123例胰腺癌临床资料及预后相关因素分析

[目的]探讨胰腺癌生存期可能的影响因素。[方法]回顾123例胰腺癌手术病例,采用Log-Rank及Cox多因素分析生存期的影响因素。[结果]123例患者中位达进展时间(TTP)7.0个月,中位生存期(OS)11.6个月。分层分析提示Ⅰ/Ⅱ期患者的中位TTP(13.0个月)及中位OS(24.3个月)长于Ⅲ/Ⅳ期患者,Ⅲ期患者的中位TTP(5.0个月)及中位OS(10.1个月)长于Ⅳ期患者(2.5个月,3.9个月;P<0.001)。接受根治性手术治疗的患者中位TTP(11.3个月)及中位OS(15.6个月)长于未能切除原发肿瘤的患者(包括短路手术及穿刺)(P<0.01),而接受姑息性短路手术与诊断性穿刺相比,中位TTP(5个月vs.4.8个月)及中位OS(10.1个月vs.7.8个月)差异无统计学意义。术后接受辅助治疗的患者中位TTP(12.8个月)及中位OS(16.9个月)长于未接受辅助治疗的患者(4.6个月,8.7个月)(P<0.01)。[结论]疾病分期、手术方式和是否接受辅助治疗是影响胰腺癌患者预后的重要因素。     

乳酸脱氢酶及肿瘤标记物对胰腺癌的预后影响

目的:观察胰腺癌患者乳酸脱氢酶(LDH)及肿瘤标记物对预后影响.方法:收集LDH及肿瘤标记物,对病理诊断明确且回访到生存期的胰腺癌患者分析预后.结果:297例胰腺癌患者中位生存期5.0月,1年、2年、3年生存率分别为27.3％,10.1％,2.0％.肿瘤最大径大及分期晚的患者1年、2年、3年生存率降低(P＜0.05).胰体尾癌及全胰腺癌较胰头癌生存期短,分期晚、LDH、CEA、CA19-9、CA125升高的患者生存期短(P＜0.05);LDH高于300U/L患者较轻度升高者生存期短(P ＜0.05):CA125、CA15-3高于100L/ml患者较轻度升高者生存期短(P＜0.05).多因素Cox比例风险回归分析显示肿瘤分期及CA19-9是独立预后因素.结论:肿瘤原发部位、分期、LDH、CEA、CA19-9、CA125是胰腺癌的独立预后因素.     

介入治疗联合三维适形放疗治疗不能手术切除的胰腺癌患者疗效分析

背景与目的:胰腺癌发病率逐年提高,预后差,近20年间治疗进展缓慢.不能手术切除的胰腺癌尚无明确的综介治疗模式.本文通过对不能手术切除的胰腺癌患者的回顾性分析,探讨介入化疗及介入化疗联合三维适形放疗(three-dimensional conformal radiation therapy,3DCRT)的疗效和影响胰腺癌预后的重要因素.方法:回顾性分析105例局部晚期和伴远处转移的胰腺癌患者,并对影响胰腺癌预后的因素和治疗模式进行单因素及Cox多因素分析.结果:全组中位生存时间(median survival time,MST)为9.0个月,1年总生存率(overall survival,OS)为31.2%,2年OS为12.2%.局部晚期胰腺癌MST为9.1个月,1年和2年OS分别为33.2%和14.7%.Ⅳ期胰腺痛MST为7.6个月,1年和2年OS分别为29.3%和9.1%.影响全组胰腺癌生存的单因素有:介入治疗次数、是否联合放疗、是否选用吉西他滨方案及肿瘤原发部位.在全组105例胰腺癌中,多次介入者的MST较单次介入者长4.9个月(12.5 vs 7.6个月,P=0.010),1年和2年OS分别为51.5%、22.2%和20.7%、8.1%.联合放疗者的MST较单纯介入治疗者长4.3个月(11.9 vs 7.6个月,P=0.003),1年和2年OS分别为48.5%、21.8%和27.7%、2.7%;吉西他滨方案的MST较其他方案者长2.2个月(9.8vs7.6个月,P=0.018),1年和2年OS分别为37.5%、18.8%和20.3%、3.1%.胰头癌的MST较体尾部者长3.0个月(10.5 vs 7.5个月,P=0.031),1年和2年OS分别为40.2%、22.0%和6.3%、8.8%.多因素分析显示,介入联合放疗可以使全组胰腺癌死亡风险下降46%(95%CI=0.272～0.891,P=0.047).结论:对于不能手术的局部晚期及Ⅳ期胰腺癌,放疗联合介入治疗给患者带来生存获益.     

胰腺癌辅助化疗的预后与复发因素分析

目的 探讨影响胰腺癌辅助化疗者预后及复发的因素,以期早期发现复发来提高远期生存。方法 回顾性分析2008年1月至2015年9月77例胰腺癌切除术后行辅助化疗患者的资料,分析影响胰腺癌辅助化疗的预后及复发的因素。结果 单因素分析显示分化程度、切缘情况、肿瘤最大径、脉管内癌栓、血管侵犯、淋巴结转移、术前癌胚抗原（CEA）水平、中性粒细胞与淋巴细胞比值（NLR）及是否完成辅助化疗与预后有关（P＜0.05）;多因素分析显示淋巴结转移、低分化、R1切除及未完成辅助化疗是胰腺癌预后差的独立危险因素。肿瘤最大径、T分期、血管侵犯及术前CEA水平与胰腺癌复发有关,Logistic回归分析显示血管侵犯及术前CEA水平升高是胰腺癌复发的独立危险因素,且复发者复发后生存时间更短。结论 对于胰腺癌辅助化疗患者,淋巴结转移、低分化、R1切除及未完成辅助化疗是影响预后的危险因素。血管侵犯及术前CEA水平升高者更易复发,且复发后生存时间更短,对这些易早期复发患者术前应重视评估病情及慎重考虑是否需要术前治疗。     

新疆313例维汉老年胰腺癌患者预后分析

目的 探讨影响新疆维汉老年胰腺癌患者(≥60岁)生存时间的预后因素。方法 对本院2003年1月1日—2015年5月30日资料完整的313例老年胰腺癌患者进行回顾性研究。采用Kaplan-Meier法计算生存率,Log-rank检验影响预后的单因素分析,符合条件的纳入Cox比例风险模型进行多因素分析。结果 313例老年胰腺癌患者中位生存时间为157天,0.5、1、2年生存率分别为34.8%、18.5%、7.0%。其中维汉两民族之间生存时间具有统计学差异(P＜0.001)。单因素分析显示,民族、ECOG评分(ZPS)、临床分期(TNM)、肿瘤大小、肿瘤部位、是否行手术治疗及行根治性手术、放化疗、治疗前CEA水平、CA199水平与胰腺癌患者的长期生存有关,Cox多因素分析则显示,临床分期、手术治疗及手术方式可作为独立影响预后因素(P＜0.05)。结论 临床分期(TNM)、手术治疗及手术方式可作为胰腺癌预后独立因素。无论汉族还是维吾尔族老年患者,及早地发现及及早行根治性手术是目前延长老年胰腺癌患者生存时间的关键。     

１７８例胰腺癌的临床分析

目的　探讨影响胰腺癌患者长期生存的预后因素。方法　对本院２００２年１月至２００８年７月资料完整的１７８例胰腺癌患者进行回顾性研究,进行单因素及多因素预后分析。结果　生存分析显示,手术方式、ＴＮＭ分期、是否进行放化疗与胰腺癌患者的长期生存相关,Ｃｏｘ多因素分析结果亦显示这３个因素可以作为胰腺癌独立的预后因素,而性别、年龄、肿瘤部位、吸烟、饮酒及合并糖尿病与胰腺癌患者的生存时间无关。结论　手术方式、ＴＮＭ分期及是否进行放化疗与胰腺癌患者的生存相关,可作为胰腺癌患者的独立预后因素。早期发现、早期治疗和进行手术治疗为主辅以放化疗的综合治疗模式,是提高胰腺癌患者生存率的关键。     

预后营养指数预测转移性胰腺癌一线化疗疗效及预后

目的 探讨了预后营养指数(PNI)对转移性胰腺癌患者预后及一线化疗疗效的预测价值。方法 回顾性分析2017年4月至2022年2月武汉大学中南医院肿瘤放化疗科接受一线化疗的83例转移性胰腺癌患者的临床资料及随访资料,计算PNI值;根据受试者操作特征曲线(ROC曲线)确定PNI预测转移性胰腺癌患者总生存(OS)的最佳截止点;根据最佳截止点将患者分为低PNI组(34例)与高PNI组(49例);采用Cox比例风险回归模型及Kaplan-Meier曲线研究PNI对于转移性胰腺癌患者生存的预测价值。结果 根据ROC曲线,确定PNI最佳截止点为43.10。PNI与转移性胰腺癌患者一线化疗的客观缓解率、无进展生存时间(mPFS)及OS显著相关。全组患者的mPFS和中位总生存时间(mOS)分别为4.61(95%CI=3.92～5.30)和9.05(95%CI=8.20～9.89)个月。低PNI组与高PNI组的转移性胰腺癌患者一线化疗客观缓解率分别为5.9%和32.7%(P<0.05)。低PNI组与高PNI组的患者mPFS分别为2.96个月(95%CI=2.53～3.47)与5.67个月(95%CI...     

局部晚期胰腺癌治疗方式的评价和分析

随着抗肿瘤药物健择的问世和放疗技术的发展，局部晚期胰腺癌的治疗得到更广泛研究。笔者1998年3月至2004年6月采用健择为主联合化疗方案或健择联合三维适形放疗治疗42例局部晚期胰腺癌，现回顾性分析如下。     

基于数据库分析NOX4基因在胰腺癌中的表达及预后

目的:通过研究NOX4在胰腺癌（pancreatic cancer,PAAD）组织中的表达和其与临床病理学参数的相关性,阐明其在PAAD预后中的重要作用。方法:运用GEPIA大数据分析NOX4在正常胰腺组织和PAAD组织中的表达差异和其对PAAD预后的影响。再运用LinkedOmics大数据分析NOX4与PAAD临床病理学参数和临床分期的相关性。 结果:数据库分析结果表明,与正常胰腺组织相比,NOX4在PAAD组织中的表达显著增高,并且NOX4的表达量与PAAD T分期和临床分期呈显著正相关性,此外高表达NOX4的PAAD患者其总生存率和无病生存率均显著低于低表达NOX4的PAAD患者（P<0.05）。结论:NOX4是一种重要的不良预后指标,高表达的NOX4预示着PAAD的恶性进展和不良预后。     

子宫内膜癌的预后及影响因素

目的探讨子宫内膜癌的预后及其影响因素。方法选取2007年2月至2009年1月手术治疗的93例子宫内膜癌患者的临床资料进行分析,采用Cox回归模型对影响因素进行评估。结果93例子宫内膜癌的3、5年的生存率分别为90.3%和84.9%,中位生存期为59.2个月。Cox回归模型分析显示,年龄≥55岁、病理分期Ⅲ期、组织学分级G3、肌层浸润≥1/2和淋巴结转移为影响子宫内膜癌预后的独立危险因素。结论子宫内膜癌具有较好的治疗效果,对其治疗应当合理评估患者的预后相关因素,实施个体化治疗方案,提高患者生存质量。     

Treatment outcomes and unfavorable prognostic factors in patients with occult breast cancer

Aims

The purpose of this study was to evaluate the treatment outcomes and prognostic factors in patients with occult breast cancer (OBC).

Methods

We retrospectively analyzed 95 patients with OBC who were treated at our facility between January 1998 and June 2010. Of the 95 patients, 64 underwent mastectomy plus axillary lymph node dissection (ALND) with or without post-mastectomy radiation (Mast + ALND group), 13 underwent ALND followed by ipsilateral breast radiotherapy (BR + ALND group) and the remaining 18 were treated with ALND (ALND group).

Results

Patients who underwent Mast + ALND or BR + ALND had significantly improved rates of locoregional recurrence-free survival (LRFS) and recurrence/metastasis-free survival (RFS) than patients who only underwent ALND (p < 0.05). There were no significant differences in the LRFS (p = 0.718), RFS (p = 0.935) and breast cancer-specific survival (BCSS) (p = 0.991) rates between the patients who underwent Mast + ALND compared with those who received BR + ALND. Multivariate analysis revealed that patients with four or more involved lymph nodes had significantly worse outcomes (p = 0.042, HR = 4.63, 95% CI = 1.66–32.47 for BCSS and p = 0.038, HR = 3.62, 95% CI = 1.08–20.77 for RFS).

Conclusions

Patients with OBC who received ALND and subsequent breast radiotherapy had similar outcomes to patients who underwent mastectomy. The presence of four or more involved lymph nodes may independently predict poor outcomes of OBC.     

Assessment of prognostic factors in long-term survival of male and female patients with colorectal cancer using non-mixture cure model based on the Weibull distribution

ObjectiveColorectal cancer (CRC) is known as one of the malignant form of cells growing in the inner lining of colon and rectum which could seriously affect the cure rate of patients. We aimed to evaluate the effect of prognostic factors on cure fraction of CRC patients.MethodsA total of 1043 CRC patients were included to the study from December 2001 to January 2007 at the Research Center of Gastroenterology and Liver Disease in Shahid Beheshti University of Medical Sciences, Tehran, Iran. Patients’ information was extracted from their medical records, then they were followed to identify their death status via phone-call. Weibull non-mixture cure model was used to evaluate the effect of the risk factors on cure fraction of CRC patients.ResultsThe five-years survival rate was 0.66 (males: 0.64 and female: 0.69). The median survival time for non-cured CRC patients were 3.45 years (males: 3.46; females = 3.45 years). In the single Weibull model, BMI≥30 (OR = 4.61, p-value = 0.033), poorly differentiated tumor grade (OR = 0.36, p-value = 0.036), tumor size≥25 mm (OR = 0.22, p-value = 0.046), and N1-stage (OR = 0.42, p-value = 0.005) had significant effect on females’ cure fraction. Also, cure fraction of male CRC patients significantly affected by BMI (levels:25.0–29.9-OR = 12.13-p-value<0.001; ≥30-OR = 7.00-p-value = 0.017), T1-stage (OR = 0.52, p-value = 0.021), M1-stage (OR = 0.45, p-value = 0.007), IV-staging (OR = 0.36, p-value = 0.041) and IBD (OR = 0.26, p-value = 0.017). In multiple Weibull model, females were associated with tumor size≥25 mm (OR = 0.20, p-value = 0.044) and N1-stage (OR = 0.45, p-value = 0.013) and males were affected by M1-stage (OR = 0.41, p-value = 0.011) and IBD (OR = 0.20, p-value = 0.022).The cure fraction of males and females CRC patients was 64% and 69%, respectively.ConclusionsThe prognostic factors for cure fraction of patients with CRC may be different among males and females. Further multicenter studies are required to assess the effect of common prognostic factors between males and females.     

IPMN-associated pancreatic cancer: Survival,prognostic staging and impact of adjuvant chemotherapy

BackgroundIntraductal papillary mucinous neoplasm (IPMN)-associated carcinoma is a subtype of pancreatic cancer for which prognostic factors, the validity of the AJCC/UICC staging system and the role of adjuvant chemotherapy remain unknown.Materials and methodsClinicopathological, treatment and follow-up data of patients with IPMN-associated carcinoma undergoing resection between 2002 and 2018 were analyzed. Uni- and multivariable survival analyses were performed to identify prognostic factors.ResultsOf 424 patients undergoing resection for IPMN-associated carcinoma, 77% patients had pancreatic ductal adenocarcinoma (IPMN-PDAC) and 23% had colloid carcinoma (IPMN-CC). Compared to IPMN-CC, IPMN-PDAC was diagnosed at more advanced tumor stages, more frequently involved lymph nodes, more frequently showed poor differentiation and were associated with higher rates of R1 resections. Resected IPMN-PDAC showed markedly shorter median overall survival than IPMN-CC (26.7 months vs. 91.3 months). The current AJCC/UICC staging system was validated for IPMN-associated carcinoma and for both of its subtypes. In multivariable analysis age ≥70 years, diabetes mellitus, high levels of Ca 19–9, IPMN-PDAC subtype, G3 tumors and higher AJCC/UICC stage were independently associated with shorter survival. Adjuvant therapy was not associated with improved survival in IPMN-associated carcinoma. Overall survival was comparable in patients receiving vs. not receiving adjuvant therapy.ConclusionsSurvival after resection of IPMN-associated carcinoma depends on tumor stage, on histologic tumor subtype, grading, and Ca 19-9 levels. The current 8th edition of the AJCC/UICC staging system is applicable for IPMN-associated carcinoma and for both of its subtypes IPMN-PDAC and IPMN-CC. The role of adjuvant therapy for IPMN-associated carcinoma remains unclear.     

An overview of prognostic factors for long-term survivors of breast cancer

Background Numerous studies have examined prognostic factors for survival of breast cancer patients, but relatively few have dealt specifically with 10+-year survivors. Methods A review of the PubMed database from 1995 to 2006 was undertaken with the following inclusion criteria: median/mean follow-up time at least 10 years; overall survival and/or disease-specific survival known; and relative risk and statistical probability values reported. In addition, we used data from the long-standing Eindhoven Cancer Registry to illustrate survival probability as indicated by various prognostic factors. Results 10-year breast cancer survivors showed 90% 5-year relative survival. Tumor size, nodal status and grade remained the most important prognostic factors for long-term survival, although their role decreased over time. Most studies agreed on the long-term prognostic values of MI (mitotic index), LVI (lymphovascular invasion), Her2-positivity, gene profiling and comorbidity for either all or a subgroup of breast cancer patients (node-positive or negative). The roles of age, socioeconomic status, histological type, BRCA and p53 mutation were mixed, often decreasing after correction for stronger prognosticators, thus limiting their clinical value. Local and regional recurrence, metastases and second cancer may substantially impair long-term survival. Healthy lifestyle was consistently related to lower overall mortality. Conclusions Effects of traditional prognostic factors persist in the long term and more recent factors need further follow-up. The prognosis for breast cancer patients who have survived at least 10 years is favourable and increases over time. Improved long-term survival can be achieved by earlier detection, more effective modern therapy and healthier lifestyle.     

Pancreatic neuroendocrine tumor: A multivariate analysis of factors influencing survival

Background

The outcomes of pancreatic neuroendocrine tumors are extremely diverse, and determining the best strategy, optimal timing of therapy and the therapeutic results depend on understanding prognostic factors. We determined the clinical, radiological and histological factors associated with survival and tumor recurrence for patients with pancreatic neuroendocrine tumor.

Methods

From January 1, 1991 to December 31, 2011, 127 patients with pancreatic neuroendocrine tumor underwent pancreatectomy. The variables including clinical characteristics, surgical data and pathological findings were examined by univariate and multivariate analyses.

Results

There were 103 patients with non-functional tumors (81%). Sixty-four patients (50%) underwent left pancreatectomy, 51 (42%) patients underwent pancreatico-duodenectomy, 12 (9%) patients underwent enucleation and 2 patients (1%) underwent central pancreatectomy. Forty-eight patients (38%) had synchronous liver metastases. Six patients (5%) required portal vein resection, and 19 (15%) patients required enlarged “en-bloc” resection of adjacent organs. The overall morbidity and mortality rates were 48% and 2.3%, respectively. The 1-, 3- and 5-year overall survival rates were 94%, 84%, and 74%, respectively. In multivariate analyses, synchronous liver metastases (p = 0.02) and portal vein resection (p < 0.01) were independent prognostic factors of survival.

Conclusions

Synchronous liver metastases and portal vein resection were found to be independent factors influencing survival.     

The impact of surgery delay on survival of resectable pancreatic cancer: A systematic review of observational studies

BackgroundPancreatic cancer is considered a lethal disease and the only potentially curative option is R0 excision. The aim of this study was to investigate whether the waiting time interval from diagnosis to surgical treatment affects overall survival in patients who undergo curative-intent surgery for pancreatic cancer.MethodsSearch in Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL and Google Scholar databases was conducted from inception until April 2022.ResultsOverall, 10 studies were included that enrolled 181,344 patients. The dominating cut-off time point was 4 weeks in studies which utilized a biphasic waiting time pattern. In addition, prolonged waiting time interval was associated with decreased overall survival in 3 studies, whereas it demonstrated a favorable effect on overall survival in 2 studies and no impact on survival in 5 studies.ConclusionThe great diversity that was observed regarding the impact of surgery delay on survival underlines the lack of knowledge about biologic pathways of pancreatic cancer. Novel imaging studies and molecular “fingerprints” in combination to time-to-treatment standardization in the design of future randomized trials could lead to the recognition of patients that could benefit from a timely resection.     

Progression-free survival as a surrogate for overall survival in first-line chemotherapy for advanced pancreatic cancer

BackgroundOverall survival (OS), as the primary end-point in first-line chemotherapy trials, requires a prolonged follow-up time and may be confounded by subsequent regimens. This study aimed to evaluate the correlation between OS and surrogate end-points (progression-free survival [PFS], response rate and disease control rate), and to identify a potential surrogate for OS in advanced pancreatic cancer.MethodsBased on an electronic search, we identified randomized controlled phase II and III trials of first-line chemotherapy for advanced pancreatic cancer. Correlation analyses were performed between surrogate end-points and OS, and between improvements in surrogates and those in OS.ResultsFifty trials (II/II–III/III, 17/2/31) with 111 treatment arms were identified, and 15,906 patients were analysed. PFS was most strongly correlated with OS (correlation coefficient, 0.76). Weighted linear regression models revealed the greatest determinant coefficient of 0.84 between the hazard ratio (HR) of the experimental arms compared with the control arms of PFS and that of OS. The approximate equation was log HR_OS = 0.01 + 0.77 × log HR_PFS, indicating that risk reduction of OS via chemotherapy would translate into a 77% risk reduction of PFS. The surrogacy of PFS for OS was robust throughout our subgroup analyses: e.g., biologic versus non-biologic regimens, locally advanced versus metastatic disease.ConclusionsThe surrogacy of PFS for OS in pancreatic cancer was validated. Therefore, the use of PFS as the primary end-point in clinical trials could facilitate the early introduction of new effective chemotherapy regimens into clinical practice.