Clinical and Biological Significance of Serum Tumor Markers in Adult T-cell Leukemia

As the clinical manifestations of adult T-cell leukemia (ATL) can be quite diverse, useful indicators for the therapy and prognosis are required for the disease. In this review, the clinical and biological significance of serum tumor markers at diagnosis in ATL patients is described.

Serum lactic dehydrogenase (S-LDH), serum thymidine kinase (S-TK) and serum parathyroid hormone-related protein (S-PTHrP) at diagnosis of ATL showed a correlation with among leukocyte count, absolute number of abnormal lymphocytes with polymorphic nuclei, platelet count, serum calcium and the length of survival after the initial diagnosis. Serum β₂Vmicroglobulin (S-β₂M) correlated with age, platelet count and survival. A statistical correlation existed between these four serum tumor markers. Other serum tumor markers such as immunosuppressive acidic protein (S-IAP), ferritin (S-Ft) and tissue polypeptide antigen (S-TPA) showed no correlation with clinical and histological data in ATL patients.     

Serum deoxythymidine kinase in small cell carcinoma of the lung. Relation to clinical features, prognosis, and other biochemical markers

Thymidine kinase (s-TK), lactate dehydrogenase (LDH), and carcinoembryonic antigen (CEA) were determined in pretreatment serum from 125 patients with small cell carcinoma of the lung. The distribution of marker levels into three ranges, when including all patients were as follows: s-TK less than 5 units 49%, 5-less than 10 units 25%, greater than or equal to 10 units 26%; LDH less than 6.7 mukat 31%, 6.7-less than 13.4 mukat 48%, greater than or equal to 13.4 mukat 21%; CEA less than 7.5 micrograms/l 51%, 7.5-less than 15 micrograms/l 25%, greater than or equal to 15 micrograms/l 24%. The percentages of patients with limited and with extensive disease within each range were s-TK less than 5 82/18, 5-less than 10 29/71, greater than or equal to 10 9/91; LDH less than 6.7 76/24, 6.7-less than 13.4 51/49, greater than or equal to 13.4 21/79; CEA less than 7.5 70/30, 7.5-less than 15 39/61, greater than or equal to 15 23/77. Analyses in relation to metastases present showed that patients with skeletal and bone marrow metastases had significantly higher s-TK and LDH than those without, while this was not the case for CEA. A strong correlation between s-TK and LDH level, a weaker correlation between CEA and s-TK, and no correlation between CEA and LDH level, was found. Both the level of s-TK and LDH correlated to the patients' performance, as defined by the Karnofsky index. These correlations were mainly confined to the patients with extensive disease. Analyses of the prognostic capacity of variables showed that s-TK, stage, and Karnofsky index could divide the patients into groups with highly significant difference in survival time, while LDH and CEA were of less value. Longitudinal studies showed that the serum markers mirrored the disease activity, with the exception that highly increased s-TK was found during remission induction for some patients. It was concluded that the expression of pathologic levels for the serum markers were dependent on different biological parameters. Of the serum markers, only s-TK was judged useful for estimation of disease spread and prognosis of the individual patient.     

Ⅳ期NSCLC化疗同期3DRT前瞻性、多中心Ⅱ期临床研究——临床因素对生存影响(PPRA-RTOG003)

目的 探讨临床因素对Ⅳ期NSCLC化疗同期原发肿瘤3DRT生存的影响。方法 对2008—2012年一项前瞻性临床研究再分析入组203例,可评价临床因素178例。化疗为含铂两药方案,中位周期数为4(2~6个周期),原发肿瘤3DRT中位剂量60.3 Gy (36.0~76.5 Gy)。Kaplan-Meier法计算OS并Logrank检验和单因素分析,Cox回归模型多因素分析。结果 全组1、2、3年OS和中位生存期分别为56%、16%、10%和13个月(95% CI为11.500~14.500)。单因素分析显示PLT≤221×10⁹/L、Neu≤5.2×10⁹/L、WBC<7×10⁹/L、疗后KPS改善的OS显著延长(P=0.000、0.022、0.003、0.029),单器官转移、Hb≥120 g/L有延长OS趋势(P=0.058、0.075)。多因素分析显示WBC<7×10⁹/L、PLT≤221×10⁹/L及疗后KPS改善对OS有益(P均<0.05)。结论 疗前WBC、PLT水平和疗后KPS是化疗同期3DRT Ⅳ期NSCLC的预后影响因素。临床试验注册 ClinicalTrials.gov,注册号:ChiCTRTNC10001026。     

基于SEER数据库的乳腺黏液腺癌临床病理学特征及生存分析

背景与目的：乳腺黏液腺癌（mucinous carcinoma,MC）恶性程度较低,预后较好。目前美国国立综合癌症网络 （National Comprehensive Cancer Network,NCCN）指南推荐对雌激素受体（estrogen receptor,ER）和孕激素受体（progesterone receptor,PR）阴性MC的辅助化疗按照非特殊类型的浸润性导管癌（invasive ductal carcinoma,IDC）处理,即激素受体阴性、淋巴结阴性的pT≥0.6 cm的MC考虑及需要辅助化疗。探讨IDC和MC的临床、病理学等因素与乳腺癌特异生存率（breast cancer-specific survival,BCSS）的关系,为MC的辅助治疗策略提供依据。方法：回顾性分析2000—2009年美国流行病监测与最终治疗结果（Surveillance, Epidemiology, and End Results,SEER）数据库中可手术的245 235例IDC及6 705例MC的病例资料,比较两种不同组织学类型乳腺癌的临床病理学特征及BCSS率的差异。结果：MC患者ER阳性率高达97.3%,而IDC为76.0%（P<0.01）;中位随访104个月,整体上MC的预后优于IDC,MC的10年BCSS率为92.0%,而IDC为84.0%（P<0.001）;ER和PR均阳性的MC和IDC的10年BCSS率分别为93.0%和87.0%（P<0.001）,ER和PR均阴性则分别为81.0%和76.0%（P=0.022）;激素受体阴性的MC患者中,pT ₂ N ₀ M ₀ 和pT _3-4 N ₀ M ₀ 的BCSS率均较低,分别为85.2%和80.0%,而pT ₁ N ₀ M ₀ 预后较好,10年BCSS率为94.5%,其中接受化疗和未经过化疗的10年BCSS率分别为94.1%和94.6%（P=0.87）。结论：MC生物学行为较好,与IDC相比,MC具有更好的长期生存;激素受体阴性、pT ₁ N ₀ M ₀ 的MC预后好,辅助化疗并没有进一步改善生存,提示对这部分高选择的患者有可能豁免辅助化疗,减少不必要的毒性。     

Serum vascular endothelial growth factor per platelet count in hepatocellular carcinoma: correlations with clinical parameters and survival

BACKGROUND: Platelets have been reported to act as transporters of tumor-originated vascular endothelial growth factor (VEGF), contributing to tumor angiogenesis and progression. Serum VEGF per platelet count, as an indirect theoretical estimate of VEGF in platelets, may predict the malignant potential of tumors. However, its prognostic significance is still unclear in hepatocellular carcinoma (HCC), a highly vascular tumor. METHODS: Serum VEGF was measured by enzyme-linked immunosorbent assay. We compared serum VEGF, platelet count and serum VEGF per platelet count in 52 HCC patients, 26 liver cirrhosis patients and 30 healthy controls. The relation of serum VEGF per platelet count with clinicopathologic variables of HCC patients and the prognostic significance were investigated. RESULTS: Serum VEGF per platelet count in HCC patients was higher than in liver cirrhosis patients and healthy controls (P < 0.01). There was a statistically significant correlation between serum VEGF and platelet count in HCC patients (r = 0.751, P < 0.01). Serum VEGF per platelet count was higher in patients with advanced stage and portal vein thrombosis (P < 0.01). Patients with high serum VEGF per platelet count (>1.4 pg/10(6)) showed poor response to treatment and shorter overall survival (P < 0.01). Serum VEGF per platelet count was an independent prognostic factor with the presence of portal vein thrombosis (P < 0.01). CONCLUSIONS: Serum VEGF per platelet count could be a feasible prognostic indicator during the follow-up of patients with HCC.     

Predictive value of serum thymidine kinase level for Ig-V mutational status in B-CLL.

In B-CLL IgV(H) genes mutational status is a major prognostic factor. Since sequencing of IgV(H) genes is not available in most laboratories, an easily performed surrogate assay is desirable. To identify the best surrogate assay, and to better discriminate prognostic subgroups we analyzed clinical and biological data from 58 typical CLL cases. A higher serum thymidine kinase level (>15 U/l) proved to be a strong predictor of mutational status, and the only independent one among the studied parameters. To further identify prognostic subgroups, cluster analysis was employed on 38 cases on which all data were available, which segregated two groups including 25 and 13 patients, respectively. These two clusters differed by their proliferative potential and appeared to discriminate patients with very different clinical course and outcome. s-TK was strikingly different among these two clusters, suggesting that s-TK level could be used routinely to identify patients at risk of progression.     

Insulin-like growth factor binding protein-3 in breast cyst fluid: relationships with insulin-like growth factors I and II and transforming growth factor-beta 1 and 2

Women who have palpable breast cysts with intracystic Na/K > 3 may have a lower risk of developing breast cancer than those with intracystic Na/K < 3. In this study significantly higher concentrations of insulin-like growth factor-binding protein-3 (IGFBP-3), insulin-like growth factors I and II (IGF-I, IGF-II) and transforming growth factor-beta 2 (TGF-β₂) were found in the Na/K > 3 sub-group. No difference was found in transforming-growth factor-beta 1 (TGF-β₂) levels between the two sub-groups of breast cysts. A positive correlation was obtained for IGFBP-3 and TGF-β₁ in the Na/K > 3 sub-group consistent with reports that TGF-β₁ may regulate the production of IGFBP-3. Equimolar amounts of total IGFs and IGFBP-3 in breast cyst fluid imply that most, if not all, of these IGFs are protein-bound. The significantly higher concentrations of TGF-β₂ in the Na/K > 3 sub-group may partly explain the lower risk of breast cancer in this group of women.     

Serum deoxythymidine kinase activity in adult T-cell leukemia

Serum deoxythymidine kinase activities (s-TK) of the patients with adult T-cell leukemia (ATL), carriers and healthy persons were measured, using a recently developed TK assay with 125I-iodo-deoxyuridine as a substrate. The mean s-TK values were 3.3 +/- 2.7 U/l (n = 21) in normal subjects (HTLV-1(-)), 4.7 +/- 5.0 U/l (n = 35) in carriers, 9.8 U/l (n = 3) in smoldering ATL and 26.7 U/l (n = 6) in chronic ATL. In the patients with acute ATL, the mean s-TK values before and after chemotherapy were 80.9 U/l (n = 2) and 11.6 U/l (n = 4), respectively. In the follow-up studies of the patients with acute ATL, the changes of s-TK levels revealed earlier than those of serum LDH levels. It is suggested that s-TK activity is more useful than LDH as a parameter of monitoring treatment in ATL.     

Variations in the low levels of cyclin D1/BCL1 have prognostic value in chronic lymphocytic leukemia

Cyclin D1 (CyD1)/BCL1 (PRAD1) is expressed at high levels in almost all cases of mantle cell leukemia/lymphoma (MCL) and in rare cases of chronic lymphocytic leukemia (CLL). The CyD1/BCL1 protein plays an important role in the progression of cells through the G1 phase of cell cycle. Most of the CyD1/BCL1 protein expression studies are performed using immunohistochemistry. We used a sensitive solid-phase radioimmunoassay (RIA) to quantify CyD1 protein expression in 199 patients with CLL. Of these 137 patients were previously untreated with the rest having had standard chemotherapeutic regimens including alkylating agents and fludarabine before being referred to our center. Median white cell count in these patients was 49x10(3) /microl (range 3.0-438.5x10(3)/microl), hemoglobin level 13.1 g/dl (range 5.2-17.3 g/dl), platelet count 157x10(3) /microl (range 10-377x10(3) /microl), age 58 (range 26-89), and beta2-microglobulin 2.75 mg/dl (range 1.1-14.3). The median radioactivity (CPM) of mononuclear cells obtained from 56 normal individuals was assigned a value of 1. There was no significant variation in CyD1 levels among normal individuals (SD=0. 12). While most CyD1 levels in MCL varied from 6.5 to 15.6, the median CyD1/BCL1 in CLL was 1.4 with 75th percentile under 2.12. Rare CLL cases (3.5%) showed levels between 4 and 8.83. When divided into two groups at the median level, patients with higher CyD1/BCL1 expression had shorter survival (P = 0.03). This remained true when applied only to the previously untreated patients (P=0.05). Despite the relatively low expression, the CyD1/BCL1 levels in univariate analysis were as good or better predictors of survival than Binet (P = 0.03) or Rai (P = 0.05) staging. Furthermore, CyD1/BCL1 levels correlated with serum beta2-microglobulin (P = 0.001), white blood cell count (P = 0.004) and hemoglobin levels at the time of collection (P = 0.0003) but not with lymphocyte count, platelet count or age. The data demonstrate that CyD1/BCL1 is likely to play a significant role in the biology of CLL and can be used as a prognostic indicator. Further studies to clarify the role of CyD1 in the biology of CLL and its value as a prognostic indicator at the time of diagnosis are encouraged.     

化疗前后 NLR、血小板计数对评估晚期非小细胞肺癌患者预后的价值

目的：探讨化疗前后中性粒细胞／淋巴细胞比值（NLR）、血小板计数对晚期非小细胞肺癌（NSCLC）患者预后的判断价值。方法选取河南省安阳市肿瘤医院2011年10月—2012年12月收治的70例晚期 NSCLC 患者为研究对象,收集化疗前及化疗2周期后 NLR 及血小板水平。NLR 以中位数3．43为界,分低 NLR 及高 NLR 组;血小板≥300×109／L 为血小板升高组,100×109／L ＜血小板＜300×109／L为正常组。化疗2周期后根据 NLR 变化,分为3组：①化疗前低 NLR 组;②化疗前高 NLR化疗后降为低 NLR 组;③化疗前高 NLR 化疗后仍为高 NLR 组。根据化疗前后血小板计数的变化分为3组：①化疗前血小板正常组;②化疗前血小板升高化疗后降至正常组;③化疗前血小板升高化疗后仍为升高组。对比不同组患者的临床病理特征和远期生存。结果低 NLR 组、高 NLR 组患者中位生存时间分别为16．0、12．5个月,差异有统计学意义（χ2＝3．654,P ＝0．041）。血小板正常组、升高组中位生存时间分别为14．3、10．0个月,差异有统计学意义（χ2＝5．358,P ＝0．021）。化疗前后 NLR 变化3组患者的中位生存时间分别为14．5、12．1、9．0个月,差异有统计学意义（χ2＝7．701,P ＝0．021）。血小板计数变化3组患者中位生存时间分别为14．3、13．1、10．4个月,差异有统计学意义（χ2＝12．775,P ＝0．002）。COX 多因素分析显示 NLR（RR ＝1．467,95％CI 为1．014～2．124,χ2＝4．130,P ＝0．042）、血小板（RR ＝1．631,95％CI 为1．108～2．402,χ2＝6．137,P ＝0．013）和 TNM分期（RR ＝1．380,95％CI 为1．052～1．809,χ2＝5．420,P ＝0．020）均是影响晚期 NSCLC 患者预后的独立预后因素。结论化疗前 NLR 和血小板计数与患者不良预后有关,NLR 和血小板升高,患者生存期缩短。     

超敏C反应蛋白对非霍奇金淋巴瘤的预后评估作用

  目的  探讨超敏C反应蛋白（high sensitivity-C reactive protein,Hs-CRP）水平与非霍奇金淋巴瘤（non-Hodgkin lympho- ma,NHL）患者预后的关系。   方法  收集85例NHL患者的临床资料,中位随访14（1~59）个月,通过与已知的预后参数进行对比,探讨Hs-CRP对该疾病预后的预测价值。   结果  治疗前血清基础Hs-CRP水平≥4 mg/L较Hs-CRP水平 < 4 mg/L患者的无病进展生存期（progression free survival,PFS）更短（P < 0.05）,Hs-CRP水平≥4 mg/L较Hs-CRP水平 < 4 mg/L患者的总生存期（overall survi- al,OS）亦更短（P < 0.05）。治疗后早中期Hs-CRP水平与OS、PFS无显著相关性（P>0.05）。Cox多因素分析显示,治疗前血清基础Hs-CRP可作为NHL患者复发以及生存的一个重要预后参数（P < 0.05）。   结论  治疗前基础Hs-CRP水平可作为NHL患者预后的一个重要依据。      

Elevated serum levels of soluble CD44 can identify a subgroup of patients with early B-cell chronic lymphocytic leukemia who are at high risk of disease progression

BACKGROUND: Although soluble CD44 (sCD44) is considered a reliable marker of both tumor burden and disease activity, to the authors' knowledge, its predictive and prognostic value in B-cell chronic lymphocytic leukemia (CLL) has not been addressed to date. METHODS: The authors studied 94 previously untreated CD5-positive B-cell CLL patients whose sera was taken at the time of diagnosis, stored at - 70 degrees C, and analyzed for the presence of standard sCD44 (sCD44(std)) using a commercial enzyme-linked-immunoadsorbent-assay. The impact of the sCD44 level on the clinical outcome of the disease was assessed in 74 patients with early CLL (61 Binet Stage A patients and 13 asymptomatic Stage B patients). Because the time to disease progression appears to predict the survival time of patients with CLL, it was used as a surrogate endpoint in the current study. RESULTS: Patients with higher than median sCD44 levels (i.e., 642 ng/mL) had a more advanced clinical disease stage (P = 0.04), higher peripheral blood lymphocytosis (P = 0.006), and increased circulating levels of either lactate dehydrogenase (P = 0.01) or beta(2)-microglobulin (P < 0.0001). In univariate analysis, seven of the nine parameters investigated predicted progression-free survival (PFS). In a stepwise multiple regression analysis, only 2 parameters provided independent prognostic information regarding PFS: Rai substages (0 vs. I-II) (P = 0.002) and serum sCD44 levels > 642 ng/mL (P = 0.01). When added to the classification of smoldering CLL versus nonsmoldering CLL, the sCD44 level distinguished two groups within the group of nonsmoldering Stage A patients; patients with a sCD44 level > 642 ng/mL had a median PFS of 36 months, whereas patients with a sCD44 level < 642 ng/mL experienced a longer PFS (median had not been reached at 8 years of follow-up). Furthermore, serum levels of sCD44 defined two different patterns of PFS within the group of patients with Rai disease Stages I-II (P = 0.01). CONCLUSIONS: An increased serum level of sCD44 can be considered to be a promising parameter for predicting the risk of disease progression in patients with early CLL. Furthermore, sCD44 helps to refine the prognostic stratification of patients with either nonsmoldering CLL or Rai Stage I-II disease, thus enabling the identification of different prognostic subgroups in patients with early CLL.     

Serum levels of syndecan-1 in B-cell chronic lymphocytic leukemia: correlation with the extent of angiogenesis and disease-progression risk in early disease

Syndecan-1 is a transmembrane proteoglycan generally not expressed in mature B-cell neoplasias like chronic lymphocytic leukemia (CLL). Moreover, information dealing with the evaluation of soluble syndecan-1 in CLL are lacking. We measured syndecan-1 concentrations in serum drawn at the time of diagnosis from 67 B-cell CLL patients (Binet stage A, 46; stage B, 7; stage C, 14). For this purpose a syndecan-1 enzyme-linked immunosorbent assay (ELISA, Diaclone, Besancon, France) was used. Detectable levels of syndecan-1 were found in all patients, although serum concentrations were significantly lower in CLL patients in comparison to age- and sex-matched controls (P = 0.02; Mann-Whitney test). No correlation was found with Binet clinical stages (P = 0.796), β2-microglobulin (P = 0.923), hemoglobin level (P = 0.605), platelet count (P = 0.992) and lymphocyte doubling time (P = 0.709). Only an association with absolute peripheral blood lymphocytosis (PBL) (P = 0.01) and LDH (P = 0.05) could be detected. Serum levels of syndecan-1 did not parallel those of several angiogenic cytokines such as vascular endothelial growth factor (VEGF) (P = 0.963), basic fibroblastic growth factor (FGF-2) (P = 0.216), angiogenin (P = 0.478), metalloproteinase-9 (MMP-9) (P = 0.125) as well as bone marrow (BM) microvessel density (P = 0.110). The same applied with adhesion molecules such as CD54 (P = 0.233), CD108 (P = 0.799), CD44 (P = 0.816) and CD31 (P = 0.508). Interestingly, the inverse correlation (r = -0.4967; P = 0.03) between serum concentrations of syndecan-1 and plasma levels of stromal derived growth factor-1 (SDF-1) is in keeping with the different function, respectively, pro- and anti-apoptotic, of these molecules. In 46 Binet stage A patients, serum levels of syndecan-1 were further evaluated as a dichotomous variable with respect to progression-free survival (PFS), an end-point surrogate for overall survival in early B-cell CLL. The best separation of curves was seen with a cut-off point at the median value of syndecan-1 (i.e. 36.5 pg/ml). Median PFS was not reached in the patient group with low syndecan-1, compared to a median of 34 months observed in the remaining patients (P = 0.018; HR = 0.208; 95% CI = 0.115 - 0.816). At the multivariate analysis performed including variables significant in the univariate analysis [i.e. PBL (P = 0.03) and syndecan-1 (P = 0.01)], only syndecan-1 retained a trend of significance (P = 0.08).

Despite the pro-angiogenic activity of syndecan-1 which mediates FGF-2 binding and activity, no correlation with either angiogenic cytokines or the extent of BM angiogenesis was found in CLL. The inverse correlation with plasma levels of SDF-1 suggests an involvement in the processes leading to apoptosis. Finally, our results highlight the involvement of syndecan-1 in the mechanisms of disease-progression of early CLL.     

Prognostic clinical factors in pretreated colorectal cancer patients receiving regorafenib: Implications for clinical management

Background

We assessed the impact on survival of angiogenesis and inflammation-related factors, particularly LDH serum levels, platelet, neutrophil and lymphocyte counts, and neutrophil-to-lymphocyte ratio (NLR), in metastatic colorectal cancer patients receiving regorafenib monotherapy.

Methods

LDH serum levels, neutrophil, lymphocyte and platelet counts were collected at the start of regorafenib monotherapy. Cut-off values were calculated by ROC curve analysis. Survival analyses were performed by Kaplan-Meier method, and multivariate analysis by Cox method.

Results

A total of 208 patients were eligible for analysis. Among factors who were related with worse overall survival and who maintained their role at the multivariate analysis, high platelet count (Exp(b):1.4963, 95% CI:1.0130–2.2103, p = 0.0439) and high neutrophil/lymphocyte ratio (Exp(b):1.6963, 95% CI:1.0757–2.6751, p = 0.0237) were those who more deeply were related to worse overall survival. High lymphocyte count (Exp(b):0.4527, 95% CI:0.2801–0.7316, p = 0.0013) was correlated with improved overall survival.

Conclusions

High neutrophil, high platelet, low lymphocyte count and/or high NLR may represent negative prognostic factors in patients receiving regorafenib monotherapy. It is advisable that these factors are taken into account in the design of subsequent trials in colorectal cancer patients receiving this drug.     

Role of lymphangiogenesis in epithelial ovarian cancer

We investigated the significance of lymphatic count, vascular count and angiogenic growth factors using immunohistochemistry in 108 tumour specimens of epithelial ovarian cancer with antibodies to lymphatic vessel endothelial hyaluronan receptor (LYVE-1), platelet endothelial cell adhesion molecule CD31, vascular endothelial growth factor (VEGF) and thymidine phosphorylase (TP) in epithelial ovarian cancer to understand the pathogenesis of metastasis in ovarian cancer. The effect of prognostic variables on progression-free and overall survival was assessed. On multivariate analysis, bulky residual disease after surgery was the best prognostic indicator (P<0.001) for progression-free and overall survival (P<0.001). Lymphatic count was statistically significant as a prognostic factor for progression-free (P=0.05) and overall survival (P=0.04). However, lymphatic count did not impact on survival curves. No correlation was found between lymphatic count and age, histological subtype, FIGO stage or residual disease. Vascular count, VEGF or TP expressions were not significant in either analysis. Lymphatic spread may be significant in aiding metastases in ovarian cancer but requires other biological factors to act in conjunction, as it does not have clearcut prognostic significance. Dissemination of ovarian cancer does not occur primarily through vascular or lymphatic routes but may occur through direct intraperitoneal spread of disease.     

骨髓增生异常综合征患者β2-MG和LDH检测的临床价值

目的：探讨骨髓增生异常综合征（myelodysplastic syndrome,MDS）患者血清β2-微球蛋白（β2-microglobulin,β2-MG）和乳酸脱氢酶（lactic dehydrogenase,LDH）检测的临床价值。方法：采用放射免疫法测定血清β2-MG,速率法检测LDH,比较两者在30例健康体检者和45例不同亚型MDS患者中的水平,并对两者均增高和均正常的MDS患者进行生存分析。结果：各组MDS患者血清β2-MG水平均明显高于正常对照组（P〈0．01）,其中难治性贫血伴原始细胞过多-II（refractory anemia with excessive blasts II,RAEB—II）组明显高于难治性贫血（refractory anemia,RA）、难治性血细胞减少伴有多系发育异常（refractorycy topenia with multilineage dysplasia,RCMD）和难治性贫血伴原始细胞过多-I（refractory anemia with excessive blastsI,RAEB—I）组,差异均有统计学意义（P均〈0．01）;RAEB—I、RAEB—II组血清LDH水平明显高于RA、RCMD组（P〈0．01）;血清LDH、β2-MG均增高的患者中位生存期明显短于两者均正常者（P〈0．01）。结论：联合检测血清β2-MG和LDH水平,对于MDS的诊断、分型及预后分析具有重要的临床价值。     

Evaluation of prognostic factors in liver-limited metastatic colorectal cancer: a preplanned analysis of the FIRE-1 trial

Background:

Liver-limited disease (LLD) denotes a specific subgroup of metastatic colorectal cancer (mCRC) patients.

Patients and Methods:

A total of 479 patients with unresectable mCRC from an irinotecan-based randomised phase III trial were evaluated. Patients with LLD and non-LLD and hepatic resection were differentiated. Based on baseline patient characteristic, prognostic factors for hepatic resection were evaluated. Furthermore, prognostic factors for median overall survival (OS) were estimated via Cox regression in LLD patients.

Results:

Secondary liver resection was performed in 38 out of 479 patients (resection rate: 7.9%). Prognostic factors for hepatic resection were LLD, lactate dehydrogenase (LDH), node-negative primary, alkaline phosphatase (AP) and Karnofsky performance status (PS). Median OS was significantly increased after hepatic resection (48 months), whereas OS in LLD (17 months) and non-LLD (19 months) was comparable in non-resected patients. With the inapplicability of Koehne''s risk classification in LLD patients, a new score based on only the independent prognostic factors LDH and white blood cell (WBC) provided markedly improved information on the outcome.

Conclusion:

Patients undergoing hepatic resection showed favourable long-term survival, whereas non-resected LLD patients and non-LLD patients did not differ with regard to progression-free survival and OS. The LDH levels and WBC count were confirmed as prognostic factors and provide a useful and simple score for OS-related risk stratification also in LLD.     

混合型小细胞肺癌临床特点及放疗价值

目的 分析混合型小细胞肺癌临床特征及预后因素,并明确放疗价值。方法 回顾分析2005-2011年收治经组织学证实的44例混合型小细胞肺癌病例。采用Kaplan-Meier法行生存分析,Logrank法单因素预后分析。结果 随访率100%,随访时间满3、5年者分别为14、9例。1、3、5年总生存率分别为69%、47%、33%,无进展生存率分别为53%、44%、32%。单因素分析显示术前卡氏评分<;80(P=0.006)、混合非鳞癌成分(P=0.006)、肿瘤直径>;3 cm (P=0.049)、切缘阳性(P=0.001)为影响预后因素。放疗显著提高局部晚期(Ⅲ_A、Ⅲ_B)(P=0.032)、淋巴结阳性(P=0.006)或术后淋巴结阳性>;4个(P=0.025)患者的总生存,有提高T₃~T₄期患者生存趋势(P=0.179)。结论 混合型小细胞肺癌病变相对局限,以综合治疗为主;卡氏评分<;80、混合非鳞癌成分、肿瘤直径>;3 cm及术后切缘阳性是预后不良因素;放疗能提高局部晚期、淋巴结阳性或术后淋巴结阳性>;4个患者的总生存。     

胃癌患者术前血小板分布宽度与临床病理特征及预后关系

  目的  活化的血小板参与肿瘤发生和进展,血小板分布宽度（platelet distribution width,PDW）是血小板活化的早期指标。本研究旨在探讨患者术前PDW对判断胃癌预后的价值。  方法  回顾分析2010年1月至2012年1月郑州大学第二附属医院收治的126例胃癌患者的临床资料。根据ROC曲线确定PDW临界值,分为低PDW组和高PDW组。采用单因素和Cox回归模型进行预后分析,评估PDW与无进展生存期（progression-free survival,PFS）及总生存期（overall survival,OS）的关系。  结果  两组患者在肿瘤分化程度、血小板计数方面比较,差异具有统计学意义。此外,降低的PDW与胃癌的PFS和OS缩短有关。在多因素Cox回归分析中,高PDW组的患者与低PDW组的患者相比,疾病进展风险下降（HR:0.562;95%CI:0.184~0.926;P=0.012）,死亡风险下降（HR:0.468;95%CI:0.263~0.834;P=0.010）。  结论  术前降低的PDW是胃癌预后不良的因素,可能成为胃癌预后的检测指标。