32例颌面部骨肉瘤临床特点比较及预后影响因素分析

背景与目的：骨肉瘤是较常发生于青少年的间叶组织来源的恶性肿瘤。多发于四肢,较少发生于颌面部。此类骨肉瘤的治疗大多为手术切除,辅以化疗和放疗。因为较为罕见,国内报道较少。故该研究探讨影响颌面部骨肉瘤预后的相关因素。方法：回顾性分析了2010年1月—2017年1月收治的32例颌面部骨肉瘤的临床病理资料并且对预后进行随访,随访时间为7~90个月,平均为75个月,以性别、年龄、肿瘤大小、手术切缘、肿瘤的生长部位、手术方式、手术后进行辅助化疗的次数、局部复发及转移这9项因素作为变量。应用Kaplan-Meier计算并分析其生存率,应用log-rank进行单因素分析检验,应用Cox回归模型进行多因素分析,研究这些因素和患者的生存率之间的关联。结果：32例骨肉瘤患者中位总生存期(overall survival,OS)为(47.6±8.4)个月(95%CI：31.1~64.1),累计1年和2年生存率分别为84%和72%,5年生存率为44%。单因素分析结果显示,骨肉瘤的手术切缘、术后化疗与患者的复发有关。肿瘤直径、手术切缘、术后辅助化疗是影响骨肉瘤生存的因素。多因素分析结果显示,肿瘤大小、术后辅助化疗是影响颌面部骨肉瘤患者治疗预后的主要因素。其他变量差异无统计学意义。结论：颌面部骨肉瘤有独特的生物学特性和预后,手术切缘和术后辅助化疗次数是影响骨肉瘤患者预后的主要因素。     

Predicting survival in patients with advanced disease

Prognostication is an important clinical skill for all clinicians, particularly those clinicians working with patients with advanced cancer. However, doctors can be hesitant about prognosticating without a fundamental understanding of how to formulate a prognosis more accurately and how to communicate the information with honesty and compassion. Irrespective of the underlying type of malignancy, most patients with advanced cancer experience a prolonged period of gradual decline (months/years) before a short phase of accelerated decline in the last month or two. The main indicators of this final phase are poor performance status, weight loss, symptoms such as anorexia, breathlessness or confusion and abnormalities on laboratory parameters (e.g. high white cell count, lymphopaenia, hyopalbuminaemia, elevated lactate dehydrogenase or C-reactive protein). The clinical estimate of survival remains a powerful independent prognostic indicator, often enhanced by experience, but research has only begun to understand the different biases affecting clinicians’ estimates. More recent research has shown probabilistic predictions to be more accurate than temporal predictions. Simple, reliable and valid prognostic tools have been developed in recent years that can be used readily at the bedside of terminally ill cancer patients. The greatest accuracy occurs with the use of a combination of subjective prognostic judgements and objective validated tools.Communicating survival predictions is an important part of cancer care and guidelines exist for improving delivery of such information. Important cultural differences may influence communication strategies and should be recognised in clinical encounters. More well-designed studies of prognosis and its impact on decision making are needed. The benefits and limitations of prognostication should be considered in many clinical decisions.     

腋淋巴结阳性Ⅰ,Ⅱ期乳癌预后因素分析

目的确定具有高危复发转移倾向的病人．给他们实施积极而合理的治疗,以改善他们的预后。方法回顾性地分析了188例脏窝淋巴结阳性,术后接受CMFVP辅助化疗的Ⅰ、Ⅱ期乳癌病人。观察的终点指标为5年无病生存率（DFS）和总生存率（OS）。考虑分析的因素包括年龄、月经状态、病程、原发肿瘤大小、雌激素受体状态、阳性腑窝淋巴结数量。结果对DFS和OS有预后意义的两个因素是原发肿瘤大小和阳性腋窝淋巴结数量。传统的T1和T2之间比较,预后无明显差别。但把肿瘤的大小由2cm改为3cm为观察界限,肿瘤的大小将是非常明显的预后因素。T≤3cm的病人的5年DFS和OS分别是71．3％和83．2％,而T＞3cm的病人5年DFS和OS分别是48．3％（P＜0．01）和62．6％（P＜0．01）。将这两个不良的预后因素按T＞3cm和N＋≥4把病人分成三组,Ⅰ组是没有以上两个因素;Ⅱ组是只有其中一个不良的因素;Ⅲ组是同时具有两个不良因素。三组病人的5年DFS分别为78．3％、59．2％、28．4％（P＜0．05）。5年OS分别为86．2％、74．3％、40．0％（P＜0．05）。结论我们的分析证实了传统预后指标的意义,同时也发现,肿瘤直径＞3cm是一个不良的预后因素,它不依赖于阳性淋巴结的数目．这提示我们在设计和分析临床试验,确定病人治疗措施时应充分     

93例转移性恶性黑色素瘤预后分析

目的:探讨转移性恶性黑色素瘤的预后因素。方法:回顾性分析93例经病理证实的转移性恶性黑色素瘤患者的临床资料及实验室、影像学检查结果。结果:93例转移性恶性黑色素瘤患者2年生存率为10.8%(10/93)。性别、体质状况、有无肝脏转移、转移部位数目、血清LDH水平、白蛋白水平以及转移灶是否切除对患者的2年生存率有显著影响;而不同年龄患者的2年生存率无统计学差异。结论:女性、体质状况较好、无肝脏转移、单一部位转移、LDH或白蛋白水平正常以及孤立转移病灶的手术切除是预后好的指标。     

Early stage carcinoma of oral tongue: prognostic factors for local control and survival

The purpose of this study was to assess prognostic factors, treatment outcomes and patterns of relapse in patients with early stage (T1-2 N0) squamous cell carcinoma of oral tongue treated primarily by surgery. The medical records of all patients with early stage (T1-2 N0) oral tongue cancer, radically treated at King Faisal Specialist Hospital and Research Center between January 1980 and December 1997, were reviewed. Eighty-five patients were identified for analysis, 38 male and 47 female. With a median follow-up for surviving patients of 64 months, 5-year actuarial overall, disease-specific (DSS), and relapse-free survival (RFS) were 71, 75, and 63%, respectively. Univariate analysis for DSS showed survival advantage for patients with tumor thickness (TT) of 10 mm (P=0.0002) and distance from resection margin (DFRM) of >5 mm (P=0.005). The effect of TT of 10 mm was maintained (P=0.001) on multivariate analysis. Higher RFS was observed with TT of 10 mm (P=0.0002), DFRM of >5 mm (P=0.0002) and DFRM of >10 mm (P=0.007). On multivariate analysis higher RFS was also found for TT 10 mm (P=0.01) and DFRM >5 mm (P=0.01). Salvage of local tongue recurrence was higher than neck node failure, with 5-year DSS of 71 and 19%, respectively (P=0.007). Time interval for recurrence showed no significant impact on outcome. In T1-2 N0 oral tongue cancer, TT, and DFRM are significant prognostic factors for both local control and survival. Neck node recurrence is associated with poor prognosis and low salvage rate.     

248例N0期非小细胞肺癌的预后因素分析

目的:回顾性分析248例N0期非小细胞肺癌的预后因素。方法:本文选取1994年1月～1997年7月间行根治性切除的248例N0期非小细胞肺癌,采用Kaplan-Meier法绘制生存曲线(Log-Rank检验)和COX多因素回归对该组病例的预后因素进行分析。结果:术中同侧肺门和纵隔淋巴结清扫超过6枚的病例生存率高于6枚以下的病例(P=0.005);术后生存率随T1、T2、T3和T4依次明显递减(P<0.001);术后化疗组病例的生存期高于非化疗组(P=0.016);鳞癌和腺癌的生存率高于其他病理类型(P=0.002)。结论:纵隔淋巴结的清扫数量、术后化疗与否、肿瘤的T分期和病理类型是影响N0期非小细胞肺癌预后的主要因素,而性别、术后放疗、术后免疫治疗、手术方式等对预后无明显影响。     

Psychosocial predictors of survival: Metastatic breast cancer

Background:Research interest in psychosocial predictors of theonset and course of cancer has been active since the 1950s. Recently wereported associations between psychological factors and survival in patientswith metastatic melanoma. We now report a replication of this study in asample of women with metastatic breast cancer.Patients and methods:Ninety-nine patients with metastatic breastcancer completed questionnaires measuring cognitive appraisal of threat,coping, psychological adjustment, perceived aim of treatment, social supportand quality of life, approximately four months after diagnosis. Survival wasmeasured from date of study entry to date of death or censored at the date oflast follow-up for surviving patients.Results:In a multivariate analysis, four factors independentlypredicted outcome. Patients with metastases in the liver, lung or pleurasurvived for a shorter duration (P < 0.001); older patients(P < 0.001) and those with a better appetite (P <0.05) also lived for a shorter time. Patients who minimised the impact ofcancer survived longer (a median of 29.1 vs. 23.9 months after study entry,P < 0.01).Conclusions:Minimisation was also significantly associated withoutcome in patients with metastatic melanoma who participated in anidentically designed study, reported elsewhere. This suggests thatminimisation may have a general impact on cancer progression and deservescloser scrutiny in other cancers.     

Risk factors for intrahepatic cholangiocarcinoma in a low-risk population: a nationwide case-control study

Recently, the incidence of intrahepatic cholangiocarcinoma (ICC) has been increasing in a number of developed (Western) countries. However, risk factors in these low-risk populations are poorly understood. In this nationwide population based case-control study in Denmark, we examined the relationship between selected medical conditions and subsequent ICC risk to provide additional clues to etiopathogenesis. All histologically confirmed ICC cases diagnosed in Denmark between 1978 and 1991 were identified from the Danish cancer registry. Population controls were selected from the central population registry and were matched 4:1 to cases on sex and year of birth. Cases and controls were linked to the Danish hospital discharge registry to obtain information on prior hospital diagnoses. Odds ratios (OR) and 95% confidence intervals (95% CI) were derived using conditional logistic regression. A total of 764 ICC cases and 3,056 population controls were included in the study. Chronic liver diseases were significantly related to ICC: alcoholic liver disease (OR = 19.22, 95% CI = 5.55-66.54), unspecified cirrhosis (OR = 75.9, 95% CI 10.2-565.7). Bile duct diseases were also associated with risk: cholangitis (OR = 6.3, 95% CI = 2.3-17.5), choledocholithiasis (OR = 23.97, 95% CI = 2.9-198.9), cholecystolithiasis (OR = 4.0, 95% CI = 2.0-7.99), though gallbladder removal did not change risk (OR = 1.6, 95% CI = 0.65-3.7). Among other conditions, chronic inflammatory bowel disease (OR = 4.7, 95% CI = 1.65-13.9) was significantly associated with ICC. Diabetes was associated with risk in the year prior to diagnosis of ICC (OR = 3.02, 95% CI = 1.05-8.69). Obesity was unrelated to risk. These results confirm that prior bile duct diseases increase risk of ICC and suggest that alcoholic liver disease and diabetes may also increase risk.     

Ⅰ、Ⅱ期霍奇金病放射治疗长期生存的分析

目的评价Ⅰ、Ⅱ期霍奇金病采用扩大照射（ＥｘｔｅｎｄｅｄＦｉｅｌｄ，ＥＦ）、次全淋巴结照射（ＳｕｂｔｏｔａｌＮｏｄａｌＩｒａｄｉａｔｉｏｎ，ＳＴＮＩ）及全淋巴结照射（ＴｏｔａｌＮｏｄａｌＩｒｒａｄｉａｔｉｏｎ，ＴＮＩ）不同方案放射治疗的长期疗效。材料与方法１９７４年４月至１９８９年２月收治的１９１例Ⅰ、Ⅱ期霍奇金病患者，所有病例均做大面积不规则野放射治疗。其中ＥＦ共３９例，ＳＴＮＩ共８８例，ＴＮＩ共６４例。结果发现总复发率和野外复发率在ＥＦ组高于ＳＴＮＩ组或ＴＮＩ组（Ｐ＜０．０５），在ＳＴＮＩ和ＴＮＩ组的总复发率和野外复发率大致相同。ＳＴＮＩ及ＴＮＩ组的５年、１０年及１４年生存率均高于ＥＦ组，虽仅ＴＮＩ组的５年生存率较ＥＦ的５年生存率差异有显著性意义（Ｐ＜０．０５），但仍提示ＥＦ组的照射范围是不够的。Ⅰ期病人５年、１０年和１４年生存率分别为９３．２％、８７．５％和７４．５％，Ⅱ期分别为８８．３％、７８．６％和７８．６％。结论本组结果显示早期霍奇金病采用放射治疗有较好的长期生存率，治疗方案宜采用ＳＴＮＩ为好。     

The management of chronic lymphocytic leukemia at a single centre over a 24-year period: prognostic factors for survival

Over a 24-year period, 137 patients were referred for management of newly diagnosed chronic lymphocytic leukemia. One hundred and nineteen patients have been reviewed in terms of response to therapy and prognostic factors for survival; 18 patients were excluded either because lymph node biopsy was not compatible with the diagnosis of CLL (11 patients), or because the lymphocyte count at presentation was < 5 × 10⁹/1 (seven patients). Patients were staged retrospectively according to both the Rai and Binet Classifications. Forty-eight per cent (57/119) were deemed not to be in need of any treatment at presentation, 36 per cent (43/119) have never received any specific therapy. The majority of patients received chlorambucil alone, at a dose of 10 mg daily given for 6 weeks, followed by a 2-week interval, followed by three, 2-week cycles. The overall response rate (complete + partial remission) was 38 per cent. In terms of survival, there was a trend in favour of patients who responded to treatment in comparison with those who did not but this did not reach statistical significance (P=0.07). Correlation with stage were highly significant, the median survivals for patients with stage A, B and C disease (Binet) were 12.5, 8 and 3.5 years respectively. On univariate analysis, the absolute lymphocyte count at presentation was the most significant prognostic factor for survival, patients presenting with an absolute lymphocyte count above 50 × 10⁹/1 having a less favourable prognosis (P=0.002). However, on multivariate analysis, older age, a low hemoglobin, low platelet count, and the presence of lymphadenopathy and fever at presentation correlated adversely with survival. Overall, 40 patients died as a consequence of CLL or from disease-related causes, 34/40 dying of infection. Twenty-one patients developed second cancers. With a median follow-up of 13 years, these results confirm that the two staging systems can separate patients into prognostic groups, however in practice, there is heterogeneity of outcome within stage. New approaches are urgently needed.     

影响ⅡB期肢体骨肉瘤预后的因素分析

目的 探讨ⅡB期肢体骨肉瘤患者综合治疗后的生存情况,并对影响预后的因素进行分析。方法 回顾性分析200例ⅡB期肢体骨肉瘤患者的一般资料,采用Kaplan-Meier法进行生存分析,Cox比例风险模型对影响预后的因素进行多元分析。结果 200例骨肉瘤患者的1、2、3年生存率分别为87.0％、71.5％和51.5％,中位总生存期（OS）为37.0个月（95%CI：25.67～48.33个月）。单因素分析显示,性别、手术方式、辅助化疗周期数、新辅助化疗后碱性磷酸酶（AKP）水平、病理类型对OS均有影响,新辅助化疗与否对OS的影响接近有统计学意义,而年龄与OS无关。Cox比例风险模型分析显示,辅助化疗周期数、新辅助化疗后AKP水平和病理类型是预后的独立影响因素。结论 规范化的化疗对延长ⅡB期骨肉瘤患者的OS有重要意义,病理类型和新辅助化疗后AKP水平可以为术后个体化治疗提供依据。     

A Retrospective Multicenter Evaluation of Cutaneous Melanomas in Turkey

Background: We defined melanoma distribution in a large series of Turkish patients and evaluated theprognostic parameters of melanomas. Materials and Methods: A total of 1574 patients’ data was retrospectivelycollected at 18 centers in Turkey. Demographic characteristics were questioned and noted. Prognostic parametreswere evaluated based on sentinel lymph node involvement. Results: Mean age was 56.7 (4-99) years. While 844(53.6%) cases were male, 730 (46.4%) cases were female. One thousand four hundred forty-seven (92%) caseswere invasive melanoma and 127 (8%) cases were in-situ melanoma. The most common histopathological formwas the superficial spreading melanoma (SSM) which was found in 549 patients (37.9%). It was followed bynodular melanoma in 379 (26.2%), acral lentiginous melanoma (ALM) in 191 (13.2%) and lentigo malignamelanoma in 132 (9.1%), respectively. On univariate analysis, lymphovascular invasion (p<0.001), tumorthickness (p<0.001), histopathological subtype (p<0.001), Clark level (p=0.001), ulceration (p<0.001), ≥6/mm2mitosis (p=0.005), satellite formation (p=0.001) and gender (p=0.03) were found to be associated with sentinellymph node positivity. Regression was associated with sentinel lymph node negativity (p=0.017). According tomultivariate analysis, lymphovascular invasion and tumor thickness were significant independent predictivefactors of SLN positivity. Patient age, tumor localization, precursor lesions, lymphocytic infiltration andneurotropism were not related with sentinel lymph node involvement. Conclusions: In this retrospective analysis,it was found that the prevalence of SSM is at a lower rate while the prevalence of ALM is at a higher rate whencompared to western countries. According to Breslow index; most of the melanoma lesions’ thickness weregreater than 2 mm, corresponding Clark IV. Vascular invasion and tumor thickness are the most importantfactors for sentinel lymph node involvement.     

甲状腺未分化癌的处理及影响预后因素的探讨

目的：探讨甲状腺未分化癌的治疗及影响预后的因素。方法：回顾性分析1959年至1996年本院收治的11例甲状腺未分化癌，其中4例颈淋巴颈淋巴结清扫，4例患侧甲状腺全切除，3例仅作甲状腺活检（1例活检后放疗）。结果：行甲状腺全切除或仅作活检的7例均有腺体外侵犯，且年龄偏大，病程长，除1例术后放疗生存2．5年外，其余均于术后1至6个月内死亡，颈淋巴结清扫术4例，其中1例有腺体外侵犯，术后仅生存1年；其余3例肿块均局限于腺体内，分别生存7年（仍生存）、12年（后失访）、18年（仍生存）；皆为女性，病程较短。结论：肿瘤局限于腺体内可能是甲状腺未分化癌预后较好的因素，对肿瘤避限于腺体内的患者，应扩大手术范围，已有腺体外侵犯者，预后较差，辅助放疗有助于延长生存期。     

Prognostic and predictive factors for breast cancer

Prognostic factors can be useful for making decisions about which patients should receive adjuvant therapy, and predictive factors can be used to predict response or lack of response to a particular therapy. We review the standard factors that are available today for primary breast cancer, and we describe some of the new, potential prognostic and predictive factors that are currently under investigation. Supported in part by grants CA30195, CA58183, CA54174 from the National Cancer Institute.     

影响食管癌切除术后患者预后的多因素分析

目的探讨影响食管癌切除术后患者预后的因素.方法从525例食管癌患者的临床病理和随访资料中选择12项指标,先后进行单因素和逐步Cox回归分析,建立术后生存预测模型.结果淋巴结转移数目、TNM分期、肿瘤浸润深度、肿瘤长度和生长部位是影响患者预后的主要因素(P＜0.01);预后指数值小的患者预后好.结论淋巴结转移是影响食管癌切除术后患者预后的最主要因素,为提高患者预后,应加强对区域淋巴结的处理;可应用预测模型来预测不同患者的术后生存率.     

放射治疗84例非小细胞肺癌临床疗效分析

目的探讨影响非小细胞肺癌的预后因素。方法对放射治疗的84例非小细胞肺癌患者的临床资料进行回顾性分析。结果临床分期早、适形放射治疗方式、Karnofsky评分大于60、照射剂量大于60 Gy者预后较好。结论多因素分析显示,临床分期、放射治疗方式、Karnofsky评分与预后有关。     

Cancer risk among patients with coal workers' pneumoconiosis in Taiwan: A nationwide population‐based study

This study is aimed to evaluate the cancer risk among patients with coal workers' pneumoconiosis (CWP) using a nationwide population‐based dataset. Patients without previous cancer who had been diagnosed with CWP and followed‐up for more than 1 year between 1997 and 2006 were recruited from the Taiwan National Health Insurance database. Standardized incidence ratios (SIRs) of cancers in CWP patients were calculated and compared to the cancer incidence in the general population. Risk factors for cancer development were also analyzed. After a median follow‐up of 9.68 years, 954 cancers developed among 8,051 recruited CWP patients, with a follow‐up of 69,398 person‐years. The SIR for all cancers was 1.12 [95% confidence interval (CI) 1.04–1.18]. Males older than 80 years had a SIR of 1.27 (95% CI: 1.06–1.51). The SIRs of esophageal (1.76, 95% CI: 1.24–2.44), gastric (1.42, 95% CI: 1.13–1.76), liver and biliary tract (1.18, 95% CI: 1.01–1.37) and lung and mediastinal (1.45, 95% CI: 1.26–1.66) cancers were significantly higher in the CWP group than in the general population. Multivariate analysis showed that age ≥ 60 years [hazard ratio (HR) 1.70, 95% CI: 1.41–2.05), male gender (HR = 1.79, 95% CI: 1.44–2.23) and liver cirrhosis (HR = 3.99, 95% CI: 2.89–5.51) were significant predictors of cancer development in patients with CWP. We concluded that patients with CWP, especially elderly males, were at increased risk of cancer. Age, male gender and liver cirrhosis were independent risk factors for cancer development.     

乳腺癌保守手术治疗后同侧局部复发危险因素的探讨

目的 探讨临床、病理因素及辅助治疗对乳腺癌保守手术合并放疗后同侧局部复发的影响。方法 应用Kaplan-Meier方法和Cox比例风险模型对126例保乳术合并放疗的早期乳腺癌患者进行回顾性分析。结果 多因素条件下56岁以上乳腺癌患者保乳手术合并放疗后同侧局部复发的风险比为2.17,EIC阳性的风险比为3.46,病灶切缘不净为1.68,无辅助TAM治疗组的风险比为1.52。结论 年龄、EIC及切缘情况对保乳术合并放疗后同侧局部复发有重要的影响,同时辅助TAM治疗可以减少局部复发的风险。     

160 例胃癌根治术后预后分析*

目的：探讨胃癌根治术后影响患者长期生存的预后因素。方法：回顾性分析天津医科大学附属肿瘤医院2001年1 月至2002年12月收治并行胃癌根治术的患者,将数据输入SPSS13.0 统计软件,通过比较1、3、5 年生存率分析各项可能影响胃癌预后的因素。结果：全组病例1、3、5 年生存率分别为72.50% 、52.50% 、45.00% 。单因素分析显示,年龄、手术方式、肿瘤最大径、Borrmann 分型、联合脏器切除、肿瘤侵犯深度、淋巴结转移度以及临床分期与术后远期生存有关（P<0.05）。 而多因素分析显示,仅患者年龄、手术方式、肿瘤侵犯深度以及临床分期是胃癌根治术后患者预后的独立因素（P<0.05）。 结论：患者年龄、手术方式、肿瘤侵犯深度以及临床分期是影响胃癌根治术后患者预后的重要因素。