术是不必要的;晚期小细胞癌患者行化疗可以帮助提高生存率以及手术切除可能。CA125可能作为GB-NEC的预后指标,但需要更多的研究证明。     

不同病理学类型的腹膜后脂肪肉瘤患者的预后分析及临床评价

背景与目的 腹膜后脂肪肉瘤是一种罕见的软组织肉瘤,其发病率低,预后差,治疗手段有限,不同病理学类型之间患者的预后差异较大,缺少针对该类患者的大样本临床研究证据,临床个体化治疗方案制定困难。本研究旨在探讨不同病理学类型腹膜后脂肪肉瘤患者预后的影响因素,并分别探讨手术、放射、化疗在他们中的应用价值。方法 从SEER数据库提取1975—2016年期间经病理学确诊且有完整随访记录的腹膜后脂肪肉瘤患者资料,根据纳入和排除标准严格筛选病例,依据ICD-O-3分为高分化脂肪肉瘤、去分化脂肪肉瘤、黏液样/圆细胞脂肪肉瘤、多形性脂肪肉瘤、混合脂肪肉瘤5类,比较不同病理学类型患者间肿瘤特异生存（CSS）和总生存（OS）的差异,并分析患者CSS与OS的影响因素。结果 共纳入2 296例腹膜后脂肪肉瘤患者,其中,高分化脂肪肉瘤917例,去分化脂肪肉瘤847例,黏液样/圆细胞脂肪肉瘤302例,多形性脂肪肉瘤135例,混合脂肪肉瘤95例。中位随访42个月（IQR：13~90个月）。估算的5年OS分别为高分化脂肪肉瘤74.99%（95% CI=71.65%~78.01%）、去分化脂肪肉瘤42.83%（95% CI=38.87%~46.73%）、黏液样/圆细胞脂肪肉瘤50.13%（95% CI=47.02%~58.86%）、多形性脂肪肉瘤34.69%（95% CI=26.39%~43.11%）、混合脂肪肉瘤57.67%（95% CI=46.43%~67.37%）,Log-rank检验显示,组间差异有统计学意义（χ²=211.54,P<0.000 1）。估算的5年CSS分别为高分化脂肪肉瘤87.98%（95% CI=85.23%~90.25%）、去分化脂肪肉瘤57.78%（95% CI=50.46%~61.85%）、黏液样/圆细胞脂肪肉瘤64.99%（95% CI=58.64%~70.62%）、多形性脂肪肉瘤46.02%（95% CI=36.22%~55.25%）、混合脂肪肉瘤67.33%（95% CI=55.71%~76.53%）,Log-rank检验显示,组间差异有统计学意义（χ²=227.92,P<0.000 1）。不同病理学类型Cox多因素分析显示,年龄是各病理学类型患者预后的独立影响因素（均P<0.05）。在高分化组脂肪肉瘤患者中,根治性和非根治性手术均能提高OS（根治性：HR=0.42,95% CI=0.19~0.92,P=0.031;非根治性：HR=0.40,95% CI=0.18~0.88,P=0.023）和CSS（根治性：HR=0.32,95% CI=0.16~0.63,P=0.001;非根治性：HR=0.23,95% CI=0.12~0.44,P=0.001）;化疗会降低患者的OS（HR=2.29,95% CI=1.54~3.40,P<0.001）和CSS（HR=3.55,95% CI=2.16~5.83,P<0.001）。在去分化脂肪肉瘤患者中,根治性和非根治性手术均能提高OS（根治性：HR=0.25,95% CI=0.18~0.35,P<0.001;非根治性：HR=0.34,95% CI=0.24~0.47,P<0.001）和CSS（根治性：HR=0.22,95% CI=0.15~0.33,P<0.001;非根治性：HR=0.31,95% CI=0.21~0.45,P<0.001）;放疗能提高CSS（HR=0.75,95% CI=0.57~0.99,P=0.043）;化疗会降低OS（HR=1.33,95% CI=1.05~1.69,P=0.018）和CSS（HR=1.64,95% CI=1.24~2.18,P=0.001）。放疗能提高黏液样/圆细胞脂肪肉瘤患者的OS（HR=0.66,95% CI=0.47~0.92,P=0.015）和CSS（HR=0.54,95% CI=0.34~0.84,P=0.007）。结论 年龄是影响不同病理学类型腹膜后脂肪肉瘤患者预后的独立危险因素。腹膜后脂肪肉瘤患者的治疗,应以病理学分类为导向制定个体化治疗方案。手术切除是高分化和去分化脂肪肉瘤最佳适应证。对于手术方式的选择,应综合评价患者全身情况。在高分化脂肪肉瘤患者中R₀切除不是必须的,R₁切除或者局部治疗（包括微波、射频等）也能达到提高患者OS和CSS的作用。而对于去分化脂肪肉瘤,则应争取达到R₀切除。放疗是黏液样/圆形细胞脂肪肉瘤的最佳适应证,同时也是去分化脂肪肉瘤患者治疗手段的重要补充。在高分化和去分化病理学类型中,化疗会增加患者的死亡风险。     

lncRNA NEAT1与消化系统恶性肿瘤预后及临床病理特征关系的Meta分析

背景与目的 长链非编码RNA核富集转录本1（lncRNA NEAT1）在多种实体肿瘤中表达失调并与不良预后密切相关,但其与消化系统恶性肿瘤患者预后之间关系仍不明确。因此,本研究通过系统评价及Meta分析探讨lncRNA NEAT1对消化系统恶性肿瘤患者预后的影响及其与临床病理特征之间的关系。方法 在线检索PubMed、Web of Science、Cochrane Library、中国知网和万方数据库,检索时间均从建库至2021年10月18日,收集公开发表的关于lncRNA NEAT1表达与消化系统恶性肿瘤患者预后或临床病理特征之间关系的队列研究,由2名研究者根据纳入和排除标准对文献进行筛选并提取相关数据,采用Stata 12.0软件进行统计学分析。结果 最终共纳入20项研究,2 031例消化系统恶性肿瘤患者。纳入研究的NOS评分均在6~9分之间,其中16项研究报道了总体生存率（OS）,5项研究报道了无病生存率（DFS）,19项研究报道了临床病理学特征。Meta分析结果显示：NEAT1高表达的消化系统恶性肿瘤患者OS（HR=1.66,95% CI=1.41~1.97,P<0.001）和DFS（HR=2.0,95% CI=1.51~2.65,P<0.001）均低于NEAT1低表达或不表达患者。根据生存分析方法、NEAT1表达截取值、样本量和随访时间进行亚组分析结果显示,NEAT1高表达患者的OS均明显降低（均P<0.05）。此外,临床病理特征分析结果显示：较高水平的NEAT1患者的肿瘤直径更大（OR=2.20,95% CI=1.73~2.79,P<0.001）、临床分期更晚（OR=3.10,95% CI=1.95~4.92,P<0.001）、淋巴结转移（OR=1.94,95% CI=1.30~2.90,P=0.001）及远处转移的风险更高（OR=2.58,95% CI=1.88~3.54,P<0.001）,其与患者年龄、性别、肿瘤分化程度及脉管浸润之间无明显关系（均P>0.05）。结论 lncRNA NEAT1高表达是消化系统恶性肿瘤的不利预后因素,且与不良临床病理特征密切相关,有望作为消化系统恶性肿瘤病情监测及预后判断的重要参考指标。     

年龄与三阴性乳腺癌临床病理特征及预后的关系

背景与目的 年龄与乳腺癌的发病、肿瘤生物学行为及预后密切相关,是临床决策的重要参考因素。不同年龄反映了患者的不同生理状态,由于三阴性乳腺癌（TNBC）缺失激素受体属于激素非依赖性,年龄是否影响该类患者的诊疗决策和预后有待研究。本研究旨在探讨诊断年龄与TNBC患者临床病理特征、治疗策略及预后的关系。方法 从美国SEER数据库中提取2010—2016年经病理诊断为I~III期的TNBC患者的病例资料,根据患者乳腺癌的诊断年龄将病例划分为18~39岁、40~49岁、50~59岁、60~69岁及≥70岁5组,比较各年龄组间的临床病理特征及治疗差异,采用多因素Cox比例风险模型分析年龄与患者的乳腺癌特异生存（BCSS）的关系并计算风险比（HR）和95%置信区间（CI）。结果 30 576例TNBC纳入分析,中位年龄57岁（IQR：48~67岁）,其中18~39岁3 007例（9.83%）、40~49岁6 071例（19.86%）、50~59岁8 097例（26.48%）、60~69岁7 176例（23.47%）和≥70岁6 225例（20.36%）。各年龄组患者间的诊断年份、种族、婚姻状态、肿瘤TNM分期、病理类型、组织学分级、手术治疗及是否放化疗的分布差异有统计学意义（均P<0.05）。随着诊断年龄的增加,肿瘤T分期和N分期呈现降低,组织学分级更好,治疗保乳率更高而化疗率更低。中位随访32个月（IQR：15~54个月）,乳腺癌相关死亡3 482例（11.39%）,各年龄段患者间的BCSS率差异有统计学意义（P<0.001）。单因素Cox比例风险模型分析结果显示,患者的诊断年龄、种族、婚姻状态、肿瘤T分期、淋巴结分期、肿瘤TNM分期、病理类型、组织学分级、手术治疗及放疗与BCSS明显有关（均P<0.05）,化疗与BCSS无明显关系（P=0.284）。多因素Cox模型的校正分析结果显示,18~39岁（HR=1.00,95% CI=0.88~1.13,P=0.990）、40~49岁（HR=0.95,95% CI=0.85~1.06,P=0.330）和50~59岁（HR=1.03,95% CI=0.93~1.14,P=0.597）患者的BCSS与60~69岁患者比较差异无统计学意义,而年龄≥70岁患者的BCSS较60~69岁患者差（HR=1.56,95% CI=1.41~1.74,P<0.001）。在不同诊断年份、TNM分期、手术方式和放化疗状态的亚组人群中,年龄与BCSS的关系基本相似。结论 TNBC患者的诊断年龄与预后存在相关性,高龄（≥70岁）是患者的不良预后因素,而18~69岁患者的预后基本相似。     

胃癌神经旁浸润的临床特征与预后分析

目的 探讨胃癌神经旁浸润（PNI）的临床意义.方法 对2004年1月至2008年5月期间178例行胃癌根治术后的胃癌组织石蜡标本行苏木精-伊红染色,以肿瘤细胞浸润神经束或神经束膜判定为PNI阳性.分析PNI与胃癌临床病理特征及预后的关系.结果 PNI阳性78例（43.8%）.PNI与肿瘤浸润深度（P＜0.01）、淋巴结转移（P＜0.01）和TNM分期（P＜0.01）有关,但与患者的年龄、性别、肿瘤位置和分化程度无关.单因素分析显示,胃癌患者总体生存率与PNI、胃癌浸润深度、淋巴结转移和TNM分期有关（均P＜0.01）;PNI阳性患者平均生存期（28.6个月）明显短于PNI阴性患者（44.3个月）（P＜0.01）.多因素分析显示,PNI是影响患者总体生存率的独立因素（相对危险度为2.257,95%CI为1.268～4.019,P=0.006）.结论 PNI与肿瘤的进展有关,胃癌术后检测PNI可以作为判断患者预后指标之一.     

The Significance of Perineural Invasion as a Prognostic Factor in Patients with Gastric Carcinoma

Purpose: Few studies have investigated the prognostic significance of perineural invasion (PNI) in gastric cancer. Therefore, we examined the association between PNI and clinicopathological factors and the effect of PNI on overall survival in patients with gastric carcinoma. Methods: Paraffin sections of surgical specimens from 354 patients who underwent gastric resection were stained with hematoxylin and eosin. PNI was assessed histologically as positive when cancer cells were seen in the perineurium or neural fascicles. Survival analysis was done in 219 patients with T_2,3,4 tumors who underwent potentially curative resection. Data were collected prospectively. Results: PNI was positive in 211 of the 354 patients (59.6%). The ratio of undifferentiated tumors, tumors with vascular invasion, and lymph node metastasis was significantly higher in the PNI-positive patients than in the PNI-negative patients (P < 0.0001 for all three associations). As the depth of mural invasion increased, so did PNI positivity (P < 0.0001). The overall survival of the PNI-positive patients was significantly worse than that of the PNI-negative patients in the univariate analysis (P = 0.0009). However, PNI had no independent prognostic significance in the multivariate Cox proportional hazards model analysis. When the patients were separated into subgroups, PNI had prognostic value in patients with T₃ tumors (P = 0.036) and no lymph node metastasis (P = 0.005) in the univariate analysis, but no prognostic significance in the multivariate analysis. Conclusions: Although the incidence of PNI is high in gastric carcinoma and increases with the progression of disease, it does not provide any additional information to the classical prognostic parameters. Received: March 4, 2002 / Accepted: July 2, 2002 Reprint requests to: N. Duraker, Ata-2 Sitesi Manolya Cad., ?am Sokak B-5 9-A Da:10, ?engelk?y 81210, Istanbul, Turkey     

The Effect of Perineural Invasion on Overall Survival in Patients with Gastric Carcinoma

Aims  The availability of different treatment options for gastric carcinoma has reopened the question of correct definition of high-risk categories, which may help in identifying patients with high risk for poor prognosis who would benefit more from adjuvant therapy after operation. Perineural invasion (PNI) seems to provide useful information for management. Therefore, we examined the effect of PNI on overall survival (OS) in patients with gastric carcinoma and the association between PNI and other clinical and pathological factors. Patients and Methods  A total of 1,632 patients with gastric carcinoma from 2000 to 2005 were analyzed retrospectively. Paraffin sections of surgical specimens from all patients who underwent gastric resection were stained with laminin. If carcinoma cells infiltrated into the perineurium or neural fascicles, PNI was assessed as positive. Survival analysis was done in 1,372 patients with T1–T4 tumors who underwent curative resection. Result  PNI was positive in 518 of the 1,632 patients (31.7%). The size of tumors, T stage, differentiation of tumor, and clinical stage were significantly related to PNI positivity. The proportion of large tumors was significantly higher in PNI-positive patients than in PNI-negative patients (P < 0.01). As the depth of gastric mural invasion or clinical stage increased, the positive rate of PNI also increased. The OS of the PNI-positive patients was significantly shorter than that of the PNI-negative patients in the univariate analysis (P < 0.01). At multivariate Cox proportional hazards model of OS analysis, the positivity of PNI appeared to be an independent prognostic factor for OS (hazards ratio [HR] = 3.23, 95%CI = 2.6–8.11, P < 0.01), which was also influenced by tumor differentiation, T stage, and clinical stage (P < 0.01). Conclusion  Our results suggested that the incidence of PNI was high in gastric carcinoma and that it corresponded to the progression of disease. It could provide additional information for identifying patients who are at high risk for poor prognosis. PNI can be a candidate for a new kind of prognostic parameters.     

直肠癌神经周围浸润的临床研究

目的 探讨直肠癌神经周嗣浸润（PNI）的临床意义.方法 回顾性分析郴州市第一人民医院2003年1月至2005年1月间行直肠前切除低位吻合术（Dixon）的204例直肠癌患者的临床资料,标本常规石蜡切片后行苏木精-伊红染色,以肿瘤细胞浸润神经束或神经束膜判定为PNI阳性.分析PNI与直肠癌临床病理特征和预后的关系.结果 204例直肠癌患者中PIN阳性65例（31.9%）.PNI与肿瘤大小、浸润深度、淋巴结转移、TNM分期、肿瘤生长方式、分化程度、肿瘤切除情况有关（P＜0.05）.PNI阳性组患者术后生存时间为（43.8±1.5）个月,明显短于PNI阴性组的（57.2±1.5）个月（P＜0.01）.PNI阳性的Ⅱ期患者术后平均生存时间为（46.5±3.2）个月,显著低于Ⅲ期患者的（55.7±1.2）个月（P＜0.05）.结论 PNI可作为直肠癌的预后判断指标.     

Prognostic Significance of Perineural Invasion in Patients with Gastric Cancer Who Underwent Curative Resection

Background

The prognostic significance of perineural invasion (PNI) in gastric cancer has been previously investigated in a few studies, but had not reached a consensus. The aim of this study was to determine the prognostic value of PNI in patients with gastric cancer who underwent curative resection.

Materials and Methods

We retrospectively analyzed 238 patients who had undergone curative gastrectomy. Paraffin sections of surgical specimens from all patients were stained with hematoxylin and eosin. PNI was defined when carcinoma cells infiltrated into the perineurium or neural fascicles. PNI and the other prognostic factors were evaluated by univariate and multivariate analysis.

Results

PNI was detected as positive in 180 of the 238 patients (75.6%). pT stage, tumor size, lymph node metastasis, clinical stage, tumor differentiation, Borrmann classification, histological type, lymphatic vessel invasion, and blood vessel invasion were closely associated with the presence of PNI. The PNI-positive tumors had significantly larger size and more lymph node metastasis than the PNI-negative tumors (P = .001 and P < .001, respectively). The median survival of the PNI-positive patients was significantly worse than that of the PNI-negative patients (28.1 vs. 64.9 months, P = .001). Multivariate analysis indicated that the positivity of PNI was an independent prognostic factor (P = .02, hazard ratio [HR]: 2.75; 95% confidence interval [95% CI]:1.12–3.13) as were classical clinicopathological features.

Conclusion

Our results showed that the frequency of PNI was high in patients with gastric cancer who underwent curative gastrectomy and the proportion of PNI positivity increased with progression and clinical stage of disease. PNI may be useful in detecting patients who had poor prognosis after curative resection in gastric cancer.     

Treatment for T1-2 Oral Squamous Cell Carcinoma with or Without Perineural Invasion: Neck Dissection and Postoperative Adjuvant Therapy

Background

Although perineural invasion (PNI) has been a poor prognostic factor for head and neck cancers, few studies have focused on oral squamous cell carcinoma (OSCC). The independent significance of PNI in early T1-2 OSCC and the benefit of treatment modification based on PNI status have not been assessed. This study investigated the role of PNI in T1-2 OSCC patients, with focus on the controversial issues of neck management and postoperative adjuvant therapy.

Methods

PNI status was re-reviewed under hematoxylin and eosin staining in tumors of 307 consecutive T1-2 OSCC patients. Oncologic and survival outcomes were analyzed by univariate and multivariate analyses.

Results

PNI was identified in 84 (27.4%) patients, correlating with several established poor prognostic factors. In multivariate analysis, PNI remained an independent predictor for neck metastasis, neck recurrence, and a worse 5-year disease-specific survival. Elective neck dissection contributed to a significantly better 5-year disease-specific survival only in cN0 patients with PNI-positive tumors (P?=?0.0071) but not in those with PNI-negative tumors (P?=?0.3566). In low-risk patients who were treated by surgery alone, including neck dissection, the 5-year disease-specific survival rates were almost the same in those with PNI-positive tumors and those with PNI-negative tumors (92.0 vs. 92.9%; P?=?0.9104).

Conclusions

Elective neck dissection is indicated for cN0 patients with PNI-positive tumors for the efficacy of improving disease-specific survival as well as neck control. However, low-risk PNI-positive patients who undergo neck dissection do not need postoperative adjuvant therapy, because the residual risk from PNI is minimal.     

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??Affact of perineural invasion on the prognosis of patients with rectum cancer FAN Ping, TIAN Jing-zhong, LI Guang-yun, et al. Department of General Surgery, Bozhou People’s Hospital, Bozhou236800, China Corresponding author: FAN Ping, E-mail: dengfang1992@sina.com Abstract Objective To analyze the effect of perineural invasion on evaluating the prognosis of patients with rectal cancer. Methods The clinical data of 213 patients with rectum cancer performed total mesorectal excision (TME) from 2000 to 2007 at Bozhou People’s Hospital were analyzed retrospectively. Paraffin sections of surgical specimens from all the patients who underwent TME were stained with laminin. The effect of PNI on overall survival (OS) in patients with rectum cancer and the association between PNI and other clinical and pathological parameters were analyzed. Results PNI was positive in 62 of all the 213 patients (29.11%). The size of tumors, T stage and clinical stage were related to PNI significantly. The OS of the PNI-positive patients [??23.04±9.95??months] was shorter than that of the PNI-negative patients [??52.10±14.61??months] in the univariate analysis significantly (P<0.01). And at multivariate Cox proportional hazards model of OS analysis, the positivity of PNI appeared to be an independent prognostic factor to OS , which was also influenced by tumor size, lymph node metastasis and clinical stage (P<0.01). Conclusion The incidence of PNI plays an important role in evaluation of the tumor classification, stage and the prognosis of rectum cancer and it could serve as an independent predictor of prognosis of rectum cancer.     

Perineural invasion has no prognostic value in patients with invasive breast carcinoma

No studies examining the relationship between perineural invasion (PNI) and clinicopathological factors in invasive breast cancer have been published. Therefore, we investigated this association and analyzed the effect of PNI on disease-free survival (DFS) in patients with invasive breast carcinoma. PNI evaluation was performed on hematoxylin- and eosin-stained tissue sections of surgical specimens from 377 patients. PNI was assessed as positive when cancer cells were seen in the perineurium or neural fascicles. PNI was found in 97 out of 377 patients (25.7%). PNI positivity was 13.9% in T1 tumors and 69.7% in T4 tumors (P<0.001). The incidence of PNI was higher in ductal and mixed type carcinomas than in other histologic types (P=0.013). Vascular invasion, axillary lymph node and progesterone receptor positivity ratios were significantly higher in PNI-positive patients than in PNI-negative ones (P<0.001, P=0.001 and 0.006, respectively). There was no difference between PNI-positive and -negative patients regarding DFS. In conclusion, in invasive breast carcinomas, PNI incidence is lower in small and axilla-negative tumors, and higher in ductal and mixed type and hormone-sensitive tumors; PNI has no prognostic importance.     

局部进展期胃癌术后进行奥沙利铂联合替吉奥辅助化疗的安全性和有效性

目的:探究奥沙利铂联合替吉奥（SOX）方案作为局部进展期胃癌D 2根治术后辅助化疗方案的安全性和有效性。 方法:采用描述性病例系列研究方法。病例纳入标准：（1）经胃镜活检或手术标本病理证实为胃腺癌;（2）接受D 2根治手术,且术后接受SOX方案辅助化疗。排除标准：（1）术后病理分期为T...     

Population-based outcome of muscle-invasive bladder cancer following radical cystectomy: who can benefit from adjuvant chemotherapy?

BackgroundThe benefit of adjuvant chemotherapy remains controversial in muscle-invasive bladder cancer (MIBC) after radical cystectomy. The present study’s primary objective was to construct a predictive tool for the reasonable application of adjuvant chemotherapy.MethodsAll of the patients analyzed in the present study were recruited from the Surveillance Epidemiology and End Results program between 2004 and 2015. Propensity score matching (PSM) was used to reduce inherent selection bias. Cox proportional hazards models were applied to identify the independent prognostic factors of overall survival (OS) and cancer-specific survival (CSS), which were further used to construct prognostic nomogram and risk stratification systems to predict survival outcomes. The prognostic nomogram’s performance was assessed by concordance index (C-index), receiver-operating characteristic (ROC) and calibration curves. Decision curve analysis (DCA) was performed to evaluate the clinical net benefit of the prognostic nomogram.ResultsA total of 6,384 patients with or without adjuvant chemotherapy were included after PSM. Several independent predictors for OS and CSS were identified and further applied to establish a nomogram for 3-, 5- and 10-year, respectively. The nomogram showed favorable discriminative ability for the prediction of OS and CSS, with a C-index of 0.709 [95% confidence interval (CI): 0.699–0.719] for OS and 0.728 (95% CI: 0.718–0.738) for CSS. ROC and calibration curves showed satisfactory consistency. The DCA revealed high clinical positive net benefits of the prognostic nomogram. The different risk stratification systems showed that adjuvant chemotherapy resulted in better OS (P<0.001) and CSS (P<0.001) than without adjuvant chemotherapy for high-risk patients; while the OS (P=0.350) and CSS (P=0.260) for low-risk patients were comparable.ConclusionsWe have constructed a predictive model and different risk stratifications for selecting a population that could benefit from postoperative adjuvant chemotherapy. Adjuvant chemotherapy was found to be beneficial for high-risk patients, while low-risk patients should be carefully monitored.