肝脏硬度与肝细胞癌患者预后相关性的meta分析

目的 系统评价肝脏硬度是否可预测肝细胞癌患者的预后。方法 检索PubMed、Web of Science、中国知网和万方数据库中有关肝脏硬度与肝细胞癌患者预后的文献,并按照纳入和排除标准进行筛选,利用RevMan 5.3软件进行统计分析。结果 共纳入文献18篇,包含肝细胞癌患者3 152例。meta分析结果显示：高肝脏硬度值的肝细胞癌患者治疗后的无复发生存时间更短[HR=1.09,95%CI(1.04,1.14),P<0.000 1],5年无复发生存率更低[OR=2.67,95%CI(2.08,3.44),P<0.000 01],5年复发率更高[OR=0.19,95%CI(0.09,0.38),P<0.000 01],总体生存时间更短[HR=2.42,95%CI(1.45,4.03),P=0.000 7],5年总体生存率更低[OR=2.89,95%CI(2.18,3.83),P<0.000 01]。结论 检测肝脏硬度可预测肝细胞癌患者的预后。     

乳酸脱氢酶与前列腺癌预后关系的Meta分析

目的系统评价乳酸脱氢酶(LDH)对前列腺癌患者预后作用的价值。方法通过计算机检索Pub Med、EMbase、中国知网(CNKI)、万方(Wan Fang Data),搜集国内外2016年3月1日前发表的关于乳酸脱氢酶对前列腺癌患者预后影响的文献;由2位评价者根据纳入和排除标准独立进行筛选文献、提取资料、评价纳入文献的质量后,运用Rev Man5.3软件进行统计分析(Meta分析),合并值为风险比(HR)及其对应的95%可信区间(95%CI)。结果共入选17篇文献,累计前列腺癌患者4390例。当纳入研究采用单因素分析时,Meta分析结果显示高水平乳酸脱氢酶的前列腺癌患者的总生存率(OS)短于低水平患者[HR=2.93,95%CI(2.41,3.56),P0.00001],差异有统计学意义。亚组分析结果显示亚洲人群[HR=3.33,95%CI(2.16,5.16),P0.00001]和欧美人群[HR=2.86,95%CI(2.29,3.57),P0.00001]高水平乳酸脱氢酶患者OS均短于低水平乳酸脱氢酶患者。当纳入研究采用多因素分析时,Meta分析结果显示高水平乳酸脱氢酶的前列腺癌患者的OS短于低水平患者[HR=2.37,95%CI(2.12,2.65),P0.00001],亚组分析结果显示亚洲人群[HR=2.50,95%CI(1.85,3.38),P0.00001]和欧美人群[HR=2.37,95%CI(2.12,2.65),P0.00001]高水平乳酸脱氢酶患者OS均短于低水平乳酸脱氢酶患者。结论 LDH是前列腺癌的不良预后因素,检测LDH有助于进行合理的预后评估,并制定个体化治疗方案。     

术前白蛋白/球蛋白比值在肝癌射频消融病人预后中的价值

目的评估术前白蛋白/球蛋白比值(albumin/globulin ratio,AGR)在肝癌射频消融病人预后中的价值和意义。方法回顾性分析华中科技大学同济医学院附属荆州医院肝胆外科2011年12月至2018年9月间接受射频消融的原发性肝癌病人资料。根据受试者的工作特征曲线(ROC曲线)确定AGR最佳截点值,进而根据该值将所有病人分为高AGR组和低AGR组。单因素、多因素分析及亚组分析探讨AGR与病人临床病理特征及预后的关系。结果 AGR最佳截点值为1.27。AGR与病人年龄、癌栓、肝硬化和腹水密切相关。单因素及多因素分析显示影响病人总体生存时间的独立危险因素为:术前腹水[风险比(HR):1.979,95%置信区间(CI):(1.035,3.786),P=0.039];肿瘤直径[HR:2.839,95%CI:(1.421,5.671),P=0.003];癌栓[HR:2.617,95%CI:(1.249,5.482),P=0.011];白蛋白[HR:0.521,95%CI:(0.305,0.890),P=0.017]及AGR[HR:0.333,95%CI:(0.187,0.593),P0.001]。而影响术后病人无瘤生存时间的独立危险因素为肝硬化[HR:2.297,95%CI:(1.261,4.184),P=0.007];乙型肝炎[HR:2.586,95%CI:(1.305,5.127),P=0.006];癌栓[HR:2.385,95%CI:(1.017,5.594),P=0.046]及AGR[HR:0.570,95%CI:(0.345,0.942),P=0.028]。亚组分析显示:AGR对大小肝癌病人术后总体生存时间均产生明显影响;而对无瘤生存时间而言,AGR主要影响非肝硬化病人。结论 AGR是影响原发性肝癌射频消融术后病人临床预后的独立危险因素。由于AGR简单、客观、容易获得且非有创等特点,其可常规作为原发性肝癌病人术前评估的指标。     

Survivin在原发性肝细胞癌中的表达及其临床意义

目的 探讨Survivin在原发性肝细胞癌(HCC)组织中的表达及其在肝癌发病机制中的作用和临床意义.方法 利用免疫组织化学S-P法检测50例原发性肝癌组织、20例正常肝组织中Survivin蛋白表达情况.结果 Survivin蛋白在肝癌中的阳性表达率为66.0%(33/50),显著高于正常肝组织组(均为阴性表达;P<0.001),阳性表达与肝癌的肝内转移和肝癌的多发性有关(P=0.019,P=0.030);Survivin的过表达与病人术后<3年生存期相关(P=0.018).结论 Survivin在肝细胞癌的发生及发展过程中起着不同程度的作用,检测Survivin对判定原发性肝细胞癌预后可提供一定的依据.     

金龙胶囊联合经导管肝动脉化疗栓塞术治疗原发性肝癌的疗效和安全性的Meta分析

目的系统评价金龙胶囊联合肝动脉化疗栓塞术(TACE)治疗原发性肝癌临床疗效和安全性。方法检索Cochrane Library、Embase、PubMed、OVID、Scopus、中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普数据库和万方数据库,文献检索限定时间均从建库至2021年2月,纳入报道金龙胶囊联合TACE治疗原发性肝癌的随机对照试验,由两人独立筛选文献,提取数据及进行文献质量评价。运用RevMan 5.3软件对提取数据进行Meta分析。结果共纳入19项随机对照试验(共1740例患者),Meta分析结果显示:相比对照组,联合治疗组的客观缓解率更高[OR=2.23,95%CI(1.78,2.80),P <0.001],KPS评分[OR=2.59,95%CI(1.86,3.60),P <0.001],1年生存率[OR=1.77,95%CI(1.14,2.76),P=0.01]、2年生存率[OR=1.76,95%CI(1.12,2.75),P=0.01]优于对照组。此外,金龙胶囊还可提高机体免疫功能,减少不良反应的发生。结论金龙胶囊联合TACE可以提高原发性肝癌的疗效,提高患者的生活质量,减少不良反应的发生。但由于纳入的研究数量有限,金龙胶囊是否能改善肝癌患者长期生存率有待进一步研究,本研究结论尚需更多设计良好、严格执行的大样本随机对照双盲试验加以证实。     

非休克型肝癌自发性破裂出血术后TAE的价值

目的:探讨非休克型肝癌自发性破裂出血术后接受肝动脉栓塞术(TAE)治疗的远期效果。方法:收集162例非休克型肝癌自发性破裂出血并接受手术治疗患者的临床病理资料和随访资料,对影响预后的相关因素行单因素和多因素分析,并根据术后是否接受TAE治疗分为两组,用Kaplan-Meier法比较两组生存差异。结果:单因素分析表明,对于非休克型肝癌自发性破裂出血的患者,肿瘤直径(P=0.008)、肝硬化(P=0.03)、肿瘤位置(P=0.028)以及治疗方法(P=0.012)与预后有关。多因素分析提示,肿瘤直径(HR=1.954,95%CI=1.691~5.526,P=0.007),肝硬化(HR=1.544,95%CI=1.003~2.000,P=0.041),肿瘤位置(HR=1.785,95%CI=1.023~3.114,P=0.026),治疗方法(HR=1.692,95%CI=1.131~2.533,P=0.011)是影响非休克型肝癌自发性破裂出血患者预后的独立危险因素。生存分析表明术后接受TAE治疗者预后较单纯手术者好(P<0.001)。结论:术后接受TAE治疗可改善非休克型肝癌自发性破裂出血患者的预后。     

对比雷替曲塞与氟尿嘧啶TACE治疗中晚期原发性肝癌疗效及安全性:Meta分析

目的通过Meta分析对比采用雷替曲塞与氟尿嘧啶行TACE治疗中晚期原发性肝癌的疗效及安全性。方法结合计算机及人工检索PubMed、Cochrane Library、Web of Science、中国生物医学文献数据库、万方数据库及中国知网收录的有关对比分析雷替曲塞与氟尿嘧啶TACE治疗中晚期原发性肝癌的文献,并从中提取相关资料。通过Meta分析方法对2种TACE的客观有效率(ORR)、疾病控制率(DCR)、患者总生存率(OS)及术后不良反应进行评价。结果最终8篇文献、共635例患者纳入分析。雷替曲塞TACE的ORR[相对危险度(RR)=1.25,95%CI(1.06,1.47),P=0.008]及DCR[RR=1.17,95%CI(1.08,1.26),P0.001]均高于氟尿嘧啶TACE,期间患者OS[RR=1.15,95%CI(0.95,1.39),P=0.141]及术后不良反应[恶心、呕吐:RR=0.90,95%CI(0.73,1.11),P=0.339;发热:RR=0.90,95%CI(0.77,1.06),P=0.219;肝区疼痛:RR=0.90,95%CI(0.80,1.01),P=0.219;外周血白细胞减少:RR=0.89,95%CI(0.65,1.21),P=0.462;转氨酶升高:RR=0.96,95%CI(0.80,1.16),P=0.663]差异均无统计学意义。结论 TACE治疗中晚期原发性肝癌时,采用雷替曲塞较氟尿嘧啶疗效更优,安全性则相似。     

人类软骨糖蛋白39在肝癌中的表达及临床意义

目的 探讨人类软骨糖蛋白39(YKL-40)在原发性肝癌组织及癌旁组织中的表达,及其与临床病理特征及预后的关系.方法 采用RT-PCR以及Western blot方法检测19例原发性肝癌及癌旁组织中YKL-40基因及蛋白表达水平.免疫组化方法检测70例原发性肝癌患者组织及11例非肝癌组织中YKL-40蛋白表达的差异性.结果 RT-PCR分析显示肝癌组织中YKL-40基因表达水平高于相应癌旁组织(0.90±0.29比0.36±0.18;P＜ 0.05).Western blot结果分析显示肝癌组织中YKL-40蛋白表达水平高于相应癌旁组织(1.13±0.21比0.44±0.15;P＜0.05).原发性肝癌组织中YKL-40蛋白的阳性率(61.43％,43/70),高于非肝癌组织(27.27％,3/11),(P＜0.05).YKL-40表达与肿瘤包膜、TNM分期及肿瘤转移相关(P=0.003,0.023,0.003),而与患者性别、年龄、肝硬化、HBsAg状态、甲胎蛋白水平无关(P＞0.05).生存分析显示YKL-40表达阳性患者较阴性患者预后差(x2 =15.715,P＜0.05).单因素及多因素回归分析显示YKL-40蛋白是原发性肝癌患者预后的独立危险因素.结论 YKL-40参与肝癌恶性进展,可以作为判断肝癌患者预后的有价值的分子标记物.     

全直肠系膜切除术与其联合侧方淋巴结清扫治疗中、低位直肠癌疗效比较的Meta分析

目的:比较单纯全直肠系膜切除术(TME)与TME联合侧方淋巴结清扫(LLND)在术后并发症及预后方面的优劣。方法:检索2010年1月至2020年5月中文、英文数据库中涉及TME与TME+LLND比较的文献,采用RevMan 5.3进行meta分析。结果:总计纳入12篇文献、3 769例中低位直肠癌患者,相较单纯TME组,TME+LLND组具有更高的Clavien-Dindo分级≥3的并发症发生率[OR=1.50,95%CI(1.06,2.13),P=0.02],更低的术后局部复发率[OR=0.47, 95%CI(0.34,0.65),P=0.00001];两组泌尿功能[OR=1.10,95%CI(0.62,1.95),P=0.74]、Clavien-Dindo分级≥1的并发症[OR=1.40,95%CI(0.95,2.06),P=0.09]、总生存率[HR=1.23,95%CI(0.94,1.61),P=0.13]、无复发生存率[HR=1.05,95%CI(0.89,1.26),P=0.55]差异无统计学意义。结论:TME+LLND较TME在局部复发方面存在显著优势,也更容易发生Clavien-Dindo分级≥3的并发症。     

VEGF在中国三阴性乳腺癌患者中的表达及与其临床病理特征关系的meta分析

目的系统评价血管内皮生长因子(VEGF)在中国三阴性乳腺癌(TNBC)患者中的表达情况以及其阳性表达与TNBC患者临床病理特征的关系。方法通过中国知网、万方数据库、维普、中国生物医学数据库、超星Medalink和Pub Med数据库检索已发表的有关关于中国TNBC患者的相关文献资料,由2名研究者按照纳入与排除标准独立筛选文献、提取资料和文献评价,然后使用Rev Man 5.3软件进行meta分析。结果本研究纳入11篇相关文献共1 838例患者,其中TNBC患者750例,非TNBC患者1 088例。meta分析结果显示,VEGF蛋白表达阳性率在TNBC患者中明显高于非TNBC患者[OR=2.64,95%CI(2.14,3.26),P0.000 01]。在TNBC患者中,VEGF蛋白表达阳性率在淋巴结(+)患者中明显高于淋巴结(–)患者[OR=0.30,95%CI(0.14,0.46),P=0.000 2]、在Ⅲ–Ⅳ期患者中明显高于Ⅰ–Ⅱ期患者[OR=0.43,95%CI(0.29,0.62),P0.000 01],其与TNBC患者的年龄[OR=0.80,95%CI(0.54,1.19),P=0.27]和肿瘤大小[OR=0.84,95%CI(0.53,1.33),P=0.46]无关。结论 VEGF蛋白在TNBC患者中呈高表达,有望成为其治疗的新靶点;且其蛋白阳性表达与TNBC患者的阳性淋巴结及TNM分期晚有关,其可能与TNBC患者的预后有一定的关系。     

KIF4A在肝细胞癌中的表达及预后价值分析

背景与目的:肝细胞癌(HCC)是原发性肝癌最常见的病理类型,其起病隐匿,预后较差,位居癌症相关死亡原因第3位.KIF4A在多种恶性肿瘤中呈高表达且与不良预后密切相关,然而其在HCC中的作用及机制尚不清楚.因此,本研究分析KIF4A基因在HCC中的表达情况及预后价值,并探讨相关的分子机制.方法:从癌症基因组图谱(TCGA...     

循环肿瘤细胞对肝癌射频消融术后复发的预测价值

目的研究分析射频消融术(RFA)前循环肿瘤细胞(CTC)预测肝癌术后复发的应用价值。方法收集2016年6月至2019年9月中山市人民医院收治的168例肝细胞癌患者,在RFA治疗前以Cyttel检测法分析患者外周血的CTC。利用X-tile软件的Kaplan-Meier模块确定CTC的最佳临界值,并分析CTC与术前临床参数的关系,Cox比例风险模型分析影响RFA术后复发的独立危险因素,采用Kaplan-Meier法绘制RFA术后复发曲线图明确CTC与RFA术后复发的关系。结果预测肝癌RFA术后复发的CTC最佳临界值为2个/3.2 ml。术前CTC与肿瘤结节数目、最大肿瘤直径、术前AFP水平以及中国肝癌临床分期(CNLC)有关(P<0.05)。术前CTC(HR=1.965,95%CI:1.314~2.937,P=0.001)、AFP水平(HR=1.743,95%CI:1.158~2.623,P=0.008)、PIVKA-Ⅱ(HR=1.559,95%CI:1.008~2.411,P=0.046)以及最大肿瘤直径(HR=1.994,95%CI:1.104~3.602,P=0.022)均是肝癌RFA术后复发的独立危险因素。术后复发率62.5%(105/168),CTC≤2个/3.2 ml患者的累积复发率明显低于CTC>2个/3.2 ml者(P<0.001)。结论术前CTC检测对预测肝癌射频消融术后复发有一定的应用价值及临床意义。     

术前纤维蛋白原水平对肝细胞癌微血管侵犯及预后的影响

目的 探讨术前血清纤维蛋白原(fibrinogen,FIB)水平与肝细胞癌(hepatocellular carcinoma,HCC)微血管侵犯(microvascular invasion,MVI)的关系及FIB对根治切除术后HCC预后的影响.方法 回顾性分析福建医科大学孟超肝胆医院2015年1月至2019年4月行根...     

Serum VEGF level is associated with the outcome of patients with hepatocellular carcinoma: a meta-analysis

Background

Hepatocellular carcinoma (HCC) is a highly vascular tumor that expresses vascular endothelial growth factor (VEGF). Various studies have evaluated the prognostic value of VEGF levels in HCC, but yielded conflicting results.

Methods

Electronic databases updated to June 2013 were searched to find relevant studies. A meta-analysis was conducted with eligible studies which quantitatively evaluated the relationship between serum VEGF level and survival of patients with HCC. Survival data were aggregated and quantitatively analyzed.

Results

We performed a meta-analysis of 11 studies that evaluated the correlation between serum VEGF level and survival in patients with HCC. Combined hazard ratios suggested that serum VEGF level had an unfavorable impact on overall survival (OS) [hazard ratio (HR) =1.88, 95% confidence interval (CI): 1.46-2.30], and disease free survival (DFS) (HR=2.27, 95% CI: 1.55-2.98) in patients with HCC. No significant heterogeneity was observed among all studies.

Conclusions

Serum high VEGF level indicates a poor prognosis for patients with hepatocellular carcinoma.Key Words: Vascular endothelial growth factor (VEGF), hepatocellular carcinoma (HCC), prognosis, meta-analysis     

Correlation Between Postoperative Early Recurrence of Hepatocellular Carcinoma and Mesenchymal Circulating Tumor Cells in Peripheral Blood

Background

Circulating tumor cells (CTCs) have been actively studied for their functions in hepatocellular carcinoma (HCC) recurrence. However, the relationship between circulating tumor cells subtypes and hepatocellular carcinoma recurrence is still unclear.

Methods

CTCs were collected from the peripheral blood of 62 postoperative HCC patients. The CTCs were isolated with a filtration-based method. Multiplex fluorescence in situ hybridization was used to characterize the CTCs based on mRNA expression levels of epithelial and mesenchymal markers.

Results

Of the 62 HCC patients, 26 were diagnosed with early recurrence (ER) and 36 did not experience recurrence. Comparison between the recurrence group and the non-recurrence group showed the total number of CTCs, mesenchymal CTCs, and mixed CTCs in the recurrence group was significantly higher than in the non-recurrence group. Receiver operator characteristic (ROC) curve analysis was performed to define the positive cutoff values as follows: total number of CTCs ≥?4, mesenchymal CTCs ≥?1, and mixed CTCs ≥?3. Analysis showed that portal vein tumor thrombus (hazard ratio [HR] = 2.905, P = 0.023) and mesenchymal CTC positivity (HR = 3.453, P = 0.007) were independent risk factors for ER. The correlation between the presence of mesenchymal CTCs and time to recurrence was further examined, and the results showed significantly shortened postoperative disease-free survival in patients positive for mesenchymal CTCs (P < 0.001).

Conclusions

HCC patients with positive peripheral mesenchymal CTCs have a more serious risk of ER, which could be a potential biomarker in HCC prognosis monitoring.

     

Molecular characterization of circulating tumor cells in pancreatic ductal adenocarcinoma: potential diagnostic and prognostic significance in clinical practice

BackgroundThe clinical value of heterogeneous sub-populations of circulating tumor cells (CTCs) in pancreatic ductal adenocarcinoma (PDAC) remains unclear.MethodsPeripheral blood samples were obtained from 67 PDAC patients. CTCs were isolated by employing CD45 negative enrichment technique and further characterized for epithelial to mesenchymal transition (EMT) or human equilibrative nucleoside transporter-1 (hENT-1). The relationships between CTCs sub-phenotypes with clinicopathological factors or post-operative recurrence in PDAC patients were analyzed.ResultsEMT related CTCs could be isolated and identified from the 81% of patients (54/67), and both the total count (median: 5 vs. 17/mL, P<0.0001) and M-CTC percentage (median: 0.2 vs. 0.345, P=0.0244) of CTCs could differentiate local/regional with metastatic disease. Multivariate analysis showed that both AJCC stage (P=0.025) and M-CTC percentage (P=0.001) were independent prognostic indicators of recurrence free survival (RFS) in resected patients. Moreover, Kaplan-Meier survival analysis showed that M-CTC after 2 courses of chemotherapy was significantly associated with inferior RFS (49.5 weeks vs. undefined, P=0.0288). No significant correlation in hENT-1 expression was found between CTCs and matched tumor tissues, and further multivariate analysis suggested hENT-1 expression in CTCs as independent prognostic factor for RFS (P=0.016). Patients with low hENT-1 expression in CTCs had decreased RFS (32 weeks vs. undefined, P=0.0337).ConclusionsCTCs could be the promising diagnostic biomarkers in PDAC patients, and phenotypic profiling of CTCs based on EMT or hENT-1 could help establish novel prognostic biomarkers in resected patients undergoing adjuvant gemcitabine-based chemotherapy.KeywordsCirculating tumor cells (CTCs); Pancreatic ductal adenocarcinoma (PDAC); Epithelial to mesenchymal transition (EMT); human equilibrative nucleoside transporter-1 (hENT-1)     

肝细胞癌肝移植89例预后分析

目的　总结肝细胞癌(HCC)肝移植临床经验,探讨HCC肝移植的预后影响因素。方法　应用单因素分析和逐步Logistic回归多因素分析方法,回顾性分析自1999年1月至2003年12月我单位施行的89例HCC肝移植患者的生存情况及各项临床病理指标对预后的影响。结果　移植后6个月、1年和2年累积生存率分别为81. 8%、55. 3%和43 .7%, 6个月、1年和2年无瘤生存率分别为62 .4%、35. 6%和24 .9%;随访期间肿瘤转移复发的总发生率为52 8%;Log rank检验结果显示,影响HCC患者肝移植术后累积生存率的因素为门静脉主干或分支癌栓形成(PVTT) (χ2 =15 14,P=0. 0001)、肿瘤大小(χ2 =15. 05,P=0 .0001 )、肝硬化背景(χ2 =6 14,P=0 .0132 )、术前甲胎蛋白(AFP)水平(χ2 =5 .82,P=0. 0159)和组织学分级(χ2 =4. 61,P=0 .0319);影响无瘤生存率的因素包括PVTT(χ2 =26 .30,P<0. 0001 )、肿瘤大小(χ2 =25 .25,P<0 0001 )、AFP水平(χ2 =14. 83,P=0 .0001)、组织学分级(χ2 =12 54,P=0. 0004 )、肿瘤分布(χ2 =12 73,P=0. 0004 )、肿瘤数目(χ2 =9 81,P=0 0017)以及肝硬化背景(χ2 =9 .76,P=0 .0018)。多因素分析结果显示,与累积生存率显著相关的因素是PVTT(RR=4. 721,P=0. 001 )、年龄(RR=3. 282,P=0 .007 )和组织学分级(RR=2. 368,P=0.     

Prognostic significance of postoperative in-hospital complications in elderly patients. I. Long-term survival

To determine the impact of in-hospital postoperative complications on long-term survival, we prospectively studied consecutive patients > or = 70 yr of age undergoing noncardiac surgery. Potential clinical risk factors were measured and evaluated for their association with the occurrence of long-term postoperative mortality. Long-term survival was determined by using the Kaplan-Meier method. Multivariate correlates of survival were analyzed with the Cox proportional hazards model. The survival of the study group was also compared with the age- and gender-matched general United States population. Five hundred seventeen patients who survived the initial hospitalization were studied. The mean follow-up duration was 28.6 +/- 12.8 mo. One hundred sixty-four of 517 patients (31.7%) were deceased at the time of follow-up. A history of cancer (hazard ratio [HR] 2.44, 95% confidence interval [CI] 1.78-3.38, P < 0.0001), ASA physical status >II (HR 2.27, 95% CI 1.61-3.21, P < 0.0001), neurologic disease (HR 1.59, 95% CI 1.13-2.24, P = 0.008), age (HR 1.42 per decade, 95% CI 1.11-1.81, P = 0.005), postoperative pulmonary complications (HR 2.41, 95% CI 1.30-4.48, P = 0.005), and renal complications (HR 6.07, 95% CI 2.23-16.52, P < 0.0001) were significant independent predictors of decreased long-term survival. Compared with the United States population, patients with complications had a greater increase in mortality risk in the first 3 mo after surgery (HR 7.3 versus general population) than those without complications (HR 2.9, P = 0.023). An effort to improve perioperative care delivery to elderly surgical patients must include measures to minimize in-hospital postoperative complications, particularly those involving the pulmonary and renal systems.     

癌旁肝星状细胞和γδT淋巴细胞比值与肝细胞癌根治性肝切除术后预后的关系研究

目的分析肝细胞癌患者癌旁组织肝星状细胞与γδT淋巴细胞比值与根治性切除术后预后的关系。方法回顾分析重庆医科大学附属第一医院肝胆外科2011年1月至2013年12月连续接受根治性肝切除的320例肝细胞癌患者资料,其中男性273例,女性47例,年龄17-80岁,中位年龄53岁。癌旁肝组织标本行免疫组化染色,计算肝星状细胞与HT淋巴细胞比值。Kaplan-Meier法进行生存分析。肝细胞癌患者预后单因素分析采用log-rank检验,多因素分析采用Cox回归分析。结果多因素分析,肿瘤多发(HR=1.895,95%CZ:1.155~3.108)、微血管侵犯(HR=1.665,95%C/:1.104-2.512)、肿瘤直径>5 cm(HR=2.400,95%CI:1.603-3.594)、肝星状细胞与γδT淋巴细胞比值>18(HR=1.880,95%CI:1.257-2.810)是肝细胞癌患者根治性肝切除术后生存的独立危险因素。术前甲胎蛋白>20 μg/L(HR=1.631,95%CZ:1.151-2.311),微血管侵犯(HR=2.145,95%CI:1.536~2.994)、肿瘤直径>5 cm(HR=1.866,95%CI:l.342~2.592)、肝星状细胞与疋丁淋巴细胞比值>18(HR=1.517,95%CI:1.084-2.122)是肝细胞癌患者无瘤生存的独立危险因素。根据癌旁组织肝星状细胞与78T淋巴细胞比值将患者分为低比值组(比值≤18,n=222)和高比值组(比值〉18=98)。低比值组患者累积生存率和累积无瘤生存率均优于高比值组,差异有统计学意义(均P<0.05)。结论癌旁肝星状细胞与γδT淋巴细胞比值是肝细胞癌患者根治性肝切除术预后的影响因素,低比值患者预后更佳。