原发性结直肠癌肝转移危险因素分析

目的：初步判断结直肠癌患肝转移的危险性，方法：选择10个可能会影响肝转移的因素：患年龄、性别、地区分布、肿瘤病理类型、部位、大小、浸润深度、侵犯肠管周径、术前癌胚抗原（CEA）水平及淋巴结转移情况，建立原发性结直肠癌肝转移危险性预测的Logistic回归模型，结果：年龄、术前CEA水平和淋巴结转移情况这3个因素对肝转移影响较为显，其回归系数分别为0．0215，0．9584和0．6404；标准误分析为0．0113，0．02740和0．29892；P值分别为0．0379，0．0005、0．0268。其他因素如浸润肠壁深度及侵犯肠管周径等对肝转移的发生也有影响，但非独立的危险因素。结论：年龄、术前CEA水平和淋巴结转移情况是原发性结直肠癌肝转移的3个显性的危险因素。     

结直肠癌肝转移相关临床病理因素研究

目的 探讨影响结直肠癌肝转移发生的相关临床病理因素.方法 运用非条件Logistic回归分析对我院2003年1月～2012年12月425例结直肠癌患者进行回顾性临床研究,分析影响肝转移发生的相关临床病理因素.结果 结直肠癌肝转移发生率24.00％(102/425),其中同时性肝转移13.17％(56/425)、异时性肝转移10.82％ (46/425);左半结肠癌34.11％(146/425)、右半结肠癌43.53％ (185/425)、直肠癌22.35％ (94/425).由标准回归系数可以得出结直肠癌肝转移的主要危险因素按其影响的大小顺次为:肿瘤相关并发症X9、肿瘤芽殖强度X17、TNM分期X1s、分化程度X19、NRS-2002评分X5、手术性质X12、发病-确诊时间差X21、围手术期输血量X13、总病程X22、术前CEA水平X8、化疗X23,所对应的相对危险度(0R)在1.148 ～1.972,手术性质X12及化疗X23是单因素分析中避免结直肠癌肝转移出现的保护因素.逐步Logistic回归分析剔除了分化程度X19、总病程X22、围手术期输血量X13、术前CEA水平X8、化疗X23,由标准回归系数可以得出胃癌术后切口并发症的主要危险因素按其影响的大小顺次为:TNM分期X18、肿瘤芽殖强度X17、发病确诊时间差X21、肿瘤相关并发症X9、NRS-2002评分X5、手术性质X12相对危险度分别为2.350、1.911、1.634、1.522、1.171、-1.343.结论 TNM分期、肿瘤芽殖强度、发病-确诊时间差、肿瘤相关并发症、NRS-2002评分、手术性质是结直肠癌肝转移发生的重要危险因素.     

同时性结直肠癌肝转移的临床病理特征分析

目的遴选同时性结直肠癌肝转移的危险因素，为预测和早期诊断肝转移提供参考依据。方法收集2003年1月至2006年12月间收治的367例原发性结直肠癌患者的临床病理资料，对患者的年龄、性别、血型、肿瘤家族史、是否合并肝炎肝硬化、有无合并肠梗阻、术前癌胚抗原（CEA）和CA19－9、原发肿瘤部位和大小、分化程度、肿瘤侵及深度、有无淋巴结转移、肿瘤分期等19项因素进行统计分析。结果本组发生同时性结直肠癌肝转移56例．占同期结直肠癌患者的15．3％。在发病年龄、是否有肠梗阻、是否有盆腔转移结节及肿瘤浸润深度方面，肝转移和无肝转移两组患者之间差异有统计学意义（P〈0．05）。右侧结肠癌肝右叶转移瘤者明显多于左叶，而左侧结肠癌转移瘤多分布于全叶。当术前CEA大于22．1μg／L时，患者发生肝转移的可能性增加。结论结直肠癌同时性肝转移与患者年龄、是否存在肠梗阻、盆腔有无转移及CEA水平存在密切关系。     

结直肠癌肝转移危险及预后因素分析

肝脏是结直肠癌最常见的远处转移器官,结直肠癌病人出现肝转移一般预后较差。结直肠癌肝转移分为同时性肝转移和异时性肝转移,对众多的临床以及病理学特征进行的单因素和多因素回归分析提示,影响结直肠癌发生肝转移的危险因素有：浸润深度、淋巴结转移、癌结节、分化程度、癌胚抗原和糖类抗原等。影响结直肠癌肝转移病人预后的因素有：肝转移灶大小及数目、肝外器官转移、原发灶手术切除、肝转移灶手术切除、全身药物治疗等。因此,手术切除肝转移灶、药物治疗获得手术切除机会等治疗模式能够最大程度地提高结直肠癌肝转移病人的存活率。由众多因素组合起来的评分系统,能够较好地预测结直肠癌肝转移病人的预后。     

手术治疗结直肠癌肝转移25例临床分析

为探讨行手术治疗的结直肠癌肝转移患者的生存情况,回顾分析25例行手术治疗的结直肠癌肝转移患者的资料。结果显示,随访至2009年12月31日,（1）≥50岁者行转移灶切除16例,存活≥5年者2例,3～5年者4例,〈3年者6例,另外4例随访不满3年仍存活。（2）〈50岁者行转移灶切除9例,无存活≥3年者,2～3年者2例,〈2年者5例,另外2例随访不满2年仍存活。结果表明,手术是治疗结直肠癌肝转移的有效方法,可延长患者生存时间。     

同时性结直肠癌远处转移的相关临床病理因素分析

目的探讨同时性结直肠癌远处转移的相关临床病理因素。方法收集2056例非连续性结直肠癌病例的临床病理资料,应用logistic回归进行单因素和多因素分析。结果单因素分析显示结直肠癌远处转移与性别、年龄等因素无关(P0.05),与肿瘤部位、肿瘤大体类型、肿瘤最大径、组织类型、病理分级、T分期、N分期、术前CEA水平等因素有关(P0.05);多因素分析显示肿瘤最大径、T分期、N分期、术前CEA水平是影响结直肠癌远处转移的独立因素(P0.05)。结论结直肠癌远处转移与肿瘤最大径、T分期、N分期、术前CEA水平有关。     

结直肠癌肝转移生存分析

目的分析结直肠癌肝转移病人的生存状况和相关影响因素。方法回顾性分析2000-2010年复旦大学附属中山医院收治的结直肠癌肝转移病人的临床资料、病理、治疗策略等情况,进行生存状况分析,并采用单因素和Cox比例风险回归模型等分析影响结直肠癌肝转移生存的相关因素。结果结直肠癌肝转移病人总体中位生存期22.0个月,5年存活率为16%,其中同时性肝转移为21.2个月和16%,异时性肝转移为30.1个月和23%,同时性肝转移组的存活率明显低于异时性肝转移组(P<0.01)。按治疗方式分组,手术组病人的中位生存期为49.8个月,5年存活率为37%,显著优于化疗组(22.2个月和0)、介入组(19.0个月和11%)、化疗+介入组(22.8个月和10%)、局部治疗组(28.5个月和0)。同时性肝转移、肠癌原发灶分化Ⅲ~Ⅳ级、肝转移灶≥4个、最大肝转移灶≥5cm和肝转移灶非手术处理是影响病人预后的独立危险因素。结论同时性肝转移病人生存期低于异时性肝转移。积极手术治疗可以改善病人存活率。扩大肝转移灶切除的适应证对病人存活率无显著影响。独立危险因素的评分体系可以评估病人的预后。     

结直肠癌肝转移危险因素分析

结直肠癌肝转移危险因素分析解放军２５３医院普外科（呼和浩特，０１００５０）任武军北京医科大学第三医院（１０００８３）侯宽永赵一鸣（指导）在结直肠癌肝转移危险因素方面已有许多报道，特别是一些病理因素已经得到了证实，如病理分期、组织分化程度及淋巴转移等。...     

结直肠癌肝转移危险因素分析

近年,随着肿瘤生物学和外科技术进步,外科治疗结直肠癌肝转移已明显提高了生存率［１］。本文对近５年作者收治的经病理证实的４１例结直肠癌肝转移危险因素进行回顾性分析,对结直肠癌肝转移的病理特点和进一步提高肝转移早期诊断、早期治疗水平作一探讨。１　临床资料本组男３１例,女１０例,男女之比为３．１∶１。年龄平均５５岁（３３～７３岁）。发生部位：２４例（５８．５％）位于乙状结肠,１０例（２４．４％）位于直肠,位于结肠其它部位者７例（１７．１％）。无病间期〔结直肠癌手术至Ｂ超和（或）ＣＴ发现肝内转移病灶时间…     

结直肠癌肝转移的治疗进展

目前,结直肠癌正逐渐成为一个越来越影响当今世界人类健康的问题.而结直肠癌肝转移是结直肠癌患者最主要的死亡原因,肝转移灶无法切除患者的中位生存期仅6.9个月,5年生存率接近0[1],而肝转移灶能根治性切除患者的中位生存期为35个月,5年生存率达30％～50％[2].故结直肠癌肝转移已成为目前结直肠癌治疗的重点和难点之一.     

������Χ��Ԥ�����Σ�����ط���

目的研究壶腹周围癌的临床病理因素与预后的相关性。方法回顾性分析2005年2月至2009年12月在复旦大学附属中山医院行胰十二指肠切除术的48例壶腹周围癌病人的临床病理资料与术后生存情况。采用寿命表法计算壶腹周围癌1年及3年累积存活率及中位生存时间,用Kaplan-Meier方法比较壶腹周围癌与同期随访的117例胰腺癌的生存情况及壶腹周围癌单因素生存分析,Cox比例风险模型进行壶腹周围癌多因素生存分析。结果 48例壶腹周围癌15例死亡,33例存活,1年及3年累积存活率分别为75%和55%,中位生存时间30个月;同期随访的117例胰腺癌病人,89例死亡,29例存活,1年及3年累积存活率分别为59%和42%,中位生存时间14个月。单因素生存分析示壶腹周围癌起源部位、淋巴结转移、神经侵犯与预后显著相关(P<0.05);而分化程度、脉管转移与预后无关。多因素生存分析示壶腹周围癌起源部位、淋巴结转移是两个预后的独立因素。结论壶腹周围癌预后明显好于胰腺癌;壶腹周围癌起源部位、淋巴结转移与预后密切相关。     

影响肝移植术后早期预后的相关危险因素分析

目的探讨影响肝移植术后早期预后的相关的危险因素。方法回顾性的分析了我院自2003年1月1日至2003年10月31日的原位肝移植病例171例。根据术后早期预后分为预后不良组及非预后不良组（术后早期住院期间死亡者或因各种并发症术后〉7d转出ICU者定为预后不良的病人），比较两组病人术前及术中的变量13项；并筛选出影响预后的一些变量。结果171例病人中，预后不良者30人（17．5％），其中围手术期死亡12人（7％）；应用单因素分析比较预后不良及非预后不良病人的各项指标，以下参数均具有显著性差异：Child分级、APACHEⅢ评分、UNOS分级、手术时间、出血量、输血及血浆量、术前cr水平、术前ICU、术前感染及再次手术干预。将预后作为因变量进行Logistic回归分析，筛选影响预后的危险因素，保留在回归方程中的变量有：APACHEⅢ评分、术前感染、手术时间、术中出血和输血量。而病人年龄、CHILD分级、UNOS分级、无肝期、术前Cr、术前ICU停留、再次手术干预被剔除方程。结论通过对肝移植病人术前及术中一些指标的评估，可以在一定程度上预测术后早期的预后。     

Cardiovascular risk factors after liver transplantation: analysis of related factors

Aims

We sought to analyze the cardiovascular risk factors (CVRF) in liver transplantation and their relation to immunosuppression and hepatitis C virus (HCV) infection.

Patients and Methods

The study included all 158 liver transplants performed between January 2005 and December 2008 that had a minimum follow-up of 1 year. There were 104 men (64%) and 54 women (36%). Data were recorded on both the pretransplant prevalence as well as new cases of diabetes mellitus (DM), hypertension, hypertriglyceridemia, hypercholesterolemia, and hyperuricemia, defined by the need for drug therapy, after a mean follow-up period of 38 months (range, 12-64). We also examined the influence on CVRF of immunosuppression and HCV.

Results

Tacrolimus was prescribed for 61% of the patients and cyclosporine, 39%. Upon univariate analysis only hypertension was significantly associated with the use of cyclosporine (P < .03). There was a trend to a greater incidence of hypercholesterolemia with cyclosporine (P = .1) and DM with tacrolimus (P = .1). The presence of HCV was significantly associated with a greater incidence of de novo DM (P < .01), as was a severe relapse of hepatitis C (P < .03). Multivariate analysis showed a 4.4 times greater risk for developing de novo DM among patients with a severe relapse of HCV.

Conclusion

The development of CVRF after liver transplantation was manifested, mainly during the first 3 months posttransplantation. Special attention should be given to the risk for de novo DM among HCV positive patients.     

食管癌淋巴结转移特点及其危险因素

目的 探讨食管癌淋巴结转移情况及其危险因素,为外科手术行淋巴结清扫提供参考。方法回顾总结2006年1月至2010年12月在复旦大学附属肿瘤医院胸外科行三野淋巴结清扫食管癌根治术308例患者的临床资料．分析淋巴结的转移规律及特点。结果308例患者平均清扫淋巴结（35．6±14．5）枚,197例（64％）患者出现淋巴结转移。Logistic单因素分析结果显示,脉管（淋巴管及血管）侵犯（P=0．019）及肿瘤浸润深度（P〈0．001）是发生淋巴结转移的危险因素。各站淋巴结中,胸部气管旁淋巴结转移率最高（25．0％）。上段食管癌腹部淋巴结转移率显著低于中段或下段食管癌（P=0．001）,而各段食管癌颈胸部淋巴结转移率比较,差异无统计学意义（P〉0．05）。颈胸部和颈胸腹部淋巴结转移率分别为14．6％和11．0％,而颈腹部和胸腹部则分别为3．6％和4．9％。脉管侵犯（P〈0．001）和胸部气管旁淋巴结转移（P=0．014）是食管癌发生颈部淋巴结转移的危险因素。结论食管癌淋巴结转移具有上、下双向和跳跃性的特点．胸部气管旁淋巴结转移可作为行颈部淋巴结清扫的指征。     

Analysis of risk factors related to patients with Sagliker syndrome

Objective To explore the clinical characteristics and related risk factors in patients with severe uremic secondary hyperparathyroidism (SHPT) complicated with Sagliker syndrome (SS). Methods A total of 229 patients with severe uremic SHPT admitted in our hospital from February 2011 to April 2015 were enrolled, among which 33 cases were taken as positive group (SS group), and 196 cases as control group. The differences between two groups in demographic data (such as gender and age), complications, and biochemical indexes were compared, with potential risk factors of SS being analyzed. Results There were significant differences between median duration of dialysis in positive group (11 years) and that in control group (8 years, P＜0.001). Compared to control group, the patients in SS group had lower levels of serum creatinine (Scr), blood urea nitrogen (BUN), albumin (Alb), phosphorus (P), and higher serum levels of parathyroid hormone (iPTH), ferritin, hypersensitive C-reactive protein and alkaline phosphatase (ALP), as well as higher calcification in heart valves and abdominal aortic (all P＜0.05). The unadjusted logistic regression models showed that longer duration of dialysis (＞10 years, OR=6.182, P=0.002), higher serum levels of ALP (＞347 U/L, OR=5.786, P=0.002) and iPTH (＞1764 ng/L, OR=4.960, P=0.001), and calcification in heart valves and abdominal aortic (OR=8.635, P＜0.001; OR=5.039, P=0.001) were associated with increased risks of SS, and higher serum Alb was a protect factor for SS (OR=0.904, P=0.014). The multivariate regression analysis showed that longer duration of dialysis (＞10 years, OR=5.121, P=0.036), higher serum level of iPTH (＞1764 ng/L, OR=4.130, P=0.017), calcification in heart valves (OR=11.714, P＜0.001) were independent risk factors of SS. Conclusions Severe uremic SHPT patients with longer duration of dialysis and higher serum level of iPTH are more likely to develop SS.     

甲状腺乳头状癌淋巴结转移相关因素分析

目的 探讨甲状腺乳头状癌颈淋巴结转移的相关因素.方法 收集2005年1月-2008年3月接受手术并进行淋巴结切除的38例(44侧)甲状腺乳头状癌患者的临床资料(不包含因复发手术的病例),回顾分析甲状腺乳头状癌淋巴结转移的相关因素.结果 在38例(44侧)患者中,颈淋巴结的转移率为57.89%,颈部中央区淋巴结转移(47.37%)为最常见的转移部位,出现颈侧区淋巴结转移的患者(31.58%)中66.67%同时伴有中央区淋巴结转移.颈部淋巴结转移的相关冈素为年龄＜45岁和肿瘤侵犯被膜,多因素分析显示,年龄为淋巴结转移的独立相关因素.结论 颈淋巴结转移是甲状腺乳头状癌的常见情况,尤其是中央区淋巴结;建议有甲状腺被膜侵犯的甲状腺乳头状癌患者应常规清扫中央区淋巴结.     

Renal cell carcinoma in young compared to older patients: comparison of clinicopathological risk factors and survival

OBJECTIVE: Renal cell carcinoma (RCC) is primarily a disease of the elderly, most patients being diagnosed in their mid-60s. However, a significant number of patients are diagnosed at a younger age. The true effect of age at diagnosis on survival has been debated, tumor stage and grade being the strongest prognostic factors of survival. The aim of this nationwide study was to study the significance of young age at diagnosis as a prognostic factor in RCC. MATERIAL AND METHODS: This retrospective study included all living patients with histologically verified RCC in Iceland diagnosed between 1971 and 2000 (n = 629). Different clinicopathological factors of patients diagnosed aged < 50 years (n = 99) were compared to those of patients diagnosed aged > or = 50 years (n = 530). Disease-specific survival was compared and multivariate analysis was used to evaluate prognostic variables. RESULTS: Clinical presentation, TNM stage, grade, tumor size and histological subtypes were comparable between the two groups. Prognostic factors were the same in both groups, most of them having a stronger prognostic value in younger patients. Both 5- and 10-year disease-specific survival was significantly higher in the younger group (66.4% vs 54.5% at 5 years). CONCLUSIONS: The clinicopathological profiles are comparable in RCC patients aged < and > or = 50 years. The reason for the more favorable survival of younger patients is not known. Further studies are needed, including studies on possible differences in age-specific host-tumor response.     

Prevalence of metastases in hepatocellular carcinoma: risk factors and impact on survival

The purpose of this study was to determine the prevalence and risk factors of metastases in hepatocellular carcinoma (HCC) patients and analyze the effects of different locations of metastases on survival. Retrospective analysis was performed on 347 HCC patients who received a metastatic workup including bone scan and computed tomography scans of chest, abdomen, and pelvis. Clinical and tumor characteristics were evaluated as risk factors for metastasis by univariate and multivariate methods. Survival was analyzed by Kaplan-Meier and Cox regression methods. One hundred forty-five patients had metastases: 72 had thoracic, 57 had abdominal, and 34 had bone metastases. Significant differences were noted with weight loss, hepatitis C, tumor grade, tumor multifocality, size, and alkaline phosphatase levels between the metastases group and the nonmetastases group by univariate analysis. Poor differentiation, multilobar spread, and size (> or = 5 cm) were strongest predictors of metastatic disease by logistic regression. Patients with thoracic metastases had significantly poorer survival. HCC metastasis is prevalent on initial presentation. Evaluation for liver transplantation or curative resection requires a full metastatic workup. Poor differentiation, larger tumors, and those with multilobar spread have increased risk for metastasis. Patients with thoracic spread have poor prognosis as compared to other locations of metastasis.