年龄因素对肝癌肝切除术患者长期预后的影响

目的:本研究旨在探讨年龄对原发性肝癌肝切除患者的临床病理特征及预后的影响。方法:回顾性分析172例行肝切除术的原发性肝癌患者,对年龄与患者临床病理及预后因素之间的关系进行探讨。结果:原发性肝癌患者低龄组（≤53岁）的肝脏储备情况较高龄组患者（>53岁）好,但是低龄组也存在更多的肿瘤侵袭因素。在经过117个月追踪随访之后,87人确认死亡。低龄组患者的5年累积生存率为55.43%,而高龄组患者的5年累积生存率为48.31%（P=0.026）。多因素分析结果显示,年龄是影响原发性肝癌肝切除患者术后生存情况的危险因素。此外,172例随访病人中有76例在术后出现了肿瘤复发。多因素分析发现对于低龄组患者和高龄组患者,肝切除术后肿瘤的复发无统计学差异。结论:年龄是影响原发性肝癌肝切除术后患者生存情况的危险因素,但是与患者术后肿瘤复发未见明显关系。     

预后营养指数在原发性肝癌肝切除患者预后评估中的价值

目的：评价预后营养指数（PNI）在接受根治性肝切除的原发性肝癌患者预后评估中的意义及价值。方法：回顾性分析西安交通大学第一附属医院肝胆外科2002年12月至2011年12月间接受肝切除的原发性肝癌患者病例及随访资料,根据患者术前的血清白蛋白和总的淋巴细胞计数算出 PNI 值,分析 PNI 与患者临床病理特征及预后的关系。结果：预后危险因素分析显示：PNI 是影响肝癌切除术后患者生存率的独立危险因素（P ＜0．05）,高 PNI 组患者的5年累计生存率为56．20％,而低 PNI 组仅为36．10％,差异显著（P ＝0．01）。分层分析发现在早期肝癌患者中,PNI 亚组间的总体生存存在显著差异（P ＜0．05）,而在晚期患者中差异不明显（P ＞0．05）。结论：PNI 是影响原发性肝癌切除术后患者生存情况的独立危险因素,但对术后肿瘤的复发作用不明显。     

复发性肝癌再切除术患者预后因素分析

目的：探讨影响复发性肝癌再切除术的预后因素。方法：回顾性分析41例行再切除术复发性肝癌患者的临床病理资料及随访记录,采用Kaplan-Meier 和Log-rank 对数秩检验对23个临床病理因素进行单因素分析,然后引入Cox 比例风险模型进行多因素分析。另外,对各次术中失血量及手术时间采用单因素方差分析进行比较。结果：再次手术后患者1、3、5 年生存率分别为68% 、36% 、35% ,无瘤生存率分别为39% 、22% 、7% 。影响生存期的独立预后因素为：第1 次手术时门静脉癌栓形成、第1 次手术时肝硬化结节直径大小、第2 次手术切缘距离、第2 次手术后辅助治疗。未得出影响无瘤生存期的独立预后因素。各次术中失血量及手术时间无显著性差异。结论：第1 次手术中合并门静脉癌栓或硬化结节直径较大的患者,行再切除术预后差。第2 次手术中肝切缘距离>1cm或者术后辅以其他综合治疗可以改善患者预后。     

影响小肝癌切除术预后的临床因素

本组１０２例小肝癌（直径≤５ｃｍ），全部行根治性不规则肝叶切除术，并经病理证实，其术后１、３、５、１０年生存率分别为９３．８７％、７５．３４％、５２．７９％、４４．６４％（生命表法）。用ＣＯＸ模型对各临床因素进行生存分析，结果显示：临床分期、γ－谷氨酰转肽酶、卫星结节、肿瘤包膜和术后复发等因素对生存率的影响有显著性意义。提出小肝癌切除术后复发，是治疗失败的最主要原因。若利用Ｂ超、ＡＦＰ、ＣＴ和肝动脉造影等方法提高小肝癌亚临床期的诊断率，术后辅加肝动脉栓塞化疗（ＴＡＥ）以减少肝内复发，以及复发后再次行手术和／或行ＴＡＥ等治疗，均可有效提高小肝癌的生存率。     

肿瘤微环境中巨噬细胞及相关细胞因子对肝癌切除术后患者预后的影响

目前肝切除术仍是临床治疗肝癌首选的治疗方式。但肝切除术后仍有一定复发率。肿瘤微环境中巨噬细胞及其相关细胞因子能够影响肝癌细胞生物学行为,促进肝癌的侵袭和转移,引发肿瘤复发和影响患者预后。测定巨噬细胞及相关细胞因子水平对判断肝癌肝切除术后患者的预后具有重要价值,同时巨噬细胞及相关细胞因子也是肝癌治疗的潜在靶点。     

不同中国肝癌分期患者肝癌根治性切除术后的临床疗效差异与预后影响因素

目的 分析不同中国肝癌分期(CNLC)患者肝癌根治性切除术后的临床疗效差异与预后影响因素。方法回顾性选取125例肝细胞癌(HCC)患者,收集患者一般信息、实验室检测指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、甲胎蛋白(AFP)]及病理学检查结果。术后进行3年随访,并依据随访生存与否分为生存组、死亡组。统计患者3年总生存率(OS),比较不同CNLC分期HCC患者3年OS,采用多因素Logistic回归方法对预后影响因素进行分析。结果 125例HCC患者3年OS为67.20%(84/125),其中CNLCⅠa期患者的3年OS高于Ⅰb期、Ⅱa期、Ⅱb期、Ⅲa期、Ⅲb期患者,Ⅰb期患者3年OS高于Ⅲa期、Ⅲb期患者,有统计学差异(P<0.05)。死亡组肿瘤数目多发、肿瘤破裂、低分化及血管侵犯患者占比高于生存组,死亡组ALT、AST、AFP水平高于生存组,有统计学差异(P<0.05);Logistic回归分析显示,肿瘤多发、肿瘤破裂、低分化、血管侵犯、ALT、AST、AFP为影响患者预后的独立危险因素(P<0.05且OR≥1)。结论 不同CNLC分期HCC患者术后OS差异...     

术中出血400 ml以上是BCLC B期肝癌患者预后不良的独立危险因素

目的 探讨BCLC B期肝癌患者进行手术治疗的预后及危险因素.方法 回顾性分析经手术治疗的805例BCLC A期和B期肝癌患者的临床资料及预后情况,对比BCLC A期及BCLC B期患者的预后差异,应用Kaplan-Meier法及Cox回归法分析BCLC B期患者的生存相关因素,并对相关因素进行危险分级.结果 365例BCLC B期肝癌患者中位随访时间为26.0个月(2.0~135.0个月);中位生存时间为50.8个月,1、3、5年生存率分别为76%、54%和40%;中位无病生存时间为25.8月,1、3、5年无病生存率分别为53%、38%和31%.单因素分析提示脉管瘤栓、肿瘤多发、术中出血≥400 ml为患者总生存时间的预后不良因素;肿瘤多发、术中出血≥400 ml是患者无病生存时间的危险因素.多因素分析显示术中出血≥400 ml是影响BCLC B期患者总生存时间及无病生存时间的独立危险因素.结论 大部分BCLC B期肝癌患者能够从手术治疗中获益,术中出血≥400 ml是提示预后不良的独立危险因素.     

预后营养指数对原发性肝癌肝切除术后感染性并发症的预测价值

目的:探讨预后营养指数(PNI)对原发性肝癌肝切除术后感染性并发症的预测价值。方法:回顾性分析2015年2月-2019年11月都江堰医疗中心普外科收治的226例行肝切除术治疗的原发性肝癌患者的临床资料。根据肝切除术后是否合并感染,分为感染组(n=56)和非感染组(n=170)。比较两组临床资料;采用多因素Logistic回归分析肝切除术后感染性并发症的影响因素。绘制受试者工作特征(ROC)曲线,探讨PNI对肝切除术后感染性并发症的评估作用。 结果:226例接受肝切除术治疗的原发性肝癌患者中56例(24.78％)术后发生了感染性并发症;两组糖尿病史、术前血清白蛋白、术前淋巴细胞计数、术前PNI、术中失血量、术后胸腔积液、引流管留置时间组间比较差异有统计学意义(P＜0.05);多因素Logistic回归分析显示,糖尿病史、术前血清白蛋白、术前PNI、术后胸腔积液、引流管留置时间是肝切除术后感染性并发症发生的独立危险因素(P＜0.05);术前PNI预测肝切除术后感染性并发症发生的曲线下面积(AUC)为0.801,敏感度和特异度分别为82.6%、72.5%。结论:术前PNI对肝切除术后感染性并发症具有较好的预测价值。     

肝癌生物学特性与预后

虽然经过几十年的研究,肝癌病人的预后有了很大程度的改善,但总体预后仍然较差。影响肝癌病人预后的因素很多,如病人的年龄、性别、肝炎状态、Child－Pugh分级、肝功能(白蛋白、GGT水平)、AFP水平、NK及TIL细胞活性、血小板数量、血清中p53抗体、尿TGF-betal;肿瘤的大小、数目、包     

结,直肠癌患者手术期输血与预后

本文对我院1963年9月到1981年1月406例B期结、直肠癌住院病人进行了输血量与预后的回顾性分析。结果表明,输≤400ml血组,5年生存率为71.16％,≥600ml组为61.79％(x~2=4.012,P<0.05)。但对不同性别、年龄、肿瘤部位,血型及肿瘤病理类型的B期结、直肠癌患者分别进行5年生存率与输血量的分析,发现均无显著性差异。     

不同输血方式对胃癌根治术围术期患者免疫功能及预后的影响分析

目的 探讨不同输血方式对胃癌根治术围术期患者免疫功能及预后的影响.方法 以收治的62例胃癌患者为研究对象(均行胃癌根治术治疗).根据围术期输血方式的不同分为2组,各31例.研究组采取自体输血,而对照组采取异体输血方式,比较2组患者的临床疗效等差异.结果 研究组患者围术期相关指标均优于对照组(P<0.05);术前两组炎性...     

Effects of Allogeneic Blood Transfusion in Patients with Stage II Colon Cancer

The aim of the present study was to determine whether allogeneic red blood cell transfusions showed adeleterious effect and what might be preoperative risk factors for blood transfusion in patients with TNM stageII colon cancer. Total 470 patients who fulfilled inclusion criteria were selected for a further 10-year followupstudy. We found that there were statistical significance between non-transfused and transfused group inmortality (P=0.018), local recurrence (P=0.000) and distant metastasis (P=0.040). Local recurrence and distantmetastasis between 1 to 3 units and more than 3 units group did not show any significant differences. There wasno difference in survival rate between non-transfused and 1 to 3 units group (log rank =0.031, P=0.860). Thedifference between different blood transfusion volume in transfused patients was found (78.77% vs 63.83%,P=0.006). Meanwhile, the significant difference of survival rate was existed between non-transfused group andmore than 3 units group (84.83% vs 63.83%, P=0.002 ). Univariate analysis showed the following 3 variablesto be associated with an increased risk of allogeneic blood transfusions: preoperative CEA level (P<0.05),location of tumor (P<0.01) and diameter of tumor (P<0.01). Multivariate analysis revealed that location of tumorand diameter of tumor are two independent factors for requirement of perioperative transfusions. Therefore,allogeneic transfusion increase the postoperative tumor mortality, local recurrence and distant metastasis inpatients with stage II colon cancer. The postoperative tumor mortality, local recurrence and distant metastasiswere not associated with the blood transfusion volume. The blood transfusion volume was associated with thesurvival rate. Location of tumor and diameter of tumor were the independent preoperative risk factors for bloodtransfusion.     

乳腺癌的不输血手术治疗

目的：探讨乳腺癌不输血手术治疗的可行性,方法：我院１９９４年１月至２０００年６月,３２１例乳腺癌患者施行乳腺极治性切除术,不预输血。其中根治术１９６例,改良根治术１２１例,双侧根治术４例,在创口合、体质状况恢复等方面进行分析。结果：３２１例乳腺癌患者行乳房根治术治疗,平均每例失血约１８５ｍｌ,仅有４３例用代血浆（血安定,贺期）,无１例输血和使用血制品,平均术后住院天数１１．８天,与围手术期输血者相比,在创口愈合,术后并发症,体质恢复等方面无明显差异,结论：对乳腺癌患者施行不输血乳房根治性切除术是可行的。     

用贺斯替代异体输血对肿瘤患者围术期免疫系统的影响

目的:探讨用血浆代用品6%贺斯(HAES)替代异体输血对肿瘤患者围术期免疫系统的影响.方法:将60例恶性肿瘤切除术患者,随机分为两组:输血组30例(B组);输贺斯组30例(H组).分别于麻醉诱导前,术后第3天及第7天抽取患者外周静脉血,应用酶联免疫吸附法(ELISA)进行细胞因子sIL-2R和IL-2浓度的测定并以乳酸脱氢酶释放法进行NK细胞活性的检测.结果:sIL-2R两组均上升B组更为明显,差异显著(P＜0.05);IL-2和NK细胞活性B组术后均明显下降(P＜0.05),H组手术前后比较均无明显变化.结论:术中输异体血后抑制患者体内抗肿瘤免疫系统;而输贺斯则对体内抗肿瘤免疫系统无不良影响.     

围手术期输血对结肠癌根治术后复发率影响

作者对129例结肠癌根治术后复发率进行回顾性总结.发现围手术期输血确能增高结肠癌根治术后复发率.输血组复发率为29.14％,未输血组复发率为零.二组数字有显著性差异.输血能增高结肠癌根治术后复发率的机理是宿主免疫系统的抑制.作者建议结肠癌根治术一般情况下应不输血.     

Prognosis and postoperative lymphocyte count in patients with hepatocellular carcinoma who received intraoperative allogenic blood transfusion: A retrospective study

Aims

The effect of perioperative blood transfusion on the survival of hepatocellular carcinoma (HCC) has not been fully investigated. To clarify the prognostic value of intraoperative allogenic blood transfusion, we conducted a comparative retrospective analysis of 224 patients with HCC who underwent hepatic resection.

Methods

We compared clinicopathologic background and survival after hepatic resection between patients who received intraoperative blood transfusion (n = 101) and those who did not (n = 123).

Results

Patients with blood transfusion had a larger tumor and more frequent vascular invasion than those without blood transfusion. The 5-year cancer-related survival rate after hepatic resection, but not the disease-free survival rate, was significantly lower in patients who underwent blood transfusion than in those who did not (38.3% vs. 66.7%, P < 0.01). Multivariate analysis showed intraoperative blood transfusion (P = 0.02), microscopic portal invasion (P < 0.01), and preoperative serum alpha-fetoprotein elevation (P = 0.03) to be independent risk factors for poor outcome after hepatic resection. The negative effect of blood transfusion on postoperative survival was observed only in patients with a tumor larger than 50 mm in diameter. The absolute peripheral blood lymphocyte count on postoperative day 1 was significantly lower in patients who underwent blood transfusion (880/mm³) than in those who did not (1081/mm³) (P < 0.01).

Conclusions

Our data suggest that intraoperative blood transfusion results in immunosuppression in the early postoperative period, allowing for progression of residual HCC after resection. Therefore, intraoperative allogenic blood transfusion should be avoided in patients with resectable HCC, particularly in those with a large tumor.     

Significance of ABO-Rh Blood Groups in Response and Prognosis in Breast Cancer Patients Treated with Radiotherapy and Chemotherapy

Background: To evaluate whether ABO-Rh blood groups have significance in the treatment response andprognosis in patients with non-metastatic breast cancer. Materials and Methods: We retrospectively evaluatedfiles of 335 patients with breast cancer who were treated between 2005 and 2010. Demographic data, clinicpathologicalfindings, treatments employed, treatment response, and overall and disease-free survivals werereviewed. Relationships between clinic-pathological findings and blood groups were evaluated. Results: 329women and 6 men were included to the study. Mean age at diagnosis was 55.2 years (range: 26-86). Of the cases,95% received chemotherapy while 70% were given radiotherapy and 60.9% adjuvant hormone therapy aftersurgery. Some 63.0% were A blood group, 17.6% O, 14.3% B and 5.1% AB. In addition, 82.0% of the cases wereRh-positive. Mean follow-up was 24.5 months. Median overall and progression-free survival times were 83.9 and79.5 months, respectively. Overall and disease-free survival times were found to be higher in patients with A andO blood groups (p<0.05). However rates did not differ with the Rh-positive group (p=0.226). In univariate andmultivariate analyses, ABO blood groups were identified as factors that had significant effects on overall anddisease-survival times (p=0.011 and p=0.002). Conclusions: It was seen that overall and disease-free survivaltimes were higher in breast cancer patients with A and O blood groups when compared to those with other bloodgroups. It was seen that A and O blood groups had good prognostic value in patients with breast cancer.