术前二十二碳六烯酸水平与肾癌患者术后预后的关系分析

目的 探究肾癌患者术前血清二十二碳六烯酸(docosahexaenoic acid, DHA)水平与术后预后的相关性.方法 选取2004年10月至2014年10月期间140例肾癌患者,分为高DHA组(n=110,患者DHA水平≥3.81%)和低DHA组(n=30,患者DHA水平<3.81%),收集患者的基本临床病理数据,测定患者术前、术后血清DHA水平,以评估相关性.结果 高DHA组患者M1期的比率显著低于低DHA组患者(P<0.05);Kaplan-Meier分析发现,高DHA组患者的癌症-特异生存率显著高于低DHA组患者(P=0.005);多变量Cox比例风险模型分析发现,恶病体质(HR=4.973,95% CI:0.136~7.851,P=0.009)、M1(HR=3.209,95% CI:1.113~4.386,P=0.023)、低DHA(HR=3.891,95% CI:0.360~8.225,P=0.021)是肾癌患者癌症-特异生存率的显著危险因素.术前DHA水平与术后DHA水平差异无统计学意义(P>0.05).结论 术前DHA水平可以作为肾癌患者术后的独立预测因子.     

肾部分切除术治疗局限性肾癌患者远期生存结果：单中心20年2 046例总结

目的探讨局限性肾癌患者肾部分切除术后远期生存情况。方法回顾性分析2001年8月至2021年2月在中山大学肿瘤防治中心接受肾部分切除术的2 046例局限性肾癌患者的临床和病理学资料。男性1 402例, 女性644例, 诊断年龄[M(IQR)]51(19)岁(范围:6～86岁)。以肿瘤特异性生存为主要研究终点, 采用Kaplan-Meier法绘制生存曲线, 使用Log-rank检验比较差异。采用单因素和多因素Cox比例风险模型分析与肿瘤特异性生存相关的因素。结果随访时间为49.2(48.0)个月(范围:1～229个月), 生存1 974例, 死亡72例。中位肿瘤特异性生存期未达到。5年和10年肿瘤特异性生存率分别为97.0%和91.2%。pT1a(1 447例)、pT1b(523例)、pT2期(58例)患者的10年肿瘤特异性生存率分别为95.3%、81.8%、81.7%。病理核分级G1(226例)、G2(1 244例)、G3～4级(278例)患者的10年肿瘤特异性生存率分别为96.6%、89.4%、85.5%。开放、腹腔镜和机器人手术患者的5年肿瘤特异性生存率无差异(96.7%比97.1%...     

血清总胆红素水平在IgA肾病预后评估中的作用

目的探究IgA肾病(IgAN)患者的血清总胆红素(TB)水平与肾脏不良预后的关系。方法回顾性分析2018年1月至2021年1月于天门市第一人民医院就诊并通过肾活检诊断为原发性IgAN的149例患者的临床及病理资料, 根据IgAN患者的血清TB水平分为低TB组(L-TB组, 76例)和高TB组(H-TB组, 73例), 比较两组的临床及病理资料。采用Kaplan-Meier生存曲线评估患者的肾脏累积生存率, 采用Cox回归模型法分析影响IgAN患者病情进展的危险因素, 采用平滑曲线拟合及阈值分析探究血清TB水平与IgAN肾脏不良预后的关系。结果 L-TB组的低密度脂蛋白胆固醇显著高于H-TB组, 血清TB显著低于H-TB组, 差异均有统计学意义(均P<0.05)。Kaplan-Meier生存曲线分析结果显示, L-TB组患者的IgAN病情进展的风险明显高于H-TB组(χ2=5.552, P=0.019)。多因素Cox回归分析结果显示TB降低(HR=0.74, 95%CI:0.61～0.88, P=0.017)、血肌酐升高(HR=1.30, 95%CI:1.21～1.98, P=0....     

术前丙氨酸氨基转移酶与天冬氨酸氨基转移酶比值作为胰腺癌根治性胰十二指肠切除术预后标志物的临床研究

目的评估天冬氨酸氨基转移酶与丙氨酸氨基转移酶比值(DRR)对于接受根治性胰十二指肠切除术的胰腺导管腺癌(PDAC)患者术后总生存的预测价值。方法回顾性分析2015年1月至2020年12月于解放军总医院行根治性胰十二指肠切除术且术后病理诊断为PDAC的137例患者临床资料, 其中男性97例, 女性40例, 年龄(58±10)岁。根据DRR最佳生存风险截断值将患者分组, 比较关键临床病理指标的组间差异。采用Kaplan-Meier法进行生存分析, 生存率比较采用log-rank检验。采用多因素Cox分析评估影响预后的危险因素。结果将137例PDAC患者依据DRR最佳截断值1.1分为两组:DRR≥1.1为高DRR组(n=29);DRR<1.1为低DRR组(n=108)。低DRR组患者累积生存率优于高DRR组, 差异有统计学意义(P=0.003)。多因素Cox回归分析结果显示, DRR≥1.1(HR=2.485, 95%CI:1.449～4.261, P=0.001)、术前胆道引流(HR=1.845, 95%CI:1.030～3.306, P=0.039)、淋巴结转移N2分期(HR=2....     

术前外周血中纤维蛋白原水平与肾癌患者预后的关系

目的探讨术前外周血中纤维蛋白原水平与经手术治疗的肾癌患者预后的关系。方法回顾性分析北大医院2010至2012年行手术治疗的280例肾癌患者的临床病理资料和术后随访资料,采用受试者工作特征曲线法确定纤维蛋白原的最佳临界值,根据临界值将患者分入高水平纤维蛋白原组和低水平纤维蛋白原组。χ~2检验分析两组间多种临床病理特征的区别,并采用Kaplan-Meier法计算生存率,Log-rank检验分析组件差距,使用Cox风险回归模型分析肾癌患者预后的独立预测因子。结果术前血浆纤维蛋白原水平与年龄、高血压、肿瘤分级、肿瘤病理分期密切相关(P=0.035,P=0.006,P0.001,P0.001)。单因素分析结果显示,血浆纤维蛋白原水平、肿瘤的分级、病理分期与患者总生存时间显著相关(P均0.001)。进一步通过Cox回归模型分析发现,术前血浆纤维蛋白原水平是肾癌术后患者总体生存时间和肿瘤特异生存时间的独立预后因子,但并非无病生存时间的独立预后因子。结论术前血浆中高纤维蛋白原水平是肾癌术后患者不良预后的独立预测因素。     

术前全身炎症反应指数和纤维蛋白原在肾癌切除术后肿瘤预后的影响

目的:探讨肾癌患者术前全身炎症反应指数(systemic inflammation response index,SIRI)和纤维蛋白原(fibrinogen,FIB)在预后评估中的临床价值。方法:回顾性分析2011年1月—2014年12月我院收治肾癌患者的临床及术后随访资料;采用受试者工作曲线(ROC)确定SIRI和FIB的最佳临界值。分析低SIRI组与高SIRI组和低FIB组与高FIB组临床特征间的差异;运用Kaplan-Meier法计算生存率,通过log-rank检验比较组间的生存率差异;通过Cox比例风险回归模型分析影响肾癌预后的影响因素。采用所有5年生存率的独立预后指标,包括Fuhrman分级,SIRI值,FIB值建立列线图,预测患者5年生存率。结果:本研究共收集188例肾癌患者,ROC曲线确定SIRI和FIB的最佳临界值分别为1.81和3.42 g/L,分为高SIR组、低SIRI组,高FIB组、低FIB组。术前SIRI水平与组间患者肿瘤大小、TNM分期、Fuhrman分级、淋巴结转移、高血压病史密切相关(P0.05);术前FIB水平与组间患者年龄、TNM分期、Fuhrman分级、淋巴结转移、有无高血压密切相关(P0.05)。Cox多因素回归分析结果显示,SIRI1.81、FIB3.42 g/L、Fuhrman分级是影响肾癌预后的独立危险因素。列线图结果发现可以预测患者术后5年生存率。结论:高SIRI和FIB是影响肾癌预后不良的独立危险因素,对预测患者术后生存状况有积极的作用。     

高龄(≥70岁)早期非小细胞肺癌胸腔镜术后生存的预后因素分析

目的探讨影响高龄(≥70岁)Ⅰ期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者术后生存的预后因素。方法回顾性分析2003年4月~2013年12月我院211例70岁及以上Ⅰ期NSCLC的临床及随访资料,对影响术后生存的预后因素采用Kaplan-Meier生存分析、log-rank检验及Cox回归分析。结果中位随访时间39个月(0~93个月)。5年总生存率为66.9%,Kaplan-Meier生存分析和Cox单因素回归分析显示病变部位、病理分期、病变直径、分化程度、查尔森合并症指数(Chalson comorbidity index,CCI)对总生存期存在影响。Cox多因素回归分析显示:病变部位(HR=3.946,95%CI1.571~9.910)、病理分化(HR=2.003,95%CI 1.049~3.824)、肿瘤直径(HR=2.841,95%CI 1.478~5.462)及CCI(HR=3.920,95%CI 1.767~8.698)是影响高龄早期肺癌患者术后生存的独立预后因素。结论对于早期高龄NSCLC患者,CCI、病变部位、分化程度、肿瘤直径是影响术后生存的重要预后因素。CCI对长期生存预后有一定的价值。加强术前综合评估有利于指导预后。     

系统免疫炎症指数在胰腺导管腺癌患者Whipple术后总体生存率中的预测价值

目的研究系统免疫炎症指数(SII)在胰腺导管腺癌患者Whipple术后总体生存率中的预测价值。方法回顾性分析2010年1月1日至2017年12月31日在郑州大学第一附属医院进行Whipple术的胰腺导管腺癌患者临床资料,计算SII值。取SII最佳截断值为900,以900为界值将所有患者分为低SII组(SII≤900)和高SII组(SII>900),应用Kaplan-Meier法绘制生存曲线,采用log-rank检验对两组患者的总生存时间进行分析,采用Cox风险回归模型对各项临床病理参数进行单因素分析,并对具有统计学意义的指标进行多因素分析。结果共纳入135例患者,其中男性78例,女性57例,年龄28.0~76.0(56.6±8.8)岁。低SII组纳入92例,年龄(56.9±9.2)岁,男性53例,女性39例;高SII组纳入43例,年龄(56.1±7.9)岁,男性25例,女性18例。低SII组和高SII组两组中位生存时间分别为32.7个月(95%CI:28.4~37.0)和24.4个月(95%CI:21.4~27.4),低SII组胰腺导管腺癌患者生存率高于和高SII组,差异有统计学意义(P<0.05)。在单因素生存分析中,胰腺导管腺癌患者术后总生存期与高SII(HR=2.047,95%CI:1.354~3.096)、R1切缘(HR=2.595,95%CI:1.663~4.048)、淋巴结阳性率>20%(HR=3.244,95%CI:1.888~5.573)、区域淋巴结(N1)(HR=3.061,95%CI:1.993~4.702)有关(均P<0.05)。多因素Cox回归分析显示,高SII(HR=1.672,95%CI:1.094~2.555)、R1切缘(HR=2.167,95%CI:1.274~3.685)、淋巴结阳性率>20%(HR=2.631,95%CI:1.309~5.285)是影响胰腺导管腺癌患者Whipple术后总生存期的独立危险因素(P<0.05)。结论SII是胰腺导管腺癌患者术前可获得的独立预后因子,在预测胰腺导管腺癌患者行Whipple术后总生存期方面有一定指导意义。     

伴有静脉癌栓肾癌患者手术效果及其相关预后因素分析

目的:探讨伴有静脉癌栓肾癌患者行根治性肾切除联合静脉癌栓取出术的手术疗效及相关预后因素。方法:回顾性分析2013年5月—2022年2月于中国科学技术大学附属第一医院(安徽省立医院)行手术治疗的伴有静脉癌栓肾癌患者的临床资料。用Kaplan-Meier分析得到总生存曲线,用log-rank检验进行统计学比较;采用Cox回归模型进行多因素生存分析,寻找影响预后的独立危险因素。结果:共纳入59例患者,0～Ⅳ级癌栓分别有36例、4例、10例、5例、4例。围手术期无死亡事件发生。患者术后3年、5年总生存率分别为66.1%、50.1%。单因素Cox分析表明,病理类型(非透明细胞癌)(HR=2.613,95%CI:1.237～5.520,P<0.05)、癌栓分级(HR=2.339,95%CI:0.985～5.557,P<0.05)、M分期(HR=3.114,95%CI:1.474～6.578,P<0.05)、肾周脂肪侵犯(HR=2.986,95%CI:1.360～6.559,P<0.05)与患者预后相关;多因素Cox回归分析表明,病理类型(非透明细胞癌)(HR=3.326,9...     

术前血小板/淋巴细胞比值与肝癌预后的关系

目的:探讨术前血小板/淋巴细胞比值(PLR)与肝癌预后的关系。方法:回顾性分析行手术治疗的256例肝癌患者的临床资料。根据患者术前PLR水平,绘制PLR诊断肿瘤复发的受试者工作特征(ROC)曲线,确定PLR界值,分析术前外周血PLR水平分与患者临床病理因素及预后的关系。结果:PLR诊断肿瘤ROC曲线下面积为0.625(95%CI=0.544~0.706),灵敏度为0.53,特异度为0.70,界值为131.81。患者术前外周血PLR水平与术前血清白蛋白、Child-Pugh分级、是否伴有腹水、血管侵犯、TNM分期等临床病理因素有关(均P0.05)。Cox风险模型分析显示,TNM分期(HR=1.441,95%CI=1.721~2.635,P0.001)、PLR(HR=1.737,95%CI=1.317~2.291,P0.001)为肝癌预后的独立影响因素,而PLR(HR=1.893,95%CI=1.434~2.497,P0.001)为肝癌复发的独立影响因素。生存分析显示,低PLR患者术后1、3、5年无瘤生存率(81.2%、53.3%、29.6%)明显高于PLR患者(62.4%、30.4%、11.6%)。结论:术前PLR可以作为肝癌患者的预后指标,高PLR水平患者术后复发率高、预后差。     

术前纤维蛋白原水平对肝细胞癌微血管侵犯及预后的影响

目的 探讨术前血清纤维蛋白原（fibrinogen,FIB）水平与肝细胞癌（hepatocellular carcinoma,HCC）微血管侵犯（microvascular invasion,MVI）的关系及FIB对根治切除术后HCC预后的影响。方法回顾性分析福建医科大学孟超肝胆医院2015年1月至2019年4月行根治性肝切除手术的566例HCC患者的临床数据。通过绘制受试者工作特征曲线（receiver operating characteristic curve,ROC）分析FIB预测MVI的能力,并确定FIB预测MVI的最佳临界值;依据该临界值分为低FIB组和高FIB组,采用χ2 检验分析FIB与临床病理因素之间的关系;采用Kaplan-Meier法进行生存分析,采用Log-rank法进行差异性检验,单因素、多因素Cox回归分析法评价HCC预后的影响因素。结果 术前FIB预测MVI的最佳临界值为2.7 g/L。根据临界值分组,高FIB组（FIB＞2.7 g/L）MVI阳性率高于低FIB组（FIB≤2.7 g/L）[64.0%（183/283）vs 47.0%（133/283）,P＜0.01],高FIB组无复发生存率（recurrence-free survival,RFS）低于低FIB组（两组1、2、3年RFS分别为68.6%、47.0%、35.4%,以及71.5%、60.0%、48.3%,P＜0.05）,但两组总体生存率（overall survival,OS）差异无统计学意义（P=0.14）。单因素和多因素Cox回归分析显示FIB是HCC的RFS危险因素（HR=1.37,95%CI 1.07～1.75,P=0.011）,MVI是影响HCC者预后的独立危险因素（HR=6.65,95%CI 2.78～15.87,P＜0.001）。结论 本研究显示,术前纤维蛋白原水平与微血管侵犯呈正相关,与肝细胞癌根治性切除术后无复发生存率呈负相关。     

Prognostic Value of Sarcopenia and Albumin in the Surgical Management of Localized Renal Cell Carcinoma

IntroductionA universally accepted model for preoperative surgical risk stratification in localized RCC patients undergoing nephrectomy is currently lacking. Both the evaluation of body composition and nutritional status has demonstrated prognostic value for patients with cancer. This study aims to investigate the potential associations between sarcopenia and hypoalbuminemia and survival outcomes in patients with localized kidney cancer treated with partial or radical nephrectomy.Materials and MethodsWe retrospectively analyzed 473 patients with localized RCC managed with radical and partial nephrectomy. Skeletal muscle index (SMI) was measured from preoperative CT and MRI. Sarcopenic criteria were created using BMI- and sex-stratified thresholds. Relationships between sarcopenia and hypoalbuminemia (Albumin <3.5 g/dL) with overall (OS), recurrence-free (RFS), and cancer-specific survival (CSS) were determined using multivariable and Kaplan-Meier analysis.ResultsOf the 473 patients, 42.5% were sarcopenic and 24.5% had hypoalbuminemia. Sarcopenia was significantly associated with shorter OS (HR=1.51, 95% CI 1.07-2.13), however, was nonsignificant in the RFS (HR = 1.33, 95% CI 0.88-2.03) and CSS (HR=1.66, 95% CI 0.96-2.87) models. Hypoalbuminemia predicted shorter OS (HR=1.76, 95% CI 1.22-2.55), RFS (HR=1.86, 95% CI 1.19-2.89), and CSS (HR=1.82, 95% CI 1.03-3.22). Patients were then stratified into low, medium, and high-risk groups based on the severity of sarcopenia and hypoalbuminemia. Risk groups demonstrated an increasing association with shorter OS (all p<0.05). Reduced RFS was observed in the medium risk-hypoalbuminemia (HR=2.18, 95% CI 1.16-4.09) and high-risk groups (HR=2.42, 95% CI 1.34-4.39). Shorter CSS was observed in the medium risk-hypoalbuminemia (HR=2.31, 95% CI 1.00-5.30) and high-risk groups (HR=2.98, 95% CI 1.34-6.61).ConclusionLocalized RCC patients with combined preoperative sarcopenia and hypoalbuminemia displayed a two to a three-fold reduction in OS, RFS, and CSS after nephrectomy. These data have implications for guiding prognostication and treatment election in localized RCC patients undergoing extirpative surgery.     

Prognostic effect of preoperative serum albumin to globulin ratio in patients treated with cytoreductive nephrectomy for metastatic renal cell carcinoma

BackgroundAccurate identification of ideal candidates for cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC) is an unmet need. We tested the association between preoperative value of systemic albumin to globulin ratio (AGR) and overall survival (OS) as well as cancer-specific survival (CSS) in mRCC patients treated with CN.MethodsmRCC patients treated with CN were included. The overall population was therefore divided into two AGR groups using cut-off of 1.43 (low, <1.43 vs. high, ≥1.43). Univariable and multivariable Cox regression analyses tested the association between AGR and OS as well as CSS. The discrimination of the model was evaluated with the Harrel’s concordance index (C-index). The clinical value of the AGR was evaluated with decision curve analysis (DCA).ResultsAmong 613 mRCC patients, 159 (26%) patients had an AGR <1.43. Median follow-up was 31 (IQR: 16–58) months. On univariable analysis, low preoperative serum AGR was significantly associated with both OS (HR: 1.55, 95% CI: 1.26–1.89, P<0.001) and CSS (HR: 1.55, 95% CI: 1.27–1.90, P<0.001). On multivariable analysis, AGR <1.43 was associated with worse OS (HR: 1.51, 95% CI: 1.23–1.85, P<0.001) and CSS (HR: 1.52, 95% CI: 1.24–1.86, P<0.001). The addition of AGR only minimally improved the discrimination of a base model that included established clinicopathologic features (C-index=0.640 vs. C-index=0.629). On DCA, the inclusion of AGR marginally improved the net benefit of the prognostic model. Low AGR remained independently associated with OS and CSS in the IMDC intermediate risk group (HR: 1.52, 95% CI: 1.16–1.99, P=0.002).ConclusionsIn our study, low AGR before CN was associated with worse OS and CSS, particularly in intermediate risk patients.     

Prognostic value of preoperative albumin-to-fibrinogen ratio (AFR) in patients with bladder cancer treated with radical cystectomy

Introduction and objectivesTo evaluate the prognostic role of albumin-to-fibrinogen ratio (AFR) for the prediction of oncological outcomes in a multi-institutional cohort of bladder cancer (BC) patients treated with radical cystectomy (RC).Materials and methodsWe retrospectively analyzed a multicenter cohort of patients treated with upfront RC for localized (cT1-4aN0M0) BC. Multivariable logistic regression analyses were performed to evaluate the ability of AFR to predict non-organ confined (NOC) disease and lymph-node involvement (LNI) at time of RC. Multivariable Cox’ regression models were performed to evaluate the prognostic effect of AFR on Time-to-Progression (TTP), overall survival (OS), and cancer-specific survival (CSS).ResultsA cut-off value to discriminate between low and high AFR was determined by calculating the receiver operating characteristic (ROC) curve. The area under the curve was 0.73 with an optimal cut-off at 9.53. Data were available for 246 patients (91 with low AFR, 155 with high AFR). Low AFR was associated with characteristics of tumor aggressiveness and independently predicted NOC (OR 2.11, P = 0.02) and LNI (OR 1.58, P = 0.04) at final pathological report. On multivariable Cox’ regression analyses, preoperative low AFR was independently associated with worse TTP (HR 2.21, P = 0.02), OS (HR 2.24, P = 0.03), and CSS (HR 2.70, P = 0.01).ConclusionPreoperative low AFR is a prognostic biomarker for worse TTP, OS, CSS, and is independently associated with adverse tumor pathological features in BC patients undergoing RC. Our results suggest that especially patients with low AFR may be considered for neoadjuvant treatment.     

Long-term outcomes after radical or partial nephrectomy for T1a renal cell carcinoma: A population-based study

IntroductionThe benefit of partial nephrectomy (PN) compared to radical nephrectomy (RN) for T1a renal cell carcinoma (RCC) remains uncertain, with observational studies conflicting with level 1 evidence. Therefore, the purpose of this population-based study was to compare long-term outcomes in patients undergoing PN or RN for T1a RCC.MethodsWe studied 5670 patients in Ontario, Canada undergoing PN or RN for T1a RCC. The primary outcome was overall survival (OS). Secondary outcomes were cancer-specific survival (CSS), chronic kidney disease (CKD), renal replacement therapy, and myocardial infarction (MI). We used multivariable Cox proportional hazard models to evaluate the association between PN or RN and these outcomes. A sensitivity analysis was performed in patients with a preoperative serum creatinine available.ResultsMedian followup was 77 months. Compared to RN, PN was associated with significantly improved OS (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.63–0.84), reduced risk of CKD (HR 0.18, 95% CI 0.12–0.27), and improved CSS (HR 0.45, 95% CI 0.30–0.65). The risk of MI was not significantly different between groups (HR 0.91, 95% CI 0.62–1.34). Few patients (n=15) required renal replacement therapy. In the sensitivity analysis, the association between type of surgery and OS and CKD persisted, while the association with CSS did not.ConclusionsOur study found that in patients undergoing surgery for T1a RCC, PN was associated with improved OS and reduced risk of CKD compared to RN. However, few patients in either group required renal replacement therapy.     

Association of preoperative serum De Ritis ratio with oncological outcomes in patients treated with cytoreductive nephrectomy for metastatic renal cell carcinoma

PurposeIdentifying which patients are likely to benefit from cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC) is important. We tested the association between preoperative serum De Ritis ratio (DRR, Aspartate Aminotransferase/Alanine Aminotransferase) and overall survival (OS) as well as cancer-specific survival (CSS) in mRCC patients treated with CN.Material and methodsmRCC patients treated with CN at different institutions were included. After assessing for the optimal pretreatment DRR cut‐off value, we found 1.2 to have the maximum Youden index value. The overall population was therefore divided into 2 DRR groups using this cut‐off (low, <1.2 vs. high, ≥1.2). Univariable and multivariable Cox regression analyses tested the association between DRR and OS as well as CSS. The discrimination of the model was evaluated with the Harrel's concordance index (C-index). The clinical value of the DRR was evaluated with decision curve analysis.ResultsAmong 613 mRCC patients, 239 (39%) patients had a DRR ≥1.2. Median follow-up was 31 (IQR 16–58) months. On univariable analysis, high DRR was significantly associated with OS (hazard ratios [HR]: 1.22, 95% confidence interval [CI]: 1.01–1.46, P = 0.04) and CSS (HR: 1.23, 95% CI: 1.02–1.47, P = 0.03). On multivariable analysis, which adjusted for the effect of established clinicopathologic features, high DRR remained significantly associated with both OS (HR: 1.26, 95% CI: 1.04-1.52, P = 0.02) and CSS (HR: 1.26, 95% CI: 1.05–1.53, P = 0.01). The addition of DRR only minimally improved the discrimination of a base model that included established clinicopathologic features (C-index = 0.633 vs. C-index = 0.629). On decision curve analysis, the inclusion of DRR did not improve the net-benefit beyond that obtained by established subgroup analyses stratified by IMDC risk groups, type of systemic therapy, body mass index and sarcomatoid features, did not reveal any prognostic value to DRR.ConclusionDespite the statistically significant association between DRR and OS as well as CSS in mRCC patients treated with CN, DRR does not seem to add any further prognostic value beyond that obtained by currently available features.     

前列腺根治术前肥胖相关的生化指标对前列腺癌患者预后的意义

目的:探讨前列腺癌根治术(RP)前肥胖相关生化指标[总胆汁酸、空腹血糖(FBG)、血尿酸、总胆固醇、甘油三酯、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)]预测前列腺癌患者预后的价值.方法:选取635例前列腺癌手术患者,根据指南分为低、中、高危三组,在RP前检测并收集其肥胖相关生化指标.根据各指标的正常值,将各组前列...     

Prognostic significance of serum lactate dehydrogenase in patients undergoing radical cystectomy for bladder cancer

BackgroundTo investigate the prognostic significance of preoperative serum lactate dehydrogenase (LDH) in patients undergoing radical cystectomy for bladder cancer (BCa).Patients and methodsA cohort of 263 patients undergoing open or laparoscopic radical cystectomy between 2011 and 2016 was studied. Baseline characteristics, hematological variables, follow-up data were collected. Kaplan-Meier curves and Cox proportional hazard regression model were applied to assess the relationship between LDH and overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS).ResultsAfter a median 34.2 (22.9–45.8) months follow-up, all-cause death, cancer-specific death, and disease recurrence occurred in 66 patients, 50 patients, and 91 patients. The elevation of serum LDH was associated with several unfavorable parameters, including advanced age, continent cutaneous urinary diversion, increased neutrophil-to-lymphocyte ratio, decreased lymphocyte-to-monocyte ratio. Patients with a higher serum LDH (> 220 U/L) had a worse OS (P < 0.001), CSS (P < 0.001) and DFS (P < 0.001). Multivariate Cox analysis suggested that elevated LDH was an independent predictor for OS (hazard ratio [HR]: 3.113, 95% confidence interval [CI]: 1.524–6.358; P = 0.002), CSS (HR: 4.564, 95% CI: 2.008–10.373; P < 0.001), DFS (HR: 2.051, 95% CI: 1.125–3.739; P = 0.019). Medical history of diabetes, high pT stage, and positive lymph node also were adverse predictors for oncological outcomes of BCa patients in multivariate analysis.ConclusionsPreoperative serum LDH is an independent prognostic biomarker for OS, CSS, and DFS in patients undergoing radical cystectomy for BCa, which can be incorporated into prognostic models.     

术前血清miR-20a、miR-17在结直肠癌预后评估中的价值

目的探讨结直肠癌患者术前血清miR-20a、miR-17水平在术后不良临床结局评估中的价值。 方法选择2013年8月至2016年2月华中科技大学同济医学院附属协和医院就诊的结直肠癌患者73例作为病例组,收集患者术前以及术后1周、1个月、3个月时的血清标本,另收集81名同期体检健康对照组的血清标本,采用实时荧光定量PCR法检测两组血清miR-20a、miR-17表达水平。根据表达平均数分为高表达组与低表达组,采用Kaplan-Meier法对两组进行生存分析;Cox比例风险回归模型筛选不良预后的影响因素,受试者工作特征（ROC）曲线分析血清miR-20a、miR-17水平对结直肠癌不良预后的诊断效能。 结果病例组患者术后血清miR-20a、miR-17水平呈下降趋势（P<0.05）,且各检测点水平均高于对照组（P<0.05）。分化程度（HR=1.462,95% CI：1.096~1.951）、TNM分期（HR=1.642,95% CI：1.339~2.014）、术前血清miR-20a（HR=1.575,95% CI：2.035~3.652）、miR-17水平（HR=2.491,95% CI：2.131~2.914）是影响结直肠癌患者不良预后的独立危险因素（均P<0.001）。术前血清miR-20a、miR-17高表达者的3年总生存率更低（22.0% vs 78.3%,21.3% vs 73.1%,P<0.05）;两者联合检测预测结直肠癌患者预后不良的曲线下面积为0.955,敏感度为97.6%,特异度为91.2%。 结论结肠癌患者术前血清miR-20a、miR-17高表达与患者不良预后有关,术前检测有助于改善不良预后高风险患者的临床结局。     

Effect of concomitant variant histology on the prognosis of patients with upper urinary tract urothelial carcinoma after radical nephroureterectomy

ObjectiveTo evaluate the prognostic effect of concomitant variant histology (CVH) on survival outcomes in patients with upper urinary tract urothelial carcinoma (UTUC) after radical nephroureterectomy.Materials and methodsData on 417 patients with UTUC treated with radical nephroureterectomy without preoperative adjuvant therapy were retrospectively reviewed with a focus on CVH. Clinicopathological features and prognostic factors were compared between patients with pure UTUC and patients with UTUC with CVH. The primary end points were cancer-specific survival (CSS), disease recurrence-free survival (DFS), and overall survival (OS).ResultsUTUC with CVH was present in 90 (21.6%) of 417 patients. At a median follow-up of 26 months, 153 (36.7%) had died of UTUC, 161 (38.6%) had experienced a relapse, and 176 (42.2%) had died of other causes. UTUC with CVH was significantly associated with advanced tumor stage, high tumor grade, tumor diameter, lymphovascular invasion, lymph node metastasis, positive surgical margins, and tumor architecture compared with pure UTUC (all P<0.01). The estimated 5-year CSS, DFS, and OS rates were 64.9%, 61.1%, and 62.1%, respectively, in the pure UTUC group, compared with 36.3%, 34.3%, and 26.5%, respectively, in the UTUC with CVH group (P<0.001). Multivariate analysis demonstrated that CVH was an independent predictor of CSS (hazard ratio [HR] = 1.594; 95% CI: 1.125–2.259; P = 0.009), DFS (HR = 1.549; 95% CI: 1.077–2.152; P = 0.017), and OS (HR = 1.685; 95% CI: 1.212–2.343; P = 0.002).ConclusionsApproximately one-fifth of the specimens of patients with UTUC were observed to exhibit CVH. CVH was an independent prognostic factor for CSS, DFS, and OS in patients with UTUC on both univariate and multivariate analyses. Genitourinary pathologists should look for potential CVH components in UTUC specimens and report this in routine pathological practice. The presence of CVH should identify patients as candidates for consultation regarding early adjuvant therapy and intensive surveillance protocols.