术前血清白蛋白水平对胃癌根治术患者的预后评估价值

目的探讨术前血清白蛋白水平对胃癌根治术患者的预后评估价值。方法回顾分析天津医科大学附属肿瘤医院2001年1月至2003年12月间行胃癌根治术的146例患者的临床病理资料,其中术前血清白蛋白正常者115例（〉35g／L,正常组）,降低者31例（≤35g/L,降低组）。结果血清白蛋白正常组和降低组术后分别有50例（43．5％）和28例（90．3％）复发,差异有统计学意义（P〈0．01）。两组术后5年生存率分别为57．4％和9．7％,差异有统计学意义（P〈O．01）。经多因素预后分析显示,术前血清白蛋白水平是胃癌根治术患者的独立预后因素（P〈0．01）。进一步分层分析显示,无论有无淋巴结转移,两组患者5年生存率的差异均有统计学意义（P〈0．05）;对于胃下部癌,两组患者5年生存率的差异有统计学意义（P〈0．01）;但对于胃中上部癌。两组差异则无统计学意义（P〉0．05）。结论术前血清白蛋白降低的胃癌患者（尤其胃下部癌者）根治术后预后不佳．应予以积极的术后辅助治疗．     

Prognostic importance of preoperative CEA in patients with colorectal cancer

Carcinoembryonic antigen is an acid glycoprotein, the levels of which may increase in patients with colorectal carcinoma. The prognostic significance of preoperative carcinoembryonic antigen levels and their relationship to other risk factors are still debatable issues. Among 512 patients operated on for colorectal cancer, whose preoperative carcinoembryonic antigen concentrations were evaluated, linear correlations were established between carcinoembryonic antigen overexpression and carcinoma staging, diameter and grading, though these were not statistically significant. Moreover, metastatic cancers were significantly more frequent in patients with increased plasma concentrations of the marker (> 60 ng/ml). There were no correlations between increased carcinoembryonic antigen levels and age, ploidy, or site and shape of the cancers. As regards survival, patients with normal preoperative carcinoembryonic antigen levels had a better prognosis in terms both of lower local recurrence rates and long- term survival. In addition. In Dukes stages B and C elevation of carcinoembryonic antigen above the cut-off point can be considered a significant prognostic factor capable of identifying a group of patients at high risk who may be candidates for aggressive adjuvant therapies and follow-up. The findings of this study suggest that preoperative carcinoembryonic antigen levels are of prognostic importance in relation both to cancer staging and to long-term survival, which may have significant clinical applications.     

结肠癌患者术前血清间皮素水平表达的临床意义

目的 探讨结肠癌患者术前血清间皮素水平表达差异.方法 选取2014年3月-2016年6月本院收治的首次诊断为早期结肠癌患者125例(病例组)和健康者75例(对照组).酶联免疫吸附法法检测病例组术前和对照组体检时血清间皮素水平.采用受试者工作曲线分析血清间皮素对结肠癌的诊断价值;Kaplan-Meier法和Log-rank检验分析生存资料.结果 对照组血清间皮素水平显著低于病例组[分别为(0.91 ±0.80) pg/ml和(7.63±3.25) pg/ml,t=17.57,P＜0.001].病例组肿瘤大小、TNM分期、浸润深度、淋巴结转移、远端转移患者的血清间皮素水平差异均有统计学意义(均P ＜0.05).术前血清间皮素预测结肠癌的最佳诊断界值为2.36 pg/ml,术前血清间皮素预测结肠癌进展的最佳诊断界值为8.62 pg/ml.以临界值8.62 pg/ml将125例结肠癌患者分为低血清间皮素组(n=56,间皮素≤8.62 pg/ml)和高血清间皮素组(n=69,间皮素≥8.62 pg/ml),两组生存期比较差异有统计学意义(t=36.01,P＜0.001).结论 间皮素可能足潜在诊断结肠癌及其进展的血清生物标志物.     

Prognostic factors and survival improvements in stage IV colorectal cancer*

BACKGROUND: The aim of the study was to evaluate prognostic factors and survival improvements in stage IV colorectal cancer patients who had all undergone resection of their primary tumor. METHODS: Between 1982 and 2006, 639 consecutive patients with UICC stage IV colorectal cancer underwent tumor resection followed by chemotherapy. Clinical, surgical, histopathological, and follow-up data were investigated and correlated with survival. RESULTS: Total R0 status was achieved in 101 patients (16%), and 128 patients (20%) underwent multivisceral resection. Median cause-specific survival for total R0 resected patients was 41 (95% CI: 32–50) months. The median cause-specific survival increased continuously from 10 (95% CI: 8–12) months for patients treated in the first years to 23 (95% CI: 19–27) months for those treated in the last 5 years of the study period. Multivariable analysis identified patients' age, pN, cM1a/b, R status, and the date of resection of the primary tumor as independent prognostic factors. CONCLUSIONS: Prognosis of stage IV colorectal cancer improved continuously in the last decades. Despite the ongoing discussion if the primary tumors should be resected in stage IV disease, prognostic factors can help to select M1 patients with potential long-term survival, who should undergo resection of the primary tumors and metastases followed by chemotherapy.     

Increased preoperative serum C-reactive protein level predicts a poor prognosis in patients with localized renal cell carcinoma

OBJECTIVE: To evaluate the value of the preoperative serum C-reactive protein (CRP) level in the prognosis of patients with localized renal cell carcinoma (RCC). PATIENTS AND METHODS: The study comprised 101 patients who had a radical nephrectomy for localized RCC (pT1-3N0M0). An elevated CRP was defined as >0.5 mg/dL before surgery. Survival rates for each variant were calculated using the Kaplan-Meier method, with the difference between survival curves evaluated using the log-rank test. Multivariate analysis was by Cox proportional hazard model; for all analyses the difference was considered significant when P < 0.05. RESULTS: The median (range) follow-up was 55 (2-187) months; 26 patients (26%) had high CRP levels, and 12 (46%) of these and three (4.0%) of the remaining 75 died from disease. The 5- and 10-year disease-specific survival rates (75% and 30%, respectively) in patients with high CRP levels were significantly worse than those in patients with normal CRP levels (both 93%, P < 0.001). In other variants, preoperative haemoglobin concentration, pathological stage, grade, histological type and microvascular tumour invasion were also related to disease-specific survival. By the Cox proportional hazards model, pathological stage and an elevated CRP were the most important prognostic factors for disease-specific survival in patients with localized RCC (P = 0.008 and 0.012, respectively). CONCLUSION: The preoperative CRP level was associated with poor survival in patients with localized RCC.     

Laparoscopic versus open colorectal resections in patients with symptomatic stage IV colorectal cancer

Background

The purpose of this study was to evaluate short-term and oncologic outcomes of laparoscopic resection (LR) for patients with symptomatic stage IV colorectal cancer compared with open resection (OR).

Methods

This study is a retrospective analysis of a prospective database. Patients with a minimum follow-up of 12?months after LR or OR for metastatic colorectal cancer were included. All analyses were performed on an “intention-to-treat” basis.

Results

A total of 162 consecutive patients submitted to LR and 127 submitted to OR were included. In the LR group, conversion rate was 26.5?%, mostly due to locally advanced disease (88.4?%). A greater risk of conversion was observed among patients with a tumor size greater than 5?cm regardless the tumor site (P?=?0.07). Early postoperative outcome was significantly better for LR group, with a shorter hospital stay (P?=?0.008), earlier onset of adjuvant treatment, and similar postoperative complications (P?=?0.853) and mortality rates (P?=?0.958). LR for rectal cancer was associated with a higher morbidity compared with colon cancer (P?=?0.058). During a median follow-up time of 72?months, there was no significant difference in overall survival between the two groups (P?=?0.622).

Conclusions

LR for symptomatic metastatic CRC is safe and, compared with OR, is associated with a shorter hospital stay and with similar survival rates. Concerns remain about LR of bulky tumors and rectal cancers due to the increased risk of conversion and postoperative complications.     

Prognostic value of the preoperative prognostic nutritional index in oldest-old patients with colorectal cancer

Surgery Today - The prognostic nutritional index (PNI), which is calculated using serum albumin and the peripheral lymphocyte count, is a simple and useful score for predicting the prognosis in...     

肿瘤标志物和Ki67在结直肠癌中的表达及预后因素分析

目的 探讨术前血清肿瘤标志物与术后Ki67联合检测对结直肠癌病人预后评估的价值.方法 收集2012年1 月至2014年6月在武汉大学人民医院胃肠外科就诊的结直肠癌病人的临床病理资料和随访资料.癌胚抗原(CEA)＞5 μg/L定义为阳性,癌抗原(CA)19-9＞35 kU/L定义为阳性.Ki67 LI大于其对应截断值定义...     

Prognostic significance of preoperative plasma D-dimer level in patients with surgically resected clinical stage I non-small cell lung cancer: a retrospective cohort study

Flowable haemostatic agents have been shown to be superior to non-flowable agents in terms of haemostatic control and need for transfusion products in patients undergoing cardiac surgery. We investigated the economic impact of the use of a flowable haemostatic agent (Floseal) compared with non-flowable oxidised regenerated cellulose (ORC) agent in primary elective cardiac surgery from the perspective of the UK National Health Service (NHS). A cost-consequence framework based upon clinical data from a prospective trial and an observational trial and NHS-specific actual reference costs (2016) was developed to compare the economic impact of Floseal with that of ORC. The individual domains of care investigated comprised complications (major and minor) avoided, operating room time savings, surgical revisions for bleeding avoided and transfusions avoided. The cost impact of Floseal versus ORC on ICU days and extended bed days avoided was modelled separately. Compared with ORC, the use of Floseal would be associated with overall net savings to the NHS of £178,283 per 100 cardiac surgery patients who experience intraoperative bleeding requiring haemostatic therapy. Cost savings were apparent in all individual domains of care (complications avoided: £83,536; operating room time saved: £63,969; surgical revisions avoided: £34,038; and blood transfusions avoided: £22,317). Cost savings per 100 patients with Floseal over ORC in terms of ICU days avoided (n = 30) and extended bed days avoided (n = 51.7) were £57,960 and £21,965, respectively. A sensitivity analysis indicated that these findings remained robust when the model parameters representing the clinical benefit of Floseal over ORC were reduced by up to 20%. Despite higher initial acquisition costs, the use of flowable haemostatic agents achieves substantial cost savings over non-flowable agents in cardiac surgery. These cost savings commence during the operating theatre and appear to continue to be realised throughout the postoperative period.     

Sequence of colorectal and liver resection in patients with surgically-treatable stage IV colorectal cancer

Approximately 25-30% of patients with colorectal cancer develop hepatic metastases. For patients diagnosed with resectable colorectal hepatic metastases, variation exists regarding the timing of resection of the colorectal primary and the hepatic metastases including three approaches: (1) the “classical” colorectal-first staged approach, (2) the “combined” or simultaneous/synchronous approach, and (3) the “reverse” or liver-first staged approach. The purpose of this chapter is to review the current literature regarding the timing of colorectal and hepatic resection in patients with surgically treatable colorectal adenocarcinoma hepatic metastases. There are inadequate data at the current time to provide definitive recommendations as to the optimal timing and sequence of surgery. Our recommendations based on existing data favor delivery of neoadjuvant therapy followed by either: (1) the combined approach for low-risk resections, (2) the liver-first staged strategy for high-risk hepatic resections or mid- to distal rectal tumors that may benefit from total neoadjuvant therapy, or (3) the colorectal-first approach for symptomatic primary colon tumors.     

Prognostic significance of the combined use of preoperative platelet count and serum carcinoembryonic antigen level in non-small-cell lung cancer

Purpose  

The prognostic significance of the combined use of preoperative platelet count and serum carcinoembryonic antigen (CEA) level in non-small-cell lung cancer patients was investigated.     

Prognostic significance of preoperative haemoglobin A1c level in patients with lung adenocarcinoma

Open in a separate window OBJECTIVESWe investigated the influence of the preoperative haemoglobin A1c (HbA1c) value on the prognosis and pathology of patients with lung adenocarcinoma who underwent surgery.METHODSWe reviewed the medical records of 400 lung adenocarcinoma patients who underwent lobectomy with mediastinal lymph node dissection between 2009 and 2013 using a prospectively maintained database. We stratified 400 patients into 4 groups according to the preoperative HbA1c value as follows: HbA1c ≤ 5.9 (n = 296), 6.0 ≤ HbA1c ≤ 6.9 (n = 70), 7.0 ≤ HbA1c ≤ 7.9 (n = 21) and HbA1c ≥ 8.0 (n = 12). We compared the recurrence-free survival and overall survival (OS) among these 4 groups. Univariate and multivariate analyses were performed to identify the risk factors for recurrence.RESULTSThe median follow-up period was 61.2 months. On comparing the recurrence-free survival and OS rates among these 4 groups, we found that these rates among patients in the HbA1c ≥ 8.0 group were significantly poorer compared with the other 3 groups (5-year recurrence-free survival: HbA1c ≤ 5.9, 70.4%; 6.0 ≤ HbA1c ≤ 6.9, 69.7%; 7.0 ≤ HbA1c ≤ 7.9, 70.7%; ≥8.0 HbA1c, 18.8%; P = 0.002; and 5-year OS: HbA1c ≤ 5.9, 88.7%; 6.0 ≤ HbA1c ≤ 6.9, 80.6%; 7.0 ≤ HbA1c ≤ 7.9, 90.2%; ≥8.0 HbA1c, 66.7%; P = 0.046). Patients in the HbA1c ≥ 8.0 group had significantly more tumours with vascular invasion (P = 0.041) and experienced distant metastasis significantly more often (P = 0.028) than those with other values. A multivariate analysis revealed that preoperative HbA1c ≥ 8.0 [hazard ratio (HR) 2.33; P = 0.026] and lymph node metastasis (HR 3.94; P < 0.001) were significant independent prognostic factors for recurrence.CONCLUSIONSOur results revealed that preoperative HbA1c ≥ 8.0 is associated to poor prognosis due to the occurrence of distant metastasis and we should carefully follow these patients after surgery.Clinical registration numberHyogo Cancer Center, G-57.     

Prognostic significance of DNA content abnormalities in young patients with colorectal cancer

Several studies have shown that the presence of DNA ploidy abnormalities, measured by flow cytometry, may correlate with a poor prognosis in a variety of cancers. The predictive value of these DNA abnormalities in young patients with colorectal cancer has not been well studied. Fifty patients aged 40 years and younger with colorectal adenocarcinoma were studied to determine the correlation of tumor DNA abnormalities with survival. DNA content was determined by flow cytometric analysis and each tumor was categorized as diploid or nondiploid. Of the parameters studied, Dukes' classification and tumor DNA ploidy were found to be significant prognostic indicators. Determination of DNA content seems to provide additional useful prognostic information in young patients with colorectal cancer.     

Modified Glasgow prognostic score in patients with incurable stage IV colorectal cancer

Background

The modified Glasgow prognostic score is an inflammation-based prognostic score. This study examined whether this score, measured before surgical procedures, could predict postoperative cancer-specific survival.

Methods

We retrospectively studied 79 colorectal cancer patients who underwent a surgical procedure for incurable stage IV disease. The modified Glasgow prognostic score (0 to 2) comprises C-reactive protein (≤10 vs >10 mg/L) and albumin (<35 vs ≥35 g/L) measurements.

Results

In terms of overall survival, univariate analysis revealed significant differences in the status of lung metastasis, peritoneal dissemination, distant metastasis, hemoglobin, C-reactive protein, albumin, tumor resection, adjuvant chemotherapy, and modified Glasgow prognostic score. Multivariate analysis revealed that hemoglobin (P = .019), adjuvant chemotherapy (P = .002), and modified Glasgow prognostic score (0 and 1, low; 2, high) (P = .0001) were significant predictive factors for postoperative mortality.

Conclusions

The modified Glasgow prognostic score is simple to obtain and useful in predicting survival in incurable stage IV colorectal cancer patients undergoing surgery.     

肿瘤浸润肥大细胞对结直肠癌患者生存预测的价值

目的 探讨肿瘤浸润肥大细胞(TIM)在结直肠癌患者中的预后价值.方法 收集2002年1月至2005年12月中山大学附属第一医院收治的282例行首次根治性切除的结直肠癌患者的肿瘤石蜡标本,通过免疫组织化学染色计算TIM的密度,根据TIM的平均密度[(8.4±6.5)／高倍视野],将患者分为TIM少量浸润组(TIM平均密度＜8.4/高倍视野)和TIM大量浸润组(TIM平均密度≥8.4／高倍视野),比较两组患者的临床病理因素及其预后情况.计量资料采用t检验,计数资料采用x2检验.采用KaplanMeier法绘制生存曲线,Log-rank检验分析患者生存情况.影响结直肠癌患者生存时间的单因素及多因素分析采用COX比例风险模型.结果 TIM在结直肠癌患者中均有不同程度的浸润.TIM少量浸润组和TIM大量浸润组患者在结直肠癌的N分期和TNM分期方面比较,差异有统计学意义(x2=6.025,7.410,P＜0.05).随访截至2010年9月,TIM少量浸润组、TIM大量浸润组患者的5年总生存率和无瘤生存率分别为82.9％、79.0％和63.1％、59.3％,两组比较,差异均有统计学意义(P＜0.05).COX比例风险模型单因素分析结果显示,肥大细胞在肿瘤组织中的浸润是影响结直肠癌患者总生存时间和无瘤生存时间的不良因素(RR=2.119,95％可信区间1.326～3.386;RR =2.084,95％可信区间1.357～3.199,P ＜0.05).多因素分析结果显示TIM是结直肠癌患者总生存时间和无瘤生存时间的独立影响因素(RR=1.651,95％可信区间1.009～2.702;RR=1.680,95％可信区间1.047～2.629,P＜0.05).结论 TIM与结直肠癌的N分期和TNM分期相关,并且TIM是结直肠癌患者预后不良的独立影响因素.     

Prognostic significance of extensive microsatellite instability in sporadic clinicopathological stage C colorectal cancer

BACKGROUND: Colorectal cancers exhibiting microsatellite instability (MSI) appear to have unique biological behaviour. This study analyses the association between extensive MSI (MSI-H), clinicopathological features and survival in an unselected group of patients with sporadic Australian Clinico-Pathological Stage (ACPS) C (tumour node metastasis stage III) colorectal cancer. METHODS: Some 255 patients who underwent resection for sporadic ACPS C colorectal cancer between 1986 and 1992 were studied. No patient had received chemotherapy. Minimum follow-up for all patients was 5 years. Archival normal and tumour DNA was extracted and amplified by polymerase chain reaction using a radioactive labelling technique. MSI-H was defined as instability in 40 per cent or more of seven markers. RESULTS: Twenty-one patients showed MSI-H. No association was found between MSI and age or sex. Tumours exhibiting MSI-H were more commonly right sided (P<0.00001), larger (P = 0.002) and more likely to be high grade (P = 0.049). After adjustment for age, sex and other pathological variables, patients whose cancers exhibited MSI-H had improved survival (P = 0.015). CONCLUSION: Recognition of MSI-H in sporadic ACPS C tumours identifies a subset of cancers with improved prognosis. Such stratification should be considered in trials of adjuvant therapy and may be relevant to therapeutic decision making.