肝外胆管癌术后预后的多因素回归分析

目的:探讨影响肝外胆管癌术后生存的预后因素。方法:采用Cox比例风险模型,选择临床因素及E 钙粘附素(E cd)及基质金属蛋白酶(MMP 9),进行多因素回归分析。结果:全组 1年生存率为 44. 2%, 3年生存率为 23. 1%, 5年生存率为 9. 6%;单因素分析显示:肿块大小、TNM分期、浸润转移、手术方式、E cd、MMP 9与肝外胆管癌术后预后显著相关(P<0. 01) ;Cox多因素回归分析显示:E cd和MMP 9的表达是影响胆管癌术后预后的重要因素,可作为判断预后的独立指标(P<0. 05)。结论:E cd和MMP 9的表达是影响胆管癌术后预后的独立因素。     

老年结肠癌根治术后复发转移Cox模型回归分析

目的收集并分析2002年1月-2013年6月11年问209例行结肠癌根治术的老年患者的病理特征和手术情况,探讨影响术后复发转移的因素。方法采用Cox风险比例模型对患者的年龄、性别、病程、住院时长、手术医生经验、手术时长、是否为腹腔镜手术、肿瘤部位、肿瘤大小、肿瘤大体形态、分化程度、浸润深度、淋巴结转移和梗阻共计14个变量进行单因素和多因素分析,运用Kaplan—Meier法绘制患者术后复发转移生存曲线。结果单因素分析发现,肿瘤大小（RR：2．658,P〈0．0001）、大体形态（浸润型RR=3．407,P=0．0054）、分化程度（RR=0．32,P〈0．0001）与结肠癌根治术后复发转移有关,多因素分析结果显示,患者性别（RR=0．585,P=0．0359）、肿瘤大小（RR=2．364,P〈0．0001）、大体形态（浸润型RR=0．246,P=0．0437）、分化程度（RR=0．31,P〈0．0001）与结肠癌根治术后复发转移有关。结论患者性别、肿瘤大小、大体形态和分化程度是影响老年结肠癌根治术后复发转移的因素,对确定高危人群,进行有针对性的术后随访,提早发现和治疗有重要意义,有利于提高患者生活质量,延长患者生存时间,     

胃癌合并腹水患者预后因素的Cox回归分析

目的 探讨影响胃癌合并腹水患者生存的预后因素。方法 回顾性分析2011年10月至2013年10月于本院住院治疗且随访资料完整的58例晚期胃癌合并腹水患者的病例资料,采用Kaplan-Meier法进行生存分析,Log-rank法进行单因素分析,Cox比例风险模型进行多因素分析。结果 58例胃癌合并腹水患者的中位生存期为14.0月。单因素分析显示分化程度、浸润深度、肝脏转移情况、KPS评分和治疗方法 与患者预后有关,而性别、年龄和腹水量则与预后无关。经Cox多因素回归分析,分化程度、浸润深度、肝脏转移情况、KPS评分及治疗方法 是影响胃癌合并腹水患者预后的独立危险因素。结论 分化程度、浸润深度、肝脏转移情况、KPS评分及治疗方法 是影响胃癌合并腹水患者预后的强相关因素,可作为独立预后指标指导胃癌合并腹水患者的治疗。     

No期食管鳞癌根治术后预后因素的Cox回归分析

目的：探讨No期食管鳞癌术后生存率的影响因素。方法：选择10个可能对术后预后产生影响的研究因素，通过Cox比例风险模型进行多因素分析，对我院1998年8月～2001年8月间的98例No期食管鳞癌术后患者预后进行研究。结果：全组1、3、5年生存率分别为95．92％、85．71％、81．63％。结论：Cox多因素分析显示，影响预后的独立因素是肿瘤浸润深度（T分期），肿瘤分化分级。     

影响晚期大肠癌预后的多因素分析

背景与目的：晚期大肠癌的预后因素分析有利于其个体化的综合治疗,而国内外相关文献报道不多.本研究探讨晚期大肠癌临床病理特征及不同治疗方法对其生存的影响.方法：对北京协和医院近5年化疗的143例晚期大肠癌患者采用单因素和多因素回归分析方法分析其预后影响因素.结果：143例晚期大肠癌患者中位生存期20.0个月.单因素分析表明,确诊晚期时转移器官数目、腹膜转移、癌胚抗原（CEA）≥50 ng/ml、乳酸脱氢酶（LDH）及碱性磷酸酶（ALP）升高、肠道外转移灶综合治疗、转移灶曾行根治性切除术为预后影响因素（P＜0.05）,新药联合分子靶向治疗、两种新药序贯化疗、单种新药化疗、不规范应用新药化疗及氟尿嘧啶类化疗组的中位生存期分别为26.0、24.0、21.0、9.0、14.0个月,前3组分别与后2组间生存期差异具有显著性（P＜0.05）.回归分析显示转移器官数目、ALP升高、全身治疗方案、肠道外转移灶综合治疗、转移灶根治性切除术是影响晚期大肠癌患者生存的独立因素.结论：确诊晚期时单器官转移、ALP正常、肠道外转移灶综合治疗、转移灶的根治性切除、新一代化疗药物的规范应用及联合分子靶向治疗是提示晚期大肠癌患者预后好的独立因素.     

卵巢癌患者预后因素的Cox回归分析

背景与目的：卵巢癌发病率高,生存率低,远期疗效依然不理想。本研究目的是探讨影响卵巢癌患者生存预后的相关因素。方法：收集1999～2004年在陕西省肿瘤医院收治的103例卵巢癌患者资料进行回顾性研究。随访100个月．以寿命表法计算生存率,变量分析以Kaplan-Meier法进行分析,用log-rank检验生存率差异,采用Cox多因素模型进行多因素分析,并对预后生存指标进行评价。结果：卵巢癌患者1年、3年、5年生存率分别为87．7％、50．8％、31．1％。单因素分析显示临床分期、分化程度、手术残余瘤的大小和化疗疗程是影响卵巢癌患者预后的因素：Cox比例风险模型分析显示,临床分期、分化程度、手术残余瘤的大小和化疗疗程是影响预后的指标。结论：卵巢癌在早期尽可能地切除病灶．术后残留灶〈2cm,术后足量疗程的化疗可改善预后。     

Prognostic factors of hepatic resection for hepatocellular carcinoma with cirrhosis: univariate and multivariate analysis

BACKGROUND AND OBJECTIVES: The objective of this investigation was to study the clinicopathological factors influencing long-term outcome of hepatocellular carcinoma (HCC) with liver cirrhosis in patients undergoing hepatectomy. Liver cirrhosis, especially the macronodular variety, has been found in up to 90% of patients with HCC. In Asia, the incidence of liver cirrhosis in patients with HCC who had undergone hepatic resection varies from 42.5% to 73.8%. However, the optimal surgical approach for HCC patients with cirrhosis is less clearly defined. Resection of the cirrhotic liver is challenging and remains controversial in the treatment of HCC. METHODS: This study retrospectively analyzed the surgical outcomes of HCC concomitant with liver cirrhosis in 218 patients who underwent hepatic resection between 1986 and 1998. Post-resection prognostic factors were assessed using a univariate log-rank test and a multivariate Cox proportional hazards model. RESULTS: The overall postoperative complication rate was 15.6%, while the surgical mortality rate was 8.8%. Meanwhile, the 1-, 3-, and 5-year disease-free survival rates were 50.9%, 33.98%, and 27.03%, respectively, and. the overall cumulative survival rates at 1, 3, and 5 years were 63.14%, 41.88%, and 31.83%, respectively. Applying Cox's multivariate proportional hazard model indicated that significant adverse prognostic indicators included elevated alkaline phosphatase value, tumor size >2 cm, presence of satellite lesions, and vascular invasion. CONCLUSIONS: This investigation found that overall survival for HCC patients concomitant with liver cirrhosis who underwent hepatic resection should be stratified on the basis of the high value of alkaline phosphatase, tumor size, satellite lesions, and vascular invasion.     

青年结肠癌的多因素生存分析（附122例）

目的：通过对122例青年结肠癌患者随访资料的统计,分析影响预后生存的主要因素。方法：收集辽宁省肿瘤医院手术结肠癌病例的病案资料,建立数据库,确定年龄≤40岁病例为青年结肠癌患者,采用COX比例风险模型从一般临床资料及术中病理特征两方面进行多因素生存分析。结果：癌胚抗原阳性、重复癌的发生、腹膜种植、肝脏转移、Duck分期、肿瘤体积大小是影响青年结肠癌预后生存的独立因素。结论：青年结肠癌的早期发现、诊断和治疗对于提高预后生存率具有重要意义。     

Prognostic factors of esophageal carcinoma: univariate and multivariate analyses

The correlation of 5-year survival rate with various clinical and histopathological factors was studied using univariate and multiple analyses of 128 patients who had undergone resection for esophageal carcinoma between 1965 and 1978 in the Department of Surgery, Kyushu University Hospital. The depth of penetration, lymph node metastasis, lymphatic or vascular invasion, and INF had a significant correlation with 5-year survival in the univariate analysis; however, only depth of penetration and lymph node metastasis were prognostic factors with a significant difference, in the multivariate analysis. In 55 patients in whom the cell nuclear DNA content had been determined, the DNA pattern was the greatest prognostic factor (p less than 0.01), in multivariate analysis. We propose that the DNA distribution in the malignant cells should be examined as a most pertinent prognostic factor.     

RISK FACTORS FOR RECURRENCE IN PATIENTS WITH HEPATOCELLULAR CARCINOMA AFTER RADICAL RESECTION

ＲＩＳＫＦＡＣＴＯＲＳＦＯＲＲＥＣＵＲＲＥＮＣＥＩＮＰＡＴＩＥＮＴＳＷＩＴＨＨＥＰＡＴＯＣＥＬＬＵＬＡＲＣＡＲＣＩＮＯＭＡＡＦＴＥＲＲＡＤＩＣＡＬＲＥＳＥＣＴＩＯＮＺｈａｎｇＢｏｈｅｎｇ张博恒ＺｈｏｕＸｉｎｄａ周信达ＹｕＹｅｑｉｎ余业勤ＴａｎｇＺｈａ...     

A comparison of all-subset Cox and accelerated failure time models with Cox step-wise regression for node-positive breast cancer

Summary Clinical studies usually employ Cox step-wise regression for multivariate investigations of prognostic factors. However, commercial packages now allow the consideration of accelerated failure time models (exponential, Weibull, log logistic, and log normal), if the underlying Cox assumption of proportional hazards is inappropriate. All-subset regressions are feasible for all these models.We studied a group of 378 node positive primary breast cancer patients accrued at the Henrietta Banting Breast Centre of Women's College Hospital, University of Toronto, between January 1, 1977, and December 31, 1986. 85% of these patients had complete prognostic factor data for multivariate analysis, and 96% of the patients were followed to 1990. There was evidence of marked departures from the proportional hazards assumption with two prognostic factors, number of positive nodes and adjuvant systemic therapy. The data strongly supported the log normal model. The all-subset regressions indicated that three models were similarly good. The variables 1) number of positive nodes, 2) tumour size, and 3) adjuvant systemic therapy were included in all three models along with one of three biochemical receptor variables 1) ER, 2) combined receptor (ER- PgR-; ER+ PgR-; ER- PgR+; ER+ PgR+; or 3) PgR.Better multivariate modeling was achieved by using quantitative prognostic factors, a check for appropriate underlying model-type, and all-subset variable selection. All-subset regressions should be considered for routine use with the many new prognostic factors currently under evaluation; it is very possible that there may not be a single model that is substantially better than others with the same number of variables.     

晚期十二指肠癌患者一线化疗的临床疗效及预后因素分析

目的 探讨晚期十二指肠癌患者一线化疗方案的疗效与安全性以及影响预后的因素。方法 回顾分析本院2008年6月至2016年1月收治的晚期十二指肠癌患者40例,9例未接受化疗,31例接受化疗,其中GEMOX方案13例、FOLFOX方案13例、卡培他滨单药2例和吉西他滨单药3例。采用RECIST 1.1版与NCI CTC 4.0版标准评价化疗的近期疗效和不良反应。生存分析采用Kaplan Meier法并行Log rank检验,多因素分析采用Cox比例风险回归模型。结果 31例化疗患者均可评价疗效和不良反应,共完成化疗146个周期,中位化疗4个周期（2～12个周期）。GEMOX方案组获PR 1例、SD 10例、PD 2例,疾病控制率（DCR）为84.6％;FOLFOX方案组获SD 6例、PD 7例,DCR为46.2％;单药组：卡培他滨获SD 2例,吉西他滨获SD 1例、PD 2例,DCR为60.0％。31例化疗患者的中位生存期（OS）为15.7个月,9例未化疗患者的中位OS为4.4个月,差异有统计学意义（P＜0.001）。GEMOX方案组的中位OS为279个月,FOLFOX方案组为152个月,单药组为152个月,差异无统计学意义（P=0.656）。GEMOX方案组的中位无进展生存期（PFS）为7.8个月,FOLFOX方案组为4.0个月,单药组为5.1个月,差异无统计学意义（P=0.053）。常见不良反应多为1～2级,主要为白细胞减少、中性粒细胞减少、贫血、乏力及恶心等。单因素分析显示,浸润深度、分化程度、是否肝转移及是否化疗与晚期十二指肠癌的预后有关（P＜0.05）。Cox多因素分析显示,分化程度、是否肝转移及是否化疗是影响晚期十二指肠癌患者预后的独立因素。结论 GEMOX方案、FOLFOX方案、卡培他滨单药及吉西他滨单药一线化疗均对晚期十二指肠癌有效,且耐受性良好;其中GEMOX方案可能有更好的生存获益。分化程度、是否肝转移及是否化疗可能是影响晚期十二指肠癌患者的预后因素,临床上可作参考。     

Comparing Cox regression and parametric models for survival of patients with gastric carcinoma.

BACKGROUND: Researchers in medical sciences often tend to prefer Cox semi-parametric instead of parametric models for survival analysis because of fewer assumptions but under certain circumstances, parametric models give more precise estimates. The objective of this study was to compare two survival regression methods - Cox regression and parametric models - in patients with gastric adenocarcinomas who registered at Taleghani hospital, Tehran. METHODS: We retrospectively studied 746 cases from February 2003 through January 2007. Gender, age at diagnosis, family history of cancer, tumor size and pathologic distant of metastasis were selected as potential prognostic factors and entered into the parametric and semi parametric models. Weibull, exponential and lognormal regression were performed as parametric models with the Akaike Information Criterion (AIC) and standardized of parameter estimates to compare the efficiency of models. RESULTS: The survival results from both Cox and Parametric models showed that patients who were older than 45 years at diagnosis had an increased risk for death, followed by greater tumor size and presence of pathologic distant metastasis. CONCLUSION: In multivariate analysis Cox and Exponential are similar. Although it seems that there may not be a single model that is substantially better than others, in univariate analysis the data strongly supported the log normal regression among parametric models and it can be lead to more precise results as an alternative to Cox.     

Can symptoms predict the prognosis of renal cell carcinoma? A multivariate analysis of 320 patients

Background The well-known, classical symptoms of renal cell carcinoma (RCC) are abdominal or flank pain, a palpable mass, and hematuria. However, the number of patients with this classical triad has been decreasing recently. This is especially true in Japan where health screening programs detect many incidental renal cell carcinomas. This study reevaluated the presenting symptoms of RCC as prognostic factors. It also showed that patients found to have RCC by health screening had a significantly low hazard ratio and a good prognosis. Patients and Methods To evaluate the presenting symptoms as prognostic factors for survival, we retrospectively studied 320 patients with renal cell carcinoma between 1978 and 1995. The following symptoms were evaluated as prognostic factors: large amount of hematuria, any hematuria (including microscopic and macroscopic), flank and/or abdominal pain, a palpable mass, malaise, weight loss, pyrexia, and the reason for examining the kidneys. Survival curves were calculated by the Kaplan-Meier method, and univariate analysis was performed using the log-rank test and Cox's proportional hazard model. Significant factors were then chosen for Cox's multivariate proportional hazard test to evaluate their relative prognostic value. Results The median follow-up period was 29 months. The overall survival rate at 1, 5, and 10 years was 90.0%, 77.6%, and 69.9%, respectively. The chi-square test revealed a close relationship between flank and/or abdominal pain and local tumor extent; pyrexia and lymph node and distant metastasis; and incidental detection by health screening with no local invasion or distant metastasis. Conclusion Of the 8 prognostic factors evaluated, univariate and multivariate analysis showed that flank and/or abdominal pain and pyrexia were poor prognostic factors, while patients with tumors found by routine health screening or during workup of other diseases showed a good outcome.     

结肠癌根治术后复发转移的单因素和多因素分析

背景与目的:目前国内外有关结肠癌根治术后复发转移的预后报道尚不多,且研究结果不一。本研究旨在探讨结肠癌患者根治术后复发转移的相关临床病理因素。方法:选择1999年1月至2000年12月在中山大学肿瘤医院行结肠癌根治术患者152例,Cox模型分析临床病理因素与复发转移的关系。结果:全组复发转移率为19.74%,肝转移率为9.87%。单因素分析显示,有无输血、病程、肿瘤大小、肿块活动度、分化程度、Dukes@分期、淋巴结转移与结肠癌术后复发转移有关,有无输血、术前血清CEA水平、肿块活动度、分化程度、Dukes@分期、淋巴结转移与术后肝转移有关;多因素分析显示,肿块活动度、分化程度、淋巴结转移与结肠癌术后复发转移有关,术前血清CEA水平、分化程度、淋巴结转移与术后肝转移有关。结论:肿块活动度、分化程度和淋巴结转移是影响结肠癌患者根治术后复发转移的重要预后因素,术前血清CEA升高、肿瘤分化不良、淋巴结转移的患者术后肝转移的风险增大。     

肥城市农村居民食管癌及癌前病变危险因素多元有序Logistic回归分析

目的食管癌是常见的消化道恶性肿瘤,山东省肥城市是我国食管癌高发地区之一。探讨山东省肥城市农村居民食管癌及癌前病变发生的危险因素,为当地食管癌的防治工作提供依据。方法以2013年在"国家食管癌早诊早治示范基地(山东省肥城市)"参与上消化道癌症筛查,并进入食管癌筛查与随访社区人群队列的40~69岁农村居民为研究对象,内镜下碘染色及病理活检结果作为诊断依据,依据诊断标准将其分为不同病变等级,进行问卷调查,并采用多元有序Logistic回归分析食管癌及癌前病变的危险因素。结果共纳入食管正常人1910名、轻度增生511例、中度增生130例、重度增生及以上100例。多元有序Logistic回归分析结果显示,年龄(OR=1.09,95%CI:1.08~1.11)、饮酒(OR=1.45,95%CI:1.13~1.86)、饮茶(OR=1.39,95%CI:1.15~1.68)、燃煤取暖(OR=1.43,95%CI:1.10~1.85)及肿瘤家族史(OR=1.35,95%CI:1.11~1.66)是食管癌及癌前病变发生的独立危险因素,P<0.05。结论年龄、饮酒、饮茶、燃煤取暖及肿瘤家族史是肥城市农村居民食管癌及癌前病变的危险因素,改变不良生活方式有利于做好食管癌的防治工作。     

Prognostic factors after curative surgery for renal cell carcinoma: Multivariate analysis of 260 patients

Background In patients with renal cell carcinoma, curative surgery may offer a chance of survival, but a fatal outcome is not infrequent. In this study, we investigated the prognostic factors influencing survival by using both univariate and multivariate analyses. Methods To identify the important prognostic factors for long-term survival, we retrospectively studied 260 patients who received curative surgery for renal cell carcinoma between 1978 and 1995. Survival curves were calculated by the Kaplan-Meier method and statistical differences were determined by the log-rank test. Survival correlations were tested using 20 prognostic factors. Significant factors were evaluated using Cox's multivariate proportional hazard test to determine the prognostic value. Results The median follow-up period was 39 months. The overall survival rate at 1, 5, and 10 years was 98.9%, 89.8%, and 83.3%, respectively. Of the 20 prognostic factors evaluated, the log-rank test showed significant differences in patient age, body temperature, hemoglobin, ESR, α₂-globulin, CRP, fibrinogen, pathological stage, Robson's stage, T classification, N classification, pathological grade, cell type, and pattern of tumor infiltration. However, several variables (body temperature, ESR, α₂-globulin, and fibrinogen) were excluded from the multivariate analysis because more then 10% of the data were missing. Pathological stage was selected as a representative variable for stage indices (pathological stage, Robson's stage, T classification, and N classification). Using the remaining 7 variables (age, hemoglobin, CRP, pathological stage, pathological grade, cell type, and pattern of tumor infiltration), Cox's multivariate proportional hazard analysis showed that tumor stage (P=0.0496) was the most important independent prognostic factor for patient survival. Conclusions From this analysis, the pathological tumor stage was found to be the most important factor predicting long-term survival in patients who received curative surgery for renal cell carcinoma.     

子宫内膜癌预后因素的Cox回归分析

目的:探讨影响子宫内膜癌预后的相关危险因素。方法:回顾分析110例子宫内膜癌患者临床资料,对年龄、子宫内膜家族史、手术-病理分期、病理类型、组织学分级、淋巴结转移、治疗方式等因素进行单因素和多因素分析。采用 Kaplan-Meier法计算生存率,Log-rank检验进行单因素分析及各组生存率曲线分布比较,Cox回归模型进行多因素分析。结果:110例子宫内膜癌患者的生存时间为2-133个月,中位生存时间52.4个月,因子宫内膜癌死亡者24例(21.8%)。1、3、5年总体生存率分别为95.4%、85.5%、78.2%。单因素分析表明:不同病理类型、手术-病理分期、肿瘤大小、淋巴结转移、组织学分级、治疗方式的生存率差异有统计学意义（P＜0.05）。Cox风险比例回归模型进行多因素分析结果显示病理类型、手术-病理分期、组织学分级、淋巴结转移、治疗方式是影响子宫内膜癌预后的独立因素。结论:病理类型、手术-病理分期、组织学分级、淋巴结转移、治疗方式是影响子宫内膜癌预后的独立因素。     

Prognostic factors associated with local recurrence in squamous cell carcinoma of the vulva

Objective

To analyze the prognostic factors related to the recurrence rate of vulvar cancer.

Methods

Retrospective study of 87 patients diagnosed of vulvar squamous cell carcinoma diagnosed at a tertiary hospital in Madrid between January 2000 and December 2010.

Results

The pathological mean tumor size was 35.1±22.8 mm, with stromal invasion of 7.7±6.6 mm. The mean free margin after surgery was 16.8±10.5 mm. Among all patients, 31 (35.6%) presented local recurrence (mean time 10 months; range, 1 to 114 months) and 7 (8%) had distant metastases (mean time, 5 months; range, 1 to 114 months). We found significant differences in the mean tumor size between patients who presented a relapse and those who did not (37.6±21.3 mm vs. 28.9±12.1 mm; p=0.05). Patients with free margins equal or less than 8 mm presented a relapse rate of 52.6% vs. 43.5% of those with free margin greater than 8 mm (p=0.50). However, with a cut-off of 15 mm, we observed a local recurrence rate of 55.6% vs. 34.5%, respectively (p=0.09). When the stromal invasion cut-off was >4 mm, local recurrence rate increased up to 52.9% compared to 37.5% when the stromal invasion was ≤4 mm (p=0.20).

Conclusion

Tumor size, pathologic margin distance and stromal invasion seem to be the most important predictors of local vulvar recurrence. We consider the cut-off of 35 mm of tumor size, 15 mm tumor-free surgical margin and stromal invasion >4 mm, high risk predictors of local recurrence rate.