基于累积评分的食管癌术后吻合口瘘的风险分级系统

目的建立食管恶性肿瘤术后吻合口瘘并发症的风险分级系统,为食管癌切除术后发生胃食管吻合口瘘风险分级,识别潜在的高危患者。 方法回顾性收集2010年1月至2015年1月于北京朝阳医院胸外科接受食管癌手术患者的临床资料,共285例食管癌患者被纳入分析。对术后胃食管吻合口瘘的潜在危险因素进行单因素分析和Logistic多因素回归分析,确定影响食管恶性肿瘤术后吻合口瘘的独立预测因素;并根据预测因素的权重进行赋值,最终建立食管恶性肿瘤术后吻合口瘘并发症的风险分级系统。 结果全组患者术后食管胃吻合口瘘发生率为9.5%(27/285),院内病死率为2.8% (8/285)。Logistic多因素回归分析发现,颈部吻合、年龄>69岁及血浆白蛋白<25 g/L是食管癌术后吻合口瘘的独立危险因素。每个独立危险因素均赋值1分,根据患者累积评分进行分组,其中0、1、2、3分组术后吻合瘘的发生率分别为2.2%、7.4%、21.0%和37.5%。 结论食管恶性肿瘤术后吻合口瘘风险分级系统,临床可操作性强,可识别食管癌术后吻合口瘘的高危患者。     

Longterm prognosis after hepatic resection for small hepatocellular carcinoma

BACKGROUND: Treatment of small hepatocellular carcinoma (HCC) remains a critical issue. In addition, the longterm prognosis and prognostic factors of small hepatocellular carcinoma after hepatic resection are not well documented. STUDY DESIGN: The surgical outcomes of 135 consecutive patients with one to three HCCs of diameter 相似文献   

Hepatocellular carcinoma: resection versus transplantation

For decision of adequate surgical therapy and comparison of results differentiation of hepatocellular carcinomas (HCC) in cirrhotic and noncirrhotic livers is important. Liver resection is the treatment of choice for HCC in noncirrhotic liver. Between 4/94 and 8/99 we treated 54 patients with hepatocellular carcinoma (HCC) by subtotal hepatic resection (n = 40) and orthotopic liver transplantation (n = 14). Overall 1- and 3-year survival rates of the resection group were 45 and 25% (median follow up: 3.5 years). One-year survival in the transplantation group was 72% (median follow up: 2.2 years). In patients with HCC in cirrhosis in UICC stage I to III the optimal therapy is a controversial issue. In these patients the results after liver resection are poor due to high operative mortality and recurrence (3-year recurrence-free survival: 30%). Regarding the literature, liver transplantation is the treatment of choice in small (< 3-5 cm, < or = 2 tumors) HCCs arising in cirrhosis with better outcome compared to resection. The data in the literature report 3-year-survival rates after liver transplantation of 60-80%. However, consequent patient selection is necessary for this treatment modality. Due to the limited donor resources liver transplantation is rarely justified in advanced tumors.     

Histological variants and lymphovascular invasion in upper tract urothelial carcinoma can stratify prognosis after radical nephroureterectomy

ObjectivesPatients with histological variants (HV) of bladder cancer have more advanced disease and poorer survival rates than those with pure urothelial carcinoma (UC). Moreover, lymphovascular invasion (LVI) is an important biomarker after RNU in systematic reviews and meta-analyses. Thus, here we investigated the clinical and prognostic impact of HV and LVI in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU).MethodsData from 223 UTUC patients treated with RNU without neoadjuvant chemotherapy were retrospectively evaluated. We analyzed differences in clinicopathological features and survival rates between patients with pure UC and those with HV. Conditional survival (CS) analysis was performed to obtain prognostic information over time.ResultsA total of 32 patients (14.3%) had HV, with the most common variant being squamous differentiation, followed by glandular differentiation. UTUC with HV was significantly associated with advanced pathological T stage (pT ≥ 3), higher tumor grade (G3), and LVI, compared to pure UC (all P < 0.01). Progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS), were all significantly worse in the HV group compared to the pure UC group (all, P < 0.001). In multivariable analysis, HV and LVI were independent predictors of CSS and OS. We classified the patients into three groups using these two predictors: low-risk (neither HV nor LVI), intermediate-risk (either HV or LVI), and high-risk (both HV and LVI). Significant differences in PFS, CSS, and OS rates were found among the 3 groups. In CS analysis, the conditional PFS, CSS, and OS rates at 1, 2, 3, 4, and 5 years improved with increased duration of event-free survival. CS analysis revealed that most progression events occurred within 2 years after RNU, and patients with risk factors had worse PFS at all time points.ConclusionsA risk model using HV and LVI can stratify PFS, CSS, and OS of patients treated with RNU. In addition, CS analysis revealed that HV and LVI were poor prognostic factors over time after RNU.     

肿瘤负荷评分在获得根治性切除肝内胆管癌患者预后预测中的价值

目的 研究肿瘤负荷评分(tumor burden score,TBS)对肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)患者根治性切除术后预后的预测价值。方法 回顾性分析2005年1月至2011年12月在复旦大学附属中山医院肝肿瘤外科连续收治的322例行根治性切除术的ICC患者资料,随访截止至2014年4月。采用ROC曲线评价TBS预测总体生存率(OS)的准确性。多因素Cox回归分析影响ICC患者预后的独立因素。结果 中位随访时间44.0个月(范围2.7～100.5)。TBS将322例ICC患者分为低、中和高三个预后风险组(104例、176例和42例)。TBS与血清CA199(P=0.004)、术前中性粒细胞/淋巴细胞比值(NLR,P=0.001)、淋巴细胞/单核细胞比值(LMR,P<0.001)、肿瘤最大径(P<0.001)、肿瘤数目(P=0.001)、淋巴结转移(P<0.001)及TNM分期(P<0.001)显著相关。TBS预测ICC患者术后5年OS的曲线下面积(AUC)为0.632(P<0.001),高于NLR≥2...     

Hepatocellular carcinoma arising in the normal liver. A clinical study and long-term prognosis after surgical resection in 12 patients]

Hepatocellular carcinoma mainly affects patients with cirrhosis or with various degrees of fibrosis. From 1979 to 1990, among 87 patients who underwent hepatic resection for non fibrolamellar hepatocellular carcinoma, 12 (14%) had a non fibrolamellar hepatocellular carcinoma developed in a normal liver. There were 8 men and 4 women, aged 29 to 74 years. In 7 patients (58%) hepatocellular carcinoma was associated with clinical manifestations. Serum hepatitis B surface antigen were absent in all patients. Serum alphafetoprotein level was less than 100 ng/ml in 10 (83%), size of the tumor was greater than or equal to 5 cm in 10 (83%) and capsule was present in 10 (83%). Resections included removal of 2 segments or more in 11 (91%). One patient died postoperatively. Actuarial survival rate at 3 and 5 years were respectively 57% and 38%. Intra or extrahepatic recurrence was recognized in 8 (67%), 2 patients were alive respectively 28 and 16 months after treatment of their intrahepatic recurrence (resection in one and intraarterial embolisation in one). In conclusion, our results suggest that aggressive surgical efforts are justified in non fibrolamellar hepatocellular carcinoma arising in normal liver.     

系统免疫炎症指数与肝细胞癌切除术后预后相关性分析

目的 研究系统免疫炎症指数(system immune-inflammation index,SⅡ)与肝细胞癌(hepatocellular carcinoma,HCC)切除术后预后相关性.方法 回顾性分析2016年1月至2018年12月在湖北医药学院附属医院行手术治疗的HCC病人的临床资料,计算SⅡ值,制作受试者工作...     

肝癌切除术后预后预测的研究进展

肝癌是消化系统最常见的恶性肿瘤类型之一,手术切除是治疗肝癌的重要方法。但是,肝癌的生物学特性决定了根治性切除术后仍存在较高的转移复发率,导致患者预后不佳。因此,探索并筛选肝癌切除术后预后预测的相关因素,将有助于为手术方案的制定和术后辅助治疗措施的选择提供更全面的参考依据。本综述将从肿瘤分期系统、免疫炎症相关指标、血清肿瘤标记物、非编码RNA、肝功能、影像学特征和临床模型等方面,对肝癌切除术后预后预测的研究进展做一综述。     

Evaluation of a new prognostic score (Munich score) to predict long-term survival after resection of pulmonary renal cell carcinoma metastases

Background

The aim of this single-center study was to analyze factors predicting long-term outcomes following surgical resection of pulmonary metastases in patients with renal cell carcinoma.

Methods

Two hundred two consecutive patients entered the study. Overall survival was analyzed by the Kaplan-Meier method. Multivariate analysis was performed using Cox regression models.

Results

In 175 cases (87%), curative resection of the pulmonary metastases was achievable, with median survival of 43 months. Multivariate analysis revealed complete metastasectomy (R0), metastasis size >3 cm, positive nodal status of the primary tumor, synchronous metastases, pleural infiltration, and tumor-infiltrated hilar or mediastinal lymph nodes as independent prognostic factors for survival. On the basis of these findings, a new scoring system (the Munich score) was established to predict survival, which discriminates 3 groups with low, intermediate, and high risk for poor outcomes (median survival, 90, 31, and 14 months, respectively, P < .001).

Conclusions

The aim of the Munich score is to define patients with low, intermediate, and high risk for poor survival and will help identify patients who may benefit from further adjuvant therapy.     

术前控制营养状态评分与肝细胞癌肝切除术后预后的研究进展

肝细胞癌(HCC)是最常见的恶性肿瘤之一。尽管在早期诊断和个体化治疗方面取得了进展,但经根治性切除等治疗后,HCC患者的临床预后仍不佳,复发率高。因此,在HCC患者中识别准确可靠的预后标志物是必要的。作为一种新的免疫营养生物标志物,控制营养状态(CONUT)评分已被报道用于预测癌症患者的预后。本文将对术前CONUT评分...     

Hepatocellular carcinoma and cholangiocarcinoma--different prognosis, pathogenesis and therapy

Primary liver cancer is one of the most common cancer worldwide. Beside hepatocellular carcinoma (HCC), accounting for more than 80%, cholangiocarcinoma (CC) is the second most frequent primary malignant epithelial liver tumor. Combined hepatocellular-cholangiocarcinoma (HCC/CC) is a rare form of liver cancer with a frequency of 1%. Both, hepatocellular carcinoma and cholangiocarcinoma, show a wide geographical variation with low-incidence areas in North America and Europe and high incidence areas in Africa and Asia. Whereas hepatocellular carcinomas develop by malignant transformation of hepatocytes, cholangiocarcinomas arise from the small intrahepatic bile duct epithelium. The UICC-TNM classification of malignant liver tumors is applied for both tumor entities. 70-80% of hepatocellular carcinoma occur in cirrhotic liver. In high incidence areas, such as Asia and Africa, HCC is strongly associated with chronic viral hepatitis B and C and liver cirrhosis. Nutritional factors, toxins and metabolic diseases contribute also to hepatocarcinogenesis. The etiology of cholangiocarcinoma remains unclear, most occur in absence of known etiological factors. But several risk factors including hepatolithiasis, liver fluke infection, and anatomical abnormalities associated with inflammation of the biliary tract have been described.     

Poor prognosis after lung resection for patients with adenosquamous carcinoma of the lung

BACKGROUND: We evaluated the prognosis of adenosquamous carcinoma of the lung after lung resection in comparison with other types of carcinoma. METHODS: We retrospectively reviewed charts of patients who underwent lung resection for lung cancer. RESULTS: Surgical outcomes for 30 patients with adenosquamous carcinoma of the lung, who were treated between 1976 and 1998, were compared with the surgical results for 1,219 patients similarly treated for adenocarcinoma or squamous cell carcinoma during the same period. Adenosquamous carcinoma comprised only 2.1% of 1,408 lung cancer cases treated by resection. The overall cumulative 5-year survival rate was only 6.2% for the patients with adenosquamous carcinoma, indicating a significantly poorer prognosis than for adenocarcinoma or squamous cell carcinoma. CONCLUSIONS: The cumulative survival rate for patients with adenosquamous carcinoma in pathologic stages IA to IIB was similar to that of patients with stage IIIA adenocarcinoma or squamous cell carcinoma.