术中阿片类药物用量对脑胶质瘤患者术后生存期的影响

目的:探究术中阿片类药物剂量对胶质瘤患者术后生存期的影响。方法:回顾性分析165例接受肿瘤切除术的脑胶质瘤患者的临床资料。根据术中阿片类药物剂量中位数(2.1 mg),将患者分为高剂量组和低剂量组。采用Kaplan-Meier法绘制生存曲线、Cox风险回归模型进行影响总生存期(overall survival, OS)和无复发生存期(relapse-free survival, RFS)的单因素和多因素分析,研究高剂量组和低剂量组之间OS和RFS的关系。结果:单因素Cox回归分析发现高、低剂量组之间在RFS(HR:1.082,95%CI:0.914～1.280,P=0.360)和OS(HR:1.099,95%CI:0.925～1.305,P=0.282)方面无差异。多因素Cox回归分析发现,术中阿片类药物剂量与RFS(HR:0.807,95%CI:0.537～1.212,P=0.301)和OS(HR:0.908,95%CI:0.599～1.378,P=0.650)无关。Kaplan-Meier法生存分析结果显示,高、低剂量组之间的RFS(P=0.525)和OS(P=0.332)无统计学...     

结直肠癌伴同时肝转移患者同期切除术后预后风险模型的创建及应用

目的:探讨结直肠癌伴同时肝转移（synchronous colorectal liver metastasis,sCRLM）患者接受原发肿瘤和肝转移灶同期切除术后的预后风险因素,并建立sCRLM术后的预后风险模型。方法:回顾性分析127例在我院接受原发肿瘤和肝转移灶同期切除的sCRLM患者的临床病理学因素,采用单因素和多因素Cox模型分析方法确定总生存期（overall survival,OS）和肝无复发生存时间（recurrence-free survival,RFS）的独立预后因素,根据Cox模型的风险比(hazard ratio,HR）对独立因素赋值,从而建立OS和肝RFS的新预后风险模型。根据新模型将患者分为低、中和高风险组,各组间生存差异采用Log-rank检验。ROC曲线下面积用于比较新风险模型和Fong临床风险评分的预后预测能力。结果:本研究中位随访期23.4个月,多因素Cox分析确定下列4个因素为OS较差的独立预后因素,并根据HR值对各危险因素赋值:原发肿瘤淋巴结转移≥4个（P=0.047,1分）,CEA≥200 ng/ml（P=0.023,2分）,TBS 3~8分（P=0.048,1分）和TBS≥9分（P=0.021,2分）。根据下列标准建立OS的预后风险模型:低风险组（0~1分）、中风险组（2~3分）和高风险组（≥4分）。新风险模型OS的预后预测能力优于Fong临床风险评分（AUC:0.726 vs 0.564)。多因素Cox分析确定下列2个因素为肝RFS较差的独立预后因素,根据HR值赋值如下:肝转移灶双叶分布（P=0.020,1分）和TBS≥9分（P=0.016,2分）。结论:本研究纳入接受同期手术切除的sCRLM患者创建了预后风险模型,用于评估sCRLM患者术后的OS和肝RFS。低风险组患者术后的生存情况（OS和肝RFS）优于高风险组,其预测能力尚需前瞻性临床模型进一步验证。     

术前营养状况对非小细胞肺癌患者预后的影响

目的:探讨影响行手术切除的非小细胞肺癌（NSCLC）患者预后的术前营养因素。方法:采用回顾性分析，选取在我院胸外科行手术切除的NSCLC患者的临床资料。采用血清白蛋白、总淋巴细胞计数、总中性粒细胞计数、预后营养指数（PNI）和中性粒细胞/淋巴细胞比值（NLR）评价患者术前的营养状况。根据胸部高分辨率计算机断层扫描的结果，将患者分为3组（正常肺组、肺气肿组和肺纤维化组）。对患者进行5年随访，比较不同营养状况患者的总生存期（OS）和无复发生存期（RFS）。应用Cox比例风险回归模型进行多变量分析影响患者预后的术前营养因素。结果:低血清白蛋白、高总中性粒细胞计数和低PNI患者的OS显著降低（分别为P＜0.001，P=0.032，P=0.008）。同时只有低血清白蛋白患者RFS明显降低（P=0.004）。正常肺患者中，低血清白蛋白患者OS显著降低（P=0.003）。肺纤维化患者中，低血清蛋白患者RFS显著降低（P=0.035）。多变量分析表明，血清白蛋白水平是影响NSCLC手术切除患者OS与RFS的独立危险因素（分别P=0.014与P=0.046）。结论:术前血清白蛋白水平是影响NSCLC患者行切除术后OS和RFS的重要预后因素。血清白蛋白水平对合并肺气肿的NSCLC患者预后无影响。     

预后营养指数及EORTC-GUCG评分对膀胱癌患者复发预测价值的探讨

目的:探讨预后营养指数（prognostic nutritional index,PNI）及EORTC-GUCG评分对膀胱癌患者复发的预测价值。方法:收集96例非肌层浸润性膀胱癌(non-muscle invasive bladder cancer,NMIBC）患者为研究对象。根据术前EORTC-GUCG评分，将患者分为低危组、中危组及高危组，比较不同风险患者的无复发生存期（recurrence-free survival,RFS）。采用ROC曲线确定PNI预测复发风险的截断值，比较不同PNI患者的RFS。结果:肿瘤数量、肿瘤大小、肿瘤分级、T分期是影响膀胱癌患者EORTC-GUCG评分的主要危险因素（P＜0.05），而年龄、肿瘤分级是影响患者PNI的主要危险因素（P＜0.05）。EORTC-GUCG低危组、中危组、高危组分别出现2例、23例、13例复发。Kaplan-Meier生存曲线显示，高危组RFS最差,中危组次之，低危组最好，差异均具有统计学意义（P＜0.05）。ROC曲线显示，PNI对RFS评价的曲线下面积为0.757，最佳截断值为53.3。PNI＜53.3组与PNI≥53.3组的复发率分别为23.1%、59.1%，生存曲线显示，PNI≥53.3组患者RFS显著差于PNI＜53.3组（P=0.001）。低危组、中危组、高危组中，PNI＜53.3的患者分别为13例、34例、5例，PNI≥53.3的分别有6例、22例、16例。生存曲线显示，在低危组内，PNI＜53.3组与PNI≥53.3组患者之间的生存率无明显差异（P=0.106），在中危组及高危组内，PNI≥53.3组患者的RFS明显更差（P=0.000，P=0.031）。结论:53.3可作为PNI的最佳截断值，用于评价NMIBC患者复发风险。将PNI与EORTC-GUCG评分相结合，对中危及高危患者的复发风险有较高的预测价值。     

强化造影定量灌注参数对子宫内膜癌的预后价值

目的:评估超声造影（contrast-enhanced ultrasonography,CEUS）定量指标对子宫内膜癌的预后价值。方法:2015年05月至2016年05月期间,共纳入112例行子宫内膜癌手术治疗的患者,记录术前CEUS的定量指标,包括增强强度（enhancement intensity,EI）、上升时间（rise time,RT）和增强率（enhancement rate,ER）以及其他临床指标。采用单因素和多因素COX分析,分析术后总生存期（overall survival,OS）和无复发生存期（recurrence-free survival,RFS）的危险因素。结果:根据ROC曲线得出ER的最佳临界值为1.8 dB/s,Kaplan-Meier生存曲线表明,高ER水平患者的RFS和OS比低ER水平的患者差（RFS:P＜0.001;OS:P=0.028）。在多因素COX分析中,ER是子宫内膜癌患者RFS（HR=1.82,95%CI:1.08~4.23,P＜0.001）和OS（HR=2.08,95%CI:1.01~5.77,P=0.018）的独立危险因素。结论:CEUS定量检测指标ER是子宫内膜癌术后患者生存的有效预测因子,可指导患者选择个性化的治疗方案。     

营养风险筛查工具(NRS-2002)对不可手术的食管鳞癌患者同步放化疗疗效和不良反应的相关性分析

目的 研究营养风险筛查工具(NRS-2002)对不可切除的局部晚期食管鳞癌(LAESCC)患者接受同步放化疗治疗的疗效及生存结果影响。 方法 回顾性分析2013-2015年浙江省人民医院放疗科行根治性同步放化疗治疗的LAESCC患者 105例,营养状况的筛查使用营养风险筛查工具NRS-2002量表,率间比较采用χ²检验,Kaplan-Meier法计算生存率,Logrank法检验,Cox回归模型预后因素分析。 结果 37.1%的患者在同步放化疗前就存在营养风险,NRS-2002评分≥3分的患者≥3级不良反应发生率显著高于评分为 1~2分者(P=0.007),所有患者的中位生存(OS)和无进展生存(PFS)分别为17.0个月和11.8个月,NRS-2002评分≥3分组的患者OS和PFS均显著低于评分为 1~2分者(均 P=0.000),进一步行多因素分析发现,评分≥3分是OS (P=0.000)和PFS (P=0.001)降低的独立预后因素。 结论 NRS-2002工具表明食管癌患者存在较高营养风险,而治疗前评分≥3分提示与不良反应增加及生存降低显著相关,值得进一步研究和应用。     

营养风险筛查工具NRS-2002评估食管癌放疗患者营养状况的价值

目的 用营养风险筛查工具NRS-2002评价食管癌放疗患者营养状态,同时评价NRS-2002在这群中的应用价值。方法 回顾分析2010—2014年在浙江省肿瘤医院确诊为食管癌并接受放疗的 97例患者资料。Kaplan-Meier法计算生存率并Logrank检验差异,Pearson法分析NRS-2002评分与血液指标的相关性,Cox模型多因素预后分析。结果 27%患者在放疗前就存在营养风险,这种风险随放疗进行而逐渐升高。入院时NRS-2002评分≤3分、≥4分的 1年OS分别为91%、62%(P=0.010)。治疗期间NRS-2002评分最高分≤2分、≥3分的 1年OS分别为94%、78%(P=0.012),最低分≤3分、≥4分的 1年OS分别为91%、55%(P=0.018)。入院时、放疗第1周NRS-2002评分与前白蛋白有关(P=0.000、0.002),放疗第3周NRS-2002评分与白蛋白有关(P=0.036)。多因素分析发现食管癌TNM分期、治疗期间NRS-2002评分最高分是预后影响因素(P=0.001、0.005)。结论 食管癌放疗患者存在较高营养风险,NRS-2002评分可提示食管癌放疗患者的预后,可作为营养风险初筛工具。     

术前合并肾积水对膀胱癌根治术后患者生存预后的影响

  目的  探讨术前合并肾积水对病理TNM不同分期膀胱癌根治术后患者生存的影响。  方法  回顾性分析2013年1月至2017年12月231例于昆明医科大学第二附属医院行膀胱癌根治性切除术患者的病例资料,根据术前有无合并肾积水分为合并肾积水组（96例）和未合并肾积水组（135例）,比较两组的总生存（overall survival,OS ）率。采用Cox比例风险回归模型进行预后因素的单因素及多因素分析;根据不同TNM分期将患者进行分组,Kaplan-Meier法分别绘制生存曲线,采用Log-rank检验进行显著性分析。  结果  合并肾积水组与未合并肾积水组患者的3年和5年OS率分别为62.5%±4.9%和38.5%±5%与 74.8%±3.7%和66.8%±4.1%,未合并肾积水组均明显高于合并肾积水组（P<0.001）。多因素Cox比例风险回归模型分析显示,术前合并肾积水、病理T分期、淋巴结转移为术后OS的独立影响因素（P<0.05）。TNM分期的分层分析发现,合并肾积水的T2N0M0组与未合并肾积水的T3～4N0M0组（P=0.816）,以及合并肾积水的T3～4N0M0组与未合并肾积水的TxN+Mx组之间的生存差异均无统计学意义（P=0.591）。  结论  术前合并肾积水是膀胱癌根治术后患者OS的独立影响因素,同时术前合并肾积水可使T2N0M0及T3～4N0M0患者的术后生存曲线向更晚的病理TNM分期偏移。      

营养风险对老年早期食管癌患者放疗的预后的影响

摘 要：［目的］ 探讨营养风险及身体质量指数（BMI）与老年早期食管癌放疗患者预后的关系。［方法］ 收集2011年7月至2014年12月于连云港市第二人民医院接受根治性放疗的41例≥70岁、Ⅰ/Ⅱ,N0期食管鳞癌患者临床资料。应用营养风险筛查工具2002（NRS-2002）行营养风险评估,营养风险定义为NRS-2002评分≥3分。分析NRS-2002评分与食管癌患者临床资料的关系,Kaplan-Meier法计算生存率并Log-rank检验差异,Cox比例风险模型进行多因素分析。［结果］ 27例患者（65.85%）放疗前存在营养风险。营养风险患者营养支持治疗前后血清白蛋白水平有统计学差异（P=0.0127）。NRS-2002评分与血清白蛋白水平及BMI有关（P＜0.05）。单因素分析显示肿瘤长度≥6cm 、BMI<18.5kg/m2、NRS-2002评分≥3分是食管癌放疗患者预后不良因素（P＜0.05）。多因素生存分析显示NRS-2002评分及BMI是食管癌放疗患者总生存时间的独立预后因素（P＜0.05）。［结论］ 营养风险及消瘦可作为预测老年早期食管癌放疗患者的预后不良指标。     

上尿路尿路上皮癌根治术后发生膀胱癌的危险因素研究

目的 探讨上尿路尿路上皮癌(UTUC)根治术后膀胱癌发生的危险因素。方法 选择UTUC患者112例，患者均行根治性肾输尿管切除术(RUN)联合膀胱袖口状切除术，依据UTUC术后是否发生膀胱癌分为膀胱癌组(30例)及无膀胱癌组(82例)。分析UTUC患者术后发生膀胱癌危险因素。结果 膀胱癌组Ⅲ～Ⅳ期、肿瘤位置位于输尿管、G3分级、术前存在膀胱癌病史及术前输尿管镜检查史比率均高于无膀胱癌组，差异有统计学意义(P<0.05);Logistic回归分析显示，肿瘤分期、病灶位置、分级，术前膀胱癌病史、输尿管镜检查史是影响UTUC根治术后膀胱癌发生的独立危险因素(P<0.05)。结论 肿瘤分期、病灶位置、分级，术前膀胱癌病史、输尿管镜检查史是影响UTUC根治术后膀胱癌发生的独立危险因素，术后需定期复查，以降低膀胱癌发生率。     

Quantifying the Overall Survival Benefit With Early Radical Cystectomy for Patients With Histologically Confirmed T1 Non–muscle-invasive Bladder Cancer

IntroductionThe objective of this study was to examine the overall survival (OS) in patients diagnosed with high-grade T1 non–muscle-invasive bladder cancer treated with early radical cystectomy versus local treatment of the primary tumor, defined as endoscopic management with or without intravesical chemotherapy or immunotherapy.Patients and MethodsWe identified 4900 patients with histologically confirmed, clinically non-metastatic high-grade T1 bladder cancer undergoing surgical intervention using the National Cancer Database for the period 2010 to 2015. Multivariable logistic regression was used to examine predictors for the receipt of early radical cystectomy (defined as radical cystectomy within 90 days of diagnosis). We then employed multivariable Cox proportional hazards regression models and Kaplan-Meier curves to evaluate the OS according to surgical treatment (early radical cystectomy vs. local treatment).ResultsA minority (23.7%) of patients underwent early radical cystectomy. Independent predictors of undergoing early radical cystectomy included lower age, White race, and lower comorbidity status. The median OS was 74.0 months for patients diagnosed with high-grade T1 bladder cancer. The 1- and 5-year survival rates of patients undergoing early radical cystectomy were 94.8% and 71.0%, whereas they were 85.2% and 52.4%, for patients undergoing initial local treatment, respectively (P < .001). Compared with patients undergoing local treatment, patients undergoing early radical cystectomy had a lower risk of all-cause mortality (hazard ratio, 0.78; 95% confidence interval, 0.67-0.91; P = .002).ConclusionIn this cohort of patients presenting with high-grade T1 non–muscle-invasive bladder cancer, we found that early radical cystectomy was associated with an OS benefit compared with initial local treatment.     

肌层浸润性膀胱癌患者根治术后预后相关因素分析

目的:探讨肌层浸润性膀胱癌根治术预后相关因素。方法:回顾性分析156例腹腔镜下根治性膀胱全切除术及盆腔淋巴结清扫术后肌层浸润性膀胱癌患者生存数据,选择17种可能对预后产生影响的因素,采用Kaplan-Meier法及Cox比例风险模型统计分析。结果:单因素分析示年龄、肿瘤T分期、有无淋巴结转移、肾积水、是否侵犯输尿管下段、是否侵犯淋巴脉管、是否行新辅助化疗、术后辅助放化疗对患者预后的影响差异有统计学意义（P<0.05）。多因素分析示年龄（P<0.001）、肿瘤T分期（P=0.003）、淋巴结转移（P=0.031）、新辅助化疗（P=0.015）为肌层浸润性膀胱癌根治术预后影响因素。结论:年龄、肿瘤T分期、淋巴结转移为影响肌层浸润性膀胱癌根治术患者生存的独立危险因素。新辅助化疗是肌层浸润性膀胱癌根治术预后保护因素。     

Lymphatic invasion is a prognostic factor for bladder cancer treated with radical cystectomy

Background We aimed to elucidate the significance of pathological prognostic factors in patients with bladder cancer treated with radical cystectomy and pelvic lymphadenectomy focusing on the association between lymphatic invasion and disease recurrence. Methods Ninety-one patients with ladder cancer who had undergone radical cystectomy were examined retrospectively. Clinicopathological findings and clinical outcomes were analyzed. Patients who received palliative cystectomy or neoadjuvant chemotherapy and patients who did not receive lymphadenectomy owing to a poor general condition or far advanced local disease status were excluded. Results Lymphatic invasion and lymph node involvement were present in 45.1% and 23.1% of patients, respectively. Multivariate analyses, using the Cox proportional hazards model, indicated that lymphatic invasion (hazard ratio [HR], 5.30; P = 0.007) and lymph node involvement (HR = 3.05; P = 0.016) were independent prognostic factors for disease-specific survival. Of the 91 patients, 29 (31.9%) had recurrent disease during the follow-up period. The rate of recurrence in patients with lymphatic invasion and without lymph node involvement was 50% (11/22), which was not significantly different from that in patients with both lymphatic invasion and lymph node involvement (73.7%; 14/19; P = 0.121), indicating a high risk of disease recurrence in patients with bladder cancer with lymphatic invasion even in the absence of the lymph node involvement. Conclusion In patients with bladder cancer treated with radical cystectomy, lymphatic invasion is an independent prognostic factor for disease-specific and disease-free survival. Patients with lymphatic invasion have a high risk of disease recurrence after radical cystectomy even in the absence of lymph node involvement.     

The prognostic value of pretreatment of systemic inflammatory responses in patients with urothelial carcinoma undergoing radical cystectomy

Background:

Systemic inflammatory response (SIR) is important in the relationship between the tumour, the host, and outcome in cancer patients. However, limited data exist regarding the prognostic significance of SIR in bladder cancer. We investigate the utility of pretreatment SIR in patients with urothelial carcinoma undergoing radical cystectomy.

Methods:

The study cohort consisted of 419 patients with a median follow-up of 37.7 months. The SIRs used for each described prognostic nomogram are consistent with previously published data: C-reactive protein, albumin, white cell count, neutrophil count, lymphocyte count, and platelet count. Primary end point was disease-specific survival (DSS) and overall survival (OS) after surgery. Cox regression models were used to determine the time to disease-specific and overall mortality. Multivariate regression coefficients of the predictors were used to develop nomograms for predicting 5-year DSS and OS probability.

Results:

Multivariate Cox regression analyses revealed that albumin, lymphocyte count, and platelet count were significantly associated with a significantly increased risk for death from bladder cancer. The nomograms including each index were developed to predict the probability of 5-year DSS and OS after radical cystectomy. The C statistics were 77.8% and 77.3%, respectively, and exceeded the 2002 AJCC (72.0% and 70.3%, respectively). In the decision curve analyses, the nomograms including SIR demonstrated higher net benefit gains compared with the models without SIR.

Conclusions:

Cellular components of SIR have better prognostic values compared with acute-phase protein in patients undergoing radical cystectomy for bladder cancer.     

Relevance of extracapsular extension of pelvic lymph node metastasis in patients with bladder cancer treated in the contemporary era

BACKGROUND: Previous reports have suggested that extracapsular extension (ECE) is a prognostic factor in patients with urothelial carcinoma who have positive lymph nodes at the time of radical cystectomy. In the current study, the relevance of ECE in patients treated in the contemporary era was evaluated. METHODS: A database search from 1993 to 2003 revealed 150 patients with pN+M0 disease detected after radical cystectomy; of these, 108 patients did not receive neoadjuvant chemotherapy and form the basis of the current report. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) data were analyzed by the Kaplan-Meier method, with log-rank tests used to evaluate associations between survival and variables studied. RESULTS: Five-year OS, DSS, and RFS rates were 30.9%, 45.5%, and 29.7%, respectively. Adjuvant chemotherapy was administered to 70% of patients. On multivariate analysis, adjuvant chemotherapy was significantly associated with prolonged OS, DSS, and RFS (P 相似文献   

Radical cystectomy for bladder cancer:oncologic outcome in 271 Chinese patients

Few large scale studies have reported the oncologic outcome of radical cystectomy for treating bladder cancer in China; hence, we lack long-term prognostic information. The aim of the current study was to determine the survival rate and prognostic factors of patients who underwent radical cystectomy for bladder cancer in a Chinese medical center. We retrospectively analyzed clinicopathologic data from 271 bladder cancer patients who underwent radical cystectomy between 2000 and 2011. Univariate and multivariate analyses were conducted to identify independent prognostic predictors for this cohort. Median follow-up was 31.7 months(range, 0.2–139.1 months). Thirty-day mortality was(1.4%). The 5-year recurrence-free survival, cancer-specific survival(CSS), and overall survival rates were 61.6%, 72.9%, and 68.0%, respectively. The 5-year CSS rates of patients with T1–T4 disease were 90.7%, 85.0%, 51.0%, and 18.0%, respectively. Patients with organ-confined disease had a higher 5-year CSS rate than those with extravesical disease(81.4% vs. 34.9%, P 0.001). For the 38 patients(14%) with lymph node involvement, the 5-year CSS rate was 27.7%—significantly lower than that of patients without lymph node metastasis(P 0.001). The 5-year CSS rate was much higher in patients with low grade tumor than in those with high grade tumor(98.1% vs. 68.1%, P 0.001). Multivariate Cox regression showed that patient age(hazard ratio, 2.045; P = 0.013) and T category(hazard ratio, 2.213; P 0.001) were independent predictors for CSS. These results suggest that radical cystectomy is a safe and effective method for treating bladder cancer in Chinese patients. Old age and high T category were associated with poor prognosis in bladder cancer patients who underwent radical cystectomy.     

Lymphovascular invasion,ureteral reimplantation and prior history of urothelial carcinoma are associated with poor prognosis after partial cystectomy for muscle-invasive bladder cancer with negative pelvic lymph nodes

Purpose

To identify predictive factors underlying recurrence and survival after partial cystectomy for pelvic lymph node-negative muscle-invasive bladder cancer (MIBC) (urothelial carcinoma) and to report the results of partial cystectomy among select patients.

Methods

We retrospectively reviewed 101 cases that received partial cystectomy for MIBC (pT_2-3N₀M₀) between 2000 and 2010. The log-rank test and a Cox regression analyses were performed to identify factors that were predictive of recurrence and survival.

Results

With a median follow-up of 53.0 months (range 9–120), the 5-year overall survival (OS), cancer-specific survival (CSS) and recurrence-free survival (RFS) rates were 58%, 65% and 50%, respectively. A total of 33 patients died of bladder cancer and 52 patients survived with intact bladder.Of the 101 patients included, 55 had no recurrence, 12 had non-muscle-invasive recurrence in the bladder that was treated successfully, and 34 had recurrence with advanced disease.The multivariate analysis showed that prior history of urothelial carcinoma (PH.UC) was associated with both CSS and RFS and weakly associated with OS; lymphovascular invasion (LVI) and ureteral reimplantation (UR) were associated with OS, CSS and RFS.

Conclusions

Among patients with pelvic lymph node-negative MIBC, PH.UC and UR should be considered as contraindications for partial cystectomy, and LVI is predictive of poor outcomes after partial cystectomy. Highly selective partial cystectomy is a rational alternative to radical cystectomy for the treatment of MIBC with negative pelvic lymph nodes.