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1.
Quah HM Chou JF Gonen M Shia J Schrag D Landmann RG Guillem JG Paty PB Temple LK Wong WD Weiser MR 《Diseases of the colon and rectum》2008,51(5):503-507
Purpose Adjuvant therapy for Stage II colon cancer remains controversial but may be considered for patients with high-risk features.
The purpose of this study was to assess the prognostic significance of commonly reported clinicopathologic features of Stage
II colon cancer to identify high-risk patients.
Methods We analyzed a prospectively maintained database of patients with colon cancer who underwent surgical treatment from 1990 to
2001 at a single specialty center. We identified 448 patients with Stage II colon cancer who had been treated by curative
resection alone, without postoperative chemotherapy.
Results With median follow-up of 53 months, 5-year disease-specific survival for this cohort was 91 percent. Univariate and multivariate
analyses identified three independent features that significantly affected disease-specific survival: tumor Stage T4 (hazard
ratio (HR), 2.7; 95 percent confidence interval (CI), 1.1–6.2; P = 0.02), preoperative carcinoembryonic antigen >5 ng/ml (HR, 2.1; 95 percent CI, 1.1–4.1; P = 0.02), and presence of lymphovascular or perineural invasion (HR, 2.1; 95 percent CI, 1–4.4; P = 0.04). Five-year disease-specific survival for patients without any of the above poor prognostic features was 95 percent;
five-year disease-specific survival for patients with one of these poor prognostic features was 85 percent; and five-year
disease-specific survival for patients with ≥2 poor prognostic features was 57 percent.
Conclusions Patients with Stage II colon cancer generally have an excellent prognosis. However, the presence of multiple adverse prognostic
factors identifies a high-risk subgroup. Use of commonly reported clinicopathologic features accurately stratifies Stage II
colon cancer by disease-specific survival. Those identified as high-risk patients can be considered for adjuvant chemotherapy
and/or enrollment in investigational trials.
Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6, 2007.
Reprints are not avaliable. 相似文献
2.
de Oca J Azuara D Sanchez-Santos R Navarro M Capella G Moreno V Sola A Hotter G Biondo S Osorio A Martí-Ragué J Rafecas A 《International journal of colorectal disease》2008,23(1):21-27
Background and aims The prognostic value of the degree of apoptosis in colorectal cancer is controversial. This study evaluates the putative clinical
usefulness of measuring caspase-3 activity as a prognostic factor in colonic cancer patients receiving 5-fluoracil adjuvant
chemotherapy.
Materials and methods We evaluated caspase-3-like protease activity in tumours and in normal colon tissue. Specimens were studied from 54 patients.
These patients had either stage III cancer (Dukes stage C) or high-risk stage II cancer (Dukes stage B2 with invasion of adjacent
organs, lymphatic or vascular infiltration or carcinoembryonic antigen [CEA] > 5). Median follow-up was 73 months. Univariate
analysis was performed previously to explore the relation of different variables (age, sex, preoperative CEA, tumour size,
Dukes stage, vascular invasion, lymphatic invasion, caspase-3 activity in tumour and caspase-3 activity in normal mucosa)
as prognostic factors of tumour recurrence after chemotherapy treatment. Subsequently, a multivariate Cox regression model
was performed.
Results Median values of caspase-3 activity in tumours were more than twice those in normal mucosa (88.1 vs 40.6 U, p = 0.001), showing a statistically significant correlation (r = 0.34). Significant prognostic factors of recurrence in multivariate analysis were: male sex (odds ratio, OR = 3.53 [1.13–10.90],
p = 0.02), age (OR = 1.09 [1.01–1.18], p = 0.03), Dukes stage (OR = 1.93 [1.01–3.70]), caspase-3 activity in normal mucosa (OR = 1.02 [1.01–1.04], p = 0.017) and caspase-3 activity in tumour (OR = 1.02 [1.01–1.03], p = 0.013).
Conclusion Low caspase-3 activity in the normal mucosa and tumour are independent prognostic factors of tumour recurrence in patients
receiving adjuvant 5-fluoracil-based treatment in colon cancer, correlating with poor disease-free survival and higher recurrence
rate. 相似文献
3.
Chun-Chi Lin Jen-Kou Lin Shih-Ching Chang Huann-Sheng Wang Shung-Haur Yang Jeng-Kai Jiang Wei-Shone Chen Tzu-Chen Lin 《International journal of colorectal disease》2009,24(6):665-676
Background Colorectal carcinoma is the most common malignancy of the gastrointestinal tract. It remains controversial for adjuvant chemotherapy
in patients with stage II colon cancer. This study was designed to identify the risk factors of tumor recurrence in stage
II colon cancer. Furthermore, the benefit of adjuvant chemotherapy for high-risk stage II colorectal cancer will be investigated.
Materials and methods From May 1998 until August 2004, 375 patients with stage II (T3N0M0, T4N0M0) colon cancer received curative operation in a
single hospital. The clinical data were extracted from the prospectively collected colorectal cancer database. The disease-free
survival curves were calculated with Kaplan–Meier’s analysis, and the survival difference was determined by log-rank test.
The p value less than 0.05 was considered to be significant.
Results Of 375 stage II colon cancer, 66 patients received 5-FU-based adjuvant chemotherapy, either oral or intravenous (IV) form.
Within the median of 48.5 months of follow-up, recurrence developed in 35 patients (9.3%). T4 lesion (p=0.024), lymphovascular invasion (p=0.022), obstruction at presentation (p=0.008), and mucinous component more than 50% (p=0.032) were associated with significantly decreased disease-free survival. High-risk patients (n=102), but not other patients with stage II colon cancer, benefited from adjuvant therapy (3-year disease-free survival: 96.4%
vs. 84.7%, p=0.045; 5-year overall survival: 100% vs. 86.4%, p=0.015).
Conclusion Adjuvant therapy for high-risk stage II colon cancer may be beneficial, and we suggest adjuvant therapy should be considered
in high-risk stage II colon cancer patients. 相似文献
4.
Nakamura T Mitomi H Kanazawa H Ohkura Y Watanabe M 《Diseases of the colon and rectum》2008,51(5):568-572
Purpose High-risk patients with Stage II colon cancer may benefit from adjuvant chemotherapy, but they are difficult to identify.
We assessed the value of tumor budding, defined as small clusters of undifferentiated cancer cells at invasive margins, as
a predictor of outcomes in patients with Stage II colon cancer.
Methods We studied a total of 200 patients with Stage II colon cancer who underwent curative surgery. With hematoxylin and eosin-stained
specimens, the degree of tumor budding was classified as low-grade or high-grade. The survival rate of patients who had Stage
II disease with low-grade or high-grade tumor budding was compared with that of 226 patients who had Stage III colon cancer.
Results Univariate analysis revealed that serosal surface involvement (P = 0.04) and tumor budding (P < 0.001) were significantly related to survival. Cumulative five- and ten-year survival rates differed significantly between
patients with low-grade tumor budding (93.9 and 90.6 percent, respectively) and those with high-grade (73.9 and 67.8 percent,
respectively). Survival rates did not differ significantly between patients with Stage II disease who had high-grade tumor
budding and patients with Stage III disease. Cox’s regression analysis demonstrated that tumor budding (hazard ratio, 4.89;
P < 0.001) and serosal surface involvement (hazard ratio, 2.561; P = 0.023) were independent prognostic factors. Liver (P < 0.001) and peritoneal (P = 0.003) metastases were more frequent in the patients with high-grade tumor budding than in those with low-grade.
Conclusions Tumor budding is useful for prognosis and identifying patients with Stage II colon cancer who have a high risk of disease
recurrence after curative surgery. 相似文献
5.
Lie Yang Qin Ma Yong-Yang Yu Cun Wang Wen-Jian Meng Gunnar Adell Maria Albertsson Gunnar Arbman Ingvar Jarlsfelt Zhi-Hai Peng Yuan Li Zong-Guang Zhou Xiao-Feng Sun 《Medicine》2014,93(28)
The present study aimed to assess the efficacy of surgery and adjuvant therapy in older patients (age ≥70 years) with colorectal cancer (CRC). Older CRC patients are under-represented in available clinical trials, and therefore their outcomes after receiving surgery and adjuvant therapy are unclear. From two prospective Swedish databases, we assessed a cohort of 1021 patients who underwent curative surgery for stage I, II, or III primary CRC, with or without adjuvant chemotherapy/radiotherapy. Of the patients with colon cancer (n = 467), 182 (39%) were aged <70 years, 162 (35%) aged 70 to 80 years, and 123 (26%) were aged ≥80 years. Of rectal cancer patients (n = 554), 264 (48%) were aged <70 years, 234 (42%) aged 70 to 80 years, and 56 (10%) aged ≥80 years. Older patients with either colon or rectal cancer had higher comorbidity than did younger patients. Older patients with colon cancer had equivalent postoperative morbidity and 30-day mortality to younger patients. Rectal cancer patients aged ≥80 years had a higher 30-day mortality than younger patients (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.6–4.55; P = 0.03). For either colon or rectal cancer, adjuvant chemotherapy compromised the 5-year overall survival (OS) of older patients with stage II disease and had no effect on those with stage III disease. Receiving adjuvant chemotherapy was a poor factor of OS for older patients with either colon (HR 1.88, 95% CI: 1.20–4.35, P = 0.03) or rectal cancer (HR 1.72, 95% CI: 1.05–2.26, P = 0.004). Preoperative short-course radiotherapy improved both OS and local control for older patients with stage III rectal cancer and had no effect on those with stage II disease. Radiotherapy was a favorable factor for the OS of the older patients with rectal cancer (HR 0.42, 95% CI: 0.21–3.57, P = 0.01). In conclusion, Older CRC patients had equal safety of surgery as younger patients, except rectal cancer patients aged ≥80 years that had a higher mortality. Adjuvant 5FU-based chemotherapy did not benefit older CRC patient, while neoadjuvant radiotherapy improved the prognosis of older patients with stage III rectal cancer. 相似文献
6.
Early relapse is a parameter that affects clinical outcomes in relapsed diffuse large B cell lymphoma (DLBCL). The prognostic
value of lymphopenia following the completion of first-line therapy and the relationship between lymphopenia and early relapse
are unknown. Therefore, we studied the role of absolute lymphocyte count (ALC) on early relapse. We retrospectively analyzed
de novo DLBCL patients who were treated with rituximab-containing treatment between 2003 and 2010. The median age at the time
of diagnosis of 59 DLBCL patients was 71 years. We identified no association between ALC at diagnosis and ALC following the
completion of first-line therapy. Among all patients analyzed, 13 (22%) patients were confirmed to exhibit early relapse.
Low ALC following the completion of first-line therapy was significantly associated with early relapse by univariate analysis
[hazard ratio (HR) = 4.05; 95% confidence interval (CI), 1.11–14.73; P = 0.02] and multivariate analysis (HR = 4.66; 95% CI, 1.24–17.48; P = 0.023). The low ALC group tended to have worse outcomes than the high ALC group with lower rates of progression-free survival
(66% and 74%, respectively; P = 0.13) and overall survival (74% and 86%, respectively; P = 0.09), but these differences did not reach statistically. Lymphopenia following the completion of first-line therapy can
be used as a marker to predict early relapse. 相似文献
7.
Araujo SE Bernardo WM Habr-Gama A Kiss DR Cecconello I 《Diseases of the colon and rectum》2007,50(11):1800-1810
Purpose In colorectal cancer, the negative effect of aneuploidy has been a controversy for more than 20 years. Studies to determine
a survival-deoxyribonucleic acid content relationship have conflicting results. A systematic literature search followed by
a meta-analysis of published studies addressing prognostic effect of aneuploidy for patients who underwent surgical treatment
of colon and rectal cancer was conducted.
Methods The main outcome measure was the five-year overall mortality rate after surgical resection. For the selected studies, we estimated
this outcome for three subsets of patients through separate meta-analyses: 1) for all patients with colorectal cancer; 2)
only between patients with Stage II colon cancer; and 3) only for studies in which follow-up losses were declared. The presence
of publication bias was assessed with a funnel plot for asymmetry.
Results A total of 5,478 patients with colorectal cancer were represented in 32 studies (Group 1), we estimated a reduction in the
five-year overall mortality from 43.2 percent for aneuploid tumors to 29.2 percent for diploid tumors (combined relative risk = 1.44;
95 percent confidence interval = 1.34–1.55; P < 0.001). In addition, 357 patients with Stage II colon cancer (Group 2) extracted from three studies had an absolute reduction
of 14.3 percent in five-year overall mortality favoring diploid tumors (combined relative risk = 1.93; 95 percent confidence
interval = 1.29–2.89; P = 0.001). Lastly, of 14 studies in which follow-up losses were declared (Group 3), 2,221 patients were represented and a
15.7 percent mortality reduction was measured favoring patients with diploid tumors (combined relative risk = 1.44; 95 percent
confidence interval = 1.3–1.61; P < 0.001).
Conclusions Patients who undergo an aneuploid colorectal cancer surgical resection have a higher risk of death after five years. This
finding may ultimately impact survival of patients with node-negative colon cancer through adjuvant therapy.
Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, Washington, June 3 to 7,
2006. 相似文献
8.
Mohammadianpanah M Ahmadloo N Mozaffari MA Mosleh-Shirazi MA Omidvari S Mosalaei A 《Annals of hematology》2009,88(5):441-447
The aim of this retrospective study was to define the natural history, clinicopathological findings, prognostic factors, and
treatment outcome of 43 patients with localized stages I and II primary non-Hodgkin’s lymphoma (NHL) of the nasopharynx, followed
up in a single institution over a 17-year period. Forty-three (13 women and 30 men) consecutive patients with localized stages
I (N = 12) and II (N = 31) primary nasopharyngeal NHL were treated in our institution between 1990 and 2007. The pathologic reports were classified
according to the International Working Formulation (N = 22) or Revised European-American Lymphoma classification (N = 21). The vast majority of patients (88%) were managed with a sequential combination of chemotherapy and radiation therapy.
Chemotherapy mainly consisted of 4–8 (median 6) cycles of CHOP regimen (cyclophosphamide, doxorubicin, vincristine and prednisolone).
Involved-field radiation therapy with a median dose of 44 Gy was delivered to the primary site and entire cervical lymph nodes.
The median age of the patients was 53 years (range, 6 to 86 years). The majority of the patients (70%) had high-grade histology.
B-cell types represented 67% of the cases, among which diffuse large B cell was the most common histological subtype. After
a median follow-up of 70 months, the 5-year disease-free survival and overall survival were 58.8% and 70.6%, respectively.
In multivariate analysis, age less than or equal to 30 years (hazard ratio (HR) = 5.32, 95% confidence interval (CI) = 1.69–16.76),
elevated serum lactate dehydrogenase level (HR = 3.69, 95% CI = 1.43–9.51), and modified International Prognostic Index with
more than or equal to two risk factors (HR = 17.99, 95% CI = 2.32–139.30) retained statistical significance. Our limited data
suggest that primary nasopharyngeal NHL tends to have aggressive histology and unfavorable clinical course with poor outcome,
despite a considerably localized disease at the time of presentation and high frequency of complete initial response rates.
Combined modality therapy should be considered for the majority of patients with primary localized nasopharyngeal NHL. 相似文献
9.
Cashen A Juckett M Jumonville A Litzow M Flynn PJ Eckardt J LaPlant B Laumann K Erlichman C DiPersio J 《Annals of hematology》2012,91(1):33-38
The inhibition of histone deacetylase (HDAC) can induce differentiation, growth arrest, and apoptosis in cancer cells. This
phase II multicenter study was undertaken to estimate the efficacy of belinostat, a potent inhibitor of both class I and class
II HDAC enzymes, for the treatment of myelodysplastic syndrome (MDS). Adults with MDS and ≤2 prior therapies were treated
with belinostat 1,000 mg/m2 IV on days 1–5 of a 21-day cycle. The primary endpoint was a proportion of confirmed responses during the first 12 weeks
of treatment. Responding patients could receive additional cycles until disease progression or unacceptable toxicity. Twenty-one
patients were enrolled, and all were evaluable. Patients were a median 13.4 months from diagnosis, and 14 patients (67%) had
less than 5% bone marrow blasts. Seventeen patients (81%) were transfusion dependent. Prior therapy included azacytidine (n = 7) and chemotherapy (n = 8). The patients were treated with a median of four cycles (range, 1–8) of belinostat. There was one confirmed response—hematologic
improvement in neutrophils—for an overall response rate of 5% (95% CI, 0.2–23). Median overall survival was 17.9 months. Grades
3–4 toxicities considered at least to be possibly related to belinostat were: neutropenia (n = 10), thrombocytopenia (n = 9), anemia (n = 5), fatigue (n = 2), febrile neutropenia (n = 1), headache (n = 1), and QTc prolongation (n = 1). Because the study met the stopping rule in the first stage of enrollment, it was closed to further accrual. 相似文献
10.
Tai WM Chung J Tang PL Koo YX Hou X Tay KW Quek R Tao M Lim ST 《Annals of hematology》2011,90(7):809-818
Central nervous system (CNS)-directed prophylactic intrathecal (IT) therapy is indicated in patients with Burkitt and acute
lymphoblastic lymphoma. Its role in diffuse large B cell lymphoma (DLBCL), a heterogeneous subtype, is less well defined.
While addition of rituximab to standard cyclophosphamide–hydroxydaunorubicin–oncovin–prednisone (CHOP) chemotherapy (R-CHOP)
has improved the outcomes of DLBCL patients, its role in reducing CNS relapse is unclear. We aim to (1) evaluate the clinical
risk factors predictive of CNS relapse, (2) the role of rituximab in influencing CNS relapse, and (3) role of intrathecal
prophylaxis. Four hundred ninety-nine patients with DLBCL from 2000 to 2008 were included (CHOP 179 vs. R-CHOP 320). IT prophylaxis
was administered to 82 patients based on our institution’s guidelines. Baseline characteristics between CHOP- and R-CHOP-treated
patients were similar. Although R-CHOP significantly increased the complete remission rate from 71% to 81% (P < 0.01), CNS relapse rates remained unchanged (R-CHOP 6% vs. CHOP 5.1%). On multivariate analysis, poor performance status
(Eastern Cooperative Oncology Group >1; hazard ratio (HR) = 2.01, 95% confidence interval (CI) 1.29–3.14), failure to attain
remission (non-complete response (CR) vs. CR: HR = 2.39, 95% CI = 1.03 to 5.51), testicular (HR = 6.67, 95% CI = 1.62 to 27.53),
kidney (HR = 20.14, 95% CI = 5.23 to 77.46), and breast involvement (HR = 6.14, 95% CI = 1.61 to 23.37) were each independently
predictive of CNS relapse. Use of IT prophylaxis did not appear to decrease CNS relapse. Median survival after CNS relapse
was 3.2 months. CNS relapse, a fatal event, remains a challenge in R-CHOP-treated patients. IT prophylaxis may not be sufficient
to reduce CNS relapse, and strategies including systemic agents with high CNS penetration should be evaluated in high-risk
patients identified in this study. 相似文献
11.
Oliver Nehls Holger G. Hass Thomas Okech Silke Zenner Chih-Jen Hsieh Mario Sarbia Franz Borchard Hans-Helmut Gruenagel Vera Gaco Rainer Porschen Michael Gregor Bodo Klump 《International journal of colorectal disease》2009,24(6):655-663
Purpose This study examined whether the apoptosis-related protein, BAX, or the microsatellite-instability phenotype provide prognostic
information in patients with resected colon cancer.
Methods A total of 371 stage I–III patients that previously underwent radical surgery were included (mean follow-up 51.8 months).
BAX expression was examined by immunohistochemical staining; high-frequency microsatellite instability (MSI+) was determined
by assessing the specific marker, BAT26, using single-strand conformation polymorphism (SSCP)-based analysis.
Results High BAX expression was found in 66.4% of patients. MSI+ tumors were observed in 14.8% of 344 patients. Univariate analysis
showed that unlike MSI, low BAX expression was significantly correlated with poor disease-specific overall survival (OS) in
stages I–III (p = 0.04). Multivariate subgroup analyses revealed that unlike MSI, low BAX was an independent predictor for OS in stage II
(p = 0.009); however, in stages I or III, BAX or MSI were not independent predictors of OS.
Conclusions In stage II colon cancer treated with surgery alone, BAX protein expression may be a predictor for prognosis.
Oliver Nehls and Holger G. Hass contributed equally to this work. 相似文献
12.
Addition of rituximab to chemotherapy (R-chemo) has been shown to improve overall survival (OS) in patients with diffuse large
B cell lymphoma (DLBCL). Germinal center B cell-like (GCB) subtype of DLBCL has a significantly better clinical outcome than
those with non-germinal center B cell-like (non-GCB) subtype. Further research is needed to confirm this difference between
those two subtypes treated with R-chemo. We searched for randomized controlled trials that compared R-chemo with identical
chemotherapy alone in patients with newly diagnosed or relapsed DLBCL. A random versus fixed effects model was selected according
to heterogeneity. Six eligible trials involving 748 adult patients were included in this meta-analysis. Fixed-effects analysis
showed OS to be superior for the GCB patients treated with R-chemo (relative risk (RR) = 1.16, 95% confidence interval (CI) = 1.03–1.31,
P = 0.02). Superiority was also observed for the GCB subtype under R-chemo with respect to disease control (RR = 1.16, 95%
CI = 0.99–1.36) and overall response (RR = 1.19, 95% CI = 0.99–1.99). Both subtypes showed an increased OS (RR = 1.30, 95%
CI = 1.11–1.51; RR = 1.89, 95% CI = 1.52–2.35, respectively) and disease control rate (RR = 1.27, 95% CI = 1.05–1.54, P = 0.01; RR = 2.21, 95% CI = 1.68–2.90, respectively) following R-chemo. Therefore, treated with R-chemo, GCB patients still
has a significantly better clinical outcome than those with non-GCB subtype. 相似文献
13.
Gastric mucosa-associated lymphoid tissue (MALT) lymphoma and diffuse large B cell lymphoma (DLBCL) show a spectrum of disease
characterized by varying proportions of low-grade and high-grade components. While the natural history and optimum treatment
for low-grade gastric MALT lymphoma and DLBCL is well established, the prognosis and optimal treatment of patients with both
low- and high-grade components is not well established. The purpose of our study was to evaluate the clinical characteristics,
survival outcomes, and prognostic factors of patients with gastric MALT lymphoma and gastric DLBCL. A retrospective review
of patients with gastric MALT lymphoma, gastric DLBCL, or MALT lymphoma with a high-grade component treated at our centers
from 1994 to 2006 was performed. Patients were divided into three categories: “pure MALT lymphoma,” “MALT lymphoma with high-grade
component” (mixed), and “pure DLBCL.” Seventy-six patients were included in our study—26 with pure MALT, 22 with MALT with
high-grade component (“mixed”), and 28 with pure DLBCL. Pure MALT lymphoma and mixed lymphoma patients had similar clinical
characteristics, whereas pure DLBCL patients had less favorable disease characteristics with significantly poorer performance
status, higher number of extranodal sites of disease, higher stage, and larger proportion of bone marrow involvement and international
prognostic index (IPI) scores compared with mixed lymphoma. The majority of mixed lymphoma (72.7%) and DLBCL patients (71.4%)
were treated with chemotherapy. Of patients receiving chemotherapy, a higher proportion of mixed lymphoma and DLBCL patients
received anthracycline-based combination chemotherapy regimens compared with MALT lymphoma (73% vs 71% vs 8%) whereas the
proportion of mixed lymphoma and DLBCL patients was similar (p = 0.919). At a median follow-up of 37 months, the 5-year overall survival was 66.9%. The 5-year overall survival was 78%
for MALT lymphoma, 84% for mixed lymphoma, and 45% for DLBCL. On univariate analysis, DLBCL histology, age, performance status,
serum albumin, lactate dehydrogenase, bone marrow, number of extranodal sites, stage, and IPI score were prognostic for inferior
survival. On multivariate analysis, DLBCL histology remained significantly prognostic for inferior survival, independent of
chemotherapy regimen (hazard ratio (HR) 6.66, 95% confidence interval (CI) 2.01–21.41, p = 0.001). Mixed histology was not prognostic for inferior survival (HR 1.13, 95% CI 0.28–4.54, p = 0.868). Other factors prognostic for inferior survival were serum albumin <37 g/L (HR 3.22, 95% CI 1.11–13.22, p = 0.034) and treatment with non-cyclophosphamide, doxorubicin, vincristine, and prednisolone chemotherapy (HR 4.89, 95% CI
1.67–14.36, p = 0.004). In conclusion, the clinical characteristics of mixed histology MALT lymphoma are similar to low-grade MALT lymphoma
and significantly different from pure DLBCL. The prognosis of mixed histology MALT lymphoma is significantly better than pure
DLBCL, independent of IPI and chemotherapy regimen, and pure DLBCL histology is independently prognostic of inferior survival
outcome. 相似文献
14.
Platell CF 《International journal of colorectal disease》2007,22(10):1223-1231
Background The management of patients with colorectal cancer has changed appreciably over the last 16 years. The aims of this study were
to compare the rates and patterns of disease recurrence over the last 10 years with a historical control group.
Materials and methods Data was obtained from a prospective database that had recorded all patients presenting with colorectal cancer from 1996 to
2006. This data was compared with a retrospective data set that included all patients treated with colorectal cancer at the
same institution from 1989 to 1995. The Kaplan–Meier technique was used to calculate the 5 year recurrence and local recurrence
rates for the two groups.
Results There were 710 patients in the study group and 475 patients in the control group. There were more patients with rectal cancer
and stage I cancer in the study group. When comparing the study group vs the control group, there was an increase in the time
to recurrence (2.1 vs 1.6 years, n.s.) and a decrease in the 5 year recurrence rate for patients undergoing curative resections
(17% [95% CI 12%–20%] vs 42% [95% CI 36%–49%], p < 0.001). These changes were noted for both colon (16% vs 34%, p < 0.001) and rectal cancers (18% vs 50%, p < 0.001). There was also a decrease in local recurrence in patients with rectal cancer (8.8% [95% CI 4.5%–13.1%] vs 33.6%
[95% CI 23.6%–43.6%], p < 0.001).
Conclusions Within this institution, there has been a significant trend during the last 16 years towards reduced disease recurrence, both
local and metastatic, and a prolongation in the time to develop recurrence. 相似文献
15.
The prognostic value of karyotype in patients with myelodysplastic syndrome (MDS) is generally appreciated. However, the factors
that are predictive of prognosis of patients with abnormal karyotypes are not known. In this study, we evaluated the prognostic
value of International Prognostic Scoring System (IPSS) and World Health Organization classification-based prognostic scoring
system (WPSS) in 164 adult MDS patients with abnormal karyotypes. We also analyzed the prognostic relevance of mean corpuscular
volume (MCV) in these patients. We found that both IPSS and WPSS had strong prognostic value in patients with abnormal karyotypes
(P < 0.001, P < 0.001). Furthermore, we observed the significant differences in the survival of patients with abnormal karyotypes based
on MCV stratification: The median survival of patients with macrocytosis was 31.0 months, significantly longer than the 16.5-month
median survival time of patients with MCVs of less than 100 fl (P = 0.001). Multivariate analysis revealed that lower level of hemoglobin (P = 0.012, HR = 6.83), higher level of marrow blasts (P < 0.001, HR = 1.93), complex karyotype (P = 0.001, HR = 3.32), and MCV of less than 100 fl (P = 0.026, HR = 1.75) were independent risk factors that affected the survival of patients with abnormal karyotypes. 相似文献
16.
Laffer U Metzger U Aeberhard P Lorenz M Harder F Maibach R Zuber M Herrmann R 《International journal of colorectal disease》2008,23(12):1233-1241
Background and aims The perioperative use of a single course adjuvant portal vein infusion chemotherapy in patients with potentially curable colorectal
cancer has been shown to significantly improve overall survival but did not reduce the occurrence of liver metastases (SAKK
40/81) [Swiss Group for Clinical Cancer Research (SAKK) Lancet 345(8946):349–353, 1995]. The objective of the present prospective, three-arm randomized multicenter trial was to assess whether peripheral venous
administration of adjuvant chemotherapy regimen based on 5-fluorouracil (5-FU) and mitomycin C decreases the occurrence of
liver metastases as well as prolongs disease-free and overall survival.
Materials and methods Stages I–III colorectal cancer patients (n = 753) were randomized to receive either surgery alone (control arm), surgery plus postoperative portal venous infusion of
5-FU 500 mg/m2 plus heparin given for 24 hours for seven consecutive days plus mitomycin C 10 mg/m2 given on the first day (arm 2), or surgery and the same chemotherapy regimen administered by peripheral venous route (arm
3).
Results The 5-year disease-free survival for the three treatment groups were 65% (control group), 60% (portal vein infusion, hazard
ratio 1.18, p = 0.23), and 64% (intravenous infusion, hazard ratio 1.04, p = 0.76); the 5-year overall survival was 72% (control group), 69% (portal vein infusion, hazard ratio 1.21, p = 0.2), and 74% (intravenous infusion, hazard ratio 1.03, p = 0.86), respectively. A significant accumulation of early deaths were observed in the portal vein infusion group (p = 0.015).
Conclusions The present prospective randomized multicenter trial provides compelling evidence that short-term perioperative chemotherapy
does not improve disease-free and overall survival in patients with potentially curative colorectal cancer. In contrary, the
chemotherapy regimen administered in the present investigation seems to have potentially harmful effects, a finding which
should be carefully considered in the planning of future trials. Postoperative short-term administration of 5-FU plus mitomycin
C either through portal infusion or a central venous catheter is not recommended for routine use in patients with potentially
curable colorectal cancer.
M. Lorenz deceased. 相似文献
17.
Yu KH Wu YJ Kuo CF See LC Shen YM Chang HC Luo SF Ho HH Chen IJ 《Clinical rheumatology》2011,30(12):1595-1601
To estimate the mortality rate and identify factors predicting survival in patients with polymyositis (PM) and dermatomyositis
(DM). The medical records of 192 PM/DM patients who were treated at Chang Gung Memorial Hospital from 1999 through 2008 were
retrospectively reviewed. The Taiwan National Death Registry (1999–2008) was used to obtain their survival status. Thirty-one
(16.1%) of the 192 patients with PM/DM had an associated malignancy; 41 (21.4%) had interstitial lung disease (ILD). During
the follow-up period, 55 (28.6%) patients died and the overall cumulative survival rate was 79.3% at 1 year, 75.7% at 2 years,
69.9% at 5 years, and 66.2% at 10 years. In univariate analysis, older age at PM/DM onset, anemia, thrombocytopenia, leukopenia,
diabetes mellitus, ILD, cancer, and non-use of azathioprine were associated with higher mortality (p = 0.0172, 0.0484, <0.0001, 0.0008, 0.0001, 0.0036, 0.0010, and 0.0019, respectively). In multivariate Cox regression analysis,
thrombocytopenia (hazard ratio [HR] 4.94, 95% confidence interval [CI] 2.60–9.37, p < 0.0001), diabetes mellitus (HR 2.57, 95% CI 1.38–4.80, p < 0.0001), cancer (HR 2.30, 95% CI 1.26–4.22, p = 0.0030), and ILD (HR 1.98, 95% CI 1.11–3.51, p = 0.0182) were positively associated with mortality. Use of azathioprine (HR 0.35, 95% CI 0.16–0.74, p = 0.0064) was negatively associated with mortality. This study confirmed the high mortality rate (28.6%) in PM/DM patients.
Survival time was significantly reduced in patients with thrombocytopenia, diabetes mellitus, ILD, and cancer patients than
in those without these conditions. 相似文献
18.
Hung HY Chen JS Yeh CY Changchien CR Tang R Hsieh PS Tasi WS You JF You YT Fan CW Wang JY Chiang JM 《International journal of colorectal disease》2011,26(8):1059-1065
Background and aims
Selection of appropriate stage II colon cancer patients for adjuvant chemotherapy is critical for improving survival outcome. With the aim of identifying more high risk factors for stage II colon cancer, this study aimed to determine whether the neutrophil?Clymphocyte ratio (NLR) is a predictor of surgical outcomes in patients with stage II colon cancer who do not receive adjuvant chemotherapy.Materials and methods
We enrolled 1,040 stage II colon cancer patients who had undergone colectomy at a single institution between January 1995 and December 2005 and did not receive adjuvant chemotherapy.Results
Of these 1,040 patients, 785 (75.5%) patients had a normal NLR and 255 (24.5%) had an elevated NLR. Those with an elevated NLR included patients ??65?years, T4b cancer, carcinoembryonic antigen ??5?ng/mL, and tumor obstruction or perforation. Patients with an elevated NLR had a significantly worse overall survival (OS) and worse disease-free survival (DFS) than did patients with a normal NLR. Cox regression analysis revealed that elevated NLR was an independent predictor of OS (P=0.012) but not DFS (P=0.255).Conclusion
An elevated NLR is an independent predictor of OS but not DFS in stage II colon cancer patients who did not receive adjuvant chemotherapy. Preoperative NLR measurement in stage II colon cancer patients may be a simple method for identifying patients with a poor prognosis who can be enrolled in further trials of adjuvant chemotherapy. 相似文献19.
Vasků A Vokurka J Bienertová-Vasků J 《International journal of colorectal disease》2009,24(3):289-294
Background Genetic variability in obesity-related genes and the resulting phenotypes are being recognized as major risk factors for colorectal
cancer and/or severity of the disease.
Materials and methods A total of 102 patients (aged 68 ± 10.2 years, 79 men and 23 women) and 101 age-matched (68.1 ± 5.4 years old) individuals
without colorectal cancer, 59 men and 42 women, were recruited. All the individuals were genotyped for the following subset
of polymorphisms in obesity-related genes: angiotensinogen gene (M235T and -6A/G), in IL-6 gene (-174 G/C and -596 A/G), in
leptin gene (-2548 A/G), and polymorphism Gln223Arg within the leptin receptor (LEPR) gene.
Results A significant increase in frequency of double heterozygote genotype (MTAG) of both angiotensinogen polymorphisms in males
with colorectal cancer was observed when compared to control men [odds ratio (OR) = 3.77, P
corr = 0.001]. A marginally significant difference in genotype distribution of -174 G/C IL-6 polymorphism between the patients
in stage I–II compared to patients in III–IV was found (P
g = 0.05, P
a = 0.173). The GG genotype of -174 G/C IL-6 polymorphism in the patients in stage III–IV carries an increased risk compared
to those in stage I–II (OR = 2.83, P
corr = 0.06). Similarly, a difference in genotype distribution of Gln223Arg in LEPR gene between the patients staged I–II compared
to III–IV was observed (P
g = 0.05). The AA genotype was shown to be risky for the patients staged III–IV (OR = 3.35, P
corr = 0.06).
Conclusions The investigated single nucleotide polymorphisms within the genes encoding for obesity-related genes were observed to be associated
both with clinical manifestation of colorectal cancer and with severity of the disease. Thus, we suggest that defined genetic
variability in the genes might become DNA markers for colorectal cancer in the future. 相似文献
20.
Zusterzeel PL Span PN Dijksterhuis MG Thomas CM Sweep FC Massuger LF 《Journal of cancer research and clinical oncology》2009,135(2):283-290
Purpose To study pre-treatment serum VEGF of patients with invasive cervical cancer and its possible role as prognostic indicator.
Methods VEGF was measured using ELISA in the largest patient group (n = 167) to date.
Reults Serum VEGF was significantly higher in advanced tumor stage (P = 0.01), large tumor size (tumors larger than 2 cm) (P = 0.03), and the presence of vascular space invasion (P = 0.05). Serum VEGF was associated with disease free and overall survival [DFS: Hazard Ratio (HR) = 2.61; 95% CI 1.32–5.17;
P = 0.006; for OS: HR = 2.09; 95% CI 1.54–2.84; P < 0.001, respectively]. In multivariate Cox regression serum VEGF retained its prognostic value for DFS (HR = 2.10, P = 0.03) and OS (HR = 1.92, P = 0.04).
Conclusions Serum VEGF levels correlate with more advanced and more aggressive disease in cervical cancer and may be a useful prognostic
factor in patients with cervical cancer. 相似文献